The nurse executive as integrator: creating a field of health caring.

Nurse executives are emerging from a state of cognitive dissonance resulting from conflicts of values and practice from the bedside to the boardroom. Three changes in hospital systems are offering the opportunity to resolve cognitive dissonance and become congruent. These are patient-focused care restructure with multidisciplinary teams, managed care and capitation calling for enhanced clinical management, and the new organizational paradigm characterized as flatter, decentralized, staff empowering, and manifesting new science concepts of self-organization within fields. The nurse executive role becomes that of integrator, pulling together the best practices of nursing and new leadership.