As I reflect upon my role as Vice-President of Patient Programs and Chief Nursing Officer in a large community hospital in Barrie, Ontario, I constantly ask myself whether I am providing effective stewardship in a time of huge transformation. The battlefield in healthcare continues to be scarred with poor decisions. As leaders, we are faced with such major problems as health human resource shortages, excessive management spans of control, unacceptable patient and employee injury rates, exponential growth in chronic diseases spurred by episodic care approaches and technological growth that consumes inordinate amounts of money. Our collective challenges are in shaping and positioning our organizations, and their articulation within healthcare systems, to ensure that we can meet the growing demands for high-quality health services within limited resources.

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