This study examines the extent of the influence of nursing documents of Purpose, Philosophy and Objectives (PP&O) in providing direction for desired patterns of nursing activity at the subunit level. The population comprised eight nursing departments in acute care organizations of 500 beds or more in one metropolitan area, where the nurse executives had been in their positions for at least three years.

An open-ended instrument was utilized to transcribe the references to desired patterns of nursing activity from the documents. The references were tracked for evidence of implementation at the subunit level in each department. Implementation was determined (1) by reviewing documented data, and (2) from non-documented data supported in interviews. The related references to desired nursing activity from the documents in each department were arranged in chains for analysis. A total of 143 chains were found, in which 25 implementation components were identified.

The low frequency of implementation components (25 of a possible 143) negates a causal relationship between references to desired nursing activity in the documents of PP&O in those departments and actual nursing activity at the subunit level. This finding was corroborated by the underutilization of these documents in regard to three other indicators investigated in the study: (1) no relationship was found between the documents and staffing patterns, (2) standards of care were related to the documents in only three departments, although they were not evaluated, and (3) reported cost containment activities were related only to statements of Objectives.

These findings should not be generalized. However, two issues central to nursing administration were identified: (1) the adequacy of the managerial model of PP&O itself, and (2) a perceived lack of focus on nursing activity in the departments participating in the study. The lack of focus on nursing may be related to inadequately conceptualized statements of Purpose. A major challenge for nurse executives may be the identification of the Purposes of the department and the delivery of the desired level of nursing care within existing constraints. It is also possible that the structure of the PP&O model may be constraining in managing complex nursing departments, possibly imposing an inflexibility which does not permit rapid response to change.