The health care industry and workplace are changing to an extent not previously experienced since the start of Medicare. Driven by financial curtailments embodied by managed care, health care workers are expected to perform at higher levels of effectiveness. It is reported by research that higher levels of flexibility and critical thinking will be required of professional nurses. Curriculum changes and other strategies have been contemplated which might encourage the development of critical thinking skills which are essential for survival in the new milieu.

The purpose of this study was to evaluate congruence and divergence among nursing professionals in their perceptions of the critical skills required for the beginning nurse to be successful in the workforce. Four groups representing nursing employers, experienced nurses, nursing instructors, and second year nursing students were selected to participate in this study. Focus group interview techniques involving samples from the above populations were used to assess their opinions and expectations as to what constituted the effective nurse in the new environment, as well as their judgment as to what strategies would achieve this. These perceptions were then collated, compared, and contrasted with each other in a qualitative fashion for congruence and divergence; and finally, summarized and evaluated for significance. The rationale for this study finally, summarized and evaluated for significance. The rationale for this study resided in the potential of identifying desirable workplace skills for nursing professionals that correlate with those sought by nursing employers.

Analysis of interviews revealed congruence in most responses. All participants appeared to feel that the imperatives of managed care were forcing changes in the health care industry which required unusual levels of cross training and reliability. Participants suggested that this could be accomplished at an undergraduate level by curricular changes and by the addition of internship programs as well as inservice training. All skills identified by the participants could be correlated with the National League for Nursing's educational outcomes for registered nurses.