title: Department of Veterans Affairs Medical Center, San Diego, California.
abstract: This article outlines the process and status of implementing self-directed nursing leadership teams at the San Diego Veterans Affairs Medical Center. Perspectives from a staff nurse and nurse practitioner, clinical specialists, nurse managers, and the director of the nursing service contribute to an overview of this endeavor. Difficulties of decentralizing management functions within a centralized system are discussed, as well as considerations and strategies prior to initiating change. Integration of self-directed leadership and total quality management principles are explored.
authors.forename: K
authors.initials: K
authors.lastname: Kerwick
authors.forename: C
authors.initials: C
authors.lastname: Verkaaik
authors.forename: N
authors.initials: N
authors.lastname: Hilyard
authors.forename: M
authors.initials: M
authors.lastname: Wiley
authors.forename: J
authors.initials: J
authors.lastname: Schnack
authors.forename: K
authors.initials: K
authors.lastname: St Morris
mesh_terms: D001291:Attitude of Health Personnel; D003659:Decision Making, Organizational; D006787:Hospitals, Veterans; D006801:Humans; D007857:Leadership; D009738:Nursing Service, Hospital / Q000458:organization & administration*; D009741:Nursing Staff, Hospital / Q000458:organization & administration* / Q000523:psychology