Background Patient safety and professional self-regulation systems both rely on professional colleagues to hold each other accountable for quality of care. Objectives To understand how staff nurses manage variations in practices within the group, and negotiate the rules-in-use for quality of care, collegiality, and accountability. Design/Methods Ethnographic case study; participant-observation, semi-structured interviews, policy analysis. Setting In-patient unit in an urban US teaching hospital. Results Explicit acknowledgement of conflicts and practice variations was perceived as risky to group cohesion. The dependence of staff on mutual assistance, and the absence of a system of group practice, led to the practice of “mutual deference”, a strategy of reciprocal tolerance and non-interference that gave wide discretion to each nurse’s decisions about care. Conclusions Efforts to improve professional accountability will need to address material constraints and the organization of nursing work, as well as communication and leadership skills.

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Nursing case management is widely acclaimed within the nursing literature as a form of advanced practice, beneficial for both clients and payers. However, case management programs involve potential conflicts between client goals and system goals, especially in relation to for-profit managed care systems. Early nursing discourse tended to minimize those conflicts, but more recent literature has begun to address role conflicts and ethical challenges. Feminist and critical-theory perspectives are used to examine nursing case management in the contexts of capitalism and sexism, thereby illuminating recurrent dilemmas within the profession. The ability of nursing case management to resolve those dilemmas is questioned.

Reforming the public health infrastructure requires substantial system changes at the state level, including the reorganization of state agencies' plans, roles, and relationships with other sectors and communities. Beyond the limited time period of pilot programs and grants, how are these public health system changes to be sustained? Turning Point is an initiative of The Robert Wood Johnson Foundation to transform and strengthen the public health system. The 21 states participating in this initiative developed multisector partnerships to produce public health improvement plans and from these, chose one or more priorities for implementation. Reform efforts to strengthen the public health system occur within complex fiscal and political environments, however, and must cope with both uncertainty and turbulence in the process of implementing change. Turning Point state partners have developed a variety of approaches to the challenge of incorporating effective community collaborations as a permanent strategy for transforming public health systems. A qualitative, descriptive study design was used to analyze the strategies used by Turning Point state partnerships to meet the challenges of sustaining their system improvements. These strategies included: institutionalization within government, establishing "third sector" institutions, cultivating relationships with significant allies, and enhancing communication and visibility among multiple communities.

Student evaluations of teaching are ubiquitous in higher education, widely disliked by faculty, and of uncertain value. The research literature on both their technical validity and their pragmatic utility is unusually polarized, with adamant opponents and defenders.Student evaluations generally consist of two parts: first, a series of questions with Likert-scale type answers (hereafter referred to as the numeric ratings), and second, an unstructured space for comments. Almost all of the existing research has focused on the numeric ratings. Faculty complaints, however, often focus on the comments, perhaps because they can be both vivid and enigmatic (Lindahl & Unger, 2010).In this paper, I will explore a set of comments from student evaluations in a community health nursing class, obtained over the course of four semesters. These comments were strikingly consistent, mostly negative, and initially, deeply puzzling. A preliminary analysis of the comments suggested that the students and the instructor had very different ideas about what the course was for, how learning worked, and what their respective roles should be in that process.Student comments focused on standardized tests as the primary measure of their learning and viewed the faculty role as helping them prepare for those tests. The instructor's efforts to include a critical analysis of social problems, and their links to community health issues, were met with confusion, suspicion, and resistance. In an effort to understand these comments at a deeper level-to take