Date of Award


Degree Name

Doctor of Nursing Science

Dissertation Committee

Janet K. Harrison, EdD, RN, Chair; Diane C. Hatton, DNSc, RN; Dorothy Kleffel, DNSc, RN


Feminism, managed care, nursing, southern California, women


The purpose of this study was to explore the perspectives of the woman/nurse/executive working in the managed care environment of Southern California. This research was extremely timely because (a) Southern California leads the nation in managed care market penetration, (b) changes in health care financing have resulted in a prolific expansion of nurse executive responsibilities, and (c) nurse executive experiences regarding increased responsibilities have not been researched. Role expansion impacts both male and female nurse executives, but female nurse executives must confront the dilemma of functioning in administrative domains which have been largely dominated by men. Knowledge about their experiences is vital to the future of the nursing profession and to the health care delivery system. This study blended feminist ideology with grounded theory. Seventeen woman/nurse/executive participants from mostly hospital settings were interviewed. Using primarily the dimensional analysis approach to grounded theory, the metaphor of a managed care battlefield became the study context. A typology of participants was discovered, consisting of four consecutive groups: (a) the Unsung Heroines, (b) the Engineers, (c) the Team Leaders, and (d) the Champions. Participants of each group made different ethical decisions about their most important responsibilities and leadership actions, resulting in a different professional identity, or battlefield position, for each group. The typology represented a continuum, ranging from the Unsung Heroines, who exhibited the strongest nursing identity and the least degree of organizational influence, to the Champions, who exhibited the weakest nursing identity but the greatest degree of organizational influence. The most important implications from this study involve nursing education, nursing research, and healthcare policy. Nursing education needs to be revamped to adequately prepare nurses for the expanding nurse executive roles. Additional research which explores the personal and professional value shifts involved in shaping these new roles is necessary. Finally, nurses must value feminist perspectives and become more involved in making healthcare policies which protect the essence of professional nursing practice.

Document Type

Dissertation: Open Access



Included in

Nursing Commons