First-line patient care management utilizes the nursing process for groups of patients rather than an individual patient. The manager leads and coordinates an often diverse team toward a common goal. Successful management is dependent upon a governance structure, patient care delivery processes, and outcome measures related to service. It requires professional practice to be consistent with the organization’s mission and vision. A structure of shared governance between management and staff creates an environment of accountability-based systems, which needs to be evaluated to determine quality, care delivery, service, and financial outcomes.

The author defines shared governance as an organizational frame work with decentralized leadership among mutually interested vested parties, including management and staff. Usually this type of structure develops council models, which have evolved from former committees. These councils consist of staff members that are charged with six different areas of accountability:
1. Clinical practice – establish practice standards for the work group
2. Quality council – credential staff and oversee unit quality management initiatives
3. Education council – assess training needs and develop and implement programs to meet staff needs
4. Research council – advances research and incorporates evidence finding into clinical practice
5. Management council – ensure practice standards are adhered to on the unit
6. Coordinating council – facilitates and integrates all of the above activities

Professional practice requires that staff be competent to perform. Competency validation can be assured through a credentialing process that is built around a career ladder which acknowledges and quantifies varying skill sets based upon education and experience. Benner’s Novice to Expert model and the Colorado Differentiated Nursing Practice model are reviewed detailing the tasks, competencies, and outcomes required for practitioners based upon different levels of expertise.

Ongoing professional staff development is part of routine performance feedback that staff expects from his/her manager. The author explores situational leadership, which maintains that there are many leadership styles that need to be matched to staff’s or individual’s task-relevant readiness.