Reshaping the practice environment: the importance of coherence.

Today's nurse leader is challenged to create a practice environment that fosters multidisciplinary collaboration, professional development, and a culture of safety. Fostering a sense of coherence among staff nurses about their place within the nursing department and the department's place within the broader organization is essential to the development of such environments. When nurses have a sense of coherence about their work setting, they are more likely to feel confident that their care of patients and families is fully supported by the organization in which they work. The authors describe the concept of coherence, discuss findings from a preliminary study regarding attributes that may contribute to coherence in individual nurses, and describe systems and programs that have been implemented in a large academic medical center to foster a sense of coherence in individual nurses, the nursing department, and the institution as a whole.