When making labor management decisions, midwives are affected by their trust in birth, the woman, the health care team, and the birth environment. Midwives report more resistance when making labor management decisions in hospitals. The findings of this study provide insight into both the decision making of midwives and how factors in different environments, in this case hospitals and freestanding birth centers, influence the ability of midwives to make independent labor management decisions.

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Patient acuity in hospital settings continues to increase, and there is greater emphasis on patient outcomes. The current nursing workforce is comprised of four distinct generational cohorts that include veterans, baby boomers, millennials, and generation Xers. Each group has unique characteristics that add complexity to the workforce and this can add challenges to providing optimal patient care. Team building is one strategy to increase mutual understanding, communication, and respect, and thus potentially improve patient outcomes. In this article, we first briefly define generational cohorts by characteristics, and discuss differing expectations for work/life balance and potential negative outcomes. Our discussion offers team building strategies for positive outcomes, a case scenario, and concludes with resources for team building and organizational opportunities.

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Background: Provision of relevant, evidence-based continuing education (CE) is an integral part of maintaining a highly competent rural nursing workforce. Numerous tangible and intangible barriers exist to nurses' participation in CE in rural settings. Major barriers to accessibility and participation in CE for rural nurses include: 1) Geographic isolation, 2) lack of perceived administrative, financial, and/or technological resources and support, 3) lack of time due to workload, inadequate staffing, and/or travel distance, 4) lack of relevance of continuing education topics, and 5) lack of a dedicated on-site nurse educator. Proactive development of academic-practice partnerships is important to support rural care providers regarding CE delivery. The purpose of this study was to assess perceptions of CE needs of nursing unit staff working in a group of health care facilities in a rural region of midwestern U.S. Methods: A cross-sectional CE needs assessment survey was conducted in winter of 2010 with rural health care providers (N=302/1107; response rate 27%) working in rural healthcare facilities (N=40), including rural hospitals (n=10) and long-term care (LTC) facilities (n=30). A well-validated 72-item Likert-type survey was distributed via a secure online university survey platform, and included assessment of 59 CE need areas. Internal consistency reliability was 0.87. Data were analyzed using SPSS software, version 16.0. Results: Descriptive statistics revealed a greater number of licensed practical nurses and nursing assistants working in rural LTC's (27.2% and 62.5%, respectively) compared to rural hospital setting (14% and 15%, respectively). There are a large number of associate degree-prepared nurses (63%) working in the participating rural hospitals compared to LTC setting (8.4%). Respondents' priority learning needs included: 1) Review aspects of medication administration/drug interactions; 2) improve skills in patient assessment (physical/mental); 3) increase knowledge of management of patients with comorbidities; 4) promotion of patient safety; 5) enhance communication skills/teamwork; 6) increase lifelong learning. Student's t tests revealed LTC nursing unit staff reported significantly higher priority learning needs in "manage aggressive behavior (verbal/physical)" (t = 2.044, df = 300, α = .003), "family participation in care" (t= 2.470, df= 300, α= www.sciedu.ca/jnep