This, the second of two articles, presents the results of a recent survey of nurses' job satisfaction and morale undertaken at the Northern General Hospital NHS Trust, Sheffield. The survey was conducted in order to provide a benchmark against which to gauge progress towards creating a work environment in which nurses are able to exercise maximum autonomy within a supportive and enabling culture. The results mirror recent national reports which highlight the increasing tension between workload pressures and the desire to provide holistic patient care. A number of factors were identified which suggest the need for remedial action across a range of fronts. Such factors are briefly described, together with the action taken to date to address the issues raised.

Over the past decade health care in general and nursing in particular have experienced a period of unprecedented change resulting from a variety of factors including demography, advances in technology and the introduction of differing service delivery systems. For nursing this has created a number of tensions, especially between professional aspirations and the demands of a new managerial culture. Many nurses have found themselves torn between the push towards the ideal of individualized holistic care and the reality of resource constrained environments. The new White Paper 'The New NHS: Modern, Dependable' (Secretary of State for Health, 1997) heralds a move away from the 'short termism' of the internal market towards a partnership model of integrated care. It also reaffirms the Government's commitment to further develop the role of the nurse. This article, the first of two, considers the challenges nurses face in responding to a managerial agenda while simultaneously maintaining the development of the nursing profession. The opportunities afforded by the recent White Paper are identified and the need to address a number of current tensions are highlighted. Developments at the Northern General Hospital in Sheffield are briefly described, with the results of a major survey being presented in the second article.

Performance audit from a clinical perspective has been widely accepted. Within Harrogate Health Care NHS Trust, a review of hours worked on day and night duty, coupled with a review of skill mix in one area, led to the successful introduction of a jobshare scheme for experienced nurses.

Little is known about hepatic T lymphocyte subpopulations in the human liver. The aim of this study was to document the various subpopulations present in the liver and compare them to peripheral T lymphocytes in the same patients. Normal hepatic tissue was obained at time of transplant from five patients, and a single cell suspension of lymphocytes were prepared by standard methods. Ceils were stained with monoclonal antibodies specific for CD8ct and CD8B chains, CD4, CD8, CD3, o~BTCR, and ySTCR, and analyzed by two and three colour flow cytometry. Of the hepatic CD3+ cells, 71% were CD8+ and 25% were CD4+, with a CD4/CD8 ratio of 1:3 in contrast to the peripheral CD4/CD8 ratio of 2:1.18% of the hepatic CD3+ cells expressed ySTCR. Significantly, CD8~ct accounted for 27% [mean] of the total hepatic CD8+ population. Conclusion: There is now evidence that the adult human gut can support extrathymic T cell differentation. A significant population of hepatic CD8txct cells would suggest that the liver is also a site of extrathymic differentiation, which may have important implications for the understanding of autoimmunity and graft tolerance.

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