Systemic exchange: responsibility for angst.

Abstract

This paper reports on research that tells the story of nurse managers' attempts to provide a 24-hour service. Although research was contextualized within the National Health Service in the United Kingdom, the outcomes are not merely about the NHS. It is argued that middle managers, possessing delegated responsibility, are considered to be empowered. Such empowerment is accompanied by widely experienced anxiety. An escalatory and contagious process is observed which exaggerates 'normal' stress and challenge among middle managers into a state of self-perceived a