Managers in four acute care hospitals in southeast Florida described the resource, management, outcome, and external issues confronting their organizations. Eight major issues and four contributing and resulting subissues associated with each were identified from the 746 separate issue statements the managers made. Nurses in the same four hospitals were asked to evaluate the impact of the eight issues on their organization and their work, as well as the extent to which the subissues had either contributed to or resulted from the main ones. Overall perceptual patterns are discussed, as well as the differential effects of both hospital type and level of employment on perceptions. It is suggested that differential perceptions among such a key component of the care delivery system as nurses will need to be better understood as hospitals seek to survive in a turbulent environment.