Leading and Managing in Nursing
Leading and Managing in Nursing
SEVENTH EDITION
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas
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Table of Contents
Cover image
Title page
Copyright
Dedication
Contributors
Reviewers
Acknowledgments
Preface
Concept and practice combined
Diversity of perspectives
Audience
Organization
Design
Learning strategies
Complete teaching and learning package
Chapter overview Part 1: Overview
1: Leading, Managing, and Following
Introduction
Theory development in leading, managing, and following
Leading, managing, and following—different but related
Traditional and emerging leadership and management roles
Leading, managing, and following in a diverse organization
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Conclusion
Reflections
The evidence
Tips for leading, managing, and following
2: Clinical Safety: The Core of Leading, Managing, and Following
Introduction
The classic reports and emerging supports
Other key agencies and endeavors
Meaning for leading and managing in nursing
Conclusion
Reflections
The evidence
Tips for clinical safety
3: Legal and Ethical Issues
Introduction
Professional nursing practice: nurse practice acts
Negligence and malpractice
Informed consent
Privacy and confidentiality
Policies and procedures
Employment laws
Professional nursing practice: ethics
Conclusion
Reflections
The evidence
Tips for incorporating legal and ethical issues in practice settings
4: Cultural Diversity and Inclusion in Health Care
Introduction
Concepts and principles
Theory
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National and global directives
Special issues
Language
Meaning of diversity in the organization
Cultural relevance in the workplace
Individual and societal factors
Dealing effectively with cultural diversity
Implications in the workplace
Conclusion
Reflections
The evidence
Tips for incorporating cultural diversity in health care
Part 2: Know Yourself
5: Gaining Personal Insight: The Beginning of Being a Leader
Introduction
Informal and formal leadership
The core of learning to be a leader
Gaining insight into self
Becoming an authentic leader
Conclusion
Reflections
The evidence
Tips for Gaining Personal Insight
6: Being an Effective Follower
Introduction
Research on followership
Followership theories
Differences between leading and following
Leader–follower relationship
Conclusion
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Reflections
The evidence
Tips on how to be an effective follower
7: Managing Self: Stress and Time
Introduction
Emotional intelligence
Understanding stress
Definition of stress
Sources of job stress
Dynamics of stress
Management of stress
Burnout
Resolution of stress
Management of time
Conclusion
Reflections
The evidence
Tips for self-management
8: Communication and Conflict
Introduction
Effective communication within healthcare settings
Types of conflict
Stages of conflict
Categories of conflict
Modes of conflict resolution
Differences of conflict-handling styles among nurses
The role of the leader
Managing incivility, lateral violence, and bullying
Conclusion
Reflections
The evidence
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Tips for effective communication and addressing conflict
9: Power, Politics, and Influence
Introduction
History
Power
Empowerment
Sharing Power
Personal power strategies
Exercising Power and Influence in the Workplace and Other Organizations
Conclusion
Reflections
The evidence
Tips for using influence
Part 3: Know the Organization
10: Healthcare Organizations
Introduction
Characteristics and types of organizations
Integration
Acquisitions and mergers
Forces that influence healthcare organizations
Theoretical Perspectives
Nursing role and function changes
Conclusion
Reflections
The evidence
Tips for healthcare organizations
11: Organizational Structures
Introduction
Mission
Vision
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Philosophy
Organizational culture
Factors influencing organizational development
Characteristics of organizational structures
Bureaucracy
Types of organizational structures
Emerging fluid relationships
Conclusion
Reflections
The evidence
Tips for understanding organizational structures
12: Care Delivery Strategies
Introduction
Historical methods of organizing nursing care
Leadership during implementation of a model of care
Organizational strategies influencing care delivery
Positive care delivery systems
Transitional care
Interprofessional education and collaboration
Conclusion
Reflections
The evidence
Tips for selecting a care delivery model
13: Staffing and Scheduling
Introduction
The staffing process
Evaluation of effective staffing
Factors in staffing that influence patient outcomes
Supplemental (agency or contract) staff and float pools
Organizational factors that affect staffing plans
Developing a staffing budget
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Scheduling
Evaluating unit staffing and productivity
Conclusion
Reflections
The evidence
Tips for staffing and scheduling
14: Workforce Engagement Through Collective Action and Governance
Introduction
Nurses as knowledge workers
Professional practice responsibility
Workplace advocacy, engagement, and empowerment
Shared governance
Collective action, collective bargaining, and unionization in nursing
Healthy work environments
Conclusion
Reflections
The evidence
Tips for workforce engagement and collective action
Part 4: Use Your Skills
15: Making Decisions and Solving Problems
Introduction
Differentiation of decision making and problem solving
Decision making
Problem solving
Conclusion
Reflections
The evidence
Tips for decision making and problem solving
16: The Impact of Technology
Introduction
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Types of technologies
Knowledge technology
Information systems
Informatics
Patient safety
Impact of clinical information systems
Safely implementing health information technology
Future trends and professional issues
Professional, ethical nursing practice and new technologies
Conclusion
Reflections
The evidence
Tips for managing information and technology
17: Delegating: Authority, Accountability, and Responsibility in Delegation Decisions
Introduction
Historical perspective
Definitions
Assignment versus delegation
NCSBN model: an organizational framework for delegation
Effective communication: an essential competency for successful delegation
Delegation and the decision-making process in nursing
Organizational and individual accountability
Legal authority to delegate
Learning how to delegate: different strategies for success
Conclusion
Reflections
The evidence
Implications for practice
Tips for delegating
18: Leading Change
Introduction
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The nature of change
The change process
People and change
Context and change
Leadership and change
Conclusion
Reflections
The evidence
Tips for leading change
19: Building Effective Teams
Introduction
Groups and teams
Creating effective teams
Key concepts of teams
Issues that affect team functioning
Interprofessional teams
The value of team-building
The role of leadership
Conclusion
Reflections
The evidence
Tips for team building
20: Managing Costs and Budgets
Introduction
What escalates healthcare costs
How health care is financed
Healthcare reimbursement
The changing healthcare economic environment
Why profit is necessary
Cost-conscious nursing practices
Budgets
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Conclusion
Reflections
The evidence
Tips for managing costs and budgets
21: Selecting, Developing, and Evaluating Staff
Introduction
Roles in an organization
Selection of staff
Developing staff
Performance appraisals
Coaching
Conclusion
Reflections
The evidence
Tips for selecting, developing, and evaluating staff
22: Person-Centered Care
Introduction
Person-centered care—why now?
Initiatives to deliver person-centered care
Challenges in the delivery of person-centered care
Patient engagement
Nurses in the delivery of person-centered care
Synthesis and application
Conclusion
Reflections
The evidence
Tips for competent person-centered care
23: Managing Quality and Risk
Introduction
Quality management in health care
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Benefits of quality management
Planning for quality management
Evolution of quality management
Quality management principles
Customers
The quality improvement process
Quality assurance
Risk management
Conclusion
Reflections
The evidence
Tips for quality management
24: Translating Research Into Practice
Introduction
From using research to evidence-based practice
Development of evidence-based practice
Comparative effectiveness research
Practice-based evidence
Participatory action research
Quality improvement
Evaluating evidence
Organizational strategies to embed evidence-based practice into organizations
Issues for nurse leaders and managers
Conclusion
Reflections
The evidence
Tips for developing skill in using evidence and translating research into practice
25: Managing Personal and Personnel Problems
Introduction
Personal/personnel problems
Documentation
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Progressive discipline
Termination
Conclusion
Reflections
The evidence
Tips in the documentation of problems
Part 5: Prepare for the Future
26: Role Transition
Introduction
Types of roles
Roles: The ABCs of understanding roles
Role transition process
Strategies to promote role transition
Conclusion
Reflections
The evidence
Tips for role transition
27: Managing Your Career
Introduction
A career framework
Career theory
Professional development
Contributing through scholarly activities and research
Career marketing strategies
Conclusion
Reflections
The evidence
Tips for a successful career
28: Developing the Role of Leader
Introduction
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What is a leader?
The practice of leadership
Leadership development
Leadership development model
Surviving and thriving as a leader
The nurse as leader
Conclusion
Reflections
The evidence
Tips for becoming a leader
29: Developing the Role of Manager
Introduction
The definition of management
Nurse manager as change leader
Nurse manager role and the intergenerational workforce
The nurse manager and interprofessional collaboration
Building a positive work environment
Consuming research
Organizational culture
Mentoring
Day-to-day management challenges
Managing resources
Technology and informatics
Dashboards and decision support tools
Budgets and finance
Quality indicators
Professionalism
Conclusion
Reflections
The evidence
Tips for implementing the role of nurse manager
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30: The Strategic Planning Process
Introduction
Strategic planning
Reasons for strategic planning
Phases of the strategic planning process
Conclusion
Reflections
The evidence
Tips for developing and executing a strategic plan for nursing
31: Thriving for the Future
Introduction
Leadership demands for the future
Leadership strengths for the future
Visioning, forecasting, and innovation
The wise forecast model©
Shared vision
Projections for the future
Conclusion
Reflections
Tips for the Thriving in the future
The evidence
Index
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Copyright
3251 Riverport Lane St. Louis, Missouri 63043
LEADING AND MANAGING IN NURSING, SEVENTH EDITION ISBN: 978-0-323-44913-7
Copyright © 2019 by Elsevier Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).
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Previous editions copyrighted 2015, 2011, 2007, 2003, 1999, 1995. International Standard Book Number: 978-0-323-44913-7
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Printed in Canada. Last digit is the print number: 9 8 7 6 5 4 3 2 1
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Dedication
This book is dedicated to the families and friends who supported all of us who created it, to the faculty who use this book to develop tomorrow’s emerging leaders and managers, and to the
learners who have the vision and insight to grasp today’s reality and mold it into the future of dynamic nursing leadership.
Lead on! ¡Adelante!
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Contributors
Joan Benson, BSN, RN, CPN Manager, Clinical Informatics and Practice, Children’s Mercy— Kansas City, Kansas City, Missouri
Kristin K. Benton, BS, BSN, MSN, DNP Director of Nursing, Nursing, Texas Board of Nursing, Austin, Texas
Amy Boothe, DNP, RN Instructor, Traditional Undergraduate Program, Texas Tech University Health Sciences Center, Lubbock, Texas
Elizabeth H. Boyd, MSN, BS Instructor/Site Coordinator, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Myra A. Broadway, JD, MS, BSN Formerly, Executive Director, Maine State Board of Nursing, Past President, National Council of State Boards of Nursing, Maine Medical Professionals Health Program Advisory Committee USAFR Nurse Corps (Retired Colonel), Gardiner, Maine
M. Margaret Calacci, MS Director, Simulation and Learning Resources, Arizona State University College of Nursing and Health Innovation, Phoenix, Arizona
Mary Ellen Clyne, PhD President and Chief Executive Officer, Administration, Clara Maass Medical Center, Belleville, New Jersey
Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FACCE, FAAN Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Mary Ann T. Donohue-Ryan, PhD, RN, APN, APRN-MH, NEA-BC Vice President for Patient Care Services and Chief Nursing Officer, Administration, Englewood Hospital and Medical Center, Englewood, New Jersey
Michael L. Evans, PhD, MSN, BSN, BA Dean and Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Victoria N. Folse, PhD, APN, PMHCNS-BC, LCPC Director and Professor; Caroline F. Rupert Endowed Chair of Nursing, School of Nursing, Illinois Wesleyan University, Bloomington, Illinois
Jacqueline Gonzalez, DNP, MBA, MSN Senior Vice President/Chief Nursing Officer, Nicklaus Children’s Hospital, Miami, Florida
Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN Clinical Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
Shari Kist, PhD, RN Missouri Quality Initiative (MOQI) Project Supervisor, Sinclair School of Nursing, University of Missouri—Columbia, Columbia, Missouri
Karren Kowalski, BSN, MSN, PhD President & CEO, Colorado Center for Nursing Excellence, Denver, Colorado Professor, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Mary E. Mancini, RN, MSN, PhD Senior Associate Dean for Education Innovation, Undergraduate Nursing, University of Texas at Arlington, Arlington, Texas
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Maureen Murphy-Ruocco, APN-C, CSN, MSN, EdM, EdD, DPNAP Senior Fellow, National Academies of Practice, Nurse Consultant/Nurse Practitioner New York, New York Professor and Dean Emerita Felician University, Lodi and Rutherford, New Jersey
Karen A. Quintana, PhD, APRN, CPNP-PC Director of Pediatric Nurse Practitioner Studies, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Elaine S. Scott, BSN, MSN, PhD Chair, Nursing Science, East Carolina University, Greenville, North Carolina
Ashley Sediqzad, RN, BSN Manager, Clinical Informatics and Practice, Children’s Mercy Kansas City, Kansas City, Missouri
Janis Bloedel Smith, DNP, MSN, BSN Senior Director, Clinical Informatics & Professional Practice, Patient Care Services, Children’s Mercy Kansas City, Kansas City, Missouri
Susan Sportsman, PhD Nurse Consultant, Collaborative Momentum Consulting, LLC, St. Louis, Missouri
Sylvain Trepanier, DNP, MSN, BSN, RN, CENP Chief Clinical Executive, Administration, Providence St. Joseph Health, Torrance, California
Diane M. Twedell, DNP, MS Chief Nursing Officer, Mayo Clinic Health System, Southeast Minnesota Region, Austin, Minnesota
Jeffery Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN Assistant Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas
Jana Wheeler, MSN, RN-BC, CPN Manager, Clinical Informatics & Practice, Children’s Mercy Kansas City, Kansas City, Missouri
Crystal J. Wilkinson, DNP, RN, CNS-CH, CPHQ Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Austin, Texas
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas
Margarete Lieb Zalon, PhD, RN, ACNS-BC, FAAN Professor, Nursing, University of Scranton, Scranton, Pennsylvania
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Reviewers
Karen E. Alexander, PhD, RN, CNOR Program Director RN-BSN, Assistant Professor, Clinical Heath and Applied Science—Nursing, University of Houston—Clear Lake, Houston, Texas
Vicki Bingham, PhD, RN, CPE Dean/Associate Professor of Nursing, Robert E. Smith School of Nursing, Delta State University, Cleveland, Mississippi
Deborah Birk, PhD, RN, MHA, NEA-BC Assistant Professor, Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
Barbara B. Blozen, EdD, MA, RN BC, CNL Associate Professor, New Jersey City University, Jersey City, New Jersey
Joseph Boney, MSN, RN, NEA-BC Director of Undergraduate Faculty Development/Instructor, Rutgers School of Nursing, Accelerated BS in Nursing Program, Newark, New Jersey
Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Nursing, Eastern University, St. Davids, Pennsylvania
Jane Campbell, DNP, RN, NE-BC Professor, School of Nursing, Northern Michigan University, Marquette, Michigan
Holly Johanna Diesel, RN, PhD Associate Professor, Academic Chair for Accelerated and RN to BSN Programs, Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, Missouri
Jennifer B. Drexler, RN, MSN, PhDc, CCRN Clinical Faculty Educator, College of Nursing, University of New Mexico, Albuquerque, New Mexico
Lynn Renee Dykstra, MS, BSN, HPCN, RN Instructor, Adjunct Faculty, Northern Illinois University, College of Health and Human Sciences, Nursing, DeKalb, Illinois Oakton Community College, Division of Science and Health Careers, Nursing Des Plaines, Illinois
Julie A. Fitzgerald, PhD, RN, CNE Assistant Professor of Nursing, Ramapo College of New Jersey, Mahwah, New Jersey
Kay E. Gaehle, PhD, RN Associate Professor of Nursing, Department of Primary Care and Health Systems, Southern Illinois University—Edwardsville, Edwardsville, Illinois
Maria Gillespie, EdD, MSN, BSN, BS, CNE, RN Assistant Professor, Nursing, University of the Incarnate Word, San Antonio, Texas
Julia Henderson Gist, PhD, RN, CNE Dean, School of Health Sciences, Arkansas State University Mountain Home, Mountain Home, Arkansas
Stephanie A. Gustman, DNP, MSN, BSN, RN Assistant Professor, School of Nursing, Ferris State University, Big Rapids, Michigan
Cam A. Hamilton, PhD, MSN, RN, CNE Assistant Professor, School of Nursing, Auburn University at Montgomery, Montgomery, Alabama
Pamela Gibler Harrison, EdD, RN, CNE Professor of Nursing, Chair, Pre-Licensure Nursing,
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Indiana Wesleyan University, Marion, Indiana
Karen L. Hoblet, PhD, MSN, RN, CNL Licensed RN, Clinical Nurse Leader, Interim Department Chairperson and Associate Professor, Interim Director Nurse Educator and Clinical Nurse Leader Programs, Advanced Population Care, The University of Toledo College of Nursing, Toledo, Ohio
Janine Dailey Johnson, MSN, RN Assistant Professor, Nursing, Clarkson College, Omaha, Nebraska
Leo-Felix M. Jurado, PhD, RN, APN, NE-BC, CNE, FAAN Associate Professor, College of Science and Health, William Paterson University of New Jersey, Wayne, New Jersey
Barbara J. Keith, RN, MSN, CNE Clinical Lecturer, Vera Z. Dwyer College of Health Sciences, Indiana University School of Nursing, South Bend, Indiana
Donnamarie Lovestrand, RN, MSN, CPAN Faculty, Nursing Programs, Nursing Department, Pennsylvania College of Technology, Williamsport, Pennsylvania
Anne Boulter Lucero, RN, MSN Assistant Director, Instructor Nursing, Nursing Department, Cabrillo College, Aptos, California
Richard C. Meeks, DNP, RN, COI Assistant Professor, Graduate Program Coordinator, School of Nursing, Middle Tennessee State University, Murfreesboro, Tennessee
Kereen Forster Mullenbach, MBA, PhD, RN Associate Professor, Nursing, Radford University School of Nursing, Radford, Virginia
Sue S. Myers, RPN, BSW, MSCTE Faculty, Psychiatric Nursing and Bachelor of Psychiatric Nursing Programs, School of Nursing, Saskatchewan Polytechnic, Parkway Campus, Regina, Saskatchewan
Barbara Pinekenstein, DNP, RN- BC, CPHIMS Clinical Professor, Richard E. Sinaiko Professor in Health Care Leadership, School of Nursing, University of Wisconsin—Madison, Madison, Wisconsin
Dawn M. Pope, MS, RN Assistant Clinical Professor (retired), College of Nursing, University of Wisconsin—Oshkosh, Oshkosh, Wisconsin
Cara L. Rigby, DNP, RN, CMSRN Associate Professor, BSN Program Director, Nursing, The Christ College of Nursing and Health Sciences, Cincinnati, Ohio
Dulce Anne Santacroce, DNP, RN, CCM Nurse Educator, Nursing, Touro University—Nevada, Henderson, Nevada
Ruth Schumacher, DNP, RN, CNL, CPN Assistant Professor, Department of Nursing and Health Sciences, Elmhurst College, Elmhurst, Illinois
Kathy S. Sweeney, MSN, RN Assistant Professor of Nursing, Nursing Education, Kansas Wesleyan University, Salina, Kansas
Denise Robin Zabriskie, DNP, RN, CWOCN, WCC Assistant Professor, School of Nursing, Touro University Nevada, Henderson, Nevada
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Acknowledgments
Patricia S. Yoder-Wise, RN, EdD, NEA-BC,ANEF, FAAN, Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas
As with any publication endeavor, many people other than those whose names appear on the cover make the actual publication possible, including the contributors and the Challenge/Solution authors. These behind-the-scenes people also include the reviewers and the publishing team at Elsevier.
We thank each of the contributors who worked diligently to meet deadlines and content expectations. Their names are listed with the chapters they produced. Without them, this book would be a lot thinner! The nurses who told their fabulous stories related to the various chapters always illustrate the real-world meaning of the importance of the chapter content; their names appear with their stories. Without all of them, this book would be much less interesting! What a fabulous group to work with.
We are indebted to our reviewers, who provided valuable feedback that helped refine the book. Receiving peer review is critical to any successful publication. Now that the book is completed, we know who they are and we thank them!
Jeff Watson took on coordinating the ancillaries, and Shelley Burson coordinated and managed an enormous number of details. Both gently nudged all of us to complete our required tasks in a timely manner.
Special thanks go to our publishing team: Senior Content Strategist Yvonne Alexopoulos, Senior Content Development Specialist Tina Kaemmerer, and Senior Production Manager Jodi Willard.
Even more special thanks go to my husband and best friend, Robert Thomas Wise, who vowed to be minimally disruptive as I sat in my office reading, writing, typing, and talking. He is a man of his word!
This book is designed to stimulate thinking and to encourage continued professional development in the area of leading and managing. When the Institute of Medicine released the report, The Future of Nursing, the idea of leadership was clearly a concern for the profession. This book continues its tradition of providing the information that nurses need to assume greater leadership practices and even new management roles. All contributors attempted to provide their best thinking on a given topic so that learners could integrate concepts to form the basis for their contribution to health care. Both the thinking and the complexities will continue to change…and so, hopefully, will you! The passion of nursing and leadership await!
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Preface
The first edition of Leading and Managing in Nursing began in a hotel room in New Orleans, Louisiana in January of 1990. Darlene Como, the founding publisher of Leading and Managing, and I conceptualized a new way of presenting content about leadership and management: one that might engage learners in valuing the importance of roles that support clinical practice. This new approach included personal stories (The Challenge and The Solution), Literature Perspectives, Research Perspectives, synopses, exercises, and boxes of key information. If you saw that first edition and compared the number of words then compared with the number of words in this edition, you would know the field has grown and become far more complex. Nursing has also grown the field of leadership and management research, and so we have many more citations we can share to make this content both theoretical and practical.
We continue to include everything today’s nurses need to know about the basics of leading and managing. The changes with each revision of Leading and Managing reflect the intensity with which we know how leading and managing influence nurses in direct and indirect caregiving roles, as well as in other aspects of being a professional nurse in a complex, ever-changing, dynamic healthcare environment.
Nurses throughout the profession serve in various leadership roles. Leading and managing are two essential expectations of all professional nurses and become increasingly important throughout one’s career. To lead, manage, and follow successfully, nurses must possess not only knowledge and skills but also a caring and compassionate attitude.
This book results from our continued strong belief in the need for a text that focuses in a distinctive way on the nursing leadership and management issues— both today and in the future. We continue to find that we are not alone in this belief. This edition incorporates reviewers from both service and education to ensure that the text conveys important and timely information to users as they focus on the critical roles of leading, managing, and following. In addition, we took seriously the various comments offered by both educators and learners as I met them in person or heard from them by e-mail.
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Concept and practice combined Innovative in both content and presentation, Leading and Managing in Nursing merges theory, research, and practical application in key leadership and management areas. Our overriding concern in this edition remains to create a text that, while well-grounded in theory and concept, presents the content in a way that is real. Wherever possible, we use real-world examples from the continuum of today’s healthcare settings to illustrate the concepts. Because each chapter contributor synthesizes the designated focus, you will find no lengthy quotations in these chapters. We have made every effort to make the content as engaging, inviting, and interesting as possible. Reflecting our view of the real world of nursing leadership and management today, the following themes pervade the text:
• Every role within nursing has the basic concern for safe, effective care for the people for whom we exist—our clients and patients.
• The focus of health care continues to shift from the hospital to the community at a rapid rate.
• Healthcare consumers and the healthcare workforce are increasingly culturally diverse.
• Today virtually every professional nurse leads, manages, and follows, regardless of title or position.
• Consumer relationships play a central role in the delivery of nursing and health care.
• Communication, collaboration, team-building, and other interpersonal skills form the foundation of effective nursing leadership and management.
• Change continues at a rapid pace in health care and society in general. • Change must derive from evidence-based practices wherever possible and from
thoughtful innovation when no or limited evidence exists. • Healthcare delivery is highly dependent on the effectiveness of nurses across roles
and settings.
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Diversity of perspectives Contributors are recruited from diverse settings, roles, and geographic areas, enabling us to offer a broad perspective on the critical elements of nursing leadership and management roles. To help bridge the gap often found between nursing education and nursing practice, some contributors were recruited from academia, and others were recruited from practice settings. This blend not only contributes to the richness of this text but also conveys a sense of oneness in nursing. The historical “gap” between education and service must become a sense of a continuum, not a chasm.
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Audience This book is designed for undergraduate learners in nursing leadership and management courses, including those in BSN-completion courses and second-degree programs. In addition, we know that practicing nurses—who had not anticipated formal leadership and management roles in their careers—use this text to capitalize on their own real-life experiences as a way to develop greater understanding about leading and managing and the important role of following. Numerous examples and The Challenge/The Solution in each chapter provide relevance to the real world of nursing.
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Organization We have organized this text around issues that are key to the success of professional nurses in today’s constantly changing healthcare environment. The content flows from the core concepts (leading, managing, and following; clinical safety; legal considerations; and culture), to knowing yourself (being an effective follower, self-management, conflicts, and power), to knowing the organization (care delivery strategies, staffing), to using your personal and professional skills (technology, delegation, change, and quality), to preparing for the future (personal role transition, self and career management and strategic planning).
Because repetition plays a crucial role in how well learners learn and retain new content, some topics appear in more than one chapter and in more than one section. For example, because problem behavior is so disruptive, it is addressed in several chapters that focus on conflict, personal/personnel problems, incivility, and self-management. Rather than referring learners to another portion of the text, the key information is provided within the specific chapter.
We also made an effort to express a variety of different views on some topics, as is true in the real world of nursing. This diversity of views in the real world presents a constant challenge to leaders, managers, and followers, who address the critical tasks of creating positive workplaces so that those who provide direct care thrive and continuously improve the patient experience.
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Design The functional full-color design, still distinctive to this text, is used to emphasize and identify the text’s many learning strategies, which are featured to enhance learning. Full-color photographs not only add visual interest but also provide visual reinforcement of concepts, such as body language and the changes occurring in contemporary healthcare settings. Figures expand and clarify concepts and activities described in the text graphically.
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Learning strategies The numerous strategies featured in this text are designed both to stimulate learners’ interest and to provide constant reinforcement throughout the learning process. Color is used consistently throughout the text to help the reader identify the various chapter elements described in the following sections.
Chapter Opener Elements
• Objectives articulate the chapter’s learning intent, typically at the application level or higher.
• Terms to know are listed and appear in color type in each chapter. • The Challenge presents a contemporary nurse’s real-world concern related to the chapter’s
focus. It is designed to allow us to “hear” a real-life situation. The Challenge ends with a question about what you might do in such a situation.
Elements Within the Chapters
• Exercises stimulate learners to reason critically about how to apply concepts to the workplace and other real-world situations. They provide experiential reinforcement of key leading, managing, and following skills. Exercises are highlighted within a full-color box and are numbered sequentially within each chapter to facilitate their use as assignments or activities. Each chapter is numbered separately so that learners can focus on the concepts inherent in a specific area and educators can readily use chapters to fit their own sequence of presenting information.
• Research Perspectives and Literature Perspectives illustrate the relevance and applicability of current scholarship to practice. Theory Boxes provide a brief description of relevant theory and key concepts.
• Numbered boxes contain lists, tools such as forms and worksheets, and other information relevant to the chapter.
• The vivid full-color chapter opener photographs and other photographs throughout the text help convey each chapter’s key message. Figures and tables also expand concepts presented to facilitate a greater grasp of important materials.
End-of-Chapter Elements
• The Solution provides an effective method to handle the real-life situations set forth in The Challenge. It reflects the response of The Challenge author and ends with a question about how that solution would fit for you.
• The Evidence contains either one example of evidence related to the chapter’s content or contains a summary of what the literature shows to be evidence related to the topic.
• Reflections provide the learner with the opportunity to reflect on something they’ve encountered in practice.
• Tips offer practical guidelines for learners to follow in applying some aspect of the information presented in each chapter.
• References provide the learner with a list of key sources for further reading on topics found in the chapter.
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Complete teaching and learning package In addition to the text Leading and Managing in Nursing, educator resources are provided online through Evolve (http://evolve.elsevier.com/Yoder-Wise/). These resources are designed to help educators present the material in this text and include the following assets:
• Updated PowerPoint Slides, with lecture notes where applicable, are provided for each chapter.
• An updated ExamView Test Bank includes answers and a rationale. • An updated TEACH for Nurses ties together the chapter resources for the most
effective class presentations, with sections dedicated to objectives, instructor and student chapter resources, teaching strategies, application activities and answers, an in-class case study discussion, and answers to the text Exercise boxes.
Student Resources Learning Resources can also be found online through Evolve (http://evolve.elsevier.com/Yoder- Wise/). These resources provide learners with additional tools for learning and include the following assets:
• NCLEX Review Questions • Sample Resumes
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Chapter overview
1 Leading, Managing, and Following, 1 The changing landscape of health care provides opportunities for nurses to be actively involved in leading at many levels, from direct patient care to national policy development. Skills related to leading, managing, and following can serve nurses, our patients, and health care well. Nurses must use these skills while incorporating numerous other skills, especially emotional intelligence, to deliver high-quality care to individuals, families, and communities. This chapter provides an overview of theories related to leading and managing as well as complexity science, which can be useful in understanding our evolving healthcare system and profession.
2 Clinical Safety: The Core of Leading, Managing, and Following, 20 Every registered nurse has a legal obligation as a leader—someone who has the opportunity and authority to make changes for his or her patients or for the staff who provide direct care. Despite years of focusing on improving safety, patient safety issues have risen to become the third leading cause of death in the United States. Functioning safely in the clinical area is the complex work of the healthcare team, and the greatest numbers of providers are derived from nursing. This chapter provides an overview of some major patient safety efforts as the basis for nursing’s leadership work. In addition, this chapter addresses staff safety, which is another obligation of nurses to improve the workplace so that safe care can be rendered without harm to providers.
3 Legal and Ethical Issues, 32 This chapter highlights and explains key legal and ethical issues pertinent to managing and leading. Nurse practice acts, negligence and malpractice, informed consent, types of liability, selected federal and state employment laws, ethical principles, and related concepts are discussed. This chapter provides specific guidelines for preventing legal liability and guides the reader in applying ethical decision-making models in everyday practice settings.
4 Cultural Diversity and Inclusion in Health Care, 62 This chapter focuses on the importance of cultural considerations for patients and staff. Although it does not address comprehensive details about any specific culture, it does provide guidelines for actively incorporating cultural aspects into the roles of leading and managing. Diverse workforces are discussed, as well as how to capitalize on their diverse traits and how to support differences to work more effectively. The chapter presents concepts and principles of transculturalism, describes techniques for managing a culturally diverse workforce, emphasizes the importance of respecting different lifestyles, and discusses the effects of diversity on staff performance.
5 Gaining Personal Insight: The Beginning of Being a Leader, 77 Being clinically competent is the goal of every registered nurse, and competence is the foundation of who we are as nurses. In addition, every registered nurse has a legal obligation as a leader. The opportunity to execute this role begins with developing a personal insight about one’s values, strengths, resources, and connections and continues throughout life. Those insights are developed over time and capitalize on past knowledge and experiences and how others react to the demonstration of knowledge, skills, and attitudes in various situations. This chapter provides an overview of some initial strategies to strengthen the skill of leading. These strategies often build on prior experiences and now take on a different perspective of nurse as leader.
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6 Being an Effective Follower, 89 Almost every formal organization has a multilayered hierarchy. The role of the leader has been explicated in the literature for decades. Less well understood, and certainly less well documented, is the role of the follower. This chapter is designed to discuss the role and responsibilities of the follower in the team.
7 Managing Self: Stress and Time, 99 This chapter recalls our understanding of stress and applies it to nursing. Almost every point made about what nurses experience could be applied or modified for other groups of professionals. This is important to remember, because any group has the tendency to think of itself as different from others. This chapter also examines the concept of self-management—developing behaviors that enhance rather than duplicate organizational cultures, social contexts, and occupational expectations as a professional nurse. Positive outcomes of effective self-management include better organization of your day, a higher degree of engagement and positivity, and respect for one’s needs for daily renewal. Three components of self-management are explored: emotional intelligence, time management, and overall stress management. Methods for managing stress and organizing your time are included. Practical exercises and suggestions for stress management and day-to-day time management are presented so they may be applied to personal and professional situations. Personal and professional growth is a life-long journey, and developing healthy habits can serve you well over your entire career.
8 Communication and Conflict, 123 Effective communication and appropriate conflict-handling strategies are essential in professional nursing practice to ensure positive patient outcomes. This chapter focuses on maximizing the ability of nurse leaders to promote a practice environment characterized by effective interprofessional communication and strategies for conflict resolution.
9 Power, Politics, and Influence, 141 The focus of this chapter is the impact of power and politics on the roles of leaders, managers, and followers and the ways in which leaders and managers use power and politics to be influential. Contemporary concepts of power, empowerment, and types of power exercised by nurses are considered. Key factors important to develop a powerfu
