leadership and management for every nurse · *western schools is accredited as a provider of...

Upon successful completion of this course, continuing education hours will be awarded as follows:Nurses: 30 Contact Hours**Western Schools is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Leadership and Management for

Every Nurse

3rd Edition

By

Antoinette Towle, EdD, MSN, APRN

H8696_Leadership_Mgmt_3e.indb 1 12/6/16 11:32 AM

P.O. Box 1930Brockton, MA 02303800-438-8888

Nurse Planner: Marcie Scott, MSN, RNThe planner who worked on this continuing education activity has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book.

Copy Editor: Graphic World, Inc.Indexer: Carol Schoun

Western Schools’ courses are designed to provide healthcare professionals with the educational information they need to enhance their career development as well as to work collaboratively on improving patient care. The information provided within these course materials is the result of research and consultation with prominent healthcare authorities and is, to the best of our knowledge, current and accurate at the time of printing. However, course materials are provided with the understanding that Western Schools is not engaged in offering legal, medical, or other professional advice.

Western Schools’ courses and course materials are not meant to act as a substitute for seeking professional advice or conducting individual research. When the information provided in course materials is applied to individual cases, all recom-mendations must be considered in light of each case’s unique circumstances.

Western Schools’ course materials are intended solely for your use and not for the purpose of providing advice or recom-mendations to third parties. Western Schools absolves itself of any responsibility for adverse consequences resulting from the failure to seek medical, or other professional advice. Western Schools further absolves itself of any responsibility for updat-ing or revising any programs or publications presented, published, distributed, or sponsored by Western Schools unless other-wise agreed to as part of an individual purchase contract.

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ISBN: 978-1-68041-298-7

COPYRIGHT© 2017—S.C. Publishing. All Rights Reserved. No part(s) of this material may be reprinted, reproduced, transmitted, stored in a retrieval system, or otherwise utilized, in any form or by any means electronic or mechanical, including photocopying or recording, now existing or hereinafter invented, nor may any part of this course be used for teaching without written permission from the publisher.

ii

ABOUT THE AUTHORAntoinette Towle EdD, PNP-BC, SNP-BC, is an assistant professor at Southern Connecticut State University, New Haven, CT, and an American Nurse Credentialing Center (ANCC) Board Certified advanced practice regis-tered nurse (APRN) in the specialty areas of Pediatric and School Health. Dr. Towle has worked as a professional nurse for more than 30 years, in a variety of capacities (Administrator, Manager, Director, Case Worker, APRN, RN, and Educator) and within a wide variety of healthcare setting (schools, residential settings for children and the elderly, veterans hospitals, insurance companies, federal and privately funded medical offices and hospitals, and community healthcare agencies). Presently, Dr. Towle teaches both graduate and undergraduate nursing students full time, with a focus on nursing leadership; understanding, respecting, and appreciating cultural diver-sity; health promotion; and integration of these key components into clinical practice. She is the first to create and continue to lead a nursing study program abroad for students at the University of Jamaica, China, and Armenia.

Antoinette Towle has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book.

Based on the original work of Lynn C. Parsons.

ABOUT THE PEER REVIEWERJoy Parchment, PhD, RN, NE-BC, is an executive nurse leader with expertise in academia, ambulatory care, and nursing administration. Dr. Parchment is a member of the American Nurses Association, a member of the American Organization of Nurse Executives, the president of the Central Florida Organization of Nurse Executives, a member of the International Association on Workplace Bullying and Harassment, and a former member of the American Nurses Association, Professional Issues Panel on Workplace Violence and Incivility Advisory Committee. Her research interests include workplace bullying, work environments, and workforce. In addition to being a conference presenter, she is the recipient of several small research grants.

Joy Parchment has disclosed that she has no significant financial or other conflicts of interest pertaining to this course book.

FP1216WS


iii

COURSE INSTRUCTIONSIMPORTANT: Read these instructions BEFORE proceeding!

HOW TO EARN CONTINUING EDUCATION CREDIT

To successfully complete this course you must: 1)Read the entire course 2)Pass the final exam with a score of 75% or higher* 3)Complete the course evaluation

*You have three attempts to pass the exam. If you take the exam online, and fail to receive a passing grade, select “Retake Exam.” If you submit the exam by mail or fax and you fail to receive a passing grade, you will be notified by mail and receive an additional answer sheet.

Final exams must be received at Western Schools before the Complete By date located at the top of the FasTrax answer sheet enclosed with your course.

Note: The Complete By date is either 1 year from the date of purchase, or the expiration date assigned to the course, whichever date comes first.

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Complete the FasTrax Answer Sheet using blue or black ink only. If you make an error use correction fluid. If the exam has fewer than 100 questions, leave any remaining answer circles blank. Respond to the evaluation questions under the heading “Evaluation,” found on the right-hand side of the FasTrax answer sheet. See the FasTrax Exam Grading & Certificate Issue Options enclosed with your course order for further instructions.

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WESTERN SCHOOLSP.O. Box 1930, Brockton, MA 02303

800-618-1670 • www.westernschools.com

ONLINE: BEST OPTION!


WESTERN SCHOOLSCOURSE EVALUATION

LEADERSHIP AND MANAGEMENT FOR EVERY NURSEINSTRUCTIONS: Using the scale below, please respond to the following evaluation statements. All responses should be recorded in the right-hand column of the FasTrax answer sheet, in the section marked “Evaluation.” Be sure to fill in each corresponding answer circle completely using blue or black ink. Leave any remaining answer circles blank.

A B C D

Agree Agree Disagree Disagree Strongly Somewhat Somewhat Strongly

OUTCOMES: After completing this course, I am able to: 1. Discuss key aspects of the roles of leadership and management in nursing.

2. Describe delegation principles utilized in nursing practice.

3. Describe effective communication and problem-solving processes that nurses use.

4. Explain how strategic planning provides different organizational structures to assist decision making in nursing.

5. Identify financial skills and management practices for nurses.

6. Outline strategies to build cohesive interprofessional teams for healthcare organizations.

7. Discuss the concepts of patient-centered care within the contexts of nursing and nursing management.

8. Describe strategies for helping nurses to manage conflict and stress.

9. Discuss the role of power and influence in creating a professional nursing practice environment.

10. Describe essential legal and ethical principles for nurses.

11. Describe the various roles of the nurse in facilitating and supporting change.

12. Explain how professional nursing organizations provide leadership opportunities.

COURSE CONTENT 13. The course content was presented in a well-organized and clearly written manner.

14. The course content was presented in a fair, unbiased, and balanced manner.

15. The course content presented current developments in the field.

16. The course was relevant to my professional practice or interests.

17. The final examination was at an appropriate level for the content of the course.

18. The course expanded my knowledge and enhanced my skills related to the subject matter.

19. I intend to apply the knowledge and skills I’ve learned to my practice.

A. Yes B. Unsure C. No D. Not Applicable

vcontinued on next page


Course Evaluation— vi Leadership and Management for Every Nurse

CUSTOMER SERVICEThe following section addresses your experience in interacting with Western Schools. Use the scale below to respond to the statements in this section.

A. Yes B. No C. Not Applicable 20. Western Schools staff was responsive to my request for disability accommodations. 21. The Western Schools website was informative and easy to navigate. 22. The process of ordering was easy and efficient. 23. Western Schools staff was knowledgeable and helpful in addressing my questions or problems.

ATTESTATION

24. I certify that I have read the course materials and personally completed the final examination based on the material presented. Mark “A” for Agree and “B” for Disagree.

COURSE RATING

25. My overall rating for this course is

A. Poor B. Below Average C. Average D. Good E. Excellent

You may be contacted within 3 to 6 months of completing this course to participate in a brief survey to evaluate the impact of this course on your clinical practice and patient/client outcomes.

Note: To provide additional feedback regarding this course and Western Schools services, or to suggest new course topics, use the space provided on the Important Information form found on the back of the FasTrax instruction sheet included with your course.


C O N T E N T SCourse Evaluation ....................................................................................................................................................vFigures, Tables, and Boxes ...................................................................................................................xxiPretest ....................................................................................................................................................xxvIntroduction .........................................................................................................................................xxix

Learning Outcomes ...................................................................................................................xxixChapter 1: Leading and Managing ........................................................................................................1

Learning Outcome .........................................................................................................................1

Chapter Objectives .........................................................................................................................1

Introduction ....................................................................................................................................1

Leadership ......................................................................................................................................1

Leadership Styles ...........................................................................................................................3

Autocratic Leadership ..............................................................................................................3

Bureaucratic Leadership ..........................................................................................................3

Democratic Leadership ............................................................................................................3

Laissez-Faire Leadership .........................................................................................................3

Participative Leadership ...........................................................................................................3

Transactional Leadership .........................................................................................................4

Transformational Leadership ...................................................................................................4

Leadership Versus Management ....................................................................................................4

Nurse Manager Responsibilities, Tasks, Characteristics, and Functions .................................5

Effective Nurse Managers ........................................................................................................7

Followership ..................................................................................................................................8

Clinical Nurse Leadership ............................................................................................................10

Leadership in Professional Organizations ...................................................................................10

Professional Nursing Specialty Organizations .......................................................................11

Case Study 1-1: Clinical Nurse Leadership .................................................................................12

Discussion Questions .............................................................................................................12

Answers ..................................................................................................................................12

Case Study 1-2: Leader or Manager? ...........................................................................................13


Answers ..................................................................................................................................13

Summary ......................................................................................................................................14

Resources .....................................................................................................................................14

Exam Questions ...........................................................................................................................15

vii


References ....................................................................................................................................17Chapter 2: Delegation ............................................................................................................................19

Learning Outcome .......................................................................................................................19

Chapter Objectives .......................................................................................................................19

Introduction ..................................................................................................................................19

Delegation ....................................................................................................................................20

Principles of Nursing Delegation ...........................................................................................20

Terms Associated With Delegation .......................................................................................21

Evidence-Based Practice and Nurse Delegation ..........................................................................22

Delegation Model and Criteria for Delegation Decisions ......................................................23

Nurses Working With UAP ...................................................................................................23

Scope of Practice ..........................................................................................................................24

Advanced Practice Registered Nurses ...................................................................................24

Registered Nurses ..................................................................................................................26

Licensed Practical Nurses ......................................................................................................26

Direct and Indirect Delegation .....................................................................................................28

Direct Delegation ...................................................................................................................28

Indirect Delegation .................................................................................................................28

Barriers to Effective Delegation ..................................................................................................28

Underdelegation .....................................................................................................................29

Overdelegation .......................................................................................................................29

Improper Delegation ..............................................................................................................29

Legal Aspects of Delegation ........................................................................................................29

Case Study 2-1: Delegation Between an RN and a UAP .............................................................30


Answers ..................................................................................................................................31

Case Study 2-2: Making Delegation Decisions ...........................................................................31


Answers ..................................................................................................................................32

Summary ......................................................................................................................................34

Resources .....................................................................................................................................34

Exam Questions ...........................................................................................................................35

References ....................................................................................................................................37Chapter 3: Decision Making .................................................................................................................39



Introduction ..................................................................................................................................39

Decision Making ..........................................................................................................................39

Contents— viii Leadership and Management for Every Nurse


Phases and Components of the Decision-Making Process ....................................................40

Attributes of Effective Decision Makers ...............................................................................40

Critical Thinking ....................................................................................................................41

Reflective Thinking ...............................................................................................................41

Intuitive Thinking ..................................................................................................................41

Decision-Making Tools ...............................................................................................................41

Decision Tree .........................................................................................................................42

Decision Grid .........................................................................................................................42

Numerical Scoring .................................................................................................................43

Payoff Table ...........................................................................................................................43

SWOT Analysis .....................................................................................................................44

Problem Solving...........................................................................................................................44

Problem Solving Versus Decision Making ............................................................................45

Steps in the Problem-Solving Process ...................................................................................45

Considerations for Problem Solving ......................................................................................47

Case Study 3-1: SWOT Analysis .................................................................................................48


Answers ..................................................................................................................................49

Summary ......................................................................................................................................50

Resources .....................................................................................................................................51

Exam Questions ...........................................................................................................................53

References ....................................................................................................................................55Chapter 4: Budgeting, Finance, and Reimbursement ........................................................................57



Introduction ..................................................................................................................................57

The Effect of Nursing on Costs ...................................................................................................58

Budgets ........................................................................................................................................58

Operating Budget ...................................................................................................................58

Capital Budget .......................................................................................................................59

Human Resources Budget ......................................................................................................60

Cost Analysis of Nurse Staffing ..................................................................................................60

Staffing Plan ...........................................................................................................................60

Nursing Hours ........................................................................................................................62

Direct Nursing Care Hours ....................................................................................................63

Case Study 4-1: Direct Care Hours ..............................................................................................64


Answers ..................................................................................................................................65

Contents—Leadership and Management for Every Nurse ix


General Inpatient Costs and Expenses .........................................................................................66

Reimbursement ............................................................................................................................66

Medicare, Medicaid, Private Insurance, Private Pay .............................................................66

Summary ......................................................................................................................................68

Resources .....................................................................................................................................69

Exam Questions ...........................................................................................................................71

References ....................................................................................................................................73Chapter 5: Management of Nurse Staffing .........................................................................................75



Introduction ..................................................................................................................................75

Staffing .........................................................................................................................................75

Staff Mix ................................................................................................................................76

Staffing Plans .........................................................................................................................76

Fixed Versus Flexible Full-Time Equivalents .......................................................................77

Block Staffing ........................................................................................................................77

Facility, State, Federal, and Regulatory Guidelines for Healthcare Organizations .....................77

Augmenting Staffing ....................................................................................................................78

Factors Affecting Nurse Staffing .................................................................................................78

Nurse Characteristics .............................................................................................................78

Overtime ................................................................................................................................78

Float Nurses and Agency Pools .............................................................................................79

Organizational Factors That Affect Staffing Plans ......................................................................79

Philosophy Statement.............................................................................................................79

Organizational Staffing Procedures .......................................................................................80

Organizational Support Systems ............................................................................................80

Productivity ..................................................................................................................................81

Patient Classification Systems .....................................................................................................82

Factor System .........................................................................................................................82

Prototype System ...................................................................................................................83

Scheduling ....................................................................................................................................83

Centralized Scheduling ..........................................................................................................83

Decentralized Scheduling ......................................................................................................84

Self-Scheduling ......................................................................................................................84

Case Study 5-1: Staffing and Scheduling ....................................................................................85


Answers ..................................................................................................................................85

Summary ......................................................................................................................................86

Contents— x Leadership and Management for Every Nurse


Resources .....................................................................................................................................86

Exam Questions ...........................................................................................................................87

References ....................................................................................................................................89Chapter 6: Staff Management and Development ...............................................................................91



Introduction ..................................................................................................................................91

Meeting Staffing Needs ...............................................................................................................91

Effect of the Nursing Shortage ..............................................................................................91

Nurse Recruitment .................................................................................................................92

Nurse Retention .....................................................................................................................93

Nurse Turnover ......................................................................................................................97

Developing and Evaluating Nursing Teams ................................................................................98

Nurses’ Professional Development ........................................................................................98

Performance Appraisals .........................................................................................................98

Case Study 6-1: Performance Appraisal ....................................................................................100

Discussion Questions ...........................................................................................................101

Answers ................................................................................................................................101

Summary ....................................................................................................................................102

Resources ...................................................................................................................................102

Exam Questions .........................................................................................................................103

References ..................................................................................................................................105Chapter 7: Strategic Planning ............................................................................................................107

Learning Outcome .....................................................................................................................107

Chapter Objectives .....................................................................................................................107

Introduction ................................................................................................................................107

Strategic Planning Process .........................................................................................................107

TOWS Matrix ......................................................................................................................108

Phase I: Environmental Assessment ....................................................................................110

Phase II: Mission and Vision Statements, Philosophy, Goals, and Objectives ...................112

Phase III: Identification of Strategies ..................................................................................114

Phase IV: Implementation ....................................................................................................115

Phase V: Evaluation .............................................................................................................115

Strategic Planning Summary ................................................................................................116

Marketing ...................................................................................................................................116

Case Study 7-1: Mission Statement ...........................................................................................116


Answers ................................................................................................................................117

Contents—Leadership and Management for Every Nurse xi


Summary ....................................................................................................................................118

Resources ...................................................................................................................................118

Exam Questions .........................................................................................................................119

References ..................................................................................................................................121Chapter 8: Organizational Design Structures ...................................................................................123



Introduction ................................................................................................................................123

Span of Control ..........................................................................................................................123

Organizational Chart ..................................................................................................................124

Lines of Authority ......................................................................................................................124

Line Authority ......................................................................................................................124

Staff Authority .....................................................................................................................124

Organizational Structures ...........................................................................................................125

Centralized Structures ..........................................................................................................125

Decentralized Structures ......................................................................................................126

Matrix Structures .................................................................................................................128

Hybrid Structures .................................................................................................................128

Shared Governance ..............................................................................................................128

Case Study 8-1: Line and Staff Positions ..................................................................................130


Answers ................................................................................................................................130

Case Study 8-2: Nurse-Managed Clinic ....................................................................................131


Answers ................................................................................................................................131

Summary ....................................................................................................................................132

Resources ...................................................................................................................................133

Exam Questions .........................................................................................................................135

References ..................................................................................................................................137Chapter 9: Building Cohesive Healthcare Teams .............................................................................139



Introduction ................................................................................................................................139

Groups and Teams .....................................................................................................................140

Purpose of Teams .................................................................................................................140

Advantages and Disadvantages of Teams ............................................................................140

Informal Teams ....................................................................................................................141

Barriers to Effective Team Functioning ....................................................................................141

Contents— xii Leadership and Management for Every Nurse


Social Loafing ......................................................................................................................142

Polarization ..........................................................................................................................142

Groupthink ...........................................................................................................................143

Scapegoating ........................................................................................................................143

Managing Disruptive Behaviors ..........................................................................................143

Successful Teams .......................................................................................................................144

Types of Teams ..........................................................................................................................145

Interprofessional Teams .......................................................................................................145

Committees ..........................................................................................................................145

Facilitating Team Decision Making ...........................................................................................145

Shared Governance ....................................................................................................................147

Other Effective Teamwork Approaches ....................................................................................148

TeamSTEPPS .......................................................................................................................148

Situation-Background-Assessment-Recommendation ........................................................148

Effective Communication ....................................................................................................148

Quality and Safety Education for Nurses (QSEN) ..............................................................150

Managing Team Meetings .........................................................................................................150

Case Study 9-1: Preventing Ineffective Team Behaviors ..........................................................151


Answers ................................................................................................................................152

Case Study 9-2: Disruptive Team Behavior ..............................................................................152


Answers ................................................................................................................................153

Summary ....................................................................................................................................153

Resources ...................................................................................................................................154

Exam Questions .........................................................................................................................155

References ..................................................................................................................................157Chapter 10: Patient-Centered Care ...................................................................................................159



Introduction ................................................................................................................................159

Healthcare Models .....................................................................................................................160

Patient-Centered Care ..........................................................................................................160

Holistic Care ........................................................................................................................160

Nurse Leaders Empower Nurses to Provide Patient-Centered Care ..........................................161

Empowering Patients to Promote Patient-Centered Care ..........................................................162

Expertise of Patients and Families .......................................................................................163

Patient Diversity ...................................................................................................................163

Contents—Leadership and Management for Every Nurse xiii


Fostering Communication Between Patients and Their Care Team ..........................................163

Personal Communication Skills ...........................................................................................163

Common Barriers .................................................................................................................164

Limits and Boundaries .........................................................................................................164

Pain and Suffering ................................................................................................................164

Technology to Support Patient-Centered Care ..........................................................................164

Electronic Health Records ...................................................................................................165

Medication Errors ................................................................................................................165

Evidence-Based Practice ......................................................................................................165

Teaching Nurses How to Enhance Patient-Centered Care ........................................................167

Clinical Simulation ..............................................................................................................167

Experiential Learning ...........................................................................................................169

Quality and Safety ......................................................................................................................170

Magnet Recognition Program ..............................................................................................170

Other Quality Measures in Nursing .....................................................................................170

Case Study 10-1: Patient-Centered Culturally Sensitive Care ...................................................171


Answers ................................................................................................................................171

Summary ....................................................................................................................................172

Resources ...................................................................................................................................172

Exam Questions .........................................................................................................................173

References ..................................................................................................................................175Chapter 11: Managing Conflict and Stress .......................................................................................177



Introduction ................................................................................................................................177

Conflict ......................................................................................................................................177

Types of Conflict .................................................................................................................178

Managing Conflict ...............................................................................................................179

Conflict Resolution Approaches ..........................................................................................179

Stress ..........................................................................................................................................179

Burnout ................................................................................................................................181

Resources for Coping With Work-Related Stress ...............................................................181

Managing Stress ...................................................................................................................182

Case Study 11-1: Conflict Resolution........................................................................................182


Answers ................................................................................................................................184

Contents— xiv Leadership and Management for Every Nurse


Case Study 11-2: Work-Related Stress ......................................................................................185


Answers ................................................................................................................................185

Summary ....................................................................................................................................186

Resources ...................................................................................................................................186

Exam Questions .........................................................................................................................187

References ..................................................................................................................................189Chapter 12: Power and Influence .......................................................................................................191



Introduction ................................................................................................................................191

Power .........................................................................................................................................191

Types of Power ....................................................................................................................191

Creating a Powerful Image ..................................................................................................192

Empowerment ......................................................................................................................192

Power Strategies ...................................................................................................................194

Power Guidelines for Leaders ..............................................................................................195

Politics in Nursing......................................................................................................................196

Political Issues in Nursing ...................................................................................................196

Involvement in the National Student Nurses Association ...................................................196

Elected Nursing Officials and Nurses on Boards ................................................................196

Involvement in Professional Nursing Organizations ...........................................................197

Case Study 12-1 .........................................................................................................................199


Answers ................................................................................................................................199

Summary ....................................................................................................................................200

Resources ...................................................................................................................................200

Exam Questions .........................................................................................................................201

References ..................................................................................................................................203Chapter 13: Legal Issues .....................................................................................................................205



Introduction ................................................................................................................................205

Nurse Practice Acts ....................................................................................................................205

Malpractice and Negligence ......................................................................................................206

Documentation ...........................................................................................................................207

Errors ....................................................................................................................................207

Incident Reports ...................................................................................................................207

Contents—Leadership and Management for Every Nurse xv


Event Reports .......................................................................................................................208

Elements of Malpractice ............................................................................................................208

Duty ......................................................................................................................................208

Breach of Duty .....................................................................................................................209

Foreseeability .......................................................................................................................209

Causation ..............................................................................................................................209

Injury ....................................................................................................................................209

Damages ...............................................................................................................................209

Defending a Malpractice Lawsuit ..............................................................................................210

Informed Consent .......................................................................................................................210

Elements of Informed Consent ............................................................................................211

Nurse’s Role in Informed Consent ......................................................................................211

Consent for Mentally Incompetent Persons .........................................................................211

Consent for Emancipated Minors ........................................................................................211

Implied Consent .........................................................................................................................212

Advance Directives, Power of Attorney, and Conservatorship .................................................212

Confidentiality ...........................................................................................................................213

Employment Laws .....................................................................................................................214

Equal Employment Opportunity Laws ................................................................................214

The Civil Rights Act of 1964 ...............................................................................................214

Affirmative Action ...............................................................................................................215

Age Discrimination ..............................................................................................................215

Americans with Disabilities Act ..........................................................................................215

Equal Pay Act ......................................................................................................................216

Occupational Safety and Health Act ....................................................................................216

Family and Medical Leave Act ............................................................................................216

Case Study 13-1: Malpractice Defense ......................................................................................217


Answers ................................................................................................................................218

Case Study 13-2: Competent Adult ...........................................................................................218


Answers ................................................................................................................................218

Case Study 13-3: Confidentiality of Medical Record ................................................................219


Answers ................................................................................................................................219

Case Study 13-4: Employment Law and the Americans With Disabilities Act ........................220


Answers ................................................................................................................................220

Contents— xvi Leadership and Management for Every Nurse


Summary ....................................................................................................................................221

Resources ...................................................................................................................................221

Exam Questions .........................................................................................................................223

References ..................................................................................................................................225Chapter 14: Ethical Principles ............................................................................................................227



Introduction ................................................................................................................................227

Ethics Defined ............................................................................................................................227

Ethical Principles .................................................................................................................228

Ethical Dilemmas .................................................................................................................228

Personal and Professional Ethics ...............................................................................................230

Ethical Frameworks ...................................................................................................................230

The ANA’s Code of Ethics for Nurses With Interpretive Statements ..................................230

The Five-Step Nursing Process ............................................................................................232

The Ethical Positioning System Model................................................................................232

The American Medical Association’s Code of Medical Ethics Compared

With the ANA’s Code of Ethics for Nurses With Interpretive Statements .....................232

Patient-Centered Communication ........................................................................................233

Cultural Considerations .......................................................................................................233

Moral Model of Ethical Decision Making .................................................................................233

Ethics Support ............................................................................................................................235

Ethics Committees ...............................................................................................................235

Ombudsmen .........................................................................................................................235

Ethical and Legal Issues .............................................................................................................236

Common Ethical Issues for Nurses ............................................................................................237

Case Study 14-1: Patient Autonomy Versus Beneficence and Respect for Others ...................237


Answers ................................................................................................................................238

Case Study 14-2: Beneficence Versus Respect for Others ........................................................238


Answers ................................................................................................................................239

Case Study 14-3: Freedom Versus Veracity ..............................................................................239


Answers ................................................................................................................................240

Case Study 14-4: Utilitarianism Versus Privacy .......................................................................240


Answers ................................................................................................................................241

Contents—Leadership and Management for Every Nurse xvii


Summary ....................................................................................................................................241

Resources ...................................................................................................................................242

Exam Questions .........................................................................................................................243

References ..................................................................................................................................245Chapter 15: Nursing Roles ..................................................................................................................247



Introduction ................................................................................................................................247

Role Transition ...........................................................................................................................247

Understanding Roles ..................................................................................................................248

Scope of Practice ..................................................................................................................249

Role of Evidence in Practice ................................................................................................249

Informatics ...........................................................................................................................249

Models of Nurse Role Transition ...............................................................................................251

Mentorship ...........................................................................................................................251

Preceptorship ........................................................................................................................251

Coaching ..............................................................................................................................252

Professional Portfolios ...............................................................................................................254

Organizing the Portfolio ......................................................................................................255

Sections Within the Portfolio ...............................................................................................255

Categories ............................................................................................................................255

Polishing the Portfolio .........................................................................................................257

Preparing Successive Leaders ....................................................................................................257

Case Study 15-1: Preceptor Programs .......................................................................................258


Answers ................................................................................................................................259

Summary ....................................................................................................................................260

Resources ...................................................................................................................................260

Exam Questions .........................................................................................................................261

References ..................................................................................................................................263Chapter 16: Leading Through Involvement in Professional Organizations ..................................265



Introduction ................................................................................................................................265

Professional Organizations ........................................................................................................265

Benefits of Belonging to Professional Organizations ................................................................266

Reasons to Belong to Professional Nursing Organizations .................................................266

Personal Benefits .................................................................................................................266

Contents— xviii Leadership and Management for Every Nurse


Professional Benefits ...........................................................................................................271

Networking ................................................................................................................................271

Professional Development .........................................................................................................271

Academic Advancement ......................................................................................................271

Nurse Certification ...............................................................................................................272

Continuing Education ..........................................................................................................272

Case Study 16-1: Professional Nurse .........................................................................................274


Answers ................................................................................................................................274

Summary ....................................................................................................................................275

Resources ...................................................................................................................................275

Exam Questions .........................................................................................................................277

References ..................................................................................................................................279Glossary ................................................................................................................................................281Index ......................................................................................................................................................289

Contents—Leadership and Management for Every Nurse xix


F I G U R E S , T A B L E S , A N D B O X E S

Chapter 1

Table 1-1: Leader Traits .................................................................................................................2

Table 1-2: Effective Manager Characteristics ................................................................................6

Table 1-3: Nurse Manager Functions .............................................................................................8

Table 1-4: Interventions in the Prevention of Adverse Occurrences ..............................................9Chapter 2

Table 2-1: Five Rights of Delegation ...........................................................................................22

Figure 2-1: Delegation Model ......................................................................................................24

Figure 2-2: Decision Tree for Delegation by RNs .......................................................................25

Box 2-1: Completed Nursing Assessment Decision Grid for Mr. Jones ......................................33Chapter 3

Table 3-1: Decision-Making Processes Compared ......................................................................40

Figure 3-1: Decision Tree – Demand for Procedures and Overtime ...........................................42

Table 3-2: Decision Grid – CPM Machine ..................................................................................43

Table 3-3: Payoff Table – Professional Development Event ........................................................43

Figure 3-2: Problem-Solving Process ..........................................................................................46

Figure 3-3: Fishbone Diagram .....................................................................................................48

Figure 3-4: Completed SWOT Analysis for J. Williams ..............................................................50Chapter 4

Table 4-1: Operating, Capital, and Human Resources Budgets ...................................................59

Figure 4-1: Capital Expense Justification Form ..........................................................................61

Figure 4-2: Sample Unit Staffing Plan .........................................................................................63

Table 4-2: Nurse Staffing Full-Time Equivalent Calculation Based on a 2-Week Pay Period ......64

Figure 4-3: Schematic Representation of Productive and Nonproductive Hours

(Based on a Full-time Employment Status) ...............................................................64

Box 4-1: Budget Problems ...........................................................................................................65Chapter 5

Figure 5-1: Staffing Plan for Orthopedic Surgical Trauma Unit ..................................................81

Box 5-1: Patient Classification System ........................................................................................83

Table 5-1: Pros and Cons of a Centralized Scheduling Coordinator ...........................................84

Table 5-2: Pros and Cons of a Decentralized Scheduling Coordinator ........................................85

xxi


Figures and Tables— xxii Leadership and Management for Every Nurse

Chapter 6

Table 6-1: Factors Contributing to the Nursing Shortage ............................................................93

Table 6-2: Recruitment Strategies ................................................................................................94

Table 6-3: Nurse Recruitment Process .........................................................................................95

Table 6-4: Nurse Turnover Costs .................................................................................................97

Table 6-5: Conducting a Performance Appraisal .........................................................................99Chapter 7

Figure 7-1: Strategic Planning ...................................................................................................108

Figure 7-2: TOWS Analysis Framework....................................................................................109

Table 7-1: TOWS Matrix to Assess Viability of Opening a Comprehensive Cardiac Care Center ..111

Box 7-1: Sample Mission Statement..........................................................................................112Chapter 8

Figure 8-1: Clinic Organizational Chart ....................................................................................125

Figure 8-2: Centralized Structure – Pyramid .............................................................................126

Figure 8-3: Centralized Organizational Structure .....................................................................127

Figure 8-4: Decentralized Organizational Structure ..................................................................128

Figure 8-5: Hybrid Organizational Structure .............................................................................129Chapter 9

Table 9-1: Leader Interventions for Ineffective Team Functioning Behaviors ..........................142

Table 9-2: Strategies for Enhancing Critical Thinking and Decision Making

Among Team Members .............................................................................................147

Table 9-3: Situation-Background-Assessment-Recommendation .............................................149Chapter 10

Table 10-1: Comparison of Healthcare Models ........................................................................161

Figure 10-1: Biomedical Healthcare Model and Patient-Centered Healthcare Model ..............162

Box 10-1: Facts About Medication Errors .................................................................................166

Box 10-2: Model for Evidence-Based Practice .........................................................................167

Box 10-3: Continuum of Clinical Simulation ............................................................................169Chapter 11

Table 11-1: Strategies for Managing Conflict ............................................................................180

Table 11-2: Physical, Mental, and Work-Related Symptoms of Stress .....................................181

Table 11-3: Stress Management Techniques ..............................................................................183

Table 11-4: Time-Management Techniques ...............................................................................183

Table 11-5: Tips To Work More Efficiently ...............................................................................184Chapter 12

Table 12-1: Power – Types, People, and Examples ...................................................................193

Table 12-2: Creating a Power Image ..........................................................................................194

Table 12-3: Power Strategies .....................................................................................................195


Chapter 13

Table 13-1: Elements of Malpractice .........................................................................................210

Table 13-2: Healthcare Directive Terminology ..........................................................................213

Table 13-3: Federal Labor Legislation .......................................................................................217Chapter 14

Table 14-1: Ethical Principles ....................................................................................................229

Box 14-1: Code of Ethics for Nurses .........................................................................................231

Table 14-2: Ethical Decision-Making Grid ................................................................................235Chapter 15

Table 15-1: Benefits of Using Electronic Health Records .........................................................250

Table 15-2: Role Expectations of Nursing Students, Preceptors, Faculty, and Nurse Managers .....253

Table 15-3: Educational Credentials for Portfolio Inclusion .....................................................256

Table 15-4: Professional Portfolio Collections ..........................................................................257

Table 15-5: Professional Portfolio Categories ...........................................................................258Chapter 16

Table 16-1: Professional Nursing Organizations .......................................................................267

Table 16-2: Benefits of Belonging to Professional Nursing Organizations ...............................269

Table 16-3: Skill Acquisition Opportunities for Active Participants

in Professional Organizations ................................................................................270

Table 16-4: Certification Examinations Through the American Nurses Credentialing Center .....273

Figures and Tables—Leadership and Management for Every Nurse xxiii


xxv

P R E T E S T1. Begin this course by taking the pretest. Circle the answers to the questions on this page, or write the

answers on a separate sheet of paper. Do not log answers to the pretest questions on the FasTrax test sheet included with the course.

2. Compare your answers to the pretest key located at the end of the pretest. The pretest key indicates the chapter where the content of that question is discussed. Make note of the questions you missed, so that you can focus on those areas as you complete the course.

3. Complete the course by reading the chapters and completing the exam questions at the end of each chapter. Answers to the exam questions should be logged on the FasTrax test sheet included with the course.

Note: Choose the one option that BEST answers each question.

1. Followership can best be described as

a. a passive process of completing tasks assigned by a leader or manager.

b. a laissez-faire leader style.

c. an active process of participation by following a leader or manager.

d. a reactive approach to working in the healthcare environment.

2. The nurse leader cannot delegate

a. accountability.

b. invasive procedures.

c. responsibility.

d. authority.

3. Managers who overdelegate are

a. poor time managers.

b. grooming successive leaders.

c. proficient in their role.

d. overtasked in their role.

4. The fiscal-management decision-making tool most likely to be used by a nurse administrator is a

a. payoff table.

b. numerical scoring tool.

c. decision tree.

d. SWOT (strengths, weaknesses, opportunities, and threats) analysis.

5. The pay period at a facility is calculated on a 2-week block of time in which a full-time nurse works ten 8-hour shifts for a total of 80 hours, which is one full-time equivalent (FTE). What is the FTE when a part-time nurse works 64 hours during the same pay period?

a. 0.8 FTE

b. 0.7 FTE

c. 0.6 FTE

d. 0.5 FTE

continued on next page


6. A nurse manager over a nursing unit in a hospital typically schedules seven registered nurses (RNs), ten licensed practical nurses (LPNs), and ten unlicensed assistive personnel (UAP) during the day and four RNs, six LPNs, and eight UAP during the night. This scheduling approach is known as

a. float staffing.

b. factor staffing.

c. centralized staffing.

d. block staffing.

7. A key component to retaining nursing staff is

a. evidence-based practice.

b. utilitarianism.

c. job satisfaction.

d. coercive power.

8. Before starting a major initiative for a new comprehensive cardiac program, the responsible hospital administration would first

a. hire specialty physicians.

b. develop a budget plan.

c. design a new physical plant.

d. complete a TOWS matrix.

9. The number of subordinates one supervisor can effectively manage is known as

a. line authority.

b. staff authority.

c. span of control.

d. employee matrix.

10. The best way for a nurse leader to handle a team member who monopolizes the conversation at the monthly unit meeting is to

a. thank the person for his or her input.

b. call on another person to speak.

c. ignore the team member.

d. end the meeting and speak privately to the offending team member.

11. One method to empower a patient is to

a. praise the patient’s self-care skills.

b. teach the patient about his or her medications.

c. engage the patient in their care routine.

d. inform the family of care options.

12. Which mode of conflict resolution is represented when a nurse acquiesces to her team’s choice of a software product, although she believes that a different product would be superior in meeting the team’s needs?

a. Accommodating

b. Avoiding

c. Retreating

d. Negotiating

13. When a nurse leader requests that all staff sign up to work one extra weekend day per month because of the unit’s nursing shortage and the nurses comply out of fear of receiving a bad performance appraisal, the power exerted by the manager is

a. positional.

b. connection.

c. coercive.

d. expert.

Pretest— xxvi Leadership and Management for Every Nurse


14. The Equal Pay Act of 1963 prohibits the payment of wages based on

a. longevity.

b. merit.

c. gender.

d. greater skill.

15. The nurse allows an entire family to visit a patient, despite the fact that the patient requested no visitors so he could rest, because the nurse thinks that the desires of the many should outweigh the desires of an individual. The nurse is following the ethical principle of

a. privacy.

b. paternalism.

c. nonmaleficence.

d. utilitarianism.

16. A transitioning strategy that educational institutions and hospital organizations use to help nurses in new roles is the use of

a. preceptor programs.

b. training modules.

c. simulation exercises.

d. professional development programs.

17. The best tool that a nurse can use to showcase his or her past work activities during a job interview is a

a. current resume.

b. professional portfolio.

c. copy of a developed teaching tool.

d. video presentation.

18. Which is the best statement regarding the educational credentials of nurses?

a. Nurses with master’s degrees are needed in management positions.

b. Nurses with all different degree levels are needed in the profession.

c. Licensed practical nurses must practice in nursing home settings.

d. At a minimum, nurses must obtain bachelor’s degrees in nursing.

PRETEST KEY1. C page 82. A page 213. A page 294. A page 435. A page 646. D page 777. C page 978. D page 1089. C page 12310. B page 15011. C page 16012. A page 17913. C page 19214. C page 21615. D page 22916. A page 25117. B page 25418. B page 271

Pretest—Leadership and Management for Every Nurse xxvii


xxix

I N T R O D U C T I O N

LEARNING OUTCOMESAfter completing this course, the learner will be able to:

1. Discuss key aspects of the roles of leadership and management in nursing.

2. Describe delegation principles utilized in nursing practice.

3. Describe effective communication and problem-solving processes that nurses use.

4. Explain how strategic planning provides different organizational structures to assist decision making in nursing.

5. Identify financial skills and management practices for nurses.

6. Outline strategies to build cohesive interprofessional teams for healthcare organizations.

7. Discuss the concepts of patient-centered care within the contexts of nursing and nursing management.

8. Describe strategies for helping nurses to manage conflict and stress.

9. Discuss the role of power and influence in creating a professional nursing practice environment.

10. Describe essential legal and ethical principles for nurses.

11. Describe the various roles of the nurse in facilitating and supporting change.

12. Explain how professional nursing organizations provide leadership opportunities.

Health care is undergoing major changes and will continue to do so over the next decade. Important reasons for these changes are clearly stated in the National Academy of Medicine (NAM, 2016),

formerly called the Institute of Medicine (IOM), report that outlines initiatives and strategies to improve the quality and safety of our present healthcare system. Also, the implementation of the Affordable Care Act with the goal to expand healthcare coverage to all Americans and to help control healthcare costs has created even more changes to the present healthcare system. Our present healthcare system is shift-ing from illness care to wellness care and prevention. Emphasis is focused on quality care at a lower cost and with shorter hospital stays, easier access to care, and economic penalties for avoidable readmis-sions and errors. The “Baby Boomer” generation, the largest generation in our population, will reach retirement age, resulting in not only a shortage of nurses but an increased need for nurses to care for this population. Finally, advances in technology are providing immediate access to healthcare resources, education, and “choices” to patients and families. With more than 3 million nurses in the United States – the largest segment of the nation’s healthcare workforce – it is imperative that nurses are prepared to help lead these changes in healthcare quality, safety, access, and value (NAM, 2015).

Nurses have been educated to practice professional nursing and use all their specialized skills to care for patients. Unfortunately, most nurses are not knowledgeable or skilled enough in leadership to


Introduction— xxx Leadership and Management for Every Nurse

effect the required changes in health care today. Nurses must expand their repertoire of knowledge and skills to practice in today’s multifaceted healthcare environment, especially their leadership skills. They are key players in healthcare organizations and are present 24 hours a day, 7 days a week. Nursing per-sonnel comprise approximately 33% of personnel in hospital organizations, and this percentage may be greater in other healthcare settings, such as home healthcare agencies, long-term care facilities, and hos-pice organizations to name a few (Bureau of Labor Statistics, 2016). Physicians rely on nurses to have direct care knowledge, familiarity with laboratory and other test results, and a relationship with family members so that the best possible decisions can be facilitated while rendering patient care. Therefore, the nurse has a significant role on the healthcare team, and he or she frequently serves as a liaison between the patient, the patient’s family, and the physician.

In today’s world, every nurse serves as a leader! Nurses provide and coordinate patient care, com-municate and collaborate with other nursing staff and the interdisciplinary team, and solve problems and facilitate decisions to ensure that patients receive quality, safe care. Nurses are involved in healthcare delivery processes on an organizational level, such as serving on committees, task forces, and other healthcare teams that plan and make decisions. They work with patients from the preadmission phase of hospitalization, move them through the healthcare system, and manage them in their home communities. There is a great need to develop nurses who are knowledgeable about leadership and management topics and able to apply this knowledge to their practice, wherever it might be.

The purpose of this course is to provide nurses with a solid foundation for effective nursing leader-ship and management. Nurses practicing in any healthcare setting will gain new knowledge or enhance previously acquired knowledge regarding leadership and management concepts such as

• leadership theory and principles,

• healthcare policy,

• legal issues and ethics,

• change and decision making,

• organizational structure and effective care delivery,

• healthcare economics,

• staff recruitment and retention, and

• leadership tools and resources.

The nurse will also explore content related to

• strategic planning,

• effective delegation,

• managing patient- and family-centered care,

• understanding and working with diversity and cultural needs,

• building interprofessional teams,

• improving teamwork through collaboration, coordination, and conflict resolution,


• effective communication,

• evidence-based practice and management, and

• quality and safety measures.

Reading and participating in the case studies in each chapter are recommended to augment learning. Resources at the end of each chapter are aimed at enhancing the retention of educational material and newly acquired knowledge.

This course is intended for nurses – licensed practical nurses, registered nurses, and advanced prac-tice registered nurses – practicing in any healthcare setting. It provides an excellent overview of the role and responsibilities of the nurse as a leader in our present and changing healthcare environment.

ReferencesBureau of Labor Statistics. (2016). Registered nurses. U.S. Department of Labor, Occupational Outlook

Handbook, 2016-17 Edition. Retrieved from http://www.bls.gov/ooh/healthcare/registered-nurses.htm

National Academy of Medicine (2015). Assessing Progress on the Institute of Medicine Report: The Future of Nursing. Report in Brief. Retrieved from http://nationalacademies.org/hmd/~/media/Files/Report%20Files/2015/AssessingFON_releaseslides/Nursing-Report-in-brief.pdf

National Academy of Medicine (2016). The NAM’s initiatives respond to current and emerging priorities in health and medicine. Retrieved from https://nam.edu/initiatives/

Introduction—Leadership and Management for Every Nurse xxxi


C H A P T E R 1LEADING AND MANAGING

LEARNING OUTCOME

After completing this chapter, the learner will be able to discuss the difference

between leadership and management, the ben-efits of both concepts to effective nursing prac-tice, and their roles in nursing.

CHAPTER OBJECTIVESAfter completing this chapter, the learner

will be able to:

1. Define leadership, management, and follow-ership as they relate to professional nursing.

2. Differentiate autocratic, bureaucratic, demo-cratic, laissez-faire, participative, transac-tional, and transformational leadership styles.

3. Describe characteristics of effective nurse leaders and managers.

4. Identify the opportunities for nursing leader-ship at all levels of an organization.

5. Explain the benefits of leadership in nursing organizations.

INTRODUCTION

Nursing leadership and nursing manage-ment are two distinct concepts. Attributes

of both are wonderful tools for nurses to have to work effectively with other healthcare pro-fessionals. In this chapter, nursing leadership, leadership styles, nursing management, nurse

manager roles, and followership are examined relative to their importance in today’s healthcare environments. The nursing profession is one that experiences constant change in clinical practice and workplace environments and must remain responsive to the healthcare needs of consumers.

The purpose of this chapter is to enumer-ate the differences between, and to highlight the various roles of, the nurse leader and the nurse manager. Different leadership styles will be reviewed. The nurse’s role in organizational leadership will be explored, and nurses will learn the benefits of membership in professional nursing organizations. The importance of nurse leadership at the bedside will be highlighted in a case study.

LEADERSHIP

Leadership and management are two con-cepts that are often intertwined. To run

effectively, every organization needs good lead-ers and managers. However, leadership and management are two completely different con-cepts. Leadership is commonly defined as one person’s ability to influence others. In health care, leadership involves the use of personal traits to guide patients, families, and teams through a process requiring the collective efforts of all persons involved to achieve goals (Finkelman, 2016). Table 1-1 identifies the per-sonal traits of effective leaders.

1


Chapter 1—2 Leadership and Management for Every Nurse

A leader is a person who demonstrates and exercises influence over others to guide direc-tion over a decision or within an organization (Sullivan, 2013). A leader focuses on relation-ships rather than on the tasks required to accom-plish a goal. Leaders have three essential traits: a vision for the future, trust of colleagues and coworkers, and excellent communication skills.

Effective leaders are good listeners. Listening is the most difficult form of communication. Listening involves more than hearing. The lis-tener must pay attention and make an effort to hear the message. Attentive listening requires time and a desire to understand what another person is saying. Leaders can make use of good listening skills to garner important information for use in their decision making (Huber, 2014).

Leadership is a reciprocal relationship be-tween a leader and a follower. Leadership can occur between one leader and one follower, a leader and a group, or a leader and a hospi-tal, community, or the global society. Being a leader encompasses more than holding a posi-tion of authority and exerting control over sub-ordinates. Professional nurses are leaders every day when they help patients achieve the goals in their treatment plans, help patients learn self-care (for example, administering their own insu-lin injections), and move patients safely through hospitalization, from preadmission to discharge. Nurses are leaders regardless of the positions they hold in their organizations. Leaders are proactive in managing issues; they do not wait for something to happen. Clinical nurses must be proactive leaders in their daily practice.

TABLE 1-1: LEADER TRAITS

Trait Explanation

Trust Always tells the truth, even when it involves an outcome or a decision that the receiver does not want to hear

Vision Analyzes current healthcare trends and envisions a better future for health care

Integrity Knows own strengths and limitations, learns from them, and takes action based on self-knowledge, honesty, and life maturity

Proactiveness Takes action versus letting an event happen

Skillful interactions with employees

Focuses on relationships (versus tasks); coaches, mentors, and counsels

Excellent communication skills

Speaks openly, with no hidden agenda; does not violate confidences and readily shares appropriate information

Willingness to take risks Takes educated risks toward achievement of organizational outcomes

Delegation skills Delegates doing nondelegable tasks to free time; delegates to empower and groom future leaders

Change master Welcomes change for the betterment of the organization

Ability to empower followership

Mentors and coaches followers to be leaders in the organization

Ability to motivate Motivates and encourages others to achieve organizational goals

Excellent listening skills Informs the leader about key pieces of information necessary to make sound decisions

Note. From Western Schools.


Chapter 1—Leading and Managing 3

LEADERSHIP STYLES

There are several different leadership styles. Depending on the healthcare setting and

the experience and skill level of the leader or employee, different leadership styles have varying levels of efficacy (Huber, 2014). The leader’s approach is influenced by his or her practice background and role expectations.

Autocratic LeadershipAutocratic leaders use centralized decision

making independent of the opinions of sub-ordinates (Huber, 2014). They use power and control to direct the workforce. This leadership style works well in crisis situations when clear directives are needed. Autocratic leaders usually have lower-performing groups that require close levels of supervision. Productivity, or “getting the job done,” is needed in healthcare organiza-tions, and using a more authoritarian leadership style leads to the success of achieving their organizational goals (Masters, 2017). A suc-cessful autocratic leader must be consistent and fair in applying rules.

Bureaucratic LeadershipBureaucratic leadership styles are closely

aligned with the autocratic leadership style (Finkelman, 2016). Subordinates are moti-vated by outside forces, such as fear related to disciplinary action and the power of the super-visor (Catalano, 2012). The bureaucratic leader relies on organizational policies and proce-dures and rules set forth by upper-level admin-istrators and takes an inflexible approach in day-to-day management decisions. The bureau-cratic leader gives directions without input from others on the healthcare team and expects orders to be followed.

Democratic LeadershipDemocratic leaders are more participa-

tory and share authority with other healthcare

team members. They employ a team approach, facilitate human and operating resources, and share responsibility for clinical decision mak-ing and quality improvements (Huber, 2014). Democratic leaders invite the opinions of subor-dinates and value their input in decision making for all aspects of clinical and managerial issues. They encourage each team member to work col-laboratively to accomplish clinical and manage-rial goals. Democratic leaders use their expert power to influence and gain the respect of their team members. Furthermore, they have close, one-on-one relationships with employees.

Laissez-Faire LeadershipLaissez-faire leaders are passive and defer

daily decision making to their subordinates. They do not set policy by preference or their inability to do so (Huber, 2014). They offer little information for editing or revising exist-ing policies. Simply put, they tend to follow existing policies without question. Their teams are generally less productive than those of auto-cratic and democratic leaders. Employees who have laissez-faire leaders tend to become frus-trated and experience low levels of job satis-faction. However, this leadership style can be useful when there are established goals and highly capable individuals who are self-directed in their practice.

Participative LeadershipParticipative leaders guide workers who are

responsible and like to problem solve (Evans, 2015). Such workers like to talk about issues to reach a consensus. They are motivated and like their work; however, they are not confi-dent enough to function independent of the leader (Huber, 2014). This style is effective in healthcare organizations that promote team-work concepts; however, it takes more time to involve others, talk with them about processes, and ask them to share their ideas. In the long



run, this style is best because there is a “buy-in” by nurses, which leads to their supporting professional initiatives. Teams who work effec-tively with a participatory leader have time to manage complex quality-of-care initiatives and work collaboratively with other disciplines to develop more elaborate, comprehensive plans of patient care.

Transactional LeadershipTransactional leaders manage the day-to-

day business of the healthcare organization. They function in a caretaker role and set goals for followers (Huber, 2014). The transactional leader’s main focus is on maintaining workflow by following established policies and protocols for completing routine care practices.

Transactional leaders are described as leaders who approach their subordinates in an exchange posture, whose purpose is the exchange of one thing for another. An example of an exchange posture is offering the team member a reward of weekend days off (instead of week days off) for chairing a committee to recommend changes to standardized care plans. Both parties benefit by this exchange: weekend days off for the team member and accomplish-ment of a major goal for the manager.

Transactional leaders are found more com-monly in healthcare organizations today (Finkel-man, 2016). Their focus is on accomplishing the routine work that needs to be done on the patient care unit.

Transformational LeadershipTransformational leaders guide teams to

function and practice at their highest level of capability (Huber, 2014). They have charismatic personalities that inspire followers to embrace change in the organization, understand their individual roles within the organization, and take personal risks to improve their performance.

Transformational leadership styles fit well with the constantly changing healthcare environment.

Transformational leaders empower others. They are self-confident, self-starters, highly motivated, honest, energetic, and committed to the organization. These leaders gain power by disseminating more power to their followers. Power, simply defined, is a person’s ability to influence others.

LEADERSHIP VERSUS MANAGEMENT

The terms leader and manager are often used interchangeably, but they are not the same.

Not every nurse manager is a good leader, and those who demonstrate strong nursing leader-ship are not necessarily managers. Finkelman (2016) states that the “difference between man-agers and leaders is that managers focus on managing or maintaining equilibrium and daily operations, whereas leaders focus on change and develop and set a strategic vision” (p. 16). Conversely, managers focus on task completion. Simply put, managers get the job done and are often described as a particular position within an organization. Managers direct work groups and complete numerous managerial tasks, such as scheduling, time card completion, quality management audits, and staffing and patient assignments. Leaders do not necessarily need a set position within the organization. Any nurse in any position within an organization can be considered a leader, whether they are a health, wellness, quality, or safe care leader for all healthcare consumers.

Nursing requires management but also needs leadership. Leaders communicate to the nursing team the importance of their contribu-tions and recognize their successes (Finkelman, 2016). Leaders motivate teams to continue to be effective and to accept and want positive



changes. Leaders are constantly searching for better ways to accomplish goals, ask questions, take risks, and are challenged by change. Nurses can demonstrate leadership skills at any level of experience and in any stage of their careers. Nurses do not have to supervise or manage any-one to position themselves as leaders. Working collaboratively with others; demonstrating enthusiasm and motivation to provide safe, quality care to patients and families; and help-ing the team function cohesively are all exam-ples of leadership. An individual can be a great leader but not a manager. Conversely, a nurse can be a manager but not possess many nursing leadership skills (Anderson, 2012). However, although differences do exist, the roles can defi-nitely overlap. The best case scenario is for an individual to have the best characteristics of both, recognizing that all nurses are leaders and managers at some level. Critical thinking, active listening, and proficient coping skills are essen-tial at all levels in today’s nursing workforce (Anderson, 2012).

Nurse Manager Responsibilities, Tasks, Characteristics, and Functions

In acute care settings, a nurse manager is a registered nurse (RN) with 24/7 responsibil-ity for the management of one or more patient care units (Gonzalez, 2015). In outpatient healthcare settings, such as clinics, schools, and nursing homes, the RN is very often the leader in assessing, planning, and evaluating patient care. He or she works collaboratively with other healthcare providers and team mem-bers to deliver and manage that care. The nurse manager has a complex role that includes many different tasks, some of which require immedi-ate attention (Finkelman, 2016). An example of this would be a graduate nurse assigned to a patient who suddenly codes. The new nurse may not be experienced in managing a life-and-death situation on a general medical unit.

The nurse manager would need to immediately ensure that appropriate support and guidance, perhaps provided by an assistant nurse manager or charge nurse, was given to the new nurse in this healthcare crisis.

The nurse manager role has many compo-nents, including determining care delivery sys-tems; managing human, operational, and capital fiscal resources; developing and promoting pro-fessional development and continuing education programs; supporting nurse practice according to professional nursing standards; and maintain-ing compliance with regulatory agency guide-lines (Gonzalez, 2015). Nurse managers deal with difficult employees, use established disci-plinary policies, and follow and enforce agency policies and procedures.

Nurse managers are skilled in coordinat-ing and motivating nursing teams and patient groups and maintaining a safe environment in healthcare settings. Nurse managers follow and enforce the rules of the organizations for which they work, balance complex healthcare environ-ments and job demands, and maintain produc-tivity and delivery of quality care to consumers in hospitals and community healthcare settings (Gonzalez, 2015). Table 1-2 identifies the char-acteristics of effective nurse managers. These characteristics are very important to the smooth running of healthcare organizations.

Many reasons can motivate a person to apply for and accept a nurse manager role. The person may be stimulated by a challenge to manage a unit that was unstable with con-stant turnover, do a better job than his or her predecessor, improve working conditions for teams, or enhance quality of care initiatives – or the motive may be loyalty to the employ-ing organization.

Other reasons that cause a person to pur-sue a nursing management position may be the need for a higher salary to support a family, to



gain management experience that supports a graduate school program focused on nursing administration, or to be held in higher regard by family, friends, and peers. A nurse may apply for a management position because an opening suddenly occurs and the nurse executive offers an “interim” role. This unexpected role change may provide the new interim manager with an opportunity to “try on” the role before making a formal application.

Nurse managers listen to others, are good collaborators across other professional disci-plines, and are coordinators of resources. They like getting the job done, whether it is complet-ing audits on crash cart checks every shift, com-pleting the payroll, or participating in required management meetings.

Every organization has different require-ments for a person to be in a nurse manager role. In all organizations, the nurse must have an active license to practice. Hospitals fre-quently require experience in the specialty in

which the nurse is applying to become a nurse manager. Years of experience may vary in dif-ferent organizations; however, many hospitals require that the nurse hold a bachelor’s degree in nursing. In large teaching and research- intensive health systems, a master’s degree in nursing may be required or preferred, depending on the complexity of the unit (American Nurses Association [ANA], 2016).

In large acute care settings, nurse manag-ers may have assistant nurse managers working on the opposite shift(s). However, the nurse manager is still responsible and accountable for the unit. When an adequate nursing team is in place, the nurse manager usually is not called at home unless a higher level situation occurs. Higher level situations may involve emergent situations, such as the sudden admis-sion of many trauma patients from the emer-gency department (ED) as a result of a bus accident. This type of situation could result in obtaining additional licensed personnel than the

TABLE 1-2: EFFECTIVE MANAGER CHARACTERISTICS

Characteristic Example

Coordinates supplies, equipment, and nursing team resources

Submits 4-week nursing team schedule to the nursing office by the first day of the month

Promotes safety Ensures sharps containers for contaminated needles are changed weekly or more often if needed

Maintains patient standards Ensures that current standards of practice are available on the unit and that clinical nurses are aware of the standards through annual check-offs

Complies with regulatory agency reports

Maintains medical record audits that are needed for a regulatory agency (The Joint Commission) visit every third year

Enforces agency policies Holds a formal counseling session with each clinical nurse about his or her medication error rate

Selects care delivery system for unit Supports team nursing on the assigned patient care unit

Coordinates continuing education programs through the facility’s continuing education department

Ensures that on-site programs are offered at quarterly programs for nurses to obtain needed continuing education for licensure

Utilizes effective listening skills Encourages others’ ideasNote. Adapted from Gonzalez, J. (2015). Developing the role of manager. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (6th ed., pp. 51-69). St. Louis, MO: Mosby Elsevier.



unit typically staffs. Another example of a situ-ation warranting a call to the nurse manager at home may be a sudden change in the weather that would preclude team members from outly-ing areas from traveling to the hospital. In this case, the nurse manager could be called in to help provide direct patient care.

Nurse managers are responsible for the day-to-day operation of their respective units, which involves every aspect of managing a patient care unit. Some of the basic functions include communicating expectations, developing teams, advancing their own management skills, rep-resenting and advocating for the unit to higher levels of management, making nurse-patient care assignments, managing budgets, conduct-ing performance evaluations, hiring new clini-cal nurse team members, enforcing disciplinary actions, terminating employees when warranted, and explaining new policies, procedures, and protocols. See Table 1-3 for a review of the nurse manager’s functions along with examples of how nurse managers achieve the functions associated with their role.

Effective Nurse ManagersEffective nurse managers must have the

stamina to meet the daily challenges of their role. They must manage the care needs of patients and their families, upper administration expectations, physician requests, patient care orders, and the needs and desires of the nurs-ing and ancillary staff. Consumers of care are more educated than in the past, and many use the Internet to investigate their health condi-tions, which commonly leads consumers to have more questions based on what they learned. The effective nurse manager listens to their ques-tions and concerns and responds by answering and, at times, referring the patient or family member to other healthcare professionals who can help with their specific situations.

Another excellent characteristic that effec-tive nurse managers will have in their repertoire of skills is clinical capabilities in the specialty field of their assigned units (Gonzalez, 2015). Understanding the care complexities of patients, contributing to (standardized) plans of patient care, and allocating care-specific resources in an objective way that includes nursing, ancillary staff, and physicians in the decision making all contribute to the effectiveness and success of the nurse manager.

The effective nurse manager maintains safety in the workplace. This is done by fol-lowing agency policy for safely disposing of hazardous materials, keeping patient care areas free from excess materials, and maintaining safe access in hallways and the main unit sta-tion. This requires the nurse manager to be a good communicator with environmental ser-vices to ensure the unit he or she is responsible for is clean and safe for patients and health-care staff. Nurse managers emphasize that all healthcare professionals, including man-agement and their teams, must make safety a concern and work together to promote safe working environments.

Violence in the hospital can occur on all units; however, the ED, psychiatric, and sub-stance abuse units are especially vulnerable (Wilkinson, 2015). Many EDs have security personnel because they are high-volume, high-traffic areas. Violence prevention programs are key to maintaining a safe workplace. Hospital personnel involved on a safety committee with middle managers and administrators can create protocols and policies that address safe working environments. Safety committee members can analyze a violent incident after an occurrence, solicit feedback from personnel present at the time of occurrence, develop prevention strate-gies, and revise safety policies and protocols as



needed (U.S. Department of Labor, Occupational Safety & Health Administration, 2016).

Entire books and multiple journal articles have been written about safety in hospitals and other healthcare organizations. Astute nurses need to know where to access information, how to reliably surf the Internet, and when to enlist the help of hospital librarians. For example, the Agency for Healthcare Research and Quality (AHRQ) offers an excellent resource for the pre-vention of medical errors, which can have serious patient consequences in many different healthcare settings. Based on hundreds of patient safety and research projects, AHRQ provides many evidence-based tips to prevent harmful events (U.S. Department of Health & Human Resources, Agency for Healthcare Research and Quality, 2016). See Table 1-4 for interventions nurse man-agers can implement based on evidence-based findings to help prevent adverse occurrences on their nursing units.

FOLLOWERSHIP

Followership is an active (versus passive), interpersonal process of participating by fol-

lowing a leader or manager (Gonzalez, 2015). Effective followership entails a set of behav-iors that demonstrate cooperation, collaboration, teamwork, influence, and action with a leader. Being an effective follower takes as much work as being a good leader. Behaviors that reflect proficient leading, managing, and following complement each other (Gonzalez, 2015).

Principles of ideal followership are

• displaying respect toward others,

• working within the healthcare system,

• using “win-win” strategies,

• being proactive,

• accepting differences in people,

• working toward agency goals with the leader,

• making decisions based on professional values,

TABLE 1-3: NURSE MANAGER FUNCTIONS

Nurse Manager Function Example for Achievement of Function

Communicates goals for patient care unit

Nurses will answer call lights for all patients as a priority over charting in the electronic medical record (EMR) to meet the goal of improving patient satisfaction with nursing care

Assigns patients to nursing team per hospital policy and state nurse practice guidelines

Patients with higher acuity and more invasive procedures will be assigned to registered nurses (RNs)

Develops nursing personnel Provides time for nurses to attend professional development sessions, continuing education offerings, and formal educational programs to increase their knowledge of nursing theory and nursing practice

Encourages specialty certification(s)

Provides performance reviews and survey measurements

Completes annual performance evaluations and includes findings of survey measurements for patient satisfaction, error/incident reports*

Develops self and successive managers

Provides guidance and mentoring of successive managers

Pursues all aspects of continuing education, including advanced degrees

Seeks and/or maintains specialty certifications*Findings of surveys should be shared with employees at the time of receipt so strategies for improvement can be made.

Note. Adapted from Gonzalez, J. (2015). Developing the role of manager. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (6th ed., pp. 51-69). St. Louis, MO: Mosby Elsevier.



• being an effective team member when work-ing in a group,

• promoting the success of effective teamwork,

• recognizing the leader’s authority,

• securing the leader’s trust, and

• achieving goals without total dependence on the leader.

The roles of leaders, managers, and follow-ers can resemble each other. Telling the truth is a key component of being a good follower, even when the truth is not welcome or what the leader necessarily wants to hear. Effective followers may ask the following questions of themselves:

• Am I a good follower?

• Do I step forward?

• Is the leader happy that I am on the team?

• Am I on board with the goals of the leader?

• Do I interact with the leader in a healthy manner?

• Do I criticize the leader?

Being an effective leader, manager, or fol-lower requires time and focused energy. All nurses will be in a position of being a manager,

leader, or follower in their careers (Evans, 2015). Such positions as charge nurse and nurse manager are more formal positions that require greater leadership and management behaviors to establish organizational goals.

TABLE 1-4: INTERVENTIONS IN THE PREVENTION OF ADVERSE OCCURRENCES

• Prevent central line-associated blood stream infections.

• Re-engineer hospital discharges.

• Prevent venous thromboembolism.

• Educate patients about using blood thinners safely.

• Limit shift durations for nurses and other hospital staff when possible.

• Consider working with a patient safety organization.

• Use good hospital design principles (reduce infections by having single-bed patient rooms, fall prevention based upon well-designed rooms and bathrooms, having decentralized nursing stations that facilitate easier access to patients).

• Measure your hospital’s patient safety culture.

• Build better teams and rapid response systems.

• Use simulation exercises when training teams.Note. Adapted from Agency for Healthcare Research and Quality. (2016). Quality and patient safety. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/index.html

CRITICAL THINKING EXERCISE

What are the characteristics of a good follower?

Response

Effective followers demonstrate inde-pendent thinking and initiative to resolve problems and issues. There are different levels of engagement for followers. Some followers will want to be actively involved in resolving an issue, whereas others may be more comfortable with offering their ideas and deferring to the nurse manager. Followers are also accountable, competent, and dedicated to the leader and the organi-zation. They must be valued, nurtured, and developed as employees and future leaders.



CLINICAL NURSE LEADERSHIP

Serving on a unit task force or committee in one’s work setting and interacting with

other nurses and healthcare professionals facili-tates the learning of leadership skills. Serving on program, education, and other committees within a healthcare organization, and eventually chairing these same committees, contributes to a nurse’s leadership perspective.

Attending meetings and being active on committees in the workplace provide the clini-cal nurse with excellent opportunities to net-work with others in the profession. Serving as a mentor for a new nurse also builds leadership acumen. Mentees learn by example and can pro-mulgate excellent leaders and managers within the profession. Being active in the nursing pro-fession by serving on a local public health board or volunteering at an indigent care clinic are a few examples of ways that nurses can bring their knowledge, skills, and desire to help others into their communities.

LEADERSHIP IN PROFESSIONAL

ORGANIZATIONS

Clinical nurses can also serve the profession by being members of their professional

organizations. Most professional organizations have a “Willingness to Serve” form for mem-bers to complete, which is a great way to learn leadership skills and takes participants to the next level. This can be accomplished by serving on a local, regional, national, or international committee. Many professional organizations have “special interest groups” that have a large number of members, which is a good way for nurses to get a foot in the door and become known to leaders in the organization. It is most

often recommended that nurses begin to develop leadership skills in professional organizations at the local level because it allows for increased mentoring opportunities for leadership devel-opment. Later, the clinical nurse can volunteer to serve on a larger committee. Some of these committees include program planning (for the next annual conference or midyear continu-ing educational offerings), research, editorial boards, or leadership succession committees to name a few. Different professional organiza-tions will have varying opportunities to serve on task forces, editorial boards, manuscript review panels, and many different committees. Being visible in the public eye brings recognition to nurses and their employers.

One of the best routes for a nurse to take to garner leadership skills is to join a professional nursing organization (Catalano, 2012; Evans, 2015). Organizational leadership is a process of gaining leadership skills and attributes through involvement in professional nursing organiza-tions. The ANA represents the professional interests of more than 3 million RNs in the United States as well as in Puerto Rico and U.S. territories. The ANA is a full-service profes-sional nursing organization that encourages new graduate nurses to join (ANA, 2016). Within the ANA, running for an elected office at the district or state level can eventually lead to a position of greater responsibility at the state or national level. If nurses are not successful in their first bids for elected office, they should run again. Losing an election can still have a posi-tive outcome by getting a nurse’s name in the public eye – a plus for when the nurse runs for election at a future date.

Many clinical nurses gain leadership knowl-edge through active involvement in ANA state associations and on committees and task forces at local levels (Evans, 2015). State and local involvement is a major benefit for employer



healthcare organizations, as the nurse will bring back new knowledge and expertise to the orga-nization. Actively involved clinical nurse lead-ers can affect policy revisions and patient care protocol changes within their organizations. Another way to gain tremendous leadership skills and visibility is to serve as a delegate at a state or national meeting.

By joining the state nurses’ association, a nurse has the option, depending on the state where the nurse resides, to become a mem-ber of the ANA. Discounts are available for new members and new graduate nurses. Retired nurses and nurses who practice part-time enjoy reduced rates for membership (Catalano, 2012). Unfortunately, fewer than 10% of RNs join the ANA. The power to influence legislators is enhanced by greater numbers; the individual nurse does not have the power and influence held by the organization.

Professional Nursing Specialty Organizations

Nursing specialty organizations provide expert clinical knowledge in a focused clinical field. There are many different nursing clinical specialty-, research-, and leadership-focused nursing organizations in the United States.

Membership in professional nursing spe-cialty organizations affords leadership oppor-tunities in the nurse’s focused interest area. Additionally, nurses gain leadership opportuni-ties to give podium presentations at local, state, regional, national, and international forums, as well as to develop and impart knowledge in poster presentation formats.

Joining professional nursing organiza-tions facilitates networking among colleagues from all over the country and around the world. Professional networking is a continu-ous means of initiating and continuing relation-ships through communication and information

sharing. Shared collaboration outside of the nurse’s place of employment gives a broader perspective on healthcare issues in general and in specialty areas (Huber, 2014). Membership in professional nursing organizations gives the nurse a competitive edge through current knowl-edge, cutting-edge technologies, activism, and a connectedness with peers from across the globe.

Certification

Another major benefit of active mem-bership in nursing specialty organizations is becoming a certified nurse. According to the American Nurses Credentialing Center (ANCC; 2014), since 1991, more than 200,000 nurses have received specialty certification through the ANCC. Each year, the ANCC administers nearly 40 specialty and advanced practice cer-tification examinations. In addition, many nurs-ing specialty organizations offer certification in their respective specialty practice areas.

Certification signifies knowledge in a nursing specialty field beyond RN licensure (Huber, 2014). Certification is voluntary, and there are many ways of obtaining and main-taining certification. A nurse usually obtains initial certification by passing the specialty orga-nization’s examination. Certification is main-tained through different venues, depending on the certified field; examples include continuing education units, retesting, formal courses, pub-lication, and professional presentations (ANCC, 2016). Certification signifies to healthcare pro-fessionals and the general public that nurses have advanced knowledge and expertise above what was taught in their formal education pro-grams. In some clinical settings, nurses receive a stipend for certification. In other organizations, nurses receive a salary increase. Certification is a method to improve competencies beyond basic nurse generalist preparation and demonstrates a nurse’s willingness to be proactive in the for-ward movement of his or her career trajectory.



CASE STUDY 1-1: CLINICAL

NURSE LEADERSHIP

Clinical nurses are with patients every day throughout the year. In healthcare orga-

nizations, although clinical nurses do not hold formal management roles, they incorporate leadership skills and abilities into their everyday practice. This case study provides an example of how a clinical nurse can practice leadership in the clinical setting because both leadership and management skills are needed to effectively manage a patient care unit.

Joe was admitted to the hospital 10 days ago after sustaining multiple injuries in a motor vehicle accident. His major injuries were a fractured pelvis, multiple rib fractures, and an open femur fracture. His treatment pro-gram included analgesics for pain, activity as his condition would permit, and use of anti-embolic stockings. While friends and family were visiting, Joe suddenly called his clinical nurse to the room. He complained of chest pain and difficulty breathing. The nurse suspected that Joe had a pulmonary embolism (PE) and immediately notified the physician. Arterial blood gases were drawn, and a spiral computed tomography (CT) scan was obtained. Further interventions were immediately taken accord-ing to protocol, and Joe was transferred to the intensive care unit (ICU) for closer monitoring.

The CT scan confirmed that Joe had a PE. The nurse’s early recognition of the symptoms of PE contributed to the earliest possible inter-vention and could well have saved the patient’s life. The nurse has approximately 9 months of experience on the unit, and this situation was her first. In addition to her rapid assessment of Joe, the nurse kept the family informed of their loved one’s symptoms and status.

Joe had a quiet night in the ICU and re-sponded well to intravenous heparin therapy. When he woke the next morning, the day was calm and quiet, and the nurse who cared for him on the orthopedic surgical unit stopped by to see him. Joe thanked the nurse by saying, “I am grateful that you were my nurse yesterday. I didn’t know what was going on. You saved my life! I can’t thank you enough.” This was a quality moment that both the nurse and patient will always cherish.

Discussion Questions1. What leadership traits did the clinical nurse

display?

2. Why is this clinical nurse regarded as a leader despite the fact that this nurse is not in an executive position within the organization?

3. Why are the leadership characteristics of clinical nurses important at all levels of a healthcare organization?

Answers1. The leadership traits demonstrated by the

clinical nurse were

• excellent communication with the patient and his family,

• proactiveness in immediately notifying the physician and initiating the treatment protocol,

• ability to gain the trust of the patient and his family,

• integrity and flexibility as demonstrated by planning a visit with the patient the next day, and

• leadership modeling to coworkers.

2. A person does not have to be in an executive role to demonstrate leadership. The clini-cal nurse in this case study is regarded as a leader because of her professional behavior



and actions when dealing with the patient scenario. The actions of the nurse were independent; a nurse supervisor did not inform the nurse how to manage the patient case or request that the nurse provide quality and continuity of care.

3. Every position in an organization is impor-tant and has its own job responsibilities. Clinical nurse leaders are needed at the bed-side. In addition, support teams, such as laundry and food services, must do their roles equally well (clean linens promote patient health, and patients need to have their special dietary needs met). Hence, the roles of many healthcare team members are extremely important in the business of pro-viding quality patient care.

CASE STUDY 1-2: LEADER OR MANAGER?

Nurse managers hold formal supervisory roles in healthcare organizations based

on their titles. Some individuals have differing levels of leadership, whereas other managers are more effective with the day-to-day management expectations of their roles. The following is an example of a nurse leader exemplifying leader-ship traits.

Carol is the nurse manager of a 42-bed general and peripheral vascular surgical unit. Carol has been the nurse manager of this unit for 9 years. Her unit is known for the deliv-ery of quality nursing care by cheerful nurses, several of whom are clinical nurses with lon-gevity. The unit employs both new nurses and very seasoned nurses with several years of nursing experience. Today, Carol is assisting a new associate degree RN to complete her application to a baccalaureate degree nurs-ing program. She has just promoted one of her night-shift clinical nurses to the full-time

afternoon shift charge nurse position. Carol has delegated responsibility for implementing a new electronic health record system to another highly experienced RN. Carol frequently makes rounds on the unit each day, ensuring that patient needs are being met. During rounds, Carol commonly asks the nursing team about their family members and events in their per-sonal lives, such as buying a new home. Many employees on the general and peripheral vas-cular surgical unit have received the Employee of the Month Award because Carol strongly believes in acknowledging the good work of nurses on the unit.

Discussion Questions1. Does Carol exhibit leadership or management

behaviors? Which leader or manager traits does she exhibit in support of your answer?

2. Are any of the clinical nurses on the general and peripheral vascular surgical unit leaders?

Answers1. Although Carol is an excellent manager,

she clearly exhibits leadership behaviors. Management and leadership behaviors are not always inclusive of one another, but in this case, they are. Carol exhibits the follow-ing traits:

• motivating and encouraging her team to (a) assume positions of higher author-ity (clinical nurse to charge nurse) and (b) obtain further formal education for a nursing degree;

• exhibiting skillful interactions with employees, such as recognizing and rewarding employee performance; and

• displaying excellent communication skills and good delegation skills.

2. Yes. Leaders are cooperative and collab-orative with those with whom they work. Leaders can be followers when another



person’s skill set is greater in a certain area. The nurses on Carol’s unit exemplify leader-ship by taking on more responsibility (transi-tioning from clinical to charge nurse) and by being proactive by advancing their education.

SUMMARY

Having good leadership and management skills is important for hospitals and other

healthcare organizations to progress. Excellent leaders and managers inspire followership. This can be a reciprocal relationship, as lead-ers may share their authority with subordinates who have unique expertise in a specific area. Clinical nurses must take active roles in leader-ship as well. They can accomplish this through providing quality, patient-centered care; being active on committees within their organizations; and becoming involved in professional nurs-ing organizations and national, state, and local healthcare associations.

Nurse leaders and managers are confronted daily with the changes rapidly occurring in today’s healthcare environment. Nursing prac-tice faces many challenges, and nurse leaders must garner new strategies to cope with the increased demands for the delivery of quality health care.

RESOURCESAmerican Nurses Association.

http://nursingworld.org

American Nurses Credentialing Center. http://www.nursecredentialing.org

American Organization of Nurse Executives. http://www.aone.org

Center for Creative Leadership. http://www.ccl.org/leadership/index.aspx

Nursing Organizations Alliance. http://www.nursing-alliance.org

U.S. Department of Health & Human Resources, Agency for Healthcare Research and Quality. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/pstools/index.html#hospitals

U.S. Department of Labor, Occupational Safety & Health Administration. https://www.osha.gov/


E X A M Q U E S T I O N SCHAPTER 1

Questions 1–7

Note: Choose the one option that BEST answers each question.

1. A clinical nurse states, “You can’t expect me to be a leader. I work as a full-time clinical nurse on the night shift.” The astute nurse manager’s best response is

a. “We expect you to have good organizational skills.”

b. “A charge nurse position will be available soon.”

c. “Leadership occurs at all levels of the organization.”

d. “You will become a leader when you become certified.”

2. A difference between the personal traits of a nurse manager and a nurse leader is that the nurse leader

a. focuses on tasks to accomplish a goal.

b. focuses on relationships to accomplish a goal.

c. interprets policy, procedures, and mandates.

d. coordinates the monthly staffing schedule.

3. A clinical nurse reports that the attainment of laboratory results is too slow via the new computer system. An experienced democratic leader might

a. ask if the nurse is willing to chair a task force to look at this issue.

b. avoid interfering with the problem.

c. tell the nurse that she will look into the issue.

d. inform the nurse that this is not her area of responsibility.

4. A nurse manager who is a passive decision maker is best described as

a. a follower.

b. an autocratic leader.

c. a democratic leader.

d. a laissez-faire leader.

5. A notable characteristic of an effective nurse manager is to maintain

a. daily informal notes on each clinical nurse.

b. a safe work environment.

c. a complete resource library for clinical nurses.

d. a supply of snack food if clinical nurses are not able to take a meal break.

15 continued on next page



6. A clinical nurse can demonstrate leadership skills in the workplace by

a. reporting underperforming nurses to the nurse manager.

b. reading journal articles.

c. serving as a committee chair.

d. socializing with other nurses after work.

7. An important benefit of becoming a leader in a professional nursing specialty organization is the opportunity to

a. attend professional meetings at no cost.

b. meet world-renowned people.

c. increase one’s salary significantly.

d. network with national and international colleagues.


17

R E F E R E N C E S

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Wilkinson, C. (2015). Workplace violence and incivility. In P. S. Yoder-Wise (Ed.), Leading and managing in nursing (6th ed., pp. 464-481). St. Louis, MO: Mosby Elsevier.
