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Leading and Managing in Nursing

SEVENTH EDITION

Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN

Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas

Table of Contents

Cover image

Title page

Copyright Dedication

Contributors

Reviewers

Acknowledgments

Preface

Conceptandpracticecombined

Diversityofperspectives

Audience

Organization

Design

Learningstrategies

Completeteachingandlearningpackage

Chapter overview

Part 1: Overview

1: Leading, Managing, and Following

Introduction

Theorydevelopmentinleading,managing,andfollowing

Leading,managing,andfollowing differentbutrelated

Traditionalandemergingleadershipandmanagementroles

Leading,managing,andfollowinginadiverseorganization

Conclusion

Reflections

Theevidence

Tipsforleading,managing,andfollowing

2: Clinical Safety: The Core of Leading, Managing, and Following

Introduction

Theclassicreportsandemergingsupports

Otherkeyagenciesandendeavors

Meaningforleadingandmanaginginnursing

Conclusion

Reflections

Theevidence

Tipsforclinicalsafety

3: Legal and Ethical Issues

Introduction

Professionalnursingpractice:nursepracticeacts

Negligenceandmalpractice

Informedconsent

Privacyandconfidentiality

Policiesandprocedures

Employmentlaws

Professionalnursingpractice:ethics

Conclusion

Reflections

Theevidence

Tipsforincorporatinglegalandethicalissuesinpracticesettings

4: Cultural Diversity and Inclusion in Health Care

Introduction

Conceptsandprinciples

Theory

Nationalandglobaldirectives

Specialissues

Language

Meaningofdiversityintheorganization

Culturalrelevanceintheworkplace

Individualandsocietalfactors

Dealingeffectivelywithculturaldiversity

Implicationsintheworkplace

Conclusion

Reflections

Theevidence

Tipsforincorporatingculturaldiversityinhealthcare

Part 2: Know Yourself

5: Gaining Personal Insight: The Beginning of Being a Leader

Introduction

Informalandformalleadership

Thecoreoflearningtobealeader

Gaininginsightintoself

Becominganauthenticleader

Conclusion

Reflections

Theevidence

TipsforGainingPersonalInsight

6: Being an Effective Follower

Introduction

Researchonfollowership

Followershiptheories

Differencesbetweenleadingandfollowing

Leader–followerrelationship

Conclusion

Reflections

Theevidence

Tipsonhowtobeaneffectivefollower

7: Managing Self: Stress and Time

Introduction

Emotionalintelligence

Understandingstress

Definitionofstress

Sourcesofjobstress

Dynamicsofstress

Managementofstress

Burnout

Resolutionofstress

Managementoftime

Conclusion

Reflections

Theevidence

Tipsforself-management

8: Communication and Conflict

Introduction

Effectivecommunicationwithinhealthcaresettings

Typesofconflict

Stagesofconflict

Categoriesofconflict

Modesofconflictresolution

Differencesofconflict-handlingstylesamongnurses

Theroleoftheleader

Managingincivility,lateralviolence,andbullying

Conclusion

Reflections

Theevidence

Tipsforeffectivecommunicationandaddressingconflict

9: Power, Politics, and Influence

Introduction

History

Power

Empowerment

SharingPower

Personalpowerstrategies

ExercisingPowerandInfluenceintheWorkplaceandOtherOrganizations

Conclusion

Reflections

Theevidence

Tipsforusinginfluence

Part 3: Know the Organization

10: Healthcare Organizations

Introduction

Characteristicsandtypesoforganizations

Integration

Acquisitionsandmergers

Forcesthatinfluencehealthcareorganizations

TheoreticalPerspectives

Nursingroleandfunctionchanges

Conclusion

Reflections

Theevidence

Tipsforhealthcareorganizations

11: Organizational Structures

Introduction

Mission

Vision

Philosophy

Organizationalculture

Factorsinfluencingorganizationaldevelopment

Characteristicsoforganizationalstructures

Bureaucracy

Typesoforganizationalstructures

Emergingfluidrelationships

Conclusion

Reflections

Theevidence

Tipsforunderstandingorganizationalstructures

12: Care Delivery Strategies

Introduction

Historicalmethodsoforganizingnursingcare

Leadershipduringimplementationofamodelofcare

Organizationalstrategiesinfluencingcaredelivery

Positivecaredeliverysystems

Transitionalcare

Interprofessionaleducationandcollaboration

Conclusion

Reflections

Theevidence

Tipsforselectingacaredeliverymodel

13: Staffing and Scheduling

Introduction

Thestaffingprocess

Evaluationofeffectivestaffing

Factorsinstaffingthatinfluencepatientoutcomes

Supplemental(agencyorcontract)staffandfloatpools

Organizationalfactorsthataffectstaffingplans

Developingastaffingbudget

Scheduling

Evaluatingunitstaffingandproductivity

Conclusion

Reflections

Theevidence

Tipsforstaffingandscheduling

14: Workforce Engagement Through Collective Action and Governance

Introduction

Nursesasknowledgeworkers

Professionalpracticeresponsibility

Workplaceadvocacy,engagement,andempowerment

Sharedgovernance

Collectiveaction,collectivebargaining,andunionizationinnursing

Healthyworkenvironments

Conclusion

Reflections

Theevidence

Tipsforworkforceengagementandcollectiveaction

Part 4: Use Your Skills

15: Making Decisions and Solving Problems

Introduction

Differentiationofdecisionmakingandproblemsolving

Decisionmaking

Problemsolving

Conclusion

Reflections

Theevidence

Tipsfordecisionmakingandproblemsolving

16: The Impact of Technology

Introduction

Typesoftechnologies

Knowledgetechnology

Informationsystems

Informatics

Patientsafety

Impactofclinicalinformationsystems

Safelyimplementinghealthinformationtechnology

Futuretrendsandprofessionalissues

Professional,ethicalnursingpracticeandnewtechnologies

Conclusion

Reflections

Theevidence

Tipsformanaginginformationandtechnology

17: Delegating: Authority, Accountability, and Responsibility in Delegation Decisions

Introduction

Historicalperspective

Definitions

Assignmentversusdelegation

NCSBNmodel:anorganizationalframeworkfordelegation

Effectivecommunication:anessentialcompetencyforsuccessfuldelegation

Delegationandthedecision-makingprocessinnursing

Organizationalandindividualaccountability

Legalauthoritytodelegate

Learninghowtodelegate:differentstrategiesforsuccess

Conclusion

Reflections

Theevidence

Implicationsforpractice

Tipsfordelegating

18: Leading Change

Introduction

Thenatureofchange

Thechangeprocess

Peopleandchange

Contextandchange

Leadershipandchange

Conclusion

Reflections

Theevidence

Tipsforleadingchange

19:

Building Effective Teams

Introduction

Groupsandteams

Creatingeffectiveteams

Keyconceptsofteams

Issuesthataffectteamfunctioning

Interprofessionalteams

Thevalueofteam-building

Theroleofleadership

Conclusion

Reflections

Theevidence

Tipsforteambuilding

20: Managing Costs and Budgets

Introduction

Whatescalateshealthcarecosts

Howhealthcareisfinanced

Healthcarereimbursement

Thechanginghealthcareeconomicenvironment

Whyprofitisnecessary

Cost-consciousnursingpractices

Budgets

Conclusion

Reflections

Theevidence

Tipsformanagingcostsandbudgets

21: Selecting, Developing, and Evaluating Staff

Introduction

Rolesinanorganization

Selectionofstaff

Developingstaff

Performanceappraisals

Coaching

Conclusion

Reflections

Theevidence

Tipsforselecting,developing,andevaluatingstaff

22: Person-Centered Care

Introduction

Person-centeredcare whynow?

Initiativestodeliverperson-centeredcare

Challengesinthedeliveryofperson-centeredcare

Patientengagement

Nursesinthedeliveryofperson-centeredcare

Synthesisandapplication

Conclusion

Reflections

Theevidence

Tipsforcompetentperson-centeredcare

23: Managing Quality and Risk

Introduction

Qualitymanagementinhealthcare

Benefitsofqualitymanagement

Planningforqualitymanagement

Evolutionofqualitymanagement

Qualitymanagementprinciples

Customers

Thequalityimprovementprocess

Qualityassurance

Riskmanagement

Conclusion

Reflections

Theevidence

Tipsforqualitymanagement

24: Translating Research Into Practice

Introduction

Fromusingresearchtoevidence-basedpractice

Developmentofevidence-basedpractice

Comparativeeffectivenessresearch

Practice-basedevidence

Participatoryactionresearch

Qualityimprovement

Evaluatingevidence

Organizationalstrategiestoembedevidence-basedpracticeintoorganizations

Issuesfornurseleadersandmanagers

Conclusion

Reflections

Theevidence

Tipsfordevelopingskillinusingevidenceandtranslatingresearchintopractice

25: Managing Personal and Personnel Problems

Introduction

Personal/personnelproblems

Documentation

Progressivediscipline

Termination

Conclusion

Reflections

Theevidence

Tipsinthedocumentationofproblems

Part 5: Prepare for the Future

26: Role Transition

Introduction

Typesofroles

Roles:TheABCsofunderstandingroles

Roletransitionprocess

Strategiestopromoteroletransition

Conclusion

Reflections

Theevidence

Tipsforroletransition

27: Managing Your Career

Introduction

Acareerframework

Careertheory

Professionaldevelopment

Contributingthroughscholarlyactivitiesandresearch

Careermarketingstrategies

Conclusion

Reflections

Theevidence

Tipsforasuccessfulcareer

28: Developing the Role of Leader

Introduction

Whatisaleader?

Thepracticeofleadership

Leadershipdevelopment

Leadershipdevelopmentmodel

Survivingandthrivingasaleader

Thenurseasleader

Conclusion

Reflections

Theevidence

Tipsforbecomingaleader

29: Developing the Role of Manager

Introduction

Thedefinitionofmanagement

Nursemanageraschangeleader

Nursemanagerroleandtheintergenerationalworkforce

Thenursemanagerandinterprofessionalcollaboration

Buildingapositiveworkenvironment

Consumingresearch

Organizationalculture

Mentoring

Day-to-daymanagementchallenges

Managingresources

Technologyandinformatics

Dashboardsanddecisionsupporttools

Budgetsandfinance

Qualityindicators

Professionalism

Conclusion

Reflections

Theevidence

Tipsforimplementingtheroleofnursemanager

30: The Strategic Planning Process

Introduction

Strategicplanning

Reasonsforstrategicplanning

Phasesofthestrategicplanningprocess

Conclusion

Reflections

Theevidence

Tipsfordevelopingandexecutingastrategicplanfornursing

31: Thriving for the Future

Introduction

Leadershipdemandsforthefuture

Leadershipstrengthsforthefuture

Visioning,forecasting,andinnovation

Thewiseforecastmodel©

Sharedvision

Projectionsforthefuture

Conclusion

Reflections

TipsfortheThrivinginthefuture

Theevidence

Index

Copyright

3251 Riverport Lane

St Louis, Missouri 63043

LEADING AND MANAGING IN NURSING, SEVENTH EDITION

ISBN: 978-0-323-44913-7

Copyright © 2019 by Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein)

Notice

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted 2015, 2011, 2007, 2003, 1999, 1995. International Standard Book Number: 978-0-323-44913-7

Senior Content Strategist: Yvonne Alexopoulos

Content Development Manager: Lisa P Newton

Senior Content Development Specialist: Tina Kaemmerer

Publishing Services Manager: Julie Eddy

Senior Project Manager: Jodi M Willard

Design Direction: Brian Salisbury

Dedication

This book is dedicated to the families and friends who supported all of us who created it, to the faculty who use this book to develop tomorrow’s emerging leaders and managers, and to the learners who have the vision and insight to grasp today’s reality and mold it into the future of dynamic nursing leadership.

Lead on! ¡Adelante!

Contributors

Joan Benson, BSN, RN, CPN Manager, Clinical Informatics and Practice, Children's Mercy Kansas City, Kansas City, Missouri

Kristin K. Benton, BS, BSN, MSN, DNP Director of Nursing, Nursing, Texas Board of Nursing, Austin, Texas

Amy Boothe, DNP, RN Instructor, Traditional Undergraduate Program, Texas Tech University Health Sciences Center, Lubbock, Texas

Elizabeth H. Boyd, MSN, BS Instructor/Site Coordinator, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Myra A. Broadway, JD, MS, BSN Formerly, Executive Director, Maine State Board of Nursing, Past President, National Council of State Boards of Nursing, Maine Medical Professionals Health Program Advisory Committee USAFR Nurse Corps (Retired Colonel), Gardiner, Maine

M. Margaret Calacci, MS Director, Simulation and Learning Resources, Arizona State University College of Nursing and Health Innovation, Phoenix, Arizona

Mary Ellen Clyne, PhD President and Chief Executive Officer, Administration, Clara Maass Medical Center, Belleville, New Jersey

Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FACCE, FAAN Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Mary Ann T. Donohue-Ryan, PhD, RN, APN, APRN-MH, NEA-BC Vice President for Patient Care Services and Chief Nursing Officer, Administration, Englewood Hospital and Medical Center, Englewood, New Jersey

Michael L. Evans, PhD, MSN, BSN, BA Dean and Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Victoria N. Folse, PhD, APN, PMHCNS-BC, LCPC Director and Professor; Caroline F Rupert Endowed Chair of Nursing, School of Nursing, Illinois Wesleyan University, Bloomington, Illinois

Jacqueline Gonzalez, DNP, MBA, MSN Senior Vice President/Chief Nursing Officer, Nicklaus Children’s Hospital, Miami, Florida

Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN Clinical Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona

Shari Kist, PhD, RN Missouri Quality Initiative (MOQI) Project Supervisor, Sinclair School of Nursing, University of Missouri Columbia, Columbia, Missouri

Karren Kowalski, BSN, MSN, PhD President & CEO, Colorado Center for Nursing Excellence, Denver, Colorado Professor, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Mary E. Mancini, RN, MSN, PhD Senior Associate Dean for Education Innovation, Undergraduate Nursing, University of Texas at Arlington, Arlington, Texas

Maureen Murphy-Ruocco, APN-C, CSN, MSN, EdM, EdD, DPNAP Senior Fellow, National Academies of Practice, Nurse Consultant/Nurse Practitioner New York, New York

Professor and Dean Emerita Felician University, Lodi and Rutherford, New Jersey

Karen A Quintana, PhD, APRN, CPNP-PC Director of Pediatric Nurse Practitioner Studies, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Elaine S. Scott, BSN, MSN, PhD Chair, Nursing Science, East Carolina University, Greenville, North Carolina

Ashley Sediqzad, RN, BSN Manager, Clinical Informatics and Practice, Children's Mercy Kansas City, Kansas City, Missouri

Janis Bloedel Smith, DNP, MSN, BSN Senior Director, Clinical Informatics & Professional Practice, Patient Care Services, Children's Mercy Kansas City, Kansas City, Missouri

Susan Sportsman, PhD Nurse Consultant, Collaborative Momentum Consulting, LLC, St Louis, Missouri

Sylvain Trepanier, DNP, MSN, BSN, RN, CENP Chief Clinical Executive, Administration, Providence St Joseph Health, Torrance, California

Diane M Twedell, DNP, MS Chief Nursing Officer, Mayo Clinic Health System, Southeast Minnesota Region, Austin, Minnesota

Jeffery Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN Assistant Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas

Jana Wheeler, MSN, RN-BC, CPN Manager, Clinical Informatics & Practice, Children's Mercy Kansas City, Kansas City, Missouri

Crystal J. Wilkinson, DNP, RN, CNS-CH, CPHQ Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Austin, Texas

Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas

Margarete Lieb Zalon, PhD, RN, ACNS-BC, FAAN Professor, Nursing, University of Scranton, Scranton, Pennsylvania

Reviewers

Karen E Alexander, PhD, RN, CNOR Program Director RN-BSN, Assistant Professor, Clinical Heath and Applied Science Nursing, University of Houston Clear Lake, Houston, Texas

Vicki Bingham, PhD, RN, CPE Dean/Associate Professor of Nursing, Robert E Smith School of Nursing, Delta State University, Cleveland, Mississippi

Deborah Birk, PhD, RN, MHA, NEA-BC Assistant Professor, Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri

Barbara B. Blozen, EdD, MA, RN BC, CNL Associate Professor, New Jersey City University, Jersey City, New Jersey

Joseph Boney, MSN, RN, NEA-BC Director of Undergraduate Faculty Development/Instructor, Rutgers School of Nursing, Accelerated BS in Nursing Program, Newark, New Jersey

Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Nursing, Eastern University, St. Davids, Pennsylvania

Jane Campbell, DNP, RN, NE-BC Professor, School of Nursing, Northern Michigan University, Marquette, Michigan

Holly Johanna Diesel, RN, PhD Associate Professor, Academic Chair for Accelerated and RN to BSN Programs, Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri

Jennifer B. Drexler, RN, MSN, PhDc, CCRN Clinical Faculty Educator, College of Nursing, University of New Mexico, Albuquerque, New Mexico

Lynn Renee Dykstra, MS, BSN, HPCN, RN Instructor, Adjunct Faculty, Northern Illinois University, College of Health and Human Sciences, Nursing, DeKalb, Illinois Oakton Community College, Division of Science and Health Careers, Nursing Des Plaines, Illinois

Julie A Fitzgerald, PhD, RN, CNE Assistant Professor of Nursing, Ramapo College of New Jersey, Mahwah, New Jersey

Kay E. Gaehle, PhD, RN Associate Professor of Nursing, Department of Primary Care and Health Systems, Southern Illinois University Edwardsville, Edwardsville, Illinois

Maria Gillespie, EdD, MSN, BSN, BS, CNE, RN Assistant Professor, Nursing, University of the Incarnate Word, San Antonio, Texas

Julia Henderson Gist, PhD, RN, CNE Dean, School of Health Sciences, Arkansas State University Mountain Home, Mountain Home, Arkansas

Stephanie A. Gustman, DNP, MSN, BSN, RN Assistant Professor, School of Nursing, Ferris State University, Big Rapids, Michigan

Cam A. Hamilton, PhD, MSN, RN, CNE Assistant Professor, School of Nursing, Auburn University at Montgomery, Montgomery, Alabama

Pamela Gibler Harrison, EdD, RN, CNE Professor of Nursing, Chair, Pre-Licensure Nursing,

Indiana Wesleyan University, Marion, Indiana

Karen L. Hoblet, PhD, MSN, RN, CNL Licensed RN, Clinical Nurse Leader, Interim Department Chairperson and Associate Professor, Interim Director Nurse Educator and Clinical Nurse Leader Programs, Advanced Population Care, The University of Toledo College of Nursing, Toledo, Ohio

Janine Dailey Johnson, MSN, RN Assistant Professor, Nursing, Clarkson College, Omaha, Nebraska

Leo-Felix M. Jurado, PhD, RN, APN, NE-BC, CNE, FAAN Associate Professor, College of Science and Health, William Paterson University of New Jersey, Wayne, New Jersey

Barbara J. Keith, RN, MSN, CNE Clinical Lecturer, Vera Z. Dwyer College of Health Sciences, Indiana University School of Nursing, South Bend, Indiana

Donnamarie Lovestrand, RN, MSN, CPAN Faculty, Nursing Programs, Nursing Department, Pennsylvania College of Technology, Williamsport, Pennsylvania

Anne Boulter Lucero, RN, MSN Assistant Director, Instructor Nursing, Nursing Department, Cabrillo College, Aptos, California

Richard C. Meeks, DNP, RN, COI Assistant Professor, Graduate Program Coordinator, School of Nursing, Middle Tennessee State University, Murfreesboro, Tennessee

Kereen Forster Mullenbach, MBA, PhD, RN Associate Professor, Nursing, Radford University School of Nursing, Radford, Virginia

Sue S. Myers, RPN, BSW, MSCTE Faculty, Psychiatric Nursing and Bachelor of Psychiatric Nursing Programs, School of Nursing, Saskatchewan Polytechnic, Parkway Campus, Regina, Saskatchewan

Barbara Pinekenstein, DNP, RN- BC, CPHIMS Clinical Professor, Richard E. Sinaiko Professor in Health Care Leadership, School of Nursing, University of Wisconsin Madison, Madison, Wisconsin

Dawn M. Pope, MS, RN Assistant Clinical Professor (retired), College of Nursing, University of Wisconsin Oshkosh, Oshkosh, Wisconsin

Cara L. Rigby, DNP, RN, CMSRN Associate Professor, BSN Program Director, Nursing, The Christ College of Nursing and Health Sciences, Cincinnati, Ohio

Dulce Anne Santacroce, DNP, RN, CCM Nurse Educator, Nursing, Touro University Nevada, Henderson, Nevada

Ruth Schumacher, DNP, RN, CNL, CPN Assistant Professor, Department of Nursing and Health Sciences, Elmhurst College, Elmhurst, Illinois

Kathy S. Sweeney, MSN, RN Assistant Professor of Nursing, Nursing Education, Kansas Wesleyan University, Salina, Kansas

Denise Robin Zabriskie, DNP, RN, CWOCN, WCC Assistant Professor, School of Nursing, Touro University Nevada, Henderson, Nevada

Acknowledgments

As with any publication endeavor, many people other than those whose names appear on the cover make the actual publication possible, including the contributors and the Challenge/Solution authors These behind-the-scenes people also include the reviewers and the publishing team at Elsevier

We thank each of the contributors who worked diligently to meet deadlines and content expectations Their names are listed with the chapters they produced Without them, this book would be a lot thinner! The nurses who told their fabulous stories related to the various chapters always illustrate the real-world meaning of the importance of the chapter content; their names appear with their stories. Without all of them, this book would be much less interesting! What a fabulous group to work with

We are indebted to our reviewers, who provided valuable feedback that helped refine the book Receiving peer review is critical to any successful publication. Now that the book is completed, we know who they are and we thank them!

Jeff Watson took on coordinating the ancillaries, and Shelley Burson coordinated and managed an enormous number of details Both gently nudged all of us to complete our required tasks in a timely manner.

Special thanks go to our publishing team: Senior Content Strategist Yvonne Alexopoulos, Senior Content Development Specialist Tina Kaemmerer, and Senior Production Manager Jodi Willard

Even more special thanks go to my husband and best friend, Robert Thomas Wise, who vowed to be minimally disruptive as I sat in my office reading, writing, typing, and talking. He is a man of his word!

This book is designed to stimulate thinking and to encourage continued professional development in the area of leading and managing When the Institute of Medicine released the report, The Future of Nursing, the idea of leadership was clearly a concern for the profession. This book continues its tradition of providing the information that nurses need to assume greater leadership practices and even new management roles All contributors attempted to provide their best thinking on a given topic so that learners could integrate concepts to form the basis for their contribution to health care. Both the thinking and the complexities will continue to change…and so, hopefully, will you! The passion of nursing and leadership await!

Preface

The first edition of Leading and Managing in Nursing began in a hotel room in New Orleans, Louisiana in January of 1990 Darlene Como, the founding publisher of Leading and Managing, and I conceptualized a new way of presenting content about leadership and management: one that might engage learners in valuing the importance of roles that support clinical practice. This new approach included personal stories (The Challenge and The Solution), Literature Perspectives, Research Perspectives, synopses, exercises, and boxes of key information If you saw that first edition and compared the number of words then compared with the number of words in this edition, you would know the field has grown and become far more complex. Nursing has also grown the field of leadership and management research, and so we have many more citations we can share to make this content both theoretical and practical

We continue to include everything today’s nurses need to know about the basics of leading and managing. The changes with each revision of Leading and Managing reflect the intensity with which we know how leading and managing influence nurses in direct and indirect caregiving roles, as well as in other aspects of being a professional nurse in a complex, ever-changing, dynamic healthcare environment

Nurses throughout the profession serve in various leadership roles. Leading and managing are two essential expectations of all professional nurses and become increasingly important throughout one’s career To lead, manage, and follow successfully, nurses must possess not only knowledge and skills but also a caring and compassionate attitude

This book results from our continued strong belief in the need for a text that focuses in a distinctive way on the nursing leadership and management issues both today and in the future We continue to find that we are not alone in this belief This edition incorporates reviewers from both service and education to ensure that the text conveys important and timely information to users as they focus on the critical roles of leading, managing, and following. In addition, we took seriously the various comments offered by both educators and learners as I met them in person or heard from them by e-mail

Conceptandpracticecombined

Innovative in both content and presentation, Leading and Managing in Nursing merges theory, research, and practical application in key leadership and management areas Our overriding concern in this edition remains to create a text that, while well-grounded in theory and concept, presents the content in a way that is real Wherever possible, we use real-world examples from the continuum of today’s healthcare settings to illustrate the concepts Because each chapter contributor synthesizes the designated focus, you will find no lengthy quotations in these chapters. We have made every effort to make the content as engaging, inviting, and interesting as possible. Reflecting our view of the real world of nursing leadership and management today, the following themes pervade the text:

• Every role within nursing has the basic concern for safe, effective care for the people for whom we exist our clients and patients.

• The focus of health care continues to shift from the hospital to the community at a rapid rate

• Healthcare consumers and the healthcare workforce are increasingly culturally diverse.

• Today virtually every professional nurse leads, manages, and follows, regardless of title or position

• Consumer relationships play a central role in the delivery of nursing and health care

• Communication, collaboration, team-building, and other interpersonal skills form the foundation of effective nursing leadership and management

• Change continues at a rapid pace in health care and society in general.

• Change must derive from evidence-based practices wherever possible and from thoughtful innovation when no or limited evidence exists

• Healthcare delivery is highly dependent on the effectiveness of nurses across roles and settings.

Diversityofperspectives

Contributors are recruited from diverse settings, roles, and geographic areas, enabling us to offer a broad perspective on the critical elements of nursing leadership and management roles To help bridge the gap often found between nursing education and nursing practice, some contributors were recruited from academia, and others were recruited from practice settings This blend not only contributes to the richness of this text but also conveys a sense of oneness in nursing The historical “gap” between education and service must become a sense of a continuum, not a chasm.

Audience

This book is designed for undergraduate learners in nursing leadership and management courses, including those in BSN-completion courses and second-degree programs In addition, we know that practicing nurses who had not anticipated formal leadership and management roles in their careers use this text to capitalize on their own real-life experiences as a way to develop greater understanding about leading and managing and the important role of following Numerous examples and The Challenge/The Solution in each chapter provide relevance to the real world of nursing.

Organization

We have organized this text around issues that are key to the success of professional nurses in today’s constantly changing healthcare environment The content flows from the core concepts (leading, managing, and following; clinical safety; legal considerations; and culture), to knowing yourself (being an effective follower, self-management, conflicts, and power), to knowing the organization (care delivery strategies, staffing), to using your personal and professional skills (technology, delegation, change, and quality), to preparing for the future (personal role transition, self and career management and strategic planning).

Because repetition plays a crucial role in how well learners learn and retain new content, some topics appear in more than one chapter and in more than one section For example, because problem behavior is so disruptive, it is addressed in several chapters that focus on conflict, personal/personnel problems, incivility, and self-management. Rather than referring learners to another portion of the text, the key information is provided within the specific chapter

We also made an effort to express a variety of different views on some topics, as is true in the real world of nursing. This diversity of views in the real world presents a constant challenge to leaders, managers, and followers, who address the critical tasks of creating positive workplaces so that those who provide direct care thrive and continuously improve the patient experience

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As I, building the altars of their souls

To something that is nameless in a name, And, like a bell upon the night-tide, tolls Setting them midst their capers all to pray.

3.

This something seems at times of less import Than what is built thereto. The altars rise Immeasurable records of surmise; The achievement is indeed of the great sort, The length of their magnificence not short, But in our wonder at their grace and size Can we forget they were fashioned for your eyes, Or make of those oblivion in our sport!

Oh no, the idolater finds the idol still, Though there be pyramids to dazzle him, And paintings of high art along the wall, Still there is left the goddess young and slim, Her lips still breathe, her breasts still rise and fall,— He kills himself, if her he tries to kill.

4.

But these my friends like other men do eat, And sleep, and spend most merrily their while Upon this lily-earth; their hours beguile Each other, each with a memory to repeat. And if by chance they do a noble feat It is for them the subject of a smile, For they know well at some uncertain mile Staunch military Death will blow retreat.

Till in a moment they are one with me, And Love has conquered in an unseen way The turrets and the bulwarks of their dreams. No longer is to-morrow yesterday,

Nor life the pagan paradox it seems, And they are begging immortality.

5.

Immortal girl, what I have said in mirth About these people,—it is true of me, Only they live still rich in poverty, While I am one beyond the reach of earth. These, of their parent clay, still weigh the worth, And hesitate to plunge into the sea. But I, the sooner lost, have found in thee A new and an eternal kind of birth.

Because your eyes are flaming, and must burn, Your body fire that kills, your beauty death, I love, worshipping that which I desire. Icarus knew no more: I breathe thy breath, And touch thy hair;—if I to dust return At least I shall be cinders, you still fire.

Dagonet

You come to me for guidance? That’s a queer

Anomaly, to ask an aged man

What course in Life he recommends, what plan Of conduct,—ask the King, or Bedivere.... The King is dead? Oh, I recall,—last year It was; and Bedivere, last of the clan

To follow, like a tired veteran Obeyed the hand that beckoned from the mere. Yes, I remember now: in Camelot

When Life was wrapped about us like a flame How we enjoyed the zeal of Arthur’s rule. But that was long ago. And there is not A thing to say, because it was with shame I saw the King seek counsel of his fool.

The Dark Priest

The dark priest tutors me to-day,

The dark priest.

I turn to the left in the cloister way To the inner court with the hollyhock row, And he looks down upon me and watches me go, The dark priest.

I climb the stair to his study door, The dark priest, And I knock (I have done it o’er and o’er) Then he opens it slowly and ushers me in And I sit on the hassock and lessons begin, With the dark priest.

His fingers are long and his eyes are grey, The dark priest. The other boys fear him, so they say, But he throws back his cowl and he lets me see The smile on his lips, and he’s kind to me, My dark priest.

He takes his viola and tunes it to play, The dark priest, For my Latin’s well read and he promised to-day, And his instrument gleams in the dust-laden beams While I sit there athrill to his music of dreams, The dark priest.

He plays an old Normandy love song I know, The dark priest, And the strings quaver back the caress of the bow.

The chamber grows dark while his notes ring out clear, But he cannot conceal the slow fall of a tear, My dark priest.

Poem

A little laughter, and a few short days And Life is done: The race throughout this long bewildering maze Is quickly run.

A little friendship, and a word or so With worth half guessed— And then a-weary to long sleep we go, And that is best.

Life is a little while to dream our dreams Before we rest— And Life to us is always what it seems: That is Life’s jest.

A little hope, a friendship which might live, The laughing sun, A tear, a star, is all Life has to give Ere Life be done.

R. C. BATES.

Sonnet

Autumnal dusk was sweeping with a star,

Over the wood where lovers’ lips were meeting; Trembled the first cold night-flame, passed the far Low-whistling sadness of a duck’s wings beating. Heart strained to heart. The purple deepened through A twilight shriven in its pain of dying; Swiftly the wing-beats slanted earthward to The darkening marshes, with a throat-soft crying.

Night crept through dusk, as now the old surprise Crept through our kisses to the inner love, An age-old wistfulness. Our pensive eyes Yearned to the darkness and the veil thereof; Yea, and our ears found sorrow in the cries Of moor-fowls,—and the darkness wheeled above.

Book Reviews

Abbé Pierre. By

“Abbé Pierre”, by Jay William Hudson, is altogether a delightful and charming book. It may not be called very subtle, nor humorous, nor dramatic, nor sordid—qualities which most modern novels seem to imbibe; but that it is delightful and charming no one may deny.

In one respect the book is a picture of a Gascon village—its customs and its traditions, its thoughts and its dreams. These walks with Abbé Pierre along the dusty roads of Gascony, these glimpses of its hills and valleys, these insights into its daily life are most interesting and picturesque. Furthermore, such a background is ideal for the unfolding of the romance of Germaine Sance and the young American, David Ware.

In another respect the book is a picture of life viewed broadly and sympathetically. Abbé Pierre left his little Gascon village when he was quite young; he has given the best of his years and strength to the world; and now he returns to spend his last days in this place that he loves above all else. Here he sits in his garden house and writes down some thoughts and ideas about life born of many years of living. And these thoughts of his give the book, along with its beauty of description, its beauty of spirit.

I wish that all of us who aimlessly rush about this world with no time to read anything but an “exciting” novel would pause and read this book. I suppose my wish is ludicrous, for does not Abbé Pierre himself say that “Americans always seem to think that unless one is bustling about all the time one is doing nothing”? And then he immediately adds: “Some of the best deeds that I have ever done have been the thoughts I have lived through in this same old garden

by the white road, where wooden shoes go up and down”. He who can appreciate such a philosophy will read “Abbé Pierre” with much interest and delight.

Confessions of an Old Priest. By R. S. D. MC. (The MacMillan Co.)

We are all, being students, in a period when our opinions are forming rapidly according to our characters and interests. For those who feel that a religious philosophy is an essential basis from which other values must be derived, or for those whose religion is an untouched field of inherited beliefs and inhibitions, the time and the subjectmatter of “Confessions of an Old Priest” are ripe. The Rev. Mr. McConnell remains in the end as devout a Christian as he was fifty years ago, when he entered the Church convinced that “it owed its origin to Jesus Christ, and that He was the unique Son of God”. But he is no longer a worshipper of Jesus; he has taken the very cornerstone out of Christian doctrine and cast it away—and the edifice still shelters him as efficaciously as before.

The volume is devoted to his explanation of this paradox: how he finds himself a faithful Christian still, while the result of his historical research has disproved for him the divinity of Jesus. For Jesus, he declares, was not the original Christ; Christus, a Greek word, was applied to the heroes of a number of Mystery religions during the century before the obscure Hebrew province of Gallilee had any intimations that the “Messiah” was born.

And the most startling attack upon traditional dogma is his analysis of “the trouble with Christianity”. “It is,” he says, “not an unworthy Christianity, but an unworthy Christ.” When the reader has swallowed hard for a moment over that declaration, he reads on to discover what this astounding pastor means, and finds a wealth of plausible argument to support his extravagance of phrase. Jesus himself preached a “workless” doctrine, a “toil not, nor spin”

existence, a “turn the other cheek” attitude, and it is his biographers, together with such followers as Paul, who have incorporated Him into the practical philosophy and morality of the Church, to make Him the greatest exemplar in history of life as it should be lived. Jesus, and “Christlike” people are delightful, adorable characters, according to this book, but they are a care to the community, and should their ethics be generally adopted, civilization would go immediately more or less to smash.

The Rev. Mr. McConnell’s conclusions are so wholesale and so radical that I am not sure we can all accept them without comment or refutation. I cannot agree with his method of discriminating between true history and apostolic imagination in the “synoptic” gospels. But I do think every Christian should read this work as a test for his present beliefs and an introduction to new areas of religious thought. And it is quite possible that here is the way to a new religion and a satisfactory one in this time of restlessness and agnosticism.

What I Saw in America. By G. K. C.

(Hodder & Stoughton, Ltd.)

After reading Mr. G. K. Chesterton’s account of his recent travels in this country, we recalled to mind a certain cartoon which appeared some time ago in a London periodical, which depicted the author as an immense Zeppelin floating over the city From his mouth came great clouds of vapor and below were written the words: “G. K. C. spreading paradoxygen over London”. A similar caricature might be made in the present instance, for the gentleman in question has, in this book, tinged his treatment of America and American life with a shade of paradox.

It would seem to us as if this most interesting and penetrating series of essays should prove to be of greater interest to American than to English readers. Mr. Chesterton came, saw, and pondered, and the results of his meditations are a series of enlightening essays

dealing with everything in America and American life from a discussion of what America is, and what manner of men Americans are, to Prohibition and the Irish question.

The author never comments on any subject as you would expect him to. His impressions of the material and the abstract, of which we have formed no very definite opinion because of what might be called that contempt bred of familiarity, come to us as truths which are as worthy of our consideration as they merit the laughter of the foreigner.

When he tells you that he is not sure that the outcome of the Civil War may not have been for the best and that he believes that Walt Whitman was the greatest American poet, you may be inclined to disagree, but you will be forced to admit that, as he himself would say, his reasons are reasonable. Nor does this Englishman spare his own country in many of his comparisons. The book is not one to be read through in a sitting; it is something to be picked up and read one part at a time. There is none of the parts but will bear a second and even a third reading, for many of its truths are buried deep. It is a text-book in the art of the appreciation of foreign lands, and its teachings, if followed, would bring more lasting harmony among all peoples than the League of Nations it condemns.

Aaron’s Rod.

Mr. Lawrence is undoubtedly the most consistent of the so-called moderns on either side of the Atlantic. His novels, thus far, have set an average standard far above that of his closest rival, Mr. James Joyce. Mr Lawrence’s books are always readable; Mr Joyce’s, seldom, but they both have gifts of sincerity and mental acuteness which lift them from the ruck of the ordinary incomprehensible. Their pungent observations on types, existing conditions, and each other, are amusing to say the least.

M T

We have heard Mr Lawrence’s name bandied promiscuously about as a realist. Nothing could be less real than “Aaron’s Rod”. The action and dialogue never took place on this earth, nor does it seem probable that they ever will. There is an odd, pervasive sense of violence saturating this novel. The Great War has evidently left its stamp on the intellects of these younger British geniuses, for their work has a tense, strained quality which is disquieting in the extreme. The characters of “Aaron’s Rod” move ceaselessly back and forth like a scurrying body of ants; they jabber in a rather inhuman way about love, socialism, Italian scenery, and Christmas trees.

There is no action, no story to speak of: A coal miner runs off to London, thence to Italy, from one of the larger Midland towns, for no reason whatsoever except that his wife is fond of him. Persons appear on Mr. Lawrence’s stage, speak their lines, and hurry off again, no one seems to know whither. Nevertheless, these characters are interesting by virtue of Mr. Lawrence’s positive genius for purely physical portraiture. Josephine, Aaron Sisson’s first incidental “amoureuse”, is particularly well done, from a pictorial standpoint. Scarcely a page is given to her, yet she leaves an impression on our minds far more lasting than that of Aaron himself. Pains have been taken with Lady Franks in the same way; it seems as if Mr. Lawrence loses interest in his major characters. He must be on to pastures new.

“Aaron’s Rod” can scarcely be called a “good” novel. It contains many advanced ideas in the field of sociology which we found rather difficult to agree with. However, the world may in time grow up to Mr. Lawrence and until then we should seize the opportunity of reading his descriptions of luxurious interiors, and the Alps. They are remarkably able bits of writing.

Mr. Lawrence is an important novelist now, but it is in his power to do much better things than he has done so far. If he would lessen his tone of violent indignation, if he would tincture his spiritual realism a little less with impure physical realism, he might be considered one of the great novelists of our time. As it is, his achievement in “Aaron’s Rod” is remarkable in that he has stripped off everything

unnecessary, merely giving us the essentials on just about every topic known as a “world problem”. However, we should prefer the doses one at a time; all at once they seem a rather large gulp.

Editor’s Babel

Chaos!

In intonations worthy priests of Baal

Ahasuerus and Bukis

Mr. Benson and the Egoist

The Welcome Intruder and Richard Cory

Shout the praises of Poesy.

Chaos!!

“Be it all poesy—that flaming goddess With bewildering hair.”

Intones Richard Cory.

Sic transit prosae contributorum

Chaos!!!

We will be Punditical....

We are Punditical.

And so is the L.

Chaos!!!!

“WHEE!” from Cory, Bukis, Ahasuerus, Benson, and the E.

The Chase National Bank

HARRY RAPOPORT

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Every Wednesday at Park Avenue Hotel, Park Ave. and 33rd St., New York

1073 CHAPEL STREET NEW HAVEN, CONN.

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We extend our most sincere wishes for success to those men who step forth this month into the world of business—may each man bring greater glory to Yale.

The “Nettleton” Shop

1004 Chapel Street

Opposite Osborn Hall

The Brick Row Book Shop, Inc.

Booksellers, Importers, Print Dealers

From the very first it has been the policy of the Brick Row to render the best service possible to all lovers of books, first in New

Haven, later in New York and Princeton.

By adhering conscientiously to this avowed purpose, the Brick Row has gained an enviable place in the hearts of its clients. We hope to be of even more service to you in the future.

The Brick Row Book Shop, Inc.

A Derby belongs in every Wardrobe

SOONER OR LATER—and not infrequently—an occasion arises where the derby surpasses the soft hat in good taste and correct grooming.

For that occasion, we suggest that you select a derby now, and select a Knox. Whatever the model, be assured it is the mode. SEVEN DOLLARS

Haberdashery—Knox Hats—Clothing Specialists 940 Chapel Street, New Haven, Conn.

We darn your socks, sew your buttons on, and make all repairs without extra charge.

PACH BROS.

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