Leading and Managing in Nursing

Leading and Managing in Nursing


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







Concept and practice combined

Diversity of perspectives




Learning strategies

Complete teaching and learning package

Chapter overview Part 1: Overview

1: Leading, Managing, and Following


Theory development in leading, managing, and following

Leading, managing, and following—different but related

Traditional and emerging leadership and management roles

Leading, managing, and following in a diverse organization






The evidence

Tips for leading, managing, and following

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


The classic reports and emerging supports

Other key agencies and endeavors

Meaning for leading and managing in nursing



The evidence

Tips for clinical safety

3: Legal and Ethical Issues


Professional nursing practice: nurse practice acts

Negligence and malpractice

Informed consent

Privacy and confidentiality

Policies and procedures

Employment laws

Professional nursing practice: ethics



The evidence

Tips for incorporating legal and ethical issues in practice settings

4: Cultural Diversity and Inclusion in Health Care


Concepts and principles





National and global directives

Special issues


Meaning of diversity in the organization

Cultural relevance in the workplace

Individual and societal factors

Dealing effectively with cultural diversity

Implications in the workplace



The evidence

Tips for incorporating cultural diversity in health care

Part 2: Know Yourself

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


Informal and formal leadership

The core of learning to be a leader

Gaining insight into self

Becoming an authentic leader



The evidence

Tips for Gaining Personal Insight

6: Being an Effective Follower


Research on followership

Followership theories

Differences between leading and following

Leader–follower relationship






The evidence

Tips on how to be an effective follower

7: Managing Self: Stress and Time


Emotional intelligence

Understanding stress

Definition of stress

Sources of job stress

Dynamics of stress

Management of stress


Resolution of stress

Management of time



The evidence

Tips for self-management

8: Communication and Conflict


Effective communication within healthcare settings

Types of conflict

Stages of conflict

Categories of conflict

Modes of conflict resolution

Differences of conflict-handling styles among nurses

The role of the leader

Managing incivility, lateral violence, and bullying



The evidence




Tips for effective communication and addressing conflict

9: Power, Politics, and Influence





Sharing Power

Personal power strategies

Exercising Power and Influence in the Workplace and Other Organizations



The evidence

Tips for using influence

Part 3: Know the Organization

10: Healthcare Organizations


Characteristics and types of organizations


Acquisitions and mergers

Forces that influence healthcare organizations

Theoretical Perspectives

Nursing role and function changes



The evidence

Tips for healthcare organizations

11: Organizational Structures








Organizational culture

Factors influencing organizational development

Characteristics of organizational structures


Types of organizational structures

Emerging fluid relationships



The evidence

Tips for understanding organizational structures

12: Care Delivery Strategies


Historical methods of organizing nursing care

Leadership during implementation of a model of care

Organizational strategies influencing care delivery

Positive care delivery systems

Transitional care

Interprofessional education and collaboration



The evidence

Tips for selecting a care delivery model

13: Staffing and Scheduling


The staffing process

Evaluation of effective staffing

Factors in staffing that influence patient outcomes

Supplemental (agency or contract) staff and float pools

Organizational factors that affect staffing plans

Developing a staffing budget





Evaluating unit staffing and productivity



The evidence

Tips for staffing and scheduling

14: Workforce Engagement Through Collective Action and Governance


Nurses as knowledge workers

Professional practice responsibility

Workplace advocacy, engagement, and empowerment

Shared governance

Collective action, collective bargaining, and unionization in nursing

Healthy work environments



The evidence

Tips for workforce engagement and collective action

Part 4: Use Your Skills

15: Making Decisions and Solving Problems


Differentiation of decision making and problem solving

Decision making

Problem solving



The evidence

Tips for decision making and problem solving

16: The Impact of Technology





Types of technologies

Knowledge technology

Information systems


Patient safety

Impact of clinical information systems

Safely implementing health information technology

Future trends and professional issues

Professional, ethical nursing practice and new technologies



The evidence

Tips for managing information and technology

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


Historical perspective


Assignment versus delegation

NCSBN model: an organizational framework for delegation

Effective communication: an essential competency for successful delegation

Delegation and the decision-making process in nursing

Organizational and individual accountability

Legal authority to delegate

Learning how to delegate: different strategies for success



The evidence

Implications for practice

Tips for delegating

18: Leading Change





The nature of change

The change process

People and change

Context and change

Leadership and change



The evidence

Tips for leading change

19: Building Effective Teams


Groups and teams

Creating effective teams

Key concepts of teams

Issues that affect team functioning

Interprofessional teams

The value of team-building

The role of leadership



The evidence

Tips for team building

20: Managing Costs and Budgets


What escalates healthcare costs

How health care is financed

Healthcare reimbursement

The changing healthcare economic environment

Why profit is necessary

Cost-conscious nursing practices







The evidence

Tips for managing costs and budgets

21: Selecting, Developing, and Evaluating Staff


Roles in an organization

Selection of staff

Developing staff

Performance appraisals




The evidence

Tips for selecting, developing, and evaluating staff

22: Person-Centered Care


Person-centered care—why now?

Initiatives to deliver person-centered care

Challenges in the delivery of person-centered care

Patient engagement

Nurses in the delivery of person-centered care

Synthesis and application



The evidence

Tips for competent person-centered care

23: Managing Quality and Risk


Quality management in health care




Benefits of quality management

Planning for quality management

Evolution of quality management

Quality management principles


The quality improvement process

Quality assurance

Risk management



The evidence

Tips for quality management

24: Translating Research Into Practice


From using research to evidence-based practice

Development of evidence-based practice

Comparative effectiveness research

Practice-based evidence

Participatory action research

Quality improvement

Evaluating evidence

Organizational strategies to embed evidence-based practice into organizations

Issues for nurse leaders and managers



The evidence

Tips for developing skill in using evidence and translating research into practice

25: Managing Personal and Personnel Problems


Personal/personnel problems





Progressive discipline




The evidence

Tips in the documentation of problems

Part 5: Prepare for the Future

26: Role Transition


Types of roles

Roles: The ABCs of understanding roles

Role transition process

Strategies to promote role transition



The evidence

Tips for role transition

27: Managing Your Career


A career framework

Career theory

Professional development

Contributing through scholarly activities and research

Career marketing strategies



The evidence

Tips for a successful career

28: Developing the Role of Leader





What is a leader?

The practice of leadership

Leadership development

Leadership development model

Surviving and thriving as a leader

The nurse as leader



The evidence

Tips for becoming a leader

29: Developing the Role of Manager


The definition of management

Nurse manager as change leader

Nurse manager role and the intergenerational workforce

The nurse manager and interprofessional collaboration

Building a positive work environment

Consuming research

Organizational culture


Day-to-day management challenges

Managing resources

Technology and informatics

Dashboards and decision support tools

Budgets and finance

Quality indicators




The evidence

Tips for implementing the role of nurse manager




30: The Strategic Planning Process


Strategic planning

Reasons for strategic planning

Phases of the strategic planning process



The evidence

Tips for developing and executing a strategic plan for nursing

31: Thriving for the Future


Leadership demands for the future

Leadership strengths for the future

Visioning, forecasting, and innovation

The wise forecast model©

Shared vision

Projections for the future



Tips for the Thriving in the future

The evidence






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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!





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





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





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

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

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

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

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

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

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

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





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.




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

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

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

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

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

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

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

• Change continues at a rapid pace in health care and society in general. • Change must derive from evidence-based practices wherever possible and from

thoughtful innovation when no or limited evidence exists. • Healthcare delivery is highly dependent on the effectiveness of nurses across roles

and settings.

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