SOLUTION: Provide a brief summary of you, and your prior leadership experience, and area of leadership intere

Provide a brief summary of you, and your prior leadership experience, and area of leadership interest , and area of interest and development

NURSING LEADERSHIP
AND MANAGEMENT
FOR PATIENT SAFETY AND QUALITY CARE

3021_FM_i-xxx 16/01/17 3:28 PM Page i

3021_FM_i-xxx 16/01/17 3:28 PM Page ii

NURSING LEADERSHIP
AND MANAGEMENT
FOR PATIENT SAFETY AND QUALITY CARE

Elizabeth Murray, PhD, RN, CNE
Program Director, MSN Nurse Educator

Assistant Professor
Florida Gulf Coast University

School of Nursing
Fort Myers, Florida

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F. A. Davis Company
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Philadelphia, PA 19103
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Copyright © 2017 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be
reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
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Library of Congress Cataloging-in-Publication Data

Names: Murray, Elizabeth J., author.
Title: Nursing leadership and management for patient safety and quality care

/ Elizabeth J. Murray.
Description: Philadelphia : F.A. Davis Company, [2017] | Includes

bibliographical references and index.
Identifiers: LCCN 2016052944 | ISBN 9780803630215 (alk. paper)
Subjects: | MESH: Nursing Care—standards | Nursing Care—organization &

administration | Patient Safety—standards | Quality Assurance, Health
Care—methods | Leadership | Nurse’s Role

Classification: LCC RT89 | NLM WY 100.1 | DDC 610.73068—dc23
LC record available at https://lccn.loc.gov/2016052944

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3021_FM_i-xxx 16/01/17 3:28 PM Page iv

Dedication

This book is dedicated to my husband, Don, and my daughter, Angel, whose patience and
encouragement are unending. Thank you for always supporting me in my professional
endeavors and for understanding when I locked myself in “my cave.”

This book is also dedicated to Marydelle Polk, my mentor and friend, who shared so much
with me and who had a great influence on my development as a faculty member and whom
I miss dearly.

Finally, this book is dedicated to the hundreds of nurses and nursing students I have taught
over the years for inspiring me to actualize my passion for nursing, quality, and patient
safety through writing this book.

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3021_FM_i-xxx 16/01/17 3:28 PM Page vi

Epigraph

“It may seem a strange principle to enunciate as the very first requirement in a Hospital
that it should do the sick no harm. It is quite necessary nevertheless to lay down such
a principle.”

Florence Nightingale, 1863
Notes on Hospitals

“The world, more specifically the Hospital world, is in such a hurry, is moving so fast,
that it is too easy to slide into bad habits before we are aware.”

Florence Nightingale, 1914
Florence Nightingale to Her Nurses

vii

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3021_FM_i-xxx 16/01/17 3:28 PM Page viii

Preface

In 2000, the Institute of Medicine shocked the health-care community when they
reported, in their landmark report, To Err is Human, that approximately 98,000
Americans die each year as a result of preventable adverse events. In response,
many patient safety and quality initiatives were launched to make health care safer
in the United States and globally. More recently, James (2013) identified evidence
suggesting that a more accurate estimate of deaths from preventable errors is
200,000 to 400,000 per year. There is no question that the health-care delivery system
is undergoing major changes related to safety and quality. Nurses at all levels and
in all settings have been identified as key to transforming health care to a safer,
higher-quality, and more effective system. Front-line nurses are being charged with
taking leadership and management roles in transforming care at the bedside. Nurse
educators must prepare a new generation of nurses to step into these roles as
well as manage safe and effective patient care. To that end, this book was written
to provide a comprehensive approach to preparing nurses in the critical knowledge,
skills, and attitudes in leadership and management needed for the current and
future health-care environment.

This book is built on the premise that all nurses are leaders and managers re-
gardless of their position or setting in which they work. First-level or front-line
nursing leaders and managers are those leading and managing care of a patient
or groups of patients at the bedside and clients or groups in the community. This
level may also include charge nurses, patient care managers, and supervisors.
Second-level nursing leaders and managers are those holding a formal position
in the system such as unit manager. Their responsibilities include leading and
managing material, economic, and human resources necessary for the care of a
group of patients, as well as clients or groups in the community. The third-level
nursing leaders and managers are those holding a formal position in the organi-
zation such as a director over several units and whose responsibilities are similar
to those of the second level manager but encompass a broader scope. The fourth
level or executive level includes nursing leaders and managers in positions such
as chief nursing officer (CNO) or Vice President of Nursing Services. Their re-
sponsibilities include administering nursing units within the mission and goals
of the organization. Finally, many nurse leaders and managers hold positions
outside direct care delivery such as nurses in academic settings, labor unions,
political action groups, health-care coalitions, and consumer advocacy groups.
This book provides an evidence-based approach to attaining the necessary knowl-
edge, skills, and attitudes for nursing practice in today’s dynamic health-care
environment. It will be beneficial to prelicensure nursing students, RNs returning

3021_FM_i-xxx 16/01/17 3:28 PM Page ix

to school, new nurse leaders and managers, and nurses in any type of leadership
and management position that impacts health care and health-care recipients.

The underpinnings of this book are evidence-based practice, safety, quality, and
effective nursing care. The book will assist students to understand a current per-
spective of nursing leadership and management theories, concepts, and principles.
Evidence-based content is presented on topics relevant in today’s ever-changing
health-care environment, such as contemporary leadership and management
theories, managing ethical and legal issues, leading and managing effectively in a
culture of safety, improving and managing quality care, building and managing
a sustainable workforce, leading change and managing conflict, creating and
sustaining a healthy work environment, and managing resources.

The safety and quality of care depend greatly on our future nurses. I believe this
book will help future nurses to attain leadership and management knowledge, skills,
and attitudes critically needed to lead, manage, and provide safe, high-quality, and
effective nursing care.

ELIZABETH J. MURRAY
Fort Myers, Florida

x Preface

3021_FM_i-xxx 16/01/17 3:28 PM Page x

Contributors

Brett L. Andreasen, MS, RN-BC
Clinical Applications Analyst
Informatics Nurse Specialist
University of Washington
Medicine IT
Seattle, Washington

Rebecca Coey, MSN, RN, FNP
Family Nurse Practitioner
Fort Myers, Florida

Paula M. Davis-Huffman, DNP, ANP-BC,
PPCNP-BC, Emeritus CCRN
Assistant Professor
Florida Gulf Coast University
School of Nursing
Fort Myers, Florida

Sara Jo Foley, RN, MSN, FNP
Family Nurse Practitioner
Fort Myers, Florida

Linda K. Hays-Gallego, MN, RN
Lead Clinical Informatics Analyst, ORCA
Clinical Informatics and Support
University of Washington
Medicine IT
Seattle, Washington

Judith Walters, DNP, RN, PMHCNS-BC
Assistant Professor
Florida Gulf Coast University
School of Nursing
Fort Myers, Florida

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3021_FM_i-xxx 16/01/17 3:28 PM Page xii

Reviewers

Suzanne Barsness, MSN, RN, CCRC
Associate Professor
Northwest University
School of Nursing
Kirkland, Washington

Jennifer D. M. Cook, PhD, MBA, RN, CNS
Professor Emeritus
Adjunct Professor
University of the Incarnate Word
San Antonio, Texas

Laura Crouch, EdD, RN, CPAN, CNE
Associate Clinical Professor
Northern Arizona University
Flagstaff, Arizona

Cheryl A. Crowe, MS, RN
Instructor
Saint Francis College of Nursing
Peoria, Illinois

Holly J. Diesel, PhD, RN
Associate Professor
Goldfarb School of Nursing at Barnes-Jewish College
St. Louis, Missouri

Laura Dulski, RNC, CNE, MSN
Assistant Professor
Resurrection University
Chicago, Illinois

Karen M. Estridge, DNP, RN
Assistant Professor
College of Nursing and Health Sciences
Ashland University
Mansfield, Ohio

Michelle Ficca, PhD, RN
Chair and Professor
Bloomsburg University of Pennsylvania
Bloomsburg, Pennsylvania

Debbie Fischer, MS, RN
Assistant Teaching Professor
Montana State University
Billings, Montana

Eileen P. Geraci, MA, PhD, ANP-C
Professor
Western Connecticut State University
Danbury, Connecticut

Pamela G. Harrison, EdD, RN, CNE
Professor Pre-Licensure Nursing
Indiana Wesleyan University
Marion, Indiana

Mary B. Killeen, RN, PhD, NEA-BC
Associate Professor, Adjunct
University of Michigan-Flint
Flint, Michigan

Anita H. King, DNP, MA, FNP-BC,
CDE, FAADE
Professor
College of Nursing
University of South Alabama
Mobile, Alabama

Mary Kovarna, EdD, RN
Department Chair and Professor
Morningside College
Sioux City, Iowa

Rebecca Krepper, PhD, MBA, RN
Professor
Texas Woman’s University
Houston, Texas

Susan Lynch, MSN, RN, CNE
RN-BSN Coordinator
University of North Carolina Charlotte
Charlotte, North Carolina

xiii

3021_FM_i-xxx 16/01/17 3:28 PM Page xiii

David Martin, MN, RN
Program Director RN-BSN Program
Clinical Associate Professor
University of Kansas School of Nursing
Kansas City, Kansas

Carrie A. McCoy, PhD, MSPH, RN,
CEN, CNE
Professor of Nursing
Northern Kentucky University
Highland Heights, Kentucky

Tammie McCoy, RN, PhD
Professor and Chair BSN Program
Mississippi University for Women
Columbus, Mississippi

Kerry A. Milner, DNSc, RN
Assistant Professor of Nursing
Sacred Heart University
Fairfield, Connecticut

Beatriz C. Nieto, PhD, RN
Associate Professor
The University of Texas–Pan American
Edinburg, Texas

Elinor Nugent, PhD, APN-BC
Professor Emeritus
Curry College
Milton, Massachusetts

Lauren E. O’Hare, EdD, RN
Associate Professor of Nursing
The Evelyn Spiro School of Nursing

at Wagner College
Wagner College
Staten Island, New York

Mary Ovitt, RN, MSN
Assistant Professor
Idaho State University
Pocatello, Idaho

Aroha Page, PhD, RN
Associate Professor
Nipissing University
North Bay, Ontario, Canada

Verna C. Pangman, RN, MEd, MN
Senior Instructor
College of Nursing
University of Manitoba
Winnipeg, Manitoba, Canada

Maria Rosen, PhD, APRN-BC
Assistant Dean
Associate Professor
Massachusetts College of Pharmacy and Health

Sciences University
Worcester, Massachusetts

Kevin Dean Tipton, PhD, MN, BSN, RN
Associate Professor
Southern Utah University
Cedar City, Utah

Paulina Van, PhD, RN, CNE
Associate Professor
School of Nursing
Samuel Merritt University
Oakland, California

Laura Pruitt Walker, DHEd, MSN, RN, COI
Assistant Professor of Nursing
Certified Online Instructor
College of Nursing
Jacksonville State University
Jacksonville, Alabama

Janet R. Webber, RN, BSN, MSN, EdD
Professor of Nursing
Director of RN-BSN Online Program
Southeast Missouri State University
Cape Girardeau, Missouri

Danielle White, MSN, RN
Associate Professor
Austin Peay State University
Clarksville, Tennessee

xiv Reviewers

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Acknowledgments

I would like to thank Joanne DaCunha for helping me see that my ideas for this
book could be a reality. I would also like to thank Echo Gerhart and Amy Reeve
for their assistance with the editing and publishing of this project and for their
encouragement throughout the entire process.

3021_FM_i-xxx 16/01/17 3:28 PM Page xv

3021_FM_i-xxx 16/01/17 3:28 PM Page xvi

Contents in Brief

xvii

P a r t I Foundations and Background

C h a p t e r 1 Core Competencies for Safe and Quality Nursing Care 2

C h a p t e r 2 Health-Care Environment and Policy 27

C h a p t e r 3 Theories and Principles of Nursing Leadership
and Management 45

C h a p t e r 4 Ethical and Legal Aspects 61

C h a p t e r 5 Critical Thinking and Decision Making 102

C h a p t e r 6 Effective Communication 118

P a r t I I Promotion of Patient Safety and Quality Care

C h a p t e r 7 Improving and Managing Safe and Quality Care 142

C h a p t e r 8 Health-Care Organizations 174

C h a p t e r 9 Information Technology for Safe and Quality Patient Care 195

P a r t I I I Leadership and Management Functions

C h a p t e r 10 Creating and Managing a Sustainable Workforce 212

C h a p t e r 11 Organizing Patient Care 229

C h a p t e r 12 Delegating Effectively 254

C h a p t e r 13 Creating and Sustaining a Healthy Work Environment 271

3021_FM_i-xxx 16/01/17 3:28 PM Page xvii

C h a p t e r 14 Leading Change and Managing Conflict 294

C h a p t e r 15 Building and Managing Teams 313

C h a p t e r 16 Budgeting Concepts 327

P a r t I V Managing Your Future in Nursing

C h a p t e r 17 Transitioning From Student to Professional Nurse 346

Index 367

xviii Contents in Brief

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Contents

P a r t I Foundations and Background

C h a p t e r 1 Core Competencies for Safe and Quality Nursing Care 2
INSTITUTE OF MEDICINE REPORTS 3
QUALITY AND SAFETY EDUCATION FOR NURSES CORE COMPETENCIES 7

Patient-Centered Care 7
Advocacy 8
Empowerment 8
Self-Management 8
Health Literacy 9
Cultural Competence 9

OPTIMAL HEALING ENVIRONMENT 10
Teamwork and Collaboration 10

Care Coordination 12
Communication 13

Evidence-Based Practice 13
Nursing Research 15
Relationship With Quality Improvement 16
Clinical Practice Guidelines 16
Evidence-Based Management 16

Quality Improvement 17
Structure or Care Environment 18
Care Process 18
Outcomes of Care 18

Informatics 19
Information Management 19
Documentation 20

Safety 20
Human Errors and Factors 21
Standardized Protocols and Practice 22
Safety Culture 22
High-Reliability Organizations 23

CURRENT STATE OF SAFETY AND QUALITY 23

xix

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C h a p t e r 2 Health-Care Environment and Policy 27
SYSTEMS WITHIN THE HEALTH-CARE ENVIRONMENT 28
CURRENT STATUS OF HEALTH CARE IN THE UNITED STATES 30

Access to Health Care 30
The Cost of Health Care 31
Quality of Care 33
Lack of Providers and Services 35
Lack of Health Insurance and Insurance With Limited Income 36

THE PATIENT PROTECTION AND AFFORDABLE CARE ACT 37
MEDICARE AND MEDICAID 38
HEALTH POLICY 40

C h a p t e r 3 Theories and Principles of Nursing Leadership
and Management 45
HISTORICAL DEVELOPMENT OF LEADERSHIP 46

Trait Theories 46
Leadership Styles 47
Situational and Contingency Leadership Theories 47

CONTEMPORARY THEORIES OF LEADERSHIP 47
Relational Leadership Theories 48

Quantum Leadership 48
Transactional Leadership 48
Transformational Leadership 49
Connective Leadership 49

Attribution Leadership Theories 50
EMERGING LEADERSHIP THEORIES 50
PROFESSIONAL COMPETENCE IN NURSING LEADERSHIP 51
LEADERSHIP CHARACTERISTICS 51
FOLLOWERSHIP 54
MENTORSHIP 57

C h a p t e r 4 Ethical and Legal Aspects 61
ETHICAL ASPECTS OF NURSING PRACTICE 62

Morals 63
Moral Integrity 63
Moral Obligation 63

Values 64
Values Clarification 64
Core Professional Values for Nurses 64

Principles 65
Autonomy 65
Beneficence 66
Nonmaleficence 66
Justice 67
Fidelity 68
Veracity 68
Privacy 68
Confidentiality 68

xx Contents

3021_FM_i-xxx 16/01/17 3:28 PM Page xx

Theories 69
Utilitarianism 69
Deontology 70
Principlism 70

Codes of Ethics 70
International Council of Nurses Code of Ethics for
Nurses 71
Canadian Nurses Association Code of Ethics for Registered
Nurses 72
American Nurses Association Code of Ethics for Nurses With
Interpretive Statements 72

Ethical Dilemmas 73
Ethical Decision Making 76
Ethics Committees 76

LEGAL ASPECTS OF NURSING PRACTICE 77
Standards for Clinical Practice 78

Nursing’s Social Policy Statement: The Essence
of the Profession 78
Nursing: Scope and Standards of Practice 79

Licensure and Regulation of Nursing Practice 79
Licensure 79
Regulation 80

STATE NURSE PRACTICE ACTS 80
NATIONAL COUNCIL OF STATE BOARDS OF NURSING 80
STATE BOARDS OF NURSING 81

Federal and/or State Legislation 81
Health Insurance Portability and Accountability Act 81
Patient Self-Determination Act 82
Safe Medical Devices Act 83
Good Samaritan Laws 83
Disclosure Statutes 83
Employment Laws 84

Classifications of Law That Relate to Nursing Practice 85
Negligence and Malpractice 85

Elements of Malpractice 86
DUTY OWED THE PATIENT 87
BREACH OF THE DUTY OWED THE PATIENT 87
FORESEEABILITY OF HARM 87
CAUSATION 87
INJURY OR HARM 87

Major Categories of Malpractice 88
FAILURE TO ASSESS AND MONITOR 88
FAILURE TO FOLLOW STANDARDS OF CARE 88
FAILURE TO COMMUNICATE 89
FAILURE TO DOCUMENT 90
FAILURE TO ACT AS A PATIENT ADVOCATE 90
FAILURE TO USE EQUIPMENT IN A RESPONSIBLE MANNER 90

Contents xxi

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Expert Witnesses 90
Liability 90

Professional Liability Insurance 93
ETHICAL AND LEGAL ISSUES 93

Advance Directives 93
Living Will 94
Do Not Resuscitate 94
Durable Power of Attorney for Health Care 95

Confidentiality and Information Security 96
Informed Consent 97
Disruptive Behavior, Incivility, and Bullying 97
Unsafe or Questionable Practice 98

C h a p t e r 5 Critical Thinking and Decision Making 102
CRITICAL THINKING 103

Elements of and Cognitive Skills for Critical Thinking 103
Reactive, Reflective, and Intuitive Thinking 105
Modeling Critical Thinking 107

DECISION MAKING 107
Decision Making and the Nursing Process 108
Tools for Decision Making 109

DECIDE Model 110
Decision-Making Grid Analysis 110
SWOT Analysis 111

Shared Decision Making 112
Appreciative Inquiry 112

C h a p t e r 6 Effective Communication 118
WHY EFFECTIVE COMMUNICATION IS CRITICAL 119
BASICS OF COMMUNICATION 120

The Communication Process 120
Verbal and Nonverbal Communication 121

Verbal Communication 121
Nonverbal Communication 122

Active Listening 123
FACTORS THAT IMPACT COMMUNICATION 124

Gender 124
Generation 124
Culture 124
Values and Perceptions 124
Personal Space 125
Environment 125
Roles and Relationships 125

FORMAL AND INFORMAL COMMUNICATION 126
TYPES OF COMMUNICATION IN A HEALTH-CARE ENVIRONMENT 127

Organizational Communication 127
Interprofessional Communication 128

xxii Contents

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Interprofessional Team Rounding 129
TeamSTEPPS 130
SBAR 130

Intraprofessional Communication 133
Nurse-to-Nurse Transitions in Care 134

P a r t I I Promotion of Patient Safety and Quality Care

C h a p t e r 7 Improving and Managing Safe and Quality Care 142
MEDICAL ERRORS 144
CREATING A CULTURE OF SAFETY 148
PATIENT SAFETY INITIATIVES 150

Agency for Healthcare Research and Quality 150
American Nurses Association 151
National Quality Forum 151
Institute for Healthcare Improvement 152
The Joint Commission 154
World Health Organization 155

PRINCIPLES OF QUALITY IMPROVEMENT 155
MODELS FOR QUALITY IMPROVEMENT 159

Donabedian Model 159
Lean Model 160
Six Sigma Model 161
Institute for Healthcare Improvement Model of Improvement 161
Failure Modes and Effects Analysis 161
Root Cause Analysis 162

QUALITY IMPROVEMENT TOOLS 164
Run Chart 164
Bar Chart 165
Histogram 165
Fishbone Diagram 165
Flow Chart 167
Pareto Chart 167

C h a p t e r 8 Health-Care Organizations 174
BASIC ELEMENTS OF A HEALTH-CARE ORGANIZATION 175

For-Profit Versus Not-for-Profit Organizations 175
Types of Health-Care Organizations 176
Levels of Service 176

ORGANIZATIONAL STRUCTURE AND CULTURE, AND STRATEGIC
PLANNING 177

Organizational Structure 177
Organizational Culture 179
Strategic Planning 179

Contents xxiii

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REGULATION AND ACCREDITATION 182
Regulation 182
Accreditation 182

The Joint Commission 183
DNV GL 183
Magnet Recognition Program 183

ORGANIZATIONAL THEORIES 188
Classical Organization Theories 189
Contemporary Organizational Theories 190

General Systems Theory 190
Complexity Theory 191
Learning Organization Theory 192

C h a p t e r 9 Information Technology for Safe and Quality Patient Care 195
UNDERSTANDING NURSING INFORMATICS 196

Basic Elements of Informatics 196
Technical Aspects of Informatics 198

Network 199
Data 199
Database 199
Data Mining 199
Interfaces 199
Decision Support Systems 200
Rules and Alerts 200
Standardized Languages 200

HOW INFORMATICS CONTRIBUTES TO PATIENT SAFETY 201
LEGISLATIVE AND REGULATORY IMPACTS ON INFORMATICS 202

Health Insurance Portability and Accountability Act 203
American Recovery and Reinvestment Act of 2009 203
Regulatory Requirements 203

INFORMATICS DEPARTMENTS 204
USE OF DATA IN INFORMATICS 204

Data Set 204
Coding 204
Data Security 205

INFORMATION SYSTEMS USED IN HEALTH CARE 205
Electronic Medication Administration Record 206
Computerized Provider Order Entry 206
Barcode Medication Administration 206
Patient Portals 206
Telehealth 206
Online Health Information 207

IMPLEMENTATION OF AN INFORMATICS PROJECT 207
Conversion Strategy and Conversion Planning 207
Implementation Support Model 208
Maintenance 208
System Downtime 208

xxiv Contents

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P a r t I I I Leadership and Management Functions

C h a p t e r 10 Creating and Managing a Sustainable Workforce 212
CREATING A SUSTAINABLE WORKFORCE 213

Recruiting 213
Interviewing 214
Orienting 216
Retaining 217

MANAGING THE WORKFORCE 218
Managing Generational Differences 218
Coaching Staff Members 220
Appraising Performance 221
Using Corrective Action 223

C h a p t e r 11 Organizing Patient Care 229
CARE DELIVERY MODELS 230

Traditional Models 231
Total Patient Care 231
Functional Nursing 231
Team Nursing 232
Primary Nursing 232
Nursing Case Management 232

Nontraditional Models 233
Patient-Focused Care 233
Partnership Models 233
Nonclinical Models 234
Integrated Models 234

Contemporary Models 234
Professional Nursing Practice Model 234
Differentiated Nursing Practice Model 235
Clinical Nurse Leader Model 235
Synergy Model for Patient Care 236
Transforming Care at the Bedside 236
Patient- and Family-Centered Care Model 238

STAFFING FOR PATIENT SAFETY 239
Shortage of Nurses 240
Core Concepts of Staffing 241

Full-Time Equivalent 241
Productive Time 242
Average Daily Census 242
Staffing Mix 242
Workload and Units of Service 242
Unit Intensity 243
Patient Acuity 243
Skill Mix 243

RN SCOPE OF PRACTICE 243

Contents xxv

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LPN/LVN SCOPE OF PRACTICE 245
UAP SCOPE OF PRACTICE 245

Staffing Approaches 245
Patient Classification Systems 246
American Association of Nurses Principles for Safe Staffing 246
Agency for Healthcare Research and Quality Nurse
Staffing Model 247
National Database of Nursing Quality Indicators Staffing
Benchmarks 247

Developing and Implementing a Staffing Plan 249
Monitoring Productivity 250
Evaluating Staffing Effectiveness 251

C h a p t e r 12 Delegating Effectively 254
KEY PRINCIPLES OF DELEGATION 255

What Can and Cannot Be Delegated 257
Who Can and Cannot Delegate 258

THE FIVE RIGHTS OF DELEGATION 259
Right Task 259
Right Circumstances 260
Right Person 260
Right Direction or Communication 260
Right Supervision or Evaluation 261

THE DELEGATION PROCESS 261
BARRIERS TO EFFECIVE DELEGATION 265

Delegator-Related Barriers 266
Delegatee-Related Barriers 267
Leadership- and Management-Related Barriers 267
Breaking Down Barriers 269

C h a p t e r 13 Creating and Sustaining a Healthy Work Environment 271
GUIDELINES FOR BUILDING A HEALTHY WORK ENVIRONMENT 272
SAFETY ISSUES IN A HEALTH-CARE ENVIRONMENT 275

Safe Patient Handling and Mobility 276
Nurse Fatigue 278
Workplace Violence 280

Types of Violence 282
NURSE-TO-NURSE VIOLENCE 282
THIRD-PARTY VIOLENCE 284
NURSE-TO-PATIENT VIOLENCE 284
PATIENT-TO-NURSE VIOLENCE 284
ORGANIZATIONAL VIOLENCE 284
EXTERNAL VIOLENCE 285
SEXUAL HARASSMENT 285
MASS TRAUMA OR NATURAL DISASTERS 285

Contributing and Risk Factors 286
Consequences 286
Strategies to Prevent Workplace Violence 287

xxvi Contents

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C h a p t e r 14 Leading Change and Managing Conflict 294
CHANGE THEORIES 295

Traditional Change Theories and Models 296
Lewin’s Force-Field Model (1951) 296
Lippitt’s Phases of Change Model (1958) 297
Rogers’ Innovation-Decision Process (1995) 298
Kotter’s Eight-Stage Process of Creating Major
Change (1996) 299

Emerging Change Theories 301
Chaos Theory 302
Learning Organization Theory 302

MANAGING CHANGE AND INNOVATION 303
Becoming a Change Agent 304
Responding to Change 304
Adopting Change 305
Dealing With Barriers to Change 306

MANAGING CONFLICT 307
Types of Conflict 308

Intrapersonal Conflict 308
Interpersonal Conflict 308
Intergroup Conflict 309
Organizational Conflict 309

Conflict Management Strategies 309
Role of Nurse Leaders and Managers in Addressing Conflict 310

C h a p t e r 15 Building and Managing Teams 313
TEAMWORK AND COLLABORATION 314
TEAM BUILDING 317

Stages of Team Development 318
Creating Synergy 319

CHARACTERISTICS OF EFFECTIVE TEAMS 320
LEADING AND MANAGING TEAMS 321

C h a p t e r 16 Budgeting Concepts 327
BUDGETING AS A CORE COMPETENCY 328
COST CONTAINMENT AND EFFECTIVENESS 329
THE BUDGET PROCESS 330

Assessment 331
Diagnosis 331
Planning 331
Implementation 332
Evaluation 332

Productivity 333
NECESSARY CARE ACTIVITIES 334
VALUE-ADDED CARE ACTIVITIES 334
NON–VALUE-ADDED CARE ACTIVITIES 334

TYPES OF BUDGETS 336

Contents xxvii

3021_FM_i-xxx 16/01/17 3:28 PM Page xxvii

Operating Budget 336
Expenses 336
Revenues 337

Personnel Budget 337
Capital Budget 340

BUDGETING METHODS 340
Incremental Budgeting 340
Performance Budgeting 341
Zero-Based Budgeting 341

P a r t I V Managing Your Future in Nursing

C h a p t e r 17 Transitioning From Student to Professional Nurse 346
CAREER PLANNING AND DEVELOPMENT 347

Preparing a Strategic Career Plan 347
Developing a Resume 349
Interviewing 351

TRANSITION TO PRACTICE 353
PRECEPTORS AND MENTORS 354
STRATEGIES FOR PROFESSIONAL GROWTH 355

Becoming a Lifelong Learner 355
Continuing Education 356
Specialty Certification 357
Advanced Degrees 359

Contributing to the Nursing Profession 359
BALANCING PERSONAL AND PROFESSIONAL LIFE 360
FUTURE DIRECTIONS 363

Index 367

xxviii Contents

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Introduction

This book reflects the notion that all nurses at all levels and in all health-care set-
tings are leaders and managers. The purpose of this book is to provide an evidence-
based approach to nursing leadership and management as well as practical
applications to real-life situations that reflect today’s dynamic health-care environ-
ment. By integrating content from the National Council of Boards of Nursing
Licensure Examination (NCLEX) blueprint, the American Association of Colleges
of Nurses (AACN) Baccalaureate Essentials, the American Association of Nurses
(ANA) foundational documents for nursing practice, Quality and Safety Education
for Nurses (QSEN), the American Organization of Nurse Educators (AONE) stan-
dards, and various quality and safety initiatives, students will be introduced to
leadership and management theories, concepts, and principles.

This book offers a comprehensive approach to prepare nursing students in the
knowledge, skills, …