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Essentials of

Nursing Leadership

andManagement fifth edition

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Essentials of

Nursing Leadership

andManagement fifth edition

Diane K. Whitehead, EdD, RN, ANEF

Associate Dean, Nursing

Nova Southeastern University

Fort Lauderdale, Florida

Sally A. Weiss,EdD, RN, CNE

Associate Chair, Nursing

Nova Southeastern University

Fort Lauderdale, Florida

Ruth M. Tappen, EdD, RN, FAAN

Christine E. Lynn Eminent Scholar and Professor

Florida Atlantic University College of Nursing

Boca Raton, Florida

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F. A. Davis Company

1915 Arch Street

Philadelphia, PA 19103

www.fadavis.com

Copyright © 2010 by F. A. Davis Company

Copyright © 2007,2004,2001,1998 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, recording, or otherwise, without written permission from the publisher.

Printed in United States of America

Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1

Acquisition Editor:Joanne Patzek DaCunha, RN, MSN

Project Editors:Kim DePaul,Tyler Baber

Manager of Art & Design:Carolyn OBrien

As new scientific information becomes available through basic and clinical research,recommended treatments and drug

therapies undergo changes.The author(s) and publisher have done everything possible to make this book accurate, up

to date, and in accord with accepted standards at the time of publication.The author(s), editors, and publisher are not

responsible for errors or omissions or for consequences from application of the book,and make no warranty,expressed

or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader

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situation.The reader is advised always to check product information (package inserts) for changes and new informa-

tion regarding dose and contraindications before administering any drug. Caution is especially urged when using new

or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data

Whitehead, Diane K., 1945-

Essentials of nursing leadership and management / Diane K.Whitehead, Sally A.Weiss, Ruth M.Tappen. -- 5th ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-8036-2208-1 (pbk. : alk. paper)

1. Nursing services--Administration. 2. Leadership. I.Weiss, Sally A., 1950- II.Tappen, Ruth M. III.Title.

[DNLM: 1. Nursing--United States. 2. Leadership--United States. 3. Nursing--organization & administration--

United States. 4. Nursing Services--organization & administration--United States. WY 16 W592e 2010]

RT89.T357 2010

362.1'73068--dc22 2009017339

Authorization to photocopy items for internal or personal use,or the internal or personal use of specific clients,is grant-

ed by F.A.Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting

Service,provided that the fee of $.25 per copy is paid directly to CCC,222 Rosewood Drive,Danvers,MA 01923.For

those organizations that have been granted a photocopy license by CCC, a separate system of payment has been

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Dedication

To my sister Michele:

Your bravery and spirit inspire me every day.

Diane K. Whitehead

To my granddaughter Sydni,

Whose curiosity and wonder continuously remind me

of the reasons I became a nurse educator.

Sally A. Weiss

To students, colleagues, family and friends,

Who have taught me just about everything I know.

Ruth M. Tappen

v

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Preface

We are delighted to bring our readers this Fifth Edition of

Essentials

of Nursing Leadership and Management.This new edition has been updated to reflect the current health-care environment. As in our previous editions, the content, examples, and diagrams were designed with the goal of assisting the new graduate to make the transition to professional nursing practice.

The Fifth Edition of

Essentials of Nursing Leadership and

Managementfocuses on the necessary knowledge and skills needed by the staff nurse as a vital member of the health-care team and manag- er of patient care.Issues related to setting priorities,delegation,qual- ity improvement, legal parameters of nursing practice, and ethical issues were updated for this edition. We are especially excited to introduce a new chapter,Quality and Safety.This chapter focuses on the current quality and safety issues and initiatives that affect the current health-care environment. In addition,the updated finance chapter and a new chapter on health- care policy will be available on the F.A. Davis Web site,DavisPlus. We continue to bring you comprehensive,practical information on developing a nursing career.Updated information on leading,manag- ing,followership,and workplace issues continues to be included. Essentials of Nursing Leadership and Managementcontinues to provide a strong foundation for the beginning nurse leader.We want to thank the people at F.A. Davis for their assistance as well as our contributors,reviewers,and students for their guidance and support.

Diane K. Whitehead

Sally A. Weiss

Ruth M. Tappen

vii

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Contributors

Patricia Bradley, MEd, PhD, RN

Coordinator, Internationally Educated Nurses

Program

Faculty, Nursing Department

York University

Toronto, Ontario, Canada

Kristie Campoe,

MSN, RN

Adjunct Faculty

Nursing Department

Nova Southeastern University

Fort Lauderdale, Florida

Patricia Welch Dittman,

PhD, RN, CDE

Graduate Program Director/Assistant Professor

Nursing Department

Nova Southeastern University

Fort Lauderdale, FloridaDenise Howard,

BSN, RN

Adjunct Faculty

Nursing Department

Nova Southeastern University

Fort Lauderdale, Florida

Marcie Rutherford,

PhD, MBA, MSN, RN

Assistant Professor

Nursing Department

Nova Southeastern University

Fort Lauderdale, Florida

Wendy Thomson,

EdD(c), MSN, BSBA, RN, CNE, IBCLC

Assistant Director of Technology and

Simulation/Assistant Professor

Nursing Department

Nova Southeastern University

Fort Lauderdale, Florida

ix

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Table of Contents

unit1Professional Considerations chapter1Leadership and Followership3 chapter2Manager13 chapter3Nursing Practice and the Law21 chapter4Questions of Value and Ethics39 chapter5Organizations, Power, and Empowerment57 unit2Working Within the Organization chapter6Getting People to Work Together73 chapter7Dealing With Problems and Conflicts91 chapter8People and the Process of Change103 chapter9Delegation of Client Care115 chapter10Quality and Safety131 chapter11Time Management157 unit3Professional Issues chapter12Promoting a Healthy Workplace171 chapter13Work-Related Stress and Burnout197 chapter14Your Nursing Career217 chapter15Nursing Yesterday and Today239 xi

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Appendices

appendix1Codes of Ethics for Nurses257 American Nurses Association Code of Ethics for Nurses257 Canadian Nurse Association Code of Ethics for Registered Nurses257 The International Council of Nurses Code of Ethics for Nurses258 appendix2Standards Published by the American Nurses Association259 appendix3Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 261

Index267

Bonus Chapters on DavisPlus

Finance

Triaxial of Action: Policy, Politics, and Nursing

Canadian Nursing Practice and the Law

xii

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1 unit

Professional Considerations

chapter1Leadership and Followership chapter2Manager chapter3Nursing Practice and the Law chapter4Questions of Values and Ethics chapter5Organizations, Power, and Empowerment

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chapter1

Leadership and Followership

OBJECTIVES

After reading this chapter, the student should be able to:

Define the terms leadership and followership.

Discuss the importance of effective leadership and followership for the new nurse. Discuss the qualities and behaviors that contribute to effective followership. Discuss the qualities and behaviors that contribute to effective leadership.OUTLINE

Leadership

Are You Ready to Be a Leader?

Leadership Defined

Followership

Followership Defined

Becoming a Better Follower

What Makes a Person a Leader?

Leadership Theories

Trait Theories

Behavioral Theories

Task Versus Relationship

Motivating Theories

Emotional Intelligence

Situational Theories

Transformational Leadership

Moral Leadership

Qualities of an Effective Leader

Behaviors of an Effective Leader

Conclusion

3

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4unit 1| Professional Considerations

Nurses work with an extraordinary variety of people: physicians,respiratory therapists,physical therapists, social workers, psychologists, technicians, aides, unit managers,housekeepers,clients,and clientsfamilies.

The reason why nurses study leadership is to

learn how to work well, or effectively,with other people. In this chapter,leadershipand followership and the relationships between them are defined.

The characteristics and behaviors that can make

you, a new nurse, an effective leader and follower are discussed.

Leadership

Are You Ready to Be a Leader?

You may be thinking,Im just beginning my career in nursing. How can I be expected to be a leader now?ŽThis is an important question.You will need time to refine your clinical skills and learn how to function in a new environment. But you can begin to assume some leadership right away within your new nursing roles.Consider the following example: Billie Blair Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high admission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly.Anyone who was freeŽat the moment was directed to handle them.Sometimes,unlicensed assis- tant personnel were directed to admit or discharge residents. Billie believed that using them was inap- propriate because their assessment skills were limited and they had no training in discharge planning.

Billie thought there was a better way to do this

but was not sure that she should say so because she was so new. Maybe theyve already thought of this,Ž she said to a former classmate. Its such an obvious solution.Ž They began to talk about what they had learned in their leadership course before graduation. I just keep hearing our instructor say- leader of our group.Ž If you want to be a leader, you have to act on your idea,Ž her friend said.

Maybe I will,Ž Billie replied.

Billie decided to speak with her nurse manager,

an experienced rehabilitation nurse who seemed not only approachable but also open to new ideas. I have been so busy getting our new record system

on line before the surveyors come that I wasnt paying attention to that,Ž the nurse manager toldher.Im so glad you brought it to my attention.Ž

Billies nurse manager raised the issue at the next executive meeting,giving credit to Billie for having brought it to her attention. The other nurse man- agers had the same response.We were so focused on the new record system that we overlooked that. We need to take care of this situation as soon as possible.

Billie Blair Thomas has leadership potential.Ž

Leadership Defined

Leadership is a much broader concept than is man-

agement. Although managers should also be lead- ers, management is focused on the achievement of organizational goals.Leadership,on the other hand: ...occurs whenever one person attempts to influence the behavior of an individual or group"up, down, or sideways in the organization"regardless of the reason. It may be for personal goals or for the goals of others,and these goals may or may not be congru- ent with organizational goals. Leadership is influ- ence (Hersey & Campbell, 2004, p. 12) In order to lead, one must develop three important competencies: (1) ability to diagnose or understand the situation you want to influence, (2) adaptation in order to allow your behaviors and other resources to close the gap between the current situation and what you are hoping to achieve, and (3) communi- cation. No matter how much you diagnose or adapt, if you cannot communicate effectively, you will probably not meet your goal (Hersey &

Campbell, 2004).

Effective nurse leaders are those who engage

others to work together effectively in pursuit of a shared goal. Examples of shared goals are pro- viding excellent client care, designing a cost- saving procedure, and challenging the ethics of a new policy.

Followership

Followership and leadership are separate but recip- rocal roles. Without followers, one cannot be a leader; conversely,one cannot be a follower without a leader (Lyons, 2002). Being an effective follower is as important to the new nurse as is being an effective leader. In fact, most of the time most of us are followers: members of a team,attendees at a meeting,staff of a nursing care unit, and so forth.

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chapter 1| Leadership and Followership5

Followership Defined

Followership is not a passive role. On the contrary, the most valuable follower is a skilled,self-directed employee, one who participates actively in setting the groups direction, invests his or her time and energy in the work of the group, thinks critically, and advocates for new ideas (Grossman & Valiga,

2000).Imagine working on a client care unit where

all staff members, from the unit secretary to the assistant nurse manager, willingly take on extra tasks without being asked (Spreitzer & Quinn,

2001), come back early from coffee breaks, com-

plete their charting on time, suggest ways to improve client care,and are proud of the high qual- ity care they provide. Wouldnt it be wonderful to be a part of that team?

Becoming a Better Follower

There are a number of things you can do to become

a better follower: ?If you discover a problem, inform your teamleader or manager right away. ?Even better, include a suggestion in your reportfor solving the problem. ?Freely invest your interest and energy in yourwork. ?Be supportive of new ideas and new directionssuggested by others. ?When you disagree, explain why you do not support an idea or suggestion. ?Listen carefully, and reflect on what your leaderor manager says. ?Continue to learn as much as you can aboutyour specialty area. ?Share what you learn. Being an effective follower will not only make you a more valuable employee but will also increase the meaning and satisfaction that you can get from your work.

Most team leaders and nurse managers will

respond very positively to having staff who are good followers. Occasionally you will encounter a poor leader or manager who can confuse, frustrate, and even distress you. Here are a few suggestions for handling this: ?Avoid adopting the ineffective behaviors of thisindividual. ?Continue to do your best work and to provideleadership for the rest of the group.

?If the situation worsens, enlist the support ofothers on your team to seek a remedy; do nottry to do this alone as a new graduate.

?If the situation becomes intolerable,consider theoption of transferring to another unit or seekinganother position (Deutschman,2005; Korn,2004).

What Makes a Person a Leader?

Leadership Theories

There are many different ideas about how a person

becomes a good leader. Despite years of research on this subject, no one idea has emerged as the clear winner. The reason for this may be that different qualities and behaviors are most important in differ- ent situations. In nursing, for example, some situa- tions require quick thinking and fast action. Others require time to figure out the best solution to a complicated problem. Different leadership qualities and behaviors are needed in these two instances.The result is that there is not yet a single best answer to the question,What makes a person a leader?Ž

Consider some of the best-known leadership

theories and the many qualities and behaviors that have been identified as those of the effective nurse leader (Pavitt, 1999; Tappen, 2001).

Trait Theories

At one time or another, you have probably heard

someone say,Leaders are born,not made.ŽIn other words, some people are natural leaders, and others are not.In reality,leadership may come more easily to some than to others, but everyone can be a leader, given the necessary knowledge and skill. Research into the traits of leaders is a continuing process. A 5-year study of 90 outstanding leaders by Warren Bennis (1984) identified four common traits shared by all of these leaders. These traits continue to hold true:quotesdbs_dbs46.pdfusesText_46

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