SEssentials of Nursing Leadership and Management Sally A. Weiss EdD RN, Ruth M. Tappen EdD RN 6th Edition

SEssentials of Nursing Leadership and Management Sally A. Weiss EdD RN, Ruth M. Tappen EdD RN 6th Edition Essentials of Nursing Leadership and Management 3663_FM_ i 9/17/2014 3:01:42 PM Process CyanProcess MagentaProcess YellowProcess Black 3663_Unit I_ 2 9/16/2014 11:25:22 AM Essentials of Nursing Leadership and Management Sally A. Weiss, MSN, EdD, RN, CNE, ANEF Professor of Nursing Nova Southeastern University Nursing Department Fort Lauderdale, Florida Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor 3663_FM_ iii 9/17/2014 3:01:43 PM Process CyanProcess MagentaProcess YellowProcess Black F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2015 by F. A. Davis Company Copyright © 2015, 2010, 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 the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor, Nursing: Megan Klim Developmental Editor: Laurie Sparks Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo Gerhart Electronic Project Editor: Katherine Crowley Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treat- ments 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 appli- cation 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 in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infre- quently ordered drugs. Library of Congress Control Number: 4 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted 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 Rose- wood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Report- ing Service is: 978-0-8036-3663-7/15 0 + $.25. 3663_FM_ iv 9/17/2014 3:01:45 PM Process CyanProcess MagentaProcess YellowProcess Black Dedication To my granddaughter Sydni and my grandson Logan, who remind me how important it is to nurture our young nurses and help them learn and grow. —SALLY A. WEISS To students, colleagues, family, and friends, who have taught me so much about leadership. —RUTH M. TAPPEN v 3663_FM_ v 9/17/2014 3:01:45 PM Process CyanProcess MagentaProcess YellowProcess Black 3663_Unit I_ 2 9/16/2014 11:25:22 AM S - The Marketplace to Buy and Sell your Study Material Preface We are delighted to bring our readers this Sixth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the dynamic health care environment, safety initiatives, and changes in nursing practice. 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 Sixth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as an integral member of the interprofessional health- care team and manager of patient care. Issues related to setting priorities, delegation, quality improve- ment, legal parameters of nursing practice, and ethical issues are updated for this edition. This edition focuses on the current quality and safety issues and initiatives impacting the current health-care environment. We continue to bring you comprehensive, practical information on develop- ing a nursing career. Updated information on leading, managing, followership, and workplace issues continue to be included. Essentials of Nursing Leadership and Management provides a strong foundation for the beginning nurse leader. We would like to thank the people at F. A. Davis for their assistance and our contribu- tors, reviewers, and students for their guidance and support. —SALLY A. WEISS —RUTH M. TAPPEN vii 3663_FM_ vii 9/17/2014 3:01:46 PM Process CyanProcess MagentaProcess YellowProcess Black 3663_Unit I_ 2 9/16/2014 11:25:22 AM Sl Contributor PATRICIA BRADLEY, MED, PHD, RN Coordinator, Internationally Educated Nurses Program Faculty, Nursing Department York University Toronto, Ontario, Canada Reviewers WENDY GREENSPAN, MSN, RN, CCRN, CNE Assistant Professor Rockland Community College Suffem, New York PAULA HOPPER, MSN, RN, CNE Professor of Nursing Jackson Community College Jackson, Mississippi CLAIRE MEGGS, MSN, RN Associate Professor Lincoln Memorial University Harrogate, Tennessee LUISE SPEAKMAN, PHD, RN Adjunct Faculty, Nursing Cape Cod Community College West Barnstable, Massachusetts JENNIFER SUGG, RN, BSN, MSN, CCRN Nursing Instructor Wayne Community College Goldsboro, North Carolina ix 3663_FM_ ix 9/17/2014 3:01:46 PM Process CyanProcess MagentaProcess YellowProcess Black 3663_Unit I_ 2 9/16/2014 11:25:22 AM S - The Marketplace to Buy and Sell your Study Material Table of Contents Professional Considerations 1 chapter 1 Leadership and Followership 3 chapter 2 Manager 17 chapter 3 Nursing Practice and the Law 27 chapter 4 Questions of Values and Ethics 49 Working Within an Organization 69 chapter 5 Organizations, Power, and Empowerment 71 chapter 6 Communicating With Others and Working With the Interprofessional Team 87 chapter 7 Delegation and Prioritization of Client Care 103 chapter 8 Dealing With Problems and Conflict 121 chapter 9 People and the Process of Change 133 Career Considerations 145 chapter 10 Issues of Quality and Safety 147 chapter 11 Promoting a Healthy Work Environment 173 Professional Issues 203 chapter 12 Your Nursing Career 205 chapter 13 Evolution of Nursing as a Profession 225 chapter 14 Looking to the Future 235 xi 3663_FM_ xi 9/17/2014 3:01:46 PM Process CyanProcess MagentaProcess YellowProcess Black S - The Marketplace to Buy and Sell your Study Material xii ■ Table of Contents Appendices appendix 1 Codes of Ethics for Nurses 247 American Nurses Association Code of Ethics for Nurses Canadian Nurse Association Code of Ethics for Registered Nurses The International Council of Nurses Code of Ethics for Nurses appendix 2 Standards Published by the American Nurses Association 249 appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 251 3663_FM_ xii 9/17/2014 3:01:46 PM Process CyanProcess MagentaProcess YellowProcess Black S - The Marketplace to Buy and Sell your Study Material Professional Considerations chapter 1 Leadership and Followership chapter 2 Manager chapter 3 Nursing Practice and the Law chapter 4 Questions of Values and Ethics 3663_Unit I_ 1 9/15/2014 4:37:34 PM Process CyanProcess MagentaProcess YellowProcess Black S - The Marketplace to Buy and Sell your Study Material 3663_Unit I_ 2 9/16/2014 11:25:22 AM S - The Marketplace to Buy and Sell your Study Material 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 leadership. ■ Discuss the qualities and behaviors that contribute to effective followership. OUTLINE Leadership Are You Ready to Be a Leader? Leadership Defined What Makes a Person a Leader? Leadership Theories Trait Theories Behavioral Theories Task Versus Relationship Motivation Theories Emotional Intelligence Situational Theories Transformational Leadership Moral Leadership Caring Leadership Qualities of an Effective Leader Behaviors of an Effective Leader Followership Followership Defined Becoming a Better Follower Managing Up Conclusion Nurses study leadership to learn how to work well with other people. We work with an extraordinary variety of people: technicians, aides, unit managers, housekeepers, patients, patients’ families, physi- cians, respiratory therapists, physical therapists, social workers, psychologists, and more. In this chapter, the most prominent leadership theories are introduced. Then, 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?” This 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 functions right away within your new nursing roles. In fact, leadership should be seen as a dimension of nursing practice (Scott & Miles, 2013). Consider the following example: Billie Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high ad- mission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly. Anyone who was “free” at the moment was directed to handle them. Sometimes, unlicensed as- sistant personnel were directed to admit or discharge residents. Billie believed that this was inappropriate because they are not prepared to do assessments and they had no preparation for discharge planning. Billie had an idea how discharge planning could be improved but was not sure that she should bring it up because she was so new. “Maybe they’ve already thought of this,” she said to a former classmate. They began to talk about what they had learned in their leadership course before graduation. “I just keep hearing our instructor saying, ‘There’s only one manager, but anyone can be a leader.’” “If you want to be a leader, you have to act on your idea. Why don’t you talk with your nurse manager?” her friend asked. “Maybe I will,” Billie replied. Billie decided to speak with her nurse manager, an experienced rehabilitation nurse who seemed not 3 3663_Chapter 1_ 3 9/15/2014 4:36:35 PM Process CyanProcess MagentaProcess YellowProcess Black S - The Marketplace to Buy and Sell your Study Material 4 unit 1 ■ Professional Considerations only approachable but also open to new ideas. “I have been so busy getting our new electronic health record system on line before the surveyors come that I wasn’t paying attention to that,” the nurse manager told her. “I’m glad you brought it to my attention.” 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 manag- ers had the same response. “We were so focused on the new electronic health record system that we overlooked that. We need to take care of this situa- tion as soon as possible. Billie Thomas has leadership potential.” Leadership Defined Successful nurse leaders are those who engage others to work together effectively in pursuit of a shared goal. Examples of shared goals in nursing would be providing excellent care, reducing infec- tion rates, designing cost-saving procedures, or challenging the ethics of a new policy. Leadership is a much broader concept than is management. Although managers need to be leaders, management itself is focused specifically on 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) diagnose: ability to understand the situation you want to influence, (2) adapt: make changes that will close the gap between the current situation and what you are hoping to achieve, and (3) communicate. No matter how much you diag- nose or adapt, if you cannot communicate effec- tively, you will probably not meet your goal (Hersey & Campbell, 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 dif- ferent situations. In nursing, for example, some situations 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?” 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, “She’s a born leader.” Many believe that some people are natural leaders, while others are not. It is true that leadership may come more easily to some than to others, but everyone can be a leader, given the necessary knowledge and skill. An important 5-year study of 90 outstanding leaders by Warren Bennis published in 1984 identi- fied four common traits. These traits hold true today: 1. Management of attention. These leaders communicated a sense of goal direction that attracted followers. 2. Management of meaning. These leaders created and communicated meaning and purpose. 3. Management of trust. These leaders demonstrated reliability and consistency. 4. Management of self. These leaders knew themselves well and worked within their strengths and weaknesses (Bennis, 1984). Behavioral Theories The behavioral theories focus on what the leader does. One of the most influential behavioral theo- ries is concerned with leadership style (White & Lippitt, 1960) (Table 1-1). The three styles are: 1. Autocratic leadership (also called directive, controlling, or authoritarian). The autocratic leader gives orders and makes decisions for the group. For example, when a decision needs to be made, an autocratic leader says, “I’ve decided that this is the way we’re going to solve our 3663_Chapter 1_ 4 9/15/2014 4:36:37 PM Process CyanProcess MagentaProcess YellowProcess Black S - The Marketplace to Buy and Sell your Study Material chapter 1 ■ Leadership and Followership 5 Autocratic Democratic Laissez-Faire Amount of freedom Little freedom Moderate freedom Much freedom Amount of control High control Moderate control Little control Decision making By the leader Leader and group together By the group or by no one Leader activity level High High Minimal Assumption of responsibility Leader Shared Abdicated Output of the group High quantity, good quality Creative, high quality Variable, may be poor quality Efficiency Very efficient Less efficient than autocratic style Inefficient Source: Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and democracy: An experimental inquiry. New York: Harper & Row. problem.” Although this is an efficient way to run things, it squelches creativity and may reduce team member motivation. 2. Democratic leadership (also called participative). Democratic leaders share leadership. Important plans and decisions are made with the team (Chrispeels, 2004). Although this appears to be a less efficient way to run things, it is more flexible and usually increases motivation and creativity. In fact, involving team members, giving them “permission to think, speak and act” brings out the best in them and makes them more productive, not less (Wiseman & McKeown, 2010, p. 3). Decisions may take longer to make, but once made everyone supports them (Buchanan, 2011). 3. Laissez-faire leadership (also called permissive or nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision making and fails to encourage others to do it. It is really a lack of leadership. For example, when a decision needs to be made, a laissez- faire leader may postpone making the decision or never make the decision at all. In most instances, the laissez-faire leader leaves people feeling confused and frustrated because there is no goal, no guidance, and no direction. Some mature, self-motivated individuals thrive under laissez-faire leadership because they need little direction. Most people, however, flounder under this kind of leadership. Pavitt summed up the differences among these three styles: a democratic leader tries to move the group toward its goals; an autocratic leader tries to move the group toward the leader’s goals; and a laissez-faire leader makes no attempt to move the group (1999, pp. 330ff ). Task Versus Relationship Another important distinction is between a task focus and a relationship focus (Blake, Mouton, & Tapper, 1981). Some nurses emphasize the tasks (e.g., administering medication, completing patient records) and fail to recognize that interpersonal relationships (e.g., attitude of physicians toward nursing staff, treatment of housekeeping staff by nurses) affect the morale and productivity of employees. Others focus on the interpersonal aspects and ignore the quality of the job being done as long as people get along with each other. The most effective leader is able to balance the two, attending to both the task and the relationship aspects of working together. Motivation Theories The concept of motivation seems simple: we will act to get what we want but avoid whatever we don’t want to do. However, motivation is still sur- rounded in mystery. The study of motivation as a focus of leadership began in the 1920s with the historic Hawthorne studies. Several experi- ments were conducted to see if increasing light and, later, improving other working conditions would increase the productivity of workers in the Haw- thorne, Illinois, electrical plant. This proved to be true, but then something curious happened: when the improvements were taken away, the workers continued to show increased productivity. The researchers concluded that the explanation was found not in the conditions of the experiments but in the attention given to the workers by the experimenters.