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C O N TENTS PART I LEADERSHIP 1 Leadership and Management Principles, 1 2 Change and Innovation, 37 3 Organizational Climate and Culture, 55 PART II PROFESSIONALISM 4 Critical Thinking and Decision-Making Skills, 65 5 Managing Time and Stress, 83 6 Legal and Ethical Issues, 94 PART III COMMUNICATION AND RELATIONSHIP BUILDING 7 Communication Leadership, 111 8 Team Building and Working with Effective Groups, 128 9 Delegation, 147 10 Power and Conflict, 159 11 Workplace Diversity, 186 PART IV KNOWLEDGE OF THE HEALTH CARE ENVIRONMENT 12 Case and Population Health Management, 197 13 Organizational Structure, 226 14 Decentralization and Shared Governance, 246 15 Professional Practice Models, 256 16 Evidence-Based Practice: Strategies for Nursing Leaders, 274 17 Quality and Safety, 291 18 Measuring and Managing Outcomes, 322 PART V 19 20 21 22 BUSINESS SKILLS Strategic Management, 330 Confronting the Nursing Shortage, 339 Staffing and Scheduling, 367 Budgeting, Productivity, and Costing Out Nursing, 387 23 Performance Appraisal, 399 24 Prevention of Workplace Violence, 410 25 All-Hazards Disaster Preparedness, 423 26 Data Management and Clinical Informatics, 441 27 Marketing, 455 References, 465 Leadership Nursing Care Management & Leadership Nursing Care Management & Fifth Edition Diane L. Huber, PhD, RN, NEA-BC, FAAN Professor College of Nursing and College of Public Health The University of Iowa Iowa City, Iowa 3251 Riverport Lane St. Louis, Missouri 63043 Leadership and Nursing Care Management, Fifth Edition 978-1-4557-4071-0 Copyright © 2014, 2010, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 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). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.
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Last digit is the print number: 9 8 7 6 5 4 3 2 1 C ONTR IB UTORS Jennifer Bellot, PhD, RN, MHSA, CNE Associate Professor Jefferson School of Nursing Thomas Jefferson University Philadelphia, Pennsylvania Sharon Eck Birmingham, DNSc, MA, BSN, RN Chief Nursing Executive Clairvia Operations, Cerner Adjunct Faculty, University of North Carolina, Colorado, Yale, and Iowa Schools of Nursing Durham, North Carolina Alice R. Boyington, PhD, RN Director of Nursing Research H. Lee Moffitt Cancer Center & Research Institute Tampa, Florida Jane M. Brokel, PhD, RN, FNI Assistant Professor College of Nursing University of Iowa Member of the Executive Committee and Advisory Council Iowa e-Health Project Iowa City, Iowa Lori Carson, MSN, RN Nurse Executive Consultant Frisco, Texas Sean P. Clarke, PhD, RN, FAAN Professor and Susan E. French Chair and Director, McGill Nursing Collaborative McGill University, Montreal, QC Status Faculty Lawrence S. Bloomberg Faculty of Nursing, University of Toronto Robert W. Cooper, PhD Employers Mutual Distinguished Professor of Insurance Drake University Des Moines, Iowa Karen S. Cox, PhD, RN, FACHE, FAAN Executive Vice President Co-Chief Operating Officer Children’s Mercy Hospitals and Clinics Kansas City, Missouri Kathleen B. Cox, PhD Assistant Professor University of Virginia School of Nursing Charlottesville, Virginia Laura Cullen, DNP, RN, FAAN Evidence-Based Practice Coordinator Nursing Research & Evidence-Based Practice Department of Nursing and Patient Care Services University of Iowa Hospitals and Clinics Iowa City, Iowa Cindy J. Dawson, MSN, RN, CORLN Director, Clinical Functions Ambulatory Care Nursing University of Iowa Hospitals and Clinics Iowa City, Iowa Nancy Dole, RN, BSN, BC Staff Nurse Ambulatory Care Nursing Department of Nursing and Patient Care Services University of Iowa Hospitals and Clinics Iowa City, Iowa Karen Drenkard, PhD, RN, NEA-BC, FAAN Executive Director American Nurses Credentialing Center Silver Spring, Maryland Elizabeth T. Dugan, PhD, RN, NEA-BC Chief Nurse Executive and AVP Patient Care Services Inova Loudoun Hospital Leesburg, Virginia Betsy Frank, PhD, RN, ANEF Professor Emeritus College of Nursing, Health, and Human Services Indiana State University Terre Haute, Indiana Jane M. Fusilero, RN, MSN, MBA, NEA-BC Vice President, Patient Care Services/Chief Nursing Officer Moffitt Cancer Center Tampa, Florida Maryanne Garon, RN, DNSc Professor California State University – Fullerton Fullerton, California v vi CONTRIBUTORS Gregory O. Ginn, BA, MEd, MBA, PhD Associate Professor University of Nevada, Las Vegas Las Vegas, Nevada Caryl Goodyear-Bruch, PhD, RN, NEA-BC Director of Professional Resources & Leadership Development Children’s Mercy Hospital and Clinics Kansas City, Missouri Kirsten Hanrahan, DNP, ARNP Nurse Scientist Nursing Research and EvidenceBased Practice University of Iowa Hospital and Clinics Iowa City, Iowa L. Jean Henry, PhD Associate Professor, Community Health Promotion Department of Health, Human Performance, and Recreation University of Arkansas Fayetteville, Arkansas Cheryl Hoying, PhD, RN, NEA-BC, FACHE, FAAN Senior Vice President of Patient Services Cincinnati Children’s Hospital Medical Center Associate Dean College of Nursing University of Cincinnati Adjunct Instructor Wright State University–Miami Valley School of Nursing Cincinnati, Ohio Lianne Jeffs, PhD, RN St. Michael’s Hospital Volunteer Association Chair in Nursing Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael’s Hospital Scientific Director, Nursing Health Services Research Unit Assistant Professor, Bloomberg Faculty of Nursing University of Toronto Susan R. Lacey, PhD, RN, MSN Director, Strategic Collaborations Director, Nursing Innovation Center Children’s Mercy Hospitals and Clinics Kansas City, Missouri Jo Manion, PhD, RN, NEA-BC, FAAN Owner/Senior Consultant Manion & Associates The Villages, Florida Raquel M. Meyer, PhD, RN Manager Baycrest Centre for Learning, Research and Innovation in Long-Term Care Assistant Professor Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto, Ontario, Canada Mary Ellen Murray, PhD, RN Professor Associate Dean Academic Affairs University of Wisconsin – M adison School of Nursing Madison, Wisconsin Lynne S. Nemeth, PhD, RN Associate Professor College of Nursing Medical University of South Carolina Charleston, South Carolina Adrienne Olney, MS Research Associate Children’s Mercy Hospitals and Clinics Kansas City, Missouri Luc R. Pelletier, MSN, APRN, PMHCNS-BC, FAAN, CPHQ, FNAHQ Administrative Liaison Sharp Mesa Vista Hospital Core Adjunct Faculty National University San Diego, California Beth Pickard, BSN General Manager Clairvia Operations, Cerner Durham, North Carolina Belinda E. Puetz, PhD, RN Principal Puetz Consulting Services, Inc. Pensacola, Florida Gene S. Rigotti, MSN, BSN, RN, NEA-BC Clifton, Virginia Linda L. Workman, PhD, RN, NEA-BC VP Center for Professional Excellence Children’s Hospital Medical Center Cincinnati, Ohio R EV IEW ERS Stephanie Corder, ND, RN Associate Professor Missouri Western State University St. Joseph, Missouri Denise Hirst, RN, MSN Clinical Assistant Professor School of Nursing University of North Carolina at Chapel Hill Chapel Hill, North Carolina vii P RE FACE The time is now for strong leadership and care management in nursing. Highlighted by a series of reports from the prestigious Institute of Medicine (IOM), most recently The Future of Nursing:
Leading Change, Advancing Health, it is clear that nurses matter to health care delivery systems. Yet the United States is in the midst of a continuing and projected nurse shortage. Strong nurse leaders and administrators are important for clients (and their safety), for delivery systems (and their viability), and for payers (and their solvency). Some have called this the Age of the Nurse, but pressures remain to balance cost and quality considerations in a complex, chaotic, and turbulent health care environment. Although society’s need for excellent nursing care remains the nurse’s constant underlying reason for existence, nursing is in reality much more than that. It is the Age of the Nurse precisely because nurses offer cost-effective expertise in solving problems related to the coordination and delivery of health care to individuals and populations in society. Nurses are well prepared to lead clinical change strategies and to effectively manage the coordination and integration of interdisciplinary teams, population needs, and systems of care across the continuum. This is especially important as implementation of the 2010 Patient Protection and Affordable Care Act rolls forward and nurses are needed to address care coordination and integration. It can be argued that nursing is a unique profession in which the primary focus is caring—giving and managing the care that clients need. Thus nurses are both health care providers and health care coordinators; that is, they have both clinical and managerial role components. Beginning with the first edition of Leadership & Nursing Care Management, it has been this text’s philosophy that these two components can be discussed separately but in fact overlap.
Because all nurses are involved in coordinating client care, leadership and management principles are a part of the core competencies they need to function in a complex health care environment. viii The turbulent swirl of change in this country’s health care industry has become a paradigm shift that has provided both challenges and opportunities for nursing. Nurses have needed a stronger background in nursing leadership and client care management to be prepared for contemporary and future nursing practice. As nurses mature in advanced practice roles and as the health care delivery system restructures, nurses will become increasingly pivotal to cost-effective health care delivery. Leadership and management are crucial skills and abilities for complex and integrated community and regional networks that employ and deploy nurses to provide health care services to clients and communities. Today nurses are expected to be able to lead and manage care across the health care continuum—a radically different approach to nursing than has been the norm for hospital staff nursing practice. In all settings, including both nurse-run and interdisciplinary clinics, nursing leadership and management are complementary skills that add value to solid clinical care and client-oriented practice. Thus there is an urgent need to advance nurses’ knowledge and skills in leadership and management. In addition, nurses who are expected to make and implement day-to-day management decisions need to know how these precepts can be practically applied to the organization and delivery of nursing care in a way that conserves scarce resources, reduces costs, and maintains or improves quality of care. The primary modality for health care in the United States has moved away from acute care hospitalization. As prevention, wellness, and alternative sites for care delivery become more important, nursing’s already rich experiential tradition of practice in these settings is emerging. This text reflects this contemporary trend by blending the hospital and nonhospital perspectives when examining and analyzing nursing care, leadership, and management. The reader will notice examples from the wide spectrum of nursing practice settings in the specific applications of nursing leadership and care management principles. ORGANIZATIONAL CULTURE ASSESSMENT
PREFACE PURPOSE AND AUDIENCE The intent of this text is to provide both a broad introduction to the field and a synthesis of the knowledge base and skills related to both nursing leadership and nursing management. It is an evidence-based blend of practice and theory. It breaks new ground by explaining the intersection of nursing care with leading people and managing organizations and systems. It highlights the evidence base for care management. It combines traditional management perspectives and theory with contemporary health care trends and issues and consistently integrates leadership and management concepts. These concepts are illustrated and made relevant by practice-based examples. The impetus for writing this text comes from teaching both undergraduate and graduate students in nursing leadership and management and from perceiving the need for a comprehensive, practice-based textbook that blends and integrates leadership and management into an understandable and applicable whole. Therefore the main goal of Leadership and Nursing Care Management is twofold: (1) to clearly differentiate traditional leadership and management perspectives, and (2) to relate them in an integrated way with contemporary nursing trends and practice applications. This textbook is designed to serve the needs of nurses and nursing students who seek a foundation in the principles of coordinating nursing services. It will serve the need for these principles in relation to client care, peers, superiors, and subordinates. ORGANIZATION AND COVERAGE This fifth edition continues the format first used with the third edition. The first two editions were Dr. Huber’s single-authored texts. The edited book approach draws together the best thinking of experts in the field—both nurses and non-nurses—to enrich and deepen the presentation of core essential knowledge and skills. Beginning with the first edition, a hallmark of Leadership and Nursing Care Management has been its depth of coverage, its comprehensiveness, and its strong evidence-based foundation. This fifth edition continues the emphasis on explaining theory in an easily understandable way to enhance comprehension. The content of this fifth edition has been reorganized and refreshed to integrate leadership and care ix management topics with the nurse executive leadership competencies of the 2005 American Organization of Nurse Executives (AONE) while trimming down the content through refocusing and synthesis. As the professional organization that speaks for nurse leaders, managers, and executives, AONE has identified the evidence-based core competencies in the field, and the content of this book has been aligned accordingly to reflect the knowledge underlying quality management of nursing services. This will help the reader develop the crucial skills and knowledge needed for core competencies. The organizational framework of this book groups the 27 chapters into the following five parts: Part I: Leadership aligns with the AONE competency category of the same name and provides an orientation to the basic principles of both leadership and management. Part I contains chapters on Leadership and Management Principles, Change and Innovation, and Organizational Climate and Culture. Part II: Professionalism aligns with the AONE competency category of the same name and addresses the nurse’s role and career development. The reader is prompted to examine the role of the nurse leader and manager. Part II discusses the content areas of Critical Thinking and Decision-Making Skills, Managing Time and Stress, and Legal and Ethical Issues. Part III: Communication and Relationship Building aligns with the AONE competency category of the same name. Part III focuses on Communication Leadership, Team Building and Working with Effective Groups, Delegation, Power and Conflict, and Workplace Diversity. These are essential knowledge and skills areas for nurse leaders and managers as they work with and through others in care delivery. Part IV: Knowledge of the Health Care Environment covers the AONE competency category of the same name and features a broad array of chapters. Part IV encompasses Case and Population Health Management, Organizational Structure, Decentralization and Shared Governance, Pro fessional Practice Models, Evidence-Based Practice: Strategies for Nursing Leaders, Quality and Safety, and Measuring and Managing Outcomes. This discussion highlights the importance of understanding the health care system and the x PREFACE rganizational structures within which nursing o care delivery must operate. This section includes information on traditional organizational theory, professional practice models, and the dynamics of decentralized and shared governance. ORGANIZATIONAL CULTURE ASSESSMENT
Part V: Business Skills aligns with the AONE competency category on business skills and principles and contains an extensive grouping of chapters related to Strategic Management; Nursing Shortage; Recruitment and Retention; Staffing and Scheduling; Budgeting, Productivity, and Costing Out Nursing; Performance Appraisal; Prevention of Workplace Violence; All-Hazards Disaster Preparedness; Data Management and Informatics; and Marketing. These chapters discuss the opportunities and challenges for the nurse leader-manager when dealing with the health care workforce. The wide range of human resource responsibilities of nurse managers is reviewed, and resources for further study are provided. The significant share of scarce organization budgets consumed by the human resources of an institution makes this area of management a key challenge that requires intricate skills in leadership and management. This section examines some of the important factors that nurse leader-managers must consider in the nursing and health care environment. Also in this section are chapters that build on organizational theory and demonstrate the importance …