leadership and management assignments in nursing

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What does nursing leadership and management look like?

By Michael Feder

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At a glance

• Many nursing positions require leadership skills, which can help improve overall patient care, quality improvement and safety.
• Some skills that can help make nurses become better leaders are empathy, patient safety and interprofessional collaboration, among others. 
• Nursing leadership roles include director of nursing, charge nurse, nurse supervisor and clinical director.
• University of Phoenix offers bachelor’s and master’s degrees in nursing that help students learn critical leadership skills. 

Many roles in the nursing profession require leadership skills, particularly in interpersonal communication , problem-solving , and quality improvement and safety . You’ll need to strike a balance between providing quality patient care while managing a variety of other tasks, or direct reports, in a healthcare environment. Let’s take a look at some of the qualities of good leadership and how to become a better nurse leader.

Explore degrees that expand your skills and prepare you to lead in nursing. 

The major qualities of good nursing leadership

Nurse leaders share a variety of key qualities that they may implement on a day-to-day basis:

• Make evidence-based practice decisions  about assessments, treatments, therapy and other modalities that help improve patients’ quality of life.
• Communicate effectively ,   which improves interprofessional collaboration, allowing nurses and patients to connect and make progress toward health-related goals.
• Mentor others  to help train the next generation of healthcare experts.
• Practice with integrity ,   maintaining strong moral principles and following the Code of Ethics for Nurses  while fulfilling daily duties.
• Efficiency and productivity  to optimize internal schedules, patient assessments and meetings with patients’ family members.

A combination of professionalism, communication, quality improvement and problem-solving allows a nurse to prioritize patient interests while performing assessment and providing any required care.

Skills that help make a better nurse leader 

Nurse leaders depend on a variety of soft and hard skills to provide value for patients and fellow team members. Here are just a handful of examples to consider:

Hard skills

• Information technology — Collect and evaluate information within informatics systems and through other IT programs.
• Evidence-based practice — Analyze research concepts and methods for evidence-based practice.
• Applied statistics — Explore the use of applied statistics and research results to support evidence-based practice.
• Regulatory compliance — Integrate safety, regulatory and ethical requirements.
• Advanced clinical practice — Analyze knowledge of advanced pharmacology, pathophysiology and physical assessment to improve direct population health.
• Project development — Apply leadership and communication skills through the development and assessment of an applied project, including evidence-based guidelines, design, an implementation plan, an evaluation plan and dissemination.

Soft skills

• Empathy  — Demonstrate a genuine interest in patient needs, interests and outcomes, and practice sensitivity.
• Problem-solving — Apply evidence to improve complex systems of healthcare for diverse populations.
• Decision - making — Lead the advancement of the nursing profession to influence interprofessional decision-making.
• Critical thinking — Exercise clinical judgment, which can impact the outcomes and care of patients.
• Interprofessional collaboration  — Work together in a healthcare setting to accomplish goals, maximize efficiency and achieve optimal outcomes for patients.

The importance of effective nursing leadership

Effective leaders help to improve the performance of everyone around them. Nursing leaders help promote a safe and evidence-based practice environment in a healthcare setting — not only for healthcare professionals but also for patients and their family members.

Effective nursing leadership can impact individual career outcomes for many of a nurse’s fellow employees. Nurse leaders often help mentor less-experienced healthcare professionals, providing valuable on-the-job training and peer feedback to help them take next steps in their own careers.

These same nursing leaders also take pride in their work — and deliver safe and quality improvement outcomes — in ways that reflect well on practitioners or physicians who collaborate with them, as well as entire healthcare organizations.

How to develop your nurse leadership skills

Improving your nurse leadership skills can take time. It’s important to choose an education partner with a history of creating effective leaders in healthcare.

Here are a few ways you can improve your leadership skills in the nursing profession:

• Obtain additional nursing education  — Learn critical skills in nursing with a Bachelor of Science in Nursing (BSN) or a Master of Science in Nursing with a concentration in Nurse Administration .
• Join professional organizations  — In such groups, either locally or online, you can network with other healthcare professionals and exchange ideas and information on leadership in your profession.
• Find a mentor  — Consider asking a nurse in your organization if they’ll serve as your mentor, someone who can answer questions and provide an example of professional nursing in action.

Leadership roles in nursing

Nursing leadership roles typically allow you to promote smooth facility operations while you advocate for better patient outcomes.

Here are a few leadership roles in nursing.

• Nurse supervisor  — Nursing supervisors provide a bridge between hospital management and clinical care providers. As a nursing supervisor, you might lead nurses in providing services like medication, treatment and therapy.
• Clinical manager  — Clinical managers help supervise a facility’s nursing staff. They strive to uphold strong standards in patient care, leveraging experience in a clinical role to make sure all patients receive adequate, correct care.
• Director of nursing  — Nursing directors manage a facility’s nursing operations, including most other leadership staff on a nursing floor. They help create goals for nursing staff members and implement policies that promote efficiency, compliance and productive patient outcomes.

These nursing positions offer varying levels of leadership. Depending on your employer, education, certifications and years of experience, you might qualify for a role in nursing leadership.

Leadership styles that can be beneficial in the nursing profession

Nursing leaders are like all other leaders: Each operates in a slightly different way. Depending on your personality and skill set, you might employ a particular leadership style in your nursing profession.

These are  common leadership styles  you might find in a nursing environment. While they may go by other designations, the standard styles include:

• Autocratic  — Leaders make decisions after little to no input from direct reports. Autocratic leadership benefits experienced nursing leaders who might understand exactly how to proceed in a delicate or time-sensitive situation where patients need immediate care.
• Participative  — Leaders field and consider feedback before reaching decisions. Democratic leadership is ideal for nursing leaders making decisions about schedules, shifts or conflicts that affect the entire nursing team.
• Transformational  — Leaders exceed expectations to implement change that helps everyone realize a shared vision. Transformational leadership can help nursing leaders encourage nurses to be empathetic, particularly when dealing with patients who might have mental health challenges requiring extra care or sensitivity.
• Delegative  — Leaders adopt a hands-off approach to leadership. Nursing leaders who use a laissez-faire leadership model are typically confident in the abilities of the nurses working under them, to the point where supervision isn’t always necessary.
• Transactional  — Leaders use a reward and discipline system to encourage correct behavior. Nurses who use a transactional leadership style might work with younger individuals who may need more attention and who could benefit more from a system that prioritizes efficiency while correcting errors.
• Bureaucratic  — Leaders prioritize company needs and rely on policies to keep team members in place. Nurse leaders often need to deploy a bureaucratic leadership style in situations where there’s little room for mistakes, particularly when patient outcomes are at stake.
• Servant  — Leaders build strong relationships as they focus on individual needs. Nurses might use a servant leadership approach to create an environment where openness and growth of younger nurses are encouraged.

No matter the size of your next nursing clinic, or your individual nursing role, you can implement one or more of these leadership styles to become a more effective leader in your workplace.

Develop your nurse leadership skills at University of Phoenix

If you’re interested in developing the skills to be a better nurse leader, a degree from University of Phoenix can help. The University offers a Registered Nurse (RN) to BSN degree as well as a Master of Science in Nursing degree with a concentration in Nurse Administration. These programs help registered nurses prepare to enhance their nursing career by teaching sought-after skills that can help them become leaders who impact organizational change. To learn more, visit the University of Phoenix website .

ABOUT THE AUTHOR

Michael Feder is a content marketing specialist at University of Phoenix, where he researches and writes on a variety of topics, ranging from healthcare to IT. He is a graduate of the Johns Hopkins University Writing Seminars program and a New Jersey native!

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4.1 Leadership & Management Introduction

Learning objectives.

• Compare and contrast the role of a leader and a manager
• Examine the roles of team members
• Identify the activities managers perform
• Describe the role of the RN as a leader and change agent
• Evaluate the effects of power, empowerment, and motivation in leading and managing a nursing team
• Recognize limitations of self and others and utilize resources

As a nursing student preparing to graduate, you have spent countless hours on developing clinical skills, analyzing disease processes, creating care plans, and cultivating clinical judgment. In comparison, you have likely spent much less time on developing management and leadership skills. Yet, soon after beginning your first job as a registered nurse, you will become involved in numerous situations requiring nursing leadership and management skills. Some of these situations include the following:

• Prioritizing care for a group of assigned clients
• Collaborating with interprofessional team members regarding client care
• Participating in an interdisciplinary team conference
• Acting as a liaison when establishing community resources for a patient being discharged home
• Serving on a unit committee
• Investigating and implementing a new evidence-based best practice
• Mentoring nursing students

Delivering safe, quality client care often requires registered nurses (RN) to manage care provided by the nursing team. Making assignments, delegating tasks, and supervising nursing team members are essential managerial components of an entry-level staff RN role. As previously discussed, nursing team members include RNs, licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP). [1]

Read more about assigning, delegating, and supervising in the “ Delegation and Supervision ” chapter.

An RN is expected to demonstrate leadership and management skills in many facets of the role. Nurses manage care for high-acuity patients as they are admitted, transferred, and discharged; coordinate care among a variety of diverse health professionals; advocate for clients’ needs; and manage limited resources with shrinking budgets. [2]

Read more about collaborating and communicating with the interprofessional team; advocating for clients; and admitting, transferring, and discharging clients in the “ Collaboration Within the Interprofessional Team ” chapter.

An article published in the Online Journal of Issues in Nursing states, “With the growing complexity of healthcare practice environments and pending nurse leader retirements, the development of future nurse leaders is increasingly important.” [3] This chapter will explore leadership and management responsibilities of an RN. Leadership styles are introduced, and change theories are discussed as a means for implementing change in the health care system.

• American Nurses Association & NCSBN. (2019). National guidelines for nursing delegation. https://www.ncsbn.org/NGND-PosPaper_06.pdf ↵
• Cherry, B., & Jacob, S. R. (2017). Nursing leadership and management. In Cherry, B. & Jacob, S. (Eds.), Contemporary nursing: Issues, trends, and management (8th ed.). Elsevier, pp. 294-314. ↵
• Dyess, S. M., Sherman, R. O., Pratt, B. A., & Chiang-Hanisko, L. (2016). Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. OJIN: The Online Journal of Issues in Nursing, 21 (1). https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No1-Jan-2016/Articles-Previous-Topics/Growing-Nurse-Leaders.html ↵

Nursing Management and Professional Concepts Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011.

The Future of Nursing: Leading Change, Advancing Health.

• Hardcopy Version at National Academies Press

5 Transforming Leadership

Key Message #3 : Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health profes sionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.

In addition to changes in nursing practice and education, discussed in Chapters 3 and 4 , respectively, strong leadership will be required to realize the vision of a transformed health care system. Although the public is not used to viewing nurses as leaders, and not all nurses begin their career with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of, as well as advocacy for, the ongoing reforms to the system that will be needed. Additionally, nurses will need leadership skills and competencies to act as full partners with physicians and other health professionals in redesign and reform efforts across the health care system. Nursing research and practice must continue to identify and develop evidence-based improvements to care, and these improvements must be tested and adopted through policy changes across the health care system. Nursing leaders must translate new research findings to the practice environment and into nursing education and from nursing education into practice and policy.

Being a full partner transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied both within the profession and in collaboration with other health professionals. In care environments, being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals. Serving as strong patient advocates, nurses must be involved in decision making about how to improve the delivery of care.

Being a full partner translates more broadly to the health policy arena. To be effective in reconceptualized roles and to be seen and accepted as leaders, nurses must see policy as something they can shape and develop rather than something that happens to them, whether at the local organizational level or the national level. They must speak the language of policy and engage in the political process effectively, and work cohesively as a profession. Nurses should have a voice in health policy decision making, as well as being engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care. Nurses must build new partnerships with other clinicians, business owners, philanthropists, elected officials, and the public to help realize these improvements.

This chapter focuses on key message #3 set forth in Chapter 1 : Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. The chapter begins by considering the new style of leadership that is needed. It then issues a call to nurses to respond to the challenge. The third section describes three avenues—leadership programs for nurses, mentorship, and involvement in the policy-making process—through which that call can be answered. The chapter then issues a call for new partnerships to tap the full potential of nurses to serve as leaders in the health care system. The final section presents the committee’s conclusions regarding the need to transform leadership in the nursing profession.

• A NEW STYLE OF LEADERSHIP

Those involved in the health care system—nurses, physicians, patients, and others—play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment. What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. This leadership style has been associated with improved patient outcomes, a reduction in medical errors, and less staff turnover (Gardner, 2005; Joint Commission, 2008; Pearson et al., 2007). It may also reduce the amount of workplace bullying and disruptive behavior, which remains a problem in the health care field (Joint Commission, 2008; Olender-Russo, 2009; Rosenstein and O’Daniel, 2008). Yet while the benefits of collaboration among health professionals have repeatedly been documented with respect to improved patient outcomes, reduced lengths of hospital stay, cost savings, increased job satisfaction and retention among nurses, and improved teamwork, interprofessional collaboration frequently is not the norm in the health care field. Changing this culture will not be easy.

The new style of leadership that is needed flows in all directions at all levels. Everyone from the bedside to the boardroom must engage colleagues, subordinates, and executives so that together they can identify and achieve common goals (Bradford and Cohen, 1998). All members of the health care team must share in the collaborative management of their practice. Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. All must display the capacity to adapt to the continually evolving dynamics of the health care system.

Leadership Competencies

Nurses at all levels need strong leadership skills to contribute to patient safety and quality of care. Yet their history as a profession dominated by females can make it easier for policy makers, other health professionals, and the public to view nurses as “functional doers”—those who carry out the instructions of others—rather than “thoughtful strategists”—those who are informed decision makers and whose independent actions are based on education, evidence, and experience. A 2009 Gallup poll of more than 1,500 national opinion leaders, 1 “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions,” identified nurses as “one of the most trusted sources of health information” (see Box 5-1 ) (RWJF, 2010a). The Gallup poll also identified nurses as the health professionals that should have greater influence than they currently do in the critical areas of quality of patient care and safety. The leaders surveyed believed that major obstacles prevent nurses from being more influential in health policy decision making. These findings have crucial implications for front-line nurses, who possess critical knowledge and awareness of the patient, family, and community but do not speak up as often as they should.

Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions”. Opinion leaders rate doctors and nurses first and second among a list of options for trusted information about health and health (more...)

To be more effective leaders and full partners, nurses need to possess two critical sets of competencies: a common set that can serve as the foundation for any leadership opportunity and a more specific set tailored to a particular context, time, and place. The former set includes, among others, knowledge of the care delivery system, how to work in teams, how to collaborate effectively within and across disciplines, the basic tenets of ethical care, how to be an effective patient advocate, theories of innovation, and the foundations for quality and safety improvement. These competencies also are recommended by the American Association of Colleges of Nursing as essential for baccalaureate programs (AACN, 2008). Leadership competencies recommended by the National League for Nursing and National League for Nursing Accrediting Commission are being revised to reflect similar principles. More specific competencies might include learning how to be a full partner in a health team in which members from various professions hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. Additionally, nurses who are interested in pursuing entrepreneurial and business development opportunities need competencies in such areas as economics and market forces, regulatory frameworks, and financing policy.

Leadership in a Collaborative Environment

As noted in Chapter 1 , a growing body of research has begun to highlight the potential for collaboration among teams of diverse individuals from different professions (Paulus and Nijstad, 2003; Pisano and Verganti, 2008; Singh and Fleming, 2010; Wuchty et al., 2007). Practitioners and organizational leaders alike have declared that collaboration is a key strategy for improving problem solving and achieving innovation in health care. Two nursing researchers who have studied collaboration among health professionals define it as

a communication process that fosters innovation and advanced problem solving among people who are of different disciplines, organizational ranks, or institutional settings [and who] band together for advanced problem solving [in order to] discern innovative solutions without regard to discipline, rank, or institutional affiliation [and to] enact change based on a higher standard of care or organizational outcomes. (Kinnaman and Bleich, 2004)

Much of what is called collaboration is more likely cooperation or coordination of care. Katzenbach and Smith (1993) argue that truly collaborative teams differ from high-functioning groups that have a defined leader and a set direction, but in which the dynamics of true teamwork are absent. The case study presented in Box 5-2 illustrates just how important it is for health professionals to work in teams to ensure that care is accessible and patient centered.

Case Study: Arkansas Aging Initiative. A Statewide Program Uses Interprofessional Teams to Improve Access to Care for Older Arkansans B onnie Sturgeon was an independent 80-year-old in 2005 when shortness of breath began to slow her down. She had been (more...)

Leadership at Every Level

Leadership from nurses is needed at every level and across all settings. Although collaboration is generally a laudable goal, there are many times when nurses, for the sake of delivering exceptional patient and family care, must step into an advocate role with a singular voice. At the same time, effective leadership also requires recognition of situations in which it is more important to mediate, collaborate, or follow others who are acting in leadership roles. Nurses must understand that their leadership is as important to providing quality care as is their technical ability to deliver care at the bedside in a safe and effective manner. They must lead in improving work processes on the front lines; creating new integrated practice models; working with others, from organizational policy makers to state legislators, to craft practice policy and legislation that allows nurses to work to their fullest capacity; leading curriculum changes to prepare the nursing workforce to meet community and patient needs; translating and applying research findings into practice and developing functional models of care; and serving on institutional and policy-making boards where critical decisions affecting patients are made.

Leadership in care delivery is particularly important in community and home settings where nurses work more autonomously with patients and families than they do in the acute care setting. In community and home settings, nurses provide a direct link connecting patients, their caregivers, and other members of the health care team. Other members of the health care team may not have the time, expertise, or first-hand experience with the patient’s home environment and circumstances to understand and respond to patient and family needs. For example, a neurologist may not be able to help a caregiver of an Alzheimer’s patient understand or curtail excessive spending habits, or a surgeon may not be able to offer advice to a caregiver on ostomy care—roles that nurses are perfectly positioned to assume. Leadership in these situations sometimes requires nurses to be assertive and to have a strong voice in advocating for patients and their families to ensure that their needs are communicated and adequately met.

Box 5-3 describes a nurse who evolved over the course of her career from thinking that being an effective nurse was all about honing her nursing skills and competencies to realize that becoming an agent of change was an equally important part of her job.

Nurse Profile: Connie Hill. A Nurse Leader Extends Acute Care Nursing Beyond the Hospital Walls I t was at a 2002 meeting at Children’s Memorial Hospital in Chicago that Connie Hill, MSN, RN, reviewed the chart of a child who had been on a ventilator (more...)

• A CALL FOR NURSES TO LEAD

Leadership does not occur in a social or political vacuum. As Bennis and Nanus (2003) note, the fast pace of change can be managed only if it is accompanied by leaders who can track the context of the “social architecture” to sustain and implement innovative ideas. Creating innovative care models at the bedside and in the community or taking the opportunity to fill a seat in a policy-making body or boardroom requires nurse leaders to develop ideas; approach management; and courageously make decisions within the political, economic, and social context that will make their solutions real and sustainable. A shift must take place in how nurses view their responsibility to those they care for; they must see themselves as full partners with other health professionals, and practice and education environments must socialize and educate them accordingly.

An important aspect of this socialization is mentoring others along the way. More experienced nurses must take the time to show those who are new and less experienced the most effective ways of being an exceptional nurse at the bedside, in the boardroom, and everywhere between. Technology such as chat rooms, Facebook, and even blogs can be used to support the mentoring role.

A crucial part of working within the social architecture is understanding how leadership and practice produce change over time. The nursing profession’s history includes many examples of the effect of nursing leadership on changes in systems and improvements in patient care. In the late 1940s and early 1950s, nurse Elizabeth Carnegie led the fight for the racial integration of nursing in Florida by example and through her extraordinary character and organizational skills. Her efforts to integrate the nursing profession were based in her sense of social justice not just for the profession, but also for the care of African American citizens who had little access to a workforce that was highly skilled or provided adequate access to health care services. Also in Florida, in the late 1950s, Dorothy Smith, the first dean of the new University of Florida College of Nursing, developed nursing practice models that brought nursing faculty into the hospital in a joint nursing service. Students thereby had role models in their learning experiences, and staff nurses had the authority to improve patient care. From this system came the patient kardex and the unit manager system that freed nurses from the constant search for supplies that took them away from the bedside. In the 1980s, nursing research by Neville Strumpf and Lois Evans highlighted the danger of using restraints on frail elders (Evans and Strumpf, 1989; Strumpf and Evans, 1988). Their efforts to translate their findings into practice revolutionized nursing practice in nursing homes, hospitals, and other facilities by focusing nursing care on preventing falls and other injuries related to restraint use, and led to state and federal legislation that resulted in reducing the use of restraints on frail elders.

Nurses also have also led efforts to improve health and access to care through entrepreneurial endeavors. For example, Ruth Lubic founded the first free-standing birth center in the country in 1975 in New York City. In 2000, she opened the Family Health and Birth Center in Washington, DC, which provides care to underserved communities (see Box 2-2 in Chapter 2 ). Her efforts have improved the care of thousands of women over the years. There are many other examples of nurse entrepreneurs, and a nurse entrepreneur network 2 exists that provides networking, education and training, and coaching for nurses seeking to enter the marketplace and business.

Will Student Nurses Hear the Call?

Leadership skills must be learned and mastered over time. Nonetheless, it is important to obtain a basic grasp of those skills as early as possible—starting in school (see Chapter 4 ). Nursing educators must give their students the most relevant knowledge and practice opportunities to equip them for their profession, while instilling in them a desire and expectation for new learning in the years to come. Regardless of the basic degree with which a nurse enters the profession, faculty should feel obligated to show students the way to their first or next career placement, as well as to their next degree and continuous learning opportunities.

Moreover, students should not wait for graduation to exercise their potential for leadership. In Georgia, for example, health students came together in 2001 under the banner “Lead or Be Led” to create a student-led, interprofessional nonprofit organization that “seeks to make being active in the health community a professional habit.” Named Health Students Taking Action Together (Health-STAT), the group continues to offer workshops in political advocacy, media training, networking, and fundraising. Its annual leadership symposium convenes medical, nursing, public health, and other students statewide to learn about health issues facing the state and work together on developing potential solutions (HealthSTAT, 2010). The National Student Nurses Association (NSNA), initiated in 1998, offers an online Leadership University that allows students to enhance their capacity for leadership through several avenues, such as earning academic credit for participating in the university’s leadership activities and discussing leadership issues with faculty. Students work in cooperative relationships with other students from various disciplines, faculty, community organizations, and the public (Janetti, 2003). Box 5-4 profiles two student leaders, one of whom eventu ally became NSNA president; both represent as well the growing diversity of the nursing profession, a crucial need if the profession is to rise to the challenge of helping to transform the health care system (see Chapter 4 ).

Nurse Profile: Kenya D. Haney and Billy A. Caceres. Building Diversity in Nursing, One Student at a Time D espite improvements to thedemographic make up of the nursing workforce in recent decades, the workforce remains predominantly white, female, and (more...)

Looking to the future, nurse leaders will need the skills and knowledge to understand and anticipate population trends. Formal preparation of student nurses may need to go beyond what has traditionally been considered nursing education. To this end, a growing number of schools offer dual undergraduate degrees in partnership with the university’s business or engineering school for nurses interested in starting their own business or developing more useful technology. Graduate programs offering dual degree programs with schools of business, public health, law, design, or communications take this idea one step further to equip students with an interest in administrative, philanthropic, regulatory, or policy-making positions with greater competencies in management, finance, communication, system design, or scope-of-practice regulations from the start of their careers.

Will Front-Line Nurses Hear the Call?

Given their direct and sustained contact with patients, front-line nurses, along with their unit or clinic managers, are uniquely positioned to design new models of care to improve quality, efficiency, and safety. Tapping that potential will require developing a new workplace culture that encourages and supports leaders at the point of care (whether a hospital or the community) and requires all members of a health care team to hold each other accountable for the team’s performance; nurses must also be equipped with the communication, conflict resolution, and negotiating skills necessary to succeed in leadership and partnership roles. For example, one new quality and safety strategy requires checklists to be completed before certain procedures, such as inserting a catheter, are begun. Nurses typically are asked to enforce adherence to the checklist. If another nurse or a physician does not wash his/her hands or contaminates a sterile field, nurses must possess the basic leadership skills to remind their colleague of the protocol and stop the procedure, if necessary, until the checklist is followed. And again, nurses must help and mentor each other in their roles as expert clinicians and patient advocates. No one can build the capabilities of an exceptional and effective nurse like another exceptional and effective nurse.

Will Community Nurses Hear the Call?

Nurses working in the community have long understood that to be effective in contributing to improvements in the entire community’s health, they must assume the role of social change agent. Among other things, community and public health nurses must promote immunization, good nutrition, and physical activity; detect emergency health threats; and prevent and respond to outbreaks of communicable diseases. In addition, they need to be prepared to assume roles in dealing with public health emergencies, including disaster preparedness, response, and recovery. Recent declines in the numbers of community and public health nurses, however, have made the leadership imperative for these nurses much more challenging.

Community and public health nurses learn to expect the unexpected. For example, a school nurse alerted health authorities to the arrival of the H1N1 influenza virus in New York City in 2009 (RWJF, 2010c). Likewise, an increasing number of nurses are being trained in incident command as part of preparedness for natural disasters and possible terrorist attacks. This entails understanding the roles of and working with community, state, and federal officials to assure the health and safety of the public. For example, when the town of Chehalis, south of Seattle, experienced a 100-year flood in 2007, a public health nurse called the secretary of Washington State’s Department of Health, Mary Selecky, to ask how to “deal with and dispose of dead cows, an unforeseen challenge [for] a public health nurse. The nurse knew she needed [to provide] tetanus shots and portable toilets but had not anticipated other, less common, aspects of the emergency” (IOM, 2010).

The profile in Box 5-5 illustrates how nurses lead efforts that provide critical services for communities. The profile also shows how nurses can also become leaders and social change agents in the broader community by serving on the boards of health-related institutions. The importance of this role is discussed in the next section.

Nurse Profile: Mary Ann Christopher. Cultivating Neighborhood Nursing at the Visiting Nurse Association of Central Jersey A t the Visiting Nurse Association of Central Jersey (VNACJ), president and chief executive officer Mary Ann Christopher, MSN, RN, (more...)

Will Chief Nursing Officers Hear the Call?

Although chief nursing officers (CNOs) typically are part of the hierarchical decision-making structure in that they have authority and responsibility for the nursing staff, they need to move up in the reporting structure of their organizations to increase their ability to contribute to key decisions. Not only is this not happening, however, but CNOs appear to be losing ground. A 2002 survey by the American Organization of Nurse Executives (AONE) showed that 55 percent of CNOs reported directly to their institution’s CEO, compared with 60 percent in 2000. More CNOs described a direct reporting relationship to the chief operating officer instead. Such changes in reporting structure can limit nurse leaders’ involvement in decision making about the most important product of hospitals—patient care. Additionally, the AONE survey showed that most CNOs (70 percent) have seen their responsibilities increase even as they have moved down in the reporting structure (Ballein Search Partners and AONE, 2003). CNOs face growing issues of contending not only with increased responsibilities, but also with budget pressures and difficulties with staffing, retention, and turnover levels during a nursing shortage (Jones et al., 2008).

Nurses also are underrepresented on institution and hospital boards, either their own or others. A biennial survey of hospitals and health systems conducted in 2007 by the Governance Institute found that only 0.8 percent of voting board members were CNOs, compared with 5.1 percent who were vice presidents for medical affairs (Governance Institute, 2007). More recently, a 2009 survey of community health systems found that nurses made up only 2.3 percent of their boards, compared with 22.6 percent who were physicians (Prybil et al., 2009). 3 While most boards focus mainly on finance and business, health care delivery, quality, and responsiveness to the public—areas in which the nature of their work gives nurses particular expertise—also are considered key (Center for Healthcare Governance, 2007). A 2007 survey found that 62 percent of boards included a quality committee (Governance Institute, 2007). A 2006 survey of hospital presidents and CEOs showed the impact of such committees. Those institutions with a quality committee were more likely to adopt various oversight practices; they also experienced lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality’s (AHRQ’s) Inpatient Quality Indicators and the State Inpatient Databases (Jiang et al., 2008).

The growing attention of hospital boards to quality and safety issues reflects the increased visibility of these issues in recent years. Several states and the Centers for Medicare and Medicaid Services, for example, are increasing their oversight of specific preventable errors (“never events”), and new payment structures in health care reform may be based on patient outcomes and satisfaction (Hassmiller and Bolton, 2009; IOM, 2000; King, 2009; Wachter, 2009). Given their expertise in quality and safety improvement, nurses are more likely than many other board members to understand the issues involved and often can educate other members about these issues (Mastal et al., 2007). This is one area, then, in which nurse board members can have a significant impact. Recognizing this, the 2009 survey of community health systems mentioned above specifically recommended that community health system boards consider appointing expert nursing leaders as voting board members to strengthen clinical input in deliberations and decision-making processes (Prybil et al., 2009).

More CNOs need to prepare themselves and seek out opportunities to serve on the boards of health-related institutions. If decisions are taking place about patient care and a nurse is not at the decision-making table, important perspectives will be missed. CNOs should also promote leadership activities among their staff, encouraging them to secure important decision-making positions on committees and boards, both internal and external to the organization.

Will Nurse Researchers Hear the Call?

Nurse researchers must develop new models of quality care that are evidence based, patient centered, affordable, and accessible to diverse populations. Developing and imparting the science of nursing is also an important contribution to nurses’ ability to deliver high-quality, safe care. Additionally, nurses must serve as advocates and implementers for the program designs they develop. Academic–service partnerships that typically involve nursing schools and nearby, often low-income communities are a first step toward implementation. Given that a nursing school does not exist in every community, however, such partnerships cannot achieve change on the scale needed to transform the health care system. Nurse researchers must become active not only in studying important care deliv ery questions but also in translating research findings into practice and developing and setting the policy agendas. Their leadership is vital in ensuring that new state-and federal-level policies are based on evidence and will help increase quality and access while decreasing costs and health care disparities. The Affordable Care Act (ACA) provides opportunities for demonstration projects and pilot programs directed at various elements of nursing. If these projects and programs do not adequately track nursing inputs and intended/unintended outcomes, they cannot hope to achieve their potential.

Nurse researchers should seek funding from the National Institute for Nursing Research and other institutes of the National Institutes of Health, as do scientists from other disciplines, to help increase the evidence base for improved models of care. Funding might also be secured from other government entities, such as AHRQ and the Health Resources and Services Administration (HRSA) and local and national foundations, depending on the research topic. To be competitive in these efforts, nurses should hone their analytical skills with training in such areas as statistics and data analysis, econometrics, biometrics, and other qualitative and quantitative research methods that are appropriate to their research topics. Mark Pauly, codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, argues that, for nursing research to achieve parity with other health services research in terms of acceptability, it must be managed by interprofessional teams that include both nurse scholars and scholars from methodological and modeling disciplines. For nurse researchers to achieve parity with other health services researchers, they must develop the skills and initiative to take leadership roles in this research. 4

Will Nursing Organizations Hear the Call?

The Gallup poll of 1,500 opinion leaders referenced earlier in this chapter also highlighted fragmentation in the leadership of nursing organizations as a challenge. Responding opinion leaders predicted that nurses will have little influence on health care reform over the next 5–10 years (see Figure 5-1 ). By contrast, they believed that nurses should have more input and impact in areas such as planning, policy development, and management ( Figure 5-2 ) (RWJF, 2010a). No one expects all professional health organizations to coordinate their public agendas, actions, or messaging for every issue. But nursing organizations must continue to collaborate and work hard to develop common messages, including visions and missions, with regard to their ability to offer evidence-based solutions for improvements in patient care. Once common ground has been established, nursing organizations will need to activate their membership and constituents to work together to take action and support shared goals. When policy makers and other key decision makers know that the largest group of health professionals in the country is in agreement on important issues, they listen and often take action. Conversely, when nursing organizations and their members disagree with one another on important issues, decisions are not made, as the decision makers often are unsure of which side to take.

Opinion leaders’ predictions of the amount of influence nurses will have on health care reform. NOTE: Govt. = Government; Ins. Execs. = Insurance executives; Pharma. execs. = Pharmaceutical executives; HC execs. = Health care executives.

Opinion leaders’ views on the amount of influence nurses should have on various areas of health care. SOURCE: RWJF, 2010b. Reprinted with permission from Frederick Mann, RWJF.

Quality and safety are important areas in which professional nursing organizations have great potential to serve as leaders. The Nursing Alliance for Quality Care (NAQC) 5 is a Robert Wood Johnson Foundation–funded effort with the mission of advancing the quality, safety, and value of patient-centered health care for all individuals, including patients, their families, and the communities where patients live. Based at the George Washington University School of Nursing, the organization stresses the need for nurses to advocate actively for and be accountable to patients for high-quality and safe care. The establishment of the NAQC “is based on the assumption that only with a stronger, more unified ‘voice’ in nursing policy will dramatic and sustainable achievements in quality and safety be achieved for the American public” (George Washington University Medical Center, 2010).

• ANSWERING THE CALL

The call for nurses to assume leadership roles can be answered through leadership programs for nurses; mentorship; and involvement in the policy-making process, including political engagement.

Leadership Programs for Nurses

Leadership is not necessarily innate; many individuals develop into leaders. Sometimes that development comes through experience. For example, nurse leaders at the executive level historically earned their way to their position through their competence, rather than obtaining formal preparation through a business school. However, development as a leader can also be achieved through more formal education and training programs. The wide range of effective leadership programs now available for nurses is illustrated by the examples described below. The challenge is to better utilize these opportunities to develop a greater number of nursing leaders.

Integrated Nurse Leadership Program

The Integrated Nurse Leadership Program (INLP), 6 funded by the Gordon and Betty Moore Foundation, works with hospitals in the San Francisco Bay area that wish to remodel their professional culture and systems of care to improve care while dealing more effectively with continual change. The program develops hospital leaders, offers training and technical assistance, and provides grants to support the program’s implementation. INLP has found that the development of stable, effective leadership in nursing-related care is associated with better-than-expected patient care outcomes and improvements in nurse recruitment and retention. The impact of the program will be evaluated to produce models that can be replicated in other parts of the country.

Fellows Program in Management for Nurse Executives at Wharton 7

When the Johnson & Johnson Company and the Wharton School joined in 1983 to offer a senior nurse executive management fellowship, the program concentrated on helping senior nursing leaders manage their departments by providing them, for example, intense training in accounting (Shea, 2005). The Wharton Fellows program has changed in many ways since then in response to the evolving health care environment, according to a 2005 review (Shea, 2005). For example, the program has strengthened senior nursing executives’ ability to argue for quality improvement on the basis of solid evidence, including financial documentation and probabilistic decision making. The program also aims to improve such leadership competencies as systems thinking, negotiation, communications, strategy, analysis, and the development of learning communities. Its offerings will likely undergo yet more changes as hospital chief executive and chief operating officers increasingly come from the ranks of the nursing profession.

Robert Wood Johnson Foundation Executive Nurse Fellows Program

The Robert Wood Johnson Foundation Executive Nurse Fellows Program 8 is an advanced leadership program for nurses in senior executive roles who wish to lead improvements in health care from local to national levels. It provides a 3-year in-depth, comprehensive leadership development experience for nurses who are already serving in senior leadership positions. The program is designed to cultivate and expand fellows’ capacity to lead teams and organizations. The fellowship program includes curriculum and program activities that provide opportunities for executive coaching and mentoring, team-based and individual leadership projects, professional development that incorporates best practices in leadership, as well as access to online communities and leadership networks. Through the program, fellows master 20 leadership competencies that cover a broad range of knowledge and skills that can be used when “leading self, leading others, leading the organization and leading in health care” (RWJF Executive Nurse Fellows, 2010).

Best on Board

Best on Board 9 is an education, testing, and certification program that helps prepare current and prospective leaders to serve on the governing board of a health care organization. Its CEO, Connie Curran, is a registered nurse (RN) who chaired a hospital nursing department, was the dean of a medical college, and founded her own national management and consulting services firm. A 2010 review cites the growing recognition by blue ribbon panels and management researchers that nurses are an untapped resource for the governing bodies of health care organizations. The authors argue that while nurses have many qualities that make them natural assets to any health care board, they must also “understand the advantages of serving on boards and what it takes to get there” (Curran and Totten, 2010).

Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards Programs

While not limited to nurses, the Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards programs 10 offer nurses, other health professionals, and behavioral and social scientists “with an interest in health [the opportunity] to participate in health policy processes at the federal level” (RWJF Scholars, Fellows & Leadership Programs, 2010). Fellows work on Capitol Hill with elected officials and congressional staff. The goal is for fellows to use their academic and practice experience to inform the policy process and to improve the quality of policies enacted. Investigators are funded to complete innovative studies of topics relevant to current and future health policy. Participants in both programs receive intensive training to improve the content and delivery of messages intended to improve health policy and practice. This training is critical, as investigators are often called upon to testify to Congress about the issues they have explored. The health policy fellows bring their more detailed understanding of how policies are formed back to their home organizations. In this way, they are more effective leaders as they strive to bring about policy changes that lead to improvements in patient care.

American Nurses Credentialing Center Magnet Recognition Program

Although not an individual leadership program, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program 11 recognizes health care organizations that advance nursing excellence and leadership. In this regard, achieving Magnet status indicates that the nursing workforce within the institution has attained a number of high standards relating to quality and standards of nursing practice. These standards, as designated by the Magnet process, are called “Forces of Magnetism.” According to ANCC, “the full expression of the Forces embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession” (ANCC, 2010). Some of these Forces include quality of nursing leadership, management style, quality of care, autonomous nursing care, nurses as teachers, interprofessional relationships, and professional development.

Mentorship 12

Leadership is also fostered through effective mentorship opportunities with leaders in nursing, other health professions, policy, and business. All nurses have a responsibility to mentor those who come after them, whether by helping a new nurse become oriented or by taking on more formal responsibilities as a teacher of nursing students or a preceptor. Nursing organizations (membership associations) also have a responsibility to provide mentoring and leadership guidance, as well as opportunities to share expertise and best practices, for those who join.

Fortunately, a number of nursing associations have organized networks to support their membership and facilitate such opportunities:

• The American Association of Colleges of Nursing (AACN) conducts an expertise survey that is used to identify subject matter experts across topic areas within its membership; it also maintains a list of nursing education experts. Names of these experts are shared with members on request. These resources also are used to identify experts to serve on boards, respond to media requests, and serve in other capacities. In addition, AACN offers an annual executive leadership development program and a new deans mentoring program to further promote and foster leadership.
• The National League for Nursing (NLN) has established an Academy of Nurse Educators whose members are available to serve as mentors for NLN members. NLN engages these educators in a variety of mentoring programs, from a National Scholarly Writing Retreat to the Johnson & Johnson mentoring program for new faculty.
• While AONE does not have a formal mentoring program, it has developed online learning communities where members are encouraged to interact, post questions, and learn from each other. These online communities facilitate collaboration; encourage the sharing of knowledge, best practices, and resources; and help members discover solutions to day-to-day challenges in their work.
• The American Academy of Nursing keeps a detailed list of nurse “Edge Runners” 13 that describes the programs nursing leaders have developed and the outcomes of those programs. Edge Runner names and contact information are prominently displayed so that learning and mentoring can take place freely. 14
• The American Nurses Association just passed a resolution at its 2010 House of Delegates to develop a mentoring program for novice nurses. The program has yet to be developed.
• Over the years, the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) has offered numerous workshops, webinars, and educational materials to develop its members’ competencies in leadership, policy, and communications. NCEMNA’s highly regarded Scholars program 15 promotes the academic and professional development of ethnic minority investigators, in part through a mentoring program. It serves as a model worth emulating throughout the nursing profession.

Involvement in Policy Making

Nurses may articulate what they want to happen in health care to make it more truly patient centered and to improve quality, access, and value. They may even have the evidence to support their conclusions. As with any worthy cause, however, they must engage in the policy-making process to ensure that the changes they believe in are realized. To this end, they must be able to envision themselves as leaders in that process and seek out new partners who share their goals.

The challenge now is to motivate all nurses to pursue leadership roles in the policy-making process. Political engagement is one avenue they can take to that end. As Bethany Hall-Long, a nurse who was elected to the Delaware State House of Representatives in 2002 and is now a state senator, writes, “political actions may be as simple as voting in local school board elections or sharing research findings with state officials, or as complex as running for elected office” (Hall-Long, 2009). For example, engaging school board candidates about the fundamental role of school nurses in the management of chronic conditions among students can make a difference at budget time. And if the goal is broader, perhaps to locate more community health clinics within schools, achieving buy-in from the local school board is absolutely vital. As Hall-Long writes, however, “since nurses do not regularly communicate with their elected officials, the elected officials listen to non-nursing individuals” (Hall-Long, 2009).

Political engagement can be a natural outgrowth of nursing experience. When Marilyn Tavenner first started working in an intensive care unit in Virginia, she thought, “If I were the head nurse or the nurse manager, I would make changes. I would try to influence that unit and that unit’s quality and staffing.” After she became a nurse manager, she thought, “I wouldn’t mind doing this for the entire hospital.” After succeeding for several years as a director of nursing, she was encouraged by a group of physicians to apply for the CEO position of her hospital when it became available. Eventually, Timothy Kaine, governor of Virginia from 2006 to 2010, recruited her to be the state’s secretary of health and human resources. In February 2010, Ms. Tavenner was named deputy administrator for the federal Centers for Medicare and Medicaid Services. Like many nurses, she had never envisioned working in government. But she realized that she wanted to have an impact on health care and health care reform. She wanted to help the uninsured find resources and access to care. For her, that meant building on relationships and finding opportunities to work in government. 16

Other notable nurses who have answered the call to serve in government include Sheila Burke, who served as chief of staff to former Senate Majority Leader Robert Dole, has been a member of the Medicare Payment Advisory Commission, and now teaches at Georgetown and Harvard Universities; and Mary Wakefield, who was named administrator of HRSA in 2009 and is the highest-ranking nurse in the Obama Administration. Speaker of the House Nancy Pelosi’s office has had back-to-back nurses from The Robert Wood Johnson Foundation Health Policy Fellows Program as staffers since 2007, providing a significant entry point for the development of new health policy leaders. Additionally, in 1989 Senator Daniel Inouye established the Military Nurse Detailee fellowship program. This 1-year fellowship provides an opportunity for a high-ranking military nurse, who holds a minimum of a master’s degree, to gain health policy leadership experience in Senator Inouye’s office. The fellowship rotates among three branches of service (Army, Navy, and Air Force) annually. 17 During the Clinton Administration, Beverly Malone served as deputy assistant secretary for health in the Department of Health and Human Services (HHS). In 2002, Richard Carmona, who began his education with an associate’s degree in nursing from the Bronx Community College in New York, was appointed surgeon general by President George W. Bush. Shirley Chater led the reorganization of the Social Security Administration in the 1990s. Carolyne Davis served as head of the Health Care Finance Administration (predecessor of the Centers for Medicare and Medicaid Services) in the 1980s during the implementation of a new coding system that classifies hospital cases into diagnosis-related groups. From 1979 to 1981, Rhetaugh Dumas was the first nurse, the first woman, and the first African American to serve as a deputy director of the National Institute of Mental Health (Sullivan, 2007). Nurses also have served as regional directors of HHS and as senior advisors on health policy to HHS.

As for elected office, there were three nurse members of the 111th Congress—Eddie Bernice Johnson (D-TX), Lois Capps (D-CA), and Carolyn McCarthy (D-NY)—all of whom had a hand in sponsoring and supporting health care–focused legislation, from AIDS research to gun control. Lois Capps organized and co-chairs the Congressional Nursing Caucus (which also includes members who are not nurses). The group focuses on mobilizing congressional support for health-related issues. Additionally, 105 nurses have served in state legislatures, including Paula Hollinger of Maryland, who sponsored one of the nation’s first stem cell research bills. None of these nurses waited to be asked; they pursued their positions, both elected and appointed, because they knew they had the expertise and experience to make changes in health care.

Very little in politics is accomplished without preparation or allies. Health professionals point with pride to multiple aspects of the Prescription for Pennsylvania initiative, a state health care reform initiative that preceded the ACA and is also described in Box 5-6 . As is clear from a detailed 2009 review, success was not achieved overnight; smaller legislative and regulatory victories set the stage starting in the late 1990s. Even some apparent legislative failures built the foundation for future successes because they caused nurses to spend more time meeting face to face with physicians who had organized opposition to various measures. As a result, nursing leaders developed a better sense of where they could achieve compromises with their opponents. They also found a new ally in the Chamber of Commerce to counter opposition from some sections of organized medicine (Hansen-Turton et al., 2009).

Case Study: Prescription for Pennsylvania. A Governor’s Leadership Improves Access to Care for Residents of a Rural State W hen Pennsylvania Governor Edward Rendell took office in 2003, one-twelfth of the state’s 12 million residents had (more...)

Hansen-Turton and colleagues draw three major lessons from this experience. First, nurses must build strong alliances within their own professional community, an important lesson alluded to earlier in this chapter. Pennsylvania’s nurses were able to speak with a unified voice because they first worked out among themselves which issues mattered most to them. Second, nurses must build relationships with key policy makers. Pennsylvania’s nurses developed strong relationships with several legislators from both major political parties and earned the support of two successive sitting governors: Thomas Ridge (Republican) and Edward Rendell (Democrat). Third, nurses must find allies outside the nursing profession, particularly in business and other influential communities. Pennsylvania’s nurses gained a strong ally in the Chamber of Commerce when they were able to demonstrate how expanding regulations to allow nurses to do all they were educated and demonstrably capable of doing would help lower health care costs (Hansen-Turton et al., 2009).

Perhaps the most important lesson to draw from the Pennsylvania experience lies in the way the campaign was framed. The focus of attention was on achieving quality care and cost reductions. A closer examination of the issues showed that achieving those goals required, among other things, expanding the roles and responsibilities of nurses. What drew the greatest amount of political support for the Prescription for Pennsylvania campaign was the shared goal of getting more value out of the health care system—quality care at a sustainable price. The fact that the campaign also expanded nursing practice was secondary. Those expansions are likely to continue as long as the emphasis is on quality care and cost reduction. Similarly, the committee believes that the goal in any transformation of the health care system should be achieving innovative, patient-centered, highvalue care. If all stakeholders—from legislators, to regulators, to hospital executives, to insurance companies—act from a patient-centered point of reference, they will see that many of the solutions they are seeking require a transformation of the nursing profession.

• A CALL FOR NEW PARTNERSHIPS

Having enough nurses and having nurses with the right skills and competencies to care for the population is an important societal issue. Having allies from outside the profession is important to achieving this goal. More nurses need to reach out to new partners in arenas ranging from business, government, and philanthropy to state and national medical associations to consumer groups. Additionally, nurses need to fortify alliances that are made through personal connections and relationships. Just as important, society needs to understand its stake in ensuring that nurses are effective full partners and leaders in the quest to deliver quality, high-value care that is accessible to diverse populations. The full potential of the nursing profession in care, leadership, and research must be tapped to deal with the wide range of health care challenges the nation will face in the coming years.

Eventually, to transform the way health care is delivered in the United States, nurses will have to move not just out of the hospital, but also out of health care organizations entirely. For example, nurses are underrepresented on the boards of private nonprofit and philanthropic organizations, which do not provide health care services but often have a large impact on health care decisions. The Commonwealth Fund and the Kaiser Family Foundation, for instance, have no nurses on their boards, although they do have physicians. Without nurses, vital ground-level perspectives on quality improvement, care coordination, and health promotion are likely missing. On the other hand, AARP provides a positive example. At least two nurses at AARP have served in the top leadership and governance roles (president and chair) in the past 3 years. Nurses serve on the health and long-term services policy committee, and the senior vice president of the Public Policy Institute is also a nurse. AARP’s commitment to nursing is clear through its sponsorship, along with the Robert Wood Johnson Foundation, of the Center to Champion Nursing.

Enactment of the ACA will provide unprecedented opportunities for change in the U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.

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• RWJF Executive Nurse Fellows. 2010. Overview . http://www ​.executivenursefellows ​.org/index ​.php?option=com_content&view ​=article&id ​=1&Itemid=34 (accessed September 28, 2010).
• RWJF Scholars, Fellows & Leadership Programs. 2010. Robert Wood Johnson Foundation Health Policy Fellows . http://www ​.rwjfleaders ​.org/programs/robert-wood-johnson-foundation-healthpolicy-fellow (accessed September 28, 2010).
• Shea, G. 2005. Developing the strategic voice of senior nurse executives . Nursing Administration Quarterly 29(2):133-136. [ PubMed : 15923976 ]
• Singh, J., and L. Fleming. 2010. Lone inventors as sources of breakthroughs: Myth or reality? Man agement Science 56(1):41-56.
• Strumpf, N. E., and L. K. Evans. 1988. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses . Nursing Research 37(3):132-137. [ PubMed : 3368353 ]
• Sullivan, P. 2007. Rhetaugh Dumas, 78; nurse rose to become NIMH deputy director . The Washington Post , July 27.
• Wachter, R. M. 2009. Patient safety at ten: Unmistakable progress, troubling gaps . Health Affairs 29(1):165-173. [ PubMed : 19952010 ]
• Wuchty, S., B. Jones, and B. Uzzi. 2007. The increasing dominance of teams in production of knowledge . Science 316(5827):1036-1039. [ PubMed : 17431139 ]

Gallup research staff—Richard Blizzard, Christopher Khoury, and Coleen McMurray—conducted telephone surveys with 1,504 individuals, including university faculty, insurance executives, corporate executives, health services leaders, government leaders, and industry thought leaders.

See http://www ​.nurse-entrepreneur-network ​.com/public/main.cfm .

It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented.

Personal communication, Mark Pauly, Bendheim Professor, Professor of Health Care Management, Professor of Business and Public Policy, Professor of Insurance and Risk Management, and Professor of Economics, Wharton School of the University of Pennsylvania, and Codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, June 25, 2010.

See http://www ​.gwumc.edu ​/healthsci/departments/nursing/naqc/ .

See http://futurehealth ​.ucsf ​.edu/Public/Leadership-Programs ​/Home.aspx?pid=35 .

See http: ​//executiveeducation ​.wharton.upenn.edu ​/open-enrollment/health-care-programs ​/Fellows-Program-Management-Nurse-Executives.cfm .

See http://www ​.executivenursefellows.org .

See http://www ​.bestonboard.org .

See http://www ​.rwjfleaders ​.org/programs/robert-wood-johnson-foundation-health-policy-fellow .

See http://www ​.nursecredentialing ​.org/Magnet/ProgramOverview ​.aspx .

This section draws on personal communication in 2010 with Susan Gergely, Director of Operations, American Organization of Nurse Executives; Beverly Malone, CEO, National League for Nursing; Robert Rosseter, Chief Communications Officer, American Association of Colleges of Nursing; and Pat Ford Roegner, CEO, American Academy of Nursing.

The Edge Runner program is a component of the American Academy of Nursing’s Raise the Voice campaign, funded by the Robert Wood Johnson Foundation. The Edge Runner designation recognizes nurses who have developed innovative, successful models of care and interventions to address problems in the health care delivery system or unmet health needs in a population.

See AAN’s Edge Runner Directory, http://www ​.aannet.org ​/custom/edgeRunner/index ​.cfm?pageid=3303&showTitle ​=1 .

See http://www ​.ncemna.org/scholarships.asp .

This paragraph draws on personal communication with Marilyn Tavenner, principal deputy administrator and chief operating officer, Centers for Medicare and Medicaid Services, May 11, 2010.

Personal communication, Corina Barrow, Lieutenant Colonel, Army Nurse Corps, Nurse Corps Detailee, Office of Senator Daniel Inouye (D-HI), August 25, 2010.

• Cite this Page Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. 5, Transforming Leadership.
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Nursing Leadership and Management

Chapter 16 Nursing Leadership and Management Barbara Cherry, DNSc, MBA, RN, NEA-BC Learning Outcomes After studying this chapter, the reader will be able to: 1.  Relate leadership and management theory to nursing leadership and management activities. 2.  Differentiate among the five functions of management and essential activities related to each function. 3.  Integrate principles of patient-centered care and customer service in professional nursing practice. 4.  Implement effective team-building skills as an essential component of nursing practice. 5.  Implement the nursing process as a method of problem solving and planning. 6.  Apply principles and strategies of change theory in the management role. 7.  Discuss implications of leadership and management challenges of the twenty-first century. Key Terms Authority The legitimate right to direct others given to a person by the employer through an authorized position, such as manager or administrator. External customers People in need of services from an organization who are not employed by the organization, including patients, family members, physicians, students, payers, discharge planners, and other groups that are a source of patient referrals. Health care organization Any business, company, institution, or facility (e.g., hospital, home health agency, ambulatory care clinic, health insurance company, nursing home) engaged in providing health care services or products. Internal customers People who are employed by the organization to provide services to various groups and individuals across the organization (e.g., nurses and other patient care staff, administrators, social workers, dietitians, therapists, housekeeping staff, and clerical support staff). Leadership The act of guiding or influencing people to achieve desired outcomes; occurs any time a person attempts to influence the beliefs, opinions, or behaviors of an individual or group ( Hersey and Blanchard, 1988 ). Management Coordination of resources, such as time, people, and supplies, to achieve outcomes; involves problem-solving and decision-making processes. Organizational chart A visual picture of the organization that identifies lines of communication and authority. Productivity The amount of output or work produced (e.g., home visits made) by a specific amount of input or resources (e.g., nursing hours worked). Resources Personnel, time, and supplies needed to accomplish the goals of the organization. As a leader and manager, the nurse will coordinate many aspects of care delivery. Additional resources are available online at: evolve.elsevier.com/Cherry/ VIGNETTE Nancy Brown, a new registered nurse (RN), has accepted a position in a busy outpatient dialysis unit. During nursing school, Nancy worked in the facility as a patient care technician, and she is confident in her clinical skills because of this experience. Mary, the nurse manager of the dialysis unit, has scheduled Nancy to attend the new-nurse orientation. Although Nancy thinks to herself, “I know what the RNs do around here; I’d like to jump right in without attending orientation,” she readily accepts the assignment. The nurse manager begins the orientation program with a discussion about the mission of the organization and the RN’s responsibility to ensure that quality patient care is provided in a safe and cost-effective manner. As Nancy progresses through the orientation program, her confidence quickly fades. She becomes overwhelmed as she listens to a description of her new responsibilities as an RN. The RN’s duties involve much more than the expected physical assessment, identifying nursing diagnoses, and developing and implementing care plans. Some of Nancy’s many new responsibilities as a staff RN are to do the following: •  Supervise patient care technicians, and manage assignments and supply use for a group of patients. •  Meet with the interprofessional team including the social worker, dietitian, nephrologist, nurse manager, and the patient and family to develop the patient’s care plan, and then follow up to coordinate and implement the plan. •  Serve on a task force charged with developing and implementing a new training and mentoring program for patient care technicians. •  Perform chart audits to review nursing documentation, identify problems, develop recommendations, and report to the quality management committee. As Nancy is trying to assimilate the information being presented, she almost fails to hear Mary say that within 6 months of employment, all staff RNs are expected to begin orientation for the charge nurse position to provide backup coverage. At the end of the orientation, Nancy has a new perspective about professional nursing practice—it seems to be more about managing the delivery of patient care than actually giving the care! Questions to Consider While Reading This Chapter 1.  What leadership and management skills will assist Nancy as she begins her new role as a staff RN responsible for supervising a group of patient care technicians, managing assignments and supply use, and serving on a task force to implement a new training program? 2. Why is it important for the nursing staff to understand the mission and values of the organization to provide direct patient care? 3.  What type of team-building skills will help Nancy as she learns to work with the interprofessional team and coordinate the patient’s plan of care with a diverse group of health professionals? 4. What resources are available to help Nancy learn and enhance her management and leadership skills? Chapter Overview During nursing school, students are often more concerned with developing clinical knowledge and skills and are less concerned with management and leadership skills. However, immediately after graduation the new nurse is placed in many situations that require leadership and management skills—managing a group of assigned patients, serving on a task force or committee, acting as team leader or charge nurse, or supervising unlicensed assistive personnel and licensed vocational or practical nurses. In addition to providing safe, evidence-based, high-quality clinical care, the challenges for RNs today are to manage nursing units that are constantly admitting and discharging higher-acuity patients, motivate and coordinate a variety of diverse health professionals and nonprofessionals, embrace change to develop work environments that are safer and more conducive to professional nursing practice, and manage limited resources and shrinking budgets. Regardless of in which position or area the nurse is employed, the health care organization will expect the professional nurse to have leadership and management skills, including the following: •  Make good clinical decisions based on safety, quality, cost, legal, and ethical aspects of care. •  Promote evidence-based practice (see Chapter 6 ). •  Promote patient safety and quality improvement in the work environment. •  Coordinate patient care activities for the interprofessional team. •  Promote staff satisfaction, patient satisfaction, and overall unit productivity. •  Create and sustain trust between and among managers and staff. •  Actively manage the process of change through good communication, staff involvement, training, sustained attention, and measurement and feedback. •  Provide leadership to maintain compliance with governmental regulations and accreditation standards. As the reader can easily visualize, leadership and management activities are a primary responsibility for the RN. In fact, professional nursing within the health care organization has as much to do with managing the delivery of care as it does with actually providing that care. This chapter presents key leadership and management concepts that will guide the nurse to grow and develop in this important aspect of the professional practice role. Throughout this chapter, the term organization is used to refer to the hospital, home health agency, post–acute care facility, long-term care facility, ambulatory clinic, managed care company, or any other area in which a nurse might be employed to practice professional nursing. Legal and ethical issues are a critical component of nursing management, although it is not within the scope of this chapter to discuss these issues. The reader is encouraged to review Chapter 8 regarding legal issues and Chapter 9 regarding ethical issues . Leadership and Management Defined and Distinguished Leadership Defined Leadership occurs any time a person attempts to influence the beliefs, opinions, or behaviors of a person or group (Hersey and Blanchard, 1988). Leadership is a combination of intrinsic personality traits, learned leadership skills, and characteristics of the situation. The function of a leader is to guide people and groups to accomplish common goals. For example, an effective nurse leader is able to inspire others on the health care team to make patient-centered care an important aspect of all care activities. It is important to note that leaders may not have formal authority granted by the organization but are still able to influence others. The job title such as “nurse manager” will not make a nurse a leader. Today’s complex health care environment requires that every nurse—regardless of his or her role or setting—provide leadership to advance excellence in nursing practice and patient care. Management Defined Management refers to the activities involved in coordinating people, time, and supplies to achieve desired outcomes and involves problem-solving and decision-making processes. Managers maintain control of the day-to-day operations of a defined area of responsibility to achieve established goals and objectives. Managers plan and organize what is to be done, who is to do it, and how it is to be done. A manager will have the following: •  An appointed management position within the organization with responsibilities to perform administrative tasks such as planning staffing, performing employee performance reviews, controlling use of supplies and time, and meeting budget and productivity goals •  A formal line of authority and accountability to ensure that safe and effective patient care is delivered in a manner that meets the organization’s goals and standards Leadership versus Management Although leadership and management are intertwined and it is difficult to discuss one without the other, these concepts are different. Leadership is the ability to guide or influence others, whereas management is the coordination of resources (time, people, supplies) to achieve outcomes. People are led, whereas activities and things are managed. Leaders are able to motivate and inspire others, whereas managers have assigned responsibility for accomplishing the goals of an organization. A good manager should also be a good leader, but this may not always be the case. A person with good management skills may not have leadership ability. Similarly, a person with leadership abilities may not have good management skills. Leadership and management skills are complementary; both can be learned and developed through experience, and improving skills in one area will enhance abilities in the other. Power and Authority Leadership and management require power and authority to motivate people to act in a certain way. Authority is the legitimate right to direct others and is given to a person by the organization through an authorized position, such as nurse manager. For example, a nurse manager has the authority to direct staff nurses to work a specific schedule. Whereas authority is the legitimate right to direct others granted by the organization, power is the ability to motivate people to get things done with or without the legitimate right granted by the organization. The primary sources of power are as follows (Hersey et al, 1979): •  Reward power comes from the ability to reward others for complying and may include such rewards as money, desired assignments, or acknowledgment of accomplishments. •  Coercive power, the opposite of reward power, is based on fear of punishment for failure to comply. Sources of coercive power include withheld pay increases, undesired assignments, verbal and written warnings, and termination. •  Legitimate power is based on an official position in the organization. Through legitimate power, the manager has the right to influence staff members, and staff members have an obligation to accept that influence. •  Referent power comes from the followers’ identification with the leader. The admired and respected nurse is able to influence other nurses because of their desire to emulate her. •  Expert power is based on knowledge, skills, and information. For example, nurses who have expertise in areas such as physical assessment or technical skills, or who keep up with current information on important topics will gain respect from others. •  Information power is based on a person’s possession of information that is needed by others. •  Connection power is based on a person’s relationship or affiliation with other people who are perceived as being powerful. An individual may also have informal power resulting from personal relationships, being in the right place at the right time, or unique personal characteristics, such as attractiveness, education, experience, drive, or decisiveness. By understanding the authority of an assigned position and the sources of formal and informal power, the nurse manager will be better able to influence others to accomplish goals. Formal and Informal Leadership Both formal and informal leadership can exist in every organization. Formal leadership is practiced by the nurse who is appointed to an approved position (e.g., nurse manager, supervisor, director) and given the authority to act by the organization. Informal leadership is exercised by the person who has no official or appointed authority to act, but is able to persuade and influence others. The informal leader, who may or may not be a professional nurse, may have considerable power in the work group and can influence the group’s attitude and significantly affect the efficiency and effectiveness of workflow, goal setting, and problem solving. The nurse manager must learn to recognize and effectively work with informal leaders. Informal leadership may be positive if the informal leader’s purpose is congruent with that of the nursing unit and organizational goals. For example, the informal leader of a patient care group may be highly supportive of a new nursing care delivery model being implemented on the unit, and as a result, the other team members will be more willing to accept the change. However, an informal leader who is not supportive of the nursing unit’s goals can create an uncomfortable work environment for the nurse manager and the entire team. Following are some strategies the nurse manager can use to work with informal leaders: •  Identify the informal leaders in the work team, and develop an understanding of their source of power (see sources of power in the previous section). •  Involve the informal leaders and other staff members in decision-making and change-implementation processes. •  Clearly communicate the goals and work expectations to all staff members. •  Do not ignore an informal leader’s attempt to undermine teamwork and change processes. Coaching and counseling the person and setting clear expectations may be required. Leadership Theory Understanding the development and progression of leadership theory is a necessary building block for developing leadership and management skills. Researchers began to study leadership in the early 1900s in an attempt to describe and understand the nature of leadership. The following sections provide a brief description of key leadership theories. Readers are encouraged to learn more about these theories, especially as they advance in their nursing career. Leadership Trait Theory Early leadership theory centered on describing the qualities or traits of leaders and has been commonly referred to as trait theory (Stogdill, 1974). Leadership trait theory was based on the assumption that leaders were born with certain leadership characteristics. Traits found to be associated with leadership include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery ( Stogdill, 1974 ). Although trait theories have been important in identifying qualities that distinguish today’s leaders, these theories have neglected the interaction between other elements of the leadership situation. Trait theories also have failed to recognize the possibility that leadership traits can be learned and developed through experience. However, by keeping in mind these traits associated with effective leadership, the new nurse can identify areas in which he or she should improve and develop. Interactional Leadership Theories Researchers progressed from developing trait theory to studying the interaction between the leader and other variables of the leadership situation. Contemporary theories of leadership, such as situational and behavioral theories, have attempted to integrate the dynamics of the interaction among the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables, including (1) organizational culture, (2) values of the leader and values of the followers, (3) influence of the leader or manager, (4) complexities of the situation, (5) work to be accomplished, and (6) environment (Marquis and Huston, 2012). Transformational Leadership In a contemporary concept of leadership, Burns (1978) identified and defined transformational leadership. Burns contends that there are two types of leaders: (1) the transactional leader, who is concerned with the day-to-day operations of the facility and (2) the transformational leader, who is committed to organizational goals, has a vision, and is able to empower others with that vision. The transformational leader is able to guide employees to feel pride in the work of the organization and to inspire them to be actively engaged to achieve the mission and goals of the organization. Transformational leaders spend time teaching and coaching, seek differing perspectives when faced with problems to solve, and seek new ways to improve the work environment. Box 16-1 compares characteristics of Burns’ (1978) transformational and transactional leadership styles. BOX 16-1     COMPARISON OF TRANSFORMATIONAL AND TRANSACTIONAL LEADERS TRANSFORMATIONAL LEADERS TRANSACTIONAL LEADERS •  Identify and clearly communicate vision and direction •  Empower the work group to accomplish goals and achieve the vision •  Impart meaning and challenge to work •  Are admired and emulated •  Provide mentoring to individual staff members based on need •  Focus on day-to-day operations and are comfortable with the status quo •  Reward staff for desired work (“I’ll do X in exchange for you doing Y.”) •  Monitor work performance, and correct as needed or •  Wait until problems occur, and then deal with the problem Studies have reported that nurse managers who demonstrate more transformational leadership characteristics achieve higher levels of staff satisfaction and work group effectiveness (Casida and Parker, 2011; Failla and Stichler, 2008 ; Raup, 2008 ). The implication for nurse managers is that transformational leadership is very effective in increasing staff satisfaction and work effectiveness. The student is encouraged to read more about transformational leadership and to seek out transformational leaders as mentors. However, it is important to note that even the most effective transformational leader will fail without possessing the day-to-day management skills of transactional leaders ( Bass et al, 1987 ). Leadership Skills Three major types of skills are required for effective leadership (Hersey and Blanchard, 1988): 1.  Technical skills—for nurses, this includes clinical expertise and nursing knowledge 2.  Human skills—the ability and judgment to work with people in an effective leadership role 3.  Conceptual skills—the ability to understand the complexities of the overall organization and to recognize how and where one’s own area of management fits into the overall organization At the staff nurse level of management, a considerable amount of technical skill and clinical expertise is needed because the nurse generally is involved in direct supervision of patient care and may be required to help train and mentor nurses and other health care providers. As one advances from lower levels to higher levels in the organization, more conceptual skills are needed. Box 16-2 provides examples of technical, human, and conceptual practices required for nurse leaders. BOX 16-2     EFFECTIVE LEADING AND MANAGING: TECHNICAL, HUMAN, AND CONCEPTUAL PRACTICES Technical Practices •  Keep your own clinical skills and knowledge current. •  Act as a willing consultant or expert resource for clinical problems, contribute to sound nursing judgments, and teach others. Human Practices •  Maintain honesty and integrity in work and relationships—trust is essential for effective leadership. •  Create a teaching and learning environment—earn a reputation for exceptional training and mentoring. •  Develop and role-model a commitment to excellence. •  Create an open, nonthreatening environment—share information, keep staff informed, and encourage them to discuss issues. •  Become a proactive problem solver—knowing how to solve problems is more important than knowing all the answers. •  Maintain a confident, positive outlook—identify areas in which you are weak, and seek help to learn and grow. Conceptual Practices •  Make a commitment to support the mission, vision, and goals of the organization. •  Accept the realities of complex health care systems, which are under pressure to improve patient safety and quality while cutting costs. •  Understand the needs of external customers (patients, families, physicians, referring facilities) and internal customers (staff, administrators, executives, and other departments). Management Theory Behavioral theories emerged to explain aspects of management based on behaviors of managers, leaders, and followers. Three prevalent management behavior styles were identified by Lewin (1951) and White and Lippit (1960) : authoritarian, democratic, and laissez-faire. Box 16-3 presents characteristics of these management styles, which vary in the amount of control exhibited by the manager and the amount of involvement that the staff has in decision making. At one extreme, the autocratic manager makes all decisions with no staff input and uses the authority of the position to accomplish goals. At the opposite extreme is the laissez-faire manager, who provides little direction or guidance and will forgo decision making. Democratic management is also often referred to as participative management because of its basic premise of encouraging staff members to participate in decision making. BOX 16-3     MANAGEMENT STYLES AUTOCRATIC/AUTHORITATIVE DEMOCRATIC/PARTICIPATIVE LAISSEZ-FAIRE •  Determines policy and makes all decisions •  Ignores subordinates’ ideas or suggestions •  Dictates the work with much control •  Gives little feedback or recognition for work •  Makes fast decisions •  Successful with employees with little education or training •  Encourages staff participation in decision making •  Involves staff in planning and developing new ideas and programs •  Believes in the best in people •  Communicates effectively, and provides regular feedback •  Builds responsibility in people •  Works well with competent, highly motivated people •  Does not provide guidance or direction •  Unable or unwilling to make decisions •  Does not provide feedback •  Initiates little change •  Communicates by memos or e-mail •  May work well with professional people Depending on the situation, the nurse manager may need to use different types of management styles. This concept of situational leadership requires consideration of staff members’ needs and experiences, the manager’s abilities, and the goals and tasks to be accomplished. For example, autocratic management might be appropriate in a life-threatening situation, such as treating a patient in cardiac arrest. However, in structuring the weekend call schedule for a home health agency, a participative style of management would be more effective. Today’s health care system requires the use of a democratic or participative management style that involves the staff in patient safety, quality improvement, and patient-centered care. Health care settings are driven to become increasingly cost-effective while continuing to improve quality, customer satisfaction, and positive patient outcomes. Staff directly involved in the challenges presented by patient care often can suggest the most workable, practical solutions. Organizational Theory Just as leadership and management theories have evolved to provide a framework for understanding leadership and management, organizational theory has evolved to provide a framework for understanding complex organizations. A brief review of bureaucracy theory, systems theory, and chaos theory can provide the reader with insight into the value of using organizational theory to understand management processes within today’s dynamic, complex health care organizations. Weber’s Theory of Bureaucracy Max Weber, known as the father of organizational theory, began his work in the 1920s when he observed the growth of large organizations and predicted that this growth required a formal set of procedures. In his classic work on defining the characteristics of bureaucracy, Weber argued that the great benefit of bureaucracy was in its ability to apply general rules to specific cases, making the actions of management fair and predictable. The basis of Weber’s concepts of bureaucracy revolves around explaining authority within organizations. He postulated that authority—the right to issue commands within an organization—is based on impersonal rules and rights granted by virtue of the management Leadership, management, and organizational theories provide the building blocks for effective nursing management practices. position rather than related to the person who occupies that position. Weber’s conceptualization of bureaucracy emphasized rules instead of individuals and competency instead of favoritism as important for effective organizations. Although the structure of bureaucracy described by Weber is still present in most organizations today, his work failed to recognize the complexity of human behavior and the constantly changing work environments. As discussed, current leadership and management theories (i.e., participatory management, transformational leadership) recognize the importance of supportive, respectful relationships between managers and employees, with employees being involved in decision making and problem solving. Systems Theory The systems theory views the organization as a set of interdependent parts that together form a whole (Thompson, 1967). The interdependent nature of the parts of the organization suggests that anything that affects the functioning of one aspect of the organization will affect the other parts of the organization. Open systems suggest that the organization is affected not only by internal changes among any of its parts, but also external environmental forces that will have a direct influence on the organization and vice versa—the internal forces will affect the external environment. In contrast to open systems theory, closed systems theory views the system as being totally independent of outside influences, which is an unrealistic view for health care organizations. To be successful, today’s health care organizations must be able to continually adapt to internal and external changes. Consider Case Study 16-1 to help explain systems theory. This example demonstrates open systems theory. As internal forces in one department (hospital CASE STUDY 16-1 The hospital in which William Scoggins, RN, works has reduced the number of RNs employed by the hospital and now requires that the remaining RNs work overtime “at the request of administration.” The quality of patient care, patient safety, and the individual nurses’ professional practice and personal health have been negatively affected by this change. William and his fellow RNs seek advice from their state nurses association about their professional responsibility to work mandatory overtime. The state nurses association is responding to the situation, which is occurring more frequently across the state and nation, by proposing legislation to mandate nurse-patient ratios and limits to mandatory overtime. The state government may now require hospital administrators to respond to the need for increased staffing levels. administration) mandated changes that affected another area (RNs and patient care), internal forces (RNs) pushed for changes from the external environment (state nurses association and state government). The external environment may now force changes to the organization (hospital administration). Systems theory has provided nurse managers with a framework to view nursing services as a subsystem of the larger organization and to realize the interrelatedness and interdependence of all the parts of the health care organization. The nurse will be wise to consider open systems theory and the effect a change in one area will have in another area, internal as well as external to the organization. Chaos Theory The chaos theory is a more recently developed organizational theory that attempts to account for the complexity and randomness in organizations. Despite the implications of the word chaos, the theory actually suggests that a degree of order can be attained by viewing complicated behaviors and situations as predictable. Nurse managers may wish for balanced and steady work environments, but in reality they are dealing with, what seems at best, a chaotic system. Chaos theory says that variation is a normal part of managing health care systems. Based on chaos theory, a nurse manager knows that staff absences as a result of illness, sick children, and family emergencies are a fact of life, requiring the nurse manager to have backup plans in place in the event that staff members “call in” and are unable to report for their assigned shift. Other examples of variation in health care are cultural diversity, a constantly fluctuating patient census, and staffing shortages. Until nurses understand that these variations are a normal, predictable state in the organization and should be planned for, they may continue to experience excessive anxiety with the daily events that occur in health care organizations (McGuire, 1999). Management Functions Classic theories of management suggest that the primary functions of managers are planning, organizing, and controlling (Stogdill, 1974). Leaders in nursing management have added two more functions to this list and now recognize five major management functions ( Figure 16-1 ) as necessary for the management of nursing organizations: (1) planning, (2) organizing, (3) staffing, (4) directing, and (5) controlling ( Marquis and Huston, 2012 ). FIGURE 16-1 Management Functions.

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3.3 Assignment

Nursing team members receive assignments at the start of their shift. Assignment  refers to routine care, activities, and procedures that are within the authorized scope of practice of the RN or LPN/VN or routine functions of the assistive personnel. [1] Assistive personnel (AP) are defined as certified nursing assistants (CNA), client care technicians (PCT), certified medical assistants (CMA), certified medication aides, and home health aides. [2] See Table 3.3a for a description of the typical scope of practice and common tasks performed by members of the nursing team. These tasks are within the traditional role that the team member has acquired through a basic educational program and are the expectation of the hiring agency during a shift of work. Keep in mind that scope of practice is defined by each state’s Nurse Practice Act. Agency policy can be more restrictive than the Nurse Practice Act but cannot be less restrictive.

Assignments are typically made by the charge nurse or nurse supervisor from the previous shift. A charge nurse is an RN who provides leadership on a hospital unit within a health care facility during their shift. Charge nurses perform many of the tasks that general nurses do, but also have some supervisory duties such as making assignments, delegating tasks, preparing schedules, monitoring admissions and discharges, and serving as a staff member resource. [3]

Table 3.3a Nursing Team Members’ Scope of Practice and Common Tasks [4]

An example of a patient assignment is when an RN assigns an LPN to care for a client with stable heart failure. The LPN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN documents this information and reports information back to the RN. This is considered the LPN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nursing Practice Act for LPN scope of practice. They are also included in the unit’s job description for an LPN. The RN may also assign this client to a CNA to help provide assistance with tasks that are allowed within the CNA scope. These tasks may include assistance with personal hygiene, toileting, and ambulation. The CNA documents these tasks as they are completed and reports information back to the RN. These tasks are considered the CNA’s assignment because they are taught within a nursing assistant educational program, are consistent with the nursing assistant scope of practice, and are included in the job description for this unit’s nursing assistant role.

Special consideration is required for advanced assistive personnel roles. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for assistant personnel. Due to the impact these skills can have on the outcome and safety of the client, the National Council of State Board of Nursing (NCSBN) recommends these activities be considered delegated tasks by the RN or nurse leader. By delegating these advanced skills when appropriate, the nurse validates competency, provides supervision, and maintains accountability for client outcomes. Read more about delegation in the “ Delegation ” subsection of this chapter.

When making assignments to other nursing team members, it is essential for the RN to keep in mind specific tasks that cannot be delegated to other nursing team members. These tasks include, but are not limited to, those tasks described in Table 3.3b.

Table 3.3b Examples of Tasks Outside the Scope of Practice of Nursing Assistive Personnel

As always, refer to the state’s Nurse Practice Act for specific details about nursing team members’ scope of practice. See the following box for an example of the scope of practice for RNs and LPNs according to Wisconsin’s Nurse Practice Act.

Read more information about scope and standards of practice for RNs and LPNs in Wisconsin’s Nurse Practice Act, Chapter N6 PDF.

• American Nurses Association and NCSBN. (2019). National guidelines for nursing delegation . https://www.ncsbn.org/NGND-PosPaper_06.pdf ↵
• RegisteredNursing.org. (2021, April 13). What is a charge nurse? https://www.registerednursing.org/specialty/charge-nurse/ ↵
• RegisteredNursing.org. (2021, January 27). Assignment, delegation and supervision: NCLEX-RN. https://www.registerednursing.org/nclex/assignment-delegation-supervision/ ↵
• State of Wisconsin Department of Health Services. (2018). Medication administration by unlicensed assistive personnel (UAP): Guidelines for registered nurses delegating medication administration to unlicensed assistive personnel. https://www.dhs.wisconsin.gov/publications/p01908.pdf ↵

Routine care, activities, and procedures that are within the authorized scope of practice of the RN, LPN/VN, or routine functions of the assistive personnel.

Leadership and Management of Nursing Care Copyright © 2022 by Kim Belcik and Open Resources for Nursing is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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55 Examples of Leadership and Management Styles in Nursing

Leadership cannot be imposed. It doesn’t come in a day. It is a long-term culture. Leadership has no boundaries. We can’t confine leadership to some limited specifications. Leadership is a basic need in every profession. All professions have some specialty in leadership. This article intends to discuss the importance of leadership and management styles in nursing.

Leadership and Management Styles in Nursing

Related: 15 inspirational traits for charismatic leaders

Some nurses have a part of leadership skills. Some are good at some level of leadership, some are at the average level of leadership as well as leadership styles in nursing management are preferred and perceived. Everyone is distinguished from one another. But, the best is that who has all of the following extraordinary leadership and management styles in nursing.

Those who don’t have can improve their effectiveness as a leader by culturing these:

1. Commitment to excellence

Commitment is a trait that gives a person a sense of responsibility that leads her to meet up the promise she undertakes with someone.

As a dynamic leader, it is your commitment to your passion and meaningful purpose. You must have the type of commitment that turns into perseverance.

Some nursing leaders seem to be committed patient advocates, lab attendants, motivation facilitators, clinicians, or employee advocates in the paper.

However, the true examination of commitment comes out when it’s difficult to go out of your comfort zone and join work with a smile on your face.

You can do it only when you can realize to serve a great purpose in your life through leadership and management styles in nursing.

Related: Future of Nursing: Top Ranked Nursing Schools in 2019

To successfully meet the challenging situation and service example in leadership and management in nursing, you should decide on three priorities every 30 days and take the nursing leadership topics as challenges to succeed. Leadership is a trait that breeds many followers.

2. Ask for feedback

On your priority nursing leadership project ideas, collect feedback on what your other colleagues are thinking about. When you comply with your team, they will stay focused. It also indicates a good insight into the strategic plan for leadership and management styles in nursing.

3. Know your passion

Many nursing leadership articles, books, and journals state that commitment to excellence starts with the leader. It is crucial to know about your passion.

Listen to your heart. Where you are is now, and where you were in the past. You will learn to serve and share your skills, abilities, talents, and commitment to your leadership process in nursing.

Related: Highest paying jobs 2019: how to negotiate a better salary

4. Self-assessment

In case you have queries or doubts about your abilities, you may reevaluate your next course of action. It is because, in the end, your leadership qualities in nursing will be reflected through your performance.

Your leadership philosophies in nursing will enable you to meet up your purpose, which will consequently increase your level of satisfaction with management styles in nursing.

5: Don’t ignore crucial issues

Service standards should be among your top priority nursing leadership jobs. Your best motivation is the higher patient satisfaction graphs, which are related to higher staff satisfaction in leadership and management styles in nursing as well. Control your anger .

Have your patience like the mountain. Measuring staff satisfaction benefits nursing leadership units, organizations departments, and teams in management styles in nursing.

6. Perfect action plan

Generate practical action plans to increase employee satisfaction, include all employee levels, and measure them every year in your nursing leadership organizations. A proper action plan speaks out about any hidden issues of leadership and management styles in nursing.

Become accustomed to your patient satisfaction measurement equipment, software, and tool. When your patients are satisfied with your service, it will automatically uplift your leadership and management styles in nursing among your team.

When you will be able to ensure quality in your nursing leadership organizations, your service will be meaningful and memorable to your patients. So, quality should be one of your top priorities. Daily practice and communication should be your core area of measurement in leadership and management styles in nursing.

When you keep this effort regularly, it will turn into a significant area in your nursing leadership units of management styles in nursing.

Related: Future Jobs for healthcare careers in demand

9. Create values among the team

Make them bloodstream in your nursing leadership organizations for leadership styles for nurses.

Make your staff, team and other employees believe that patient satisfaction, safety, and value addition are among the breadth of your nursing leadership theories.

Share and inspire your team from the front to maintain quality standards, which are a meaningful way of pleasing leadership and management styles in nursing.

A unit- and department-centric performance improvement measure is to be initiated. You should make this process practice for all in your leadership styles in nursing. An evaluation of a stipulated time will be effective.

10. Professionalism

Use your staff, and colleagues, very professionally. Human resources are a vital part to maximize success in your nursing leadership roles. Your people are your strength. Above all, you have to set examples before them. Be the role model.

11. Encourage positive conflict

A perfect team should have positive conflicts over innovation. Spur their skills and strengths to expedite your nursing leadership qualities and leadership styles in nursing management.

You can reorder the number of beds, a number of patients, or a number of services in your existing unit to justify your growing abilities in leadership and management styles in nursing.

Related: Enhance emotional intelligence skills in the workplace

12. Financial plan

Pay full attention to the financial sector of your unit. Finance is not less important than improving people, education, quality, experience, service, and implementing nursing leadership project ideas. Finance is a key trigger that is associated with the growth of leadership.

Generate your team-based financial plan preferably for a year. When there will be a budget for remuneration, training, expenses, resources, supplies, and capital investment for executing well-planned nursing leadership roles.

13. Execute a short target

Focus on executing short-term financial targets. When you miss your monthly financial goal, take initiative to recover in the following month so that you may justify nursing leadership positions.

14. Set Priorities

Your priorities will be to meet the standard for parents’ admissions, transfers, and discharges in your nursing leadership jobs.

Display the chart in a visible place, so that your team may realize the costs for belated admissions, transfers, and discharges as well as to hold patients in the emergency section, intensive care unit, and other zones.

Related: How to improve work ethics in office or business

15. Nurture professionalism

Nursing leadership organizations demand some nurse leaders who will have vision and passion for their nursing jobs. Nursing leaders should have a commitment to excellence.

Patients come to them in a distressing situations. Handling patients in a professional way meets the demand for nursing leadership jobs as well as leadership styles for nurses.

In need, a nursing leader needs to demonstrate traits like integrity, courage, ability to inspire and develop others, and empathy for both patients and the staff in the nursing leadership and management.

16. Search for a mentor

Mentors are useful coaches in nursing leadership organizations. A good mentor is an invaluable ingredient in nursing leadership jobs.

Experts in nursing leadership books, journals, theories, quotes, and articles say mentors are very essential for nurses to uplift to the next step of their position.

All mentors are not appropriate for everyone. Different mentors in nursing leadership organizations have different impacts on different positions and personalities.

You justify your need and pick your mentor for leadership and management styles in nursing accordingly. The selection tip is, pick a mentor whom you admire, or whose qualities coincide with you.

17. Patients centric

As the first and foremost duty, a nurse from a leadership position must be clinically competent as well as clinically knowledgeable in nursing leadership management and leadership styles.

The nurse clinical leader is knowledgeable, stays current in the professional, and maintains professional growth.

18. Set your action plan

Set your one, two, five, and ten-year goals that you aim to achieve from your nursing leadership position. Know your strengths and weaknesses, so that you can address these properly in leadership and management styles in nursing.

19. Self-development

None but you know yourself the most. With the pace of time, you have to uplift yourself as competitively as possible.

Learning and development have no limit. Continue to pursue education, training, and development in your area of interest or expertise.

Invest in yourself whenever possible. Read nursing leadership books, journals, quotes, quizzes, theories, articles, and certifications as many as you can.

Learn new nursing leadership topics from others. Take part in nursing leadership project ideas, conferences, courses, workshops, seminars, and competitions. No learning goes in vain.

Pay your time and effort to reflect on good leadership qualities in nursing, behaviors, and attributes. Compare your behavior with a leader’s so that you can understand what makes a good leader in nursing leadership and management roles.

You will find a lot of nursing leadership articles, quotes, books, journals, ideas, or projects that talk about growth in leadership styles in nursing.

When there will not be continuous growth in your nursing leadership, you won’t be able to estimate your growth.

Related: Creative ways to find and relate passion in a career

20. Involve yourself

Understand that the nursing leadership organization needs your contribution. Get involved in your role dedicatedly.

Create opportunities when your role is needed. Try to perform more than the expectation of your nursing leadership roles. The best leaders are those who set their little footsteps and build up from there.

Create, drive, and lead change that will have a great impact on nursing leadership and management.

Improvise some new nursing management roles that will extend your personal and professional goals. Doing more will allow you to exercise and compare your leadership capabilities.

21. Visible growth

The best way to make your growth visible is to make a proper course of action and business plans on the basis of team-based projection volume.

When you measure your growth, you can easily re-frame your growth opportunities in case your team can’t perform up to their productivity in your leadership and management styles in nursing.

22. Harness your ingenuity

Leaders must be fair and candid. They are authentic. In nursing leadership organizations, truthfulness is a sheer necessity. Be honest, ethical, and encouraging to yourself with integrity, and transparency in your nursing leadership positions.

A fantastic nurse leader is a person who has the openness and confidence to perform consistently from the front in a variety of people with inspiration, aspiration, authenticity, and values.

23. Payback

Since you take the leadership, you have to give back to the surroundings you are attached to. Assist others to achieve their goals for management styles in nursing.

When you will be able to create more leaders, you will be a successful leader in the leadership and management styles in nursing.

Be the leader of the leaders in the nursing leadership organizations. When the changes will take place, and when the achievements will be gained, your nursing leadership positions will be visible.

24. Develop a self-management goal

As a leader, your challenge is to go a long way. There will have a series of efforts and endeavors on your way to reaching your goals.

The success path is not the bed of roses. Recharge your strength, spirit, and stamina. Ensure you take care of your own health with physical activity, a healthy diet, and stress management procedures in leadership and management styles in nursing.

25. Enjoy nursing leadership

Enjoy the journey in your nursing leadership roles. Have a lot of fun. When you will have love and passion for a task, it will turn into a play.

When you love your work, and love people around you, they will also rely upon you. When you get love, respect, and acknowledgment from your team, it should be your greatest achievement in leadership and management styles in nursing.

Related: 20 traits that answer how to become a great CEO

26. Earn Credibility

Leadership is an action of credibility. When your followers will be accepting your direction, decision, and discussion from their hearts, your leadership success will reach its peak. Credibility is the foundation of leadership styles in nursing.

Followers are prone to go with a leader who is credible. It is the foundation because, without the trust and confidence of the followers, a leader is not a leader in the true sense of nursing leadership and management.

27. Keep the commitment

Commitment is a promise that is to keep. Respect your commitments in your nursing leadership roles. You have to keep your commitment to leadership and management styles in nursing. Never make a commitment that you may not be able to keep.

28. Accept mistakes

Mistakes are common in every person’s life. You won’t find anyone who never does mistakes. But the difference is that a leader accepts her mistakes and takes responsibility for mistakes.

29. Discard the blame game

A person who doesn’t have the courage to win his own frequently falls into the bad habit of playing the blame game, during real challenges. You are the leader, not any other else. Leadership mentality and spirit never give an excuse for failure.

30. Be generous

Accept the compliments with generosity in leadership and management styles in nursing. Also, lavishly compliment and praise your team members whenever they deserve this for any achievements. Take the charge of your team’s failure.

31. Listen more than speak

A good nurse leader is a good listener. It is mentioned in many nursing leadership quotes, books, and journals. In the leadership styles in nursing, listening is very important. Patients usually like a nurse who is a good listener.

Listening is the prerequisite for understanding. When you will be understanding the problem, you will address the deal properly. Listening is a way to express empathy who are around you.

32. Reflect personal values

Filter your personal values so that you can communicate them to your team and supervisor through your intention, words of mouth, and actions in leadership and management styles in the nursing environment.

33. Be productive

You should grow your productivity in your nursing leadership jobs. Growing leadership will enable you to work productively in groups or teams in leadership and management styles in nursing.

34. Be optimistic

Grow your enthusiasm for your nursing leadership activities, assignments, and ideas. Keep an optimism for the future. Be positive nurse managers as transformational and transactional leaders.

Segment your time wisely. Found in history, a person who uses his time properly can achieve a lot. Set priorities for your work, and discard activities that waste your valuable time in the nursing leadership roles.

Related: 5 reasons why people do not perform at their best

35. Personal relationship

Your personal relationship with the team will make your job much easier. Develop personal relationships and networking.

Good networking allows you to improve social skills, and emotional intelligence opportunities to expand your knowledge.

Build relationships with the patients at the individual level, as their caregiver, at their mental state, level of pain, the risk for falls, etc. intervene, counsel, and advocate for your patients in the nursing leadership roles by speaking to the care team.

36. Effective communication

Share your opinion and thoughts with related team members in your nursing leadership positions. Inform the right person in case you have found something that doesn’t seem quite right.

Stop if you notice any corruption, negligence, or incongruity by anyone in the nursing leadership organizations. Be willing to share ideas that can enhance the quality of care in your unit.

37. Enhance your knowledge

With time, your knowledge, expertise, and career goal should enhance systematically.

Grow willingness to undergo some MORE research on a patient’s condition, as well as a workflow process you deem could be further improved and systematic in the nursing leadership roles.

There are plenty of learning materials all around. Pick the right one for you.

Read nursing leadership articles, books, journals, theories, projects, and quotes, attend conferences, and seminars, and take courses, quizzes, or quilts related to leadership skills development.

Next, keep your efforts on putting these skills into practice as regularly as you can. Additionally, find out a mentor who can share knowledge, information, and learning materials with you in your nursing leadership roles.

Related: 10 life lessons people learn too late

38. Develop teamwork

Your team will be your strength. Develop a good team. Be willing to mentor less experienced, amateur nurses, and staff.

It will be a good testimonial for your nursing leadership positions. Volunteer to dedicatedly serve on a formal or informal committee.

Help others achieve their goal without any return. Proactively come forward in case you feel something needs a successful finishing.

Motivation, guidance, and support are important to equip your team. Different persons have different needs. Assess them well, mitigate negativity, and delegate property in order to ensure leadership styles for nurses.

39. Have a clear vision

Without a clear vision, anyone’s life is like an aimless journey. A journey to nowhere. A nursing leader should have a fixed vision, that should be the best of all.

The trait of the thriving leader in nursing positions is to assist others in performing their best to accomplish the optimum outcome in the end.

A charismatic leader in nursing management is a role model of confidence, which is a key leadership skill.

Every action like being proactive in every opportunity, knowing what needs to accomplish, and offering patients at the individual level a compassionate, confident, and empathetic attitude to improve their situation.

Related: Improve leading social skills essential for success at work

40: Service culture

Nursing leadership is a culture that is nurtured from the soul. It is not qualities that are imposed externally in the leadership and management styles in nursing. Motivate your colleagues to appreciate patients as more than customers.

It is your personalized services, care, and compassion that motivate your patent customers to return to your hospital, nevertheless, you even don’t have modern state-of-the-art amenities and the latest technology.

Make such a culture that your staff renders such superb services to the patients as if they are in a posh hospital. Be a role model of a servant-leader with tremendous efforts for being nurse managers as transformational and transactional leaders.

41. Etiquette

From a nursing leadership position, teach them to properly maintain telephone etiquette .

You can instruct them to take support from prompts and scripts while answering telephone calls. Here lie your successful leadership and management styles in nursing.

It is also required to welcome patients with a sincere smile on their faces when entering and leaving their rooms in leadership and management styles in nursing.

43. Proactive initiatives

Nursing leadership positions ask for proactive initiatives to be imperative, impartial, humble, open, compassionate, and available to learn every day. Remember, when your team will get a leader like you to lead, they will follow you.

44. Develop & create more leaders

One of the nursing leadership quotes is, “when your contingent or unit can play their role & run independently without you, your job is done.” This adage is obviously true. To comply with this, set a succession plan for yourself as well as your unit as early as possible.

Know the individual requirements of your team. strengths and weaknesses of your individual team members.

Celebrate publicly when any of your employees can incorporate this into the team. Reward them for success. Mitigate in case there are any seen or unseen conflicts prevail within the contingent.

Give them credits. Do regular effective meetings , mentoring, coaching, and counseling with them. Communicate properly.

Show them hope, growth, and development. Stay positive so that they also remain positive.

Related: Improve top soft skills that employers look for in future

45. Lifetime learner

A successful nurse clinical leader is a person who is a lifetime learner, a critical thinker, and open to innovative ideas.

You can’t do it all alone from your nursing leadership roles. Take assistance from other mentors, leaders, and colleagues. When you keep this practicing as a part of a nursing leadership position, your team will gradually be equipped to go on independently. Learn whatever you can.

46. Prioritize employee satisfaction

When your colleagues and staff will not be happy with their job, and the environment you give them, you will not be able to uplift your nursing leadership positions in the end. Formulate the work environment around nursing leadership roles as a fantastic place to work for all.

47. Relationship development

A personal relationship is very useful in everyday affairs. Recall names, hobbies, problems, and their children’s names on a personal level. Send gifts and cards on occasions, successes, and events.

One of the nursing leadership quotes is, that an informed employee is a satisfied employee. Review their pertinent information, new changes they faced, celebrations they observed, problems they faced, the success they achieved, etc.

Address every single issue seriously. Don’t micromanage them, but don’t even ignore their little problems, which might be bigger gradually.

48. Individual accountability

Make sure all of your employees are accountable to meet their overall goals in the assigned nursing leadership and management jobs and leadership styles in nursing management preferred and perceived.

Implement a reporting system for the individual level. An online reporting software will be good for the existing nursing leadership theories.

Google form or excel sheet is very handy to collect reports on the daily, weekly, or monthly reports on their activities, achievements, challenges faced, challenges overcome, generated impact, or any other set standard KPI.

You may also develop a simple scorecard for every staff in your nursing leadership roles. Monitor their progress, development graph, achievements, areas of improvement, etc. at regular intervals.

49. Continuous improvement

You have to assess the level of growth of your employees. When you cannot justify their performances, how will you mentor them for development in your nursing leadership and management?

SWOT approach (strengths, weaknesses, opportunities, and threats) should be working great. Give them feedback during the 1-to-1 meeting at every interval. Check out whether they finish their committed jobs or not. Manage your time well .

Keep accurate records of your leadership and management styles in nursing, for their annual performance evaluation.

When the employees will properly be evaluated, they will have something for themselves in the nursing leadership jobs.

50. Synchronize values and attitudes with vision

In nursing leadership and management, behavioral standards for all staff should be aligned with values, mission, and standards in nursing leadership organizations. Gather all initiatives taken by your team as per the set standard.

Nursing leadership project ideas should be aligned with the nursing leadership and management of the hospital.

There should be a commitment to writing. Reiterate standards regularly. They should know the nursing leadership quotes of your organization. Counsel them from your nursing leadership books when required.

51. Communicate

Proper communication is a way to hold an interdisciplinary team tight in a successful nursing leadership and management style.

Your team should know their authority in your leadership and management styles in nursing. They should also know who does what to successfully execute their nursing leadership roles.

Related: Overcome challenges of first-day work experience

52. Respect for others

You can cross the administrative responsibilities of your team so that they know each other well. It grows fellow feeling and respect for other persons.

Ensure support wherever needed. Incorporating senior personnel having hand-to-hand experience will be encouraging for the juniors.

A collaborative relationship among senior leaders and front-line leaders on nursing leadership topics will strengthen the continuous influx of nursing leadership certification.

A hospital with higher vacancy and turnover rates may incorporate them so that the team may hear about the retention and recruitment process. They should also know organizational policies, rules, and regulations.

53. Recognize achievements

People love quick recognition. Make a culture to recognize success, don’t make it delay. It is found in the research that, the contributor feels more than 70% motivated to promise better performance if they get recognition within the next 24 hours.

Your leadership and management styles in nursing should recognize and appreciate any remarkable small as well as a big success by your team members.

Ongoing recognition and reward go a long way to motivating the community and increasing creativity and innovation in the leadership and management styles in nursing.

Make your dedicated time to meet, offer words of appreciation, pat his shoulder with a candid smile on your face, and say you have an interest in them.

There are many other instances to reward and motivate your nursing leadership organizations.

Your success in a nursing leadership position greatly depends on the achievements of your team. Significant success lies when you produce more leaders behind you. It is a way of sustainable leadership in nursing organizations.

Related: How could you convert your failure to success?

55. Clarify expectation

Let your employees know your expectations from them. Set achievable and justified targets, goals, and objectives for them. Reward them in any form when they achieve as a token of appreciation from your nursing leadership position.

Collaborate, share, assist, and explain measurable data to your team on a regular basis to cultivate your leadership and management styles in nursing.

Whatever nursing position you meet, grow your nursing leadership roles by reading useful nursing leadership articles.

Your nursing leadership theories should encompass staying committed and focused. Inscribe your nursing leadership certification to the hearts of the team you have built to assist you to meet the goals and objectives.

Enlist your leadership model in nursing leadership books or journals. Create your own leadership styles in nursing instead of following the old pattern.

Everyone is not a leader, very few persons can be part of nursing leadership quotes! Through this, you will gradually be developed your leadership and management styles in nursing.

Related: Male should consider joining a nursing career

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Investigating thedistinctive nature of leadership and management in nursing

• Uncategorized

Question: Provide an overview of leadership and management in nursing. Which leadership styles are applied in nursing management? Examine the qualities of a nurse to become a good leader.

All healthcare facilities worldwide are encountering miscellaneous difficulties when providing effective and good quality healthcare. The usage of and application of innovative technologies is another challenge faced by this sector. Further technological advancements connected with this industry in the future will bring more challenges. Therefore, it is essential to maintain strong leadership and management in nursing. The challenges mentioned can only be addressed when there is strong leadership that can help foster teamwork. Having a strong nurse leader can motivate the team members to communicate and coordinate with each other on the occurrence of any issue and support each other despite having a busy schedule. A perfect nursing leader cannot be just a definition; their conduct and actions must reflect perfection in leadership. They shouldn’t be satisfied with completing a task until they are 100 per cent satisfied. Such leadership and management in nursing will always motivate the staff to work harder.

Effective nurse leaders encourage the staff members to work cooperatively to pull off common goals.Do you know the familiar quality between leadership and nursing?Compassion and careare common qualities.To pursue continuous positive leadership and management in nursing, the nurse must use various techniques like learning new and old things continuously, walking around the wards to check every patient, and mentoring all the staff members at regular intervals.

Nursing leadership demands respect and trustfor human dignity. A nurse performing leadership and management role in nursing must assist the staff in achieving a common vision. Customer-oriented must be the ultimate motive behind nursing leadership.Effective nurse leaders can be recognized when they work on their imperfections.

Suppose you are pursuing a nursing course to become a professional nurse. In that case, you must have proper organizational knowledge, knowledge about relationship building, informal coaching, monitoring and the ability to recognize the efforts of other staff members in a nursing setting. The assignments and essays that you write must demonstrate the link between leadership and management in nursing, along with patient safety. To write a standard quality nursing paper, you can avail help from TotalAssignment.com. The competent writers at the organization can help you revive your professional career in the nursing field.

Get the best Assignment Help from leading experts from the field of academics with assured onetime, 100% plagiarism free and top Quality delivery.

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Openai announces leadership transition.

Chief technology officer Mira Murati appointed interim CEO to lead OpenAI; Sam Altman departs the company.

Search process underway to identify permanent successor.

The board of directors of OpenAI, Inc., the 501(c)(3) that acts as the overall governing body for all OpenAI activities, today announced that Sam Altman will depart as CEO and leave the board of directors. Mira Murati, the company’s chief technology officer, will serve as interim CEO, effective immediately.

A member of OpenAI’s leadership team for five years, Mira has played a critical role in OpenAI’s evolution into a global AI leader. She brings a unique skill set, understanding of the company’s values, operations, and business, and already leads the company’s research, product, and safety functions. Given her long tenure and close engagement with all aspects of the company, including her experience in AI governance and policy, the board believes she is uniquely qualified for the role and anticipates a seamless transition while it conducts a formal search for a permanent CEO.

Mr. Altman’s departure follows a deliberative review process by the board, which concluded that he was not consistently candid in his communications with the board, hindering its ability to exercise its responsibilities. The board no longer has confidence in his ability to continue leading OpenAI.

In a statement, the board of directors said: “OpenAI was deliberately structured to advance our mission: to ensure that artificial general intelligence benefits all humanity. The board remains fully committed to serving this mission. We are grateful for Sam’s many contributions to the founding and growth of OpenAI. At the same time, we believe new leadership is necessary as we move forward. As the leader of the company’s research, product, and safety functions, Mira is exceptionally qualified to step into the role of interim CEO. We have the utmost confidence in her ability to lead OpenAI during this transition period.”

OpenAI’s board of directors consists of OpenAI chief scientist Ilya Sutskever, independent directors Quora CEO Adam D’Angelo, technology entrepreneur Tasha McCauley, and Georgetown Center for Security and Emerging Technology’s Helen Toner.

As a part of this transition, Greg Brockman will be stepping down as chairman of the board and will remain in his role at the company, reporting to the CEO.

OpenAI was founded as a non-profit in 2015 with the core mission of ensuring that artificial general intelligence benefits all of humanity. In 2019, OpenAI restructured to ensure that the company could raise capital in pursuit of this mission, while preserving the nonprofit's mission, governance, and oversight. The majority of the board is independent, and the independent directors do not hold equity in OpenAI. While the company has experienced dramatic growth, it remains the fundamental governance responsibility of the board to advance OpenAI’s mission and preserve the principles of its Charter.