Nursing Leadership and Management: Theories, Processes and Practice doc

Nursing
Leadership
Management
Nursing
Leadership
and
Management
Theories, Processes and Practice
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Nursing
Leadership
Management
Rebecca A. Patronis Jones, DNSc, RN, CNAA, BC
Chancellor and Professor
West Suburban College of Nursing
Oak Park, IL
Rebecca A. Patronis Jones, DNSc, RN, CNAA, BC
Nursing
Leadership
and
Management
Theories, Processes and Practice

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F.A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright
©
2007 by F.A. Davis Company
All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Publisher: Joanne P. DaCunha, RN, MSN
Developmental Editor: Caryn Abramowitz
Project Manager: Kristin L. Kern
Manager of Art & Design: Carolyn O’Brien
As new scientific information becomes available through basic and clinical research, recommended
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contents of the book. Any practice described in this book should be applied by the reader in accordance
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Library of Congress Cataloging-in-Publication Data
Jones, Rebecca A. Patronis.
Nursing leadership and management : theories, processes, and practice / by Rebecca Patronis Jones.

p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1362-1 (pbk. : alk. paper)
1. Nursing services—Administration. 2. Nurse administrators. 3. Leadership. I. Title.
[DNLM: 1. Leadership—Problems and Exercises. 2. Nursing, Supervisory—Problems and Exercises. 3.
Nursing Care—organization & administration—Problems and Exercises. WY 105 J78n 2007]
RT89.J645 2007
610.68—dc22 2006034670
Authorization to photocopy items for internal or personal use, or the internal or personal use of spe-
cific clients, is granted by F.A. Davis Company for users registered with the Copyright Clearance Center
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Transactional Reporting Service is: 8036-1362/07 0 ϩ $.10.
00Jones Leadership(F)-FM 1/16/07 9:29 PM Page x
To all of the chapter authors for their diligence in going the extra mile to create both
student and instructor learning materials that enhance the content of this book.
To my husband Robert, daughter Aislan, and parents Jim and Ada Lee for their words of
encouragement; and to the nurses from three generations of my family, Alice, Zelma, Jean,
Patty, and Ginger, who have provided numerous stories about nursing. And last to Abbie,
who provided nursing care to all of the members of our family in need.
dedication
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xiii
preface
Introduction
Nurses lead and manage nursing care for patients,
families, aggregates, and communities in a variety

of settings, ranging from ambulatory to community
to inpatient. Nurses also lead and manage care
across the health-care continuum, including pri-
mary health promotion and prevention; secondary
skilled, long term, and rehabilitative; and tertiary:
emergent, urgent, and acute care. Strategies are
drawn from both leadership and management theo-
ries. Leadership involves both the leader and the
follower. In this text, we have defined Leadership
as the process of envisioning a new and better
world, communicating that vision to others, moti-
vating others and enticing them to join in efforts
to realize the vision, thinking in a different way,
challenging the status quo, taking risks, and facili-
tating change (Valiga and Grossman). Effective
Followers are individuals who work with and sup-
port leaders in their efforts to realize a vision by
being engaged rather than alienated, suggesting
new ideas and options, providing critical feedback
on the ideas of others (including the leader), pro-
moting positive relationships within the group, and
acting as potential “leaders-in-waiting” (Valiga and
Grossman). Management, one of the responsibili-
ties of leadership, is a five-step process that com-
prises planning, organizing, directing, coordinating,
and controlling (Garrison, Morgan, and Johnson).
The nurse’s approach to leadership and manage-
ment reflects the dynamic state of nursing practice
and health care. Leadership has evolved from theo-
ries of the past, which pronounced that only great

and noble men could be leaders, to more current
theories that look at leadership as a learned process
or a changing role depending on the situation.
Management has evolved from competing manage-
rial activities in a hierarchical, bureaucratic organi-
zation to complexity theory involving both the
physical and social sciences. We have included a dis-
cussion of each of these concepts and theories in
this textbook.
Purpose
The book is based on the philosophy that all nurses
are leaders who use creative decision making, entre-
preneurship, and life-long learning to create a work
environment that is efficient, cost-effective, and
committed to quality care. With that in mind, the
primary goal for the textbook is to provide broad
and comprehensive coverage of leadership and
management theories and processes by synthesizing
information from nursing, health care, general
administration and management, and leadership lit-
erature and applying it to nursing. The book should
engage readers with learning activities that will
teach them how to research decision-making data
(participatory action research process) and analyze
and make reliable choices in managing their work
environment. The content is based on research
from several disciplines and provides a theory-based
scholarly, yet practical, approach that is consistent
with higher education.
Each chapter synthesizes information from nurs-

ing, health care, general administration and man-
agement, and leadership literature and incorporates
relevant examples, case studies, vignettes, and best
practices from leading experts in these fields.
Specific Objectives
The nurse is viewed as a proactive decision maker
and problem solver engaged in critical thinking.
Thus, the first specific objective of the book is to
keep the student engaged in the learning process.
The second goal of the book is to guide students
toward applying the theory to practice and integrat-
ing evidence-based practice. Chapters require the
student to participate in current research and analy-
sis of the literature to become an active learner.
Research briefs occur throughout various chapters
to assist the student with application to practice and
evidence-based practice to reach the second specific
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objective of the textbook. The third specific objec-
tive of the book is to help faculty keep students
engaged in the learning process by providing the
instructor with numerous elements on which to
build the evaluation.
Key Features
Pedagogy included in the chapters follows:
• Chapter Motivation (a quotation representa-
tive of the chapter’s content)
• Chapter Motives (measurable objectives for
the chapter)
• Hot Topic (brief discussion of something cur-

rently at the forefront of the topic of a chapter)
• Chapter Star (description of a real-life person
performing services that apply to the chapter
in an exceptional way)
• Practice to Strive For (box focusing on best
practices in the area of the chapter)
• Practice Proof (description of research study,
with questions, to encourage thinking about
evidence-based practice)
• All Good Things (summary of the chapter)
• Let’s Talk (discussion and thought questions
regarding the chapter content and related
areas)
• Names of Web sites
• References
• NCLEX-style Test Questions
An Instructor’s CD package includes:
• Chapter objectives
• Glossary of terms used throughout the book
• Case studies with discussion questions and
answers
• Learning exercises
• Names of Web sites
• PowerPoint slide presentation with key points
for each chapter
• Image bank
• A test bank with multiple-choice and short-
answer essay questions
A student CD will accompany each book and
include:

• Chapter objectives
• Study notes (PowerPoint slides of key points
for each chapter)
• Group/individual interactive learning exer-
cises or clinical scenarios that require students
to gather data and apply theory to solve prob-
lems
• Discussion questions
• Case studies
• Interactive self-assessment exercises
• Résumé help
• Games
• Names of Web sites
• A practice test bank
Tour of the Units and Chapters
The text is divided into five major parts with corre-
sponding chapters. Part 1 focuses on understanding
the theories of leading, following, and managing.
The first three chapters are devoted to these topics
and theories. The third chapter focuses on motiva-
tional theory. Part 2 provides information to aid
readers in understanding organizations. Chapters
4 through 9 describe organizational structures and
cover legal, ethical, and economic issues and influ-
ences related to the regulation of nursing care.
This part also offers information on communica-
tion, both organizational and through the use of
computers, or informatics. Part 3 discusses the
skills needed to be an effective leader. Chapters 10
through 13 provide the reader with the latest deci-

sion-making and problem-solving theories and
strategies. Part 3 also covers the concepts of change,
team building, power, politics, and influence, along
with tips for the new nurse leader on how to use
these concepts. Part 4 focuses on the skills for being
an effective manager. Chapters 14 through 21 cover
the nuts and bolts of management. The theoretical
base, principles, techniques, and strategies for the
day-to-day management of nursing care are
described in detail. Readers will learn how to plan,
manage quality and risk, budget, staff and schedule,
deal with conflict, and delegate to manage nursing
care. The concept of culture is also discussed. Part 5
changes the focus to the skills new nurses need for
a successful career. In Chapters 22 through 25, the
reader will learn how to manage one’s self and how
to obtain the important first job.
xiv Preface
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xv
contributors
NANCY HOWELL AGEE, RN, MN
Chief Operating Officer/Executive Vice President
Carilion Health System
Roanoke, VA
SHARON BATOR, MSN, RN
Assistant Professor
Southern University School of Nursing
Baton Rouge, LA
CONNIE J. BOERST, MSN, RN, BC

Assistant Professor
Bellin College of Nursing
Green Bay, WI
BARBARA B. BREWER, MALS, MBA, PHD, RN
Director of Professional Practice
John C. Lincoln North Mountain Hospital
Phoenix, AZ
CAROLINE CAMUÑAS, EDD, RN
Adjunct Associate Professor
Teachers College, Columbia University
New York, NY
Research Coordinator
J. J. Peters VA Medical Center
Bronx, NY
THERESA L. CARROLL, RN, PHD, CNAA
Professor, Department of Nursing Systems
University of Texas School of Nursing at
Houston
Houston, TX
BARBARA SHELDEN CZERWINSKI, PHD, RN,
CNAA-BC, FAAN
The Ohio State University Medical Center
Clinical Nurse Scientist
Columbus, OH
JUDY A. DAVIS, MS, MPH, APN, CNP
Clinical Faculty
University of Illinois at Chicago
Chicago, IL
MARY E. HORTON, ELLIOTT, DNSC, RN
Associate Professor

West Suburban College of Nursing
Oak Park, IL
BETSY FRANK, RN, PHD
Professor
Indiana State University College of Nursing
Terre Haute, IN
ELIZABETH GANEY-CODE, MSN, RN
Patient Care Nurse Manager
University of Texas MD Anderson Cancer Center
Houston, TX
SHIRLEY GARICK, PHD, RN MSN, ABQARP
DIPLOMATE, LEGAL NURSE CONSULTANT
(LNC)
Associate Professor
College of Health & Behavioral Sciences
Texas A&M University
Texarkana, TX
DEBORAH R. GARRISON, PHD, RN
Associate Professor
Associate Dean, Graduate Nursing Programs
University of Toledo
Toledo, OH
SHEILA C. GROSSMAN, PHD, APRN-BC
Professor and Director of Family Nurse
Practitioner Program
Fairfield University School of Nursing
Fairfield, CT
MICHELLE B. HAGADORN, MA, CPA
Masters of Accountancy
Assistant Professor of Business Administration

and Economics
Roanoke College
Salem, VA
EMILY HARMAN, MSN, RN
Assistant Professor and Associate Director of the
RN to BSN PRogram
Ohio University School of Nursing
Athens, OH
PATRICIA M. HAYNOR, DNSC, RN, NHA
Villanova University
Villanova, PA
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JACQUELINE J. HILL, PHD, RN, CRRN
Associate Professor
Interim Chair, Undergraduate Nursing Program
Southern University School of Nursing
Baton Rouge, LA
STACY GRANT HOHENLEITNER, MSN, RN,
CNA, NHA
Villanova University
Villanova, PA
DEBORAH A. JASOVSKY, MSN, PHD, RN,
CNAA, BC
Director of Nursing—Special Projects and
Magnet Project Director
Raritan Bay Medical Center
Perth Amboy, NJ
JEWETT J. JOHNSON, MS, RN
Assistant Professor
Wilson School of Nursing

Midwestern State University
Wichita Falls, TX
ESPERANZA VILLANUEVA JOYCE, EDD, CNS,
RN
Professor
School of Nursing
New Mexico State University
Athens, OH
JOSEPHINE KAHLER, EDD, RN, CS
Dean/Professor
College of Health & Behavioral Sciences
Texas A&M University-Texarkana
Texarkana, TX
MARY KAMIENSKI, PHD, RN, APRN-C, FAEN
Assistant Dean Graduate Nursing Programs
University of Medicine and Dentistry
Newark, NJ
PATRICIA MARTINEZ, MD
Chief Quality Officer
Asante Health System
Medford, OR
SHARON MCLANE, MBA, RN, BC
Director Nursing Informatics
University of Texas MD Anderson Cancer Center
Houston, TX
DEBRA A. MORGAN, EDD, RN
Assistant Professor and Coordinator of the RN
to BSN and RN to MSN Programs
Wilson School of Nursing
Midwestern State University

Wichita Falls, TX
CAROLE A. MUTZEBAUGH, EDD, NP, CNS
Consultant, Care Management Associates
Director, Foundation for Care Management
Foundation for Care Management
Vashon, WA
MARY E. O’KEEFE, RN, PHD, JD
Legal Nurse Consultant
Mills Shirley L.L.P.
Galveston, TX
CARLA G. PHILIPS, PHD, RN
Ohio University School of Nursing
Athens, OH
DENISE TOP RHINE, MED, RN, CEN
Professor
Oakton College
Des Plaines, IL
CAROL SEAVOR, EDD, RN
President
Jefferson College of Health Sciences
Roanoke, VA
SUSAN SPORTSMAN, PHD, RN
Dean
College of Health Sciences and Human Services
Midwestern State University
Wichita Falls, TX
GEORGIANNA THOMAS, EDD, RN
Dean and Associate Professor
West Suburban College of Nursing
Oak Park, IL

THERESA M. VALIGA, EDD, RN, FAAN
Chief Program Officer
National League for Nursing
New York, NY
SHARON WALKER, MA
Career Planning Specialist
Our Lady of the Lake College
Baton Rouge, LA
xvi Contributors
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xvii
reviewers
JOAN MANNING BAKER, RN, MSN, CCRN
Assistant Professor
Molloy College
Rockville Centre, NY
THOMAS BEEMAN, RN, PHD
Director, Undergraduate Nursing
University of Texas
El Paso, TX
MARY HILL, RN, DSN
Associate Professor
University of Mississippi
Jackson, MS
SUSAN MEYER, RN, MSN
Assistant Professor
Mount St. Mary’s College
Los Angeles, CA
KAY MUGGENBURG, RN, PHD
Assistant Professor

University of Kentucky
Lexington, KY
VIVIAN SCHRADER, PHD, RN
Associate Professor
Boise State University
Boise, ID
PAMELA WHEELER, RN, PHD
Associate Professor
Linfield College
Portland, OR
JOYCE M. WOODS, RN, PHD
Nursing Instructor
Mount Royal College
Calgary, AB, Canada
POLLY GERBER ZIMMERMANN, RN, MS, MBA,
CEN
Assistant Professor, Department of Nursing
Harry S Truman College
Chicago, IL
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xix
acknowledgments
A special thanks to Caryn Abramowitz and Mary
Horton Elliott, DNSc, RN, Associate Professor,
West Suburban College of Nursing, Oak Park, IL,
for their assistance in the development of the ancil-
lary materials.
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xxi
contents
Part 1 Understanding the Theory
of Leading, Following, and
Managing,1
Chapter 1 Leadership and Followership, 3
Chapter 2 Management Theory, 13
Chapter 3 Motivating Yourself and Others
for a Satisfying Career, 29
Part 2 Understanding
Organizations 39
Chapter 4 Understanding Organizational
Structures, 41
Chapter 5 Legal and Ethical Knowledge for
Nurses, 57
Chapter 6 Regulating Nursing, 69
Chapter 7 Economic Influences, 95
Chapter 8 Organizational Communication,
113
Chapter 9 Informatics, 131
Part 3 Skills for Being an
Effective Leader, 149
Chapter 10 Enhancing Your Critical
Thinking, Decision Making, and Problem
Solving, 151
Chapter 11 Nurses Leading Change, 167
Chapter 12 Building Teams for Productivity
and Efficiency, 183

Chapter 13 Power, Politics, and Policy, 201
Part 4 Skills for Being an
Effective Manager, 221
Chapter 14 Planning and Marketing for a
Healthy Organization, 223
Chapter 15 Managing Quality and Patient
Safety, 239
Chapter 16 Budgeting, 265
Chapter 17 Staffing and Scheduling, 279
Chapter 18 Maximizing Employee
Performance, 297
Chapter 19 Nursing Celebrates Cultural
Diversity, 315
Chapter 20 Constructive Conflict
Management, 329
Chapter 21 Delegation: An Art of
Professional Practice, 345
Part 5 Skills for a Successful
Career, 357
Chapter 22 Manage Yourself for a More
Fulfilling Career, 359
Chapter 23 Getting Your First Job, 375
Chapter 24 Career Development, 389
Chapter 25 Managing Your Professional and
Financial Future, 415
Index, 431
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UNDERSTANDING

THE THEORY
OF LEADING,
FOLLOWING,
AND MANAGING
1
1
UNDERSTANDING
THE THEORY
OF LEADING,
FOLLOWING,
AND MANAGING
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