,
,The Pedagogy
Management and Leadership for Nurse Administrators, Ninth Edition increases comprehension through various
strategies that meet the learning needs of students while also generating enthusiasm about the topic. This interac-
tive approach addresses different learning styles, making this text ideal for ensuring mastery of key concepts. The
pedagogical aids that appear in most chapters include the following:
CHAPTER 1
Influencers and Multipliers
of Nursing Leadership
Linda A. Roussel Learning Objectives:
Each chapter includes
learning objectives that
LEARNING OBJECTIVES help readers identify
1. Describe major constructs of influencing and the role of influencers. and discuss important
2. Delineate the power of multipliers in accelerating change and innovation.
3. Discuss current trends in healthcare management and their impact on quality, safety, and value-added care concepts from the text.
(care delivery).
4. Envision care delivery systems for the future.
5. Discuss major influences—specifically, Institute of Medicine (IOM), Agency for Healthcare Research and Quality
(AHRQ), Institute for Healthcare Improvement (IHI), Magnet, Baldrige, and other major stakeholders—in healthcare
systems.
6. Identify how ethics relates to managing healthcare services.
AONL KEY COMPETENCIES
American Organi-
I. Communication and relationship building IV. Professionalism
II. Knowledge of the healthcare environment V. Business skills zation for Nursing
III. Leadership
Leadership (AONL) Key
AONL KEY COMPETENCIES DISCUSSED IN THIS CHAPTER Competencies: AONL
II. Knowledge of the healthcare environment Key Competencies are
III. Leadership
IV. Professionalism outlined at the start of
II. Knowledge of the healthcare environment • Understanding each chapter, focusing
•• Clinical
of utilization and case
management
practice knowledge student attention on
Patient care delivery models and work design
knowledge •• Knowledge of quality improvement and metrics
Knowledge of risk management important concepts in
•• Healthcare economics knowledge III. Leadership the material.
• Understanding • Foundational
Healthcare policy knowledge
• Understanding of evidence-based practice •• Personal
of governance thinking skills
journey disciplines
• Outcomes measurement
• Succession planning
Ability to use systems thinking
• Knowledge of, and dedication to, patient safety • Change management
© Twomeows/Moment/Getty Images. 3
ii © Twomeows/Moment/Getty Images.
, The Pedagogy iii
4 Chapter 1 Influencers and Multipliers of Nursing Leadership
IV. Professionalism • Evidence-based clinical and management
•• Career planning
Personal and professional accountability practices
• nursing practice clinical enterprise and for
Advocacy for the
• Ethics American Association of Colleges of
• Active membership in professional organizations
AACN ESSENTIALS DOMAINS Nursing (AACN) Essentials Domains:
Domain 3: Population Health Descriptor: Population
health spans the healthcare delivery continuum from
of health care. Nurses effectively and proactively The specific AACN Essentials Domains
coordinate resources to provide safe, quality,
public health prevention to disease management of
populations and describes collaborative activities
with both traditional and non-traditional partnerships
equitable care to diverse populations.
Domain 8: Informatics and Healthcare Technologies
covered in each chapter are outlined
from affected communities, public health, industry,
academia, health care, local government entities,
Descriptor: Information and communication
technologies and informatics processes are at the beginning, so that students have
used to provide care, gather data, form
and others for the improvement of equitable
population health outcomes.
information to drive decision making, and
support professionals as they expand knowledge
awareness and can apply the domains
Domain 4: Scholarship for Nursing Practice Descriptor:
The generation, synthesis, translation, application,
and dissemination of nursing knowledge to improve
and wisdom for practice. Informatics processes
and technologies are used to manage and throughout.
improve the delivery of safe, high-quality, and
health and transform health care.
efficient healthcare services in accordance with
Domain 5: Quality and Safety Descriptor: Employment
best practice and professional and regulatory
of established and emerging principles of safety
standards.
and improvement science. Quality and safety, as
Domain 9: Professionalism Descriptor: Formation and
core values of nursing practice, enhance quality
cultivation of a sustainable professional nursing
and minimize risk of harm to patients and providers
identity, accountability, perspective, collaborative
through both system effectiveness and individual
disposition, and comportment that reflects nursing’s
performance.
characteristics and values.
Domain 6: Interprofessional Partnerships Descriptor:
Domain 10: Personal, Professional, and Leadership
Intentional collaboration across professions and
Development Descriptor: Participation in activities
with care team members, patients, families,
and self-reflection that foster personal health,
communities, and other stakeholders to optimize
resilience, and well-being, lifelong learning, and
care, enhance the healthcare experience, and
support the acquisition of nursing expertise and
Introductions: Important
strengthen outcomes.
Domain 7: Systems-Based Practice Descriptor:
Responding to and leading within complex systems
assertion of leadership.
concepts
and topics covered in each chapter
are highlighted at the beginning of the
chapter to help focus students’ attention
Introduction Gaps in Health Care on the essential material.
Healthcare delivery systems continue to be challenged COVID-19 has had an impact on nurses’ health and
by an increased demand for safer, quality care pro- the nursing workforce. Raso, Fitzpatrick, and Masick
vided in an effective and efficient way (IOM, 2001). (2021) completed a cross-sectional, descriptive study
Coupled with improving the patient experience of with more than 5,000 nurses from a national sample.
care quality and satisfaction, an intense focus on pop- Specifically, participants were asked to rate their per-
ulation health, and reducing per capita cost of health ceptions of the pandemic impact on their practice and
care, providers now face unending requirements their intent to leave their position and profession. The
to optimize health system performance (IHI, n.d.). purposes of the study were twofold: (1) to describe
Complex adaptive systems (CAS) mandate proactive the relationships between perceptions of the pan-
coordination of resources to assure equitable care to demic influence on intent to leave current
between positions
nursing leaders and staff m embers are de- • Examining coach motives
diverse populations. The COVID-19 pandemic con- and the profession of clinical nurses’
sirable and nurse
because lead-
memoranda and suggestion boxes are • Creating a discussion plan for the coaching session
tinues to shine a light on the gaps and inconsistencies
in our delivery system that impact workers’ health
ers; and (2) based on background factors, describe the
not adequate substitutes for direct co mmunication in • Initiating
and well-being.
differences in pandemic impact and intent to leave
variables. reactions involving trust and clarity(Barker, 1991). • Providing and eliciting feedback
This can be achieved through nursin g forums, round- • Having a follow-up meeting
ing, huddles, or small group meetings. As a coach, observing behaviors and responding
The third competency is management of trust, with insights and strategies go further than instructing
which is associated with reliability. Nurses respect others on what to do. This approach affords greater
leaders whose judgment is sound and consistent and opportunities for learning and advancing skills and
whose decisions are based on fairness, equity, and opportunities. Porter-O’Grady and Malloch (2007)
honesty. Staff members can be heard to comment describe innovation coaching, stating the importance
about leaders they trust with statements such as “I of creating the structure and content of the experi-
don’t always agree with her decision, but I know she ence. Specifically, the following guidelines are given
wants the best for the patients.” Bennis (1991) be- to facilitate this effort:
lieves that “people would much rather follow individ-
uals they can count on, even when they disagree with • Setting the bar high
their viewpoint, than people they agree with but who • Being clear about who you are
shift positions frequently” (p. 24). • Treating transformation as a mission, not a job
The fourth competency is management of self, • Exposing staff to different messages and different
which is knowing one’s skills and using them effec- messengers
tively. It is critical that nurses in leadership positions • Creating an egalitarian organizational structure
recognize when they lack management skills and take • Putting money where the ideas are
responsibility for their own continuing education. • Letting talented people experiment
Incompetent leaders can demoralize a nursing unit • Allowing people to share in the fruits of their
and contribute to poor patient care. When leadership creativity
skills are mastered by nurse leaders, stress and burn- Box 2-1 illustrates impediments to effective coach-
out are reduced. Nurse leaders thus need to master ing, and Figure 2-1 illustrates a transformational model
the skills of leadership (Bennis, 1991). of coaching.
Although effective leaders support shared power
and decision making, they continue to accept respon-
sibility for making decisions even when their deci-
Box 2-1 Impediments to Effective Coaching
sions are not popular. Constituents like to have their
wishes considered, but there are times when they Use of power
Chapter Related Boxes: want prompt and clear decisions from a leader. This is ■
■
Inadequate power
especially true in times of crisis. Autocratic application of power
Most chapters contain Transformational leaders are flexible and able to ■
■
Lack of empowerment
Nonstrategic use of power
adapt leadership styles to the chaos and rapid change
Chapter Related Boxes that is occurring in the current healthcare environment. Self-image
that aid in the students’ Transformational Leader
■
■
Poor self-esteem
Unclear role
■ Psychological flaws
learning of the material, as Coach
Coaching and mentoring are important skill sets for Knowledge
by providing supplemental transformational leaders. Coaching denotes a way of
■
■
Undeveloped knowledge
Learning needs
being with others that provides opportunities to facil-
examples that expand on itate growth and development (Thomas et al., 2020).
■
■
Inexperience
Lack of personal technique
Coaching requires exquisite communication skills
the chapter content. that model ways of interacting and networking with Problem solving
■ Inadequate worldview
others, whereby those coaches find ready examples
■ Intolerance of diversity
of best practices in working with others. Hill (2014) ■ No clear process
describes the predictable process of coaching, which ■ Situational solutions
includes the following:
,The Pedagogy
Management and Leadership for Nurse Administrators, Ninth Edition increases comprehension through various
strategies that meet the learning needs of students while also generating enthusiasm about the topic. This interac-
tive approach addresses different learning styles, making this text ideal for ensuring mastery of key concepts. The
pedagogical aids that appear in most chapters include the following:
CHAPTER 1
Influencers and Multipliers
of Nursing Leadership
Linda A. Roussel Learning Objectives:
Each chapter includes
learning objectives that
LEARNING OBJECTIVES help readers identify
1. Describe major constructs of influencing and the role of influencers. and discuss important
2. Delineate the power of multipliers in accelerating change and innovation.
3. Discuss current trends in healthcare management and their impact on quality, safety, and value-added care concepts from the text.
(care delivery).
4. Envision care delivery systems for the future.
5. Discuss major influences—specifically, Institute of Medicine (IOM), Agency for Healthcare Research and Quality
(AHRQ), Institute for Healthcare Improvement (IHI), Magnet, Baldrige, and other major stakeholders—in healthcare
systems.
6. Identify how ethics relates to managing healthcare services.
AONL KEY COMPETENCIES
American Organi-
I. Communication and relationship building IV. Professionalism
II. Knowledge of the healthcare environment V. Business skills zation for Nursing
III. Leadership
Leadership (AONL) Key
AONL KEY COMPETENCIES DISCUSSED IN THIS CHAPTER Competencies: AONL
II. Knowledge of the healthcare environment Key Competencies are
III. Leadership
IV. Professionalism outlined at the start of
II. Knowledge of the healthcare environment • Understanding each chapter, focusing
•• Clinical
of utilization and case
management
practice knowledge student attention on
Patient care delivery models and work design
knowledge •• Knowledge of quality improvement and metrics
Knowledge of risk management important concepts in
•• Healthcare economics knowledge III. Leadership the material.
• Understanding • Foundational
Healthcare policy knowledge
• Understanding of evidence-based practice •• Personal
of governance thinking skills
journey disciplines
• Outcomes measurement
• Succession planning
Ability to use systems thinking
• Knowledge of, and dedication to, patient safety • Change management
© Twomeows/Moment/Getty Images. 3
ii © Twomeows/Moment/Getty Images.
, The Pedagogy iii
4 Chapter 1 Influencers and Multipliers of Nursing Leadership
IV. Professionalism • Evidence-based clinical and management
•• Career planning
Personal and professional accountability practices
• nursing practice clinical enterprise and for
Advocacy for the
• Ethics American Association of Colleges of
• Active membership in professional organizations
AACN ESSENTIALS DOMAINS Nursing (AACN) Essentials Domains:
Domain 3: Population Health Descriptor: Population
health spans the healthcare delivery continuum from
of health care. Nurses effectively and proactively The specific AACN Essentials Domains
coordinate resources to provide safe, quality,
public health prevention to disease management of
populations and describes collaborative activities
with both traditional and non-traditional partnerships
equitable care to diverse populations.
Domain 8: Informatics and Healthcare Technologies
covered in each chapter are outlined
from affected communities, public health, industry,
academia, health care, local government entities,
Descriptor: Information and communication
technologies and informatics processes are at the beginning, so that students have
used to provide care, gather data, form
and others for the improvement of equitable
population health outcomes.
information to drive decision making, and
support professionals as they expand knowledge
awareness and can apply the domains
Domain 4: Scholarship for Nursing Practice Descriptor:
The generation, synthesis, translation, application,
and dissemination of nursing knowledge to improve
and wisdom for practice. Informatics processes
and technologies are used to manage and throughout.
improve the delivery of safe, high-quality, and
health and transform health care.
efficient healthcare services in accordance with
Domain 5: Quality and Safety Descriptor: Employment
best practice and professional and regulatory
of established and emerging principles of safety
standards.
and improvement science. Quality and safety, as
Domain 9: Professionalism Descriptor: Formation and
core values of nursing practice, enhance quality
cultivation of a sustainable professional nursing
and minimize risk of harm to patients and providers
identity, accountability, perspective, collaborative
through both system effectiveness and individual
disposition, and comportment that reflects nursing’s
performance.
characteristics and values.
Domain 6: Interprofessional Partnerships Descriptor:
Domain 10: Personal, Professional, and Leadership
Intentional collaboration across professions and
Development Descriptor: Participation in activities
with care team members, patients, families,
and self-reflection that foster personal health,
communities, and other stakeholders to optimize
resilience, and well-being, lifelong learning, and
care, enhance the healthcare experience, and
support the acquisition of nursing expertise and
Introductions: Important
strengthen outcomes.
Domain 7: Systems-Based Practice Descriptor:
Responding to and leading within complex systems
assertion of leadership.
concepts
and topics covered in each chapter
are highlighted at the beginning of the
chapter to help focus students’ attention
Introduction Gaps in Health Care on the essential material.
Healthcare delivery systems continue to be challenged COVID-19 has had an impact on nurses’ health and
by an increased demand for safer, quality care pro- the nursing workforce. Raso, Fitzpatrick, and Masick
vided in an effective and efficient way (IOM, 2001). (2021) completed a cross-sectional, descriptive study
Coupled with improving the patient experience of with more than 5,000 nurses from a national sample.
care quality and satisfaction, an intense focus on pop- Specifically, participants were asked to rate their per-
ulation health, and reducing per capita cost of health ceptions of the pandemic impact on their practice and
care, providers now face unending requirements their intent to leave their position and profession. The
to optimize health system performance (IHI, n.d.). purposes of the study were twofold: (1) to describe
Complex adaptive systems (CAS) mandate proactive the relationships between perceptions of the pan-
coordination of resources to assure equitable care to demic influence on intent to leave current
between positions
nursing leaders and staff m embers are de- • Examining coach motives
diverse populations. The COVID-19 pandemic con- and the profession of clinical nurses’
sirable and nurse
because lead-
memoranda and suggestion boxes are • Creating a discussion plan for the coaching session
tinues to shine a light on the gaps and inconsistencies
in our delivery system that impact workers’ health
ers; and (2) based on background factors, describe the
not adequate substitutes for direct co mmunication in • Initiating
and well-being.
differences in pandemic impact and intent to leave
variables. reactions involving trust and clarity(Barker, 1991). • Providing and eliciting feedback
This can be achieved through nursin g forums, round- • Having a follow-up meeting
ing, huddles, or small group meetings. As a coach, observing behaviors and responding
The third competency is management of trust, with insights and strategies go further than instructing
which is associated with reliability. Nurses respect others on what to do. This approach affords greater
leaders whose judgment is sound and consistent and opportunities for learning and advancing skills and
whose decisions are based on fairness, equity, and opportunities. Porter-O’Grady and Malloch (2007)
honesty. Staff members can be heard to comment describe innovation coaching, stating the importance
about leaders they trust with statements such as “I of creating the structure and content of the experi-
don’t always agree with her decision, but I know she ence. Specifically, the following guidelines are given
wants the best for the patients.” Bennis (1991) be- to facilitate this effort:
lieves that “people would much rather follow individ-
uals they can count on, even when they disagree with • Setting the bar high
their viewpoint, than people they agree with but who • Being clear about who you are
shift positions frequently” (p. 24). • Treating transformation as a mission, not a job
The fourth competency is management of self, • Exposing staff to different messages and different
which is knowing one’s skills and using them effec- messengers
tively. It is critical that nurses in leadership positions • Creating an egalitarian organizational structure
recognize when they lack management skills and take • Putting money where the ideas are
responsibility for their own continuing education. • Letting talented people experiment
Incompetent leaders can demoralize a nursing unit • Allowing people to share in the fruits of their
and contribute to poor patient care. When leadership creativity
skills are mastered by nurse leaders, stress and burn- Box 2-1 illustrates impediments to effective coach-
out are reduced. Nurse leaders thus need to master ing, and Figure 2-1 illustrates a transformational model
the skills of leadership (Bennis, 1991). of coaching.
Although effective leaders support shared power
and decision making, they continue to accept respon-
sibility for making decisions even when their deci-
Box 2-1 Impediments to Effective Coaching
sions are not popular. Constituents like to have their
wishes considered, but there are times when they Use of power
Chapter Related Boxes: want prompt and clear decisions from a leader. This is ■
■
Inadequate power
especially true in times of crisis. Autocratic application of power
Most chapters contain Transformational leaders are flexible and able to ■
■
Lack of empowerment
Nonstrategic use of power
adapt leadership styles to the chaos and rapid change
Chapter Related Boxes that is occurring in the current healthcare environment. Self-image
that aid in the students’ Transformational Leader
■
■
Poor self-esteem
Unclear role
■ Psychological flaws
learning of the material, as Coach
Coaching and mentoring are important skill sets for Knowledge
by providing supplemental transformational leaders. Coaching denotes a way of
■
■
Undeveloped knowledge
Learning needs
being with others that provides opportunities to facil-
examples that expand on itate growth and development (Thomas et al., 2020).
■
■
Inexperience
Lack of personal technique
Coaching requires exquisite communication skills
the chapter content. that model ways of interacting and networking with Problem solving
■ Inadequate worldview
others, whereby those coaches find ready examples
■ Intolerance of diversity
of best practices in working with others. Hill (2014) ■ No clear process
describes the predictable process of coaching, which ■ Situational solutions
includes the following:
