Fluent Essays

Legal Cases   #2 The patient’s chart indicated that she had serious difficulty with her balance which made it necessary for her to have assistance when standing or walking with a walker and when transferring.  She had fallen backward six days earlier, but was caught and lowered to the floor without injury.  She was afraid of falling and needed not only physical assistance, but also encouragement to take steps forward with her walker.   According to the court, the student nurse had read the patient’s chart and knew the patient had weakness and an unsteady gait.  Nevertheless, the student nurse helped her up from the commode, then walked away and left the patient standing with her walker in the bathroom, while the student nurse propped the door hinge open and adjusted her wheelchair, expecting the patient to walk to the wheelchair on her own.  The patient took a step forward, fell backward and was injured. Questions Legal Issues in Nursing Read the legal case studies. As a nurse, you may encounter similar situations someday.  1.Should this case have reached the courts? Why or why not? 2.Was there an error in judgment on the part of the nurse? If so, what should have been considered or done differently? If not, why not? 3.Who, ultimately, is responsible for what happened? 4.Justify your answers using legal guidelines that you have learned in school.  Bottom of Form INSTRUCTIONS: CITE USING APA 7TH EDITION WHEN ANSWERING QUESTIONS, SIMPLE ENGLISH PLEASE. • Sally A. Weiss and Ruth M. Tappen • • • • • • • • • • • ••• • ••• • ••• •••••••••• • •••• • • • • • • • • • • • • • • • •• • •• • •• • • • • • • . Essentials of Nursing Leadership and Management • • • • • • • I • •• Essentials of Nursing Leadership and Management SIXTH EDITION 3663_FM_i-xii.indd i3663_FM_i-xii.indd i 9/17/2014 3:01:42 PM9/17/2014 3:01:42 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM Essentials of Nursing Leadership and Management SIXTH EDITION Sally A. Weiss, MSN, EdD, RN, CNE, ANEF Professor of Nursing Nova Southeastern University Nursing Department Fort Lauderdale, Florida Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor Florida Atlantic University College of Nursing Boca Raton, Florida 3663_FM_i-xii.indd iii3663_FM_i-xii.indd iii 9/17/2014 3:01:43 PM9/17/2014 3:01:43 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015, 2010, 2007, 2004, 2001, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor, Nursing: Megan Klim Developmental Editor: Laurie Sparks Director of Content Development: Darlene D. Pedersen Content Project Manager: Echo Gerhart Electronic Project Editor: Katherine Crowley Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treat- ments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from appli- cation of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infre- quently ordered drugs. Library of Congress Control Number: 2014945714 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rose- wood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Report- ing Service is: 978-0-8036-3663-7/15 0 + $.25. 3663_FM_i-xii.indd iv3663_FM_i-xii.indd iv 9/17/2014 3:01:45 PM9/17/2014 3:01:45 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black v Dedication To my granddaughter Sydni and my grandson Logan, who remind me how important it is to nurture our young nurses and help them learn and grow. —SALLY A. WEISS To students, colleagues, family, and friends, who have taught me so much about leadership. —RUTH M. TAPPEN 3663_FM_i-xii.indd v3663_FM_i-xii.indd v 9/17/2014 3:01:45 PM9/17/2014 3:01:45 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM vii Preface We are delighted to bring our readers this Sixth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the dynamic health care environment, safety initiatives, and changes in nursing practice. As in our previous editions, the content, examples, and diagrams were designed with the goal of assisting the new graduate to make the transition to professional nursing practice. The Sixth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as an integral member of the interprofessional health- care team and manager of patient care. Issues related to setting priorities, delegation, quality improve- ment, legal parameters of nursing practice, and ethical issues are updated for this edition. This edition focuses on the current quality and safety issues and initiatives impacting the current health-care environment. We continue to bring you comprehensive, practical information on develop- ing a nursing career. Updated information on leading, managing, followership, and workplace issues continue to be included. Essentials of Nursing Leadership and Management provides a strong foundation for the beginning nurse leader. We would like to thank the people at F. A. Davis for their assistance and our contribu- tors, reviewers, and students for their guidance and support. —SALLY A. WEISS —RUTH M. TAPPEN 3663_FM_i-xii.indd vii3663_FM_i-xii.indd vii 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM ix Contributor PATRICIA BRADLEY, MED, PHD, RN Coordinator, Internationally Educated Nurses Program Faculty, Nursing Department York University Toronto, Ontario, Canada Reviewers WENDY GREENSPAN, MSN, RN, CCRN, CNE Assistant Professor Rockland Community College Suffem, New York PAULA HOPPER, MSN, RN, CNE Professor of Nursing Jackson Community College Jackson, Mississippi CLAIRE MEGGS, MSN, RN Associate Professor Lincoln Memorial University Harrogate, Tennessee LUISE SPEAKMAN, PHD, RN Adjunct Faculty, Nursing Cape Cod Community College West Barnstable, Massachusetts JENNIFER SUGG, RN, BSN, MSN, CCRN Nursing Instructor Wayne Community College Goldsboro, North Carolina 3663_FM_i-xii.indd ix3663_FM_i-xii.indd ix 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM xi Table of Contents unit 1 Professional Considerations 1 chapter 1 Leadership and Followership 3 chapter 2 Manager 17 chapter 3 Nursing Practice and the Law 27 chapter 4 Questions of Values and Ethics 49 unit 2 Working Within an Organization 69 chapter 5 Organizations, Power, and Empowerment 71 chapter 6 Communicating With Others and Working With the Interprofessional Team 87 chapter 7 Delegation and Prioritization of Client Care 103 chapter 8 Dealing With Problems and Conflict 121 chapter 9 People and the Process of Change 133 unit 3 Career Considerations 145 chapter 10 Issues of Quality and Safety 147 chapter 11 Promoting a Healthy Work Environment 173 unit 4 Professional Issues 203 chapter 12 Your Nursing Career 205 chapter 13 Evolution of Nursing as a Profession 225 chapter 14 Looking to the Future 235 3663_FM_i-xii.indd xi3663_FM_i-xii.indd xi 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black xii ■ Table of Contents Appendices appendix 1 Codes of Ethics for Nurses 247 American Nurses Association Code of Ethics for Nurses Canadian Nurse Association Code of Ethics for Registered Nurses The International Council of Nurses Code of Ethics for Nurses appendix 2 Standards Published by the American Nurses Association 249 appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 251 3663_FM_i-xii.indd xii3663_FM_i-xii.indd xii 9/17/2014 3:01:46 PM9/17/2014 3:01:46 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black unit 1 Professional Considerations chapter 1 Leadership and Followership chapter 2 Manager chapter 3 Nursing Practice and the Law chapter 4 Questions of Values and Ethics 3663_Unit I_0001-0002.indd 13663_Unit I_0001-0002.indd 1 9/15/2014 4:37:34 PM9/15/2014 4:37:34 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 3663_Unit I_0001-0002.indd 23663_Unit I_0001-0002.indd 2 9/16/2014 11:25:22 AM9/16/2014 11:25:22 AM 3 chapter 1 Leadership and Followership OBJECTIVES After reading this chapter, the student should be able to: ■ Define the terms leadership and followership. ■ Discuss the importance of effective leadership and followership for the new nurse. ■ Discuss the qualities and behaviors that contribute to effective leadership. ■ Discuss the qualities and behaviors that contribute to effective followership. OUTLINE Leadership Are You Ready to Be a Leader? Leadership Defined What Makes a Person a Leader? Leadership Theories Trait Theories Behavioral Theories Task Versus Relationship Motivation Theories Emotional Intelligence Situational Theories Transformational Leadership Moral Leadership Caring Leadership Qualities of an Effective Leader Behaviors of an Effective Leader Followership Followership Defined Becoming a Better Follower Managing Up Conclusion Nurses study leadership to learn how to work well with other people. We work with an extraordinary variety of people: technicians, aides, unit managers, housekeepers, patients, patients’ families, physi- cians, respiratory therapists, physical therapists, social workers, psychologists, and more. In this chapter, the most prominent leadership theories are introduced. Then, the characteristics and behaviors that can make you, a new nurse, an effective leader and follower are discussed. Leadership Are You Ready to Be a Leader? You may be thinking, “I’m just beginning my career in nursing. How can I be expected to be a leader now?” This is an important question. You will need time to refine your clinical skills and learn how to function in a new environment. But you can begin to assume some leadership functions right away within your new nursing roles. In fact, leadership should be seen as a dimension of nursing practice (Scott & Miles, 2013). Consider the following example: Billie Thomas was a new staff nurse at Green Valley Nursing Care Center. After orientation, she was assigned to a rehabilitation unit with high ad- mission and discharge rates. Billie noticed that admissions and discharges were assigned rather hap- hazardly. Anyone who was “free” at the moment was directed to handle them. Sometimes, unlicensed as- sistant personnel were directed to admit or discharge residents. Billie believed that this was inappropriate because they are not prepared to do assessments and they had no preparation for discharge planning. Billie had an idea how discharge planning could be improved but was not sure that she should bring it up because she was so new. “Maybe they’ve already thought of this,” she said to a former classmate. They began to talk about what they had learned in their leadership course before graduation. “I just keep hearing our instructor saying, ‘There’s only one manager, but anyone can be a leader.’ ” “If you want to be a leader, you have to act on your idea. Why don’t you talk with your nurse manager?” her friend asked. “Maybe I will,” Billie replied. Billie decided to speak with her nurse manager, an experienced rehabilitation nurse who seemed not 3663_Chapter 1_0003-0016.indd 33663_Chapter 1_0003-0016.indd 3 9/15/2014 4:36:35 PM9/15/2014 4:36:35 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 4 unit 1 ■ Professional Considerations only approachable but also open to new ideas. “I have been so busy getting our new electronic health record system on line before the surveyors come that I wasn’t paying attention to that,” the nurse manager told her. “I’m glad you brought it to my attention.” Billie’s nurse manager raised the issue at the next executive meeting, giving credit to Billie for having brought it to her attention. The other nurse manag- ers had the same response. “We were so focused on the new electronic health record system that we overlooked that. We need to take care of this situa- tion as soon as possible. Billie Thomas has leadership potential.” Leadership Defined Successful nurse leaders are those who engage others to work together effectively in pursuit of a shared goal. Examples of shared goals in nursing would be providing excellent care, reducing infec- tion rates, designing cost-saving procedures, or challenging the ethics of a new policy. Leadership is a much broader concept than is management. Although managers need to be leaders, management itself is focused specifically on achievement of organizational goals. Leadership, on the other hand: . . . occurs whenever one person attempts to influence the behavior of an individual or group—up, down, or sideways in the organization—regardless of the reason. It may be for personal goals or for the goals of others, and these goals may or may not be congru- ent with organizational goals. Leadership is influ- ence (Hersey & Campbell, 2004, p. 12). In order to lead, one must develop three important competencies: (1) diagnose: ability to understand the situation you want to influence, (2) adapt: make changes that will close the gap between the current situation and what you are hoping to achieve, and (3) communicate. No matter how much you diag- nose or adapt, if you cannot communicate effec- tively, you will probably not meet your goal (Hersey & Campbell, 2004). What Makes a Person a Leader? Leadership Theories There are many different ideas about how a person becomes a good leader. Despite years of research on this subject, no one idea has emerged as the clear winner. The reason for this may be that different qualities and behaviors are most important in dif- ferent situations. In nursing, for example, some situations require quick thinking and fast action. Others require time to figure out the best solution to a complicated problem. Different leadership qualities and behaviors are needed in these two instances. The result is that there is not yet a single best answer to the question, “What makes a person a leader?” Consider some of the best-known leadership theories and the many qualities and behaviors that have been identified as those of the effective nurse leader (Pavitt, 1999; Tappen, 2001): Trait Theories At one time or another, you have probably heard someone say, “She’s a born leader.” Many believe that some people are natural leaders, while others are not. It is true that leadership may come more easily to some than to others, but everyone can be a leader, given the necessary knowledge and skill. An important 5-year study of 90 outstanding leaders by Warren Bennis published in 1984 identi- fied four common traits. These traits hold true today: 1. Management of attention. These leaders communicated a sense of goal direction that attracted followers. 2. Management of meaning. These leaders created and communicated meaning and purpose. 3. Management of trust. These leaders demonstrated reliability and consistency. 4. Management of self. These leaders knew themselves well and worked within their strengths and weaknesses (Bennis, 1984). Behavioral Theories The behavioral theories focus on what the leader does. One of the most influential behavioral theo- ries is concerned with leadership style (White & Lippitt, 1960) (Table 1-1). The three styles are: 1. Autocratic leadership (also called directive, controlling, or authoritarian). The autocratic leader gives orders and makes decisions for the group. For example, when a decision needs to be made, an autocratic leader says, “I’ve decided that this is the way we’re going to solve our 3663_Chapter 1_0003-0016.indd 43663_Chapter 1_0003-0016.indd 4 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black chapter 1 ■ Leadership and Followership 5 problem.” Although this is an efficient way to run things, it squelches creativity and may reduce team member motivation. 2. Democratic leadership (also called participative). Democratic leaders share leadership. Important plans and decisions are made with the team (Chrispeels, 2004). Although this appears to be a less efficient way to run things, it is more flexible and usually increases motivation and creativity. In fact, involving team members, giving them “permission to think, speak and act” brings out the best in them and makes them more productive, not less (Wiseman & McKeown, 2010, p. 3). Decisions may take longer to make, but once made everyone supports them (Buchanan, 2011). 3. Laissez-faire leadership (also called permissive or nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision making and fails to encourage others to do it. It is really a lack of leadership. For example, when a decision needs to be made, a laissez- faire leader may postpone making the decision or never make the decision at all. In most instances, the laissez-faire leader leaves people feeling confused and frustrated because there is no goal, no guidance, and no direction. Some mature, self-motivated individuals thrive under laissez-faire leadership because they need little direction. Most people, however, flounder under this kind of leadership. Pavitt summed up the differences among these three styles: a democratic leader tries to move the group toward its goals; an autocratic leader tries to move the group toward the leader’s goals; and a laissez-faire leader makes no attempt to move the group (1999, pp. 330ff ). Task Versus Relationship Another important distinction is between a task focus and a relationship focus (Blake, Mouton, & Tapper, 1981). Some nurses emphasize the tasks (e.g., administering medication, completing patient records) and fail to recognize that interpersonal relationships (e.g., attitude of physicians toward nursing staff, treatment of housekeeping staff by nurses) affect the morale and productivity of employees. Others focus on the interpersonal aspects and ignore the quality of the job being done as long as people get along with each other. The most effective leader is able to balance the two, attending to both the task and the relationship aspects of working together. Motivation Theories The concept of motivation seems simple: we will act to get what we want but avoid whatever we don’t want to do. However, motivation is still sur- rounded in mystery. The study of motivation as a focus of leadership began in the 1920s with the historic Hawthorne studies. Several experi- ments were conducted to see if increasing light and, later, improving other working conditions would increase the productivity of workers in the Haw- thorne, Illinois, electrical plant. This proved to be true, but then something curious happened: when the improvements were taken away, the workers continued to show increased productivity. The researchers concluded that the explanation was found not in the conditions of the experiments but in the attention given to the workers by the experimenters. table 1-1 Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles Autocratic Democratic Laissez-Faire Amount of freedom Little freedom Moderate freedom Much freedom Amount of control High control Moderate control Little control Decision making By the leader Leader and group together By the group or by no one Leader activity level High High Minimal Assumption of responsibility Leader Shared Abdicated Output of the group High quantity, good quality Creative, high quality Variable, may be poor quality Efficiency Very efficient Less efficient than autocratic style Inefficient Source: Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and democracy: An experimental inquiry. New York: Harper & Row. 3663_Chapter 1_0003-0016.indd 53663_Chapter 1_0003-0016.indd 5 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black 6 unit 1 ■ Professional Considerations Frederick Herzberg and David McClelland also studied factors that motivated workers in the work- place. Their findings are similar to the elements in Maslow’s Hierarchy of Needs. Table 1-2 summa- rizes these three historical motivation theories that continue to be used by leaders today (Herzberg, 1966; Herzberg, Mausner, & Snyderman, 1959; Maslow, 1970; McClelland, 1961). Emotional Intelligence The relationship aspects of leadership are also the focus of the work on emotional intelligence and leadership (Goleman, Boyatzes, & McKee, 2002). From the perspective of emotional intelligence, what distinguishes ordinary leaders from leadership “stars” is that the “stars” are consciously addressing the effect of people’s feelings on the team’s emo- tional reality. How is this done? First, the emotionally intel- ligent leader recognizes and understands his or her own emotions. When a crisis occurs, he or she is able to manage them, channel them, stay calm and clearheaded, and suspend judgment until all the facts are in (Baggett & Baggett, 2005). Second, the emotionally intelligent leader welcomes constructive criticism, asks for help when needed, can juggle multiple demands with- out losing focus, and can turn problems into opportunities. Third, the emotionally intelligent leader listens attentively to others, recognizes unspoken concerns, acknowledges others’ perspectives, and brings people together in an atmosphere of respect, coop- eration, collegiality, and helpfulness so they can direct their energies toward achieving the team’s goals. “The enthusiastic, caring, and supportive leader generates those same feelings throughout the team,” wrote Porter-O’Grady of the emotionally intelligent leader (2003, p. 109). Situational Theories People and leadership situations are far more complex than the early theories recognized. Situa- tions can also change rapidly, requiring more complex theories to explain leadership (Bennis, Spreitzer, & Cummings, 2001). Instead of assuming that one particular approach works in all situations, situational theories recog- nize the complexity of work situations and encour- age the leader to consider many factors when deciding what action to take. Adaptability is the key to the situational approach (McNichol, 2000). Situational theories emphasize the importance of understanding all the factors that affect a par- ticular group of people in a particular environment. The most well-known is the Situational Leader- ship Model by Dr. Paul Hersey. The appeal of this model is that it focuses on the task and the follower. table 1-2 Leading Motivation Theories Theory Summary of Motivation Requirements Maslow, 1954 Categories of Need: Lower needs (listed first below) must be fulfilled before others are activated. Physiological Safety Belongingness Esteem Self-actualization Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction, but their presence does not motivate or increase satisfaction. 1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary 2. Motivators: Achievement, recognition, the work itself, responsibility, advancement McClelland, 1961 Motivation results from three dominant needs. Usually all three needs are present in each individual but vary in importance depending on the position a person has in the workplace. Needs are also shaped over time by culture and experience. 1. Need for achievement: Performing tasks on a challenging and high level 2. Need for affiliation: Good relationships with others 3. Need for power: Being in charge Source: Adapted from Hersey, P., & Campbell, R. (2004). Leadership: A behavioral science approach. Calif.: Leadership Studies Publishing. 3663_Chapter 1_0003-0016.indd 63663_Chapter 1_0003-0016.indd 6 9/15/2014 4:36:37 PM9/15/2014 4:36:37 PM Process CyanProcess CyanProcess MagentaProcess MagentaProcess YellowProcess YellowProcess BlackProcess Black chapter 1 ■ Leadership and Followership 7 The key is to marry the readiness of the follower with the tasks at hand. “Readiness is defined as the extent to which a follower demonstrates the ability and willingness to accomplish a specific task” (Hersey & Campbell, 2004, p. 114). “The leader needs to spell out the duties and responsibilities of the individual and the group” (Hersey & Campbell, 2004). Followers’ readiness levels can range from unable, unwilling, and insecure to able, willing, and confi- dent. The leader’s behavior will focus on appropri- ately fulfilling the followers’ needs, which are identified by their readiness level and the task. Leader behaviors will range from telling, guid- ing, and directing to delegating, observing, and monitoring. Where did you fall in this model during your first clinical rotation? Compare this with where you are now. In the beginning, the clinical instructor gave you clear instructions, closely guiding and directing you. Now, she or he is most likely delegat- ing, observing, and monitoring. As you move into your first nursing position, you may return to the needing, guiding, and directing stage. But, you may soon become a leader/instructor for new nursing students, guiding and directing them. Transformational Leadership Although the situational theories were an improve- ment over earlier theories, there was still something missing. Meaning, inspiration, and vision were not given enough attention (Tappen, 2001). These are the distinguishing features of transformational leadership. The transformational theory of leadership emphasizes that people need a sense of mission that goes beyond good interpersonal relationships or an appropriate reward for a job well done (Bass & Avolio, 1993). This is especially true in nursing. Caring for people, sick or well, is the goal of the profession. Most people chose nursing in order to do something for the good of humankind; this is their vision. One responsibility of nursing leader- ship is to help nurses see how their work helps them achieve their vision. Transformational leaders can communicate their vision in a manner that is so meaningful and excit- ing that it reduces negativity (Leach, 2005) and inspires commitment in the people with whom they work (Trofino, 1995). Dr. Martin Luther King Jr. had a vision for America: “I have a dream that one day my children will be judged by the content of their character, not the color of their skin” (quoted by Blanchard & Miller, 2007, p. 1). A great leader shares his or her vision with his followers. You can do the same with your colleagues and team. If suc- cessful, the goals of the leader and staff will “become fused, creating unity, wholeness, and a collective purpose” (Barker, 1992, p. 42). See Box 1-1 for an example of a leader with visionary goals. Moral Leadership A series of highly publicized corporate scandals redirected attention to the values and ethics that underlie the practice of leadership as well as that of patient care (Dantley, 2005). Moral leadership involves deciding how one ought to remain …