Fluent Essays

Research one of the three theories (presented in Chapter 18) for planned change and how that process could be applied to a real nursing change situation. Be sure to apply concepts from the readings and research. You must cite (with reference) at least one source: your textbook, scholarly resources, or ATI textbook (no blogs, Wiki, or other school of nursing website) in current APA Style. THE TEXTBOOK IS UPLOADED BELOW IN FILES TO FIND A THEORY IN CHAPTER 18 Leading and Managing in Nursing SEVENTH EDITION Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas 2 Table of Contents Cover image Title page Copyright Dedication Contributors Reviewers Acknowledgments Preface Concept and practice combined Diversity of perspectives Audience Organization Design Learning strategies Complete teaching and learning package Chapter overview Part 1: Overview 1: Leading, Managing, and Following Introduction Theory development in leading, managing, and following Leading, managing, and following—different but related Traditional and emerging leadership and management roles Leading, managing, and following in a diverse organization 3 kindle:embed:0006?mime=image/jpg Conclusion Reflections The evidence Tips for leading, managing, and following 2: Clinical Safety: The Core of Leading, Managing, and Following Introduction The classic reports and emerging supports Other key agencies and endeavors Meaning for leading and managing in nursing Conclusion Reflections The evidence Tips for clinical safety 3: Legal and Ethical Issues Introduction Professional nursing practice: nurse practice acts Negligence and malpractice Informed consent Privacy and confidentiality Policies and procedures Employment laws Professional nursing practice: ethics Conclusion Reflections The evidence Tips for incorporating legal and ethical issues in practice settings 4: Cultural Diversity and Inclusion in Health Care Introduction Concepts and principles Theory 4 National and global directives Special issues Language Meaning of diversity in the organization Cultural relevance in the workplace Individual and societal factors Dealing effectively with cultural diversity Implications in the workplace Conclusion Reflections The evidence Tips for incorporating cultural diversity in health care Part 2: Know Yourself 5: Gaining Personal Insight: The Beginning of Being a Leader Introduction Informal and formal leadership The core of learning to be a leader Gaining insight into self Becoming an authentic leader Conclusion Reflections The evidence Tips for Gaining Personal Insight 6: Being an Effective Follower Introduction Research on followership Followership theories Differences between leading and following Leader–follower relationship Conclusion 5 Reflections The evidence Tips on how to be an effective follower 7: Managing Self: Stress and Time Introduction Emotional intelligence Understanding stress Definition of stress Sources of job stress Dynamics of stress Management of stress Burnout Resolution of stress Management of time Conclusion Reflections The evidence Tips for self-management 8: Communication and Conflict Introduction Effective communication within healthcare settings Types of conflict Stages of conflict Categories of conflict Modes of conflict resolution Differences of conflict-handling styles among nurses The role of the leader Managing incivility, lateral violence, and bullying Conclusion Reflections The evidence 6 Tips for effective communication and addressing conflict 9: Power, Politics, and Influence Introduction History Power Empowerment Sharing Power Personal power strategies Exercising Power and Influence in the Workplace and Other Organizations Conclusion Reflections The evidence Tips for using influence Part 3: Know the Organization 10: Healthcare Organizations Introduction Characteristics and types of organizations Integration Acquisitions and mergers Forces that influence healthcare organizations Theoretical Perspectives Nursing role and function changes Conclusion Reflections The evidence Tips for healthcare organizations 11: Organizational Structures Introduction Mission Vision 7 Philosophy Organizational culture Factors influencing organizational development Characteristics of organizational structures Bureaucracy Types of organizational structures Emerging fluid relationships Conclusion Reflections The evidence Tips for understanding organizational structures 12: Care Delivery Strategies Introduction Historical methods of organizing nursing care Leadership during implementation of a model of care Organizational strategies influencing care delivery Positive care delivery systems Transitional care Interprofessional education and collaboration Conclusion Reflections The evidence Tips for selecting a care delivery model 13: Staffing and Scheduling Introduction The staffing process Evaluation of effective staffing Factors in staffing that influence patient outcomes Supplemental (agency or contract) staff and float pools Organizational factors that affect staffing plans Developing a staffing budget 8 Scheduling Evaluating unit staffing and productivity Conclusion Reflections The evidence Tips for staffing and scheduling 14: Workforce Engagement Through Collective Action and Governance Introduction Nurses as knowledge workers Professional practice responsibility Workplace advocacy, engagement, and empowerment Shared governance Collective action, collective bargaining, and unionization in nursing Healthy work environments Conclusion Reflections The evidence Tips for workforce engagement and collective action Part 4: Use Your Skills 15: Making Decisions and Solving Problems Introduction Differentiation of decision making and problem solving Decision making Problem solving Conclusion Reflections The evidence Tips for decision making and problem solving 16: The Impact of Technology Introduction 9 Types of technologies Knowledge technology Information systems Informatics Patient safety Impact of clinical information systems Safely implementing health information technology Future trends and professional issues Professional, ethical nursing practice and new technologies Conclusion Reflections The evidence Tips for managing information and technology 17: Delegating: Authority, Accountability, and Responsibility in Delegation Decisions Introduction Historical perspective Definitions Assignment versus delegation NCSBN model: an organizational framework for delegation Effective communication: an essential competency for successful delegation Delegation and the decision-making process in nursing Organizational and individual accountability Legal authority to delegate Learning how to delegate: different strategies for success Conclusion Reflections The evidence Implications for practice Tips for delegating 18: Leading Change Introduction 10 The nature of change The change process People and change Context and change Leadership and change Conclusion Reflections The evidence Tips for leading change 19: Building Effective Teams Introduction Groups and teams Creating effective teams Key concepts of teams Issues that affect team functioning Interprofessional teams The value of team-building The role of leadership Conclusion Reflections The evidence Tips for team building 20: Managing Costs and Budgets Introduction What escalates healthcare costs How health care is financed Healthcare reimbursement The changing healthcare economic environment Why profit is necessary Cost-conscious nursing practices Budgets 11 Conclusion Reflections The evidence Tips for managing costs and budgets 21: Selecting, Developing, and Evaluating Staff Introduction Roles in an organization Selection of staff Developing staff Performance appraisals Coaching Conclusion Reflections The evidence Tips for selecting, developing, and evaluating staff 22: Person-Centered Care Introduction Person-centered care—why now? Initiatives to deliver person-centered care Challenges in the delivery of person-centered care Patient engagement Nurses in the delivery of person-centered care Synthesis and application Conclusion Reflections The evidence Tips for competent person-centered care 23: Managing Quality and Risk Introduction Quality management in health care 12 Benefits of quality management Planning for quality management Evolution of quality management Quality management principles Customers The quality improvement process Quality assurance Risk management Conclusion Reflections The evidence Tips for quality management 24: Translating Research Into Practice Introduction From using research to evidence-based practice Development of evidence-based practice Comparative effectiveness research Practice-based evidence Participatory action research Quality improvement Evaluating evidence Organizational strategies to embed evidence-based practice into organizations Issues for nurse leaders and managers Conclusion Reflections The evidence Tips for developing skill in using evidence and translating research into practice 25: Managing Personal and Personnel Problems Introduction Personal/personnel problems Documentation 13 Progressive discipline Termination Conclusion Reflections The evidence Tips in the documentation of problems Part 5: Prepare for the Future 26: Role Transition Introduction Types of roles Roles: The ABCs of understanding roles Role transition process Strategies to promote role transition Conclusion Reflections The evidence Tips for role transition 27: Managing Your Career Introduction A career framework Career theory Professional development Contributing through scholarly activities and research Career marketing strategies Conclusion Reflections The evidence Tips for a successful career 28: Developing the Role of Leader Introduction 14 What is a leader? The practice of leadership Leadership development Leadership development model Surviving and thriving as a leader The nurse as leader Conclusion Reflections The evidence Tips for becoming a leader 29: Developing the Role of Manager Introduction The definition of management Nurse manager as change leader Nurse manager role and the intergenerational workforce The nurse manager and interprofessional collaboration Building a positive work environment Consuming research Organizational culture Mentoring Day-to-day management challenges Managing resources Technology and informatics Dashboards and decision support tools Budgets and finance Quality indicators Professionalism Conclusion Reflections The evidence Tips for implementing the role of nurse manager 15 30: The Strategic Planning Process Introduction Strategic planning Reasons for strategic planning Phases of the strategic planning process Conclusion Reflections The evidence Tips for developing and executing a strategic plan for nursing 31: Thriving for the Future Introduction Leadership demands for the future Leadership strengths for the future Visioning, forecasting, and innovation The wise forecast model© Shared vision Projections for the future Conclusion Reflections Tips for the Thriving in the future The evidence Index 16 Copyright 3251 Riverport Lane St. Louis, Missouri 63043 LEADING AND MANAGING IN NURSING, SEVENTH EDITION ISBN: 978-0-323-44913-7 Copyright © 2019 by Elsevier Inc. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notice Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds or experiments described herein. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors, editors or contributors for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Previous editions copyrighted 2015, 2011, 2007, 2003, 1999, 1995. International Standard Book Number: 978-0-323-44913-7 Senior Content Strategist: Yvonne Alexopoulos Content Development Manager: Lisa P. Newton Senior Content Development Specialist: Tina Kaemmerer Publishing Services Manager: Julie Eddy Senior Project Manager: Jodi M. Willard Design Direction: Brian Salisbury 17 http://www.elsevier.com/permissions Printed in Canada. Last digit is the print number: 9 8 7 6 5 4 3 2 1 18 Dedication This book is dedicated to the families and friends who supported all of us who created it, to the faculty who use this book to develop tomorrow’s emerging leaders and managers, and to the learners who have the vision and insight to grasp today’s reality and mold it into the future of dynamic nursing leadership. Lead on! ¡Adelante! 19 Contributors Joan Benson, BSN, RN, CPN Manager, Clinical Informatics and Practice, Children's Mercy— Kansas City, Kansas City, Missouri Kristin K. Benton, BS, BSN, MSN, DNP Director of Nursing, Nursing, Texas Board of Nursing, Austin, Texas Amy Boothe, DNP, RN Instructor, Traditional Undergraduate Program, Texas Tech University Health Sciences Center, Lubbock, Texas Elizabeth H. Boyd, MSN, BS Instructor/Site Coordinator, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Myra A. Broadway, JD, MS, BSN Formerly, Executive Director, Maine State Board of Nursing, Past President, National Council of State Boards of Nursing, Maine Medical Professionals Health Program Advisory Committee USAFR Nurse Corps (Retired Colonel), Gardiner, Maine M. Margaret Calacci, MS Director, Simulation and Learning Resources, Arizona State University College of Nursing and Health Innovation, Phoenix, Arizona Mary Ellen Clyne, PhD President and Chief Executive Officer, Administration, Clara Maass Medical Center, Belleville, New Jersey Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FACCE, FAAN Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Mary Ann T. Donohue-Ryan, PhD, RN, APN, APRN-MH, NEA-BC Vice President for Patient Care Services and Chief Nursing Officer, Administration, Englewood Hospital and Medical Center, Englewood, New Jersey Michael L. Evans, PhD, MSN, BSN, BA Dean and Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Victoria N. Folse, PhD, APN, PMHCNS-BC, LCPC Director and Professor; Caroline F. Rupert Endowed Chair of Nursing, School of Nursing, Illinois Wesleyan University, Bloomington, Illinois Jacqueline Gonzalez, DNP, MBA, MSN Senior Vice President/Chief Nursing Officer, Nicklaus Children’s Hospital, Miami, Florida Debra Hagler, PhD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN Clinical Professor, College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona Shari Kist, PhD, RN Missouri Quality Initiative (MOQI) Project Supervisor, Sinclair School of Nursing, University of Missouri—Columbia, Columbia, Missouri Karren Kowalski, BSN, MSN, PhD President & CEO, Colorado Center for Nursing Excellence, Denver, Colorado Professor, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Mary E. Mancini, RN, MSN, PhD Senior Associate Dean for Education Innovation, Undergraduate Nursing, University of Texas at Arlington, Arlington, Texas 20 Maureen Murphy-Ruocco, APN-C, CSN, MSN, EdM, EdD, DPNAP Senior Fellow, National Academies of Practice, Nurse Consultant/Nurse Practitioner New York, New York Professor and Dean Emerita Felician University, Lodi and Rutherford, New Jersey Karen A. Quintana, PhD, APRN, CPNP-PC Director of Pediatric Nurse Practitioner Studies, Graduate Program, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Elaine S. Scott, BSN, MSN, PhD Chair, Nursing Science, East Carolina University, Greenville, North Carolina Ashley Sediqzad, RN, BSN Manager, Clinical Informatics and Practice, Children's Mercy Kansas City, Kansas City, Missouri Janis Bloedel Smith, DNP, MSN, BSN Senior Director, Clinical Informatics & Professional Practice, Patient Care Services, Children's Mercy Kansas City, Kansas City, Missouri Susan Sportsman, PhD Nurse Consultant, Collaborative Momentum Consulting, LLC, St. Louis, Missouri Sylvain Trepanier, DNP, MSN, BSN, RN, CENP Chief Clinical Executive, Administration, Providence St. Joseph Health, Torrance, California Diane M. Twedell, DNP, MS Chief Nursing Officer, Mayo Clinic Health System, Southeast Minnesota Region, Austin, Minnesota Jeffery Watson, DNP, RN-BC, NEA-BC, NE-BC, CRRN Assistant Professor, School of Nursing, Texas Tech University Health Sciences Center, Lubbock, Texas Jana Wheeler, MSN, RN-BC, CPN Manager, Clinical Informatics & Practice, Children's Mercy Kansas City, Kansas City, Missouri Crystal J. Wilkinson, DNP, RN, CNS-CH, CPHQ Associate Professor, School of Nursing, Texas Tech University Health Sciences Center, Austin, Texas Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas Margarete Lieb Zalon, PhD, RN, ACNS-BC, FAAN Professor, Nursing, University of Scranton, Scranton, Pennsylvania 21 Reviewers Karen E. Alexander, PhD, RN, CNOR Program Director RN-BSN, Assistant Professor, Clinical Heath and Applied Science—Nursing, University of Houston—Clear Lake, Houston, Texas Vicki Bingham, PhD, RN, CPE Dean/Associate Professor of Nursing, Robert E. Smith School of Nursing, Delta State University, Cleveland, Mississippi Deborah Birk, PhD, RN, MHA, NEA-BC Assistant Professor, Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri Barbara B. Blozen, EdD, MA, RN BC, CNL Associate Professor, New Jersey City University, Jersey City, New Jersey Joseph Boney, MSN, RN, NEA-BC Director of Undergraduate Faculty Development/Instructor, Rutgers School of Nursing, Accelerated BS in Nursing Program, Newark, New Jersey Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Nursing, Eastern University, St. Davids, Pennsylvania Jane Campbell, DNP, RN, NE-BC Professor, School of Nursing, Northern Michigan University, Marquette, Michigan Holly Johanna Diesel, RN, PhD Associate Professor, Academic Chair for Accelerated and RN to BSN Programs, Department of Nursing, Goldfarb School of Nursing at Barnes-Jewish College, St. Louis, Missouri Jennifer B. Drexler, RN, MSN, PhDc, CCRN Clinical Faculty Educator, College of Nursing, University of New Mexico, Albuquerque, New Mexico Lynn Renee Dykstra, MS, BSN, HPCN, RN Instructor, Adjunct Faculty, Northern Illinois University, College of Health and Human Sciences, Nursing, DeKalb, Illinois Oakton Community College, Division of Science and Health Careers, Nursing Des Plaines, Illinois Julie A. Fitzgerald, PhD, RN, CNE Assistant Professor of Nursing, Ramapo College of New Jersey, Mahwah, New Jersey Kay E. Gaehle, PhD, RN Associate Professor of Nursing, Department of Primary Care and Health Systems, Southern Illinois University—Edwardsville, Edwardsville, Illinois Maria Gillespie, EdD, MSN, BSN, BS, CNE, RN Assistant Professor, Nursing, University of the Incarnate Word, San Antonio, Texas Julia Henderson Gist, PhD, RN, CNE Dean, School of Health Sciences, Arkansas State University Mountain Home, Mountain Home, Arkansas Stephanie A. Gustman, DNP, MSN, BSN, RN Assistant Professor, School of Nursing, Ferris State University, Big Rapids, Michigan Cam A. Hamilton, PhD, MSN, RN, CNE Assistant Professor, School of Nursing, Auburn University at Montgomery, Montgomery, Alabama Pamela Gibler Harrison, EdD, RN, CNE Professor of Nursing, Chair, Pre-Licensure Nursing, 22 Indiana Wesleyan University, Marion, Indiana Karen L. Hoblet, PhD, MSN, RN, CNL Licensed RN, Clinical Nurse Leader, Interim Department Chairperson and Associate Professor, Interim Director Nurse Educator and Clinical Nurse Leader Programs, Advanced Population Care, The University of Toledo College of Nursing, Toledo, Ohio Janine Dailey Johnson, MSN, RN Assistant Professor, Nursing, Clarkson College, Omaha, Nebraska Leo-Felix M. Jurado, PhD, RN, APN, NE-BC, CNE, FAAN Associate Professor, College of Science and Health, William Paterson University of New Jersey, Wayne, New Jersey Barbara J. Keith, RN, MSN, CNE Clinical Lecturer, Vera Z. Dwyer College of Health Sciences, Indiana University School of Nursing, South Bend, Indiana Donnamarie Lovestrand, RN, MSN, CPAN Faculty, Nursing Programs, Nursing Department, Pennsylvania College of Technology, Williamsport, Pennsylvania Anne Boulter Lucero, RN, MSN Assistant Director, Instructor Nursing, Nursing Department, Cabrillo College, Aptos, California Richard C. Meeks, DNP, RN, COI Assistant Professor, Graduate Program Coordinator, School of Nursing, Middle Tennessee State University, Murfreesboro, Tennessee Kereen Forster Mullenbach, MBA, PhD, RN Associate Professor, Nursing, Radford University School of Nursing, Radford, Virginia Sue S. Myers, RPN, BSW, MSCTE Faculty, Psychiatric Nursing and Bachelor of Psychiatric Nursing Programs, School of Nursing, Saskatchewan Polytechnic, Parkway Campus, Regina, Saskatchewan Barbara Pinekenstein, DNP, RN- BC, CPHIMS Clinical Professor, Richard E. Sinaiko Professor in Health Care Leadership, School of Nursing, University of Wisconsin—Madison, Madison, Wisconsin Dawn M. Pope, MS, RN Assistant Clinical Professor (retired), College of Nursing, University of Wisconsin—Oshkosh, Oshkosh, Wisconsin Cara L. Rigby, DNP, RN, CMSRN Associate Professor, BSN Program Director, Nursing, The Christ College of Nursing and Health Sciences, Cincinnati, Ohio Dulce Anne Santacroce, DNP, RN, CCM Nurse Educator, Nursing, Touro University—Nevada, Henderson, Nevada Ruth Schumacher, DNP, RN, CNL, CPN Assistant Professor, Department of Nursing and Health Sciences, Elmhurst College, Elmhurst, Illinois Kathy S. Sweeney, MSN, RN Assistant Professor of Nursing, Nursing Education, Kansas Wesleyan University, Salina, Kansas Denise Robin Zabriskie, DNP, RN, CWOCN, WCC Assistant Professor, School of Nursing, Touro University Nevada, Henderson, Nevada 23 Acknowledgments Patricia S. Yoder-Wise, RN, EdD, NEA-BC,ANEF, FAAN, Professor and Dean Emerita, Texas Tech University Health Sciences Center, Lubbock, Texas As with any publication endeavor, many people other than those whose names appear on the cover make the actual publication possible, including the contributors and the Challenge/Solution authors. These behind-the-scenes people also include the reviewers and the publishing team at Elsevier. We thank each of the contributors who worked diligently to meet deadlines and content expectations. Their names are listed with the chapters they produced. Without them, this book would be a lot thinner! The nurses who told their fabulous stories related to the various chapters always illustrate the real-world meaning of the importance of the chapter content; their names appear with their stories. Without all of them, this book would be much less interesting! What a fabulous group to work with. We are indebted to our reviewers, who provided valuable feedback that helped refine the book. Receiving peer review is critical to any successful publication. Now that the book is completed, we know who they are and we thank them! Jeff Watson took on coordinating the ancillaries, and Shelley Burson coordinated and managed an enormous number of details. Both gently nudged all of us to complete our required tasks in a timely manner. Special thanks go to our publishing team: Senior Content Strategist Yvonne Alexopoulos, Senior Content Development Specialist Tina Kaemmerer, and Senior Production Manager Jodi Willard. Even more special thanks go to my husband and best friend, Robert Thomas Wise, who vowed to be minimally disruptive as I sat in my office reading, writing, typing, and talking. He is a man of his word! This book is designed to stimulate thinking and to encourage continued professional development in the area of leading and managing. When the Institute of Medicine released the report, The Future of Nursing, the idea of leadership was clearly a concern for the profession. This book continues its tradition of providing the information that nurses need to assume greater leadership practices and even new management roles. All contributors attempted to provide their best thinking on a given topic so that learners could integrate concepts to form the basis for their contribution to health care. Both the thinking and the complexities will continue to change…and so, hopefully, will you! The passion of nursing and leadership await! 24 Preface The first edition of Leading and Managing in Nursing began in a hotel room in New Orleans, Louisiana in January of 1990. Darlene Como, the founding publisher of Leading and Managing, and I conceptualized a new way of presenting content about leadership and management: one that might engage learners in valuing the importance of roles that support clinical practice. This new approach included personal stories (The Challenge and The Solution), Literature Perspectives, Research Perspectives, synopses, exercises, and boxes of key information. If you saw that first edition and compared the number of words then compared with the number of words in this edition, you would know the field has grown and become far more complex. Nursing has also grown the field of leadership and management research, and so we have many more citations we can share to make this content both theoretical and practical. We continue to include everything today’s nurses need to know about the basics of leading and managing. The changes with each revision of Leading and Managing reflect the intensity with which we know how leading and managing influence nurses in direct and indirect caregiving roles, as well as in other aspects of being a professional nurse in a complex, ever-changing, dynamic healthcare environment. Nurses throughout the profession serve in various leadership roles. Leading and managing are two essential expectations of all professional nurses and become increasingly important throughout one’s career. To lead, manage, and follow successfully, nurses must possess not only knowledge and skills but also a caring and compassionate attitude. This book results from our continued strong belief in the need for a text that focuses in a distinctive way on the nursing leadership and management issues— both today and in the future. We continue to find that we are not alone in this belief. This edition incorporates reviewers from both service and education to ensure that the text conveys important and timely information to users as they focus on the critical roles of leading, managing, and following. In addition, we took seriously the various comments offered by both educators and learners as I met them in person or heard from them by e-mail. 25 Concept and practice combined Innovative in both content and presentation, Leading and Managing in Nursing merges theory, research, and practical application in key leadership and management areas. Our overriding concern in this edition remains to create a text that, while well-grounded in theory and concept, presents the content in a way that is real. Wherever possible, we use real-world examples from the continuum of today’s healthcare settings to illustrate the concepts. Because each chapter contributor synthesizes the designated focus, you will find no lengthy quotations in these chapters. We have made every effort to make the content as engaging, inviting, and interesting as possible. Reflecting our view of the real world of nursing leadership and management today, the following themes pervade the text: • Every role within nursing has the basic concern for safe, effective care for the people for whom we exist—our clients and patients. • The focus of health care continues to shift from the hospital to the community at a rapid rate. • Healthcare consumers and the healthcare workforce are increasingly culturally diverse. • Today virtually every professional nurse leads, manages, and follows, regardless of title or position. • Consumer relationships play a central role in the delivery of nursing and health care. • Communication, collaboration, team-building, and other interpersonal skills form the foundation of effective nursing leadership and management. • Change continues at a rapid pace in health care and society in general. • Change must derive from evidence-based practices wherever possible and from thoughtful innovation when no or limited evidence exists. • Healthcare delivery is highly dependent on the effectiveness of nurses across roles and settings. 26 …