Lawrence D. Prybil | Melanie C. Dreher | Connie R. Curran
Nearly 18% of the United States' gross national product presently is devoted to healthcare, and for many years, the rate of growth has exceeded other sectors of our nation's economy. However, landmark studies by the Institute of Medicine, the Commonwealth Fund, and other organizations have demonstrated that-despite our large investment of resources in healthcare-the United States lags behind other industrialized countries on multiple metrics of population health such as infant mortality and life expectancy. 1 Moreover, there is strong evidence of disparities around our country in access, cost, and quality of healthcare services. 2 . © 2014 Mosby, Inc.
Stephanie B. Turner
© 2014 Mosby, Inc. The purpose of this paper is to provide a review of the concept of resilience and how it relates to the field of nursing. By definition, resilience is the ability to return to a state of normalcy or to "bounce back" from adversity or trauma and remain focused and optimistic about the future. 1 Resilience is an imperative quality for nurses to possess because of the stressful nature of the profession of nursing. Studies have shown that those who have high levels of resilience are less likely to develop stress disorders and more likely to remain in the profession as healthy nurses. 2 The concept is important for nursing management because resilience may play an important role in nursing longevity and retention. Nurse leaders may benefit from understanding how resilience applies to their staff and how to improve and enhance this concept in others. This paper provides a historical discussion of the concept of resilience, describes qualities of resilient nurses, discusses the impact of stress and coping on resilience, and proposes strategies to improve and enhance resilience in nurses.
Sharon Pappas | John M. Welton
© 2015 by Elsevier Inc. Nursing is a practice discipline and occurs as 1 nurse and 1 patient, family, or community at a time. The encounter between a nurse and patient forms a fundamental bond that defines, not only nursing as a profession, but each individual nurse as a provider of care. Nursing practice drives value, and nurses have a direct and intimate influence on the quality, safety, and costs of patient-centered care. If we define nursing value as the function of outcomes divided by costs,1 there is a need to better define the measures and analytics for patient-level costs and outcomes of nursing care. This fundamental shift to capture the patient or consumer impact of nursing care is an important expansion of how nursing value is quantified. This will require rethinking how we view nursing care delivery beyond solely measuring nursing in terms of tasks or ratios and staffing levels, to one that recognizes the individual and collective accomplishments and results provided by each nurse across the broad spectrum of care. True nursing value can only be described by measurement of the clinical and financial impact of nursing care.
Christine Fardellone | Elizabeth R. Click
A recommendation in the 2010 Institute of Medicine's (IOM) report The Future of Nursing: Leading Change, Advancing Health challenges the nursing profession to enhance nursing's leadership role in healthcare redesign. 1 This new role can be achieved through leadership programs focused on mentorships, leadership training, and development of leadership competencies. Nurses are frontline caregivers and play a vital role in meeting the objectives of the Affordable Care Act. In order to make maximum impact within the healthcare reform effort, nurses need to utilize leadership behaviors effectively. 1 . © 2013 Mosby, Inc.
Cynthia Baxter | Nora Warshawsky
Dan Weberg | Jane Braaten | Lillee Gelinas
The constantly changing healthcare environment is increasingly complex and rapidly evolving, forcing the development of new systems of care faster than ever before. Therefore, nursing leaders today need different behaviors to ensure both personal and organizational success tomorrow. The skills that characterize the traditional leadership model, such as planning, controlling, and managing, are no longer adequate to move a healthcare organization along a trajectory that leads to better patient, staff, and system outcomes. 1 The traditional method may have worked in the past in a predictable, stable system, but the healthcare organization of today is emergent and unstable,. 2 requiring a new leadership model depicted by such skills as engaging, facilitating, and inquiring. Current expectations of leaders to address issues of quality, safety, errors, and resources are increasingly urgent, also driving the need for different leadership behaviors. 1 Organizations can be drawn into traditional actions to address these challenges or chose to embrace them with the development of innovative leadership practices. © 2013 Mosby, Inc.
Jeannette T. Crenshaw | Patricia S. Yoder-Wise
The number of leaders with the skill of supporting evidence-based practice (EBP) has increased over the past decade. Yet the number of leaders with the skill for taking risks has not experienced a similar growth. Without the competence for taking considered risks, nursing, and thus healthcare, will not reach its full potential to improve what people need when seeking quality healthcare. Both nurse leaders and followers need to function in an environment that welcomes considered risk. To this end, two complementary models illustrate a structured way to think about the value of innovation, which requires risk taking, and the leadership needed to facilitate innovation in healthcare. © 2013 Mosby, Inc..
Kevin B. Whitney | Sharon A. Gale
© 2015 Mosby, Inc. Nonprofit professional membership organizations (NPMOs) are valuable resources for many healthcare disciplines. For nursing leaders, NPMOs offer several benefits, including opportunities for professional development, leadership mentoring, networking, and legislative advocacy. 1 However, to provide the best value for members over the long term, NPMOs must develop a solid operational infrastructure, including sufficient human, financial and information technology (IT) resources, to achieve organizational sustainability. 2 .
© 2014 Mosby, Inc. Transformational leadership is an essential element of a high-performing organization in this era of rapid healthcare delivery system evolution. Specifically, recruiting and retaining top nurse executive talent is critical, as is development of senior nursing leadership talent, to ensure that a pipeline of prepared nurse executives exists for key leadership roles. A nurse executive residency program was developed to address the impending need for prepared, transformational nursing leaders. In this article, the terms chief nursing officer (CNO) and nurse executive are used interchangeably to describe this senior leadership role.
Rebecca L. Taylor-Ford | Donna Abell
© 2015 Mosby, Inc. The Institute of Medicine report The Future of Nursing 1 calls for the development of nurse leaders who possess the necessary skills to act as "full partners" with physicians and other professional colleagues in leading change and improving health outcomes. In contrast to the historical advancement of the nurse leader from expert clinician to frontline manager specializing in microsystem oversight, today's nurse leaders must rapidly develop comprehensive leadership skills inclusive of macrosystem concepts. As the number of nurses choosing leadership as a career is in decline, the profession is even more so at risk from a significant number of experienced leaders, clinicians, and educators who plan to leave practice in the years to come. 2 Organizations are faced with the challenge of identifying future leaders and fostering the professional development of managers who are capable of ensuring quality care, financial viability, and patient satisfaction in an environment that is increasingly complex. 3,4 Significant human and financial losses can ensue when newly appointed leaders fail to adjust to their new roles, making leadership transitions a topic of urgent importance in the healthcare industry. 5 .
Good leadership that is both effective and moral has been long recognized as crucial to human achievement and well-being. 1 Given the changing nature of healthcare organizations in the digital age, pressures for increased quality, expectations of lower costs, and the demand for innovation, examination of our leadership models, and exploration of new approaches are needed to ensure that current leadership models do support human achievement and well-being. © 2014 Mosby, Inc.
Kathy Malloch | Michael Meisel
Susan H. Weaver | Suellyn Ellerbe
A nurse was removing an intravenous line, and blood splashed into her eye-what should be done? Can dopamine be given on a medical-surgical unit? Is the chest tube set up correctly? A nurse needs help because she believes that the respiratory therapist working on her unit is intoxicated. A radiology technician notifies you that water is leaking from the ceiling and apparently a pipe burst-who should be called? A patient's family member is upset and wants to speak with the administrator. A patient wants to leave against medical advice; what needs to be done? Two registered nurses just called in sick for the night shift on the oncology unit. These are just some of the questions and situations that confront the off-shift management. © 2013 Mosby, Inc.
K. T. Waxman | Christine Delucas
Laura V. Alvarado
Having contemplated the plethora of articles dedicated to the past, current, and future nursing shortage, I am reminded of a comment my boss, a chief executive officer who happened to be a physician, made when I was chief nursing officer in a level 1 trauma center in 2005: "Laura, nurses leave nursing because physicians are jerks," whereby I quickly responded: "If that were truly the case, the profession would have long been extinct!" © 2013 Mosby, Inc.
Claire Zangerle | Mary Beth Kingston
© 2016 Mosby, Inc. When a staff nurse becomes a manager or director, it is the result of a combination of clinical excellence, education, and leadership qualities inherent or developed within the individual. He or she typically has a number of years' experience on the unit and within the organization; they know the ins and outs and are respected by their peers.
Bonnie Pilon | Terri D. Crutcher | Susie Leming-Lee | Richard Watters | Kelly A. Wolgast | Debra Arnow
The economic impact of higher education on the individual has been widely documented, with benefits measured in terms of lifetime earning power, accumulation of household wealth, lower unemployment, access to healthcare coverage, and overall better health across all ages and income levels. 1-6 The economic impact within the workplace, to the employer, is less precisely defined. Overall benefits include a better prepared workforce, which can lead to increased economic benefit to the employer and to society as a whole. Specific benefits related to investing in the education of current and future health systems nurse leaders may have an early, as well as a sustained, impact on the organization. Using case studies, this report explores the beneficial economic and quality impact on healthcare agencies and institutions during, as well as after, the completion of degree requirements when emerging nurse leaders pursue graduate education in health systems management. © 2014 Mosby, Inc.
Cole Edmonson | Beth Bolick | Joyce Lee
Giancarlo Lyle-Edrosolo | K. T. Waxman
© 2016 Mosby, Inc. There is little to no improvement in the quality of patient care since the publication of To Err Is Human report in 1999 by the Institute of Medicine. Health care provider education must address quality and patient safety language in order to meet the demands of the 21st century. Academic institutions focus on the quality and safety language as outlined by the Quality and Safety Education for Nurses (QSEN). Conversely, hospitals emphasize competencies and standards as outlined in The Joint Commission accreditation standards and the American Nurses Credentialing Center Magnet® competencies. Nurse leaders need a crosswalk among all 3 standards that can help guide their practice. The crosswalk can help nurse leaders have an increased understanding of the role that QSEN plays in educating a competent and safe nursing workforce.
© 2015 Mosby, Inc. In the United States, as well as globally, a nursing shortage is highly expected within the next decade and will continue to be a major problem affecting healthcare delivery in the years to come. Baby boomers presently dominate the registered nurse (RN) workforce, accounting for 40% of actively working RNs who will soon be entering retirement. In 2011, nursing schools were unable to accept 60,000 qualified applicants as a result of budgetary constraints and insufficient numbers of faculty, clinical preceptors, and clinical sites. Although the United States has previously experienced nursing shortages, projections estimate that this RN shortage will likely surpass 500,000 RNs by the year 2025 and will persist for the long term. It is forecasted that the shortage will affect the delivery of healthcare directly, as well as the quality of patient care. Factors thought to be contributing to the anticipated shortage include the increasing number of individuals insured through the Affordable Care Act, the healthcare demands from the elderly population, and the retiring baby-boomer RN workforce. According to 2013 data from the Bureau of Labor Statistics, it is anticipated that by 2020, there will be a need for 1.05 million RNs in the United States. The projected nursing shortage is a concern beyond the United States, expanding internationally to other developed nations.
Terri Ann Parnell
© 2014 Mosby, Inc. The United States has been experiencing a demographic transformation which began decades ago and is continuing to accelerate and dramatically change our landscape. Minority groups are the fastest growing demographic, currently accounting for one-third of the U.S. population. 1 and the US is projected to become a majority-minority nation for the first time in 2043.
Rose O. Sherman | Ruth Schwarzkopf | Anna J. Kiger
If you engage any group of executive nurse leaders in a conversation about today's healthcare system, they are likely to tell you that it is the most challenging environment that they have experienced in their careers. The business of caring has become exceedingly complex. During the past decade, the cost of care in the United States has skyrocketed to an average cost of over $8,000 per year per person. Left unchecked, we could spend over $13,000 per person by 2018. 1 It is not surprising that the recent debates on healthcare reform have focused on how costs can be reduced. Payment incentives are quickly moving away from volume-based incentives toward a greater focus on value of services and health outcomes, including fewer hospitalizations. 2 . © 2013 Mosby, Inc..
Ashley Gresh | Evi Dallman | Emily Johnson | Fernando Mena-Carrasco | Lauren Rosales | Violeta Pantaleon | Patricia M. Davidson | Phyllis Sharps
Leadership is an important aspect of almost any industry. Most people would often think that leadership is only important in industries that are related to business or making profit. It is only logical to think that leadership is important in all aspects of managing an organization because an organization without an effective leader would not be able to survive the harsh business environment that is prevalent in a highly interconnected world economy. There are sources that suggest that leadership is part of a learning process. The objective of this paper is to discuss the importance of leadership and management in the field of nursing, particularly to support the idea that suggests that not all leadership is about changing or challenging people’s vision of the future. The author of this paper will draw on previously published literature on the topic of clinical leadership and management in the field of nursing to support the assumptions and inferences that will be made in this paper.
A leader, regardless of the type of organization or the processes and operations that it is involved in, is often described as someone who can easily inspire others to do orders and work together in order to achieve the goals of the company or organization. In this case, we are talking about an organization that is involved in the nursing industry. Examples of goals that a good leader in the nursing leadership can do are the enhancement of the quality of patient and healthcare, accessibility, and affordability, among others. This would of course vary from one organization to another, depending on the focus of the leader, and the current issues and problems that the nursing organization faces. Regardless, an effective clinical management and nursing leader should be able to know how to manage the available funds and financial resources, among others that can be used to fuel a project or any organization-related campaign, in order to achieve the organizational goals and objectives. This is where the effectiveness and skills of a leader in the nursing industry would be tested. Naturally, a leader who shows greater promise in meeting the organization’s clients and senior leaders’ expectations, or ideally, in outperforming them, would be considered as more effective compared to one that shows less promising results.
A common assumption in organizational management is the one that suggests that leadership is all about changing or challenging a group of people’s vision of the future. This assumption may pertain to the various changes that any leader of an organization would have to spearhead in order for the organization to reach its goals and objectives. This, at some point, may be considered to be true because after all, a company would not be able to grow without introducing significant changes to the way how things are organized from the chain of command down to the way how each small processes and operations are carried out(Stanley, Congruent Leadership: Values in Action, 2008). Often, the greater the changes that have been introduced, the better it would be for the organization in the long run, provided that everything from the planning process down to the part where the planned processes have to be implemented were properly executed. This is not to say, however, that all management-induced organizational changes lead to better results for the organization because there are surely other organizational change management plans that go awry. This is why there are indicators that can be used to access the effectiveness of a leader, regardless of the industry and one of such indicators is his ability to overcome the hindrances to meeting the organizational goals and objectives.
The idea of continuous innovation is not only used in the field of technology. It may also be considered important in other fields such as in the field of nursing in this case. Any nursing organization which has failed to continuously innovate either the delivery of its product and services or the quality of its products and services themselves would surely suffer from the negative consequences of being left out by its competitors who have managed to do the opposite—to continuously introduce innovations despite the often high price that organizations have to pay for it. Introducing innovation is not a one-night thing. It is rather a continuous process and most of the time, the leader of the organization plays a major role on whether an organization would be highly innovative or otherwise (Stanley, 2011). Also, the process of introducing innovation is often coupled with the process of introducing changes. Innovation is something that would not be made possible without introducing changes. This actually brings us back to the main question about the validity of the idea that suggests that leadership is all about introducing changes and challenging people’s vision of the future. An effective leader would surely be able to find a workaround on how to introduce innovations without having to make dramatic changes or even go to as far as challenge the people’s vision of the future(Howieson & Thiagarajah, 2011), unless the aspect of the organization that the leader would like to change is the vision of the organization itself.
In a nursing organization, the role of the leader is often geared at improving the quality of healthcare delivered by the entire nursing team or department or if its quality is already at par with the organizational performance, maintaining it(Marquis & Huston, 2014). Other goals that the nursing leader may participate may have something to do with increasing the affordability and the accessibility of health and patient care. An effective leader often exhibits a set of personal qualities that would help him surpass the hurdles involved in achieving the goals and objective of the organization, some of which include but may not be limited to persistence, initiative, integrity, courage, and his ability to handle stress. The leader’s ability to think critically, set goals and execute the necessary actions to meet those goals, communicate skillfully with other members of the team, be it a subordinate or someone who has a higher position, and collaborate with other people when it comes to nursing-related works and responsibilities are often the ones that would determine whether the organization’s vision and mission would be realized or not(Davidson, Becoming a nurse leader, 2010).
Nurses are often forced to be creative and innovative in their work. This is because they are the ones who usually have the first-hand experience in interacting with patients. They are often the ones who become compelled to make last minute decisions with regards to patient and healthcare(Marquis & Huston, Classical Views of Leadership and Management, 2012; Davidson, Elliott, & Daly, 2006). Nurses function as the front liners when it comes to patient care. At times, they often become required to do administrative works such as documenting the patients’ progressions and regressions. The same is, in fact, true for nurse leaders, except for the fact that they have the added responsibility of managing and leading people. Also, their co-nurses look up to their nurse leaders and often, an ineffective and highly inefficient nurse leader creates an equally ineffective and highly inefficient set of new nurse leaders as well. In the end, the purpose of the nursing leader would always have something to do with the ultimate goal of meeting the expectations of the entire department in meeting department and organizational goals and objectives.
In conclusion, the role of the nursing leader in a clinical leadership and management in the nursing industry is more concerned with the fundamental goal of effectively and efficiently executing the conceptualized plan of actions in order to reach the set organizational goals and objectives than changing and or challenging the people’s vision of the future. At some point this is true but there is more to being a leader than just introducing changes to the organization and stimulating changes among one’s subordinates. The idea is to see the bigger picture of being a leader and just by doing so, one would be able to determine that being a nursing leader is not just about changing or challenging the people’s vision of the future. In this case, being a nursing leader is more concerned with being a role model to the people, exhibiting the signs of being a leader such as having integrity and excellent communication skills, among other traits of being an effective nursing leader.
Davidson, P. (2010). Becoming a nurse leader. Elsevier Australia, 258.
Davidson, P., Elliott, D., & Daly, J. (2006). Clinical Leadership in Contemporary Clinical Practice: Implications for Nursing in Australia. Journal of Nursing Management, 180.
Howieson, B., & Thiagarajah, T. (2011). What is Clinical Leadership: A Journal-based meta-review. International Journal of Clinical Leadership, 7-18.
Marquis, B., & Huston, C. (2012). Classical Views of Leadership and Management. Lippincot Williams and Wilkins.
Marquis, B., & Huston, C. (2014). Leadership Roles and Management Functions in Nursing: Theory and Application. Wolters Kluwer Health.
Stanley, D. (2008). Congruent Leadership: Values in Action. Journal of Nursing Management , 519.
Stanley, D. (2011). Clinical Leadership: Innovation into Action. Australia: Palgrave Macmillan.