Solve one of the following Learning Exercises from Marquis and Huston’s Leadership Roles and Management Functions in Nursing, 10th edition.
•Learning Exercise 4.2 (page 92)
•Learning Exercise 4.7 (page 104)
•Learning Exercise 4.10 (page 106)
•Learning Exercise 5.2 (page 116)
•Learning Exercise 5.8 (page 132)
•Learning Exercise 5.9 (page 133)
List which Learning Exercise you are solving at the start of your analysis and provide a brief summary of the case.
Be sure to apply an appropriate problem-solving/decision-making model (Traditional Problem-Solving Process, Managerial Decision-Making Model, The Nursing Process, or the Integrated Ethical Problem-Solving Model) in determining what you should do.
Justify your decision with supporting evidence.
In solving the Learning Exercise, you must select a formal problem-solving or decision-making model and apply each step of the model to reach a decision about the best way to address the problem.
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9th edition Copyright © 2017 Wolters Kluwer..
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Library of Congress Cataloging-in-Publication Data
Names: Marquis, Bessie L., author. | Huston, Carol Jorgensen, author. Title: Leadership roles and management functions in nursing : theory and application / Bessie L. Marquis, Carol J. Huston. Description: Ninth edition. | Philadelphia : Wolters Kluwer Health,  | Includes bibliographical references and index. Identifi ers: LCCN 2016046163 | ISBN 9781496349798 Subjects: | MESH: Nursing, Supervisory | Leadership | Nurse Administrators | Nursing—organization & administration Classifi cation: LCC RT89 | NLM WY 105 | DDC 362.17/3068—dc23 LC record available at https://lccn.loc.gov/2016046163
Care has been taken to confirm the accuracy of the information presented and to describe generally
accepted practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage
set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration
(FDA) clearance for limited use in restricted research settings. It is the responsibility of the health-care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice.
I dedicate this book to the two most important partnerships in my life: my husband, Don Marquis,
and my colleague, Carol Huston. Bessie L. Marquis
I dedicate this book to my husband Tom, who has stood by my side for almost 45 years. I love you.
Carol Jorgensen Huston
Carol Amann, PhD, RN-BC, FNGNA Nursing Instructor Villa Maria School of Nursing Gannon University Erie, Pennsylvania
Andrea Archer, EdD, ARNP Undergraduate Nursing Department Florida International University Miami, Florida
Cynthia Banks, PhD Program Director, RN to BSN Department of Nursing Sentara College of Health Sciences Chesapeake, Virginia
Dana Botz, MSN Faculty, Department of Nursing North Hennepin Community College Brooklyn Park, Minnesota
Sharon Bradley, DNP Clinical Assistant Professor Director of Student Success College of Nursing University of Florida Gainesville, Florida
Carolyn Brose, EdD, MSN Associate Professor
MSN Program Director Missouri Western State University St. Joseph, Missouri
Beryl Broughton, MSN, CRNP, CS, CNE Nursing Instructor, Nursing Education Aria Health School of Nursing Trevose, Pennsylvania
Suzette Cardin, PhD Adjunct Associate Professor School of Nursing University of California, Los Angeles Los Angeles, California
Fran Cherkis, DHSc Associate Professor Department of Nursing Farmingdale State College Farmingdale, New York
Alice Colwell, MSN Assistant Professor Department of Nursing Kent State University Trumbull Campus Warren, Ohio
Laura Crouch, EdD, MSN Associate Clinical Professor School of Nursing Northern Arizona University Flagstaff, Arizona
Karen Davis, DNP Assistant Professor College of Nursing University of Arkansas for Medical Sciences Little Rock, Arkansas
Karen Estridge, DNP, RN Assistant Professor Department of Nursing Ashland University
James Fell, MSN, MBA, BSN, BS Associate Professor Director Department of Nursing Baldwin Wallace University Berea, Ohio
Rick García, PhD Associate Professor Faculty Fellow Rory Meyers College of Nursing New York University New York, New York
Evalyn Gossett, MSN Clinical Assistant Professor School of Nursing Indiana University Northwest Gary, Indiana
Debra Grosskurth, PhD(c) Assistant Chair Department of Nursing Salve Regina University Newport, Rhode Island
Patricia Hanson, PhD Professor Department of Nursing Madonna University Livonia, Michigan
Tammy Henderson, MSN Associate Director Conemaugh School of Nursing Conemaugh Memorial Medical Center Johnstown, Pennsylvania
Barbara Hoerst, PhD, RN Assistant Professor Department of Nursing
La Salle University Philadelphia, Pennsylvania
Brenda Kucirka, PhD, RN, PMHCNS-BC, CNE Assistant Professor Department of Nursing Widener University Chester, Pennsylvania
Coleen Kumar, PhD College of Nursing State University of New York Downstate Medical Center Brooklyn, New York
Kathleen Lamaute, EdD Professor Department of Nursing Molloy College Rockville Centre, New York
Pamela Lapinski, MSN Professor Department of Nursing Valencia College Orlando, Florida
Jamie Lee, MSN, RN, CNL Assistant Professor Department of Nursing James Madison University Harrisonburg, Virginia
Carolyn Lewis, PhD Assistant Professor Department of Nursing Angelo State University San Angelo, Texas
Bette Mariani, PhD, RN Assistant Professor College of Nursing Villanova University Villanova, Pennsylvania
David Martin, MSN Director RN-BSN & Shared Curriculum Programs School of Nursing University of Kansas Kansas City, Kansas
Donna McCabe, DNP, APRN-BC, GNP Clinical Assistant Professor Department of Nursing Rory Meyers College of Nursing New York University New York, New York
Theresa Miller, PhD Associate Professor, Nursing Education OSF Saint Francis Medical Center College of Nursing Peoria, Illinois
Donna Molyneaux, PhD Associate Professor Department of Nursing Gwynedd Mercy University Gwynedd Valley, Pennsylvania
LaDonna Northington, DNS Professor, Traditional Undergraduate Nursing Program University of Mississippi School of Nursing Jackson, Mississippi
Sally Rappold, MSN, BSN Assistant Teaching Professor Department of Nursing Montana State University Missoula, Montana
Karen Ringl, MSN Faculty Department of Nursing California State University, Fullerton Fullerton, California
Joyce Shanty, PhD, RN
Associate Professor Nursing and Allied Health Professions Indiana University of Pennsylvania Indiana, Pennsylvania
Jean Short, MSN Assistant Professor Division of Post-Licensure Nursing School of Nursing Indiana Wesleyan University Marion, Indiana
Jennifer Sipe, MSN, CRNP Assistant Professor School of Nursing and Health Sciences La Salle University Philadelphia, Pennsylvania
Ana Stoehr, PhD, MSN Faculty Department of Nursing George Mason University Fairfax, Virginia
Patricia Thielemann, PhD Professor College of Nursing St. Petersburg College Pinellas Park, Florida
Charlene Thomas, PhD, MSN, BSN Associate Professor School of Nursing and Allied Health Aurora University Aurora, Illinois
Nina Trocky, DNP, RN Assistant Professor Department of Organizational Systems and Adult Health School of Nursing University of Maryland Baltimore, Maryland
Brenda Tyczkowski, DNP, RN, RHIA Assistant Professor Professional Program in Nursing University of Wisconsin Green Bay Green Bay, Wisconsin
Dannielle White, MSN Associate Professor School of Nursing Austin Peay State University Clarksville, Tennessee
Mary Williams, MS Associate Professor School of Nursing and Health Science Gordon State College Barnesville, Georgia
Connie Wilson, EdD Professor Emeritus School of Nursing University of Indianapolis Indianapolis, Indiana
Kelly Wolgast, DNP School of Nursing Vanderbilt University Nashville, Tennessee
Renee Wright, EdD Assistant Professor Department of Nursing York College, City University of New York New York, New York
Judith Young, DNP Clinical Assistant Professor, Community and Health Systems School of Nursing Indiana University Indianapolis, Indiana
Legacy of Leadership Roles and Management Functions in Nursing This book’s philosophy has evolved over 35 years of teaching leadership and management. We entered academe from the acute care sector of the health-care industry, where we held nursing management positions. In our first effort as authors, Management Decision Making for Nurses: 101 Case Studies, published in 1987, we used an experiential approach and emphasized management functions appropriate for first-and middle-level managers. The primary audience for this text was undergraduate nursing students. Our second book, Retention and Productivity Strategies for Nurse Managers, focused on leadership
skills necessary for managers to decrease attrition and increase productivity. This book was directed at the nurse-manager rather than the student. The experience of completing research for the second book, coupled with our clinical observations, compelled us to incorporate more leadership content in our teaching and to write this book. Leadership Roles and Management Functions in Nursing was also influenced by national events in
business and finance that led many to believe that a lack of leadership in management was widespread. It became apparent that if managers are to function effectively in the rapidly changing health-care industry, enhanced leadership and management skills are needed. What we attempted to do, then, was to combine these two very necessary elements: leadership and
management. We do not see leadership as merely one role of management nor management as only one role of leadership. We view the two as equally important and necessarily integrated. We have attempted to show this interdependence by defining the leadership components and management functions inherent in all phases of the management process. Undoubtedly, a few readers will find fault with our divisions of management functions and leadership roles; however, we felt it was necessary first to artificially separate the two components for the reader, and then to integrate the roles and functions. We do believe strongly that adoption of this integrated role is critical for success in management. The second concept that shaped this book was our commitment to developing critical thinking skills
through the use of experiential learning exercises. We propose that integrating leadership and management can be accomplished through the use of learning exercises. The majority of academic instruction continues to be conducted in a teacher-lecturer–student-listener format, which is one of the least effective teaching strategies. Few individuals learn best using this style. Instead, most people learn best by methods that
utilize concrete, experiential, self-initiated, and real-world learning experiences. In nursing, theoretical teaching is almost always accompanied by concurrent clinical practice that
allows concrete and real-world learning experience. However, the exploration of leadership and management theory may have only limited practicum experience, so learners often have little first-hand opportunity to observe middle-and top-level managers in nursing practice. As a result, novice managers frequently have little chance to practice their skills before assuming their first management position, and their decision making thus often reflects trial-and-error methodologies. For us, then, there is little question that vicarious learning, or learning through mock experience, provides students the opportunity to make significant leadership and management decisions in a safe environment and to learn from the decisions they make. Having moved away from the lecturer–listener format in our classes, we lecture for only a small
portion of class time. A Socratic approach, case study debate, and small and large group problem solving are emphasized. Our students, once resistant to the experiential approach, are now enthusiastic supporters. We also find this enthusiasm for experiential learning apparent in the workshops and seminars we provide for registered nurses. Experiential learning enables management and leadership theory to be fun and exciting, but most important, it facilitates retention of didactic material. The research we have completed on this teaching approach supports these findings. Although many leadership and management texts are available, our book meets the need for an
emphasis on both leadership and management and the use of an experiential approach. More than 280 learning exercises, representing various health-care settings and a wide variety of learning modes, are included to give readers many opportunities to apply theory, resulting in internalized learning. In Chapter 1, we provide guidelines for using the experiential learning exercises. We strongly urge readers to use them to supplement the text.
New to This Edition The first edition of Leadership Roles and Management Functions in Nursing presented the symbiotic elements of leadership and management, with an emphasis on problem solving and critical thinking. This ninth edition maintains this precedent with a balanced presentation of a strong theory component along with a variety of real-world scenarios in the experiential learning exercises. Responding to reviewer recommendations, we have added and deleted content. In particular, we have
attempted to strengthen the leadership component of the book while maintaining a balance of management content. We have also attempted to increase the focus on quality and safety as well as health-care finance, and used outpatient/community settings as the location for more learning exercises. We have also retained the strengths of earlier editions, reflecting content and application exercises
appropriate to the issues faced by nurse leader-managers as they practice in an era increasingly characterized by limited resources and emerging technologies. The ninth edition also includes contemporary research and theory to ensure accuracy of the didactic material. Additional content that has been added or expanded in this edition includes the following:
26 new learning exercises, further strengthening the problem-based element of this text. Over 200 displays, figures, and tables (17 of which are new) help readers visualize important
concepts, whereas photographs of nurses in leadership and management situations help students relate concepts to real-world practice. An expanded focus on evidence-driven leadership and management decision making Time management and productivity apps Newer care delivery models focused on ambulatory care and outpatient settings (primary care nurse coordinator in medical homes, nurse navigators, clinical nurse leaders [CNLs], leaders in patient- centered care) Impact of the 2010 Patient Protection and Affordable Care Act (PPACA) on quality and health-care finance in this country The shifting in health-care reimbursement from volume to value Personality testing as an employment selection tool Electronic health records and meaningful use Reflective practice and the assessment of continuing competency Civility, healthy workplaces, and bullying Interprofessional collaboration and workgroups Working with diverse workforces and patient populations Social media and organizational communication New quality Initiatives put forth by the Centers for Medicare & Medicaid Services, The Joint Commission, and other regulatory bodies Sentinel events Lean Six Sigma methodologies Medication reconciliation Self-appraisal, peer review, and 360-degree evaluation as performance appraisal tools
The Text Unit I provides a foundation for the decision-making, problem-solving, and critical-thinking skills as well as management and leadership skills needed to address the management–leadership problems presented in the text. Unit II covers ethics, legal concepts, and advocacy, which we see as core components of leadership
and management decision making. Units III–VII are organized using the management processes of planning, organizing, staffing, directing,
Features of the Text The ninth edition contains many pedagogical features designed to benefit both the student and the instructor:
Examining the Evidence, appearing in each chapter, depicts new research findings, evidence-based practice, and best practices in leadership and management.
Learning Exercises interspersed throughout each chapter foster readers’ critical-thinking skills and
promote interactive discussions. Additional learning exercises are also presented at the end of each chapter for further study and discussion. Breakout Comments are highlighted throughout each chapter, visually reinforcing key ideas. Tables, displays, figures, and illustrations are liberally supplied throughout the text to reinforce learning as well as to help clarify complex information. Key Concepts summarize important information within every chapter.
A crosswalk is a table that shows elements from different databases or criteria that interface. New to the eighth edition was a chapter crosswalk of content based on the American Association of Colleges of Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing Practice (2008), the AACN Essentials of Master’s Education in Nursing (2011), the American Organization of Nurse Executives (AONE) Nurse Executive Competencies (updated September 2015), and the Quality and Safety Education for Nurses (QSEN) Competencies (2014). For this edition, the newly revised Standards for Professional Performance from the American Nurses Association (ANA) Nursing Scope and Standards of Practice (2015) have been included. This edition, then, attempts to show how content in each chapter draws from or contributes to content identified as essential for baccalaureate and graduate education, for practice as a nurse administrator, and for safety and quality in clinical practice. In health care today, baccalaureate education for nurses is being emphasized as of increasing
importance, and the number of RN-MSN and BSN-PhD programs is always increasing. Nurses are being called on to remain lifelong learners and move with more fluidity than ever before. For these reasons, this textbook includes mapping to Essentials, Competencies, and Standards not only at the baccalaureate level but also at the master’s and executive levels, so that nurses may become familiar with the competencies expected as they continue to grow in their careers. Without doubt, some readers will disagree with the author’s determinations of which Essential,
Competency, or Standard has been addressed in each chapter, and certainly, an argument could be made that most chapters address many, if not all, of the Essentials, Competencies, or Standards in some way. The crosswalks in this book then are intended to note the primary content focus in each chapter, although additional Essentials, Competencies, or Standards may well be a part of the learning experience.
The American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice The AACN Essentials of Baccalaureate Education for Professional Nursing Practice (commonly called the BSN Essentials) were released in 2008 and identified the following nine outcomes expected of graduates of baccalaureate nursing programs (Table 1). Essential IX describes generalist nursing practice at the completion of baccalaureate nursing education and includes practice-focused outcomes that integrate the knowledge, skills, and attitudes delineated in Essentials I to VIII. Achievement of the outcomes identified in the BSN Essentials will enable graduates to practice within complex health-care systems and to assume the roles of provider of care; designer/manager/coordinator of care; and member of a profession (AACN, 2008) (Table 1).
TABLE 1 AMERICAN ASSOCIATION OF COLLEGES OF NURSING ESSENTIALS OF BACCALAUREATE EDUCATION FOR PROFESSIONAL NURSING PRACTICE
Essential I: Liberal education for baccalaureate generalist nursing practice • A solid base in liberal education provides the cornerstone for the practice and education of nurses.
Essential II: Basic organizational and systems leadership for quality care and patient safety • Knowledge and skills in leadership, quality improvement, and patient safety are necessary to provide high-quality health care.
Essential III: Scholarship for evidence-based practice • Professional nursing practice is grounded in the translation of current evidence into one’s practice.
Essential IV: Information management and application of patient-care technology • Knowledge and skills in information management and patient-care technology are critical in the delivery of quality patient care.
Essential V: Health-care policy, finance, and regulatory environments • Health-care policies, including financial and regulatory, directly and indirectly influence the nature and functioning of the health-care system and thereby are important considerations in professional nursing practice.
Essential VI: Interprofessional communication and collaboration for improving patient health outcomes • Communication and collaboration among health-care professionals are critical to delivering high quality and safe patient care.
Essential VII: Clinical prevention and population health • Health promotion and disease prevention at the individual and population level are necessary to improve population health and are important components of baccalaureate generalist nursing practice.
Essential VIII: Professionalism and professional values • Professionalism and the inherent values of altruism, autonomy, human dignity, integrity, and social justice are fundamental to the discipline of nursing.
Essential IX: Baccalaureate generalist nursing practice • The baccalaureate graduate nurse is prepared to practice with patients, including individuals, families, groups, communities, and populations across the lifespan and across the continuum of health-care environments.
• The baccalaureate graduate understands and respects the variations of care, the increased complexity, and the increased use of health-care
resources inherent in caring for patients.
The American Association of Colleges of Nursing Essentials of Master’s Education in Nursing The AACN Essentials of Master’s Education in Nursing (commonly called the MSN Essentials) were published in March 2011 and identified the following nine outcomes expected of graduates of master’s nursing programs, regardless of focus, major, or intended practice setting (Table 2). Achievement of these outcomes will prepare graduate nurses to lead change to improve quality outcomes, advance a culture of excellence through lifelong learning, build and lead collaborative interprofessional care teams, navigate and integrate care services across the health-care system, design innovative nursing practices, and translate evidence into practice (AACN, 2011).
TABLE 2 AMERICAN ASSOCIATION OF COLLEGES OF NURSING ESSENTIALS OF MASTER’S EDUCATION IN NURSING
Essential I: Background for practice from sciences and humanities • Recognizes that the master’s-prepared nurse integrates scientific findings from nursing, biopsychosocial fields, genetics, public health, quality improvement, and organizational sciences for the continual improvement of nursing care across diverse settings.
Essential II: Organizational and systems leadership • Recognizes that organizational and systems leadership are critical to the promotion of high quality and safe patient care. Leadership skills are needed that emphasize ethical and critical decision making, effective working relationships, and a systems perspective.
Essential III: Quality improvement and safety • Recognizes that a master’s-prepared nurse must be articulate in the methods, tools, performance measures, and standards related to quality, as well as prepared to apply quality principles within an organization.
Essential IV: Translating and integrating scholarship into practice • Recognizes that the master’s-prepared nurse applies research outcomes within the practice setting, resolves practice problems, works as a change agent, and disseminates results.
Essential V: Informatics and health-care technologies • Recognizes that the master’s-prepared nurse uses patient-care technologies to deliver and enhance care and uses communication technologies to integrate and coordinate care.
Essential VI: Health policy and advocacy • Recognizes that the master’s-prepared nurse is able to intervene at the system level through the policy development process and to employ advocacy strategies to influence health and health care.
Essential VII: Interprofessional collaboration for improving patient and population health outcomes • Recognizes that the master’s-prepared nurse, as a member and leader of interprofessional teams, communicates, collaborates, and consults with other health professionals to manage and coordinate care.
Essential VIII: Clinical prevention and population health for improving health • Recognizes that the master’s-prepared nurse applies and integrates broad, organizational, client-centered, and culturally appropriate concepts in the planning, delivery, management, and evaluation of evidence-based clinical prevention and population care and services to individuals, families, and aggregates/identified populations.
Essential IX: Master’s level nursing practice • Recognizes that nursing practice, at the master’s level, is broadly defined as any form of nursing intervention that influences health-care outcomes for individuals, populations, or systems. Master’s-level nursing graduates must have an advanced level of understanding of nursing and relevant sciences as well as the ability to integrate this knowledge into practice. Nursing practice interventions include both direct and indirect care components.
The American Organization of Nurse Executives Nurse Executive Competencies In 2004 (updated in 2015), the AONE published a paper describing skills common to nurses in executive practice regardless of their educational level or titles in different organizations. While these Nurse Executive Competencies differ depending on
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