Leadership Roles and Management Functions in Nursing Theory and Application / Carol J Huston

it will occur.

LEARNING EXERCISE 25.5

The Marginal Employee

As the nursing supervisor of a 35-bed oncology unit in a 400-bed hospital, this is how you may solve the

problems posed by a marginal employee (Judy) on your staff.

1. Identify the problem. The marginal performance of one employee is affecting unit morale.
2. Gather data to analyze the causes and consequences of the problem. The following information should

be gathered and considered:

Judy has been an RN for 15 years and probably has always been a marginal employee.
Judy states she is highly motivated to be an oncology nurse.
Judy has been coached on several occasions regarding how she might improve her performance, and
no improvement is evident.
It is difficult to recruit and retain staff nurses for this unit.
The unit is already short of two full-time RN positions.
Judy’s performance is not unsatisfactory; it is only marginal.
The other nurses on the floor considered Judy’s performance to be disruptive enough to ask you to
remove her from the floor.

3. Identify alternative solutions
Alternative 1—Terminate Judy’s employment.
Alternative 2—Transfer Judy to another floor.
Alternative 3—Continue coaching Judy and help her identify specific and realistic goals about her
performance.
Alternative 4—Do nothing and hope the problem resolves itself.
Alternative 5—Work with the other staff nurses to create a work environment that will make Judy want
to be transferred from the unit.

4. Evaluate the alternatives

Alternative 1—Although this would provide a rapid solution to the problem, there are many negative
aspects to this alternative. Judy, although performing at a marginal level, has not done anything that
warrants discipline or termination. Although some staff members have requested her removal from
the unit, this action could be viewed as arbitrary and grossly unfair by a silent minority. Thus,
employees’ sense of security and unit morale could decrease even more. In addition, it would be
difficult to fill Judy’s position.

Alternative 2—This alternative would immediately remove the problem from the supervisor and would
probably please the staff. This alternative merely transfers the problem to a different unit, which is
counterproductive to organizational goals. This might be an appropriate alternative if the supervisor
could show that Judy could be expected to perform at a higher level on another unit. It is difficult to
predict how Judy would feel about this alternative. Judy is probably aware of the other staff’s
frustration with her, and a transfer would provide at least temporary shelter from her colleagues’
hostility. In addition, although Judy would be pleased that she was not dismissed, she would
appropriately view the transfer as her failure. This recognition is demoralizing, and the opportunity
for her to fulfill a long-term career goal would be denied.

Alternative 3—This alternative requires a long-term and time-consuming commitment on the part of the
manager. There is inadequate information in the case to determine whether the supervisor can make
this type of commitment. In addition, there is no guarantee that setting short-term, specific, and
realistic goals will improve Judy’s work performance. It should, however, increase Judy’s self-
esteem and reinforce her supervisor’s interest in her as a person. It also retains an RN who is

701

difficult to replace. This alternative does not address the staff’s dissatisfaction.
Alternative 4—There are few positive aspects to this alternative other than that the supervisor would not

have to expend energy at this point. The problem, however, will probably snowball, and unit morale
will get worse.
Alternative 5—Although most would agree that this alternative is morally corrupt, there are some
advantages. Judy would voluntarily leave the unit, and the supervisor and staff would not have to
deal with the problem. The disadvantages are similar to those cited in Alternative 1.
5. Select the appropriate solution. As in most decisions with an ethical component, there is no one right
answer, and all the alternatives have desirable facets. Alternative 3 probably presents the least number of
undesirable attributes. The cost to the supervisor is in time and effort. There is really little to lose in
attempting this plan to increase employee productivity because there are no replacements to fill the
position anyway. Losing Judy by dismissal or transfer merely increases the workload on the other
employees due to short staffing. It also cannot help the employee.
6. Implement the solution. In implementing Alternative 3, the supervisor should be very clear with Judy
about her motives. She also must be sure that the goals they set are specific and realistic. Although the
staff may continue to verbalize their unhappiness with Judy’s performance, the supervisor should be
careful not to discuss confidential information about Judy’s coaching plan with them. The manager
should, however, reassure the staff that she is aware of their concerns and that she will follow the
situation closely.
7. Evaluate the results. The supervisor elected to review her problem solving 6 months after the plan was
implemented. She found that although Judy was satisfied with her performance and appreciative of her
supervisor’s efforts, her performance had not improved appreciably. Judy continued to be a marginal
employee but was meeting minimal competency levels. The supervisor did find, however, that the staff
seemed more accepting of Judy’s level of ability and rarely verbalized their dissatisfaction with her
anymore. In general, unit morale increased again.

702

Index

Note: Page numbers followed by d indicate displays, those followed by f indicate figures, and those followed
by t indicate tables.

A
Absence of leadership, 53
Accommodating, 558
Accommodating transfers, 691
Accommodation, union, 585
Accountability, 301–302
Accountable care organizations (ACOs), 234, 238d, 256–257
Accuracy, in performance appraisal, 651–653, 653d
Achievement-oriented people, 472
Action stage, for change, 193, 193t
Active management-by-exception, 52–53
Acuity index, 238d
Acute care case management, 358
Ad hoc design, 302–303
Administrative agencies, 111, 111t
Administrative cases, 111–112, 112t
Administrative decision making, 21
Administrative man, 21, 21t
Administrative Simplification plan, 126
Adult learning theory, 412–413, 413t, 414d
Advanced beginner nurses, 269d
Advance directives (ADs), 123
Advanced practice nurses, 114, 358
Adverse drug events (ADEs), 631
Adverse event(s), 631, 641
Adverse event forms, 119
Advisory positions, 297
Advocacy, 84, 134–158

common areas of, 139d
culture and, 139–140
definition of, 135
ethics in, 138, 148, 153–154
leadership roles in, 136d, 152
learning exercises on, 137, 139–140, 143, 146, 148, 153–157
legislation and public policy, 148–149
letter writing in, 149, 150d, 154
management functions in, 135, 136d, 152
media and, 149–152, 151d
patient, 138–144
peer, 156–157
professional, 147–152
subordinate and workplace, 144–145

703

values and, 136–137, 137d, 155–156
whistleblowing as, 145–147
Advocate, 135
Affective conflict, 556
Affiliation-oriented people, 472–473
Affirmative action, 600
Affirming the consequences, 16
Affordable Care Act. See Patient Protection and Affordable Care Act
AFL-CIO, 586
Age Discrimination in Employment Act (ADEA), 596t, 601
Agency for Healthcare Research and Quality (AHRQ), 138–139, 138d, 617–618, 629–630, 631
Agency nurses, 439–440
Agency shop, 583d
Agenda for Change (The Joint Commission), 625
Aggressive communication, 501
Aggressively taking over, 568
Aging workforce, 379
Aiken, Linda, 67
Alternative dispute resolution (ADR), 569–570
Alternatives, generating, 15
Ambiguous questioning, 568
American Academy of Nursing (AAN), 310
American Association of Colleges of Nursing (AACN), 331, 364, 377–379, 694
American Association of Critical-Care Nurses, 279
American Association of Nurse Anesthetists, 279
American College of Nurse-Midwives, 279
American Federation of Government Employees, 586
American Federation of Labor–Congress of Industrial Organizations, 586
American Federation of State, County, and Municipal Employees, 586
American Federation of Teachers (AFT), 586
American Hospital Association (AHA)
on engaging health-care users, 138
on patient rights, 141
on power in nursing, 332
on unionization, 584
American Nurses Association (ANA)
bullying, incivility, and workplace violence position, 564
certification programs, 128, 279
chemical impairment policy, 694
Code of Ethics, 89, 90–91, 92d, 138, 694
Code of Ethics for Nurses with Interpretive Statements, 278, 564, 590
delegation statement, 525, 534
duty to care vs. work stoppage, 590
mission, 586
National Database of Nursing Quality Indicators, 630
Principles for Social Networking, 508, 509d
professional advocacy, 149
scope and standards of practice, 91–92, 92d, 138, 144, 311, 616–618
staffing concerns, 437
standardized nursing languages, 620–621, 621d
unionization/collective bargaining, 584, 586–587
American Nurses Credentialing Center (ANCC), 279, 310–312, 391

704

American Recovery and Reinvestment Act (ARRA), 126–127, 141, 510–511
Americans with Disabilities Act, 603
Analogy, arguing from, 16
Andragogy, 412–413, 413t, 414d
Anticipatory socialization, 419
Appearance, 499
Applied ethics, 83
Arbitration, 570, 583d, 689–690
Arguing from analogy, 16
Argyris, Chris, 45, 45t
Aristotle, 46, 54t
Assault, 120
Assertive communication, 500–502, 518
Assets, 238d
Assignment, delegation vs., 525
Associate nurse, 355
At-will doctrine, 686
Audit(s), 618–620

concurrent, 618
definition of, 618
process, 619
prospective, 618
retrospective, 618–619
structure, 619–620
Augmentation effect, 52
Authentic leadership, 68–70, 69d
Authoritarian leadership, 46–48
Authority
definition of, 301, 322
hierarchy of, 295
legal-rational, 294
as legitimate power, 322, 325, 326t
organizational chart of, 301
socialization and, 326–327
Authority–power gap, 326–330, 327f, 345
bridging, 327–329
credibility and, 328
future promising and, 328
negative effect of, 326
in student role, 329
Autonomy, 87–88, 88d
Avoiding, 559
Avolio, B. J., 50–52, 54t

B
Bachelor of science in nursing (BSN), 391
Background checks, 119, 391–392
Balanced Budget Act (BBA) of 1997, 250, 252
Balanced processing, 69
Balanced scorecard, 169
Bandura, Albert, 414
Bar coding, 632–633
Baseline data, 238d

705

Bass, B. M., 50–52, 54t
Battery, 120
Behavioral expectation scales, 654–655
Behaviorally anchored rating scale (BARS), 654–655, 661d
Behavioral theories, of leadership, 46–48
Behavior change

in chemically impaired employees, 695, 695d
in conflict resolution, 561
Behavior modification, 470
Benchmarking, 614
Beneficence, 88, 88d
Benefit time, 243
Best Care at Lower Cost: The Path to Continuously Learning Health Care in America (IOM), 410
Best practice, 614, 617
Bias
confirmation, 13, 24–25
personal

in interview, 387, 401–402
in performance appraisal, 651
Biological variations, racial/ethnic, 539
Biomechatronics, 164
Biometrics, 164
Blackberry smartphones, 200
Blake, R. R., 48, 54t
Blanchard, K., 48, 54t
Blue Cross and Blue Shield, 70
Board of Certification for Emergency Nursing, 279
Body language, 497. See also Nonverbal communication
Boom generation, 450, 450t
Bottom line, 565
Brain hemisphere dominance, 18–19
Brainstorming, 15
Brandeis, Louis, 42
Breach of duty, 114, 115t
Break-even point, 238d
Breslin, Eileen, 331
Budget
basics of, 237
capital, 244
definition of, 237
fiscal-year, 240
implementation of, 240–241
operating, 244
perpetual, 240
personnel, 241–243
types of, 241–244
Budgetary process, 240–241
Budgeting methods, 244–247
decision package in, 245, 246d, 247
flexible, 246
incremental, 244
performance, 246–247

706

zero-based, 245, 246d
Bullying, 562–564
Bundled care, 256
Bundled Payments Initiative, 256
Bundled payments, 234, 238d, 256
Burden of proof, 112
Bureaucracy, 43, 294–296, 302
Burns, J. M., 50, 54t
Bush, George, 510
Butterfly effect, 199

C
California

LVN duties in, 527
nurses union in, 586, 587, 589–590
patient rights in, 142d
right to die in, 143–144
staffing mandates in, 437, 438t, 448
California Fair Pay Act, 596t
California Nurses Association (CNA), 586, 589–590
Cancer care, nurse navigators in, 363, 363d
Capella, Elena, 199
Capital budget, 244
Capitation, 238d, 251
Care-centered organizations, 304
Career coaching, 273–274, 275f
Career development, 266–290
continued competency in, 277–279
definition of, 267
individual responsibility for, 271, 272t
justifications for, 270–271, 270d
leadership roles in, 268d, 284
learning exercises on, 270, 273, 274, 279, 281, 283, 286–290
management functions in, 268d, 284
organization’s role in, 271–272, 272t
professional portfolio in, 280–281
reflective practice in, 280
resumé for, 283, 284d, 285f, 287
specialty certification in, 279–280, 280d
Career ladders, 271
Career mapping, 288, 288f
Career paths, 271–272
Career planning
definition of, 271
individual responsibility for, 271
new graduate nurse and, 281
Career stages, 267–270, 269d
Care pairs, 354
Care pathways, 247
Case management, 349, 358–359
Case Management Society of America (CMSA), 358
Case method of assignment, 350. See also Total patient care
Case mix, 238d

707

Case scenarios, in interview, 385, 385d
Case studies, 5
Cash flow, 238d
Centers for Medicare & Medicaid Services (CMS), 163, 249, 252, 628–630
Centrality, on organizational chart, 299–301
Centralized decision making, 304
Centralized staffing, 435–437, 436t
Central tendency, 652
Certification programs, 128, 279–280, 280d, 358
Chain of command, 297
Change. See also Planned change

chaos theory of, 198–199
classic strategies for, 193–195
complex adaptive systems theory of, 198–199, 199d
covert vs. overt, 195
mandated vs. proactive, 195
organizational, with nonlinear dynamics, 197–199
organizational aging and, 200
resistance to, 195–196, 205
Change agent, 187–188
definition of, 187
responsibilities of, 191d
Change by drift, 187
Channels of communication, 496, 496t
Chaos theory, 198–199
Charge nurses, 594–595
Charismatic power, 326, 326t
Charitable immunity, 118
Checklist for meeting Ethical and Legal Obligations (ChELO), 125
Checklists, for performance appraisal, 656, 661d
Chemical dependency
drugs of choice, 694
prevalence in nursing, 693–694
Chemically impaired employees, 675, 693–702
confronting, 697–698
manager’s role in assisting, 698–699
recognizing, 694–697, 695d
recovery process for, 700
reentry to workplace, 702
state board of nursing treatment programs for, 701–702
Child learning, 412–413, 413t
Chunking, 416
Civil cases, 111–112, 112t
Civil Rights Act of 1964, 127, 596t, 600–601, 602
Clark, Cynthia, 562
Classic change strategies, 193–195
Clear and convincing standard, 112
Clinical guidelines, standardized, 617–618
Clinical leader, 39
Clinical nurse-leader (CNL), 364, 369–370
Clinical nursing ethics, 83
Clinical pathways, 247

708

Clinical reasoning, 4
Clinical research, informed consent for, 123
Closed shops, 588
Closed-unit staffing, 452d
Closure stage, of group, 513
CMS. See Centers for Medicare & Medicaid Services
Coaching

career, 273–274, 275f
definition of, 425
marginal employee, 691–692
by new nurse, 667
ongoing, 684
performance appraisal, 665–666
performance deficiency, 684–685, 684d
problem-centered, 684
as teaching strategy, 425–426
Coalitions, building, 333, 339
Code of Ethics, 89, 90–91, 92d, 138, 694
Code of Ethics for Nurses with Interpretive Statements, 278, 564, 590
Code pink, 564
Coercive power, 325, 326t
Collaboration
in conflict resolution, 559
interprofessional, 163
in planned change, 196–197
Collective bargaining, 581–582, 583d
ANA and, 584, 586–587
definition of, 583d
leadership and management functions in, 581, 582d, 604–605
learning exercise on, 587
Collins, Jim, 64–65
Committee(s), 312–314, 318. See also specific types
groupthink of, 314
organization, factors to consider in, 313d
responsibilities and opportunities of, 313–314
Communication, 490–522
aggressive, 501
assertive, 500–502, 518
channels of, 496, 496t
confidentiality in, 510
culture and, 127, 449, 539
definition of, 493
delegation and, 528, 539
grapevine, 294, 496, 496t
group, 491, 513–516
internal and external climate in, 493, 494t
interpersonal, 491, 562–564
ISBAR tool for, 502–503
leadership roles in, 491–492, 492d, 515–516
learning exercises on, 494, 497, 499, 503, 505, 507, 511, 517–521
listening skills in, 504, 505
management functions in, 491–492, 492d, 515–516

709

modes of, 496–498
nonverbal, 493, 497–500
organizational, 491–492

gender and, 494
power and, 495
strategies for, 495–496
variables affecting, 494–495
passive–aggressive, 501
in planned change, 196–197
SBAR tool for, 502–503, 502t
social media and, 508–509, 509d
technology as tool in, 506–510
verbal, 493, 500–503
written, 497, 504–506, 507, 517, 519–520
Communication process, 493–494, 493f
Community Health Network, 363
Compassion, from leaders, 64
Competence, definition of, 416
Competency, 654
areas of, 277
continued, 277–279
continuing education for, 278–279
individual responsibility for, 278
portfolio demonstrating, 280–281
specialty certification in, 279–280
Competency assessment, 648, 654
Competent nurses, 269d
Competing, 558
Complementary and alternative medicine, 163
Complex adaptive systems (CAS) theory, 198–199, 199d
Complexity science, 198
Compliments, accepting, 336
Compromising, 558
Computer-aided error analysis (CEA), 615
Computerized physician–provider order entry (CPOE), 632, 633t
Conciliation, 583d
Concurrent audits, 619
Confidentiality, 88d, 90, 126–127, 141–142, 510
Confirmation biases, 13, 24–25
Conflict
affective, 556
causes of, 560, 560d
constructive vs. destructive, 552
definition of, 552
felt, 556
intergroup, 555–556, 555f
interpersonal, 555, 555f, 556
intrapersonal, 555, 555f, 556
latent, 556
manifest or overt, 556
and organizational effectiveness, 554, 554f
perceived, 556

710

quantitative and qualitative, 554
Conflict aftermath, 557
Conflict management, 551–579

alternative dispute resolution in, 569–570
history of, 553–554
leadership roles in, 552–553, 553d, 570–571
learning exercises on, 555, 559, 560, 569, 572–578
management functions in, 552–553, 553d, 570–571
negotiation in, 564–569
seeking consensus in, 570
strategies for, 557–559, 558d
unit, 560–561
Conflict process, 556–557, 557f
Conflict resolution, 552. See also Conflict management
Confrontation, 561
Confronting chemically impaired employee, 697–698
Congruent (authentic) leadership, 68–70
Consensus, 570
Consent
express, 122
implied, 122
informed, 121–123, 121d
Consequences, affirming, 16
Consequence tables, 23–24, 24t
Consequentialist theory, 87
Consistency, in discipline, 678, 678d
Consolidation, in health care, 162
Constitution, 110, 111t
Consumer Bill of Rights and Responsibilities, 141
Contemplation, for change, 193, 193t
Contingency leadership, 48–49
Contingent reward, 52
Continued competency, 277–279
Continuing education (CE), 278–279
Continuity of information, 163–164
Continuous health improvement, 359. See also Disease management
Continuous quality improvement (CQI), 621–622
Control/controlling, in management, 38, 44, 44f, 611–612
Control criteria, 614
Controllable expenses (costs), 237, 238d
Cooperating, 558
Copayment, 252
Core Measures, 626–627, 627d
Cost–benefit ratio, 238d
Cost center, 238d
Cost containment, 236
Cost drivers, 360
Cost-effective, definition of, 236
Cost management, 163
Courage, in decision making, 20, 25–26
Court decisions, 111, 111t
Courts, types of, 111–112, 112t

711

Covey, Stephen R., 37, 72
CPGs, 617–618
Creating and Sustaining Civility in Nursing Education (Clark), 562
Creativity, in decision making, 20, 25–26
Credentials, 391
Credibility, 328
Criminal cases, 111–112, 112t
Crisis management, 230
Critical incident, 651
Critical indicators, 443
Critical pathways, 247, 358
Critical thinking

characteristics of critical thinker, 4d
definition of, 4
Marquis-Huston teaching model of, 5–7, 7f
Crossing the Quality Chasm: A New Health System for the 21st Century (IOM), 635–636
Cross-training, 451
Cultural diversity, 330
Culture
and advocacy, 139–140
and communication, 127, 449, 539
and delegation, 539–540, 540d
and educational needs, 427–428
and staffing/scheduling, 375, 449
and time orientation, 539
and workplace legal issues, 127
Culture, organizational, 305–308, 319
assessing, 307d
definition of, 305–306
motivation in, 468
organizational climate vs., 306
for patient-and family-centered care, 366

D
Data, gathering, 13, 13d
Day planning, 227–230
Decentralized decision making, 304–305
Decentralized staffing, 435–437, 436t
Decertification of union, 593
Decision grids, 22, 22f
Decision making, 3–26

administrative, 21
assessing skills of, 27, 33–35
brain hemisphere dominance and, 18–19
centralized, 304
choice and action in, 16
critical elements in, 12–16, 12d, 28
data gathering in, 13, 13d
decentralized, 304–305
definition of, 3
emotion and, 69
ethical, 92–95

difficulty with, 92–93

712

frameworks for, 86–87, 86t
outcome and process of, 93
theory–practice–ethics gap in, 93–95
evidence-based approach for, 14–15, 14d
gender and, 17
heuristics for, 7
individual preference and, 17–18, 19
individual variations in, 17–19
individual vulnerability in, overcoming, 19–20
individual ways of thinking and, 20
intuitive models of, 10–12
leadership roles and management functions in, 25–26
learning exercises on, 11, 15, 18, 27–35
life experience and, 17, 19
managerial model of, 8–9, 8d
moral model of, 95, 97d
naturalistic, 12
nursing process for, 9–10, 9f, 10t, 95
objectives in, defining, 12–13
organizational, 20–21, 304–305
participative, 45
power and, 20–21, 338–339, 343
proactive, 338–339
problem solving vs., 3–4
qualities of successful decision maker, 20
rational, 8–9, 21
recognition-primed decision model for, 12
scientific models for, 11
shared, 308–310, 309f, 317
in staffing, 385
theoretical approaches to, 7–12
thinking styles and, 18–19
time necessary for, 14
tools for, 22–24
consequence tables, 23–24, 24t
decision grids, 22, 22f
decision trees, 23, 23f
logic models, 24
payoff tables, 22–23
pitfalls in using, 24–25
values and, 17, 19
vicarious learning to increase skills, 4–7
Decision package, 245, 246d, 247
Decision trees, 23, 23f
for delegation, 535, 536f
Deductive reasoning, 16
Defamation, 120
Defendant, 114
Delegation, 523–550
ANA/NCSBN statement on, 525, 534
assignment vs., 525
communication in, 528, 539

713

cultural diversity and, 539–540, 540d
deadlines and monitoring in, 529
decision tree for, 535, 536f
definition of, 525
effective, 525–530
errors in, common, 530–532, 530d
five rights of, 525, 527t
identifying skills and education needed for, 526–528
leadership roles in, 525, 526d, 541
learning exercises on, 532, 538, 540, 542–549
management functions in, 525, 526d, 541
to modular health-care team, 548–549
Nurse Practice Act and, 526–528, 546
as nursing function, 532–537
performance evaluation in, 529
planning for, 528
rewarding accomplishments in, 529
role model and guidance for, 529
selection and empowerment for, 528
subordinate resistance to, 537–538
successful, strategies for, 527d
to unlicensed assistive personnel, 527, 533–537, 534d, 536f, 537d
Demand, for nurses, 378
Deming, W. Edward, 621–622
Democratic leadership, 46–48
Deontological theory, 86t, 87
The Deprivation of Liberty Safeguards and Mental Capacity Act (United Kingdom), 142
Diagnosis, budget, 240
Diagnosis-related groups (DRGs), 238d, 249–250, 624
Diagonal communication, 496, 496t
Direct costs, 238d
Directing, in management process, 44, 44f, 465
Director of nursing, 299
Disability
definition of, 603
legislation affecting Americans with, 603
Disciplinary conference, 686–688
Discipline, 673–707
agreement and acceptance of action plan, 687–688
at-will doctrine and, 686
consistency in, 678, 678d
constructive vs. destructive, 675–676
documentation of, 683–684
employee’s response to action, 687
employee transfer in, 690–691
environment for, 688
expectations for change in, 687
fair and effective, 677–678, 678d
forewarning of, 678, 678d
grievance procedures in, 689–690
group norms and, 677
immediate consequence of, 678, 678d

714

impartiality in, 678, 678d
leadership roles in, 676d, 702–703
learning exercises on, 677, 679, 682, 685, 692, 704–706
management functions in, 676d, 702–703
origin of word, 675
performance deficiency coaching in, 684–685, 684d
as progressive process, 679–681, 681t
rationale for action, 687
reason for action, 687
self-discipline, 69, 69d, 677
strategies for manager, 683–685
termination conference in, 688–689
union employee, 685–686
Discover Nursing campaign, 70
Discrete event simulation, 5
Disease management, 359–361
common program features in, 360d
goal of, 359–360
researching programs in, 361
Dismissal, 681, 681t, 688–689
Dispute resolution, 569–570
Diversion, drug, 693–694
Diversion programs, for chemically impaired employees, 701
Diversity. See also Culture
definition of, 127
educational needs in, 427–428
generational, 450–451, 450t
workforce, 127, 375, 427–428, 449
Division of labor, 294
Doctrine of charitable immunity, 118
Documentation
of discipline, 683–684
of performance appraisal, 651–652, 664, 665f
Downsizing, 486–487
Downward communication, 496, 496t
Downward transfer, 690–691
Dozer, Carol, 56
DRGs. See Diagnosis-related groups
Driving forces, for change, 192, 192f
Due process, 569, 686
Durable power of attorney, 123
Duty-based reasoning, 86–87, 86t

E
Eastman, George, 200
Economic man, 21, 21t
Education. See also Learning organization

assessing needs for, 416–417
coaching in, 425–426
continuing, 278–279
cultural diversity and, 427–428
evaluation of activities, 417
leadership roles in, 409d, 428–429

715

learning theories and, 412–416
management functions in, 409d, 428–429
selection requirements, 391
sequence for development program, 417d
training vs., 411
Educational expenses, 287
Education department, responsibilities of, 411–412
Effectiveness report, 648
Ego and power, 340, 345
Electronic health records (EHRs), 164, 510–513, 629
Emergency Nurses Association, 145
Emotional intelligence (EI), 68, 68d, 76–78
Emotional literacy, 68
Employee discipline, 673–707. See also Discipline; Impaired employees
Employee empowerment, 329–330, 336, 340, 475–476, 528
Employee engagement, 466
Employee handbook, 398
Employee indoctrination, 397–400, 397d
Employee interview, 381–390
Employee motivation. See Motivating climate; Motivation
Employee recruitment, 379–381. See also Staffing
Employee selection, 390–395. See also Staffing
Employee–supervisor relationship, 476–477
Employment law, 595–604, 596t
leadership and management functions in, 581, 582d, 604–605
learning exercises on, 597, 601, 603, 606–607
Empowerment, 329–330, 336, 342, 475–476, 528
End-of-life issues, 123–125, 143–144
End of Life Option Act (California), 144
End-of-shift overtime, 66
Energy
in decision making, 20, 25–26
in power, 334
Engagement
employee, 466
patient and family, 138–139, 138d
Engaging Health Care Users: A Framework for Healthy Individuals and Communities (AHA), 138
Entry level, for nurses, 154
Environment, in communication, 499
Environmental control, culture and, 539
Equal Employment Opportunity Commission (EEOC), 392, 600–602
Equal employment opportunity laws, 596, 599–600
Equal Pay Act of 1963, 596t, 598
Equal treatment, 89
Errors. See Medical errors
Essay appraisal method, 656, 661d
Ethical behavior, as norm, 95–99, 99d
Ethical decision making, 92–95
difficulty with, 92–93
frameworks for, 86–87, 86t
outcome and process of, 93
theory–practice–ethics gap in, 93–95

716

Ethical dilemma, 86
Ethical Dilemmas in Nursing-Middle Manager Questionnaire, 84
Ethical principles, 87–90, 88d
Ethical problem-solving model, integrated, 10, 10d
Ethical relativism, 87
Ethical universalism, 87
Ethical work environment, fostering, 100
Ethics, 82–107

advocacy and, 138, 148, 153–154
applied, 83
clinical nursing, 83
code of, 89, 90–92, 92d, 138, 278, 564, 590, 694
communication and, 510
definition of, 83
informed consent and, 122
learning exercises on, 89, 90, 91, 93–98, 101–107
legal issues vs., 99
nursing management, 83–84
staffing and, 404, 452–453
values and, 91
Ethics committees, 99
Evaluation. See also Performance appraisal
definition of, 648
Evidence-based hospital referral (EHR), 632, 633t
Evidence-based policies and procedures, 180
Evidence-based practices, 14–15, 14d, 271, 334, 417–418, 418d
Exchanges (marketplaces), 234, 257, 364
Exclusive provider organization (EPO), 252
Execution, as leadership domain, 63
Executive Coaching Network, 273
Executive Order 10988 (Kennedy), 584, 584t
Executive Order 11246 (Johnson), 596t, 600
Executive Order 11375 (Johnson), 596t, 600
Exemplary leadership, 51, 51d
Expectancy model, 471–472, 473f
Expenses, in budget, 237, 240d
Expert networks, 164
Expert nurses, 268–269, 269d
Expert patient, 164
Expert power, 325, 326t
Express consent, 122
Expressed policies, 180
External climate, in communication, 493, 494t
External stakeholders, 305, 306t
External whistleblowing, 146
Externships, 282–283
Extrinsic motivation, 466–468, 467t
Eye contact, 499–500

F
Face-to-face communication, 497
Facial expression, 500
Fact finding, 570, 583d

717

Faculty shortage, 378–379
Failure mode and effects analysis (FMEA), 625
Fair Labor Standards Act (FLSA), 596t, 597
Fairness

in discipline, 677–679, 678d
in justice, 88–89, 88d
in performance appraisal, 651–653, 653d
False imprisonment, 120
Family-centered care, 364–366, 365d
Family engagement, 138–139, 138d
Fayol, Henri, 44, 45t
Federal Health IT Strategic Plan, 165
Federal Mediation and Conciliation Service, 589
Feedback
in nursing process, 9, 9f
in performance appraisal, 662
Fee-for-service (FFS) system, 238d, 248, 252–253
Felt conflict, 556
Fidelity, 88d, 89
Fiedler, F., 48, 54t
First-level managers, 299, 299t
Fiscal accountability, 253, 452–453
Fiscal planning, 233–265
balancing cost and quality in, 236–237
budgetary process in, 240–241
budget basics in, 237
budgeting methods in, 244–247
budget types in, 241–244
decision package in, 245, 246d, 247
forecasting in, 237
leadership roles in, 236d, 257–258
learning exercises on, 241, 243, 245, 247, 253, 259–264
management functions in, 236d, 257–258
responsibility accounting in, 237
Fiscal terminology, 238d–240d
Fiscal-year budget, 240
Fixed budget, 238d
Fixed expenses (costs), 237, 238d
Flat organizational designs, 304
Flat-percentage increase budgeting, 244
Flattened organizations, 298, 304, 304f
Flattery, 568
Flexibility, power of, 336
Flexible budgeting, 246
Flextime, 441
Float pools/floating, 131, 439–441, 458
Flowcharts, 24, 25f, 30
Follett, Mary Parker, 45, 45t, 48, 54t
Followers, 63–67
Forced checklist, 656
Forecasting, 167, 237
Foreseeability of harm, 115, 115t

718

Forewarning, of discipline, 678, 678d
Formal communication networks, 495
Formal reprimand, 679, 680f, 681t
Formal structure, 293
Forming stage, of group, 513–514, 513t
For-profit organization, 239d
Forum of State Nursing Workforce Centers, 379
Four quadrant (4-Q) personality tests, 392
Free choice of physician rule, 252
Free-form review, 656
Free speech, and unionization, 583d
Frontline Service Alliance, 586
Full costs, 239d
Full-range leadership model (FRLM), 51–53, 52d, 63
Full-time equivalent (FTE), 239d
Functional foremen, 42
Functional method of nursing, 349, 351–352, 351f
The Future of Nursing (IOM), 168d, 277–278, 282, 354, 379
Future-oriented culture, 539
Future promising, 328

G
Gardner, J. W., 53, 54t
Gatekeeping positions, 301
Gellerman, Saul, 473
Gender

and communication, 494
and decision making, 17
and equal pay, 598
and nursing, 488, 600
and power, 323–324
Generational diversity, 450–451, 450t
Generation X, 450, 450t, 451
Generation Y, 450t, 451
Genetic Information and Nondiscrimination Act (GINA), 141–142
Gestures, 500
“The Giving of Orders” (Follett), 45
Glass ceiling, 324
Goal(s), 178–179
for change, 190
definition of, 178
incremental setting of, 184
writing, 179
Goal statements, 178d
Goleman, D., 68, 68d
Good Samaritan laws, 125
Good to Great: Why Some Companies Make the Leap . . . and Others Don’t (Collins), 64–65
Governmental immunity, 118
Grandfathering, 154
Grapevine, 294, 496, 496t
Great Man theory, 46
Greenleaf, R. K., 65
Grievance, 583d

719

Grievance procedures, 689–690
Grievance resolution, rights and responsibilities in, 690
Group communication, 491, 513–516
Group conflict, 555–556, 555f
Group dynamics, 513–515
Group HMOs, 251
Group norms, 677
Group roles, 514–515
Group stages, 513–514, 513t
Groupthink, 314, 380
GRRRR listening tool, 504, 504t
Guidance, in delegation, 529
Guide to Patient and Family Engagement in Hospital Quality and Safety (AHRQ), 138–139, 138d
Gulick, Luther, 44, 45t

H
Halo effect, 652
Hand hygiene, 93–95
Handoffs, in communication, 502–503
Harrison, Mary Starmann, 56
Harvest, as career stage, 269
Hawthorne effect, 45
Health care. See also specific topics

consolidation in, 162
emerging paradigms of, 162–164
factors influencing, 164, 166
fiscal planning in, 233–265
future of, 161–166
milestones in, U.S., 254d–255d
unionization in, 585–595
value vs. volume in, 163, 234
Health-care costs, 163, 236–237
Healthcare Information Technology for Economic and Clinical Health Act (HITECH), 511
Healthcare in the Crossroads (The Joint Commission), 116, 117d
Health-care proxy, 123
Health-care quality
defining, 612–614
staffing/scheduling and, 447–449
Health-care team, 164
Health-care user engagement, 138–139, 138d
Health insurance, 89, 141, 163, 248–257, 254d–255d
Health insurance marketplaces, 234, 257, 364
Health Insurance Portability and Accountability Act (HIPAA) of 1996, 126–127, 141, 509–510
Health Maintenance Organization Act of 1973, 251
Health maintenance organizations (HMOs), 239d, 251–253
Health Plan Employer Data and Information Set (HEDIS), 630
Health Resources and Services Administration, 379
Health Workforce Solutions, 362
Healthy work environment, 380
Heart, of authentic leader, 69, 69d
Helplessness, in negotiation, 568
Herrmann, Ned, 18
Hersey, P., 48, 54t

720

Herzberg, Frederick, 470–471
Heuristics, 7
Hidden agendas, 566
Hierarchy of authority, 295
Hierarchy of needs, 468, 469f
High-performance teams, 50
High-reliability organizations, 612
Hill Burton Act, 351
HIPAA. See Health Insurance Portability and Accountability Act (HIPAA) of 1996
Hiring. See Selection
HMOs. See Health maintenance organizations
Hollander, E. P., 49
Hope, from leaders, 64
Horizontal bullying, 562
Horizontal communication, 496, 496t
Horns effect, 652
Hospital-acquired conditions (HACs), 629
Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), 629–630
Hospital information system, 507
Hospital Inpatient Quality Reporting (IQR) Program, 628
Hospital Quality Initiative (HQI), 628
Hospital Quality Measures, 626–627, 627d
Hospital value-based purchasing, 257, 629
Hot stove rules, for discipline, 677–678, 678d
Hours

nursing care, per patient-day, 242–243, 243f, 443, 443f
per patient-day (HPPD), 239d
worked, 597
Human capital, 67, 77
Human capital theory, 67
Human patient simulation (HPS), 6
Human relations management, 44–45
Humor, 336
Hygiene factors, 471, 471t

I
ICU physician staffing, 632, 633t
Idealized influence

attributed, 52
behavior, 52
IKEA effect, 477
Illinois, Medical Patient Rights Act in, 141
Immediate consequence, 678, 678d
Immunity (legal)
charitable, 118
governmental, 118
Impaired employees, 101–102, 675
chemically impaired, 675, 693–702
psychologically impaired, 675
RN, definition of, 693
Impartiality, in discipline, 678, 678d
Impersonality of interpersonal relationships, 295
Implied consent, 122

721

Implied policies, 180
Improper delegating, 531
Improving Diagnosis in Health Care (IOM), 635–636
Inactivism, 166
Inappropriate questioning, 568
Inappropriate transfer, 691
Incentives, 476
Incident reports, 119
Incivility, 431, 562–564
Inconsistency, in leadership, 70
Incremental budgeting, 244
Independent practice association (IPA), 251
Indirect costs, 239d
Individualized consideration, 52
Individual philosophies, 176–177
Indoctrination, employee, 397–400, 397d
Induction, 398
Industrial age leadership, 72–75, 73t
Inference, 16
Influence, as leadership domain, 63
Informal communication networks, 294, 495, 496, 496t
Informal reprimand, 679, 681t
Informal structure, 293–294
Informational power, 326, 326t
Informed consent, 121–123

for clinical research, 123
ethical issues in, 122
guidelines for, 121d
learning exercise on, 122
Injury, as element of negligence, 115, 115t
Innovative Care Delivery Models: Identifying New Models That Effectively Leverage Nurses (Health

Workforce Solutions), 362
Inspiration, for change, 190
Inspirational motivation, 52
Institute for Health Improvement (IHI), 623
Institute for Patient-and Family-Centered Care (IPFCC), 364–365
Institute of Medicine (IOM)

Best Care at Lower Cost, 410
Crossing the Quality Chasm, 635–636
To Err Is Human, 116, 331, 332, 631, 636
The Future of Nursing, 168d, 277–278, 282, 354, 379
health-care quality definition of, 612–614
Improving Diagnosis in Health Care, 635–636
on patient-centered care, 365
Roundtable on Evidence-Based Medicine, 417
Institutional licensure, 128
Institutional review boards (IRBs), 99–100
Insubordination, 673, 706
Integrated ethical problem-solving model, 10, 10d
Integrated leader-managers, 53, 75. See also specific roles and functions
Integrated model of leadership, 73, 73f
Intellectual stimulation, 52

722

Intensive care unit (ICU) physician staffing (IPS), 632, 633t
Intentional torts, 120
Interactional leadership theories, 49–50, 65–67
Interactive (proactive) planning, 164, 166–167
Intergroup conflict, 555–556, 555f
Internal climate, in communication, 493, 494t
Internalized moral perspective, 69
Internal stakeholders, 305, 306t
Internal whistleblowing, 146
International Brotherhood of Teamsters, 586
International Classification for Nursing Practice (ICNP), 621
International Classification of Diseases, 10th revision (ICD-10), 163, 239d, 250
International Council of Nurses (ICN), 621
International nurses, socialization of, 422–423
Internet

and communication, 507
and health care, 164
and unionization, 592
Internships, 282–283
Interpersonal communication, 491, 562–564
Interpersonal conflict, 555, 555f, 556
Interpersonal relationships, impersonality of, 295
Interprofessional collaboration, 163
Interrater reliability, 382
Interruptions, dealing with, 216
Intervention, for chemically impaired employees, 701
Interview, media, 151–152
Interview, performance, 662–664
closure and follow-up in, 664
documentation of, 664, 665f
overcoming difficulties in, 662–664
planning, 662
preparation for, 663
process of, 663–664
reducing trauma of, 669
Interview, selection, 381–390
acceptable and unacceptable inquiries in, 388, 389t
anxiety in, 404–405
case scenarios in, 385, 385d
definition of, 381
evaluation of, 387
guide for, designing, 405
interview of, 381
legal aspects of, 388
limitations of, 381–384
multiple, 385–386
personal bias in, 387, 401–402
planning, conducting, and controlling, 386–387
purposes or goals of, 381
reliability and validity in, 382–383
semistructured, 381
strategies for, 383–386

723

structured, 381, 382, 383, 384d
subjectivity in, 381–382
tips for interviewee, 388–390, 390d
training for effective techniques in, 386
unstructured, 381
Intranets, 507
Intrapersonal conflict, 555, 555f, 556
Intrinsic motivation, 466–468, 467t
Intuitionist framework, 86–87, 86t
Intuitive decision-making models, 10–12
Involuntary termination, 681, 681t, 688–689
IOM. See Institute of Medicine
Iowa Interventions Project, 621
ISBAR communication tool, 502–503

J
Japanese style of management, 49, 634
Job dimension scales, 654, 655t, 661d
Job interview. See Interview, selection
Job performance changes, in chemically impaired employees, 695, 695d
Johnson, Lyndon, 600
Johnson and Johnson, 70
Joint liability, 117–118
Joint practice committees, 308
Justice, 88–89, 88d
Just-in-time ordering, 244

K
Kaiser Permanente, 502, 512
Kant, Immanuel, 87
Kanter, R. M., 50, 54t
Kaplan, Robert, 169
Kassebaum–Kennedy Act (HIPAA), 126–127, 141, 510
Kavanagh, Joan M., 451
Kentucky, delegation decision tree in, 535, 536f
Kentucky River cases, 594
Klein, G., 12
Knowledge of results, 416
Knowles, M., 412–413, 414d
Kodak, 200
Kouzes, J., 51, 51d, 54t

L
Labor, division of, 294
Labor-intensive organizations, 241, 375, 448
Labor law, 595–604, 596t
Labor–management relations, 585. See also Employment law; Union(s)
Labor relations law, 596, 598–599
Labor standards, 596, 597–598
Laissez-faire leadership, 46–48, 52
Landmark decisions, 113
Language differences, 127, 449
Languages, standardized nursing, 620–621, 621d

724

Latent conflict, 556
Lateral transfer, 690
Law(s). See also Legal and legislative issues

sources of, 109–111, 111t
types of, 111–112, 112t
Law of the situation, 48
Leadership, 37–60. See also specific roles
absence of, 53
advocacy in, 136d, 152
authentic, 68–70, 69d
authoritarian, 46–48
characteristics of, 40, 47d
clinical, 39
definition of, 40
democratic, 46–48
dynamic nature of, 40, 49–50
effectiveness of, 38
emotional intelligence in, 68, 68d, 76–78
exemplary, 51, 51d
fatal flaws in, 40, 41d
followers and, 63–67
industrial age-to-relationship age transition in, 72–75, 73t
integrated model of, 73, 73f
laissez-faire, 46–48, 52
learning exercises on, 42, 46, 48, 55–59, 66, 67, 69, 70, 74–78
Level 5, 64–65, 64d
management integration with, 53, 75
management relationship with, 38–40, 38d, 41d, 53
new (21st-century) thinking about, 61–79
operational, 73–74
proactive, 50
quantum, 72
reactive, 50
responsive, 50
roles in, 41d
role vs. behavior in, 40
servant, 65, 65d, 66
situational and contingent, 48–49
strategic, 73–74
strengths-based, 63–64, 64d
thought, 70–71
transactional, 50–51, 50t, 52
transformational, 50–51, 50t, 52
Leadership styles, 46–48, 59
Leadership succession, 334
Leadership theory, 46–53, 54t
behavioral, 46–48
disillusionment with, 51
full-range, 51–53, 52d, 63
Great Man, 46
interactional, 49–50, 65–67
reflective thinking and practice, 71, 71d

725

situational and contingency, 48–49
trait, 46, 47d
transactional and transformational, 50–51, 50t
Lean Manufacturing, 634
Lean Six Sigma, 634
Leapfrog Group, 632–633, 633t
Leapfrog Safe Practices, 632, 633t
Learning exercises, 6–7. See also specific topics
Learning organization (LO), 407–432
coaching in, 425–426
cultural diversity and, 427–428
definition of, 408
leadership roles in, 409d, 428–429
learning exercises on, 413, 419, 420, 424, 426, 427, 429–431
learning theories and, 412–416, 413t, 414d
management functions in, 409d, 428–429
overcoming motivational deficiencies in, 425
Senge’s five disciplines of, 410, 410d
socialization in, 418–425
staff development in, 411–412
Learning theories, 412–416, 413t, 414d
Left-brain thinkers, 18
“Legacy” clinicians, 269
Legal and legislative issues, 108–133
breach of duty in, 114–115, 115t
delegation, 526–527, 533–537, 546
diverse workforce in, 127
employment law, 595–604
ethics vs., 99
extended liability in, 117–119
foreseeability of harm in, 115, 115t
leadership roles in, 110d
learning exercises on, 112, 116, 118, 119, 122, 130–132
legal doctrines and practice of nursing in, 113
liability reform, 634–635
management functions in, 110d, 120–127
medical records in, 123, 124
Nurse Practice Acts in, 109, 111, 112, 116, 127, 526–528, 546, 694
nursing advocacy in, 148–149
professional negligence in, 113–119
selection interview and, 388
self-determination in, 123–125
standard of care in, 114–115, 115t, 120, 127
torts in, 120
unionization, 584, 584t, 589, 594–595
Legal-rational authority, 294
Legitimate power, 322, 325, 326t
Letter writing
in advocacy, 149, 150d, 154
skills for, 506, 507, 519–520
Level 5 leadership, 64–65, 64d
Lewin, Kurt, 46, 48, 54t, 188

726

Lewin’s change theory
driving and restraining forces, 192, 192f
phases of change, 188–191, 191d

LGBT patients, 140, 141
Liability, legal, 113–119, 634–635

avoiding claims of, 116–117
elements of, 114–115, 115t
extending, 117–119
Good Samaritan laws and, 125
joint, 117–118
personal, 118
product, 121
vicarious, 118
Libel, 120
License (licensure), 127–128
certification programs vs., 128
institutional, 128
suspension or revocation of, 127, 128d
Licensed practical nurses (LPNs)
delegating to, 526–527
unionization of, 585, 594–595
Licensed vocational nurses (LVNs)
delegating to, 526–527
unionization of, 585
Licensing of health facilities, 604
Life experience, and decision making, 17, 19
Lillibridge, J., 693–694, 697, 702, 703
Line structure/organization, 296–297, 296f, 302
Linguistic diversity, 449
Lippitt, R., 46, 48
Listening skills, 504, 505
Lists, for time management, 215, 216
Lobbying, 148–149
Lockout, 583d
Locus of control, 539
Logical thinking, 16
Logic models, 24
Long-range planning, 167–170
Long-term coaching, 274, 275f, 426
Lorenz, Edward, 198–199

M
Magnet designation, 310–312, 311d, 379, 391
Maintenance (hygiene) factors, 471, 471t
Maintenance stage, for change, 193, 193t
Malpractice, 113–119

avoiding claims of, 116–117
definition of, 114
elements of, 114–115, 115t
extended liability in, 117–119
Malpractice insurance, 114
Managed care, 250–256, 251d, 369
capitation in, 251

727

definition of, 239d, 250
future of, 254–256
Medicare and Medicaid, 252
proponents and critics of, 252–253
selective contracting in, 250
types of, 251–252
utilization review in, 250
Managed care organizations (MCOs), 251–252
Management. See also specific functions
control in, 38, 44, 44f, 611–612
definition of, 40
human relations, 44–45
identifying functions in, 44
Japanese style of, 49, 634
leadership integration with, 53, 75
leadership relationship with, 38–40, 38d, 41d, 53
learning exercises on, 42, 43, 55–59
new (21st-century) thinking about, 61–79
participative, 45, 309
philosophy impact on, 172, 183
scientific, 42–43, 675
Theory X, 45, 474–475, 475t
Theory Y, 45, 474–475, 475t
Theory Z, 49–50
Management by crisis, 230
Management-by-exception
active, 52–53
passive, 53
Management by objectives (MBO), 652, 657–658, 659, 661d
Management development, 276–277, 287
Management process, 44, 44f, 293
Management style, 56
Management theory, 42–45, 45t
Managerial decision-making models, 8–9, 8d
Managerial levels, 298–299, 299t
Manager power, 326
Mandatory overtime, 452
Manifest conflict, 556
Manthey, M., 355–356
Marginal employees, 675, 691–692
Marketplaces, health insurance, 234, 257, 364
Marquis-Huston critical thinking teaching model, 5–7, 7f
Maslow, Abraham, 468–470
Massachusetts Nurses Association, 586
Matrix organizational structure, 303, 303f
Matthew effect, 652
Mayo, Elton, 45, 45t
McClelland, David, 472–473
McGregor, Douglas, 45, 45t, 46, 474–475
McGregor’s rules for discipline, 677–678, 678d
McLeod, Jane, 393
Meaningful use, of EHRs, 511–512

728

Media
nursing and, 149–152
preparing for interview, 151–152
tips for interacting with, 151d

Mediation, 570, 583d
Mediator, professional, 689
Medicaid, 239d, 249, 252
Medical errors, 631–635

definition of, 631
To Err Is Human on, 116, 331, 332, 631, 636
Leapfrog Group initiatives on, 632–633, 633t
progress on preventing, 634–635
reporting and analyzing, 632
Medical home, 234, 257, 356–357
Medical records
access to, 126–127
continuity of information in, 163–164
electronic, 164, 510–513, 629
legal issues of, 123, 124, 126
Medical savings accounts (MSAs), 252
Medicare, 239d, 248–249, 249t
accountable care organizations, 256–257
diagnosis-related groups, 249–250
managed care, 252
Medicare Advantage, 248, 249t, 252
Medicare Advantage prescription drug (MA-PD) plans, 248
Medicare Part D, 248, 249t
Medicare Quality Initiative, 628
Medicare Severity, 249
Medicare Shared Savings Program, 256–257
Medication errors, 631, 641, 643
bar coding to prevent, 632–633
five rights to prevent, 633
Medication reconciliation, 627, 628d
Memo, 506, 517, 519
Memory, 416
Men in nursing, 488, 600
Mental Health Act (Alberta, Canada), 142
Mentors, 334, 423–425
Merit rating, 648
Metrics, 169
Middle-level managers, 298–299, 299t
Millennials, 451
Mind Tools Editorial Team, 325–326
Minimal criteria, for employee, 391
Minimum staffing ratios, 437–439
Minimum wages, 597
Mini-team, in modular nursing, 354
Mission statements, 171–173, 172d
Mobbing, 562
Modeling, 414
Modular nursing, 349, 354, 548–549

729

Momentum, as career stage, 268–269
Montana, right to die in, 143–144
Moral conflict, 85
Moral decision-making model (MORAL), 95, 97d
Moral dilemma, 86
Moral distress, 85
Moral hazard, 253
Moral indifference, 85
Moral issues, 85–86
Moral outrage, 85–86
Moral perspective, internalized, 69
Moral uncertainty, 85
Motivating climate, 464–489

creating, 475–477
employee–supervisor relationship in, 476–477
empowerment in, 475–476
incentives and rewards in, 476
leadership roles in, 465–466, 467d, 481–482
learning exercises on, 468, 473, 474, 478–481, 483–488
management functions in, 465–466, 467d, 481–482
promotion in, 479–481
self-care in, 481
strategies for, 477, 478d
Motivation
definition of, 465
intrinsic vs. extrinsic, 466–468, 467t
performance appraisal and, 648–650
Motivational theory, 468–475
Herzberg on, 470–471
Maslow on, 468–470
McClelland on, 472–473
McGregor on, 474–475
Skinner on, 470
Vroom on, 472
Motivation–hygiene theory, 471, 471t
Motivation to learn, 415
Motivator factors, 471, 471t
Mouton, J. S., 48, 54t
Movement, for change, 190–191, 191d
Multiculturalism, 127
Multidisciplinary action plans (MAPs), 358
Multidisciplinary team leader role, 354
Multistate Nursing Home Case Mix and Quality Demonstration, 630

N
Nanterme, Pierre, 651
National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research, 99–100
National Committee for Quality Assurance (NCQA), 630
National Council of State Boards of Nursing, 379, 508, 509d, 525, 534, 693
National Database of Nursing Quality Indicators (NDNQI), 630
National drug code, 632–633
National Federation of Nurses (NFN), 586, 587
National Guideline Clearinghouse (NGC), 617, 618d

730

National Labor Relations Act (NLRA), 584t, 589, 593–595
National Labor Relations Board (NLRB), 583d, 584t, 586, 593–595
National League for Nursing (NLN), 141, 375
National Nurses Organizing Committee, 586
National Nurses United (NNU), 437, 438t, 586, 587, 589–590
National Patient Safety Goals, 503, 627
National Practitioner Data Bank, 119
National Union of Healthcare Workers (NUHW), 586
National Union of Hospital and Health Care Employees of the Retail, Wholesale, and Department Store

Union, 586
Naturalistic decision making, 12
Nebraska, LPN duties in, 527
Needs, hierarchy of, 468, 469f
Need to know, 30
Negative sanctions, 425
Negligence, 113–119

avoiding claims of, 116–117
definition of, 114
elements of, 114–115, 115t
extended liability in, 117–119
Negotiation, 564–569
closure and follow-up in, 565d, 569
destructive tactics in, 568–569
preparation for, 564–566, 565d
process of, 565d, 566–567, 567d
Negotiation consciousness, 565
Network groups, 149
Network HMOs, 251
Neutral operants, 470, 470d
New graduate nurses, 267–268, 269d
career planning by, 281
coaching by, 667
emotional exhaustion of, 419
socialization of, 418–420
transition-to-practice programs/residencies for, 282–283
New York
LPN duties in, 527
unionization in, 586
Nightingale, Florence, 325
NLRB v. Health Care & Retirement Corp., 594–595
Noncontrollable costs, 239d
Nonlinear change theory, 197–199
Nonmaleficence, 88, 88d, 90
Nonproductive time, 243
Nonverbal communication, 493, 497–500
No representation, as union vote, 593
Normative–reeducative strategies, for change, 193–195
Norming stage, of group, 513–514, 513t
North American Nursing Diagnosis Association taxonomy, 621
North Carolina Board of Nursing, 280
Norton, David, 169
Not-for-profit organization, 239d

731

Novice nurses, 267–268, 269d. See also New graduate nurses
Novice-to-expert transition, 267–268
Nursebots, 164
Nurse navigators, 363–364, 363d
Nurse Practice Acts, 109, 111, 112, 116, 127

and chemically impaired employee, 694
and delegation, 526–528, 546
Nurse-recruiter, 379–380
Nursing assistive personnel (NAP), 352
delegating to, 527, 533–537, 534d, 536f, 537d
Nursing care hours (NCH), 447–449
Nursing care hours (NCH) per patient-day (PPD), 242–243, 243f, 443, 443f
Nursing care plan, 358
Nursing employment bubble, 377
Nursing homes, fiscal planning in, 234–235
Nursing Interventions Classification (NIC), 621
Nursing management ethics, 83–84
Nursing Minimum Data Set (NMDS), 620–621
Nursing process, 9–10, 9f, 10t, 95
Nursing school enrollment, 378–379
Nursing sensitivity, 334, 619
Nursing service philosophy, 173, 174d
Nursing shortage, 377–379, 451–452
demand factors in, 378
supply factors in, 378–379

O
Oakwood ruling, 595
Obama, Barack, 510–511
Objectives, 12–13, 178–179

criteria for, 179
process, 179
result-focused, 179
writing, 179
Observational learning, 414
Occupational Safety and Health Act (OSHA), 604
Ombudspersons, 570
Omnibus Budget Reconciliation Act of 1987, 534
Oncology, nurse navigators in, 363, 363d
Ongoing coaching, 684
Open-ended questions, 567
Open shops, 588
Open system, 49
Operant conditioning, 470, 471
Operating budget, 244
Operating expenses, 239d
Operational leadership, 73–74
Operational planning, 208. See also Planning
Oregon, right to die in, 143
Organization(s)
career development role of, 271–272, 272t
decision making in, 20–21
effectiveness of, 314

732

flattened, 298, 304, 304f
high-reliability, 612
language and symbols of, 335
learning, 407–432
powerful in, determining, 335
priorities in, 335
visibility and voice in, 336
Organizational aging, 200
Organizational change
with nonlinear dynamics, 197–199
strategies for, 495–496
Organizational charts, 296–302
advantages of, 302d
centrality on, 299–301
limitations of, 301–302, 302d
managerial levels on, 298–299, 299t
relationships and chain of command on, 296–297
Organizational climate, 306
Organizational communication, 491. See also Communication
gender and, 494
power and, 495
technology as tool in, 506–510
variables affecting, 494–495
written, 504–506, 507
Organizational culture, 305–308, 319
assessing, 307d
definition of, 305–306
motivation in, 468
organizational climate vs., 306
for patient-and family-centered care, 366
Organizational philosophy, 173–175
Organizational power, and decision making, 20–21
Organizational standards, 617
Organizational structure, 292–320
committees in, 312–314
components of, 296–301
decision making within, 304–305
formal, 293
informal, 293–294
leadership roles in, 295d, 314–315
learning exercises on, 297, 300, 308, 312, 316–319
management functions in, 295d, 314–315
shared governance in, 308–310, 309f, 317
span of control on, 298
types of, 302–304
Weber’s bureaucracy in, 294–296
Organizational theory, 294–296
Organizing, in management process, 44, 44f, 293
Orientation, 398–400, 399d, 399t, 402, 421–422
Orlando, Ida Jean, 9
ORYX, 625–626
ORYX Plus, 625

733

Ouchi, W. G., 49
Outcome(s)

definition of, 619
staffing/scheduling and, 447–449
Outcome audit, 619
Outcomes accountability, 612
Outlier, 250
Overdelegating, 531
Overgeneralization, 16
Overjustification effect, 476
Overt conflict, 556
Overtime, 66, 452

P
PACs (political action committees), 148–149
Part A Medicare, 248, 249t
Part B Medicare, 248, 249t
Part C Medicare, 248, 249t, 252
Part D Medicare, 248, 249t, 256
Participation, motivation in, 474
Participative decision making, 45
Participative management, 45, 309
Partners in care, 349. See also Team nursing
Passive–aggressive communication, 501
Passive management-by-exception, 53
Past-oriented cultures, 539
Paternalism, 88, 88d
Pathway to Excellence, 312
Patient advocacy, 138–144
Patient Bill of Rights, 141, 256
Patient care

case management for, 349, 358–359
disease management for, 359–361
functional method of, 349, 351–352, 351f
leadership roles in, 348, 348d–349d, 366–367
learning exercises on, 351, 352, 354–355, 359, 361, 366, 368–371
management functions in, 348, 349d, 366–367
modular nursing for, 349, 354
new roles in, 362–366, 363d
optimum mode of, selecting, 361–362
organizing, 347–371
patient-and family-centered, 364–366, 365d
primary nursing for, 349, 355–358, 356f
team nursing for, 349, 352–353, 353f
total patient care nursing for, 349, 350–351, 350f
traditional modes of, 349–359, 349d
Patient-centered care, 364–366, 365d
Patient-Centered Medical Home (PCMH), 234, 257, 356–357
Patient classification system (PCS), 239d, 443–447, 444t–445t, 459–460
Patient engagement, 138–139, 138d
Patient Protection and Affordable Care Act, 89, 141, 175, 234, 238d, 249, 256–257, 331, 332, 356
Patient rights, 141–144, 142d
Patient Safety and Quality Improvement Act, 632

734

Patient Safety Event, 625
Patient Safety Goals, 503, 627
Patient safety officer, 623
Patient safety organizations, 632
Patient Self-Determination Act (PSDA), 123–125
Patient service partners, 349. See also Team nursing
Pay for performance (P4P) programs, 239d, 628–629, 628d
Pay for value programs, 239d
Payoff tables, 22–23
PCS. See Patient classification system
Pedagogy, 412–413, 413t
Peer advocacy, 156–157
Peer assistance programs, 701
Peer review, 658–660, 661d
Perceived conflict, 556
Per diem staff, 440
Performance appraisal, 646–672

accuracy and fairness in, 651–653, 653d
coaching as mechanism for, 665–666
common pitfalls in, 652
documentation of, 651–652, 664, 665f
effective, factors influencing, 649, 649d
interview for, 662–664, 669
leadership roles in, 647, 648d, 667–668
learning exercises on, 650, 653, 657, 661, 662, 667, 669–671
management functions in, 647, 648d, 667–668
manager, by employee, 666–667
Matthew effect in, 652
motivating employees in, 648–650
recency effect in, 651–652
self-appraisal, 652, 656–657, 661d
successful, management strategies for, 653d
360-degree evaluation for, 660–662, 666
tools for, 654–662, 661d
Performance budgeting, 246–247
Performance deficiency coaching, 684–685, 684d
Performance evaluation, 648, 654
Performance improvement plan (PIP), 687
Performance management, 664
Performing stage, of group, 513–514, 513t
Permanent assignments, 370–371
Perpetual budget, 240
Personal bias
in interview, 387, 401–402
in performance appraisal, 651
Personality changes, in chemically impaired employees, 695, 695d
Personality tests, 392
Personal liability, 118
Personal power base, 334–337, 337t
Personal time management, 218–222, 220d
Personal values, 176–177
Personnel budget, 241–243

735

Peter Principle, 480
Philosophy

congruence of, 173, 174f
impact on management action, 172, 183
organizational, 173–175
societal, 175–176
unit, 173–175
Philosophy statement, 173d, 175
Physical examination, preemployment, 393
Physician-assisted suicide, 143–144
Physician integration, 163
Physician Quality Reporting System (PQRS), 628
PICO format, 14
Placement, employee, 395
Plaintiff, 114
Planetree, 365
Planned change, 186–206
assessment for, 188
classic strategies in, 193–195
as collaborative process, 196–197
definition of, 187
driving and restraining forces for, 192, 192f
leader-manager as role model during, 197
leadership roles in, 187–188, 189d, 201
learning exercises on, 188, 192, 194, 196, 200, 202–205
Lewin’s phases of, 188–191, 191d
management functions in, 187–188, 189d, 201
movement for, 190–191, 191d
organizational, with nonlinear dynamics, 197–199
organizational aging and, 200
refreezing in, 191, 191d, 197–198
resistance to, 195–196, 205
stages of change model of, 193, 193t
unfreezing for, 189–190, 191d
Planning, 160–185
balanced scorecard in, 169
budget, 240
current events and, 184
day, 227–230
definition of, 161
fiscal, 233–265
goals and objectives in, 178–179
leadership roles in, 161, 162d, 182
learning exercises on, 166, 170, 172, 175, 177, 179, 183–185
management functions in, 161, 162d, 169–170, 182
in management process, 44, 44f
mission statements in, 171–173, 172d
organizational philosophy in, 173–174, 174f
overcoming barriers to, 181
policies and procedures in, 180–181
proactive, 164, 166–167
reactive, 166

736

rules in, 181
short-term, 208
societal philosophies in, 175–176
strategic, 167–170
SWOT analysis in, 168–169, 168d, 169d
time management, 208–211
visionary, 164–165
vision statements in, 171–172, 171d
Planning fallacies, 210
Planning hierarchy, 171–181, 171f
Planning lists, 215, 216
Planning style, 166
Point-of-care testing, 164
Point-of-service (POS) plans, 252
Policies, 180
Policy and procedure committees, 180
Political action committees (PACs), 148–149
Political awareness, 333
Political office, 332–333
Politics
definition of, 338
of power, 338–340
Population-based health care, 359, 360
Portfolio, professional, 280–281
POSDCORB mnemonic, of management functions, 44
Positive organizational scholarship, 63
Positive psychology movement, 63–64, 468
Positive reinforcement, 477
Positive sanctions, 425
Posner, B., 51, 51d, 54t
Posture, in communication, 500
Power, 321–346
authority gap with, 326–330, 345
building, as new nurse, 337
and communication, 495
and decision making, 20–21, 338–339, 343
definition of, 322
ego and, 340, 345
expert, 325, 326t
gender and, 323–324
leadership roles associated with, 322, 323d, 340–341
learning exercises on, 324, 328, 329, 330, 337, 340, 342–345
legitimate, 322, 325, 326t
management functions in, 322, 323d, 340–341
nursing profession

action plan for increasing, 332–334, 332d
mobilizing, 330–332, 331d
personal base of, 334–336, 337t
politics of, 338–340
shifting of, 340
subordinate (empowerment), 329–330, 336, 342, 475–476, 528
timing and, 331, 339

737

types of, 325–326, 326t
understanding, 323–326
Power–coercive strategies, for change, 195
Powerlessness, 325
Power of attorney, 123
Power-oriented people, 473
Power struggle, 344
Practice standards, 91–92, 92d, 138, 144, 311, 616–618, 617d
Preactivism, 166
Preceptors, 289, 423–425
Precontemplation, for change, 193, 193t
Preemployment testing, 392
Preferred criteria, for employee, 391
Preferred provider organizations (PPOs), 239d, 252–253
Pregnancy Discrimination Act, 600
Preparation stage, for change, 193, 193t
Preponderance of evidence, 112
Prescription drug plans, Medicare, 248
Present-oriented cultures, 539
Primary care coordinators, 356–357
Primary health-care teams (PHCTs), 357–358
Primary nursing, 349, 355–358
advantages and disadvantages of, 356
inpatient setting, 355–356
staffing needs in, 448–449
structure of, 356f
“Prime” experience, 269
Principal agent theory, 65–67
Principles for Social Networking, 508, 509d
Priorities
reprioritizing of, 215–216, 231
in time management, 208–211, 213, 214, 215d, 225
Privacy Rule, 126–127
Private FFS plans, 252
Privileged information, 90, 141–142
Proactive change, 195
Proactive decision making, 338–339
Proactive leadership, 50
Proactive planning, 164, 166–167
Problem-based learning (PBL), 5
Problem-centered coaching, 684
Problem employees, 673–707. See also Discipline; Impaired employees
Problem solving
critical elements in, 12–16
data gathering in, 13, 13d
decision making vs., 3–4
definition of, 3
ethical, 92–95
evidence-based approach for, 14–15, 14d
integrated ethical model of, 10, 10d
nursing process for, 9–10, 9f, 10t
objectives in, defining, 12–13

738

theoretical approaches to, 7–12
time necessary for, 14
traditional process of, 8, 8d, 95
vicarious learning to increase skills, 4–7
Procedures, 180–181
Process audit, 619
Process objectives, 179
Procrastination, 214
Production hours, 240d
Productive time, 243
Product liability, 121
Professional, definition of, 277
Professional advocacy, 147–152
Professional code of ethics, 89, 90–91, 92d, 138
Professional mediator, 689
Professional negligence, 113–119
avoiding claims of, 116–117
definition of, 114
elements of, 114–115, 115t
extended liability in, 117–119
Professional portfolio, 280–281
Professional practice model, 349. See also Primary nursing
Professionals, in unions, 583d
Professional specialty certification, 279–280
benefits of, 279–280, 280d
organizations offering, 279
Professional standard review organizations, 624
Professional standards, 91–92, 92d
Professional Standards Review Board, 624
Proficient nurses, 269d
Program Evaluation and Review Technique (PERT), 24, 25f
Progressive discipline, 679–681, 681t
Promise, as career stage, 267–268
Promise keeping (fidelity), 88d, 89
Promotion, as motivational tool, 479–481
Prospective audits, 619
Prospective payment system, 240d, 249–250, 624
Provider-sponsored organizations, 252
Proxemics, 498, 539
Psychological impairment, 675
Public policy, advocacy in, 148–149
Punishers, 470, 470d
Punishment, 325, 326t, 675
Purpose, of authentic leader, 69, 69d

Q
Qualitative conflict, 554
Quality assurance (QA), 621
Quality control, 610–644

audits for, 616, 618–620
CMS initiatives on, 628–630, 628d
components of, 612, 612d
definition of, 612

739

leadership roles in, 612, 613d, 636–637
Leapfrog Group initiatives on, 632–633, 633t
learning exercises on, 616, 620, 622, 624, 639–644
liability reform and, 634–635
management functions in, 612, 613d, 636–637
medical errors and, 631–635
National Database of Nursing Quality Indicators for, 630
NCQA initiatives on, 630
as process, 614–616, 615f
progress on, 634–635
report cards for, 631, 644
Six Sigma approach for, 634
staff involved in, 623
standards in, 614–618
The Joint Commission initiatives on, 625–627
Quality gap, 614
Quality health care
defining, 612–614
staffing/scheduling and, 447–449
Quality improvement (QI), 621
Quality improvement models, 621–622
Quality measurement, 612, 623–624
Quantitative conflict, 554
Quantum leadership, 72
Queen bee syndrome, 334

R
Rapid Response Teams, 623
Rational decision making, 8–9, 21
Rational–empirical strategies, for change, 193
Reactive leadership, 50
Reactive planning, 166
Readiness to learn, 415
Readmissions Reduction Program, 629
Reality shock, 419
Reasonable and prudent person, 114
Reasonable suspicion, 694
Recency effect, 651–652
Recognition-primed decision (RPD) model, 12
Recovery process, for chemically impaired employees, 700
Recruitment, 379–381. See also Staffing

advertisements for, 381
definition of, 379
nurse-recruiter in, 379–380
promotion in, 479–481
and retention, 380
Reengineering, 447–448
Reentry, as career stage, 269
Reference checks, 391–392
Referent power, 326, 326t, 331
Reflective practice, 280, 656
Reflective thinking. See Critical thinking
Reflective thinking and practice, 71, 71d

740

Refreezing, 191, 191d, 197–198
Regulations, 181
Rehabilitation Act of 1973, 596t, 603
Rehabilitation Nursing Certification Board, 279
Reimbursement, 89, 141, 163, 248–257, 254d–255d. See also specific models
Reinforcement, 415, 477
Reinforcers, 470, 470d
Relational transparency, 69
Relationship(s)

of authentic leader, 69, 69d
interpersonal, impersonality of, 295
organizational chart of, 296–297
Relationship age leadership, 72–75, 73t
Relationship-based nursing, 355. See also Primary nursing
Relationship building, 63
Relativism, ethical, 87
Reliability, in selection interview, 382–383
Report cards, 631, 644
Reprimand, 679, 680f, 681t
Reprioritizing, 215–216, 231
Research, informed consent for, 123
Residencies, 282–283, 419
Resistance to change, 195–196, 205
Res judicata, 113
Resocialization, 420–421, 430
Respondeat superior, 118
Responsibility, definition of, 301
Responsibility accounting, 237
Responsibility charting, 561
Responsive leadership, 50
Restraining forces, in change, 192, 192f
Restraints, and false imprisonment, 120
Restructuring, 447–448
Result-focused objectives, 179
Resumé
format/sample of, 283, 285f
preparation of, 283, 284d, 287
Retention, employee, 380
Retrospective audits, 618–619
Revenue, 240d
Revenue management, 163
Revoked license, 127, 128d
Reward(s), 476, 529
Reward power, 325, 326t
Ridicule, 568
Right-brain thinkers, 18
Rights, patient, 141–144, 142d
Rights-based reasoning, 86–87, 86t
Right to die movement, 143–144
Right-to-work states, 589, 589d
Robert Wood Johnson Foundation, 623
Roe v. Wade, 113

741

Role ambiguity, 412, 422
Role expectations, 423–425
Role models, 336, 423–425, 529
Role overload, 419, 422
Role strain, 421
Role stress, 421
Rotating assignments, 370–371
Rules, 181

S
Sadness, in negotiation, 568
Salary expense, 243
Sanctions, positive and negative, 425
Satisficing, 21
SBAR communication tool, 502–503, 502t
Scabs, 590
Scalar chain, 304
Scheduling, 433–461

developing policies on, 453–454, 454d
flextime in, 441
floating in, 131, 440–441, 458
leadership roles in, 434, 435d, 455
management functions in, 434, 435d, 455
mandatory overtime and, 452
nursing care hours per patient-day, 242–243, 243f, 443, 443f
options in, 439–442, 440d
patient classification system and, 443–447, 444t–445t, 459–460
patient outcomes in, 447–449
self-scheduling in, 441, 442
shift-based, 439, 441–442, 453, 454
staffing mandates and, 437–439, 438t
workload measurement tools in, 443–447
Schein, E. H., 49
Schmidt, W., 48–49, 54t
Scientific management, 42–43, 675
principles of, 42
results of, 42–43, 43f
Scope of practice, 109, 113, 116, 144, 311, 616–618, 617d
Selection, 390–395
definition of, 390
finalizing, 393
interview for, 381–390, 401–402, 404–405
making, 393
process of, 394f
Selective contracting, 250
Self-actualization, 469–470, 469d
Self-appraisal, 652, 656–657, 661d
Self-awareness, 69, 218–220
Self-care, 481
Self-determination, 87–88, 88d, 123–125
Self-discipline, 69, 69d, 677
Self-scheduling, 441, 442
Semistructured interview, 381

742

Senge, P., 408–410, 410d
Sensitivity, in decision making, 20, 25
Sentinel events, 563, 625, 626d
Servant leadership, 65, 65d, 66
Service Employees International Union (SEIU), 586
Service line organization, 304
Service rating, 648
70/30 Rule, 567
Sexual harassment, 602–603
Shared governance, 308–310, 309f, 317
Shift-based scheduling, 439, 441–442, 453, 454
Shift bidding, 441–442
Shift time inventory, 226
Short-term coaching, 274, 426
Short-term planning, 208
Sigma, 634
Silence, 498, 499
Silent generation, 450
Simon, Herbert A., 21
Simple checklist, 656
Simulation, 5

discrete event, 5
human patient, 6
Situational leadership, 48–49
Six Sigma approach, 634
Skinner, B. F., 470
Slander, 120
SMART approach, 210, 210d
“Smart cards,” 164
Smart pumps, 633
Smith, Doug, 56
Smoothing, 558
Social capital, 67, 77
Socialization, 418–425
anticipatory, 419
authority and, 326–327
definition of, 418
experienced nurse (resocialization), 420–421, 430
international nurse, 422–423
leadership roles in, 409d, 428–429
management functions in, 409d, 428–429
new manager, 421–422
new nurse, 418–420
Social learning activities, 277
Social learning theory, 414, 415f
Social media, 508–509, 509d
Social organization, 539
Societal philosophies, 175–176
Soothing, 561
Space
communication and, 498
culture and, 539

743

Spaced practice, 416
Span of control, 298
Span of memory, 416
Special Survey on Vacant Faculty Positions, 378
Specialty certification, 279–280

benefits of, 279–280, 280d
organizations offering, 279
Sperry, Roger, 18
Stability, of leaders, 64
Staff development, 411–412
assessing needs for, 416–417
cultural diversity and, 427–428
evaluation of activities, 417
learning theories and, 412–416
Staff HMOs, 251
Staffing, 374–406
agency and travel nurses in, 439–440
aging workforce and, 379
centralized, 435–437, 436t
closed-unit, 452d
decentralized, 435–437, 436t
developing policies on, 453–454, 454d
diversity in, 375, 449
downsizing and, 486–487
educational and credential requirements for, 391
ethical issues in, 404
fiscal and ethical accountability for, 452–453
flextime in, 441
floating in, 131, 440–441, 458
generational considerations in, 450–451, 450t
indoctrination in, 397–400, 397d
leadership roles in, 376d, 400, 434, 435d, 455
learning exercises on, 381, 385, 394–396, 401–405, 439, 441, 442, 447, 454, 456–460
management functions in, 376d, 400, 434, 435d, 455
in management process, 44, 44f
mandatory overtime and, 452
needs in, 433–461
nursing care hours per patient day, 242–243, 243f, 443, 443f
nursing shortage and, 377–379, 451–452
options in, 439–442, 440d
patient classification system and, 443–447, 444t–445t, 459–460
patient outcomes in, 447–449
per diem staff in, 440
in personnel budget, 241–243
placement in, 395
predicting needs for, 376–377
preemployment testing for, 392
recruitment for, 379–381
reference and background checks for, 391–392
replacement cost for RN, 380
retention in, 380
safe, minimum criteria for, 452d

744

selection for, 390–395, 394f
selection interview for, 381–390, 401–402, 404–405
self-scheduling in, 441, 442
sequential steps in, 375d
standard for, 242
unit manager’s responsibilities in, 434–435
workload measurement tools in, 443–447
Staffing mandates, 437–439, 448
Staffing mix, 240d, 241, 447–449
Staffing ratios, 437–439, 438t, 448
Staff structure/organization, 296f, 297, 302
Stages of change model (SCM), 193, 193t
Stakeholder analysis, 305
Stakeholders, 305, 306t
Standard(s), 614–618
definition of, 614
organizational, 617
Standardized clinical guidelines, 617–618
Standardized nursing languages, 620–621, 621d
Standard of care, 114–115, 115t, 120, 127
Standards of practice, 91–92, 92d, 138, 144, 311, 616–618, 617d
Stare decisis, 113
State Boards of Nurse Examiners, 127
State Boards of Nursing, 111, 112, 127–128
treatment programs for chemically impaired employees, 701–702
State health facilities licensing boards, 604
Statutes, 111, 111t
Storming stage, of group, 513–514, 513t
Strategic leadership, 73–74
Strategic planning, 167–170
balanced scorecard in, 169
as management process, 169–170
persons involved in, 170
SWOT analysis in, 168–169, 168d, 169d
Strategic thinking, 63
Strengths-based leadership, 63–64, 64d
Stretching, motivation in, 473–474
Strike, 583d, 589–590, 591
Structure audit, 619–620
Structured interview, 381, 382, 383, 384d
Students
authority–power gap and, 329
personal time management of, 218–222
SMART approach for, 210, 210d
time management and productivity apps for, 211d
Subcultures, organizational, 306
Subordinate advocacy, 144–145
Subordinate empowerment, 329–330, 336, 342, 475–476, 528
Subordinate resistance, to delegation, 537–538
Substance misuse, 693. See also Chemically impaired employees
Substantive conflict, 556
Substitution criteria, for employee, 391

745

Succession planning, 276
Suicide, physician-assisted, 143–144
Sullivan v. Edward Hospital, 113
Summative task, 443
Supervisor, union status of, 594–595
Supply, of nurses, 378–379
Supraordinate goal, 559
Suspended license, 127, 128d
Suspension from work, 679–681, 681t
SWOT analysis, 8, 168–169, 168d, 169d
System, 49
Systematic soldiering, 42

T
Taft-Hartley Amendment, 584t, 598
Tannenbaum, R., 48–49, 54t
Task learning, 415–416
Taylor, Frederick W., 42–43, 45t
Team(s)

health-care, 164
high-performance, 50
planned change by, 187
primary health-care, 357–358
rapid response, 623
selection interview by, 383
Team nursing, 349, 352–353, 353f
Team player, 335
Technology
balance with human element, 509–510
communication via, 506–510
electronic health records, 164, 510–513
Telehealth, 164
Teleological theory, 86t, 87
Telephone communication, 497
Termination, involuntary, 681, 681t, 688–689
Termination conference, 688–689
Termination stage, of group, 513
Texas Nurse-Friendly Program for Small/Rural Hospitals, 312
The Joint Commission (JC), 116, 117d, 503, 625–627, 654
Theory–practice–ethics gap, 93–95
Theory X, 45, 474–475, 475t
Theory Y, 45, 474–475, 475t
Theory Z, 49–50
Thinking styles, 18–19
Third-party consultation, 561
Third-party payment system, 240d
Thought leadership, 70–71
360-degree evaluation, 660–662, 666
Time, culture and, 539
Time and attendance changes, in chemically impaired employees, 695, 695d
Time clocks, 597
Time inventory, 221–222, 221d, 226
Time management, 207–232

746

apps for students, 211d
basic steps to, 208–218, 209f
dealing with interruptions, 216
definition of, 208
habits for mastering, 219, 220d
leadership roles in, 209d, 222
learning exercises on, 212, 214, 222, 224–231
lists for, 215, 216
management functions in, 209d, 222
personal, 218–222, 220d
planning for, 208–211
priorities in, 208–211, 213, 214, 215d, 225
reprioritizing in, 215–216, 231
self-awareness and, 218–220
work environment, 212–213
Time wasters, 216–218, 217d
Timing, in communication, 500
Title VII, 127, 600–601, 602
To Err Is Human (IOM), 116, 331, 332, 631, 636
Top-level managers, 298, 299t
Torts, 120
Total patient care, 349, 350–351, 350f
Total quality management (TQM), 621–622, 622d
TOWS analysis. See SWOT analysis
Toyota Production System (TPS), 634
Trade-offs, 566
Traditional modes of patient care, 349–359, 349d
Traditional problem-solving process, 8, 8d, 95
Training vs. education, 411
Trait rating scales, 654, 655t, 661d
Trait theories, of leadership, 46, 47d
Transactional leadership, 50–51, 50t, 52
Transfer, employee, 690–691
Transfer of learning, 416
Transformational leadership, 50–51, 50t, 52
Transforming Care at the Bedside (TCAB), 623
Transgender patients, 140, 141
Transition-to-practice programs, 282–283, 419
Travel nurses, 439–440
Treatment programs, for chemically impaired employees, 701–702
Tridimensional leadership effectiveness model, 48
True value, 176
Trust
for change, 190
in leaders, 64
Truth telling (veracity), 88d, 89, 90, 97, 105, 342–343
Tuckman, Bruce, 513–514
Turnover, 240d, 380
12-hour shifts, 439, 441, 454
24/7 Frontline Service Alliance, 586
Two-factor theory, 471, 471t

U

747

Underdelegating, 530–531
Underpromise, 328
Unfreezing, 189–190, 191d
Unintentional torts, 120
Union(s), 581–595

accommodation of, 585
ANA and, 584, 586–587
averting, 590–592, 592d
decertification of, 593
disciplining unionized employee, 685–686
history of unionization in United States, 582–585, 583d
labor relations laws and, 596, 598–599
leadership roles and, 581, 582d, 604–605
learning exercises on, 587, 590, 591
legislation leading to, 584, 584t
management functions and, 581, 582d, 604–605
manager’s role during organizing, 593–595
nurses, 583d, 585–595

reasons for joining, 587–589, 588d
reasons for not joining, 588d, 589
supervisor status and, 594–595
open vs. closed shops, 588
organizing strategies for, 592, 592d
right-to-work states vs., 589, 589d
steps in establishing, 593
strike by, 583d, 589–590, 591
terminology associated with, 583d
Union shop, 583d
United American Nurses (UAN), 586, 587
United Auto Workers, 586
United Kingdom, patient rights in, 142
United Steelworkers of America, 586
Unit philosophy, 173–175
Unity of command, 297
Universalism, ethical, 87
Unlicensed assistive personnel (UAP), 352
delegating to, 527, 533–537, 534d, 536f, 537d
Unstructured interview, 381
Upward communication, 496, 496t
U.S. Food and Drug Administration (FDA), 632–633
U.S. News & World Report hospital rankings, 311–312
User engagement, in health-care system, 138–139, 138d
Utilitarianism, 86–87, 86t, 88
Utility, 88, 88d
Utilization review, 250

V
Validity, in selection interview, 382–383
Value(s)

and advocacy, 136–137, 137d, 155–156
of authentic leader, 69, 69d
and decision making, 17, 19
definition of, 175

748

and ethics, 91
and fiscal planning, 263–264
generational differences in, 450–451
and individual philosophies, 176–177
and organizational culture, 305–308
reflecting on, 177
and societal philosophies, 175–176
true, 176
Value-based purchasing (VBP), 234, 240d, 257, 628–629
Value indicator, 176
Value vs. volume, 163, 234
Variable expenses (costs), 237, 240d
Veracity, 88d, 89, 90, 97, 105, 342–343
Verbal admonishment, 679, 681t
Verbal communication, 493, 500–503
Vermont, right to die in, 143
Veteran generation, 450, 450t
Veterans Health Administration, 364
Veterans Readjustment Assistance Act, 603
Vicarious learning, 4–7
Vicarious liability, 118
Victimization, power vs., 334, 335
Vietnam Veterans Act, 596t
Violence, workplace, 562–564
Visionary planning, 164–165
Vision statements, 171–172, 171d
Vocal expression, 500
Vroom, Victor, 471–472

W
Wagner Act, 584, 584t, 598–599
Walkout (strike), 589–590, 590, 591
Washington State, right to die in, 143
Weber, Max, 43, 45t, 294–296
Weighted scales, 656
Wellness care, 163
Whistleblowing, 145–147, 147d
White, R. K., 46, 48, 54t
Wireless local area networking (WLAN), 508
Worked time, 243
Work environment

ethical, fostering, 100
healthy, 380
time-efficient, 212–213
Workforce budget, 241–243
Workforce diversity, 127, 375, 427–428, 449
Working with Emotional Intelligence (Goleman), 68
Workload, sharing, 27
Workload measurement, 443–447
Workload units, 240d
Workplace advocacy, 144–145
Workplace violence, 562–564
Written admonishment, 679, 680f, 681t

749

Written communication, 497, 504–506, 507, 517, 519–520
Z
Zero-based budgeting, 245, 246d

750