For nurse leaders, concepts from the disciplines of policy, finance, strategic planning, and budgeting are among the essential resources for their integrative toolkit. This chapter addresses key issues related to budget principles for nurse leaders. It helps the reader to define and apply foundational cost concepts and terminology for budget planning, implementation, and control. The chapter discusses the processes and concepts for budget planning, revenue estimation, operating budgets, and capital budgets. It helps the reader to differentiate evaluation methods for capital budget proposals and to compare traditional budget variance analysis with flexible budgeting and variance analysis methods. Nurse leaders hold critical positions in healthcare organizations and enterprises, ranging from large hospitals to small clinics. While most nurse leaders are responsible for ensuring quality clinical care or direct provision of patient services, these responsibilities are inseparable from the financial systems that allow healthcare entities and their services to exist.

This chapter helps the reader to compare and contrast change theories, explain the change process and articulate strategies to facilitate change. It describes the direction of the force for the change and provides strategies to support individuals through the change process. Change is important in a healthcare system for that organization to remain viable in the competitive healthcare environment. Clinical nurse leaders (CNLs) and advanced practice registered nurses (APRNs) are uniquely qualified to lead or manage change. Change is complex, messy, and uncomfortable—but it does not have to be perceived in this manner. Graduate nurse leaders can be wildly successful by: deconstructing the change into component parts; recognizing change occurs in stages; recognizing resistance is an expected part of the change process; acknowledging that change is disruptive to the organization and the individual; and intentionally (objectively) using transformational leadership and skills.

As one of the most trusted professions, nurses need to make decisions daily that are both ethical and support the profession and population for which nurses provide care. In order to understand how to do this, nurses need to have a basic understanding of health policy, governmental regulations, and how they can affect the professional practice. This chapter helps the reader to describe what is health policy, discuss the importance of why nurse leaders need to be involved in health policy decision making and to examine why policy should be grounded in research evidence. It discusses key legislative issues currently of importance to nursing. The chapter also helps the reader to identify resources for current policy issues. As a future or current leader in healthcare, it is responsibility of clinical nurse leader and advanced practice registered nurses to be aware of the policies affecting the profession and the nursing unit.

Clinical nurse leaders (CNLs) and other advanced practice registered nurses (APRNs) are specifically tasked with implementation of quality improvement (QI) work, across all settings, to continually evaluate and refine processes to better, and more efficiently, meet the needs of patients. This chapter discusses the historical impetus for current focus on safety and QI including the affect QI and safety have had on the development of the graduate nurse leader roles (CNLs/APRNs). It also discusses the utility and function of quality and safety metrics, with an emphasis on nurse-sensitive quality indicators. The chapter then identifies processes for conducting QI work in the context of the role of CNLs/APRNs including how to initiate and utilize these processes to positively influence healthcare. With this information, CNLs/APRNs are able to initiate and utilize these processes to positively influence healthcare within the context of their setting.

This chapter describes successful interprofessional team building models and identifies the characteristics of an effective team coordinator. It also discusses the stages of team development and identifies communication tools for supporting team success. The chapter discusses examples of advanced practice registered nurse (APRN) leading teams. Master’s nursing education focuses on assisting nurse leaders to succeed in critical multifaceted systems that require flexible leadership within diverse organizational systems. The APRN is prepared with valuable knowledge and skills to lead change, promote health, and elevate care in various roles and settings. The literature suggests that to deliver quality, efficient, and safe care, it is necessary to establish high-functioning teams. Graduate nurse leaders are at the forefront of implementing change in the healthcare setting, with the education and knowledge to promote collaborative practice. Collaboration should occur within and across settings, following patients throughout the healthcare system.

A strong foundation of knowledge and advanced clinical assessment skills are essential for the clinical nurse leader (CNL) and other advanced practice registered nurse (APRN) leaders. The CNL/APRN (master’s-prepared nurse leader) conducts client assessments that are evidence based and exhibits proficiency in keen observation skills and clinical reasoning. This chapter helps the reader to define the CNL/APRN role in health assessment and describe the purpose of therapeutic relationships in developing plans of care. It also helps the reader to describe the components of a comprehensive, holistic assessment and determine clinical decision-making tools to help guide care. The master’s-prepared nurse must exhibit strong assessment skills. Assessment serves as the crucial first step of the nursing process and the foundation of determining patient-centered plans of care. These nurse leaders should be familiar with and utilize evidence-based resources to adequately advise care.

This chapter helps the reader to recognize the interplay of social, political, and historical influences on past and current financing for healthcare services. It describes evolving trends in the financing of healthcare services, including quality, safety, and value-based purchasing initiatives. It also describes the role and responsibilities of nurse leaders in all aspects of financial management for organizations. The chapter empowers current and future graduate nurse leaders with the introductory language, tools, and competencies to be active partners in determining the financial futures of the organizations and practices in which they work. The context of healthcare financing and driving forces in policy, insurance, and purchasing informs how practice, finance, and regulatory environments interface. Fluency in common cost concepts allows nurse leaders to bridge language barriers with key partners in their organizations and the community that build credibility, confidence, and trust.

Transforming nursing practice will involve creating processes for people and technology to flow together. Expert critical care nurses transform technology into what researchers have referred to as nursing technology. A nursing technology approach has been found to deliver individualized, patient-centered care. This is still an important goal today. This chapter explores how the clinical nurse leader (CNL)/ advanced practice registered nurse (APRN) uses information and technology to actively contribute to the making of a patient-centered, learning healthcare system. By connecting with clinical nurses at the point of care, nurse informaticists, data science nurses, nurse scientists, interdisciplinary partners, and innovators, the CNL/APRN advocates for individuals and populations and manages teams and information to create value in the system. The chapter covers topics such as health informatics legislation and policy; nursing informatics organizations and competencies; informatics and quality and safety; technology, informatics, and clinical practice; and technology, informatics, and innovation.

This chapter lists the essential aspects of the clinical nurse leader (CNL)/advanced practice registered nurse (APRN) role and demonstrates how integration of the role contributes to excellence of quality outcomes in various disciplines of clinical leadership. It compares competencies of the CNL/APRN with other nursing leadership disciplines. The chapter describes how the application of emotional intelligence can contribute to the success of the CNL/APRN role in the microsystem. It identifies two approaches to periodically evaluate and revise the nurse leader role. The chapter describes methods for settings in which the CNL role has been established and those where CNLs and other APRNs practice. Both settings demonstrate that the CNL/APRN is valued as a graduate nurse leader who accounts for a myriad of contributions in the healthcare system. This broad application of the CNL/APRN skill set is part of the professional growth that a master’s-prepared nurse experiences.