Health care is extremely complex and continuously changing. Decision making is the essence of leadership and not a new concept for nurse managers. Managers and leaders are expected to make decisions, which are the visible outcome of their leadership and management process. Decision making is also a behavior exhibited in making a selection and implementing a course of action from alternative courses of action to address a situation or problem. Complexity and rapid change in the health care environment require nurse managers to keep pace with the changes if they are to be effective decision makers. There are many formalized decision-making models: decision tree, cost-benefit analysis, cause-and-effect charts, DECIDE, and evidence-based decision-making (EBD) model. Decision making by nurse managers is a key aspect of their leadership and involves implementing a course of action after considering alternatives.
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This chapter examines the concept of triage nurse expertise that holds a particularly important role in the domain of nursing practice. It defines the attributes for triage nurse expertise such as triage skill and triage knowledge. The antecedents to triage nurse expertise are education, training, and experience. In order for triage nurse expertise to be present, an individual nurse must have the education, training, and experience to adequately assess and prioritize patients for care. Triage education programs must provide nurses with adequate practical experience in order to develop advanced decision-making skills. Appropriate action and decision making are the consequences of triage nurse expertise. Appropriate triage is reflected in the emergency severity index (ESI) level assigned to the patient. The attributes, triage skills and triage knowledge, can also be measured using patient simulation scenarios. The chapter provides case studies demonstrating the presence and absence of the attributes.
This chapter presents a review of the foundations of effective leadership—ethical, spiritual, legal, and professional advocacy. Knowledge and behaviors related to ethical practice, spiritual awareness, legal requirements, and professional advocacy are core dimensions of an effective nurse leader. Ethical nurse leaders are responsible with regard to their practice to be aware of the organizational work environment, to establish systems to enhance nurse's knowledge of ethics within their practice, and to facilitate discussion of ethics in the day-to-day practice environment. The chapter provides case studies and reflective questions to provoke self-assessment and awareness of one's professional practice with regards to ethical dilemmas that one may have encountered or experienced in the work environment. The goal of these reflective exercises is to stimulate a greater understanding of one's role as a nurse leader and as an advocate for both patients and nurses.
In the health care fields, compassion fatigue has been defined by a number of related terms. Potter et al provide some insight into the current uses of the concept, noting that compassion fatigue is viewed as the combination of burnout and secondary traumatic stress. The emotional relationship between the caregiver professional and the client or patient requiring service results in the development of emotional tension or stress for the professional, leading to an erosion of coping capabilities over time. Compassion fatigue in which the nurse is unable to provide safe care for his or her patient results in the development of emotional detachment from the caring environment. Nurses in this situation experience overwhelming negative feelings, anger, irritability, and emotional breakdown. They can develop compassion fatigue programs using the antecedents and consequences as an educational framework.
In social sciences, accountability is defined as the implicit or explicit expectation that one may be called on to justify one’s beliefs, feeling, and actions to others. The nurse manager role has been identified as critical in the retention and organizational commitment of staff nurses and provision of high-performing, highly reliable, effective, and efficient patient care at the unit level. The nurse manager is responsible for ensuring that the appropriate systems and processes are in place to support the staff in the delivery of quality and safe patient care in accordance with regulatory standards of care. The defining attributes of nurse manager accountability are organizational commitment, openness, answerability, and resilience. The antecedents of nurse manager accountability are rules, self-awareness, motivation, and engagement. The consequences of nurse manager accountability include empowerment, teamwork, goal attainment, and job satisfaction.
This book delivers analyses of 30 core concepts that define nursing theory, research, education, and professional practice. Grounded in the concept analysis framework developed by Walker and Avant, the book clearly demonstrates how concepts are used to build theory, support research, and improve education and professional practice. Expert authors from clinical and research disciplines focus on the core of nursing-- the nurse-patient relationship--grouping concepts into the categories of patient/client-focused concepts, career-focused concepts, and organizational/systems-focused concepts. The concept analyses follow a specific method, with defining attributes, antecedents, and consequences given. It talks about the personal characteristics of patients/clients experiencing health/illness. These concepts include hardiness, hope, motivation and self-motivation. The book then explains the caregiver-focused concepts such as anxiety, caregiver burden, clinical autonomy, compassion fatigue, cultural competence, decision making, emotional intelligence, empathy and so on. It also presents analysis of concepts pertinent to nurse workaround, commitment, teamwork, transformational leadership, work engagement, and nurse manager accountability. Nurse workarounds are described as nurses devising an alternative work procedure to address a block in the workforce, even though these alternatives are deviations from policies, procedures, and work processes. The book also includes diagrams of characteristics across concepts for comparison. It helps nurse scholars to develop a sophisticated analytic ability and provide graduate nursing students with a foundation for developing a DNP capstone or PhD research project.
This book on leadership and management includes all of the basic content that registered nurse (RN) -to- bachelor of science in nursing (BSN) students need. It is organized into 5 parts comprising 17 chapters. Part I provides introductory information such as leadership attributes, leadership and management roles in professional nursing, and foundational aspects of leadership. Part II discusses leadership skills that are essential to the practice of nursing. Those skills include handling stress, setting priorities, managing time, communication, accountability, delegation, teams, problem solving, decision-making, and confliict resolution. Given the need for nurses to lead us to a preferred healthcare future, Part III focuses on leading change. The book introduces the readers to the factors that influence organizational culture, innovation, change, power, politics, and managing quality and safety. Part IV concentrates on the business aspect of healthcare by reviewing how to manage human and fiscal resources. Finally, Part V of the book helps the reader to contemplate his or her evolution as a professional by discussing how to integrate leadership and management competencies into his or her nursing practice. Although one book cannot cover all aspects of leadership and management, our goal is to provide a core framework and useful skills and strategies to successfully lead nursing and healthcare forward. Each chapter of the book contains essential information that acknowledges the prior learning experience of the practicing nurse who is now an RN-to-BSN or RN-to-master of science in nursing student. Each chapter begins with a brief overview of specific leadership and management topics. The book presents case scenarios throughout the chapters to help readers apply the information to practical situations. It provides concise and application-based examples that help promote selfgrowth as a professional.