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NURSING LEADERSHIP AND MANAGEMENT I

Nursing Leadership and Management REVIEW MODULE EDITION 8.0

Contributors Honey C. Holman, MSN, RN

Debborah Williams, MSN, RN

Sheryl Sommer, PhD, RN, CNE

Janean Johnson, MSN, RN, CNE

Brenda S. Ball, MEd, BSN, RN

Terri Lemon, DNP, MSN, RN

Consultants Tracey Bousquet, BSN, RN

Julie Traynor, MSN, RN

INTELLECTUAL PROPERTY NOTICE ATI Nursing is a division of Assessment Technologies Institute®, LLC.

Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved.

The reproduction of this work in any electronic, mechanical or other means, now known or hereafter

invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the

content in this publication, including, for example, the cover, all of the page headers, images, illustrations,

graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual

property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by

third parties who have licensed their materials to Assessment Technologies Institute, LLC.

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II CONTENT MASTERY SERIES

IMPORTANT NOTICE TO THE READER Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for

informational and educational purposes only and may be modified or updated by the publisher at any time. This

publication is not providing medical advice and is not intended to be a substitute for professional medical advice,

diagnosis, or treatment. The publisher has designed this publication to provide accurate information regarding the

subject matter covered; however, the publisher is not responsible for errors, omissions, or for any outcomes related to

the use of the contents of this book and makes no guarantee and assumes no responsibility or liability for the use of the

products and procedures described or the correctness, sufficiency, or completeness of stated information, opinions, or

recommendations. The publisher does not recommend or endorse any specific tests, providers, products, procedures,

processes, opinions, or other information that may be mentioned in this publication. Treatments and side effects described

in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect

that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by

the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice,

and government regulations often change the accepted standard in this field. When consideration is being given to use

of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the

drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations

on dose, precautions, and contraindications and determining the appropriate usage for the product. Any references

in this book to procedures to be employed when rendering emergency care to the sick and injured are provided solely

as a general guide. Other or additional safety measures may be required under particular circumstances. This book

is not intended as a statement of the standards of care required in any particular situation, because circumstances

and a patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this book

shall in any way advise personnel concerning legal authority to perform the activities or procedures discussed. Such

specific determination should be made only with the aid of legal counsel. Some images in this book feature models.

These models do not necessarily endorse, represent, or participate in the activities represented in the images. THE

PUBLISHER MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, WITH

RESPECT TO THE CONTENT HEREIN. THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES

SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY

DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT.

Director of content review: Kristen Lawler

Director of development: Derek Prater

Project management: Tiffany Pavlik, Shannon Tierney

Coordination of content review: Honey C. Holman, Debborah Williams

Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers

Layout: Spring Lenox, Maureen Bradshaw, Bethany Phillips

Illustrations: Randi Hardy

Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson

Cover design: Jason Buck

Interior book design: Spring Lenox

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NURSING LEADERSHIP AND MANAGEMENT USER’S GUIDE III

User’s Guide Welcome to the Assessment Technologies Institute®

Nursing Leadership and Management Review Module Edition 8.0. The mission of ATI’s Content Mastery Series®

Review Modules is to provide user-friendly compendiums of nursing knowledge that will:

● Help you locate important information quickly. ● Assist in your learning efforts. ● Provide exercises for applying your nursing knowledge. ● Facilitate your entry into the nursing profession as a

newly licensed nurse.

This newest edition of the Review Modules has been redesigned to optimize your learning experience. We’ve fit more content into less space and have done so in a way that will make it even easier for you to find and understand the information you need.

ORGANIZATION Chapters in this Review Module use a nursing concepts organizing framework, beginning with an overview describing the central concept and its relevance to nursing. Subordinate themes are covered in outline form to demonstrate relationships and present the information in a clear, succinct manner. Some chapters have sections that group related concepts and contain their own overviews. These sections are included in the table of contents.

ACTIVE LEARNING SCENARIOS AND APPLICATION EXERCISES

Each chapter includes opportunities for you to test your knowledge and to practice applying that knowledge. Active Learning Scenario exercises pose a nursing scenario and then direct you to use an ATI Active Learning Template (included at the back of this book) to record the important knowledge a nurse should apply to the scenario. An example is then provided to which you can compare your completed Active Learning Template. The Application Exercises include NCLEX-style questions (multiple- choice and multiple-select items), providing you with opportunities to practice answering the kinds of questions you might expect to see on ATI assessments or the NCLEX. After the Application Exercises, an answer key is provided, along with rationales.

NCLEX® CONNECTIONS To prepare for the NCLEX, it is important to understand how the content in this Review Module is connected to the NCLEX test plan. You can find information on the detailed test plan at the National Council of State Boards of Nursing’s website, www.ncsbn.org. When reviewing content in this Review Module, regularly ask yourself,

“How does this content fit into the test plan, and what types of questions related to this content should I expect?”

To help you in this process, we’ve included NCLEX Connections at the beginning of each unit and with each question in the Application Exercises Answer Keys. The NCLEX Connections at the beginning of each unit point out areas of the detailed test plan that relate to the content within that unit. The NCLEX Connections attached to the Application Exercises Answer Keys demonstrate how each exercise fits within the detailed content outline.

These NCLEX Connections will help you understand how the detailed content outline is organized, starting with major client needs categories and subcategories and followed by related content areas and tasks. The major client needs categories are: ● Safe and Effective Care Environment

◯ Management of Care ◯ Safety and Infection Control

● Health Promotion and Maintenance ● Psychosocial Integrity ● Physiological Integrity

◯ Basic Care and Comfort ◯ Pharmacological and Parenteral Therapies ◯ Reduction of Risk Potential ◯ Physiological Adaptation

An NCLEX Connection might, for example, alert you that content within a chapter is related to:

● Management of Care ◯ Advance Directives

■ Provide clients with information about advance directives.

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IV USER’S GUIDE CONTENT MASTERY SERIES

QSEN COMPETENCIES As you use the Review Modules, you will note the integration of the Quality and Safety Education for Nurses (QSEN) competencies throughout the chapters. These competencies are integral components of the curriculum of many nursing programs in the United States and prepare you to provide safe, high-quality care as a newly licensed nurse. Icons appear to draw your attention to the six QSEN competencies.

Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others.

Patient-Centered Care: The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.

Evidence-Based Practice: The use of current knowledge from research and other credible sources, on which to base clinical judgment and client care.

Informatics: The use of information technology as a communication and information-gathering tool that supports clinical decision-making and scientifically based nursing practice.

Quality Improvement: Care related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs.

Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes.

ICONS Icons are used throughout the Review Module to draw your attention to particular areas. Keep an eye out for these icons.

This icon is used for NCLEX Connections.

This icon indicates gerontological considerations, or knowledge specific to the care of older adult clients.

This icon is used for content related to safety and is a QSEN competency. When you see this icon, take note of safety concerns or steps that nurses can take to ensure client safety and a safe environment.

This icon is a QSEN competency that indicates the importance of a holistic approach to providing care.

This icon, a QSEN competency, points out the integration of research into clinical practice.

This icon is a QSEN competency and highlights the use of information technology to support nursing practice.

This icon is used to focus on the QSEN competency of integrating planning processes to meet clients’ needs.

This icon highlights the QSEN competency of care delivery using an interprofessional approach.

This icon appears at the top-right of pages and indicates availability of an online media supplement (a graphic, animation, or video). If you have an electronic copy of the Review Module, this icon will appear alongside clickable links to media supplements. If you have a hard copy version of the Review Module, visit www.atitesting.com for details on how to access these features.

FEEDBACK ATI welcomes feedback regarding this Review Module. Please provide comments to comments@atitesting.com.

As needed updates to the Review Modules are identified, changes to the text are made for subsequent printings of the book and for subsequent releases of the electronic version. For the printed books, print runs are based on when existing stock is depleted. For the electronic versions, a number of factors influence the update schedule. As such, ATI encourages faculty and students to refer to the Review Module addendums for information on what updates have been made. These addendums, which are available in the Help/FAQs on the student site and the Resources/eBooks & Active Learning on the faculty site, are updated regularly and always include the most current information on updates to the Review Modules.

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NURSING LEADERSHIP AND MANAGEMENT TABLE OF CONTENTS V

Table of Contents

NCLEX® Connections 1

CHAPTER 1 Managing Client Care 3

Leadership and management 3

Critical thinking 4

Assigning, delegating, and supervising 7

Staff education 10

Quality improvement 11

Performance appraisal, peer review, and disciplinary action 13

Conflict resolution 14

Resource management 17

NCLEX® Connections 21

CHAPTER 2 Coordinating Client Care 23

NCLEX® Connections 33

CHAPTER 3 Professional Responsibilities 35

Client rights 35

Advocacy 35

Informed consent 36

Advance directives 37

Confidentiality and information security 38

Information technology 40

Legal practice 40

Disruptive behavior 45

Ethical practice 45

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VI TABLE OF CONTENTS CONTENT MASTERY SERIES

NCLEX® Connections 49

CHAPTER 4 Maintaining a Safe Environment 51

Culture of safety 51

QSEN competencies in nursing programs 52

Handling infectious and hazardous materials 52

Safe use of equipment 53

Specific risk areas 53

Home safety 55

Ergonomic principles 58

NCLEX® Connections 63

CHAPTER 5 Facility Protocols 65

Reporting incidents 65

Disaster planning and emergency response 65

Security plans 71

References 75

Active Learning Templates A1 Basic Concept A1

Diagnostic Procedure A3

Growth and Development A5

Medication A7

Nursing Skill A9

System Disorder A11

Therapeutic Procedure A13

Concept Analysis A15

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NURSING LEADERSHIP AND MANAGEMENT NCLEX® CONNECTIONS 1

NCLEX® Connections

When reviewing the following chapter, keep in mind the relevant topics and tasks of the NCLEX outline, in particular:

Management of Care ASSIGNMENT, DELEGATION AND SUPERVISION Evaluate delegated tasks to ensure correct completion of activity.

Evaluate effectiveness of staff members� time management skills.

CASE MANAGEMENT: Practice and advocate for cost effective care.

CONCEPTS OF MANAGEMENT Manage conflict among clients and health care staff.

Identify roles/responsibilities of health care team members.

ESTABLISHING PRIORITIES Apply knowledge of pathophysiology when establishing priorities for interventions with multiple clients.

Prioritize the delivery of client care.

PERFORMANCE IMPROVEMENT (QUALITY IMPROVEMENT): Participate in performance improvement projects and quality improvement processes.

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2 NCLEX® CONNECTIONS CONTENT MASTERY SERIES

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NURSING LEADERSHIP AND MANAGEMENT CHAPTER 1 MANAGING CLIENT CARE 3

CHAPTER 1 Managing Client Care

Managing client care requires leadership, management skills, and knowledge to effectively coordinate and carry out client care.

To effectively manage client care, a nurse must develop knowledge and skills in several areas, including leadership, management, critical thinking, clinical reasoning, clinical judgment, prioritization, time management, assigning, delegating, supervising, staff education, quality improvement, performance appraisal, peer review, disciplinary action, conflict resolution, and cost-effective care.

Leadership and management ● Management is the process of planning, organizing,

directing, and coordinating the work within an organization.

● Leadership is the ability to inspire others to achieve a desired outcome.

● Effective managers usually possess good leadership skills. However, effective leaders are not always in a management position.

● Managers have formal positions of power and authority. Leaders might have only the informal power afforded them by their peers.

● One cannot be a leader without followers.

LEADERSHIP

LEADERSHIP STYLES Most can be categorized as authoritative, democratic, or laissez-faire. The nurse might need to use any of these leadership styles depending on the situation.

Authoritative ● Makes decisions for the group. ● Motivates by coercion. ● Communication occurs down the chain of command, or

from the highest management level downward through other managers to employees.

● Work output by staff is usually high: good for crisis situations and bureaucratic settings.

● Effective for employees with little or no formal education.

Democratic ● Includes the group when decisions are made. ● Motivates by supporting staff achievements. ● Communication occurs up and down the chain

of command. ● Work output by staff is usually of good quality when

cooperation and collaboration are necessary.

Laissez-faire ● Makes very few decisions, and does little planning. ● Motivation is largely the responsibility of individual

staff members. ● Communication occurs up and down the chain of

command and between group members. ● Work output is low unless an informal leader evolves