Focus on how to apply knowledge, not only acquire it.
2. Integrate clinical and classroom teaching, rather than separately.
3. Emphasize clinical reasoning, not only critical thinking.
4. Emphasize formation, rather than socialization and role taking (Benner et al., 2009).
Even More Change . . . What does the future hold for health care? Change is the one constant. Quality of care will continue to be monitored and reported with accompanying demands to tie pay to performance. Technology of care, communication, and data management will become more and more com- plex as computer processing power and storage capacity expand (Clancy, 2010) and equipment becomes smaller and more mobile. Access to care and how to pay for it will continue to drive policy and funding decisions. Everyone in health care must learn to live with ambiguity and be flexible enough to adapt to the changes it brings.
Challenges Facing Nurses and Managers Every nurse must be prepared to manage. Specific training in management skills is needed in nursing school as well as in the work setting. Most important, however, is that nurses be able to transfer their newly acquired skills to the job itself. Thus, nurse managers must be experienced in management themselves and be able to assist their staff in developing adequate management skills. Management training for nurses at all levels is essential for any organization to be effi- cient and effective in today’s cost-conscious and competitive environment.
The challenge for nurse managers and administrators is how to manage in a constantly changing system. Working with teams of administrators and providers to deliver quality health care in the most cost-effective manner offers opportunity as well. Nurses’ unique skills in communication, negotiation, and collaboration position them well for the system of today and for the future.
Nurse managers today are challenged to monitor and improve quality care, manage with limited resources, help design new systems of care, supervise teams of professionals and nonprofessionals from a variety of cultures, and, finally, teach personnel how to function well in
8 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
the new system. This is no small task. It requires that nurses and their managers be committed, involved, enthusiastic, flexible, and innovative; above all else, it requires that they have good mental and physical health. Because the nurse manager of today is responsible for others’ work, the nurse manager must also be a coach, a teacher, and a facilitator. The manager works through others to meet the goals of individuals, of the unit, and of the organization. Most of all, the man- ager must be a leader who can motivate and inspire.
Nurse managers must address the interests of administrators, colleagues in other disciplines, and employees. All want the same result—quality care. Administrators, however, must focus on cost and efficiency in order for the organization to compete and survive. Colleagues want col- laborative and efficient systems of care. Employees want to be supported in their work with ad- equate staffing, supplies, equipment, and, most of all, time. Therein lies the conflict. Between all of them is the nurse manager, who must balance the needs of all. Being a nurse manager today is the most challenging opportunity in health care. This book is designed to prepare you to meet these challenges.
What You Know Now • Health care is radically changing and is expected to continue to change in the foreseeable future. • The tension between providing adequate nursing care and paying for that care will continue to dominate
health policy decisions. • Reducing medical errors is the goal of quality initiatives. • Cultural, gender, and generational diversity will continue to shape the nursing workforce. • Evidence-based practice will guide nursing decisions into the future. • Electronic health records, robotics, and virtual care are just a few of the many technologies continuing to
evolve. • Expansion in communication technologies will continue to offer opportunities and challenges to health
care organizations. • Threats of natural disasters, terrorism, and pandemics require all health care organizations to plan and
prepare for mass casualties. • The nurse manager is challenged to manage in a constantly changing environment.
Questions to Challenge You 1. Name three changes that you would suggest to reduce the cost of health care without compromising
patients’ health and safety. Talk about how you could help make these changes. 2. What mechanisms could you suggest to improve and ensure the quality of care? (Don’t just suggest
adding nursing staff!) 3. How could you help reduce medical errors? What can you suggest that a health care organization
could do? 4. Do your clinical decisions rely on evidence-based practice? If you answer no, why not? 5. What are some ways that nurses could take advantage of emerging technologies in health care and
information systems? Think big. 6. Have you participated in a disaster drill? Did you notice ways to improve the organization’s readi-
ness for mass casualties? Name at least one. 7. What steps can you take to transfer the knowledge and skills you learn in this book into your work
setting?
CHAPTER 1 • INTRODUCING NURSING MANAGEMENT 9
Pearson Nursing Student Resources Find additional review materials at www.nursing.pearsonhighered.com
Prepare for success with additional NCLEX®-style practice questions, interactive assignments and activities, Web links, animations and videos, and more!
Agency for Healthcare Research and Quality. (2011). AHRQ disaster response tools and resources. Retrieved May 25, 2011 from http://www.ahrq. gov/research/altstand
American Nurses Credential- ing Center (2011). Magnet Recognition Program. Retrieved April 27, 2011 from http://www. nursecredentialing.org/ Magnet.aspx
Benner, P., Sutphen, M., Leonard, V., and Day, L. (2009). Educating nurses: A call for radical trans- formation. San Francisco: Jossey-Bass.
Binder, L. (2010). Leapfrog: Unique and salient mea- sures of hospital quality and safety. Prescriptions for Excellence in Health Care, 8, 1–2.
Brown, D. S., Aydin, C. E., Donaldson, N., Fridman, M., & Sandhu, M. (2010). Benchmarking for small hospitals: Size didn’t mat- ter! Journal of Healthcare Quality, 32(4), 50–60.
Centers for Medicare and Medic- aid Services (CMS) (2011). National health expenditure data. Retrieved April 25, 2011 from https://www. cms.gov/NationalHealth- ExpendData/25_NHE_Fact_ Sheet.asp
Chambers, P. D. (2010). Tap the unique strengths of the mil- lennial generation. Nursing
Management, 41(3), 37–39.
Christianson, J. B., Volmar, K. M., Alexander, J., & Scanlon, D. P. (2010). A report card on provider report cards: Current status of the health care transpar- ency movement. Journal of General Internal Medicine, 25(11), 1235–1241.
Clancy, T. R. (2010). Technology and complexity: Trouble brewing? Journal of Nurs- ing Administration, 40(6), 247–249.
Dunton, N., Gonnerman, D., Montalvo, I., & Schumann, M. J. (2011). Incorporating nursing quality indicators in public reporting and value- based purchasing initiatives. American Nurse Today, 6(1), 14–18.
Encinosa, W. E., & Hellinger, F. J. (2008). The impact of medical errors on ninety- day costs and outcomes: An examination of sur- gical patients. Health Services Research, 43(6), 2067–2085.
Hader, R. (2010). The evident that isn’t . . . interpreting research. Nursing Manage- ment, 41(9), 23–26.
Health Resources and Services Administration (HRSA) (2011). The registered nurse population: Findings from the 2008 national sample survey of registered nurses. Retrieved April 26, 2011
from http://bhpr.hrsa.gov/ healthworkforce/ rnsurvey2008.html
Houser, J., & Oman, K. S. (2010). Evidence-based practice: An implementa- tion guide for healthcare organizations. Sudbury, MA: Jones & Bartlett.
Gomez, R. (2010). Automation: HER upgrade consider- ations. Nursing Manage- ment, 41(2), 35–37.
Institute of Medicine (1999). To err is human: Build- ing a safer health system. Washington, DC: National Academy Press.
Institute of Medicine (2010). The future of nursing: Leading change, advancing health. Retrieved April 26, 2011 from http://www. thefutureofnursing.org/ IOM-Report
Kaplan, A. M., & Haenlein, M. (2010). Users of the world, unite! The challenges and opportunities of social media. Business Horizons, 53(1), 59–68.
Keepnews, D. M., Brewer, C. S., Kovner, C. T., & Shin, J. H. (2010). Genera- tional differences among newly licensed registered nurses. Nursing Outlook, 58(3), 155–163.
Lake, E. T., Shang, J., Klaus, S., & Dunton, N. E. (2010). Patient falls: Association with hospi- tal magnet status and nursing unit staffing. Research in
References
10 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
Nursing & Health, 33(5), 413–425.
Markoff, J. (2010, September 4). The boss is robotic, and rolling up behind you. New York Times. Retrieved April 28, 2011 from http://www.nytimes. com/2010/09/05/ science/05robots.html
Milstein, A. (2009). Encing extra payment for “never events”—Stronger incen- tives for patients’ safety. New England Journal of Medicine, 360(23), 2388–2390.
Nolte, E. (2011). International benchmarking of healthcare quality: A review of the literature. The Rand Corpo- ration. Retrieved April 26, 2011 from http://www.rand. org/pubs/technical_reports/ TR738.html
Raso, R. (2010). Social media for nurse managers: What does it all mean? Nursing Management, 41(8), 23–25.
Shreve, J., Van Den Bos, J., Gray, T., Halford, M., Rustagi, K., & Ziemkiewicz, E. (2010). The economic measurement of medical errors. Society of Actuaries. Retrieved April 28, 2011 from http:// www.soa.org/files/ pdf/research- econ-measurement.pdf
Sullivan, E. J. (2013). Becom- ing influential: A guide for nurses (2nd ed.). Upper Saddle River, NJ: Prentice Hall Health.
Trossman, S. (2009a). Issues up close: No peeking allowed. American Nurse Today, 4(2), 31–32.
Trossman, S. (2010b). Sharing too much? Nurses nation- wide need more informa- tion on social networking pitfalls. American Nurse Today, 5(11), 38–39.
Trossman, S. (2010c, November/ December). Not “part of the job”: Nurses seek an end
to workplace violence. The American Nurse, p. 1, 6.
U.S. Census Bureau (2011, March 24). 2010 Census shows America’s diversity. Retrieved April 29, 2011 from http://2010.census. gov/news/releases/ operations/cb11-cn125.html
U.S. Department of Labor. (2011). Occupational out- look handbook, 2010–11 edition. Retrieved April 26, 2011 from http://stats. bls.gov/oco/ocos083. htm#outlook
Wachter, R. M., Foster, N. E., & Dudley, R. A. (2008). Medi- care’s decision to withhold payment for hospital errors: The devil is in the details. Joint Commission Journal on Quality and Patient Safety, 34(2), 116–123.
Zapatochny-Rufo, R. J. (2010). Good-better-best: The virtual ICU and beyond. Nursing Management, 41(2), 38–41.
Traditional Organizational Theories
CLASSICAL THEORY
HUMANISTIC THEORY
SYSTEMS THEORY
CONTINGENCY THEORY
CHAOS THEORY
COMPLEXITY THEORY
Traditional Organizational Structures
FUNCTIONAL STRUCTURE
HYBRID STRUCTURE
MATRIX STRUCTURE
PARALLEL STRUCTURE
Service-Line Structures
Shared Governance
Ownership of Health Care Organizations
Health Care Settings PRIMARY CARE
ACUTE CARE HOSPITALS
HOME HEALTH CARE
LONG-TERM CARE
Complex Health Care Arrangements HEALTH CARE NETWORKS
INTERORGANIZATIONAL RELATIONSHIPS
DIVERSIFICATION
MANAGED HEALTH CARE ORGANIZATIONS
ACCOUNTABLE CARE ORGANIZATIONS
Redesigning Health Care
Strategic Planning
Organizational Environment and Culture