Leadership and
Management in

Ninth Edition

Eleanor J. Sullivan

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Library of Congress Cataloging-in-Publication Data

Names: Sullivan, Eleanor J., 1938- author.
Title: Effective leadership and management in nursing / Eleanor J. Sullivan,
Description: Ninth edition. | Boston : Pearson, [2017] | Includes index.
Identifiers: LCCN 2016021687 | ISBN 9780134153117 | ISBN 0134153111
Subjects: LCSH: services—Administration. | Leadership.
Classification: LCC RT89 .S85 2017 | DDC 362.17/3068—dc23
LC record available at https://lccn.loc.gov/2016021687

1 17

ISBN-10: 0-13-415311-1
ISBN-13: 978-0-13-415311-7




About the Author

leanor J. Sullivan, PhD, RN, FAAN, is the
former dean of the University of Kansas
School of , past president of

Sigma Theta Tau International, and previous edi-
tor of the Journal of Professional . She has
served on the board of directors of the American
Association of Colleges of , testified
before the U.S. Senate, served on a National Insti-
tutes of Health council, presented papers to
international audiences, been quoted in the Chi-
cago Tribune, St. Louis Post-Dispatch, and Rolling
Stone Magazine, and named to the “Who’s Who in
Health Care” by the Kansas City Journal.
She earned nursing degrees from St. Louis Community College, St. Louis University,
and Southern Illinois University and holds a PhD from St. Louis University.

Dr. Sullivan is known for her publications in nursing, including this award-
winning textbook, Effective Leadership & Management in , and Becoming Influential:
A Guide for Nurses, from Pearson Education. In addition, Dr. Sullivan has authored
numerous professional articles, book chapters, and books, including Creating ’s
Future: Issues, Opportunities and Challenges, among others.

Today, Dr. Sullivan is also active in the mystery writing field. She served on the
national board of Sisters in Crime, chaired an award committee for the Mystery Writ-
ers of America, and is published in Mystery Scene Magazine and Ellery Queen Mystery

She has published five mystery novels. Her first three mysteries (Twice Dead,
Deadly Diversion, and Assumed Dead) feature nurse sleuth Monika Everhardt. The latter
two were bought by Harlequin, reissued in paperback, and are still available as e-books
(Deadly Diversion, Assumed Dead).

Her latest series, the Singular Village Mysteries, features 19th century midwife Ade-
laide Bechtmann and her cabinetmaker husband, Benjamin. Two books in the series
(Cover Her Body and Graven Images) are available in print, e-book, and audio formats.
The third book, Tree of Heaven, will be released in the fall of 2017. The series is set in the
Ohio village of Dr. Sullivan’s ancestors. Dr. Sullivan’s blog, found on her website,
reveals the history behind her historical fiction.

Connect with her at EleanorSullivan.com, Facebook, and LinkedIn.

This book is dedicated to my family
for their continuing love and support.

—Eleanor J. Sullivan


Thank You

ur heartfelt thanks go out to our colleagues from schools of nursing across the
country who gave generously of their time, expertise, and knowledge to help
us create this exciting new edition of our text. We have reaped the benefit of

your collective experience as nurses and teachers, and this edition is vastly enriched
due to your efforts.

Michael Bleich, PhD, RN, FAAN
President, Maxine Clark and Bob Fox Dean and Professor
Goldfarb School of
Barnes Jewish College
Chapter 2: Designing Organizations

Debra J. Ford, PhD.
Program Director, Leadership, and Research Assistant Professor
The University of Kansas Medical Center
Chapter 10: Communicating Effectively
Chapter 13: Handling Conf lict

Rachel A. Pepper, RN, DNP, NEA-BC
Senior Director of
The University of Kansas Hospital
Chapter 15: Budgeting and Managing Fiscal Resources
Chapter 17: Staffing and Scheduling

Pamela Klauer Triolo, PhD, RN, FAAN
Former Chief Officer (Corporate) and Associate Dean
University of Pittsburgh Medical Center
Chapter 19: Evaluating Staff Performance
Chapter 20: Coaching, Disciplining, and Terminating Staff

Wendy Bailes, PhD, RN
Associate Director, Undergraduate Programs
University of Louisiana at Monroe
Monroe, Louisiana

Diane Daddario, MSN, ANP-C, ACNS-BC, RN-BC, CMSRN
Adjunct Faulty, College of
Pennsylvania State University
University Park, Pennsylvania


Teresa Fisher, MSN, RN, PBT (ASCP)
Assistant Professor of
Arkansas State University
Jonesboro, Arkansas

Ruth Gladen, MS, RN
Associate Professor
RN Faculty & Director
North Dakota College of Science
Wahpeton, North Dakota

Lisa Harding, RN, MSN, CEN
Bakersfield College
Bakersfield, California

Mary Alice Hodge, PhD, CNL-C, RN
Director, Graduate Program
The University of South Carolina Upstate
Spartanburg, South Carolina

Mona P. Klose, MS, RN, CNE, CPHQ
Director of Quality Management
Assistant Professor of
University of Jamestown
Jamestown, North Dakota

Tara O’Brien, PhD, RN, CNE
Assistant Professor
The University of North Carolina
Charlotte, North Carolina

Jennifer O’Connor, RN, MS, CFCN, CNE
Northeastern State University
Tahlequah, Oklahoma

Rose M. Powell, PhD, RN
Associate Professor
Stephen F. Austin State University
Nacogdoches, Texas

Joyce A. Shanty, PhD, RN
Associate Professor
Indiana University of Pennsylvania
Indiana, Pennsylvania

Deborah Smitherman, MSN, RN, CCM
Assistant Professor of
Belhaven University
Jackson, Mississippi

Thank You v


ever have nurses been more important to healthcare organizations than they
are today. Passage of the Affordable Care Act (ACA) in 2010 reversed decades
of focus on providing quantities of care to emphasize quality of care. Prevent-

ing illness and coordinating care are the cornerstones of the ACA, and nurses are key
to its success.

In addition, leading and managing are essential skills for all nurses in this radically
changed healthcare environment. New graduates find themselves managing unlicensed
assistive personnel, and experienced nurses are managing groups of healthcare providers
from a variety of disciplines and educational levels. All need to know how to manage.

This text is designed to provide new graduates or novice managers with the infor-
mation they need to become effective managers and leaders in healthcare. In addition,
a sidebar in each chapter illustrates how nurses can lead at the bedside. More than
ever before, today’s rapidly changing healthcare environment demands highly devel-
oped management skills and superb leadership.

Features of the Ninth Edition
Effective Leadership and Management in has made a significant and lasting con-
tribution to the education of nurses and nurse managers in its eight previous editions.
Used worldwide and translated into numerous languages, this award-winning text is
now offered in an updated and revised edition to reflect today’s healthcare arena and
in response to suggestions from the text’s users. The ninth edition builds upon the
work of previous contributors to provide the most up-to-date and comprehensive
learning package for today’s busy students and professionals.

Features of the ninth edition include the following:

• Implementation of the Affordable Care Act

• Evolving models of healthcare organizational structures and relationships

• Expanded content on cultural and gender diversity

• Emphasis on quality management

• Addition of emotional leadership concepts

• Use of social media in management

• Harassing, bullying, and lack of civility in healthcare

• Emergency preparedness for terrorism, disasters, and mass shootings

• Prevention of workplace violence

Two new chapters have been added to this award-winning text. Chapter 7, Under-
standing Legal and Ethical Issues, encompasses the myriad of issues confronting nurses
and managers today. Chapter 28, Imagining the Future, helps readers contemplate the
possibilities inherent in a fast-evolving environment.

Most notably, this text is available for the first time with a suite of digital resources
to enhance your learning. This digital program includes the MyLab program


that lets you review the chapter materials, decision-making cases that allow you to
apply your learning, and the E-Text 2.0 digital text that is easy to navigate and gives
you tools for highlighting, note taking, and more.

Student-friendly Learning Tools
Designed with the adult learner in mind, the text focuses on the application of the con-
tent presented and offers specific guidelines on how to implement the skills included.
To further illustrate and emphasize key points, each chapter in this edition includes
these features:

• A chapter outline and preview

• A complete audio version of each chapter

• Key terms in pop-up boxes linked to their first appearance and defined in the
glossary at the end of the text

• Flashcards to self-test knowledge of new vocabulary

• What You Know Now summaries at the end of each chapter

• A Tool Box with a list of tools, or key behaviors, for using the skills presented in
the chapter

• Questions to Challenge You in an interactive journal format to help students relate
concepts to their experiences

• Up-to-date references

• Case Studies to demonstrate application of content, with discussion board

The text is organized into five sections that address the essential information and key
skills that nurses must learn to succeed in today’s volatile healthcare environment and
to prepare for the future.

Part 1. Understanding Management
and Organizations
Part 1 introduces the context for nursing management, with an emphasis on chang-
ing organizational structures, ways that nursing care is delivered, the concepts of
leading and managing, how to initiate and manage change, providing quality care,
and how to use power and politics—all necessary for nurses to succeed and prosper
in today’s chaotic healthcare world. A new chapter addresses how to weigh legal
and ethical issues,

Part 2. Learning Key Skills in Management
Part 2 delves into the essential skills for today’s managers, including thinking
critically, making decisions, solving problems, communicating with a variety of
individuals and groups, delegating, working in teams, resolving conflicts, and
managing time.

Preface vii

Part 3. Managing Resources
Knowing how to manage resources is vital for today’s nurses. They must be adept at
budgeting fiscal resources; recruiting and selecting staff; handling staffing and sched-
uling; motivating and developing staff; evaluating staff performance; coaching, disci-
plining, and terminating staff; managing absenteeism, reducing turnover, and
retaining staff; and handling disruptive staff behaviors, especially harassing and bul-
lying behaviors. In addition, collective bargaining, preparing for emergencies and pre-
venting workplace violence are included in Part 3.

Part 4. Taking Care of Yourself
Nurses are their own most valuable resource. Part 4 shows how to manage stress and
to advance in a career.

Part 5. Looking Toward the Future
New to this edition, this chapter provides ways to consider the future, societal predic-
tions about the future, the future of healthcare, and the future of nursing.

Instructor Resources
The assignable and gradable assessments in MyLab provide educators with
insight into students’ preparation for class, students’ understanding of the material,
and clarity around areas in which additional instruction may be needed.

Additional Instructor Resources can be accessed by registering and logging in at
www.pearsonhighered.com/nursing and include the following:

• TestGen Test Bank

• Lecture Note PowerPoints

• Instructor’s Resource Manual

viii Preface


Part 1 Understanding
Management and Organizations

1 Introducing
Management 1

2 Designing Organizations 13

3 Delivering Care 33

4 Leading, Managing, Following 43

5 Initiating and Managing Change 60

6 Managing and Improving
Quality 75

7 Understanding Legal and
Ethical Issues 94

8 Understanding Power and
Politics 110

Part 2 Learning Key Skills
in Management

9 Thinking Critically, Making
Decisions, Solving Problems 125

10 Communicating Effectively 145

11 Delegating Successfully 163

12 Building and Managing Teams 178

13 Handling Conflict 198
14 Managing Time 211

Part 3 Managing Resources

15 Budgeting and Managing
Fiscal Resources 224

16 Recruiting and Selecting Staff 241

17 Staffing and Scheduling 260

18 Motivating and Developing Staff 271

19 Evaluating Staff Performance 283

20 Feedback and Coaching,
Disciplining, and Terminating
Staff 296

21 Managing Absenteeism,
Reducing Turnover, Retaining
Staff 307

22 Dealing with Disruptive
Staff Problems 323

23 Preparing for Emergencies 332

24 Preventing Workplace Violence 340

25 Handling Collective
Bargaining Issues 349

Part 4 Taking Care of Yourself

26 Managing Stress 356

27 Advancing Your Career 366

Part 5 Looking to the Future

28 Imagining the Future 382

Brief Contents



he success of previous editions of this text has been due to the expertise of many
contributors. administrators, management professors, and faculty in
schools of nursing all made significant contributions to earlier editions. I am

enormously grateful to them for sharing their knowledge and experience to help
nurses learn leadership and management skills.

I am especially grateful to the contributors to this edition. They revised and
updated content in the following chapters: Chapter 2: Michael Bleich, Chapters 10
and 12: Debbie Ford, Chapters 15 and 17: Rachel Pepper, and Chapters 19 and 20:
Pamela Triolo. All are excellent writers, and this edition would not exist without
their contributions. In addition, Michael Bleich lent his expertise to a review of the
eighth edition, and Rachel Pepper reviewed the previous edition and added specific
examples to demonstrate content for this edition as well.

At Pearson Education, I am grateful to continue to work with Executive Editor
Pamela Fuller, who has supported this text through many editions. For this edition,
Program Manager Erin Rafferty facilitated all aspects of the text’s progress, and Devel-
opment Editor Pamela Lappies’s expertise and fine attention to detail ensure that the
text will continue to be the first choice of faculty and students worldwide.

To everyone who has contributed to this fine text over the years, I thank you.

Eleanor J. Sullivan, PhD, RN, FAAN




About the Author iii
Thank You iv
Preface vi

Part 1 Understanding
Management and

1 Introducing
Management 1

Introduction 2

Changes in Healthcare 2
Paying for Healthcare 2

Changes in Society 7
Cultural, Gender, and Generational Differences 7
Violence, Pandemics, and Disasters 8

Changes in ’s Future 8
Current Status of 8
Institute of Medicine’s Recommendations
for 9
Adapting to Constant Change 9
What You Know Now 9

Questions to Challenge You 10

References 10

2 Designing Organizations 13
Introduction 14

Reductive and Adaptive Organizational Theories 15
Reductive Theory 15
Humanistic Theory as a Bridge 17
Adaptive Theories 18

Organizational Structures and Shared Governance 19
Functional Structure 19
Service-line Structure 20
Matrix Structure 21
Parallel Structure 21
Shared Governance 22

Healthcare Settings 22
Primary Care 23
Acute Care Hospitals 23
Home Healthcare 23
Long-term Care 23

Ownership and Complex Healthcare Arrangements 24
Ownership of Healthcare Organizations 24
Healthcare Networks 24
Interorganizational Relationships 26
Diversification 26
Managed Healthcare Organizations 27
Accountable Care Organizations 27

Redesigning Healthcare 28
Organizational Environment and Culture 29
What You Know Now 30

Questions to Challenge You 30

References 31

3 Delivering Care 33
Introduction 34

Traditional Models of Care 34
Total Patient Care 35
Functional 35
Team 35
Primary 35

Integrated Models of Care 36
Practice Partnerships 36
Case Management 36
Critical Pathways 37

Evolving Models of Care 38
Patient-centered Care 38
Synergy Model of Care 39
Patient-centered Medical Home 39
What You Know Now 41

Questions to Challenge You 41

References 41

4 Leading, Managing, Following 43
Introduction 44

Leaders and Managers 44
Leadership 45

Leadership Theories 45
Traditional Leadership Theories 45
Contemporary Leadership Theories 46

Followership: An Essential Component
of Leadership 49


xii Contents

Traditional Management Functions 50
Planning 50
Organizing 51
Directing 51
Controlling 51

Nurse Managers in Practice 52
Nurse Manager Competencies 52
Staff Nurse 52
First-level Management 54
Charge Nurse 54
Clinical Nurse Leader 56
What You Know Now 57

Tools for Leading, Managing, and Following 57

Questions to Challenge You 58

References 58

5 Initiating and Managing
Change 60

Introduction 61

The Nurse as Change Agent 62

Change Theories 62

The Change Process 64
Step 1: Identify the Problem or
Opportunity 64
Step 2: Collect Necessary Data and
Information 65
Step 3: Select and Analyze Data 65
Step 4: Develop a Plan for Change, Including
Time Frame and Resource 65
Step 5: Identify Supporters and Opposers 66
Step 6: Implement Interventions to Achieve
Desired Change 66
Step 7: Evaluate Effectiveness of the Change
and, if Successful, Stabilize the Change 66

Change Strategies 67
Power–Coercive Strategies 67
Empirical–Rational Model Strategies 67
Normative–Reeducative Strategies 67

Resistance to Change 68

The Nurse’s Role 69
Initiating Change 69
Implementing Change 71
Unplanned Change 71
Handling Constant Change 72
What You Know Now 73

Tools for Initiating and Managing Change 73

Questions to Challenge You 73

References 74

6 Managing and Improving
Quality 75

Introduction 76

Quality Management 76
Total Quality Management 76
Continuous Quality Improvement 77
Components of Quality Management 77
Six Sigma 78
Lean Six Sigma 79
DMAIC Method 79

Improving the Quality of Care 80
National Initiatives 81
Evidence-based Practice 82
Electronic Health Records 82
Dashboards 82
Rounding 82
Reducing Medication Errors 83

Risk Management 83
’s Role in Risk Management 84
Incident Reports 84
Examples of Risk 85
Root-cause Analysis 87
Peer Review 87
Role of the Nurse Manager 87
Creating a Blame-free Environment 90
What You Know Now 90

Tools for Managing and Improving Quality 91

Questions to Challenge You 91

References 92

7 Understanding Legal
and Ethical Issues 94

Introduction 95

and Ethics 95

Ethical Decision Making 96
Autonomy 96
Beneficence and Nonmaleficence 97
Distributive Justice 97

The Legal System 97
Sources of 97
Types of 98
Liability 99

Legal Issues in 100
Licensure 100
Patient Care Rights 100
Management Issues 105

Employment Issues 107
What You Know Now 108

Questions to Challenge You 109

References 109

8 Understanding Power
and Politics 110

Introduction 111

Power and Leadership 111
Power: How Managers and Leaders Get
Things Done 111

Using Power 114
Image as Power 114
Using Power Appropriately 116

Shared Visioning as a Power Tool 117

Power, Politics, and Policy 118
’s Political History 118
Using Political Skills to Influence Policies 119
Influencing Public Policies 121

How Nurses Can Influence the Future 123
What You Know Now 123

Tools for Using Power and Politics 124

Questions to Challenge You 124

References 124

Part 2 Learning Key Skills
in Management

9 Thinking Critically,
Making Decisions,
Solving Problems 125

Introduction 126

Critical Thinking 126
Critical Thinking in 127
Using Critical Thinking 127
Creativity 128

Decision Making 130
Types of Decisions 130
Decision-making Conditions 131
The Decision-making Process 132
Decision-making Techniques 133
Group Decision Making 135

Problem Solving 135
Problem-solving Methods 135
The Problem-solving Process 137
Group Problem Solving 140

Stumbling Blocks 141
Personality 141
Rigidity 141
Preconceived Ideas 141

Innovation 142
What You Know Now 142

Tools for Making Decisions and Solving
Problems 143

Questions to Challenge You 143

References 143

10 Communicating Effectively 145
Introduction 146

Communication 146
Transactional Model of Communication 147
Channels of Communication 148
Nonverbal Messages 149
Directions of Communication 150
Effective Listening 150

Effects of Differences in Communication 151
Gender Differences in Communication 151
Generational and Cultural Differences
in Communication 152
Differences in Organizational Culture 152

The Role of Communication in Leadership 153
Employees 153
Administrators 154
Coworkers 156
Medical Staff 156
Other Healthcare Personnel 156
Patients and Families 157

Collaborative Communication 157

Enhancing Your Communication Skills 158
What You Know Now 160

Tools for Communicating Effectively 160

Questions to Challenge You 161

References 161

11 Delegating Successfully 163
Introduction 164

Delegation 164

Benefits of Delegation 165
Benefits to the Nurse 166
Benefits to the Delegate 166
Benefits to the Manager 166
Benefits to the Organization 166

The Five Rights of Delegation 166

Contents xiii

The Delegation Process 167
Steps in the Delegation Process 168
Key Behaviors for Successful
Delegation 170
Accepting Delegation 171

Ineffective Delegation 172
Organizational Culture 172
Lack of Resources 172
An Insecure Delegator 172
An Unwilling Delegate 174
Underdelegation 174
Reverse Delegation 175
Overdelegation 175
What You Know Now 176

Tools for Delegating Successfully 176

Questions to Challenge You 176

References 177

12 Building and Managing
Teams 178

Introduction 179

Groups and Teams 179
Group Interaction 182
Group Leadership 182

Group and Team Processes: Homans
Framework 182

Norms 184
Roles 185

Building Teams 186
Assessment 186
Team-building Activities 187

Managing Teams 187
Task 187
Group Size and Composition 188
Productivity and Cohesiveness 188
Development and Growth 190
Shared Governance 190

The Nurse Manager as Team Leader 190
Communication 190
Evaluating Team Performance 191

Leading Committees and Task Forces 192
Guidelines for Conducting Meetings 192
Managing Task Forces 193
Patient Care Conferences 195
What You Know Now 196

Tools for Building and Managing Teams 196

Questions to Challenge You 196

References 196

13 Handling Conflict 198
Introduction 199
Conflict 199

Interprofessional Conflict 199
Conflict Process Model 200

Antecedent Conditions 200
Perceived and Felt Conflict 202
Conflict Behaviors 203
Conflict Resolved or Suppressed 203
Outcomes 203

Managing Conflict 204
Conflict Responses 206
Alternative Dispute Strategies 208
What You Know Now 209

Tools for Handling Conflict 209

Questions to Challenge You 209

Resources 209

References 210

14 Managing Time 211
Introduction 211

Time-wasters 212

Setting Goals 214
Determining Priorities 215
Daily Planning and Scheduling 216
Grouping Activities and Minimizing
Routine Work 216
Personal Organization and Self-discipline 217

Controlling Interruptions 217
Phone Calls, Voice Mail, Email, and
Text Messages 218
In-person Interruptions 220
Paperwork 220

Controlling Time in Meetings 221

Respecting Time 222
What You Know Now 222

Tools for Managing Time 222

Questions to Challenge You 223

References 223

Part 3 Managing Resources

15 Budgeting and Managing
Fiscal Resources 224

Introduction 225

The Budgeting Process 225
Timetable for the Budgeting Process 227

xiv Contents

Approaches to Budgeting 227
Incremental Budget 228
Zero-based Budget 228
Fixed or Variable Budgets 229

The Operating Budget 229
The Revenue Budget 229
The Expense Budget 230

Determining the Salary and Nonsalary Budget 230
The Salary Budget 230
The Supply and Nonsalary Expense
Budget 233

The Capital Budget 234

Monitoring and Controlling Budgetary
Performance During the Year 234

Variance Analysis 235
Position Control 237

Staff Impact on Budget 237
Improving Performance 237
What You Know Now 239

Tools for Budgeting and Managing Resources 240

Questions to Challenge You 240

References 240

16 Recruiting and
Selecting Staff 241

Introduction 242

The Recruitment and Selection Process 242

Recruiting Applicants 243
Where to Look 244
How to Look 245
When to Look 245
How to Promote the Organization 245
Cross-training as a Recruitment Strategy 246

Selecting Candidates 247

Interviewing Candidates 248
Principles for Effective Interviewing 248
Involving Staff in the Interview Process 252
Interview Reliability and Validity 253

Making a Hire Decision 253
Education, Experience, and Licensure 253
Integrating the Information 254
Making an Offer 255

Legality in Hiring 255
What You Know Now 258

Tools for Recruiting and Selecting Staff 259

Questions to Challenge You 259

References 259

17 Staffing and Scheduling 260
Introduction 261

Staffing 261
Patient Classification Systems 262
Determining Care Hours 263

Planning FTE Workforce 263
Determining Staffing Mix 264
Determining Distribution of Staff 264

Scheduling 266
Self-staffing and Scheduling 266
Shared Schedule 267
Open Shift Management 267
Weekend Staffing Plan 267
Automated Scheduling 268

Supplementing Staff 268
Internal Pools 268
External Pools 269
What You Know Now 269

Tools for Handling Staffing and Scheduling 269

Questions to Challenge You 270

References 270

18 Motivating and
Developing Staff 271

Introduction 272

A Model of Job Performance 272
Employee Motivation 273
Motivational Theories 273

Staff Development 275
Orientation 276
On-the-job Instruction 276
Preceptors 277
Mentoring 278
Coaching 278
Nurse Residency Programs 279
Career Advancement 279
Leadership Development 280

Succession Planning 281
What You Know Now 281

Tools for Motivating and Developing Staff 281

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