4.1 Leadership & Management Introduction

As a nursing student preparing to graduate, you have spent countless hours on developing clinical skills, analyzing disease processes, creating care plans, and applying clinical judgment. In comparison, you have likely spent much less time on developing management and leadership skills. Yet, soon after beginning your first job as a registered nurse, you will become involved in numerous situations requiring nursing leadership and management skills. Some of these situations include the following:

• Prioritizing care for a group of assigned clients
• Collaborating with the interprofessional team regarding client care
• Participating in an interdisciplinary team conference
• Acting as a liaison when establishing community resources for a patient being discharged home
• Serving on a unit committee
• Investigating and implementing a new evidence-based best practice
• Mentoring nursing students

Delivering safe, quality client care often requires registered nurses (RN) to manage care provided by the nursing team. Making assignments, delegating tasks, and supervising nursing team members are essential managerial components of an entry-level staff RN role. Nursing team members include registered nurses (RN), licensed practical/vocational nurses (LPN/VN), assistive personnel (AP) such as certified nursing assistants (CNA), client care technicians (PCT), certified medical assistants (CMA), certified medication aides, and home health aides.^[1]

The professional nurse is expected to demonstrate leadership and management skills in many other facets of the role. Nurses manage care for high-acuity patients as they are admitted, transferred, and discharged; coordinate care from a variety of diverse health professionals; advocate for clients’ needs; and manage limited resources with shrinking budgets.^[2]

An article in the Online Journal of Issues in Nursing by the American Nurses Association (ANA) states, “With the growing complexity of healthcare practice environments and pending nurse leader retirements, the development of future nurse leaders is increasingly important…The next generation of nurses will play key roles in partnering with other healthcare professionals to lead  the improvement and design of the health system and practice environments. To meet these challenges, we need emerging leaders in nursing who are both interested in leadership and well-prepared to assume the role.”^[3] This chapter will explore leadership and management responsibilities of a registered nurse. Leadership styles are introduced and change theories are explored as a means for implementing change in the health care system.