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Library of Congress Cataloging-in-Publication Data

Names: Marquis, Bessie L., author. | Huston, Carol Jorgensen, author.
Title: Leadership roles and management functions in nursing : theory and
application / Bessie L. Marquis, Carol J. Huston.
Description: Ninth edition. | Philadelphia : Wolters Kluwer Health, [2017] |
Includes bibliographical references and index.
Identifi ers: LCCN 2016046163 | ISBN 9781496349798
Subjects: | MESH: Nursing, Supervisory | Leadership | Nurse Administrators |
Nursing—organization & administration
Classifi cation: LCC RT89 | NLM WY 105 | DDC 362.17/3068—dc23
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LWW.com

I dedicate this book to the two most important
partnerships in my life: my husband, Don Marquis,

and my colleague, Carol Huston.
Bessie L. Marquis

I dedicate this book to my husband Tom,
who has stood by my side for almost 45 years. I love you.

Carol Jorgensen Huston

REVIEWERS

Carol Amann, PhD, RN-BC, FNGNA
Nursing Instructor
Villa Maria School of Nursing
Gannon University
Erie, Pennsylvania

Andrea Archer, EdD, ARNP
Undergraduate Nursing Department
Florida International University
Miami, Florida

Cynthia Banks, PhD
Program Director, RN to BSN
Department of Nursing
Sentara College of Health Sciences
Chesapeake, Virginia

Dana Botz, MSN
Faculty, Department of Nursing
North Hennepin Community College
Brooklyn Park, Minnesota

Sharon Bradley, DNP
Clinical Assistant Professor
Director of Student Success
College of Nursing
University of Florida
Gainesville, Florida

Carolyn Brose, EdD, MSN
Associate Professor

MSN Program Director
Missouri Western State University
St. Joseph, Missouri

Beryl Broughton, MSN, CRNP, CS, CNE
Nursing Instructor, Nursing Education
Aria Health School of Nursing
Trevose, Pennsylvania

Suzette Cardin, PhD
Adjunct Associate Professor
School of Nursing
University of California, Los Angeles
Los Angeles, California

Fran Cherkis, DHSc
Associate Professor
Department of Nursing
Farmingdale State College
Farmingdale, New York

Alice Colwell, MSN
Assistant Professor
Department of Nursing
Kent State University Trumbull Campus
Warren, Ohio

Laura Crouch, EdD, MSN
Associate Clinical Professor
School of Nursing
Northern Arizona University
Flagstaff, Arizona

Karen Davis, DNP
Assistant Professor
College of Nursing
University of Arkansas for Medical Sciences
Little Rock, Arkansas

Karen Estridge, DNP, RN
Assistant Professor
Department of Nursing
Ashland University

Mansfield, Ohio

James Fell, MSN, MBA, BSN, BS
Associate Professor
Director
Department of Nursing
Baldwin Wallace University
Berea, Ohio

Rick García, PhD
Associate Professor
Faculty Fellow
Rory Meyers College of Nursing
New York University
New York, New York

Evalyn Gossett, MSN
Clinical Assistant Professor
School of Nursing
Indiana University Northwest
Gary, Indiana

Debra Grosskurth, PhD(c)
Assistant Chair
Department of Nursing
Salve Regina University
Newport, Rhode Island

Patricia Hanson, PhD
Professor
Department of Nursing
Madonna University
Livonia, Michigan

Tammy Henderson, MSN
Associate Director
Conemaugh School of Nursing
Conemaugh Memorial Medical Center
Johnstown, Pennsylvania

Barbara Hoerst, PhD, RN
Assistant Professor
Department of Nursing

La Salle University
Philadelphia, Pennsylvania

Brenda Kucirka, PhD, RN, PMHCNS-BC, CNE
Assistant Professor
Department of Nursing
Widener University
Chester, Pennsylvania

Coleen Kumar, PhD
College of Nursing
State University of New York Downstate Medical Center
Brooklyn, New York

Kathleen Lamaute, EdD
Professor
Department of Nursing
Molloy College
Rockville Centre, New York

Pamela Lapinski, MSN
Professor
Department of Nursing
Valencia College
Orlando, Florida

Jamie Lee, MSN, RN, CNL
Assistant Professor
Department of Nursing
James Madison University
Harrisonburg, Virginia

Carolyn Lewis, PhD
Assistant Professor
Department of Nursing
Angelo State University
San Angelo, Texas

Bette Mariani, PhD, RN
Assistant Professor
College of Nursing
Villanova University
Villanova, Pennsylvania

David Martin, MSN
Director
RN-BSN & Shared Curriculum Programs
School of Nursing
University of Kansas
Kansas City, Kansas

Donna McCabe, DNP, APRN-BC, GNP
Clinical Assistant Professor
Department of Nursing
Rory Meyers College of Nursing
New York University
New York, New York

Theresa Miller, PhD
Associate Professor, Nursing Education
OSF Saint Francis Medical Center College of Nursing
Peoria, Illinois

Donna Molyneaux, PhD
Associate Professor
Department of Nursing
Gwynedd Mercy University
Gwynedd Valley, Pennsylvania

LaDonna Northington, DNS
Professor, Traditional Undergraduate Nursing Program
University of Mississippi School of Nursing
Jackson, Mississippi

Sally Rappold, MSN, BSN
Assistant Teaching Professor
Department of Nursing
Montana State University
Missoula, Montana

Karen Ringl, MSN
Faculty
Department of Nursing
California State University, Fullerton
Fullerton, California

Joyce Shanty, PhD, RN

Associate Professor
Nursing and Allied Health Professions
Indiana University of Pennsylvania
Indiana, Pennsylvania

Jean Short, MSN
Assistant Professor
Division of Post-Licensure Nursing
School of Nursing
Indiana Wesleyan University
Marion, Indiana

Jennifer Sipe, MSN, CRNP
Assistant Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania

Ana Stoehr, PhD, MSN
Faculty
Department of Nursing
George Mason University
Fairfax, Virginia

Patricia Thielemann, PhD
Professor
College of Nursing
St. Petersburg College
Pinellas Park, Florida

Charlene Thomas, PhD, MSN, BSN
Associate Professor
School of Nursing and Allied Health
Aurora University
Aurora, Illinois

Nina Trocky, DNP, RN
Assistant Professor
Department of Organizational Systems and Adult Health
School of Nursing
University of Maryland
Baltimore, Maryland

Brenda Tyczkowski, DNP, RN, RHIA
Assistant Professor
Professional Program in Nursing
University of Wisconsin Green Bay
Green Bay, Wisconsin

Dannielle White, MSN
Associate Professor
School of Nursing
Austin Peay State University
Clarksville, Tennessee

Mary Williams, MS
Associate Professor
School of Nursing and Health Science
Gordon State College
Barnesville, Georgia

Connie Wilson, EdD
Professor Emeritus
School of Nursing
University of Indianapolis
Indianapolis, Indiana

Kelly Wolgast, DNP
School of Nursing
Vanderbilt University
Nashville, Tennessee

Renee Wright, EdD
Assistant Professor
Department of Nursing
York College, City University of New York
New York, New York

Judith Young, DNP
Clinical Assistant Professor, Community and Health Systems
School of Nursing
Indiana University
Indianapolis, Indiana

PREFACE

Legacy of Leadership Roles and Management Functions in Nursing
This book’s philosophy has evolved over 35 years of teaching leadership and management. We entered
academe from the acute care sector of the health-care industry, where we held nursing management
positions. In our first effort as authors, Management Decision Making for Nurses: 101 Case Studies,
published in 1987, we used an experiential approach and emphasized management functions appropriate
for first-and middle-level managers. The primary audience for this text was undergraduate nursing
students.
Our second book, Retention and Productivity Strategies for Nurse Managers, focused on leadership

skills necessary for managers to decrease attrition and increase productivity. This book was directed at
the nurse-manager rather than the student. The experience of completing research for the second book,
coupled with our clinical observations, compelled us to incorporate more leadership content in our
teaching and to write this book.
Leadership Roles and Management Functions in Nursing was also influenced by national events in

business and finance that led many to believe that a lack of leadership in management was widespread. It
became apparent that if managers are to function effectively in the rapidly changing health-care industry,
enhanced leadership and management skills are needed.
What we attempted to do, then, was to combine these two very necessary elements: leadership and

management. We do not see leadership as merely one role of management nor management as only one
role of leadership. We view the two as equally important and necessarily integrated. We have attempted
to show this interdependence by defining the leadership components and management functions inherent in
all phases of the management process. Undoubtedly, a few readers will find fault with our divisions of
management functions and leadership roles; however, we felt it was necessary first to artificially separate
the two components for the reader, and then to integrate the roles and functions. We do believe strongly
that adoption of this integrated role is critical for success in management.
The second concept that shaped this book was our commitment to developing critical thinking skills

through the use of experiential learning exercises. We propose that integrating leadership and management
can be accomplished through the use of learning exercises. The majority of academic instruction continues
to be conducted in a teacher-lecturer–student-listener format, which is one of the least effective teaching
strategies. Few individuals learn best using this style. Instead, most people learn best by methods that

utilize concrete, experiential, self-initiated, and real-world learning experiences.
In nursing, theoretical teaching is almost always accompanied by concurrent clinical practice that

allows concrete and real-world learning experience. However, the exploration of leadership and
management theory may have only limited practicum experience, so learners often have little first-hand
opportunity to observe middle-and top-level managers in nursing practice. As a result, novice managers
frequently have little chance to practice their skills before assuming their first management position, and
their decision making thus often reflects trial-and-error methodologies. For us, then, there is little question
that vicarious learning, or learning through mock experience, provides students the opportunity to make
significant leadership and management decisions in a safe environment and to learn from the decisions
they make.
Having moved away from the lecturer–listener format in our classes, we lecture for only a small

portion of class time. A Socratic approach, case study debate, and small and large group problem solving
are emphasized. Our students, once resistant to the experiential approach, are now enthusiastic
supporters. We also find this enthusiasm for experiential learning apparent in the workshops and seminars
we provide for registered nurses. Experiential learning enables management and leadership theory to be
fun and exciting, but most important, it facilitates retention of didactic material. The research we have
completed on this teaching approach supports these findings.
Although many leadership and management texts are available, our book meets the need for an

emphasis on both leadership and management and the use of an experiential approach. More than 280
learning exercises, representing various health-care settings and a wide variety of learning modes, are
included to give readers many opportunities to apply theory, resulting in internalized learning. In Chapter
1, we provide guidelines for using the experiential learning exercises. We strongly urge readers to use
them to supplement the text.

New to This Edition
The first edition of Leadership Roles and Management Functions in Nursing presented the symbiotic
elements of leadership and management, with an emphasis on problem solving and critical thinking. This
ninth edition maintains this precedent with a balanced presentation of a strong theory component along
with a variety of real-world scenarios in the experiential learning exercises.
Responding to reviewer recommendations, we have added and deleted content. In particular, we have

attempted to strengthen the leadership component of the book while maintaining a balance of management
content. We have also attempted to increase the focus on quality and safety as well as health-care finance,
and used outpatient/community settings as the location for more learning exercises.
We have also retained the strengths of earlier editions, reflecting content and application exercises

appropriate to the issues faced by nurse leader-managers as they practice in an era increasingly
characterized by limited resources and emerging technologies. The ninth edition also includes
contemporary research and theory to ensure accuracy of the didactic material.
Additional content that has been added or expanded in this edition includes the following:

26 new learning exercises, further strengthening the problem-based element of this text.
Over 200 displays, figures, and tables (17 of which are new) help readers visualize important

concepts, whereas photographs of nurses in leadership and management situations help students
relate concepts to real-world practice.
An expanded focus on evidence-driven leadership and management decision making
Time management and productivity apps
Newer care delivery models focused on ambulatory care and outpatient settings (primary care nurse
coordinator in medical homes, nurse navigators, clinical nurse leaders [CNLs], leaders in patient-
centered care)
Impact of the 2010 Patient Protection and Affordable Care Act (PPACA) on quality and health-care
finance in this country
The shifting in health-care reimbursement from volume to value
Personality testing as an employment selection tool
Electronic health records and meaningful use
Reflective practice and the assessment of continuing competency
Civility, healthy workplaces, and bullying
Interprofessional collaboration and workgroups
Working with diverse workforces and patient populations
Social media and organizational communication
New quality Initiatives put forth by the Centers for Medicare & Medicaid Services, The Joint
Commission, and other regulatory bodies
Sentinel events
Lean Six Sigma methodologies
Medication reconciliation
Self-appraisal, peer review, and 360-degree evaluation as performance appraisal tools

The Text
Unit I provides a foundation for the decision-making, problem-solving, and critical-thinking skills as
well as management and leadership skills needed to address the management–leadership problems
presented in the text.
Unit II covers ethics, legal concepts, and advocacy, which we see as core components of leadership

and management decision making.
Units III–VII are organized using the management processes of planning, organizing, staffing, directing,

and controlling.

Features of the Text
The ninth edition contains many pedagogical features designed to benefit both the student and the
instructor:

Examining the Evidence, appearing in each chapter, depicts new research findings, evidence-based
practice, and best practices in leadership and management.

Learning Exercises interspersed throughout each chapter foster readers’ critical-thinking skills and

promote interactive discussions. Additional learning exercises are also presented at the end of each
chapter for further study and discussion.
Breakout Comments are highlighted throughout each chapter, visually reinforcing key ideas.
Tables, displays, figures, and illustrations are liberally supplied throughout the text to reinforce
learning as well as to help clarify complex information.
Key Concepts summarize important information within every chapter.

The Crosswalk

A crosswalk is a table that shows elements from different databases or criteria that interface. New to the
eighth edition was a chapter crosswalk of content based on the American Association of Colleges of
Nursing (AACN) Essentials of Baccalaureate Education for Professional Nursing Practice (2008), the
AACN Essentials of Master’s Education in Nursing (2011), the American Organization of Nurse
Executives (AONE) Nurse Executive Competencies (updated September 2015), and the Quality and
Safety Education for Nurses (QSEN) Competencies (2014). For this edition, the newly revised Standards
for Professional Performance from the American Nurses Association (ANA) Nursing Scope and
Standards of Practice (2015) have been included. This edition, then, attempts to show how content in
each chapter draws from or contributes to content identified as essential for baccalaureate and graduate
education, for practice as a nurse administrator, and for safety and quality in clinical practice.
In health care today, baccalaureate education for nurses is being emphasized as of increasing

importance, and the number of RN-MSN and BSN-PhD programs is always increasing. Nurses are being
called on to remain lifelong learners and move with more fluidity than ever before. For these reasons, this
textbook includes mapping to Essentials, Competencies, and Standards not only at the baccalaureate level
but also at the master’s and executive levels, so that nurses may become familiar with the competencies
expected as they continue to grow in their careers.
Without doubt, some readers will disagree with the author’s determinations of which Essential,

Competency, or Standard has been addressed in each chapter, and certainly, an argument could be made
that most chapters address many, if not all, of the Essentials, Competencies, or Standards in some way.
The crosswalks in this book then are intended to note the primary content focus in each chapter, although
additional Essentials, Competencies, or Standards may well be a part of the learning experience.

The American Association of Colleges of Nursing Essentials of Baccalaureate
Education for Professional Nursing Practice
The AACN Essentials of Baccalaureate Education for Professional Nursing Practice (commonly called
the BSN Essentials) were released in 2008 and identified the following nine outcomes expected of
graduates of baccalaureate nursing programs (Table 1). Essential IX describes generalist nursing practice
at the completion of baccalaureate nursing education and includes practice-focused outcomes that
integrate the knowledge, skills, and attitudes delineated in Essentials I to VIII. Achievement of the
outcomes identified in the BSN Essentials will enable graduates to practice within complex health-care
systems and to assume the roles of provider of care; designer/manager/coordinator of care; and member
of a profession (AACN, 2008) (Table 1).

TABLE 1 AMERICAN ASSOCIATION OF COLLEGES OF NURSING
ESSENTIALS OF BACCALAUREATE EDUCATION FOR PROFESSIONAL
NURSING PRACTICE

Essential I: Liberal education for baccalaureate generalist nursing
practice
• A solid base in liberal education provides the cornerstone for the practice
and education of nurses.

Essential II: Basic organizational and systems leadership for quality
care and patient safety
• Knowledge and skills in leadership, quality improvement, and patient
safety are necessary to provide high-quality health care.

Essential III: Scholarship for evidence-based practice
• Professional nursing practice is grounded in the translation of current
evidence into one’s practice.

Essential IV: Information management and application of patient-care
technology
• Knowledge and skills in information management and patient-care
technology are critical in the delivery of quality patient care.

Essential V: Health-care policy, finance, and regulatory environments
• Health-care policies, including financial and regulatory, directly and
indirectly influence the nature and functioning of the health-care system
and thereby are important considerations in professional nursing practice.

Essential VI: Interprofessional communication and collaboration for
improving patient health outcomes
• Communication and collaboration among health-care professionals are
critical to delivering high quality and safe patient care.

Essential VII: Clinical prevention and population health
• Health promotion and disease prevention at the individual and population
level are necessary to improve population health and are important
components of baccalaureate generalist nursing practice.

Essential VIII: Professionalism and professional values
• Professionalism and the inherent values of altruism, autonomy, human
dignity, integrity, and social justice are fundamental to the discipline of
nursing.

Essential IX: Baccalaureate generalist nursing practice
• The baccalaureate graduate nurse is prepared to practice with patients,
including individuals, families, groups, communities, and populations
across the lifespan and across the continuum of health-care environments.

• The baccalaureate graduate understands and respects the variations of
care, the increased complexity, and the increased use of health-care

resources inherent in caring for patients.

The American Association of Colleges of Nursing Essentials of Master’s Education
in Nursing
The AACN Essentials of Master’s Education in Nursing (commonly called the MSN Essentials) were
published in March 2011 and identified the following nine outcomes expected of graduates of master’s
nursing programs, regardless of focus, major, or intended practice setting (Table 2). Achievement of these
outcomes will prepare graduate nurses to lead change to improve quality outcomes, advance a culture of
excellence through lifelong learning, build and lead collaborative interprofessional care teams, navigate
and integrate care services across the health-care system, design innovative nursing practices, and
translate evidence into practice (AACN, 2011).

TABLE 2 AMERICAN ASSOCIATION OF COLLEGES OF NURSING
ESSENTIALS OF MASTER’S EDUCATION IN NURSING

Essential I: Background for practice from sciences and humanities
• Recognizes that the master’s-prepared nurse integrates scientific findings
from nursing, biopsychosocial fields, genetics, public health, quality
improvement, and organizational sciences for the continual improvement
of nursing care across diverse settings.

Essential II: Organizational and systems leadership
• Recognizes that organizational and systems leadership are critical to the
promotion of high quality and safe patient care. Leadership skills are
needed that emphasize ethical and critical decision making, effective
working relationships, and a systems perspective.

Essential III: Quality improvement and safety
• Recognizes that a master’s-prepared nurse must be articulate in the
methods, tools, performance measures, and standards related to quality, as
well as prepared to apply quality principles within an organization.

Essential IV: Translating and integrating scholarship into practice
• Recognizes that the master’s-prepared nurse applies research outcomes
within the practice setting, resolves practice problems, works as a change
agent, and disseminates results.

Essential V: Informatics and health-care technologies
• Recognizes that the master’s-prepared nurse uses patient-care technologies
to deliver and enhance care and uses communication technologies to
integrate and coordinate care.

Essential VI: Health policy and advocacy
• Recognizes that the master’s-prepared nurse is able to intervene at the
system level through the policy development process and to employ
advocacy strategies to influence health and health care.

Essential VII: Interprofessional collaboration for improving patient and
population health outcomes
• Recognizes that the master’s-prepared nurse, as a member and leader of
interprofessional teams, communicates, collaborates, and consults with
other health professionals to manage and coordinate care.

Essential VIII: Clinical prevention and population health for improving
health
• Recognizes that the master’s-prepared nurse applies and integrates broad,
organizational, client-centered, and culturally appropriate concepts in the
planning, delivery, management, and evaluation of evidence-based clinical
prevention and population care and services to individuals, families, and
aggregates/identified populations.

Essential IX: Master’s level nursing practice
• Recognizes that nursing practice, at the master’s level, is broadly defined
as any form of nursing intervention that influences health-care outcomes for
individuals, populations, or systems. Master’s-level nursing graduates
must have an advanced level of understanding of nursing and relevant
sciences as well as the ability to integrate this knowledge into practice.
Nursing practice interventions include both direct and indirect care
components.

The American Organization of Nurse Executives Nurse Executive Competencies
In 2004 (updated in 2015), the AONE published a paper describing skills common to nurses in executive
practice regardless of their educational level or titles in different organizations. While these Nurse
Executive Competencies differ depending on the leader’s specific position in the organization, the AONE
suggested that managers at all levels must be competent in the five areas noted in Table 3 (AONE, 2015).
These competencies suggest that nursing leadership/management is as much a specialty as any other
clinical nursing specialty, and as such, it requires proficiency and competent practice specific to the
executive role.

TABLE 3 AMERICAN ORGANIZATION OF NURSE EXECUTIVES NURSE
EXECUTIVE COMPETENCIES

1. Communication and relationship building
• Communication and relationship building includes effective
communication, relationship management, influencing behaviors,
diversity, community involvement, medical/staff relationships, and
academic relationships.

2. Knowledge of the health-care environment
• Knowledge of the health-care environment includes clinical practice
knowledge, delivery models and work design, health-care economics

and policy, governance, evidence-based practice/outcome measurement
and research, patient safety, performance improvement/metrics, and risk
management.

3. Leadership
• Leadership skills include foundational thinking skills, personal journey
disciplines, systems thinking, succession planning, and change
management.

4. Professionalism
• Professionalism includes personal and professional accountability,
career planning, ethics, and advocacy.

…