Essentials of Nursing Leadership & Management

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 Sally A. Weiss, EdD, APRN, FNP-C,
CNE, ANEF
Professor, Lead Faculty Graduate Program
Herzing University
Menominee Falls, Wisconsin

Ruth M. Tappen, EdD, RN, FAAN

Christine E. Lynn Eminent Scholar and Professor
Florida Atlantic University College of Nursing
Boca Raton, Florida

Karen A. Grimley, PhD, MBA, RN,

NEA-BC, FACHE
Chief Nursing Executive, UCLA Health
Vice Dean, UCLA School of Nursing
Los Angeles, California
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Library of Congress Cataloging-in-Publication Data

Names: Weiss, Sally A., 1950- author. | Tappen, Ruth M., author. | Grimley, Karen A., author.
Title: Essentials of nursing leadership & management / Sally A. Weiss, Ruth M. Tappen, Karen A.
Grimley.
Description: Seventh edition. | Philadelphia : F. A. Davis Company, [2019] | Includes bibliographical
references and index.
Identifiers: LCCN 2019000397 (print) | LCCN 2019001079 (ebook) | ISBN 9780803699045 | ISBN
9780803669536 (pbk. : alk. paper)
Subjects: | MESH: Leadership | Nursing, Supervisory | Nursing Services—organization & administra-
tion | United States
Classification: LCC RT89 (ebook) | LCC RT89 (print) | NLM WY 105 | DDC 362.17/3068—dc23
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 Dedication

To my granddaughter, Sydni, and my grandsons, Logan and

Ian. Their curiosity and hunger for learning remind me how
nurturing our novice nurses helps them in their quest to seek
new knowledge and continue their professional growth.
—SALLY A. WEISS

To students, colleagues, family, and friends, who have taught

me so much about leadership.
—RUTH M. TAPPEN

To my kids, Kristina, Kathleen, Meagan, and Ian, for their

love and understanding during this lifelong pursuit of learning.
To my dad for teaching me that the only limits we face are the
ones we create and to my mom for instilling the value of a good
education.
—KAREN A. GRIMLEY

v
 Preface
We are pleased to bring our readers this seventh edition of Essentials of Nursing Leadership &
Management. This new edition has been updated to reflect the dynamic health-care environment,
new safety and quality initiatives, and changes in the nursing practice environment. As in our previ-
ous editions, the content, examples, and diagrams were designed with the goal of assisting the new
graduate to make the transition to professional nursing practice.
Our readers may have noticed that we have added a new author to our team: Dr. Karen A.
Grimley, Chief Nurse Executive at UCLA Health Center and Vice Dean of the School of Nursing
at UCLA. We are delighted to have her join us, bringing a fresh perspective to this new edition.
The seventh edition of Essentials of Nursing Leadership & Management focuses on essential lead-
ership and management skills and the knowledge needed by the staff nurse as a key member of the
interprofessional health-care team and manager of patient care. Issues related to setting priorities,
delegation, quality improvement, legal parameters of nursing practice, and ethical issues were also
updated for this edition.
This edition discusses current quality and safety issues and the high demands placed on nurses in
the current health-care environment. In addition, we continue to bring you comprehensive, practical
information on developing a nursing career and addressing the many workplace issues that may arise
in practice.
This new edition of Essentials of Nursing Leadership & Management will provide a strong foun-
dation for the beginning nurse leader. We want to thank all of the people at F. A. Davis for their
continued support and assistance in bringing this edition to fruition. We also want to thank our
contributors, reviewers, colleagues, and students for their enthusiastic support. Thank you all.
—SALLY A. WEISS
RUTH M. TAPPEN
KAREN A. GRIMLEY

vii
 Reviewers
JENNA L. BOOTHE, DNP, APRN, FNP-C CANDACE JONES, BSN, MSN, RN
Assistant Professor Professor of Nursing
Hazard Community and Technical College Greenville Technical College
Hazard, Kentucky Greenville, South Carolina

LYNETTE DEBELLIS, MS, RN SUSAN MUDD, MSN, RN, CNE

Chairperson and Assistant Professor of Nursing Coordinator, Associate Degree Nursing Program
Westchester Community College Elizabethtown Community & Technical
Valhalla, New York College
Elizabethtown, Kentucky
SONYA C. FRANKLIN, RN, EdD/CI, MHA,
MSN, BSN, AS, ADN DONNA WADE, RN, MSN
Associate Professor of Nursing Professor of Nursing
Cleveland State Community College Mott Community College
Cleveland, Tennessee Flint, Michigan

ix
 Table of Contents

unit 1 Professionalism 1

chapter 1 Characteristics of a Profession 3

chapter 2 Professional Ethics and Values 13

chapter 3 Nursing Practice and the Law 35

unit 2 Leading and Managing 55

chapter 4 Leadership and Followership 57

chapter 5 The Nurse as Manager of Care 71
chapter 6 Delegation and Prioritization of Client Care Staffing 81

chapter 7 Communicating With Others and Working

With the Interprofessional Team 99
chapter 8 Resolving Problems and Conflicts 117

unit 3 Health-Care Organizations 131

chapter 9 Organizations, Power, and Professional

Empowerment 133
chapter 10 Organizations, People, and Change 149
chapter 11 Quality and Safety 163
chapter 12 Maintaining a Safe Work Environment 181
chapter 13 Promoting a Healthy Work Environment 197

unit 4 Your Nursing Career 213

chapter 14 Launching Your Career 215

chapter 15 Advancing Your Career 235

xi
xii Table of Contents

unit 5 Looking to the Future 249

chapter 16 What the Future Holds 251

Bibliography 263

Appendices
appendix 1 Standards Published by the American Nurses Association 285

appendix 2 Guidelines for the Registered Nurse in Giving, Accepting,

or Rejecting a Work Assignment 287

appendix 3 National Council of State Boards of Nursing Guidelines

for Using Social Media Appropriately 293

®
appendix 4 Answers to NCLEX Review Questions 295

Index 321
 unit 1
Professionalism
chapter 1 Characteristics of a Profession

chapter 2 Professional Ethics and Values

chapter 3 Nursing Practice and the Law

 chapter 1
Characteristics of a Profession
OBJECTIVES OUTLINE
After reading this chapter, the student should be able to: Introduction
■ Explain the qualities associated with a profession
Professionalism
■ Differentiate between a job, a vocation, and a profession
Definition of a Profession
■ Discuss professional behaviors
Professional Behaviors
■ Determine the characteristics associated with nursing as a

profession Evolution of Nursing as a Profession

■ Explain licensure and certification Nursing Defined
■ Summarize the relationship between social change and the The National Council Licensure Examination
advancement of nursing as a profession Licensure
■ Discuss some of the issues faced by the nursing profession
Licensure by Endorsement
■ Explain current changes impacting nursing ’s future
Qualifications for Licensure
Licensure by Examination
NCLEX-RN®
Political Influences and the Advance of Nursing
Professionals
Nursing and Health-Care Reform
Nursing Today
The Future of Professional Nursing
Conclusion

3
4 unit 1 ■ Professionalism

Introduction Professionalism
It is often said that you do not know where you Definition of a Profession
are going until you know where you have been. A vocation or calling defines “meaningful work”
More than 40 years ago, Beletz (1974) wrote depending on an individual’s point of view (Dik
that most people thought of nurses in gender- & Duffy, 2009). Nursing started as a vocation or
linked, task-oriented terms: “a female who per- “calling.” Until Nightingale, most nursing occurred
forms unpleasant technical jobs and functions as through religious orders. To care for the ill and
an assistant to the physician” (p. 432). Interest- infirmed was a duty (Kalisch & Kalisch, 2004). In
ingly, physicians in the 1800s viewed nursing as early years, despite the education required, nursing
a complement to medicine. According to War- was considered a job or vocation (Cardillo, 2013).
rington (1839), “. . . the prescriptions of the best Providing a definition for a “profession” or “pro-
physician are useless unless they be timely and fessional” is not as easy as it appears. The term is
properly administered and attended to by the used all the time; however, what characteristics
nurse” (p. iv). define a professional? According to Saks (2012),
In its earliest years, most nursing care occurred several theoretical approaches have been applied
at home. Even in 1791 when the first hospital to creating a definition of a profession, the older
opened in Philadelphia, nurses continued to care of these looking only at knowledge and expertise,
for patients in their own home settings. It took whereas later ones include a code of ethics, prac-
almost another century before nursing moved into tice standards, licensure, and certification, as well
hospitals. These institutions, mostly dominated by as expected behaviors (Post, 2014).
male physicians, promoted the idea that nurses Nurses engage in specialized education
acted as the “handmaidens” to the better-educated, and training confirmed by successfully passing
more capable men in the medical field. the National Council Licensure Examination
The level of care differed greatly in these early (NCLEX®) and receiving a license to practice
health-care institutions. Those operated by the in each state. Nurses follow a code of ethics and
religious nursing orders gave high-quality care to recognized practice standards and a body of con-
patients. In others, care varied greatly from good to tinuous research that forms and directs our practice.
almost none at all. Although the image of nurses Nurses function autonomously within the desig-
and nursing has advanced considerably since then, nated scope of practice, formulating and delivering
some still think of nurses as helpers who carry out a plan of care for clients, applying judgments, and
the physician’s orders. utilizing critical thinking skills in decision making
It comes as no surprise that nursing and health (Cardillo, 2013).
care have converged and reached a crossing point.
Nurses face a new age for human experience; the
very foundations of health practices and thera- Professional Behaviors
peutic interventions continue to be dramatically According to Post (2014), professional characteris-
altered by significantly transformed scientific, tics or behaviors include:
technological, cultural, political, and social realities
■ Consideration
(Porter-O’Grady, 2003). The global environment
■ Empathy
needs nurses more than ever to meet the health-
■ Respect
care needs of all.
■ Ethical and moral values
Nursing sees itself as a profession rather than a
■ Accountability
job or vocation and continues with this quest for its
■ Commitment to lifelong learning
place among the health-care disciplines. However,
■ Honesty
what defines a profession? What behaviors are
expected from the members of the profession? Professionalism denotes a commitment to carry
Chapter 1 discusses nursing as a profession with out specialized responsibilities and observe ethical
its own identity and place within this new and principles while remaining responsive to diverse
ever-changing health-care system. recipients (Al-Rubaish, 2010). Communicating
 chapter 1 ■ Characteristics of a Profession 5

effectively and courteously within the work envi- Evolution of Nursing

ronment is expected professional behavior. State as a Profession
boards of nursing through the nurse practice acts
elaborate expected behaviors in a registered nurse’s Nursing Defined
professional practice and personal life (National The changes that have occurred in nursing are
Council of State Boards of Nursing [NCSBN], reflected in the definitions of nursing that have
2012, 2016). Nurses may lose their licenses for a developed through time. In 1859, Florence Night-
variety of actions deemed unprofessional or illegal. ingale defined the goal of nursing as putting the
For example, inappropriate use of social media, client “in the best possible condition for nature to
posting emotionally charged statements in blogs or act upon him” (Nightingale, 1992/1859, p. 79). In
forums, driving without a license, and committing 1966, Virginia Henderson focused her definition
felonies outside of professional practice may be on the uniqueness of nursing:
cause for suspending or revoking a nursing license.
Commitment to others remains central to a The unique function of the nurse is to assist the
profession. In nursing, this entails commitment individual, sick or well, in the performance of those
to colleagues, lifelong learning, and accountability activities contributing to health or its recovery (or
for one’s actions. Professionalism in the workplace to peaceful death) that he would perform unaided
means coming to work when scheduled and on if he had the necessary strength, will or knowledge.
time. Coming to work late shows disrespect to your And to do this in such a way as to help him gain
peers and colleagues. It also indicates to your super- independence as rapidly as possible. (Henderson,
visor that this position is not important to you. 1966, p. 21)
Always portray a positive attitude. Although
everyone experiences a bad day, projecting personal Martha Rogers defined nursing practice as “the
feelings and issues onto others affects the work process by which this body of knowledge, nursing
environment. Many agencies and institutions have science, is used for the purpose of assisting human
dress codes. Dress appropriately per the employ- beings to achieve maximum health within the
er’s expectations. Wearing heavy makeup, colognes, potential of each person” (Rogers, 1988, p. 100).
or inappropriate hairstyles demonstrates a lack of Rogers emphasized that nursing is concerned with
professionalism. Finally, always speak profession- all people, only some of whom are ill.
ally to everyone in the work environment. A good In the modern nursing era, nurses are viewed
rule to follow should be, “If you wouldn’t say it as collaborative members of the health-care team.
in front of your grandmother, do not say it in the Nursing has emerged as a strong field of its own
workplace” (McKay, 2017). in which nurses have a wide range of obligations,
Work politics often create an unfavorable envi- responsibilities, and accountability. Recent polls
ronment. Stay away from gossip or engaging in show that nurses are considered the most trusted
negative comments about others in the workplace. group of professionals because of their knowl-
Change the topic or indicate a lack of interest in edge, expertise, and ability to care for diverse
this type of verbal exchange. Negativity is conta- populations.
gious and affects workplace morale. Professionals Nightingale’s concepts of nursing care became
maintain a positive attitude in the work environ- the basis of modern theory development, and in
ment. If the environment affects this attitude, it is today ’s language, she used evidence-based prac-
time to look for another position (McKay, 2017). tice to promote nursing. Her 1859 book Notes on
Lastly, professional behavior entails honesty Nursing: What It Is and What It Is Not laid the foun-
and accountability. If a day off is needed, take a dation for modern nursing education and practice.
personal or vacation day; save sick days for illness. Many nursing theorists have used Nightingale’s
Own up to errors. In nursing, an error may result thoughts as a basis for constructing their view of
in injury or death. The health-care environment nursing.
should promote a culture of safety, not one of pun- Nightingale believed that schools of nursing
ishment for errors. This is discussed more in later must be independent institutions and that women
chapters. who were selected to attend the schools should be
6 unit 1 ■ Professionalism

from the higher levels of society. Many of Night- license in one state is recognized in another. States
ingale’s beliefs about nursing education are still belonging to the compact passed legislation adopt-
applicable, particularly those involved with the ing the terms of the agreement. The state in which
progress of students, the use of diaries kept by the nurse resides is considered the home state, and
students, and the need for integrating theory into license renewal occurs in the home state (NCSBN,
clinical practice (Roberts, 1937). 2018a).
The Nightingale school served as a model Licensure may be mandatory or permissive.
for nursing education. Its graduates were sought Permissive licensure is a voluntary arrangement
worldwide. Many of them established schools and whereby an individual chooses to become licensed
became matrons (superintendents) in hospitals to demonstrate competence. However, the license is
in other parts of England, the British Common- not required to practice. In this situation a manda-
wealth, and the United States. However, very few tory license is not required to practice. Mandatory
schools were able to remain financially indepen- licensure requires a nurse to be licensed in order to
dent of the hospitals and thus lost much of their practice. In the United States and Canada, licen-
autonomy. This was in contradiction to Nightin- sure is mandatory.
gale’s philosophy that the training schools were
educational institutions, not part of any service Licensure by Endorsement
agency. If a state is not a member of the compact, nurses
licensed in one state may obtain a license in
another state through the process of endorsement.
The National Council Each application is considered independently and
Licensure Examination is granted a license based on the rules and regula-
tions of the state.
Professions require advanced education and an States differ in the number of continuing edu-
advanced area of knowledge and training. Many cation credits required, mandatory courses, and
are regulated in some way and have a licensure other educational requirements. Some states may
or certification requirement to enter practice. This require that nurses meet the current criteria for
holds true for teachers, attorneys, physicians, and licensure at the time of application, whereas others
pilots, just to name a few. The purpose of a profes- may grant the license based on the criteria in effect
sional license is to ensure public safety, by setting at the time of the original license. When applying
a level of standard that indicates an individual has for a license through endorsement, a nurse should
acquired the necessary knowledge and skills to always contact the board of nursing for the state
enter into the profession. and ask about the exact requirements for licensure
in that state. This information is usually found on
Licensure the state board of nursing Web site.
Licensure for nurses is defined by the NCSBN NURSYS is a national database that houses
as the process by which boards of nursing grant information on licensed nurses. Nurses apply-
permission to an individual to engage in nursing ing for licensure by endorsement may verify their
practice after determining that the applicant has licenses through this database. The nurse’s license
attained the competency necessary to perform a verification is available immediately to the endors-
unique scope of practice. Licensure is necessary ing board of nursing (NCSBN, 2016). Not all
when the regulated activities are complex, require states belong to NURSYS.
specialized knowledge and skill, and involve
independent decision making (NCSBN, 2012). Qualifications for Licensure
Government agencies grant licenses allowing an The basic qualification for licensure requires
individual to engage in a professional practice and graduation from an approved nursing program.
use a specific title. State boards of nursing issue In the United States, each state may add
nursing licenses. This limits practice to a specific additional requirements, such as disclosures
jurisdiction. However, as the NCLEX® is a nation- regarding health or medications that could affect
ally recognized examination, many states have practice. Most states require disclosure of criminal
joined together to form a “compact” where the conviction.
 chapter 1 ■ Characteristics of a Profession 7

Licensure by Examination health services. Public health nursing found itself

A major accomplishment in the history of nursing in an ideal position to step up and assume respon-
licensure was the creation of the Bureau of State sibility for providing care to dependent mothers
Boards of Nurse Examiners. The formation of and children, the blind, and disabled children
this agency led to the development of an identical (Black, 2014). In 1965, under President Lyndon B.
examination in all states. The original examination, Johnson, amendments to the Social Security Act
called the State Board Test Pool Examination, was designed to ensure access to health care for the
created by the testing department of the National elder adult, the poor, and the disabled resulted in
League for Nursing (NLN). This was completed the creation of Medicare and Medicaid (Centers
through a collaborative contract with the state for Medicare and Medicaid Services [CMS],
boards. Initially, each state determined its own 2017). Health insurance companies emerged and
passing score; however, the states did eventually increased in number during this time as well. Hos-
adopt a common passing score. The examination pitals started to rely on Medicare, Medicaid, and
is called the NCLEX-RN® and is used in all states insurance reimbursement for services. Care for the
and territories of the United States. This test is sick and new opportunities and roles emerged for
prepared and administered through a professional nurses within this environment.
testing company. Historically, as a profession, nursing has made
most of its advances during times of social change.
The 1960s through the 1980s brought many
NCLEX-RN® changes for both women and nursing. In 1964,
The NCLEX-RN® is administered through com- President Johnson signed the Civil Rights Act,
puterized adaptive testing (CAT). Candidates which guaranteed equal treatment for all individ-
need to register to take the examination at an uals and prohibited gender discrimination in the
approved testing center in the state in which they workplace. However, the law lacked enforcement.
intend to practice. Because of a large test bank, During this time, the feminist movement gained
CAT permits a variety of questions to be adminis- momentum, and the National Organization for
tered to a group of candidates. Candidates taking Women was founded to help women achieve
the examination at the same time may not neces- equality and give women a voice. Nursing moved
sarily receive the same questions. Once a candidate forward as well. Specialty care disciplines devel-
answers a question, the computer analyzes the oped. Advances in technology gave way to the
response and then chooses an appropriate question more complex medical–surgical treatments such
to ask next. If the candidate answers the question as cardiothoracic surgery, complex neurosurgical
correctly, the following question may be more dif- techniques, and the emergence of intensive care
ficult; if the candidate answers incorrectly, the next environments to care for these patients. These
question may be easier. changes fostered the development of specializa-
In April 2016, the NCSBN released the tion for nurses and physicians, creating a shortage
updated test plan. The new test plan redistributed of primary care physicians. The public demanded
the percentages for each content area and updated increased access to health care, and nursing again
the question format with increased use of technol- stepped forward by developing an advanced prac-
ogy that better simulated patient care situations. tice role for nurses to meet the primary health-care
More updated information on the NCLEX® test needs of the public.
plans may be found on the NCSBN Web site Throughout the years, wars created situations
(www.ncsbn.org). that facilitated changes in nursing and its role
within society. Wars increased the nation’s need
for nurses and the public’s awareness of nursing’s
Political Influences and the Advance role in society (Kalisch & Kalisch, 2004). Nurses
of Nursing Professionals served in the military during both world wars and
the Korean conflict and changed nursing practice
Nursing made many advances during the time of during the time of war. For the first time, nurses
social upheaval and change. The passing of the were close to the front and worked in mobile hos-
Social Security Act in 1935 strengthened public pital units. Often they lacked necessary supplies
8 unit 1 ■ Professionalism

and equipment (Kalisch & Kalisch, 2004). They to recognized standards of nursing practice”
found themselves in situations where they needed (American Nurses Association [ANA], 2006).
to function independently and make immediate Nursing has recognized the need for the
decisions, often assuming roles normally associated profession to understand and function during
with the physicians and surgeons. human-caused and natural disasters such as 9/11
The Vietnam War afforded nurses opportunities and hurricanes. The profession has answered the
to push beyond the boundaries as they functioned call by increasing disaster preparedness training for
in mobile hospital units in the war theater, often nurses.
without direct supervision of physicians. These
nurses performed emergency procedures such as
tracheostomies and chest tube insertions in order Nursing and Health-Care Reform
to preserve the lives of the wounded soldiers (Texas
For more than 40 years, Florence Nightingale
Tech University, 2017). After functioning inde-
played an influential part in most of the important
pendently in the field, many nurses felt restricted
health-care reforms of her time. Her accomplish-
by the practice limits placed on them when they
ments went beyond the scope of nursing and
returned home.
nursing education, affecting all aspects of health
Challenges for society and nurses continued
care and social reform.
from the 1980s through 2000. The 1980s were
Nightingale contributed to health-care reform
marked by the emergence of the HIV virus and
through her work during the Crimean War, where
AIDS. Although we know more about HIV and
she greatly improved the health and well-being of
AIDs today than we knew more than 30 years ago,
the British soldiers. She kept accurate records and
society ’s fear of the disease stigmatized groups of
accountings of her interventions and outcomes,
individuals and created fear among global popu-
and on her return to England she continued this
lations and health-care providers. Nurses became
work and reformed the conditions in hospitals and
instrumental in educating the public and working
health care.
directly with infected individuals.
The 21st century brings both challenges and
The increase in available technology allowed
opportunities for nursing. It is estimated that
for the widespread use of life-support systems.
more than 434,000 nurses will be needed by the
Nurses working in critical care areas often faced
year 2024 (Bureau of Labor Statistics [BLS],
ethical dilemmas involving the use of these tech-
2017). The severe nursing shortage has increased
nologies. During this time period, nurses voiced
the demand for more nurses, whereas the passing
their opinions and concerns and helped in formu-
of the Affordable Care Act (ACA) offers oppor-
lating policies addressing these issues within their
tunities for nurses to take the lead in providing
communities and institutions. The field of hospice
primary health care to those who need it. More
nursing received a renewed interest and support
advanced practice nurses will be needed to address
(National Hospice and Palliative Care Organi-
the needs of the diverse population in this country.
zation [NHPCO], 2012); therefore, the number
Health-care reform is discussed in more detail in
of hospice care providers grew and opened new
Chapter 16.
opportunities for nurses.
The first part of the 21st century introduced
nurses to situations beyond anyone’s imagina- Nursing Today
tion. Nursing’s response to the terrorist attack
on the World Trade Center and during the onset Issues specific to nursing reflect the problems and
and aftermath of Hurricane Katrina raised mul- concerns of the health-care system as a whole.
tiple questions regarding nurses’ abilities to react The average age of nurses in the United States is
to major disasters. Nurses, physicians, and other 46.8 years, and approximately 50% of the nursing
health-care providers attempted to care for and workforce is older than 50 (NCSBN, 2015).
protect patients under horrific conditions. Nurses Because of changes in the economy, many nurses
found themselves trying to function “during unfa- who planned to retire have instead found it nec-
miliar and unusual conditions with the health essary to remain in the workforce. However, the
care environment that may necessitate adaptations recent data collected also noted an increase in men
 chapter 1 ■ Characteristics of a Profession 9

entering the field as well as an increase in younger Advanced practice nurses (APRNs) are qual-
and more diverse populations seeking nursing ified to diagnose and treat certain conditions.
careers. These highly educated nurses are more than phy-
Concerns about the supply of registered nurses sician extenders as they sit for board certification
(RNs) and staffing shortages persist in both the examinations and are licensed by the states in
United States and abroad. For the first time, multi- which they practice. Educational requirements for
ple generations of nurses find themselves working APRNs include a minimum of a master’s degree
together within the health-care environment. The in nursing with a clinical focus, and a designated
oldest of the generations, the early baby boomers, number of clinical hours. Many nurse practition-
planned to retire during the last several years; ers are obtaining the Doctor of Nursing Practice
however, economics have forced many to remain (DNP) degree. The American Association of Crit-
in the workplace. They presently work alongside ical Care Nurses (AACN) and the NLN both
Generation X (born between 1965 and 1979) and promote this as the terminal degree for nurse
the generation known as the millennials (born in practitioners. Areas of advanced practice include
1980 and later). Nurses from the baby boomer family nurse practitioner, acute care nurse prac-
generation and Generation X provide the major- titioner, pediatric nurse practitioner, and certified
ity of bedside care. Where the millennials find nurse midwife.
themselves comfortable with technology, the baby
boomers feel the “old ways” worked well. Conclusion
Generational issues in the nursing workforce
present potential conflicts in the work environ- Professional behavior is an important component
ment as these generations come with differing of nursing practice. It is outlined and guided by
viewpoints as they attempt to work together within state nurse practice acts, the ethical codes, and
the health-care community (Bragg, 2014; Moore, standards of practice. Acting professionally both
Everly, & Bauer, 2016). Each generation brings its while in the workplace and in one’s personal life is
own set of core values to the workplace. In order to also an expectation. As nursing moves forward in
be successful and work together as cohesive teams, the 21st century, the need for committed profes-
each generation needs to value the others’ skills sionals and innovative nurse leaders is greater than
and perspectives. This requires active and assertive ever. Society ’s demand for high-quality health care
communication, recognizing the individual skill at an affordable cost is now law and an impetus
sets of the generations, and placing individuals in for change in how nurses function in the new
positions that fit their specific characteristics. environment.
The related issues of excessive workload, man- Employers, colleagues, and peers depend on
datory overtime, scheduling, abuse, workplace new nurses to act professionally and provide safe,
violence, and lack of professional autonomy con- quality patient care. Taking advantage of expand-
tribute to the concerns regarding the nursing ing educational opportunities, engaging in lifelong
shortage (Clarke, 2015; Wheatley, 2017). These learning, and seeking certification in a specialty
issues impact the workplace environment and often demonstrate professional commitment.
place patients at risk. Professional behavior requires Nursing has its roots as a calling and vocation.
respect and integrity, as well as safe practice. It originated in the community, moved to hospi-
tals, returned to the community, and is now seen
The Future of Professional Nursing in multiple practice settings. The ACA has opened
doors for more opportunities for nurses, and the
The changes in health care and the increased need IOM report on the Future of Nursing states that
for primary care providers has opened the door for nurses need to be permitted to use their educa-
nursing. The Institute of Medicine (IOM, 2010) tional skills in the health-care environment.
report specifically stated that nurses should be Often students ask the question: “So what can
permitted to practice to the full extent of their I do? I am a new graduate.” Get involved in your
education. Nurses are educated to care for individ- profession by joining organizations and becoming
uals who have chronic illnesses and need health politically active. Continue pursuing excellence and
teaching and monitoring. set the stage for those who will come after you.
10 unit 1 ■ Professionalism

Study Questions

1. Read Notes on Nursing: What It Is and What It Is Not by Florence Nightingale. How much of its
content is still true today?
2. What is your definition of nursing? How does it compare or contrast with Virginia Henderson’s
definition?
3. Review the mission and purpose of the ANA or another national nursing organization online.
Do you believe that nurses should belong to these organizations? Explain your answer.
4. Professional behaviors include a commitment to lifelong learning. What does “lifelong learning”
mean beyond mandatory continuing education?
5. Formulate your plan to prepare for the NCLEX®.

Case Studies to Promote Critical Reasoning

Case I
Thomas went to nursing school on a U.S. Public Health Service scholarship. He has been directed
to go to a rural village in a small Central American country to work in a local health center.
Several other nurses have been sent to this village, and the residents forced them to leave.
The village lacks electricity and plumbing; water comes from in-ground wells. The villagers and
children suffer from frequent episodes of gastrointestinal disorders.
1. How do you think Florence Nightingale would have approached these issues?
2. What do you think Thomas should do first to gain the trust of the residents of the village?
3. Explain how APRNs would contribute to the health and welfare of the residents of the village.
Case II
The younger nurses in your health-care institution have created a petition to change the dress code
policy. They feel it is antiquated and rigid. Rather than wearing uniforms or scrubs on the nursing
units, they would prefer to wear more contemporary clothing such as khakis and nice shirts with
the agency logo along with laboratory coats. The older-generation nurses feel that this will detract
from the nursing image, as patients expect nurses to dress in uniforms or scrubs and this is what
defines them as a “profession.”
1. What are your thoughts regarding the image of nursing and uniforms?
2. Do you feel that uniforms define nurses? Explain your reasoning.
3. Explain the reasons certain generations may see this as a threat to their professionalism.
4. Which side would you support? Explain your answer with current research.
 chapter 1 ■ Characteristics of a Profession 11

NCLEX®-Style Review Questions

1. Nursing has its origins with

1. Florence Nightingale
2. The Knights of Columbus
3. Religious orders
4. Wars and battles
2. Who stated that the “function of the nurse is to assist the individual, sick or well, in the
performance of those activities contributing to health or its recovery (or to peaceful death)”?
1. Henderson
2. Rogers
3. Robb
4. Nightingale
3. You are participating in a clinical care coordination conference for a patient with terminal
cancer. You talk with your colleagues about using the nursing code of ethics for professional
registered nurses to guide care decisions. A non-nursing colleague asks about this code. Which
of the following statements best describes this code?
1. Improves communication between the nurse and the patient
2. Protects the patient ’s right of autonomy
3. Ensures identical care to all patients
4. Acts as a guide for professional behaviors in giving patient care
4. The NCLEX® for nurses is exactly the same in every state in the United States. The
examination:
1. Guarantees safe nursing care for all patients
2. Ensures standard nursing care for all patients
3. Ensures that honest and ethical care is provided
4. Provides a minimal standard of knowledge for a registered nurse in practice
5. APRNs generally: Select all that apply.
1. Function independently
2. Function as unit directors
3. Work in acute care settings
4. Work in the university setting
5. Hold advanced degrees
6. Nurses at a community hospital are in an education program to learn how to use a new
pressure-relieving device for patients at risk for pressure ulcers. This is which type of
education?
1. Continuing education
2. Graduate education
3. In-service education
4. Professional registered nurse education
7. Which of the following is unique to a professional standard of decision making?
Select all that apply.
1. Weighs benefits and risks when making a decision
2. Analyzes and examines choices more independently
3. Concrete thinking
4. Anticipates when to make choices without others' assistance