mission statement nursing definition

How to Create a Nurse Mission Statement

In my opinion, if you’re going to do something, do it 100%. Do it with soul, do it with your whole heart. That’s why I created a nurse mission statement for myself.

It would be easy to go to work every day solely for the paycheck. And there’s nothing necessarily wrong with that; you’re making an honest living, and you’re benefiting society in the meantime. But what I realized recently is that I’m just not okay with setting for that. Nurses show up in patient’s weakest moments in life, when they’re the most vulnerable and helpless. Although I don’t work in direct patient care, I support nurses that do. So I need to bring all of my heart with me. I’m not benefiting anyone if I’m just trying to rush through my work so I can check the latest Facebook updates.

You see, I could’ve gone into many occupations where I could make the same amount (or more) of money and deal with a lot less stress and pressure. But, I chose to become a nurse.

Creating a nurse mission statement can be one of the single most important things you could do for your career and for your patients. I became a nurse for a reason, and I want to represent that reason every day.

What is a Nurse Mission Statement?

A nurse mission statement is a declaration of the values and goals of your nursing career. It’s what drives your career, tells people what you’re all about and what you aim to bring to the table.

I didn’t always understand why a mission statement was beneficial, but as my time at the as a nurse ticks on, the importance has been made clear to me.

It’s easy to get really burnt out as a nurse. As a new grad, you start off very excited and eager to make a difference in the nursing field. But it doesn’t take long for that excitement to wear off and for the demands of the career to pull you in like quicksand. I see it on a regular basis, and the nurses I’m speaking of (who are already preparing to quit the profession) have been nurses for only six months. Having your own mission statement can be a daily reminder of why you became an RN, and what exactly you aspire to do with your life and your career. It can help to pull you out of the daily dramas that threaten your career (and sanity) and gently shift your perspective back to what really matters.

Time to Reflect

To begin, I would suggest grabbing a notepad and pen. Writing all of this down is essential, and can also help you to keep your thoughts organized. The key to creating your own nurse mission statement is simple, but it requires some reflection and some honesty. In allowing ourselves to be honest, we become a better nurse as well as a better person, and thus permitting ourselves to bring our “true selves” to light. Being honest also allows us to consciously acknowledge our strengths and weaknesses. This is really important, as there’s so much in life that we keep in our subconscious but don’t intentionally think through.

So with that in mind, answer these questions:

• What inspired you to become a nurse?
• Where do you feel the most called? Is there a certain population of people or a certain disease process that you feel you want to work with?
• What is your primary motivation and goals in your career? Is there anything specific that you wish to accomplish as a nurse?
• What values do you want to bring to the profession?

After going through these questions, you may have a clearer focus on what your nurse mission statement should be. These questions could also bring up other questions in your mind, and you may not have answers to them right now. That’s okay. As you go to work this week, you can also examine yourself and see where you shine the most, so to speak. Indirectly, you may be answering these questions without even realizing it.

Putting it all Together

Now, let’s look at a few examples of mission statements. There’s no magic formula in structuring it, and you can engineer your statement however you choose. Perhaps the following will give you some ideas, though.

• My mission as a registered nurse is to provide competent and compassionate care to every patient and family member. I vow to remain educated, honest, and professional for the duration of my career.
• In going to work as a nurse every day, I will be loving to people of all backgrounds and ethnicities. I will help educate people with substance abuse and work closely with social workers to help them be placed in programs to overcome their addictions. I will never show any judgment and will remember that we all are flawed and have weaknesses.
• I devote myself to employ best practices in nursing care and help ease the suffering of those with chronic medical conditions. I will remember that pain is subjective and considered a vital sign, and I will do everything in my power for people to be without pain.

I hope that you are encouraged to develop your own nurse mission statement ! Enjoy the process and what it reveals about you.

Also be sure to check out how to define and attain a nursing goal in a nursing care plan .

For more information on Nurse Mission Statements check out:

• Free Writing Course for Nurses and Other Healthcare Professionals
• Why Personal Branding is Important for Nurses
• How to Create the Perfect Registered Nurse Resume

• Are Nurse’s Notes Becoming a Lost Art?

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About The Author

Brittney wilson, bsn, rn, related posts, evidence based practice: nurses barriers to implementation, meaningful use and the continuity of care document.

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Mission, Vision, Values, Objectives and Philosophy of an Organization

Introduction.

MISSION STATEMENTS

VISION STATEMENTS

VALUE STATEMENTS

NURSING SERVICE PHILOSOPHY

Setting of organizational objectives is the starting point of managerial actions. An organisation’s end results for which an organization strives is termed as “mission”, purpose, objective, goal, target etc. Many times these terms are used interchangeably as all these denote end results.

A Mission Statement defines the organization's purpose and primary objectives. Its prime function is internal – to define the key measure or measures of the organization’s success – and its prime audience is the leadership team and stockholders. Mission statements are the starting points of an organisation’s strategic planning and goal setting process. They focus attention and assure that internal and external stakeholders understand what the organization is attempting to accomplish.

MISSION AND PURPOSE

Mission and purpose are used interchangeably, though at theoretical level, there is a difference between two. Mission has external orientation and relates the organization to the society in which it operates. A mission statement helps the organization to link its activities to the needs of the society and legitimize its existence. Purpose is also externally focused but it relates to that segment of the society to which it serves; it defines the business which the institution will undertake.

Dimensions of Mission statements:

According to Bart, the strongest organizational impact occurs when mission statements contain 7 essential dimensions.

Key values and beliefs

Distinctive competence

Desired competitive position

Competitive strategy

Compelling goal/vision

Specific customers served and products or services offered

Concern for satisfying multiple stakeholders

According to Vern McGinis , a mission should:

Define what the company is

Define what the company aspires to be

Limited to exclude some ventures

Broad enough to allow for creative growth

Distinguish the company from all others

Serve as framework to evaluate current activities

Stated clearly so that it is understood by all

Developing a Mission Statement

Structure of a mission statement

The following elements can be included in a mission statement. Their sequence can be different. It is important, however, that some elements supporting the accomplishment of the mission be present and not just the mission as a "wish" or dream.

Purpose and values of the organization (products or services, market) or who are the organization's primary "clients" (stakeholders)

What are the responsibilities of the organization towards these "clients"

What are the main objectives supporting the company in accomplishing its mission

A mission statement explains the company's core purpose and values.

1.   At is most basic, the mission statement describes the overall purpose of the organization.

2. If the organization elects to develop a vision statement before developing the mission statement, ask “Why does the image, the vision exist -- what is it’s purpose?” This purpose is often the same as the mission.

3. Developing a mission statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational mission.

4. When wording the mission statement, consider the organization's products, services, markets, values, and concern for public image, and maybe priorities of activities for survival.

5. Consider any changes that may be needed in wording of the mission statement because of any new suggested strategies during a recent strategic planning process.

6. Ensure that wording of the mission is to the extent that management and employees can infer some order of priorities in how products and services are delivered.

7. When refining the mission, a useful exercise is to add or delete a word from the mission to realize the change in scope of the mission statement and assess how concise is its wording.

8. Does the mission statement include sufficient description that the statement clearly separates the mission of the organization from other organizations?

 Mission Statements of Well Known Enterprises

"To solve unsolved problems innovatively" -Mary Kay Cosmetics "To make people happy.” - Walt Disney

Vision statements reflect the ideal image of the organization in the future. They create a focal point for strategic planning and are time bound, with most vision statements projected for a period of 5 to 10 years.  The vision statement communicates both the purpose and values of the organization. For employees, it gives direction about how they are expected to behave and inspires them to give their best. Shared with customers, it shapes customers’ understanding of why they should work with the organization.

Developing a Vision Statement

1.   The vision statement includes vivid description of the organization as it effectively carries out its operations.

2. Developing a vision statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational vision.

3. Developing the vision can be the most enjoyable part of planning, but the part where time easily gets away from you.

4. Note that originally, the vision was a compelling description of the state and function of the organization once it had implemented the strategic plan, i.e., a very attractive image toward which the organization was attracted and guided by the strategic plan. Recently, the vision has become more of a motivational tool, too often including highly idealistic phrasing and activities which the organization cannot realistically aspire.

Value statements define the organisation’s basic philosophy, principles and ideals. They also set the ethical tone for the institution. An organisation’s values are evident in the statements that define the organization and the processes used to achieve its mission and vision.

Developing a Values Statement

1. Values represent the core priorities in the organization’s culture, including what drives members’ priorities and how they truly act in the organization, etc. Values are increasingly important in strategic planning. They often drive the intent and direction for “organic” planners.

2. Developing a values statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational values.

3. Establish four to six core values from which the organization would like to operate. Consider values of customers, shareholders, employees and the community.

4. Notice any differences between the organization’s preferred values and its true values (the values actually reflected by members’ behaviors in the organization).

5. Incorporate into the strategic plan, actions to align actual behavior with preferred behaviors.

Objectives are the ends toward which activity is aimed-they are the end results to ward which activity is aimed.

“Objectives are goals, aims or purposes that organizations wish over varying periods of time”-McFarland

“A managerial objective is the intended goal that prescribes definite scope and suggests direction to the planning efforts of a manger”-Terry and Franklin

GUIDELINES FOR OBJECTIVE SETTING

Must be clearly specified

Must be set taking into account the various factors affecting their achievement

Should be consistent with organizational mission

Should be rational and realistic rather than idealistic

Should be achievable but must provide challenge to those responsible for achievement

Should start with “to” and be followed by an action verb

Should be consistent over the period of time

Should be periodically reviewed

Should have hierarchy

Organisational objectives

Should have social sanction

An organization may have multiple objectives

Can be changed

NATURE OF OBJECTIVES

Each organization or group of  individuals have some objectives

Objectives may be broad or they may be specifically mentioned

Objectives may be clearly defined

Objectives have hierarchy.

Organisational objectives have social sanction, that is, they are created within the social norms.

An organisation may have multiple objectives.

 Organisational objectives can be changed

FUNCTIONS OF OBJECTIVES

 To define an organization

 To provide directions for decision making

 To set standards of performance

 To provide a basis for decentralization

 Integrate organization, group and individual

The statement of philosophy is defined as an explanation of the systems of beliefs that determine how a mission or a purpose is to be achieved. An organisation’s philosophy states the beliefs, concepts and principles of an organization. 

The nursing service philosophy is a statement of beliefs that flows from and is congruent with the institution’s philosophy. The belief system of the nursing philosophy should reflect the nursing  division member’s ideas and ideals for nursing and should be endorsed by others.

COMPONENTS OF NURSING SERVICE PHILOSOPHY

1.NURSING/NURSING PRACTICE

Nursing is a  health care service  mandated by society; the practice of nursing stems from the beliefs and ideals of the nursing service department.

In the first area, nursing theory, the task for the nurse manager is to decide whether and how to incorporate theory. Three different methods may be considered.

One method is to use an eclectic approach, selecting ideas and constructs from various nursing theories and incorporating these into the philosophy.

A second method is to use one theory throughout the philosophy.

A third approach is to adopt a theory, then attach the entire document describing the theory to the philosophy and refer to the theory at appropriate places in the philosophy.

A second set of values related to nursing/nursing practice center around practice, education and research.

Values specific to education are essential content for most departments of nursing. The beliefs may focus on the need for continuing education off staff members. The third value related to the concept of nursing practice is research and this include the department’s commitment to applying research findings or supporting others in their research efforts. The beliefs held about the areas of impact of administration will influence  the formation of philosophy. The last content area related to nursing/nursing practice is nursing ‘s role in over all organization.

2.PATIENT/CLIENT

The patient is the main reason for the institution’s existence, examine patient’s rights. Beliefs concerning patient's rights will be influenced in part by institutional policies and practices .

Nurses are essential in the day-to –day operations of the hospital organization. They are the providers of nursing acts which result in quality, care. To keep the organization functioning smoothly ,it is necessary to address values related to and beliefs about nurses. These values and beliefs center around nurses rights, advancement criteria and responsibilities to other health professionals, as well as professional organizations.

PHILOSOPHY OF NURSING EDUCATION

“ Philosophy of nursing education is the written statement of the believes, values, attitudes and ideas which the faculty as a group agreed upon in relation to the nursing educational programme such as health, disease, nursing, nurse, nursing profession, education, learner, society, patient, nursing education and preparation of nurses.”

Philosophy of f nursing education is a perfect combination of nursing and philosophy of education, more precisely, philosophy of nursing and philosophy of education is the application of the fundamental belief of nursing and education in the field of nursing. In the philosophy of education, importance is given to the students. The objectives formulated with a philosophical basis of education focus on the student life and the all round development.

FACTORS INFLUENCING PHILOSOPHY OF NURSING EDUCATION

 Beliefs and values of faculty members regarding god, man, life, health, disease, nursing etc

The philosophical values and beliefs of the institution

The environment where the education takes place

The student and activities

Health needs of the society

The culture and background of the people

Developments in nursing, medicine and allied fields

Philosophy of nursing service administration

The goals and objectives of the health care delivery system

The disease pattern, the health awareness and health facilities available

The available resources in terms of man, money and materials

Mission, vision, value statements, objectives and philosophy act as a basis for any organization. So an administrator has to be vigilant while formulating these.

Basavanthappa BT. Nursing Administration. 1st edn. New Delhi: Jaypee Brothers; 2000

Wehrich H, Koontz H. Management A global perspective. 11th edn.New Delhi: Tata McGraw-Hill Publishing company ltd;2005

Marquis BL,Huston CJ. Leadership and Management Functions in Nursing- Theory and application. 5th edn. Philadelphia: Lippincott Williams and Wilkins; 2006

Ward MJ, Price SA .Issues in nursing administration. St.Louis: Mosby;1991.

Marquis B.L. ,Hutson C.J . Leadership roles and management functions in nursing– Theory and application. 5th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.

Douglass L M. The effective nurse- leader and manager. 5th ed. Mosby: St. Louis; 1996.

Morrison M. Professional skills for leadership. Mosby: US; 1993.

Ellis J R, Hartley C L. Managing and Co-ordinating nursing care. 3rd ed. Lippincott: Philadelphia;1995.

Basvanthappa BT. Nursing administration. New Delhi: Jaypee brothers;2000.

Anthony, Mary K., Theresa; Hertz, Judith .Factors Influencing Outcomes After Delegation to Unlicensed Assistive Personnel. JONA.  30(10):474-481, October 2000.

Cheryl L. Plasters, Seagull F J, Xiao Y. Coordination challenges in operating-room management: an in-depth field study. Amia annu  symp  proc; 2003.

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The National League for Nursing implements its mission guided by four dynamic and integrated core values that permeate the organization and are reflected in its work:

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Enhance the NLN's national and international impact as the recognized leader in nursing education. OBJECTIVES:  The NLN will:

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What Are Mission, Vision, & Values Statements?

Why are mission, vision, & value statements important, examples of healthcare mission statements, examples of healthcare vision statements, examples of healthcare values statements, how to create & use mission, vision, & value statements in your healthcare organization, final thoughts, a guide to crafting great healthcare mission, vision, & values statements.

Jul 24, 2024

Mission, vision, and values statements allow healthcare organizations to determine what, exactly, they aim to accomplish and how they can provide the standard of care their patients deserve.

Each type of statement serves a separate function, but they can seem similar. In this guide, we’ll help you understand their purpose and key differences by highlighting examples of each.

First, we’ll get started with basic definitions:

• Mission Statement: A mission statement is an explanation that focuses on the present. What does your organization aim to accomplish in the here and now?
• Vision Statement: While mission statements are all about now, your vision statement highlights where your organization will be in the future. You might not fulfill the terms of your vision just yet, but you aspire to eventually reach such lofty goals.
• Values Statement: Which qualities are prioritized by your organization? These philosophical ideals form the heart of your values statement. Typically, this consists of several subsections highlighting key descriptors such as “compassion,” “cultural sensitivity,” or “innovation.”

What is your healthcare organization’s core identity? If you’ve yet to define it, you’ll struggle to control the narrative. This, in turn, makes it difficult to get both patients and promising employees through the door. By outlining your mission, vision, and values, you can develop a blueprint to guide both long-term initiatives and day-to-day concerns.

The following are a few of the most compelling reasons why mission, vision, and values statements warrant so much consideration:

1. They help patients determine where to seek care.

Today’s patients are discerning and have high expectations regarding the level of care they expect to receive from the clinics or hospitals they visit. Beyond this, they may prefer a specific type of bedside manner or integration of advanced technology. These and other considerations can instantly be conveyed in mission, vision, and value statements so patients know which facilities are best suited to their unique needs.

2. They help employees determine where to work.

In addition to guiding patients, mission, vision, and value statements can help many types of employees determine whether they’ll fit into the workplace culture of any given facility. They should understand what your organization represents before they apply or interview.

3. They help ensure ethical care is provided.

It is your organization’s responsibility to abide, not only by a societally determined standard of care, but also to do so in an ethically sound way. Such considerations are especially noteworthy among religious institutions, where phrases such as “promoting reverence for life” can have a huge influence on who receives which types of treatments and how that care is delivered. A report by the AMA Journal of Ethics reminds us that such directives could potentially “restrict healthcare service delivery.” To that end, organizations must be “honest and transparent about [their] mission and the ways it might affect patients.”

4. They help improve patient outcomes by creating a mission-driven culture.

A compelling mission and vision statement can ignite passion among employees. As Jeff Selander, of HealthCatalyst , explained, this type of organizational culture “engages the right people, in the right place, at the right time, to do the right thing.” The result? Healthier patients and greater vitality in the community at large.

Given all that mission statements are charged with accomplishing, the prospect of developing one that fits your organization may seem daunting. Thankfully, a variety of excellent examples provide inspiration.

Keep in mind that each mission statement must be carefully cultivated based on the realities of the organization it describes. What works well for the hospitals and departments referenced below could be all wrong for your organization.

St. David’s Healthcare exemplifies the ideal with a mission statement that is simple, but highly meaningful: “To provide exceptional care to every patient every day with a spirit of warmth, friendliness, and personal pride.”

The need for specificity at the departmental level can be seen in an example statement referenced by the American Academy of Pediatrics : “Our mission is to provide our patients with the best and most comprehensive pediatric care possible from birth until 21 years of age.”

Targeted language can also be found in the Massachusetts General Hospital’s Department of Neurology’s mission statement , which references a commitment to being the “preeminent academic neurology department in the U.S. by providing outstanding clinical care while rapidly discovering new treatments to reduce and eliminate the devastating impact of neurological disorders.”

Meanwhile, the same hospital’s Center for Community Health Improvement keeps its mission statement simple: “To improve the health and well-being of the diverse communities we serve.”

The importance of mission statements within smaller healthcare organizations is evident on the website for the DeNiel Foot and Ankle Center . There, the simple but effective mission statement is, “It is our mission to exceed expectations by providing exceptional foot and ankle care to our patients and at the same time build relationships and trust with them.”

As mentioned previously, a desirable vision statement will highlight ideals at which a given organization hopes to arrive in the future. These may seem ambitious, especially as compared to the mission statement.

Massachusetts General Hospital (MGH)’s CCHI exemplifies the forward-thinking nature of the vision statement by expressing a desire for a future with “healthy, safe, and thriving communities where all people have equitable access to employment, food, education, housing, and a high-quality health care system.”

In Albuquerque, the University of New Mexico Hospital (UNMH) aims for lofty ideals with a vision statement that explains, “We aspire to be one of the nation’s leading university hospitals that captures the synergy in being both an excellent academic institution and an innovative, community-oriented public teaching hospital.”

While it’s arguable as to whether the UNMH can be described as a national leader, the purpose of this vision statement is to ensure that all understand this is what the hospital wants for its future.

Similarly, the website for the Alaska Native Tribal Health Consortium identifies an ambitious vision: “Alaska Native people are the healthiest people in the world.” There is never any question as to what this organization wants to achieve.

Many healthcare organizations prefer to outline values statements in simple, easy-to-scan bullet points. For example, the aforementioned neurology department from Massachusetts General Hospital highlights priorities like “rapid translation of laboratory advances to patient care” and the “seamless integration of research” in a list of bullet points under the heading “We Value.”

The CCHI from MGH delivers an even more streamlined approach, with bullet points referencing the following core values:

• Social, economic, and racial justice
• Health care as a human right
• Education for all
• Partnership and collaboration

Some hospitals mention core values within their mission statements. Chicago’s St. Bernard Hospital , for example, explains that its mission “calls us to care for the sick and promote the health of the residents in the community while witnessing the Christian values of respect, dignity, caring, and compassion for all persons.”

Later, St. Bernard Hospital expands on these concepts under subheadings accompanied by images that convey each value. With compassion, this means a “respectful, caring and supportive environment by listening to others with empathy and sensitivity, respectful of their feelings.” Under the respect category, the hospital references an intention to acknowledge every patient’s “unique worth and diversity as a human being. We will be sensitive to their right to privacy and confidentiality of their personal information.”

Definitions of specific values can also be seen on the website for Seattle Children’s Hospital , which provides a full paragraph to describe each value and how it’s acted upon. With the stated value of collaboration, this means working “in partnership with patients, their families, staff, providers, volunteers, and donors. This spirit of respectful cooperation extends beyond our walls to our business partners and the community.” Under innovation, the page explains that “because innovation springs from knowledge, we foster learning in all disciplines.”

Now that you understand why mission, vision, and value statements work and what they look like at different types of facilities, it’s time to put that knowledge into action. This means you’ll have to dig deep to determine the current status of your organization’s culture and how this can be shaped with the right statements.

Tip #1: Determine where you stand.

Keep in mind that you already hold values—they just might not be properly defined or understood on an organizational level. To get a better sense of your current mission, vision, and values (and how these might change) consider your purpose. Why does your organization exist? Which types of services do you currently provide?

Feedback from patients and staff members can also help you determine the current status of your organization as it relates to your mission, vision, and values. To begin, perform an assessment to determine perceptions among patients and employees. Which descriptors do they reference? They can verify your strengths or highlight whether any weaknesses might prevent your mission or values from being fully accurate.

Tip #2: Avoid jargon.

As you draft various statements, aim for simple, precise language that prospective patients or employees can easily understand. Confusing medical terminology should be avoided, even when describing missions, visions, or values for specific departments.

The Fairview system accomplishes this with a short and sweet mission statement: “Fairview is driven to heal, discover, and educate for longer, healthier lives.”

Tip #3: Get employees aligned.

Once you’ve developed statements for your mission, vision, and values, it’s time to get employees on board. Experts at Insperity reference this in the context of a marching band, where instrumentalists look to the drum major for direction.

Similarly, employees will be happy to align their work with your mission, vision, and values if they understand how these work—and if they see them in action. To keep these essentials top-of-mind, reference them in company-wide meetings, employee newsletters, and when helping staff members set individual goals .

Your healthcare organization’s structure and culture can determine your ability to deliver high-quality, compassionate care. This, in turn, plays heavily into patient outcomes, employee satisfaction, and public perception. All this can be boosted under the guidance of strategic mission, vision, and values statements. Any effort you place into developing statements that accurately convey your organization’s goals will be well-rewarded.

At first glance, the overarching aim of modern healthcare organizations seems simple: provide quality care for patients. Take a closer look, however, and it quickly becomes evident that this is more complicated than it seems.

What constitutes “quality” may vary dramatically from one institution to the next, with factors such as the types of patients and their respective conditions coming into play.

Image courtesy of iStock.com/ Drepicter

Last updated on Jul 24, 2024. Originally published on Aug 25, 2021.

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Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022.

Nursing Management and Professional Concepts [Internet].

• About Open RN

Chapter 4 - Leadership and Management

4.1. leadership & management introduction, learning objectives.

• Compare and contrast the role of a leader and a manager

• Examine the roles of team members

• Identify the activities managers perform

• Describe the role of the RN as a leader and change agent

• Evaluate the effects of power, empowerment, and motivation in leading and managing a nursing team

• Recognize limitations of self and others and utilize resources

As a nursing student preparing to graduate, you have spent countless hours on developing clinical skills, analyzing disease processes, creating care plans, and cultivating 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 interprofessional team members 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. As previously discussed, nursing team members include RNs, licensed practical/vocational nurses (LPN/VN), and assistive personnel (AP).[ 1 ]

Read more about assigning, delegating, and supervising in the “ Delegation and Supervision ” chapter.

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

Read more about collaborating and communicating with the interprofessional team; advocating for clients; and admitting, transferring, and discharging clients in the “ Collaboration Within the Interprofessional Team ” chapter.

An article published in the  Online Journal of Issues in Nursing  states, “With the growing complexity of healthcare practice environments and pending nurse leader retirements, the development of future nurse leaders is increasingly important.”[ 3 ] This chapter will explore leadership and management responsibilities of an RN. Leadership styles are introduced, and change theories are discussed as a means for implementing change in the health care system.

4.2. BASIC CONCEPTS

Organizational culture.

The formal leaders of an organization provide a sense of direction and overall guidance for their employees by establishing organizational vision, mission, and values statements. An organization’s  vision statement  defines why the organization exists, describes how the organization is unique from similar organizations, and specifies what the organization is striving to be. The  mission statement  describes how the organization will fulfill its vision and establishes a common course of action for future endeavors. See Figure 4.1 [ 1 ] for an illustration of a mission statement. A  values statement  establishes the values of an organization that assist with the achievement of its vision and mission. A values statement also provides strategic guidelines for decision-making, both internally and externally, by members of the organization. The vision, mission, and values statements are expressed in a concise and clear manner that is easily understood by members of the organization and the public.[ 2 ]

Mission Statement

Organizational culture  refers to the implicit values and beliefs that reflect the norms and traditions of an organization. An organization’s vision, mission, and values statements are the foundation of organizational culture. Because individual organizations have their own vision, mission, and values statements, each organization has a different culture.[ 3 ]

As health care continues to evolve and new models of care are introduced, nursing managers must develop innovative approaches that address change while aligning with that organization’s vision, mission, and values. Leaders embrace the organization’s mission, identify how individuals’ work contributes to it, and ensure that outcomes advance the organization’s mission and purpose. Leaders use vision, mission, and values statements for guidance when determining appropriate responses to critical events and unforeseen challenges that are common in a complex health care system. Successful organizations require employees to be committed to following these strategic guidelines during the course of their work activities. Employees who understand the relationship between their own work and the mission and purpose of the organization will contribute to a stronger health care system that excels in providing first-class patient care. The vision, mission, and values provide a common organization-wide frame of reference for decision-making for both leaders and staff.[ 4 ]

Learning Activity

Investigate the mission, vision, and values of a potential employer, as you would do prior to an interview for a job position.

Reflective Questions

1. How well do the organization’s vision and values align with your personal values regarding health care?

2. How well does the organization’s mission align with your professional objective in your resume?

Followership

Followership  is described as the upward influence of individuals on their leaders and their teams. The actions of followers have an important influence on staff performance and patient outcomes. Being an effective follower requires individuals to contribute to the team not only by doing as they are told, but also by being aware and raising relevant concerns. Effective followers realize that they can initiate change and disagree or challenge their leaders if they feel their organization or unit is failing to promote wellness and deliver safe, value-driven, and compassionate care. Leaders who gain the trust and dedication of followers are more effective in their leadership role. Everybody has a voice and a responsibility to take ownership of the workplace culture, and good followership contributes to the establishment of high-functioning and safety-conscious teams.[ 5 ]

Team members impact patient safety by following teamwork guidelines for good followership. For example, strategies such as closed-loop communication are important tools to promote patient safety.

Read more about communication and teamwork strategies in the “ Collaboration Within the Interprofessional Team ” chapter.

Leadership and Management Characteristics

Leadership and management are terms often used interchangeably, but they are two different concepts with many overlapping characteristics.  Leadership  is the art of establishing direction and influencing and motivating others to achieve their maximum potential to accomplish tasks, objectives, or projects.[ 6 ],[ 7 ] See Figure 4.2 [ 8 ] for an illustration of team leadership. There is no universally accepted definition or theory of nursing leadership, but there is increasing clarity about how it differs from management.[ 9 ]  Management  refers to roles that focus on tasks such as planning, organizing, prioritizing, budgeting, staffing, coordinating, and reporting.[ 10 ] The overriding function of management has been described as providing order and consistency to organizations, whereas the primary function of leadership is to produce change and movement.[ 11 ] View a comparison of the characteristics of management and leadership in Table 4.2a .

Management and Leadership Characteristics[ 12 ]

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Not all nurses are managers, but all nurses are leaders because they encourage individuals to achieve their goals. The American Nurses Association (ANA) established  Leadership  as a Standard of Professional Performance for all registered nurses. Standards of Professional Performance are “authoritative statements of action and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”[ 13 ] See the competencies of the ANA  Leadership  standard in the following box and additional content in other chapters of this book.

Competencies of ANA’s Leadership Standard of Professional Performance

• Promotes effective relationships to achieve quality outcomes and a culture of safety

• Leads decision-making groups

• Engages in creating an interprofessional environment that promotes respect, trust, and integrity

• Embraces practice innovations and role performance to achieve lifelong personal and professional goals

• Communicates to lead change, influence others, and resolve conflict

• Implements evidence-based practices for safe, quality health care and health care consumer satisfaction

• Demonstrates authority, ownership, accountability, and responsibility for appropriate delegation of nursing care

• Mentors colleagues and others to embrace their knowledge, skills, and abilities

• Participates in professional activities and organizations for professional growth and influence

• Advocates for all aspects of human and environmental health in practice and policy

Read additional content related to leadership and management activities in corresponding chapters of this book:

• Read about the culture of safety in the “ Legal Implications ” chapter.

• Read about effective interprofessional teamwork and resolving conflict in the “ Collaboration Within the Interprofessional Team ” chapter.

• Read about quality improvement and implementing evidence-based practices in the “ Quality and Evidence-Based Practice ” chapter.

• Read more about delegation, supervision, and accountability in the “ Delegation and Supervision ” chapter.

• Read about professional organizations and advocating for patients, communities, and their environments in the “ Advocacy ” chapter.

• Read about budgets and staffing in the “ Health Care Economics ” chapter.

• Read about prioritization in the “ Prioritization ” chapter.

Leadership Theories and Styles

In the 1930s Kurt Lewin, the father of social psychology, originally identified three leadership styles: authoritarian, democratic, and laissez-faire.[ 14 ],[ 15 ]

Authoritarian leadership  means the leader has full power. Authoritarian leaders tell team members what to do and expect team members to execute their plans. When fast decisions must be made in emergency situations, such as when a patient “codes,” the authoritarian leader makes quick decisions and provides the group with direct instructions. However, there are disadvantages to authoritarian leadership. Authoritarian leaders are more likely to disregard creative ideas of other team members, causing resentment and stress.[ 16 ]

Democratic leadership  balances decision-making responsibility between team members and the leader. Democratic leaders actively participate in discussions, but also make sure to listen to the views of others. For example, a nurse supervisor may hold a meeting regarding an increased incidence of patient falls on the unit and ask team members to share their observations regarding causes and potential solutions. The democratic leadership style often leads to positive, inclusive, and collaborative work environments that encourage team members’ creativity. Under this style, the leader still retains responsibility for the final decision.[ 17 ]

Laissez-faire  is a French word that translates to English as, “leave alone.” Laissez-faire leadership gives team members total freedom to perform as they please. Laissez-faire leaders do not participate in decision-making processes and rarely offer opinions. The laissez-faire leadership style can work well if team members are highly skilled and highly motivated to perform quality work. However, without the leader’s input, conflict and a culture of blame may occur as team members disagree on roles, responsibilities, and policies. By not contributing to the decision-making process, the leader forfeits control of team performance.[ 18 ]

Over the decades, Lewin’s original leadership styles have evolved into many styles of leadership in health care, such as passive-avoidant, transactional, transformational, servant, resonant, and authentic.[ 19 ],[ 20 ] Many of these leadership styles have overlapping characteristics. See Figure 4.3 [ 21 ] for a comparison of various leadership styles in terms of engagement.

Leadership Styles

Passive-avoidant leadership  is similar to laissez-faire leadership and is characterized by a leader who avoids taking responsibility and confronting others. Employees perceive the lack of control over the environment resulting from the absence of clear directives. Organizations with this type of leader have high staff turnover and low retention of employees. These types of leaders tend to react and take corrective action only after problems have become serious and often avoid making any decisions at all.[ 22 ]

Transactional leadership  involves both the leader and the follower receiving something for their efforts; the leader gets the job done and the follower receives pay, recognition, rewards, or punishment based on how well they perform the tasks assigned to them.[ 23 ] Staff generally work independently with no focus on cooperation among employees or commitment to the organization.[ 24 ]

Transformational leadership  involves leaders motivating followers to perform beyond expectations by creating a sense of ownership in reaching a shared vision.[ 25 ] It is characterized by a leader’s charismatic influence over team members and includes effective communication, valued relationships, and consideration of team member input. Transformational leaders know how to convey a sense of loyalty through shared goals, resulting in increased productivity, improved morale, and increased employees’ job satisfaction.[ 26 ] They often motivate others to do more than originally intended by inspiring them to look past individual self-interest and perform to promote team and organizational interests.[ 27 ]

Servant leadership  focuses on the professional growth of employees while simultaneously promoting improved quality care through a combination of interprofessional teamwork and shared decision-making. Servant leaders assist team members to achieve their personal goals by listening with empathy and committing to individual growth and community-building. They share power, put the needs of others first, and help individuals optimize performance while forsaking their own personal advancement and rewards.[ 28 ]

Visit the Greenleaf Center site to learn more about  What is Servant Leadership ?

Resonant leaders  are in tune with the emotions of those around them, use empathy, and manage their own emotions effectively. Resonant leaders build strong, trusting relationships and create a climate of optimism that inspires commitment even in the face of adversity. They create an environment where employees are highly engaged, making them willing and able to contribute with their full potential.[ 29 ]

Authentic leaders  have an honest and direct approach with employees, demonstrating self-awareness, internalized moral perspective, and relationship transparency. They strive for trusting, symmetrical, and close leader–follower relationships; promote the open sharing of information; and consider others’ viewpoints.[ 30 ]

Characteristics of Leadership Styles

Outcomes of Various Leadership Styles

Leadership styles affect team members, patient outcomes, and the organization. A systematic review of the literature published in 2021 showed significant correlations between leadership styles and nurses’ job satisfaction. Transformational leadership style had the greatest positive correlation with nurses’ job satisfaction, followed by authentic, resonant, and servant leadership styles. Passive-avoidant and laissez-faire leadership styles showed a negative correlation with nurses’ job satisfaction.[ 31 ] In this challenging health care environment, managers and nurse leaders must promote technical and professional competencies of their staff, but they must also act to improve staff satisfaction and morale by using appropriate leadership styles with their team.[ 32 ]

Systems Theory

Systems theory  is based on the concept that systems do not function in isolation but rather there is an interdependence that exists between their parts. Systems theory assumes that most individuals strive to do good work, but are affected by diverse influences within the system. Efficient and functional systems account for these diverse influences and improve outcomes by studying patterns and behaviors across the system.[ 33 ]

Many health care agencies have adopted a culture of safety based on systems theory. A  culture of safety  is an organizational culture that embraces error reporting by employees with the goal of identifying systemic causes of problems that can be addressed to improve patient safety. According to The Joint Commission, a culture of safety includes the following components[ 34 ]:

• Just Culture:  A culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn by managers between human error, at-risk, and reckless employee behaviors. See Figure 4.4 [ 35 ] for an illustration of Just Culture.
• Reporting Culture:  People realize errors are inevitable and are encouraged to speak up for patient safety by reporting errors and near misses. For example, nurses complete an “incident report” according to agency policy when a medication error occurs or a client falls. Error reporting helps the agency manage risk and reduce potential liability.
• Learning Culture:  People regularly collect information and learn from errors and successes while openly sharing data and information and applying best evidence to improve work processes and patient outcomes.

“Just Culture Infographic.png” by Valeria Palarski 2020. Used with permission.

The Just Culture model categorizes human behavior into three categories of errors. Consequences of errors are based on whether the error is a simple human error or caused by at-risk or reckless behavior[ 36 ]:

• Simple human error:  A simple human error occurs when an individual inadvertently does something other than what should have been done. Most medical errors are the result of human error due to poor processes, programs, education, environmental issues, or situations. These errors are managed by correcting the cause, looking at the process, and fixing the deviation. For example, a nurse appropriately checks the rights of medication administration three times, but due to the similar appearance and names of two different medications stored next to each other in the medication dispensing system, administers the incorrect medication to a patient. In this example, a root cause analysis reveals a system issue that must be modified to prevent future patient errors (e.g., change the labelling and storage of look alike-sound alike medications).[ 37 ]
• At-risk behavior:  An error due to at-risk behavior occurs when a behavioral choice is made that increases risk where the risk is not recognized or is mistakenly believed to be justified. For example, a nurse scans a patient’s medication with a barcode scanner prior to administration, but an error message appears on the scanner. The nurse mistakenly interprets the error to be a technology problem and proceeds to administer the medication instead of stopping the process and further investigating the error message, resulting in the wrong dosage of a medication being administered to the patient. In this case, ignoring the error message on the scanner can be considered “at-risk behavior” because the behavioral choice was considered justified by the nurse at the time.[ 38 ]
• Reckless behavior:  Reckless behavior is an error that occurs when an action is taken with conscious disregard for a substantial and unjustifiable risk. For example, a nurse arrives at work intoxicated and administers the wrong medication to the wrong patient. This error is considered due to reckless behavior because the decision to arrive intoxicated was made with conscious disregard for substantial risk.[ 39 ]

These categories of errors result in different consequences to the employee based on the Just Culture model:

• If an individual commits a simple human error, managers console the individual and consider changes in training, procedures, and processes.[ 40 ] In the “simple human error” example above, system-wide changes would be made to change the label and location of the medications to prevent future errors from occurring with the same medications.
• Individuals committing at-risk behavior are held accountable for their behavioral choices and often require coaching with incentives for less risky behaviors and situational awareness.[ 41 ]In the “at-risk behavior” example above, when the nurse chose to ignore an error message on the barcode scanner, mandatory training on using barcode scanners and responding to errors would likely be implemented, and the manager would track the employee’s correct usage of the barcode scanner for several months following training.
• If an individual demonstrates reckless behavior, remedial action and/or punitive action is taken.[ 42 ] In the “reckless behavior” example above, the manager would report the nurse’s behavior to the State Board of Nursing for disciplinary action. The SBON would likely mandate substance abuse counseling for the nurse to maintain their nursing license. However, employment may be terminated and/or the nursing license revoked if continued patterns of reckless behavior occur.

See Table 4.2c describing classifications of errors using the Just Culture model.

Classification of Errors Using the Just Culture Model

Systems leadership  refers to a set of skills used to catalyze, enable, and support the process of systems-level change that is encouraged by the Just Culture Model. Systems leadership is comprised of three interconnected elements:[ 43 ]

• The Individual:  The skills of collaborative leadership to enable learning, trust-building, and empowered action among stakeholders who share a common goal
• The Community:  The tactics of coalition building and advocacy to develop alignment and mobilize action among stakeholders in the system, both within and between organizations
• The System:  An understanding of the complex systems shaping the challenge to be addressed

4.3. IMPLEMENTING CHANGE

Change is constant in the health care environment.  Change  is defined as the process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures.[ 1 ] The outcomes of change must be consistent with an organization’s mission, vision, and values. Although change is a dynamic process that requires alterations in behavior and can cause conflict and resistance, change can also stimulate positive behaviors and attitudes and improve organizational outcomes and employee performance. Change can result from identified problems or from the incorporation of new knowledge, technology, management, or leadership. Problems may be identified from many sources, such as quality improvement initiatives, employee performance evaluations, or accreditation survey results.[ 2 ]

Nurse managers must deal with the fears and concerns triggered by change. They should recognize that change may not be easy and may be met with enthusiasm by some and resistance by others. Leaders should identify individuals who will be enthusiastic about the change (referred to as “early adopters”), as well as those who will be resisters (referred to as “laggers”). Early adopters should be involved to build momentum, and the concerns of resisters should be considered to identify barriers. Data should be collected, analyzed, and communicated so the need for change (and its projected consequences) can be clearly articulated. Managers should articulate the reasons for change, the way(s) the change will affect employees, the way(s) the change will benefit the organization, and the desired outcomes of the change process.[ 3 ] See Figure 4.5 [ 4 ] for an illustration of communicating upcoming change.

Identifying Upcoming Change

Change Theories

There are several change theories that nurse leaders may adopt when implementing change. Two traditional change theories are known as Lewin’s Unfreeze-Change-Refreeze Model and Lippitt’s Seven-Step Change Theory.[ 5 ]

Lewin’s Change Model

Kurt Lewin, the father of social psychology, introduced the classic three-step model of change known as Unfreeze-Change-Refreeze Model that requires prior learning to be rejected and replaced. Lewin’s model has three major concepts: driving forces, restraining forces, and equilibrium. Driving forces are those that push in a direction and cause change to occur. They facilitate change because they push the person in a desired direction. They cause a shift in the equilibrium towards change. Restraining forces are those forces that counter the driving forces. They hinder change because they push the person in the opposite direction. They cause a shift in the equilibrium that opposes change. Equilibrium is a state of being where driving forces equal restraining forces, and no change occurs. It can be raised or lowered by changes that occur between the driving and restraining forces.[ 6 ],[ 7 ]

• Step 1: Unfreeze the status quo.  Unfreezing is the process of altering behavior to agitate the equilibrium of the current state. This step is necessary if resistance is to be overcome and conformity achieved. Unfreezing can be achieved by increasing the driving forces that direct behavior away from the existing situation or status quo while decreasing the restraining forces that negatively affect the movement from the existing equilibrium. Nurse leaders can initiate activities that can assist in the unfreezing step, such as motivating participants by preparing them for change, building trust and recognition for the need to change, and encouraging active participation in recognizing problems and brainstorming solutions within a group.[ 8 ]
• Step 2: Change.  Change is the process of moving to a new equilibrium. Nurse leaders can implement actions that assist in movement to a new equilibrium by persuading employees to agree that the status quo is not beneficial to them; encouraging them to view the problem from a fresh perspective; working together to search for new, relevant information; and connecting the views of the group to well-respected, powerful leaders who also support the change.[ 9 ]
• Step 3: Refreeze.  Refreezing refers to attaining equilibrium with the newly desired behaviors. This step must take place after the change has been implemented for it to be sustained over time. If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium. Refreezing integrates new values into community values and traditions. Nursing leaders can reinforce new patterns of behavior and institutionalize them by adopting new policies and procedures.[ 10 ]

Example Using Lewin’s Change Theory

A new nurse working in a rural medical-surgical unit identifies that bedside handoff reports are not currently being used during shift reports.

Step 1: Unfreeze:  The new nurse recognizes a change is needed for improved patient safety and discusses the concern with the nurse manager. Current evidence-based practice is shared regarding bedside handoff reports between shifts for patient safety.[ 11 ] The nurse manager initiates activities such as scheduling unit meetings to discuss evidence-based practice and the need to incorporate bedside handoff reports.

Step 2: Change:  The nurse manager gains support from the Director of Nursing to implement organizational change and plans staff education about bedside report checklists and the manner in which they are performed.

Step 3: Refreeze:  The nurse manager adopts bedside handoff reports in a new unit policy and monitors staff for effectiveness.

Lippitt’s Seven-Step Change Theory

Lippitt’s Seven-Step Change Theory expands on Lewin’s change theory by focusing on the role of the change agent. A  change agent  is anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort. Change agents can be internal, such as nurse managers or employees appointed to oversee the change process, or external, such as an outside consulting firm. External change agents are not bound by organizational culture, politics, or traditions, so they bring a different perspective to the situation and challenge the status quo. However, this can also be a disadvantage because external change agents lack an understanding of the agency’s history, operating procedures, and personnel.[ 12 ] The seven-step model includes the following steps[ 13 ]:

• Step 1: Diagnose the problem.  Examine possible consequences, determine who will be affected by the change, identify essential management personnel who will be responsible for fixing the problem, collect data from those who will be affected by the change, and ensure those affected by the change will be committed to its success.
• Step 2: Evaluate motivation and capability for change.  Identify financial and human resources capacity and organizational structure.
• Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.
• Step 4: Select progressive change objectives.  Define the change process and develop action plans and accompanying strategies.
• Step 5: Explain the role of the change agent to all employees and ensure the expectations are clear.
• Step 6: Maintain change.  Facilitate feedback, enhance communication, and coordinate the effects of change.
• Step 7: Gradually terminate the helping relationship of the change agent.

Example Using Lippitt’s Seven-Step Change Theory

Refer to the previous example of using Lewin’s change theory on a medical-surgical unit to implement bedside handoff reporting. The nurse manager expands on the Unfreeze-Change-Refreeze Model by implementing additional steps based on Lippitt’s Seven-Step Change Theory:

• The nurse manager collects data from team members affected by the changes and ensures their commitment to success.
• Early adopters are identified as change agents on the unit who are committed to improving patient safety by implementing evidence-based practices such as bedside handoff reporting.
• Action plans (including staff education and mentoring), timelines, and expectations are clearly communicated to team members as progressive change objectives. Early adopters are trained as “super-users” to provide staff education and mentor other nurses in using bedside handoff checklists across all shifts.
• The nurse manager facilitates feedback and encourages two-way communication about challenges as change is implemented on the unit. Positive reinforcement is provided as team members effectively incorporate change.
• Bedside handoff reporting is implemented as a unit policy, and all team members are held accountable for performing accurate bedside handoff reporting.

Read more about additional change theories in the  Current Theories of Change Management pdf .

Change Management

Change management  is the process of making changes in a deliberate, planned, and systematic manner.[ 14 ] It is important for nurse leaders and nurse managers to remember a few key points about change management[ 15 ]:

• Employees will react differently to change, no matter how important or advantageous the change is purported to be.
• Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change.
• Change often results in a feeling of loss due to changes in established routines. Employees may react with shock, anger, and resistance, but ideally will eventually accept and adopt change.
• Change must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future. Employees should be provided information honestly and allowed to ask questions and express concerns.

4.4. SPOTLIGHT APPLICATION

Jamie has recently completed his orientation to the emergency department at a busy Level 1 trauma center. The environment is fast-paced and there are typically a multitude of patients who require care. Jamie appreciates his colleagues and the collaboration that is reflected among members of the health care team, especially in times of stress. Jamie is providing care for an 8-year-old patient who has broken her arm when there is a call that there are three Level 1 trauma patients approximately 5 minutes from the ER. The trauma surgeon reports to the ER, and multiple members of the trauma team report to the ER intake bays. If you were Jamie, what leadership style would you hope the trauma surgeon uses with the team?

In a stressful clinical care situation, where rapid action and direction are needed, an autocratic leadership style is most effective. There is no time for debating different approaches to care in a situation where immediate intervention may be required. Concise commands, direction, and responsive action from the team are needed to ensure that patient care interventions are delivered quickly to enhance chance of survival and recovery.

4.5. LEARNING ACTIVITIES

Learning activities.

(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activities are provided as immediate feedback.)

Sample Scenario

An 89-year-old female resident with Alzheimer’s disease has been living at the nursing home for many years. The family decides they no longer want aggressive measures taken and request to the RN on duty that the resident’s code status be changed to Do Not Resuscitate (DNR). The evening shift RN documents a progress note that the family (and designated health care agent) requested that the resident’s status be made DNR. Due to numerous other responsibilities and needs during the evening shift, the RN does not notify the attending physician or relay the information during shift change or on the 24-hour report. The day shift RN does not read the night shift’s notes because of several immediate urgent situations. The family, who had been keeping vigil at the resident’s bedside throughout the night, leaves to go home to shower and eat. Upon return the next morning, they find the room full of staff and discover the staff performed CPR after their loved one coded. The resident was successfully resuscitated but now lies in a vegetative state. The family is unhappy and is considering legal action. They approach you, the current nurse assigned to the resident’s care, and state, “We followed your procedures to make sure this would not happen! Why was this not managed as we discussed?”[ 1 ]

1. As the current nurse providing patient care, explain how you would therapeutically address this family’s concerns and use one or more leadership styles.

2. As the charge nurse, explain how you would address the staff involved using one or more leadership styles.

3. Explain how change theory can be implemented to ensure this type of situation does not recur.

IV. GLOSSARY

The process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures.[ 1 ]

Anyone who has the skill and power to stimulate, facilitate, and coordinate the change effort.

Organizational culture that embraces error reporting by employees with the goal of identifying systemic causes of problems that can be addressed to improve patient safety. Just Culture is a component of a culture of safety.

The upward influence of individuals on their leaders and their teams.

A culture where people feel safe raising questions and concerns and report safety events in an environment that emphasizes a nonpunitive response to errors and near misses. Clear lines are drawn between human error, at-risk, and reckless employee behaviors.

The art of establishing direction and influencing and motivating others to achieve their maximum potential to accomplish tasks, objectives, or projects.[ 2 ],[ 3 ]

Roles that focus on tasks such as planning, organizing, prioritizing, budgeting, staffing, coordinating, and reporting.[ 4 ]

An organization’s statement that describes how the organization will fulfill its vision and establishes a common course of action for future endeavors.

The implicit values and beliefs that reflect the norms and traditions of an organization. An organization’s vision, mission, and values statements are the foundation of organizational culture.

A set of skills used to catalyze, enable, and support the process of systems-level change that focuses on the individual, the community, and the system.

The concept that systems do not function in isolation but rather there is an interdependence that exists between their parts. Systems theory assumes that most individuals strive to do good work, but are affected by diverse influences within the system.

The organization’s established values that support its vision and mission and provide strategic guidelines for decision-making, both internally and externally, by members of the organization.

An organization’s statement that defines why the organization exists, describes how the organization is unique and different from similar organizations, and specifies what the organization is striving to be.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 4 - Leadership and Management.
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• LEADERSHIP & MANAGEMENT INTRODUCTION
• BASIC CONCEPTS
• IMPLEMENTING CHANGE
• SPOTLIGHT APPLICATION
• LEARNING ACTIVITIES

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Key Statements, Beliefs and Philosophies of the American Association of Critical-Care Nurses (AACN)

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AACN drives excellence in acute and critical care for nurses, patients and families.

AACN is dedicated to creating a healthcare system driven by the needs of patients and families where acute and critical care nurses make their optimal contribution.

As AACN works to promote its mission and vision, it is guided by values that are rooted in, and arise from, the Association’s rich history, traditions and culture. Our values are the foundation upon which we build our relentless pursuit of excellence. AACN’s members, volunteers and staff will honor the following:

• Integrity — We demonstrate sound judgment, ethical behavior and accountability in all we do.
• Inclusion — We build an equitable culture, inviting the full contribution of all people.
• Transformation — We drive change and innovation to positively impact the healthcare system and improve the lives of patients, families and nurses.
• Leadership — We advocate and influence to achieve optimal outcomes and healthy work environments.
• Relationships — We collaborate and advance partnerships, honoring each individual to strengthen the collective.

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2.2 Organizational Vision, Mission, and Values

Relationship between organizational culture and mission, vision & values.

Organizational culture can be described as  the implicit values and beliefs that reflect the norms and traditions of an organization. An organization’s vision, mission, and values statements are the foundation of organizational culture. Because individual organizations have their own vision, mission, and values statements, each organization has a different culture.

As health care continues to evolve and new models of care are introduced, nursing managers must develop innovative approaches that address change while aligning with that organization’s vision, mission, and values. Leaders embrace the organization’s mission, identify how individuals’ work contributes to it, and ensure that outcomes advance the organization’s mission and purpose. Leaders use vision, mission, and values statements for guidance when determining appropriate responses to critical events and unforeseen challenges that are common in a complex health care system. Successful organizations require employees to be committed to following these strategic guidelines during the course of their work activities. Employees who understand the relationship between their own work and the mission and purpose of the organization will contribute to a stronger health care system that excels in providing first-class patient care. The vision, mission, and values provide a common organization-wide frame of reference for decision-making for both leaders and staff.

 Organizational vision, mission, and values, established by leadership, provide the foundation for the establishment’s culture. Since individual organizations have their own vision, mission, and value statements, each organization has a different culture. Not surprisingly, when there are conflicts between the mission and vision of various institutions, collaboration in providing services to the patient or consumer can also lead to disagreements ( Ko et al. 2015 ). With the increasing emphasis upon collaboration between health care organizations, it is essential to understand how to overcome the challenges of cultural differences that may impede group efforts.

Vision, Mission, and Values & Leadership

Organizational leaders provide a sense of direction and overall guidance to their employees through the use of organizational vision, mission, and values statements. An organization’s vision statement defines why the organization exists, describes how the organization is unique and different from similar organizations, and specifies where the leaders hope the organization is going ( Sanders, 2013 ). The mission describes how the organization will fulfill its vision and establishes a common course of action for future endeavors. Finally, values are developed to assist with the achievement of the vision and mission and provide strategic guidelines for decision making, both internally and externally, by members of the organization ( Kotalik et al., 2014 ) . The vision, mission , and value statements are expressed in a concise and clear manner that is easily understood by all the members of the organization. The vision, mission , and values provide guidelines for every person participating in all activities occurring within the organization and sets the tone for expectations of employees.

The United States of America’s health care is an open system that is undergoing constant change while responding to the surrounding environment. Complexity science requires leaders and staff to handle this rapid change in a thoughtful manner. As health care continues to evolve and new models of care are introduced, managers need to consider innovative approaches that meet the needs of change while complying with their individual organization’s vision, mission, and values. According to Porter – O’Grady and Malloch , “the language of leadership must reflect the requisites of embracing the mission, identifying how individual work effort contributes to it, and ensuring that work outcomes advance the organization’s mission and purpose” ( 2011, p. 233 ). Leaders look through the lenses of the vision, mission, and values statements for guidance when determining appropriate responses to critical events and unforeseen challenges, common in a complex system. Successful organizations require each employee to be committed to following these strategic guidelines during the course of their work activities. Employees who understand the relationship between their own work and the mission and purpose of the organization will contribute to a stronger health care system that excels in providing first-class patient care. The vision, mission, and values provide a common organization-wide frame of reference for decision making for both leaders and staff ( Kotalik et al., 2014 ).

Learning Exercise 2.2.1

Watch this  video  “ How to Write a Mission Statement ” (4:00), presented by M3 Planning, then  answer the following questions:

• What is a mission statement?
• What are five characteristics of a mission statement?
• Who needs to be involved in writing a mission statement?
• What information do you need to write a mission statement?
• What should the process of writing a mission statement involve?

Learning Exercise 2.2.2

Consider the mission, vision, and values of your employer and reflect on the following questions:

• How well do your organization’s vision and values align with your personal values regarding health care?
• How well does your organization’s mission align with your potential Quality Improvement project?

Next: 2.3 Spotlight Application

The implicit values and beliefs that reflect the norms and traditions of an organization.

Leading Change in Health Systems: Strategies for RN-BSN Students Copyright © 2023 by Kathy Andresen DNP, MPH, RN, CNE is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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