Health Care System Transformation for Nursing and Health Care Leaders

Health Care System Transformation for Nursing and Health Care Leaders

Author: Anne Boykin, PhD, MN

Publisher: Springer Publishing Company

Published: 2013-09-10

Total Pages: 253

ISBN-13: 0826196446

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"The authors' approach to creating a transforming culture through use of foundations laid in the theoretical development of "Nursing As Caring" offers a solid foundation upon which to recalibrate and reconfigure toward a caring organizational health system." -Tim Porter-O'Grady, DM, EdD, APRN, FAAN, FACCWS Associate Professor, Leadership Scholar, College of Nursing and Healthcare Innovation, Arizona State University Clinical Professor, Leadership Scholar, College of Nursing, The Ohio State University This is a time-tested, practical guide for nurses and other healthcare professionals who wish to transform their healthcare systems based on caring values and the promotion of intra- and inter-professional dialogue among stakeholders. It describes a theoretically grounded model created by nurses for transforming the culture of healthcare systems at all levels, and features tested strategies that facilitate accessibility, efficiency, effectiveness, and enhanced outcomes. At its most basic level, this model, the Dance of Caring Persons, expresses the fundamental beliefs and attitudes that each person in the healthcare system lives caring meaningfully in unique and valuable ways, and the contributions of each person to the whole of the enterprise have a significant place within it. The book features successful examples of how various units of the healthcare system can apply specific strategies to their inter- and intra-professional work, and how to engage and sustain authentic dialogue among and between stakeholders. Chapters feature information from a great variety of health professionals that represent a broad range of participants in healthcare. Detailed information is presented in a variety of formats ranging from formal written responses to chapter contents to transcriptions of small group conversations relating to the topic at hand. The book reflects the interests of such major stakeholders as patients and families, nurses, physicians and other primary and adjunctive care providers, ancillary service providers, administrators and managers, and all other individuals involved in the many aspects of organizational models and delivery of health care and human resource functions and outcomes. Each chapter includes questions to consider and suggested resources to help with implementation of strategies. The text incorporates professional standards and essentials from the Joint Commission, ANCC, and AACN (DNP). Key Features: Presents a theoretically grounded, proven caring-based model for healthcare system change for all stakeholders across the continuum of care Provides practical strategies for transformation in all aspects of a healthcare system applicable across the range of health services Describes how healthcare system change happens, who initiates it, and how to sustain it through caring science Includes success stories from patients and their families, nurses, physicians, ancillary service providers, healthcare administrators, and others Promotes inter- and intra-professional dialogue and collaboration


Book Synopsis Health Care System Transformation for Nursing and Health Care Leaders by : Anne Boykin, PhD, MN

Download or read book Health Care System Transformation for Nursing and Health Care Leaders written by Anne Boykin, PhD, MN and published by Springer Publishing Company. This book was released on 2013-09-10 with total page 253 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The authors' approach to creating a transforming culture through use of foundations laid in the theoretical development of "Nursing As Caring" offers a solid foundation upon which to recalibrate and reconfigure toward a caring organizational health system." -Tim Porter-O'Grady, DM, EdD, APRN, FAAN, FACCWS Associate Professor, Leadership Scholar, College of Nursing and Healthcare Innovation, Arizona State University Clinical Professor, Leadership Scholar, College of Nursing, The Ohio State University This is a time-tested, practical guide for nurses and other healthcare professionals who wish to transform their healthcare systems based on caring values and the promotion of intra- and inter-professional dialogue among stakeholders. It describes a theoretically grounded model created by nurses for transforming the culture of healthcare systems at all levels, and features tested strategies that facilitate accessibility, efficiency, effectiveness, and enhanced outcomes. At its most basic level, this model, the Dance of Caring Persons, expresses the fundamental beliefs and attitudes that each person in the healthcare system lives caring meaningfully in unique and valuable ways, and the contributions of each person to the whole of the enterprise have a significant place within it. The book features successful examples of how various units of the healthcare system can apply specific strategies to their inter- and intra-professional work, and how to engage and sustain authentic dialogue among and between stakeholders. Chapters feature information from a great variety of health professionals that represent a broad range of participants in healthcare. Detailed information is presented in a variety of formats ranging from formal written responses to chapter contents to transcriptions of small group conversations relating to the topic at hand. The book reflects the interests of such major stakeholders as patients and families, nurses, physicians and other primary and adjunctive care providers, ancillary service providers, administrators and managers, and all other individuals involved in the many aspects of organizational models and delivery of health care and human resource functions and outcomes. Each chapter includes questions to consider and suggested resources to help with implementation of strategies. The text incorporates professional standards and essentials from the Joint Commission, ANCC, and AACN (DNP). Key Features: Presents a theoretically grounded, proven caring-based model for healthcare system change for all stakeholders across the continuum of care Provides practical strategies for transformation in all aspects of a healthcare system applicable across the range of health services Describes how healthcare system change happens, who initiates it, and how to sustain it through caring science Includes success stories from patients and their families, nurses, physicians, ancillary service providers, healthcare administrators, and others Promotes inter- and intra-professional dialogue and collaboration

Transforming Health Care Leadership

Transforming Health Care Leadership

Author: Michael Maccoby

Publisher: John Wiley & Sons

Published: 2013-07-29

Total Pages: 416

ISBN-13: 1118603672

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Health care organizations are challenged to improve care at the bedside for patients, learn from individual patients to improve population health, and reduce per capita costs. To achieve these aims, leaders are needed in all parts of the organization need positive solutions. Transforming Health Care Leadership provides healthcare leaders with the knowledge and tools to master the unprecedented level of change that health care organizations and their leaders now face. It also challenges management myths that served in bureaucracies but mislead in learning organizations.


Book Synopsis Transforming Health Care Leadership by : Michael Maccoby

Download or read book Transforming Health Care Leadership written by Michael Maccoby and published by John Wiley & Sons. This book was released on 2013-07-29 with total page 416 pages. Available in PDF, EPUB and Kindle. Book excerpt: Health care organizations are challenged to improve care at the bedside for patients, learn from individual patients to improve population health, and reduce per capita costs. To achieve these aims, leaders are needed in all parts of the organization need positive solutions. Transforming Health Care Leadership provides healthcare leaders with the knowledge and tools to master the unprecedented level of change that health care organizations and their leaders now face. It also challenges management myths that served in bureaucracies but mislead in learning organizations.

Leading Health Care Transformation

Leading Health Care Transformation

Author: Maulik Joshi DrPH

Publisher: CRC Press

Published: 2015-07-06

Total Pages: 222

ISBN-13: 1498700195

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A succinct and practical primer on healthcare transformation, Leading Healthcare Transformation is a key resource for all clinicians in leadership positions. It summarizes high-profile healthcare topics and includes a synopsis of the evidence, examples, lessons learned, and key action steps for each topic covered.Providing cutting-edge insights fro


Book Synopsis Leading Health Care Transformation by : Maulik Joshi DrPH

Download or read book Leading Health Care Transformation written by Maulik Joshi DrPH and published by CRC Press. This book was released on 2015-07-06 with total page 222 pages. Available in PDF, EPUB and Kindle. Book excerpt: A succinct and practical primer on healthcare transformation, Leading Healthcare Transformation is a key resource for all clinicians in leadership positions. It summarizes high-profile healthcare topics and includes a synopsis of the evidence, examples, lessons learned, and key action steps for each topic covered.Providing cutting-edge insights fro

The Future of Nursing

The Future of Nursing

Author: Institute of Medicine

Publisher: National Academies Press

Published: 2011-02-08

Total Pages: 700

ISBN-13: 0309208955

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The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.


Book Synopsis The Future of Nursing by : Institute of Medicine

Download or read book The Future of Nursing written by Institute of Medicine and published by National Academies Press. This book was released on 2011-02-08 with total page 700 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Future of Nursing explores how nurses' roles, responsibilities, and education should change significantly to meet the increased demand for care that will be created by health care reform and to advance improvements in America's increasingly complex health system. At more than 3 million in number, nurses make up the single largest segment of the health care work force. They also spend the greatest amount of time in delivering patient care as a profession. Nurses therefore have valuable insights and unique abilities to contribute as partners with other health care professionals in improving the quality and safety of care as envisioned in the Affordable Care Act (ACA) enacted this year. Nurses should be fully engaged with other health professionals and assume leadership roles in redesigning care in the United States. To ensure its members are well-prepared, the profession should institute residency training for nurses, increase the percentage of nurses who attain a bachelor's degree to 80 percent by 2020, and double the number who pursue doctorates. Furthermore, regulatory and institutional obstacles-including limits on nurses' scope of practice-should be removed so that the health system can reap the full benefit of nurses' training, skills, and knowledge in patient care. In this book, the Institute of Medicine makes recommendations for an action-oriented blueprint for the future of nursing.

Transforming Health Care

Transforming Health Care

Author: Charles Kenney

Publisher: CRC Press

Published: 2010-11-08

Total Pages: 248

ISBN-13: 1439863091

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For decades, the manufacturing industry has employed the Toyota Production System the most powerful production method in the world to reduce waste, improve quality, reduce defects and increase worker productivity. In 2001, Virginia Mason Medical Center, an integrated healthcare delivery system in Seattle, Washington set out to achieve its compe


Book Synopsis Transforming Health Care by : Charles Kenney

Download or read book Transforming Health Care written by Charles Kenney and published by CRC Press. This book was released on 2010-11-08 with total page 248 pages. Available in PDF, EPUB and Kindle. Book excerpt: For decades, the manufacturing industry has employed the Toyota Production System the most powerful production method in the world to reduce waste, improve quality, reduce defects and increase worker productivity. In 2001, Virginia Mason Medical Center, an integrated healthcare delivery system in Seattle, Washington set out to achieve its compe

Team Leadership and Partnering in Nursing and Health Care

Team Leadership and Partnering in Nursing and Health Care

Author: Cynthia Armstrong Persily, PhD, RN, FAAN

Publisher: Springer Publishing Company

Published: 2013-06-28

Total Pages: 271

ISBN-13: 0826199895

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"I enjoyed this book. It provides excellent information on the current use of healthcare teams and partnerships. It is a worthwhile resource for anyone interested in developing and working with healthcare teams." Score: 100, 5 Stars.--Doody's Medical Reviews Teamwork is an undisputed asset for reducing nursing and medical errors, improving quality of patient care, resolving workload issues, and avoiding burnout. This text helps to foster the leadership expertise and partnerships that will facilitate the delivery of the highest-quality care. It based on the time-tested wisdom that leadership knowledge, skills and, competencies gained by training a group of nurses in the same organization rather than a single nurse are much more likely to result in genuine organizational transformation. It is the only text available to focus in depth on building and maintaining effective partnerships, motivating and developing others in the team, organizational analysis, strategizing, communicating, planning and managing change, measuring team and partnership effectiveness through metrics, and leveraging results within and outside of the organization. Case studies across a variety of organizations and environments and drawn from years of nursing team and leadership training, illuminate key points and provide readers with real life examples of the application of key concepts. These include such scenarios as developing a team to create, implement and evaluate a nurse residency program in a large tertiary hospital; creating a cross-agency public health team to plan and deploy rural H1N1 responses; founding a multi-campus team for the creation and implementation of a new BSN curriculum; and leadership in a partnership to support the legislative creation of a nursing workforce center. Learning objectives, tables, charts, models, and questions for thought in each chapter reinforce information in the text. Plentiful references provide opportunities for further study. Authored by a noted expert in education, team building, and policy making in nursing and health care, the book will be of value to emerging and seasoned leaders and graduate educators and students, including CNL, DNP, and NPs. Key Features: Examines, in depth, team leadership and professional, clinical, and educational partnering in and for nursing Features real-life case studies in diverse practice and academic centers Offers a practical approach to applying team leadership and partnership concepts when facilitating health care change Reviews team models and skills, how to take action, issues and challenges along the way, measuring results, and applying leverage to sustain gains Presents information in a concise, step-by-step format replete with learning objectives, tables, charts, and questions for thought


Book Synopsis Team Leadership and Partnering in Nursing and Health Care by : Cynthia Armstrong Persily, PhD, RN, FAAN

Download or read book Team Leadership and Partnering in Nursing and Health Care written by Cynthia Armstrong Persily, PhD, RN, FAAN and published by Springer Publishing Company. This book was released on 2013-06-28 with total page 271 pages. Available in PDF, EPUB and Kindle. Book excerpt: "I enjoyed this book. It provides excellent information on the current use of healthcare teams and partnerships. It is a worthwhile resource for anyone interested in developing and working with healthcare teams." Score: 100, 5 Stars.--Doody's Medical Reviews Teamwork is an undisputed asset for reducing nursing and medical errors, improving quality of patient care, resolving workload issues, and avoiding burnout. This text helps to foster the leadership expertise and partnerships that will facilitate the delivery of the highest-quality care. It based on the time-tested wisdom that leadership knowledge, skills and, competencies gained by training a group of nurses in the same organization rather than a single nurse are much more likely to result in genuine organizational transformation. It is the only text available to focus in depth on building and maintaining effective partnerships, motivating and developing others in the team, organizational analysis, strategizing, communicating, planning and managing change, measuring team and partnership effectiveness through metrics, and leveraging results within and outside of the organization. Case studies across a variety of organizations and environments and drawn from years of nursing team and leadership training, illuminate key points and provide readers with real life examples of the application of key concepts. These include such scenarios as developing a team to create, implement and evaluate a nurse residency program in a large tertiary hospital; creating a cross-agency public health team to plan and deploy rural H1N1 responses; founding a multi-campus team for the creation and implementation of a new BSN curriculum; and leadership in a partnership to support the legislative creation of a nursing workforce center. Learning objectives, tables, charts, models, and questions for thought in each chapter reinforce information in the text. Plentiful references provide opportunities for further study. Authored by a noted expert in education, team building, and policy making in nursing and health care, the book will be of value to emerging and seasoned leaders and graduate educators and students, including CNL, DNP, and NPs. Key Features: Examines, in depth, team leadership and professional, clinical, and educational partnering in and for nursing Features real-life case studies in diverse practice and academic centers Offers a practical approach to applying team leadership and partnership concepts when facilitating health care change Reviews team models and skills, how to take action, issues and challenges along the way, measuring results, and applying leverage to sustain gains Presents information in a concise, step-by-step format replete with learning objectives, tables, charts, and questions for thought

EBOOK: Leadership For Nursing And Allied Health Care Professions

EBOOK: Leadership For Nursing And Allied Health Care Professions

Author: Veronica Bishop

Publisher: McGraw-Hill Education (UK)

Published: 2009-03-16

Total Pages: 192

ISBN-13: 033523917X

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"Good leadership is more creative and satisfying than simply managing. But it takes a book as good as this to help us realise that. Wherever you are in your career - this book offers a great deal to inspire and to provoke thought. We could all learn from it." Nursing Standard "This book is timely. The increasing emphasis on the need for good leadership is signalled by the establishment across the world of new leadership development initiatives. In the United Kingdom, for example, this includes the new NHS National Leadership Council that will champion the transformation of leadership capacity and capability across the healthcare system. Effective leadership is crucial for improving the quality of care for patients and others and for developing staff. This highly readable and informative book, written by experts in the field, will be of interest to all nursing and allied health professionals, particularly those aspiring and emerging leaders." Professor David R Thompson, University of Leicester, UK "This is a book that all students studying leadership in health care have been waiting for. It provides an excellent broad perspective on aspects of leadership common to all disciplines. It aims to empower all health care providers to fully realise their potential as a leader and demonstrates how this can be achieved in reality. It is inspirational, exciting to read with its many different case studies, exercises to bring about reflection and should result in a more empowered and enlightened work force." Phil Halligan, University College Dublin, Ireland "With the increased focus on clinical leadership this book is a welcome addition to the vast array of leadership books currently available and will appeal to a wide range of practising clinicians looking for an introduction to the subject. The use of historical case studies allows comparison of leadership styles of a range of well known figures and sets the scene for an exploration of some of the multitude of leadership theories that are available in the literature ... Readers who are currently practising clinicians, regardless of profession, should use this opportunity to 'stand up and be counted' and to take forward the leadership agenda in their professions for the benefit of patients and inform future practice and knowledge." Mark Sewell, Postgraduate Student, University of Birmingham/University of Manchester, UK It is time to take stock, to promote and support our articulate and strategic thinkers, and to let them shine! This inspiring book is a wake-up call to nurses and allied health professionals to develop their leadership skills and to make a real difference to global health and social development. Veronica Bishop uses high profile historical case studies to illustrate the concept of leadership and put it into a context that is easily understood. The book demystifies the key elements of leadership, highlights the difference between leadership and management and identifies the essential components for successful leadership amongst health care professionals. The book incorporates: A new research based theory of leadership that embraces clinical excellence Educational and practice based concepts to support key leadership skills Case examples of real experiences Exercises for developing your own leadership skills at the end of each chapter Contributions from experts from a wide range of countries and with diverse knowledge bases make a topic that is often presented as highly complex and 'out of reach' readily accessible. Leadership for Nursing and Allied Health Care Professions is key reading for all nurses and allied health care professionals aspiring to be leaders. Contributors: Sue Antrobus, Mary Lovegrove, Annie Macleod, Abigail Masterson, Dawn Freshwater, Iain Graham, Philip Esterhuizen, David Stanley, Mike Saks, Veronica Bishop, Tyrone Goh. With a foreword by Tony Butterworth.


Book Synopsis EBOOK: Leadership For Nursing And Allied Health Care Professions by : Veronica Bishop

Download or read book EBOOK: Leadership For Nursing And Allied Health Care Professions written by Veronica Bishop and published by McGraw-Hill Education (UK). This book was released on 2009-03-16 with total page 192 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Good leadership is more creative and satisfying than simply managing. But it takes a book as good as this to help us realise that. Wherever you are in your career - this book offers a great deal to inspire and to provoke thought. We could all learn from it." Nursing Standard "This book is timely. The increasing emphasis on the need for good leadership is signalled by the establishment across the world of new leadership development initiatives. In the United Kingdom, for example, this includes the new NHS National Leadership Council that will champion the transformation of leadership capacity and capability across the healthcare system. Effective leadership is crucial for improving the quality of care for patients and others and for developing staff. This highly readable and informative book, written by experts in the field, will be of interest to all nursing and allied health professionals, particularly those aspiring and emerging leaders." Professor David R Thompson, University of Leicester, UK "This is a book that all students studying leadership in health care have been waiting for. It provides an excellent broad perspective on aspects of leadership common to all disciplines. It aims to empower all health care providers to fully realise their potential as a leader and demonstrates how this can be achieved in reality. It is inspirational, exciting to read with its many different case studies, exercises to bring about reflection and should result in a more empowered and enlightened work force." Phil Halligan, University College Dublin, Ireland "With the increased focus on clinical leadership this book is a welcome addition to the vast array of leadership books currently available and will appeal to a wide range of practising clinicians looking for an introduction to the subject. The use of historical case studies allows comparison of leadership styles of a range of well known figures and sets the scene for an exploration of some of the multitude of leadership theories that are available in the literature ... Readers who are currently practising clinicians, regardless of profession, should use this opportunity to 'stand up and be counted' and to take forward the leadership agenda in their professions for the benefit of patients and inform future practice and knowledge." Mark Sewell, Postgraduate Student, University of Birmingham/University of Manchester, UK It is time to take stock, to promote and support our articulate and strategic thinkers, and to let them shine! This inspiring book is a wake-up call to nurses and allied health professionals to develop their leadership skills and to make a real difference to global health and social development. Veronica Bishop uses high profile historical case studies to illustrate the concept of leadership and put it into a context that is easily understood. The book demystifies the key elements of leadership, highlights the difference between leadership and management and identifies the essential components for successful leadership amongst health care professionals. The book incorporates: A new research based theory of leadership that embraces clinical excellence Educational and practice based concepts to support key leadership skills Case examples of real experiences Exercises for developing your own leadership skills at the end of each chapter Contributions from experts from a wide range of countries and with diverse knowledge bases make a topic that is often presented as highly complex and 'out of reach' readily accessible. Leadership for Nursing and Allied Health Care Professions is key reading for all nurses and allied health care professionals aspiring to be leaders. Contributors: Sue Antrobus, Mary Lovegrove, Annie Macleod, Abigail Masterson, Dawn Freshwater, Iain Graham, Philip Esterhuizen, David Stanley, Mike Saks, Veronica Bishop, Tyrone Goh. With a foreword by Tony Butterworth.

Physician Leadership

Physician Leadership

Author: Mo Kasti

Publisher:

Published: 2015-03-13

Total Pages: 136

ISBN-13: 9781612442167

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When medicine meets leadership everything changes: the culture, the care, the way we collaborate, and most importantly, outcomes.


Book Synopsis Physician Leadership by : Mo Kasti

Download or read book Physician Leadership written by Mo Kasti and published by . This book was released on 2015-03-13 with total page 136 pages. Available in PDF, EPUB and Kindle. Book excerpt: When medicine meets leadership everything changes: the culture, the care, the way we collaborate, and most importantly, outcomes.

Quantum Leadership:Creating Sustainable Value in Health Care

Quantum Leadership:Creating Sustainable Value in Health Care

Author: Tim Porter-O'Grady

Publisher: Jones & Bartlett Learning

Published: 2017-03-01

Total Pages: 634

ISBN-13: 1284143031

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Quantum Leadership: Creating Sustainable Value in Health Care, Fifth Edition provides students with a solid overview and understanding of leadership in today’s complex healthcare delivery system. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.


Book Synopsis Quantum Leadership:Creating Sustainable Value in Health Care by : Tim Porter-O'Grady

Download or read book Quantum Leadership:Creating Sustainable Value in Health Care written by Tim Porter-O'Grady and published by Jones & Bartlett Learning. This book was released on 2017-03-01 with total page 634 pages. Available in PDF, EPUB and Kindle. Book excerpt: Quantum Leadership: Creating Sustainable Value in Health Care, Fifth Edition provides students with a solid overview and understanding of leadership in today’s complex healthcare delivery system. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.

Leadership and the Advanced Practice Nurse

Leadership and the Advanced Practice Nurse

Author: Diane Whitehead

Publisher: F.A. Davis

Published: 2017-01-25

Total Pages: 292

ISBN-13: 0803642253

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Envision a better future… Be prepared to lead the way to better outcomes…for your patients, your team, your institution, and yourself. You’ll not only learn about leadership, but also how to use your skills to manage staff, implement policy changes, and to develop systems that deliver cost effective, quality-controlled care. The coverage encompasses the competencies required by the American Association of Colleges of Nursing in conjunction with major specialty nursing organizations. You’ll begin with the theories, models, and frameworks that provide the window through which to view leadership in the context of the regulations and standards that guide the delivery of care. Then, you’ll explore the importance of creating a culture that ensures safe, quality care, and learn how to plan and evaluate programs to affect change.


Book Synopsis Leadership and the Advanced Practice Nurse by : Diane Whitehead

Download or read book Leadership and the Advanced Practice Nurse written by Diane Whitehead and published by F.A. Davis. This book was released on 2017-01-25 with total page 292 pages. Available in PDF, EPUB and Kindle. Book excerpt: Envision a better future… Be prepared to lead the way to better outcomes…for your patients, your team, your institution, and yourself. You’ll not only learn about leadership, but also how to use your skills to manage staff, implement policy changes, and to develop systems that deliver cost effective, quality-controlled care. The coverage encompasses the competencies required by the American Association of Colleges of Nursing in conjunction with major specialty nursing organizations. You’ll begin with the theories, models, and frameworks that provide the window through which to view leadership in the context of the regulations and standards that guide the delivery of care. Then, you’ll explore the importance of creating a culture that ensures safe, quality care, and learn how to plan and evaluate programs to affect change.