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How to Manage an Assignment Despite Objection: 5 Tips for Facilities

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Nurses are legally accountable for the quality of care they provide to patients. Under that responsibility, they must ensure that they’re competent to provide the treatment necessary for each individual assigned to their care. While most supervisors attempt to allocate patients according to each nurse’s ability, there are instances where a nurse may believe that their assignment places themselves or their patients at risk.

In these situations, it is the nurse’s duty to complete an Assignment Despite Objection (ADO) form . You may be wondering — What does ADO paperwork look like, and what are the steps required to ensure the forms are completed appropriately?

In this article, we introduce the purpose of ADO forms, review an example scenario that highlights the ADO paperwork submission process, and list five tips for facilities looking to appropriately manage ADO situations to ensure staff protection and patient safety.

What Does Assignment Despite Objection Mean?

The term “Assignment Despite Objection” is used to describe a situation in which a nurse has been made responsible for an unmanageable patient load. Despite making it clear to unit leadership that the staff member feels unsafe, unqualified, or unsupported in managing the care of that particular assignment, they have been mandated to assume care for that assignment. A nurse may complete an ADO for a number of reasons, including:

• Being assigned to care for a number of patients that falls outside of any legal nurse-to-patient ratio .
• Feeling inexperienced or untrained in a particular area or specialty.
• Experiencing a shortage of support staff that would make the assignment manageable.
• Lacking sufficient safety equipment or machinery to provide care effectively.
• Being forced to work overtime or miss meal breaks.

ADO paperwork helps provide legal protection for nurses who believe they may be put in an unsafe patient care situation. “Whistleblowing” the potential for patient harm doesn’t completely remove liability from the nurse, but it does raise concerns for facility leadership and can put them on notice of elevated patient care risks. State nursing boards and nursing unions encourage staff to complete ADO paperwork to protect themselves and their patients.

What Does ADO Paperwork Look Like?

Each state nursing board or nursing union utilizes its own version of an ADO form , which covers employees working in that state. While they all vary in terms of layout or design, each form contains similar elements, including:

• The nurse’s name, license number, and place of employment.
• The supervisor’s name and date/time of notification.
• The reason for the nurse’s objection.
• The unit’s census details, including the number of patients and staff members.
• A space to outline any actual or potential patient harm that may have been caused.

Assignment Despite Objection: Example Scenario

The ADO process can seem confusing out of clinical context. The table below lists the steps involved when a nursing professional files an ADO, along with a scenario to help highlight the process in a realistic clinical situation.

Managing an ADO: 5 Tips for Facilities

As you review how the Assignment Despite Objection form submission process works, you’re probably looking for tips on how to effectively manage these situations in your unit or facility. Below, we review five key strategies for managing an ADO safely and effectively.

1. Ensure All Patient Assignments Meet Mandated State Staffing Ratios

A key step to keeping clinical operations running smoothly is to prevent ADO situations from arising in the first place. Adhering to your state’s legally mandated staffing ratios is the first step to ensuring compliance and safety .

2. Provide Staff Training on ADO Protocol

Many nurses might not be familiar with the ADO process. They may not know how to speak up if they find themselves in a situation where they aren’t able to practice safely or competently. One way to prevent this from happening is to include Assignment Despite Objection education as part of your employee onboarding training .

Be sure to show staff where to find the forms, explain how to complete them, and relay who to submit them to when necessary. This not only helps your staff feel empowered and supported, but also ensures that your patients receive the best possible care.

3. Encourage Team Cohesion

As the term “objection” implies, ADO submissions can become contentious if management and nursing staff perceive each other to be on separate teams. It’s important that both sides abandon the “them versus us” mentality and understand that the entire unit is focused on preserving staff and patient safety.

Team bonding activities can help to unite facility leadership and bedside staff and ensure that no side feels like they’re fighting against the other. Collaborative team meetings can also help clinical leaders and staff work side-by-side to discuss mutual issues and problem solve together.

4. Incorporate Per Diem and Float Pool Nurses to Cover Schedule Gaps

One of the most common reasons an ADO arises is due to short staffing . By utilizing flexible staffing solutions, you can ensure that all patient assignments can be safely distributed, even during high census.

Per diem nurses, who work only one or two shifts a week, could be added into the staffing matrix on busy shifts or during predictable nursing shortages like maternity leaves or staff vacations. Float pool nurses, alternatively, could be requested on short notice to assist with unpredictable staff shortages like sick calls.

5. Review Submitted ADO Paperwork to Plan Long-Term Solutions

The submission of an ADO form only means that the situation has been documented. It doesn’t mean that the situation was handled safely or that outcomes were improved.

Therefore, it’s essential that facility management reviews those forms and performs a root-cause analysis to prevent future improper patient assignments. Typically, this is done in unit leadership meetings or in a facility-wide shared governance committee .

Discover More Ways to Promote Patient Safety in Your Facility

Safely managing an Assignment Despite Objection situation prevents future patient harm and ensures your staff members practice safely and effectively. Follow along in our expertly-written newsletter for additional tips and strategies on encouraging employee engagement and optimizing care quality.

Legal Disclaimer: This article contains general legal information, but it is not intended to constitute professional legal advice for any particular situation and should not be relied on as professional legal advice. Any references to the law may not be current, as laws regularly change through updates in legislation, regulation, and case law at the federal and state level. Nothing in this article should be interpreted as creating an attorney-client relationship. If you have legal questions, you should seek the advice of an attorney licensed to practice in your jurisdiction.

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3.3 Assignment

Nursing team members working in inpatient or long-term care settings receive client assignments at the start of their shift. Assignment refers to routine care, activities, and procedures that are within the legal scope of practice of registered nurses (RN), licensed practical/vocational nurses (LPN/VN), or unlicensed assistive personnel (UAP). [1] Scope of practice for RNs and LPNs is described in each state’s Nurse Practice Act. Care tasks for UAP vary by state; regulations are typically listed on sites for the state’s Board of Nursing, Department of Health, Department of Aging, Department of Health Professions, Department of Commerce, or Office of Long-Term Care. [2]

See Table 3.3a for common tasks performed by members of the nursing team based on their scope of practice. These tasks are within the traditional role and training the team member has acquired through a basic educational program. They are also within the expectations of the health care agency during a shift of work. Agency policy can be more restrictive than federal or state regulations, but it cannot be less restrictive.

Client assignments are typically made by the charge nurse (or nurse supervisor) from the previous shift. A charge nurse is an RN who provides leadership on a client-care unit within a health care facility during their shift. Charge nurses perform many of the tasks that general nurses do, but also have some supervisory duties such as making assignments, delegating tasks, preparing schedules, monitoring admissions and discharges, and serving as a staff member resource. [3]

Table 3.3a. Nursing Team Members’ Scope of Practice and Common Tasks [4]

An example of a client assignment is when an RN assigns an LPN/VN to care for a client with stable heart failure. The LPN/VN collects assessment data, monitors intake/output throughout the shift, and administers routine oral medication. The LPN/VN documents this information and reports information back to the RN. This is considered the LPN/VN’s “assignment” because the skills are taught within an LPN educational program and are consistent with the state’s Nurse Practice Act for LPN/VN scope of practice. They are also included in the unit’s job description for an LPN/VN. The RN may also assign some care for this client to UAP. These tasks may include assistance with personal hygiene, toileting, and ambulation. The UAP documents these tasks as they are completed and reports information back to the RN or LPN/VN. These tasks are considered the UAP’s assignment because they are taught within a nursing aide’s educational program, are consistent with the UAP’s scope of practice for that state, and are included in the job description for the nursing aide’s role in this unit. The RN continues to be accountable for the care provided to this client despite the assignments made to other nursing team members.

Special consideration is required for UAP with additional training. With increased staffing needs, skills such as administering medications, inserting Foley catheters, or performing injections are included in specialized training programs for UAP. Due to the impact these skills can have on the outcome and safety of the client, the National Council of State Board of Nursing (NCSBN) recommends these activities be considered delegated tasks by the RN or nurse leader. By delegating these advanced skills when appropriate, the nurse validates competency, provides supervision, and maintains accountability for client outcomes. Read more about delegation in the “ Delegation ” section of this chapter.

When making assignments to other nursing team members, it is essential for the RN to keep in mind specific tasks that cannot be delegated to other nursing team members based on federal and/or state regulations. These tasks include, but are not limited to, those tasks described in Table 3.3b.

Table 3.3b. Examples of Tasks Outside the Scope of Practice of Nursing Assistive Personnel

As always, refer to each state’s Nurse Practice Act and other state regulations for specific details about nursing team members’ scope of practice when providing care in that state.

Find and review Nurse Practice Acts by state at https://www.ncsbn.org/policy/npa.page .

Read more about the Wisconsin’s Nurse Practice Act and the standards and scope of practice for RNs and LPNs at Wisconsin’s Legislative Code Chapter N6.

Read more about scope of practice, skills, and practices of nurse aides in Wisconsin at DHS 129.07 Standards for Nurse Aide Training Programs.

• American Nurses Association and NCSBN. (2019). National guidelines for nursing delegation . https://www.ncsbn.org/public-files/NGND-PosPaper_06.pdf ↵
• McMullen, T. L., Resnick, B., Chin-Hansen, J., Geiger-Brown, J. M., Miller, N., & Rubenstein, R. (2015). Certified nurse aide scope of practice: State-by-state differences in allowable delegated activities. Journal of the American Medical Directors Association, 16 (1), 20–24. https://doi.org/10.1016/j.jamda.2014.07.003 ↵
• RegisteredNursing.org. (2021, April 13). What is a charge nurse? https://www.registerednursing.org/specialty/charge-nurse/ ↵
• RegisteredNursing.org. (2021, January 27). Assignment, delegation and supervision: NCLEX-RN. https://www.registerednursing.org/nclex/assignment-delegation-supervision/ ↵
• State of Wisconsin Department of Health Services. (2018). Medication administration by unlicensed assistive personnel (UAP): Guidelines for registered nurses delegating medication administration to unlicensed assistive personnel. https://www.dhs.wisconsin.gov/publications/p01908.pdf ↵

Routine care, activities, and procedures that are within the authorized scope of practice of the RN, LPN/VN, or routine functions of the assistive personnel.

Making adjustments to medication dosage per an established protocol to obtain a desired therapeutic outcome.

Nursing Management and Professional Concepts 2e Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

The Ultimate Guide to Nursing Assignments: 7 Tips and Strategies

Nursing assignments are a critical component of every nursing student’s academic journey. They serve as opportunities to test your knowledge, apply theoretical concepts to real-world scenarios, and develop essential skills necessary for your future nursing career. However, tackling nursing assignments can often be overwhelming, particularly when you’re juggling multiple responsibilities. In this comprehensive guide, we provide valuable tips, strategies, and expert assignment help services to help you excel in your nursing assignments. Whether you’re struggling with research, structuring your assignment, or proofreading, we’re here to support you every step of the way.

Understanding the Nursing Assignments

To excel in nursing assignments , it’s crucial to start by thoroughly understanding the requirements. Take the time to carefully read the assignment prompt, paying close attention to the topic, word count, formatting guidelines, and any specific instructions provided by your instructor. Understanding these key components will ensure that you meet all the necessary criteria.

Conducting Thorough Research

Once you have a clear understanding of the assignment, it’s time to conduct thorough research. Solid research forms the foundation of any successful nursing assignment. Begin by gathering relevant and credible sources, such as nursing textbooks, scholarly articles, reputable websites , and academic databases specific to nursing. These resources will provide you with evidence-based information to support your arguments and demonstrate your understanding of the topic.

Creating a Well-Structured Outline

A well-structured outline is essential for organizing your thoughts and ensuring a logical flow in your nursing assignment. An effective outline acts as a roadmap, guiding you through the writing process and ensuring that you cover all the necessary points.

At [Your Service Name], our expert writers can assist you in creating a comprehensive outline tailored to your specific assignment. By collaborating with us, you can receive personalized guidance in organizing your ideas effectively and structuring your assignment in a logical manner. Our writers understand the nuances of nursing assignments and can help you identify the most important concepts and supporting evidence to include.

Using a Professional Tone

Maintaining a professional tone throughout your nursing assignment is crucial. As aspiring healthcare professionals, it’s essential to communicate your ideas with clarity, conciseness, and professionalism. Use clear and concise language, avoiding jargon or slang that may hinder the reader’s understanding. Present your arguments and supporting evidence in a logical and coherent manner, demonstrating your ability to think critically and apply nursing principles.

Our expert writers have extensive experience in academic writing within the field of nursing. They possess a deep understanding of the professional tone required for nursing assignments and can ensure that your assignment is written to the highest standards. By collaborating with us, you can receive guidance in maintaining a professional tone and effectively conveying your ideas.

Incorporating Practical Examples

In addition to a professional tone, incorporating practical examples into your nursing assignment can greatly enhance its quality. Practical examples bring theoretical concepts to life, illustrating their application in real-life scenarios. They demonstrate your understanding of nursing principles and showcase your ability to bridge the gap between theory and practice.

Our team consists of experienced nursing professionals who can assist you in incorporating relevant practical examples into your assignment. Drawing from their extensive knowledge and expertise, they can provide you with real-life scenarios or case studies that strengthen the impact and credibility of your work. By collaborating with us, you can elevate the quality of your assignment by demonstrating your ability to apply nursing concepts in practical settings.

Proofreading and Editing

Proofreading and editing are essential steps in the assignment writing process. They ensure that your nursing assignment is polished, error-free, and effectively communicates your ideas. After completing the initial draft, it’s crucial to take a break and return to your work with fresh eyes. During the proofreading stage, carefully review your assignment for grammar, spelling, punctuation, and sentence structure. Correct any errors and inconsistencies that may affect the clarity and professionalism of your writing.

At nursingresearchhelp.com , we have a dedicated team of proofreaders and editors who specialize in nursing assignments. They meticulously review your work, ensuring that it adheres to formatting guidelines and meets the highest standards of academic writing. Our proofreaders and editors will help you refine your assignment, ensuring that it is polished and error-free. By collaborating with us, you can rest assured that your assignment will be thoroughly reviewed and refined before submission.

Seeking Help When Needed

In addition to proofreading and editing, it’s important to seek help when needed. Nursing assignments can be challenging, and it’s perfectly normal to require assistance. Whether you’re facing difficulties in understanding the assignment prompt, need guidance in specific areas, or simply want a fresh perspective on your work, don’t hesitate to reach out for support.

Our friendly and knowledgeable support team is always available to address any questions or concerns you may have. We understand the unique challenges faced by nursing students and can provide you with the guidance and clarification you need. By seeking help when needed, you can overcome obstacles and ensure the successful completion of your nursing assignments.

Mastering nursing assignments is within your reach with the right tips, strategies, and expert assignment help services. At nursingresearchhelp.com we are committed to supporting nursing students in excelling in their academic pursuits. Our experienced writers, proofreaders, and editors can provide personalized assistance throughout the assignment writing process, ensuring that your assignments meet the highest standards of quality and professionalism.

With our help, you can confidently tackle your nursing assignments and overcome any challenges you may face. Visit our website nursingresearchhelp.com to learn more about our services and how we can support you in achieving academic excellence. Whether you need guidance in understanding the assignment, conducting thorough research, creating a well-structured outline, using a professional tone, incorporating practical examples, or ensuring a polished final product, we are here to assist you. Trust us for reliable and professional assignment help tailored to your needs.

Don’t let the challenges of nursing assignments hold you back—reach out to us for reliable and professional assignment help tailored to your needs.

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Common Assignments: Writing in Nursing

Although there may be some differences in writing expectations between disciplines, all writers of scholarly work are required to follow basic writing standards such as writing clear, concise, and grammatically correct sentences; using proper punctuation; demonstrating critical thought; and, in all Walden programs, using APA style. When writing in nursing, however, students must also be familiar with the goals of the discipline and discipline-specific writing expectations.

Nurses are primarily concerned about providing quality care to patients and their families, and this demands both technical knowledge and the appropriate expression of ideas (“Writing in nursing,” n.d). As a result, nursing students are expected to learn how to present information succinctly, and even though they may often use technical medical terminology (“Writing in nursing,” n.d.), their work should be accessible to anyone who may read it. Among many goals, writers within this discipline are required to:

• Document knowledge/research
• Demonstrate critical thinking
• Express creative ideas
• Explore nursing literature
• Demonstrate understanding of learning activities. (Wagner, n.d., para. 2)

Given this broad set of objectives, nursing students would benefit from learning how to write diverse literature, including scholarly reports, reviews, articles, and so on. They should aim to write work that can be used in both the research and clinical aspects of the discipline. Walden instructors often ask nursing students to write position and reflective papers, critique articles, gather and analyze data, respond to case studies, and work collaboratively on a project. Although there may be differences between the writing expectations within the classroom and those in the workplace, the standards noted below, though more common in scholarly writing, require skills that are transferrable to the work setting.

Because one cannot say everything there is to say about a particular subject, writers present their work from a particular perspective. For instance, one might choose to examine the shortage of nurses from a public policy perspective. One’s particular contribution, position, argument, or viewpoint is commonly referred to as the thesis and, according to Gerring et al. (2004), a good thesis is one that is “new, true, and significant” (p. 2). To strengthen a thesis, one might consider presenting an argument that goes against what is currently accepted within the field while carefully addressing counterarguments and adequately explaining why the issue under consideration matters (Gerring et al., 2004). The thesis is particularly important because readers want to know whether the writer has something new or worthwhile to say about the topic. Thus, as you review the literature, before writing, it is important to find gaps and creative linkages between viewpoints with the goal of contributing innovative ideas to an ongoing discussion. For a contribution to be worthwhile you must read the literature carefully and without bias; doing this will enable you to identify some of the subtle differences in the viewpoints presented by different authors and help you to better identify the gaps in the literature. Because the thesis is essentially the heart of your discussion, it is important that it is argued objectively and persuasively.

With the goal of providing high quality care, the healthcare industry places a premium on rigorous research as the foundation for evidence-based practices. Thus, students are expected to keep up with the most current research in their field and support the assertions they make in their work with evidence from the literature. Nursing students also must learn how to evaluate evidence in nursing literature and identify the studies that answer specific clinical questions (Oermann & Hays, 2011). Writers are also expected to critically analyze and evaluate studies and assess whether findings can be used in clinical practice (Beyea & Slattery, 2006). (Some useful and credible sources include journal articles, other peer-reviewed sources, and authoritative sources that might be found on the web. If you need help finding credible sources contact a librarian.)

Like other APA style papers, research papers in nursing should follow the following format: title, abstract, introduction, literature review, method, results, discussion, references, and appendices (see APA 7, Sections 2.16-2.25). Note that the presentation follows a certain logic: In the introduction one presents the issue under consideration; in the literature review, one presents what is already known about the topic (thus providing a context for the discussion), identifies gaps, and presents one’s approach; in the methods section, one would then identify the method used to gather data; and in the results and discussion sections, one then presents and explains the results in an objective manner, noting the limitations of the study (Dartmouth Writing Program, 2005). Note that not all papers need to be written in this manner; for guidance on the formatting of a basic course paper, see the appropriate template on our website.

In their research, nursing researchers use quantitative, qualitative, or mixed methods. In quantitative studies, researchers rely primarily on quantifiable data; in qualitative studies, they use data from interviews or other types of narrative analyses; and in mixed methods studies, they use both qualitative and quantitative approaches. A researcher should be able to pose a researchable question and identify an appropriate research method. Whatever method the researcher chooses, the research must be carried out in an objective and scientific manner, free from bias. Keep in mind that your method will have an impact on the credibility of your work, so it is important that your methods are rigorous. Walden offers a series of research methods courses to help students become familiar with the various research methods.

Instructors expect students to master the content of the discipline and use discipline- appropriate language in their writing. In practice, nurses may be required to become familiar with standardized nursing language as it has been found to lead to the following:

• better communication among nurses and other health care providers,
• increased visibility of nursing interventions,
• improved patient care,
• enhanced data collection to evaluate nursing care outcomes,
• greater adherence to standards of care, and
• facilitated assessment of nursing competency. (Rutherford, 2008)

Like successful writers in other disciplines and in preparation for diverse roles within their fields, in their writing nursing students should demonstrate that they (a) have cultivated the thinking skills that are useful in their discipline, (b) are able to communicate professionally, and (c) can incorporate the language of the field in their work appropriately (Colorado State University, 2011).

If you have content-specific questions, be sure to ask your instructor. The Writing Center is available to help you present your ideas as effectively as possible.

Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation . http://www.hcmarketplace.com/supplemental/3737_browse.pdf

Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm

Dartmouth Writing Program. (2005). Writing in the social sciences . http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml

Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing , 13 (1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html

Wagner, D. (n.d.). Why writing matters in nursing . https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/

Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html

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Nursing School Assignments and Tips to Ace All of Them

If you are about to start nursing school or considering enrolling in a nursing program, you would want to know what to expect. You will write many papers in nursing school and do many other assignments. This is true whether you pursue ADN, BSN, MSN, DNP, or PhD in Nursing.

Before we delve into the types of assignments and papers to expect in nursing school, let us begin by dispelling the myth that nursing school is hell; it is NOT. Instead, it is a beautiful and exciting journey into a noble profession. It entails a commitment to life-long continuous learning for you to grow.

Nursing school writing assignments are an excellent way for students to understand concepts taught in the classroom. You might wonder what kinds of assignments nursing students do. These assignments come in various forms and help students build critical thinking, creativity, research, clinical reasoning, and problem-solving skills that are critical in clinical settings.

This blog post looks at the diverse assignments you should expect or will cover in nursing school, including some tips to help you ace them and get better grades.

Common Nursing School Writing Assignments

Classwork forms the core of most nursing programs. You must have high-quality assignment submissions to attain better grades in nursing school. As soon as you decide to become a nursing student, you sign up for a marathon of writing different types of papers.

Whether you love or hate it, you will write papers before graduating from nursing school; that is the norm. Although not so many, you will encounter a few homework and assignments where you must submit a well-researched, formatted, and organized nursing paper.

The typical nursing school assignments include essays, research papers, term papers, and case studies. Others are article critiques/reviews, critical appraisal, evidence synthesis tables (synthesis matrix), PowerPoint Presentations, posters, discussion posts/ responses, and policy analysis papers. Other advanced papers include nursing care plans, SBAR template papers, evidence-based papers, capstone projects, theses, dissertations, proposals, etc.

These assignments are submitted either individually or as a group. Let us expound on this so you have a clear picture.

Essays for nursing classes come in various forms, including admission essays , scholarship essays, descriptive essays, persuasive essays, speech essays, expository essays, and narrative essays.

Notably, nursing essays focus on a single perspective, argument, or idea, which constantly forms the thesis of the paper.

Nursing essays focus on various topics relating to nursing practice and the broader healthcare field. You can write an essay examining a nursing theory or non-nursing theory or discuss a nursing issue .

Some essays, such as reflective nursing essays, use reflective models to reflect, analyze, and understand personal and professional encounters during clinical practice.

Each nursing essay should demonstrate your understanding of the topic, critical analysis, and organization skills. Besides, you should use evidence from peer-reviewed scholarly sources to support your arguments and ideas.

Discussion Board Posts

If you pursue a hybrid or exclusively online nursing program, you will be assigned to write weekly discussion forum posts and responses. Discussion board posts are short essay-like assignments posted in a threaded format so students can discuss nursing and healthcare topics.

You will write an original discussion post, between 200 and 300 words long, and post it on the forum. You are also expected to write a peer-response post in response to or to comment on an original post done by your peers.

Discussion boards help nursing students advance theoretical concepts, learn from one another, share ideas, and get feedback that can help them advance their knowledge in clinical reasoning and practice.

Research Papers

Nursing practice is evidence-driven, translating evidence into practice to ensure quality, accessible, and affordable healthcare. As such, nursing research takes precedence during studies and when practicing.

Nursing professors assign nursing students to write research papers on various evidence-based practice topics. The students must prove their worth by researching, analyzing, and organizing facts.

Related Writing Guides:

• How to write a nursing school research paper.
• Systematic Reviews vs Literature Review

Research papers help student nurses to review literature, conduct research, implement solutions, and draw evidence-based conclusions.

Research papers are critical in developing research and writing skills, maintaining good communication, and fostering creativity and clinical reasoning.

Potential nursing research paper topics can be quality improvement, healthcare/nursing informatics , healthcare policies, practice privileges, nursing ethics, ethical dilemmas , pathophysiology, and epidemiology .

Term Papers

In nursing school, a term paper is a type of assignment completed and submitted toward the end of the semester.

Usually, a professor can assign you a specific term paper topic, or they can let you choose a topic and consult with them for approval.

Term papers can be done individually or as a group project. A term paper has an impact on your final grade.

You should use credible scholarly sources published within the last five years for recent information.

Besides, also ensure that you plan your time well, do everything as per the instructions, and submit the nursing term paper before the deadline.

A term paper can also be a nursing process change report that is expected to address an area that needs change.

Case Studies

Nursing school case study assignments are an essential learning tool.

Most professors assign hypothetical clinical case studies or case scenarios (snippets) to test your clinical reasoning skills.

As a nursing educational tool, nursing case studies help you to develop practical, theoretical knowledge by simulating real-world experiences.

When analyzing a case study, you must use concepts and knowledge from class and class text to assess a patient, plan and implement care, and evaluate the outcomes.

Sometimes, you encounter simulated or digital clinical experience case studies such as iHuman and Shadow Health .

You should be very keen when analyzing a case study and when writing the analysis report.

Case studies help you get beyond books and use your creativity, clinical reasoning, problem-solving, and analytical skills to apply theoretical knowledge to real-world problems.

Your professor can give you a case study of a patient presenting with a given condition and expect you to take them through the care planning process, including admission and discharge, as you would in a real healthcare setting.

Other times, you can be asked to develop a hypothetical case study of a patient presenting with a chronic disease or a disorder and then use the case study guidelines, including head-to-toe assessment , diagnosis , nursing care planning , and discharge planning.

Related Guides:

• How to write a great nursing case study.
• How to complete a case conceptualization report (for psychiatric nursing students)

Nursing Care Plans and SOAP Notes

A nursing care plan can be part of a case study or a stand-alone assignment. Nursing care plans are essential in nursing education as they help students develop effective nursing care planning. Formulating a nursing care plan for a patient scenario or case helps treat them as you define the guidelines and roles of nurses in caring for the patient.

You also develop solid action plans for focused and patient-centred care by documenting the patient's needs. When they are part of an assignment, you can tabulate the nursing care plan using columns so that you explore every aspect independently.

Remember to use evidence from peer-reviewed scholarly sources when giving rationale.

The SOAP notes are a clinical tool healthcare professionals use to organize patient information to minimize confusion and assess, diagnose, and treat patients. Check our comprehensive guide on developing good SOAP Notes in nursing school .

Concept Maps

Another common nursing school assignment is concept maps. Concept mapping helps you visually organize, compartmentalize, and categorize information about nursing care planning, medical diagnosis, pathophysiology, SBAR, nursing responsibilities, etc.

A nursing concept map assignment equips you with strong critical thinking, analytical, and problem-solving skills. You also hone your clinical reasoning skills in the process.

Whether it is part of an assignment or a stand-alone, learn how to write great concept maps to score the best grades.

Concept Analysis Papers

If you are taking BSN, MSN, or DNP, you will likely be assigned to write a concept analysis paper. Make sure to distinguish this from a concept paper that is a proposal. A concept analysis paper examines the structure and function of a nursing concept.

The process entails a review of the literature and creativity in coming up with borderline, related, contrast, inverted, and illegitimate cases.

You also explore the antecedents and consequences of the concept before finalizing with empirical referents.

If you need to learn about the structure of a good concept analysis paper, check out our nursing concept analysis guide . We have listed concepts you can analyze depending on your speciality, instructions, and passion.

Capstone Projects

At an advanced stage in nursing school, students are expected to submit longer research papers; capstone project papers. A nursing capstone project is a final project that allows students to demonstrate the skills, knowledge, and concepts gained throughout the nursing program.

In nursing education, the capstone project typically covers an evidence-based practice issue or problem. You can write a nursing change paper, look into a clinical process, problem, or issue, and then develop recommendations based on a study.

Most of the MSN and DNP capstone projects focus on clinical change or quality improvement. You will be expected to develop a PICOT question and formulate a research study to examine the issue, implement a change process using evidence-based models, and make recommendations.

Nursing capstone projects are individual research projects based on nursing topics either of your professional or personal interest. You have to demonstrate competency and commitment to improve health outcomes.

Apart from capstone projects, you will also write a nursing thesis and dissertation papers, which depend on the program requirements and your professor's preferences.

Check out these specific writing guides for advanced papers:

• How to write a nursing dissertation or thesis
• Tips for choosing the best nursing dissertation topic
• How to write an excellent capstone project paper
• List of capstone project topics for nursing school
• How to formulate a PICOT question
• PICOT question examples to inspire nursing students

Group Assignments

In nursing school and practice, collaboration and teamwork are highly recommended. You will encounter collaborative group assignments such as presentations (PowerPoint slides, Prezi, or other platforms), simulation assignments, writing nursing reports, and group research projects.

Group projects allow you to research, learn, and organize ideas together so that you can understand concepts better. It is essential to avoid social loafing in a group to gain more. Besides, plan your time well and avoid excuses.

You can also be assigned to work on simulation exercises as a group of nursing students. The aim of such exercises is to build a collaborative, teamwork, and decision-making spirit among the team.

When in such groups, expect to work with your peers to assess the hypothetical patient, communicate with your peers, formulate a care plan, and manage any arising issues as you would in clinical settings. Do not take such activities for granted; they contribute significantly to your grade.

Presentations

Your professor can assign you to design a PowerPoint Slide accompanied by speaker notes and send it for grading or present it online or in class. Under presentations, you will also be requested to design flyers, posters, and other visual documents to disseminate information.

It could be about a disease, health promotion, or nursing research. You must also make PowerPoint slides when presenting a thesis, dissertation, or capstone for assessments. Remember, this is the chance to bring out your creativity.

Expect other assignments such as dosage calculations, HESI test exams, skills checkoffs, electronic medical record documentation, nursing student portfolio, online quizzes, drug write-ups, process recordings, group drug presentations, etc.

In most cases, you will be given a template to use wisely and make it as appealing as possible.

Tips to Help You Ace Nursing Assignments

A lot goes into getting the best grades in nursing school. One of the main determinants of your nursing school grades is the assignments, which you are required to do and complete within set deadlines.

Even though many nursing students perform better on clinical, that needs to reflect in written assignments. Most students fear research and writing or do not take writing assignments seriously. Regardless of the assignment, here are some practical and effective tips to help you ace your nursing school writing assignments and surprise everyone, including yourself.

1. Plan your Time

The number one challenge for nursing students that inhibits them from completing assignments is the need for more time management.

Most students are juggling studies and work to make ends meet. It worsens when you have a massive workload from more than one class and a family to look after.

The simple trick to beat this is to manage your time well. You can schedule your assignments for periods when you are free and when you can concentrate and cover more. Assignments have deadlines ranging from hours to days or a few weeks.

To succeed, keep track of your assignments and other academic activities, such as mid-term and final examinations, so that you can plan your study periods. You can use online time management tools and apps to allocate your nursing school homework time.

With proper planning, you should be reassured about the last-minute rush to complete your assignment, which is responsible for the colossal failure we are experiencing in nursing schools.

2. Follow the Course Guidelines to the T

Guidelines, prompts, and reading materials accompany each writing assignment and homework. Sometimes a professor can be generous enough also to give you access to the Rubric, which breaks down how they will assess assignments. Ensure you read everything and note what is required before working on any paper.

Pay attention to these, read, and familiarize yourself with the course guidelines. Understand the formatting requirements preferred by your school, such as Vancouver, APA, or Harvard. Most nursing schools will specify this in the course documents. Also, check the databases and journal articles you can use when writing your nursing assignments.

Preparing in advance by reading the course materials to identify the recommended study materials. You will have a deeper understanding, knowledge, and skills to handle every nursing assignment correctly.

3. Have an Active Study Buddy

A nursing study buddy can be one of your classmates whom you study with. Study buddies offer mutual support, which comes in handy when completing assignments.

Select a bright and committed person with something to offer so you are not only giving. Set the study hours and have accountability follow-ups to ensure you cover much of the syllabus and concepts in time.

A study buddy can help you understand nursing concepts, theories, models, and frameworks. They can also help you review your written papers and give valuable feedback when editing and proofreading your nursing papers.

A knowledgeable, accountable, committed study partner can help you revamp your grades by submitting high-quality assignments.

4. Join a Study Group

A study group is a tried and tested means of completing nursing assignments. Apart from building your teamwork and collaborative skills, you can brainstorm ideas, critique one another, and learn more about the class assignments. With diversity in thoughts, you can get valuable insights and inputs for personal-level work.

Besides, you are also guaranteed to ace the nursing group assignments with ease. When doing group work, try to rotate into new groups so that you can appreciate the diversity of thoughts and reasoning. You can also identify individuals from your groups, those that are active, as your study buddies.

When you have accountability partners within the group, you commit to given tasks and make necessary follow-ups. If you are a part-time student, consider having students whose free time is similar to yours to benefit everyone.

5. Get Writing Assignment Help

As with other subjects in college and university, nursing students face challenges such as time management, complexity of assignments, too many assignments, and writer's block. When you feel overwhelmed with completing your nursing class assignments, you can always pay someone to handle the class for you or at least do your coursework or assignments.

One sure way to get assistance without drawing too much attention is by trusting assignment help websites like NurseMyGrade.com with your papers. Many students do not have time to complete assignments or find them challenging. Consequently, many hire nursing assignment helpers from nursing paper writing platforms.

If you feel like hiring the right professionals, use NurseMyGrade. We offer customized writing solutions to nursing students at different academic levels. Our nursing experts can complete short and lengthy assignments. You will have a well-researched and formatted paper written in Vancouver, APA, MLA, ASA, AMA, Harvard, or any citation style you choose.

You can use the tips and insights above to master nursing school assignments. We wish you all the best as you strive towards excellence. Don't worry about the many assignments. Instead, be grateful that they will equip you with knowledge, skills, and experience to make you the best nurse.

How Many Papers to Write in Nursing School

We have so far covered the general aspects of the types of assignments to expect in nursing school. Under the assignments, you may ask yourself if you must write many papers in nursing school.

While the answer depends on your professor, institutional curriculum requirements, and nursing level, you will undoubtedly write a couple of academic papers before graduating from nursing school. You will write research papers, essays, proposals, white papers, policy analysis papers, capstone project papers, case studies, scholarship essays, personal statements, quality improvement reports, etc.

Suppose you are pursuing a Licensed Practical Nurse (LPN) program. In that case, you will likely write between 13 and 15 papers during the LPN program, including short and long essays, reflective journals, essays, patient-based case studies, and others as your professor pleases.

If you are in a 2-year ADN program, expect to complete about 20 to 30 papers, including care plans, SBAR reports, essays, case studies analyses, research papers, reports, and other assignments.

For a 4-year Bachelor of Science in Nursing (BSN) program, you will write between 35 and 50 papers. If you are taking the online class program options, like the WGU BSN program, you might write more papers because they form the basis for your assessment.

BSN-level papers are demanding because you must strictly adhere to the formatting styles and be critical and organized in your presentation.

If you are taking a Master of Science in Nursing (MSN) program, an advanced-level study for registered nurses (RNs), you will do about 20-50 papers, given that it offers the foundation for nursing research. Again, at an advanced level, the MSN writing assignments are complex.

You need to plan well, research widely, and analyze facts thoroughly before drawing conclusions. During this level, expect to write papers such as MSN essays, discussion posts and responses, specialized case studies, research papers, clinical reports, advanced SOAP notes, nursing care plans, policy papers, position papers (white papers), dissertations, theses, capstone papers, project papers, and change project papers.

You are expected to show exquisite research skills for the Doctor of Nursing Practice (DNP) program, considered the highest level or terminal degree in nursing practice. At this level, you have specialized, advanced your knowledge, and have adequate experience.

Mostly, DNP papers are a little longer. You will write between 20-30 papers; depending on your nursing school curriculum and supervisor's preference, it could be less or more.

If you opt for the research route, you will write many research papers, technical papers, policy analysis papers, white papers, reflection papers, nursing dissertations, PICOT-based change project papers (DNP change project papers), and other assignments.

Finally, for the Doctor of Philosophy (PhD) in nursing programs, you should expect to write between 10 and 15 papers covering research-oriented topics.

Attaining this degree makes you the epitome of success in the field. You can advance into a nursing researcher, educator, leader, or manager.

We have writers that can help you handle all these types of papers regardless of the academic level. Our Online Nursing Writing pros are available for hire anytime and any day.

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Before you go ...

There are many assignments and papers to complete in nursing school, including written assignments, quizzes, exams (oral and written), reflective journals, journal entries, e-Portfolio, integrative reviews, teaching plans, presentations, etc. Whether taking an LPN program or advancing your career by pursuing a Ph.D. in Nursing, you will do many nursing school assignments.

Do not take assignments as a punishment. Instead, consider them as tools to equip and shape you into a desirable nurse practitioner.

If you feel overwhelmed, stressed, and anxious about completing the assignments, you can hire our nursing writers to help you. We can help you ace nursing assignments online and ensure that you get 100% well-researched, organized, and proofread papers.

Our papers are 100% original and non-plagiarized. The writers understand how to structure nursing papers, formulate great paragraphs using the MEAN, PEEL, or TEEL formats, and write desirable papers consistently, scoring the best grades. You can call us your nursing assignment slayers or acers because, in a few hours, we will help you get it all behind you. We can help you ace online nursing classes and tests/quizzes .

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‘Racism absolutely must not be tolerated’

STEVE FORD, EDITOR

• You are here: Students

‘Top tips for starting a student nurse assignment’

08 September, 2022 By Soneika Atkinson

According to the Nursing and Midwifery Council, practice must account for 50% of learning; this means that you will learn in a placement environment.

However, for the other 50% in areas of academia, accomplishing assignments is an integral part of the learning process.

“There are some assignment preparation generalisations that all students should embrace”

Most assignments contribute to students’ grades at the end of their courses. As such, assignments should not be taken lightly.

Students should ensure that all assignments are done to the best of their abilities, so they may be able to get maximum scores.

Regardless of the different areas in which students study and the assignment types, there are some assignment preparation generalisations that all students should embrace.

These include, but are not limited to, understanding the assignment, doing research, planning, writing, reviewing, and reading the recommended reading material.

Prior to beginning an assignment, students ought to ensure they investigate the assignment and address and comprehend what they are required to do. This will assist them with directing the task and deciding the construction of the task.

Comprehending the assignment will guarantee that it doesn’t consist of unimportant data and isn’t muddled, which will prove deplorable.

Students ought to continuously understand what is required of them and what they are expected to produce.

If necessary, rehashing the guidelines will assist students with understanding what’s generally anticipated of them.

In addition, they likewise need to decide how long the task ought to be and the ways that they will proceed.

Doing research is another essential assignment preparation guideline. Students should explore their assignment subject and track down important and dependable data.

Before beginning an assignment, they should gather different material sources and make sure they follow the assignment guideline that will direct them.

It is imperative to go through different materials and then record highlights of the most important data to use in the assignment.

“Students ought to continuously understand what is required of them and what they are expected to produce”

This will include assessing the data found and decisive reasoning for perusing and examination. The writing cycle will be easier when they have all of the needed information.

Third, there should be ample planning. Planning how assignment questions can be answered will help students to concentrate more and make composing their tasks more straightforward.

A structure will be there to ensure they answer the questions accurately. Arranging an assignment likewise includes making a timetable for composing tasks, and students ought to guarantee that they adhere to their timetables.

Planning also includes double-checking cutoff times so they will not feel overpowered when their cutoff times are close.

Students should separate their time and undertakings into manageable chunks, so they will continuously be on top of their tasks.

Writing a draft before an assignment is also integral. Subsequent to finishing their assignment planning, the next thing students should do is compose their first drafts.

This segment is fundamentally free composition and students are urged to write as much as possible without agonising over the phrasing being 100% correct.

It is prudent to not invest excessive energy attempting to get this draft to perfection, as changes are likely. After drafting, students ought to then continue on toward the process of adjusting.

This includes amending the draft and ensuring that it checks out and incorporates all it needs. Cohesion and flow are vital in this assignment preparation step.

Students should guarantee that each passage or part of their assignment is clearly connected to one another before putting the final thing together. This is to ensure that whoever marks the assignment stays connected with the information.

“Students should guarantee that each passage or part of their assignment is clearly connected to one another ”

To accomplish this, students need to return to their assignment plan, then look for essential concepts that will assist them with smoothly connecting the sections.

Finally, preparing to do an assignment and reviewing the collected information is also essential. This is where students inspect if the accumulated data matches the assignment's context.

Here students should check their information against the rubric to ensure it matches. The design and logical arrangement of the data must likewise be entirely inspected and checks carried out to guarantee that all aspects of the assignment are appropriately covered by the data collected.

After all this, the assignment is now suitable for completing and submitting. This is when the assignment will be formally done and turned in.

Soneika Atkinson is a first-year student mental health nurse at the University of Essex, national volunteer manager at Raising Awareness of Mental Health in Higher Education and regional student quality ambassador, Health Education England 

Visit NT's Student section

More student blogs ‘We need to be aware of the power of touch’ ‘Student nurses should be encouraged to pursue management and leadership’ ‘A nurse’s journey in research should start as a student’ ‘The mentally unwell Muslims who suffer in silence’ ‘Patient education can challenge health inequalities’ ‘Student nurses champion improving the healthcare experiences of vulnerable groups’ ‘Mentorship training should be mandatory for registered nurses’ ‘Learning disability nurses should build on their presence in primary care’ ‘How caring during lockdown inspired me to lockdown on career goals’ ‘It is everyone's responsibility to broaden their knowledge of communication’ ‘Peer support should be seen as a vital part of team work’ ‘Virtual placement or virtually no placement’

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Questions to Ask in Making the Decision to Accept a Staffing Assignment for Nurses

Registered nurses need to know their rights and responsibilities when considering a patient assignment. If you feel that you lack expertise on a unit and patient population, you don’t just have the right to refuse an assignment there, you have an obligation to do so. Your case managers should never ask you to work with patients you aren’t qualified to have in your care. There are many factors to consider before accepting a new patient assignment.

This set of questions can help guide you through decisions about nurse staffing assignments .

• What is the assignment? Clarify what is expected. Do not assume. Be certain in the details.
• What are the characteristics of the patients being assigned? Don’t just respond to the number of patients; make a critical assessment of the needs of each patient, complexity, stability, and acuity and the resources available to meet those needs.
• Do you have the expertise to care for the patients? Are you familiar with caring for the types of patients assigned? If this is a “float assignment,” are you crossed-trained to care for these patients? Is there a “buddy system” in place with staff who are familiar with the unit? If there is no cross-training or “buddy system,” has the patient load been modified accordingly?
• Do you have the experience and knowledge to manage the patients for whom you are being assigned care? If the answer to the question is “no,” you have an obligation to articulate your limitations. Limitations in experience and knowledge may not require refusal of the assignment, but rather an agreement regarding supervision or a modification of the assignment to ensure patient safety. If no accommodation for limitations is considered, the nurse has an obligation to refuse an assignment for which she or he lacks education or experience.
• What is the geography of the assignment? Are you being asked to care for patients who are in close proximity for efficient management, or are the patients at opposite ends of the hall or in different units? If there are geographic difficulties, what resources are available to manage the situation? If the patients are in more than one unit and you must go to another unit to provide care, who will monitor patients out of your immediate attention?
• Is this a temporary assignment? When other staff are located to assist, will you be relieved? If the assignment is temporary, it may be possible to accept a difficult assignment, knowing that there will soon be reinforcements. Is there a pattern of short staffing, or is this truly an emergency?
• Is this a crisis or an ongoing staffing pattern? If the assignment is being made because of an immediate need or crisis on the unit, the decision to accept the assignment may be based on that immediate need. However, if the staffing pattern is an ongoing problem, you have the obligation to identify unmet standards of care that are occurring as a result of ongoing staffing inadequacies. This may result in a request for “safe harbor” and/or peer review.
• Can you take the assignment in good faith? If not, you will need to get the assignment modified — or refuse the assignment. Consult your state’s nursing practice act regarding clarification of accepting an assignment in good faith. In understanding “good faith,” it’s sometimes easier to identify what would constitute bad faith. For example, if you have not taken care of pediatric patients since nursing school and you are asked to take charge of a pediatric unit, unless this is an extreme emergency, such as a disaster (in which case you would need to let people know your limitations, but you might still be the best person, given all factors for the assignment), it would be bad faith to take the assignment. It’s always your responsibility to articulate your limitations and to get an adjustment to the assignment that acknowledges the limitations you have articulated. Good-faith acceptance of an assignment means that you are concerned about the situation and believe that a different pattern of care or policy should be considered. However, you acknowledge the difference of opinion on the subject between you and your supervisor and are willing to take the assignment, and await the judgment of other peers and supervisors.

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Nursing Management: Guide to Organizing, Staffing, Scheduling, Directing and Delegating

Effective nursing management is crucial for ensuring high-quality patient care and maintaining a harmonious work environment. This involves several key concepts, including organizing, delegation, motivation, supervision, coordination, and conflict management.

Table of Contents

Organizing process, three forms of authority, organizational chart, managerial levels, patterns of organizational structure, staffing process, staffing pattern, patient classification system, shifting patterns, elements of directing, barriers in communication, common errors in delegation, steps in effective delegating, key concepts in effective delegation, conflict resolution strategies.

Organizing is a crucial management function that ensures tasks are logically identified, assigned, and grouped. It determines who is responsible for each task, establishes clear lines of reporting, and facilitates decision-making. At its core, organizing defines roles and relationships within the organization, clarifying each staff member’s functions to execute the organizational plan effectively.

The process of organizing involves the following:

• Identifying and Defining Tasks . Determine the basic tasks that need to be accomplished.
• Delegating Authority and Assigning Responsibility . Allocate authority and assign responsibilities to appropriate individuals.
• Establishing Relationships . Create a structure that separates activities, arranges them hierarchically, and fosters efficient teamwork.

Authority within an organization can be categorized into three primary forms:

Line Authority

Line authority is the direct supervisory authority that flows from a supervisor to their subordinates. It represents the clear, direct chain of command where decisions and instructions are passed down the hierarchy. For example, a nurse manager has direct supervisory authority over a team of registered nurses (RNs) on a hospital ward. The nurse manager delegates tasks, oversees patient care , and evaluates the performance of the nursing staff, ensuring that the ward operates smoothly.

Staff Authority

Staff authority is based on expertise and typically involves providing advice and support to line managers. Staff authority does not entail direct command over other employees but focuses on specialized knowledge and guidance. For example, a clinical nurse specialist (CNS) provides expert advice to the nursing staff and line managers on best practices for patient care . Although the CNS does not have direct supervisory control, they influence decisions through their specialized knowledge in areas such as wound care , pain management , or diabetes education.

Team Authority

Granted to committees or work teams involved in daily operations, team authority empowers groups of employees who share a common vision , goals, and objectives. These teams are responsible for collaborative decision-making and achieving specific outcomes. For example, in a hospital setting, the chain of command starts with the Chief Nursing Officer (CNO) at the top, followed by nurse directors, nurse managers, charge nurses, and finally the staff nurses. This hierarchy ensures that decisions and instructions are passed down systematically and that issues can be escalated appropriately.

Additional concepts related to authority include:

• Chain of Command . This is an unbroken line of reporting relationships that extends through the entire organization, defining the formal decision-making structure and ensuring clarity in the flow of authority.
• Unity of Command . This principle states that each person in the organization should take orders from and report to only one supervisor, preventing confusion and overlapping directives.
• Span of Control . This refers to the optimal number of employees that one leader-manager can effectively supervise. A well-defined span of control ensures efficient management and communication within the organization.

An organizational chart is a visual representation that illustrates the structure of an organization. It shows how different parts of the organization are linked, highlighting formal relationships, areas of responsibility, accountability, and communication channels.

Organizational Structure

The chart clearly depicts roles and expectations, as well as the arrangement of positions and working relationships within the organization.

Lines of Authority

In an organizational chart, various lines are used to represent different types of authority and relationships within the organization:

• Dotted Line. Represents staff positions or staff authority, indicating advisory roles to line managers.
• Solid Horizontal Line. Represents positions of equal status but different functions.
• Solid Vertical Line. Indicates the chain of command, showing direct authority from supervisors to subordinates (line authority).
• Centrality. Refers to the position on the chart where frequent and diverse communication occurs. Positions with smaller organizational distance, closer to the center, receive more information compared to those located more peripherally.

In an organization, managerial roles are divided into different levels, each with distinct responsibilities and scope of influence:

• Top-Level Managers . Make strategic decisions with minimal guidelines or structure. Coordinate both internal and external influences. Examples include: CEO, President, Vice President, Chief Nursing Officer
• Middle-Level Managers. Oversee day-to-day operations while also engaging in long-term planning and policy-making. Examples include: Head Nurse, Department Head, Unit Supervisor/Manager
• First-Level Managers. Focus on specific unit workflows and address immediate, day-to-day issues. Examples: charge Nurse, Team Leader, Primary Nurse, Staff Nurse

Organizational structures define how tasks, responsibilities, and authority are distributed within an organization. Different structures cater to various organizational needs and scales, each with distinct characteristics and implications for communication and management. These may include:

Tall or Centralized Structure

Tall or centralized structures are characterized by a narrow span of control, where supervisors are responsible for only a few subordinates. Due to its vertical nature, this structure involves many levels of communication. Communication can be difficult, and messages often fail to reach the top effectively. Workers tend to be boss-oriented due to close supervision.

Flat or Decentralized Structure

Flat or decentralized structures feature few levels and a broad span of control, making communication easy and direct. This structure shortens the administrative distance between top and lower levels, facilitates fast problem-solving and response, and encourages workers to develop their abilities and autonomy. However, it is impractical for large organizations.

Types of Organizational Structure

Organizational structures can vary significantly, each designed to meet specific operational needs and management styles. Understanding the different types helps in selecting the most appropriate structure for a given organization.

• Line Organization/Bureaucratic/Pyramidal . In a line organization, there is a clearly defined superior-subordinate relationship. Authority and power are concentrated at the top.
• Flat/Horizontal Organization . A decentralized type, flat organizations are applicable in small organizations. Nurses become more productive and directly involved in decision-making processes, leading to greater worker satisfaction.
• Functional Organization . This structure allows specialists to assist line positions within a limited and clearly defined scope of authority.
• Ad Hoc Organization . An ad hoc organization is a modification of the bureaucratic structure, often created for specific projects or purposes.
• Matrix Structure . The matrix structure focuses on both products and functions, making it the most complex type. It incorporates both vertical and horizontal chains of command and lines of communication.

Staffing is the process of assigning competent individuals to fulfill the roles designated within an organizational structure. This involves recruitment, selection, development, induction, and orientation of new staff to align with the organization’s goals, vision, mission, and philosophy.

Staffing involves a systematic approach to ensuring the organization has the right number and type of personnel to achieve its goals. The following steps outline the key stages in the staffing process:

• Preparing to Recruit . This initial step involves determining the types and number of personnel required to meet the organization’s needs.
• Attracting Staff . Formal advertisements and outreach efforts are used to attract potential candidates.
• Recruiting and Selecting Staff . This phase includes conducting interviews, induction, orientation, job orders, pre-employment testing, and signing contracts to onboard new employees.

Developing an effective staffing pattern is essential for ensuring that an organization has the right number of staff with the appropriate skills to meet its needs. There are two primary methods for creating a staffing pattern:

Determining Nursing Care Hours

This method involves calculating the number of nursing care hours required per patient. For example, if each patient needs an average of 6 hours of nursing care per day and the unit has 20 patients, the total nursing care hours needed per day would be 120 hours. This helps in determining the number of nurses required per shift to meet patient care needs effectively.

Calculating Full-Time Equivalents (FTEs)

This approach measures the work commitment of full-time employees. For instance, 1.0 FTE represents a full-time employee who works 5 days a week, 8 hours a day, totaling 40 hours a week. Conversely, 0.5 FTE corresponds to a part-time employee working 5 days every 2 weeks, totaling 20 hours a week.

Considerations in Staffing Pattern

When developing a staffing pattern, several key factors must be taken into account to ensure optimal organizational performance and compliance with regulations. The following considerations are essential:

• Benchmarking. This management tool is used to seek out the best practices within the healthcare industry to improve performance. For instance, a hospital might compare its nurse-to-patient ratio with top-performing hospitals. By measuring their staffing practices and patient outcomes against these benchmarks, the hospital can identify areas for improvement and set realistic targets for nurse staffing levels.
• Regulatory Requirements. Staffing patterns must adhere to mandated regulations, such as those outlined in relevant legislative acts. For example, the laws regarding safe staffing in certain regions mandates specific nurse-to-patient ratios that must be maintained to ensure patient safety and care quality.
• Skill Mix. The skill mix refers to the percentage or ratio of professionals to non-professionals within the staff. For example, in a hospital unit with 40 full-time equivalents (FTEs), if there are 20 registered nurses (RNs) and 20 nursing assistants, the RN mix is 50%. This ratio ensures a balanced team with the necessary expertise and support staff, allowing RNs to focus on complex patient care tasks while nursing assistants handle more routine duties.
• Staff Support. Adequate staff support must be in place for the operations of units or departments. For example, a nursing unit might need administrative staff to handle scheduling, clerical tasks, and patient records . This support allows nurses to dedicate more time to patient care rather than administrative duties.
• Historical Information. Reviewing historical data on quality and staff perceptions regarding the effectiveness of previous staffing patterns is crucial. For example, a hospital may analyze past staffing patterns during peak flu seasons to determine the optimal number of nurses required to maintain patient care standards. This historical review helps in planning and adjusting staffing levels to meet future demands more effectively.

The term Patient Classification Systems refers to measurement systems in nursing that reflect actual patient care needs for staffing purposes. These systems, also known as Acuity Systems, are used to articulate the nursing workload for specific patients or groups of patients over a defined period. While “Acuity” typically denotes the unidimensional severity of illness in a medical context, the nursing community prefers the broader term “Patient Classification” to encompass the bio-psycho-social-spiritual aspects of patient care. For this discussion, the term Patient Classification/Acuity System is used.

Patient Care Classification

Patients are classified into different categories based on their care needs:

• Self-Care or Minimal Care . These patients are capable of performing activities of daily living (ADLs) independently, such as hygiene and meals. They require minimal assistance from the nursing staff.
• Intermediate or Moderate Care . Patients in this category require some assistance from the nursing staff for special treatments or specific aspects of personal care. Examples include patients with IV fluids , catheters, or on respirators.
• Total Care . These patients are bedridden and lack the strength or mobility to perform ADLs. They require comprehensive nursing care. Examples include patients on complete bed rest (CBR), those in the immediate post-operative phase, or those with significant mobility restrictions.
• Intensive Care : Intensive care patients are critically ill and in constant danger of death or serious injury . They require continuous monitoring and specialized nursing care. Examples include comatose patients or those with life-threatening conditions who are bedridden.

By classifying patients according to their care needs, the Patient Classification System ensures that nursing resources are appropriately allocated, enhancing patient care and optimizing the nursing workload.

Scheduling is the process of creating a timetable that outlines the planned workdays and shifts for nursing personnel. Effective scheduling takes into account several key factors to ensure that staffing meets patient care needs and maintains staff well-being. Several key factors must be considered to create an optimal schedule that meets both patient needs and staff preferences. The following are some issues to consider in scheduling staff:

• Patient Type and Acuity . Different patients require varying levels of care, significantly impacting how staff is allocated. For example, intensive care unit (ICU) patients need constant monitoring and specialized care, requiring more experienced nurses compared to patients in a general ward.
• Number of Patients . The total patient count directly influences the number of staff needed. A higher patient load requires more nursing staff to ensure each patient receives adequate attention and care. For instance, during peak flu season, a hospital might need to increase its nursing staff to handle the influx of patients.
• Experience of Staff . The skill and experience levels of the staff should match the complexity of patient care required. For example, a novice nurse might handle basic patient care tasks, while a more experienced nurse might be assigned to complex cases or critical care units.
• Support Available to the Staff . The availability of support personnel, such as nursing assistants and administrative staff, affects how nursing duties are distributed. For example, having sufficient administrative support can allow nurses to focus more on patient care rather than paperwork.
• Shifting Variations . Different shift patterns are utilized to meet both patient care needs and staff preferences. These variations can help in maintaining a balanced and effective workforce.

To meet the diverse needs of patients and preferences of nursing staff, various traditional shifting patterns are utilized. Each pattern offers unique benefits and challenges, helping to ensure continuous and effective patient care.

• 3 Shift (8-hour shift) . Commonly used to provide 24-hour care, this pattern divides the day into three 8-hour shifts. For instance, one nurse might work from 7 AM to 3 PM, another from 3 PM to 11 PM, and a third from 11 PM to 7 AM.
• 12-hour Shift . This pattern involves longer shifts with fewer workdays, often preferred by nurses who enjoy having more consecutive days off. A nurse might work from 7 AM to 7 PM, providing continuity of care for patients but also requiring adequate rest between shifts to prevent burnout .
• 10-hour Shift . Less common but offers a balance between 8 and 12-hour shifts. This pattern might involve a nurse working from 7 AM to 5 PM, allowing for extended care periods without the intensity of a 12-hour shift.
• Weekend Option . Staff works primarily on weekends, which can be ideal for nurses who prefer or need weekdays off. This option helps in ensuring adequate coverage during weekends when patient admissions might fluctuate.
• Rotating Work Shift . Shifts rotate between day, evening, and night, allowing all staff to experience different times of day. This can help in maintaining a fair distribution of shifts but requires careful management to avoid disruption to staff routines and circadian rhythms.
• Self-Scheduling . Staff members create their own schedules, promoting autonomy and job satisfaction. For example, a nurse might choose to work three consecutive days followed by four days off, allowing flexibility in managing personal commitments.
• Permanent Work Shift . Staff work consistent shifts without rotation, providing stability and predictability. For instance, a nurse might always work the night shift , ensuring they can plan their personal life around a steady work schedule.
• Floaters . Staff who are “on-call” to fill in as needed. Floaters provide critical support during unexpected absences or increased patient loads, ensuring that the unit remains adequately staffed at all times.

Directing is the act of issuing orders, assignments, and instructions to achieve organizational goals and objectives. It involves guiding and supervising staff to ensure effective performance.

The following are the elements of directing:

• Communication . The exchange of ideas, thoughts, or information through verbal speech, writing, and signals.
• Delegation . Assigning responsibility and authority to subordinates.
• Motivation . Encouraging staff to achieve high performance and job satisfaction.
• Coordination :.Harmonizing efforts to ensure efficient operations.
• Evaluation . Assessing performance to provide feedback and improve outcomes.

The following are the common barriers of communication:

• Physical Barriers : Environmental factors that hinder communication, such as distance and noise.
• Social and Psychological Barriers : Judgments, emotions, and social values that obstruct communication, such as stress, trust issues, fear , and defensiveness. These include the internal climate (values, feelings, temperament, and stress levels) and external climate (weather, timing, temperature, and lack of message validation).
• Semantics : Misunderstandings arising from words, figures, symbols, penmanship, and the interpretation of messages through signs and symbols.
• Interpretations : Defects in communication skills, including verbalizing, listening, writing, reading, and using telephony

Delegation involves assigning a portion of work to someone else, along with the corresponding authority, responsibility, and accountability. According to the American Nurses Association (ANA), it is the transfer of responsibilities, but not of accountability, for the performance of a task from one person to another. Much of a manager’s work is accomplished by transferring responsibilities to subordinates.

Managers often delegate routine tasks to free themselves for more complex problems requiring higher levels of expertise. Additionally, delegation is beneficial when someone else is better prepared or has greater expertise in solving specific problems. However, some managers hesitate to delegate due to a lack of trust in others, fear of mistakes, fear of criticism, or doubt about their own ability to delegate effectively. Here are the three common errors involved in delegation:

Under Delegation

Managers may underdelegate due to the false assumption that delegation might be seen as a lack of ability to do the job correctly. For example, a charge nurse might feel that only they can correctly handle patient assessments and may avoid delegating these tasks to other nurses, leading to unnecessary workload and burnout .

Over Delegation

This occurs when subordinates become overburdened, leading to dissatisfaction and low productivity. For instance, a nurse manager who delegates too many tasks to a single nurse, such as patient care duties, administrative tasks, and training responsibilities, can cause that nurse to become overwhelmed and reduce their effectiveness and morale.

Improper Delegation

Delegating tasks to the wrong person, at the wrong time, or tasks beyond the subordinate’s capability can lead to inefficiencies and errors. For example, assigning a newly graduated nurse to handle a critical care patient without adequate supervision can lead to mistakes and compromise patient safety .

Effective delegation involves a systematic approach to ensure tasks are appropriately assigned and executed. Here are the steps to achieve effective delegation:

• Plan Ahead . Anticipate future needs and identify tasks that can be delegated. For instance, a nurse manager can plan to delegate routine check-ups during busy shifts.
• Identify Necessary Skills and Levels . Determine the skills and experience required for the tasks. For example, wound care should be delegated to a nurse with specialized training.
• Select the Most Capable Personnel . Choose individuals who are best suited for the tasks. A senior RN may be chosen to oversee the orientation of new nurses.
• Communicate Goals Clearly . Ensure that the delegate understands the objectives and expectations. For instance, clearly explain the expected outcomes of a patient discharge process.
• Empower the Delegate . Provide the necessary authority and resources for the task. Ensure that the nurse has access to all needed supplies and information.
• Set Deadlines and Monitor Progress . Establish timelines and check in regularly to ensure progress. For example, set a deadline for completing patient assessments and follow up to track progress.
• Model the Role and Provide Guidance . Demonstrate how to perform the task and offer support as needed. Show a nurse how to use new medical equipment and be available for questions.
• Evaluate Performance . Assess the delegate’s performance and provide feedback for improvement. After delegating a task, review the outcomes and discuss areas for improvement.

Effective nursing management and delegation involves several key concepts that ensure high-quality patient care and efficient team operations. Here are three essential concepts:

Motivation influences our choices and drives the direction, intensity, and persistence of our behavior. In nursing, motivation can come from personal fulfillment, professional recognition, and the desire to provide excellent patient care. For example, nurses might be motivated by positive patient outcomes or career advancement opportunities.

Supervision

Supervision entails guiding and directing work, motivating staff, and encouraging participation in activities that meet organizational goals while fostering personal development. Effective supervision in nursing includes regular check-ins, feedback, and professional growth opportunities. For instance, nurse managers might hold weekly meetings to discuss challenges, celebrate successes, and provide training on new protocols.

Coordination

Coordination involves arranging activities to create harmony and facilitate success. In nursing, effective coordination ensures team members work together efficiently to provide optimal patient care. This includes coordinating schedules, assigning tasks based on expertise, and ensuring clear communication.

Conflict Management

Conflict arises from internal and external discord due to differences in ideas, values, or feelings between two or more people. It often stems from economic and professional value differences and can significantly impact workplace harmony and productivity. Conflict can either be competitive or disruptive:

• Competitive Conflict. This occurs when two or more groups vie for the same goal, but only one can attain it. Management typically sets these goals, leading to a competitive environment where each group strives to outperform the others.
• Disruptive Conflict. This type of conflict happens in environments filled with anger, fear, and stress. There are no mutually acceptable rules, and each party’s goal is to eliminate the opponent. This destructive form of conflict can severely hinder cooperation and productivity.

Effective conflict management involves employing various strategies to address and resolve conflicts constructively in the nursing field. Here are some common approaches:

• Use of Dominance and Suppression . This win-lose strategy involves one party imposing their will on the other, often leading to anger and resentment. For example, a head nurse might unilaterally decide on a new scheduling system without consulting the staff, leading to dissatisfaction and resistance.
• Smoothing Behavior. This strategy involves persuading the opponent diplomatically to maintain harmony and avoid confrontation. For example, a nurse manager might smooth over a conflict between two nurses by diplomatically discussing their concerns and finding a temporary compromise to ease tensions.
• Avoidance Behavior. Both parties are aware of the conflict but choose not to acknowledge or resolve it. For example, two nurses who have a personal disagreement might avoid discussing it, which can lead to unresolved issues affecting teamwork and patient care.
• Majority Rule. This approach relies on a unanimous decision-making process. For instance, when deciding on a new policy, the nursing team might vote on the options, with the majority’s decision being implemented.
• Compromising. This consensus strategy involves each side agreeing to solutions that partially satisfy both parties, aiming for a middle ground. For example, a nurse manager might compromise on shift preferences to balance the needs of the staff and the unit.
• Interactive Problem-Solving. A constructive process where the parties involved recognize the conflict, assist each other, and openly work together to solve the problems. For example, a nursing team might hold a meeting to discuss and collaboratively find solutions to recurring staffing issues.
• Win-Win Strategy. This strategy focuses on goals and attempts to meet the needs of both parties, fostering cooperation and mutual satisfaction. For example, a head nurse and a staff nurse might work together to develop a new patient care protocol that improves efficiency and meets both management and frontline needs.
• Lose-Lose Strategy. In this approach, neither side wins, often leading to a situation where both parties are dissatisfied. For example, if a nurse manager enforces a policy change that neither the administration nor the nursing staff fully support, it may result in widespread dissatisfaction.
• Confrontation. Considered the most effective means of resolving conflict, confrontation involves addressing the issue openly with knowledge and reason, seeking a solution through direct communication. For example, a nurse manager might directly address a conflict between two staff members by facilitating a mediated discussion to resolve their differences.
• Negotiation. This “give and take” process involves both sides making concessions to reach an agreement that satisfies both parties to some extent. For instance, during a staff meeting, nurses and management might negotiate shift schedules to balance personal preferences and unit needs.

Effective nursing management integrates crucial concepts to create a well-functioning healthcare environment . By organizing tasks and defining roles, clarity and efficiency are ensured. Delegation allows managers to focus on complex issues while empowering staff. Motivation, supervision, and coordination are vital for maintaining high performance and smooth operations. Conflict management strategies, including competitive and disruptive conflict resolution, ensure disputes are handled constructively, fostering a positive work atmosphere. By applying these principles, nursing managers can create a supportive and efficient workplace, leading to improved patient outcomes and higher staff satisfaction.

11 thoughts on “Nursing Management: Guide to Organizing, Staffing, Scheduling, Directing and Delegating”

nice article :)

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Very helpful in my leadership and management course 🙏

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I have learnt a lot and it has help my long essay

Well discussed piece of work 👏

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• Library Guides

Bachelor of Nursing and Midwifery

• Getting started on your assignment

Bachelor of Nursing and Midwifery: Getting started on your assignment

• Reading a Scholarly Article
• Books & eBooks
• Databases & journals
• Referencing

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• Steps to a successful assignment 
• Getting ready for your nursing degree
• Identifying keywords
• Nursing writing online

Steps to a successful assignment

1.    Collect all your information about the assignment

• the handout on the assignment (due date, word limit, formatting, presentation, marking guide)
• the type of sources required for your Reference List e.g. books, journal articles
• notes from classes on how to complete the essay 

2.    Analyse and prepare

• read your notes and class readings for direction
• do a mind map on the topic- use questions to expand the ideas and knowledge you already have
• do some preliminary research to expand your ideas
• from your mind map write some points grouped under general headings
• where there are gaps in information (or more detail or examples needed) write down some questions that you can research
• identify keywords & search the Library for additional sources e.g. books, journal articles (see the box below for an example of how to break down a topic into Keywords, see the videos in this guide on searching for journal articles)
• write a plan for your essay, 
• what information do you already have? what further information do you need?

3.    Read for Information

• read Required Reading and make notes
• read the additional articles etc. for information not in the Required Reading
• prepare each Reference as you read it, ensure it is written in the APA referencing style. See the  APA referencing guide  for further assistance

4.    Start writing

• collect notes from your reading and start to build your essay
• write the correct References for each of your readings for your Reference

Identifying keywords for searching 

Watch this video to learn how to identify keywords when searching for information on a topic

Keyword search strategies from Victoria University Library on Vimeo .

Example essay topic

Always check your  VU Collaborate unit space for information about assessment  requirements.

Once you have analysed your Essay topic and done some preliminary reading you are ready to break down the topic into areas for research. The next step is to identify keywords that you can use to search for academic sources of information  on your topic.

Select keywords from both the topic and your readings. Keywords can be single words or phrases. You will need to use different combinations  of keywords in a number of different searches  to ensure you cover all aspects of a topic.

Example Essay Topic

Caring is fundamental in nursing, and develops with therapeutic use of self, a process between the nurse and patient.  Outline characteristics of therapeutic nursing, and describe how these skills can be implemented to increase the therapeutic value of nursing care. 

Suggested keywords for searching Library Search and Library databases to find information on the above topic.

Example search 1:

("therapeutic relationship" OR "therapeutic nursing") AND "nurse-patient relation*"

Example search 2:

(caring OR therapeutic*) AND nurse AND patient

A list of relevant nursing databases can be found on the "Databases & journals" tab of this guide.

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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.

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• 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 ]

View in own window

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.
• PDF version of this title (18M)

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• LEADERSHIP & MANAGEMENT INTRODUCTION
• BASIC CONCEPTS
• IMPLEMENTING CHANGE
• SPOTLIGHT APPLICATION
• LEARNING ACTIVITIES

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Patient acuity tool on a medical-surgical unit

Use a tool for consistent, objective, and quantifiable patient assignments..

• Patient assignments can lead to dissatisfaction among nursing staff, especially when they’re not consistent, objective, and quantifiable.
• Dissatisfaction can create barriers to the adaptability and teamwork that are critical to good patient care.
• The patient acuity tool addresses the important issue of unbalanced nurse-patient assignments and helps nurses influence decision-making in their organizations.

Patient assignments can lead to dissatisfaction among nursing staff, especially when they’re not consistent, objective, and quantifiable. This dissatisfaction can create barriers to the adaptability and teamwork that are so critical to good patient care.

In 2016, three RNs on a complex 23-bed medical-surgical unit at Durham VA Health Care System identified a recurring complaint by nursing staff that patient assignments were inconsistent and unequal. An average of five RNs and one charge nurse were assigned five patients per nurse per shift. The nursing assignment system included placing patients in one of two categories: “standard patient” or “involved care” patient. The problem was the subjectivity of these terms; they had no supporting evidence. The result was frustrated nurses, which prompted the unit to develop a process improvement project.

Standardizing handoff communication

The Bedside Mobility Assessment Tool 2.0

Hours per patient day: Understanding this key measure of productivity

Purpose and goals

We used evidence-based information to create an objective acuity tool to establish patient assignments. The tool uses both clinical patient characteristics and workload indicators to score patients from 1 to 4 based on acuity level. This approach gives nurses the power to score their patient, then report to the charge nurse so that RN assignments for the oncoming shift are quantifiable and equitable. It also gives them the opportunity to assess the level of patient safety risk.

The goals of the tool are to:

• increase nurse satisfaction with their patient assignment
• increase nurse perception of patient safety by assigning patients with high acuity scores equitably.

The patient acuity tool

Each patient is scored on a 1-to-4 scale (1, stable patient; 2, moderate-risk patient; 3, complex patient; 4, high-risk patient) based on the clinical patient characteristics and the care involved (workload.) Each nurse scores his or her patients, based on acuity, for the upcoming shift and relays this information to the charge nurse, who then assigns patients before the shift change. The handoff report between RNs allows each to validate patients’ current acuity and care needs. (See Patient acuity tool .)

Methodology

Anecdotal reports by the RN staff and our observations prompted the collection of data from staff. Some of the staff comments about the current system included:

• “Why are my patient assignments so unfair?”
• “How will I care for all of my patients effectively?”
• “Involved care is a subjective term.”

We conducted a literature review and eventually combined two existing tools and restructured them to create our acuity tool. Before implementing the process improvement project, we used the newly created tool to assess the current average distribution of total acuity among nurse assignments, and we asked RNs to complete a 10-question survey to measure their satisfaction with patient assignments and perceptions of patient safety. We then taught the RNs how to use the tool and placed color-coded, laminated copies at every nursing computer.

The tool was pilot tested for 28 days. After the first 14 days, we conducted an audit to assess compliance, which revealed that average compliance among all four shifts was 35%. We then collected data on the average distribution of total acuity among nurse assignments. Progress e-mails were sent to staff, and individual follow-ups were held to promote compliance. At the end of the 28 days, we conducted another compliance audit, which revealed an average compliance among all four shifts of 77%, an increase of 220%.

At the end of the pilot study, we reviewed patient assignments before and after implementing the acuity tool to assess their equality, and we surveyed RNs about the two goals we set for the project: improve nurse satisfaction and increase nurse perception of patient safety.

Equality of patient assignments

To determine the equality of nurses’ assignments within a shift, the difference in total acuity between the highest and lowest scoring assignments was obtained. (See RN assignments using acuity tool .)

Before implementing the acuity tool, the average distribution of total acuity between highest and lowest nurse assignments for each shift was 4.83 (using a scale of 1 = lowest acuity and 4 = highest acuity). After implementation, the average distribution of total acuity between highest and lowest nurse assignments was 3.06, a 36.6% improvement in equality and accuracy.

Goal 1: Improve nurse satisfaction

Three of the 10 questions in the nurse survey were aimed at nurse satisfaction, including RN perception of patient assignment equality, having input into making assignments, and frequency of feeling overwhelmed with patient assignments. The most significant change occurred with the question “Please rate how frequently you feel overwhelmed with your patient assignment.” Response options were never (1), rarely (2), sometimes (3), frequently (4), and every shift (5). According to the survey, the weighted average of nurse satisfaction was 3.19 before implementing the acuity tool and 2.84 (11% improvement) after.

Goal 2: Increase nurse perception of patient safety 

When asked to respond to the statement “I feel like patient safety is a concern when I accept my patient assignment,” RN staff chose from the following options: never (1), rarely (2), sometimes (3), frequently (4), and every shift (5). The weighted average was 3.38 pre-implementation and 3.21 post-implementation, a 5% improvement in RNs’ perception of patient safety. After reviewing the annual performance improvement data, we found no direct correlation between using the acuity tool and patient safety measurements (rate of falls, medication errors, and restraint use). However, by distributing high-acuity patients among nurses, this tool, used in conjunction with other current actions, can reduce the need for patient safety measures such as using sitters and frequent rounding.

We attributed many of the challenges faced during the implementation of this project to staff assignment changes during some 24-hour periods. Sometimes patient assignments changed every 4 hours because of differences in nurse shift length, which left the staff with no consistent communication between shifts. The charge nurse would also occasionally take a patient assignment when patient acuity was high and RN census was low, resulting in outliers in data.

Another challenge included RN staff changes during the pilot study, leading to gaps in education about proper use of the tool, decreased feedback, and less data in post-implementation than pre-implementation. As part of our sustainment plan, we’ll incorporate education on the tool in new staff orientation, adapt it to other medical-surgical units in the hospital, and continue quarterly audits to assess compliance.

Given the original concern by staff that assignments were unequal, one of the strengths of this acuity tool is that it allows nurses to become stakeholders in making patient assignments. In addition, it also gives the charge nurse an objective way to justify assignment rationale. The tool costs no money to implement and requires no special technology. In addition, it’s noninvasive to the unit’s workflow, easy to implement, and easily adapted to different units and their specific needs. We’ve also found that the tool enhances the shift-to-shift handoff report and that it can be used to assign patients based on nurse competence (novice nurses, expert nurses, etc.).

Striking a balance

The patient acuity tool addresses the important issue of unbalanced nurse-patient assignments and helps nurses influence decision-making in their organizations. Our research found that an objective patient acuity tool on a medical-surgical floor could increase assignment equality, improve nurse satisfaction, and improve nurse perception of patient safety. The tool is now being piloted on other units at this facility, and we’ve received consults from other facilities in the Veterans Affairs Health Care System.

Andrea Ingram is a medical-surgical certified nurse at the VA Health Care System in Durham, North Carolina. Jennifer Powell is a neonatal intensive care unit nurse at Novant Health Hemby Children’s Hospital in Charlotte, North Carolina.

Selected references

Chiulli KA, Thompson J, Reguin-Hartman KL. Development and implementation of a patient acuity tool for a medical-surgical unit . Academy of Medical-Surgical Nurses. 2014;23(2):1, 9-12.

Kidd M, Grove K, Kaiser M, Swoboda B, Taylor A. A new patient-acuity tool promotes equitable nurse-patient assignments . American Nurse Today. 2014;9(3):1-4.

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Best Nursing Research Topics for Students

What is a nursing research paper.

• What They Include
• Choosing a Topic
• Best Nursing Research Topics
• Research Paper Writing Tips

Writing a research paper is a massive task that involves careful organization, critical analysis, and a lot of time. Some nursing students are natural writers, while others struggle to select a nursing research topic, let alone write about it.

If you're a nursing student who dreads writing research papers, this article may help ease your anxiety. We'll cover everything you need to know about writing nursing school research papers and the top topics for nursing research.  

Continue reading to make your paper-writing jitters a thing of the past.

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A nursing research paper is a work of academic writing composed by a nurse or nursing student. The paper may present information on a specific topic or answer a question.

During LPN/LVN and RN programs, most papers you write focus on learning to use research databases, evaluate appropriate resources, and format your writing with APA style. You'll then synthesize your research information to answer a question or analyze a topic.

BSN , MSN , Ph.D., and DNP programs also write nursing research papers. Students in these programs may also participate in conducting original research studies.

Writing papers during your academic program improves and develops many skills, including the ability to:

• Select nursing topics for research
• Conduct effective research
• Analyze published academic literature
• Format and cite sources
• Synthesize data
• Organize and articulate findings

About Nursing Research Papers

When do nursing students write research papers.

You may need to write a research paper for any of the nursing courses you take. Research papers help develop critical thinking and communication skills. They allow you to learn how to conduct research and critically review publications.

That said, not every class will require in-depth, 10-20-page papers. The more advanced your degree path, the more you can expect to write and conduct research. If you're in an associate or bachelor's program, you'll probably write a few papers each semester or term.

Do Nursing Students Conduct Original Research?

Most of the time, you won't be designing, conducting, and evaluating new research. Instead, your projects will focus on learning the research process and the scientific method. You'll achieve these objectives by evaluating existing nursing literature and sources and defending a thesis.

However, many nursing faculty members do conduct original research. So, you may get opportunities to participate in, and publish, research articles.

Example Research Project Scenario:

In your maternal child nursing class, the professor assigns the class a research paper regarding developmentally appropriate nursing interventions for the pediatric population. While that may sound specific, you have almost endless opportunities to narrow down the focus of your writing. 

You could choose pain intervention measures in toddlers. Conversely, you can research the effects of prolonged hospitalization on adolescents' social-emotional development.

What Does a Nursing Research Paper Include?

Your professor should provide a thorough guideline of the scope of the paper. In general, an undergraduate nursing research paper will consist of:

Introduction : A brief overview of the research question/thesis statement your paper will discuss. You can include why the topic is relevant.

Body : This section presents your research findings and allows you to synthesize the information and data you collected. You'll have a chance to articulate your evaluation and answer your research question. The length of this section depends on your assignment.

Conclusion : A brief review of the information and analysis you presented throughout the body of the paper. This section is a recap of your paper and another chance to reassert your thesis.

The best advice is to follow your instructor's rubric and guidelines. Remember to ask for help whenever needed, and avoid overcomplicating the assignment!

How to Choose a Nursing Research Topic

The sheer volume of prospective nursing research topics can become overwhelming for students. Additionally, you may get the misconception that all the 'good' research ideas are exhausted. However, a personal approach may help you narrow down a research topic and find a unique angle.

Writing your research paper about a topic you value or connect with makes the task easier. Additionally, you should consider the material's breadth. Topics with plenty of existing literature will make developing a research question and thesis smoother.

Finally, feel free to shift gears if necessary, especially if you're still early in the research process. If you start down one path and have trouble finding published information, ask your professor if you can choose another topic.

The Best Research Topics for Nursing Students

You have endless subject choices for nursing research papers. This non-exhaustive list just scratches the surface of some of the best nursing research topics.

1. Clinical Nursing Research Topics

• Analyze the use of telehealth/virtual nursing to reduce inpatient nurse duties.
• Discuss the impact of evidence-based respiratory interventions on patient outcomes in critical care settings.
• Explore the effectiveness of pain management protocols in pediatric patients.

2. Community Health Nursing Research Topics

• Assess the impact of nurse-led diabetes education in Type II Diabetics.
• Analyze the relationship between socioeconomic status and access to healthcare services.

3. Nurse Education Research Topics

• Review the effectiveness of simulation-based learning to improve nursing students' clinical skills.
• Identify methods that best prepare pre-licensure students for clinical practice.
• Investigate factors that influence nurses to pursue advanced degrees.
• Evaluate education methods that enhance cultural competence among nurses.
• Describe the role of mindfulness interventions in reducing stress and burnout among nurses.

4. Mental Health Nursing Research Topics

• Explore patient outcomes related to nurse staffing levels in acute behavioral health settings.
• Assess the effectiveness of mental health education among emergency room nurses .
• Explore de-escalation techniques that result in improved patient outcomes.
• Review the effectiveness of therapeutic communication in improving patient outcomes.

5. Pediatric Nursing Research Topics

• Assess the impact of parental involvement in pediatric asthma treatment adherence.
• Explore challenges related to chronic illness management in pediatric patients.
• Review the role of play therapy and other therapeutic interventions that alleviate anxiety among hospitalized children.

6. The Nursing Profession Research Topics

• Analyze the effects of short staffing on nurse burnout .
• Evaluate factors that facilitate resiliency among nursing professionals.
• Examine predictors of nurse dissatisfaction and burnout.
• Posit how nursing theories influence modern nursing practice.

Tips for Writing a Nursing Research Paper

The best nursing research advice we can provide is to follow your professor's rubric and instructions. However, here are a few study tips for nursing students to make paper writing less painful:

Avoid procrastination: Everyone says it, but few follow this advice. You can significantly lower your stress levels if you avoid procrastinating and start working on your project immediately.

Plan Ahead: Break down the writing process into smaller sections, especially if it seems overwhelming. Give yourself time for each step in the process.

Research: Use your resources and ask for help from the librarian or instructor. The rest should come together quickly once you find high-quality studies to analyze.

Outline: Create an outline to help you organize your thoughts. Then, you can plug in information throughout the research process. 

Clear Language: Use plain language as much as possible to get your point across. Jargon is inevitable when writing academic nursing papers, but keep it to a minimum.

Cite Properly: Accurately cite all sources using the appropriate citation style. Nursing research papers will almost always implement APA style. Check out the resources below for some excellent reference management options.

Revise and Edit: Once you finish your first draft, put it away for one to two hours or, preferably, a whole day. Once you've placed some space between you and your paper, read through and edit for clarity, coherence, and grammatical errors. Reading your essay out loud is an excellent way to check for the 'flow' of the paper.

Helpful Nursing Research Writing Resources:

Purdue OWL (Online writing lab) has a robust APA guide covering everything you need about APA style and rules.

Grammarly helps you edit grammar, spelling, and punctuation. Upgrading to a paid plan will get you plagiarism detection, formatting, and engagement suggestions. This tool is excellent to help you simplify complicated sentences.

Mendeley is a free reference management software. It stores, organizes, and cites references. It has a Microsoft plug-in that inserts and correctly formats APA citations.

Don't let nursing research papers scare you away from starting nursing school or furthering your education. Their purpose is to develop skills you'll need to be an effective nurse: critical thinking, communication, and the ability to review published information critically.

Choose a great topic and follow your teacher's instructions; you'll finish that paper in no time.

Joleen Sams is a certified Family Nurse Practitioner based in the Kansas City metro area. During her 10-year RN career, Joleen worked in NICU, inpatient pediatrics, and regulatory compliance. Since graduating with her MSN-FNP in 2019, she has worked in urgent care and nursing administration. Connect with Joleen on LinkedIn or see more of her writing on her website.

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