Effective Leadership and Management in Nursing / Edition 8

by Eleanor Sullivan

Overview

This book provides students with an overall foundation in leadership and management as well as the necessary skills to make sound management decisions in a dynamic health environment.

Features:

• A three-part organization—Part I, Understanding Nursing Management and Organizations; Part II, Key Skills in Nursing Management; Part III, Human Resource Management—teaches an understanding of the basic principles of leadership and management and then outlines the principle skills readers need to make effective decisions.
• Focus on managed care and its implications in patient care.
• Companion Website includes additional student activities with links to the student workbook, career tips, practical skills application exercises, and Internet links.
• Presents expertise from both business schools and nursing administrators to give students a well-rounded perspective.
• Leadership and Management in Action exercises challenge readers to explore and apply concepts to practice.

Also Available:

Nursing Leadership and Management in Action, Jamerson (ISBN 0-13-092048-7): A workbook consisting of a series of modules, each focusing on a particular skill.

Product Details

ISBN-13:	2900132814545
Publication date:	07/26/2012
Pages:	368
Product dimensions:	7.90(w) x 9.90(h) x 0.50(d)

About the Author

Eleanor J. Sullivan, PhD, RN, FAAN, is the former dean of the University Kansas School of Nursing and past president of Sigma Theta Tau International. She has served on the board of directors of the American Association of Colleges of Nursing and on the advisory council of the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health, among other professional positions.

Dr. Sullivan is known for her publications in nursing, including this award-winning textbook, Effective Leadership & Management in Nursing, and most recently, Becoming Influential: A Guide for Nurses from Prentice Hall. Other publications include Creating Nursing's Future: Issues, Opportunities and Challenges and Nursing Care for Clients with Substance Abuse. From 1997 to 2002, she served as editor of the Journal of Professional Nursing, the official journal of the American Association of Colleges of Nursing.

Today Dr. Sullivan is a professional speaker and mystery author. Her first mystery, Twice Dead, features nurse sleuth Monika Everhardt. By showing nursing realistically, she hopes that readers will understand the complexity of nursing care and the skills and knowledge involved in being a nurse. Deadly Diversion, the second book in the series, was recently released by Hilliard & Harris.

Read an Excerpt

Preface

Leading and managing are essential skills for all nurses in today's rapidly changing health care arena. New graduates find themselves managing unlicensed assistive personnel, and experienced nurses are managing groups of health care providers from a variety of disciplines and educational levels. Declining revenues and increasing costs mandate that every organization use its resources efficiently; thus, nurses are challenged to manage effectively with fewer resources. Never has the information presented in Effective Leadership and Management in Nursing, Fifth Edition, been needed more. This textbook can help both student nurses and those with practice experience acquire the skills to ensure success in today's dynamic health care environment.

FEATURES OF THE FIFTH EDITION

Effective Leadership and Management in Nursing has made a significant and lasting contribution to the education of nurses and nurse managers in its four previous editions. Used worldwide, this award-winning textbook is now offered in an updated and revised edition to reflect changes in the current health care system and in response to suggestions from the book's users. The Fifth Edition builds upon the work of previous contributors to provide the most up-to-date and comprehensive learning package for today's busy students and professionals.

Two supplementary texts, the popular student workbook and the Instructor's Resource Manual, have been revised. In addition, we have added a few unique new supplements—a Companion Website and online course management systems—designed to enhance both student and faculty use of this textbook.Together this complete package facilitates rapid learning of essential content and skills.

Student-Friendly Learning Tools

Designed with the adult learner in mind, the book focuses on the application of the content presented and integrates clinical examples throughout each chapter. To further illustrate and emphasize key points, each chapter in this edition includes these features:

• Chapter outline and content preview
• Key terms defined on the pages where they first appear
• "Leadership and Management in Action"—end-of-chapter critical thinking exercises that help students apply what they have learned
• A bulleted summary at the end of the chapter
• Up-to-date references

Plus, at the end of each chapter, the reader will find a link to the Companion Website for additional exercises and research on the Web.

HALLMARK FEATURE: MULTIDISCIPLINARY AUTHORS

This book has been a success for many reasons. It combines practicality with conceptual understanding; is responsive to the needs of faculty, nurse managers, and students; and taps the expertise of contributors from a variety of disciplines, especially management professionals whose work has been adapted by nurses for current nursing practice. The expertise of management professors in schools of business and practicing nurse managers is seldom incorporated into nursing textbooks. This unique approach provides students with invaluable knowledge and skills and sets the book apart from others.

ORGANIZATION

The text is organized into three sections that address the essential information and key skills that nurses must learn to succeed in today's volatile health care environment.

Part I. Understanding Nursing Management and Organizations. Part I introduces the concepts of organizations and organizational theory and design with an emphasis on redesign, restructuring, reengineering, integrated care networks, and managed care. Leadership is presented within a theoretical framework, and management functions are explained. Also included in Part I is information about legal challenges, ethical dilemmas, power, and politics, all necessary for nurses to succeed and prosper.

Part II. Key Skills in Nursing Management. Essential skills for today's managers comprise Part II. These include creating and managing budgets, encouraging efficiency and productivity, promoting quality management, solving problems and making decisions, communicating with a variety of individuals and groups, resolving conflicts, using information technology effectively, managing time and stress, delegating, working in teams, and effecting change.

Part III. Human Resource Management. Human resources are the health care system's most valuable asset so nurses must be adept at recruiting and selecting staff, assigning staff, handling scheduling, managing turnover, appraising and enhancing performance, and handling the inevitable personnel problems. In addition, collective bargaining—a key issue today in many organizations—is included in Part III.

NEW EXPANDED TEACHING AND LEARNING PACKAGE

Effective Leadership and Management in Nursing has been designed for leadership and management courses for undergraduate students and for experienced nurses who are new managers. The book comes with a complete teaching/learning package, which includes the Instructor's Resource Manual; a student workbook, Nursing Leadership and Management in Action; a Companion Website; and online course companions available in WebCT and Blackboard.

Instructor's Resource Manual. The popular Instructor's Resource Manual provides instructors with a comprehensive outline of the entire book for syllabi and classroom lectures, a complete test bank, and overhead transparency masters. The Instructor's Resource Manual also guides instructors in how to get the most out of the other elements of the teaching/ learning package, such as the student workbook, Nursing Leadership and Management in Action, and the Companion Website.

Nursing Leadership and Management in Action. The companion workbook, Nursing Leadership and Management in Action, has been designed for use with Effective Leadership and Management in Nursing, Fifth Edition. Developed to help students acquire practical management skills, the workbook consists of a series of modules, each focusing on a particular skill. Some modules are designed for individual student practice and others for use in the skills laboratory or classroom. This workbook provides the instructor with valuable teaching activities and gives students opportunities to practice the skills introduced in the textbook. Activities in the workbook cover important timely topics, including problem solving, critical thinking, leadership styles, budgeting, using the Internet, communication, conflict resolution, delegation, and sensitivity to multicultural issues.

Companion Website. New to this package is a free Companion Website. This website serves as a text-specific, interactive online workbook to both Effective Leadership and Management in Nursing and Nursing Leadership and Management in Action. The Companion Website includes modules for objectives, chapter outlines, key terms and definitions, discussion questions with essay responses, NCLEX review questions with automatic grading, current event exercises with links to other sites for student research and essay responses, and more. Instructors adopting this textbook for their courses have free access to an online Syllabus Manager with a whole host of features that facilitate the students' use of this Companion Website.

Online Course Management. Also new to this package are online course companions available for schools using WebCT and Blackboard course management systems. For more information about adopting an online course management system to accompany Effective Leadership and Management, Fifth Edition, please contact your Prentice Hall Health sales representative.

ACKNOWLEDGMENTS

The success of previous editions of this book has been due to the expertise of many contributors. Nursing administrators, management professors, and faculty in schools of nursing all made significant contributions to earlier editions. I am enormously grateful to them for sharing their knowledge and experience to help nurses learn leadership and management skills. Without them, this book would not exist. A complete list of contributing authors to all the editions of Effective Leadership and Management in Nursing is found on page viii.

At Prentice Hall Health, Executive Editor, Maura Connor, and Beth Romph, Editorial Assistant, guided this revision throughout. Gretchen Miller provided editing services, Larry Purnell contributed advice about health care organizations, Carol Perry offered up-to-date information on employment law, and Karen Backus furnished information on the status of collective bargaining. I am grateful to all of them.

Because health care continues to change, reviewers who are using the book in their management practice and in their classes provided invaluable comments and suggestions. I am indebted to the reviewers listed on page viii.

A special thank you to Consulting Editor, Pat Jamerson. She managed the project throughout, updated content, wrote, and edited chapters. Her work was vital to this edition and is greatly appreciated.

To everyone who has contributed to this fine book over the years, I thank you.

Eleanor J. Sullivan, PhD, RN, FAAN

Table of Contents

Part I	Understanding Nursing Management and Organizations	1
Chapter 1	Introduction to Nursing Management	2
	The Changing Health Care System	3
	Cost Containment	3
	Quality and Outcomes	4
	Rural Health Care	4
	Cultural Diversity	5
	Changes in Nursing	5
	Challenges for Nurse Managers	6
Chapter 2	Organizational Theory and Design	8
	Organizational Theories	9
	Classical Theory	9
	Neoclassical Theory	11
	Systems Theory	11
	Contingency Theory	12
	Chaos Theory	13
	Health Care Organizations	13
	Types of Health Care Organizations	13
	Interorganizational Relationships	16
	Diversification	16
	Organizational Structure	17
	Functional Structure	17
	Service-Integrated Structure	18
	Hybrid Structure	19
	Matrix Structure	19
	Parallel Structure	20
	Shared Governance	20
	Self-Organizing Structures	22
	Redesigning, Restructuring, and Reengineering	22
	Strategic Planning	24
	Values	25
	Vision	25
	Mission	25
	Philosophy	25
	Goals	25
	Organizational Environment and Culture	25
Chapter 3	Nursing Care Delivery Systems	29
	Types of Nursing Care Delivery Systems	30
	Functional Nursing	31
	Team Nursing	31
	Total Patient Care	33
	Primary Nursing	33
	Practice Partnerships	34
	Case Management	34
	Differentiated Practice	38
	Patient-Centered Care	39
Chapter 4	Leading and Managing	41
	Leaders and Managers	42
	Leadership	42
	Power: How Managers and Leaders Get Things Done	43
	Leadership Theories	47
	Trait Theories	47
	Behavioral Theories	47
	Contingency Theories	50
	Contemporary Theories	56
	Management Functions	58
	Classical Description	58
	Mintzberg's Behavioral Description	60
	A Contemporary Model of Managerial Work	61
	Roles and Functions of Nursing Managers	62
	Levels of Management	63
	First-Level Management	63
	Middle-Level Management	65
	Upper-Level Management	66
	Charge Nurse	67
	Staff Nurse	67
Chapter 5	Legal and Ethical Issues	70
	Laws and Ethics	71
	Ethical Decision Making	72
	Ethical Theories	72
	Ethical Principles	72
	The Legal System	73
	Sources of Law	73
	Types of Law	74
	Tort Law	75
	Liability	75
	Legal Issues in Nursing	76
	Nursing Licensure	76
	Patient Care Issues	77
	Management Issues	79
	Employment Issues	83
Chapter 6	Power and Politics	88
	Politics: The Art of Influencing	89
	A Framework for Political Action	90
	Politics in the Workplace	90
	Politics in Government	91
	Politics in Financing	91
	Politics in the Organization	91
	Politics in the Community	92
	Power and Leadership	93
	Image as Power	93
	Using Power to Increase your Professional Influence	95
	Why Power?	95
	Power plus Vision	96
	Applying Power and Politics to Managing Nursing Care	97
	How Nursing's Voice Can Become Powerful	97
	The Impact of Power and Politics on Nursing's Future	99
Part II	Key Skills in Nursing Management	101
Chapter 7	Budgeting and Resource Allocation	103
	The Budgeting Process	104
	Approaches to Budgeting	105
	Incremental Budget	105
	Zero-Based Budget	106
	Fixed or Variable Budgets	106
	The Operating Budget	106
	The Revenue Budget	106
	The Expense Budget	107
	Determining the Salary (Personnel) Budget	108
	Benefits	108
	Shift Differentials	108
	Overtime	109
	On-Call Hours	110
	Bonuses and Premiums	110
	Salary Increases	110
	Final Considerations	110
	Managing the Supply and Nonsalary Expense Budget	110
	Developing the Capital Budget	111
	Timetable for the Budgeting Process	111
	Monitoring Budgetary Performance during the Year	111
	Variance Analysis	113
	Position Control	115
	Staff Impact on Budgetary Performance	115
	Future Trends	115
Chapter 8	Effectiveness, Efficiency, and Productivity	117
	What Are Effectiveness, Efficiency, and Productivity in Health Care?	118
	Organizational Effectiveness in Health Care Today	118
	Health Care Inputs	119
	Health Care Outputs	119
	Output or Outcome?	121
	Effectiveness	121
	Efficiency	121
	What Is Nursing Productivity?	122
	Measuring Nursing Productivity	122
	Resources per Patient Day	122
	Utilization Rates	123
	Improving Nursing Effectiveness, Efficiency, and Productivity	125
	Changes in Use of Inputs	126
	Changes in the Process of Care	126
Chapter 9	Quality Management	133
	History of Quality Management	134
	Total Quality Management (TQM)	135
	TQM Characteristics	137
	Continuous Quality Improvement (CQI)	138
	Comprehensive Components of Quality Management	140
	CQI--How It Works: A Practical Example	142
	Risk Management	143
	A Risk Management Program	143
	Nursing's Role in Risk Management	144
	Examples of Risk	144
	Role of the Nurse Manager	146
	Key Behaviors for Handling Complaints	147
	A Caring Attitude	147
	Evaluation of Risk Management	148
Chapter 10	Problem Solving and Decision Making	150
	Critical Thinking	151
	Problem Solving	152
	Problem-Solving Methods	152
	The Problem-Solving Process	154
	Group Problem Solving	157
	Decision Making	159
	Types of Decisions	160
	Decision-Making Conditions	160
	The Decision-Making Process	162
	Decision-Making Techniques	163
	Group Decision Making	164
	Stumbling Blocks	167
	Creativity in Decision Making	168
	Characteristics of Creative Persons	168
	Managing Creativity in Health Care Settings	169
Chapter 11	Communication and Conflict	172
	Communication	173
	Modes of Communication	173
	Directions of Communication	174
	Factors Influencing Communication	175
	Assertiveness	178
	The Role of Communication in Leadership	179
	Communicating with Different Populations	179
	Subordinates	179
	Superiors	180
	Peers	182
	Medical Staff	182
	Other Health Care Personnel	184
	Patients and Families	184
	Difficult People	184
	Conflict	185
	Conflict Process Model	186
	Conflict Management	188
	Goals of Conflict Management	189
	Conflict Management Modes	191
	Other Conflict Management Techniques	191
Chapter 12	Using Management Information Systems	195
	Information Systems	196
	Management Information Systems	196
	Hospital Information Systems	196
	Expert Nursing Information Systems	196
	Benefits of Using Information Systems	196
	Obstacles Associated with Information Systems	197
	Computer Applications in Nursing	198
	Patient-Care Applications	198
	Nursing Management Systems	199
	Communication Systems	199
	Educational Applications	201
	Research Applications	201
	Software Selection and System Implementation	201
	Selecting a System: The Decision-Making Process	201
	Ethical and Social Considerations	203
	The Nurse Informatics Specialist	203
	Future Trends in Informatics	204
Chapter 13	Stress and Time Management	206
	The Nature of Stress	207
	Causes of Stress	208
	Role Conflict and Role Ambiguity	210
	Consequences of Stress	211
	Managing Stress	211
	Personal Methods	211
	Organizational Methods	212
	Time Management	213
	Goal Setting	213
	Delegation	214
	Time Analysis	214
	Setting Priorities	215
	Daily Planning and Scheduling	216
	Grouping Activities and Minimizing Routine Work	216
	Implementation	216
	Personal Organization and Self-Discipline	216
	Controlling Interruptions	217
	Paperwork	218
	Respecting Time	219
Chapter 14	Effective Delegation	221
	Defining Delegation	222
	Responsibility and Accountability	222
	Authority	223
	Differentiating Delegation from Work Allocation	224
	Benefits of Delegation	224
	Benefits to the Delegator	224
	Benefits to the Delegate	224
	Benefits to the Organization	224
	Benefits to the Patient	224
	The Delegation Process	224
	Identifying and Defining the Task and Level of Delegation	224
	Determining Who	226
	Describing Expectations	227
	Reaching Agreement	227
	Monitoring Performance and Providing Feedback	227
	Accepting Delegation	227
	Obstacles to Delegation	228
	A Nonsupportive Environment	228
	An Insecure Delegator	228
	An Unwilling Delegate	231
	Ineffective Delegation	231
	Underdelegation	231
	Reverse Delegation	231
	Overdelegation	231
	Liability and Delegation	231
Chapter 15	Building and Managing Teams	233
	Differentiating Groups from Teams	234
	Group and Team Processes	236
	Phases of Group and Team Development	236
	Team-Building	238
	Characteristics of Groups	239
	Norms	239
	Roles	240
	Communication in Groups	241
	How Groups Affect Individuals	241
	The Nurse Manager as Team Leader	242
	Group Task	243
	Group Size and Composition	243
	Managing Committees and Task Forces	243
	Guidelines for Conducting Meetings	244
	Managing Task Forces	245
	Patient Care Conferences	246
Chapter 16	Initiating and Managing Change	248
	Nurse as Change Agent	249
	Nurse as Entrepreneur	249
	The Process of Change	250
	Change Theories	250
	Lewin's Force-Field Model	250
	Lippitt's Preface Leading and managing are essential skills for all nurses in today's rapidly changing health care arena. New graduates find themselves managing unlicensed assistive personnel, and experienced nurses are managing groups of health care providers from a variety of disciplines and educational levels. Declining revenues and increasing costs mandate that every organization use its resources efficiently; thus, nurses are challenged to manage effectively with fewer resources. Never has the information presented in Effective Leadership and Management in Nursing, Fifth Edition, been needed more. This textbook can help both student nurses and those with practice experience acquire the skills to ensure success in today's dynamic health care environment. FEATURES OF THE FIFTH EDITION Effective Leadership and Management in Nursing has made a significant and lasting contribution to the education of nurses and nurse managers in its four previous editions. Used worldwide, this award-winning textbook is now offered in an updated and revised edition to reflect changes in the current health care system and in response to suggestions from the book's users. The Fifth Edition builds upon the work of previous contributors to provide the most up-to-date and comprehensive learning package for today's busy students and professionals. Two supplementary texts, the popular student workbook and the Instructor's Resource Manual, have been revised. In addition, we have added a few unique new supplements—a Companion Website and online course management systems—designed to enhance both student and faculty use of this textbook. Together this complete packagefacilitates rapid learning of essential content and skills. Student-Friendly Learning Tools Designed with the adult learner in mind, the book focuses on the application of the content presented and integrates clinical examples throughout each chapter. To further illustrate and emphasize key points, each chapter in this edition includes these features: Chapter outline and content preview Key terms defined on the pages where they first appear "Leadership and Management in Action"—end-of-chapter critical thinking exercises that help students apply what they have learned A bulleted summary at the end of the chapter Up-to-date references Plus, at the end of each chapter, the reader will find a link to the Companion Website for additional exercises and research on the Web. HALLMARK FEATURE: MULTIDISCIPLINARY AUTHORS This book has been a success for many reasons. It combines practicality with conceptual understanding; is responsive to the needs of faculty, nurse managers, and students; and taps the expertise of contributors from a variety of disciplines, especially management professionals whose work has been adapted by nurses for current nursing practice. The expertise of management professors in schools of business and practicing nurse managers is seldom incorporated into nursing textbooks. This unique approach provides students with invaluable knowledge and skills and sets the book apart from others. ORGANIZATION The text is organized into three sections that address the essential information and key skills that nurses must learn to succeed in today's volatile health care environment. Part I. Understanding Nursing Management and Organizations. Part I introduces the concepts of organizations and organizational theory and design with an emphasis on redesign, restructuring, reengineering, integrated care networks, and managed care. Leadership is presented within a theoretical framework, and management functions are explained. Also included in Part I is information about legal challenges, ethical dilemmas, power, and politics, all necessary for nurses to succeed and prosper. Part II. Key Skills in Nursing Management. Essential skills for today's managers comprise Part II. These include creating and managing budgets, encouraging efficiency and productivity, promoting quality management, solving problems and making decisions, communicating with a variety of individuals and groups, resolving conflicts, using information technology effectively, managing time and stress, delegating, working in teams, and effecting change. Part III. Human Resource Management. Human resources are the health care system's most valuable asset so nurses must be adept at recruiting and selecting staff, assigning staff, handling scheduling, managing turnover, appraising and enhancing performance, and handling the inevitable personnel problems. In addition, collective bargaining—a key issue today in many organizations—is included in Part III. NEW EXPANDED TEACHING AND LEARNING PACKAGE Effective Leadership and Management in Nursing has been designed for leadership and management courses for undergraduate students and for experienced nurses who are new managers. The book comes with a complete teaching/learning package, which includes the Instructor's Resource Manual; a student workbook, Nursing Leadership and Management in Action; a Companion Website; and online course companions available in WebCT and Blackboard. Instructor's Resource Manual. The popular Instructor's Resource Manual provides instructors with a comprehensive outline of the entire book for syllabi and classroom lectures, a complete test bank, and overhead transparency masters. The Instructor's Resource Manual also guides instructors in how to get the most out of the other elements of the teaching/ learning package, such as the student workbook, Nursing Leadership and Management in Action, and the Companion Website. Nursing Leadership and Management in Action. The companion workbook, Nursing Leadership and Management in Action, has been designed for use with Effective Leadership and Management in Nursing, Fifth Edition. Developed to help students acquire practical management skills, the workbook consists of a series of modules, each focusing on a particular skill. Some modules are designed for individual student practice and others for use in the skills laboratory or classroom. This workbook provides the instructor with valuable teaching activities and gives students opportunities to practice the skills introduced in the textbook. Activities in the workbook cover important timely topics, including problem solving, critical thinking, leadership styles, budgeting, using the Internet, communication, conflict resolution, delegation, and sensitivity to multicultural issues. Companion Website. New to this package is a free Companion Website. This website serves as a text-specific, interactive online workbook to both Effective Leadership and Management in Nursing and Nursing Leadership and Management in Action. The Companion Website includes modules for objectives, chapter outlines, key terms and definitions, discussion questions with essay responses, NCLEX review questions with automatic grading, current event exercises with links to other sites for student research and essay responses, and more. Instructors adopting this textbook for their courses have free access to an online Syllabus Manager with a whole host of features that facilitate the students' use of this Companion Website. Online Course Management. Also new to this package are online course companions available for schools using WebCT and Blackboard course management systems. For more information about adopting an online course management system to accompany Effective Leadership and Management, Fifth Edition, please contact your Prentice Hall Health sales representative. ACKNOWLEDGMENTS The success of previous editions of this book has been due to the expertise of many contributors. Nursing administrators, management professors, and faculty in schools of nursing all made significant contributions to earlier editions. I am enormously grateful to them for sharing their knowledge and experience to help nurses learn leadership and management skills. Without them, this book would not exist. A complete list of contributing authors to all the editions of Effective Leadership and Management in Nursing is found on page viii. At Prentice Hall Health, Executive Editor, Maura Connor, and Beth Romph, Editorial Assistant, guided this revision throughout. Gretchen Miller provided editing services, Larry Purnell contributed advice about health care organizations, Carol Perry offered up-to-date information on employment law, and Karen Backus furnished information on the status of collective bargaining. I am grateful to all of them. Because health care continues to change, reviewers who are using the book in their management practice and in their classes provided invaluable comments and suggestions. I am indebted to the reviewers listed on page viii. A special thank you to Consulting Editor, Pat Jamerson. She managed the project throughout, updated content, wrote, and edited chapters. Her work was vital to this edition and is greatly appreciated. To everyone who has contributed to this fine book over the years, I thank you. Eleanor J. Sullivan, PhD, RN, FAAN From the B&N Reads Blog Page 1 of Related Subjects Business Medicine & Nursing Management & Leadership Nursing Industry Profiles - Management Health Care Industries - Management Nursing Fundamentals & Skills Nursing Management & Leadership Business Medicine & Nursing Management & Leadership Nursing Industry Profiles - Management Health Care Industries - Management Nursing Fundamentals & Skills Nursing Management & Leadership Editorial Reviews This book provides students with an overall foundation in leadership and management as well as the skills to make management decisions in a dynamic health environment. Specific sections cover understanding nursing management and organizations, key skills in nursing management, and human resource management. Basic principles of leadership and management are emphasized, and principal skills are outlined. Sullivan teaches nursing at University of Kansas. Decker teaches business and public administration at the University of Houston. Jameson teaches nursing at University of Missouri. Annotation c. Book News, Inc., Portland, OR (booknews.com) Booknews Customer Reviews