About the Book

Leadership and Influencing Change in Nursing is designed for a single-semester introduction to the professional nurse’s leadership role as both a care provider and a formal leader. Nursing students will take this course in their third year as they prepare to assume a professional nursing role within the clinical health care environment. An assortment of authors with diverse nursing leadership roles across Saskatchewan and Canada have contributed to this textbook. These diverse voices are focused on providing student nurses with the foundational tools, techniques, and knowledge required to empower them to meet the leadership challenges found within the ever-changing Canadian health care environment. Assembling this information using an online format allows for the material to be updated regularly so as to keep pace with the rapid expansion of knowledge.

The specific goals of this textbook are:

  • to ensure the information is relevant to Saskatchewan nursing students,
  • to tailor the content to nursing students’ needs for both practical knowledge and theoretical knowledge,
  • to provide up-to-date, evidence-informed content on nursing leadership,
  • to thread Indigenous content throughout the textbook, and
  • to tailor the textbook to the curriculum.

Approach and Pedagogy

This open access textbook introduces you to concepts related to leadership and the ability to influence change in the nursing profession. Essential theory and readings will be provided. The authors offer real-life management wisdom that is derived from a combination of clinical practice and evidence-based knowledge obtained through research. This wisdom will assist you in developing essential critical thinking skills that will enable you to make critical leadership decisions based on evidence-informed best practice. The authors will continue to work to ensure that the readings provided in this textbook contain the most up-to-date and relevant information. Since this is an open textbook, content will be reviewed and updated annually to ensure that the predetermined critical learning elements and outcomes are met for the course in which it is used. Instructors may assign additional readings in their classes in order to enrich your learning.

Each chapter begins with a significant leadership quotation relevant to the chapter content. Key terms throughout the chapters are highlighted in bold.

Coloured boxes are used in each chapter to differentiate and highlight important learning features (see diagram below).

Key Learning Features
Learning Objectives
From the Field
Research Notes
Essential Learning Activities

The Learning Objectives set out at the beginning of each chapter provide a guide to chapter contents and structure to your learning.

Three types of textboxes in each chapter offer important information:

From the Field textboxes provide wise words from nurse leaders.

Research Notes demonstrate how each chapter is evidence-based and provide you with links to important academic research that further explores the critical topics addressed in each chapter.

Essential Learning Activities in each chapter include links to important resources. These Essential Learning Activities may also include podcasts from chapter authors that have been developed for this textbook. The authors have chosen to provide you with links to source documents and videos, rather than summarizing or restating the contents of these important resources. These Essential Learning Activities are an integral part of the chapter content and will provide you with an in-depth understanding of contemporary issues within the nursing profession. It is important to review the sources offered in Essential Learning Activities and complete the accompanying questions. These questions require you to apply critical thinking and synthesize new knowledge. The information within these links is an essential component of your course work. This important information will not be provided elsewhere within the textbook.

Each chapter ends with a Summary, which gives a general overview of chapter content and a review of the chapter objectives, a number of Exercises to give you an opportunity to review and use your new leadership knowledge, and a complete list of References for all material cited in the chapter to assist you in locating it as needed.


Hypothesis (or Hypothes.is) is an open source web annotation tool that students and instructors can use to highlight and annotate online text, which they can share publicly or privately (for group discussion) or use for individual study. Hypothesis encourages deeper engagement with academic text and other Internet resources.

Hypothesis has been enabled for the online format of this textbook. In order to use this tool, you will first need to create a free account with Hypothesis and then follow the step-by-step instructions.

For more information, Hypothesis offers the following Quick Start Guides:

  1. Quick Start Guide for Students
  2. Quick Start Guide for Teachers

Chapter Structure

Chapter 1 introduces the emerging nurse leader to leadership theory. Descriptions of the skills that form the core of leadership excellence are provided. In addition, a quick overview of different nursing leadership styles that have been practised over the past century is presented. Emerging nurse leaders are also given the opportunity to compare and contrast different leadership styles while building a foundation for their own leadership style.

Chapter 2 provides a comprehensive discussion of workplace diversity in health care organizations. The nurse leader is introduced to cultural diversity and theoretical models that provide guidance to nurses in their provision of culturally competent care. Nurse leaders are assisted in developing an understanding of diversity, which will help them, as nurse leaders, to manage the workplace.

Chapter 3 offers an introduction to Indigenous health care and supports nurse leaders “to become leaders in the ‘Indian way’ ” (Nichols, 2004, p.177). The nurse leader is provided with a snapshot of the Indigenous worldview and the authors illustrate how worldviews affect leadership decisions. A review of the evolution of the health care system in Indigenous communities and the development of Indigenous health care structures provides the student with further essential knowledge required for nursing leadership. This chapter concludes with recommendations that will support the nurse leader in future collaborative work with Indigenous communities.

Chapter 4 illustrates the historical connections between the nursing profession and the Canadian health care system. Historically, the role played by nurses ranged from providing care to early settlers and Indigenous peoples, to lobbying for extensive changes to the Canada Health Act, to establishing PhD nursing programs, and finally, developing a unique body of Canadian nursing research. Nurse leaders have been a strong and vigilant group dedicated to building the future for nursing and health care in Canada.

Chapter 5 highlights some of the significant changes occurring within the Canadian health care system that have had an impact on nursing leadership and nursing practices. It contains a brief overview of the principles of a complex adaptive system and the importance of an organization’s vision, mission, and values in providing guidance to nurse leaders for decision making. The chapter concludes with a discussion of the recent adaptations to our health care organizational culture, which have led to an evolving scope of practice for registered nurses and the creation of a protocol for delegation of care.

Chapter 6 stresses the need for collaboration between health professionals to provide quality health care to clients in the community. The shift to care in the community sector is challenged by the specialized care of a growing population of geriatric clients, with a distinct focus on Indigenous seniors, and the special attention required by people with mental health and palliative care needs. Strong nurse leaders are required to engage in interprofessional collaborative relationships that lead to effective teamwork focused on determining client needs and ensuring successful outcomes.

Chapter 7 focuses on the development of quality management initiatives throughout the world in response to emerging patient safety issues. The impact of Magnet hospitals in the United States and the Francis report in England on international patient safety culture will be described in this chapter. Finally, the ways in which quality care is affected by Lean management principles and quality improvement tools, such as the plan-do-study-act cycle, will be discussed.

Chapter 8 illustrates the importance of evidence-informed leadership and practice for the delivery of safe, quality patient care. The three clusters of innovation addressed by leaders to promote a transparent learning organization are reviewed in this chapter. Leaders must constantly question, listen, and explore better ways for delivering quality and safe care that it is based on evidence. The chapter concludes by describing the opioid crisis in Canada and the US and demonstrating how evidence-informed harm reduction approaches bring nurse leaders back to basic nursing principles.

Chapter 9 stresses the importance of nurse leaders as change agents. Different theories and models of change theories are presented and several theories are applied to the nurse leader’s role in managing change. The chapter concludes with a discussion of resistance to change, with practical suggestions that will assist the leader in walking beside individuals throughout change.

Chapter 10 introduces the Canadian Nurses Association’s (CNA) Code of Ethics, which guides Canadian nursing practice. With its focus on “how broad societal issues affect health and well-being,” the Code of Ethics calls for advocacy to address health inequities. A discussion of advocacy, social justice, power, empowerment, critical social theory, whistle-blowing, and social activism provide the student with a foundation to better understand the requirements for nurse leaders to advocate for the health and well-being of all, as described in the Code of Ethics.

Chapter 11 shares the wisdom of mediators from the Ministry of Justice’s Dispute Resolution Office, and other experts, on how to resolve conflict. This chapter starts with a description of conflict and provides different approaches to dealing with it. These approaches are then applied to real-life nursing scenarios. A description of how conflict escalates and advice on how to de-escalate conflict and coach people toward resolution concludes the chapter. This knowledge will assist nurse leaders in learning to understand others and adapt their leadership approaches accordingly.

Chapter 12 focuses on the tools and resources required to support the nurse leader and builds on ethical and professional nursing practices. The recent transformation of the Canadian health care system requires the nurse leader to be visionary and contemporary while demonstrating strong organizational and management skills. The authors discuss changes in the system that require the nurse leader to align personal and professional values, such as those found in the CNA Code of Ethics, with responsibilities for excellence in patient care.

Chapter 13 familiarizes nurse leaders with their role in emergency preparedness and disaster planning. Nurses frequently have extensive leadership responsibilities during times of natural or anthropogenic (caused by humans) disasters. This chapter provides a description of the four areas of focus in emergency planning: mitigation, preparedness, response, and recovery. Students are given suggestions for how to prepare for unexpected events by planning responses that will minimize damage and facilitate the recovery. A coordinated effort among professionals throughout the health care, public, and private sectors is required to address the challenges presented by disasters, whether they are natural, anthropogenic, or technological.

Chapter 14 provides nursing students with an understanding of nursing informatics and technology. Different types of information technology are defined and discussed within this chapter. Technological advances bring many benefits to clients; however, the nurse leader must consider the safety, legality, and challenges associated with the use of information technology.

Chapter 15 discusses the role of professional nursing organizations to support and engage Canadian registered nurses in the development of a strong profession. The mandates of professional regulatory bodies, unions, and four national organizations (CNA, CFNU, CNPS, and CINA) will be discussed. In addition, the chapter will assist the nurse leader in understanding how these organizations are evolving and changing to more effectively support professional nurses in Canada by providing leadership in the delivery of safe, quality nursing care.

Chapter 16 describes the rapid evolution of nursing leadership and management linked to health care change. Changes include rapidly evolving international, national, and provincial health care landscapes, and system transformations that not only have impact on the workforce, but also entail changes in management systems and leadership styles. Many of these changes require that nurse managers and leaders have business acumen and tangible business skills. Finally, the consumer (or client) and family are requesting that their voices become a fundamental component of the care process. The rapidly evolving health care/nursing environment requires the nurse leader to manage personal stress by taking time for self-care. Self-care is especially important for new nurses as they transition from student to new graduate nurse.


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Leadership and Influencing Change in Nursing Copyright © 2018 by Joan Wagner is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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