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Leading and Managing in Nursing Patricia S. Yoder-Wise
Digital Instant Download
Author(s): Patricia S. Yoder-Wise
ISBN(s): 9780323185776, 0323185770
Edition: Paperback
File Details: PDF, 20.87 MB
Year: 2014
Language: english
Leading and Managing in Nursing

SIXTH EDITION

Patricia S. Yoder-Wise
Texas Tech University Health Sciences Center, Lubbock, Texas

2
Table of Contents

Cover image

Title page

Contents
Part 1 Core Concepts

Part 2 Managing Resources

Part 3 Changing the Status Quo

Part 4 Interpersonal and Personal Skills

Copyright

Dedication

Contributors

Reviewers

Acknowledgments

Preface
Concept and Practice Combined

Diversity of Perspectives

Audience

Organization

Design

Learning Strategies

Chapter Opener Elements

Elements Within the Chapters

End of Chapter Elements

Other Teaching/Learning Strategies

Complete Teaching and Learning Package

Part 1: Core Concepts

3
Overview

Chapter 1: Leading, Managing, and Following

Abstract

Introduction

Differentiating Leading, Managing, and Following

Traditional and Emerging Leadership and Management Roles

Emotional Intelligence Development for Professional Practice

Theory Development in Leading, Managing, and Following

Complexity Science Takes Hold

Tasks of Leading, Managing, and Following

Leading, Managing, and Following in a Diverse Organization

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Leading, Managing, and Following

Chapter 2: Safe Care: The Core of Leading and Managing

Abstract

Introduction

The Classic Reports and Emerging Supports

The Institute of Medicine Reports on Quality

Agency for Healthcare Research and Quality

The National Quality Forum

The Joint Commission

The Det Norske Veritas/National Integrated Accreditation for Healthcare OrganizationsSM

Magnet Recognition Program®

Institute for Healthcare Improvement

Quality and Safety Education for Nurses

Meaning for Leading and Managing in Nursing

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Patient Safety

Chapter 3: Developing the Role of Leader

Abstract

Introduction

What is a Leader?

4
 The Practice of Leadership

Leadership Development

Developing Leaders in the Emerging Workforce

Surviving and Thriving as a Leader

The Nurse as Leader

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Becoming a Leader

Chapter 4: Developing the Role of Manager

Abstract

Introduction

The Definition of Management

Nurse Manager Role and the Intergenerational Workforce

Consuming Research

Organizational Culture

Mentoring

Day-to-Day Management Challenges

Managing Work Complexity and Stress

Managing Resources

Managed Care

Case Management

Informatics

Budgets

Quality Indicators

Professionalism

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Implementing the Role of Nurse Manager

Context

Chapter 5: Legal and Ethical Issues

Abstract

Introduction

Professional Nursing Practice

Liability: Personal, Vicarious, and Corporate

5
 Causes of Malpractice for Nurse Managers

Protective and Reporting Laws

Informed Consent

Privacy and Confidentiality

Policies and Procedures

Employment Laws

Patient Protection and Affordable Care Act and Health Care and Education Reconciliation Act

Professional Nursing Practice: Ethics

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Incorporating Legal and Ethical Issues in Practice Settings

Chapter 6: Making Decisions and Problem Solving

Abstract

Introduction

Differentiation of Decision Making and Problem Solving

Decision Making

Problem Solving

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Decision Making and Problem Solving

Chapter 7: Healthcare Organizations

Abstract

Introduction

Characteristics and Types of Organizations

Forces that Influence Healthcare Organizations

A Theoretical Perspective

Nursing Role and Function Changes

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Healthcare Organizations

Chapter 8: Understanding and Designing Organizational Structures

Abstract

Introduction

6
 Mission

Vision

Philosophy

Organizational Culture

Factors Influencing Organizational Development

Characteristics of Organizational Structures

Bureaucracy

Types of Organizational Structures

Emerging Fluid Relationships

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Understanding Organizational Structures

Chapter 9: Cultural Diversity in Health Care

Abstract

Introduction

Concepts and Principles

Theory

National and Global Directives

Special Issues

Language

Meaning of Diversity in the Organization

Cultural Relevance in the Workplace

Individual and Societal Factors

Dealing Effectively With Cultural Diversity

Implications in the Workplace

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Chapter 10: Power, Politics, and Influence

Abstract

Introduction

History

Into the Twenty-First Century

Policy, Power, and Activism

Focus on Power

Empowerment

Personal Power Strategies

7
 Exercising Power and Influence in the Workplace and other Organizations

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Using Influence

Part 2: Managing Resources

Chapter 11: Caring, Communicating, and Managing with Technology

Abstract

Introduction

Types of Technologies

Information Systems

Communication Technology

Informatics

Patient Safety

Impact of Clinical Information Systems

Safely Implementing Health Information Technology

Future Trends and Professional Issues

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Managing Information and Technology

Chapter 12: Managing Costs and Budgets

Abstract

Introduction

What Escalates Healthcare Costs?

How is Health Care Financed?

Healthcare Reimbursement

The Changing Healthcare Economic Environment

What Does this Mean for Nursing Practice?

Why is Profit Necessary?

Cost-Conscious Nursing Practices

Budgets

Types of Budgets

The Budgeting Process

Managing the Unit-Level Budget

Conclusion

The Evidence

What New Graduates Say

8
 Chapter Checklist

Tips for Managing Costs and Budgets

Chapter 13: Care Delivery Strategies

Abstract

Introduction

Case Method (Total Patient Care)

Functional Nursing

Team Nursing

Primary Nursing

Nursing Case Management

Critical Pathways

Differentiated Nursing Practice

Transforming Care at the Bedside

Transitional Care

Interprofessional Education and Collaboration

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Selecting a Care Delivery Model*

Chapter 14: Staffing and Scheduling

Abstract

Introduction

The Staffing Process

Productivity Models

Evaluation of Effective Staffing

Organizational Factors that Affect Staffing Plans

Scheduling

Evaluating Unit Staffing and Productivity

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Staffing and Scheduling

Chapter 15: Selecting, Developing, and Evaluating Staff

Abstract

Introduction

Role Concepts and the Position Description

Selecting Staff

9
 Developing Staff

Performance Appraisals

Performance Appraisal Methods

Performance Appraisal Environment

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Conducting an Interview

Part 3: Changing the Status Quo

Chapter 16: Strategic Planning, Goal-Setting, and Marketing

Abstract

Introduction

Strategic Planning

Marketing

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Planning, Goal-Setting, and Marketing

Chapter 17: Leading Change

Abstract

Introduction

The Nature of Change

The Change Process

People and Change

Context and Change

Leadership and Change

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Leading Change

Chapter 18: Building Teams Through Communication and Partnerships

Abstract

Introduction

Groups and Teams

Generational Differences

Communicating Effectively

10
 Key Concepts of Teams

Tools And Issues that Support Teams

Positive Communication Model

Qualities of a Team Player

Creating Synergy

Interdisciplinary/Interprofessional Teams

The Value of Team-Building

Managing Emotions

Reflective Practice

The Role of Leadership

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips For Team-Building

Chapter 19: Workforce Engagement and Collective Action

Abstract

Introduction

Collective Action

Governance

Collective Bargaining

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Collective Action

Chapter 20: Managing Quality and Risk

Abstract

Introduction

Quality Management in Health Care

Benefits of Quality Management

Planning for Quality Management

Evolution of Quality Management

Quality Management Principles

The Quality Improvement Process

Quality Assurance

Risk Management

Clinical Microsystems

Conclusion

The Evidence

11
 What New Graduates Say

Chapter Checklist

Tips for Quality Management

Chapter 21: Translating Research into Practice

Abstract

Introduction

From Using Research to Evidence-Based Practice

Development of Evidence-Based Practice

Comparative Effectiveness Research

Practice-Based Evidence

Participatory Action Research

Quality Improvement

Diffusion of Innovations

Translating Research Into Practice

Evaluating Evidence

Organizational Strategies

Issues for Nurse Leaders and Managers

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Developing Skill in Using Evidence

Part 4: Interpersonal and Personal Skills

Interpersonal

Chapter 22: Consumer Relationships

Abstract

Introduction

Relationships

Service

Advocacy

Teaching

Leadership

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Promoting a Consumer Focus

12
Chapter 23: Conflict: The Cutting Edge of Change
Abstract

Introduction

Types of Conflict

Stages of Conflict

Categories of Conflict

Modes of Conflict Resolution

Differences of Conflict-Handling Styles Among Nurses

The Role of the Leader

Managing Lateral Violence and Bullying

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Addressing Conflict

Chapter 24: Managing Personal/Personnel Problems

Abstract

Introduction

Personal/Personnel Problems

Documentation

Progressive Discipline

Termination

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips in the Documentation of Problems

Chapter 25: Workplace Violence and Incivility

Abstract

Introduction

Defining Workplace Violence and Incivility

Scope of the Problem

The Cost of Workplace Violence

Ensuring a Safe Workplace

Making a Difference

Prevention Strategies

Horizontal Violence: The Threat from Within

Developing a Safety Plan

Conclusion

The Evidence

13
 What New Graduates Say

Chapter Checklist

Tips for Preventing Workplace Violence

Chapter 26: Delegation: An Art of Professional Nursing Practice

Abstract

Introduction

Historical Perspective

Definitions

A Framework for Delegation

Assignment Versus Delegation

Importance of Delegating

Legal Authority to Delegate

Selecting the Delegatee

Supervising the Delegatee

Delegation Decision Making

Challenges Related to the Delegation Process

Charge Nurses

Conclusion

The Evidence

What New Grads Say

Chapter Checklist

Tips for Delegating

Personal

Chapter 27: Role Transition

Abstract

Introduction

Types of Roles

Leadership

Roles: The ABCs of Understanding Roles

Role Transition Process

Strategies to Promote Role Transition

From Role Transition to Role Triumph

Conclusion

The Evidence

What New Grads Say

Chapter Checklist

Tips for Role Transitioning

14
Chapter 28: Self-Management: Stress and Time
Abstract

Introduction

Understanding Stress

Sources of Job Stress

Management of Stress

Resolution of Stress

Management of Time

Meeting Management

Delegating

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for Self-Management

Chapter 29: Managing Your Career

Abstract

Introduction

A Framework

Career Development

Career Marketing Strategies

Professional Development

Academic and Continuing Education

Certification

Professional Associations

A Model for Involvement

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for a Successful Career

Future

Chapter 30: Thriving for the Future

Abstract

Introduction

Leadership Demands for the Future

Leadership Strengths for the Future

Visioning

15
 The Wise Forecast Model©

Shared Vision

Projections for the Future

Implications

Conclusion

The Evidence

What New Graduates Say

Chapter Checklist

Tips for the Future

Illustration Credits
Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 12

Chapter 14

Chapter 18

Chapter 21

Chapter 22

Chapter 23

Chapter 25

Chapter 26

Chapter 28

Chapter 29

Chapter 30

Glossary

Index

Key Leadership Skills

16
Contents

17
Part 1 Core Concepts
Overview
1 Leading, Managing, and Following, 2
2 Safe Care: The Core of Leading and Managing, 23
3 Developing the Role of Leader, 34
4 Developing the Role of Manager, 51
Context
5 Legal and Ethical Issues, 70
6 Making Decisions and Problem Solving, 100
7 Healthcare Organizations, 118
8 Understanding and Designing Organizational Structures, 136
9 Cultural Diversity in Health Care, 153
10 Power, Politics, and Influence, 167

18
Part 2 Managing Resources
11 Caring, Communicating, and Managing with Technology, 186
12 Managing Costs and Budgets, 211
13 Care Delivery Strategies, 232
14 Staffing and Scheduling, 255
15 Selecting, Developing, and Evaluating Staff, 279

19
Part 3 Changing the Status Quo
16 Strategic Planning, Goal-Setting, and Marketing, 291
17 Leading Change, 305
18 Building Teams Through Communication and Partnerships, 321
19 Workforce Engagement and Collective Action, 346
20 Managing Quality and Risk, 361
21 Translating Research into Practice, 383

20
Part 4 Interpersonal and Personal Skills
Interpersonal
22 Consumer Relationships, 409
23 Conflict: The Cutting Edge of Change, 431
24 Managing Personal/Personnel Problems, 450
25 Workplace Violence and Incivility, 464
26 Delegation: An Art of Professional Nursing Practice, 485
Personal
27 Role Transition, 506
28 Self-Management: Stress and Time, 518
29 Managing Your Career, 544
Future
30 Thriving for the Future, 566

21
Copyright

3251 Riverport Lane

St. Louis, Missouri 63043

LEADING AND MANAGING IN NURSING

SIXTH EDITION
978-0-323-18577-6

Copyright © 2015 by Mosby, an imprint of Elsevier Inc.

Copyright © 2011, 2007, 2003, 1999, 1995 by Mosby, Inc., an affiliate of Elsevier Inc.

No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrangements
with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency,
can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).

Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each
product to be administered, to verify the recommended dose or formula, the method and duration
of administration, and contraindications. It is the responsibility of practitioners, relying on their
own experience and knowledge of their patients, to make diagnoses, to determine dosages and the
best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.

22
Library of Congress Cataloging-in-Publication Data
Leading and managing in nursing / [edited by] Patricia S. Yoder-Wise. – Sixth edition.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-323-18577-6 (pbk. : alk. paper)
I. Yoder-Wise, Patricia S., 1941- editor of compilation.
[DNLM: 1. Nurse Administrators–organization & administration. 2. Leadership. WY 105]
RT89
362.17'3–dc23
2014001017

Senior Content Strategist: Yvonne Alexopoulos

Content Development Manager: Jean Sims Fornango
Senior Content Development Specialist: Danielle Frazier
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Tracey Schriefer
Design Direction: Ashley Miner

23
Dedication

This book is dedicated to the families and friends who supported us as we created it; to the faculty
who are dedicated to producing the nursing service leaders for the ever changing healthcare
services; to the learners who have committed to an exciting career in nursing administration; and
to the nurse leaders who face the incredible issues of health care every day, who do their best in
leading important changes in practice, and who remain committed to the glory of nursing: the care
we deliver to patients.

Lead on! ¡Adelante!

24
Contributors
Michael R. Bleich, PhD, RN, NEA-BC, FAAN President and Maxine Clark and Bob Fox Dean
and Professor Goldfarb School of Nursing at Barnes-Jewish College St. Louis, Missouri

Chapter 1: Leading, Managing, and Following

Mary Ellen Clyne, MSN, RN, NEA-BC President and Chief Executive Officer Clara Maass
Medical Center Belleville, New Jersey
Chapter 16: Strategic Planning, Goal-Setting, and Marketing
Jeannette T. Crenshaw, DNP, RN, LCCE, IBCLC, NEA-BC, FAAN Doctor of Nursing Practice
Executive Leadership in Nursing Specialization, Assistant Professor, Texas Tech University Health
Sciences Center, Lubbock, Texas
Chapter 6: Making Decisions and Problem Solving
Chapter 28: Self-Management: Stress and Time
Richard G. Cuming, RN, MSN, EdD, NEA-BC Nurse Executive – Operations Management,
Performance Management & Innovation, Tenet Healthcare Corporation, Dallas, Texas
Chapter 19: Workforce Engagement and Collective Action
Mary Ann T. Donohue, PhD, RN, APN, PMH-CNS, NEA-BC Vice President and Chief Nursing
Executive, Jersey Shore University Medical Center, Meridian Health System, Neptune, New Jersey

Chapter 28: Self-Management: Stress and Time

Karen A. Esquibel, PhD, RN, CPNP-PC Associate Professor of Nursing, Pediatric Nurse
Practitioner, Texas Tech University Health Sciences Center School of Nursing, Lubbock, Texas
Chapter 9: Cultural Diversity in Health Care
Michael L. Evans, PhD, RN, NEA-BC, FACHE, FAAN Dean and Professor, Texas Tech
University Health Sciences Center School of Nursing, Lubbock, Texas

Chapter 3: Developing the Role of Leader

Victoria N. Folse, PhD, APN, PMHCNS-BC, LCPC Director and Associate Professor, School of
Nursing, Illinois Wesleyan University, Bloomington, Illinois

Chapter 20: Managing Quality and Risk

Chapter 23: Conflict: The Cutting Edge of Change
Jacqueline Gonzalez, DNP, ARNP, MBA, NEA-BC, FAAN Senior Vice President & Chief
Nursing Officer and Patient Safety Officer, Miami Children’s Hospital, Miami, Florida
Chapter 4: Developing the Role of Manager
Ginny Wacker Guido, JD, MSN, RN, FAAN Regional Director for Nursing and Assistant Dean,
College of Nursing, Washington State University Vancouver, Vancouver, Washington

25
 Chapter 5: Legal and Ethical Issues
Debra Hagler, PhD, RN, ACNS-BC, CNE, ANEF, FAAN Clinical Professor, College of Nursing
& Health Innovation, Arizona State University, Phoenix, Arizona
Chapter 29: Managing Your Career
Karen Kelly, EdD, RN, NEA-BC Associate Professor & Director, Continuing Education, Southern
Illinois University Edwards, ville School of Nursing, Edwardsville, Illinois
Chapter 10: Power, Politics, and Influence
Shari Kist, PhD, RN

Assistant Professor, Goldfarb School of Nursing at Barnes-Jewish College,

St. Louis, MissouriChapter 1: Leading, Managing, and Following
Karren Kowalski, PhD, RN, NEA-BC, FAAN
Professor, Texas Tech University Health Sciences Center, Lubbock, Texas
President and CEO, Colorado Center for Nursing Excellence Denver, Colorado
Chapter 18: Building Teams Through Communication and Partnerships
Chapter 24: Managing Personal/Personnel Problems
Mary E. Mancini, PhD, RN, NE-BC, FAHA, FAAN Professor and Associate Dean of
Undergraduate Nursing Programs, The University of Texas—Arlington, College of Nursing
Arlington, Texas
Chapter 7: Healthcare Organizations
Chapter 8: Understanding and Designing Organizational Structures
Maureen Murphy-Ruocco, ANP, C, MSN, EdM, DPNAP, FNAP Professor and Associate Dean
School of Nursing and Health Education Graduate Program, Felician College School of Education,
Rutherford, New Jersey
Chapter 26: Delegation: An Art of Professional Nursing Practice
Dorothy A. Otto, EdD, MSN, RN, ANEF Associate Professor, University of Texas Health Science
Center-Houston, School of Nursing, Houston, Texas

Chapter 9: Cultural Diversity in Health Care

Elaine S. Scott, PhD, RN, NE-BC Associate Professor, Director, East Carolina Center for Nursing
Leadership, College of Nursing, East Carolina University, Greenville, North Carolina

Chapter 17: Leading Change

Ashley Sediqzad Clinical Informatics Manager, Children’s Mercy Hospitals and Clinics, Kansas
City, Missouri

Chapter 11: Caring, Communicating, and Managing with Technology

Janis B. Smith, RN, DNP Director, Clinical Informatics and Professional Practice, Children’s
Mercy Hospitals and Clinics, Kansas City, Missouri
Chapter 11: Caring, Communicating, and Managing with Technology
Susan Sportsman, PhD, RN, ANEF, FAAN Director, Academic Consulting Group, Nursing and
Health Professions, Elsevier Inc., St. Louis, Missouri

26
 Chapter 13: Care Delivery Strategies
Chapter 14: Staffing and Scheduling
Sylvain Trepanier, DNP, RN, CENP Senior Director, Patient Care Services, Tenet Healthcare
Corporation, Dallas, Texas
Chapter 6: Making Decisions and Problem Solving
Chapter 12: Managing Costs and Budgets
Diane M. Twedell, DNP, RN, CENP Chief Nursing Officer, Southeast Minnesota Region Mayo
Clinic Health System, Austin, Minnesota
Chapter 15: Selecting, Developing, and Evaluating Staff
Chapter 27: Role Transition
Jana Wheeler, RN, MSN, CPN Manager, Clinical Informatics, Children’s Mercy Hospitals &
Clinics, Kansas City, Missouri

Chapter 11: Caring, Communicating, and Managing with Technology

Crystal J. Wilkinson, DNP, RN, CNS-CH, CPHQ Assistant Professor Texas Tech University
Health Sciences Center, School of Nursing, Lubbock, Texas
Chapter 25: Workplace Violence and Incivility
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN Professor and Dean Emerita, Texas
Tech University Health Sciences Center, Lubbock, Texas
Chapter 2: Safe Care: The Core of Leading and Managing
Chapter 30: Thriving for the Future
Margarete Lieb Zalon, PhD, RN, ACNS-BC, FAAN Professor Department of Nursing,
University of Scranton, Scranton, Pennsylvania
Chapter 21: Translating Research into Practice
Chapter 22: Consumer Relationships
David Zambrana, DNP, MBA, RN Chief Operating Officer, University of Miami Hospital,
Miami, Florida

Chapter 19: Workforce Engagement and Collective Action

EVOLVE RESOURCES
Test Bank

Joyce Engel, PhD, RN, BEd, MEd Associate Professor, Department of Nursing Brock University,
St. Catharines, Ontario

27
Reviewers
Peer review is a critical aspect of most publications. Peers tell us what is strong and what is missing.
They direct the content of a publication from their area of knowledge and experience. These
individuals provide insightful comments and suggestions to hone the information presented in a
text or article, and we are indebted to them. The end result of their efforts, as in any peer review
process, is a stronger presentation of information for the readership. We are grateful to the masked
reviewers of this publication. Thank you!

Mary T. Boylston, RN, MSN, EdD, AHN-BC Professor of Nursing, Eastern University, St.
Davids, Pennsylvania

Elizabeth P. Crusse, MS, MA, RN, CNE Clinical Assistant Professor, Towson University,
Department of Nursing, Towson, Maryland

Dee Ernesti, RN, MSN, CENP Instructor, University of Nebraska Medical Center College of
Nursing, Omaha, Nebraska

Mary L. Fisher, PhD, RN Professor of Nursing, Associate Vice Chancellor for Academic Affairs,
Indiana University-Purdue University, Indianapolis, Indianapolis, Indiana

Shirley Garick, PhD, RN Interim Director of Nursing, Professor of Nursing, Texas A&M
University-Texarkana, Texarkana, Texas

Beth Bates Gaul, PhD, RN Professor of Nursing, Grand View University, Des Moines, Iowa

Evalyn J. Gossett, MSN, RN Clinical Assistant Professor, Indiana University Northwest, College
of Health and Human Services, School of Nursing, Gary, Indiana

Judy Gregg, MS, RN Nursing Instructor, Mount Vernon Nazarene University, Mount Vernon,
Ohio

Nancy Grove, PhD, RN Associate Professor (Retired), University of Pittsburgh, School of

Nursing, Johnstown, Pennsylvania

Emma Kientz, MS, APRN-CNS, CNE Assistant Professor, The University of Oklahoma, Tulsa,
Oklahoma

Mary B. Killeen, PhD, RN, NEA-BC Adjunct Associate Professor, Department of Nursing,
University of Michigan-Flint, Flint, Michigan

Dimitra Loukissa, PhD, RN Associate Professor, North Park University, School of Nursing,
Chicago, Illinois

Catherine Poillon Lovecchio, PhD, RN Assistant Professor of Nursing, The University of

Scranton, Scranton, Pennsylvania

Anne Boulter Lucero, MSN, RN Assistant Director, Nursing Instructor, Cabrillo College, Aptos,
California

Dorothea E. McDowell, PhD, RN Professor of Nursing, Henson School of Science and

Technology, Salisbury University, Salisbury, Maryland

Lynn A. Menzel, RN, BSN, MA Case Management, Martin Health System, Stuart, Florida

28
Bettie G. Miller, MSN, MS, BSE, BSN, RN-BC Instructor of Nursing, Eleanor Mann School of
Nursing, PhD (Candidate), Public Policy Program-Policy Studies in Aging, University of Arkansas,
Fayetteville, Arkansas

Juleann H. Miller, PhD, RN Associate Professor, Assistant Director of the Nursing Program, St.
Ambrose University, Davenport, Iowa

Jack E. Rydell, DNP, RN Assistant Professor, Concordia College, Moorhead, Minnesota

Charlotte Silvers, RN, MSN, CPHQ Assistant Professor, Texas Tech University Health Sciences
Center School of Nursing, Lubbock, Texas

Darlene Sredl, PhD, RN Professor of Nursing, College of Nursing, University of Missouri-St.

Louis, St. Louis, Missouri

Charlotte A. Wisnewski, PhD, RN, CDE, CNE BSN Program Director, University of Texas
Medical Branch School of Nursing at Galveston, Galveston, Texas

Joyce Wright, PhD, RN, CNE, CNL Associate Professor, Coordinator of the RN to BSN Program,
New Jersey City University, Jersey City, New Jersey

Judith Young, DNP, CCRN Clinical Assistant Professor, Indiana University School of Nursing,
Indianapolis, Indiana

29
Acknowledgments
Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAAN, Texas Tech University Health Sciences Center,
Lubbock, Texas

From the beginning of the precedent setting first edition leadership/management text to this sixth
edition, many people had a part in making this publication possible. Perhaps the group that is often
overlooked is, in a sense, the most important—the graduates who tell me how valuable information
was in this text and how it prepared them for the evolving role of nurses as they take on new roles
and responsibilities in their careers. Thank you for sharing your wisdom with us!
Special acknowledgment goes to the team at Elsevier—the “behind the scenes” people who turn
Word documents into a graphically appealing and colorful presentation. To our content strategist,
Yvonne Alexopoulos; to our content development specialist, Danielle Frazier; and to our project
manager, Tracey Schriefer: THANKS!
To the authors who made this edition possible: thank you for helping the next generation of
nurses be well prepared to enter the profession of nursing and to exercise both leadership and
management in responsible and artistic ways. To the educators who have used this textbook and
provided feedback, we listened and, as with the comments of the reviewers, incorporated
suggestions as needed.
Most of all, for me personally, I have to thank my husband and best friend, Robert Thomas Wise.
He has lived through six editions of this text and knows by now that when the deadlines tighten,
his humor and creativity need to increase. And they do! His willingness to take on more of the
things that might be deemed mutual tasks is a small example of his ongoing support. You are the
best!
As has been true since the beginning of Leading and Managing in Nursing, we who created and
revised this edition learned more about a particular area and the impact of each area on the whole
of leadership and management. Our learning reflects the condition of nursing today: there is no
room for stagnation on any topic. The context in which nurses lead and manage is constantly
changing—so the key to success is to learn continuously. Keep learning, keep caring, and maintain
our passion for nursing and the patients we serve. That message, if nothing else, must be instilled in
our leaders of tomorrow.
Lead on! ¡Adelante!

30
Preface
Leading and managing are two essential expectations of all professional nurses and become
increasingly important throughout one’s career. To lead, manage, and follow successfully, nurses
must possess not only knowledge and skills but also a caring and compassionate attitude.
This book results from our continued strong belief in the need for a text that focuses in a
distinctive way on the nursing leadership and management issues of today and tomorrow. We
continue to find that we are not alone in this belief. This edition incorporates reviewers from both
service and education to be sure that the text conveys important and timely information to users as
they focus on the critical roles of leading, managing, and following. Additionally, we took seriously
the various comments by educators and learners offered as I met them in person or heard from
them by email.

31
Concept and Practice Combined
Innovative in both content and presentation, Leading and Managing in Nursing merges theory,
research, and practical application in key leadership and management areas. Our overriding
concern in this edition remains to create a text that, while well grounded in theory and concept,
presents the content in a way that is real. Wherever possible, we use real-world examples from the
continuum of today’s healthcare settings to illustrate the concepts. Because each chapter contributor
synthesizes the designated focus, you will find no lengthy quotations in these chapters. We have
made every effort to make the content as engaging, inviting, and interesting as possible. Reflecting
our view of the real world of nursing leadership and management today, the following themes
pervade the text:
• Every role within nursing has the basic concern for safe, effective care for the people for whom we
exist—our clients and patients.
• The focus of health care continues to shift from the hospital to the community at a rapid rate.
• Healthcare consumers and the healthcare workforce are increasingly culturally diverse.
• Today virtually every professional nurse leads, manages, and follows, regardless of title or
position.
• Consumer relationships play a central role in the delivery of nursing and health care.
• Communication, collaboration, team-building, and other interpersonal skills form the foundation
of effective nursing leadership and management.
• Change continues at a rapid pace in health care and society in general.
• Change must derive from evidence-based practices wherever possible and from thoughtful
innovation when no or limited evidence exists.
• Healthcare delivery is highly dependent on the effectiveness of nurses across roles and settings.

32
Diversity of Perspectives
Contributors are recruited from diverse settings, roles, and geographic areas, enabling them to offer
a broad perspective on the critical elements of nursing leadership and management roles. To help
bridge the gap often found between nursing education and nursing practice, some contributors
were recruited from academia and others from practice settings. This blend not only contributes to
the richness of this text but also conveys a sense of oneness in nursing. The historical “gap” between
education and service must become a sense of a continuum and not a chasm.

33
Audience
This book is designed for undergraduate learners in nursing leadership and management courses,
including those in BSN-completion courses and second-degree programs. In addition, we know that
nurses in practice, who had not anticipated formal leadership and management roles in their
careers, use this text to capitalize on their own real-life experiences as a way to develop greater
understanding about leading and managing and the important role of following. Numerous
examples and The Challenge/Solution in each chapter provide relevance to the real world of
nursing.

34
Organization
We have organized this text around issues that are key to the success of professional nurses in
today’s constantly changing healthcare environment. So the content flows from the core concepts
(leading, managing, and following; patient safety; and role development as a leader and manager)
to the context in which leading and managing occur (legal considerations, organizational aspects,
culture, and power) to managing resources (technology, costs, staffing, change, building teams,
quality, and applying research) to personal and professional skills (consumer relationships,
conflicts, delegation, personal role transition, self and career management and preparing for the
future).
Because repetition plays a crucial role in how well learners learn and retain new content, some
topics appear in more than one chapter and in more than one section. For example, because
disruptive behavior is so disruptive, it is addressed in several chapters that focus on conflict,
personal/personnel problems, incivility, and self management. Rather than referring learners to
another portion of the text, the key information is provided within the specific chapter, but perhaps
in less depth.
We also made an effort to express a variety of different views on some topics, as is true in the real
world of nursing. This diversity of views in the real world presents a constant challenge to leaders,
managers, and followers, who address the critical tasks of creating positive workplaces so that those
who provide direct care thrive and continuously improve the patient experience.

35
Design
The functional full-color design, still distinctive to this text, is used to emphasize and identify the
text’s many learning strategies, which are featured to enhance learning. Full-color photographs not
only add visual interest but also provide visual reinforcement of concepts, such as body language
and the changes occurring in contemporary healthcare settings. Figures expand and clarify concepts
and activities described in the text graphically.

36
Learning Strategies
The numerous strategies featured in this text are designed both to stimulate learners’ interest and to
provide constant reinforcement throughout the learning process. Color is used consistently
throughout the text to help the reader identify the various chapter elements described in the
following sections.

37
Chapter Opener Elements
• The introductory paragraph briefly describes the purpose and scope of the chapter. It is a preview
of what the chapter contains.
• Objectives articulate the chapter’s learning intent, typically at the application level or higher.
• Terms to know are listed and appear in color type in each chapter. Definitions appear alphabetically
in the Glossary at the end of the text.
• The Challenge presents a contemporary nurse’s real-world concern related to the chapter’s focus.
It is designed to allow us to “hear” a real-life situation. The Challenge ends with a question about
what you might do in such a situation.

38
Elements Within the Chapters
Exercises stimulate learners to reason critically about how to apply concepts to the workplace and
other real-world situations. They provide experiential reinforcement of key leading, managing, and
following skills. Exercises are highlighted within a full-color box and are numbered sequentially
within each chapter to facilitate using them as assignments or activities. Each chapter is numbered
separately so that learners can focus on the concepts inherent in a specific area and educators can
readily use chapters to fit their own sequence of presenting information.
Research Perspectives and Literature Perspectives illustrate the relevance and applicability of current
scholarship to practice. Perspectives always appear in boxes with a “book” icon in the upper left
corner. These remain the same in the edition of the text and additional research and literature
perspectives are updated on a scheduled basis so that newer information is available should
educators wish to substitute any perspectives.
Theory Boxes provide a brief description of relevant theory and key concepts.
Numbered boxes contain lists, tools such as forms and work sheets, and other information relevant
to the chapter.
The vivid full-color chapter opener photographs and other photographs throughout the text help
convey each chapter’s key message. Figures and tables also expand concepts presented to facilitate
a greater grasp of important materials.

39
End of Chapter Elements
The Solution provides an effective method to handle the real-life situations set forth in The Challenge.
It reflects the response the author of The Challenge took and ends with a question about how that
solution would fit for you.
The Evidence contains one example of evidence related to the chapter’s content or it contains a
summary of what the literature shows to be evidence related to the topic.
What New Graduates Say is a new feature that illustrates comments recent graduates have made
related to the concepts discussed in the chapter.
The Chapter Checklist summarizes the main point in a brief paragraph and an itemized list of the
major headings from the chapter.
Tips offer practical guidelines for learners to follow in applying some aspect of the information
presented in each chapter.
References and Suggested Readings provide the learner with a list of key sources for further reading
on topics found in the chapter.

40
Exploring the Variety of Random
Documents with Different Content
 "Corpus Domini nostri Jesu Christi custodiat animam meam in
vitam æternam."
A cold sweat broke out on Rudolph's forehead as the communion
began. Along the line Father Schwartz moved, and with gathering
nausea Rudolph felt his heart-valves weakening at the will of God. It
seemed to him that the church was darker and that a great quiet had
fallen, broken only by the inarticulate mumble which announced the
approach of the Creator of Heaven and Earth. He dropped his head
down between his shoulders and waited for the blow.
Then he felt a sharp nudge in his side. His father was poking him
to sit up, not to slump against the rail; the priest was only two places
away.
"Corpus Domini nostri Jesu Christi custodiat animam meam in
vitam æternam."
Rudolph opened his mouth. He felt the sticky wax taste of the
wafer on his tongue. He remained motionless for what seemed an
interminable period of time, his head still raised, the wafer
undissolved in his mouth. Then again he started at the pressure of
his father's elbow, and saw that the people were falling away from
the altar like leaves and turning with blind downcast eyes to their
pews, alone with God.
Rudolph was alone with himself, drenched with perspiration and
deep in mortal sin. As he walked back to his pew the sharp taps of
his cloven hoofs were loud upon the floor, and he knew that it was a
dark poison he carried in his heart.

"Sagitta Volante in Dei"

 The beautiful little boy with eyes like blue stones, and lashes that
sprayed open from them like flower-petals had finished telling his sin
to Father Schwartz—and the square of sunshine in which he sat had
moved forward half an hour into the room. Rudolph had become less
frightened now; once eased of the story a reaction had set in. He
knew that as long as he was in the room with this priest God would
not stop his heart, so he sighed and sat quietly, waiting for the priest
to speak.
Father Schwartz's cold watery eyes were fixed upon the carpet
pattern on which the sun had brought out the swastikas and the flat
bloomless vines and the pale echoes of flowers. The hall-clock
ticked insistently toward sunset, and from the ugly room and from the
afternoon outside the window arose a stiff monotony, shattered now
and then by the reverberate clapping of a far-away hammer on the
dry air. The priest's nerves were strung thin and the beads of his
rosary were crawling and squirming like snakes upon the green felt
of his table top. He could not remember now what it was he should
say.
Of all the things in this lost Swede town he was most aware of this
little boy's eyes—the beautiful eyes, with lashes that left them
reluctantly and curved back as though to meet them once more.
For a moment longer the silence persisted while Rudolph waited,
and the priest struggled to remember something that was slipping
farther and farther away from him, and the clock ticked in the broken
house. Then Father Schwartz stared hard at the little boy and
remarked in a peculiar voice:
"When a lot of people get together in the best places things go
glimmering."
Rudolph started and looked quickly at Father Schwartz's face.
"I said—" began the priest, and paused, listening. "Do you hear
the hammer and the clock ticking and the bees? Well, that's no good.
The thing is to have a lot of people in the centre of the world,
wherever that happens to be. Then"—his watery eyes widened
knowingly—"things go glimmering."
 "Yes, Father," agreed Rudolph, feeling a little frightened.
"What are you going to be when you grow up?"
"Well, I was going to be a baseball-player for a while," answered
Rudolph nervously, "but I don't think that's a very good ambition, so I
think I'll be an actor or a Navy officer."
Again the priest stared at him.
"I see exactly what you mean," he said, with a fierce air.
Rudolph had not meant anything in particular, and at the
implication that he had, he became more uneasy.
"This man is crazy," he thought, "and I'm scared of him. He wants
me to help him out some way, and I don't want to."
"You look as if things went glimmering," cried Father Schwartz
wildly. "Did you ever go to a party?"
"Yes, Father."
"And did you notice that everybody was properly dressed? That's
what I mean. Just as you went into the party there was a moment
when everybody was properly dressed. Maybe two little girls were
standing by the door and some boys were leaning over the
banisters, and there were bowls around full of flowers."
"I've been to a lot of parties," said Rudolph, rather relieved that
the conversation had taken this turn.
"Of course," continued Father Schwartz triumphantly, "I knew
you'd agree with me. But my theory is that when a whole lot of
people get together in the best places things go glimmering all the
time."
Rudolph found himself thinking of Blatchford Sarnemington.
"Please listen to me!" commanded the priest impatiently. "Stop
worrying about last Saturday. Apostasy implies an absolute
damnation only on the supposition of a previous perfect faith. Does
that fix it?"
 Rudolph had not the faintest idea what Father Schwartz was
talking about, but he nodded and the priest nodded back at him and
returned to his mysterious preoccupation.
"Why," he cried, "they have lights now as big as stars—do you
realize that? I heard of one light they had in Paris or somewhere that
was as big as a star. A lot of people had it—a lot of gay people. They
have all sorts of things now that you never dreamed of."
"Look here—" He came nearer to Rudolph, but the boy drew
away, so Father Schwartz went back and sat down in his chair, his
eyes dried out and hot. "Did you ever see an amusement park?"
"No, Father."
"Well, go and see an amusement park." The priest waved his
hand vaguely. "It's a thing like a fair, only much more glittering. Go to
one at night and stand a little way off from it in a dark place—under
dark trees. You'll see a big wheel made of lights turning in the air,
and a long slide shooting boats down into the water. A band playing
somewhere, and a smell of peanuts—and everything will twinkle. But
it won't remind you of anything, you see. It will all just hang out there
in the night like a colored balloon—like a big yellow lantern on a
pole."
Father Schwartz frowned as he suddenly thought of something.
"But don't get up close," he warned Rudolph, "because if you do
you'll only feel the heat and the sweat and the life."
All this talking seemed particularly strange and awful to Rudolph,
because this man was a priest. He sat there, half terrified, his
beautiful eyes open wide and staring at Father Schwartz. But
underneath his terror he felt that his own inner convictions were
confirmed. There was something ineffably gorgeous somewhere that
had nothing to do with God. He no longer thought that God was
angry at him about the original lie, because He must have
understood that Rudolph had done it to make things finer in the
confessional, brightening up the dinginess of his admissions by
saying a thing radiant and proud. At the moment when he had
affirmed immaculate honor a silver pennon had flapped out into the
breeze somewhere and there had been the crunch of leather and the
shine of silver spurs and a troop of horsemen waiting for dawn on a
low green hill. The sun had made stars of light on their breastplates
like the picture at home of the German cuirassiers at Sedan.
But now the priest was muttering inarticulate and heart-broken
words, and the boy became wildly afraid. Horror entered suddenly in
at the open window, and the atmosphere of the room changed.
Father Schwartz collapsed precipitously down on his knees, and let
his body settle back against a chair.
"Oh, my God!" he cried out, in a strange voice, and wilted to the
floor.
Then a human oppression rose from the priest's worn clothes,
and mingled with the faint smell of old food in the corners. Rudolph
gave a sharp cry and ran in a panic from the house—while the
collapsed man lay there quite still, filling his room, filling it with voices
and faces until it was crowded with echolalia, and rang loud with a
steady, shrill note of laughter.
Outside the window the blue sirocco trembled over the wheat, and
girls with yellow hair walked sensuously along roads that bounded
the fields, calling innocent, exciting things to the young men who
were working in the lines between the grain. Legs were shaped
under starchless gingham, and rims of the necks of dresses were
warm and damp. For five hours now hot fertile life had burned in the
afternoon. It would be night in three hours, and all along the land
there would be these blonde Northern girls and the tall young men
from the farms lying out beside the wheat, under the moon.

RAGS MARTIN-JONES AND THE PR-NCE OF

W-LES

The Majestic came gliding into New York harbor on an April

morning. She sniffed at the tugboats and turtle-gaited ferries, winked
at a gaudy young yacht, and ordered a cattle-boat out of her way
with a snarling whistle of steam. Then she parked at her private dock
with all the fuss of a stout lady sitting down, and announced
complacently that she had just come from Cherbourg and
Southampton with a cargo of the very best people in the world.
The very best people in the world stood on the deck and waved
idiotically to their poor relations who were waiting on the dock for
gloves from Paris. Before long a great toboggan had connected the
Majestic with the North American continent, and the ship began to
disgorge these very best people in the world—who turned out to be
Gloria Swanson, two buyers from Lord & Taylor, the financial minister
from Graustark with a proposal for funding the debt, and an African
king who had been trying to land somewhere all winter and was
feeling violently seasick.
The photographers worked passionately as the stream of
passengers flowed on to the dock. There was a burst of cheering at
the appearance of a pair of stretchers laden with two Middle-
Westerners who had drunk themselves delirious on the last night
out.
The deck gradually emptied, but when the last bottle of
Benedictine had reached shore the photographers still remained at
their posts. And the officer in charge of debarkation still stood at the
foot of the gangway, glancing first at his watch and then at the deck
as if some important part of the cargo was still on board. At last from
the watchers on the pier there arose a long-drawn "Ah-h-h!" as a
final entourage began to stream down from deck B.
First came two French maids, carrying small, purple dogs, and
followed by a squad of porters, blind and invisible under innumerable
bunches and bouquets of fresh flowers. Another maid followed,
leading a sad-eyed orphan child of a French flavor, and close upon
its heels walked the second officer pulling along three neurasthenic
wolfhounds, much to their reluctance and his own.
A pause. Then the captain, Sir Howard George Witchcraft,
appeared at the rail, with something that might have been a pile of
gorgeous silver-fox fur standing by his side.
 Rags Martin-Jones, after five years in the capitals of Europe, was
returning to her native land!
Rags Martin-Jones was not a dog. She was half a girl and half a
flower, and as she shook hands with Captain Sir Howard George
Witchcraft she smiled as if some one had told her the newest,
freshest joke in the world. All the people who had not already left the
pier felt that smile trembling on the April air and turned around to
see.
She came slowly down the gangway. Her hat, an expensive,
inscrutable experiment, was crushed under her arm, so that her
scant boy's hair, convict's hair, tried unsuccessfully to toss and flop a
little in the harbor wind. Her face was like seven o'clock on a
wedding morning save where she had slipped a preposterous
monocle into an eye of clear childish blue. At every few steps her
long lashes would tilt out the monocle, and she would laugh, a
bored, happy laugh, and replace the supercilious spectacle in the
other eye.
Tap! Her one hundred and five pounds reached the pier and it
seemed to sway and bend from the shock of her beauty. A few
porters fainted. A large, sentimental shark which had followed the
ship across made a despairing leap to see her once more, and then
dove, broken-hearted, back into the deep sea. Rags Martin-Jones
had come home.
There was no member of her family there to meet her, for the
simple reason that she was the only member of her family left alive.
In 1913 her parents had gone down on the Titanic together rather
than be separated in this world, and so the Martin-Jones fortune of
seventy-five millions had been inherited by a very little girl on her
tenth birthday. It was what the consumer always refers to as a
"shame."
Rags Martin-Jones (everybody had forgotten her real name long
ago) was now photographed from all sides. The monocle persistently
fell out, and she kept laughing and yawning and replacing it, so no
very clear picture of her was taken—except by the motion-picture
camera. All the photographs, however, included a flustered,
handsome young man, with an almost ferocious love-light burning in
his eyes, who had met her on the dock. His name was John M.
Chestnut, he had already written the story of his success for the
American Magazine, and he had been hopelessly in love with Rags
ever since the time when she, like the tides, had come under the
influence of the summer moon.
When Rags became really aware of his presence they were
walking down the pier, and she looked at him blankly as though she
had never seen him before in this world.
"Rags," he began, "Rags——"
"John M. Chestnut?" she inquired, inspecting him with great
interest.
"Of course!" he exclaimed angrily. "Are you trying to pretend you
don't know me? That you didn't write me to meet you here?"
She laughed. A chauffeur appeared at her elbow, and she twisted
out of her coat, revealing a dress made in great splashy checks of
sea-blue and gray. She shook herself like a wet bird.
"I've got a lot of junk to declare," she remarked absently.
"So have I," said Chestnut anxiously, "and the first thing I want to
declare is that I've loved you, Rags, every minute since you've been
away."
She stopped him with a groan.
"Please! There were some young Americans on the boat. The
subject has become a bore."
"My God!" cried Chestnut, "do you mean to say that you class my
love with what was said to you on a boat?"
His voice had risen, and several people in the vicinity turned to
hear.
"Sh!" she warned him, "I'm not giving a circus. If you want me to
even see you while I'm here, you'll have to be less violent."
But John M. Chestnut seemed unable to control his voice.
 "Do you mean to say"—it trembled to a carrying pitch—"that
you've forgotten what you said on this very pier five years ago last
Thursday?"
Half the passengers from the ship were now watching the scene
on the dock, and another little eddy drifted out of the customs-house
to see.
"John"—her displeasure was increasing—"if you raise your voice
again I'll arrange it so you'll have plenty of chance to cool off. I'm
going to the Ritz. Come and see me there this afternoon."
"But, Rags!" he protested hoarsely. "Listen to me. Five years ago
——"
Then the watchers on the dock were treated to a curious sight. A
beautiful lady in a checkered dress of sea-blue and gray took a brisk
step forward so that her hands came into contact with an excited
young man by her side. The young man retreating instinctively
reached back with his foot, but, finding nothing, relapsed gently off
the thirty-foot dock and plopped, after a not ungraceful revolution,
into the Hudson River.
A shout of alarm went up, and there was a rush to the edge just
as his head appeared above water. He was swimming easily, and,
perceiving this, the young lady who had apparently been the cause
of the accident leaned over the pier and made a megaphone of her
hands.
"I'll be in at half past four," she cried.
And with a cheerful wave of her hand, which the engulfed
gentleman was unable to return, she adjusted her monocle, threw
one haughty glance at the gathered crowd, and walked leisurely from
the scene.

II
 The five dogs, the three maids, and the French orphan were
installed in the largest suite at the Ritz, and Rags tumbled lazily into
a steaming bath, fragrant with herbs, where she dozed for the
greater part of an hour. At the end of that time she received business
calls from a masseuse, a manicure, and finally a Parisian hair-
dresser, who restored her hair-cut to criminal's length. When John M.
Chestnut arrived at four he found half a dozen lawyers and bankers,
the administrators of the Martin-Jones trust fund, waiting in the hall.
They had been there since half past one, and were now in a state of
considerable agitation.
After one of the maids had subjected him to a severe scrutiny,
possibly to be sure that he was thoroughly dry, John was conducted
immediately into the presence of m'selle. M'selle was in her bedroom
reclining on the chaise-longue among two dozen silk pillows that had
accompanied her from the other side. John came into the room
somewhat stiffly and greeted her with a formal bow.
"You look better," she said, raising herself from her pillows and
staring at him appraisingly. "It gave you a color."
He thanked her coldly for the compliment.
"You ought to go in every morning." And then she added
irrelevantly: "I'm going back to Paris to-morrow."
John Chestnut gasped.
"I wrote you that I didn't intend to stay more than a week anyhow,"
she added.
"But, Rags——"
"Why should I? There isn't an amusing man in New York."
"But listen, Rags, won't you give me a chance? Won't you stay for,
say, ten days and get to know me a little?"
"Know you!" Her tone implied that he was already a far too open
book. "I want a man who's capable of a gallant gesture."
"Do you mean you want me to express myself entirely in
pantomime?"
 Rags uttered a disgusted sigh.
"I mean you haven't any imagination," she explained patiently. "No
Americans have any imagination. Paris is the only large city where a
civilized woman can breathe."
"Don't you care for me at all any more?"
"I wouldn't have crossed the Atlantic to see you if I didn't. But as
soon as I looked over the Americans on the boat, I knew I couldn't
marry one. I'd just hate you, John, and the only fun I'd have out of it
would be the fun of breaking your heart."
She began to twist herself down among the cushions until she
almost disappeared from view.
"I've lost my monocle," she explained.
After an unsuccessful search in the silken depths she discovered
the illusive glass hanging down the back of her neck.
"I'd love to be in love," she went on, replacing the monocle in her
childish eye. "Last spring in Sorrento I almost eloped with an Indian
rajah, but he was half a shade too dark, and I took an intense dislike
to one of his other wives."
"Don't talk that rubbish!" cried John, sinking his face into his
hands.
"Well, I didn't marry him," she protested. "But in one way he had a
lot to offer. He was the third richest subject of the British Empire.
That's another thing—are you rich?"
"Not as rich as you."
"There you are. What have you to offer me?"
"Love."
"Love!" She disappeared again among the cushions. "Listen,
John. Life to me is a series of glistening bazaars with a merchant in
front of each one rubbing his hands together and saying 'Patronize
this place here. Best bazaar in the world.' So I go in with my purse
full of beauty and money and youth, all prepared to buy. 'What have
you got for sale?' I ask him, and he rubs his hands together and
says: 'Well, Mademoiselle, to-day we have some perfectly be-oo-tiful
love.' Sometimes he hasn't even got that in stock, but he sends out
for it when he finds I have so much money to spend. Oh, he always
gives me love before I go—and for nothing. That's the one revenge I
have."
John Chestnut rose despairingly to his feet and took a step toward
the window.
"Don't throw yourself out," Rags exclaimed quickly.
"All right." He tossed his cigarette down into Madison Avenue.
"It isn't just you," she said in a softer voice. "Dull and uninspired
as you are, I care for you more than I can say. But life's so endless
here. Nothing ever comes off."
"Loads of things come off," he insisted. "Why, to-day there was an
intellectual murder in Hoboken and a suicide by proxy in Maine. A bill
to sterilize agnostics is before Congress——"
"I have no interest in humor," she objected, "but I have an almost
archaic predilection for romance. Why, John, last month I sat at a
dinner-table while two men flipped a coin for the kingdom of
Schwartzberg-Rhineminster. In Paris I knew a man named Blutchdak
who really started the war, and has a new one planned for year after
next."
"Well, just for a rest you come out with me to-night," he said
doggedly.
"Where to?" demanded Rags with scorn. "Do you think I still thrill
at a night-club and a bottle of sugary mousseaux? I prefer my own
gaudy dreams."
"I'll take you to the most highly-strung place in the city."
"What'll happen? You've got to tell me what'll happen."
John Chestnut suddenly drew a long breath and looked cautiously
around as if he were afraid of being overheard.
 "Well, to tell you the truth," he said in a low, worried tone, "if
everything was known, something pretty awful would be liable to
happen to me."
She sat upright and the pillows tumbled about her like leaves.
"Do you mean to imply that there's anything shady in your life?"
she cried, with laughter in her voice. "Do you expect me to believe
that? No, John, you'll have your fun by plugging ahead on the beaten
path—just plugging ahead."
Her mouth, a small insolent rose, dropped the words on him like
thorns. John took his hat and coat from the chair and picked up his
cane.
"For the last time—will you come along with me to-night and see
what you will see?"
"See what? See who? Is there anything in this country worth
seeing?"
"Well," he said, in a matter-of-fact tone, "for one thing you'll see
the Prince of Wales."
"What?" She left the chaise-longue at a bound. "Is he back in New
York?"
"He will be to-night. Would you care to see him?"
"Would I? I've never seen him. I've missed him everywhere. I'd
give a year of my life to see him for an hour." Her voice trembled with
excitement.
"He's been in Canada. He's down here incognito for the big prize-
fight this afternoon. And I happen to know where he's going to be to-
night."
Rags gave a sharp ecstatic cry:
"Dominic! Louise! Germaine!"
The three maids came running. The room filled suddenly with
vibrations of wild, startled light.
 "Dominic, the car!" cried Rags in French. "St. Raphael, my gold
dress and the slippers with the real gold heels. The big pearls too—
all the pearls, and the egg-diamond and the stockings with the
sapphire clocks. Germaine—send for a beauty-parlor on the run. My
bath again—ice cold and half full of almond cream. Dominic—
Tiffany's, like lightning, before they close. Find me a brooch, a
pendant, a tiara, anything—it doesn't matter—with the arms of the
house of Windsor."
She was fumbling at the buttons of her dress—and as John
turned quickly to go, it was already sliding from her shoulders.
 "Orchids!" she called after him, "orchids, for the love of heaven!
Four dozen, so I can choose four."
And then maids flew here and there about the room like frightened
birds. "Perfume, St. Raphael, open the perfume trunk, and my rose-
colored sables, and my diamond garters, and the sweet-oil for my
hands! Here, take these things! This too—and this—ouch!—and
this!"
With becoming modesty John Chestnut closed the outside door.
The six trustees in various postures of fatigue, of ennui, of
resignation, of despair, were still cluttering up the outer hall.
"Gentlemen," announced John Chestnut, "I fear that Miss Martin-
Jones is much too weary from her trip to talk to you this afternoon."

III

"This place, for no particular reason, is called the Hole in the Sky."
Rags looked around her. They were on a roof-garden wide open
to the April night. Overhead the true stars winked cold, and there
was a lunar sliver of ice in the dark west. But where they stood it was
warm as June, and the couples dining or dancing on the opaque
glass floor were unconcerned with the forbidding sky.
"What makes it so warm?" she whispered as they moved toward a
table.
"It's some new invention that keeps the warm air from rising. I
don't know the principle of the thing, but I know that they can keep it
open like this even in the middle of winter—"
"Where's the Prince of Wales?" she demanded tensely.
John looked around.
"He hasn't arrived yet. He won't be here for about half an hour."
 She sighed profoundly.
"It's the first time I've been excited in four years."
Four years—one year less than he had loved her. He wondered if
when she was sixteen, a wild lovely child, sitting up all night in
restaurants with officers who were to leave for Brest next day, losing
the glamour of life too soon in the old, sad, poignant days of the war,
she had ever been so lovely as under these amber lights and this
dark sky. From her excited eyes to her tiny slipper heels, which were
striped with layers of real silver and gold, she was like one of those
amazing ships that are carved complete in a bottle. She was finished
with that delicacy, with that care; as though the long lifetime of some
worker in fragility had been used to make her so. John Chestnut
wanted to take her up in his hands, turn her this way and that,
examine the tip of a slipper or the tip of an ear or squint closely at
the fairy stuff from which her lashes were made.
"Who's that?" She pointed suddenly to a handsome Latin at a
table over the way.
"That's Roderigo Minerlino, the movie and face-cream star.
Perhaps he'll dance after a while."
Rags became suddenly aware of the sound of violins and drums,
but the music seemed to come from far away, seemed to float over
the crisp night and on to the floor with the added remoteness of a
dream.
"The orchestra's on another roof," explained John. "It's a new idea
— Look, the entertainment's beginning."
A negro girl, thin as a reed, emerged suddenly from a masked
entrance into a circle of harsh barbaric light, startled the music to a
wild minor, and commenced to sing a rhythmic, tragic song. The pipe
of her body broke abruptly and she began a slow incessant step,
without progress and without hope, like the failure of a savage
insufficient dream. She had lost Papa Jack, she cried over and over
with a hysterical monotony at once despairing and unreconciled.
One by one the loud horns tried to force her from the steady beat of
madness but she listened only to the mutter of the drums which were
isolating her in some lost place in time, among many thousand
forgotten years. After the failure of the piccolo, she made herself
again into a thin brown line, wailed once with sharp and terrible
intensity, then vanished into sudden darkness.
"If you lived in New York you wouldn't need to be told who she is,"
said John when the amber light flashed on. "The next fella is Sheik
B. Smith, a comedian of the fatuous, garrulous sort——"
He broke off. Just as the lights went down for the second number
Rags had given a long sigh, and leaned forward tensely in her chair.
Her eyes were rigid like the eyes of a pointer dog, and John saw that
they were fixed on a party that had come through a side entrance,
and were arranging themselves around a table in the half-darkness.
The table was shielded with palms, and Rags at first made out
only three dim forms. Then she distinguished a fourth who seemed
to be placed well behind the other three—a pale oval of a face
topped with a glimmer of dark-yellow hair.
"Hello!" ejaculated John. "There's his majesty now."
Her breath seemed to die murmurously in her throat. She was
dimly aware that the comedian was now standing in a glow of white
light on the dancing floor, that he had been talking for some
moments, and that there was a constant ripple of laughter in the air.
But her eyes remained motionless, enchanted. She saw one of the
party bend and whisper to another, and after the low glitter of a
match the bright button of a cigarette end gleamed in the
background. How long it was before she moved she did not know.
Then something seemed to happen to her eyes, something white,
something terribly urgent, and she wrenched about sharply to find
herself full in the centre of a baby spot-light from above. She became
aware that words were being said to her from somewhere, and that a
quick trail of laughter was circling the roof, but the light blinded her,
and instinctively she made a half-movement from her chair.
"Sit still!" John was whispering across the table. "He picks
somebody out for this every night."
 Then she realized—it was the comedian, Sheik B. Smith. He was
talking to her, arguing with her—about something that seemed
incredibly funny to every one else, but came to her ears only as a
blur of muddled sound. Instinctively she had composed her face at
the first shock of the light and now she smiled. It was a gesture of
rare self-possession. Into this smile she insinuated a vast
impersonality, as if she were unconscious of the light, unconscious of
his attempt to play upon her loveliness—but amused at an infinitely
removed him, whose darts might have been thrown just as
successfully at the moon. She was no longer a "lady"—a lady would
have been harsh or pitiful or absurd; Rags stripped her attitude to a
sheer consciousness of her own impervious beauty, sat there
glittering until the comedian began to feel alone as he had never felt
alone before. At a signal from him the spot-light was switched
suddenly out. The moment was over.
The moment was over, the comedian left the floor, and the far-
away music began. John leaned toward her.
"I'm sorry. There really wasn't anything to do. You were
wonderful."
She dismissed the incident with a casual laugh—then she started,
there were now only two men sitting at the table across the floor.
"He's gone!" she exclaimed in quick distress.
"Don't worry—he'll be back. He's got to be awfully careful, you
see, so he's probably waiting outside with one of his aides until it
gets dark again."
"Why has he got to be careful?"
"Because he's not supposed to be in New York. He's even under
one of his second-string names."
The lights dimmed again, and almost immediately a tall man
appeared out of the darkness and approached their table.
"May I introduce myself?" he said rapidly to John in a supercilious
British voice. "Lord Charles Este, of Baron Marchbanks' party." He
glanced at John closely as if to be sure that he appreciated the
significance of the name.
John nodded.
"That is between ourselves, you understand."
"Of course."
Rags groped on the table for her untouched champagne, and
tipped the glassful down her throat.
"Baron Marchbanks requests that your companion will join his
party during this number."
Both men looked at Rags. There was a moment's pause.
"Very well," she said, and glanced back again interrogatively at
John. Again he nodded. She rose and with her heart beating wildly
threaded the tables, making the half-circuit of the room; then melted,
a slim figure in shimmering gold, into the table set in half-darkness.

IV

The number drew to a close, and John Chestnut sat alone at his
table, stirring auxiliary bubbles in his glass of champagne. Just
before the lights went on, there was a soft rasp of gold cloth, and
Rags, flushed and breathing quickly, sank into her chair. Her eyes
were shining with tears.
John looked at her moodily.
"Well, what did he say?"
"He was very quiet."
"Didn't he say a word?"
Her hand trembled as she took up her glass of champagne.
 "He just looked at me while it was dark. And he said a few
conventional things. He was like his pictures, only he looks very
bored and tired. He didn't even ask my name."
"Is he leaving New York to-night?"
"In half an hour. He and his aides have a car outside, and they
expect to be over the border before dawn."
"Did you find him—fascinating?"
She hesitated and then slowly nodded her head.
"That's what everybody says," admitted John glumly. "Do they
expect you back there?"
"I don't know." She looked uncertainly across the floor but the
celebrated personage had again withdrawn from his table to some
retreat outside. As she turned back an utterly strange young man
who had been standing for a moment in the main entrance came
toward them hurriedly. He was a deathly pale person in a dishevelled
and inappropriate business suit, and he had laid a trembling hand on
John Chestnut's shoulder.
"Monte!" exclaimed John, starting up so suddenly that he upset
his champagne. "What is it? What's the matter?"
"They've picked up the trail!" said the young man in a shaken
whisper. He looked around. "I've got to speak to you alone."
John Chestnut jumped to his feet, and Rags noticed that his face
too had become white as the napkin in his hand. He excused himself
and they retreated to an unoccupied table a few feet away. Rags
watched them curiously for a moment, then she resumed her
scrutiny of the table across the floor. Would she be asked to come
back? The prince had simply risen and bowed and gone outside.
Perhaps she should have waited until he returned, but though she
was still tense with excitement she had, to some extent, become
Rags Martin-Jones again. Her curiosity was satisfied—any new urge
must come from him. She wondered if she had really felt an intrinsic
charm—she wondered especially if he had in any marked way
responded to her beauty.
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