NUR 412 – Nursing Leadership and Management

Module 1: Leadership and Management in Nursing

Introduction:

Leadership and Management are currently emphasized within health care

as important aspects of the nurse„s role. This module aims help the students
know the differences between Leadership and Management and understand the
theories related to this.

Learning Outcome:

At the completion of this module, the students will be able to:

1. Distinguish between leadership and management;
2. Discuss related leadership and management theories.

Lesson 1: Concepts of Leadership and Management

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 1

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 2
Lesson 2: Leadership Theories

EARLY LEADERSHIP THEORIES

1. The great man theory of leadership states that some people are born with the
necessary attributes that set them apart from others and that these traits are
responsible for their assuming positions of power and authority.
A leader is a hero who accomplishes goals against all odds for his followers.
The theory implies that those in power deserve to be there because of their
special endowment. Furthermore, the theory contends that these traits remain
stable over time and across different groups. Thus, it suggests that all great
leaders share these characteristic regardless of when and where they lived or the
precise role in the history they fulfilled.
“Some people are born to lead, whereas others are born to be led”.
“Great leaders will arise when the situation demands it”

2. Trait theories assume that some people have certain characteristics or

personality traits that make them better leaders than others.

Core traits of a leader:

a. Achievement drive: High level of effort, high levels of ambition, energy
and initiative
b. Leadership motivation: an intense desire to lead others to reach shared
goals
c. Honesty and integrity: trustworthy, reliable, and open
d. Self-confidence: Belief in one‟s self, ideas, and ability
e. Cognitive ability: Capable of exercising good judgment, strong analytical
abilities, and conceptually skilled
f. Knowledge of business: Knowledge of industry and other technical
matters
g. Emotional Maturity: well adjusted, does not suffer from severe
psychological disorders.
h. Others: charisma, creativity and flexibility

3. Behavioral theories assumes that leadership capability can be learned, rather

than being inherent. This theory is based on the principle that behaviors can be
conditioned in a manner that one can have a specific response to specific stimuli.
Rather than seeking inborn traits this theory looks at what leaders actually do by
studying their behaviors in response to different situations, assessing leadership
success by studying their actions and then correlating significant behaviors with
success.

The practical application of the theory is that leader‟s behavior affects their
performance and different leadership behaviors could be appropriate at different

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 times. The best leaders are those having the adaptability to flex their behavioral
style, and choose the right style suitable for each situation.
According to this theory, people can learn to become leaders through teaching
and observation and certain behavioral patterns may be identified as leadership
styles.

a. The Ohio State University Studies: A group of researchers at Ohio

State University prepared a questionnaire to be surveyed in military
and industrial setups, to determine the perception of the
subordinates for the actual behaviour of their leaders. From their
findings, the researchers identified two major categories of leader
behaviour:

Consideration: The leaders are attentive towards their subordinates

and build up an excellent inter-personnel relationship with them.
They are very supportive and friendly. This was termed as „people-
oriented behaviour‟.

Initiating structure: The leaders are majorly concerned about the

achievement of goals and schedule and structure work accordingly.
For such leaders, subordinates are just resources, and they have to
make the optimal utilisation of them. This was termed as „task-
oriented behaviour‟.

b. The University of Michigan Studies: This study is based on how

the leader‟s behaviour is related to group performance. Researchers
made a comparison of effective managers with the ineffective ones
and found that the two can be discriminated on the basis of their
behaviour, i.e. job-centric behaviour and organisational-member
centric behaviour.

The study further resulted in the identification of four additional

behaviours essential for effective leadership which are:
 Support
 Goal emphasis
 Work facilitation
 Interaction facilitation

c. Blake and Mouton’s Leadership Grid: Robert R. Blake and Jane

S. Mouton gave the Leadership/Managerial Grid Theory and
discovered the five different styles of leadership by categorising the
managers into 81 possible ways arising out of the combination of

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 rating depending on two variables, concern for people and concern
for results.
Following are the various styles of Leadership according to this model:

 Indifferent: Neither the attention is paid towards the work, nor

towards the employees, it is the most ineffective style of leadership.
 Controlling or the country club: All that matters is the well-being of
the staff.
 Accommodating or task oriented: All that matters is production
and output.
 Status Quo or balance: Moderate and equal importance and
attention are given to work as well as employee welfare.
 Sound: A high level of concern is shown towards both, the output as
well as the employees, it is the most effective style of leadership.

4. Contingency Theory: states that effective leadership comprises of all the

three factors, i.e. traits, behaviour and situation. A leader‟s behaviour
varies as per the situation.
 Fiedler‟s (1967) suggests that no one leadership style is ideal for
every situation. Interrelationships between the group‟s leader and its

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 members were most influenced by the manager‟s ability to be a
good leader.

 Hersey and Blanchard (1977) stated that leadership style is contingent

on the situation, which means the level of followers' readiness or maturity.
The successful leader, according to Hersey and Blanchard, chooses the
appropriate style for the particular situation.

5. Attribution and charismatic theories: Attribution theory associates the

performance of an organization to the leader (Pfeffer, 1992) and the charismatic
theory in which the followers attribute the observed leader's behaviors to heroic
or extraordinary leadership abilities (Conger & Kanungo, 1988).

CONTEMPORARY LEADERSHIP THEORIES

1. Servant leadership: serving is the first priority of a leader who is obligated and
responsible for the moral environment of his group, organization, or society. In
other words, the premise of servant leadership is that the leader is one for whom
serving and the search for serving are natural components of the leader (Farling,
Stone & Winston, 1999; Greenleaf, 1977).
Greenleaf (2002) believed that a leader earns the right to lead only when
people's needs are satisfied. Servant leadership is based on the virtues of love,
humility, altruism, vision, trust, empowerment, and service (Harrison, 2002;
Kaplan, 2000; Patterson, 2003; Veronesi, 2001; Wis, 2002).

2. Transactional and transformational leadership:

Transactional leadership involves motivating and directing followers primarily

through appealing to their own self-interest. The power of transactional leaders
comes from their formal authority and responsibility in the organization. The main
goal of the follower is to obey the instructions of the leader. The style can also be
mentioned as a „telling style‟. The leader believes in motivating through a system
of rewards and punishment. If a subordinate does what is desired, a reward will
follow, and if he does not go as per the wishes of the leader, a punishment will
follow. Here, the exchange between leader and follower takes place to achieve
routine performance goals.

Transformational Leadership Theory: The transformational theory states that a

leader is effective only if he can transform or change the perceptions, behaviour
and expectations of the followers and direct them towards a common goal which

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 will lead to the accomplishment of the leader‟s vision. Such leaders have a
charismatic and influential personality.

Difference between Transactional and Transformational Leaders

Transactional leadership Transformational Leadership

Leadership is responsive Leadership is proactive

Works within the organizational culture Work to change the organizational culture by implementing
new ideas

Transactional leaders make employees Transformational leaders motivate and empower

achieve organizational objectives through employees to achieve company‟s objectives by appealing
rewards and punishment to higher ideals and moral values

Motivates followers by appealing to their own Motivates followers by encouraging them to transcend their
self-interest own interests for those of the group or unit

3. The emotional intelligence theory- promoted by Goleman (1998), argues that

intrapersonal and interpersonal skills (self-awareness, self-regulation, motivation,
empathy, social skills) are necessary for individual adjustment in today's world.
Their application in the leadership context makes it possible to establish better
and healthier relationships with workers or employees.

4. Negotiational leadership refers to an approach that founds its principles on the

basis of a learning and reflecting process of negotiation of interest and
commitment through a social interaction of influencing, serving, and transforming
each other, between leader and follower, to achieve a shared vision (Jean
Francois, 2005).

Lesson 3: Management Theories

1. Classical Management Theory: It is the oldest theory and is sometimes referred

to as traditional management theory. The classical perspective includes three sub
fields of management: scientific management, bureaucratic management and
administrative management. (Wren, 1979, Daft and Marcic, 2001)

 Scientific Management Theory: In this theory, the focus is on the goals and
productivity. The organization is viewed as a machine to be run efficiently to
increase production. Managers must closely supervise the work to assure
maximum efficiency. Workers must have proper tools and equipment. There is a
focus on training the workers to work more efficiently and performance incentives

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 are used. Time and motion studies are the vehicle for determining how to do and
organize the work in the most efficient manner.

 Bureaucratic Management Theory: The focus of this theory is on the superior-

subordinate communication transmitted from top to bottom via a clear chain of
command, a hierarchy of authority and division of labor chain. This theory uses
rational and impersonal management process. Here, there are explicit rules and
regulations for the governing activities, focusing on exacting work processes and
technical competence. There is a use of merit and skill as the basis for promotion
or reward. The emphasis is given on lifetime career service and salaried
managers.

 Administrative Management Theory: Here, the focus is on the science of

management and principles of an organization applicable in any setting. It
identifies the need for 'POSDCORB' where P stands for planning, O for
organization, S for staffing, D for directing, Co for co-ordination, R for reporting
and B for budgeting. It is mainly concerned with the optimal approach for
administrators to achieve economic efficiency.

2. Human Relation Management Theory: In this theory, the focus is on the

empowerment of the individual worker as a source of control, motivation, and
productivity in the organizations. The Hawthorne studies led to belief that human
relations between workers and managers and among the workers were the main
determinants of efficiency. The Hawthorne effect refers to the phenomenon of
how being observed or studied result in a change of behavior. This theory also
emphasizes on the participatory decision making which increases worker's
autonomy. It also lays emphasis on the training of the employees to improve
work.

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 8

Teaching and Learning Activities

Instructions:
A. Explain the following in 150 words using APA 7th edition student format
available at https://www.youtube.com/watch?v=c0e9DKDxUYU
B. You have to include your references. Copy paste or plagiarism is strictly
prohibited and will have a mark of 5 or failed.
C. Observed proper decorum and etiquette in sending an email. Please
indicate the Subject. On the message section, include the salutation,
greetings, short message, your name, year and section.
D. Submit all paper on or before September 15, 2021 on email
aea.consultation@gmail.com at 11.59am.

Questions to answer:

1. Give one leadership theories and explain its relevance on the current
nursing leadership that you have observed during your clinical exposure.

2. Among the management theories that you have read, what do you think is
the best among them? Justify your choice of management.

3. What makes a person a leader?

4. Why is it important for nurses to be a good leaders?

5. Select an individual whose leadership skills you particularly admire. What

are the qualities and behaviors that this individual display? In what ways
you emulate this person?

Case Study to Promote Critical Reasoning

Two new associate-degree graduates were hired for the pediatric

unit. Both worked three 12-hour shifts a week, Jan in the day-to-evening
shift and Ronnie at night. Whenever their shifts connected, they would
compare notes on their experience. Jan felt she was learning rapidly,
gaining clinical skills and beginning to feel at ease with her colleagues.
Ronnie, however, still felt unsure of herself and often isolated. “There have
been times,” she told Jan, “that I am the only registered nurse on the unit
all night. The aides and LPNs are really experienced, but that‟s enough. I
wish I could work with an experience nurse as you are doing.”
Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 9
 “Ronnie, you are not even finished with your 3-month orientation
program,” said Jan. “You should never be felt alone with all these sick
children. Neither of us is ready for that kind of responsibility. And how will
you get the experience you need with no experienced nurse to help you?
You must speak to our nurse manager about this”.”
“I know I should, but she‟s so hard to reach. I‟ve called several times, and
she‟s never available. She leaves all the shift assignment to her assistant.
I‟m not sure she even reviews the schedule before it‟s posted.”
“You will have to try harder to reach her. Maybe you could stay past the
end of your shift one morning and meet with her,” suggested Jan. “If
something happens when you are the only nurse on the unit, you will be
held responsible.”
1. In your words, summarize the problem that Jan and Ronnie are
discussing. To what extend is this problem due to a failure to lead? Who
has failed to act?
2. What style of leadership was displayed by Ronnie and the nurse
manager? How effective was their leadership? Did Jan‟s leadership differ
from that of Ronnie and the nurse manager? In what way?
3. In what ways has Ronnie been an effective follower? In what ways
has Ronnie not been so effective as a follower?
4. If an emergency occurred and was not handled well while Ronnie
was the only nurse on the unit, who would be responsible? Explain why
this persons would be responsible.
5. If you found yourself in Ronnie‟s situation, what steps would you
take to resolve the problem? Show how the leader characteristics and
behaviors found in this chapter support your solution to the problem

Recommended learning materials and resources for supplementary reading.

Leadership theories. Available at: https://businessjargons.com/theories-of-leadership.html

Management theory. Available at: https://nursekey.com/nursing-leadership-and-management/

Flexible Teaching Learning Modality (FTLM) adopted)

Join Zoom Meeting

https://zoom.us/j/7908854731?pwd=VjZxRUtSeXJqUENINnhGTUFSWGVIdz09

Meeting ID: 790 885 4731

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 10

Assessment Task

How Good Are Your Leadership Skills? Instructions, for each statement, check in the
column that best describes you. Please answer questions as you actually are (rather
than how you think you should be), and don't worry if some questions seem to score "in
the wrong direction." When you are finished, please honestly calculate your answers by
adding all answers on each items. The corresponding scores are as follows;

5 – Very often 4 – often 3 – sometimes 2- rarely 1-not at all

Not Some- Very

Rarely Often
Statements to Answer at All times Often

1I When assigning tasks, I consider people's

skills and interests.

2I doubt myself and my ability to succeed.

3I expect nothing less than top-notch results

from people.

4I expect my people to work harder than I do.

5When someone is upset, I try to understand

how he or she is feeling.

6When circumstances change, I can struggle to

know what to do.

7I think that personal feelings shouldn't be

allowed to get in the way of performance and

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 11

 Not Some- Very
Rarely Often
Statements to Answer at All times Often

productivity.

8I am highly motivated because I know I have

what it takes to be successful.

9Time spent worrying about team morale is time

that's wasted.

10I get upset and worried quite often in the

workplace.

11My actions show people what I want from

them.

12When working with a team, I encourage

everyone to work toward the same overall
objectives.

13I make exceptions to my rules and

expectations. It's easier than being the enforcer
all the time!

14I enjoy planning for the future.

15I feel threatened when someone criticizes me.

16I make time to learn what people need from

me, so that they can be successful.

17I'm optimistic about life, and I can see beyond

temporary setbacks and problems.

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 12

 Not Some- Very
Rarely Often
Statements to Answer at All times Often

18I think that teams perform best when

individuals keep doing the same tasks and
perfecting them, instead of learning new skills
and challenging themselves.

Total = 0

Score Interpretation

Score Comment

You need to work hard on your leadership skills. The good news is that if you use
more of these skills at work, at home, and in the community, you'll be a real asset to
18-34
the people around you. You can do it – and now is a great time to start!

You're doing OK as a leader, but you have the potential to do much better. While
you've built the foundation of effective leadership, this is your opportunity to improve
your skills, and become the best you can be. Examine the areas where you lost
35-52
points, and determine what you can do to develop skills in these areas.

Excellent! You're well on your way to becoming a good leader. However, you can
never be too good at leadership or too experienced – so look at the areas where you
didn't score maximum points, and figure out what you can do to improve your
53-90
performance.

References

Whitehead, D.K., Sally, A.W., Tappen, R.M.. (2010). Essentials of nursing leadership
and management. F.A. Davis company. Philadelphia, USA

Mind tools essential skills for an excellent career. Available at:

https://www.mindtools.com/pages/article/newLDR_50.htm

Nursing Leadership and Management by Assistant Professor DR. ANGELITO E. ALVARADO 13