N C M 1 1 9 (ENDTERM)

Nursing Leadership and Management

Nursing Leadership & Management Leadership/Management Skills
Leadership vs. Management  Complementary
 Can be learned and developed through
Leadership
experience
 The act of influencing and motivating a group  Improve skills in one area will enhance
of people to act in the same direction towards abilities in the other
achieving a common goal
Power and Authority
Leadership Combines:
Nurse Manager has
 Intrinsic personality traits
 Authority – formal right to direct others
 Learned leadership skills granted by the organization
 Characteristics of the situation  Power – ability to motivate people to get
Leader: things done with or without the formal right
granted by the organization
 Guides people are group to accomplish  Ability to influence others to accomplish goals
common goals
 Influences the beliefs, opinions or behaviors Formal and Informal Leadership
of a person, or groups of people Formal Leadership Practices by:
Nurse Leader:  Nurse manager
 Is able to inspire others on the health care  Supervisor
team to make patient education an important  Charge nurse
aspect of all care activities  Coordinator and gives the authority to act by
the organization
Leadership Qualities:
Informal Leadership
 Unique personality characteristics
 Exceptional clinical expertise  Is exercised by the person who:
 Relationships with others in the organization o Has no official or appointed authority to
act
Management o Is able to persuade
 The process of leading and directing an o Able to influence others in the work
organization to meet its goals through the use group
of appropriate resources o Strategies the nurse manager can use to
 Coordinates people, time, and supplies to work with informal leaders
achieve desired outcomes Leadership vs. Management
 Involves problem-solving and decision-
making process Leadership Management
 Do not have delegated Legitimate source of
Management Responsibility:
authority but obtain power due to the
 Maintain control of the day-to-day operations their power through delegated authority
 Achieve established goals and objectives other means such as Emphasize control,
influence decision making,
Manager:  Focus on group decision analysis and
process, information results
 Plans
gathering, feedback Greater formal
 Organize
and empowering responsibility and
 What is to be done others accountability for
 Who will do it  Have goals that may rationality and control
 How it is to be done or may not reflect than leaders
Nurse Manager will have: those of the
organization
 An appointed management position within
the organization with responsibilities to .. Management is efficiency in climbing the ladder of
perform administrative tasks: success; leadership determines whether the ladder is
o Planning staffing requirements learning against the right wall – Stephen R. Covey
o Perform employee performance
appraisals Development of Management Theories
o Controlling use of supplies and time Leadership and Management Theory
o Meeting budget and productivity goals
 Leadership Trait theory
A good manager also should be a good leader  Interactional Leadership Theories
 Transformational Leadership
  Management Theory  Nurse must keep customer service first and
 Organizational Theory foremost as the motivator of all plans and
activities
Transformational Leadership  Without customers, the organizational will go
 Identify and clearly communicate vision and out of business.
direction Team Builder
 Empower the work group to accomplish goals
and achieve the vision  A team is a group of people organized to
 Impart meaning and challenge to work accomplish the necessary work of an
 Are admired and emulated organization.
 Provide mentoring to individual staff
Resource Manager
members based on need
 Resources include the personnel, time and
Contemporary Theories of Leadership
supplies needed to accomplish the goals of
Depends on several variables, including (Marquis and the organizational
Huston, 2000):  Nurse manager has the responsibility –
effectively manage resources in providing
1. Organizational culture safe, effective patient care in an economic
2. Values of the leader manner.
3. Values of the followers
4. Influence of the leader/manager Decision Maker and Problem Solver
5. Complexities of the situation
 Components of effective leadership and
6. Work to be accomplished
management in clinical patient care
7. Environmental
 Problem solving is focused on solving an
Transactional Leadership immediate problem
 Decision maker includes a decision-making
 Focus on day-to-day operations and are step
comfortable with the status quo (the existing
state of affairs) Nursing Process = Problem – Solving Process
 Reward staff for desired work (“I’ll do x in Includes:
exchange for your doing y”)
 Assessment
 Monitoring work performance and correct as
needed  Analysis and diagnosis
 Wait until problems occur and deal with the  Planning
problem  Implementation
 Evaluation
Leadership, Management and Organizational  Has proven to be effective to manage the
Theories complex decisions
 Provide the building blocks on which to build The Nurse – Change Agent
effective nursing management practices and
skills  Is responsible for guiding people
 Through the change process and needs
Management Theory  To develop an understanding about the
nature of change and effective change
 Behavioral theories explain aspects of
strategies
management and leadership based on
1. Change should be implemented only for
behaviors of managers/leaders and followers
good reason
Organizational Theory 2. Change should always be planned and
implemented gradually
 Provides framework for understanding 3. Change should never be unexpected or
complex organizations abrupt
 Helps to understand the management process 4. All people who may be affected by the
Roles of the Nurse Manager changes should be involved in planning
for the change
 Customer service provider
Scientific Management
 Team builder
 Resource manager Frederick W. Taylor
 Decision maker and problem solver
 Change agent  The “father of scientific management.”
 Work should be studied scientifically to
Customer Service Provider determine the method to of task performance
that would yield maximum work output with
 Providing service or care to customers minimum work expenditure
(patient/clients)
 An American Mechanical Engineer 1856-1915
(Classical or Scientific Period 1896)

Four Overriding Principle of Scientific
Management:
1. Traditionally “rule of thumb” means
organizing work must be replaced with
scientific methods
2. A scientific personnel system must be
established so that workers can be hired,
trained, and promoted based on their
technical competence and abilities
3. Workers should be able to view how they “fit”
into the organizational and how they
contribute to overall organizational
productivity
4. The relationship between managers and
workers should be cooperate and
interdependent, and the work should be
shared equally
Bureaucracy
Max Weber (1922)
 Theory of Social and Economic Organization
advocated Bureaucracy
 Need for legalized, formal authority and
consistent rules and regulations for personnel
in different positions.
 A German Sociologist 1864-1920
Characteristic of Weber’s Bureaucracy
 Hierarchy of authority
 Salaried careers
 Specialization and technical qualifications
 Written rules
Management Functions
Henry Fayol (1925)
 first identified the management functions of
planning, organization, command,
coordination and control
 A French mining engineer (1841-1925)
Management Function 1841-1925
 Forecasting
 Planning
 Organizing
 Commanding
 Coordinating
 Controlling
Activities of Management
Luther Gulik (1937)
 Expanded on Fayol’s management of the
“Seven Activities of Management” - planning,
organizing, staffing, directing, coordinating,
reporting and budgeting
 He is an American political scientist 1892-
1993
Activities of Management
Planning
 Determines philosophy, goals, objectives,
policies, procedures and rules; carrying out
long-and-short-range projection; determining
in fiscal course of action and managing
planned change
Organizing
 Establishes the structure to carry out pans,
determining the most appropriate type of
patient care delivery and grouping activities
to meet unit goals
Staffing
 Consist of recruiting, interviewing, hiring and
orienting staff. Scheduling, staff development,
employee socialization and team building
Directing
 Consists of motivating, managing conflict,
delegating, communicating and facilitating
collaboration
Controlling
 Functions include performance appraisals,
fiscal accountability, quality control, legal and
ethical control and professional and collegial
control
14 Principles of Management by Henri Fayol
1. Division of work: allows specialization
2. Authority: right to command balanced with
responsibility and accountability
3. Discipline: employees will only obey orders
if management play their part by providing
good leadership
4. Unity of command: there should only be one
boss with no conflicting lines of command
5. Unity of direction: people engaged in the
same kind of activities must have the same
objectives in a single plan
6. Subordination of individual interest to
general interest: the goals of the firms are
always paramount
7. Remuneration: payment is an important
motivator
8. Centralization or Decentralization: depends
on the condition of business and the quality
of its personnel
9. Scalar chain/line of authority: refers to the
number of levels in the hierarchy
 10. Order: both material order (minimizes lost
time & useless handling of materials) and
social order (organization and selection) are
necessary
11. Equity: employees should be treated well to
achieve equity
12. Stability of tenure of personnel: job
security and career progress are important
for employees to work better
Employee Participation
13. Initiative: allow personnel to show their
initiative, it may be a source of strength for Chris Argyris (1964)
the organization
14. Esprit de corps: management should foster  managerial domination causes workers to
the moral of employees become discouraged and passive\
 If self-esteem and independence needs are
Participative Management not met, employees will become discouraged
Mary Parker Follet (1926) and troublesome or may leave the
organization
 Was one of the first theorists to suggest
participative decision making or participative Management Theories
management THEORIST THEORY
 Manager should have authority with, rather
than over, employees Taylor Scientific Management
 An American social worker management
Weber Bureaucratic Organization
consultant Mother of Modern Management
1868-1933 Fayol Management Functions
Illumination Studies Gulick Activities of Management
Elton Mayo and his Harvard Associates (1927- Follet Participative Management
1932)
Mayo Hawthorne Effect
 Look at the relationship between the light
illumination in the factory and productivity. McGregor Theory X and Y
 Hawthorne effect indicated that people Argyris Employee Participation
respond to the fact that they are being
studied, attempting to increase whatever
behavior
 An Australian Psychologist 1880-1949 Great Man Theory
Theory X and Y  The Great Man Theory, from Aristotle
philosophy, asserts that some people are born
Douglas McGregor (1960)
to lead, whereas others are born to be led
 X and Theory Y, posited that managerial  Great leaders will arise when the situation
attitudes about employees can be directly demands it
correlated with employee satisfaction
Leadership Styles
 An American Management professor 1906-
1964 Democratic Leader exhibits the following behaviors:
 Less control is maintained
 Economic and ego awards are used to
Theory X managers Theory Y managers motivate
believe that their believe that their  Others are directed through suggestions and
employees are workers enjoy their guidance
basically lazy, need work, are self-  Communication flows up and down
constant supervision motivated and are  Decision making involves others
and direction and are willing to work hard  Emphasis is on “we” rather than “I” and “you”
indifferent to to meet personal and  Criticism is constructive
organizational needs. organizational goal
Authoritarian Leader characterized by the following
behaviors:
 Strong control is maintained over the work
group
 Others are motivated by the coercion
 Others are directed with commands
 Communication flows downward
 Decision making does not involve others
  Emphasis is on difference in status (“I” and
“you”)
 Criticism in punitive
Laisses-faire Leader characterized by the following
behaviors:
 Is permissive, with little or no control
 Motivates by support when requested by the
group
 Provides little or no direction
 Uses upward and downward communication
between members of the group
 Disperses decision making throughout the
group
 Places emphasis on the group
 Does not criticize
Contingency Approach
Fiedler’s (1967)
 Contingency Approach, suggests that no one
leadership style is ideal for every situation
 Interrelationship between the group’s leader
and its member were most influenced by the
manager’s ability to be a good leader
Situational Approach
Hersey and Blanchard (1977),
 Developed a Situational Approach to
leadership
 Tridimensional leadership effectiveness
model predicts which leadership style is most
appropriate in each situation on the basis of
the level of the followers’ maturity
 As people mature, leadership style becomes
less task focused and more relationship
oriented
Transactional and Transformational
Leadership
Burn (2003),
 Suggest that both leaders and followers have
the ability to raise each other to higher levels
of motivation and morality
 There are two primary types of leaders in
management
o The traditional manager, concerned with
the day-to-fay operations, was termed a
transactional leader
o The manager who is committed, has
vision and is able to empower others with
this vision was termed a
transformational leader.
Transactional Transformational
Leader
Leader
 Identifies common Focuses on
management tasks
values
Is committed
 Is a care taker
 Inspires others with Uses trade-offs to meet
vision goals
Does not identify shared
 Has long-term vision values
 Looks at effects Examines causes
 Empowers others Uses contingency
rewards
Exemplary Leadership
Kouzes and Posner’s Five Practices for Exemplary
Leadership
1. Modeling the way: Requires value
clarification and self-awareness so that the
behavior is congruent with values
2. Inspiring a shared vision: Entails visioning
which inspires followers to want to
participate in goal attainment
3. Challenging the process: Identifying
opportunities and taking actions
4. Enabling others to act: Fostering
collaboration, trust, and the sharing of power
5. Encouraging the heart: recognize,
appreciate, and celebrate followers and the
achievement of shared goals
Case Management
 A collaborate process of assessment,
planning, facilitation and advocacy for
options and services to meet an individual’s
health needs through communication and
available resources to promote quality cost-
effective outcomes
 Nurses address each patient individually,
identifying the most cos-effective providers,
treatments and care setting possible
Staffing
 The leader-manager recruits, selects, places
and indoctrinates personnel to accomplish
the goals of the organizational
Steps in Staffing
1. Determine the number and types of
personnel needed to fulfill the philosophy,
meet fiscal planning responsibilities and care
out the chosen patient care delivery system
selected by the organization
2. Recruit. Interview, select and assign
personnel based on established job
description performance standards.
3. Use organizational resources for induction
and orientation
4. Ascertain that each employee is adequately
socialized to organization values and unit
norms
5. Use creative and flexible scheduling based on
patient care needs to increase productivity
and retention
Recruitment
  Is the process of actively seeking out or
attracting applicants for existing position and
should be an ongoing process.
 A leadership role in staffing includes
identifying, recruiting and hiring gifted
people
Selection
 Socialization refers to a learning of the
behaviors that accompany each tole by
instruction, observation and trial and error
 Resocialization occurs when individuals are
forced to learn new values, skills, attitudes,
and social rules as a result of changes in the
type of work they do, the scope of
responsibility they hold or in the setting itself

 Is the process of choosing from among Types of Staffing

applicants the beast-qualified individual or
individuals for a particular job or position Centralized staffing
 Involves verifying the applicant’s
 Where staffing decisions are made by
qualifications, checking his or her work
personnel in a certain office or staffing center
history, and deciding if a good match exists
between the applicant’s qualifications and the Decentralized staffing
organization’s expectations
 The unit manager is often responsible for
Placement covering all scheduled staff absences,
reducing staff during periods of decreased
 The nurse leader is able to assign a new
patient census or acuity, preparing monthly
employee to a position within his/her sphere
unit schedules, and preparing holiday and
of authority, where the employee will have a
vacation schedules
reasonable chance for success
 Proper placement fosters personal growth, Minimum Staffing Ratio
provides a motivating climate for the
employee, maximizes productivity and Unit Staffing Ratio
increases the probability that organizational Critical Care/ICU 1:2
goals will be met
Operating Room 1:1
Indoctrination
Labor & Delivery 1:2
 Planned, guided adjustment of an employee
to the organization and the work Antepartum 1:4
environment Pediatrics 1:4
 Induction, the first phase of indoctrination
includes all activities that educate the new Medical-surgical 1:5
employee about the organization and
Emergency Department 1:4
employment and personnel policies and
procedures
 Orientation activities are more specific for
Patient Classification System
the position.
 The purpose of the orientation process is to Category I 1-2 hrs. of nursing
make the employee feel like a part of the team care/day
Self-care
 This will reduce burnout and help new
employees become independent more quickly Category II 3-4 hrs. of nursing
in their new roles care/day
Minimal Care
Staff Development
Category III 5-6 hrs. of nursing
 The better trained and more competent the care/day
Intermediate Care
staff, the fewer the number of staffs required,
which in turn saves the organization money Category IV 7-8 hrs. of nursing
and increases productivity care/day
 Staff development activities are normally Modified Intensive
carried out for one of three reasons: to Care
establish competence, to meet new learning Category V 10-14 hrs. of nursing
needs and to satisfying interests the staff may care/day
have in learning in specific areas Intensive Care

Socialization
Formula for Staffing
  Maslow (1970), people are motivated to
satisfy certain needs, from basic survival to
complex psychological needs, and people
seek a higher need only when the lower
needs have been met

Percentage of Professionals to Non-Professionals

 Professionals – 60%
 Non-Professionals – 40%
Percentage of Distribution per Shift

 Morning – 45%
 Afternoon – 37%
 Night – 18% Operant Conditioning and Behavior Modification

Solve  Skinner (1953), demonstrated that people

could be conditioned to behave in a certain
way based on a consistent reward or
punishment system

Case Management: Directing

Directing Herzberg’s Two-Factor Theory

 Motivation is the force within the individual
that influences or directs behavior.
 Leaders should apply techniques, skills and
knowledge of motivational theory to help
workers achieve what they want out of work
Types of Motivation
 Frederick Herzberg (1977), believed that
employees can be motivated by the work
itself and that there is an internal or personal
need to meet organizational goals

Intrinsic Extrinsic
 Comes from within  Comes from outside
the individual the individual
 Often influenced by  Rewards and
family unit and reinforcements are
cultural values given to encourage
certain behaviors
and/or levels of
achievement
Motivational Theories Vroom’s Expectancy Model
Maslow’s Hierarchy of Needs and Theory of
Human Motivation
  Victor Vroom (1964), looks at motivation in
term of the person’s valence, or preferences
based on social values
 A person’s expectations about his/her
environment or a certain event will influence
behavior

McClelland’s Three Basic Needs

 David McClelland (1971), examined what Communication

motives guide a person to action
 Communication is “the exchange of thoughts,
messages, or information by speech, signals,
writing or behavior.”
 Occur on at least two levels: verbal and
nonverbal f
Climates of Communication
Internal Climate

 Includes internal factors such as the values,

feelings, temperament and stress levels of the
sender and the receiver
External Climate

 Achievement-Oriented People actively focus  Includes external factors such as the weather,
on improving what is; they transform ideas temperature, timing, status, power, authority
into action, judiciously and wisely, taking and the organizational climate itself
risks when necessary
Communication Process
 Affiliation-Oriented People focus their
energies on families and friends; their overt
productivity is less because they view their
contribution to society in a different light
form those who are achievement oriented
 Power-Oriented People are motivated by the
power that can be gained as a result of a
specific action. They want to command
attention, get recognition and control others
McGregor’s Theory X and Theory Y

 Douglas McGregor (1960) examined the

importance of a manager’s assumptions
about workers on the intrinsic motivation of
the workers. Channel of Communication

 Upward Communication
o The manager is a subordinate to higher
management
 Downward Communication
o The manager relays information to
subordinates
 Horizontal Communication
o Managers interact with others on the
same hierarchal level as themselves who
 are managing different segments of the
organization
 Diagonal Communication
o The manager interacts with personnel
and managers of other departments and
groups who are not on the same level of
the organizational hierarchy
 Grapevine Communication
o Flows quickly and haphazardly among
people at all hierarchal levels and usually
involves three or four people at a time
Communication Skills
 Assertive communication
o Allows people to express themselves in
direct, honest and appropriate ways that
do not infringe on another person’s
rights.
 Passive communication
o Occurs when a person suffers in silence
although he/she may feel strongly about
the issue
 Aggressive communication
o Is generally direct, threatening and
condescending
 Passive-Aggressive Communication
o Is an aggressive message presented in a
passive way. This person feigns
withdrawal in an effort to manipulate the
situation
Communication Tools
Situation
 Introduce yourself to the patient and briefly
state the issue that you want to discuss
Background
 Describe the background or context (patient’s
diagnosis, admission date, medical diagnosis
and treatment to date)
Assessment
 Summarize the patient’s condition and state
what you think the problem is
Recommendation
 Identify any new treatments or changes
ordered and provide opinions or
recommendations for further action
Listening Skills
 The leader who actively listens gives genuine
time and attention to the sender, focusing on
verbal and nonverbal communication
 The leader must continually work to improve
listening skills by giving time and attention to
the message sender
“The biggest communication problem is we do not
listen to understand, we listen to reply”
Greeting
 Offer greetings and establish positive
environment
Respectful Listening
 Listen without interrupting and pause to
allow others to think
Review
 Summarize message to make sure it was
heard accurately
Recommend or Request More Information
 Seek additional information as necessary
Reward
 Recognize that a collaborative exchange has
occurred by offering thanks
Social Networking
1. Nurses must not transmit or place online
individually identifiable patient information
2. Nurses must observe ethically prescribed
professional patient – nurse boundaries
3. Nurses should understand that patients,
colleagues, institutions and employers may
view posting
4. Nurse should take advantage or privacy
setting and seek to separate personal and
professional information online
5. Nurses should bring content that could harm
a patient’s privacy, rights, or welfare to the
attention of appropriate authorities
6. Nurses should participate in developing
institutional policies governing online
conduct
Delegation
 Delegation is getting work done through
others or as directing the performance of one
or more people to accomplish organizational
goals
 The mark of a great leader is when he/she
can recognize the excellent performance of
someone else and allow others to shine for
their accomplishments
5 Rights of Delegation
 Right task
 Right circumstances
 Right person
 Right direction/communication
 Right level or supervision
Criteria for Delegation to an Unlicensed
Personnel
1. Frequently recur in the daily care of a client
or group of clients
2. Are performed according to an established
(stabilized) sequence of steps
3. Involve little or no modification from one
client-care situation to another
4. May be performed with a predictable
outcome
5. Do not inherently involve ongoing
assessment, interpretation or decision
making which cannot be logically separated
from the procedure(s) itself
6. Do not endanger the health or well-being of
clients
7. Are allowed by agency policy/procedures
Conflict Resolution
 Conflicts is generally defined as the internal
or external discord that results from
differences in ideas, values, or feelings
between two or more people
 Conflicts is neither good or bad and it can
produce growth or destruction, depending on
how it is managed
Categories of Conflict
Intergroup Conflict
 Occur between two or more groups of people,
departments and organizations
Intrapersonal Conflict
 Occurs within the person. It involves an
internal struggle to clarify contradictory
values or wants
Interpersonal Conflict
 Happens between two or more people with
differing values, goals, beliefs and may be
closely linked with bullying, incivility and
mobbing
 Bullying
o is repeated, offensive, abusive,
intimidating or insulting behaviors; abuse
of power; or unfair sanctions that make
recipients feel humiliated, vulnerable or
threatened, thus creating stress and
undermining their self-confidence
(Townsend, 2012)
 Incivility
o is behavior that lacks authentic respect
for others that requires time, presence,
willingness to engage in genuine
discourse and intention to seek common
ground (Clark, 2010)
 Mobbing
o occurs when employees “gang up” on an
individual
 When bullying, incivility and mobbing occur
in the workplace, this known as workplace
violence
Conflict Resolution Strategies
Compromising
 Each party gives up something it wants
Competing
 One party pursues what it wants at the
expense of the others
Cooperating
 One party sacrifices his/her beliefs and
allows the other party to win
Smoothing
 One party in a conflict attempts to pacify the
other party or focus on agreements rather
than differences
Avoiding
  Parties involved are aware of a conflict but
chose not to acknowledge it or attempt to
resolve it
Collaborating

 All parties set aside their original goals and

work together to establish a supraordinate or
priority common goal
Negotiation

 Each party gives up something and the

emphasis is on accommodating differences
between the parties
 The very last for which a person will settle is
often referred to as the bottom line
 Negotiation is psychological and verbal. The
effective negotiator always appears calm and
self-assured
Collective Bargaining

 Collective bargaining involves activities

occurring between organized labor and
management that concern employee relations
 Management that is perceived to be deaf to
the workers’ needs provides a fertile ground
for union organizers, because unions thrive in
a climate that perceives the organizational
philosophy to be insensitive to the worker