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Leadership in Nursing (revised)
 

Leadership in Nursing (revised)

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Leadership in Nursing: Definitions, theories, characteristics, etc.

Leadership in Nursing: Definitions, theories, characteristics, etc.

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    Leadership in Nursing (revised) Leadership in Nursing (revised) Presentation Transcript

    • Leadership in Nursing
      By: Eric F. Pazziuagan, RN, MAN
    • Do not follow where the path may lead. Go instead where there is no path and leave a trail.Harold R. McAlindon
    • LEADER:
      One who directs others.
      Occupies the chief position and therefore has the responsibility to love and care for his followers.
    • “Good leaders keep a close watch on their fellow workers’ needs”
    • QUALITIES OF A LEADER:
      Wisdom
      Vision
      Faithfulness
      Caring
      Diligence
      Trustworthy
    • ROLES OF A LEADER:
      Decision- maker
      Communicator
      Evaluator
      Facilitator
      Risk taker
      Mentor
      Energizer
      Coach
      Counselor
    • Teacher
      Critical thinker
      Buffer
      Advocate
      Visionary
      Forecaster
      Influencer
      Creative problem solver
      Change agent
      Diplomat
      Role model
    • LEADERSHIP:
      Process of influencing the activities of an organized group in its efforts toward goal setting and goal achievement. (Stogdill)
      Process of persuasion and example by which an individual (or leadership team) induces a group to take action that is in accord with the leader’s purposes or the shared purposes of all (Gardner)
      Social interaction in which one person influences others (Merton).
      Vital ingredient that transforms a crowd into a functioning, useful organization. (Talbott)
    • Use of personal traits to constructively and ethically influence patient, families, and staff through a process where clinical and organizational outcomes are achieved through collective efforts.
      A collective function in the sense that it is integrated synergized expression of a group’s efforts; it is not the sum of individual dominance and contributions, it is their interrelationship.
      Occurs when you persuade a person to take an action that is your mutual best interest.
      Process of influencing the actions of a person or a group to attain desired objects.
      Concept and process that is capable through interactional phenomena to influence a group towards goal achievement.
      Process of persuasion and by example by which an individual induces a group to take action that is in accordance with the group’s purpose.
    • NURSING LEADERSHIP:
      Process whereby a nurse influences two or more persons to achieve specific goal in the provision of nursing care for one or more clients.
      Formula for a successful nurse manager performance:
    • SKILLS: Technical, behavioural, conceptual
      +
      VARIABLES: Motivational, Abilities, Role Calrity
      =
      SUCCESSFUL NURSE MANAGER
    • REASONS IN THE STUDY OF NURSING LEADERSHIP:
      Rising intensive and specialized areas in the hospitals.
      Swift in population group.
      Increase in physical facilities and decrease in nursing personnel in the hospital.
      Technology and computers.
      Emerging social problems.
    • 5 ELEMENTS OF LEADERSHIP
      Leader: a person performing leadership functions.
      Formal
      Informal
      Followers: the constituents who are duty- bound to follow leader’s orders and gives respect to latter.
      Group: includes the leaders and the group members.
      Process: the means, style, formula, policies used by both leader and his follower for the achievement of a common goal.
      Goal: the purpose, objectives or reason for leadership.
    • FORMULA FOR EFFECTIVE LEADERSHIP:
      Knowledge of basic ingredients for leadership and management.
      Systematic use of self to get the right things done at the right time.
      Understanding of individual’s strength and weaknesses and potentials.
      EFFECTIVE LEADERSHIP AND MANAGEMENT
    • “Leaders not only know; they also know how to get there.”
    • NURSING LEADERSHIP CAN BE BEST DESCRIBED USING THE WORD LEADER:
      L- lead, love, learn
      E- enthusiastic, energetic
      A-Assertive, achiever
      D- dedicated and serious
      E- effective, efficient
      R- responsible, respectful
    • FUNDAMENTAL CONSIDERATIONS FOR EFFECTIVE LEADERSHIP:
      A person receiving a communication understands it.
      This person has the resources to do what is being asked in the communication.
      This person believes it is consistent with the purpose and values of the organization.
    • MAJOR VARIABLES IN LEADERSHIP:
      The characteristics of a leader.
      The attitude, needs and other personal characteristics of followers.
      The characteristics of the organization, such as its purpose, its structure; the nature of the task to be performed.
      The social, economic and political milieu. The personal characteristics required for effective performance of a leader vary, depending on the other factor.
    • TYPES OF FOLLOWERS:
      Alienated: independent and critical yet passive in their behaviour.
      Sheep: dependent and uncritical; they are being told by their leaders.
      Yes people: dependent and uncritically reinforce the thinking and ideas of their leaders with enthusiasm, never questioning of challenging the leader’s ideas or proposals; most dangerous to a leader.
      Survivors: least disruptive and lowest risk- followers; “Better safe than sorry.”
      Effective followers: self- leaders and do not require close supervision.
    • 4 ESSENTIAL QUALITIES OF EFFECTIVE FOLLOWERS:
      Self- management: thinks for oneself and works well without close supervision.
      “Before you can lead anyone else, you must first learn to manage yourself
      Commitment: effective followers are committed to something beyond themselves.
      “Leadership is not about power. It is not about control.It’s about helping to live according to the vision”
    • Competence and focus: builds competence and focuses their efforts for maximum impact.
      Courage: effective followers establish themselves as independent, critical thinkers, and will fight for what they believe is right.
    • ELEMENTS OF LEADERSHIP:
      VISION:
      provides a direction to the influence process.
      A vision for effectiveness should:
      Appear as simple, yet vibrant, image in the mind of the leader.
      Describe a future state, credible and preferable to a present state.
      Appear desirable enough to energize followers.
      Succeed in speaking to followers at an emotional or spiritual level.
    • Where there is no vision, the people perish.
      Proverbs 29:18
    • “Leaders always have an eye on the future and that includes preparing their organization for its next leader”
    • INFLUENCE
      Ability to obtain followers; any attempt by any individual to change the behaviour of others.
      “When leaders have influence, people begin to follow them.
      When they have respect, people keep following them.”
       
    • Kinds of influence:
      Assertiveness: one sends direct messages to others and is able to stand up for her own rights without violating others.
      Ingratiation: where an individual makes another feel important or good before making any request.
      Rationality: convincing someone the merits of a detailed plan, which is usually supported by information, reasoning or logic.
      “One of a leader’s greatest sources of influence over their followers is their example”
       
    • Blocking: holistic form of influence where an individual achieves the goal of influencing another person either with the threat of or the cutting off from communication or interaction the other person intended to be influenced.
      Coalition: collective form of influence where a person get several persons to “back her up” when making a request.
    • Sanction: hinged on the promise of punishment in the case of non- cooperation and reward in case of acquiescence or cooperation; behaviour- based.
      Exchange: offering a favour or a personal sacrifice as an incentive for the performance of the request.
      Upward appeal: obtaining support from a higher up to push someone into action
    • LEVELS OF LEADERSHIP AS AN ACT OF INFLUENCE:
      LEVEL I- POSITION (RIGHTS)
      Territorial rights; protocol; traditional and organizational charts; the only influence a nurse can have at this level is that which comes with a title.
      LEVEL II- PERMISSION (RELATIONSHIP)
      Based on how well the people know the leader.
      People want to know what motivates their leader and if this means she will care for them.
      Often lead by intimidation.
      Leaders at this level lead by interrelationship or through caring concern for others.
    • LEVEL III- PRODUCTION (RESULTS)
      Purpose of coming together.
      People work together to achieve similar objectives and hope for the same things.
       
      LEVEL IV- PEOPLE DEVELOPMENT (REPRODUCTION)
      Great- leader: empowers others because a leader’s main responsibility is to develop others.
      LEVEL V- PERSONHOOD (RESPECT)
      Only a proven leader may arrive at this level and reap the rewards that are eternally satisfying.
      The higher the leader goes, the easier it becomes to lead and the greater the growth.
      It is essential that along with the leader, the other influential people in the group ascend as well.
    • legitimate right to give commands, to act in the interest of an organization; right to direct other’s obtained through position power.
      “Power has the potential to control the behaviour of others while authority has the potential to exert control through the legitimacy of a managerial position
      AUTHORITY
    • - ability to impose the will of one person or group to bring about certain behaviours in other groups
      -ability to efficiently and effectively exercise authority and control through personal, organizational and social strength.
      - includes caring practices by nurses which are used to empower patients; nurses need power to influence patients, physicians and other health care professionals, as well as each other.
      POWER
    • UNDERSTANDING POWER
      -may be feared, worshipped or mistrusted
      -frequently misunderstood
      -appears to be more aligned with male than with female
      GENDER and POWER
      -Some women hold negative connotation of power and never learn to use power constructively
      -Some women, power maybe viewed as a dominance versus submission, associated with personal qualities; not accomplishment and dependent on personal or physical attributes, not skill
    • 1. LEGITIMATE POWER- bestowed upon a leader by a given position in the hierarchy of an organization
      2. REWARD POWER- derived from the manager’s ability to give rewards to her subordinates for compliance with her orders or request
      3. COERCIVE POWER- leader’s ability to punish subordinates for non-compliance with his directives; holds rewards or even create an untenable working conditions
      4. EXPERT POWER- special abilities or skills unique to the leader; ability to influence others through the possession of knowledge or skills that are useful to them.
      SOURCES OF POWER
    • 5. INFORMATION POWER- being well-informed and up-to-date; power comes from knowledge and access to information
      6. REFERENT POWER- based on relationships and connections; attracts others and build loyalty; based on charisma and interpersonal skills of the power holder; shown in two forms:
      a. it can be based on certain attractiveness or appeal of one person to another
      b. it may also be based on a person’s connection with another powerful individual
      7. SELF-POWER- the power a person gains over his or her own life and maintains that this power that comes from maturity, ego, integration, security in relationship and confidence in one’s impulse.
    • REFERENT association with others
      LEGITIMATE position
      COERCIVE fear
      REWARD ability to grant favors
      EXPERT knowledge and skills
      CHARISMATIC personal
      INFORMATIONAL the need for information
      SELF maturity, ego, strength
      TYPES OF POWERSOURCE
    • 1. Taking good care of yourself
      2. Eat a well-balanced diet
      3. Rest. Relax. Exercise
      4. Develop relationship
      5. Develop hobbies and interest.
      6. Have fun.
      7. Develop and focus your goal.
      8. Recognize priorities.
      9. Be assertive.
      10. Learn how to collect and review accurate information
      11. Be a proactive decision-maker
      12. Expand your personal resources by broadening your skill base and continuing education
      13. Show up to do networking and develop potential alliances and coalitions
      SOURCES OF PERSONAL POWER
    • KEY FACTORS THAT CONTRIBUTE TO ONE’S POWER IMAGE
      SELF-IMAGE -thinking of oneself as powerful and effective
      GROOMING and DRESS -well-groomed hair; appropriate make up; clothing and appearance that are neat, clean and appropriate to the situation
      GOOD MANNERS - treating people with courtesy and respect
      BODY LANGUAGE - good posture, gestures that avoid too much drama, good eye contact and confident movement
      SPEECH - a firm confident voice, good grammar and diction, an appropriate vocabulary and good communication skills
    • -Self-image
      -Grooming and dress
      -Speech
      -Body language
      -belief in power as positive force
      -belief in value of nursing to society
      -career commitment
      -continuing professional education
      STRATEGIES FOR DEVELOPING A POWERFUL IMAGE
    • -Be honest
      -always be courteous
      -smile whenever appropriate
      -accepts responsibility for and learn from them your own mistakes
      -be a risk taker
      -win and lose gracefully
      -learn to be comfortable with conflict and ambiguity
      -develop the ability to take constructive criticism gracefully
      -always follow through on promises
      Additional Power Strategies
    • –corresponding obligation to the assigned task; authority granted must equal the assigned responsibility
      2 CATEGORIES of RESPONSIBILITY
       
      1. INDIVIDUAL RESPONSIBILITY- proficient in job; responsible for their actions; assume when one accepts a position in the organization
      2. ORGANIZATIONAL RESPONSIBILITY- collective organizational accountability and include how well the department perform their work
      RESPONSIBILITY
    • answer the results or outcomes of her actions and decisions in her work;
      flows upward in the organization;
      final act in the establishment of one’s credibility;
      rewards in good performance, as well as discipline in poor performance
      ACCOUNTABILITY
    • 1. PASSIVE or NON-ASSERTIVE- feels self-pity and is lacking self-worth; acts apologetically; easily dominated by others and speaks hesitantly, softly refusing to look at others when talking; allows others to choose and does not achieve desired goals 
       
      BEHAVIOURS of LEADERS
    • 2. AGGRESSIVE BEHAVIOR- talks loudly on every subject, depreciates others remarks and has shown, insensitivity to the feelings of other people; disregard other people’s rights; propensity to point a finger and says “you” frequently; dictate the action of others and achieve desired goals by hurting others
    • 3.ASSERTIVE BEHAVIOR- midway between passive and aggressive; express opinions and beliefs without infringing on or belittling the right or belief of others; refused to be dominated and manipulated; feel good about their self and others
    • THAT’S WHAT WE OUGHT TO BE 
      We are moulded uniquely by the Potter’s hands
      Took a life in college with hardships like countless sands
      Of all those RRs, NCPs, and LFDs
      We became more than we thought we can ever be
      In the near future, we’d be out somewhere
      Applying all what we have learned
      Teaching and caring for the sick and the needy
      Just what we’ve learned from our dear HTU
      To be compassionate, loving and over understanding
      Guided by the God’s will we are we’re planning
      And living a good Christian leader and nurse’s life
      Both locally and globally
      That’s what we’re all ought to be!
      From the Orange Group
    • STYLES OF LEADERSHIP:
    • Autocratic Leadership
      Directive or bureaucratic
      Most extreme; uses coercion in the exercise of power
      High concern for task accomplishment but low concern people who performs this task.
      No confidence or trust to subordinates.
      Subordinates do not feel free to discuss their job with their supervisors.
      Seldom gets ideas and opinions form subordinates in solving work problems.
      In nursing, gives orders and expects adherence to policies and procedures.
    • Subordinates are expected to follow without questions.
      Provides strong motivation and psychological regard to the leader.
      Most effective in crisis situation when highly specialized skills are required and options for activities are limited.
      Used to bring order out of chaos.
      Sometimes called “centric”
      Workers fear the leader
      Communication flows downward
      Emphasis is on the difference in status (I and You)
    • People- oriented
      Focuses on human aspects and builds effective teamwork.
      Interaction between leader and subordinates is open, friendly, and trusting.
      Collaborative spirit and joint effort exists.
      Group participation in decision- making.
      Open communication prevails.
      Leader consults subordinates to in solving problems and work- related decisions are made by the group.
      “consultative” style of leadership
      Democratic, Participative, or Consultative Leadership
    • Performance standards exist to provide guidelines and performance appraisal.
      “radic” leader because he/ she radiates out to encompass the needs of others
      Economic and ego awards are used to motivate.
      Communication flows up and down.
      Criticism is constructed.
      Emphasis on “we” rather than “I” and “You”
    • Permissive, Ultraliberal or Laissez- Fare Style of Leadership
      “let alone” style of leadership
      Leader who is appointed manager abdicates leadership responsibility and leaves workers without direction, supervision, or coordination.
      Workers lack central direction and control.
      Free- rein leader avoids responsibility by relinquishing power to subordinates.
      Permits followers to engage in managerial activities such as decision making, planning, structuring the organization, setting goals, and controlling the organization.
      Leader is ultraliberal.
      Effective in highly motivated professionals like those in research, where independent thinking is rewarded.
    • Not useful in organizations that are highly structured such as the healthcare delivery system where organization and control form the baseline of the organization.
      Kind of leader is permissive with little or no little or no control, motivates by support when requested by the group or individuals, puts emphasis on the group, does not criticize, disperses decision making within the group, and provides little or no direction at all.
      Motivation by support when requested by the group or the individual.
      Communication upward and downward flow among members of the group.
      Decision making dispersed throughout the group.
      Emphasis on the group.
      Criticisms withheld.
    • -Nurse leader manages “by the book”
      -everything must be done according to procedure or policy
      -highly structured; systematic control of superior
      -members are methodologic and disciplined; they are expected to be competent and responsible
      -climate of rules; clear division of labor; standardized
      -systems of procedures; written specification; memos and minutes
      -bureaucratic nurse leader and manager- more of a police officer than a leader
       
      . BUREAUCRATIC
    • -this style can be effective when:
      a. routine tasks are performed
      b. certain standards or procedures are to be understood
      c. employees are working with dangerous or delicate equipment that requires a definite set of procedures to operate
      d. safety or security training is conducted, and
      e. employees are performing tasks that require handling cash
    • LEADING
      To guide, to go before or show the way.
      Leadership in nursing is necessary to guide nursing personnel to a specific goal, that is, the provision of quality nursing care to their patient.
      The art of developing people.
      Leadership activities:
      Directing which is actuating efforts to accomplish goals
      Supervising or overseeing work of employees
      Coordinating or unifying personnel and services among others.
    • In LEADERSHIP
      SUCCESS is SUCCESSION
      If someone coming along behind me is not
      Able to take what I have offered and built on it
      Then I have FAILED in my responsibility to the NEXT GENERATION
    • LEADERSHIP ROLES
      Top ---------------------- Administrator
      Middle ------------------ Supervisors/ Clinical Coordinators/ Clinical managers
      First Line -------------- Head Nurses/ Senior Nurses
      Operational level----- Staff Nurses/ Nursing attendants
    • Administrators: over-all planning and setting up of objectives, developing and scheduling programs, budget proposals, and establishment of policies.
      Supervising nurse: managing nursing care and services in two or more nursing units.
    • Head nurse/ senior nurse: management and supervision of a particular nursing unit
      Connecting link between the staff nurses and the higher management
      Oversees the technical and interpersonal skills of his staff and coordinate the services and activities through daily rounds, reports, referrals, and review of the patients’ nursing care plans.
      It is the manager’s duty to:
      Ensure that all activities in his nursing unit are going on smoothly
      The patients’ welfare is promoted and protected
      Employees adhere to established standards and procedures
      Proper work flow is facilitated
    • LEADERSHIP QUALITIES
    • A leader possesses a striking personality and is energetic.
      A leader possesses a sense of purpose and direction. A leader knows his own personal objectives and those of the group. He is able to set goals and move towards the direction.
      A leader has the power of ready speech. He is able to communicate in both written and spoken language.
      A leader is enthusiastic about the purpose of the group and devoted to its cause.
      A leader has keen insight into the human nature of people. He has faith and trust in the people he leads.
    • A leader displays courage and persistence even in the face of opposition.
      A leader is decisive. He uses independent judgment and does not hesitate to consult others when needed.
      A leader is cheerful and even- tempered.
      A leader shows technical mastery that inspires others to do above average performance in their jobs.
      A leader is intelligent, versatile and has a keen sense of humor.
      A leader has moral vision, integrity, and idealism.
    • LEADERSHIP SKILLS
    • Skills in personal behaviour
      Sensitivity to the feelings of others
      Identification with the needs of the group
      Acceptance of people’s suggestion rather than criticizing or ridiculing them
      Helping others feel important and needed
    • Communication skills
      Ability to listen attentively to the opinion of others
      Establish positive communication within the group
      Make sure everyone understands what are expected of them
      Getting feedback from followers and recognizing that everyone may have important contributions to make.
    • Organization skills
      Willingness to assist the group in making short- and long- range plans and objectives
      Share responsibilities and opportunities
      Implement plans, follow up and evaluate results
      Participate in problem solving
    • Skills in self analysis
      Awareness of personal motivations, of own strengths and weaknesses, and willingness to improve them.
      Assisting the group in recognizing and utilizing Filipino values essential to caring for their patients.
    • ESSENTIAL QUALITIES OF NURSE LEADERS
    • The nurse leader should have:
      Intellectual, technical and administrative skills
      Integrity, honesty, ability to work with others
      Tact and emotional stability
      Ability to win the support and loyalty of fellow workers; and
      Good human relationships with co-workers
    • THEORIES OF LEADERSHIP
    • SITUATIONAL THEORIES
      Leader behaves according to a given situation which may vary from one setting to another.
      Considers a person’s qualities and motivations, the role expectations of the group, and the social forces at work such as the external factors that bring forth the leadership potential.
      Situational or “contingency” style of leadership is one in which the leader’s style matches the situation and needs.
      In the work situation, the manager’s leadership style and expectations, and the follower’s characteristics and expectations blend together and form a productive combination.
    • The natural leader who becomes a leader in spite of himself/ or herself.
      Does not seek the role but the group thrusts upon him/ her by the tide of events.
      The charismatic leader who is an authentic hero in the eyes of his/ her followers.
      To the, he can do no wrong; he inspires people to make sacrifices for the cause they represent.
      The rational leader who is consistent and persistent in what he thinks is right.
      The consensus leader who is perceived to be accepted by all.
      The leader who dominates by force or fear.
      Ruthless in suppressing opposition.
      Does not reign long (contains within the seeds of self destruction).
      Five kinds of leaders:
    • TRAIT THEORY
      Based on the belief that leaders are born with certain qualities that properly develop to enable them to be successful leaders.
      Leaders are gifted with certain qualities that are developed and which show in their ability to get along well with people and persuade them to a course of action.
      They have forceful personalities, possess integrity, and are efficient in work.
    • Categories of traits:
      Physical characteristics: age, built, height and weight bearing
      Background information: education, social status, experience
      Intelligence: knowledge, judgement, ability
      Personality: decisiveness, authoritarianism, extroversion, alertness, aggressiveness, enthusiasm, independence, self- confidence.
      Task- oriented characteristics: persistence, responsibility, achievement need, initiative
      Social characteristics: supervisory activity, popularity, prestige, tact, diplomacy
    • Leadership behaviour is generally determined by the leader’s personality and the specific situation.
      To be successful, the leader must diagnose the situation and select appropriate strategies from a large repertoire of skills.
      INTERACTIONAL THEORY
    • Concerned with what leaders did and act than who the leader is.
      The actions of the leaders and not their mental qualities or traits make them leaders.
      Based upon the belief that great leaders are made, not born.
      BEHAVIORAL THEORIES
    • THEORY Z (by Ouchi)
      Enlarges upon Theory Y and the democratic approach to leadership.
      Has a humanistic viewpoint and focuses on developing better ways of motivating people.
      Collective decision making
      Opinion of all members are taken
      Everyday problems are discussed through problem- solving groups called quality circles.
      They are encouraged to identify and resolve problems faced by the organization.
    • Long- term employment
      Employees are employed by only one organization during the entire career.
      They work in various organization to understand how other departments work.
      It fosters commitment and loyalty to the company.
      Slower promotion
      Allows time for the evaluation of the employee’s long- time contribution to the organization.
    • Indirect supervision
      Supervision is subtle
      Workers become part of the organization’s culture and are intimately familiar with its philosophy, values and goal.
      The employee becomes elf- directed.
      Holistic concern
      Trust, fair treatment, strong commitment to the organization, and loyalty are all characteristics of Theory Z.
      The company considers the employees as a whole, taking note of their health and well- being, as well as their performance as workers.
    • Burn’s concept (1978) of leader- follower interaction is raised to higher levels of motivation and morality.
      Identified this concept as transactional leadership along with two types of leaders in management:
      Transactional leaders: traditional manager concerned with the day-to-day operations
      Transformational leader: has a vision, is committed, and has the ability to empower others to share that vision
      TRANSFORMATIONAL LEADERSHIP
    • Transactional leaders focus on management tasks.
      Caretakers who use trade- offs to meet goals.
      Do not identify shared values, do not examine causes, and use contingency reward.
      Transformational leaders
      Identify common values, are committed, inspire others with a long-term vision, look at efforts, and empower others.
      Tyrell (1994) identifies VISIONING as a mark of transformational leaders.
      “Nurses at all levels are expected to demonstrate visionary leadership that sets direction for nursing practice creating a picture of an ideal future.”
    • Based on trust, the leader and the followers become united in purpose thereby creating unity, wholeness, and environments that enhance change brought by creativity and innovation. (Wolf, et. al.)
      Shared environment be maintained to develop and support transactional, transformational leadership skills among its employees.
      “Vision is the essence of transformational leadership. It implies the ability to picture some future state, sharing with others, that they too, may share that dream.” (Marquiz and Huston, 2006)
      It is equally important that leaders recognize and manage their failings because it is only then that leaders can achieve greatness (Kellerman, 2004)
    • LEADERSHIP VS. MANAGEMENT
      The manager is the person who brings things about; the one who accomplishes’ has the responsibility, and conducts.
      A leader is the person who influences and guides direction, opinion, and course of action.