Module-1-Introduction-to-Leadership_FINAL.pptx
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Module-1-Introduction-to-Leadership_FINAL.pptx
- 2. Objectives: Module 1 • Understand how the concept of leadership has evolved over time • Understand current leadership theories in the context of long-term care (LTC) • Define clinical nurse leadership • Reflect on personal leadership strategies • Identify personal leadership strengths
- 3. Trends That Impact Health Care in Canada Self–care is the norm Villeneuve & MacDonald, 2006 Enhancing role of RN more in acute care Increased responsibility of RPN in LTC More nurses in full-time positions 70% Focus on patient safety Focus on nurses working in inter-disciplinary teams Trends in nursing education Focus on diversity Nursing shortage Issues in the workplace: Violence, workload, overtime, scheduling, lack of professional autonomy
- 4. Changing Health Care Environment What changes have you seen in LTC over the past five years? • One case of Alzheimer's Disease in Canada every 5min - will increase to 69% in 2034 • 76% of people over age 65 have a chronic health problem • More RPNs, fewer RNs in long-term care • Focus on increasing quality care • Deprescribing • More of a leadership role for nurses as the complexity of care increases
- 5. Impact on Nursing • Restructuring • Bed closure & merger of hospital services • Patient acuity (hospital, LTC, and home care) • Complexity in care delivery (technology) Nursing human resources and quality of work life • Recruitment and retention • Sick time • Team work • Conflicts • Resident/patient satisfaction - compliance
- 6. Governing Bodies… Standards of Practice • College of Nurses of Ontario (CNO) • Regulated Health Professions Act (RHPA) • Nursing Act • Ministry of Health and Long-term Care (MOHLTC)
- 7. Knowledge, Skill, Judgment Evidenced-Based Practice • Nursing research • Review of literature • Clinical Practice Guidelines • Experience, judgment, and skill • Quality improvement • Access to websites • Patient, consumer interest, knowledge, and expectations
- 8. ETHICS… Essential for nursing and nursing leadership: • Health and well-being • Choice • Dignity • Confidentiality • Fairness • Accountability Practice environments that are conducive to safe, competent, and ethical care
- 9. Leadership in the 21st Century It is all about change and adaptation
- 10. What Makes a Leader? • Vision • Cope with change • Empowers others • Influence others by what they say, how they say it, and what they do • Create environments for success • Develop people, versus controlling people • Respect others • Trust their experiences • Model rather than mold
- 11. Nursing Leaders • Are key to client/resident care • Choose their results • Articulate their expectations • Understand the organization structure • Understand the nature of power and politics – a choice to take it and skills to build it • Take risks and encourage others • Use a problem-solving approach that focuses on positive results
- 12. LEADERSHIP MANAGEMENT Position Selected/allowed by group Appointed by higher person in organization (org) Power – comes from… Knowledge, credibility, & ability to motivate Position of authority Goals/visions Personal /passion – may not align with org Prescribed by organization Risk level High risk, high creativity & innovation Low risk/ balance/ maintain status quo Degree of order Relative disorder Rationality & control Nature of activities r/t Vision & judgment Efficiency /cost effect Focus People Systems & structure Perspective Long-range – with an eye on the horizon Short range – eye on the bottom line often present The carrot always wins over the stick, Just ask your horse - Maxwell
- 13. Leaders, Managers, Followers (Yoder-Wise & Grant, 2015) Leaders: • Engaging & influencing • Visionary, energetic, inspirational, innovative • Go beyond status quo • Critical thinking, action, advocacy (CNA, 2009) Managers: • Getting job done, work with HHR, budgets, traditional – authoritative, timelines Followership: • Engaging with others leading, promotes team effectiveness, collaboration, offering constructive critiquing
- 15. Trait Theories Style Theories Situational- Contingency Theories Transformational Leadership Authentic Leadership Key Leadership Theories Yoder-Wise, 2015
- 16. Trait Theories • “GREAT MAN THEORY” • Born to lead • Studied from 1900-1950 • Leaders had a certain set of physical and emotional characteristics that were crucial for inspiring others toward a common goal • Useful if self-aware, particularly if traits are: drive, motivation, integrity, confidence etc.
- 17. Style Theories • Based on two types of behaviour • Task • Relationship • Combination of task/relationship that determines effectiveness • Believed to be learned and cultivated – not born but taught
- 18. Situational-Contingency Theories • Dependent upon the situation • Path-Goal Theory – dependent upon task and relationship of followers • Supportive • Directive • Participative • Achievement oriented • Situational Leadership Theory • Level of follower maturity influences appropriate mix of task characteristics – leader may be more directive if follower new
- 19. Authentic Style Leadership • Authentic leaders are aware of their own values and moral convictions and are constantly realigning actions to match their values • Transparent • Truthful • Consideration not given to others • Works if you are congruent with the leader • Some association with Emotional Intelligence
- 21. Transformational Leadership • Raise each other up to higher levels of motivation for resident outcomes • Behaviour – charisma, intellectual stimulation, individual consideration, self-confidence, self-direction • Moves resources from areas of lesser to greater productivity Outcomes • Job satisfaction • Quality of Life • Empowerment • Retention of staff • Resident satisfaction
- 22. Transformational Leadership “The ultimate goal of transformational leadership is for the leader and the follower to discover meaning and purpose in relation to their work, in addition to growth and maturity.” (Atkinson-Smith, M. 2011, p. 44)
- 23. “Transformational leadership is viewed as the most effective model of leadership because, while it recognizes the importance of rewards, it goes further to satisfy the higher needs of the follower by engaging this person emotionally and intellectually.” (Surakka, 2008)
- 24. Five Practices of Transformational Leadership RNAO Guidelines
- 25. Building Relationships and Trust • Is a critical leadership practice, the foundation on which the other practices rest. • Relationships include those formed between individual nurses, on teams, and in internal and external partnerships. Creating an Empowering Work Environment • depends on respectful, trusting relationships among people in a work setting. • An empowered work environment has access to information, support, resources, and opportunities to learn and grow, in a setting that supports professional autonomy and strong networks of collegial support.
- 26. Creating a Culture that Supports Knowledge Development and Integration • involves fostering both the development and dissemination of new knowledge and instilling a continuous-inquiry approach to practice, where knowledge is used to continuously improve clinical and organizational processes and outcomes. Leading and Sustaining Change • involves the active and participative implementation of change, resulting in improved clinical and organizational processes and outcomes.
- 27. Balancing the Complexities of the System, Managing Competing Values and Priorities • entails advocating for the nursing resources necessary for high- quality patient care, while recognizing the multiple demands and complex issues that shape organizational decisions. Proper use of evidence is the key.
- 28. Organizations that Support this... • Validate the nurses critical role • Supply sufficient human resources • Provide necessary information and decision support • Create a culture and a climate conducive to effective, efficient nursing care RNAO, 2013
- 29. References Atkinson-Smith, M. (2011). Are you a transformational leader? Nursing Management, 44-50. Chu, C. H., Wodchis, W. P., & McGilton, K. S. (2014). Turnover of regulated nurses in long-term care facilities. Journal of Nursing Management, 22, 553-562. Cook, Michael J. "The attributes of effective clinical nurse leaders." Nursing Standard 15.35 (2001): 38-44. Cummings, G. G., MacGregor, T., Davey, M., Wong, C. A., Lo, E., Muise, M. & Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies, 47, 363-385. Enterkin, J., Robb, E., & McLaren, S. (2013). Clinical leadership for high-quality care: Developing future leaders. Journal of Nursing Management, 21, 202-216.
- 30. References Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: Towards a more critical approach. Nursing Inquiry, 20(1), 11-22. Kelly, P., & Crawford, H. (2008). Nursing Leadership and Management. (1st Canadian ed.). USA: Thomson Delmar Learning. Kelsey, C., & Hayes, S. (2012). A framework for educational leadership. Change Management, 22(8), 16-20. Lacasse, C. (2013). Developing nursing leaders for the future: Achieving competency for transformational leadership. Oncology Nursing Forum, 40(5), 431-433. McIntyre, M. & McDonald C. (2014). Realities of Canadian Nursing; Professional, practice, and power issues. (4th ed.). China: Lippincott Williams & Wilkins.
- 31. References Munir, F., Nielsen, K., Garde, M.H., Albertsen, K., & Carneiro, I.G (2012). Mediating the effects of work–life conflict between transformational leadership and health-care workers job satisfaction and psychological wellbeing. Journal of Nursing Management, 20, 512-521. Rankin, V. (2015). Clinical nurse leader: a role for the 21st century. MedSurg Nursing, 24(3), 199-203. RNAO, (2013). Developing and sustaining nursing leadership. Best Practice Guideline (2nd ed.). Squires, M., Tourangeau, A., Spence Laschinger, H. K., & Doran, D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management, 18, 914-925.
- 32. References Surakka, T. (2008). The nurse manager's work in the hospital environment during the 1990s and 2000s: responsibility, accountability and expertise in nursing leadership. Journal of Nursing Management, 16(5), 525-534. Weberg, D. (2010). Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly, 34(3), 246-258. Welford, C. (2002). Matching theory to practice. Nursing Management, 9(4), 7-11. Weiss, S.A., & Tappen, R.M. (2015). Essentials of Nursing Leadership and Management. (6th ed.). Philadelphia: F.A. Davis Company. Yoder-Wise, P.S. (2015). Leading and Managing in Canadian Nursing. (1st ed.). Toronto: Elsevier Canada.
Editor's Notes
- Notes to Facilitator: Provide some information about yourself and your professional background. This allows participants to understand your own personal lens in the context of the material you will present.
- Speaker notes This slide provides an overview of the external factors that impact health care in Canada as described in the reference below. Discuss the CAN “Vision 2020” with group and how the concepts in the slide are interrelated. Consider using examples pertaining to staff and patient safety (i.e. transfers and injury prevention). Consider using examples pertaining to quality improvement initiatives for drug administration and the effects of deprescribing. Discussion Activity: Ask the group to provide examples of how some of these trends have impacted the practice of nursing on their units or how it could in the future. Reference: Villeneuve, M. & MacDonald, J. (2006). Toward 2020: Visions for Nursing. Ottawa, ON: Canadian Nurses Association.
- Speaker Notes: Discuss the need for clinical nursing leadership in light of the changing health care environment. Focus on what the needs are of the resident/family in LTC and how the needs are different than what they had been previously. Understanding individual resident needs brings complexity to the care component provided by the front line workers. This means there is a greater need for leadership styles that emphasize working with and empowering rather than the old school style of directive care. Additional Reference: Canadian Union of Public Employees, (2009). Residential Long-Term Care in Canada: Our Vision for Better Seniors’ Care, Ottawa, ON, Canada. Retrieved from the Canadian Union of Public Employees website: http://archive.cupe.ca/updir/CUPE-long-term-care-seniors-care-summary.pdf
- Speaker Notes: Discuss with the group how the evolving health care environment impacts the profession of nursing through various changes such as the reduction in front line staff, fewer RNs, and a growing need for nurses to become "coordinators” of care.
- Speaker Notes: Discuss how the knowledge of standards of practice (i.e. medication, documentation, delegation) is critical to leadership. Discuss how standards of practice are governed by the following organizations and legislation: RHPA – reminds us of responsibility to the health care system – governs how all professionals must act (for example quality assurance) – mandate for all self-regulating professions Nursing Act reminds us of what we can and cannot do MOHLTC – higher jurisdiction over what we do
- Speaker Notes: Remind the audience that knowledge, skill, and judgement determines what we do in nursing and that ongoing training is essential for all three components. Evidence-based practice guides what we do. Tools to keep us up on the evidence can be found in a number of places including clinical practice guidelines. RNAO has guidelines for leadership, and various other tools, that help us as nurses to practice in a safe and ethical manner. Activity: Have the group discuss how nursing practice has changed to reflect new evidence. Consider the areas of skin care (e.g. use of baby powder/plastic draw sheets) and fall prevention (e.g. use of restraints).
- Speaker Notes: Remind the group that everything we do is based on a set of standards and a code of ethics within the nursing profession that guides us to make decisions that are in the best interest of the resident. This slide lists elements of ethical practice that can be discussed in terms of the LTC context. Examples: Choice – Residents who are cognitively impaired have the right to determine what is best for them even if it does not go along with the plan of care set out by the health care team (the plan of care should be updated to reflect the resident’s wishes). Dignity – often lost for people in nursing homes for a variety of reasons. Fairness – that everyone gets the same treatment – nobody is treated differently because of who they are. Discussion Activity: Ask the group for examples of ethical dilemmas encountered in their practice environments.
- Further Reference: Rankin, V. (2015). Clinical Nurse Leader: A Role for the 21st Century. Medsurg Nursing, 24, 199-201, 198. http://faculty.sites.uci.edu/ncrc/files/2016/01/76.pdf
- Speaker Notes: Ask the group to think about the qualities that they feel makes a good leader. This slide lists some qualities that have been described in the reference provided on the previous slide. Expand on how these qualities look in the context of LTC.
- Speaker Notes: Discuss key attributes of effective clinical nurse leaders as outlined in the slide and discussed in the reference provided below. Further Reference: Cook, M. J. (2001). The attributes of effective clinical nurse leaders. Nursing Standard, 15(35), 38-44.
- Speaker Notes: Overview of the difference between the concepts of leadership and management. Many of us in nursing assume that others are the leaders and that we are just followers but all nurses (i.e. RPNs and RNs) are leaders by the nature of our profession.
- Facilitator Notes: Discuss how the three roles described in the slide fit together to support effective resident care. Reference: Yoder-Wise, P.S. (2015). Leading and Managing in Canadian Nursing. (1st ed.). Toronto: Elsevier Canada.
- Objective: The following slides describe various theoretical perspectives from key leadership theories. The objective is to give participants an overview of how the concept of leadership has evolved over the years, and to present different ways of thinking about leadership.
- Speaker Notes: Transformational leadership is a leadership approach that has been extensively studied and felt generally to be more effective that instrumental or task-based approaches since it emphasizes the importance of inspiring and supporting team members. This is the leadership approach that has been adopted by the RANO best practice guidelines.
- Speaker Notes: This slide outlines additional traits associated with transformational leadership along with the outcomes that have been associated with this leadership approach. Additional References: The following studies provide evidence of positive outcomes associated with transformational leadership style: Chu, C. H., Wodchis, W. P., & McGilton, K. S. (2014). Turnover of regulated nurses in long-term care facilities. Journal of Nursing Management, 22, 553-562. Cummings, G. G., MacGregor, T., Davey, M., Wong, C. A., Lo, E., Muise, M. & Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies, 47, 363-385. Squires, M., Tourangeau, A., Spence Laschinger, H. K., & Doran, D. (2010). The link between leadership and safety outcomes in hospitals. Journal of Nursing Management, 18, 914-925. Weberg, D. (2010). Transformational leadership and staff retention: An evidence review with implications for healthcare systems. Nursing Administration Quarterly, 34(3), 246-258.
- Reference: Smith, M. A. (2011). Are you a transformational leader?. Nursing Management, 42(9), 44-50.
- Reference: Surakka, T. (2008). The nurse manager's work in the hospital environment during the 1990s and 2000s: responsibility, accountability and expertise in nursing leadership. Journal of Nursing Management, 16(5), 525-534.
- Speaker Notes The following slides provide and overview of the five practices of transformational leadership described in the RNAO guidelines. Each will be described briefly but elaborated on more as the course progresses. Reference: RNAO, (2013). Developing and sustaining nursing leadership. Best Practice Guideline (2nd ed.).
- Speaker Notes: Draw parallels between building trust with team members and building trust with residents (e.g. Therapeutic Nurse Client Relationship) – and use examples to illustrate how both types of trust enhances care.