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1. Special Leadership & Management Challenges in the 21st Century Rami N. Abdel Rahman Oncology Nursing Master Student 2010 – 2011 Supervised and directed By: Dr. Nejmeh Al Attyat. 10/10/10 1

2. Questions to Consider!! Why is it important for you to understand the mission &values of the organization to provide direct patient care? What leadership and management skills will assist you as beginingnew role as Nursing leader? What type of team-building skills will help you leading a multidisciplinary team and coordinate patient care? 10/10/10 2

3. Learning Outcomes Relate leadership and managementtheory to nursing leadership and management activities. Differentiate among the five functions of management essential activities related to each function 10/10/10 3

4. Learning Outcomes Integrate principles of the customer service role in professional nursing practice. Implement effective team-buildingskills as an essential component of nursing practice. 10/10/10 4

5. Learning Outcomes Implement the concept of transformational leadership in nursing directed institutions. Discuss the implications Magnet Hospitals on the leadership & management. 10/10/10 5

6. Key Terms Authority Healthcare Organizations Leadership Management Organizational Chart Resources Productivity Safety Quality Service excellence Point of care Stakeholders Transactional vs. Transformational Customers 10/10/10 6

9. 21st century demands Higher – acuity patients. Diverse health professionals and nonprofessionals. Work environment . Reimbursements, health insurance. Constant admitting and discharging units. Shrinking budgets. Limited resources. 10/10/10 9

10. Health care providers and Nursing Turnover. Nurse : Patient (ratio). Standardization (JCI, CCHSA..etc) Cultural and societal development and changes. Traditional  Evidence-based Nursing 21st century demands and challenges 10/10/10 10

11. What is expected! Regardless of which position or area the nurse is employed, the health care organization will expect the professional nurse to have leadership and management skills 10/10/10 11

12. What is leadership? Leadershipoccurs any time a person attempts to influence the beliefs, opinions, or behaviors of a person or group (Hersey and Blanchard, 1988) Situational Leadership Model 10/10/10 12

13. So… what is leadership? It is a combination of: intrinsic personality traits. Learned leadership skills. and characteristics of the situation. It is to guide people or groups to accomplish common goals. May not have formal authority. 10/10/10 13

15. Unique characteristics.

16. Exceptional clinical expertise.

17. Relationships with other organizations.10/10/10 14

18. What is Management? Management refers to the activities involved in coordinatingpeople, time, supplies to achieve desired outcomes and involves problem-solving and decision making processes. 10/10/10 15

19. So.. What is Management? Control of day-to-day operations of a defined area or responsibility. Plan and organize: What is to be done. Who is to do it. When is to be done. 10/10/10 16

20. Nurse Manager.. e.g… An appointed management position within an organization: Planning staffing. Employee performance reviews. Controlling use of supplies. Meeting, budgeting, productivity goals… etc A formal line of authority and accountability to ensure: Safe and effective patient care along with organization’s goals and standards. 10/10/10 17

21. Leadership versus management Leadership and management are intertwined. Its difficult to discuss one without the other. Though… they are different concepts. 10/10/10 18

22. Leadership versus management Leadership The ability to guide or influence others. People are led. Leaders are able to motivate and inspire others. Management The coordination of resources (time, people, supplies) Activities and things are managed. Managers have the assigned responsibility to accomplish organization’s goals. 10/10/10 19

23. Leadership versus management Leadership A person with good management skills may not have leadership ability. Same the way around. Leadership and management skills are complementary Both can be learned and developed through experience. Improving skills in one area will enhance abilities in the other. Management 10/10/10 20

24. Power and Authority Authority: is the legitimate right to direct others and is given to a person by the organization through an authorized person (e.g. Nurse Manager) 10/10/10 21

25. Power and Authority Power: is the ability to motivate people to get things done with or without the formal right granted by the organization. Sources of Power are identified 10/10/10 22

26. The primary sources of power Reward Power: to reward others (e.g. money, acknowledgment, desired assignment… etc.) Coercive Power: based of fear of punishment (opposite of reward) 10/10/10 23

27. The primary sources of power Legitimate Power: based on an official position in the organization (granted right to influence) Referent Power: comes from the followers to the leader (admiration, respect… etc) 10/10/10 24

28. The primary sources of power Expert Power: based on knowledge, skills and information Information Power: information that is needed by others. Connection Power: relationship or affiliation with powerful people. 10/10/10 25

29. Chain of Authority (e.g.) 10/10/10 26

30. Organizational Chart and Chain of Authority 10/10/10 27

31. 10/10/10 28

32. Leadership Theories 10/10/10 29

33. Sir Francis Galton One of the earliest leadership theorists Wrote “Hereditary Genius” pub. 1869 Believed leadership qualities were genetic This theory assumes physical and psychological characteristics (traits) account for effective leadership Basic intelligence Clear and strong values High personal energy Leadership Trait Theory Leaders were born with such traits 10/10/10 30

34. Leadership Trait Theory Edwin Gheselli identified six traits for effective leadership: Need for achievement Intelligence Decisiveness Self-confidence Initiative Supervisory ability 10/10/10 31

35. Leadership Trait Theory Borrow Ideas Leading by example Accountable Fairness Virtue Respect Listening Involving Planner Dreamer Integrity Sense of Humor Humble Simplifier Serve 10/10/10 32

36. Leadership Behavior Theory In the 1930s, emphasis on behaviorism moved researchers in the direction of leadership behavior Kurt Lewin trained assistants in behaviors indicative of three leadership styles: Autocratic: tight control of group activities, decisions made by the leader Democratic: group participation, majority rule Laissez-faire: little activity of any type by the leader. 10/10/10 33

37. Leadership Behavior Theory In the 1940s, research focused on leader behaviors Assumed that leaders take distinct actions Ralph Stogdill at Ohio State University Helped develop the Leader Behavior Description Questionnaire (LBDQ) Respondents described leaders’ behavior in two dimensions: Initiating structure Showing consideration 10/10/10 34

38. Leadership Behavior Theory 3D Behavioral Scale 10/10/10 35

39. Take a Break 10/10/10 36

40. Do you know them..? 10/10/10 37

41. Do you know them..? 10/10/10 38

42. Do you know them..? 10/10/10 39

43. Do you know them..? 10/10/10 40

44. Nursing Leaders 10/10/10 41

45. Do you know them..? If you know 30 names… You are genius!! 10/10/10 42

46. Other Leadership Theories Situational Leadership Theory. Interactional Leadership Theory. Leadership Contingency Theory. 10/10/10 43

47. Transformational Leadership Leadership theory is an evolving field; while these highlight the most common theories of the last century, more theories continue to be researched in the elusive search for a definitive understanding of leadership. More recent leadership theories are discussed on the following slides. 10/10/10 44

48. Transformational Leadership Burns (1978) identified and defined transformational leadership. Tow types of leaders: The transactional leader; concerned with day-to-day operation of the facility. The transformational leader; committed to organizational goals, has vision and is able to empower others 10/10/10 45

49. Transactional Vs. Transformational Transformational Identify and clearly communicate vision and direction. Empower the work group to achieve goals and vision. Are admired and emulated. Provide mentoring based on needs. Transactional Focus on day–to–day operation. Reward staff for desired work (I’ll do x for you doing y). Monitor work performance. Wait until problems occur and deal with it. 10/10/10 46

51. Focus is innovation and change.

52. Followers have a sense of mission.

53. Leaders inspire followers beyond interpersonal relationships and extrinsic rewards for a job well done.

54. People have a purpose: worthwhile, meaningful and important.10/10/10 47

56. Appeal to our sense of mission and purpose of making a difference in people’s livesManage well in an environment of constant change 10/10/10 48

58. Nurse and Patient Educators

59. Nurse Managers

60. Directors, Vice-Presidents, the CNO

61. Patient Safety and Quality

62. Nurses in non-traditional, non-direct care rolesWE ALL ARE! WE ARE COLLECTIVELY EMPOWERED TO BE LEADERS WHEREVER WE PRACTICE 10/10/10 49

63. The New Magnet Model Evidence Based Leadership 10/10/10 50

64. Magnet Recognition Program 10/10/10 51

65. Transforming Our Practice Building a culture of change Transformational leaders will help to build exemplary professional practice at the unit level Our Transformational Leadership Council’s role will evolve to reflect the roles defined by the New Magnet Model Initially, the Council will provide the foundational structure needed to build all other councils 10/10/10 52

66. Transformational Leadership Council Roles Advocacy and Influence Visibility, Accessibility and Communication Strategic Planning 10/10/10 53

67. Application:Nursing Process Assess. Plan. Intervene. Evaluate 10/10/10 54

68. Nursing Assessment – Evaluation Cycle Leadership. Management Power Authority Transformational 10/10/10 55

69. Evidence – Based Leadership in Nursing Process 10/10/10 56 “ … in any moment of decision, the best thing you can do is the right thing, the next best thing to do is the wrong thing, and the worst things you can do is nothing.” Theodore Roosevelt

70. Pathway for Patient Safety;Working as a Team 10/10/10 57

71. Effective Team Work and Communication 10/10/10 58

72. Effective Team Work 10/10/10 59

73. Questions, Ideas, Suggestions!! 10/10/10 60

74. References www.nursingcredintialing.org www.ihi.org www.ahqr.org www.nursingquality.org Cherry, Barbara; Jacob, Suzan R.; Contemporary Nursing Issues, Trends and Management, Chapter 15, 2008. 10/10/10 61