Chapter 16

Chapter 16
Nursing Leadership
and Management
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

Leadership and Management
Defined and Distinguished
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. 2

 Attempt to influence the beliefs, opinions, or
behaviors of a person or group
 Guide people and groups to accomplish
common goals
 May not have formal authority but are still able to
influence others
Leaders

 Coordinate people, time, and supplies to
achieve desired outcomes in a defined area of
responsibility
 Have an appointed management position and a
formal line of authority and accountability
Managers

 Leadership: ability to guide or influence others
 Management: coordination of resources (time,
people, supplies) to achieve outcomes
Leadership vs. Management

 Authority: legitimate right to direct others through
an authorized position in an organization
 Power: ability to motivate people to get things
done with or without the formal right granted by
the organization
Power and Authority

 Reward power
 Coercive power
 Legitimate power
 Referent power
 Expert power
 Informational power
 Connection power
Types of Power

 Practiced by the nurse who is appointed to an
approved position and is given authority by the
organization to act
Formal Leadership

 Exercised by the person who has no official
authority to act but is able to influence others in
the work group
Informal Leadership

 Strategies for working with informal leaders
 Understand their source of power
 Involve them in decision making and change
implementation processes
 Clearly communicate goals and work expectations
 Do not ignore attempts to undermine teamwork and
change processes
Informal Leadership (cont'd)

Leadership and Management
Theory

 Based on the assumption that leaders are born
with certain leadership characteristics
 Traits associated with leadership include
intelligence, alertness, dependability, energy,
drive, enthusiasm, ambition, decisiveness, self-
confidence, cooperativeness, and technical
mastery
Leadership Trait Theory

 Integrate dynamics of interaction between
leader, worker, and leadership situation
 Effective leadership depends on:
 Organizational culture
 Values of the leader and followers
 Influence of the leader/manager
 Complexities of the situation
 Work to be accomplished
 Environment
Interactional Leadership Theories

 Suggests two types of leaders
 Transactional
 Transformational
Transformational Leadership

 Transactional leader is concerned with the day-
to-day operations of the facility/unit
 Transformational leaders
 Committed to organizational goals and clearly
communicate vision and direction
 Empower the work group to accomplish goals
 Impart meaning and challenge to work
 Are admired and emulated
 Provide mentoring to individual staff members on the
basis of need
(cont'd)

 Nurse executives who demonstrate
transformational leadership characteristics
achieve higher levels of staff satisfaction and
greater work group effectiveness
(cont'd)

 Three major areas required for effective
leadership (Hersey and Blanchard, 1988)
 1. Technical skills: clinical expertise and nursing
knowledge
 2. Human skills: ability and judgment to work with
people in an effective leadership role
 3. Conceptual skills: ability to understand the
complexities of the overall organization and to
recognize how one’s own area of management fits
into the overall organization
Leadership and Management Skills

 At the staff nurse level of management, a
considerable amount of technical skill and
clinical expertise is needed
 As one advances from lower levels to higher
levels in the organization, more advanced
conceptual skills are needed
Leadership and Management Skills
(cont'd)

 Authoritarian: makes all decisions with no staff input and
uses the position to accomplish goals
 Democratic: encourages staff involvement in goal
setting, problem solving, and decision making
 Laissez-faire: provides little direction or guidance and will
forgo decision making
 Today’s health care system requires democratic (or
participative) management
 Depending on the situation, the nurse manager may
need to use different types of management styles
Management Theory

 Provides a framework for understanding
complex organizations
 Weber’s bureaucracy theory
 Defined characteristics of bureaucracy, including
authority and ability to apply general rules to specific
cases
 Emphasized rules instead of individuals and
competency instead of favoritism
 Failed to recognize the complexity of human behavior
and constantly changing environments
Organizational Theory

 Systems theory
 Views organization as a set of interdependent parts
that together form a whole
 Anything that affects one aspect of the organization
will affect the other parts
 Open systems suggest that the organization is
affected by not only internal changes but also external
environmental forces
Organizational Theory (cont'd)

 Chaos theory
 Attempts to account for complexity and randomness
in organizations
 Views complicated behaviors, situations, and
variations as predictable; reflects cultural diversity,
constantly fluctuating patient census, and staffing
shortages
Organizational Theory (cont'd)

1. The hospital’s nursing administration wants to implement a policy
that all wound care be implemented and monitored by the
hospital’s certified enterostomal nurse because of a high rate of
hospital-acquired wound infections. The nursing administrator
refuses to hire an outside consultant suggested by the nurse
managers, stating, “We can do this ourselves; no one needs to
know our problems.” The nursing administrator is adhering to which
management theory?
A. Open systems
B. Closed systems
C. Chaos theory
D. Participative theory

Management Functions

 Five management functions are interrelated:
 1. Planning
 2. Organizing
 3. Staffing
 4. Directing
 5. Controlling
 Different phases of the process occur simultaneously
 Processes should be circular, with the manager always
working toward improving the quality of health care,
patient safety, and staff and customer satisfaction
Overview

 Decide in advance what to do; how, when, and
where it is to be done; and who is to do it
 All management functions based on planning
 Important components of planning
 Mission and philosophy
 Strategic planning: long-range; extends 3 to 5 years
into the future
 Goals and objectives: state actions necessary to
achieve the strategic plan
 Operational planning: encompasses the day-to-day
activities of the organization
Planning

 Establish formal structure to define the lines of
authority, communication, and decision making
 Define roles and responsibilities for each level of
management and staff
 Coordinate activities with other departments
 Communicate to ensure a smooth workflow
Organizing

 Components of organizing
 Organizational chart
 Policies and procedures
 Job descriptions
Organizing (cont'd)

 Determine the number and type of staff needed
 Recruit, interview, select, and assign personnel
 Orient, train, socialize, and develop staff
members
 Implement ongoing staff development programs
 Implement creative and flexible scheduling
Staffing

 RN work satisfaction factors
 Input into organizational decision making
 Organizational leaders who actively promote cohesive
work environments
 High level of support and encouragement provided by
the supervisor
 High autonomy
 Paid time off benefit
 Distributive justice
 Promotional opportunities
 Strong group cohesion
Staffing (cont'd)

 Clearly communicate performance expectations
 Create a motivating climate and team spirit
 Positive reinforcement in the form of a sincere thank
you is a powerful motivational resource
 For positive reinforcement to be effective, it must:
• Be specific, with praise given for a particular task
• Occur as close as possible to the time of the achievement
• Be spontaneous and unpredictable
• Be given for a genuine accomplishment
 Role model expected behaviors
 Manage conflict and facilitate collaboration
Directing

 Ensure that employees accomplish goals while
maintaining high-quality performance
 Establish performance or outcome standards
 Measure and evaluate performance against
established standards
 Determine an action plan to improve
performance
Controlling

 Resources for establishing performance
standards
 Written organizational policies and procedures
 Standards for the practice of professional nursing
developed by the ANA
 Standards for professional nursing specialty practices
Controlling (cont'd)

 Evaluating employee performance
 Occurs through formal annual evaluation process and
frequent feedback and coaching
 Consistent daily feedback and coaching clarify
expectations, improve work quality, allow manager to
correct problems before they become serious
 Result of routine performance evaluations should be
mutual goal setting designed to meet the employees’
training, educational, and work improvement needs
Controlling (cont'd)

2. Which of the following would have the greatest
influence on the success of a health care
organization?
A. Effective protocols
B. Clear goals and objectives
C. A transactional nurse manager
D. Human skills

Roles of the Nurse Leader

 Competitive marketplace in which health care
facilities compete for patients
 Nurse must keep patient safety and quality first
and foremost as the motivator of all plans and
activities
 Internal customers
 Employed by the organization
 Include patient care staff members, staff of other
departments, administrators, social workers,
dietitians, therapists, and so forth
Patient Satisfaction and Customer
Service Provider

 External customers
 Not employed by the organization
 Include patients and families, as well as physicians,
payers, and other users of the facility
 Customer service standards should be defined
by the customers
Patient Satisfaction and Customer
Service Provider (cont'd)

 Team is a group of people organized to
accomplish work
 Teams bring together a range of people with
different knowledge, skills, and experiences to
meet customer needs, accomplish tasks, and
solve problems
Team Builder

 Teams should create synergy through:
 Defined goals and objectives
 Commitment to work together
 Good communication
 Willingness to cooperate
Team Builder (cont'd)

 Nurse manager as a role model for teams
 Respect all members of the team; value their input
 Clearly define team goals
 Define the team’s decision-making authority
 Encourage members to develop stewardship
 Exhibit a personal commitment to team goals
 Encourage team members to help each other
 Provide resources necessary to accomplish goals
 Teach members to exchange constructive feedback to
achieve team goals
 Provide relevant and timely feedback to the team
Team Builder (cont'd)

 Resources include personnel, time, and supplies needed
to accomplish goals
 Plan for the necessary resources (primarily staff and
supplies) to manage the unit
 Organize resources to meet identified goals
 Staff appropriately, as determined by patient needs and
the budget plan
 Maintain resource allocations within budgetary guidelines
 Control by analyzing financial reports and making
adjustments where necessary
Resource Manager

 Decision making
 Not always related to a problem situation
 Required throughout all aspects of management
Decision Maker and Problem
Solver

 Problem solving
 Focused on solving an immediate problem
 Includes a decision-making step
Solver (cont'd)

 Nursing process as a guide for decision making and
problem solving
 Assessment: gather all information about the issue
 Analysis and diagnosis: use information/data from the
assessment phase to identify the specific problem
 Planning: identify and weigh options for risks, consequences,
positive and negative outcomes
 Implementation: implement the plan
 Evaluation: ensure problem was resolved effectively
 More important to understand the process to solve
problems rather than knowing all the answers
Solver (cont'd)

 Responsible for guiding people through the
change process
 Rules to follow when change is necessary
 Should be implemented only for good reason
 Should always be planned and implemented gradually
 Should never be unexpected or abrupt
 Everyone who may be affected by the change should
be involved in planning for the change
Change Agent

 Lewin’s stages of change
 Unfreezing stage: change agent promotes problem
identification and encourages awareness of the need
for change
 Moving stage: change agent clarifies the need to
change, explores alternatives, defines goals and
objectives, plans the change, and implements the
change plan
 Refreezing stage: change agent integrates the
change into the organization
Change Agent (cont'd)

 Important components of change
 Involvement
 Education and training
Roles of the Nurse Manager

 Clinical consultant
 Resource for clinical advice
 Role model for excellence in nursing care and
evidence-based practice
Other Roles

 Staff developer
 Offers learning and training opportunities to enhance
professional and personal growth for all employees
 Accesses resources and plans staff development
activities that meet the needs of individual staff
members
Other Roles (cont'd)

 Mentor
 Accepts responsibility to act as a mentor to new
nurses
 Recognizes that mentoring is key to developing future
nursing leaders and managers

 Corporate supporter
 Committed to the mission, goals, and objectives of
the employing organization
 Professional representative for the organization

Creating a Caring Environment

 Caring for staff members as well as for patients
and families
 Staff members who feel that their manager
sincerely cares about them and the work they do
are able to pass that feeling of caring on to their
patients and other customers
Overview

 Offer sincere positive recognition
 Praise and give thanks for a job well done
 Spend time with staff members to reinforce
positive work behaviors
 Meet staff’s personal needs whenever possible
 Provide guidance and support for professional
and personal growth
 Maintain a positive, confident attitude and a
pleasant work environment
Caring Actions

Twenty-First Century
Leadership
and Management Challenges

 Nurses as leaders face daunting challenges
 Rapidly rising health care costs
 Implementation of health care reform
 Ongoing concerns about safety and quality of care
 Three national initiatives provide a framework for making
significant changes
 A Proclamation for Change: Transforming the Hospital Patient
Care Environment (Hendrich, Chow, and Goshert, 2009)
 Keeping Patients Safe: Transforming the Work Environment of
Nurses (IOM and Page, 2003)
 The Future of Nursing: Leading Change, Advancing Health
(IOM, 2010)
Overview

 Provides evidence-based recommendations to
address inefficiencies that threaten patient
safety and to improve nurse retention
 Basic tenets
 Patient-centered design
 System-wide, integrated technology
 Seamless workplace environments
 Vendor partnerships
Proclamation for Change
(Hendrich et al., 2009)

 IOM Report Keeping Patients Safe: Transforming the
Work Environment of Nurses (2003)
 Demonstrated a strong connection between the nurse’s work
environment and medical errors
 Scientific evidence that nurses are essential to patient safety
continues to grow
 Major categories of recommendations from IOM’s Keeping
Patients Safe report:
• Promote transformational leadership and evidence-based
management
• Maximize workforce capability
• Redesign work processes to prevent errors
• Create and sustain a culture of safety
Patient Safety and the Nurse’s
Work Environment

 Purpose of the initiative:
 Guide advancement of the nursing profession in recognition of
the vital role that nurses play in safe, cost-effective, high-quality
health care
 Four key recommendations for nurses:
 Practice to the full extent of their education and training
 Achieve higher levels of education
 Be full partners, with physicians and other health care
professionals, in redesigning health care
 Engage in effective workforce planning and policy making with
better data collection and information infrastructure
The Future of Nursing

 It will be up to the nurse leader at all levels to
begin this long, yet exciting, process of
redesigning work environments
Challenges

Chapter 16

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (14)

Similar to Chapter 16

Similar to Chapter 16 (20)

More from stanbridge

More from stanbridge (20)

Chapter 16

Editor's Notes