Introduction to Nursing Leadership & Management

Leadership

• __ in nursing is the process of influencing and guiding individuals or teams toward achieving shared goals in patient care, through vision-setting, motivation, and fostering collaboration, while maintaining ethical and professional standards. (Marquis & Huston, 2021)

• Is “the process of influencing people to accomplish goals by providing purpose, direction, and motivation.” (Northouse, 2022

Management

Is “the coordination of work activities so that they are completed efficiently and effectively with and through other people.” (Robbins & Coulter, 2018)

Leadership Relationship & Difference

1. People Orientation

2. Leading People

3. Achievements

4. Facilitative

5. Influence

Management Relationship & Difference

1. Task Orientation

2. Managing

3. Results In

4. Involved

5. Formal Authority & Position

Nursing Leadership

• The ability to influence, inspire, and empower others to achieve common goals in patient care

• Concerned with vision, innovation, and transformation

• May be formal (charge nurse, head nurse) or informal (a bedside nurse who sets a positive example)

Nursing Management

• The process of planning, organizing, staffing, directing, and controlling to ensure the delivery of safe, efficient, and effective care

• Concerned with systems, structures, and stability

• Usually, a formal role with authority over resources and processes

Both roles are important in nursing

A leader without management skills may inspire, but fail to implement change. A manager without leadership skills may keep order, but fail to inspire commitment

Example: During a disaster, a nurse leader keeps morale high and motivates the team. A nurse manager ensures triage is organized, resources are distributed, and communication with hospital administration is maintained

The Nurse Leader’s Responsibilities

• Setting and communicating a clear vision for the team.

• Acting as a role model in ethical and professional practice.

• Mentoring and coaching staff.

• Encouraging professional development and continuous improvement.

The Nurse Manager’s Responsibilities

• Developing staffing schedules.

• Managing budgets and resources.

• Implementing hospital policies and procedures.

• Monitoring quality indicators and patient safety standards.

• Addressing performance issues and conducting appraisals.

Geraldine Bednash

• “Leadership is leading.”

• The need to develop nursing leadership skills has never been greater than it is today.

Leadership -

• A vital component of change (Bednash, 2003)

• The process of persuasion and example by which an individual (or leadership team) induces a group to pursue objectives held by the leader or shared by the leader and his or her followers (Gardner, 1990)

• The art of getting work done through others willingly

• A job title alone does not make a person a leader. Only a person’s behavior determines if he or she occupies a leadership position.

Leadership Requires

Getting very clear about your values, taking risks, and having a willingness to seek partners and collaborators who will commit to the common good

Roles of Leadership

1. Coach

2. Counselor

3. Teacher

4. Forecaster

5. Visionary

6. Influencer

7. Creative Problem Solver

8. Change Agent

9. Diplomat

10. Role Model

11. Decision Maker

12. Communicator

13. Evaluator

14. Facilitator

15. Risk-taker

16. Energizer

17. Mentor

18. Critical Thinker

19. Buffer

20. Advocate

Leadership Skills

Skills in Personal Behavior

This requires sensitivity to the feelings of others, identification with the needs of the group, acceptance of other people's suggestion rather than criticizing or ridiculing them and helping others feel important and needed

Leadership Skills

Communication Skills

This means the ability to listen attentively to the opinions of others, establish positive communication within group and make sure everyone understands what are expected of them

Leadership Skills

Organization Skills

This includes willingness to assist the group in making short and long range plans and objectives; to share responsibilities and opportunities; to implement plans, follow-up and evaluate results and to participate in problem solving.

Leadership Skills

Skills in Self Analysis

This means awareness of personal motivations of own strengths and weaknesses and willingness to improve them. It also includes assisting the group in recognizing and utilizing the 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

• Good human relationships with coworkers.

Theories of Leadership

Great Man Trait Theories

The __ Theory, from Aristotelian philosophy, asserts that some people are born to lead whereas others are born to be led. It also suggests that great leaders will arise when the situation demands it.

Trait Theory

• Assume that some people have certain characteristics or personality traits that make them better leaders than others.

• __ Theory is based on the belief that leaders are born with certain qualities that properly develop to enable them to be successful leaders

Classification of Trait Theory

1. Physical characteristics – age, built, height, weight, bearing

2. Background information – education, social status, experience.

3. Intelligence – knowledge, judgment, ability

4. Personality – decisiveness, authority, extroversion, alertness, aggressiveness, enthusiasm, independence, self-confidence

5. Task-oriented characteristics – persistence, responsibility, achievement, initiative

6. Social characteristics – supervisory, activity, popularity, prestige, tact, diplomacy

Behavioral Theories

Kurt Lewin, Ralph K. White, and Ronald Lippit ( 1960) isolated the common leadership styles such as authoritarian, democratic, and laissez-faire leadership. For some time, theorist believed that leaders had a predominant leadership style and used it consistently

Behavioral Theories

The Autocratic Leader

Characteristic Behaviors:

• Strong control is maintained over the work group.

• Others are motivated by coercion.

• Others are directed with commands.

• Less input from staff or communication flows downward.

• Decision making does not involve others.

• Emphasis is on difference in status ("I" and "you").

• Criticism is punitive.

Behavioral Theories

The Democratic Leader

Characteristic Behaviors:

• Less control is maintained.

• Economic and ego awards are used to motivate.

• Others are directed through suggestions and guidance.

• Communication flows up and down.

• Decision making involves others.

• Emphasis is on "we" rather than "I" and "you."

• Criticism is constructive

Behavioral Theories

The Laissez-Faire Leader

Characteristic Behaviors:

• Is permissive, with little or no control.

• Motivates by support when requested by the group or individuals.

• Provides little or no direction.

• Uses upward and downward communication between members of the group

• Places emphasis on the group.

• Does not criticize,

Situational Leadership

Hersey and Blanchard (1977) also developed a situational approach to leadership. Their tridimensional leadership effectiveness model predicts which leadership style is most appropriate in each situation based on the level of the followers' maturity. As people mature, leadership style becomes less task focused and more relationship oriented.

Situational Leadership Theories

Natural Leader

The leader who becomes a leader in spite of himself or herself. He or she does not seek the role but tie group thrusts the leadership upon him/her by the tide of events.

Situational Leadership Theories

Charismatic Leader

The leader who is an authentic hero in the eyes of his followers. To them he/she can do no wrong. He/She inspire people to make sacrifices for the cause they represent.

Situational Leadership Theories

Rational Leader

The leader who is consistent and persistent in what he/she thinks is right.

Situational Leadership Theories

Consensus Leader

The leader who is perceived to be acceptable to all. He/She rises in the absence of the above three.

Situational Leadership Theories

Coercive Leader

The leader who dominates by force and fear.

Contingency Leadership Theories

• Knight Fiedler's (1967) contingency approach reinforced these findings, suggesting that no on leadership style is ideal for every situation.

• Fiedler felt that the interrelationships between the group's leader and its members were most influenced by the manager's ability to be a good leader.

• The task to be accomplished and the power associated with the leader's position also were cited as key variables.

Interactional Leadership Theories

The basic premise of __ theory is that leadership behavior is generally determined by the relationship between the leader's personality, the specific situation, and followers.

William Ouchi’s Theory Z

• Consensus decision making

• Fitting employees to their jobs

• Job security – Long Term Employment

• Slower promotions – Take time to assess employees

• Guarantee of lifetime employment

• Establishment of strong bonds of responsibility between superiors and subordinates

• A holistic concern for the workers

Transactional Leadership

• Focuses on management tasks

• Uses trade-offs to meet goals

• Does not identify shared values

• Examines causes

• Uses contingency reward

Transformational Leadership

• Identifies common values

• Is committed

• Inspires others with vision

• Has long-term vision

• Looks at effects

• Empowers others

Barriers to Communication

Physical Barriers

• Use clear short sentences and facing individual will improve the potential for the message to be received.

• Use hearing aids if there is a hearing impairment

• If visually impaired, announce your presence, touch as appropriate and explain sounds or noises to the person

• Encourage patience, allowing them to take their time, or use of gestures to facilitate communication

Barriers to Communication

Psychological Barriers

• Attitudes, prejudices and personality can get in the way of effective communication.

• Judging others based on appearance, lifestyle or socioeconomic status.

• Stereotyping others such as “dumb blonde”, “computer nerd”or “geezer” can negatively affect the communication process.

Barriers to Communication

Cultural Barriers

Is a values, belief, customs, and attitudes shared by a group of people. It lets us interpret the environment and behave appropriately.

Barriers to Communication

Attitudes and Behaviors

• Giving opinions may tell the other person that you are judging his or her values.

• Silence have meanings. It may mean acceptance, fear or the time to think.

• Talking when others are silent is usually due to nervousness.

• Changing the subject is sometimes done when the topic becomes uncomfortable.

Principles for Effective Leadership

Have a dream that will leave this world a better place.

• "Is there anything worse than being blind? Yes. The most pathetic person in the whole world is someone who has sight but has no vision." So said Helm Keller.

• Leadership is simply the ability to turn a dream or a vision of a desired future state into a reality with and through the cooperation other people. To throw your life into something worthwhile, your dream must be worth dying for.

• Have a big vision; something beyond your capabilities to keep you challenged If we have aimed our efforts for this moment only for ourselves, for the accumulation of material things, for pleasure-we will soon become dissatisfied and disillusioned with life.

• Former british prime minister margaret thatcher said, "there is little hope for democracy if the hearts of men and women cannot be touched by a call to something greater than themselves.“

• Have a dream and vision that is greater than yourself--one that will leave this world a better place.

Principles for Effective Leadership

Know what your strengths are

• We need to surround ourselves with people to fill in our gaps. Seventy-nine year-old muriel tower, an experienced entrepreneur, said. "you get things done through other people. Number one in business is get the best person for the job. Number two, delegate. Number three, supervise - go back and see that they did it.“

• In order to be effective, you need a team to work with. We lead on the basis of our strengths; we gather our team on the basis of their strengths.

• Understanding your strengths and the strengths of others is a key to effective leadership.

• Strive for excellence

• The people you want to influence will not rise to a higher standard of excellence than what they observe in you

• The authors of megatrends for women write, "male or female.” The effective leader wins commitment by setting an example of excellence “

• We wanted to influence leaders and we had to do things right, not only do the right things. Leaders must strive for excellence

• Strive for excellence and you will motivate others to do the same

Principles for Effective Leadership

Be Persistent

• Mother Teresa was a determined woman Margaret thatcher was a determined woman The key to being a good leader is endurance-being a non-quitter and be encouraged to quit by those who are friends and enemies. Be willing to throw in the towel. Be determined.

• In order to leave this world a different place, you have to be persistent. Leaders don't grow in a comfort zone. Leaders are not people with exceptional talent; they are people who have learned from their mistakes and get up and try again.

• Persistence is a key to effective leadership

Principles for Effective Leadership

Be willing to stand alone

• If you have a passion, a dream or a mission, set measurable goals and work toward accomplishing them You will find that many times you may have to work Alone You will probably be lonely.

• People are looking for leaders who are willing to give it all they have, and they will follow-for a while However, when the going gets tough. when pleasure and comfort compete with responsibility and long hours, followers will drop away. That is when you have to be sure that what you are doing is right, so that you will keep going

• James Cook said, "A person who wants to lead the orchestra must turn his back on the crowd.

Principles for Effective Leadership

Be ready for resistance

• One of the facts of life is that when you are in leadership, you have to solve problems.

• Pastor Lloyd Ogilvie, for many years the senior pastor at First Presbyterian Church of Hollywood, California and now Chaplain of the U.S. Senate, once observed that "Everyone has problems; if you don't have any now, you will have problems: wherever you work or live, you'll have problems, or you just might be someone else's problem.

• Sometimes we have the faulty notion that we should be able to go through life problem free--that if we have problems. something is wrong with our life. As leaders, we have to be responsible, no matter how painful it is. Running away is not an option

• You don't need to wait for someone else's help. You will have problems. Be ready. Expect it. If you know you are doing what is right, you won't cave in when the going gets tough.

• Facing problems and dealing with them by making good decisions is the difference between a leader and a follower

Principles for Effective Leadership

Set an example for your staff

• "Work hard and become a leader: be lazy and never succeed."

• I am amazed at how often people want a position. Nit not the responsibility. It is natural to want to escape responsibility; we all do it. However, being a leader means working long hours It means being available to solve problems or give direction whenever necessary. Being a leader means being a servant, whether you are in your home or at work. You are always on call

• A Leader Works Hard

Principles for Effective Leadership

Let God be your guide

• Elizabeth Dole, President of the American Red Cross, stated in an interview "To me it's very important to know I have a source of strength beyond my own When I'm undertaking a difficult assignment or making a tough decision I'm glad I don't have to rely on my own energy, wisdom, and judgement "

• 24 years ago. I realized I needed a source of strength beyond myself. The goals I had set for myself were not satisfying and even relationships did not fill my deepest need. At the age of 32, I gave the control of my life to God. He is that source of strength I needed. I simply prayed, “I want you to be my guide from now until I die. ”He heard me.