LNM N4S1: Nursing Leadership and Management

Leadership

the use of one’s skill to influence others

1. Assertiveness

2. Rationality

3. Ingratiation

4. Exchange

5. Sanction

6. Blocking

7. Coalition

8. Upward Appeal

Kinds of Influence:

1. Assertiveness

standing up for oneself and other’s without violating the rights of others
Ex. You have chosen me as your leader…

2. Rationality

trying to convince someone by using reason, logic, or supporting information
Ex. We should do this because we need to give to the patient total quality care

3. Ingratiation

making an individual feel important or good before making a request

4. Exchange

offering an exchange of favor

5. Sanction

• coercive authority
• give punishment for noncompliance or reward for
compliance

6. Blocking

• backing up a request with a threat to damage an individual’s opportunity for advancement
• not really the best

7. Coalition

getting co-workers to back-up a request

8. Upward appeal

obtaining formal or informal support of a higher-up

• Personhood
• People Development
• Production
• Permission
• Position

Levels of Leadership

Personhood

o Respect
o People follow because of what you are and
what you represent

• People Development

o Reproduction
o People follow because of what you have done
for them

• Production

o Results
o People follow because of what you have done
for the organization

• Permission

o Relationships
o People follow because they want to

• Position

o Rights
o People follow because they have to

1. Formal

2. Informal

Types of Leader

1. Formal

 officially appointed, elected
 managers

2. Informal

 chosen by the group
 those who initiate an action

Management

 getting things done
 it is the process of getting activities completed efficiently and effectively with and through people; production
 is the process of planning, organizing, directing and controlling human and physical resources

Effectiveness

 able to accomplish your objectives within the resource parameters
 “doing the right things”
 related to leadership

Efficiency

 able to accomplish you objectives/ production of results with minimum waste of time and effort
 “doing the things right”
 related to management

Management

• Is the process of planning, organizing, directing and controlling human and physical resources and technology to achieve organizational goals / objectives?

1. Manpower

2. Money

3. Machine

4. Materials

5. Methods

6. Moment/Minutes

7. Market

7 Basic resources of management

3. Machine

o bigger equipment; capital expenses; to start a
business; costs more

4. Materials

o lesser/minor equipment; operation of organization or unit

5. Methods

process

6. Moment/Minutes

time management

Administration

• Those at the top level of organization

• Focus on establishing goals and on integrating work units to achieve the organization’s mission

Management

• Directly responsible to the production of services

• Midline and lower levels of hierarchy

• Directs and guides the operations of the organization
  Upper level manager:

• Upper level manager:

- Primary responsible for establishing organizational goals

and strategic plans for the entire division of nursing

- Director of Nursing Services, Chairman, Executive Vice-

President

- 24/7 responsibility

Middle level manager:

• Usually coordinate nursing activities of several units

• Supervisor, coordinator, clinical nurse managers, case managers

• 24/7 responsibility

First level manager:

• Directly responsible for the actual production of nursing services; acts as links between higher level managers and non-managers

• Head nurse (nurse manager), charge nurse (informal), team leader, primary nurse

Authority

• Legitimate right to give command, to make decisions

• Ability to impose his or her with another person or group

Power

• Ability to get results

• Given with authority

‣ Legitimate Power
‣ Reward Power
‣ Coercive Power
‣ Expert Power
‣ Referent Power
‣ Self (Personal) Power
‣ Information Power

Powers a manager/leader may possess

• Legitimate power

based on position given

• Reward power

reward/incentives

• Coercive power

give sanctions or punishment

• Referent power

o Charisma – innate personality trait
o Connection

o Charisma

innate personality trait

• Self (Personal) power

based on individual’s maturity, credibility, reputation, experience, gender

• Information power

based on the individual’s access to valued data

1. Upper Level Manager

2. Middle Level Manager

3. First Level Manager

Levels of Nurse Managers

1. Upper Level Manager

 primary responsible for establishing
organizational goals and strategic plans for the
entire division of nursing
 director of nursing service, chairman, executive
vice president
 nurse executives
 Policy making body of an organization
 oversee the activities of the lower levels

2. Middle Level Manager

 usually coordinates nursing activities of several
units
 supervisor, coordinator, clinical nurse managers, case managers
 oversee the activities of the lower levels

3. First Level Managers

 directly responsible for the actual production of
nursing services
 acts as links between higher level managers and non-managers
 head nurse (nurse manager), charge nurse, team leader, primary nurse

Authority

 legitimate right to give commands, to make decisions

Power

 ability to get results
 ability to impose his or her will on another person or group

1. Conceptual skills

2. Technical skills

3. Human relations

4. Administrative skills

5. Communication skills

6. Analytical skills

7. Decision making skills

7 Basic Skills Required of a Leader/Manager

1. Autocratic

2. Democratic

3. Laissez-Faire

4. Bureaucratic

LEADERSHIP STYLES

1. Autocratic

 Makes decisions alone
 Task oriented
 Power with coercion
 Proves useful (even necessary) in crisis situation
 Authoritarian or exploitative style of leadership
 Satisfaction is low
 Effective when needed for immediate action
 High productivity, less satisfaction of workers
 2 Types accdg. to Rensis Likert (Systems 4 approach):
i. Exploitative-authoritative
ii. Benevolent-authoritative

i. Exploitative-authoritative

 Have little trust in employees and exclude
them in decision making

ii. Benevolent-authoritative

 Are kind to employees but still do not
involve them in decision making
 They ask the members

2. Democratic

 Involve their followers in decision making
 People oriented
 Leads to increase productivity and job satisfaction
 There is compliance
 Participative/Consultative
 2 Types accdg. Rensis Likert (Systems 4 approach):
i. Consultative-democratic
ii. Participative-democratic

i. Consultative-democratic

 Seek employees advice about decisions

ii. Participative-democratic

 Value employee involvement, teamwork
and seek advice in decision making

3. Laissez-faire

 Loose and permissive
 Ultraliberal
 Foster freedom for everyone and wants everyone to be happy
 Results in low productivity and employee frustration
 Most beneficial to a staff of highly motivated
professionals

4. Bureaucratic

 Lacks a sense of security and depends on established rules and policies
 Tends to relate impersonality to staff
 Avoids decision making without standards or norms for guidance
 Needed when discipline should be imposed

1. Passive or Non-assertive

2. Assertive

3. Aggressive

Types of Behaviour

2. Assertive

stand for oneself but doesn’t violate rights of others

3. Aggressive

violates rights of others

1. Frederick Taylor

 “Theory of Scientific Management”
 Observed people in an electric plant
 Time and motion studies
 One best way to do the job

2. Max Weber

 The ideal form of organization is “Bureaucracy”
 With hierarchies—with rules and regulations

3. Luther Gulick

 Introduced the 7 activities of management as
“POSDCORB” - planning, organizaing, staffing,
directing, coordinating, reporting.

4. Henry Fayol

 Developed the principles management and functions of management

Fayol’s 14 Principles of Management:

i. Division of labor-you should know your job
ii. Authority, responsibility (pure obligation to
do the task to the best of your ability), and
accountability
iii. Unity of command
iv. Unity of direction – one path, goal, objective
v. Scalar chain of authority and
communication-highest to lowest level;
channels of communication
vi. Interest of the whole organization over
interest of the individual
vii. Equity and justice
viii. Order (hierarchy, everything in order, in their
place)
ix. Stability or tenure of personnel – rapid
turnover would not benefit the organization
x. Initiative-right to make their own projects,
decisions
xi. Centralization- upper level of hierarchy
makes decision
xii. Discipline- follows rules
xiii. Remuneration - compensation
xiv. Teamwork and esprit de corps

Command responsibility

o Leader responsible for acts of subordinate
o Respondeat superior

 Principle of Definition

o Every employee must have a job description

 Principle of delegation

o Entrusting responsibility to others and to
create accountability for results

 Delegation

o Provides learning opportunities for
subordinates
o Increases power
o Cannot delegate total responsibility
o Do not delegate responsibility without
authorityg
o Don’t just delegate boring jobs
 For nurses, delegation is not an option but a
necessity

o Right Person
o Right Task
o Right Circumstance
o Right Direction/Communication
o Right Supervision

5 Rights of Delegation

 Causes of Underdelegating

o Waste of time to explain
o Believes that no one else can do the
job
o Fear- fear of criticism, fear of failing to
get others to follow him
o The need to control or be perfect
o Enjoys the personal satisfaction
o Gained from doing the work herself

 Rules of Delegation to Unlicensed Staff

o Do not delegate the functions of assessment, teaching, evaluation and nursing judgement
o Delegate activities that involve standard, unchanging procedures
o Delegate care of stable patients with predictable outcomes; assessment as long as stable

 Task that may not be delegated

o Assessment
o Interpretation of data
o Care of invasive lines
o Performing triads during emergencies
o Making a nursing diagnosis
o IV insertion

 Span of Control

o Number of persons that the leader can
effectively manage
o If noob-small span of control muna

5. Mary Follet

 Exercise power WITH people rather than power
over people
 Participatory management

6. Elton May

 “Hawthorne Effect”
 Tendency of people to perform as expected
because of special attention
 Should show concern to subordinates to increase level of performance

7. Kurt Lewin

 3 phases of behaviour change
o Unfreezing
o Changing
o Refreezing

o Unfreezing

identify what needs to be
changed

o Changing

practicing, doing

o Refreezing

integrating into your daily
activities

8. Peter Drucker

 Management by objectives (MBO)
 Be able to achieve your goals by having
objectives

9. Herbert Simon

 2 approaches to decision making
o Optimizing
o Satisfying

o Optimizing

choosing the best possible
alternative; longer time to achieve

o Satisfying

first workable acceptable
solution

10. Henry Mintzberg

 Proposed the managerial roles
 Interpersonal roles
 Informational Roles
 Decision Roles

Interpersonal roles

o Figurehead role
o Leader role
o Liaison role

 Informational Roles

o Monitor
o Dissemination
o Spokesman

 Decision Roles

o Entrepreneur
o Disturbance handler
o Negotiator
o Resource allocator role

1. Maslow's Hierarchy of Needs

2. Douglas McGregor's Theory X and Y

3. William Ouchi (Theory Z)

4. Ferdinand Herberg

MOTIVATIONAL THEORIES

2. Douglas McGregor’s Theory X and Y

 Theory X

o Man is lazy, dislike work, unmotivated

 Theory Y

o Man is self-motivated, enjoy their work

3. William Ouchi (Theory Z)

 Involved workers are key to inc. productivity

4. Ferdinand Herzberg

 Hygienic factors- working environment

 Motivation factors-work itself o Give them work they really know

Hygenic factors
(working environment)

- Adequate salary

- Appropriate supervision

- Good interpersonal relations

- Safe and tolerable working condition

- Job security

- Agency policies and procedures

Motivational Factors (work itself)

- Achievement

- Recognition

- Appropriate responsibility

- Opportunity for advancement and achievement

1. Trait Theories

2. Behavioral Theories

3. Contingency - Situational Theories

4. Path Goal Theory

5. Contemporary Leadership Theory

THEORIES OF LEADERSHIP

1. Trait Theories

who the leader is

 Great Man Theory (Aristotelian)

o Leaders are born, not made

 Charismatic Theory

 Trait Studies

o integrity, intelligence, initiative, industry o popularity, sociability, dependability

2. Behavioral Theories

what leader can do

 Lewin, Lippit and White

o Leadership Styles

 Rensis Liker

o Systems 4 approach

 Blake and Mouton

o Managerial Grid

o Country Club-high concern for people, low on results

o Impoverished-low concern for people and results

o Middle of the road

o Authority Compliance-high concern for results, low for people

o Team- high concern for people and results