CONCEPTS OF NURSING LEADERSHIP AND MANAGEMENT

The Beginning Nurse's Roles

these are basic competencies that we need to provide care to clients.

• Client care provider

• Manager and leader

• Researcher

Encompasses the 3 roles of nurses

facility, health program, nursing service

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

Manages ___________

Provide safe and quality care

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

Not limited to human resources, we also apply it to facilities and materials

Accountability for safe nursing practice

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

Accountable in the results may it be good or not for the patients that are receiving the care.

Lead and supervise nursing support staff

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

• Expected to supervise, even the outcome of the subordinates

• Design specific program that will improve their competencies

Deliver health programs and services

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

• Program development, we are implementation up to evaluation.

• From the assessment to evaluation of the program

Manage a community/village-based health facility/competent of a health program or a nursing service

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

• Community barangay health station

• City health departments

• Programs such as family planning

Networking, linkage building, and referrals

RESPONSIBILITIES OF A NURSE MANAGER/ LEADER

• Not limited to our resources

• The only way to maximize community resources

• There is a need to involve other organizations - government, sociocivic, etc.

LEADERSHIP

the use of one's skills to influence others to perform to the best of their ability toward goal achievement;

• The art of getting others to want to do what one deems important

FIVE LEVELS OF LEADERSHIP

levels are our leadership journey but not everybody can reach all the levels because of barriers/challenges

POSITION, PERMISSION, PRODUCTION, PEOPLE DEVELOPMENT, PERSONHOOD

FIVE LEVELS OF LEADERSHIP

POSITION

Rights - people to follow because they have to

• It is an obligation to follow whatever you say

• May not consider you their leader beyond position

• Asserting right being appointed to a certain position

• Subordinates would only see you as a leader in the context of your job

• Shallow working relationship

PERMISSION

Relationships - people follow because they want to

• They are willingly or voluntarily submit themselves to your leadership/direction or guidance

• Established working relationship between the leader and subordinate

PRODUCTION

Results people follow because of what you have done for the organization

• They know that you are doing something good and beneficial for the organization

• Example: You are chief nurse and your units gets recommended by ISO

• More clients = stable job

• Leaders usually stay at this level only

PEOPLE DEVELOPMENT

Reproduction - people follow because of what you have done for them

• Reproducing leaders like you

• Able to spot potential leaders that would continue the legacy of the organization

• Train people that could take their position

• True leaders prepare for the future of the organization

PERSONHOOD

Respect - people follow because of what you are and what you represent.

• People consider your words/actions as a rule

• They believe in your capability

• Something that greatly influences other people.

• They emulate your behaviors.

• You are making an influence without saying words or doing actions

Formal and Informal Leaders

TYPES OF LEADERS

Formal Leaders

• Appointed by leaders; administration and given official or legitimate authority to act

• Sanctioned

• Belong to an organization

• Example: Dean chosen by the administration of the University

Informal Leaders

Do not have official sanction to direct the activities of others

• Is not assigned but steps up

• May be part of an organization, but not officially recognized or not designated to do a specific activity

• Example: When you are starting as a nurse, you will be partnered with a Senior nursing staff where they will teach you and give you directions on what to do (not part of admin)

Autocratic, Democratic, Laissez - Faire, Bureaucratic

LEADERSHIP STYLES

Autocratic

The leader makes decision alone

• Acts as the top of the pyramid, and orders are cascaded down

• People at the bottom of the pyramid cannot question, change or make decisions

• Task-oriented

• Just made to follow

• A con as it exercises power with coercion o Uses power, punishment, and fear to follow their authority

• No opportunity for inputs

• They make use of coercion and fear so that others will follow

• A pro as it is proven to be useful and even necessary in crisis situations

• Example: a person gives the directions during a Code Blue to provide the proper flow of actions to be done so that actions are well-coordinated

• Authoritarian or exploitative style of leadership

Democratic

task focus

• Involves followers in decision-making

• Subordinates are involved in the decision-making process

• People-oriented

• Feel as if you are valued; you value the people who work with you

• All inputs are valued = feel good about self = increased motivation = greater productivity = greater results/job satisfaction.

• Leads to increased productivity and job satisfaction

• Empowers subordinates due to their participation→ increases motivation

Participative or consultative style of leadership

Two Approaches of Democratic

Participative

Everyone will be asked for their input before arriving at a consensus

Consultative

Ask only some of the participants; will represent the interests of the entire group

Laissez - Faire

relationship focus

• Loose and permissive

Ultraliberal

• Fosters freedom for everyone and wants everyone to feel good

• They evaluate their own tasks

• Leaders do not give feedbacks

• It is relationship focused, you have trust on your members

• Results in low productivity and employee frustration

• Most beneficial to a staff of highly motivated professionals

Bureaucratic

• Lacks a sense of security and depends on established policies and rules

• Follows existing documentations, structures, standards, or norms

• Good when starting your position as a leader (can't go wrong with following the rules)

• Tends to relate impersonally to staff

• You are too engrossed in following the norms without acknowledging the unique circumstances surrounding the staff

■ Neglects some parts of the situation you are in.

• Impersonally can be seen in two ways:

■ First, not attacking personally when you do something.

■ Second, when you make a decision based on protocols, you might be missing out on some aspects of your employees' experiences.

• Example: Suspending a nurse for being absent for 3 days without knowing their circumstances

PASSIVE BEHAVIOR, AGGRESSIVE BEHAVIOR, ASSERTIVE BEHAVIOR

LEADERSHIP BEHAVIORS

PASSIVE BEHAVIOR

Submissively accepts whenever force without resistance or complaint

o Blindly follows and comply what is being imposed

• Conform with whatever they say

• Feels self-pity and is lacking in self worth

• Not confident in the role they are fulfilling

• Acts apologetically

• Easily dominated by others

• Does not know how to speak up for himself

• Can be easily dissuaded by other people

• Speaks hesitantly without looking at others when talking

AGGRESSIVE BEHAVIOR

Acts in a bold, attacking, and hostile manner

• Talks loudly on every subject and often makes depreciating remarks about the opinion of others

• Proving a point by all means making depreciating remarks insensitive

• Seems incentive about the rights of others

• Points a finger and says "you" frequently

• Difficulty owning accountability

• They hardly understand the perspective of other people

ASSERTIVE BEHAVIOR

Expresses opinions and beliefs without infringing on or belittling the beliefs of others

• Give value to the input of others

• Stands up for his own rights

• Willing to accept the rights of others to express agreements of disagreement

INFLUENCE

ability to change or affect the perceptions, attitudes, and behaviors of others

• When people hear our ideas, it affects the people who are listening to us

• Can be intentional or unintentional

Logical Appeals, Emotional Appeals, Cooperative Appeals

KINDS OF INFLUENCE

Logical Appeals

Make use of information and ideas to affect other people

Tap into people's rational and intellectual positions.

Emotional Appeals

A way to project how we feel in order to influence others

Connect your message, goal, or project to individual goals and values.

Cooperative Appeals

How we relate with other people

Involve collaboration, consultation, and alliances

Assertiveness

Standing up for oneself and one's rights without violating the rights of others

• You are the charge nurse, and there are a lot of patients with higher acuity of illness = more nurses are needed

• As a charge we talk to the manager, we ask for additional staff

• Making assertion because you making sure that both the nurse and patients' right are not violated

Rationality

Trying to convince someone by relying on a detailed plan, supporting information, reasoning, or logic : If the manager is not convinced yet, provide information

• In order for the person decide and help on his decision making

• Example: classify patients according to acuity of care to determine the need of additional staff

• Manager will decide whether to give into the request for additional staff of not

Ingratiation

Making an individual feel important or good before making a request

• Putting the person in a situation where he cannot say no

• Has to prove they are efficient at their job

• Praise the person in order for them to feel feel good, then make a request of them

• Some managers provide more tasks to do

• Example: praising your junior that they are good at their work then assigning him to do overtime

Exchange

• Offering an exchange of favors

• Both benefit from the agreement

• Consensual within both parties

• Example: Exchanging shifts to attend their affairs

• As a result, they were both able to attend to their duties and personal affairs

Sanction

Use of coercive authority in giving punishment for non-compliance or reward for compliance

Associated with punishment

Positive sanction

reward for compliance

• Example: receive incentives for not being absent the whole year

Negative sanction

punishment for non-compliance

• Example: Having a lot of absences resulting to possible suspension

Blocking

Backing up a request with a threat to damage an individual's opportunity for advancement

• Example: Senior nurse encourages junior nurses to further studies

Coalitions

Getting co-workers to back up a request

• Most common example is a signature campaign

• Everyone who affixes his signature is someone who backs up what is being requested

Upward Appeal

Obtaining formal or informal support of a higher-up

Something you can relate to Filipino values

Padrino system (Upward appeal)

look for someone na influential who can influence the decision maker to back up your favor

MANAGEMENT

process of getting activities completed efficiently and effectively with and through people

• Always intended

Towards an organizational goal achievement

• This means that there's a function we do and steps we consider and follow thoroughly

• Management involves:

• Manipulation of people, environment, money, time, and other resources to reach organizational goals; and

• The process of planning, organizing, directing, and controlling human and physical resources, and technology to achieve organizational goals and objectives

EFFECTIVENESS

"Doing the right things"

• Accomplishing the objectives within resource parameters

• Given a circumstance, the right interventions are carried out

• Right intervention that achieves the outcome you wanted

• A patient is rushed to the ER with the chief complaint of difficulty of breath

• As a nurse, our instinct is to position the patient to high fowlers

EFFICIENCY

"Doing the things right"

• Accomplishing objectiveness and the production of desired results with minimum waste of time and effort

• Carrying out the right intervention in the right manner - no wastage of resources

• Doing and achieving it with minimal utilization of effort and equipment

• There is distention of bladder upon palpation with no spontaneous voiding

• The patient is for catheterization in which you are supposed to finish it within 5 minutes

Manpower, Money, Machine, Materials, Methods, Market, Moments/ Minutes

BASIC RESOURCES IN MANAGEMENT

Manpower

BASIC RESOURCES IN MANAGEMENT

Human resources

Most important resource

• Make things happen

• Carry out the goals, plans, and objectives

• Example: administration, healthcare organization members

Money

BASIC RESOURCES IN MANAGEMENT

Financial resources

Allocation that will go to the salaries of the staffs, major projects, supplies, and equipment

Machine

BASIC RESOURCES IN MANAGEMENT

For us to lighten or augment the work of a nurse

Ease responsibilities

Example 1: patient to be transported to another area - a stretcher/wheelchair is needed to facilitate transport

Example 2: a patient occupying a bed and you want to change the linens - patient lifters

Materials

BASIC RESOURCES IN MANAGEMENT

Articles or supplies you are to use in order to carry out a certain nursing procedure

Example 1: cannula, tape, cotton balls, needed - materials that are needed to insert an IV catheter

Example 2: Manometer, needle, sterile gloves - materials needed for a lumbar tap

Methods

BASIC RESOURCES IN MANAGEMENT

The nursing care models to be used in the delivery of patient care

• Classic delivery methods = total patient care, functional patient care, team nursing care, primary pc, and case management

• Contemporary = if needs of patients become complex

Market

BASIC RESOURCES IN MANAGEMENT

• Stakeholders of an organization

Beneficiaries of organization

• Internal and External Stakeholders

Internal: belongs in the same organization and benefits from it ■ Ex: hospital owners, personnel, staffs, administration, management, employees

• External: from outside who benefit from the activities of the organization

■ Availing of services

■ Ex: ensure the catchment area

(security companies, laundry services), patients, families, communities, external provider of resources or stakeholders (other hospitals)

Moments/ Minutes

BASIC RESOURCES IN MANAGEMENT

• Time allotted for us to be able to complete the task assigned or expected of you

• Assume you will be able to complete everything in that certain amount of time

Example: nurses work in an 8-hour shift and we're expected to carry out responsibilities within the time allotted

• Allows timeline of activities

•Manage time in order to be efficient

ORGANIZATION

Signifies an institution or a functional group with a formal intentional structure of roles or positions working towards a common goal; and

Refers to the way in which work is arranged and allocation among the members of an institution so that the goals can be efficiently achieved.

INSTITUTION

How do they relate to each other to achieve a common goal

• Example: health center is an institution

• Has different positions/roles and functions related to one another

PROCESS

Manner of how you do things • Organizing the tasks

Example: someone in a group will analyze how it is meant to be done - leader will chunk and divide various roles among the group

Upper Level, Middle Level, First Level

HIERARCHY IN THE ORGANIZATION

First Level

Head nurse, unit nurse managers, charge nurses, team leaders, primary nurse

Middle Level

Integrating a number of nursing units which provide the same services

o Assistant Executive Officers, Division Heads, Department Heads, Clinical Specialists, Supervisors, coordinators, Clinical Nurse managers, Case managers

Upper Level

Chief nurse, chief nursing officer, director of nursing, chairman of nursing, executive vice president for nursing

ADMINISTRATION

Involves the process of administering an organization by a group of people;

Refers to the top level authority of the organization; and • Administrators

Example: dean, chief nursing officers ■ Responsible for setting the vision on how to move forward

■ Must know what is going on in all departments

• Has full control over the activities of the organization

AUTHORITY

An officially sanctioned responsibilities; and

• By virtue of your qualifications

The legitimate right to give command

Authority remains true as long as you occupy that position

Example: A chief nursing officer can appoint a person to be a nurse manager in a certain ward

POWER

A demonstrated ability to get results

• You make things happen for your organization

• The ability to obtain, retain, and motivate people and to organize informational and material resources to accomplish a task

Legitimate, reward, Coercive, Expert, Referent, Self, Information Power

BASES OF POWER

Legitimate Power

Given to the manager by the organization because of his position in the hierarchy

Example: Dean appointed as the admin o It comes along with duties responsibilities

o Nobody can question her decisions and actions since she has the authority to do SO

Reward Power

Based on the ability to control and administer rewards to others for compliance with the leader's orders or requests

Can be related or comparable with "sanction"

• Ex: You did not have any tardiness, at the end of the year, you will receive cash incentive

Coercive Power

Founded on fear and depends on the ability to use punishment of others for non-compliance with manager's orders

• Similar to autocratic leadership

• Negative consequences of not being able to follow the orders of the manager

Ex: Multiple absences = job suspension

Expert Power

Derived from a special ability, skill, or knowledge demonstrated by an individual

• Comes from years of experience or formal education, informal education, and training

• Nursing management can relate to this because of formal education

Can be a source of power for someone leading an organization

Example: Sir Battad has been in the neuro and psychiatric unit, therefore, he can teach in psychiatric nursing

Referent Power

Based on the attractiveness or appeal of one person to another and connection or relationship with a powerful individual

Self Power

Derived from one's maturity, credibility, reputation, experience, and gender

Technically possessing attributes or characteristics that can be a source of power

Example: being guided by a senior staff nurse - gives you opportunities, guiding your actions, allows you to believe in your capacity because of someone else's self power

Information Power

Based on the information the manager possesses

Become more credible if you access to certain data or information

Example: Working on the DOH, then they collect data on the top leading causes of morbidity in the Philippines

• You will believe them because they are an expect and part of the collection of data

ADMINISTRATION

Refers to the top level of organization

Focuses on establishing goals and on integrating work units to achieve the organization's mission

Do leadership and management roles

MANAGEMENT

Refers to the middle and lower levels of the hierarchy

Directs and guides the operation of the

More patient care activities

Conceptual skills, Technical skills, Human relations, Administrative/organizational skills, Communication skills, Analytic skills, Decision-making skills

BASIC SKILLS REQUIRED OF A NURSE LEADER/MANAGER

Conceptual skills

Ability to create something out of nothing

o From a mere observation you can come up with a certain program/activity that can solve a problem

• Example: observe that common among the concerns that you encounter in the unit are related to the interpersonal relationships of the nurses

Technical skills

Technical competence

• Denote the hard and soft skills that one should develop

• Reason why you should know the skillset of a staff nurse as a nursing manager/supervisor

Human relations

Need to have good interpersonal and working relationships

• If you have poor interpersonal skills, you cannot accomplish what you want for your organization

• You have to relate with the people you are working with

• People tend to resort to coercive power

Administrative/organizational skills

Not everything can be achieved by going through it in the job

• Learned through informal and formal training, education, or experience

• Should know how to conduct strategic planning and meetings, budget, staffing patterns, conflict resolution, disciplinary actions, evaluation of staffs, conduct quality improvement activities

Communication skills

Can be written or spoken

• Articulate what is on your mind whenever you delegate or give instructions

Analytic skills

Sense making give meaning to the information you get

• Make interpretation of the data given to us

Decision-making skills

Ideally, everybody should be involved in decision making

• However, there are times when leaders are expected to make a decision

• Have to be decisive

LEADERS

Are frequently not part of a formal organization

MANAGERS

Always assigned a position within an organization

LEADERS

Often do not have delegated authority, but obtain their power through other means

• This is because you are not appointed

MANAGERS

Have legitimate source of power due to the delegated authority that accompanies their position

• Given upon appointment to your hierarchy

LEADERS

Have a wide variety of roles than managers

MANAGERS

Expected to carry out specific functions, duties, and responsibilities

LEADERS

Focus on group process, information, gathering, feedback, and empowering others

MANAGERS

Emphasize control, decision making, decision analysis, and results

LEADERS

Direct willing followers

MANAGERS

Direct willing and unwilling subordinates

LEADERS

Emphasize interpersonal relationships

MANAGERS

Manipulate people, environment, money, time, and other resources to achieve organizational qoal

LEADERS

Can take risks and explore other roles

Concerned with the group dynamics

voluntarily submits to your leadership

Your "puhunan" is interpersonal relationships

Source of authority and power