NURS3720 Test1

Management

• Getting the job done & ensuring people have resources to get their job done

• Requires practice knowledge to know their pt. population

• Set goals & objectives & achieve withing timelines & budgets

Followership

• Engaging w/ others who are leading or managing by contributing to the works that needs to be done

• Involves actively participating & challenging leadership decisions

Personal Attributes needed to Lead, Manage & Follow

• Sense of ethical responsibility

• Code of ethics

• Patient-centered care

• Emotional intelligence

• Appreciative Inquiry

• Resilience

• Mindfulness

Appreciative Inquiry

• Key attribute in effective leadership, management & followship

• a five dimensional cycle associated w/ how we question & problem solve while focusing on the positive (instead of negative)

1. Definition

2. Discovery

3. Dream

4. Design

5. Destiny

Leadership Theories

1. Trait leadership

2. Style leadership

3. Situational-contingency leadership

4. Transformational leadership

5. Authentic leadership

Trait leadership Theories

• The Great Man Theory

• Leaders have certain set of physical & emotional traits crucial for inspiring other

• Debate on whether these traits can be learned or are born w/

• Application: Self-awareness of traits is useful to assess personal strength and apply them

• Leadership theory

• Traits Classified

  • Cardinal: rare; dominating personality

  • Central: personality not as dominating; honest, shy, etc.

  • Secondary: attitudes & personality preferences; anxiety & impatience

Style Theories

• Focuses on how leaders behave

• Based on task & relationship behaviors

• Leaders need to be develop competences in completing task & maintaining relationships to be successful

• Leadership Theory

• Styles of leadership include:

  • task-oriented

  • People-oriented

  • Country club

  • Status quo

  • Dictatorial

Situational Contingency Theory

• Leadership effectiveness depends on situational factors

• Patho-goal theory: leader’s behaviors should be dependent on the task & followers characteristics

• Leaders should asses each situation differently & determine appropriate actions

• Leadership theory

• Factors that impact a leader:

  • Type of company

  • Size of company

  • Innate leadership style

  • Customer feelings/satisfaction

  • Marketplace

Transformational Theory

• Leaders inspire & motivate workers to embrace change

• relationship focused leadership

• Fosters workplace accountability, ownership & autonomy

• Leaders have 4 attributes

  • Idealized & charismatic

  • Inspirational motivators

  • Intellectually stimulating

  • Considerate

• Example: Uses effective communication skills to build trust & establish a shared vision around a culture of safety where everyone understands their role in working to protect patients.

Authentic Leadership Theory

• Leaders are aware of own values & morals & are align their actions to match their values

• Self-aware, transparent, genuine, ethical

• Fosters trust & respect

• Team members feel comfortable providing honest feedback

• Examples: Champions initiatives to improve patient safety, openly shares concerns about staffing shortages & actively participates in team discussions to adrdress challenges

Management Theories

• Taylor founder of scientific management & efficiency movement

  • Introduced concepts: labour division & specialization, systematic analysis of relationship between workers & assigned task, written standardized procedures, close supervision, shared manager-worker responsibility for goal achievement, etc.

• Mintzberg: focused on organizational structures & process contributing to management theory

  • Proposed coordination mechanism to complete complex task, standardization of work processes outputs, worker skills & knowledge, etc.

Complexity Science

• the study of complex systems: how they are sustained, self-organize, relationships within them & how outcomes emerge

• Nurses must be flexible & dynamic to keep up w/ changing systems of people, health care, public policy, & human relationships

• Achieve through networking, attractors, emergence, systems thinking & the Butterfly effect

• Followship Theory

Competencies for Leadership & Management

• Managing the business

• Leading within

• Leading people

Self Leadership

• Learning skills & abilities to guide personal leadership path

• Strength based approach

• Develop internal self-control, self-determination & self-regulation

• rooted in emotional intelligence

Group vs Team

• Group: collection of people aware they belong together & have social ties

• Team: collection of people who are working together to achieve a set goal

Interdisciplinary Team

• Composed of members from different clinical disciplines with specialized knowledge, skills & abilities

• Ex: nurses, surgeon & physiotherapists working together for the needs of a pt. receiving postoperative care after orthopedic surgery

Intraprofessiona team

• Composed of individuals withing the same profession

Interprofessional Team

• comprised of different health or social professions working together toward common goals to meet the needs of a patient population

• Work is divided based on scope of practice

Canadian Interprofessional Health Collaborative Competency Framework

1. Relationship-focused care/service

2. team communication

3. role clarification & negotiation

4. Team functioning

5. Team differences/disagreements processing

6. Collaborative leadership

Relationship Focused Care/Service CIHC Framework

• All members of team will collaborate, create purposeful relationship among & between care/service partners & persons participating in or receiving care/services

• Reflect on value & diversity of thoughts, beliefs, talents, literacy & experiences into designing, implementing & evaluating care/services

• Develop & continuously cultivate trusting relationships

Team Communication CIHC Framework

• All members of a team will communicate w/ each other in cooperative, responsive & respectful manner while paying attention to context & relational elements of communications

• Foster open & authentic communication and address potential communication barriers

Role Clarification & Negotiation CIHC Framework

• All members of team understand & negotiate their own role & roles of all while using their knowledge & skills appropriately to achieve collaborative relationship-focused care

• Seek to understand knowledge, skills and values of team members & including person participating in or receiving care service

Team Functioning CIHC Framework

• All members of team understand nature of interprofessional teams

• Team members work interdependent & bring shared perspectives to cooperate, coordinate & collab towards shared goal

• Optimize efficiency & effectiveness of all members time, expertise & contributions

Team Differences/Disagreement Processing CIHC Framework

• Establish a safe enviro. to express opinions & develop level of consensus among different views

• All members must actively engage constructively in addressing disagreements

• Acknowledge, recognize & value potential positive nature of differences in team

Collaborative Leadership CIHC Framework

• All members of team value each other ‘s knowledge, skills & expertise

• Acknowledge eveyone contributes different strengths & perspectives

• Value & support each other in sharing decision-making, accountability, & responsibilities to achieve common goals

Synergy

• phenomenon where an effective team works together to produce results & achieve a common goal that couldn’t be achieved by any one individual

• To create synergy team requires

  • Clear purpose

  • Active listening

  • Compassion

  • Telling the truth

  • Flexible

  • Committing to resolution

Positive Communication Model

• When humans are distressed, disengaged or have emotional reactions to situation or blame they respond with blame judgement or demand

• Reacting at feeling level = unconsciously; blame so by taking accountability for these feeling you move out of blame & focus on “I feel”

• Trapped in distress or reaction = judgement; so by being compassionate you can respond with “I think”

• Distress = make unreasonable demands; so by calming oneself we can find respect & make a request “I want”

Communicating During Conflict 4 Steps

1. Stop: considering the situation can prevent regretful interaction, collect/organize thoughts & time to think how response

2. Think: analyze situation; how do you want to change the other person, situation, or yourself

3. Listen:

4. Communicate

   • Linear: focus on goals, purpose & intention of message

   • Transactional: focus on process of communication; allows conflict to not be one-sided

STOP5: Critical Event Debrief

• Stop for 5 minutes

• Start w/ intro

  • Is everyone okay?

  • explain purpose

  • participation not compulsory

  • confidential

S:summary of the case

T:things that went well

O: Opportunities to improve

P:points to action and responsibilities

TAKE STOCK: Hot debrief Tools

Take an instruction sheet

Ask if everyone is okay

Know if anyone needs a break

Equipment issues?

Summaries the event

Things that went well

Opportunities to learn

Cold debrief necessary?

Know who is present

Hot/clinical debriefs

• Structured interactive team discussion that occur immediately after a clinical event

• Addresses immediate concerns, calm emotions & make sense of event

• Facilities reflection identifies strengths & areas improvement, and promotes learning

Why do a Clinical Debrief?

• Improves healthcare performance

• Leads to better patient outcomes & safer healthcare

• Opportunity to discuss, experience & learn for each other & better collaborate

• Manage stress, emotions, & strengthen resilience from challenging events

• Identify system issues & implement change

Active Listening Guideliness

• Be compassionate

• Tell the truth

• Be flexible

• Manage emotions

Communication Pitfalls

• Give advice

• Make the other feel wrong

• being defensive

• judging

• patronizing

• false assurances

• asking why

• blaming others

Resonant Leadership

• Relationship focused leadership

• High emotional intelligence

• Effective in conflict resolution

• Collab & solution focused

• Encourages team to work at highest potential

• Example: actively seeks & incorporates feedback from nurses acknowledges staff burnouts & implements flexible work arrangements.

Transactional (Autocratic) Leadership

• Task completion leader

• Sets standards for performance & task

• Seeks obedience, loyalty & strict adherence to rules

• Effective in high pressure or crisis situation where clear directives are needed

• Bring structure & clarity to team roles & responsibilities

• Rewards staff w/ recognition or bonuses for achieving targets

• Can lead to low team morale, frustration, stifles creativity & creates dependence

• Example: during a code decisions must be made quickly, the nurse takes control of decision-making due to limited time to collab & discuss.

Laissez-Faire Leadership

• Task completion leadership

• Hands-off approach

• Autonomy for highly-skilled & self-motivated teams

• Team members work independently w/ minimal supervision or guidance

• Works well in creative environments

• May lack sense of direction or accountability

• May lead to difficulties if team members lack initative or need more guidance, supervision or structure

• Example: allow a team of experienced nurses to manage daily task & pt care w/ minimal direction

Democratic Leadership

• Encourages collab, diverse input, & shared discission making

• Works to reach consensus

• Time consuming

• Conflicts & disagreements can arise

• Ineffective in emergencies or w/ inexperienced teams

• Example: staff meet, a nurse manager invited input from team on how to improve shift handover processes. After reviewing everyone suggestions, they collectively decide on a new & efficient protocol.

Servant leadership

• Fosters culture of care, empathy & community

• High level of team satisfaction & patient trust

• Strong sense of selflessness

• Prioritize needs & well-being of others, emphasizes service & development of team members

• Less likely to work well where strict protocols, timeliness & accuracy are required

• Example: prioritizes the well-being of the team by ensuring adequate breaks during long shifts & mentoring junior staff to help grow professionally

Indigenous Leadership

• Not hierarchal or linear

• Holistic, shared & determined by community

• Address issues that affect the collective

• 4-inter-related lenses

  1. Individual leader: skills used to contribute to community well-being

  2. Leadership through culture: actions driven by communities cultural values

  3. Leadership through processes: distributed leadership & collective desicion making involving the community

  4. Leadership through integration: leadership as a communal activity

Key Points in Nursing Leadership

1. Understand personal leadership style & how you will use in nursing practice

2. Consider how you engage w/ your team from a lens of leadership

3. Use a blend of different leadership styles depending upon the situation

4. As you grown & gain experience & confidence as RN you might adjust your leadership approach over time

LEADS in a Caring Environment Framework

• Approach to developing Leadership ability

• Lead self

• Engage others

• Achieve results

• Develop coalitions

• Systems transformation

Strengths-based nursing & health leadership

• Approach to developing Leadership ability

• 6 core values

  • Healing & Health: restoring wholeness

  • Uniqueness: everyone has different strengths

  • Holism & embodiment: all aspects are interconnected & interrelated

  • Subjective reality & created meaning: understanding/interpretations affect reactions/responses

  • Self-determination: take charge, making choices, feelin in control

  • Person environment: goodness-of-fit between environment demands & values, needs, goals, strengths