Leadership and Management Notes

Define & discuss nursing responsibility & accountability (owning your mistake).
Define & discuss professional accountability.
Define & discuss leadership & management roles including characteristics of each.
Specifically discuss characteristics of the following leadership styles:
- Autocratic
- Laissez-faire
- Democratic
- Transformational
Review the 3 levels of management.
Discuss the role of the charge nurse.

Responsibility: authority over your actions based on scope of practice for your role; ability to act independently and make decisions without authorization.
- Ex. Charting
Accountability: ownership for your actions; makes independent decisions; ultimate responsibility.
- Ex. Nurse delegates a task to the CNA appropriately but the CNA makes a mistake, it becomes nurse responsibility.

Responsible for: Our practice, work environment, and patient safety.
ANA Code of Ethics: Answerable to yourself and others for your actions.
- 9 Codes
- Not rules, but a guideline.
Involvement in:
- Protocols, processes, policies.
- Competent staff, staffing ratios.
- Professional development, “spirit of inquiry”.
  - “The Bigger Picture” → how do you stay current? How do you get better at your job?
- Evidence-based practice.
  - Ex. Reading, attending conferences, published research, etc.
    - Hospitals generally look at evidence when writing policies.
      - They look at different levels of evidence: what’s out there, what’s actually being practiced, what’s happening in the community, and how will they be a better hospital.
- Problem-solving: increasing acuity, workloads, organizational needs.
  - How do I provide safety or comfort?
Model professional behaviors for others; mentor.
Do the right thing!!

Use of individual traits & personal power to influence & guide strategy development.
- We are viewing leadership as the overall idea behind management.
- Reflection of personal experience.
Leading by example.
Influences others to respond.
“Do the Right Thing”

Authoritative: Nurse manager decides everything, is controlling, does not encourage autonomy.
Democratic: Incorporates input from all.
Laissez-faire: Employees allowed to work in any way they want to, no guidance/supervision of the nurse manager. Employees are responsible for problem-solving on their own.
- Ex. Home health
Transformational: Uses positive motivation & inspiration encouraging employees to “do their best.” Focus is toward a common vision.

Focus is on the organization.
3 management levels: First-level manager, middle-level manager, and upper-level manager.
Focus is on excellence in practice.
All levels of nurse managers work together.
Organizational structure determines titles & the responsibility of the various levels of patient care management.

Responsibilities:
- Supervise the work of non-managerial personnel.
- Day to day activities of a specific unit or units.
- Responsible 24/7.
- Personnel development.
- Compliance with regulatory and professional standards.
- Fostering interdisciplinary, collaborative relationships.
- Short-range operational planning

Responsibilities:
- Supervises first level managers.
- Liaison between upper management and first-level management.
- Spends more time planning, evaluating & coordinating staff than first level manager.
- May include some patient care.

Responsibilities:
- Most of time spent in strategic planning and working with key-stakeholders, establishing organizational goals.
- Part of the executive management team.
- Rare patient care; responsible for all nursing practice.

Role: Assist nurse manager or head nurse
Charge nurse (patient care manager): a staff nurse with managerial responsibility; no title.
Resource Nurses: Nurse with recognized clinical expertise who is able to mentor less experienced nurses
Roles/responsibilities:
- Shift coordinator
- Create patient assignments for the shift.
- Make patient care rounds during shift.
- Trouble-shoot problems that occur during shift.
- Assist staff members with making decisions and prioritizing care
- Serve as liaison between staff of working and off-shift and first-line management
- Patient care

Managing clients requires leadership skills & management skills.
All nurses need leadership skills to maintain a good work environment, coordinate care & manage conflict.
Leaders are individuals that inspire others. Often not a formal position.
Effective managers usually possess good leadership skills.
Managers hold formal positions of authority & make decisions about the function of the organization (resources, budget, hiring, firing).
Responsibility focuses on the authority we have to make independent decisions.
Accountability focuses on ownership we have over our actions.