Leadership and Management

Leadership and Management

• Leadership is the ability to influence people to work toward meeting stated goals, using individual traits and personal power to influence and guide strategy development.

Types of Leaders

• Trait theory suggests that leaders are based on specific traits such as drive, persistence, initiative, and the ability to influence others.
• Behavioral theory focuses on how leaders behave, rather than their traits.
• Autocratic leaders change behaviors within the organization using coercion, authority, punishment, and power.
• Democratic leaders influence change through participation, staff involvement in goal setting, and collaboration.
• Permissive (laissez-faire) leaders assume people can make their own decisions and complete their work without facilitation.
• Bureaucratic leaders influence behavior through organizational policies and rules.
• Contingency theory says that leaders use different leadership styles in different situations.
• Charismatic leaders have the ability to engage others due to their powerful personality.
• Connective leaders bring others together to affect change.
• Shared leadership acknowledges that no one person can accomplish all the work.
• Servant leadership is committed to the growth of the employee, not the leader, and puts others before self.

Transformational & Transactional Leadership

• Transformational leadership is consultative and collaborative, challenges the process, creatively thinking of new ways of doing things and motivates and inspires.
• Transformational leaders empower others to ask, model the change, praise employees for work done, and demonstrate idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration.
• Transactional leadership involves exchange between leader and employee.
• Transactional leadership provides rewards to meet needs in exchange for performance, identifies employee needs, and operates within a hierarchical organization from the top down.

Qualities of a Leader

• Leaders are future-oriented, visionary, focus on purposes.
• Leaders empower others to set and achieve goals, establish direction, align people, motivate, inspire, and produce change.
• Leaders do the right thing, focus on changes, purpose, future, strategy, asks why, journey, and potential.
• Leaders innovate, develop, focus on people, inspire trust, have a long-range perspective, challenge the status quo, own their person, and keep their eyes on the horizon.

Relational vs. Task Oriented Leader

• Relational leadership invests time, energy, and resources in building quality relationships.
• Task-oriented leadership emphasizes the transaction or economic exchange between leaders, colleagues, and followers (transactional leadership).

Nurse Manager Roles

• Nurse Manager roles include preparing orientation schedules, submitting time schedules for shifts, assigning staff for patient care, and making budget recommendations based on unit needs.
• Nurse Managers also calculate staff needs, conduct staff meetings and employee reviews, interview potential staff members, set goals for staff, and maintain current knowledge of profession and regulatory requirements.
• Nurse Managers ensure care is delivered with respect for patient's rights, accept accountability for services provided to patients, and evaluate quality of health care.
• Nurse Managers coordinate nursing care and assist in integrating services across the nursing continuum.
• Nurse Managers participate in recruitment, selection, and retention of personnel, assess the impact of and planning strategies to address ethnic, cultural diversity, and political, social, financial, economic, ethical issues.
• Nurse Managers assume responsibility for staffing and assignments.
• Nurse Managers provide guidance and supervision for personnel, develop, implement, monitor, and account for budgets.
• Nurse Managers are expected to use evidenced based practice by involving staff.
• Nurse Managers provide educational experience for nursing and students, and advocate for a work environment that minimizes work related illness and injury.

Levels of Managers

• First-level managers are responsible for supervising nonmanagerial personnel and day-to-day activities of specific work units.
• First-level managers focus on clinical nursing practice, patient care delivery, use of resources, personnel development, compliance with regulatory and professional standards, fostering interdisciplinary, collaborative relationships, and strategic planning.
• Middle-level managers (supervisors, directors, assistant directors, or associate directors of nursing) supervise first-level managers within a specific area and are responsible for the people and activities within those areas.
• Middle-level managers generally act as a liaison between first-level and upper-level management.
• Upper-level managers (executive level managers, VP of care and nursing, chief nursing executives, CNO) are at the top level to whom middle managers report.
• Upper-level managers are primarily responsible for establishing organizational goals and strategic plans for the entire division of nursing.

Care Manager - Charge Nurse

• Care Manager responsibilities include time management, interdisciplinary collaboration, prioritizing, flexibility and creativity, critical thinking, conflict resolution, and ability to delegate.
• Care Managers assist in shift coordination, patient assignments in shift, and deal with personnel issues during shift.
• Care managers participate in patient care rounds, troubleshoot problems, assist staff members with delegating and prioritizing, they use resources efficiently and conduct staff evaluations, serves as a liaison between staff and management.

Nursing Metaparadigm Concepts

• Nursing Metaparadigm includes nursing actions, the person (recipient of care), nursing, health, environment, and internal & external factors.

Nursing Theory Overview

• Comfort Theory (Katharine Kolcaba): Comfort is identified in three main goals: relief, ease, and transcendence. Nursing provides comfort in the environment, physically, mentally, spiritually, and culturally.
• Adaptation Model (Callista Roy): Persons and groups are adaptive systems influenced by stimuli, coping processes, and integrated adaptation. Nursing's goal is promoting adaptation and providing the stimulus to develop a framework for people and groups to deal with changes.
• Need Theory (Henderson): Emphasizes increasing the patient's independence, categorizes nursing activities into fourteen components based on human needs. Four roles for nurses: substitutive (doing for), supplementary (helping), complementary (working with).
• Human Becoming Theory (Rosemary Parse): Meaning is how the patient views their experience, rhythmicity is how the patient interacts. The patient is viewed as a bio-psycho-socio and spiritual being.
• Casey Model of Nursing (Anne Casey): Nursing works with the child and family.
• Self-Care Deficit Nursing Theory (Dorothea Orem): Patients wish to care for themselves, and nurses promote independence and control.
• Twenty-One Nursing Problem Theory (Faye Abdella): Uses a ten-step process to ascertain patient's problems and prioritize them for individualized care.
• Nursing Need Theory (Virginia Henderson): Patients have basic needs that must be met. Nurses' role is doing for the person, helping the person, and working with the person.
• The Helping and Human Relationship Theory (Robert Carkhuff): Humans tasked with improving the quantity and quality of person's life. Nurse assists others/themselves in four stages: attending, responding, personalizing, and initiating.
• Theory of Interpersonal Relations(Hildegard Peplau): Interpersonal relations between nurse and patient. Four Stages include Orientation, Identification, Exploitation and Resolution.
• Hierarchy of needs (Maslow): Organizes human needs into Physical, Safety, Love and belonging, Esteem and Self-actualization. Ensure basic needs are met before moving up the pyramid to prioritize care.
• Environmental (Florence Nightingale): How patients and nurses interact with the environment and impact on the patients health. Nurses provide a therapeutic milieu.
• Dynamic Nurse-Patient Relationship Theory (Orlando):Apply effective nursing practice. Includes communication and is dynamic -changing.
• Transformational theory (James Burns): Employees valued team members with high expectations from the leader.
• Health Promotion Model (Nola Pender): The goal is a health state of being & to empower patient participate in their health.
• Theory of goal attainment (Imogen King): Nurse - patient relations set attainable goals for the patient to allow for a working relationship.
• Human to Human Relationship Model (Joyce Travelbee):Seven basic concepts that focus on suffering, meaning, nursing, hope, communication, self-therapy and a targeted intellectual approach.
• Role Attainment Theory (Romoinfivina Mercer): Women mothers makes the transition during pregnancy, with 4 phases.
• Modelling and role-Modelling theory (Erikso, H, Tomllin and Swain):Nursing practices with focus on the needs of the patient as individuals.
• Model for Nursing (Roper-Locan-Tierney): Individualize care plans to better care for patients.
• Science of Caring Theory (Jean Watson): Holistic, care and compassion.
• Interpersonal Theory (Henry Stack): Social interactions which is of high significance to the nursing practice.
• Therapeutic Environment (Rogers): Must go beyond diagnosis, the unitary human being must be present.
• Novice to Expert (Dr. Patricia Benner): Nurse enters the profession and continues to the expert phase.
• Transcultural Nursing (Madeline Leininger): Recognize the role, cultural and health practice as it relates to the nursing setting.
• The Helping Art of Clinical Nursing (Ernestine Wiedenbach): "art of nursing” -similar to ADPIE, identifying the need for help, exploring the symptoms, and determining the cause
• Theory of Moral Development (Lawrence Kohlberg): Pre-Conventional, Conventional and Post conventional.

Evidence Based Practice (EBP)

• Steps to EBP include formulating a clinical question, searching for evidence (literature, experience, patient outcomes), appraising evidence (credibility including generalizability, replication, quality study, and methods), applying evidence to practice (with clinical expertise, patient wants/needs), and evaluating evidence use.
• PICOT questions include: P (patient or population), I (intervention), C (comparison), O (outcomes), T (time).
• EBP is the judicious use of best current evidence in decisions about the care of an individual patient.
• EBP incorporates the nurse's clinical experience, what is reviewed in literature, and what the patient wants/expects.

Delegation and Prioritization

• Rights of delegation: Right Task (doesn't require nursing judgment, is simple), Right Circumstance (noncritical, predictable outcome), Right Person (competent, within scope), Right Direction/Communication (specific, clear, consistent).
• The RN must be a Right Supervision by ensuring tasks are done correctly and the RN is responsible for delegated tasks.
• When assigning patients appropriately, base the decision on census, patient condition, and staff abilities.
• RNs cannot delegate tasks for newly diagnosed patients, new admissions, immediate post-op patients, unstable patients, patients needing monitoring, initial assessments, teaching, or IV push medications.
• Prioritizing care involves : identify priorities, interact effectively with others, identify when can handle an issue, ask questions before taking assignment, ask for help when needed, delegate, and initiate action.

Accreditation and Regulation

• Regulatory Agencies (federal and state governments) set the rules to be followed, standards for operation of health care organizations.
• Regulatory Agencies ensure compliance with federal, state regulations, investigate and make judgements regarding complains.
• Accreditation(seal of approval) founded to set minimum of standard care.
• Accreditation leads improved patient care and demonstrates the organization's commitment to safety and quality.
• The New Mexico Board of Nursing handles discipline and provides Diversion Programs.

Organizational Structure

• Decentralized (Shared Governance) is knowledge based and occurs at point of care/service.
• Decentralized facilitates direct communication, high staff input, integrates equity, accountability, and authority for staff and managers, and promotes a synergistic work environment.
• Organizational theories: Organizational and systems theory focuses on formal structure, neglects human aspects, and treats organization as a machine with "one right way".
• Systems theory studies society as a complex element, including individuals and beliefs as it relates as a "whole" & as components.
• Systems theory contains Sub-systems, Synergy, Open and closed systems, System boundaries, Flow and Feedback.
• Feedback comes in the forms of Negative (Goes backwards) and/or Positive (Goes forward, promotes Growth and change).
• Equifinality means there is no one best way to organize
• All ways of organization are good