Leadership Styles and Practices

• Registered nurses are leaders influencing and inspiring others to achieve optimal health outcomes.
• Nursing leadership requires strong professional identity grounded in nursing knowledge, relational practice, and ethical practice.

CNO Entry to Practice Competencies

• Nurses participate in innovative client-centered care models.
• Nurses participate in creating and maintaining healthy, respectful, and psychologically safe workplaces.
• Nurses recognize the impact of organizational culture and act to enhance the quality of a professional and safe practice environment.
• Nurses demonstrate self-awareness through reflective practice and feedback.

What is Leadership?

• Leadership influences a group to achieve a common goal and can be demonstrated by all nurses, regardless of management position.

Nursing Leadership

• Nurse leaders influence with the goal of achieving optimal outcomes at all levels of the health system.
• Nurse leaders establish vision and direction.
• Nurse leaders influence care delivery, clinical operations, change, quality, research, policy, ethical practice, and system transformation.

Benefits of Nursing Leadership

• Improved patient outcomes, quality nursing care, and healthy work environments are associated with demonstrated leadership behaviors.
• Nurse job satisfaction, organizational commitment, enhanced team collaboration, and more innovation are associated with demonstrated leadership behaviors.

Approaches to Leadership

• Leadership approaches can either be task focused or relational.

Task-Focused Leadership Styles

• Transactional leadership focuses on exchanges between leader and follower, providing rewards for meeting expectations and corrective action if standards are not met.
• Autocratic leadership is highly directive, with decisions made alone.
• Laissez-faire leadership involves a hands-off approach where staff are left with little direction and autonomy is encouraged.

Relational Leadership Styles

• Democratic leadership encourages active participation in decision-making, with an emphasis on collaboration.
• Authentic leadership involves leaders staying true to their values and beliefs, building on strengths, and acting as role models.
• Resonant leadership requires high emotional intelligence and focuses on building strong relationships.
• Servant leadership places the follower at the forefront.
• Transformational leadership challenges the status quo, empowers staff, and emphasizes relationships.

Transactional Leadership

• Bureaucratic leadership maintains formal roles, follows organizational structures, and clarifies work tasks.

Critique of Transformational Leadership

• Over emphasizes the role of the leader, potentially overlooks ethical concerns, and may not address negative leader behaviors.
• Can privilege gendered assumptions

Competencies of Effective Leaders

• LEADS in a Caring Environment Framework includes: Lead Self, Engage Others, Achieve Results, Develop Coalitions, and Systems Transformation.
• The Canadian College of Health Leaders defines leadership competencies withinLEADS framework.

LEADS Domains

• Lead Self: Leaders are self-aware, manage and develop themselves, and demonstrate character.
• Engage Others: Leaders foster development, contribute to healthy organizations, communicate effectively, and build teams.
• Achieve Results: Leaders set direction, align decisions with vision and evidence, take action, and evaluate outcomes.
• Develop Coalitions: Leaders build partnerships and networks to create results.
• Systems Transformation: Leaders demonstrate critical thinking, encourage innovation, and champion change.

Emotional Intelligence (EI)

• EI involves recognizing one’s own and others' feelings and managing emotions.
• EI may be twice as important as technical skills in developing leadership competence.

Four Competencies of Emotional Intelligence (EI)

• Self-awareness: Knowing strengths, weaknesses, and impact on others.
• Self-management: Managing own emotions.
• Social awareness: Recognizing others' emotions.
• Relationship management: Influencing and resolving conflict.

Strengthening EI

• EI can be strengthened through reflective practice, paying attention to emotions, active listening, and seeking feedback.

Followership

• Followership is a relational role where followers influence leaders and contribute to organizational goals.
• Followers promote team effectiveness through relationships and feedback.
• There are no leaders without followers.

Follower Responsibilities

• Develop a high degree of literacy about the organization.
• Take ownership of work and be active, not passive.
• Engage in self-management and be self-aware of personal and professional values.
• Contribute to the team, express opinions, and be open to change.

Clinical Leadership

• Clinical leaders are experts in their field and are followed because they match their actions with their values and beliefs about quality patient care with clinical competence in a clinical area.

Characteristics of Clinical Leadership

• Clinical Expertise: Recognized competence in a clinical area.
• Effective Communication: Highly developed listening skills; able to communicate at the right level.
• Collaboration: Strong interpersonal skills and teamwork abilities.
• Role Modeling: Inspires other nurses through professionalism and practice expertise.
• Coordination of Care: Plans and organizes care holistically.
• Advocacy & Empowerment: Acts on behalf of patients and staff.
• Education: Serves as a knowledge source for staff and patients.
• Accountability: Sets expectations and is accountable for own actions.
• Authenticity: Acts with integrity and honesty.
• Empathy: Understands the perspectives of others.
• Vision & Driving Change: Develops a strategic sense of improving frontline practice.

Facilitators & Barriers to Clinical Leadership

• Facilitators: Positive relationships with management and interdisciplinary teams, positive culture, and enabling structures.
• Barriers: Lack of support, ineffective teamwork, increased workload, burnout, poor communication, lack of confidence and lack of training.

Leadership vs. Management

• Leadership: Influencing others through creative thinking & communication.
• Management: Accomplishing tasks with formal authority.

Management Functions

• Management involves systematically planning, organizing, leading, coordinating, and controlling staff, resources, and services.

Management Function Examples

• Planning: Choosing goals and strategies.
• Organizing: Establishing structure.
• Leading: Articulating vision.
• Staffing: Recruiting and hiring.
• Controlling: Evaluating performance.

Nurses as Managers

• Nurses accomplish tasks and maintain quality.

Nurses as Leaders

• Nursing practice involves influencing others to achieve goals.

Nurse/Unit Manager Influence

• Nurse and unit manager may influence work life of nurses through transformational/relational leadership in democratic culture.

Types of Management in Nursing

• Nurse managers include: unit managers, nursing unit supervisors, clinical managers, and NUA.

Responsibilities of Nurse Managers

• Nurse managers promote quality care, participate in policy formulation, and participate in personnel decisions.

Performance Appraisal

• Individual evaluations of work performance is measured often.

Performance Appraisal Goals

• Goals may include: improving performance, improving accountabililty, promoting growth and development and acknowledging work well done.

Nurse Executives

• Nurse executives establish a vision for nursing practice and manage high-cost operation issues.

Other Formal Leadership Roles

• Nurse preceptors support new staff and students, nurse educators develop education, and nurse champions promote organizational change.
• Leadership roles also include: Charge Nurse, Head Nurse, Shift Supervisor, Team leader, and Client Care Coordinator.
• Each role must coordinate activities for staff nurses and healthcare team members.

Federal Chief Nursing Officer (CNO)

• First appointed in 1968, eliminated in 2012, and reinstated in 2022.

Representation in Nursing Leadership

• Under-representation of racialized nursing leaders and nurses of colour exists.

Strategies to Promote Representation

• Efforts through education, mentoring, and collaboration can reduce barriers.

Power as a Leadership Attribute

• Power is "the ability to mobilize resources (human and material) to get thins done", (Kanter, 1997, p. 136) and can be positive or negative.
• Power may influences influence and authority.

Types of Power in Leadership

• Legitimate: Based on formal position and expectation of compliance.
• Referent: Informal power based on admiration.
• Expert: Respected for expertise and skills.
• Persuasive: Influencing others.
• Coercive: Based on punishment.
• Reward: Ability to reward performance.
• Informational: Arises from accessing and sharing information.

Psychological Empowerment

• Psychological empowerment allows them to influence their work.

Cognitive Factors Impacting Psychological Empowerment

• Meaning: Work is meaningful.
• Competence: Belief in one's capability.
• Self-Determination: Sense of control.
• Impact: Actions influence outcomes.

• Empowerment leads to positive outcomes like job satisfaction and retention.

Structural Empowerment

• Based on organization's policies that provide power to staff.

Structural Empowerment Resources

• opportunities
• Acces to Information
• Access to support
• Access to resources

• Structural empowerment reduces stress and burnout, and affects performance.

Span of Control

• The span of control is the number of people a manager supervises.
• Increased span of control = increased adverse outcomes.

Organizational Structure

• Characterized by complexity, formalization, and centralization.
• Centralized orgs = decisions made at the top.
• Decentralized orgs = are made at/closer to pt's level of care.

Organizations

• Flat organizations have few layers of management.
• Tall organizations are hierarchical with many layers.

Shared Governance

• A structure involves nurses in decision making.

Quality Councils

• Councils address policies and procedures.

Mission, Vision & Values

• Mission: Organization's purpose.
• Vision: Long-term goals.
• Values: Guiding principles.

Organizational Culture

• Shaped by employee productivity
• Each has a unique culture.

Organizational Cultures

• Each may have a safety culture based on trust and learning, along with a non-punitive approach.

Just Culture

• "an atmosphere of trust in which providers are supported and treated fairly".

Quality Practice

• The environment supports safe care.

Healthy Work

• Includes open relation exchange that aims to promote well-being.

Models of Care

-Team based or collaborative. -Functional -Individual.

Magnet

• The program improves patient/staff outcomes.

QI

• Quality Improvement shapes care.

Quality in Healthcare Domains

-Equitable: provides high quality across patient population. -Safe: ensures the pt is not harmed. -Timely: provides pt's needs in a timely manner.

Quality Improvement

• "A systematic, formal approach to analyzing/improve performance". -aims to improve quality of a company outputs.

Quality vs. Quaility Improvement

Quality Improvement continuously looks to improve organization's outputs.

Quality Improvement Steps

• -Planning for change.
• -Implementing Change.
• -Sustaining Change.

Approaches to Quality Improvement

• -Lean.
• -6 Sigma.
• -Model for Improvement.

Model for Improvement Components

• -Plan: identifying task owners, objectives, outcomes and implementation.
• -Do: putting plan into action and record Data.
• -Study: evaluates for plan is in working.
• -Act: adopt, adapt to intervene.

Applying Improvement

• • know what you want to improve.

Forming A Team

Teams are necessary for quality improvement work and require members from different backgrounds.

• • Different Health professional etc. -Engage people who will benefit from the problem being solved.

QI Team Composition

• • Team lead.
• • Executive sponsor etc.

Team Size

• • small enough for effective communication CIHC Competency Framework

Identifying/Improvement

• Patient/Staff perspective
• Practice data and how we can do better

Clarifying the problem a problem is a gap b/w the current and future state

Clarifying steps

• • what is the problem
• • who is affected etc.
• • what is the impact

Links to content

• consider contextual factors that may be influencing the problem

Why understand Problems

• • clear goals/potential/solutions.

Tools exploring the problem

• -5 whys
• -Process map identify gaps

Pareto Chart

Uses 80/20

• Used to prioritize problems
• -vital few vs trivia

Setting an Aim

statements needs to be SMART

Links to weeks

• Align with priorities and goals.

Change

• general approac that improve ideas
• -eliminate, improve workflows etc.

Drivers

• diagram of project aim

Factors

organizational, mission, structure.

Links

• persuasion is highly important

Benefits

opportunities to improve skills/leadership.

Driving Results

• improve measures

5 Why's

explore causes w/ your team

aims

• identify pt @ risk

Plan Measure

Project measures are a must-

4 points data measures

Quantiative

Structure measures

• describe environment

Examples

Process & outcomes Measures

• -Reflections relate goals . Examples Outcomes measures relate and demonstrative example adverse drags

Balance Measures

• highlights consequence .

Tips

• Keep it simple baseline = needs the establish improvment.

Variation

• inherent/common-natural

Random

Atypical or not typical.

Run Chart

• X axis- time; Y to mean.

Run Chat Rules

If you improve , or decline.

Point

• Relies on team, for support.

PDSA CYCLE

Sequential PDSAs Best used

1 best= test approach

Test your knowledge of various leadership styles, including autocratic, laissez-faire, democratic, authentic, and servant leadership. Explore the characteristics, strengths, and applications of each to enhance your understanding of effective leadership in different contexts.