Nursing Leadership and Management

Learning Outcomes

• By the end of the chapter, it is expected that one can explain why every nurse is a manager and can be a leader
• Furthermore, the student will differentiate between leaders and managers, as well as discuss different theories that explain leadership and management
• They will describe management roles that nurses fill in practice
• The student will understand why followership is essential to leadership and what makes a leader successful

Introduction

• Nurse managers require a specific knowledge base and skills distinct from those for nursing practice
• Many nurses lack the necessary education or training for management roles
• Managers often rely on experiences with former supervisors for supervisory techniques
• A gap exists between what managers know and what they need to know
• In practice, all nurses are managers, not necessarily in a formal organizational sense
• Leadership and management skills improve a nurse's effectiveness and career success

Leaders and Managers

• While 'manager' and 'leader' are often used interchangeably, they are distinct
• A leader uses interpersonal skills to influence others towards a specific goal
• Leaders forge connections among team members to promote high levels of performance and quality outcomes
• The functions of a leader include achieving consensus on goals, maintaining a structure that facilitates goal accomplishment, providing necessary information for direction and clarification
• A leader also works to maintain group satisfaction, cohesion, and performance
• A manager is employed by an organization and is responsible and accountable for efficiently achieving organizational goals
• Managers coordinate and integrate resources by planning, organizing, supervising, staffing, evaluating, negotiating, and representing
• A manager needs interpersonal skills as well as authority, responsibility, accountability, and power
• These are defined by the organization
• Managerial functions clarify the organizational structure, choose the means to achieve goals
• Assign and coordinate tasks, developing and motivating as needed and evaluate outcomes and provide feedback
• Effective managers are also good leaders
• One can be a strong manager of resources but not a good leader of people
• Conversely, a good leader may not manage effectively
• Both leadership and management skills can be learned

Leadership Theories

• There are six main types of leadership theories including Quantum, Transactional, Transformational, Shared, Servant, and Emotional

Quantum Leadership

• Movement in one part of the system reverberates throughout the entire system
• Roles are fluid and outcome-oriented
• The outcomes are the priority, not what you did
• Within the framework, employees are directly involved in decision-making as accountable partners
• Leaders take on a facilitative role

Transactional Leadership

• Based on the principles of social exchange theory
• Premise is that individuals engage in social interactions expecting to give and receive social benefits or rewards
• The exchange process between leaders and followers is essentially economic
• A sequence of exchange behavior continues until one party finds the exchange of performance and rewards is no longer valuable
• Leaders are successful when they understand and meet the needs of their followers and use incentives to improve loyalty and performance
• For example: staff respond affirmatively to a nurse manager's request to work overtime in exchange for granting special requests for time off

Transformational Leadership

• Focuses on merging the motives, desires, values, and goals of leaders and followers into a common cause
• The goal of the transformational leader is to generate employees' commitment to the vision, rather than commitment to themselves
• Transformational leaders encourage followers to pursue higher values, humanitarian ideals, moral missions, and causes
• This type of leadership has been linked to reduced burnout among employees
• Transformational leadership can be effective with clients or coworkers at the bedside, in the home, in the community health center, and in the health care organization

Shared Leadership

• Partnerships are essential
• Assumes the notion of a single nurse as the wise and heroic leader is unrealistic
• Many individuals at various levels in the organization must be responsible for organizational performance
• Different issues call for different leaders, or experts, to guide the problem-solving process
• Leaders are not expected to always have knowledge and ability beyond that of others
• Shared governance and co-leadership, where two people work together to execute a leadership role, are common examples

Servant Leadership

• Based on the idea that leadership originates from a desire to serve, which may lead to being called to lead
• Appeals to nurses because the profession is founded on principles of caring, service, the growth and health of others, and nurses are selfless in promoting change in individuals, systems, and organizations

Emotional Leadership

• Emotional intelligence involves personal competence, which includes self-awareness and self-management
• Emotional intelligence also involves social competence, including social awareness and relationship management
• Attachment to others is an innate trait of human beings
• Emotions are "catching"

Traditional Management Functions

• Planning
• Organizing
• Directing
• Controlling

Planning

• A four-stage process that includes establishing objectives or goals, evaluating the present situation, and predicting future trends and events
• Also includes formulating a planning statement and converting the plan into an action statement
• Planning can be contingent or strategic
• Contingency planning may be reactive, in response to a crisis, or proactive, in anticipation of future problems or opportunities
• Strategic planning involves the process of continual assessment, planning, and evaluation to guide the future

Organizing

• Process of coordinating the work to be done
• Includes identifying the work of the organization, dividing the labor, developing the chain of command, and assigning authority
• Ongoing process that systematically reviews the use of human and material resources
• In health care, the mission, organizational structure, delivery systems, job descriptions, and staffing patterns form the basis for the organization

Directing

• Process of getting the organization's work done
• Requires communication skills, motivational techniques, and delegation skills
• Professional staff are autonomous, but need guidance
• Managers sell ideas and counsel to achieve organizational objectives

Controlling

• Comparing actual results with projected results
• Includes establishing standards of performance, determining the means to be used in measuring performance
• Evaluating performance, and providing feedback
• Organizations that use continuous quality improvement (CQI) involve staff in leading teams
• Some organizations use peer review to control the quality of care

Followership

• Leaders depend on followers, similar to how instructors depend on students
• Everyone is a follower at some time or another
• Followership is interactive and complementary to leadership
• Followers are active participants in the relationship with the leader
• Most leaders welcome active followers because they help leaders accomplish their goals and the team succeeds
• Poor managers can undermine good followers by criticism, belittling, or ignoring their input
• Followership is fluid, with the nurse possibly being a leader in one moment and a follower soon after
• The ability to move along the continuum of followership is a must for successful teamwork
• The nurse is often a leader with subordinate staff and a follower of the nurse manager
• A constructive follower is self-directed, proactive, supportive, committed, and has initiative
• These are some of the same attributes that make a good leader