Nursing-Leadership.pdf

Nursing Leadership and Management AILEEN G. SYPONGCO, MN, RN, RM 2 Nursing as a Profession Today, nursing is an applied science, a practice profession. Nursing is more than just a job; it is a professional career requiring commitment. 3 4 The Current definition of NURSING as established by ANA (2015) “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” Definitions of Nursing (Historical Perspective) Florence Nightingale Virginia Henderson Martha Rogers American Nurses Association International Council of Nursing 6 Characteristics A systematic body of knowledge that provides the framework for the profession’s practice Standardized, formal higher education Commitment to providing a service that benefits individuals and the community 7 Characteristics Maintenance of a unique role that recognizes autonomy, responsibility, and accountability Control of practice responsibility of the profession through standards and a code of ethics Commitment to members of the profession through professional organizations and activities 8 Hood’s Professional Nurse Contributions Model 9 Professional Self-Concept Benner’s Novice to Expert Model The helping role The teaching-coaching function The diagnostic and patient monitoring function Effective management of rapidly changing situations Administrative and monitoring therapeutic interventions and regimens Monitoring and ensuring the quality of health practices Organizational and work-role competencies 10 Nursing in Today’s Evolving Health Care Environment Ambulatory care settings – nurse-based practices Public and community health Extended care (Nursing homes) Nursing in Medical Offices (works in tandem with physicians) Nursing in the Workplace (Occupational and environmental health nurse) Nursing in the Armed Services 11 Nursing in Today’s Evolving Health Care Environment Nursing in Schools Nursing in Palliative Care and End-of-Life Settings Nursing from a Distance: Telehealth Nursing in Faith Community Managing Information in Nursing: Informatics Nurses in Business: Entrepreneurs 12 Nursing in Today’s Evolving Health Care Environment Nurse Educators Clinical Nurse Leaders Advanced Practice Nursing Clinical Nurse Specialist Nurse-Midwives Nurse Anesthetist 13 14 “if there has been a moment in history when a comprehensive strategic view of leadership was needed…..this is certainly it LEADERSHIP 15 Process of influencing the activities of an organized group in its efforts toward goal setting and goal achievement (Stogdill) 16 The process of persuasion and example by which an individual (or leadership team) induces a group to take action that is in accord with the leader’s purposes and the shared purposes of all (Gardner) 17 Social interaction in which one person influences others (Merton) Vital ingredient that transforms a crowd into a functioning, useful organization (Talbott) 18 Use of personal traits to constructively and ethically influence patient, families, and staff through a process where clinical and organizational outcomes are achieved through collective efforts 19 Process whereby a nurse influences two or more persons to achieve specific goals in the provision of nursing care for one or more clients 20 Tasks of Leadership 1. Envisioning goals 2. Affirming values 3. Motivating 4. Managing 5. Achieving a workable unity 6. Explaining 7. Serving as a symbol 8. Representing the group 9. Renewing 21 Tasks of Leadership 1. Envisioning goals pointing others in the right direction and helping the group members balance and deals with any tension between long- and short-term goals 22 Tasks of Leadership 2. Affirming values regenerating and revitalizing the beliefs, values, purpose and vision shared by members of the group, challenging the values held by some 23 Tasks of Leadership 3. Motivating unlocking and channeling motives that exist within members of the group, having and promoting positive attitudes, being creative and encouraging others to be excited about the future and about how they can be part of it 24 Tasks of Leadership 4. Managing planning and setting priorities, making decisions, facilitating change, and keeping the system functioning, all in an effort to move the group toward achieving the goals and realizing the vision 25 Tasks of Leadership 5. Achieving a workable unity establishing trust, striving toward cohesion and mutual tolerance, managing conflict and creating loyalty to larger venture 26 Tasks of Leadership 6. Explaining helping others understand what the vision is, why they are being asked to do certain things, and how they relate to the larger picture 27 Tasks of Leadership 7. Serving as symbol serving as a risk taker and acting as the group’s source of unity, voice of anger, collective identity and continuity as well as its source of hope 28 Tasks of Leadership 8. Representing the group speaking and acting for or on behalf of the group and being an advocate for the group 29 Tasks of Leadership 9. Renewing blending continuity and change and breaking routines, habits, fixed attitudes, perceptions, assumptions and unwritten rules In the process of renewing, the leader must keep a measure of diversity and dissent in the system (as a way to avoid) the trance of renewal In essence leadership is not tidy, it is more of an art than a science. Management in comparison often is thought of as a science in which a series of steps can be followed to implement the role 30 Differences between Leadership and Management 31 Differences between Leadership and Management 32 33 Henry Ford: Affordable cars for “common” people Mahatma Gandhi: Freedom of the people of India 34 Steve Jobs: Desktop computers for personal use Martin Luther King: Racial equality 35 Mother Theresa: Compassionate care for the poorest of the poor Florence Nightingale: Reduced battlefield fatalities resulting from poor care 36 37 Classical views of Leadership and Management 38 Ten Distinctions Between Leaders and Managers (Kerr, 2015) Leadership inspires change; management manages transformation. Leadership requires vision; management requires tenacity. Leadership requires imagination; management requires specifics. Leadership requires abstract thinking; management requires concrete data. Leadership requires ability to articulate; management requires ability to interpret. 39 Ten Distinctions Between Leaders and Managers (Kerr, 2015) Leadership requires an aptitude to sell; management requires an aptitude to teach. Leadership requires understanding of the external environment; management requires understanding of how work gets done inside the organization. Leadership requires risk taking; management requires self-discipline. Leadership requires confidence in the face of uncertainty; management requires blind commitment to completing the task at hand. Leadership is accountable to the entire organization; management is accountable to the team. 40 Which is more important? Good Leadership or Good Management? 41 42 Other Characteristics of Leaders Leaders often do not have delegated authority but obtain their power through other means, such as influence. Leaders have a wider variety of roles than do managers. Leaders may or may not be part of the formal organization. Leaders focus on group process, information gathering, feedback, and empowering others. Leaders emphasize interpersonal relationships. Leaders direct willing followers. Leaders have goals that may or may not reflect those of the organization. 43 Ten Fatal Leadership Flaws A lack of energy and enthusiasm Acceptance of their own mediocre performance Lack of a clear vision and direction Having poor judgment Not collaborating Not walking the talk Resisting new ideas Not learning from mistakes A lack of interpersonal skills Failing to develop others 44 Common Leadership Roles 45 A Comparison of Traditional and Leadership Components MANAGERS Are assigned a position by the organization Have a legitimate source of power due to delegated authority that accompanies their position Have specific duties and responsibilities they are expected to carry out Emphasize control, decision making, decision analysis, and results Manipulate people, the environment, money, time, and other resources to achieve the goals of the organization Have a greater formal responsibility and accountability for rationality and control than leaders Direct willing and unwilling subordinates 46 A Comparison of Traditional and Leadership Components LEADERS Often do not have delegated authority but obtain power through other means, such as influence Have a wider variety of roles than managers Focus on group process, information gathering, feedback, and empowering others May or may not be part of the formal hierarchy of the organization Emphasize interpersonal relationships Direct willing followers Have goals that may or may not reflect those of the organization 47 Historical Development of Leadership Theory (1900 to present) The Great Man Theory / Trait Theories (1900-1940) 48 Historical Development of Leadership Theory (1900 to present) Behavioral Theories (1940-1980) – Kurt Lewin ○ Emergence of Leadership styles Authoritarian Democratic Laissez-faire 49 Authoritarian Leader Strong control is maintained over the work group. Others are motivated by coercion. Others are directed with commands. Communication flows downward. Decision making does not involve others. Emphasis is on difference in status (“I” and “you”). Criticism is punitive. 50 Democratic Leader Less control is maintained. Economic and ego awards are used to motivate. Others are directed through suggestions and guidance. Communication flows up and down. Decision making involves others. Emphasis is on “we” rather than I and you. Criticism is constructive. 51 Laissez-faire Leader Is permissive, with little or no control Motivates by support when requested by the group or individuals Provides little or no direction Uses upward and downward communication between members of the group Disperses decision making throughout the group Places emphasis on the group Does not criticize 52 Historical Development of Leadership Theory (1900 to present) Situational and Contingency Leadership Theories (1950-1980) ○ Mary Parker Follett Leadership as being more flexible Different Leadership styles being used at different times depending upon the circumstances. Suggested that leadership is not a fixed series of characteristics that can be transposed into different contexts. May depend on type of staff, history of business, culture of business, quality of relationship, nature of the change needed, and accepted norms within the institution 53 Historical Development of Leadership Theory (1900 to present) Situational and Contingency Leadership Theories (1950- 1980) ○ Fidler’s Contingency approach (1967) The model was based on the premise that a certain leadership style would be most effective in different types of leadership To measure a leader’s style, Fiedler developed LPC (Least preferred coworker) 54 Historical Development of Leadership Theory (1900 to present) ○ Fidler’s Contingency approach (1967) Three Contingency Dimensions (LPC) Leader-member relations – the degree of confidence, trust, and respect subordinates have in their leader Task structure – the degree to which the job assignments are procedurized Position power – influence derived from one’s formal structural position in the organization; includes power to hire, fire, discipline, promote, and give salary increase 55 Historical Development of Leadership Theory (1900 to present) Situational and Contingency Leadership Theories (1950-1980) Blake and Mouton (1964) ○ showed various combinations of concern or focus that managers had for or on productivity, tasks, people, and relationships. In each of these areas, the leader-manager may rank high or low, resulting in numerous combinations of leadership behaviors. Various formations can be effective depending on the situation and the needs of the worker. 56 The Blake and Mouton Managerial Grid Model 57 Historical Development of Leadership Theory (1900 to present) Situational and Contingency Leadership Theories (1950-1980) ○ Hersey and Blanchard – tridimensional leadership effectiveness (1977) Hersey and Blanchard (1977) also developed a situational approach to leadership. Their tridimensional leadership effectiveness model predicts which leadership style is most appropriate in each situation on the basis of the level of the followers’ maturity. As people mature, leadership style becomes less task focused and more relationship oriented. 58 Situational and Contingency Leadership Theories (1950-1980) Hersey and Blanchard Four Specific Leadership Styles: ○ Telling (high task and low relationship) – the leader defines roles ○ Selling (high task and high relationship) – the leader provides both directive and supportive behavior ○ Participating (low task and high relationship) – the leader and follower share in decision making. Main role of leader is facilitating and communicating ○ Delegating (low task and low relationship) – the leader provides little direction and support 59 Situational and Contingency Leadership Theories (1950-1980) Hersey and Blanchard Four Stages of Follower Readiness: ○ R1– people are both unable and unwilling to take responsibility for doing something ○ R2– people are unable but willing to do the job tasks ○ R3– people are able but unwilling to do what the leader wants ○ R4 – people are both able and willing to do what is asked of them 60 Historical Development of Leadership Theory (1900 to present) Interactional Leadership Theories (1970-present) ○ Schein – Interactional theorist (1970) an interactional theorist, was the first to propose a model of humans as complex beings whose working environment was an open system to which they responded. A system may be defined as a set of objects, with relationships between the objects and between their attributes. A system is considered open if it exchanges matter, energy, or information with its environment. 61 Historical Development of Leadership Theory (1900 to present) Interactional Leadership Theories (1970-present) ○ Hollander (1978) According to Hollander, a leadership exchange involves three basic elements: The leader, including his or her personality, perceptions, and abilities The followers, with their personalities, perceptions, and abilities The situation within which the leader and the followers’ function, including formal and informal group norms, size, and density 62 Historical Development of Leadership Theory (1900 to present) Interactional Leadership Theories (1970-present) Ouchi – Theory Z (1981) ○ A blend of eastern and western management philosophies. ○ The theory suggests that organizations incorporate strong company philosophy and culture in order to create a happy, productive, and loyal workforce ○ Employees should become generalists in their roles rather than pigeonholing themselves into a specialty 63 Historical Development of Leadership Theory (1900 to present) Interactional Leadership Theories (1970-present) ○ Nelson and Burns (1984) suggested that organizations and their leaders have four developmental levels and that these levels influence productivity and worker satisfaction. The first of these levels is reactive. The reactive leader focuses on the past, is crisis driven, and is frequently abusive to subordinates. In the next level, responsive, the leader is able to mold subordinates to work together as a team, although the leader maintains most decision-making responsibility. At the proactive level, the leader and followers become more future oriented and hold common driving values. Management and decision making are more participative. At the last level, high-performance teams, maximum productivity and worker satisfaction are apparent. 64 Historical Development of Leadership Theory (1900 to present) Interactional Leadership Theories (1970-present) ○ Kanter(1989) best summarized the work of the interactive theorists by her assertion that title and position authority were no longer sufficient to mold a workforce where subordinates are encouraged to think for themselves, and instead managers must learn to work synergistically with others. 65 Path and Goal Theory Effective leaders clarify the path to help their followers get from where they are to the achievement of their work goals and make the journey along the path easier by reducing road blocks and pitfalls There are 4 different types of leadership depending on the situation: ○ Directive leadership ○ Supportive leadership ○ Participative leadership ○ Achievement-oriented leadership 66 Historical Development of Leadership Theory (1900 to present) Transactional and Transformational Leadership 67 Historical Development of Leadership Theory (1900 to present) Full-Range Leadership Model/Theory ○ Created in the late 20th century ○ A leader who could apply the three specific types of leadership at any given time: Transformational Transactional Laissez-faire 68 Leadership Competencies Leadership skills and behavior Organizational climate and culture Communicating vision Managing change 69 Gardner (1990) asserted that integrated leader-managers possess six distinguishing traits: They think longer term: They are visionary and futuristic. They consider the effect that their decisions will have years from now as well as their immediate consequences. They look outward, toward the larger organization: They do not become narrowly focused. They are able to understand how their unit or department fits into the bigger picture. 70 Gardner (1990) asserted that integrated leader-managers possess six distinguishing traits: They influence others beyond their own group: Effective leader-managers rise above an organization’s bureaucratic boundaries. They emphasize vision, values, and motivation: They understand intuitively the unconscious and often nonrational aspects that are present in interactions with others. They are very sensitive to others and to differences in each situation. 71 Gardner (1990) asserted that integrated leader-managers possess six distinguishing traits: They are politically astute: They are capable of coping with conflicting requirements and expectations from their many constituencies. They think in terms of change and renewal: The traditional manager accepts the structure and processes of the organization, but the leader-manager examines the ever- changing reality of the world and seeks to revise the organization to keep pace. 72 The 21st Century Thinking About Leadership 73 New Thinking about Leadership and Management 74 Strengths-based Leadership and the Positive Psychology Movement Rath and Conchie (2008): Balance of strengths in the following four leadership domains: ○ Strategic Thinking ○ Influence ○ Relationship building ○ Execution 75 Strengths-based Leadership and the Positive Psychology Movement Rath and Conchie (2008): Followers words that best describe the contribution that a leader make to their life: ○ Trust ○ Compassion ○ Stability ○ Hope 76 Strengths-based Leadership and the Positive Psychology Movement Assessing your Strengths-based Leadership (Ambler, 2015) Do you have a good understanding of your personal strengths and weaknesses? What are your top three strengths and are you using them on a daily basis? Are you deliberately investing in your strengths? Are you building a team that compensates for your weaknesses? 77 Strengths-based Leadership and the Positive Psychology Movement Assessing your Strengths-based Leadership (Ambler, 2015) Do you select team members for their leadership strengths as opposed to their knowledge and technical expertise? Are you developing your team members’ strengths? What is the level of trust between you and your team? 78 Strengths-based Leadership and the Positive Psychology Movement Assessing your Strengths-based Leadership (Ambler, 2015) Does your team feel that you care for them on a personal level? Does your team know what to expect from you? Is your team inspired by a positive future? 79 Level 5 Leadership (Jim Collins, 2001) 80 Servant Leadership (Greenleaf, 1977) 81 Defining Qualities of Servant Leaders The ability to listen on a deep level and to truly understand The ability to keep an open mind and hear without judgment The ability to deal with ambiguity, paradoxes, and complex issues The belief that honestly sharing critical challenges with all parties and asking for their input is more important than personally providing solutions Being clear on goals and good at pointing the direction toward goal achievement without giving orders 82 Defining Qualities of Servant Leaders The ability to be a servant, helper, and teacher first and then a leader Always thinking before reacting Choosing words carefully so as not to damage those being led The ability to use foresight and intuition Seeing things whole and sensing relationships and connections 83 Principal Agent Theory 84 Human and Social Capital Theory 85 Emotional Intelligence (EI or EQ) 86 “Not all class valedictorians fare well in life, we don’t always become rich & famous, because while our IQs are high, some of us have EQs and SQs that are surprisingly very low. “ Marky Bee September 27, 2020 87 Five Components of Emotional Intelligence (Goleman, 1998) 88 Authentic Leadership 89 Thought Leadership 90 Reflective Thinking and Practice 91 Using Reflections in Leadership How can you bring the power of reflection to bear on your day-to-day work? How could you amplify the effectiveness of your decision making and empower your teams to step up and participate in the decision- making process? 92 Quantum Leadership 93 94 Transition from Industrial Age Leadership to Relationship Age Leadership 95 Integrated model of leadership. (Ki ThoughtBridge, LLC, & Scott Tyler, Katherine (2006, September 29), The gifts of leadership. Paper presented at the Sigma Theta Tau International Chapter Leader Academy, Indianapolis, IN. LLC. All rights reserved. The primary drivers of economic prosperity in the industrial age were machines and capital—in other words, things. People were necessary, but replaceable (Covey, 2011) 96 Operational Leadership (Blanchard, 2015) Who is the best leader for performance? 97 Integrating Leadership Roles and Management Functions in the 21st Century Effective leadership is absolutely critical to organizational success in the 21st century. Becoming a better leader-manager begins with a highly developed understanding of what leadership and management are and how these skills can be developed. 98 Integrating Leadership Roles and Management Functions in the 21st Century Contemporary leader-managers, then, are challenged not only to know and be able to apply classical leadership and management theory but also to keep abreast of new insights, new management decision-making tools, and new research in the field. 99 Nurses Preparation in the Era of the Fourth Industrial Revolution 100 Historical Development of Nursing and Nurses The Evolution of Nurses as juxtaposed with Darwin’s Evolution of Man 101 Dino, M.J. (2021) 102 Dino, M.J. (2021) 103 Robotics Utilization in healthcare 104 https://www.youtube.com/watch?v=6lcyBTis17g 105 106 Where are we heading to? “May our philosophies keep pace with our technologies. May our compassion keep pace with our powers, and may love [caring], not fear, be the engine of change” 107 21st century leaders are less reliant on “how things should be” and instead approach business challenges and opportunities with an enquiring mind—one that makes room for new possibilities. —Shirlaws Pty Ltd We are not creatures of circumstance; we are creators of circumstance…… - Benjamin Disraeli References: Lucy J Hood, Susan Leddy, J Mae Pepper (2014). Conceptual bases of professional nursing. Wolters Klluwer Lippincott Williams and Wilkins Korniewicz, Denise M. (2015). Nursing leadership and management: the advanced practice role. DEstech Publications, Inc. Elizabeth Murray (2017). Nursing leadership and management for patient safety and quality care. F.A. Davis Company Elaine Sorensen Marshall, Marion E. Broome (2016). Transformational leadership in nursing from expert clinician to influential leader. Springer Publishing Company Carol J. Huston (2017). Leadership roles and management functions in nursing, theory and application. Wolters Klluwer Lippincott Williams and Wilkins Shiela Grossman, Theresa Valiga (2008). The new leadership challenge: creating the future of nursing. F.A. Davis Company Yupin Aungsuroch and Joko Gunawan (2019). Viewpoint: Nurses preparation in the era of the fourth industrial revolution. Belitung Nursing Journal 110

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