Nursing Leadership and Management PDF

NURSING LEADERSHIP AND MANAGEMENT ©FanBV 1 ©FanBV 2 ©FanBV 3  LEADERSHIP ❖ A process of influence ❖ A leader influences others to move in the direction of achieving goals ❖ Can occur in a number of dyna...

NURSING LEADERSHIP AND MANAGEMENT ©FanBV 1 ©FanBV 2 ©FanBV 3  LEADERSHIP ❖ A process of influence ❖ A leader influences others to move in the direction of achieving goals ❖ Can occur in a number of dynamics and settings ©FanBV 4  Successful leadership is characterized by… ❖ Positive interactions between the leader and the followers ©FanBV 5  Successful leadership is characterized by… ❖ Leader and followers must have a reciprocal relationship Communications, ideas, and respect move back and forth, not top-down ©FanBV 6  Successful leadership is characterized by… ❖ Not based on traditional views as having authority, command, or power over others ©FanBV 7  Types of Leadership: 1. Formal Leader A person in position has influence and authority Has a sanctioned role within the organization ©FanBV 8  Types of Leadership: 2. Informal Leader A person who demonstrates leadership and has influence in an organization ©FanBV 9  Key traits of an informal leader: ❖ With ability to influence others ❖ Other people in the organization recognize and are influenced by that ability ©FanBV 10  Qualities of effective leadership: Guiding vision ©FanBV 11  Qualities of effective leadership: Passion ©FanBV 12  Qualities of effective leadership: Intelligence Integrity ©FanBV 13  Qualities of effective leadership: ©FanBV 14  Qualities of effective leadership: Flexible Ability to support others ©FanBV 15  Qualities of effective leadership: Desire to lead Self-confidence ©FanBV 16 ©FanBV 17  Theories on Leadership ©FanBV 18  Theories on Leadership ❖ Behavioral Theories – developed by Kurt Lewin and colleagues in 1930’s focusing on the leader’s actions or behavior ❖ Contingency Theories – outcome of leadership style are determined by environmental factors other than the leader’s behavior ©FanBV 19  Theories on Leadership ❖ Contemporary Theories – address the leader’s behaviors or functions to allow organizations to transform themselves based on changes in environment ❖ Motivational Theories – designed to help understand the processes involved in people’s behavior ❖ Others: “new leadership”, “feminine approach” ©FanBV 20  Behavioral Theories on Leadership: Autocratic Leadership Centralized decision making Leader makes decision and expects subordinates to obey Leader uses power to command and control May produce significant result, but generally not effective as long-term style ©FanBV 21 ©FanBV 22 ©FanBV 23 ©FanBV 24  Behavioral Theories on Leadership: Laissez-faire Leadership Opposite of autocratic leadership Decision making defers to the followers or subordinates Leader often permissive and tends to be uninvolved ©FanBV 25 ©FanBV 26 ©FanBV 27  Behavioral Theories on Leadership: Democratic Leadership Leader allows others to participate in decision making and to share authority Leader’s power is derived from own expertise and leverage from close relationships with others Organization performs well whether the leader is present or not Both leaders and followers maintain positive relationship ©FanBV 28 ©FanBV 29 ©FanBV 30 ©FanBV 31  Behavioral Theories on Leadership: Employee-centered Leadership Focus is on human needs of the employees Considered more effective than job-focused style ©FanBV 32  Contingency Theories on Leadership: Contingency Theory (Fred Fiedler) Leader’s behavior depends on the interaction of the leader’s personality and the particular needs of the situation ©FanBV 33 ©FanBV 34  Contingency Theories on Leadership: Path-Goal Theory (Robert House) Leader matches style to the situation and creates appropriate path easier for workers to follow and achieve goals Based on expectancy theory  motivated by carrying out the tasks resulting to desired outcome and provision of rewards for the work ©FanBV 35 ©FanBV 36  Contingency Theories on Leadership: Situational Theory (Hersey-Blanchard) Effectiveness of leader depends on the followers Leader tends to change or adapt leadership style to match the followers’ needs Leader attempts to increase the followers’ level of maturity ©FanBV 37 ©FanBV 38  Contingency Theories on Leadership: Substitute-for-Leadership Theory (Kerr and Jermier) Certain factors may influence followers’ behaviors as much as or even more than the leader’s behavior Identified “substitutes” for leader behavior: − Amount of feedback provided by the task itself − Significant work group cohesion − Group’s rigid adherence to rules − Intrinsic satisfaction provided by the task ©FanBV 39 ©FanBV 40  Contemporary Theories on Leadership: Charismatic Theory Charisma – leadership quality that inspires followers’ allegiance and devotion Leaders with charisma can make emotional connections with their followers ©FanBV 41 ©FanBV 42 ©FanBV 43 ©FanBV 44  Contemporary Theories on Leadership: Transactional Leadership Theory Responsible for day-to-day operations Focuses on exchange of rewards and punishment to motivate and manage followers Can be effective in achieving short-term goals and maintaining performance standards May not foster supportive and innovative work environment in the long run ©FanBV 45 ©FanBV 46 ©FanBV 47  Contemporary Theories on Leadership: Transformational Leadership Theory Based on the concept of empowerment Focuses on allowing change and innovation Maintains the overall vision and motivates people to incorporate that vision in their work Both leader and follower work together to achieve a common or collective goal ©FanBV 48 ©FanBV 49 ©FanBV 50 ©FanBV 51  Motivational Theories on Leadership: Reinforcement Theory Based on B.F. Skinner’s operant conditioning theory Views motivation as learning Leaders are most effective when they can control or even manipulate the consequence of followers’ behavior ©FanBV 52  Motivational Theories on Leadership: Reinforcement Theory Considered as behavior-modification approach Works well when: − Enough positive reinforcements exist − Leaders have certain control over followers’ access to rewards ©FanBV 53 ©FanBV 54  Motivational Theories on Leadership: Expectancy Theory (Victor Vroom) Emphasis on people’s expectations about a situation helps determine their behavior People actively and consciously interacting with their environment ©FanBV 55  Motivational components of expectancy theory: 1. Expectancy – perceived probability that certain effort leads to desired action or behavior 2. Instrumentality – belief that a given performance level leads to an outcome 3. Valence – perceived value of that outcome ©FanBV 56 ©FanBV 57  Motivational Theories on Leadership: Equity Theory Degree of perceived fairness in work situation is key to job satisfaction and workers efforts Rewards to workers’ efforts should be proportionate, fair, and just ©FanBV 58  Motivational Theories on Leadership: Goal-setting Theory (Locke and Latham) People expend efforts to accomplish goals, and not just for rewards or task outcomes Assumptions: ▪ Specific goals are more effective than general roles for motivating higher performance ▪ More difficult or challenging goals lead to higher performance A goal without a plan ▪ Incentives or rewards are is just a wish. effective only in encouraging people to change their goals ©FanBV 59 ©FanBV 60 ©FanBV 61 ©FanBV 62  Other Theories on Leadership: New Leadership (Margaret Wheatley) Based on biological concept of organisms Most effective leadership emerges from teams that can direct and The organization as organize themselves living entity and its different parts are interdependent on each other for the entire organization to thrive ©FanBV 63  In “new leadership” concept… Leader’s function in the organization: − Use vision to guide the followers − Help followers make choices based on values shared by the leader and followers − Provide meaning and coherence in the organizational culture ©FanBV 64  Other Theories on Leadership: Servant Leadership Prioritizes the growth and well-being of others ©FanBV 65 ©FanBV 66 Other Theories on Leadership: Feminine leadership ©FanBV 67  Other Theories on Leadership: Feminine leadership: Appropriate to nursing practice Flexible to keep pace with complexities of people, client care, and technology ©FanBV 68 ©FanBV 69 ©FanBV 70  Characteristics of “feminine” approach to leadership: Flexible interconnections are valued more than rigid hierarchies Power and information are seen as a shared, nonfinite commodity Less emphasis on competition or “winning” Focus on relation, participation, facilitating, nurturing, and diversity ©FanBV 71  Distinctive leadership styles in nursing: Adaptive Strength-based Flexible, willing to change, Focuses and capitalizes on and devise new approaches own and others’ talents Mindful Emotionally intelligent Thoughtful, analytic, and Aware of own and others’ open to new ideas feelings Servant Empathetic, leads to serve others ©FanBV 72  Distinctive leadership styles in nursing: Resonant Charismatic Motivates others through With magnetic personality, their energy and enthusiasm attracting others to follow them Tribal Authentic Builds a common culture Demonstrates integrity, with strong sharing of character, and honesty in values and beliefs relating to others ©FanBV 73  Distinctive leadership styles in nursing: Storyteller Narcissistic Uses stories to convey Does not listen to others and messages in a memorable, does not tolerate disagreement, motivating fashions but have a compelling vision No Excuse The Level 5 Mentally tough, Ferociously pursue goals, but emphasizes accountability gives credit to others and take and decisiveness responsibility for own mistakes ©FanBV 74 ©FanBV 75  Power The capacity to act The strength and potency to accomplish something ©FanBV 76  “The nurse leader/manager who is knowledgeable about the wise use of authority, power, and political strategy is more effective at meeting personal and organization goals.” ©FanBV 77 ©FanBV 78  Coercive Power Based on fear of punishment if leader/manager’s expectation is not met Reward Power Obtained by ability to grant favors or reward others with whatever they value ©FanBV 79  Legitimate Power Gained by a title or official position within an organization Expert Power Gained through knowledge, expertise, or experience ©FanBV 80  Referent Power Inherent in a person, as others identify with that leader or with what the leader symbolizes “charismatic power” ©FanBV 81 ©FanBV 82 ©FanBV 83  Leadership styles and empowerment in application to Nursing practice.... ©FanBV 84 ©FanBV 85  MANAGEMENT ❖ A process of: − coordinating actions − directing actions − assigning resources ❖ Purpose: To perform actions/tasks in order to achieve the goals or desired outcomes of the organization ©FanBV 86  MANAGEMENT ❖ Focuses on costs, productivity, staffing, and effectiveness ❖ Leadership plays an important role in management ❖ Nurse manager – responsible for translating the administration’s vision into operating plans and acting in the middle and first-line levels of hierarchy ❖ Involves the process of planning, organizing, staffing, directing, and controlling ©FanBV 87  Management Functions ©FanBV 88  Management Functions PLANNING Determining the objectives of the organization and what needs to be done Addresses the what, why, where, when, how, and by whom ©FanBV 89  Management Functions PLANNING 4-stage process: 1. Establish objectives or goals 2. Evaluate the present and predict future trends and events 3. Formulate a planning statement 4. Convert the plan into an action statement ©FanBV 90  Management Functions ORGANIZING Process of coordinating human and other resources to meet established goals Based on plan and knowledge about the structure of the organization ©FanBV 91  Management Functions ORGANIZING Effective organizing consists of: − Knowledge of factors in institution, environment, structure, people, and technology − Ability to assign tasks appropriately Delegating to people who can accomplish the tasks successfully − Using appropriate and accepted types of authority to ensure required tasks are completed ©FanBV 92  Management Functions STAFFING Selecting people who can carry out the tasks or actions Selection is usually based on: − Knowledge, skills, and experience of the nurse − The number and types of clients needing care − Number and type of support staff available ©FanBV 93  Management Functions DIRECTING Motivating and leading personnel to accomplish objectives Depends on the manager’s authority, power, and leadership style ©FanBV 94  Management Functions DIRECTING Effective directing is achieved through: − Setting specific, clear, realistic, and measurable expectations − Providing sufficient resources to accomplish the tasks − Fostering a work environment that balances challenge and success − Finding ways to recognize and reward work that meets objectives ©FanBV 95  Management Functions CONTROLLING Establishing standards of performance Comparing results with benchmarks Correcting performance that differs from accepted standards ©FanBV 96  Management Functions CONTROLLING Includes evaluation of goals/objectives, managerial surveillance, quality control, and performance appraisal ©FanBV 97  Decision-making in management functions: ❖ Identify problems ❖ Establish criteria that can evaluate potential solutions to the problem ❖ Seek alternative solutions, including taking no actions ❖ Evaluate all alternatives identified ❖ Select the best or appropriate alternate based on organizational objectives, staff, environment, and other available resources ©FanBV 98  Factors affecting management roles and decisions: ❖ Organizational structure ❖ Objectives of the organization ❖ Environmental factors → current economic status or social influences ❖ Tasks required or expected ❖ Social structure ❖ Technology ©FanBV 99  Theories on Management ©FanBV 100  Theories on Management: Scientific Management Theory (Frederick Taylor) Focuses on maximizing the workers’ production levels and efficiency Includes systematic series of tasks that can be measured, predicted, and manipulated to increase efficiency Provides important feedback about workflow Revolutionized the surgical method ©FanBV 101 ©FanBV 102  Theories on Management: Bureaucratic Theory (Max Weber) Focuses on employee competence as basis for hiring and promoting Emphasis on orderly and rational, not the interpersonal Efficiency is achieved through impersonal relations within a formal structure Stresses strong top-down hierarchy with clear superior-subordinate communication and relationships ©FanBV 103 ©FanBV 104 ©FanBV 105  Theories on Management: Administrative Theory (Henri Fayol) Essentials to the functioning of an organization → planning, organizing, coordinating, and controlling Unity of command and direction as additional component of the management process Managers must recognize Also recognizes the power of informal and work with these informal structures within the organization structures to achieve the best outcomes for the organization ©FanBV 106 ©FanBV 107  Theories on Management: Human Relations Theory Known also as organizational behavior Focuses on the individual worker as the key to organizational motivation, productivity, and control Workers are motivated by other workers Hawthorne effect – person’s behavior changes when being observed or monitored ©FanBV 108  Theories on Management: Motivational Theory Based on human relations theory Emphasized that workers’ performance or outputs are best when treated humanely Motivation directs human behavior to work efficiently and satisfy needs ©FanBV 109  Common Motivational Theories on Management: ❖ Maslow’s Hierarchy of Needs Satisfy basic needs first before higher needs ©FanBV 110  Common Motivational Theories on Management: ❖ Herzberg’s Motivation-Hygiene Theory Maintain adequate wages and safe workplace Motivations include meaningful work, recognition of accomplishments, and development of opportunities ©FanBV 111  Common Motivational Theories on Management: ❖ Herzberg’s Motivation-Hygiene Theory ©FanBV 112  Common Motivational Theories on Management: ❖ McGregor’s Theory X and Theory Y Theory X – manager must direct and control work motivation Theory Y – manager must remove obstacles and help workers meet personal goals self-controlled and self-disciplined ©FanBV 113  Common Motivational Theories on Management: ❖ Ouchi’s Theory Z Collective decision making, long-term job security, use of quality circles, and humanistic management style are best ways to motivate ©FanBV 114 ©FanBV 115 ©FanBV 116 ©FanBV 117 ©FanBV 118 ©FanBV 119  LEADERSHIP VS. MANAGEMENT Based on influence and shared meaning Based on authority Set the vision Follow the vision Think ideas Think execution Look in the future Work in the present Shape the culture Endorse the culture An informal role A formally designated role An achieved position An assigned position Usually responsible for planning, organizing, Part of every nurse’s responsibility directing, and controlling processes Enhanced using effective leadership Requires initiative and independent thinking skills/styles Inspire people Drive people’s success ©FanBV 120  The Management Process  Planning Organizing Directing Controlling ©FanBV 121  PLANNING Determining the objectives of the organization and what needs to be done Addresses the what, why, where, when, how, and by whom ©FanBV 122 ©FanBV 123  ❖ Forecasting Involves trying to estimate how a condition will be in the future Takes advantage of input from others Gives sequence in activity Protects the organization against undesirable changes ©FanBV 124  ❖ Strategic Planning Examines an organization’s purpose, mission, philosophy, and goals in the context of its external environment ©FanBV 125 ©FanBV 126 ©FanBV 127  ❖ SWOT Analysis Developed by Albert Humphrey Tool used to assess the Strengths, Weaknesses, Opportunities, and Threats of an organization ©FanBV 128  Internal attributes that help the organization achieve its goals Internal attributes that challenge the organization in achieving its goals External conditions that promote achievement of organizational goals External conditions that challenge or threaten the achievement of organizational goals ©FanBV 129  and Vision Core Values ©FanBV 130  and Vision Core Values ©FanBV 131  Mission Vision A brief statement identifying the Used to describe future goals reason the organization exists or aims of the organization Identifies the organization’s Conjures up a picture and constituency and addresses its guides all members of what position regarding principles, they want to accomplish ethics, and standards of practice together ©FanBV 132  Philosophy The foundation that directs all further planning toward that mission Flows from the purpose or mission statement and describes the set of values and beliefs that guide all actions of the organization Provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole ©FanBV 133  Goals and Objectives The foundation that directs all further planning toward that mission Flows from the purpose or mission statement and describes the set of values and beliefs that guide all actions of the organization Both motivate people to a specific end S.M.A.R.T. ©FanBV 134  Policies Procedures Stated plans and instructions Plans that establish routines to direct the organization in or acceptable ways of decision making accomplishing specific tasks Explain how goals will be met Outline sequence of steps of required actions Guide the general course and scope of organizational Identify the process or steps activities needed to implement a policy Generally found in manuals at the unit level of the organization ©FanBV 135  Policies Procedures Stated plans and instructions Plans that establish routines to direct the organization in or acceptable ways of decision making accomplishing specific tasks Explain how goals will be met Outline sequence of steps of required actions Guide the general course and scope of organizational Identify the process or steps activities needed to implement a policy Generally found in manuals at the unit level of the organization ©FanBV 136 ©FanBV 137  Rules and Regulations Define specific action or non-action Enforced to keep morale from breaking down and to allow organizational structure ©FanBV 138  CHANGE THEORY Change agent undertakes phases before a planned change becomes part of the system (Kurt Lewin 1951) 1. Unfreezing – occurs when change agent convinces members to Ensures readiness for change or when guilt, anxiety, or change concern can be elicited 2. Movement – change agent Make sure driving identifies, plans, and implements forces exceed restraining forces appropriate strategies 3. Refreezing – change agent assists Becomes integrated into in stabilizing the system change the status quo ©FanBV 139 ©FanBV 140  Roles and responsibilities during the phases of change: 1. Unfreezing phase ✓ gather data ✓ accurately diagnose the problem ✓ decide if change is needed ✓ make others aware of the need for change Nursing Alert: ❖ Do not proceed until status quo has been disrupted and the need for changes is perceived by others ©FanBV 141  Roles and responsibilities during the phases of change: 2. Movement phase ✓ develop a plan ✓ set goals and objectives ✓ set target dates ✓ include everyone who will be affected by the change in planning ✓ identify areas of support and resistance ✓ develop appropriate strategies ✓ implement the change ✓ be available to support others and offer encouragement through the change ✓ use strategies for overcoming resistance to change ✓ evaluate the change ✓ modify the change if necessary ©FanBV 142  Roles and responsibilities during the phases of change: 3. Refreezing phase ✓ ensure change becomes permanent ✓ develop ways to sustain the change ✓ anchor the change into the culture ✓ provide support and training so that change continues ✓ celebrate successes ©FanBV 143  CHAOS THEORY ▪ Tiny changes in variables often dramatically affect the outcomes (Edward Lorenz 1960) ▪ Small changes in conditions can drastically alter a system’s long-term behavior  “butterfly effect” ©FanBV 144  BUDGET ❖ A financial plan that includes estimated expenses and target income for a period of time ❖ The more accurate is the budget plan, the better the institution/organization can plan the most efficient use of its resources ©FanBV 145 ©FanBV 146  The Management Process Planning  Organizing Directing Controlling ©FanBV 147