Essentials of Nursing Leadership and Management PDF

Essentials of Nursing Leadership and Management fifth edition Essentials of Nursing Leadership and Management fifth edition Diane K. Whitehead, EdD, RN, ANEF Associate Dean, Nursing Nova Southeastern University...

Essentials of Nursing Leadership and Management fifth edition Essentials of Nursing Leadership and Management fifth edition Diane K. Whitehead, EdD, RN, ANEF Associate Dean, Nursing Nova Southeastern University Fort Lauderdale, Florida Sally A. Weiss, EdD, RN, CNE Associate Chair, Nursing Nova Southeastern University Fort Lauderdale, Florida Ruth M. Tappen, EdD, RN, FAAN Christine E. Lynn Eminent Scholar and Professor Florida Atlantic University College of Nursing Boca Raton, Florida F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2010 by F. A. Davis Company Copyright © 2007, 2004, 2001, 1998 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisition Editor: Joanne Patzek DaCunha, RN, MSN Project Editors: Kim DePaul, Tyler Baber Manager of Art & Design: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new informa- tion regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Whitehead, Diane K., 1945- Essentials of nursing leadership and management / Diane K. Whitehead, Sally A. Weiss, Ruth M. Tappen. -- 5th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8036-2208-1 (pbk. : alk. paper) 1. Nursing services--Administration. 2. Leadership. I. Weiss, Sally A., 1950- II. Tappen, Ruth M. III. Title. [DNLM: 1. Nursing--United States. 2. Leadership--United States. 3. Nursing--organization & administration-- United States. 4. Nursing Services--organization & administration--United States. WY 16 W592e 2010] RT89.T357 2010 362.1'73068--dc22 2009017339 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is grant- ed by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-2208-2/10 0 + $.25.  Dedication To my sister Michele: Your bravery and spirit inspire me every day. Diane K. Whitehead To my granddaughter Sydni, Whose curiosity and wonder continuously remind me of the reasons I became a nurse educator. Sally A. Weiss To students, colleagues, family and friends, Who have taught me just about everything I know. Ruth M. Tappen v  Preface We are delighted to bring our readers this Fifth Edition of Essentials of Nursing Leadership and Management. This new edition has been updated to reflect the current health-care environment. As in our previous editions, the content, examples, and diagrams were designed with the goal of assisting the new graduate to make the transition to professional nursing practice. The Fifth Edition of Essentials of Nursing Leadership and Management focuses on the necessary knowledge and skills needed by the staff nurse as a vital member of the health-care team and manag- er of patient care. Issues related to setting priorities, delegation, qual- ity improvement, legal parameters of nursing practice, and ethical issues were updated for this edition. We are especially excited to introduce a new chapter, Quality and Safety. This chapter focuses on the current quality and safety issues and initiatives that affect the current health-care environment. In addition, the updated finance chapter and a new chapter on health- care policy will be available on the F.A. Davis Web site, DavisPlus. We continue to bring you comprehensive, practical information on developing a nursing career. Updated information on leading, manag- ing, followership, and workplace issues continues to be included. Essentials of Nursing Leadership and Management continues to provide a strong foundation for the beginning nurse leader. We want to thank the people at F.A. Davis for their assistance as well as our contributors, reviewers, and students for their guidance and support. Diane K. Whitehead Sally A. Weiss Ruth M. Tappen vii  Contributors Patricia Bradley, MEd, PhD, RN Denise Howard, BSN, RN Coordinator, Internationally Educated Nurses Adjunct Faculty Program Nursing Department Faculty, Nursing Department Nova Southeastern University York University Fort Lauderdale, Florida Toronto, Ontario, Canada Marcie Rutherford, PhD, MBA, MSN, RN Kristie Campoe, MSN, RN Assistant Professor Adjunct Faculty Nursing Department Nursing Department Nova Southeastern University Nova Southeastern University Fort Lauderdale, Florida Fort Lauderdale, Florida Wendy Thomson, EdD(c), MSN, BSBA, RN, CNE, IBCLC Patricia Welch Dittman, PhD, RN, CDE Assistant Director of Technology and Graduate Program Director/Assistant Professor Simulation/Assistant Professor Nursing Department Nursing Department Nova Southeastern University Nova Southeastern University Fort Lauderdale, Florida Fort Lauderdale, Florida ix  Table of Contents unit 1 Professional Considerations chapter 1 Leadership and Followership 3 chapter 2 Manager 13 chapter 3 Nursing Practice and the Law 21 chapter 4 Questions of Value and Ethics 39 chapter 5 Organizations, Power, and Empowerment 57 unit 2 Working Within the Organization chapter 6 Getting People to Work Together 73 chapter 7 Dealing With Problems and Conflicts 91 chapter 8 People and the Process of Change 103 chapter 9 Delegation of Client Care 115 chapter 10 Quality and Safety 131 chapter 11 Time Management 157 unit 3 Professional Issues chapter 12 Promoting a Healthy Workplace 171 chapter 13 Work-Related Stress and Burnout 197 chapter 14 Your Nursing Career 217 chapter 15 Nursing Yesterday and Today 239 xi Appendices appendix 1 Codes of Ethics for Nurses 257 American Nurses Association Code of Ethics for Nurses 257 Canadian Nurse Association Code of Ethics for Registered Nurses 257 The International Council of Nurses Code of Ethics for Nurses 258 appendix 2 Standards Published by the American Nurses Association 259 appendix 3 Guidelines for the Registered Nurse in Giving, Accepting, or Rejecting a Work Assignment 261 Index 267 Bonus Chapters on DavisPlus Finance Triaxial of Action: Policy, Politics, and Nursing Canadian Nursing Practice and the Law xii  1 unit Professional Considerations chapter 1 Leadership and Followership chapter 2 Manager chapter 3 Nursing Practice and the Law chapter 4 Questions of Values and Ethics chapter 5 Organizations, Power, and Empowerment  chapter 1 Leadership and Followership OBJECTIVES OUTLINE After reading this chapter, the student should be able to: Leadership Define the terms leadership and followership. Are You Ready to Be a Leader? Discuss the importance of effective leadership and Leadership Defined followership for the new nurse. Discuss the qualities and behaviors that contribute to Followership effective followership. Followership Defined Discuss the qualities and behaviors that contribute to Becoming a Better Follower effective leadership. What Makes a Person a Leader? Leadership Theories Trait Theories Behavioral Theories Task Versus Relationship Motivating Theories Emotional Intelligence Situational Theories Transformational Leadership Moral Leadership Qualities of an Effective Leader Behaviors of an Effective Leader Conclusion 3 4 unit 1 | Professional Considerations Nurses work with an extraordinary variety of people: paying attention to that,” the nurse manager told physicians, respiratory therapists, physical therapists, her. “I’m so glad you brought it to my attention.” social workers, psychologists, technicians, aides, unit Billie’s nurse manager raised the issue at the next managers, housekeepers, clients, and clients’ families. executive meeting, giving credit to Billie for having The reason why nurses study leadership is to brought it to her attention. The other nurse man- learn how to work well, or effectively, with other agers had the same response. “We were so focused on people. In this chapter, leadership and followership the new record system that we overlooked that. We and the relationships between them are defined. need to take care of this situation as soon as possible. The characteristics and behaviors that can make Billie Blair Thomas has leadership potential.” you, a new nurse, an effective leader and follower are discussed. Leadership Defined Leadership is a much broader concept than is man- agement. Although managers should also be lead- Leadership ers, management is focused on the achievement of Are You Ready to Be a Leader? organizational goals. Leadership, on the other hand: You may be thinking, “I’m just beginning my career...occurs whenever one person attempts to influence in nursing. How can I be expected to be a leader the behavior of an individual or group—up, down, now?” This is an important question. You will need or sideways in the organization—regardless of the time to refine your clinical skills and learn how to reason. It may be for personal goals or for the goals function in a new environment. But you can begin of others, and these goals may or may not be congru- to assume some leadership right away within your ent with organizational goals. Leadership is influ- new nursing roles. Consider the following example: ence (Hersey & Campbell, 2004, p. 12) Billie Blair Thomas was a new staff nurse at Green In order to lead, one must develop three important Valley Nursing Care Center. After orientation, she competencies: (1) ability to diagnose or understand was assigned to a rehabilitation unit with high the situation you want to influence, (2) adaptation admission and discharge rates. Billie noticed that in order to allow your behaviors and other resources admissions and discharges were assigned rather hap- to close the gap between the current situation and hazardly. Anyone who was “free” at the moment was what you are hoping to achieve, and (3) communi- directed to handle them. Sometimes, unlicensed assis- cation. No matter how much you diagnose or tant personnel were directed to admit or discharge adapt, if you cannot communicate effectively, you residents. Billie believed that using them was inap- will probably not meet your goal (Hersey & propriate because their assessment skills were limited Campbell, 2004). and they had no training in discharge planning. Effective nurse leaders are those who engage Billie thought there was a better way to do this others to work together effectively in pursuit of a but was not sure that she should say so because she shared goal. Examples of shared goals are pro- was so new. “Maybe they’ve already thought of viding excellent client care, designing a cost- this,” she said to a former classmate. “It’s such an saving procedure, and challenging the ethics of a obvious solution.” They began to talk about what new policy. they had learned in their leadership course before graduation. “I just keep hearing our instructor say- Followership ing, ‘There’s only one manager, but anyone can be a leader of our group.” Followership and leadership are separate but recip- “If you want to be a leader, you have to act on rocal roles. Without followers, one cannot be a your idea,” her friend said. leader; conversely, one cannot be a follower without “Maybe I will,” Billie replied. a leader (Lyons, 2002). Billie decided to speak with her nurse manager, Being an effective follower is as important to the an experienced rehabilitation nurse who seemed new nurse as is being an effective leader. In fact, not only approachable but also open to new ideas. most of the time most of us are followers: members “I have been so busy getting our new record system of a team, attendees at a meeting, staff of a nursing on line before the surveyors come that I wasn’t care unit, and so forth.  chapter 1 | Leadership and Followership 5 Followership Defined If the situation worsens, enlist the support of Followership is not a passive role. On the contrary, others on your team to seek a remedy; do not the most valuable follower is a skilled, self-directed try to do this alone as a new graduate. If the situation becomes intolerable, consider the employee, one who participates actively in setting the group’s direction, invests his or her time and option of transferring to another unit or seeking energy in the work of the group, thinks critically, another position (Deutschman, 2005; Korn, 2004). and advocates for new ideas (Grossman & Valiga, 2000). Imagine working on a client care unit where What Makes a Person a Leader? all staff members, from the unit secretary to the assistant nurse manager, willingly take on extra Leadership Theories tasks without being asked (Spreitzer & Quinn, There are many different ideas about how a person 2001), come back early from coffee breaks, com- becomes a good leader. Despite years of research on plete their charting on time, suggest ways to this subject, no one idea has emerged as the clear improve client care, and are proud of the high qual- winner. The reason for this may be that different ity care they provide. Wouldn’t it be wonderful to qualities and behaviors are most important in differ- be a part of that team? ent situations. In nursing, for example, some situa- tions require quick thinking and fast action. Others Becoming a Better Follower require time to figure out the best solution to a There are a number of things you can do to become complicated problem. Different leadership qualities a better follower: and behaviors are needed in these two instances.The If you discover a problem, inform your team result is that there is not yet a single best answer to leader or manager right away. the question, “What makes a person a leader?” Even better, include a suggestion in your report Consider some of the best-known leadership for solving the problem. theories and the many qualities and behaviors that Freely invest your interest and energy in your have been identified as those of the effective nurse work. leader (Pavitt, 1999; Tappen, 2001). Be supportive of new ideas and new directions Trait Theories suggested by others. At one time or another, you have probably heard When you disagree, explain why you do not someone say, “Leaders are born, not made.” In other support an idea or suggestion. words, some people are natural leaders, and others Listen carefully, and reflect on what your leader are not. In reality, leadership may come more easily or manager says. to some than to others, but everyone can be a Continue to learn as much as you can about leader, given the necessary knowledge and skill. your specialty area. Research into the traits of leaders is a continuing Share what you learn. process. A 5-year study of 90 outstanding leaders Being an effective follower will not only make you by Warren Bennis (1984) identified four common a more valuable employee but will also increase the traits shared by all of these leaders. These traits meaning and satisfaction that you can get from continue to hold true: your work. 1. Management of attention. These leaders were Most team leaders and nurse managers will able to communicate a sense of goal or direction respond very positively to having staff who are to attract followers. good followers. Occasionally you will encounter a 2. Management of meaning. These leaders created poor leader or manager who can confuse, frustrate, and communicated meaning with clarity and and even distress you. Here are a few suggestions purpose. for handling this: 3. Management of trust. These leaders demon- Avoid adopting the ineffective behaviors of this strated reliability and consistency. individual. 4. Management of self. These leaders were able to Continue to do your best work and to provide know self and work within their strengths and leadership for the rest of the group. weaknesses (Bennis, 1984). 6 unit 1 | Professional Considerations Behavioral Theories because they need little guidance. Most people, The behavioral theories are concerned with what however, flounder under this kind of leadership. the leader does. One of the most influential theo- Pavitt summed up the difference among these three ries is concerned with leadership style (White & styles: a democratic leader tries to move the group Lippitt, 1960) (Table 1-1). toward its goals; an autocratic leader tries to move The three styles are: the group toward the leader’s goals; and a laissez- Autocratic leadership (also called directive, con- faire leader makes no attempt to move the group trolling, or authoritarian). The autocratic leader (1999, pp. 330ff ). gives orders and makes decisions for the group. For example, when a decision needs to be made, Task Versus Relationship an autocratic leader says, “I’ve decided that this Another important distinction in leadership style is is the way we’re going to solve our problem.” between a task focus and a relationship focus Although this is an efficient way to run things, (Blake, Mouton, & Tapper, 1981). Some nurses it usually dampens creativity and may inhibit emphasize the tasks (e.g., reducing medication motivation. errors, completing patient records) and fail to real- Democratic leadership (also called participative). ize that interpersonal relationships (e.g., attitude of Democratic leaders share leadership. Important physicians toward nursing staff, treatment of plans and decisions are made with the team housekeeping staff by nurses) affect the morale and (Chrispeels, 2004). Although this is often a less productivity of employees. Other nurses focus on efficient way to run things, it is more flexible the interpersonal aspects and ignore the quality of and usually increases motivation and creativity. the job being done as long as people get along with Democratic leadership is characterized by guid- each other. The most effective leader is able to bal- ance from rather than control by the leader. ance the two, attending to both the task and the Laissez-faire leadership (also called permissive or relationship aspects of working together. nondirective). The laissez-faire (“let someone do”) leader does very little planning or decision Motivating Theories making and fails to encourage others to do so. The concept of motivation seems fairly simple. We It is really a lack of leadership. For example, do things to get what we want and avoid things that when a decision needs to be made, a laissez-faire we don’t want. However, motivation is still sur- leader may postpone making the decision or rounded in mystery. The study of motivation as a never make the decision. In most instances, the focus of leadership began in the 1920s with the laissez-faire leader leaves people feeling con- historic Hawthorne study. Several experiments were fused and frustrated because there is no goal, no conducted to see if increasing light and, later, guidance, and no direction. Some very mature improved working conditions would improve pro- individuals thrive under laissez-faire leadership ductivity of workers in the Hawthorne, Illinois, table 1-1 Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles Autocratic Democratic Laissez-Faire Amount of freedom Little freedom Moderate freedom Much freedom Amount of control High control Moderate control Little control Decision making By the leader Leader and group together By the group or by no one Leader activity level High High Minimal Assumption of responsibility Leader Shared Abdicated Output of the group High quantity, good Creative, high quality Variable, may be poor quality quality Efficiency Very efficient Less efficient than Inefficient autocratic style Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and Democracy: An Experimental Inquiry. New York: Harper & Row.  chapter 1 | Leadership and Followership 7 electrical plant. Those workers who had the First, learn how to recognize and understand improved working conditions taken away continued your own emotions, and learn how to manage to show improved productivity. Therefore, the them, channel them, stay calm and clear-headed, answers were found not in the conditions of the and suspend judgment until all the facts are in experiments but in the attention given to the work- when a crisis occurs (Baggett & Baggett, 2005). ers by the experimenters. Similar to the 1954 The emotionally intelligent leader welcomes con- Maslow Hierarchy of Needs theory, the 1959 structive criticism, asks for help when needed, can Motivation-Hygiene theory developed by Frederick juggle multiple demands without losing focus, and Herzberg looked at factors that motivated workers can turn problems into opportunities. in the workplace. Following closely after Herzberg Second, the emotionally intelligent leader listens was David McClelland and his 1961 Theory of attentively to others, perceives unspoken concerns, Needs. Clayton Alderfer responded to Maslow’s acknowledges others’ perspectives, and brings peo- theory with his own Existence, Relatedness, and ple together in an atmosphere of respect, coopera- Growth (ERG) theory. Table 1-2 summarizes these tion, collegiality, and helpfulness so they can direct four historical motivation theories. their energies toward achieving the team’s goals. “The enthusiastic, caring, and supportive leader Emotional Intelligence generates those same feelings throughout the The relationship aspects of leadership are a focus team,” wrote Porter-O’Grady of the emotionally of the work on emotional intelligence (Goleman, intelligent leader (2003, p. 109). Boyatzes, & McKee, 2002). Part of what distin- guishes ordinary leaders from leadership “stars” Situational Theories is consciously addressing the effect of people’s People and leadership situations are far more complex feelings on the team’s emotional reality. How is than the early theories recognized. In addition, situa- this done? tions can change rapidly, requiring more complex table 1-2 Leading Motivation Theories Theory Summary of Motivation Requirements Maslow, 1954 Categories of Need: Lower needs (below, listed first) must be fulfilled before others are activated. Physiological Safety Belongingness Esteem Self-actualization Alderfer, 1972 Three categories of needs, also ordered into a hierarchy: 1. Existence: Physical well-being 2. Relatedness: Satisfactory relations with others 3. Growth: Development of competence and realization of potential Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction, but their presence does not motivate or increase satisfaction. 1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary 2. Motivators: Achievement, recognition, the work itself, responsibility, advancement McClelland, 1961 Motivation results from three dominant needs. Usually all three needs are present in each individual but vary in importance depending on the position a person has in the workplace. Needs are also shaped over time by culture and experience. 1. Need for achievement: Performing tasks on a challenging and high level 2. Need for affiliation: Good relationships with others 3. Need for power: Being in charge Adapted from Hersey, P. & Campbell, R. (2004). Leadership: A Behavioral Science Approach. Calif.: Leadership Studies Publishing. 8 unit 1 | Professional Considerations theories to explain leadership (Bennis, Spreitzer, & that goes beyond good interpersonal relationships Cummings, 2001). or the appropriate reward for a job well done (Bass Adaptability is the key to the situational & Avolio, 1993). This is especially true in nursing. approach (McNichol, 2000). Instead of assuming Caring for people, sick or well, is the goal of the that one particular approach works in all situations, profession. Most people chose nursing in order to situational theories recognize the complexity of work do something for the good of humankind: this is situations and encourage the leader to consider many their vision. One responsibility of leadership is to factors when deciding what action to take. help nurses achieve their vision. Situational theories emphasize the importance Transformational leaders can communicate of understanding all the factors that affect a partic- their vision in a manner that is so meaningful and ular group of people in a particular environment. exciting that it reduces negativity (Leach, 2005) The most well-known and still practiced theory is and inspires commitment in the people with whom the Situational Leadership Model by Dr. Paul they work (Trofino, 1995). If successful, the goals of Hersey. The appeal of this model is that it focuses the leader and staff will “become fused, creating on the task and the follower. The key is to marry unity, wholeness, and a collective purpose” (Barker, the readiness of the follower with the task behav- 1992, p. 42). ior at hand. “Readiness is defined as the extent to which a follower demonstrates the ability and will- Moral Leadership ingness to accomplish a specific task” (Hersey & The corporate scandals of recent years have redi- Campbell, 2004, p. 114). The task behavior is rected attention to the values and ethics that defined as “the extent to which the leader engages underlie the practice of leadership as well as that of in spelling out the duties and responsibilities of an client care (Dantley, 2005). Caring about the peo- individual and a group” (Hersey & Campbell, ple who work for you as people as well as employ- 2004, p. 114). ees (Spears & Lawrence, 2004) is part of moral Followers’ readiness levels can range from unable leadership. This can be a great challenge in times of and unwilling (or insecure) to able, willing, and limited financial resources. confident. The leader’s behavior will focus on appro- Molly Benedict was a team leader on the acute priately fulfilling the follower’s needs, which are iden- geriatric unit (AGU) when a question of moral tified by their readiness level and the task. Leader leadership arose. Faced with large budget cuts in behaviors will range from telling, guiding, and direct- the middle of the year and feeling a little desperate ing to delegating, observing, and monitoring. to f igure out how to run the AGU with fewer Where did you fall in this model during your first staff, her nurse manager suggested that reducing clinical rotation compared with where you are now? the time that unlicensed assistive personnel (UAP) In the beginning, the clinical instructor was giving spent ambulating the clients would enable him to you clear instructions and guiding and directing you. increase UAP workload from 10 to 15 clients. Now, she or he is most likely delegating, observing, “George,” responded Molly, “you know that inac- and monitoring. However, as you move into your tivity has many harmful effects, from emboli to first nursing position, you may return to the guiding disorientation in our very elderly population. and directing stage. On the other hand, you may Instead, let’s try to figure out how to encourage have become a leader/instructor for new students, more self-care or even family involvement in care and you may be guiding and directing them. so the UAP can still walk clients and prevent their Transformational Leadership becoming nonambulatory.” Molly based her response on important values, particularly those of Although the situational theories were an improve- prevention. ment over earlier theories, there was still something missing. Meaning, inspiration, and vision were not given enough attention (Tappen, 2001). These Qualities of an Effective Leader are the distinguishing features of transformational If leadership is seen as the ability to influence, what leadership. qualities must the leader possess in order to be able The transformational theory of leadership to do that? Integrity, courage, attitude, initiative, emphasizes that people need a sense of mission energy, optimism, perseverance, balance, ability to  chapter 1 | Leadership and Followership 9 handle stress, and self-awareness are some of the endeavors that require effort. It is also important qualities of effective leaders in nursing (Fig. 1.1): that the energy be used wisely. Optimism. When the work is difficult and one Integrity. Integrity is expected of health-care crisis seems to follow another in rapid succession, professionals. Clients, colleagues, and employers it is easy to become discouraged. It is important all expect nurses to be honest, law-abiding, and not to let discouragement keep you and your trustworthy. Adherence to both a code of per- coworkers from seeking ways to resolve the prob- sonal ethics and a code of professional ethics lems. In fact, the ability to see a problem as an (Appendix 1, American Nurses Association opportunity is part of the optimism that makes a Code for Nurses) is expected of every nurse. person an effective leader. Like energy, optimism Would-be leaders who do not exhibit these is “catching.” Holman (1995) called this being a characteristics cannot expect them of their winner instead of a whiner (Table 1-3). followers. This is an essential component of Perseverance. Effective leaders do not give up moral leadership. easily. Instead, they persist, continuing their Courage. Sometimes, being a leader means efforts when others are tempted to stop trying. taking some risks. In the story of Billie Blair This persistence often pays off. Thomas, for example, Billie needed some Balance. In the effort to become the best nurses courage to speak to her nurse manager about a they can be, people may forget that other aspects problem she had observed. of life are equally important. As important as Attitude. A good attitude goes a long way in clients and colleagues are, family and friends are making a good leader. In fact, many outstanding important, too. Although school and work are leaders cite attitude as the single greatest reason meaningful activities, cultural, social, recreational, for not hiring someone (Maxwell, 1993, p. 98). and spiritual activities also have meaning. People A leader’s attitude is noticed by the followers need to find a balance between work and play. more quickly than are the actions. Ability to handle stress. There is some stress in Initiative. Good ideas are not enough. To be a almost every job. Coping with stress in as posi- leader, you must act on those good ideas. This tive and healthy a manner as possible helps to requires initiative on your part. conserve energy and can be a model for others. Energy. Leadership requires energy. Both lead- Maintaining balance and handling stress are ership and followership are hard but satisfying reviewed in Chapter 10. Self-awareness. How is your emotional intelli- gence? People who do not understand them- selves are limited in their ability to understand Qualities the motivations of others. They are far more likely to fool themselves than are self-aware peo- Integrity Perseverance ple. For example, it is much easier to be fair with Courage Balance a coworker you like than with one you do not Initiative Ability to Energy handle stress Optimism Self-awareness table 1-3 Winner or Whiner—Which Are You? Behaviors A winner says: A whiner says: “We have a real “This is really a problem.” challenge here.” Think critically Set goals, share “I’ll give it my best.” “Do I have to?” Solve problems vision “That’s great!” “That’s nice, I guess.” Communicate Develop self and “We can do it!” “That will never succeed.” skillfully others “Yes!” “Maybe....” Adapted from Holman, L. (1995). Eleven Lessons in Self-leadership: Insights for Personal and Professional Success. Lexington, Ky.: A Lessons Figure 1.1 Keys to effective leadership. in Leadership Book. 10 unit 1 | Professional Considerations like. Recognizing that you like some people more Skillful communication. This includes listening than others is the first step in avoiding unfair to others, encouraging exchange of information, treatment based on personal likes and dislikes. and providing feedback: 1. Listening to others. Listening is separate from Behaviors of an Effective Leader talking with other people: listening emphasizes Leadership requires action. The effective leader that communication involves both giving and chooses the action carefully. Important leadership receiving information. The only way to find behaviors include setting specific goals, thinking out people’s individual wants and needs is to critically, solving problems, respecting people, com- watch what they do and to listen to what they municating skillfully, communicating a vision for say. It is amazing how often leaders fail simply the future, and developing oneself and others. because they did not listen to what other people were trying to tell them. Setting priorities. Whether planning care for a 2. Encouraging exchange of information. Many group of clients or setting the strategic plan misunderstandings and mistakes occur because for an organization, priorities continually people fail to share enough information with shift and demand attention. As a leader you each other. The leader’s role is to make sure will need to remember the three “E’s” of that the channels of communication remain prioritization: evaluate, eliminate, and esti- open and that people use them. mate. Continually evaluate what you need to 3. Providing feedback. Everyone needs some infor- do, eliminate tasks that someone else can do, mation about the effectiveness of his or her and estimate how long your top priorities performance. Frequent feedback, both positive will take you to complete. and negative, is needed so people can continu- Thinking critically. Critical thinking is the care- ally improve their performance. Some nurse ful, deliberate use of reasoned analysis to reach a leaders find it difficult to give negative feedback decision about what to believe or what to do because they fear that they will upset the other (Feldman, 2002). The essence of critical think- person. How else can the person know where ing is a willingness to ask questions and to be improvement is needed? Negative feedback can open to new ideas, new ways to do things. To be given in a manner that is neither hurtful nor avoid falling prey to assumptions and biases of resented by the individual receiving it. In fact, your own and those of others, ask yourself it is often appreciated. Other nurse leaders, frequently, “Do I have the information I need? however, fail to give positive feedback, assum- Is it accurate? Am I prejudging a situation?” ing that coworkers will know when they are ( Jackson, Ignatavicius, & Case, 2004). doing a good job. This is also a mistake because Solving problems. Client problems, paperwork everyone appreciates positive feedback. In fact, problems, staff problems: these and others occur for some people, it is the most important frequently and need to be solved. The effective reward they get from their jobs. leader helps people to identify problems and to work through the problem-solving process to Communicating a vision for the future. The find a reasonable solution. effective leader has a vision for the future. Respecting the individual. Although people Communicating this vision to the group and have much in common, each individual has dif- involving everyone in working toward that ferent wants and needs and has had different vision create the inspiration that keeps people life experiences. For example, some people really going when things become difficult. Even better, value the psychological rewards of helping involving people in creating the vision is not others; other people are more concerned about only more satisfying for employees but also has earning a decent salary. There is nothing wrong the potential for the most creative and innova- with either of these points of view; they are tive outcomes (Kerfott, 2000). It is this vision simply different. The effective leader recognizes that helps make work meaningful. these differences in people and helps them Developing oneself and others. Learning does find the rewards in their work that mean the not end on leaving school. In fact, experienced most to them. nurses say that school is just the beginning, that  chapter 1 | Leadership and Followership 11 school only prepares you to continue learning Conclusion throughout your career. As new and better ways to care for clients are discovered, it is your Leadership ability determines a person’s level of responsibility as a professional to critically effectiveness.To be an effective nurse, you must be an analyze these new approaches and decide effective leader. Your patients, your peers, and your whether they would be better for your clients organization are depending on you to influence oth- than current approaches to care. Effective lead- ers. Leadership develops daily. True leaders never ers not only continue to learn but also encour- stop learning and growing. John Maxwell (1998), one age others to do the same. Sometimes, leaders of America’s experts on leadership, states “who we are function as teachers. At other times, their role is who we attract” (p. xi). To attract leaders, people is primarily to encourage and guide others need to start leading and never stop learning to lead. to seek more knowledge. Observant, reflective, The key elements of leadership and followership analytical practitioners know that learning have been discussed in this chapter. Many of the takes place every day if people are open to it leadership qualities and behaviors mentioned here (Kagan, 1999). are discussed in more detail in later chapters. Study Questions 1. Why is it important for nurses to be good leaders? What qualities have you observed from nurses on the units that exemplify effective leadership in action? How do you think these behaviors might have improved the outcomes of their patients? 2. Why are effective followers as important as effective leaders? 3. Review the various leadership theories discussed in the chapter. Which ones might apply to leading in today’s health-care environment? Support your answer with specific examples. 4. Select an individual whose leadership skills you particularly admire. What are some qualities and behaviors that this individual displays? How do these relate to the leadership theories discussed in this chapter? In what ways could you emulate this person? 5. As a new graduate, what leadership and followership skills will you work on developing or enhanc- ing during the first 3 months of your first nursing position? Why? Case Study to Promote Critical Reasoning Two new associate-degree graduates were hired for the pediatric unit. Both worked three 12-hour shifts a week, Jan in the day-to-evening shift and Ronnie at night. Whenever their shifts connected, they would compare notes on their experience. Jan felt she was learning rapidly, gaining clinical skills and beginning to feel at ease with her colleagues. Ronnie, however, still felt unsure of herself and often isolated. “There have been times,” she told Jan, “that I am the only registered nurse on the unit all night. The aides and LPNs are really expe- rienced, but that’s not enough. I wish I could work with an experienced nurse as you are doing.” “Ronnie, you are not even finished with your 3-month orientation program,” said Jan. “You should never be left alone with all these sick children. Neither of us is ready for that kind of responsibility. And how will you get the experience you need with no experienced nurses to help you? You must speak to our nurse manager about this.” “I know I should, but she’s so hard to reach. I’ve called several times, and she’s never available. She leaves all the shift assignments to her assistant. I’m not sure she even reviews the schedule before it’s posted.” 12 unit 1 | Professional Considerations “You will have to try harder to reach her. Maybe you could stay past the end of your shift one morning and meet with her,” suggested Jan. “If something happens when you are the only nurse on the unit, you will be held responsible.” 1. In your own words, summarize the problem that Jan and Ronnie are discussing. To what extent is this problem due to a failure to lead? Who has failed to act? 2. What style of leadership was displayed by Ronnie and the nurse manager? How effective was their leadership? Did Jan’s leadership differ from that of Ronnie and the nurse manager? In what way? 3. In what ways has Ronnie been an effective follower? In what ways has Ronnie not been so effective as a follower? 4. If an emergency occurred and was not handled well while Ronnie was the only nurse on the unit, who would be responsible? Explain why this person or persons would be responsible. 5. If you found yourself in Ronnie’s situation, what steps would you take to resolve the problem? Show how the leader characteristics and behaviors found in this chapter support your solution to the problem. References Kagan, S.S. (1999). Leadership Games: Experiential Learning for Organizational Development. Thousand Oaks, Calif.: Sage Baggett, M.M., & Baggett, F.B. (2005). Move from management Publications. to high-level leadership. Nursing Management, 36(7), 12. Kerfott, K. (2000). Leadership: Creating a shared destiny. Barker, A.M. (1992). Transformational Nursing Leadership: A Vision Dermatological Nursing, 12(5), 363–364. for the Future. New York: National League for Nursing Press. Korn, M. (2004). Toxic Cleanup: How to Deal With a Dangerous Bass, B.M., & Avolio, B.J. (1993). Transformational leadership: A Leader. Fast Company, 88, 17. response to critiques. In Chemers, M.M., & Ayman, R. (eds.). Leach, L.S. (2005). Nurse executive transformational leadership Leadership Theory and Research: Perspectives and Direction. and organizational commitment. Journal of Nursing San Diego: Academic Press. Administration, 35(5), 228–237. Bennis, W. (1984). The four competencies of leadership. Training Lyons, M.F. (2002). Leadership and followership. The Physician and Development Journal, August, 1984, pp. 15–19. Executive, Jan/Feb, 91–93. Bennis, W., Spreitzer, G.M., & Cummings, T.G. (2001). The Future of Maxwell, J.C. (1993). Developing the Leader Within You. Tenn.: Leadership. San Francisco: Jossey-Bass. Thomas Nelson Inc. Blake, R.R., Mouton, J.S., & Tapper, M., et al. (1981). Grid Approaches Maxwell, J. C. (1998). The 21 Inrrefutable Laws of Leadership. for Managerial Leadership in Nursing. St. Louis: C.V. Mosby. Tenn.: Thomas Nelson Inc. Chrispeels, J.H. (2004). Learning to Lead Together. Thousand Oaks, McNichol, E. (2000). How to be a model leader. Nursing Calif.: Sage Publications. Standard, 14(45), 24. Dantley, M.E. (2005). Moral leadership: Shifting the management Pavitt, C. (1999). Theorizing about the group communication- paradigm. In English, F.W. The Sage Handbook of Educational leadership relationship. In Frey, L.R. (ed.). The Handbook of Leadership (pp. 34–46). Thousand Oaks, Calif.: Sage Group Communication Theory and Research. Thousand Oaks, Publications. Calif.: Sage Publications. Deutschman, A. (2005). Is your boss a psychopath? Making Porter-O’Grady, T. (2003). A different age for leadership, Part II. Change. Fast Company, 96, 43–51. Journal of Nursing Administration, 33(2), 105–110. Feldman, D.A. (2002). Critical Thinking: Strategies for Decision Spears, L.C., & Lawrence, M. (2004). Practicing Servant-Leadership. Making. Menlo Park, Calif.: Crisp Publications. New York: Jossey-Bass. Goleman, D., Boyatzes, R., & McKee, A. (2002). Primal Leadership: Spreitzer, G.M., & Quinn, R.E. (2001). A Company of Leaders: Five Realizing the Power of Emotional Intelligence. Boston: Harvard Disciplines for Unleashing the Power in Your Workforce. Business School Press. San Francisco: Jossey-Bass. Grossman, S., & Valiga, T.M. (2000). The New Leadership Challenge: Tappen, R.M. (2001). Nursing Leadership and Management: Creating the Future of Nursing. Philadelphia: FA Davis. Concepts and Practice. Philadelphia: FA Davis. Hersey, P. & Campbell, R. (2004). Leadership: A Behavioral Science Trofino, J. (1995). Transformational leadership in health care. Approach. Calif.: Leadership Studies Publishing. Nursing Management, 26(8), 42–47. Holman, L. (1995). Eleven Lessons in Self-Leadership: Insights for White, R.K., & Lippitt, R. (1960). Autocracy and Democracy: Personal and Professional Success. Lexington, Ky.: A Lessons in An Experimental Inquiry. New York: Harper & Row. Leadership Book. Jackson, M., Ignatavicius, D., & Case, B. (eds.). (2004). Conversations in Critical Thinking and Clinical Judgement. Pensacola, Fla.: Pohl.  chapter 2 Manager OBJECTIVES OUTLINE After reading this chapter, the student should be able to: Management Define the term management. Are You Ready to Be a Manager? Distinguish scientific management and human relations–based What Is Management? management. Explain servant leadership. Management Theories Discuss the qualities and behaviors that contribute to effective Scientific Management management. Human Relations–Based Management Servant Leadership Qualities of an Effective Manager Behaviors of an Effective Manager Interpersonal Activities Decisional Activities Informational Activities Conclusion 13 14 unit 1 | Professional Considerations Every nurse should be a good leader and a good name implies, the human-relations approach follower. Not everyone should be a manager, how- emphasizes the interpersonal aspects of managing ever. In fact, new graduates simply are not ready to people, whereas scientific management emphasizes take on management responsibilities. Once you the task aspects. have had time to develop your clinical and leader- ship skills, you can begin to think about taking on Scientific Management management responsibilities (Table 2-1). Almost 100 years ago, Frederick Taylor argued that most jobs could be done more efficiently if MANAGEMENT they were analyzed thoroughly (Lee, 1980; Locke, 1982). With a well-designed task and enough incentive to get the work done, workers could be Are You Ready to Be a Manager? more productive. For example, Taylor promoted For most new nurses, the answer is no, you should the concept of paying people by the piece instead not accept managerial responsibility. The breadth of by the hour. In health care, the equivalent and depth of your experience are still undeveloped. would be by the number of patients bathed or vis- You need to direct your energies to building your ited at home rather than by the number of hours own skills before you begin supervising other people. worked. This would create an incentive to get the most work done in the least amount of time. What Is Management? Taylorism stresses that there is a best way to do a The essence of management is getting work done job. Usually, this is also the fastest way to do the through others. The classic definition of manage- job (Dantley, 2005). ment is Henri Fayol’s 1916 list of managerial tasks: The work is analyzed to improve efficiency. In planning, organizing, commanding, coordinating, health care, for example, there has been much dis- and controlling the work of a group of employees cussion about the time it takes to bring patients to (Wren, 1972). But Mintzberg (1989) argued that radiology or to physical therapy versus bringing the managers really do whatever is needed to make sure technician or therapist to the patient. Eliminating that employees do their work and do it well. excess staff or increasing the productivity of remain- Lombardi (2001) points out that two-thirds of a ing employees is also based on this kind of thinking. manager’s time is spent on people problems. The Nurse managers who use the principles of scien- rest is taken up by budget work, going to meetings, tific management will pay particular attention to preparing reports, and other administrative tasks. the type of assessments and treatments done on the unit, the equipment needed to do this efficiently, Management Theories and the strategies that would facilitate efficient accomplishment of these tasks. Typically, these There are two major but opposing schools of nurse managers keep careful records of the amount thought in management: scientific management of work accomplished and reward those who and the human relations–based approach. As its accomplish the most. Human Relations–Based Management table 2-1 McGregor’s theories X and Y provide a good Differences Between Leadership example of the difference between scientific man- and Management agement and human relations–based management. Leadership Management Theory X, said McGregor (1960), reflects a com- Based on influence Based on authority mon attitude among managers that most people do and shared meaning not want to work very hard and that the manager’s An informal role A formally designated role job is to make sure that they do work hard. To An achieved position As assigned position accomplish this, according to Theory X, a manager Part of every nurse’s Usually responsible for budgets, needs to employ strict rules, constant supervision, responsibility hiring, and firing people and the threat of punishment (reprimands, withheld Requires initiative and Improved by the use of raises, and threats of job loss) to create industrious, independent thinking effective leadership skills conscientious workers.  chapter 2 | Manager 15 Theory Y, which McGregor preferred, is the The servant leader–style staff manager believes opposite viewpoint. Theory Y managers believe that people have value as people, not just as workers that the work itself can be motivating and that peo- (Spears & Lawrence, 2004).The manager is commit- ple will work hard if their managers provide a sup- ted to improving the way each employee is treated at portive environment. A Theory Y manager empha- work. The attitude is “employee first,” not “manager sizes guidance rather than control, development first.” So the manager sees himself or herself as being rather than close supervision, and reward rather there for the employee. Here is an example: than punishment (Fig. 2.1). A Theory Y nurse manager is concerned with keeping employee Hope Marshall is a relatively new staff nurse at morale as high as possible, assuming that satisfied, Jefferson County Hospital. When she was invited to motivated employees will do the best work. be the staff nurse representative on the search com- Employees’ attitudes, opinions, hopes, and fears mittee for a new vice-president for nursing, she was are important to this type of nurse manager. very excited about being on a committee with so Considerable effort is expended to work out con- many managerial and administrative people. As the flicts and promote mutual understanding to pro- interviews of candidates began, she focused on what vide an environment in which people can do their they had to say. They had very impressive résumés best work. and spoke confidently about their accomplishments. Hope was impressed but did not yet prefer one over Servant Leadership the other. Then the final candidate spoke to the com- The emphasis on people and interpersonal rela- mittee. “My primary job,” he said, “is to make it pos- tionships is taken one step further by Greenleaf sible for each nurse to do the very best job he or she (2004), who wrote an essay in 1970 that began the can do. I am here to make their work easier, to servant leadership movement. Like transforma- remove barriers, and to provide them with whatev- tional leadership, servant leadership has a special er they need to provide the best patient care possible.” appeal to nurses and other health-care profession- Hope had never heard the term servant leadership, als. Despite its name, servant leadership applies but she knew immediately that this candidate, who more to people in supervisory or administrative articulated the essence of servant leadership, was the positions than to people in staff positions. one she would support for this important position. QUALITIES OF AN EFFECTIVE MANAGER THEORY X Two-thirds of people who leave their jobs say the main reason was an ineffective or incompetent Work is something to be avoided manager (Hunter, 2004). A survey of 3266 newly licensed nurses found that lack of support from People want to do as little as possible their manager was the primary reason for leaving Use control-supervision-punishment their position, followed by a stressful work environ- ment as the second reason. Following are some of the indicators of their stressful work environment: 25% reported at least one needle stick in their first year. THEORY Y 39% reported at least one strain or sprain. 62% reported experiencing verbal abuse. The work itself can be motivating 25% reported a shortage of supplies needed to People really want to do their job well do their work. Use guidance-development-reward These results underscore the importance of having effective nurse managers who can create an envi- ronment in which new nurses thrive (Kovner, Figure 2.1 Theory X versus Theory Y. Brewer, Fairchild, et al., 2007) 16 unit 1 | Professional Considerations The effective nurse manager possesses a combi- nation of qualities: leadership, clinical expertise, and Informational business sense. None of these alone is enough; it is the combination that prepares an individual for the Representing employees complex task of managing a unit or team of health- Representing the organization care providers. Consider each of these briefly: Public relations monitoring Leadership. All of the people skills of the leader are essential to the effective manager. They are skills needed to function as a manager. Interpersonal Clinical expertise. It is very difficult to help others develop their skills and evaluate how well Networking they have done so without possessing clinical Conflict negotiation and resolution expertise oneself. It is probably not necessary Employee development and coaching (or even possible) to know everything all other Rewards and punishment professionals on the team know, but it is impor- tant to be able to assess the effectiveness of their work in terms of patient outcomes. Decisional Business sense. Nurse managers also need to be concerned with the “bottom line,” with the Employee evaluation cost of providing the care that is given, especially Resource allocation in comparison with the benefit received Hiring and firing employees from that care and the funding available to Planning pay for it, whether from insurance, Medicare, Job analysis and redesign Medicaid, or out of the patient’s own pocket. Figure 2.2 Keys to effective management. This is a complex task that requires knowledge of budgeting, staffing, and measurement of patient outcomes. Interpersonal Activities There is some controversy over the amount of The interpersonal category is one in which leaders clinical expertise versus business sense that is and managers have overlapping concerns. However, needed to be an effective nurse manager. Some the manager has some additional responsibilities argue that a person can be a “generic” manager, that are seldom given to leaders. These include the that the job of managing people is the same no following: matter what tasks he or she performs. Others Networking. Nurse managers are in pivotal argue that managers must understand the tasks positions, especially in inpatient settings where themselves, better than anyone else in the work they have contact with virtually every service of group. Our position is that equal amounts of clin- the institution as well as with most people above ical skill and business acumen are needed, along and below them in the organizational hierarchy. with excellent leadership skills. This provides them with many opportunities to influence the status and treatment of staff nurses BEHAVIORS OF AN EFFECTIVE and the quality of the care provided to their MANAGER patients. It is important that they “maintain the line of sight,” or connection, between what they Mintzberg (1989) divided a manager’s activities do as managers, patient care, and the mission into three categories: interpersonal, decisional, of the organization (Mackoff & Triolo, 2008, and informational. We use these categories and p. 123). In other words, they need to keep in have added some activities suggested by other mind how their interactions with both their authors (Dunham-Taylor, 1995; Montebello, staff members and with administration affects 1994) and by our own observations of nurse man- the care provided to the patients for whom they agers (Fig. 2.2). are responsible.  chapter 2 | Manager 17 Conflict negotiation and resolution. Managers Hiring and firing employees. Nurse managers often find themselves resolving conflicts among decide either independently or participate in employ- employees, patients, and administration. The ment and termination decisions for their units. ineffective manager either lets people go Planning for the future. The day-to-day opera- unmanaged emotionally or mismanages feelings tion of most units is complex and time-consum- in the workplace (Welch & Welch, 2008). ing, and nurse managers must also look ahead in Employee development. Providing for the order to prepare themselves and their units for continuing learning and upgrading of the skills future changes in budgets, organizational priori- of employees is a managerial responsibility. ties, and patient populations. They need to look Coaching. It is often said that employees are beyond the four walls of their own organization to the organization’s most valuable asset (Shirey, become aware of what is happening to their com- 2007). This is one of the ways in which nurse petition and to the health-care system (Kelly & managers can share their experience and exper- Nadler, 2007). tise with the rest of the staff. The goal is to Job analysis and redesign. In a time of extreme nurture the growth and development of the cost sensitivity, nurse managers are often employee (the “coachee”) to do a better job required to analyze and redesign the work of through learning (McCauley & Van Velson, their units to make them as efficient as possible. 2004; Shirey, 2007). Some managers use a directive approach: “This is Informational Activities how it’s done. Watch me.” or “Let me show you Nurse managers often find themselves in positions how to do this.” Others prefer a nondirective within the organizational hierarchy in which they approach: “Let’s try to figure out what’s wrong acquire much information that is not available to here” (Hart & Waisman, 2005). “How do you think their staff. They also have much information about we can improve our outcomes?” their staff that is not readily available to the admin- You can probably see the parallel with demo- istration, placing them in a strategic position with- cratic and autocratic leadership styles described in in the information web of any organization. The Chapter 1. The decision whether to be directive effective manager uses this position for the benefit (e.g., in an emergency) or nondirective (e.g., when of both the staff and the organization. The follow- developing a long-term plan to improve infection ing are some examples: control) will depend on the situation. Spokesperson. Nurse managers often speak for Rewards and punishments. Managers are in a administration when relaying information to position to provide specific (e.g., salary increases, their staff members. Likewise, they often speak time off ) and general (e.g., praise, recognition) for staff members when relaying information to rewards as well as punishments. administration. You could think of them as clearinghouses, acting as gatherers and dissemi- Decisional Activities nators of information to people above and below Nurse managers are responsible for making many them in the organizational hierarchy (Shirey, decisions: Ebright, & McDaniel, 2008, p. 126). Monitoring. Nurse managers are also expert Employee evaluation. Managers are responsible “sensors,” picking up early signs of problems for conducting formal performance appraisals of before they grow too big (Shirey, Ebright, & their staff members. Effective managers regularly McDaniel, 2008). They are expected to moni- tell their staff how well they are doing and where tor the many and various activities of their they need improvement (Welch & Welch, 2008). units or departments, including the number of Resource allocation. In decentralized organiza- patients seen, average length of stay, infection tions, nurse managers are often given a set amount rates, fall rates, and so forth. They also monitor of money to run their units or departments and the staff (e.g., absentee rates, tardiness, unpro- must allocate these resources wisely. This can be ductive time), the budget (e.g., money spent, difficult when resources are very limited. money left to spend in comparison with money 18 unit 1 | Professional Considerations table 2-2 Bad Management Styles These are the types of managers you do not want to be and for whom you do not want to work: Know-it-all Self-appointed experts on everything, these managers do not listen to anyone else. Emotionally remote Isolated from the staff and the work going on, these managers do not know what is going on in the workplace and cannot inspire others. Pure mean Mean, nasty, dictatorial, these managers look for problems and reasons to criticize. Overnice Desperate to please everyone, these managers agree to every idea and request, causing confusion and spending too much money on useless projects. Afraid to decide In the name of fairness, these managers do not distinguish between competent and incompetent, hard-working and unproductive employees, thus creating an unfair reward system. Based on Welch, J. & Welch, S. (2007, July 23). Bosses who get it all wrong. BusinessWeek, p. 88. needed to operate the unit), and the costs of of some of the most common ineffective procedures and services provided, especially approaches to being a manager. those that are variable such as medical supplies (Dowless, 2007). Conclusion Public Relations. Nurse managers share infor- mation with their patients, staff members, and Nurse managers have complex, responsible posi- employers. This information may be related to tions in health-care organizations. Ineffective man- the results of their monitoring efforts, new agers may do harm to their employees, their developments in health care, policy changes, and patients, and to the organization, and effective so forth. Review Table 2-2, “Bad Management managers can help their staff members grow and Styles,” to compare what you have just read develop as health-care professionals while provid- about effective nurse managers with descriptions ing the highest quality care to their patients. Study Questions 1. Why should new graduates decline nursing management positions? At what point do you think a nurse is ready to assume managerial responsibilities? 2. Which theory, scientific management or human relations, do you believe is most useful to nurse managers? Explain your choice. 3. Compare servant leadership with scientific management. Which approach do you prefer? Why? 4. Describe your ideal nurse manger in terms of the person for whom you would most like to work. Then describe the worst nurse manager you can imagine, and explain why this person would be very difficult. 5. List 10 behaviors of nurse managers, then rank them from least to most important. What rationale(s) did you use in ranking them? Case Study to Promote Critical Reasoning Joe Garcia has been an operating room nurse for 5 years. He was often on call on Saturday and Sunday, but he enjoyed his work and knew that he was good at it. Joe was called to come in on a busy Saturday afternoon just as his 5-year-old daughter’s birthday party was about to begin. “Can you find someone else just this once?” he asked the nurse manager who called him. “I should have let you know in advance that we have an important family event  chapter 2 | Manager 19 today, but I just forgot. If you can’t find someone else, call me back, and I’ll come right in.” Joe’s manager was furious. “I don’t have time to make a dozen calls. If you knew that you wouldn’t want to come in today, you should not have accepted on-call duty. We pay you to be on-call, and I expect you to be here in 30 minutes, not one minute later, or there will be consequences.” Joe decided that he no longer wanted to work in the institution. With his 5 years of operating room experience, he quickly found another position in an organization that was more supportive of its staff. 1. What style of leadership and school of management thought seemed to be preferred by Joe Garcia’s manager? 2. What style of leadership and school of management were preferred by Joe? 3. Which of the listed qualities of leaders and managers did the nurse manager display? Which behaviors? Which ones did the nurse manager not display? 4. If you were Joe, what would you have done? If you were the nurse manager, what would you have done? Why? 5. Who do you think was right, Joe or the nurse manager? Why? References Mackoff, B.L., & Triolo, P.K. (2008). Why do nurse managers stay? Building a model engagement. Part I: Dimensions of Dantley, M.E. (2005). Moral leadership: Shifting the manage- engagement. Journal of Nursing Administration, 38(3), ment paradigm. In English, F.W. The Sage Handbook of 118–124. Educational Leadership (pp. 34–46). Thousand Oaks, Calif.: McCauley, C.D., & Van Velson, E. (eds.). (2004). The Center for Sage Publications. Creative Leadership Handbook of Leadership Development. Dowless, R.M. (2007). Your guide to costing methods and New York: Jossey-Bass. terminology. Nursing Management, 38(4), 52–57. McGregor, D. (1960). The Human Side of Enterprise. New York: Dunham-Taylor, J. (1995). Identifying the best in nurse executive McGraw-Hill. leadership. Journal of Nursing Administration, 25(7/8), 24–31. Mintzberg, H. (1989). Mintzberg on Management: Inside Our Greenleaf, R.K. (2004). Who is the servant-leader? In Spears, L.C., Strange World of Organizations. New York: Free Press. & Lawrence, M. Practicing Servant-Leadership. New York: Montebello, A. (1994). Work Teams That Work. Minneapolis: Best Jossey-Bass. Sellers Publishing. Hart, L.B., & Waisman, C.S. (2005). The Leadership Training Activity Shirey, M.R. (2007). Competencies and tips for effective leader- Book. New York: AMACOM. ship. Journal of Nursing Administration, 37(4), 167–170. Hunter, J.C. (2004). The World’s Most Powerful Leadership Principle. Shirey, M.R., Ebright, P.R., & McDaniel, A.M. (2008). Sleepless in New York: Crown Business. America: Nurse managers cope with stress and complexity. Kelly, J., & Nadler, S. (2007, March 3–4). Leading from below. Journal of Nursing Administration, 38(3), 125–131. Wall Street Journal, p. R4. Spears, L.C., & Lawrence, M. (2004). Practicing Servant-Leadership. Kovner, C.T., Brewer, C.S., Fairchild, S., et al. (2007). Newly New York: Jossey-Bass. licensed RNs’ characteristics, work attitudes, and intentions Welch, J., & Welch, S. (2007, July 23). Bosses who get it all to work. American Journal of Nursing, 107(9), 58–70. wrong. BusinessWeek, p. 88. Lee, J.A. (1980). The Gold and the Garbage in Management Theories Welch, J., & Welch, S. (2008, July 28). Emotional mismanage- and Prescriptions. Athens, Ohio: Ohio University Press. ment. BusinessWeek, p. 84. Locke, E.A. (1982). The ideas of Frederick Taylor: An evaluation. Wren, D.A. (1972). The Evolution of Management Thought. Academy of Management Review, 7(1), 14. New York: Ronald Press. Lombardi, D.N. (2001). Handbook for the New Health Care Manager. San Francisco: Jossey-Bass/AHA Press.  chapter 3 Nursing Practice and the Law OBJECTIVES OUTLINE After reading this chapter, the student should be able to: General Principles Identify three major sources of laws. Meaning of Law Explain the differences between various types of laws. Sources of Law Differentiate between negligence and malpractice. The Constitution Explain the difference between an intentional and an Statutes unintentional tort. Administrative Law Explain how standards of care are used in determining negligence and malpractice. Types of Laws Describe how nurse practice acts guide nursing practice. Criminal Law Explain the purpose of licensure. Civil Law Discuss issues of licensure. Tort Explain the difference between internal standards and Quasi-Intentional Tort external standards. Negligence Discuss advance directives and how they pertain to clients’ Malpractice rights. Other Laws Relevant to Nursing Practice Discuss the legal implications of the Health Insurance Good Samaritan Laws Portability and Accountability Act (HIPAA) Confidentiality Slander and Libel False Imprisonment Assault and Battery Standards of Practice Use of Standards in Nursing Negligence Malpractice Actions Patient’s Bill of Rights Informed Consent Staying Out of Court Prevention Appropriate Documentation Common Actions Leading to Malpractice Suits If a Problem Arises Professional Liability Insurance End-of-Life Decisions and the Law Do Not Resuscitate Orders Advance Directives Living Will and Durable Power of Attorney for Health Care (Health-Care Surrogate) Nursing Implications Legal Implications of Mandatory Overtime Licensure Qualifications for Licensure Licensure by Examination NCLEX-RN Preparing for the NCLEX-RN Licensure Through Endorsement Multistate Licensure Disciplinary Action Conclusion 21 22 unit 1 | Professional Considerations The courtroom seemed cold and sterile. Scanning her 2. Common law develops within the court system surroundings with nervous eyes, Germaine decided as judicial decisions are made in various cases she knew how Alice must have felt when the Queen and precedents for future cases are set. In this of Hearts screamed for her head. The image of the way, a decision made in one case can affect White Rabbit running through the woods, looking decisions made in later cases of a similar nature. at his watch, yelling, “I’m late! I’m late!” flashed This feature of American law is based on the before her eyes. For a few moments, she indulged English tradition of case law: “judge-made law” herself in thoughts of being able to turn back the (Black, 2004). Many times a judge in a subse- clock and rewrite the past. The future certainly