Leadership & Nursing Roles PDF

### **PRELIM TOPICS** #### Definition Leadership in a forest analogy-the forest implies getting lost and we need a leader who can lead us in the right direction. One of the roles of a leader is to take people in the right direction. Leadership is: - a social influence (collective manner); a p...

### **PRELIM TOPICS** #### Definition Leadership in a forest analogy-the forest implies getting lost and we need a leader who can lead us in the right direction. One of the roles of a leader is to take people in the right direction. Leadership is: - a social influence (collective manner); a person's ability to move other people to act leaving a mark (where you are able to change that person). - it is initiating and guiding and the result is change. Types of leadership 1. Aristocratic (authoritative) 2. Monarchy (Queen and King) Leadership defined broadly: - Influence process involving determination. - Motivating task behavior - Influencing group maintenance and culture - Move them forward, do not leave them behind One of the many responsibilities of a leader is that once you motivate a group, allow them to maintain it. A nurse leader's traits and action **L**ead, love, learn **E**nthusiastic and Energetic**\ A**ssertive and Achiever**\ D**edicated, desirous**\ E**fficient, and effective**\ R**esponsible, respectful [Lead, love, learn] - A nurse should be able to lead, love the diversity of the people she meets and constantly learn because nursing is an evolving process. [Enthusiastic and Energetic] - Bring positive energy to the people around her as it is infectious, meaning it can make other people project positive energy - A professional nurse can temporarily set aside her own concerns and problems and ill feelings while at work because she wants to devote full attention to the feelings while at work because she wants to devote full attention to the patients. [Assertive and Achiever] - A nurse should know the reasons for things and why things must be done. - Nursing has a wide horizon, therefore, she should strive hard to achieve her goals Being assertive means - To express one's feelings - To choose how one will act - To speak up for one's rights when it is appropriate - To enhance one's self esteem, to help oneself develop self confidence - To disagree when one thinks it is important - To carry out plans for modifying one's behavior and asking others to change their offensive behavior An assertive nurse can negotiate mutually satisfactory solutions to a variety of interpersonal problems. (e.g. dealing with one's co worker who likes to come in late during shift-changes) [Dedicated, desirous] As a leader, a nurse should develop her heart for the profession. Commitment is key. Nursing profession provides room for improvement for those willing to take the challenge. [Efficient, and effective\ ]A nurse should do the right things and be able to do it right. She must be certain of her actions. Avoid ambiguity. [ ] Minimize mistakes and learn the lessons arising from those mistakes. [Responsible, respectful] She holds herself responsible and accountable for the mistakes she might commit. She remembers the maxim that before she points a finger to other people, her four other fingers are pointing at her. She blames no one if things do not go her way (to encourage good social interactions and allows nurses to get along with other people) A leader considers views and desires. She does not necessarily agree but considers. Respect can also mean taking care of oneself and the environment. Leadership is: - The privilege to have the responsibility to direct the actions of others. - Process of influencing the activities of an organized group - A means of persuasion and example by which an individual induces a group to take action in accord with a purpose common to everyone - Inspires others and work together for the achievement of a common mission and goal - A vital ingredient that transforms a crowd into a functional and useful organization Nursing leadership is defined as the [process where the nurse influences one or more persons] to achieve specific goals in the provision of [nursing care of one or more patients.] It is a [multidimensional process] - John W. Gardner #### Dimensions of leadership - Leadership is viewed as a dynamic interactive process that involves three dimensions: leader, follower and situation **(LFS)** - Each dimension influences the other - A nurse can only know that she is leading when there are people who follow her lead #### Followership Effective followers [are active, responsible and autonomous] in their behavior and critical in their thinking without being disrespectful. [Types of followers] - **Alienated (**independent and critical yet passive in behavior. Potentially disruptive and a threat to the health of the organization) - **Sheep** (Dependent and uncritical, do as they are told by their leaders) - **Yes people** (uncritical or dependent but active in their behavior. Most dangerous to a leader bc they are most likely to give false positive reaction and give no warning of potential pitfalls) - **Survivors** (Least disruptive and lowest risk followers. Better safe than sorry) - **Effective followers** (Self leaders and do not require close supervision) - Effective followers share 4 essential qualities - **Self management** - (think for oneself and to work well without close supervision) - **Commitment** - (Effective followers are committed to something beyond themselves) - **Competence and focus**- (for maximum impact) - **Courage** - (Independent, critical thinkers and will fight for what they believe is right) #### Elements of Leadership Core elements of nursing leadership are **vision,** **influence, power, authority, responsibility and accountability.** **[Vision ]** The essence of leadership. Essential for organizational effectiveness and success. It provides direction to the influence process. Nurses can have one or more vision. For leadership to occur, leaders must communicate the vision to their followers in such a way that the followers adopt the vision as their own. A vision, for effectiveness, should: - Appear as simple, yet vibrant image - Describe a future state, credible and preferable to the present state - Act as a bridge between current state and a future optimum state - Appear desirable enough to energize followers - Succeed in speaking to followers at an emotional or spiritual level. The three (3) critical components involved in making that vision work: **LME** 1. The [leader] or head of the organization 2. The [members] of the organization or staff 3. The [environment] in which they function or the community **[Influence]** A skill that can be developed and one of the major components of the power triangle which includes recognition and communication. The apex of the power triangle is communication. **[Communication holds utmost importance]**. Power is transmitted through the way the leader communicates to her followers. The ability to articulate the needs of the group is one way for the leader to exercise power as her followers trust her to understand what their needs are. Poor communication = poor or no influence at all. THE BEST INVESTMENT IN TOMORROW A leader's good deeds are **recognized** by the group. It is the group that vests power on the leader because of what they perceive to be her significant contribution to the well-being of the group. [Kinds of influence: (]Any attempt by an individual to change the behavior of others) **AIR BECUS** a. [Assertiveness] - One sends direct messages to others and is able to [stand up for her own rights without violating] those of others. b. [Ingratiation] - An individual makes another feel important or good before making a request. c. [Rationality] - A type of influence that involves convincing someone of the merits of a detailed plan, which is usually supported by information, reasoning or logic. d. [Blocking] - A [hostile form] of influence where an individual achieves the goal of influencing another person either with the threat of or the actual act of cutting off from communication. - Ex. A new nurse is told to keep to herself her observations of the abuses of some colleagues or else she will be cut off from the group. e. [Coalition] - Collective form of influence where a person gets several co-workers to "back her up" when making a request. - Ex. Entire pediatric nursing staff would go up to their area manager to request for a change in shift schedule f. [Sanction] - The promise of punishment in the case of non-cooperation and reward in case of cooperation. - Behavior-based. - Ex. Nurse is given duties to care for an autistic child with cancer. Should she fail to care for the patient properly, then she loses the opportunity to handle such a difficult case. g. [Exchange] - Involves offering a favor or a personal sacrifice as an incentive for the performance of the request. h. [Upward appeal] - Involves obtaining support from a higher-up to push someone into action - Ex. A nurse talk to the manager to make sure that other non-performing nurse would do their jobs in the nursing care unit. ##### Levels of leadership as an act of influence John Maxwell states that there are five levels of leadership that anyone designated as a leader is likely to occupy depending on her personal and professional growth. The five levels progress as time is passed in leadership.  The level at which a leader occupies greatly depends on her willingness to assume the mantle of authority and responsibility that comes with leadership. ***Level 1: Position*** - The only influence a nurse can have at this level is that which comes with the title. People start to defend their leadership position because they feel they have earned the right to keep it. A real nurse knows the difference between being a leader and being the boss. - People at position level often lead by intimidation such as coaches, captains, and teachers. - Based on how well people know the leader. Leadership begins with the heart and not with the head. Leaders at the second level of leadership lead through interrelationships or through caring concern for others. - People who are unable to build, solid, lasting relationships will soon discover they are unable to sustain long, effective leadership. ***Level 3: Production ("results" level)*** - The level of products and results. There is a purpose for coming together. People work together to achieve similar objectives and hope for the same things. ***Level 4: People Development*** - A true leader is distinguishable through the consistently superior performance of her subordinates. A great leader is one who empowers others because a leader's main responsibility is to develop others. - Ex. In a nursing care setting, this means making new staff nurses stronger. ***Level 5: Personhood*** - Only a proven leader may arrive at this level and reap the rewards that are eternally satisfying. Each increase in level comes a higher commitment to serve the people and the organization. - Statesmanship is the result of arriving at this level. A statesman's duty is to bridge the gap between experience and vision. **[Power]** - The ability to efficiently and effectively exercise authority and control through personal, organizational and social strength. "A" influences "B" so that "B" does things that she would not otherwise do. "B" is not a puppet. She merely recognizes the influence that "A" has over her. Organizational power -- the capacity to influence others through the control over needed resources. Power can be viewed as a positive, infinite force that helps to establish the possibility that nurses can free themselves from oppression. [Sources of power a leader may possess:] 1. Legitimate power 2. Reward power 3. Coercive power 4. Expert power 5. Information power 6. Referent power **[Authority]** - Represents the right to expect or secure compliance; authority is backed by legitimacy. Differentiating between authority and power +-----------------------------------+-----------------------------------+ | [Authority] | [Power] | | | | | The nurse-manager has the | Staff nurse responds to the power | | authority or right to request | that the nurse-manager has over | | that the nursing staff does two | her. | | rounds nightly to prevent | | | injuries from bed falls. | Power has the potential to | | | control the behavior of others | | Authority has the potential to | | | exert control through the | | | legitimacy of a managerial | | | position | | +-----------------------------------+-----------------------------------+ Forms of authority: 1. Line Authority 2. Staff authority 3. Team Authority **[Responsibility ]** Authority is the right to decide and command, responsibility is the corresponding obligation and accountability answers for all actions done. Responsibility is the obligation to do assigned tasks. Responsibilities fall into two categories: [individual and organizational] 1. Individual 2. Organizational **[Accountability]** When someone is responsible for something, she is liable or accountable to a superior. Accountability is answering for the result of one's actions or omissions. It is a form of reckoning, where one accepts the consequences of their decisions, good or bad [Leaders] Types of leaders 1. Formal leaders -- appointed, elected or designated (e.g. head nurse) 2. Informal leaders- does not have the official sanction to direct the activities of others. (eg. Seniority) A nurse can lead without being placed in a leadership position because leadership is influence. Behavior of leaders 1. Passive or nonassertive behavior - Feels self-pity, acts apologetically. Easily dominated by others. 2. Aggressive behavior - Talks loudly on every subject. Shows insensitivity to the feelings of other people. Points a finger and says "you" frequently. Enhance their selves at the expense of others 3. Assertive behavior - Midway between passive and aggressive. Expresses opinions and beliefs without infringing on or belittling the right or beliefs of others. Styles of leadership 1. Autocratic Leadership style -- classical approach - Nurse leader-manager retains as much power and decision-making authority. Rely on threats and punishment to influence. - In an emergency care set up, this leadership is the best style. 2. Bureaucratic leadership style --"by the book" 3. Democratic leadership style- participative style 4. Laissez-Faire Leadership style -- "hands off" style - Little or no direction from the leader and the nursing staff has as much freedom as possible Face of leadership: Rational and emotional Leadership involves both rational and emotional side of human experience. Influences action based on reasons and logic as well as those based on inspiration and passion Management - A process of getting things done through people - Responsible for initiating steps - Uses **delegated (selected/given to you ang position)** authority within a formal organization. #### Early Leadership Theories 1. TRAIT THEORIES - Assumes that a person must have certain innate abilities or personality traits in order to be a leader. - Traits: Assertive, adaptable, cooperative, creative, fluent in speaking, organized, assertive, decisive-dependable 2. "GREAT MAN" THEORY - Assumes that the capacity for leadership is inherent, that great leaders are born, not made. Example: Monarchy. 3. INDIVIDUAL CHARACTER THEORY - Distinctive physical and psychological individual characteristics account for leadership effectiveness. However, Napoleon Bonaparte went against this ideal. 4. BEHAVIORAL THEORIES - Concerned with what leaders do and act - Based upon the belief that great leaders are made (meaning gi appoint ra siya), not born #### Early Management Theories Theories emphasizing organizational structure 1. Scientific Management theory (most time efficient) -- Frederick Taylor - The best practice through which the worker is able to get the most done for the least energy spent. Train workers -- do most of the work in the least amount of time 2. Systemic Management theory -- Henri Fayol - A guiding behavior in each management situation with appropriate principles will make management move effective #### 17 Principles of Management Management principles serve as guides for managers for effective and efficient practice. ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- *Authority* [The right to give orders] and the power to exact obedience *Specialization of Labor* [Specialization encourages continuous improvement in skills] and the development and improvements in methods *Discipline* [No slacking or bending of rules.] The workers should be obedient and respectful of the organization *Unity of command* Each employee has one and only one boss to give instructions or assignment *Unity of Direction* A single mind generates a single plan and all-play their part in that plan but only one person is in charge of the group's activities *Subordination of individual interests* When at work, only work things should be pursued or thought about. The needs of the patients must take precedence over the staff nurse's personal needs in the same manner that a leader should be concerned with the needs of the unit patients and subordinates *Remuneration* Employees receive fair payment or compensation for services, not what the company can get away with *Centralization of authority* Consolidation of management functions. Decisions are made from the top. This produces uniformity of action, utilizes experts, and reduces risks of error in the performance of tasks *Chain of command (line of authority)* Formal chain of command running from top to bottom of the organization, like the military *Decentralization of authority* Focuses on the importance of human elements. Increases motivation of nurses at lower levels since they are asked to participate in decision making. *Material and social order* All materials and personnel have prescribed values and places, embodied in the institution's policies and regulations and they must remain there *Equity and justice* Fair and just treatment (but not necessarily identical treatment); no favoritism *Personnel tenure* Limited turnover of personnel. Lifetime employment for good workers. Granting security of tenure or permanent status after a satisfactory performance *Initiative* Thinking out a plan and do what it takes to make it happen *Scalar chain* The interconnectedness of people within the organization from top to bottom *Hierarchy* Line of authority *Motivation of personnel* Nurses are rational beings and must be allowed to work their minds in problem solving and decision making *Espirit de Corps* Harmony, cohesion among personnel. To promote spirit de corps, the principle of unity of command should be observed and the dangers of divide and rule and the abuse of written communication should be avoided. ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 3. Organizational theory - Max Weber advocated a complex form of bureaucracy based on: - Hierarchy of authority (legalized through position) - Division of work based on specialization of function #### Theories Focused On Human Relations 1. **Social process (Mary Follet)** - Based on collaboration and cooperation - In this theory, managers did not give orders but worked together with the group 2. **Elton Mayo and Fritz Roethlisberger** - Nag duda sila and tested the assumptions of the scientific management theory, through studies called the [Hawthorne effect.] - To find out the effect on a worker's productivity they studied the effect of the physical environment and participation in decision making and they concluded that productivity was affected by BOTH the physical and social environment. PHYSICAL ENVIRONMENT & PARTICIPATION IN DECISION MAKING has something to do with the productivity of a client. Which includes, - The ability or opportunity to participate in decision making with the administration. - The recognition from the administration. Hawthorne effect - Refers to the momentary change of behavior or performance in response to a change in a worker's environment, the response usually being an improvement #### Contemporary Management Theories 1. **Management by Objectives** by Peter Drucker - Peter Drucker is the FATHER OF MODERN CORPORATE MANAGEMENT, a consensual process where both management and rank and file meet to understand and agree on the organization's objectives. Peter Drucker's approach - Evident in organization - Involved joint efforts between supervisors and subordinates and a breakdown of their respective responsibilities, goals and objectives. 2. **Management by Decision making.** In hospitals and other service institutions, decisions are made by all employees at all levels of Organization, forming a network of decision makers Centralized principle - The superior position makes all the decision Decentralized principle - Decisions are given by all employees and not relying on above position Simon's 2 distinct approaches to decision making 1. **Optimizing** meant the search for the best alternative possible 2. **Satisfying** meant using the first workable solution A 3-step process to reach the best ultimate decision 1. Listing alternative strategies - List all possible methods. 2. Determining the consequences for each - Point out the actions and result to overcome that destruction 3. Comparative evaluation of these consequences - Seek Plan B by comparing. #### Managerial Roles Managerial roles of Henry Mintzberg names three basic roles of typical manager: 1. Interpersonal role - Talks about **people** - The ***figurehead*** role -- performance of ceremonial duties. - Signing contract, memorandum, affiliation, go and attend graduation/meetings. - The ***leader*** role -- direct involvement in choosing managerial team - Team leader on every level, RLE chairperson - The ***liaison*** role -- dealing with outside people - Consultative Meeting 2. Informational role - The **monitor** role -- receipt and sending information for control purposes. - Ex. Memorandum of school, seminars to attend to - **Dissemination** role -- sharing of information, collected as monitor, with subordinates - Similar to when sending memorandums, enrollment - The **spokesman** role -- speaks for his department - Dean of every department, non-academic heads meeting 3. Decision making role - ***Entrepreneurial*** role -- involvement with constant addition or deletion of projects - Initiation of steps that others may follow - e.g. WELA during enrollment - The ***disturbance handler*** role- attention to problems arising out of strikes, bankruptcies, and interference. - Should be firm and strong in implementing the rules of the school e.g., shift course - The ***resource allocator*** role- allocation of budgets, time and information - e.g., huge number of students need a lot of C.I or manpower - The ***negotiator*** role- ranges from negotiation of an argument to negotiation of a labor contract #### Theories Review on [Abraham Maslow's Hierarchy of needs] and its significance with leadership and management theories - As a leader/manager, the Maslow's theory helps you understand the basic and diverse needs of your subordinates, which can influence their motivation and behavior. [Motivation- Hygiene Theory] Ferdinand Herzberg's two factor theory - Two factors influence people- hygiene factors and motivation factor - Hygiene factors can negatively influence people - Motivation factors can result in satisfaction and psychological growth +-----------------------------------+-----------------------------------+ | Hygiene factors | Motivation factors | | | | | (dissatisfiers) | (satisfiers) | +-----------------------------------+-----------------------------------+ | Adequate salary | Satisfying meaningful work | | | | | Appropriate supervision | Opportunity for advancement and | | | achievement | | Good interpersonal relations | | | | Appropriate responsibility | | Safe and tolerable working | | | condition | Adequate recognition | +-----------------------------------+-----------------------------------+ [Theory X & Y ] By Douglas McGregor - Theory X proposes that man is lazy, unmotivated, irresponsible, unintelligent, and not interested in work. - Theory Y assumes man to be responsible, creative self-proposed, self- directed and a problem solver - A leader meets diverse members that have different characteristics and personality. The theory x and y help a leader create a balance approach on how to handle both personalities. [Theory Z] - Is based on the principle that work is natural and can be source of satisfaction when aimed at a higher order to meet human psychological needs [Total quality management] - A management approach, centered on a quality, based on the participation of all members and aiming at long term success through costumer satisfaction, and benefits of all members of the organization. - Empathize with the family/patient. Provide top quality care to the patient. #### Patient Care Delivery System Patient classification system - A measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. Patient acuity - The measure of nursing working but is generally good for each patient - The sicker the patient the higher the activity level rises. [Self-care or minimal patients] - Capable of carrying ADLs [Intermediate or moderate care] - Requires some help from the nursing staff with special treatments or certain aspects of personal care. - Examples: patients with IVFs, catheter of respirator [Total care patients] - Those who are bedridden and lack strength and mobility to do average daily living. - Examples: patients with CBR, immediate post-op [Intensive care patients] - Critically ill and in constant danger of death or serious injury - Examples: comatose and bedridden patients #### Nursing Care Models 1. **[The Case Method or Total Patient Care]** - Original model of nursing care delivery - A registered nurse is responsible for all aspects of the care of one or more patients. 2. **[The Functional Method]** - Also called task nursing - The needs of a group of patients are broken down into task which are assigned to RNs, LPNs or UAPs. - Skill and licensure of each caregiver is used to the best advantage. - Task and procedure-oriented method - Technical approach to a patient care 3. **[Team Nursing]** - A team of nursing personnel provides total patient care to a group of patients - The personnel work together to identify plan, implement, and evaluate comprehensive client-centered nursing care, the common goal is providing quality client care. 4. **[Primary Nursing Method]** - Design to place the RN back at the patient's bedside - Decentralized decision-making is the core principle with responsibility, authority, and accountability. 5. **[Progressive Client Care]** - Defined as the organization of hospital facilities services and staff as per medical and nursing needs of the patient - Provide optimum level of care to the patient as per nursing needs Open photo a. [Intensive care] - Concentrated around patient who are unable to communicate their needs - Requires extensive nursing care, constant observation and supervision - Requires ventilatory support, round the clock equipped and skilled service facilities - Facilities for mobilization b. [Long term care] - Requires care and services not available at home - Convalescent patients from ICU, post-op case with infection - Patients with poor progress requiring skilled palliative treatment such as cancer patient, occupational therapy, and physiotherapy. - Regular periodic assessment is needed c. [Home care] - Hospital services extends to home care (outreach services) d. [Ambulatory or OPD care] - Post operative follow up - Promotive, preventive, and rehabilitative services - Diagnosis, treatment and investigation 6. **[Managed Home Method]** - Involves unit-based care that is organized to achieve specific patient outcomes - Focuses on collaboration and cooperation of all services to avoid overlap, duplication, and delays and to reduce costs 7. **[Practiced Partnership]** - As RN and an assistant -- UAP, LPN or less experiences RN agree to be practice partners - Senior and junior staff members share patient care responsibilities 8. **[Case Management Method]** - Care is directed by a case manager focused on achievement of outcome and appropriate time frame and resources - Case manager is focuses on an entire episode of illness, does not provide patient care only supervise the care provided by the RNs or the non-RNs 9. **[Modular Method]** - Modular nursing is not new-it began its evolution on the1950s-but its rather a modification of the team nursing model - Team nursing eventually evolved into modular nursing. In this model a patient care unit is divided into geographic modules with an RN as team leader - The same team of caregivers is regularly assigned to the modules. The team will include RNs and will also include LPNs and nursing assistants - The goal of modular nursing is to make patient care less fragmented. #### Innovation in nursing - Innovation in nursing ranges from [impromptu solution] for immediate problem to [long-term studies] and [sophisticated technologies] designed to improve healthcare delivery and patient outcomes. - A [predictive model developed by Kaiser Permanente] is one of the example pf nursing innovations. The model relies on an algorithm to identify patient at risk for decline while hospitalized so that staff can proactively treat them and prevent patient mortality. - Known as the Advance Alert Monitor (AAM) program, it identifies high-risk patients in a real time. So, rather than react to a patient when a complication arises, the AAM program gives clinicians 12 hours lead time to respond, plan and take action - The AAM program predates the pandemic, but it proved useful when COVID-19 hit. By that point, it had been implemented at 21 Kaiser Permanente Northern California hospitals over two and half years, during which time 520 deaths were avoided per year over the 3.5-year study period. - Virtualization is positively impacting nursing on multiple levels - Technology advanced cameras that afford virtual access to a patient's condition so tat caregivers can examine a patient virtually. - They can actually measure the pupils of the eyes of the patient from the camera" she marvels. These virtual tools augment the ability to assess and support the local team on the ground with clinical decision-making. - Telemedicine, it took off with the advent of the pandemic's social distancing protocols