Nursing Leadership and Management

Nursing Nursing Leadership and Leadership and Management Management

LET HIM THAT LET HIM THAT WOULD MOVEWOULD MOVE

THE WORLD,THE WORLD,

FIRST MOVEFIRST MOVE

HIMSESF.HIMSESF.

- Socrates- Socrates

CONTENTS

Leadership and Management Defined and Distinguished

Leadership and Management Theory

Management Functions

Roles of the Nurse Manager

Creating a Caring Environment

Leadership and Management Skills and Behaviors

Leadership Defined and Distinguished

Leadership Defined

Management Defined

Leadership and Management concepts

Power and Authority

Formal and Informal Leadership

Leadership DefinedLeadership combines: Leadership combines:

intrinsic personality traits, intrinsic personality traits, learned leadership skills,learned leadership skills, characteristics of the characteristics of the

situation.situation.Leader - Leader -

guides people and groups guides people and groups to accomplish common to accomplish common goals,goals,

influences the beliefs, influences the beliefs, opinions, or behaviors of a opinions, or behaviors of a person, group, or groups person, group, or groups of people. of people.

Nurse leaderNurse leader is able to inspire others on the is able to inspire others on the

health care team to make health care team to make patient education an important patient education an important aspect of all care activities.aspect of all care activities.

Leadership qualities:Leadership qualities: unique personality unique personality

characteristics,characteristics, exceptional clinical expertise,exceptional clinical expertise, relationships with others in the relationships with others in the

organization.organization.

Management Defined

Management - coordinates people, time, and

supplies to achieve desired outcomes,

involves problem-solving and decision-making processes.

Managers responsibility: maintain control of the day-

to-day operations, achieve established goals and

objectives.

ManagerManager

plans plans

organizes organizes what is to be what is to be

done done who is to do who is to do it it

how it is to be donehow it is to be done

Nurse manager Nurse manager will have:will have:

an appointed management position an appointed management position within the organization with within the organization with responsibilities to perform responsibilities to perform

administrative tasks:administrative tasks: planning staffing planning staffing

requirements,requirements, performing employee performing employee

performance appraisals, performance appraisals, controlling use of supplies and controlling use of supplies and

time,time, meeting budget and meeting budget and

productivity goals.productivity goals.

LeadershipLeadership and Management and Management

are intertwined concepts,

are different,

difficult to discuss one without the other .

A good manager also should be A good manager also should be a good leadera good leader

Leadership, Leadership, management management skills:skills:

-- complementary;complementary; - can be learned - can be learned

and developed: and developed: • through through

experience,experience,• improving skills improving skills

in one area will in one area will enhance abilities enhance abilities in the other.in the other.

Power and AuthorityPower and Authority

Nurse manager hasNurse manager has authority - formal right to direct authority - formal right to direct

others granted by the others granted by the organization, organization,

power - ability to motivate power - ability to motivate people to get things done with or people to get things done with or without the formal right granted without the formal right granted by the organization,by the organization,

ability to influence others to ability to influence others to accomplish goals. accomplish goals.

Formal and Formal and Informal Leadership Informal Leadership

Formal leadershipFormal leadership practices by: practices by: nurse manager, nurse manager, supervisor, supervisor, charge nurse,charge nurse, coordinator and gives the coordinator and gives the

authority to act by the authority to act by the organization.organization.

Informal LeadershipInformal Leadership

is exercised by the person whois exercised by the person who

has no official or appointed has no official or appointed

authority to act, authority to act, is able to persuade, is able to persuade, is able to influence others in the is able to influence others in the

work group, work group, strategies the nurse manager can strategies the nurse manager can

use to work with informal use to work with informal leaders.leaders.

Leadership and Management Theory

Leadership Trait Theory Interactional Leadership

Theories Transformational

Leadership Management Theory Organizational Theory

Leadership, management, and

organizational theories

provide the building blocks

on which to build effective

nursing management practices and

skills.

Contemporary theories of Contemporary theories of leadership leadership

depends on several variables, depends on several variables, including (Marquis and Huston, including (Marquis and Huston,

2000):2000): 1. Organizational culture.1. Organizational culture. 2. Values of the leader.2. Values of the leader. 3. Values of the followers.3. Values of the followers. 4. Influence of the 4. Influence of the

leader/manager.leader/manager. 5. Complexities of the situation.5. Complexities of the situation. 6. Work to be accomplished.6. Work to be accomplished. 7. Environment.7. Environment.

Transformational leadersTransformational leaders Identify and clearly communicate Identify and clearly communicate

vision and direction.vision and direction. Empower the work group to Empower the work group to

accomplish goals and achieve the accomplish goals and achieve the vision.vision.

Impart meaning and challenge to Impart meaning and challenge to work.work.

Are admired and emulated.Are admired and emulated. Provide mentoring to individual Provide mentoring to individual

staff members based on need.staff members based on need.

Transactional leadersTransactional leaders

Focus on day-to-day operations Focus on day-to-day operations and are comfortable with the and are comfortable with the

status quo (the existing state of status quo (the existing state of affairs).affairs).

Reward staff for desired work Reward staff for desired work ("I'll do x in exchange for you ("I'll do x in exchange for you

doing y").doing y"). Monitor work performance and Monitor work performance and

correct as needed; correct as needed; oror Wait until problems occur and Wait until problems occur and

then deal with the problemthen deal with the problem..

Management TheoryManagement Theory Behavioral theories explain Behavioral theories explain

aspects of management and aspects of management and leadership based on behaviors of leadership based on behaviors of managers/leaders and followers.managers/leaders and followers.

Organizational TheoryOrganizational Theory provides a framework for provides a framework for

understanding complex understanding complex organizations,organizations,

helps to understand the helps to understand the management process.management process.

Management Functions

PlanningOrganizingStaffingDirectingControlling

PlanningPlanning includes defining goals and includes defining goals and objectives, developing policies and objectives, developing policies and procedures; determining resource procedures; determining resource allocation; and developing allocation; and developing evaluation methods.evaluation methods.

OrganizingOrganizing includes identifying the includes identifying the management structure to management structure to accomplish work, determining accomplish work, determining communication processes, and communication processes, and coordinating people, time and work.coordinating people, time and work.

StaffingStaffing includes those activities includes those activities required to have qualified people required to have qualified people accomplish work such as recruiting, accomplish work such as recruiting, hiring, training, scheduling and hiring, training, scheduling and ongoing staff development. ongoing staff development.

Directing Directing encourages employees encourages employees to accomplish goals and to accomplish goals and objectives and involves objectives and involves communicating, delegating, communicating, delegating, motivating, and managing motivating, and managing conflict.conflict.

ControllingControlling analyzes results to analyzes results to evaluate accomplishments and evaluate accomplishments and includes evaluating employee includes evaluating employee performance, analyzing performance, analyzing financial activities, and financial activities, and monitoring quality of care.monitoring quality of care.

Roles of the Nurse Manager

Customer Service Provider

Team Builder Resource Manager Decision Maker and Problem Solver Change Agent

Customer Service Provider Providing service or care to

customers (patient or clients).. Nurse must keep customer Nurse must keep customer

service first and foremost as the service first and foremost as the motivator of all plans and motivator of all plans and activities.activities.

Without customers, the Without customers, the organization will go out of organization will go out of business. business.

Team Builder

A team is a group of people organized to accomplish the necessary work of an organization.

Teams have become important in the changing health care environment.

Teams bring together a

range of people with different knowledge, skills, and experiences to meet customer.

Resource Manager Resources include the

personnel, time, and supplies needed to accomplish the goals of the organization.

Nurse manager has the responsibility - effectively manage resources in providing safe, effective patient care in an economic manner.

Three Types of BudgetsThree Types of Budgets1. Personnel1. Personnel

Allocates funds for salaries, overtime, Allocates funds for salaries, overtime, benefits, staff development and training, benefits, staff development and training, and employee turnover costsand employee turnover costs

2. Operating budget2. Operating budgetAllocates funds for daily expenses such as Allocates funds for daily expenses such as

utilities, repairs, maintenance, and utilities, repairs, maintenance, and patient care suppliespatient care supplies

3. Capital budget3. Capital budgetAllocates funds for construction projects Allocates funds for construction projects

and/or long-life equipment such as and/or long-life equipment such as cardiac monitors, defibrillators, andcardiac monitors, defibrillators, and

computer hardware; capital budget items computer hardware; capital budget items are generally more expensive than are generally more expensive than operating supplies.operating supplies.

Decision Maker and Decision Maker and Problem Solver Problem Solver

components of effective components of effective leadership and management leadership and management in clinical patient care.in clinical patient care.

Problem solving is focused Problem solving is focused on solving an immediate on solving an immediate problem andproblem and

decision maker includes decision maker includes a decision-making stepa decision-making step..

Nursing process = Nursing process = problem-solving problem-solving process process includes includes ::

assessment, assessment, analysis and diagnosis,analysis and diagnosis, planning, planning, implementation,implementation, evaluation; evaluation; has proven to be effective to has proven to be effective to

manage the complex decisions.manage the complex decisions.

ASSESSMENTASSESSMENT Gather information about the Gather information about the

situationsituation Identify the problem; separate the Identify the problem; separate the

symptomssymptoms Identify people and groups Identify people and groups

involvedinvolved Identify cultural and environmental Identify cultural and environmental

factorsfactors Encourage input from involved Encourage input from involved

partiesparties

ANALYSIS AND ANALYSIS AND DIAGNOSISDIAGNOSIS

Analyze results of Analyze results of information gatheredinformation gathered

Identify, clarify, and Identify, clarify, and prioritize the actual problem prioritize the actual problem (s)(s)

Determine if intervention is Determine if intervention is appropriateappropriate

PLANNING PLANNING Identify as many solutions as Identify as many solutions as

possiblepossible Elicit participation from people or Elicit participation from people or

groups affectedgroups affected Review options and consider Review options and consider

safety, efficiency, costs, quality, safety, efficiency, costs, quality, and legal issuesand legal issues

Consider positive and negative Consider positive and negative outcomesoutcomes

Remain open-minded and flexible Remain open-minded and flexible when considering options when considering options

IMPLEMENTINGIMPLEMENTING Communicate plans to Communicate plans to

everyone affectedeveryone affected Be sure plans, goals, and Be sure plans, goals, and

objectives are clearly objectives are clearly identifiedidentified

Maintain open, two-way Maintain open, two-way communication with staff communication with staff

Support and encourage Support and encourage compliance among all staffcompliance among all staff

EVALUATIONEVALUATION Identify evaluation criteria in the Identify evaluation criteria in the

planningplanning Identify who is responsible for Identify who is responsible for

evaluation, what will be evaluation, what will be measured, and when it will take measured, and when it will take placeplace

Maintain open communication Maintain open communication with all involvedwith all involved

Was the decision successful?Was the decision successful? What might have made it better?What might have made it better?

The nurse - change agentThe nurse - change agent is responsible for guiding is responsible for guiding

peoplepeople through the change process through the change process

and needs and needs to develop an understanding to develop an understanding

about the nature of change about the nature of change and effective change and effective change strategies.strategies.

1. Change should be 1. Change should be implemented only for good implemented only for good reason.reason.

2. Change should always be 2. Change should always be planned and implemented planned and implemented gradually.gradually.

3. Change should never be 3. Change should never be unexpected or abrupt.unexpected or abrupt.

4. All people who may be 4. All people who may be affected by the change should affected by the change should be involved in planning for be involved in planning for the change.the change.

The most important The most important responsibility for the nurse in responsibility for the nurse in

any leadership or any leadership or managementmanagement

role is to create an environment of role is to create an environment of caring - caring for staff members as caring - caring for staff members as

well as for patients and families.well as for patients and families. Staff members who believe that Staff members who believe that their manager sincerely cares their manager sincerely cares

about them and the work they do about them and the work they do are able to pass that feeling of are able to pass that feeling of caring on to their patients and caring on to their patients and

other customers.other customers.

Caring for the staff members can Caring for the staff members can be demonstrated through be demonstrated through (McNeese-Smith, 1997):(McNeese-Smith, 1997):

Offering sincere positive Offering sincere positive recognition for both individuals recognition for both individuals and teams.and teams.

Praising and giving thanks for a Praising and giving thanks for a job well done.job well done.

Spending time with staff Spending time with staff members to reinforce positive members to reinforce positive work behaviors.work behaviors.

Meeting the staff member's Meeting the staff member's personal needs whenever personal needs whenever possible, such as possible, such as accommodating scheduling accommodating scheduling needs for family events and needs for family events and being flexible in times of being flexible in times of illness.illness.

Providing guidance and Providing guidance and support for professional and support for professional and personal growth.personal growth.

Maintaining a positive, Maintaining a positive, confident attitude and a confident attitude and a pleasant work environment.pleasant work environment.

LEADERSHIP AND MANAGEMENT SKILLS AND BEHAVIORS

Hersey and Blanchard (1988) have identified that effective leadership and

management requires skills in three major areas:

Technical skills—such as clinical expertise and nursing

knowledge. Human skills—the ability and

judgment to work with people in an effective leadership role.

Conceptual skills—the ability to understand the complexities of the overall organization

and where one's own area of management fits into the overall organization.