1. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 15 Nursing Leadership and Management

2. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Leadership and Management Defined and Distinguished

3. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Attempt to influence the beliefs, opinions, or behaviors of a person or group  Guide people and groups to accomplish common goals  May not have formal authority but are still able to influence others Leaders

4. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Managers  Coordinate people, time, and supplies to achieve desired outcomes in a defined area of responsibility  Have an appointed management position and a formal line of authority and accountability

5. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Leadership versus Management  Leadership is the ability to guide or influence others  Management is the coordination of resources (time, people, supplies) to achieve outcomes

6. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Power and Authority  Authority is the legitimate right to direct others through an authorized position in an organization  Power is the ability to motivate people to get things done with or without the formal right granted by the organization

7. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Types of Power Reward power Reward power Coercive power Coercive power Legitimate power Legitimate power Referent power Referent power Expert power Expert power Informal power Informal power

8. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Formal Leadership  Practiced by the nurse who is appointed to an approved position and is given authority by the organization to act

9. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Informal Leadership  Exercised by the person who has no official authority to act but is able to influence others in the work group

10. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Informal Leadership  Strategies for working with informal leaders Understand their source of power Understand their source of power Involve them in decision making and change implementation processes Involve them in decision making and change implementation processes Clearly communicate goals and work expectations Clearly communicate goals and work expectations Do not ignore attempts to undermine teamwork and change processes Do not ignore attempts to undermine teamwork and change processes

11. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Leadership and Management Theory

12. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Based on the assumption that leaders are born with certain leadership characteristics  Traits found to be associated with leadership include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery Leadership Trait Theory

13. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Interactional Leadership Theories  Integrate dynamics of the interaction between the leader, the worker, and the leadership situation  Effective leadership depends on several variables: Organizational culture Organizational culture Values of the leader and followers Values of the leader and followers Influence of the leader/manager Influence of the leader/manager Complexities of the situation Complexities of the situation Work to be accomplished Work to be accomplished Environment Environment

14. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Transformational Leadership  Suggests two types of leaders Transactional Transactional Transformational Transformational

15. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Transformational Leadership  Transactional leader is concerned with the day-to-day operations of the facility/unit  Transformational leaders Committed to organizational goals and clearly communicate vision and direction Committed to organizational goals and clearly communicate vision and direction Empower the work group to accomplish goals Empower the work group to accomplish goals Impart meaning and challenge to work Impart meaning and challenge to work Are admired and emulated Are admired and emulated Provide mentoring to individual staff members on the basis of need Provide mentoring to individual staff members on the basis of need

16. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Transformational Leadership  Nurse executives who demonstrate transformational leadership characteristics achieve higher levels of staff satisfaction and greater work group effectiveness

17. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Leadership and Management Skills  Three major areas required for effective leadership (Hersey and Blanchard, 1988) Technical skills—clinical expertise and nursing knowledge Technical skills—clinical expertise and nursing knowledge Human skills—ability and judgment to work with people in an effective leadership role Human skills—ability and judgment to work with people in an effective leadership role Conceptual skills—ability to understand the complexities of the overall organization and to recognize how one’s own area of management fits into the overall organization Conceptual skills—ability to understand the complexities of the overall organization and to recognize how one’s own area of management fits into the overall organization

18. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Leadership and Management Skills  At the staff nurse level of management, a considerable amount of technical skill and clinical expertise is needed.  As one advances from lower levels to higher levels in the organization, more advanced conceptual skills are needed

19. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Management Theory  Authoritarian—makes all decisions with no staff input and uses the authority of the position to accomplish goals  Democratic—encourages staff involvement in goal setting, problem solving, and decision making  Laissez-faire—provides little direction or guidance and will forego decision making  Today’s health care system requires democratic (or participative) management  Depending on the situation, the nurse manager may need to use different types of management styles

20. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizational Theory  Provides a framework for understanding complex organizations  Weber’s bureaucracy theory Defined characteristics of bureaucracy, including authority and ability to apply general rules to specific cases Defined characteristics of bureaucracy, including authority and ability to apply general rules to specific cases Emphasized rules instead of individuals and competency instead of favoritism Emphasized rules instead of individuals and competency instead of favoritism Failed to recognize the complexity of human behavior and constantly changing environments Failed to recognize the complexity of human behavior and constantly changing environments

21. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizational Theory  Systems theory Views the organization as a set of interdependent parts that together form a whole Views the organization as a set of interdependent parts that together form a whole Anything that affects one aspect of the organization will affect the other parts Anything that affects one aspect of the organization will affect the other parts Open systems suggest that the organization is affected not only by internal changes but also by external environmental forces Open systems suggest that the organization is affected not only by internal changes but also by external environmental forces

22. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizational Theory  Chaos theory Attempts to account for complexity and randomness in organizations Attempts to account for complexity and randomness in organizations Views complicated behaviors, situations, and variations as predictable; reflects cultural diversity, constantly fluctuating patient census, and staffing shortages Views complicated behaviors, situations, and variations as predictable; reflects cultural diversity, constantly fluctuating patient census, and staffing shortages

23. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Management Functions

24. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Overview  Five management functions are interrelated: Planning Planning Organizing Organizing Staffing Staffing Directing Directing Controlling Controlling  Different phases of the process occur simultaneously  Processes should be circular, with the manager always working toward improving the quality of health care, patient safety, and staff and customer satisfaction

25. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Planning  Decide in advance what to do; how, when, and where it is to be done; and who is to do it  All management functions are based on planning.  Important components of planning Mission and philosophy Mission and philosophy Strategic planning—long-range plan that extends 3 to 5 years into the future Strategic planning—long-range plan that extends 3 to 5 years into the future Goals and objectives—state actions necessary to achieve the strategic plan Goals and objectives—state actions necessary to achieve the strategic plan Operational planning—encompasses the day-to-day activities of the organization Operational planning—encompasses the day-to-day activities of the organization

26. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizing  Establish formal structure to define the lines of authority, communication, and decision making  Define roles and responsibilities for each level of management and staff  Coordinate activities with other departments  Communicate to ensure a smooth workflow

27. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Organizing  Components of organizing Organizational chart Organizational chart Policies and procedures Policies and procedures Job descriptions Job descriptions

28. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Staffing  Determine the number and type of staff needed  Recruit, interview, select, and assign personnel  Orient, train, socialize, and develop staff members  Implement ongoing staff development programs  Implement creative and flexible scheduling

29. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Staffing  Factors positively associated with the work satisfaction of RNs  Good relationships with supervisor  High level of support and encouragement provided by the supervisor  High autonomy  Paid time off benefit  Distributive justice  Promotional opportunities  Strong group cohesion

30. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Directing  Clearly communicate performance expectations  Create a motivating climate and team spirit Positive reinforcement in the form of a sincere thank you is a powerful motivational resource Positive reinforcement in the form of a sincere thank you is a powerful motivational resource For positive reinforcement to be effective, it must For positive reinforcement to be effective, it must  Be specific, with praise given for a particular task  Occur as close as possible to the time of the achievement  Be spontaneous and unpredictable  Be given for a genuine accomplishment  Role model expected behaviors  Manage conflict and facilitate collaboration

31. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Controlling  Ensure that employees accomplish goals while maintaining high-quality performance  Establish performance or outcome standards  Measure and evaluate performance against established standards  Determine an action plan to improve performance

32. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Controlling  Resources for establishing performance standards Written organizational policies and procedures Written organizational policies and procedures Standards for the practice of professional nursing developed by the ANA Standards for the practice of professional nursing developed by the ANA Standards for professional nursing specialty practices Standards for professional nursing specialty practices

33. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Controlling  Evaluating employee performance Occurs through the formal annual evaluation process and through frequent feedback and coaching Occurs through the formal annual evaluation process and through frequent feedback and coaching Consistent day-to-day feedback and coaching clarify expectations, improve the quality of work, and allow the manager to correct problems before they become serious Consistent day-to-day feedback and coaching clarify expectations, improve the quality of work, and allow the manager to correct problems before they become serious Result of routine performance evaluations should be mutual goal setting designed to meet the employees’ training, educational, and work improvement needs Result of routine performance evaluations should be mutual goal setting designed to meet the employees’ training, educational, and work improvement needs

34. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Roles of the Nurse Manager

35. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Customer Service Provider  Competitive marketplace in which health care facilities compete for patients  Nurse must keep customer service first and foremost as the motivator of all plans and activities  Internal customers Employed by the organization Employed by the organization Include patient care staff members, staff members of other departments, administrators, social workers, dietitians, therapists, and so forth Include patient care staff members, staff members of other departments, administrators, social workers, dietitians, therapists, and so forth

36. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Customer Service Provider  External customers Not employed by the organization Not employed by the organization Include patients and families, as well as physicians, payers, and other users of the facility Include patients and families, as well as physicians, payers, and other users of the facility  Customer service standards should be defined by the customers.

37. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Team Builder  Team is a group of people organized to accomplish work  Teams bring together a range of people with different knowledge, skills, and experiences to meet customer needs, accomplish tasks, and solve problems

38. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Team Builder  Teams should create synergy through Defined goals and objectives Defined goals and objectives Commitment to work together Commitment to work together Good communication Good communication Willingness to cooperate Willingness to cooperate

39. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Team Builder  Nurse manager as a role model for teams Show respect for all members of the team and value their input Show respect for all members of the team and value their input Clearly define team goals Clearly define team goals Clearly define the team’s decision-making authority Clearly define the team’s decision-making authority Encourage members to develop a sense of stewardship Encourage members to develop a sense of stewardship Exhibit a personal commitment to team goals Exhibit a personal commitment to team goals Encourage team members to willingly help each other Encourage team members to willingly help each other Provide the resources necessary to accomplish goals Provide the resources necessary to accomplish goals Provide relevant and timely feedback to the team Provide relevant and timely feedback to the team

40. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Resource Manager  Resources include personnel, time, and supplies needed to accomplish goals  Plan for the necessary resources (primarily staff and supplies) to manage the unit  Organize resources to meet identified goals  Staff appropriately, as determined by patient needs and the budget plan  Direct to maintain resource allocations within budgetary guidelines  Control by analyzing financial reports and making adjustments where necessary

41. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Decision Maker and Problem Solver  Decision making Not always related to a problem situation Not always related to a problem situation Required throughout all aspects of management Required throughout all aspects of management

42. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.  Problem solving Focused on solving an immediate problem Focused on solving an immediate problem Includes a decision-making step Includes a decision-making step Decision Maker and Problem Solver

43. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Decision Maker and Problem Solver  Nursing process as a guide for decision making and problem solving  More important to understand the process to solve problems rather than knowing all the answers

44. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Change Agent  Responsible for guiding people through the change process  Rules to follow when change is necessary: Change should be implemented only for good reason Change should be implemented only for good reason Change should always be planned and implemented gradually Change should always be planned and implemented gradually Change should never be unexpected or abrupt Change should never be unexpected or abrupt All people who may be affected by the change should be involved in planning for the change All people who may be affected by the change should be involved in planning for the change

45. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Change Agent  Lewin’s stages of change Unfreezing stage: Change agent promotes problem identification and encourages awareness of the need for change Unfreezing stage: Change agent promotes problem identification and encourages awareness of the need for change Moving stage: Change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan Moving stage: Change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan Refreezing stage: Change agent integrates the change into the organization Refreezing stage: Change agent integrates the change into the organization

46. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Roles of the Nurse Manager  Important components of change Involvement Involvement Education and training Education and training

47. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Roles  Clinical consultant Resource for clinical advice Resource for clinical advice Role model for excellence in nursing care and evidence-based practice Role model for excellence in nursing care and evidence-based practice

48. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Roles  Staff developer Offers learning and training opportunities to enhance professional and personal growth for all employees Offers learning and training opportunities to enhance professional and personal growth for all employees Accesses resources and plans staff development activities that meet the needs of individual staff members Accesses resources and plans staff development activities that meet the needs of individual staff members

49. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Roles  Mentor Accepts responsibility to act as a mentor to new nurses Accepts responsibility to act as a mentor to new nurses Recognizes that mentoring is key to developing future nursing leaders and managers Recognizes that mentoring is key to developing future nursing leaders and managers

50. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Other Roles  Corporate supporter Committed to the mission, goals, and objectives of the employing organization Committed to the mission, goals, and objectives of the employing organization Professional representative for the organization Professional representative for the organization

51. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Creating a Caring Environment

52. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Overview  Caring for staff members as well as for patients and families  Staff members who feel that their manager sincerely cares about them and the work they do are able to pass that feeling of caring on to their patients and other customers

53. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Caring Actions  Offer sincere positive recognition  Praise and give thanks for a job well done  Spend time with staff members to reinforce positive work behaviors  Meet staff members’ personal needs whenever possible  Provide guidance and support for professional and personal growth  Maintain a positive, confident attitude and a pleasant work environment

54. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Leadership and Management Twenty-First Century Leadership and Management Challenges

55. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Patient Safety and the Nurse’s Work Environment IOM Report Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) Demonstrated a strong connection between the nurse’s work environment and medical errors Demonstrated a strong connection between the nurse’s work environment and medical errors Scientific evidence that nurses are essential to patient safety continues to grow Scientific evidence that nurses are essential to patient safety continues to grow Major categories of recommendations from IOM’s Keeping Patients Safe report: Major categories of recommendations from IOM’s Keeping Patients Safe report:  Promote transformational leadership and evidence- based management  Maximize workforce capability  Redesign work processes to prevent errors  Create and sustain a culture of safety

56. Mosby items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Twenty-First Century Leadership and Management Challenges  It will be up to the nurse leader at all levels to begin this long, yet exciting, process of redesigning work environments