Chapter 19: The Gerontological Nurse as Manager and Leader

Learning Objectives Identify characteristics of effective nurse managers and leaders. Compare various leadership styles and strategies. Describe effective communication strategies. Describe the process of delegation, including how it is used in the management of unlicensed assistive personnel.

Learning Objectives (cont’d) Compare various leadership roles available to nurses who care for older adults. Analyze the characteristics of the major generations of nurses. Recognize the value of professional associations to the nurse manager and leader. Evaluate one’s own strengths and weaknesses as a future nurse manager or leader.

The Nurse Manager Nurse Manager Leadership Partnership (NMLP) Learning Domain Framework (Figure 19-1, p. 676) The Leader Within: Creating the Leader in Yourself Self assessment Goal setting The Art of Leadership: Leading the People High-performance work team: motivation technique Conflict resolution: focus on mutual goal Culture of safety: RN is responsible for safely delegating Delegation (Box 19-1, p. 680)

The Nurse Manager (cont’d) The Science of Leadership: Managing the Business Financial management Human resource management Performance improvement Foundational thinking skills Technology Strategic management Clinical practice knowledge

The Nurse Manager (cont’d) Tasks Associated with the Role of Nurse Manager (T. 19-1,) Staffing for patient care Developing goals and objectives for the unit Establishing standards of care Developing budgets and using resources in a cost-effective manner Implementing quality improvement activities to affect patient outcomes Engaging in problem solving Planning, organizing, managing, controlling, and directing unit activities Hiring, orienting, evaluating, and educating staff Mentoring and developing staff Identifying systems problems and suggesting solutions Acting as a resource for clinical issues Ensuring compliance with policies, procedures, and accrediting or regulatory agencies Recruiting and retaining staff Participating in organizational committees and task forces Acting as a corporate supporter

Comparison between Managers and Leaders Administer Ask how and when Focus on systems Do things right Maintain Rely on control Short-term perspective Accept status quo Have eye on the bottom line Imitate Classic “good soldiers” A copy Innovate Ask what and why Focus on people Do the right things Develop Inspire trust Long-term perspective Challenge status quo Have eye on the horizon Originate Own person The original

The Nurse Leader Leader develops and articulates clear vision of the future of the organization Performance improvement catalyst Interpersonal relations facilitator Human resources developer Resource and financial manager Standards and compliance expert resource Customer service advocate

Leadership Qualities and Theories Qualities of effective leaders (Table 19-2, p. 689) Transactional leadership Behavior theory: autocratic leadership, bureaucratic leadership, democratic l. , laissez-faire, situational l. 21st century leadership (Table 19-3, p.691) Transformational/charismatic leadership(T 19-4) Servant leadership Complexity leadership

Effective Communication Role of the nurse leader in establishing effective communication Facilitates collegial relationship among team members, whether all nurses or interdisciplinary. Sets clear expectations for professionalism, respect, and collegiality to foster effective communication and patient safety. Role model for effective communication and promotes opportunities for ongoing education about effective communication strategies. Patient safety and quality care flourish in an environment where leader actively pursues establishing effective communication among the team.

Nursing Leadership Roles in Caring for Older Adults Executive Roles Director of Nursing Charge Nurse Staff Nurse Gerontological Nurse Practitioner Clinical Nurse Leader (CNL) Registered Nurse Assessment Coordinator: Minimum Data Set (MDS) coordinator

Multigenerational Workforce Issues Veterans – born before 1945 Bring a lifetime of experience, respect for authority, dedication, loyal, and sacrifice. Baby boomers – born 1946-1964 Value personal growth, interpersonal communication, often question the status quo, strong work ethic Generation X – born 1965-1980 Value independence, informality, technological literacy, and having fun Millennials (Generation Y) – born 1981-1999 Confident, bring a mastery of all things technical, adept at multitasking, collaborative decision making

Professional Associations Coalition of Geriatric Nursing Organizations National Gerontological Nursing Association National Association of Directors of Nursing Administration in Long Term Care (NADONA) American Association for Long Term Care Nursing American Association of Nurse Assessment Coordinators American Health Care Association Leading Age National Association of Health Care Assistants American Medical Directors Association (AMDA) American College of Health Care Administrators

Summary Both nurse managers and nurse leaders are needed in gerontological nursing Managers focus on direction of the details of a unit Leaders are visionaries who see the larger picture Engaged staff means better, safer care for patients and residents Developing sound management strategies requires the desire to change and maintain a constant state of self-reflection