Nursing Leadership and Management

LET HIM THAT WOULD MOVE THE WORLD, FIRST MOVE HIMSESF. - 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 Management Defined Leadership and Management concepts Power and Authority Formal and Informal Leadership

Leadership Defined Leadership combines: intrinsic personality traits, learned leadership skills, characteristics of the situation. Leader - guides people and groups to accomplish common goals, influences the beliefs, opinions, or behaviors of a person, group, or groups of people.

Leadership qualities: Nurse leader is able to inspire others on the health care team to make patient education an important aspect of all care activities. Leadership qualities: unique personality characteristics, exceptional clinical expertise, relationships with others in the 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.

Manager plans organizes how it is to be done what is to be done who is to do it how it is to be done

Nurse manager will have: an appointed management position within the organization with responsibilities to perform administrative tasks: planning staffing requirements, performing employee performance appraisals, controlling use of supplies and time, meeting budget and productivity goals.

Leadership and Management are intertwined concepts, are different, difficult to discuss one without the other .

A good manager also should be a good leader Leadership, management skills: - complementary; - can be learned and developed: through experience, improving skills in one area will enhance abilities in the other.

Nurse manager has Power and Authority authority - formal right to direct others granted by the organization, power - ability to motivate people to get things done with or without the formal right granted by the organization, ability to influence others to accomplish goals.

Formal and Informal Leadership Formal leadership practices by: nurse manager, supervisor, charge nurse, coordinator and gives the authority to act by the organization.

is exercised by the person who Informal Leadership is exercised by the person who has no official or appointed authority to act, is able to persuade, is able to influence others in the work group, strategies the nurse manager can use to work with informal 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 leadership depends on several variables, including (Marquis and Huston, 2000): 1. Organizational culture. 2. Values of the leader. 3. Values of the followers. 4. Influence of the leader/manager. 5. Complexities of the situation. 6. Work to be accomplished. 7. Environment.

Transformational leaders Identify and clearly communicate vision and direction. Empower the work group to accomplish goals and achieve the vision. Impart meaning and challenge to work. Are admired and emulated. Provide mentoring to individual staff members based on need.

Transactional leaders Focus on day-to-day operations and are comfortable with the status quo (the existing state of affairs). Reward staff for desired work ("I'll do x in exchange for you doing y"). Monitor work performance and correct as needed; or Wait until problems occur and then deal with the problem.

Management Theory Behavioral theories explain aspects of management and leadership based on behaviors of managers/leaders and followers. Organizational Theory provides a framework for understanding complex organizations, helps to understand the management process.

Management Functions Planning Organizing Staffing Directing Controlling

Planning includes defining goals and objectives, developing policies and procedures; determining resource allocation; and developing evaluation methods. Organizing includes identifying the management structure to accomplish work, determining communication processes, and coordinating people, time and work. Staffing includes those activities required to have qualified people accomplish work such as recruiting, hiring, training, scheduling and ongoing staff development.

Directing encourages employees to accomplish goals and objectives and involves communicating, delegating, motivating, and managing conflict. Controlling analyzes results to evaluate accomplishments and includes evaluating employee performance, analyzing financial activities, and 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 service first and foremost as the motivator of all plans and activities. Without customers, the organization will go out of 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 Budgets 1. Personnel Allocates funds for salaries, overtime, benefits, staff development and training, and employee turnover costs 2. Operating budget Allocates funds for daily expenses such as utilities, repairs, maintenance, and patient care supplies 3. Capital budget Allocates funds for construction projects and/or long-life equipment such as cardiac monitors, defibrillators, and computer hardware; capital budget items are generally more expensive than operating supplies.

Decision Maker and Problem Solver components of effective leadership and management in clinical patient care. Problem solving is focused on solving an immediate problem and decision maker includes a decision-making step.

Nursing process = problem-solving process includes : assessment, analysis and diagnosis, planning, implementation, evaluation; has proven to be effective to manage the complex decisions.

ASSESSMENT Gather information about the situation Identify the problem; separate the symptoms Identify people and groups involved Identify cultural and environmental factors Encourage input from involved parties

ANALYSIS AND DIAGNOSIS Analyze results of information gathered Identify, clarify, and prioritize the actual problem (s) Determine if intervention is appropriate

PLANNING Identify as many solutions as possible Elicit participation from people or groups affected Review options and consider safety, efficiency, costs, quality, and legal issues Consider positive and negative outcomes Remain open-minded and flexible when considering options

IMPLEMENTING Communicate plans to everyone affected Be sure plans, goals, and objectives are clearly identified Maintain open, two-way communication with staff Support and encourage compliance among all staff

EVALUATION Identify evaluation criteria in the planning Identify who is responsible for evaluation, what will be measured, and when it will take place Maintain open communication with all involved Was the decision successful? What might have made it better?

The nurse - change agent is responsible for guiding people through the change process and needs to develop an understanding about the nature of change and effective change strategies.

1. Change should be implemented only for good reason. 2. Change should always be planned and implemented gradually. 3. Change should never be unexpected or abrupt. 4. All people who may be affected by the change should be involved in planning for the change.

The most important responsibility for the nurse in any leadership or management role is to create an environment of caring - caring for staff members as well as for patients and families. Staff members who believe 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.

Caring for the staff members can be demonstrated through (McNeese-Smith, 1997): Offering sincere positive recognition for both individuals and teams. Praising and giving thanks for a job well done. Spending time with staff members to reinforce positive work behaviors.

Meeting the staff member's personal needs whenever possible, such as accommodating scheduling needs for family events and being flexible in times of illness. Providing guidance and support for professional and personal growth. Maintaining a positive, confident attitude and a pleasant work environment.

Technical skills—such as clinical expertise and nursing knowledge. 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.