Leadership and Supervision EFREN N. AQUINO M.D. JUNE 16, 2008, JULY 7, 2009

Leadership and Management Leadership  The art of getting others to want to do something you are convinced should be done Management  Handles the day-to-day operations to achieve a desired outcome

LEADER: A person who uses specific skills, such as role modeling to influence others to accomplish a task or do the work. MANAGER: Coordinates and controls the work of others. A manager is involved with organizing, planning, directing and controlling LEADER = influences others MANAGER = controls others

LEADER = influences others MANAGER = controls others

Leadership Leadership involves qualities related to a person's character and behaviors, as well as roles within a group or organization. It requires that a person have the ability to guide and influence another person, group, or both to think in a certain way, achieve common goals, or provide inspiration for change. Marquis and Huston (2003) state that leaders:  Often do not have delegated authority, but obtain their power through other means, such as influence.  Have a wider variety of roles than do managers.  May not be part of the formal organization.

Leadership Leaders: Focus on group process, information gathering, feedback, and empowering others. Emphasize interpersonal relationships. Direct willing followers. Have goals that may or may not reflect those of the organization.

Leadership Leaders: Any healthcare provider has the potential to be a leader in terms of influencing a group or exercising power in a particular situation. Accordingly, LPN/LVNs also may be leaders, informally or formally. For example, an LPN working on a medical– surgical unit may assume responsibility for organizing social events for fellow employees. A more formal leadership role would be acting as co-chairperson of the unit's staffing policy committee.

STYLES OF LEADERSHIP 1. AUTOCRATIC 2. BUREAUCRATIC 3. DEMOCRATIC 4. LASSEZ-FAIRE

AUTOCRATIC Style  Retains all authority and responsibility  Concerned primarily with tasks and goal accomplishment  Assigns clearly defined tasks  Establishes one-way communication with the group  Excels in times of crisis (cardiac arrest) and in situation of disorder (natural disasters)  Works well with newly graduates

AUTOCRATIC Style  Tasks are accomplished without questions.  Communication is directive and flows downward.  Lines of authority and policies are clear.  Decisions are made quickly.

AUTOCRATIC Style  DISADVANTAGES Subordinates have little input into decision- or policy-making and receive little feedback or recognition. Staff members are not invested in management's goals. Leaders may create hostility and dependency. Work is highly controlled and dictated.

BUREAUCRATIC :  Policy-minded  Leaders rely on established protocols for decision making.  The policy and procedure manual of healthcare facility offers step-by-step instructions; the leader will consider them as rules.  This style like the Autocratic style is often helpful for new graduates who need detailed instructions.

DEMOCRATIC  People-centered approach  Allows employees more control and participation in the decision-making process  Emphasis is on team building and collaboration  Works best with mature employees who work well together as groups

DEMOCRATIC  Disadvantages Decisions may not occur in a timely way. Staff members may fail to acknowledge the manager's role. Employees do not recognize the need for urgent decisions that are made without staff input.

LAISSEZ-FAIRE  “Free-run style” or permissive leadership  Relinquishes control completely  Chooses to avoid responsibility by delegating all decision making to the group  Wants everyone to feel free to “do their own thing”  May work well with highly motivated professional groups

Laissez-Faire Leadership Unstructured leadership where a manager gives subordinates direct decision-making responsibilities. While this is the weakest form of management style, it is consistent with employee empowerment.

Laissez-Faire Leadership Disadvantages  Employees receive little direction or guidance.  Generally, decisions are not made because managers are unable or unwilling to make them  Staff members do not receive feedback regarding their performance.

Empowerment Form of Participative Management where employees share management responsibilities, including decision making. Self-directed work teams are an outgrowth of empowerment where employee groups establish and implement their own work goalsParticipative Management

An open form of management where employees have a strong decision- making role. Participative management is developed by managers who actively seek a strong cooperative relationship with their employees. The advantages of participative management include increased productivity, improved quality, and reduced costs.

Participative Leadership Consultative management method that encourages others to participate. Leadership decisions are achieved as the end result of group participation. Participative management is the process of consultative management.

CHARACTERISTICS OF AN EFFECTIVE MANAGER Being a good manager requires sound communication, decision-making and problem solving skills A desire to manage – comfort with the position Trust in one’s own judgment – ability to work without constant guidance from others Skills in stress management

Motivation to guide and to work with people, not just to attain power Ability to make competent decisions, especially in emergencies Ability to channel others’ feelings and hostility into constructive problem- solving Ability to handle different situations

QUALITIES OF AN EFFECTIVE LEADER 1. Self-confidence 2. Self-awareness 3. Strong personal values 4. Skills of Value Clarification (choosing freely from alternatives, prizing the choice and acting consistently on that choice. 5. Advocacy (the act of arguing on behalf of a particular issue, idea or person). 6. Accountability (taking responsibility for values and actions)

Situational Leadership  Takes into account the style of the leader, the maturity of the group, and the situation at hand to form a comprehensive approach  Four typical styles 1. Directing  Provides specific instructions and supervises the accomplishment of tasks  New employees, employees with repeated performance problems, and crisis work situations

2. Coaching Monitors the accomplishment of tasks while also explaining decisions, asking for feedback or suggestions, and recognizing good performance Typically, leader and staff have jointly developed a work plan.

3. Supporting Supports the efforts of others, facilitates their goal accomplishment, and shares responsibility for decision making Values growth and not perfection, collaboration and not competition 4. Delegating Gives responsibility for decision making and problem solving to mature staff who have demonstrated their competence

LVN/LPN AS CHARGE NURSES 1. Responsible for getting shift reports 2. Assign clients to staff members 3. Determine client acuity 4. Handle emergencies 5. Assign staff breaks 6. Attend special meetings 7. Attends to client tests and procedures 8. Ensure availability of needed supplies and equipments

9. Count narcotics at the beginning and end of the shift 10. Check the crash cart 11. Report to the nursing supervisor 12. Check staffing for the next shift 13. Send client acuity reports to administration.

Leadership and Management Team Leading  Assisting and guiding the nursing team in providing care for a select group of patients  Duties Receive reports on assigned patients Make assignments for team members Make rounds and assess all assigned patients Assist in administering medications and treatments Confer with team members on priority patients

Time Management  Using time to good advantage will be of great value.  Learn effective time management skills, and practice them frequently until they become fully developed.  These skills will help you manage not only at work but also in daily living.

Anger Management  Anger gives you a cue that something is wrong.  Justified Helps you get your needs met by stimulating you to action  Unjustified or displayed inappropriately Can get you and others in trouble

Burnout  Physical, emotional, and spiritual exhaustion  Occurs more often in people who have excessively high expectations of themselves  High-risk areas Intensive care Hospice Oncology Emergency department

Burnout (continued)  Signs and symptoms Physical  Fatigue; changes in sleeping and eating  Lack of energy; loss of interest in sex Psychologic  Irritability; hypersensitivity  Frustration; negative outlook  Forgetting Spiritual  Loss of commitment, meaning, and integrity

Symptoms of burnout. BURN OUT SYNDROME

Transcribing Physicians’ Orders  Written Recorded on the chart by the physician. NEVER GUESS NEVER GUESS: If in doubt, get a second opinion. If it is a little different that “usual,” clarify it with the physician.

Transcribing Physicians’ Orders Written If you still believe the orders to be inappropriate, contact your supervisor and document why the orders are not being carried out. Nurses are responsible for their own actions regardless of who told them to perform those actions.

Clarifying the physician’s order.

Transcribing Physicians’ Orders (cont’d)  Verbal or via telephone They may only be taken from a physician or a nurse. They are more subject to error. Clarify the order by repeating it to the person giving it. Ask them to repeat it more slowly if necessary. Write it down immediately. Be careful about medications that sound alike.  For example, Zantac and Xanax

Computerized system for narcotic distribution.

Giving a change-of-shift report.

Change of Shift Report  The report provides the next shift with pertinent information about the patient.  The quality of nursing care the patient receives is contingent on how well each shift communicates with the other.  The report may be given orally in person, by audiotape recording, or with rounds from patient to patient.  Before beginning the report, write down all necessary information.

Malpractice Insurance: Chemically Impaired Nurses 16. You are ready to give end-of-shift report to C.D., who will be in charge of your unit for the next shift; when she arrives, 15 minutes late, she does not have eye contact with you, smells of mints, her hands are trembling, her uniform is disheveled, and her shoes are untied. She asks you no questions regarding any patients, and leaves the room when your report is completed. What do you do? A. Go home, your shift is completed. B. Call the supervisor and report your observations. C. Stay on the unit until you are sure C.D. has no questions regarding the patients. D. Call the state board of nursing and report C.D.'s behavior.

17. After C.D. has begun,a substance abuse outpatiert treatment program, she is allowed to return to work, with supervision. Which statement by C.D. indicates that she is recovering from her substance abuse problem? A. "I wish I knew who turned me in to administration; I would like to give that nosy witch a piece of my mind!" B. “Just because I had a glass of wine with a meal before I came to work once or twice, I'm going to be watched like a hawk. What a pain!" C. "I realize that I'm going to have to regain the trust of my co-workers and administrators, but I can do that, one day at a time." D. "If other people took their jobs as seriously as I take mine, they wouldn't have time to rat on other people."

LEADERSHIP The nurse is a leader, not only in the healthcare facility, but also in the community. Take this responsibility seriously, for other people look up to nurses. The nurse continues to learn throughout the career and throughout life. ***

1. Which of the following roles of a nurse is an example of legitimate power? A) Director of nursing B) Team leader making assignments C) Head nurse scheduling vacations D) Shift supervisor

1. Which of the following roles of a nurse is an example of legitimate power? A) Director of nursing B) Team leader making assignments C) Head nurse scheduling vacations D) Shift supervisor  Ans: A  Difficulty: Easy

2. Which of the following are the advantages of autocratic leadership styles? A) Staff members are invested in management's goals. B) Lines of authority and policies are clear. C) Communication is limited to memos. D) Decisions may not occur on time.

2. Which of the following are the advantages of autocratic leadership styles? A) Staff members are invested in management's goals. B) Lines of authority and policies are clear. C) Communication is limited to memos. D) Decisions may not occur on time. Ans: B Difficulty: Moderate

3. When delegating tasks to unlicensed assistive personnel (UAP), a licensed practical nurse (LPN) should assess the situation. Which of the following is the first step involved in assessing the situation? A) Communicate expectations clearly to UAP. B) Identify the UAP who will best handle the delegated tasks. C) Know the client's needs and priorities. D) Trust the UAP to complete the task.

3. When delegating tasks to unlicensed assistive personnel (UAP), a licensed practical nurse (LPN) should assess the situation. Which of the following is the first step involved in assessing the situation? A) Communicate expectations clearly to UAP. B) Identify the UAP who will best handle the delegated tasks. C) Know the client's needs and priorities. D) Trust the UAP to complete the task. Ans: C Difficulty: Moderate

4. A licensed practical nurse (LPN) has delegated a task to unlicensed assistive personnel (UAP). Identify the person who is accountable for evaluating the results of the tasks? A) Physician B) Shift supervisor C) UAP D) LPN

4. A licensed practical nurse (LPN) has delegated a task to unlicensed assistive personnel (UAP). Identify the person who is accountable for evaluating the results of the tasks? A) Physician B) Shift supervisor C) UAP D) LPN Ans: D Difficulty: Easy

5. How do licensed practice nurses (LPNs)/licensed vocational nurses (LVNs) function as client advocates? A) By knowing the client's need B) By supporting the client's decision C) By communicating expectations D) By delegating tasks to unlicensed assistive personnel (UAP)

5. How do licensed practice nurses (LPNs)/licensed vocational nurses (LVNs) function as client advocates? A) By knowing the client's need B) By supporting the client's decision C) By communicating expectations D) By delegating tasks to unlicensed assistive personnel (UAP) Ans: B Difficulty: Easy

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