Presentation on theme: "The Leadership Role of the Licensed Practical Nurse"— Presentation transcript:
1 The Leadership Role of the Licensed Practical Nurse Chapter 4The Leadership Role of the Licensed Practical Nurse
2 Learning Objectives Differentiate between leadership and management. Describe leadership styles.Discuss leadership theories.Discuss management theories.List tips for effective management.Describe the role of the licensed vocational nurse as a team leader.
3 Leadership versus Management Terms leadership and management used interchangeably but have different meaningsLeadership is broader and more futuristic; management is more local and task focusedLeadership: inspiration; management: perspirationIdeally, leadership and management complement and build on each other
4 Leader Creates a vision that energizes others to follow Guides or shows the way to othersClarifies values for groups that, when combined with vision, create a mission for the groupFormal leaders and informal leadersInspires people to strive to accomplish particular goals by doing the right thingSees beyond the here and now to what might be and is internally driven toward that visionWhat are examples of a formal leader and an informal leader?
5 ManagerAssigned or appointed; focuses on the organization’s day-to-day workDriven by external organizational rewardsProvides means to achieve organization’s goals by doing the thing rightGets things organized so the leader’s vision can be achieved
6 Leaders and ManagersLeaders and managers must have certain characteristics to be effectiveCompetenceAbility to gain respect of those who work with themAbility to communicate with othersAbility to motivate othersUnderstanding of what others consider important and why they behave as they doWillingness to reinforce motivation, enhance positive outcomes, and provide multiple motivators
7 Leaders and ManagersGood leaders and managers seem to have certain characteristics in commonAbility to set realistic goalsWillingness to try out new ideasAbility to think positively
9 Autocratic Leaders Authoritarian, directive, or bureaucratic Achieve goals by setting objectives and having them carried out without input from othersBelieve they have complete authority and should not be questionedDo not encourage individual initiative or cooperation among members of the organizationTask oriented, making decisions independently and issuing orders to those working with themThis style of leadership does not work well in many situations; in other situations it is necessaryDuring an emergency, one person must take chargeWhen an autocratic leader hires an autocratic manager, a power struggle is likely to occur.When would an autocratic leadership style be justified?
10 Democratic Leaders Focus on the individual abilities of each member Encourage input into the problem-solving processDecisions often are made through group consensusAll are informed of the organization’s goals and direction; input has a direct relationship to attaining goalsInstead of power struggles, democratic leaders turn problems over to the group to manageLead by suggestion rather than by dominationPersuade and teach rather than ruleGroup members are satisfied because they help manage the decision-making processWhat is participative leadership?
11 Laissez-Faire Leaders Opposite of autocratic leadersProvide little or no directive leadershipIndividuals are allowed to do anything they want with no direction from administrationResult: people do not know or care about what they are supposed to do and may lose initiative and desire for achievementMay work well with a highly motivated, focused group
12 Multicratic Leaders Cross between autocratic and democratic leaders Sometimes called situational leadersPresent their own views to group members, who provide criticism and commentsAnalyze group feedback and then make final decisionsWork well within a group as well as in emergency situations, when events need to be handled quicklyResponse not as quick as under autocratic leadershipGroup members assist the multicratic leader with setting goals, thereby achieving for themselves a sense of empowerment and control
13 Transformational Leadership In a well-functioning group that shares a common vision, leadership will flow among the members based on the task or problem at hand and the members’ individual skillsAll group members are leaders and followersMay not replace reporting lines or formal job responsibilities, but it may be very effective in identifying the best option at the moment and in energizing others to take action because they are very involved in the decision-making processWhat is the quantum theory?Experience, personal values, individual personality, maturity, and education may influence how one sees a situation as well as what solutions are identified.
14 Classic Management: Theory X Assumes that people in the workplaceFind no pleasure in their workDislike responsibilityAre naturally lazy and prefer to do nothingWork mainly for the moneyWork only because they fear being firedAre basically childlike and like being told what to doDo not want to think for themselvesAre not capable of making decisions for themselvesAccording to theory X, people have these characteristics; thus, they want to be directed and controlledWho developed theory X and theory Y?Leaders who adhere to the X theory of management usually have an autocratic style.
15 Classic Management: Theory Y Assumes people are dynamic, flexible, and adaptiveBelievers in this theory assume that peopleAre active and enjoy setting their own goalsWork for personal rewards other than moneyAre productive because of their own goalsAre mature and responsibleAre self-directedAccept responsibilityCare about what they are doingAre constantly striving to growAccording to theory Y, people like their work when they know what is expected of them and when their work gives them satisfactionLeaders who adhere to the Y theory of management usually have a democratic style.
16 Classic Management: Theory Z An organizational philosophy and structureGrew out of the times when most employees were related to one another and worked together for the good of the company rather than for individual gainFocus is on participative management based on mutual trust and loyaltyEmployees frequently remain with the same organization for their entire career, learning all areas of its operations and merging their individual success with that of the organizationWhere did theory Z originate?Leaders with a democratic management style often are able to fit into this type of management.
17 Classic Management: Theory Z Involves all workers in every phase of the operation of the company: planning, organizing, decision making, and problem solvingAll group members have similar abilities and status; may be rotated to perform different dutiesGroup members know and understand organizational objectives and methods of achieving themResults in greater efficiency and satisfaction among members of the workforce
20 Planning First step in the management process Entails deciding in advance what needs to be done and how to do itA good plan for carrying out their care must be developed to provide effective care for patientsTwo important components of planning are decision making and problem solving
21 Decision Making and Problem Solving Identify the problemSometimes the problem is obvious, but other times underlying issues make the real problem less obviousExplore all aspects of the situation to identify the real problemSeek answers to such questions as who, how, when, and why
22 Decision Making and Problem Solving Explore all possible solutionsThis is a creative process that can involve other people in the health care settingBrainstorming sessions may be held to obtain input from a variety of sources
23 Decision Making and Problem Solving Choosing the most desirable action for solving the problem, to select the best solutionConsider whether the action is likely to accomplish the objectives of the organizationDetermine whether the action increases effectiveness and efficiency and whether it is realistic to implement it
24 Decision Making and Problem Solving Implement the decisionCommunicate with other people who are involved in the organization to gain their support for the actionExpress the decision in such a way that others support rather than oppose itHow can antagonism and negative feelings be avoided?
25 Decision Making and Problem Solving Determine how the results will be evaluatedWritten tools, such as audits or checklistsVerbal or written feedback from individuals in the organization or from patients who are receiving the careIf the chosen solution to the problem is not satisfactory, another alternative can be selected and tried, followed by another evaluation.
26 Organizing Second step in the management process Must be a formal structure or organization to ensure that individuals carry out actions in the most efficient and effective mannerHelps develop order, promote cooperation among workers, and foster productivity
27 Organizing Develop objectives Establish policies and procedures Guide the process of planning and organizingEstablish policies and proceduresProvide guidelines for carrying out the objectivesMake appropriate staff assignmentsThe most qualified people should be assigned to activities and tasks that will achieve the objectivesMay involve the development of job descriptions, performance standards, and staffing patterns
28 Directing The third step of the management process Make assignments and direct people to carry out the assignmentsExplain what is to be done, how it is to be done, and why it is to be doneMaking assignments is related to patient careAssignments should be made carefully so that the skills of assigned personnel match patient needsImportant to estimate the difficulty of the task and the time needed to complete the careHelp and additional instruction should be providedIn nursing, making assignments is related to patient care.How many people should be involved in making assignments?
29 DirectingOne person should be responsible for making assignments, especially with team nursingAssignments must be specific, easily understood, and posted where everyone can see themStaff members should be helped to understand their assignments and the importance of each taskDirections must be complete and understandableGive directions in a clear, logical order and limit the number of directions given at any one timeProviding written directions increases understanding and complianceDirecting people to carry out their assignments requires good communication skills and assertive behavior.Should directions be given in the form of a demand or a request?
30 Coordinating Step of the management process Pulls together various activities toward a goalEnsures all important activities are being carried out and helps to identify overlap, duplication, and omissionsInvolves personnel and servicesYou must be sure that proper nursing care is given by the appropriate people
31 CoordinatingCarried out within a single nursing unit or among units and departments in a hospital, long-term care facility, or community agencyDemands skill in problem solving and decision makingRequires good communication skills and an ability to resolve conflicts within an organizationRequires an assessment of what all individuals and groups are doing; important for all parts of the organization to function effectively for the good of the whole
32 Controlling The last step in the management process Ongoing process: activities are analyzed to make sure the plans are being carried outEfficiency and effectiveness are evaluatedPurposes of controlling are to determine whether there are enough staff and supplies, the operation is economical, and the objectives have been achievedControlling is fundamentally a form of evaluationControlling has three basic stepsEstablishing standards and objectivesMeasuring performance and comparing results with standardsRemedying any deficiencies in the caregiving operations
33 Controlling Continuous quality improvement Quality assurance (QA), continuous quality improvement (CQI), and total quality management (TQM) used in relation to controllingMeasures performance against set standards and expectations and alerts the organization when an action falls below standardQA committees set standards for care and evaluate complianceAmerican Nurses Association, American Hospital Association, and Joint Commission on Accreditation of Healthcare Organizations set standards for nursing practice and medical careContinually seeks ways to improve nursing practice
34 Conflict ResolutionConflicts arise from differences in many factors, such as beliefs, knowledge, opinions, values, personalities, and backgroundsCreates stress and negative feelings that can adversely affect the work situationMay be within an individual (intrapersonal conflict), between two or more people (interpersonal conflict), or between individuals and organizations (organizational conflict)
35 Four Stages of Conflict Stage 1: FrustrationPeople who believe their goals are being blocked feel frustratedMay become angry or resigned to the situationStage 2: ConceptualizationEach party formulates a view of the basis for the conflictTypically centers on perceived differences in facts, goals, how to achieve goals, and the values on which goals are based
36 Four Stages of Conflict Stage 3: ActionThe conflict leads to various behaviors that may or may not help resolve the issueStage 4: OutcomesGoals may be reformulated so they are acceptable to all partiesOne party may “win,” the other may “lose”Emotions may be positive or negative
37 Modes of Conflict Resolution AccommodationCollaborationCompromiseAvoidanceCompetitionTable 4-5 shows the positive and negative outcomes of each modeWhat is the key to making conflict resolution work effectively?
38 Tips for Effective Management Managing health care workers is a complex taskStrategies to improve your management skillsTake active approach to planning; avoid conflict before it occursHave a clear vision, communicate it well, listen, and stay focusedEmphasize importance of documentation as part of managementTreat other health care workers or team members as you would like to be treated yourselfKeep confidential information confidentialMake employees accountable for their actions and be accountable for yoursSeek help and support from a variety of sourcesLPNs often are asked to assume responsibilities for the care that other staff members give to patients.Who may the LPN be responsible for managing?
39 The Licensed Practical Nurse as a Leader Team nursingIntroduced during the 1950s, when there was a shortage of professional nurses and an abundance of auxiliary nursing staffThe team functions by using the skills and knowledge of the professional nurse to direct the care provided by a diverse staff through group actionAll members have input into the nursing care process by contributing suggestions and sharing ideas
40 The Role of the Team Leader Functions: plan, set priorities, supervise, and evaluate patient careResponsible for ongoing collection of data about each patient and assistance in determining nursing interventionsEnsure that medical orders and plans are carried out and documentedInitiate discharge planning, identify referral needs, and facilitate patient educationThe role of the team leader traditionally was carried out by a registered nurse; however, an LPN may be assigned to the position of team leader, especially in long-term care settings.
41 The Role of the Team Leader Responsible for keeping care plans current and documenting the nursing care providedResponsible for planning and conducting team conferences and reporting changes to the RN supervisorAn LPN who assumes the position can help carry out these responsibilities under the supervision and guidance of an RN
42 Making AssignmentsYou must be able to assign tasks to others and make sure that those tasks are carried outDelegation allows nurses to accomplish nursing care for more clients than one individual could provide aloneDelegation (defined by the NCSBN): “the act of transferring to a competent individual the authority to perform a selected nursing task/activity/function in a selected situation, the process for doing the work”
43 Making AssignmentsInvolves identifying specific tasks needed to provide care for a specific personBased on patient needs, available staff, job descriptions, scope of practice for licensed nurses, and scope of functions for nursing assistantsWhen delegating a task, your duty is patient safetyEffective delegation: delegating a clearly identified task, identifying patient needs, empowering the staff person to carry out activities to complete the task, and monitoring staff performanceAmong nurses working in clinical settings, delegation involves “working through others” and assignment describes “what a person is directed to do.”How many state boards of nursing authorize delegation by RNs? By LPNs?
44 Making Assignments Essential elements of effective delegation Know your state nurse practice act statements on delegation and your institution’s policy and procedures manualKnow the training and background of people to whom you delegate tasksDecide which tasks can be safely delegatedEvaluate the patient’s responseYou must find out what the unlicensed personnel know, delegate appropriately, and document the outcomes.
45 Making Assignments Delegate tasks only to licensed personnel Do not delegate nursing processes to unlicensed personnel. Assessment, planning, evaluation, and judgment cannot be delegatedDelegation is specific to each clientAn unlicensed person who completes a task for one patient cannot do the same task for all patientsDelegation is also situation specificYou delegate a task for one patient in one situation
46 Accident Prevention and Safety Every health care facility must meet minimal safety regulations established by law in addition to those adopted by the agency to meet its unique needsAll staff members, particularly the team leader, should learn these regulations during job orientationThe team leader should know the regulations and be sure that staff members are aware of them
47 Accident Prevention and Safety Everyone must understand procedures to follow in case of disasters such as fires, tornadoes, and hurricanesEveryday safety issues related to handling equipment, using proper procedures, and working with potentially dangerous drugs must constantly be addressed to be sure that knowledge and skills are up to date
48 AccountabilityTeam leaders demonstrate accountability for their own actions as well as those of their staffIndividuals are answerable for their actions and may be called on to explain or justify themTeam leaders are legally responsible for all nursing care and documentationRN team leader is responsible for ensuring that proper and accurate charting is carried out for all nursing assessments, interventions, and evaluationsInvolves communicating patient needs to others through both oral and written interactions
49 Accountability Guidelines for clear and complete reporting Organize the report before beginningGive the patient’s room number, name, age (if appropriate), diagnosis, and physicianProvide a brief account of each patient’s condition, including new or changed ordersRefer to vital signs, temperature elevations, intravenous fluids, and intake and output as relevantThe LPN is usually responsible for reporting to the RN in charge but may be only indirectly responsible for the report.What is the key to good communication?
50 Accountability Guidelines For patients receiving pain medication, note the drug name, dosage, prescribed frequency, time of last administration, and effectivenessCover the necessary information for preoperative patients, including the preoperative teaching, the time of preoperative medications, completion of surgical checklists and the like
51 Accountability Guidelines Give information about postoperative patients, including the time of arrival from the operating or recovery room, general condition, vital signs, intravenous fluids required (e.g., kind, rate of flow, fluids to follow), dressings, voiding, diet, nature of breathing, coughing, and type, location, and patency of tubes
52 Characteristics of an Effective Team Leader Has skills in leadership, management, and supervisory techniquesCommunicates effectively, both orally and in writingWorks well with others; shows that others’ input and suggestions are valuedUnderstands how to build an effective teamThe leader’s possession of these qualities leads to greater satisfaction among the staff and a higher quality of patient care.
53 Characteristics of an Effective Team Leader Strategies to build an effective teamEstablish a clear purposeListen activelyBe compassionateBe honestBe flexibleBe committed to conflict resolutionWhat must you understand to be a good team leader?A team is a group of people who need to work together to achieve a goal or task; for nursing it is delivery of care to patients.
54 The LPN as Charge Nurse Depends on LPN’s state nurse practice act Common for LPNs in long-term care to fill this roleMost states require that written protocols and procedures be in place and that the LPN work under the general supervision of an RNThe LPN who is placed in a charge position is expected to have adequate preparation to perform competently.What should the LPN be able to do to function as a charge nurse?
55 The LPN as Charge NurseLPN must have adequate preparation to perform competentlyRequires education, training, and/or experience beyond the basic LPN educational programLPN must assign patient care, assess patients, delegate tasks (as permitted by state law), receive and give shift reports, and handle common workplace issues