Leadership & management PrinciplesChapters 1, 3 & 4

Joseann DeWitt, RN, MSN

3 Essential and Interrelated Elements

Leadership Followership Management

LEADERSHIP

Leadership is the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance.

Effective leaders enable people to move “in the same direction, toward the same destination, at the same speed, not because they have been forced to, but because they want to” (Lansdale, 2002)

Three primary tasks of a leader are (Drath, 2001) : To help people develop a sense of direction and purpose

Through mission, goals, vision, purpose To build the group’s commitment to its goals

Through motivation, spirit, teamwork To face the numerous challenges that arise in a health

care setting Through change and turbulence

Leadership Overview

Leadership is a natural element of nursing practice because themajority of nurses practice in work groups or units.

Possessing the license of an RN implies certain leadership skillsand requires the ability to delegate and supervise the work of others.

Is every nurse a leader?

Are YOU ready to be a leader?

LEADERSHIP THEORIES

Trait Theories Focuses on identifying specific characteristics of

leaders. What a leader is….

Behavioral Theories Focuses on attitudes toward leader behavior. What a leader does…

Situational Theories Focuses on how leadership styles change according to

the situation. How a leader responds…

Trait Theories

Traits (qualities) of leaders: Intelligence Initiative Excellent interpersonal skills High self-esteem Creativity Willingness to take risks Ability to tolerate the consequence of taking

risks

Situational Theories

Adaptability to the situation Doesn’t assume that one particular approach

works in all situations Recognizes the complexity of work situations

and encourage Considers many factors when deciding what

action to take Every situation is different

Behavioral Theories Leadership styles

Authoritarian Leadership Democratic Leadership (Participative) Laissez-faire Leadership

AUTHORITARIAN

AKA Autocratic, Directive, Controlling

Dictates policies and procedures Decides what goals are to be

achieved Directs and controls all activities

without any meaningful participation by the subordinates

DEMOCRATIC

AKA Participative Followers are encouraged

to be part of the decision making process.

Requires the leader to be a coach who has the final say, but gathers information from staff members before making a decision.

LAISSEZ-FAIRE

AKA Permissive, Nondirective

The least possible guidance is given to subordinates.

“Let it alone” Does very little planning or

decision making Fails to encourage others to

participate Truly a lack of leadership

COMPARISON OF LEADERSHIP STYLESAUTHORITARIAN DEMOCRATIC LAISSEZ-FAIRE

Strong Control Less Control No Control

Gives Orders Offers Suggestions Nondirective Style

Does Decision Making Makes Suggestions Abdicates Decision Making

Leader Does Planning Group Does Planning No Planning

Directive Participative Uninvolved

High quantity, good quality output by group

Creative, high quality output by group

Variable output by group, may be poor quality

Fosters Dependency Fosters Independence Fosters Chaos

Breaking it down further… Transformational Leadership Addresses meaning, inspiration and vision People need a sense of mission Communicates vision in a manner that is meaningful

and exciting, which inspires commitment in others Motivates followers to perform to their full potential

over time by influencing a change in perceptions and by providing a sense of direction

Uses charisma, individualized consideration & intellectual stimulation to produce greater effort, effectiveness, and satisfaction in followers

Generates greater follower commitment Generates greater follower satisfaction Generates overall effectiveness

MAGNET RECOGNITION PROGRAM®

5 key components to obtain Magnet status:

1. Transformational Leadership2. Structural Empowerment3. Exemplary Professional Practice4. New Knowledge, Innovations, and

Improvements5. Empirical Outcomes

NOTE: Magnet emphasizes transformational leadership

Qualities of an Effective Leader Integrity

Adherence to a code of personal ethics and a code of professional ethics

Courage Risk-taking

Initiative Act on ideas

Energy Requires effort

Optimism Optimism is “catching” – can re-motivate a discouraged group

Perseverance Do not give up easily

Balance Balance between work and play

Ability to handle stress Coping with stress in a positive and healthy manner

Self-awareness Understand self

Behaviors of an Effective Leader Thinking critically

Careful, deliberate use of reasoned analysis to reach a decision

Solving problems Helps identify problems and to work through the

problem-solving process Respecting the individual

Recognizes the differences in people and helps them find the rewards in their work

Skillful communication Listening to others Encouraging the exchange of information Providing feedback Setting specific goals/communicating a vision for the

future Developing oneself and others

Continue to learn and encourage others to do the same

Winner or Whiner – Which Are You? A winner says…

We have a real challenge here.

I’ll give it my best. That’s great! We can do it. Yes!

A whiner says… This is really a

problem. Do I have to? That’s nice, I guess. Impossible. It can’t be

done. Maybe…

Holman (1995)

SKILLS NECESSARY TO BE A NURSE LEADER

American Organization of Nurse Executives' (AONE):five domains of nurse executive competency:

1. Communication and relationship management 2. Leadership 3. Business skills and principles 4. Knowledge of the health care environment 5. Professionalism

LEADERSHIP DO’S

A profile of leaderships “do’s” includes: Honesty Energy Drive Tenacity Creativity Flexibility Visibility Emotional stability Knowledge Conceptual skills Leadership motivation

Leadership is founded on trust and does not survive without it.

Leadership is hard, sustained work that requires a great deal of energy and sputters without it.

LEADERSHIP DON'TS

A profile of leadership “don'ts” includes: Untrustworthiness Insensitivity to others

a likely cause for ineffective leadership Aloofness Over-managing Abrasiveness Inability to think strategically or staff effectively Inability to build a team Focusing on internal organizational politics (overly

ambitious)

Followership

“If you think you are leading and no one is following you, then you are just taking a nice walk.”

— John Maxwell

FOLLOWERSHIP

Followership and Leadership are separate but reciprocal roles

A leader can’t lead without followers A follower can’t follow without a leader Followership is NOT passive and unthinking!

5 CATEGORIES OF FOLLOWERS

“Sheep” Lack initiative, sense of responsibility, and critical thinking

“Yes-people” Lack enterprise and yield to the opinions, will or decisions of others

“Alienated” followers Capable of independence and critical thinking but appear passive

because they resist open opposition The result is frustration and disillusionment

“Survivors” Never make waves or take risks; they go which way the wind blows

“Effective” followers Have initiative and think for themselves. Manage themselves well and are responsible and well balanced. Competent and committed.

Effective followers are an asset to be nurtured, developed, and valued. Effective followers contribute to success in organizations.

TIPS FOR BEING A GOOD FOLLOWER

The most valuable follower is a skilled, self-directed employee, who participates actively in setting the group’s direction, invests his/her time and energy in the work of the group, thinks critically and advocates for new ideas. (Grossman & Valiga, 2000) Inform team leader or manager of a problem. Offer

suggestions for solving the problem. Invest interest and energy in your work. Be supportive of new ideas. When you disagree, explain why. Listen carefully and reflect. Continue to learn as much as you can about your specialty. Share what you learn with others.

Pygmalion Effect

The greater the expectation placed upon employees the better they perform

Management Effective nursing managers are responsible for

ensuring safe patient care and ensuring that it is given in the most effective, efficient and cost-effective manner possible.

Management (Fayol, 1916) Plan Organize Command Coordinate Control work

Mintzberg (1989) The manager’s function is to do whatever is necessary

to make sure that employees do their work and do it well.

Differences Between Leadership and Management

Leadership Based on influence and

shared meaning An informal role An achieve position Pare of every nurse’s

responsibility Initiative Independent thinking

Management Based on authority and

influence A formally designated

role Formal authority to

direct the work of a given set of employees

An assigned position Usually responsible for

budgets, hiring and firing people

Improved by the use of effective leadership skills

Key Point

Leadership is an essential part of effective management

You do not have to be a manager to be a leader BUT you do need to be a good leader to be an effective manager

The Importance of Effective Leadership Skills

First, it is important to nurses because of the size of the profession

Second, nursing's work is complex, often conducted in complex settings. Authenticity and caring are valued in nurse leaders and are

exhibited by people who are genuine, trustworthy, reliable, and believable and who create a positive environment

Third, nurses enter the practice of nursing by licensure but they come from a variety of educational backgrounds. Nurses need a strong leadership to resolve the

interprofessional dilemmas derived from educational diversity and issues related to professionalization and employment.

Leadership is Key to the Success of Health Care Organizations

Leadership principles can be learned through education and practice.

Leaders must know themselves and their followers, the situation, the communication process, and goals, and they must be flexible enough to make necessary adaptations.

Leaders are those who innovate and take the risks inherent in new approaches.

Effectiveness means matching leadership behaviors to the environment and then adapting within that environment.

Leaders who never vary their style are probably ineffective some of the time.

Leadership involves a concern for task and a concern for people. Good leaders need good followers.

Practices Common to Exceptional Leadership Achievement

Challenging the process by searching for opportunities, experimenting, and taking risks

Inspiring a shared vision by envisioning the future and enlisting the support of others

Enabling others to act by fostering collaboration and strengthening others

Modeling the way by setting an example and planning small successes

Encouraging the heart by recognizing contributions and celebrating accomplishments

Management

Management Theories

The Human Relations Approach Emphasizes the relationship aspects of managing

people

Scientific Management Emphasizes the task aspects of management

McGregor’s Theory X and Theory Y Theory X

Reflects a common attitude among managers that most people really do not want to work very hard and that the manager’s job is to make sure that they do work hard

Therefore, a manager needs to employ strict rules, constant supervision, and the threat of punishment to create industrious, conscientious workers

Theory Y Managers believe that the work itself can be

motivating and that people will work hard if their managers provide a supportive atmosphere

Manager emphasizes guidance rather than control, development rather than close supervision, and reward rather than punishment

McGregor’s Theory X and Theory Y

X Work is something to be avoided People want to do as little as possible Use control-supervision-punishment

Y The work itself can be motivating People really want to do their job well Use guidance-development-reward

Contingency Theory

The basic principle is that managers need to consider the situation and all its elements when making a decision.

Managers need to act on the key situational aspects with which they are confronted.

Sometimes described as “it all depends” decision making, contingency theory is most often used for choosing a leadership or management style.

The “best” style depends on the situation

Systems Theory

Managers recognize that changing one part of a system inevitably affects the whole system, creating a ripple effect within the whole.

Complexity Theory

Complexity theory is a more general umbrella theory that encompasses chaos theory.

The focus of complexity theory is the behavior over time of certain complex and dynamically changing systems.

Chaos Theory

Randomness and complexity are two principal characteristics of chaos.

The slightest variation can have enormous results in a dynamic and changing system.

Viewing the organization as similar to a living organism, taking a holistic approach.

Believe that the universe is not orderly and that things do not progress in a linear fashion. Much of nature moves in a circular and ebbing manner. Disturbances create disequilibrium that can lead to growth. Nature is self-organizing and self-renewing. A distinguishing

feature of a self-renewing organization is that it has resiliency instead of stability.

Life tries to find what works and uses messes to arrive at better solutions because messes can be opportunities. It is good for us to be authentic, support each other, and to thrive on our differences

Qualities of an Effective Manager Leadership

The “people skills” of the leader are the core skills needed to function as a manager

Clinical Expertise Need to be able to help others develop their skills and

to evaluate how well they have performed those skills Business sense

Cost of providing care that is given, budgeting, staffing, measuring patient outcomes

What do you think? Is it better to have a “generic” manager and “managing

people is managing people”, or Is it better to have a manager that understands the

tasks of the worker?

Behaviors of an Effective Manager

Three categories Interpersonal Decisional Informational

Behaviors of Effective Manager: Interpersonal

Networking Develop positive working relationships with other

disciplines, departments, and units Conflict negotiation and resolution

Conflicts between employees, between clients and staff members, and between staff members and administration

Employee development Providing continuing learning and upgrading of

the skills of employees Rewards and punishments

Tangible rewards: salary, time off Intangible rewards: praise, recognition

Behaviors of Effective Manager: Decisional

Employee evaluation Performance appraisals

Resource allocation Have a set amount of money for running the unit

Hiring and firing employees Participate in or fully carry out the employment

and termination of staff Planning for the future

Prepare for changes in budgets, organizational priorities, patient populations

Job analysis and redesign Analyze and redesign the work of unit to make it

as efficient and cost-effective as possible

Behaviors of Effective Managers:Informational

Spokesperson Relay information to staff from administration Speak for staff when relaying information to

administration Represent unit/department at meetings or

discussions Monitoring

Monitor activities of unit, including patient population, infection rates, staff, budget

Dissemination Sharing information such as new policies,

development in healthcare

MANAGERIAL ROLES

Management Process

1. Planning2. Organizing3. Coordinating or Directing4. Controlling

Planning

Encompasses determining philosophy, goals, objectives, policies, procedures, and rules

Carrying out long- and short-range projections

Determining a fiscal course of action

Managing planned change

PHASES OF PLANNING

1. Identify the mission2. Conduct an environmental scan3. Analyze the situation: SWOT analysis of

Strengths, Weaknesses, Opportunities, and Threats

4. Establish goals5. Identify strategies to reach goals6. Set objectives to achieve goals7. Assign responsibilities and timelines8. Write a planning document9. Celebrate success and completion

Strategies to Ensure Implementation

Involve the right people in planning. Do a written plan, and communicate it widely. Establish goals and objectives that are specific,

measurable, acceptable, placed in a time frame, stretching, and rewarding.

Build in accountability (regular review). Note deviations and re-plan. Evaluate the planning process and the plan. Conduct ongoing communications. Make the planning process compatible with the

preferences of the planners.

ERRORS THAT MAY CREATE PLANNING FLAWS

Errors of factThe plan is based on misinformation

Errors in assumptionThe plan is based on incorrect assumptions

Errors of logicThe plan is based on faulty reasoning

Organizing

Organizing includes: establishing the structure to carry out plans determining the most appropriate type of

patient care delivery, and grouping activities to meet unit goals

Other functions involve working within thestructure of the organization and

understanding and using power and authority appropriately.

Directing

Usually entails human resource managementresponsibilities such as: Motivating Managing conflict Delegating Communicating Facilitating collaboration

Controlling

Includes: • Performance appraisals• Fiscal accountability• Quality control• Legal and ethical control, and• Professional and collegial control

Important Managerial Skills

Developing peer relationships Carrying out negotiations Motivating subordinates Resolving conflicts Establishing information networks and disseminating information Making decisions in conditions of extreme ambiguity Allocating resources

Role of the Nurse Manager

Managing clinical nursing practice Managing human, fiscal, and material resources Developing personnel Complying with regulatory and professional

standards Making strategic plans Fostering interdisciplinary and collaborative

relationships

Comparison of NURSE EXECUTIVE AND NURSE MANAGER

Manages one or more defined areas of nursing services and is responsible to a nurse executive.

Allocates available resources, coordinate activities, facilitate interactive management

Has a major responsibility for implementing the vision, mission, philosophy, goals, plans, and standards of the organization and nursing services

Responsible for managing organized nursing services from the perspective of the organization as a whole and for transforming values into daily operations to produce an efficient, effective, and caring organization.

Accountable for the environment in which clinical nursing practice occurs.

Provides leadership and direction for all aspects of nursing care

Nurse Manager Nurse Executive (CNO)

EFFECTIVE MANAGERS & EFFECTIVE LEADERS

Envision the future Communicate their visions Motivate followers Lead the way Influence others to

accomplish goals Inspire confidence Take risks Empower followers Master change

Coordinate resources Optimize resource use Meet organizational goals

and objectives Follow rules Plan, organize, control, and

direct Use reward and

punishment effectively to achieve organizational goals

Leaders Managers

ETHICAL PRINCIPLES FOR MANAGERS

1. Frugality and sophisticated therapeutic skill (doing the most with the least resource expenditure)

2. Clinical credibility through organizational competence

3. Presence (visibility)

4. Responsible representation at highest levels

5. Loyal service

6. Deliberate delegation

7. Responsible innovation

8. Fiduciary accountability

9. Self-discipline

10. Continuous learning

Legal Aspects of Management Personal negligence in clinical practice

Liability for delegation and supervision

Organizational liability related to employment issues

Emotional Intelligence

One part of managing people and relationships in organization is to manage the expression of emotion.

Skill building and training in positive thinking and a focus on positive emotions assist nurses to better listen, encourage, motivate, and create connections.

Emotional intelligence is the intersection of thinking and emotion.

The goal is to achieve optimal outcomes.

Essential for Leadership:Emotional Intelligence

Self-Awareness Attuned to own emotional state Recognizing your emotions, differentiating between emotions,

knowing the reason behind the emotion

Self Management Ability to stay calm, clear-headed Maintaining control Resisting or delaying an impulse, drive, or temptation to act;

controlling aggression, hostility, and irresponsible behavior; managing emotions in a flexible and adaptable way

Essential for Leadership:Emotional Intelligence

Perceiving accurately Accurately assessing a situation, having clear vision, keeping a

broad perspective, being objective

Social Awareness Attuned to others’ emotional state Reading others Being aware of the emotions of others, appreciating the

emotions of others, understanding how and why people feel and act as they do

Relationship Management Redirects emotional energies toward shared objectives Communicating with flexibility Having a full range of emotional expressions, being authentic,

addressing your needs as well as the needs of others

Current Issues & Trends in Management

Within health care delivery systems, issues and trends facing today's managers include:

Management of populations with chronic illnesses Resources to acquire technology on an ongoing basis The need for primary and preventive services and programs,

including complementary and alternative programs Integration and seamlessness of clinical and financial services and

information Protection of consumers' privacy Doing more with less Shortages of key personnel, especially registered nurses Financing structures such as capitation and managed care Care delivery and process management Management of knowledge workers and personal accountability Pressures for quality and sustainable outcomes Leadership skills related to change management

American Nurses Association

American Nurses Association membershipThe strength of a profession lies in the number

of members in its professional organization, its internal unity and the ability to mobilize collective action.

ANA represents nursing at the national level. Yet less than 5% of all RNs belong to the organization