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• Conflict resolution• Culture of safety• 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)

1. Staffing for patient care2. Developing goals and objectives

for the unit3. Establishing standards of care4. Developing budgets and using

resources in a cost-effective manner

5. Implementing quality improvement activities to affect patient outcomes

6. Engaging in problem solving7. Planning, organizing, managing,

controlling, and directing unit activities

8. Hiring, orienting, evaluating, and educating staff

9. Mentoring and developing staff10. Identifying systems problems

and suggesting solutions11. Acting as a resource for clinical

issues12. Ensuring compliance with

policies, procedures, and accrediting or regulatory agencies

13. Recruiting and retaining staff14. Participating in organizational

committees and task forces15.Acting as a corporate supporter

Comparison between Managers and Leaders

Managers Leaders

AdministerAsk how and whenFocus on systems

Do things rightMaintain

Rely on controlShort-term perspective

Accept status quoHave eye on the bottom line

ImitateClassic “good soldiers”

A copy

InnovateAsk what and whyFocus on people

Do the right thingsDevelop

Inspire trustLong-term perspective

Challenge status quoHave eye on the horizon

OriginateOwn personThe 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: automatic leadership, bureaucratic

leadership, democratic l. , laissez-faire, situational l.

• 21st century leadership (Table 19-3)• 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• 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