Explains the purpose and constraints the program

1. 4.1 Differentiate between leaders and managers.

LISTEN TO THE AUDIO
The terms manager, leader, supervisor, and administrator are often used interchangeably, yet they are not the same. A is anyone who uses interpersonal skills to influence others to accomplish a specific goal. The leader exerts influence by using a flexible repertoire of personal behaviors and strategies. The leader is important in creating connections and forging links among an organization’s members to promote high levels of performance and quality outcomes. The functions of a leader are to achieve a consensus within the group about its goals, maintain a structure that facilitates accomplishing the goals, supply necessary information that helps provide direction and clarification, and maintain group satisfaction, cohesion, and performance.

 Evaluate outcomes and provide feedback.

All good managers are also good leaders—the two go hand in hand. However, one may be a good manager of resources and not be much of a leader of people. Likewise, a person who is a good leader may not manage well. Both roles can be learned; skills gained can enhance either role.

1. 4.2 Evaluate different theories that explain leadership.

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Research on leadership has a long history, but the focus has shifted over time from personal traits to behavior and style, to the leadership situation, to change agency (the capacity to transform), and to other aspects of leadership. Each phase and focus of research has contributed to managers’insights and understandings about leadership and its development.

Contingency approaches suggest that managers adapt their leadership styles in relation to changing situations. According to contingency theory, leadership behaviors range from authoritarian to permissive and vary in relation to current needs and future probabilities. A nurse manager may use an authoritarian style when responding to an emergency situation such as a cardiac arrest but use a participative style to encourage development of a team strategy to care for patients with multiple system failure.

Contemporary Leadership Theories

Quantum leadership demands a different way of thinking about work and leadership. Change is expected. Informational power, previously the purview of the leader, is now available to all. Patients and staff alike can access untold amounts of information. The challenge, however, is to assist patients uneducated about healthcare in learning how to evaluate and use the information they have. Because staff members have access to information that only the leader had in the past, leadership becomes a shared activity, requiring the leader to possess excellent interpersonal skills.

Transactional Leadership

Transformational leaders appeal to individuals’ better selves rather than these individuals’ self-interests. They foster followers’ inborn desires to pursue higher values, humanitarian ideals, moral missions, and causes. Transformational leaders also encourage others to exercise leadership. The transformational leader inspires followers and uses power to instill a belief that followers also have the ability to do exceptional things.

Transformational leadership may be a natural model for nursing managers because nursing has traditionally been driven by its social mandate and its ethic of human service. In fact, found that transformational leadership reduced burnout among employees, and

Examples of shared leadership in nursing include the following:

 Self-directed work teams. Work groups manage their own planning, organizing, scheduling, and day-to-day work activities.

 Empathy

 Awareness

(See Table 4-1.)
Table 4-1 Emotional Intelligence Domains and Associated Competencies

PERSONAL COMPETENCE: These capabilities determine how we manage ourselves.

Emotional intelligence has been linked with leadership (;). One study, however, found no relationship between emotional intelligence and transformational leadership ().

Nurses, with their well-honed skills as compassionate caregivers, are aptly suited to this direction in leadership that emphasizes emotions and relationships with others as a primary attribute for success. These skills fit better with the more contemporary relationship-oriented theories as well.

LISTEN TO THE AUDIO
Leaders cannot lead without followers in much the same way that instructors need students in order to teach. Nor is anyone a leader all the time; everyone is a follower as well. Even the hospital CEO follows instructions from the board of directors.

is interactive and complementary to leadership, and the follower is an active participant in the relationship with the leader (). A skilled, self-directed, energetic staff member is an invaluable complement to the leader and to the group. Most leaders welcome active followers; they help leaders accomplish their goals and the team succeed.

Box 4-1 Guidelines for Followers

 Find out what you are expected to do.

 Support efforts to make necessary changes.

 Show appreciation and provide recognition when appropriate.

Traditional Management Functions

1. 4.4 Explain why nurses need to learn management skills.

is a four-stage process to achieve the following:

 Establish objectives (goals).

group process that addresses the questions of what, why, where, when, how, and by whom.

Decision making and problem solving are inherent in planning, and computer software programs

Antonio, the nurse manager of a home care agency, plans to establish an in-home phototherapy

program, knowing that part of the agency’s mission is to meet the healthcare needs of the child-

 Who would provide the service

 How staffing would be accomplished

Strategic planning refers to the process of continual assessment, planning, and evaluation to guide the future (). Its purpose is to create an image of the desired future and design ways to make those plans a reality. A nurse manager might be charged, for example, with developing a business plan to add a time-saving device to commonly used equipment, presenting the plan persuasively, and developing operational plans for implementation, such as acquiring devices and training staff.

Organizing

is the process of getting the organization’s work done. Power, authority, and leadership style are intimately related to a manager’s ability to direct. Communication abilities,

motivational techniques, and delegation skills also are important. In today’s healthcare organization, professional staff are autonomous, requiring guidance rather than direction. The manager is more likely to sell the idea, proposal, or new project to staff rather than tell them what to do. The manager coaches and counsels to achieve the organization’s objectives. In fact, it may be the nurse who assumes the traditional directing role when working with unlicensed personnel.

involves comparing actual results with projected results. This includes establishing standards of performance, determining the means to be used in measuring performance, evaluating performance, and providing feedback. The efficient manager constantly attempts to improve productivity by incorporating techniques of quality management, evaluating outcomes and performance, and instituting change as necessary.

When Antonio introduces the home phototherapy program, the team of nurses involved in the

Leadership Theories

1. 4.2 Evaluate different theories that explain leadership.

Research on leadership in the early 1930s focused on what leaders do. In the behavioral view of leadership, personal traits provide only a foundation for leadership; real leaders are made through education, training, and life experiences.

Contingency approaches suggest that managers adapt their leadership styles in relation to changing situations. According to contingency theory, leadership behaviors range from authoritarian to permissive and vary in relation to current needs and future probabilities. A nurse manager may use an authoritarian style when responding to an emergency situation such as a cardiac arrest but use a participative style to encourage development of a team strategy to care for patients with multiple system failure.

Quantum leadership demands a different way of thinking about work and leadership. Change is expected. Informational power, previously the purview of the leader, is now available to all. Patients and staff alike can access untold amounts of information. The challenge, however, is to assist patients uneducated about healthcare in learning how to evaluate and use the information they have. Because staff members have access to information that only the leader had in the past, leadership becomes a shared activity, requiring the leader to possess excellent interpersonal skills.

Transactional Leadership

Transformational leaders appeal to individuals’ better selves rather than these individuals’ self-interests. They foster followers’ inborn desires to pursue higher values, humanitarian ideals, moral missions, and causes. Transformational leaders also encourage others to exercise leadership. The transformational leader inspires followers and uses power to instill a belief that followers also have the ability to do exceptional things.

Transformational leadership may be a natural model for nursing managers because nursing has traditionally been driven by its social mandate and its ethic of human service. In fact, found that transformational leadership reduced burnout among employees, and

Different issues call for different leaders, or experts, to guide the problem-solving process. A single leader is not expected always to have knowledge and ability beyond that of other members of the work group. Appropriate leadership emerges in relation to the current challenges of the work unit or the organization. Individuals in formal leadership positions and their colleagues are expected to participate in a pattern of reciprocal influence processes. and found shared leadership common in Magnet-certified hospitals.

Examples of shared leadership in nursing include the following:

Founded by Robert Greenleaf (Greenleaf, 1991), is based on the premise that leadership originates from a desire to serve and that, in the course of serving, one may be called to lead (). Servant leaders embody three characteristics:

 Empathy

 Second, nurses serve many constituencies, often quite selflessly, and consequently bring about change in individuals, systems, and organizations.

Emotional Leadership

Thus, the workplace is a more complex and intricate environment than previously suggested.

Healthcare environments require innovations in care delivery and therefore innovative leadership approaches. Quantum, transactional, transformational, shared, servant, and emotional leadership make up a new generation of leadership styles that have emerged in response to the need to humanize working environments and improve organizational performance. In practice, leaders tap a variety of styles culled from diverse leadership theories.

Followers are powerful contributors to the relationship with their leaders. Followers can influence leaders in negative ways, as in government cover-ups, Medicare fraud, and corporate law-breaking attest. The reverse is also true. Poor managers can undermine good followers in direct and indirect ways, such as criticizing, belittling, or ignoring positive contributions to the

between leaders and followers led to an increase in nurse burnout, resulting in a decrease in the quality of care and, in some cases, causing nurses to leave the profession.

 Take the initiative to deal with problems.

 Keep the boss informed about your decisions.

 Challenge flawed plans and proposals made by bosses.

 Resist inappropriate influence attempts by the boss.

LISTEN TO THE AUDIO

In 1916, French industrialist Henri Fayol first described the functions of management as

 Evaluate the present situation and predict future trends and events.

 Formulate a planning statement (means).

and databases are available to help facilitate it.

Organization-level plans, such as determining organizational structure and staffing or operational

rearing family. To effectively implement this program, he would need to address the following:

 How the program supports the organization’s mission

 How charges would be generated

 What those charges should be

is the process of coordinating the work to be done. Formally, it involves identifying the work of the organization, dividing the labor, developing the chain of command, and assigning authority. It is an ongoing process that systematically reviews the use of human and material resources. In healthcare, the mission, formal organizational structure, delivery systems, job descriptions, skill mix, and staffing patterns form the basis for the organization.

In organizing the home phototherapy project, Antonio develops job descriptions and protocols,

In directing the home phototherapy project, Antonio assembles the team of nurses to provide the

service, explains the purpose and constraints of the program, and allows the team to decide how

program identifies standards regarding phototherapy and individual performances. A subgroup of

the team routinely reviews monitors designed for the program and identifies ways to improve the

LISTEN TO THE AUDIO
Putting nursing management into practice in the dynamic healthcare system of today is a challenge. Organizations are in flux, structures are changing, and roles and functions of nurse managers become moving targets.

Managers are essential to any organization. A manager’s functions are vital, complex, and frequently difficult. They must be directed toward balancing the needs of patients, the healthcare organization, employees, physicians, and self. Nurse managers need a body of knowledge and skills distinctly different from those needed for nursing practice, yet few nurses have the education or training necessary to be managers. Frequently, managers depend on experiences

Box 4-2 AONE Five Areas of Competency
AONE believes that managers at all levels must be competent in the following:

Communication and Relationships-Building Competencies Include:  Effective communication
 Relationship management
 Influence of behaviors

Ability to work with diversity  Shared decision making
 Community involvement
 Medical staff relationships
 Academic relationships