principles of leadership and management in nursing

If the delivery of nursing services involves the organization and coordination of complex activities in the human services realm, then both leadership and management are important elements. management is a branch of the nursing field which focuses on managing nurses and patient care. Groups have personalities that include a discernible level of trust. 3. evolve.elsevier.com/Huber/leadership/ This, in turn, is driven by perseverance to be the best patient and employee advocate one can be. Once again, a task-oriented style is called for—challenging individuals by using the motivation they need to continue to produce. Some say leadership and management are two very different things. Based on the work of Goleman (2007), relational and emotional integrity are hallmarks of good leaders. Some individuals are able to integrate styles and flexibly match to the situation at hand, but this is rare. Autonomy refers to the nurse allowing the client to make their own decision. For example, directing occurs in both leadership and management activities (the area of overlap), whereas inspiring a vision is clearly a leadership function. Nursing has drawn from both classic and contemporary thinkers. The laissez-faire style results in a decision, conscious or otherwise, to avoid interference and let events take their own course. 2. They suggest that “one of the most reliable indicators and predictors of true leadership is an individual’s ability to find meaning in negative events and to learn from even the most trying circumstances” (Bennis & Thomas, 2002, p. 39). Hersey and colleagues (2013) said that leadership styles are the consistent behavior patterns exhibited in influencing the activities of others by working with and through them, as perceived by those others. Leadership theory began to move beyond a focus on traits to explore the concept of leadership styles. Task structure means how structured the group’s assigned task is. Developing realistic action plans to build employee satisfaction. The inclination is for a democratic power style, and the emphasis is on the importance of establishing relationships, maintaining connections with others, and deriving strength from empowering others. One way to foster effective leadership is to evaluate leaders according to Fiedler’s contingency model (1967) and then use this information to increase leaders’ awareness of their natural style tendency: relationship-oriented or task-oriented. Social awareness: An intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others, 4. • Actively managing the change process through communication, feedback, training, sustained effort and attention, and worker involvement Nurses have two basic roles: care providers and care coordinators. The leader should use selling, convincing, encouraging, and motivating strategies. Please contact us. Policies are a matter of group discussion and decision. Terms related to leadership are leadership styles, followership, and empowerment.Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. Empowerment means giving people the authority, responsibility, and freedom to act on their expert knowledge and skills. They are sets or clusters of behaviors used in the process of effecting leadership. Level 1 is unable and unwilling or insecure. Readiness has two aspects: ability and willingness. The acute care medical model in hospitals over time came to be the primary focus of attention and jobs for nurses. Service. This overlap occurs where the two processes are integrated or synthesized to accomplish goals and where the same strategies are employed even though the goals may differ. This approach implies a relationship and person orientation. By contrast, leadership approaches described by men tend to be influenced by the military and participating in team sports. This style emphasizes a high concern for task. However, according to the definitions, characteristics, and processes, the concepts of leadership and management are different, but at the area of overlap they look similar. The true essence of a Magnet organization stems from exemplary … This is because the leader operates in a crucial cultural and contextual influencing mode. Decisions of policy are made solely by the leader who tends to dictate tasks and techniques to followers. The leader observes and analyzes which abilities and motives are present in the followers. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), LEADERSHIP AND CARE MANAGEMENT DIFFERENTIATED. Nurses can start by examining their own behaviors and then taking deliberative actions to strengthen trust in the environment. A servant-leadership model can support personal and professional growth, empowering nurses to play a leadership role and thereby increasing nurse collaboration, satisfaction, and retention. Leadership is hard, sustained work that requires a great deal of energy and sputters without it. Hersey and colleagues (2013) described the Tri-Dimensional Leader Effectiveness Model first developed by Hersey and Blanchard. Further background on the history of leadership research can be found online (e.g., www.sedl.org/change/leadership/history.html). A third phase of leadership theories grew out of a group of contingency theories whose central idea was that organizational behavior is contingent on the situation or environment. Level 4 is able and willing or confident. The culture is more solidified in a work group that has worked together for many years on a particular unit. Both leadership and management are necessary. DEFINITIONS Adapting to the situation, and • Communication and relationship management 1. Self-awareness: Ability to read one’s own emotional state and be aware of one’s own mood and how this affects staff relationships, 2. Environmental or cultural differences also cause the leadership situation to vary. However, attitudinal theories still did not fully capture the leadership experience because the environment and its complexity were not factored in. What is needed by the leader is diagnostic ability. Such an environment generates challenges to the nurse’s identity, coping skills, and ability to work with others in harmony. This is because of the increasing demand from shifting demographics in the population… Thus there is no one best way to influence others or one best style. Clearly, “something changes as leadership blossoms” (, Leadership is a natural element of nursing practice because the majority of nurses practice in work groups or units. Fiedler’s measure for leadership style is the Least Preferred Coworker (LPC) scale (Fiedler & Chemers, 1984). However, several authors have developed lists of traits common to good leaders (Bass, 1985; Bennis & Nanus, 1985), and interest remains in the characteristics to look for in good leaders. The nurse leader combines clinical, administrative, financial, and operational skills to solve problems in the care environment so that nurses can provide cost-effective care in a way that is satisfying and health promoting for patients and clients. Hersey and colleagues (2013) defined leadership as a process of influencing the behavior of either an individual or a group, regardless of the reason, in an effort to achieve goals in a given situation. Bennis (1994) made a strong argument for leadership, stating that quality of life depends on the quality of leaders. Leadership theories have evolved away from an early focus on the traits or characteristics of the leader as a person because it was found that it is not possible to predict leadership from clusters of traits. In her new position as ED nursing director at Hahnemann University Hospitalin Philadelphia, Sharon Sandt, BSN, RN, considers clear communication a key component of leadership. Thus leadership is a social exchange phenomenon. However, leadership and management do serve distinct purposes. Thus no one leadership style is optimal in all situations. Hersey and colleagues (2013) emphasized the importance of the readiness of followers. Communication processes vary among groups regarding the patterns and channels used and how open or closed the communication flow is. This occurs because once the group has less conflict, individuals may begin to coast along and positive motivation may be lost as individuals become apathetic. This means that which theory or style is the best all depends on the situation at hand. Impoverished: This style uses minimal effort to get the work done. Fiedler’s measure for leadership style is the Least Preferred Coworker (LPC) scale (, (© Copyright 2006. As applied to the continuum of authoritarian versus democratic styles, telling would be authoritarian and participating would be democratic. In a way, nursing’s struggle for greater economic parity in health care is courageous and risky. All rights reserved.). A profile of leadership don’ts includes untrustworthiness, insensitivity to others, aloofness, over-managing, abrasiveness, inability to think strategically or staff effectively, inability to build a team, and focusing on internal organizational politics (overly ambitious). Each has advantages and disadvantages. Exemplary Professional Practice. Consequently, leaders come to a new or altered sense of identity. An evidence-based approach to differentiating nursing leadership from management was taken to identify discrete competencies through an integrative content analysis of the literature base (Jennings et al., 2007). 1. As applied to the continuum of authoritarian versus democratic styles, telling would be authoritarian and participating would be democratic. If the nurse leader is a task-oriented person, a high-relationship person may need to be called on to assist the group process so that it is facilitated and becomes effective. Their work suggested that there are a variety of leadership styles (Figure 1-2) or points along the continuum. Nurses need to be aware of the interacting elements in any leadership situation. Communication is transmitted through both verbal and nonverbal modes. Leaders are active, not passive. This style promotes complete freedom for group or individual decisions. Leadership means giving guidance and using a focused vision. For example, if a nurse works in a situation in which there is a high level of frustration, it may be time to step back and analyze the basic five elements. Tannenbaum and Schmidt (1973) suggested that a leader might select one of many behavior styles arrayed along a continuum. Flexibility is important. Popularity is not leadership; results are. Although the lists of leadership characteristics and competencies vary somewhat, the functions of visioning, setting the direction, inspiration, motivation, and enabling systems and followers are at the core of leadership activity. Good managers should strive to be good leaders and good leaders, need management skills to be eff ective. Here are some the ways an effective, forward-thinking nurse leads: Nurses must not only think like leaders, but they must transform the above leadership principles into action by: Good nurse leaders are even more effective when they develop the following personal skills: Learning how to be a good nurse leader is an important part of an RN to BSN program because leadership skills are required for almost any job in today's many areas of nursing. The leader innovates and conquers the context. FIGURE 1-3 Expanded Situational Leadership® model. Clancy (2003) noted that leaders need to “consistently find the courage to hold true to their beliefs and convictions” (p. 128). Examples include when technology changes more quickly than clinicians are able to learn and adapt to it, when management duties extend to include temporary workers employed by others (e.g., outsourced functions and agency nurses), and when a radical organizational shift to an accountable care organization (ACO) is necessary. Organizations include a variety of communication structures and flows. Styles can be chosen to match the situation (Hersey et al., 2013). Nursing Leadership & Management 1. 3. Relationship management: Use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members. Leadership is defined here as the process of influencing people to accomplish goals. • Management: Resource coordination and integration to accomplish specific goals Fiedler (1967) examined which style (task-oriented versus relationship-oriented) would be most effective for each of eight situations. There are situational and contextual factors to consider when choosing a style. to leader-centered). Leaders may grow gradually out of a smoldering issue or erupt through a crisis event. Behaviors that build trust include sharing relevant information, reducing controls, and meeting expectations. Perhaps it is time to apply leadership and management concepts and competencies by setting, level of role responsibility, career stage, and social context to more fully apply the evidence base to practice. At its core, leadership is about influencing people. For this situation, the task-oriented leader is a more effective match between leader and job. Fiedler’s measure for leadership style is the Least Preferred Coworker (LPC) scale (Fiedler & Chemers, 1984). For example, Bennis and Nanus (1985) studied 90 chief executives from 1978 to 1983 and found that there were two key leadership traits. Hersey and colleagues (2013) defined leadership as a process of influencing the behavior of either an individual or a group, regardless of the reason, in an effort to achieve goals in a given situation. distinctions between leadership and management. Only gold members can continue reading. Figure 1-1 shows how these components relate to one another. For example, telling is an appropriate leadership style to use with followers who are at the novice level and with followers who are not able or willing. 2. Work avoidance (resistance) means that people are outside the productive range of tension. Level 3 is able but unwilling or insecure. 2. 3. Popularity is not leadership; results are. Leaders engage their environment with behaviors of doing, influencing, and moving. Hersey and colleagues (2013) noted that the leadership process is a function of the leader, the followers, and other situational variables. The IOM focus is on the following five areas of management practice: • Balancing tensions between efficiency and reliability, • Actively managing the change process through communication, feedback, training, sustained effort and attention, and worker involvement. It is important for nurses to recognize that they can learn, practice, and improve their personal leadership competencies. Organizational man: This approach works on balancing the necessity to accomplish the task with maintaining morale. For example, a nurse may use leadership strategies or management strategies to motivate others, but the desired outcome of the motivation is likely to be different. Diagnosing: Diagnosing involves being able to understand the situation and the problem to be solved or resolved. Leaders need to be willing to make tough choices plus overcome the fear associated with them. At the next level, the nurse manager concentrates on the day-to-day administration and coordination of services provided by a group of nurses. It includes achievement motivation, wanting to do well, persistence, a work attitude, and a sense of independence. Fiedler (1967) examined which style (task-oriented versus relationship-oriented) would be most effective for each of eight situations. Kotter (2001) noted that managers cope with complexity whereas leaders cope with change. A nurse’s job is to lead and manage a hospital’s critical care area, which has serious morale problems. Leadership is not rank but responsibility. He noted that the leader focuses on people, whereas the manager focuses on systems and structures. Challenging the process: Leaders go beyond the status quo to search for opportunities, experiment, and take risks to achieve lofty goals. Log In or Register to continue If this idea were visualized, it would appear as concentric circles—not as separate but overlapping circles. Bennis (1994) listed a number of distinctions between leadership and management. KNOW your job. Hersey and colleagues (2013) defined these terms as follows: • Task behavior: The extent to which leaders organize and define roles; explain activities; determine when, where, and how tasks are to be accomplished; and endeavor to get work accomplished, • Relationship behavior: The extent to which leaders maintain personal relationships by opening communication and providing psychoemotional support and facilitating behaviors. Leadership is founded on trust: “Trust is the emotional glue that binds leaders and employees together and is a measure of the legitimacy of leadership” (Malloch, 2002, p. 14). Leadership is best defined as: a. an interpersonal process of participating by encouraging fellowship. The continuum ranges from democratic to authoritarian (or subordinate-centered to leader-centered). However, according to the definitions, characteristics, and processes, the concepts of leadership and management are different, but at the area of overlap they look similar. Lack of leadership and poor management skills by nurse managers are the chief reasons employees give for leaving their jobs. Favorable or unfavorable situations are determined in part by the receptivity of the followers, but they are also determined by whether the larger environment is positive or negative. One choice a leader has is to alter his or her own behavior and the leadership style used. The focus of each is different: management is focused on task accomplishment and leadership is focused on human relationship aspects. When the problem no longer is just the need to get the group moving but also includes solving numerous interpersonal conflicts, a relationship-oriented leader is better matched to the situation. The situational approach focuses on observed behaviors of leaders and how leadership styles can be matched to situations. Strong evidence for the nurse leader’s critical role both in the business of a health care organization and in the quality and safety of service delivery has been laid out by the Institute of Medicine (IOM) (2004), the American Nurses Credentialing Center’s (ANCC) Magnet Recognition Program® (ANCC, 2008a, b), and the American Organization of Nurse Executives (AONE) (2005). Characteristics such as knowledge, motivating people to work harder, trust, communication, enthusiasm, vision, courage, ability to see the big picture, and ability to take risks are associated with important leadership qualities in research findings. Because the style is based on noninterference, a clear decision may never be formulated. Followers may need greater structure than the leader gives them. Nurses can best respond by demonstrating vision, adapting to changes, seeking new tools for dealing with the new health care environment, and leading the way with client-centered strategies. The AONE 2005 nurse executive competencies are described in the following five domains of skill: • Communication and relationship management, • Knowledge of the health care environment. Nurses prefer managers who are participative, facilitative and emotionally intelligent. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). If, however, the staff nurse’s mind is closed about any changes or if passive-aggressive or subversive actions occur, then the leader needs be more directive. Interpersonal, emotional, and social intelligence skills also contribute to the effective leadership of knowledge workers (. Cost containment, patient’s rights, safe staffing, stress and anger, and ethical dilemmas all challenge the leader to identify right from wrong and act from his or her sense of conviction. By submitting this form, I am providing my digital signature agreeing that University of Louisiana at Lafayette (UL Lafayette) may email me or contact me regarding educational services by telephone and/or text message utilizing automated technology or a pre-recorded message at the telephone number(s) provided above. On the other hand, in a staff meeting, an authoritarian leader may be ineffective with a group of professionals and would need to be flexible enough to switch to a democratic or laissez-faire style, depending on the circumstances. If the leader plays a major role in creating a group’s culture and ethos, then closing down communication, breeding distrust and competition, and neglecting positive motivation can sow the seeds of group disintegration. In contrast, the goal of the individual nurse may be to spend time counseling and teaching clients because that is what is seen by the nurse as the most important activity. Leaders can create an environment that is positively charged for productivity or that allows followers to languish without direction or mission. The ability to diagnose, choose, and alter behavior to implement a leadership style best matched to the situation is a critical skill needed for effective leadership. The nature of the situation needs to be considered. process includes five interwoven aspects: (1) the leader, (2) the follower, (3) the situation, (4) the communication process, and (5) the goals (Kison, 1989). These are trials, tests, and transformative experiences that force leaders to question themselves and what matters and to hone their judgment. The individual nurse’s task is to determine in which environments he or she functions best and is most comfortable or where he or she most likely will succeed. Have the members worked together for a long time in the job, or are they new employees? For example, Bennis and Nanus (1985) studied 90 chief executives from 1978 to 1983 and found that there were two key leadership traits. Based on the work of Goleman (2007), relational and emotional integrity are hallmarks of good leaders. Readiness can be applied to a work group. The effectiveness of an individual nurse depends partly on that individual’s competence and partly on the creation of a facilitating environment that contains sufficient resources to accomplish goals. The democratic style makes output appear to move more slowly and is thought to take longer than using an authoritarian style. Internal forces in leaders that impinge on leadership style are values, confidence in employees, leadership inclinations, and sense of security in uncertainty (Tannenbaum & Schmidt, 1973). This is an unfavorable situation and a leadership challenge. • Leadership The four skill sets needed by good leaders are as follows: Hersey and colleagues (2013) defined management as the “process of working with and through individuals and groups and other resources (such as equipment, capital, and technology) to accomplish organizational goals” (p. 3). 4. Organizations have goals, and individuals working in organizations also have goals. The situation is dynamic and subject to change. These are core to all leadership in all situations. Their Situational Leadership® is a synthesis of the interplay among task behavior, relationship behavior, and the readiness of the followers. Nurses use managerial and leadership skills to facilitate delivery of quality nursing care. For this situation, the task-oriented leader is a more effective match between leader and job. Followership is defined as an interpersonal process of participation. Fiedler’s theory (1967) suggests that the best leadership style under unfavorable circumstances is task-oriented. Bennis (1994) listed a number of, Hersey and colleagues (2013) noted that the leadership process is a function of the leader, the followers, and other situational variables. Bennis (1994) made a strong argument for leadership, stating that quality of life depends on the quality of leaders. Communicating as an interdisciplinary team and incorporating support services. The other part of readiness is psychological willingness, which means being willing to take responsibility and have a positive attitude toward accepting the obligation to complete a task. ; Research Notes in each chapter summarize relevant nursing leadership and management studies and highlight practical applications of research findings. She noted that relational coordination drives quality and efficiency outcomes and health care performance. This involves the ability to think critically, to identify problems, and to develop objectivity and a degree of maturity or judgment. Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. They identified management as a special kind of leadership that concentrates on the achievement of organizational goals. 4. Leadership Management: Principles, Models and Theories 313 KNOW human nature. One way to foster effective leadership is to evaluate leaders according to Fiedler’s contingency model (1967) and then use this information to increase leaders’ awareness of their natural style tendency: relationship-oriented or task-oriented. • Knowledge of the health care environment The situation is dynamic and subject to change. Self-awareness: Ability to read one’s own emotional state and be aware of one’s own mood and how this affects staff relationships Such an environment generates challenges to the nurse’s identity, coping skills, and ability to work with others in harmony. The demands of management work are increasing in amount, scope, complexity, and intensity and thus increase role stress and leave less time to plan and focus on unit management (Porter-O’Grady, 2003). He noted that the leader focuses on people, whereas the manager focuses on systems and structures. The leadership courage continuum runs from “good coward” (cannot muster courage to make tough choices) to “reckless courage” (shoot from the hip). The chaos and complexity of the seismic shifts in health care structure, delivery, form, technology, and content have made visible the urgent need for leaders to emerge, mobilize, and encourage followers. This may include such activities as arranging access to services, providing direct care, doing referrals, and supporting a patient’s family. A third phase of leadership theories grew out of a group of contingency theories whose central idea was that organizational behavior is contingent on the situation or environment. The way people influence others through actions taken and the perspectives of other people is related to leadership efforts and constitutes leadership style. Such an environment does not simply happen; it requires special skills and the courage and motivation to move a vision into action. In the trait approach, theorists have sought to understand leadership by examining the characteristics of leaders. Their internalized pattern of basic behaviors influences actions and the ability to lead. The wise leader assesses the trust and readiness to change levels of the group. The values, skills, and style of leaders are important. Followership is not as simple as it seems (see Followership section). Encouraging the heart: Leaders appreciate and recognize individual contributions and formally celebrate accomplishments. For example, a staff nurse goes into a nursing unit meeting not wanting any extra assignments but hoping that some of the ongoing problems will be solved. Trust goes both ways and needs to be nurtured. If the delivery of nursing services involves the organization and coordination of complex activities in the human services realm, then both leadership and management are important elements. Emphasizing vision, values, and motivation. These dimensions are similar to the authoritarian (or task) and democratic (or relationship) ideas of the leader behavior continuum. An evidence-based approach to differentiating nursing leadership from management was taken to identify discrete competencies through an integrative content analysis of the literature base (Jennings et al., 2007). He noted that the leader focuses on people, whereas the manager focuses on systems and structures. Level 4 is able and willing or confident. There is a difference between the role of authority and the exercise of leadership. Yet clearly there is overlap in that one can be, “The nurse leader plays a critical role in the business of the healthcare organization and the quality and safety of the services provided” (O’Connor, 2008, p. 21). The individual nurse’s task is to determine in which environments he or she functions best and is most comfortable or where he or she most likely will succeed. Self-awareness is crucial to leadership effectiveness and is the focus for many leadership exercises. Courage – take well considered risks for the goal of improvement. There is always a relationship between leadership and management in nursing, Malby (1996) indicates that developing and fostering leadership competencies could direct nurse managers to think beyond tradition and to coordinate multidisciplinary dialogue which articulates the needs of the system and the patients whilst empowering employee. The long history of leadership theory has highlighted the importance of focusing on both of the two basic leadership elements of tasks and relationships. Leadership can be best understood as a process. Thus the overlap area appeared to be larger than previously thought. Inspiring shared vision: Leaders envision the future and enlist others in sharing the dream. She identified female leadership as a weblike structure—dynamic and continuously expanding and contracting. Among these characteristics, untrustworthiness is a fatal flaw, and insensitivity to others is a likely cause for ineffective leadership (Hersey et al., 2013). The task is to change the environment, but the nurse discovers that this work group has maintained its traditions over a long period. Nursing is a service profession whose core mission is the care and nurturing of human beings in their experiences of health and illness. Leadership Dos and Don’ts Visioning Clearly, a balance of the two is necessary. Because of the factor of constant change, maintaining good leadership is complicated for any group. Eventually, as the situation progresses, a relationship-oriented leader can become less effective. Their Situational Leadership® is a synthesis of the interplay among task behavior, relationship behavior, and the readiness of the followers. A task-oriented style is needed for situations on the extremes, whereas a relationship-oriented style is needed when the situation is moderately favorable. These can be distilled into leadership dos and don’ts. Little reward came from the “thinking” and integrating skills nurses were capable of. The personality styles of both superiors and subordinates have an influence on the situation, the work demands, and the amount of time and resources available. Fiedler’s theory (1967) suggests that the best leadership style under unfavorable circumstances is task-oriented. Nurses need to have a solid foundation of knowledge in leadership and care management. The leader innovates and conquers the context. Good RN to BSN programs explore leadership principles and how to implement them. Leaders’ perceptions of themselves, their roles, and their expectations also have an impact on their followers. The basic needs are for leader self-awareness and knowledge of the group’s ability and willingness levels before examining the situational elements and choosing a leadership style. 5. Styles should vary according to the appropriateness of the situation with reference to an evaluation of effectiveness. The leader should use selling, convincing, encouraging, and motivating strategies. If they do not know each other and the situation is politically charged, the nurse leader needs to help people become comfortable with each other. Intergroup cohesion is a focus with this style. The practices and qualities of leadership help nurses enrich their own style and contribute to a more productive workplace. Leadership skills build on professional and clinical skills. To choose an appropriate style, the leader needs to be knowledgeable about the readiness of the followers. In this area of overlap, the processes and strategies look similar and may be employed for a similar outcome or blended together to accomplish goals. Leadership and management are equally important processes. Remember the adage: if your unit or department can run without you, you've done your job. Leaders need to be concerned about both tasks to be accomplished and human relationships in groups and organizations. Leaders’ perceptions of themselves, their roles, and their expectations also have an impact on their followers. If the leader plays a major role in creating a group’s culture and ethos, then closing down communication, breeding distrust and competition, and neglecting positive motivation can sow the seeds of group disintegration. Nursing. The only definition of a leader is someone who has followers. This view would position management as a part of leadership, not as a distinct concept. In contrast, management involves influencing employees to meet an organization’s goals and is focused primarily on organizational goals and objectives. Authority-obedience: This style strives for efficiency in operations. This is a development of the work conducted in the 1980s by the American Academy of Nursing – according to which, hospitals that were able to recruit and retain highly qualified nurses in a competitive market displayed 14 ‘forces of magnetism’, including quality of nursing leadership and management style (Royal College of Nursing, 2015). Most leadership definitions incorporate the two components of an interaction among people and the process of influencing. For example, the nurse care provider concentrates on the coordination of nursing care to individuals or groups. • Leadership: Guiding, directing, teaching, and motivating to set and achieve goals 1. With sensitivity, cues in the environment can be identified and used to make choices regarding leadership style. Situations in which members of a group are not accustomed to working together or do not hold shared expectations frequently lead to conflict. LEADERSHIP AND CARE MANAGEMENT DIFFERENTIATED In nursing, leadership is studied as a way of increasing the skills and abilities needed to facilitate clinical outcomes while working with people across a variety of situations and to increase understanding and control of the professional work setting. In the middle of the continuum, a high-relationship style is needed, again to foster productivity. 4. Today, however, nurses must have leadership skills from day one. Despite its potential drawbacks, this style has advantages when used with groups of fully independent care providers or professionals working together. In 140 articles reviewed, they found 894 competencies, of which 862 (96%) were common to both leadership and management. The Trait Approach has led to long lists of skills and characteristics associated with successful leaders. From an early awareness of the leader’s need to be concerned about both tasks and human relationships (output and people) sprang a long history of leadership theories that can be grouped as trait, attitudinal, and situational (Hersey et al., 2013). LEADERSHIP THEORIES If you already have a BSN, consider going for an MSN. One currently accepted view of organizational behavior describes leadership as situational or contingent and concerned with what produces effectiveness. Impoverished: This style uses minimal effort to get the work done. 1. Followers may need greater structure than the leader gives them. Possessing the license of an RN implies certain leadership skills and requires the ability to delegate and supervise the work of others. The IOM has raised awareness about patient safety and quality of care issues, and the Magnet Recognition Program® is one evidence-based nursing response. Because they each have a different focus, their importance varies according to what is needed in a specific situation. The other part of readiness is psychological willingness, which means being willing to take responsibility and have a positive attitude toward accepting the obligation to complete a task. Figure 1-1 shows how these components relate to one another. Leaders arise in a context, and they are said to be made, not born. Pagonis (1992) noted that to lead successfully a leader must demonstrate two active, essential, and interrelated traits: expertise and empathy. Taken together, these source documents overlap and converge on the primary attributes, knowledge domains, and skills that nurse leaders need to lead people and manage organizations in health care. 4. With sensitivity, cues in the environment can be identified and used to make choices regarding leadership style. Every nurse needs two critical skills to enhance professional practice. Hersey and colleagues (2013) thought that leadership was a broader concept than management. Modeling the way: Leaders set an example and structure events so that incremental progress is celebrated as small wins. Appreciation – remember to compliment others and let them know their work and efforts are appreciated. Exploring the feminist perspective on leadership is valuable in that it provides food for thought as health care organizations and the nurses working in them struggle with not wanting to let go of the familiar hierarchy management style yet needing to reconfigure to the circular or web structure to be effective. Diagnosing: Diagnosing involves being able to understand the situation and the problem to be solved or resolved. Motivating participation is a constant challenge. Thus there is no one best way to influence others or one best style. Situations in which members of a group are not accustomed to working together or do not hold shared expectations frequently lead to conflict. Task structure means how structured the group’s assigned task is. Furthermore, the needs of disenfranchised minority groups must be balanced. This involves the ability to think critically, to identify problems, and to develop objectivity and a degree of maturity or judgment. These goals may or may not be congruent. Their style can create hostility and dependency among followers; it may also stifle creativity and innovation. about leadership theory and focuses on the integration of general leadership principles with the applied clinical sciences, emphasiz-ing the advanced practice healthcare professional . Leader behavior was described as having two separate dimensions, as follows: For example, if a nurse works in a situation in which there is a high level of frustration, it may be time to step back and analyze the basic five elements. Relationship management: Use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members The leader’s leadership style would have to take into account where the followers are in terms of their readiness as a critical factor for determining the style to choose. 2. It is important for nurses to recognize that they can learn, practice, and improve their personal leadership competencies. 4. Reprinted with permission of the Center for Leadership Studies, Inc., Escondido, CA 92025. Choose from 500 different sets of nursing leadership and management flashcards on Quizlet. Authoritarian leaders are characterized by giving orders. However, the depth and focus of care management roles and skills may vary by level. From an early awareness of the leader’s need to be concerned about both tasks and human relationships (output and people) sprang a long history of leadership theories that can be grouped as trait, attitudinal, and situational (Hersey et al., 2013). This forms a composite of the ability to do the job. Studies have shown that nurse managers have a large effect on retention, so a good nurse leader understands that employees remember how they are treated. Examples: where to go for help, its climate and culture, who the unofficial leaders are. This style emphasizes a high concern for task. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). Ethical leadership in nursing has shifted to fulfilling the universal ethical principles in nursing which are autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity (Henry, et al., 2016). Leaders are pivotal for connecting the efforts of followers to organizational goals. Keeping your staff motivated to perform at top quality takes clever nursing leadership. Drucker (1996) noted that effective leaders know the following four things: This applies at all levels: nurse care provider, nurse manager, and nurse executive. Flexibility is important. A distinction can be made between leadership and management roles. Position power refers to power that is conferred on the leader by the organization as a result of the assigned job. They appear to learn leadership skills in stages (Bennis, 2004). Social awareness: An intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others Hersey and colleagues (2013) defined these terms as follows: Relational coordination focuses on relationships between roles rather than between individuals. On the other hand, this style can be very efficient, especially in a crisis. JOFRED M. MARTINEZ, RN, MAN NG Review and Training Center, Inc. Iloilo City, Philippines CONCEPTS, PRINCIPLES, THEORIES AND METHODS OF DEVELOPING NURSING LEADERS AND MANAGERS IN THE … The leadership situation in a group that is knowledgeable and experienced in solving problems is very different from the leadership situation in a group that is not experienced at the task or at working together. To choose an appropriate style, the leader needs to be knowledgeable about the readiness of the followers. In 140 articles reviewed, they found 894 competencies, of which 862 (96%) were common to both leadership and management. Little reward came from the “thinking” and integrating skills nurses were capable of. Leadership can be understood as the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance. For example, a nurse is appointed as chair of a committee. The nature of the situation needs to be considered. The nature of the situation needs to be considered. Reprinted with permission of the Center for Leadership Studies, Inc., Escondido, CA 92025. Democratic Characteristics of Leadership A long history and rich literature surround leadership theories, much of it from outside of nursing. 2. The ANCC’s magnet program acknowledges excellence in nursing services and leadership based on these five components: transformational leadership, structural empowerment, new knowledge, exemplary professional practice, and empirical outcomes (Wolf et al., 2008). These five practices can be seen as the way leaders get extraordinary things done through people in an organization. These are core to all leadership in all situations. Leading means establishing direction for employees and initiating the day-to-day work that is necessary to effectively accomplish the company’s overall objectives. Examples: Human needs, emotions, and how people respond to stress. Nurses use managerial and leadership skills to facilitate delivery of quality nursing care. This applies at all levels: nurse care provider, nurse manager, and nurse executive. nurses, such … Have the members worked together for a long time in the job, or are they new employees? There is a “gray area” in which the foci of their outcomes overlap. In Situational Leadership® theory,* leadership in groups is never a static circumstance. Management and leadership are important for the delivery of good health services. Eventually, as the situation progresses, a relationship-oriented leader can become less effective. Leadership can be understood as the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance. Good nurse leadership is the process of persuasion or showing by example the way in which one nurse induces other individuals or a group to act. There may be values clashes between the leader and the followers. He classified group situational variables of leader-member relations, task structure, and position power into eight possible combinations, ranging from high to low on these three major variables. A task-oriented style is needed for situations on the extremes, whereas a relationship-oriented style is needed when the situation is moderately favorable. Keywords nursing management , ethnographic research , servant-leadership , community health nursing , psychiatric nursing For this situation, the task-oriented leader is a more effective match between leader and job. The continuum ranges from democratic to authoritarian (or subordinate-centered to leader-centered). Leadership theory began to move beyond a focus on traits to explore the concept of leadership styles. In the trait approach, theorists have sought to understand leadership by examining the characteristics of leaders. For example, a staff nurse goes into a nursing unit meeting not wanting any extra assignments but hoping that some of the ongoing problems will be solved. Hersey and colleagues (2013) noted that the common themes include the following: the leader needs to be flexible in behavior, able to diagnose the leadership style appropriate to the situation, and able to apply the appropriate style. The primary objective of the role of nursing service “The nurse leader plays a critical role in the business of the healthcare organization and the quality and safety of the services provided” (O’Connor, 2008, p. 21). What is needed by the leader is diagnostic ability. 5. If the nurse has a reasonably good relationship with the leader, the leader should use a high-relationship style with the nurse. Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) It is characterized by a concern for family, community, and culture. If the nurse leader is a task-oriented person, a high-relationship person may need to be called on to assist the group process so that it is facilitated and becomes effective. Internal forces in leaders that impinge on leadership style are values, confidence in employees, leadership inclinations, and sense of security in uncertainty (Tannenbaum & Schmidt, 1973). In times of chaos, complexity, and change, leadership is essential to provide the guidance, direction, and sense of stability needed to ensure followers’ effectiveness and satisfaction. Research by Bennis and Thomas (2002) indicated that extraordinary leaders possess skills required to overcome adversity and emerge stronger and more committed. Photo used with permission from Photos.com. Overlaid on the basic grid is a continuum of readiness ranging from low to high. Vision and Trust On the other hand, this style can be very efficient, especially in a crisis. The leader’s behavior, patterns of actions, attitude, and performance have a special impact on the team’s attitude and behaviors and on the context and character of work life. Favorable or unfavorable situations are determined in part by the receptivity of the followers, but they are also determined by whether the larger environment is positive or negative. Start studying Theories and Principles of Nursing Leadership and Management. Whereas managers are adept at controlling processes, making decisions, and coordinating resources, leaders empower others, inspire innovation, and challenge traditional practices. Women tend to be more flexible and value cooperation, connectedness, and relationships. Since we started in 2010, Nurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Using leadership theory, leaders assess themselves, look at the followers’ readiness, and assess the situation to determine whether it is favorable or unfavorable. Certain pressures influence the role of the manager and demand new skill sets to facilitate clinical work. Do not feel obligated to have all the answers, but be adept at asking the right questions. This means that which theory or style is the best all depends on the situation at hand. Clancy (2003) noted that leaders need to “consistently find the courage to hold true to their beliefs and convictions” (p. 128). Another distinction is that a leader innovates, whereas a manager administers. All five elements interact within any given leadership moment. Fiedler examined the favorableness of the situation from the perspective of the leader’s influence over the group. Because of the factor of constant change, maintaining good leadership is complicated fo, Hersey and Blanchard’s Tri-Dimensional Leader Effectiveness Model. These may be downward, upward, horizontal, grapevines, or networks. This can be seen in their distinct definitions. Nurse leaders will always face challenges, but they should remember that their goal is to remain committed to their patients, employees and communities. Men tend to spend their time on meetings and tasks requiring immediate attention, focusing on completion of tasks and achievement of goals. The premise of this book is that leadership and management are not identical ideas. The leader observes and analyzes which abilities and motives are present in the followers. 1. Leaders arise in a context, and they are said to be made, not born. Because of the factor of constant change, maintaining good leadership is complicated for any group. Nurses need to have a solid foundation of knowledge in leadership and care management. However, good leaders are anchors to the vision and the larger mission, guides to coping and being productive, and champions of energy and enthusiasm for the work. What can I do to make a difference? Trust goes both ways and needs to be nurtured. Followers also need self-awareness to know themselves and their expectations. Followers expect that leaders will provide a sense of vision and a sense of direction with standards for achieving the group’s goals. He noted three reasons why leaders are important: the character of change in society, the de-emphasis on integrity in institutions, and the responsibility for the effectiveness of organizations. Communication – make your requests and/or thoughts known in a clear, concise way. After choosing a channel, the sender transmits a message. FIGURE 1-1 Components of a leadership moment. The leader encourages and assists discussion and group decision making. If they do not know each other and the situation is politically charged, the nurse leader needs to help people become comfortable with each other. Leadership is a unique role and function. The challenge of the democratic style is to get people with different professional backgrounds, personal biases, and psychological needs together to focus on the problem and next action steps. Hersey and colleagues (2013) thought that leadership was a broader concept than management. A key general principle is that the need for task-oriented leaders occurs when the situation is either highly favorable or very unfavorable. Some democratic leaders cannot vary their style sufficiently to handle crises. Tannenbaum and Schmidt (1973) suggested that a leader might select one of many behavior styles arrayed along a continuum. Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. These can be distilled into leadership dos and don’ts. Obtaining the staff's insights on the priorities so the team will stay focused and its members will have a stake in the strategic plan. Readiness has two aspects: ability and willingness. The leader shares responsibility with the followers by involving them in decision making. Hersey and colleagues (2013) combined ability and willingness into four levels of readiness. 2. Tags: Leadership and Nursing Care Management They identified management as a special kind of leadership that concentrates on the achievement of organizational goals. The AONE 2005 nurse executive competencies are described in the following five domains of skill: Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. Adapting: Adapting involves being able to adapt behaviors and other resources to match the situation. As leadership theories evolved, leadership came to be viewed as a dynamic process and an interaction among the leader, the followers, and the situation. This can be seen in their distinct definitions. Initiating structure and consideration in the Ohio State Leadership Studies Communicating is basic to the process of influencing and thus to leadership. Once graduates were in the working world, they had to learn to be good nurse leaders on a trial-and-error basis. A possible reaction might be to give the nurse an assigned task. Submit the form below and we will help with your questions! The third dimension is the environment in which a leader operates and which interacts with the leader’s style. Diagnosing and analyzing the five elements, Decisions of policy are made solely by the leader who tends to dictate tasks and techniques to followers. You may also needManaging Time and StressDelegationQuality and SafetyBudgeting, Productivity, and Costing Out NursingCommunication LeadershipChange and InnovationLegal and Ethical IssuesOrganizational Structure Challenging the process: Leaders go beyond the status quo to search for opportunities, experiment, and take risks to achieve lofty goals. Authoritarian Leadership is an important issue related to how nurses integrate the various elements of nursing practice to ensure the highest quality of care for clients. Modeling the way: Leaders set an example and structure events so that incremental progress is celebrated as small wins. There is a minimum of leader participation. Gittell (2009) emphasized the centrality of relationship management because patient care is a coordination challenge. 4. The leadership task is to ensure direction, alignment and commitment within teams and organisations. Another distinction is that a leader innovates, whereas a manager administers. The trait approach has generated multiple lists of traits proposed to be essential to leadership.

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