Leadership and Management Nursing Review

Management ‐ process of coordinating actions & allocating resources to achieve organizational goals. Managers often work long hours @ hectic pace. Managerial work is driven by problems that emerge in random order & have a range of importance and urgency. Most of a manager’s time is spent w/others and more of the work is concerned w/handling info than in making decisions.

Management Theories ‐ based on the classical perspective of management that were introduced in the 1800’s during the industrial age as factories developed.
  1. Bureaucratic Theory ‐ Max Weber, believed it’s based on family‐type structure in which employees were loyal to an individual, not to the organization. Efficiency is achieved through impersonal relations w/in a formal structure, competence should be basis for hiring and promoting an employee, and decisions should be made in orderly and rational ways based on rules and regulations. The bureaucratic organization is when orders from the top are transmitted down thru the organization via clear chain of command.
  2. Human Relations ‐ the individual worker is the source of control, motivation, and productivity in organizations. The idea that people increase their work output in the presence of others was a result of the Hawthorne experiments.
    • Hawthorne Effect‐ the effect of being watched and receiving special attention could alter a person’s behavior. It is a phenomenon of being observed or studied, resulting in changes of behavior
Administrative Principles ‐ the science of management, principles of organization applies in any setting.
  • POSDCORB‐ planning, organization, supervising, directing, controlling, and organizing, reviewing, and budgeting. Unity of command and direction means workers would get orders from only one supervisor and related work would be grouped under one manger.
Human Motivation Theories
  1. Maslow’s Hierarchy of satisfaction of physiology, safety, belonging, ego, and self actualization needs‐ how a person is motivated, getting needs met
  2. Two Factor‐Hygiene‐ Maintenance factors prevent job dissatisfaction; provide adequate salary and supervision, safe and tolerable work conditions.
  3. X Theory‐ leaders must direct and control as motivation results from reward and punishment
  4. Y Theory‐ Leaders remove obstacles as workers self control, self discipline; their reward is their involvement in work.
  5. Z Theory‐ Collective decision making, long term employment, mentoring, holistic concern, and use of quality circles to manage service and quality, a humanistic style of motivation based on Japanese organization.
Leadership ‐ the process of influence in which the leader influences others toward a goal achievement.
  • Influence is an instrumental part of leadership and means that leaders affect others, often by inspiring, enlivening and engaging others to participate. It involves the leader and the follower in interaction.
  • This implies that leadership is a reciprocal relationship. Nurses are leaders.
  • Not all leaders are managers.
  • Differentiation of leadership and management‐ “managers are people who do things right and leaders are people who do the right thing” says Bennis
  • Kotter says, “Leadership is about creating change and management is about controlling complexity in an effort to bring order and consistency.”
  • Bennis and Nanus say 3 qualities that effect leaders share….guiding vision, passion, and integrity. Characteristics of a leader…intelligence, self‐confidence, determination, integrity, and sociability.
***(Research finding from the studies on nurses revealed that caring, respectability, trustworthiness, and flexibility were the leader characteristics most valued)***

Leadership Theories‐ behavioral, situational, and transformation
  1. Autocratic Leadership
    • Centralized decision making with the leader, making decisions, and using power to command and control others.
    • Associated with high performing groups, but close supervision was necessary and feelings of hostility were often present.
  2. Democratic leadership
    • Participatory, with authority delegated to others
    • To be influential, the democratic leader uses expert power and the power base afforded by having close, personal relationships,.
    • These leaders engendered positive feelings in their groups and performance was strong whether or not the leader was present.
  3. Laissez‐faire leadership
    • Passive and permissive and the leader defers decision making = low productivity and feeling of frustration
Situational Theories
  • Addresses follower characteristics in relations to effective leader behavior
  • High task behavior is called a telling leadership style
    • telling leadership style ‐ high task behavior and low relationship behavior
    • selling leadership style‐ high task, high relationship
    • participating leadership style‐ low task and low relationship
    • delegating leadership style‐ low task and relationship
    • NOTE: The leader not only changes leadership style according to followers needs but also develops followers over time to increase their level of maturity.
Transformational Theories
  • Process in which “leaders and followers raise one another to higher levels of motivation and morality.”
  • It empowers others to engage in pursuing a collective purpose by working together to achieve visions of a preferred future.
  • It’s influence by both the leader and the follower to a higher level of conduct and achievement the transforms them both
Transitional leader
  • The manager that is concerned with the day to day operations
  • These leaders motivate others by behaving in accordance with values , provide a vision that reflects mutual values, and empowers others to contribute.
  • Transformational leadership has been a popular approach in nursing
Generational Issues
  1. Boomers
    • 1946‐1964
    • Demonstrate loyalty to an employer
    • Work hard with strong emphasis on money and acquire thing
    • More personalized training methods
  2. Busters
    • 1965‐1981
    • Regularly change organizations to advance their development
    • More individual approach to work
    • Value work‐family balance lifestyle more highly
    • More computer skilled and comfortable with high tech tools
    • Note: Different styles reveal differences in how learning occurs and the methods best suites us.

Supervising the Work of Others

a. Supervision
  1. Actively monitoring or overseeing acitivies of others
  2. Nurses must be ware of the agency’s goal, particularly as they relate to pt care.
  3. Must monitor the extent to which these goal are met
  4. Focus us upon the main goal of the job
    • Includes pt care and pt safely
    • Remember‐‐‐treat staff fairly
Characteristics of Effective Supervisions
  1. Ensure working conditions are suitable to meet patient needs
    • What does the staff nurse do if they are not?
  2. Ensure resources are available to meet pt needs
  3. Orientating/teaching/and guiding co‐workers, based upon individual backgrounds and needs
  4. Stimulating desire for self improvement in others, as well as encouraging the use of unique talents and skills.
  5. Acting as a role model with desired attitudes, skills, interests, and work habits.
Evaluating Patient Care Performed by Others
  • Using nursing standards as quality care guidelines
    • Ex agency standards, ANA standards
  • Using specific criteria to measure pt care outcomes
    • Ex care maps, evidence based practice
Accepting Responsibility for Subordinates

a. Methods include:
  • Clarify work expectations
  • Assuming responsibility for ones own assignment
  • Overseeing by walking around‐must is focused upon what you want to evaluate. Makin notes is effective
  • Asking staff to tell you how they are progressing with their assignments
  • Observing for patterns of behavior in subordinates, dependable? Provide quality care? Follow directions? Get stressed easily?
  • Performing chart audits for the purpose of monitoring adherence to standard of care. Many agencies require the RNs be involved in this process.

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