Leadership - Occurs when one person attempts to influence the behavior of an individual or group - up,

down, or sideways in the organization - regardless of motivation.

Power - The ability to influence other individuals despite their resistance.

Autocratic leadership - Style of leadership which dampens creativity and is characterized by control.

Democratic leadership - Style of leadership that is more flexible and characterized by guidance.

Laissez-faire leadership - Style of leadership which often creates confusion & frustration; lacks goals,
guidance, or direction.

Transformational - Style of leadership that involves a mission, vision, inspiration, & common goals.

Followership - A skilled, self directed individual who participates in assisting the group direction.

Three required competencies of leadership:

1. Ability to diagnose or understand

2. Adaptation
3. Communication

4 common traits of leadership trait theory:

1. Attention (attract via communicating)

2. Meaning (clarity & purpose)
3. Trust (reliability & consistency)
4. Self (know who you are)

Maslow's Hierarchy of Needs:

1-Physiological
2-Safety
3-Belonging
4-Esteem
5-Self-actualization

Management - Getting work done through others.

3 management theories:

1. Scientific management (task aspects)

2. Human relations-based management (interpersonal aspects)
3. Servant leadership

Scientific management - Style of management with focus on increased efficiency (most work done in
least amt. of time).

Human relations-based management - Style of management which involves theory X and theory Y.

Theory X - Management theory which assumes people want to do as little work as possible &
control/punishment must be used to get work done.

Theory Y - Management theory which assumes people want to do their jobs well & guidance/rewards
are used.

Servant Leadership - Style of management in which the emphasis is on people & interpersonal
relationships; commitment is to improving the treatment of employees.

3 effective manager behaviors:

1. Interpersonal activities
2. Decisional activities
3. Informational activities

Interpersonal activities - Manager behavior that includes networking, conflict negotiation & resolution,
employee development, & coaching.

Decisional activities - Manager behavior that includes employee evaluation, resource allocation,
hiring/firing, planning for the future, & job analysis & redesign.

Informational activities - Manager behavior that includes being a spokesperson, monitoring for
problems, & public relations.

Shared governance - Style of management most likely to promote empowerment

legitimate power- power granted to manager because of position they hold in the chain of command in
the organization.

information-processing role - role of the manager where they monitor, disseminate, and are the
spokesperson. receive info and transmit it to the organization.

interpersonal role -
role of the manager where they create and maintain relationships with others within the organization.
decision-making role - managerial role as an entrepreneur, disturbance handler, resource allocator, and
negotiator.

accountability - responsible and answerable.

responsibility - obligation to accomplish work.

authority - given the right to delegate; official power.

assignment - licensed with scope of practice per state.

5 rights to delegation:

1. right task
2. right circumstance
3. right person
4. right communication
5. right supervision

overdelegation - leads to delegating duties to personnel who are not educated or competent to
complete tasks.

Functions of management:
1-Planning
2-organizing
3-directing and
4-controlling

Managerial Roles:
1-Information processing role,
2-interpersonal role, and
3-decisional role

manager resources:

1-Human,
2-financial,
3-physical,
4-information

Race - Classification of people according to shared biologic characteristics, genetic markers or features.
Cultural ethnicity - Identifies a person or group based or racial, tribal, linguistic, religious, national or
cultural group.

Acculturation - Adaption to conditions, languages and customs of a new culture.

Intersectionality - Belonging simultaneously to multiple social groups.

Cultural competence - Aims to increase health equity and reduce disparities by concentrating on people
of color and other disadvantaged populations.

Organizational culture - System of shared values and beliefs that actively influences behavior of
organizational members.

Collectivism - Emphasizes the importance of group decisions and places the rights of the group as a
whole above the rights of any individual in the group.

Individualism - Emphasizes the importance of individual rights and rewards.

Baby boomers - Generation that values work for the challenge of work and career advancement. They
have been characterized as workaholics, strong-willed individuals who are working for material gain,
promotions, recognition, job security, and corner offices.

Gen X - Generation that is used to doing things themselves, and this formative dynamic translates into
staff who respond well to goal setting. They tend to be skeptical, independent workers who seek a
balance between work and leisure. They want to work in an environment that is technologically current,
has competent leadership and provides a mentor for coach for a boss.

Millennials (gen y) - Generation that grew up with the internet and a speak your mind philosophy. Their
lives have been characterized by demanding schedules filled with structure and activities. Considered a
true "global generation" where diversity is the cultural norm.

Methods of conflict resolution:

1-Avoidance,
2-accommodation,
3-competition,
4-compromise,
5-mediation

Types of conflict:
1-Intrapersonal,
2-interpersonal,
3-organizational,
4-interprofessional

Avoidance - Method of conflict resolution where parties are aware of conflict but choose not to
acknowledge or attempt to resolve. Unassertive and uncooperative.

Accommodate - Method of conflict resolution where one party neglects their own needs, goals, or
concerns while trying to satisfy those of others. Often feel resentment and disappointment because
they get nothing in return.

Competition - Method of conflict resolution where one party pursues what it wants at the expense of
the other. Ex: during a rapid response.

Compromise - Method of conflict resolution where each party give up something it wants. Assertive and
cooperative. Work creatively and openly to find the solution that most fully satisfies all important goals
and concerns to be achieved.

Incivility - Another term used to describe bullying, mistreatment to discourtesy to another person.
Disruptive behaviors such as eye rolling, and other nonverbal behaviors and sarcastic comments,
intimidation, and physical violence.

Mobbing - Employees "gang up" on an individual.

Team - A small number of people with complementary skills who are committed to a common purpose,
performance goals, and approach for which they are mutually accountable.

Teamwork - Functioning effectively within nursing and inter professional teams, fostering open
communication, mutual respect, and shared decision making to achieve quality patient care.

Types of teams:
1-Multidisciplinary,
2-Interdisciplinary,
3-transprofessional,
4-interprofessional and
5-committees

Multidisciplinary - Type of team comprised of professionals from a variety of disciplines. One person
makes the final treatment decision.

Interdisciplinary - Type of team comprised of necessary disciplines contributing to an individual patient's

care. All members work together to come up with alternative solutions and final decisions.

Interprofessional - Type of team comprised of multiple health workers from different professional
backgrounds work together with patients, families, caregivers and communities to deliver the highest
quality care. Leadership is based on expertise that matches the situation.

Advantages of a team:
1-Equalizes power
2-Creates effective inter professional communication
3-Optimizes safe patient outcomes
4-Improves interpersonal relationships and job satisfaction
5-Promotes free exchange of ideas, team cohesion, trust, and mutual respect
6-Improves stability in employee satisfaction

Challenges of a team:
1-Disciplinary
2-May be a lack of interest or motivation
3-May take longer to achieve a goal
4-Team members may have disagreements on the best course of action

Interprofessional consultation - A process in which a specialist is sought to identify methods of care or a

treatment plan to meet the needs of a client. EX: rapid response team.

Synergy - Team members work together to produce extraordinary results that could not have been
achieved by one individual.

leadership - the use of individual traits and abilities, in a relationship with others, and the ability to
interpret the environment/context where a situation is emerging.

what are the traits of a leader?

*emotionally stable (remaining composed even in a crisis)
*conscious of others (aware of other's feelings)
*bold
*assertive
*self-assured

management - the ability to plan, direct, control, and evaluate others in situations where the outcomes
are known or pre-established.

What are traits of a manager?

*ability to identify recurring problems

*persistent and vigilant behavior in self and others
*communication that maintains loyalty and enthusiasm in the face of reptetitive work tasks.

Autonomy - Respect for an individual's right to self-determination; respect for individual liberty.

Benefice - The duty to do good to other and maintain a balance between benefits and harm.

Nonmaleficence - The principle of doing no harm.

Justice - The principle of fairness - give what is owed, due, deserved, or can be legitimately claimed.

Fidelity - The duty to keep one's promise or word.

Veracity - The obligation to tell the truth.

Respondeat Superior - The legal principle that allows the court to hold an employer responsible for the
actions of an employee when performing services for the organization.

Good Samatitan Law:

-The care rendered in an emergency situation
-The health care worker is rendering the care without pay
-The care provided did not recklessly or intentionally cause injury or harm

Right Circumstance - Sufficient time to complete assignment.

Authority:
-The right to act
-The right to delegate/act, based on the state nurse practice act and power from the employer

Responsibility:
-The obligation to complete the task
-Reliability, dependability and obligation to accomplish work when an assignment is accepted

Accountability - Ownership of the results/outcomes of care.

Right Task
-Match skills with tasks
-Look at scope of practive

Leadership
-The ability to inspire others to achieve desired outcomes
-Attained role
Management
-The process of planning, organizing directing and coordinating the work within an organization
-Assigned

Informal leadership - Found throughout an organization; NOT just among those at the top.

Six Components of Leadership:

-Knowledge
-Self awareness
-Communication
-Problem-solving
-Goals
-Action

Leadership characteristics
-Vision
-Passion
-Knowledge
-Emotional Intelligence
-Integrity

Emotional Intelligence
-Recognizes emotions
-Welcomes constructive criticism
-Listens attentively to others

Theory - Formulation of ideas about how, when what is involved in leading and managing.

Benefits of using a theoretical approach to practice

-Organizes "thinking"
-Provides a "framework" for decision-making

Leadership styles
-Authoritarian
-Democratic
-Laissez-faire
-Multicratic

Democratic Leadership Style

-Focuses on involving subordinates in decision making
-Disadvantage is that it can become a costly, lengthy process
-Advantage is that it results in a more motivated workforce

Authoritarian
-Strong control to the manager over the work group. Communication flows downward and emphasis is
on accomplishing the task.
-Advantage is that decisions can be made expeditiously

Laissez-Faire - Provides minimal structure and control, passive and very permissive.

Multicratic - One of the skills of leadership is identifying which style fits a particular situation.

Great Man Theories - Some people are born to lead and others are born to follow.

Trait or Attribute Theory - Its limited because it focuses only on the traits of the individual and does not
take into account how the person acts in specific situations.

Situational-Contingency Theories
-Recognizes that no one approach works in all situations
-Leaders can be effective in one instance and not another
-Adjust the leadership style and behavior to the situation
Focus is on the context of the situation

Transformational (Contemporary) Leader Theories

-The process by which "leaders & followers raise one another to higher levels of motivation and
morale."
-Helping a group create a vision and the motivation to achieve it
-Leadership is dispersed
-Leaders appeals to the interests of the employees - inspiring them, & providing opportunities for
growth

Transactional Leader
-Focus on day-to-day operations, and maintenance (routine work) rather than vision and growth
-Assumes a caretaker role

Quantum Leadership
-Focus on the future, and "out of the box" thinking
-Combines intellect and "people skills"
-Elements are discovering, passion, relationship, inquiry, and fiscal astuteness

Servant Leadership
-Put others first - "it is a people-oriented approach"
-Considers needs of others
-Values teamwork
-Promotes caring behaviors

Early management theories

-Getting as much work as possible out of each employee
-Planning, organizing, directing, coordinating, controlling

Time-Motion Theory
-Frederick Taylor - founder of management science (1890s - 1900s - he was a mechanical engineer - a
machine shop foreman)
-He concentrated on the amount of time it took to do a certain task - production efficiency
-According to this approach, the function of management is to discover the "one best way" to perform
manual tasks

Bureaucratic Management
-Developed by Max Weber
-Formal structures
-Competence as the basis for hiring & promotion
-Rules & regulations
-Clear superior-subordinate communications (clear chain of command)

Leadership
*Process of influence whereby the leader influences others towards goal achievement
* Leaders are not always in authority positions but inspire, motivate, enliven
* It is about expressing a vision, establishing a direction, aligning people through empowerment,
motivating and inspiring people, and achieving the vision.

Management
*Is a process of coordinating actions and allocating resources to achieve organizational goals
* It is about planning, organizing, staffing, controlling complexity and coordinating to bring about order,
consistency and predictability

rait Theories
* Leaders have a certain set of physical and emotional characteristics that are crucial for inspiring others
towards a common goal
* Self awareness of traits is useful in self development (example: developing assertiveness) and in
seeking employment that matches traits (drive, motivation, integrity, confidence, cognitive ability and
task knowledge)

Style Theories
Autocratic Leader: I'm the boss, "Do it MY way", and Controlling
Democratic Leader: They care about what others think, allow input and let them participate in decisions
Laissez-Faire (To Let, To Do) Leader: Whatever... Leaders and employees can do whatever they want to

Contingency (Situational) Theories

Leader adjust based on the situation and the individual

Scientific Managment - All about production; based on the idea that there is one best way to accomplish
a task.

Bureaucratic Leader
Rules and policies to abide by; specific rules, hierarchy, top = boss, bottom = workers
example: ranks in the military

Human Relations (Management Theory)

More workers involvement in management , derived from motivational theories

Motivational theories - Is a process that occurs internally to influence and direct a person's behavior in
order to satisfy his/her needs. Environment can be created to motivate someone.

Situational Awareness - Knowing what is going on around you

Mutual Support - Ability to anticipate and support other team members needs through accurate
knowledge about their responsibilities and workload.

Situational Monitoring - Process of actively scanning and assessing situational elements to gain
information, understanding or maintain awareness to support functioning of the team.

Leadership - Ability to coordinate the activities of team members by ensuring team actions are
understood, changes in information are share, and that team members have the necessary resources.

Team Structure - Delineates fundamentals such as team size, membership, leadership, composition,
identification and distribution.

Six Rules to Sustain Synergy

1. Define a clear purpose
2. Active Listening
3. Be Compassionate
4. Maintain Honesty
5. Demonstrate Compassion
6. Commit to Resolution of Conflicts

Elements of a Good Team

1. Cohesiveness: Mutual understanding and support; Self-esteem and successful completion of
goals/mission
2. Moral: Motivation factors related to productivity anf quality indicators
3. Synergy: Combined thinking power of the team
4. Minimize Group think

Stages of Group and Team Development

1. Forming: Orientation; Expectations, Interactions and Boundary Formations
2. Storming: Conflict; Tension; Confrontation
3. Norming: Cohesion; Positioning and Goal Setting
4. Performing: Working; Agreement; Actual Work Occurs; Relationships and Group Maturity
5. Adjourning: Termination; Closure; Evaluation and Outcome Reviews
Reforming: Happens instead of Adjourning

Committee
-Is a work group with a specific task or goal to accomplish as defined by the organization
-It is a group to assist an organization with communication and decision making.

Heterogeneous Team
Member of a variety of clinical backgrounds
Example: Quality Improvement Team

Homogeneous Team
Member have similar backgrounds and abilities
Example: Nurses

Team - Small number of people with complementary skills who are committed to a common purpose or
goal and have a set of performance goals and approaches for which they hold themselves mutually
accountable.
Membership is based on specific skills required to accomplish the task.

Secondary Group
Formal
Held together with formal rules and regulations
Has procedures for maintenance of the group and association policies
Meets for an organized purpose, for a specific project for a specific time frame

Primary Group
Informal
Consists of people who share a common bond
Is informal and evolves naturally from social interactions
Usually has no written rules for membership
Can begin or need at any piont

Group
Is a number of individuals assembled together and have some unifying relationship

Hand-Off
Transferring information (along with authority and responsibility) during transition of care across the
continuum; to include an opportunity to ask questions, clarify and conform.

Transcultural Delegation
The process of having personnel perform duties with the diversities of culture taken into consideration

Communication - Process by which team members accurately exchange information clearly.

Barriers to Communication
Gender,Culture, Anger, Incongruent response, Conflict, Unclear Expectations, Distractions, Inadequate
Knowledge, Poor Planning, Differences in Perceptions, Emotional and Personality Response

Incongruent Responses
When words and actions in a communication do not match the inner experience of self and/or are
inappropriate to the context.

Effective Communication
The transfer of information and understanding from one person to another.
Is timely, accurate, complete, unambiguous and understood by the recipient
* Reduces error
* Results in improved patient safety

Assignment Making
-Process of assigning the duties and all aspects of care for a patient to individual personnel.
-Education, skills, knowledge and judgment levels of the personnel being assigned to a task must be
relative to the assignment

Authority - Occurs when a persons who has been given the right o delegate, based on the state Nurse
Practice Act, also has the official power from an agency to delegate.

Responsibility - Reliability, dependability, and the obligation to accomplish work. Also includes each
person's obligation to perform at an acceptable level.

Delegation - Achieving performance of care outcomes for which you are accountable and responsible by
sharing activities with other individuals who have the appropriate authority to accomplish the work
Moral Distress - A type of distress that occurs when faced with situations in which two ethical principles
compete, such as when the nurse is balancing the patients autonomy issues with attempting to do what
the nurse knows is in the patients best interest.

Ethical Committees - Groups of persons who provide structure and guidelines for potential healthcare
problems, serve as an open forum for discussion and function as patient advocate
-Provides: education, policy and guidelines recommendations and case reviews

Respect for other-

The highest ethical principle, acknowledges the right of individuals to make decisions and live by those
decisions

Fidelity
Keeping one's promises or commitment
Example: Keeping promises to patients
Maintaining staff vacation request

Veracity
Principle that compels the truth to be told completely
Examples: Informing patient of medication error
Completing a near miss report
Reporting RN friend who arrives to work impaired

Paternalism
Principle that allows one to make decisions for another
examples: Mandatory flu vaccine and not give "BAD" information about terminal diagnosis

ustice
Principle that persons should be treated equally and fairly
Example: Holiday schedule and float rules

Nonmaleficence
Principle that states do no harm
Most helpful when balanced with beneficence
Examples: Stopping medication, treatment harmful to the patient or viewed as an ineffective treatment
Refusing to provide a treatment that has been shown to be ineffective

Beneficence
Principle that states that the actions one takes should promote good
Example: CPR, Progressive disciple, Educating community about STD prevention
Autonomy
Personal freedom and the right to choose what will happen to one's own person
Example: informed consent and staff decisions regarding patient care

Ethics
Science relating to moral actions and moral values; rules of conduct recognized in respect to a particular
class of human actions

Followership
Those with whom a leader interacts; involves assertive use of personal behaviors in contributing
towards organizational outcomes while still acquiescing certain tasks to the leader or other team
members

Roles and Responsibilities of a Leader

Expert
Life-Long learner
Administrator
People Person
Strategist (planning for the future)

Servant Leadership
Serves the workers and uses that to get the job done; underlying loyalty of their workers

Emotional Intelligence
Monitoring emotions in a situation to guide actions and inform thought process

Equity Theory - Work has to be equitable to motivate; inequitable will lead to job dissatisfaction.

Transactional Leader
Focuses on management task; is a caretaker; uses trade offs to meet goals; does not identify shared
values; examines causes; uses contingency rewards

Transformational Leader
Identifies common values; is committed; inspires others with vision; has long term vision; looks at
effects and empowers others

Complexity Theory
Requires leaders to expand and respond to engaging dynamic change and focus on relationships rather
than on prescribing and approaching change as a lock-step, pre-prescribed method. Traditional
organizational hierarchy plays a less significant role as the "keeper of high level knowledge" and replaces
it with the idea that knowledge applied to complex problems is better distributed among the human
assets within an organization without regard to hierarchy. Leaders try less control the future and spend
more time influencing, innovating and responding to the many factors that influence healthcare.

Servant Leadership
Serves the workers and uses that to get the job done; underlying loyalty of their workers

Emotional Intelligence
Monitoring emotions in a situation to guide actions and inform thought process

Roles and Responsibilities of a Leader

Expert
Life-Long learner
Administrator
People Person
Strategist (planning for the future)

Roles and Responsibilities of a Manager

Help people develop realistic goals (motivate staff)
Create positive work environment
* 4 generations of nurses
* Ensure the nine principles of healthy environment are present
Participate in research and interpret it
Mentor staff
Balance Demand
* From upper management, consumers and staff
Know the organizational culture
Manage resources
Maintain credibility as a clinician
Set a positive example

Generation Y (16-31 yrs)

Dynamic
Confident
Straight-forward
Opinionated
"Linked" Generation

eneration X (32-48 yrs)

Seek balance between work and family
realistic
Team-orientated
Advanced technology skills
Work independently and see work experiences where they apply their ability and expertise
See Boomer as domineering

Boomers (47-65 yrs)

Idealistic
Hard Working
Dedicated
Value promotions
Position and Title
See Generation X as the "wild generation" without a sense of social commitment

Veterans (66+ yrs)

Conservative
Loyal to the organization and authority
Reluctant to use technology

The Management Process: Planning

Philosophy, goals, policies, procedures and rules
Managing planned change

The Management Process: Organizing

Working within the structure of the organization to use resources wisely and maintain productivity

The Management Process: Staffing

Recruiting, interviewing, hiring, orientation
Scheduling, staff development, team building

The Management Process: Directing

Human resource management
Motivating climate, managing conflict, delegating, collaboration

The Management Process: Controlling

Performance appraisals, fiscal accountability, quality control, legal and ethical control, professional and
collegial control

Deontology -Definition overall? • Judges whether the action is right or wrong regardless of the
consequences .

-Duty-based reasoning:
• Ethical framework stating that some decisions must be made bc there is a duty to do something or to
refrain from doing something

-Rights-based reasoning:
• Based on the belief that some things are a person's just due (ie. each individual has basic claims, or
entitlements, with which there should be no interference)

-Intuitionist framework
• Allows the decision maker to review each ethical problem or issue on a case-by case basis, comparing
the relative weights of goals, duties, and rights
• Weighting is determined by primarily intuition—what the decision maker deems as right for the
particular situation

Ethical Relativism
Individuals make decisions according to their own value system.

thical Universalism
Ethical decision making should not vary based on individual circumstances or cultural differences

Utility
• The good of the many outweighs the wants or needs of the individual

Professional code of ethics

• A set of principles established by a profession to guide the individual practitioner

Moral outrage
• When an individual witnesses the immoral act of another but feels powerless to stop it

Ethics
• Concerned with doing the right thing and with being a certain kind of person, in terms of conduct and
character
• System of moral conduct and principles that guide a person's actions in regard to right and wrong and
in regard to oneself and society at large

Transactional vs. Transformational Leadership

-The transactional leader, also known as the traditional manager, focuses on day-to-day operations and
getting tasks and work done.
-The transformational leader is committed, has a vision, and is able to empower others with this vision.

Elton Mayo
-Studies relating to humanistic approach to management were being done at the Hawthorne Works of
the Western Electric Company near Chicago between 1927-1932
-Elton Mayo and his colleagues were attempting to study the relationship between light and illumination
in the factory and productivity
-His colleagues found that when management paid special attention to workers, productivity was likely
to increase, regardless of the environmental working conditions = the Hawthorne Effect --> explains how
people respond to the fact that they are being studied, attempting to increase whatever behavior they
feel will continue to warrant the attention
-**When people feel more important, they work harder

Max Weber
-What did he focus on?
-How did he address this?
-German sociologist
-Studied what made some workers in large-scale organizations more efficient than others
-Wrote "Bureaucracy" in 1922 in response to what he perceived as a need to provide more rules,
regulations, and structure within organizations to increase efficiency

Henri Fayol
-What did he do?
-Who expanded upon his work?
-Identified management functions: planning, organization, command, coordination, and control
-Luther Gulick expanded on Fayoli's management functions--the management process is made up of:
planning, organizing, staffing, directing, controlling (pg. 37).

Good managers and leaders

-Good Managers
-Coordinate resources
-Meet organizational goals and objectives
-Accountable
-Plan, organize, control and direct
-Use reward & punishment effectively to achieve organizational goals

-Good Leaders
-Motivate and lead
-Influence others
-Inspire confidence
-Take risks
-Master of change
-Communicate their vision

Management
-Definition?
-Manipulation of what?
-More and more managers are being looked at for what?
-What are managers getting more involved in now?
-"The act or manner of guiding or taking charge" or "handling, direction, or control"
-The manipulation of people, the environment, money, time and other resources
-To forecast, plan, organize, coordinate and control
-The creation of an internal environment in an enterprise in which individuals work together as a group
-More and more managers are being looked at for team satisfaction—can the manager hold onto team
members? Are the team members satisfied?
-Due to the business nature of health care, managers have gotten involved with marketing--ie. ER wait
time, discharge percentages, admission rates, etc.