Leadership & management

Principles

Chapters 1, 3 & 4

Joseann DeWitt, RN, MSN

3 Essential and Interrelated Elements

Leadership
Followership
Management

LEADERSHIP

Leadership is the ability to inspire confidence and support

among followers, especially in organizations in which
competence and commitment produce performance.

Effective leaders enable people to move in the same direction,

toward the same destination, at the same speed, not because
they have been forced to, but because they want to (Lansdale,
2002)

Three primary tasks of a leader are (Drath, 2001) :

To help people develop a sense of direction and purpose

To build the groups commitment to its goals

Through mission, goals, vision, purpose

Through motivation, spirit, teamwork

To face the numerous challenges that arise in a health care

setting

Through change and turbulence

Leadership Overview

Leadership is a natural element of nursing practice because the

majority of nurses practice in work groups or units.

Possessing the license of an RN implies certain leadership skills

and requires the ability to delegate and supervise the work of
others.

Is every nurse a leader?

Are YOU ready to be a leader?

LEADERSHIP THEORIES
Trait Theories

Focuses on identifying specific characteristics of leaders.

What a leader is.

Behavioral Theories

Focuses on attitudes toward leader behavior.

What a leader does

Situational Theories

Focuses on how leadership styles change according to the

situation.
How a leader responds

Trait Theories

Traits (qualities) of leaders:

Intelligence
Initiative

Excellent

interpersonal skills
High self-esteem
Creativity
Willingness to take risks
Ability to tolerate the consequence of taking risks

Situational Theories
Adaptability to the situation
Doesnt assume that one particular approach
works in all situations
Recognizes the complexity of work situations and
encourage
Considers many factors when deciding what
action to take

Every

situation is different

Behavioral Theories

Leadership styles
Authoritarian

Leadership
Democratic Leadership (Participative)
Laissez-faire Leadership

AUTHORITARIAN

AKA Autocratic, Directive,

Controlling
Dictates policies and procedures
Decides what goals are to be
achieved
Directs and controls all activities
without any meaningful
participation by the subordinates

DEMOCRATIC
AKA Participative
Followers are encouraged to
be part of the decision
making process.

Requires the leader to be a

coach who has the final say,
but gathers information
from staff members before
making a decision.

LAISSEZ-FAIRE
AKA Permissive, Nondirective
The least possible guidance is
given to subordinates.

Let it alone

Does very little planning or

decision making
Fails to encourage others to
participate

Truly a lack of leadership

COMPARISON OF LEADERSHIP STYLES

AUTHORITARIAN

DEMOCRATIC

LAISSEZ-FAIRE

Strong Control

Less Control

No Control

Gives Orders

Offers Suggestions

Nondirective Style

Does Decision Making Makes Suggestions

Abdicates Decision
Making

Leader Does Planning

Group Does Planning

No Planning

Directive

Participative

Uninvolved

High quantity, good

quality output by
group

Creative, high quality

output by group

Variable output by
group, may be poor
quality

Fosters Dependency

Fosters Independence Fosters Chaos

Breaking it down further

Transformational Leadership

Addresses meaning, inspiration and vision

People need a sense of mission

Communicates vision in a manner that is meaningful and

exciting, which inspires commitment in others
Motivates followers to perform to their full potential over
time by influencing a change in perceptions and by
providing a sense of direction
Uses charisma, individualized consideration & intellectual
stimulation to produce greater effort, effectiveness, and
satisfaction in followers

Generates greater follower commitment

Generates greater follower satisfaction

Generates overall effectiveness

MAGNET RECOGNITION PROGRAM

5 key components to obtain Magnet status:
1.
2.
3.
4.
5.

Transformational Leadership
Structural Empowerment
Exemplary Professional Practice
New Knowledge, Innovations, and Improvements
Empirical Outcomes

NOTE: Magnet emphasizes transformational leadership

Qualities of an Effective Leader

Integrity

Courage

Balance between work and play

Ability to handle stress

Do not give up easily

Balance

Optimism is catching can re-motivate a discouraged group

Perseverance

Requires effort

Optimism

Act on ideas

Energy

Risk-taking

Initiative

Adherence to a code of personal ethics and a code of professional ethics

Coping with stress in a positive and healthy manner

Self-awareness

Understand self

Behaviors of an Effective Leader

Thinking critically

Solving problems

Recognizes the differences in people and helps them find

the rewards in their work

Skillful communication

Helps identify problems and to work through the problemsolving process

Respecting the individual

Careful, deliberate use of reasoned analysis to reach a

decision

Listening to others
Encouraging the exchange of information
Providing feedback
Setting specific goals/communicating a vision for the future

Developing oneself and others

Continue to learn and encourage others to do the same

Winner or Whiner Which Are You?

A winner says

We have a real challenge

here.
Ill give it my best.
Thats great!
We can do it.
Yes!

A whiner says

This is really a problem.

Do I have to?
Thats nice, I guess.
Impossible. It cant be
done.
Maybe

Holman (1995)

SKILLS NECESSARY
TO BE A NURSE LEADER
American Organization of Nurse Executives' (AONE):
five domains of nurse executive competency:
1.
2.
3.
4.
5.

Communication and relationship management

Leadership
Business skills and principles
Knowledge of the health care environment
Professionalism

LEADERSHIP DOS
A profile of leaderships dos includes:
Honesty
Energy
Drive
Tenacity
Creativity
Flexibility
Visibility
Emotional stability
Knowledge
Conceptual skills
Leadership motivation
Leadership is founded on trust and does not survive without it.
Leadership is hard, sustained work that requires a great deal of
energy and sputters without it.

LEADERSHIP DON'TS
A profile of leadership don'ts includes:
Untrustworthiness
Insensitivity to others
a

likely cause for ineffective leadership

Aloofness
Over-managing
Abrasiveness
Inability to think strategically or staff effectively
Inability to build a team
Focusing on internal organizational politics (overly
ambitious)

Followership
If you think you are leading and no one is following
you, then you are just taking a nice walk.
John Maxwell

FOLLOWERSHIP
Followership and Leadership are separate but
reciprocal roles
A leader cant lead without followers
A follower cant follow without a leader
Followership is NOT passive and unthinking!

5 CATEGORIES OF FOLLOWERS

Sheep

Yes-people

Capable of independence and critical thinking but appear passive because they
resist open opposition
The result is frustration and disillusionment

Survivors

Lack enterprise and yield to the opinions, will or decisions of others

Alienated followers

Lack initiative, sense of responsibility, and critical thinking

Never make waves or take risks; they go which way the wind blows

Effective followers

Have initiative and think for themselves.

Manage themselves well and are responsible and well balanced.
Competent and committed.
Effective followers are an asset to be nurtured, developed, and valued.
Effective followers contribute to success in organizations.

TIPS FOR BEING A GOOD FOLLOWER

The most valuable follower is a skilled, self-directed

employee, who participates actively in setting the groups
direction, invests his/her time and energy in the work of the
group, thinks critically and advocates for new ideas.
(Grossman & Valiga, 2000)

Inform team leader or manager of a problem. Offer suggestions for

solving the problem.
Invest interest and energy in your work.
Be supportive of new ideas.
When you disagree, explain why.
Listen carefully and reflect.
Continue to learn as much as you can about your specialty.
Share what you learn with others.

Pygmalion
Effect
The greater the expectation placed upon employees
the better they perform

Management

Effective nursing managers are responsible for ensuring

safe patient care and ensuring that it is given in the most
effective, efficient and cost-effective manner possible.
Management (Fayol, 1916)

Plan
Organize
Command
Coordinate
Control work

Mintzberg (1989)

The managers function is to do whatever is necessary to

make sure that employees do their work and do it well.

Differences Between
Leadership and Management

Leadership

Based on influence and

shared meaning
An informal role
An achieve position
Pare of every nurses
responsibility
Initiative
Independent thinking

Management

Based on authority and

influence
A formally designated
role

Formal authority to direct

the work of a given set of
employees

An assigned position
Usually responsible for
budgets, hiring and
firing people
Improved by the use of
effective leadership skills

Key Point

Leadership is an essential part of effective

management
You do not have to be a manager to be a leader
BUT you do need to be a good leader to be an
effective manager

The Importance of Effective Leadership Skills

First, it is important to nurses because of the size of the

profession
Second, nursing's work is complex, often conducted in
complex settings.

Authenticity and caring are valued in nurse leaders and are

exhibited by people who are genuine, trustworthy, reliable, and
believable and who create a positive environment

Third, nurses enter the practice of nursing by licensure but

they come from a variety of educational backgrounds.

Nurses need a strong leadership to resolve the interprofessional

dilemmas derived from educational diversity and issues related to
professionalization and employment.

Leadership is Key to the

Success of Health Care Organizations

Leadership principles can be learned through education and practice.

Leaders must know themselves and their followers, the situation, the
communication process, and goals, and they must be flexible enough to
make necessary adaptations.
Leaders are those who innovate and take the risks inherent in new
approaches.
Effectiveness means matching leadership behaviors to the environment
and then adapting within that environment.
Leaders who never vary their style are probably ineffective some of the
time.
Leadership involves a concern for task and a concern for people.
Good leaders need good followers.

Practices Common to
Exceptional Leadership Achievement

Challenging the process by searching for opportunities,

experimenting, and taking risks
Inspiring a shared vision by envisioning the future and enlisting
the support of others
Enabling others to act by fostering collaboration and
strengthening others
Modeling the way by setting an example and planning small
successes
Encouraging the heart by recognizing contributions and
celebrating accomplishments

Management

Management Theories

The Human Relations Approach

Emphasizes

people

the relationship aspects of managing

Scientific Management
Emphasizes

the task aspects of management

McGregors Theory X and Theory Y

Theory X
Reflects

a common attitude among managers that

most people really do not want to work very hard and
that the managers job is to make sure that they do
work hard
Therefore, a manager needs to employ strict rules,
constant supervision, and the threat of punishment to
create industrious, conscientious workers

Theory Y

Managers

believe that the work itself can be

motivating and that people will work hard if their
managers provide a supportive atmosphere
Manager emphasizes guidance rather than control,
development rather than close supervision, and
reward rather than punishment

McGregors Theory X and Theory Y

Work is something to be avoided

People want to do as little as possible
Use control-supervision-punishment

The work itself can be motivating

People really want to do their job well
Use guidance-development-reward

Contingency Theory

The basic principle is that managers need to consider

the situation and all its elements when making a
decision.
Managers need to act on the key situational aspects
with which they are confronted.
Sometimes described as it all depends decision
making, contingency theory is most often used for
choosing a leadership or management style.

The best style depends on the situation

Systems Theory
Managers recognize that changing one part of a
system inevitably affects the whole system, creating a
ripple effect within the whole.

Complexity Theory
Complexity theory is a more general umbrella theory
that encompasses chaos theory.
The focus of complexity theory is the behavior over
time of certain complex and dynamically changing
systems.

Chaos Theory

Randomness and complexity are two principal characteristics of

chaos.
The slightest variation can have enormous results in a dynamic
and changing system.
Viewing the organization as similar to a living organism, taking
a holistic approach.
Believe that the universe is not orderly and that things do not
progress in a linear fashion. Much of nature moves in a circular
and ebbing manner. Disturbances create disequilibrium that
can lead to growth.
Nature is self-organizing and self-renewing. A distinguishing
feature of a self-renewing organization is that it has resiliency
instead of stability.
Life tries to find what works and uses messes to arrive at better
solutions because messes can be opportunities. It is good for us to
be authentic, support each other, and to thrive on our differences

Qualities of an Effective Manager

Leadership

Clinical Expertise

Need to be able to help others develop their skills and to

evaluate how well they have performed those skills

Business sense

The people skills of the leader are the core skills needed
to function as a manager

Cost of providing care that is given, budgeting, staffing,

measuring patient outcomes

What do you think?

Is it better to have a generic manager and managing

people is managing people, or
Is it better to have a manager that understands the tasks of
the worker?

Behaviors of an Effective Manager

Three categories
Interpersonal
Decisional

Informational

Behaviors of Effective Manager:

Interpersonal

Networking
Develop

positive working relationships with other

disciplines, departments, and units

Conflict negotiation and resolution

Conflicts

between employees, between clients and

staff members, and between staff members and
administration

Employee development
Providing

continuing learning and upgrading of the

skills of employees

Rewards and punishments

Tangible

rewards: salary, time off

Intangible rewards: praise, recognition

Behaviors of Effective Manager:

Decisional

Employee evaluation
Performance

Resource allocation
Have

appraisals

a set amount of money for running the unit

Hiring and firing employees

Participate

in or fully carry out the employment and

termination of staff

Planning for the future

Prepare

for changes in budgets, organizational

priorities, patient populations

Job analysis and redesign

Analyze

and redesign the work of unit to make it as

efficient and cost-effective as possible

Behaviors of Effective Managers:

Informational

Spokesperson
Relay

information to staff from administration

Speak for staff when relaying information to
administration
Represent unit/department at meetings or
discussions

Monitoring
Monitor

activities of unit, including patient

population, infection rates, staff, budget

Dissemination
Sharing

information such as new policies,

development in healthcare

MANAGERIAL ROLES

Management Process
1. Planning
2. Organizing
3. Coordinating or Directing
4. Controlling

Planning

Encompasses determining philosophy, goals,

objectives, policies, procedures, and rules

Carrying out long- and short-range projections

Determining a fiscal course of action

Managing planned change

PHASES OF PLANNING
1.
2.
3.

Identify the mission

Conduct an environmental scan
Analyze the situation: SWOT analysis of

4.
5.
6.
7.
8.
9.

Strengths, Weaknesses, Opportunities, and Threats

Establish goals
Identify strategies to reach goals
Set objectives to achieve goals
Assign responsibilities and timelines
Write a planning document
Celebrate success and completion

Strategies to Ensure Implementation

Involve the right people in planning.
Do a written plan, and communicate it widely.
Establish goals and objectives that are specific,
measurable, acceptable, placed in a time frame,
stretching, and rewarding.
Build in accountability (regular review).
Note deviations and re-plan.
Evaluate the planning process and the plan.
Conduct ongoing communications.
Make the planning process compatible with the
preferences of the planners.

ERRORS THAT MAY CREATE

PLANNING FLAWS

Errors of fact
The plan is based on misinformation
Errors in assumption
The plan is based on incorrect assumptions
Errors of logic
The plan is based on faulty reasoning

Organizing
Organizing includes:

establishing the structure to carry out plans

determining the most appropriate type of patient
care delivery, and
grouping activities to meet unit goals

Other functions involve working within the

structure of the organization and understanding
and using power and authority appropriately.

Directing
Usually entails human resource management
responsibilities such as:
Motivating
Managing conflict
Delegating
Communicating
Facilitating collaboration

Controlling
Includes:
Performance appraisals
Fiscal accountability
Quality control
Legal and ethical control, and
Professional and collegial control

Important Managerial Skills

Developing peer relationships
Carrying out negotiations
Motivating subordinates
Resolving conflicts
Establishing information networks and disseminating
information
Making decisions in conditions of extreme ambiguity
Allocating resources

Role of the Nurse Manager

Managing clinical nursing practice
Managing human, fiscal, and material resources
Developing personnel
Complying with regulatory and professional standards
Making strategic plans
Fostering interdisciplinary and collaborative
relationships

Comparison of NURSE EXECUTIVE

AND NURSE MANAGER
Nurse Manager

Manages one or more defined

areas of nursing services and is
responsible to a nurse executive.

Nurse Executive (CNO)

Allocates available resources,

coordinate activities, facilitate
interactive management
Has a major responsibility for
implementing the vision,
mission, philosophy, goals,
plans, and standards of the
organization and nursing
services

Responsible for managing

organized nursing services
from the perspective of the
organization as a whole and
for transforming values into
daily operations to produce
an efficient, effective, and
caring organization.
Accountable for the
environment in which
clinical nursing practice
occurs.
Provides leadership and
direction for all aspects of
nursing care

EFFECTIVE MANAGERS & EFFECTIVE LEADERS

Leaders

Envision the future

Communicate their visions

Motivate followers

Lead the way

Influence others to accomplish

goals

Inspire confidence

Take risks

Empower followers

Master change

Managers

Coordinate resources

Optimize resource use

Meet organizational goals and

objectives
Follow rules
Plan, organize, control, and
direct
Use reward and punishment
effectively to achieve
organizational goals

ETHICAL PRINCIPLES
FOR MANAGERS
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Frugality and sophisticated therapeutic skill (doing the

most with the least resource expenditure)
Clinical credibility through organizational competence
Presence (visibility)
Responsible representation at highest levels
Loyal service
Deliberate delegation
Responsible innovation
Fiduciary accountability
Self-discipline
Continuous learning

Legal Aspects of Management

Personal negligence in clinical practice

Liability for delegation and supervision

Organizational liability related to employment issues

Emotional Intelligence

One part of managing people and relationships in

organization is to manage the expression of emotion.
Skill building and training in positive thinking and a
focus on positive emotions assist nurses to better listen,
encourage, motivate, and create connections.
Emotional intelligence is the intersection of thinking and
emotion.
The goal is to achieve optimal outcomes.

Essential for Leadership:

Emotional Intelligence

Self-Awareness
Attuned to own emotional state
Recognizing your emotions, differentiating between emotions, knowing
the reason behind the emotion

Self Management
Ability to stay calm, clear-headed
Maintaining control
Resisting or delaying an impulse, drive, or temptation to act;
controlling aggression, hostility, and irresponsible behavior; managing
emotions in a flexible and adaptable way

Essential for Leadership:

Emotional Intelligence

Perceiving accurately
Accurately assessing a situation, having clear vision, keeping a broad
perspective, being objective
Social Awareness
Attuned to others emotional state
Reading others
Being aware of the emotions of others, appreciating the emotions of
others, understanding how and why people feel and act as they do
Relationship Management
Redirects emotional energies toward shared objectives
Communicating with flexibility
Having a full range of emotional expressions, being authentic,
addressing your needs as well as the needs of others

Current Issues & Trends in Management

Within health care delivery systems, issues and trends facing today's
managers include:
Management of populations with chronic illnesses
Resources to acquire technology on an ongoing basis
The need for primary and preventive services and programs, including
complementary and alternative programs
Integration and seamlessness of clinical and financial services and
information
Protection of consumers' privacy
Doing more with less
Shortages of key personnel, especially registered nurses
Financing structures such as capitation and managed care
Care delivery and process management
Management of knowledge workers and personal accountability
Pressures for quality and sustainable outcomes
Leadership skills related to change management

American Nurses Association

American Nurses Association membership

The strength of a profession lies in the number of
members in its professional organization, its
internal unity and the ability to mobilize collective
action.
ANA

represents nursing at the national level.

Yet less than 5% of all RNs belong to the
organization