Ch. 23 Nursing Leadership and Management

Types of Power
*Explicit* —power by virtue of position

*Implied* —power due to other factors, such as personality

Leadership Qualities
Politically aware
Leadership Skills
Problem solving
Achieving Self-Knowledge
Identify your strengths.
Evaluate how you accomplish work.
Clarify your values.
Determine where you belong and what you can contribute.
Assume responsibility for relationships.
Leadership Styles
*Autocratic*- also called directive leadership or authoritarian leadership, involves the leader assuming complete control over the decisions and activities of the group.

*Democratic*- also called participated leadership, is characterized by a sense of equality among the leader and other participants.

*Laissez-faire*- also called nondirective leadership, the leader relinquishes power to the group, such that an outsider could not identify the leader in the group.

*Transformational*- can create revolutionary change.

*Situational*- theory considers the leadership style, the work’s group maturity, and the situation at hand to form a comprehensive approach to management style.

*Quantum*- leadership that moves beyond the traditional modes previously experienced by all levels of workers; spawned by the impact of the information age on work and the worker.

Role of Nurse Manager
Evolving Models of Nursing Care Delivery
*Functional nursing*
Nurses and other staff are assigned to specific tasks for a group of patients.
Based on the assembly-line concept found in industry; specializing tasks increases efficiency but results in impersonal

*Team nursing*
A team made up of a registered nurse and other caregivers provides care to a designated group of patients on a given shift.
Modified the depersonalized approach of functional nursing and focused on individual patient care

*Total care or Case nursing*
A nurse as a caregiver provides total care to a group of patients for a designated shift.
A patient-centered model; suffers from a lack of continuity between shifts and is expensive because of highly paid nurses provide all aspects of care.

*Primary nursing*
A nurse is accountable for planning, evaluating, and directing the care of a patient 24 hours a day throughout the patient’s period of care.
A model of providing comprehensive, individualized, and consistent care; expensive

*Case management*
One nurse is responsible for overseeing the quality and financial outcomes of patient care.
The nurse works collegially with physicians and other caregivers as well as with payers to manage patients along an agreed-on clinical pathway

*Patient-centered or Patient-focused care*
Cross-functional teams consisting of groups of professionals and assistive personnel from various departments.
These teams work together as a unit-based team to provide care to a given group of patients.
Care is designed around the needs of the patients and not the needs of the departments or professionals

*Collaborative practice model*
Nurses and physicians work together in collaborative practice models

Gosling and Mintzberg (2003) Five Managerial Perspectives
*Reflective mindset*- allows managers to mentally digest experiences and relfect on them in a different way.
*Analytical mindset*- encourages introspection so that one can recognize biases and see things in a unique way.
*Worldly mindset*- recognizes cultures and contexts or “seeing differently out to reflect differently in”
*Collaborative mindset*-involves listening more than talking and allowing people to take initiative and control their own work.
*Action mindset*- mobilizes energy to change while being sensitive about the capabilities of the team and the direction that is needed.
Factors Prompting Change in Healthcare Industry
Increased number of chronically ill and older people
Increased role of government and industry in healthcare
Rising cost of healthcare
Changing patterns of healthcare delivery
Lewin's Theory of Change
Lewin’s Theory of Change
*Unfreezing* —the need for change is recognized
*Moving* —change is initiated after a careful process of planning
*Refreezing* —change becomes operational
Considerations for Planned Change
What is amenable to change?
How does the group function as a unit?
Is the group ready for change and at what rate?
Are the changes major or minor?
Reasons for Resistance to Change
Threat to self
Lack of understanding
Limited tolerance for change
Disagreements about the benefits of change
Fear of increased responsibility
Conflict Resolution Strategies
*Avoiding-* awareness of the situation but the parties involved decided to ignore or avoid/postpone its resolution.
*Collaborating-* win win situation. all parties set aside previously determined goals, determine a common goal, and accept mutual responsibility for achieving this goal.
*Competing-* win for one party. win-lose
*Compromising-* both parties must be willing to relinquish something of equal size.
*Cooperating/Accommodating-* one party makes a conscious decision to let the other group win. but IOU’s in the future.
*Smoothing-* an effort to complement the other party and focus on agreement rather than disagreement thus reducing the emotion in the conflict.
Overcoming Resistance to Change
Explain proposed change to all affected.
List the advantages of the change.
Relate the change to the person’s existing beliefs and values.
Provide opportunities for open communication and feedback.
Indicate how change will be evaluated.
Introduce change gradually.
Provide incentives for commitment to change.
Steps for Using Time Effectively
Establish goals and priorities for each day.
Evaluate goals in terms of your ability to meet needs of patients.
Establish a time line.
Evaluate your success or failure in managing time.
Use these results to direct your next day’s priorities and time line.
Considerations When Delegating Nursing Care
Patient’s condition
Complexity of the activity
Potential for harm
Degree of problem solving and innovation necessary
Level of interaction required with the patient
Capabilities of the UAP
Availability of professional staff to accomplish workload
ANA Principles for Delegating Care
The nursing profession determines the scope of nursing practice
The nursing profession defines and supervises UAPs involved in providing direct nursing care
The RN is responsible and accountable for nursing practice
The RN supervises any assistant providing direct patient care
The purpose of UAP is to work in supportive role to the RN
The Five Rights of Delegation
Right task
Right circumstances
Right person
Right direction/communication
Right supervision
Nursing Care That Should Never Be Delegated Except to an RN
Initial and ongoing nursing assessment of patient
Determination of nursing diagnosis, plan, progress, and evaluation of care delivered to patient
Supervision and education of nursing personnel; patient teaching requiring assessment of the patient’s educational needs
Any other nursing intervention requiring professional nursing knowledge, judgment, or skill
Developing Leadership Responsibilities
Nursing organizations
Continuing education