Leadership, Management and Followership

Dr. Yoder-Wise is Dean of Texas Tech School of Nursing
Leadership:
-Ability to influence other people
-“enables people to work more effectively together in a state of interdependence” (Covey, 1992)
-“the use of personal traits and personal power to constructively and ethically influence patients, families, and others toward an end point vision or goal” (Yoder-Wise, 2003)
Management
“is a set of behaviors and activities that provides structure and direction in conducting patient care and organizational functions where the norms and outcomes to be achieved are know and where a desired sequence to accomplish these outcomes is prescribed, either in writing or through historical practices embedded in the organization’s culture” (Yoder-Wise 2003)
Management as a role
Planning, organizing, commanding, coordinating, and controlling the work of a given set of employees (Fayol 1916)
Do whatever is necessary to make sure that employees do their work and do it well, includes interpersonal, informational, and decisional actions (Mintzberg 1989)
Leader Traits
Based on influence and shared meaning
An informal role
An achieved position
Part of every nurse’s responsibility
Independent management
Manager Traits
Based on authority and influence
A formally designated role
An assigned position
Usually responsible for budgets, hiring and firing people
Improved by the use of effective leadership skills
Emotional Intelligence
Having self-awareness
Managing emotions
Motivating oneself
Being empathetic
Handling relationships
Having self-awareness –
the ability to step outside and see oneself in the context of what is happening while recognizing and owning feelings associated with an event
Managing emotions –
naming, claiming, and taming feelings such as fear, anxiety, anger, and sadness and taking appropriate actions to progress through feelings in a healthy manner; avoiding passive-aggressive and victim responses
Motivating oneself –
focusing on a goal, often with delayed gratification, such that emotional self-control is achieved and impulses are stifled
Being empathetic
Handling relationships –
exhibiting social appropriateness and using social skills to help others manage emotions
Top Ten EI Suggestions
Become emotionally literate. Label your feelings, rather than labeling people or situations.
Distinguish between thoughts and feelings.
Take more responsibility for your feelings.
Use your feelings to help them make decisions.
Show respect for other people’s feelings
I feel impatient vs. This is ridiculous
Thoughts: I feel like… & I feel as if.. & I feel that Feelings: I feel: (feeling word)
I feel afraid vs. You are driving like an idiot
I feel jealous. vs. You are making me jealous.
Ask How will you feel if I do this? How will you feel if I don’t.
Feel energized, not angry.
Validate other people’s feelings.
Practice getting a positive value from emotions.
Don’t advise, command, control, criticize, judge or lecture to others.
Avoid people who invalidate you.
Use what others call anger to help feel energized to take productive action.
Show empathy, understanding, and acceptance of other people’s feelings.
Ask yourself: How do I feel? and What would help me feel better? Ask others How do you feel? and What would help you feel better?
Instead, try to just listen with empathy and non-judgment.
While this is not always possible, at least try to spend less time with them, or try not to let them have psychological power over you.
Trait Theories
Assertiveness
Ambition
Charisma
Creativity
Decisiveness
Enthusiasm
Intelligence

Initiative
Integrity
Persistence
Physical characteristics
Sense of self
Technical mastery
Verbal ability

Great Man Theory
The leaders are born and not made and posses certain traits which were inherited
Great leaders can arise when there is a great need. is a 19th-century idea according to which history can be largely explained by the impact of “great men”, or heroes: highly influential individuals who, due to either their personal charisma, intelligence, wisdom, or political skill utilized their power in a way that had a decisive historical impact.
Autocratic leader
attempts to move the group toward the leader’s goals

leader directs the group, makes all of the decisions, tell people what to do and how to do it

Democratic leader
attempts to move the groups towards its goals
more people-oriented approach; decisions are made by the group, teamwork focus, leader shares responsibility for outcomes with the group and allows them to guide direction. Group concensus is fostered.
Laissez-faire leader
makes no attempt to move the group

promotes complete individual and group freedom with little direction from leader; often seen in circumstances of leader apathy; not structured, leader gives no direction. The enefit to this style may be if working with a group of professionals who know their own jobs and do them independently; a different style might create group decension.

Scientific Management –
Taylor, Gantt Viewed workers as cogs in a machine and concentrated on time and motion studies

Came along in the early 20th century with industrialization/manufacturing industry
Formalized, ultra-structured, predictable, stable, and economically driven

Human Relations –
Hawthorne Studies
People’s behavior improved when you give them some kind of extra attention
The “Hawthorne effect”

Post-WWI at a time where there was increasing activism and unionism; more democratic style where workers are empowered; focus on motivating workers.

Dimensions of Transformational Leadership
Charisma: have a profound effect on followers based on personal abilities
Visionary: provides a sense of mission & instills pride, commitment, and trust
Intellectual stimulation: promotes intelligent, rational, problem solving
Individualized consideration: attentive, treats people individually, coaches/advises
Integrity –
personal and professional code ANA
Courage –
to take risks
Initiative –
act on good ideas
Energy –
use wisely
Optimism –
needed to remotivate
Perseverance –
do not give up easily
Balance –
in life
Ability to handle stress –
learn to cope
Self-awareness –
knowing, understanding and accepting yourself as a thinking, feeling human being who interacts with other thinking, feeling people.
Think critically –
reflective, reasoned analysis that focuses on thinking before deciding what to believe or do
Solve problems –
work through process
Respect people –
recognizing differences
Communicate skillfully-
listening and communicating
Set goals, share a vision –
personal and group
Develop self and others –
always
Qualities of an Effective Manager
Leadership
Clinical Expertise
Business Sense
Behaviors of an Effective Manager , Interpersonal
Networking
Conflict negotiation and resolution
Employee development
Rewards and punishment
Behaviors of an Effective Manager Decisional
Employee evaluation
Resource allocation
Planning
Job analysis and redesign
Behaviors of an Effective Manager Informational
Representing employees
Representing the organization
Monitoring
Dissemination
Followership
“is the healthy, assertive use of personal behaviors that contributes to patient, family, and healthcare team achievement” (Yoder-Wise, 2003)
Effective Follower
Willingly and earnestly be led
Share time and talents
Synergistically create and innovate solutions to problems
Effective Follower(Yoder-Wise, 2003)
“…take direction from the manager as needed while asserting oneself in the tasks that need accomplishment and to honor and respect the need for structured work activities that, despite their structured nature, are not devoid of critical-thinking decision making.”
A winner says…
We have a real challenge here
I’ll give it my best
That’s great!
We can do it!
Yes!
A whiner says…
This is really a problem
Do I have to?
That’s nice, I guess
Impossible. It can’t be done
Maybe…..
Total patient care
developed by Nightengale

Pros – works directly to patients, MD, health care team members

Cons – continuity of care from shift to shift, day to day can be a problem

Total Patient Care

Functional Nursing
developed in 50s during nursing shortage
Pros – nurses become highly competent with tasks
Cons – lack of continuity, absence of holistic view of client, care becomes mechanical, communication not always clear

Functional

Team Nursing
also developed in 50s
Pros – team leader acts as advisor and coordinates care, collaborative style

Cons – lack of time the team leader spends w pts
prep of assisted personnel
pts may see RN infrequently

Primary Nursing
developed in 70s

Primary nurse over a couple of nurses who are responsible for pts

Pros – maintain continuity over shifts and days, reduces delays in therapies, increased collab with other members of hte health care team, enhanced nurs-pt relationship can be used in many settings

Cons – perceived as costly

Case Management
1990s – everything circles around the pt

Pros – continuity in lifespan, outcome oriented

Cons – cost outcomes may be overemphasized

Client focused care
90’s
used in the ICU

Pros – staff satisfaction
cons – staff dissatisfaction

Product Line Management
focuses on unique areas of services

Pros – quality
Cons – may have difficulty in focusing on client and family needs that are incongruent with business decisions

Delegation
the transfer of nursing activity and responsibility for completion of that activity to another person.

It is not the same as telling someone to do something

The delegator
does not transfer oversight but retains accountability for the activity.

This means that the RN may authorize an LPN or an unlicensed assistant to do some phase of patient care but the original RN retains accountability for the accurate, safe, appropriate completion of that care.

Assignment
in contrast to delegation is a lateral shift of nursing activity to someone with the same level of responsibility and accountability
The Four Rights of Delegation
The Right Task
The one that can be delegated
The Right Person
The one qualified to do the job
The Right Communication
Clear, concise description of the objective and your expectations
The Right Feedback
Evaluations in a timely manner, during and after the task is completed
The Right Task
“While employers and administrators may suggest which nursing acts should be delegated and to whom the delegation may be made, it is the nurse who ultimately decides and who is accountable for deciding whether the delegation occurs.”

National Council of State Boards of Nursing 1990

“While tasks and procedures may be delegated, the functions of assessment, evaluation, and nursing judgment should not be delegated.”

National Council of State Boards of Nursing 1990