16245134 Directing in Nursing Management

8/8/2019 16245134 Directing in Nursing Management

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DirectingIntroduction

Direction represents one of theessentials functions of managementbecause it deals with human relations.Direction is also, infrequently and bysome, labeled as actuating. Once theorganizational plans have been laid

down, the structure being designedand competent people brought in to fillvarious positions in organization.Direction is the managerial function ofguiding, motivating, leading,supervising the subordinates toaccomplish desired objectives.Acquiring physical and human assetswill not suffice; what is more importantis that people must be directed towardorganizational goals. Without proper

direction and supervision employeesbecome inactive, dull and inefficientand consequently the physical assetslike machinery and plant will be put toineffective use.

DefinitionIt is the directing style wherein

managers tell their personnel what todo, how to do it and when to have itcompleted by. They assign roles andresponsibilities, set standards, anddefine expectations.

Directing is the fourth phase ofthe management process. This phasecould also be referred as coordinating,or activating. It is the action phase ofmanagement, requiring the leadershipand management skills necessary toaccomplish the goals of theorganization

It is the issuance of orders,assignments and directions thatenable the nursing personnelunderstand what are expected ofthem. Directing includes supervisionand guidance so that in doing their jobwell, nurses can maximally contributeto the organizations goal in generaland into nursing service objective inparticular.

Directing includes delegation ofwork to be performed, utilization ofpolicies and procedures, supervision ofpersonnel, coordination of services,communication, staff development,and making decisions.

Communications - It is one way. Themanager speaks, employees listenand react. The only feedbackmanagers ask for is - "Do youunderstand what needs to be done?"

Goal-Setting - The managerestablishes short-term goals withspecific deadlines.

Decision-Making - The managermakes most if not all decisions. Whenproblems arise the managerevaluates options, makes decisionsand directs employees as to whatactions to take.

Providing Feedback - The managerprovides candid, detailed instructionsas to what changes the employeeneeds to make.

Rewards and Recognition - Managers

reward and recognize people forfollowing directions.

Basic Concepts about Directing

Direction consists of the processand techniques utilizing in issuinginstruction and making certain thatoperations are carried out asoriginally planned.

Direction is a complex function

that includes all those activitieswhich are designed to whichencourage subordinates to workeffectively and efficiently in bothshort and long run.

Direction is telling people whatto do and seeing that they do it tothe best of their ability.


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Directing deals with the steps amanager takes to get subordinatesand others to carry out plans.

Direction provides link betweendifferent functions in an organization.

Points to Remember When Using the

Directing Style1. Organize your thoughts beforeyou begin to speak.

2. Start with the big picture, andthen discuss the details.

3. Make sure your directions areclear and specific.

4. If possible show employees thedesired output. Take the mystery and

guess work out of what you want.

5. Assign due dates.

6. Provide written instructions if thedirections are complex or lengthy.

7. Get feedback -test the transfer.Ask the employee to explain in his orher own words what you want done.

Elements of Directing

The directing functions of the managerinclude the following:1. Delegation

2. Supervision

3. Leadership

4. Motivation

5. Communication

6. Coordination7. Orientation

Principles of Delegation

Select the right person to whomthe job is to be delegated.

Delegate both interesting anduninteresting tasks.

Provide subordinates withenough time to learn.

Delegate gradually.

Delegate in advance.

Consult before delegating

Avoid gaps and overlaps

Nursing Care AssignmentsNursing care assignments can becalled by various terms this issometimes called modalities of nursingcare, systems of nursing care, orpatterns of nursing care.Functional Nursing

Task-oriented

A particular nursing function isassigned to each worker

Best system when there aremany patients and many nursesavailable

For short term use

Advantage:

Allows work to be done inshortest time

Worker learns to work fast

Learn skills faster

Disadvantage:

Wholistic care is not achieved

Nurses accountability andresponsibility are diminished

Patients cannot identify theirreal nurse

Nurse-patient relationship is notfully developed

Evaluation of nursing care ispoor and evaluation are rarelydocumented


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Difficult to find a specific personwho can answer patients orrelatives question

Total Care or Case Nursing

One nurse is assigned for thedelivery of total care

The nurse plans, coordinate,implements, evaluate, and documentthe nursing care she has given duringthe shift.

Commonly used in privatenursing, special care units, isolationunits and on nursing students

Nurses are accountable forhis/her actions

Provides wholistic care

Works only when there areplenty of nurses and patients are few

Team Nursing

Decentralized system of care

A nurse leads a group of nursing

personnel in providing patient carethrough participative effort.

The team leader assigns patientsand tasks to team membersaccording to job description

The team leader is responsiblefor coordinating the total care of agroup of patients.

The heart if team nursing is teamconference

Team plan recognize andprioritize strength and weakness ofall team members

The team leader supervises thenursing care goals and focuses onattaining them through guidance andsetting of high standard of care.

Primary Nursing

A form of assigningresponsibilities for patient care,

A decentralization authority

Each registered nurse isresponsible for the care of small

group of patients from admission todischarge.

The primary nurse asses thepatients needs for care, set caregoals, writes a nursing care plan,administer care according to thatplan, evaluates the outcome of care,and make the necessary adjustmentand revision as necessary. He/Sheprovides pre-discharge planning and

teaching

Assumes 24-hour responsibilitythe secondary or associate nurseexecute the nursing plan during theafternoon and night shifts and ondays that the primary nurse is offduty

Primary and secondary nursesare freed from administrative andhousekeeping responsibilities tomaximize their time for patient care.

Authority, accountability, andautonomy are values of primarynurse

Modular Method

It is the modification of team andprimary nursing

Unlike in team nursing, a nurse

provides direct care with theassistance of aides. The professionalnurse provides leadership, supportand instruction t the non-professionalaide.

It is similar in primary nursing inthat each pair or trio of nursingpersonnel is responsible for the careof patients from admission todischarge


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It is customary to assign the twoor three-worker team fullresponsibility for a case load of 8 12patients

The same in primary nursing,another group of nurses will care onthe patient on alternating shifts and

day off.

Responsibility is to assesspatient needs, plans and implementcare, and assess outcomes includingguiding and instructing her partners.

Case Management

A system of patient care deliverythat focuses on the achievement ofoutcomes with effective an

appropriate time frames andresources.

Focuses on entire episode ofillness, crossing all settings in whichthe patient receives care

Care is directed by casemanager who ideally is involved in agroup practice. She is responsible forassessment of patient and family,establishes the nursing diagnosis,develops nursing care plan,delegates nursing care to associates,activates intervention, coordinatesand collaborates withinterdisciplinary team, and evaluateoutcomes of care

In institution these activities aredone prior to admission andcontinues to 2-3 weeks afterdischarge

In communities, activities occurin different setting- the home; clinic,hospital-as long as necessary.Examples are prepaid health careplans and health maintenance(HMOs).

Relationship between the casemanager, physicians, primary nurse,

public health nurse, andinterdisciplinary staff must beestablished and nurtured.

Communication The word communication comes

from the Latin word communis,meaning commonness. Communication

is a two-way process by whichinformation exchanged between oamong individuals through a commonsystem of symbols, signs and behavior.

Communication is the process toimpart information from a sender to areceiver with the use of a mediumCommunication requires that all partieshave an area of communicativecommonality. Chitty (2001) definescommunication as the complex

exchange of thoughts, ideas, orinformation on at least two levelsverbal and nonverbal.

Verbal Communication- thetransmission of ideas, opinionsfeelings, emotions or attitudes throughthe use of words. Ex: commentsquestion, reactions

Nonverbal Communication- refers tothe sending of messages to anotherperson utilizing methods or means

other then words. Ex: faciaexpression, gesture, eye contact

Communication is a process bywhich we assign and convey meaning inan attempt to create sharedunderstanding. This process requires avast repertoire of skills in intrapersonaand interpersonal processing, listeningobserving, speaking, questioninganalyzing, and evaluating. Use of theseprocesses is developmental and

transfers to all areas of life: homeschool, community, work, and beyondIt is through communication thatcollaboration and cooperation occur.

Communication Process (Diagram onthe last page)

As a process, communication isdynamic, adaptive, and continuousCommunication helps us to develop to
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be unique persons, relating andcooperating with others.

An internal and an externalclimate also exist in communication.The internal climate includes the values,feelings, temperament, and stresslevels of the sender and the receiver.Weather conditions, temperature,

timing, and the organizational climateitself are parts of the external climate. The external climate also includesstatus, power, and authority as barriersto manager-subordinatecommunication.Internal climate External climate

Internal

External

Written

Non-verbalVerbal

Both sender and the receivermust be sensitive to the internal andexternal climate, because theperception of the message is alteredgreatly depending on the climate thatexisted at the time the message wassent or received. Example, an insecuremanager who is called to meet withsuperiors during a period of stringentlayoffs will probably view the messagewith more trepidation than a mangerwho is secure in his or her role.

In assessing the internal climate,remember that the human mindperceives only what it expects toperceive. The unexpected is generallyignored or misunderstood. In otherwords, receivers cannot communicate ifthe message is incompatible with theirexpectations. Therefore, effectivecommunication requires the sender todetermine what receivers see and hear.

Variables Affecting OrganizationalCommunication

Formal organization structure hasan impact on communication. People atlower levels of organizational hierarchyare at risk for inadequatecommunication from higher levels. Thisoccurs because of the number of levelscommunication must filter through inlarge organizations. As the numbers of

employees increases, the quantity ofcommunication generally increaseshowever, employees may perceive it asincreasingly closed.

In addition, in large organizationsit is impossible for individual managersto communicate personally with eachperson or group involved inorganizational decision making. Jackson(1984) has identified the followingcharacteristics of large organizations

that make communication particularlydifficult:

Spatial distance within anorganization can be a barrier tocommunication.

Different subgroups orsubcultures within the organizationhave their own value systems andidentities. Members within thatsubgroup form an allegiance to theirown members. This results in differenttranslations of messages from themanagement, depending on thesignificance of the message to thethings the subgroup values and isstriving to accomplish.

People are structured intodifferent systems of relationships inorganizations. A work structure existsin which certain people are expectedto complete tasks with other people

An authority structure exists whensome workers are in charge ofsupervising others. A status structuredetermines which people have rightsand privileges. A prestige structureallows some people to expectdeferential treatment from others. Thefriendship structure encouragesinterpersonal trust. All of thesesystems influence who should

Sender

Message

Receiver


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communicate with whom and in whatmanner.

Organizations are in constantstate of flux. Relationships (subgroupsor subcultures) and geographicallocations constantly change. It isdifficult to communicate decisions toall people who are affected by them

because of this constant state ofchange.

Gender is also a significant factorin organizational communications sincemen and women communicate and uselanguage differently. Indeed, Hall andRoters (1998) study of communicationpatterns of male and female physiciansfound that the communication style offemale physicians included more focuson the patients emotional andpsychosocial concerns, more positivelytoned communication, and a moreegalitarian style reflected in increaselevels patient participation.

Complicating the picture further isthe historical need in the healthcareindustry for a predominantly malemedical profession. Chitty (2001) statesthat during female-dominated nursingschool experiences, most nurses areencouraged to view physicians asteammates and to collaborate withthem whenever possible. Male-dominated medical schools, however,tend to instill in their graduates thehierarchal model of teamwork with thephysician at the top of the hierarchy.The combination of difference in use oflanguage and difference in status oftenresults in patterns of malepredominance and female deference incommunication.

In addition, majority of healthcareadministrators continue to be male. Therefore, male physicians and maleadministrators may feel little incentiveto seek a more enlightened,collaborative approach incommunication that female nursesoften desire. These differences ingender and in power and status

continue to affect tremendously thetypes and quality of organizational andunit-level communication.

Organizational CommunicationStrategies

Although organizationacommunication is complex, the

following strategies can increase thelikelihood of clear and completecommunication:

Managers must understand theorganizations structure and recognizewho will be affected by decisions thatare made. Both formal and informacommunication networks need to beconsidered.o Formal Communication

networks follow the formal line ofauthority in the organizationshierarchy.

o Informal Communication

networks occur between people atthe same or different levels of theorganizational hierarchy but do notrepresent formal lines of authority orresponsibility. Although there may bea significant exchange of informationabout unit or organizationafunctioning, this communicationnetwork would not be apparent onthe organization chart. It isimperative, then, that managers bevery careful of what they say and towhom until they have a goodunderstanding of the formal andinformal communication networks.

Communication is not a one-waychannel. If another departments ordisciplines will be affected by the

communication, the manager mustconsult with those areas for feedbackbefore the communication.

The communication must bclear, simple and precise. Themanager (sender) is responsible forensuring the message is understood.

Managers should seek feedbackregarding whether theircommunication was accurately


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received. One way to do this is to askthe receiver to repeat thecommunication or instructions. Inaddition, the sender should continuefollow-up communication in an effortto determine if the communication isbeing acted upon.

Multiple communication methods

should be used when possible if amessage is important. Using variety ofcommunication methods incombination increases the likelihoodthat everyone in the organization whoneeds to hear the message will.

Mangers should not overwhelmsubordinates with unnecessaryinformation. Although information andcommunication are different, they areinterdependent. Information is formal,impersonal and unaffected byemotions, values, expectations andperceptions. Communication, on theother hand, involves perception andfeeling. It does not depend oninformation and may represent sharedexperiences. In contrast to informationsharing, superiors must continuallycommunicate with subordinates.

Channels of Communication

Upward Communication, the manageris a subordinate to highermanagement. Needs and wants arecommunicated upward to the nextlevel in the hierarchy. Those at thishigher level make decisions for agreater segment of the organizationthat the lower-level manager.

Downward Communication, themanager relays information to

subordinates. This is the traditionalform of communication inorganizations and helps coordinateactivities in various levels of thehierarchy.

Horizontal Communication, managersinteract with other on the samehierarchical level as themselves whoare managing different segments ofthe organization.

Diagonal Communication, themanager interacts with personnel andmanagers of other departments andgroups, such as physicians, who arenot on the same level of theorganizational hierarchy.

Grapevine, the most informacommunication network. Usuallyinvolves three or four people at a timeIt is subject to error and distortionbecause of the speed at which itpasses and because the sender haslittle formal accountability for themessage. Ribeiro and Blakely (1998suggest this distortion occurs becausetransmitters using this often do one ofthe following: (1) elaborate on theoriginal story but convey its originaintent, (2) distort the message eitherdeliberately or unintentionally, or (3)start a contradictory message becausethey disagree with the originamessage received.

Communication Modes

Written communication. Writtenmessages allow for documentation They may, however, be open tovarious interpretations and generally

consume more managerial time. Mostmanagers are required to do aconsiderable amount of this type ofcommunication and therefore need tobe able to write clearly.

Face-to-face communication. Oracommunication is rapid but may resultin fewer people receiving theinformation than necessary. They also,communicate verbally in formameetings, with people in peer work

groups, and when making formapresentations.

Nonverbal communication. Nonverbacommunication includes faciaexpression, body movements, andgestures and is commonly referred toas body language. Because nonverbacommunication indicates theemotional component of the messageit is generally considered more reliablethan verbal communication. There is


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significant danger, in misinterpretingnonverbal messages if they are notassessed in context with the verbalmessage.

Telephone communication. Atelephone call is rapid and allows thereceiver to clarify the message at thesame time it is given. Accents may be

difficult to understand as well in amulticultural workforce.

INTERPERSONAL COMMUNICATION IN AMULTICULTURAL WORKPLACE

Because it is impossible for theindividual manager to communicateface to face with each member in thelarge organization, managers mustdevelop other interpersonalcommunication skills. These skillsinclude nonverbal communication,verbal communication skills, andlistening skills. Perhaps even moreimportantly, the manager must havethe sensitivity and leadership skills tocommunicate in todays multiculturalworkplace.

NONVERBAL COMMUNICATION SKILLSMuch of our communication

occurs through nonverbal channels thatmust be examined in the context of theverbal content. Generally, if verbal andnonverbal messages are incongruent,the receiver will believe the nonverbalmessage.

Because nonverbal behavior canbe frequently is misinterpreted,receivers must validate perceptionswith senders. The incongruencebetween verbal and nonverbal leads tomany communication problems.

The following is a partial list ofnonverbal clues that can occur with orwithout verbal communication:

Space. The space between thesender and receiver influence what iscommunicated. Although distanceimplies a lack of trust or warmth,inadequate space, as defined bycultural norms, may make people feelthreatened or intimidated.

Environment. The area where thecommunication takes pace is animportant part of the communicationprocess. Communication that takesplace in a superiors office is generallytaken more seriously than that whichoccurs in the cafeteria.

Appearance. Mush iscommunicated by our clothinghairstyles, cosmetics, andattractiveness. The phrase dressingfor success appropriately designs theimpact of dress and appearance onrole perception and power, howeveragain, care should be exercised toestablish dress policies thatincorporate both cultural and gender-related sensitivities.

Eye contact. This nonverbal clueis often associated with sincerity. Eyecontact invites interaction. Likewisebreaking eye contact suggests thatthe interaction is about to ceaseBohannon (200,p.21) states thatmaking eye contact is one f the keycomponents of effective bodylanguage. Blinking, staring, or lookingaway when you begin speaking makesit hard for you to connect with another

person emotionally. Posture. Posture and the way youcontrol the other parts of your bodyare extremely important. In additionthe weight of a message is increased ifthe sender faces the receiver, standsor sits appropriately close, and, withhead erect, leans toward the receiver.

Gestures. A message accentedwith appropriate gestures takes onadded emphasis. Too much gesturing

can, however, be destructing. Indeed,the use of touch is one gesture thatoften sends messages that aremisinterpreted by receivers frodifferent cultures.

Facial Expression. Effectivecommunication requires a faciaexpression that agrees with yourmessage. Managers who present apleasant and open expression are


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following the employees line ofreasoning.

Restate the message by usingassertive language. Rephrasing theaggressors language will defuse theemotion. Paraphrasing helps theaggressor focus more on the cognitivepart of the message. The manager

might use restating by changing ayou message to an I message.

Question. When the aggressorsuses nonverbal clues to be aggressive,the assertive person can put thisbehavior in the form of a question asan effective means of helping theother person become aware of anunwarranted reaction.

Andrews (1998) suggest the followingstrategies to promote effective verbalcommunication in the multiculturalworkplace:

Use proper titles of respect. Donot call a person by his or her firstname until given permission to do so.

Be aware of subtle linguisticmessages that may convey bias orinequality.

Avoid slang, pejorative, or

derogatory terms when referring topersons from a particular ethnicity,race, or religious group.

Avid making remarks to staff thatthey should consider themselvesfortunate to be employed by theorganization. Do not compare theiremployment opportunities andconditions to people in their country oforigin.

Avoid using phrases such as

culturally disadvantaged,socioeconomically disadvantaged,and culturally deprived as theysuggest inferiority and may beoffensive to others.

Do not expect a staff member toknow or get along well with all otherstaff members of the same ethnicity.Although they share the sameethnicity, their uniqueness as

individuals creates a diversity ointeractions, values, experiences, andbeliefs.

LISTENING SKILLSThe active process of listening is

as important as verbal skills. Theselistening skills are so important that

Kerfoot (1998) suggests, Listening andhearing what people are saying to youis a science and an art. It is importantthat the leader/manager approachlistening as an opportunity to learnappreciation for a cultural perspectiveof the organization that is different onhis or her own.

To become better listenerleaders must first become aware of howtheir own experiences, values

attitudes, and biases affect how theyreceive and perceive messagesSecond, leaders must overcome theinformation and communicationoverload inherent in the middlemanagement role. It easy foroverwhelmed managers to sop listeningactively to the many subordinates whoneed and demand their timesimultaneously.

Finally, the leader mustcontinually work to improve listeningskills. The leader who actively listensgives genuine time and attention to thesender, focusing on verbal andnonverbal communication. The leadersprimary purpose, then, is to receive themessage being sent rather than forminga response before the transmission ofthe message is complete.

GROUP COMMUNICATIONManagers must communicate with

large and small groups, as well asindividual employees. Because a groupcommunicates differently thanindividuals do, it is essential that themanager have an understanding ofgroup dynamics, including the sequenceeach group must go through beforework can be accomplished.


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Juckman and Jenses (1977)labeled theses stages forming,storming, norming and performing.When people are introduced, they mustgo through a process of meeting eachother: the forming stage. They thenprogress through a stage where there ismuch competition and attempts at the

establishment of individual identities:the storming stage. Next, the groupbegins to establish rules and design itswork: the norming stage. Finally, duringtheperforming stage, the work actuallygets done.

Some experts suggest there isanother phase: termination or closure.In this phase, the leader guidesmembers to summarize, expressfeelings, and come to closure.

Because a groups work developsover time, the addition of new membersto a committee can slow productivity. Ittakes some time for the group to acceptnew members. Some developmentalstages will be performed again ordelayed if several new members join agroup. Therefore, it is important whenassigning members to a committee toselect those who can remain until thework is finished or until theirappointment is over.

GROUP DYNAMICSIn addition to forming, storming,

and norming, two other functions ofgroups are necessary for work to beperformed. One has to do with the taskor the purpose of the group, and theother has to do with the maintenance ofthe group or support functions.Managers should understand howgroups carry out their specific tasks androles.

TASK ROLES OF GROUPS There are 11 tasks that each

group performs. A member mayperform several tasks, but for the workof the group to be accomplished, all thenecessary tasks will be carried out,

either by members or by the leaderThese roles or tasks follow:1. Initiator. Contributor who

proposes or suggests group goals orredefines the problem. There may bemore than one initiator during thegroups lifetime.

2. Information seeker. Searches for a

factual basis for the groups work.3. Information giver. Offers an

opinion of what the groups view ofpertinent values should be.

4. Opinion seeker. Seeks opinionsthat clarify or reflect the value of othermembers suggestions.

5. Elaborator. Gives examples oextends meanings of suggestionsgiven and how they could work.

6. Coordinator. Clarifies and

coordinates ideas, suggestions andactivities of the group.

7. Orienter. Summarizes decisionand actions, identifies and questionsdepartures from predetermined goals.

8. Evaluator. Questions groupaccomplishes and compares them tostandard.

9. Energizer. Stimulates and prodsthe group to act and raises the level ofit actions.10. Procedural technician. Facilitatesgroup action y arranging theenvironment.11. Recorder. Records the groupsactivities and accomplishments.

GROUP BUILDING and MaintenanceRoles

The group task roles contribute tothe work to be done; the group-buildingroles provide for the care andmaintenance of the group. Examples ofgroup-building roles include:

Encourager. Accepts and praisesall contributions, viewpoints, and ideaswith warmth and solidarity.

Harmonizer. Mediatesharmonizes, and resolves conflicts.

Compromiser. Yields his or herposition in a conflict situation.


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Gatekeeper. Promotes opencommunication and facilitatesparticipation by all members.

Standard setter. Expresses orevaluate standard to evaluate groupprocess.

Group commentator. Recordsgroup process and provide feedback tothe group.

Follower. Accepts the groupsideas and listens to discussion anddecision.

INDIVIDUAL ROLES OF GROUPMEMBERS

Group members also carry outroles that serve their own needs. Groupleaders must be able to manage

member roles so that individuals do notdisrupt group productivity. The goal,however, should be management andnot suppression. Not every groupmember has a need that results in theuse of one of these roles. The eightindividual roles follow;1. Aggressor: expresses disapproval

of others values or feelings throughjokes, verbal attacks, or envy.

2. Blocker: persist in expressing

negative points of view and resurrectdead ideas.3. Self-confessor: uses the group

setting as a forum for personalexpression.

4. Recognition seeker: works tofocus positive attention on her/him.

5. Playboy: remains uninvolved anddemonstrate cynicism, nonchalance orhorseplay.

6. Dominator: Attempts to control or

dominate the group.7. Help seeker: uses expression orpersonal insecurity, confusion or self-depreciation to manipulate sympathyfrom other members.

8. Special interest pleader: cloakspersonal prejudices or biases byostensibly speaking for others.

Managers must be well grounded ingroup dynamics and group rolesbecause of their need to facilitate group

communication and productivity withinthe organization. However, theleadership roles have an even greaterimpact on group effectiveness. Dynamicleaders inspire followers towardparticipative management by how theywork and communicate in groupsleaders keep group members on course

draw out shy, politely cut off garrulous,and protect the weak.

PRINCIPLES OF EFFECTIVECOMMUNICATION1. Clear lines of communication

serve as the linking process by whichparts of the organization are unifiedtoward goal achievementSynchronization of efforts is facilitatedwhen proper lines of communication

are identified and utilized.2. Simple, exact, and concise

messages ensure understanding of themessage to be conveyed. Sineeffective communication starts withthe perception of the recipientoverloading or under loading ofmessages should be avoided toprevent distortion andmisunderstanding.

3. Feedback is essential to effectivecommunication. Mutual interaction isrequired. There is little or nocommunication when there is nofeedback. Listening, openness to theother persons point of view and beingsupportive provide the means toeffective feedback.

4. Communication thrives best in asupportive environment whichencourages positive values among itspersonnel. Communication is used tosupport the vision, mission, and goalsof the organization and the nursingservice.

5. A managers communication skilis vital to the attainment of the goalsof the organization. Successfumanagers utilize various mode s ofcommunication. It may be for the maor informal, written or verbalMeetings interviews, counseling, turn-


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of-the shift reports, memos, charts,and official publications are examplesof written communication. Bodylanguage affects he effectively ofcommunication.

6. Adequate and timelycommunications of work-related issuesor changes that may affect jobs

enhance compliance. People resistchange if they do not understand thereason for it. Such announcementsshould be factual and comprehensiveand given face to face for betterreception and understanding.

TYPES OF COMMUNICATIONMainly, there are three types of

communication: spoken words, writtenwords, and physical expression or

significant gestures.Verbal communication involves

spoken words. The speaker must beable to speak slowly, enunciating thewords clearly. Choose words that can beclearly understood instead of using tootechnical ones. Only relevantinformation should be conveyed toprevent confusion. It ascertainsimmediate response when time is short.

Written communication must beclear, correct, complete and concise.This should be written in words that areclearly understood by the reader.Written communication comes in theform of memoranda, hospital orders,documentation, records and reports,policies, procedures, and the like.Ambiguous terms should be voided toprevent misunderstanding.

Non-verbal communication istransmission of message without theuse of words. People oftentimesunconsciously use facial expressions,gestures, touch, body language, orvocal tones.1. PERSONAL APPEARANCE The

appearance of a person gives thegeneral impression of his personalityand self-concept. Nurses shouldalways appear neat and clean. Nursesshould sport a neat hair style which

does not touch the collar line. Malenurses must be clean-shaven. Theymust carry their uniforms with prideand dignity.

2. INTONATION OF THE VOICE Theinformation of the nurses voice shouldbe soft and gentle. It should not beirritating to the ear.

3. FACIAL E XPRESSION A friendlysmile establishes immediate rapportwith the client and invites trust andconfidence in the nurse.

4. POSTURE and GAIT The nursesposture and gait indicate his physicawellness, his emotions, and attitudetowards his clients.

5. TOUCH Touch is a way of caringA gentle touch conveys a caringperson. A rough person indicates

insensitivity to the patients andunresponsiveness to their needs.

LINES OF COMMUNICATIONCommunication is described as a

two-way process, yet in an organization,it is four-dimensional.

Downward Communication The traditional line

communication is from superior tosubordinate which may pass troughvarious levels of management. Thecommunication is primarily directiveand activities are coordinated at variouslevels of the organizationCommunication aims to impart what thepersonnel need to know. What they areto do and why they are to do these.

Downward communicationincludes policies, rules and regulationsmemoranda, handbooks, interviews, jobdescriptions, and performanceappraisal.Upward Communication

Upward communication emanatesfrom subordinates and goes upwardThis is usually in the form of feedbackto show the extent to which downwardcommunication has been receivedaccepted, and implemented.


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Upward communication does notflow as easily as downwardcommunication. Subordinates may nothave the ability to express theirthoughts or maybe too shy to expressthem. Supervisors and head nurseshave a big role to ply in ensuring theeffectiveness of communication.

Through tactful questioning orobservation any misinterpretation canbe detected to avoid difficulty inimplementation. This maybe ironed outat their level or referred to highermanagement if necessary.

Examples of upwardcommunication are discussions betweensubordinates and superiors, grievanceprocedures, written reports, incidentreports, and statistical reports.

Horizontal CommunicationHorizontal or lateral

communication flows between peers,personnel or departments on the samelevel. It is used most frequently in theform of endorsements, between shifts,nursing rounds, journal meetings andconference, or referrals betweendepartments or services.

Coordination of duties andcooperation among the variousdepartments will be maximized ifcommunication is open to ensuresmooth work flow.Outward Communication

Outward communication dealswith information that flows from thecaregivers to the patients, theirfamilies, relatives, visitors and thecommunity. Patients should understandthe nature of heir illness, the medicaland the prescribed nursing plans of careso that they cold participate in thedecisions regarding these.

The image of the organization tothe public depends on the employeesunderstanding of its philosophy, vision,mission and objectives, and how theseare communicated to the public. Clearexplanations of policies, rules andregulations promote good publicrelations.

Outward communication alsoinvolves how employees value theirwork. This may be directly or indirectlycommunicated to their families. If theythink highly of their jobs, their familiesbecome very supportive. It is commonto hear My mom works in that hospitalThat is our hospital.

Job satisfaction to opecommunication lines. Positivecommunication between employees andtheir immediate supervisors, andpersonal feedback on job performance.

All personnel should have accessto information when they need it mostsuch as availability of supervisors, ofprocedure manual, job descriptions andwork schedules. Such open access wilenable them to do their jobs in the most

effective and efficient mannerCommunication should be clear andunderstandable.

Personnel should be able toreceive adequate and timelyinformation regarding wok relatedissues or changes that may affect theirjobs. Communication overload or underload should be avoided as these maycause confusion, distrust, andmisunderstanding.

Communication can be enhancedby carefully choosing the words oinformation anyone wishes to conveyby creating an environment thatpromotes its acceptance, by avoidingpreconceived opinions and biases abouta person, by listening to andunderstanding the other persons pointof view, and by being open andsupportive. Most people learn tocommunicate through example. NurseManagers should promote a responsivecommunication climate in their units.

COMMUNICATION ROLE OF SUPERVISORAs a nursing supervisor, your role

involves a lot of key responsibility anddedication. Nursing supervisors need tobe motivated, dedicated within their lineof work, team players and team leadersand have the ability to work effectively
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with staff and employers alike. Nursingsupervisors are appointed with a BAdegree and relative experience withinthe nursing field, individuals who rankto this position are unique in that theypossess desired qualities, such as theability to be a nurse and a friend, aconfidant and a leader, a hard worker

and a person with diverse abilities. Formany nurses, their positions fulfill themas individuals, however, many nursesstrives to be executives and supervisorsand it is this striving that leads them toachieve their goals.

The task of a nursing supervisor isto oversee the other nurses, to ensurethat everyone is performing optimally intheir work and to ensure that patientsare receiving the best possible care.

When any problems occur in a certainnursing unit, the nursing supervisor iscalled to inspect and repair thesituation. The task of a nursingsupervisor is therefore very stressfuland demanding and it is typical for anursing supervisor to suffer from stress,burnout and fatigue. The task of thenursing supervisor is to also ensuresuccess of the nursing team that he orshe is in charge of; this is done by beinga team leader, encouragingcommunication and openness andincreasing the spirit of the nurses.People enjoy their work when they feelhappy with what they are doing andwith whom they are working; it is yourduty to achieve this.

As a nursing supervisor, you arerequired to work with other highlyranked, lead nurses in the hospital. Together with the other lead nurses,you are provided with the responsibilityof allocated units and wards, this wouldbe according to your fields ofexperience. It would then be your dutyto coordinate the activities within thepatient care unit and to assign nurses totheir units along with their shiftschedules etc. Critical thinking andcreative skills are therefore two keyaspects required of a nursing

supervisor. The nursing supervisor mustensure that the patients needs arecatered for at all times and he or shemust ensure that the nursing care andperformance that is offered is of topstandard. As a nursing supervisor, youare leading and directing the work ofothers and therefore, one must be

prepared for a very challenging andhard work when applying for such aposition. The nursing supervisor usuallyreports to the head of the hospital unitfor whom he or she works

Strategies in Creating MotivatingClimate1. Have clear expectations for

workers, and communicate theseexpectations effectively.

2. Be fair and consistent whendealing with all employees.

3. Be a firm decision maker using anappropriate decision-making style.

4. Develop the concept of teamwork5. Integrate the staffs needs and

wants with the organizations interestand purpose.

6. Know the uniqueness of eachemployee.

7. Remove traditional blocksbetween the employee and the workto be done.

8. Provide experiences thatchallenge the employee and allowopportunities for growth.

9. When appropriate, requestparticipation and input from alsubordinates in decision making.

10. Be certain that employeesunderstand the reason behinddecisions and actions.11. Reward desirable behaviorbe consistent in how you handleundesirable behavior.12. Let employees exerciseindividual judgment as much aspossible.13. Create a trustful andhelping relationship with employees.
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14. Let employees exercise asmuch control as possible over theirwork environment.15. Be a role model foremployees.

Supervision

supervise comes from the wordsupervide which means to oversee

or view directly It means personally observing a

function or activity, providingleadership in the process of nursingcare, delegating functions or activitieswhile retaining the accountability,evaluating and ensuring that thenursing care provided is adequate anddelivered appropriately.

Principles of Good Supervision1. Good supervision requires

adequate planning and organizationwhich facilitate cooperation,coordination, and synchronization ofservices.

2. Good supervision gives autonomyto workers depending on theircompetency, personality andcommitment.

3. Good supervision stimulates theworkers ambition to grow intoeffectiveness.

4. Good supervision creates anatmosphere of cordiality and trust.

5. Good supervision considers thestrengths and weaknesses ofemployees.

6. Good supervision strives to makethe unit an effective learning situation.

Techniques in Supervision

Observation of the worker whilemaking the rounds

Spot checking of charts throughnursing audits

Asking the patients about the carethey receive

Looking into the general condition ofthe units

Getting feedback from co-workers orother supervisors or relatives

Asking questions discretely to find outthe problems they encounter in thewards

Drawing out suggestions from theworkers for improvement of their workor work situation

Delegation

It is the process by which themanager assigns specific tasks/dutiesto workers with commensurateauthority to perform the job.

By delegating well defines tasksand responsibilities, the nursemanager can be freed of valuable timethat can well be spent on planning andevaluating nursing programs andactivities.

It also trains and develops staff

members who desire greateropportunities and challenges in theirwork making them more committedand satisfied in their jobs.

Common Delegation ErrorsUnderdelegating frequently stemsfrom the managers false assumptionthat delegation may be interpreted as alack of ability on his part to do the jobcorrectly or completely; the managers

desire to complete the whole jobpersonally due to lack of trust in thesubordinates; the manager believesthat he or she needs the experience orthat he can do it better and faster thananyone else.Overdelegating because they are poormanagers of time, spending most of it just trying to get organized; they feeinsecure in their ability to perform atask.

Improper delegating delegating at thewrong time, to the wrong person, or forthe wrong person.*Legal implication that pertains todelegation and supervisionorespondeat superior meaning let

the superior answer for the acts of thesubordinate

o The nurse who delegates

responsible for the acts of the


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subordinate and may incur liability iffound negligent in the process ofdelegating and supervising.

o If the task is delegated to a competent

worker and the latter commits amistake, then the latter is accountablefor the assessment of the situation,supervision, follow-up, intervention,

and corrective action.

What cannot be delegated?1. Overall responsibility, authority

and accountability for satisfactorycompletion of all activities in the unit.

2. Authority to sign ones name isnever delegated.

3. Evaluating the staff and/or takingnecessary corrective or disciplinaryaction.

4. Responsibility for maintainingmorale or the opportunity to say a fewwords of encouragement to the staffespecially the new ones.

5. Jobs that are too technical andthose that involve trust andconfidence.

Coordination

Unites personnel and servicestoward a common objective

Enhances collaborative effortsresulting in efficient, smooth andharmonious flow of work

Prevents overlapping of functions,promotes good working relationshipsand work schedules are accomplishedas targeted

Convey clearly defined polices,standard operating procedures,policies and guidelines using the

proper channels of communication.Decision Making

Decision is a course of action thatis consciously chosen from availablealternatives for the purpose ofachieving a desired result.

It involves a choice utilizingmental processes at the consciouslevel and is aimed at facilitating adefined objective.

Problem Solving

Problem Solving is part of decisionmaking, a systemic process thatfocuses on analyzing a difficultsituation.

5 Steps in Decision Making Process1. Definition of the ProblemoPre-determined objectives provide

the focus for the decision. He shouldgather all relevant data so as torecognize the real problem.

2. Analysis of the ProblemoThis means getting to the cause o

the problem.o It produces an explanation that can

be verified because the event orcause has already taken place.*The Supervisor/head Nurseproceeds to investigate, gather data,and evaluate the results.*He should be careful not to let hisprejudices or biases color theevaluation of facts.*She should be open-minded andflexible.

3. Development of AlternativeSolutionso It focuses on the search for and

analysis of alternatives and theirpossible consequences.o It involves the premises if we do

this, the result will be.oSufficient information enables the

decision maker to arrive at rationadecisions.

Factors to be considered in evaluatingalternative solutions: time, availableresources, labor, cost of tools andequipments to be used, and the mora

and legal implications.4. Selection of a Solutiono The Head Nurse chooses the bes

course to follow considering advicefrom others, experience, and logicareasoning; weigh the advantagesand disadvantages of each.

5. Implementation and Follow-up


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Traditional Problem-Solving Process effective model; weakness lies in theamount of time needed for properimplementation; les effective when timeconstraints are a consideration; lack ofan initial objective-setting step thathelps to prevent the decision makerfrom becoming sidetracked.

1. Identify the problem.2. Gather data to analyze the causes

and consequences of the problem.3. Explore alternative solutions.4. Evaluate the alternatives.5. Select the appropriate solution.6. Implement the solution.7. Evaluate the results.

Managerial Decision-Making Models added an objective setting step;

suggested by Sorach (2000)1. Determine the importance and

the context of the decision. Problemsolvers must consider the possibleconsequences of the decision, timeperiod involved, and who needs to beinvolved in the decision process.

2. Determine the objectives for thedecision. Primary and secondary goalsare outlined.

3. List all options. Problem solversmust attempt to identify as manyalternatives as possible.

4. Explore promising options.Alternatives are analyzed by the useof SWOT (strengths, weaknesses,opportunities, and threats).

5. Establish decision-making criteria.Objectives are rank ordered orqualified so that problem solvers areclear regarding which criteria will beweighted most heavily in making theirdecision.

6. Evaluate the options against thecriteria. Apply quantitatively decision-making tools to objectively review thedesirability of alternatives.

7. Select the options to pursue.Desirable alternatives or combinationsof alternatives are selected forimplementation.

8. Analyze the risks. Challenges tosuccessful implementation of chosenalternatives are identified andstrategies are developed to managethose risks.

Nursing Process developed by Ida JeanOrlando; the greatest strength of this

process may be its multiple venues forfeedback; the weakness is like of thetraditional problem-solving model, notrequiring clearly stated objectives.

1. Assessment2. Planning3. Implementation4. Evaluation

The IDEALS Model developed byFacione (2006)

Identify theproblem.

Whats the real questionwere facing here

Define thecontext.

What are the facts andcircumstances that framethis problem?

Enumeratethe choices.

What are our mostplausible three or fouopinions?

Analyzeoptions.

What is our best courseof action, all thingsconsidered?

List reasonsexplicitly.

Lets be clear. Why arewe making this particularchoice?

Self-correct. Okay, lets look at itagain. What did we miss?

Intuitive Decision-Making Model

Andrews (2006) suggests thatone of the critical skills separatinggood leaders from great leaders is the

conscious use of intuition in dailydecision making.Gary Klein developed the Recognition-

Primed Decision (RPD) Model forintuition decision making to explainhow people can make effectivedecisions under time pressure anduncertainty. This model attempts tounderstand how humans makerelatively quick decisions in complex,real world setting without having to


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compare options. Many individuals acton their first impulse if the imaginedfuture looks acceptable.

Aloi (2006) suggests that manyexpert nurses use intuition in solvingproblems. He warns that the dark sideof intuition is misjudgment and thatintuition should serve only as an

adjunct to decision making founded onnursing scientific knowledge base.

LEADERSHIP THEORIESMany believe that the critical

factor needed to maximize humanresources is leadership. A more in-depthunderstanding of leadership can begleaned from a review of leadershiptheories.

The Great Man TheorySet forth the premise that certain

people are born to be leaders, havinginherited a set of innate characteristicsthat endow with unique ability to leadothers. This theory grew because theability to lead others was often seen toroyal and prominent families. Others enot allowed to become leaders, a factthat also helps explain its demise.Currently, most people do not acceptthe idea that an individual is born tolead.

Trait or Attribute TheoryEvolve from great man theory of

leadership when soil and economicbarriers no longer prevented membersof the general public from occupyingleadership roles. Behavioral scientistsbegan to identify the common traits ofgreat leaders throughout the ages. These traits frequently includedassertiveness, ambition, charisma,creativity, decisiveness, enthusiasm,intelligence, initiative, integrity,persistence, physical characteristics,sense of self and other more. The traittheory approach to leadership appealbecause it failed to look at the situationin which action is occurring, neglectedthe role of the follower, and did not

consider the importance of groupsituation. Leaders in one situation mayfunction as follower in another. Inaddition, leaders who are effective insome circumstances are ineffective inothers.

Behavioral theories

During the human elation eramany behavioral and social scientiststudying management also studyleadership. For example, McGregors(1960) theories had as much influenceon leadership research as they did onmanagement science. As leadershiptheory developed, researchers moveaway from studying what traits theleader had and placed emphasis onwhat he or she did- the leaders style of

leadership.A major break through occurred

when Lewin (1951) and White andLippitt (1962) isolated commonleadership style. Later, this styles cameto be cold Authoritarian, democraticand Laissez-faire.

The authoritarian leader ischaracterized by the followingbehaviors:

Strong control is maintained overthe work group.

Others are motivated by coercion.

Others are directed withcommands.

Communications flows downward.

Decision making does not involveothers.

Emphasize is on difference instatus (I and you).

Criticism is punitiveAuthoritarian leadership results in

well-define group actions that areusually predictable, reducing frustrationin the work group and giving membersa feeling of security. Productivity isusually high, but creativity, selfmotivation, and autonomy are reducedAuthoritarian leadership useful in crisissituation is frequently found in very


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emotional connection from thefollowers. House (1971) developedtheory of charismatic leadership thatdescribe how charismatic leader behaveas well as distinguishing characteristicand situation in which such a leaderswould be effective. Charismatic leadersdisplay self confidence, have strength in

their conviction, and communicate highexpectations and their confidence inothers. They have been described asemerging during a crisis,communicating vision, and usingpersonal power and unconventionalstrategies.

Interactional Leadership theoriesThe basic premise of interactional

theory is that leadership behavior is

generally determined by the r betweenthe leaders personality and the specificsituation.

Schein (1970) was the first topropose a model of humans as complexhuman being whose workingenvironment was an open system towhich they responded. A system maybe defined as a set of objects, withrelationship between the objects andbetween their attributes. A system isconsidered open if it exchanges matter,energy, or information with itsenvironment. Scheins model based ontheory has the following assumption:

People are very complex and highvariable. They have multiple motivesfor doing things. For example, a payraise might mean status to oneperson, security to another, and bothto a third.

Peoples motives do not stayconstant but change over time.

Goals can differ in varioussituations. For example, an informalgroups goal maybe quite distinct froma formal groups goal.

Persons performance andproductivity are affected by nature ofhe tasks and by his or her ability,experience and motivation.

No single leadership strategy iseffective in every situation.

Transformational leadership theoryOften reflected in nursing

literature and practice. It is based onthe idea of empowering other to engagein pursuing a collective purpose by

working together to achieve a visionand preferred future. This kind ofleadership can influence both the leaderand the follower to a higher level ofconduct and achievement thattransform them both. Essentially, atransformational leader may be defineas a leader who motivates followers toperform at their full potential byinfluencing changes in perception andby providing a sense of direction to thegroup. The group is encouraged to setaside personal interests for the good ofthe group. Group members areempowered and motivated and provideinput to decision making, and leadersand followers raise one another tohigher levels of performance.Servant leadership theory- developedby Greenleaf (1995), in which hepictured successful leaders as beingable to influence others as a result ofdedicating their lives to serving others.

Attributes for Effective Leader1.Honesty

Leaders have to be honest. If thoseunder your charge do not trust youthen they wont follow you. Commonsense, if you ask me

2. Responsibility

If you are going to make decisions, thenyou should take responsibility for thedecisions that you make. Good leadersdont pass the buck or blame otherpeople they deal with situations thatarise and take responsibility for theresults. Oh, and if you delegate aresponsibility to someone under yourcharge and they screw it up, then it is


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YOU who have screwed up. Thats whatleadership and responsibility is allabout.

3. ConfidenceYou have to believe in yourself. I know itsounds corny, but confidence makes theleader. You have to believe every word

that comes out of your mouth. If youdont your charges will begin toquestion whether or not you know whatyou are talking about.This literally means that even when asituation is hopeless, you have to giveoff an air of confidence. Your chargeswill look to YOU for guidance whentimes get tough. If they see panic oruncertainty in your eyes, then all is lost.

4. EnthusiasmHow do you make someone dosomething that they dont want to do?Enthusiasm! Get psyched about thetask that youre assigning. Emphasizeits importance, and rollup your sleevesand demonstrate. Enthusiasm iscontagious if your charges see you allexcited and ready to have at it, theyllget excited too. If you give off an I justdont give a hoot attitude, then yourcharges wont give a hoot either.

5. ReliabilitySaying that youre going to dosomething means that you will actuallyhave to do it. Nobody likes an unreliableperson, even if theyre not a leader.After your first time going back on yourword, people just arent going to trustyou anymore. I guarantee that if youare unreliable, you wont be a leader forlong (if ever).

6. PatienceDont underestimate the importance ofpatience. If you explain a task orsituation to you charge and they dontunderstand, then clarify it for them. Itsnot their fault that they dontunderstand your instructions its YOURfault. Take the time to help out your

charges so that they can perform theirassigned tasks as you intended. Answertheir questions and make sure that theyunderstand by asking a few yourself!

7. DecisivenessSome politicians should pay carefuattention to this. Dont waffle on see-

saw on decisions. Go through thisexactly once: gather relevantinformation, gather input from youcharges, and make a safe andreasonable decision based on theinformation that you have availableNever second-guess yourself unless newand important information is available.Often, leaders have to make importantdecisions very quickly. Make sure thatyoure psychologically prepared to do

this its not as easy as it seems.

8.Determination This pretty much amounts to finishwhat you start. See tasks through tothe bitter end, and keep your chargesmotivated to continue.

9.Loyalty This is something that you expect oyour charges. It is also something thatyour charges expect from you. The firsttime that you stab your charges in theback will also be the last.

10.CourageThis could be the most important of thelist, since it encompasses so much. As aleader, you must have courage in orderto be decisive. You cant be afraid offailure, or else you will not be able tofunction as a leader. Have the courage

to stick to your convictions or go with agut instinct. Dont be afraid to try a newapproach.

Most importantly, dont be afraid toadmit that you made a mistake. This iswhat separates the true leaders fromthe wanna-bees. If you messed upadmit that you messed up, and thentake corrective action to fix your


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mistake. Your charges wont think lessof you for it in fact, theyll think moreof you because you didnt insist thatblack was white when both you andyour charges know youre wrong.

Leadership StylesI. Authoritarian leadership

Characteristics:1. Strong control is maintained over

the workgroup2. Others are motivated by coercion3. Others are directed with

commands4. Communication flows downward5. Decision making does not involve

others6. Emphasis is on difference in

status ( I and You)

7. Criticism is punitiveResults in ell-defines group actions

that are usually predictable, reducingfrustration in the work group andgiving the members a feeling ofsecurity

Subordinates are expected to followwithout questions

Provides strong motivation andpsychological regard for the leader

Most effective in crisis situations

It is appropriate when there is a needfor immediate action and themanager is the individual with thebest understanding of the situation.Example: emergency departmentsetting

Used to bring order out of chaos

centric the leader makes decisionfor the group

Also called theory X by McGregor

Boss-centeredOften results in high productivity

Creativity, self-motivation andautonomy are reduced

Workers become blind followers andsometimes they avoid their leaders

Useful in crisis situations

E.g. bureaucracies (armed forces)

Directive/bureaucratic

Authoritative/autocratic leader

A leader who uses coercion in theexercise of his/her powers

Has increased concern for taskaccomplishment but less concernfor people who perform these tasks

Has no confidence or trust inhis/her subordinates

Thinks all workers are lazy, need tobe coerced, threatened withpunishment, indifferent toorganizational goals, resistant tochange, not very bright and cannotbe trusted, want to avoidresponsibility and are moreinterested in financial incentivesthan personal achievement

II. Democratic leadership (participative

leadership)Characteristics:1. Less control is maintained2. Economic and ego awards are

used to motivate3. Others are directed through

suggestion and guidance4. Communication flows up and

down5. Decision making involves others6. Emphasis is on we rather than

and you7. Criticism is constructive

Appropriate fro groups who worktogether for extended periods

Promotes autonomy and growth forindividual workers

Particularly effective whencooperation and coordinationbetween groups are necessary

According to studies, it is lessefficient quantitatively than

authoritative leadership People-oriented

Focuses on human aspects and buildseffective teamwork

Interaction between the leader andsubordinates is open, friendly andtrusting

Cooperative spirit and joint effortexist


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Allows governance through groupparticipation in decision making

Open communication prevails

The leader consults his/hersubordinates in solving problems andwork-related decisions made by thegroup

Promotes cohesiveness amongmembers, greater job satisfaction,few feelings of hostility andfrustration

This style will satisfy high humanneeds resulting in greater employeeresponsibility which in turn leads tohigh productivity

The most desirable form of management

It is participatory with authority

delegated to othersConsultative style of leadership

Permit performance appraisal

Theory Y according to McGregor

Disadvantages: decision making canbecome a lengthy process

Advantage: coworkers are consultedsand who have input into decisionsare more motivated to support suchdecisions

Democratic leadership is appropriatewhen task or decision at hand is notone that requires urgent action, whensubordinates can be expected tomake meaningful contributions, andwhen their input can be taken intoaccount.

Democratic Leader

does not resist change, iscreative, exercises self-directionand self-control

Considers workers as ambitious

radic leader he radiates outto encompass the needs ofothers

III. Situational Leadership

In this approach, the leader behavesaccording to a given situation whichmay vary from one setting to theother.

Contingency Style of Leadership one in which the leader matches thesituation and its needs

Fiedler and Chemers state that in thework situation, the managersleadership style and expectationand the followers characteristics andexpectations blend together andform a productive combination

The nurse-manager assesses eachnurses needs and determine whichleadership behaviors will help thenurse to do the work with the fewestproblems. The nurse-manager firstconsiders the staff nurses ability tocomplete a given task. Then thenurse-manager, in a particulasituation, either tells or teaches thestaff what to do and explains thebenefits of learning from a newsituation. He/she participates withthe subordinate in doing a speciaprocedure that the subordinate is notfamiliar with. He or she delegates amore experienced staff to work withthe employee until the latter gainsthe skill and competence inperforming a new task.

The situational leader must b

flexible enough to make adaptationsand changes.

The theory considers a personqualities and motivations, the roleexpectations of the group, and thesocial forces at work such as externafactors that bring forth theleadership potential

Five kinds of leader under thistheory:

Natural Leader becomes a hero in

spite of himself or herself; he/shedoes not seek the role but thegroup thrusts the leadership uponhim/her by the tide of events

Charismatic Leader an authentichero in the eyes of his followers; tothem he/she can do no wronginspires people to make sacrificesfor the cause they represent


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Rational Leader consistent andpersistent in what he/she thinks isright.

Consensus Leader is perceived tobe acceptable to all; rises in theabsence of the above three leaders

Leader by Force dominates byforce and fear; he/she is ruthless insuppressing opposition; he/shedoes not reign long; this type ofleadership contains within itself theseeds of self-destruction; examplesare Hitler and Idi Amin

IV. Laissez-faire Leadership (permissiveleadership)

Also referred to as delegatingapproach

Little or no direction is provided

Coworkers develop their owngoals, make their own decisions,and take responsibility for theirown management

Managers concentrate onproviding maximum support andfreedom for coworkers

Decision making is dispersedthroughout the group

Uses upward and downward

communication with the group Does not criticize

Appropriate when problems arepoorly defined and brainstormingis needed to generate alternativesolutions

Advantages:

Providing maximum freedom forindividuals

Increased motivation of the

subordinates to perform at highlevels because of independence

When all members are highlymotivated and self-directed, thisleadership style can result inmuch creativity and productivity

Disadvantage:

Group apathy and disinterestcan occur

Example: inpatient psychiatricunit

Leadership vacuum

this may occur in circumstancesin which a laissez-faire approachto leadership is inappropriatelyattempted

An informal leader will arise andgive direction to the group

Coworkers recognize an implicitauthority or degree of expertisein the informal leader

This may temporarily allow thegroup to continue to functionwhile the informal leaderprovides the necessary directionand assistance

Authority and PowerAuthorityAuthority identifies the source of

power to act. Authority occurs when aperson who has been given the right todelegate, based on the state nursepractice act, also has an official powerfrom an agency to delegate.

Authority comes with the job asauthority given by an agencylegitimizes the right of a nurse to give

direction to others and expect that theywill comply. An understanding of thelevel of authority at the time the task isdelegated and the level of authority thatis identified by the state nurse practiceact and the agencys job descriptionprevents each party from makinginaccurate assumptions about authorityfor delegated assignments. (Kelly-Heidenthal & Marthaler, 2005)

PowerAccording to Neufeldt, power is

the ability to do, act or produce; theability to control others; an authoritysway, or influence. Power is not a staticphenomenon; it can change and shiftincrease or decrease. Bass (1990)points out that difference in power in agroup, organization, or society influencethe kind of leadership that can be


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effective. When there are greatdifferences in power among individualsor groups, a more directive leadership islikely; when the differences in powerare small, a more participativeleadership is likely.

Forms of power

Reward power Obtained by the ability to grant

favors or reward others withwhatever they value.

The arsenal of rewards that amanager can dispense to getemployees to work toward meetingorganizational goals is very broad.

Positive leadership through rewardstends to develop a great deal of

loyalty and devolution towardsleaders.

Punishment or coercive power

The opposite of reward power, isbased on fear of punishment if themanagers expectations are not met.

The manager may obtain compliancethrough threats (often implied) oftransfer, layoff, demotion, ordismissal.

The manager who shuns or ignores

an employee is exercising powerthrough punishment; as is themanager who berates or belittles anemployee.

Legitimate power

Is also called position power.Authority also is called legitimatepower.

It is the power gained by a title orofficial position within anorganization. Legitimate power hasinherent in it the ability to createfeelings of obligation orresponsibility.

As previously discussed, thesocialization and culture ofsubordinate employees will influenceto some degree how much power amanager has due to his or herposition.

Expert power

Is gained through knowledgeexpertise, or experience.

Having critical knowledge allows amanager to gain power over otherswho need that knowledge. This typeof power is limited to a specializedarea. For example, someone withvast expertise in music would bepowerful only in that area, not inanother specialization.

Fralic (2000) feels that FlorenceNightingale was the first nurse toeffectively use this expert powerWhen Nightingale used research t oquantify the need for nurses inCrimea (by showing that whennurses were present, fewer soldiersdied), she was using her research todemonstrate expertise in the healthneeds of the wounded.

Referent power

A power a person has because othersidentify with that leader or with whatthat leader symbolizes.

Referent power also occurs when onegives another person feeling opersonal acceptance and approval. Itmay be obtained through associationwith the powerful.

People may also develop referentpower because others perceive themas powerful. This perception could bebased on personal charisma, the waythe leader talks or acts, theorganization to which he or shebelongs, or the people with whom heor she associates.

People others accept as role modelsor leaders enjoy referent powerPhysicians use referent power very

effectively; society as a whole, viewsthem as powerful, and they carefullymaintain this image. Some theoristsdistinguish charismatic power fromreferent power. Willey (1990) statesthat charisma is a type of personapower, whereas referent power isgained only through association withpowerful others.


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Sources of power

Type Source

Referent Association withothers

Legitimate Position

Coercive Fear

Reward Ability to grantfavors

Expert Knowledge and skill

Charismatic Personal

Informational The need forinformation

Self Maturity, egostrength

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