1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 4 The Leadership Role of the Licensed Practical Nurse

1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc.

Chapter 4

The Leadership Role of the Licensed Practical Nurse


Learning Objectives

• Differentiate between leadership and management.• Describe leadership styles.• Discuss leadership theories.• Discuss management theories.• List tips for effective management.• Describe the role of the licensed vocational nurse as a

team leader.


Leadership versus Management

• Terms leadership and management used interchangeably but have different meanings

• Leadership is broader and more futuristic; management is more local and task focused

• Leadership: inspiration; management: perspiration

• Ideally, leadership and management complement and build on each other


Leader

• Creates a vision that energizes others to follow • Guides or shows the way to others• Clarifies values for groups that, when combined with

vision, create a mission for the group • Formal leaders and informal leaders • Inspires people to strive to accomplish particular goals

by doing the right thing • Sees beyond the here and now to what might be and is

internally driven toward that vision


Manager

• Assigned or appointed; focuses on the organization’s day-to-day work

• Driven by external organizational rewards • Provides means to achieve organization’s

goals by doing the thing right• Gets things organized so the leader’s vision

can be achieved


Leaders and Managers

• Leaders and managers must have certain characteristics to be effective

• Competence • Ability to gain respect of those who work with them• Ability to communicate with others• Ability to motivate others • Understanding of what others consider important

and why they behave as they do • Willingness to reinforce motivation, enhance

positive outcomes, and provide multiple motivators


Leaders and Managers

• Good leaders and managers seem to have certain characteristics in common• Ability to set realistic goals• Willingness to try out new ideas• Ability to think positively


Figure 4-2


Autocratic Leaders

• Authoritarian, directive, or bureaucratic• Achieve goals by setting objectives and having them

carried out without input from others • Believe they have complete authority and should not

be questioned• Do not encourage individual initiative or cooperation

among members of the organization• Task oriented, making decisions independently and

issuing orders to those working with them• This style of leadership does not work well in many

situations; in other situations it is necessary• During an emergency, one person must take charge


Democratic Leaders

• Focus on the individual abilities of each member • Encourage input into the problem-solving process• Decisions often are made through group consensus • All are informed of the organization’s goals and

direction; input has a direct relationship to attaining goals

• Instead of power struggles, democratic leaders turn problems over to the group to manage

• Lead by suggestion rather than by domination • Persuade and teach rather than rule • Group members are satisfied because they help

manage the decision-making process


Laissez-Faire Leaders

• Opposite of autocratic leaders• Provide little or no directive leadership • Individuals are allowed to do anything they

want with no direction from administration • Result: people do not know or care about what

they are supposed to do and may lose initiative and desire for achievement

• May work well with a highly motivated, focused group


Multicratic Leaders

• Cross between autocratic and democratic leaders • Sometimes called situational leaders• Present their own views to group members, who

provide criticism and comments • Analyze group feedback and then make final decisions• Work well within a group as well as in emergency

situations, when events need to be handled quickly • Response not as quick as under autocratic leadership • Group members assist the multicratic leader with

setting goals, thereby achieving for themselves a sense of empowerment and control


Transformational Leadership

• In a well-functioning group that shares a common vision, leadership will flow among the members based on the task or problem at hand and the members’ individual skills

• All group members are leaders and followers • May not replace reporting lines or formal job

responsibilities, but it may be very effective in identifying the best option at the moment and in energizing others to take action because they are very involved in the decision-making process


Classic Management: Theory X

• Assumes that people in the workplace• Find no pleasure in their work• Dislike responsibility• Are naturally lazy and prefer to do nothing• Work mainly for the money• Work only because they fear being fired• Are basically childlike and like being told what to do• Do not want to think for themselves• Are not capable of making decisions for themselves

• According to theory X, people have these characteristics; thus, they want to be directed and controlled


Classic Management: Theory Y

• Assumes people are dynamic, flexible, and adaptive • Believers in this theory assume that people

• Are active and enjoy setting their own goals• Work for personal rewards other than money• Are productive because of their own goals• Are mature and responsible• Are self-directed• Accept responsibility• Care about what they are doing• Are constantly striving to grow

• According to theory Y, people like their work when they know what is expected of them and when their work gives them satisfaction


Classic Management: Theory Z

• An organizational philosophy and structure• Grew out of the times when most employees were

related to one another and worked together for the good of the company rather than for individual gain

• Focus is on participative management based on mutual trust and loyalty

• Employees frequently remain with the same organization for their entire career, learning all areas of its operations and merging their individual success with that of the organization


Classic Management: Theory Z

• Involves all workers in every phase of the operation of the company: planning, organizing, decision making, and problem solving

• All group members have similar abilities and status; may be rotated to perform different duties

• Group members know and understand organizational objectives and methods of achieving them

• Results in greater efficiency and satisfaction among members of the workforce


Figure 4-1


Functions in the Management Process


Planning

• First step in the management process• Entails deciding in advance what needs to be

done and how to do it • A good plan for carrying out their care must be

developed to provide effective care for patients• Two important components of planning are

decision making and problem solving


Decision Making and Problem Solving

• Identify the problem • Sometimes the problem is obvious, but other times

underlying issues make the real problem less obvious

• Explore all aspects of the situation to identify the real problem

• Seek answers to such questions as who, how, when, and why



• Explore all possible solutions• This is a creative process that can involve other

people in the health care setting• Brainstorming sessions may be held to obtain input

from a variety of sources



• Choosing the most desirable action for solving the problem, to select the best solution• Consider whether the action is likely to accomplish

the objectives of the organization • Determine whether the action increases

effectiveness and efficiency and whether it is realistic to implement it



• Implement the decision • Communicate with other people who are involved in

the organization to gain their support for the action• Express the decision in such a way that others

support rather than oppose it



• Determine how the results will be evaluated • Written tools, such as audits or checklists• Verbal or written feedback from individuals in the

organization or from patients who are receiving the care


Organizing

• Second step in the management process • Must be a formal structure or organization to

ensure that individuals carry out actions in the most efficient and effective manner

• Helps develop order, promote cooperation among workers, and foster productivity


Organizing

• Develop objectives• Guide the process of planning and organizing

• Establish policies and procedures• Provide guidelines for carrying out the objectives

• Make appropriate staff assignments• The most qualified people should be assigned to

activities and tasks that will achieve the objectives • May involve the development of job descriptions,

performance standards, and staffing patterns


Directing

• The third step of the management process• Make assignments and direct people to carry out

the assignments• Explain what is to be done, how it is to be done, and why it

is to be done• Making assignments is related to patient care • Assignments should be made carefully so that the skills of

assigned personnel match patient needs • Important to estimate the difficulty of the task and the time

needed to complete the care • Help and additional instruction should be provided


Directing

• One person should be responsible for making assignments, especially with team nursing

• Assignments must be specific, easily understood, and posted where everyone can see them

• Staff members should be helped to understand their assignments and the importance of each task

• Directions must be complete and understandable • Give directions in a clear, logical order and limit the

number of directions given at any one time • Providing written directions increases understanding

and compliance


Coordinating

• Step of the management process• Pulls together various activities toward a goal• Ensures all important activities are being carried out

and helps to identify overlap, duplication, and omissions

• Involves personnel and services

• You must be sure that proper nursing care is given by the appropriate people


Coordinating

• Carried out within a single nursing unit or among units and departments in a hospital, long-term care facility, or community agency

• Demands skill in problem solving and decision making • Requires good communication skills and an ability to

resolve conflicts within an organization• Requires an assessment of what all individuals and

groups are doing; important for all parts of the organization to function effectively for the good of the whole


Controlling

• The last step in the management process • Ongoing process: activities are analyzed to make sure

the plans are being carried out • Efficiency and effectiveness are evaluated • Purposes of controlling are to determine whether there

are enough staff and supplies, the operation is economical, and the objectives have been achieved

• Controlling is fundamentally a form of evaluation• Controlling has three basic steps

• Establishing standards and objectives• Measuring performance and comparing results with standards• Remedying any deficiencies in the caregiving operations


Controlling

• Continuous quality improvement • Quality assurance (QA), continuous quality improvement

(CQI), and total quality management (TQM) used in relation to controlling

• Measures performance against set standards and expectations and alerts the organization when an action falls below standard

• QA committees set standards for care and evaluate compliance

• American Nurses Association, American Hospital Association, and Joint Commission on Accreditation of Healthcare Organizations set standards for nursing practice and medical care

• Continually seeks ways to improve nursing practice


Conflict Resolution

• Conflicts arise from differences in many factors, such as beliefs, knowledge, opinions, values, personalities, and backgrounds

• Creates stress and negative feelings that can adversely affect the work situation

• May be within an individual (intrapersonal conflict), between two or more people (interpersonal conflict), or between individuals and organizations (organizational conflict)


Four Stages of Conflict

• Stage 1: Frustration• People who believe their goals are being blocked

feel frustrated • May become angry or resigned to the situation

• Stage 2: Conceptualization• Each party formulates a view of the basis for the

conflict • Typically centers on perceived differences in facts,

goals, how to achieve goals, and the values on which goals are based


Four Stages of Conflict

• Stage 3: Action• The conflict leads to various behaviors that may or

may not help resolve the issue

• Stage 4: Outcomes• Goals may be reformulated so they are acceptable

to all parties • One party may “win,” the other may “lose”• Emotions may be positive or negative


Modes of Conflict Resolution

• Accommodation• Collaboration• Compromise• Avoidance• Competition• Table 4-5 shows the positive and negative

outcomes of each mode


Tips for Effective Management

• Managing health care workers is a complex task • Strategies to improve your management skills

• Take active approach to planning; avoid conflict before it occurs

• Have a clear vision, communicate it well, listen, and stay focused

• Emphasize importance of documentation as part of management

• Treat other health care workers or team members as you would like to be treated yourself

• Keep confidential information confidential• Make employees accountable for their actions and be

accountable for yours• Seek help and support from a variety of sources


The Licensed Practical Nurse as a Leader

• Team nursing• Introduced during the 1950s, when there was a

shortage of professional nurses and an abundance of auxiliary nursing staff

• The team functions by using the skills and knowledge of the professional nurse to direct the care provided by a diverse staff through group action

• All members have input into the nursing care process by contributing suggestions and sharing ideas


The Role of the Team Leader

• Functions: plan, set priorities, supervise, and evaluate patient care

• Responsible for ongoing collection of data about each patient and assistance in determining nursing interventions

• Ensure that medical orders and plans are carried out and documented

• Initiate discharge planning, identify referral needs, and facilitate patient education


The Role of the Team Leader

• Responsible for keeping care plans current and documenting the nursing care provided

• Responsible for planning and conducting team conferences and reporting changes to the RN supervisor

• An LPN who assumes the position can help carry out these responsibilities under the supervision and guidance of an RN


Making Assignments

• You must be able to assign tasks to others and make sure that those tasks are carried out

• Delegation allows nurses to accomplish nursing care for more clients than one individual could provide alone

• Delegation (defined by the NCSBN): “the act of transferring to a competent individual the authority to perform a selected nursing task/activity/function in a selected situation, the process for doing the work”


Making Assignments

• Involves identifying specific tasks needed to provide care for a specific person

• Based on patient needs, available staff, job descriptions, scope of practice for licensed nurses, and scope of functions for nursing assistants

• When delegating a task, your duty is patient safety • Effective delegation: delegating a clearly identified

task, identifying patient needs, empowering the staff person to carry out activities to complete the task, and monitoring staff performance


Making Assignments

• Essential elements of effective delegation• Know your state nurse practice act statements on

delegation and your institution’s policy and procedures manual

• Know the training and background of people to whom you delegate tasks

• Decide which tasks can be safely delegated• Evaluate the patient’s response


Making Assignments

• Delegate tasks only to licensed personnel• Do not delegate nursing processes to unlicensed

personnel. Assessment, planning, evaluation, and judgment cannot be delegated

• Delegation is specific to each client • An unlicensed person who completes a task for one

patient cannot do the same task for all patients

• Delegation is also situation specific

• You delegate a task for one patient in one situation


Accident Prevention and Safety

• Every health care facility must meet minimal safety regulations established by law in addition to those adopted by the agency to meet its unique needs

• All staff members, particularly the team leader, should learn these regulations during job orientation

• The team leader should know the regulations and be sure that staff members are aware of them


Accident Prevention and Safety

• Everyone must understand procedures to follow in case of disasters such as fires, tornadoes, and hurricanes

• Everyday safety issues related to handling equipment, using proper procedures, and working with potentially dangerous drugs must constantly be addressed to be sure that knowledge and skills are up to date


Accountability

• Team leaders demonstrate accountability for their own actions as well as those of their staff

• Individuals are answerable for their actions and may be called on to explain or justify them

• Team leaders are legally responsible for all nursing care and documentation• RN team leader is responsible for ensuring that proper and

accurate charting is carried out for all nursing assessments, interventions, and evaluations

• Involves communicating patient needs to others through both oral and written interactions


Accountability

• Guidelines for clear and complete reporting• Organize the report before beginning• Give the patient’s room number, name, age (if

appropriate), diagnosis, and physician• Provide a brief account of each patient’s condition,

including new or changed orders• Refer to vital signs, temperature elevations,

intravenous fluids, and intake and output as relevant


Accountability

• Guidelines• For patients receiving pain medication, note the

drug name, dosage, prescribed frequency, time of last administration, and effectiveness

• Cover the necessary information for preoperative patients, including the preoperative teaching, the time of preoperative medications, completion of surgical checklists and the like


Accountability

• Guidelines• Give information about postoperative patients,

including the time of arrival from the operating or recovery room, general condition, vital signs, intravenous fluids required (e.g., kind, rate of flow, fluids to follow), dressings, voiding, diet, nature of breathing, coughing, and type, location, and patency of tubes


Characteristics of an Effective Team Leader

• Has skills in leadership, management, and supervisory techniques

• Communicates effectively, both orally and in writing

• Works well with others; shows that others’ input and suggestions are valued

• Understands how to build an effective team


Characteristics of an Effective Team Leader

• Strategies to build an effective team• Establish a clear purpose • Listen actively • Be compassionate • Be honest • Be flexible • Be committed to conflict resolution


The LPN as Charge Nurse

• Depends on LPN’s state nurse practice act • Common for LPNs in long-term care to fill this

role • Most states require that written protocols and

procedures be in place and that the LPN work under the general supervision of an RN


The LPN as Charge Nurse

• LPN must have adequate preparation to perform competently • Requires education, training, and/or experience

beyond the basic LPN educational program

• LPN must assign patient care, assess patients, delegate tasks (as permitted by state law), receive and give shift reports, and handle common workplace issues

Documents

1Elsevier items and derived items © 2007 by Saunders, an imprint of Elsevier, Inc. Chapter 4 The Leadership Role of the Licensed Practical Nurse