UNIT 4 Leadership Styles and Management Gordons Functional Health Pattern Roles and Relationships

UNIT 4

Leadership Styles and Management

Gordons Functional Health Pattern Roles and Relationships

Leadership style and managementObjectives:– Discuss the theories of management/motivational styles– Discuss the styles / types of leadership– Compare the types of nursing care delivery systems– Define efficient and effective– Describe 4 categories of client care priorities– Discuss the principles of work organization– Discuss the delegation of nursing tasks– Describe methods of effective communication, when

interrelating with clients, significant others and health team members

– Describe the change of shift report

Leadership Styles & Management• Required readings:

– Smeltzer & Bare: Chapter 1, 3– -Zerwekh: Chapters 10,11,13,14,& 15– CDROM (available in the Nursing Skills Lab)--

Clinical Delegation & Nursing Roles (Graphic Education Corp. 1997)

*****Do Case Studies at the End of this Unit Syllabus Before Class

Leadership Styles & Management

• Roles of nurses: nursing is a service provided to individual clients & to aggregates of people (families, groups, communities, population).– Roles overlap but must be distinguish.– Nurses providers of direct care, educators, & managers

• Nursing management vs. nursing leadership– Nursing management – for team of patients

• Coordinator of human & material resources in providing care to patients

– Nursing leadership – process with 4 components:• Decision making, relating, influencing, & facilitating

Leadership Styles & Management• Leadership defined:

– Is the ability to influence other people– Steven Covey – enables people to work more

effectively together in a state of interdependence– 3 elements in definition: influence, groups & goal– Effective nurse leaders inspire others to work

together to pursue a shared goal• Pt care; cost-saving procedures

Leadership Styles & Management• Management Defined

– S. Covey states effective managers are able to elicit from employees “creativity, consistent excellent productivity & maximum potential contribution toward….continuous improvement of process, product & service.”

• Comparison of Leadership & Management– Management: formal authority to direct the work of

a given set of employees, & responsible for quality of work & costs

• Effective manager needs to be good leader• Reverse need not be true – you do not need to be a

manager to be a leader

Leadership Styles & Management• Theories of management/ motivational styles

– Maslow’s• Workers have a hierarchy of needs that drive them to

make choices in a predictable manner

– Theory X• Employees avoid work because they dislike it• The manager must control, direct, coerce & threaten

employees to get them to strive toward organizational goals.

• Employees lack ambition and prefer to be directed


• Theory Y– Employees do not dislike work and remain

committed to goals– Employees seek & accept responsibility, are self-

motivated and are innovative in solving job-rlated problems

• Theory A– Predominantly downward communication pattern– Individual decision making– Rapid evaluation & promotion


• Theory Z– Long term employment– Open communication patterns– Harmonious work group or consensus decision

making– Slow evaluation & promotion

• Situational leadership– Incorporates the needs of the work group & their

responses to the tasks to be done


• Styles/ types of Leadership– Authoritarian (autocratic, direct, controlling)

• Orders given; makes decisions for everyone in group; responsible for the outcome; efficient; stifles creativity; may be punitive or benign, closed system

– Laissez-faire (permissive, non-direct)• Ultra liberal, lack of central direction or control; permissive

system

– Democratic (participative)• People oriented; mutual responsiveness to meeting group

goals with work-related decisions made by the group; fosters creativity; open system


• Transformational Leadership: qualities– Communicate vision, have a sense of mission,

has effective leadership qualities: integrity, courage, initiative, energy, optimism can remotivate a discouraged group; “being a winner rather than a whiner”; perseverance, balance in their lives; ability to handle stress

– Behaviors:think critically; identify & solve problems (client, staff, paperwork problems), respect others; good communication skills (listening to others, encouraging info exchange)


• Followers– Effective followers – demonstrates self-

management skills, commitment to the agency’s mission & goals, develops competence useful to the organization; independent thinkers; trust their own knowledge and judgment; insightful & expresses concerns to superiors

– Nonproductive follower – • Appliance nurse – in it for the money• Doomseyer – that can’t possibly work• Subversive – plots to defeat• Accommodator – always agrees

Types of Nursing Care Delivery System Functional Nursing – the charge nurse makes assignments and gives

directions to all nursing personnel assigned to the nursing unit; the primary purpose is to accomplish tasks with the greatest efficiency making personal attention to client needs difficult.

Advantages- Client care is provided in an economic and efficient manner- Minimum number of RNs are required for client care- Tasks are completed quickly and there is little confusion about job

responsibilities- Cost effective and less staffingDisadvantages- Care may be fragmented, possibly overlooking priority client needs- Clients may feel confused because of the many different care providers- Caregivers may feel unchallenged and understimulated in performing

repetitive functions.

Types of Nursing Care Delivery System

• Total Care – One nurse is responsible for planning, organizing and delivery of care to a particular client or group of clients during the assigned shift.Advantages

- The nurse maintains a high degree of practice autonomy- Lines of responsibility and accountability are clear- Clients should receive holistic, unfragmanted care- Clients assignment process is simple and direct.

Disadvantages- Continuity of care may suffer because each nurse has

the right to modify the care plan and client may get different approaches to care

- costly


• Team Leading- an RN leads a group of health care personnel in providing care for a group of 10-20 clients during the shift.

Advantages- Emphasizes holistic care, high quality comprehensive

care can be provided with a relatively high proportion of ancillary staff

- Each team is able to participate in decision making an d problem solving

- Each team member is able to contribute their own special expertise or skills caring for the client

Disadvantages- Time consuming, may cause undue workload and stress

for team leader- Continuity of care may suffer if daily assignment of team

varies and client is exposed to many different caregivers.


• Primary Nursing – an RN assumes 24 hour responsibility for planning, directing, and evaluating client care from the time of admission through discharge

Advantages- Care provided by a few nurses allows for high quality, holistic client

care, increased client satisfaction, increased rapport with RN, increased accountability, high job satisfaction (nurses have a high degree of autonomy and feel rewarded & challenged)

Disadvantages- Expensive, needs large number of RNs- May be difficulty to recruit and train large number of RNs- Inadequately prepared nursed may not make necessary clinical

decisions or communicate effectively with the health care team- The RN may no be willing to accept 24 hour responsibility – RN

“emotional burn out”


• Case Management – a model of care delivery, the nurse case manager assesses, plans, implements, coordinates, monitors and evaluates client care options and services to meet health care needs

Advantages- Maintains quality care while streamlining costs- Client outcomes should be achieved within a specific

time frame- Clients are linked to appropriate recourses and

coordinating service providersDisadvantages- The nurse may have a large case load- Monitoring of health expenses may be more important

than quality of care


• Client-Focused Care – services and staff are organized around clients’ needs rather than hospital or a department orientation

Advantages- Client comes into contacts with fewer workers- The workers are unit-based and able to spend more time in direct

care than in transit between client care areas- RNs functions at a high level because of being accountable for a

wider range of services to the client – expertise care- Cost productive- Increase in client, staff, and physician satisfactionDisadvantages- Major change is required in the health organization and health team

members- Departments and nursing may have difficulty accepting shared tasks- An increase in training, staff stress.

Effective & Efficient

• Effective – doing the right things- Depends on the nurses assessment and

analysis of client needs – involves critical thinking

Efficient – doing things right- Depends on the nurses work organization and

ability to complete nursing activities smoothly without excessive effort, time or resources

- Nurse provides client care without wasting time, equipment, supplies or effort.

Categories of Client Care

• 1st – immediate threat

• 2nd – actual problem the client/family have requested immediate help

• 3rd – actual or potential problems unrecognized by client/family

• 4th – future anticipated actual or potential problems

Principles of Work Organization• Determine the short-term and long-term

goals of assigned clients

• Make a “things to do” list

• Time estimation

• Set limits

• Eliminate unnecessary steps

• Plan for the unexpected

Legal Aspects of Client Care

• Accountability

• Charting

• Incident report

• Antidotal notes

Leadership Styles & Management• Components of effective communication

– Information giving is not communication– The sender is responsible for clarity– Use simple & exact language– Encourage feedback– The sender must have credibility– Acknowledging the contributions of others is

essential– Direct channels of communication are best

Delegation of Client Care• Delegation: entrusting the performance of selected

nursing tasks to competent persons in selected situations “the transfer of responbility for the performance of an activity from one individual to another while retaining accountability for the outcome” (ANA, 1992).– Accountability for the task/process remains with the

delegator.– Direct delegation = “verbal direction by the RN delegator

regarding an activity or task in a specific nursing situation”– Indirect delegation = “ an approved list of activities or tasks

that have been established in policies & procedures of the health care institution or facility”

Delegation of Client Care• Delegation to unlicensed assistant personel (UAP’s)

– Individuals who are trained to function in assistive role to the RN in providing care to the clients as delegated & supervised by the RN

• Vital signs, bathing, making beds, transportation

• Supervision – is more direct, overseeing the work• Chain of command• Nursing Process & Delegation:

– Assessment: must assess each client’s needs, set specific client goals, and match skills to assigned patients

– Plan: align staff to patients which are best suited, with knowledge & skill level to handle the patient – UAP’s, LVNs, RNs, RT/PT/PTA

– Implementation: assign tasks to appropriate person – Evaluation: nurse oversees & determines if clients needs have been

met

Delegation of Client Care• 5 rights of delegation:

– Right task– Right circumstance– Right person– Right direction/ communication– Right supervision/evaluation

Organize the workload – fairnessProcesses –Assess the clients’ needsGrasp the situation as a wholeDetermine what needs to be doneSubdivide the whole into manageable partsAssign tasks so that cooperation is reciprocal; high standards

of conduct and performances are maintained; sound decisions are made; team is assisted to grow; set goals.

Evaluate performance and reassess client

Communications• Establish a positive environmentNo hallway confrontations, no loud arguments in public

work areas, listen empathetically, pause to reflect, handle criticism, present your response frankly and assertively

• Effective communicationMore than just words – tone of voice, choice of words,

facial expressions, gestures – validate nonverbal cuesmust interchanges, try to understand otherscommon barrier – preconceived ideas, opinions and beliefs, abstract terms, lack of clarifications, use of persuasion.

• Deal with rumors.

Communications• Resolving Confilict

Learn to recognize and name a conflict, separate the person from the problem, use visual images to decrease anxiety, obtain and give information assertively, establish mutual goals, summarize what was agreed upon

Communications• Change of Shift ReportPurpose is to provide continuity of care1. Change of shift report should be:Comprehensive, descriptive, objective, factual, concise,

started on time, delivered in an organized manner.2. Change of shift report should include (but not limited to)

client’s demographics, expected outcomes, treatment plan, equipment, changes in condition with related nursing interventions, medications – response, tests & procedures/on past shift/orders for oncoming shift – including 8 or 12 hours orders reconfirmation by the oncoming and offgoing shift, mental status and activity level, teaching plan, discharge plan. Emphasis should be on reporting abnormal findings and results.

Communications• Change of shift report – should not

include:

Irrelevant vital sign, lab values, irrelevant stories, repeated information found on kardex and care plan, old information (what happened last week, unless relevent to present)

Documents

UNIT 4 Leadership Styles and Management Gordons Functional Health Pattern Roles and Relationships