Chapter 10 Leading, Managing, and delegating Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Power • Explicit: power by virtue of position • Implied: power due to other factors, such as personality Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Tell whether the following statement is true or false. A good example of explicit power is a class bully who gets his way by intimidating his classmates. A. True B. False Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer Answer: B. False Rationale: A good example of implied power is a class bully who gets his way by intimidating his classmates. Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Qualities • Charismatic • Dynamic • Enthusiastic • Poised • Confident • Self-directed • Flexible • Knowledgeable • Politically aware Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Tell whether the following statement is true or false. It is increasingly difficult for the nurse manager to be both a clinical and managerial expert. A. True B. False Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer Answer: A. True Rationale: It is increasingly difficult for the nurse manager to be both a clinical and managerial expert. Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Skills • Commitment to excellence • Problem-solving skills • Commitment to and passion for one’s work • Trustworthiness and integrity • Respectfulness • Accessibility • Empathy and caring • Responsibility to enhance personal growth of all staff Copyright © 2015 Wolters Kluwer • All Rights Reserved Achieving Self-Knowledge • Identify your strengths. • Evaluate how you accomplish work. • Clarify your values. • Determine where you belong and what you can contribute. • Assume responsibility for relationships. Copyright © 2015 Wolters Kluwer • All Rights Reserved Leadership Styles • Autocratic • Democratic • Laissez-faire • Quantum [has theory to follow… wholes came out of parts] • Transactional [promote compliance through rewards and punishments. Can only keep followers motivated/compliant for a short-term.] • Transformational Copyright © 2015 Wolters Kluwer • All Rights Reserved Question Which style of leadership describes a nurse leader who assumes control over the decisions and activities of the group? A. Autocratic leadership B. Democratic leadership C. Laissez-faire leadership D. Transformational leadership Copyright © 2015 Wolters Kluwer • All Rights Reserved Answer Answer: A. Autocratic leadership Rationale: Autocratic leadership involves a firm, insistent, self-assured leader who keeps at the center of attention. Democratic leadership is characterized by a sense of equality among the leader and other participants. In laissez-faire leadership, the leader relinquishes power to the group. Transformational leadership can create revolutionary change instituted by charismatic leaders. Copyright © 2015 Wolters Kluwer • All Rights Reserved Role of Nurse Manager • Planning • Organizing • Directing • Controlling Copyright © 2015 Wolters Kluwer • All Rights Reserved Management Structures • Centralized – Senior managers generally make decisions with little input from the group. • Decentralized – Decisions are made by those who are most knowledgeable about the issues being decided. – Nurses are thus intimately involved in decisions concerning patient care. Copyright © 2015 Wolters Kluwer • All Rights Reserved Factors Prompting Change in Health Care Industry • Increased number of chronically ill and older people • Increased role of government and industry in health care • Rising cost of health care • Changing patterns of health care delivery Copyright © 2015 Wolters Kluwer • All Rights Reserved Conflict Resolution Strategies • Avoiding • Collaborating • Competing • Compromising • Cooperating/accommodating • Smoothing Copyright © 2015 Wolters Kluwer • All Rights Reserved Lewin’s Theory of Change • Unfreezing: The need for change is recognized. • Moving: Change is initiated after a careful process of planning. • Refreezing: Change becomes operational. Copyright © 2015 Wolters Kluwer • All Rights Reserved Considerations for Planned Change • What is amenable to change? • How does the group function as a unit? • Is the group ready for change and at what rate? • Are the changes major or minor? Copyright © 2015 Wolters Kluwer • All Rights Reserved Planned Change: An Eight-Step Process • Recognize symptoms that indicate a change is needed and collect data. • Identify a problem to be solved through change. • Determine/analyze alternative solutions to the problem. • Select a course of action from possible alternatives. • Plan for making the change. • Implement the selected course of action to effect change. • Evaluate the effects of change. • Stabilize the change. Copyright © 2015 Wolters Kluwer • All Rights Reserved Reasons for Resistance to Change • Threat to self • Lack of understanding • Limited tolerance for change • Disagreements about the benefits of change • Fear of increased responsibility Copyright © 2015 Wolters Kluwer • All Rights Reserved Overcoming Resistance to Change • Explain proposed change to all affected. • List the advantages of the change. • Relate the change to the person’s existing beliefs and values. • Provide opportunities for open communication and feedback. • Indicate how change will be evaluated. • Introduce change gradually. • Provide incentives for commitment to change. Copyright © 2015 Wolters Kluwer • All Rights Reserved Steps for Using Time Effectively • Establish goals and priorities for each day. • Evaluate goals in terms of your ability to meet needs of patients. • Establish a time line. • Evaluate your success or failure in managing time. • Use these results to direct your next day’s priorities and time line. Copyright © 2015 Wolters Kluwer • All Rights Reserved A Student Reviews Time Management With Her Clinical Instructor Copyright © 2015 Wolters Kluwer • All Rights Reserved Factors Increasing the Power Base of Nursing • Right timing • Size of the nursing profession • Nursing’s referent power • Increasing knowledge base and education for nurses • Nursing’s unique perspective • Desire of consumers and providers for change Copyright © 2015 Wolters Kluwer • All Rights Reserved Evidence-Based Strategies to Improve Leadership Skills • Strive to become an authentic leader. • Develop leadership skills. • Promote a healthy work environment. • Engage staff to commit to their best effort at work. • Assist new graduates to transition into the RN roles. Copyright © 2015 Wolters Kluwer • All Rights Reserved Clinical Nurse Leader Role • Position was created by the American Association of Colleges of Nursing (AACN) as a leadership role. • The CNL works collaboratively with the health care team to facilitate, coordinate, and oversee patient care. • The CNL should be able to clearly communicate with other health care professionals, integrate evidence-based practices into patient care, and evaluate patient risks and outcomes. • The person-centered focus of the CNL role includes functioning as a patient advocate, educator, and provider of patient care in complex situations. Copyright © 2015 Wolters Kluwer • All Rights Reserved Considerations When Delegating Nursing Care… UAP • Patient’s condition • Complexity of the activity • Potential for harm • Degree of problem solving and innovation necessary • Level of interaction required with the patient • Capabilities of the UAP • Availability of professional staff to accomplish workload Copyright © 2015 Wolters Kluwer • All Rights Reserved ANA Principles for Delegating Care • The nursing profession determines the scope of nursing practice. • The nursing profession defines and supervises UAPs involved in providing direct nursing care. • The RN is responsible and accountable for nursing practice. • The RN supervises any assistant providing direct patient care. • The purpose of UAP is to work in supportive role to the RN. Copyright © 2015 Wolters Kluwer • All Rights Reserved Factors to Consider Prior to Delegating Patient Care • Qualifications and capabilities of the UAP • Stability of the patient condition • Complexity of the activity to be delegated • The potential for harm • The predictability of the outcome • The overall context of other patient needs Copyright © 2015 Wolters Kluwer • All Rights Reserved Developing Leadership Responsibilities • Mentorship • Preceptorship • Nursing organizations • Continuing education Copyright © 2015 Wolters Kluwer • All Rights Reserved The Nurse Preceptor Advises and Teaches by Example Copyright © 2015 Wolters Kluwer • All Rights Reserved
