Chapter 1 Nursing Leadership & Management – Flashcards
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is about controlling complexity in an effort to bring order and consistency. Planning and budgeting, organizing and staffing, problem solving, and controlling complexity to produce predictability and order.
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Management
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Caring, integrity, diversity, excellence.
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Leadership Values
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promoting health, healing, and hope in response to the human condition
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Caring
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respecting the dignity and moral wholeness of every person without conditions or limitation
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Integrity
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affirming the uniqueness of and differences among persons, ideas, values, and ethnicities
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Diversity
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creating and implementing transformative strategies with daring ingenuity
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Excellence
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Guiding vision, passion, and integrity.
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3 Fundamental Qualities of Effective Leaders
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Kurt Lewin, Iowa State University, Conveyed information about 3 leadership styles that are still widely recognized today. Autocratic, democratic, laissez-faire.
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Behavioral Approach
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involves centralized decision making, with the leader making decisions and using power to command and control others. Associated with high-performing groups, but close supervision necessary, and feelings of hostility often present.
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Autocratic Leadership
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is participatory, with authority delegated to others. To be influential, they use expert power and the power base afforded by having close, personal relationships. Engendered positive feelings in their groups, and performance was strong whether or not the leader was present.
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Democratic Leadership
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is passive and permissive and the leader defers decision making. Associated with low productivity and feelings of frustration.
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Laissez-Faire Leadership
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Effective leadership described as having focus on the human needs of subordinates
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Employee-Centered Leadership
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Seen as less effective leadership because of their focus on schedules, cost, and efficiency resulting in lack of attention to developing work groups and high performance goals.
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Job-Centered Leadership
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involves emphasis on the work to be done, a focus on the task, and production.
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Initiating Structure
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involves activities that focus on the employee and emphasize relating and getting along with people.
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Consideration
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high initiating structure and high consideration leadership behaviors
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Best Leadership Style
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Low production concern and low people concern
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Impoverished Leader
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high production concern and low people concern
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Authority Compliance Leader
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high people concern and low production concern
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Country Club Leader
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moderate people and production concern
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Middle-of-the-Road Leader
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high production concern and high people concern
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Team Leader
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acknowledges that other factors in the environment influence outcomes as much a leadership style and that leader effectiveness depends upon something other than the leader's behavior.
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Contingency Theory
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This theory of leadership effectiveness views the pattern of leader behavior as dependent upon the interaction of the personality of the leader and the needs of the situation.
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Fielder's Contingency Theory
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The feelings and attitudes of the followers regarding acceptance, trust, and credibility of the leader.
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Leader-Member Relations
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Exists when followers respect, trust, and have confidence in the leader.
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Good Leader-Member Relations
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Reflect distrust, a lack of confidence and respect, and dissatisfaction with the leader by the followers.
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Poor Leader-Member Relations
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Refers to the degree to which work is defined, with specific procedures, explicit directions, and goals.
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Task Structure
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Involves routine, predictable, clearly defined tasks.
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High Task Structure
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Involves work that is not routine, predictable, or clearly defined, such as creative, artistic, or qualitative research activities.
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Low Task Structure
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The degree of formal authority and influence associated with the leader.
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Position Power
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A favorable leader
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High Position Power
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An unfavorable leader.
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Low Position Power
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Addresses follower characteristics in relation to effective leader behavior. Consider follower readiness as a factor in determining leadership style using task behavior and relationship behavior. An additional aspect of this model is the idea that the leader not only changes the leadership style according to followers' needs but also develops followers over time to increase their level of maturity.
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Hersey & Blanchard's Situational Theory
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High task behavior and low relationship behavior
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Telling Leadership Style
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High task behavior and high relationship style
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Selling Leadership Style
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Low task and high relationship style
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Participating Leadership Style
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Low task and low relationship style
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Delegating Leadership Style
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(Robert House) The leader works to motivate followers and influence goal accomplishment. By using the appropriate leadership style for the situation, the leader makes the path toward the goal easier for the follower.
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Path-Goal Theory
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provides structure through direction and authority, with the leader focusing on the task and getting the job done
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Directive Style of Leadership
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relationship oriented, with the leader providing encouragement, interest, and attention.
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Supportive Style of Leadership
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the leader focuses on involving followers in the decision making process.
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Participative Leadership
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provides high structure and direction as well as high support through consideration behavior.
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Achievement-Oriented Style of Leadership
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variables that may influence followers to the same extent as the leader's behavior.
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Substitutes for Leadership
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Experience may serve as a substitute for leadership. True or False?
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True
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address the leadership functions necessary to develop learning organizations.
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Contemporary Approaches to Leadership
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These leaders have an inspirational quality that promotes an emotional connection from followers. They display self-confidence, have strength in their convictions, and communicate high expectations and their confidence in others. One consequence of this type of leadership is a belief in the leader is so strong that it takes on an almost supernatural purpose, and the leader is worshipped as if superhuman. Such as Florence Nightingale or Martin Luther King.
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Charismatic Theory
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(Burns) A process in which "leaders and followers raise one another to higher levels of motivation and morality." Based on the idea of empowering others to engage in pursing a collective purpose by working together to achieve a vision of a preferred future.
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Transformational Leadership Theory
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the traditional manager concerned with day-to-day operations
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Transactional Leader
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the leader who is committed to a vision that empowers others. Motivates others by behaving in accordance with values, providing a vision that reflects mutual values, and empowering others to contribute. "Commits people to action, who converts followers into leaders, and who converts leaders into agents of change."
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Transformational Leader
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-Focuses on management tasks -Is a caretaker -Uses trade-offs to meet goals -Does not identify shared values -Examines causes -Uses contingency reward -Task oriented -Concerned with the day to day operation
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Transactional Leader
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-Committed to a vision that inspires others -Long-term vision that reflects mutual values -Empowers & motivates others to contribute -Change agent, courageous, believes in people, value driven, ability to deal with complexity, ambiguity and uncertainty -Not defined by a position -Empowers others -Needed to cause change
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Transformational Leader
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-1970's, Robert Greenleaf -Wanting to put needs of others above all else as #1 priority -Characteristics: listening, empathy, healing, awareness, persuasion, foresight, stewardship, growth, and building community -Demotes self for the benefit of others -Not a weak form of leadership -Ex: Woody from Toy Story
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Servant Leadership
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Example of someone who is a servant and a leader
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Nurses
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includes the management of something entrusted to one's care
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Stewardship
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people who bring specialized, expert knowledge to an organization. They are valued for what they know.
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Knowledge Workers
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refers to the ability to change skill sets as well as having the work dispersed among a variety of work locations, rather than work occurring at fixed sites.
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Mobility
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working through virtual means using digital networks, where the worker may be far from the patient but present in digital reality.
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Virtuality
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the individual, at a time when digital mediums have given us more access to information and therefore more choices, acts more independently and is increasingly accountable for for those choices and actions.
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User-Driven Practices
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-recognize even subtle changes in patient's conditions -anticipate patient care problems -intervene appropriately to minimize/avoid complications
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How nurses use knowledge
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Have the right type & right number of personnel
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How nurse managers use knowledge
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-a component of leadership and refers to the capacity to recognize your own feelings and those of others, for motivating yourself, and for managing emotions well in yourself and in your relationships. -Complementary to academic intelligence.
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Emotional Intelligence
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-Includes 5 basic emotional and social competencies: -Self-awareness -Self-regulation -Motivation -Empathy -Social skills -Important component used to guide decision making
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Emotional Intelligence 4 competencies
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-knowing what you are feeling in the moment and using your preferences to guide your decision making -having a realistic assessment of your own abilities and a well grounded sense of self-confidence.
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Self-Awareness
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-Handling your emotions so that they facilitate rather than interfere with the task at hand -Being conscientious and delaying gratification to peruse goals -Recovering well from emotional distress
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Self-Regulation
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Using your deepest preferences to move and guide you toward your goals, to help you take initiative and strive to improve, and to persevere in the face of set backs and frustration
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Motivation
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-Sensing what people are feeling -Being able to take their perspectives -Cultivating rapport and being in tune with a broad diversity of people.
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Empathy
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-Handling emotions in relationships well and accurately reading social situations and networks -Interacting smoothly -Using these skills to persuade and lead and negotiate and settle disputes -For cooperation and teamwork
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Social skills
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-Margaret Wheatly (1999) -The leader's function is to guide an organization using vision, to make choices based on mutual values, and to engage in the culture to provide meaning and coherence. -This type of leadership fosters growth within each of us as individuals and as a member of the group. -Humans learn best when they are engaged in relationships with others and can exchange knowledge and expertise through informal, self organized communities. -Communities of Practice
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The New Leadership
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-Informal, self-organized communities that use a group process of organizing, principles of learning, and sharing information -Allows the creation of meaning from information or the exchange of knowledge -A way to develop new leaders -Emerge from shared activity, shared knowledge, and ways of knowing that create meaning and thus a culture of engagement, participation, and and relationships.
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Communities of Practice
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A process of coordinating actions and allocating resources to achieve organizational goals.
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Management
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-Planning, organizing & staffing, leading and controlling actions to achieve goals -Daily activities are diverse, fast-paced, and full of interruptions -Ability to set priorities, make decisions and interact with others is key -Very operational
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Management
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involves setting goals and identifying ways to meet them
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Planning
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Process of ensuring that the necessary human and physical resources are available to achieve the planning goals. -Assigning work to the right person or group and specifying who has the authority to accomplish certain tasks
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Organizing and Staffing
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-Entrepreneur, disturbance handler, allocator of resources, and negotiator -Use by managers to take action when making decisions
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Decisional Roles
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influencing others to achieve the organization's goals and involves energizing, directing, and persuading others to achieve those goals
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Leading
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Comparing actual performance to a standard ad revising the original plan as needed to achieve the goals
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Controlling
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a system that orders principles into a grouping or classification
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Taxonomy
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Includes behaviors, expectations, and recurrent activities within a pattern that is part of the organization's structure -Information processing -Interpersonal -Decisional
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Managerial Roles
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-Monitor, disseminator and acting as spokesperson -Each of which is used to mange the information needs that people have
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Information Processing Roles
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Figurehead, leaders and liaison to manage relationships with people -Used to manage relationships with people
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Interpersonal Roles
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-Art of accomplishing things through people -Includes planning, organizing, coordinating, and controlling -How managers spend their time on particular roles or functions varies by the level of their positions in the organizations -First-level -Mid-level -Executive level
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Managerial Process
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-the nurse-manager at the clinical bedside -spend the majority of the time directly managing patient care and supervising others as they deliver care. the next highest percentage of their time is spent planning and the remainder of their functions take 10% or less of their time. -charge nurse
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First-Level
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-Often called nursing unit managers or directors -Spend less time in direct supervision and more tim ein managerial roles or functions, particularly planning and coordinating
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Mid-Level
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-Highest level of the organization -Planning and being a generalist are greatly expanded role functions -Direct supervision is not a major job assignment -Chief Nurse Executive or Vice President of Patient Care Services
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Executive level
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-Human resources -Financial resources -Physical resources -Information resources
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Managerial Resources
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Ex: Having the right staff on the healthcare team to complete various assignments.
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Human Resources
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Managers must use these wisely to achieve organizational goals
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Financial Resources
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Ex: Patient care equipment used to complete work.
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Physical Resources
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These keep managers up to date in delivering care to their patients. Ex: EBP Nursing
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Information Resources
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-*Scientific Management -*Bureaucratic Management -*Human Relations -Contingency -Resource Dependence -*Strategic Management -Population Ecology -Institutional -Social Network -Complex Adaptive Systems
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Management Theories
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-Fredrick Taylor considered the "father" of this -Principles of Scientific Management (1911) -Used the scientific method -Focused his activity on the on the operations within an organization by exploring production at the worker level -Focused on productivity and goals -Viewed the organization as a machine to be run efficiently to increase production -Selects the right person to do job; provides the proper tools, training, and equipment to work efficiently -Uses time and motion studies to make work efficient
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Scientific Management
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-Max Weber -Hierarchical superior subordinate communication transmitted from top to bottom via clear chain of command -Merit/skill as basis for promotion and/or reward -Uses rules and regulations -Focuses on technical competence -Limits personal freedom -Emphasizes career service, salaried managers.
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Bureaucratic Management
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Focuses on empowerment of the individual worker as the source of control, motivation, and productivity in meeting the organizations goals -Hawthorne Experiments - -Hawthorne Effect -Emphasizes that participatory decision making increases worker autonomy and provides training to improve work
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Human Relations
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Western Electric Plant in Chicago led to the belief that relations between workers and managers and among workers are the main determinants of efficiency. -Also concluded that the effect of being watched and receiving special attention could alter a person's behavior.
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Hawthorne Experiments
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The phenomena of being observed or studied, resulting in changes in behavior -"Social facilitation" -the idea that people increase their work output in the presence of others
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Hawthorne Effect
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-Emphasizes fit or alignment between the organization's strategy, external environment, and internal structure and capability -Links quality improvement efforts to core strategies and capabilities of the organization to meet organizational needs
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Strategic Management
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-Whatever influences peoples' choices and creates direction, intensity, and persistence in behavior -Process that occurs internally to influence and direct behavior in order to satisfy needs -Help leaders to lead efficiently
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Motivation
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-Worker output is greater when the worker is treated humanistically. -Helpful to explain why people act the way they do and how nurse managers can relate to individuals as human beings and workers -Considered alongside management theories
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Motivation Theories
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Define motivation in terms of satisfaction of needs -Maslow's, Herzberg's two-factor theory, Theory X, Theory Y, Theory Z
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Content Motivation Theories
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Define motivation in terms or rational cognitive processes -Expectancy theory and Equity theory
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Process Motivation Theories
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Motivation occurs when needs are not met. Certain needs have to be met first, beginning with physiological needs, then safety and security needs, then social needs, followed by self-esteem needs, and then self-actualization needs. Needs at one level must be satisfied before one is motivated by needs at the next higher level of needs.
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Maslow's Hierarchy of Needs
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-Hygiene maintenance factors -Motivator factors
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Herzberg's Two Factor-Theory
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Include adequate salary status, job security, quality of supervision, safe and tolerable work conditions, and relationships with others
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Hygiene-Maintenance Factors
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can be sources of job dissatisfaction,
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Hygiene-Maintenance Factors:Absent
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Job dissatisfaction can be avoided, but this alone will not lead to job satisfaction
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Hygiene-Maintenance Factors:Present
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include satisfying and meaningful work, development and advancement opportunities, and responsibility and recognition. -Important to recognize that not al lpeople respond to the same ones.
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Motivator Factors
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People are motivated and satisfied with their job
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Motivator Factors: Present
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People have neutral attitudes about their jobs or organizations
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Motivator Factor: Absent
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-Leaders must direct and control because motivation results from reward and punishment. -Employees prefer security, direction, and minimal responsibility and they need coercion and threats to get the job done. -Employees are unable to offer creative solutions to help the organization advance.
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Theory X
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Leaders must remove work obstacles because, under the right work conditions, workers have self-control and self-discipline. -The workers' rewards are their involvement in work and in the opportunities to be creative. -Employees are motivated by their ties to the group, the organization, and the work itself.
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Theory Y
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-Uses collective decision making, long-term employment, mentoring, holistic concern, and use of quality circles to manage service and equality -This is a humanistic style of motivation based on the study of Japanese organizations.
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Theory Z
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-Centers around what people want and thier prospect of getting it. -Can be demonstrated in the form of an equation. This theory proposes that this equation can help to predict the motivation, or force, of an individual to achieve a goal as negative, neutral, or positive. -Has 3 variables that are subdivided into 3 indicators: -Force, Valence, and Expectancy
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Vroom's Expectancy Theory
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describes the amount of effort one will exert to reach one's goal
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Force
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-speaks to the level of attractiveness or unattractiveness of the goal (+1= highly attractive, -1=highly unattractive, 0= goal does not interest the individual)
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Valence
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-the perceived possibility that that the goal can be achieved. (1= assurance goals will be achieved, 0=individual sees the goal as impossible to achieve)
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Expectancy
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Force= Valence x Expectancy
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Vroom's Expectancy Equation
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- Focuses on a better way of motivating people through their involvement. - Humanistic style based on Japanese companies - Uses collective decision making, long term employment, mentoring, holistic concern
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Theory Z
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-Bring crises -Undermine morale -Decrease productivity -Create conflict
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VIctim of Change
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-Improvement -Raise morale -Increase productivity -Meet patient and employee needs effectively
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Manager of Change
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Object is to gain control of the forces of change in your organization, work environment and life.
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Handling Change
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-the person who leads and manages the change -Ultimately responsible for the success (or failure) of the change project -Manage the dynamics of the change process -MUST maintain communication, momentum and enthusiasm while still managing the process
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Importance of the Change Agent
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-Lewin's Force-Field Model (1951) -Lippitt's Phases of Change (1958) -Havelock's Six-Step Change Model (1973) -Roger's Diffusion Model (1983)
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Traditional Change Theories
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Involve the right people. Start small then expand. -Unfreeze -Move -Refreeze
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Lewin's Force-Field Model
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-Built on Lewin's model -Emphasizes the participation of key personnel & change agent in designing and planning change -Emphasizes communication 1.Diagnose problem 2.Assess motivation and capacity for change 3.Assess change agent's motivation and resources 4.Select progressive change objectives 5.Choose appropriate role of change agent 6.Maintain change 7.Terminate helping relationship
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Lippitt's Phases of Change
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...
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Havelock's Six-Step Change Model
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Roger's Diffusion Model
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-Brainstorm to produce a list of all driving and restraining forces. -Estimate the strength of each force. -Note the most important forces, then research and analyze them. -List and document possible responses or actions that might strengthen each important driving force or weaken each important restraining force.
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Force Field Analysis
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What will cause change to happen
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Driving forces
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What will keep change from happening
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Restraining forces
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-Prevalent in healthcare organizations -Organizations must be able to organize and implement change quickly and forcefully -Little time for orderly linear change Ex: Changing to 12 hour shifts at the hospitals
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Chaos Theory
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-Purposeful and intentional. -There are specific reasons or goals prompting change. -To solve a problem -To improve efficiency -To reduce unnecessary workload for some group -The change is by design, not by default.
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Planned Change
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-Recognize Symptoms -Diagnoise Need -Look for Alternative Solutions (Listen to nay-sayers) -Select Change -Plan Change -Implement Change -Evaluate Change
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Planned Change Model
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Similar to the nursing process -Identify problem or opportunity -Collect data -Plan the change -Implement the Change -Evaluate the Change -Stabilize the change
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The Change Process
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-Select people to carry out the change plan -Design a method to evaluate the outcome -Anticipate resistance to the change -Develop strategies to manage resistance -Design a plan to stabilize the change
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Plan the Change
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-Clear understanding (and preparation) of the change to take place -What to expect, -The meaning of the change, and -What is required of the client system in adapting to the change. -Pilot study -Iron out problems -Less threatening -"Sell" the rest of the client system on the idea
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Implement the Change
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-Analyze each objective -Was it met? -What evidence shows that it was met? -Was the best means used to accomplish it, or would another method have worked better? -Adjustments are made if needed
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Evaluate the Change
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-Reinforcement -Two-way communication -Follow-up
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Stabilize the Change
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D. planning, organizing, coordinating, and controlling
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1. Management is a process that is used today by nurses or nurse managers in health care organizations and is best described as A. scientific management B. decision making C. commanding and controlling others using hierarchical authority D. planning, organizing, coordinating, and controlling
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B. are able to contribute to decisions about getting the work done
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2. A participative leadership style is appropriate for employees who A. are not able to get the task done and are less mature B. are able to contribute to decisions about getting the work done C. are unable and unwilling to participate D. need direction, structure, and authority
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B. Nurses use self-direction and self-control to achieve work objectives in which they believe
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3. If you applied the concepts of Theory Y to describe nurses, which of the following statements would be the best descriptions? A. Nurses prefer to be directed and want job security more than other things B. Nurses use self-direction and self-control to achieve work objectives in which they believe. C. Nurses have a hard time accepting responsibility, but they learn this over time. D. Nurses don't really want to work and would quit if they could.
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A. The organization recognizes and rewards those nurses who advance their education and achieve certification such as the CCRN certification for critical care RNs
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4. Nurse retention is an important focus for health care organizations as we face a growing shortage of health care professionals in the future. According to Herzberg's motivation factors, which of the following would most likely contribute to increased job satisfaction? A. the organization recognizes and rewards those nurses who advance their education and achieve certification such as the CCRN certification for critical care RNs. B. Hiring bonuses of up to $5,000 are given to nurses to reduce the vacant positions and prevent short-staffing C. Nurse managers place an emphasis on establishing effective relationships with the nurses who work for them. D. Salary is increased.
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B. Professional nursing standards, code of ethics, and the intrinsic reward you get from this important work.
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5. Consider your role as a staff nurse in a patient care unit of a hospital. What factors are present that may serve as a substitute for your need for leadership for your nurse manager? A. Your desire for a promotion and an increase in pay. B. Professional nursing standards, code of ethics, and the intrinsic reward you get from this important work. C. Your manager spends time telling you exactly what to do and how to do it. D. Your nurse manager is inspiring and highly motivating to work for.
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B. a process of interaction in which the leader influences others toward goal achievement.
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6. Leadership is defined as A. being in a leadership position with authority to exert control and power over subordinates. B. a process of interaction in which the leader influences others toward goal achievement. C. managing complexity. D. being self-confident and democratic.
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