Leadership and Management in Nursing – Test 2

Factors Contributing to Rising Costs
best health care in the world

longer life spans

prescription drugs

chronic health problems

anyone who uses interpersonal skills to influence others to accomplish a specific goal
an employee who is responsible and accountable to efficiently accomplishing the goals of the organization
functions of leaders
– achieve consensus within the group about goals

– maintain structure that facilitates accomplishing goals

– supply information that helps provide direction and clarification

– maintain group satisfaction, cohesion and performance

functions of managers
– clarify the organizational structure

– choose the means to achieve goals

– assign and coordinate tasks

– evaluate outcomes and provide feedback

formal leadership
practiced by a nurse with legitimate authority described in a job description
informal leader
exercised by a staff member who does not have a specified management role
functions of nurse managers


directing – the process of getting the organization’s work done

controlling – establishing standards of performance, measuring performance, evaluating performance, and providing feedback

leadership styles




American Organization for Nurse Executives (AONE) Core Competencies

– communication and relationship management
– professionalism
– business skills and principles
– knowledge of health care environment

Nursing Roles
Staff Nurse
Charge Nurse
First-Level Manager
Clinical Nurse Leader
– need followers to lead

– need followers to accomplish goals and help team succeed

– are followers too

– influence leaders
– vary from passive to active, dependent and uncritical, to independent and critical
– share qualities with leaders
Authentic Leaders
– connect to pressures of front-line staff
– are passionate about creating quality work environment
– generate energy to do the impossible
Emotional Leaders
– have emotional intelligence and social competence
– maintain positive environment
– emphasize the importance of emotions and relationships in success
4 generations work side by side
– traditionals
– baby boomers
– generation X
– millenials (generation Y)
the Nurse Manager
– balances the needs of administrators and employees

– functions as coach, teacher, and facilitator

– motivates and inspires others

Leadership involves influencing other people, usually in some type of group, to work toward the achievement of the group’s goals. Leaders hope others develop a sense of what’s important or a sense of direction and of purpose.
A manager has the formal authority to direct the work of a given set of employees and is formally responsible for the quality of that work and what it costs to do it. Leadership is an essential part of effective management.
Great Man Theory
– leader by birthright
– great leaders are born with ability to lead
– leadership cannot be developed
Trait Theory
Leadership exists as an attribute of a personality.

An individual is a leader if certain traits are exhibited.

Successful traits vary between situations, so no exhaustive trait list was produced.

Common Traits
honesty, trustworthiness, integrity, fair, skilled communicator, goal-oriented, dedicated, committed, hard working
Qualities of an Effective Leader
– communication – both verbal and non-verbal
– listening skills
– positive attitude

– clinical expertise – it is important to be able to assess the effectiveness of the work in terms of patient outcomes

Behaviors of an Effective Leader
Interpersonal: networking, conflict negotiation and resolution, employee development, and rewards and punishments
Task verse relationship: Lewin’s Behavioral Theories
– autocratic – made decisions alone

– directive controlling

– concerned with the task rather than the people

– participative, involves followers indecisions
– people or relationship oriented rather than the task
– focuses on Teamwork
– neither task nor relationship focused
– essentially lack of leadership
– usually results in low productivity and employee frustration
Contingency Theories – Fiedler
Assumes that group performance depends on:

1. Leadership style – task motivation and relationship motivation

2. Favorableness, determined by three factors: leader-member relations, task structure, and position power

Contingency Theory
– no single personality typifies a leader; traits differ according to the situation

– leadership is a relationship existing among people in a social situation, so a person could be leader in one situation and not in another

– relationship-motivated leaders are most effective in moderately favorable situations.

– task-motivated leaders are most effective at either end of the scale

Situational Leadership Theory
Situational theory:
– using different types of leadership styles after understanding all of the factors affecting the group
– consider the follower’s readiness and willingness to perform the assigned tasks
New Theory
– attention through vision
– meaning through communication
– trust through positioning
– deployment of self through positive self-regard and the Wallenda factor
Transformational Leadership
– leaders and followers have the same purpose, and help each other to better their performance.

– relies on cooperation and mutuality

– emphasis on outcome rather than the process

– endorsed by some leadership scholars

– studies exploring the effectiveness have either supported or showed no significant difference for transformational leadership

Connective Leadership
– based on research
– a multidimensional model
– focuses on *caring* in order to empower and instill confidence
– connects individuals to their goals, one another, the immediate group, and the larger network
Leadership Theory
– developed over time
– provides framework for understanding how to think about and enact skills
Leadership Development
– process of individual’s becoming a leader
– begins with an understanding of oneself
– aim is to produce an effective leader capable of using proper behavior according to the situation
Common Leader Personality Traits
– intelligence
– social sensitivity
– social participation
– communication skills – KEY
Leadership Behaviors Correspond to Leadership Style
– telling: what leader says goes
– selling: persuasion
– testing: leader consults group before finalizing
– consulting: leader asks group to form a solution to problem
– joining: leader acts as fellow member; whatever group says, goes
4 actions for leadership from Kouzes and Posner’s Transformational Leadership Survey
– model the way

– inspire a shared vision

– challenge the process

– encourage the heart

Transactional Leadership
– exchange between leader and follower
– frequently one sided – i need you to work christmas day and i will authorize you to have 3 days off
– work OT and i will give you next friday off
Process Model of Leadership
– requires application of theory to determine the best possible action
– summarizes essential factors that comprise a leadership decision
– identifies the elements considered to produce and appropriate, group-oriented, and measurable leadership action
Process Model of Leadership – Stage 1, Analysis and Problem Identification

(example – meal trays are coming up too late)

– categorizes elements of the problem
– provides framework to select the critical aspects from the broad organizational influences and the actual problem
– composed of the following variables: the event, the participants and their perception, the organization factors, interpersonal processes, and controlling forces
Process Model of Leadership – Stage 2, Determination of Action
– uses decision making after considering factors that contribute to the situation
– many alternatives should be considered (democratic leadership)
– weigh positive and negative aspects of all hypothetical outcomes
– select the solution with the greatest number of overall advantages
Process Model of Leadership – Stage 3, Evaluation of Action
– a judgment that determines with worth of the solution after action was taken based on established criteria
– aim to reduce subjectivity and increase objectivity through measurable data
– evaluation criteria should be compared in the framework of a variety of issues: the acceptability of action for a particular setting, the psychologic-social acceptance of the selected action, the effect on the quality of nursing care, the possible growth for the group implementing the plan, and the solution’s ability to maintain order
– established norms of expected conduct
– provide guidelines for care provided and professional responsibilities, level of excellence
– standards of nursing are usually classifed in one of three ways: structure, process, outcome
– predetermined elements, qualities, or characteristics
– used to measure the extent to which a standard is met
– used when criteria cannot be written because standers are immeasurable
– an outcome that in all probability demonstrate that standards were met
– received by meeting standards made by the Joint Commission
– traditionally focused its standard on quality concerns in order to improve the quality of care provided to the public
Structure Standards
– address the integrative mechanisms of an organization, such as, the environment, instrumentation, qualifications of personnel, job categorizations, number of staff, and committee configuration
– influenced by federal bodies
– for example, if an agency serves a person using Medicare as payment, the agency must meet Medicare regulations
Process Standards
– address nursing activities that nurses perform
– written statements that include: nursing actions of assessment, diagnosis, intervention, and evaluation
– emanate from patient needs
– can be found in documents from the American Nurses Association and specialty nursing organizations
Outcome Standards
– address the end results of client care
– patient-centered
– usually identified with process standards
– frequently written in terms of client’s behaviors
– example – a client’s regular cardiac rhythm indicated by the electrocardiogram strip
– an example of a structure standard
– reflects certain qualifications of an *individual* rather than of an agency
– credential to enhance one’s professional status
– voluntary for some specialities, but required for nurse practitioners
– requirements usually include three stipulations: written examination in a specific area of competence, active practice in the specialty, and re-certification at specified periods
American Nurse Credentialing Center
– exams in 37 specialized and advanced practice fields
– enables all qualified RNs to become certified in 5 specialty areas
1965, largest single payer in the U.S.
The Bennett Amendment
– established professional standards review organizations
– provided a review of medical care at institutions receiving federal reimbursement
– two purposes: utilization review, quality review
– unfortunately, no effect on medical effectiveness or control of costs
The National Health Planning and Resources Development Act of 1974
– purpose was to correct the poor distribution of health care facilities and personnel
– health care agencies were established
– focused on maintenance and quality health care through governmental regulation
The Social Security Act Amendments of 1983
– most significant impact of governmental regulation
– changed the way hospitals were reimbursed for Medicare clients
– attempted to limit cost increases in hospital health care
– reorganization of the Medical Trust Fund
– Introduction of DRGs, Diagnosis Related Groups
– utilization review and quality assessment have taken on new meanings
Clinical Practice Guidelines
– assist practitioners in the prevention, diagnosis, treatment, and management of clinical conditions
– provide the patterns of practice for a particular condition
– used for evaluating quality of care, implementing improvement strategies, and reducing cost of care
Relationship between Clinical Practice Guidelines and Outcome Standards
– interrelated
– following CPG will ensure normal outcome standards and positive client feedback
– carelessness or failure to act as a prudent person would ordinarily act under the same circumstances
– professional personnel are obligated to provide reasonable care to clients
– professional is liable
Conditions that Must be Met to claim injury due to negligence
– proof that the nurse owed a duty to the patient
– proof that failure to act properly would cause harm to the patient
– proof that the prevailing standard was not met
– proof that the injury directly resulted form the nurse’s actions
Nurse Practice Act
look at your state _ PA
Systems of nursing care delivery
– ways nurse manager can organize nurses’ work
Case Method
– earliest
– nurses assigned to give total care to each client and reported to the head nurse
– disadv – not all personnel were qualified to deliver all care and too many people reporting to head nurse
Function Method
– way to deal with multiply levels of caregivers
– care was provided by assignment of tasks, math than of clients
– each caregiver performed certain tasks in keeping with her education and experience
– Disadvantage – fragmentation of care, leads to reduction in quality of care and staff is dissatisfied
Team Nursing
– influx of post- WWII nurses and the head nurse’s overextended span of control
– teams consisted of: the senior prof nurse becoming the leader, RNs, LPNs, nurse aides and orderlies
– disadv:
Other types
Primary nursing – 24 hr accountability for patient but had help; the nurse had to be available for consult 24 hrs

Total patient care – primary nurses for each patient and associate nurse assigned – accountable for the hours you are at work…

Differentiated Practice – spoke to different education levels on a unit – work together, but BSN nurse had additional responsibilities

Partners in practice – constantly scheduled with partner…BSN with same LPN…manage patient workload together – every shift together

Case management – multidisciplinary team; mostly nurses are case managers, patients put into clinical pathways and they are tracked along timeline

Total quality management – data driven; whole hospital contributes to care of patient; facilitate changes toward quality care based on data; looks at entire system

Essential elements to consider when analyzing a management situation
external environment – what factors impact the current situation

missions and goals of org



management assessment guide
– the proper ratio must be assessed so a manager can mange the work and adequacy of the personnel and the resources to provide prepared employees
– after assessment, the managerial decision and plan can be made
– guide highlights essential variables to consider
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