The least favorable situation occurs when the leader is disliked, has an unstructured task, and has little position power. Among these characteristics, untrustworthiness is a fatal flaw, and insensitivity to others is a likely cause for ineffective leadership (Hersey et al., 2013). Clearly, leadership is a complex and multidimensional process. It is characterized by a concern for family, community, and culture. Hersey and colleagues (2013) emphasized the importance of the readiness of followers. Good RN to BSN programs explore leadership principles and how to implement them. Women tend to focus on process; men tend to focus on achievement and closure. Diagnosing and analyzing the five elements, Hersey and colleagues (2013) have done a thorough overview of leadership and organizational theory through the situational leadership school of thought. There are situational and contextual factors to consider when choosing a style. The laissez-faire style results in a decision, conscious or otherwise, to avoid interference and let events take their own course. Environmental or cultural differences also cause the leadership situation to vary. 877-588-2429877-588-2429 Submit the form below and we will help with your questions! Hersey and colleagues (2013) have done a thorough overview of leadership and organizational theory through the situational leadership school of thought. Because the style is based on noninterference, a clear decision may never be formulated. These are trials, tests, and transformative experiences that force leaders to question themselves and what matters and to hone their judgment. All five elements interact within any given leadership moment. Overlaid on the basic grid is a continuum of readiness ranging from low to high. Figure 1-1 shows how these components relate to one another. Leadership theory often is discussed separately from management theory. The focus on leadership as a crucial need arises from the impact of significant changes that have occurred in the organization, delivery, and financing of health care during this period of time that has been characterized as turbulent and tumultuous because of “waves of chaos.” Under such circumstances, nurses are challenged to respond with leadership. Followers expect that leaders will provide a sense of vision and a sense of direction with standards for achieving the group’s goals. For example, the goal of the organization may be to decrease costs or increase revenue. First, the nurse might undertake a leadership analysis to determine whether this group needs high-relationship behaviors. The personality styles of both superiors and subordinates have an influence on the situation, the work demands, and the amount of time and resources available. A profile of leadership don’ts includes untrustworthiness, insensitivity to others, aloofness, over-managing, abrasiveness, inability to think strategically or staff effectively, inability to build a team, and focusing on internal organizational politics (overly ambitious). Self-awareness is key to strategically using leadership styles. Hersey and colleagues (2013) identified a second approach to leadership research that focused on the measurement of attitudes or predispositions toward leader behavior. This may include such activities as arranging access to services, providing direct care, doing referrals, and supporting a patient’s family. This is fundamental to leadership and the work of nursing. Leaders may grow gradually out of a smoldering issue or erupt through a crisis event. These readiness levels can be matched with the corresponding leadership styles of level 1 with telling, level 2 with selling, level 3 with participating, and level 4 with delegating. By contrast, leadership approaches described by men tend to be influenced by the military and participating in team sports. Only gold members can continue reading. Leaders arise in a context, and they are said to be made, not born. Kotter (2001) noted that managers cope with complexity whereas leaders cope with change. Nursing management is a lot different than leadership. Different styles evoke variable responses in different situations. Some say leadership and management are two very different things. The basic needs are for leader self-awareness and knowledge of the group’s ability and willingness levels before examining the situational elements and choosing a leadership style. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), LEADERSHIP AND CARE MANAGEMENT DIFFERENTIATED. Grant (1994) noted that leadership, management, and professionalism have different but related meanings, as follows: There is always a relationship between leadership and management in nursing, Malby (1996) indicates that developing and fostering leadership competencies could direct nurse managers to think beyond tradition and to coordinate multidisciplinary dialogue which articulates the needs of the system and the patients whilst empowering employee. Motivating participation is a constant challenge. Clancy (2003) noted that leaders need to “consistently find the courage to hold true to their beliefs and convictions” (p. 128). The leadership courage continuum runs from “good coward” (cannot muster courage to make tough choices) to “reckless courage” (shoot from the hip). Chapter 1 Leadership can be understood as the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance. They suggest that “one of the most reliable indicators and predictors of true leadership is an individual’s ability to find meaning in negative events and to learn from even the most trying circumstances” (, The ability to engage others in shared meaning, A combination of hardiness and ability to grasp context, called “adaptive capacity”. Every nurse needs two critical skills to enhance professional practice. A third phase of leadership theories grew out of a group of contingency theories whose central idea was that organizational behavior is contingent on the situation or environment. With a shift to primary care and care coordination, the nurse’s care management role has become more prominent, needed, and valued. Please contact us. The leadership situation in a group that is knowledgeable and experienced in solving problems is very different from the leadership situation in a group that is not experienced at the task or at working together. Certain pressures influence the role of the manager and demand new skill sets to facilitate clinical work. On the other hand, in a staff meeting, an authoritarian leader may be ineffective with a group of professionals and would need to be flexible enough to switch to a democratic or laissez-faire style, depending on the circumstances. He classified group situational variables of leader-member relations, task structure, and position power into eight possible combinations, ranging from high to low on these three major variables. The AONE 2005 nurse executive competencies are described in the following five domains of skill: These are core to all leadership in all situations. Readiness has two aspects: ability and willingness. At the next level, the nurse manager concentrates on the day-to-day administration and coordination of services provided by a group of nurses. Human relations and teamwork are the focus. Team: This style promotes work accomplishment from committed people and interdependence through a common cause, leading to trust and respect. Nurses have two basic roles: care providers and care coordinators. Hersey and colleagues (2013) said that leadership styles are the consistent behavior patterns exhibited in influencing the activities of others by working with and through them, as perceived by those others. Drucker (1996) noted that effective leaders know the following four things: 1. Challenging the process: Leaders go beyond the status quo to search for opportunities, experiment, and take risks to achieve lofty goals. • Communication and relationship management If they do not know each other and the situation is politically charged, the nurse leader needs to help people become comfortable with each other. Job ability is based on the amount of past job experience, job knowledge, ability to solve problems, ability to take responsibility, and ability to meet deadlines. Decisions of policy are made solely by the leader who tends to dictate tasks and techniques to followers. There is a “gray area” in which the foci of their outcomes overlap. There is a difference between the role of authority and the exercise of leadership. The other part of readiness is psychological willingness, which means being willing to take responsibility and have a positive attitude toward accepting the obligation to complete a task. Styles should vary according to the appropriateness of the situation with reference to an evaluation of effectiveness. A nurse’s job is to lead and manage a hospital’s critical care area, which has serious morale problems. Some say leadership and management are two very different things. For example, Bennis and Nanus (1985) studied 90 chief executives from 1978 to 1983 and found that there were two key leadership traits. The challenge of the democratic style is to get people with different professional backgrounds, personal biases, and psychological needs together to focus on the problem and next action steps. If the delivery of nursing services involves the organization and coordination of complex activities in the human services realm, then both leadership and management are important elements. Fiedler’s Contingency Theory From an early awareness of the leader’s need to be concerned about both tasks and human relationships (output and people) sprang a long history of leadership theories that can be grouped as, In the trait approach, theorists have sought to understand leadership by examining the characteristics of leaders. The third dimension is the environment in which a leader operates and which interacts with the leader’s style. In Situational Leadership® theory,* leadership in groups is never a static circumstance. The leader should make the nurse feel good about his or her ability to accomplish a task, provide something of quality, and work with other people. Different styles evoke variable responses in different situations. Almost every issue or problem contains a communication aspect. A combination of hardiness and ability to grasp context, called “adaptive capacity”. Leadership theory began to move beyond a focus on traits to explore the concept of leadership styles. The trait approach has generated multiple lists of traits proposed to be essential to leadership. avoiding discussion of sensitive issues, and encouraging competition via winners and losers. The attitudinal approach measures attitudes toward leader behavior. Organizational culture and ethos also are important factors in the situation. The most favorable situation occurs with good leader-member relations, high task structure, and high position power. For this situation, the task-oriented leader is a more effective match between leader and job. Their Situational Leadership® is a synthesis of the interplay among task behavior, relationship behavior, and the readiness of the followers. An example of an unfavorable situation in nursing is the following: Hersey and colleagues (2013) combined ability and willingness into four levels of readiness. Hersey and colleagues (2013) defined management as the “process of working with and through individuals and groups and other resources (such as equipment, capital, and technology) to accomplish organizational goals” (p. 3). Certain pressures influence the role of the manager and demand new skill sets to facilitate clinical work. Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition via winners and losers. The leader shares responsibility with the followers by involving them in decision making. Level 4 is able and willing or confident. 2. To begin with, fundamentals of leadership are to believe in the vision and to … Leadership is defined here as the process of influencing people to accomplish goals. It includes achievement motivation, wanting to do well, persistence, a work attitude, and a sense of independence. ; Research Notes in each chapter summarize relevant nursing leadership and management studies and highlight practical applications of research findings. A leader may see the need to chart a course that is new or unknown, unpopular, or risky because it challenges those with vested interests who have much to lose. They are sets or clusters of behaviors used in the process of effecting leadership. These interpersonal relationship skills are crucial to the work of leadership. All rights reserved.) Impoverished: This style uses minimal effort to get the work done. Bennis (1994) made a strong argument for leadership, stating that quality of life depends on the quality of leaders. Obtaining the staff's insights on the priorities so the team will stay focused and its members will have a stake in the strategic plan. Once again, a task-oriented style is called for—challenging individuals by using the motivation they need to continue to produce. The Group Dynamics Studies highlighted goal achievement (similar to task) and group maintenance (similar to relationship) elements of leadership behavior (Cartwright & Zander, 1960). However, the depth and focus of care management roles and skills may vary by level. It can be part of a formal organizational managerial position, or it can arise spontaneously in any group. Hersey and colleagues (2013) noted that the leadership process is a function of the leader, the followers, and other situational variables. The nurse executive’s role and function concentrate on long-term administration of an institution or program that delivers nursing services, focusing on integrating the system and building a culture (Mintzberg, 1998). There is a minimum of leader participation. The leader’s leadership style would have to take into account where the followers are in terms of their readiness as a critical factor for determining the style to choose. Thus no one leadership style is optimal in all situations. Because of the factor of constant change, maintaining good leadership is complicated for any group. Nursing is a service profession whose core mission is the care and nurturing of human beings in their experiences of health and illness. Although the lists of leadership characteristics and competencies vary somewhat, the functions of visioning, setting the direction, inspiration, motivation, and enabling systems and followers are at the core of leadership activity. The area of overlap may not be clear or explained. The nature of the situation needs to be considered. CHAPTER ELEVEN Leading and managing change in nursing John Daly, Esther Chang, Karen Hancock, Patrick Crookes LEARNING OBJECTIVES At the completion of this chapter, the reader will be able to: describe and discuss critical leadership attributes in effective change processes; discuss and explain theories of change; identify principles that enhance management of change processes; analyse… With Fiedler’s model, group situations can be analyzed to determine the most effective leadership style. A long history and rich literature surround leadership theories, much of it from outside of nursing. Popularity is not leadership; results are. Leaders need to ask the right questions, such as these: What needs to be done? The leadership task is to ensure direction, alignment and commitment within teams and organisations. What is needed by the leader is diagnostic ability. Psychological readiness is manifested by willingness to take some risk and by accepting the job requirements. Learn nursing leadership and management with free interactive flashcards. Styles should vary according to the appropriateness of the situation with reference to an evaluation of effectiveness. It is likely that without followers there is no leadership. Flexibility is important. Popularity is not leadership; results are. Some have seen management as a subset of leadership. These goals may or may not be congruent. For example, Bennis and Nanus (1985) studied 90 chief executives from 1978 to 1983 and found that there were two key leadership traits. The trait approach focuses on identifying specific characteristics of leaders. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). This involves the ability to think critically, to identify problems, and to develop objectivity and a degree of maturity or judgment. In a way, nursing’s struggle for greater economic parity in health care is courageous and risky. Leaders engage their environment with behaviors of doing, influencing, and moving. However, groups do not remain static; they move back and forth through stages. Exploring the feminist perspective on leadership is valuable in that it provides food for thought as health care organizations and the nurses working in them struggle with not wanting to let go of the familiar hierarchy management style yet needing to reconfigure to the circular or web structure to be effective. In Situational Leadership® theory,* leadership in groups is never a static circumstance. 5. Leadership theory often is discussed separately from management theory. The situation is dynamic and subject to change. Examples: be proficient and be able to train others in their tasks. One choice a leader has is to alter his or her own behavior and the leadership style used. Leaders need to be willing to make tough choices plus overcome the fear associated with them. Enabling others to act: Leaders foster collaboration and develop and strengthen others so that the whole team performs well. Hersey and colleagues (2013) thought that leadership was a broader concept than management. For nearly 20 years, nursing has topped Gallup polls as the most honest and ethical profession. Relational coordination focuses on relationships between roles rather than between individuals. Nurses can best respond by demonstrating vision, adapting to changes, seeking new tools for dealing with the new health care environment, and leading the way with client-centered strategies. Groups have personalities that include a discernible level of trust. This model of leadership has been used in nursing research (Patrick et al., 2011). The authoritarian leadership style uses primarily directive behaviors. Leaders’ perceptions of themselves, their roles, and their expectations also have an impact on their followers. Leadership is important for nurses because they need to possess knowledge and skill in the art and science of solving problems in work groups, systems of care, and the environment of care delivery. These five practices can be seen as the way leaders get extraordinary things done through people in an organization. Nursing has drawn from both classic and contemporary thinkers. The leadership, The values, skills, and style of leaders are important. If you already have a BSN, consider going for an MSN. In nursing, leadership is studied as a way of increasing the skills and abilities needed to facilitate clinical outcomes while working with people across a variety of situations and to increase understanding and control of the professional work setting. Hersey and colleagues (2013) noted that the common themes include the following: the leader needs to be flexible in behavior, able to diagnose the leadership style appropriate to the situation, and able to apply the appropriate style. Nurses need to have a solid foundation of knowledge in leadership and care management. Furthermore, the needs of disenfranchised minority groups must be balanced. The specific circumstances surrounding any given leadership situation will vary. Ethical leadership in nursing has shifted to fulfilling the universal ethical principles in nursing which are autonomy, beneficence, fidelity, justice, nonmaleficence, and veracity (Henry, et al., 2016). Nurses prefer managers who are participative, facilitative and emotionally intelligent. This applies at all levels: nurse care provider, nurse manager, and nurse executive. Followers expect that leaders will provide a sense of vision and a sense of direction with standards for achieving the group’s goals. Using leadership theory, leaders assess themselves, look at the followers’ readiness, and assess the situation to determine whether it is favorable or unfavorable. Effective leadership is important in nursing for those same reasons, specifically because of its impact on the quality of nurses’ work lives, being a stabilizing influence during constant change, and for nurses’ productivity and quality of care. Authoritarian This is because the leader operates in a crucial cultural and contextual influencing mode. These readiness levels can be matched with the corresponding leadership styles of level 1 with telling, level 2 with selling, level 3 with participating, and level 4 with delegating. Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. Such an environment generates challenges to the nurse’s identity, coping skills, and ability to work with others in harmony. Leadership theories have evolved away from an early focus on the traits or characteristics of the leader as a person because it was found that it is not possible to predict leadership from clusters of traits. Leaders’ perceptions of themselves, their roles, and their expectations also have an impact on their followers. • Task behavior: The extent to which leaders organize and define roles; explain activities; determine when, where, and how tasks are to be accomplished; and endeavor to get work accomplished There is a “gray area” in which the foci of their outcomes overlap. evolve.elsevier.com/Huber/leadership/ Followers need to be able to depend on role consistency, balance, and behavioral integrity from the leader. Fiedler’s measure for leadership style is the Least Preferred Coworker (LPC) scale (Fiedler & Chemers, 1984). Organizations have goals, and individuals working in organizations also have goals. These dimensions are similar to the authoritarian (or task) and democratic (or relationship) ideas of the leader behavior continuum. The ANCC’s magnet program acknowledges excellence in nursing services and leadership based on these five components: transformational leadership, structural empowerment, new knowledge, exemplary professional practice, and empirical outcomes (Wolf et al., 2008). The inclination is for a democratic power style, and the emphasis is on the importance of establishing relationships, maintaining connections with others, and deriving strength from empowering others. Leadership is founded on trust: “Trust is the emotional glue that binds leaders and employees together and is a measure of the legitimacy of leadership” (Malloch, 2002, p. 14). Pagonis (1992) noted that to lead successfully a leader must demonstrate two active, essential, and interrelated traits: expertise and empathy. Do not feel obligated to have all the answers, but be adept at asking the right questions. Effectiveness is a key outcome of leadership efforts in health care. Guyton, Nate. Autonomy refers to the nurse allowing the client to make their own decision. Followership is defined as an interpersonal process of participation. In contrast, management involves influencing employees to meet an organization’s goals and is focused primarily on organizational goals and objectives. Effectiveness is defined as how appropriately a given leader’s style interrelates with a given situation. A sense of integrity Exhibiting quiet but respected competence, a leader may be the wise or go-to person within the group, a superior problem solver, a strategic communicator, or someone who is emotionally intelligent and strong in interpersonal relationship skills. Hersey and colleagues (2013) said that leadership styles are the consistent behavior patterns exhibited in influencing the activities of others by working with and through them, as perceived by those others. You may also needManaging Time and StressDelegationQuality and SafetyBudgeting, Productivity, and Costing Out NursingCommunication LeadershipChange and InnovationLegal and Ethical IssuesOrganizational Structure Both ethical fitness and moral courage form the backbone of making necessary and hard—but right and unpopular—decisions. • Balancing tensions between efficiency and reliability r any group. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Policies are a matter of group discussion and decision. Terms related to leadership are leadership styles, followership, and empowerment.Leadership styles are defined as different combinations of task and relationship behaviors used to influence others to accomplish goals. The leadership situation in a group that is knowledgeable and experienced in solving problems is very different from the leadership situation in a group that is not experienced at the task or at working together. Examples: Human needs, emotions, and how people respond to stress. Nurses need to have a solid foundation of knowledge in leadership and care management. In this area of overlap, the processes and strategies look similar and may be employed for a similar outcome or blended together to accomplish goals. On the extremes of highly favorable or highly unfavorable situations, leaders need to use task-oriented behavior to get the work moving. He noted three reasons why leaders are important: the character of change in society, the de-emphasis on integrity in institutions, and the responsibility for the effectiveness of organizations. Among these characteristics, honesty (defined as trustworthiness) and energy are at the top of the list. Communication may be formal or informal (Hersey et al., 2013). Burns (1978) noted that leadership occurs when human beings with motives and purposes mobilize in competition or conflict with others to arouse, engage, and satisfy motives. In her new position as ED nursing director at Hahnemann University Hospitalin Philadelphia, Sharon Sandt, BSN, RN, considers clear communication a key component of leadership. 5. 2. A leader may see the need to chart a course that is new or unknown, unpopular, or risky because it challenges those with vested interests who have much to lose. With Fiedler’s model, group situations can be analyzed to determine the most effective leadership style. The acute care medical model in hospitals over time came to be the primary focus of attention and jobs for nurses. Certain acts performed by leaders have positive effects and make people feel more respected; listening and informal chatting are prime examples (Alvesson & Sveningsson, 2003). Fiedler (1967) examined which style (task-oriented versus relationship-oriented) would be most effective for each of eight situations. One currently accepted view of organizational behavior describes leadership as situational or contingent and concerned with what produces effectiveness. All rights reserved.). In a very difficult situation, relationships may be the leader’s preferred emphasis. They described management as a special kind of leadership. Log In or. For example, a nurse may use leadership strategies or management strategies to motivate others, but the desired outcome of the motivation is likely to be different. Every nurse needs two critical skills to enhance professional practice. Through communication, the leader’s vision and message are received by the followers. Nursing is a service profession whose core mission is the care and nurturing of human beings in their experiences of health and illness. This is a development of the work conducted in the 1980s by the American Academy of Nursing – according to which, hospitals that were able to recruit and retain highly qualified nurses in a competitive market displayed 14 ‘forces of magnetism’, including quality of nursing leadership and management style (Royal College of Nursing, 2015). Leadership styles appear to have a gender component. Leadership is hard, sustained work that requires a great deal of energy and sputters without it. Fiedler’s theory (1967) suggests that the best leadership style under unfavorable circumstances is task-oriented. For example, in one setting the culture may resemble one big happy family, with an emphasis on teamwork and morale boosting. Hersey and colleagues (2013) described the Tri-Dimensional Leader Effectiveness Model first developed by Hersey and Blanchard. “The nurse leader plays a critical role in the business of the healthcare organization and the quality and safety of the services provided” (O’Connor, 2008, p. 21). Communication processes vary among groups regarding the patterns and channels used and how open or closed the communication flow is. However, if interpersonal relationships are not an immediate problem or if the group is on the verge of collapse, then strong authoritative direction is needed to get the group moving and accomplishing. For example, directing occurs in both leadership and management activities (the area of overlap), whereas inspiring a vision is clearly a leadership function. In previous Management Moment columns, we have discussed a range of leadership and management issues. Followership is not as simple as it seems (see Followership section). 1. Such an environment generates challenges to the nurse’s identity, coping skills, and ability to work with others in harmony. The authoritarian leadership style uses primarily directive behaviors. Elements such as work demands, control systems, amount of task structure, degree of interaction, amount of time available for decision making, and external environment shape the differences among situations (Hersey et al., 2013). Authoritarian leaders are characterized by giving orders. Leaders are those who talk about adventures into new territory and take the risks inherent in innovation (, A leader may see the need to chart a course that is new or unknown, unpopular, or risky because it challenges those with vested interests who have much to lose. Women tend to be more flexible and value cooperation, connectedness, and relationships. Developing realistic action plans to build employee satisfaction. This forms a composite of the ability to do the job. The wise leader assesses the trust and readiness to change levels of the group. Fiedler and Garcia (1987) argued that leadership is one of the most important factors that determine the survival and success of groups and organizations. There are a variety of definitions of leadership. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). Nurses can start by examining their own behaviors and then taking deliberative actions to strengthen trust in the environment. Styles of leadership range from authoritarian to permissive to democratic and from transactional to transformational. Women tend to be more flexible and value cooperation, connectedness, and relationships. Each has advantages and disadvantages. Leadership can be understood as the ability to inspire confidence and support among followers, especially in organizations in which competence and commitment produce performance. Leader behavior was described as having two separate dimensions, as follows: 1. The first role is more often the role that is recognized. Doing so sets the stage for better decision making about change strategies and strategic management. Styles should vary according to the appropriateness of the situation with reference to an evaluation of effectiveness. As situations become more complex, leadership becomes more difficult. He noted that the leader focuses on people, whereas the manager focuses on systems and structures. Nurses can be aware of the crucial nature of trust in the leadership and management relationship. The personality styles of both superiors and subordinates have an influence on the situation, the work demands, and the amount of time and resources available. Followership is defined as an interpersonal process of participation. Followership is the flip side of leadership. Much has been written about how to think like a nurse leader. 1. For this situation, the task-oriented leader is a more effective match between leader and job. Download 5-page research paper on "Nursing Leadership, Management Theories, and Principles" (2020) ☘ … last several years, health care has been going through a leadership crisis. However, according to the definitions, characteristics, and processes, the concepts of leadership and management are different, but at the area of overlap they look similar. The delivery of nursing services involves the organization and coordination of complex activities. Nurses can start by examining their own behaviors and then taking deliberative actions to strengthen trust in the environment. Fiedler (1967) developed a Leadership Contingency Model to explain how to apply this idea. Men tend to spend their time on meetings and tasks requiring immediate attention, focusing on completion of tasks and achievement of goals. Studies have shown that nurse managers have a large effect on retention, so a good nurse leader understands that employees remember how they are treated. The two major leadership terms are task behavior and relationship behavior, and a leader’s leadership style is some combination of task and relationship behavior. Interpersonal, emotional, and social intelligence skills also contribute to the effective leadership of knowledge workers (. One is a skill at interpersonal relationships. The continuum ranges from democratic to authoritarian (or subordinate-centered to leader-centered). The individual nurse’s task is to determine in which environments he or she functions best and is most comfortable or where he or she most likely will succeed. The situation is dynamic and subject to change. 1. and moral courage form the backbone of making necessary and hard—but right and unpopular—decisions. The democratic style makes output appear to move more slowly and is thought to take longer than using an authoritarian style. This style emphasizes a high concern for task. The feminist perspective on leadership was presented by Helgeson (1995a, b). Bennis (1994) listed a number of distinctions between leadership and management. In nursing, interdisciplinary teamwork is a major element in effectiveness. Fiedler and Garcia (1987) argued that leadership is one of the most important factors that determine the survival and success of groups and organizations. With a shift to primary care and care coordination, the nurse’s care management role has become more prominent, needed, and valued. For example, in one setting the culture may resemble one big happy family, with an emphasis on teamwork and morale boosting. KNOW your job. What is needed by the leader is diagnostic ability. Management activities are concerned with managing the resources of an organization. Kouzes and Posner (1995) defined the following five behaviors that correlated with leadership excellence: 1. He noted that the leader focuses on people, whereas the manager focuses on systems and structures. There are two types of challenges: technical and adaptive. Drucker (1996) noted that effective leaders know the following four things: Fiedler examined the favorableness of the situation from the perspective of the leader’s influence over the group. Little reward came from the “thinking” and integrating skills nurses were capable of. A good nurse leader is someone who can inspire others to work together in pursuit of a common goal, such as enhanced patient care. Management activities are concerned with managing the resources of an organization. 4. Being the resident role model; who you are is whom you will attract. In this illness-focused model, the nurse’s care provider or “doing” role was the most important and valued aspect of nursing. However, the message is filtered through the receiver’s perception. These are action terms. “The nurse leader plays a critical role in the business of the healthcare organization and the quality and safety of the services provided” (O’Connor, 2008, p. 21). Exemplary Professional Practice. These quadrants represent four basic leadership styles: telling, selling, participating, and delegating. Some democratic leaders cannot vary their style sufficiently to handle crises. Leadership styles appear to have a gender component. Kotter (2001) noted that managers cope with complexity whereas leaders cope with change. This is a behavioral competency. These are core to all leadership in all situations. Clearly, “something changes as leadership blossoms” (, Leadership is a natural element of nursing practice because the majority of nurses practice in work groups or units. Leadership is founded on trust and does not survive without it. For example, if a nurse prefers to operate in a democratic style yet suddenly a code situation occurs, then the nurse must rapidly switch from a democratic to an authoritarian style. In this area of overlap, the processes and strategies look similar and may be employed for a similar outcome or blended together to accomplish goals. Level 1 is unable and unwilling or insecure. Leaders need to ask the right questions, such as these: What needs to be done? Clearly, “something changes as leadership blossoms” (Huber & Watson, 2001, p. 29). All rights reserved. It is not known whether gender differences are permanent characteristics or are culturally mediated artifacts that blur with time. Relationship management: Use of effective communication with others to disarm conflict, and the ability to develop the emotional maturity of team members. Movement into a participative leadership style requires much less structure and task-directive behavior from the leader because the individual or group is performing but is not quite confident enough in its own ability for the leader to completely let go. This overlap occurs where the two processes are integrated or synthesized to accomplish goals and where the same strategies are employed even though the goals may differ. Organizations that focus on sustaining a healing culture rebuild organizational trust by focusing on trust in relationships with employees. This is because of the increasing demand from shifting demographics in the population… He noted three reasons why leaders are important: the character of change in society, the de-emphasis on integrity in institutions, and the responsibility for the effectiveness of organizations. Thus although both are used to accomplish goals, each has a different focus. There are a variety of definitions of leadership. Because of the factor of constant change, maintaining good leadership is complicated fo, Hersey and Blanchard’s Tri-Dimensional Leader Effectiveness Model. However, the depth and focus of care management roles and skills may vary by level. After choosing a channel, the sender transmits a message. In contrast, management involves influencing employees to meet an organization’s goals and is focused primarily on organizational goals and objectives. Clancy (2003) noted that leaders need to “consistently find the courage to hold true to their beliefs and convictions” (p. 128). Group consensus needs time and facilitation to be fostered. Despite its potential drawbacks, this style has advantages when used with groups of fully independent care providers or professionals working together. This is an unfavorable situation and a leadership challenge. The nurse leader combines clinical, administrative, financial, and operational skills to solve problems in the care environment so that nurses can provide cost-effective care in a way that is satisfying and health promoting for patients and clients. Leadership is a broad concept and a process that can be applied to any group. They are sets or clusters of behaviors used in the process of effecting leadership. Both the leadership style (task versus relationship) and the attitude of the leader about leadership behaviors are important. The effectiveness of an individual nurse depends partly on that individual’s competence and partly on the creation of a facilitating environment that contains sufficient resources to accomplish goals. Leadership is a unique role and function. The area of overlap may not be clear or explained. Possessing the license of an RN implies certain leadership skills and requires the ability to delegate and supervise the work of others. • Professionalism: An approach to an occupation that distinguishes it from being merely a job, focuses on service as the highest ideal, follows a code of ethics, and is seen as a lifetime commitment Then a telling, selling, participating, or delegating style is selected. If the nurse has a reasonably good relationship with the leader, the leader should use a high-relationship style with the nurse. 4. Organizations that focus on sustaining a healing culture rebuild organizational trust by focusing on trust in relationships with employees. Unlike other professions, nurses must constantly evaluate and compare their own ethical standards with those of other colleagues, patients, and family members. Bennis (1994) made a strong argument for leadership, stating that quality of life depends on the quality of leaders. Leadership is defined here as the process of influencing people to accomplish goals. On the other hand, in a staff meeting, an authoritarian leader may be ineffective with a group of professionals and would need to be flexible enough to switch to a democratic or laissez-faire style, depending on. Thus leadership is a social exchange phenomenon. Critical thinking can be applied to: 1. This may include such activities as arranging access to services, providing direct care, doing referrals, and supporting a patient’s family. Once again, a task-oriented style is called for—challenging individuals by using the motivation they need to continue to produce. Potential health care leaders likely will possess “a passion to make things better, a commitment to values, a focus on creativity and innovation, and the knowledge and skills necessary to identify health care needs and then to mobilize and array the human and other resources necessary to achieve goals and effect outcomes” (Huber & Watson, 2001, p. 29). Leading means establishing direction for employees and initiating the day-to-day work that is necessary to effectively accomplish the company’s overall objectives. Some say leadership and management are two very different things. Fiedler (1967) developed a Leadership Contingency Model to explain how to apply this idea. Nurses have two basic roles: care providers and care coordinators. When about 500,000 registered nurses retire in the coming decade, they wont just leave a void in much-needed clinical care positions. Thus no one leadership style is optimal in all situations. The democratic style makes output appear to move more slowly and is thought to take longer than using an authoritarian style. All five elements interact within any given leadership moment. The leadership courage continuum runs from “good coward” (cannot muster courage to make tough choices) to “reckless courage” (shoot from the hip). A distinctive and compelling vocal tone 5. One is a guiding set of concepts, and the other is the ability to communicate a vision. Goals may thus be in conflict, in which case there is tension and a need for leadership. Leadership styles contribute to team cohesion, lower stress, and higher empowerment and self-efficacy. Cost containment, patient’s rights, safe staffing, stress and anger, and ethical dilemmas all challenge the leader to identify right from wrong and act from his or her sense of conviction. However, good leaders are anchors to the vision and the larger mission, guides to coping and being productive, and champions of energy and enthusiasm for the work. Trait Theories Interdisciplinary team building The ability to engage others in shared meaning Leadership and Management Principles Add gratitude, humility, and caring. In this illness-focused model, the nurse’s care provider or “doing” role was the most important and valued aspect of nursing. Keep in mind that leadership and management skills are different. It also presents the opportunity to lead, challenge assumptions, consolidate a purpose, and move a vision forward. Ethical nurse leaders create work environments that impact employee choices, behaviors, and values. 3. Enabling others to act: Leaders foster collaboration and develop and strengthen others so that the whole team performs well. Nurses can be aware of the crucial nature of trust in the leadership and management relationship. For this situation, the task-oriented leader is a more effective match between leader and job. As applied to the continuum of authoritarian versus democratic styles, telling would be authoritarian and participating would be democratic. Related Possessing the license of an RN implies certain leadership skills and requires the ability to delegate and supervise the work of others. Hersey and colleagues (2013) defined these terms as follows: Self-awareness is crucial to leadership effectiveness and is the focus for many leadership exercises. MBA – General Business Administration Online, http://www.americannursetoday.com/nine-principles-of-successful-nursing-leadership/, http://www.nursingcenter.com/lnc/JournalArticle?Article_ID=2421922. Readiness can be applied to a work group. 4. This forms a composite of the ability to do the job. Start studying Theories and Principles of Nursing Leadership and Management. This facilitates placement for success and a better match between leader and follower. Each has advantages and disadvantages. Taken together, these source documents overlap and converge on the primary attributes, knowledge domains, and skills that nurse leaders need to lead people and manage organizations in health care. Followers are vital because they accept or reject the leader and determine the leader’s personal power (Hersey et al., 2013). Hersey and colleagues (2013) noted that the common themes include the following: the leader needs to be flexible in behavior, able to diagnose the leadership style appropriate to the situation, and able to apply the appropriate style. Leadership is about relationship-building; it facilitates management. Meeting the challenging times by establishing three priorities every 90 days and committing to seeing them through. He classified group situational variables of leader-member relations, task structure, and position power into eight possible combinations, ranging from high to low on these three major variables. • Implementing evidence-based management An evidence-based approach to differentiating nursing leadership from management was taken to identify discrete competencies through an integrative content analysis of the literature base (Jennings et al., 2007). If the leader plays a major role in creating a group’s culture and ethos, then closing down communication, breeding distrust and competition, and neglecting positive motivation can sow the seeds of group disintegration. Key concepts related to leadership are influence, communication, group process, goal attainment, and motivation. Management is defined as the coordination and integration of resources through planning, organizing, coordinating, directing, and controlling to accomplish specific institutional goals and objectives. Hersey and colleagues (2013) identified a second approach to leadership research that focused on the measurement of attitudes or predispositions toward leader behavior. This style emphasizes a high concern for task. Organizational man: This approach works on balancing the necessity to accomplish the task with maintaining morale. Decisions of policy are made solely by the leader who tends to dictate tasks and techniques to followers. However, if interpersonal relationships are not an immediate problem or if the group is on the verge of collapse, then strong authoritative direction is needed to get the group moving and accomplishing. Occurring mainly between 1945 and the mid-1960s, the attitudinal approaches began with the Ohio State Leadership Studies and included the Michigan Leadership Studies, Group Dynamics Studies, and Blake and McCanse’s Leadership Grid. Level 2 is unable but willing or confident. Self-confidence – this inspires confidence in others. On the other hand, this style can be very efficient, especially in a crisis. Much attention has been focused on leadership as a group and organizational process because organizational change is heavily influenced by the context or environment. Tags: Leadership and Nursing Care Management Trust-destroying behaviors include being insensitive to beliefs and values, avoiding discussion of sensitive issues, and encouraging competition via winners and losers. This is both tricky and risky and may be overwhelming (Porter-O’Grady, 2003). Gittell (2009) emphasized the centrality of relationship management because patient care is a coordination challenge. They discussed three distinct styles: authoritarian, democratic, and laissez-faire. Case Presentation Caroline Smart DNP, CNS, RN was a hospital nursing educa-tor until her recent graduation from a Doctor of Nursing Practice Program. Leaders need to be willing to make tough choices plus overcome the fear associated with them. To choose an appropriate style, the leader needs to be knowledgeable about the readiness of the followers. FIGURE 1-3 Expanded Situational Leadership® model. The individual or group wants to talk about things. Through communication, the leader’s vision and message are received by the followers. Hersey and colleagues (2013) noted that Blake and Mouton’s (1964) conceptualization tended to be an attitudinal model that measured the values and feelings of managers, whereas the Ohio State model included both attitudes and behaviors and focused on leadership. A long history and rich literature surround leadership theories, much of it from outside of nursing. • Business skills and principles Effectiveness is defined as how appropriately a given leader’s style interrelates with a given situation. If the delivery of nursing services involves the organization and coordination of complex activities in the human services realm, then both leadership and management are important elements. Thus leadership is a social exchange phenomenon. The primary objective of the role of nursing service Organizations have goals, and individuals working in organizations also have goals. Bennis (1994) identified a recipe for leadership that contained six ingredients: a guiding vision, passion, integrity (including self-knowledge, candor, and maturity), trust, curiosity, and daring. Some individuals are able to integrate styles and flexibly match to the situation at hand, but this is rare. Each has advantages and disadvantages. A profile of leadership don’ts includes untrustworthiness, insensitivity to others, aloofness, over-managing, abrasiveness, inability to think strategically or staff effectively, inability to build a team, and focusing on internal organizational politics (overly ambitious). Their departures will deplete the pool of nurse managers the experienced professionals who bridge the gap between bedside care and administrative roles. First, a two-dimensional model was constructed, in which task behavior and relationship behavior were displayed on a grid from high to low and were divided into four quadrants: (1) high task, low relationship; (2) high task, high relationship; (3) high relationship, low task; and (4) low task, low relationship (Figure 1-3). Leaders are those who talk about adventures into new territory and take the risks inherent in innovation (Kouzes & Posner, 1995). He noted three reasons why leaders are important: the character of change in society, the de-emphasis on integrity in institutions, and the responsibility for the effectiveness of organizations. Fiedler’s theory (1967) suggests that the best leadership style under unfavorable circumstances is task-oriented. One currently accepted view of organizational behavior describes leadership as situational or contingent and concerned with what produces effectiveness. the circumstances. Some individuals are able to integrate styles and flexibly match to the situation at hand, but this is rare. Keeping your staff motivated to perform at top quality takes clever nursing leadership. 3. Leaders are those who talk about adventures into new territory and take the risks inherent in innovation (Kouzes & Posner, 1995). Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Click to share on Google+ (Opens in new window) One way to foster effective leadership is to evaluate leaders according to Fiedler’s contingency model (1967) and then use this information to increase leaders’ awareness of their natural style tendency: relationship-oriented or task-oriented. 2. P.O. As leadership theories evolved, leadership came to be viewed as a dynamic process and an interaction among the leader, the followers, and the situation. For example, a nurse may use leadership strategies or management strategies to motivate others, but the desired outcome of the motivation is likely to be different. Nurses can be aware of the crucial nature of trust in the leadership and management relationship. The way people influence others through actions taken and the perspectives of other people is related to leadership efforts and constitutes leadership style. Interactive planning The acute care medical model in hospitals over time came to be the primary focus of attention and jobs for nurses. Budgeting, Productivity, and Costing Out Nursing. This is a process competency. There may be values clashes between the leader and the followers. Encouraging the heart: Leaders appreciate and recognize individual contributions and formally celebrate accomplishments. If the nurse leader is a task-oriented person, a high-relationship person may need to be called on to assist the group process so that it is facilitated and becomes effective. Leaders may grow gradually out of a smoldering issue or erupt through a crisis event. 2. Chapters divided according to AONE competencies for nurse leaders, managers, and executives. The leader’s focus is on people; the manager focuses on systems and structure (Bennis, 1994). The idea of management can generate a negative reaction when it is equated with the “command and control” concept of authoritarian and bureaucratic organizations. They are sets or clusters of behaviors used in the process of effecting leadership. Communicating: Communicating is used to advance the process in a way that individuals can understand and accept. 1. Social awareness: An intuitive skill of empathy and expressiveness in being sensitive and aware of the emotions and moods of others Certain characteristics, such as being motivated by challenge, commitment, and autonomy, are thought to be associated with leadership. Leadership is not rank but responsibility. For example, if a nurse prefers to operate in a democratic style yet suddenly a code situation occurs, then the nurse must rapidly switch from a democratic to an authoritarian style. Leadership can be understood as the ability to inspire confidence. These may be downward, upward, horizontal, grapevines, or networks. Bennis (1994) listed a number of distinctions between leadership and management. The opportunity to lead is a gift, not an entitlement. LEADERSHIP AND CARE MANAGEMENT DIFFERENTIATED Leadership is important to study, learn, and practice in today’s complex, rapidly changing, turbulent, and chaotic health care work environment. The only definition of a leader is someone who has followers. Leaders need to be concerned about both tasks to be accomplished and human relationships in groups and organizations. Examples include when technology changes more quickly than clinicians are able to learn and adapt to it, when management duties extend to include temporary workers employed by others (e.g., outsourced functions and agency nurses), and when a radical organizational shift to an accountable care organization (ACO) is necessary. Adapting: Adapting involves being able to adapt behaviors and other resources to match the situation. The true essence of a Magnet organization stems from exemplary … 3. Favorable or unfavorable situations are determined in part by the receptivity of the followers, but they are also determined by whether the larger environment is positive or negative. Most leadership definitions incorporate the two components of an interaction among people and the process of influencing.
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