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Managing and Coordinating Nursing Care, Ellis
& Hartley, Chapter 1: Developing Leadership
Behavior
and Management Skills
Leadership
 Leadership may be viewed as the process of guiding,
teaching, motivating, and directing the activities of others
toward attaining goals.
 It Involves having the ability to influence others.
 Leadership often involves moving into a position because
of special abilities, skills or attributes.
It could be formal or informal within the organization.
Management
• Management involves the coordination and
integration of resources through the activities
of planning, organizing, directing, and
controlling in order to accomplish specific
goals and objectives within an organization.
• Management positions tend to be ones to
which an individual is appointed.
• Typically a manager has responsibility and
accountability for tasks that must be
accomplished, and to fulfill those
responsibilities plans, hires, coordinates,
directs, organizes, evaluates, and budgets.
• If an individual functions poorly in the
management role, the tendency within
organizations is to replace that person with
someone who can carry out the responsibilities
in a more effective manner.
• Ideally, a good manager should also possess leadership
abilities, but this does not always occur.
• On the other hand, a good leader may not possess
management skills.
• However, both can be learned and improved by
experience and the desire to increase your abilities and
skil1s in both areas.
• Nurses must understand leadership and management
as an important part of their responsibilities, and must
prepare themselves to participate at all levels.
LEADERSHIP THEORIES
1. Great Man and Trait Theories:
“Some people are born to lead and others are born to be
led”.
– Set forth the premise that certain people are born to be
leaders, having inherited a set of innate characteristics that
endow them with the unique ability to lead others.
– This theory grew because the ability to lead others was often
seen within royal and prominent families.
– Others were not allowed to become leaders, a fact that also
helps explain its premise.
– Currently most people do not accept the idea that an
individual is born to lead.
2. The Trait /or Attribute Theory:
–It evolved from the Great Man Theory of
leadership when social and economic
barriers no longer prevented members of
the general public from occupying
leadership roles.
–Behavioral scientists began to identify the
common traits of great leaders
throughout the ages.
These Traits Frequently Included:
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Assertiveness,
Ambition,
Charisma (charismatic theory),
Creativity,
Decisiveness (certainty),
Enthusiasm (passion),
Intelligence,
Initiative,
These Traits Frequently Included:
• Persistence,
• Integrity,
• Physical characteristics (especially
above-average height),
• Sense of self,
• Technical mastery,
• Verbal ability, and similar skills.
The trait theory lost appeal because it
failed to look at the situation in which
action was occurring, neglected the role of
the follower and didn’t consider the
importance of the group situation.
• Leaders in one situation may function as
followers in another
• Leaders who are effective in some
circumstances calling for sociability,
popularity and dependability are
ineffective in others that require prompt
and decisive actions.
3. Behavioral Theories:
– At times also referred to as the humanist
approach.
– They were so named because they looked
at the behaviors in which leaders engaged.
Barnard, who was very influential in introducing
the need to look at behavioral, intuitive, and
emotional aspects of leadership, looked at both
the formal and informal structures that exist in
any organization and identified additional
components, such as the cooperative system that
must be a part of any organizational
assessment.
He suggested that authority is delegated upward
and is granted by one's subordinates.
– Leaders who were uninvolved, did little planning,
and showed little concern for team members earned
the lowest ratings.
– The most effective leadership approach was
identified as one involving both a high-task and a
high-relationship orientation in which the leader:
1. Promotes open communication
2. Sets goals,
3. Intervenes in conflicts, and
4. Involves team members in decision making.
4. Situational and Contingency Theory
• Focus is the context or the situation in which the leader functions.
• Based on the premise that the leadership style that is successful in
one set of circumstances may not be effective in another.
• The situational determines the approach to be followed:
1. Hierarchical structure of the organization
2. Atmosphere of the organization
3. Characteristics of the leader role and follower role
The leader must remain sensitive to the followers’
readiness (Hersey and Blanchard).
Leadership has four basic styles:
1. Telling,
2. Selling,
3. Participation, and
4. Delegation.
Fiedler’s (1967) believed that leadership style alone
was not enough to explain leadership effectiveness.
He developed the contingency theory approach of
leader effectiveness:
- The nature of the leader-member relationship,
- The structure of the task to be performed, and
- The authority or power the leader had to act as
determined by job description and organizational
support.
- Leader-Member Relation:
The degree of confidence, trust, and respect
subordinates have in their leader.
- Task Structure:
The degree to which the job assignments are
procedurized
- Position Power:
Influence derive from one’s formal structural position in
the organization; include power to hire, fire, discipline,
promote, and increase salary.
5. Process Theories
• Looked at leadership as it related to group interaction.
• Transformational Leadership Theory:
1. Define a leader as one who motivates follower to perform at
their full potential.
2. By influencing change in perception and providing a sense of
direction in a group.
3. Group members are empowered and motivated and provide
input to decision making, and
4. Leaders and followers raise one another to higher levels of
performance.
- Relational Model of Leadership
Leader is empowering, process-oriented, moving the
group toward the goals.
- Servant Leadership Theory
Successful leaders are able to influence others as a result
of dedicating their lives to serving others.
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Social change model of leadership
Individuals and groups work toward a common goal.
WOMEN AND LEADERSHIP
• Women have been viewed as less effective in leadership
positions than men.
• Some suggest that the lower prestige and desirability of
nursing as a profession is related to the fact that it is
primarily female-oriented.
• Bass (1990) concluded that the role of women in leadership is
changing so rapidly that earlier research may need to be
discounted, but encourages continued consideration be
directed to the underlying dynamics and dimensions of
importance to success and effectiveness of women leaders.
WOMEN AND LEADERSHIP
• Some studies have found that stereotypes
have identified women as less competent,
less aggressive, less task oriented, more
dependent, and more emotional than males.
• He also noted that women were found to be
more effective communicators, more
attentive to upward communications from
their subordinates, and more relations
oriented than their male counterparts.
TYPES OF LEADERSHIP STYLES
• Authoritarian or Autocratic leadership
• Democratic or Participative Leadership
Style
• Laissez-faire Leadership
• Multicratic Leadership
1. Authoritarian or Autocratic Leadership:
The authoritarian or autocratic leadership style is
characterized by strong control by the manager over
the workgroup and also may be referred to as the
directive approach.
The activities of the group are primarily directive with
activities determined by the leader and dictated to the
followers with no input from the followers on decisions.
Communication flows downward and emphasis is on
accomplishing the task.
– Managers who exercise this style of
leadership are characteristically found in
bureaucratic organizations that reinforce the
centrality of authority and reliance on
formal rules such as seen in the military.
– Their authority is generally derived from
position power that is tied to their official job
title within the organization.
– An authoritarian leadership style is
appropriate when there is a need for
immediate action and the manager is the
individual with the best understanding of
the situation.
– An example of this type of leadership
might occur in an emergency department
setting.
– An advantage of this style of leadership is that
decisions can be made expeditiously without the
lengthy time required for consultation to arrive at
a collaboratively agreed-on course of action.
– Disadvantages of this type of leadership style are
clear. When subordinates feel that they are not
listened to or supported, they are less likely to have
a personal stake in the achievement of management
goals.
– In addition, this style of leadership can create
hostility and dependency among followers.
2. Democratic or Participative Leadership Style:
– This style of leadership focuses on involving
subordinates in decision making.
– Democratic leaders see themselves as co-workers
rather than as superiors and stress the importance
of communication, consensus, and teamwork.
– Although this authority is not exercised in a
coercive manner and the leader leads by providing
information suggesting direction, and being
supportive of co-workers.
Advantages of the democratic style are that
workers who are consulted and who have
input into decisions are more motivated to
support such decision.
Involving subordinates in data gathering
and analysis, planning, implementation and
evaluation of task ensures the widest
possible scope and may provide information
to which the manager alone would not have
had access.
–Generally, the democratic leader functions best in an
organization in which power is less centralized and
there is less reliance on formal rules and policies.
–Disadvantages of this style of leadership are:
1. Decision making can become a lengthy process,
2. If coworkers are not confident about their own abilities to
participate in planning and decision making they may feel that
the manager is not doing his or her job, and
3. Is foisting (imposing) difficult decisions off onto others who are
not being paid to manage.
3. Laissez-faire Leadership:
– Also called permissive leadership.
– Laissez-faire leadership provides the least structure and
control and is also referred to as the delegating approach.
– Little or no direction is provided: coworkers develop their
own goals, make their own decisions and take responsibility
for their own management.
– Managers concentrate on providing maximum support and
freedom for coworkers, and decision making is dispersed
throughout the group.
– Advantages of this style of leadership include
providing maximum freedom for individuals and,
presumably increased motivation of subordinates
to perform at high levels because of this
independence.
– An example of laissez-faire leadership might occur
in an inpatient psychiatric unit.
– Disadvantages of this style , because of the
multidisciplinary nature of patient care, there
usually must be more centralized decision making
and agreement in following generally accepted
policies and procedures.
4. Multicratic Leadership:
• Multicratic style combines the best of all styles
mediated by the requirements of the situation
at hand.
• The Multicratic leader provides a maximum of
structure when the situation requires it,
a maximum of group participation when
needed, and support and encouragement for
subordinates in all instances.
POWER AND THE LEADERSHIP ROLE
• The term power evokes many different feelings such as
fear, mistrust, control over others, and domination.
• It also has a wide variety of synonyms, such as force,
strength, potency, stamina, vigor, control, and command.
• Power has many different meanings:
1.
2.
3.
4.
5.
6.
The ability to do;
Act or produce;
The ability to control others;
Authority;
Sway; and
Influence.
• Power is not a static phenomenon;
it can change and shift, increase or
decrease.
• Bass (1990) points out that differences in
power in a group, organization, or society
influence the kind of leadership that can
be effective. When there are great
differences in power among individuals or
groups, a more directive leadership is
likely.
• When the differences in power are small, a
more participative leadership is likely.
• Within an individual, power may vary from
one time to another or from one situation to
another.
• For example, the unit manager may have a
great deal of power when it comes to the
operation of a particular unit but very little
in meetings chaired by the hospital
administrator.
Types of Power
1. Legitimate power
2. Referent power
3. Reward power
4. Coercive power (punishment power)
5. Expert power
6. Connection power
1. Legitimate Power
• Often termed authority,
• Is most frequently thought of as the power granted by
an official position who ever holds the position has the
same amount of authority which may include making
decisions on behalf of the organization.
• Acquiring or controlling information, having access to
people of higher status or power, and controlling the
human and material resources of the organization.
• Most often, the individual holding legitimate power is
given a title to indicate the authority that has been
delegated, such as unit manager, vice president of
patient care services, or administrator.
2. Referent Power
• Refers to the potential influence one has because of the
strength of the relationship between the leader and followers.
For example; when people admire leaders and see them as
someone to model, leaders are said to have referent power.
• The term charisma has been used to describe this type of
referent power and is sometimes referred to separately as
another basis of power.
• Charisma is the power that attracts one person to another
and relates to the way leaders act, talk, walk, the
organizations to which they belong, and personal
associations.
3. Reward Power
• Is achieved by having the potential to
influence others because of one's control
over desired resources.
• These may include the power to give
raises, bonuses, and promotions; select
individuals for special projects or
assignments, or distribute valued
resources.
4. Coercive Power
• Also referred to as punishment power, is the opposite of
reward power.
• It ranges from negative sanctions to verbal threats of
punishments, and is based on the fear of punishment if the
manager's expectations are not met.
• It implies the ability to impose penalties for
noncompliance.
• The manager can control through the fear of loss of job or
of punishment, such as undesirable assignments or shifts.
• Although we tend to view coercive power negatively, some
situations may require coercion.
5. Expert Power:
• Is gained through the possession of special knowledge,
wisdom, sound judgment, good decisions, skill, or ability.
• Experts wield power and are able to accomplish their
purposes because others recognize their abilities and turn
to them for guidance.
• Typically, this type of power is limited to a specialized
area.
• As nursing becomes evermore specialized, we see an
increase in expert power among professionals.
6. Connection Power
• May be described as power based on having
connections (or associations) with others who are
powerful.
• One often sees politicians exercising connection
power when being seen with a powerful political
figure may infer a higher personal status.
• Connection power may also involve working with
others to accomplish a common goal.
Empowerment
• Is the process by which a leader shares power with
others or enables them to act.
• It is the basis of transformational leadership.
• Delegates a great deal of authority for decision
making.
• Allows employee to share in the satisfaction derived
from goal achievement.
• It results in employees having a strong sense of self.
John van Maurik (2001) views three factors
when giving assignment to subordinate:
• Direction: Sufficient to give confidence.
• Challenge: Bring out creativity and
satisfaction on completion.
• Autonomy/support: Confidence and help.
• The opposite of empower is powerless, in
which the individual feels:
1- Demotivated,
2- Unable or incapable of accomplishing
desired activities,
3- Frustrated with the work environment
Powerlessness lead to dependent behavior
Empowering Others
• Empowerment can begin with modeling
personal behaviors that will encourage others
to be active participants, and be patient with
others.
• Encourage others to make choices for
themselves.
• To have input in decisions.
• Delegate the power to make decision to
subordinates, thus fostering greater initiative
and responsibility for task.
Example, rather than direct the nursing
assistant to do bathe to the patient, permit the
nursing assistant to decide which is the best
which is the best way to proceed. In this way
you help the nursing assistant to build self
confidence in her/his own ability, a hallmark
empowerment.
• Empower others by developing the habits of
asking questions rather than giving directions.
• Share your pleasure and pride with subordinates and
share the successes of individuals with the group; this
help in build confidence and self-esteem.
• Offer helpful suggestions to improve the situation and
give recognition to the improvement.
• Be supportive and encouraging, specially when an
individual is feeling stress and anxiety.
• All recognition and praise must be provided in
a sincere manner and not to excess.
• The Reciprocal Role:
• The effectiveness of an organization can be determined
on the basis of how well followers follow.
• We often find ourselves occupying two roles: one of
leader, another as follower; when we have subordinates,
we also have bosses.
• The importance of recognizing this interchanging of
roles in today’s health care setting is great.
• Some individuals choose to stay in follower roles and
serve as team players who gain satisfaction from helping
accomplishing the goals of the organization in that role.
Role of the Followers
The distinguish between an effective followers from
an ineffective ones:
• Enthusiastic
• Intelligent, and
• Self-reliant participation
• The Quality of the Followers
1- They manage themselves well.
2- They are committed to the organization and to the
purpose, principle, or person outside themselves.
3- They build their competence and focus their efforts
for maximum impact.
4- They are courageous, honest, and credible.
• Being a Good Follower
1-Invest in yourselves:
You must begin to see how your own goal
fit into the goal of the organization as a
whole maintaining your competence by
expand your skills through education
and workshop and seminars related to
you area of practice.
2- Clearly identify your responsibilities as follower:
1.
2.
3.
4.
What is expected of you?
What does your job description involve?
To whom do you repot?
How is your performance evaluated and by
whom?
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Usual resources include your job description.
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Make sure you identify resource person to whom you
can go for continued clarification and assistance.
3- Clearly identify your expectation of the leader:
- The leader’s role and relationship to you.
- You need to understand what realistically to expect
from your leader in relation to you and other.
4- Support your leader and your group:
- Understanding your role as follower and manager’s
role as a leader,
- Learning to work productively with others.
5- Provide stimulation for your leader and your group:
- Provide stimulate discussion,
- Provide a fresh look at problems,
- Propose other potential solution, and
- Carried out in constructive manner,
6- follow channels of communication and responsibility:
- Include channels of authority and routs of
communication
DEVELOPING YOUR LEADERSHIP ABILITY
• Increase your personal competence and knowledge.
• Develop and maintain flexibility.
• Develop self-confidence. decisiveness and integrity in
decision making.
• Walk, talk and look poised and confident (well groomed
and appearance as well as being assertive and gentle.
DEVELOPING YOUR LEADERSHIP ABILITY
• Develop and maintain alliances (focus
beyond yourself and listen, support,
provide feedback and coach).
• Develop your personal physical resources
(relax. rest. and have fun).
Other factors influencing your leadership style:
1. The size of the group.
2. The abilities, educational abilities of the group.
3. The structure of the organization.
4. The task to be accomplished.
5. The degree of stress in the situation or environment.
Assessing Your Effectiveness As A leader
1. Self Assessment of your own leadership and followership
characteristics.
2. Environment Assessment.
3. Identifying Role Models.
4. Trying out Leadership Styles: Experimentation with different
styles.
5. Evaluating Effectiveness are part of the ongoing process of
developing a good management style.
• All registered nurses, regardless of position,
must be prepared to function as leaders and
managers.
• Nurses must be prepared to function as a
leaders because:
1.They are responsible for coordinating and
managing care of patients.
2.Delegating task to subordinates, and
supervising the subordinates.
The End
Thank You