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UNIT 4
Leadership Styles and Management
Gordons Functional Health Pattern
Roles and Relationships
Leadership style and management
Objectives:
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Discuss the theories of management/motivational styles
Discuss the styles / types of leadership
Compare the types of nursing care delivery systems
Define efficient and effective
Describe 4 categories of client care priorities
Discuss the principles of work organization
Discuss the delegation of nursing tasks
Describe methods of effective communication, when
interrelating with clients, significant others and health team
members
– Describe the change of shift report
Leadership Styles & Management
• Required readings:
– Smeltzer & Bare: Chapter 1, 3
– -Zerwekh: Chapters 10,11,13,14,& 15
– CDROM (available in the Nursing Skills Lab)-Clinical Delegation & Nursing Roles (Graphic
Education Corp. 1997)
*****Do Case Studies at the End of this Unit
Syllabus Before Class
Leadership Styles & Management
• Roles of nurses: nursing is a service provided to
individual clients & to aggregates of people (families,
groups, communities, population).
– Roles overlap but must be distinguish.
– Nurses providers of direct care, educators, & managers
• Nursing management vs. nursing leadership
– Nursing management – for team of patients
• Coordinator of human & material resources in providing
care to patients
– Nursing leadership – process with 4 components:
• Decision making, relating, influencing, & facilitating
Leadership Styles & Management
• Leadership defined:
– Is the ability to influence other people
– Steven Covey – enables people to work more
effectively together in a state of interdependence
– 3 elements in definition: influence, groups & goal
– Effective nurse leaders inspire others to work
together to pursue a shared goal
• Pt care; cost-saving procedures
Leadership Styles & Management
• Management Defined
– S. Covey states effective managers are able to elicit
from employees “creativity, consistent excellent
productivity & maximum potential contribution
toward….continuous improvement of process,
product & service.”
• Comparison of Leadership & Management
– Management: formal authority to direct the work of
a given set of employees, & responsible for quality
of work & costs
• Effective manager needs to be good leader
• Reverse need not be true – you do not need to be a
manager to be a leader
Leadership Styles & Management
• Theories of management/ motivational styles
– Maslow’s
• Workers have a hierarchy of needs that drive them to
make choices in a predictable manner
– Theory X
• Employees avoid work because they dislike it
• The manager must control, direct, coerce & threaten
employees to get them to strive toward organizational
goals.
• Employees lack ambition and prefer to be directed
Leadership Styles & Management
• Theory Y
– Employees do not dislike work and remain
committed to goals
– Employees seek & accept responsibility, are selfmotivated and are innovative in solving job-rlated
problems
• Theory A
– Predominantly downward communication pattern
– Individual decision making
– Rapid evaluation & promotion
Leadership Styles & Management
• Theory Z
– Long term employment
– Open communication patterns
– Harmonious work group or consensus decision
making
– Slow evaluation & promotion
• Situational leadership
– Incorporates the needs of the work group & their
responses to the tasks to be done
Leadership Styles & Management
• Styles/ types of Leadership
– Authoritarian (autocratic, direct, controlling)
• Orders given; makes decisions for everyone in group;
responsible for the outcome; efficient; stifles creativity;
may be punitive or benign, closed system
– Laissez-faire (permissive, non-direct)
• Ultra liberal, lack of central direction or control; permissive
system
– Democratic (participative)
• People oriented; mutual responsiveness to meeting group
goals with work-related decisions made by the group;
fosters creativity; open system
Leadership Styles & Management
• Transformational Leadership: qualities
– Communicate vision, have a sense of mission,
has effective leadership qualities: integrity,
courage, initiative, energy, optimism  can
remotivate a discouraged group; “being a winner
rather than a whiner”; perseverance, balance in
their lives; ability to handle stress
– Behaviors:
think critically; identify & solve problems (client,
staff, paperwork problems), respect others; good
communication skills (listening to others,
encouraging info exchange)
Leadership Styles & Management
• Followers
– Effective followers – demonstrates selfmanagement skills, commitment to the agency’s
mission & goals, develops competence useful to
the organization; independent thinkers; trust their
own knowledge and judgment; insightful &
expresses concerns to superiors
– Nonproductive follower –
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Appliance nurse – in it for the money
Doomseyer – that can’t possibly work
Subversive – plots to defeat
Accommodator – always agrees
Types of Nursing Care Delivery System
Functional Nursing – the charge nurse makes assignments and gives
directions to all nursing personnel assigned to the nursing unit; the
primary purpose is to accomplish tasks with the greatest efficiency
making personal attention to client needs difficult.
Advantages
- Client care is provided in an economic and efficient manner
- Minimum number of RNs are required for client care
- Tasks are completed quickly and there is little confusion about job
responsibilities
- Cost effective and less staffing
Disadvantages
- Care may be fragmented, possibly overlooking priority client needs
- Clients may feel confused because of the many different care providers
- Caregivers may feel unchallenged and understimulated in performing
repetitive functions.
Types of Nursing Care Delivery
System
• Total Care – One nurse is responsible for planning,
organizing and delivery of care to a particular client or
group of clients during the assigned shift.
Advantages
- The nurse maintains a high degree of practice autonomy
- Lines of responsibility and accountability are clear
- Clients should receive holistic, unfragmanted care
- Clients assignment process is simple and direct.
Disadvantages
- Continuity of care may suffer because each nurse has
the right to modify the care plan and client may get
different approaches to care
- costly
Types of Nursing Care Delivery System
• Team Leading- an RN leads a group of health care
personnel in providing care for a group of 10-20 clients
during the shift.
Advantages
- Emphasizes holistic care, high quality comprehensive
care can be provided with a relatively high proportion of
ancillary staff
- Each team is able to participate in decision making an d
problem solving
- Each team member is able to contribute their own
special expertise or skills caring for the client
Disadvantages
- Time consuming, may cause undue workload and stress
for team leader
- Continuity of care may suffer if daily assignment of team
varies and client is exposed to many different caregivers.
Types of Nursing Care Delivery System
• Primary Nursing – an RN assumes 24 hour responsibility for
planning, directing, and evaluating client care from the time of
admission through discharge
Advantages
- Care provided by a few nurses allows for high quality, holistic client
care, increased client satisfaction, increased rapport with RN,
increased accountability, high job satisfaction (nurses have a high
degree of autonomy and feel rewarded & challenged)
Disadvantages
- Expensive, needs large number of RNs
- May be difficulty to recruit and train large number of RNs
- Inadequately prepared nursed may not make necessary clinical
decisions or communicate effectively with the health care team
- The RN may no be willing to accept 24 hour responsibility – RN
“emotional burn out”
Types of Nursing Care Delivery System
• Case Management – a model of care delivery, the nurse
case manager assesses, plans, implements,
coordinates, monitors and evaluates client care options
and services to meet health care needs
Advantages
- Maintains quality care while streamlining costs
- Client outcomes should be achieved within a specific
time frame
- Clients are linked to appropriate recourses and
coordinating service providers
Disadvantages
- The nurse may have a large case load
- Monitoring of health expenses may be more important
than quality of care
Types of Nursing Care Delivery System
• Client-Focused Care – services and staff are organized around
clients’ needs rather than hospital or a department orientation
Advantages
- Client comes into contacts with fewer workers
- The workers are unit-based and able to spend more time in direct
care than in transit between client care areas
- RNs functions at a high level because of being accountable for a
wider range of services to the client – expertise care
- Cost productive
- Increase in client, staff, and physician satisfaction
Disadvantages
- Major change is required in the health organization and health team
members
- Departments and nursing may have difficulty accepting shared tasks
- An increase in training, staff stress.
Effective & Efficient
• Effective – doing the right things
- Depends on the nurses assessment and
analysis of client needs – involves critical
thinking
Efficient – doing things right
- Depends on the nurses work organization and
ability to complete nursing activities smoothly
without excessive effort, time or resources
- Nurse provides client care without wasting time,
equipment, supplies or effort.
Categories of Client Care
• 1st – immediate threat
• 2nd – actual problem the client/family have
requested immediate help
• 3rd – actual or potential problems
unrecognized by client/family
• 4th – future anticipated actual or potential
problems
Principles of Work Organization
• Determine the short-term and long-term
goals of assigned clients
• Make a “things to do” list
• Time estimation
• Set limits
• Eliminate unnecessary steps
• Plan for the unexpected
Legal Aspects of Client Care
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Accountability
Charting
Incident report
Antidotal notes
Leadership Styles & Management
• Components of effective communication
– Information giving is not communication
– The sender is responsible for clarity
– Use simple & exact language
– Encourage feedback
– The sender must have credibility
– Acknowledging the contributions of others is
essential
– Direct channels of communication are best
Delegation of Client Care
• Delegation: entrusting the performance of selected
nursing tasks to competent persons in selected
situations “the transfer of responbility for the
performance of an activity from one individual to
another while retaining accountability for the
outcome” (ANA, 1992).
– Accountability for the task/process remains with the
delegator.
– Direct delegation = “verbal direction by the RN delegator
regarding an activity or task in a specific nursing situation”
– Indirect delegation = “ an approved list of activities or tasks
that have been established in policies & procedures of the
health care institution or facility”
Delegation of Client Care
• Delegation to unlicensed assistant personel (UAP’s)
– Individuals who are trained to function in assistive role to the RN in
providing care to the clients as delegated & supervised by the RN
• Vital signs, bathing, making beds, transportation
• Supervision – is more direct, overseeing the work
• Chain of command
• Nursing Process & Delegation:
– Assessment: must assess each client’s needs, set specific client
goals, and match skills to assigned patients
– Plan: align staff to patients which are best suited, with knowledge &
skill level to handle the patient – UAP’s, LVNs, RNs, RT/PT/PTA
– Implementation: assign tasks to appropriate person
– Evaluation: nurse oversees & determines if clients needs have been
met
Delegation of Client Care
• 5 rights of delegation:
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Right task
Right circumstance
Right person
Right direction/ communication
Right supervision/evaluation
Organize the workload – fairness
Processes –
Assess the clients’ needs
Grasp the situation as a whole
Determine what needs to be done
Subdivide the whole into manageable parts
Assign tasks so that cooperation is reciprocal; high standards
of conduct and performances are maintained; sound
decisions are made; team is assisted to grow; set goals.
Evaluate performance and reassess client
Communications
• Establish a positive environment
No hallway confrontations, no loud arguments in public
work areas, listen empathetically, pause to reflect,
handle criticism, present your response frankly and
assertively
• Effective communication
More than just words – tone of voice, choice of words,
facial expressions, gestures – validate nonverbal cues
must interchanges, try to understand others
common barrier – preconceived ideas, opinions and
beliefs, abstract terms, lack of clarifications, use of
persuasion.
• Deal with rumors.
Communications
• Resolving Confilict
Learn to recognize and name a conflict,
separate the person from the problem,
use visual images to decrease anxiety,
obtain and give information assertively,
establish mutual goals, summarize what
was agreed upon
Communications
• Change of Shift Report
Purpose is to provide continuity of care
1. Change of shift report should be:
Comprehensive, descriptive, objective, factual, concise,
started on time, delivered in an organized manner.
2. Change of shift report should include (but not limited to)
client’s demographics, expected outcomes, treatment
plan, equipment, changes in condition with related
nursing interventions, medications – response, tests &
procedures/on past shift/orders for oncoming shift –
including 8 or 12 hours orders reconfirmation by the
oncoming and offgoing shift, mental status and activity
level, teaching plan, discharge plan.
Emphasis should be on reporting abnormal findings and
results.
Communications
• Change of shift report – should not
include:
Irrelevant vital sign, lab values, irrelevant
stories, repeated information found on
kardex and care plan, old information
(what happened last week, unless relevent
to present)