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LEADERSHIP
Leading as defined in Webster Dictionary means to guide, to go before and show the way Leadership in nursing is necessary to guide nursing personnel to a specific goal, that is, the provision of quality nursing care tot heir patients. Leadership is the art of developing people. Ability to influence others to the attainment of goals. An interpersonal ability to cause others to respond, not because they have to/ but because they want to.
It is a style or a process of persuading and inducing a group of people, usually his followers to attain a desired objective.
Elements of Leadership:
Leader person who influences his/her members. Followers members, who are duty-bound to follow leaders orders and give respect to him. Group includes both the leader and the members. Process the means, style, formula, policies used by both the leader and his followers for the achievement of a common goal. Goal the purpose, objective or reason of the group.
Two types of leaders according to appointment: Formal leader Informal leader Nurses who were promoted as unit managers based on their qualifications are examples of formal leader. While persons who exercise leadership functions but not formally appointed or elected are examples of an informal leader.
Characteristics:
L lead, love, learn E enthusiastic, energetic A assertive, achiever D dedicated E effective, efficient R responsible, respectful
Theories in Leadership
Trait Theory
it states that a person can be a good leader if he has the basic characteristics of a leader. He must have the personality, intelligence and abilities of an effective leader. Acquisition or development of said traits are important in becoming a good leader.
Charismatic theory
a good leader is one who has charisma, charm, inspirational quality, devotion or referent peer. Only some people has this power to make others feel better with their socalled charisma.
Situational Theory
It is a theory that states that a person can be a good leader in one situation but only a follower in another situation. case to case basis of leadership leadership is a relationship between the leader, his followers and the situation arising There is no exact leadership style, but as the situation so demands.
2. Charismatic Leader an authentic hero in the eyes of his followers to them he/she can do no wrong he/she inspires people to make sacrifices for the cause they represent 3.Rational Leader consistent and persistent in what he/she thinks is right
4. Consensus Leader who perceived to be acceptable to all 5. Leader by force dominates by force and fear; contains within itself the seeds of selfdestruction; ex. Hitler
Contingency Theory
A nurse can be a leader if she can immediately resolve a sudden crisis, emergency or critical situation. Introduces leadership utilizing three important dimensions; such as leader-member relations, task structure and position-power.
Path-Goal Theory
effective leadership style provides a path for members in attaining their common goal
Theory Z
Theory Z by Ouchi enlarges upon Theory Y and the democratic approach to leadership. This theory has a humanistic viewpoint and focused on developing better ways of motivating people.
a. b. c. d. e.
Collective decision making Long term employment Slower promotion Indirect Supervision Holistic Concern
AUTOCRATIC LEADERSHIP
sometimes called directive or bureaucratic the autocratic leader functions with high concern for task accomplishment but low concern for the people who perform these tasks (productivity) subordinates do not feel free to discuss their job with their superior
gives orders and expects adherence to policies and procedures. Subordinates are expected to follow without question centric because the leader makes decision for the group; he or she is the center of attention also called Theory X by Mc Gregor; boss-centered effective in crisis situations
People oriented Focuses on human aspects and builds effective teamwork Interaction between the leader and subordinates is open, friendly, and trusting allows governance through group participation in decision-making
Consultative style of leadership open communication prevails. Performance standards exist to provide guidelines and permit performance appraisal Theory Y; the leader considers workers as ambitious the democratic leader is also called radic leader
The leader is ultra liberal workers lack central direction and control effective in highly motivated professionals, like those in research, where independent thinking is rewarded.
Motivation
Motive
a need or desire that incites and directs a persons actions a force within the individual that influences strength or direction of behavior (Mills)
In setting a motivating climate, the manager must create conditions that encourage interdependent work; a competitive environment that recognizes and rewards work well done. He/ She provide guidance and counseling for those who need such, finds solutions rather than avoid problems.
Motivational Theories
Need Theory
1. Abraham Maslows Hierarchy of needs people are motivated to satisfy certain needs beginning from physiological needs to complex psychological needs.
2. The Two-Factor Theory developed by Frederick Herzberg Hygiene Factors: relate to the working conditions such as salary, quality of supervision, job security, interpersonal relations policies, and supervision.
These are growth-producing motivations and prevent lost productivity due to dissatisfaction and called as dissatisfiers. Motivating factors relate to the job itself and include opportunities for growth and development and advancement; added responsibilities, challenging aspects of work, recognition, and achievement; these are satisfiers.
3. McClellands Three Basic Needs Theory developed by David McClelland three basic needs: achievement, power, and affiliation
Expectancy Theory
developed by Victor Vroom expectancy is the perceived probability of satisfying a particular need based on past experience managers need to provide specific feedback about position and performance
Operant Theory
developed by B.F. Skinner suggests that an employees work motivation is controlled by conditions in the external environment instead of internal needs and desires
ex. A head nurse reprimands a staff nurse for failure to put a side rail on the bed of an elderly confined patient, the nurse will likely put side rails to all elderly confined patients.
Equity Theory
developed by Jo Stacy Adams assess fairness by considering their input and the psychological, social and financial rewards in comparison with those of others.
Legitimate Power the power vested upon a leader in relation with his position or rank. Sanction by the institution itself Expert Power the power to control a group utilizing ones extra-ordinary or exceptional knowledge or skill which is not ordinarily observed with other staff
Referent Power Based on special character and personality that empowers him to acquire the admiration and respect of members to achieve their respective goals and functions.
Connection Power ability to influence others due to linkage to influential people. Reward Power Positive power of a leader to compensate or remunerate the achievements of his staff Coercive Power Fear, threat or duress is used to gain control negative power exercised by a leader to force others to follow him
A. AUTHORITY
It is the legitimate right of a leader to exact obligations from his subordinates.
Responsibility is the personal or professional obligation and dependability to perform a specific task. Accountability is the legal liability arising from any omission or improper performance of any task or responsibility.
Delegating
Process by which a manager assigns specific tasks/ duties to workers with commensurate authority to perform the job. The worker assumes responsibility for its satisfactory performance and is held accountable for its results
2 criteria of paramount importance in delegation: Ability of the worker to carry out the task Fairness not only to the employee but to the team as a whole
Principles of delegation
1. Select the right person to whom the job is to be delegated 2. Delegate both interesting and uninteresting tasks 3. Provide subordinates with enough time to learn 4. Delegate gradually
Do Not Delegate
Jobs that are too technical and those that involve trust and confidence Authority to sign ones name Responsibility for maintaining morale Evaluating the staff or taking necessary corrective or disciplinary action Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit
Foley catheter insertion Taking vital signs Feeding a patient Hygienic care Medication administration Discontinuing an IV line Teaching insulin administration
2. Right Person FOCUS ON OUTCOMES Patient: Mr. Y Outcome: Patient will be clean Task/ Process: Bath Who will Perform it: Nursing assistant or other care associate
3. RIGHT COMMUNICATION Clear: Does the team member understand what I am saying? Concise: Have I confused the direction by giving too much unnecessary information? Correct: Is the direction according to policy, procedure, job description, and the law? Complete: Does the delegate have all the information necessary to complete the task?
4. RIGHT FEEDBACK Youve just noticed that the night shift Mario didnt chart the I and O on three patients on your coronary care unit. Youve called him and are thinking about how to discuss this with him in a positive manner, yet you know that he isnt going to want to chat since it is about for him to rest.
Supervision
means to inspect to guide, evaluate, and improve work performance of employees through a criteria against which the quality and quantity of work production and utilization of time and resources are made.
Supervisory techniques
1. Observation of the worker while making her rounds 2. Spot checking of charts through nursing audits 3. Asking the patients about the care they receive 4. Looking into the general condition of the units
5. Getting feedback from co-workers or other supervisors or relatives 6. Asking questions discretely to find out the problems they encounter in the wards 7. Drawing out suggestions from the workers for improvement of their work or work situation
FINALS
B. BEHAVIOR
Behavior affects leadership. It is required that a leader must possess a behavior which is group-centered.
C. COMMUNICATION
2. Orientation the stage where the caregiver and the client establishes rapport and trust they get to know each other better
3. Interaction/Working one listens, understands and gives necessary feedback to client as a means to show empathy and respect 4. Termination the client resolves his problems and conflicts resulting to an actual fulfillment of ones goals
4. Communication thrives best in a supportive environment which encourages positive values among its personnel. 5. A managers communication skill is vital to the attainment of the goals of the organization 6. Adequate and timely communication of work related issues or changes that may affect jobs enhance compliance.
HORIZONTAL
To Peers and Members of the Health Team
OUTWARD
To Patient, Family and Community To Workers Family and Friends
DOWNWARD
To Subordinates
2. Upward Communication this is usually in the form of feedback to show the extent to which the downward communication has been received, accepted, and implemented subordinates may not have the ability to express their thoughts or may be too shy to express them
3. Horizontal or Lateral Communication flows between peers, personnel or departments on the same level it is used most frequently in the form of endorsements, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services
4. Outward Communication deals with information that flows from the caregivers to the patients, their families, relatives, visitors and the community patients should understand the nature of their illness, the medical and the prescribed nursing plans of care so that they could participate in the decisions regarding these
Decision Making
Decision
a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result it involves a choice utilizing mental processes at the conscious level and is aimed at facilitating a defined objective
decisions at the unit level usually pertain to everyday problems which may have routine answers or which the Supervising Nurse and Head Nurses may have learned to solve through experience
Types of Decisions
1. Considered Decisions require interaction with others because the perceptions and the ideas of other people often provide multiple alternatives that help in approaching the problem situation
2. Operational Decisions those we make practically everyday. Some of these decisions may be made at approximately the same time each day and they may prevent problems as well as solve them
3. Swallow-hard Decisions those that are often personally uncomfortable to make because they may result in discomfort or uneasiness for subordinates or others.
4. Ten-second Decisions those we make during daily operation they are the decisions that bring operation together, keep it ready, alive and running well
1. Definition of the Problem 2. Analysis of the problem 3. Development of an alternative solution 4. Selection of solution 5. Implementation 6. Evaluate the results
E. ETHICAL
To be an ethical nurse, he/she must have a good manners and right conduct. Nurses should have an appropriate behavior, morality and conscience in guiding and motivating other members of the team to function conscientiously.
F. SOLVING CONFLICT
Conflict clash between two opposing and oftentimes hostile parties a warning to manger that something is wrong and needs solution through problem solving and clarification of objectives, establishment of group norms, and determination of group boundaries
Sources of Conflicts
Intrapersonal occurs within the person Interpesonal occurs between two individuals Organizational/Interdepartmental occurs between two or more groups, departments, units
1. Avoidance The method commonly used by groups who do not want to do something that may interfere with their relationships Neutrality is maintained at all costs No acknowledgement of a conflict
This method may be appropriate when more information is needed to solve the problem, when it is appropriate for others to solve the problem, or when one wishes to reduce tension and gain composure
2. Accommodation Self-sacrifice Focuses on points of agreement and on minor problems although the real problem stall exists and has to be attended to
The person neglects his own needs to meet the goals of the other party. It is appropriate when the person is wrong, when the opponent ismore powerful or when the issue is more important to someone else Used to preserve harmony and gain social credits that can be used later
3. Collaboration Inspires attention to the problem and utilizes the talents of all parties Focuses on problem-solving to find mutually satisfying solutions Useful in situations where the goals are too important to be compromised
Problems are identified, alternatives are expected, and threats are considered until disagreements are resolved Most effective method of conflict resolution
4. Compromise Both parties seek expedient, acceptable answers for short periods when met goals are only moderately important and the parties have equivalent power Because both parties feel that they sacrifice something, they are only partially satisfied and a lose-lose atmosphere results.
5. Competition The supervisor or nurse manager exerts power at the subordinates expense Expressed though the suppression of conflict through authority-obedience approach Enforces the rule of discipline An assertive position that fosters conflict resolution on the part of the subordinate
6. Smoothing Disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence This may be appropriate in solving minor problems but issues also remain unsolved and may later resurface
7. Withdrawing One party is removed thereby making it possible to resolve the issue Produces same results as smoothing Issues also remain unsolved and may later resurface
8. Forcing A method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved may be appropriate in life or death situations but is otherwise inappropriate.
5. Records forms that are used for recording purposes must be maintained at all times 6. Confidential records and reports should be safeguarded 7. Dry, sturdy storage for records must be provided 8. Records should be filed chronologically and by subjects to facilitate accessibility and effective use of data 9. A property trained responsible person should be assigned in keeping records and reports
Reports
exchanges of information between nurses and/or members of the health team through oral, taped or written.
Types:
1. Change of Shift Report a system of communication aimed at transferring essential information and holistic care for patients purpose: to provide continuity of patient care for 24 hours
Oral Report: prior to the nursing rounds, a preconference is made at the nurses station or Conference Room Audio-tape report: made by the outgoing nurse and is replaced by the incoming nurse Nursing Rounds: made at the patients bedside patients care plan is discussed
2. Telephone Reports and Orders legal risks: these may be misunderstood or misinterpreted by the receiving nurse
3. Transfer Reports patients may be transferred from one unit to another as their condition or case warrants
Example: A patient from the Medical Ward diagnosed to have bleeding peptic ulcer, may be transferred to the Surgical Department for further management proper referral and assessment of a surgeon.
2. Graphic Flowsheets are forms that allow nurses to record specific measurements or observations on a repeated basis Example: TPR sheet
3. Medicine and Treatment Record contains all medications and treatments given on a repeated basis
4. Nursing Kardex a flip-over card information is organized in a useful manner which has two parts: an activity and treatment section and a nursing care plan section information found in the kardex: basic demographic data, medical diagnosis, current physicians orders to be used in client care, and factors related to activities of daily living
5. Discharge Summary a special progress report that helps ensure that a clients discharge results in desirable outcomes