LEADERSHIP

Prepared by: Ms. Zielene Myrus T. Alzo, RN, MAN

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

Great Man Theory

it explains that leaders are born and not developed because some people are born to be great leaders and not as subordinates. They were born with the capacity to persuade, influence and motivate others. To be a leader under this theory, experience or skill that you may develop through the years is not an utmost consideration, if you were already born as one.

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.

Five kinds of leaders under this theory:

1. Natural leader he/she does not seek the role but the group thrusts the leadership upon him/her by the tide of events

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.

Transformational Leadership theory

gives emphasis on the members values and commitment to service it depends on group empowerment to achieve a goal

Transcultural Leadership Theory

gives emphasis to written or documented policies, rules and regulations in influencing a group

Path-Goal Theory
effective leadership style provides a path for members in attaining their common goal

Life Cycle Theory

In this theory, the leader assesses the capacity of the followers to complete the task assigned and provides the leadership behavior that would best meet the needs of the followers in a given situation.

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

Different Styles of Leadership

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

DEMOCRATIC, PARTICIPATIVE OR CONSULTATIVE LEADERSHIP

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

Permissive, Ultraliberal, or LaissezLaissez-faire Style of Leadership

Let alone style of leadership avoids responsibility by relinquishing power to subordinates Permissive climate: He permits his followers to engage in managerial activities such as decision making, planning, structuring the organization, setting goals, and controlling the organization.

 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.

Intrinsic versus Extrinsic Motivation

Intrinsic motivation comes from within the person driving him to be more productive Extrinsic motivation enhanced by the environment or external rewards come in the form of promotions, increases in salary, added benefits, or external rewards

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.

Powers exercised by a leader:

POWER the ability to impose the will of one person or group to bring about certain behaviors in other persons or groups ones capacity to influence 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

Skills/ Qualities of a Leader

A. AUTHORITY
It is the legitimate right of a leader to exact obligations from his subordinates.

Accountability vs. Responsibility

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.

2 Ways of Delegating Authority:

Centralized Authority: the authority is solely vested to people occupying administrative or top-level positions. Decentralized Authority: the leader delegates authority to the operational level or ordinary personnel. It encourages full participation, better communication and relationship in a group.

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

5. Delegate in advance 6. Consult before delegating 7. Avoid gaps and overlaps

Four Rights of Clinical Delegation

1. Right Task Basis: Nurse Practice Act Employee Job Description Skills Checklist Demonstrated competency

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

Right Task: Can you delegate the following tasks?

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.

Some positive behaviors of a leader include the following:

Vision integrity patience passion direction and purpose ability to motivate ability to listen trustworthy critical thinker intelligence self-confidence flexibility

C. COMMUNICATION

It is the transfer of information with understanding from one person to another.

Phases of Therapeutic Relationship:

1. Pre-interaction occurs prior to any initial contact with a client all relevant and necessary information related to a certain client are collected and reviewed prior to any initial meeting

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

Elements of Communication Process:

a. b. c. d. e. f. g. Sender/ Encoder Message Encoding Actual Transmission of Message Receiving Decoding Feedback

Barriers to Effective Communication

Psychological Barriers Environmental Barriers Disinterested Listeners Semantic Barriers Physical Barriers Difference in the dialect or overuse or technical/medical terminologies

Principles of Effective Communication:

1. Clear lines of communication serve as the linking process by which parts of the organization are unified toward goal achievements. 2. Simple exact and concise messages ensure understanding of the message to be conveyed. 3. Feedback is essential to effective communication. Mutual interaction is required.

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.

Four Dimensional Flow of Communication in Nursing Care

UPWARD
To Superior

HORIZONTAL
To Peers and Members of the Health Team

OUTWARD
To Patient, Family and Community To Workers Family and Friends

DOWNWARD
To Subordinates

Four Dimensional Flow of Communication in Nursing Care

1. Downward Communication the traditional line of communication is from superior to subordinate which may pass through various levels of management the communication is primarily directive and activities are coordinated at various levels of the organization communication aims to impart what the personnel need to know, what they are to do and why they are to do these

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

Decision Making Process

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

Common Approaches to Management of Conflict/ Conflict Resolution

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.

RECORDS AND REPORTS

Records contain data or information that may be used for decision-making, recommendations or as a basis for the management of the unit and patient care

Points in Record Keeping:

1. Records should be accurate, adequate and up to date 2. Records should be clear, brief and concise 3. Records should provide relevant facts for evaluation and study 4. Records and reports may be temporary or permanent

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.

Guidelines for Good Reporting and Documentation

Factual Accurate Confidential Complete Current

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

Example: December 12, 2011 3:20 pm

Discontinue IV infusion when consumed

Telephone order by Dr. J. V. Santos/

D. J. Roxas, RN Staff 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.

Forms for Nursing Documentations:

1. Nursing Health History and Assessment Worksheet a special form completed by the nurse when the patient is admitted to the unit contains biographical data, present illness, past health history, family health history, and physical assessment, including nursing diagnosis on admission.

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

THANK YOU! GOD BLESS FUTURE RNS!