Ch.2 Nursing Leadership and Management, Nursing Leadership and Management (Chapter 1)

What are the *3 Managerial Roles*

*1) Information-processing role* is used to manage the information needs people have. --Monitoring, Disseminator, Spokesperson *2) Interpersonal role* is used to manage relationships with people --Figurehead, Leader, Liaison *3) Decision-making role* is used to take action when making decisions --Entrepreneur, Disturbance handler, Resource allocator, Negotiator

1) *Leader-member relations* (Fielder's Contingency Theory)

*1) Leader-member relations* are the feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader. --*Good* leader-member relations exist when followers respect, trust, and have confidence in the leader. --*Poor* leader-member relations reflect distrust, a lack of confidence and respect, and dissatisfaction with the leader by the followers.

Name and describe the *4 selected Motivation Theories*

*1) Maslow: Hierarchy of Needs* --Motivation occurs when needs are not met. Needs of one level (physiological, safety, social, self-esteem, self-actualization) must be satisfied before one is motivated by needs at the next level higher level of needs. *2) Two-factor theory* (Herzberg) --Hygiene-maintenance & Motivator Factors contribute to job motivation/satisfaction of work *3)* *Theory X* and *Theory Y* --*Theory X* states that leaders must direct and control because motivation results from reward and punishment. --*Theory Y* says that leaders must remove obstacles because, under the right work conditions, workers have self-control and self-discipline. *4) Theory Z* --Humanistic style of motivation valuing collective decision making, mentoring, and holistic concerns

What is the difference between a *transactional leader* and a *transformational leader*?

*1) Transactional leaders* are the traditional managers concerned with the *day-to-day operations*. *2) Transformational leaders* are committed to a vision that *empowers others*.

List the *3 behavioral theories* of leadership

*1)* Autocratic *2)* Democratic *3)* Laissez-faire

List the *2 contingency theories* of leadership

*1)* Fielder's Contingency Theory *2)* Hersey and Blanchard's Situational Theory

List the *4 types of management theories*

*1)* Scientific Management *2)* Bureaucratic Management *3)* Administrative Management *4)* Human Relations

What are the *3 levels of management*?

*1)* Top-level (Executive-Level) managers *2)* Middle-level managers *3)* First-level managers

List the *contemporary approaches* to leadership

*1)* Transformational theory *2)* Servant leadership

2) *Task structure* (Fielder's Contingency Theory)

*2) Task structure* refers to the degree to which work is defined, with specific procedures, explicit directions, and goals. --*High* task structure involves routine, predictable, clearly defined work tasks. --*Low* task structure involves work that is not routine, predictable, or clearly defined, such as creative, artistic, or qualitative research activities.

3) *Position power* (Fielder's Contingency Theory)

*3) Position power* is the degree of formal authority and influence associated with the leader. --*High* position power is favorable for the leader --*Low* position power is unfavorable

What is the *autocratic* behavioral theory of leadership?

*Autocratic* leadership involves *centralized decision making*, with the leader making decisions and *using power to command and control others*. -Associated with high-performing groups, but close supervision is necessary, and feelings of hostility are often present.

What is the *democratic* behavioral theory of leadership?

*Democratic* leadership is participatory, with *authority delegated to others*. To be influential, the democratic leader *uses expert power and the power base afforded by having close, personal relationships*. -Engenders positive feelings in their groups, and performance is strong whether or not the leader is present.

*Management* vs *Leadership*

*Management* emphasizes *control* of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies. *Leadership* increases productivity by maximizing workforce *effectiveness*

Characteristics of *management* include:

-*Assigned position* -*Legitimate source of power* -*Carries out specific functions*, duties, and responsibilities -*Emphasizes control*, decision making, decision analysis, and results -*Manipulate people*, the environment, money, time, *and other resources* to achieve organizational goals -Have *greater formal responsibility and accountability* for rationality and control *than leaders* -*Direct willing and unwilling subordinates*

*Managers*

--Are always *assigned a position* within an organization --Have a *legitimate source of power* due to the *delegated authority* that accompanies their position --Are expected to *carry out specific functions* --*Emphasize*: Control, decision making, decision analysis, and results

*Leaders*

--Often *do not have delegated authority*, but obtain their power through other means --Have a *wider variety of roles* than managers --Are *frequently not part of the formal organization* --*Focus*: Group process, information gathering, feedback, and empowering others

Leadership tips (part 2 of 3)

-Always admit if there is a problem and make a commitment to "fix" it. Be willing to acknowledge that if there is a problem in the organization you want to know about it to be able to correct the issue. -A "good nurse" does not necessarily make the best supervisor. Supervisors and managers need to have and/or be willing to develop additional skill sets.

Leadership tips (part 1 of 3)

-Always be willing to listen to another point of view -Listen, consider, and respond respectfully. If possible, find a compromise solution. People want acknowledgement that they are being heard and their opinions are being considered. -Don't hesitate to seek the input and comments of others about your ideas or to review your work product. "Two heads are better than one."

What *functions of management* define the *management process*?

-Controlling -Planning -Organizing -Staffing -Directing -Creative problem solving

Leadership tips (part 3 of 3)

-Follow-up on what you say you will do. People will remember. -Develop a "customer-service" focus and know who your customers are.

Leadership *traits*

-Guiding vision -Passion -Integrity -Self-confidence -Determination -Intelligence -Sociability -Visionary -Resource -Experience -Humility -Have high standards -Value education -Value professional development -Demonstrate power in the organization -Active in a professional organization -Model learned beliefs and practices as they mentor other nurses

What are *First*-level managers?

A First-level managerial role or function in health care organizations is the *nurse manager at the clinical bedside*. First-level managers spend the *majority of their time directly managing patient care* and *supervising others as they deliver care*. --Concerned mainly with technical skills and their vision is focused on today.

*Formal* leader

A person is *in a position of authority* or in a sanctioned, assigned role within an organization *that connotes influence*, such as a clinical nurse specialist.

What is *leadership*?

A process of influence by which the leader influences others *toward goal achievement*

Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? A.Trait B. Chaos C. Bureaucracy D. Organizational

ANS: A Correct: Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? A. Referent B.Legitimate C. Information D. Connection

ANS: A Correct: Referent power comes from the followers' identification with the leader Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her.

An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a.Autocratic b.Democratic c.Laissez-faire d.Referent

ANS: A Correct: The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency.

A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? A.Transactional B. Situational C. Transformational D. Contemporary

ANS: A Correct: The transactional leader is concerned with the day-to-day operations of the facility.

A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? A. Transformational B. Transactional C. Laissez-faire D. Authoritative

ANS: A Correct: Transformational leaders mentor followers through a vision and are admired and emulated.

In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance

ANS: A Correct: Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider chang

According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? A. Bureaucracy B. Closed systems C. Open systems D. Trait

ANS: A Correct: Weber's concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization.

Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (Select all that apply.) A. serving on interdisciplinary care teams. being competent to work in several areas independently when dictated by patient census. B. attending a meeting to plan advanced training for unlicensed assistive personnel. C. evaluating outcomes of care that are reported to a standing committee. D. managing units with higher acuity, shorter length of stay, and more diverse patients and staff.

ANS: A, C, D, E Correct: a. The new nurses will be placed in many situations that require leadership and management skills: for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and require complex interventions delivered during shorter stays with an ever-increasing diverse staff. c. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. d. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. e. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.

The illustration below identifies which type of chart? A. Productivity B. Organizational C.Resource D. Staffing

ANS: B Correct: An organizational chart is a visual picture of an organization that identifies lines of communication and authority. Incorrect: a. Productivity is the amount of output or work that is produced with a specific quantity of input or resources. c. Resources include personnel, time, and supplies needed to accomplish the goals of an organization. d. Staffing is the manpower needed to complete the work.

The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions.

ANS: B Correct: The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision-making and problem-solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation.

A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? A. Expert B. Legitimate C. Connection D. Reward

ANS: C Correct: Connection power results from knowing or associating with power people such as the upper administration.

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. This stage of Lewin's change is: A. unfreeze. B. moving. C. refreeze. D. resistance.

ANS: C Correct: In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation.

Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a.Informal b.Expert c.Coercive d.Reward

ANS: C Correct: Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished.

An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? A. Rewards B. Coercion C. Expert D. Legitimate

ANS: C Correct: Seven primary sources of power are known. Expert power is based on knowledge, skills, and information.

A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? A. Transactional B. Clinical consultant C. Corporate supporter D. Autocratic

ANS: C Correct: The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement.

One difference between a leader and a manager is that a: a.leader has legitimate authority. b.manager motivates and inspires others. c.manager focuses on coordinating resources. d.leader focuses on accomplishing goals of the organization.

ANS: C Correct: The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.

2. A nurse asks, "What is meant by 'internal' customers?" The correct response is: (Select all that apply.) A. Insurance companies B. Accreditors such as The Joint Commission C. X-ray technicians D. Clinical pharmacist E. Chief financial officer

ANS: C, D, E Correct: c. Internal customers are employees of an organization at all levels. An x-ray technician is an example of an internal customer. d. Internal customers are employees of an organization at all levels. A clinical pharmacist is an example of an internal customer. e. Internal customers are employees of an organization at all levels. A chief financial officer is an example of an internal customer.

Which action represents the key management function of strategic planning? A. Determining that all nurses on the unit understand the current organizational philosophy B. Evaluating the communication process between the pharmacy and the nursing departments C. Monitoring data from the quality management initiative related to the last three orientation programs D. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

ANS: D Correct: A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future.

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? A. Directing B. Planning C. Organizing D. Controlling

ANS: D Correct: Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality.

A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? A. Send memos to all staff except the upset nurse to invite them to a luncheon. B. Ask management to transfer the upset nurse to another unit. C. Assign the upset nurse to committees that do not directly affect that nursing unit. D. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

ANS: D Correct: The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members.

A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? A. Coercive B. Transformational C. Laissez-fair D. Legitimate

ANS: D Correct: The coordinator of the committee has an official position within the organizational committee.

A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? A. Every morning at shift change, thank each employee for an excellent job. B. Rotate a monthly "employee recognition award" among all employees on the unit. C. Wait until the annual performance review to recognize accomplishments. D. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

ANS: D Correct: To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.

*Informal* leader

An individual who *demonstrates leadership outside the scope of a formal leadership* role or *as a member of a group* rather than as the head or leader of the group.

What is *Bureaucratic Management*?

Bureaucratic management *emphasizes impersonal relations within a formal structure*. --Competence is the basis for hiring and promoting an employee, and *decisions are made in an orderly and rational way* based on *rules and regulations*. --There are *clear superior-subordinate communications and relations*, based on positional authority, in which *orders from the top are transmitted down through the organization via a clear chain of command*.

What are *contemporary approaches* to leadership?

Contemporary approaches to leadership *address the leadership functions necessary to develop learning organizations*.

What are *contingency theories* of leadership?

Contingency theory acknowledges that *other factors in the environment influence outcomes as a much leadership style*. -The premise is that *different leader behavior patterns will be effective in different situations*.

What is *emotional intelligence*?

Emotional intelligence (EI) is a component of leadership and *refers to the capacity for recognizing your own feelings and those of others*, for motivating yourself, and for *managing emotions well in yourself and in your relationships*. --...a different type of intelligence. *It's about being "heart smart,"* not just "book smart."

How can I develop *emotional intelligence*?

Emotional intelligence (EI) is developed through *five key skills*: *1) Lessen your stress* *2) Understand your emotions* through self-awareness and self-regulation *3) Connect with others through nonverbal communication*, express empathy, and improve on social skills *4) Use humor* *5) Resolve conflicts*

What is *Fielder's Contingency Theory*?

Fielder's Contingency Theory is credited with the development of the contingency model of *leadership effectiveness*. Fielder's theory of leadership effectiveness views the pattern of leader behavior as *dependent upon* the* interaction of the personality of the leader* and the *needs of the situation*.

What is *Hersey and Blanchard's Situational Theory*?

Hersey and Blanchard's Situational Theory *addresses follower characteristics/readiness in relation to effective leader behavior*. *Follower readiness*, called maturity, is assessed in order to select one of four leadership styles: *1) Telling leadership* (high task, low relationship) *2) Selling leadership* (high task, high relationship) *3) Participating leadership* (low task, high relationship) *4) Delegating leadership* (low task, low relationship) --Use of these four leadership styles helps a nurse manager assign work to others.

What is *Human Relations Management*?

Human relations management *focuses on empowerment of the individual worker* as the source of control, motivation, and productivity in meeting the organization's goals. Emphasizes that *group decision making increases worker autonomy and provides training* to improve work. *Emphasizes employee morale*

What are *knowledge workers*?

Knowledge workers, as defined by Peter Druker, are *those who bring specialized, expert knowledge to an organization* and are considered leaders in the organization. They are valued for what they know.

What is the *laissez-faire* behavioral theory of leadership?

Laissez-faire leadership is *passive and permissive*, and the *leader defers decision making*. -Associated with low-productivity and feelings of frustration are found within their groups.

What is *management*?

Management is defined as *a process of coordinating actions and allocating resources* to achieve organizational goals. --Effective management can be viewed as the art of accomplishing things through people.

What are *Middle*-level managers?

Middle-level managers, *often called nursing unit managers* or *nursing directors*, spend *less time in direct supervision* and *more time in other managerial roles* or functions, particularly, planning and coordinating. --Concerned with many aspects of management and their vision is 1-year.

What is *Scientific Management*?

Scientific management emphasizes the area of *focus on productivity*. --Underlying theme is that the *organization is a machine to be run efficiently* to increase production and culminates in "one best way" of carrying out work.

What is *Servant leadership*?

Servant leadership focuses on *putting the needs of others above all else* as the number one priority. --Characteristics include: listening, empathy, awareness, persuasion, foresight, stewardship, growth, and building community. --This is most often *seen in the nurse-patient relationship*, and through a commitment to growth, nurses help patients grow as individuals.

What is Fielder's Contingency Theory contingent upon?

The needs of the situation or how favorable the situation is toward the leader *involves*: 1) *leader-member relationships*, 2) the degree of *task structure*, 3) and the leader's *position of power*. --When all of these dimensions (leader-member relationships, task structure, and position power) are high, the situation is favorable for the leader. --This approach can help match the needs of the organizational situation with the most favorable leadership style for the situation.

What are *Top*-level (*Executive*-Level) managers?

Top-level (Executive-Level) managers are concerned with *planning and generalizing at the highest levels* of an organization. Direct supervision is *not* a major job requirement. Nurses in these roles usually carry the title of *Chief Nurse Executive* or, in acute care hospitals, the title may be *Vice President of Patient Care Services*. --Concerned mainly with conceptual aspects and their vision is 5-years.

What is *Transformational theory*? (Contemporary approach to leadership)

Transformational theory is based on the idea of *empowering others* to engage in *pursuing a collective purpose* by working together to *achieve a vision of a preferred future*. --This kind of leadership can influence both the leader and the follower to a higher level of conduct and achievement that transforms them both.