CNUR 301

Nursing leadership

"Nursing leadership is about the competent and engaged practice of nurses, who provide exemplary care, think critically and independently, inform their practice with evidence, delegate and take charge appropriately, advocate for patients and communities, insist on practicing to their full and legal scope and push the boundaries of practice to innovative new levels." Can be task or relationship focused

Ability model and mixed model (EI)

Ability- 4 branched model, perceive emotion, use emotion to facilitate thought to understand emotions and manage emotions Mixed- mangage emotions and empathy, persistence, social skills, and motivation among others, associated with job performance and wellbeing, linked to resonant ls-work in tune with others, healthy work environment

4 phase process of appreciative inquiry

Discovery- appreciating, where individuals identify and share the best of what exists, dream- envisioning, group imagines what could be-shared vision, design- co-constructing , plans about what the organization needs to do to get to where they want, destiny- sustaining-translates plan into action steps and commits to implementation and evaluation of the new design/challenges

Emotional Intelligence vs Social intelligence

Emotional- Self-awareness: Knowing one's self Self-regulation: Managing one's self Motivation: Sentiments and passions that facilitate the attainment of goals Social- Empathy: Understanding of others and compassion toward them Social skills: Expertise in inspiring others to be in agreement

Empowerment and Advocacy

Empowerment: "a process of enhancing feelings of self-efficacy among organizational members through the identification of conditions that foster powerlessness and through their removal by both formal organizational practices and informal techniques of providing efficacy information" •Four main theoretical areas of critical social theory (Manias & Street, 2000): •Theory of false consciousness shows how a group of people may have a common set of false beliefs. •Theory of crisis requires people to look at how their dissatisfaction threatens the cohesion of a society. •Theory of education, in which individuals receive benefit from education. •Theory of transformative action, which involves making plans for change.

Beyond the nurse act: making a difference through advocacy

Florence Nightingale- policies, licensing exams, healthcare changes- errors Ethical imperative to engage in policy- core nursing values pt outcomes mapped to nursing care Nurse staffing- workload and hospital environment, culture MSK injuries- hand with care campaign-safe pt handing, TLR Failed advocacy- not protecting patients from harm, not reporting infection control- advocacy protections- refusal to engage, report staff concerns/ facility concerns-standards, safe harbour orally/forms, input from nurses-policies

Laissez-faire leadership

Little or no direction or supervision, weak support, doesn't address problem areas/empower others, let things happen, gain insight- sincerity, good listening skills, use humor, mentors - means of sharing knowledge, skills, attitudes, behaviours, encouragement, self knowledge, vision, affective communication, supporting and patient, kind, motivational, approachable, certifications, new, inexperienced/chose not to address issues, flexibility, effective when group members are highly skilled and motivated, routine is familar but decisions/ changes are not made, little/no direction/supervision, unproductive if group is inexperienced, opinion is offered only when requested

Comparing models of change

Nursing Process •Assessment •Planning •Implementation •Evaluation Lewin •Unfreezing •Movement •Refreezing Lippitt, Watson, & Westley •Diagnose problem •Assess motivation and capacity for change •Assess change agent's motivation and resources •Select progressive change objectives •Choose appropriate change agent role •Maintain change •Terminate helping relationships Havelock •Build relationship •Diagnose problem •Acquire resources •Choose the solution •Gain acceptance •Maintain and separate Rogers •Knowledge •Persuasion •Decision •Implementation •Confirmation

Authoritarian/ autocratic leadership

Person makes every decision without considering others input, negative reinforcement, punishment - blame, in emergency, leaders make all of the decisions-emergencies, useful when groups lack skill/knowledge but input is not considered, limits discussion of new ideas, mistakes are not tolerated, blame on individuals, does not promote communication/ teamwork

Collaboration according to the NICF

Role clarification- understand own roles and roles of others to establish goals, perform roles in culturally respectful way, communicate roles, skills and knowledge pt/client/ fam/ community- centered care- seek out, integrate, and value input/engagement-support, share info, listen respectfully to expressed needs team functioning- understand team work dynamics/processes to enable effective interprofessional collaboration-develop set of principles, facilitate discussions and interactions among members, participate and respect decision making, regularly reflect on functioning, healthy work rs, respect team ethics, collaborative ls- shared decision making, continued individual accountability, work with others to determine outcome, advancement of interdependent working rs, facilitation of team processes, environment of collaboration-co-creation, application of decision-making collaborative principles, inter professional communication- respectful, responsible, establish team work principles, actively listen to other team members, communicate to ensure common understanding of care decisions, develop trusting rs, use info and communication technology, inter professional conflict resolution- positively and constructively, recognize potential for conflict-know/understand strategies to deal with conflict, set guidelines for addressing disagreements- work to resolve, establish safe environment, develop level of consensus, complexity, contextual issues, quality improvement

Nursing leadership to address SDOH

SDOH includes living environment, socio-economic status, geographical location, social class, gap between levels of society Socioeconomic gradient- extending from top to bottom ranks of society- healthier at the top- better food, higher education, safer neighbourhoods, recreation, higher paying jobs and health care-protective factors, lower= higher stress= maladaptive physical responses and disease, affect developmental capacity, fall outside scope of HCP, nurses can bring aware and begin effective strategies Florence Nightingale- address economic, social and environmental factors- teach in nursing schools-experience in caring for ppl, consider individual, family and community- advocate for Transformational ls- identify needed change and inspire others to commit implementation of a new vision, motivate through vision, morality and credibility Structural change: economic strategies, tax policies, promote economic equity, education policy- living and working conditions: regulation of working environments to decrease hazardous exposure, management reform access to affordable housing, decrease community segregation, nutritious food-community interventions: volunteers, interventions to promote community health- health fairs/ educational programs, individual interventions: smoking cessation, affordable gym memberships Expanding role of nursing- interdisciplinary collaboration, advocate, educator

Social justice and advocacy

Social Justice: requires that all peoples, without discrimination, "have the right to live in dignity and freedom and to enjoy the fruits of social progress and should, on their part, contribute to it" •Advocacy refers to the act of supporting or recommending a cause or course of action, undertaken on behalf of persons or issues. It relates to the need to improve systems and societal structures to create greater equity and better health for all. Nurses endeavour, individually and collectively, to advocate for and work toward eliminating social inequities. •Advocacy for health encourages political, economic, social, cultural, environmental, behavioural, and biological factors that favour health rather than suppress health.

Task focused leadership styles

Transactional leadership- leaders explain expectations and reward good performance, correct departures from expectations and attempt to prevent future problems Laissez-faire- refuse to take responsibility, not concerned about outcomes/ follower's behaviors Manage by exception- provide correction when tasks are not completed appropriately Instrumental leaders- focus on strategy and expedition of outcomes Passive-avoidant leaders- avoid taking action until problems become serious and corrective action is needed Dissonant leadership- lack EI, negative without empathy

Accommodating conflict resolution style

Types of Accommodating- •Playing down the conflict to maintain surface harmony •Self-sacrifice •Yielding to the other point of view Results- Builds relationships that will allow you to be more effective in future problem solving •Increases the chances that the other party may be more accommodating to your needs in the future •Does not improve communication Appropriate When- You are flexible on the outcome, or when the issue is more important to the other party •Preserving harmony is more important than the outcome •It's necessary to build up good faith for future problem solving •You are wrong or in a situation where competition could damage your position •Accommodators may need to know that no matter what happens during the conversation, your relationship will remain intact. When dealing with accommodators, say, for example, "This will not affect our relationship or how we work together."

Collaborating conflict resolution style

Types of Collaborating- Maximizing use of fixed resources •Working to increase resources •Listening and communicating to promote understanding of interests and values •Learning from each other's insight Results •Builds relationships and improves potential for future problem solving •Promotes creative solutions Appropriate When- Parties are committed to the process and adequate time is available •The issue is too important to compromise •New insights can be beneficial in achieving creative solutions •There is a desire to work through hard feelings that have been a deterrent to problem solving •There are diverse interests and issues at play •Participants can be future focused •Collaborators may need to know what you want before they are comfortable sharing their needs. When dealing with collaborators, say, for example, "I need this, this, and this. . . . What do you need?"

Compromising conflict resolution style

Types of Compromising- Splitting the difference •Exchanging concessions •Finding middle ground Results •Both parties may feel they lost the battle and feel the need to get even next time •No relationship is established although it should also not cause relationship to deteriorate •Danger of stalemate •Does not explore the issue in any depth Appropriate When- Time pressures require quick solutions •Collaboration or competition fails •Short-term solutions are needed until more information can be obtained •Compromisers may need to know that they will get something later. When dealing with compromisers, say, for example, "We will go to this movie tonight, and next week you can pick." (Be true to your word.)

Avoiding conflict resolution style

Types-•Physical flight •Mental withdrawal •Changing the subject •Blaming or minimizing •Denial that problem exists •Postponement to a more appropriate time (which may never occur) •Use of emotions •Results- The dispute is not resolved •Disputes often build up and eventually explode •Low satisfaction results in complaining, discontentment, and talking back •Stress spreads to other parties Appropriate when-•The issue is trivial or unimportant or another issue is more pressing •Potential damage outweighs potential benefits •Timing for dealing with the conflict is inappropriate •Avoiders may need to feel physically and emotionally safe. When dealing with avoiders, try taking the time to assure them that they are going to be heard and listened to.

Commitment to change

a force that binds an individual to a course of action of relevance to one/more targets- to change- a psychological state that binds a follower to a course of action deemed necessary for the successful implementation of a change initiative

SDOH according to the CNA

all factors work to eliminate health inequity-intersectoral collaboration, conditions in which ppl are born, grown, live, work and age, shaped by disruption of money, power and resources, conditions of early childhood, access to education, nature of employment and working conditions, access to healthy housing, food and income, social inclusion, natural environment, different groups have different experiences, influences choices, affect ability to use health care , inequities represent differences in distribution of health bw different populations, enforce disadvantage and vulnerability, inconsistent with Canadian values, threaten the cohesiveness of the community and society, challenge sustainability of health system impact economy

3 styles of change

behaviour analysis- info is collected, expectations, precautions, transition- maintenance, organization as a whole, sharing results, refreeze- provide permanence and continuation, training and support activities

Individual initiative

behaviour to induce change-acts of creativity and innovation explanation to increase task/performance-important to implement change initiatives, discretionary behaviours- A ls- facilitate learning process essential for change, learning at all levels, innovation, may scan external factors and interpret environmental trends, 4I model- intuiting: realizing patterns and possibilities, interpreting- explanation of thoughts and ideas, integrating, institutionalizing- change renewal process- explore and learn new ways and what they have learned, dialogue- inquiry and questioning, A may enhance psychological safety, genuine, identify own weaknesses and lack of knowledge, institutionalizing

organizational change

cause- mergers, acquisition, outsourcing, downsizing, streamlining or restructuring alteration of a core aspect fo the operation-structure, technology, culture, ls, goal, personnel-change can be from internal and external forces, organizational change is planned- link bw existing parts-set priorities and timelines, delegate- responsibility, design mechanism

interprofessional collaboration

client entered care, evidence informed decision making, access, epidemiology, social justice and equity, ethics, communication, collaborative practice- when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings, inter professional education

Primary health care collaboration

community based health care service philosophy that is focused on illness prevention, health promotion, treatment, rehab and identification of ppl at risk, assessibility, active public participation, health promotion, chronic disease prevention and management, use of appropriate technology and innovation, intersectional cooperation and collaboration, increased seniors- hospital resources, Indigenous- complex needs- little accessibility, complex medical, psychological and social needs, increased chronic conditions= nonacute care, collaborative practice, community care- health promotion and illness prevention, team approach- diversity, tele nursing, nurses- aptitude to be an advocate and meet needs

Change ls

concerned with skills, knowledge and behaviours a leader needs to initiate, drive, and embed sustained change, able to embrace change, get people to buy into underlying vision and keep them engaged ls is a social influence process- voluntary participation of followers- to reach goals-- exploitative/authoritative: more attention to things, long, little conviction/ self-confidence in followers, gives out orders, fear, punishment --Benevolent/ authoritative- some faith but is patronizing and authoritarian manner --consultative- term, values/ principles, mission, purpose, direction, belief and reassurance in followers, seek out their views and thinking --participative- entirely relies on followers, set foals --authoritarian- head takes control of decisions and commands discipline --transformational- figure out needs and ways to address them, purpose, values, morals, ethics, long term goals, growth, proactive, makes use of resources, beyond incentives, clear vision, inspiration, persuasion and excitement, ideal inspirations that allow the capability to increase fidelity, devotion and empathy, visualization, intellectual stimulus and coordination --laissez-faire- opposite of authoritarian, followers have complete freedom --servant- concern for team members and their needs, stare ideas, support, involve employees --transactional- man's need to get a job done and make a living- power and position, politics, perks/advantages, daily affairs, short term and hard data, focus on treatment, role expectations --democratic- open and crystal clear concept, decision making powers are distributed amongst members, all members are valued --Strategic- perceive as effective, connection between a company's man operations and its growth opportunities, executive interests and stable working conditions --bureaucratic- seldom effective, rules,

Conflict and leadership

conflict has negative outcomes-practice errors, lower self esteem, increased absenteeism, and greater intent to leave nursing, decrease work hours Interpersonal conflict- dynamic process occurring between individuals experiencing negative emotional reactions to perceived disagreements and interferes with goal attainment, less conflict with integrating, accommodating, or collaborating style-more conflict with dominating/avoiding style , be cautious addressing conflict- stress management, CBT, increase in communication, have self awareness, and be able to reframe conflict, conflict- a power struggle in which a person intends to harass, neutralize, injure/ eliminate a rival, if managed effectively- growth, if not= hinder ability to provide quality care- postive rs, to struggle, clash, be incompatible

participative style of ls

conscious and intended effort to provide role expanding opportunities-invited and control, individual need for achievement and independence and high levels of job involvement and commitment influence participative practices- A ls- increases commitment, pc, look for new solutions and info, provide followers with opportunities

EI and conflict

core beliefs, personality traits, motives, attitudes, values and knowledge, EI= higher level of collaborating and compromising management, higher levels of neuroticism= higher level of conflict-limited social networks, unable to control emotions, higher extraversion= more conflict, assertiveness and force, higher levels of conscientiousness= lower level of conflict-perservance, impulse control and determination, high goal internalization- dominating style, high intrinsic process- integrating style, core self evaluation-self-esteem, self-efficacy, locus of control and neuroticism- higher= less conflict, need for clarification, avoid escalation, empathy, being engaged/collaborative vs self serving, interpersonal harmony and team goals= less conflict

5 competency areas of ls

create the case for change, engage others, implement and sustain changes, facilitate and develop capability, succeeds in adjusting

Transformational leadership

creates positive change in invidividuals- develop ppl into leaders, individualized consideration, intellectual stimulation, inspiration, motivation, role models, inspirational motivation, treat members as individauls-concerned about needs and skills, values and morals are observed/emphasized but leader may misuse influence, members may lose inspiration/motivation, overemphasis on some members, pursuit of intellectual ideas with no merit

Nursing leadership CNA

critical thinking, action and advocacy, accountability, mentoring, create and use research, needed in every nursing position, shared responsibility, leadership and management skills co-exist, essential determinant of vibrant professional work environments, coaching/supporting, study/develop/ test solutions, global perspective, technology skills, expert decision making skills, organization, understanding and intervening political processes, collaborate and team building skills, balance authenticity and performance expectations, envision and adapt to changing adn chaotic health care

Positive ways to fix conflict

detailed job descriptions, clear responsibilities, early detection of conflict and mutual negotiations, provide opportunities to express opinions, conflict resolution meetings, show respect, professional development, inspirational motivation, clear and inspiring vision and giving purpose to work, being sensitive to needs, encouraging respect, trust building activites, collegue support, maintaining calm, problem solving, confront about unacceptable bheaviour, self-reflection/insight, positive role modeling

Managing change effectively

establish a sense of urgency, create the guiding team, develop a vision and strategy, communication, empowering, generate short term wins, consolidate gains and produce more change, make the change culture the norm backing is central to success of the process, roles- sponsor: advocate, role model: be willing to take the lead, demonstrate expected behaviour and attitude, make decisions-y/n, decisive, priorities, communicate: share information and encouragement, transparent and consistent, engage:motivation, urgency/importance, commitment and passion, recognition, energetic, empathetic, hold accountable: uphold agreements, remove obstacles, consequences, exacting and fair, change takes people out of their comfort zones- transform lifestyles-own pace and style, adapting, controlling and effecting, reactive change- only adjsut to new situation basded on responses (reactions), pre/pro-active, do not want to wait to act, pre-expect changes, planning, pro- do not wait for changes-influence the environment to conform to their objectives, developmental, transitional, transformational

8 steps to make change

establish a sense of urgency, forming a powerful guiding coalition, create a vision, communicate the vision, empowering others to act on the vision, planning for and creating short term wins, consolidate improvements and producing still more change, institutionalizing new approaches

Psychological capabilities of an authentic leader

hope- positive motivational state that is based on an interactively derived sense of successful agency and pathways- for uncertainties and failures optimism- cognitive process containing positive outcome experiences and casual attributions that are external, temporary, interpreting +/- events, higher levels of work motivation, performance, job satisfaction and morale, and perserverance, personal failures are temporary-motivate, resilency- strength of sustaining and bouncing back to achieve success when facing problems and failures, essential Self-efficacy- resource for putting necessary efforts into being successful at challenging tasks

4 factors that characterize transformational ls

idealized influence/charisma, inspirational motivation, intellectual stimulation, individual consideration, role models

Topdown change management

if mangers plan things properly, change can be excused smoothly, employee resistance -transformational cm- personal example and challenging people to think outside the box- strategic cm- recite, contrast to top down, introduce new behaviours, communication- spread info, bottom down- get info from lower level employees-bidirectional communication: change is vital-manage and control, power and discourse- structured collections of texts embodied in the practices of talking and writing that bring organizationally related objects into being as these texts are produced, disseminated and consumed, no communication leads to stories, made and remove, combos of talk (formal and informal) settings, language- vehicle to construct meaning instead of a medium to transit info- sense making processes, resist against unknown, not feasible-change is disruptive and awakens the fear about future and unknown- educate, participate, facilitate, negotiate, manipulate, coercion/ discussion

Conflict with colleagues

impact positive rs- negatively affect the delivery of care, power dynamics, escalate if: horizontal violence/bullying, barriers to collaboration, different practice perspectives, do not support each other, (un)intentionally put into situations beyond capabilities, new grads are not supported, fear of reprisal, lack of awareness-promote respectful work environment, mentor and support new staff, self reflect- good communication. mutual acceptance and understanding, use of persuasion, balance of reason and emotion, address conflict directly, focus on behaviours, validate assumptions through open dialogue, collaborate to find underlying cause

ways to address workplace conflict

implement no abuse policies, ensure policies also combat forms of discrimination, manners mode and professionalism, establish and uphold values, vision, mission, educate in communication- support effective collaboration, implement strategies to ease impact of change, identify staffing needs, ensure a comfortable and safe physical environment, provide a system that promotes reporting incidents, routinely assess conflict, clear policies and consequences

Failed leadership qualities

incompetent, rigid, intemperate, callous, corrupt, insular, evil, not available, avoid conflict, unaware of issues, poor intellectual skills, transactional-rewards compliance and disciplines staff for failure to follow rules, passive= no discipline= low productivity, absenteeism, high turnover, disengagement and low morale

workplace conflict

increase if: organizational policies/programs do not follow human rights code, policies are not communicated, lack of formal performance feedback -existing ones do not address how behaviour affect conflict, under-reporting, managers abuse/bully/show favouritism, lack of role clarification, communication is negatively affected by working conditions, nurses are working at peak stress times, poor working conditions, intense change, job insecurity

Conflict between nurse and a patient

increase is pt is: intoxicated/withdrawing, being constrained/ restrained, fatigue/ overstimulated, tense, anxious, worried, confused, disoriented, afraid, if pt has: hx of aggressive/violent behaviour, condition that impairs judgement/ cognitive status, drug/ETOH dependency, difficulty communicating, ineffective coping skills, if a nurse: judges, labels, or misunderstands, uses a threatening tone of voice/body language, has expectations based on culture, does not listen to concerns of family- does not provide sufficient health info, does not reflect on impact of behaviour

Servant leadership

influences others by developing rs and team member skills, value diverse opinions, cultivate a culture of trust, have excellent listening skills, think long term, respond to needs with humility

leading change authentically

know self in terms of thoughts/emotions, know who they are, what they believe, emphasize and value, act transparently with others and accordingly, psychological capacities- follower's self efficacy, resilience, hope, optimism, considerable awareness of personal judgements and biases, do not copy others, characteristic, vision, participation, experimentation, self-awareness, internalized moral perspective, balanced processing, relational transparency, relational phenomenon bw leaders and followers, mortality, followers are committed, hopeful and optimistic, charismatic ls is important when leading strategic change- mobilize and sustain activities, transformational, leaders may be a role model or share collective environment for change, promote positive response, authentic ls- important for change-capacities can influence follower's change-oriented attitudes and beliefs- commitment and readiness, psychological capacities can be energizing resources- change can be stressful, threatening and demanding-resources can provide coping behaviours, trust, increase benevolence and integrity, a process that draws from both + pc and highly developed organizational context= increased self awareness and self-regulated behaviour=+ self development, increase follower identification with target/course of action- followers choose goals, leaders can help followers internalize values and vision, justice, create a strong sense of responsibility based on a follower modeling the authentic leadrer's values and actions, positive modeling

Roles of nurses in conflict

lead by example, make conflict resolution ad priority, empower staff to resolve problems, provide increased autonomy, foster positive rs, trust and respect among staff members, diffuse conflict, help others develop management interventions, change can precipitate conflict, seek learning opportunities, offer confidential environment, deal with reports promptly, fairly, ensure that follow up procedures are in place, debrief- consult with those involved about meaning of experience, review/reflect on responses/behaviour, help pt understand how their behaviour affected positive rs-develop communication strategies, use best practice strategies, anticipatory planning

Leading in Nursing Practice

leaders use interpersonal skills to help others achieve their full potential-influencing the attitudes, beliefs, behaviours and feelings of other people managers are adept at controlling processes, making decisions, and coordinating resources Leaders empower others, inspire innovation, and challenge traditional practices, focuses on rs-faciliatates management, leadership- the ability to guide others into actions that meets the needs of the organization, the process of engaging and influencing others

Good leadership skills

leadership is key for patient outcomes, changes in healthcare= need for strong leaders, clear communication, availability for meetings, ability to face problems head on, obtaining staff input, instilling fear of reprisal/ discipline, set ground rules to decrease bias, be available listen to staff concerns, create a positive environment/ atmosphere, ability to motivate and engage others, passionate, transformational leadership is similar to emotional intelligence-self-awareness, self-efficacy, interpersonal control, respect, open, self-confidence- good morale, staff retention/spirit/enthusiasm, goals, belonging, empowerment, translate vision into reality, knowledge and confidence to deal with uncertanity, commitment to being visible as nurses, 4 qualities- clear communication, ability to be a visionary, orientation toward mentoring and ability to empower others, passion and optimisitic, moral centre-principles- faith, integrity, professionalism, congruent with beliefs, golden rule, respect, knowledge/expertise, connection with staff, caring and concern, patience,teamwork, mentoring and role modeling

Cynicism about change

negative attitude held by followers toward genuine intention and capabilities of managers during change process, pessimistic view, view change as managers getting power/control/profit- managers can convey-message- transformational ls-employees feel recognized, A ls- trust, decrease impact of cynicism and miscommunication

Chaos change theory

non-linear, •Non-human-induced responses in the environment indicate there is some predictability in random patterns •Small changes of randomness in a system that constantly changes can dramatically affect the long-term behaviour of that system and make it difficult to predict future outcomes.

Democratic leadership

participation and teamwork, validate the importance of each member's input-find themes, listening skills, staff participates, open communication, responsibility, accountability and feedback but may need lead to communication failure and uncomplicated projects, unproductive when members are inexperienced

Ways to resolve nurse/patient conflict

patient entered care, seek to understand needs and perspectives, acknowledge feelings behind behaviour, OEQ, active listening, open body language, acknowledge pt concerns, repeat and address wishes, concerns, values, priorities and POV, anticipate conflict and create a plan, self reflect, management- critical-incident management plan, remain calm, encourage expression of concerns, avoid arguing, focus on pt behaviour, involve everyone, state that abusive language and behaviours are unacceptable, step away from pt, protect self

coalition for change

postive, formation of a group with the power and energy to lead and support collaborative change efforts and can rally others to support change efforts- A ls encourage and motivate, social identity- transfer values and characteristics to followers, followers become more familiar with each other, ls- demonstrate appropriate emotional response

Change management

process of moving the organization from its present situation to another desirable situation-transition, process of continuing renewing an organization's direction, structure and capabilities to serve the changing needs of customers

Point of care leadership

safe pt care, clinical nurses make decisions, develop skills through oppurtunities, clarify info for pt, empower pt, 5 practices- build rs and trust, empower others, contributing to an environment that supports knowledge integration, leading, supporting and sustaining change, balancing complexity of the system and managing competing priorities

EI leadership

self-awareness, purpose/direction and motivating/inspiring teams, reflection- 1st level= descriptive, 2nd level= connects principles and practice, 3rd level= explore a complex situation in depth by drawing on theoretical, ethical, political, personal and professional perspectives, systematically examine experiences, increase self awareness, organization, passion, socio-cultural architect- leader's ability actively to influence and create the workplace culture and its values, self, others, general situation (reflective framework), what, so what, now what, leadership qualities framework- personal qualities (Self belief, awareness, management, personal integrity), setting direction (seizing the future, intellectual flexibility, political astuteness), delivering the service (collaborative working, empowering others, leading change through people)

Psychological contract

set of beliefs held by a person regarding the terms of an exchange agreement to which that person is party- expectations that are violated= cynicism

Relationships as power

social groups have power, discourse produces power, power often overlooked Positivist views of power- A has power over B- A can get B to do something B would not otherwise do, power is something that can be possessed, harnessed and traded like a commodity, controlling,directing or influencing others, sources of power- expert, referent, legitimate, reward and coercive Learn about power through experiences-family structures, school, organizations, no difference between I and we, power in rs-ppl communicate and make meaning of experience in a medium of symbols and emotion, cooperation /competition, cannot do whatever we wish-enabling/ constraining- power balance shifts depend on needs, groupings are formed (inclusion-exclusion)-belonging Power relating- patterns of inclusion and exclusion, form of emotions-shame, jealousy, empathy, compassion, cooperation, conflicts, politics and negotiations, always making evaluative choices bw one action and another, values and norms- what is right (morals), obligatory restrictions on how one should act that becomes habitual in a group, culture or society, values- good, ethics that arise as individually felt compulsions-choose one action over the other-ideology- individuals employ in making choices power relations- complex responsive processes formed by values, norms and ideologies as integral aspects of self/ identity formation (individual/collective), tools- tv, computer, documents, data, polices, protocols, procedures- shape communication

Factors contributing to nursing teamwork in an acute care setting

teamwork- team ls, backup behaviour, adaptability, team orientation, mutual performance, trust and communication, individual contribution- pts- increase safety, decrease errors and mortality- nurse- increase job satisfaction and staff retention, mentoring- dysfunctional teams increase conflict, absenteeism, decrease performance, and job satisfaction total communication- open, teamwork, strong rs, spontaneous/informal and formal convos, unit based ls- ongoing training, well being of team members is dependent upon the shared understanding-trust that safety is assured not assumed, variation in nursing designation may cause conflict, leaders enhance work quality- decrease potential for conflict, effectively manages the barriers from generational gaps, closed loop communication-all team members are actively exchanging info, training

Readiness for change

the extent to which an individual(s) are cognitively and emotionally inclined to accept, embrace and adopt a particular plan to purposefully alter the status quo, sense of discrepancy, appropriateness of response, efficacy, principal support, violence of change, create sense of urgency and need- effective communication

multigenerational challenges

workforce that encompasses several generations must learn to work together, forming teams and recognizing the inherent diversity in order to deliver effective health care and meet desired patient outcomes- 4 generational cohorts (year of birth, events-personalities, values and beliefs), veterans, baby boomers, Gen X, Milennials, work-life balance-amount of time you spend doing your job compared with the amount of time you spend with family and doing things you enjoy, understand generational differences has ability to decrease incivility- if not patients are at risk, differences in priorities, skills and perceptions may lead to miscommunication, stereotyping leads to misconceptions and dysfunction, mentorship, teamwork- greater job satisfaction, equity and fairness, leadership builds foundation for a team- time and resources, clear goals and objectives and trust, empowering patience, honesty and balance, team building- increased problem solving and morale= healthier work environments , increased learning and openness-open communication, inclusion, trust, conflict resolution

Interprofessional collaboration in health care

working together with members of the team who each make a unique contribution to achieving a commons goal, enhancing the benefit for the patient, within their scope, communication and decision making with separate and shared knowledge, leadership- horizontal, relational and situational- participatory style- self-understanding, new managers seldom have orientation , EI and self-reflecting, shared leadership and appreciative inquiry, high EI- how individuals follow direction, interact with one another and cope in stressful situations, trust in leadership, ns building, promoting teamwork and conflict resolution, listen and focus on strengths, reflective practice- the ability to examine actions and experiences with the outcome of developing practice and enhancing clinical knowledge, increase critical thinking, optimizes nurse empowerment, provides for a greater self-awareness, growth, active listening- engage more deeply- SL- situational ls adjusted to needs and professional competencies to meet those needs, complicated when a change in leader is wanted, shared responsibility of the whole team, understanding needs- AI- participative ls- engages everyone, reinforces positive actions, learning from successes and what is working well, humans move in direction of what we ask about, opportunities for individual voice through 4 phase process, collaboration-collective action focused on acheiving a common goal in a spirit of harmony adn trust, client and family engagement

Factors affecting conflict

workload, staffing/scheduling, working OT, job stress and time pressures, understaffing, unclear tasks/duties, emotional demands, complexity of care, Shiftwork, long shifts, fast paced, lack of time to discuss issues, inability to retreat from co-workers, temperature, poor air quality, noise, lack of meetings, problems with decision- making process, lack of consistent goals, changes not clearly communicated, authority given to Dr.- intimidation, resentful and silenced, unfair resource allocation, lack of resources/ oppurtunity for career advancement, lack of trust/support, poor communication, injustice/lack of fairness, not listening to input, reporting to multiple managers, leadership style has a significant effect on conflict, poor unit morale, cultural differences, nature of interaction, lack of identification with team

Primary health care

•A community-based health care service philosophy that is focused on illness prevention, health promotion, treatment, rehabilitation, and identification of people at risk" (Howse & Grant, 2015, p. 132) •The Canadian Nurses Association (CNA) issued a position statement strongly supporting the five essential principles of primary health care: •Accessibility •Active public participation •Health promotion and chronic disease prevention/management •Use of appropriate technology and innovation •Intersectional cooperation and collaboration

Thin line between advocacy and paternalism

•Advocacy and change are irrevocably linked. •The term "advocacy" suggests that individuals and communities are working to promote change. Zomorodiand Foley (2009) further advised that the "thin line between advocacy and paternalism may be crossed" (p. 1748) when patients are unable to communicate or practice autonomy due to illness or intimidation •Paternalism: "intentional overriding of one person's known preferences or actions by another person, where that person justifies the action with the goal of benefiting or avoiding harm to the person whose will is over written" •Patients have the right to make their own decisions, even when professional caregivers believe that the decisions are wrong.

Advocacy

•Advocacy involves engaging others, exercising voice and mobilizing evidence to influence policy and practice. It means speaking out against inequity and inequality. It involves participating directly and indirectly in political processes and acknowledges the important roles of evidence, power, and politics in advancing policy options. (CNA, 2018) •Awareness: professional nurses are aware of inequity and inequality within patient practice, among professional colleagues, and within local, national, and international communities. •The nurse leader's awareness of health, well-being, and social justice extends beyond the health care workplace to his or her local, national, and global communities. •Community, communication, and evidence-informed action •Advocacy requires the nurse leader to communicate with others and involve the community in the development of plans and potential solutions to health-related problems. •It is not a solitary act! It is constructed upon a foundation of evidence that provides strength

Conflict spiral

•An appropriate level of risk must be taken by the individuals involved to de-escalate a conflict. •By taking risks to de-escalate conflict, whether the result is successful or unsuccessful, the nurse leader sends a message that they want to rebuild trust, respect, and effective communication. •A nurse leader's emotional intelligence plays an important role in the de-escalation of conflict. •When conflict is not de-escalated and resolved appropriately, it results in more conflict. Co-operation, competition, assume deliberate actions, get defensive, look for support, attribute motives, rely on assumptions, group think, beliefs feed observation, become moralistic, personalize and stereotype, hurt before being hurt, mutual self destruction---- self awareness, raising the issue, follow up, when change is not implemented

Appreciative inquiry

•Appreciative inquiry (AI) reinforces positive actions, focusing on learning from successes and on what is working well in order to bring the desired future into being •AI provides opportunities for individual voice through a four-phase process: •Discovery •Dream •Design •Destiny

The nursing process as the change process

•Assessment—identifying the problem •Planning—participation of the staff that will be affected by the change •Sharing information •Disconfirming currently held beliefs •Providing psychological safety •Implementation—plans are put into action •Evaluation—have goals been met?

Collaboration and teamwork

•Collaboration: A collective action focused on achieving a common goal "in a spirit of harmony and trust" •Teamwork: One must acquire an understanding and develop a sense of when it is important to be the leader, the collaborator, and indeed, at times, the follower.

Complexity, community care and collaborative practice

•Community care encompasses medical, psychological, and social care, as well as health promotion and illness prevention strategies. For such an all-encompassing service to be delivered, an array of professionals and skills are required in a team approach (Xyrichis & Lowton, 2008). •There is often inadequate communication among multidisciplinary teams and insufficient engagement with the client and family members. •Nonetheless, recognition of the client perspective, along with the engagement and participation of the client and family in that client's care planning and implementation, has led to quality care in many health care settings in Saskatchewan.

The theory of conflict

•Conflict: to struggle, clash, be incompatible •For centuries, people accepted adversarial disputes and harsh conflict as a by-product of human nature. •If we are to make progress toward better conflict resolution, we must understand: •Why conflict arises; and •How people have reacted to conflict situations.

Critical social theory and empowerment

•Critical social theory strives to create an awareness of how culture and the norms of everyday life constrain or disempower people. It strives to remove oppressive barriers, which are revealed in exchanges that contain hidden values and norms; these values and norms change, depending on the situation and the participants (Sumner & Danielson, 2007). •Critical race theory, queer theory, and feminist theory are examples of well-known critical social theories. Another important critical social theory that is crucial to the profession of nursing is associated with oppressed groups.

Shift to community sector

•Current health systems continue to be challenged by complex geriatric clients with chronic medical, psychological, and social needs. The responsibility for their care, once the domain of the hospital and long-term care facilities, has shifted to the community (Bernabei et al., 2008). •The growing number of clients in the community with complex and chronic medical, psychological, and social needs require health care services. •Evolution of client- and family-centred care. •Difficulties with this shift: •How can the complex needs be met, keeping quality, safety, and efficiency in mind? •How do we ensure a client- and family-centredapproach? •How can we optimize recovery, wellness in chronicity, and prevention as we provide care in the community?

4 types of conflicts

•Data Conflicts; •Relationship Conflicts; •Value Conflicts; and •Structural Conflicts.

Data conflicts

•Data conflicts occur when: •People lack the information necessary to make wise decisions; •People are misinformed; •People disagree over which data are relevant; •People interpret information differently; and •People have competing assessment procedures. Conflicts stem from: •Lack of information •Different information •Different interpretations of data •Different assessment procedures

Conflict resolution strategies

•Every individual or group manages conflict differently. •Commitment to goals or assertiveness—the extent to which an individual (or a group) attempts to satisfy his or her own concerns or goals. •Commitment to relationships or co-operation—the extent to which an individual (or a group) attempts to satisfy the concerns of the other party, and the importance of the relationship with the other party •Thomas and Kilmann use these factors to explain the five different approaches to dealing with conflict: •Avoiding •Competing •Accommodating •Compromising •Collaborating •It is important to be flexible and shift your approach according to the situation and the other people with whom you are working. •Taking the wrong approach can escalate conflict, damage relationships, and reduce your ability to effectively meet goals. •We react with our most dominant style when we are under stress, but other styles can be learned and applied with practice and self-awareness.

Force field model of change theory

•Force field model: best applied to stable environments and the nurse makes note of two types of forces: driving forces and restraining forces. Change can occur if the driving forces override or weaken the restraining forces. •Driving forces: those that push in a direction that causes the change to occur or that facilitate the change because they push a person in a desired direction. •Restraining forces: those that counter the driving force and hinder the change because they push a person away from a desired direction.

Leadership in primary health care

•Interprofessional leadership •Shared leadership •Emotional intelligence •Reflective practice •Appreciative inquiry

Emotional intelligence

•Leaders who exhibit high emotional intelligence (EI) have an effect on how individuals •follow direction, •interact with one another, and •cope in stressful situations. •Leaders with high EI identify the effect they are having on followers, and adjust styles to create positive outcomes. Ability to monitor and discriminate among emotions and to use the data to guide thought and action, abilities such as being able to motivate oneself and persist in the face of frustrations, control impulses and delay gratification, regulate one's moods, and to keep distress from swamping the ability to think, to empathize and to hope, self-awareness, self-regulation, motivation, empathy, social skills Self development concept, enhance the management of feelings and interpersonal r/s, can augment nurse leadership skills, the ability to perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge and to reflectively regulate emotions so as to promote emotional and intellectual growth

Planned change

•Lippitt, Watson, and Westley (1958) focus more on the role and responsibility of the change agent than on the process of the change itself. Their theory expands Lewin's model of change into a seven-step process and emphasizes the participation of those affected by the change. •The seven steps of the planned change model: •Diagnosing the problem •Assessing the motivation and capacity for change in the system •Assessing the resources and motivation of the change agent •Establishing change objectives and strategies •Determining the role of the change agent •Maintaining the change •Gradually terminating the helping relationship as the change becomes part of the organizational culture •The six phases of Havelock's model: •Building a relationship •Diagnosing the problem •Acquire resources for change •Selecting a pathway for the solution •Establish and accept change •Maintenance and separation •Rogers' five-step theory: •Knowledge •Persuasion •Decision •Implementation •Confirmation

Management, Leadership, Followership, and Mentorship

•Managers •Planning, organizing, commanding, coordinating, and controlling •Leaders •Managers vs. leaders •Followers •Upward influence •Effective followers can also influence change •Mentors •Supportive relationships

The nurse as change agent

•Nurse leaders must ensure the day-to-day operation of their unit(s) in a rapidly evolving health care system. •Literature suggests that leaders continue to struggle with change despite the frequency with which they are involved in leading change (Gilley, Gilley, & McMillan, 2009; Quinn, 2004). •Change Agent: an individual who has formal or informal legitimate power and whose purpose is to direct and guide change (Sullivan, 2017) •Nurse leaders must have the requisite skills for influencing human behaviour: •Supervisory ability •Intelligence •Need for achievement •Decisiveness Persistence to guide the process

Political Activism as advocacy

•Political Activism: "a doctrine or practice that emphasizes direct vigorous action especially in support of or opposition to one side of a controversial issue" (Merriam-Webster Dictionary, n.d.). Political activism directs action toward creating change related to the making of government policy. •Political activism is required on behalf of patients and the profession of nursing

Power and advocacy

•Power: "the ability to get things done, to mobilize resources, to get and use whatever it is that a person needs for the goals he or she is attempting to meet." (Kanter, 1993, p. 166) •Power is not owned, it is relational or situational. "Nurses need to work with power rather than against it, recognizing that their task is not to overcome more powerful others . . . but to understand how power and its effects operate in order to enhance their sense of empowerment and hence, their practice." •Five Types of Nursing Social Power (MacPhee, 2015): •Personal power based on one's reputation and credibility; •Expert power [referring to the possession of skills and knowledge] that are needed by others; •Position power that is a result of your position in the organization or group; •Perceived power resulting from your status as a powerful person; and •Connection power ensuing from your association with, or links to, powerful people. •Power and health care for Indigenous people •Recognizes the impact of colonization and residential schools on the health and well-being of Indigenous people. •Requires the nurse leader to take a closer look at the relationship between power and diverse populations, more specifically the Indigenous population. The Government of Canada developed the First Nations and Inuit Home and Community Care (FNIHCC) 10-Year Plan (2013-2023)

CNA primary values

•Providing safe, compassionate, competent, and ethical care •Promoting health and well-being •Promoting and respecting informed decision making •Honouring dignity •Maintaining privacy and confidentiality •Promoting justice •Being accountable

Psychological empowerment

•Psychological Empowerment: Psychological empowerment does not focus on sharing a manager's organizational power, but rather concentrates on how employees experience their work. •Components of psychological empowerment (Spreitzer, 2008): •Meaning; •Competence; •Self-determination; and •Impact.

Response and resistance to change

•Several factors can influence resistance to change. Leaders who can help members psychologically own the change are more likely to see the change initiative sustained and embedded in practice. •Strategies to counter resistance: •Understand resistance is a natural process •Learn why the change is being resisted •Bridge the old with the new •Identify people willing to change •Assist staff to value the change in their practice •Communicate a clear vision of and benefits to change •Change can be unsettling or, in some cases exciting, but it will always generate a reaction. Anxiety : How will I cope with this change? Happiness - Finally something is going to change and make a difference. Fear - How is this change going to impact me? Threat - This problem is so much bigger than I thought. Guilt - Do we have to change because of me? Disillusionment - I can't handle this change, so I am leaving. Acceptance - If the change happens , things won't be so bad. Excitement - I am really looking forward to this change. Change curve- shock: surprise or shock at the event, looking for evidence that isn't true, frustration: recognition that things are different, sometimes angry, depression: low mood, lacking in energy, experiment: initial engagement with the new situation, decision: learning how to work in the new situation, feeling more positive, integration: changes integrated, a renewed individual, •We always need to remember every person reacts to change differently. •Limitation of a model like this - While the change curve image is linear, some people will not progress through change in a linear fashion. They may stay in one phase longer than another and regress from time to time. •Communication is a key to assist people in moving through the change curve. Continuum of response to change- resistance: persona

Relationally focused leadership styles

•Situational and contingency-based- no one leadership style is ideal for every situation, must be adapted •Strengths-based- leaders strive to empower worker's strengths rather than identify problems •Authentic or congruent- followers are inspired to act Servant- service to others and recognize that the role of organizations is to create ppl to build a better tomorrow •Principal agent- leader must provide incentives for followers to act in the organization's best interest •Transformational- idealized influence, inspirational motivation, intellectual stimulation, idealized consideration, sensitive to requirements of others •Feminist- emphasizes an ethic of care expressed through the use of collaborative, relational skills and the development of gender equality and empowering organizational goals •Quantum- direct response to change, builds on transformational, leaders must work together to identify goals, exploit opportunities and empower staff to make decisions •Dyad- mini teams with at least 2 individuals, different skill sets, education and background, are paired to fulfill the organization's mission

Structural empowerment

•Structural Empowerment: the sharing of power and the eventual transference of pertinent decision-making power from managers to lower levels of the organizational hierarchy. •Access to structural empowerment is gained through formal power (one's position in the organization) and informal power (networks and alliances with supervisors, peers, and colleagues, both within and without the organization). •Employees have empowerment when they have access to: (1) opportunities, (2) information, (3) resources, and (4) support.

Structural conflicts

•Structural conflicts are caused by oppressive patterns of human relationships. •These patterns are often shaped by forces external to the people in dispute. •Often, these conflicts can be overcome by identifying the structural problem and working to change it. Conflicts relate to: •How a situation is set up •Who is involved in making decisions •Geographical and physical relationships •Unequal power and authority

The nurse leader's role in managing organizational change

•The change agent has two main responsibilities: •Change oneself •Build capacity in others •A change coach or leader uses coaching behaviours that include: •Guidance •Facilitation Inspiration

the medicine wheel as a change model

•The medicine wheel, drawn as a circle with four quadrants, represents a holistic set of beliefs encompassing the mind, body, emotions, and spirit, which is foundational to the human being. The medicine wheel is manifested within the community as a "process (healing), a ceremony (sweats, sharing circles) and teachings (a code for living)" •The medicine wheel helps community members connect with each other, while also supporting balance and harmony across the four dimensions of mind, body, emotions, and spirit for the individual and the extended community (Clarke & Holtslander, 2010). •The medicine wheel guides healthy change and can be individualized to the specific needs of the client or community, taking into account the context of culture, socioeconomic status, family situation, disease process, and other significant factors, culminating in balance, healing, and growth in all four aspects.

Integrating ethics into nurse leadership

•The ultimate goal of nursing ethics is to promote the wellbeing of patients through the delivery of good nursing care" •Ethical principles that guide the leadership practices of clinical nurse leaders: •Nurses remain true to their beliefs, by embodying principled practice; •Nurses recognize that not all practices fit every patient, offering ethical leadership in ambiguous situations; Nurses are open to people's concerns and provide fair and just solutions

Relationship conflicts

•These problems often result in what have been called unrealistic or unnecessary conflicts. •They occur due to the presence of strong emotions (e.g., jealousy, mistrust, hatred) and are created from perceptions, poor communication, stereotypes, and so on. •Relationship conflicts often fuel disputes, causing them to escalate. Conflicts stem from: •Misperceptions •Stereotypes •Poor communication

Value conflicts

•This type of conflict is caused by perceived or actual incompatible value systems. •Value conflicts occur only when people attempt to force their set of values onto others. Conflicts relate to: •Day-to-day values •Self-definition

Change strategies

•Three strategies can be used to facilitate change. The characteristics of the change agent and the amount of resistance encountered will determine which of the following strategies should be used. •Power-coercive: power through authority, little effort to enforce change, change is critical, time is limited, high levels of resistance, no consensus •Empirical-rational: provide knowledge, people are rational and will act in own self interest, change is reasonable/beneficial •Normative-reeducate: ppl act in accordance with social norms and values, focus on roles, attritubutes, feelings and rs Change communication- As a leader, consider using the 4 P's of communication when implementing change with a group. Purpose - explain why we are doing what we are doing Picture - tell people what the change will look and feel like when we reach our goal Plan - tell people how we will get from A to B Part - explain what people need to do to help make the change a reality and a success

Competing conflict resolution style

•Types of Competing-Power of authority, position, or majority •Power of persuasion •Pressure techniques •Disguising the issue •Tying relationship issues to substantive issues •Appropriate when the conflict may escalate or the other party may withdraw •Reduces the quality and durability of the agreement •Assumes no reciprocating power will come from the other side •Increases the likelihood of future problems between parties •Restricts communication and decreases trust Results-•There are short time frames and quick action is vital •Dealing with trivial issues •Tough decisions require leadership •Competitors may need to feel that something will be accomplished in order to meet their goals. When dealing with competitors, say, for example, "We will work out a solution; it may take some time for us to get there."

Unfreezing-movement-refreezing change theory

•Unfreezing-Movement-Refreezing: based on the idea that if one can identify and determine the potency of forces, then it is possible to know the forces that need to be diminished or strengthened to bring about change (Burnes, 2004). •Unfreezing: disequilibrium occurs to disrupt the system, making it possible to identify the driving forces for the change and the likely restraining forces against it. •Moving or change: involves the process of a change in thoughts, feelings, and/or behaviours—often in the face of fear and uncertainty. •Refreezing: establishing the change as a new habit.

Whistle-blowing as advocacy

•Whistle-blowing: "a conscious act of disclosure about organizational or individual practices and behaviours to those who could achieve possible change" (Jackson et al., 2011, p. 656). •The CNA Code of Ethics supports the act of whistle-blowing when there are ethical violations: "Nurses support a climate of trust that sponsors openness, encourages the act of questioning the status quo and supports those who set out in good faith to address concerns (e.g., whistle-blowing)" Whistle-blowing is always a last resort

Interprofessional leadership

•Working together with one or more members of the health care team who each make a unique contribution to achieving a common goal, enhancing the benefit for patients. •Interprofessional leadership is realized and practiced through a collaborative relationship that is horizontal, relational, and situational. •Participatory style of leadership., shared style of leadership