Nursing Leadership

When delegating, the RN delegator is accountable for the following:

-Determining patient needs and when to delegate -Ensuring patient safety -Being available to the delegatee -Performing assessment and follow-up evaluation -Performing any intervention or corrective action that may be required to ensure safe and effective care

Effective nurse leaders also inspire successful teams in the following ways:

-Displaying excellent communication skills -Developing insight into their own personal strengths and weaknesses -Seeking multiple opinions -Understanding what they can and cannot change -Practicing mindfulness in reflecting and recharging -Taking responsibility for their own actions -Displaying understanding and empathy -Seeking to be a role model and motivate others to do their best -Identifying and supporting change -Using different leadership styles appropriately

The delegatee is accountable for the following:

-His or her own actions -Accepting delegation within the parameters of his or her competency level -Communicating the appropriate information to the delegator -Completing the task

nursing actions for technical skills

-Keep your own clinical skills and knowledge current. -Act as a willing expert resource and teacher for clinical problems. -Maintain honesty and integrity in work and relationships.

nursing actions for human skills

-Maintain honesty and integrity in work and relationships; trust is essential. -Create a teaching and learning environment; earn a reputation for exceptional teaching and mentoring. -Develop and role-model a commitment to excellence. -Create an open, nonthreatening environment; share information, keep staff informed, and encourage them to discuss issues. -Become a proactive problem solver; knowing how to solve problems is more important than knowing all the answers. -Maintain a confident, positive outlook; identify areas in which you are weak, and seek help to learn and grow.

nursing actions for occupational skills

-Make a commitment to support the mission, vision, and goals of the organization. -Accept the realities of complex health care systems, which are under pressure to improve patient safety and quality while reducing cost. -Understand the needs of external customers (patient, families, health care providers, referring facilities) and internal customers (staff, administrators and other departments).

What should and should not be delegated? The answer varies depending on the following:

-Nurse practice acts and other applicable state laws -Patient needs -Job descriptions and competencies of staff members -Policies and procedures of the health care organization -The clinical situation -Professional standards of nursing practice

Which tasks might the nurse delegate to a UAP?

-Shampooing a 23-year-old's hair -Bathing a 41-year-old who is incontinent -Ambulating a steady 50-year-old after surgery

Nurses can be leaders at any level and in many roles such as:

-direct patient care provider -patient advocate -case manager -clinical nurse leader -educator -financial resource manager -collaborative team member.

Which reliable resources would a new nurse consult to learn how to safely delegate to others in the employment setting?

-job descriptions -hospital policy manual -nurse practice acts

Which nursing actions demonstrate human skills?

-maintaining honesty and integrity in work and relationships -creating an open, nonthreatening environment

Before delegating an assignment to an LPN/LVN or UAP, the nurse must identify which factors?

-task required -a safe environment -ability to supervise the task -strengths and weaknesses of the delegatee

Which characteristics of effective leaders inspire successful teams?

-uses excellent communication skills -uses different leadership styles appropriately -seeks multiple opinions -identifies and supports change -displays understanding and empathy

five rights of delegation

1. Right Task 2. Right Circumstance 3. Right Person 4. Right Direction/Communication 5. Right Supervision

skills of effective nurse managers

1. communication skills 2. relationship skills 3. health care environment knowledge 4. business skills 5. leadership skills 6. professionalism

three principles of delegation

1. first principle 2. second principle 3. third principle

World-renowned scholar on leadership Warren Bennis (1989) is frequently quoted as saying "Leadership is like beauty, it's hard to define but you know it when you see it" (p. 1). Bennis went on to identify six essential qualities of an effective leader:

1. integrity 2. dedication 3. magnanimity 4. humility 5 openness 6. creativity

skills required for effective leadership: technical skills

Clinical expertise and nursing knowledge

in which role does a nurse collaborate with other health care team members and provide patient care and education on a hospital unit?

Clinical nurse leaders

example of bureaucratic leadership

Decisions are made based on a specific order.

example of autocratic leadership

Decisions are made without input from team members.

right person

Delegate to the right staff member on the right patient. Know the licensure, role, preparation, strengths, and weaknesses of the staff member before delegation.

right direction/communication

Give the other staff member direction, and communicate what is being delegated and why. Practice the 4 Cs of communication: Clear: Information is understood by the listener. Concise: The nurse gives enough but not too much additional information. Correct: Information is accurate and aligned to rules, regulations, or job descriptions. Complete: There is no room for doubt on the part of the supervisor or delegatee.

Which statement represents the second principle of delegation?

If the delegatee does not carry out the assignment in a satisfactory manner, the RN is responsible

Which question would the nurse ask before delegating the task of ambulating the patient to a UAP?

Is the assignment within the UAP's ability to perform safely? This question addresses whether the task is within the scope and abilities of the person to whom it is being delegated. It is one of the Five Rights of Delegation within the right task.

The charge nurse who takes responsibility for coordinating the staff schedule and asks the staff to develop their own schedule is demonstrating which type of leadership style?

Laissez-Faire

Which leadership style is represented by a leader who believes that employees want little or no direction in obtaining organizational goals?

Laissez-faire

which allows staff members to make decisions. In this scenario, the nurse is engaging staff to obtain their input but is not allowing them to make actual decisions?

Laissez-faire

in which role do nurses provide direct leadership in educating staff nurses and students?

Nurse educators

first principle of delegation

Nurses must have knowledge of the nurse practice act in the state where they are licensed. Each state's nurse practice act defines the RN scope of practice and discusses appropriate delegation

interprofessional team leader

Nurses play an important leadership role when coordinating care of patients -nurse works in collaboration with other health care team members such as health care providers and other allied health colleagues for the patient's benefit. As the member of the health care team that spends the most time with the patient, the nurse is usually the leader of this interprofessional team.

leader

One who excels above the accepted norm of a role and uses interpersonal skills and the ability to form relationships with others to influence actions. These individuals are visionaries who share a common vision and values with those around them.

right supervision

Provide direct or indirect supervision and guidance of the task as appropriate. This is not only the initial direction, but includes oversight of the task, evaluation of the task done, and follow-up with the other staff member as needed.

example of Laissez-Faire leadership

Team members are allowed to make decisions.

second principle of delegation

The RN cannot delegate assessment, planning, evaluation, or accountability for the assigned task -even though the task has been assigned, the RN is still responsible for following up with the delegatee to ensure that the task has been completed -If the delegatee does not carry out the task in a satisfactory manner, the RN is responsible for seeing that it is completed.

leadership

The ability to guide or influence the beliefs, opinions, or behaviors of other persons or groups by combining intrinsic personality traits, skills, and characteristics of the situation to achieve desired outcomes

Laissez-Faire leadership

The leader allows employees to make decisions, however the leader is still responsible for the decisions that are made.

right circumstance

The other staff member is working in the right setting, with all available resources, in a safe environment, and in the right patient situation. The nurse must assess the patient and situation before delegation.

third principle of delegation

The person to whom the assignment was delegated cannot delegate that assignment to someone else -If the person cannot carry out the assignment, the individual needs to notify the delegating RN so that the task may be reassigned or completed by the RN

The manager who makes threats of writing up errors to motivate staff members is exhibiting which management style?

Theory X

right task

This is a specific task that can be transferred to another person for a specific patient. It must be able to be done safely for the patient given the overall picture and purpose of the task. The task must fall in the scope of practice and competency of the other staff member.

nurse leader

anyone who uses interpersonal skills to influence others to accomplish a specific goal -assist in managing the delivery of patient care in a safe and efficient manner. -achieve consensus within a group about its goals, and facilitate accomplishment of goal -can be in a managerial position or can be a staff nurse at the bedsid

A nurse manager is discussing nursing assignments with team members and makes the following statement: "We are going to do what I think is best." Which leadership style is being demonstrated?

autocratic

Which leadership style is most useful in reducing errors or during a health crisis situation in the workplace?

autocratic

Effective nurse leaders inspire successful teams through a variety of leadership styles such as

autocratic, bureaucratic, democratic, laissez-faire, and servant

A new nurse manager is attending a week-long training course to learn to become a better leader. Which leadership theory best matches this nurse manager's actions?

behavioral

Which role does the nurse exhibit by providing the newest evidence-based practice to other members of the health care staff in providing patient care?

clinical nurse leader

A nurse who accepts the realities of complex health care systems is demonstrating skills in which area of effective leadership?

conceptual

spending time needed to accomplish tasks

dedication

two types of leadership

formal and informal

appreciating others' contributions

humility

The staff nurse who is recognized by peers as being a leader is demonstrating which type of leadership?

informal

demonstrating clear ethical principles

integrity

Effective leaders have qualities that assist them in leadership roles including

integrity, dedication, magnanimity, humility, openness, and creativity

Which qualities do effective nurse leaders possess?

integrity, humility, and openness

giving credit where it is due

magnanimity

Nurse _____________ plan, organize, coordinate, and control the work of their employees to achieve outcomes and accomplish goals

managers

McGregor's Management Theory Y

managers believe that people are self-directed and when properly encouraged can be creative and autonomous in their work -Managers work at maintaining a motivating environment -managers think that given the proper conditions, employees will accept and seek responsibility on the job.

Nurse leaders also are excellent communicators who seek others'

opinions, support and motivate others, and use different leadership styles to develop strong teams

A manager is ordering extra supplies and putting staff into groups to accomplish a task. Which management function is the manager performing?

organizing

The ANA describes delegation as the transfer of responsibility. Which action does the transfer of responsibility allow a competent person such as the UAP to do?

perform a selected task in a selected situation

A nurse manager is assessing the need to hold immunization clinics on Saturdays one month before school begins to increase immunization rates among children in the community. Which leadership function is demonstrated by the nurse manager?

planning

skills of effective nurse managers: leadership skills

possess the ability to lead and inspire their staff to accomplish goals

Staff members recognize which skill in nurse managers who hold themselves accountable with the highest level of ethical behavior?

professionalism

"I have already checked Mr. Price for swallowing issues, and he is safe to feed now. When his lunch arrives, would you please stay with him and assist him in eating?" is an example of which right of delegation?

right circumstance

"I noticed the vital signs haven't been charted. Have you completed them yet, and were there any issues?" is an example of which right of delegation?

right circumstance

"Please take a urinal to Mr. Thomas in 9150 now, and provide me with his output as soon as you are done. I need to know how much he urinates." is an example of which right of delegation?

right direction/communication

"Susie, you are an LPN, correct? In that case, would you give Miss Jones her oral acetaminophen at noon?" is an example of which right of delegation?

right person

"Would you make Mrs. Brown's bed while she is down for an x-ray?" is an example of which right of delegation?

right task

Fayol's Function of Management: Planning

similar to the first steps of the nursing process in assessing and planning care -creating a plan to meet company goals and objectives -involves allocating employee resources and delegating responsibilities, as well as setting realistic timelines and standards for completion -requires those in management roles to continuously check on team progress in order to make small adjustments when necessary, while still maintaining a clear picture of a company's larger aims and goals.

these theories suggest that leaders change their approach depending on the situation?

situational

skills of effective nurse managers: relationship skills

staying connected with staff, families, and other health care team members

Successful managers rely on a variety of abilities, including:

strong communication skills, organizational proficiency, and critical-thinking skills

Example of activities that can be delegated might include:

taking routine vital signs on a patient who is stable (has had previous vital signs within normal limits) -providing comfort measures such as bathing and linen changes -helping a steady patient ambulate.

Delegation is a two-way process in which

the RN requests that a qualified staff member perform a specific task, and the qualified staff member accepts the task.

management

the coordination of people, time, and supplies to achieve a desired outcome and accomplish an organization's goal

trait theories

the earliest theories about leadership -focus on personality traits of leaders with the premise that leaders are born and not made -Specific qualities of effective leaders include good interpersonal skills, self-confidence, and a willingness to take risks -These theories do not account for the possibility that leadership can be learned through experience.

what can nurses not delegate?

the nursing process and retain accountability and responsibility for the assigned task

Bennis' Essential Qualities: humility

the opposite of arrogance and narcissism. It means recognizing that you are not inherently superior to others and consequently that they are not inferior to you. It does not mean diminishing yourself, nor does it mean exalting yourself. Humble leaders do not debase themselves, neither falsely nor due to low self-esteem. They simply recognize all people as equal in value and know that their position does not make them a god.

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. Based on contemporary leadership theories, which type of leader accurately describes this nurse?

transactional

nurse educator

works primarily in schools of nursing, staff development departments of health care agencies, and patient education departments -provides direct leadership to other staff nurses and students.

case manager

A nurse may have a primary job in leadership as a case manager in overseeing the care given to a group of patients -leads the health care team to identify issues and overcome barriers to increase patients' health and outcomes -The staff nurse at the bedside also acts as a leader in providing case management in such areas as discharge planning, communicating with the health care team, educating the patient, and assisting to provide safe patient care

what provides the basis for effective delegation?

A state's nurse practice act along with the principles of authority, accountability, and responsibility

skills required for effective leadership: human skills

Ability and judgment to work with people in an effective leadership role

skills required for effective leadership: conceptual skills

Ability to understand the complexities of the overall organization and to recognize how and where one area of management fits in the overall organization

these theories focus on relational, dyadic, and complex social models, not on an individual leader?

contemporary

informal leadership

depends on knowledge, personal skills, and ability to persuade and influence others. The informal leader is a colleague and does not hold a formal position as a leader but is recognized as a leader by his or her peers.

Which belief does the Theory X-style manager hold?

employees are motivated by external rewards and punishment

skills of effective nurse managers: communication skills

excellent at imparting or exchanging meaningful information

The nurse exhibits which role when actively monitoring patient costs and preventing waste?

financial resource manager

Behavioral theories

focus on how leaders behave with the assumption that leaders can be taught to be leaders. Characteristics that were consistent in leaders included task-oriented behavior and consideration for others.

transactional leadership

focuses on the daily progress of goals and is concerned with the day-to-day operations of the facility -focus on a reward and punishment system using incentives and discipline to get the job done. In this style of task and outcome leadership, employees usually know exactly what is expected of their job performance.

Bennis' Essential Qualities: magnanimity

gives credit where it is due. It also means being gracious in defeat and allowing others who are defeated to retain their dignity. Magnanimity in leadership includes crediting the people with success and accepting personal responsibility for failures.

example of servant leadership

Decisions are made with consensus within the group through listening and coaching by the leader.

qualities of Laissez-Faire leadership

-open minded -delegates decision making -communicative

qualities of bureaucratic leadership

-organized -consistent -focused

Effective delegation results in:

-the achievement of quality, safe patient care -improved efficiency -increased productivity -empowered staff -skill development

Fayol's Functions of Management

1. Planning 2. Organizing 3. Directing 4. Controlling

qualities of democratic leader

-actively engaged -supportive -accountable

Leadership styles group the patterns of behavior that may be demonstrated by leaders. Individuals may use a combination of these styles in their leadership roles:

-autocratic -bureaucratic -democratic -Laisse-Faire -servent

qualities of servant leadership

-commitment to others -listening -trust -caring and empathetic

what is true about situational theories?

-different circumstances drive leaders to change their approach -based on flexibility and critical thinking -propose that leaders adapt their responses based on what is happening

qualities of autocratic leader

-disciplined -decisive -confident

There are numerous roles that a nurse leader can assume. The primary roles include acting as a:

1. care provider 2. patient advocate 3. case manager 4. clinical nurse leader

Additional roles that nurse leaders can assume include acting as a:

1. nurse educator 2. financial resource manager 3. interprofessional team leader

three types of skills required for effective leadership according to Hersey and Blanchard (1988):

1. technical skills 2. human skills 3. conceptual skills

who assists in coordinating care of patients with other members of the health care team?

Collaborative team members

servant leadership

The leader builds a team through caring by putting others first and welcomes input in decision making.

democratic leadership

The leader includes employees in the decision-making process, but the leader normally maintains the final decision-making authority.

example of democratic leadership

The leader solicits team members' opinions before decisions are made.

autocratic leadership

The leader tells his or her employees what to do and how to do it, without getting their advice.

bureaucratic leadership

The leader uses a highly formalized set of processes, procedures, and structures. Rules, policies, and hierarchies form a clear set of expectations as well as an explicit chain of command.

McGregor's (1960) management theories that focus on human relations-based management have been titled:

Theory Y and Theory X

A bureaucratic leader makes decisions based on

a specific set of rules

skills of effective nurse managers: business skills

ability to deal with budget, information, and human resource management

patient advocate

acts on behalf of patients to protect their rights and best interests. This often includes a component of patient education.

Bennis' Essential Qualities: Integrity

alignment of words and actions with inner values. It means sticking to these values even when an alternative path may be easier or more advantageous. -A leader with integrity can be trusted and will be admired for sticking to strong values. They also act as a powerful model for people to copy, thus building an entire organization with powerful and effective cultural values.

which leader makes decisions without input from staff members?

autocratic

which theories assume that leaders learn certain behaviors (these theories focus on what leaders do?)

behavioral

Bennis' Essential Qualities: openness

being able to listen to ideas that are outside one's current mental models, being able to suspend judgement until after one has heard someone else's ideas. An open leader listens to their people without trying to shut them down early, which at least demonstrates care and builds trust. Openness also treats other ideas as potentially better than one's own ideas. In the uncertain world of new territory, being able to openly consider alternatives is an important skill.

A leader often keeps members in the dark about organizational goals while citing policy and rules as the rationale behind prescribed actions. Which leadership style does this describe?

bureaucratic

Which role is the school nurse performing when coordinating the health care for a group of children to identify issues and overcome health care barriers?

case manager

in which role does the nurse oversee the care given to a group of patients?

case manager

When a nurse leader is willing to work an additional 4 hours to cover a portion of another staff member's shift, which leadership quality is the nurse leader exhibiting?

dedication

skills of effective nurse managers: health care environment knowledge

deep understanding of the health care environment

One of the ways a staff nurse provides leadership is through

delegation

A leader on a hospital unit encourages nurses to form a leadership committee made up of staff members related to professional practice. This leader is exhibiting which leadership style?

democratic

which leader solicits staff members' opinions before making a decision?

democratic

financial resource manager

helps manage financial resources by using supplies wisely, preventing waste, and controlling costs to manage charges for the patient -Nurses in all roles and settings have a responsibility to make fiscally sound decisions in the care of patients and families.

skills of effective nurse managers: professionalism

holding themselves to the highest standards of accountability and ethica

transformational leadership

inspire others to follow their lead. -They go above and beyond to transform the workplace and achieve organizational goals by motivating others.

If a nurse leader complains about patient assignments to another staff member within hearing distance of another patient's family, which leadership quality would the manager need to develop?

integrity

traits in three categories:

intelligence, personality, and abilities

Fayol's Function of Management: Organizing

involves the coordination of work to prevent duplication of effort -help to ensure a company or departmental unit runs smoothly -From establishing internal processes and structures to knowing which employees or teams are best suited for specific tasks, keeping everyone and everything organized throughout daily operations are important functions of management.

Which leadership quality is the nurse demonstrating when giving credit to those who achieve their goals?

magnanimity

McGregor's Management Theory X

managers believe that people are basically lazy and prefer to be directed in their work -Employees are motivated by threats and punishments. Managers must actively work to supervise and control their employees. -managers motivate employees by threatening punishment. They think that most workers value job security and have little ambition beyond it.

Fayol's Function of Management: Coordinating

part of the directing function of management in which the manager organizes the work to be done -ensuring that all personnel understand their responsibilities and resources and activities across the organization work in harmony in order to achieve the desired goal.

A nurse speaks up for a child to keep her favorite blanket, labels the blanket, and communicates both verbally and in the child's electronic health record that the child will keep the blanket. Which role is the nurse exhibiting through these actions?

patient advocate

care provider

primary nursing role -Nurses must be able to plan, organize, deliver, and evaluate nursing care for patients in a variety of inpatient and outpatient settings (e.g., clinics, schools, homes) -Nurses act as leaders by providing the best care for their patients, families, and communities.

delegation

process of assigning part of one's responsibility to another qualified person in a specific situation -essential component of interdisciplinary collaboration or teamwork

situational theories

proposed that situations drive the leader to change his or her approach to leadership based on flexibility and critical thinking. These leaders adapt their responses based on the situation at hand.

clinical nurse leader (CNL)

provide leadership in collaborating with other members of the health care team -provide leadership in high-quality patient care across a hospital unit by providing evidence-based practice and can educate patients and other health care staff.

Laissez-faire leaders

provide minimal supervision and direction to their staff and require highly motivated and efficient employees

Fayol's Function of Management: Directing

refers to ensuring that the work of the organization is done

formal leadership

refers to legitimate authority conferred by an organization (e.g., in the nursing role of director or supervisor)

Transactional leadership concepts are based on:

rewards and punishments -Being given the opportunity to go to a nursing conference is a reward that, according to this theory, could motivate high performance by the nurse in the future.

Bennis' Essential Qualities: dedication

spending whatever time and energy on a task is required to get the job done, rather than giving it whatever time you have available. The work of most leadership positions is not something to do 'if time'. It means giving your whole self to the task, dedicating yourself to success and to leading others with you.

Bennis' Essential Qualities: creativity

thinking differently, being able to get outside the box and take a new and different viewpoint on things. For a leader to be able to see a new future towards which they will lead their followers, creativity provides the ability to think differently and see things that others have not seen, and thus giving reason for followers to follow.

these theories focus on the intrinsic traits of individuals (who or what leaders are)?

trait

contemporary theories of leadership

transformational leadership and transactional leadership