Chapter 22Nurse Leader, Manager, and Care Coordinator

Lewin's Theory of Change

1). *Unfreezing*: The need for change is recognized. 2). *Moving*: Change is initiated after a careful process of planning. 3). *Refreezing*: Change becomes operational.

Management Structures

1). Centralized. 2). Decentralized.

Preceptorship

An alternative model is preceptorship. The preceptor (experienced nurse) is selected (and generally paid) to introduce an employee to new responsibilities through teaching and guidance

leadership involves a firm, insistent, self-assured leader who keeps at the center of attention. 1). Autocratic 2).Democratic 3). In laissez-faire leadership, 4). Transformational

Autocratic

Autocratic leadership

Autocratic leadership, also called directive leadership or authoritarian leadership, involves the leader assuming control over the decisions and activities of the group

Conflict Resolution Strategies

Avoiding. Collaborating. Competing. Compromising. Cooperating/accommodating. Smoothing .

Decentralized

Decisions are made by those who are most knowledgeable about the issues being decided. Nurses are thus intimately involved in decisions concerning patient care.

leadership is characterized by a sense of equality among the leader and other participants. 1). Autocratic 2).Democratic 3). In laissez-faire leadership, 4). Transformational

Democratic

Compromising

For this technique to be effective, both parties must be willing to relinquish something of equal value. If that does not occur, either or both parties may feel that they have lost the conflict and given up more than the other group.

Mentorship

Mentorship is a relationship in which an experienced person (the mentor) advises and assists a less experienced person (protégé).

Cooperating/Accommodating

One party makes a conscious decision to let the other group win and frequently collects an "IOU" for use in the future. This party's original loss may result in a more positive outcome in the future.

Leadership

Paradoxically, it is at the same time clear and vivid, as well as elusive and subtle. Leadership has been described as the ability to direct or motivate a person or group to achieve set goals. Effective leaders in groups or systems do this by encouraging others to be their best selves as they work collaboratively in the pursuit of common organizational or unit goals. Leaders have power, whether explicit or implied. e.g. explicit, implied

Role of Nurse Manager

Planning. Organizing. Directing. Controlling.

Centralized

Senior managers generally make decisions with little input from the group.

Smoothing

Smoothing is an effort to compliment the other party and focus on agreement rather than disagreement, thus reducing the emotion in the conflict. The original conflict is rarely resolved with this technique.

Avoiding

There is awareness of the conflict situation, but the parties involved decide to either ignore the conflict or avoid/postpone its resolution. The conflict has not been resolved and may resurface later in an exaggerated form.

Transformational leadership

They communicate honestly and openly and can express emotions as well as ideas as they share themselves with others. They show concern and care for others and are willing to take risks. They pay attention to process as well as outcomes.

Competing

This approach results in a win for one party at the expense of the other group. This win-lose confrontation can leave the loser frustrated, with a desire to get even in the future. This strategy may be utilized when one party has more knowledge regarding the situation or when resistance is appropriate because of ethical concerns or unsafe patient care practices.

Collaborating

This is a joint effort to resolve the conflict with a win-win solution. All parties set aside previously determined goals, determine a priority common goal, and accept mutual responsibility for achieving this goal. This focus on problem solving is based on mutual respect, honest communication, and shared decision making.

leadership can create revolutionary change instituted by charismatic leaders. 1). Autocratic 2).Democratic 3). In laissez-faire leadership, 4). Transformational

Transformational

Transactional leadership

based on a task-and-reward orientation. Team members agree to a satisfactory salary and working conditions in exchange for commitment and compliance to their leader. Health care organizations have often used transactional leadership strategies to provide direction and recognize employees' progress in meeting pre-established goals and work deadlines. Transactional leaders maintain control by rewarding good behavior and punishing behavior they perceive as detrimental or negative. Employees have minimal opportunities for creative thinking and involvement in organizational decisions, and employer and employee may not share a common vision

Transformational leadership

can create revolutionary change. Often described as charismatic, transformational leaders are unique in their ability to inspire and motivate others. They create intellectually stimulating practice environments and challenge themselves and others to grow personally and professionally, and to learn. Gifted in creating a common vision, they demonstrate passion for their vision and keep others similarly focused. One of the unique qualities of transformational leaders is their vulnerability.

Democratic leadership AKA participative leadership

characterized by a sense of equality among the leader and other participants. Decisions and activities are shared. Participants are encouraged to develop their skills and strengths within the group. The group and leader work together to accomplish mutually set goals and outcomes.

implied power

implied though not directly expressed; inherent in the nature of something. *power due to other factors, such as personality* Implicit power exists when an individual controls or has the potential to control another individual or group in the absence of any "official" agreement. We had an implicit agreement not to raise the subject

the leader relinquishes power to the group. 1). Autocratic 2).Democratic 3). In laissez-faire leadership, 4). Transformational

laissez-faire leadership

Explicit power

precisely and clearly expressed or readily observable; leaving nothing to implication. *power by virtue of position * Explicit power is the power an institution gives to an individual over other individuals. Basically anyone not at the bottom of an org chart has explicit power over all those below. e.g. explicit instructions

laissez-faire leadership

style of leadership is a person in leadership position who does not provide leadership, leaving the group to fend for itself. Subordinate are given a free hand in deciding their own policies and methods.

Laissez-faire leadership: AKA nondirective leadership

the leader relinquishes power to the group, such that an outsider could not identify the leader in the group. This approach encourages independent activity by group members. This style depends on the strengths of followers to direct the group activities

Quantum leadership theory

views an organization and its members as interconnected and collaborative—a helpful approach when unpredictable events and changing environments present themselves Nursing leaders can model these new behaviors by combining these new attributes with the requisite technical skills.

Leadership Styles

• Autocratic • Democratic • Laissez-faire • Quantum • Transactional • Transformational

Overcoming Resistance to Change

• Explain proposed change to all affected. • List the advantages of the change. • Relate the change to the person's existing beliefs and values. • Provide opportunities for open communication and feedback. • Indicate how change will be evaluated. • Introduce change gradually. • Provide incentives for commitment to change.

Evidence-Based Strategies to Improve Leadership Skills

• Strive to become an authentic leader. • Develop leadership skills. • Promote a healthy work environment. • Engage staff to commit to their best effort at work. • Assist new graduates to transition into the RN roles.

ANA Principles for Delegating Care

• The nursing profession determines the scope of nursing practice. • The nursing profession defines and supervises UAPs involved in providing direct nursing care. • The RN is responsible and accountable for nursing practice. • The RN supervises any assistant providing direct patient care. • The purpose of UAP is to work in supportive role to the RN.

Reasons for Resistance to Change

• Threat to self. • Lack of understanding. • Limited tolerance for change. • Disagreements about the benefits of change. • Fear of increased responsibility.

Considerations for Planned Change

• What is amenable to change? • How does the group function as a unit? • Is the group ready for change and at what rate? • Are the changes major or minor?

Tell whether the following statement is true or false. It is increasingly difficult for the nurse manager to be both a clinical and managerial expert. A. True B. False

Tell whether the following statement is true or false. It is increasingly difficult for the nurse manager to be both a clinical and managerial expert. A. True B. False

Leadership Qualities

• Charismatic • Dynamic • Enthusiastic • Poised • Confident • Self-directed • Flexible • Knowledgeable • Politically aware

Leadership Skills

• Commitment to excellence • Problem-solving skills • Commitment to and passion for one's work • Trustworthiness and integrity • Respectfulness • Accessibility • Empathy and caring • Responsibility to enhance personal growth of all staff

Steps for Using Time Effectively

• Establish goals and priorities for each day. • Evaluate goals in terms of your ability to meet needs of patients. • Establish a time line. • Evaluate your success or failure in managing time. • Use these results to direct your next day's priorities and time line

Achieving Self-Knowledge

• Identify your strengths. • Evaluate how you accomplish work. • Clarify your values. • Determine where you belong and what you can contribute. • Assume responsibility for relationships.

Factors Prompting Change in Health Care Industry

• Increased number of chronically ill and older people • Increased role of government and industry in health care • Rising cost of health care • Changing patterns of health care delivery

Developing Leadership Responsibilities

• Mentorship • Preceptorship • Nursing organizations • Continuing education

Considerations When Delegating Nursing Care

• Patient's condition • Complexity of the activity • Potential for harm • Degree of problem solving and innovation necessary • Level of interaction required with the patient • Capabilities of the UAP • Availability of professional staff to accomplish workload

Clinical Nurse Leader Role

• Position was created by the American Association of Colleges of Nursing (AACN) as a leadership role. • The CNL works collaboratively with the health care team to facilitate, coordinate, and oversee patient care. • The CNL should be able to clearly communicate with other health care professionals, integrate evidence-based practices into patient care, and evaluate patient risks and outcomes. • The person-centered focus of the CNL role includes functioning as a patient advocate, educator, and provider of patient care in complex situations.

Factors to Consider Prior to Delegating Patient Care

• Qualifications and capabilities of the UAP • Stability of the patient condition • Complexity of the activity to be delegated • The potential for harm • The predictability of the outcome • The overall context of other patient needs

Planned Change: An Eight-Step Process

• Recognize symptoms that indicate a change is needed and collect data. • Identify a problem to be solved through change. • Determine/analyze alternative solutions to the problem. • Select a course of action from possible alternatives. • Plan for making the change. • Implement the selected course of action to effect change. • Evaluate the effects of change. • Stabilize the change.

Factors Increasing the Power Base of Nursing

• Right timing • Size of the nursing profession • Nursing's referent power • Increasing knowledge base and education for nurses • Nursing's unique perspective • Desire of consumers and providers for change