Chapter 28: Developing the Role of the Leader

Becky graduated 5 years ago and is keenly interested in pursuing leadership opportunities. She has been active in learning about leadership through workshops and Internet research and recently began a graduate degree program with a focus on nursing administration. She has excellent clinical skills and eagerly accepts responsibility for various projects on the unit. Her sarcastic and sometimes aggressive behavior tends to alienate other staff members on the unit. In coaching Becky, you: a. suggest that she reflect on situations in which she has had a positive influence and consider how her interactions contributed to the situation. b. suggest that she not consider leadership roles because her interaction skills are more suited to roles in which she has limited opportunities to work with others. c. ask staff members on the unit with whom she works to provide her feedback about ways in which her behavior irritates or turns them away. d. encourage her to continue her graduate courses, as information about strategies and technical aspects of the role will compensate for negative interactions.

ANS: A Leadership involves radiating positive energy and the ability to inspire and motivate others. Management can be taught through formal instruction, but leadership is attained through reflection on rich personal experience.

The adage "leaders are born and not made" reflects which of the following ideas around leadership? a. Management can be taught; leadership depends on abilities. b. Mentorship is important in developing innate skills of leaders. c. Leadership is a natural skill that cannot be refined or developed. d. Succession planning and formal education related to leadership are ineffective.

ANS: A Leadership is an abilities role that is reflective of rich personal experience. It can be developed and refined through such strategies as coaching, mentorship, and reflection. Management can be taught and learned.

During a discussion of concern about approaches used with aggressive patients in the Emergency Department, several staff members express concern for their safety. As a leader, the nurse manager should: a. look directly at speakers and acknowledge their comments. b. promise to implement each suggestion that is made. c. implement the idea that receives the most discussion. d. listen but implement the plan that she had in mind before the discussion began.

ANS: A One of the five rules for leaders is to listen to the constituents—in this instance, the staff members who have safety concerns. Active listening in the United States means establishing direct eye contact and asking probing questions. Listening does not obligate the leader to any one course of action. Action will be based on what is best for the group.

After being interviewed for the unit manager position, the staff nurse reflects on the interview process. The staff nurse is aware that leadership begins: a. within. b. through a relationship with a mentor. c. with the job description. d. with the chief nursing officer of the organization.

ANS: A People notice differences in workplaces and tend to choose those that evidence a high degree of trust between leaders and followers. Stephen M.R. Covey suggests that trust begins with self and that leaders must focus first on developing character and confidence, which is their credibility. Credibility enables leaders to trust themselves and gives others someone or something that they can trust.

A nurse executive is hired to restore a unit's productivity, which has decreased as the result of low staff morale. The nurse executive utilizes which of the following leadership principles? a. The leader declares the intent and goals to enhance productivity and assumes that the unit also wishes to increase productivity, which allows nurses to feel in control of the environment. b. If staff members increase productivity, then they are given opportunity to engage in learning events such as workshops and conferences. If the staff members are not satisfied, they will insist on a different leader, who will get them what they want. c. Leaders at the national level who are seeking relief for nurses in the workplace are seen as the solution to the nursing shortage. d. Workplace satisfaction depends on staffing ratios, adequate pay, and tuition reimbursement, and these are things the leader can control.

ANS: A Stephen M.R. Covey suggests that Smart Trust is a method for restoring trust in organizations. Smart Trust Actions include declaration of the leader's intent and assumption by the leader that others also have positive intentions. Building trust involves signaling goals and intended actions in advance. Actions such as promising external rewards such as additional learning opportunities, workload relief, and compensation are consistent with transactional leadership, which leads to low to stable commitment and limited satisfaction.

A group of managers is meeting to discuss ideas related to the successful implementation of evidence-based practice on their units. Susan has been asked by the director of care to assume leadership of these discussion groups. After two such sessions, Susan expresses disappointment to her mentor that the group seems disinterested in her ideas and that they are listening to Ken, who has much less experience with leadership. In discussing this with Susan, the mentor understands that leadership: a. is a designated role. b. must be earned. c. is more likely to be taken by someone who is more talkative. d. rarely is taken over by someone with less experience.

ANS: B A person can have an impressive title, but title or designation does not make the person a leader. A leader must have the ability to inspire others to follow.

Recruiting among the emerging work force (18 to 35 year olds) is a challenge for healthcare agencies. Marketing brochures should address the leadership and vision of the healthcare agency. Which of the following workplace environments will attract applicants in the emerging work force? a. A highly professional environment b. A nurturing and receptive environment c. An environment highlighted by lots of meetings, so staff members can have lots of input d. A totally online environment, so staff members will not have to interface with uncaring colleagues

ANS: B A study of student nurses who represent this age-group indicates that they want a leader who is receptive, approachable, a team player, and motivating.

A nurse executive who considers herself a Baby Boomer will have the challenge of convincing the emerging work force of the necessity of committee meetings. One of the primary reasons that the Baby Boom generation appears to have so many meetings in the work environment is that: a. they feel more comfortable in a group. b. they find that the journey to the solution is as important as the solution itself. c. they were deprived of collective action opportunities in the past and now feel that solutions are better when many people have input. d. Baby Boomers are aging and need the respite from work that meetings offer, so they can recuperate from the physical demands of the work environment.

ANS: B Baby Boomers mistrust authority and trust in collective action, based on successes with social movements in their formative years.

The new head nurse on G Unit has been the subject of a great deal of discussion and complaining during breaks. She is a competent nurse of tremendous integrity with approximately 30 years' experience. Her predominant method of problem solving and communication is through meetings, which can go over the allotted time. The staff may: a. be represented by a high number of Baby Boomers. b. be presenting different generational values and attitudes than the head nurse. c. be unresponsive to her transactional leadership style. d. want a leader rather than a manager.

ANS: B Leaders who come out of the Baby Boomer generation may be more comfortable with collective action than followers who come out of the Emerging Work force generation, who are more comfortable with interactions if they are seen as having value for them and with activities if they are seen as having benefit. A group that is highly weighted toward the Emerging Work force generation may find the approach of a leader who is part of the Baby Boomer generation frustrating and may not understand the meaning or value of the meetings.

The Sunny long-term care facility has experienced numerous difficulties with staff relationships, despite its success in maintaining financial viability and judicious use of resources. Staff members complain that the primary concerns of the facility include applying policy, saving money, and ensuring that lawsuits are avoided. There is little trust in, and involvement of, staff members. This facility may be: a. well managed and well led. b. overly managed and not well led. c. poorly managed and well led. d. overly led and overly managed.

ANS: B This organization is concerned primarily with coordination of resources, application of current policy, and economic issues connected to the present. These behaviors are consistent with the management role. There is little evidence that the organization displays leadership, which involves trust, belief, hope, and vision.

Which of the following nurses is MOST likely to inspire others to do their best? a. Nancy, RN, is an individual who enjoys details and organization. She regularly leaves notes for the next shift about what has been done incorrectly or omitted. b. Jim, RN, has been involved in nursing for several years and is well liked by patients and families. He continually searches for new knowledge and skills, and his sense of humor and optimism are infectious. c. Clara has been the head nurse on Unit 3Y for years. She is quiet but enjoys patients and their families. She has not been to a conference in years because the unit is her entire life. d. Karen is a team leader. She is extraordinarily vigilant about ensuring that everyone is treated fairly in assignments. She is also very conscientious about care and regularly checks up on what everyone is doing to ensure that it is done correctly.

ANS: B To be inspired, people must have a positive leader who radiates energy, a zest for learning, and an interest in the common good, and is engaged in self-renewal. This leader is hopeful and optimistic. Leaders, not managers, inspire others to work to their highest level.

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style? a. Transformational b. Transactional c. Trusting d. Truthful

ANS: B Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

The nurse manager in the Emergency Department needs to implement new staffing patterns. As a transformational leader, the nurse manager would: a. explain in detail how well the new idea will work. b. reinforce how this change will respond to the ideas and solutions generated by staff members. c. reason with staff members that the new idea will save money and allow more free time. d. imply that raises will be smaller than anticipated if the new idea is not accepted.

ANS: B Transformational leadership inspires and motivates others through influence and persuasion rather than through rewards (e.g., free time) and punishment (e.g., smaller raises). This type of leader listens to the views of others (such as those of the staff members), empowers others to lead (such as in generating solutions for staffing problems), finds ways to remove barriers, and serves as an advocate for those who care for patients.

The style of leadership that Kari is exhibiting is likely to: a. ensure that the organization is financially stable. b. stifle innovative thinking about ways to move out of financial jeopardy. c. lead to apathy and disinterest in the organizational goals. d. lead to decreased attrition of staff on her unit.

ANS: B Whether or not the organization achieves financial stability is a function of financial envisioning and planning, but the style of leadership (transactional) that Kari is demonstrating is likely maintaining the status quo within the organization, without generating creative and innovative ideas to address the financial issues. Staff commitment is low to stable, and conformity to organizational goals is motivated by external rewards.

As a senior executive, you are keen to develop your hospital as a learning organization. Part of your purpose in translating this vision into practice is to: (Select all that apply.) a. retain funding from third-party payers. b. develop leaders. c. maintain and/or improve quality of care. d. stay abreast of new knowledge and evidence.

ANS: B, C, D Learning organizations are concerned with providing opportunities and incentives for individuals and groups to engage in lifelong learning, in recognition of the positive impact that learning has on patient outcomes and staying abreast of new knowledge. Lifelong learning and reflection are also characteristics of leaders.

The hospital administration is discussing the possibility of closing hospital beds in your unit because of a nursing shortage and the increased amount of overtime required to care for patients. As the leader on the unit, which of the following examples best demonstrates your transformational leadership style? a. Your entire staff walks out on strike. b. Your staff sends an ultimatum to the clinic director demanding higher pay. c. A group of your staff members goes to the administration to propose closing of a different unit. d. A group of your staff members goes to the administration to request that they be allowed to work the overtime hours.

ANS: C Commitment to the vision that has been created is seen in the ability of the leader to influence, motivate, and persuade others. The transformational leader can motivate employees by encouragement of novel, innovative thinking. True transformational leadership as occurring when the leader is able to motivate followers to create new ways to problem solve and manage the changes together.

In working with Cheryl, her mentor suggests that it is really important for Cheryl to engage in self-appraisal and to know her strengths. This observation is based on an understanding that: a. self-confidence comes automatically out of leading. b. self-confidence requires constant self-affirmation of strengths. c. there is little external motivation and affirmation in leadership. d. supervisors of leaders rarely provide feedback.

ANS: C Followers usually hold opinions about decisions that are made; these opinions can be favorable or not, which means that external motivation and affirmation are rare. Leaders have to be confident in their own abilities and enthused about the vision that they have created.

To retain supervisory staff members, the director of nursing develops a mentoring program. The best person to be a mentor for a new supervisor in a leadership position is someone who has: a. been in the same position and can relate to the new supervisor's problems. b. had vast leadership opportunities and likes to talk about his or her past experiences. c. leadership experience and time to spend communicating with the new supervisor about his or her experiences. d. people who can help the new supervisor get what he or she needs to make the organization grow quickly and prosper in the process.

ANS: C Mentors need to have experience and some success in the leadership area of interest, as well as interest in the future development of the novice. The mentor can be geographically distant or close and able to provide advice and feedback.

As the clinical director of 24 employees, you have been asked to explain to staff members why they are not getting a raise this year, even though they have been working short-handed for many months and patient satisfaction scores have never been higher. Because you believe yourself to be a transformational leader, you will approach this problem by: a. telling the assistant clinical director and asking her to share the bad news with the other staff members. b. posting a note on the bulletin board that includes the phone number of the chief nursing officer, so anyone who has complaints may express them. c. showing staff members the budget and asking for input about how to cut costs so that raises will be possible in the future. d. meeting with a small group of seasoned staff members and asking them how to break the news.

ANS: C Transformational leadership involves engaging those being led and inspiring shared vision in moving toward a goal that all will accept as desirable. This involves enabling and empowering others to believe that their input and effort will make a difference in solving problems.

John is interested in leadership positions within his nursing organization. Although he has been on the same unit for 10 years, he has attended two workshops during that time and has steadfastly refused opportunities to engage in leadership development opportunities or other learning offered as part of the hospital's succession planning strategy. He says that he is interested in a leadership role primarily because it will give him a more stable work schedule and will enable him to spend more time with his family. In coaching John, it would be important to: a. affirm that his years of service and stability on the unit are the most important attributes for assumption of a leadership role. b. reinforce that his concern with maintaining balance outside work would be a key factor in selecting him for a leadership position. c. encourage him to consider the financial rewards of the position, as well as the positive effect on his work schedule. d. encourage him to seek out new experiences and learning that will complement his existing strengths derived from experience and his interest in work-life balance.

ANS: D According to Covey, effective leaders continually engage in learning and self-renewal, as well as in maintaining a balanced life, radiating positive energy, believing in other people, being concerned with the common good, and being synergistic.

The senior executive praises John for the positive patient evaluations that his unit has received. As an effective leader, John: a. thanks the senior executive for having confidence in him and celebrates by going out to a special restaurant. b. points out the impact that the changes he has initiated have had on the unit. c. advises the senior executive that the mission statement and goals are important to him. d. points out the contributions of his staff to the outcomes and shares the praise with his staff.

ANS: D An effective leader is eager to share the glory with those who have worked with him or her to achieve outcomes and success. The act of acknowledging the achievement to the senior executive and of sharing the positive feedback with his staff empowers the staff and builds a support base for the leader.

After a newly hired director of nursing has reviewed the hospital's strategic plans, she develops a time line for achieving those plans. The new leader is: a. not expecting that novice leaders will have a vision. b. demonstrating mistrust of the abilities of her staff to implement the plans. c. instituting deadlines against which the performance of staff will be evaluated. d. translating a global document into realistic plans for nursing.

ANS: D Followers need three things from leaders: direction, trust, and hope. Developing time lines for the strategic plan involves translating a vision into reality and being able to communicate a vision meaningfully, which is an example of a leader's influencing behavior.

Susan, a new graduate on the dialysis unit, appears to take Kari's remarks very seriously and works even harder, often volunteering for extra assignments. She also is often in Kari's office, advising of successes with her patients and of the extra effort that she is committing. This behavior suggests that Susan: a. is fearful of losing her job. b. lacks understanding of Kari's leadership style. c. is not intimidated by Kari's leadership style. d. knows how to "play the game."

ANS: D Followers under transactional leadership feel secure about what will happen next or what is needed to be rewarded; therefore, they learn to "play the game."

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader? a. The unit secretary who knows everyone's business b. The chief nursing officer who is in charge and is responsible for nursing services c. The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician d. The staff nurse who persuades other staff members to practice by making evidence-based decisions

ANS: D Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

While explaining the importance of developing leadership skills among nurses to a group of first-year nursing students, Natalie, a nursing unit manager, emphasizes that: a. most nurses are not expected to assume leadership roles. b. the role of nurse leadership is only at the bedside, ensuring that patient care is performed according to established standards. c. only individuals in formal leadership roles are expected to be leaders. d. the public depends on nurses to assume leadership in moving consumer advocacy concerns forward.

ANS: D The complexity of nursing and the healthcare environment demands that all nurses assume roles of manager, leader, and follower, depending on the situation. Nurses are involved in providing leadership in direct patient care, in leading others at a unit or organizational level, in moving the profession forward, and in participating in legislative and policy arenas. Consumers depend on nursing leadership to carry the healthcare agenda forward.