Nursing Leadership,
Followership and Management
Nursing 493: Unit II
Why study leadership &
management?
Who are our
leaders?
What are the most serious
problems people face in the work
environment?
Technical
Safety
People
Financial
Ethical
Why?
To learn how to work with people, not only as
individuals, but as members of groups,
teams, and organizations
Provides greater understanding and control of
events in the work situation
Imparts a sense of personal power & self
direction
Definitions
Leadership- the process of influencing
others
Leaders inspire thru personal
trustworthiness & self-confidence
Leaders communicate a vision that turns
self-interest into commitment to the job
What are the 3 primary tasks
of a leader?
Set direction: mission, goals, vision
Build commitment: motivate & inspire
Confront challenges: innovation, deal
with change, turbulence, take risks
What does the study of
leadership involve?
Leadership theories
Motivation
Group development & team work
Power & conflict
Confrontation & negotiation
Effective communication
Critical thinking & problem solving
Leadership
All people have untapped leadership
potential …it is there in you.
The attempt defines leadership…it does
not have to be successful
To be a leader you must make a
decision to act
What is Followership
Followership & leadership are reciprocal
roles
Being an effective follower is as
important to the new nurse as being an
effective leader
What are the characteristics of
an effective follower?
Self direction
Actively participates in setting group
direction
Invests time & energy in the work of
the group
Thinks critically
Advocates for new ideas
What is management?
Management – too is a process of influencing
people but with the specific intention of
contributing to meeting the organization’s
goals
Management is the process of getting work
done through other people
Management is planning, organizing,
coordinating, and controlling work given to
employees
Management Functions
Officially responsible for the work of a group
Hiring & firing
Evaluating staff performance
Recommending raises and promotions
Prepare & implement a budget
Approve expenses & purchases
Handle conflicts
Work schedules & assignments
Plan current & future activities of unit
Be open to demands of continuous change
New definition of
management
To do whatever is necessary to see
that employees do their work and do
it well.
Differences b/w leadership &
management
Leadership Management
based on influence based on authority
an informal a formally designated
designation position
an achieved position an assigned position
part of every nurse’s improved by use of
role effective leadership
independent of skills
management
What makes a person a
leader?
We look to Leadership theories
Most Prominent Leadership
Theories
TRAIT THEORIES
BEHAVIORAL THEORIES (Leadership
styles)
SITUATIONAL THEORIES
(understanding all the factors)
TRANSFORAMTIONAL THEORIES
(inspiration & meaning)
Comparison of Authoritarian,
Democratic, & Laissez-Faire
Authoritar.Democrat. Laissez-F
Degree of
freedom
Little Moderate Much
Degree of control
High Moderate None
Decsision making
By leader Leader& Group or
group no one
Leader activity level
High High Minimal
Assumption of
Responsibility Leader Shared Abdicated
Output of group
High& High & Variable-
good qual. creative Poor?
What are the key differences
in the 3 leadership styles?
Democratic leader moves the group
toward its goals
Autocratic leader moves the group
toward the leader’s goals
Laissez-faire leader makes no attempt
to move the group
Behaviors of an Effective
Leader
Think critically
Solve problems
Respect people
Communicate skillfully
Set goals, share a vision
Develop self & others
Transformative Leadership
Qualities
Integrity (Action Optimism
matches words) Balance(work,
Courage (take reflection,play)
risks) Ability to handle
Initiative (Act on stress
ideas) Self-Awareness)
Energy
What distinguishes ordinary
leaders from STARS?
Emotional Intelligence –
addressing the effects of people’s
feelings on the team
Management Theories: Two
Opposing Schools of Theory
Scientific
management
Human relations-
oriented
management
Scientific management
Frederick Taylor Father of S.M.
Focus on tasks & ways to increase
efficiency & productivity by getting
more work out of individual employees
What makes a person a
manager? Two Perspectives
Scientific Management - Frederick
Taylor says (emphasis is on the task
aspect of providing care, paying people
by the # of clients seen, incentive is to
get the most work done in the least
amount of time. The current emphasis
on reducing staff & increasing
productivity is based on this type of
thinking.
Human Relations-Oriented
Management Theory: X&Y
Theory X (McGregor’s ) says most
people think work is something to be
avoided, and the managers job is to
make them work hard.
According to Theory X employees need
strict rules, constant supervision, & the
threat of punishment to make them
conscientious.
Theory Y
Theory Y manager believes the work
itself is motivating and people really
want to do a good job.
The Theory Y manager emphasizes
guidance rather than control,
development vs close supervision, &
reward vs punishment.
Communication
Is at the heart of leadership
Leadership can not occur except in
relationship to other people &
communication is the means through
which leadership is accomplished
Communication
We “cannot not
communicate”!
Communication
Giving & receiving feedback
Linking (connecting ideas in a group)
Networking (connecting people in a
group or organization
Verbal & Nonverbal:KeyPoints
Most nonverbal is done unconsciously
It is more difficult to control
Discrepancies often exist between
verbal & nonverbal
What is stated is often not felt or
believed
Listening is the most critical
communication skill
Emotional Intelligence
Listen to others
Pick up unspoken concerns
Acknowledge others’ perspectives
Welcome constructive criticism
Bring people together in a spirit of trust
Communication with
colleagues
Telephone etiquette
Information systems/computer/e-mail
Change-of-shift report
Be assertive without being aggressive
Staying calm & demonstrating good
communication skills demonstrates
professionalism& an ability to work well
with others
Communicating with other
disciplines
Nurses are client care coordinators
Nurses spend the most time with clients,
therefore they are in the best position to
communicate among disciplines info re client
Physicians: nurses need to communicate
changes in the client condition, discuss
modification in treatment plan, clarify orders
This may be stressful-have the info you need
on hand before phoning (meds, vitals, general
health assessment status)
Maintain a record of calling logs
Communicating with clients &
family
Recognize signs of anger or anxiety
Intervene to diffuse the situation
Practice good listening & show respect
GIVING FEEDBACK
1. Give both positive & negative feedback
2. Give immediate feedback
3. Give frequently-keeps motivation high &
prevents problems from growing high
4. Be objective - use standards for making
judgments, tell “Why” it is good/bad
5. Base feedback on observable behavior- be
factual & accurate
Feedback (cont’d)
6. Communicate effectively - give
feedback & be prepared to receive
feedback in return. Engage in active
listening. When you give negative
feedback allow time for the individual to
express their feelings & for problem
solving to find ways to improve the
situation. This is impt. If the problem
has been ignored a long time.
7. Include suggestions for change. Try to
suggest alternative behaviors
8. Communicate in a non-threatening
manner. Highly threatening messages
reduce motivation & inhibit learning. Too
much fear immobilizes people.
Remember your ultimate purpose is to
bring about improved performance.
Performance Appraisal
Peer Review
Evaluation procedures
One by manager or superior (hierarchical)
One by colleagues with similar status &
education
Peer review may be combined with
performance appraisal to form a
comprehensive system of evaluation
Case Scenario: Small Change
in Procedure??!!
It was not “big deal” just a small change in
procedure. At least that is what the VP
Nursing of the Tri-County Home Care Agency
thought when she ordered the staff to bring
their lap top computers back to the office
every evening. “These machines are
expensive”, the VP noted, “We can not
continue to let staff take them home. They
could be broken, stolen, or used to play
games in the evening.”
Questions for critical reflection
How do you think the staff reacted to
this change? Explain why they reacted
as you describe?
Did the VP act primarily as a leader or
as a manger? Explain your choice
What alternative procedure might be
implemented to protect the laptops?