NURSING LEADERSHIP AND

MANAGEMENT
Leadership and Followership

Today’s climate demands individuals who are

• Flexible
• Creative
• able to empower others to be flexible and
creative.
Nurses need to be more effective leaders
because of
• - nursing shortage
• - managed care
• - higher patient acuity
• - fewer resources
• - highly diverse demographics
• - outside influences,.
• Effective leader need the nurses to be
effective followers (knowing who to follow,
when to follow, how to follow, and how to use
the follower role most powerfully).
• Lleadership is about having a vision and
getting people to follow, using the art of
persuasion.
• Nursing’s focus today is on delivering quality
and cost-effective patient care rather than on
accomplishing a list of nursing tasks.
Leadership Theories— Past and Contemporary
GREAT MAN THEORY
• This theory assumed that all leaders were men and all were
great (i.e., of the noble class). Thus, those who assumed
leader- ship roles were determined by their genetic and
social inheritance.
TRAIT THEORIES
• Studies revealed that these leaders possessed multiple
characteristics.
SITUATIONAL OR CONTINGENCY THEORIES
• These theories embodied the idea that the right thing to do
depended on the situation the leader was facing..
TRANSFORMATIONAL THEORY
Leadership is not the ability to motivate people to work hard
for their pay but the ability to transform followers to become
more self-directed in all they do.
NEW SCIENCE LEADERSHIP
Leaders should follow five practices of
leadership:
• - challenging the status quo
• - inspiring a shared vision
• - enabling others to act rather than to react
• - being a role model
• - encouraging the heart.
Several tasks that leaders must perform :
• Envisioning goals
• Affirming values
• Motivating
• Managing
• Achieving a workable unity
• Explaining
• Serving as a symbol
• Representing the group
• Renewing
Followership
Those are importance of leaders and fol- lowers
working together in order to realize a vision.
Four types of followers:
• - sheep
• - yes people
• - alienated followers
• - effective or exemplary followers
• Sheep are passive individuals.
• “Yes” people are actively involved in the group’s
work and eagerly support the leader; they do not,
however, initiate ideas or think for themselves.
• Alienated followers do think for themselves and
often are critical of what the leader is doing; they
do not, however, share those ideas openly, they
seem disengaged, and they “rarely invest time or
energy to suggest alternative solutions or other
approaches”.
• Effective or exemplary followers reffer to the
individuals who are engaged, suggest new ideas,
share criticisms with the leader, and invest time
and energy in the work of the group
Four types of followers:
• - subordinates,
• - contributors
• - politicians
• - partners.
• The leaders cannot be leaders unless they
have followers, the role of the follower is
extremely important.

• Effective followers are not employees who sim

ply “follow the rules” and accept whatever
management decides.
Leadership and Management
Leadership and management are not the same.
• not all individuals in management positions are necessarily
leaders,
• leadership is not necessarily tied to a position of authority.

Not all managers are leaders and not all leaders are managers.
Leaders are able to manage and managers are able to lead.
Leaders do the right thing, and managers do things right.

All nurses need to lead and manage effectively in patient care

settings in order to accomplish tasks and achieve maximum
care quality.
Nursing Leaders
The nursing profession claims many true
leaders.
• They have expressed bold visions,
• invested enormous amounts of energy to
realize those visions,
• effectively engaged followers in the quest,
• been passionate about the futures they hoped
to create,
• absorbed criticism, setbacks, and opposition
on the road to success.
Talented nurses
• articulated a vision of a better future,
• was passionate about working to realize that
preferred future,
• was successful in enlisting nurses in the effort,
• was willing to take risks,
• accepted criticism and suggestions,
• spoke eloquently,
• exhibited enormous amounts of energy,
• was unwilling to accept the status quo or settle
for “second best.”
Each of these nurse individuals was a leader.
Leadership Qualities
Several attributes of leaders,
• physical vitality and stamina,
• intelligence, good judgment,
• willingness to accept responsibilities,
• task competence
• understanding of followers’ needs,
• ability to work effectively with others,
• a need to achieve,
• ability to motivate others,
• courage.
The leaders have the following six competencies:
• 1. Leaders must foster a clear vision
• 2. Getting people to support a vision or mission
takes work.
• 3. Leaders must be optimistic and see
possibilities.
• 4. Leaders must create a culture of candor
(opened/honesty)
• 5. Leaders must mentor others and
acknowledge their ideas and accomplish- ments.
• 6. Good leaders must be in tune to getting
results.
Power is a definitive aspect of leadership
because it motivates individuals and contributes
to their charisma.

The two primary sources of power are

• One’s position in an organization
• One’s personal qualities.
BECOMING A NURSE LEADER
In order to become leaders, however, nurses must
• learn about leadership in their academic programs
• through on-the-job experiences,
• through mentors,
• through other avenues.

In order to develop their leadership skills, it is imperative

for nurses
• to observe expert leaders,
• work hand-in-hand with such individuals,
• receive constructive feedback on their performance
Management Theory
• Nurses manage care for individual clients, families, and
communities in hospitals, outpatient settings, clinics, health
departments, home health agencies, long-term care
facilities, and rehabilitation centers as well as in other
specialized healthcare organizations.
• Managers have traditionally been responsible for the
control of resources required to accomplish organizational
goals.

Management have a five-step process:

• 1. Planning
• 2. Organizing
• 3. Directing
• 4. Coordinating
• 5. Controlling
• The manager is employed by an organization
and given the responsibility to accomplish
specified goals for the organization.

• Nursing management roles in the hospital

vary, and the work to be accomplished
depends on the span of authority inherent in a
particular position.
Management and Leadership
Management or leadership was the better approach to accomplishing the
goals of an organization.

The concepts of management and leadership in this way:

• The manager administers; the leader innovates.
• The manager maintains; the leader develops.
• The manager focuses on systems and struc- ture; the leader focuses on
people.
• The manager relies on control; the leader inspires trust.
• The manager has a short-range view; the leader has a long-range
perspective.
• The manager asks how and when; the leader asks what and why.
• The manager has his eye on the bottom line; the leader has his eye on the
horizon.
• The manager imitates; the leader originates.
• The manager accepts the status quo; the leader challenges it.
• The manager is the classic good soldier; the leader is his own person.
• The manager does things right; the leader does the right thing.
21ST-CENTURY MANAGEMENT THOUGHT
• Management theory in the first decade of the 21st
century is influenced by a new worldview, which had
its roots in the physical sciences.

• Complexity science “is not a single theory. It is the

study of complex adaptive systems—the patterns of
relationships within them, how they are sustained,
how they self-organize, and how out- comes emerge.

• Mmanagers first must manage themselves to ensure

their own integrity, character, ethics, knowledge, wis-
dom, words, and acts.
Management for Nurses
The nurse manager has many varied formal and
informal roles :
• 1. Team builder
• 2. Decision maker
• 3. Communicator
• 4. Negotiator
• 5. Delegator
• 6. Mentor
Motivation Yields Job Satisfaction Yields More
Successful Organizations
• Job satisfaction occurs when a nurse’s
motivational needs are met.
• Nurses and other employees work in order to
have certain needs met, such as financial and
growth needs.
• When those needs are met, employees
express satisfaction with their jobs
Job Satisfaction For Nurses
Money is not the primary motivation for job satisfaction for nurses.

Factors that inhibited job satisfaction were those that hindered the
ability to accomplish patient care, including
• lack of supplies,
• feeling overloaded,
• difficulties in communicating with physicians.

The combination of core job dimensions leads to job satisfaction,

such as
• skill variety,
• task identity,
• task significance,
• autonomy,
• feedback on job performance,
• perceived meaningfulness of work,
• knowledge of and responsibility for outcomes.
• Nurse job satisfaction was related in part to
some measure of patient satisfaction, such as
satisfaction with pain management and
arrangement for follow-up care post-discharge

• Nurse satisfaction also affects the bottom line

of health-care organizations.
Organizational Structures
• Affected by the economic, political, social, and
technological pressures in society. The structure
identifies the authority, the responsibility, and
the decision-making processes.
• Nursing is an integral and major component of
the health-care organization, with nursing being
the largest group of employees within the health-
care setting.
• Organizations consist of groups of people coming
together for a common purpose. An organization
can be defined as “a group of persons with
specific responsibilities who are acting together
for the achievement of a specific purpose
determined by the organization”
Classical theory
From classical principles, Weber’s model consists of
the following components:
• Organizational structure
• Division and specialization of labor
• Chain of command
• Span of control

NEOCLASSICAL THEORY (HUMANISTIC THEORY)

• It placed emphasis on cooperation and
participation in the workplace. The key factor in
this theory is motivation. A motivated employee
will produce better output in the job setting.
SYSTEMS THEORY
• This theory asserts that systems are a whole and that
organizations should be viewed as a whole, considering
the relationships within the structure of the
organization.
CHAOS THEORY
• The Chaos Theory stresses the importance of change
within organizations. Change is the stimulation of the
organization, and it is constant in health care today.
CONTINGENCY THEORY
• The concept within the Contingency Theory is that the
organization’s structure must match the working of the
environment. The most common aspect of the
Contingency Theory recognizes the style of the leader
and how this influences the situation.
LEARNING ORGANIZATIONS
• In a learning organization, the people and the
systems respond and expand their capabilities
to obtain the results that are desired.
• The basic con-cept is that in situations of
change, the organization that is adaptive to
the change will thrive.
Organizational Components and Planning
• ORGANIZATIONAL VALUES
• MISSION STATEMENTS
• VISION STATEMENTS
• ORGANIZATIONAL PHILOSOPHY
• ORGANIZATIONAL GOALS AND OBJECTIVES
• ORGANIZATIONAL POLICIES AND PROCEDURES
• ORGANIZATIONAL STRATEGIC PLANNING
The Organization Chart
• The organization chart outlines the formal
working relationships and the way people
interact within the given structure.

The organization chart establishes the

following:
• Formal lines of authority—the official
power to act
• Responsibility—the duty or assignment
• Accountability—the moral responsibility
CHAIN OF COMMAND
Chain of command demonstrates who formally
reports to whom within the organization. It is a
formal line of authority and communication
within the organization and the structure.
• Line Positions
• Staff Positions
Unity of Command
• The concept of unity of command is central to the
hierarchy of the organization. The overall thought is
that each person on the organization chart has one
manager or one boss.

Span of Control
• Span of control is denoted on the chart as the number
of people reporting to each manager. The span of
control determines how the organizational structure
will appear on paper (Altaffer, 1998). A wide span of
control indicates that many people are reporting to a
manager, and a narrow span of control indicates that
only a few people are reporting to the manager.
DECISION MAKING
• Organization charts also depict how decisions
are made within an organization.
• Centralized decision making occurs when a
few people at the top levels of the
organizational structure make decisions.
• Decentralized decision making occurs when
decisions are made throughout the organ-
ization, at the lowest level possible within the
organization.
Type of Organizational Structures
• TALL/CENTRALIZED/BUREAUCRACY
• FLAT/DECENTRALIZED STRUCTURE
• AD HOC/ADHOCRACY STRUCTURE
• MATRIX STRUCTURE
STRUCTURES SPECIFIC TO HEALTH CARE
• Integrated Health-Care System

• Integrated health-care systems can be defined as

innovative, patient-centered hospital delivery sys-
tems that continuously improve quality and use
resources cost-effectively

• The push for an integrated system stems from the

need to improve the quality of care within
organizations, to reduce costs associated with
health care, and to ensure patient/customer
satis- faction
TYPES OF HEALTH-CARE SERVICES
• There are three types of health-care services on
the health-care continuum. Integrated systems
often provide all three types. The shift to
managed care has also changed the focus from
secondary and ter- tiary care to primary health
care.

MAGNET STATUS
• The American Academy of Nursing (AAN) began
to review and identify as magnet hospitals those
hospitals that had solid organizational structures
and a decentralized, open management style.
There are 14 criteria necessary to obtain magnet status:
• 1. Quality of nursing leadership
• 2. Organizational structure
• 3. Management style
• 4. Personnel policies and programs
• 5. Professional models of care
• 6. Quality of care
• 7. Quality improvement
• 8. Consultation and resources
• 9. Autonomy
• 10. Community and the hospital
• 11. Nurses as teachers
• 12. Image of nursing
• 13. Interdisciplinary relationships
• 14. Professional development
ORGANIZATIONAL CULTURE
• Culture can be defined as the assumptions and beliefs that
organizational members have in com- mon. It is the “shared values
and beliefs within the organization”

ORGANIZATIONAL CLIMATE
• The climate of the organization is the “perception of how it feels to
work in a particular environment”.

Some characteristics of climate include

• amount of involvement members can have,
• supervisor support given,
• amount of responsibility given,
• commitment of the members,
• flexibility of the work setting,
• standards set for improving practice.