Essentials of Nursing Leadership and Management 5th edition Whitehead eBook

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  • Published: 2009
  • ISBN-10: 0803622082
  • ISBN-13: 978-0803622081

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essentials of nursing leadership and management 5th edition eBook

Table of Contents

unit 1 Professional Considerations

chapter 1 Leadership and Followership 3

chapter 2 Manager 13

chapter 3 Nursing Practice and the Law 21

chapter 4 Questions of Value and Ethics 39

chapter 5 Organizations, Power, and Empowerment 57

unit 2 Working Within the Organization

chapter 6 Getting People to Work Together 73

chapter 7 Dealing With Problems and Conflicts 91

chapter 8 People and the Process of Change 103

chapter 9 Delegation of Client Care 115

chapter 10 Quality and Safety 131

chapter 11 Time Management 157

unit 3 Professional Issues

chapter 12 Promoting a Healthy Workplace 171

chapter 13 Work-Related Stress and Burnout 197

chapter 14 Your Nursing Career 217

chapter 15 Nursing Yesterday and Today 239

xi

Appendices

appendix 1 Codes of Ethics for Nurses 257

American Nurses Association Code of Ethics for Nurses 257

Canadian Nurse Association Code of Ethics for Registered Nurses 257

The International Council of Nurses Code of Ethics for Nurses 258

appendix 2 Standards Published by the American Nurses Association 259

appendix 3 Guidelines for the Registered Nurse in Giving, Accepting,

or Rejecting a Work Assignment 261

Index 267

Bonus Chapters on DavisPlus

Finance

Triaxial of Action: Policy, Politics, and Nursing

Canadian Nursing Practice and the Law

xii

chapter1

Leadership and Followership

OBJECTIVES

After reading this chapter, the student should be able to:

■ Define the terms leadership and followership.

■ Discuss the importance of effective leadership and

followership for the new nurse.

■ Discuss the qualities and behaviors that contribute to

effective followership.

■ Discuss the qualities and behaviors that contribute to

effective leadership.

OUTLINE

Leadership

Are You Ready to Be a Leader?

Leadership Defined

Followership

Followership Defined

Becoming a Better Follower

What Makes a Person a Leader?

Leadership Theories

Trait Theories

Behavioral Theories

Task Versus Relationship

Motivating Theories

Emotional Intelligence

Situational Theories

Transformational Leadership

Moral Leadership

Qualities of an Effective Leader

Behaviors of an Effective Leader

Conclusion

3

4 unit 1 | Professional Considerations

Nurses work with an extraordinary variety of people:

physicians, respiratory therapists, physical therapists,

social workers, psychologists, technicians, aides, unit

managers, housekeepers, clients, and clients’ families.

The reason why nurses study leadership is to

learn how to work well, or effectively, with other

people. In this chapter, leadership and followership

and the relationships between them are defined.

The characteristics and behaviors that can make

you, a new nurse, an effective leader and follower

are discussed.

Leadership

Are You Ready to Be a Leader?

You may be thinking, “I’m just beginning my career

in nursing. How can I be expected to be a leader

now?”This is an important question. You will need

time to refine your clinical skills and learn how to

function in a new environment. But you can begin

to assume some leadership right away within your

new nursing roles. Consider the following example:

Billie Blair Thomas was a new staff nurse at Green

Valley Nursing Care Center. After orientation, she

was assigned to a rehabilitation unit with high

admission and discharge rates. Billie noticed that

admissions and discharges were assigned rather haphazardly.

Anyone who was “free” at the moment was

directed to handle them. Sometimes, unlicensed assistant

personnel were directed to admit or discharge

residents. Billie believed that using them was inappropriate

because their assessment skills were limited

and they had no training in discharge planning.

Billie thought there was a better way to do this

but was not sure that she should say so because she

was so new. “Maybe they’ve already thought of

this,” she said to a former classmate. “It’s such an

obvious solution.” They began to talk about what

they had learned in their leadership course before

graduation. “I just keep hearing our instructor saying,

‘There’s only one manager, but anyone can be a

leader of our group.”

“If you want to be a leader, you have to act on

your idea,” her friend said.

“Maybe I will,” Billie replied.

Billie decided to speak with her nurse manager,

an experienced rehabilitation nurse who seemed

not only approachable but also open to new ideas.

“I have been so busy getting our new record system

on line before the surveyors come that I wasn’t

paying attention to that,” the nurse manager told

her. “I’m so glad you brought it to my attention.”

Billie’s nurse manager raised the issue at the next

executive meeting, giving credit to Billie for having

brought it to her attention. The other nurse managers

had the same response. “We were so focused on

the new record system that we overlooked that. We

need to take care of this situation as soon as possible.

Billie Blair Thomas has leadership potential.”

Leadership Defined

Leadership is a much broader concept than is management.

Although managers should also be leaders,

management is focused on the achievement of

organizational goals.Leadership, on the other hand:

…occurs whenever one person attempts to influence

the behavior of an individual or group—up, down,

or sideways in the organization—regardless of the

reason. It may be for personal goals or for the goals

of others, and these goals may or may not be congruent

with organizational goals. Leadership is influence

(Hersey & Campbell, 2004, p. 12)

In order to lead, one must develop three important

competencies: (1) ability to diagnose or understand

the situation you want to influence, (2) adaptation

in order to allow your behaviors and other resources

to close the gap between the current situation and

what you are hoping to achieve, and (3) communication.

No matter how much you diagnose or

adapt, if you cannot communicate effectively, you

will probably not meet your goal (Hersey &

Campbell, 2004).

Effective nurse leaders are those who engage

others to work together effectively in pursuit of a

shared goal. Examples of shared goals are providing

excellent client care, designing a costsaving

procedure, and challenging the ethics of a

new policy.

Followership

Followership and leadership are separate but reciprocal

roles. Without followers, one cannot be a

leader; conversely, one cannot be a follower without

a leader (Lyons, 2002).

Being an effective follower is as important to the

new nurse as is being an effective leader. In fact,

most of the time most of us are followers: members

of a team, attendees at a meeting, staff of a nursing

care unit, and so forth.

chapter 1 | Leadership and Followership 5

Followership Defined

Followership is not a passive role. On the contrary,

the most valuable follower is a skilled, self-directed

employee, one who participates actively in setting

the group’s direction, invests his or her time and

energy in the work of the group, thinks critically,

and advocates for new ideas (Grossman & Valiga,

2000). Imagine working on a client care unit where

all staff members, from the unit secretary to the

assistant nurse manager, willingly take on extra

tasks without being asked (Spreitzer & Quinn,

2001), come back early from coffee breaks, complete

their charting on time, suggest ways to

improve client care, and are proud of the high quality

care they provide. Wouldn’t it be wonderful to

be a part of that team?

Becoming a Better Follower

There are a number of things you can do to become

a better follower:

■ If you discover a problem, inform your team

leader or manager right away.

■ Even better, include a suggestion in your report

for solving the problem.

■ Freely invest your interest and energy in your

work.

■ Be supportive of new ideas and new directions

suggested by others.

■When you disagree, explain why you do not

support an idea or suggestion.

■ Listen carefully, and reflect on what your leader

or manager says.

■ Continue to learn as much as you can about

your specialty area.

■ Share what you learn.

Being an effective follower will not only make you

a more valuable employee but will also increase the

meaning and satisfaction that you can get from

your work.

Most team leaders and nurse managers will

respond very positively to having staff who are

good followers. Occasionally you will encounter a

poor leader or manager who can confuse, frustrate,

and even distress you. Here are a few suggestions

for handling this:

■ Avoid adopting the ineffective behaviors of this

individual.

■ Continue to do your best work and to provide

leadership for the rest of the group.

■ If the situation worsens, enlist the support of

others on your team to seek a remedy; do not

try to do this alone as a new graduate.

■ If the situation becomes intolerable, consider the

option of transferring to another unit or seeking

another position (Deutschman, 2005; Korn, 2004).

What Makes a Person a Leader?

Leadership Theories

There are many different ideas about how a person

becomes a good leader. Despite years of research on

this subject, no one idea has emerged as the clear

winner. The reason for this may be that different

qualities and behaviors are most important in different

situations. In nursing, for example, some situations

require quick thinking and fast action. Others

require time to figure out the best solution to a

complicated problem. Different leadership qualities

and behaviors are needed in these two instances.The

result is that there is not yet a single best answer to

the question, “What makes a person a leader?”

Consider some of the best-known leadership

theories and the many qualities and behaviors that

have been identified as those of the effective nurse

leader (Pavitt, 1999; Tappen, 2001).

Trait Theories

At one time or another, you have probably heard

someone say, “Leaders are born, not made.” In other

words, some people are natural leaders, and others

are not. In reality, leadership may come more easily

to some than to others, but everyone can be a

leader, given the necessary knowledge and skill.

Research into the traits of leaders is a continuing

process. A 5-year study of 90 outstanding leaders

by Warren Bennis (1984) identified four common

traits shared by all of these leaders. These traits

continue to hold true:

1. Management of attention. These leaders were

able to communicate a sense of goal or direction

to attract followers.

2. Management of meaning. These leaders created

and communicated meaning with clarity and

purpose.

3. Management of trust. These leaders demonstrated

reliability and consistency.

4. Management of self. These leaders were able to

know self and work within their strengths and

weaknesses (Bennis, 1984).

6 unit 1 | Professional Considerations

Behavioral Theories

The behavioral theories are concerned with what

the leader does. One of the most influential theories

is concerned with leadership style (White &

Lippitt, 1960) (Table 1-1).

The three styles are:

■ Autocratic leadership (also called directive, controlling,

or authoritarian). The autocratic leader

gives orders and makes decisions for the group.

For example, when a decision needs to be made,

an autocratic leader says, “I’ve decided that this

is the way we’re going to solve our problem.”

Although this is an efficient way to run things,

it usually dampens creativity and may inhibit

motivation.

■ Democratic leadership (also called participative).

Democratic leaders share leadership. Important

plans and decisions are made with the team

(Chrispeels, 2004). Although this is often a less

efficient way to run things, it is more flexible

and usually increases motivation and creativity.

Democratic leadership is characterized by guidance

from rather than control by the leader.

■ Laissez-faire leadership (also called permissive or

nondirective). The laissez-faire (“let someone

do”) leader does very little planning or decision

making and fails to encourage others to do so.

It is really a lack of leadership. For example,

when a decision needs to be made, a laissez-faire

leader may postpone making the decision or

never make the decision. In most instances, the

laissez-faire leader leaves people feeling confused

and frustrated because there is no goal, no

guidance, and no direction. Some very mature

individuals thrive under laissez-faire leadership

because they need little guidance. Most people,

however, flounder under this kind of leadership.

Pavitt summed up the difference among these three

styles: a democratic leader tries to move the group

toward its goals; an autocratic leader tries to move

the group toward the leader’s goals; and a laissezfaire

leader makes no attempt to move the group

(1999, pp. 330ff ).

Task Versus Relationship

Another important distinction in leadership style is

between a task focus and a relationship focus

(Blake, Mouton, & Tapper, 1981). Some nurses

emphasize the tasks (e.g., reducing medication

errors, completing patient records) and fail to realize

that interpersonal relationships (e.g., attitude of

physicians toward nursing staff, treatment of

housekeeping staff by nurses) affect the morale and

productivity of employees. Other nurses focus on

the interpersonal aspects and ignore the quality of

the job being done as long as people get along with

each other. The most effective leader is able to balance

the two, attending to both the task and the

relationship aspects of working together.

Motivating Theories

The concept of motivation seems fairly simple.We

do things to get what we want and avoid things that

we don’t want. However, motivation is still surrounded

in mystery. The study of motivation as a

focus of leadership began in the 1920s with the

historic Hawthorne study. Several experiments were

conducted to see if increasing light and, later,

improved working conditions would improve productivity

of workers in the Hawthorne, Illinois,

table 1-1

Comparison of Autocratic, Democratic, and Laissez-Faire Leadership Styles

Autocratic Democratic Laissez-Faire

Amount of freedom Little freedom Moderate freedom Much freedom

Amount of control High control Moderate control Little control

Decision making By the leader Leader and group together By the group or by no one

Leader activity level High High Minimal

Assumption of responsibility Leader Shared Abdicated

Output of the group High quantity, good Creative, high quality Variable, may be poor quality

quality

Efficiency Very efficient Less efficient than Inefficient

autocratic style

Adapted from White, R.K., & Lippitt, R. (1960). Autocracy and Democracy: An Experimental Inquiry. New York: Harper & Row.

chapter 1 | Leadership and Followership 7

electrical plant. Those workers who had the

improved working conditions taken away continued

to show improved productivity. Therefore, the

answers were found not in the conditions of the

experiments but in the attention given to the workers

by the experimenters. Similar to the 1954

Maslow Hierarchy of Needs theory, the 1959

Motivation-Hygiene theory developed by Frederick

Herzberg looked at factors that motivated workers

in the workplace. Following closely after Herzberg

was David McClelland and his 1961 Theory of

Needs. Clayton Alderfer responded to Maslow’s

theory with his own Existence, Relatedness, and

Growth (ERG) theory.Table 1-2 summarizes these

four historical motivation theories.

Emotional Intelligence

The relationship aspects of leadership are a focus

of the work on emotional intelligence (Goleman,

Boyatzes, & McKee, 2002). Part of what distinguishes

ordinary leaders from leadership “stars”

is consciously addressing the effect of people’s

feelings on the team’s emotional reality. How is

this done?

First, learn how to recognize and understand

your own emotions, and learn how to manage

them, channel them, stay calm and clear-headed,

and suspend judgment until all the facts are in

when a crisis occurs (Baggett & Baggett, 2005).

The emotionally intelligent leader welcomes constructive

criticism, asks for help when needed, can

juggle multiple demands without losing focus, and

can turn problems into opportunities.

Second, the emotionally intelligent leader listens

attentively to others, perceives unspoken concerns,

acknowledges others’ perspectives, and brings people

together in an atmosphere of respect, cooperation,

collegiality, and helpfulness so they can direct

their energies toward achieving the team’s goals.

“The enthusiastic, caring, and supportive leader

generates those same feelings throughout the

team,” wrote Porter-O’Grady of the emotionally

intelligent leader (2003, p. 109).

Situational Theories

People and leadership situations are far more complex

than the early theories recognized. In addition, situations

can change rapidly, requiring more complex

table 1-2

Leading Motivation Theories

Theory Summary of Motivation Requirements

Maslow, 1954 Categories of Need: Lower needs (below, listed first) must be fulfilled before others are activated.

Physiological

Safety

Belongingness

Esteem

Self-actualization

Alderfer, 1972 Three categories of needs, also ordered into a hierarchy:

1. Existence: Physical well-being

2. Relatedness: Satisfactory relations with others

3. Growth: Development of competence and realization of potential

Herzberg, 1959 Two factors that influence motivation. The absence of hygiene factors can create job dissatisfaction,

but their presence does not motivate or increase satisfaction.

1. Hygiene factors: Company policy, supervision, interpersonal relations, working conditions, salary

2. Motivators: Achievement, recognition, the work itself, responsibility, advancement

McClelland, 1961 Motivation results from three dominant needs. Usually all three needs are present in each individual

but vary in importance depending on the position a person has in the workplace. Needs are also

shaped over time by culture and experience.

1. Need for achievement: Performing tasks on a challenging and high level

2. Need for affiliation: Good relationships with others

3. Need for power: Being in charge

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