Leadership

• 1. Maslow’s hierarchy of needs to
• evaluate employee satisfaction can be used by asking; do your employees feel
• safe and secure? Do they feel included or do they feel they belong? Do they
• feel competent? (This reflects self-esteem). Do they feel they are used to
• their full potential? (This reflects self-actualization). If their needs are
• met the employee should feel satisfied and they no longer have that particular
• need motivating them any longer; but if the need is not met the person may feel
• stress, frustration, and conflict and this can affect their performance.( Page
• 339, Finkelman)

• Factors that can serve as motivators for employees are
• as simple as Maslow’s hierarchy of needs. Your employees are motivated by
• satisfiers and dissatisfiers, need for achievement, need for affiliation, the
• need for power, reinforcement( positive and negative) and equity.(Page 339-340,
• Finkelman)

• Strategies that a nurse manager can use to increase
• staff job satisfaction is; rewarding staff, pay for performance, merit raises,
• spot rewards, skill based pay, recognition awards, job design, empowerment,
• goal setting, positive reinforcement, and lifelong learning. (Page341,
• Finkelman)

• The
• significance of The Joint Commission to a health care facility is that if you
• are accredited by TJC this status can be used in marketing and it communicates
• to consumers that your institution provides quality care. Also for schools of
• nursing or medicine to use a hospital as a clinical site it must be accredited.
• (Page 181, Finkelman)

• Primary characteristics of a nurse leader are being
• able to assess, create, guide, direct, and project. (Slideshow 1, slide 2 and 5)

• -Leaders
• have a long-range perspective, focus on people and never want to maintain at
• the current level; leaders have authority from their influence. Key leadership
• roles include: expert, administrator, people person, and strategist.

• Pg.3
• ATI Resource The primary characteristics of a nurse leader are, initiative,
• inspiration, energy, positive attitude, communication skills, respect, and
• problem-solving/ critical thinking skills.

• Primary characteristics of a nurse manager are being
• able to plan, organize, lead, and control. (slideshow1, slide 6)

• -A nurse manager
• guides using evidence-based practice and procedures. Managers maintain the
• current state, focus on efficiency, are concerned with structure, and have a
• short-range view of things. Managers have authority from position in the
• organization. These individuals have roles in planning, organizing, leading,
• and controlling. Five basic functions of a nurse manager include establishes objectives
• and goals for each area and communicates them, organizes and analyzes,
• motivates and communicates, analyzes, appraises, and interprets performance,
• and develops people, including self.

• Pg.
• 3 ATI Resource The primary characteristics of a nurse manager are, formal
• position of authority and power, clinical expertise, network, coach, and
• decision maker.

• Characteristics
• of managed care are managing costs of health care, quality of health care, and
• access to health care. ((Page 155, Finkelman)

• The
• goal of managed care is to provide needed services efficiently and at an
• appropriate cost. This includes ensuring safe, effective, and affordable care.

• Workplace violence
• can develop in a healthcare facility because of individual characteristics,
• interpersonal factors, organizational factors, also facts, goals, approaches,
• and values. (Slide show 4, slide 11 and 15)

• o A significant source of interpersonal conflict in the
• workplace stems from lateral violence (aggressive and destructive behavior or
• psychological harassment of nurses against each other). Lateral violence may be
• a response to the practice environment in which ineffective leadership may
• exacerbate the problem(Yoder-Wise pg 477)

• A nurse manager
• can successfully use informatics in the workplace by taking leadership in
• selection and implementation and if the nurse manager participates this will
• get buy-in from the other staff. (Page 500, Finkelman)

• · (Yoder-Wise
• p. 62)

• o The electronic medical record gives quick and ready
• access to current and retrospective clinical
• patient data. The use of electronic patient classification systems allows
• managers to better measure the acuity of nursing areas, as well as assist in
• budget planning and need for resources.

• o The accessibility and use of the Internet facilitates
• the education of staff, patients, and their families.

• legal-ethical issues that should concern a nurse manager are Legal:
• Negligence, malpractice, assault, battery, consent, consent implied by law,
• informed consent, Living wills, durable power of attorney, DNR and Ethical:
• Autonomy, beneficence, justice, and veracity.( Page 45, Finkelman)

• a. The nurse manager retains personal liability
• for the reasonable exercise of assignment, delegation, and supervision
• activities. The failure to assign, delegate, and supervise within acceptable
• standards of professional nursing practice may constitute malpractice and may
• extend to direct corporate liability for the institution. (pg 75)

• b. Nurse managers also have a duty to orient,
• educate, and evaluate. They and their representatives are responsible for
• the daily evaluation of whether nurses are performing safe and competent care.
• (pg 76)

• c. Failure to warn potential employers of staff incompetencies or impairment. Info about suspected
• addictions, violent behavior, and incompetency is of vital importance to
• subsequent employers. If the institution has sufficient in for and suspicion to
• warrant the discharge of an employee or force resignation, subsequent employers
• should be advised of those issues. (pg 76)

• d. Staffing Issues: Accreditation, state, and federal standards mandate
• that healthcare institutions provide adequate staffing with qualified
• personnel. Nurse managers should exercise sound judgment to ensure patient
• safety and quality care rather than rely on exact nurse-to-patient ratios. To
• prevent nurse manager liability, he or she must show that sufficient numbers of
• competent staff were available to meet nursing needs. (pg 77)

• - Guidelines for nurse managers in inadequate staffing
• issues include alerting hospital administrators and upper-level managers of
• concerns.

• - Before floating staff from one area to another, the
• nurse manager should consider staff expertise, patient-care delivery systems,
• and patient-care requirements. Nurses should be floated to units as comparable
• to their own unit as possible.

• - When using agency or temporary personnel, ensure that
• the temporary staff member is given a brief but thorough orientation to
• institution policies and procedures, is made aware of resource materials within
• the institution, and is made aware of documentation procedures.

• Nurse
• managers are responsible for ensuring correct info is reported to the correct
• agencies, thus avoiding potential liability against the institution. (Ex: cases
• of STDs, suspected abuse)

• The nurse
• manager must fully understand informed consent policies because her or she can
• become a staff consultant

• - The NM is
• queried about patients’ rights in research studies that are being conducted in
• the institution

• - The NM must become aware of patient literacy and
• ensure that the info the nurse communicate to the patients is at a level they
• understand

• The nurse
• manager is cautioned to ensure that staff members both understand and abide by
• rules regarding patient privacy and confidentiality

• Nurse managers should review the policies and
• procedures frequently for compliance and timeliness. If the policies are absent
• or outdated, the nurse manager must request the appropriate person or committee
• to either initiate or update the policy

• Nurse
• managers must have a deep understanding of ethical principles and their
• application.

- Ethical Principles

Autonomy, Beneficence, Nonmaleficence, Veracity, Justice, Parternalism, Fidelity, Respect for others, and Moral Distress.

• , personal
• freedom and the right to choose what will happen to one’s own person; this principle underlies
• the nurse manager’s clinical practice b/c autonomy is reflected in individual
• decision making about patient care issues and in group decision making about
• unit operations decisions

• actions one takes should promote good; Nurse managers
• employ this principle when encouraging employee to seek more challenging
• clinical experiences or to take on additional responsibilities as a charge
• nurse

• one should do no harm; For a nurse manager following
• this principle, performance evaluation should emphasize the employee’s good
• qualities and give positive direction for growth. Destroying the employee’s
• self esteem would be considered as doing harm

• concerns
• telling the truth and incorporates the concept that individuals should always
• tell the truth; Nurse managers employ this principle when they give all the
• facts of a situation truthfully and then
• assist employees to make decisions

• , the
• principle of treating all persons equally and fairly; Nurse managers use this
• principle when assigning vacation time for staff and deciding who will be
• floated to another unit

• may be used
• to assist persons to make decisions when they do not have sufficient data or
• expertise

• keeping
• one’s promises or commitments

• acknowledges
• the right of individuals to make decisions and to live by these decisions

• Occurs when
• faced with situations in which two ethical principles compete; The NM may have
• to balance a staff nurse’s autonomy with what the NM perceives to be a better
• solution to an ethical dilemma

• The staff
• should participate in as much of the planning and establishment of goals and
• decision making as possible. Individual autonomy is a critical part of this
• theory of management. Drucker believed that when staff participated in the core
• functions of management the organization would be more effective. Includes the
• assumption that leadership can be learned. Leaders are not born, but rather
• staff can be nurtured to gain greater leadership competency

• Autocratic- make decisions independent of the input or
• participation of others; has been referred to as an authoritative style

• - Appropriate for crisis situations or when groups are
• likely to accept this type of decision style

• o Democratic (participative)- involves the appropriate personnel in the
• decision-making process

• o Brainstorming- team
• decision making; list all ideas as stated without critique or discussion. The
• group leader or facilitator should encourage people to tag onto or spin off
• ideas from those already suggested. The goal is to generate ideas, no matter
• how seemingly unrealistic or absurd (pg 105) Nominal
• group- participants are asked not to talk
• to each other as they write down their ideas. Next each member is asked to
• share an idea. Comments and elaboration are not allowed during this phase. Then
• each member privately assigns a priority rank to each option (pg 105)

• o Focus groups- purpose is
• to explore issues and generate info. Can be used to identify problems or to
• evaluate the effects of an intervention; the groups meet face-to-face to
• discuss issues (pg 105)

• o Delphi technique- involves systematically collecting and summarizing opinions and
• judgments from respondents, such as expert panels, on a particular issue
• through interviews, surveys, or questionnaires; the goal is to achieve
• consensus (pg 105)

• Finkleman p
• 81-82

• o Unilateral- one person
• makes decisions with limited or no input from others

• o Individual- one person
• makes decisions with limited or no input from others

o Authoritarian- one person makes decisions with limited or no input from others

o Participative- including others in decision making

• o Consensus- including
• others in decision making

• o Decisive- depends on
• less data to arrive at one decision

• o Integrative- uses all
• available data and identifies multiple alternatives

• o Hierarchic- focuses on
• a large amount of info but arrives at one alternative solution

• o Flexible- uses a
• small amount of data while generating multiple alternatives and may change as
• info is reinterpreted

• o Systematic- decisions
• are formed logically and uses a structural approach

• o Intuitive-
• trial-and-error; may ignore info and change their alternatives if it does not
• feel right; “gut” approach

• Team- focuses on
• synergy, which is the combination of people’s efforts that results in a output
• which is greater than the sum of the parts. Multiple ideas and experiences come
• together to form a decision

• Define the
• problem- Problem
• identification is influenced by the info available; by the values, attitudes,
• and experiences of those involved; and by time

• o Gather data- Objective
• (facts) and subjective (feelings) information. Info should be valid, accurate,
• relevant to the issue, and timely

• o Analyze Information- Further refines the problems statement and identifies possible
• solutions or options; important to differentiate a problem from the symptoms of
• a problem

• o Develop solutions- The goal of generating options is to identify as many choices as
• possible; being flexible, open-minded, and creative –attributes of a critical
• thinker—is critical to being able to consider a range of possible options Choose a solution- Criteria for evaluation might include variables such as
• cost-effectiveness, time, and legal or ethical considerations; the solution
• selected should be the one that is most feasible and satisfactory and has the
• fewest undesirable consequences

• o Implement the solution- carryout the decision; be prepared to institute “plan
• B” if necessary

o Evaluate the result- important to help guide future actions

• Whistleblower-
• someone who exposes federal fraud

• o Nurses can be whistleblowers by reporting or filing
• lawsuits when they are concerned about unsafe practice

• · Yoder-Wise p
• 88

• o In “whistleblowing” cases, the healthcare provider in
• terminated for one of three distinct reasons: (1) speaking out against unsafe
• practices, (2) reporting violations of federal laws, or (3) filing lawsuits
• against employers. Essentially, whistleblower laws state that no employer can
• discharge, threaten, or discriminate against an employee regarding
• compensation, terms, conditions, location, or privileges of employment because
• the employee in good faith reported or caused to be reported, verbally or in
• writing, what the employee had a reasonable cause to believe was a violation of
• a state or federal law, rule, or regulation.

• A nurse
• manager can judge if a change process is moving acceptable toward desired
• outcomes or goals and whether an outcome has been fully or partially met

• A configuration of healthcare agencies that provide
• basic and supplemental health maintenance and treatment services to voluntary
• enrollees who prepay a fixed periodic fee without regard to the amount of
• services used. To be federally qualified, an HMO company must offer inpatient
• and outpatient services, treatment and referral for drug and alcohol problems,
• laboratory and radiology services, preventive dental services for children
• younger than 12 years, and preventive healthcare services in addition to
• physician services

• Finkleman p
• 157

• o The original model or prototype of managed care, which
• integrates the delivery of service with reimbursement for those services. The
• HMO pays the bills for its members’ health services, but it also manages and
• provides care to its members. An enrollee in an HMO such as Group Health goes
• to one site to receive care, both primary and usually specialty care. Most HMOs
• require that the patient/enrollee pay a small co-payment. There may be limited
• provider choice. The HMO develops incentives to encourage its providers to
• provide the lowest-cost care to the HMO members.

• Budgeting
• done annually in relation to organization’s fiscal year which can begin at any
• point on the calendar. The process
• includes gathering information and planning, developing unit budgets,
• developing the cash budget, negotiating and revising, and using feedback to
• control budget results and improve future plans. A timetable with specific
• dates for implementing the budgeting process is developed by each organization.
• .

• -Budgets
• may be the direct responsibility of nurse managers. Most decentralized organizations allow nurse
• managers to allocate fiscal resources for their designated unit. Managers must have the business and financial
• skills to be able to prepare and justify a detailed budget that reflects the
• short-term and long-term needs of the unit.
• The most important aspect of budget is the provision for a mechanism
• that allows some self-control, such as decision making at the point of service
• (POS), which does not require hierarchical approval and a rationale for
• budgetary spending.

• Functional structures—arrange
• departments and services according to specialty. Departments providing similar functions
• report to a common manager or executive. (e.g. vice presidents for each major
• function: nursing, finance, human resources, and information technology)
• Service-Line structures (aka product lines)—functions needed to produce
• a specific service are under one unit under one manager (e.g. all
• cardiovascular areas in the hospital are under one manager)
• Matrix—combination of function and service (e.g. pediatric nurse could
• report to a vice-president for pediatric services [the service-line manager]
• and a vice-president of nursing [the functional manager])
• Flat—decentralized decision-making: staff can make decisions while
• providing patient care. Removal of
• hierarchical layer thereby placing authority to the professionals doing the
• work (e.g. Magnet hospitals in their nursing satisfaction and patient outcomes)
• Shared governance—nursing staff have more autonomy resulting in higher
• levels of staff satisfaction, enhanced productivity, and improved retention.
• (Read Yoder-Wise pp. 150-151 for a good example)

• Shared
• governance is described as a democratic concept; it is a dynamic process
• resulting from shared decision making & accountability. Basic principles
• include partnerships, equity, accountability, and ownership. It is more
• accurate to say that shared governance demands participation in decision making
• rather than provides for participation. Characteristics that empowered nurses were
• career ladders, access to power, participation in decision making, recognition
• of accomplishments, and EBP.

• · Workplace advocacy is an umbrella
• term encompassing activities within the practice setting. The choice of
• advocacy to reflect the framework in which nurses control the practice of
• nursing is consistent with the goals of the profession. Includes activities to
• address the challenges faced by nurses in their practice setting. The focus is
• on career development, employment
• opportunities, terms and conditions of employment, employment rights and
• protections, control of practice, labor-management relations, occupational
• health and safety, and employee assistance. The objective is to equip nurses to
• practice in a rapidly changing environment.

o These manifestations include:

§ Ensuring relevant information

• § Enabling the selection of
• information

Disclosing a personal view

• § Providing support for making and
• implementing decisions

§ Helping determine personal values

• · Collective bargaining is the performance
• of the mutual obligation of the employer and representatives of the employees
• to meet at reasonable times and confer in good faith with respect to wages,
• hours, and other terms and conditions of employment or the negotiation of any
• agreement or any question arising from those terms and conditions. The purpose
• is to secure reasonable and satisfactory conditions of employment, including
• the right to participate in decisions regarding their practice.

• arrange departments and services according to
• specialty. Departments providing similar
• functions report to a common manager or executive. (e.g. vice presidents for
• each major function: nursing, finance, human resources, and information
• technology)

• functions needed to produce a specific service
• are under one unit under one manager (e.g. all cardiovascular areas in the
• hospital are under one manager)

• combination of function and service (e.g.
• pediatric nurse could report to a vice-president for pediatric services [the
• service-line manager] and a vice-president of nursing [the functional manager])

• decentralized decision-making: staff can make
• decisions while providing patient care.
• Removal of hierarchical layer thereby placing authority to the
• professionals doing the work (e.g. Magnet hospitals in their nursing
• satisfaction and patient outcomes)

• nursing staff have more autonomy resulting in
• higher levels of staff satisfaction, enhanced productivity, and improved
• retention. (Read Yoder-Wise pp. 150-151 for a good example)
• described as a democratic concept; it is a dynamic
• process resulting from shared decision making & accountability. Basic
• principles include partnerships, equity, accountability, and ownership. It is
• more accurate to say that shared governance demands participation in decision
• making rather than provides for participation. Characteristics that empowered
• nurses were career ladders, access to power, participation in decision making,
• recognition of accomplishments, and EBP

• is an
• umbrella term encompassing activities within the practice setting. The choice
• of advocacy to reflect the framework in which nurses control the practice of
• nursing is consistent with the goals of the profession. Includes activities to
• address the challenges faced by nurses in their practice setting. The focus is
• on career development, employment
• opportunities, terms and conditions of employment, employment rights and
• protections, control of practice, labor-management relations, occupational
• health and safety, and employee assistance. The objective is to equip nurses to
• practice in a rapidly changing environment.

o These manifestations include:

§ Ensuring relevant information

• § Enabling the selection of
• information

Disclosing a personal view

• § Providing support for making and
• implementing decisions

§ Helping determine personal values

• · Collective bargaining is the performance
• of the mutual obligation of the employer and representatives of the employees
• to meet at reasonable times and confer in good faith with respect to wages,
• hours, and other terms and conditions of employment or the negotiation of any
• agreement or any question arising from those terms and conditions. The purpose
• is to secure reasonable and satisfactory conditions of employment, including
• the right to participate in decisions regarding their practice.

• A
• system is an interacting collection of components or parts that together make
• up an integrated whole. The basic tenet of systems theory is that the
• individual components of any system interact with each other and with their
• environment. Professional nurses need to understand the specific part- role and
• function- they play within a system and how they interact, influence, and are
• influenced by other parts of the system. Staff need to understand the mission,
• vision, philosophy and structure at the organization and unit level to maximize
• their contribution to patient care. Major focus of the work to be accomplished
• and the manner in which it will be accomplished. Understanding the philosophy
• provides knowledge of the behaviors that are valued in the delivery of patient
• care and in interactions with persons employed by the organization.

• -It views
• organizations as one entity with multiple elements or components that interact
• interdependently. Feedback is a critical process in a system. Input, process,
• and output all rely on feedback, which is the dynamic process in which an
• organism learns from experiences within the environment. Within a hospital
• system, professional staff, administrative staff, equipment, supplies, and
• patients represent the system inputs. The process is the delivery of health
• care as patients work their way through the system to discharge.

• The mission
• statement defines the organization’s reason or purpose of being. It identifies
• the organization’s customers and the types of services offered, such as
• education, supportive nursing care, rehabilitation, acute care, and home care.
• Identify the kinds of technologies and human resources to be employed.

• · Vision statements are future-oriented,
• purposeful statements designed to identify the desired future of an
• organization. Unify all subsequent statements toward the view of the future and
• to convey the core message of the mission statement. They are brief, consisting
• of only one or two phrases or sentences.

• Indifferent,
• tense working environment; frequently unfocused discussion; unclear objectives
• or many personal agendas, judgmental listening – much interruption; premature
• decision making, formal voting occurs frequently, simple majority,
• embarrassing/ destructive criticism; autocratic leadership, unclear
• assignments, hidden or explosive feelings and infrequent self-regulation or
• outside meetings.

• -Different
• conflicts can arise in the hospital that can increase the level of frustration.
• For example there can be conflict between nurses and physicians because nurse
• focus on shorter periods of time whereas physicians do not understand the
• structure of nurses’ work. Also, physicians are not concerned with the staffing
• or finances that take place. Physicians have few patients throughout the
• hospital; nurses have multiple patients admitted by several MDs. Physicians don’t
• understand nursing care delivery models. Physicians usually are independent
• practitioners; nurses usually are salaried at an hourly rate. Conflict can also
• increase frustration from hospital policies, Joint Commission requirements,
• competing goal priorities, and results of personal opinions and beliefs among staff.

• to provide
• nursing professional development and education services by assisting nurses in
• preparing for contemporary practice and supporting them in acquiring the
• knowledge and skills so that they can competently collect patient health data,
• analyze the data to determine diagnoses, identify expected outcomes
• individualized to the patient, develop a plan of care that prescribes
• interventions to attain the expected outcomes, implement the interventions identified
• in the plan of care, and evaluate the patient’s progress toward attainment of
• the outcomes in the medical/surgical care settings. The CNE will also be
• involved in the development and education services of the unlicensed assistive
• personnel.

• Unfreezing
• stage- focuses on developing problem awareness and decreasing forces that
• maintain the status quo. Recognize the problem and whether or not there is a
• feeling that the problem can be improved.

• · Moving stage – problem is clearly
• identified, and goals and objectives are developed. They are implemented, the
• working stage of the process where new values, attitudes, and behaviors are
• promoted.

• · Refreezing stage- when the change is
• incorporated into the work environment and its processes.

• Define the
• problem – know the facts, separate the facts from interpretation, be objective
• and descriptive, determine the scope of the problem

· Gather data- through assessment

• · Develop solutions – identify as many
• choices as possible

• · Select a solution – weigh each
• option: consequences and risks

• · Implement the solution – include a
• contingency plan to deal with negative consequences if they arise.

• · Evaluate the result – take time to
• monitor and evaluate and take responsibility for any mistakes

• They are
• exposed to high stress levels from increased demands on an ever-limited and
• aging workforce, a decrease in available resources, a more acutely ill and
• underinsured patient population, and a profound period of change in the
• practice environment.

• -Conflict
• can be caused by almost anything, including inadequate communication, incorrect
• facts, lack of trust, unclear position descriptions, misunderstanding of roles
• & responsibilities, unclear or conflicted goals and objectives, inadequate
• action plans, directions, unstable leadership, receiving direction from 2 or
• more “bosses”, inability to accept change, lack of leadership, lack of or
• limited staff participation in decision making, & power issues.

• Three major
• causes of inter-group conflict:

• 1. Groups that
• must work interdependently and compete for resources will experience more
• conflict. (ex: units competing for funding)

• 2. Groups
• working together may have different goals, or different ideas on the best way
• to accomplish shared goals.

• 3. Conflict may
• surface when there is inadequate differentiation (or too severe
• differentiation) between co-workers. (such as between LPNs and RNs)

• Role
• – occurs when there is incompatibility between one or more role expectations
• (ex: conflict between role as a mother with a sick child and as a staff nurse
• scheduled to work the night shift), also when staff do not fully understand the
• roles of other staff

• Intrapersonal- occurs within a
• person when confronted with the need to think or act in a way that seems at
• odds with one’s sense of self. Conflict over priorities, ethical standards, and
• values.

• · Interpersonal – transpires between
• and among patients, family members, nurses, physicians and other staff. Focuses
• on difference of opinion, priority or approach with others

• · Organizational – arises when discord
• exists about policies and procedures, personnel codes of conduct, or accepted
• norms of behavior and patterns of communication. Related to hierarchical
• structor and role differentiation among employees. Major source of it stems
• from strategies that promote more participation and autonomy of staff nurses.

• -Covert
• vs overt conflict: Covert conflict is
• often unacknowledged, and usually destructive.
• It can be difficult to acknowledge covert conflicts, but this is a
• necessary step. Overt conflict is
• obvious, and it is easier to resolve.
• Overt conflict can be positive, as an agent of innovation and change.

• Negative-
• avoiding, accommodating, competing, bullying, backstabbing, withholding
• information

• · Positive- Compromising,
• collaborating

• -Examples of
• destructive behavior are ignoring a policy, denying a problem, avoiding a staff
• member, and criticizing staff in public.
• Examples of constructive behavior are encouraging the group to identify
• and solve the problem, expressing appropriate feelings, and offering to help out
• a co-worker.

• Avoiding –
• very unassertive and uncooperative because people who avoid neither pursue
• their own needs, goals, or concerns immediately nor assist others to pursue
• theirs. It only ensures that conflict is postponed and has a tendency to
• escalate in intensity.

• · Accommodating – people neglect their
• own needs, goals and concerns (unassertive) while trying to satisfy those of
• others (cooperative). It has element of being self-sacrificing and simply
• obeying orders or serving. People who use this may feel disappointment and
• resentment.

• · Competing – people pursue their own
• needs and goals at the expense of others. They use whatever power, creativeness
• that are available to “win”.

• · Compromising- involves both
• assertiveness and cooperation on the part of everyone and requires maturity and
• confidence. Negotiating is a learned skill that is developed over time and it
• is more like trading. Compromise is very often the exchange of concessions as
• it creates a middle ground.

• · Collaborating- the most
• time-consuming approach, is the most creative stance. It is both assertive and
• cooperative because people work creatively and openly to find the solution that
• most fully satisfies all important concerns and goals to be achieved

-Goals of conflict management:

• 1. to eliminate
• or decrease the conflict

• 2. to meet the
• needs of the patient, family/significant others, & the organization

• 3. to ensure that all parties feel
• positive about the resolution so that future work together can be productive

• Bully is associated with psychological and physical
• stress, underperformance, professional disengagement, increased job turnover,
• and the potential for diminished quality of care. Verbal abuse toward others
• like putting down another. New graduates reported feeling undervalued by other
• nurses and reported having learning opportunities blocked; many felt neglected
• and given too much responsibility without the appropriate support.

• Assignment
• refers to the work each person is to accomplish in a designated work period. It
• consists of patient care expectations and unit-related activities. Another
• meaning relates to assignment as the transference of both responsibility and
• accountability. Assigning—ANA states that assignments is
• the distribution of work that each staff member is responsible for during a
• given work period. The staff member is assigned both the accountability and
• responsibility. The nurse manager is accountable only for making the
• assignment and selecting who will be responsible for the care of the patients.
• It is the staff nurse is accountable and responsible for actually provided the
• care. Staff nurses cannot make assignments.

• · Delegation is a critical skill for
• accomplishing care in a timely manner.

• _Delegating—The
• act of delegation requires at least 2 people, work, and some kind of transfer
• of authority and responsibility to perform the work. Accountability is not
• abdicated but instead remains fixed with the delegator. The nurse is
• merely sharing responsibility and legal accountability still rests with
• him/her. Staff nurses can delegate.

• Leadership
• is the process of engaged decision making linked with actions taken in the face
• of complex, unchartered or perilous circumstances present in clinical
• situations for no standardized solution exists

• · Management is an engaged process of
• guiding others through a set of derived practices and procedures that are
• evidence-based and known to satisfy pre-established outcomes based on repeated
• clinical situations.

• · Followership is engaging with others
• who are leading or managing by contributing to problem identification,
• completing tasks, and providing feedback for evaluation.

• When they use delegation decision making and their other functions like
• budgeting. Critical thinking is a process of examining
• underlying assumptions, interpreting and evaluating arguments, imagining, and
• exploring alternatives, and developing relative criticism for the purpose of
• reaching a reasoned, justifiable conclusion. In nursing it means constantly
• striving to find a better way by focusing on two key questions: What are the
• outcomes? And how can we do better? A nurse manager should use critical
• thinking to make decisions and problem solve for those he/she is responsible
• for so that. He/she should use it for direct care, advocating for the patient,
• in coordinating care, working with other staff to resolve issues on the unit,
• to ensure that quality, safe care is provided on the unit, and to collaborate
• with others.

• Establishes
• objectives and goals for each area and communicates them to the persons who are
• responsible for attaining them

• · Organizes and analyzes the
• activities, decisions, and relations needed and divides them into manageable
• tasks

• · Motivates and communicates with the
• people responsible for various jobs through teamwork

• · Analyzes, appraises and interprets
• performance and communicates the meaning of measurement tools and their results
• to staff and superiors

· Develops people, including self

• (modern
• management, participatory management, leadership learned) Staff should participate in as much of the
• planning and establishment of goals and decision making as possible. Allowing the staff to participate in the core
• functions of management the organization would be more effective. Nurse manager should seek out stagg members
• ideas and ask them to assist with planning.
• The staff can be nutured to gain greater leadership competency. Pg 7 Finkleman

• A manager
• can prepare staff members for a visit from TJC by setting up practice
• evaluations of the hospital, let the staff know what is expected for them to
• know, and have in-services for the staff.

• There are many different
• roles the nurse manager may play in this. Examples include: providing feedback
• on performance, participation in their own performance appraisal, collecting
• data, awareness of errors and applying this to their practice, assisting with
• analysis of data, and using conclusions from quality analysis to improve their
• practice. Assign standards to team leaders. Team leaders should delegate work to
• team members. Conduct quarterly "mock" surveys to gauge compliance.
• Fix any opportunities for improvement identified during the mock survey. Form a
• specially designated team to perform weekly rounds in different areas to
• monitor compliance. Monitor progress in a grid-type form, with columns for
• standard, performance, due date, action plan, follow-up and assigned person(s).

• Accurately assess, createsolutions, guide employees, direct employees to carry out goals at min risk to patient and themselves., and project an air of confidence.
• motivate and encourage others.
• work with others to achieve goals.
• assess and develop new opportunities for nursing.
• adapt and develop new roles and skills as health system changes.
• understand broader health and socail system within which nursing functions.
• have external awareness.
• use technology
• contribute and influence health and public policy.

• A leader makes decisions and takes action in situations when there is no bovious solution.
• A manager guides using eveidenced based practice and procedures.(protocol)

• identify problems
• complete tasks
• provide feedback

• Vision-ideas for the future
• influence- trust from employees
• power- change behaviors, use consistency, tell what you will do and do it.
• values-should be congruent with the facility

• planning
• organizing
• leading
• controlling
• *maintains day to day functions. Thinks short term.

• managers maintain current state; leaders focus on change
• managers focus on efficiency, are concerned with structure, and have a short range view of things
• leaders have a long term range perspective(future), focus on people never want to maintain the current level
• leaders have authortiy from their influence
• managers have authority from position in the organization

• expert- have knowlege(power)
• administrator-know how efficient things are, policy and procedures, computer system, budgets, knows peoples strengths.
• people person- training, goals
• strategist -change agent (smooth transitions)

• first level : unit manager or charge nurse
• middle level: director of critical care services
• upper level: chief nurse executive

• envisioning goals(for staff-realistic)
• affirming values(gives direction and purpose and get priorities straight.)
• motivating-can promote change
• managing-practices
• achieving workable unity
• renewing
• developing trust
• explaining
• serving as a symbol
• representing the group

• identify processess relating to patient care
• decide max and min standars
• validate knowledge skills and abilities of staff
• develop big pic plan
• eliminate obstacles to work effectiveness
• measure out workload equitably(equally)
• reward and recognize
• recommend ways to improve
• use informal network to engage employees

• traditional boss
• no imput from lower level employees
• performance will be rewarded or punished depending

• wants employees to think "outside the box"
• considers each employees needs and abilities
• wants to change organization and employees.
• Asks why is it done this way and how can it be done more effectively?
• Helps employees set up realistic goals.
• Extra effort is rewarded and important.
• Is a role model of desired behavior
• pays attention to people and their personal ongoings
• higher level of staff satifaction and patient.
• Able to reatin staff
• has vision and a mission.
• motivates followers
• lets staff be involved in leadership
• has increased recognition of the staff

• -modern management; participatory management.
• -staff should participate in planning and goal development
• -Staff should have autonomy
• -leaders are made!
• EXAMPLE: Staff nurses should provide imput into planning and changes that might be necessary Seek out staff ideas and ask them to assist with planning.

• -relationship of leader to team
• - amount of confidence employees have in the leader is critical and inspires loyalty
• - position power -power of leader has becasue of his/her position in the facility.
• -best situation-positive leader-employee relations, highly structured tasks, high level of position of power.
• * situation changes affect of leadership.

• autocratic-* works well in emergencies* issues orders.
• bureaucratic-rigid, gives orders, relies on policies and rules
• Laissez-faire-hands off; can result in no leadership and lack of guidance.

• Impoverished-Leader has limited interest. Work requirements are at minimum level.
• Country CLub-Interested in people. Friendly.Productivity not a concern.
• Authority-obedience- Get job done Not personable.
• Organization man-balance necessityto accomplish with maintaining morale
• Team- very concerned with productitvity and about staff morale and satisfaction.

• Leader collaborates within the hospital and amoung other oraganizations in the community.
• the more connections that occur, the more successful the leader will be.

• Self- Awareness cluster- understanding
• feelings and applying accurate self assessment. Recognize feelings and how they affect others. Identify strengths and limitations.
• Self-Management Cluster- managing
• internal emotions, impulses and resources.
• Emotional self control- handle their own emotions and expresses emotions appropriately.
• Trustworthiness- letting others know one’s values and principles, intentions and feelings and
• acting in ways that are consistent with them. Forthright about mistakes and confront others about their lapses. Conscientiousness- Leader is careful, self-disciplined, and ensures that responsibilities are met.
• Adaptability- open to new ideas, search out challenges and opportunities, and use them to move forward. “thinks
• outside the box”. Risk is not a barrier to moving forward. Achievement drive-optimistic striving to continually improve
• performance.
• Initiative- a step ahead at all times and seem to seek out opportunities
• before others are aware of them.
• Social Awareness Cluster- empathy- being aware of others feelings,
• needs, and concerns. Service Orientation-ability
• to identify a clients unstated needs and concerns and then match them to
• products or services. Organizational
• Awareness- able to identify group feelings and organizational needs, which
• helps the leader develop coalitions and network.
• Relationship Management Cluster- developing others- leader knows when staff is ready for further development.
• Influence- ability if a leader to persuade others. Communication- ability to communicate emotions and facts, listen, share info, and encourage sharing info.
• Conflict Management- requires negotiation and the ability to see outside the box.
• Visionary leadership- can develop a
• vision and includes staff in the vision for success.
• Change Catalyst- See change as opportunity, recognize barriers to change and remove them whenever possible, challenge the status quo, and involve as many of the staff as possible in change process.
• Building Bonds- make connections with others, build trust, and recognize the importance of
• relationships.
• Collaboration and teamwork.

• ·
• 
  

• - multiple solutions
• -input from multiple people on a situation
• -Creativity required for the team to be successful
• -Participative leadership.
• -Future is uncertain.
• -Sensitive to indicators of change
• -Analysis of info
• Leaders
• shouldn’t predict future-no one knows it anyhow. Leaders should be keen to
• hints of change and respond when need be. Be able to translate info to used to
• produce outcomes. Be able to analyze info.