1. 1. Review the Scope and Standards of Nursing Practice. Which Standards relate to the role of the nurse as a leader and manager?
  2. 2. What are the differences between leaders and managers? Define leader. Define manager.
  3. Leader
    •Do not have delegated authority: power derives from other means, such as personal influence
  4. •Have a wider variety of roles
  5. •May not be a part of the formal organization
  6. •Focus on group process, information gathering, feedback, and empowering others
  7. •Emphasize interpersonal relationships
  8. •Direct willing followers
  9. •Have goals that may or may not reflect those of the organization
  10. Manager
    •Have an assigned position in the formal organization
  11. •Have a legitimate source of power because of the delegated authority that is part of their position
  12. •Are expected to carry out specific functions, duties, and responsibilities
  13. •Emphasize control, decision making, decision analysis, and results
  14. •Manipulate personnel, the environment, money, time, and other resources to achieve goals
  15. •Have a greater formal responsibility and accountability
  16. •Direct willing and unwilling subordinates
  17. •Have an assigned position in the formal organization
  18. •Have a legitimate source of power because of the delegated authority that is part of their position
  19. •Are expected to carry out specific functions, duties, and responsibilities
  20. •Emphasize control, decision making, decision analysis, and results
  21. •Manipulate personnel, the environment, money, time, and other resources to achieve goals
  22. •Have a greater formal responsibility and accountability
  23. •Direct willing and unwilling subordinates
  24. 3. Describe 15 characteristics of effective leaders.
  25. •Use a natural leadership style
  26. •Use a leadership style appropriate to the task and members
  27. •Assesses the effects of their behavior
  28. •Are sensitive to forces for and against change
  29. •Express optimistic view about human nature
  30. •Are energetic, open, and encourage openness
  31. •Facilitate personal relationships
  32. •Plan and organize activities of group
  33. •Are consistent in behavior
  34. •Delegate tasks and responsibilities to develop members abilities
  35. •Involve members in decisions
  36. •Value and use members contributions
  37. •Encourage creativity
  38. •Encourage feedback
  39. 4. Discuss the following leadership styles. Give an example of people in your experience who demonstrates each of the leadership styles. They may be figures from politics, government, education, religion, entertainment, sports, etc.
  40. a. Charismatic leadership- is a characterized by an emotional relationship between the leader and the group members in which the leader “ inspires others by obtaining an emotional commiment from followers and by arousing strong feelings of loyalty and enthusiasm”. A charismatic relationship exists when the leader can communicate a plan for change and the followers adhere to the pln because of their faith and belief in the leader’s abilities. The followers of a charismatic leader may be able to overcome extreme hardship to achieve the goal because of their faith in the leader.
    • b. Authoritarian leadership- The leader makes the decisions for the group. This style of leadership has also been reffered to as a directive or autocratic leadership. Authoritarian leadership is likened to a dictatorship and presupposes that the group is incapable of making its own decisions. The leader determines policies, giving orders and directions to the group members. Authoritarian leadership generally has negative connotations and often makes group members dissatisfied.
    • c. Democratic or participative leadership- The leader acts as a catalyst or facilitator, actively guiding the group toward achieving the group goals. Providing constructive criticism, offering information, making suggestions, and asking questions become the focus of the participative leader: This type of leadership demands that the leader hve faith in the group members to accomplish the goals. Democtratic leadership is based on the following principles.
    • 1. Every group member should participate in decision making.
    • 2. Freedom of belief and action is allowed within reasonable bounds that are set by society and by the group.
    • 3. Each individual is responsible for himself or herself and for the wellfare of the group.
    • 4. There should be concern and consideration for each group member as a unique individual.
  41. d. Laissez-faire or non-directional leadership- Is described as inactive, passive, and permissive: offering few commands, questions, suggestions, or criticism. Although there are various degrees of nondirectional leadership, leadership participation is, in general, minimal.
    • e. Situation leadership- Levels of direction and support vary according to the level of maturity of the employees or group. The leader assumes one of four styles.
    • 1. Directive. A leadership style characterized by expanding of clear instructions and specific direction to immature employees.
    • 2. Coaching. A leadership style charactrized by expanding twoway communication and helping maturing employees build confidence and motivation.
    • 3. Supporting. A leadership “ “ active two-way communication and support of mature employees’ efforts to use their talents.
    • 4. Delegating. A hands-off leadership style in which the highly mature employees are given responsibilities for carrying out plans and making task decisions.
    • f. Transactional leadership- Represents the traditional manager focused on the day-to-day tasks of achieving organizational goals. The transactional leader understands and meets the needs of the group. Relationships with followers are based on an exchange for some resource valued by the follower. These incentives are used to promote loyalty and performance.
  42. g. Transformational leadership- Theory which was developed in the 1980’s “reconsiders the characteristics of the leader-manager, reemphasizes the vision that the leader-manager shares with the group, and stresses the importance of preparing people for change” This model combines elements of earlier theories and recognized the influence of the leader, workers, tasks, and environment. Transformational leadership is characterized by four primary factors:
  43. 1. Charisma- Charismatic leaders are highly respected and are viewed with reverence, dedication, and awe. They set high standards, challenging their staff to go beyond the expected level of effort.
    • 2. Inspirational motivation. The leader shares visions with the staff that appeal to both their emotions and their ideals.
    • 3. Intellectual stimulation. The leader stimulates followers to question the status quo: to question critically wha they are doing and why.
    • 4. Contingent reward. The leader recognizes mutually agreed-upon goals and rewards the employee’s achievements.
  44. 5. Describe 10 strategies for putting humanistic and caring leadership into action.
  45. • Praise or positively recognize staff and colleagues.
    • • Always think good thoughts about yourself and others.
    • • Work on discovering group members’ unque personal and professional aneeds.
    • • Always give before you get-give colleagues and staff a reason for doing whatever it is that you are asking of them.
    • • Smile-often- it generates enthusiasm and goodwill.
    • • Recognize the expertise of others.
    • • Remember the names of the people you work with.
    • • Think, act, and look successful.
    • • Always greet others with a positive, affirmative statement.
  46. 6. Discuss the following theories of management style:
  47. •Traditional –focuses on the manager’s role in a strict hierarchy and efficient and consistent job performance.
  48. •Behavioral –stresses the importance of group dynamics and leadership style
  49. • Contingency- Contingency theories are a class of behavioral theory that contend that there is no one best way of leading and that a leadership style that is effective in some situations may not be successful in others.
  50. 7. Discuss six competencies for effective managers described by Hellriegel et al.
  51. •Communication
  52. •Planning and administration
  53. •Teamwork
  54. •Strategic action –understand overall mission and values of organization
  55. •Global awareness –awareness of multicultural beliefs, values and practices of clients and staff
  56. •Self-management –willing to be responsible for life at work and outside work
  57. 8. Define the terms authority and accountability as they relate to management roles.
  58. Authority- is the official power given by the orignazation to direct the work of others. It is an integral component of managing. Authority is conveyed through leadership actions; it is determined largely by the situation, and it is always associated with responsibility and accountability.
  59. Accountability- is the ability and willingness to assume responsibility for one’s actions and to accept the consequences of one’s behavior. Accountability can be viewed within a hierarchic systems framework, starting at the individual leve,l through the institutional/professional level, and then to the societal level.
  60. 9. Discuss the following functions of managers:
  61. a. Planning- is often considered the first and most basic management functions. It includes these steps.
    • • Choosing the organization’s mission and vision. The mission describes the purpose or reason for the existence of the organization. The vision “expesses the organiztion’s fundamental aspirations and purpose. A vision statement adds soul to the mission statement.”
    • • Devising departmental goals. The nursing unit should reflect the more global goals of the nursing department and the health care agency.
    • • Selecting strategies to achieve the goals. Strategies are the course of action the unit staff will take in order to achieve the unit’s goals.
    • • Deciding on the allocation of resources. Distribution of money, personnel, equipment, and physical space is included in resource allocation.
    • • Planning can help the nurse-manager identify future opportunities, anticipate and avoid future problems, and develop strategies and course of action.
  62. b. Organizing- is the formal system working relationships. The nurse-manager is responsible for identifying particular tasks and assigning them to individuals or teams who have the training and expertise to carry them out. The nurse manager is also responsible for coordinating activites to meet the unit’s objectives. Health care reform, downsizing, restructuring, and the nursing shortage have all affected the management role of organizing.
    • c. Leading and delegating- Leading is the different combinations of task and relationship behaviors used to influence others to accomplish goals.
    • Delegating- getting work done through others or as directing the performance of one or more people to accomplish organizational goals. It is a major tool of nursing. An important aspect of delegation is the development of the potential of nursing and support personnel. By knowing the background, experience, knowledge, skill, and strengths of each person, a nurse can delegate responsibilities that help develop each person’s competence.
    • d. Controlling- is a method to ensure that behaviors and performances are consistent with the planning process. Formal structured, bureaucratic controls, such as tightly written job descriptions, extensive rules and procedures, andtop-down authority, are familiar control mechanisms.
  63. 10. Describe seven characteristics of effective nurse managers as identified by Tappen.
  64. •Assume leadership of the group
  65. •Actively engage in planning the current and future work of the group
  66. •Provide directions to staff members to maintain quality and productivity
  67. • Monitor the work done by staff members to maintain quality and productivity.
  68. •Recognize and reward quality and productivity
  69. •Foster the development of every staff member
  70. •Represent both administration and staff members as needed
  71. 11. Describe the following nursing delivery models:
  72. a. Total Patient Care- also reffered to as case method, is one of the earliest models of nursing care. This method is client centered: one nurse is assigned to and is responsibile for the comprehensive care of the client or group of clients during an 8- or 12- hr shift. For each client, the nurse assesses the needs, makes nursing plans, formulates diagnoses, implements care, and evaluates the effectiveness of care.
    • b. Functional Method- it evolved from concepts of scientific management used in the field of buisness administration, focuses on the jobs to be completed. This task oriented approach, personnel with less preparation than the professional nurse perform less complex care tasks.
    • c. Team Nursing- the delivery of individualized nursing care to clients by a nursing team led by a professional nurse. A nursing team consists of registered nurses, licensed practical nurses, and, often nursing assistants. Eleanor Lambersten (1950’s) and her colleagues proposed a system of care resulting from the task-oriented functional approach and to meet the increasing demands for professional nurses created by advances in the technologic aspect of care.
    • d. Primary Nursing- system in which one nurse is responsible for total care of a number of clients 24hrs a day, 7 days a wk, was introduced by at the Loeb Center for Nursing and Rehabilitation in the Bronx, New York. It is a method of providing comprehensive, individualized, and consistent care.
    • e. Case Management- A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services needed to meet a person’s health needs.
    • f. Shared Governance-is a organizational goverance that is shared among board members, nurses, physicians, and management. The underlying principle of shared goverane is that employees will be more committed to an organization’s goals if they have had input into planning and decision making.
    • g. Managed Care- is a method of organizing care delivery that emphasizes communication and coordination of care among health care team members.
    • h. Differentiated Nursing Practice- refers to the sorting of the roles, functions, and work of registered nurses according to some identified criteria-usually education, experience, and competence- or some combination of these.
  73. 12. I previous discussions, we discussed case management. Identify and describe the functions of Nurse Case Managers.
    • • Review client demographic data
    • • Administer assessment tools and risk screens
    • • Review client history and current health status
    • • Validate clinical data
    • • Identify client problems
    • • Identify educaional needs of clients and readiness to learn.
    • • Identify target populations in disease management programs
    • • Identifying client health goals
    • • Identifying available resources
    • • Plan and coordinate client care
    • • Link clients to needed services
    • • Identify opportunities for health promotion and illness/injury prevention
    • • Advocate for client needs
    • • Monitor adherence
    • • Identify barriers to availability, accessibility, and affordability of treatment.
    • • Evaluate support systems
    • • Monitor delivery of services
    • • Examine patterns of over-and/ or underutilization of resources.
  78. 13. What is a Mentor? What are the characteristics of a mentor? Describe the three phases of the mentoring process. Who are the mentors in your life?
  79. •Mentors are “competent, experienced professionals who develop a relationship with a novice for the purpose of providing advice, support, information, and feedback in order to encourage the development of the individual.”
    • Mentors are usually of the same sex, 8-14yrs old, and have a position of authority in the organization. Most are knowledgeable individuals who are willing to share their knowledge and experience. Mentors often choose proteges because of their leadership or managerial qualities.
    • Three phases:
    • The invitational stage: This stage, the mentor must be willing to use time and energy to nurture an individual who is goal directed, willing to learn, and respectfully trusing of the mentor. The nurse-mentor invites the new nurse to share knowledge, skill, and personal experiences of professional growth.
    • The questioning stage: In this stage, the novice experiences self-doubt and fear of being unable to meet goals. The mentor helps the protege clairfy gols and the strategies for achieving them, shares personal experiences, and serves as a sounding board and a source of support during time of doubt.
    • The transitional stage: In this stage, the mentor asists the protege to become aware of the protege’s own strengths and uniqueness. The protege now is able to mentor someone else.
  80. 14. What is a Preceptor? What are the characteristics of a preceptor?
    Is an experienced nurse who provides emotional support and is a strong clinical role model for the new nurse. They must be patient and willing to teach new nurses, and they must be willing to answer questions and clarify the expectations of the nurse’s role within the practice environment.
  81. 15. What is networking? What are the benefits of networking?
    A process whereby professional links are established through which people can share ideas, knowledge, and information, offer support and direction to each other, and facilitate accomplishment of professional goals. Networking builds linkages with people throughout the profession, both within and outside the work environment.
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