1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 9 The Nurse as Leader and Manager

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 9.1 Differentiate between leadership and management. 9.2 Describe American Nurses Association and American Organization of Nurse Executives competencies for nurses regarding leadership and management. 9.3 Compare and contrast the leadership styles: authoritarian, democratic, laissez-faire, situational, charismatic, transactional, transformational, caring, quantum, and servant leadership. 9.4 Describe the management concepts of authority, accountability, planning, organizing, leading and delegating, and controlling. 9.5 Discuss the competencies needed to be an effective nurse-manager. 9.6 Compare and contrast the following nursing delivery models: total patient care, the functional method, team nursing, and primary nursing. 9.7 Describe Magnet status and Pathway to Excellence as mechanisms for ensuring quality nursing care. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 9.8 Describe case management as a mechanism for ensuring continuity and quality health care. 9.9 Describe shared governance as a mechanism for nursing involvement in organizational decision making. 9.10 Differentiate between the roles and functions of mentors and preceptors. 9.11 Discuss the benefits of professional networking. Learning Objectives

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities Limited access to healthcare services for many Limited resources for providing care Need to provide care for uninsured and underinsured Need to recruit and retain high-quality nurses Develop innovative approaches to nursing care delivery and redefine the roles of professional nurses

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.1 Differentiate between leadership and management.

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership Advocate for improvements in –Client care quality –Working environment –Social well-being Leadership occurs when influencing others to act –Managers are assigned their roles –Leaders attain their roles

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership Leadership and management are responsibility of all nurses Leadership characteristics –Integrity –Courage –Positive attitude –Initiative –Energy –Optimism

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership Leadership characteristics –Perseverance –Balance –Ability to handle stress –Self-awareness –Vision

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.2 Describe American Nurses Association and American Organization of Nurse Executives competencies for nurses regarding leadership and management.

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership American Nurses Association charges nurses with leadership expectations –Participate in professional organizations –Communicate effectively –Seek ways to advance nursing autonomy and accountability –Participate in effort to influence healthcare policy

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership American Nurses Association charges nurses with leadership expectations –Oversee nursing care by others while retaining accountability for quality of care –Abide by vision, goals, and plan to implement and measure progress of clients –Mentor colleagues –Develop communication and conflict resolution skills

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.3 Compare and contrast the leadership styles: authoritarian, democratic, laissez-faire, situational, charismatic, transactional, transformational, caring, quantum, and servant leadership.

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Authoritarian leadership –Makes the decisions for the group –Directive, autocratic, or bureaucratic –Negative connotations

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Democratic leadership –Participative leadership –Leader  Acts as a catalyst or facilitator  Seeks participation or consultation of subordinates  Actively guides the group toward achieving the group goals  Provides constructive criticism, offers information, makes suggestions, asks questions

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Laissez-faire leadership –Nondirectional leadership –Minimal participation –Group’s members act independently of each other

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Situational leadership –Levels of direction and support vary depending on the maturity of the group –Value placed on accomplishment of tasks and on interpersonal relationships –Leadership style changes based on task, urgency, and individual needs

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Charismatic leadership –Emotional relationship between the leader and group members –Inspires other by obtaining emotional commitment –Followers have faith and belief in leader’s abilities

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Transactional leadership –Traditional manager focused on the day-to-day tasks of achieving organizational goals –Relationship is based on exchange for some resource valued by the follower

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Transformational leadership –Emphasizes the importance of interpersonal relationships –Leader serves as a role model who encourages and empowers team members to achieve team and personal goals –Vital in creation of healthcare system that embodies community well-being, basic care for all, cost- effectiveness, and holistic nursing care

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Caring leadership –An extension of transformational leadership –Good management is a matter of love –Proper management involves caring for people, not manipulation

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Quantum leadership –Humanistic interaction involving leader and followers –Additional focus on problem to be solved or goal to be achieved –Interaction and outcomes are affected by the leader, the followers, and the task to be accomplished –Leader is creative, flexible, and encouraging –Each team member adds value

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Leadership Style Servant leadership –Based on the desire to serve first; then conscious choice brings one to aspire to lead –Leader and followers work together to attain desired goal; decision making is shared

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Leadership Effective leadership is a learned process requiring an understanding of the needs and goals that motivate, knowledge to apply skills, and interpersonal skills to influence others Success is more than goal attained, also opportunity for growth

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.4 Describe the management concepts of authority, accountability, planning, organizing, leading and delegating, and controlling.

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Management Nurses as managers responsible for –Planning –Organizing –Directing/delegating –Controlling resources used in delivery of client care

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Management Resources used in delivery of client care –Equipment and materials –Technology –Finances –Environment –Personnel

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Authority –Official power given by organization to direct work of others –Conveyed through leadership action Accountability –Ability and willingness to assume responsibility and consequences

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Planning –First and most basic management function –Four stages  Establishing goals and objectives  Evaluating current situation and predicting future trends and events  Formulating a planning statement  Converting plan into an action statement

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Organizing –Process of coordinating work to be done Leading –Power is essential component of leading –Power is the ability and authority to influence others –Based on honor, respect, loyalty, and commitment

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Delegating –Five “rights” of delegation  Right task  Rights circumstances  Right person  Right direction and communication  Right supervision and evaluation

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Management Delegating –Determine what is required, then identify help –Development of the potential of nursing and support personnel –Delegated individuals must be supervised and evaluated –Provide ongoing feedback about performance

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Delegating –Getting work done through others –Major tool in making most efficient use of time –Effective delegation requires nurses to be aware of  Needs and goals of the client and family  Nursing activities that can help the client meet the goals  Skills and knowledge of various nursing and support personnel

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Management Roles Controlling –Method to ensure that behaviors and performances are consistent with expectations developed in planning process –Should be done with employees, not to employees –Shared governance and team building help make control easier

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.5 Discuss the competencies needed to be an effective nurse-manager.

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Management Three levels of management –First level –Middle level –Upper level Dependent on the type of organization

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Management Management competencies described by American Organization of Nurse Executives –Communication and relationship building –Knowledge of healthcare environment –Leadership skills –Professionalism –Business skills

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.7 Describe Magnet status and Pathway to Excellence as mechanisms for ensuring quality nursing care.

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Magnet Recognition Magnet recognition –Program of American Nurses Credentialing Center –Recognizes healthcare organizations for quality patient care, nursing excellence, and innovations –Identifies characteristics of hospitals that are successful in recruiting and retaining nurses

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Magnet Recognition Pathway to Excellence Program –Program of American Nurses Credentialing Center, launched in 2009 –Recognizes healthcare organizations and long-term- care facilities for having positive practice environments –Standards unique to long-term-care environment have been developed

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.6 Compare and contrast the following nursing delivery models: total patient care, the functional method, team nursing, and primary nursing.

42. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Delivery Models Total patient care –Case method –Earliest model of nursing care –Private-duty nurses –Client-centered –Client has consistent contact with one nurse during shift

43. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Delivery Models Functional method –Evolved from concepts of scientific management –Focuses on jobs to be completed –Task-oriented approach –Disadvantage is fragmentation of care

44. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Delivery Models Team nursing –Individualized nursing care given to clients by a nursing team led by a professional nurse –Members include RNs, LPNs, nursing assistants –Responsible for coordinated nursing during a shift –Emphasizes humanistic values and individualized client care at a personal level –Nurse leader motivates employees

45. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Delivery Models Primary nursing –A system in which one nurse is responsible for total care of a number of clients 24 hours a day, seven days a week –Provides comprehensive, individualized, and consistent care –Associates provide care, but the primary nurse plans and coordinates care

46. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Delivery Models Interdisciplinary team model –Team consists of all disciplines required to provide quality care to client –Each team member brings expertise to help client achieve quality outcome –All members focus on client’s needs and collaborate to meet those needs

47. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.8 Describe case management as a mechanism for ensuring continuity and quality health care.

48. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Case Management Pioneered at the New England Medical Center Used in –Insurance-based programs –Employer-based health programs –Workers’ compensation –Maternal-child health –Mental health –Hospital-based practice

49. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Case Management Defined as –A collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individual’s and family’s comprehensive health needs to promote quality, cost-effective outcomes Case managers assist clients through complex healthcare system

50. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Differentiated Practice Differentiates nurses by level of education, expected clinical skills or competencies, job descriptions, pay scales, and participation in decision making Can improve client care and contribute to client safety Allows for the effective and efficient use of resources

51. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.9 Describe shared governance as a mechanism for nursing involvement in organizational decision making.

52. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Shared Governance Nurses participate in decision making at all levels of the organization Employees will be more committed to an organization’s goals if they have input Promotes involvement, investment, participation, sharing of power, interdependence, cooperation, horizontal relationships, autonomy, and accountability

53. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.10 Differentiate between the roles and functions of mentors and preceptors.

54. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Mentors and Preceptors Mentor –Wise and trusted adviser who guides others on particular journey –Provides support, challenge, and vision Three phases –Invitational –Questioning –Transitional Process can promote professional growth of both mentor and mentee

55. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Mentors and Preceptors Preceptor –An experienced nurse who orients a nurse who is new to the nursing unit and organization –Assigned to assist in improving clinical nursing skill and judgment necessary for effective practice in her or his environment –Assists new nurses in learning routines, policies, and procedures of the unit

56. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 9.11 Discuss the benefits of professional networking.

57. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Networking Professional network consists of people that nurses may call on for assistance, support of ideas, and guidance Networking builds linkages with people Long-term process for building relationships Requires time, commitment, and follow-through

58. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Networking Opportunities include –Active membership in professional organizations –Continuing education and university classes –Socializing with professional colleagues –Keeping in touch with former professors and nursing associates