Please you may be my preferred writer for this class, so you might need save the work you have finish for me because you may refer to them in the future, some of it will be a continuation. Thank You
Leadership and Management
DQ 1
One of the five elements of emotional intelligence is self-awareness. Write my Essay Online Writing Service with Professional Essay Writers – Explain why emotional intelligence is crucial for effective leadership. Homework help – Discuss what behaviors someone with a high degree of self-awareness would demonstrate within the context of leading and managing groups. Provide an example.
Please this discussion question DOES NOT need an APA format. Research the answers to the questions and answer them in the sequence. Please be detail and answer all the parts/segments of the question. Please use the information below and you are also free to use other credible websites like CDC etc. We are required to have at least 2 references and with intext citation for each DQs. Thank you very much.
RESOURCES from the our portal
Read “The Impact of Nurse Manager’s Leadership Styles on Ward Staff,” by Saleh et al., from British Journal of Nursing (2018).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=128259219&site=eds-live&scope=site
Review “Code of Ethics for Nurse With Interpretive Statements,” by the American Nurses Association (ANA) (2015), located on the ANA website.
URL:
https://www.nursingworld.org/coe-view-only
Read “Nurse Manager Risk Information Management for Decision-Making: A Qualitative Analysis,” by Islam, Hutchinson, and Bucknall, from Collegian (2017).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1322769617300872
Read “They Lived Experiences of Becoming First-Line Nurse Managers: A Phenomenological Study,” by Guanawan, Aungsuroch, Nazliansyah, and Sukarna, from Iranian Journal of Nursing and Midwifery Research (2018).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edsdoj&AN=edsdoj.bccedfd8aeaf4c56a169ec4bb534b1c8&site=eds-live&scope=site
Read “Nurse Managers’ Insights Regarding Their Role Highlight the Need for Practice Changes,” by Moore, Sublett, and Leahy, from Applied Nursing Research (2016).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S0897189715002086
Read “Personality Characteristics of Nurse Managers: The Personal and Professional Factors that Affect Their Performance,” by Handan and Uiku, from Journal of Psychiatric Nursing (2018).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=129500749&site=eds-live&scope=site
Read “Understanding the Role of the Nurse Manager: The Full-Range Leadership Theory Perspective,” by Witges and Scanlan, from Nurse Leader (2014).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1541461214000846
Read “Assessing the Nurse Manager’s Span of Control: A Partnership Between Executive Leadership, Nurse Scientists and Clinicians,” by Cupit, Stout-Aguilar, Cannon and Norton, from Nurse Leader (2019).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1541461218303963
Read “Student Nurses’ Perceptions of the Nurse Manger as a ‘Servant Leader,'” by Jooste and Jordaan, from Africa Journal of Nursing and Midwifery (2012).
URL:
https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=107926799&site=eds-live&scope=site
Read “A Servant Leader and Their Stakeholders: When Does Organizational Structure Enhance Leader’s Influence?” by Neubert, Hunter, and Tolentino, from The Leadership Quarterly (2016).
URL:
https://www-sciencedirect-com.lopes.idm.oclc.org/science/article/pii/S1048984316300297
ead “Growing Nurse Leaders: Their Perspectives on Nursing Leadership and Today’s Practice Environment,” by Dyess, Sherman, Pratt, and Chiang-Hanisko, from Online Journal of Issues in Nursing (2016).
URL:
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No1-Jan-2016/Articles-Previous-Topics/Growing-Nurse-Leaders.html
Roles and Responsibilities in Leadership and ManagementBy Stacey Whitney
Essential Questions
• What impact do effective decision-making skills have on the nurse leader?
• How does self-awareness affect how nurses lead and manage effectively?
• How do leaders and managers approach issues differently? How are they alike?
• How does role stress negatively affect the nurse leader?
• What are the necessary components of delegation?
Introduction
Nurses are considered leaders in the health care industry. Professional nurses naturally acquire leadership and management skills as they practice by providing safe, quality nursing care for their patients. Because nurses provide patient advocacy, follow evidence-based practices, and create necessary change in health care environments that affect quality care, nurse leadership is vital, especially as health care reform becomes increasingly focused on patient/client/consumer satisfaction.
The work that professional nurses provide by leading and managing in nursing has the potential to impact not only the nurses under their command, but ultimately every single patient who is cared for by their team of nurses. Theoretically speaking, every element has the potential to impact every other element. This fact should influence one’s willingness to lead and manage in a purposeful way. Consistent challenges exist for nurses who choose to lead or manage. In an effort to meet those challenges, the goal of this chapter is to provide a solid foundation of understanding of the role of nurse managers, professional leadership, emotional intelligence, inter/intraprofessional relationships and collaboration, and the process of working in teams.
While reviewing this chapter, consider the following:
• How does the organizational structure of a hospital or agency affect the role of a nurse manager?
• Are mentoring relationships really important?
• What does shared governance mean?
• How do nurse managers motivate nursing teams?
Nurse Managers: Organizational Role and Function
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To understand their function within the current health care environment, nurse managers must first be aware of their role within an organizational structure. Health care organizations can be categorized by the types of services offered and by the length of time those services are provided. These varying health care organizations may function through institutional providers, such as acute care hospitals, long-term care facilities, and rehabilitation facilities. Facilities may provide different ranges of care for specific patient care populations or treat only certain diseases or conditions. Further, ownership of such health care organizations can be categorized as public, private nonprofit/not-for-profit, or for-profit.
Certain characteristics exist that define health care organizations and institutional providers. These characteristics include:
1. Ownership – Public, private nonprofit or not-for-profit, and for-profit
2. Accreditation Status – Joint Commission, Magnet
3. Types of Services Offered – General or specialized care
4. Length of Direct Care Services – Primary care, secondary care, or tertiary care.
a. Primary care providers provide entry into the system through health maintenance, chronic care, and long-term care.
b. Secondary care providers focus on prevention of disease complications and function as home health care, ambulatory care centers, and nursing centers.
c. Tertiary care providers offer rehabilitation or long-term care in the form of home health care, long-term care facilities, rehabilitation centers, skilled nursing facilities, assisted living programs, or retirement centers.
5. Teaching Status – Teaching hospitals typically provide exceptional care because of access to state-of-the-art equipment and researchers (Yoder-Wise, 2015).
Table 2.1
Examples of Direct Care Services
Primary Care Providers
(Entry into health care system) Secondary Care Providers
(Prevention of disease complications) Tertiary Care Providers
(Rehabilitation or long-term care)
Ambulatory Care Centers Home Health Care Home Health Care
Independent Providers Ambulatory Care Centers Skilled Nursing Facilities
Physician Offices Nursing Centers Assisted Living Centers
School Health Clinics Long-Term Care Facilities
Nursing Centers Retirement Centers
Nurses practicing in managerial positions should understand their organization’s functional organization structure. The structure can be presented in a diagram or chart that identifies the functions and main managerial positions within an organization. Nurse managers do not function solely at upper levels in health care organizations. Depending on the size and structure of the organization, management positions can be present at lower, middle, and upper levels. The flow of authority depends upon the organizational structure. Typically, lower level managers have lower levels of authority than middle or upper level managers. Middle level managers, for example, typically serve in the role of directors, heads of departments, or supervisors of units. Middle level managers are responsible for completion of day-to-day operations of units and departments and often coordinate the flow of information from upper to lower levels. Organizational charts can serve as visual aids that are helpful in understanding the flow of authority. Depending on the size of the organization, the charts can be complex and include varying levels of administration. Figure 2.1 is an example of an organizational chart that specifically outlines the nursing structure of a hospital.
Figure 2.1
Hospital Nursing Organizational Structure
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Administrative and Managerial Responsibilities
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Responsibilities of nurse managers may seem to solely revolve around managing staff shortages, increasing patient acuity, and increasing costs of care, but daily operations should not overshadow the need for influential leadership. Administrative and managerial responsibilities of the nurse manager of a department or unit can be complex and ever changing. The term management can be defined as the process, including social and technical functions and tasks, that occurs within an organization for the purpose of accomplishing predetermined goals (Longest, Rakich, & Darr, 2000). Managerial functions are generally the same regardless of organization size and structure, but the amount of time spent on each is related to the manager’s perceived importance of each task (Purnell, 1999). The main tasks of the nurse manager can be categorized into the following functions:
1. Planning – This includes the task of prioritizing and knowing what needs to be accomplished within the organization. Setting goals to reach performance targets is an example of planning.
2. Organizing – This function relates to the organizational structure as assignments are made by prioritizing tasks and analyzing activities, such as distribution of authority and assigning teams.
3. Staffing – This function includes the hiring and retaining of quality staff, which is vital for ensuring positive patient outcomes.
4. Directing – This function involves motivating and empowering the nursing team through effective leadership and can be accomplished by giving and receiving feedback to other team members, establishing and communicating goals and objectives, and developing people.
5. Controlling – This is the task of supervising and monitoring staff members, including analyzing, appraising, and interpreting performance. Corrective action is sometimes necessary by enforcing accountability for individual actions.
6. Decision Making – Effective decision making is based on organizational policies and procedures. Managers often provide recommendations to improve systems and processes. (Longest et al., 2000)
Effective communication between the nurse manager and team members is a key component of all these functions. Nurse retention, motivation, satisfaction, and engagement are positively affected by nurse managers who communicate in an effective and professional way (Saleh et al., 2018). Furthermore, the leadership style of nurse mangers has a direct correlation to nurse job satisfaction and retention (Asamani, Naab, & Ansah Ofei, 2016). There are many characteristics that comprise successful leaders (See Table 2.2). A study in 2011 included the act of humility on the list, finding that practicing humble leadership, by empowering others, was a strong predictor of organizational success (Grande, 2017). This can be done by sharing authority and responsibility, which makes others feel valued, thus more productive.
Leadership can be defined as the process of influencing people so that they willingly and enthusiastically strive to achieve the goals of the group (Weihrich & Koontz, 2005). Nurses at all levels, from bedside nurses to nurse managers and chief nursing officers, are leaders. In fact, the publication of the Institute of Medicine’s (IOM) report, The Future of Nursing: Leading Change, Advancing Health, produced a significant directive for nurse leaders: “Clinical nursing leadership, at the point of service now, is recognized as a central professional competency to ensure quality patient care and patient safety” (Grindel, 2016). As nurse managers recognize the need for clinical leadership at the bedside, or point of service, they should model effective leadership skills by intertwining them into day-to-day management practices. By demonstrating successful leadership, nurse managers can positively influence future nurse leaders (Arzouman, 2015).
Table 2.2
Effective Characteristics of Nurse Leaders and Managers
Trustworthy Able to identify needs of others
Uses critical-thinking skills Trusts personal intuition
Empathetic to others, sincere Self-motivating
Accepts responsibility willingly Timely follow-up of actions
Considers multiple options in decision making Sets boundaries
Good communicator Willing to counsel others
Motivates others Able to control own emotions
Skilled in dealing with difficult people Acknowledge others ideas and opinions
Good steward of resources Professional
Values people Invests in building up others
Strategic Planning
The health care environment is in constant change, faced with significant challenges, and in need of continuous process improvement. Nurses play a key role in developing and planning organizational goals for the future. Strategic planning is the process in which organizational leaders purposefully look ahead into the future, outline goals for the organization, and develop a process to reach those goals. Many are the plans in a person’s heart, but it is the Lord’s purpose that prevails. —Proverbs 19:21 (New International Version)Traditionally planning is based on an organization’s mission and vision, and change should be accomplished in an organized way. Strategic planning for health care has changed over time. Goals for the 1960–1980s included infrastructure and expanding facilities. The 1980s through 2010 mainly involved building physician staff. Due to managed care and the Patient Protection and Affordable Care Act of 2010, expanding services to larger populations was a priority, as organizations desired competitive costs. Currently the strategic planning trend is consumer-based, meaning that it is driven by the level of satisfaction of services provided (Healthcare Financial Management Association, 2017).
Strategic planning is what nurses do as they plan daily, weekly, monthly, annually—5 years, 10 years, 20 years in the future—and what strategies they need to use to achieve established goals. In other words, planning is always happening, and it is a good practice for a nurse manager to be organized, thoughtful, and purposeful. Applying strategic planning skills is the cornerstone of a leadership or management position and can be described as the conceptual framework of looking into the future and strategically planning the approach for what the future will look like in the short term and in the long term. It is important to understand the mission, vision, and trajectory of the organization involved and incorporate strategic planning in creating the goals that accompany that trajectory. Irrespective of the current organizational situation, strategizing how to achieve outcomes for identified goals and planning for the future should be considered priorities.
Many factors affect future planning of organizations, including budgeting, level of staff expertise, levels of care provided, and time. A SWOT analysis is an effective planning tool that can identify strengths, weaknesses, opportunities, and threats (SWOT) related to a project, institution, or organization (see Figure 2.2). Organizational strengths and weaknesses can be graphed against opportunities and threats. This subjective tool can prove useful in decision making, planning, and understanding the direction of an organization.
Figure 2.2
SWOT Analysis
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Delegation
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Delegation is the use of personnel to accomplish a desired task by allocation of responsibility and authority (Joseph, 2014). Increasing complexities of care and demands for health care services that exceed the capabilities of available licensed nurses creates the need for delegating nursing tasks to unlicensed assistive personnel (UAP) who act for the nurse and provide competent care. Delegation can occur within teams of colleagues at the same level or in situations in which there are subordinates or individuals in an assistive capacity. UAPs require delegation and supervision, but anyone can receive delegation. Delegation occurs when tasks are assigned to individuals, in general, irrespective of title or position. The most important aspect of delegation is determining whether delegating a task is appropriate and if the knowledge, skill, and ability of the individual aligns with the task to be delegated.
The registered nursing license is an agreement between the nurse and the governing bodies of the state of practice. The registered nurse agrees to practice competently within the guidelines of the Nurse Practice Act (NPA). Competency can be defined as an ongoing process that integrates knowledge, skills, and judgment to safely and ethically practice in a defined role (Currie, 2008, p. 86). Common concerns of delegation to UAPs by registered nurses include:
• Is delegation legal in all states?
• Do the organizational policies permit delegation?
• What are the nurses’ responsibilities in delegation?
• Is it appropriate to delegate nursing tasks to UAPs?
• Is the nurse liable for the actions of UAPs when delegating?
• What patient safety risks are associated with delegation?
Each question can be answered by examining the NPA that governs the nurse’s practice in the state of employment and the organizational policies. Health care organizations should develop delegation policies that are consistent with the state board guidelines. The definition of delegation in the NPA can vary from state to state. Key concepts that remain the same in most NPAs include:
• The practice of nursing cannot be delegated, only nursing tasks that are within the scope of nursing practice.
• Appropriate delegation is an individual decision that depends on the situation, patient status, and capability of the UAP. Tasks should not be routinely delegated.
• Almost all NPAs include a section of what not to delegate, including any activity that requires professional nursing judgement and skill.
• The nurse is ultimately responsible for the nursing care provided by the UAP (Johnson, 1996).
Laws in each state define the use of UAPs in performing nursing care. The American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have issued a joint statement asserting that “mastering the skill and art of delegation is a critical step on the pathway to nursing excellence” (ANA/NCSBN, n.d., p. 4), which also included a decision tree for delegation, accounting for assessment and planning, communication, surveillance and supervision, and evaluation and feedback.
Professional Relationships
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Roles are behavior expectations of a person in a certain position. Nurses often wear many “hats” and function in society not only as health care professionals, but also in other roles such as spouses, parents, children, and friends. Multiple roles often lead to interrole conflict due to multiple demands. Maintaining professional boundaries when professional and societal roles intersect is an important aspect to consider. It is no surprise that nurses, as trusted health care professionals, often share close relationships with patients. Special care must be taken so that the nurse does not damage the therapeutic nurse-patient relationship. The nurse must adhere to professional boundaries (National Council of State Boards of Nursing [NCSBN], 2014).
Professional boundaries are defined by the NCSBN (2014) as “the spaces between the nurse’s power and the client’s vulnerability” (p. 4). Crossing these boundaries can occur when the needs of the nurse are mixed with the needs of the patient. The boundary lines can sometimes be blurred when either the patient or the nurse introduces inappropriate conversation or physical contact (Hanna & Suplee, 2012). The following should be considered as warning signs of inappropriate professional behavior:
• Personal discussions regarding intimate issues with a patient,
• Acknowledging a particular patient as a favorite,
• Meeting with a patient in settings other than those used for direct patient care,
• Behavior that could be considered flirting,
• Speaking negatively about other staff members with patients or their families,
• Keeping secrets for or with a patient,
• Spending more time that usual with a patient, becoming overly involved,
• Thinking that one is the only nurse who can care for the patient, and
• Believing one is the only nurse who understands the patient.
Patients may also seek out personal information about a nurse or demonstrate inappropriate behavior. The nurse should consult a respected colleague or request assistance from a supervisor in this case (NCSBN, 2014).
The nurse-patient relationship is one of unequal power. The nurse demonstrates power in the relationship because of the nurse’s position in the health care system. The needs of the patient, including patient safety, must be a priority. The nurse must never use the nurse-patient relationship to meet personal needs. Civil actions, penalties, and criminal charges can be brought against the nurse who commits unthinkable acts with a patient, such as sexual misconduct, sexual harassment, or battery, to name a few. Charges could apply at the level of a felony or misdemeanor and could include jail time (Hanna & Suplee, 2012).
Technology is ever changing and so are the ways used to communicate with others. Social media has become one of the most common forms of communication in today’s society. Some social networks such as Facebook, Instagram, and LinkedIn can provide necessary ways for health care professionals to develop and maintain relationships with patients, but caution must be taken, as these platforms can easily be used to cross professional boundaries.
Consensus Building
Consensus building includes gathering opinions, listening, discussing ideas and differences, and coming to a mutual agreement. It does not include a majority or minority rule, a unanimous vote, or bargaining (“United States Office of Personnel Management,” n.d.). Conflict should be expected in the workplace and can be used as a tool for positive change. It is important to note that consensus building is a voluntary process in which participants seek a mutually accepted resolution of their differences (Bingham, 2011). Various methods, such as brainstorming, negotiation, and mediation, can be used to resolve conflict successfully.
Behavior in the workplace that is positive or negative should be considered as one component of a performance appraisal or evaluation. Professional performance appraisals are a common responsibility of nurse managers. Areas of growth, including areas in need of improvement or discipline should be included in appraisals. It is important that performance appraisals accurately depict individual work performance, as income and promotions are typically linked to them.
Collaboration and Shared Governance
Cooperatively working together toward a common goal can be termed the process of collaboration. Collaboration is needed in situations such as significant issues involving patient care, organizational decision-making processes, and times when professional relationships are in need of repair. When differing viewpoints cannot be merged together into one solution, it is important that individuals involved in the collaboration process put personal satisfaction and personal goals aside to determine the best possible solution. Collaboration can by key in negotiating differences, by providing health care professionals the opportunity to learn and grow through cooperative problem solving (Blair & Wood, 2014). The Canadian Nurses Organization recently acknowledged key points related to professional collaboration at its annual meeting. These key points include:
1. Enhanced intraprofessional collaboration leads to safer patient care and supports nurses in focusing on patents rather than professional boundaries.
2. Addressing professional boundaries, hierarchies, and silos will support nurses in providing patient-centered care.
3. Entry-to-practice educational reform, ongoing education for nurses in practice, and strong leadership are needed to develop and support the attitudes and skills for successful intraprofessional collaboration.
4. Effective intraprofessional relationships can strengthen the professional voice and image of nursing. (Lankshear & Limoges, 2018, p. 20)
Collaboration and shared governance should be used to determine the best ways to practice and produce positive patient outcomes. Shared governance has been proven to improve patient outcomes, patient satisfaction, nurse retention, and job satisfaction. It has been connected to nurse autonomy, empowerment, and improved decision making. In addition, the Magnet Recognition Program includes shared governance as a key component of its evidence-based management practices (Joseph & Bogue, 2016).
Shared governance is an “organizational innovation that legitimizes health care professionals’ decision-making control over their practice, while extending their influence to administrative areas previously controlled by managers” (Hess, 2011, p. 235). Shared governance, as a partnership between bedside nurses and nursing managers and leaders, empowers nurses by giving them a voice. Through shared governance coordinated councils, periodic meetings of staff and management provide a platform for open communication and transparency regarding decisions that need to be made in the organization.
Consider the following example of the shared governance process in a postoperative cardiac unit within a large urban hospital. Monthly meetings are voluntary for all staff members. The council consists of 10 representatives, including two nurse managers, four registered charge nurses, two unit nurse practitioners, and two clinical nurse educators. In order for the council to foster shared governance, an equal number of staff members are assigned to each representative. The representatives are expected to communicate with those staff members and seek feedback regarding agenda items and discussion topics, allowing each staff member to have the opportunity to voice an opinion to the council (Bieber & Joachim, 2016).
Bieber and Joachim (2016) offered a case study example regarding a situation in which a shared governance council addressed dissatisfaction of a unit’s self-scheduling guidelines. A group of RNs, including a leadership representative, formed a council to address the scheduling issues. The concerns were discussed and the current self-scheduling procedure was reviewed. A revised set of self-scheduling guidelines was then presented at the council meeting and sent to all RNs on the unit. For the final set of guidelines to be successful, the council held that it was essential that all RNs felt they had an equal role in the discussion of changes to the guidelines. Certain changes were controversial and needed further discussion. These changes were addressed one at a time at the council meetings. Through negotiation, a new set of guidelines were agreed upon and became the new self-scheduling guidelines. The study claimed that changing the scheduling process gave the RNs a voice and resulted in improved RN satisfaction (Beiber & Joachim, 2016, pp. 64-65).
Studies have shown that a connection between perceptions of shared governance and overall work engagement exists. It is the essence of nursing leadership and the key to empowering professional nurses to be an active part of the change process (Joseph & Bogue, 2016).
Change, Innovation, and Conflict Management
Continuous change in the health care field has become a constant for nurses and a constant for life in general. Change can be defined as the process of making something different. Most aspects of health care have experienced changes in some form, such as changes in patient acuity, computer software systems, skill mixes of medical providers, or changes in protocols, but the fundamental basics of providing nursing care have not changed.
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At the national level, health care reform has fueled enormous change in the health care industry. The IOM has encouraged nurses to take a leading role in health care change by being active in the process rather than resisting it. The IOM report, The Future of Nursing: Leading Change, Advancing Health, details how nurses’ roles, responsibilities, and education should change to meet the needs of a complex and ever-changing health care system that provides care for an aging and increasingly diverse population (Institute of Medicine [IOM], 2010).
All registered nurses should be recognized as important change agents and innovators whose voices should be heard regarding topics such as improving health care services or health care cost containment. Nurses on the front lines of health care have valuable information regarding professional trends, such as predicting and preventing hospital readmissions or improving continuity of care and care coordination, and can act as agents of change within the process (Garon, 2016).
Change is rarely easy and is often complex and difficult. Barriers to change continue to exist. Nurse managers should have an understanding of nursing theory as they attempt to guide their teams through the process and navigate through the barriers. As one of the most commonly used theories related to nursing education and patient learning, the governing principle of change theory is the use of certain motivating factors that can provide empowerment and the desire to change. By setting goals and offering incentives, learning and change occur.
Differences in opinion regarding change can often cause conflict or disruption, which is common in work environments. Grohar-Murray and Langan (2011) identified the seven types of conflict that can occur in the workplace (see Table 2.3).
Table 2.3
Types of Conflict in Health Care Environments
Type of Conflict Characteristics/Examples of Conflict
Professional-Bureaucratic Conflict A nursing supervisor in middle management defending staff and patient care needs to organizational administrators who are decreasing nursing resources and funding.
Nurse-Nurse Conflict Two nurses disagree.
Nurse-Physician Conflict One side attempts to force values on another. An example of a nurse-physician conflict might be a disagreement regarding a patient’s plan of care.
Personal Competency-Gap Conflict A nurse that is unable to be objective and unbiased in situations that involve personal conflicts of interest.
Competing Role Conflict A nurse feels that his or her roles are in opposition. An example might be performing tasks that might be against the nurse’s religious beliefs.
Expressive-Instrumental Conflict The need to release emotional tension conflicts with the need to complete tasks.
Patient-Nurse Conflict A patient disagrees with restrictions placed on him or her, such as dietary or visiting hour restrictions.
Note. Adapted from Leadership and Management in Nursing (4th ed.), by M. E. Grohar-Murray & J. C. Langan, Boston, MA: Pearson, 2011, pp. 91-92.
Conflict that is managed poorly or avoided can create negative working environments that can have negative effects on patient quality of care and patient safety, create patient dissatisfaction, and increase health care costs (Kantek & Kavla, 2007). The good news is that positive work relationships and positive change can result from successful conflict management. In fact, when conflict is managed in a constructive way, the quality of patient care and patient safety are improved (Labrague & McEnroe-Petitte, 2017). Strategies for managing conflict include the five approaches of dominating, obliging, avoiding, compromising, and integrating, which are explained in the Table 2.4. Nursing leadership requires effective communication skills and productive conflict management. Professional opinions often vary and misunderstanding often occurs. Conflict cannot be avoided, but it can be resolved with effective leadership and management.
Table 2.4
Strategies for Managing Conflict
Strategy Characteristics/Examples
Dominating Used when quick action is needed, sometimes seen as aggressive use of power, or forcing a solution to the conflict.
Obliging Person or group gives up own needs for the needs of others, in an attempt to smooth the conflict or situation. This may reduce the emotional component of conflict.
Avoiding Postponing dealing with conflict due to emotional upset. Both sides are aware of a conflict but choose not to acknowledge it.
Compromising Preferred strategy in which both parties accept middle ground. Neither side gets what it wants, and the rewards are divided between both parties.
Integrating Integrating ideas or problem solving when goals of both sides have importance.
Note. Adapted from Managing Conflict in Organization, by M. A. Rahim, New Brunswick, NJ: Transaction Publishers, 2011.
Quality Improvement and Creating High-Performance Teams
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Professional nurses aim to deliver high-quality patient care in a safe, effective way. They carry this responsibility first and foremost for the patient, but also for themselves and their respective organizations. Quality improvement (QI) is a process that involves continuous improvement of health care delivery. Every organizational department should be involved in the QI process, and ideally all departments should work together to identify appropriate aims for QI projects. As quality initiatives are decided upon, the next steps are to collect data, analyze the results, and implement change. The QI process is very similar to the nursing process, which includes assessment, diagnosis, planning, implementation, and evaluation (Barnhorst, Martinez, & Gershengorn, 2015).
Improvement in quality health care was fueled by the 2000 IOM report, To Err Is Human. This report encouraged evidence-based care by suggesting that medical errors were a leading cause of death in the United States. Based on this premise of 20 years ago, evidence-based care and QI have become popular terms in all health care settings (Kohn, Corrigan, & Donaldson, 2000). A few examples of QI projects lead by nurses that are known to improve patient outcomes include central-line associated bloodstream infections (CLABSIs) prevention protocols, ventilator-associated pneumonia prevention protocols, improving early mobility, decreasing average length of stay, and prevention of catheter-associated urinary tract infections (Barnhorst et al., 2015).
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The opportunity to build and create effective teams exists in many areas of nursing. Creating high-performance teams in health care is a leadership challenge that can be difficult, but it is of the utmost importance, as ineffective teamwork can negatively affect patient care. Rarely do high-performance teams naturally occur; they must be created and managed by nurse leaders (Eggenberger, Sherman, & Keller, 2014). The IOM discussion paper, “Core Principles & Values of Effective Team-Based Health Care” (Mitchell et al., 2012), outlined five personal values that usually characterize members of effective teams: honesty, humility, curiosity, creativity, and discipline. The following characteristics exist in effective teams:
• Cooperation amongst members,
• Conflicts effectively managed,
• Decisions made cooperatively,
• Shared goals,
• Members engaged in teamwork,
• Clear communication,
• Clear roles,
• Mutual trust,
• Cultural differences accepted, and
• Measurable outcomes and processes (Eggenberger et al., 2014).
The nurse manager should recognize common obstacles that typically occur when working with teams, such as mistrust, communication breakdowns, and confrontation. Assessing the effectiveness of teams should be an ongoing process (Eggenberger et al., 2014).
Personal Leadership
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While there are some people who are natural leaders, leadership skills can also be learned and put into action. Consider this description of leadership provided by John P. Kotter, PhD, the Konosuke Matsushita Professor Emeritus of Leadership at Harvard Business School:
Leadership in a modest sense—i.e., leadership with a lower-case (little) “l”—is far more prevalent and far more important than most people realize. . . . Not flashy or dramatic, it rarely attracts much attention, and often goes unnoticed. But it can be found in all leadership stories. A person steps into the situation, figures out which direction things need to move, communicates that successfully to a few other people whose help is needed, and then energizes him/herself and the others to make something happen under difficult conditions. (as cited in Escott-Stump, 2011, p. 1109)
Acts of leadership are not always recognized as notable acts by those in authoritative positions. All nurses have potential to make a difference in patients’ lives on a daily basis through various types of leadership opportunities that present themselves in everyday practice.
Successful leadership is important because it has been associated with staff nurse job satisfaction and retention, and independent, proactive leadership is desired by staff nurses. The values and behaviors of an organization begin with its leadership (Azaare & Grosse, 2011). Successful leaders can be relied upon for professional responsibility and accountability. A responsibility is an obligation to complete a duty, task, or assignment. Accountability is being morally responsible for nursing actions and professional conduct and accepting ownership of those actions. Successful leadership is closely related to self-awareness, or understanding one’s self by recognizing strengths and weaknesses, moral values, thought processes, character, emotions, motivations, desires, and goals. Having a good awareness of self allows leaders to have more control over interactions with others. It allows for greater control over time management as well, which is a key component of balancing work and personal/family life (Marquis & Huston, 2017). In fact, balancing stress, or stress management, along with time management, are two important strategies for self-management.
Keep in mind that leadership is not always tied to positions of authority. Good leaders produce quality care in many settings. Clinical nurse leaders, for example, are critical to the success of patient care. Professional leadership can simply be viewed as a relationship with others that requires a defined skill set. Kouzes and Posner (2017) have developed five practices and 10 commitments of exemplary leaders in any setting that, when applied, can enable the leader to motivate others, inspire change, and share in common organizational goals (see Table 2.5).
Table 2.5
Five Practices of Exemplary Leaders
Five Practices Ten Commitments
Model the Way 1. Clarify values by finding your voice and affirming shared ideals.
2. Set the example by aligning actions with shared values.
Inspire a Shared Vision 3. Envision the future by imagining exiting and ennobling possibilities.
4. Enlist others in a common vision by appealing to shared aspirations.
Challenge the Process 5. Search for opportunities by seizing the initiative and by looking outward for innovative ways to improve.
6. Experiment and take risks by constantly generating small wins and learning from experiences.
Enable Others to Act 7. Foster collaboration by building trust and facilitating relationships.
8. Strengthen others by increasing self-determination and developing competence.
Encourage the Heart 9. Recognize contributions by showing appreciation for individual excellence.
10. Celebrate the values and victories by creating a spirit of community.
Note. Adapted from The Leadership Challenge (6th ed.), by J. M. Kouzes & B. Z. Posner, Hoboken, NJ: John Wiley & Sons, Inc. 2017.
Nursing role models, preceptors, or mentors assist nurses with transition into professional practice. Role models can be defined as competent experienced nurses who are effective in inspiring others. Their relationship with the nurse is passive in that the nurse does not actively seek out their information, but rather, models their behavior over time. Preceptors are experienced nurses who provide not only knowledge of the role, but also a short-term, one-on-one relationship with the nurse that typically offers emotional support. As they clarify role-expectations and promote organizational values, preceptors may receive incentive pay from the organization for participating in this role. Mentors use education in the form of teaching and modeling as a means to clarify the nurses’ professional role. Mentorship is an intentional, long-term relationship between the nurse, considered an expert in the field, and a novice nurse desiring expert status. The two professionals intentionally decide upon a mentoring relationship. The mentor may offer activities that facilitate growth for the novice nurse, including role modeling, listening, empathizing, and challenging activities outside of their comfort zone, which can provide opportunities for professional growth, set professional standards, and establish expectations for interpersonal communication. Mentors lead others by example and typically possess strong moral and ethical values (Jakubik, Eliades, Weese, & Huth, 2016; Marquis & Huston, 2017).
Madison (2014) reviewed mentoring relationships as a three-phase process:
1. Finding and connecting with a more experienced person in the workplace.
2. Teaching, modeling, and offering insider knowledge, which fosters a sense of competence and confidence.
3. Sensing change and growth as the mentoring relationship moves to a conclusion (Madison, 2014, pp. 121-135).
Emotional Intelligence
To be successful in the workplace, the nurse leader or manager must be able to handle interpersonal conflicts in a therapeutic way. Emotional intelligence (EI) signifies the nurse’s ability to correctly acknowledge people’s emotions from their expressions, including body language, facial expressions, and spoken word. EI is the ability of self-perceptions of the person’s empathy, impulsivity, and assertiveness, as well as social and personal intelligence applied to respond to another person or situation in a therapeutic manner (Kemerer & Cwiekala-Lewis, 2016; Petrides & Furnham, 2001).
EI has been credited as being extremely important in developing leadership skills, communication skills, and other skills expected from nurses that are noncognitive. It is a trait that is linked to safer working practices (Parnell & Onge, 2015). Despite many organizational changes made by health care facilities to improve patient safety, errors still occur. The Joint Commission named the most frequent cause of such events as ineffective leadership and communications (“Sentinel Event Data,” 2013).
Goleman (1995) identified five characteristics of EI proven to be helpful for leaders, which include self-awareness, self-regulation, motivation, empathy, and social skills. Self-awareness, or emotional awareness, includes the ability to understand personal emotions and how they can affect others. Self-regulation is emotional control. It is the ability to think before acting and then redirect impulsive actions. Motivation is the desire to achieve goals. It is the ability to face obstacles with persistence. Empathy is an innate ability to sense and understand the emotions of others. It is the ability to anticipate and consider the needs of others in the decision-making process. Finally, social skills are the ability to manage relationships. Social skills allow individuals to listen and respond appropriately to others in an inspiring way (Goleman, 1995; Parnell & St. Onge, 2015, p. 89).
The effects of EI in the individual nurse leader or manager can be seen in the health care team as a whole. Collaboration, communication, and respect in the health care team are some of the positive effects of individual team member EI on the health care team as a whole (Holbery, 2015).
Interprofessional/Intraprofessional Relationships and Collaboration
The term interprofessional communication refers to communication between or amongst groups. Intraprofessional communication occurs on the inside or within an organization. For example, while many organizations have intranet communications that function privately for authorized users only, Internet communication can occur between any groups that are connected on the World Wide Web. Collaboration, by utilizing the skills of professionals, improves coordination of care, patient safety, and quality of care. Why is there a lack of collaboration in health care if it reaps so many benefits? Collaboration seems to be effective only if it begins early in the educational process.
In its 2011 report, the IOM recommended that nurses should be educated with doctors and other health professionals both as students and later. The concept of interprofessional collaboration is advanced further by the Patient Protection and Affordable Care Act (2010), which promotes better health care outcomes through coordinated care. Examples of coordinated care include patient-centered medical homes and accountable care organizations (IOM, 2011). Interprofessional collaboration occurs when health professionals work together to identify patient needs, solve problems, make decisions regarding patient care, and evaluate collectively. Patients and professionals benefit from this collaborative approach. Increasing costs of health care, including an aging population, and increasing demand for health care workers contribute to the need for quality services provided to patients. It is important to remember that the patient, as well as family members, should be involved in the decision-making process about the patient’s health. Interprofessional collaboration should be
a practice orientation, a way of health-care professionals working together with their patients. It involves the continuous interaction of two or more professionals . . . organized into a common effort, to solve or explore common issues with the best possible participation of the patient. (Herbert, 2005, as cited in McDonald & McCallin, 2010, p. 2.)
The term shared vision suggests that all members of a group have the same future goals for an organization. As nurse leaders and managers, it is imperative that the organizational purpose, or mission statement, is recognized and integrated into professional practice. The mission statement should serve as a decision-making tool or a template of purpose for the organizational leadership and guide all activities of the organization. It is the highest priority in meeting organizational goals and objectives. Mission statements are useful only if the organization uses them honorably for guidance (Marquis & Huston, 2017).
Figure 2.3
Sample Mission Statement
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Core values can accompany mission statements to provide the fundamental beliefs of an organization. Core values are also the personal beliefs, priorities, and motivating forces that provide the framework for leadership and daily decision making. They are the basic elements of how nurses practice the profession, and are used every day in all actions and activities.
Just as core values of individuals and organizations can differ, so can the diversity of the workforce. The main area of diversity is language, which can include accents, alternative meanings of words, and dialects (Marquis & Huston, 2017). Cultural differences, such as religion, age, gender, ethnicity, and sexual orientation, create a diverse workforce. The nurse manager should be aware that problems may occur when cultural awareness and sensitivity are not practiced. Responses or actions that could be seen as discriminatory should be recognized and avoided. Managers have a legal responsibility as well. Discrimination is prohibited by Title VII of the Civil Rights Act of 1964.
Diversity in Nursing
“Each individual is unique and recognizes individual differences – race, ethnicity, gender, sexual orientation and gender identity, socio-economic status, age, physical abilities, religious beliefs, political beliefs, or other attributes. It encourages self-awareness and respect for all persons, embracing and celebrating the richness of each individual. It also encompasses organizational, institutional, and system-wide behaviors in nursing, nursing education, and health care.” (National League for Nursing, 2016, p. 2)
Nursing leaders should be comfortable working with a diverse workforce, without an attitude of only tolerance. Organizational employees should reflect the diversity of the community they serve by incorporating various genders, ages, and spoken languages. The importance of this cannot be overstated. Educating and hiring nurses who mirror the diversity already present in the American population is key for positive patient outcomes. (Elfman, 2018; Marquis & Huston, 2017).
When managing a diverse staff, considerations regarding group dynamics should be taken into account when assigning tasks. Group dynamics are the attitudes and behaviors that occur within a group. Nurse managers should be obligated to communicate with not only individual employees, but small and large groups as well. It is important for nurse managers to understand how groups typically perform to aid in communication among members of the group.
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Merriam-Webster’s dictionary defines professionalism (2018) in practice as “the conduct, aims, or qualities that characterize or mark a profession or person.” A professional nurse should pay particular attention to promoting a professional image. Further, professional nurses should be aware of virtual first impressions, such as e-mail correspondence, social media remarks, and discussion forums. Correct formatting, grammar, spelling, and tone should always be practiced to ensure that the nurse projects a professional image (Bergren, 2005).
Professionalism should certainly be evidenced in the workplace. Demands placed on nurses and other professionals can cause very high stress levels, which in turn can increase incidents of incivility, or the lack of formal politeness and courtesy in speech or behavior. Civility, or politeness and courtesy, can be seen as general respect of the rights and feelings of others (Pinckney, 2015). According to Clark (2015), characteristics of a healthy workplace include “civil conversations at all organizational levels, shared organizational vision and values, leadership, both formal and informal, and civil conversations at all levels of the organization” (p. 19). The Code of Ethics for Nurses With Interpretative Statements, produced by the ANA, states that all nurses have an obligation to their clients and themselves to promote an ethical, safe, and civil environment (American Nurses Association, 2015).
Working in Teams
One task of the nurse manager or leader is the organization and structure of teams to accomplish patient care and organizational goals. The nurse manager is responsible for selecting, planning, and monitoring groups of nurses to deliver coordinated patient care. The teams are structured in various ways according to the organization, such as:
• Team nursing includes a nurse leader who coordinates team members to care for groups of patients.
• Primary care nursing involves one registered nurse responsible for 24-hour planning and coordination of care.
• Modular nursing, or mini-teams, includes a registered nurse and unlicensed assistive personnel who provide care to a small group of patients.
• Interprofessional teams working together to deliver coordinated patient care (Marquis & Huston, 2017).
Motivated employees typically have the desire to achieve goals despite obstacles that may occur. Motivating factors may vary, depending on personal preference, and can be short-term approaches to inspire and engage staff. These motivators should be consistent with the organization’s vision and mission. Nurse leaders and managers should strive for staff who are not only motivated, but are actively engaged in their health care roles. According to Clark (2018), employees desire work that matters to them, personally, organizationally, and societally. Nurse leaders and managers should use the following steps to increase engagement for a more committed and involved staff:
1. Lead the team with optimism,
2. Create a positive and healthy work environment,
3. Be visible and available to the staff,
4. Foster interpersonal and organizational trust,
5. Cultivate relationships with others,
6. Set clear goals and provide feedback,
7. Provide meaningful work,
8. Encourage autonomy and individual growth,
9. Communicate and be transparent, and
10. Use simple yet powerful strategies to keep employees engaged (Clark, 2018).
Effective communication is one of the fundamental elements of good nursing practice and should be prioritized as such when working with teams. Communication is the heart of holistic patient care that is absolutely essential in health care today. Communication is an ongoing process in which participants share information. Nurse managers should understand the difference between individual and group communication and recognize the process a group often goes through prior to meeting set goals or tasks. Communication in written and verbal forms is important at all stages of group work. The stages of newly formed groups, as identified by psychologist Bruce Tuckman (1965), include:
1. Forming – Boundaries are being tested to determine acceptable behavior.
2. Storming – Members break off into subgroups and resist requested demands.
3. Norming – Conflict is resolved, consensus is met.
4. Performing – Focus and energy are on task completion and performance.
Nonverbal communication (e.g., silence, appearance, eye contact, facial expression, and posture) is estimated to include approximately 70% of all communication (Cherry, 2016). This can be a significant barrier if the intended verbal message does not match the nonverbal communication received. Consideration and positive modeling of nonverbal communication should be an important consideration for the nurse leader and manager.
Planning, a critical part of teamwork, is an attempt to reduce the risk and uncertainty that may affect outcomes. Planning is necessary to answer questions of what, when, where, why, how, and by whom, and is important on both organizational and personal levels (Sullivan, 2012, p. 50). It includes unity of goals that are set for the organization and/or team, and can be used to direct team members toward set objectives (Marquis & Huston, 2017).
A team’s productivity relates to how well the team worked together by using available resources. When a team’s work has come to completion, the team may provide recommendations for the nurse leader or manager regarding the assigned task. These recommendations are reflective of the teams’ productivity.
Reflective Summary
Nurses provide quality patient care for patients that has a far-reaching impact. Effective nursing leadership and management skills are critical in keeping up with health care reform and changes in health care environments. Effective communication, decision making, self-awareness, and proper delegation of nursing tasks are a few required skills exceptional nursing leaders require. The baccalaureate-prepared nurse will provide the important leadership and management skills that today’s rapidly changing health care environment demands.
