Week 1: Chapters 1 - Leadership and Management
& 2 - Organizational structure of Healthcare
Chapter 1 Objectives:
1. • Define & discuss nursing responsibility & accountability
a. Responsibility: authority over your actions based on scope of practice for your
role; ability to act independently and make decisions without authorization.
Focuses on the authority we have to make independent decisions.
b. Accountability: ownership for your actions; makes independent decisions,
ultimate responsibility. Focuses on ownership we have over our actions.
2. • Define & discuss professional accountability
a. We are responsible for our practice, work environment and patient safety
b. ANA code of ethics: answering to yourself and others for your actions
i. Involvement in: protocols, processes, policies
ii. Competent staff, staffing ratios
iii. Professional development, “spirit of inquiry”
iv. Evidence-based practice
v. Problem solving: increasing acuity, workloads, organizational needs
c. Model professional behavior for others, act as a mentor
d. DO THE RIGHT THING!!
3. • Define & discuss leadership & management roles including characteristics of
each
a. Leadership: defined as the use of individual traits and personal power to
influence and guide strategy development. Leaders need to “do the right thing,”
be future oriented, be visionary, focus on purposes, and empower others to set
and achieve organizational goals. According to Porter-O’Grady and Mallach, the
major tasks of the 21st century health care leader include:
1. • Deconstructing the barriers and structures of the 20th century
2. • Alerting staff about the implications of changing what they do
3. • Establishing safety around taking risks and experimenting
4. • Embracing new technologies as a way of doing work
5. • Reading the signposts along the road to the future
6. Translating the emerging reality of health reform into language the
staff can use
7. • Demonstrating personal engagement with health reform
8. • Helping others adapt to the demands of a value-driven health
system
9. • Creating a safe milieu for the struggles and pain of changing
practice and service
10. • Enumerating small successes as a basis for supporting staff
11. • Celebrating the journey and all progress made
, i. Ways of behaving that influences others to respond
ii. Help others to identify and focus on goals
iii. Focus on personal development
iv. May not have a titled position
Characteristics:
- Communication
- Conflict management
- Role model
- Motivator
- Visionary
- Skilled
Skills:
- Communication***
- Motivation***
- Delegation**
- Positivity
- Trustworthiness
- Creativity
- Feedback
- Commitment
- Flexibility
b. Management: the act of planning, organizing, staffing, directing, and controlling
for the present. Management can be taught, whereas leadership is usually a
reflection of personal experience.
i. Problem-oriented focus
ii. Focus is on the group process
iii. What is needed to achieve a goal:
1. Structure
2. Resources
3. Direction
iv. Power and authority granted by the organization
Characteristics:
- Planning
- Organizing
- Staffing
- Directing
- Controlling
- Hold a formal position of authority
Skills:
- Interpersonal skills
- Communication*
- Motivation**
- Organization
- Delegation**
,- Forward and strategic planning
- Problem solving
- Commercial awareness
- Mentoring
4. • Specifically discuss characteristics of the following leadership styles:
a. Autocratic: Nurse manager decides everything, is controlling, does not
encourage autonomy. Leaders change behaviors within the organization through
the use of coercion, authority, punishment, and power.
b. Laissez-faire: Employees are allowed to work in any way they want to, no
guidance/supervision of the nurse manager. Employees are responsible for
problem solving on their own. Permissive or laissez-faire leaders assume that
people are able to make their own decisions and complete their work without any
facilitation of the leader
c. Democratic: Incorporates input from all. Leaders influence change within the
organization through participation, involvement of staff in goal setting, and
collaboration.
d. Transformational: Uses positive motivation and inspiration encouraging
employees to “do their best”. Focus is toward a common vision. Leaders are
those who stimulate and inspire followers to achieve extraordinary outcomes and
, in the process develop their own leadership potential.The transformational
nursing leader communicates expectations, develops leaders, and evolves the
organization. They also evolve the organization through strategic planning to
meet current and future needs and strategic challenges. Nursing leaders at all
levels of the organization demonstrate advocacy and support on behalf of staff
and patients
5. • Review the 3 levels of management
a. First Level Manager: AKA first-line manager, nurse manager, or head nurse.
responsible for supervising the work of non managerial personnel and the day-to-
day activities of a specific work unit or units. This manager is responsible for the
units 24/7. The first-level manager straddles the worlds of staff and upper
management, ensuring a two-way flow of information
Responsibilities:
i. Supervise the work of non-managerial personnel
ii. • Day to day activities of a specific unit or units
iii. • Responsible 24/7
iv. • Personnel development
v. • Compliance with regulatory and professional standards
vi. • Fostering interdisciplinary, collaborative relationships
vii. • Strategic planning
b. Middle-Level Manager: AKA supervisor, assistant director of nursing. supervises
a number of first-level managers. They are positioned on the organizational chart
between the nurse manager and the chief nursing officer (CNO) of the site.
These managers usually are within the same specialty or the same geographic
location. Specialty directors may manage all specialty care for both inpatient and
outpatient experience. They may spend more time planning, evaluating, and
coordinating and less time with direct patient care supervision than the first-line
manager. They are responsible for the people and activities within the
departments they supervise 24/7.
Responsibilities:
i. Supervises first level managers
ii. • Liaison between upper management and first-level management
iii. • Spends more time planning, evaluating & coordinating staff than first
level manager
iv. • May include some patient care
c. Upper-Level Manager: AKA CNO, VP for nursing, executive-level manager.
Middle management reports to the vice president for nursing. ANCC defines the
