Leadership and Management in Nursing

A. Concepts of Leadership and Management

B.

NURSE LEADER (NL) VS. NURSE MANAGER (NM)

NURSE LEADERS (NLs) main aim is improving nursing practice and outcomes. RNs working in
nursing leadership can hold positions such as Head Nurse, Patient Care Director, or Chief Nursing
Officer. They will generally delegate tasks to Nurse Managers. At the same time, they keep a birds-
eye view over the improvement of patient health outcomes. Nurse Leaders focus on empowering
others and motivating, inspiring, and influencing the nursing staff to meet the standards of the
organization. (Administrative and supervisory role)(works under the CEO).
Their approach is less hands-on and more focused on the bigger picture: implementing the
vision, fulfilling the mission, and developing long-term plans for the organization in which they work.
Nurse Leaders’ help and expertise are invaluable in creating annual strategies for achieving
financial and operational goals. They oversee the upholding of ethical, professional, and medical
standards within their institution. Also, they spearhead projects and initiatives which revolve around
two essential goals: increasing the quality and reducing the costs of patient care.

NURSE MANAGERS (NMs)

As with all other professions, a management position in nursing implies overseeing, directing, and
organizing employees in their department they supervise.(Charge Nurse; Supervisors) (Provides
patient care and also have administrative duties).
Certain processes within a healthcare organization fall under the jurisdiction of Nurse Managers.
Planning, organizing, staffing, and guiding the nursing staff is the direct responsibility of the NM.
They are in charge of the daily operations of the department and coordinating the patient’s continuum
of care.
Nurse Managers are also the person the staff goes to when they have issues with fulfilling their duties,
when they encounter problems with coworkers, or when they need advice and guidance on accurately
diagnosing or offering care to patients. They may not be as hands-on as bedside RNs. However, they
are still involved in patient care planning, overlooking the collaboration and communication between
nurses and other members of the healthcare team.
Also, a position in nursing management necessitates a thorough understanding of the business side of
healthcare. Nurse Managers will often deal with budgets in addition to their other responsibilities.
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Nursing Management vs. Leadership:

Duties and Responsibilities

What Does a Nurse Leader Do?

A NLs job description concentrates on setting policy, influencing nursing teams, and kick-starting
transformation and change in nursing practice. They must always be well informed about the latest
developments in healthcare research.
 Introducing initiatives and projects meant to shorten the average length of patient hospital
stays
Developing strategies for reducing patient readmission rates
Committing to reducing healthcare costs
Overseeing the implementation of quality and safety measures in their institution
Developing treatment plans
Ensuring the employees’ compliance with rules, regulations, and ethical standards
Managing fiscal responsibilities
Working to reduce the turnover rates of RNs
Advocating for patients, nurses, and the profession in general

What Does a Nurse Manager Do?

A NM’s role centers around increasing the efficiency of the nursing staff by directly overseeing their
activities.
Identifying staffing requirements and ensuring that the institution is adequately staffed
Evaluating the performance of Registered Nurses and offering constructive feedback
Hiring and firing nurses
Creating schedules and distributing assignments to nursing staff
Offering career mentoring advice
Managing the budget of the department they supervise
Ensuring that their department is supplied with the appropriate equipment and supplies
Encouraging the professional development of staff by planning and implementing educational
opportunities
Evaluating the quality and effectiveness of nursing practice within the institution
Serving as the liaison between the nursing staff and the top management, thus making sure
Registered Nurses are involved in the decision making and the implementation of initiatives
that affect them directly

What are the Qualities They Should Possess?

Leadership skills- leadership skills are essential for both roles. Effective leaders know how to
motivate their teams. They are pros at handling and delegating responsibilities and are great problem
solvers. They always manage to find creative solutions to problems, which is a requirement for NMs
and NLs. Also, good command of leadership skills helps motivate staff, keep morale high, and
contribute to job satisfaction.
Interpersonal skills- Jobs that require teamwork and dealing with people on a daily basis would be
hard to fulfill without a firm grip on interpersonal skills. Nurse Managers and Nurse Leaders need to
communicate with both groups and individuals in their professional lives, so they must build good
relationships and work efficiently with others.
Analytical skills- This is another high-priority competency for those who wish to pursue nursing
management and leadership positions. Analytical skills allow you to find solutions to any problem
thrown your way and help you make informed decisions about the best course of action.
Understanding problems and scrutinizing the situation for viable solutions is a crucial skill for Nurse
Managers and Leaders. In order to sharpen these skills, they must understand and follow current
regulations in nursing and adapt to new laws.
Communication skills- By their very nature, nurse management and leadership roles require fantastic
communication skills. These professionals must be able to communicate policies and procedures
effectively. They must ensure that the staff and people they oversee follow and comply with the new
policies and regulations. Knowing how to communicate them properly plays a crucial role in their
adoption.
Technical skills- Nurse Leaders and Nurse Managers must always be on top of the game. Hence, they
must follow the newest advancements in healthcare technology and data analytics. For instance,
suppose a Nurse Manager doesn’t know how to operate the Electronic Health Record Systems. How
will they train and prepare the nursing staff to use them when the facility adopts these technologies?
Proficiency in the technical side of nursing plays a significant role in the success of NMs and NLs.
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Educational Requirements
BSN; Masters degree (MN, MAN); MSN (trained RNs)
Graduate programs take between two and three years to complete. They include coursework and
practical experience directly related to leadership and management. Thus, graduates of MSN
programs are better prepared to take on the responsibilities associated with being a manager or leader
in the healthcare industry. Many aspiring Nurse Leaders and Managers also contemplate advancing
their nursing degree even further by pursuing a doctorate. Doctor of Nursing Practice (DNP)
programs elevate learners’ skills and knowledge, allowing them to pursue and excel in more senior
positions.
“It’s best when effective Nurse Leaders also excel at management and when Nurse Managers are
effective leaders”
Nurse Leaders and Managers must be passionate, respected, and committed individuals. They need to
work ceaselessly to improve the quality of care for the patients and job satisfaction for the employees.
These are not easy roles to fill, but one is bound to succeed with the proper education, training, and
skill set.
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II.) Nursing Leadership Theories
Early Leadership Theories:
1. Trait theories (Great Man Theory)
2. Behavioral theories
3. Situational & Contingency theories
4. Interactional theories
5. Transactional & transformational
6. Full-range leadership theory
1. TRAIT THEORIES (1900-1940)
*Great Man Theory/ Trait Theory/ Individual Character Theory (Aristotelian philosophy (great
leaders will arise when the situation demands it)*
Great Man Theory Assumes that the capacity for leadership is inherent, great leaders are born, not
made. Often portray great leaders as heroic, mythic and destined to rise to leadership when needed.
The term Great Man was used because leadership was thought primarily as a male quality, especially
in terms of military leadership.
2. BEHAVIORAL THEORIES (1940-1980) – HUMAN RELATIONS ERA
Concerned with what leaders did and act than who the leader is Based upon the belief that leaders are
made not born, people can be taught to become leaders through experience and observation.
LEADERSHIP STYLES
A. Autocratic - leaders make decisions alone; more concerned with task accomplishment than
people; tends to promote hostility and aggression.
B. Democratic - get their followers involved in decision making; are people
oriented; leads to increased productivity and job satisfaction
C. Laissez-faire - leaders are loose and permissive; foster freedom for everyone and want them
to feel good; results in low productivity and employee frustration
3. SITUATIONAL or CONTINGENCY THEORIES (1950-1980)
Different situations demand different types of leadership--- because the leadership style would be
dependent on the situation that the leader is faced at the moment (the situation should determine the
directives given after allowing everyone to know the problem)
4. INTERACTIONAL LEADERSHIP THEORY (1970 TO PRESENT)
Leadership behavior is generally determined by the relationship between the leader’s personality and
the specific situation. A persons performance and productivity are affected by the nature of task and
by his ability, experience, & motivation.
5. TRANSACTIONAL & TRANSFORMATIONAL LEADERSHIP
Transactional leader- concerned with the day-to-day operations (traditional manager); identifies
common values; empowers others; is a caretaker; looks at effects; inspires others with vision
Transformational leader- committed; focused on management tasks; does not identify shared values;
examine causes; uses trade-offs to meet goals; uses contingency reward
6. FULL-RANGE LEADERSHIP THEORY
A general leadership theory focusing on the behavior of leaders towards the workforce in different
work situations. This relates transactional and transformational leadership styles with laissez-faire
leadership style.
CONTEMPORARY LEADERSHIP THEORIES
Contemporary generally means “modern” or “new.” The theory suggests the same. It is all about the
leadership approaches for the 21st century. This theory is still relevant today though introduced in the
1990s.
Contemporary leadership style helps to cope with changing circumstances of the current world. This
approach to leadership is also known as the Neo Charismatic Theory. It relies on three aspects-
 Rapid change,
 Technological innovations, and
 Increased globalization
1.)Management Theory or Transactional Theory - Transactional leadership theory is a contemporary
leadership style approach. This leadership style emphasizes the interactions between leaders and
followers.
The achievement of goals and objectives under this leadership relies on these interactions. The theory
works on Maslow’s basic needs of satisfaction. A transactional leader is someone who values order
and structure. These leaders recognize their followers’ desires and motivate them to improve their
performance. They encourage employees by rewarding them for achieving the objectives. Military
operations, large corporations are best fit for such leaders. These are places that need rules and
regulations to complete objectives on time.
Transactional leaders aren’t a good fit for creative and innovative workplaces.
This type of leadership sets defined ways to work for its subordinates.
These leaders’ preferred method of tracking employee performance is through performance
reviews.
2.)Relationship Theory or Transformational Theory
A-transformational-leader-inspiring-and-motivating-employees-
“focus on getting employees to achieve the desired organizational goals”
Transformational leaders have the following traits-
 Transformational leaders are innovative thinkers with creative skills.
 Charisma, motivation, and interactions are important for these leaders.
 They use these methods to influence, increase performance, build trust and
understanding.
 Leaders and followers have high moral and ethical standards under transformational
leadership. These traits help them to achieve set organizational goals and objectives.
 Transformational leaders are highly committed, motivated and bring significant
change to the organization.
  The success of transformational leaders is based on the flexibility of set rules. It also
depends on the ability of a leader to
convince their followers.
3.)Leader-Member Exchange (LMX) Theory
It’s not uncommon for different managers to have other
relationships with various employees. Many leaders end
up developing different relationships with followers in
the same group.
To understand this concept better, we must go back to
high school. Almost every student could be divided into
two categories- popular or unpopular. LMX theory is
somewhat like that. It explains that in any group, there are in-group members and out-group
members.You may find in-group members close to the leaders and out-group members who are more
distant.
 In-group members work well with the leader and have a personality that fits with the leader.
They are often willing to take on extra tasks or responsibilities. In-group members are more
likely to earn promotions.
 Out-group members are less compatible with the leader. They hold dissenting opinions and
are less willing to take on extra assignments. Out-group members are more likely to leave.
4.)Servant Leadership Theory
This theory originated in the writings of Robert Greenleaf. The approach defines leadership as serving
the needs of others over their self-interests.
 Servant leaders help employees develop and reach their goals.
 They put their employees first and understand their personal needs and desires.
 These leaders also empower employees and help them build their careers.
 This leadership approach positively impacts organizational commitment, employee behaviors,
and work performance.
 Servant leaders create a climate of fairness in their departments.
 Servant leadership is effective but a tough transition for many managers. Many corporate
leaders of today are infamous for their humility. But, leaders who have adopted this approach
attest to its effectiveness.
 Servant leadership sometimes overlaps with other leadership theories, such as
transformational leadership. But, work ethics and selflessness are distinct in this leadership
style.
5.) Authentic Leadership Theory
6.) Complexity Leadership Theory

7.) Charismatic Leadership Theory

8.) Participative Leadership Theory

9.) Power-and-Influence Theory
NOTE:

III.) THEORIES IN NURSING MANAGEMENT

FREDERICK W. TAYLOR
5 FORMS OF POWER by French and Ravens
FORMS OF POWER ( Ability to impose the will of one person or group to bring about certain
behaviors in other persons or group)
A. Legitimate power- given to the manager by the organization because of the
manager position in the hierarchy.
Ex: director of Nursing services, supervisor, head nurse
B. Reward power- based on the ability of the manager to control and administer rewards (e.g.
promotion) to other for compliance with the leaders orders or request.
C. Coercive power- founded on the managers ability to use punishment on
others (e.g. reprimands) for noncompliance with the managers orders
D. Expert power- derived from some special ability, skill or knowledge (e.g.
dialysis nurse) demonstrated by the individual.
E. Referent power- maybe based on a certain attractiveness or appeal of one
person to another (e.g. the nurse who is consistently supportive or helpful). May also be based
on a persons connection or relationship with another powerful individual.

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