LEADERSHIP

and
MANAGEMENT
In
Nursing

WHY LEADERSHIP AND MANAGEMENT? Relationship on which a person

influences others to work together
All nurses are managers willingly on related task to attain
Changing health care system goals desired by the leader or
group; conferencing and interaction
a. Cost of health care of people to attain goal.
b. Integrated systems of care
ROLES OF A LEADER
Quality in health care:
a. Medical errors DECION MAKER
b. Quality management CRITICAL THINKER
c. Benchmarking BUFFER
d. Nursing care and outcome ADVOCATE
VISIONARY
Future of health care: FORECASTER
a. Nursing shortage TEACHER
b.Cultural diversity COMMUNICATOR
c. Telehealth EVALUATOR
d. More change FACILITATOR
RISK TAKER
LEADERSHIP MENTOR

Process of influence whereby the KEY TRAITS OF AN EFFECTIVE LEADER

leader influences others toward goal High level of personal drive
achievement. (Kelly) The desire to lead
Personal Integrity
An interaction among people, a Self-confidence
process of influencing the activities of Analytical ability/judgement
an organized group toward goal setting  KEY TRAITS OF AN EFFECTIVE
and goal achievement. (Stogdill) LEADER
6. Knowledge of the
A process of empowering beliefs and company/industry/technology
teaching others to tap their full 7. Charisma
potential or capabilities by shifting the 8. Creativity
beliefs that have been limiting them 9. Flexibility
(Robbins)
 4 Leadership Domains (Houston &
Marquiz 2018)
 Strategic Thinking – Effective
leaders keep everyone focused
on a long term future.
 Influence – can sell ideas,
develop political support, and
get people to rally behind a
project/an initiative.
 Providing guidance
Relationship building – able to
unite a group of disperate
individuals into a team that
works toward a common goal
Execution – Effective leaders
know how to get things done by
translating plans into action.
Words to describe a leader (Ambler
(2015) researchers)
Trust – nothing happens w/o sense of
trust
Compassion – leaders care about their
followers
Stability – leaders who they can depend
Hope – want to feel positive about
their future
IMPORTANCE OF LEADERSHIP
1. Initiates action
2. Motivation
3. Providing guidance
4. Creating confidence
5. Building morale
6. Builds work environment
7. Co-ordination
Initiates action
Leader communicates the policies
and plans to the subordinates from
where the work actually starts.
Motivation
A leader motivates the employees with
economic and non- economic rewards
and thereby gets the work from the
subordinates.
A leader guides by instructing the
subordinates the way they have to
perform their work effectively and
efficiently.
Creating confidence
Confidence is an important factor
which can be achieved through
expressing the work efforts to the
subordinates, explaining them clearly
their role and giving them guidelines to
achieve the goals effectively.
It is also important to hear the
employees with regards to their
complaints and problems.
Building morale
A leader can be a morale booster by
achieving full co-operation so that they
perform with best of their abilities as
they work to achieve goals.
Builds work environment
Management is getting things done
from people. An efficient work
environment helps in sound and stable
growth. He should listen to his
subordinates problems and solve them.
He should treat employees on
humanitarian terms.
Co-ordination
Co-ordination can be achieved through
reconciling personal interests with
organizational goals. This
synchronization can be achieved
through proper and effective co-
ordination which should be primary
motive of a leader.
Elements of Leadership
VISION
INFLUENCE
POWER
AUTHORITY
RESPONSIBILITY
ACCOUNTABILITY
1. VISION
Provides direction to the
influence process.For leadership
to occur, leaders must
communicate the vision the their
followers in such a way that the
followers adopt the vision as
their own
2. INFLUENCE
Ability to obtain followers, compliance
or request
3. POWER
Ability to efficiently and effectively
exercise authority and control through
personal, organizational and social
strength
Ability to impose the will of one person
or group to bring about certain
behaviors in other groups or persons
4. AUTHORITY
Represents the right to expect or
secure compliance
Authority is backed by legitimacy
5. RESPONSIBILITY
Corresponding obligation and
accountability for all actions done
Ability to do assigned task
Responsibilities fall into 2 categories:
individual and organizational
6. ACCOUNTABILITY
Is answering for the result of one’s
actions or omissions.
It is a form of reckoning, where one
accepts the consequences of their
decisions, good or bad
4 developmental levels of a leader
(Nelson & burns 1984)
 Reactive – leader focuses on
past, is crisis driven, and
frequently abusive to
subordinates
 Responsive – molds subordinate
to work together as a team
 Proactive – L & F becomes more
future oriented and hold
common driving values.
 High performance level –
maximum productivity and
worker satisfaction are
apparent
THEORIES OF LEADERSHIP
EVOLUTION OF LEADERSHIP THEORY
The major leadership theories can be
classified according to the following
approaches:
1. Behavioral Approach
2. Contingency Approach
3. Contemporary Approach
1. Behavioral Approach
Autocratic leadership
Democratic leadership
Laissez-faire leadership
Bureaucratic Leader

Behavioral Approach
Autocratic
Autocratic leadership involves
centralized decision making, with the
leader making decisions and using
power to command and control others.
Maybe dictatorial and complete
disregard for others.
Emphasis is on difference in status (“I”
and “You”)
INEFFECTIVE when subordinates:
 become tense, fearful, or resentful
 expect to have their opinions heard
 have low morale, high turnover and
absenteeism and work stoppage
EFFECTIVE when:
 Employees do not respond to any
other leadership style
 There is high-volume production
 There is limited time to make a
decision
 A manager’s power is challenged
by an employee
Democratic leadership
- is participatory, and authority is
delegated to others. The democratic
leader uses expert power and the
power base afforded by having close,
personal relationships to be influential.
- People oriented
- Less controlling
- Every group members participates in
decision making.
Laissez-faire leadership
-Laissez-faire leadership is passive and
permissive, and the leader defers
decision making or leave it to the group
-Lack of central direction or control.
-Manager wants everyone to feel good
including himself.
EFFECTIVE when EMPLOYEES are:
-highly skilled, experienced, and
educated.
-trustworthy
-Utilizing outside experts, such as staff
specialists or consultants
INEFFECTIVE when…
• It makes employees feel insecure
at the unavailability of a manager.
• Leaders are ungrateful
BUREAUCRATIC LEADER
-Lacks a sense of security and depends
on established policies and rules.
-Exercises power by applying fixed,
relatively inflexible rules
-Tends to relates impersonally to staff
-Avoids decision making without
standards or norms for guidance.
Two Basic Leader Behavior
Employee Centered – Focus on human
needs of subordinates
Job – Centered Leaders – Focus on
schedules, cost, efficiency resulting
in lack of attention to developing
work and high performance goals.
University of Michigan and Ohio State
University Studies
Employee-centered leadership was
considered more effective and was
 described as having a focus on the
human needs of subordinates.
Job-centered leadership was seen as
less effective for its focus on
schedules, cost, and efficiency and the
resulting lack of attention to
developing work groups and high
performance goals.
Two Dimensions of Leader Behavior
Initiating structure - Leaders who
focus on initiating structure are
concerned with how work is organized
and on the achievement of goals.
Consideration - The leader is involved
in creating a relationship that fosters
communication and trust as a basis for
respecting other people and their
potential contribution.
Managerial Grid (Blake and Mouton
1985)
Five styles:
1. Low production and people
concern; authority compliance
leader
2. High production concern and low
people concern; country club
leader
3. High people concern, but low
production concern; middle off
the road leader
4. For moderate concern in both
dimensions; team leader
5. For high production and people
concern
2. Contingency Approaches
Contingncy theory acknowledges that
other factors in the environment
influence outcomes as much as
leadership style and behavior.
A. Fielder’s Contingency Theory
Fiedler’s theory views leader behavior
as dependent upon the interaction of
the leader’s personality and the needs
of the situation.
Leader-member relations are the
feelings and attitudes of followers
regarding acceptance, trust, and
credibility of the leader.
 Task structure means the degree to
which work is defined with specific
procedures, explicit directions, and
goals.
 Position power is the degree of
formal authority and influence
associated with the leader
B. Hersey and Blanchard’s Situational
Theory
Situational leadership theory
emphasizes follower readiness as a
factor in determining leadership style.
Follower readiness, called maturity, is
assessed in order to select one of four
leadership styles for a situation:
High task behavior and low relationship
behavior is called a Telling leadership
style.
High task, high relationship is called a
Selling leadership style
Low task and high relationship is called
Participating leadership style
Low task, low relationship is called
Delegating style of leadership.
Telling (S1): This style involves
the leader telling people what to do
and how to do it.
Selling (S2): This style involves
more back-and-forth between leaders
and followers. Leaders "sell" their ideas
and message to get group members to
buy into the process.
Participating (S3): In this approach,
the leaders offers less direction and
allows members of the group to take a
more active role in coming up with
ideas and making decisions.
Delegating (S4): This style is
characterized by a less involved, hands-
off approach to leadership. Group
members tend to make most of the
decisions and take most of the
responsibility for what happens.
So how exactly do leaders and
managers determine which style of
leadership to use?
The right style depends a lot on the
maturity level
* The model predict w/c leadership
style would be most effective in
situations. Based on followers
maturity
Low Maturity (M1) - Telling (S1)
Medium Maturity (M2) - Selling (S2)
Medium Maturity (M3) - Participating
(S3)
High Maturity (M4) - Delegating (S4)
four different levels of maturity
M1: Group members lack the
knowledge, skills, and willingness to
complete the task.
M2: Group members are willing and
enthusiastic, but lack the ability.
M3: Group members have the skills and
capability to complete the task, but
are unwilling to take responsibility.
M4: Group members are highly skilled
and willing to complete the task.
C. Path-Goal Theory
In this leadership approach, the
leader works to motivate followers
and influence goal accomplishment.
 Directive Style provides
structure through direction and
authority; leader is focused on
the task and getting the job
done.
 Supportive Style is
relationship-oriented; the
leader provides encouragement,
interest, and attention.
 Participative Style focuses on
involving followers in the
decision-making process.
- Achievement-oriented Style
provides high structure and direction as
well as high support through
consideration behavior
Path-Goal Situations
&
Preferred Leader Behavior
D. Substitutes for Leadership
Substitutes for leadership are
variables that may influence or have
an effect on followers to the same
extent as the leader’s behavior:
 Experience, ability, training
 Professionalism
 Structured, routine tasks
 Feedback provided by the task
 Intrinsic satisfaction
 Cohesive group
 Formalized organization
3. Contemporary Approaches
Approaches that could lead to the
process of transforming change.
A. QUAntum leadership
Effective leadership reflects a
remarkable fusion of traits, behavior
and contingency approaches
• Roles are outcome oriented
• Employees are directly involved in
decision making as equitable
partners and manager assumes
more of an influential facilitative
role rather one of control
• Reality is constantly shifting –
CHANGE is expected.
• Information power is now available
to all leader, staff and patients.
B. Charismatic Leadership Theory
Charismatic leaders display self-
confidence, have strength in their
convictions, and communicate high
expectations and their confidence in
others. They have been described as
emerging during a crisis,
communicating vision and using
personal power and unconventional
strategies.
C. Transformational Leadership
Transformational leadership theory is
based on the idea of empowering
others to engage in pursuing a
collective purpose by working
together to achieve a vision of a
preferred future.
Two types:
 Transactional Leader –
concern with day to day
operations
 Transformational
Leader
Committed to a vision that empowers
others, motivate others by behaving
in accordance with values, providing
a vision that reflects mutual value.
Commits people to action, who
converts followers into leaders and
who converts leaders into change
agent. (Bennis and Nanus)
D. Relational leadership
Known as relationship-oriented or
connective leadership
Value collaboration and teamwork;
interpersonal skills are used to promote
collegiality in achieving organizational
goals.
Its purpose is to better coordinate and
integrate patient care services in a
caring, non competitive manner.
E. Shared Leadership
Based on empowerment principles of
participative and transformational
leadership
Essential elements include relationship,
dialogues, partnership and
understanding boundaries
Different issues calls for different
leaders or experts. Appropriate
leadership emerges in relation to the
current challenges of the work unit or
organization.
Servant leadership
Leadership originates from a desire
to serve
Occurs when peoples need take
priority, when those being served
“becomes healthier, wiser, more
autonomous, and more likely
themselves to become servant.
Have substantive appeal for nursing
leadership because nursing is founded
on principles of caring, service, and the
growth and health of others.
Level 5 leadership (jim Collins)
Level 1 – Highly Capable individual
Level 2 - Contributing team members
Level 3 – Competent Manager
Level 4 – Effective leader
Level 5 – Great leader
PRINCIPAL Agent theory
Not all followers (agents) are
inherently motivated to act in the best
interest of the principal(leader).
Followers may have knowledge,
expertise advantage over the leader .
Principal must provide incentives to
act in the organizations best interest.
Human and social capital theory
Human capital – refers attributes of a
person which are productive in some
economic context.
It is a collective group knowledge.
(EI) Emotional Intelligence
Refers to ability to perceive,
understand and control one’s own
emotion as well as those of others.
Using your emotions in an adaptive
ways.
Also known as EQ
Authentic leadership
Suggest that in order to lead, one must
be true to themselves and their values
and act accordingly.
It is the leaders principles and their
convictions to act accordingly that
inspire followers
Distinguishing characteristics of an
authentic leader
 Purpose
 Values
 Heart
 Relationship
 Self- discipline
Thought leadership theory
Aplies to a person who is recognized as
having innovative ideas, who
demonstrate confidence to promote
those ideas.
They challenge the status quo, attract
followers not by any promise but by
their risk taking and vision in terms of
being innovative.
Ideas are future oriented
Reflective thinking practice theory
Reflective leadership is a way of
approaching the work of being
a leader by leading one's life with
presence and personal mastery. ... It
approaches the study
andpractice of leadership from the
perspective of human experience.
https://www.americannursetoday.com/
thinking-it-through-the-path-to-
reflective-leadership/
4. Great Man Theory (Aristotelian
Philosophy)
“ Leaders were born, not made”
Asserts that some people are born to
led, where as, others were born to
be led.
People are said to have possessed
innate characteristics that made them
great leaders.
Displays both instrumental and
supportive behavior.
5. Trait Theory
Trait Theory – studies focused on the
personal trait of leaders and
attempted to identify a set of
individual characteristics or traits
that distinguished leaders from
followers and successful from
unsuccessful leaders
StOGDill’s trait factor
-Intelligence and scholarship
-Physical trait
-Personality
-Social status and experience
-Task orientation
CHARACTERISTICS OF AN EFFECTIVE
LEADER (Stogdill)
Self confidence
Strong drive for responsibility
Ability to complete task
Energy
Willingness to accept consequences of
decisions and actions.
Acceptance of interpersonal stress
Tolerance of frustrations and delay
Ability to influence behavior
Ability to structure social interactions
to accomplish purposes
Venturesome and originality
Excessive analysis
Gheselli’s personal trait
A. VERY IMPORTANT TRAITS:
Decisiveness
Intellectual capacity
ob achievement orientation
Self actualization feelings
Self confidence
Management abilities
B. MODERATELY IMPORTANT TRAITS
Affinity for working class
Drive and initiative
Need for a lot of money
Need for job security
Personal maturity
Gardner’s leadership attributes
Physical vitality and stamina
Intelligence and action oriented
judgement
Eagerness to accept responsibility
Task competence
Understanding of followers and their
needs
Skills in dealing with people
Need for achievement
Gardner’s leadership attributes -Communicates openly and are active
in professional associations.
Capacity to motivate people
Courage and resolutions Formal and informal leadership
Trustworthiness
Decisiveness
Self- confidence
 Formal leadership is based on
occupying a position in an
Assertiveness
organization, called assigned
Adaptability/flexibility
leadership.
 Informal leadership occurs
when an individual
demonstrates leadership
21 INDISPENSABLE QUALITIES OF A outside the scope of a formal
LEADER (John C. Maxwell) leadership role or as a member
1. CHARACTER 11. of a group, rather than as the
LISTENING head or leader of the group.
2. CHARISMA 12. PASSION The informal leader can be
3. COMMITMENT 13. POSITIVE considered to emerge as a
ATTITUDE leader when accepted by others
4. COMMUNICATION 14. PROBLESOLVING and perceived to have
5. COMPETENCE 15. influence.
RELATIONSHIPS
6. COURAGE 16. RESPONSIBILITY
7. DISCERNMENT 17. SECURITY
8. FOCUS 18. SELF- COMPONENTS OF AN EFFECTIVE
DISCIPLINE LEADERSHIP
9. GENEROSITY 19.
SERVANTHOOD 1. Set goals that are clear,
10. INITIATIVE 20. congruent and meaningful to the group.
TEACHABILITY 2. Has adequate knowledge and
21. VISION skills in leadership and in his/her
professional field.
3. Possess self awareness and uses
QUALITIES/CHARACTERISTICS OF AN this understanding to recognize both
EFFECTIVE NURSE LEADER (Magnet personal needs and needs of other
Hosp.) people.
4. Communicates clearly and
-Visionary and Enthusiastic effectively.
-Supportive and knowledgeable 5. Mobilizes adequate energy for
-High standards and expectations leadership activities
-Value education and professional 6. Takes action.
development
-Demonstrate power and status in the
organization
-Visible and responsive
Three Important Skills of a Leader

Technical skills – knowledge and

proficiency required for the
performance of work
Human relations – ability of the leader
to work with his/her subordinates
Conceptual skills – help him see
relationships between groups and
outside the organization.