Chapter 28

Leading, Managing, and Delegating

Reference:
Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing.
10th ed. Pearson Education, Inc. (pages 448- 499).

Prepared by:
Jacqueline D. Guerra - Polancos, RN, MSN, DrPH
Associate Professor, AUP College of Nursing
Second Semester, 2020
Nursing Roles

 Nurses function within health care systems,

working with multiple clients and other health
care providers.
 As a part of multidisciplinary teams, the nurse
is often in a leadership position and frequently
delegates aspects of care to others.
 Leadership, management, delegation, and
change are consistent aspects of nursing role.
Leaders
 Influence others to work together to accomplish a
specific goal
 Visionary
 Outstanding interpersonal skills
 Excellent listeners and communicators
 Innovate change, motivate, facilitate, and mentor
 Guide teams that assess effectiveness of care
 Implement evidence-based practice
 Construct process improvement strategies
 Formal leaders
 Informal leaders
Managers

 Are given authority, power, and responsibility for

planning, organizing, coordinating, and directing
the work of others
 Establish and evaluate standards
 Understand organizational structure and culture
Managers (cont'd)

 Control human, financial, and material resources

 Accomplish the work of the organization
 Set goals
 Make decisions
 Solve problems
 Initiate and implement change
WHO NEEDS NURSING MANAGEMENT?

All types of health-care organizations, including nursing

homes, hospitals, home health-care agencies,
ambulatory care centers, student infirmaries, and
many others, need nursing management.
Even the nurse working with one client and family
needs management knowledge and skills to help
people work together to accomplish a common goal.
A primary nurse working with several clients prioritizes
their care to assist time to improve health or,
sometimes, peaceful death.
Classic Leadership Theories

Leadership style
 Autocratic
 Authoritarian; makes decision for group
 Democratic
 Encourages group discussion and decision making
 Laissez-faire
 Permissive

 Groups need autonomy and self-regulation to be effective

 Bureaucratic
 Follows organization’s rules, policies, procedures
Leadership style (cont.)

 Situational
 Task-oriented; adapts to readiness/ability of group to
perform tasks
 Charismatic
 Emotional relationship of leader and group
 Transactional
 Relationship based on an exchange for some resource
valued by followers
Leadership style (cont.)

 Transformational
 Empowers group to share organization’s vision
 Shared leadership
 Emerges in relation to challenges that confront
the work group
 Shared governance
 Attempts to share decision making among group
members
 Leadership Style Transactions

Autocratic I Win – You Lose

Democratic SITUATIONAL I Win – You Win

Leadership

Laissez-faire I Lose – You Win

Effective Leadership Principles

 Vision
 Influence
 Role model
 GOAL
The work of education and
the work of redemption are
Philosophy one:
to restore in humanity the
Vision lost image of God through the
harmonious development of
Mission the mental, physical, social,
and spiritual faculties.
Objectives
 GOAL

Philosophy
Adventist University of the
Philippines envisions to be a
Vision leading Adventist educational
institution in the Asia Pacific
Mission region by 2022.

Objectives
 GOAL

Philosophy
Vision
Adventist University of the
Philippines is committed
Mission to provide quality Bible-based
education, nurturing students for
Objectives academic excellence,
Christ-like character, and
exemplary service.
 GOAL

Philosophy

Vision

Mission

Objectives
Characteristics of Effective Leaders

 Leadership style that is natural to them

 Leadership style that is appropriate to the task
and group
 Assess effects of behaviors
 Sensitive to forces acting for and against change
 Optimistic view of human nature
 Energetic
Characteristics of Effective Leaders (cont'd)

 Open; encourage openness

 Facilitate personal relationships
 Plan and organize activities of the group
 Consistent in behavior
 Delegate tasks and responsibilities, not merely to
get tasks performed
 Involve members in all decisions
Characteristics of Effective Leaders (cont'd)

 Value and use contributions from group members

 Encourage creativity
 Encourage feedback about leadership style
 Assess for and promote use of current technology
Levels of Management
 First Level
 Manage nonmanagerial personnel
 Motivate staff to achieve organization’s goals
 Communicate staff issues to upper
administration
 Report administrators’ messages to staff
 Top Chief Nurse/ Director of Ns. Service/
Administrator

Middle Supervisors

Head Nurses/ Senior Nurses

First Line

Operating Level Staff Nurses/ RNs / Unlicensed

Assistive Personnel (UAP)
Levels of Management

Chief Nurse/ Director of Ns. Service/

Top Administrator

Middle Supervisors

Head Nurses/ Senior Nurses

First Line
Levels of Management (cont'd)

 Middle Level
 Manage first-level managers
 Responsible for activities of departments
supervised
 Upper Level
 Establish goals and develop strategic plans
 Responsible for management of nursing and
practice of nursing
Management Functions

 Planning
 Organizing
 Directing
 Coordinating
Planning
 Assessing a situation
 Establishing goals and objectives
 Developing a plan of action
 Delineating who is responsible
 Determining deadlines
 Describing how outcomes are achieved and
evaluated
 Organizing

 Determining responsibilities
 Communicating expectations
 Establishing chain of command
Directing

 Assigning and communicating expectations

 Providing instruction and guidance
 Ongoing decision making
Coordinating

 Ensuring plans are carried out

 Evaluating outcomes
 Measuringresults or actions against
standards or outcomes
 Reinforcingeffective actions or changing
ineffective ones
 LEADERSHIP
is the conception of a goal and a method of achieving it; the mobilization of the means
necessary for attainment; and the adjustment of values and environmental factors

ENVIRON-
GOAL METHOD MEANS VALUES MENTAL
FACTORS
Management •Character of
Functions the Leader &
Philosophy Resources the Followers Social
•Planning •Organization
Vision Money - its purpose Economic
•Organizing - structure
Mission Tools - its values Political
•Directing •Nature of the
Objectives Equipments tasks to be
•Controlling performed

To achieve this conception the Leader also has to utilize

* Leadership Style * Managerial Skills /Roles * Time Management
* Motivation * Planned Change * Conflict Management
Difference Between Leadership & Management
Activities
Management A Process Planning, Organizing, Directing,
Controlling
A Position /
Leadership authority Uses leadership style / power to
influence/ motivate people to perform

Leadership & Management is needed to accomplish the goal.

Skills and Competencies of a
Nurse Manager

 Critical
thinking
 Communicating (networking)
 Managing resources
Skills and Competencies of a
Nurse Manager (cont.)
 Enhancing employee performance
Mentor
Preceptor (clinical skills)
 Building and managing teams
Effectiveness, efficiency, productivity
 Managing conflict
 Managing time
Delegation

 Act of transferring to a competent individual the

authority to perform a selected task in a selected
situation
 Delegate accepts responsibility for performance
 Delegator retains accountability for outcome of task
Five Rights of Delegation

 Right Task
 Right Circumstances
 Right Person
 Right Directions and Communication
 Right Supervision and Evaluation
The Nurse as Delegator

 Principles of delegating to Unlicensed Assisting Personnel

 Assesses the client
 Clientmust be medically stable or in a chronic condition
and not fragile
 Task routine for this client
 Not require a substantial amount of scientific knowledge
or technical skill
 Considered safe for this client
 Has a predictable outcome
Principles of delegating to UAP(cont.)
 Follows agency’s procedure and policies for
delegation
Knows UAP’s scope of practice
 Knows customary knowledge, skills, and job
description for UAP
 Knows work abilities and experiences of UAP
 Observes performance or demonstrates task when
unsure about UAP’s abilities
The Nurse as Delegator (cont'd)

 Principles of delegating to UAP

Clarifies reporting expectations
Createsan atmosphere that fosters
communication, teaching, and learning
 Principles of delegating to LPNs and LVNs
Change

 Process
of making something different
from what it was
 Involves gaining new knowledge
 Adapting what is currently known
 Obtaining new skills
 Change agent
Areas where PLANNED CHANGE is used:

Nursing Standards Desirable Norms

Nursing Service Policies Guidelines

Nursing Procedures Specific directions

Types of Change

 Planned change
Intended purposeful attempt to influence
its own current status
Covert change
Hidden, without awareness
Overt change
Obvious or open; person is aware
 Types of Change (cont’d)

 Unplanned change
Alteration imposed by external events or
persons
Unexpected events force a reaction
Models of Change
 Lewin
Unfreezing, moving, and refreezing
Establish likelihood change will be accepted
Determine markers that show acceptance
 Change takes time; test on small scale first
 Change accepted better if people are
involved in the process
Three possible situations that may occur before
change happens

Restraining
force

Driving
force
Dynamic Equilibrium Desired Change Undesired Change
‘Status Quo’

DECISION
UNFREEZING MOVING REFREEZING
MAKING
‘Implementing ‘Stabilizing the
‘Deciding ‘Desiring to Change Change
‘Felt Need’ The Change’
to Change’
Forces that Drive Change

 Perception change is challenging or will

improve situation
 Economic gain
 Visualizing impact of change
 Potential
for growth, achievement,
improved relationships
Forces that Restrain Change

 Fear
 Misunderstanding
 Low tolerance for change
 Perception change will not achieve goals
 Lack of time, energy, or resources
 Perceived loss of freedom
Test your Knowledge!

The nurse leader informs the staff of a local

emergency and instructs them to stay at the hospital
to prepare for major casualties. The staff displays
high levels of anxiety and disorganization. Which is
the most appropriate leadership style at this time?
A. Autocratic
B. Democratic
C. Laissez-faire
D. Bureaucratic
Situation: Nurses encounter various types
of situations that calls for management
and decision making.

Under varying conditions the best approach

to management is: Management by:
a. situation
b. policy
c. goals
d. objective
Your democratic leadership is best
demonstrated when you:

a. share leadership with others

b. respect opinion of others
c. make acceptable decisions
d. uphold professional standards
 After three years of working as a staff nurse in the
medical ward, Miss Fernando was promoted as a head
nurse of a new unit on the basis of the leadership skills she
had demonstrated with her co-nurses. As a good leader,
Miss Fernando has most likely demonstrated that she can:
A. Be subservient to nursing authorities in the hospital
B. Expect pressure upon her co-workers to work to achieve
objectives
C. Always follow instructions and mandated of the hospital
administration
D. Influence her co-workers to work for the achievement
of the goals of nursing service
This is a problem-oriented process with similarities
to the nursing process, with 4 functions like:
planning, organizing, directing, and controlling:

A. Leadership
B. Management
C. Power and authority
D. Leadership and management
The nurse manager plans to implement a new method for
scheduling staff vacations. Senior staff members oppose the
change, whereas newer staff members are more accepting.
Which is the most effective strategy for resolving this
differences?
A. Provide an extensive and detailed rationale for the
proposed change, then implement. I Win – You Lose

B. Explain that the change will occur as designed, regardless

of the staff’s preference. I Win – You Lose

C. Withdraw the proposal to prevent a decrease in staff

I Lose – You Win
morale
D. Encourage interaction between the opposing sides to
attempt resolution. I Win – You Win
The nurse manager plans to implement a new method for
scheduling staff vacations. Senior staff members oppose the
change, whereas newer staff members are more accepting.
Which is the most effective strategy for resolving this
differences?
A. Provide an extensive and detailed rationale for the
proposed change, then implement. Autocratic

B. Explain that the change will occur as designed, regardless

of the staff’s preference. Autocratic

C. Withdraw the proposal to prevent a decrease in staff

Laissez-faire
morale
D. Encourage interaction between the opposing sides to
attempt resolution. Democratic
As a nurse manager, for you to initiate change, the most
appropriate approach is:
A. Make a ward Standing Operating Procedure (SOP) Autocratic
B. Impose a time for charting Autocratic

C. Discuss matter with nurses Democratic

D. Resolve the issue through discussion Democratic

As a nurse manager, for you to initiate change, the most
appropriate approach is:
A. Make a ward Standing Operating Procedure (SOP) Autocratic
B. Impose a time for charting Autocratic

C. Discuss matter with nurses Democratic

D. Resolve the issue through discussion Democratic

Harry is a Unit Manager in the Medical Unit. He is not
satisfied with the way things are going in his unit. Patient
satisfaction rate is 60% for two consecutive months and staff
morale is at its lowest. He decides to plan and initiate
changes that will push for a turnaround in the condition of
the unit. Which of the following actions is a priority for Harry?

A. Seek help from her manager. Lassez-faire

B. Ignore the issues since these will dissipate Lassez-faire

C. Call for a staff meeting and take this up in the agenda Democratic
D. Develop a strategic action on how to deal with these Autocratic
concerns.
 Chapter 28

Leading, Managing, and Delegating

Reference:
Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing.
10th ed. Pearson Education, Inc. (pages 448- 499).

Prepared by:
Jacqueline D. Guerra - Polancos, RN, MSN, DrPH
Associate Professor, AUP College of Nursing
Second Semester, 2020