VIJAYA COLLEGE OF NURSING

COURSE - II YEAR M.Sc NURSING

SBJECT - ADMINISTRATION & MANAGEMENT

TOPIC - LEADERSHIP

NAME OF THE STUDENT - ANJU.R

NAME OF THE EVALUATOR - PROF. SMITHA MOHAN

TIME ALLOTTED - 2 HOURS

SUBMITTED TO - PROF. SMITHA MOHAN

DATE OF SUBMISSION - 28/5/20

 I. LOBBYING
INTRODUCTION

Nurses can take an active role in the legislative and political process to affect
change. They may become involved in influencing one specific piece of legislation
or regulation, or they can become involved more universally and systematically to
influence health care legislation on the whole. Lobbying, persuasion, or interest
representation is the act of lawfully bribing or attempting to influence the actions,
policies, or decisions of officials, most often legislators or members of regulatory
agencies. Lobbying, which usually involves direct, face-to-face contact, is done by
many types of people, associations and organized groups, including individuals in
the private sector, corporations, fellow legislators or government officials,
or advocacy groups (interest groups). Lobbyists may be among a legislator's
constituencies, meaning a voter or bloc of voters within their electoral district; they
may engage in lobbying as a business. Professional lobbyists are people whose
business is trying to influence legislation, regulation, or other government
decisions, actions, or policies on behalf of a group or individual who hires them.
Individuals and nonprofit organizations can also lobby as an act of volunteering or
as a small part of their normal job. Governments often define and regulate
organized group lobbying that has become influential.

DEFINITION- LOBBYING

 Lobbying is the deliberate attempt to influence political decisions through

various forms of advocacy directed at policymakers on behalf of another person,
organization or group.
 Lobbying is the practice of private advocacy with the goal of influencing a
governing body by promoting a point of view that is conducive to an individual's
or organization's goals.

MEANING OF LOBBYIST

1) A lobbyist is an individual who attempts to influence legislation on behalf of

others, such as professional organizations or industries.

2) Lobbyists are advocates. That means they represent a particular side of an issue.
3) A person who receives compensation or reimbursement from another person,
group, or entity to lobby.

TYPES OF LOBBYING

 Direct

 Grassroots

DIRECT LOBBYING

Is communicating your views to a legislator or a staff member or any other

government employee who may help develop the legislation
To be lobbying, one must communicate a view on a "specific legislative proposal."
Even if there is no bill, one would be engaged in lobbying if one asked a legislator
to take an action that would require legislation, such as funding an agency. Asked
one‘s members to lobby for this bill is also considered as direct lobbying.

GRASSROOTS LOBBYING

Is simply citizen participation in government. The key to successful grassroots

lobbying efforts is assembling people who share common goals and concerns.
Grassroots communications are vital in educating legislators to the concerns of the
voting population in their state. If you do not share your views with your
representative, then your views will not be considered by your state representative
when he votes on an issue which affects you. You can make a difference by simply
writing, calling, meeting, or faxing your representative.

TYPES OF LOBBYISTS

The Lobbyists Registration Act identifies three types of lobbyists:

The consultant lobbyist: The consultant lobbyist is a person who is gainfully

employed or not and whose occupation is to lobby on behalf of a client in
exchange for money, benefits or other forms of compensation. Consultant lobbyists
may work for public relations firms or be self-employed. For example, he or she
might be a public relations expert, a lawyer, an engineer, an architect.

The enterprise lobbyist: This is a person who holds a job or has duties in a profit-
making organization, whose duties include, for a significant part, lobbying on
behalf of the firm.

The organization lobbyist: This is a person who holds a job or has duties in a
non-profit organization. Like the enterprise lobbyist, this lobbyist is affected by the
Act if a significant part of his or her duties is to lobby on behalf of this
organization.

PREPARING FOR LOBBYING CAMPAIGN

An effective lobbying initiative takes background work.
1. Develop plan of action. Consider, rework, revamp, and define the plan in
advance of the trip to the legislator‘s office.
2. Be sure one is fully aware of all similar initiatives on the same topic and the
position of those opposing one‘s idea.

3. Check with other nursing organizations to determine their positions and if they
have information to help support one‘s position.

4. Fine-tune one‘s presentation to several key points because time will be limited.
5. Follow up after the meeting with a call or correspondence outlining the points.

PREPARING FOR AN EFFECTIVE LETTER-WRITING CAMPAIGN

 Define the goals of this grass-roots campaign.

 Develop a plan

 Assess the knowledge level of the participants concerning the legislative

process and the issues that impact the organization. Use this information to plan
educational sessions with the goal of improving the political sophistication of the
group.

 Give interested participants information about the bill in question and how this
bill would directly affect their practice. Clearly state what action the legislative
body needs to take to meet the goal, and include the specific bill number and name.
 Set up effective telephone or e-mail networks that can contact key members
quickly. Often legislative issues are scheduled and moved up quickly on that
schedule, requiring an immediate change of plan.

 Identify and set up contacts with the key legislators involved in your issue.

 Set numerical goals for how many letters or mailings will be generated.

 On large issues, focus groups or polls may be used to acquire information that
can be analysed and send to the legislators.
  Get the timing right. The time to begin your campaign is just before the
committee hearings begin or just prior to the vote o the floor. Too early is
ineffective; too late is wasted effort. You must follow the progress of your issue
closely so as to mobilize your members at the right time.

USEFUL TIPS- Dos:

a. Do write legibly or type. Handwritten are perfectly acceptable so long as they

can be read.

b. Do use persona stationary. Indicate that you are a registered nurse. Sign your full
name and address. If you are writing for an organization, use that organization‘s
stationary and include information about the number of members in the
organization, the services you perform, and the employment setting you are found
in.

c. Do state if you are a constituent. If you campaigned for or voted for the official,
say so.

d. Do identify the issue by number and name if possible or refer to it by the

common name.

e. Do state your position clearly and state what you would like your legislator to
do.

f. Do draft the letter in your own words and convey your own thoughts.

g. Do refer to your own experience of how a bill will directly affect you, your
family, your patients, and members of your organization or your profession.
Thoughtful, sincere letters on issues that directly affect the writer receive the most
attention and are those that are often quoted in hearings or debates.

h. Do contact the legislator in time for your legislator to act on an issue. After the
vote is too late. If your representative is a member of the committee that is hearing
the issue, contact him/her before the committee hearings begin. If he/she is not on
the committee, write just before the bill is due to come to the floor for debate and
vote.

i. Do write the governor promptly for a state issue, after the bill passes both
houses, if you want to influence his/her decision to sign the bill into law or veto it.
j. Do use e-mails to state your points.

k. Do be appreciative, especially of past favourable votes. Many letters legislators

receive feedback from constituents who are unhappy or displeased about actions
taken on an issue. Letters of thanks are greatly appreciated.

l. Do make your point quickly and discuss only one issue per letter. Most letters
should be one page long.

m. Do remember that you are the expert in your professional area. Most legislators
know little about the practice of nursing and respect your knowledge. Offer your
expertise to your elected representative as an advisor or resource person to his or
her staff when issues arise.

n. Do ask for what you want your legislator to do on an issue. Ask him/her to state
his/her position in the reply to you.

Don’ts:
a. Do not begin a letter with ―as a citizen and a taxpayer.‖ Legislators assume that
you are a citizen, and all of us pay taxes.

b. Do not threaten or use hostility. Most legislators ignore ―hate‖ mail.

c. Do not send carbon copies of your letter to other legislators. Write each
legislator individually. Do not send letters to other legislators from other states-
they will refer your letter to your congressional representative.

d. Do not write House members while a bill is in the Senate and vice versa. A bill
may be amended many times before it gets from one house to the other. e. Do not
write postcards; they are tossed.

f. Do not use form letters. In large numbers these letters get attention only in the
form that they are tallied. These letters tend to elicit a ―form letter response‖ from
the legislator.

g. Do not apologize for writing and taking their time. If your letter is short and
presents your opinion on an issue, they are glad to have it.

KEEP ABREAST OF LEGISLATION AND REGULATION:

When issues are important to your professional, contact the legislator and
provide the important facts that support your position and be sure to follow up
routinely so your opinions stay fresh in his/her mind. Legislation: To keep in
contact with the legislature, it is important to identify key committees and
subcommittees in the legislative bodies, and to identify and develop
communication with the members of those committees. Ways to keep abreast of
new information include the following: Volunteer for campaign work and develop
contacts with legislators. Obtain pertinent government documents using online
resources. Get the general telephone number for the state government and the
mailing addresses for correspondence. Develop liaisons with other health
professionals and utilize them as information sources and allies in lobbying for
health care issues. Register a member of your group as a lobbyist- the fee is
generally small. If possible, hire a lobbyist. Once you have notified your legislator
about your interest in a particular issue, the legislator‘s office may routinely send
literature outlining his or her activities throughout the sometimes arduous process.
Regulation: Because lobbying activities can significantly affect individuals and
industry, regulation is essential to avoid abuse. Lobbyists have created ethics
codes, guidelines for professional conduct and standards. The following will help
you keep abreast o the newest regulations and standards: Subscribe to the state
register (which contains all state regulations under consideration). Identify and
develop contacts with state agencies that exert control on or impact your practice
and ask to be added to their mailing lists. A limited list includes the following:

1. Nurse practice act: rules and regulations

2. Medical practice act: rules and regulations
3. Pharmacy act: rules and regulations
4. Dental practice act: rules and regulations
5. Hospital licensing act: rules and regulations
6. Ambulatory surgical center licensing act: rules and regulations
7. Insurance statute: rules and regulations
8. Trauma center statute: rules and regulations
9. Department of Health
10. Podiatric Act: rules and regulations
 II. STRESS MANGEMENT

INTRODUCTION

Stress and anxiety are basic to life, no matter how wealthy, powerful; good
working and happy you might be mild stress can be stimulating, motivating and
sometimes even desirable. The word stress was originally used by Selyle in 1956
to describe the pressure experienced by a person in response to life demands.
These demands are referred to as stressors. Many practical stress management
techniques are available, some for use by health professionals and others, for self-
help, which may help an individual reduce their levels of stress, provide positive
feelings of control over one's life and promote general well-being. Other stress
reducing techniques involve adding a daily exercise routine, spending quality time
with family and pets, meditation, finding a hobby, writing your thoughts, feelings,
and moods down and also speaking with a trusted one about what is bothering you.
It is very important to keep in mind that not all techniques are going to work the
same for everyone, that is why trying different stress managing techniques is
crucial in order to find what techniques work best for you. An example of this
would be, two people on a roller coaster one can be screaming grabbing on to the
bar while the other could be laughing while their hands are up in the air (Nisson).
This is a perfect example of how stress effects everyone differently that is why
they might need a different treatment. These techniques do not require doctors
approval but seeing if a doctors technique works better for you is also very
important.

DEFINITION

1. Stress is a process of adjusting to or dealing with circumstances that disrupt or

threaten to disrupt a person‘s physical or psychological functioning.
 -Selyle(1976)

2. According to Brunner and Suddart stress is a state produced by a change in the

environment that is perceived as challenging, threatening or damaging to the
person‘s dynamic balance or equilibrium.

3. Stress is a physical or emotional state always present in a person as a result of

living. Stress is the body‘s automatic response to any physical or mental demand
placed on it.

DEFINITION OF STRESS MANAGEMENT

Stress management is the amelioration of stress for the purpose of improving

everyday functioning.

TYPES OF STRESS

According to Hans Selye it is of two types:

1. Eustress

2. Distress

Eustress: Stress that helps us function better. In fact, a bit of stress can be
energizing and motivating, that is why many of us work best under pressure.

Distress: Stress that cause mental agony. Stress can be mild moderate or severe

SOURCES OF STRESS

There are many sources of stress: there are broadly classified as:

Internal stress: they originate within a person eg: cancer, feeling of depression
External stress: it originates outside the individual eg: moving to another city, a
death in family.

Developmental stress: it occurs at predictable times throughout an individual‘s

life. Eg: child- beginning of school.

Situational stress: they are unpredictable and occur at any time during life. It may
be positive or negative eg death of family member, marriage/ divorce.

SOURCES OF CLINICAL STRESS

For patients

 Uncertainty

 Fear

 Pain

 Cost

 Lack of knowledge

 Risk for harm

 Unknown resources

For nurses

 Poor patient outcomes

 Risk of making an error

 Unfamiliar situations

 Excessive workload
 Inadequate resources

COMMON SYMPTOMS OF STRESS

 Insomnia

 Fatigue

 Depression

 Irritability

 Anger

 Hopelessness

 Change in appetide

STRESS ASSOCIATED DISEASES

 Hypertension

 Coronary heart

 Migraine, tension headache

 Ulcers

 Asthmatic conditions

 Chronic backaches

 Arthritis

 Diminished Immunity

 Fatigue
 Psoriasis/Eczema

 Decreased sex drive

INDICATORS OF STRESS

It may be physiological, psychological and cognitive: Physiological

indicators: the physiological signs and symptoms of stress result from activation of
sympathetic and neuro- endocrine systems of body.

 Pupils dilate to increase visual perception

 Sweat production increases

 Heart rate and cardiac output increases

 Skin is pallid due to peripheral blood vessel constriction

 Mouth may be dry

 Urine output decreases

 Blood sugar increases

Psychologic indicators:

the manifestations: of stress includes anxiety, fear, anger, depression and

unconscious ego defense mechanism.

 Anxiety: state of mental uneasiness, apprehension, dread or feeling of helpness.

It can be experienced at conscious, subconscious or unconscious level.

 Fear: it is an emotion/ feeling of apprehension aroused by impending or

seeming danger, pain or threat.
 Depression: it is an extreme feeling of sadness, despair, lack of worth or
emptiness.

 Unconscious ego defense mechanism: it is a Psychologic adaptive mechanism

developing as the personality attempts to defend itself and alay inner tensions.

Cognitive indicators: problem solving: the person assesses the situation or

problem analyzes, chose alternatives, carries out selected alternatives and
evaluates.

 Structuring: arrangement/ manipulation of a situation so that threatening events

does not occur.

 Self control: assuming a manner and facial expression that conveys a sense of
being in control or in change.

 Suppression: willfully putting a thought or feeling out of mind.

 Day dreaming: unfulfilled wishes and desires are imagined as fulfilled or a

threatening experience is re worked or re played so that it ends differently from
reality.

STRESSORS

Each person operates at a certain level of adaptation and regularly encounters a

certain amount of change. Such change is expected; it contributes to growth and
enhances life Types of stressors:

1. Physiological stressors:

a. Chemical agents
b. Physical agents

c. Infectious agent

d. Nutrition imbalances

e. Genetic or immune disorders

2. Psychological stressors:

a. Accidents can cause stress for the victim, the person who caused the accident
and the families of both

b. Stressful experiences of family members and friends

c. Fear of aggression or mutilation from others such as murder, rape, terrorist and
attacks.

d. Events that we see on T.V. such as war, earthquake, violence

e. Developmental and life events

f. Rapid changes in our world, including economic and political structures and
technology.

SELECTED STRESSOR WITH DEVELOPMENTAL STAGES

1. Child: Beginning school, establishing a peer relationship, peer competition

2. Adolescent: Changing physique, relationship involving sexual attraction

3. Young adult: Marriage, leaving home, managing a home, getting started in an

occupation, continuing one‘s education
 4. Middle adult: Physical changes of aging, maintaining social status and
standards of living, helping teenage children to become independent, aging parents

5. Older adult: Decreasing physical abilities and health, changes in residence,

retirement and reduced income, death of spouse and friend

STRESS MODELS

STIMULUS BASED MODELS: in this model, stress is defined as a stimulus, a

life event or a set of circumstances that arouses physiologic or Psychologic
reactions may increase the individuals vulnerability to illness

TRANSACTION BASED MODEL: It is based on the works of Lazarus (1966)

who states that stimulus theory and response theory do not consider individual
differences. It encompasses a set of cognitive, affective and adaptive responses that
arises out of person environment transactions. As the person and environment are
inseparable, each affects and is affected by other.

RESPONSE BASED MODEL:

It consists of mainly 2 responses,

1. Local adaptation syndrome: it is a localized response of body to stress. The local

adaptation syndrome may be traumatic or pathologic, Eg: inflammatory responses
of a body part in response to a trauma or injury.

2. General adaptation syndrome:(Stages of the Stress Response) it describes body‘s

general response to stress. It consists of 3 stages

 The alarm reaction: it is initiated when a person perceives a specific stressor,

various defence mechanisms are activated. The autonomic nervous system initiates
the flight or flight response preparing the body to either fight off the stressor or to
run away from it.

 Resistance: the body attempts to adapt to stressor, after perceiving the threat.
Vital signs and hormone levels return to normal. If the stress can be managed or
confirmed to small area the body regains homeostasis.

 Exhaustion: it results when the adaptive mechanism are exhausted. Without

defence against the stressor, the body either rest or mobilize its defence to return to
normal or reach total exhaustion and die.

STRESS ADAPTATION MODEL:

The model was given by Gail stuart so it is called Stuart stress adaptation model. It
integrates biological, socio cultural, psychological, environmental and legal-
ethical aspects of patient care in to a unified frame work for practice.

The first assumption of Stuart stress adaptation model is the nature is ordered as
a society hierarchy from the simplest unit to the most complex. Each level is a part
next higher level, so nothing exists in isolation. Thus individual is a part of family,
group, community, society and the large biosphere, through which material and
information flows across various levels

BIOSPHERE

Society

Community

Group

Family
 Individual

Body system

Organ

Tissue

Cell

1.Second assumption of the model is that nursing care is provided within a

biological, psychological, sociolcultural, environmental and legal- ethical context.
The nurse must understand each of them to provide holistic nursing care.

2. Third assumption of the model is that health/ illness and adaptation /

maladaptation are 2 distinct continuums:

The health/illness continuum comes from a medical world view. The

adaptation/ maladaptation continuum comes from a nursing world view. This
means that a person with a medically diagnosed illness may be adapting well to it.
In contrast a person without a medical illness may have adaptative coping
resources.

3. Fourth assumption is that the model includes the primary, secondary, and
tertiary levels of prevention by describing four stages of psychiatric treatment:
crisis, acute, maintenance and health promotion. For each stage of treatment, the
model suggests a treatment goal, a focus of nursing assessment, nature of
interventions and expected outcomes of nursing care.

4. Fifth assumption is based on the use of nursing process and standards of care
professional performance. Each step of the process is important and the nurse
assumes full responsibility for all nursing implemented.
PSYCHOLOGICAL RESPONSE TO STRESS:

Various emotional responses occur due to stress including depression and

anger. The most common response is anxiety.

 Anxiety- it is vague, uneasy feeling of discomfort or dread accompanied by

autonomic response.

The four levels are:

 Mild: present in day to day living. It is manifested by restlessness and increased

questioning.

 Moderate: narrows the person perceptual field and focus on immediate

concerns. Manifested by a quivering, voice, tremors, increased muscle tension,
slight increase in respiration and pulse.

 Severe: creates the person to lose control and experience dread and terror.
Manifested by difficulty to communicate verbally, agitation, trembling, poor motor
control, sweating tachycardia, dyspnoea palpitations, chest pain or pressure in
chest

 Panic: state of apprehension. Here mild anxiety has a positive effect. For eg:
mild anxiety motivates a student to do the required reading for an upcoming
examination

PHYSIOLOGICAL RESPONSES TO STRESS

It is a response of body to stress and it involves only specific body part (tissues,
organs) instead of the whole body. It is a short term adaptive response which
primarily is homeostatic. Second most common stress responses that influence
nursing care are reflex pain response and the inflammatory response.
 Reflex pain response:

It is the response of central nervous system to pain. It is rapid, automatic and

serves as a protective mechanism to prevent injury. Eg: if you are about to step into
a bath tub filled with dangerous hot water, skin senses the heat and immediately
sends a message to the spinal cord. A message is then sent to motor nerve, which
consciously realize that the water is too hot not safe.

 Inflammatory response:

It is a local response to injury or infection. It helps to localize and prevent the

spread of infection and promote wound healing. There are 3 phases:

First phase: vasoconstriction occurs to control bleeding initially. Histamines are

realised and capillary permeability increases resulting in increased blood flow to
wbcs to the area. Then the blood flow returns to normal but wbcs remain to help
resist the infection.

Second phase: exudates (made up of fluids, cells and inflammatory by products)

are realised from the wound. The amount of exudates depends up on the site,
severity of wound.

Third phase: damaged cells are repaired by regeneration (replacement with

identical cells) or formation of scar tissue.

COPING MECHANISMS

They are behaviors used to reduce stress and anxiety like Crying, laughing,
sleeping and cursing Coping: coping may be described as dealing with problems or
situations or contending with them successfully. A coping mechanism is an innate
or acquired way of responding to changing environment or specific situation.
TYPES OF COPING

1. Problem focused coping: it refers to efforts to improve a situation by

making changes or taking some action.
2. Emotion focused coping: it includes thoughts and actions that relieve
emotional distress. It does not improve the situation but the person often
feels better.

Coping can also be classified as

 Short term coping: it reduces stress to a tolerable limit temporarily, but

ineffective way to deal with reality. Eg: day dreaming

 Long term coping: it is constructive and realistic.eg: talking to others about

problems.

 Adaptive coping: It helps a person to deal with a stressful event and

minimizes distress associated with them.

 Maladaptive coping: it can result in unnecessary distress for a person and

others associated with person or stressful events.

Avoid Maladaptive Coping

 blurring of boundaries
 Avoidance/withdrawal
 Negative attitude
 Anger outbursts
 Alcohol/Drugs
 Hopelessness
 Negative self-talk
 Resentment
  Violence
STRESS MANAGEMENT
Stress management encompasses techniques intended to equip a person
with effective coping mechanisms for dealing with psychological stress,
with stress defined as a person's physiological response to an internal or
external stimulus that triggers the fight-or-flight response. Stress
management is effective when a person uses strategies to cope with or alter
stressful situation.
STRESS MANAGEMENT STRATEGIES

 Take a breath: when you feel uptight try taking a minute to slow down and
breathe deeply. Breathe in through your nose and out through your mouth. Try to
inhale enough so that your lower abdomen rises and falls. Count as you exhale-
slowly.

 Practice specific relaxation techniques: Techniques are meditation, self

hypnosis, and deep muscle relaxation work in a similar fashion. In this state both
body and mind are at a rest and outside world is screened out for a time period.
The practice of this for a regular basis provides calming and relaxing feeling that
seems to have lasting effect for many people.

Manage time: Give priority to important ones. And do those first. If a particularly
unpleasant task faces you, tackle it early in the day and get over with it; the rest
your day will include much less anxiety. Schedule time for both work and
recreation.

 Connect with others: A good way to combat sadness, boredom and loneliness
is to see out activities involving others.
 Talk it out: Share your feelings. Bottled up emotions increase frustration and
stress. Talking with someone else can help clear your mind of confusion so that
you can focus on problem solving. Also consider writing down thoughts and
feelings. Putting problems on paper can assist you in clarifying the situation and
allow you a new perspective.

 Take a minute vacation: Imaging a quiet country scene can take you out of a
stressful situation. When you have opportunity, take a moment to close your eyes
and imagine a place where you feel relaxed. Notice all details of your chosen
place, including pleasant sounds, smells and temperature or change your mental
channel by reading a good book or playing relaxing music to create a sense of
peace.

 Monitor your physical comfort: Wear comfortable clothing. If its too hot, go
somewhere where it‘s not. If chair is comfort is uncomfortable change it. If
computer causes eye strain change it. Don‘t wait until discomfort changes to real
problem.

 Get physical: When you feel nervous, angry or upset, release the pressure
through exercise or physical activity. Running, walking or swimming are good
options for some people, while others prefer dance etc. working in the garden,
washing your car or playing with children can relieve uptight feeling. Aerobics can
be done for 20 min daily to reduce stress.

Clarify your values and develop a sense of life meaning: Clarify your values and
deciding what you really want out of your life, can help you feel better about
yourself and have that sense of satisfaction and centeredness that helps you deal
with the stresses of life. Compromise: Consider cooperation or compromise rather
than confrontation. A little give and take on both sides may reduce the strain and
help you feel more comfortable.

 Have a good cry: A good crying during periods of stress can be a healthy way
to bring relief to your anxiety, and it might prevent a headache or other physical
consequences of bottling things up.

 Avoid self medication: Alcohol and other drugs do not remove stress. Although
they may seems to mask or disguise problems. In the long run, alcohol use
increases rather than decreases stress, by changing the way you think and solve
problems and by impairing your judgments and other cognitive capacities.

 Look for the pieces of gold around you: Pieces of gold are positive or
enjoyable moments or reactions thee may seem like small events but as these
pieces of gold accumulate them can often provide a big lift to energy and spirits
and help you begin to new, more balanced way.

 Identify your Strengths

 Recognize skills and talents

 Use your strengths and talents
 Actively cope

Social Support

 Social support has a profound effect on life expectancy

 Patients have better outcomes with strong social support
  Isolation and poor social support are associated with a poor stress response
 Few hardy individuals ―go it alone‖

 Religion & Spirituality

 Associated with psychological and physical well being

 Guards against despair
 Provides social support
 Provides positive role models
 Provides a positive mission

 Altruism

 Unselfish regarding the welfare of others

 Believe in a meaningful cause
 Mutual cooperation

 Take of your body: Healthy eating and adequate sleep fuels your mind as well
as body. Avoid consuming too much caffeine and sugar. Take time to have
breakfast in morning. Well nourished bodies will cope better with stress. Increase
the amount fruits and vegetables in diet. Take time for personal interests and
hobbies. Listen to one‘s body.

 Laugh: Maintain your sense of humour, including the ability to laugh at

yourself.

 Know your limits: There are many circumstances in life beyond your control,
consider the fact that we live in an imperfect world. Know your limits. If a problem
is beyond your control and cannot be changed at the moment, don‘t fight the
situation. Learn to accept what is, for now, until such time when you can change
things.

 Think positively: Refocus the negative to be positive. Make an effort to stop

negative thoughts.

BENEFITS OF STRESS MANAGEMENT

 Improves physical health

More energy and stamina

 Stabilizes emotions

Positive attitude Hopeful/happier

 Improves ability to focus

Able to learn and achieve

ROLE OF A NURSE IN A STRESS MANAGEMENT

Assessment: Assessment of the person:

o -Assess for the following characteristics in the individual. Such individuals are
at high risk of developing stress related disorders

o -Rigid and self punishing and moral standards

o -High and unrealistic expectations

o -Too much dependence on others for love and affection and approval

o -Inability to master change or learn new ways of dealing with frustration.

o -Easily prone to extreme emotional responses of fear, anxiety and depression

o -Type personality persons

o -In addition the stressful events like birth, deaths, marriages, divorces,
retirement etc. can predispose to stress related illness.

Assessment of the family:

 -Assess the family perception of the problem, and whether it is supportive of the
client‘s efforts at coping.

 -Assessment of the environment:

 -Occupations with a high degree of stress; adverse environmental influences

like too much of lightning, temperature etc.

Interventions:

 -They are directed towards relief of acute or chronic stress. a nurse can help
person to examine the situation, identify possible solutions and accept his feelings
without guilt or fear.

 -People suffering from acute stress related illness often needs to change their
life styles and ways of relating to others. The initial work of nurse involves helping
the client to recognize that change is essential in relation to the change.

 -Some clients show resistance to necessary changes. These includes Increasing

the client awareness as an actual or potential health problem exists.

 -Helping him realize that the health problem can increase if personal changes do
not occur.
 -Identifying all personal resources. To support the client through the process of
change and cooperation with the treatment

When the client becomes aware of the nature of the health problems and is told of
the change need, he often experiences a feeling of anxiety, depression and anger.

 -The client is encouraged to talk about the losses that has resulted from the
behaviour change.

 -Family members also need accurate information about nature of the disorder,
and how they can help the client in coping with stress. The client and families also
need to be informed about various alternatives such as meditation, yoga, relaxation
training etc. these technique have a valuable role to play in helping individuals
cope with stressful life events.

 -In all this, the nurse must always bear in mind that they are only facilitators of
the change process, and the clients have rights and responsibilities in relation to
change.

III. APPLICATION TO NURSING SERVICE AND EDUCATION

INTRODUCTION

Leadership counts and leading like it matters is essential for inspiring and engag-
ing our constituents, colleagues, and stakeholders. Without a spirited and deeply
satisfied workforce, sustained safety and quality care are improbable. Gallup’s
State of the American Workplace report said a staggering 70% of Americans have
negative feelings about their work Only 30% of employees are engaged and
inspired at work, About 52% of employees are present but not engaged, A full 18%
are actively disengaged or worse, As much as $550 billion in productivity is lost
because of the 18% of actively disengaged employees.  Leadership theories and
models and their application to administrative practices. How leaders impact
workforce and patient outcomes serves as the impetus for ongoing improvements
and innovations. Nurses should practice to the full extent of their education and
training. Nurses should achieve higher levels of education and training through an
improved education system that promotes seamless academic progression.

BEING A LEADER
Kotter (2014) notes that management and leadership are different. Specifically, he
notes the following: 
1. Management involves planning and budgeting. Leadership involves setting a
direction. 
2. Management involves organizing and staffing. Leadership involves aligning
people. 
3. Management provides control and solves problems. Leadership provides
motivation and inspiration. 
4. Gardner (1993) asserts that first-class managers are usually first-class
leaders. Leaders and leader–managers distinguish themselves beyond run-of-
the-mill managers in six respects: 
5. They think longer term—beyond the day’s crises, beyond the quarterly
report, beyond the horizon.
6. They look beyond the unit they head and grasp its relationship to larger
realities, such as the larger organization of which they are a part, conditions
external to the organization, and global trends. 
7. They have the political skill to cope with the conflicting requirements of
multiple constituencies. 
8. They think in terms of renewal. A routine manager tends to accept struc-
tures and processes as they exist.
 9. The leader or leader–manager seeks revi- sions of processes and structures
that are required by a changing reality. 
GOOD LEADERS
1. Good leader like good managers
2. provide visionary inspiration
3. motivation, and direction.
GOOD MANAGERS
1. like good leaders
2. attract and inspire.
People want to be lead rather than managed. They want to pursue goals and
values they consider worthwhile. Therefore they want leaders who respect the
dignity, autonomy, and self-esteem of constituents. The dynamic of complex
relationship building in leading change necessitates various approaches to
innovating health care. Dooley and Lichtenstein (2008) discuss methods for
studying complex leadership interactions.
centering on micro, daily interactions using real-time experience, participant-
observation actions; meso interactions (days and weeks) involving social network
analysis, where there is discovery of a set of agents and how they are connected
and aligned over time; and macro interactions (weeks, months, and longer)
through event history analysis. The researchers describe agent-based modeling
simulations, which are computer simulations using a set of explicit assumptions
about how agents (leaders) are thought to operate and used as a means to study
complexity leadership. Using a micro, meso, and macro interaction approach adds
different lenses to social networks and interprofessional collaboration. 
Effective nurse executives combine leadership and management and work to
achieve these requisite goals. Leadership is a subsystem of a management system.
It is included as an element of management science in management textbooks and
other publications. In some sources, the term leading has replaced the term
directing as a major function of management. In such a context, communication
and motivation are elements of leadership (a concept that could be debated
according to management theorists’ philosophical bent) (Van Buren & Safferstone,
2014). 
Management includes written plans, clear organizational charts, well-
documented annual objectives, frequent reports, detailed and precise job descrip-
tions, regular evaluations of performance against objectives, and the administrative
ordering of theory. Nurse managers who are leaders can use these tools of manage-
ment without making them a bureaucratic roadblock to autonomy, participatory
management, maximum performance, and employee productivity.
Preparation of Nursing Leaders
Parks (2013) believes that leadership can be taught. Education begins in basic
nurs- ing education programs. To develop risk-taking behaviors and self-
confidence, students should be encouraged to create new solutions and to disagree
and debate, and they should be coached to make mistakes without fear of reprisal.
Critical thinking and reflection are important to this process. Faculty should
encourage and support students who exercise their leadership abilities in projects
and organi- zations on campus and in the community. 

LEADERSHIP MATTERS

Four core masteries that every leader needs to attain at a reasonable level of
competency: personal mastery, interpersonal mastery, team mastery, and culture
and systems mastery. A self-assessment of leadership style; knowing yourself and
your emotional intelligence, preferences, life purpose, values, and vision; and how
you influence others are the focus of personal mastery. Knowing how you
communicate; deeply listening; providing critical and construc- tive feedback; and
managing conflict are the skills of interpersonal mastery. How your team works;
how members come together; how information is handed off; and group dynamics
are skills of team mastery, along with decision making that works; delegation for
development; and meetings that garner great results. Culture and systems mastery
includes understanding the interaction of the organization’s culture and systems
dynamics. Doing a cultural assessment is important to under- standing how culture
facilitates or deters change initiatives (Hewertson, 2015). 
Learning skills to lead and motivate interprofessional teams fosters collabora-
tion and cooperation. An engaged workforce facilitates engaged patients through
the patient experience and patient-centered care. Manary, Boulding, Staelin, and
Glickman (2013) report on the patient experience and health outcomes. Their
research notes that when studies are designed and administered appropriately,
patient-experience surveys can provide robust measures of quality, as accessing
patient experiences can be critical to continued quality improvement in healthcare
redesign. The researchers report that while there are challenging methodologic
issues related to measuring and interpreting patient experience, such as mode and
timing of survey administration, and patients’ prior experience, it is essential to
find ways to capture this vital information. Capturing indicators of healthcare
quality can serve to improve healthcare structures and processes (admission, dis-
charge, and educating patient). The authors underscore the importance of focusing
on how to improve the patient’s care experience by emphasizing care coordination
and patient engagement activities noted to be associated with both satisfaction and
outcomes. Other important activities include evaluating the effects of new care-
delivery models on patients’ experiences and subsequent outcomes and developing
appropriate measurement approaches that can provide timely and action-oriented.
 
LEADERSHIP THEORY AND APPLICATION FOR NURSE LEADERS

  Leadership theory and application for nurse leader nformation to enhance

organizational change.
1. These strategies can improve data collection methods and procedures and
provide appropriate and accurate assessments of individual providers.
hospital improve, executives.
2. Health literacy fully describes and engaged patient, patient patients
satisfaction engagement can scores.
3. Reduce as a Patients costly strategic readmissions often imperative come to
and for a healthcare experience with past experience, expertise, and insights.
4. This has been noted and addressed by the Centers for Medicare and Medic
aid Services which is based on at least 5% of patients viewing, downloading,
and transmitting their health information within 36 hours of discharge
(Stemp- niak, 2014).
5. Patients are consumers of health care, and engagement is an expectation for
healthcare providers to meet regulatory mandates and standards of care.
6. Leadership skills that provide innovative strategies for patient engagement
are in demand. By creating a culture of engagement that inspires team
members, the odds for patient engagement are increased. 

ARCHETYPES OF LEADERSHIP

Kets de Vries (2013) describes his approach to leadership assessment that is

based on observational studies of real leaders, primarily at the strategic apex of
their organizations. His focus is helping leaders see and understand that their
attitudes and interactions with people are the result of a complex confluence of
their inner circles and may include their relationships with authority figures early
in life, memorable life experiences, examples set by other executives, and formal
leader- ship training. Kets de Vries posits that the complex confluences may play
out over time, and often there are recurring patterns of behavior that influence an
indi- vidual’s effectiveness within an organization. The author considers these
patterns to be leadership archetypes that reflect the various roles managers and
executives assume in organizations. It is a lack of fit between a leader’s archetype
and the operational context that may result in team and organizational dysfunction
and leadership failure. The eight archetypes are as follows: 
▪ The strategist: Leadership is a game of chess. These managers often excel when
dealing with developments in the organization’s environment. They provide vision,
strategic direction, and outside-the-box thinking to create new organizational forms
and generate future growth. 
▪ The change catalyst: Leadership is a turnaround activity. These leaders relish
messy situations. They are exceptional at reengineering and creating new
organizational blueprints. 
▪ The transactor: Leadership is deal making. Leaders as transactors are great deal
makers. Because they are skilled at identifying and tackling new oppor- tunities,
they thrive on negotiations. 
▪ The builder: Leadership is an entrepreneurial activity. The leader as builder often
dreams of creating something and has the talent and determination to make the
dream come true. 
▪ The innovator: Leadership is creative idea generation. Innovators focus on new,
exciting, and creative ideas. They possess a great capacity to solve extremely
difficult problems. 
▪ The processor: Leadership is an exercise in efficiency. Leaders who are
processors create organizations that run smoothly, like well-oiled machines. They
are very effective at setting up structures and systems that are needed.
▪ The communicator: Leadership is stage management. Leaders who are great
influencers have a considerable impact on their surroundings. 

TRANSFORMATIONAL LEADERSHIP
The healthcare system is immersed in tremendous change and chaos, and
organi- zational situations and problems are increasingly complex. Healthcare
organiza- tions are restructuring and redesigning delivery models to meet the
challenges of these changes. Health care is prohibitively expensive for many
Americans. Hospitals and emergency rooms are financially burdened by uninsured
people who may suffer from recurring and multiple chronic health issues, violence,
drug overdose, and HIV infection. Many people, especially in rural areas and inner
cities, do not have access to health care due to the downsizing of hospitals and a
shortage of healthcare personnel. Leaders are tasked with keeping staff inspired
and motivated in this chaotic, unstable environment. Effective leaders in this
atmosphere of rapid change must acknowledge uncertainty, be flexible, and
consider the values and needs of constituents. 
Now more than ever, the need for transformational leadership is critical. Trans-
formational leaders commit people to action, convert followers into leaders, and
convert leaders into agents of change (Tuuk, 2011). The nucleus of leadership is
power, as the basic energy to initiate and sustain action translating intention into
reality. Transformational leaders do not use power to control and repress constitu-
ents. These leaders instead empower constituents to have a vision about the orga-
nization and trust the leaders so they work for goals that benefit the organization
and themselves (Tuuk, 2012; Watkins, 2014). Leadership is thus not so much the
exercise of power itself as it is the empower- ment of others. This does not mean
that leaders must relinquish power, but rather that reciprocity, an exchange
between leaders and constituents, exists. The goal is change in which the purpose
of the leader and that of the constituent become enmeshed, creating a collective
purpose. Empowered staff members become criti- cal thinkers and are active in
their roles within the organization.
A creative and committed staff is the most important asset that administrators
can develop individual leadership. Transformational style and that humanizing
empowers leaders others the mobilize high-tech and their values work staff
collaboration environment. By focusing instead on Experts the of welfare
competition favor of lead the People are empowered when they share in decision
making and when they are rewarded for quality and excellence rather than
punished and manipulated. When the team, who environment share and believe
power is motivate they humanized, are contributing people to excel are to
empowered, feel that the success of the organization. By inspiring them to they be
part are of part Leaders a vision of the rather than punishing them for mistakes. In
nursing, empowerment can result in improved patient care, fewer staff sick days,
and decreased attrition. Nurses who are transformational leaders have staff
members with higher job satisfaction and who that establishment are stay
composed in the organization of of, a but shared are for not governance longer
limited periods. To model nursing This that can practice, includes be accomplished
staff development, councils through research, quality, recruitment and retention,
and unit-based councils. Nurse executives who like to feel they are in charge may
feel threatened by the concept of sharing power with staff members, so they need
to be personally empowered to assist in the empowerment of others. They will
have a sense of self- worth and self-respect, and confidence in their own abilities. 
Transformational Leadership and Innovative Approaches 
Transformational leadership and innovative approaches are needed for change in
health care and are critical to successful organizational outcomes. Transfor-
mational leadership is central to safety in a variety of industries and to an orga-
nization’s competitive cost position after a change initiative. Transformational
leadership has been specifically identified by the Institute of Medicine (2001) in its
work on medical error and patient safety. Changes in nursing leadership have been
underscored in creating safe environments for patients and staff, particularly as the
weakening of clinical leadership has been cited as a cause of organizational
concerns and issues. The Institute of Medicine described outcomes of poor, prob-
lematic leadership (Buerhaus, Staiger, & Auerbach, 2000): 
▪ Increased emphasis on production efficiency (bottom-line management) 
▪ Weakened trust (reengineering initiatives, poor communication patterns) 
▪ Poor change management (inadequate communication, insufficient worker
training, lack of measurement and feedback, short-lived attention, limited worker
involvement in developing change initiatives) 
▪ Limited involvement in decision making pertaining to work design and work
flow (hierarchical structures, limited voice on councils and committees) 
▪ Limited knowledge management (process failures, limited second-order
attention) 
To address these challenges, the following recommendations were made for
healthcare organizations by the Institute of Medicine, particularly related to
acquiring nurse leaders for all levels of management (e.g., at the organization-
wide and patient care unit levels). Nurse leaders are challenged to do the following
(American Nurses Association [ANA], 2009). Excellence nurse leadership, leaders
hospitals at the the focus have most of found senior the recommendations some
level positive of management. Magnet related well- to staff and patient satisfaction
that correlated with participatory and transforma- tional leadership. Clearly,
transformational leadership is called for to address these challenges, to improve
quality outcomes for patients and staff, and to heighten overall organizational
effectiveness (ANA, 2009). 

Buffering 
Nursing leaders can act as buffers or advocates for nurses. In doing so, they
protect constituents from internal and external pressures of work. Nurse managers
can reduce barriers to clinical nurses who are completing their clinical work.
Buffering protects practicing clinical nurses from external health system factors,
the health- care organization, other supervisors and employees, top administrators,
the medi- cal staff, and themselves when their behavior jeopardizes their careers.
Buffering is another facet of the theory of leadership related to management, and it
requires leadership training (Zheng, Singh, & Mitchell, 2014). 
Nurse managers can buffer, and therefore protect, nurse practitioners, extended-
role nurses, staff nurses, and ancillary personnel. Professional nurses do not want
to have additional responsibilities delegated to them if they are already under
severe pressure and stress. The delegation of decision making is power; the delega-
tion of work is drudgery. Professional nurses are there to motivate, inspire, and
engage, not to dissatisfy. 
Management writers say there is a difference between leaders and managers, but
their textbooks and writings on the subject include leadership content. Profes-
sional nurses want to be led, mentored, and coached, not directed or controlled.
Also, nurse managers can learn the concepts, principles, and laws that will assist
them in becoming effective leader–managers. 

Competencies for Transformational Leaders 

 Bennis having or self-importance; positive and Nanus self-regard. (1985)
rather, believe Positive leaders the self-regard most with important positive is not,
self-esteem trait however,of  successful self-centeredness recognize leaders their is
strengths and do not emphasize their weaknesses. A leader who has positive self-
regard seems to create in others a sense of confidence and high expectations.
Techniques go Through of the used need research to to increase be perfect and
self-worth observations, include Bennis visualization, (1991) defined affirmations,
four competencies and letting for dynamic and effective transformational
leadership:
(1) Management of attention
(2) Management of meaning
(3) Management of trust
(4) Management of self.
The first competency, management of attention, is achieved by having a vision
or a sense of outcomes or goals. Vision is the image of a realistic, attainable,
credible, and attractive future state for an organization. Vision statements are
written to define where the healthcare organization is headed and how it will serve
society. They differ from mission and philosophy statements in that they are more
futuristic and describe where energies are to be focused. The vision of nursing is
supported by a nursing strategic plan that is integrated in and supports the overall
organizational plan. 
The second leadership competency is management of meaning. To inspire
commitment, leaders must communicate their vision and create a culture that
sustains the vision. A culture or social architecture, as described by Bennis and
Nanus (1985), is “intangible, but it governs the way people act, the values and
norms that are subtly transmitted to groups and individuals, and the construct of
binding and bonding within a company”. Barker (1991) believes that “social archi-
tecture provides meaning and shared experience of organizational events so that
people know the expectations of how they are to act”. 
Nursing leaders transform the social architecture or culture of healthcare orga-
nizations by using group discussion, agreement, and consensus building, and they
support individual creativity and innovation. To do this, Barker (1991) believes the
nurse transformational leader will pay attention to the internal consistency of the

1. vision
2. goals
3. Objectives
4. selection and placement of personnel
5. feedback
6. appraisal
7. Rewards
8. Support
9. Development.
For example, rewards and appraisals must relate to goals, and the vision must
be consistent with the goals and objectives. Most important, all elements must
enhance the self-worth of individuals, allow creativity, and appeal to the values of
nurses. For many nurse leaders, these are new skills that will take time and support
from mentors to develop. 
Because vision statements are a new concept to many, nursing leaders should
provide opportunities for staff to openly explore feelings, criticize, and articulate
negative reactions. Face-to-face meetings between nursing leaders and staff are
desirable because in reactions involving trust and clarity, memoranda and
suggestion boxes are not adequate substitutes for direct communication
Transformational Leader as Coach 
 Coaching and mentoring are important skill sets for transformational leaders.
Coaching denotes a way of being with others that provides opportunities to
facilitate growth and development. Coaching requires exquisite communication
skills that model ways of interacting and networking with others, whereby those
coached will find ready examples of best practices in working with others. Hill
(2007) describes the predictable process of coaching, which includes the
following: 
▪ Observing 
▪ Examining coach motives 
▪ Creating a discussion plan for the coaching session 
▪ Initiating 
▪ Providing and eliciting feedback 
▪ Having a follow-up meeting As a coach, observing behaviors and responding
with insights and strategies will go further than instructing others on what to do.
This approach will afford greater opportunities for learning and advancing skills
and opportunities. Porter- O’Grady and Malloch (2007) describe innovation
coaching, stating the importance of creating the structure and content of the
experience. Specifically, the following guidelines are given to facilitate this effort: 
▪ Setting the bar high 
▪ Being clear about who you are 
▪ Treating transformation as a mission, not a job 
Knowledge Use of power 
▪ Inadequate power 
▪ Undeveloped knowledge 
▪ Autocratic application of power 
▪ Learning needs 
▪ Lack of empowerment 
▪ Inexperience 
▪ Nonstrategic use of power 
▪ Lack of personal technique 
Self-image 
Problem solving 
▪ Poor self-esteem 
▪ Inadequate worldview 
▪ Unclear role 
▪ Intolerance of diversity 
▪ Psychological flaws 
▪ No clear process 
▪ Situational solutions 
▪ Exposing staff to different messages and different messengers 
▪ Creating an egalitarian organizational structure 
▪ Putting money where the ideas are 
▪ Letting the talented experiment 
▪ Allowing people to share in the fruits of their creativity 
STRATEGIC LEADERSHIP 
The self-assessment tool for determining strategic leadership is available in the
cited publication. It includes the following skills: anticipate, challenge, interpret,
decide, align, and learn. Each skill includes methods to improve strategic leading;
some examples are as follows: 
▪ Anticipate: The actions include talking to customers, suppliers, and other partners
to understand their challenges, and conducting market research and business
simulations to understand competitors’ perspectives, gauge their likely reaction to
new initiatives or products, and predict potential disruptive offerings. Additional
activities might include scenario planning to anticipate possible futures and prepare
for the unexpected, and viewing trends and fast-growing rivals by examining
strategies they have used that are surprising. 
▪ Challenge: Leaders can improve by focusing on root causes, applying the five
whys of Sakichi Toyoda, encouraging debate by creating safe-zone meetings that
facilitate open dialogue and conflict, including naysayers in decision- making
processes to discover challenges early, and capturing input from persons who are
not directly affected by a decision who may have a good perspective on the
repercussions. 
▪ Interpret: Strategies include listing three possible explanations for observa- tions,
inviting perspectives from diverse stakeholders, and supplementing observations
with quantitative analysis. Additional strategies may include stepping away to get a
fresh perspective, going for a walk, listening to unfamil- iar music, looking at art,
and other activities that promote open-mindedness. 
▪ Decide: Leaders can reframe binary decisions by asking team members about
other options for decision making, dividing decisions into chunks to understand
component parts and reveal unintended consequences, and tailoring decision
criteria to long-term versus short-term projects. Leaders can be transparent about
decisions by letting others know if they are seek- ing divergent ideas and debate or
if they are moving toward closure. It is also important to determine who needs to
be directly involved and who can influence the success of the decision. 
▪ Align: Leaders should communicate early and often to keep the two most
common complaints in organizations from becoming a reality: no one ever asked
me, and no one ever told me. Additional strategies include using structured and
facilitated conversations to expose areas of misunderstand- ing or resistance and
reaching out to resisters directly to understand their concerns and then address
them. 
▪ Learn: Useful strategies include creating a culture in which inquiry is valued and
mistakes are considered learning opportunities, conducting learning audits to see
where decisions and team interactions may have fallen short, and identifying
initiatives that are not producing as anticipated and examin- ing their root causes. 
LEADERSHIP AND JUST CULTURE 
Creating a fair and just culture is an essential responsibility of nursing leadership.
A fair and just culture is important to high-reliability organizations in facilitating
safe patient care. Frankel, Leonard, and Denham (2006) describe three initiatives
that are critical to the ethics of creating and maintaining a safe environment for
patients and staff:
(1) Develop a fair and just culture
(2) Intelligently engage by using frontline insights to directly influence operational
decisions.
(3) Provide systematic and reinforced training in teamwork and effective
communication. Ethical decision making and actions underscore safe, high-quality
care. 
NURSING AND LEADERSHIP HEALTHCARE POLICY 
Nursing is conspicuous in its absence from lists of national leaders. National
con- sumers do not perceive nurse leaders as having power. The healthcare system
has failed to recognize nurses as professionals who have knowledge that is useful
in creating solutions to complex problems. The Institute of Medicine’s (2011)
report on the future of nursing further underscores the need for nurses to be at the
table by being better educated and by being full partners with physicians and other
healthcare professionals in redesigning health care in the United States. 
Historically, nurses have avoided opportunities to obtain power and political
muscle. The profession now understands that power and political savvy will help
achieve the goals to improve health care and increase nurses’ autonomy. Also, if
the healthcare system is to be reformed, nurses must participate individually and
col- lectively. Nurses need to find ways to influence healthcare policy making so
their voices are heard. Milstead (2013) believes that nurses have the capacity for
power to influence public policy and recommends the following steps to prepare: 
▪ Organize. 
▪ Do homework to understand the political process, interest groups, specific
people, and events. 
▪ Frame arguments to suit the target audience by appealing to cost contain- ment,
political support, fairness and justice, and other data that are relevant to particular
concerns. 
▪ Support and strengthen the position of converted policy makers. 
▪ Concentrate energies. 
▪ Stimulate public debate. 
▪ Make the position of nurses visible in the mass media. 
▪ Choose the most effective strategy as the main one. 
▪ Vertical orientation 
▪ Hierarchical structures 
▪ Focus on control 
▪ Reductionistic scientific processes 
▪ Top-down decision making 
▪ Mechanistic models of design 
▪ Process-driven action 
▪ Act in a timely fashion. 
▪ Maintain activity. 
▪ Keep the organizational format decentralized. 
▪ Obtain and develop the best research data to support each position. 
▪ Learn from experience. 
▪ Never give up without trying. 
Nurses in leadership positions are most influential in organizational, systems,
national, and international changes that impact global policy initiatives. 
FUTURE DIRECTION: QUANTUM LEADERSHIP 
Porter-O’Grady and Malloch (2015) describe quantum leadership as new leader-
ship for a new age. From a conceptual perspective, quantum theory considers the
whole, integration, synthesis, relatedness, and team action. compares the
Newtonian and the quantum perspectives. According to Porter-O’Grady and
Malloch (2015), quantum theory has informed leaders that change is not an
occurrence or an event; it is a dynamic that is essential to the universe. Quantum
leadership incorporates transformation, a dynamic flow that integrates transitions
from work, rules, scripts, chaos, and loss. Adaptation considers driving forces from
sociopolitical, economic, and technical perspectives. The term chaos , as used in
quantum leadership, refers to the transitional period focused on relational and
whole systems thinking, as compared with separate components and linear
thinking.

QUALITIES OF LEADERSHIP IN NURSING

1. Emotional Intelligence

In clinical settings, nurse leaders work closely with trainees to help them develop
emotional intelligence. Such support helps peers to cope with the stressors that
present during routine challenges. Nurse leaders assist trainees in managing those
challenges and other counterproductive influences that can result in emotional
exhaustion and poor team collaboration.

2. Integrity
Integrity for one’s self and among charges is a primary objective for nurse leaders.
Personal integrity aids nurse practitioners in making the right choices during
critical junctures in patients’ treatment plans. Additionally, effective leaders adapt
to use, and teach, ethically viable practices that enable fledgling nurse leaders to
make safe and effective care decisions intrinsically.

3. Critical Thinking

Nurse leaders guide unpolished practitioners in the use of critical thinking to

develop their ability to make decisions based on a complex array of factors. This
skill is vital in a health care environment with increasing instances of
multidisciplinary collaboration. The growing trend of autonomy for nurses also
makes critical thinking a valuable professional skill for practitioners.

4. Dedication to Excellence

Nurse leaders are committed to their passion and purpose and exemplify this
through their perseverance in the caregiving setting. To foster this trait among new
nurses, leaders may assess performances quarterly. Despite the technique used to
improve nurse performance, all nurse leaders teach their charges dedication to
excellence by delivering top-notch service so that trainees can learn from their
examples.

5. Communication Skills

The current multidisciplinary treatment environment greatly increases the

importance of collaboration in the care provider setting. To facilitate collaboration,
nurse leaders arrange for trainees to attend rounds while engaging with various
medical professionals, such as support staff, primary care providers, and senior
executives. Some health care organizations also establish recruitment retention
teams, who might engage in these rounds with trainees.

6. Professional Socialization

During training, nurse leaders gain an intense understanding of patient-nurse

dynamics. Nurse leaders focus on developing how trainees engage with patients
after the triage process. Effective nurse leaders identify opportunities to develop
new organizational leaders during this learning process.

7. Respect

Nurse leaders are passionate, dynamic influencers who inspire change in others
and, in the process, win the respect and trust of their charges. To accomplish this,
leaders teach communication techniques such as two-way communication and
rephrasing to promote a workplace environment where stakeholders engage each
other in a productive, positive manner. By understanding each other’s
circumstances, trainees gain respect for their peers and nurse leaders.

8. Mentorship

Nurse leaders deploy motivational strategies that cater to the individual

personalities of their trainees. By empowering trainees and guiding them toward
understanding their roles as care providers, nurse leaders cultivate an environment
of continual learning. While effective nurse leaders make every effort to identify
learning opportunities, they give trainees enough autonomy so that they do not feel
micromanaged.

9. Professionalism
Nursing is a dynamic profession that requires competent, confident leadership. As
organizational leaders, these professionals represent the nursing field at nearly
every professional point of contact within the organization. This will increase in
significance as nurse leaders find themselves representing the field in the
boardroom more frequently as time moves forward.
Nursing leadership will change hands to a new generation of nursing talent over
the next decade. These professionals will play a vital role in liaising between
nurses and executive leaders in the evolving health care environment. Therefore, it
is critical that nurse leaders start cultivating their replacements now and that the
new generation of nurses pursue advanced training, such as Doctor of Nursing
Practice accreditation, that will allow them to practice to the full extent of their
capabilities.

IMPORTANCE OF LEADERSHIP IN NURSING

1. The primary reason of leadership in nursing is to determine the appropriate

goals and objectives for the organization.

2. The leader, who will guide the nurse group in accordance with these goals
and objectives and activate them within a plan, provides everyone’s ideas,
demands and needs in the group to come at a common point together and
disclose these common decisions and ideas and express themselves against
other groups.

3. A leader nurse should be aware that in the health sector, it is necessary to

establish multidimensional relationships beyond the integration of the
activities of the participants from different service disciplines.
4. In order to establish connections and integration a leader nurse has the
responsibility for identifying the existing and potential collaborators, creating
a vision that can be shared among personnel’s in different conditions and
environments, defining the value of the potential benefits of each participant
to the enterprise, others and themselves, communicating by sharing
information, rewarding participation and officializing this integrated effort at
the right time. It depends on the leadership abilities of the nurses that the
groups are able to be directed effectively to the right objectives, in accordance
with their duties and responsibilities.

5. Self-management and self-decision-making abilities of nurses increase the

importance of the leadership more. For that reason, managerial nurse
candidates who have leadership ability and leadership capacity should be
recognized in time in order to improve their skills. A collective understanding
in organization and success of this understanding almost depend on an
effective leader nurse.

6. With creativity, vision, continuous improvement of leadership qualifications,

courage to take responsibility and risk, they bring success to the top by
creating a learning-oriented and development supporting working atmosphere

7. Nurses working in internal diseases, making vital and critical decisions and
using practical and mental skills besides their cognitive skills should have
critical thinking, problem solving and effective leadership skills. It is
considered that the development of leadership skills can enhance the service
quality of the active organization and satisfaction and facilitate the active role
of nurses in solving problems related to the professional, interpersonal or
working conditions that nurses experience.
8. leadership tendencies of the nurses working in internal diseases clinics most
of the nurses stated that they had the leadership qualifications (determined,
patient and self-confident) as personal qualifications. They should have
leadership qualifications in intellectual (critical thinking and problem-solving
skills, experienced) and behavioral (sensitive, good listener, understanding,
persuasive, collaborative) dimensions, namely, in all three dimensions.

9. Nurses, as a member of health team, interact with groups during the role of
management and the care for patients.

10.Since nurses realize the training and counselling services during this
interaction, they need leadership qualifications. In preparing nurses to
leadership it is important to acquire some qualifications such as taking risks,
self-recognizing, coping with stress, creating a change, communication skills.

11.Leadership is important for determining the atmosphere of the organization.

12.Leaders provide a vision for the objectives of organization and a program on

how to realize them. It is their responsibility to provide the necessary
motivation, tools, knowledge and skills to achieve the stated objectives in the
workplace.

13.Leadership in nursing can be defined as a process in which a nurse influences

the other ones in order to achieve certain objectives in providing nursing care
to the patients and the healthy individuals. It can be suggested that the most
important of the basic factors affecting job satisfaction and occupational
complaints are the leadership behaviors by managers. One of the reasons
influencing the general job satisfaction levels of the nurses is the way, the
manner, the type of management.
 14.Nurses who are successful in their fields make changes. In order to do this,
you should have the desire of power and control, a strong ego, flexibility and
strong interpersonal relationships. These skills influencing the productivity
and quality require the leadership knowledge and skills.

15. Leadership qualifications in positive working environments are not limited

with formal leaders. Positive working environments indicate that nurses are
allowed to be autonomous, work with full capacity and take initiatives. Using
full capacity of the personnel is on behalf of an organization. When the
atmosphere of the organization supports the empowerment of personnel
individually, nurses express more job satisfaction and patients get better
results

LEADERSHIP IN EDUCATION

Educational leadership have become popular as replacements for educational

administration in recent years, leadership arguably presents only a partial picture
of the work of school, division or district, and ministerial or state education agency
personnel, not to mention the areas of research explored by university faculty in
departments concerned with the operations of schools and educational institutions. 

The term "educational leadership" is also used to describe programs beyond

schools. Leaders in community colleges, proprietary colleges, community-based
programs, and universities are also educational leaders.

Some United States university graduate masters and doctoral programs are

organized with higher education and adult education programs as a part of an
educational leadership department. In these cases, the entire department is charged
with educating educational leaders with specific specialization areas such as
university leadership, community college leadership, and community-based
leadership (as well as school leadership). Masters of education are offered at a
number of universities around the United States in traditional and online formats
including the University of Texas at El Paso, Pepperdine University Some United
States graduate programs with a tradition of graduate education in these areas of
specialization have separate departments for them. The area of higher education
may include areas such as student affairs leadership, academic affairs leadership,
community college leadership, community college and university
teaching, vocational, adult education and university administration, and
educational wings of nongovernmental organizations.

SUMMARY

Lobbying, persuasion, or interest representation is the act of lawfully

bribing or attempting to influence the actions, policies, or decisions of officials,
most often legislators or members of regulatory agencies. Lobbying, which usually
involves direct, face-to-face contact, is done by many types of people, associations
and organized groups, including individuals in the private sector, corporations,
fellow legislators or government officials, or advocacy groups (interest groups).
Stress is mental or physical tension brought about by external pressures.
Researchers have found significant biochemical changes that take place in the body
during stress. Exaggerated, prolonged, or genetic tenderness to stress caused
destructive changes which lower the body‘s immune system response and can lead
a variety of disease and disorders. These include depression cardiovascular disease,
stroke and cancer. Leadership counts and leading like it matters is essential for
inspiring and engag- ing our constituents, colleagues, and stakeholders. Without a
spirited and deeply satisfied workforce, sustained safety and quality care are
improbable.

CONCLUSION

Nurses can take an active role in the legislative and political process to affect
change. They may become involved in influencing one specific piece of legislation
or regulation, or they can become involved more universally and systematically to
influence health care legislation on the whole. Stress and anxiety are basic to life,
no matter how wealthy, powerful; good working and happy you might be mild
stress can be stimulating, motivating and sometimes even desirable. The word
stress was originally used by Selyle in 1956 to describe the pressure experienced
by a person in response to life demands. These demands are referred to as
stressors. Leaders do more than organize, direct, delegate, and have vision; they
use interpersonal skills to help others achieve their highest potential. A recurrent
theme in the leadership involves influencing the attitudes, beliefs, behaviors, and
feelings of other people. This results in a feeling of being genuinely valued and
respected a basic way to achieve self-actualization and establish a trusting culture.
Leadership is the foundation that brings an organization's mission and vision to
fruition .Keep in mind that leadership and management skills are different.
Whereas managers are adept at controlling processes, making decisions, and
coordinating resources, leaders empower others, inspire innovation, and challenge
traditional practices. Leadership is about relationship-building; it facilitates
management. However, these skill sets need to overlap to ensure safe, quality care.
As a nurse who may not be in a formal leadership position, how can be a leader in
clinical area By cultivating a positive leadership style, considering techniques such
as leadership by walking around (LBWA) and mentorship, and continuing
education, nurses in every role and at all levels can be effective leaders.

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