LEADERSHIP and

MANAGEMENT ROLES of
A PSYCHIATRIC-MENTAL
HEALTH NURSE in an
ORGANIZATION and in
RESEARCH

AIDA I. BAUTISTA PhD. MAN. RN.

LEARNING OBJECTIVES

 1. Explain the leadership and management

responsibilities of the nurse manager.
2. Describe the roles and responsibilities of a
nurse manager
3. Understand the different leadership styles
4. Discuss the role of a PMHN in research.
 MANAGEMENT  LEADERSHIP
A French term meaning “directing”.  “The action of leading a group of people
or an organization.” (Oxford Dictionary)
 It is the process of coordinating and  Leadership is encouraging others to
supervising personnel and resources to follow and motivating them to achieve
accomplish organizational goals. something new, better or more
 It is to design and maintain an internal productively.
environment in which people working together in
groups can perform effectively and efficiently
towards the attainment of group goals.
 Management emphasizes control - control of
hours, costs, salaries, overtime, use of sick
leave, inventory, and supplies whereas
leadership increases productivity by maximizing
workforce effectiveness.
 Leaders lead, look forward and imagine the possibilities that the future
may bring in order to set direction.
 Managers monitor and adjust today’s work, regularly looking backward to
ensure that current goals and objectives are being met.
 If a manager guides, directs, and motivates and a leader empowers others,
then it could be said that “EVERY MANAGER SHOULD BE A LEADER.”
 LEADERSHIP STYLES IN NURSING
1. TRANSFORMATIONAL LEADERSHIP IN
NURSING
Transformational leadership is a management
style that motivates employees to take
ownership for their roles and perform beyond
expectations.
Instead of assigning tasks from the top,
transformational leadership teaches people
how to think rather than just do what they are
told.
 Sometimes called quiet leaders, they lead by
example.
ADVANTAGE
 Inspires and motivates employees to find
better ways of achieving a goal, as these
leaders excel at conflict resolution.
 Mobilize people into groups that can get
work done, raising the well-being, morale
and motivation level of a group through
excellent rapport.
DISADVANTAGE
 Ineffective in initial stages of initiatives,
meaning it’s not ideal for brand-new
organizations.
 LEADERSHIP STYLES IN NURSING
2. DEMOCRATIC LEADERSHIP IN NURSING
 The democratic leadership style welcomes
and encourages input and communication
from the team when making decisions.
 Relationships are highly valued
Ensure the team feels comfortable and willing
to voice concerns, opinions, and ideas.
They see value in providing feedback to their
team, truly viewing communication as a two-
way process.
ADVANTAGE
 Ensure the team feels valued and comfortable
speaking up.
 Value transparency and input from team
members with the most expertise, not
necessarily seniority or highest rank, making this
type of leader beneficial in creating a culture
that promotes input from the entire team.
DISADVANTAGE
 Unable to make quick decisions independently
and without input from the team might struggle
to succeed
 LEADERSHIP STYLES IN NURSING
3. LAISSEZ-FAIRE LEADERSHIP IN NURSING
Laissez-faire leadership in nursing is most
often seen in new or inexperienced nurse
leaders.
Typically referred to as a “hands-off”
approach,
Rarely provide direction or feedback to their
team, but rather allow the team to function as
they prefer, without strong supervision.
These leaders are not thought of as strong
decision makers.
ADVANTAGE
 Because laissez-faire leadership in nursing does
not micromanage or dictate how their team
should function, a highly experienced and
effective team may thrive under this type of
leadership.
DISADVANTAGE
 Not a good fit for the healthcare industry, due to
the constant state of change and need for quick
decision making.
 LEADERSHIP STYLES IN NURSING
4. AUTOCRATIC LEADERSHIP IN NURSING
 Autocratic leadership in nursing is extremely
“hands on” and includes a great deal of
decision making.
 Nursing leaders using the autocratic
leadership style are comfortable making
decisions without input from their team, and
often withhold information from the team in
general.
This type of leader has little tolerance for
mistakes.
ADVANTAGE
 Autocratic leadership in nursing will be effective
in making quick decisions when necessary.
 This may serve the team well in emergency
situations, or when implementing “zero
occurrence” policies
DISADVANTAGE
 Does not promote trust or communication
amongst a team, but instead creates a culture
whereby team members’ valuable insights and
knowledge go untapped.
 Stifles collaborative decision-making and
transparency, which hinder an organization’s
journey to high reliability.
 LEADERSHIP STYLES IN NURSING
5. SERVANT LEADERSHIP IN NURSING
With a recent growth in popularity, servant
leadership refers to leaders who influence and
motivate others by building relationships and
developing the skills of individual team
members.
Drawn to serve first, which aspires them to
lead (Coined by Robert K. Greenleaf in 1970)
Cares about ensuring each team member has
the resources and tools they need to succeed.
ADVANTAGE
 Extremely beneficial when leading a
multidisciplinary, diverse team.
 Excel at meeting the needs of individual team
members, regardless of their roles, specialties,
and resource requirements.
DISADVANTAGE
 Servant leadership in nursing is not
recommended when top-down decisions must
be made with the goal of quickly aligning the
entire team.
 WHAT IS A NURSE MANAGER
 Nurse Manager or Nurse Supervisor
 Is a part of the leadership team
working with their staff to coordinate all
aspects of daily patient care on the unit.
DUAL ROLE OF a NURSE MANAGER
Nurse managers embody both the nurse and executive
roles
 1. Nurse ROLE - Represent and support the nursing staff
 Responsible for the function of their unit
 Work with their staff to coordinate all aspects of daily
patient care on the unit.
 Help unit staff members deliver the safest possible care
to the patient
 2. ADMINIDTRATIVE ROLE - Oversee unit-based operation
 Manage human and financial resources;
 Maintain standards and quality of care
 Ensure patient and staff satisfaction, safety & security
 Align the unit goals with the hospital's strategic goals.
Staffing costs
 Include recruiting costs, overheads and software
costs, equipment costs, salary, pension, employer's
national insurance contribution (NIC), expenses,
and medical benefits
Operating costs and physical plant costs
 Includes expenditures related to heating, cooling,
light and power, gas, water, and any other utilities
necessary for operation of the physical plant.
Necessary equipment and supplies
 Include any fixture, furniture, mechanical or
electrical apparatus, or component thereof.
 Nurse managers are responsible for hiring,
training, developing employees to grow
professionally; thus, nurse managers require
strong coaching skills.
 When hiring staff, nurse managers ensure the
unit's staffing needs are met in the most
economical way possible
 Nurse managers also manage staff behavior.
Managing behavior calls for nurse managers to
use empathy, coaching skills, and discipline when
working with their staff.
Responsible in resolving conflicts in the unit
 Nurse Manger as mentor and coach helps
cultivate nurse leaders, retain nurses, and
diversify and strengthen the nursing workforce
which improve the quality of patient care and
outcomes.
Patience
Passionate Qualities of a Nurse Manger as Mentor:
Approachable  Patience and have the passion to teach or
Emphatic share knowledge with others.
Admit weakness  Easily accessible and approachable
 Admit when they do not have an answer and
actually go through the process to figure out
how to find the right answer.
Nurse manager role for staff professional
development
 Nurse manager encourages professional
development of the staff through
training, workshops, certification
and continuing education
 Continuing professional development
(CPD) is how nurses can maintain,
improve and broaden their knowledge,
expertise and competence, and develop
the personal and professional qualities
required throughout their professional
lives.
The hospital unit has numerous customers, and each
has its unique needs and care delivery requirements.
Nurse managers are responsible for ensuring the
needs of customers are met.
Patient- and family-centered care
Nurse managers work with patients, families, and unit
staff to develop patient- and family-focused care
plans.
Involving patients and their families in their care
ensures the best possible care for the patient and
creates a supportive and caring environment in which
staff members are able to work closely with patients
and their families.
Nurse managers understand the professional
and regulatory guidelines that govern patient
care
Nurse managers make sure their staff members
are educated on standards of care and any
changes to those standards so that staff
members are able to provide the safest care
possible on the unit.
Nurse managers collaborate with the mental
health team to determine the most up-to-date
standards of care provided to patients.
Nurse managers are responsible for aligning the unit's
goals with the hospital's goals.
Nurse managers serve as the decision makers who are
responsible for the best interests of the unit.
They make sure unit staff members are able to clearly
see how unit goals align with the hospital's goals.
Nurse managers use the 4E's
 ENGAGE unit staff to participate in the project,
 EDUCATE them on the importance of their
involvement,
 EXECUTE a plan of action with their staff
 EVALUATE their progress with the intervention being
carried out on the unit.
 NURSING MANAGEMENT
 Nursing management consists of the
performance of the leadership functions of NURSING MANAGEMENT PROCESS
governance and decision-making within
organizations employing nurses.
 Management process is a well-defined
 It includes processes common to all system of setting goals, planning and
management
controlling any action's execution.
 1. Planning,
 It constitutes a set of interrelated
 2. Organizing, operations or functions necessary to
 3. Staffing, accomplish desired organizational
 4. Directing objectives.
 5. Controlling.
 MANAGEMENT PROCESS
 1. PLANNING is determining the  2. ORGANIZING includes
philosophy, goals and objectives, establishing the organizational structure
policies, procedures and rules. to carry out plans.
Organizing Process Includes:
2.1. Identifying and defining basic tasks.
2.2. Delegation of authority and
assigning responsibility
2.3. Establishing relationships
ORGANIZATIONAL STRUCTURE
 Depicts and identifies role and
expectations, arrangement of positions and
working relationships.
ORGANIZATIONAL CHART
 Depicts an organization’s structure.
 It depicts the formal organizational
relationship, areas of responsibility and
accountability and channel of
communication.
Three forms of authority in an organization ◦ Chain of Command
◦ Unbroken line of reporting relationships that
2.1. Line authority – is a direct supervisory authority extends through the entire organization.
from supervisor to subordinates.
◦ The line defines the chain of command and the
formal decision-making structure.
◦ Unity of Command
◦ Each person in the organization should take
orders and reports only to one person.
◦ Span of Control
◦ Refers to the number of employees that should
be placed under the direction of one leader-
manager.
2.2. Staff Authority – authority that is 2. 3. Team Authority
based on the expertise and which
 Granted to committees or work teams
usually involves advising the line involved in an organization’s daily
managers. operations.
 Members of a working group work
independently and meet primarily to share
information.
Work teams have five key characteristics:
◦ They are accountable for achieving
specific common goals.
◦ They function interdependently.
◦ They are stable.
◦ They have authority.
◦ They operate in a social context.
 MANAGERIAL LEVEL
LEVEL SCOPE OF RESPONSIBILITY EXAMPLES

Top Level Managers  Generally make decisions based on the CEO, President, V-President, Chief
guidelines or structure of the organization. Nursing Officer
 Coordinates internal and external
influences

Middle Level Managers  Conduct day-day operations with some
involvement, long term planning and
policy making.
First Level Managers  Concerned with specific unit workflows.
 Deals with immediate day-day problems
Head Nurse, Department Head,
Unit Supervisor/Manager
Charge Nurse, Team Leader,
Primary Nurse, Staff Nurse
 MANAGEMENT PROCESS
 3. STAFFING is the process of assigning
competent people to fulfill the roles
designated for the organizational structure
through recruitment, selection and
development, induction and orientation of the  Attracting a Staff – formal advertisement
new staff on the goals, vision, mission,
philosophy etc.
Staffing Process
 Preparing to Recruit – types and number of
personnel
 Recruiting and Selecting a Staff - through
interview, orientation, job order, contract
signing
 Staffing Pattern – plan that articulates how
many and what kind of staff are needed/shift
or per day in a unit or in a department.
ESTABLISHING A STAFFING PATTERN
PATIENT CLASSIFICATION SYSTEM
 Measuring tool used to articulate the
nursing workload for specific patient or
group of patients over a specific time.
PATIENT ACUITY
 A measurement of intensity of nursing
care needed by a patient
 Measure of nursing workload that is
generated for each patient
PATIENT CARE IS CLASSIFIED ACCORDING TO:
1. Self care or minimal care - patients 2. Intermediate or moderate care - requires
can carry ADL some help from the nursing staff with special
treatments or certain aspects of personal care
3. Total care - patients are bedridden and 4. Intensive care - patients are critically
lack strength and mobility to do average ill and in constant danger of death or
daily living. serious injury.
 MANAGEMENT PROCESS
4. DIRECTING
 Act of issuing orders, assignments,
instructions, to accomplish the
organizational goals and objectives.
 Elements of Directing
 4.1. Communication
 4.2. Delegation
 4.3. Motivation
 4.4. Coordination
 4.5. Evaluation
4.1. COMMUNICATION – exchange of
ideas, thoughts or information through
verbal speech, writing and signals
Barriers in Communication
 1.1. Physical Barriers
 1.2. Social and Psychological Barriers
 1.3. Semantics
 1.4. Interpretations
4.2. DELEGATION
 Act of assigning to someone else a portion of  Manager delegate routine task so that they
the work to be done with corresponding
authority, responsibility and accountability
(ARA).
 According to ANA, it is the transfer of
responsibilities for the performance of the
task from one person to another
 Much of the work of manager is
accomplished by transferring the
responsibilities to subordinates
Good Reasons for Delegation
are free to handle problems that are more
complex or require higher level of expertise
 Delegate routine task if someone else is
better prepared or has greater expertise or
knowledge in solving the problems
Managers who do not delegate
 Does not trust
 Fear of mistake
 Fear of criticism
 Fear of own ability to delegate
Common Errors in Delegation IMPROPER DELEGATION – delegating at the wrong
person, time, tasks and beyond the capability of the
UNDERDELEGATING – systems from the manager’s subordinates.
false assumptions that delegation maybe
interpreted as a lack of ability on his part to do the
job correctly and competently. Reasons are:
◦ Managers believe that they can do the work
faster and better
◦ Managers believe that the responsibility may be
rejected if delegated
OVERDELEGATING – subordinates become
overburdened which may lead to dissatisfaction
and low productivity. Reasons are:
◦ Managers who are lazy
◦ Manager who are overburdened and exhausted
4.3. MOTIVATION
Motivation – whatever influences our
choices and creates direction, intensity,
and persistence in our behavior.
4.4. SUPERVISION
Supervision – guiding and directing the
work to be done. It entails motivating and
encouraging the staff to participate in the
activities to meet the goals and objectives
for personal development in making the
work better.
4.5. COORDINATION
Coordination – arranging in proper order.
It creates harmony in all activities to
facilitate success of work
4.6. EVALUATION
Evaluation - judging the quality,
importance, amount, or value of work
done. It helps determine what works well
and what could be improved in a program.
PSYCHIATRIC NURSING ROLE
AS MEMBER OF THE
RESEARCH TEAM

AIDA I. BAUTISTA PhD. MAN. RN.

THE RESEARCH CULTURE IN NURSING
 The research culture in nursing has evolved in the
last 150 years, beginning with Nightingale's work in
the mid-1850s and culminating in the creation of the
National Institute of Nursing Research (NINR) at the
National Institutes of Health (NIH).
 Many studies, journals and articles highlights
nursing’s efforts to facilitate the growth of the
research culture by developing theory, establishing
the importance of a research-based practice,
advancing education, and providing avenues for
dissemination of research.
Why is Mental Health Research important?
 Improve our understanding of the causes
and risk factors for mental health
problems,
 Support promotion and prevention in
helping people to stay well holistically
 Underpin the development and
evaluation of new forms of support,
treatment and management
 Provide evidence based-outcome on how
innovative approaches can be put into
practice in the mental health care system
and in wider settings.
 Improve the mental health of children and
young people and other population group
 Understand further the links between
physical and mental health
 Develop and improve the support and
interventions we can offer
 Ensure access and choice to good mental
health care in a range of appropriate and
accessible settings
ROLE OF A NURSE IN RESEARCH
 1. The Clinical nurse as caregiver of patient-participants
before, during, or after participation in clinical research
 2. The Nurse as study coordinator or clinical trial nurse
who works closely with the principal investigator to
coordinate all aspects of a study, and who may function as
a kind of case manager for research participants in the
study
 3. The Nurse as principal investigator on a research study
responsible for designing, planning, and conducting clinical
research. Each of these roles has its own set of particular
ethical challenges.
1. CLINICAL NURSE CAREGIVER
A clinical nurse is the first point of contact that a
research volunteer has with the clinical research
enterprise. He/she have more direct contact with
individual research participants
The nurse’s role could include:
 Sharing information about studies that patients might
be eligible for
 Answering questions about specific trials
 Consulting with clinical research staff,
 Referring patients
 Collaborating with clinical research facilities in the
participant’s care.
 General education or information about clinical
research
CLINICAL NURSE CAREGIVER
 The clinical nurse could influence a patient’s 
decision about participating in a clinical trial,
therefore, the clinical nurse should understand
what the research is all about, the purpose
and details of the study to fully support the
patient in this trial.
Several studies have shown a relationship
between familiarity with research methods
and procedures and nurses’ acceptance of and
support for research
CLINICAL NURSE CAREGIVER
The clinical nurse providing care to a patient participating
in a clinical trial may not have any other involvement in the
research other than direct and frequent access to the
patient and his/her family or support system.
 However, the nurse might be the first to recognize and
communicate adverse events/effects, lack of adherence
with study requirements, and the impact on the patient
participant.
 The clinical nurse should need accurate and up-to-date
information about the disorder under study.
The research team should make such information available
to the clinical nurse, and help the nurse recognize his or
her role in communicating critical data to the research
team
CLINICAL NURSE CAREGIVER
 The relationship of the clinical nurse with the research
participant might also extend beyond the clinical trial.
For example, in a community practice setting, a nurse
might care for a patient for several years before the patient
is referred for a clinical trial at an urban research center.
The community practice nurse will hopefully maintain a
supportive relationship with the patient while he/she is
participating in the trial and resume the primary care
relationship when participation is complete.
 Good communication between the research center and
the referring office helps to minimize possible
misinformation or frustration that could affect the
patient’s experience.
2. CLINICAL TRIAL NURSE (CTN)
Many nurses function as study coordinators,
research coordinators, or clinical trial nurses (CTN).
These roles may vary from organization to
organization, but there are elements common to
many settings.
The primary responsibility of the CTN is to
safeguard the integrity of the study while managing
study participants. Each study has specific
requirements that must be adhered to in order for
the results to be valid and interpretable.
CLINICAL TRIALS NURSE (CTN)
 The CTN works to assure that the study CTN assures the collection, management, and
requirements are met consistently, while integrity of data, as well as compliance with
balancing the safety and rights of research regulatory requirements and reporting, among
participants. other things.
 CTN is responsible for study coordination and A CTN or research nurse coordinator is
data management, often including responsibility responsible and advocates for the study, while
for managing subject recruitment and also advocating for the participant as both a
enrollment, and screening for eligibility. subject and a patient.
CTN provide education and counseling regarding
informed consent, and in some cases obtain
informed consent. They ensure consistency of
study implementation, accurate collection of
specimens, monitoring of subjects throughout
the study, and study drug accountability.
3. NURSE PRINCIPAL INVESTIGATOR
 Nurses as principal investigators (PI) are
responsible for designing, implementing, and
analyzing research with the goal of expanding
the science base for care.
Similar to any clinical researcher, the nurse PI
has many ethical obligations with respect to
clinical research, including asking a clinically or
scientifically useful question, and designing
the study, methods, and procedures in a
rigorous and feasible manner.
The PI roles include:
 Identify appropriate research participants
to be invited into the research,
 Minimizing the research risks and
maximizing potential benefits,
 Send the proposal through the appropriate
levels of independent review,
 Obtain the informed and voluntary consent
of participants, and
 Carefully monitor and respect participants’
rights and welfare throughout the study
COMMON CHALLENGES IN CLINICAL TRIALS
1. Identifying and finding the right
subjects/patients
 One of the reasons for this is the
specific requirements of the trial. For
instance, the trial requires patients to
have a particular condition, but patients
have other conditions as well which
might lead to complications
2. Compliance with several rules and
regulations
 Since trials are full of complex activities,
involve human subjects, untested drugs,
devices, and procedures, ensuring
compliance becomes mandatory to
ensure patient safety as well as
maintaining ethics of the trials. Usually,
institutional review boards (IRBs) have to
approve the processes, and that can be
time-consuming
COMMON CHALLENGES IN CLINICAL TRIALS
3. Managing multiple sites 5. Managing library
While clinical trials usually occur over Library management and functioning is
multiple sites to involve diverse patients, not satisfactory in many Universities; A lot
more sites mean more vendors, of time and energy is spent on tracing
procedures, diverse compliance
requirements, and coordination efforts, appropriate books, journals, reports etc.
leading to more complexities down the Also, many of the libraries are not able to
line. get copies of new reports and other
publications on time.
4. Managing time
Spending ample time in learning the skills
and practical implementation consumes a
lot of time.
COMMON CHALLENGES IN CLINICAL TRIALS
6. Implementing quality of writing within the
literature review:
A literature review has to go beyond being a
series of references and citations. Investigator
need to interpret the literature and be able to
position it within the context of his/her study.
This requires careful and measured
interpretation and writing to synthesize and
bring together the materials.
7. Focus is either too broad or too narrow:
This concern is inevitable. Look through the
literature. This might require to either increase
the focus or narrow down so that the research
is manageable.
8. Gathering data:
researchers may not be able to gather
sufficient data or misuse the data provided.
This affects the purpose of research studies for
which that particular data may be of utmost
importance.
9. Lacking confidence: Lack of confidence is
one of the most common problems among
researchers. Researchers with low self-esteem
feel less motivated thereby affecting the
quality of the work.
BALANCING ADVOCACIES
 Patient advocacy is integral to nursing in any setting. Nurses generally spend more time with
patients than other care providers and are therefore in a primary position to assess and evaluate
whether research participation is or continues to be consistent with a patient’s best interests,
values, and preferences.
 Occasionally, the nurse may advocate for a reconsideration of the patient’s participation in a
research study based on changes in the patient’s condition or the patient’s choices, even though
such advocacy could conflict with the expectations of the research team.
Regardless of the position that a nurse holds in clinical research, a recurrent challenge is
balancing the various advocacies that stem from the role or roles that the nurse plays,
advocacies that can and sometimes do come into conflict.
 RESEARCH PARTICIPANT
ROLE & ADVOCACY PATIENT ADVOCACY RESEARCH ADVOCACY
ADVOCACY
As patient advocate, the Clinical
The Clinical Nurse may have a
Nurse also has an important role
critical role in carrying out
The Clinical Nurse’s in making sure that the patient
procedures consistent with the
primary role is care and knows about appropriate
Clinical Nurse research plan, and/or reporting
advocacy for the research opportunities and has
symptoms and side effects that
patient. needed information about the
may be important to the
study and his or her rights as a
research question.
research participant.
Having been trained as
CTN has a critical role in ensuring
a patient advocate, the CTN is a pivotal member of the
that participants are recruited in
CTN keeps in mind what research team working closely
a responsible manner, well-
Clinical Trials Nurse is best for the patient with or for the Principal
informed about the study and
when considering the Investigator to successfully and
that their rights and welfare are
patient as a possible ethically conduct the research.
protected.
research participant.
REFERENCES
https://www.ahrq.gov/hai/cusp/index.html
https://www.ahrq.gov/hai/cusp/modules/nursing/nursing-note
https://nurseslabs.com/nursing-management-guide-to-organizing-staffing-scheduling-directing-
delegation/#organizing_process_includes
https://www.accountingtools.com/articles/staff-authority
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739074/
https://isfglobal.org/what-is-self-care/
https://www.ruralhealthinfo.org/toolkits/rural-toolkit/4/evaluation-importance
https://www.nihr.ac.uk/blog/mental-health-research-goals/25856
https://www.rightpatient.com/professional-patients/4-common-challenges-clinical-trials/
https://www.relias.com/blog/5-leadership-styles-in-nursing