Leadership and Management

Question 1

What is Leadership?

Answer 1

The art of establishing direction and influencing and motivating others to achieve their maximum potential to accomplish tasks, objectives or projects

Question 2

What is the Role of a Leader

Answer 2

o Establishing Direction
 Creating a shared vision
 Identifying issues requiring change
 Set strategies
 Implement evidence-based practices
o Influencing Others
 Listen to team member’s concerns
 Communicate effectively
 Advocate for clients, family members, communities and the nursing profession
 Build effective teamwork
o Motivating
 Inspire, energize, and empower team members
 Promote professional growth

o The primary function of leadership is to produce change and movement

Question 3

What is a Manager?

Answer 3

Refers to roles that focus on tasks such as planning, organizing, prioritizing, budgeting, staffing, coordinating, and reporting

Question 4

What is the Role of a Manager?

Answer 4

o Planning, Organizing and Prioritizing
 Establish agenda
 Set goals and time frames
 Prioritize tasks
 Establish policies and procedures
o Budgeting and Staffing
 Allocate resources
 Hire and terminate employees
 Make assignments
o Coordinating and Problem-Solving
 Generate solutions
 Develop incentives
 Take corrective actions
 Participate in quality improvement initiatives

Question 5

What is Followership?

Answer 5

Described as the upward influence of individuals on their leaders and their teams

Question 6

Examine the Role of Team Members

Answer 6

o The action of followers has an important influence on staff performance and patient outcomes
o Being an effective follower requires individuals to contribute to the team, not only by doing as they are told but also by being aware and raising relevant concerns
o Effective followers realize that they can initiate change and disagree or challenge their leaders if they feel their organization or unit is failing to promote wellness and deliver safe, value, driven and compassionate care
o Key Elements of Effective Followership include:
 Proactive engagement
* Do not passively wait for instructions by rather take initiative to address issues, propose solutions and contribute to ideas
* Recognize their voice in engaging in problem solving
 Constructive communication
* Message is clearly conveyed, measures to confirm the message are employed, and the confirmation is received
 Collaboration
* Supporting colleagues and working together toward the common goal even when viewpoints may differ
 Advocacy
* Ensuring that the needs of clients are prioritized and respected
* Ability to courageously challenge any decisions or actions that may jeopardize care or organizational values
 Continuous improvement
* Seeking feedback to contribute their own performance and also the growth of the team
 Supportive leadership environment
* Further cultivated when leaders and followers come together with mutual respect, trust and work with a purposeful drive toward shared goals that reflect the organization’s mission

Question 7

Describe the Role of the RN as a Leader and Change Agent

Answer 7

• Promote effective relationships to achieve quality outcomes and a culture of safety
• Leads decision-making groups
• Engages in creating an interprofessional environment that promotes respect, trust and integrity
• Embraces practice innovations and role performance to achieve lifelong personal and professional goals
• Communicates to lead change, influence other, and resolve conflict
• Implements evidence-based practice for safe, quality health care and health care consumer satisfaction
• Demonstrates authority, ownership, accountability and responsibility for appropriate delegation of nursing care
• Mentors’ colleagues and others to embrace their knowledge, skills and abilities
• Participates in professional activities and organizations for professional growth and influence

Question 8

What is an Authoritarian Leadership?

Answer 8

The leader has full power

1. They tell team members what to do and expect team members to execute their plans
2. When fast decision must be made in emergency situations like when a patient codes, the authoritarian leader makes quick decisions and provides the group with direction instructions
3. Disadvantage to authoritarian leadership is that these leaders are more likely to disregard creative ideas of other team members, causing resentment and stress

Question 9

What is a Democratic Leadership?

Answer 9

Balances decision-making responsibility between team members and the leader

1. Actively participate in discussions, but also make sure to listen to the views of others
2. This leadership styles often leads to positive, inclusive and collaborative work environments that encourage team members’ creativity
3. Under this style, the leader still retains responsibility for the final decision

Question 10

What is a Laissez-Faire Leadership?

Answer 10

Gives team members total freedom to perform as they please.

1. Leaders DO NOT actively participate in decision-making processes and rarely offer opinions
2. Can work well if team members are highly skilled and highly motivated to perform quality work
3. However, without leader’s input, conflict and a culture of blame may occur as team members disagree on roles, responsibilities and policies
4. By not contributing to the decision-making process, the leader forfeits control of team performance

Question 11

What is a Passive-Avoidant Leadership?

Answer 11

Similar to laissez-faire leadership and is characterized by a leader who avoids taking responsibility and confronting others

1. Employees perceive the lack of control over the environment resulting in the absence of clear directives
2. Organizations with this leadership have high staff turnover and low retention of employees
3. These types of leaders tend to react and take corrective action only after problems have become serious and often avoid making any decisions at all

Question 12

What is a Transactional Leadership?

Answer 12

Involves both the leader and the follower receiving something for their efforts; the leader gets the job done and the follower receives pay, recognition, rewards, or punishment based on how well they perform the tasks assigned to them

1. Staff generally work independently with no focus on cooperation among employees or commitment to the organization

Question 13

What is a Transformational Leadership?

Answer 13

Involves leaders motivating followers to perform beyond expectations by creating a sense of ownership in reaching a shared vision

1. Characterized by leader’s charismatic influence over team members that includes EFFECTIVE COMMUNICATION, VALUED RELATIONSHIPS and CONSIDERATION OF TEAM MEMBER INPUT.
2. These leaders know how to convey a sense of loyalty through shared goals resulting in increased productivity, improved morale and increased employees’ job satisfaction
3. They often motivate others to do more than originally intended by inspiring them to loos past individual self-interest and perform to promote team and organizational interest

Question 14

What is a Servant Leadership?

Answer 14

1. Focuses on the professional growth of employees while simultaneously promoting improved quality care through a combination of interprofessional teamwork and shared decision making
2. Servant leaders assist team members to achieve their personal goals by listening with empathy and committing to individual growth and community-building
3. They share power, put the needs of others first and help individuals optimize performance while forsaking their own personal advancement and rewards

Question 15

What is a Resonant Leader?

Answer 15

1. Are in tune with the emotions of those around them, use empathy and manager their own emotions effectively
2. Build strong, trusting relationships and create a climate of optimism that inspires commitment even in the face of adversity
3. They create an environment where employees are highly engaged, making them willing and able to contribute with their full potential

Question 16

What is an Authentic Leader?

Answer 16

1. Have an honest and direct approach with employees, demonstrating self-awareness, internalized moral perspective and relationship transparency
2. They strive for trusting, symmetrical and close leader-follower relationships; promote the open sharing of information and consider others’ viewpoints

Question 17

What is a Systems Theory?

Answer 17

Based on the concept that systems do not function in isolation but rather there is an interdependence that exists between their parts.

1. Systems theory assumes that most individuals strive to do good work, but are affected by diverse influences within the system

Question 18

What is a Culture of Safety?

Answer 18

An organizational culture that embraces error reporting employees with the goal of identifying systemic causes of problems that can be addressed to improve patient safety

Question 19

Components of a Culture Safety

Answer 19

1. Just Culture: a culture where people feel safe raising questions and concerns and report safety evens in an environment that emphasizes a nonpunitive response to errors and near misses
2. Report Culture: people realize errors are inevitable and are encouraged to speak up for the patient safety by reporting errors and near misses
3. Learning Culture: people regularly collect information and learn from errors and successes while openly sharing data and information and applying best evidence to improve work processes and patient outcome

Question 20

What is Just Culture?

Answer 20

1. Recognizes that individual practitioners should not be held accountable for system failings over which they have no control
2. Recognizes many individual or ‘active’ error represent predictable interactions between human operators and the systems in which they work
3. Does not tolerate conscious disregard of clear risks to patients or gross misconduct (falsifying a record or performing a professional duty while intoxicated)
4. The Just Culture model categorizes human behaviors into three causes of errors
   o Consequences of errors are based on whether the error is a simple human error or caused by at-risk or reckless behavior
5. A just culture in which employees aren’t afraid to report errors is a highly successful way to enhance patient safety, increase staff and patient satisfaction and improve outcomes
   o Success is achieved through good communication, effective management resources and an openness to changing processes to ensure the safety of patient and employees

Question 21

Simple Human Error

Answer 21

1. Occurs when an individual inadvertently does something other than what should have been done
2. Most medical errors are the result of human error due to poor processes, programs, education, environmental issues or situations
   o These errors are managed by correcting the cause, looking at the process, and fixing the deviation
3. Example: A nurse appropriately checks the rights of medication administration three times, but due to the similar appearance and names of two different medication stored next to each other in the medication dispensing system, administers the incorrect medication to a patient
4. If an individual commits a simple human error, manager CONSOLE the individual and consider changes in training, procedures and process

Question 22

At-Risk Behavior

Answer 22

1. An error due to at-risk behavior occurs when a behavioral choice is made that increases the risk where the risk is not recognized or is mistakenly believed to be justified
2. Example: A nurse scans a patient’s medication with a barcode scanner prior to administration, but an error message appears on the scanner. The nurse mistakenly interprets the error to be a technology problem and proceeds to administer the medication instead of stopping the process and further investigating the error message, resulting in the wrong dosage of a medication being administered to the patient
3. Individuals committing at-risk behavior are held accountable for their behavioral choice and often require COACHING with incentives for less risk behaviors and situational awareness

Question 23

Reckless Behavior

Answer 23

1. An error that occurs when an action is taken with conscious disregard for a substantial and unjustifiable risk
2. For example, a nurse arrives at work intoxicated and administers the wrong medication to the wrong patient
3. If an individual demonstrates reckless behavior, REMEDIAL ACTION and/or PUNITIVE ACTION is taken.

Question 24

What is Systems Leadership?

Answer 24

Refers to a set of skills used to catalyze, enable and support the process of system-level change the is encourage by the Just Culture Model

*Comprised of three interconnected elements:
o The Individual: the skills of collaborative leadership to enable learning, rust-building and empowered action among stakeholders who share a common goal
o The Community: the tactics of coalition building and advocacy to develop alignment and mobilize action among stakeholders in the system, both within and between organizations
o The System: an understanding of the complex systems shaping the challenge to be addressed

Question 25

What is Change?

Answer 25

Defined as the process of altering or replacing existing knowledge, skills, attitudes, systems, policies, or procedures
o The outcome of change must be consistent with an organization’s mission, vision and values

1. Nurse managers must deal with the fears and concerns triggered by change
   o Early adopters: individuals who will be enthusiastic about change
   o Laggers: individuals who will be resisters

2.Managers should articulate the reasons for change, the way(s) change will affect employees, the way(s) the change will benefit the organization and the desired outcomes of the change process

Question 26

Lewin’s Change Model

Answer 26

1. Kurt Lewin, the father of social psychology introduces the classic three step model of change known as the Unfreeze-Change-Refreeze Model that requires prior learning to be rejected and replaced
2. Step 1: Unfreeze: the process of altering
   
   • Ex: Motivating participants by preparing them for change, building trust and recognition for the need to change and encourage active participation in recognizing problems and brainstorming solutions within a group
3. Step 2: Change: moving to a new equilibrium
   
   • Ex: Working together to search for new, relevant information and connecting the vies of the group to well-respected, powerful leaders who also support the change
4. Step 3: Refreeze: attaining the equilibrium with the newly desired behaviors
   
   • Must take place after change
   • If this step does not occur, it is very likely the change will be short-lived and employees will revert to the old equilibrium
   • Nursing leader can reinforce new patterns of behavior and institutionalize them by adopting new policies and procedures

Question 27

Lippitt’s Seven-Step Theory

Answer 27

1. Expands on Lewin’s change theory by focusing on the role of the change agent
    Change Agent: anyone who has the skill and power to stimulate, facilitate and coordinate the change effort
    Ex: Nurse managers or employees appointed to oversee the change process or external such as outside consulting firm.

Step 1: Diagnose the Problem: Examine possible consequences, determine who will be affected by the change, identify essential management personnel who will be responsible for fixing the problem, collect data from those who will be affected by the change and ensure those affected by the change will be committed to its success

Step 2: Evaluate motivation and capability for change: Identify financial and human resources capacity and organizational structure

Step 3: Assess the change agents’ motivation and resources, experience, stamina and dedication

Step 4: Select progressive change objectives: Define the change process and develop action plans and accompanying strategies

Step 5: Explain the role of the change agent to all employees and ensure the expectations are clear

Step 6: Maintain change: Facilitate feedback, enhance communication, and coordinate the effects of change

Step 7: Gradually terminate the helping relationship of the change agent

Question 28

What is Change Management

Answer 28

The process of making changes in a deliberate, planned and systemic manner

Question 29

Important for Nurses and Managers to Remember for Change Management:

Answer 29

1. Employees will react differently to change, no matter how important of advantageous the change is purported to be
2. Basic needs will influence reaction to change (need to be part of the change process, the need to feel that one has some control over the impact of change, and the need to be able to express oneself openly and honestly)
3. Change often results in a feeling of loss due to changes in established routines (employees may react with shock, anger, and resistance but will eventually accept and adopt the change)
4. Change must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future (Employees should be provided with information honestly and allowed to ask questions and express concerns)

Question 30

Strategies for Effective Change Management

Answer 30

1. Engage Stakeholders Early
2. Communicate Clearly and Frequently
3. Provide Training and Resources
4. Build a Supportive Culture
5. Monitor and Adjust