Unit I. The Critical Triad: Management & Leadership Ch.

1: Introduction to Management

Ch.1- Introduction to Nursing Management

Outline
(1) Introduction
(2) Definitions
(3) Manager roles
(4) Functions of manager
(5) Seven habits of highly effective managers
(6) Management Competencies
(7) Skill Approach
(8) Historical Development of Management Theory
(9) Organizational Hierarchy
(10) Summary
(11) References

At completion of session, participants should be able to identify following intended learning

objectives:
■ Understand concept and importance of management
■ Define related terms.
■ List manager roles
■ Orient to functions of manager
■ Identify 7 habits of highly effective manager
■ Clarify management competencies.
■ Identify skill approach.
■ Discuss historical development of management theory
■ Specify organizational hierarchy
■ Summarize management in nursing
■ List used references in lecture

(1) Introduction
• Nursing has always held a human care and caring stance with respect to
people and their health-illness-healing concerns.

(Human Caring Science: A Theory of Nursing, page 43) / Dr. Jean Watson
• Management thinkers emphasize how leaders shape structural features of
organizations.
• Since change is a primary feature of contemporary healthcare environments,
managers must focus on operational task completion to leadership skills of
visioning, motivating, and inspiring others before desired outcomes can be
achieved.
• Management emphasizes control—control of hours, costs, salaries, overtime,
use of sick leave, inventory, and supplies.

(2) Definitions
1= Management
• Is attainment of organizational goals in an effective & efficient
manner through planning, organizing, staffing, leading, & controlling
organizational resources.
• Getting things done through others.
• All of activities & tasks undertaken by one or more persons for purpose
of planning & controlling activities of others in order to achieve an
objective or complete an activity that could not be achieved by others
acting independently.
• Good management, as defined by strong planning, organizational skills, and
control, allows managers to intervene when goals are threatened.

2= Nursing Management
• Is process of working through nursing members to achieve organizational
objectives.
• It is coordination & integration of nursing resources by applying
management process in order to accomplish care and service, goals and
objectives.

3= Manager
• Is someone who plans, organizes, leads, and controls people & work of
organization in such a way that organization achieve its objectives.
• Who guides, directs, and motivates
• Is person who brings things about— one who accomplishes, has
responsibility, and conducts.

4= Nurse Manager
• Is key person who coordinate work through management levels.
• Is neither genuine, nor hero, but rather manager is persistent, tough-
minded, hard worker, intelligent & have analytical ability.

5= Management process
• Called a process because work of attaining objectives through a series of
interrelated and interdependent activities to solve a problem and these
activities each one is considered a process in itself.
• Always begins by planning and ends by controlling.

(3) Manager Roles

1- Informational
• Monitor
• Disseminator
• Spokesperson

2- Interpersonal
• Figurehead
• Leader
• Liaison

3- Decisional
• Entrepreneur
• Disturbance Handler
• Resource Allocator
• Negotiator

(4) Functions of Manager

1- Have an assigned position within formal organization.
2- Have a legitimate source of power due to delegated authority that
accompanies their position.
3- Are expected to carry out specific functions, duties, and responsibilities.
4- Emphasize control, decision making, decision analysis, and results.
5- Manipulate people, environment, money, time, and other resources to
achieve organizational goals.
6- Have a greater formal responsibility and accountability for rationality and
control than leaders.
7- Produce order and consistency

(5) Seven Habits of Highly Effective Managers

• Sharpen saw
• Be proactive
• Begin with end in mind
• Put first things first
• Think win-win
• Synergize
• Seek to understand and then to be understood
(6) Management Competencies
• Conceptual Skill: ability to see organization as a whole and relationship between its parts.
• Human Skill: ability to work with and through people.
• Technical Skill—Mastery of specific functions and specialized knowledge.

(7) Skill Approach

• Skills are learned, not inherited
1- Diagnostic skills: to define problems correctly and find correct
solutions
2- Decision making skills:
• competence to understand organization
• competence to make decisions when all information is not available
3- Time management skills

(8) Historical Development of Management Theory

• Management science, like nursing, develops a theory base from many
disciplines, such as:
• business
• psychology
• sociology
• anthropology.
A= Scientific Management (1900 to 1930)
• Frederick W. Taylor, “father of scientific management,” was a mechanical
engineer.
• He postulated if workers could be taught ‘one best way to accomplish a task”
productivity will increase.

B= Human Relations Management (1930 to 1970)

• Management scientists began to look at role of worker satisfaction in
production.
• This human relations era developed concepts of participatory & humanistic
management, emphasizing people rather than machines.

C= Management Functions Identified

• Henri Fayol (1925) first identified management functions of

• Planning
• Organization
• Staffing / Command
• Coordination / Direct
• Control

• These are incorporated into what is known as management process.

• Management Functions include:
1- Planning
• Process of selecting and developing best course of action to accomplish an objective
• Keystone of all other management functions
• It encompasses
@ determining philosophy, goals, objectives, policies, procedures & rules
@ carrying out long- and short-range projections, and set time tables
@ determining a fiscal course of action & managing planned change, and
allocate resources.
@ establish agenda

2- Organizing
• Follows planning and reflects how organization tries to accomplish plan.
• Involves assignment & grouping of tasks into departments, and allocation of resources.
• It includes:
@ Establishing structure to carry out plans
@ Determining most appropriate type of patient care delivery
@ Grouping activities to meet unit goals
@ Working within structure of organization, understanding & using power
and authority appropriately.

3- Staffing
@ Functions consist of recruiting, interviewing, hiring, orienting staff and
make job replacement.
@ Scheduling
@ Staff development, employee socialization & team building
@ Establish rules and procedures

4- Directing / Leading
• It includes
@ Motivating: Use of influence to motivate employees to achieve
organization's goals and develop incentives.
@ Managing conflict, generate creative solutions and take corrective
actions.
@ Delegating
@ Communicating & facilitating collaboration: Creating a shared culture
and values, communicating goals to employees throughout
organization, and infusing employees to perform at a high level

5- Controlling
• Monitoring employees' activities, determining if organization is on target toward its
goals, and making corrections as necessary.
• It includes:
@ Performance appraisals
@ Fiscal accountability
@ Quality control
@ Legal and ethical control
@ Professional and collegial control

(9) Organizational Hierarchy

• Management in Organization Hierarchy include:
1- Operative/Lower management
• close to actual processes
• short time range of planning
• Look after day-to-day operations
• Develop short-range plans referred to as operational plans for controlling
(responsible for operational decisions)

2- Middle management and experts

• Development of their units and coordination between other same level units
• Region managers, business unit managers
• Middle time range of planning covering a time span of about one year
• Responsible for implementing policies of top management pertaining to their areas
of operation, by identifying, arranging and allocating resources needed
3- Top management
• Strategic planning & decision
• Overall development and coordination of organization
• Long time range of planning
• Board of Directors, Chief Executive and Head of Divisions
• Require an extensive knowledge of management roles and skills
• Check out plan for effectiveness in future

(10) Summary
• Nurse managers have complex, responsible positions in health-care
organizations.
• Ineffective managers may do harm to their employees, their patients, and
organization.
• Whereas effective managers can help their staff members grow and develop
as health-care professionals providing highest-quality care to their patients.

(11) References
1) Marquis B.L. and Huston C. J. (2020): Leadership roles and management
th
functions in nursing; theory and application. 9 ed. Philadelphia:
Lippincott Co.
2) Marquis B.L. and Huston C. J. (2018): Leadership roles and management
th
functions in nursing; theory and application. 9 ed. Philadelphia:
Lippincott Co.
3) Weiss Sally A, Tappen Ruth M and Grimley Karen A. (2019): Essentials of
th
Nursing Leadership and Management.7 Edition. F. A. Davis Company /
Library of Congress Cataloging-in-Publication Data / USA - pp. 77
AAUP- Nursing Faculty- Nursing Management Department- Spring 2024 8
Unit I. The Critical Triad: Management & Leadership Ch.2-Introduction to Leadership

Ch.2- Introduction to Nursing Leadership

Outline
(1) Introduction
(2) Definitions
(3) Factors of leadership
(4) Fatal Leadership Flaws
(5) Leadership Competencies
(6) Historical Development of Leadership Theory
(7) Importance of Leadership in Healthcare
(8) Summary
(9) References

At completion of session, participants should be able to identify following intended learning

objectives:
■ Understand concept and importance of leadership
■ Define related terms.
■ Discuss qualities & behaviors that contribute to effective leadership and fellowship
■ List factors of leadership
■ Clarify fatal leadership flaws
■ Identify leadership competencies
■ Discuss the historical development of management theory
■ Specify the importance of leadership in healthcare
■ Summarize management in nursing
■ List used references in the lecture

(1) Introduction
• Nurses work with an extraordinary variety of people:
@ Physicians
@ Physical therapists
@ Psychologists
@ Technicians
@ Clients
@ Families
• Management thinkers emphasize how leaders shape structural features of
organizations.
• Since change is a primary feature of contemporary healthcare environments,
managers must focus on operational task completion to leadership skills of
visioning, motivating, and inspiring others before desired outcomes can be
achieved.
• Nurses study leadership in order to learn how to work well, or effectively,
with other people
• Relationship between leadership and management continues to prompt
some debate.

(2) Definitions
1= Leadership
• Is an influence relationship among leaders and followers who intend real
changes that reflect their shared purposes.
• Art of motivating a group of people to act towards achieving a common goal.
• Interpersonal behavior that increases productivity by maximizing workforce
effectiveness.
• Encompasses leading, influencing, communicating and guiding people.
• Is a much broader concept than is management

2= Leader
• Is person who influences and guides direction, opinion, and course of action.
• Leaders are in front, moving forward, taking risks, attempting to achieve
shared goals, inspiring others to action and challenging status quo.

3= Effective Nurse Leader

• Those who engage others to work together effectively in pursuit of a shared
goal, such as:
@ Providing excellent client care.
@ Designing a cost-saving procedure.
@ Challenging ethics of a new policy.
• Most team leaders will respond very positively to having staff who are good

followers.

• Behaviors of an Effective Leader include:

• Communicating a vision for future and aware of current social and political situations
• Thinking critically (strategic thinking) and relating whole to parts
• Setting priorities and direction
• Solving problems and making it happen.
• Skillful communication with inside and outside partners.
• Respecting individual
• Developing oneself and others (release energy)
• Interest in group concerns, decisive and integrate a variety of different perspectives.

4= Poor Leader
• Is one who can confuse, frustrate, and even distress you.
• Suggestions for Handling Poor Leader
■ Avoid adopting ineffective behaviors of individual.
■ Continue to do your best work & provide leadership for rest of group.
■ If situation worsens, enlist support of others on your team to seek a remedy, don’t try to do
this alone.
■ If situation becomes intolerable, consider option of transferring to another unit or seeking
another position.

5= Follower
• Is a skilled, self-directed employee, one who participates actively in:

@ Setting group’s direction

@ Invest one time & energy in work of groups
@ Think critically
@ Advocates for new ideas.
• Being an effective follower is an important to new nurse as is being an
effective leader.
• Without followers, one can’t be a leader, conversely, one can’t be a follower
without a leader.
• Most of time, most of us are followers:
@ Members of a team.
@ Attendees at a meeting.
@ Staff of a nursing care unit.
• Things done for becoming better followers
■ Inform your leader right away when you discover a problem.
■ Include suggestions in your report for solving the problem.
■ Freely invest your energy & interest in your work.
■ Be supportive of new ideas & new directions suggested by others.
■ When you disagree, explain why you don’t support an idea or suggestion.
■ Listen carefully, and reflect on what your leader says.
■ Continue to learn as much you can about your specialty area.
■ Share what you learn.

(3) Factors of Leadership

Followers: leader responsible for leading.
Leader: who you are, what you know, what you can do.
Situation: all situations are different.
Communications: Exchange of information and ideas between one another

(4) Ten Fatal Leadership Flaws

■ Lack of energy and enthusiasm
■ Acceptance of their own mediocre performance
■ Lack of a clear vision and direction
■ Having poor judgment
■ Not collaborating
■ Not walking the talk
■ Resisting new ideas
■ Not learning from mistakes
■ Lack of interpersonal skills
■ Failing to develop others

(5) Leadership Competencies

• Contemporary leadership experts suggest that there are certain
competencies:

1= Skills and abilities, behaviors and adaptability

• Skills are learned, not inherited
2= knowledge about organizational climate and culture, how to manage change,
and communicating vision
3= Attitudes

(6) Historical Development of Leadership Theory

• There are many different ideas about how a person becomes a good leader.
• Consider some of best-known leadership theories and many qualities and
behaviors that have been identified as those of effective nurse leader.

A= Behavioral Theories (1940-1980)

• Concerned with what leader does.
• Concerned with leadership style that has a great deal of influence on climate and outcome of
work group.
1- Autocratic Leadership
■ Also called Directive, Controlling, Authoritarian.
■ When a Leader Usually Trying to Sell a Preconceived Decision
■ Leader gives orders and makes decisions for group.
■ Although this is an efficient way to run things, it usually dampens creativity and may
inhibit motivation.
■ Tries to move group toward leader’s goals.

Characteristics of Authoritarian Leader

■ Strong control is maintained over work group.
■ Others are motivated by coercion.
■ Others are directed with commands.
■ Communication flows downward.
■ Decision-making does not involve others.
■ Emphasis is on differences in status (“I” and “you”).
■ Criticism is punitive.

Authoritarian leadership results:

@ In well-defined group actions that are usually predictable
@ Reducing frustration in a workgroup
@ Giving members a feeling of security.
@ Productivity is usually high, but creativity, self-motivation and autonomy
are reduced.
2- Democratic Leadership
■ Also called Participative
■ Involving subordinates in making work-related decisions
■ Important plans & decisions are made with team.
■ Tries to move group toward it’s goal.
■ Although it is often a less efficient way to run things, it is more
@ Flexible
@ Usually increases motivation and creativity.
@ Characterized by guidance from rather than control by leader

Characteristics of Democratic Leader

■ Less control is maintained.
■ Economic & ego awards are used to motivate.
■ Others are directed through suggestions and guidance.
■ Communication flows up and down.
■ Decision-making involves others.
■ Emphasis is on “we” rather than “I” and “you.”
■ Criticism is constructive.
Democratic leadership results:
■ Appropriate for groups who work together for extended periods, promotes autonomy &
growth in individual workers.
■ Because many people must be consulted, it takes more time and, therefore, may be
frustrating for those who want decisions made rapidly.

3- Laissez-Faire Leadership
■ Is permissive, or nondirective with little or no control.
■ Let someone do.
■ Motivates by support when requested by group or individuals.
■ Uses upward & downward communication between members of group.
■ Disperses decision-making throughout group.
■ Places emphasis on group.
■ Does not criticize.
■ When a decision needs to be made, leader may postpone or never make a decision.
■ This leaves people feeling confused & frustrated, because there is no goal, guidance and
direction.

B= Situational & Contingency Leadership Theories (1950-1980)

• Idea that leadership style should vary according to situation or individuals
involved which indicated that situation should determine directives given
after allowing everyone to know problem, was contingency leadership
• Situations can change rapidly, requiring more complex theories to explain
leadership.
• Adaptability is key to situational approach, and recognize complexity of work situations.
• Emphasize importance of understanding all factors that affect a particular group of people in a
particular environment that include:
@ Organizational culture
@ Values of leader and followers
@ Work
@ Environment
@ Influence of leader-manager
@ Complexities of situation.

C= Transactional and Transformational Leadership

• Suggest that both leaders and followers have ability to raise each other to higher levels of
motivation and morality.
• Maintained that there are two primary types of leaders in management.
1- Transactional Theories
• Focus on tasks, and getting work done.
• Concerned with day-to-day operations
2- Transformational Leaders
• Focus on vision and empowerment and is able to empower others with this vision to
achieve it.
• Leaders can communicate their vision in a manner that is so meaningful and exciting that it
reduces negativity and inspires commitment in people
• Emphasizes that people need a sense of mission that goes beyond good interpersonal
relationships OR appropriate reward for a job well done.
• Caring for people, sick or well, is goal of profession.
• Most people choose nursing in order to do something for good of humankind.

D= Motivating Theories
■ This concept of motivation seems simple.
■ We do things to get what we want and avoid things that we don’t want.
■ Motivation is still surrounded in mystery.
■ Maslow hierarchy need theory.

E= Emotional Intelligence Theories

■ Addressing consciously effect of people’s feelings on team’s emotional reality.
■ Learn how to:
= recognize and understand your own emotions
= manage them
= channel them
= stay calm and clear headed
= suspend judgment until all facts are in when crisis occurs

■ Emotionally intelligent leader who generates enthusiastic, caring and supportive

@ welcomes constructive criticism
@ asks for help when needed
@ can juggle multiple demands without losing focus
@ can turn problems into opportunities.
@ listen attentively to others
@ Perceives unspoken concerns
@ Acknowledges others’ perspectives
@ brings people together in an atmosphere of respect, cooperation, collegiality,
and helpfulness, so they can direct their energies toward achieving team’s
goals.

(7) Importance of Leadership in Healthcare

• Health care professionals work in teams or groups as well as on an individual basis
• Staff need support, feedback about performance, clear job content and development
• Quality of team leaders is crucial to wellbeing of staff and patients through:
= showing way by going first and
= need to be accountable to those you serve.
(8) Summary
• Because rapid, dramatic change will continue in nursing and healthcare
industry, it has grown increasingly important for nurses to develop skill in
leadership roles
• What nurses need is to be treated fairly, have a sense of achievement from
work, and working well together as a team is a tremendous source of
satisfaction for people.
• It is important to remember that a job title alone does not make a person a
leader.

• Only a person’s behavior determines if he or she holds a leadership role.

• But it is leadership skill that is needed to implement planned change that is
a part of system improvement.
• Your patients, peers, and organizations are depending on you to influence
others
• To be an effective nurse, you must be an effective leader.
• Those individuals who choose to follow a leader do so by choice, not because
they have to.
• What is needed is a healthy MIX of leaders and managers
• Thus, integration of both leadership and management skills is critical to goal
attainment.
(9) References
1) Marquis B.L. and Huston C. J. (2020): Leadership roles and management
th
functions in nursing; theory and application. 9 ed. Philadelphia:
Lippincott Co.
2) Marquis B.L. and Huston C. J. (2018): Leadership roles and management
th
functions in nursing; theory and application. 9 ed. Philadelphia:
Lippincott Co.
3) Weiss Sally A, Tappen Ruth M and Grimley Karen A. (2019): Essentials of
th
Nursing Leadership and Management.7 Edition. F. A. Davis Company /
Library of Congress Cataloging-in-Publication Data / USA - pp. 77
AAUP- Nursing Faculty- Nursing Management Department / Spring-2024 3