Types OF LEADERSHIP

There are two basic leadership styles: permissive and autocratic. These styles can be further
broken down into subcategories. A nurse leader who is a permissive democrat, for example,
engages his nurses in decision-making and allows them to work independently. A directive
autocrat, on the other hand, gives instructions without seeking input and supervises his nurses
closely.

The Difference Between a Manager and a Leader

• Managers, that are not leaders, do things by the book and think inside the box. Leaders
improvise given the situation at hand and will weight their thoughts by thinking outside of
the box.
• Managers will make decisions based on pure facts. Leaders will consider the big picture
and take into consideration the effects it has on their employees.
• Leaders are empathetic towards the people they lead.
• A leader has a precise vision and that vision is conveyed to their employees.
• The leader will pull or attract their employees to that vision, not push them into getting
the job done through coercion.
• A leader will get their employees to buy into their vision with enthusiasm and rigor.
• A manager does what’s best for the bottom line, regardless of the consequences. A
leader does what’s right.

roles of a head nurse

The Head Nurse Manager serves as manager, clinician, teacher, and researcher/consultant in
the three major areas of patient care management, personnel management, and unit
management. He/she has authority to make decisions in these areas specific to the unit
managed and has 24-hour accountability for unit operation. The philosophy, goals & objectives,
and policies and procedures of the hospital and the Department of Nursing are translated into
effective action by the Head Nurse Manager.

DUTIES AND RESPONSIBILITIES:

Ongoing development and maintenance of the standards of nursing care and management of
staff activities in the designated patient care unit are also the responsibilities of the Head Nurse
Manager. Allocation of the Head Nurse Manager’s duties, particularly between clinical and
management functions, is based on unit needs and is agreed upon by the Head Nurse Manager
and the Nursing Director.

The Head Nurse Manager practices within the limits of the Nurse Practice Act for Nurses, and
hospital policies and procedures, adheres to department and unit standards of care, and
understands the legal consequences of and is accountable for his/her nursing interventions.
Harmonious relationships among the members of the health care team and a positive image of
Hospital are promoted by the Head Nurse Manager.
Team Nursing
Features
This method of nursing care was introduced in the early 1950s.
Team nursing is based on the belief that nursing personnel with different levels of
competencies can make an effective contribution to total nursing care. The overall aim is to
provide a range of nursing to the individual patient in an efficient and effective way.
A nursing team made up of professional nurses, nursing auxiliaries, and nursing aids. They
can work together cooperatively under a well-qualified team leader to provide a range of
nursing services which may vary from the very simple to the most complex nursing
functions.
A typical nursing team in a ward may include the head nurse, staff nurses, nurse auxiliaries,
nursing aids and nursing students.

Primary Nursing
Primary nursing concept was envisaged to promote individualized nursing care and to make
qualified, registered nurses assume responsibilities for nursing care provided to patients.
Under traditional system of nursing, in a typical hospital ward, the patient is not assigned to
nurse for the care that is provided to him during his hospitalization. Nurses carry out
nursing functions and no nurse is specifically assigned to assume responsibility for care of
patient on a 24-hour basis during hospitalization. Under this system it was difficult to
promote accountability for nursing care provided to a patient. Primary nursing concept was
developed as a solution to this problem.
Features
Started in 1960s, became popular in 1980s.
l One registered nurse is responsible for patient care over 24 hour period 7 days a week
from the time the patient is admitted to the hospital till the discharge.
l Primary nurse is assigned the total care of a patient by the head nurse or nursing
coordination for initiating and updating the nursing care plan.
l An associated nurse works with the same patient on other shifts and on the primary
nurses’ ‘day off’. The associate nurse carries out the plan established by the primary
nurse.
l Nurses mostly find greater job satisfaction because they have more autonomy and
control over the care giver. They can enjoy extended and expanded roles alongwith
traditional role of care giver.

Functional NursingThis system emerged in 1930s in U.S.A.l A number of Licensed Practice

Nurses (LPNS) and nurse aides were employed tocompensate for less number of registered
nurses (R.N.S.) who demanded increasedsalaries.l Completion of routines and tasks is given
more importance.Nuresing Concept/Approach: Basic nursing care concept (task or work
oriented), nospecific nursing role, less scope for utilization of holistic nursing process.

Challenges and Issues

Lack of individualised and coordinated care. Patient as a person is neglected although
routines were carried out very efficiently.
l Patients get confused as so many nurses attend to them, e.g. head nurse, medicine
nurse, dressing nurse, temperature nurse, etc.
l Communication gaps may occur because of many nurses involved in doing a specific
type of task.
l In the modern context this method is good for long-term care
Different Leadership Styles in Nursing

There are two basic leadership styles are free and unfettered. These styles can be further
broken down into subcategories. A nurse leader who is an independent Democrat, for example,
decides to engage their nurses and allows working independently. Directed an autocrat, on the
other hand, without seeking input instructs and supervises the nearby nurses.

DIFFRENCE BETWEEN LEADER AND A MANAGER

Management is how you can organize your things.

Leadership is how you can command your people.

Roles of a head nurse

This is a supervisory position

involving responsibility for maintaining high standards of professional nursing services in
the management of a hospital or nursing home clinical unit. Head Nurses may also assist in
the supervision and management of a division of units or group of wards. The work is
performed under general supervision with latitude for instructing, planning and making
assignments to subordinates. Does related work as required.

Responsibilities

Collaborates with medical staff in

care and treatment of patients; Visits patients and makes inspections to maintain high
standards of professional nursing service; Promotes and maintains good relationships with
patients and their relatives and friends; Observes condition of patients and r ecords any
mental or physical changes; Pr ovides for accurately descriptive records of the medical
treatment and nursing care of patients; Checks physicians' orders, medication records and
charts to insure prompt and accurate execution of orders; Instructs and assists Registered
Professional Nurses, Licensed Practical Nurses and Nurses Aides on nursing problems, unit
management and related
activities; Coordinates the services rendered by other departments in the interest of effective
management and patient' s welfare; Supervises the activities of and instructs professional
subordinates in a clinical unit or special unit and assists at operation or delivery; Instructs a
variety of personnel management, unit management, and supply distribution activities;
Assists in the formulation and execution of policies and procedures; Acts as Supervising
Nurse in her or his absence or as directed.
DELIVERY OF CARE

Primary Method

Primary nursing was developed in the 1980’s by Marie Manthey and the hallmark of this model
is that one nurse cares for one group of patients with 24 hour accountability for planning their
care. In other words, a Primary Nurse (PN) cares for her primary patients every time she works
and for as long as the patient remains on her unit. An Associate Nurse cares for the patient in
the PN’s absence and follows the PN’s individualized plan of care. This is a decentralized
delivery model: more responsibility and authority is placed with each staff nurse. It has been
debated whether PN is a cost-effective model. Some say it is because the RN has all the skills
necessary to move the patient through the health care system quickly. Others say it is not cost
effective because RNS spend time doing things that other, less expensive employees can do.

Advantages: Increased satisfaction for patients and nurses

More professional system: RN plans and communicates with all
disciplines. RNs are seen as more knowledgeable and responsible.
RNs more satisfied because they continue to learn as a function of
the in-depth care they are required to deliver.
Disadvantages: Intimidating for new graduates who are less skilled and
knowledgeable
Where do we get all these RNS during times of shortage?

Functional Method

This model is also referred to as the Task Method, and for good reason! Functional nursing
evolved during the Depression when RNS went from being private practitioners (see above) to
becoming employees for the purposes of job security. Once WWII broke out, however, nurses
left to care for the soldiers which left the hospitals short-staffed. To accommodate this shortage,
hospitals increased their use of ancillary personnel (sound familiar?). For efficiency, nursing was
essentially divided into tasks, a model that proved very beneficial when staffing was poor. The
key idea was for nurses to be assigned to TASKS, not to patients. For example, one nurse
would be responsible for all the treatments, another nurse for all the medications, and so on.

Advantages: A very efficient way to delivery care. Could accomplish a lot of tasks
in a small amount of time
Staff did what only they were capable to do: no extraneous work
was added that could be done by assistive personnel.
Disadvantages: Care of persons became fragmented
Patients did not have one identifiable nurse and the nurse had no
accountability.
Very narrow scope of practice for RNS
Lead to patient and nurse dissatisfaction
Team Method

This is the most commonly used model and is still in use today. It was developed in the 1950’s
in order to somewhat ameliorate the fragmentation that was inherent in the functional model
(see above). The goal of the Team method is for a team to work democratically. In the ideal
team, an RN is assigned as a Team Leader for a group of patients. The Team Leader has a
cadre of staff reporting to her and together they work to disseminate the care activities. The
team member possessing the skill needed by the individual patient is assigned to that patient,
but the Team Leader still has accountability for all of the care. Team conferences occur in which
the expertise of every staff member is used to plan the care; a hallmark is that each member’s
input (RN, LPN, NA, etc) is considered essential for the process to work. As is obvious, the
Team Leader must be both a skilled clinician and an effective group leader.

Advantages: Each member’s capabilities are maximized so job satisfaction

should be high
Patients have one nurse (the Team Leader) with access to other
providers
Disadvantages: Requires a team spirit and commitment to succeed
RN may be the Team Leader one day and a team member the next,
thus continuity of patient care may suffer.
Care is still fragmented with only 8 or 12 hour accountability.