LEADERSHIP STYLE Basic Leadership Style 1.

Autocratic Leadership Style - The classical approach - Manager retains as much power and decision making authority as possible - Does not consult staff, nor allowed to give any input - Staff expected to obey orders without receiving any explanations - Structured set of rewards and punishments - Greatly criticized during the past 30 years - Rely on threats and punishment to influence Staff - Do not trust staff - Do not allow for employee input 2. Bureaucratic Leadership Style - Manages by the book - Everything done according to procedure or policy - If not covered by the book, referred to the next level above - A police officer not a leader - Enforces the rules 3. Democratic Leadership Style - Also known as participative style - Encourages staff to be a part of the decision making - Keeps staff informed about everything that affects their work and shares decision making and problem solving responsibilities 4. Laissez-Faire Leadership Style - Also known as the hands-off style - The manager provides little or no direction and gives staff as much freedom as possible - All authority or power given to the staff and they determine goals, make decisions, and resolve problems on their own Others; 1. Charismatic Leadership - the leader uses charm to get the admiration of their followers - They show concern for their people and they look after their people's needs - They create a comfortable and friendly atmosphere for their followers by listening to them and making them feel that they have a voice in the decision making

2. Participative Leadership - This kind of leadership is usually seen in corporate settings. - Leaders act more like facilitators rather than dictators. - They facilitate the ideas and the sharing of information with the end goal of arriving at a decision. - The final decision ultimately rests on the leader but all considerations and factors of a decision come from the collective mind of the group under this leadership. 3. Situational Leadership - The leader adjusts to whatever limitation is laid out in front of him by his subordinates and the situation itself. - The leaders need to be as dynamic as the different situations they are faced with. 4. Transactional Leadership - In this kind of leadership, a clear chain of command is established. - The leader motivates his subordinates by presenting them rewards and punishments. - All requirements for a subordinate are clearly stated with corresponding rewards. If they fail to satisfy those requirements, they will receive a corresponding punishment. 5. Transformational Leadership - Transformational leaders lead by motivating by their followers. - Leaders appeal to their followers' ideals and morals to motivate them in accomplishing their tasks. - Basically, these kinds of leaders empower their followers using their own beliefs and personal strengths. Simply put, they inspire their followers. 6. The Quiet Leader The quiet leader leads by example. They do not tell people what to do. They do not force people to do things that they are not willing to do. They do not give loud speeches, sweeping statements and clear cut orders. They do what needs to be done, inspiring their followers to do the same.

7. Servant Leadership - In servant leadership, the leader takes care of the needs of his followers first before they take care of their own. - Instead of acting like a king to their subordinates, leaders act as servants.

The leader feels that they need to serve their followers rather than force upon them what they want.

LEADERSHIP THEORIES 1. "Great Man" Theories - Leaders are born and not made. - Great leaders will arise when there is a great need. - Most researchers were also male, and concerns about androcentric bias were a long way from being 2. Trait Theory - People are born with inherited traits. - Some traits are particularly suited to leadership. - Trait theories often identify particular personality or behavioral characteristics shared by leaders. 3. Behavioral Theory - Leaders can be made, rather than are born. - Successful leadership is based in definable, learnable behavior 4. Contingency Theory - Contingency theories are a class of behavioral theory that contend that there is no one best way of leading and that a leadership style that is effective in some situations may not be successful in others. 5. Situational Theory - The overall situational leadership approach suggests that the leader must act in a flexible manner to be able to diagnose the leadership style appropriate to the situation, and to be able to apply the appropriate style. - Leader traits and/or leader behaviors are important aspects but must be taken in context. - No single best way to lead - Focus on maturity or readiness of followers - Suggests that no one leadership style is the best for every situation 6. Participative Theory - Suggest that the ideal leadership style is one that takes the input of others into account. - Consult with other people before making a decision making 7. Relationship Theory - Also known as Transformational Theory

Make change happen in Self, Others, Groups, and Organizations. Charisma a special leadership style commonly associated with transformational leadership; extremely powerful, extremely hard to teach focus upon the connections formed between leaders and followers. These leaders motivate and inspire people by helping group members see the importance and higher good of the task.

8. Management Theory - also known as Transactional theories - focus on the role of supervision, organization, and group performance. Leadership Skills 1. Case Analysis - Leaders need critical-thinking skills to analyze and anticipate the effects of change and respond appropriately. They need to create strategies to identify not only potential changes but also ways to position a unit to respond favorably to change. These related needs are why analysis and strategy are so closely linked. For instance, nurse-managers are obligated to understand billing and accreditation requirements in order to design documentation tools that proactively meet the ever-changing requirements. The implementation of ambulatory payment classifications requires that hospitals place a variety of codes on outpatient procedures and treatments (e.g., use of intravenous infusions, Foley catheter insertions, radiographs). In order to expedite the coding process, documentation tools must be efficient for the nurses and must facilitate accurate coding and billing. Collaboration and critical-thinking skills are used by a units leader and team members to coordinate the implementation of ambulatory payment classifications and to maintain the units charge description master. 2. Decision Making - Educating leaders and team members about different decision-making strategies cultivates critical-thinking skills. There are also tools such as the decision tree and force-field analysis that help a group analyze data and options when solving problems. These tools encourage teams to remain focused as the teams evaluate possible solutions. Tools should be easy to use so that staff

members do not spend more time learning the tool than evaluating the solutions. Bases of Power Power is described as the ability to create, get and use resources to achieve ones goal. There are six bases of social power common in organizations. 1. Reward Power - based upon the incentives the leader can provide for group members to influence behavior by granting rewards. For example, a nurse manager may have considerable influence in determining a vacation time of a staff nurse and give incentives or recommendations. 2. Coercive Power - based in influencing behavior through the negative things a leader might do to individual group members or the group as a whole by withholding rewards or applying sanctions. Example, Giving undesirable job assignment or salary cut. 3. Information Power - based upon who knows what in an organization and the degree to which they can control access to that information by other individuals. The nurse manager, for instance, is has private ground to information obtained at meetings with the nursing director or through other informal channels of communication that either are not available to or are unknown to members of staff nurses. 4. Legitimate Power - stems from the group members perception that the nurse manager has a legitimate right to make a request; this power is based on the authority delegated to the nurse manager by virtue of his her/his job and position within kith management hierarchy. 5. Expert Power - based upon particular knowledge and skill not possessed by staff members. Nurse managers, by virtue of their experience and, possibly, advanced education, frequently qualify as the persons who know best of what to do in a given situation. For example, newly graduated nurses might look to the nurse manager for advice regarding particular

procedures or for help in using equipment on the unit. 6. Referent Power - is based upon admiration and respect for an individual as a person. For example, a new graduate might ask the advice of the nurse manager regarding career planning. Principle of delegation Delegating is the process by which a manager assigns specific tasks or duties to worker with commensurate authority to perform a job. There are seven principles in delegation. 1. Select the right person to whom the job is to be delegated. 2. Delegate both interesting and uninteresting jobs. Uninteresting jobs can be use to challenge, motivates and increase personal performance and commitments. 3. Provide subordinate with enough time to learn. Expertise can be achieved through training and experience. 4. Delegate gradually. New employees may not be able to assume full responsibilities as employees who have stayed longer on the job. 5. Delegate in advance. Specify goals and objectives to be met within a set time frame. Described the specific results expected out of the activities to be performed. 6. Consult before delegating. Clarification minimizes problems and promotes teamwork. 7. Avoid gaps and overlaps. Communication - Is the activity of conveying meaningful information, it is the process by which information is exchanged. Elements of the communication process 1. Sender - A message originates with the sender. Laswells classic model of communication (1948) describes the sender as the who in communication. If nurses initiate communication, they are the senders. 2. Message - The message originates with the sender. It consists of verbal and/or nonverbal stimuli that are taken in by receiver. The message is the what in communication.

3. Receiver - The receiver takes in the message and analyzes it. When nurses listen to patient-initiated conversations, they are the receivers. When the receiver reacts by returning a new message, the receiver and sender reverse roles. 4. Feedback - The new message that is generated by the receiver response to the original message from the sender is the feedback. Bradley and Edinberg (1986) describe feedback as the with what effect and note that feedback is effective when the two communicators are sensitive are sensitive to each others messages and they change behaviors based on the message exchanges. Channels of Communication In almost every nursing interaction, there is vision (seeing), auditory (hearing), and kinesthetic (touching) input. 1. The visual Channel - All seeing people take in information from the surrounding environments through sight. For example, a nurse who is caring for a fresh postoperative patient looks at the dressing to validate that it is dry, intact and free of discharge. The nurse interprets these negative findings as being a stable situation. 2. The auditory Channel - Hearing is another sensory channel that is focused on words that are spoken, as well as the volume, pitch, tone, rhythm and speed with which they are delivered. Babies are typically born with the ability to hear, but they must learn to listen. Listening involves making sense out of what is said. 3. The kinesthetic Channel - All aspects of communication that relate to feelings are considered kinesthetic. At the most basic level, this involves touch and physiological responses. Modes of Communication 1. Verbal Communication - relies on speaking words to convey a message. It involves the use of the auditory channel. The accuracy of the message is dependent on the senders vocabulary and the receivers ability to make sense of the words used to send a

message. The verbal message is influenced by the senders tone. 2. Nonverbal Communication - consists of aspects of communication that are outside what is spoken. The communicators appearance, facial expressions, posture, gait, body movements, positions, gestures, and touch all influence how the message is processed. 3. Electronic communication - communication is shifting to an electronic mode, with computer technology playing an increasingly dominant role. Patients are being monitored long distance and connecting to their health care providers using a variety of technologies including telephones, voice mail, and e-mail. Level of communication The level of communication involves who the audience when communicating. 1. Public Communication - is the process of speaking to a group of people in a structured, deliberate manner intended to inform, influence, or entertain the listeners. It is closely allied to "presenting", although the latter has more of a commercial connotation. 2. Intrapersonal communication - it is what individuals do within themselves and can present as doubts or affirmations. 3. Interpersonal communication - involves communication between individuals, person to person or in small group. Communication skills 1. Attending - involves active listening, the most important skill used by nurses to gain an understanding of the patient message. 2. Responding - entails verbal and nonverbal acknowledgement of the senders message. When the nurse nods affirmatively as she listens, she is responding nonverbally that the message has worth.

3. Clarifying by using such skills such as restating, questioning, and rephrasing, helps the message become clear. 4. Confronting - means to work jointly with others resolve a problem or conflict. Barriers to Communication 1. Gender - interferes with communication when men and women lack the understanding that they may process information differently. Some men are more interested in using reason while some women want to be heard and validated through communication. 2. Culture - culture grows increasingly diverse. This diversity reduces the likelihood that patient and nurses will share a common cultural background. 3. Anger - is a universal, strong feeling of displeasure that is often precipitated by a situation that frustrates or prevents a person from attaining a goal or getting what is wanted from life. 4. Incongruent Responses - it is when words and actions in a communication do not match the inner experience of self or are inappropriate to the context. Motivation Theories 1. Motivation - is not explicitly demonstrated by people but rather is interpreted from their behaviour. Motivation is whatever influences our choices and creates direction, intensity and persistence in our behaviour. It is a process that occurs internally to influence and direct our behaviour in order to satisfy our needs. 2. Maslows Hierarchy of Needs - This is one of the most well-known theories of motivation. Maslow developed a hierarchy of needs that shows how an individual is motivated. 3. Two-factor Theory - Frederick Herzberg contributed to research on motivation and developed the two-factor theory of motivation. He analyzed the responses of accountants

and engineers and concluded that there were two sets of factors associated with motivation. 4. Theory X and Theory Y - These are about two different ways to motivate or influence others based on underlying attitudes about human nature. 5. Theory X - Leaders must direct and control as motivation results from reward and punishment. 6. Theory Y - Leaders remove obstacles as workers have self-control, self-discipline; their reward is their involvement in work. 7. Theory Z - was developed by William Ouchi (1981) based on his years of study of organization in japan. He identified that Japanese organizations had better productivity than organizations in the United States and that they were managed differently with their use of quality circles to pursue better productivity and quality. Theory Z focuses on a better way of motivating people through their involvement. Conflict - An important part of the change process is the ability to resolve conflict. Conflict resolution skills are leadership and management tools that all registered nurses should have in their list. Types of Conflict: 1. Intrapersonal Conflict - occurs within the individual. 2. Interpersonal Conflict - may be between two people or between groups or work team. 3. Organizational conflict - a healthy way of introducing a new ideas and encouraging creativity. The Conflict Process In 1975, Filley suggested a process for conflict resolution that is widely accepted. In this process, there are five stages of conflict: 1. 2. 3. 4. Antecedent conditions Perceived and/or felt conflict Manifest behavior Conflict resolution or suppression

5. Resolution aftermath Conflict Resolution These methods dictate the outcome of the conflict process. There are seven methods of conflict resolution: 1. Avoiding- ignoring the conflict 2. Accommodating- smoothing or cooperating. One side gives in to the other side. 3. Competing- forcing; the two or three sides are forced to compete for the goal. 4. Compromising- each side gives up something and gains something. 5. Negotiating- high-level discussion that seeks agreement but not necessarily consensus. 6. Collaborating- both sides work together to develop optimal outcome 7. Confronting- immediate and obvious movement to stop conflict at the very start. Open, honest, clear communication is the key to successful conflict resolution. Courtesy in communicating is to be encouraged. This includes listening actively to the other side. The setting for the discussions for conflict resolution should be private, relaxed and comfortable. In the conflict process resolution, it is expected that both sides in the conflict will comply with the results. Time management - Time management has been defined as a set of related common-sense skills that helps you use your time in the most effective and productive way possible. It allows us to achieve more with available time. a. Shift to an outcome orientation b. Analysis of time Strategies to Plan Effective use of time: 1. Understand the big picture- Nurses should know what is expected of their coworkers, what is happening on the other shifts, and what is happening beyond the unit. 2. Decide on Optimal Desired Outcomeswhen nurses begin their shifts; they need to decide what optimal outcomes can be achieved. 3. Do First Things First- to decide what is reasonable to accomplish, a nurse has to come to terms with the resources that are available and the outcomes that must be achieved. - First Priority: A Life-Threatening or Potentially Life-Threatening Occurrence

Second Priority: Activities Essential to Safety Third Priority: Activities essential to the Plan of Care

Application of Time management Strategies to the Delivery of Care 1. Estimate Activity time consumption 2. Create an Environment Supportive of time management and patient care 3. Shift report as a tool for effective and efficient care - Face-to-face report - Audiotaped report - Walking rounds 4. Formulate and write the shift action plan 5. Make patient care rounds 6. Evaluate outcome achievement Controlling - Controlling can be defined as the regulation of activities in accordance with the requirements of plans. - Is the regulation of activities in accordance with the plan. Controlling is a function of all managers at all levels. Its basic objective is to ensure that the task to be accomplished is appropriately executed. Control involves establishing standards of performance, determining the means to be used in measuring performance, evaluating performance, and providing feedback of performance data to the individual so Nursing Leadership and Management 70 behavior can be changed. Controlling is not manipulation, rigid, tight, and autocratic or oppression. Management by objectives (MBO) can be considered as a control mechanism. Based on MBO principle determining objectives (standards) against which performance can be measured can be stated. Second, specific measures have to be established to determine whether these objectives are met. Third, the actual accomplishment of the objectives would be measured in relation to the standard and this information would be fed back to the individual. Then corrective action could be taken. Steps of control - The control function, whether it is applied to cash, medical care, employee morale or anything else, involves four steps. 1. Establishments of standards. 2. Measuring performance 3. Comparing the actual results with the standards.

4. Correcting deviations from standards. Budget - operational management plan related to income and expenses for division of time; allocated resources necessary for future expenditures - Budgeting, though primarily recognized as a device for controlling, becomes a major part of the planning process in any organization. It is expressed in financial terms and based on expected income and expenditure. Budget is the heart of administrative management. It served as a powerful tool of coordination and negatively an effective device of eliminating duplicating and wastage. - Budgets serve a dual purpose: they are numerical expressions of plans, and they become control standards against which results are compared or benchmarked. Types of budgets and the time frames of the budgets may vary. Budgets are management tools. Preparing and working with a budget enable managers to reflect upon previous expenses and to be aware of current and future costs as well as the amount of resources that have been and will be utilized. As part of working with and comparing budgets, a manager will review periodic budget reports generally on a monthly basis. As part of this monthly budget review, the manager will compare actual expenditures for the month with the approved budgeted amount and the yearto-date budget status. 3 Types of Budgets 1. Personnel - Allocates funds for salaries, overtime, benefits, staff development and training, and employee turnover costs. 2. Operating budget - Allocates funds for daily expenses such as utilities, repairs, maintenance, and patient care supplies - Is a combination of the revenue and expense budget. It is a forecast of the revenue that is expected to be earned during the defined budget period and the expenses incurred to earn the revenue during the same period. The personnel costs are a significant part of this budget. This budget is a plan for the

units or organizations daily operating revenue and expenses. It includes the workload budget (FTEs); units of service, such as patients days or visits; and expense budgets with personnel costs, supplies, equipment, and overhead. 3. Capital budget - Allocates funds for construction projects and/or long-life equipment such as cardiac monitors, defibrillators, and computer hardware; capital budget items are generally more expensive than operating supplies. - Summarize the anticipated purchases for the fiscal year and usually have a dollar minimum cost to be included (e.g. _ $300). The life span of equipment projected during this phase of budget planning is usually longer than 3 or more years. The capital budget is separate from the everyday operating budget, and the funds for these purchases are usually released by the finance department when available for approved purchases. CREATING A BUDGET Nurses have been expertly educated to use the nursing process. The same type of process is the most widely used approach to preparing a budget Assessment Planning Implementation Evaluation

BUDGETARY PROCESS

1. PLANNING - Gathering information related to goals and objectives, setting priorities, conducting an environmental assessment, and identifying financial objectives. 2. DEVELOPMENT OF THE BUDGET - Collecting and analyzing data from past budgets, allocating amounts based ob priority, and approving the operational and capital budgets. 3. IMPLEMENTATION AND MONITORING - Analyzing variances and adjustments during the fiscal period, negotiating and revising the budget as necessary, allocating departmental and cash budgets. 4. EVALUATION - Obtaining performance reports and analyzing efficiency. Costing of nursing service 1. Fixed cost - not related to volume and remain constant 2. Variable cost - related to volume and varies according to different factors. 3. Direct cost - related to providing direct product service 4. Indirect cost - incurred in support of providing product services Cost Containment 1. Cost monitoring - focuses on how much will be spent, where whena nd why. 2. Cost management - what can be done to manage cost 3. Cost incentives - motivation and rewards 4. Cost avoidance - not buying supplies, technology or services not necessary needed. 5. Cost reduction - spending less for goods or services.

6. Cost control - effective use of available resources through careful planning, forecasting and monitoring. Procedure: Nursing service a. b. c. d. e. f. g. Determine productivity goal Forecast workload Budget patient care hours Budget patient care hours and staffing Plan for nonproductive hours Chart productive time Estimate the cost of supplies and services h. Anticipate capital expense Performance Evaluation/Appraisal - A systemic review of an individual employee's performance on the job. Purpose: a. Provide information upon which to base management decision. Salary raises promotions, transfers or discharges. b. Help to assist employees to their personal development. c. Help to assess the effectiveness of hiring and recruiting practices. Performance appraisal information. d. Help to identify training and development needs of the employees. Supply information to the organization. e. Used as a criterion to Nursing Leadership and Management assess the validity of personnel selection and training procedures. Help in the establishment of standard performance. Common Problems in Personnel Appraisal: a. Demanding b. Leniency-errors c. Halo-errors d. Lack of information e. Giving feedback Characteristics of an Effective Performance Appraisal: a. Relate performance appraisal to job description b. Understanding the criteria of evaluation c. Tools of Performance Appraisal: d. Rating scale e. Checklist f. Management by objective Appraisal Method Designed to Avoid Rater Bias: a. The field review method b. The forced choice rating method

Staff Development - To assist these newly employed people in learning specific skills to perform that job. Steps: a. Assessment b. Planning c. Implementation d. Evaluation D. QUALITY IMPROVEMENT / QUALITY MANAGEMENT Quality in the Health-Care System - The IOM defines quality as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current and professional knowledge (IOM, 2001, p. 232) Health care should be: a. Safe: Avoiding injuries to patients from the care that is intended to help them b. Effective: Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse) c. Patient-centered: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions d. Timely: Reducing waits and sometimes harmful delays for those who receive and those who give care e. Efficient: Avoiding waste, in particular that of equipment, supplies, ideas, and energy f. Equitable: Providing care that does not vary in quality because of characteristics such as gender, ethnicity, geographic location, and socioeconomic status. QI ( Quality Improvement) - activities have been part of nursing care since Florence Nightingale evaluated the care of soldier during the Crimean War (Nightingale & Barnum 1992). To achieve quality health care, QI activities use evidence-based methods for gathering data an achieving desired results. QI usually involves common characteristic: a. A link to key elements of the organizations strategic plan b. A quality council consisting of the institutions top leadership c. Training programs for all levels of personnel

d. Mechanisms for selecting improvement opportunities e. Formation of process improvement teams f. Staff support for process analysis and redesign g. Personnel policies that motivate and support h. Staff participation in process improvement Regardless of the term used, QI is a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations Unit level QI process a. Assign Responsibilities b. Identify Vital Areas c. Define Scope of Care d. Analyze Area in Terms of: - Aspects - Standards - Indicators - Criteria e. Measure Actual Performance and Measure Patient Outcomes f. Evaluate Performance and Outcomes g. Recommend and Implement Actions h. Evaluate Degree of Improvement i. Nursing audits and rounds j. Variance Reports k. Solutions to identified problems Many Sources of Conflict 1. Power Plays and Competition Between Groups - Nurse-physician relationships are frequent sources of conflicts (Vivar, 2006).The most common problem is disrespect, but sarcasm, finger pointing, throwing things, inappropriate language, and demeaning remarks also occur (Lazoritz & Carlson, 2008). Disagreements over professional territory can occur in any setting. Nurse practitioners and physicians may disagree over limitations on nurse practitioner independence. Bullying involves behavior intended to exert power over another person. Physician dominance and authoritarian management may create an environment in which bullying occurs. - In some settings nurses feel powerless, trapped by the demands of the tasks they must complete and frustrated that they cannot provide quality care (Ramos, 2006). Union-management conflicts occur regularly in some workplaces.Gender-based conflicts,

including equal pay for women and sexual harassment issues, are other examples (Ehrlich, 1995). 2. Increased Workload - Emphasis on cost reductions has resulted in work intensification, a situation in which employees are required to do more in less time (Willis, Taffoli, Henderson, & Walter, 2008). Common examples are skipping lunch and unpaid over-time. This leaves many health-care workers believing that their employers are taking advantage of them (Ketter, 1994) and causes conflict if they believe others are not working as hard as they are. 3. Multiple Role Demands - Inappropriate task assignments (e.g., asking nurses to clean the floors as well as nurse their patients) are often the result of cost-control efforts, which can lead to disagreements about who does what task and who is responsible for the outcome. 4. Threats to Safety and Security - When cost saving is emphasized and staff members face layoffs, peoples economic security is threatened. This can be a source of considerable stress and tension (Qureshi, 1996; Rondeau & Wagar, 2002). 5. Scarce Resources - Inadequate money for pay raises, equipment, supplies, or additional help can increase competition between or among departments and individuals as they scramble to grab their share of what little there is available. 6. Cultural Differences - Different beliefs about how hard a person should work, what constitutes productivity, and even what it means to arrive at work on time can lead to problems if they are not reconciled. 7. Invasion of Personal Space - Crowded conditions and the constant interactions that occur at a busy nurses station can increase interpersonal tension and lead to battles over scarce work space (McElhaney, 1996). Resolving Problems and Conflicts Signs That Conflict Resolution Is Needed

a. You feel very uncomfortable in a situation. b. Members of your team are having trouble working c. together. d. Team members stop talking with each other. e. Team members begin losing their cool, attacking each f. other verbally. Resolving Problems and Conflicts

Problem Resolution The use of the problem-solving process in patient care should be familiar. The same approach can be used when staff problems occur. The goal is to find a solution to a given problem that satisfies everyone involved.

1. Identify the Problem or Issue Ask participants in the conflict what they want (Sportsman, 2005). If the issue is not highly charged or highly political, they may be able to give a direct answer. At other times, however, some discussion and exploration of the issues are necessary before the real problem emerges. It would be nice, wrote Browne and Kelley, if what other people were really saying was always obvious, if all their essential thoughts were clearly labeled for us . . . and if all knowledgeable people agreed about answers to important questions (1994,

p. 5). Of course, this is not what usually happens. People are often vague about what their real concern is; sometimes they are genuinely uncertain about what the real problem is. High emotion may further cloud the issue. All this needs to be sorted out so that the problem is identified clearly and a solution can be sought.

6. -

Evaluate the Situation Check whether the problems are resolve or not. Usually not every problem is resolved successfully on the first attempt. If the problem has not been resolved, then the process needs to be resumed with even greater attention to what the real problem is and how it can be resolved successfully. References:

2. Generate Possible Solutions - Here, creativity is especially important. Try to discourage people from using old solutions for new problems. It is natural for people to try to repeat something that has already worked well, but previously successful solutions may not work in the future (Walsh, 1996). Instead, encourage searching for innovative solutions (Smialek, 2001). When an innovative solution is needed, suggest that the group take some time to brainstorm. Ask everyone to write down (or call out as you write on a flip chart) as many solutions as he or she can come up with (Rees, 2005). Then give everyone a chance to consider each suggestion on its own merits. 3. Evaluate Suggested Solutions - An open-minded evaluation of each suggestion is needed, but accomplishing this is not always easy. - Some groups are stuck in a rut, unable to think outside the box. Other times, groups find it difficult to separate the suggestion from its source. On an interdisciplinary team, for example, the status of the person who made the suggestion may influence whether the suggestion is judged to be useful. Whose solution is most likely to be the best one: the physicians or the unlicensed assistants? That depends. Judge the suggestion on its merits, not its source. Choose the Best Solution - Which of the suggested solutions is most likely to work? A combination of suggestions is often the best solution. Implement the Solution Chosen - The true test of any suggested solution is how well it actually works. Once a solution has been implemented, it is important to give it time to work. Impatience sometimes leads to premature abandonment of a good solution.

http://psychology.about.com/od/leadership/p/lea dtheories.htm http://people.stfx.ca/agillis/n493%20Unit %202%20Class%201%20Nov%203rd.ppt http://www.cartercenter.org/resources/pdfs/healt h/ephti/library/lecture_notes/nursing_students/L N_nsg_ldrshp_final.pdf http://www.brighthub.com/office/home/articles/ 76450.aspx#ixzz1QBLXdf3A http://ccn.aacnjournals.org/content/24/3/52.full Rebecca A. Patronis Jones, DNSc, RN, CNAA, BC Nursing Leadership and Management Theories, Chancellor College of and Processes Professor and West Practice Suburban

Nursing

Oak Park, IL

BRIAN A. VASQUEZ, , RN, MAN Nursing Leadership and Management http://people.stfx.ca/agillis/n493%20Unit %202%20Class%201%20Nov%203rd.ppt http://www.cartercenter.org/resources/pdfs/healt h/ephti/library/lecture_notes/nursing_students/L N_nsg_ldrshp_final.pdf The New Leadership Challenge 3rd edition, by Shiela C. Grossman and Theresa M. Valiga Essentials of Nursing Leadership and Management 5th edition by Diane Whitehead, Sally Weiss, Ruth Tappen QI usually involves common characteristic (McLaughlin & Caluzny, 2006, p 3) Adapted from Patterson, K., Grenny, J., McMillan, R., & Surtzler, A. (18 March 2003). Crucial conversations: Making a difference between being healed

4.

5.

and being seriously hurt. Vital Signs, 13(5), 14 15. Robert E. Neff The American Journal of Nursing Vol. 30, No. 7 (Jul., 1930), pp. 841-844 (article consists of 4 pages) Published by: Lippincott Williams & Wilkins Six Aims for Improving Quality in Health-Care (IOM, 2001, p. 39). McLaughlin & Kaluzny, 2006 McLaughlin & Caluzny, 2006, p 3 (Adapted from Hunt,D.V. [1992]. Quality in America: How to Implement a Competitive Quality Program. Homewood, IL: Business One Irwin; and Duquette, A.M. [1991]. Approaches to monitoring practice: Getting started. In Schroeder, P. [ed.]. Monitoring and Evaluation Aspen.) http://www.jstor.org/stable/3410493 http://www.scribd.com/doc/50017232/Costingof-nursing-service http://www.jstor.org/pss/3410493 in Nursing. Gaithersburg,MD:

Prepared by: Bsn 4A, GROUP 4.

I have fought the good fight, I have finished the course, I have kept the faith II Timothy 4: 7