Chapter 22

Nurse Leader, Manager, and Care

Coordinator

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Types of Power

Explicit
Power by virtue of position
Implied
Power due to other factors, such as personality

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Leadership Qualities

Charismatic
Dynamic
Enthusiastic
Poised
Confident
Self-directed
Flexible
Knowledgeable
Politically aware

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Leadership Skills

Commitment to excellence
Problem-solving skills
Commitment to and passion for ones work
Trustworthiness and integrity
Respectfulness
Accessibility
Empathy and caring
Responsibility to enhance personal growth of all staff

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Achieving Self-Knowledge

Identify your strengths.

Evaluate how you accomplish work.
Clarify your values.
Determine where you belong and what you can
contribute.
Assume responsibility for relationships.

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Leadership Styles

Autocratic
Democratic
Laissez-faire
Quantum
Transactional
Transformational

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Role of Nurse Manager

Planning
Organizing
Directing
Controlling

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Management Structures

Centralized
Senior managers generally make decisions with little
input from the group.
Decentralized
Decisions are made by those who are most
knowledgeable about the issues being decided.
Nurses are thus intimately involved in decisions
concerning patient care.

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Conflict Resolution Strategies

Avoiding
Collaborating
Competing
Compromising
Cooperating/accommodating
Smoothing

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Factors Prompting Change in

Health Care Industry
Increased number of chronically ill and older people
Increased role of government and industry in health care
Rising cost of health care
Changing patterns of health care delivery

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Lewins Theory of Change

Unfreezing: The need for change is recognized.

Moving: Change is initiated after a careful process of
planning.
Refreezing: Change becomes operational.

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Considerations for Planned Change

What is amenable to change?

How does the group function as a unit?
Is the group ready for change and at what rate?
Are the changes major or minor?

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Planned Change: An Eight-Step Process

Recognize symptoms that indicate a change is needed
and collect data.
Identify a problem to be solved through change.
Determine/analyze alternative solutions to the problem.
Select a course of action from possible alternatives.
Plan for making the change.
Implement the selected course of action to effect change.
Evaluate the effects of change.
Stabilize the change.

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Reasons for Resistance to Change

Threat to self
Lack of understanding
Limited tolerance for change
Disagreements about the benefits of change
Fear of increased responsibility

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Overcoming Resistance to Change

Explain proposed change to all affected.

List the advantages of the change.
Relate the change to the persons existing beliefs and
values.
Provide opportunities for open communication and
feedback.
Indicate how change will be evaluated.
Introduce change gradually.
Provide incentives for commitment to change.

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Steps for Using Time Effectively

Establish goals and priorities for each day.

Evaluate goals in terms of your ability to meet needs of
patients.
Establish a time line.
Evaluate your success or failure in managing time.
Use these results to direct your next days priorities and
time line.

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Factors Increasing the Power Base of

Nursing
Right timing
Size of the nursing profession
Nursings referent power
Increasing knowledge base and education for nurses
Nursings unique perspective
Desire of consumers and providers for change

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Evidence-Based Strategies to Improve

Leadership Skills
Strive to become an authentic leader.
Develop leadership skills.
Promote a healthy work environment.
Engage staff to commit to their best effort at work.
Assist new graduates to transition into the RN roles.

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Clinical Nurse Leader Role

Position was created by the American Association of

Colleges of Nursing (AACN) as a leadership role.
The CNL works collaboratively with the health care team
to facilitate, coordinate, and oversee patient care.
The CNL should be able to clearly communicate with
other health care professionals, integrate evidence-based
practices into patient care, and evaluate patient risks and
outcomes.
The person-centered focus of the CNL role includes
functioning as a patient advocate, educator, and provider
of patient care in complex situations.

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Considerations When Delegating Nursing

Care
Patients condition
Complexity of the activity
Potential for harm
Degree of problem solving and innovation necessary
Level of interaction required with the patient
Capabilities of the UAP
Availability of professional staff to accomplish workload

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ANA Principles for Delegating Care

The nursing profession determines the scope of nursing

practice.
The nursing profession defines and supervises UAPs
involved in providing direct nursing care.
The RN is responsible and accountable for nursing
practice.
The RN supervises any assistant providing direct patient
care.
The purpose of UAP is to work in supportive role to the
RN.

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Factors to Consider Prior to Delegating

Patient Care
Qualifications and capabilities of the UAP
Stability of the patient condition
Complexity of the activity to be delegated
The potential for harm
The predictability of the outcome
The overall context of other patient needs

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Developing Leadership Responsibilities

Mentorship
Preceptorship
Nursing organizations
Continuing education

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