Table of Contents

Objectives 2

Part 1 - Roles and Responsibilities of the Charge Nurse 3

Part 2 - Leadership Styles 14

Part 3 - Change Management 26

Part 4 - Strategic Planning 33

Part 5 - Organizing 38

Part 6 – Quality Improvement 40

Part 7 - Delegation 45

Part 8 - Supervision 50

Part 9 - Communication 52

Part 10 - Decision Making, Problem Solving and Critical Thinking 60

Part 11 - Conflict Management 65

Part 12 - Motivation 81

Part 13 - Team Building 90

References 96

1
Objectives

Desired outcomes of the Charge Nurse Manual are:

 Development of charge nurses so that they may function effectively in the work
environment.
 Charge nurses will be able to apply theories learned to practical situations in day-to-day
practice.

On completion, the charge nurse will be able to:

 Verbalize expanded roles and responsibilities.
 Discuss different leadership styles and their application to different situations.
 Understand the necessity for change and assist colleagues to manage the process of
change.
 Differentiate between Strategic and Operational Planning
 Organize unit activities in a structured manner to ensure the smooth running of the unit
 Describe principles of and barriers to delegation.
 Practice effective delegation whilst exercising a supervisory role
 Implement effective communication at unit level
 Understand and demonstrate the communication process and define techniques that
improve listening skills.
 Describe the steps in decision making and apply critical thinking to the decision-making
process.
 Discuss major approaches to dealing with conflict.
 Integrate leadership and management roles by creating a motivational environment.
 Explain benefits of team building.

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Part 1- Roles and Responsibilities of the Charge Nurse

Objectives:
 Define the charge nurse position.
 Identify the role and responsibilities of the charge nurse.
 Understand the responsibility, accountability and authority of the charge nurse role

Definition:
The Charge Nurse position is an expanded staff nurse role with increased responsibility. The
charge nurse functions as a liaison to the head nurse.

Roles and responsibilities:

Performance improvement:
 Nursing care and practice are evaluated through rounds, patient observation and
documentation.
 Action and guidance provided based upon clinical judgment.
 Performance improvement is focused on continuous improvement of systems and
processes with special emphasis on patient safety.
 Performance improvement is supported by written policies and procedures.
 All patients, visitors and health care providers’ concerns and occurrences are responded to.
 A productive and positive working environment is fostered and good relationships with
other departments are encouraged.
 The unit’s response to emergency situation is coordinated.

Staff utilization:
 Staff scheduling is in line with bed occupancy and patient needs.
 Absenteeism and poor timekeeping is managed.
 Nursing personnel are allocated according to their scope of practice and level of
competence.
 Tasks and special responsibilities are assigned to ensure general ward management (e.g.
narcotic count).

Clinical competence:
 Direction to staff is provided as needed.
 Problems on the shift are recognized and anticipated and assignments are reorganized
based on patient needs and acuity.
 A system of regular competency assessment is implemented.
 All staff is competent in basic life support and applicable life support skills.
 Serves as clinical expert and role model in the provision of good standards of nursing
practice and problem solving.
 Preceptor ship is implemented and maintained and new staff is monitored during the
orientation period.
 Learning opportunities are provided for staff.

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Part 1- Roles and Responsibilities of the Charge Nurse

Safe patient care:

 Life support equipment is checked as per policy.
 Infection control policy and procedures are adhered to.
 Aseptic and sterile techniques are adhered to.
 Patient safety risks are identified and adhered to.
 Admissions and discharge are coordinated from the unit.
 Total patient care is applied and recorded according to policy.

Records and documentation:

 All documentation comply with KFMC policies and procedures.
 Assures appropriate documentations of care given are done.
 Record audits are done according to policy and procedure.
 Irregularities in record audits are addressed.

Stock and equipment management:

 Staff trained and competent to handle/operate/maintain and store equipment according to
procedure.
 Damaged or defective equipment is reported as per policy.
 Borrowing and lending of equipment to other units are controlled.
 All stock levels optimally maintained and adjusted according to ward/patient turnover
needs.
 Aged and excess stock identified and managed.

Charge
Nurse

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Part 1- Roles and Responsibilities of the Charge Nurse

Improved Patient and Staff Satisfaction

A well-trained charge nurse has a positive impact on both patient and employee satisfaction.
Multiple studies have shown that employees cite their relationships with their supervisors as
the most important predictor of employee satisfaction. Charge nurses may have a greater
impact on staff satisfaction than any other nurse leader, due to their close and continuous
contact with nursing staff. Because they are on the front line when dealing with patients and
family members, their role is critical to patient satisfaction.

Reduced Nurse Turnover

Improving nurse turnover rates has many positive financial implications for healthcare
organizations. When a seasoned nurse leaves a facility, that facility loses all the orientation,
training and education investment it has made during that nurse’s tenure. Even worse, a nurse
often takes that knowledge to a competitor that benefit from the hospital’s original
investment. Due to the nursing shortage, the gap left when a nurse departs is often filled with
overtime or expensive agency nurses. An effective charge nurse leader can positively impact
nursing turnover by improving the work environment for nurses using proven leadership
strategies to retain the best staff.

Reduced Risk
A well-trained, vigilant charge nurse can reduce risk and improve quality considerably on his or
her unit. Risks on the nursing unit apply not only to patients, but also to staff and visiting
family members. The costs associated with nosocomial infections, medical errors and falls can
run into the millions. Even though most future executive nurse leaders begin their careers as
charge nurses, many healthcare organizations have no succession plans in place. Furthermore,
recent Centers for Medicare & Medicaid Services reimbursement changes regarding avoidable
medical errors will result in higher costs as hospitals begin to absorb the full cost of managing
avoidable medical mistakes.

Improved Strategic Outcomes — Charge nurses are key to the successful implementation of
hospital strategies and ensuring that the organization’s mission, vision and values are
translated into action on the nursing floor. When charge nurses are properly trained, the skills
they have developed are then translated into tangible results with a real, lasting impact on the
organization.

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Part 1- Roles and Responsibilities of the Charge Nurse

Helping Charge Nurses understand their leadership role

As the amount of patients admitted to hospitals every day increases, it becomes more pressing
to ensure charge nurses are well aware of their role, responsibility, accountability, and
authority.

It is the role of the charge nurse that is the key to providing leadership at the point of care,
retention and turnover of staff, ensuring safe and effective practice occurs, and enhancing the
patient/family experience by ensuring excellent quality care.

Most charge nurses, when asked about their role, responsibility, accountability, and authority
(RAA) within their particular organization, felt confident about three of the four areas.

The charge nurses could state some aspects of what their role and responsibilities are, as well
as their accountability. However, they were hesitant to answer what they felt their authority as
a charge nurse is.

Despite the fact that the charge nurses received a copy of the job description, they were never
formally told what their authority is, let alone receive any formal training on the matter.

This matter brings to the forefront the imperative need for formal charge nurse and leadership
training.

After observing the varied levels of charge nurse experience, expertise, and inconsistencies
throughout National Neuroscience Institute it was clear that charge nurses need a more in
depth training manual to guide them through their daily routine. Linked to this training manual
the need for monthly workshop activities is required.

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Part 1- Roles and Responsibilities of the Charge Nurse

In this manual all charge nurses receive the necessary knowledge and tools to better help
them function in their role

The NNI leadership team and nurse educator met to discuss the identified concerns and
ultimately agree upon the education and training topics.

The leadership team agreed that communication, delegation, mentoring, role modeling, and
teamwork were important to include in the education and training workshop for charge
nurses.

However, these topics will follow after the role and RAA sections and in the same order
discussed, as the flow allows for the dialogue that will ensue.

The workshop will also include interactive activities that deal with their fears as a charge
nurse, delegation, teamwork, and self-assessments of their communication and conflict
management styles.

The decision that the best approach in providing the necessary tools to the charge nurses was
to begin with the evidence out in the literature:
 What the role of the charge nurse is
 Their RAA demands

Accountability

ROLES

Responsibility Authority

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Part 1- Roles and Responsibilities of the Charge Nurse

Helping Charge Nurses understand their leadership role

The workshop should open with an icebreaker activity called "Fear in the Bucket." This activity
entails reading the following statement: "As a charge nurse I am most afraid of…"

Each charge nurse must finish the sentence by writing on a piece of paper and placing their
statements into a bucket located at the center of the table.

After all charge nurses have submitted their entries, the buckets get switched with the other
tables. The charge nurses then read each other's statements and discuss the reality of what
fears are being experienced by their peers.

The goal of the icebreaker is to have everyone be aware of the fact that they are not alone.

By the end of the workshop, many of their fears—if not all—will either be resolved or lessened
to where they can feel more at ease in their role and with the decisions they have to make on
any given day.

Along with being an icebreaker, this activity brings about a lot of dialogue and at times
laughter amongst the participants.

Once the icebreaker is complete, the discussion on the role of charge nurses ensues. The
question then asked is what do you believe to be important attributes or traits a charge nurse
should have. The answers that follow should fall in conjunction with what is in the literature.

According to the literature, charge nurses should be:

 Confident
 Accountable
 Responsible
 Fair
 Flexible
 Assertive
 Authoritative

Charge nurses must also have:

 A positive attitude
 The need to control
 Initiative
 An image
 The ability to learn from mistakes -Humor (Connelly, 2003)

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Part 1- Roles and Responsibilities of the Charge Nurse

The workshop's leaders discuss and define each characteristic by giving examples to help the
participants better understand each attribute and trait they should hold themselves.

From there, the discussion should flow into asking nurses how they feel as a charge nurse. Do
they feel overwhelmed or that they should be a psychic, and know what is going to happen
before it does.

The charge nurses should know that although these are some examples of how they can feel,
the expectations are not the same.

Charge nurses need to understand that they are human and the expectation is to ensure the
flow of the daily unit operations is in conjunction with meeting the organization's objectives,
while ensuring the quality of care is being rendered in a cost effective manner.

It is important to make sure the charge nurses are aware that their role encompasses being
the:
 Coordinator of nursing services
 Evaluator of staff performance
 Resource to the staff, patients, visitors, and physicians
 Mentor
 Coach
 Role model
 Supporter to staff so that the expectations set will be met with guidance and
direction
 Clinical expert
 Key role in ensuring the deliverance of excellent quality care

It is also important for charge nurses to understand their actions set the pace and what they
set as an example will soon become the rule.

Another role a charge nurse can take on is being a leader. This is a big part of their role
because they need to exhibit communication and problem-solving skills while instigating
change by encouraging, motivating, and inspiring at the point of care.

As Connelly, et al, 2003, postulates as a leader you need to be visible, identifiable, accessible,
approachable, and authoritative to not only your staff but your customers as well.

The charge nurse is the conduit for information provided from management to staff and from
staff to management (Nurses First, 2003.)

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Part 1- Roles and Responsibilities of the Charge Nurse

An important area to stress throughout the workshop is charge nurses not only need to be
aware and understand what their RAA is, but that they know the differences between each.

The charge nurses should comment on what they think the difference between RAA and the
information given to them from the literature search.

Having the charge nurses comprehend and put the words to action will assist them in better
understanding their role. Miller and Manthey, 1994, define responsibility as taking ownership
(Creative Healthcare Management, 2003). It is the obligation to answer for one's actions;
ensuring a task is accomplished; it is about getting the job done.

According to Miller and Manthey, 1994, (Creative Healthcare Management, 2003),

accountability is about reflecting on actions and decisions, evaluating the effectiveness and
then directing future efforts. According to Hardy, 2008, it is 'not just about getting the job
done, but how it gets done.'

Authority, as defined by Miller and Manthey, 1994, (Creative Healthcare Management, 2003),
is about the right to act in areas where one is given and accepts responsibility. While Hardy,
2008, postulates it is the power that is vested in an individual or organization to accomplish a
given task or responsibility.

After going over the difference and asking for examples from each charge nurse, have them
divide into groups of four to five, giving them a form to work on. For about 15 minutes, the
charge nurses will meet and add additional information they gained from hearing other
presentation topics.

The forms distributed cover areas on the management of patient flow, quality/risk, delegation,
etc., and each has specific duties associated i.e. prioritization of flow, discharge planning,
clinical outcomes, key performance indicators, etc.

The workshop continues delving deeper into the responsibility of a charge nurse. Some of
these responsibilities include:
 Ensuring safe and effective clinical practices are occurring
 Enhancing the patient's experience by performing patient rounds and building
relationships
 Managing the people and patient flow
 Contributing to the delivery of the organization's objectives
 Acting as a change agent by being the catalyst for change using evidence-based,
thereby, leading development and ensuring clinically effective practice
 Being a role model to staff members by creating an atmosphere that empowers
them to contribute to the delivery of high quality care.

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Part 1- Roles and Responsibilities of the Charge Nurse

When speaking on the topic of accountability, remember to discuss in detail what will be
expected of each charge nurse when it comes to accountability. Remind them that as charge
nurses they will be accountable for/to:
 All customers, eg: staff, patients, families, visitors, physicians, as well as the
organization
 Communicating deviations in safe and effective practice
 Supporting and demonstrating the organization's missions and values
 Being the change agent
 Setting the expectations

Most importantly, the charge nurse will be accountable for being the role model by practicing
what they preach.

Authority is the last topic discussed because it is a difficult topic. Authority generally creates
many questions and concerns, and requires additional time for dialogue.

There is very little literature on the topic of a charge nurse's authority is because it varies given
the organization's objectives, policies, and procedures. However, what a charge nurse has the
authority to ensure is a common theme among organizations.

Charge nurses have the authority to ensure:

 Assignments are completed and covered based on a patient's needs
 A schedule is completed and any gaps are dealt with
 Tasks are delegated effectively and the care is supervised
 Decision-making in the areas where they are both responsible and accountable for,
eg: guidance to those with less experience, requesting additional staff when census
rises
 Staff accountability, especially if patient safety or the performance of patient care
duties is compromised, adherence to regulatory or organization requirements are
not being followed.
The role encompasses many functions, along with having responsibilities, accountability, and
authority.
Advising the charge nurse with proper education, training, backing from leadership, and a
tangible job description will allow them to function and produce positive results.
It is the skills the charge nurses possess:
 Technical proficiency
 Knowing other staff and looking out for their welfare
 Keeping staff informed
 Ensuring the tasks are understood, supervised, and accomplished
 Making sound and timely decisions
 Developing a sense of responsibility in the staff members and peers
 Setting an example

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Part 1- Roles and Responsibilities of the Charge Nurse

Leading your Team

“Finding good players is easy. Getting them to play as a team is another story”. - Casey
Stengel

Many nurses today are reluctant to take charge nurse roles. Charge nurses are unsung heroes
in today’s health-care environment. Their nursing leadership is right at the point of care and
critical to better patient outcomes. Yet, we know that many nurses assume charge nurse roles
without the skills that they need to effectively lead teams.

The Charge Nurse Role in Today’s Health Care Environment

“I am just not sure that I am ready to take charge. I know I have leadership skills but I am a
relatively new nurse. Am I really ready to assume all this responsibility? My nurse manager
thinks I have excellent leadership potential and is encouraging me to take the plunge. But what
if the staff does not respect me in the role and what if I fail?”

This is a concern that many nurses have before they begin the charge nurse role. Charge
nurses are expected to lead staff on their team, while managing the work systems and
processes on their units to insure that the needs of patients are met. It is a skillful balancing
act and can be very challenging. With 12 hour tours, there is often little continuity in the
membership of the team. Yet despite the challenges, embracing the role of charge nurse can
provide enormous professional satisfaction and a tremendous leadership growth experience.

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Part 1- Roles and Responsibilities of the Charge Nurse

Role Responsibilities

Charge nurses have accountability to the organization, staff and patients for the care that is
delivered. Organizations depend on charge nurses to be the gate keepers for safe and efficient
care, which meets regulatory requirements and ensures an economic return.

Charge nurses conduct real time assessments of unit productivity during various points
throughout the shift. They often determine how staff resources will be distributed on their
shift, or the upcoming shift in response to changing institutional and patient needs. Charge
nurses must also be familiar with the institutions policies and procedures in order to navigate
through what is often a very complex system.

As a charge nurse, you will be interacting with physicians related to patient care issues,
interfacing with support departments and facilities management to ensure patients have the
needed supplies, medications and an environment conducive to healing. You also have direct
patient and family contact, often with difficult patient or family dynamics and complex care
management challenges. As the health-care environment is changing, charge nurses now
often take on additional duties such as oversight of core measures performance and hourly
rounding.

Charge nurses set expectations for staff and provide support so that staff can carry out those
expectations. They are expected to hold staff accountable for performance of their
professional patient care duties, adherence to regulatory requirements, and documentation of
this essential information. The charge nurse serves as the conduit for information provided
from staff to management and from management to staff. Charge nurses assist with the
orientation, training and professional development of staff. They play a key role in the
competency assessment process and make sure that the team works together effectively.

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Part 2- Leadership Styles

Objectives:
 To differentiate between a manager and a Leader
 To understand the process of leadership and identify a true leader
 To describe the various leadership styles
 To identify the different leadership skills
 To discuss the secret blend

Effective Leadership:
…. No one is a born leader. Leadership can be learned and developed.

Leadership is:
Relationship management.
 An interactive conversation that pulls people toward becoming comfortable with the
language of personal responsibility and commitment.
 Not just for people at the top. Everyone can learn to lead by discovering the power that lies
within each one of us, about having enough courage and a spirit to make a significant
difference.
 A process by which a person influences others to accomplish an objective and directs the
organization in a way that makes it more cohesive and coherent.
 Acknowledging others and display personal accountability.
 Creates the atmosphere in which people turn challenging opportunities into remarkable
successes.
 Ultimately about creating a way for people to contribute to making something extra
ordinary happen.
 Albert Einstein once said, “We should take care not to make the intellect our God; it has of
course, powerful muscles but as personality. It cannot teach; it can only serve.

The Two Most Important Keys to Effective Leadership

 Trust and confidence in leadership is the single most reliable predictor. Effective
communication by leadership was the key to winning organizational trust and confidence.
 The staff should understand the hospital’s overall business strategy.
 They must understand how they can contribute to achieving these objectives.
 Sharing information with the staff on both how the health care organization is doing and
how the staff’s own unit is doing.
 So in a nutshell -- you must be trustworthy and you have to be able to communicate a
vision of where the unit needs to go.

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Part 2- Leadership Styles

 Formal Leadership:
 Described in one’s job description
 Nurse Manager /Supervisor
 Depends on personal skills
 Reinforced by organizational authority and position

 Informal Leadership:
 Is exercised by an individual who does not have a specified management role
 A nurse whose thoughtful and concerning ideas substantially influence the efficiency of
workflow is exercising leadership skills.
 And personal skills in persuading - guiding others

 Role model:
 When they respect you as a leader, they do not think about your attributes, rather, they
observe what you do so that they can know who you really are.
 They use this observation to tell if you are an honourable and trusted leader or a self-
serving person who misuses authority to look good and get promoted.
 Self-serving leaders are not as effective because their employees only obey them, not
follow them.
 They succeed in many areas because they present a good image to their seniors at the
expense of their workers.

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Part 2- Leadership Styles

Principles of Leadership:
Know yourself and seek self-improvement:
 Be technically proficient - As a leader, you must know your job and have a solid familiarity
with your employees' tasks.
 Seek responsibility and take responsibility for your actions - Search for ways to guide your
organization to new heights. And when things go wrong, they always do sooner or later --
do not blame others. Analyse the situation, take corrective action, and move on to the next
challenge.
 Make sound and timely decisions - Use good problem solving, decision making, and
planning tools.
 Set the example - Be a good role model for your employees. They must not only hear what
they are expected to do, but also see. We must become the change we want to see -
Mahatma Gandhi
 Know your people and look out for their well-being - Know human nature and the
importance of sincerely caring for your workers.
 Keep your workers informed - Know how to communicate with not only them, but also
seniors and other key people.

Factors of Leadership
There are four major factors in leadership:
 Follower
 Different people require different styles of leadership.
 A new hire requires more supervision than an experienced employee.
 A person who lacks motivation requires a different approach than one with a high
degree of motivation.
 You must know your people!
 Leader
 It is the followers, not the leader who determines if a leader is successful.
 If they do not trust or lack confidence in their leader, then they will be uninspired.
 To be successful you have to convince your followers, not yourself or your
superiors, that you are worthy of being followed.
 Communication
 What and how you communicate either builds or harms the relationship between
you and your employees.
 Situation (all are different):
 What you do in one situation will not always work in another.
 Use your judgment to decide the best course of action and the leadership style
needed for each situation.
 For example, you may need to confront an employee for inappropriate behavior, but
if the confrontation is too late or too early, too harsh or too weak, then the results
may prove ineffective.

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Part 2- Leadership Styles

Difference between Management and Leadership

Managers are people who do things right, while leaders are people who do the right thing.

Management:
Managers:
 Rely on systems, task-orientated.
 Think of the everyday problems they are faced with in their planning.
 Managers focus on getting things done, and react to everyday pressures and events.
 Prefer to maintain order and sustain the present situation, but are willing to make smaller
fast order a functional changes when the need arises.

The function of the manager is to:

 Clarify the organizational structure.
 Choose the means by which to achieve goals.
 Assign and coordinate tasks.
 Developing and motivating as needed.
 Evaluate outcomes and provide feedback.
 All good managers are also good leaders the two go hand in hand. But, one way be a good
manager of resources and not be much of a leader of people. Or, one way be good leader,
and not manage well. The most important fact - both roles can be learned.

Leadership
Leaders:
 Rely on people, who use interpersonal skills to influence the staff to reach or accomplish a
specific goal.
 Will seek opportunities to create correctness among the staff to promote high levels of
performance and quality nursing care.
 Empower others and create meaning.
 Facilitate learning and develop knowledge.
 Thinking reflectively and use effective communication skills.
 Solving problems, making decisions, and working with others.

Leaders are:
 More concerned with long term and strategic planning.
 Concerned with the future - they will develop a vision of the future and a strategy to get
there a guiding, influencing role sees himself/herself as serving others has an active
attitude towards goals.
 Formulates goals to influence the organization to bring about change and to create a
different future.
 More detached emotionally.

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Part 2- Leadership Styles

Leaders take real risks because:

 They have faith in other people.
 Faith in the judgment of their key executives
 Focus on making the work for their followers purposeful in meaningful in order to motivate
them.

When faced with changed, leaders:

 Actively effect second - order or organizational/structural change to create a better future.
 Change the way people think about the disability and possibility of innovations and
developments.
 Use intuitive teaching and other than rational, prepared to create describe in order to effect
radical changes and they use power to change human, economic and political relationships.

Leaders use practices to transform:

 Values into actions.
 Visions into realities.
 Obstacles into innovations.
 Separateness into solidity.
 Risks into rewards.

Thus, good leaders are:

 Made, NOT born.
 Have the desire and willpower, to become an effective leader.
 Develop through a never-ending process of self-study, education, training, and experience.
 Are continually working and studying to improve their leadership skills; they are NOT resting
on their laurels.
 Leaders generate excitement & show enthusiasm.
 Clearly define their purpose and mission.
 Leaders understand people and their needs.
 They recognize and appreciate differences in people.
 Individualizing their approach.
 Leaders also have a way that they worth with them staff to earn and hold trust.
 They have a genuine concern for others, and help to achieve their potential.

Leaders influence many aspects of work. They:

 Are the chief communicator of the group.
 Affect motivation by their behaviour.
 Are responsible for the group’s objectives.
 Being understood and achieved.

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Part 2- Leadership Styles

Leadership Theories:
Theory of leadership states that there are three basic ways to explain how people become
leaders.

 The Trait Theory

Some personality traits may lead people naturally into leadership roles. Successful leaders
possess certain special qualities that make them superior to their followers. Only some leaders
have:
 Energy
 Initiative
 Creativity
 Emotional maturity

 The Great Man Theory

This theory was based on the philosophy that few men are born to lead, while many are born
to be led.
A crisis or important event may cause a person to rise to the occasion, which brings out
extraordinary leadership qualities in an ordinary person.

 Charismatic Theory
A nurse manager may be a leader because of charisma.
This inspirational quality, which some people possess, makes others feel better in their
presence.
Charismatic leaders inspire followers by obtaining emotional commitment from them and by
arousing strong feelings of loyalty and enthusiasm.

 The Transformational Leadership Theory.

It is the most widely accepted theory today and the premise on which this guide is based.
 People can choose to become leaders.
 People can learn leadership skills.

Behaviour-based Theory:
In the above view of leadership, personal traits provide only a foundation for leadership; real
leaders are made through education, training and life experiences. Behaviour - based theories
assume that effective leaders acquire a pattern of learned behaviours.

The manner in which manager make decisions directly reflects their leadership style.
 Autocratic leadership style
 Democratic/participation leadership style
 Liassez - faire leadership style
 Bureaucratic leadership style

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Part 2- Leadership Styles

 The Autocratic Leadership Style:

Autocratic leaders have little trust in employees and systematically exclude them from
decision-making.
These individuals are motivated by external forces, such as: Power, Authority & Need for
approval.

The leader makes all the decisions & uses: Conversion/ Punishment to change follower’s
behaviour and to achieve results.

A leadership style that:

 Assumes external forces motivate individuals, therefore, the leader makes all the decisions
and directs the followers’ behaviour.

 The Democratic Leadership Style:

Individuals are motivated by:
 Internal drives and impulses.
 Active participation in decisions.
 Want to get the task done.
 Participation.
 Majority rule in setting goals and working toward achievement.

Participation is a democratic leader’s value:

 Employee involvement, teamwork and team building.
 High levels of confidence in employees.
 Seek consensus in decision making.
 In this way, the participative leaders shares power.

A leadership style that:

 Assumes internal forces motivate individuals.
 The leader uses participation and majority rule to get the work done.

 The Laissez - Faire Leadership Style:

 Assumes that individuals are motivated by internal drives and impulses.
 Assumes that they need to be left alone to make decisions about how to complete
the work.
 Provides no direction or facilitation.
A leadership style that:
 Assumes individuals are motivated by internal forces and should be left alone to
complete work;
 The leader provides no direction or facilitation.

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Part 2- Leadership Styles
 The Bureaucratic Leadership Style:
 Assumes that employees are motivated by external forces.
 Do not trust followers or self to make decisions.
 Relies on organizational policies and rules to identify goals and direct worth processes.

A leadership style, that:

 Assumes individuals are motivated by external forces.
 The leader trusts neither followers nor self to make decisions.
 Relies an organizational policies and rules.

Four Types of Leaders:

 Authoritarian Leader: (high task, low relationship)
People who get this rating are very much task oriented and are hard on their workers
(autocratic). There is little or no allowance for cooperation or collaboration.

Heavily task oriented people display these characteristics:

 They are very strong on schedules.
 They expect people to do what they are told without question or debate.
 When something goes wrong they tend to focus on who is to blame rather than
concentrate on exactly what is wrong and how to prevent it.
 They are intolerant of what they see as dissent.
 It may just be someone's creativity.
 Difficult for their subordinates to contribute or develop.

 Team Leader: (high task, high relationship)

 Leads by positive example and endeavors to foster a team environment in which all
team members can reach their highest potential, both as team members and as people.
 They encourage the team to reach team goals as effectively as possible, while also
working tirelessly to strengthen the bonds among the various members.
 They normally form and lead some of the most productive teams.

 Country Club Leader: (low task, high relationship)

 Predominantly reward power to maintain discipline and to encourage the team to
accomplish its goals.
 Almost incapable of employing the more punitive coercive and legitimate powers.
 This inability results from fear that using such powers could jeopardize relationships
with the other team members.

 Impoverished Leader (low task, low relationship)

 A leader who uses a "delegate and disappear" management style.
 Not committed to either task accomplishment or maintenance.
 They essentially allow their team to do whatever it wishes and prefer to detach them
from the team process by allowing the team to suffer from a series of power struggles.

21
Part 2- Leadership Styles

Situational Leadership Theory:

In Situational Leadership, leadership is the act of providing the correct amount of supervision
(directing behaviour) and arousal (supportive behaviour), which in turn, produces the best
learning environment as shown in the model below:

Situational Leadership is a four-step model:

 The Directive Style: (also known as the telling style)

This style is selected when the staff does not possess the necessary abilities to perform or
carry out fundamental nursing care. There is, however a high degree of enthusiasm and
willingness to commitment among the staff. They require purposeful direction, as well as high
intensity supervision by the leader.

The leader gives specific instructions in respect of what should be done and how the task
should be performed and completed. The leader thus structures the tasks, exercise directive
control during the performance of the task and maintains high intensity supervision and low
intensity support to the staff. Thus the inability of the staff to perform the tasks require
directive guidance by the leader and that he or she not leave the staff members on his or her
own to complete the task. She or he exercises purposeful and directive control.

Under-supervision leads to: Miscommunication and a lack of coordination.

 Perception by subordinates that the leader does not care.
Over-supervision stifles: Initiative, Breeds resentment & Lowers morale.

The goal is to provide the correct amount of supervision and this is determined by the
employee’s skill and knowledge level.

 The Coaching Style: (also known as the selling style)

This style is exercised when the staff possesses minimal knowledge and skills to execute the
tasks and displays minimal willingness or commitment.
They require direction and supervision because of their lack of adequate experience.
They require support and recognition to foster their security, and self-confidence
The leader encourages two-way communication between her or him and the staff – explains
decisions and encourages decision-making by the staff, which is confirmed by the leader.
Supervision by the leader during task performance is intense, as is support to the followers

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Part 2- Leadership Styles

 The Delegating Style:

This style is exercised when the staff posses the necessary knowledge and skill to perform the
tasks and projects and to display the necessary willingness and commitment.

They have a high degree of responsibility and their level of professional maturity is adequate.
The leader delegates the entire task to the staff, and no supervision is required.
The leader and the followers accept shared accountability for the consequences in performing
the task.

 The Supportive Style: (also known as the participative style)

This style is exercised when the staff displays a high degree of expertise, but there is doubt
about their willingness or commitment to perform a task, or else it has not yet been proven
because the leader does not know the staff. Or the staff does not have the necessary self-
confidence to perform the task in view of its complexity. To be able to succeed in the applying
of this style, all the staff members must be involved in decision-making. The intensity of
supervision by the leader is low, but a high degree of support is give to emphasize recognition,
also listening to problems and acting as facilitator.

This style then also offers an opportunity for participative leadership.

The level of professional maturity of the staff is of such a nature that independent decision-
making, as well as creativity is encouraged. The cultivating of a sense of responsibility among
the staff is important in this style.

In this situation the leader applies various motivation strategies to increase the level of
maturity of the staff and to prepare them for the delegation style.

23
Part 2- Leadership Styles

Leadership Skills:
Leaders should not think of themselves as simply managers, supervisors, etc., but rather as
"team leaders." By understanding the personal work preferences and motivations of your team
members, you as an individual, rather than your position, will earn their real respect and trust.

 Promoting a cooperative atmosphere of openness:

 Exchanging ideas without fear.
 Open communication climate.
 Capability of dealing with any problem.
 Being a motivator.

 Supportiveness:
 Desire and willingness to help each other.
 The team’s goal above any individual agenda.
 Team members have a positive.
 Consistent, dependable behaviour attitude.

 Positive personality:
 Enthusiastic, optimistic.
 Self-confidence and self-awareness.
 Make decisions speedily and effectively.
 Problem-solving.
 Think outside the box.
 Consistent, dependable behaviour.

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Part 2- Leadership Styles

Leadership Qualities: The Secret Blend

 Integrity is:
 Leading with integrity means being the person you want others to be.
 Lays the foundation for trust and respect.
 Creating a set of values and then living true to them
 People are more apt to trust and respect you when what you say and what you do are one
and the same.

 Partnership is:
 The key to effective leadership is the relationship you build with your team.
 Sharing the big picture puts everyone on the same page.
 It is easier to get up the hill when you climb it together

 Affirmation is:
 Let people know that what they do is important.
 Leaders need to know their staff for who they are, beyond their job titles.
 Each individual on the team is unique.
 They don’t want a thank you - they want to feel valued:
 Praise is the easiest way to let people know they are appreciated.
 Each of us has the power to recognize the goodness in others.

 Perfecting the Blend is:

People will think for themselves when you quit doing it for them.
Leadership is the process of getting everyone to the place they are supposed to go.
The highest achievement as a leader is winning the respect and trust of your team

25
Part 3- Change Management

Objectives:
 Explain change management.
 Discuss and analyze the forces of change.
 Explain how to manage change.
 Recognize and manage resistance to change.

 Change management is the process of making something different from what it was.
 Change is inevitable, necessary for growth.
 Produces anxiety and fear.
 Even when planned, can be threatening and a source of conflict.
 Creates a sense of loss of the familiar.
 A grief reaction may still occur even if valued.
 Continual unfolding process rather that an event.
 Begins with the present state, moves through a
 transition period and ultimately comes to a desired state.
 Then begins again.
 Change Agent
 One who works to bring about change.
 Leaders initiate change, followers survive it. Reason
Type of
for
Change
The Change Process Change
1. Assessment
 Problem or opportunity. IDENTIFY
2. Planning Current
Scope THE
State
 Who, how, when. CHANGE
3. Implementation
 Design to gain the necessary compliance.
4. Evaluation Future
Concepts
 Evaluate effectiveness and stabilize the change. State

 Response to Change
 Varies according to degree of change.
 May affect all parts and layers of the organization multiple levels and groups.
 Change process must be coordinated and integrated.
 Set up an infrastructure to support change.

 Major Forces of Change

 Increased demands for quality.
 High levels of customer service and satisfaction.
 Greater flexibility in the structure of work organization and patterns of
management.
 The changing nature and composition of the workforce.

26
 Part 3- Change Management

Changes within the Organization

Force Example
Nature of the work force  More cultural diversity, increase in professionalism
 Many new entrants with inadequate skills
Technology  More computers and education
 TQM programs
 Re-engineering programs
 Security market crushes
Economic shocks  Interest rate fluctuations
 Foreign currency fluctuations
 Global competitors
Competition  Merges and consolidations
 Growth of specialty retailers
 Increases, university, college trends
Social trends  Delayed marriages by young people
 Increase in divorce rate

IMPLEMENT

Transition
Action Plan Biz Systems Management
Plan
Communication Readiness
Plan Review

Resistance Plan Escalation

Training Plan
Process

 Effects of Organizational Change

 Feelings of lack of identify.
 Lack of involvement.
 Lack of direction.
 Lack of affection.
 Feeling of being threatened and disorientated by challenge of change.

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Part 3- Change Management

 Requirement for Successful Change

 Dedicated workforce.
 Effective management of change.
 Leadership to accept that change impacts each person differently.

 Types of Change
 Planned change.
 Imposed change.
 Unplanned change.

 Planned Change
 Intentional and goal oriented.

 What is the Goal of Planned Change?

 To improve the ability of the organization to adapt
to changes in its environment.
 To change employer behaviour (individuals, groups).

 Examples of Planned Change

 Efforts to stimulate innovation. Process Changes
 Directed at responding to change in environment.
 Empower employees. People Changes
 Introduce work teams.
Behavior Changes
 Change Agents:
 Senior Executive Information Changes
 Manager
 Employees Cost of Change
 Outside consultants
Risk Assessment
 Changing Structure
 Organizational structure is defined by how tasks are divided, grouped and
coordinated.
 Change agent alter one or more of key elements in organizational design
 Can be combined, vertical, layers removed.
 Span of control widened to make organization “less bureaucratic”.
 More rules and procedures can be implemented to increase standardization.
 Increase decentralization to speed up to decision-making process.

 Changing Technology
 Introduction of new nursing, radical equipment
 SIS system – paperless records.

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Part 3- Change Management

 Changing the Physical Setting

 Layout of workspace should not be a random activity.
 Consideration for work demands:
 Formal interaction requirements.
 Social needs.
 Interior design.
 Equipment placement.

 Changing People
Help individuals/ groups to work more effectively -change attitudes, behaviour by:
 Communication process.
 Decision-making.
 Problem solving.
 Create on environment of trust and shared commitment.
 Involve staff in decisions and actions.
 Positive advantages to be gained from participation.
 Staff understands reasons for change.
 Avoid change for sake of change.
 Full participation of all staff concerned before introduction of new equipment or
systems.
 Communicate information.
 Proposed change.
 Benefits.
 Implications.
 Encourage staff to contribute ideas, suggestions and experiences.

 Maintain Momentum of Change

 Discuss problems directly with staff.
 Use steering groups, liaison committee.

 Resistance to Change
 Individual-perceptions, personalities and
organizational needs.

THE APPROACH
Role of
Stakeholder Resistance to
Change
Analysis Change
Management

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Part 3- Change Management

 Individual Resistance
 Habit.
 Life is complex: rely on habits and programmed responses.
 When confronted with change: resistance.
 Security: people with high need for security resist change.
 Economic factors.
 Concern that changes will lower one’s income.
 Loss of income or status
 Fear: ambiguity and dislike for uncertainty, failure.

 Organizational Resistance
 Structural inertia: organization has built-in mechanisms to produce stability.
E.g. , training in specify roles and skills, and job descriptions
 People are hired or chosen for fit, shaped and directed to behave in certain ways.

 These structural inertia act as counter balance to sustain stability in a change

 Limited focus of change - organization made up have inter departmental systems
changes in one affects others.
 Group Inertia-An individual may be willing to accept change but group norm act as
constraint e.g., union resisting unilateral change.
 Threat to expertise - change may threaten the expertise to specialized groups.
 Threat to established power relations-redistribution of decision-making authority.

 Recognize Resistance to Change

 We tried that before.
 No one else does it like that.
 We’ve always done it this way.
 We can’t afford it.
 We don’t have the time.
 It will cause too much commotion.
 Let’s wait awhile. KPI Reporting
 Every new boss wants to do something different.

Sensing Management
(Behaviors) Review
MONITOR

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Part 3- Change Management

Overcoming Resistance

 Education and Communication

 Communicate with employees to help see logic of change.
 One-on-one discussions, memos, group presentations or reports.

 Participation
 Involve resisters in decision making.
 Obtain commitment to increase quality of change.

 Facilitation
 Employee counselling and therapy, if fear and anxiety.
 New skills training.
 Short paid leave of absence may facilitate adjustment.

 Negotiation
 Exchange something of value to decrease resistance if resistance is with few
powerful individuals.

 Manipulation
 Distorting, twisting facts to appear attractive, withholding undesirable information.
E.g. failure to accept pay cut will result in closure organ.

 Co-optation
 “Buy-off “leaders by giving them a key role in change decision.
 Get endorsement of leader.

 Coercion
 Direct threats / force upon resisters.
E.g., transfer, loss of promotions, negative performance evaluations.

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Part 3- Change Management

Approaches to Managing Organization Change

**Unfreezing-Movement-Refreezing**
 Levin’s Three-Step change model.
 Unfreezing the status quo = equilibrium.
 Movement to new state.
 Refreezing new change to permanent.
 To overcome pressures of individual resistance and group conformity =>unfreezing is
necessary.

Unfreezing
 Increase driving forces-direct behaviour from status quo.
 Restraining forces-hinder movement from equilibrium.
 Combine first 2 approaches.

DRIVING FORCES use positive incentives:

 In pay to accept transfer.
 Pay for moving expenses.
 Low cost mortgage funds.

RESTRAINING FORCES –Individual counselling

 Change implemented refreezes to sustain over time.
 Stabilize new situation by balancing driving and restraining forces.

Activity- Scenario
 Recall a situation staff resisted change.
 Think back of this situation and reflect on the following:
 What led to the resistance?
 What are the reasons people gave for their resistance?
 How did the situation make you feel?

32
Part 4- Strategic Planning

Objectives:
 Know the strategic and operational plan definition
 Know the role as Charge Nurse regarding strategic planning at KFMC
 Define Nursing values and main objectives
 Utilize key documents such as the KFMC Vision, Mission and HOPE Model during the
planning process

OUTLINE

1
Strategic Planning
Strategic plan definition
Operational plan definition
Strategic vs. Operational Planning

Strategic And Operational Plan Tools

2
Vision statement
Mission statement
Values

3
Strategic And Operational Plan Tools
Goal and Objectives
Policy and Procedure

4 SWOT Analysis
Strength Weakness
Opportunity Threats

33
Part 4- Strategic Planning

Strategy
Implementation
• Develop Vision & Mission • Implement the • Measure &
Statement long and short Evaluate
• Establish Goals Objectives term Plan Performance
• Select The Strategies
Strategy Strategy
Formulation Evaluation

Strategic Plan
The strategic plan outlines the organization's direction for the future and a broad framework
of goals and objectives to be achieved in line with this direction.

The strategic plan typically applies across a three to five-year period, and identifies the areas
that need particular attention during this period to ensure the organization gets to where it
wants to be.

Operational Plan
The operational plan details how the organization will accomplish the goals, objectives and
strategies outlined in the strategic plan.

It includes the actions to be undertaken in line with the strategic plan objectives, who are
responsible for carrying out these actions, and the time frames, costs and key performance
indicators associated with these actions.

The operational plan should apply to the life of the strategic plan, but should be reviewed on a
regular basis to ensure sufficient progress is being made towards achieving the objectives and
so priorities can be revised as necessary

Strategic Versus Operational Planning

In strategic planning, management develops a mission and long-term objectives and
determines in advance how they will be accomplished.

In operational planning, management sets short-term objectives and determines in advance

how they will be accomplished.

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Part 4- Strategic Planning

Vision Statement
Is a mental image or the imagination to see something that is not actually visible. the preferred
future).

It will include the following components:

What the organization will be.
What the organization will do/achieve.
Who the organization will work with (the target group).

Key words:
Modern, successful, strong, high-profile, well-managed, provision, professional, active, healthy,
motivational, stable, pioneer
industrious, responsive, pro-active, fun and inclusive, Benchmark Specialized

Vision
Mission Objectives
Statement
Statement

Values
Goals
Statement

Mission Statement Values Statement

The purpose for which the organizations It is the worth, usefulness, or importance of
exist. some thing the guiding value for general
hospital are as follows:
A mission statement should include:
 what the organization is  Quality
 what the organization does/achieves  Compassion
 who the work is aimed at (the target  Fairness
group)  Integrity
 Innovation
 Fiscal responsibility.

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Part 4- Strategic Planning

Goals & Objectives

State actions for achieving the mission and Vision

The more quantitative the objectives the more likely its achievement to receive attention and
the less likely it is to be distorted.

Policies & Procedures are a means of accomplishing goals and objectives

SWOT Analysis
Is an effective planning tool used to understand the Strengths, Weaknesses, Opportunities,
and Threats involved in a project or in a business.

It usually involves specifying the objective of the organization or project and identifying the
internal and external factors that are supportive or unfavourable to achieving that objective.

A SWOT analysis is often used as part of a strategic planning process

Often used during strategic planning for identifying possible areas for change, or refining and
redirecting efforts mid plan.

Internal Factors
STRENGTHS WEAKNESSES

SWOT Analysis
OPPORTUNITIES THREATS

External Factors
Positive Factors Negative Factors

36
Part 4- Strategic Planning

Strengths Opportunities
 What advantages does your organization  What good opportunities can you spot?
have?  What interesting trends are you aware of?
 What do you do better than anyone else?
 What unique or lowest-cost resources  Useful opportunities can come from such
can you draw upon that others can't? things as:
 What do people in your market see as  Changes in technology and markets on
your strengths? both a broad and narrow scale.
 What is your organization's Unique  Changes in government policy related to
services your field.
 Consider your strengths from both an  Changes in social patterns, population
internal perspective, and from the point profiles, lifestyle changes, and so on.
of view of your customers and people in
your market. Threats
 What obstacles do you face?
 What are your competitors doing?
Weaknesses  Are quality standards or specifications for
 What could you improve? your job, products or services changing?
 What should you avoid?  Is changing technology threatening your
 What are people in your market likely to position?
see as weaknesses?  Do you have bad debt or cash-flow
 What factors lose your services? problems?
 Could any of your weaknesses seriously
threaten your business?

Internal Factors
STRENGTHS WEAKNESSES

SWOT Analysis
OPPORTUNITIES THREATS

External Factors
Positive Factors Negative Factors

37
Part 5- Organizing

Objectives:
 Organize unit activities in a structured manner to ensure the smooth running of the
unit.
 Compile a duty schedule, bearing in mind the principles of duty scheduling.
 Practice effective delegation whilst exercising a supervisory role.
 Implement effective communication at unit level.

Organizing refers to:

 The process of translating plans into action.
 Orderly structuring and division of tasks and responsibilities to ensure smooth running of
the unit.
 Creating order in the unit.
 Bring resources together, use them effectively to achieve objectives.

Organizing involves different aspects:

 Departmentation
 Span of Control
 Delegation of Authority
 Establishment of superior-subordinate relationship
 Organization is a process and a structure

Step 1:
Reflect on Plans and
Objectives

feedback

Step 5:
Step 2:
Evaluate results of
Establish major tasks
organizing survey

Step 4: Step 3:
Allocate resources and Divide major task into
directives for subtasks subtasks

38
Part 5- Organizing

Organizational Structure
 Intentionally created
 Provides a framework
 Use of chart
 Provides formal picture
 Specifies which individuals will work as subordinates to which superiors
 Defines interpersonal relationships that should exist between individuals and work
 Promotes co ordination of functions and activities

Organizing

Organizational Structures

Duty Scheduling

Effective Delegation

The Role of Supervision in

Delegation

Effective Communication

39
Part 6- Quality Improvement

Objectives:
 Identify opportunities for improvement
 Utilize the FOCUS-PDCA approach to improve processes

Continuous Quality Improvement

Continuous quality improvement (CQI) is a concept that came out of the business
industry. Rather than creating a culture of blame if things do not go well, the focus is on a
team approach to improvement that rewards the group when things get better.

CQI has been adapted for health care in several ways. One acronym for this is FOCUS-PDCA
work:

FOCUS - PDCA is an extension of the Plan, Do, Check, Act (PDCA) cycle sometimes called the
Deming or Shewhart cycle.

FOCUS-PDCA it is a simple, logical, and systematic approach to accomplish incremental

improvement of an existing process, or to redesign an existing process or design an essentially
new process or in problem solving.

The guidelines for using FOCUS-PDCA are:

 If a problem analysis is needed,
 If a task is either new or unique. A routine task normally doesn't necessitate a PDCA
unless a major new factor is introduced,

First, FOCUS on a particular issue.

 Find a process to improve
 Organize to improve a process
 Clarify what is known
 Understand variation
 Select a process improvement

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Part 6- Quality Improvement

Then, move through a process improvement plan, PDCA

Plan: create a timeline of resources, activities, training and target dates. Develop a data
collection plan, the tools for measuring outcomes, and thresholds for determining when
targets have been met.
Do: implement interventions and collect data.
Check: analyze results of data and evaluate reasons for variation.
Act: act on what is learned and determine next steps. If the intervention is successful,
work to make it part of standard operating procedure. If it is not successful, analyze
sources of failure, design new solutions and repeat the PDCA cycle.

ANY PI project should begin with FOCUS if a process already exists. If a process does not
exist, begin with PDCA.

F-O-C-U-S
 Find a process that needs improvement
 Organize a team who is knowledgeable in the process
 Clarify the current knowledge of the process
 Understand the causes of variation
 Select the potential process improvement

P-D-C-A
 Plan the improvement/data collection
 Do the improvement/data collection/data analysis
 Check the data for process improvement
 Act to hold the gain/continue improvement

F O C U S

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Part 6- Quality Improvement

FOCUS

F- FIND
 What is the process?
 Is there a simple clear description of the process?
 What are the process problems?
 Who will benefit from the improvement in the process?
 How does it fit within the hospital’s system and priorities?

O- ORGANISE
 Determine team size, members who represent various levels in the organization.
 Select members who know and work with this process.
 Is technical guidance and support available?
 Document the progress of the team.

C- CLARIFY
 Who are the customers?
 What are their needs?
 What is the actual flow of the process?
 Is there needless complexity/redundancy?
 What are the outcomes/best way for the process to work?

U- UNDERSTAND
 What are the major causes of variation?
 Which key characteristics are measurable?
 What.. Who.. Where.. When.. How will data be collected?
 Does the data reflect common or special cause?
 Which causes of variation can we change to improve the process?

S- SELECT
 Select a portion of the process to improve.
 Determine the actions that needs to be taken to improve the process.
 Must be supported by documented evidence.

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Part 6- Quality Improvement

CAUSE & EFFECT – FISHBONE DIAGRAM

Determine and define the major categories which describe the system or process
under review, e.g.,

5Ps: 5Ms:
 People  Manpower
 Provisions  Materials
 Policies  Machines
 Procedures  Methods
 Place  Measurements

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Part 6- Quality Improvement

PDCA

P- PLAN
 What is the process improvement to be piloted?
 Who will do the pilot?
 How will it be piloted?
 Where will it be tested?
 When will it be tested?
 What data must be collected to measure the improvement?

D- DO
 The improvement.
 Data collection.
 Data analysis.

C- CHECK - The results and lessons learned.

 Did the process improve as expected?
 Does the data support the improvement?
 How could the team efforts be improved?

A- ACT
 What parts of the improved process need to be standardized?
 Policies or procedures to be revised?
 Who needs to be made aware of the change?
 What are the next steps in CONTINUOUSLY improving this process?

44
Part 7- Delegation
Objectives:
 To understand key terms related to delegation.
 To be aware of the principles of delegation.
 To identify barriers of delegation.
 To know the when, where and how of delegation.
Definitions:
 Delegation
 Responsibility and authority are transferred but the delegator remains accountable.
 Responsibility
 Obligation to accomplish a task.
 Authority
 The right to act.
 Accountability
 The act of accepting ownership of the results or lack thereof.

Principles of Delegation:
 Select the right person. Choose someone who is capable of doing the task, and give that
person the accountability and authority to do it.
 Delegate the good and the bad. Delegate interesting, rewarding, and challenging projects, too.
 Take your time. Your subordinate will need time.
 Delegate gradually. Do not try to transfer all responsibility overnight.
 Delegate in advance. Try not to wait for a problem to develop before delegating a task.
 Delegate the whole. Delegate a complete project or action to one person as much as possible.
 Delegate for specific results. Describe the specific results you expect.
 Avoid gaps and overlaps. A gap is a job for which no one has been assigned responsibility. An
overlap is when two or more people have responsibility for the same job.
 Consults before you delegate. Delegation flows both ways.
 Leave the subordinate alone. Once delegation has been made let him do it.
 Responsibilities will be delegated, but not accountability.
 Accountable. The supervisor will remain accountable for all delegated duties – the person who
accepts the task will also be accountable
 Competence. Ensure staff competence and be realistic
 Scope of practice. Delegate within scope of practice.
 SUPERVISE and Monitor progress periodically and provide the necessary support.

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Part 7- Delegation

Barriers to Delegation
A variety of obstacles to effective delegation can be found in the delegator, the delegatee, and
possibly, the situation itself.

Barriers in the Delegator

 Preference for operating by oneself.
 Perfectionism
 “I can do it better myself “ fallacy.
 Only after the manager accepts the idea that the work gets done through other
people will the manager be able to make full use of delegation.
 Lack of experience in the job or in delegating.
 Insecurity.
 They are afraid that the delegate will fail.
 They are afraid that the delegate will do it better than they do.
 They are afraid that they will be accused of dumping.
 Fear of being disliked.
 Lack of confidence in subordinates.
 To remedy this situation, either education through staff development or programs
should be offered to help the employee to improve on the performance problem.
 Lack of organizational skill in balancing workloads.
 Failure to delegate authority commensurate with responsibility.
 Uncertainty over tasks and inability to explain.
 Disinclination to develop subordinates.
 Failure to establish effective controls and follow-up.

Barriers in the Delegatee

 Lack of experience.
 They don’t think they are qualified.
 Lack of competence.
 Previous efforts have failed.
 Avoidance of responsibility.
 They lack confidence that the delegator will support them.
 Overdependence on the boss.
 They don’t think they will have enough authority.
 Disorganization.
 They don’t think they have the time.
 Overload of work.
 They think they are being manipulated or dumped on.

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Part 7- Delegation

Barriers in the Situation:

 One-person-show policy.
 No toleration of mistakes.
 Criticality of decisions.
 Urgency, leaving no time to explain (crisis management).
 Confusion in responsibilities and authority.
 Understaffing.

WHERE and WHEN to Delegate:

 Routine Tasks: activities that may be parcelled out to subordinates when you are not
inclined to de them yourself.
 Tasks for which you do not have time: when more urgent matters occupy your attention,
these may be passed along to a capable subordinate.
 Problem Solving: usually of a low or medium priority area.
 Change in your own job emphasis: as a practical matter, delegate “old” aspects of his or
her responsibility to subordinates.
 Capability Building: may be used to increase the capability of individual subordinates.

When NOT to Delegate:

 The power to discipline.
 This is the backbone of executive authority.

 Responsibility for maintaining morale.

 You may call on others to help carry out assignments that will improve morale.
 You can not ask anybody else to maintain it.

 Overall control.
 No matter how extensive are the delegations, ultimate responsibility for final
performance rests on your shoulders.

 The hot potato.

 Do not ever make the mistake of passing one along, just to take yourself off the
spot.

 Jobs that are too technical.

 Completely beyond a subordinate’s skill.

 Duties that involve a trust or confidence.

 Handling confidential department information and dealing with the personal affairs
of one of your staff.

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Part 7- Delegation

HOW to Delegate
Many charge nurses find it difficult to delegate tasks to other members of their health care
team. When done well, delegation can be a very effective management tool. It frees
professional nurses to attend to more complex client needs, develop the skills of nursing
assistive personnel and promote cost containment for the organization. Ineffective delegation
or a lack of follow-up supervision for tasks delegated can result in errors or omissions of care.
Effective delegation begins with a clear understanding of your professional responsibilities as
a Registered Nurse.
 Select and organize the task:
 Establish a priority order.
 Select the appropriate person:
 Matching the qualifications.
 Instruct and Motivate the person:
 The necessity for you and the employee to achieve agreement on the results
you expect.
 Maintain Reasonable Control:
 (Over control; under control) try to avoid being a crutch for the employee.

Steps in Delegation
Step One – Assessment and Planning
Goal – the Right Task, Under the Right Circumstances to the Right Person
 What are the needs and condition of the patient?
 What level of clinical decision making and assessment is needed?
 What is the predictability of the patient’s response to care?
 What is the potential for adverse outcomes associated with the performance of
tasks and functions?
 What are the cognitive and technical abilities needed to perform the
activity/function/task?
 Which team member has the scope of practice, skills, competencies and experience
to perform the tasks needed?
 What is the context of the situation and the environment – was the patient just
admitted or did they have recent surgery, is it a high acuity environment such as an
intensive care unit or ER?
 What level of interaction/communication is needed in the care of the patient and
with whom?

Step Two – Communication

Goal – the Right Direction
 How is the task to be accomplished?
 When and what information is to be reported?
 What is the process for seeking clarification about delegated care?
 What are the communication expectations in emergency situations?

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Part 7- Delegation

Step Three – Supervision and Surveillance

Goal – the Right Supervision
 What level of supervision and observation does the charge nurse need to provide?
 What will be the frequency of monitoring and observing care?
 How will the completion of care be verified and documented?
 How will unexpected changes in a patient’s condition be managed?

Step Four – Observation and Feedback

Goal – Assessment of the Effectiveness of Delegation
 Was the delegation successful?
 Is there a better way to meet the needs of the patient?
 Is there a need to adjust the plan of care?
 Were there learning moments for staff or charge nurse?
 Was appropriate feedback and follow-up provided by the charge nurse?

During their shift of responsibility, charge nurses manage people, patient flow, use of
equipment, and unit communication to ensure that the patients and staff get the support that
they need. In order to manage all of these responsibilities, charge nurses must be able to
effectively delegate and supervise care. The delegation of nursing care is both an art and a
science. The science to delegation involves understanding licensure responsibilities from a
legal standpoint and the policies of agencies where nurses work. The art of delegation
involves effective communication with members of the health care team.

Five (5) R’s of Delegation:

 Right tasks: Plan ahead.
 Right person: Select the most capable personnel.
 Right direction or communication: Communicate goal clearly.
 Right supervision or feedback: Provide guidance and evaluate performance.
 Right circumstances: Assess the situation and the person.

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Part 8- Supervision

Objectives:
 To persist in the delivery of high quality health care services
 To assist in the development of staff to their highest potential
 To interpret the policies, objectives etc
 To plan services cooperatively & to develop coordination to avoid duplication
 To develop standards of service 7 methods of evaluation of staff & services
 To assist in problem solving related to staff, administrative and operations matters
 To evaluate the care and service rendered.

Definition:
A cooperative relationship between a leader and one or more persons, to accomplish a
particular purpose: (Lambertson)

The Purpose of Supervision

 The quality of work depends directly on the degree of supervision
 Intensity of supervision should always depend on supervisor ratio
 Establish a span of control

Function of Supervision
 Administrative function
 Teaching
 Helping
 Linking
 Evaluation

Function of Supervision in Directing

 Orientation of New Staff
 Assessment of workload of individuals & Groups
 Arranging the flow of activities
 Coordination of efforts
 Promotion of confidence of staff & staff Cohesion

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Part 8- Supervision

Qualities of a Supervisor Tools for Supervision

 Thoroughness  Observation & Supervisory Rounds
 Fairness  Check Lists
 Imitative  Printed manuals, Policies, Procedures
 Tactfulness  Written & Verbal Reporting
 Enthusiasm  Records, including anecdotal Records
 Emotional intelligence
 Professional & Clinical Competence  Follow Up & Evaluation
 Facilitating the flow of communication  In- Service Education
 Raising the level of motivation
 Instilling confidence in staff
 Acknowledge achievement of staff
 Precise Record Keeping
 Positive Attitude
 Teaching Ability
 Interpersonal & Communication Skills

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Part 9- Communication

Objectives:
 Identify the components of effective communication.
 Recognize the climate for effective communication.
 Describe verbal and non-verbal communication.
 Define techniques that will improve listening skills.

“In a leadership role, one must have excellent interpersonal communication skills. These are,
perhaps, the most critical leadership skills. The ability to communicate effectively often
determines success as a leader/manager.” (Marquis and Huston, 2006)

The Communication Process

Communication is the complex exchange of thoughts, ideas or information on at least two
different levels: verbal and nonverbal. Communication begins the moment two or more people
become aware of each other’s presence.

In all communication, there is at least one sender, one receiver and one message. There is also
a mode, or medium, through which the message is sent, such as verbal, written or nonverbal.

Communication is a complex, ongoing, dynamic process in which participants share meaning in

am interaction. The goal is a common understanding of the message sent and the message
received.

Communication is influenced by:

 Past conditioning
 Present situation
 Each person’s purpose in the current communication
 Each person’s attitude toward self, the topic and each other

Communication Climate
An internal and an external climate exist in communication.
 The internal climate includes the values, feelings, temperament and stress levels of
the sender and receiver.
 The external climate includes weather conditions, temperature, timing, and the
organizational climate. It also includes status, power and authority as barriers to
manager-subordinate communication.

Both sender and receiver need to be sensitive to the internal and external climate, because
the perception of the message is altered depending on the climate that existed when the
message was sent or received. If an insecure manager is called to a meet with superiors during
a time of strict layoffs, he/she will view the message with more concern than a manager that is
very secure in their role.

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Part 9- Communication

Communication facts:
 Working people are engaged in communication 70% of the waking day – approximately 11
hours and 20 minutes.
 Of that time, 45% is spent listening, of which 50% will be forgotten within 24 hours, and
another 25% within 2 weeks.
 After a 10 minute speech, we remember 50% of what we heard. 25% is considered a good
retention level.
 A person can listen 4 times faster than the 125-150 words per minute that someone can
speak.
 More than 80% of a manager’s time is spent on communication:
 Reading 16%
 Writing 9%
 Speaking 30%
 Listening 45%

Communication versus Information

Communication involves perception and feelings.
Information is logic, it is formal, impersonal and unaffected by emotions, values, expectations
and perceptions.

Modes of Communication
 Written
 Memos, faxes, emails
 Oral
 Face to face
 Groups
 Telephone

If a message is important, multiple methods of communication should be used.

Verbal methods are said to be:

 7% verbal – word choice
 38% vocal – oral presentation
 55% facial expression

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Part 9- Communication

Causes of Distorted Communication

 Intrasender conflict: the nonverbal message is incongruent with the verbal message.
 Intersender conflict: arises when there are conflicting messages from different sources
 Using strong judgmental words
 Speaking too fast or too slow
 Using unfamiliar words
 Giving too much detail

Nonverbal Communication
“What you are speaks so loudly I cannot hear what you say.” (Ralph Waldo Emerson, 1998)

Because nonverbal behavior can be and frequently is misinterpreted, receivers must validate
perceptions with sender.

Remember - 60% of a message is nonverbal.

 Space
 Varies by culture
 Lack of space may make a person feel threatened
 Distance may increase perception of power and status

 Environment
 Formal or informal

 Appearance
 Much is communicated with hairstyle, cosmetics, clothing and attractiveness
 Varies with culture

 Eye contact
 Associated with sincerity
 Invites interaction
 Key component to effective body language
 Strongly influenced by cultural standards

 Posture
 Extremely important
 Slouching, shuffling and stooping imply indifference
 Arm waving, throat clearing – may come across as insincere
 Arms crossed or folded, hands in pockets – appear protective, defensive,
unwelcoming
 Face the receiver, sit or stand appropriately close, head erect, lean towards receiver
 Forward lean may indicate friendliness in some contexts and aggression in others

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Part 9- Communication

 Gestures
 Appropriate gestures add emphasis
 Too much gesturing can be distracting
 Varies by culture
 Touch may send messages that are misinterpreted

 Facial expression
 A pleasant and open expression is approachable
 Facial expression can greatly affect what people are willing to relate

 Timing
 Hesitations diminish effect of statement
 May imply untruthfulness

 Vocal Clues
 Tone
 Volume
 Inflection
 Speaking rapidly implies nervousness
 Speaking in a monotone implies disinterest
 Tentative statements sound hesitant

Verbal Communication
 Assertive
Assertive behavior is a way of communicating that allows people to express themselves in a
direct, honest and appropriate way that does not infringe on another person’s rights.
 Express clearly and firmly
 Use “I” statements
 Verbal and nonverbal messages must be congruent
 Is not rude or insensitive
 Passive
Passive communication occurs when a person is silent, although he or she may feel strongly
about an issue.
 Aggressive
Expression is direct and often hostile. Behavior infringes on another person’s rights.
 Usually conveys dissatisfaction about a situation
 Passive-Aggressive
An aggressive message is presented in a passive way. It may involve limited verbal exchange
with incongruent nonverbal behavior by a person who feels strongly about the subject.
Individual may feign withdrawal in an attempt to manipulate the situation.

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Part 9- Communication

How to Communicate Effectively

Good Communication Matters

Poor communication is the primary root cause of most sentinel events and medical
errors. The charge nurse role has been compared to an air traffic controller, because you are
at the center of communication flow on your unit. As a charge nurse, you are seen as the
pivotal point person, or ‘go to’ person. You must master the art of assertive and persuasive
communication, as well as develop negotiation and listening skills. Conversations may be
initiated by staff, patients, families, physicians, hospital leadership, or by the charge nurse.
Information is gathered and processed. Communication outcomes often result in changes in
patient treatments plans, transfers to other levels of care, or in facilitating interdisciplinary
communication with physicians or other departments.

Your success in charge nurse’s communication efforts is often reflected in staff, patient, and
physician satisfaction surveys. They are frequently the first stop for any complaint. Charge
nurses must also be familiar with the unique communication issues, styles, and preferences
related to gender, generation, and cultural dynamics. Additionally, charge nurses must
overcome the many distractions which create barriers to communication that prevent them
from advocating effectively on behalf of the patients and staff.

Some communication takes place during times of escalating stress, such as in a code blue
event. Here effective and efficient communication is crucial for successful patient
outcomes. As charge nurse, you can model and demonstrate evidenced based practice by
utilizing recognized communication tools such as SBAR (Situation-Background-Assessment-
Recommendation).
If the team is communicating well, then responses to patient needs will be quicker and deaths
due to ‘failure to rescue’ will be avoided. Charge nurse handoffs to one another are also
critically important so that continuity of care is maintained for the patient.

Staff nurses must be able to trust in the charge nurses ability to assist them to respond to a
sudden change in a patient’s condition. Skilled communication at the unit level is viewed as
one measure to balance a culture of safety with the workforce challenges that exist in the
current healthcare environment. When there are communication difficulties at the unit level,
it can lead to the development of conflict between one or more team members.

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 Part 9- Communication

Facing Aggressive Individuals

Do not accept that you are the cause of the anger; it may well lie completely elsewhere, but is
likely to lie within the angry person.
You have the right to walk away from anyone shouting at you.

Actions to take:
 Establish eye contact.
 Reflect the speaker’s message back to him/her. This helps the aggressor to evaluate
whether the intensity of his/her feelings is appropriate to the situation.
 Repeat the assertive message. Focus on the objective content of the message.
 Point out implicit assumptions. Listen closely and let the aggressor know that you have
heard and understood them.
 Restate the message using assertive language. Paraphrasing helps the aggressor focus more
on the cognitive part of the message. Restate the message by changing the “you” to “I”.
 Question implied threats to see if they are real or a result of anger.

Communication Skills in a Multicultural Workplace

Communication skills in a multicultural workplace require cultural sensitivity. Do not assume
people of the same culture are similar.
 Use titles of respect
 Be aware of messages that may convey bias or inequality. Addressing a white male as
“mister” and a black male by his first name suggests a difference in status.
 Avoid slang when referring to people of ethnic groups.
 Do not expect staff to get along well with others of the same ethnicity. Their uniqueness as
individuals creates a diversity in values, experiences and beliefs.

Communication Style Comparison

Nonassertive Assertive Aggressive

Verbal Apologetic Honest Accusations

Rambling Objective Subjective
Hesitant “I” statements Rude
Sarcastic

Nonverbal Soft voice Firm voice Loud demanding voice

Eyes averted Direct eye contact Staring
Posture stooped Posture relaxed, erect Hands on hips
Fidgety Hands relaxed Feet apart
Hands clammy Listening attentively Stiff, rigid
Hands clenched

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Part 9- Communication

Effective Listening Skills

Most people only retain a small amount of what is said. Although the average person spends
over half his/her time listening, only one third of the messages are retained.

Active listening is a technique that involves concentrating on what is being said as well as
verbal and nonverbal components. Remove environmental distractions!

Below are some techniques for effective listening:

 Door Openers:
 phrases that invite others to speak
 “Tell me about….”

 Open Questions:
 Enquiries that require more than a single word answer
 How
 What
 When
 Where
 Why
 “What is your opinion about….”

 Paraphrasing
 Summarizing without interpreting what the speaker says or how he/she feels
 “You feel frustrated because you can’t rely on Jane to complete her assignments”.

 Confirmation
 Used after paraphrasing to determine the accuracy of the paraphrase.

 Clarification
 A technique that facilitates understanding vague or uncertain statements.
 “I don’t understand what you mean by ‘being dumped on’ ”

Summary
In a leadership role, one must have excellent communication skills. These are, perhaps, the
most critical leadership skills.

The incongruence between verbal and nonverbal messages is the most significant barrier to
effective communication.

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 Part 9- Communication

Giving & Accepting

Presenting
Criticism
Telephone Skills Employing a logical order
& structure. Using visual Saying sorry in an
Thinking through in assertive, not passive
aids effectively. Building
advance what you want way. Allowing
rapport with your
to say. Keeping calls to disagreements to be
audience. Being clear &
the point. brought into the open.
concise. Encouraging
questions. Using the praise sandwich
when criticizing.

Persuading &
Motivating & Negotiating
Supporting Getting an agreement
Giving encouragement. SPOKEN acceptable to both sides:
Giving thanks for praise COMMUNICATION Win: Win. Backing up
or help. Working well in a points with logic.
team. Showing tact to those you
disagree with.

Gathering Information Body Language

Listening
Asking open & probing Using it yourself & being
questions to understand Accurately hearing what
sensitive to its use by
views & feelings of other. people are saying &
others: eye contact,
expressing interest.
Clarifying & summarizing gestures, head nodding,
Showing empathy.
what they are saying. smiling, open posture.

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Part 10- Decision Making, Problem Solving and Critical Thinking

Objectives:
 Differentiate between critical thinking, problem solving and decision making.
 Understand why critical thinking skills are essential in management.
 Learn how to enhance decision making and problem solving skills.
 Learn how to make decisions in various situations.

Critical Thinking
Critical thinking is the process of examining underlying assumptions, interpreting and
evaluating arguments, imagining and exploring alternatives, and developing a reflective
criticism for the purpose of reaching a reasoned conclusion that can be justified. Critical
thinking can be used to resolve problems rationally. It is also an essential component of
decision making.

Identifying, analyzing and questioning the evidence and implications of each problem
stimulate critical thought processes. Compared to problem solving and decision making, which
involve seeking a single solution, critical thinking is broader and involves considering a range of
alternatives and selecting the best one for the situation.
Characteristics of an expert critical thinker include
 Outcome directed  Persistent
 Open to new ideas  Caring
 Flexible  Energetic
 Willing to change  Risk-taker
 Innovative  Knowledgeable
 Creative  Resourceful
 Analytical  Observant
 Communicative  Intuitive
 Assertive  “Out of the box” thinker

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Part 10- Decision Making, Problem Solving and Critical Thinking

Good critical thinkers can explain what they think and how they arrived at that decision.

Creativity is an essential part of the critical thinking process. Creativity is the ability to develop
and implement new and better solutions. Creativity keeps organizations alive. Functioning “by
the rule” stifles creativity and is inflexible.
Creative people do not view authority as absolute, make few black-and white distinctions,
have a less dogmatic view of life, show more independence of judgment and less conformity
and are less rigid.

The creative process involves 4 steps:

1. Preparation
 Gather relevant facts, challenging every detail
2. Incubation
3. Insight
 Solutions emerge
4. Verification
 Solutions are evaluated

Decision Making
The term decision making is often used in the same context as problem solving. While the two
processes are similar, they are not the same.

Decision making may or may not involve a problem. However, it does involve selection one of
several options after weighing the alternatives.

Decision making is often a subset of problem solving. However, some decisions are not of a
problem solving nature, for example, decisions about scheduling or equipment.

Problem Solving
Problem solving is a process whereby a dilemma is identified and corrected.
It may not mean deciding on one correct solution.

Types of Decision Making

 Routine
The problem is relatively well defined and common, and established rules, policies and
procedures can be used to solve the problem.

 Adaptive
Problems and alternative solutions are somewhat unusual and only partly understood.

 Innovative
Problems are unusual and unclear and creative, novel solutions are necessary.

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Part 10- Decision Making, Problem Solving and Critical Thinking

Decision Making Conditions

Decisions are made under conditions of certainty, uncertainty and risk.

 Decision making under certainty

 Alternatives are known
 Conditions surrounding each alternative are known
 Decision can be made with full knowledge of what the risk is.
 Decision making under uncertainty and risk
 All alternatives are not known
 Conditions surrounding each alternative are unknown
 Risks and consequences unknown
 Most critical decision making in organizations is done under conditions of
uncertainty and risk.
 Successful decisions are dependent on human judgment

The Decision Making Process

 Rational or “Normative” Decision Making Model
Decisions are made using a series of steps to make a logical, well-grounded rational choice
that maximizes the achievement of objectives. This model is dependent on the individual’s
ability to use information and analysis, and on personal values, beliefs and objectives.

 Descriptive or “Bounded” Rationality Model

This model emphasizes the limitations of the rationality of the decision maker and the
situation. It recognizes 3 ways in which decision makers move away from the rational decision
making model:
1. The decision maker’s search for alternatives is limited due to time, energy and
money
2. Individuals lack adequate information about problems
3. Individuals cannot control the conditions under which they operate

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Part 10- Decision Making, Problem Solving and Critical Thinking

Satisfising Model
The decision maker chooses an alternative that is not ideal but that is good enough under
existing circumstances to meet minimum standards of acceptance or is the first acceptable
alternative.

Steps in Decision Making

 Identify the purpose
 Why is a decision necessary?
 What needs to be determined?
 Set the criteria
 What needs to be achieved?
 What needs to be avoided?
 Weigh the criteria
 Rank criteria in order of importance
 Seek alternatives
 List all possible courses of action
 Test alternatives
 Crank alternatives and compare results
 Troubleshoot
 What can go wrong?
 How can you plan?
 Could the choice be improved?
 Evaluate the action
 Is it effective?

Establish Priorities
All decisions will not be of equal importance.

Five factors may affect the priority of job responsibilities:

 Fatal
 Aspects of the job that must be provided because failure to provide them
could result in serious harm or death to a patient, family member, or staff.
 Fundamental
 Aspects of the job that represent an essential element of competent
performance for a given position.
 Frequent
 Aspects of the job that must be performed numerous times.
 Fixed
 Aspects of the job that must be provided within specific time frames.
 Facility
 Aspects of the job that the hospital requires be included in the orientation
program

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Part 10- Decision Making, Problem Solving and Critical Thinking

 Group Decision Making

Groups can provide more input, often produce better decisions and generate more
commitment. Numerous group decision making techniques exist, but are not included in this
material.

The outcome of group decision making lies on whether the team needs to reach complete
consensus on a decision, or whether a team leader will consider all views and make an
independent informed decision.

Some basis concepts apply when utilizing the group decision making technique:
 Approach the task on the basis of logic
 Avoid arguing for your own personal judgment
 Avoid changing your mind to reach agreement and avoid conflict
 Only support solutions with which you at least partially agree.

 Stumbling Blocks in Decision Making

 Personality traits
 Inexperience
 Lack of adaptability
 Preconceived ideas

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Part 11- Conflict Management

Objectives:
 Define conflict.
 Recognize conflict.
 Identify the dynamics of conflict.
 Identify the benefits and adverse effects of conflict.
 Identify interpersonal and behavior traits in conflict.
 Identify the causes of conflict.
 Understand the resolution and management of conflict.
 Describe the prevention of conflict.

Introduction
 Research indicates that the incidence of conflict in nursing is rife, and although this is the
responsibility of the Nurse Managers, conflict management is the least popular of all her
responsibilities.
 Research also indicates that Nurse Managers spend approximately 20% of their time dealing
with conflict.
 Conflict is a natural and inevitable condition in organizations; it is also often the
prerequisite to change in people and organizations

Definitions
Conflict is caused when two or more parties become aware of the fact that what each party
wants is incompatible with the wishes of the other. (Hein and Nicholson.)
 Within one individual, intrapersonal conflict.
 Between two individuals, Interpersonal conflict.
 Within one group, intra-group conflict.
 Within two or more groups, intercrop conflict.

Conflict occurs among individuals or groups that are interdependent, who feel angry, who
perceive the others as being at fault and who act in a way that cause a business problem.

NOTE: this definition includes:

 Feelings (emotions).
 Perceptions (thoughts.
 Actions (behaviour).

Psychologists consider these three the only dimensions of human experience. So, conflict is
rooted in all parts of human nature.

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Recognizing Conflict
 Conflict is dynamic.

 The content, requirements or fuels for conflict need 4 main characteristics;

Interdependency of the parties; they need each other (makes them vulnerable).
Blame is exchanged. (Perception) Fault finding; so get personal.
Anger/ Emotion. Both are upset so display anger, this can be direct and open or hidden
behind politeness but there none the less
Their Behaviour (actions) impacts on the workplace. Productivity and job performance
drops due to distraction and lack of co-operation

 Conflict needs to be identified early.

 Conflict has a way of growing and takes on a life of its own as it escalates. The earlier it is
resolved the better.

 Levels of Conflict
A. Irritation:
 The problem or difficulty is not significant; you can do without them but
they can be ignored.
B. Annoyance:
 The problems bring increasing frustration; stress increases and difficulties
are expected. Objections are usually voiced logically.
C. Anger:
 The problem bring out strong feelings
 Of injustice, hurt and enmity. Objections are voiced emotionally.
D. Violence:
 The position taken is justified. Retribution and payback become the order of
the day; there is a need to win, no matter what the cost is, and the other
party must lose. Objections are voiced with threats of physical action e.g.
walk off the job, go on strike etc.

CAUTION: Don’t confuse Conflict with indecision, disagreement, stress and other common
experiences that may cause Conflict or be a result of Conflict.

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Dynamics of Conflict
This generates change in an individual and an organization.
Conflict affects the psychological health of employees as well as the general efficiency of an
organization

Benefits of Conflict:
 It can heighten sensitivity to issues thus affecting action.
 It can pique interest and curiosity in others thus affecting changes in behaviour or policies.
 Increased creativity occurs when staff is challenged to develop new ideas for problem
solving.
 Increased motivation and energy to do tasks.
 Each party develops greater awareness of their identity and position as they are forced to
articulate and support their views.
 Recognition of differences, cultural and personal motivates staff to improve performances
and effectiveness.
 Recognizing legitimate differences within the organization and profession encourages staff
to be motivated to interact and communicate more efficiently.
 Staff satisfaction levels improve when changes are made to increase productivity and
effectiveness by minimizing inter-group conflict.

Adverse Effects of Conflict:

 Diminish trust and respect in the team.
 Information at work is not readily shared and errors occur due to loss of communication.
 Status and ego become more important than the reason and reality.
 Productivity diminishes.
 Higher stress levels amongst the parties.
 Inter-group conflict increases as We -They camps develop.
 Indirect expressed conflict creates new conflict.
 An individual to suppress conflict use emotional energy, less attention is given to work
related issues.
 Indirect conflict has a longer life expectancy and is costly because it is long term. Escalating
conflict is the result.
 Repressed conflict causes productivity levels to drop, as staff is distracted by hurt, angry and
aggressive feelings.
 Costs to cover negotiation and mediation time increases. Arbitration and even legal costs
can be incurred if conflict continues.

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Interpersonal and Organizational Causes of Conflict

 Disposition clashes – dominant versus mild.
 Cultural clashes - religious beliefs.
 Age clashes – age versus youth
 ” Win-Lose” power clashes - competition increases conflict and bias.
 Scapegoating: individuals or groups see each other as the enemy and this decreases
effective teamwork later.
 Covert and inappropriate conflict: anger may be displaced to bystanders.
 Repressed conflict due to resentment, anger and/or frustration: This may surface in
behaviour like increased errors, accidents or illness.
 Inappropriate responses to conflict include: retaliation, projection, and attention seeking
behaviour, rationalization, repression, and escape tactics such as resignation or fantasy
flights.
 Unions -management.
 Organizational: administrative versus departmental.
 Rivalry between companies, deadlines and competition
 Moral issues: defiant attitude and unhappiness of individuals or groups.
 Interpersonal skills: immature and defensive management of criticism.
 Interpersonal skills: autocratic or weak personalities in leaders.
 Dominant, extrovert, introvert and submissive behaviour traits.
 Proactive leaders, analytical, creative and proactive personalities or groups can all be
components of conflict.
 Organizations with little tolerance for change or non-empowerment of staff will also
escalate conflict situations.
 Multicultural groups with conflicting beliefs, standards and training backgrounds.

Common Causes for Conflict in the Nursing Environment.

 Cultural, ethical and moral beliefs and training methodology
 Differ in a multicultural nursing environment, thus potential hostility towards each
other occurs from insecurities or unresolved childhood influences as well as
differences.
 Teamwork
 The close proximity of team workers is open to provocation as actions from one may
affect team-mates. Often the instigator is unaware of her friendly or negative
manner exciting team-mates.
 Stress
 Can be created by different factors in the work environment, too little or too much
responsibility, lack of management support, no involvement in decision making, too
many technological changes etc.
 Constant interaction
 Constant interaction between nurses, doctors, and other disciplines can all invite
conflict as stress can build up. Competition can be too intense.

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 Different beliefs, values and goals

 Different beliefs, values and goals of staff may differ from the manager, Drs, patients,
visitors or the organization e.g. Abortion, Aids management, not for active
resuscitation orders.

 Off duties, staffing and scheduling

 Can be a large source of conflict as the goals of the staff may differ from those of the
organization.

 Nurse Managers
 Can be a large source of conflict as they are expected to initiate and institute
organizational objectives and changes that may be unpopular with staff. They may
also not have clear expectations for staff.

 Changes
 Cause potential conflict as they cause adjustment, change in roles, power
equilibrium and comfort zones, they threaten vested interests, create stress and so
invite further conflict.

 Managers are also under varied amount of stress due to their role diversification e.g., cost
management, improving patient care, in service training, collective bargaining, supportive to
staff, motivation and empowerment of staff, initiation of organizational changes and policies
etc.

 Leadership styles can cause discord.

 Authoritarianism and dogmatism provide breeding grounds for staff dissention and
conflict.

 Role ambiguity or confusion and disagreement over job description amongst staff and the
senior management all cause stress and conflict.
 The greater the number of positions within the workforce as well as hierarchical
levels, the greater the potential for interpersonal conflict.

 Formation of us versus them cliques:

 This causes hostility, suspicion and distorted communication.

 Off the job problems impact on staff.

 Marital discord, teenagers stress, alcohol or drug related issues, financial pressures
etc.

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How to Manage Conflict

Conflict is Part of the Work Environment

A conflict-free workplace would be a beautiful place. However, it’s just not possible to avoid
conflict entirely especially in high stress healthcare environments. If conflict is managed
effectively, it can be viewed as an opportunity for team growth. The necessity of effectively
managing team conflict should be framed in terms of a patient safety issue. Root cause
analysis studies done by the Joint Commission on Accreditation of Healthcare Organizations
since 1995 indicate that a breakdown in communication among caregivers is the top
contributor to sentinel events. Often, these breakdowns in communication are a result of
unresolved conflicts.

Managing conflict is an important and integral part of the nurse manager’s job. (Sullivan and
Decker)
 They need to identify whether there is conflict and what level the conflict is.
 They are involved on many levels.
 As participants, as individuals, as representatives of a unit.
 They may initiate conflict by confronting staff, either individuals or groups when problems
arise.
 They may serve as mediators or judges to conflicting parties.
 Conflict management is a difficult process, time and energy consuming. Both the
management and staff need to be committed to resolution of conflict by listening and help
find agreeable solutions.
 They need to recognize the level of conflict and act accordingly

Guidelines: Managing Conflict Constructively.

 Realistic outcomes should be set.
 Managers must make a decision of when and if they should intervene. Allowing the parties
to resolve matters empowers them. They develop experience and improve their ability to
resolve issues constructively.
 They may allow conflict to escalate as this may motivate the participants to resolve the
matter, the manager has to be careful that the conflict is not high intensity and that it will
impact on the effectiveness of the team.
 Intervention by the manager should always be guided by application of the mediation
techniques in all situations.

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Steps in Managing Conflict

The following steps in the conflict resolution process can be used to help staff discuss and
mediate conflict that involves differences:

1. Bring the individuals in conflict together to discuss the problem.

It seems obvious that there is a need to bring individuals together who are in conflict with one
another, but you may find resistance to this from those involved in the conflict. The problem is
that if you allow each individual to tell their story to you individually, you risk polarizing their
positions. You need to make sure that all parties concerned are participating together in the
discussion. These conversations should not be a one-sided monologue.

2. Agree to ground rules for discussion that are acceptable to all parties.
As the mediator of the conflict, it will be helpful to establish some ground rules regarding the
discussion. These ground rules could include topics like no interrupting, no personal attacks
and no discussion of issues unrelated to this specific conflict.

3. Let the other person clarify his or her perspective and opinion on the issue.
Allow each person to tell their story from their perspective. It may be helpful to apply a time
limit to the discussion. Doing so helps each person speak about the issues that really matter
and reduces conversational clutter that has little bearing on the conflict.

4. Highlight some common ground that all involved in the conflict can agree on.
Common ground in conflict is important because it can serve a reference point to help bring
discussion back on track. Most staff will agree that they are there to provide the best possible
care to patients as an example. When conflict escalates, you can bring the individuals back to
the point of common ground.

5. Develop interventions collaboratively and agree to disagree on points of contention.

Holding desperately to a dogmatic grudge isn’t likely to yield many benefits in a workplace
conflict. And presenting a conflict as a black-or-white, right-or-wrong situation heightens
tension. Work to help the individuals develop interventions collaboratively. Where there are
point of major contention, it may be necessary to just agree to disagree.

6. Keep the lines of communication open and respect differences in attitudes, values and
behaviors.
Your goal in most conflicts will be to try to open the lines of communication and re-establish
working relationships. Try not to take someone’s conflicting opinion as a negative assessment
of you as a person or as a co-worker. It can help to openly acknowledge the differences in
attitudes, values and beliefs.

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Rules for Prevention of Conflict

 Establish clear policies, rules and guidelines in your department.

 Appreciate everyone’s efforts and genuinely praise for work well done. Staff needs to be
appreciated on all levels.
 Create a supportive work environment that empowers staff and encourages them to be
creative and proactive.
 Avoid Power play as this promotes conflict. Rather seek agreement and incorporate staff’s
input.
 Have the necessary self-esteem to value the input of others rather than feel threatened by
their ideas.
 A manager should be able to identify with the value of others; this promotes relationships
with success expectancies.
 She should quickly identify traits of trustworthiness and responsibility in others’; this is
empowering and promotes job satisfaction.
 Managers must act with assertiveness.
 Active support and open communication promotes focus in the team.
 Feedback on behaviour is important and constructive but avoids feedback on personality
traits. Avoid giving advice but rather enlist help of others in finding solutions.
 Desired behaviours should be stated, if behaviour does not meet the levels of satisfaction
they should be pinpointed and the employee should be suggesting how she can improve or
change the behaviour to attain acceptable levels. These levels of competence should be
built into the organizational structure.

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Resolution of Conflict
The optimal solution is to manage the conflict issues so that both parties see themselves as
winners and the problem is solved. Win-Win.
Both parties are equally committed to carry out the solution as agreed upon.

Strategies for Resolving Conflict: 3 Basic Strategies and 4 Outcomes

 Win-lose or Lose-Win
 One party exerts dominance and the other submits and loses.
 Score = -2.
 Exercise of power: Winner is the strongest with the most power. Conflict unresolved,
as there is one loser who is resentful.

 Lose-Lose
 Neither side wins: the settlement reached is unsatisfactory to both parties.
 Score =0.
 Exercise of rights: Decisions are made that fall under the prevailing law or culture.
Agreement and resolution may be achieved but the conflict may not be resolved, as
all may have reached a decision but are all dissatisfied.

 Win-Win
 Both parties win. The focus is on the solution and attempts to meet needs of both
parties. Both parties satisfied.
 Score=+2.
 Exercise of Mutual Interests: Mutual interdependency and need to work together
agreement is reached with the long-term goal of maintaining good work relations.

Win-Lose and Lose-Lose Strategies share these characteristics

 Person-centered (We-They), not problem-centered.
 Parties direct their energy toward total victory for themselves and total defeat for the
others. (We-They).
 Each sees it from their point of view rather than a problem that needs a solution. (We-
They).
 The emphasis is on outcomes rather than definition of goals, values and objectives.
 Conflicts are personalized. (We-They)
 Short-term view of the conflict, the goal is to settle the immediate problem rather than
resolve differences. Conflict may be resolved but cause is not addressed.

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Styles and Modes

There are several ways in which conflict can be resolved using the following styles and
modes.

 Consensus
A solution meets everyone’s needs is agreed upon. (Win-Win)

 Integrative decision-making
The focus is on ways of solving the problem and on defeating the problem and not each other.
Look for solutions that satisfy both parties’ real interests. (Win-Win)

 Collaboration
The focus is on solving the problem and not defeating the opponent. This is ideal in a situation
where the goals of both parties are too important to compromise. (Win-Win)

 Compromise
(Win-lose or Lose-lose) a management technique where the rewards are divided equally
between the parties. This is normally after collaboration has failed. It is also used if a solution
is needed rapidly.

 Competing
(Win-Lose) an all out effort to win at all costs. This is often used when unpopular or critical
decisions are being introduced and there is not enough time to allow for more cooperative
methods.

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 Avoiding
 (Win-Lose or lose-lose) a management technique in which the participants deny that conflict
exists.
 Avoidance does not solve the problem and an escalation of the conflict usually develops.
 This occurs in a situation where there is a large power difference in staff levels or in large
cohesive groups.
 These groups will avoid disagreement to preserve the good feelings about each other.
 Withdrawal
 (Win-Lose or Lose-lose) this is another form of Avoiding.
 The removal of at least one party from the conflict, making it impossible to resolve the
situation.
 Sometimes withdrawal is appropriate if levels of hostility are very high or enough data is not
available to solve the problems.
 Alienation
 (Lose-lose) this is another form of Avoiding.
 This also occurs when a party refuses to communicate or integrate; this is common in
Nursing as parties resign. The problem goes away but the cause is unresolved or addressed.
 Individuals who will not voice an opinion or take a stand when conflict looms often use this
style, and so decisions are made by default without input from all staff.
 Accommodating
 (Win-Lose or Lose-lose) an unassertive, cooperative tactic used when individuals neglect
their own concerns in favour of other’s concerns.
 Often the unassertive party will go to all lengths to win approval of the group.
 This is an appropriate action if the party was in the wrong and the harmony of the group
outweighs the need to win. Or if the opponent is too powerful it may be wiser to concede.
o Smoothing: (Win-Lose or Lose-lose) another form of Accommodation.
Complimenting one’s opponent, downplaying differences and focusing on minor
areas of agreement
o Suppression: (Win-Lose or Lose-lose) another form of Accommodation. In situations
where conflict is avoided and discouraged suppression is used. This could even
include eliminating one party through transfer or termination.
o Forcing: (Win-Lose or Lose-lose) a technique that forces an immediate end to conflict
but leaves the cause unresolved. A superior can resort to issuing orders but the
subordinate will lack commitment to the action demanded.
 Confrontation
 This is considered an effective mode for resolution, it is problem orientated, the conflict is
brought out into the open and attempts are made to resolve it through knowledge and
reason. (Win-win or win-lose)
 Negotiation
 A management technique in which the party’s give and take on various issues, the purpose is
to achieve agreement though consensus will never be reached.

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Specific Strategies for Resolution of Conflict:

Stress listening
This is a good strategy to cope with an angry colleague. If she is shouting and using bad
language and half expressed ideas there is a potential situation where tempers can flare out of
control.

The manager can turn this confrontation into a productive meeting by doing the following:
 Avoid sharing anger. Stay calm, be matter of fact and sympathetic. Don’t be aloof and
impersonal
 Respond constructively. Channel her strong emotions into a productive channel by
conveying by verbal and non verbal behaviour the employee and her problem has her full
attention, this can be done by doing the following:
 Avoid smiling and small talk. A comment like take a breath will not calm her down.
 Maintain eye contact. She will see that you are being attentive to her problem and
temper.
 Prevent interruptions. Close office door, phone off the hook.
 Do not hide behind the desk. Sit face to face.
 Uses comfy seating arrangement, get her to sit down. This will help to break down
barriers and calm her down.
 Maintain a serious manner.
 Ask Questions. Anger may confuse the issue so short concise questions will get
clarity on the problem. Don’t correct misinterpretations but guide the employee to a
clear understanding of the problem by asking leading questions and careful listening.
 Separate fact from opinion. An angry person finds it difficult to separate facts
causing anger from her personal opinion of it. Ask simple questions and give
dispassionate summaries, this will assist the employee to calm down and move
away from the emotional interpretation to a more objective exploration of the real
facts.
 Avoid hasty responses. Haste is the boss’s worst enemy! Wait until you understand
the whole story, including the personality before making a decision. Always plan
your response.
 Encourage employee to find the solution. If suggested solutions are offered be sure
to express them from the employee’s viewpoint.
 Help her find a solution by leading “what would you do? What ideas do you have?”
Don’t patronize her or offer parental type advice, or embarrass her.
 When these tactics are used the employee will maintain her self esteem and the
angry outburst will be used in a constructive way.

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Managing Defiance
When an employee does this she employs a strategy aimed at getting the manager to respond
with guilt, lack of self-discipline, and incompetence. Employ these tactics and strategies to
defuse her.
 Distinguish between defiance, on the job errors or hesitancy to accept change.
 Identify the Defier. Group defiance is usually led by one central figure.
 Stay calm at all costs; be emotionally restrained. Use this type of approach, “ I know you are
upset but…” or “this is neither an appropriate setting nor time to discuss this…” Please join
me for a discussion in my office….
 When challenged Act immediately to resolve matters ASAP and in private.
 Remember to set the example of appropriate behaviour at all times. Share info of mutual
professional interest, policy changes etc. timeously to minimize conflict.

Managing Defensive People

Staff that feels they are being ignored often uses Explosions of defensive behaviour; their
wishes and needs are unimportant to the manager. This employee may explode and fire
accusations at her. Follow 6 steps:
 Listen actively. Ask questions to clarify problem and allow her to talk.
 Defensive people are in need of positive feedback in a one to one encounter. Feedback to
them what you understand they needs and recognize their feelings. Empathy does not
mean agreement and you need to make them understand that you are willing to work with
them to resolve the issues to improve the situation.
 Once emotions have dissipated share your point of view re your understanding of the
problem. This must be factual and objective, don’t advise or accuse.
 Give them chance to feedback now on their interpretation of your viewpoint. Clarify any
misunderstandings. Define the problem clearly.
 Look for common ground so that an acceptable agreement can be reached. Both parties
have expressed and discriminated between wants and wishes and what can and should be
done. A mutual understanding of the issues can form the foundation of trust to revive the
damaged relationship.
 Finally consider whether the situation arose due to your poor approach to the issue and
thus gave the staff member had a valid point. If so then an apology or expression if regret
would resolve the issue.

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Managing Difficult People

Charge nurses have a unique challenge in work environments because they have to learn to
lead teams of staff and manage patients with little formal power. When all is working well on
the unit and with the team, this is not a problem. But when a staff member, patient,
physician or family member is a difficult person to keep happy, the role of charge nurse
becomes more challenging. Learning to manage difficult people is both an art and a science.

We can all be difficult at times. The difference with difficult people is that they do it more
often. It becomes a pattern of behavior. They may have been given feedback about their
behavior, but have not made a consistent change. Part of what motivates difficult people is
that they often are able to wear people down, and get what they want. You may not be able
to change the behavior of the difficult person, but you can change how you respond to it. By
learning to effectively disengage, you will avoid getting hooked into the difficult behavior cycle.

Difficult Personalities Types

Dr. Louellen Essex had identified the following 4 different types of difficult personalities:
 The Volcano – these individuals are abrupt, intimidating, domineering, arrogant,
prone to personal attacks and are extremely aggressive in their approach to get
what they want.
 The Sniper – these individuals are highly skilled in passive-aggressive behavior, take
pot shots, engage in non-playful teasing, are mean spirited and work to sabotage
leaders.
 The Chronic Complainer – these individuals are whiny, find fault in every situation,
accuse and blame others for problems, are self-righteous and see it as their
responsibility to complain to set things right.
 The Clam – these individuals are disengaged, unresponsive, close down when you
try to have a conversation, avoid answering direct questions and don’t participate as
members of the team.

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Tips for Dealing with Difficult People

You can probably identify the personality types of some of the difficult people you deal with
from the list above. The bigger challenge is how do you respond to the behavior. Here are
some great tips offered by Stephanie Staple:

1. Don’t try to change them – generally with difficult people, you are experiencing well
established patterns of behavior. Any change in behavior with a difficult person will only come
if they take accountability for it. You can point out the behavior, but it is not your
responsibility to change it.

2. Don’t take it personally – the behaviors that you witness from difficult people are more a
reflection of where they are personally than anything you may have said or done. They may be
sick, tired or have extreme emotional problems. When you see an explosive reaction to a
minor situation, you can be sure that there are strong underlying emotions that the person is
experiencing.

3. Set boundaries – let the person know that you will respect them but expect to be treated
with respect in return. Don’t tolerate yelling, and if necessary tell the person that you need to
remove yourself from the situation.

4. Acknowledge their feelings – you may not agree with their point of view but acknowledge
that they appear to be very angry about a situation.

5. Try empathy – recognize that it must be difficult to be stuck in a place of negativity or

anger. Empathy can sometimes help to de-escalate explosive situations.

6. Hold your ground – remember that you teach other people how to treat you so don’t open
the door to challenges.

7. Use fewer words – less conversation is often more effective with difficult people. Use
short, concise messages to drive your point home and set a time limit of how much you will
engage in the discussion. Avoid using the word “attitude” because this will be viewed as very
subjective – focus instead on the behavior.
While these tips are not guaranteed to work every time, you may find them helpful in many
situations. The real key to managing difficult people is managing your own reaction to the
situation. In the end, the only behavior that you can truly control is your own.

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Basic Rules on How to Mediate a Conflict:

 Protect each parties self respect.
 Provide a supportive environment with privacy and time.
 Set clear guidelines. e.g. don’t lose tempers or attack each other.
 Use a non-combative approach to assist in a win-win resolution.
 Deal with conflict issues, not personalities.
 Do not blame or make participants responsible for the problem.
 Be responsible for finding a solution to the problem.
 Allow open and complete discussion from all participants.
 Maintain equity in frequency and duration of each ones presentation.
 Encourage both positive and negative feelings in an accepting atmosphere.
 Emphasize mutual interests.
 Ensure both parties listen actively to the others words. Make the one summarize what his
opponent has said before voicing his view.
 Identify key themes in the discussion and restate them frequently to keep the discussion on
track.
 Agree on a temporary solution for re evaluation after a specified period if time is a factor.
 Encourage the parties to provide frequent feedback to each other’s comments, show that
they understand each other s views.
 Help the parties develop alternative solutions, to select mutually agreeable ones and then
develop a plan to carry it out. All must agree to the solution for successful resolution to
occur.
 Follow up on progress of the plan at an agreed upon interval.
 Give positive feedback to the participants regarding their cooperation in solving the conflict.
 Follow steps when confronted by a defiant person.
 Give a defensive emotional person time to relax by listening with empathy but set limits
clearly.
 Always indicate by your tone, body language that you trust and care for the staff and are
willing to accept their viewpoints may differ from yours.

Your overall goal in the mediation of conflict should be able to help team members work more
effectively together to meet the needs of patients. Not every conflict will require intervention
from you, but serious conflicts can escalate so don’t be a conflict avoider. Keep in mind that
the conflict never just impacts the people involved. Your team members and every employee
with whom the conflicting employees interact, is affected by the stress. To create a positive
work environment, as a charge nurse, you will need to learn conflict mediation skills.

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Objectives:
 Identify motivation and demotivation.
 Recognize effects of demotivation and motivation within the team.
 Demonstrate the development of strategies to overcome demotivation.
 Demonstrate the unit Manager’s role ensuring a motivating climate in the unit.

Introduction
Motivation is the will to act. The art of motivating people starts with learning how to influence
individual’s behaviour.

This can be compared to freshly baked bread:

 Well risen and without any cracks or bulges.
 An even light brown crust.
 The slices are almost square with a slightly rounded upper crust.
 For its size, it feels light.
 The texture depends on several factors, including whether the dough was kneaded
thoroughly and long enough to become smooth and elastic, was it left long enough to prove
at the correct temperature and was it baked at the correct temperature.
 The flavour should be sweet and nutty.

Before one can have freshly baked bread, one should assemble all the ingredients like flour,
yeast, milk, salt, sugar, butter, and eggs. Then one needs to follow the correct method and
instructions of preparation. One of the most important factors is the dry yeast.

The yeast causes dough to raise, forming gas while it is growing. It needs very favourable
conditions in order to grow. The temperature and moisture levels must be just right and it
needs sufficient food.

Now you might ask what has a baked bread to do with motivation.
 The bread represents the team.
 The ingredients resemble the qualities a leader should have to motivate the team
 The instructions for preparation is the strategies used to develop a positive and motivated
team.

To be able to have well risen and nice looking bread, one should follow the steps preparing the
yeast. The same apply to human beings. The performance of your team is an outcome of
motivation, ability to perform, and the environment he gets at the work place and at home.

Therefore you get two types of motivation: intrinsic and extrinsic.

 Intrinsic motivation comes from within and that drives you to be productive.
 Extrinsic motivation comes from the environment and external reward.

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What is Motivation?

Motivation is the willingness of an individual to exert high levels of effort towards

organizational and individual goals or needs.
Motivated leaders show specific behaviour patterns which are labelled as motivated
behaviour.

Five Specific Patterns for Motivated Behavior

 Determination
Motivated nurses will always strive to improve and work towards their goal. For example, if an
individual wants to complete his competencies to be able to work on their own, they might
put more effort into this than the person who’s not so motivated.

 Dedication
A motivated team member dedication is always more than the team member who is not
motivated. Example of a dedicated person, someone who has to support a sick family
member will be greater than the one who only have him/herself to look after.

 Creativity
This is the most important characteristic identified in a motivated person. When a motivate
person reaches a block, they always try to find a way to reach their goal.

 Body language of a motivated person

Motivated people reflect enthusiasm and speak about the future with hope and expectation.
A motivated person can be identified by their appearance.
 Appealing personality.
 Dressed appropriately.
 Eyes and mouth are smiling.
 Positive facial expressions.
 Talking with enthusiasm.

 Body language of a demotivated person

You can identify this person easily by his looks.
 Negative.
 Careless about his dress code.
 Face communicates lack of interest in work or in people.
 No eye contact.
 Workplace looks poorly.
 Quality of work is poor.
 Walk as if he/she drags himself along.

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The Demotivated Team

If you want to have a healthy team a team with “humph”, you need to identify the
demotivators present in the team. The demotivated team will be like bread with no texture,
bad taste and burned crust.
It is reminiscent of an old Arabic proverb: “Biakhdak lel-Baher binagake At-shaan”. This means
“Take you to the sea and you come back thirsty”.
The team member can refuse to work and lose interest in performing for different reasons:
lack of interest in job, stubbornness, fear of punishment, inappropriate rewards, and conflict
with manager or leaders in the unit.
Therefore when ever you find a team member refusing to work due to demotivation, consider
carefully what your next step will be. The key to get the job done will depend on your
capability to identify the problem and how to remove it.

Demotivators and the Leader’s Responsibility

 Lack of direction
If you don’t give direction to your team, how can they follow? Therefore it is very important to
take the lead. Inform them about their personal progress to prevent dissatisfaction and
demotivation.

 No recognition
Recognition and reward increase the staff members’ self-esteem and create a feeling of
accomplishment.
Never reprimand in public. This affects the individual’s self-esteem, whereas recognition
should always be made public as it enhances self-esteem.

 Close supervision
Close supervision happens when the leader doubt the capabilities or credibility of team
member.
Forcing people to work your way can lead to demotivation.

 Company policies
Company policies are one of the common causes of employee demotivation.
The policies are already available when and employee is employed at the company.
Sometimes it happens that neither the manager nor the staff member understands or agrees
with the policy.

 Conflicting expectations of supervisors

It happens that a leader can give contradicting messages to a tem member which can cause a
lot of confusion and dissatisfaction.
Therefore, it is important that the instructions you give do not contradict the instruction of the
manger, company or your own.

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 Monotony of work
Doing the same job over and over, day by day, can lead to boredom and dissatisfaction of team
members.
Therefore, it is important to ensure that you have proper job rotations is in place.
Example: Staff looking after the same patients day by day can be very demotivated.

 Working conditions
Working conditions can have a negative influence on the team.
Working abroad and far away for home.
Inadequate off duties.
All above can lead to demotivation and low performance.

 Lack of communication
If the leader doesn’t have good communication skills, it can make it difficult for the team to
know where they stand with him.
It is important that the leader communicate with the team when changes take place in the
unit, so thy can plan their activities better.
“As the leader, your communication sets the tone for interaction among your people.” – John.
C. Maxwell

 Lack of empathy
The leader shows no empathy and gives no support.
What is empathy? Empathy is to understand the feelings of another.
Lack of empathy leads to misunderstanding between you and your team members and
eventually leads to demotivation.
To prevent demotivation, put yourself in the team members’ situation, this will allow you to
provide them with the appropriate solutions.

 Low morale
When staff start to talk about how bad it is to work in the unit, the leader should see the red
lights flickering.
This can result in poor performance and low expectations.
Leaders need to make sure that the team know what their goal is, where they going, and what
the outcome will be to prevent a low morale.
Leaders who have faith in their team and in their capabilities always have high expectations.
For example: A staff member with poor language skills, who struggled with the everyday
terminology and grammar. This staff member starts to read English books, she attends the
English classes given at the hospital and was forced by her own nationality group to only speak
English at home and work. What an achievement! With the positive attitude of the manager,
leaders and team, she exceeded her own expectations. The manager could have reacted
oppositely and established a very low moral in her unit.

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 Inappropriate leadership style

Unfulfilled promises – The leader makes false promises to motivate people for the time being,
to motivate them for better performance.
Lack of interpersonal relationships.
A team is like a family and a family stands together, no matter who or what they are.
One also gets the leader who instructs a staff member to do a task and then changes the
procedure or policy, this prevents the team member from completing the task.
Favouritism – all staff must be treated the same way. Unfortunately, some leaders have their
favourites; this can be very demotivating for the rest of the team.
Leave is a very delicate subject. Staff members prepare themselves mentally for vacation and
when it’s refused, it can causes a mentally block.
Working extra hours.

 Criticism
Remember to criticize the act, not the person.
Praise in public and criticize in private.
Remember when you need to criticize some one give the positive first and then the negative.

 Inappropriate communication
Words are like bullets of a gun. If used improperly, they can hurt a person permanently: scars
remain for a lifetime.” – Unknown

Barriers in Communication
 Not listening to what the other is telling you.
 Having negative thoughts or feelings about others while communicating.
 Selective listening.
 Using an aggressive approach.
 Wrong body language.
o Important to keep on observing the signals your team members may give you when
they get demotivated.

The red flushing signals to observe for:

 Lack of enthusiasm.
 Ignores actions suggested.
 Avoid responsibility.
 Always late and want to leave early.
 No team spirit.
 Don’t attend meetings.
 No commitment.
 Always find fault.
 Complaining.
 Tardiness and absenteeism.

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How to Build an Effective and Motivated Team

A motivated team works in harmony with each other. They stand together to achieve their
objective.

Establish a SMART goal:

S = STRETCH
Stretch the goal, the objective should be a little bit more than what can be achieved.
M = MEASURABLE
Tangible and quantifiable.
A = ACHIEVABLE and ACTION
R = REALISTIC and RELEVANT
T = TIME BOUND
Have a time limit.

How to Create a Motivating Climate in Your Unit

“Coming together is a beginning, staying together is progress, and working together is
success.” – Henry Ford

 Make sure staff knows what you expect from them by giving clear instructions.
 Use effective communication strategies.
 Be fair to all team members.
 Set goals and projects for the team to build teamwork and ensure harmony in the team.
 Remove cultural differences. Remember, a team is like a family and a family stands
together.
 Know the uniqueness of all staff members. Let them know you understand each of them in
their unique way.
 Be a firm decision maker, using an appropriate decision making style.
 Give the team members recognition and credit.
 Build on the team spirit by developing group goals and projects.
 Allow opportunities for growth.
 Show respect in time. All team members are always in time for meetings.
 A motivated team develops a bond with each other.
 Plan an offside activity for team building. This is an effective way to ensure staff is closer to
each other.
 A challenge leads to a rewarding team experience.
 Teams that have both responsibility and authority tend to maintain their motivation for a
longer period. In order to sustain the high performance of team members, one needs to
create an environment free from fear, where people can come forward and be ready to
accept responsibility.
 Create a trustful and helping relationship with employees.
 Be a role model to the team members.

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The Unit Manager / Head Nurse

Unit manager’s/Head Nurse role in motivating the team:

 Time and stress management

 The Unit Manager/Head Nurse needs to implements effective time management
strategies.
 Know how to manage your own stress.

 Effective management strategies

 Implements effective participative management, problem solving and decision
making strategies.
 Accept all staff members for who and what they are. Each one is unique in his/her
own way.
 Set clear and specific goals and allow the staff members to be involved in the
development of it.

 Physical personnel needs

 The Unit Manager / Head Nurse must display emotional, personal and professional
maturity.
 The Unit Manager / Head Nurse must also demonstrate assertiveness and self
awareness.
 Demonstrate critical thinking.
 Build a trusting relationship with team members.
 Lead by example and they will follow.

 Favourable working conditions

 Ensure a safe environment in unit with adequate equipment and staff.
 Ensure the nursing unit is organized and cleaned on a daily basis.

 Necessary human resources

 Be flexible and ensure fair off duties and applicable guidelines.
 Allocation must be fair.
 Motivate when in need for more staff.

 Personal and professional development

 Make the team’s work as challenging as possible and give them enough
responsibility and authority to ensure a sense of accomplishment and achievement.
 Praise the staff member when he/she has completed a task successfully.
 Rewards should be unpredictable and intermittent.
 Boost their self confidence.

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 Building relationships
 Building positive relationships in the unit is very important.
 Establish positive relationships between staff members in the unit by:
 Creating and maintaining mutual respect, trust and integrity.
 Demonstrating reliability and dependability.
 Establish open and honest communication and feedback.
 Effective listening skills.
 Teamwork.
 Treating every staff member as a unique individual with valuable input.
 Effective interpersonal relationships.
 Effective conflict management.
 Protection of the rights of each personnel member.
 Ensure effective promotional system.

• Assigning responsibility
 Provide guidance to the staff members in the unit.
 Delegate authority in order to develop staff.

 Sharing ownership
 The Unit Manager/ Head Nurse and the staff members must share in all of the
aspects of the nursing unit.
 Maintain an open, informal, friendly atmosphere in the unit where staff can feel free
to speak their minds without fear of retribution.
 Motivation is higher in staff when specified and realistic expectations are made.
They experience pride in the job, themselves and in the nursing unit. This will let
them feel part of a successful nursing team.

 Effective change management

 Change should be implemented very slowly because with change comes resistance.
 Involve all the staff to participate.
 Identify the factors of resistance and implement strategies to overcome these
factors.

 Effective performance management

 Make realistic and specific expectations.
 This will result in pride in the job, themselves and in nursing unit. This will let the
staff feel part of a successful nursing team.

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Summary

The most important role for the leader is to know how to motivate the demotivated staff in
the nursing unit. Know how to create a motivating climate to ensure your team/ family is
satisfied.

As the leader, remember to apply the letter “H” in your practice.

 Hope
 Create sense of hope

 Humanity
 Never forget that you are a human and so is your team.

 Humility
 Closely related to humanity. Good leaders know no conquest is their own.

 Humour
 Have a good sense of humour. It is a good indicator of mental health and an
asset to any work place.

Remember: Before you can have freshly baked bread, you need to assemble all the
ingredients, follow the correct method and instructions of preparation. And last but not least,
the most important factor is the dry yeast. Let the yeast rise in you and make a difference in
your team members lives.

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Part 13- Team Building

Objectives:
 Define team and team building and explain the benefits of team building.
 Discuss ways to create team work.
 List the roles and responsibilities of team leader and team members.

Definition of Team:
A team is a highly communicative group of people with different backgrounds, skills and
abilities who have a shared sense of direction with a clearly identified goal.

Developing a Productive Team:

 Team building is an effort in which a team works together and acts to create a climate that
encourages and values the contributions of team members.
 Their energies are directed toward problem solving, task effectiveness, and maximizing
the use of all members’ resources to achieve the team’s purpose.
 It recognizes that it is not possible to fully separate one’s performance from those of
others.

Team building works best when the following conditions are met:
 There is a high level of interdependence among team members.
 The team is working on important tasks in which each team member has commitment and
teamwork is critical for achieving the desired results.
 The team leader has good people skills, is committed to developing a team approach, and
allocates time to team building activities.
 Team management is seen as a shared function, and team members are given the
opportunities to exercise leadership when their experiences and skills are appropriate to
the needs of the team.
 Each team member is capable and willing to contribute information, skills and experiences
that provide an appropriate mix for achieving the team’s purpose.
 The team develops a climate in which people feel relaxed and are able to direct and open
in their communications.
 Team members develop a mutual trust for each other and believe that other team
members have skills and capabilities to contribute to the team.
 Both the team and individual members are prepared to take risks and are allowed to
develop their abilities and skills.
 The team is clear about its important goals and establishes performance targets that cause
stretching but are achievable.
 Team member roles are defined, and effective ways to solve problems and communicate
are developed and supported by all team members.
 Team members know how to examine team and individual errors and weakness without
making personal attacks, which enables the group to learn from its experiences.
 Team efforts are devoted to the achievement of results, and team performance is
frequently evaluated to see where improvement can be made.

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 The team has the capacity to create new ideas through group interaction and the influence
of the outside people.
 Good ideas are followed up, and people are rewarded for innovative risk taking.
 Each member of the team knows that he or she can influence the team agenda.
 There is a feeling of trust and equal influence among team members that facilitate open
and honest communication.

Characteristics of Good Team Building:

 High level of interdependence among team members.
 Team leader has good people skills and is committed to team approach.
 Each team member is willing to contribute.
 Team develops a relaxed climate for communication
 Team members develop a mutual trust.
 Team and individuals are prepared to take risks.
 Team is clear about goals and establishes targets.
 Team member roles are defined.
 Team members know how to examine team and individual errors without personal attacks.
 Team has capacity to create new ideas.
 Each team member knows he can influence the team agenda.

When to Use Teams:

 Task is complex.
 Creativity is needed.
 More efficient use of resources is required.
 Fast learning is necessary.
 The plan requires cooperation.
 The process is cross-functional.
 The change will impact multiple departments.

Benefits of Team Building:

 Provides professional and social support for its members.
 Gives members a sense of belonging.
 Builds self esteem.
 Allows for members to identify with each other’s concerns and ideas; they form common
ground, thereby reducing anxiety.
 Empowers members to act as a group and to more efficiently and confidently approach
supervisors.
 Complex issues are more easily broken down, analyzed and solved.

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Team Selection:
 Make sure team members have skills relevant to task.
 Select “workable” number of people.
 If process identified is across departments (cross-functional), each department
should be represented on team.
 Select employees who are interested and committed.

Ways to Create Teamwork:

 Conduct staff meeting on a routine or as needed basis for purpose of sharing new
information.
 Hold inter-departmental meetings for problem solving.
 Celebrate as an organization.
 Welcome new employees to teams.

Team Effectiveness:
When evaluating how well team members are working together, the following statements can
be used as a guide:

 Team goals: team goals are developed through a group process of team interaction and
agreement in which each team member is willing to work toward achieving these goals.
 Participation: all team members actively show participation and roles are shared to
facilitate the accomplishment of tasks and feelings of group togetherness.
 Feedback: feedback is asked for by members and freely given as a way of 3evaluating the
team’s performance and clarifying both feelings and interests of the team members. When
feedback is given, it is done with a desire to help the other person.
 Team decision-making: involves a process that encourages active participation by all
members.
 Leadership: are distributed and shared among team members and individuals willingly
contribute their resources as needed.
 Problem solving: all team members encourage discussing team issues and critiquing team
effectiveness.
 Conflict: conflict is not suppressed. Team members are allowed to express negative
feelings and confrontation within the team, which is managed and dealt with by team
members. Dealing with and managing conflicts is seen as a way to improve team
performance.
 Team member resources: talents, skills, knowledge, and experiences are fully identified,
recognized and used whenever appropriate.
 Risk taking and creativity: risk taking and creativity are encouraged. When mistakes are
made, they are treated as a source of learning rather than reasons for punishment.

After evaluating team performance against the above guidelines, determine those areas in
which the team members need to improve and develop strategies for doing so.

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Team leader roles and responsibilities:

 Prepares agendas for meetings.
 Conducts meetings.
 Assigns activities to team members.
 Keep team on track.
 Assess progress.
 Interfaces with other teams and support resources.

Team member roles and responsibilities:

 Consider team’s work a priority.
 Participates fully.
 Listens to others and is open to their ideas.
 Carries out assignments between meetings.
 Shares experiences and knowledge.

Key Ingredients for Effective Teamwork

If you have worked on a highly effective and smooth running team, it is an experience you are
not likely to forget. Effective teams have the following 10 key characteristics:
 Make team work an organizational priority.
 Set clear Goals that everyone on the team works towards
 Clarify the role and contributions of each team member
 Encourage open and clear communication
 Maintain effective communication
 Ensure effective decision making
 Engage team members in the work of the team
 Appreciate diversity – generational, cultural and diversity in thinking
 Effectively management of conflicts
 Trust among team members
 Ensure cooperative relationships
 Inspire participative leadership
 Bite off what you can chew.
 Fix obvious problems.
 Look upstream (at the source of the problem).
 Document progress and problems.
 Monitor changes, celebrate success

You can see from this list that charge nurses need to understand their own position description
and that of all of their team members. Understanding the level of competency of staff is also
important. The knowledge and skills of a new graduate will be very different from more
experience staff. Team members will have different attitudes, beliefs and values so developing
common ground such as we are here for the patient and everyone on this team helps one
another is important.

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Criteria for Health Care Teamwork:

 Multiple health disciplines are involved in the care of the same patients.
 The plan of care reflects an integrated set of goals shared by the providers of care.
 Team members share information and coordinate their services through a systematic
communication process.

Why Things Go Wrong On Teams

The most common behaviors that create obstacles to effective team work include blaming
others, turf protection, mistrust and an inability to directly confront issues. In the absence of
complete trust, people are more likely to withhold their ideas, observations and
questions. Professionals are also more likely to leave teams with trust issues. It is not
surprising that in our health care system, ineffective teamwork is now recognized as a
potential patient safety issue.

As a charge nurse, you will need to help your team to develop the ability to collaborate
effectively, build relationships and trust, innovate and achieve results at a consistently high
level. Being sensitive to their needs is very important. Staff members need to feel valued and
essential to unit function. Many times nurses go without needed breaks. If nurses are not
supported in caring for self, this leads to low staff morale. The charge nurses can assist with
seeing that these breaks are taken and heavy workloads are redistributed. An additional
stressor is when staff nurses precept orientees or novice nurses. When making assignments,
the orientation for new staff must be adjusted for and supported.

The charge nurse role in today’s environment can be compared to air traffic controllers in the
aviation industry. On today’s busy and often chaotic patient care units, patients, staff and
interdisciplinary team members rely heavily on charge nurses for their guidance and
direction. Rising to meet this leadership challenge can provide enormous professional
satisfaction and a tremendous leadership growth experience.

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Problems in Health Care Team Work:

 Failure to appreciate the value of different roles.
 Power differentials inhibit communications.
 Professional roles limit participation in decision-making.
 Conflict and conflict avoidance limit team effectiveness.
 Frequent staff changes complicate team learning and development.
 Effective team work may be compromised by a predominance of less experienced workers.

Signs of Team Stress:

 Decrease in moral
 Increase in sick leave.
 Increase in complaints.
 Increase in work related injuries.
 Increase in turn over.

Signs of Individual Stress:

 Headaches.
 Avoidance.
 Difficulty in concentrating.
 Over reactivity.
 Short temper.
 Depressive mood.

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COMPILED BY:

Ms. Ingrid Annamalay, BSN, BCUR, HONS

Nurse Educator
Nursing Education Administration

Ms. Ashika Somduth, RN

Nurse Manager
National Neuroscience Institute

DESIGNED BY:

Jolaisa Panalandang
Staff Nurse 2
Pediatric Neuroscience Ward 3

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