I.

Nursing Leadership
Sir Parc Abejuela

Assignment [Algorithm of care]

Requisites for successful leadership and Management

1. Decision Making , a thought process of selecting a logical choice from the available options. | “it
entails confidence.” Tree analogy Leaves, Branches, Trunk, Roots.
Leaves - quick decision making. Fast action

Branches - make the decision but make sure to make it look good for others to see. Make the
decision, act on it. Report the action you took; daily, weekly, or monthly, as appropriate.

Roots - involves the whole organization. Different departments involved.

Trunk - Staffing, includes key people to make the move. Within the department.

Leaves (Quick Decision Making): This represents the ability to

make quick decisions and take fast actions when necessary. It
implies being responsive to immediate needs and challenges.

Branches (Decision-Making with Visibility): Branches symbolize

making decisions while considering how they appear to others
within the department. It's about making choices that are not
only effective but also align with organizational values and
goals. Additionally, it emphasizes the importance of reporting
and communicating decisions and actions.

Roots (Involving the Whole Organization): The roots of the tree

signify involving the entire organization in the decision-making
process. This means that decisions are made with input from
various departments and stakeholders. It highlights collaboration
and inclusivity.

Trunk (Staffing and Key Roles): The trunk represents the staffing
and key personnel required to execute decisions. Just as the
trunk supports the branches and leaves of the tree, having the
right people in key positions is essential for successful
decision implementation within specific departments or areas of
responsibility.
This analogy effectively illustrates how decision-making in leadership and management is a
multifaceted process that requires speed, alignment with organizational values, inclusivity, and the
support of skilled individuals in key roles.

2. Problem Solving , a part of decision making, and a systematic process that focuses on analyzing
a difficult situation. “Think critically.” “dili basta basta.”

3. Critical Thinking , a disciplined thinking that is clear, rational, open-minded and informed by
evidence.
reflective thinking

Components of critical thinking:

1. insight
2. intuition
3. empathy
4. willingness to take action.

Individual variations in Decision Making

1. Gender - women are more affected by the environment. Men make decision based on goal
oriented performance.
2. Values - these are important beliefs of every individual. Influences our behaviors and
attitudes.
3. Life Experiences - we have different experiences, we perceive the world and live uniquely.
4. Individual preferences -
5. Brain Hemisphere Dominance and thinking styles -
Right brain thinkers - process information from creative and intuitive.

Left brain thinkers - better at processing language, logic and numbers than Right-
brain.

Conceptual Paradigm of Leadership and Management

Resources -> Theories and Principles -> Management process and Functions -> Effective
and Efficient Leadership

7 M’s
Man
Moment
Machine
Materials
Money
Manager
Method

Leadership

1. a social influence or a person’s ability to move other people to act.

2. ability to direct or motivate an individual or group to achieve a set of goals (to do something).
3. It is an influence process involving a determination of the group’s or organization’s objectives.

Leadership is a function of Knowing yourself, having a Vision that is communicated, Building

trust among colleagues, and Taking effective action to realize your own leadership.

Management

1. a set of interactive or interrelated processes.

2. the process of coordination and integration of resources through activities of planning,
organizing, directing, and controlling to accomplish specific institutional goals and
objectives.

Nursing Leadership

1. the process where the nurse influences one or more persons achieve specific goals in the
provision of nursing care of one or more patients.
2. is a multidimensional process where the learned and inherited characteristics of the leader is
combined with situational, interactional, goal directed dimensions of the leadership theories.

The nurse caregiver’s leadership skills

a. Areas of leadership
– leadership should be approached like any other new role or skills: slowly and carefully.

*Nursing students and beginning nurses should be prepared with all of the necessary tools or
skills before attempting the new role

b. Patient Care Coordination

– nursing leadership beings with nursing care of the individual patient
– through interpersonal skills and effective communication techniques NURSES’ lead their
patients in acquiring:
New knowledge

Solving Problems

Changing Behaviors

c. Employee Responsibilities
– these are determined by the plan and objectives of the health care agency
– Autonomy principle [patient’s right]

d. Managerial Responsibilities and Delegation

e. Nursing Department
– nurses should have an interest of the function of the department.

f. Support for Leadership Training

g. Mentorship
– is a relationship in which an experienced individual advises and assists a less expert
individual (protege)
– it is valuable in all types of nursing positions

h. Preceptorship
– the preceptor is selected to introduce an employee to new responsibilities.

i. Continuing Education
– equip ourselves with new knowledge from time to time.

j. Employing Institutions or Agency

– all nurses at all levels need to be knowledgeable about the administrative structure and
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functions of their employing institution or agency.

Effective leadership

Self- management - the key to being a good follower is to think for oneself and to work well
without close supervision.

Commitment - are committed to something beyond themselves, making progress toward

achieving goals.

Competence and focus - focus their efforts for maximum impact and competence centers on
mastering skills that will be useful to the organization.

Courage - establish themselves as independent, critical thinkers and will fight for what he
believe is right.

LEADER FOLLOWER SITUATION

DIFFERENCE BETWEEN A LEADER AND A MANAGER

(managing and leadership goes together)
LEADER MANAGER
May not have official appointment to the officially appointed.
position.
Vested power and authority by the group. Vested power and authority by the
organization.
Influence others toward goal setting. Implements predetermined goals,
policies, rules and regulations.
Interested in risk taking and exploring Measures the risks to be taken in line with
new ideas. the expected results, hence; an orderly
controlled performance must be carried
out.
Relates to people personally. Relates to people according to their roles.
Feels rewarded by personal achievement. Feels rewarded when accomplishing
organizational mission goals.
May and may not be as successful as Are managers as long as the appointment
managers. holds.
Leadership Path

a. begin with yourself

b. know how
c. apply yourself
d. evaluate your gains and reflect on losses
e. change yourself

a. Begin with Yourself: Leadership starts with self-awareness and

self-improvement. Before leading others, it's essential to
understand your strengths, weaknesses, values, and beliefs. Self-
awareness forms the foundation for authentic leadership.

b. Know How: Once you have a strong understanding of yourself,

you need to acquire the necessary knowledge and skills for
effective leadership. This includes learning about leadership
theories, communication, decision-making, and other relevant
areas.

c. Apply Yourself: Knowledge alone is not enough; it must be put

into practice. Effective leaders actively engage in leadership
activities, whether through formal leadership roles or by taking
the initiative in their current roles to demonstrate leadership
qualities.

d. Evaluate Your Gains and Reflect on Losses: Regularly assessing

your leadership efforts is crucial. Evaluate your successes and
setbacks objectively. Reflecting on both your achievements and
failures allows you to learn and grow as a leader.

e. Change Yourself: Adaptability is a key trait of successful

leaders. Based on your self-evaluation and reflections, be
willing to make changes in your leadership approach. This could
involve adjusting your communication style, revising your
strategies, or developing new leadership skills.

By following this leadership path, individuals can develop into effective and adaptable leaders who
continuously evolve and improve their leadership capabilities. Starting with self-awareness and
progressively building knowledge, skills, and practical experience creates a strong foundation for
successful leadership.
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Elements of Leadership

I. Vision
1. provides direction to the influence process
2. must be communicated to the followers
3. a major tool in enlisting its members towards defined objective

critical component to make the vision work

the leader/head of organization

members of the organization

environment in which they function

II. Influence
1. Ability to obtain followers, compliance or request for power triangle

3 components of the power triangle = POWER to convince people

COMMUNICATION

RECOGNITION

INFLUENCE

KINDS OF INFLUENCE
ASSERTIVENESS - one send direct messages to others and is able to stand up for her
own rights without violating those of others.

INGRATIATION - individual makes another feel important or good before making a

request.

RATIONALITY - involves convincing someone of the merits of a detailed plan supported

by information, logic, reasoning.

BLOCKING - it is a hostile form of influence where an individual achieves the goal of

influencing another person with a threat.

COALITION - a collective form of influence where a person gets several co-workers to ”

 back her up” when making a request.

SANCTION - form of influence hinged on the promise of punishment in the case of

non-cooperation and a reward in case of cooperation.

EXCHANGE - offering a favor or personal sacrifice as an incentive for the performance

of the request.

UPWARD APPEAL - involves obtaining support from higher-up to push someone into
action.

III. POWER
1. the ability to efficiently and effectively exercise authority, control through personal,
organizational and social strength.

POWER
capacity “A” to influence
the behavior of “B” so that
“B” does things he/she would not
otherwise do.

A influence B = Behavior

Organizational Power - the capacity to influence others through the control over needed resources.
- Caring practices by the nurse to empower clients
-In conflicting and contradictory use of nurse’s time
◆ DOCTORS
◆ PATIENTS
◆ OTHER HEALTH CARE PROFESSIONALS

Sources of Powers

Legitimate power - it is bestowed upon a leader by a given position in the hierarchy of

an organization. Most obvious and most important.

Reward power - derived from the manager’s ability to give rewards to her subordinate
for compliance with her orders.

Coercive power - leader’s ability to punish subordinates for non-compliance with

directives.

Expert power - derived from the special abilities or skills unique to the leader.

Information power - derived from being well-informed and up-to-date; with expertise,
 credibility.

Referent power - based on relations and connections. also called as networking.

IV. AUTHORITY
1. the legal and formal rights of a person or someone in a superior position to control the
decision-making and direct the actions or tasks carried out by their subordinates.
2. backed by legitimacy.

POWER AUTHORITY
POWER AUTHORITY
has the potential to control/influence the has the potential to exert the control
behavior through the legitimacy of a managerial
position

Forms of Authority
Line Authority - a direct supervisory from the supervisor to subordinates.

Chain of command - an unbroken line of reporting relationships that extends through the
entire organization. It defines the chain of command and the formal decision making. It helps
employees know to whom they are accountable, and with whom to go with a problem.

Unity of command - each person in an organization should take orders from and reports to
only one person. Helps prevent conflicting demands being placed on employees by more than
one superior.

Span of control - refers to the number of employees that should be placed under the
direction of one leader-manager.

Staff Authority - is based on the expertise and which usually involves advising line managers.
Staff supervisors help line departments decide what to do and how to do it.

Team authority - is granted to committees/work teams involved in an organization’s daily

operations.

RESPONSIBILITY
– is the corresponding obligation and accountability answers for all actions done. the obligation
to do assigned tasks (the nurse-employee is responsible for being proficient at her job.)
 individual responsibilities - nobody gives or delegates individual responsibilities. Nurse
assumes them when she accepts a position in an organization.

organizational responsibilities - it is a collective organizational responsibility, including how

well the departments perform their work.

ACCOUNTABILITY
– when someone is responsible for something she is liable to a superior for the outcome. This
means that a nurse will have to answer for the result of her actions and decisions in her work.

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Leadership Theorist and Theories

THEORY PROPONENT CONCEPT

Great Man Theory Aristotle (Aristotelian Leaders are born not
Theory) raised
Leadership Styles Lewin and White Determined 3 basic
leadership style
(autocratic, Democratic,
Laissez-Faire)
Law of Situation Mary Parker Follet One person should not
give orders to another
person, but both should
agree to take their orders
from the situation
Contingency Theory of Fred fiedler Leadership style will be
Leadership effective or ineffective
depending on the situation
Task vs Relationship in Blake and Mouton determine a leader’s
determining leadership behavioral style, identifying
style their concern for people
versus their concern for
 task production
Situational Leadership Hershey and Blanchard The most effective
Theory leadership style is affected
by the circumstances
leaders find themselves in.
Situational Leadership Tannenbaum and Schmidt The relationship between
theory freedom, and authority at
work.
Leadership as part of the Selznick Leadership is the action of
organization leading people in an
organization towards
achieving goals.
Organizational structures Kanter Empowerment is promoted
shape leaders’ in work environments that
empowerment provide employees with
access to information,
resources, support, and
the opportunity to learn
and develop.
Servant leadership Greenleaf A leader practices what he/
she preach
Transactional and Burns A transformational
transformational leadership style creates a
Leadership vision and inspires
subordinates to strive
beyond required
expectations, whereas
transactional leadership
focuses more on extrinsic
motivation for the
performance.
Theory Z Ouchi The involvement of
employees in the matters
of the management
 improves their
performance and
commitment.
Interactional leadership Schein and Hollander Acknowledges that a
Theory leader’s behavior is
determined by their own
personality and the
situation which they find
themselves.

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1. LEADERSHIP STYLES IN NURSING PRACTICE

Autocratic Leadership
(“buhata na”, “buhata ni”, “adto didto”)

[e.g. Communism, Military, etc.]

– Also called directive leadership, involves the leader assuming complete control over the
decisions and activities of the group.
– Little communication and interrelating with between the leader and the group.
– Results in a well-defined group actions that are usually predictable, reducing frustration in
the workgroup, and giving members a feeling of security.
– Productivity is usually high BUT creativity, self-motivation, and autonomy are reduced.
– Useful in crisis situations.
– Emphasis is on difference in status (I and YOU)

Drawback:
– No one likes to be micromanaged

CHARACTERISTICS
– Task oriented
– Gives direct, clean and exact orders to his/her subordinates with detailed instructions as to
what is to be done and how leaving no or little room for followers’ initiative
– Delegates as little as possible and believes that he/she can do a better job than his/her
 –
followers
– Has little or no confidence in workers
– Functions with high concern for task accomplishment but low concern for the people who
perform these tasks.
– Frequently exercises power with coercion and is firm, dominating and insistent.

AUTOCRATIC LEADERSHIP
ADVANTAGES DISADVANTAGES
Some forms of authoritarian leadership The workers only work when leader is
are applicable to healthcare. present but, in his absence, they spend
time trying to undermine him at the
expense of working.
It is particularly suitable in crisis It may cause employees to lose interest
situations when clear directions are part and initiative and stop thinking because
of highest priority i.e. it is the only way to there is no need for independent thought.
get action done in an emergency.
Action first, no time to question, orders It may also lead to loss of motivation for
must be issued. they are going to adopt an attitude of
obedience to the autocratic boss.
It may also apply in situations where the Due to the lack of motivation the
people being led are inexperienced. employees may reluctantly give only
minimum performance.
As a result, less than the optimal foals
are achieved because the resources
utilized are those of the manager only.

2.DEMOCRATIC or PARTICIPATIVE or CONSULTATIVE LEADERSHIP

– Fair and logical use leadership role to stimulate others to achieve a collective goal
– The leader encourages subordinates to give views, opinions, and suggestions during
planning, organizing, and decision-making through discussions among members.
– Weakness and strengths are accepted.
– The contributions of all members are fostered and utilized.

Characteristics
– nurse manager should have a good communication skills and believes that the staff is always
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striving to do their best.
– Communication flows up and down.
– Provides general supervision.
– Emphasis on “WE rather than, I and YOU”
– Works well with trained staff

DEMOCRATIC LEADERSHIP
ADVANTAGES DISADVANTAGES
Leads to cooperation spirit in work Discussions cause delay, and tine-
performance. wasting because of disagreements and
postponements.
Enables collective ownership of decisions,
successes and failures.
Research has shown that this type of
leadership leads to high productivity and
is the most desirable form in a wide
desirable form in a wide variety of work
situations.

3.BUREAUCRATIC or DIRECTIVE LEADERSHIP

– a style of leadership characterized by rigid adherence to rules, regulations, and established

procedures within the organization.
– It is based on the principle of bureaucracy, which emphasizes hierarchical authority, division
of labor, formalized communication channels, and a systematic approach to decision-making.

Manages by the book. Set of rules

CHARACTERISTICS

– A bureaucratic leader loves rules and policies and follow procedures meticulously.
– Decision making process are typically slow-paced.
– There is no room for new ideas or innovations.
– A management approach of this sort is also very well organized, Leaders delegate the tasks
as per ranks for better results and accountability.
BUREAUCRATIC or DIRECTIVE LEADERSHIP
ADVANTAGES DISADVANTAGES
Rigid leadership style. No room for creativity
it does not encourage change and Lack of competition.
improvisation.
Best suited for large manufacturing Difficult to adapt to change.
organizations.
Quick for completion of tasks. Must follow and go by the rules.
It is predictable. Slow personal growth and development.

4. LASSEZ-FAIRE (DELEGATIVE) LEADERSHIP

– In this style the leader lets people do what they want. This is where there is no guidance from
the leader.
– The workers work as they wish with or without achieving the objectives.
– The leader is preoccupied with his own work and never communicates with subordinates.
– the leader plays down his/her role in the group’s activity and exercises minimum direction or
control
– The leader wants everyone to feel good about what they are doing and often avoids
responsibility by relinquishing power to followers and permitting them to engage in
managerial activities.

LASSEZ-FAIRE (DELEGATIVE) LEADERSHIP

ADVANTAGES DISADVANTAGES
This type of leadership can lead to
organizational collapse

5. TRANSFORMATIONAL LEADERSHIP

– this type of leadership style believes in the concept of transforming anything into something
better.
– The most effective and beneficial leadership long-term behavior to achieve long term
 –
success and improved performance.
– promotes employee development.
– attend to needs and motivate followers.
– inspires through optimism, and influences changes in perception thus providing intellectual
stimulation.
– uses role modeling.
– provides a sense of direction and encourages self-management.

CHARATERISTICS
– works best when you need fresh ideas or new perspective.
– there is also a particular appetite for risk in this leadership style because leaders are always
on the lookout for better ways. Which means they tend to go out of their comfort zone.
– this style encourages both the professional and personal growth of the employees.

TRANSFORMATIONAL LEADERSHIP
ADVANTAGES DISADVANTAGES
it gives a lot of freedom to the team too much focus on the bigger picture
members
it encourages creativity regular feedback is essential
it breaks the monotony too much freedom can also be risky
it encourages learning and development not always detailed oriented
it encourages change it can result in an employees burnout