and differentiate between leadership and management.
2 Distinguish characteristics of effective leaders.
3 Identify leadership theories.
4 Explain emotional intelligence.
5 Identify direct care nurses as Knowledge Workers and first‐line leaders of patient care delivery.
6 Apply knowledge of leadership theory in carrying out the nurse's role as a leader.
7 Describe the management process.
8 Explain frontline, middle and executive level management roles that nurses fulfill in an organization.
9 Relate management theories.
10 Summarize motivation theories.
OPENING SCENARIO
Ed Harley was admitted to the cardiac observation unit earlier in the day. He had been diagnosed previously with heart disease and had experienced episodes of ventricular arrhythmias. His cardiologist had determined the need to change his antiarrhythmic medication to reduce the side effects Mr. Harley was experiencing. That evening, while Mr. Harley was talking to his wife on the phone and as his nurse, Maria, was walking to his bedside, he suddenly stopped talking and went into ventricular fibrillation and cardiac arrest. Maria reacted instinctively and startedAdvanced Cardiac Life Support (ACLS) defibrillating him immediately. Normal sinus rhythm appeared on the monitor before anyone else could respond to the code. Mr. Harley was then transferred to theCoronary Care Unit (CCU).
Maria had been a Registered Nurse (RN) for less than one year at the time, and although she had participated in Code arrests a few times, she had never witnessed one occur right before her eyes. Her knowledgeable action saved this patient's life. In nursing, Cardiopulmonary Resuscitation (CPR) and ACLS are mandatory skills and considered part of a nurse’s ordinary work. Yet it is quite extraordinary work.
Everything had happened so quickly that evening that Maria did not have a chance to talk to the patient before he was transferred. She entered his room the next morning in CCU, as the sun was just rising. As he awoke, Maria spent that quiet time with him. While he embraced the start of a new day, his thoughts were intense. What he chose to share was this acknowledgment: “You saved my life. Thank you.” This precious moment was a celebration of both of their lives.
What leadership characteristics did Maria demonstrate in preventing a nurse‐sensitive outcome of cardiac arrest?
Why is Maria considered a leader, even though she is not in a formal leadership or management position?
For all nurses, their knowledge of nursing and ability to apply that knowledge, is the basis of their leadership. Many people think that leaders are only top corporate executives and administrators, political representatives, military generals, or those who head an organization. This is because these leaders are highly visible and hold high‐profile positions. However, leaders are needed at all levels of an organization. With the advent of the information age, many professionals, including nurses, became known as knowledge workers. Nurses' education and specialized clinical preparation develops their expertise and leadership ability. Nursing knowledge workers are leaders. This idea of nursing knowledge workers contrasts with the manufacturing age, where the manager was the most knowledgeable person and closely supervised employees to carry out routine work. Leadership however is a basic competency for all nursing professionals. Leadership development is a necessary part of the preparation of nurses.
Nurses make a critical difference every day in the lives of their patients and patients' families, yet nurses believe those accomplishments are part of their ordinary work. Nurses are leaders, and by using their expert knowledge, they coordinate patient care and lead patients and families through health care journeys. Nurses lead themselves as they develop in their career and nurses lead change to improve patient outcomes and the quality of care. Nurses are leaders and lead without being in a management position.
Leadership and management are different. Leadership influences or inspires the actions and goals of others. One does not have to be in a position of authority to demonstrate leadership. Not all leaders are managers. Leaders have been characterized as people who do the right thing whereas managers are viewed as people who do things right (Drucker, 1993). Both leadership and management are crucial but different.
This chapter lays the groundwork for the development of knowledge about nursing leadership and management. Many concepts touched on in this chapter will be developed in depth in the chapters that follow. This chapter discusses leadership and provides a framework to differentiate leadership and management and explain emotional intelligence. Leadership characteristics, styles of leadership, and leadership theories are described emphasizing transformational leadership and complexity leadership. The chapter introduces the process of management and explains management and motivation theories. The content is developed for the beginning nurse preparing to graduate from a pre‐licensure program and enter the profession in the role of registered nurse. Benner's work describing skill acquisition of nurses uses a framework called, “From Novice to Expert” and labels this new graduate nurse as an advanced beginner (Benner, Tanner, & Chesla, 2009).
Definition of Leadership
Leadership is commonly defined as a process of influence in which the leader influences others toward goal achievement (Yukl, 2006). Nurses function as leaders when they lead themselves and influence others toward goal achievement. Influence is an instrumental part of leading others and leaders influence others, often by inspiring, enlivening, and engaging others to participate. Leadership can occur personally. It can occur between the leader and another individual; between the leader and a group; or between a leader and an organization, a community, or a society. Defining leadership as a process helps us understand more about leadership than the traditional view of a leader being in a position of authority, exerting command, control, and power over subordinates. There are many more leaders in organizations than those who are in positions of authority. Each person has the potential to set goals and enact leadership. What this means for nurses as professionals is that nurses set goals and are leaders.
Leadership can be formal leadership, as when a person is in a position of authority or in a sanctioned, assigned role within an organization that connotes influence, such as a nurse manager (Northouse, 2018). The traditional formal leadership roles in nursing include clinical supervisor, unit/department manager, director of nursing and the top‐level nurse executive, usually called the chief nurse executive or chief nursing officer. Other formal leader roles in nursing include the charge nurse of a patient care unit, the Chief Operating Officer, of a hospital the nurse who leads interprofessional team rounds and the nurse who represents her unit/department at an event or meeting.
An informal leader is a person who demonstrates leadership outside the scope of a formal leadership role or as a member of a group rather than as the head or leader of the group. The informal leader is considered to have emerged as a leader when she is accepted by others, is an opinion leader, and is perceived to have influence. Informal leader roles in nursing include examples such as the staff nurse who regularly sets personal, proffessional, and patient care goals, assuring the delivery of safe, evidence‐based, patient‐centered, high quality care, including responding quickly to a code.
Leaders and Followers
Leaders and followers are both necessary roles. Nurses are alternately leaders and followers when they work with other health care team members to achieve patient care goals, participate in meetings, and so forth. The most valuable followers are skilled, self‐directed employees who participate actively in setting the group's direction and who invest time and energy in the work of the team or group, thinking critically and advocating for new ideas (Grossman & Valiga, 2013). Good followers communicate and work well with others, being supportive, yet thoughtful, in their approach to new ideas.
Leaders Versus