Leadership and Management in nursing CH 2&3

Fredrick Taylor
Advocate for Scientific Management
1. His theory would require time/motion studies to determine the most efficient way to complete each task.
2. The only way to make it work is if we hire and train and promote people based on abilities.
3. Everyone knows where they “fit” into the organization and how they contribute to overall organizational productivity. Get paid for what they produce. People are only motivated by money (short term)
4. Managers and workers need to work together—as long as the workers do all the “work”

Max Weber
• Created Beaurocracy
• Under the impression that we need a structure so that employees know there are rules and regulations and a formal chain of command.
• This allows people to know where or who to go to when there is a problem

Henry Fayol
Created the management process

Management Process
1. Planning: determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long and short-term range projections; determining a fiscal course or action; and managing planned change
• What is the philosophy of the organization/business? What are its goals, objectives, policies, procedures, etc. This step could parallel with assessment in nursing or the “P” of the Plan, Do, Study, Act. What is their strategic plan? Long range, short-term goals? What is their fiscal health?

2. Organizing: establishing the structure to carry out plans. We have a plan—now how are we going to carry it out.

3. Staffing: Recruiting, interviewing, hiring, and orienting staff. Scheduling, staff development, employee socialization, and team building are also included.
• Let’s recruit and hire the best. How will we orient them? What about the most effective means of scheduling? Is it 8 hours, 12 hours, a combination? Self-scheduling? What will we have in place for employee socialization?

4. Directing: Some overlap with staffing but includes (HR responsibilities like motivating, managing conflict, delegating, communicating, collaboration). We may disagree that this is not always an HR function.

5. Controlling: We have to make sure we are fiscally responsible, that our employees are ethical in their actions, professional and collegial.

Mary Parker Follett
Participative management: • Suggested that managers should have authority WITH and not over employees.

Elton Mayo
•Conducted a study looking at the relationship between illumination in the factory and productivity. They saw increased productivity b/c they were being observed not because of the lighting

Coined term “The Hawthorne Effect”

Discovered that Weber’s bureaucratic management system is missing out on the “Human Element”

The Hawthorne Effect
“people respond when they are being studied

McGregor X Theory
• Theory X:
o People need close supervision
o Will avoid work when possible
o Will avoid responsibility
o People only desire money
o People must be pushed to preform

McGregor Y Theory
• Theory Y:
o People want independence in work
o People seek responsibility
o People are motivated by self fulfilment
o People naturally want to work
o People will drive themselves to perform

Great Man theory
Some people are born to be leaders, while others are born to be led

Trait theory
Some people have characteristics or personality traits that make them good leaders

Situational Or Contingency Leadership
when your leadership style changes or fluctuates depending on the situation

Interactional leadership theories
operate on the premise that our working environments are open systems and we react to them (and all that they encompass—people, energy, information, matter).

o People are complex and highly variable
o People’s motives change over time
o Goals can differ based on the situational goals on units should be congruent with goals of hospital
o Performance and productivity are impacted by the task, the person’s ability, experience and motivation
o No one leadership strategy works in every situation

Hollander’s leadership Exchange
o 2-way street
o Leader (personality, perceptions and abilities)
o The followers (personality, perceptions and abilities)
o The situation (group norms, size, density – was the first to theorize that the relationship between leaders and followers may be impacted by events going on in their “other” roles. He said that the leader and follower contribute to the relationship and receive something from it—a 2-way process.

Transactional (traditional) leadership theory
Focuses on day-to-day tasks
Is a caretaker
Uses trade-offs to reach goals
Does not identify shared values
Examines causes
Uses contingency rewards

Transformational leadership theory
Identifies common values
Is committed
Inspires others with vision
Has long-term vision
Looks at effects
Empowers others

Strengths-based leadership
-Works with the whole, while appreciating the interrelationships among its parts
-Recognizes the uniqueness of staff and organization
-Creates work environments that promote nurses health and facilitates their development
-Understands the significance of subjective reality and created meaning
-Value self-determination
-Recognizes that person and environment are integral and that nurses function best in environments where there is a “goodness of fit” that capitalizes on their strengths.
-Creates environment that promote learning and recognizes the importance of readiness and timing
-Invests in collaborative partnerships

Level 5 Leadership
humble, growth of company is important to them

1) highly capable individual, 2) contributing team member, 3) competent manager, 4) effective leader, 5) executive

Servant leadership
•Serving others is priority #1

•Differs from traditional management where organizational goals and needs are #1

•Trust, mutual respect and feedback are paramount to servant leadership

Principal agent theory:
• Follower (agent)
• Principal (leader)-make assumption that

-the agents are all working in the best interest of the organization or principal.

-This is because agents may have expertise or knowledge advantage over the leader as well as their own preferences, which may deviate from the principles.

-The risk is that agents will pursue their own objectives or interests instead of that of their principal. Principals must identify and provide agents with appropriate incentives to act in the organizations best interest.

Human Capital theory (p. 58)
-refers to the attributes of a person which are productive in some economic context

Example: formal educational attainment like the new baccalaureate prepared nurse or the politically astute nurse or a charismatic CEO

Organization benefits from nurses knowledge and skills that they bring to unit. The professors are human capitol for UNCC.

Collective group knowledge or experience

Social Capitol theory
-How can it be helpful to you as an individual AS WELL AS the organization?

•Can be helpful or detrimental to you. Not something that is based on your ability. It is based on who you know, what school you attended, etc.

•So John got into Harvard because his dad donates a ton of money to Harvard. John isn’t very smart but still got accepted

Quantum leadership
•Change is constant

•From chaos comes order

•The workplace is not static

•According to Wolfe (2012) You can work with people more successfully by enlisting their feelings than by convincing their reason. This increases productivity.

•Quantum leadership theory is the only theory that attempts to take the “order” out of managing and leading-Remember Fayol?

Emotional Intelligence leadership

•Goes beyond “technical” skills

•Getting optimal results from relationships with others or how to use emotions to your benefit because that skill is key to developing high-performing relationships

•Develops with age

•Some argue it can be learned

•5 component: self awareness, self-regulation, motivation, empathy, social skills

Authentic leadership
•In order to lead you must be true to yourself and your values and act accordingly.

•Differs from transformational leadership in that it is the leaders’ principles and values that inspire. In transformational leadership, the leader is often inspired by external forces.

•Are your actions consistent with your convictions?

•How can in incongruence harm your leadership effectiveness?

•Gotta walk the walk and talk the talk

Intrinsic motivation
-motivation from within the individual, often influenced by family unit and cultural values

oWhat drives you to be productive

oDirectly related to your aspirations

oExample: the challenge of the job, the joy of the work, and autonomy motivate you

Extrinsic Motivation
-motivation that comes from external forces (work environment)

oEnhanced by external rewards

oExample: money, praise, a good grade, a prize, fame, recognition motivate you

Theories of Employee Motivation: Maslow
oPhysiological needs: (Base- most important) air, water, food, rest, exercise. Etc

oSafety Nees: shelter, job security, retirement plan, insurance

oLove and Belonging: kids, friends, partners

oSelf Esteem (1): fame, recognition, reputation, dignity

oSelf Esteem (2, top- least important): confidence, achievements, freedom

oRecognized that people were not solely motivated by economic factors

Theories of Employee Motivation: Skinner
oSkinner’s black box: Skinner saw the mind as a black box. Information in, a process out—but what happened in between (in the “black box” (internal processes) was not significant.

oOperant conditioning—behavior can be shaped/manipulated through the use of rewards and/or punishment.

Theories of Employee Motivation: Herzberg’s Hygiene Theory
o Hygiene Factors (Extrinsic)
• Pay and Benefits
• Company Policy and Administration
• Relationships with co-workers
• Physical Environment
• Supervision
• Status
• Job Security
• Salary

o Motivation Factors (Intrinsic)
• Achievement
• Recognition
• Work Itself
• Responsibility
• Promotion
• Growth

oYou can be intrinsically satisfied but dissatisfied extrinsically.

oHygiene factors can keep you from being dissatisfied or demotivated but they are not “real” motivators.

oThe opposite of dissatisfaction is not satisfaction—so even when you are happy with hygiene factors, you may not be dissatisfied but it doesn’t mean you are satisfied either.

oTo be motivated—you need both hygiene and motivation factors.

Vroom: The Expectant Theory
-Deals with motivation and management.

-Assumes that behaviour is a result from conscious choices among alternatives.

-The purpose of the choices is to maximize pleasure and to minimize pain.

-Vroom suggested that the relationship between people’s behaviour at work and their goals was not as simple as first imagined by other scientists.

-Vroom realized that an employee’s performance is based on individual factors such as personality, skills, knowledge, experience and abilities.

-The ET says that individuals have different sets of goals and can be motivated if they have certain expectations.

The Expectant Theory’s Expectations
•There is a positive correlation between effort and performance

•Favorable performance will result in a desirable reward

•The reward will satisfy an important need

•The desire to satisfy the need is strong enough to make the effort worthwhile

Motivational Force Formula
oVroom suggests that an employee’s belief about expectancy, instrumentality and valence interact psychologically. In this way they create a motivational force, such that the employee will act in a way that brings pleasure and avoids pain.

oThis force can be calculated via a formula:
Motivation = Valence x Expectancy (Instrumentality)

oThis formula can be used to indicate and predict things as: job satisfaction, occupational choice, the likelihood of staying in a job and the effort that one might expend at work.

1. Achievement (task accomplishment)
•Set people up in situations where they can achieve
•Achievement is more important than material or financial reward.
•Achieving the aim or task gives greater personal satisfaction than receiving praise or recognition.
•Financial reward is regarded as a measurement of success, not an end in itself.
•Security is not prime motivator, nor is status.
•Feedback is essential, because it enables measurement of success, not for reasons of praise or recognition (the implication here is that feedback must be reliable, quantifiable and factual).
•Achievement-motivated people constantly seek improvements and ways of doing things better.
•Calculated risk takers

2. Power (supervisory roles)
•Focus on influence and control
•May be forceful
•Perform well if given key position of authority

3. Affiliation (need to be liked)
•Problems: may not tell the truth
•They try to affiliate themselves with individuals and groups.
•They are driven by love and faith.
•They like to build a friendly environment around themselves.
• Social recognition and affiliation with others provides them motivation.

Stretching and Participating:

•I am not out to get you. I am out to make you better.
•Pushing beyond what they think they can achieve.
•Should not be done on a daily/routine basis.
•Participating encourages employees to participate in decisions that impact their jobs

4 Characteristics of Values
1. Must be freely chosen from among alternatives only after due reflection
2. It must be prized and cherished
3. It is consciously and consistently repeated (part of a pattern)
4. It is positively affirmed and enacted

•Why are we here?

•Identifies constituencies (residents, region served), discusses ethics, principles and standards of practice.

•High priority when it comes to planning and setting goals and making policies.

•Must be congruent.

•Should flow from the mission statement because it will direct all further planning towards achieving the mission.

•There can be an organizational philosophy as well as a nursing service or unit philosophy but they must both mirror the organizational mission statement.

•ALL members of the team should be able to tell you the mission, vision, values of the organization.

•The mission, vision and values should be evident. You should see them in action from top to bottom.

•These statements are worthless if there is not buy-in from all employees.

the desired result toward which effort is directed-the aim of the philosophy

how the goal will specifically be achieved (includes time frame and is measurable).

plans reduced to statements or instructions that direct organizations in their decision-making

step-by-step process

plans that specifically define acceptable choices of action. Least flexible-should be limited

Planning Hierarchy
Mission–> Philosophy–> Goals–> Objectives–>Policies–> Procedures–> Rules

Kurt Lewin
Change model

Change is linear and can be predicted


Convincing members to change either out of guilt, anxiety or concern (creating discontent)

The change agent (you) identifies, plans and implements strategies to ensure that driving forces exceed restraining forces so that the change can occur.

Stabilization of the change and making it status quo. Support and reinforcement is required.

•So…Change should never be attempted unless the change agent can make a commitment to be available until the change is complete.

Non-linear change Theory

oAssumes resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change

oThis type of strategy is used when there is little anticipated resistance to change or when the change is perceived as reasonable

oExample: Our organization did poorly on the Joint Commission Core Measure related to CAUTIs. How can I use this change strategy to improve the score?

oUses group norms and peer pressure to to socialize and influence people so that change will occur. The change agents assume that humans are social creatures, more easily influenced by others than facts

oThe change agent doesn’t have to be in a power role, just have good interpersonal relationships

oExample: We hired a new nurse and she just isn’t fitting in. She doesn’t follow policy, she is often late. Besides firing her, how can we use this change strategy?

oThese strategies assume that people are set in their ways and will change only when rewarded for the change or when they are forced by some other power coercive method. Resistance is handled by authority measure-you can either accept it or leave it

oExample: I am the Director of the ED. The organization has decided to implement a bar scanner and the ED is last to adopt. I am getting a lot of blowback from administration for the resistance I am getting from staff. How can I use this change strategy to get the project done?

Out of Chaos Comes Order Theory
•Finding underlying order in random data

•Even small changes can impact a system’s long-term behavior. (butterfly effect)

•So, even minor changes are not inconsequential.

•The change agent has to keep his/her eye on the target.

•People will attempt to undermine change efforts.

•If the effort fails, did you actually find “the cause?”

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