 Why Study

Leadership in
Nursing?
 What are the
most serious
problems
nurse leaders
or people face
in the work
environment?
 Think like a
LEADER….
Ms. Da Costa, The hospital Administrator and Jessa, a nurse
who’s been employed for 6 months walked together at the
hallway. While they were walking, Nurse Jessa said, “
hmmm, we must have morale problems Ms. Da Costa, look at
all the litters and soft drink cans..”
Ms. Da Costa Said, Jessa, you confirmed my judgment in
promoting you as a nurse Supervisor.
Rana asked, why Sir? Anyway thank you for that.
 So what's the point????
Because Nurse Jessa thinks BIG!
Another person would have look at the litter
and simply concluded that the maintenance
people are not doing their job, instead you look
at the possible message indicated by the litter,
Ms. Da Costa said.

Nurse Jessa thinks like a LEADER….

What makes it possible for people who might
seem ordinary to achieve great things?
In Fact: More than 50% of all CEOs of Fortune
500 companies had C or C- averages in college
In Fact: Nearly 75% of all U.S. Presidents were in
the bottom half of their school classes
In Fact: More than 50% of all millionaires
entrepreneurs never finished college

In They All Had Passion, It Makes A Difference!

What LEADERSHIP really means?
 DEFINITION
Leadership
is commonly defined
As a process of
Influence whereby the
leader influences
others toward
goal achievement- John Maxwell
What ARE THE 3 Dimensions of
Leadership?

LEADERSHIP IS A
RESULT OF THE
RELATIONSHIP
BETWEEN THE
ENVIRONMENT,
GROUP MEMBERS
AND THE
LEADER
Personal Attributes of Successful Nurse
Leaders (Simms et.al,2005)
courage
conviction
Successful
creativity Nurse
Leaders
communication

coping
• Leaders are often described as being visionary,
equipped with strategies, a plan and desire to
direct their teams and services to a future goal
(Mahoney, 2001). – Nursing Times Journal
What does the study of leadership
involve?
• Leadership theories
• Motivation
• Group development & team work
• Power & conflict
• Confrontation & negotiation
• Effective communication
• Critical thinking & problem solving
 What are the 3 primary tasks of a
leader?
• Set direction: mission, goals,
vision
• Build commitment: motivate &
inspire
• Confront challenges: innovation,
deal with change, take risks
John Maxwell’s 5 Levels of Leadership
Position: Rights
the most basic level of leadership.
Nurse is able to influence because of
her title.
Territorial rights
Permission:Relationship
people begin to follow you because
they want to
People want to know what
motivates their leader
Production: Results
people begin to produce and follow
you because of what they see you.
People work together to achieve a
certain results.
People: Reproduction
you have others follow you and they
are growing within them leadership
Leader empower subordinates to
become leaders too…
Personhood: Respect
the pinnacle of leadership
people follow you based on who you
are and what you represent or stand
for.
 Theories of
Leadership

A leader takes people

where they want to
go. A great leader
takes people where
they don’t
necessarily want to
go, but ough to be.”
-Rosalynn Carter
Great Man Theory
Trait Theory
Charismatic Theory
Situational Leadership Theory
Contingency Theory
Robert House Path Goal Theory
Situational Theory
Transactional Theory
Transformational Theory
Gender Differences in Leadership
Quantum Leadership
Leadership Model
Servant Leadership
Authentic Leadership
Ethical Leadership
Values-based Leadership
Bureaucratic Leadership
Charismatic Leadership
Narcissistic Leadership
Douglas McGregor's XY Theory
Blake-Mouton's Managerial Grid
Kurt-Lewin's Three Styles Model
Bolman & Deal's Four Frame Model
Fiedler's Contingency Model
Hersey-Blanchard's Situational Leadership
Model
Tannenbaum & Schmidt's Leadership
Behavior Continuum Model
John Adair's Action-Centered Leadership
Model
Kouzes & Posner Five Leadership Practices
James Scouller's Three Levels of
French & Raven's Five Forms of Power
 Great Man Theory
–holds that some people are born to
lead, while others are born to be
led
–indicates that few people are born
with the necessary characteristics
to be great
–possess both instrumental and
supportive leadership behavior.
 Early Leadership Theories

Great Man Theory

Instrumental activities: planning, organizing,
and controlling the activities of subordinates
to achieve goals

Supportive leadership: socially-oriented, and

allows for participation and consultation from
subordinates for decisions that concerns them

Sir Francis Galton

 Believed leadership qualities were genetic
Early Leadership Theories
 Trait Theory (1950s)
• traits could be obtained through learning and
experience.
• intelligence, dominance, self-confidence,
high energy level and task-relevant
knowledge are five traits that show consistently
positive correlations with leadership
• Not clear which traits are important
Charismatic Theory (1940s)
Have a strong
conviction in their
own beliefs, high self
confidence and a need
for power
Spiritual leaders
Mahatma Gandhi &
Adolf Hitler
 Situational Leadership
Leader behaviors
High

Participating Selling

S3 S2
Relationship Behavior

Delegating Telling
S4 S1

Low Directive Behavior High

R4 R3 R2 R1
Able and Able, but Unable, but Unable and
willing unwilling willing unwilling
Follower Readiness
Copyright 2006 Vandeveer, Menefee,
Chapter 9 25
Sinclair
According to Hersey and Blanchard, there are
four main leadership styles:
Telling (S1) – Leaders tell their people
exactly what to do, and how to do it.

Selling (S2) – Leaders still provide

information and direction, but there's
more communication with followers.
Leaders "sell" their message to get the
team on board.
Participating (S3) – Leaders focus more on
the relationship and less on direction.
The leader works with the team, and
shares decision-making responsibilities.

Delegating (S4) – Leaders pass most of the

responsibility onto the follower or group.
The leaders still monitor progress, but
they're less involved in decisions.
M1 – People at this level of maturity are at
the bottom level of the scale. They lack
the knowledge, skills, or confidence to
work on their own, and they often need
to be pushed to take the task on.

M2 – at this level, followers might be

willing to work on the task, but they still
don't have the skills to do it successfully.
M3 – Here, followers are ready and willing
to help with the task. They have more
skills than the M2 group, but they're still
not confident in their abilities.

M4 – These followers are able to work on

their own. They have high confidence
and strong skills, and they're committed
to the task.
 Maturity Level
Most Appropriate Leadership Style
M1: Low maturity
S1: Telling/directing
M2: Medium maturity, limited skills
S2: Selling/coaching
M3: Medium maturity, higher skills but
lacking confidence
S3: Participating/supporting
M4: High maturity
S4: Delegating
 Exercise NO. 1
SITUATION: You're about to leave for an
extended holiday, and your tasks will be
handled by an experienced colleague.
He's very familiar with your
responsibilities, and he's excited to do the
job. Instead of trusting his knowledge
and skills to do the work, you spend
hours creating a detailed list of tasks for
which he'll be responsible, and
instructions on how to do them.
Your work gets done, but you've damaged the
relationship with your colleague by your lack
of trust. He was an M4 in maturity, and yet
you used an S1 leadership style instead of an
S4, which would have been more appropriate
 Exercise no.2
SITUATION: You've just been put in charge
of leading a new team. It's your first time
working with these people. As far as you
can tell, they have some of the necessary
skills to reach the department's goals,
but not all of them. The good news is
that they're excited and willing to do the
work.
You estimate they're at an M2 maturity level,
so you use the matching S2leadership style.
You coach them through the project's goals,
pushing and teaching where necessary, but
largely leaving them to make their own
decisions. As a result, their relationship with
you is strengthened, and the team's efforts
are a success.
 Contingency Theory
• 1960s, Fred Fiedler
• he argued that a leadership style will be
effective or ineffective depending on the
situation.
• States that there are other factors in the
environment which influence outcomes as
much as leadership style.
Leaders-members relation
involve the amount of confidence &
loyalty the followers have
Task structure
refers to the goal and policies or
procedures (low = difficult to define &
measure progress towards achievement)
Position power
authority, ability to give rewards &
punishment
 Path-Goal Theory
• Robert House
• He Argued that a person acts as she does
because she expects her behavior to produce
satisfactory results.
• people are motivated when they believe that
they are able to carry out the work which lead
to expected outcome.
• Leaders facilitate task accomplishment by
rewarding task completion
 Path-Goal Theory
 Leaders motivate followers by:
1. Directive style- provide structure through
directions
2. Supportive style-encouragement,
attention
3. Participative-involve followers in decision
making
4.A chievement-oriented-considers
behavior
The 3 styles of LEADERSHIP
 The 3 styles of LEADERSHIP
1. Autocratic: Everything is defined by
the leader who tells his subordinates what to do
and expects them to
• carry out his decisions (commands).
• rewards and punishment
• Adv: good quality output,concern for the task
• Disadv: little autonomy, creativity and self
motivation,low concern for people
• Can be used in emergencies
 The 3 styles of LEADERSHIP

2. Democratic,Consultative
or Participative:
 The leader fully shapes her decision-making power
with her subordinates allowing each member of
the group to carry an equal vote.

 The leader consults with subordinates

 and encourages participation from them;gives self
worth
3.Laissez-
faire,Permissive,Ultrabilateral
or the free-rein:
• The leader does not use his power, giving
subordinates a high degree of independence
in their operations.
• No planning, non directive, chaos is likely to
develop, unproductive
These 3 styles of leadership falls on
BEHAVIORAL THEORY (Kurt Lewin)

• Therefore, A person’s leadership style

has a great deal of influence on the
climate and outcome of the work group
CONTEMPORARY
APPROACHES TO
LEADERSHIP
 Transactional Leadership
Weber(1947) & Bass (1981)
focuses on the
accomplishment
of day to day tasks and
good worker relationships
in exchange for
desirable rewards.
 Transformational Leadership
(James Mc Gregor Burns)
 Is a true leader who
inspires his or her
team with a shared
vision of the future.
 Transformational
leaders are highly
visible, and spend a
lot of time
communicating.
 Servant Leadership Theory
Robert Greenleaf in his 1970
leaders are servants first and leaders later.
listening, empathy, healing relationships,
awareness, commitment to human resource
development, and commitment to building
community.
Emotional Intelligence Theory
Howard Gardner
EQ embraces two aspects of
intelligence:
1.Understanding yourself, your goals,
intentions, responses, behaviour
and all.

2. Understanding others, and their

feelings.
Studies* show:
For all levels of jobs, EI
competencies are twice as
effective as IQ in determining
an individual’s success rate.
The higher the level of a
position in an organization, the
more EI seems to matter.
 Executive Leaders show an
85% correlation between EI
competency and success.
 EI Competencies
• Self-Awareness
• Self-Management
EI
• Social Awareness
• Relationship
Management
Self-Awareness
Knowing one’s internal states, preferences,
resources and intuitions

Self-Management
Managing one’s internal states, impulses and
resources
 Social Awareness
Awareness of other’s feelings, needs, concerns and
the currents, networks and politics of the
organization
• Empathy

• Organizational
Awareness

• Service
Orientation
 Relationship Management

Awareness of
one’s effect on
others, ability
to work
effectively and
efficiently with
others
 Multiple Intelligence
By HOWARD GARDNER
Proposed the 8 different intelligences
1. Linguistic Learner
likes to: read, write and tell stories.
is good at: memorizing names, places, dates
and trivia.
learns best by: saying, hearing and seeing
words.
2. Logical/Mathematical Learner
likes to: do experiments, figure things out,
work with numbers, ask
questions and explore patterns and
relationships.
is good at: math, reasoning, logic and
problem solving.
learns best by: categorizing,
classifying and working with abstract
patterns/relationships.
3. Spatial likes to: draw, build,
Learner
design and create things,
daydream, look at
pictures/slides, watch
movies and play with
machines.
is good at: imagining
things, sensing changes,
mazes/puzzles and
reading maps, charts.
.
 4. Bodily/Kinesthetic Learner
likes to: move around, touch
and talk and use body language.
is good at: physical activities
(sports/dance/acting) and crafts.

5. Naturalistic Learner
likes to: be outside, with
animals, geography, and
weather; interacting with the
surroundings
learns best by: studying
natural phenomenon, in a
natural setting, learning about
how things work.
6. Musical Learner
likes to: sing, hum tunes, listen to music,
play an instrument and respond to music.
is good at: picking up sounds,
remembering melodies, noticing
pitches/rhythms and keeping time.
learns best by: rhythm, melody and music
7. Interpersonal Learner
likes to: have lots of friends, talk to people and join
groups.
is good at: understanding people, leading others,
organizing, communicating, manipulating and
mediating conflicts.
learns best by: sharing, comparing, relating,
cooperating and interviewing.
8. Intrapersonal Learner
likes to: work alone and pursue own interests.
is good at: understanding self, focusing inward on
feelings/dreams, following instincts, pursuing
interests/goals and being original.
learns best by: working alone, individualized
projects, self-paced instruction and having own space.
 Quantum leadership
Described by Porter O’grady and Malloch
 Leadership for new age
 Control is not the issue but change dominates
the climate
 Continual movement and change in reality
and creativity
 THE 2 TYPES OF LEADER

FORMAL – person in legitimate or

official authority to act the assigned role
INFORMAL – does not have official
sanction to direct activities and yet
chosen by groups
Age, seniority,
Special competencies
 TYPES OF POWER FOR LEADERS
1. Reward power
is power that a person has
because he or she has control of the
resources.
2. Coercive power
is power that a person has because
he or she has control of the
punishments or demotions.
3. Legitimate power

is power based on the position or

title that one person may have.
4. Expert power
is power based on some knowledge
that a person may have that others
may not.
5. Referent power
 is power based solely on attractive
characteristics that a person may
have.
Taylors Monistic Theory
• Physiological
• Meal breaks, adequate pay, no
overworked
• Safety & Security
• No threats and deprivation, stable job
• Social & Belongingness
• Recognition, communication
• Esteem Needs
• Give praise, pay raises, promotions
• Self
Actualization
Needs
• Feelings of
accomplishment

• Transcendence
• Helping others;
beyond self
 FREDERICK HERZBERG’S
2 FACTOR MOTIVATION
HYGIENE THEORY
1st category : dissatisfiers or
hygiene factors
2nd category: satisfiers or motivators
 Hygiene Factors Motivation Factors
Company policy and Status
administration Opportunity for
Wages, salaries and advancement
other financial Gaining recognition
remuneration Responsibility
Challenging / stimulating
Quality of supervision
work
personal relations
Sense of personal
Working conditions
achievement & personal
Feelings of job security
growth in a job
 VROOM’S EXPECTANCY THEORY
by Victor Vroom
Motivation depends on how much people
want something and their estimate of
probability of getting it.

VALENCE + EXPECTANCY = MOTIVATION

 Skinners + Reinforcement Theory
by B.F. Skinner
Behavior weakens or strengthens depending
upon the reinforcement.
Example:
memo to prepare budget report Prepared
budget report raises received
a sense of satisfaction
(may increase the frequency of desired behavior)
Douglas Mc Gregor’s Theory X & Y
Theory X – most people would
rather be directed than assumed
responsibility for creative problem
solving

Theory Y – assumes that people are

basically reliable and naturally enjoy
work conditions.
MC GREGORS’S
 EQUITY THEORY
-Jo Stacy Adams-

Amount of tension is proportional

to the magnitude of the
perceived inequity.
 Intrinsic Motivation
-Edward Deci-
Intrinsically motivated behavior
seems to be stimulated by
peoples needs for feeling
competent and self determining
 David mcclelland's motivational
needs theory
1. The need for affiliation (N-Affil);
need for friendly relationships and human
interaction.
need “to feel liked” and “accepted” by others.
 A person with a high need for affiliation is
likely to be a team player and thrive in a
customer services environment. They will
perform best in a co-operative environment.
2. The need for power (N-Pow);
 need to lead others and make an impact
need for personal power may be viewed as
undesirable as the person simply needs to feel
that they have “power over others”. They
don’t have to be effective or further the
objectives of their employer.
 need for institutional power. People with the
need for institutional power; want to direct
the efforts of their team, to further the
objectives of their organization
3. The need for achievement (N-Ach);
This is the need to achieve, excel and succeed.
A person with this type of need, will set goals
that are challenging but realistic.
This type of person prefers to work alone or
with other high achievers. They do not need
praise or recognition, achievement of the task
is their reward.
 Followership

How followership assists leaders in leading…

 Agree or Disagree???
• Effective followership is effective leadership
where people work collaboratively to realize
the vision they share
• Role of the follower is extremely important
since leaders cannot be leaders unless they
have followers
• Characteristics of good followers are similar to
those outlined for good leaders
 Kelley’s Four Types of Followers
1. Sheep–people
 who are passive and comply with whatever
the leader says but who are not actively
engaged in the work of the group
2. “Yes” people–people who are actively
involved in the group’s work, think for
themselves, and eagerly support the leader
 Kelley’s Four Types of Followers
(Continued)…
3. Alienated followers
people who think for themselves but are often
critical of the leader
4. Effective or Exemplary followers
people who are engaged in the work of the
group, suggest new ideas, share criticisms with
the leader, and invest their energy in the work
of the group
 Follower Types (Pittman, Rosenbach
and Potter, 1998)
1. Subordinates–do what they are told but are
not actively involved
2. Contributors–are supportive, involved, and do
a good job, but don’t challenge the leader’s
ideas
3. Politicians–give honest feedback and support
the leader but are not peak performers
4. Partners–are highly involved, are peak
performers, and are seen as “leaders in
waiting”
 The Politics of Power
Strategies to help novice manager negate the
negative effects of organizational politics
1. Become an expert handler of information &
communication. Must be cautious in
accepting facts; decisions should be delayed
until adequate information has been
gathered.
2. Be a proactive decision maker
3. Expand personal resources
4. Develop political alliances and coalitions.
Nurse managers can sharpen their political
skills by becoming involved with peers outside
to keep abreast of current happenings
5. Be sensitive to timing
6. Promote subordinate indentification:
recognition/thank you
CRITICAL THINKING

PROBLEM SOLVING

DECISION MAKING
 CRITICAL THINKING

Thinking about your thinking

while you’re thinking in
order to make your thinking
better.
(Paul, 1992)
Scriven & Paul (2004)

intellectually disciplined process of

actively & skillfully
conceptualizing, applying,
analyzing, synthesizing from
gathered facts, experience and
observation.
Decisions, decisions decisions …
We keep making decisions, keep postponing
decisions, sometimes jump to decisions and
sometimes sit on decisions, sometimes are
faced with tough decisions and sometimes we
delegate decisions. But decisions are part of
life, more so, if you are designated as Nurse
Manager.
 Decision making process &
PROBLEM SOLVING
1st step: define the problem

2nd step: plan or generate a list

Of alternatives

3rd step: choose the best &

implement

4th step : evaluate

 If students will be
taught how to reason
insightfully this will
eliminate trial and
error and will arrive
quality decisions.
When evaluating courses of action it
is important to:
A. identify your values and those of
stakeholders.
B. realize that values are not
important.
C. realize that values confuse the
issue and increase difficulties.
D. always insist on your values.
In solving a problem it is important
to
A. identify your position and stick
with it.
B. present your solution as best.
C. identify flaws in other positions.
D. collaborate.
 You are the night shift caring
for Mr. Tan. He is scheduled
EXERCISE:
for a pacemaker insertion
tomorrow. Hospital policy
states that no visitor may
stay a patient at night
unless the patient is
critically ill. The wife is
requesting that she should
stay with her husband so as
to lessen the anxiety that
her husband would
experience
What are the individual variations in
decision making?
VALUES influence
perceptions

LIFE EXPERIENCE
the more mature, the
more alternatives he can
identify

INDIVIDUAL PREFERENCE
courage, sensitivity, energy &
& creativity
 Management
Decision Making Tools
• Rational Model – based on common goals,
technical competence and sequential process
• Political Model – based on power, self interest
• Collegial Model – based on full participation of
a community, consensus, respect
• Bureaucratic Model – based on historical
norms
• Garbage Can Model – based on the premise of
pure accident, coincidental, unplanned
 Decision Making Tools

Henry Gannt
• Rows of assigned
responsibility &
columns for time
frame
• A line is drawn while
task is in progress
 Decision Making Tools
Decision making Tree
 Useful when
choosing from
2 choices eg.
Deciding a method
of care
 Decision Making Tools
• PERT (Program Evaluation and Review
Technique
• Involves identifying key activities in a
project, sequencing the activities,
assigning the duration of each phase
• Designed for an complex project that
involes extensive research and
development
• Subtask must be completed before
total project can be done
PERT CHART