elsevier items and derived items © 2009, 2005 saunders, an imprint of elsevier, inc. all rights...

Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Chapter 15 Leadership Skills


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Lesson 15.1Chapter 15


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Learning Objectives

• Describe the expanded role of the practical/vocational nurse (LPN/LVN), as described in your state’s Nurse Practice Act.

• Identify the location of the practical/vocational charge nurse on the organizational chart of a long-term care facility.

• Explain the difference between leadership and management.


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Learning Objectives (cont’d)

• Identify your personal leadership style.

• Explain the following leadership styles in your own words:a. Autocratic

b. Democratic

c. Laissez-faire


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LPN/LVN as First-Line Leader

• Responsible for supervising nursing assistants who deliver care in long-term care situations

• Referred to as charge nurse positions • Need to develop leadership and

management skills• Direct and supervise others in a manner

that will effectively meet the goals of the employing agency


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Organizational Chart

• Picture of responsibility in an employment situation

• Traditional organizational chart: individuals who are lower on the chart report to individuals directly above them

• Contemporary organizational chart: some middle manager positions eliminated due to changes in organizational structure


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Traditional Organizational Chart

• A picture of responsibility in an employment situation • Traditional organizational chart

– Individuals who are lower on the organizational chart report to the person directly above them on the chart.

– Vertical in appearance

• Because of changes in the structure of organizations, organizational charts have become more horizontal. – Eliminated some of the middle manager positions in

organizations – Remaining middle managers have taken on more

responsibilities and are spread thin.


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Traditional Organizational Chart


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Contemporary Organizational Chart


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Expanded Role of LPN/LVN

• It is important to review the current Nurse Practice Act in your state– Legally defines the exact role and

boundaries for LPNs/LVNs

• Expanded role: more administrative and supervisory responsibilities


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How You Are Already Preparing for a Leadership and Management Role

• Basic nursing skills, including the nursing process

• Time-management techniques for home and clinical time

• How to learn new information, including use of resources for learning

• The power of positive self-talk and thinking

• Rules for assertiveness


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How You Are Already Preparing for a Leadership and Management Role (cont’d)

• Communication Skills

• Ethical Aspects of Health Care

• Legal Aspects of Health Care

• Problem Solving and Critical Thinking

• Stress Management

• Participation in Clinical Evaluation


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Management and Leadership

• Management is the organization of all care required of patients in a health care setting for a specific period.– The focus of management is planning and directing to meet

patient goals.– Management is a formal role given to a person by the

employer.– Managers are appointed by their employers.– The tools needed for management could be written in a

step-by-step manner and given to you to follow.– Following the directions for using the management skills

would possibly get the job done in an efficient manner.


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Management and Leadership

• Leadership is the manner in which the leader gets along with coworkers and accomplishes the job.– The focus of leadership is to produce changes in the workplace

that will meet the goals of the employing agency.– Leadership is an informal role that is given to a person by a

group of workers. You become a leader when your team members decide to follow you.

– Leaders cannot be appointed.– The leader needs to influence others in the work setting to want

to implement desired change.– Directions for leadership skills can also be written, but it is

through experience that leadership skills are truly developed.


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What Kind of Leader Are You?

• There are several different ways to lead.

• What is your predominant leadership style?


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Leadership Styles

Three Leadership Styles• Autocratic

– Task-oriented– Involves telling people what to do – Does not share responsibility with employees– Emphasizes policies– May reach goals– Good in crisis situations, code situations,

emergencies


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Leadership Styles (cont’d)

• Democratic– Focuses on both the task and the employee– Shares responsibility and authority with employees– Enforces policies in the context of concern for

employees– Seeks input; encourages problem solving– Goals may be achieved with positive staff feelings– Good for daily nursing care situations, meetings,

review of care plans, committees


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Leadership Styles (cont’d)

• Laissez-faire– Purely people-oriented– Gives away responsibility to employees;

employees act without any direction– Puts employees before policies– Tries to please everyone– Goals may not be achieved– Good when organizational policies and

goals are not a consideration


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Using the Leadership Continuum as a Guide (cont’d)

• The value of a continuum is that as you move along the continuum from each extreme toward the center or midpoint, the two extremes begin to blend together.

• You have some of each style, depending on where you are on the continuum.

• A blend, to some degree, of the two extremes in the appropriate work situation would be the leadership style needed at the moment.


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Continuum of Leadership Styles


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Chapter 15Lesson 15.2


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Learning Objectives

• Identify ways to attain competency in the following five core areas, in which knowledge and skills are needed to be an effective first-line leader:1. Motivate team members to accomplish goals.2. Communicate assertively.3. Problem solve effectively.4. Build a team of cooperative workers.5. Manage stress effectively.


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• Describe how the Howlett Hierarchy of work motivators can help the practical/vocational nurse leader influence nursing assistants to motivate themselves.

• Use the problem-solving approach to set up a plan to solve a clinical problem.

• Read the mission statement for your current area of clinical assignment.

• Using suggestions in this chapter, write a plan that could be used to build a team to work on a unit in long-term care.


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• Develop a plan to decrease stress in the clinical area.

• Using the ABCD method of Ellis, identify an irrational thought you have had on the clinical area, and convert it to a rational thought.


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Core Knowledge and Skills Needed for Leadership

• Motivate team members to accomplish team goals.

• Communicate assertively.

• Problem solve effectively.

• Build a team of cooperative workers.

• Manage stress effectively.


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Understanding Motivation and Human Needs

• Motivation– A drive that causes people to set personal goals and

take actions to meet them– Comes from within a person (intrinsic)– One person cannot motivate another

• Human Needs– Must be filled in order for goals to be met– Maslow’s Hierarchy of Needs: meeting needs on lower

level is a motivator for meeting needs on next level– Howlett’s hierarchy of work motivators: nursing context


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Maslow’s Hierarchy of Needs


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Howlett’s Hierarchy of Work Motivators


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Understanding Motivation and Human Needs

• Adapting Maslow’s Hierarchy– Howlett's hierarchy of work motivators

• All levels of the pyramid are considered to be needs of employees in an employment situation.

• The opportunity to meet these needs can be encouraged or discouraged by the employer, the work environment, and the charge nurse.


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Motivation: Role of Charge Nurse

• Assists managers to influence and direct employees to act in certain ways to benefit the employer, as well as meet personal needs

• Meeting needs of nursing assistants will help to retain staff– Encourage internal motivation– Channel motives of employees to meet

organizational goals– Reward desired behaviors


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Applying Communication Skills as an LPN/LVN Leader

• Effective use of verbal and nonverbal communication

• Principles of communication are building blocks for communication skills for a practical/vocational charge nurse.


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Applying Problem Solving as an LPN/LVN Leader

• Identify the real issue and solve it.

• Avoid spending precious time on finding solutions for what is not really the problem.

• The nursing process can be used to solve resident problems as well as staff problems.


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Team Building

• Mission Statement– Defines the purpose and goals of the organization

• You are a role model for attitudes and behavior.

• Your team will model the attitudes and behavior you expect of them.

• Most employees want to do a good job at work.

• Most employees want to reach their full potential.


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Stress Management

• Stress and anxiety in the clinical area can result in dysfunctional behavior on the job.

• Your goal will be to do the following:– Display the ability to cope with stress as it

affects you.– Create a work environment with decreased

stress levels.– Guide and support nursing assistants when

they experience stress.


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Stress Control Skills for the Practical/Vocational Charge Nurse

• Controlling Stress by Altering How You Think– Stress is the body’s reaction to the mind’s

analysis of a situation. – If you learn to manage how you think about

the many interactions you have daily with nursing assistants, residents, and family members, you can control your reaction and therefore your stress level.


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Chapter 15Lesson 15.3


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Learning Objectives

• Identify ways to obtain competency in the following three specific areas, in which knowledge and skills are needed to be an effective first-line leader:a. Occupational Skills

1) Nursing (clinical) skills, including the nursing process2) Documentation3) Legal aspects4) Federal, state, and private organization regulations

b. Organizational Skills1) Time management2) Continuous quality improvement


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c. Human Relationship Skills1) Anger management

2) Performance evaluations for nursing assistants

3) Empowering team members

• Identify the importance of documenting objective, not subjective, charting entries in long-term care.


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• In your own words, explain specific skills required of the practical/vocational charge nurse in long-term care because of the Omnibus Reconciliation Act of 1987 (OBRA) regulations.

• Prioritize tasks that need to be completed for your next clinical assignment.

• Identify areas to improve efficiency in your current area of clinical assignment.


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• Practice giving positive and negative feedback, in measurable terms, to peers in a mock clinical situation.

• Develop a plan for personal growth as a practical/vocational charge nurse.


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Specific Knowledge and Skills Needed for Leadership

• Occupational (Clinical) Skills– The knowledge and skills of nursing

• Organizational Skills – Skills necessary to function in the

organization that delivers health care

• Human Relationship Skills – The ability to get along with and relate to

people


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Occupational Skills: Nursing (Clinical Skills)

• Nursing (Clinical) Skills, Including the Nursing Process– Solid clinical skills are essential for

leadership.– Knowledge of your role in nursing process– Visible expertise in clinical skills– Demonstrate skills to nursing assistants as

needed.– Show that resident care comes first.


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Occupational Skills: Documentation

• Be aware of requirements of federal and state laws and accrediting agencies.

• Documentation should be:– Specific– Objective: Avoid subjective comments and

personal judgments in your charting.

• Effective documentation is the basis for reimbursement.

• See charting guidelines in Chapter 20.


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Occupational Skills: Legal Aspects and Regulations

• Nurse Practice Act• Health care facility policies and procedures• State and federal regulations• Published standards of your nursing

organizations and codes of conduct • The Omnibus Budget Reconciliation Act (OBRA)

of 1987 • The Joint Commission: independent

accreditation agencySee legal guidelines in Chapter 20


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Organizational Skills

• Time Management– More about management and less about time– Your ability to manage time will help you organize tasks

and allow you to be successful as a charge nurse.– The nursing process will be the tool to help you get

organized.

• Continuous Quality Improvement– Focus is quality of care – Quality is indicated by patient outcomes.– Involves all departments of health care facilities,

including long-term care


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Organizational Skills

• Conflict Resolution– Conflict is not always a bad thing; sometimes it is

an opportunity for growth and learning.– The presence of conflict can point out the need for

change in an organization. – When conflicts are out in the open, the opportunity

exists to settle issues. – Conflict resolution involves people settling their

differences.


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Human Relationship Skills

• Leaders with human relationship skills will get the job done with style and tact, without sacrificing quality.

• Nursing assistants will value their leader’s style more and be more effective in reaching the goals of the unit.

• Because success depends on what is accomplished through others, the ability to relate well to others is crucial.


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Human Relationship Skills: Anger Management

• Foster belonging, affiliation, and recognition.

• Use assertive communication.• Be an active listener.• Seek input to find solutions to problems.• Encourage self-evaluation.• Attempt to help nursing assistants reach

their potential.


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Human Relationship Skills: Performance Evaluation

• OBRA mandates regular evaluations of nursing assistants.• Purpose of evaluation is to encourage personal and career

growth • Should be constructive• Identify and encourage positive behaviors.• Identify behaviors that need improvement and provide feedback

as close to the event as possible.• Objectively point out consequences of negative behaviors.• Encourage the development of employees who will meet the

facility’s objectives and fulfill the mission statement.


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Human Relationship Skills

• Empowering team members and encouraging personal growth and development of confidence– Can be very rewarding for charge nurse– Provide opportunities to be successful in new

situations.– Praise early successes.– Plan educational opportunities.– Provide challenging assignments.– Encourage problem solving.

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