Determining a Need to Know
You are a nursing student. You are also hiV positive as a result of some high-risk behaviors you engaged in a decade ago. (it seems like a lifetime ago.) You are now in a committed, monogamous relationship and your partner is aware of your hiV status. You have experienced relatively few side effects from the antiretroviral drugs you take and you appear to be healthy.
You have not shared your sexual preferences, past history, or hiV status with any of your classmates, primarily because you do not feel that it is their business and because you fear being ostracized in the local community, which is fairly conservative.
Today, in the clinical setting, one of the students accidentally stuck herself with a needle right before she injected it into a patient. Laboratory follow-up was ordered to ensure that the patient was not exposed to any blood-borne disease from the student. Tonight, for the first time,
you recognize that no matter how careful you are, there is at least a small risk that you could inadvertently expose patients to your bodily fluids and thus to some risk.
Assignment: decide what you will do. is there a need to share your hiV status with the school?
With future employers? With patients? What determines whether there is “a need to tell” and a
“need to know”? What objective weighted most heavily in your decision?
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2
Classical Views of Leadership and Management
… management is efficiency in climbing the ladder of success; leadership determines whether the ladder is leaning against the right wall.
—Stephen R. Covey
… no executive has ever suffered because his subordinates were strong and effective.
—Peter Drucker
CROSSWALK
thiS ChaPteR aDDReSSeS:BSN Essential II: Basic organizational and systems leadership for quality care and patient safety BSN Essential VI: interprofessional communication and collaboration for improving patient health outcomes
BSN Essential IX: Baccalaureate generalist nursing practice MSN Essential II: Organizational and systems leadership
MSN Essential VII: interprofessional collaboration for improving patient and population health outcomes
MSN Essential IX: advanced generalist nursing practice
AONE Nurse Executive Competency I: Communication and relationship building AONE Nurse Executive Competency II: a knowledge of the health-care environment AONE Nurse Executive Competency III: Leadership
QSEN Competency: teamwork and collaboration
LEARNING OBJECTIVES
The learner will:l discuss the evolution of management theory in relationship to changing society
l correlate management theorists with their appropriate theoretical contributions
l discuss the need for health-care managers to have highly integrated, well-developed leadership and management skills
l define the components of the management process
l differentiate between leadership roles and management functions
l identify common leadership styles and describe situations in which each leadership style could be used appropriately
l describe the differences between interactional and transformational leadership theories
l analyze the historical development of leadership theory
l differentiate between authoritative, democratic, and laissez-faire leadership styles
l identify contextual factors impacting the relationship between leaders and followers, based on full-range leadership theory
l delineate variables suggested in situational and contingency theories
The relationship between leadership and management continues to prompt some debate, although there clearly is a need for both. “Psychologists tend to define leadership in terms of interpersonal behavior, while management thinkers emphasize how leaders shape structural features of organizations” (Kaiser, Lindberg McGinnis, & Overfield, 2012, p. 120).
Leadership is also viewed by some as one of management’s many functions; others maintain that leadership requires more complex skills than management and that management is only one role of leadership. Still others suggest that management emphasizes control—control of hours, costs, salaries, overtime, use of sick leave, inventory, and supplies—whereas leadership increases productivity by maximizing workforce effectiveness.
But if a manager guides, directs, and motivates and a leader empowers others, then it could be said that every manager should be a leader. Similarly, leadership without management results in chaos and failure for both the organization and the individual executive.
Thompson (2012) agrees, suggesting that good management, as defined by strong planning, organizational skills, and control, allows managers to intervene when goals are threatened. But it is leadership skill that is needed to implement the planned change that is a part of system improvement. Thus, the integration of both leadership and management skills is critical to goal attainment.
Dignam et al. (2012) also agree, suggesting that since change is a primary feature of contemporary health-care environments, managers must be able to shift from a traditional focus on operational task completion to the leadership skills of visioning, motivating, and inspiring others before desired outcomes can be achieved. MacLeod (2012) echoes similar thoughts in his assertion that in the face of significant change, both sound management and strong leadership skills are essential to the long-term viability of today’s health-care organizations.
Yet, we are all aware of individuals in leadership positions who cannot manage and individuals in management roles who cannot lead. This chapter first artificially differentiates between management and leadership, focusing on how theory development in each field of study has changed over time, and then concludes with a discussion of how closely integrated the two roles must actually be for individuals in contemporary leadership or management roles.