Quiet at Night?
You are the night shift charge nurse on a busy surgical unit in a large, urban teaching hospital.
Surgeries occur around the clock, and frequently, noise levels are higher than desired because of the significant number of nurses, physicians, residents, interns, and other health-care workers who gather at the nurses station or in the halls outside of patient rooms. today, the unit manager has come to you because the hospital’s score on the Centers for Medicare and Medicaid Hospital Consumer Assessment of Healthcare Providers and Systems (hCahPS) survey for the category Always Quiet at Night falls far below the desired benchmark. She has asked you to devise a plan to address this quality of care issue. the management goal in this situation is to achieve an hCahPS score on Always Quiet at Night that meets the accepted best practices benchmark, thus assuring that patients get the rest they need to promote their recovery. the leadership goal is to foster a shared commitment among all health-care professionals working on the unit to achieve the Always Quiet at Night goal.
Assignment:
1. identify five management strategies you might use to address the problem of excessive noise on the unit at night. For example, your list might include structural environmental changes or work redesign.
2. then identify five leadership strategies you might use to promote buy-in of the Quiet at Night initiative by all health-care professionals on the unit. how will you inspire these individuals to work with you in achieving this critically important goal? What incentives might you use to reward behavior conducive to meeting this goal?
3. Discuss whether you feel this goal could be achieved by employing only the management strategies you identified. Could it be achieved only with the implementation of leadership strategies for team building?
REFERENCES
Antonakis, J., Avolio, B. J., & Sivasubramaniam, N. (2003).
Context and leadership: An examination of the nine- factor full-range leadership theory using the Multifac- tor Leadership Questionnaire. Leadership Quarterly, 14, 261–295.
Argyris, C. (1964). Integrating the individual and the organi- zation. New York, NY: John Wiley and Sons.
Avolio, B., Walumbwa, F., & Weber, T. (2009). Leadership:
Current theories, research, and future directions. An- nual Review of Psychology, 60, 421–449.
Bass, B. M., & Avolio, B. J. (Eds.) (1994). Improving organizational effectiveness through transformational leadership. Thousand Oaks, CA: Sage.
Blake, R. R., & Mouton, J. S. (1964). The managerial grid.
Houston, TX: Gulf Publishing.
Brandt, M. A. (1994). Caring leadership: Secret and path to success. Nursing Management, 25(8), 68–72.
Braun, S., Peus, C., & Frey, D. (2012). Is beauty beastly?:
Gender-specific effects of leader attractiveness and leadership style on followers’ trust and loyalty.
Zeitschrift FüR Psychologie, 220(2), 98–108.
Burns, J. M. (2003). Transforming leadership. New York, NY: Grove/Atlantic, Inc.
Dictionary.com (2013). Management. Definition. Retrieved January 28, 2013, from http://www.ask.com/dictionar y?q=management&qsrc=999&o=3986
Dignam, D., Duffield, C., Stasa, H., Gray, J., Jackson, D., &
Daly, J. (2012). Management and leadership in nurs- ing: An Australian educational perspective. Journal of Nursing Management, 20(1), 65–71.
Doody, O., & Doody, C. M. (2012). Transformational leader- ship in nursing practice. British Journal of Nursing, 21(20), 1212–1218.
Esparza, S. & Rubino, L (2014). A call for new leadership in healthcare. In L. Rubino, G. Esparza, S. J., & Reid Chassiakos, Y. S. (Eds.), New leadership for today’s health care professionals. Concepts and cases. Jones and Bartlett Learning. Retrieved February 25, 2013, from http://samples.jbpub.com/9781284023572/
Chapter1.pdf
Fayol, H. (1925). General and industrial management. Lon- don: Pittman and Sons.
Fiedler, F. (1967). A theory of leadership effectiveness. New York, NY: McGraw-Hill.
Follett, M. P. (1926). The giving of orders. In H. C. Metcalf (Ed.), Scientific foundations of business administra- tion. Baltimore, MD: Williams & Wilkins, 29–37.
Gardner, J. W. (1990). On leadership. New York, NY: The Free Press.
Gulick, L. (1937). Notes on the theory of the organization. In L. Gulick & L. Urwick (Eds.), Papers on the science of administration (pp. 3–13). New York, NY: Institute of Public Administration.
Hersey, P., & Blanchard, K. (1977). Management of or- ganizational behavior: Utilizing human resources (3rd ed.). Englewood Cliffs, NJ: Prentice Hall.
Hollander, E. P. (1978). Leadership dynamics: A practical guide to effective relationships. New York, NY: The Free Press.
Kaiser, R. B., Lindberg McGinnis, J., & Overfield, D. V.
(2012). The how and the what of leadership. Consult- ing Psychology Journal: Practice & Research, 64(2), 119–135.
Kanter, R. M. (1977). Men and women of the corporation.
New York, NY: Basic Books.
Kanter, R. M. (1989). The new managerial work. Harvard Business Review, 67(6), 85–92.
Kouzes, J., & Posner, B. (2007) The leadership challenge (4th ed.). San Francisco, CA: Jossey Bass.
Lewin, K. (1951). Field theory in social sciences. New York, NY: Harper & Row.
MacLeod, L. (2012). A broader view of nursing leadership:
Rethinking manager-leader functions. Nurse Leader, 3(10), 57–61.
Mayo, E. (1953). The human problems of an industrialized civilization. New York, NY: Macmillan.
McCrimmon, M. (n.d.). What’s wrong with leadership theory? Retrieved August 3, 2006, from http://www .leadersdirect.com/What%27s%20wrongV4.pdf McGregor, D. (1960). The human side of enterprise. New
York, NY: McGraw-Hill.
Nelson, L., & Burns, F. (1984). High-performance program- ming: A framework for transforming organizations.
In J. Adams (Ed.), Transforming work (pp. 225–242).
Alexandria, VA: Miles River Press.
North Carolina Center for Student Leadership in Ethics
& Public Service (2009). Leadership resources:
Transformational leadership. Retrieved August 30, 2009, from http://www.ncsu.edu/csleps/leadership/
Resource%20-%20Transformational_Style.htm Ouchi, W. G. (1981). Theory Z: How American business can
meet the Japanese challenge. Reading, MA: Addison- Wesley.
Rowold, J., & Schlotz, W. (Spring 2009). Transformational and transactional leadership and followers’ chronic stress. Leadership Review, 9, 35–48. Retrieved August 29, 2009, from http://www.leadershipreview .org/2009spring/article1_spring_2009.asp
Schein, E. H. (1970). Organizational psychology (2nd ed.).
Englewood Cliffs, NJ: Prentice-Hall.
Smith, B. E. (2012). The evolution of leadership. H&HN:
Hospitals & Health Networks, 86(10), 55–65.
Tannenbaum, R., & Schmidt, W. (1958). How to choose a leader- ship pattern. Harvard Business Review, 36, 95–102.
Taylor, F. W. (1911). The principles of scientific management.
New York, NY: Harper & Row.
Thompson, J. (2012). Transformational leadership can im- prove workforce competencies. Nursing Management (Harrow), 18(10), 21–24.
White, R. K., & Lippitt R. (1960). Autocracy and democracy:
An experimental inquiry. New York, NY: Harper &
Row.
Wolf, G. A., Boland, S., & Aukerman, M. (1994, May).
A transformational model for the practice of
professional nursing. Part 2, Implementation of the model. Journal of Nursing Administration, 24(5), 38–46.
Wong, C. A. (2012). Advancing a positive leadership orienta- tion: From problem to possibility. Nursing Leader- ship, 25(2), 51–55.
Zenger, J., & Folkman, J. (2009). Ten fatal flaws that derail leaders. Harvard Business Review, 18.
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Twenty-First-Century Thinking about Leadership and Management
… 21st century leaders are less reliant on “how things should be” and instead approach business challenges and opportunities with an enquiring mind—one that makes room for new possibilities.
—Shirlaws Pty Ltd
… we are not creatures of circumstance; we are creators of circumstance.
—Benjamin Disraeli
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 IX: advanced generalist nursing practice
MSN Essential VII: interprofessional collaboration for improving patient and population health outcomes
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 analyze how current and future paradigm shifts in healthcare may affect the leadership skills needed by nurses in the 21st century
l compare strengths-based leadership, which focuses on the development or empowerment of workers’ strengths, with the traditional management practices of identifying problems, improving underperformance, and addressing weaknesses and obstacles
l identify Level 5 Leadership skills (as espoused by Jim collins) which differentiate great companies from good companies
l identify the characteristics of a servant leader and suggest strategies for encouraging a service inclination in others
l explore elements of human and social capital which impact resource allocation in organizations
l describe situations where followers (agents) might not be inherently motivated to act in the best interest of the principal (leader or employer)
l describe components of emotional intelligence which promote the development of productive work teams
3
l identify characteristics of authentic leadership and discuss the consequences to the leader–
follower relationship when leaders are not authentic
l identify contemporary nurse-leaders who exemplify thought leadership and the innovative ideas they have suggested
l describe why quantum leaders need flexibility in responding to the complex relationships that exist between environment and context in work environments
l describe complexities that exist in the relationship between followers and leaders
l provide examples of the 21st-century shift from industrial age leadership to relationship age leadership
l develop insight into his or her individual leadership strengths
Throughout history, nursing has been required to respond to changing technological and social forces. In the last decade alone, a growing elderly population, health-care reform, reductions in federal and state government reimbursement as well as commercial insurance, and new quality imperatives such as value-based purchasing and pay for performance have resulted in major redesigns of most health-care organizations. In addition, the locus of care continues to shift from acute-care hospitals to community and outpatient settings, innovation and technological advances are transforming the workplace, and organizational cultures are increasingly shifting to externally regulated, safety-driven, customer-focused care. All of these changes have brought about a need for leader-managers to learn new roles and develop new skills.
The new managerial responsibilities placed on organized nursing services call for nurse administrators who are knowledgeable, skilled, and competent in all aspects of management.
Now more than ever, there is a greater emphasis on the business of health care, with managers being involved in the financial and marketing aspects of their respective departments.
Managers are expected to be skilled communicators, organizers, and team builders and to be visionary and proactive in preparing for emerging new threats such as domestic terrorism, biological warfare, and global pandemics.
In addition, the need to develop nursing leadership skills has never been greater. At the national level, nurse-leaders and nurse-managers are actively involved in implementing health-care reform and in addressing a potential international nursing shortage. At the organizational and unit levels, nurse-leaders are being directed to address high turnover rates by staff, an emerging shortage of qualified top-level nursing administrators, growing trends toward unionization, and intensified efforts to legislate minimum staffing ratios and eliminate mandatory overtime, while maintaining cohesive and productive work environments.
Moreover, ensuring successful recruitment, creating shared governance models, and maintaining high-quality practice depends on successful interprofessional team building, another critical leadership skill in contemporary health-care organizations. This challenging and changing health-care system requires leader-managers to use their scarce resources appropriately and to be visionary and proactive in planning for challenges yet to come.
In confronting these expanding responsibilities and demands, many leader-managers turn to the experts for tools or strategies to meet these expanded role dimensions. What they have found is some new and innovative thinking about how best to manage organizations and lead people as well as some reengineered interactive leadership theories from the later 20th century. This chapter explores this contemporary thinking about leadership and management, with specific attention given to emergent 21st-century thinking.