Nursing Management and Leadership


• In fact the experienced professional people often say that most of the major problems conflicts and challenges that they face in their work are not technical problems but people problems


Definition of Leadership:

– The Process of directing the behavior of others toward the accomplishment of objectives.

• Leadership is influencing people – by providing purpose, direction, and motivation – while operating to accomplish the mission and improving the organization."

Leadership is:

– An interpersonal process of influencing the activities of an individual or group toward goal attainment in a given situation.

– Key words should of leadership (influence – listen –agree)

– Without follower who listen and agree you cant be leader.

– Without action there can be no result or leadership.

– Leadership involve use of power, authority, influence, managing human process and responsibility .

– Leadership depend on the leader, the people who are led and the situation where leadership takes place .

– Leadership is formal when practiced by a team member who is not designated as the nurse in-charge.

– Leadership is formal when practiced by the designated nurse in-charge of the unit.


Leadership Requirement:

– Have positive attitude, be honest .

– Dare (Challenge) to do unusual.

– Be an explorer, an innovator, a problem solver and fighter for right.

– Respects his people, be there advocate, educate, stimulate, initiate, operates.

– Start where the people are, talk their language, come down to their level and lead them upward .

– Praise people who you lead specially in front of others.

– Train followers to be future leaders.


Leadership Traits

– Interested in group’s concerns while sensitive to individual needs.

– Aware of current social and political situations.

– Good communicator.

– Patient, creative and flexible.

– Decisive when necessary.


Do we need leaders or managers?

– All organization need effective leaders and good managers. There is a place for both types of individuals.

– Leadership qualities of individuals in middle and first line leadership position are required.

– Not appropriate to have all staff focusing on ideas and changes– nor all staff focusing on getting the day-to-day job done.

What is needed is:

– A healthy MIX of leaders and managers


Why do we need Nursing leaders?

– A Nurse leader makes decisions and provides guidance to staff in a rapidly changing environment. Actions which are effective in one instance may not be in another.


A Nurse leader will:

  • Motivate staff on a daily basis to provide quality of care for patients.
  • Deal with fatigued staff.
  • Focusing on interpersonal relation among staff, between nurses and the patient/family and relation with other professionals

Management is:

The Process undertaken by one or more individuals to coordinate the activities of others toward the accomplishment of objectives

• The process of getting work done through others, done properly, on time, and within budget, including the deployment of resources to accomplish organizational goals .

• Management is an integral part of human life.

• Management both influences and influenced by social, culture, environment, politics, technology, sciences, and economic resources.

• The most important principle in management is commitment to achieve.


Differences between leaders & managers:




Leaders require using power and authority to influence the thoughts and actions of other people

Managers have official authority and responsibility but may or may not have the power to establish

Leadership consists of directing, supervising and coordinate the efforts of individuals

Management consists of planning, organizing, directing and control available financial material and human resources.

Have wider roles than managers

Have a legitimate source of power due to delegated authority that accompanies their position

Focus on group process information gathering , feedback and empowering others

Emphasize control, decision making, decision – analytical and results

Leaders usually hold their positions more through characteristics and behavior than through official authority.

Managers are official with a job description selected and a chain of command
A leader has some charisma that makes others want to follow

They create and maintain an environment so that other people can work efficiently in it using material resources

Are not frequently part of the formal organization chart

•Are a part of organization and expected to carry out specific function


Leading versus Managing







Inspire Control

Long-term view

Short-term view

Ask what & why

Ask how & when



Challenge status quo

Accept status quo

Do the right things

Do things right


Importance of management :

– Provide effectiveness to human efforts

– Bring order to work

– Improving economical growth and social standards.

– Use of available resources

– Induce change, determine the control measures and fosters the decision making process .

– Deals with people’s behavior and relations , environment resources , budget, equipment , staffing and time .


Management Levels

  1. Top level  management
  2. Middle level management
  3. First line management

• Top level management: responsible for overall operations ex. (chief officer executive – director of nursing )

• Middle level management: coordinates activities of several unites (supervisors)

• First line managers: responsible for actual production of services (head nurse)


Management Skills

  1. Technical skills
  2. Human relation skills
  3. Conceptual skills

• Technical skills: involves method, procedures, techniques and knowledge of work being performed in the organization

• Human Relation skills: ability to motivate and educate others and to manage conflicts.

• Conceptual skills: requires analytical thinking and being able to perceive trends and to conceive the organization as a whole.


Leadership Style

• The manner in which a leader uses interpersonal behaviors to influence the accomplishment of goals.

• Styles of leadership range from very authoritarian to very permissive and change according to the situation.

  • Autocratic (Directive): manager makes decision and announces it
  • Democratic (Participative): manager defines limits ;asks group to take decision.
  • Laissez-faire (Permissive- non directives): manager permits subordinates to function within limits defined by superior

The Authoritarian Style

• Concerned with the task than employee.

• Maintain strong control over the work group.

• Motivate others by coercion.

• Direct others within command .

• Communication flows downward.

• Decision-making does not involve others.

• Personality of leaders is firm, insistent, dominating and self centered.

• Use coercive power (Telling).

• Criticism is punitive.

• It is suitable in time of crises when there is no time for group discussion.

• Found in a large bureaucracies such as armed forces


Autocratic Leadership

Can be used with:

  • Under qualified subordinates.
  • Those who don’t have the sense of responsibility.
  • Large group with a predetermined performance standard.
  • Emergency situations.

Advantages of Autocratic Leadership

• Group action are well determined.

• Reduce work group frustration.

• Give members a feeling of security.

• Productivity is usually high (quantity).

• It is suitable in time of crises when there is no time for group discussion.


Disadvantages of Autocratic Leadership

• Reduce creativity

• Decrease self –motivation

• Decrease autonomy.


The Democratic style

– This style does not consistently to high productivity but it does enhance employee job satisfaction.

– Maintain less control.

– Motivate by rewards.

– Direct others through suggestions and guidance.

– Decision-making involve others .

– Communication flows up and down .

– Emphasis is on (We rather than I and You)

– Criticism is constructive .


Democratic Leadership

Can be used with :

  • Creative work conditions.
  • Experienced and qualified subordinates.
  • people Who have the sense of responsibility.
  • Decision makers.

Advantages of Democratic Leadership

• Promote autonomy and growth in individuals.

• Effective when cooperation and coordination is necessary (team work).

• Appropriate for groups who work together for long period.


Disadvantages Democratic Leadership

• May be frustrating for others who want decision made rapidly (decision usually takes time

• Less efficient quantitatively than authoritarian style



Characterized by :

• Permissive with little or no control.

• Motivates by support when requested by the group or individuals .

• Provide little or no direction

• Communication is between members of the group, upward and downward.

• Decision-making is dispersed through the group.

• Emphasis is on the group .

• Criticism is not given .



• Appropriate when problems are poorly defined and brainstorming is needed to generate alternative solutions.

• Much creativity and productivity can result when group members are highly motivated and self –directed.


Disadvantages of LAISSEZ-FAIRE STYLE

• Because it is non- directed leadership style, it can be frustrated.


The Best Style

• It was believed that most leaders had a predominant style and use it consistently, but new theories have demonstrated that individual leaders are capable of dynamically moving along the continuum situation.




Leader leads more than followers.

Concern in the task

Concern in both task and followers.

Followers lead more than leader.

Concern is followers.

Give commands, orders

Dominates the group, makes the decisions

Gives criticism versus praise

Get the job done

Stimulates and include the group to goals and in D.M.

Shares information

Offers constructive criticism

Team work

Inactive, non-directive

Gives control and D.M. to the group

Allow any behavior

Goals are unclear

Unproductive and inefficient





• Focus on the assumption that some people are natural leaders.

• Based on the inherited personal characteristics of the leader.

• (leader are born not made ) who have certain characteristic or personality traits that make them better leader than others.


Some common traits

• Later theories suggested that traits could be obtained through learning and experience.

• Intelligent

• Initiative

• Creativity

• Communication skills

• Emotional maturity

• Persuasiveness

• Ability to participate in social activities



• Emphasize on what a leader does (behavior) in achieving organizational goals.

• McGreoger theories have much influence on leadership and management.

• He focused what the leader do (leader style) rather than what traits a leader has.


Situational theories

• No one set of traits and no one leadership style is effective in all situation.

• A person may be a leader in one situation and a follower in another.

• They began to realize that other factors in the work environment influence outcomes as much as leadership styles.


Based on the situational in term of:

– The organization size and structure

– The climate in the organization either supportive or not

– The leader characteristic (power- influence- authority)

– The follower characteristics (knowledge –skills- maturity)


Contingency theories

• The leadership style will be effective or ineffective depending on three situational factors:

1.The leader member relation.

2.Task structure.

3.Position power.

Leader member relations: the amount of confidence and loyalty the followers have in their leader.

Task structure: the extent to which the task is defined and its accomplishment can be measured (every one knows exactly what to do).

Position power: the authority inherent in a position, the power to reward or punish and the organization support for one decisions.

• Directors (high position= hire or fire)

• Elected committee chairpersons- low position.


Motivational Theories


• Developed a hierarchy of needs based on human needs and motivation

• ( physiological needs- security &safety – social /love – self esteem – self actualization)

• Peoples first satisfy lower level needs before they move to the higher level needs

• Maslow reinforced the concept that human beings are complex, therefore manager must recognize that employees are motivated by different things at different times in there life


• Suggested that some factors lead to job satisfaction and dissatisfaction

Satisfiers (satisfying factors)

• Intrinsic factors: Achievement – recognition – the work itself – responsibility – growth- and advancement.

• Extrinsic factors: Institution policy –administration – supervision – salary – interpersonal relationships – working condition – status- security .



• Focus on the main three issues:

–Leader’s behavior

–Maturity of the group

–Effectiveness of the leader

• Schein’s model based upon system theory


System theory has the following assumption

• People are very complex and highly variable, they have multiple motives for doing things.

• People’s motives do not stay constant but change over time.

• Goals can differ in various situations.

• A person performance and productivity are affected by the nature of the task, by his experience and motivation.

• There is no single leadership strategy that will be effective in every situation.


Transformational theory

• Burns (1987): both the leaders and follower have the ability to raise each other to higher level of motivation and morality based on building trust, in self esteem in ones self and others which creates a shared commitment to excellence and mutual growth.

• Make work place meaningful, inspiring and motivational


Two types of leader

Transactional/Traditional: concerns with day to day operations (work without plan).


– People are motivated by reward and punishment.

– Social systems work best with a clear chain of command.

• When people have agreed to do a job, a part of the deal is that they cede all authority to their manager.

• The prime purpose of a subordinate is to do what their manager tells them to do.

Transformational: committed, has a vision able to empower others with his vision.

– The central concept here is change and the role of leadership in envisioning and implementing the transformation of organizational performance

• Leadership is about coping with change

• Major changes are more and more necessary to survive and complete effectively in this new environment


Life cycle theory

• Fiedler Model: Predict the most appropriate style of leadership from the level of maturity of followers.

• To determine the most appropriate leadership style, one must assess the maturity level of the individual or group.

• Task: task high if its easy to define.

• Relationship: the amount of confidence and loyalty the followers have in their leader.





• Successful leaders guide their followers in reaching their hopes, aspirations and expectation.

• The most effective leader is the one who can create an environment in which people highly motivated and therefore highly productive.

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