Different Leadership Styles in Nursing

By Sandy Keefe, eHow Contributor

Types
o There are two basic leadership styles: permissive and autocratic. These styles can be further broken
down into subcategories. A nurse leader who is a permissive democrat, for example, engages his nurses
in decision-making and allows them to work independently. A directive autocrat, on the other hand, gives
instructions without seeking input and supervises his nurses closely.
Situational Leadership
o An experienced nurse leader chooses the leadership style that works best in any given situation. For
example, she may act as a permissive democrat when it's time to buy new equipment for her unit. She
can arrange to purchase the equipment the nurses want and then allow them to use it independently.
When there's an emergency Code Blue, on the other hand, she may be a directive autocrat who gives
instructions unilaterally to less experienced nurses while she closely supervises their work.
Considerations
o A nurse leader may alter his leadership style based on the age and experience level of his nurses.
Veterans, nurses born before 1943, like to share their hard-earned expertise but don't want or need close
supervision. On the other hand, younger and less experienced Generation Y nurses may benefit from
close monitoring along with plenty of guidance and feedback.
Skills
o When a nurse graduates from school and earns his RN license, he generally has basic leadership skills to
apply to direct patient care. As he advances to charge nurse, nurse manager and, ultimately, nurse
executive, he'll need to learn more about leadership. There are courses available through colleges and
universities, professional education companies and hospitals. It's important for a nurse to seek advice and
mentoring from a more senior nurse leader who can provide honest feedback about his leadership style.
Significance
o Nursing has trended toward a shared governance model of management that involves nurses in
decisions affecting their practice. In that model, a nurse manager uses a permissive democrat style,
encouraging her nurses to actively participate in clinical decision-making and monitor their patient
outcomes. The nurse executive, in turn, uses the same style to establish nursing councils with
representation from staff nurses
Reaction: A nurse leader may be a nurse manager, responsible for one nursing unit, or a nurse
executive, responsible for all in-patient nursing units. Rather than choosing just one leadership style, an
outstanding nurse leader typically uses multiple styles depending on the situations she's facing.







Nursing Management
By: NurseGuides.com

Since the turn of the century, medical error and tort reform have increasingly taken center stage in the
healthcare debate. Patients, politicians, policy makers, and healthcare professionals struggle with the
striking prevalence and consequences of medical error, whether it be a near miss or an error resulting in
patient injury. The Institute of Medicine (IOM) defines medical error as the failure of a planned action to
be completed as intended or the use of a wrong plan to achieve an aim.
Among the problems that commonly occur during the course of providing healthcare are adverse drug
events, improper blood transfusions, surgical injuries such as wrong site surgery, falls, burns, mistaken
identity, and even death. Moreover, high error rates with more serious consequences are most likely to
occur in intensive care units (ICUs), operating rooms, and the emergency department. The Quality of
Health Care in America Committee of the IOM has concluded that it isn't acceptable for patients to be
harmed by a healthcare system that's supposed to offer healing and comfort; a system that promises to
do no harm. This increased proclivity toward medical errors both creates and fosters an environment of
mistrust. It's because of concerns such as these that the matter of patient safety is now in the healthcare
spotlight.
The consideration of patient safety first is central to every decision made and every action performed by
healthcare professionals and other care providers at any level of the continuum, including in the patient's
home. In great part, the patient safety movement is about being a team player. If the patient is at the
center of our efforts then case management is a cornerstone in the support system of patient care. With
patient safety increasingly under the microscope, the case manager's role as a multifunctional
coordinator of care expands beyond the team and the patient/family members, into the community and to
other providers of care. Effective communication and enhanced decision making can reduce the
fragmentation of care that places patients at risk for medical error.
There are five main areas of patient safety upon which case managers exert their efforts on a daily basis.
These areas center upon:
* transitions or handoffs of care
* medication reconciliation
* patient/caregiver education
* access to the right services at the right time
* timely and effective communication.
Background
As patients are stabilized and transitioned through a hospital's system of care, there can be multiple
handoffs of care. Because patient care is often fragmented, duplicative, and sometimes disorganized and
improperly planned, the risk of life-threatening medical errors increases as the patient's exposure within
the healthcare system increases.
Handoffs or care transitions shouldn't be an abrupt end of care previously provided, but rather considered
to be a coordinated changeover for the patient to a new team of involved caregivers. With few
mechanisms in place for coordinating care across settings, often no single provider or team assumes
responsibility during transitions. If discharge planning truly begins at the time of admission, each care
transition should ideally be a planned process, unless of course the transition is an emergent one.
Collaboration and effective communication among team members, before, during, and after the hand-
off, are crucial at each stage of the medical management process. These critical interactions offer
opportunities for clinical interface that can promote patient safety and contribute optimally to the
avoidance of life-threatening medical errors.
Fortunately there are mandated systems in place that help to support appropriate care transitions and
hand-offs. These mechanisms were developed and implemented to ensure patient safety and regulatory
compliance. Discharge planning is a component of various pieces of legislation at both the federal and
state level; it's also the requirement of various accrediting bodies such as The Joint Commission.
Federal conditions of participation
The Federal Conditions of Participation are rules that hospitals must follow in order to participate in the
Medicare or Medicaid programs. Hospitals must have in effect a discharge planning process that applies
to all patients. The hospital's policies and procedures must be specified in writing and updated
accordingly. Those conditions that relate to the discharge planning process were last published August
11, 2004, effective October 1, 2004 and can be found in Section 42 CFR 482.43 of the Social Security
Act. They're listed as standards in the Federal Conditions of Participation. Some of these relate directly to
care transitions.
Provision of care, treatment, and services
Care, treatment, and services are provided through the successful coordination and completion of several
processes that include:
* appropriate initial assessment of needs
* development of a plan for care, treatment, and services; and the provision of care, treatment, and
services
* ongoing assessment of whether the care, treatment, and services provided are meeting the patient's
needs
* either the successful discharge of the patient or referral or transfer of the patient for continuing care,
treatment, and services.
Although the presence of standards is crucial to establishing accountability, it's noteworthy that the
standards primarily reflect the perspective of the sending institution, but not that of the receiving
institution. For example, Joint Commission standards include language relating to the exchange of
information during transfers; however, the language speaks globally to the sending facility. Clearly, both
the sending and receiving team have individual responsibilities as well as joint responsibilities. It's
incumbent upon both to ensure, through effective collaboration and communication, that the patient's
transition is safe. Enhancing accountability begins with setting expectations for both the sending and
receiving healthcare teams.
Transfers among care settings are common. Twenty-three percent of hospitalized patients over the age of
65 are discharged to another institution, i.e., a skilled nursing facility, and 11.6% are discharged with
home healthcare. Unfortunately, an estimated 19% of patients discharged from a hospital to a skilled
nursing facility are readmitted to the hospital within 30 days. While much of the literature addresses
facility-to-facility transfers, or facility-to-home transfers, there's little written that addresses intra-
institutional care transitions, which is unit-to-unit, or from one level-of-care to another level-of-care within
the hospital setting.
Reaction: The goal of this function is to define, shape, and sequence the processes and activities
related to care delivery along the illness-to-wellness continuum. Over time the patient may receive a
range of care in multiple settings from multiple providers. For this reason, it's important for the hospital to
view the patient care it provides as part of an integrated system of settings, services, healthcare
practitioners, and care levels that make up the continuum of care.