13
                           Initiating the Leadership/
                           Management Role
                      LEARNING OUTCOMES
                          After completing this chapter, you should be able to:
                           1.  Compare and contrast the skills involved in leadership and management.
                           2.  Differentiate between the terms authority and accountability.
                           3.  Discuss the major theories regarding leadership.
                           4.  Compare and contrast the three prevailing leadership styles.
                           5.  Analyze the factors that have resulted in the development of transforma-
                               tional leadership.
                           6.  Describe how power and empowerment relate to leadership.
                           7.  Identify ways an individual can empower another.
                           8.  Analyze methods by which the development of leadership style can be
                               enhanced.
                           9.  Describe the basic characteristics of effective communication.
                          10. Analyze the communication strategies that are essential for effective
                               leadership, identifying the critical role of each.
                          11. Describe the elements of an effective performance-appraisal system,
                               including the conduct of the interview.
                          12. Analyze the importance of time management and evaluate methods that
                               will help overcome major time wasters and procrastination.
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                                                       CHAPTER 13 Initiating the Leadership/Management Role   491
                       KEY TERMS
                           Accountability               Expert power                Motivational power
                           Authority                    Informational power         Multicratic leadership
                           Autocratic/authoritarian     Job description                style
                             leadership style           Laissez-faire/permissive    Performance appraisal
                           Charisma                       leadership style          Procrastination
                           Coercive power               Leadership                  Referent power
                           Communication                Leadership/management       Responsibility
                           Connection power               style                     Reward power
                           Democratic/participative     Legitimate power            Standards
                             leadership style           Management                  Theories of leadership
                           Empowerment                  Mentor                      Time management
                                  The novice in the area of health care administration can easily be dazzled by the many
                                   terms devoted to the topics of leadership and management that populate the litera-
                                   ture. Words such as authority, responsibility, accountability, team building, empow-
                                   erment, coaching, mentoring, motivating, and collective power are but a few of those
                                 incorporated into articles, monographs, and books addressing the topic of successful
                           leadership and management. What do these terms mean to you as you begin reading this chap-
                           ter? What will they mean to you when you finish this course? In what ways will the meanings
                           gain greater significance as you begin your career as a staff nurse? What will they mean as
                           you begin to assume a leadership role in patient care?
             UNDERSTANDING LEADERSHIP AND MANAGEMENT
                           Although the terms leadership and management are often used interchangeably, differences
                           exist in how each is practiced in the work situation. Gaining an understanding of each will
                           help you be effective in either role. Let’s explore the differentiations and how they are applied
                           in the work situation. 
                           How Leadership and Management Differ
                           Managementrefers to activities such as planning, organizing, directing, and controlling, with
                           the purpose of accomplishing specific goals and objectives within an organization. Essential-
                           ly, it involves organizing and directing a group of people to accomplish specific tasks. Man-
                           agement positions often are ones to which one is appointed or are ones to which one is hired
                           after a competitive job application and interview. From this appointment, the manager is
                           granted the power to direct others and is responsible for assuring that certain tasks within the
                           organization are completed effectively and efficiently. In other words, the authority to act is
                           gained by virtue of the position one holds within the organization. 
     492 UNIT IV Career Opportunities and Professional Growth
             Leadership,on the other hand, refers to the ability to persuade others to follow your direc-
           tion, to motivate, to inspire, and to instill vision and purpose. To provide leadership, one must
           be able to influence the beliefs, opinions, or behaviors of others. This can be accomplished in
           a number of different ways, referred to as leadership styles, that we will discuss later. 
             Although managers may not always be leaders, the very best managers also are leaders.
           Conversely, not all leaders are officially managers in the sense we have defined it. Individu-
           als may become leaders because of the way in which they inspire others to follow them. Can
           you think of a situation in which an individual was a leader but did not have the role of man-
           ager? Similarly, can you think of any situations in which the manager lacked the ability to lead
           a group of people? Can you recall situations in which the manager also was a leader?
     UNDERSTANDING ACCOUNTABILITY AND AUTHORITY
           We frequently hear three terms associated with leadership and management roles: account-
           ability, responsibility, and authority. Are you clear about the definitions of each of these
           terms?
             Accountability and responsibility are terms with similar meanings. They refer to the
           obligation to answer for one’s actions and to accomplish what you have agreed to do. For
           example, the team leader assigns you the care of four patients and you agree to that assign-
           ment; therefore, the patients’ care is your responsibility. You have an obligation to provide
           timely care to that group of patients to achieve the desired outcome regarding that care.
             By virtue of the state nurse practice acts, nurses are held responsible or accountable for
           their actions. This means they must provide the necessary care competently and in compli-
           ance with accepted standards, using sound judgment, thinking critically, and delegating wise-
           ly. Failure to perform in a responsible manner could result in legal action being taken against
           the nurse if harm occurs to the patient.
             Nurses have always been accountable for the care they give from both a personal and a
           professional standpoint. However, as we have witnessed the rapid technologic, fiscal, and
           operational changes that have occurred within the health care system, the term now carries
           stronger legal implications. Patient involvement in health care decision-making, consumer
           rights, and public availability of records has created more legal vulnerability for the nurse.
           Nurses must be aware of the legal aspects of nursing and of the laws that protect the client.
           Legal aspects of care are discussed in greater detail in Chapter 8.
             Accountability flows upward in the organizational hierarchy. Individuals are accountable
           for their own actions and also for some of the actions of those they supervise. Thus, we see
           that tasks can be delegated but accountability cannot be. Nurses who delegate tasks to assis-
           tive personnel continue to be accountable for that care (see Chapters 7 and 14). For example,
           if you ask the nursing assistant to check the vital signs of four of your patients, you are ask-
           ing the assistant to act in your place. You are still accountable for that activity; that the vital
           signs are accurately measured, reported, and documented. This accountability has become a
           sensitive issue for nurses as, in an effort to contain costs, more unlicensed assistive personnel
           are hired to replace licensed staff.
             The word authoritycan be defined as the power or right to give directions, to take action,
           to make decisions (Neufeldt, 1996). Traditionally, we have considered it the manager’s job to
                                                       CHAPTER 13 Initiating the Leadership/Management Role   493
                           command or make decisions. In this sense, the manager “authored” all critical decisions. As
                           you read further, you will note that in today’s work environment, authority is more often
                           being shared. And along with this shared authority and decision-making is a mutual respon-
                           sibility for outcomes. We will discuss this concept in greater detail after we have talked about
                           leadership.
                               In the ideal work situation, workers are given the amount of authority needed to carry out
                           the responsibilities expected of them. However, many nurses experience frustration because
                           they must be accountable for activities yet have no authority to impact the situation or create
                           change. For example, an evening charge nurse has the responsibility of assuring that all
                           patients receive competent care, but the nurse may have no input into the performance
                           appraisal of nursing assistants working on that shift. Therefore, the nursing assistants may not
                           be as responsive to the charge nurse’s instructions as they should be. Or perhaps a nurse has
                           the responsibility for seeing that there are adequate supplies on a unit but has no opportunity
                           to affect the unit’s budget.
                           Critical Thinking Activity
                            Think for a moment of behaviors you noted in your clinical experiences this past week.
                            What behavior did you observe that was a clear demonstration of authority? What were
                            the characteristics that made it so? Can you recall a situation in which a registered nurse
                            (RN) accepted responsibility for an action that had been taken? How was this done?
                           Theories of Leadership
                           Let’s talk briefly about the various theories of leadership (Table 13-1). Just as theories of
                           nursing help us to understand nursing (see Chapter 5), leadership theories help us to describe
                           and understand the processes of leadership. As a society, we have studied leadership theory
                           since about the mid-20th century, and a number of theories have been set forth, far too many
                           to discuss in detail in this text. The theories of leadership listed in Table 13-1 are those most
                           frequently cited as helpful in understanding specific situations. 
                               Current emphasis in most management literature is placed on transformational leader-
                           ship. Today’s work environment relies on teamwork and shared decision-making. In this envi-
                           ronment, the goals of the organization are most likely to be met if transformational leadership
                           is employed. 
                               As a student preparing for graduation from your nursing program, you may wonder
                           how all the information on leadership theories relates to you. Health care represents one of
                           the largest, if not the largest business in the United States. Historically, the administrative
                           structure in hospitals has been a predominately bureaucratic one, with few decision-makers
                           and many followers. That situation is changing as more and more hospitals adopt a pattern
                           of transformational leadership. But that will not be true in all organizations nor will it
                           reflect the attitudes of some of the individuals with whom you will work. Having basic
                           knowledge of the various approaches to leadership will help you understand the environ-
                           ments in which you work and will help you determine the leadership approach you wish to
                           develop.