Setting the stage

z. miraflores,rn,mn
LEADERSHIP GAP
The health care delivery system
urgently needs 

a strong nursing leadership 

to enable it to meet the various

challenges it faces today
Globally:
There is a severe nursing shortage that
puts the profession in crisis

LOCALLY:

Profession produce thousands of nurses yearly

but many intend to work outside the country
after gaining experience leaving the country
with untrained and unskilled nurses RISK
FACTOR to the healthcare profession
*** locally and globally a leadership
gap exists
Gap exists between
Growing demand of a rising
population (delivery of quality and
costs effective outcomes in healthcare)

Lack of a strong nursing leadership

Video clips
Leadership gaps
ACTIVITY:
Ask at least 5
individuals in the
university about their
definition of
leadership.
Write them down and
make a matrix .
Find out if there are
similarities in the
definition given.
What is a new
nurse to do
when faced
with a similar
situation?
Video clips
New nurse vs old nurse
“ Skilled and
trained nurses
are a requisite of
proper health
care.”
-Bernardo
Individual work: Answer the
following questions
1. Who is a leader? Are you
leader?
2. Do you possess the qualities
of a leader? What qualities
are those? If not do you
think you can become a
leader?
LEADERSHIP

zcmiraflores,rn,mn
How do you
define
leadership?
Social influence or the
persons ability to move other
people to act
Leaving a mark in terms of
the actions which one has
spurred other people to do
Initiating and guiding

CHANGE
Leaders through
their ideas and
actions, show
others the way
( Manning and
Curtis,2007)
Leadership means different
things and often confused with
other related concepts like:

Power
Authority
Management
Administration
Control
Supervision
Video clips
LEADERSHIP is defined broadly as:

 1. influence processes
involving determination
or the groups
organizations objective

 2. motivating task and

behavior in pursuit of
their objectives

 3. influencing group
maintenance and
culture
Leaders can be bests
characterize by the following:

 L - lead, love, learn ( lead the

team, constant learning)
 E - enthusiastic, energetic
(willing to work hard,
positive energy)
 A- assertive, achiever (should
always know the reasons for
doing things and why things
should be done) CHOICE
 D - dedicated, desirous (develop
a heart for the profession,
committed to what she is
doing) GROW
PROFESSIONALLY/WILLING
TO TAKE CHALLENGE
 E - effective, efficient (do the
right things and to do the
things right, certain in all her
actions) AVOID AMBIGUITY
 R – responsible, respect
(responsibility towards
others/patients, assumes
personal responsibility for
decisions)
ACCOUNTABLE/ANSWERABLE
for mistakes
LEADERSHIP is really about
LEADING PEOPLE.
Leadership is the ability to
listen, translate, decide, and
motivate others. The lack of
leadership is often more
apparent in hospitals and
healthcare organizations
because were not trained to
recognized true leadership.
Chen (2007)
Definitions of leadership can
be categorized:
1. Who leaders are
.values motives and
personal traits
2. What leaders know
.knowledge ,skills and
abilities
3. What leaders do
.behaviors, habits,
styles and
competencies
Video clips
What kind of
a leader are
you?
Nursing leadership
Defined as the process
where the nurse
influences one’s or more
persons to achieved
specific goals in the
provision of nursing
care of one or more
patients
It is a multidimensional
process
Video clips..

1. nursing leadership
2. nursing leadership and mgt
Dimensions of leadership

Leader Follower Situation

Each dimension influence the

other
 Often
interchangeable;
They are not the
same
Leader
is anyone who uses
interpersonal skills to
influence others

 influences by using a flexible

repertoire of personal
behaviors and strategies

important in forging links-

creating connections- among
an organization’s members to
promote high levels of
performance and quality
outcomes
Functions:
Achieve a consensus within
the group about its goals
maintain a structure that
facilitates accomplishing the
goals
Supply necessary information
that helps provide direction
and clarification
Maintain group satisfaction ,
cohesion, and performance
Manager :
Is an individual employed by an
organization who is responsible
and efficiently accomplishing
the goals of the organization

Focus on coordinating and

integrating resources, using the
functions of planning,
organizing, supervising,
staffing, evaluating,negotiating,
and representing

. Interpersonal skill is important

Managers job :
Clarify the organizational structure

Choose the means by which to

achieve goals

Assign and coordinate task,

developing and motivating as
needed

Evaluate outcomes and provide

feedback
Points to ponder:

All good managers are also

good leaders-the two go hand
in hand

ONE MAY BE A GOOD MANAGER

OF RESOURCES AND NOT BE
MUCH OF A LEADER OF PEOPLE

Likewise: PERSON WHO IS A

GOOD LEADER MAY NOT
MANAGE WELL
 both roles CAN
BE LEARNED;

 skills GAINED CAN

ENHANCE EITHER
ROLE
Therefore:

Leadership- is viewed as one of

management’s many
functions

-requires more complex

skills

-increases productivity
by maximizing work
force effectiveness

Management- emphasizes
CONTROL
 Leadership versus
Management
…two concepts are not
INTERCHANGEABLE..

Leaders do the right thing. Managers do

things right.

Leaders get other people to want to do something

while managers get other people to do what they
do not want to do.
Management works within the
paradigm. Leaderships
creates new paradigms.

Management works within the

system. Leadership works on
the system .

You manage “things”

but you “lead” people.
LEADER VS. MANAGER QUALITIES

Leader Manager
Visionary Rational
Passionate Consulting
Creative Persistent, problem-
solving
Flexible Tough-minded

Inspiring Tough-minded
Innovative Analytical
Courageous Structured
Imaginative Deliberate
Experimental Authoritative
Initiate Changes Stabilizing
Soul/Heart Mind
Personal power Position power
Video clips..

.Differences of leadership and

management

.Management and leadership

Characteristics of nurse leaders….

a. Specialist and generalist

experts in particular field

b. Self-reliance  rely on themselves

but effectively balance
value to and role within the
organization

c. Connectedness  effective nurse

leaders are always excellent
team players (members of one
team in an organization
Roles and functions of nurse
managers:
1. Excellence in nursing clinical practice
and delivery of patient care in a
particular unit or area of an
organization.
2. Managing human, monetary, and other
resources needed to provide excellent
patient care and achieve expected
outcomes.
3. Facilitating the development of nursing
and other health care personnel.
4. Ensuring that all standards of care
practiced in that area are in
compliance with professional and
government standards of care.
Key nurse management roles
in the health care
environment:

1. FIRST LINE MANAGER 

nurse manager/head
nurse
-primarily supervises other
nonmanagerial staff and
monitors the quality of care
that staff provide to patients
-motivating staff
-other time is usually spent in
planning and coordination
and staff evaluation
2. MIDDLE LEVEL
MANAGER nurse
director
-supervises first-level
managers, usually
within the specialty
area, responsible for
all people and activities
in this area
-spend more time planning,
coordinating, negotiating
and evaluating and less time
directly supervising staff
3. EXECUTIVE LEVEL MANAGERS
chief nurse executive or vice
president of patient care services

-spent the lowest amount of time in

supervision, more on planning and
making policies
-more responsible for establishing
overall organizational goals and
strategic plans for the
department/division/entire
organization
Other managerial roles…
1. Charge nurse (ALSO CALLED
RESOURSE NURSE)
- expanded staff nurse role
-maybe permanent or rotating
assignment
-usually functions as a liaison to the
nurse manager, particularly on off-
shifts
Task includes:
.assisting in shift coordination
.promoting quality care
.using resources efficiently
.troubleshooting problems
.helping staff members with making decisions
.prioritizing care
2. Staff nurse
 this position may not have formal
managerial rank but the nurse uses
managerial and leadership skills to
work with other nurses and assistive
personnel
-management responsibilities includes:
a. supervising to ensure quality patient
care
b. delegating task appropriately
c. Motivating staff (Sullivan and Decker)
Video clips:

Guided question:
Take note of the
discrepancies of functions of
the leader in the video and
discuss/support your
discussions on why such
attitude of a leader should
be avoided or change.
7 habits of highly
ineffective manager
 Opening activity

Build the tallest /

highest building
Reflection/guide questions about
the activity…

 1. What can you say about the attitude and the behavior
of your followers? Does they simply do what they are
told or they at least suggest something in order to
obtain good results?

 2. You as a follower, what can you say about the

leadership applied by your leader? Is it the right method
to apply? Why and why not?
Followership

 Not a passive agent in leadership

 Good follower leads herself by
assuming responsibilities thus
influencing her own performance

Contemporary nursing:
a. followers recognize
interdependence with leaders
b. challenge oneself and at the same
learn to respect leaders authority
Types of followers (Kellerman
2007)
1. Alienated
Independent and critical
yet passive in their
behavior resulting in
psychological and
emotional distance with
their leaders
potentially disruptive and
a threat to the health of
the organization
2. Sheep

Dependent or
uncritical
Simply do as
they are told by
their leaders
3. YES people
 Dependent or uncritical, but
very active in their behavior
 Uncritically reinforce of the
thinking and ideas of their
leaders with enthusiasm
 Never questioning or
challenging the leaders ideas
or proposals
 They are the most
dangerous to a leader 
likely to give a false positive
reaction/nor gives no
warning of potential pittfalls
4. Survivors

Least disruptive and

lowest-risk followers
Perpetually sample the
wind
MOTTO: “Better safe
than sorry”
5. Effective followers

Effective followers
and do not require
close supervision
 Effective followers share 4
essential qualities:
 1. Self-management  think for
oneself and to work well without
close supervision
 2. commitment committed to
something beyond themselves
GOAL
 3. Competence and focus build
competence and focus efforts to a
maximum impact mastering skills
 4. Courage established
themselves as independent, critical
thinkers and will fight for what
they believe is right