© 2008 marianne mcauley nursing leadership & management eileen daley ms, np assistant professor...

NURSING NURSING LEADERSHIP & LEADERSHIP & MANAGEMENTMANAGEMENT

Eileen Daley MS, NPEileen Daley MS, NP

Assistant ProfessorAssistant Professor

Fall 2011Fall 2011

THE CLINICAL EXPERIENCETHE CLINICAL EXPERIENCE

Review Head Start SchedulesReview Head Start Schedules DirectionsDirections Uniform Policy-Professional attireUniform Policy-Professional attire HIPPA Privacy ComplianceHIPPA Privacy Compliance Attendance & Lateness PolicyAttendance & Lateness Policy

Absences-call Prof DaleyAbsences-call Prof Daley

ROLE OF PRECEPTORROLE OF PRECEPTOR Complete Complete preceptor evaluation formpreceptor evaluation form

– Include commentsInclude comments!!!!!!!!!!– Appendix AAppendix A

Collect Collect student evaluation formstudent evaluation form from from preceptor on last day – sealed envelopepreceptor on last day – sealed envelope– Appendix BAppendix B

RETURN BOTH TO MRS. DALEYRETURN BOTH TO MRS. DALEY– Put in your brown envelope with your Put in your brown envelope with your

assignmentassignment

CLINICAL OBJECTIVESCLINICAL OBJECTIVES

Bring these with you to clinicalBring these with you to clinical Review objectives with your Review objectives with your

preceptor (Family Advocate)preceptor (Family Advocate) Have preceptor sign one copy and Have preceptor sign one copy and

submit to student submit to student Student return copy to Prof. DaleyStudent return copy to Prof. Daley Appendix CAppendix C

STAFF EDUCATIONSTAFF EDUCATION

Required competency of ADN Required competency of ADN educationeducation

Follow the Nursing Process when you Follow the Nursing Process when you teachteach

Use the Lesson Plan Rubric as a Use the Lesson Plan Rubric as a guideguide– Hand this in with your lesson planHand this in with your lesson plan– Appendix EAppendix E

INSERVICE PROJECTINSERVICE PROJECTA WIN-WIN FOR ALLA WIN-WIN FOR ALL

Use the Nursing ProcessUse the Nursing Process Early StartEarly Start

– Asthma Teaching ProjectAsthma Teaching ProjectABCs of AsthmaABCs of Asthma

Late StartLate Start– Head Start Topic:Head Start Topic:

Allergies Allergies Hygiene Hygiene Child Abuse AwarenessChild Abuse AwarenessCultural SensitivityCultural Sensitivity

Plan:Plan: during the week! Collaborative! during the week! Collaborative!– develop the lesson plan - develop the lesson plan - have 2 copieshave 2 copies– typewritten, professional appearancetypewritten, professional appearance– 1 copy to preceptor1 copy to preceptor– 1 copy to Prof Daly1 copy to Prof Daly

Implement:Implement: the second day the second day – Snacks may facilitate learning (optional) Snacks may facilitate learning (optional) – use audio-visual aids/handoutsuse audio-visual aids/handouts

Evaluate:Evaluate: – Develop a written pre/post testDevelop a written pre/post test

for head start staff for head start staff 1 question for each objective 1 question for each objective No less than 5 and no more than 10 questions.No less than 5 and no more than 10 questions.

– Staple a copy of this to the lesson planStaple a copy of this to the lesson plan– Include a Include a Teacher evaluation formTeacher evaluation form– The head start staff must evaluate your The head start staff must evaluate your

performanceperformance– It requires written commentsIt requires written comments– Staple a copy of this to the lesson planStaple a copy of this to the lesson plan

COMPONENTS OFCOMPONENTS OFA LESSON PLANA LESSON PLAN

Cover SheetCover Sheet– topic, date, agency topic, date, agency – presenter - your namespresenter - your names

ObjectivesObjectives Content OutlineContent Outline Pre/Post test questionsPre/Post test questions Teacher Evaluation FormTeacher Evaluation Form Attendance Sheet – Attendance Sheet – Goes to Prof. Daley!Goes to Prof. Daley!

– Appendix FAppendix F

ChecklistsChecklistsAgencyAgency Give copy of lesson plan to preceptorGive copy of lesson plan to preceptor Certificates of teaching-copies for everyone taught!Certificates of teaching-copies for everyone taught!

Professor DaleyProfessor Daley Lesson planLesson plan Objectives copy signed by preceptorObjectives copy signed by preceptor Pre/Post Tests completed by HS staffPre/Post Tests completed by HS staff Teaching evaluations completed by HS staffTeaching evaluations completed by HS staff Attendance sheetAttendance sheet Preceptor evaluationPreceptor evaluation

– Include comments Please!!Include comments Please!! Student evaluation by preceptor - sealed envelop Student evaluation by preceptor - sealed envelop Return to Prof Daley one day after experience. Leave at Sayville Center with secretary.Leave at Sayville Center with secretary.

HOW TO WRITE OBJECTIVESHOW TO WRITE OBJECTIVES

Focused on the learner: Focused on the learner: – Head Staff staffHead Staff staff

Measurable - Use action verbsMeasurable - Use action verbs– Ex: state, describe, list, explainEx: state, describe, list, explain– Avoid words: understand, know, Avoid words: understand, know,

nicenice Time component Time component

– (By the end of the session).(By the end of the session).

EXAMPLES OF OBJECTIVESEXAMPLES OF OBJECTIVES 1. By the 1. By the end of the in-serviceend of the in-service the the HS staff HS staff

will be able to state 3 triggers of asthmawill be able to state 3 triggers of asthma 2. By the 2. By the end of the in-serviceend of the in-service the the HS staff HS staff

will be able to identify children at risk for will be able to identify children at risk for asthmaasthma

3. By the 3. By the end of the in-serviceend of the in-service the the HS staffHS staff will be able to describe methods to will be able to describe methods to decrease trigger exposure of asthmadecrease trigger exposure of asthma

REFER TO EXAMPLES WHEN WRITING REFER TO EXAMPLES WHEN WRITING YOUR OBJECTIVESYOUR OBJECTIVES

TYPES OF OBJECTIVESTYPES OF OBJECTIVES

COGNITIVECOGNITIVE PSYCHOMOTORPSYCHOMOTOR AFFECTIVEAFFECTIVE

– Objectives can include one from Objectives can include one from each category or a combination.each category or a combination.

COGNITIVE OBJECTIVESCOGNITIVE OBJECTIVES

Knowledge, factsKnowledge, facts

Example:Example:

HS staff will state 3 triggers ofHS staff will state 3 triggers of

asthma by the end of the in-asthma by the end of the in-serviceservice

PSYCHOMOTOR PSYCHOMOTOR OBJECTIVESOBJECTIVES

SkillsSkills Example:Example: HS staff will demonstrate proper use HS staff will demonstrate proper use

of maintaining the environment to of maintaining the environment to decrease potential asthma triggers.decrease potential asthma triggers.

AFFECTIVE OBJECTIVESAFFECTIVE OBJECTIVES

Emotions, feelingsEmotions, feelings

Example:Example: HS staff will express feelings about HS staff will express feelings about

caring for a child with acute asthma caring for a child with acute asthma exacerbation by end of in-serviceexacerbation by end of in-service

CONTENT OUTLINECONTENT OUTLINE

Outline format – don’t write a Outline format – don’t write a narrativenarrative

Comprehensive – give a detailed Comprehensive – give a detailed outlineoutline

Number objectives to match the Number objectives to match the contentcontent

– It should be very clear what content It should be very clear what content goes with each objectivegoes with each objective

EXAMPLE OF CONTENT EXAMPLE OF CONTENT OUTLINEOUTLINE

Objective:Objective:1. By the end of the in-service the HS 1. By the end of the in-service the HS staff will be able to state 3 triggers of staff will be able to state 3 triggers of asthmaasthma

Content Outline:Content Outline:1. a. URI symptoms1. a. URI symptoms

b. Dust mitesb. Dust mites c. Exposure to coldc. Exposure to cold

EVALUATION OF KNOWLEDGEEVALUATION OF KNOWLEDGE Pre/post testPre/post test

– multiple-choice, true-falsemultiple-choice, true-false– state in positive, all choices same lengthstate in positive, all choices same length

Which of the following is a trigger of asthma?Which of the following is a trigger of asthma?a.a. Warm sunny dayWarm sunny dayb.b. Recent coldRecent coldc.c. A trip to museum A trip to museum d.d. Pt taking singulair every dayPt taking singulair every day

EVALUATION OF TEACHEREVALUATION OF TEACHER(Student)(Student)

List items for head start staff to rate studentList items for head start staff to rate studentExample: Teacher’s knowledge of subject?Example: Teacher’s knowledge of subject?

Ask other questionsAsk other questionsUse a rating scale code:Use a rating scale code:

4-excellent4-excellent 3-very satisfactory3-very satisfactory 2-satisfactory2-satisfactory 1-unsatisfactory1-unsatisfactoryInclude a space for comments*****Include a space for comments*****

WHY L & M? WHY L & M?

Economics of health careEconomics of health care

Staff RedesignStaff Redesign

NCLEXNCLEX

NCLEX-RN TEST PLANNCLEX-RN TEST PLAN

Physiological integrity needs of clientsPhysiological integrity needs of clients Psychosocial integrity needs of clientsPsychosocial integrity needs of clients Promotion and maintenance of healthPromotion and maintenance of health Management and coordination of the Management and coordination of the

care environmentcare environment www.ncsbn.orgwww.ncsbn.org

Leaders Are Mostly MadeLeaders Are Mostly MadeNOT Born NOT Born

Integrating Leadership/Management Integrating Leadership/Management into an Associate Degree Nursing into an Associate Degree Nursing ProgramProgram– Management introduced 1Management introduced 1stst semester semester– Workshop and rotation in NR46Workshop and rotation in NR46

WorkshopWorkshop 2 full days at various head start centers in 2 full days at various head start centers in

Suffolk CountySuffolk County

What are the Skills of Effective What are the Skills of Effective Leaders?Leaders?

The Great CommunicatorThe Great Communicator– listening skillslistening skills– articulation skillsarticulation skills

oraloralwritingwriting

Be An Assertive CommunicatorBe An Assertive Communicator

The Team PlayerThe Team Player

understands the work of othersunderstands the work of others appreciates the work of othersappreciates the work of others credible - performs wellcredible - performs well persuasive, enthusiasticpersuasive, enthusiastic

– increases cohesiveness among team increases cohesiveness among team membersmembers

The MotivatorThe Motivator

Inspires others to reach goalsInspires others to reach goals Uses power to motivate othersUses power to motivate others

The DelegatorThe Delegator

A nursing task is transferred to an A nursing task is transferred to an individual individual competentcompetent to perform the to perform the tasktask

The delegator remains accountable The delegator remains accountable for the taskfor the task

How to Increase Your Expertise How to Increase Your Expertise as a Delegator?as a Delegator?

Follow the five rights of delegationFollow the five rights of delegation– National Council of State Boards of National Council of State Boards of

NursingNursing– Right taskRight task– Right personRight person– Right communicationRight communication– Right supervisionRight supervision– Right circumstancesRight circumstances

Is It the Right Task?Is It the Right Task?

What is the difference between the What is the difference between the scope of practice of the RN & LPN?scope of practice of the RN & LPN?

– Look at the NYS Nurse Practice ActLook at the NYS Nurse Practice Act– Article 139 of the Education LawArticle 139 of the Education Law– http://www.emsc.nysed.gov/sss/Laws-Re

gs/Health_Services/Nurse_Practice_– Act-full.htmAct-full.htm

Is It the Right Task?Is It the Right Task?

What tasks can be delegated to What tasks can be delegated to the UAP?the UAP?– Health-related activities not in the Health-related activities not in the

legally protected scope of nursing legally protected scope of nursing practicepractice

– Do not involve professional judgment or Do not involve professional judgment or critical thinkingcritical thinking

– Results are predictableResults are predictable

Is It An Appropriate Health Is It An Appropriate Health Related Activity?Related Activity?

The guidelines regarding the The guidelines regarding the utilization of licensed nurses and utilization of licensed nurses and unlicensed assistive personnel in the unlicensed assistive personnel in the delivery of nursing caredelivery of nursing care

NYSNANYONE – 2003NYSNANYONE – 2003 http://www.nysna.org/images/pdfs/

practice/scope/rn_uap_guidelines03.pdfpractice/scope/rn_uap_guidelines03.pdf

More Skills of Effective More Skills of Effective LeadersLeaders

The Staff Educator: in-servicesThe Staff Educator: in-services The Change Maker: institutes The Change Maker: institutes

changechange The Evaluator: evaluates the work The Evaluator: evaluates the work

of othersof others The Problem Solver: resolves The Problem Solver: resolves

conflictsconflicts The 21st Leader: vision The 21st Leader: vision

How Do Leadership & How Do Leadership & Management Differ?Management Differ?

ManagementManagement– Working with and through othersWorking with and through others– Achieve organizational objectivesAchieve organizational objectives

LeadershipLeadership– InfluencingInfluencing the activities of a group the activities of a group– Toward goal achievementToward goal achievement

Best manager is a good leaderBest manager is a good leader

Differences between Differences between Managing and LeadingManaging and Leading

Manager administers, Leader Manager administers, Leader innovatesinnovates

Manager relies on control, Leader Manager relies on control, Leader inspires trustinspires trust

Manager has a short-range view, Manager has a short-range view, Leader a long-range perspectiveLeader a long-range perspective

Manager does things right, Leader Manager does things right, Leader does the right thingdoes the right thing

TYPES OF POWERTYPES OF POWER

Legitimate - leader’s formal Legitimate - leader’s formal position in organizationposition in organization

Reward – underutilizedReward – underutilized– leader’s ability to reward follower’sleader’s ability to reward follower’s

Coercive – don’t use thisCoercive – don’t use this– follower’s fear of punishmentfollower’s fear of punishment

TYPES OF POWERTYPES OF POWER

Referent - follower’s identification Referent - follower’s identification with leaderwith leader– confidenceconfidence– power dressingpower dressing– What qualities do you have that What qualities do you have that

give you this power?give you this power? Expert - leader’s specialized Expert - leader’s specialized

knowledgeknowledge

Effective Leader and Manager Effective Leader and Manager FormulaFormula

Understanding Self Understanding Self – self-assessment self-assessment

Knowledge Knowledge LearningLearning

– role modelsrole models Emotional IntelligenceEmotional Intelligence

– assess yourselfassess yourself

EMOTIONAL INTELLIGENCEEMOTIONAL INTELLIGENCE

Set of skills that includes excellence Set of skills that includes excellence at at listening, empathy, handling listening, empathy, handling upsetsupsets

Midbrain – center for emotionsMidbrain – center for emotions A different set of skills than IQ abilitiesA different set of skills than IQ abilities Helps workers stay in positive Helps workers stay in positive

emotional rangeemotional range Can learn these skills with practiceCan learn these skills with practice GO to “leadership skills rate yourself”GO to “leadership skills rate yourself”

Great Man or Trait TheoryGreat Man or Trait Theory

Leaders born, not madeLeaders born, not made Physical, psychological , personal Physical, psychological , personal

characteristics define leaderscharacteristics define leaders Charismatic theory - leaders Charismatic theory - leaders

possess charismapossess charisma

BEHAVIORAL THEORIESBEHAVIORAL THEORIES

AutocraticAutocratic DemocraticDemocratic Laissez-FaireLaissez-Faire

AUTOCRATIC STYLEAUTOCRATIC STYLE

Leader dominates groupLeader dominates group Commands rather than makes Commands rather than makes

suggestionssuggestions Maintains strong controlMaintains strong control Sometimes punitiveSometimes punitive

LAISSEZ-FAIRE STYLELAISSEZ-FAIRE STYLE

Leader is passive, nondirective, Leader is passive, nondirective, inactiveinactive

All decision making left to groupAll decision making left to group Little, if any, leader guidance or Little, if any, leader guidance or

supportsupport

DEMOCRATIC STYLEDEMOCRATIC STYLE

Group participates in decision Group participates in decision makingmaking

Leader acts as facilitatorLeader acts as facilitator Leader has concern for group Leader has concern for group

members members

ROLE-PLAYSROLE-PLAYSLEADERSHIP STYLES LEADERSHIP STYLES

See appendix DSee appendix D Demonstrate an Authoritarian Demonstrate an Authoritarian

ManagerManager Demonstrate a Laissez-Faire Demonstrate a Laissez-Faire

ManagerManager Demonstrate a Democratic ManagerDemonstrate a Democratic Manager

– Provides privacy, listens, uses open-Provides privacy, listens, uses open-ended questions, involves employee in ended questions, involves employee in goal setting, offers suggestions for goal setting, offers suggestions for improvementimprovement

Situational Leadership Situational Leadership

Assess the situationAssess the situation Assess the group membersAssess the group members Select the style or blending of Select the style or blending of

styles best for the situationstyles best for the situation

Transformational LeadershipTransformational LeadershipProcess TheoriesProcess Theories

View leadership as it relates to group View leadership as it relates to group interactioninteraction

Motivates followers to perform at their Motivates followers to perform at their full potentialfull potential

Group is empoweredGroup is empowered Group has input into decisionsGroup has input into decisions Raise one another to higher levels of Raise one another to higher levels of

performanceperformance Habel & Sherman (2010) Transformational Leadership, Habel & Sherman (2010) Transformational Leadership,

Nursing Spectrum October 11, 2010 Nursing Spectrum October 11, 2010

NY Nurse.comNY Nurse.com

THE CHANGE MAKERTHE CHANGE MAKER

How can you be an agent of How can you be an agent of change rather than a target of change rather than a target of change?change?

How do people react to How do people react to change?change?

threat to selfthreat to self

fear of increased responsibilityfear of increased responsibility

lack of understandinglack of understanding

limited tolerance for changelimited tolerance for change

What role do you play when it What role do you play when it comes to change?comes to change?

Laggard or AdventurerLaggard or Adventurer

CHANGE THEORYCHANGE THEORY

Process of change - force field Process of change - force field analysisanalysis

Three phases required to accomplish Three phases required to accomplish changechange– unfreezingunfreezing– movingmoving– refreezingrefreezing

STAGES OF CHANGESTAGES OF CHANGE

Unfreezing: Unfreezing: recognize need for recognize need for changechange– loosen the status quoloosen the status quo– driving factors versus restraining factorsdriving factors versus restraining factors

Moving: Moving: initiate change afterinitiate change after planningplanning

Refreezing: Refreezing: change becomes change becomes operationaloperational

STEPS IN THE CHANGE STEPS IN THE CHANGE PROCESSPROCESS

Recognize need for a changeRecognize need for a change Define area of concernDefine area of concern Gather & analyze information to Gather & analyze information to

understandunderstand Establish goals: contrast current to idealEstablish goals: contrast current to ideal Seek alternativesSeek alternatives

– identify & rank all possibilitiesidentify & rank all possibilities Implement the selected strategyImplement the selected strategy

HOW TO OVERCOME HOW TO OVERCOME RESISTANCE TO CHANGERESISTANCE TO CHANGE

Involve Involve everyoneeveryone affected affected establish establish open communicationopen communication & &

trusttrust list list advantagesadvantages of the change of the change show your show your commitmentcommitment to the to the

changechange provide provide incentivesincentives for change for change introduce change introduce change slowlyslowly

TECHNIQUES FOR TECHNIQUES FOR IMPLEMENTING CHANGEIMPLEMENTING CHANGE

RunRun productive meetings productive meetings Use Use participative participative decision-decision-

makingmaking Schedule aSchedule a brainstorming brainstorming

session session when neededwhen needed– quantityquantity, , freewheeling, no criticismfreewheeling, no criticism

ROLE-PLAYROLE-PLAY

See Appendix DSee Appendix D INITIATING CHANGEINITIATING CHANGE

– Conduct a staff meeting to address this Conduct a staff meeting to address this situationsituation

– Head nurse & LPNs Head nurse & LPNs in the fishbowlin the fishbowl– Observers Observers outside the fishbowloutside the fishbowl

What are the driving & restraining factors for What are the driving & restraining factors for this change?this change?

PERFORMANCE PERFORMANCE APPRAISALSAPPRAISALS

Base on job description & observationBase on job description & observation Written & presented by same personWritten & presented by same person After 90 days, then annuallyAfter 90 days, then annually Evaluatee involved in setting goalsEvaluatee involved in setting goals Evaluatee may comment & receive Evaluatee may comment & receive

copycopy Opportunity to improve & be re-Opportunity to improve & be re-

evaluatedevaluated

Coaching RoleCoaching Role

Be seen as trying to be helpfulBe seen as trying to be helpful Timing is everythingTiming is everything Discuss behavior in relation to Discuss behavior in relation to

standardsstandards– Don’t be preachy or use word “should”Don’t be preachy or use word “should”

Give specific suggestions for changeGive specific suggestions for change Recognize & praise improvementsRecognize & praise improvements

CONDUCTING THE CONDUCTING THE INTERVIEWINTERVIEW

Select appropriate time & placeSelect appropriate time & place Begin with small talkBegin with small talk Stay job-focusedStay job-focused Provide opportunity to improveProvide opportunity to improve Pitfalls to avoid:Pitfalls to avoid:

– social visitsocial visit– charge-excuse cyclecharge-excuse cycle

USE THE SANDWICH USE THE SANDWICH APPROACHAPPROACH

Begin with the positive attributes, Begin with the positive attributes, accomplishmentsaccomplishments– Be specificBe specific– Spend timeSpend time

Identify and address the deficienciesIdentify and address the deficiencies– Don’t use avoidance or minimize theseDon’t use avoidance or minimize these

Finish with a positive statementFinish with a positive statement

ROLE-PLAYROLE-PLAYPERFORMANCE PERFORMANCE

APPRAISALSAPPRAISALS See Appendix DSee Appendix D

Demonstrate an ineffective Demonstrate an ineffective interviewinterview

Demonstrate an effective interviewDemonstrate an effective interview

RESPONSES TO CONFLICTRESPONSES TO CONFLICT

Competition/PowerCompetition/Power: Win /Lose: Win /Lose– manager concerned with workmanager concerned with work– little regard for stafflittle regard for staff

SmoothingSmoothing: Lose/Win: Lose/Win– manager concerned with relationshipsmanager concerned with relationships– secondary concern for worksecondary concern for work

AvoidanceAvoidance: Lose/Lose: Lose/Lose– Low regard for both tasks & Low regard for both tasks &

relationshipsrelationships– Ignores/withdraws from conflictsIgnores/withdraws from conflicts

CompromisingCompromising: Lose/Lose: Lose/Lose– each side makes concessionseach side makes concessions– neither side gets what they wantneither side gets what they want

CollaborationCollaboration: Win/Win: Win/Win– confront issue openlyconfront issue openly– look for acceptable resolutionlook for acceptable resolution– no dominating, suppressing, no dominating, suppressing,

compromisingcompromising

Strategies for Effective Strategies for Effective Conflict ResolutionConflict Resolution

Identify the problemIdentify the problem– Set some ground rules for the discussionSet some ground rules for the discussion– Set a time limit for the discussionSet a time limit for the discussion

Encourage free exchange of ideas & Encourage free exchange of ideas & feelingsfeelings– Create an atmosphere of trustCreate an atmosphere of trust– Set firm limits on individuals out of controlSet firm limits on individuals out of control

Strategies for Effective Strategies for Effective Conflict ResolutionConflict Resolution

Search for alternative ways to Search for alternative ways to resolve problemresolve problem– Shift talk from problem to solutionShift talk from problem to solution– List points of agreement for all to seeList points of agreement for all to see

Ask for help from outside as neededAsk for help from outside as needed Set up means to evaluate solutionsSet up means to evaluate solutions Keep interacting until all want the Keep interacting until all want the

solutionsolution

ROLE-PLAYSROLE-PLAYSCONFLICT RESOLUTIONCONFLICT RESOLUTION

See Appendix DSee Appendix D Competition/PowerCompetition/Power SmoothingSmoothing AvoidanceAvoidance CompromisingCompromising CollaborationCollaboration

21ST CENTURY LEADER21ST CENTURY LEADERROLE OF VISIONROLE OF VISION

How innovative are you? How innovative are you?

Identify your barriers to innovative action Identify your barriers to innovative action – low self-confidencelow self-confidence– dislike of risk-takingdislike of risk-taking– need for conformityneed for conformity– no abstract thinkingno abstract thinking– lack of time for creativitylack of time for creativity

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