
What is management?
Process of coordinating actions and allocation of
resources to achieve organizational goals
 Persons adept at continuously seeking
information
 Constantly engaged in interactions with others
 Provide assistance and guidance to improve
healthcare
 Prioritization of needs
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De veloped by Carol Amann
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Information-processing role
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Interpersonal role
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Decision making role
De veloped by Carol Amann
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Managing the work

› Planning and
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organization
Problem solving
Clarifying roles and
objectives
Informing
Monitoring
Consulting
Delegating
De veloped by Carol Amann
Managing relationships
› Networking
› Supporting
› Developing and
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mentoring
Managing conflict
Team building
Motivating and
inspiring
Recognizing and
rewarding

Nurse Manager
› First level management
 Directly manage patient care and supervising
others

Directors
› Middle level management
 More time is spent in planning and
coordinating

Chief Nurse Executive
› Executive level
 Oversee all nursing functions and operations
De veloped by Carol Amann
 American
Organization of Nurse
Executives
› The vision of the American Organization of
Nurse Executives (AONE) is to shape the
future of healthcare through innovative
nursing leadership.

Innovative nursing leadership requires
that nurses in leadership or management
positions are competent.
De veloped by Carol Amann

AONE believes that managers at all levels
must be competent in:
I. Communication/relationship building
II. Knowledge of the healthcare
environment
III. Management skills
IV. Professionalism
V. Business skills
De veloped by Carol Amann

Communication and relationship building
competencies include:
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Effective communication
Relationship management
Influence of behaviors
Ability to work with diversity
Shared decision-making
Community involvement
Medical staff relationships
Academic relationships
De veloped by Carol Amann

Knowledge of the healthcare environment
includes:
› Clinical practice knowledge
› Patient care delivery models and work design
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knowledge
Healthcare economics knowledge
Healthcare policy knowledge
Understanding of governance
Understanding of evidence-based practice
Outcome measurement
Knowledge of and dedication to patient safety
Understanding of utilization/case management
Knowledge of quality improvement and metrics
Knowledge of risk management
De veloped by Carol Amann

Professionalism includes:
Personal and professional accountability
Career planning
Ethics
Evidence-based clinical and management
practice
› Advocacy for the clinical enterprise and for
nursing practice
› Active membership in professional
organizations
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De veloped by Carol Amann

Skills include:
› Foundational thinking skills
› Personal journey disciplines
› The ability to use systems thinking
› Succession planning
› Change management
De veloped by Carol Amann

Business skills include:
› Understanding of healthcare financing
› Human resource management and
development
› Strategic management
› Marketing
› Information management and technology
De veloped by Carol Amann

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Have assigned position in organization
Have legitimate source of power
Carry out specific functions, duties and
responsibilities
Emphasize control, decision making,
decision analysis, and results
Manipulate people, environment, money,
time, people and other resources to
achieve goals
Direct the willing and the unwilling
De veloped by Carol Amann
Staff nurses are at the bedside 24 hours a day,
seven days a week. They are on the front lines and
have a distinct power to influence sustainable
outcomes and productivity.
 By permitting autonomy in their decision-making
however slight, we lay the foundation of
leadership.

› New nurses decide appropriate times to call a physician,
choose applicable care plans and pertinent interventions.

These early autonomous steps form the building
blocks of leadership.
De veloped by Carol Amann
Managing relationships
Managing the work
Management
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Planning and organizing
Problem solving
Clarifying roles and objectives
Informing
Monitoring
Consulting
Delegating
Intrapersonal
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Networking
Supporting
Developing and mentoring
Managing conflict and team building
Motivating and inspiring
Recognizing and rewarding
De veloped by Carol Amann
De veloped by Carol Amann

Focus on goals and productivity
› Run the organization like a fine oiled
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machine to increase productivity
Closely supervise staff
Requires workers to have proper tools
Focus on productivity only
Use of time studies to improve workflow
Use of incentives to increase productivity
De veloped by Carol Amann

Focus on superior/subordinate
communication
› Clear chain of command
› Hierarchy of authority
› Rational and impersonal
› Explicit rules and regulations…clear cut
direction and consequences
› Focus on technical competence
› Merit and skill promotions and awards
De veloped by Carol Amann

Focus on the science of management
› Identifies need for planning, organizing,
supervising, directing, controlling, organizing,
and reviewing and budget
› Concerned with most optimal approach to
achieve economic efficiency
› Realize that people make a difference in the
organization
› Work grouped under one manager
De veloped by Carol Amann

Focus on empowerment of the individuals
as source of control, motivation, and
productivity
› Social facilitation increases work performance
› Participatory decision making increases
autonomy, productivity, and buy-in
› Provide training to improve work
› Derived in 1930’s as a result of the labor
movement
De veloped by Carol Amann
Middle managers are being downsized
 Others are taking on more responsibility,
spending more time with management
of clinical systems vs. managing nurses

› Leadership responsibilities are integrated to
all employees
Will be responsible for increasing direct
reports/FTE’S (Full time equivalents)
 Continue with 24/7 accountability

De veloped by Carol Amann
The ability to recognize your own feelings
and the feelings of those around you
 The ability to maintain a balance between
one’s emotional and thought processes
 Includes five basic emotional and social
competencies
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Self-awareness
Self-regulation
Motivation
Empathy
Social skills
De veloped by Carol Amann
Complete
Management
questionnaire
De veloped by Carol Amann
Management is doing things right;
leadership is doing the right things.
 Leaders sell the tickets for the journey,
Managers drive the bus to the
destination.
 A job title alone does not make a
leader…only a person’s behavior
determines if he/she occupies a
leadership position

De veloped by Carol Amann
Defined as a process of influence in
which the leader influences others
toward goal achievement
 How do we influence others:

› Inspiration
› Enlivening
› Engaging others
De veloped by Carol Amann

Formal
› A person in a position of authority or
assigned role within an organization that
holds influence

Informal
› One who demonstrates leadership outside
the scope of a formal leadership role
 Considered a leader when accepted by
others and is perceived to have influence
De veloped by Carol Amann
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Visionary - Create a vision, a
picture of the future, of
where they want to take their
organizations
Inspirational - Inspire
everyone in the company to
get onboard
Strategic - Clear and directly
face the strengths and
weaknesses of their own
organizations
Tactical - Wired like
businesspeople, bottom-line
oriented and committed to
results
Focused - Achieve what they
set out to do before
launching new initiatives.
De veloped by Carol Amann
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Persuasive – use logic,
reason, emotion and the
force of their personalities.
They motivate by
persuasion rather than
intimidation.
Likeable - people-centric
Decisive - make decisions
quickly -- often with
incomplete data.
Ethical - Good leaders are
direct and straightforward.
They set clear performance
expectations and hold
people accountable.
Open to feedback - seek
feedback about their
performance

What are some ways you initiate a
leadership role?
Influence others for goal achievement
Set nursing practice
Influence health practices
Ensure safe practices are instituted and
maintained
› Contribute to the health care needs of others
› Continually question current practices and
guidelines
› Assist in providing an optimal work environment
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De veloped by Carol Amann

Leadership
› Create change
 Establishing direction
 Aligning people through empowerment
 Motivating and inspiring others for the common
goal/mission/vision

Manager
› Control environment for order and consistency
 Planning and budget
 Organizing and staffing
 Problem solving
De veloped by Carol Amann

Guiding Vision
› Provide direction for the future

Passion
› Ability to inspire and align people for a
common goal

Integrity
› Knowledge of self, honesty and maturity
developed through experience and growth
De veloped by Carol Amann
Copyright © 2005 by the American Organization of Nurse Executives. All rights reserved.
De veloped by Carol Amann
Shaping the future of healthcare
through innovative nursing leadership.







Clinical practice knowledge
Patient care delivery models, work design,
case management and risk management
Healthcare economics and policy
Governance
EBP and outcome measures
Champion for patient safety
Quality improvement and metrics
De veloped by Carol Amann








Effective communication
Relationship management
Influence behaviors
Ability to work with diversity
Shared decision-making
Community involvement
Medical staff relationships
Academic relationships
De veloped by Carol Amann
Healthcare financing
 Human resource management and
development
 Strategic management
 Marketing
 Information management and
technology

De veloped by Carol Amann
Personal and professional accountability
 Career planning
 Ethics
 Evidence-based clinical and
management practice
 Advocacy for the clinical enterprise and
for nursing practice
 Active membership in professional
association

De veloped by Carol Amann
Foundational thinking skills
 Personal journey disciplines
 Appreciation and application of systems
thinking
 Succession planning
 Change management

De veloped by Carol Amann
There is mounting evidence that
unhealthy work environments contribute
to medical errors, ineffective delivery of
care, and conflict and stress among
health professionals.
 The creation of healthy work
environments is imperative to ensure
patient safety, enhance staff recruitment
and retention, and maintain an
organization’s financial viability.

De veloped by Carol Amann
De veloped by Carol Amann

Skilled Communication
› Nurses must be as proficient in communication
skills as they are in clinical skills.

True Collaboration
› Nurses must be relentless in pursuing and fostering
true collaboration.

Effective Decision Making
› Nurses must be valued and committed partners in
making policy, directing and evaluating clinical
care, and leading organizational operations.
De veloped by Carol Amann

Appropriate Staffing
› Staffing must ensure the effective match between
patient needs and nurse competencies.

Meaningful Recognition
› Nurses must be recognized and must recognize
others for the value each brings to the work of the
organization.

Authentic Leadership
› Nurse leaders must fully embrace the imperative of a
healthy work environment, authentically live it and
engage others in its achievement.
De veloped by Carol Amann
Have desire to lead
 Honesty and integrity
 Self confidence
 Cognitive ability
 Knowledge of the business

De veloped by Carol Amann
Three styles:
 Autocratic/Authoritarian leadership

› Centralized decision making

Democratic/Participative leadership
› Participatory with authority delegated to
others

Laissez-faire/Permissive/Free Rein
leadership
› Passive and permissive
De veloped by Carol Amann

Employee centered focus
› Focused needs on those who work for you

Job centered focus
› Less effective approach
› Focus on schedules, cost, efficiency
De veloped by Carol Amann
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Initiating structure
› Emphasis on work to be done
› Focus on task and production
› Concerned with how work is organized and
goal achievement

Consideration
› Involves activities that focus on the
employee
› Emphasis on employee relations
De veloped by Carol Amann
Low initiating structure, low consideration
 High initiating structure, low consideration
 High initiating structure, high consideration
 Low initiating structure, high consideration

Which works best?
De veloped by Carol Amann
Contingency theories acknowledge that
other factors in the environment
influence outcomes as much as
leadership style
 So which came first…the chicken or the
egg?

De veloped by Carol Amann

Views the pattern of leadership behavior is
dependant on the interaction or the
personality of the leader and the needs of the
situation
› Leader – member relations
 Feelings, attitudes of followers regarding
acceptance, trust and credibility of the leader
› Task structure
 Degree to which work is defined: explicit directions
and goals
› Position power
 Degree of formal authority and influence associated
with the leader
De veloped by Carol Amann

Consider follower readiness to determine
leadership style
› Groups with little experience (immaturity) need
leader to provide direction and close supervision
› Groups with low to moderate ability (maturity)
require clear direction and supportive feedback
› Groups with moderate to high ability (maturity)
require support and encouragement
› Groups with high ability engage in task without
direction or support
De veloped by Carol Amann

Leader works to influence goal
accomplishment by motivating followers
› Uses appropriate style of leadership for the
situation
› Makes the path toward goal
accomplishment easier
 Directive style = structure
 Supportive style = encouragement, person
oriented
 Participative style = involving others with
decisions
 Achievement style = structure direction and
support De veloped by Carol Amann

Variables that may influence followers to
equate to the leaders behavior
› For nurses our experience serves as a leader
substitute = intrinsic satisfaction
 Substitutes praise and acknowledgement form
the leader with the nurse patient relationship
De veloped by Carol Amann

Charismatic Theory
› Inspirational, promotes emotional
connection

Transformational Leadership Theory
› Empowering others, working collaboratively
for a common goal
› Two types:
 Transactional Leader
 Manager/day to day operations
 Transformational Leader
 Leader committed to vision empowering others
De veloped by Carol Amann
 Create
an Inspiring Vision:
Lead by Example
› Create an inspiring vision, establish shared
values, give direction and set stretch goals
› Create change, lead change, manage
resistance to change
› Lead by example; practice what you preach;
set an example, and share risks or hardship
› Demonstrate confidence; win respect and
trust without courting popularity
De veloped by Carol Amann

Empower, Inspire, and Energize People
› Be enthusiastic; inspire and energize people,
create a positive work environment
› Empower people; delegate authority; be
open to ideas; have faith in the creativity of
others
› Communicate openly and honestly; give
clear guidelines; set clear expectations
› Empathize; be willing to discuss and solve
problems; listen with understanding; support
and help
De veloped by Carol Amann
 Build
and Lead a Team
› Use team approach; facilitate
cooperation; involve everyone; trust your
group; rely on their judgment
› Bring out the best in your people; have
common touch with them; coach and
provide feedback
› Permit group decision; help your team
reach better decisions
› Monitor progress, but don't
micromanage; avoid close supervision;
do not over boss; do not dictate
De veloped by Carol Amann
What type of leader do you want to be?
 What type of leader do you want to
work for?
 What is the importance for you
regarding the following traits:

› Intelligence, self confidence, determination,
integrity, sociability, caring, respectability,
trustworthiness, flexibility
De veloped by Carol Amann
Leaders can’t succeed without
committed, contributing followers
 Full partners in an organization
 The responsibility for making the leaderfollower relationship work remains with
the follower

De veloped by Carol Amann
An art--a skill that is learned, cultivated, and
consciously developed and exercised.
 Complement the leader’s strengths,
specialties, strengths and areas of
expertise.
 Provide input that focuses on finding
solutions not just problem identification.
 Thinks critically, has skills to advocate for
ideas, and provides leader support.

De veloped by Carol Amann
Effective or exemplary followers
 Alienated followers
 Yes People
 Sheep

De veloped by Carol Amann
Partner
 Contributor
 Politician
 Subordinate

De veloped by Carol Amann

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Studies & creates
new ideas
Makes decisions
Assigns appropriate
responsibilities
Creates
environments of trust
Takes risks
Reliable
Tests new ideas
 Challenges decisions
as needed

De veloped by Carol Amann
Knows when to
accept
responsibility &
does
 Uses freedom
responsibly
 Risk following
 Trustworthy and
respectful

Loyal to followers
 Self-confident
 Assumes a leadership position
 Interdependent
 Loyal to the leader
 Knows themselves
 Follows when appropriate

De veloped by Carol Amann
Know their strengths and abilities
Have self confidence
Know how, when, and who to question
Have something to offer
Understand that a follower is critical to
being an effective leader
De veloped by Carol Amann