Online Companion: Nursing Fundamentals: Caring & Clinical Decision Making

Chapter 24: Leadership, Delegation, and Collaboration

The term leadership is defined as the process of influencing others toward the achievement of goals. Philosophers and leaders from the time of Aristotle have debated whether leadership is innate or learned. The modern study of leadership began in the early 20th century when scientific management principles were first applied.

Several leadership frameworks (transformational, servant, emotional intelligence, and the Collins leadership model) have been advanced. Transformational leadership is leadership that (1) promotes justice, equality, and human rights; and (2) endorses honesty, loyalty, and fairness as a basis for influencing change. Servant leadership is leadership based on the needs of others. Leaders employing the emotional intelligence model value self-direction in others. The Collins leadership level model describes five levels of leadership, the highest of which focuses on the contributions of team members.

“Leadership” and “management” are often used interchangeably. However, management is the accomplishment of tasks, either by oneself or by directing others; and leadership is the interpersonal process that involves motivating and guiding others to achieve goals.

Leaders tend to use one of four leadership styles; but effective leaders use situational leadership, a blend of styles based on the current circumstances. The four leadership styles (autocratic, consultative, democratic or participative, and laissez-faire) range from tight control to little control. In the autocratic leadership style, the leader maintains control, makes all of the decisions, and solves all the problems. In the consultative leadership style, leaders must sell their decisions to subordinates. Democratic leadership is also known as participative leadership. In democratic leadership, every member has input and communication is open and mutual. In laissez-faire leadership style, the responsibilities are assumed by the group, the leader does not set limits, and the leader does not state expectations.

Effective leaders use helpful communication, are credible, collaborate with others, delegate to others, and use critical thinking when making decisions. Collaboration involves working within multidisciplinary teams with common goals and mutual trust. Delegation is the process of transferring a selected task in a situation to an individual who is competent to perform that specific task.

Conflict among team members occurs on three levels: within the individual, between individuals/within groups, and between groups. Conflict is natural and eventually inevitable. Conflict can be handled with accommodation (giving aggrieved parties what they want), pressing (using assertive behavior to get what you want), avoidance (hoping that time will take care of the problem), or negotiation (working with other parties to obtain a win-win solution).

Nursing leaders must adequately manage the resources provided by the organization. Most nursing managers operate on a fiscally sound budget that estimates their unit’s revenues and expenses. Expenses can be direct (attributable to the department) or indirect (allocated from the operation of the larger organization).

Three maxims are applicable at all levels of nursing organizations: nursing leadership is based on values, nursing leaders are change agents, and nursing leaders must be self-aware. Nursing leaders must be change agents because the health care system and society constantly change. Nursing leaders need to be able to anticipate the changes that will be needed and possess the courage to guide the organizations into those changes.