Practical/vocational nurses need to develop leadership and management skills so they can direct and supervise others in a manner that will effectively meet the goals of the employing agency. In your practical/vocational nursing program, you started to build a strong, solid base in these skills. This chapter and Chapter 21 will help you to continue to develop skills to lead and manage. This chapter focuses on the leadership role and provides 20 Leadership Hints, 5 Leadership Activities, and 1 Critical Thinking exercise to get you started thinking in a leadership mode. Chapter 21 provides 11 Management Hints, 12 Management Tools, and 7 Critical Thinking exercises to help you apply the knowledge and skills needed to be a charge nurse. The interactive format of both chapters, especially Chapter 21, will have you thinking as a new charge nurse and solving some of the problems new charge nurses face. This chapter and Chapter 21 can both be used as reference tools of skills while orienting to a practical/vocational charge nurse position.

Organizational chart

The organizational chart is a picture of responsibility in an employment situation. In the traditional organizational chart, individuals who are lower on the organizational chart report to the person directly above them on the chart. Figure 20-1 shows where the practical/vocational nurse fits into the traditional organizational chart as a first-line leader. In Figure 20-1, the practical/vocational nurse reports to the nurse manager, who is a registered nurse. Nursing assistants report to the practical/vocational nurse. To whom does the nurse manager report?

Because of changes in the structure of organizations, organizational charts have become more horizontal than vertical in appearance. Figure 20-2 provides an example of a contemporary organizational chart. This “flattening out” has eliminated some of the middle manager positions in organizations. As a result, the remaining middle managers have taken on more responsibilities and are spread thin. Middle managers in this system have more persons reporting to them than in the past. Middle managers depend on the people who report to them, such as the practical/vocational charge nurse, to think critically and problem solve. Middle managers expect to be contacted when you have tried and are unable to solve your own problems. See the Coordinated Care, Leadership Activity: Examining Organizational Charts box.

Figure 20-2 Sample contemporary organizational chart for the practical/vocational nurse in the charge nurse role.

Coordinated Care

Leadership Activity

Examining Organizational Charts

Resources needed:

• Organizational charts from clinical sites used by students in your practical/vocational nursing program

Organizational charts may differ by region of the United States. Obtain organizational charts of long-term care facilities in your area. Clarify specific levels of responsibility as they apply to the practical/vocational nurse. Identify whether these charts reflect a traditional or contemporary style of organization.

Expanded role of practical/vocational nursing

It is important for you to review the current Nurse Practice Act of your state. This law legally defines the exact role and boundaries for practical/vocational nurses. Also review the following for more guidelines related to the expanded role of the practical/vocational nurse:

1. Appendix A: NAPNES Standards of Practice and Educational Competencies of Graduates of Practical/Vocational Nursing Programs

2. Appendix B: NFLPN Nursing Practice Standards for the Licensed Practical/Vocational Nurse

See the Coordinated Care, Leadership Activity: Determining Your State’s Requirements to Assume the Position of Practical/Vocational Charge Nurse box.

Coordinated Care

Leadership Activity

Determining Your State’s Requirements to Assume the Position of Practical/Vocational Charge Nurse

Resources needed:

• Your state’s Nurse Practice Act

Obtain a current copy of your state’s Nurse Practice Act. Identify the part of the act that addresses your state’s position on the practical/vocational nurse who is assuming the charge nurse position in the following areas:

1. Requirements before assuming the practical/vocational charge nurse position

2. Site of employment

3. Scope of practice

If your state’s Nurse Practice Act does not address the issue of charge nurse, how can this information be obtained?

An example of the expanded role of the practical/vocational nurse is the first-line manager position, also called charge nurse, in a nursing home or long-term care facility. In these situations the practical/vocational nurse has the responsibility of supervising the care given by nursing assistants and other personnel. The practical/vocational nurse will direct, guide, and supervise these health care workers as they attempt to meet the goals of the resident’s plan of care.

The most recent practice analysis of entry-level practical/vocational nurses by the National Council of State Boards of Nursing (NCSBN, 2010) for which data are available occurred in 2009. This survey identified that 45.2% of practical/vocational nurses responding to the survey reported they had administrative responsibilities, with 65.8% of these respondents working in long-term care. Fifty-two percent of respondents in long-term care reported the charge nurse position as their administrative responsibility. To carry out the first-line manager/charge nurse role effectively, you will need the abilities found in both a leader and a manager. The 2009 practice analysis can be obtained at www.ncsbn.org.

Preparing for a leadership and management role

The topic of leadership and management for the practical/vocational nurse is a vast one. All practical/vocational nurses are already managers in the sense that they consistently need to direct, handle, and organize care for assigned patients. It is worthwhile for you to review the ways in which your practical/vocational nursing program helps prepare you for a management position. The practical/vocational nursing program encourages development of the following skills, which are necessary for functioning successfully as a first-line manager:

1. Basic nursing skills, including the nursing process

2. Time-management techniques for home and clinical time

3. How to learn new information, including using resources for learning

4. The power of positive self-talk and thinking

5. Rules for assertiveness

6. Communication skills

7. Ethical aspects of health care

8. Legal aspects of health care

9. Problem solving and critical thinking

10. Stress management

11. Participation in clinical evaluation

Learning leadership and management involves much more than taking one course or reading one chapter about becoming a leader. Learning leadership is a process (continual development) that includes many skills and is something that evolves over time. This chapter encourages you to think specifically of a leadership role, and it provides leadership hints that practical/vocational nurses need.

Difference between management and leadership

Management is the organization of all care required of patients in a health care setting for a specific period.

• The focus of management is planning and directing to meet patient goals.

• Management is a formal role given to a person by the employer.

• Managers are appointed by their employers.

• The tools needed for management could be written in a step-by-step manner and given to you to follow.

• Following the directions for using the management skills would possibly get the job done in an efficient manner.

Leadership is the manner in which the leader gets along with coworkers and accomplishes the job.

• The focus of leadership is to produce changes in the workplace that will meet the goals of the employing agency.

• Leadership is an informal role that is given to a person by a group of workers. You become a leader when your team members decide to follow you.

• Leaders cannot be appointed.

• The leader needs to influence others in the work setting to want to implement desired change.

• Directions for leadership skills can also be written, but it is through experience that leadership skills are truly developed.

The practical/vocational nurse who has the skills of both management and leadership will get the job done in the most efficient and effective manner, and the practical/vocational nurse manager and coworkers will enjoy the experience that much more! A manager is not automatically an effective leader, and a leader is not automatically an effective manager. Your goal will be to develop skills of leadership and management.

What kind of leader are you?

You can lead in several different ways. What is your predominant leadership style? Each of the statements given in the Coordinated Care, Leadership Activity: Discovering Your Personal Leadership Style box is an extreme. The responses are not positive or negative. One answer does not have value over another answer. They just are.

Coordinated Care

Leadership Activity

Discovering Your Personal Leadership Style

Put a check mark next to the statement that best describes the way you might be at work, not how you want to be.

A Short Test of Leadership Style

1. My primary goal at work is to:

a. Get the job done.

b. Get along with the people with whom I work.

c. Do the job correctly.

d. Hope the work I do is noticed.

2. My clinical coworkers would say I am:

a. Domineering in my relationships.

b. Friendly and personable in my relationships.

c. Likely to attend to details of the resident care plan.

d. Creative and energetic in giving care.

3. At work, I feel like I have to be:

a. In control of the resident situation.

b. Liked by my coworkers.

c. Correct in giving care.

d. Recognized and praised for my care.

4. When I communicate on the nursing unit:

a. I am usually direct and to the point.

b. I am more considerate of the person to whom I am talking rather than strongly getting my point across.

c. I usually give detailed information.

d. I usually elaborate on the point at hand.

5. My coworkers would say I am a person who:

a. Gets the job done regardless of what shift I work.

b. Is very likable and patient.

c. Is precise and accurate in giving nursing care.

d. Is optimistic and has good verbal skills.

6. My charge nurse might describe my behavior while on my shift by saying that:

a. Sometimes I alienate people.

b. Sometimes I waste time and fall for excuses others may give.

c. Sometimes I can be stubborn with coworkers.

d. Sometimes I appear flaky to my coworkers.

7. I react to a stressful incident on the nursing unit:

a. By being rude, blaming other departments, and yelling at coworkers.

b. By being accommodating to the person in charge and by passive behavior.

c. By becoming silent and withdrawing from the situation.

d. By talking faster and louder.

8. When I deal with my coworkers on the nursing unit regarding patient matters, I like them to:

a. Get to the point and be businesslike in their behavior.

b. Be casual and sincere in their behavior.

c. Use the facts of the matter and go step by step when explaining a resident-care situation.

d. Be enthusiastic about the situation and use demonstrations to explain their points.

Add up your “a” and “c” answers. These answers are more characteristic of a task-oriented person. In leadership terms, this person is called an autocratic leader. Add up your “b” and “d” responses. These are more characteristic of a people-oriented person. In leadership terms, this person is called a laissez-faire leader.* Your score can give you a rough estimate of the tendency of your leadership style.

^*French for not interfering in the affairs of others.

Leadership styles

The literature abounds with examples of leadership styles. Figure 20-3 illustrates a continuum (a line with extreme opposites at each end) of leadership styles. Box 20-1 compares and contrasts the leadership styles found on this continuum.

Box 20-1 Comparing Autocratic, Democratic, and Laissez-Faire Styles of Leadership

General description

Autocratic: Does not share responsibility and authority with employees

Democratic: Shares responsibility and authority with employees

Laissez-faire: Gives away responsibility and authority to employees

Importance of agency’s policies

Autocratic: Emphasis is on policies

Democratic: Enforces policies but with concern for employees

Laissez-faire: Puts employees before policies

How leader gets the job done

Autocratic: Tells employees what tasks to do; does not seek input from employees

Democratic: Seeks input from employees and encourages problem solving

Laissez-faire: Tries to please everyone

What gets done

Autocratic: May reach goals

Democratic: Because of involvement of employees, goals may be achieved with positive staff feelings

Laissez-faire: Maybe nothing, but at least staff feels good

When style can be used

Autocratic: Crisis situations, code situations, emergencies

Democratic: Daily nursing care situations, meetings, committees, review of care plans

Laissez-faire: When agency goals/policies are not a consideration

Benefits and disadvantages of leadership styles

A purely task-centered leadership style (called autocratic style) thrives on power. It involves telling someone what to do, with little regard for the employee as a person who may have ideas about how to improve resident care or reach the goals of the employer. Adopting the autocratic or laissez-faire style in Box 20-1 to use consistently as a leadership style is unrealistic. Its consistent use could be disastrous. However, there is room for an autocratic leadership style—for example, in times of emergency. On the following lines, list two additional examples of situations that might require the autocratic style of leadership.

1. _______________________________________

2. _______________________________________

A purely people-oriented style (laissez-faire) focuses on people’s feelings but ignores the task at hand. It allows employees to act without any direction. The goals of the employer will be compromised when the laissez-faire leadership style is used. At times, persons in leadership roles may feel the need to be liked by all team members and use this leadership style, but the task of accomplishing goals will be compromised.

Focusing on both the task and the employee is characteristic of the democratic style of leadership. In this style the practical/vocational charge nurse displays concern for the work that needs to be done, as well as for the team performing the work. When using this leadership style, the practical/vocational charge nurse encourages supervised nursing assistants to discuss resident care, make decisions, and problem solve improvements in care. It may take longer than the autocratic style for work to be accomplished, but patient goals (outcomes) will be achieved, with staff having positive feelings about their supervisor and the experience. Examples of situations in which the democratic style of leadership is useful include daily nursing care situations, unit meetings, and reviews of patient care plans.

Situational Leadership

Using the leadership continuum as a guide

The value of a continuum, as shown in Figure 20-3, is that as you move along the continuum from each extreme toward the center or midpoint, the two extremes begin to blend together. You have some of each style, depending on where you are on the continuum. A blend, to some degree, of the two extremes in the appropriate work situation would be the leadership style needed at the moment.

Coordinated Care

Leadership Activity

Plotting My Leadership Style Score

Using your leadership style score from the Discovering Your Personal Leadership Style box, place an “X” on the continuum in Figure 20-3 to indicate where you are at this point in general leadership style tendencies.

Do the exercise in the Coordinated Care, Leadership Activity: Plotting My Leadership Style Score box. Remember, this score is your tendency. If your “X” is far to the left or right, it will benefit you to be aware of this tendency and to avoid using this style consistently. Remember the continuum and the need to be flexible in your style. Balance task and people orientation as needed. Knowing what your predominant style of leadership is will be helpful in your evaluation of work situations and the style needed at that time. Some situations require a supportive style, whereas others require a more directive approach.

Core knowledge and skills needed for leadership

To function well in your expanded role as practical/vocational charge nurse, you will strive to be a good leader. The scenario at the beginning of this chapter provides examples of what not to do as a nurse leader. Much research in learning about the business of leading others and the theories that go with leading is available in the literature. Core knowledge and skills lay the foundation for leadership. They will help you develop other necessary knowledge and skills for your leadership role. We identify five core areas of knowledge and skills that are necessary for the practical/vocational charge nurse to be an effective leader. These core areas include the ability to do the following:

1. Motivate team members to accomplish team goals.

2. Communicate assertively.

3. Problem solve effectively.

4. Build a team of cooperative workers.

5. Manage stress effectively.

Motivating Nursing Assistants

Maslow’s Hierarchy of Needs can be adapted to help the first-line LPN/LVN leader understand motivation of team members in a health care setting, based on needs (Figure 20-4). Remember, all behavior is internally motivated. As an LPN/LVN manager, you can influence what nursing assistants might be motivated to do. If nursing assistants see that doing a good job helps them meet personal needs, they will also be meeting the goals of their employer.

Figure 20-4 Howlett Hierarchy of work motivators.

All levels of the pyramid in Figure 20-4 are considered to be needs of employees in an employment situation. As you go up the Howlett Hierarchy, strategies could be used to encourage meeting needs of nursing assistants at each level. The opportunity to meet these needs can be encouraged or discouraged by the employer and/or the work environment, including the charge nurse (extrinsic motivators). If these needs are met, the person can proceed to the next highest level of the pyramid. If these needs are not met, a person may become dissatisfied with the work situation. Strategies for levels 3 and 4 can play an important role in motivation for team members at any level of the Howlett Hierarchy. Praise, recognition, and rewards are extremely important tools for leaders.

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