12Jones Leadership(F)-ch 12 198 1/14/07 3:43 PM Page 198 Skills for Being an Effective Leader All Good Things This chapter has explored the value of team building and teamwork in health care The innumerable numbers and types of health-caregivers create potential for chaos and require coordination of care for patient safety Coordination of care occurs best with teamwork, and the elements of good teamwork include good communication and good group work Effective communication is based on intentional application of good sending and receiving techniques Effective group work occurs when group members understand group structure and process and are committed to achieving group goals Groups grow through stages of development; those that are highly developed become productive teams The best teams have effective leaders, excellent communication, group loyalty, clear goals, flexibility, competence, and members who care about each other Teams are the cornerstone of high-quality patient care and satisfying work environments Let’s Talk Think about the various health-care workers you have met How well informed you feel about the roles they fill? How does the nursing role differ from the respiratory therapist role? How are they the same? How could you find out more about their role and the roles of other health-care disciplines? NCLEX Questions The situation that best exemplifies why nurses must be skilled in functioning as an interdisciplinary team member is: A Nurses are frequently expected to serve as a team leader on their nursing unit, which may include several levels of nurse caregivers B Most practicing nurses are expected to be a member of or provide leadership for formal nursing committees C Nurses must be prepared to participate in nursing research groups to improve nursing care D Most nurses function in hospitals that employ specialists from many different caregiver groups who must work together to provide coordinated care Pick the situation below that would provide the greatest opportunities for misunderstanding, friction, and conflict based on the concepts described in this chapter A Ms Hassad, AS, RN; Mr Krank, CAN; and Dr Arrington, ER physician, are applying a cast to Steven, a 4-year-old accident victim Steven’s mother, father, and grandparents are present The family is very anxious and watching to be sure that Steven receives the best care B The staff members of the NICU (six BSN, RNs; two CNAs, one medical director, one surgical director, two respiratory therapists, two unit administrative assistants, one pharmacist, and one MSN nurse manager) are working as a team to lower the nosocomial infection rate on their unit C Ms Carmen, BSN, RN, is a home health nurse caring for Mr Wolinski who lives alone and is very depressed, argumentative, and hard of hearing D Six BSN nursing students enrolled in Nursing 301, Healthy Communities, have been assigned to work as a group to develop a teaching plan for smoking cessation Which of the statements below best describes the relationship between nursing care, groups, and teams? A Good teamwork is dependent on understanding how groups work B Good nursing care is dependent on good teamwork, and good teamwork is dependent on good group dynamics C All three are equally important, and it is not necessary to understand their relatedness D Good group work has nothing to with good teamwork All of the following groups are considered “for- mal” groups except: A The nursing research committee of the NICU B Nurses who are friends and have a walkers’ group at lunchtime C Memorial Hospital Nursing Safety Committee D The IRB of University Medical Center 12Jones Leadership(F)-ch 12 1/14/07 3:43 PM Page 199 Building Teams for Productivity and Efficiency Consider the following description of the NICU staffing group in Question above: All staff members have been employed on this unit and have been working together for at least months All the staff caregivers deliver conscientious quality care each day Part of their caregiving plan follows a special protocol that the group developed (based on research about nosocomial infections in the NICU) It includes careful handwashing, careful adherence to sterile technique and universal precautions, careful adherence to proper equipment use, and careful observation of all caregiver behaviors to be sure they are aligned with agreed upon standards of care Disagreements occur and are discussed and resolved at team meetings When illness requires a change in staff workdays, someone volunteers to cover; members celebrate holidays and birthdays; they their homework and they work together to screen new applicants for open positions to protect the collaborative culture and effective caregiving model they have developed This group best exemplifies what stage of group development? A Norming B Forming C Storming D Performing The critical importance of teamwork and com- munication in health care has been documented in many published reports These reports support the positive association between effective teamwork and: A Quality patient care B Higher medication errors C Compromised patient safety D Lower staff morale The best way to check to see if what you have communicated has been understood the way you meant it to be is to use: A Content and context clues B Nonverbal communication C Reliance on paralanguage D Active listening and feedback Effective communication is a cornerstone of effective teamwork and it works best when those involved are committed to all of the following except: 199 A Utilizing mechanical techniques B Attempting to suspend personal judgments C Extending respect and positive regard for their teammates D Utilizing excellent communication skills Skills of good team leaders include all of the following except: A Clearly defining the goal and providing frequent visual reminders of the goal B Ignoring nonperformers and expecting others to so C Explaining how tasks or assignments will contribute to accomplishment of the goal and asking members to the same D Using frequent examples of how all contributions are moving toward the goal 10 When a team leader recognizes a need for improved technical expertise in the team, the leader may address this problem by: A Demanding that the team members work harder to gain more knowledge and experience in the necessary technical areas B Sharing disappointment with the team and requesting that members solicit assistance from a colleague to help them become more competent C Adding a new team member who is knowledgeable and can provide the team with strong consultation to assist other members D Explaining to the employer that the team does not have the necessary knowledge and skills to meet the team goals REFERENCES Arnold, E., & Boggs, K (1995) Interpersonal Relationships (2nd ed.) Philadelphia: W.B Saunders California Strategic Planning Committee for Nursing Retrieved September 9, 2004, from http://www.csuchico.edu/nurs/ levelsofnursed.htm Burgoon, J.K., et al (1996) Deceptive realities: Sender, reviewer, and observer perspectives in deceptive conversations Communication Research, 23, 724–748 Drinka, P., & Clark, P (2000) Health care teamwork: Interdisciplinary practice and teaching Westport, CT: Auburn House Firth-Cozens, J (2001) Cultures for improving patient safety through learning: The role of teamwork Quality in Health Care, 10(Suppl II), 1126–1131 Geriatric Interdisciplinary Team Training: A Curriculum from the Huffinton Center on Aging at Baylor College of Medicine (2001) Long, D.M., & and Wilson, N.L (eds.) New York: John Hartford Foundation, Inc Retrieved 12Jones Leadership(F)-ch 12 200 1/14/07 3:43 PM Page 200 Skills for Being an Effective Leader November 5, 2004, from http://www.hospice.va.gov/Bronx/ module_3.htm HealthGrades Quality Study (2004) Patient safety in American hospitals HealthGrades, Inc Homans, G (1950) The human group New York: Harcourt Brace Jovanovich Homans, G (1961) Social behavior: Its elementary forms New York: Harcourt Brace Institute of Medicine (1999) To err is human: Building a safer health system Washington, DC.: National Academy Press Kaissi, A., Johnson, T., & Kirschbaum, M (2003) Measuring teamwork and patient safety attitudes of high risk areas Nursing Economics, 21(5), 211–218 Lacoursiere, R.B (1980) The life cycle of groups: Group development theory New York: Human Sciences Press LaFasto, R., & Larson, C (2001) When teams work best Thousand Oaks, CA: Sage Larson, C.E., & LaFasto, F.M.J (1989) Team work: What must go right/what can go wrong Newbury Park, CA: Sage Majzun, R (1998) The role of teamwork in improving patient satisfaction Group Practice Journal, 47 McPherson, K., Headrick, L., & Moss, F (2001) Working and learning together: Good quality care depends on it, but how can we achieve it? Quality in Health Care, 2110(10): 47–53 Nondestructive Testing (2004) Teamwork in the Classroom Retrieved October 29, 2004, from http://www.ndted org/TeachingResources/ClassroomTips/Teamwork.htm Riley, J.B (2000) Communication in nursing (4th ed.) St Louis: Mosby Risser, T.R., et al (1999) The potential for improved teamwork to reduce medical errors in the emergency department Annals of Emergency Medicine, 34(3): 373–383 Rogers, C.R (1961) On becoming a person Boston: Houghton Mifflin Schuster, P.A (2000) Communication: The key to the therapeutic relationship Philadelphia: F.A Davis Sexton, J., Thomas, F., & Helmreich, R (2000) Error, stress, and teamwork in medicine and aviation: Cross sectional surveys British Medical Journal, 320, 745–749 Silence kills: The seven crucial conversations for healthcare (2005) Retrieved July 2, 2005, at http://www.silencekills com Stout, R., Salas, E., & Fowlkes, J (1997) Enhancing teamwork to complex environments through team training Group Dynamics: Theory, Research & Practice 1(2): 169–182 Tuckman, B (1965) Developmental sequence in small groups Psychological Bulletin, 63, 384–399 Tuckman, B., & Jensen, M (1977) Stages of small group development Group and Organizational Studies, 2, 419–427 Wenzel, R., & Edmond, M (2001) The impact of hospital acquired bloodstream infections Emerging Infectious Disease, 7(2) Williamson, J., et al (1993) Human failure: Analysis of 2000 incident reports Anesthesia Intensive Care, 21(5): 678–683 13Jones Leadership(F)-ch 13 1/14/07 3:44 PM Page 201 chapter 13 Power, Politics, and Policy CAROLINE CAMUÑAS, EDD, RN CHAPTER MOTIVATION “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has.” Margaret Mead “The ultimate measure of a person is not where one stands in moments of comfort and convenience but where one stands in times of challenge and controversy.” Martin Luther King, Jr CHAPTER MOTIVES ■ ■ ■ ■ To define power, politics, and policy To investigate and discuss power, politics, and policy in relation to nursing and health care To examine outcomes of the workings of power, politics, and policy To develop an understanding of how effective use of power, politics, and policy can enhance nursing and health care 201 13Jones Leadership(F)-ch 13 202 1/14/07 3:44 PM Page 202 Skills for Being an Effective Leader P ower, politics, and policy should be familiar concepts for all nurses and are especially important for nursing leaders Power, politics, and policy influence nursing practice, education, and research, which in turn influence health care Power and politics are intricately entwined concepts and are sometimes difficult to differentiate Both are used to achieve ends or goals, and both so through manipulation of others Power and politics also interact People who are powerful are able to exert more political pressure; political success brings power that allows people to accomplish goals through policy development and implementation Power is the ability to or act; it is a state in which one can manipulate others Politics is negotiation for (scarce) resources; it is a process through which one tries successfully or unsuccessfully to reach a goal Policy is the “consciously chosen course of action (or inaction) directed toward some end” (Kalish & Kalish, 1982, p 61) Obtaining and allocating resources are two examples of possession and use of power They also exemplify the use of politics in that influence is needed to get what you want and need Policies are guidelines that tell us how we obtain and allocate those resources Understanding power, politics, and policy is crucial to effective patient care because these concepts have a significant impact on access to care, allocation of funds, and standards of care ers There are no definitive models of power, which often makes aspects of power complex and contradictory Power can shift; it is dynamic There are a variety of sources (types or bases) of power that have been identified, as derived from the work of French and Raven (1959), Hersey, Blanchard, and Natemeyer (1979), Ferguson (1993), and Joel and Kelly (2002) Understanding sources of power facilitates analysis of individual and organizational behavior and enables prediction in specific situations Power sources or types are presented below TYPES OR SOURCES Power can be either positional and personal Positional power is awarded or granted to a person, but it is derived from a person’s position, office, or rank in a formal organization system Personal power, on the other hand, is derived from followers Leaders who act in ways that are important to followers are given power An example is the nurse managers who have power because they are seen as highly competent, are good role models, or have some personal attribute that makes them effective in their roles Expertise (which is discussed below) is a way to gain personal power Common types of power include (a) authority, (b) expertise, (c) reward, (d) coercive, and (e) referent Authority and Administrative Power There are multiple definitions of power Some assert that power is an overall concept that includes authority and influence Others see authority and influence as separate ideas or concepts; as such, they require individual consideration Power is the ability to influence other people despite their resistance and may be actual or potential, intended or unintended It may be used for good or evil, for serious purposes or for frivolous and selfish ones Power is the ability to control, dominate, or manipulate the actions of others or, as Rollo May stated, “power is the ability to cause or prevent change” (1972, p 99) It is a term used freely by politicians, policy analysts, and many others Power is important to nursing because having it is necessary to achieve goals as individuals, professionals, and lead- Administrative (sometimes called legitimate) or positional power requires that one serve in a line position and have responsibility for management and actions of other employees This kind of authority is given to a position rather than to a particular person, for it is part of a role regardless of who fills that role For example, although the chief executive officer (CEO) in a health-care organization has the most power, the CEO is still answerable to the board of trustees or directors The chief nurse executive (CNE) has the most power relative to the nurses who are situated further down the chart of the organization, such as supervisory staff, nurse managers, and staff nurses It is power accorded to a person by virtue of the position held by that person Nurse managers and team leaders have more power than staff nurses CNEs, deans, senators, mayors, governors, presidents, and other elected officials have administrative power ... investigate and discuss power, politics, and policy in relation to nursing and health care To examine outcomes of the workings of power, politics, and policy To develop an understanding of how... all nurses and are especially important for nursing leaders Power, politics, and policy influence nursing practice, education, and research, which in turn influence health care Power and politics... work of French and Raven (1959), Hersey, Blanchard, and Natemeyer (1979), Ferguson (1993), and Joel and Kelly (2002) Understanding sources of power facilitates analysis of individual and organizational