Leadership Behavior and Decision-Making - Case Study Example

Head: LEADERSHIP BEHAVIOR Leadership Behavior and Decision-Making Leadership Behavior and Decision-MakingMrs. B is a Registered Nurse (RN) working at a long-term care facility. She directly supervises the LPNs (Licensed Practical Nurses), the CNAs (Certified Nurses Aids) and is responsible for most floor scheduling and other related activities. All medical care and treatment are managed under the authority of the Medical Director and the Nurse Practitioner. The latter is also responsible for the staff of RNs, their scheduling and supervision. Mrs. B has worked at this facility for thirteen years. Staff infers that she has a reputation of being an excellent nurse, but difficult to work under. Most staff see her as hard nosed when it comes to taking time off and meeting standards of behavior around the floor, but her determination has led to many of her LPNs going on to become RNs themselves, or serving in other administrative roles. For the most part it was observed that Mrs. B. was fairly task oriented in her leadership style. When giving instructions in morning meetings she did not ask for input or comments, only if there were any questions about the assignment. She said this in a way that did not truly encourage people to respond. She also spoke in a lecturing style and used the words like "I need" or "I want," etc. There were little or no references to the group as a whole. Later she would often follow up to see if her instruction were carried out and then micromanaged the result if it was not up to her expectations. When reprimanding a CNA she also used the wording, "I need you to do it this way," "I need you to be on time," and so on. In this respect Mrs. B. exhibits what the Ohio State Model of Leader Behavior identifies as LB1which is a high task, low relations method of leadership, also know as "telling." Even with this more autocratic style, she did seem to have the respect and trust of her staff. They were never heard talking about her disparagingly and usually followed her orders well and without question, as stated. There was an instance when a visiting doctor was on the floor and he was treating one of the nurses like his secretary, asking for a pen a paper and then for her to go to his patients room and do something. Mrs. B. stepped in and requested that the doctor make out the proper notations for a work order and that he should not treat her nurses as if they work for him. He was not pleased, but acquiesced. These kind of actions go a long way to earning the respect and trust of her staff. Mrs. B. does not seem to be overtly aware or concerned of her effect on her staff. She certainly shows some empathy for the patients, but also exhibits what one would call tough love when working with some. She is aware that often when left to their own devices, the patients will often sit around and not try to perform their daily exercises, etc. She will motivate them by constantly reminding them to do so and either she or someone on her staff will assist them. She seems to show that same tough love when trying to educate her staff on the proper procedures and requirements of the job. She is not too concerned with input on trying to change anything that is in place, but rather imposes the preordained methods that have been in use since probably before her arrival, many for good reasons. For instance, using the correct drill to fill the medication trays so that they can be checked and rechecked before being distributed is crucial. Some LPNs insist that there are better and more efficient ways of doing so, but Mrs. B. is set on the present system. Mrs. B. had an interesting attitude regarding obstacles, she did not believe in them for the most part. She said that an obstacle is only something that is meant to be overcome so you can achieve your goal. In her personal life she did not view her family life as an obstacle to her profession; rather she just found ways to work it all out. If she thought of them as an obstacle she would probably start to resent them and that would not be good. She says that you have to have your priorities right, do one thing than the next thing and everything will eventually fall into place. She also noted that she does not like to hear her staff complaining about their lives and how hard they have it. She believes it is not good for morale and cuts it off whenever she hears it. I asked her if it was not good to let off some steam once in a while and she said they can save it for home, this is work. Regarding maturity levels, while some CNAs are young and have a tendency to often perhaps have more fun than allowable, Mrs. B. will always reprimand them when they start laughing too much or carrying on or acting otherwise unprofessionally. She does try and instill in them a sense that their behavior may be counterproductive for them to continue on to better jobs and more responsibility. She certainly lays the law down equally from LPNs to CNAs. While communication appears at first to only travel from top down, the duty logs and copious notes and meetings keep everyone on the floor informed of any information regarding patient care and certainly appears to move laterally at all times. Mrs. B. insists on everyone keeping up to date with what is going on regarding the patients on the floor as well as the facility at large. This helps to keep everyone on the same page and provides a consistency of care among the patients. The only patient complaints observed is that the staff works too many hours and often seemed tired. Patients are concerned that tired staff is going to make mistakes. This is also a concern in the profession as a whole that mandatory overtime in the medical profession has become norm-based behavior Staff nurses across the nation are reporting a dramatic increase in the use of mandatory overtime as a staffing tool. This dangerous staffing practice is having a negative impact on patient care, fostering medical errors, and driving nurses away from the bedside. (Staff Nurses, 2007) Most staff will never say to overtime and this practice often eliminates the need for additional staff that may or may not be as qualified and that surely will need to be trained. The trade off is certainly a possibility in the decline of patient care and safety for both staff and patient.. Mrs. B. is certainly educationally qualified in the skills of her profession. Not only is she an RN but also has a BSN (Bachelors of Science in Nursing) as well as participating in all CE (Continuing Education) requirements and hundreds of hours of in-service trainings. She has also taught many in-service trainings herself for both the staff here and in local meetings of nursing professionals. Most staff perceive her as knowing just about everything and would be surprised, and perhaps a little glad, if they ever found her making an error. Staff also feels the need to be perfect as well and walk on eggshells regarding making mistakes. This may result in mistakes going undiscovered because staff will try and hide them. Such practice is certain to lead to more problems for the unit in the long run. In this respect, clinical skills and leadership skills are certainly not the same thing. While a staff leader needs to be clinically trained in order to do this job, he or she must also have greater skills in supervision and leadership in order to be effective. In this case Mrs. B’s acute clinical skills have been transferred into unrelenting perfectionism in her leadership style and this is often a problem when staff tries to make her understand the human side of the equation. In this sense the environment for learning and growth is not as supportive as it should be and staff may not feel the urge to try if they are going to be berated for failure. The decision making process is almost totally autocratic. Mrs. B. sets the standard and the rules and decisions are always passed through her before they are implemented. If they are not, even if they are good decisions, there are often words between staff and her. In a time of crisis this is often the case. A quick decision to call the staff doctor is sometimes made by one of the LPNs before telling Mrs. B. and most times Mrs. B. is always upset, the better to be safe than sorry rule does not seem to apply, when it should. Sometimes the criterion for the decision is called into question. Was the patient just complaining or was there a genuine problem detectable by the nurse? These are the variables but Mrs. B wants to have the final word on any assessment. References Staff Nurses. (2007). Retrieved January 15, 2008, from American Nurses Association Web site: http://nursingworld.org/EspeciallyForYou/stafftesting.aspx Read More