Hillary Hockenberry has been a nurse for 4 years in a long-term care facility. Recently, the position of unit manager has become available and she is considering applying for it. Peers have encouraged her to con- sider doing so and have commented, "You are a born leader and manager and will do really well in the position." Hillary Hock- enberry is now asking herself the following questions:

Am I ready for a position like this?

What management skills will I need to be a good unit manager?

What are the rewards and challenges to a management position?

She seeks input from both the former unit manager, who is now the assistant director of nursing (ADON), whom she views as a mentor, as well as the preceptor whom she originally worked with as a new graduate.

305

1.The preceptor states, "You've got good management skillsthey are often inherent in what every nurse does in managing the care of patients." Discuss what the preceptor means by this statement.

2.

Qualities

Examples Inherent in Nursing Practice

Discuss the qualities and behaviors of followership that could be beneficial when moving into a leadership role.

3.The ADON states, "The biggest challenge of management is juggling the needs of patients with the needs of the organization." What does the ADON mean by this statement in light of the economic climate and the nursing labor market?

Hillary accepts the position, and 6 months into her role as unit manager she was asked to follow up on survey results indicating insufficient staffing to help feed patients at mealtimes, especially the breakfast meal. The majority of residents on the unit need assistance with feeding, from setting up trays to needing to be fed. On the 30-bed unit, the ratio of staff to residents is 1:10 inclusive of licensed and unlicensed personnel. Meals are encouraged to be taken in the dining room, but traditionally, the majority of residents in this unit eat in their rooms. A strategy must be implemented to ensure that feeding/nutritional needs are met for the unit's residents.

4.One staff member says, "You've got the power to change this so do it." Looking at the sources of power, how should Hillary respond to this statement?

5.How would each of the following behavioral theories be reflected in the leadership styles and implementation of strategies toward resolution of this problem?

a.Behavioral Theory

b.Task vs. Relationship

c.

Example of Discussion for

TheoryStylesIdentification of a Strategy

Behavioral

Dependent on the type of leadership style used by the unit manager:

Authoritarian: Autocratic/controlling/ directive (individual "top down" decision making; decision made and "orders" given) on how it is to be implemented, without group input; can be punitive or rewarding depending on situation; efficient method of decision making, and can lead to high-quality/-quantity output.

Emotional Intelligence

Example of Discussion for

TheoryStylesIdentification of a Strategy

Democratic: Participative; sharing of ideas, planning, and outcomes ofa new strategy; less efficient but facilitates creativity and motivation within the staff; outcome tends to be high quality

Laissez-faire: Permissive or nondirec- tive; high degree of frustration be- cause there is no goal, guidance,or direction and everyone does their own thing, but the outcomes are expected to be the same; no decision-making from the leader

Task vs. Relationship

Leadership style is eitherfocused on the tasks to be done or the "happiness" of the workforce, re- gardless of outcomes. Balance is needed between the two aspects to ensure that needs are being met for both the implementers (staff) and the outcomes (patient/institutional).

Emotional Intelligence

Constant surveillance for how work/expectations/new strategies affect individuals and teams and how they feel about their work in terms of support, caring, and en- thusiasm

6.In this situation describe how both the transformational leadership style and the trans- actional leadership style could be used to address this problem. Consider in your discussion whether there is a place for both types in any given situation.

It is decided that a new dining process will be implemented throughout the facility. All residents will be transported to the dining room for all meals unless contraindicated by health status. Residents/families are in support of this strategy, as it appears it will both ensure that residents are fed and encourage socialization of all residents, regardless of their cognitive level of functioning. All staff will be present in the dining room to assist with meal/feeding needs.

7.Identify possible factors within the three major sources that will cause resistance to change and implementation of this strategy.

Sources of Resistance to ChangePossible Factors

Technical concerns

Psychosocial needs

Threats to position/power

8.What kind of actions/behaviors might you see in both your licensed and unlicensed personnel that indicate resistance to the change?

Sources of Resistance

to ChangeExamples of Actions/Behaviors

Active

Passive

Technical concerns

Regardless of the source, active resistance is expressed directly

Passive resistance can involve avoiding required work through excuses, being too busy to integrate the new strategy, or simply ignoring the strategy altogether.

Psychosocial needs

Threats to position/power

9.

For each of the following comments that were made by staff members in resisting the change to the new dining process, write a response that reflects the four approachesto lowering resistance to change.

Actions/BehaviorsPossible Comment Based on Strategy

Commanding

Sharing Information

Refuting Beliefs

Providing Psychosocial Safety

"I am not going to do thisit creates too much work for everyone."

Actions/BehaviorsPossible Comment Based on Strategy

"It is not my job to do the nurse aide work here."

"Mrs. Smith doesn't want to go to the dining room in the morning and I don't want to upset her by making her

do this."

"I couldn't get the residents in the last four rooms to the dining room. I ran out of time so I

am just going to get their breakfast meal to them in their rooms."

"Sorry I didn't help with the feedings. I got tied up giving medications down the back hall."

Change is difficult for most organizations and their way of doing things. Look at the strategy to be implemented in the dining process. Implementing the change requires an understanding of the characteristics of the change.

10.Discuss each of the characteristics of this change in regard to the new dining process:

Magnitude of the change

Complexity of the change

Pace of the change

Stress level of those involved

CharacteristicDining Process

Magnitude

Complexity

Pace

Stress level

11.How will Hillary, as the unit manager, evaluate the integration of the change?

After several months, conflict has arisen between the UAP of the skilled care unit and those on the custodial care/assisted living unit regarding feeding responsibilities during the meals. The UAP are very territorial regarding "their" residents and do not feel that they should have to assist other residents in the dining room since "their people" are there to help them. Due to the higher acuity of the skilled unit residents, they require more assistance with feeding than those who are more independent from the custodial/ assisted living unit. The UAP from the assisted living unit feel that they should not have to "pick up the slack" with feeding needs of the residents from the other unit. As the unit manager, Hillary needs to resolve this conflict for optimal resident outcomes.

12.Using the steps of conflict resolution, how should the unit manager work through this problem?

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Evaluateis the problem resolved?

Evaluateis the problem resolved?

13.Discuss how time management may be an important component in the integrationof the dining process when one staff member says, "I can't help feed residents when all I can think about is that I have to administer medications and complete the treat- ments on my 30 residents." Consider the suggestions for time management. Discuss which ones may be helpful in this situation.

Leading and Management

Hillary Hockenberry has been a nurse for 4 years in a long-term care facility. Recently, the position of unit manager has become available and she is considering applying for it. Peers have encouraged her to con- sider doing so and have commented, "You are a born leader and manager and will do really well in the position." Hillary Hock- enberry is now asking herself the following questions:

Am I ready for a position like this?

What management skills will I need to be a good unit manager?

What are the rewards and challenges to a management position?

She seeks input from both the former unit manager, who is now the assistant director of nursing (ADON), whom she views as a mentor, as well as the preceptor whom she originally worked with as a new graduate.

305

1.The preceptor states, "You've got good management skillsthey are often inherent in what every nurse does in managing the care of patients." Discuss what the preceptor means by this statement.

2.

Qualities

Examples Inherent in Nursing Practice

Discuss the qualities and behaviors of followership that could be beneficial when moving into a leadership role.

3.The ADON states, "The biggest challenge of management is juggling the needs of patients with the needs of the organization." What does the ADON mean by this statement in light of the economic climate and the nursing labor market?

Hillary accepts the position, and 6 months into her role as unit manager she was asked to follow up on survey results indicating insufficient staffing to help feed patients at mealtimes, especially the breakfast meal. The majority of residents on the unit need assistance with feeding, from setting up trays to needing to be fed. On the 30-bed unit, the ratio of staff to residents is 1:10 inclusive of licensed and unlicensed personnel. Meals are encouraged to be taken in the dining room, but traditionally, the majority of residents in this unit eat in their rooms. A strategy must be implemented to ensure that feeding/nutritional needs are met for the unit's residents.

4.One staff member says, "You've got the power to change this so do it." Looking at the sources of power, how should Hillary respond to this statement?

5.How would each of the following behavioral theories be reflected in the leadership styles and implementation of strategies toward resolution of this problem?

a.Behavioral Theory

b.Task vs. Relationship

c.

Example of Discussion for

TheoryStylesIdentification of a Strategy

Behavioral

Dependent on the type of leadership style used by the unit manager:

Authoritarian: Autocratic/controlling/ directive (individual "top down" decision making; decision made and "orders" given) on how it is to be implemented, without group input; can be punitive or rewarding depending on situation; efficient method of decision making, and can lead to high-quality/-quantity output.

Emotional Intelligence

Example of Discussion for

TheoryStylesIdentification of a Strategy

Democratic: Participative; sharing of ideas, planning, and outcomes ofa new strategy; less efficient but facilitates creativity and motivation within the staff; outcome tends to be high quality

Laissez-faire: Permissive or nondirec- tive; high degree of frustration be- cause there is no goal, guidance,or direction and everyone does their own thing, but the outcomes are expected to be the same; no decision-making from the leader

Task vs. Relationship

Leadership style is eitherfocused on the tasks to be done or the "happiness" of the workforce, re- gardless of outcomes. Balance is needed between the two aspects to ensure that needs are being met for both the implementers (staff) and the outcomes (patient/institutional).

Emotional Intelligence

Constant surveillance for how work/expectations/new strategies affect individuals and teams and how they feel about their work in terms of support, caring, and en- thusiasm

6.In this situation describe how both the transformational leadership style and the trans- actional leadership style could be used to address this problem. Consider in your discussion whether there is a place for both types in any given situation.

It is decided that a new dining process will be implemented throughout the facility. All residents will be transported to the dining room for all meals unless contraindicated by health status. Residents/families are in support of this strategy, as it appears it will both ensure that residents are fed and encourage socialization of all residents, regardless of their cognitive level of functioning. All staff will be present in the dining room to assist with meal/feeding needs.

7.Identify possible factors within the three major sources that will cause resistance to change and implementation of this strategy.

Sources of Resistance to ChangePossible Factors

Technical concerns

Psychosocial needs

Threats to position/power

8.What kind of actions/behaviors might you see in both your licensed and unlicensed personnel that indicate resistance to the change?

Sources of Resistance

to ChangeExamples of Actions/Behaviors

Active

Passive

Technical concerns

Regardless of the source, active resistance is expressed directly

Passive resistance can involve avoiding required work through excuses, being too busy to integrate the new strategy, or simply ignoring the strategy altogether.

Psychosocial needs

Threats to position/power

9.

For each of the following comments that were made by staff members in resisting the change to the new dining process, write a response that reflects the four approachesto lowering resistance to change.

Actions/BehaviorsPossible Comment Based on Strategy

Commanding

Sharing Information

Refuting Beliefs

Providing Psychosocial Safety

"I am not going to do thisit creates too much work for everyone."

Actions/BehaviorsPossible Comment Based on Strategy

"It is not my job to do the nurse aide work here."

"Mrs. Smith doesn't want to go to the dining room in the morning and I don't want to upset her by making her

do this."

"I couldn't get the residents in the last four rooms to the dining room. I ran out of time so I

am just going to get their breakfast meal to them in their rooms."

"Sorry I didn't help with the feedings. I got tied up giving medications down the back hall."

Change is difficult for most organizations and their way of doing things. Look at the strategy to be implemented in the dining process. Implementing the change requires an understanding of the characteristics of the change.

10.Discuss each of the characteristics of this change in regard to the new dining process:

Magnitude of the change

Complexity of the change

Pace of the change

Stress level of those involved

CharacteristicDining Process

Magnitude

Complexity

Pace

Stress level

11.How will Hillary, as the unit manager, evaluate the integration of the change?

After several months, conflict has arisen between the UAP of the skilled care unit and those on the custodial care/assisted living unit regarding feeding responsibilities during the meals. The UAP are very territorial regarding "their" residents and do not feel that they should have to assist other residents in the dining room since "their people" are there to help them. Due to the higher acuity of the skilled unit residents, they require more assistance with feeding than those who are more independent from the custodial/ assisted living unit. The UAP from the assisted living unit feel that they should not have to "pick up the slack" with feeding needs of the residents from the other unit. As the unit manager, Hillary needs to resolve this conflict for optimal resident outcomes.

12.Using the steps of conflict resolution, how should the unit manager work through this problem?

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Evaluateis the problem resolved?

Evaluateis the problem resolved?

13.Discuss how time management may be an important component in the integrationof the dining process when one staff member says, "I can't help feed residents when all I can think about is that I have to administer medications and complete the treat- ments on my 30 residents." Consider the suggestions for time management. Discuss which ones may be helpful in this situation.

Leading and Management

Hillary Hockenberry has been a nurse for 4 years in a long-term care facility. Recently, the position of unit manager has become available and she is considering applying for it. Peers have encouraged her to con- sider doing so and have commented, "You are a born leader and manager and will do really well in the position." Hillary Hock- enberry is now asking herself the following questions:

Am I ready for a position like this?

What management skills will I need to be a good unit manager?

What are the rewards and challenges to a management position?

She seeks input from both the former unit manager, who is now the assistant director of nursing (ADON), whom she views as a mentor, as well as the preceptor whom she originally worked with as a new graduate.

305

1.The preceptor states, "You've got good management skillsthey are often inherent in what every nurse does in managing the care of patients." Discuss what the preceptor means by this statement.

2.

Qualities

Examples Inherent in Nursing Practice

Discuss the qualities and behaviors of followership that could be beneficial when moving into a leadership role.

3.The ADON states, "The biggest challenge of management is juggling the needs of patients with the needs of the organization." What does the ADON mean by this statement in light of the economic climate and the nursing labor market?

Hillary accepts the position, and 6 months into her role as unit manager she was asked to follow up on survey results indicating insufficient staffing to help feed patients at mealtimes, especially the breakfast meal. The majority of residents on the unit need assistance with feeding, from setting up trays to needing to be fed. On the 30-bed unit, the ratio of staff to residents is 1:10 inclusive of licensed and unlicensed personnel. Meals are encouraged to be taken in the dining room, but traditionally, the majority of residents in this unit eat in their rooms. A strategy must be implemented to ensure that feeding/nutritional needs are met for the unit's residents.

4.One staff member says, "You've got the power to change this so do it." Looking at the sources of power, how should Hillary respond to this statement?

5.How would each of the following behavioral theories be reflected in the leadership styles and implementation of strategies toward resolution of this problem?

a.Behavioral Theory

b.Task vs. Relationship

c.

Example of Discussion for

TheoryStylesIdentification of a Strategy

Behavioral

Dependent on the type of leadership style used by the unit manager:

Authoritarian: Autocratic/controlling/ directive (individual "top down" decision making; decision made and "orders" given) on how it is to be implemented, without group input; can be punitive or rewarding depending on situation; efficient method of decision making, and can lead to high-quality/-quantity output.

Emotional Intelligence

Example of Discussion for

TheoryStylesIdentification of a Strategy

Democratic: Participative; sharing of ideas, planning, and outcomes ofa new strategy; less efficient but facilitates creativity and motivation within the staff; outcome tends to be high quality

Laissez-faire: Permissive or nondirec- tive; high degree of frustration be- cause there is no goal, guidance,or direction and everyone does their own thing, but the outcomes are expected to be the same; no decision-making from the leader

Task vs. Relationship

Leadership style is eitherfocused on the tasks to be done or the "happiness" of the workforce, re- gardless of outcomes. Balance is needed between the two aspects to ensure that needs are being met for both the implementers (staff) and the outcomes (patient/institutional).

Emotional Intelligence

Constant surveillance for how work/expectations/new strategies affect individuals and teams and how they feel about their work in terms of support, caring, and en- thusiasm

6.In this situation describe how both the transformational leadership style and the trans- actional leadership style could be used to address this problem. Consider in your discussion whether there is a place for both types in any given situation.

It is decided that a new dining process will be implemented throughout the facility. All residents will be transported to the dining room for all meals unless contraindicated by health status. Residents/families are in support of this strategy, as it appears it will both ensure that residents are fed and encourage socialization of all residents, regardless of their cognitive level of functioning. All staff will be present in the dining room to assist with meal/feeding needs.

7.Identify possible factors within the three major sources that will cause resistance to change and implementation of this strategy.

Sources of Resistance to ChangePossible Factors

Technical concerns

Psychosocial needs

Threats to position/power

8.What kind of actions/behaviors might you see in both your licensed and unlicensed personnel that indicate resistance to the change?

Sources of Resistance

to ChangeExamples of Actions/Behaviors

Active

Passive

Technical concerns

Regardless of the source, active resistance is expressed directly

Passive resistance can involve avoiding required work through excuses, being too busy to integrate the new strategy, or simply ignoring the strategy altogether.

Psychosocial needs

Threats to position/power

9.

For each of the following comments that were made by staff members in resisting the change to the new dining process, write a response that reflects the four approachesto lowering resistance to change.

Actions/BehaviorsPossible Comment Based on Strategy

Commanding

Sharing Information

Refuting Beliefs

Providing Psychosocial Safety

"I am not going to do thisit creates too much work for everyone."

Actions/BehaviorsPossible Comment Based on Strategy

"It is not my job to do the nurse aide work here."

"Mrs. Smith doesn't want to go to the dining room in the morning and I don't want to upset her by making her

do this."

"I couldn't get the residents in the last four rooms to the dining room. I ran out of time so I

am just going to get their breakfast meal to them in their rooms."

"Sorry I didn't help with the feedings. I got tied up giving medications down the back hall."

Change is difficult for most organizations and their way of doing things. Look at the strategy to be implemented in the dining process. Implementing the change requires an understanding of the characteristics of the change.

10.Discuss each of the characteristics of this change in regard to the new dining process:

Magnitude of the change

Complexity of the change

Pace of the change

Stress level of those involved

CharacteristicDining Process

Magnitude

Complexity

Pace

Stress level

11.How will Hillary, as the unit manager, evaluate the integration of the change?

After several months, conflict has arisen between the UAP of the skilled care unit and those on the custodial care/assisted living unit regarding feeding responsibilities during the meals. The UAP are very territorial regarding "their" residents and do not feel that they should have to assist other residents in the dining room since "their people" are there to help them. Due to the higher acuity of the skilled unit residents, they require more assistance with feeding than those who are more independent from the custodial/ assisted living unit. The UAP from the assisted living unit feel that they should not have to "pick up the slack" with feeding needs of the residents from the other unit. As the unit manager, Hillary needs to resolve this conflict for optimal resident outcomes.

12.Using the steps of conflict resolution, how should the unit manager work through this problem?

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Evaluateis the problem resolved?

Evaluateis the problem resolved?

13.Discuss how time management may be an important component in the integrationof the dining process when one staff member says, "I can't help feed residents when all I can think about is that I have to administer medications and complete the treat- ments on my 30 residents." Consider the suggestions for time management. Discuss which ones may be helpful in this situation.

Leading and Management

Hillary Hockenberry has been a nurse for 4 years in a long-term care facility. Recently, the position of unit manager has become available and she is considering applying for it. Peers have encouraged her to con- sider doing so and have commented, "You are a born leader and manager and will do really well in the position." Hillary Hock- enberry is now asking herself the following questions:

Am I ready for a position like this?

What management skills will I need to be a good unit manager?

What are the rewards and challenges to a management position?

She seeks input from both the former unit manager, who is now the assistant director of nursing (ADON), whom she views as a mentor, as well as the preceptor whom she originally worked with as a new graduate.

305

1.The preceptor states, "You've got good management skillsthey are often inherent in what every nurse does in managing the care of patients." Discuss what the preceptor means by this statement.

2.

Qualities

Examples Inherent in Nursing Practice

Discuss the qualities and behaviors of followership that could be beneficial when moving into a leadership role.

3.The ADON states, "The biggest challenge of management is juggling the needs of patients with the needs of the organization." What does the ADON mean by this statement in light of the economic climate and the nursing labor market?

Hillary accepts the position, and 6 months into her role as unit manager she was asked to follow up on survey results indicating insufficient staffing to help feed patients at mealtimes, especially the breakfast meal. The majority of residents on the unit need assistance with feeding, from setting up trays to needing to be fed. On the 30-bed unit, the ratio of staff to residents is 1:10 inclusive of licensed and unlicensed personnel. Meals are encouraged to be taken in the dining room, but traditionally, the majority of residents in this unit eat in their rooms. A strategy must be implemented to ensure that feeding/nutritional needs are met for the unit's residents.

4.One staff member says, "You've got the power to change this so do it." Looking at the sources of power, how should Hillary respond to this statement?

5.How would each of the following behavioral theories be reflected in the leadership styles and implementation of strategies toward resolution of this problem?

a.Behavioral Theory

b.Task vs. Relationship

c.

Example of Discussion for

TheoryStylesIdentification of a Strategy

Behavioral

Dependent on the type of leadership style used by the unit manager:

Authoritarian: Autocratic/controlling/ directive (individual "top down" decision making; decision made and "orders" given) on how it is to be implemented, without group input; can be punitive or rewarding depending on situation; efficient method of decision making, and can lead to high-quality/-quantity output.

Emotional Intelligence

Example of Discussion for

TheoryStylesIdentification of a Strategy

Democratic: Participative; sharing of ideas, planning, and outcomes ofa new strategy; less efficient but facilitates creativity and motivation within the staff; outcome tends to be high quality

Laissez-faire: Permissive or nondirec- tive; high degree of frustration be- cause there is no goal, guidance,or direction and everyone does their own thing, but the outcomes are expected to be the same; no decision-making from the leader

Task vs. Relationship

Leadership style is eitherfocused on the tasks to be done or the "happiness" of the workforce, re- gardless of outcomes. Balance is needed between the two aspects to ensure that needs are being met for both the implementers (staff) and the outcomes (patient/institutional).

Emotional Intelligence

Constant surveillance for how work/expectations/new strategies affect individuals and teams and how they feel about their work in terms of support, caring, and en- thusiasm

6.In this situation describe how both the transformational leadership style and the trans- actional leadership style could be used to address this problem. Consider in your discussion whether there is a place for both types in any given situation.

It is decided that a new dining process will be implemented throughout the facility. All residents will be transported to the dining room for all meals unless contraindicated by health status. Residents/families are in support of this strategy, as it appears it will both ensure that residents are fed and encourage socialization of all residents, regardless of their cognitive level of functioning. All staff will be present in the dining room to assist with meal/feeding needs.

7.Identify possible factors within the three major sources that will cause resistance to change and implementation of this strategy.

Sources of Resistance to ChangePossible Factors

Technical concerns

Psychosocial needs

Threats to position/power

8.What kind of actions/behaviors might you see in both your licensed and unlicensed personnel that indicate resistance to the change?

Sources of Resistance

to ChangeExamples of Actions/Behaviors

Active

Passive

Technical concerns

Regardless of the source, active resistance is expressed directly

Passive resistance can involve avoiding required work through excuses, being too busy to integrate the new strategy, or simply ignoring the strategy altogether.

Psychosocial needs

Threats to position/power

9.

For each of the following comments that were made by staff members in resisting the change to the new dining process, write a response that reflects the four approachesto lowering resistance to change.

Actions/BehaviorsPossible Comment Based on Strategy

Commanding

Sharing Information

Refuting Beliefs

Providing Psychosocial Safety

"I am not going to do thisit creates too much work for everyone."

Actions/BehaviorsPossible Comment Based on Strategy

"It is not my job to do the nurse aide work here."

"Mrs. Smith doesn't want to go to the dining room in the morning and I don't want to upset her by making her

do this."

"I couldn't get the residents in the last four rooms to the dining room. I ran out of time so I

am just going to get their breakfast meal to them in their rooms."

"Sorry I didn't help with the feedings. I got tied up giving medications down the back hall."

Change is difficult for most organizations and their way of doing things. Look at the strategy to be implemented in the dining process. Implementing the change requires an understanding of the characteristics of the change.

10.Discuss each of the characteristics of this change in regard to the new dining process:

Magnitude of the change

Complexity of the change

Pace of the change

Stress level of those involved

CharacteristicDining Process

Magnitude

Complexity

Pace

Stress level

11.How will Hillary, as the unit manager, evaluate the integration of the change?

After several months, conflict has arisen between the UAP of the skilled care unit and those on the custodial care/assisted living unit regarding feeding responsibilities during the meals. The UAP are very territorial regarding "their" residents and do not feel that they should have to assist other residents in the dining room since "their people" are there to help them. Due to the higher acuity of the skilled unit residents, they require more assistance with feeding than those who are more independent from the custodial/ assisted living unit. The UAP from the assisted living unit feel that they should not have to "pick up the slack" with feeding needs of the residents from the other unit. As the unit manager, Hillary needs to resolve this conflict for optimal resident outcomes.

12.Using the steps of conflict resolution, how should the unit manager work through this problem?

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Evaluateis the problem resolved?

Evaluateis the problem resolved?

13.Discuss how time management may be an important component in the integrationof the dining process when one staff member says, "I can't help feed residents when all I can think about is that I have to administer medications and complete the treat- ments on my 30 residents." Consider the suggestions for time management. Discuss which ones may be helpful in this situation.

Leading and Management

Hillary Hockenberry has been a nurse for 4 years in a long-term care facility. Recently, the position of unit manager has become available and she is considering applying for it. Peers have encouraged her to con- sider doing so and have commented, "You are a born leader and manager and will do really well in the position." Hillary Hock- enberry is now asking herself the following questions:

Am I ready for a position like this?

What management skills will I need to be a good unit manager?

What are the rewards and challenges to a management position?

She seeks input from both the former unit manager, who is now the assistant director of nursing (ADON), whom she views as a mentor, as well as the preceptor whom she originally worked with as a new graduate.

305

1.The preceptor states, "You've got good management skillsthey are often inherent in what every nurse does in managing the care of patients." Discuss what the preceptor means by this statement.

2.

Qualities

Examples Inherent in Nursing Practice

Discuss the qualities and behaviors of followership that could be beneficial when moving into a leadership role.

3.The ADON states, "The biggest challenge of management is juggling the needs of patients with the needs of the organization." What does the ADON mean by this statement in light of the economic climate and the nursing labor market?

Hillary accepts the position, and 6 months into her role as unit manager she was asked to follow up on survey results indicating insufficient staffing to help feed patients at mealtimes, especially the breakfast meal. The majority of residents on the unit need assistance with feeding, from setting up trays to needing to be fed. On the 30-bed unit, the ratio of staff to residents is 1:10 inclusive of licensed and unlicensed personnel. Meals are encouraged to be taken in the dining room, but traditionally, the majority of residents in this unit eat in their rooms. A strategy must be implemented to ensure that feeding/nutritional needs are met for the unit's residents.

4.One staff member says, "You've got the power to change this so do it." Looking at the sources of power, how should Hillary respond to this statement?

5.How would each of the following behavioral theories be reflected in the leadership styles and implementation of strategies toward resolution of this problem?

a.Behavioral Theory

b.Task vs. Relationship

c.

Example of Discussion for

TheoryStylesIdentification of a Strategy

Behavioral

Dependent on the type of leadership style used by the unit manager:

Authoritarian: Autocratic/controlling/ directive (individual "top down" decision making; decision made and "orders" given) on how it is to be implemented, without group input; can be punitive or rewarding depending on situation; efficient method of decision making, and can lead to high-quality/-quantity output.

Emotional Intelligence

Example of Discussion for

TheoryStylesIdentification of a Strategy

Democratic: Participative; sharing of ideas, planning, and outcomes ofa new strategy; less efficient but facilitates creativity and motivation within the staff; outcome tends to be high quality

Laissez-faire: Permissive or nondirec- tive; high degree of frustration be- cause there is no goal, guidance,or direction and everyone does their own thing, but the outcomes are expected to be the same; no decision-making from the leader

Task vs. Relationship

Leadership style is eitherfocused on the tasks to be done or the "happiness" of the workforce, re- gardless of outcomes. Balance is needed between the two aspects to ensure that needs are being met for both the implementers (staff) and the outcomes (patient/institutional).

Emotional Intelligence

Constant surveillance for how work/expectations/new strategies affect individuals and teams and how they feel about their work in terms of support, caring, and en- thusiasm

6.In this situation describe how both the transformational leadership style and the trans- actional leadership style could be used to address this problem. Consider in your discussion whether there is a place for both types in any given situation.

It is decided that a new dining process will be implemented throughout the facility. All residents will be transported to the dining room for all meals unless contraindicated by health status. Residents/families are in support of this strategy, as it appears it will both ensure that residents are fed and encourage socialization of all residents, regardless of their cognitive level of functioning. All staff will be present in the dining room to assist with meal/feeding needs.

7.Identify possible factors within the three major sources that will cause resistance to change and implementation of this strategy.

Sources of Resistance to ChangePossible Factors

Technical concerns

Psychosocial needs

Threats to position/power

8.What kind of actions/behaviors might you see in both your licensed and unlicensed personnel that indicate resistance to the change?

Sources of Resistance

to ChangeExamples of Actions/Behaviors

Active

Passive

Technical concerns

Regardless of the source, active resistance is expressed directly

Passive resistance can involve avoiding required work through excuses, being too busy to integrate the new strategy, or simply ignoring the strategy altogether.

Psychosocial needs

Threats to position/power

9.

For each of the following comments that were made by staff members in resisting the change to the new dining process, write a response that reflects the four approachesto lowering resistance to change.

Actions/BehaviorsPossible Comment Based on Strategy

Commanding

Sharing Information

Refuting Beliefs

Providing Psychosocial Safety

"I am not going to do thisit creates too much work for everyone."

Actions/BehaviorsPossible Comment Based on Strategy

"It is not my job to do the nurse aide work here."

"Mrs. Smith doesn't want to go to the dining room in the morning and I don't want to upset her by making her

do this."

"I couldn't get the residents in the last four rooms to the dining room. I ran out of time so I

am just going to get their breakfast meal to them in their rooms."

"Sorry I didn't help with the feedings. I got tied up giving medications down the back hall."

Change is difficult for most organizations and their way of doing things. Look at the strategy to be implemented in the dining process. Implementing the change requires an understanding of the characteristics of the change.

10.Discuss each of the characteristics of this change in regard to the new dining process:

Magnitude of the change

Complexity of the change

Pace of the change

Stress level of those involved

CharacteristicDining Process

Magnitude

Complexity

Pace

Stress level

11.How will Hillary, as the unit manager, evaluate the integration of the change?

After several months, conflict has arisen between the UAP of the skilled care unit and those on the custodial care/assisted living unit regarding feeding responsibilities during the meals. The UAP are very territorial regarding "their" residents and do not feel that they should have to assist other residents in the dining room since "their people" are there to help them. Due to the higher acuity of the skilled unit residents, they require more assistance with feeding than those who are more independent from the custodial/ assisted living unit. The UAP from the assisted living unit feel that they should not have to "pick up the slack" with feeding needs of the residents from the other unit. As the unit manager, Hillary needs to resolve this conflict for optimal resident outcomes.

12.Using the steps of conflict resolution, how should the unit manager work through this problem?

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Identify the problem

Generate possible solutions

Evaluate suggested solutions

Choose the best solution

Implement the solution

Evaluateis the problem resolved?

Evaluateis the problem resolved?

13.Discuss how time management may be an important component in the integrationof the dining process when one staff member says, "I can't help feed residents when all I can think about is that I have to administer medications and complete the treat- ments on my 30 residents." Consider the suggestions for time management. Discuss which ones may be helpful in this situation.