Question

Using the definitions of leadership, management, and followership, imagine you are faced with a critically ill client whose family members are spread throughout the country. Some family members are holding vigil at the bedside, whereas others are calling the unit incessantly, taking nurses away from client care responsibilities. You recognize the family concerns and want to move from a reactive stance to a proactive position. How would you engage in solving this problem in a leader role? A manager role? A follower role? In which role would you be most comfortable? Least comfortable? Which role would lead to the best outcomes for the situation?

Answer 1

Leading, managing, and following are integral to professional nursing practice. Engaging in constructive behaviors associated with these concepts influences patient care and organizational outcomes, regardless of position title. By examining self-motivation and confidence in relation to power, authority, influence, decision making, conflict, and change, the professional nurse is enabled to lead, manage, and follow with meaning and purpose.

Decision making and the corresponding actions taken are core work performed in engagement with others. This core work demands that nurses be leaders, managers, and followers at the point-of-care, unit, institutional, and even societal levels.

The way nurses lead, manage, and follow has changed over time. Formerly, nurses took direction from physicians or senior nurses, such as “head” or “charge” nurses. These roles still exist today, but the expectation has shifted from top-down order giving with an expectation of unquestioning following a model in which shared decision making with collaborative action is the norm.

Leadership is the process of engaged decision making linked with actions taken in the face of complex, unchartered, or perilous circumstances present in clinical situations for which no standardized solution exists. In exercising leadership, the leader assesses the context surrounding the situation, creates and adapts strategies based on scientific evidence and tacit knowledge, and guides others to broad-based outcomes that, at a minimum, alleviate risk and harm.leadership is enacted by a willingness to identify and act on complex problems in an ethical manner.

Management is an engaged process of guiding others through a set of derived practices and procedures that are evidence-based and known to satisfy pre-established outcomes based on repeated clinical situations. Management-based decisions and actions may be routine in frequency and low in complexity; however, they increasingly are highly complex and require sophisticated skills and abilities.Management differs from leadership where the outcomes are known and a sequence of actions is prescribed, either in writing or through historical practices that are embedded in the organization’s culture.

Followership is engaging with others who are leading or managing by contributing to problem identification, completing tasks, and providing feedback for evaluation. Followers provide a complementary set of healthy and assertive actions to support the leader (who is forging into unknown, complex problem solving) or the manager (who is directing and coordinating predetermined actions to achieve outcomes). The nurse as follower promotes clinical and organizational outcomes by practicing acquiescence to individuals leading or managing the team over certain tasks.

The collective behaviors that reflect leading, managing and following enhance each other. All interdisciplinary healthcare providers, including professional nurses, experience situations each day in which they must lead, manage, and follow.

Here in the present scenario, I am dealing with a critically ill client whose family members are spread throughout the country. Some family members are holding vigil at the bedside, whereas others are calling the unit incessantly, taking nurses away from client care responsibilities.

Already we have discussed the definition of different roles of the nurse as a leader, manager, and follower.

If acting as a leader we have to approach decision making and action setting by communicating direction, using principles to guide the process with the other members within the group in an ethical manner. Thus all can act as timely to manage the critically ill case in an effective manner by preventing any complications.

If acting as a manager we have to manage the case based on the predetermined criteria for the critically ill patient or based on the management protocols of the critically ill patient or may be evidence-based.

If acting as a follower we have to follow the instructions given by a nurse leader or manager and helps in contributing to problem identification at each and every stages, completing tasks, and providing feedback for evaluation.

In my view, I think the leadership role is comfortable why because we have chosen the mode as proactive instead of reactive. Thus by leading others we can detect any changes as early as possible and take the appropriate decisions in a timely manner.

I think the leat comfortable role is as a follower, why because if the leaders are not taking the case as that much importance or less aware this role is more difficult in managing this type of case.

The leadership role will give the best outcome for the present situation if lead properly and make the decision as in an ethical manner timely.