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Module 1: The Nurse as Team Leader

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Introduction to the Nurse as Team Leader

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Introduction to the role of Practical Nurse as Team Leader

In 1953, Eleanor Lambertson and her colleagues proposed a system of team nursing to overcome the fragmentation of care resulting from the task-oriented functional approach. Team nursing responds to the needs of both the patient and the staff. Team members are stimulated by the team leader to learn and develop new skills. The team leader instructs the team members, supervises them, and provides assignments that offer them potential for growth.

Learning Outcomes:

• Cite from a list of facts, those facts, which define, team nursing.

• Identify factors related to Leadership.

The following facts define team nursing:
(1) It is direct patient care accomplished by a specific group of nurses and allied health care workers.
(2) It is accomplished by using the nursing process.
(3) It allows for comprehensive, holistic nursing care when the team functions at a high level of efficiency.
(4) It is composed of a team leader who coordinates patient care and supervises team members, and team members who are responsible for total care given to an assigned group or number of patients.
(5) It requires cooperation and effective communication with all staff members.

b. Basic to team nursing are the team conference, nursing care plan, and leadership skills.
(1) The conference is led by the team leader, and all personnel assigned to the team should be included. The team leader should discuss the needs of the patients, establish goals, individualize the plan of care for each patient, instruct the team members, and follow up on all directions previously given to the team.
(2) The nursing care plan is a written guide that organizes information about a patient's health. It focuses on the actions that must be taken to address the patient's identified nursing diagnoses and meet the stated goals. It provides for continuity of care by a constantly changing nursing staff. The team leader starts the care plan as soon as the patient is admitted to the medical treatment facility. In response to changes in the patient's condition, and evaluation of goal achievement, the nursing care plan is updated and revised throughout the patient's hospital stay.
(3) Three leadership styles have been described: autocratic, democratic, and laissez-faire. The three are sometimes blended to fit the situation, the needs of the team leader, and/or the needs of the nursing team.
(a) Autocratic leadership. The leader determines policies and gives orders and directions to the members. Autocratic leadership often makes team members dissatisfied. It may be a necessary style when urgent decision-making is required.
(b) Democratic leadership. The leader encourages team discussion and decision-making. This supportive style increases team productivity and satisfaction. Democratic leadership has positive connotations but requires time for discussion. It may not always be the most effective method when team members lack the skills to make decisions or when urgent decision-making is required.
(c) Laissez-faire leadership. The leader participates minimally and acts as a resource person and consultant at the request of the team members. Laissez-faire leadership is described as a "hands-off" approach. It is most effective after the team has made a decision, is committed to that decision, and has the expertise to implement it.
LEADERSHIP QUALITIES
a. Although many great nursing leaders emerged in the past, most nurses were kept in subordinate positions. This subordination has diminished as more nurses learn to apply their leadership skills to attain the ultimate goal of improved patient care. Nurses with leadership skills can effect desired changes in the patient's health patterns, in the medical treatment facility, in the nursing profession, and in the community.
b. Many adjectives are used to describe the traits or qualities of a leader. With education, training, and practice, every nurse can develop the following leadership qualities.
(1) Professional knowledge. Nursing involves knowledge in biology, nursing science, social science, and many other areas. It is impossible to master them all. Learn how to find and use appropriate reference materials and resource persons quickly and efficiently. Keep up with current nursing practices for validity, reliability, and applicability and share your knowledge with peers and subordinates. Political awareness is also required. Know how local, state, and national level legislation will affect health care before supporting candidates or voting. Good leaders must be advocates of patient's rights in order to improve patient care.
(2) A positive self-image. Leaders must be enthusiastic, dynamic, and self-directed. They must be comfortable with themselves and act as role models to followers.
(3) Effective communication. Leaders must communicate effectively in order to relate to others. The ability to communicate effectively is especially needed when relating to patients, peers, subordinates, and superiors. Effective communication skills are used to:
(a) Share information with team members and involve them in the decision-making process.
(b) Define specific expectations.
(c) Offer suggestions and assistance in the completion of tasks.
(d) Elicit feedback from team members and provide feedback to superiors.
(e) Give constructive criticism and offer positive reinforcement to subordinates.
(f) Practice active listening.
(4) Assertiveness. Leaders need to be assertive in team interaction and other leadership situations. Assertiveness is used extensively when effecting change. Many nurses participate in assertiveness training programs so they can strengthen the position of nursing in the health-care system and increase its influence on patient care.
(5) Flexibility. Changes in the needs of patients, families, and the nursing team can occur within minutes. The nursing role and all nursing functions require flexibility.
(6) An understanding of human needs. The highest level on Maslow's hierarchy of needs is self-actualization, which is the need for an individual to reach his or her potential through full development of their unique capabilities. Effective leaders seek ways to promote self-actualization in themselves and team members. An effective leader understands the human need to feel useful and important, and the desire to belong, and to be recognized as an individual.