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Situational Leadership A TOOLFOR OR STAFF DEVELOPMENT Jeffrey Zurlinden, RN; Beth A. Bongard While making rounds in the ORs in which new OR nurses are assigned, you walk in on a radical neck procedure. You see the frozen look on the scrub nurse’s face and realize something is wrong. You quickly assess that the patient’s endotracheal tube is out of the trachea and immediate action is necessavy. The surgeon is yelling for the hook and dilator, but the scrub nurse is rooted to the floor, unable to reach for the needed instruments. Unfortunately, the

scrub nurse is Roger, the most recently hired nurse. s Roger’s supervisor, what would you do? Obviously you are concerned with the patient’s health and safety, but you also want to help Roger develop as an OR nurse and preserve his feelings of self-worth. We will refer to this case study and others to illustrate applications of Situational Leadership,@ as developed by Paul Hersey,

Jeffrey Zurlinden, RN, MS, is director of the Chicago Community Programs for Clinical Research on AIDS. He earned his bachelor of science degree in nursing from Wayne State University, Detroit, and his master of science degree in parent-child health nursing from Rush University, Chicago.

Medical Center. She received her bachelor of science degree in psychology and her master of arts degree in counseling psychology from Loyola University, Chicago.

Beth A. Bongard is a staff consultant and director of management and organizational development for the department of nursing at the University of California, Los Angeles,

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The authors wish to thank Sheri Subach McGinness, RN, BSN, for her assistance in stating the clinical scenarios. She was a staff nurse in the operating room at McGaw Medical Center, Loyola University of Chicago, Maywood, Ill, when this article was written. 967

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EdD, and Kenneth Blanchard, PhD.’ By applying the principles of Situational Leadership theory, the manager can help his or her employees during an immediate crisis and meet long-term staff development goals. Situational Leadership is the application of different leadership styles based on a situation and the manager’s assessment of the employee’s professional readiness. It is a management system that can be modified, helping the manager deal with people and situations effectively and flexibly.’ We have used this theory as the basis for our analyses, but the examples are drawn from our own management and teaching experiences.

Readiness Quadrants/ Leadership Styles

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eadiness refers to the employee’s ability and willingness or confidence to complete a specific task. I n Situational Leadership, readiness qualities are charted in four quadrants, Your behavior as a manager depends on which readiness quadrant you assess the employee to be in for the specific task. Leadership behavior is described as the task behavior (ie, giving specific directions and telling the employee exactly how, when, and where to do something) and the relationship behavior (ie, listening, providing emotional support, and ensuring that the employee feels important and valuable) that will be the most helpful to an employee in each quadrant of readiness. Instead of acting the same way in every instance, the manager is flexible and modifies his or her behavior to suit the employee’s ability and willingness. A manager’s leadership behavior stems from the readiness quadrant assessment. For each readiness quadrant, there is a corresponding leadership style that prescribes the manager’s behavior. For example, a “telling” style is the style most likely to succeed when managing an employee in readiness quadrant 1; a “selling” style is useful when managing an employee in readiness quadrant 2; a “participating” style works with employees in readiness

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quadrant 3; and a “delegating” style is the best way to manage employees in readiness quadrant 4 (Fig 1). Assessing readiness. To apply Situational Leadership to Roger’s predicament, you must quickly assess Roger’s readiness. You consider the two aspects of readiness (ie, ability and willingness) separately. To measure Roger’s ability, ask yourself Is he able to perform this task? Can he do it without prompting? Could he do it if his life depended on it? Has he ever done it under these conditions? In this case, if there is a “no” answer to one of these questions, you know that Roger is unable to complete this specific task. He is too inexperienced to anticipate the surgeon’s needs. Next, you assess Roger’s willingness. Is he willing, confident, and comfortable to complete the task? Does he have enough energy? In this instance, he is unwilling because he lacks confidence. In fact he is panicked. Therefore, Roger is in readiness quadrant 1 (ie, unable and unwilling or insecure).

Adapting in a Crisis ecause Roger is in readiness quadrant 1 during this emergency, a telling style (ie, high amount of task behavior, low amount of relationship behavior) is the appropriate behavior for you to implement. You give Roger immediate, specific, and frequent directions. In a quiet, firm voice you make statements similar to these: “Roger, the instruments are set up on the table behind you.” “Turn around and pick up the cryohook.” “Good, now give Dr Smith the dilator.” “Now, get ready to hand him the anode tube, just to your right.” “Good, now Peggy, your circulator, will finish telling you what will be needed next.” A telling style also includes low amounts of relationship behavior. In this instance, to demonstrate a low amount of relationship behavior, you use a matter-of-fact tone of voice

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Leadership Styles and Readiness Quadrants

Fig 1. Assessing the follower's readiness and determining the manager's consequent leadership behavior. (Adapted from "Situational Leadership: A management system to increase staff satisfaction, " (MarcWApril1990),J Zurlinden, B Bongard, M Magafas, with permission from Orthopaedic Nursing, Pitman, NJ) that does not punish Roger's panicked behavior or seek his opinion-he is too overwhelmed to give it. It is not appropriate to say, "How would you feel about handing the surgeon the cryohook?' At the same time, a low amount of relationship behavior does not mean being cruel or sarcastic. Nothing is gained by saying, "Roger you're acting like a fool. Now get a grip and hand some instruments to the surgeon before this patient suffocates." Although low amounts of relationship behavior are helpful during the crisis, high amounts of relationship behavior are appropriate later because Roger is a willing nurse and he will become more confident with time. After the emergency is over, you can talk to Roger pri-

vately, which gives you the opportunity to listen to how he feels about what happened in the OR and to ensure that he still feels like a valuable, respected member of the OR. Although many inexperienced managers may use a telling style whenever an employee performs a task poorly or reluctantly, a telling style rarely works outside of emergencies. Figure 2 gives a second scenario illustrating the appropriate use of the telling style.

Facilitating Problem Solving

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ost novice nurses are readiness quadrant 2 (ie, unable but willing). They demonstrate their willingness by try969

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for a microscopic discectomy procedure. As you walk by her, Pat steps up and tells Fig 2 you about the following Readiness Quadrant I problem. As she was checkTelling Leadership Style” ing the patient’s chart, she noticed that the consent form During an appendectomy, a newly hired nurse dropped a was for “Dr Abrams and specimen tube filled with blood. Although this is a relaAssociates.” Pat knew that tively common accident, the nurse panicked because the Dr Lyons, the senior resident, patient was known to be infected with the human immunwas scheduled to perform the odeficiency virus (HIV). procedure. She is uncomfortable proceeding because Dr Assessment of follower: Leader’s behavior: Lyons’s name is not on the Task.. .......................... high Able .......................... no consent form and she Willing or remembered hearing some Relationship ................low confident.. .................no concern at a recent in-service program about the legal Leader will: aspects of surgical consents. 1. Give specific directions, “Find the spill pack that conPat is confident in her tains bleach. It’s on the cart to your left.” relationship skills and wants 2. Clean up the spill while the nurse watches. Explain how to handle this problem, but you wear gloves, pour the bleach, and carefully dispose she does not know enough of the glass without cutting yourself. about this hospital and its 3. After the blood and glass are properly discarded, give procedures to continue. the nurse step-by-step instructions of what to do to conBecause Pat is willing to tinue to assist with the appendectomy. Stop giving solve this problem, but is instructions after she regains her composure and acts unknowledgeable, you assess without prompting. that she is in readiness quad4. After the surgery, give her time to privately express her rant 2, which calls for you to fears and concerns about the risk of HIV infection. use high amounts of both relationship and task behav*(Based on Situational Leadership Simulator: A ior. Simulation for Learning Behavioral Science Theory You use high amounts of (1987), P Hersey, K H Blanchard, L Peters, published by relationship behavior by sayLeadership Studies, Inc, San Diego) ing to Pat, “You did a great j o b catching this, it could be a real problem. I agree with you that ing hard, being energetic, and wanting to do in the legal in-service program the hospiwell. The problem is that they lack ability. tal lawyer said that Dr X and associates For example, you are the clinical specialist in is acceptable for a consent. On the other an operating room where Pat is in the fourth hand, our policy does require that all day of her neurosurgery orientation. Her rotanames be listed. You really have done a tions through general surgery, urology, and otoremarkable job for this stage of your orilaryngology went very smoothly. Pat proved to entation. be an energetic and quick learner in those speYou use high amounts of task behavior as cialties. you continue, Today she is assigned as the circulating nurse ’I

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Fig 3

Readiness Quadrant 2 Selling Leadership Style” During orientation, a new graduate sets up the laser carefully for a vocal cord polypectomy. She thinks everything is done correctly, but the surgeon strongly criticizes her because there is not enough carbon dioxide, and the procedure is delayed while she brings in a fresh tank. Assessment of follower: Able .................no Willing or confident.. ......yes

Leader’s behavior: Task ................high Relationship ...high

Leader will: 1. Give encouragement that lessens the negative effect of the surgeon’s criti-

cism. “I can tell that you’re upset by the surgeon’s harsh words, but everyone has problems with the laser setup the first time. Overall, you’re really doing very well in orientation. The surgeons may not know what to expect, but I do, and I’m pleased with you.” State clear standards for setting up the laser, and do everything you can to help her meet these standards. “You gathered the correct set of supplies, but you didn’t check the level of gas in the tank. Let me show you how to check the level and where we store extra tanks. Next time we can set up the laser together.” 3. While you clarify standards or instruct, talk in a friendly manner.

“(Based on Situational Leadership Simulator: A Simulation for Learning Behavioral Science Theory (1987),P Hersey, K H Blanchard, L Peters, published by Leadership Studies, Inc, San Diego)

“Bringing this to me was the right thing to do. I will get this clarified right away with risk management while you finish checking the patient’s chart and interview the patient. By the time you are done, I will have an answer for you. Then I will go with you to talk to Dr Lyons and the anesthesiologist about whether to proceed or wait for Dr Abrams to arrive.” By reassuring Pat of her accuracy in identifying this as a problem, you help her feel that she is contributing even though she cannot proceed without help. By providing her with specific task instructions, you allow her to continue to care for the patient within the limits of her skill level. Pat also learns when she will have an answer and what will happen after the answer is known. Pat receives reassurance and encour-

agement for her problem-solving skills and the necessary information to complete her tasks. If your focus had been only on the task (ie, giving instructions), Pat may have been left wondering if she were stupid, or had done something wrong. Figure 3 gives another example of the selling leadership style, where high task and high relationship behaviors are appropriate.

Facilitating Independence

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or many managers, the most challenging nurses to supervise are in readiness quadrant 3 (ie, able but unwilling or insecure). The next example describes Maureen, an experienced nurse who is new to the OR. She started one month ago, and after an uneventful general orientation, she has spent three weeks in 973

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tasks, the preceptor does not believe that Maureen is any more comfortable or independent, even though Maureen is clearly able to perform them. The preceptor does not know whether to extend Maureen’s orientation or to discipline her. You ask the preceptor what she has done to correct the problem. The preceptor says, “I show her the procedure over and over again; we look at the next day’s assignment together, and I prepare her thoroughly; I praise her for everything she does right.” You coach the preceptor to ask Maureen a series of questions: Fig 4 “How do you think you Readiness Quadrant 3 are doing?’ Participating Leadership Style” @ “ Y o u look like you know how to scrub for An experienced nurse quickly learned how to work with a these cases, but I’ve new epoxy used by some of the orthopedic surgeons. noticed that you’re very Although she is skilled with the epoxy, she does not like it scared to be alone. Can because she is afraid that the fumes are harmful. Now she you tell me more about refuses to be assigned in rooms where the epoxy is used. that?’ “In your last job, what Leader’s behavior: Assessment of follower: helped you to get Task ............................. low Able ......................... Yes accustomed to being Willing or alone? What was the Relationship ...............high confident...................no most helpful?’ These are examples of Leader will: statements that show a high 1. Ask the nurse to help develop safety guidelines for amount of relationship working with the epoxy. To develop the guidelines, behavior. suggest that she call the manufacturer, as well as other When the preceptor hospitals that use the epoxy. approached Maureen with 2 . Ask her to solve the problem by saying, “You seem to these questions, Maureen and be concerned about working with the new epoxy. Using the preceptor set a goal statthe epoxy is an important part of some of the orthopeing when Maureen would be dic procedures. What do you think would help in makable to scrub alone. At the ing you more confident to work with the epoxy?’ same time, the preceptor was 3. Emphasize her usual excellent contributions and high able to elicit what support skill level in the OR. Maureen expected her to provide. *(Based on Situational Leadership Simulator: A Simulation Six months later, you for Learning Behavioral Science Theory (1987),P Hersey, K know your coaching worked; H Blanchard, L Peters, published by Leadership Studies, the preceptor successfully Inc, San Diego) used the participating leadership style because Maureen

the gastrointestinal service, where she is steadily mastering the routines. Maureen’s preceptor comes to you, as the manager, for advice and expresses her frustration because Maureen is afraid to act as the scrub nurse without supervision. When the preceptor is present, Maureen does everything that is required but she always looks to her preceptor for approval. “After three weeks in one service,” the preceptor says, “most nurses are able to act alone.” After repeatedly reviewing the

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is now independent and confident in her scrub nurse role, which changes your assessment of her to readiness Fig 5 quadrant 4 (ie, able and willing). She Readiness Quadrant 4 does not need encouragement or praise Delegating Leadership Style” for a task that she is able and willing to perform. The preceptor has changed The nurses on the open heart team loudly disthe kind of relationship behavior she agreed about their on-call schedule. For the past uses with Maureen; she eats lunch year, they have devised their own schedule withwith Maureen about once a week, but out needing your help. instead of work-related matters, they usually talk about their families. Assessment of follower: Leader’s behavior: Occasionally, the preceptor asks Able. ........................ yes Task....................... low Maureen for advice about orienting Willing or recently recruited nurses. confident .................y es Relationship ..........low Why did the preceptor’s first approach fail but the second approach Leader will: work? In the first approach, the pre1. Intentionally avoid interfering. ceptor applied interventions suited for 2. Monitor their progress toward working togethnurses in readiness quadrant 2. She er to devise a schedule, but at this time do not was giving information about how and step in to either write a schedule or direct their when to perform the task combined process of working together to come up with a with sincere praise and encouragement schedule. when Maureen was really in readiness 3. Allow them to solve their disagreement in quadrant 3. their own way. In the second approach, the preceptor was able to elicit from Maureen the “(Basedon Situational Leadership Simulator: A type of support that would be effecSimulation for Learning Behavioral Science tive. Allowing the employee to take Theory (1987),P Hersey, K H Blanchard, L Peters, part in decisions about the future published by Leadership Studies, Inc, Sun Diego) course of action is one of the hallmarks of a participating style. Although the preceptor was flexible as soon as possible.” When you ask the surgeon and conscientious and the new nurse was bright for more information she tells you that there are and motivated, applying Situational Leadership unexplained silences when one of the nurses theory helped guide and move them to readienters the OR, and she suspects there are unreness quadrant 4.Another example of the particsolved conflicts. You recall that the nurses on ipating style and readiness quadrant 3 is disthe transplant team have worked together for cussed in Figure 4. years, and when they have had a problem getFacilitating Team Work ting along in the past, they have recognized the problem quickty and corrected it. ou are the manager of an OR with a To examine this predicament using group of nurses on the kidney transSituational Leadership, first define the task. In plant team who usually are able to get this instance, it is to resolve conflicts. You along together. The surgeon on the team comes decide that these nurses know how to do it, and to your office to complain that “the atmosphere you wisely decide not to interfere. You bring it in the OR is tense” and she wants you “to fix it to their attention, however, by saying,

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“I hear that things seem tense at times during your cases lately, is there anything I can do to help? If there is anything I can do, please tell me, otherwise, I trust that you can solve this.” You have defined the task, allowed the nurses to solve their own disagreements, and made yourself available for consultation. Of course, you monitor the situation and get back to the surgeon to assure her that the nurses are working on their problem. Figure 5 offers another example of this situation. Many managers overmanage this situation. They intervene when they are not needed. Overmanaging can be exhausting and can lead to hard feelings. Nurses in readiness quadrant 4 feel mistrusted or patronized when they are told how to do something and are not allowed to do as well as they are able to do. Other managers undermanage. They may withdraw their guidance too quickly when employees are still in readiness quadrant 2. Employees may feel angry because they feel abandoned or think the manager does not care about performance.

Staying on Track

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ccording to Dr Blanchard, Situational Leadership is a sequential model.’ He describes a typical problem of managers who try to apply Situational Leadership. Frequently, the manager does not stay on track as the employee grows from one stage to the next. Instead, managers move prematurely from a telling style to a delegating style. Managers mistakenly expect employees to use their new skills immediately without the benefit of receiving coaching and support from their manager. This sets up the employee to fail. Only rarely can an employee truly integrate new learning into his or her behavior without first being coached. A similar problem occurs when managers inappropriately skip back too many stages (eg, disciplining an employee who was previously able and willing to perform a task). This could apply to Betty’s situation. She is one of the 978

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most reliable and punctual nurses in the OR where you are the day charge nurse. Recently, she has developed a pattern of tardiness. Using a participating leadership style, you might say, “Betty, you are one of the best nurses in the OR. I have always counted on you. But recently you have been late several times a week. What’s changed? What would help you to start work on time? Is there anything I can do to help? ’’ With a participating style, the employee knows that you value her contribution to the unit, and that you respect her as a person. This style also tells the employee that you trust her to devise solutions that work. It would be inappropriate to discipline Betty in this situation. As a manager who uses Situational Leadership, your greatest challenge is to continually assess the readiness of each employee and modify your behavior accordingly. There is no such thing as an employee who is always in readiness quadrant 4. As new tasks arise, even experienced, motivated, and independent nurses will inevitably be in readiness quadrant 2 for a short period of time while they learn the new task. Similarly, nurses in readiness quadrant 4 may become unwilling and revert to readiness quadrant 3 because of stress, exhaustion, frustration, or burnout. At those times, you will need to act as a consultant and facilitate their process for solving problems. Standardized questionnaires allow you to measure your ability to recognize the kind of leadership behavior necessary and which leadership style to use. (See “Measuring Situational Leadership.”)

Research Studies

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ew studies have tested the effects and predictive value of Situational Leadership directly. A 1987 study questions whether statistical tests can measure the complex predictions of the Situational Leadership t h e ~ r y The . ~ researcher studied 300 teachers and their principals and found that the Situational Leadership theory was accurately

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Measuring Situational Leadership* To measure your behavior as a leader or your employee’s level of readiness, you and your employees can complete self-administered questionnaires that measure characteristics of Situational Leadership. The questionnaires are available from University Associates, Inc, San Diego, a firm that specializes in training managers and human resource development consultants. By completing these questionnaires, you can learn your most frequently used leadership style and your leadership style range. You also can learn how accurately your leadership style matches the readiness of your employees and how flexibly you adapt to different levels of readiness among employees. Leaders complete one set of questionnaires, and followers complete another set. Although the questionnaires describe work-related situations that are not specific to nursing, nurses can apply these situations to their own work experiences. Of the 25 different Leadership Effectiveness and Adaptability Description (LEAD) questionnaires and scoring tools that measure distinct aspects of Situational Leadership, we recommend the following. They are available from University Associates, Inc, 85 17 Production Ave, San Diego, CA 92121, (619) 578-5900. LEAD Instrument-Self. (Developed by P Hersey, K H Blanchard) For each of 12 work-relat-

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ed situations, the manager chooses one of four “alternative actions” that best addresses the situation. LEAD Instrument-Other. (Developed by P Hersey, K H Blanchard) The employee chooses the “alternative actions” that best describe the manager’s response to each of 12 work-related situations. This is an important questionnaire because the employee’s perception of the manager’s leadershlp style is more important than the manager’s perception of his or her own leadership style. LEAD Matrix Directions for Matrix Scoring and Analysis. (Developed by P Hersey) This is one of the best tools to score and interpret the LEAD-Self and LEADOther questionnaires. By using this tool you can learn how effective you are as a leader, how accurately and flexibly you adjust your behavior to suit your employee’s level of readiness, and how many leadership styles you use. LEAD Feedback on Leadership Styles and Instrument Rationale and Analysis. (Developed by P Hersey, K H Blanchard) This 28page booklet provides the rationale for the situations and the alternative actions used in the LEAD-Self and the LEAD-Other. It interprets the manager’s range of leadership styles, and it stresses the importance of assessing the employee’s level of readiness and then adapting your behavior to the employee.

*(Adaptedfrom “Situational Leaders..ip :A management system to increase stuflsatisfaction, (MarcWApril1990), J Zurlinden, B Bongard, M Magafas, with permission from Orthopaedic Nursing, Pitman, NJ) ”

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predictive for teachers who demonstrated a low level of readiness, but the study was inconclusive for teachers who were either moderate- or high-readiness employees. Nonetheless, there are a few studies that lend support for the effectiveness of this theory. In a 1989 study of nurses, researchers found a link between head nurses’ range of leadership styles and the staff nurses’ job satisfaction.’ Twenty head nurses were studied and 3 to 5 staff nurses who were supervised by each of the head nurses were randomly selected.6 T h e results show a significant statistical correlation. Staff nurses who were the most satisfied with their jobs were supervised by head nurses who had a wide range of leadership styles; the staff nurses who were least satisfied with their jobs worked with head nurses who had a limited range of leadership behaviors.

Improved Skills and Confidence

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n the OR, employees must develop technical competencies and working relationships based on trust and respect. Newly hired nurses need to learn new skills because they have not learned them in nursing school, they have transferred from a different specialty area in nursing, or they are unfamiliar with the procedures and surgeons in the new setting. The formal training period may last 3 to 6 months, but it may be more than a year before nurses are truly independent. As new surgical procedures are developed, even experienced nurses in the OR must learn new technical skills. Situational Leadership helps a manager help new OR nurses acquire technical skills and experienced nurses continually master new technologies. Managers also can use Situational Leadership to foster professional attitudes based on respect. Because the staff members in the OR work closely and are dependent on one another, their feelings a n d attitudes cannot b e ignored. Situational Leadership guides people to adapt their behavior, allowing them to build independence. avoid hard feelings, and gain more confidence and respect among staff members and management personnel. 980

Notes 1. P Hersey, K H Blanchard, Management of Organizational Behavior: Utilizing Human Resources, fifth ed (Englewood Cliffs, NJ: PrenticeHall, Inc, 1988); P Hersey, B W Duldt, Situational Leadership in Nursing (Norwalk, Conn: Appleton & Lange, 1989); P Hersey, K H Blanchard, E L LaMonica, “A situational approach to supervision: Leadership theory and the supervising nurse,” Supervisor Nurse 7 (May 1976) 17-22; P Hersey, K H Blanchard, E L LaMonica, “A look at your supervisory style,” Supervisor Nurse 7 (June 1976) 27-40. 2. J Zurlinden, B Bongard, M Magafas, “Situational Leadership: A management system to increase staff satisfaction.” Orthopaedic Nursing 9 ( M ~ ~ h / A p r1990) i l 47-52. 3. K H Blanchard, “Metaphor for management,” E.recutive Excellence 5 (November 1988) 3-4. 4. R P Vecchio, “Situational Leadership theory: An examination of a prescriptive theory,” Journal of Applied Psychology 72 (August 1987) 444-451. 5. M Blankenship, K Wilhoit, C Blankenship, “Leadership: Do it with style,” Nursing Management 20 (February 1989) 81-82. 6. J Zurlinden, personal communication with M Blankenship, Chicago, 4 April 1989. Suggested reading

Adams, C. “Leadership behavior of chief nurse executives.” Nursing Management 21 (August 1990) 36-39. Birkenstock, M. “OR nurse turnover: Collecting pertinent data to analyze the problem.” AORN Journal 52 (August 1990) 315-324. Carew, D K; Parisi-Carew, E; Blanchard, K H. “Group development and Situational Leadership: A model for managing groups.” Training and Development Journal 40 (June 1986) 46-50. Hersey, P; Blanchard, K H; Peters, L. Situational Leadership Simulator: A Simulation for Learning Behavioral Science Theory. San Diego: Leadership Studies, Inc, 1987. Hornstein, H A, et al. “Responding to contingent leadership behavior.” Organizational Dynamics 15 (Spring 1987) 56-65. Middleton, A. “Leadership for one minute managers.” Association Management 37 (May 1985) 103-106.

Nicholls, J R. “A new approach to Situational Leadership.” Leadership & Organization Development Journal 6 no 4 (1985) 2-7. Tyndall, A. “Situational Leadership theory.” Nursing Leadership 2 (June 1979) 25-29.

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bxarnination SITUATIONAL LEADERSHIP

1. Situational Leadership$ is a management system that a. can only be used by managers because it deals with confidentiality issues b. involves application of different leadership styles based on a situation and the manager‘s assessment of the employee’s professional readiness c. involves a decision-making process and designates which people should intervene in different situations rather than dealing with the behaviors of people d. helps a manager analyze his or her personality and decide which leadership style will be most effective for him or her in all situations 2. By applying the principles of the Situational Leadership theory, the manager can I . help employees develop their skills, but also preserve their feelings of selfworth 2. help employees deal with surgeons and anesthesiologists more effectively by helping them use assertiveness skills in the appropriate situations 3. help employees during an immediate crisis and meet long-term staff development goals 4. relax and be assured that the staff can handle their own conflicts regardless of the situation a. I and 2 b. 2 and 3 c. 1 a n d 3 d. 4only 3 . A s a manager w h o uses Situational Leadership, your greatest challenge is 982

a. to memorize the components of your specified leadership style and to use that style consistently so others know what to expect from you b. to teach your subordinates to assess your leadership behavior so they can modify their behavior accordingly c. to concentrate on using high amounts of relationship behavior, because many w o r k e r s p e r c e i v e this as the most important trait of a competent manager d. to continually assess the readiness of each employee and modify your behavior accordingly 4. A manager who inappropriately uses the principles of Situational Leadership may have employees who feel angry or abandoned because they think the manager does not care about performance. This may be a result of a. overmanagement-the manager intervenes unnecessarily b. underinanagemen-the manager withdraws guidance too quickly c. overusing discipline-the manager skips backward too many quadrants d. underusing high relationship behaviorthe manager uses too much high task behavior 5 . Situational Leadership is described as a sequential model. What does this mean? 1. To stay on track, a manager must not move from a telling style to a delegating style. 2. Assessment of the employee’s readiness is necessary before a leadership behavior can be determined.

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6.

7.

8.

9.

3. When people are trying to learn new skills, it is essential that a manager use supporting and coaching styles. 4. A manager must understand his or her own personality type before a leadership style can be determined. a. 1 and3 b. 2 a n d 4 c. I, 2, and 3 d. all of the above When assessing an employee’s readiness, what components must be considered separately? a. employee’s personality profile scores and employee’s date of hire b. employee’s rating (ie, high or low) on tasks and relationships c. employee’s perceptions based on wholebrain learning theory d. employee’s willingness or confidence and ability or knowledge Identify the concepts that are included in each of the four readiness quadrants. a. manager’s perception of his or her own leadership behavior, leadership behavior as perceived by employees, and employee’s ability b. manager’s degree of assertiveness (active or passive), employee’s degree of cooperativeness, and employee’s ability c. assessment of follower, behavior of leader, and leadership style d. manager’s temperament type, employee’s temperament type, and employee’s ability When deciding which leadership behavior to use, the manager chooses a combination of which concepts? a. task behavior and relationship behavior b. verbal communication and body language c. persuasive or manipulative negotiation and coercion d. analytical (thinking) behavior and intuitive (feeling) behavior Which readiness assessment is the most common description of novice nurses?

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a. unable to do the task, but is willing and confident to perform b. unable to do the task, and insecure and unwilling to perform c. able to do the task, but is insecure and unwilling to perform d. able to do the task, is willing and confident to perform Use the following choices to answer questions 10-20. a. Telling b. Delegating c. Participating d. Selling 10. Readiness quadrant 1 matches w i t h leadership style. 11. Readiness quadrant 2 matches with leadership style. 12. Readiness quadrant 3 matches with leadership style. 13. Readiness quadrant 4 matches with leadership style. 14. When your readiness assessment shows that an employee is able to do the task, but is insecure and unwilling to perform, what is the corresponding leadership style? 15. When your readiness assessment shows that an employee is able to do the task, and is willing and confident to perform, what is the corresponding leadership style? 16. When your readiness assessment shows that an employee is unable to do the task, but is willing and confident to perform, what is the corresponding leadership style? 17. When your readiness assessment shows that an employee is unable to do the task, and is insecure and unwilling to perform, what is the corresponding leadership style‘? 18. As the day charge nurse in the operating room, you are planning lunch reliefs when you get a call to come immediately to one of the ORs. When you arrive, the circulating nurse reports that the surgeon may have hit the aorta on this laparoscopy and the scrub nurse is becoming very flustered. Which leadership style is most effective for this type of crisis situation? 19. As the nurse manager in the OR, you have 983

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done a readiness assessment and you have decided there is a need for teamwork. Which leadership style is most effective for facilitating teamwork? 20. Which leadership style is the least effective for promoting teamwork among OR nurses? 21. As the orthopedic team leader in the OR. you want to use Situational Leadership. After a readiness assessment, you have decided the members of your team need a leadership behavior that will provide coaching and supporting. Which leadership styles are appropriate to use? 1. Telling 2. Delegating 3. Participating 4. Selling a. I a n d 4 b. 2 a n d 3 c. 3 and4 d. all of them Use the following choices to answer questions 22-23. a. Telling b. Delegating c. Participating d. Selling 22. You are the clinical specialist in an OR where a group of highly-rated preceptors are disagreeing on what types of new approaches are needed in the orientation program. You decide on the leadership style because it is associated with the least amount of intervention. 23. As an OR nurse manager, you want to let an employee know that you value his or her contribution to the unit and that you respect him or her as a person. Which leadership style would you choose? 24. You are the nurse manager in an OR and you are working on the December staffing schedule. You have notified the staff nurses that there is a serious staffing problem for the holidays. A new staff nurse comes to your office and offers to take the nightshift call for both Christmas eve and New Year's eve. You know that she has been in the department for only two weeks and is 984

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not scheduled to complete the orthopedic or neurosurgery service rotations before the holidays. What is your follower assessment, and which readiness quadrant, leadership behavior, and leadership style do you choose? 1. able to do the task, but is insecure and unwilling to perform 2. able to do the task, is willing and confident to perform 3. unable to do the task, but is willing and confident to perform 4. unable to do the task, is insecure and unwilling to perform 5. readiness quadrant 1 6. readiness quadrant 2 7. readiness quadrant 3 8. readiness quadrant 4 9. Telling 10. Delegating 1 1. Participating 12. Selling 13. low task behavior, low relationship behavior 14. high task behavior, high relationship behavior 15. low task behavior, high relationship behavior 16. high task behavior, low relationship behavior a. 1, 6, 9, 16 b. 3 , 6 , 12, 14 c. 4,5, 1 1 , 16 d. 3 , 7 , 11, 15 25. You are the clinical specialist in an OR that has a vacancy in the evening charge nurse position. No one has been willing to apply for this position and you are interested in helping the nurse manager find a candidate on the current staff. You know a person that has the appropriate skills for the position and has said in the past she would not mind working off-shift hours on a permanent basis, but this person lacks the confidence to apply for the position. You would like to facilitate her independence, so you use Situational Leadership to decide on your leadership behavior. What is your fol-

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lower assessment and which readiness quadrant, leadership behavior, and leadership style apply to this situation? 1. able to do the task, but is insecure and unwilling to perform 2. able to do the task, is willing and confident to perform 3. unable to do the task, but is willing and confident to perform 4. unable to do the task, is insecure and unwilling to perform 5. readiness quadrant 1 6. readiness quadrant 2 7. readiness quadrant 3 8. readiness quadrant 4 9. Telling 10. Delegating 11. Participating 12. Selling 13. low task behavior, low relationship behavior 14. high task behavior, high relationship behavior 15. low task behavior, high relationship behavior 16. high task behavior, low relationship behavior a. 2, 8, 10, 13 b. 4,9, 11, 15 c. 1,6, 12, 14 d. 1,7, 11, 15 Professional nurses are invited to submit clinical or managerial manuscripts for the home study program. Manuscripts or queries should be sent to the Editor, AORN Journal, 10170 E Mississippi Ave, Denver, CO 80231. As with all manuscripts sent to the Journal, papers submitted for home study programs should not have been previously published or submitted simultaneously to any other publication.

AORN JOURNAL

Why Nurses Leave Nursing Retaining quality staff members is a problem hospitals deal with daily. Retention is tied to redesign of the staff nurse role and how retention initiatives and staff nurse role redesign may serve to enhance recruitment into the profession, according to an article in the June 1991 issue of the Journal ofNursing Administration.

The article is based on information gathered from a study conducted by the University of North Carolina (Chapel Hill) Area Health Education Center Program, the Health Services Research Center, and the School of Nursing. Some principal dissatisfying characteristics of nursing include inadequate salary increases, inadequate RN:patient ratios, nonsupportive physicians, work environments that do not cultivate teamwork, and no freedom to exercise nursing judgment. These characteristics represent desired standards for professional performance and are some of the reasons nurses who are currently employed in other areas left nursing, according to the article. Of the 218 respondents no longer in nursing, 68% said they would consider returning to nursing if there was more scheduling flexibility and better pay. Eighty-seven percent of respondents were satisfied with the respect they received from others in their current nonnursing job, whereas fewer than 50% were satisfied with the respect they received from others when they were nurses. Employers should be encouraged to ensure nurse satisfaction by offering continuing education to enhance nurse retention and professional competence. They should monitor nurses’ levels of satisfaction with their professional roles and redesign aspects of the institution that may impinge on nurses’ abilities to participate in decisions, exercise their professional judgment, and work collaboratively with physicians, because nurses who remain in nursing also expressed dissatisfaction with these characteristics, according to the article. 985

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Answer Sheet SITUATIONAL LEADERSHIP

P

lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Accounting Department c/o Home Study Program 10170 E Mississippi Ave Denver, CO 80231 Event # 925006

Mark only one answer per question 1 2 3 4

Session # 5505

Program offered November 1991

5

The deadline for this program is May 3 1, 1992.

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1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination, starting with question one. 3 . A score of 70% correct is required for credit. 4. Record the time required to complete the program 5. Enclose fee: Members $7; Nonmembers $14.

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8 9

10 11 12

AORN (ID) #

13

If nonmember, please provide Social Security

14

15 Name

16

Address

17

City State

Zip

18 19

RN license and state Florida license #

20 (Required for Flonda CE credit)

Phone number (

21

Fee enclosed

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or bill the credit card indicated

23

'JMastercard

24

5 Visa

Card #

25

Expiration date

(Turn Over)

Signature (for credit card authanirlian)

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AORN JOURNAL

Learner Evaluation The following evaluation is used to determine the extent to which this home study program met your learning needs. Rate the following items on a scale of 1 to 5.

Objectives. To what extent were the following objectives of this home study program achieved? Discuss the theory of Situational Leadership. Identify the components of the four readiness quadrants. Discuss the leadership style that corresponds with each readiness quadrant. Apply Situational Leadership concepts in at least two perioperative situations by choosing the appropriate leadership behavior.

(4)

Contenf. (1) Did this article increase your knowledge of the subject matter? (2) Was the content clear and organized? (3) Did this article facilitate learning? (4) Were your individual objectives met? (5) Was the content of the article relevant to the objectives?

Test questions/answers. (1) Were they reflective of the content? (2) Were they easy to understand? (3) Did they address important points? What other topics would you like to see addressed in a future home study program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):

Author names and addresses:

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