Running head: LEADERSHIP AND MANAGEMENT

Leadership and Management in the NICU

NUR4827C: Leadership and Management in Professional Nursing
Brittaney Bures
November 21, 2014

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Leadership and Management in the NICU

After shadowing the nurse manager of the Neonatal Intensive Care Unit (NICU), it is
evident that the role of nurse manager comes with many responsibilities. Nurse mangers are
responsible for identifying emerging trends, adopting innovative ideas, and guiding and leading
nurses while contributing towards the success of the organization. They are also responsible for
overseeing all budget matters and creating an environment that promotes employee engagement
and supports professional practice. The purpose of this shadowing experience was to observe the
managers role and understand how different leadership styles can be utilized and put in to
practice. This paper will further go on to explain about how these leadership styles can influence
the field of nursing.
The NICU nurse manager was previously a NICU nurse for five years prior to becoming
the manager. On days the NICU is short of nursing staff, she still works as a nurse in order to
help the other nurses with their patient load. This allows her to gain the respect of her employees
and also show her support. Through these actions, the nurse manager demonstrates leadership
among her employees; however, she did admit that switching from manager to floor nurse does
require her to constantly switch gears from her managerial role. She also admits that the
relationships between her and her employees did change when she became the nurse manager for
the unit.
While the NICU manager does exhibit characteristics of a leader, it is imperative to
distinguish the difference between leadership and management. Leadership and management are
two distinct competencies. Management is regarded as a position where authority is given based
on hierarchical organizational management (Grady & Malloch, 2013). Management style is
largely transactional, in that the manager informs employees what the nature of the work is, the

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direction to which that work is oriented and how it impacts the organization, the functions that
are critical to the activities of work, and the training and performance expectations necessary to
do work well (Grady & Malloch, 2013).
Leadership is more about the person rather than the position. Leaders tend to influence
others by advancing their strong relationship skills in a way that supports the collaborative team
as a whole. Leaders possess influential characteristics, have strong interactional skills, are
innovative and creative, encourage positive team relationships, and have personal characteristics
that inspire competence, confidence, engagement, commitment, and support (Grady & Malloch,
2013).
There are many different types of leadership styles, five in particular that are regarded as
the most common. These styles include the authoritarian (or autocratic) leadership style, the
democratic leadership style, the laissez-faire leadership style, the transactional leadership style,
and transformational leadership style (Johnson, 2014).
The authoritarian leadership style is one where managers make decisions without the
input of others. This leader establishes a distinct professional relationship with employees in
order to maintain boundaries between the authoritarian leader and other team members. They
keep close watch over employees by strictly monitoring policies and procedures. They believe
that direct and close supervision is crucial in order to uphold a successful work environment
(Johnson, 2014).
The democratic leadership style is one where the leader includes team members in the
decision-making process. While the final decision ultimately rests on them, this leader values the
ideas and opinions of other team members. This leadership style builds moral among employees
because it allows them to contribute to the decision-making process (Johnson, 2014).

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The laissez-faire leader does not provide direction supervision and fails to regularly
provide feedback to team members under their management. All rights and power in the
decision making process are given to the employees. Employees with more experience that
require little supervision work well under this leadership. However, this leadership style limits
productivity to employees needing guidance and supervision (Johnson, 2014).
The transactional leadership style motivates team members by assigning certain tasks for
employees to perform and providing rewards or punishments based on performance results.
Managers that follow this leadership style work with the employees to set predetermined goals
together, while employees agree to follow the direction and guidance of the manager in order to
achieve them. If goals are not met, the manager is responsible for training and correcting
employees in order to improve future outcomes. When goals are accomplished, employees
receive rewards and incentives, such as bonuses, for a job well done (Johnson, 2014).
Transformational leaders enhance productivity and efficiency through strong
communication with employees and maintaining high visibility. The main objective is to
transform team members needs and way of thinking. Leaders that follow this style of leadership
challenge and inspire their employees with a sense of purpose and excitement. They also create a
vision of what and who they aspire to be, and communicate these ideas to their team members
(Johnson, 2014).
After shadowing the NICU manager and observing her interactions with other team
members, it is apparent that the leadership style that is most consistent with the leadership style
of the NICU manager is a combination of the democratic leadership style and the
transformational leadership style.

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The nurse manager aims to inspire and influence her employees rather than dictate. This
influence comes from the nurse managers ability to earn credibility and inspire her team
members to both believe in her and to believe in themselves. In order for her employees to
believe in her, it is necessary for the nurse manager to gain their trust. The nurse manager builds
trust within the unit by using behavior cards from The Speed of Trust. Each card has a
behavior of high trust on it. The nurse manager distributes one card to a selected team member
once a week, three times a day to allow her employees the opportunity to provide feedback on
how she can build trust within the relationship. Similar to the transformational style, the nurse
manager maintains high visibility within the unit and creates a vision of the type of leader she
aspires to be. She encourages communication among her employees so that they can grow
together as a team.
Throughout the day, I also witnessed the nurse manager attending several meetings.
Each of the meetings covered topics that included quality improvement and patient care
processes, budgeting for new staff members, and employee engagement. Prior to the employee
engagement meeting, a survey was sent to all employees on the unit regarding their satisfaction
with work conditions on the unit. The purpose of the meeting was to go over the results and areas
of improvement. While at times there was obvious tension, the nurse manager continued to
respect and listen to her employees in an attempt to include their ideas and concerns in the
decision making processes moving forward. Similar to the democratic style, the nurse manager
values and responds to the input provided by her team members, however, she is ultimately
responsible for making the final decision.
Through these experiences, the nurse manager demonstrated collaboration among her
team members. Collaboration can be defined as having team members work well together,

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deliberate with determination, and act in ways to serve the interests of both the patient and the
team (Grady & Malloch, 2013). Collaboration and interdisciplinary practices are important in the
profession of nursing because it is necessary all health professionals to work diligently together
to develop mutual accountability for advancing quality and reducing errors (Porter-OGrady, T.,
2011).
While the leadership styles discussed have been related to the leadership styles of the
nurse manager, it is important to note that leadership can and should be seen at all levels of
healthcare, including the role of the professional nurse. Because of the professional nurses
position and involvement in patient care, a leadership role is naturally obtained by coordinating,
integrating, and facilitating the team practices necessary to create mutual commitment among
interdisciplinary practices (Porter-OGrady, T., 2011).
As a new graduate nurse, this experience has been irreplaceable. It has showed me the
significance of culture, collaboration, effective leadership styles, and the roles of the nurse
manager and the professional nurse. Understanding the pivotal role that the professional nurse
has, as well as encompassing these values and beliefs, will demonstrate my leadership and allow
me to have a greater impact in the field of nursing.

LEADERSHIP AND MANAGEMENT

References
Grady, T., & Malloch, K. (2013). Leadership in nursing practice: Changing the landscape of
healthcare. Burlington, Mass.: Jones & Bartlett Learning.
Johnson, R. (2014). 5 different types of leadership styles. Retrieved October 14, 2014, from
http://smallbusiness.chron.com/5-different-types-leadership-styles-17584.html
Porter-OGrady, T. (2011). Leadership at all levels. Nursing Management, (42)5, 32-37.