Holy Angel University Graduate School of Nursing Advance Nursing Management (GSNANM)
A Case Study presented to the Graduate School of Nursing
Actions that inspire others to dream more, learn more, do more and become more
Submitted by: Alneil T. Antonio R.N
Submitted to: Christopher D. Guarin RN, MAN, Ph.D May 30, 201
I. Introduction Leadership is a concept that is increasingly under analysis as it is a characteristic of the acute care work environment that affects both nurse and patient outcomes. Nursing leadership can have strong implications for how nurses manage their roles as patient caregivers in the acute care setting. Nurses have identified that there are certain styles of leadership that interfere with their ability to provide quality patient care (Cook & Leathard, 2004). Working as a nurse leader requires complex skills and competencies that could affect not only staff, but also patients. A leader is anyone who uses interpersonal skills to influence others to accomplish a specific goal. The leader exerts influence by using a flexible repertoire of personal behaviors and strategies. (Sullivan & Decker 2009). Numerous problems have been associated with the nurse leadership role: No formal job description, an increase in responsibility without an increase in authority, and a lack of leadership education (Krugman & Smith, 2003). A continual and troublesome question facing nurse managers today is why some employees perform better than others. Making decisions about who performs what task in a particular manner without first considering individual behavior can lead to irreversible, long term problems. Each employee is different in many respects. A manager needs to ask how such differences influence the behavior and performance of the job requirements. Because individuals bring to the workplace different needs and goals, the type and intensity of motivators vary among employees. Nurse managers prefer motivated because they strive or find the best way to perform their jobs. Motivated employees are more likely to be productive than are non motivated workers.
In managing nursing care in the future, nurses must realize that nursing expertise and clinical judgment are the best combination to effectively influence nursing practice and policy changes. Using influence, knowledge, and expertise can make the health care delivery system work that inspire others to dream more, learn more, do more and become more. Based on opinion of Messick and Kramer (2004) that the degree to which individuals’ exhibits leadership depends on the characteristics and personal abilities, characteristics of the location and environment in which he finds himself. Furthermore, they explained that since human beings could become members of an organization in order to achieve certain personal objectives, the extent to which they are active members depends on how they are convinced that their membership will enable them to achieve their predetermined objectives. Therefore an individual will support an organization if he believes that through it, his personal objectives and goals could be met, if not the person’s interest in the organization will decline.
The Angeles University Foundation Medical Center (AUFMC) is a non-stock, nonprofit world-class healthcare facility located in Angeles City, Philippines, less than an hour north of Manila and minutes away from Diosdado Macapagal International Airport. HISTORICAL BACKGROUD OF THE INSTITUTION It was 1985 when Dr. Emmanuel Y. Angeles first decided to put up what is now known as the Angeles University Foundation Medical Center (“AUFMC”). At the time, Dr. Angeles envisioned the establishment of a five (5)-storey, one hundred fifty (150)-bed capacity medical facility that would satisfy the need for quality health care services in the region. Giving birth to AUFMC was no easy task. Financing was hard to come by. No institution was willing to lend the huge amount of money needed to construct the hospital. Besides, even if financing for construction could be obtained, there was the problem of how to get equipment. Nevertheless, Dr. Angeles proceeded to organize AUFMC in February of 1985 and the first members of the Board of Directors accepted the challenge of making this vision a reality. These were Dr. Angeles, Diosdado P. Macapagal, Dr. Antonio Y. Angeles, Ramon R. Panlilio, Ruben G. Henson, Dr. Rodolfo Dimayuga and Dr. Edgardo Timbol. In its first meeting, the board resolved that forty-nine percent (49%) of the shares of AUFMC be authorized for sale to prospective stockholders, a majority of which were doctors and medical practitioners, and the remaining fifty-one percent (51%) be subscribed by the Angeles University Foundation. Apart from raising capital for the construction of the hospital building, the resolution would also encourage patronage of hospital facilities and services. Although a significant amount was raised from investment, the required capital was not reached, thus putting construction on hold.
In 1987, the Social Security System, then administered by Mr. Jose L. Cuisia, Jr., launched a Hospital Loan Program to aid in the establishment of hospitals as an attempt to make health care more accessible to the masses. AUFMC was among the first beneficiaries of this program and was granted a loan of Thirty-Five Million Pesos (P35,000,000.00). Thus, on February 17, 1988, ground-breaking ceremonies were held for a building which was to be named the St. Martin de Porres Hall. The hospital was originally named the Angeles University Hospital. While funding for the building had been obtained, there was still the issue of how to get sufficient medical equipment. The AUFMC officers and directors gathered donations from several hospitals, but these donations were hardly adequate. Furnishing a hospital required the practically the same amount of money as the hospital building itself. In a stroke of luck, Dr. Angeles learned from Dr. Jaime B. Yamat that the entire contents of the two hundred fifty (250)-bed St. Anthony’s Medical Center in Milwaukee, Wisconsin was up for sale. Dr. Angeles, assisted by Dr. Yamat and Mr. John Cherba, lost no time in negotiating for the purchase of the medical equipment. While AUFMC offered the lowest bid, the owners of St. Anthony’s Medical Center awarded the bid to AUFMC because its objectives ran parallel to theirs: that of providing public service. Dr. Angeles together with his wife, Dr. Cornelia Lukban-Angeles, Engr. Sancho Cuyugan and Dr. Noel Panlilio spent almost four months in Milwaukee packing all the equipment and supplies and preparing them for shipment to the Philippines. When they finished, over thirty (30) containers were filled.
Various hospital equipment were also obtained from donors in the United States of America such as Dr. Marc Rose, Mr. Fred Argosino, Dr. Jenny Batungmalaque, State Library of San Francisco, Edrina Kalinske, Queen of Angels of Los Angeles and Mr. Oscar Tandog. AUFMC was inaugurated on February 23, 1990, with President Corazon C. Aquino as principal sponsor and formally opened to serve the public on May 25, 1990. In December of that year, the board decided to open the hospital to physicians accredited by the specialty boards. This allowed visiting consultants to avail of AUFMC services and facilities. It also encouraged practitioners, though not members of the Angeles Medical Society, to join the medical staff. On January 31, 1998, AUFMC was converted from a stock corporation to a non-stock, non-profit medical foundation. Stockholders were given the option to either donate their shares to the foundation, allow their shares to be repurchased, or to transfer their shares to another corporation established to purchase and operate a CT-Scanner within AUFMC. This ensured that AUFMC would, for its entire existence, provide genuine public service. Through the years, AUFMC continued to grow and develop. On December 16, 2004, ground-breaking ceremonies were held for the Doña Evangelina Macapagal Medical Tower, a twelve (12)-storey expansion to the original building. The Medical Tower was named after the First Lady of President Diosdado Macapagal, Fifth President of the Republic of the Philippines. Once completed, the expansion would allow AUFMC to increase bed capacity and provide more specialized quality healthcare services. The first five floors of the Medical Tower were inaugurated on July 9, 2008 with President Gloria Macapagal-Arroyo as principal sponsor. As it now stands, AUFMC is the only university-based private tertiary level teaching, training and research hospital in Central Luzon with accredited Residency Training Programs. Celebrating its 20th year of providing quality and compassionate health care, AUFMC was
recognized as the Best Private Tertiary Hospital in Central Luzon by the Philippine Health Insurance Corporation in 2009, an affirmation of the excellence it adheres to, which all patients can rely on. AUFMC is a non-profit institution. All income and surplus from operations are entirely used to support charity patients, employee benefits, and for the continuing improvement of hospital facilities. Management and financial support for AUFMC is primarily extended by two organizations: the Angeles University Foundation and the Angeles University Development Foundation, Inc. The Angeles University Foundation is a non-stock, non-profit educational institution established in 1962 and is the parent organization of AUFMC. Accredited by the Philippine Council for Non-Government Organization Certification, all local donations to the foundation and AUFMC are tax deductible and exempt from donor’s tax. The Angeles University Development Foundation, Inc. is a corporation based in Virginia, USA whose core function is to provide support to Angeles University Foundation and AUFMC. It is certified by the US Treasury Department to receive donations for the two Philippine institutions exempt from federal taxes MISSION AUFMC is committed to the Highest Quality in Healthcare Services, Education and Research. VISION To be Among Asia's finest Healthcare Institutions.
GOAL To provide Quality Health Care Services for "Total Customer Satisfaction". QUALITY POLICY We are committed to "Total Customer Satisfaction" by providing efficient, effective, accurate & timely delivery of quality healthcare, diagnostic & therapeutic services through continual improvement process. NURSING SERVICE VISION To be recognize as a leading center for professional nursing practice in Central Luzon MISSION To render quality nursing care utilizing the therapeutic and expressive role in response to the identified needs of the client and his family in collaboration with other members of the health care team
PERSONAL INFORMATION Maritess S. Coronel, 37 years old Natural Born Filipino born on June 18, 1974 in Capas, Tarlac, She’s married to Alvin Coronel with 4 children, She Is currently the Head Nurse of the Angeles University Foundation Medical Center Operating Room-Delivery Room Complex. Mrs. Coronel earned her diplomatic degree in BS Nursing in the year 1995 at the University of Assumption and took and passed the Licensure Examination for Nurses on September of the same year. Mrs. Coronel started her professional practice In June 1996 as an Operating Room Nurse at Concepcion Tarlac District Hospital then shifted her career on the year 1997 to becoming a Professional Medical Representative at MEDHAUS Pharmaceuticals in Quezon City. In the year 2000 up to 2005 she decided to become a full time housewife until July 2005 when her door opened in Angeles University Foundation Medical Center where she was hired as an Operating Room Staff Nurse. In August 2008 she was hired as a charge nurse in the same area and institution and in the year 2011 she was appointed to become a Head Nurse at the Operating and Delivery Room Complex. According to Mrs. Coronel, Handling two areas in the hospital plus the Post Anesthesia Care Unit and Managing more than 50 employees including the 10 Charge Nurses, 27 Staff Nurses, 8 Volunteer Nurses, 7 Midwifes, 7 Attendants and 2 Clerks is never an easy job. There are so many obligations to make especially when it comes to incidence reports. As the Nurse Manager in the Operating-Delivery Room Complex, Maritess is routinely responsible for supervising patient care, trouble shooting, maintaining compliance with standards, and giving guidance and direction as needed. She is responsible for supervising the work of the unit personnel and the day to day activities of a specific work. With primary
responsibility for motivating the staff to achieve the organization’s goals. She also have the 24hour accountability for the management in the area. Reports any unusual occurrences and complete hospital Reports incidents if indicated. She is also responsible in assisting in
control and maintenance of supplies and
equipments. Assist in supervision of personnel to provide optimum assurance of safe environment. Coordinates with OR Central supply Room to maintain high standards and quality in the materials used. Manages proper scheduling of procedures including patients and availability of OR rooms. Manages proper scheduling of OR staff nurses to control the ratio of staff and scheduled procedures and endorses ongoing procedures and concerns which are needed to be addressed. She Is also the one who makes the schedule and evaluate the performance of the staff nurses. SWOT ANALYSIS OF THE OPERATING ROOM- DELIVERY ROOM COMPLEX Strengths 1. Offers the most therapeutic services in the region. It boasts of state-of-the-art facilities, equipments comparable to international medical centers. 2. Recognized
as the Best Private Tertiary Hospital in Central Luzon by the Philippine
Health Insurance Corporation in 2009 3. Offers General surgery, Neurosurgery ;Minimally Invasive Surgery; Eye surgery; Urology surgery; Pediatric Surgery; OB-GYNE surgery, Ear, Nose, throat (ENT) Surgery; Endoscopic Procedures; Kidney Transplant Surgery, Open Heart Surgery; All Types of Minor Surgery
4. The only and first in Northern and Central Luzon that is equipped with the expertise and technology to perform major cardiac procedures such as coronary angiography and angioplasty, bypass surgery, pacemaker insertions and other complicated cardiac procedures. 5. The first hospital outside Metro Manila to perform endoscopic thyroidectomy 6. Only hospital north of Metro Manila with an active DOH-accredited transplant program 7. Only university-based private tertiary level teaching, training and research hospital in Central Luzon 8. Availability of expertise nursing staffs (more than 3 years) and trained Nurses in Cardiovascular, Kidney Transplantation Care and Critical care. 9. Compliance code of ethics of hospital health care providers. 10. Periodically evaluation for nurses staffs. 11. Health care provider's development. 12. Different program development through continues education department and training courses through in house seminars and trainings. 13. Good interdisciplinary working place social support. Weakness 1. Low commitments of hospital polices and regulations. 2. Overlapping of scheduled cases 3. Overlapping duties of nursing staffs. 4. Insufficient rewards and recognition for nurse's staff. 5. Lack of visibility and transparency regarding to inappropriate behaviors.
Opportunities of the hospital 1. Strong relationships and form of collaboration with other hospitals and health departments. 2. Location of hospital serves large population, more available connections, and resources. 3. Easy of the public transportation to the hospital. 4. Ability to expand in hospital departments and health care services. 5. Opportunity to Create training program and courses in health by collaboration with the health faculties that trainee their students in the hospital. Threats 1. New and highly advance medical centers near the hospital 2. Low staff income in comparison with other private hospital sector. 3. Lack of external fund resources for development of nurses and other hospital employees. 4. High nurse salaries in other countries. 5. Surgeons tends to refer their patients to a hospital which has new facilities and equipments in surgery.
II.
ANALYSIS AND DISCUSSIONS “Actions that inspire others to dream more, learn more, do more and become more” Leadership is an action, not position; this is congruent with the difference between a
manager and a leader. A leader is the one who influences others, anyone who uses his or her skills to accomplish a specific goal. A leader is the one who exerts influence by using a flexible selection of behaviors and strategies. Leadership is less about the needs, and more about the needs of the people and the organization leading. Leadership styles are not something to be tried on like so many suits, to see which fits (Alan Murray, 2010). There are a number of different approaches, or 'styles' to leadership and management that are based on different assumptions and theories. The style that individuals use will be based on a combination of their beliefs, values and preferences, as well as the organizational culture and norms which will encourage some styles and discourage others.
“The best way to have a good idea, is to have a lot of ideas” They say that the best leaders are the one who has lot of leadership style, they have lot of ideas and they can easily adjust to different situation; this is how Mrs. Maritess lead the OR-DR Complex of Angeles University Foundation. By being a flexible leader she must be when there is substantial change in situation and the leadership behaviors, it is also important when unusual events and external changes that creates an immediate crisis or an emerging threat or opportunity. In the interview, Mrs. Maritess said that she is a leader who gets the opinion of her subordinates before she’ll make the final decision. She encouraged her staffs to engage in decision making regarding the problems encountered in the area. She stated that this leadership
style (democratic style) is more preferred than being a leader who wants to accomplish tasks and decides without getting the advice of the followers. She believe that this leadership help her subordinates to be more satisfied in their work, become more productive, and to help more in developing their skills, but she also said that it still depends on the situation if what style of leadership she will use, for some times if needed she use the Authoritarian style of leadership, this style is used when there is an emergency or in case of incident reports, In the Leadership Expert; How do You Lead Questionnaire by Simeon Oates, the results shows that Mrs. Maritess is more of a Democratic Leader and next to it, with the score of 14 is Authoritarian Style of Leadership. Make a difference! A transformational leader “An inspirational leader, positive, motivational, approachable, reliable, considerate and a role model”, this is how the staffs of the OR-DR Complex describes Mrs. Maritess as a leader. According to Mrs. Maritess, she is more of a transformational leader, she stated that she is a leader who wants a change and improvement in the handled area, she encourage her staff members to participate and make advancements, become more creative and influence to solve the problems of the area, this is parallel to the multi factor leadership questionnaire, it shows that there is a high factor in the four components, the Idealized Influence, Inspirational motivation, Intellectual stimulation and Individualized consideration. According to Sidani (2007), Idealized Influence describes managers who are exemplary role models for associates. Managers with idealized influence can be trusted and respected by associates to make good decisions for the organization, thus the interpretation shows that Mrs. Maritess has a high and strong bond with her subordinates; she is treated with value and the
staffs are enjoying working with her. During the duty hours, it was observed that staffs were very comfortable talking with the problems in the area and she is being valued with her judgments.
The second component is the Inspirational motivation that describes managers who motivate associates to commit to the vision of the organization. Managers with inspirational motivation encourage team spirit to reach goals of increased revenue and market growth for the organization. (Sidani 2007). In the Interview question, “How can you motivate your staff to improve and develop their skills and knowledge in the duty” “One motivation that I’m always saying to them is that, they must love their work and what they are doing because if you love your work the outcome will be good and beneficial”
Intellectual Stimulation describes managers who encourage innovation and creativity through challenging the normal beliefs or views of a group. Managers with intellectual stimulation promote critical thinking and problem solving to make the organization better. (Northouse, Peter G. 2001) In the question, “How do your subordinates contributes to the improvement in the area you are handling? Are there any circumstances that they made a change in some of the problems in the area?" “Almost all of the staff works hand in hand in the improvement in the area, there were so many changes that happened to the area unlike before. Now,
the area is more organize from the position of the different places in the area that can help the staffs to move freely, to become more flexible. The proper way of assisting to the surgeons and circulate a case, the proper disposal of different wastes and a lot more”
Individual consideration describes managers who act as coaches and advisors to the associates. Managers with individual consideration encourage associates to reach goals that help both the associates and the organization. This component is equal to the answer of Mrs. Maritess in the questions about her specific duty as a head nurse. “A part of my duty as a head nurse in the unit is to train new rotated nurses in the area and nurse Trainee, If I have a lot of time I’m teaching them the proper procedure in the area, I also orient them about the places and the equipments and different work in the Operating and delivery Room. I can be also an adviser if there are encountered problems in the area”
The call to lead: A Servant Leader Based on the premise that leadership originates from a desire to serve and that in the course of serving, one may be called to lead. (Sullivan & Decker, 2010). Servant Leadership occurs when people’s needs take priority, when those being served “become healthier, wiser, freer, more autonomous, and more likely themselves to become servants” The servant leadership can be seen to Mrs. Maritess by her listening skills, the awareness of the situation in the area, the visionary to create a change, the responsibility and accountability and the commitment.
I decide according to the situation: A Contingency Approach As being the head of the two areas in the hospital Mrs. Maritess used the contingency Approach wherein she changes her leadership style according to the situation. The one that best complements the organizational environment, the tasks to be accomplished, and the personal characteristics of the people involved in each situation.
A Desire to lead: How to Become a Successful Leader Maritess is a naturally born leader; she stated that on her school days, she once became a leader in their group. She said that being able to influence others in their work, gain trust, able to guide others, facilitate learning, develop knowledge and make changes are factors that must be seen in a great leader. Being a natural leader and the years of her experience as being nurse qualified her to become the head of the OR DR Department. According to Kerfoot (2000), Leaders have the capacity to earn and hold trust. They have genuine concern for others and help others achieve their potential, Leadership is attending to and acknowledging others and personally authentic and accountable. The leader must have enthusiasm, energy, and commitment, but most of all, the leader must be able to inspire others to commit the goals of the organization. Let’s Make a Change! Leading change is an art (Bruhn, 2004), never needed more in rapidly evolving system of healthcare. Organizational change is essential for adaptation; creative change is mandatory for growth. This climate for change produces new opportunities for nurses. Nurses change produces
new opportunities for nurses. Nurses are rethinking the way health care is organized and delivered. Change is inevitable, if not always welcome. Change is necessary for growth, although it often produces anxiety and fear. Even when planned, it can be threatening and a source of conflict because change is the process of making something different from what it was. According to the interview in the question, “In the years of experience as being the head of the Operating-Delivery Room Complex, what are the changes that you have made and what could be the other possible changes you can make in the future?.” “When I was hired as a head nurse, the Operating and Delivery Room Complex were two separate units, but because of the unexpected number of cases on two both areas there was a problem on the number of nurses on duty. I as the head nurse, together with my colleagues thought of a way on how to solve this problem that’s why we came up with the decision to combine these two units into one, in which the staff nurses in two areas can have a duty either in the Operating Room or Delivery Room, the separation of the two units made the nurses more flexible and can solve the problem of shortage of nurses. The nurses’ duty on two areas can work hand in hand to help both areas.” “As being the head for more than 2 years, there were so many changes happened in the area, aside from combining the two units, changes in the design that made the area more conducive was made. The assignment of floater nurses was also made in able to fit for the unexpected cases.”
“For the future I am thinking for a more specialized, more favorable, more ideal Operating-Delivery Room wherein there are enough duty nurses and our patients will be satisfied in our duty and care.” Change has always occurred; what’s different today is both the pace of change and that an initial change causes a chain reaction of more and more change (Bridges, 2004). Change, rather than an occasional event, has become the rule. Regardless of their position in an organization, nurses find themselves constantly dealing with change. Whether they thrive in such an atmosphere is a function of both their own personal resources and the environment in which change occurs. How well do you Decide: The Decision Making Process of a Head Nurse Thinking of all the practices individuals get in making decisions, it would seem they might become very good at it. However, the number of decisions a person makes does not correspond to the person’s skill at making them. The assumption is that decision making comes naturally, like breathing. It does not. In the interview question, “How well do you involve yourself in the decision making process in your area?” “As the head of the OR-DR I am the main decision maker in the area, but before I decide for something, I make sure that my colleagues are well informed about it and they have the participation in the decision making process. In Solving the problem, usually in every unit meeting, these topics will be opened and the
suggestions and recommendations are entertained to come up with the best decision.” There is a problem! How the Head Nurse Handles Conflict Conflict is a natural, inevitable condition in organizations, and is often a prerequisite to change in people and organizations. Conflict is defined as the consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actions within one individual, between two or more individuals, within on group, or between two or more groups. Conflict is dynamic. It can be positive or negative, healthy or dysfunctional.(Sullivan and Decker 2008) A certain amount of conflict is beneficial to an organization. It can provide heightened sensitivity to an issue, further stimulating the interest and curiosity of others. Conflict can also increase creativity by acting as a stimulus for developing new ideas or identifying methods for solving problems. Disagreements can help all parties become more aware of the tradeoffs, especially costs versus benefits, of a particular service or technique. According to the SWOT Analysis determined during the interview, Mrs. Maritess cited solutions to the problems found out. On the weakness determined, Mrs. Maritess cited the solutions that could possibly help in solving these problems.
Opportunities of the hospital 6. Strong relationships and form of collaboration with other hospitals and health departments. 7. Location of hospital serves large population, more available connections, and resources. 8. Easy of the public transportation to the hospital. 9. Ability to expand in hospital departments and health care services. 10. Opportunity to Create training program and courses in health by collaboration with the health faculties that trainee their students in the hospital. Threats 6. New and highly advance medical centers near the hospital 7. Low staff income in comparison with other private hospital sector. 8. Lack of external fund resources for development of nurses and other hospital employees. 9. High nurse salaries in other countries. 10. Surgeons tends to refer their patients to a hospital which has new facilities and equipments in surgery.
III. FINDINGS, RECOMMENDATIONS AND CONCLUSIONS
Every Nurse must be prepared to manage. Specific training in management skills is needed in the work setting. Most important, however, is that nurse must be able to transfer their newly acquired skills to the job itself, thus, nurse managers must be experienced in management and must be able to assist their staff in developing adequate management skills. Management training for nurses at all levels is essential in today’s cost-conscious and competitive environment. The challenge for nurse managers is how to manage in a constantly changing system. Working with teams of administrators and providers to deliver quality health care in the most cost effective manner offers opportunity as well. Nurses’ unique skills in communication, negotiation, and collaboration position them well for the system of today and for the future. Nurse managers today are challenged to manage with decreasing resources, to help design new systems of care, to supervise teams of professionals and non professionals from a variety of cultures, and finally, to teach personnel how to function well in the new system. This is no small task. It requires that nurse and managers be committed, involved, enthusiastic, flexible, and innovative; above all else, it requires that they have good mental and physical health. Because the nurse managers of today are responsible for others’ work, the nurse manager must also be coach, teacher, and a facilitator. The manager works through others to meet the goals of individuals, of the unit, and of the organization. Most importantly, the nurse manager must be a leader who can motivate and inspire. Nurse managers must address the interest of both administrators and employees. Both want the same result-quality care. Administrators, However, must focus on cost and efficiency in
order for the organization o complete and survive. Employees want to be supported in their work with adequate staffing, supplies, equipment, and most of all time. Therein lies the conflict. Between the two is the nurse manager, who must balance the needs of both. Being a nurse manager today is one of the most challenging opportunities in heath care. Leading change is an art, never needed more in rapidly evolving system of health care. Change is a continually unfolding process rather than an event. The process begins with the present state, is disrupted, moves through a transition period, and ultimately comes to a desired state. Once the desired state has been reached, however, the process begins again. Although nurses should understand and anticipate these reactions to change, they need to develop and exude a different approach. They can view change as a challenge and encourage their colleagues to participate. Making change is not easy, but it is mandatory skills for managers. Successful change agents demonstrate certain characteristics that can be cultivated ad mastered with practice
IV. REFERENCE
Cook, M., & Leathard, H. (2004). Learning for clinical leadership Krugman, M., & Smith, V. (2003). Charge nurse leadership development and evaluation. Alan Murray, (2010). The Wall Street Journal Essential Guide to Management Peter G. Northouse, 2010) Leadership: Theory and Practice Kerfoot, K (2000) On Leadership; Leading from the inside out. Bridges, W. (2004). Managig transitions (2nd expanded edition)
