News, Skilled Nursing Facility

Four basic leadership styles every long-term care manager should follow

This is an excerpt from The Long-Term Care Director of Nursing Field Guide, Third Edition, written by Barbara Acello, MS, RN.

For a long time, people thought there were only two leadership styles—autocratic and democratic. In fact, people used to shout at each other from these two extremes, insisting that one style was better than the other. Democratic managers were accused of being too soft and easy, while their autocratic counterparts were often called too tough and domineering. Today’s manager, however, is flexible and is able to use all four of the leadership styles described below.

Leadership and staff empowerment

For many years, leaders were believed to be effective because of personality or personal charisma. This was called the “trait theory” of leadership, and it was not until the Ohio State management and leadership studies by Paul Hersey and Ken Blanchard in the late 1960s that this conventional wisdom was debunked. Through their research, they found effective leaders had a talent for aligning the style they used with the particular needs of the person or group with whom they were dealing. This approach became known as “situational leadership,” reflecting that the leader varies his or her style and uses “different strokes for different folks.”

To use this approach effectively, learn to diagnose which style is needed when and become comfortable moving between four different styles depending on the situation. Over the course of usually three to five years, the staff with whom you are working should progress from requiring a directing style (e.g., orientation) to a coaching style (e.g., they are competent and developing talents) to a more independent phase in which you support their decisions and can finally delegate, knowing that you can trust their judgment.

Because staff gain authority as they develop, leaders, in a sense, work themselves out of a job. It has often been said that “the effectiveness of a leader is measured by what happens in his or her absence.” The four basic leadership styles leaders can use to develop staff are described in more detail below.

Directing. In this style, the leader provides specific direction and closely monitors the accomplishment of tasks. Communication is largely one-way: You tell staff what, when, where, and how to do something, then carefully monitor their performance. Explain what the goal is and what a good job looks like, then describe the plan for meeting that goal. Essentially, you solve the problem. You make the decisions and the person carries out your ideas. A directing style is appropriate:

  • When a decision has to be made quickly and the stakes are high
  • For inexperienced people with the potential to be self-directive
  • For someone with good potential who is not familiar with the organization (e.g., the past history, established protocols, or political implications of a situation)

Usually, staff will not resent direction and close supervision when they are first learning a task. Most are enthusiastic beginners who want to do a good job and welcome any advice that will help them succeed.

Coaching. Shift to two-way communication and coaching as the new manager begins to understand the expectations and begins developing the necessary skills and abilities. Good coaches bring out the best in people by helping them see their talents and abilities and the value they add to the team. They also are adept at pointing out the “rough edges” that need more work or the skills that need to be added to the basic ones they acquired in the first year of employment. The new manager begins as a novice and progresses to independent success. Ask questions such as, “What can I do to help you become more effective?”

Many managers find this phase in the staff development process to be very rewarding as they watch staff blossom in their roles and grow in their senses of self-esteem. The coaching style works best with:

  • Staff that want to develop a particular technical skill or specialized interest, such as patient teaching, discharge planning, or competence in a new process
  • A group that has a sense of what it wants to accomplish but needs direction
  • Employees who have transferred from another department and know facility policies, but need to learn and grow in their new positions

Supporting. As staff accept more responsibility for and become proficient in their roles, the leader shares with them the decision-making and problem-solving responsibilities and supports them in applying their ideas. The leader can be much less directive in this role due to the proficiency of the person or group, and, in a sense, it becomes the leader’s job not to give answers but to ask the right questions. For example, you might say, “Tell me what needs to happen. What are the pros and cons of this policy as we have developed it? What needs to be done to finalize and implement it?” Asking for their opinion shows you have confidence in them. Make sure to show your appreciation with comments such as, “You have done a great job putting it together and I know this project will be successful.”

Supporting style works best with:

  • Staff who are two or three years into the job and have developed their ideas about what needs to be done to improve the work environment
  • Experienced staff who are brought together on a short-term task force that needs to produce results
  • Staff who have transferred from another facility (who have demonstrated proficiency in the role) and want to implement some ideas that worked at a previous employer

Delegating. In this style, the leader turns over the responsibility for day-to-day decision-making and problem solving to staff. This style offers the most latitude for authority in decisions and autonomy. Delegating is appropriate for people who are self-reliant achievers—people who are competent and committed and need little direction. They are also able to provide their own support. For example, top performers do not need much supervision or praise as long as they know how well they are doing. Leaders using this style present the problem and then get out of the way as staff develop a solution. Delegating works best with:

  • Seasoned experts who are ready for “job enrichment,” so they can stay enthusiastic and invested in their role
  • Issues like staff scheduling, because staff know what needs to happen and can make it happen using guidelines agreed upon by the group
  • Task forces that have implemented a process and need to fine tune it or maintain and update its structure