requirement of leadership quality in nursing

1. MS. Trupti Rekha Swain
MN(PEV.)

3. CONCEPTS:
The origin of the word “lead”
meaning “to go”.
 The leader is one who is one
with others to the extent
necessary to give them a feeling
of a quality and yet different
from them in terms of his own
work and achievement for which
they admire him.

4. Cont.
Leadership is a complex
relationship existing between the
leader, the organization, social
values, economic and political
conditions.
 A leader influences others by their
qualities i.e. confidence,
communication abilities, awareness
of his impact on others as well as
perception about the situation and
his subordinates.

5. HISTORY:
 Florence Nightingale, after leaving the
crimea, exercised extra ordinary leadership
in health care for decades with no
organization in her command.
 Nightingale took on the establishment and
revolutionized healthcare in the british
military services. Florence Nightingale was
both leader and manager.

6. Leadership versus management
 In looking at nurse leadership in the community it is
useful to distinguish between leadership and management.
Leadership is about providing direction to others in
relation to a vision of where the organisation or team
needs to go, while management is the organisation of the
processes or tasks required to deliver that vision.

7. DEFINITION
 Stogdill’s definition of leadership as “the process of
influencing the activities of an organized group in its
efforts toward goal setting and goal achievement”, which
can be applied to nursing.
 Tallbott said “leadership is the vital ingredient that
transforms a crowd into a functioning, useful
organization.”

8. Types of leaders:
 Formal leader: by virtue of position, by virtue of power,
for example like Political Leader and official leader.
 Informal leader: those who have certain admirable
qualities, person may be vocal, assertive, maintain good
IPR. They are influential people and are leader not by
virtue or power. Informal leaders are present in all institute
or organization.

9. Factors of leadership:
Follower
Leader
Communication
Situation

10. FEATURES OF LEADERSHIP:
 Leadership is a continuous process of behaviours, it is
not one-shot activity.
 Leadership may be in terms of relations between a
leader and his followers which arise out of their
functioning for common goals.
 By exercising his leadership, the leader tries to
influence the behaviour of individuals or group of
individuals around him to achieve common goals.
 The followers work willingly and enthusiastically to
achieve these goals.

11. PRINCIPLES OF LEADERSHIP
1) Know yourself and seek
self improvement.
2) Be technically proficient.
3) Seek responsibility and
take responsibility for your
actions.
4) Make sound and timely
decision.
5) Know your people and
look out for their
wellbeing.

12. cont
6) Keep your workers
informed.
7) Develop as sense of
responsibility in your
workers.
8) Ensure that tasks are
understood, supervised
and accomplished.
9) Train as a team.
10) Use the full capabilities of
your organization

13. NURSING LEADERSHIP
 Nursing leader is one who has acquired the
proper nursing education, training and
practical experience, displays the
leadership behaviour.(MJ Seivwright.)
 Today’s professional nurse assume
leadership and management
responsibilities, regardless of the activities
in which they are involved although
leadership and management are different
they are frequently interwined (knotted).

14. Cont.
 The nurse can be a leader in a care of the
individual clients, the client family, group of
clients, society at large the purpose of nursing leadership
vary according to the level of application and include the
following
Improving the health status of individual or families.
Increasing the effectiveness and level of satisfaction
among professional college who provides care.
Improving the attitude of citizen and legislator to word
the nursing profession and their expectation from it. A
process whereby a person who is a nurse effects the
actions of others and help in goal determination and
achievements

15. FIVE IMPORTANT SETS OF COMPOSITIN ACCORDING TO
BENN’S FOR LEADERSHIP IN NURSING
 The leader should have knowledge about the
organization in which she is working.
 The leader should have practical and theoretical
knowledge for guiding the system.
 Interpersonal competencies especially in regard to
recognizing the effects one has on others.
 Have set of values and competencies that enable to
know that best way to approach others.
 Have ability to develop and used all type of
information system.

16. IMPORTANCE OF LEADERSHIP
Leadership is an important factor for making any type of
organizations successful. The importance of good leadership is
Motivating employees – Motivation is necessary for work
performance, higher the motivation, better the performance.
A good leader, by exercising his leadership, motivates the
employees for high performance.
Creating confidence – A good leader may create confidence
in his followers by directing them, giving them advice and
getting through them good results in the organization.
Building morale – Morale is expressed as attitude of
employees towards organization, management and voluntary
cooperation to offer their ability to the organization. High
morale leads to high productivity and organization

17. EFFECTIVE LEADERSHIP
Effective leadership involves
 Application of certain techniques and
 qualities of good teachers.
Techniques of effective leadership in nursing
 To be an effective leader, the nurse administrator
needs to know; the principles or team leadership,
administration and supervising and motivational
theory; to identify the personnel needs and their
differences as individuals.

18. Cont.
 The following are the technique which can be applied
by the nurse administrator to be effective leaders.
Planning and organizing
Division of labour
Guidance
Effective communication
Cooperation and coordination
Encouraging participation
Supervision
Evaluation

19. QUALITIES OF GOOD LEADERS
 Effective leadership requires good leaders.
Some theories postulate that a leader either born or made a
good leader has both personal and acquired qualities.
 These are as follows:-
 Knowledge of self i.e. self awareness
 Personal qualifications – like integrity, honesty, ability to
cooperate and ability to attract, motivate, enthuse and unite
others to work.
 Initiative qualities – like willingness to come forward to help
and assist, self confidence courage and decisiveness.
 Technical mastery i.e. expert knowledge and expertise to work.
 Teaching abilities i.e. ability to communicate.

20. Cont.
Administrative abilities i.e. abilities to
manage, organize, and coordinate.
Enthusiasm
Tact i.e. ability to win the loyalty and support to
resource
Emotional control
Quality of acting as catalyst, consultant and resource
Helping the individuals to grow;
Awareness of responsibilities and accountability.

21. FUNCTIONS OF LEADERSHIP:
 Leaders act to help a group attain objectives through
the maximum application of its capabilities. They
don’t stand behind a group to push and prod; they
place themselves before the group as they facilitate
progress and inspire the group to accomplish
organizational goals.
 Development of team work
 Representing the team
 Counselling the workmen
 Managing time
 Using proper power
 Securing group effectiveness

22. THEORIES OF LEADERSHIP
Researcher given a number of theories to explain
leadership and its development. Some leadership
theories are :-
 Great man theory or charismatic theory – A leader has
some charisma which acts as influencer.
 Trait theory – trait is defined as, relative enduring
quality of an individual. On the basis of such qualities
it is said that – leaders are born and not made.
 Behavioural theory – emphasis, that strong leadership
is the result of effective role behaviour. Leadership
shown by a person’s acts more that by his traits.

23. Cont.
 Situational theory or contingency theory –
effectiveness of leadership will be affected by the
factors associated with the situation.
 New theory of leadership – leadership can be learned
and cultivated.
 Path- goal theory of leadership – this theory of
leadership suggesting that primary function of a leader
are to make valued or desired reward’s available in the
workplace and to clarify for the subordinates for the
kinds of behaviour that will lead to those reward’s that
is leader should clarify the path’s to goal attainment.

24. LEADERSHIP STYLES
 Leadership theories helps in understanding the various
types of behaviour of a leader. These consistent
behaviour patterns that the leader uses when they are
working with and through other people (as perceived
by leaders or other people) are called the leadership
styles.
 The classic research done by Lewin, Lippitt, and White
(White, Lippitt, 1960) on the interaction between
leaders and group members indicated that the
behaviour of the leader could substantially influence
the climate and outcomes of the group.

25.  The leader’s behaviours were divided into three
distinct patterns called leadership styles:
authoritarian, democratic, and laissez- faire in a
leadership situation but they are far more action.
 These styles can be thought of as a continuum from
highly controlling and directive type of leadership to a
very passive, inactive style.

26.  Leadership: Leadership is the process of influencing
the thoughts and actions of other people (a person or
group) to attain the desired objectives.
 Style: Style is a particular form of a behaviour directly
associated with an individual. Or the way in which a
leader uses interpersonal influences to achieve the
objective of an organization.

27.  The reasons are:-
 A style of leadership affects the health care delivery
system.
 A style allows the nurse to interact more productively
and more harmoniously to achieve personal and
organizational goals.
 Leadership style is how a leader uses
interpersonal influence to accomplish goals of an
organization.

28. Types of Leadership styles:
Autocratic style of
leadership
Democratic style of
leadership
Laissez – faire style of
leadership

29. AUTOCRATIC STYLE OF LEADERSHIP
 The leader assumes complete control over the decisions and
activities of the group. The authority for decision making is
not delegated to persons in lower level of positions
(centralized organization)
 Personality of the leader:
 Firm personality, insistent, self assured, highly directive,
dominating with or without intention
 Has high concern for work than for the people who perform
the task.
 Uses the efforts of the workers to the best possible shows no
regard to the interest of the employees
 Sets rigid standards and methods of performance and expect
the subordinates to obey the rule and follow the same

30. Makes all decisions by himself or herself related to the
work and pass orders to the workers and expect them
carry out the orders.
There is minimal group participation or none from the
workers
 Thinks that what he or she plans & does is the best.
May listen to them by not influenced by their
suggestions.
Has no trust or confidence in the subordinates in turn
they fear and feel they have nothing much in common.
Exercises power manipulates the subordinates to act
according to his goals plans and keeps at the centre of
attention.

31. ADVANTAGES AND DISADVANTAGES OF AUTOCRATIC
LEADERSHIP
Advantages Disadvantages
 Efficient in times of crisis, easy
to make decision by one person
than by group. And less time
consuming.
 It is useful when there are only
leader who is experienced
having new and essential
information while
subordinates are in
experienced and new.
 It is useful when the workers
are unsure of taking decision
and expect the leader to tell
them what to do.
 Does not encourage the
individual’s growth and does
not recognize the potentials,
imitativeness and creates less
cooperation among members.
 The leader lacks supportive
power that results in decision
made with consultation
although he may be correct.
 Inhibits groups participation
which results in lack of
growth, less job satisfaction
can lead to less commitment
to the goals of organization.

32. DEMOCRATIC LEADERSHIP STYLE
It is also referred to participative, consultative style of
leadership.
1. This style is characterized by a sense of equality among
leaders and followers.
 The leader is people oriented
 Focuses on the human aspects
 Builds effective work group
 Togetherness is emphasized
2. Open system of communication prevails
 The group participates in work related decisions (sharing
the thoughts in problem solving)

33. 3.The interaction between the leader and the group is
friendly and trusting
 The leader brings the subject to be discussed to the group
 Consults
 Decision of the majority is made and implemented by the
entire group
 Makes final decision after seeking input from the total
group.
 Therefore the group feels they have important contribution
to make, freedom – ideas drawn, develop sense of
responsibility for the good of the whole.

34. 4.Leader works through people not by domination but
by suggestions and persuasions
 The leader motivates the workers to set their own
goals, makes their own work plans and evaluates their
own performance.
 Informs the overall purpose and the progress of the
organization.
5.Performance standards exist to provide guide lines and
permit appraisal of workers thus results in high
productivity.

35. ADVANTAGES AND DISADVANTAGES OF
DEMOCRATIC LEADERSHIP
Advantages Disadvantages
 It permits and encourages all
employees to practice decision
making skills.
 It promotes personal
involvement. Suggestions are
welcomed. This results in
greater commitment to work
and enhanced job satisfaction.
 Decisions made by the group are
more effective than by the
leader alone. Members may
have more information than the
leader.
 It takes more time for
making the decisions by the
group than by leader alone.
However the advantages
over weigh the negative
outcomes.

36. THE LAISSEZ – FAIRE LEADERSHIP
It is also referred to as Free- rein, Anarchic, Ultra liberal style
of leadership. The leader gives up all power to the group.
Characteristic features
1)This encourages independent activity by the group members.
 An outsider would not be able to identify he leader in such a
group
 The leader exerts little or no influence on the group members.
 There is lack of central direction, supervision, coordination
and control.
2)Group members are free to set their own goals determine their
own activities and allowed to do almost what they desired to
do. A variety of goals may be set by every individual and it will
be difficult to carry out to accomplish the task by the group
easily.

37. Cont.
3)This style may be chosen by the leader or it may evolve
because:-
 The leader is too weak to exert any influence on the group
 Attempting to please everyone to feel good
 And fails to function as an effective leader
4)This style is effective in highly motivated professional
groups eg: research projects where independent thinking is
rewarded or when the leader feels that the problem must
be solved by the group alone
5)This style is not useful in a highly structured health care
health care delivery system or any institution.
6)The group where there is no appointed leader will fall into
this category.

38. ADVANTAGES AND DISADVANTAGES
OF LAISSEZ – FAIRE LEADERSHIP
Advantages Disadvantages
 In limited situations
creativity may be encouraged
for specific purposes. Eg.
Highly qualified people plan a
new approach to a problem
that need freedom of action.
 To try new methods of
actions
 May lead to instability,
disorganization, inefficiency,
no unity of actions.
 Neither the group nor anyone
in the group will feel to be
responsible to solve the
problems that may arise.

39. BUREAUCRATIC
LEADERSHIP
 In this kind of leadership the leader functions only on
lines with rules and regulations. The leader cannot be
flexible and does not like to take any risk out of the
rules. Example: Defence leaders. They are strictly
adhering to the rules and maintain the discipline of
group.

40. COMPARISION OF LEADERSHIP STYLES
Parameters
Control over the group
Authoritarian
Strong
Democratic
less
Laissez faire
Little or none
Motivation By coercion Economic / ego
awards
By support
Direction By command Suggestion /
guidance
Little, upward
& down ward
Decision
making
Self Participative Dispersed
Status
difference
I & U We The group
Criticism Punitive Constructive None

41. FACTORS WHICH INFLUENCE THE
LEADERSHIP OF A NURSE MANAGER
1. Work assignment:- If difficulty or complicity of assign
task, Bureaucratic and participatory leadership is required.
If work assignment is easy and repetitions done close
supervision is not required, democratic leadership is
required. If properly trained employees for then also close
and constant supervision is not required in that case also
democratic or participatory leadership is required.
2. Amount of time available for task completion:- In
emergency the autocratic leadership is required.
3. Size of the work group:- less worker or staff absent or
vacation or on leave, participating leadership is required.

42. 4)Communication within the group:- If more than
one channel- by way communication participatory
leadership is required.
5)Education and experienced background or
employees or team member:-those who have more
experience, educated democratic leadership are
required. Those who are less educated needs very close
supervision Autocratic leadership. Those who are new
or very less experience first paternalistic than change
into participatory, you have to guide them or train
them.

43. 6. Worker needs for independency:- They know, they can
do their work, those workers who are independents with
rules and regulation; they will work under participatory,
leadership style. Those are dependent or unskilled they
required more supervision.
7.Leadership personality and training:- leadership may be
the more Autocratic and Bureaucratic depend on the
personality of the leader, effective leader is the one who
satisfied the need of work group to support and facilitate
work environment who consider the dynamic nature of
work culture that is essence(spirit) of situational theory.

44.  Authoritarian leadership is particularly suitable in an
emergency situation when clear directions are the
highest priority. It is also appropriate when the entire
focus is on getting the job done or in large group.
 Democratic leadership is particularly appropriate for
groups of people who will work together for an
extended time, when interpersonal relationships can
substantially affect the work of the group. It is often
called supportive or participative leadership today.

45.  The effective leadership style:
 No one functions always with a particular leadership
style.
 No single style is appropriate for all situation.
 At times combination of styles may be most
appropriate. E g. A midway between authoritarian and
democratic or between democratic and laissez faire.

46. ACTIVITIES OF LEADERSHIP
 Community health nurse managers, consultants need
effective leadership, with interpersonal, organizational
and political skills.
 Leadership skill essential to these roles provide the
ability to identify a vision and influence others to
achieve that vision by emphasizing that client needs
are the basis for health services, by empowering
others, paying equal attention to task, delegating
duties, managing time and making decision
effectively. There are mainly four activities of
leadership:-

47.  Direction
 Supervision
 Coordination
 Staff development
 These activities will be carried at all level of leadership
status.

48. DIRECTION
 A key leadership skill for community health nurse is
the ability balance attention to the people and to task.
This skill is derived from contingency leadership
theory and means the effective leaders do not focus all
their attention on simple getting the job done.
 A community nurse leaders empower others to make
organization more responsive to client care. This
means giving staff the knowledge and skills, and
authority to act on behalf of client.
 Community health nurse share responsibility for any
task they delegate to others but retain final
accountability for the safe and effective outcome of the
task.

49.  Effective leaders need to be able to delegate
appropriately and to manage time well. The purpose of
delegation include increasing organizational efficiency,
developing others talents, and managing time well.
 A core leadership skill is ability make decisions
effectively. This is two stage process in which the
community health nurse decide how much inputs are
needed from the others and also generate and choose
alternatives.

50. Cont.
She must have clear cut concept of :-
 Policies of the organization
 Rules and regulation or the instruction.
 She should be familiar with subordinate ability
 She appreciates the cost effectiveness of the source and
accordingly give direction.
 Leader’s role is to direct the followers or team member towards
achieving the goal of program or to active the goal of institution.
 She gives specific assignment to worker through orders. Orders is
the way or function of leader of day to day activities of the
program, this order may be circular, having meeting with team
member. Order can be put on notice board; this direction can be
written or oral. Order has more autocratic tone.
 Directives can be used be in turn of order. These directions may
bear leadership style, nature of work.

51. SUPERVISION
It is one of the most effective tools of any management
system. Supervision means helping and enabling process
through literally it means inspection or over seeing.
Principles of supervision:
 It should stimulate self expression, capabilities, talents etc.
thus if ANM is a good public speaker, leader should
stimulate her capabilities by giving her more chance for
public speaking.
 Supervision should provide initiative for taking
responsibilities. A health supervisor should appreciate and
praise the work of the person supervised so that it will
encourage her to take more responsibility and achieve
better.

52. Cont.
 It should provide full opportunity for team work.
 Supervision interprets policies and provides necessary
instructions.
 Supervision should fulfil individual need.
 Supervision is en inherent teacher. Her role is to guide,
help and encourage. Most important job of PHN is to
teach her subordinates.
 Supervision should be democratic.

53. Cont.
 It is not only inspecting the work of others, it is rather
helping, guiding so we can achieve goal. Supervision will
evaluate the adequacy, efficiency and utilization of
time resources of any organization. It is facilitating or
remedial process that means supervision is a process which
helps in controlling the quality of work. For ex:- PHN in
emergency – helping to the ANM to work better. If she is
not improving than she can have discussion and better to
send her for orientation in service education program for
the improvement of the work.
 Supervision creates anxiety and fear of worker because of
evaluation of the work. Supervisor also has fear of
supervising when she does not have knowledge and
competency.

54. Cont.
 Activities of CHN to fulfil the role of a supervisor:
 Act as a leader, guiding and counselling her workers.
 Act as a liaison between authority and workers
 Instil feeling of self respect, competency and pride in
accomplishment in the workers.
 Responsible for orientation and in service education of her
staff.
 Help in getting and understanding information.
 Provide resources to make the job interesting and for better
performances.
 Support utilization of new skill.
 Encourage adaptability to change circumstances.
 Increase awareness of the need of the programmes.
 Responsibility for updating policies and standing orders.

55. COORDINATION
 According to Brech, coordination is the balancing and
keeping the team together by ensuring a suitable
allocation for working activities to the various
members, and seeing that these are performed with
due harmony among the members, themselves.
 PHN is a link person between worker or PHC and sub
centre, she will carry information and will give the
information regarding procedure, method, policies.
 She should be clear with goal and policies so she can
help them what expected to do.

56. Cont.
 She can share the problem, discuss the problem with
administrator.
 She should be able to clearly discuss the problem to be
solved.
 The PHN is the supervisor of the ANM, she will review
the record, visit sub centre regularly.
 She should do coordination with worker similarly she
can give direction.
 She will inform the higher administration about the
need of sub centre for the eg. – Orientation of new
employee, time to time meeting with village people.

57. STAFF DEVELOPMENT
 It includes both formal and informal learning
activities relating to the employee’s role that take place
either within or outside the organization. It includes
both formal and informal activities relating to the
employee’s role that take place either within or outside
the organization. The community health nurse carried
out activities of staff development for ANM/ MPHW

58. Cont.
a) Conducts good orientation programmes.
b) Gives them skill training to develop nursing skill and
knowledge.
c) Provides job related counselling.
d) Plan and organize learning experience in variety of
setting.
 Effective leadership qualities transform people’s way of
thinking, behaving and feeling they are
transformational as well as transactional. They change
the definition of life, and give meaning to it.

59. NATIONAL STRATEGY FOR
HEALTH FOR ALL
Alma – Ata declaration and India’s commitment to
HFA resulted in formulation of national health
policy.
 Objective of national health policy:-
 To increase public health investment through
substantially increased contribution by central
government.
 To enhance the participation of private and NGO
sector in health services.
 Increased sectoral share of allocation for preventive
and curative initiatives at the primary health care
level.
 Emphasis will be laid on use of rational drugs within
the allopathic system and appropriately
supplemented with tried and tested system of
traditional medicine.

60. GOAL TO BE ACHIEVED BY 2002-2015
Eradicate polio and yaws 2005
Eliminate leprosy 2005
Eliminate kala azar 2010
Eliminate lymphatic fialariasis 2015
Achieve zero level growth of HIV/ AIDS 2007
Reduce mortality by 50 % on account of
TB, malaria and other vector and water
borne diseases.
2010
Reduce prevalence of blindness to 0.5% 2010

61. Cont.
Reduce IMR to 30/ 1000 and MMR to 100/ lakh 2010
Increase utilization of public health facilities from
current level < 20 to >75%
2010
Establish an integrated system of surveillance, national
health accounts and health statistics.
2005
Increase health expenditure by government as a % of
GDP from the existing 0.9% to 2.0%
2010
Increase share of central grants to constitute at least
25% of total health spending
2010
Increase share sector health spending from 5.5% to 7%
of the budget
2005
Further increase to 8% 2010

62. Leadership in nursing for “Health for All”
 Nurses are valued and respected members of their
communities. As trusted professionals, nurses have an
opportunity to serve as catalysts in leadership
opportunities in the community. In partnership
with others in the community, nurses can help build a
more just, more peaceful, and more healthful society.
Nurses are actualizing these possibilities in
communities everywhere.

63.  1979, WHO and International council of nurses
(ICN) conducted a workshop in Nairobi on the role
of nursing in primary health care for leaders of nurses
association in which the commitment of the nursing
profession to the goal of attaining health for all by
2000 was formally confirmed. Subsequently, National
nurses association planned their own strategies in
relation to their own national health policies. The
Trained Nurses Association of India (TNAI) also
participated in this exercise.

64.  In 1981, an informal meeting was convened in Geneva
by WHO on 16-20 November to consider the role of
nursing in contributing to the achievement of the goal
of HFA by 2000 through Primary health care.
Strategies and Action Proposed at International
Level

65. Five basic strategies
 The development in each country of a corps of nurses that
is well informed about health care and ready to bring
necessary changes in the nursing system.
 The inclusion of nursing personnel at the levels of policy
making and administration so that the profession can
contribute to determining the action plan.
 The involvement of nurses, and the use of their skills, in
initiating or expanding primary health care
 Fundamental changes in all levels of nursing education (
basic, post- basic and continuing) to ensure that the
priority needs of population functionally integrated into
the education and into nursing practice.
 Research into nursing administration practice, and
education that will demonstrate nursing contribution to
primary health care.

66. Cont.
 The TNAI in its conference in nursing education
in 1979 affirmed its commitment to health for all
through primary health care approach and
recommended to prepare nurses to work in
community, to reorient nurses to primary health
care to have at least three nurses at decision
making position in the state health directorate
and so also in directorate general of health
services. Here we see the nurse working as a
leader, to have more post of nurse in district and
primary health centre; there also they work as
leader.

67. ROLE OF THE NURSE LEADERS IN THE DELIVERY
OF THE CORE SERVICES
 The community health nurse functions as a leader
when she performs the role of nurse manager. The
following are the core services in health promotion,
illness prevention and health protection and many
PHN services can be listed under these three
categories.
Health promotion
 Build healthy Public policy
 Create supportive environment
 Strengthen community action
 Reorient health services
 Develop personal skills

68. Cont.
Prevention
 Reproductive & family health
 Sexual health
 Prevention of chronic illness
 Nutrition or food security
 Mental health
Health protection
 Communicable diseases
 Protection from injury
 Environmental health
 Emergency health

69. The public health nurse provides leadership in both
nursing and public health
 Public health nurses are granted a societal privilege to
practice therefore have a responsibility to understand
learn and take individual or collective action on health
disparities. Public health nurses are, therefore, advocates
for health equality and social justice.
 Public health nursing leaders advocate for structures
within state and local health departments that foster
participation by public health nurses in systems and
community interventions, not just with individuals and
families.
 Information about communities, and the importance of
ethnicity, language and culture, needs to be translated
and interpreted to policy makers in a way that encourages
doing “the right things”.

70. Achieving cultural competence
 The public health nurse systematically enhances the
quality and effectiveness of nursing practice and attains
knowledge and competency that reflects current nursing
and public health practice.
 Public health nurses take steps to acquire knowledge of
the population they serve, model respect for varied
cultures, and insist on accountability in cultural
competence.

71.  Public health nurses assure their organization assess
the level of cultural competency and move toward
sensitive and effective services and interactions.
 Public health nurses work within systems that can
better support diversity and equity in health outcomes.
 Public health nurses are role models and exemplify the
principle of social justice, increase the cultural
competence among their staff and work to close gaps
in health outcomes that impact population
disproportionately.

72. Assessment, population diagnosis& priority
setting
 Assessment is a core function of public health and of
public health nursing.
 Recognition of health disparities and tracking of progress
toward their elimination requires appropriate data. Public
health nurses ensure that wherever possible, data are
collected to document any disparities and track progress
toward their elimination.
 Good data are needed to ensure the appropriate
evaluation of new strategies.
 Public health nurses work with communities and
populations to provide context and meaning to the data,
and to generate to test innovative solutions to community
problems.

73. Partnering with others
 A core competency of public health nursing is the
ability to establish partnership.
 Public health nurses partner with groups and
populations in planning interventions to address and
resolve health issues, enabling them to learn from the
community and formulate appropriate solutions
 The public health nurse develops plans that reflect
best practices; identifies strategies, action plans and
alternatives to attain expected outcomes; and
implements the identified plans through partnerships
within the community.

74. Creating an environment for care
 Public health nurses have unique power in design of
programs and services for diverse populations.
 It is the nurse who creates and upholds caring
environments by assessing, correcting, controlling, and
preventing those factors in the care environment and in
clinical and community relationships that can adversely
affect health.
 The strength of public health nursing lies its capacity to
uphold a caring a environment regardless if the focus is
caring for the family or caring for the individual.
 Creating an environment for care extends beyond delivery
of services to the infrastructure of the state or local health
department itself.

75. Advocacy
 Advocacy is a standard of practice for
public health nursing .
 According to the national scope and standard of public
health nursing practice, advocacy is defined as “the act
of pleading or arguing in favour of cause, idea or policy
on someone else’s behalf, with the object of developing
the community, system, individual or family’s capacity
to plead their own cause or act on their own behalf.”
 The public health nurse advocates protecting the
health, safety and rights of the population.
 Public health nursing leaders are often uniquely placed
in government agencies and are often in a position be
consulted in issues to related to policy and legislation.

76. Educating the current and future public health
nursing
 Workforce she should be aware of and sensitive the
needs of others and can work effectively within
communities to facilitate the changes necessary to
bring about greater equity in health outcomes. Public
health institutions & institution of higher education in
nursing have an obligation to help facilitate this
process and support this journey with their staff and
students

77. Evaluation and research
 Each public health nurse see his or her role as more
than custodial of current policies or programs.
 Public health nurses are constantly be aware of
opportunities to improve programs and services to
better serve communities and population groups at
increase risk of illness, injury, premature death and
disability.
 The public health nurse is constantly evaluating his or
her nursing practice in relation to professional practice
standards and guidelines, ethics, relevant status, rules
and regulations and against the unmet and evolving
needs of the populations served.

78. ROLE OF PUBLIC HEALTH NURSE
(DISTRICT LEVEL)
 The public health nurse will be a member of the
district health and family welfare team in the district
health organization and will enjoy the status
equivalent to that of the district mass education and
information officer.
 She will work in collaboration with other functionaries
in the district health welfare bureau like the mass
media and extension officer, health education officer,
statistical officer, etc.

79.  To help in organization of maternal and child health
program as a whole and in the implementation of the
special plan scheme, centrally sponsored and
otherwise in particular like the immunization
program, training of traditional birth attendants (dais)
and their active involvement in MCH/ FP work,
prophylaxis against nutritional deficiency disease etc.
 To promote health and nutrition education activities
through the lady health visitors, auxiliary nurse
midwives by providing them with “talking points” and
printed materials produced by various agencies.

80.  To ensure that the lady health visitors / ANM/ female
multipurpose workers etc. integrate MCH, family
planning, health and nutrition education in their day
to day activities.
 To help in developing school health program at the
district level.
 To ensure regular supply of equipments, records,
registers drugs, vaccines and other sundries necessary
for MCH work in the primary health centres and sub
centres by assisting storekeeper in procuring and
distributing the supplies.

81.  To ensure the maintenance of records and submission of
periodical progress report of MCH/ FP/ nutritional activities.
 To help the statistical officer in the District family welfare bureau
in compiling the periodical progress report s of MCH activities.
 To review the periodical progress reports on MCH / FP work
done by the LHVs/ ANMs, female, multipurpose workers etc.
and put up to the district medical officer /District family Welfare
Officer the points requiring attention and further action.
 To give technical guidance, supervision, and support to the
ANMs, female multipurpose workers, LHVs, public health nurse
working in MCH/ FP program in the district and to review the
annual confidential reports in respect of these functionaries.

82.  To investigate into complaints against female
paramedical personnel in the district and submit
reports/ recommend to the District medical Officer/
district family welfare officer.
 To provide for continuing education of the female
MCH/ FP/ functionaries in the district through in
service training sources.
 To work together with the functionaries of other
government departments like social welfare, rural
development and education engaged in programs for
woman and children.

83.  To co-operate MCH/ FP activities undertaken through
the voluntary organization in the district and provide
health inputs to the possible extend for mothers and
children organized in balwadis, anganwadis etc.
 To tour for a minimum 15 days in month and visit
primary health centres, sub centres, villages dais,
balwadis, mahila mandals etc according to an advance
program duly approved by the district medical officer/
district family welfare officer.

84. Health program
 As we know various health programs in India are
launched time to time as a part of public health
program to improve the health status of the country,
where most of the work done by community health
nurse, she participate in administration and
management of the program working as a leader. Now
a days, the most important program which is going on
national rural health mission.

85. The main aim of NRHM
 To provide accessible, affordable, accountable,
effective and reliable primary health care and bridging
the gap in rural health through the creation of cadre
of ASHA.
 The program covered by NRHM are RCH II, national
vector control program including malaria, filarial, kala
azar, dengue fever and Japanese encephalitis , national
leprosy control program , revised T.B. control program,
national program for, national program for blindness,
iodine deficiency disorder control program and
integrated disease surveillance poject.

86.  Overall to achieve the goal “Health For Goal” the
nursing leader’s – community health nurses take
leadership role in persuading people to solve their
health problems and become self reliant in their
health matters by persuasion. She also initiates various
community activities which motivate people to
change. She helps people to identify health needs with
their active participation.

87. CONCLUSION
 Leadership is a process to influence others to strive
willingly to achieve a common goal. Nurse leaders
create a vision for themselves and for their group
members’. Community health nurse leads the group by
giving them directions, ensuring by way
communication, providing supervision and guidance
and by co-ordinating their activities and infrastructure
etc. Above all, we must believe that health equity is
achievable and within or reach. It is our role and
responsibility as public health nurses to provide
leadership in making this happen.

88. REFERENCES
 Gulani K.K.,(2010) . Community Health Nursing, 1st
edition, Kumar publishing house, Delhi. page- 47-51
 Patney Sunita,(2005), The Text Book of Community
Health Nursing, 1st edition, Modern Publisher, Delhi
page- 11-18
 Downie NM (1958), Fundamentals of Management
techniques and Practices, 1st Edition, Oxford
University press page- 180 -183
 Swarnburg Russell C.Swarnburg Richard J. (2002),
Introduction to Management and Leadership for nurse
Managers, 3rd edition, 2002 Jones and Bartlett
Publishers, page- 393-410.