m
 

m  

m
 The Nurse roles are ways of describing the nurseƞs activities in practice.
However, the roles are not in actuality exclusive of one another. In practice, several
roles often coincide.
The American Association of Critical-Care Nurses believes that patient
advocacy is an integral component of critical care nursing practice. Therefore,
definitions of advocacy are essential.
r m nurses safeguard the patient and the public when health care
and safety are affected by the incompetent, unethical, or illegal practice of any
person and
r m critical care nurses are confronted with situations that require
them to act immediately on the patientƞs behalf, and
r m personal and professional risks are associated with being a
patient, and
r m state nurse practice acts may require the nurse to be a patient
advocate, and
r m the process of informed consent mandates that the patient or
the patientƞs surrogate be informed fully and give consent freely, and

r m the continuum of advocacy is not limited to the individual but

may extend to societal concerns,
Ú

 



ð
˜



 
˜ 

˜







  


 ˜

º 
˜

 

 As CAREGIVER
As a caregiveris
caregiveris the role of human relations. The
chief goal of a nurse in this role is to convey
understanding about what is important and to
provide support. The nurse supports the client
by attitudes and actions that show concern for
client welfare and acceptance of the client as a
person, not merely a mechanical being. Caring
is central to most nursing interventions and an
essential attribute of the expert nurse.
 As PATIENT ADVOCATE
A iatientadvocate is an advocate of clientƞs
rights. According to Disparti (1988), advocacy
involves promoting what is best for the client,
ensuring that the clientƞs needs are met, and
protecting the clientƞs rights. Social advocacy
entails advocating on behalf of a population or a
community to effect positive change. Nurses
engaged in this form of advocacy can create
healthy environments through political action,
community education, and involvement in
professional organizations.
According to Kohnke (1982), the actions of an
advocate are to inform and support. An advocate
informs the client about the rights in a situation,
and provides them with the information they need
to make an informed decision. The first step in
informing is to make sure the client agrees to
receiving the information. In addition, an advocate
must (a) either have the necessary information or
know how to get it, (b) want the client to have
the information, (c) present information in a way
that is meaningful to the client, and (d) deal with
that fact that there may be those who do not wish
the client to be informed.
Private duty nurse
 As a COUNCILOR
Nurse as a councilor focuses on helping the
person develop new attitudes, feelings, and
behaviors rather than on promoting intellectual
growth. The nurse encourages the client to look
at alternative behaviors, recognizes the choices,
and develop a sense of control. Counseling can
be provided on a one-
one-to
to--one basis or in groups.
Often nurses lead group counseling sessions.
The nurse may be a leader, member, or
resource person in any self-
self-help group in which
the nurse may assume the role of structuring
activities and fostering a climate conductive to
group interaction and productive work.
 Obviously, counseling requires therapeutic
communication skills. In addition, the nurse must be a
skilled leader able to analyze a situation, synthesize
information and experiences, and evaluate the
progress and productivity of the individual or group.
The nurse must also be willing to model and teach
desired behaviors, to be sincere when caring in the
welfare of the others.
 As a LEADER
At a client level, nursing leadership is defined as a
mutual process of interpersonal influence
through which the nurse helps a client make
decisions in establishing and achieving goals to
improve the clientƞs well-
well-being. The purposes of
leadershii vary according to the level of
application and include (a) improving the health
status and potential of individuals or families, (b)
increasing the effectiveness and level of
satisfaction among professional colleagues
providing care, and (c) raising citizensƞ and
legislatorsƞ attitudes toward and expectations of
the nursing profession.

eadership
e
- refers to the Ơindividualƞs pattern of relating to others or
how the leader gets along with members of the work groupơ.
(1)Chari
c
eerp
- is characterized by an emotional relationship between
the leader and the group members in which the leader
Ơinspires others by obtaining an emotional commitment from
followers and by arousing strong feelings of loyalty and
enthusiasmơ. A charismatic relationship exists when the
leader can communicate a plan for change and the followers
adhere to the plan because of their faith and belief in the
abilities of the leader.
(2)uthoritarianorirective
eadershii
- The leader makes the decision for the group. The leader
determines policies and gives orders and directions to the
members. Authoritarian leadership generally has negative
connotations and often makes group members dissatisfied.
However, there are times that this kind of leadership is most
effective. When decisions are necessary in an urgent situation,
one person must assume the responsibility to make decisions
without being challenged by other team members.
(3)eocraticorarticiiativeorConsultative
eadershii
- the leader participates as a facilitator, encouraging group
discussion and decision making.
The leader focuses on the human aspects of the work relationship
and tries to build effective work groups. Group members
participate in decision making through collaboration and
cooperation. This style increases group productivity and
satisfaction. Democratic leadership is based on this principles
(Tappen 1989):
D Every group member should participate in decision making.
D Freedom of belief and action is allowed within reasonable
bounds that are set by society and by the group.
D Each individual is responsible for himself or herself and for
the welfare of the group.
DThere should be concern and consideration for each group
member as a unique individual.
(4)
aissezaireornondirective
eadershii
- the leader participates minimally and often only on
request of the members. This leadership style is also referred
to as permissive or ultraliberalism. This style is described as a
Ơhands-offơ approach. This style is most effective for groups
whose members have both personal and professional maturity,
so that once the group has made a decision, the members
become committed to it and have the required expertise to
implement it. The leader acts as a resource person.
(5)ituational
eadershii
- encourages managers to consider the environment
or context in which management decisions are made.
Douglass (1992) states that the situational leadership
theorists share a basic assumption that successful
leadership occurs when the leaderƞs style matches the
situation. One factor influencing situational leadership is the
personal and professional maturity of the group members.
Also important in this style is the value given to the
accomplishment of tasks and the concern given to the
interpersonal relationships between leader and the group
members and among group members.
(6)ransorational
eadershii
- is a style in which the leader motivates others through
values, vision, and empowerment. The leader envisions a clear,
attractive, and attainable goal and enlists others to participate
in attaining the goal. Through shared values, honesty, trust,
and continuous learning, the leader empowers the group to
share in goal attainment.
 ˜ m˜ m ˜ ˜ 
m
[ Use a leadership style that is natural to them.
[ Use a leadership style appropriate to the task and the
members.
[ Assess the effects of their behavior on others and the
effects of othersƞ behavior on themselves.
[ Are sensitive to forces acting for and against change.
[ Express an optimistic view about human nature.
[ Are energetic.
[ Are open and encourage openness, so that real issues
are confronted.
[ Facilitate personal relationships.
 ˜ m˜ m˜ ˜ 
m˜ 
[ Plan and organize activities of the group.
[ Are consistent in behavior toward group members.
[ Delegate tasks and responsibilities to develop membersƞ
abilities, not merely to get tasks performed.
[ Involve members in all decisions.
[ Value and use group membersƞ contributions.
[ Encourage creativity.
[ Encourage feedback about their leadership style.
 As a MANAGER
As a anager
anager,, nurse manages the nursing care
of individuals, groups, families, and
communities. The nurse-
nurse-manager also delegates
nursing activities to ancillary workers and other
nurses and supervises and evaluates their
performance. In addition, the nurse uses
principles of management and leadership was
functioning as a case manager. Case
management involves coordination among
disciplines and with ancillary personnel to deliver
care to the client in the most appropriate setting
and in a cost-
cost-efficient matter.
Management is often confused with leadership,
because in much of the literature, leadership is
associated with group interaction within an
organizational setting. Tappen (1989) defines
management as Ơplanning, giving direction,
developing staff, monitoring operations, giving
rewards fairly, and representing both staff members
and administration as needed.ơ Management,
therefore, occurs within an organizational
environment. Leadership, by contrast, may or may
not require delegated authority within a formal
organization
 Comparison of Leader and Manager
Roles

eer __________________
er__________________
May or may not have official appointment
to the position.
Have power and authority to enforce
decisions only so long as followers are
willing to be led.
Influence others toward goal setting,
either formally or informally.
Interested in risk taking and exploring new
ideas.
Relate to people personally in an intuitive
and emphatic manner.
Feed rewarded by personal achievements.
May or may not be successful as
managers.
er
Are appointed officially to the position.
Have power and authority to enforce
decisions.
Carry out predetermined policies, rules,
and regulations.
Maintain an orderly, controlled, rational,
and equitable structure.
Relate to people according to their roles.
Feel rewarded when fulfilling
organizational mission or goals.
Are managers as long as the appointment
holds.
 As a COORDINATOR
- Nurse as a coordinator help shapes
relationships between nurses and clients,
nurses and support persons, and nurses
and colleagues. In this role,
communication is important.
Communication facilitates all nursing
actions. The nurse communicates to other
health care personnel the nursing
interventions planned and implemented
for each client.