Management and leadership: analysis of nurse manager's knowledge

Rev Lat ino- am Enferm agem 2005 j ulho- agost o; 13( 4) : 469- 73 w w w .eer p.usp.br / r lae Art igo Original 469 MANAGEMENT AND LEADERSHI P: ANALYSI S OF NURSE MANAGERS’ KNOW LEDGE1 Mar ia Regina Lour enço 2 Gilber t o Tadeu Shiny ashik i 3 Mar ia Aux iliador a Tr ev izan 4 Lourenço MR, Shinyashiki GT, Trevizan MA. Managem ent and leadership: analysis of nurse m anagers’ knowledge. Rev Lat ino- am Enfer m agem 2005 j ulho- agost o; 13( 4) : 469- 73. Nur ses hav e assum ed m anagem ent posit ions in m any healt h inst it ut ions. To pr oper ly accom plish t he dem ands of t his role, it is im port ant t hat t hey be com pet ent in bot h m anagem ent and leadership. For appropriat e p er f or m an ce, k n ow led g e of m an ag em en t an d su p er v ision st y les is a p r ior it y . Th er ef or e, t h e g oal of t h is invest igat ion is t o ident ify t he nurse m anager’s knowledge regarding m anagem ent and leadership. A st ruct ured quest ionnair e cont aining t w ent y - sev en quest ions w as applied t o t w elv e Br azilian nur se m anager s of pr im ar y care cent er called “ Fam ily Basic Healt h Unit s” . Dat a analysis suggest ed t hat t he nurse m anager lower knowledge in m an agem en t an d leader sh ip is r elat ed t o v ision ar y leader sh ip, m an agem en t an d leader sh ip con cept u al differ ences, leader ’s behavior , and sit uat ional leader ship. And, nur se m anager gr eat er know ledge is r elat ed t o pow er ; t eam w or k, and coher ence bet w een v alues and at t it udes. DESCRI PTORS: leader ship; nur sing; adm inist r at ion; nur se GESTI ÓN Y LI DERAZGO: ANÁLI SI S DEL CONOCI MI ENTO DE ENFERMEROS GERENTES Los enfer m er os han asum ido car gos ger enciales en div er sas inst it uciones de salud. Par a que ej er zan su cargo de form a adecuada, deben desarrollar com pet encias de gest ión y liderazgo. Eso requiere conocim ient o. La finalidad de est a inv est igación fue ident ificar el conocim ient o de los enfer m er os/ ger ent es sobr e gest ión y lider azgo. Aplicam os un cuest ionar io est r uct ur ado con v eint isiet e cuest iones a doce enfer m er os/ ger ent es de las Unidades Básicas de Salud y de Unidades de Salud de la Fam ilia. El análisis de los dat os m ost r ó que los enfer m er os/ ger ent es poseían m enos conocim ient os r espect o a lider azgo v isionar io; difer encias concept uales de gest ión y lider azgo; com por t am ient o del líder y lider azgo sit uacional. Los m ay or es conocim ient os est aban r elacionados con el poder ; t r abaj o en equipo y coher encia ent r e v alor es y act it udes. DESCRI PTORES: lider azgo; enfer m er ía; adm inist r ación; enfer m er o GERENCI AMENTO E LI DERANÇA: ANÁLI SE DO CONHECI MENTO DOS ENFERMEI ROS GERENTES Os enferm eiros t êm assum ido cargos gerenciais em diversas inst it uições de saúde. Para que exerçam o car go de for m a adequada é necessár io que desenv olv am com pet ências de ger enciam ent o e lider ança. Par a o desenvolvim ent o dest as com pet ências é pr eciso conhecim ent o. O pr opósit o dest a invest igação foi ident ificar os conhecim ent os dos enfer m eir os/ ger ent es acer ca de ger enciam ent o e lider ança. Aplicam os um quest ionár io est r ut ur ado cont endo vint e e set e quest ões a doze enfer m eir os ger ent es de Unidades Básicas de Saúde e de Unidades de Saúde da Fam ília. Pudem os const at ar, pela análise dos dados, que as quest ões que apresent aram m ais er r os est ão r elacionadas aos conhecim ent os acer ca de: Lider ança Visionár ia; difer enças conceit uais de ger enciam ent o e lider ança; com por t am ent o do líder e Lider ança Sit uacional. As quest ões que os enfer m eir os m ais acert aram são relat ivas aos conhecim ent os sobre poder; t rabalho em equipe e coerência ent re valores e at it u des. DESCRI TORES: lider an ça; en fer m agem ; adm in ist r ação; en fer m eir o 1 Art icle ext ract ed from Doct oral Thesis, Graduat e Program in Fundam ent al Nursing, Universit y of São Paulo at Ribeirão Pret o College of Nursing, Brazil, WHO Collaborat ing Cent re for Nursing Research Developm ent ; 2 Nurse, PhD St udent , Graduat e Program I n Fundam ent al Nursing, Universit y of São Paulo at Ribeirão Pret o College of Nursing, e- m ail: m rl.j abur@t erra.com .br; 3 Psychologist , Professor, Universit y of São Paulo At Ribeirão Pret o School of Econom ics, Business Adm inist rat ion and Accourt ancy, Brazil, e- m ail: gt shinya@usp.br; 4 Nurse, Full Professor, Universit y of São Paulo at Ribeirão Pret o College of Nursing, Brazil, WHO Collaborat ing Cent re for Nursing Research Developm ent , e- m ail: t revizan@eerp.usp.br Ava ila ble in Por t u gu e se on SciELO Br a sil w w w .scie lo.br / r la e Managem ent and leadership... Lourenço MR, Shinyashiki GT, Trevizan MA. 470 Rev Lat ino- am Enferm agem 2005 j ulho- agost o; 13( 4) : 469- 73 w w w .eer p.usp.br / r lae I NTRODUCTI ON at t em pt t o dev elop t he necessar y abilit ies t o act as leaders. Managers m ust possess a view of t he fut ure T he Br azilian collect iv e h ealt h sy st em h as and what scenarios need t o be const ruct ed. They m ust been m aking great effort s t o reorganize and redirect w o r k i n t e a m s t o b u i l d t h e o r g a n i za t i o n a n d b e it s Single Healt h Syst em ( SHS) – “ Sist em a Único de equipped t o conduct t he change pr ocess. They m ust S a ú d e ( S US ) ” b a s e d o n d e c e n t r a l i z a t i o n . Th i s a l so b e cr ea t i v e, a b l e t o h a n d l e a m b i g u i t i es a n d decent r alizat ion appr oach is applied t hr ough r egional conflict s, assum e et hical com m it m ent s, and know how d ist r ib u t ion of r esou r ces an d d ev elop m en t of local t o list en and com m unicat e ( 1) . Like ot her organizat ions, healt h services have m an agem en t capacit y. We are facing rapid and int ense t echnological, b een t r y in g t o k eep u p w it h t h is n ew t en d en cy of social, cu lt u r al an d beh av ior al m odif icat ion s, w h ich m anagem ent advances, in order t o give an adequat e hav e led t o pr ofound changes in t he philosophy and r espon se t o cu r r en t dev elopm en t s. Difficu lt ies h av e f o r m o f b u s i n e s s m a n a g e m e n t . Or g a n i z a t i o n a l been m et t o im plant t he SHS. Mainly, decent ralizat ion ch an g es ar i se f r o m t h e n eed f o r a n ew st r at eg i c h as occu r r ed , b ecau se t h is m od el p r esu p p oses d ir ect ion s, m od if icat ion s, or t r an sf or m at ion s w h ich m unicipal aut horit ies t o assum e great er aut onom y and m ay lead t o d if f er en ces in t er m s of or g an izat ion al r esp on sib ilit y in h ealt h ser v ice m an ag em en t . Th is cu l t u r e or st r u ct u r e ( 1 ) . I n v i ew o f t h ese ch an g es, pr ocess h as collided w it h t h e h ealt h t eam s’ lack of m anagers need t o acquire new knowledge and skills. pr epar at ion t o assu m e m an agem en t an d leader sh ip The dev elopm ent of t hese sk ills r equir es k now ledge f u n ct ion s. Th e f u n ct ion of a m u n icip al m an ag er is a b o u t t h e d i f f e r e n ce s b e t w e e n m a n a g e m e n t a n d r elat iv ely new . I n t he cent r alized m odel t hat ex ist ed leader ship and bet w een t heir com ponent elem ent s. befor e t he SHS, decisions w er e m ade at t he feder al We believe t hat a m anagers’ role as a change agent is subj ect t o t he developm ent of leadership skills. lev el an d m er ely pu t in t o pr act ice in t h e m u n icipal con t ex t . In Alt hough t he current view of leadership is not focused Br azi l , the d ecen t r alizat ion and on one single individual, it is t his kind of leader who is ad m i n i st r at i v e r ef o r m p r o cess, i n p l ace si n ce t h e f r eq u en t l y cal l ed u p o n t o co n d u ct t h e p r o cess o f 1 9 8 0 ’s, organizat ional change. New dem ands and needs m ay m anagem ent t echnologies; highlight ing t he need for require m anagers t o be able t o act bot h as m anagers m anagem ent and leaders. Organizat ions have t o be m anaged, but organizat ions in view of current perspect ives on t he world and life, been going t hr ough alr eady pr ov ok es or ganizat ional t hey are in m uch great er need of leadership ( 2) . changes t hat affect t he ent ire healt h syst em ( 1) . I n t his has ( 4) r ev ealed the ch an g es at debat e on all lev els of healt h healt h .The healt h sect or reform in Brazil has The t erm s m anager, leader and adm inist rat or cont ext , nurses have assum ed m anagem ent posit ions are m ixed up in lit erat ure, due t o t he variet y of ways at Basic Healt h Un it s ( BHU) an d n eed t o d ev elop i n w h i c h a u t h o r s u s e t h e m . Th e r e f o r e , a c l e a r m anagem ent and leadership skills t hat allow t hem t o dist inct ion bet w een t hese t hr ee t er m s is essent ial t o act as ch an g e ag en t s. A st u d y of n u r ses act iv e in u n der st an d t h e r ole each play s in an or gan izat ion . BHU m an ag em en t r ev eal ed t h at , i n p er f o r m i n g a Man ag er d en o t es a p o si t i o n i n t h e o r g an i zat i o n al m anagem ent role, t hese professionals hold an idealist st r uct ur e and r efer s t o a per son v est ed w it h for m al and disciplinarian view and get frust rat ed w hen t hey au t h o r i t y ; l ead er i n d i cat es a p er so n al at t i t u d e, a see t h at t h in g s d o n ot h ap p en as t h ey ex p ect ed , co m p e t e n cy i n r e l a t i o n sh i p s a i m e d a t a ch i e v i n g t urning int o a source of const ant t ension ( 4) . r esu lt s; an ad m in ist r at or occu p ies a su p er ior W h e n a ssu m i n g a m a n a g e m e n t f u n ct i o n , h i er ar ch i cal p ost , w or k s w i t h an or g an i zat i on ’s nurses m ust have a clear view of changes in societ y f u n ct ion al pr ocesses, allocat es r esou r ces, an d u ses and how t hey affect organizat ions, as well as t he fact st aff in t he best possible way ( 3) t h at t h ey n eed t o act d i f f er en t l y. Ch o o si n g t o g o . Leading and adm inist er ing pr edispose t o t he bey ond est ablished par adigm s is a condit io sine qua per f or m an ce of dif f er en t bu t com plem en t ar y r oles. non for t hem t o develop t heir funct ion. The t radit ional An or ganizat ion can hav e m anager s w ho adm inist er n u r si n g a d m i n i st r a t i o n m o d e l d o e s n o t f i t h e r e ( 3) . a n y m o r e ; p e o p l e ch a n g e a n d n u r se s a r e f a ci n g To exercise leadership, m anagers have t o underst and difficult ies t o assim ilat e t his process. Changes happen, t he differ ences bet w een leading and m anaging in an and if we lose t he opport unit y of t ransform at ion t hey as well as m anagers who efficient ly act as leaders Rev Lat ino- am Enferm agem 2005 j ulho- agost o; 13( 4) : 469- 73 w w w .eer p.usp.br / r lae Managem ent and leadership... Lourenço MR, Shinyashiki GT, Trevizan MA. 471 o f f e r, t h e y k n o c k u s d o w n . To i n c o r p o r a t e t h e cont aining t went y- seven quest ions was used t o verify necessar y changes int o t he healt h sect or s, aim ed at t h e su b j ect s’ k n ow led g e on m an ag em en t an d offer ing com pr ehensiv e, equit able and efficient car e, leader sh ip. Et h ical appr ov al w as obt ain ed f r om t h e ef f o r t s a r e b ei n g m a d e t o i m p l a n t n ew ca r e a n d Resear ch Et hics Com m it t ee at t he Univ er sit y of São m a n a g em en t m o d el s. Th er ef o r e, t h e g o a l o f t h i s Paulo at Ribeir ão Pr et o College of Nur sing. invest igat ion is t o ident ify nurse m anagers’ knowledge r egar ding m anagem ent and leader ship. RESULTS AND DI SCUSSI ON METHODS Ch ar act er i zat i on of st u d y p ar t i ci p an t s: As shown in Table 1, six ( 50% ) part icipant s are bet ween A qu an t it at iv e m et h odology w as u sed. Th is 25 and 30 y ear s old; four ( 33. 3% ) ar e bet w een 30 ex p lor at or y st u d y w as d on e in t h e in t er ior of São an d 4 0 y ear s old an d t w o ( 1 6 . 6 6 % ) ar e ov er 4 0 ; Paulo, Brazil, and involved t welve nurse m anagers at elev en ( 9 1 . 6 6 % ) ar e w om en ; sev en ( 5 8 . 3 3 % ) Basic Healt h Unit s and Fam ily Basic Healt h Unit s, who gr aduat ed sev en or less y ear s ago; and nine ( 75% ) a g r e e d t o p a r t i c i p a t e a n d s i g n e d t h e Fr e e a n d part icipant s have occupied t his m anagem ent funct ion I nfor m ed Consent For m . A st r uct ur ed quest ionnair e for t w o y ear s. Table 1 - Part icipant charact erizat ions according t o age, gender, t im e since graduat ion and t im e in m anagem ent posit ion - São José do Rio Pret o, 2003 Identification Nurse 1 Nurse 2 Nurse 3 Nurse 4 Nurse 5 Nurse 6 Nurse 7 Nurse 8 Nurse 9 Nurse 10 Nurse 11 Nurse 12 Age 44 years 29 years 38 years 27 years 30 years 30 years 38 years 24 years 31 years 39 years 27 years 41 years Gender Fem ale Fem ale Fem ale Fem ale Fem ale Fem ale Fem ale M ale Fem ale Fem ale Fem ale Fem ale Tim e since graduation 22 years 7 years 15 years 7 years 7 years 7 years 14 years 4 years 4 years 18 years 3 years 19 years Tim e in managem ent position 2 years 8 m onths 2 years 2 years 1 - 6 months 2 years 2 years 10 m onths 2 years 2 years 2 years 2 years Table 2 - Part icipant charact erizat ion in t erm s of previous m anagem ent experience, highest degree, m anagem ent and leader ship- r elat ed cour ses - São José do Rio Pr et o, 2003 Identification Nurse 1 Nurse 2 Nurse 3 Nurse 4 Nurse 5 Nurse 6 Nurse 7 Nurse 8 Nurse 9 Nurse 10 Nurse 11 Nurse 12 Previous management experience No Yes No No No No No Yes No No No No Highest degree Management-related course Specialization Specialization Specialization Specialization Undergraduate Undergraduate Specialization Specialization Specialization Specialization Specialization Specialization GERUS* in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course GERUS in course Leadership-related course Yes No No No No No Yes No No Yes No No * GERUS: Managem ent Developm ent of Basic SUS Unit s Ten ( 83. 33% ) par t icipant s do not hav e any pr ev ious m anagem ent ex per ience and assum ed t his N URSE M AN AGERS’ KN OW LED GE ABOUT MANAGEMENT AND LEADERSHI P funct ion for t he first t im e under t he current m unicipal g o v e r n m e n t ; t e n ( 8 3 . 3 3 % ) p o sse ss a sp e ci a l i st A st r uct ur ed quest ionnair e w it h 27 m ult iple degr ee, n in e ( 7 5 % ) of w h om t ook a Specializat ion choice and t rue- false quest ions was used t o evaluat e Cour se in Collect iv e Healt h; all ( 100% ) par t icipant s k n ow ledge abou t m an agem en t an d leader sh ip. Th e are t aking t he GERUS program , and nine ( 75% ) have f ollow in g asp ect s w er e con sid er ed : con cep t u al never part icipat ed in any specific course on leadership d if f er en ces b et w een m an ag em en t an d lead er sh ip ; ( Table 2) . t y p e s o f p o w e r ; l e a d e r sh i p t h e o r i e s; si t u a t i o n a l Managem ent and leadership... Lourenço MR, Shinyashiki GT, Trevizan MA. Rev Lat ino- am Enferm agem 2005 j ulho- agost o; 13( 4) : 469- 73 w w w .eer p.usp.br / r lae 472 leader sh ip; v ision ar y leader sh ip; t eam w or k ; v alu es t o t heir collabor at or s. All par t icipant s classified t his and at t it udes of a leader; vision; and t ransform at ional st at em ent as false. The answ er s t o quest ions 3, 21, leadership. We have lim it ed our analysis t o t hose it em s and 24 reveal t hat , alt hough nursing hist ory displays on w h ich t h e p ar t icip an t s r ev ealed t o p ossess t h e a m or e dir ect ive leader ship, t his has been changing. gr eat est or sm allest k now ledge. We b e l i e v e t h a t u n d e r g r a d u a t e p r o g r a m s h a v e The group answered approxim at ely ( 62% ) or st i m u l a t e d r e f l e ct i o n s f o r n u r se s t o a d o p t m o r e 17 quest ions correct ly. All part icipant s gave t he right part icipat ory m odels, delegat e power t o collaborat ors, answer t o quest ions 3; 15; 21; 22; and 24. Quest ion be coher ent in t eam coor dinat ion, and k now how t o 3 refers t o t he power at t ached t o t he posit ion. One of use t heir posit ion pow er. t h e ch a r a ct e r i st i cs o f l e a d e r sh i p i s t h a t l e a d e r s St u d y p a r t i ci p a n t s r e v e a l e d t h e sm a l l e st ex er cise pow er ( 5) . Pow er is t he capacit y t o influence knowledge in quest ions 2; 7; 10; 17; 19; 25. Quest ion an ot h er per son or gr ou p’s beh av ior so as t o m ak e 2 r efer s t o v ision ar y leader sh ip. Leader s possess a t h em d o som et h in g t h ey w ou ld n ot d o ot h er w ise. clear sen se of t h e f u t u r e an d w h at it t ak es t o get ( 6) . w h er e t h ey w an t ; in ot h er w or d s, lead er s h av e a The differ ence bet w een leader ship and pow er is t hat v ision . Qu est ion 7 look s f or k n ow led g e ab ou t t h e leader ship is sim ply any at t em pt t o ex er t influence, d i f f e r e n ce b e t w e e n l e a d e r sh i p a n d m a n a g e m e n t . w h ile leader s’ pow er is t h eir pot en t ial t o in flu en ce. An sw er s r ev eal ed t h at m o st p ar t i ci p an t s i n v er t ed Thus, power allows a leader t o influence ot her persons t h ese con cep t s. or get t hem t o subm it t hem selves. Posit ion pow er is m anagem ent . The for m er const it ut es t he basic for ce also called legit im at e power and represent s t he power behind any successful change. Managem ent im plies a per son r eceiv es as a r esu lt of h is/ h er posit ion in m aint aining t he cur r ent sy st em funct ioning t hr ough Power is t he abilit y t o induce or influence behaviors t he or ganizat ion’s for m al hier ar chy ( 5) Le a d e r s h i p is differ ent fr om p lan n in g , b u d g et in g , or g an izat ion an d con t r ol. . Var iou s st u d ies h av e at t em p t ed t o classify Leader sh ip w or k s t h r ou gh people an d cu lt u r e, it is p o w e r b a se s. We h a v e i d e n t i f i e d f i v e : co e r ci o n , flex ible and w ar m . Managem ent , on t he ot her hand, c o m p e t e n c e , l e g i t i m a c y, r e f e r e n c e , a n d r e w a r d act s t hrough t he hierarchy and is m ore rigid and cold. ( 6) . Quest ion num ber 15 focuses on t he t eam . Le a d e r s h i p Team s appear when t he result is a m at t er of collect ive pu r poses ( 9 ) . pow er and m anagem ent ser v e differ ent r espon sibilit y. Leader sh ip in cr easin gly occu r s in t h e Qu est i o n 1 0 d escr i b es t h e m o st f r eq u en t cont ext of t eam s. This is a great challenge for leaders b e h a v i o r s i n l e a d e r sh i p r e se a r ch , su ch a s: t a sk nowadays. Team leaders need t o develop abilit ies like: p er f or m an ce, g r ou p m ai n t en an ce; an d d eci si on inst ruct ing; conflict solving; list ening; giving feedback; m ak ing. I n t his r espect , it st ands out t hat , in t heir and using oral persuasion. They need t o learn how t o answ ers, part icipant s cont inue indicat ing research on shar e aut hor it y and r esult s( 5) . st y les, su ch as au t ocr at ic, dem ocr at ic an d laissez- Qu e st i o n 2 1 i s r e l a t e d t o t h e co h e r e n ce fair e leader s. Quest ion 17 st at es t hat “ t ask- or ient ed bet ween values and at t it udes t hat influence behavior. leader s ar e w or r ied about guar ant eeing high Leaders’ behavior has t o be st rict ly in accordance wit h per for m ance lev els for t he or ganizat ion”. t heir discourse. The values t hey adopt in t heory and St udies on behav ior al t heor ies in leader ship pract ice have t o be coherent . Leadership is a relat ion have t ried t o ident ify which charact erist ics of leaders’ based on credibilit y and t rust ( 7) . b eh av ior cou ld b e r elat ed t o ef f icien t p er f or m an ce Quest ion 22 refers t o t he power of reference, and reach t w o dim ensions: t ask- orient ed behavior or is good p eop le- or ien t ed b eh av ior. Th ese st u d ies con clu d ed int erpersonal abilit ies. This power is based on personal t hat em ploy ee- or ient ed behav ior is m or e associat ed ch ar ism a, on t h e w ay lead er s sp eak or act ( 8 ) . Th e w it h sat isfact ion and pr oduct iv it y t han t ask- or ient ed p ow er of r ef er en ce is ad op t ed b y t r u ly p r od u ct iv e behav ior. We k now fr om cont ingency t heor ies, w hich leaders. They are efficient because of t heir followers’ in clu d ed sit u at ion al f act or s, t h at t h er e is n o id eal ad m ir at ion an d id en t if icat ion w it h t h e lead er as a behav ior for all sit uat ions. w h ich par t ially m aint ained t hr ough per son an d t h e cau se ( s) h e def en ds. Th is k in d of pow er nat ur ally inv olv es it s follow er s ( 3) . Quest ion 19 deals w it h cont ingency t heor ies of lead er sh ip , m or e sp ecif ically t h e t h eor y of Qu est ion 2 4 , also r elat ed t o pow er, affir m s sit uat ional leadership ( 6) . I n t his approach, t he aut hors t hat leaders lose power when t hey delegat e a decision conclude t hat t he pr ocess of leading is a funct ion of Rev Lat ino- am Enferm agem 2005 j ulho- agost o; 13( 4) : 469- 73 w w w .eer p.usp.br / r lae Managem ent and leadership... Lourenço MR, Shinyashiki GT, Trevizan MA. 473 t he leader, t he subor dinat e and sit uat ional var iables. i m ag e o f t h e f u t u r e, an d h as t o b e p er cei v ed as I n research on nurses’ leadership st yle in t he ch allen gin g an d possible ( 5 ) . Par t icipan t s m ade m ost cont ex t of sit uat ional leader ship, t he aut hor s affir m m ist akes on quest ions relat ed t o visionary leadership; t hat , w hen nur ses ent er t he labor m ar k et , it is v er y t o a con cept u al u n der st an din g of m an agem en t an d d if f icu lt f or t h em t o ex er cise lead er sh ip , an d t h ey leader sh ip; t o leader s’ beh av ior ; an d t o sit u at ion al usually do not hav e a r efer ence fr am ew or k t o guide lead er sh ip . Th e h ig h est n u m b er of cor r ect an sw er s t hem in t his process ( 10) . The part icipant s’ answ ers t o w ent t o quest ions relat ed t o: pow er; t eam w ork; and t h ese qu est ion s r ev eal t h at t h ey do n ot k n ow t h is coher ence bet w een v alues and at t it udes. r ef er en ce f r am ew or k . Quest ion 25 affir m s t hat all leader s hav e a v ision. We k now t hat not all leader s ar e v isionar ies. FI NAL OBSERVATI ONS I n lead er sh ip st u d ies, v ision com es u p as a charact erist ic of t he charism at ic leader. These leaders We b e l i e v e t h a t u n d e r g r a d u a t e n u r s i n g are willing t o t ake risks because of t heir vision, but it p r og r am s sh ou l d st i m u l at e t h e d ev el op m en t of is in visionary leadership st udies t hat t he vision get s m anagem ent and leader ship com pet encies, as t hese st r o n g e r. I t i s d i f f e r e n t f r o m a l l o t h e r f o r m s o f ar e r equir ed by t he labor m ar k et . The sam e is t r ue g u id an ce. A v ision is accom p an ied b y a clear an d f o r t h e i n st i t u t i o n s w h e r e n u r se s h a v e sk i l l s a s in st igat in g im age t h at of f er s an in n ov at iv e f or m of m anager s. But , in assum ing m anagem ent funct ions, im provem ent . I t uses people’s energy and em ot ions. n u r ses n eed t o sear ch f or k n ow led g e an d d ev elop A v ision ’s essen t ial ch ar act er ist ics seem t o b e t h e t h e n ecessar y com pet en cies t o be able t o act as a in sp ir in g p ossib ilit ies t h at ar e f easib le an d v alu e- m an ager an d a leader, in accor dan ce w it h t h e n ew focused. I t is capable of offer ing a clear and bet t er p ar ad ig m . BI BLI OGRAPHI C REFERENCES 1 . Kisil M. Gest ão da m u dan ça or gan izacion al, v. 4 . - São Paulo ( SP) : Faculdade de Saúde Pública da Univ er sidade de São Paulo; 1998. ( Sér ie Saúde e Cidadania) 2. Bot elho EF. Do gerent e ao líder: a ev olução do profissional. 2 nd ed. São Paulo ( SP) : At las; 1991. 3. Bergam ini CW. O líder eficaz. São Paulo ( SP) : At las; 2002. 4. Fracolli LA, Egry EY. O processo de t rabalho de gerência: in st r u m en t o pot en t e par oper ar m u dan ças n as pr át icas de s a ú d e ? 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