MANAGEMENT AND LEADERSHIP: ANALYSIS OF NURSE MANAGERS’ KNOWLEDGE

Nurses have assumed management positions in many health institutions. To properly accomplish the demands of this role, it is important that they be competent in both management and leadership. For appropriate performance, knowledge of management and supervision styles is a priority. Therefore, the goal of this investigation is to identify the nurse manager’s knowledge regarding management and leadership. A structured questionnaire containing twenty-seven questions was applied to twelve Brazilian nurse managers of primary care center called “Family Basic Health Units”. Data analysis suggested that the nurse manager lower knowledge in management and leadership is related to visionary leadership, management and leadership conceptual differences, leader’s behavior, and situational leadership. And, nurse manager greater knowledge is related to power; team work, and coherence between values and attitudes.


INTRODUCTION
The Brazilian collective health system has been making great efforts to reorganize and redirect its Single Health System (SHS) -"Sistema Único de Saúde (SUS)" based on decentralization.This decentralization approach is applied through regional distribution of resources and development of local management capacity.
We are facing rapid and intense technological, social, cultural and behavioral modifications, which have led to profound changes in the philosophy and form of business management.Organizational changes arise from the need for a new strategic directions, modifications, or transformations which may lead to differences in terms of organizational culture or structure (1) .In view of these changes, managers need to acquire new knowledge and skills.
The development of these skills requires knowledge about the differences between management and leadership and between their component elements.
We believe that a managers' role as a change agent is subject to the development of leadership skills.
Although the current view of leadership is not focused on one single individual, it is this kind of leader who is frequently called upon to conduct the process of organizational change.New demands and needs may require managers to be able to act both as managers and leaders.Organizations have to be managed, but in view of current perspectives on the world and life, they are in much greater need of leadership (2) .
The terms manager, leader and administrator are mixed up in literature, due to the variety of ways in which authors use them.Therefore, a clear distinction between these three terms is essential to understand the role each plays in an organization.
Manager denotes a position in the organizational structure and refers to a person vested with formal authority; leader indicates a personal attitude, a competency in relationships aimed at achieving results; an administrator occupies a superior hierarchical post, works with an organization's functional processes, allocates resources, and uses staff in the best possible way (3) .
Leading and administering predispose to the performance of different but complementary roles.
An organization can have managers who administer as well as managers who efficiently act as leaders (3) .
To exercise leadership, managers have to understand the differences between leading and managing in an attempt to develop the necessary abilities to act as leaders.Managers must possess a view of the future and what scenarios need to be constructed.They must work in teams to build the organization and be equipped to conduct the change process.They must also be creative, able to handle ambiguities and conflicts, assume ethical commitments, and know how to listen and communicate (1) .In Brazil, the decentralization and administrative reform process, in place since the 1980's, has revealed the debate on health management technologies; highlighting the need for management changes at all levels of health organizations (4) .The health sector reform in Brazil has been going through already provokes organizational changes that affect the entire health system (1) .In this context, nurses have assumed management positions at Basic Health Units (BHU) and need to develop management and leadership skills that allow them to act as change agents.A study of nurses active in BHU management revealed that, in performing a management role, these professionals hold an idealist and disciplinarian view and get frustrated when they see that things do not happen as they expected, turning into a source of constant tension (4) .
When    3 refers to the power attached to the position.One of the characteristics of leadership is that leaders exercise power (5) .Power is the capacity to influence another person or group's behavior so as to make them do something they would not do otherwise.

RESULTS AND DISCUSSION
Power is the ability to induce or influence behaviors (6) .
The difference between leadership and power is that leadership is simply any attempt to exert influence, while leaders' power is their potential to influence.
Thus, power allows a leader to influence other persons or get them to submit themselves.Position power is also called legitimate power and represents the power a person receives as a result of his/her position in the organization's formal hierarchy (5) .
Various studies have attempted to classify power bases.We have identified five: coercion, competence, legitimacy, reference, and reward power (6) .Question number 15 focuses on the team.
Teams appear when the result is a matter of collective responsibility.Leadership increasingly occurs in the context of teams.This is a great challenge for leaders nowadays.Team leaders need to develop abilities like: instructing; conflict solving; listening; giving feedback; and using oral persuasion.They need to learn how to share authority and results (5) .
Question 21 is related to the coherence between values and attitudes that influence behavior.
Leaders' behavior has to be strictly in accordance with their discourse.The values they adopt in theory and practice have to be coherent.Leadership is a relation based on credibility and trust (7) .
Question 22 refers to the power of reference, which is partially maintained through good interpersonal abilities.This power is based on personal charisma, on the way leaders speak or act (8) .The power of reference is adopted by truly productive leaders.They are efficient because of their followers' admiration and identification with the leader as a person and the cause (s) he defends.This kind of power naturally involves its followers (3) .
Question 24, also related to power, affirms that leaders lose power when they delegate a decision to their collaborators.All participants classified this statement as false.The answers to questions 3, 21, and 24 reveal that, although nursing history displays a more directive leadership, this has been changing.
We believe that undergraduate programs have stimulated reflections for nurses to adopt more participatory models, delegate power to collaborators, be coherent in team coordination, and know how to use their position power.Leadership and management serve different purposes (9) .
Question 10 describes the most frequent behaviors in leadership research, such as: task performance, group maintenance; and decision making.In this respect, it stands out that, in their answers, participants continue indicating research on styles, such as autocratic, democratic and laissezfaire leaders.Question 17 states that "task-oriented leaders are worried about guaranteeing high performance levels for the organization".
Studies on behavioral theories in leadership have tried to identify which characteristics of leaders' behavior could be related to efficient performance and reach two dimensions: task-oriented behavior or people-oriented behavior.These studies concluded that employee-oriented behavior is more associated with satisfaction and productivity than task-oriented behavior.We know from contingency theories, which included situational factors, that there is no ideal behavior for all situations.
Question 19 deals with contingency theories of leadership, more specifically the theory of situational leadership (6) .In this approach, the authors conclude that the process of leading is a function of

METHODSA
quantitative methodology was used.This exploratory study was done in the interior of São Paulo, Brazil, and involved twelve nurse managers at Basic Health Units and Family Basic Health Units, who agreed to participate and signed the Free and Informed Consent Form.A structured questionnaire containing twenty-seven questions was used to verify the subjects' knowledge on management and leadership.Ethical approval was obtained from the Research Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing.

Table 1 -
Participant characterizations according to age, gender, time since graduation and time in management position -São José do Rio Preto, 2003