LEC 1 PRELIM Nursing Leadership and Management

7/27/2019 LEC 1 PRELIM Nursing Leadership and Management

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NURSING LEADERSHIP &

MANAGEMENT


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Leadership the process of influence in which the

leader influences others toward goal

achievement

is the effort to envision and inspirechanges

A social transaction in which one

person influences others.


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LEADERSHIP

Process of influencing the behavior or

actions of a person or group to attain

desired objectives

A dynamic, interactive process that

involves three dimensions: leader,

follower and the situation


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Leader the one who leads, conducts or guides

the process


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Lead to go with or ahead of so as to show

the way; guide


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A Leader is one others followwillingly and voluntarily


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TYPES OF LEADERS

Informal leader

Does not have official sanction to

direct activities of others; chosen bythe group itself

Usually become leaders because of

age, seniority, especialcompetencies, an invitingpersonality or ability tocommunicate with and counsel

others


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TYPES OF LEADERS

Informal leader

Play a valuable role if their behavior

and influence are congruent withthe goals of the organization.


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Formal or appointed

chosen by administration, and givenofficial or legitimate authority to act

Ex. The elected and appointed officers


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Theories of Leadership


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Great Man TheoryArgues that few people are born to begreat leaders who are well rounded &

simultaneously instrumental &supportive

Many finds this theory unattractivebecause of the premise that leaders are

born not made, which suggests that

leadership cannot be developed


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Charismatic theory

Leader inspires others by obtaining

emotional commitment from followers

and by arousing feelings of loyalty &enthusiasm


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Robert House - found that thisleaders have st rong convic t ion &

high sel f conf idence & fo l lowers

has the similar belief with thecharismatic leader thus showing

signs of unquest ion ing acceptance

& obedience


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Bernard Bass - it sometimes leads

into bl ind obedience but a

t ransformational leaders use it to

mot ivate members


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Jay Conger & Kanungo (1998) -Theyfound out that char ismais more of an

at t ribut ional phenomenon


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Charm is an inspirational

quality


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Trait Theory Early works in this area maintained

that traits are inherited, but later

theories suggest that the t rai ts can be

obtained through learning &experience


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Leaders are born, notcreated.


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Leadership Traits

Task-Oriented

Relationship-Oriented

Participative Leadership


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Leadership Traits

Task-Oriented

behaviors includes planning,

scheduling, &coordinating activities.


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Relationship-Oriented

includes being friendly & considerate,

showing trust & confidence, expressingappreciation & providing recognition


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Participative Leadership

enlists associates participation in

making decisions


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Situational

Leadership Theory

Predicts the most appropr iate

leadership sty le from the level of

matur i ty of the fo l lowers


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Contingency Theory leadership style will be effect ive&ineffect ive depending on the

si tuat ion


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Path-Goal Theory derived from the expectancy theorywhere people act as they do

because they expecttheir behavior

to produce sat isfactory resu l ts


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In path-goal relationship, the leaderfacil i tates task accompl ishmentby

minim izing obst ruct ionto the goals

(structured activity), & by rewardingfo l lowersfor completing their task


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staff associates are introduced as avariable where in staff associates

wi th high need for achievement

probably will prefer a task o rientedleader, but peop le w ith high need

for aff i l iat ion will prefer a

considerate leader


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Transactional

Leadership an exchange posture that identi f iesthe needsof the followers & provides

reward in exchange for expected

performance

a contract for mutual benefits that has

contingent rewards


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Transformational

Leadership Promotes employee development &

attend to their needs by mot ivat ing,

inspi r ing, & inf luencing the

fo l lowers

Leader serves as a ro le modelwho

provides a sense of direction &encourages self management


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described it in terms of charisma &intellectual stimulation

transformational leaders change theorganization by real igning the

organizations cul turewith the new

vis ion, & rev is ion of assumpt ions,values, & norms


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Integrative Leadership

Model Obviously there is no one bestleadership sty le. Leaders are rarely

totally people oriented or task

oriented.

One should be aware of h is own

behavior & learn to adapt.


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Styles of Leadership


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Democratic

is part ic ipatory, with the author i tydelegated to others, influential by

having close and personal

relat ionsh ip w i th the subord inates


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Bureaucratic

is done acco rding to pro cedu re orpol icy. Its more of a po l ice off icer

than a leader and managesby the

book .


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Laissez-Faire

Is passive & permissive, nondirective,inactive. Chaos is most l ike ly to

developbecause members may work

independently


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Elements of Ledearship


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Vision

Provides direction to the influence

process towards a successfully goal.

Act as a bridge between the current

state and a future state.


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Influence

The ability to obtain followers,

compliance or request.


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Authority

Legitimate power to direct others

right to expect or secure compliance


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Power

Is defined as the ability to efficiently

and effectively exercise authority andcontrol through personal,

organizational and social strength.

Ability to impose the will of one personor group to bring about certain

behaviors.


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Sources of power

Expert power it is derived from the

knowledge & skills one possess


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Legitimate power is derived from the

position one holds in a group &

indicates authority but not sufficient asones only source of power


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Referent power derived from respect

& trust coming from any individual

group or organization. It is also callednetworking.


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Reward power it comes from the

ability to recognize others for

complying by compensate throughmeans of benefits, time off, desired

gifts, promotions or increase in pay or

responsibility.


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Coercive power is based on fear of

punishment if one fails to conform


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Connection power it comes from

coalition & interpersonal relationship


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Informational power it comes from

knowledge & access to information.


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Review


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THEORIES OF LEADERSHIP

TRAIT THEORY

*leaders are born with inherited

tasks

*envisioning goals, affirming valuesserving as a symbol

QUALITIES/TRAITS OF A


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QUALITIES/TRAITS OF A

LEADER

Intelligence: judgment, knowledge

and fluency of speech

Personality: adaptability, alertness,

creativity, cooperativeness, personal

integrity, self confidence, emotional

balance and control, independence


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QUALITIES OF .

Abilities: ability to enlist cooperation,

popularity and prestige,

sociability/interpersonal skills, social

participation, tact and diplomacy


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GREAT-MAN THEORY

Leaders are born and not made

Great leaders will arise when there is

a great need

Ex. King of Spain


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BEHAVIORAL THEORY

Successful leadership is based in

definable, learnable behavior


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PARTICIPATIVE LEADERSHIP

People are more committed to actions


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SITUATIONAL THEORY

The best action of leader depends on

range of situational factors

*motivation

*capability of followers

performance of leader and follower

attitudes, needs and expectations

SITUATIONAL LEADERSHIP


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SITUATIONAL LEADERSHIP

THEORY

Depends on the level of the maturity of

individual


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CONTINGENCY THEORY

Leaders ability to lead is contingent

upon situation.

a.leadership member relation

b.task structure

c.position power


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TRANSACTIONAL LEADESHIP

People are motivated by reward and

punishment


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TRANSFORMATIONAL THEORY

People will follow a person who

inspires them

A person with vision and passion

Value based leadership


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PATH-GOAL THEORY

Leaders has certain objectives and

initiates their followers to attain their

own objectives


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STRATEGY THEORY

BASED ON HUMAN HANDLINGSKILLS OF LEADERS Strategy 1 attention thru vision

Strategy 2 meaning thru communication

Strategy 3 - trust thru positioning

Strategy 4 - deployment of self thrupositive self regard


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CHARISMATIC THEORY

Charm and grace are needed to

create followers

Self belief


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STYLES OF LEADERSHIP

1. AUTHORITARIAN/AUTOCRATI C

Strong control over the group ordirective approach

Concern with task accomplishments


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2. DEMOCRATIC OR PARTICIPATIVE

Leaders focuses on involving

subordinates in decision making

People oriented


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3. LAISSEZ FAIRE OR PERMISSIVE

Delegating approach

Little or no direction is provided to

subordinates

BASES OF POWER FOR


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BASES OF POWER FOR

LEADERS

Legitimate/authority power granted byan official position

Referent potential influence one hasbecause of the strength of relationships

between leaders and followers

Expert gained thru the position of

special knowledge, wisdom, sound

judgment, good decision skills, skills or


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Informational power exists when an

individual have information that others

must have to accomplish particular

goals

Connection power based on having

connections or associations withothers who are powerful


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Coercive power or punishment power

manager control the groups through

fears, threats and sanctions

Reward power this is achieved

through influencing others because of

ones control over desired resources

COMPONENTS OF EFFECTIVE


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COMPONENTS OF EFFECTIVE

LEADERSHIP

Understanding of the individual

strength, weaknesses and potential

Knowledge of basic ingredients for

leadership and management

Systematic use of self to get things

done at the right time


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Leadershipis the essence of professionalism andshould be considered an essential component of

all nurses and other professionalroles

Joyce Clifford


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MANAGEMENT

Art of getting things done thru people

Process that involves guidance,direction of a group of people toward

organizational goals or objectives

Process thru which the objectives of

an organization are accomplished by

utilizing human, physical and technical


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Management

the act of planning, organizing, directing

(leading), controlling (evaluating).

is a process by which a cooperative groupdirects actions towards common goals

is a process of coordinating and allocating

resources toachieve organizational goal


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Manager

a person that creates and maintainsan internal environment in an

enterprise in which individual work

together as a group

M i


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Managing

accomplishing the goals of the groupthrough effective and efficient use of

resources


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MANAGEMENT ROLES

Information role monitor,

disseminator, spokesperson

Interpersonal role- figurehead,

leaders, liaison

Decisional roles entrepreneur,

disturbance handler, resource

allocator, negotiator


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MANAGEMENT LEVELS

FIRST LEVEL Supervises the

operative employee

MIDDLE LEVEL plan and coordinate

activities of the organization.

TOP LEVEL manages the

organization as a whole.

C i f L d &


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Comparison of Leaders &

Managers


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Leadership Management

Motto Do the right things Do things rightChallenge Change ContinuityFocus Purpose Structures & proceduresTime Frame

Future

Present

Methods Strategies SchedulesQuestions Why? Who, What, When, Where

& How?Outcomes Journeys DestinationsEvaluate

Human Potential Performance


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MANAGEMENT THEORY

Purposes of Theory

1. Provide a stable focus of understanding

what we experience

2. Enable us to communicate freely

3. Challenge us to keep learning of our

world

PRINCIPLES OF


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PRINCIPLES OFMANAGEMENT

(MODERN ERA)

Scientific Classical Human Relations Behavioral

Scientific


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Scientific

ManagementFocused on the best way to do atask

- Eff ic iencyprovided information on:standards

time & motion studies

task analysis

job simplification

productivity incentives

FREDERICK TAYLOR (1856-1915)


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FREDERICK TAYLOR (1856 1915)

FATHER OF SCIENTIFICMANAGEMENT

Used stopwatch studies & applied the

principles of:

observation

measurement

scientific comparison

to determine the most efficient way to

accomplish a task


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Reduced wasted effort Set standard for performance

Encourage specialization

Stressed the selection of qualifiedworkers who could be developed for a

particular job.


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Monistic Theory

FRANK GILBRETH(1868-1924)LILIAN GILBRETH(1878 1972)


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LILIAN GILBRETH(1878-1972)


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Pioneers in time and motion studies

Emphasized the benefits of:

job simplificationestablishment of work standards

effects of the incentives wage plan

fatigue on work performance


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First to use motion picture films toanalyze workers emotions

Developed a micro chronometer

Henry Gantt (1861-1919)


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y ( )

Disciple of Taylor, was concerned w/problems of efficiency

Refined previous work rather than

introduce new concepts Developed a task and bonus

remuneration plan


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Argued for:more humanitarian approach

placed emphasis on servicerather than profit objectives

recognize useful non-monetaryincentives

CLASSIC ORGANIZATON


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CLASSIC ORGANIZATON

Deductive rather than inductive

-views the organization as a whole

rather than focusing sole ly onproduction

-focused on: planning

organizingcontrolling

Henry Fayol (1841 1925)


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Henry Fayol (1841-1925)

Father of Management Process School


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Studied the functions of managers andconcluded that management is

universal

A believer in the division of work , he

argued that special izat ion inc reases

eff ic iency


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Believed that workers:should be allowed to think

implement plans

be adequately remunerated fortheir services


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Encourage devt of group harmonythrough equal treatmentand stabi l i ty

of tenu refor personnel

a place for everything and

everything in i ts p lace.

FAYOLS MANAGEMENT


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PRINCIPLES

Division of Labor the more peoplespecialize, the more efficient they canperform

Authority management needs to beable to give orders so that they canget things done.


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Discipline members in anorganization need to respect the rulesand regulation that govern theorganization

Unity of command subordinatesshould receive orders from only one

superior

Unity of direction member of any


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y yorganization should have only oneobjectives

Subordination of Individual Interestto the Common Good give way for

the interest of everybody.

Remuneration workers should be

paid according/commensurate to thework they perform.


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Centralization managers should

retain the final responsibility butshould at the same time give theirsubordinate enough time and authorityto do their job.

Hierarchy the line of authority in anorganization runs in order of rank.

Order materials and people shouldbe at the right time and at the right

place

Equity people in the organizationshould be treated with equity and


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should be treated with equity andjustice

Stability of Staff the greater theturn-over rate, the less workers are

efficient

Initiative subordinate should begiven the freedom to do their

work/conceive plans even thoughsome mistakes occur

Espirit de Corps good relationship

Max Weber (1864 1920)


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Max Weber (1864-1920)

Father of OrganizationalTheory


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Conceptualized bureaucracy w/

emphasis on rules instead of

individuals and competency overfavoritism as the mos t effic ient basis

of organization


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Conceptualized a structure of

author i ty that would facilitate the

accompl ishment of theorgan izat ional object ives

Basis Of Authority


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Basis Of Authority

1. Traditional Authority

2. Charisma

3. Rational/Legal Authority

Human Relations


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Human Relations

Stresses the SocialEnvironment

-focused on the effect ind ividualshaveon the success or fa i lure of an

organization

Chester Barnard (1886-


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1961)


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Studied the func t ions of execut iveswhile he was a manager for the New

Jersey bell telephone system

He defined the managers

responsibilities


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1. Defining Objectives

2. Acquiring Resources

3. Coordinating Activities


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Stressing the importance ofcooperation b/w management and

labor, he noted that the degree of

cooperat ion depends on the non-

f inanc ial inducement


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Stressed the role of in formalorganizat ion fo r

aiding communication

meeting individuals needs maintaining cohesiveness

Mary Parker Follett (1868-


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1933)

Mother of Modern Management


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Stressed the importance ofcoordinating the psychological and

sociological aspect of management

Perceived the organizat ion as a

social sys temand managementas

social process


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She considered subordinat ion

offensive


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Distinguished between power w/othersand power over othersand

indicated that legi t imate power is

produced by a circular behavior

whereby super iorand subordinates

mutually inf luenceone another.


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The law of the situation dictates that a

person does no t take orders from

another person but f rom thesi tuat ion

Elton Mayo (1810-1949)


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Elton Mayo (1810 1949)

Author of The Hawthorne Studies


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Though criticized for poor research

methods, the HawthorneStudies

stimulated considerable interest inhuman problems on the job

lighting had li t t le effect onproduction


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Work norms obviously had more

influence than wage incentive

Kurt Lewin (1890-1974)


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Kurt Lewin (1890 1974)

Study of Group Dynamics


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maintained that groups have

personal i t ies of their own;

composi te of the memberspersonal i t ies

advocated democrat ic superv is ion


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Identified the three types of leadersAuthorat

Democrat

Laissez-Faire

Jacob Moreno (1892-1979)


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( )

Developed Sociometryto analyze

group behavior


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Claimed that people are either:attracted to

repulsed by

indifferent towards others Developed the sociogram to chart

pairings of preferences for others


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Contributed to: psychodrama (individual therapy)

sociodrama ( related to social and cultural

roles)

and role playing techniques

for the analysis of interpersonal

relations

Behavioral Science


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emphasizes the use of scient i f icprocedures to study the

psychological , sociological , and

anthropological aspects of human

behavior in organization

Abraham Maslow (1908-1970)


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Abraham Maslow (1908 1970)

Hierarchy of NeedsTheory


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Initiated the Human Behavioral School in

1943

He outlined a hierarchical structure for

human needs classified into fivecategories:

1. Physiological

2. Safety

3. Belonging

4. Esteem


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Once needs are met, newer

and more mature ones mustemerge

Frederick Herzberg(1923-

2000)


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2000)

Factors in the job can raise the level ofperformance and meet the higher

order needs

Job-content (factors in the job) ex:

achievement, recognition, growth =

mot ivators

Job-context (surrounding environmental

factors) ex: supervision, company policy,working conditions = hygiene factors

Douglas McGregor (1906-

1964)


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1964)

Theory X and Y


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Developed the managerialimplications ofMaslows Theory

Notes that ones style of managementis dependent on ones philosophy of

humans


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Theory Xmanagers emphasis onthe goal of the organization

People dislike & will avoid work

Workers must be directed, controlled,

coerced, threatened


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Theory Y emphasis is on the goal ofthe individual

People do not inherently dislike work

Work can be a source of satisfaction Workers have self direction, self-

control, responds to rewards for the

accomplishment of goals

William Ouchi


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Theory Z


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Published Theory Z: How American

Business Can Meet the Japanese

Chal lengein 1981


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Japanese organization lifetime employment

Slow evaluation & promotion

Non-specialized career paths Implicit control mechanisms

Collective decision-making &

responsibility Wholistic concern


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US organization Short-term employment

Rapid evaluation & promotion

Specialized career paths

Explicit control mechanisms

Individual decision-making

Individual responsibility

Segmented concern

Richard Pascale & Anthony

Athos


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Athos

Gave a more extensive discussion of

the Art o f Japanese Management:

App l icat ion for Amer icanExecut ivesin 1981.


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Explain that organization in the UStend to savor strategy, structure,

and systems, whereas the Japanese

organization focus on staff, ski l ls,

sty le, and superord inate goals

Rensis Likert (1903-1981)


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Theory of Management is based on his work atthe University of Michigans Institute for Social

Research


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He identified 3 types of variables in

organization

1. Causal


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Includes: Leadership behavior

Organizational structure

Policies

Controls

2. Intervening


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These are: Perceptions

Attitudes

motivations

3. End-result


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Includes: Measures of profits

Costs

Productivity


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Managers may act in ways harmful tothe organization because they

evaluate end results to the exclusion

of intervening variables.

Managerial Grid


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Managerial Grid

B

(1,9)

E

(9,9)


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C

(5,5)

A

(1,1)

D

(9,1)

Vertical concern for people Horizontal concern fro production

Behavioral Science

Robert Blake (1918) & Jane Mouton (1930)


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Maintained that there are 2 critical dimensions

of leadership1. Concern for people

2. Concern for production

They depicted these on a 9 x 9 or 81 squaremanagerial grid. The vertical axis represents

the managers concern for people, & the

horizontal axis represents concern forproduction. The 5 basic styles are to each

corner & in the middle

A. Impoverished Manager

( )


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(1,1)

lack of concern for both people &

production

B. Country Club Manager

(1 9)


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(1,9)

thoughtful & friendly but lack concern forproduction

C. Organization Man

M (5 5)


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Management (5,5)

represents a moderate concern for bothpeople & production but not at the sametime

D. Authority-Obedience

(9 1)


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(9,1)

efficiency in operation but lacks concernfor human element

E T M t (9 9)


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E. Team Management (9,9)

the optimal managerial style. These managersintegrate their concern for people & production

Skills of a Manager


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Accdg to Robert Katz Technical ski l ls knowledge and

proficiency in activities involving

methods, procedures and process. It

also involves working w/ tools and

specific techniques to achieve the

desire result.


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Human ski l ls the ability to work w/people. It is the creation of work

environment in w/c people feel secure

and free to express their opinion.


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Conceptual ski l ls the ability to seethe over-all pictures to identify

important elements in a situation and

to understand the relationship among

the elements


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Summeremphasized Knowledge factors

Attitude factors

Ability factors

Roles of Managers


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INTERPERSONAL ROLE

Symbol

Leader Liaison


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INFORMATIONAL ROLE

Monitors Information

Disseminates Information Spokesperson or Representative


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DECISIONAL ROLE

Entrepreneur or Innovator

Troubleshooter Negotiator

I. PLANNING


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Forecasting or setting the broad outlineof work to be done

-Why it will be done?

-What action is necessary?

-Where it will be done?

-When it will be done?

-Who will do it?

-How it will be done?


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Defined as pre-determining a courseof action in order to arrive at a desired

result.

It is the continuous process of

assessing, establishing goals and

objectives, implementing and

evaluating them, and subjecting these

to change as new facts are known.

PRINCIPLE OF PLANNING


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Always based and focused on thevision, mission, philosophy, and

clearly defined objectives of the

organization

Provison for proper analysis would

indicate a revision to make it more

effective

Pervasive within the entire

organization covering the various

departments, services and the


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Utilizes all available resources Must be prcised in its scope and

nature. It should be realistic and

focused on its expected outcomes.

Should be time-bound with short- and

long- range plans.

Projected plans must be documented

for proper dissemination to all

concerned for implementation and

evaluation

Scope of planning

Supervisors


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Supervisors

- formulate policies, rules and regulations,methods and procedures

-coordinates nursing activities

-translate strategies and procedures into

specific objectives and program Head nurses

- schedule daily and weekly plans for theadministration of patient care for his orher unit

- directly responsible for the actualproduction of nursing services

CHARACTERISITCS OF GOOD

PLAN


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Based on clearly defined objectives It should be simple

It should provide for the proper

analysis and classification of action It should be flexible

It should be balance

It should make use of all availableresources

REASONS FOR PLANNING


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Increases the chance of success byfocusing on results not activities

Forces analytic thinking and

evaluation of alternatives Establish a framework for decision

making

Orient people to action than reaction Includes day to day and future

focused managers

REASONS FOR PLANNING


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-Helps avoid crisis management andprovide decision making flexibility

-Provide a basis for managing

organizational and individual

performance

-Increases employee involvement and

improves communication

-Cost effective

STAGES OF PLANNING


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1. Develop the purpose or missionstatement, goals, objectives,

philosophy

Vision organization future role and

function, something to strive for.

Mission purpose of existence and reasonbehind organizational structure

Philosophy statements of shared values and


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Goals statement of intent derived from

the purposes of the organization, usually

stated broadly and generally

Objectives specific aims, purposes ortargets that will have to be accomplished


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2. Collect and analyze data - externaland internal forces

3. Assess for the strength (opportunitiesthat will facilitate effectiveness and

achievement of goals and

weaknesses (threats that will impede

achieving goals and objectives)

4. Write realistic and general statements


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of goal

5. Identify strategies to achievespecified goals

6. Develop a timetable foraccomplishing each objectives

7. Provides guideline for developingoperational and functional plans


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8. Put plans to work/implement

9. Provide for formative evaluation

reports before, during and after theplan is implemented

BUDGET (AS A TOOL FOR

PLANNING)


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Budget

operational management plan related to

income and expenses for division of time;allocated resources necessary for future

expenditures

PREREQUISITES TO

BUDGETING


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Sound organizational structure withclear line of authority and

responsibility

Managerial support

Formal policies and procedures mustbe reflected in the budgetary manual

PUPOSES OF BUDGETING IN

NURSING SERVICE


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To plan the objective, programs,activities of the nursing service and

finance to accomplish them.

To motivate nursing workers through

analysis of actual experience.

To serve as standards.

Types of Budget


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Capital Operational

Personnel or manpower

Flexible

Cash flow

Fixed ceiling

COSTS


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Fixed cost - not related to volume andremain constant.

Variable cost - related to volume and

varies according to different factors. Direct cost - related to providing

product service.

Indirect cost - incurred in support ofproviding products service.

PROCEDURENURSING

SERVICE


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1. Determine productivity goal

2. Forecast workload

3. Budget patient care hours

4. Budget patient care hours andstaffing

5 Plan for nonproductive hours


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6. Chart productive time

7. Estimate the cost of supplies and

services

8. Anticipate capital expense

II. ORGANIZING


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Grouping of activities, providingassignments, supervising, defining

means of coordinating activities to

accomplish goals and objectives The process of establishing formal

authority which includes developing

job descriptions by defining thequalifications and functions of

personnel.


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Elements of Organizing


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It include setting up: Organizational structure

Staffing

Scheduling Developing job decription

CHARACTERISTICS OF

ORGANIZATIONAL STRUCTURE


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Division of work in which each boxesrepresent an individual responsible for

a given part of the organizations

workload

Chain of command, with lines

indicating who reports to whom andwhy what authority

CHARACTERISTICS


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The type of work performed, indicatedby the labels or description for each

boxes

The grouping of work segmentsshown by the cluster of work groups

The level of management, which

indicate individual and entiremanagement hierarchy

COMPONENTS OF



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People

Purpose

structure

BASIC TYPES OF O.S.


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Informal consists of the personaland social relationship of the members

in the organization

Formal describes the positions,

responsibilities and those occupying

the positions and their relationshipsamong them


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PATTERNS/FORMS OF


1. Vertical or Tall Chart/Centralized Structure

D i t th Chi f E ti t th t


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Depicts the Chief Executive at the top

with line of authority flowing down the

hierarchy.DIRECTOR

CN

SN SNSN

NANA NA

2. Horizontal or Flat Chart/Decentralized Structure

D i t th t th t /


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Depicts the manager at the top w/ a

wide span of control

CN

SN SNSN

NA NA NANANA

SN SN

3. Concentric or CircularChart

h t d fl f


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shows outward flows of

communication from center

SN SN

SN

CN


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3 General Types of

Organizational Chart:

1. Line Organizational/Bureaucratic/

I th i l t d t di t t f


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Is the simplest and most direct type of

organization in which position has

general authority over the lower

position in the hierarchy.DIRECTOR

CHIEF NURSE

SN SNSN

ADVANTAGES

1. Maintain

DISADVANTAGES

1. Neglects special


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simplicity.2. Makes clear

division of

authority.3. Encourage

speedy action

planning2. Overworks key

people

3. Depends uponretention of a few

key people

2. FunctionalOrganizational

Is one here each nit is responsible


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Is one where each unit is responsible

for a given part of the organizations

workload. There is a clear delineation

of roles and responsibilities which are

actually interrelated


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ADVANTAGES1. Relieves line

executive ofroutine

DISADVANTAGES1. Makes relationship

more complex2 Makes limits of


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routinespecializeddecision

2. Provides

frameworks forapplying expertknowledge

3. Relieves press of

need for largenumber of well-roundedpersonnel

2. Makes limits ofauthority of eachspecialist a difficultcoordination

3.Teach towardcentralization oforganization.

3. Staff Organization

Is purely advisory to the line structure


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Is purely advisory to the line structure

w/ no authority to put

recommendations into action.

DIRECTOR

CHIEF NURSE

TRAINING OFFICER

SNSN SN

ADVANTAGES

1. Enables specialist

to give expert

DISADVANTAGES1. Continues in

organization even


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to give expert

advise

2. Frees the line

executive of

detailed analysis3. Affords young

specialist a mass

training

if its function arenot clear

2. Reduces expertpower to place

recommendationinto action

3. Tends towards

centralization ofthe organization

4. Flat Organization /Horizontal organization


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Category Flat Pyramidal

Number of Levels Fewer More

Span of control Broad Narrow

Delegation Greater Lesser

Authority Decentralized Centralized

Control overSubordinates

Lesser More

Type Modern Traditional


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STAFFING


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Is the process of determining andproviding the acceptable number

and mix of nursing personnel to

produce a desired level of care tomeet the patients demand.

Assigning competent people to fill

designated for the organizationalstructure

STEPS IN STAFFING

Determine the number and types of


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Determine the number and types of

personnel needed

Recruit Personnel

Interview

Induct or Orient the Personnel

Job Offer

Staffing Pattern

Is a plan that articulates how many and what


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Is a plan that articulates how many and what

kind of staff are needed by shift and day tostaff a unit or department

Some of a these consideration in the

development of staff pattern are: Benchmarking

Regulatory Requirements

Skill Mix

Staff Support

Historical Information

Patient Classification System

Measurement tool used the nursing


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Measurement tool used the nursing

workload for a specific patient or

group of patients over a specific

period of time. Patient care is

classified according to:

Self care or minimal care patients

Intermediate or moderate care

Total care patients eg bedridden

Intensive care patients

NURSING CARE MODEL

1 CASE METHOD or TOTAL PATIENT


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1. CASE METHOD or TOTAL PATIENT

CARE nurse works directly with

patient, family, physician and other

health care staff implementing a plan

of care.

2. FUNCTIONAL METHOD also task

nursing and this method is task and

procedure oriented. Nurses areassigned to selected functions.

3 TEAM NURSING which evolved


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3. TEAM NURSING which evolved

from functional nursing , a team of

nursing personnel provides total

patient care to a group of patients.

4. PRIMARY NURSING METHOD thismethod represents total nursing care

directed by a nurse on a 24 hours

basis, from the moment of admissionto discharge with ARA.

5 PROGRESS CLIENT CARE client are


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5. PROGRESS CLIENT CARE client are

evaluated with respect to the level orintensity of care needed.

6. MANAGED CARE METHOD involves

unit based care that is organized toachieve specific patient outcomes with in

her stay in the unit.

7. PRACTICE PARTNERSHIP the senior

and junior staff member share patient careresponsibilities

8 CASE MANAGEMENT METHOD this is


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8. CASE MANAGEMENT METHOD this is

a model for identifying , coordinating, andmonitoring the implementation of service to

achieve desired patient care outcomes

within a specified period of time.

9. MODULAR METHOD in this method, the

RN provides direct nursing care with

assistance of aides. This is modified team &

primary nursing method where RN providesleadership, support and instruction.

COMPUTING FOR THE NUMBER

OF NURSING PERSONNEL


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When computing for the nursing personnel,one should ensure that there is sufficient staffto cover:

1. All shifts

2. Off-duties

3. Holidays

4. Leaves

5. Absences

6. Time for Staff Development

ACCORDING TO R.A. 5901 OTHERWISE

KNOWN AS THE FORTY-HOUR WEEK


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KNOWN AS THE FORTY HOUR WEEK

LAW, EMPLOYEES WILL WORK FOR

40HRS/WK:

1. FOR HOSPITALS WITH100-BED CAPACITY OR

MORE

2. COMMUNITY POPULATIONOF AT LEAST 1 MILLION


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HOWEVER, A NURSE WILL RENDER48HRS/WK WITH ONLY 1 OFF-DUTY A

WEEK IF:

1. HOSPITALS WITH LESSTHAN 100-BED CAPACITY

2. COMMUNITIES WITH LESS

THAN 1 MILLION

POPULATION

THERE ARE BENEFITS ENJOYED BY THE


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PERSONNEL REGARDLESS OF THEWORKING HOURS. AS PER CIVIL

SERVICE COMMISSION MEMORANDUM

CIRCULAR NO. 6, SERIES OF 1996,

GOVERNMENT EMPLOYEES ARE

GRANTED 3 DAYS WHICH MAY BE SPENT

FOR:

1. BIRTHDAYS


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2. WEDDINGS3. ANNIVERSARIES

4. FUNERALS (MOURNING)

5. RELOCATION6. ENROLMENT/GRADUATION

LEAVE

7. HOSPITALIZATION

8. ACCIDENT LEAVES

Total number of working hours and non-working days and hours of nursing personnel

per year.


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Rights & privileges given

each personnel/year

Working

hr/wk

48 hrs

Working

hr/wk

40 hrs

1. Vacation leave

2. Sick leave

3. Legal holidays

4. Special holidays

5. Special privileges

15

15

10

2

3

15

15

10

2

3

Cont.


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6. Off duties/ R.A. 5901

7. Continuing Education Prog.

Total Non-working days/year

Total Working days/ year

Total Working hours/ year

104

3

152

213

1,704

52

3

100

265

2,120

To compute for relievers needed, the

following should be considered:


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1. Ave. number of leaves taken each year---- 15

Vacation Leave --------------------------------10

Sick Leave--------------------------------------- 5

2. Holidays ---------------------------------------------- 123. Special Privileges --------------------------------- 3

4. Continuing Education Program for

Professionals ------------------------------------- 3

Total Average Leaves 33

To determine the relieversneeded:


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33 (ave # of days an employee is absent)213 or 265

(# of working days/year that each

employee serves)= 0.15 (15%) for persons who work

40hrs/wk

= 0.12 (12%) for persons who work48hrs/wk

To distribute the staff byshifts:

Morning shift = 45 51% (0.45 0.51)


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Morning shift 45 51% (0.45 0.51)

Afternoon shift= 34 47% (0.34 0.47)

Night shift = 15 18% (0.15 0.18)

***Note: In the Philippines, thedistribution usually followed is 45%

(0.45) for the morning shift, 37% (0.37)

for the afternoon shift and 18% (0.18)

for the night shift.


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STAFFING FORMULA

1. Categorize the patients according tolevels of care. Multiply the total # of

patients by the % of patients at each


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level of care.Ex. Find the # of nursing personnel needed

for 250 bed capacity in a tertiary hospital

250 (pts) x .30 = 75 pts need L1250 (pts) x .45 = 112.5 pts need L2

250 (pts) x .15 = 37.5 pts need L3

250 (pts) x .10 = 25 pts need L4

2. Find the # of nursing care hrs (NCH)

needed by patients at each level of care/


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day.75 pts x 1.5 (NCH at L1) =112.5 NCH/day

112.5 pts x 3 (NCH at L2) =337.5 NCH/day

37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day

25 pts x 6 (NCH at L3) =150 NCH/day

Total = 768.75 NCH/day

3. Find the total NCH needed by givennumber of patients or bed capacity/year.

768.75 x 365 (days) = 280,593.75


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( y ) ,NCH/year

4. Find the actual number of working hoursrendered by each nursing personnel/year.

8 (hrs/day) x 213 (working days/year)=1,704 (working hrs/year)

5. Find the total # of nursing personnel

needed. (immediate, reliever, totalpersonnel)

a. Total NCH/year = 280,593.75 = 165


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working hrs/yr 1,704

b. Relief x total immediate nsg personnel

165 x 0.15 = 25

c. Total nsg. Personnel needed

165 + 25 = 190

6. Categorize the nursing personnel intoprofessional and non-professional.

190 x .65 = 124 professional nurses


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p

190 x .35 = 66 nursing attendants

190 nursing personnel

7. Distribute by shift

124 x .45 = 56 nurses on AM shift

124 x .37 = 46 nurses on PM shift

124 x .18 = 22 nurses on Night shift

124 nurses


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66 x .45 = 30 nsg attendants on AM shift66 x .37 = 24 nsg attendants on PM shift

66 x .18 = 12 nsg attendants on Night shift

66 nursing attendants


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SCHEDULING

SCHEDULE It is a timetable showing planned work


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g p

days and shift for nursing personnel.

Scheduling is to assign working days

and days off to the nursing personnel

so that adequate patient care isassured.

ASSESSING A SCHEDULINGSYSTEM

1. Ability to cover the needs of the unit.


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y

2. Quality to enhance the nursing

personnels knowledge, training and

experience.

3. Fairness to the staff

4. Stability

5. Flexibility


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Modified workweeks

include systems of scheduling


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y g

personnel such as 10-hour and

12-hour shifts, weekend

alternative, team rotation, andflexible hours.

Self-scheduling

is a method of scheduling in


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g

which the nurse manager

determines the needs per day and

shift and the nursing staff

schedule themselves to meet

these needs.

(Exhibit 7-8 p. 106)


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Productivity

is a system of measuring worker


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y g

output and is commonly defined

as outputs divided by inputs.

Temporary workers

are contract workers hired from a


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staffing agency for a period of

time that may be for one to

several days or weeks.

Temporary workers are not

employees of the health care

agency where they work.

Manager behavior

Oversees staffing activities


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through human resource

management that includes use of

a patient classification system and

provision of qualified nursing

personnel in adequate numbers to

meet patient care needs.

Leader behavior

Uses input from employees to


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develop and implement a staffing

philosophy and staffing policies

that inspire personnel to work to

their maximum level of

productivity.

Basic to planning for staffing of a divisionof

nursing is the fact that qualified nursing


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personnel must be provided in sufficientnumbers to ensure adequate, safe

nursing care

for all patients 24 hours a day, 7 days aweek,

52 weeks a year. Each staff ing planmust be

tai lored to the needs of the agency

and canno t

be determ ined w ith a simple worker-

(Exhibit)


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(Exhibit 7-7 p. 105)


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Components of patientclassification system Classification categories


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Factor Prototype

Guidelines

Average care time for a patient in each

category Method for calculating required staffing,

personnel mix, and required nursing carehours

o e approac es o

nurse staffing and

scheduling


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10-hour shift

12-hour shift

Weekend alternative

Flex timeOthers

Productivity

Is commonly defined as output /


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input

Percent productivity

= required staff hours / providedstaff hours x 100

Staffing activities

include recruitment, hiring,


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assignment, scheduling,

calculating turnover, preparing

payroll, developing and

administering policies, and related

activities.

Human ResourceDepartment involves tasks like interviewing, hiring,

hi t ti f t t d


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coaching, retention of state andperformance evaluation/appraisal

Personnel

are persons employed in an agency or

d t t


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department

Recruitment

the process of enlisting personnel for

l t th f hi i


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employment; the process of hiring

Selection

the process of choosing or selecting

did t di t th i


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candidates according to theirqualifications to the job; the process of

elimination

Retention

capacity to retain employees once

th hi d


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they are hired

Modes of Recruitment Employee recommendation

W d f th


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Word of mouthAdvertisement

Flyers

Newsletter Bulletin

Posters

Career Days

Job Fairs

Placement

Screening Potential Staff

Philosophies in the screening process:Th h ld t li t


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The manager should screen out applicants

who do not fit the agencys image.

The manager should try to fit the job to a

promising applicant.

Usually the manager should try to fit the

applicant to the job.

App l ication Forms and Resumes

Determine whether the applicant

meets minimal hiring requirements.

F i h b k d d t f l i


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Furnish background data useful in

planning the selection interview.

Obtain names of references who may

be contacted for additional informationabout the applicants work experience

and general character.

Collect information for personneladministration (SSN, # of dependents

etc.).

Letter o f Reference

Inter ie


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Interview face to face contact between the job

seeker and a person with full authority

to fill the position under discussion. The purpose of the interview is to

obtain information, to give information,

and to determine if the applicantmeets the requirements for the

position.

Types of Interview

Directive interviewuses closed-ended

question


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questionNon-directive interviewthe applicant

narrates himself.

Structure interviewthe interviewer uses

pre-prepared guidelines for interview.Group interviewseveral applicants or

interviewees are interviewed together.

Board interviewconducted by selected

member of the personnel to an

applicant.

Test Used in Selection of Applicant


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Aptitude Testmeasures capacity on

potential ability to learn

Psychomotormeasures strength and

coordinationJob knowledge

Proficiencymeasures how well theapplicants can do a simple work

Psychological testmeasures personalitycharacteristics

JOB DESCRIPTION

Are specifications of duties, conditions

and requirements of a particular job


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and requirements of a particular jobprepared through a careful job

analysis and also called performance

description which includes: Job title

Job relationship

Performance description

EMPLOYEE DISCIPLINE

Is a process of generating employee

compliance to institutional rules and


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compliance to institutional rules andregulation

DISCIPLINARY PROBLEMS Problems tend to occur when there is

methodological weakness, such as when

the manager lacks skill in interviewing or

documentation, or when there is aprocedural omission, such as poor

application of discipline

Step to AddressingDisciplinary Problems Coaching a day to day process of helping

employees improve their performance


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employees improve their performance.

Confrontation is a communication

technique used to address specific issuessuch as violation of policy or procedure.

Disciplinary Conference using a

combination of directive and non- directivetechnique in order to minimize stress during

interview

Steps of ProgressiveDisciplineMeans the adherence to the principle of due

process and fair treatment of subordinates


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process, and fair treatment of subordinates.There different measures are:

1. Counseling

2. Verbal reprimand3. Written reprimand

4. Short suspension

5. Longer suspension

6. Discharge/dismissal/termination

III. DIRECTING

Issuance of assignments, orders and

instructions that permits the worker


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instructions that permits the workerwhat is expected of the to achieve

organizational goals and objectives

Delegating

is getting the work done through

employees


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employees.

Is the process by which a manager

assigns specific task/duties to workers


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assigns specific task/duties to workerswith commensurate authority to

perform the task.

The worker in return assumes

responsibility & is held accountable for

its result.

2 Important Criteria inDelegation

1 Ability of the worker to carry out the


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1. Ability of the worker to carry out thetask.

2. Fairness not only to the employeebut to the team as a whole.

Principles of Delegation

Select the right person

Delegate both interesting &


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Delegate both interesting &

uninteresting task

Provide staff with enough time to learn

Delegate gradually

Delegate in advance

Consult before delegating

Avoid gaps & overlaps

Nursing Care


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Nursing CareAssignments/ Modalities

of Nursing Care or

System/Pattern ofNursing Care

Primary Extension of principle of decentralization


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Extension of principle of decentralization Nursing process driven

Primary nurses and associate nurses

24-hour coverage Greater patient and staff satisfaction

Advantages 1) patient & family are able

to develop trusting relationship with RN;


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to develop trusting relationship with RN;2) there is defined accountability &responsibility; 3) there isholistic/continuity of care.

Disadvantages 1) high cost becausethere is a higher RN skill; 2)proximity of patient assignment; 3)overlappingof staff functions; 4) nursepatient ratio must be realistic.

Case Method

1:1 nurse/patient ration


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1:1 nurse/patient ration

Examples include private duty, ICU,

Community Health Nurse

Similar to Primary, however, no AssociateRN

The nurse is responsible for the total care

of the patient for the shift shes working

Advantages 1) consistency of one

individual caring for the patient for the


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individual caring for the patient for thewhole shift; 2) more opportunity to

observe & monitor the patient.

Disadvantages 1) the nurse may not

have the same patient the next day; 2)

it does not serve the purpose ofdecentralization.

Functional Nursing

divides the work to be done & every


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divides the work to be done & every

member is responsible for his actions

best system that can be used if there aremany patient & professional nurses are

few

Advantages of functional nursing are

that 1) work is done fast; 2) workers


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that 1) work is done fast; 2) workerslearn to work fast; 3) they gain skill

faster in that particular task.

Disadvantages include 1)

fragmentation of nursing care


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fragmentation of nursing caretherefore holistic care is not achieved;

2) patient cannot identify who their

real nurse is; 3) nurse-patientrelationship is not fully developed;

4) evaluation of nursing care is poor &

outcomes are rarely documented, and6) it is hard to find a specific person to

answer the relatives questions.

Joint Practice (Team Nursing /

Modular Nursing )


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Modular Nursing ) More than modality

Involves nurses and physicians

collaborating as colleaguesAgreed upon protocols to manage care in

primary settings

Modular nursing is a kind of team nursing

that divides the area into modules of

patient, with each module cared by a

team of nurses.

Advantage 1) work is shared with

others


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others

Disadvantages 1) patient receives

fragmented, depersonalized care;2) communication is complex; 3)

accountability & responsibility is

shared which can cause confusion; 4)these factors affects RNs

dissatisfaction.

Case Management

Clinical system with accountability for


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Clinical system with accountability forindividual or group through continuum ofcare

Negotiating

Procuring

Coordination of services and resources

RESPONSIBILITIES IN DIRECTING


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1. Promotive improve systems

2. Preventive anticipate problems &difficulties

3. Corrective institute measures tocorrect problems

4. Regulatory preserve existingassignments

CHANGE PROCESS

Change purposeful designed effortto bring about improvements in a


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Change purposeful, designed effortto bring about improvements in a

system, with the assistance of change

agent

THEORIES OF CHANGE

REDDINS THEORY suggested seven

techniques by which change can be


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techniques by which change can beaccomplished

1. Diagnosis

2. Mutual setting of objectives3. Group emphasis

4. Maximum information

5 Di i f i l t ti


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5. Discussion of implementation

6. Use of economy and ritual

7. Resistance interpretation

LEWINS THEORY

Unfreezing stage the nurse is


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Unfreezing stage the nurse ismotivated by the need to create

change

Moving stage the nurse will gatherinformation

Refreezing stage changes are

integrated and stabilized as part of thevalue system

ROGERS THEORY

1. awareness


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1. awareness

2. interest

3. evaluation

4. trial

5. adoption

MOTIVATION

Forces that make or propels one to acti t i


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Forces that make or propels one to actin a certain way.

Individual desire and responses toevents which prompts extraordinary

effort to attain goal and enthusiasm

LEVELS OF MOTIVATION

EXTRINSIC MOTIVATION

anticipated rewards or avoidance of


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anticipated rewards or avoidance ofnegative consequences in the

performance of action

INTRINSIC satisfaction derived fromthe action itself

TRANSCENDENTAL recognition of

the usefulness of action to some otherperson

THEORIES OF MOTIVATION

CONTENT THEORY motivation factors orneeds within a person


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needs within a person

1. Maslows Needs Theory

2. Alderfers theory (Existence, Relatedness,Growth) ERG

3. Herzbergs Theory two factor theory

Di ti fi h i i ( t i i ) l j b


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a. Disatisfiers or hygienic (extrinsic) salary, jobsecurity, working condition, relationships

b. Satisfiers or non hygienic (intrinsic)achievement, recognition, reward,advancement, work itself

4. McClelland theory affiliation, achievement

and power


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p

5. Monistic/scientific theory salary as the

best motivating factor

PROCESS THEORY

1. Arousal theory focuses on internal


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yprocess that mediate the effect of work

performance

2. Expectancy theory focuses on

peoples expectation that their efforts will

result in good performance and valued

results

3. Equity theory focuses on fair treatment

DECISION MAKING

A systematic, sequential process of

choosing


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gamong alternatives & putting those

choices

into action

STEPS

1. Identify problem

2 Prioritize problem


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2. Prioritize problem

3. Gather and analyze situation related

to problem

4. Evaluating all alternatives

5. Select an alternative for

implementation

IV. CONTROLLING

The process by which managers

attempt to measure if actual activities


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pconform to planned activities

A process wherein the performance is

measured and corrective action istaken to ensure the accomplishment

of organization goal

STEPS IN CONTROL PROCESS

Establish standards and criteria

Measure performance


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Compare results with standards

Match with standards?

YES do nothing or improve

NO - take corrective action

PERFORMANCE

APPRAISAL/EVALUATION

SYSTEM Process of evaluating employees

performance against standards


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p g To determine job competence

Enhance staff development and

motivate employee discover employees aspirations and

recognize accomplishments

Improve communication

Aid managers in counseling and


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g gcoaching

Determine training and dev. needs of

staff Inventories of talent

Legal purposes

METHODS OF EVALUATION

Anecdotal records objective description of

behaviorR ti l


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Rating scale

Ranking

Self appraisal/self rating Peer review

Paired comparison

Forced - choice

Subordinates

Team evaluation multiple raters


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Behavior anchored list specific

description of good, average and good

performance

Essay evaluation describe strength and

weaknesses of employee

Critical incident describe effective and

effective behavior of employee

PROBLEM AREAS OFEVALUATION

Subordinates have not been motivated

to want to change


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g People are unable to make change

Subordinates become resentful and

anxious when merit system is applied

COMMON ERRORS OFEVALUATION

Halo error allowing one trait to

influence the evaluation of others orf f f


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rating of all traits on the basis of first

impression

Horn error the evaluator ishypercritical

Contrast error managers rate the

nurse opposite the way they perceivethemselves

Leniency of error

Central tendency error


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y

Racial bias

System design and operating

problems focuses on the method(system) and process (operating) of

evaluation

Overgeneralization Recency of Events error

TOTAL QUALITYMANAGEMENT Systematic process to improve

outcomes based on customers needsDoing the right thing


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Doing the right thing

-meeting the needs of the customer

-building quality performance into thework process

-employ scientific approach toassessment and problem solving

QUALITY ASSURANCE PROG

Process of establishing a standards of

excellence of intervention and takingt t th t h ti t


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steps to ensure that each patient

receives the expected level of care

Fulfillment of social contract betweensociety and professions

QUALITY NURSING CARE

Presence of all

elements/characteristics specified inthe standards


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the standards.

FRAMEWORK OF QA

1.Structure instrumentalities in thedelivery of care (personnel, suppliesetc)

2. Process how the service was

delivered3. Outcome results expected of the

service

NURSING AUDIT

Official examination of: nursing

records, physical facilities, personneli l d i ti t


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involved in patient care

Tool to analyze and evaluate nurses

bedside records and physical facilities Serves as a means of improving

nursing care by revealing existing

deficiencies

STANDARD OF CARE

Yardstick for gauging the quality and

quantity of service


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Describes the quality of service

Ex. Nurses are professional in dealing

with clients

CRITERIA

Measures the quality of care or

standards


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Standard: Nurses are professional in

dealing with clientsCriteria : greets them with

corresponding smiles

always attend to their needs

Thank You!


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Thank You!

Documents

LEC 1 PRELIM Nursing Leadership and Management