NSG 129: Nursing Leadership and Management
NURSING LEADERSHIP & MANAGEMENT
Leadership – behaviour and
attitude
The act of influencing and
motivating a group of people to
act in the same direction
towards achieving a common
goal.
do not have delegated authority
but obtain their power through
other means, such as influence
focus on group process,
information
gathering,
feedback, and empowering
others
have goals that may or may not
reflect those of the organization
Management - process
The process of leading and
directing an organization to
meet its goals through the use
of appropriate resources.
legitimate source of power due
to the delegated authority
emphasize control, decision
making, decision analysis, and
results
greater formal responsibility
and accountability for rationality
and control than leaders
DEVELOPMENT OF MANAGEMENT THEORIES
SCIENTIFIC MANAGEMENT
Frederick W. Taylor  “father of scientific management”
 Work should be studied scientifically to determine the
method of task performance that would yield maximum
work output with minimum work expenditure.
 Work should be studied, every methods and steps before
acting
 Efficient to task
Four overriding principles of scientific management:
1. Traditional “rule of thumb” means of organizing work must
be replaced with scientific methods.
2. A scientific personnel system must be established so that
workers can be hired, trained, and promoted based on
their technical competence and abilities.
3. Workers should be able to view how they “fit” into the
organization and how they contribute to overall
organizational productivity.
4. The relationship between managers and workers should
be cooperative and interdependent, and the work should
be shared equally.
BUREAUCRACY
Max Weber (1922)
THEORY OF SOCIAL AND ECONOMIC ORGANIZATION
 advocated bureaucracy
 Need for legalized, formal authority and consistent rules
and regulations for personnel in different positions
MANAGEMENT FUNCTIONS
Henry Fayol (1925)  first identified the management functions of
planning, organization, command, coordination, and control
ACTIVITIES OF MANAGEMENT
Luther Gulick (1937)  expanded on Fayol’s management
functions in his introduction of the “Seven Activities of
Management” - planning, organizing, staffing, directing,
coordinating, reporting, and budgeting.
Activities of Management:
Planning
determines philosophy, goals, objectives, policies,
procedures, and rules; carrying out long-and shortrange projections; determining a fiscal course of
action; and managing planned change
Organizing establishes the structure to carry out plans,
determining the most appropriate type of patient care
delivery, and grouping activities to meet unit goals.
Staffing
Directing
Controlling
consist of recruiting, interviewing, hiring, and orienting
staff. Scheduling, staff development, employee
socialization, and team building.
consists of motivating, managing conflict, delegating,
communicating, and facilitating
functions include performance appraisals, fiscal
accountability, quality control, legal and ethical
control, and professional and collegial control.
14 PRINCIPLES OF MANAGEMENT
1. Division of work
allows specialization
right to command balanced with
2. Authority
responsibility and accountability
employees will only obey orders if
3. Discipline
management play their part by providing
good leadership
there should only be one boss with no
4. Unity of command
conflicting lines of command
people engaged in the same kind of
5. Unity of direction
activities must have the same objectives in
a single plan
6. Subordination of the goals of the firms are always
individual interest to paramount.
general interest
7. Remuneration
payment is an important motivator
8. Centralization or
depends on the condition of business and
Decentralization
the quality of its personnel
9. Scalar chain/line
refers to the number of levels in the
of authority
hierarchy
both material order (minimizes lost time &
useless handling of materials) and social
10. Order
order (organization and selection) are
necessary.
employees should be treated well to
11. Equity
achieve
equity
12. Stability of
job security and career progress are
tenure of personnel
important for employees to work better
allow personnel to show their initiative, it
13. Initiative
may be a source of strength for the
organization
management should foster the moral
14. Esprit de corps
of employees
PARTICIPATION MANAGEMENT
Mary Parker Follett (1926) was one of the first theorists to suggest
participative decision making or participative management.
 Managers should have authority with, rather than over,
employees.
ILLUMINATION STUDIES
Elton Mayo and his Harvard associates (1927-1932)
 look at the relationship between light illumination in the
factory and productivity.
indicated that people respond to the fact that they are
Hawthorne
being studied, attempting to increase whatever
effect
behavior
THEORY X AND Y
Douglas McGregor (1960)
 X and Theory Y, posited that managerial attitudes about
employees can be directly correlated with employee
satisfaction.
Theory X managers
Theory Y managers
believe that their employees are believe that their workers enjoy
basically lazy, need constant their work, are self-motivated,
supervision and direction, and and are willing to work hard to
are indifferent to organizational meet
personal
and
needs.
organizational goals.
NSG 129: Nursing Leadership and Management
Laissez-faire
leader
EMPLOYEE PARTICIPATION
Chris Argyris (1964), managerial domination causes workers to
become discouraged and passive.
 If self-esteem and independence needs are not met,
employees will become discouraged and troublesome or
may leave the organization.
Management Theories (Summary)
Theorist
Theory
Taylor
Scientific management
Weber
Bureaucratic organizations
Fayol
Management functions
Gulick
Activities of managements
Follet
Participative management
Mayo
Hawthorne effect
McGregor
Theory X and Y
Argyris
Employee participation
DEVELOPMENT OF LEADERSHP THEORIES
GREAT MAN THEORY
 From Aristotelian philosophy, asserts that some people
are born to lead, whereas others are born to be led.
 Great leaders will arise when the situation demands it.
TRAIT THEORY
 assume that some people have certain characteristics or
personality traits that make them better leaders than
others.
characterized by the following behaviors:
 Is permissive, with little or no control.
 Motivates by support when requested by
the group. Provides little or no direction.
 Uses
upward
and
downward
communication between members of
the group.
 Disperses decision making throughout
the group.
 Places emphasis on the group.
 Does not criticize.
CONTINGENCY APPROACH
Fiedler (1967)
 suggests that no one leadership style is ideal for every
situation.
 Interrelationships between the group’s leader and its
members were most influenced by the manager’s ability
to be a good leader
SITUATIONAL APPROACH
Hersey and Blanchard (1977)
 Tridimensional leadership effectiveness model predicts
which leadership style is most appropriate in each
situation on the basis of the level of the followers’ maturity.
 As people mature, leadership style becomes less task
focused and more relationship oriented.
TRANSACTIONAL AND TRANSFORMATIONAL APPROACH
Burns (2003)
 both leaders and followers have the ability to raise each
other to higher levels of motivation and morality.
 There are two primary types of leaders in management
Transactional
Transformational
Traditional manager, concerned committed, has a vision, and is
with the day-to-day operations
able to empower others with this
vision
 Focuses
on
 Identifies common
management tasks
values
 Is committed
 Is a caretaker
 Uses trade-offs to
 Inspires others with
meet goals
vision
 Does not identify
 Has long-term vision
shared values
 Looks at effects
 Examines causes
 Empowers others
 Uses contingency

reward
EXEMPLARY LEADERSHIP
Kouzes and Posner's Five Practices for Exemplary Leadership
LEADERSHIP STYLES
Lewin and White
Democratic
exhibits the following behaviors:
leader
 Less control is maintained.
 Economic and ego awards are used to
motivate.
 Others are directed through suggestions
and guidance.
 Communication flows up and down.
 Decision making involves others.
 Emphasis is on “we” rather than “I” and
“you.”
 Criticism is constructive.
Authoritarian characterized by the following behaviors:
leader
 Strong control is maintained over the
work group.
 Others are motivated by coercion.
 Others are directed with commands.
 Communication flows downward.
 Decision making does not involve
others.
 Emphasis is on difference in status (“I”
and “you”).
 Criticism is punitive
1.
2.
3.
4.
5.
Modeling the way: Requires value clarification and selfawareness so that behavior is congruent with values.
Inspiring a shared vision: Entails visioning which
inspires followers to want to participate in goal attainment.
Challenging the process: Identifying opportunities and
taking action.
Enabling others to act: Fostering collaboration, trust,
and the sharing of power.
Encouraging the heart: Recognize, appreciate, and
celebrate followers and the achievement of shared goals.
Dili sa tanan oras bright ta hahahaha
INTEGRATING LEADERSHIP AND MANAGEMENT
Gardner (1990) asserted that integrated leader-managers possess
six distinguishing traits:
1.
2.
3.
4.
5.
6.
They think longer term.
They look outward, toward the larger organization.
They influence others beyond their own group.
They emphasize vision, values, and motivation.
They are politically astute.
They think in terms of change and renewal.
NSG 129: Nursing Leadership and Management

Leadership Theories (Summary)
Theorist
Theory
Aristotle
Great Man theory
Lewin and White
Leadership styles
Fiedler
Contingency leadership
Henry and Blanchard
Situational leadership theory maturity
Burns
Transactional and
Transformational leadership
Gardner
The integrated leader-manager
POWER
 defined as the capacity to act or the strength and potency
to accomplish something.
 The manager who is knowledgeable about the wise use of
authority, power, and political strategy is more effective at
meeting personal, unit, and organizational goals.
Types of Power
Reward power obtained by the ability to grant favors or reward
others with whatever they value
Punishment or based on fear of punishment if manager’s
coercive
expectations are not met
power
Legitimate
the power gained by a title or official position
power
within an organization
Expert power
gained through knowledge, expertise, or
experience
Referent
is power that a person has because others
power
identify with that leader or with what that leader
symbolizes ( jesus, allah, something convincing
ang power) (believing his or her goals)
Charismatic
is distinguished by some from referent power
power
(kpop, music industry …)
Informational
is obtained when people have information that
power
others must have to accomplish their goal
MANAGEMENT PROCESS: PLANNING
FOUR MODES OF PLANNING
Modes of Planning
Reactive
Inactivism
Preactivism
occurs after a problem exists
seek the status quo
utilize technology to accelerate change
and
are
future
oriented
(envisioning the change by doing
whatever you can)
attempt to plan the future of their
organization rather than react to it

Opportunities – are external conditions that promote
achievement of organizational objectives.
Threats – are external conditions that challenge or threaten
the achievement of organizational objectives.
[huhu bubu ka gurl why naay meet]
THE PLANNING HIERARCHY
VISION



Vision statements are used to describe future goals or aims
of an organization.
It conjures up a picture for all group members of what they
want to accomplish together.
An organization will never be greater than the vision that
guides it.
MISSION
 The mission statement is a brief statement identifying the
reason that an organization exists.
 It identifies the organization’s constituency and addresses its
position regarding ethics, principles, and standards of
practice.
FORECASTING
 involves trying to estimate how a condition will be in the future.
 Takes advantage of input from others, gives sequence in
activity, and protects an organization against undesirable
changes.
PHILOSOPHY STATEMENT
 The philosophy flows from the purpose or mission statement
and delineates the set of values and beliefs that guide all
actions of the organization.
 It is the basic foundation that directs all further planning
toward that mission.
 The organizational philosophy provides the basis for
developing nursing philosophies at the unit level and for
nursing service as a whole.
STRATEGIC PLANNING
 examines an organization’s purpose, mission, philosophy,
and goals in the context of its external environment.
 Complex organizational plans that involve a long period
(usually 3 to 10 years) are referred to as long range or
strategic plans.
GOALS AND OBJECTIVES
 Goals and objectives are the ends toward which the
organization is working.
 Objectives are similar to goals in that they motivate people to
a specific end and are explicit, measurable, observable or
retrievable, and obtainable.
SWOT ANALYSIS
 also known as TOWS Analysis, was developed by Albert
Humphrey at Stanford University in the 1960s and 1970s
POLICIES AND PROCEDURES
 Policies are plans reduced to statements or instructions that
direct organizations in their decision making.
 These explain how goals will be met and guide the general
course and scope of organizational activities.
Interactive or Proactive
SWOT definitions:
 Strengths – are those internal attributes that help an
organization to achieve its objectives.
 Weaknesses – are those internal attributes that challenge an
organization in achieving its objectives.
Policies also can be implied or expressed:
IMPLIED
EXPRESSED
 neither
written
nor
 delineated verbally or
expressed verbally
in writing
NSG 129: Nursing Leadership and Management

usually developed over
time and follow a
precedent
For example, a hospital may
have an implied policy that
employees
should
be
encouraged and supported in
their activity in community,
regional, and national healthcare organizations.


RULES



may include a formal
dress code, policy for
sick leave or vacation
time, and disciplinary
procedures
PROCEDURES are plans that establish customary or
acceptable ways of accomplishing a specific task and
delineate a sequence of steps of required action.
Identify the process or steps needed to implement a policy
and are generally found in manuals at the unit level of the
organization.
Rules and regulations are plans that define specific action or
nonaction.
Existing rules should be enforced to keep morale from
breaking down and to allow organizational structure.
CHANGE THEORY
Kurt Lewin (1951)
1. identified three phases through which the change agent
must proceed before a planned change becomes part of
the system:
Three Phases:
occurs when the change agent convinces members of
Unfreezing
the group to change or when guilt, anxiety, or concern
can be elicited.
the change agent identifies, plans, and implements
Movement
appropriate strategies, ensuring that driving forces
exceed restraining forces
the change agent assists in stabilizing the system
Refreezing
change so that it becomes integrated into the status
phase
quo
Stages of change and responsibilities of the change agent:
STAGE 1 – UNFREEZING
1. Gather data.
2. Accurately diagnose the problem.
3. Decide if change is needed.
4. Make others aware of the need for change; do not proceed
until the status quo has been disrupted and the need for
change is perceived by the others.
5.
STAGE 2 – MOVEMENT
1. Develop a plan.
2. Set goals and objectives.
3. Identify areas of support and resistance.
4. Include everyone who will be affected by the change in its
planning.
5. Set target dates.
6. Develop appropriate strategies.
7. Implement the change.
8. Be available to support others and offer encouragement
through the change.
9. Use strategies for overcoming resistance to change.
10. Evaluate the change.
11. Modify the change, if necessary.
STAGE 3 – REFREEZING
1. Support others so that the change continues
CHAOS THEORY
Edward Lorenz (1960s)
 discovered that even tiny changes in variables often
dramatically affected outcomes.
 Even small changes in conditions can drastically alter a
system’s long-term behavior (butterfly effect).
BUDGET
 a financial plan that includes estimated expenses as well as
income for a period of time.
 Accuracy dictates the worth of a budget; the more accurate
the budget blueprint, the better the institution can plan the
most efficient use of its resources
Types of Budgets
Workforce or
largest of the budget expenditures because
personnel budget
health care is labor intensive.
reflects expenses that change in response to
the volume of service, such as the cost of
Operating budget
electricity, repairs and maintenance, and
supplies
plan for the purchase of buildings or major
Capital budget
equipment, which include equipment that has a
long life (usually greater than 5 to 7 years)
MANAGEMENT PROCESS: ORGANIZING
ORGANIZATIONAL STRUCTURE
Formal Structure
Informal Structure
 Through
 generally a naturally
departmentalization and
forming social network of
work division, provides a
employees
framework for defining  It is the informal structure
managerial
authority,
that fills in the gaps with
responsibility,
and
connections
and
accountability.
relationships that illustrate
 Roles and functions are
how employees network
defined and systematically
with one another to get
arranged, different people
work done.
have differing roles, and
rank and hierarchy are
evident.
RELATIONSHIPS AND CHAIN OF COMMAND

The organization chart defines formal relationships within the
institution
MANAGERIAL LEVELS



Top-level managers look at the organization as a whole,
coordinating internal and external influences, and generally
make decisions with few guidelines or structures.
Middle-level managers coordinate the efforts of lower levels
of the hierarchy and are the conduit between lower and toplevel managers.
First-level managers are concerned with their specific unit’s
work flow.
Top level
Chief nurse
Scope
of
responsibility
Primary
planning focus
Communication
flow
Look at
organization
as a whole
as well as
external
influences
Strategic
planning
Top-down
but receives
subordinate
feedback
both directly
and
via
middle-level
managers
Mid-level
Unit
supervisor
Department
head
Integrating
unit level dayto-day needs
with
organizational
needs
Combination
of long-and
shortrange
planning
Upward and
downward
with
great
centrality
First level
Charge nurse
Team leader
Primary nurse
Focus primarily
on day-to-day
needs at unit
level
Short-range,
Operational
planning
More
often
upward;
generally relies
on middle level
managers to
transmit
communication
NSG 129: Nursing Leadership and Management
to
top-level
managers
TYPES OF ORGANIZATIONAL STRUCTURES
Bureaucratic
commonly called line structures or line
organizational
organization
designs
Ad hoc design
a modification of the bureaucratic structure
and is sometimes used on a temporary basis
to facilitate completion of a project within a
formal line organization
Matrix
focus on both product and function. Function
organization
is described as all the tasks required to
structure
produce the product, and the product is the
end result of the function.
Service
line which can be used to address the
organization
shortcomings that are endemic to traditional
large bureaucratic organizations
Flat organizational are an effort to remove hierarchical layers by
designs
flattening the chain of command and
decentralizing the organization


Functional nursing is efficiency-based; tasks are completed
quickly, with little confusion regarding responsibilities.
Allow care to be provided with a minimal number of RNs

TEAM NURSING
 Ancillary personnel collaborate in providing care to a group of
patients under the direction of a professional nurse.
 As the team leader, the nurse is responsible for knowing the
condition and needs of all the patients assigned to the team
and for planning individual care

MODULAR NURSING
 uses a mini-team (two or three members with at least one
member being an RN), with members of the modular nursing
team sometimes being called care pairs.
 Patient care units are typically divided into modules or districts
and assignments are based on the geographical location of
patients
ORGANIZING PATIENT CARE
Traditional Patient Care Delivery Methods
 Total patient care
 Functional nursing
 Team and modular nursing
 Primary nursing
 Case management
TOTAL PATIENT CARE
 Nurses assume total responsibility during their time on duty
for meeting all the needs of assigned patients.
 Sometimes referred to as the case method of assignment
because patients may be assigned as cases
PRIMARY NURSING
 The primary nurse assumes 24-hour responsibility for
planning the care of one or more patients from admission or
the start of treatment to discharge or the treatment’s end.
 During work hours, the primary nurse provides total direct
care for that patient.
 when the primary nurse is not on duty, associate nurses, who
follow the care plan established by the primary nurse, provide
care


FUNCTIONAL METHOD
CASE MANAGEMENT
 A collaborative process of assessment, planning, facilitation
and advocacy for options and services to meet an individual’s
health needs through communication and available resources
to promote quality cost-effective outcomes.
NSG 129: Nursing Leadership and Management

Nurses address each patient individually, identifying the most
cost-effective providers, treatments, and care settings
possible
MANAGEMENT PROCESS: STAFFING

1.
2.
3.
4.
5.
The leader-manager recruits, selects, places, and
indoctrinates personnel to accomplish the goals of the
organization
STEPS IN STAFFING
Determine the number and types of personnel needed to fulfill
the philosophy, meet fiscal planning responsibilities, and
carry out the chosen patient care delivery system selected by
the organization.
Recruit, interview, select, and assign personnel based on
established job description performance standards.
Use organizational resources for induction and orientation.
Ascertain that each employee is adequately socialized to
organization values and unit norms.
Use creative and flexible scheduling based on patient care
needs to increase productivity and retention
RECRUITMENT
 Is the process of actively seeking out or attracting applicants
for existing positions and should be an ongoing process
 A leadership role in staffing includes identifying, recruiting,
and hiring gifted people
SELECTION
 Is the process of choosing from among applicants the bestqualified individual or individuals for a particular job or
position.
 Involves verifying the applicant’s qualifications, checking his
or her work history, and deciding if a good match exists
between the applicant’s qualifications and the organization’s
expectations.
PLACEMENT
 The nurse leader is able to assign a new employee to a
position within his or her sphere of authority, where the
employee will have a reasonable chance for success.
 Proper placement fosters personal growth, provides a
motivating climate for the employee, maximizes productivity,
and increases the probability that organizational goals will be
met.
STAFFING
CENTRALIZED STAFFING,
 where staffing decisions are made by personnel in a central
office or staffing center.
DECENTRALIZED STAFFING
 the unit manager is often responsible for covering all
scheduled staff absences, reducing staff during periods of
decreased patient census or acuity, preparing monthly unit
schedules, and preparing holiday and vacation schedules.
MINIMUM STAFFING RATIO
National Nurses United (2010–2013). RN to patient ratios. Retrieved
June 9, 2013
UNIT
Critical care/ICU
Operating room
Labor and delivery
Antepartum
Pediatrics
Medical-surgical
Emergency department
PATIENT CLASSIFICATION SYSTEM
Category I
1 – 2 hours of nursing care/day
Self care
Category II
3 – 4 hours of nursing care/day
Minimal care
Category III
5 – 6 hours of nursing care/day
Intermediate care
Category IV
7 – 8 hours of nursing care/day
Modified intensive care
Category V
10 – 14 hours of nursing care/day
Intensive Care
FORMULA FOR STAFFING
National League for Nurses Formula for Staffing
ABO X NCH
No.of working hours
INDOCTRINATION
 Planned, guided adjustment of an employee to the
organization and the work environment.
 INDUCTION, the first phase of indoctrination includes all
activities that educate the new employee about the
organization and employment and personnel policies and
procedures.
 ORIENTATION activities are more specific for the position.
 The purpose of the orientation process is to make the
employee feel like a part of the team.
 This will reduce burnout and help new employees become
independent more quickly in their new roles
STAFF DEVELOPMENT
 The better trained and more competent the staff, the fewer
the number of staff required, which in turn saves the
organization money and increases productivity.
 Staff development activities are normally carried out for one
of three reasons: to establish competence, to meet new
learning needs, and to satisfy interests the staff may have in
learning in specific areas.
SOCIALIZATION
 SOCIALIZATION refers to a learning of the behaviors that
accompany each role by instruction, observation, and trial
and error.
 RESOCIALIZATION occurs when individuals are forced to
learn new values, skills, attitudes, and social rules as a result
of changes in the type of work they do, the scope of
responsibility they hold, or in the work setting itself.
STAFFING RATIO
1:2
1:1
1:2
1:4
1:4
1:5
1:4
= Total no. of nursing service personnel for 24
Where:
ABO = Average Bed Occupancy
NCH = Nursing Care Hours
No. of working hours: 8 Based on RA 5901
The 40 working hours per week law
Standard values for NCH:
Medical = 3.4
OB = 3.0
Surgical = 3.4
Pedia = 4.6
Mixed MS = 3.5
Nursery = 2.8
Percentage of Professionals to Non-Professionals
Professionals - 60%
Non-Professionals - 40%
Percentage of Distribution per Shift
Morning - 45%
Afternoon - 37%
Night - 18%
Sample:
Staffing for an OB Ward: 30-bed capacity Percentage of
Professionals to Non-Professionals
NSG 129: Nursing Leadership and Management
Herzberg’s Two-Factor Theory
Frederick Herzberg (1977)
 believed that employees can be motivated by the work
itself and that there is an internal or personal need to meet
organizational goals.
Vroom’s Expectancy Model
Victor Vroom (1964)
 looks at motivation in terms of the person’s valence, or
preferences based on social values. • A person’s
expectations about his or her environment or a certain
event will influence behavior.
MANAGEMENT PROCESS: DIRECTING
DIRECTING
 MOTIVATION is the force within the individual that influences
or directs behavior.
 Leaders should apply techniques, skills, and knowledge of
motivational theory to help workers achieve what they want
out of work.
TYPES OF MOTIVATION
INTRINSIC
 Comes from within the
individual
 Often influenced by family
unit and cultural values
EXTRINSIC
 Comes from outside the
individual
 Rewards
and
reinforcements are given to
encourage
certain
behaviors and/or levels of
achievement
MOTIVATIONAL THEORIES
Maslow’s Hierarchy of Needs and Theory of Human Motivation
Maslow (1970)
 people are motivated to satisfy certain needs, from basic
survival to complex psychological needs, and people
seek a higher need only when the lower needs have
been met.
McClellands’s Three Basic Needs
David McClelland (1971)
 examined what motives guide a person to action.
Achievement-oriented
actively focus on improving what is; they
people
transform ideas into action, judiciously
and wisely, taking risks when necessary.
Affiliation-oriented
focus their energies on families and
people
friends; their overt productivity is less
because they view their contribution to
society in a different light from those who
are achievement oriented.
Power-oriented people are motivated by the power that can be
gained as a result of a specific action.
They want to command attention, get
recognition, and control others.
McGregor’s Theory X and Theory Y
Douglas McGregor (1960)
 examined the importance of a manager’s assumptions
about workers on the intrinsic motivation of the workers.
Operant Conditioning and Behavior Modification
Skinner (1953)
 demonstrated that people could be conditioned to behave
in a certain way based on a consistent reward or
punishment system

NSG 129: Nursing Leadership and Management


COMMUNICATION
Communication is “the exchange of thoughts, messages, or
information, by speech, signals, writing, or behavior.”
Occur on at least two levels: verbal and nonverbal.
CLIMATES OF COMMUNICATION
Internal Climate
External climate
Includes internal factors such as Includes external factors such as
the
values,
feelings, the weather, temperature,
temperament, and stress levels timing, status, power, authority,
of the sender and the receiver
and the organizational climate
itself
COMMUNICATION PROCESS
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The leader must continually work to improve listening skills by
giving time and attention to the message sender.
G
Greeting
R
Respectful
listening
R
Review
R
Recommend or
request more
information
R
Reward
Offer greetings and establish positive
environment
Listen without interrupting and pause to
allow others to think
Summarize message to make sure it
was heard accurately
Seek additional information as
necessary
Recognize that a collaborative exchange
has occurred by offering thanks
SOCIAL NETWORKING
American Nurses Association. (2011, September). Principles for social
networking and the nurse
1.
2.
3.
4.
5.
CHANNELS OF COMMUNICATION
Upward
the manager is a subordinate to higher
communication management
Downward
the manager relays information to subordinates
communication
managers interact with others on the same
Horizontal
hierarchical level as themselves who are
communication
managing different segments of the organization
the manager interacts with personnel and
Diagonal
managers of other departments and groups who
communication are not on the same level of the organizational
hierarchy
flows quickly and haphazardly among people at
Grapevine
all hierarchical levels and usually involves three
communication
or four people at a time
Assertive
communication
Passive
communication
Aggressive
communication
COMMUNICATION SKILLS
allows people to express themselves in direct,
honest, and appropriate ways that do not infringe
on another person’s rights
occurs when a person suffers in silence although
he or she may feel strongly about the issue
is generally direct, threatening, and
condescending
COMMUNICATION TOOLS
SBAR
S
Situation
B
Background
A
Assessment
R
Recommendation
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Introduce yourself and the patient and
briefly state the issue that you want to
discuss
Describe the background or context
(patient’s diagnosis, admission date,
medical diagnosis, and treatment to
date)
Summarize the patient’s condition and
state what you think the problem is
Identify any new treatments or changes
ordered and provide opinions or
recommendations for further action
LISTENING SKILLS
The leader who actively listens gives genuine time and
attention to the sender, focusing on verbal and nonverbal
communication.
6.
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1.
2.
3.
4.
5.
1.
2.
3.
4.
5.
6.
7.
Nurses must not transmit or place online individually
identifiable patient information.
Nurses must observe ethically prescribed professional
patient–nurse boundaries.
Nurses should understand that patients, colleagues,
institutions, and employers may view postings.
Nurses should take advantage of privacy settings and seek to
separate personal and professional information online.
Nurses should bring content that could harm a patient’s
privacy, rights, or welfare to the attention of appropriate
authorities.
Nurses should participate in developing institutional policies
governing online conduct.
DELEGATION
Delegation is getting work done through others or as directing
the performance of one or more people to accomplish
organizational goals.
The mark of a great leader is when he or she can recognize
the excellent performance of someone else and allow others
to shine for their accomplishments.
“Getting somebody to do the task”
“Leaders are self-actualize”
5 RIGHTS OF DELEGATION
Right task
Right circumstances
Right person
Right direction/communication
Right level of supervision
“mugawas nisa board exam”!!!!
Criteria for Delegation to an Unlicensed Personnel
Frequently recur in the daily care of a client or group of clients
Are performed according to an established (standardized)
sequence of steps
Involve little or no modification from one client-care situation
to another
May be performed with a predictable outcome
Do not inherently involve ongoing assessment, interpretation,
or decision making which cannot be logically separated from
the procedure(s) itself
Do not endanger the health or well-being of clients
Are allowed by agency policy/procedures
CONFLICT RESOLUTION
NSG 129: Nursing Leadership and Management
Smoothing
Avoiding
Collaborating
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Conflict is generally defined as the internal or external discord
that results from difference in ideas, values, or feelings
between two or more people.
Conflict is neither good nor bad, and it can produce growth or
destruction, depending on how it is managed.
CATEGORIES OF CONFLICT
occurs between two or more groups of
Intergroup conflict
people, departments, and organizations
occurs within the person. It involves an
Intrapersonal
internal struggle to clarify contradictory
conflict
values or wants
happens between two or more people with
Interpersonal
differing values, goals, and beliefs and may
conflict
be closely linked with bullying, incivility, and
mobbing
INTERPERSONAL CONFLICT
Bullying
repeated, offensive, abusive, intimidating, or insulting
behaviors; abuse of power; or unfair sanctions that
make recipients feel humiliated, vulnerable, or
threatened, thus creating stress and undermining
their self-confidence (Townsend, 2012)
Incivility
behavior that lacks authentic respect for others that
requires time, presence, willingness to engage in
genuine discourse and intention to seek common
ground (Clark, 2010).
Mobbing
occurs when employees “gang up” on an individual.
Workplace When bullying, incivility, and mobbing occur in the
violence
workplace
Think before you speak, think before you act to avoid conflict – be
careful!!
Miscommunication can lead to conflict
CONFLICT PROCESS
Problem with conflict process if nay psychological
problem ang kalaban!!!
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one party in a conflict attempts to pacify the other
party or to focus on agreements rather than
differences – see objectively both sides
parties involved are aware of a conflict but choose
not to acknowledge it or attempt to resolve it – not
advisable if gainit pa ang ulo hahahaha but can
help in most volatile situation (NEGATIVE)
all parties set aside their original goals and work
together to establish a supraordinate or priority
common goal
NEGOTIATION
Each party gives up something, and the emphasis is on
accommodating differences between the parties.
The very least for which a person will settle is often referred
to as the bottom line.
Negotiation is psychological and verbal. The effective
negotiator always appears calm and self-assured.
COLLECTIVE BARGAINING
Collective bargaining involves activities occurring between
organized labor and management that concern employee
relations.
Management that is perceived to be deaf to the workers’
needs provides a fertile ground for union organizers, because
unions thrive in a climate that perceives the organizational
philosophy to be insensitive to the worker
TIME MANAGEMENT
Time management is making optimal use of available time.
Good time management skills allow an individual to spend
time on things that matter
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PROCRASTINATION
6 STEPS OF PROCRASTINATION
CONFLICT RESOLUTION STRATEGIES
Compromising each party gives up something it wants
one party pursues what it wants at the expense of
Competing
the others (CAN BE NEGATIVE OR POSITIVE)
one party sacrifices his or her beliefs and allows
Cooperating
the other party to win
TIME WASTERS
1.
2.
3.
Technology (Internet, gaming, e-mail, and social media sites)
Socializing
Paperwork overload
NSG 129: Nursing Leadership and Management
4.
5.
A poor filing system
Interruptions
MANAGEMENT PROCESS: CONTROLLING
QUALITY CONTROL
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QUALITY CONTROL refers to activities that are used to
evaluate, monitor, or regulate services rendered to
consumers.
HEALTH-CARE QUALITY is the degree to which health
services for individuals and populations increase the
likelihood of desired health outcomes and are consistent with
current professional knowledge.
Hallmarks of effective quality control programs:
1. Support from top-level administration.
2. Commitment by the organization in terms of fiscal and human
resources.
3. Quality goals reflect search for excellence rather than
minimums.
4. Process is ongoing (continuous).
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TOYOTA PRODUCTION SYSTEM
 is a production system built on the complete elimination of
waste and focused on the pursuit of the most efficient
production method possible.
 Health-care organizations that use TPS would have
caregivers not only attempt to directly solve problems at
the time they occur, but it would also have them determine
the root cause of the problem, so that the likelihood of the
problem recurring would be minimized.
Quality Control Process
[picture below]
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PERFORMANCE APPRAISALS
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NURSING AUDIT
Audit is a systematic and official examination of a record,
process, structure, environment, or account to evaluate
performance.
Auditing in health-care organizations provides managers with
a means of applying the control process to determine the
quality of services rendered
TYPES OF NURSING AUDIT
are performed after the patient receives the
service
are performed while the patient is receiving
Concurrent audits
the service
attempt to identify how future performance
Prospective audits
will be affected by current interventions
reflect the end result of care or how the
Outcome audits
patient’s health status changed as a result of
an intervention.
are used to measure the process of care or
how the care was carried out and assume
Process audits
that a relationship exists between the
process used by the nurse and the quality of
care provided.
includes resource inputs such as the
Structure audit
environment in which health care is delivered
Retrospective
audits
QUALITY IMPROVEMENT MODELS
TOTAL QUALITY MANAGEMENT
 also referred to as continuous quality improvement (CQI),
is a philosophy developed by Dr. W. Edward Deming.
 The individual is the focal element on which production
and service depend (i.e., it must be a customerresponsive environment) and that the quest for quality is
an ongoing process
Performance appraisals let employees know the level of their
job performance as well as any expectations that the
organization may have of them.
If employees believe that the appraisal is based on their job
description rather than on whether the manager approves of
them, they are more likely to view the appraisal as relevant.
PERFORMANCE APPRAISAL TOOLS
Trait rating scales
Rates an individual against some standard
Job dimension
Rates the performance on job requirements.
scales
Behaviorally
Rates desired job expectations on a scale of
anchored rating
importance to the position
scales
Rates the performance against a set list of
Checklists
desirable job behaviors.
Essays
A narrative appraisal of job performance.
An appraisal of performance by the
Self-appraisals
employee.
Management by
Employee and management agree upon
objectives
goals of performance to be reached.
Assessment of work performance carried out
Peer review
by peers.
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EFFECTIVE COACHING
Be specific, not general, in describing behavior that needs
improvement.
Be descriptive, not evaluative, when describing what was
wrong with the work performance.
Be certain that the feedback is not self-serving but meets the
needs of the employee.
Direct the feedback toward behavior that can be changed.
Use sensitivity in timing the feedback.
Make sure that the employee has clearly understood the
feedback and that the employee’s communication has also
been clearly heard
[LEGAL BASES NA ANG NEXT MING GINA TRANSCRIBE PA NAKO
SO KULANG NI]
NSG 129: Nursing Leadership and Management
PROFESSIONAL STANDARDS
STANDARDS OF NURSING PRACTICE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Safe & quality nursing practice
Management of resources & environment
Health education
Legal responsibility
Ethico – moral responsibility
Personal & professional development
Quality improvement
Research
Record management
Communication
Collaboration & teamwork
LEGAL BASES
Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002”
 Board shall monitor & enforce quality standards of nursing
practice necessary to ensure the maintenance of efficient,
ethical and technical, moral and professional standards in the
practice of nursing taking into account the health needs of the
nation.
Significance of core competency standards:
 Unifying framework for nursing practice, education, regulation
 Guide in nursing curriculum development
 Framework in developing test syllabus for nursing profession
entrants
 Tool for nurses’ performance evaluation
 Basis for advanced nursing practice, specialization
 Framework for developing nursing training curriculum
 Public protection from incompetent practitioners
 Yardstick for unethical, unprofessional nursing practice
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The Benner Model is designed to emphasize the skill
acquisition of health care professionals (Benner, 2001)
NOVICE, a new practitioner’s practice is driven by rules and
tends to provide task focused care.
ADVANCED BEGINNERS, providers have developed safe
practice but lack a strong knowledge base to found their
practice and management skills.
COMPETENT PROVIDER, NPs will find they can prioritize
and begin to use past experiences to form their care.
PROFICIENT PROVIDERS have a good sense of what their
patient situation is and can prioritize needs and routinely
predict accurate outcomes.
EXPERT PROVIDERS, NPs are confident, have an extensive
knowledge base and will be able to quickly grasp complex
patient situations.
OCCUPATIONAL HEALTH NURSE
Specialty practice that provides for and delivery of health and safety
programs and services to workers, worker population and community
groups.
Functions:
• Promotion and restoration of health
• Prevention of illness and injury and
• Protection from work related and environmental hazards.
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ADVANCED PRACTICE NURSE (APN)
The most independent functioning nurse.
Has a master’s degree in nursing, advanced education in
pharmacology and physical assessment, and certification and
expertise in specialized area of practice.
CLINICAL NURSE SPECIALIST
Nursing expertise in a specialized area of practice (medicalsurgical nursing, psychiatric and mental health nursing,
pediatric nursing, community health nursing, gerontologic
nursing).
NURSING ADMINISTRATOR
Manages client care and the delivery of specific nursing
services within a health care agency.
Begins with positions such as the charge nurse or assistant
nurse manager, then nurse manager of a specific patient care
area.
PARISH NURSE
The role that gathers in churches, cathedrals, temples,
mosques, and acknowledge common faith traditions.
Respond to health and wellness needs within the context of
populations of faith community.
Functions:
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Provider of spiritual care
Health Counselor
Health Advocate
Health Educator
Facilitator of Support Groups
Trainer or Volunteers
Liaison to community resources and referral agent
PUBLIC HEALTH NURSE
 A registered nurse with special training community health
Function:
 Health Advocate
 Care Manager
 Referral Resource
 Health Educator
 Direct Primary Caregivers
 Communicable Disease Control
 Disaster Preparedness
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EXPANDED ROLES FOR NURSES
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SCHOOL HEALTH NURSE
Goal – Superior educational success by enhancing school
health
Functions:
• Direct caregiver
• Case finder
• Consultant
• Counselor
• Health Educator
• Researcher.
NOVICE TO EXPERT
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NURSE RESEARCHER
Investigates problems to improve nursing care and to further
define and expand the scope of nursing practice.
Employed in an academic setting, hospital, or independent
professional or community service agency.
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PRIVATE DUTY NURSE
A registered nurse or a licensed practical nurse who provide
nursing services to patients at home or any other setting in
accordance with physician orders.
HOME CARE NURSE
A nurse who provides periodic care to patients within their
home environment as ordered by the physician.
Functions:
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Health Maintenance
Education
Illness Prevention
Diagnosis and treatment of disease.
Palliation and rehabilitation.
HOSPICE NURSE
Provides a family centered care and allows clients to live and
remain at homes with comfort, independence and dignity,
while alleviating the strains caused by terminal phase i.e. at
the time of death.
NSG 129: Nursing Leadership and Management
Functions:
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Pain & symptom control.
Spiritual Care
Home Care and impatient Care
Family Conferences
Co-ordination of Care
Bereavement Care
REHABILITATION NURSE
A nurse who specializes in assisting persons with disabilities
and chronic illness to attain optimal function, health and adapt
to an altered life style.
NURSE EPIDEMIOLOGIST
Monitors standards and procedures for the control and
prevention of infectious diseases and other conditions of
public health significance including nosocomial infections.
NURSING ORGANIZATIONS
Ang Nars
Association of Deans of Philippine Colleges of Nursing
(ADPCN)
Association of Diabetes Nurse Educators of the
Philippines (ADNEP)
Association of Nursing Service Administrators of the
Philippines (ANSAP)
Association of Private Duty Nurse Practitioners
Philippines (APDNPP)
Critical Care Nurses Association of the Philippines
(CCNAPI)
Gerontology Nurses Association of the Philippines
(GNAP)
Military Nurses Association of the Philippines (MNAP)
Mother and Child Nurses Association of the
Philippines (MCNAP)
National League of Philippine Government Nurses
(NLPGN)
Occupational Health Nurses Association of the Philippines
(OHNAP)
Operating Room Nurses Association of the Philippines
(ORNAP)
Mother and Child Nurses Association of the Philippines
(MCNAP)
National League of Philippine Government Nurses
(NLPGN)
Occupational Health Nurses Association of the Philippines
(OHNAP)
Operating Room Nurses Association of the Philippines
(ORNAP)
Renal Nurses Association of the Philippines (RENAP)
Society of Cardiovascular Nurse Practitioners of the
Philippines (SCVNPPI)
Philippine Association of Public Health Nursing Faculty
Psychiatric Nursing Specialists Foundation of the
Philippines
Integrated Registered Nurses of the Philippines (IRNUP)
References:
Marquis, B. L., & Huston, C. J. (2011). Leadership Roles and
Management Functions in Nursing: Theory and Application.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.