L E A D E R S H I P

LEADERSHIPLEADERSHIP

the process of influencing & persuasion of the

actions of a person or group to attain the goal

dynamic, interactive process that involves the

leader, follower and the situation.

What Is Leadership?What Is Leadership?

Leadership◦ The ability to influence a

group toward the achievement of goals

Management◦ Use of authority inherent

in designated formal rank to obtain compliance from organizational members

Both are necessary for organizational success

© 2009 Prentice-Hall Inc. All rights reserved.

12-3

Leadership

is the conception of a goal and a method of achieving it; the mobilization of the means necessary for attainment; and the adjustment of values and environmental factors

GOAL METHOD MEANS VALUES

ENVIRON-MENTAL

FACTORS

Philosophy

Vision

Mission

Objectives

Management Functions

•Planning

•Organizing

•Directing

•Controlling

Resources

Money

Tools

Equipments

•Character of

the Leader &

the Followers•Organization

- its purpose

- structure

- its values•Nature of the

tasks to be

performed

Social

Economic

Political

To achieve this conception the Leader has to utilize

* Leadership Style * Managerial Skills * Managerial Roles

* Motivation * Planned Change * Conflict Management

MANAGEMENTMANAGEMENTthe art of getting things done

through peopleto forecast and plan, to organize,

command, coordinate and to control.

… … the efficient, effective use of the efficient, effective use of organizational resources organizational resources through people through people

MAN – still an element of management

AGE – old and young should be together

MENT (AL) – do not stop learning

Management:Management:ProcessProfessionScienceArtClass of People

Management Theories: Management Theories: EarlyEarly

Scientific Management (Taylor, 1900-1930)

PRINCIPLES:

Scientific personnel system-hired, trained and promoted based on their technical competence and abilities.

Workers view how they “fit” into the org. to contribute org. productivity.

Relationship bet. Managers (“functional foremen”-plan, prepare, supervise) and workers (to do work)-cooperative/interdependent-work shared equally.

PRODUCTIVITY AND PROFITS ROSE DRAMATICALLY

Bureaucracy (Weber, 1922)Organizational Bureaucracy (Weber, 1922)Organizational theorytheoryCHARACTERISTICS: (Danna, 2006) “legal-rational” authority to issue commands Formality, low autonomy, a climate of rules, division of labor, specialization, standardized procedures, written specifications, memoranda and minutes, centralization, controls and emphasis on a high level of efficiency and production.

Systematic MANAGEMENT (FAYOL, Systematic MANAGEMENT (FAYOL, 1925)1925)

POCCC (command, coordination, control) GULICK (1937)-EXPANDED –POSDCORB (mnemonic)

Simplified Nursing Process Management Process Functions Assessing Planning

Planning Planning/Staffing/Organizing

Implementing Organizing/Directing

Evaluation Controlling

Scenario:A nurse –manager spent part of the day working on the

budget (planning) , meet with the staff about changing the patient care management delivery system from primary care to team nursing (Organizing), altered the staffing policy to include 12- hour shifts (staffing), held a meeting to resolve a conflict between nurses and physicians (directing), and gave an employee a job performance evaluation (controlling).

Not only would the nurse-manager be performing all phases of the management process, but each function has a planning, implementing, and controlling phase.

Theories Focused on Human Theories Focused on Human RelationsRelations

Human Relations/Participative Human Relations/Participative Management (Follett, 1930-1970)Management (Follett, 1930-1970) Participative decision making /humanistic management-

emphasizing integration of people (“human element) into a work situation rather than machines.

HAWTHORNE EFFECT (MAYO, 1953) Conducted experimental study on relationship of social

factors to productivity: It was found out that physical factors were decidedly not

the sole determinants of productivity Results revealed that that interaction among workers and

participation in informal social groups had a great impact on individual behavior and productivity.

Theory X and Theory Y (McGregor,1960) Theory X and Theory Y (McGregor,1960) ((managerial attitudes about employees can be directly correlated with managerial attitudes about employees can be directly correlated with employee satisfaction)employee satisfaction) Theory X Manager- believes their employees are basically

lazy, need constant supervision and direction, indifferent to organizational needs.

Theory Y Manager – believes their employees enjoy their work, are self motivated, willing to work hard to meet personal and organizational goals.

Theory Z (Ouchi, 1981) –motivate Theory Z (Ouchi, 1981) –motivate peoplepeople

Characteristics: Collective decision making, Long term employment Slower but more predictable promotions Indirect supervision holistic concern for the workers.Soft “S” (staff, skills, Style)Hard “S” (superordinate goals, strategy,

structure, sysyems)

TQM (Total Quality Management,1986)TQM (Total Quality Management,1986) Premises that the individual is the focal element on which

production and service depend (customer-responsive environment) and that the quest for quality is an ongoing process.

Identifying and doing the right things, the right way, the first time, problem-preventing planning-not inspection and reactive problem solving-lead quality outcomes.

Never-ending process, everything & everyone in the organization are subject to continuous improvement efforts.

No matter how good the service is, problems-approached in a preventive/proactive mode –crisis mngt. Unnecessary.

Customer needs and experiences with the product are constantly evaluated.

Empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity.

Quality is placed before profit, well implemented TQM program attracts more customers, increased profit margins and financially healthier organization.

TQM Principles (Deming, 1986)TQM Principles (Deming, 1986)

Create a constancy of purpose for the improvement of products and service. Adopt a philosophy of continual learning. Focus on improving processes, not on inspection of product End the practice of rewarding business on price alone; instead, minimize

total cost by working with a single supplier. Improve constantly every process for planning, production, and service. Institute job training and retraining. Develop the leadership in the organization Drive out fear by encouraging employees to participate actively in the

process Foster interdepartmental cooperation and break down barriers between

departments. Eliminate slogans, exhortations, and targets for the workforce Focus on quality and not just quantity; eliminate quota systems if they are in

place Promote teamwork rather than individual accomplishments. Eliminate the

annual rating or merit system Educate/train employees to maximize personal development Change all employees with carrying out the TQM package.

PRINCIPLES OF MANAGEMENT(Robbins, PRINCIPLES OF MANAGEMENT(Robbins, 1994)1994)1. DIVISION OF WORK- specialization makes employees-more efficient-more/better

outputs.

2. AUTHORITY- managers give orders, goes with responsibility.

3. DISCIPLINE - good discipline-clear understanding between management and workers about organization’s rules, and judicious use of penalties for infractions of the rules.

4. UNITY OF COMMAND – each employee should receive orders only from one superior.

5. UNITY OF DIRECTION – for each group of organizational activities having the same objective, direction comes from one manager using one plan.

6. SUBORDINATION OF INDIVIDUAL INTEREST TO THE GENERAL INTEREST- employee or group of employees’ interest should not precede over the interests of the whole organization.

7. RENUMERATION –employee must be paid a fair wage for their services rendered.

8. CENTRALIZATION – degree subordinates involvement in decision making. Centralized (Management), or decentralized (subordinates).

9. SCALAR CHAIN- the line of authority from top management to the lowest ranks in the organization .

10.ORDER- people and materials are in the right place at the right time.

11.EQUITY & Justice- fair and just treatment; no favoritism.

12.STABILITY OF TENURE-orderly personnel planning to ensures that replacements are available to fill vacancies.

13. INITIATIVE – whenever employees are allowed to originate and carry out plans, they are expected to exert high levels of efforts.

14.ESPRIT DE CORPS- promotion of team spirit builds harmony and unity within the organization.

15.Motivation of personnel – allowed to work in problem solving/decision making(Tan & Beltran, 2009).

10 BASIC MANAGERIAL ROLES (MINTZBERG, 1975)10 BASIC MANAGERIAL ROLES (MINTZBERG, 1975)

Leadership Roles

Figurehead –performance of ceremonial duties Leader-direct involvement to approve decisions and choose

managerial team Liaison- dealing with outside people

Informational Roles

Monitor- receipt and sending of information for control purposes.

Dissemination- sharing of information, collected as monitor, with subordinate.

Spokesman-speaks for his department

Decisional Roles

Entrepreneurial – involvement with constant addition or deletion of new projects

Disturbance handler- attention to problems arising out.

Resource allocator- of an argument to negotiation of a labor allocation of budgets, time, and information

Negotiator- ranges from negotiating contract.

LEVELS OF SKILLS MANAGEMENT IN NURSINGLEVELS OF SKILLS MANAGEMENT IN NURSING

CONCEPTUAL – individual’s mental ability to coordinate a variety of interests and activities. Thinks critically and able to conceptualize how things could be. VISIONARY

INTERPERSONAL – individuals’ preferred ways of using language, the degrees to which they listens, and their ways on responding to others.

TECHNICAL- tools, procedures, and techniques that are unique to the nurse manager’s specialized situation. Master of the job-viewed as a source of help. AN EXPERT.

A nurse manager performs theseA nurse manager performs these management functions to deliver management functions to deliver health care to patients. health care to patients. Nurse managers or administrators work atNurse managers or administrators work at all levels to put into practice the all levels to put into practice the concepts,concepts, principles and theories of nursing principles and theories of nursing management. management.They manage the organizational They manage the organizational environmentenvironment to provide a climate optimal to provision to provide a climate optimal to provision ofof nursing care by the clinical nurses. nursing care by the clinical nurses.

Nursing administrationNursing administration

the application of the art and science of management to the discipline of nursing.

Nursing managementNursing managementthe process by which nurse managers practice their profession.

also the group of nurse managers who manage the nursing organization.

Who Needs Nursing Who Needs Nursing Management?Management?

All types of health-care organizations, including nursing homes, hospitals, home health-care agencies, ambulatory care centers, student infirmaries, and many others, need nursing management.

Even the nurse working with one client and family needs management knowledge and skills to help people work together to accomplish a common goal.

A primary nurse working with several clients prioritizes their care to assist time to improve health or, sometimes, peaceful death.

Nursing Management Functions:Nursing Management Functions:IN nursing, management relates to performing the four basic

functions (Processes): or

Planning – provides the framework for performanceOrganizing – in order to establish order and systematically achieve the

goalsDirecting – focuses on leading the staff in the most effective manner possibleControlling – evaluates performance against established standards

Top Management

Middle Management

First-Line Management

P O D S C

P

P

O

O

D

D S

S

C

C

P - Planning

O - Organizing

Amount of Emphasis on Management Function

D - DirectingC - Controlling

S - Staffing

Universality of Management

P L A N N I N GP L A N N I N Gpre-determining a course of action in

order to arrive at a desired result.the continuous process of assessing,

establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known.

While planning is largely conceptual, its results are clearly visible.

is a thinking or conceptual act that is frequently committed to writing – if plan is not written down, they probably won’t be implemented.

is primary to all other activities or functions of management

is an important management function that helps reduce the risks of decision making

problem solving, and effecting planned change.

nursing managers who nursing managers who learns to PLAN will aim learns to PLAN will aim

for maximum for maximum utilization of all utilization of all

resources – resources – money, supplies, money, supplies, equipment, and equipment, and

personnelpersonnel..

Principles of Planning:Principles of Planning: Always based and focused on the VMP, and clearly defined

objectives of the organization.

Continuous process to be more effective.

Pervasive within the entire organization (departments, services, level of management) to provide maximal cooperation and harmony.

Utilizes available resources

Precise in its scope and nature, realistic and focused on expected outcome.

Time –bound (short/long range plan)

Projected plans-documented for proper dissemination to all concerned for implementation and evaluation as to the extent of its achievement.

CHARACTERISTICS of PLANNING (Levey and Loomba,1984)CHARACTERISTICS of PLANNING (Levey and Loomba,1984)

Purposeful - analysis of both external/internal factors, objective process

Process Oriented – continuous

Hierarchical in nature-all members contribute to the process in their own ways

Future directed- forecasts of economic, needs and demands of patients, direction of political forces

Multi-dimensional- key dimensions: time (short range/<1 yr, medium range/<5yrs, long range/>5yrs), organizational(departmental), functional area, orientation (internal/external), scope (strategic, tactical, implementation plan)

Importance of Planning :Importance of Planning : It It leads to the achievement of goals & objectivesgives meaning to workprovides for effective use of available resources &

facilitieshelps in coping with crises is cost-effective is based on the past & future activitiesdiscovers the need for changenecessary for effective controlorients people to action, instead of reaction increases the chances of success by focusing on

results, not on activities increases employee involvement & improves

communication

Scope of PlanningScope of Planning Top Management ( Nursing Directors, Chief Nurses, Directors of Nursing

& their assistants)

- Set the over-all goals and policies of the organization. - Scope of responsibility is the over-all management of the organization.

Middle Management ( Nursing Supervisors) -Direct the activities that actually implement the broad operating

policies such as staffing and delivery of services to the units headed by the

Senior or head Nurses. - Formulation of policies, rules and regulations, methods and procedures for personnel for intermediate level planning for ongoing activities and projects are done in coordination with top management and those in the lower level.

Lower or first level management (Head Nurses or Senior Nurses (including Charge Nurses or team leaders)

- do the daily schedules, or weekly plans for the administration of direct patient care in their respective units

Top

Middle

First Line

Operating Level

Administrator

Staff Nurses / Nursing Attendant

Head Nurses/ Senior Nurses

Supervisors

Top Management

Middle Management

First-Line Management

Conceptual HumanTech-nical

Conceptual

Con-ceptual

Human

Human

Technical

Technical

Proportions of Management skills needed atDifferent levels of management

Concerned with broad-based, long-range decisions that affect the entire organization; therefore, conceptual skill is most important at that level

TopManagement

First-Line Management

Focuses basically on her or his group, Therefore, the need for conceptual skill is at a minimum

Human Skill

The need to be able to understand and work with people is important at all levels, but the first-line manager’s position places a premium on human skill requirements because of the great number of employee interactions required

4 -Types of Planner4 -Types of Planner::Reactive-planning occurs after a problem exists,

done in response to a crisis, lead to hasty decisions and mistakes.

Inactivist- consider status quo, spend a great deal of energy preventing change and maintaining conformity

Preactive-utilize technology to accelerate change, future oriented

Proactice/interactive-consider the past, present, and future, and attempt to plan the future of their organization rather than react to it, dynamic and adaptive to the environment

Types of Planning:Types of Planning:Strategic/long range- forecasts the future success of an org. by matching

and aligning all its capabilities with its external

opportunities (Marquis & Huston,2006).SWOT Analysis

(a tool frequently used to conduct environmental assessments.

STRENGTHS,WEAKNESSES,OPPORTUNITIES, THREATS) Tactical/short-term

Planning ProcessPlanning Process:(Tomey, 2005):(Tomey, 2005)

External Assessment (Opportunities/Threats) Internal Assessment (Strengths/Weaknesses) Priority Strategic issues and programs VValuesMPG (Strategic-org./Operational-unit) Objectives Strategies (timeliness/plans) Policies Procedures Implementation Evaluation (Production/operations/finance/ marketing)

Elements of PlanningElements of Planning:: Forecasting

- estimates the future, including the environment in

which the plan will operate. - It includes who the patients are – their

customs, beliefs, language/dialect barriers, public attitude and behavior, the acuity of their conditions/illnesses, the kind of care they will receive; the number and kind of personnel (professional and non-professional); and the resources-equipment, facilities, supplies

needed

Nursing Standards, Policies and Nursing Standards, Policies and ProceduresProcedures

1. Nursing Standards – this can supply professionally desirable norms against which the department’s performance can be measured. Areas for improvement are identified, and a plan of action to correct this be made and implemented.

2. Nursing Service Policies – are broad guidelines for the managerial decisions that are necessary in organizational and departmental planning. - they govern the action of workers and supervisors at all levels and are intended to achieve pre-determined goals. - they serve as basis for future actions and decisions, help coordinate plans, control performance, and increase consistency of action by increasing the probability that different managers will make similar decisions when independently facing similar situations.

Three General Areas in Nursing that Three General Areas in Nursing that requires POLICY formulationrequires POLICY formulation

1) areas in which confusion about the locus of responsibility might result in neglect or mal performance of an act necessary to a patient’s welfare,

2) areas pertaining to the protection of patients and families’ rights e.g right to privacy, property rights,

3) areas involving personnel management and welfare

Characteristics of Good PoliciesCharacteristics of Good Policies

1. written and understandable and known by those who will be affected by them.

2. comprehensive in scope, stable, flexible so they can be applied to different conditions that are not so diverse that they require different set of policies.

3. consistent to prevent uncertainty, feelings of bias, preferential treatment and fairness.

4. realistic and prescribe limits

5. should allow for discretion and interpretation by those responsible for it.

Example of Nursing Service Policies 1. Admissions – Receiving, consent, notifying doctor, care of patients 2. Doctor’s Orders – written, verbal, telephone 3. Reporting On or Off-Duty – Information given in leaving unit

33. . Nursing ProceduresNursing Procedures

- are specific directions for implementing written policies.

Two areas where procedures are needed:

1) related to job situations such as reporting complaints or disciplinary instances,

2) involves patient care

C. Development & Scheduling Program

- programs are determined, developed and targeted within a time frame to reach the goals and objectives set.

D. Preparing the Budget is a plan for allocation of resources based

om preconceived needs for a proposed series of programs to deliver patient care.

Components of Budget

Cash Budget – estimating the amount of money received form patients and allocating it to cash disbursement required to meet obligations promptly as they come.

Operating Budget – salaries, supplies, drugs & pharmaceuticals, etc…

Capital Expenditure Budget – consists of accumulated

data for fixed assets that are expected to be acquired

during the budgeted period

Time and Planning:Time and Planning:

Time Management – is a technique for

allocation of one’s time through the setting of goals, assigning

priorities, identifying and eliminating time

wastes and use of managerial techniques to reach goals

efficiently.

Barriers to Planning:Barriers to Planning:No specified goals and

objectives.Not flexible planNo communication, coordination

and involvement of people.Not SMARTEROverplan and underplanNo final evaluation at the end of

the plan

THE URGENT VS. THE IMPORTANT

URGENT BUT UNIMPORTANT

B

THE 80/20 LEADER

URGENT & IMPORTANT

C

THE CRISIS LEADER

NON-URGENT & UNIMPORTANT

A

THE SHUFFLER

NON-URGENTBUT IMPORTANT

D

THE PLANNER

CRITICAL THINKING- Examine these two mission statements and then CRITICAL THINKING- Examine these two mission statements and then respond to the questions that follow.respond to the questions that follow.

Hospital A: “ Our mission is to ensure the highest

ORGANIZINGORGANIZING

the grouping of activities for the purpose of achieving objectives.

it shows the part each person will play in the general social pattern as well as the responsibilities, relationships and standards of performance.

Theories:Theories: Classical (1890s) –components (organizational structure,

specialization of labor, chain of command, span of control); flat organizational structure.

Neoclassical (Humanistic,1930s) –employees are given satisfactory working conditions and opportunities to socialize with other employees .IMPROVE JOB SATISFACTION/MORE MOTIVATED

Systems Theory – org. viewed as a whole mix of intertwined elements: input (employees, pts materials, money, equipment), throughputs (work), output (product )

Chaos Theory - change is inevitable, employees must learn to adapt and excel to remain employable.

Contingency Theory- org. structure match the working of the environment, flexible, varies based on the needs of the org. and the leader.

Organizational CharacteristicsOrganizational Characteristics

Organizing Principles Organizing Principles 1. Unity of Command – responsible to only one superior.

2. Scalar principle – authority & responsibility should flow in clear unbroken lines from the highest to the lowest executive.

3. Homogenous Assignment or Departmentation - workers performing

similar assignment are grouped together for a common purpose.

4.Span of Control- the # of workers that a supervisor can effectively manage should be limited depending upon the pace & pattern of the working area

5. Exception Principle -recurring decisions should be handled in a routine manner by a lower-level manager. Unusual matters/problem should be referred to higher levels.

6. Decentralization or Proper Delegation of Authority

Organizational StructureOrganizational Structure

process or way a group is formed, its channels of authority, span of control and lines of communication

mechanism through which work is arranged & distributed among the members of the organization so that the goals can be logically achieved.

Organizational Chart – a line drawing that shows how the

parts of an organization are linked.

Organizational Chart-Organizational Chart-outlines the formal working relationships and the way people outlines the formal working relationships and the way people

interact within the given structure. interact within the given structure. Displays the decision making authority w/in the org., Displays the decision making authority w/in the org.,

illustrating who has the power to make and enforce decisions for the illustrating who has the power to make and enforce decisions for the org.org.

It establishes the following:

Formal lines of authority - the official power to act.

Responsibility – the duty or assignment

Accountability – the moral responsibility

Characteristics of Organizational Characteristics of Organizational ChartChart

1. Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload.

2. Chain of Command – lines indicate who reports to whom & by what authority.

3. Type of work to be Performed - indicated labels or descriptions for the boxes.

4.Grouping of work segment- shown by the clusters of work groups

5.The level of Management, which indicate individual & entire management hierarchy, regardless of where an individual appears on the chart.

Figure: Organizational Chart of Nursing

Division With Assistant Chief Nurses for Nursing Training and Research and for Clinical Areas

Chief of Hospital

Chief Nurse

Ass. Chief NurseTrng & Research

Ass. Chief NurseClinical Service

SupervisingNurse Instructor

Nurse Instructors

Supervising NurseClinical Services

Supervising NurseSpl. Services

Senior Nurses Senior Nurses

Staff Nurses Staff Nurses

Nursing Attendants Nursing Attendants

Figure: An Organizational Structure Showing the Relationship of

the Nursing Service / Division with the

College of Nursing

Medical Center Chief

Chief Nurse

Ass. Chief Nurse

Supervising Nurses

Senior Nurses

Supervising Nurse Ins

Nurse Instructors

Staff Nurses Trainees

Nsg. & Midwifery Affiliates

Midwives

Nursing Attendants

Institutional Workers

Dean of AffiliatingColleges

Clinical Coordinators

Clinical Instructors

Types of Organizational Types of Organizational StructureStructure1. Hierarchical / line organization

- oldest and simplest form- associated with the principle of chain of command,

bureaucracy, vertical control and coordination, levels differentiated by function & authority & downward communications

- has authority for direct supervision of employees2. Staff organization-assists the line in accomplishing the primary objectives of the

unit- provides advice and counsel- includes clerical, personnel, budgeting & finance, staff

development, research & specialized clinical consulting

3. Free –Form/ Matrix

- super imposes a horizontal program over the traditional vertical hierarchy. personnel from functional depts. are assigned to a specific program or project & become responsible to 2 bosses – a program manager & the functional dept. head.

- actually an interdisciplinary team of core & extended members

- e.g. “task force”, “ad hoc committee”

- the expert is the authority that leads the team

4. Flat/horizontal

- few or no levels of intervention between management and staff

Difference between flat and pyramidal structure.Difference between flat and pyramidal structure.

CATEGORY FLAT PYRAMIDAL

No. of Levels Fewer More

Span of Control Broad Narrow

Delegation Greater Lesser

Authority Decentralized Centralized

Control over Subordinates

Lesser More

Type Modern Traditional

Patient Classification System Patient Classification System (PCS(PCS))

method of grouping patients according to the amount and complexity of their nursing care requirements, of nursing time & skill they require.

serves in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.

Purposes for classifying patientsPurposes for classifying patients: For/ : For/ toto

1. staffing. Perceived patient needs can be

matched with available nursing resources

2. program costing & formulation of the nursing budget 3. tracking changes in patient care needs 4. determine values for the productivity equation: output divided by input. 5. determine quality

7171

Orem’s Self-Care TheoryOrem’s Self-Care Theory

NURSE

PATIENT

Wholly Compensatory

PartiallyCompensatory

Educative / Supportive

Intense Work for the

Nurse

Intense Work for the

Patient

Self Care Capabilities Deficit Nursing Systems

Types of Patient Classification SystemsTypes of Patient Classification Systems::

A. Descriptive – narrative descriptive of various degrees of care required

by a particular patient A.1 Checklist – lists down patient problems according to patient

acuity.A1.1. Self-careA.1.2 Minimal careA.1.3 Moderate CareA.1.4 Extensive careA.1.5 Intensive care

A.2 Time-based – lists patient needs according to

level of acuity and ascribe the amount of

nurse-time needed to meet the needs A.2.1 Minimal

A.2.2 PartialA.2.3 AcuteA.2.4 Complex

The number of categories in a patient classification may range from 3 to 4, which is the most popular, to 5 or 6. These classes relate to the acuity of illness and care requirements, such as minimal, moderate, or intensive care.

Other factors affecting the classification system would relate to the patient’s capability to meet his physical needs to ambulate, bathe, feed himself, instructional needs including emotional support.

Patient care classifications have been developed primarily for medical, surgical, pediatrics, and obstetrical patients in acute care facilities.

Classification CategoriesClassification Categories

Level I – Self Care or Minimal Care – Patient can bathe, feed and perform ADL.

Level II – Moderate Care or Intermediate Care

– Patient needs some assistance in ADL, ambulating up and about for short periods of time,

Level III – Total, Complete or Intensive Care

– Patients are completely dependent upon the nursing personnel.

Level IV – Highly Specialized Critical Care -

- Patients maximum nursing care, they need

continuous treatment, observation, many medications, IV piggy backs, vital signs q

15- 30 mins. hourly output;

- significant changes in doctor’s orders more

than care hours / patient /day may range from 6-9 or more.

Levels of Care NCH Needed Per Patient/ Day

Ratio of Prof. to Non-Prof

Level I Self Care or Minimal CareLevel II Moderate or Intermediate Care

Level III Total or Intensive Care Level IV Highly Specialized or Critical Care

1.5

3

4.5

6 7 or higher

55:45

60:40

65:35

70:3080:20

Percentage of Nursing Care Hours

The percentage of nursing care hours at each level of care also depends on the setting in which the care is being given.

Percentage of Patients in Various Levels of Care

Types of Hospital Minimal Care

ModerateCare

IntensiveCare

Highly Specialize

Care

Primary Hospital

Secondary Hospital

Tertiary Hospital

Special Tertiary Hospital

70

65

30

10

25

30

45

25

5

5

15

45

-

-

10

20

•The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. •This also applies to employees working in agencies with at least one million population.•Employees working in agencies located in communities with less than one million popu- lation,will work 48 hours/week and therefore will get only one off-duty a week

2. Staffing

– the process of determining & providing

the acceptable # & mix of personnel to

produce a desired level of care to meet

patient’s demand for care.

Types of Staffing

1. Centralized – done by the nursing director who develops a master plan

for nursing personnel; an

impersonal approach

2.Decentralized – the managers of individual nursing units have more control over the budget, resources, and process.

3. Mixed or Preference Scheduling – Flexible can be combined with self scheduling.

Methods of Staffing Pattern1. Conventional – centralized- decentralized

combination; oldest and most common2. Cyclical – staffing pattern repeats itself

every 4 – 6 wks or 7 -12 wks, etc. 2.a 40 hrs/4 days – 40 hrs a wk is worked in 4 days, followed by a block of off duty time 2.b Seven days off, 7 on – a 10 hr day is worked for 7 days, followed by 7

days off

Criteria for staffing patterns depends on:

1. Existing organizational structure & Standards

2. Availability of job descriptions or performance responsibilities which spell out precise job content, including duties, activities to be performed, responsibilities & results expected from the various roles by the organization.

NursingManagementInformation

System

Budgeting Plan

PositionControl

Plan

SchedulingPlan

Master Staffing Planning

StaffingStudy

Components of the Staffing ProcessSOURCE: Reprinted from Topics in Health Care Financing. Vol. 6, No. 4, p. 15

3. Scheduling

– a timetable showing planned

work days and shift for nursing

personnel

Types of Scheduling:

Centralized – Chief Nurse or designate do assigns the personnel to the hospital unitsDecentralized – Chief Nurse or designate assigns personnel but supervising Nurse/ Head or Senior arranged the shift and off dutiesCyclical – Covers designated number of wks. (cycle length) - it assigns required number of nursing personnel

to each nursing unit consistent with the unit’s patient care requirements, the staff preference, then, education, training and experience.

The following scheduling variables should be considered:

a. Length of scheduling period whether 2 or 4 weeks

b. Shift rotationc. Week-ends offd. Holiday offse. Vacation leavesf. Special days ( birthdays, wedding

anniversaries, etc.)

g. Scheduled events in the hospital training programs,

meetings, etc.h. Job categoriesi. Continuing Professional Education (CPE)

programs

Advantages of Cyclical Schedule

1. It is fair to all2. It saves time as the schedule does not

have to be redone every week or two3. It enables the employees to plan ahead

for their personal needs preventing frequent changes in the schedule.

4. Scheduled leave coverage such as vacation, holidays and sick leaves are more stable

5. Productivity is improved

Factors Considered in Making Factors Considered in Making SchedulesSchedulesa. the different levels of the nursing staff

- adequate mix of nurses and nursing attendants should be observed

so that they only assume duties they are legally responsible for, according to their positions, education, training and experiences.

b. adequate coverage for 24 hours, seven days a week

c. staggered vacations and holidays

- not everybody can enjoy the holiday off on exactly the same day that these occur; schedules for holidays are staggered at least once a month

- Vacations (whether forced or requested) are likewise staggered to

ensure adequate coverage at all times.

d. weekends – Weekends are scheduled in such a way that everyone

gets a fair share of at least one week-end off a month. Saturdays and Sundays tend to have lower requirements

since there are lesser medical rounds, fewer medical orders and lower patient census.

e. long stretches of consecutive working days are to be avoided as much as possible because it might affect the health of the nursing personnel. Afternoon and night shifts are more difficult than the day shifts.

Nursing personnel should get their fair share of these things

including The ‘relief ’ duty for the three shifts periods.

f. evening and night shifts requirements for staff are usually lower

than in the morning shift

g. floating

Some problems that occur in the schedules:

* busy units may require additional help* unscheduled absences may occur and suddenly

a staff may be pulled out from her regular area of assignment to cover for another unit.

- in order to minimize problems as a result of emergency assignments cross training

and/ or orientation to complementary units is advised.

Modalities of Patient Care

1. Primary nursing - total care of an individual is the responsibility of one nurse.

2. Team nursing – a group of nurses work together to fulfill the full functions of professional nurse, to be led by one nurse

3. Case method/total Patient Care – provides one-to-one RN-to- client ratio & constant care for a specified period of time.

4. Functional Method/Task nursing – the oldest nursing practice modality

- task oriented method: 1 nurse for giving medicines

- no one is responsible for total care of any patient - it accomplishes the most work in the shortest amount of

time.

5. Modular Nursing –RN provides direct nursing care with assistance of aides.

4. Developing Job Description

– a statement that sets the duties and

responsibilities of a specific job.

CONTENTS: CONTENTS: (Uses)(Uses)

Identifying Data:Position Title:Department:Supervisor’s Title:

Job Summary-essential features of the job that distinguish it from the others.

Qualification Requirements

Job Relationship – source of workers

Specific and Actual Functions and Activities

DIRECTINGDIRECTING- the issuance of orders, assignments

and instructions that enables the nursing

personnel to understand what are

expected of them.

Element:Element:

A. Delegating

- getting the work done through subordinates

– assigning specific tasks/duties to workers

with commensurate authority to perform the

job

WWhat Cannot Be Delegatedhat Cannot Be Delegated::

Overall responsibility, authority, accountabilityAuthority to sign one’s name is never

delegated

Evaluating the Staff/or taking necessary corrective/ disciplinary action

Responsibility for maintaining morale/ encouragement of staffToo technical jobs and those that involves

trust and confidence

NURSING CARE ASSIGNMENTNURSING CARE ASSIGNMENT ((sometimes calledsometimes called.. ).. )

Modalities of Nursing Care, Modalities of Nursing Care, Systems of Nursing Care,Systems of Nursing Care, Patterns of Nursing Care Patterns of Nursing Care

1. Functional Nursing

– Task oriented

- best system that can be used

when there are many patients and

few professional nurses.

Head / Senior Nurse

R.N.Medication

R.N.Treatment

Nsg. AttendantHygienic Care

HousekeeperLinen Attendant

Patients

Lines of Authority:

Total Care / Care Nursing

– 1 nurse: 1 patient (private duty nursing) - the nurse is accountable for her

own actions - this works best when there are

plenty of nurses and patients are few - nurses may not be familiar with patients in other areas

Staff Nurse

Patient

Head / Senior Nurse

Total Care / Care Nursing

Team Nursing – decentralized system giving care through participative effort

assigning patients and task according to job description

leader has the responsibility for coordinating the total care of a group of patient (Team Conference – the heart of team nursing)

if not fully implemented, it can lead to fragmentation of care

in this method only team leader has significant responsibility and authority & care may resemble functional method if the leader does not keep members informed

Charge Nurse

Team Leader

Staff Nurse

Clients

Team Nursing

Primary Nursing – a form assigning patient care responsibilities is an extension of the principle of decentralization.

Each RN is responsible for the total care of a small group of patient from admission to discharge.

nurse assumes 24 hours responsibility for nursing care

Secondary or associate nurses executes the nursing care plan during afternoon and night shifts or day when the primary nurse is off-duty.

Physician Head Nurse Hospital and Community

Resources

Primary NursePatient/ Client

Secondary/ Ass. Nurse PM

Secondary/ Ass.Nurse Nite

Secondary/ Ass.Nurse Relief

Lines of Authority in Primary Nursing

Modular Method - Modification of team

and primary nursing - RN provide direct nursing care

with assistance of aides

Case Management – responsible for assessment of patient and

family

B. Utilizing / Revising/ Updating Nursing Service Policies and

Procedures

C. Supervision – to inspect, guide, evaluate, improve work performance of employees

Leading – actuating efforts to accomplish goals; supervision or overseeing work of employees; and coordinating or unifying personnel and services among others.

Managers at different levels of institutional hierarchy are referred to in different terms: Management Levels in Nursing

D. Communication - the transmission of information, opinions, and intentions between and among individuals. - It binds the organization together to ensure common under-standing

Purposes: * facilitate work * increase motivation * effect change * optimize care * increase worker satisfaction and facilitate coordination

Lines of CommunicationLines of Communicationa. Downward – from superior to the subordinate which may pass through various levels. e.g. policies, rules and regulations, memos, handbooks, interviews, job descriptions, and performance appraisalb. Upward – emanates from subordinates to superior, usually in the form of feedback and does not flow as easily as downward communication.

e.g. discussions between subordinates and superiors, grievance procedures written reports, incident reports and statistical

reports.

c. Horizontal – or lateral – flows from between peers, personnel or departments on the same level.

e.g. endorsements, between shifts, nursing rounds,

journal meetings and conferences, or referrals

between departments or services

d. Outward – deals with information that flows from the care-givers to the patients, his family, relative,

visitors and the community.

e.g. information about the nature of their illness, medical and nursing plans of care

Communication can be enhanced by carefully choosing the words or information you wish to convey, by creating an environment that

promotes its acceptance, by avoiding preconceived opinions and biases about a person, by listening to and understanding the other person’s point of view and by

being open and supportive. Most people learn to communicate through example. Nurse managers should promote a responsive communication climate in their

units.

E. E. CoordinationCoordination

synchronization of activities with the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious work flow.

coordination also prevents

overlapping of functions, enhances good working relationships and work schedules are finished on time.

e.g Coordination with the Medical Service, Administrative Service, Laboratory Service (Nothing by Mouth After Midnight For Fasting Blood Sugar in AM ),

Radiology Service ( For Chole-GI Series in AM! Pls. withhold Breakfast Until Aft Exam), Pharmacy Service, Dietary Service, Medical Records, Community Agencies, Other Institutions and Civic Organization

F. Staff Development- to improve performance of employee

Orientation In-service education Continuing education

Organization development

Decision Making - A decision is a course of action that is consciously chosen from available

alternatives for purpose of achieving a desired result.

Most people rise to the top of their chosen careers share a common characteristics: they are decisive. They make decisions and are not afraid to take risks.

Five Steps in Decision MakingDefinition of the ProblemAnalysis of the ProblemDevelopment of an Alternative

solutionSelection of the solutionImplementation and follow-up

◦If the solution is proved to be unsatisfactory, the whole process of decision making is repeated and the entire problem is reviewed.

Decision Making Stages: 1. Intelligence 2. Design3. Choice

e.g SWOT ANALYSIS: S – Strength, W – Weakness, O – Opportunities, T – Threat

H. H. MotivatingMotivatingMOTIVATIONIs a skill in aligning employee and

organizational interest so that behavior results in achievement of employee wants simultaneously with attainment of organizational objectives.

Many managers claim that motivating employees is their most difficult daily task. Managers must stimulate workers to release their energies constructively toward the accomplishment of assigned tasks.

Common practical problems encountered by managers include the following:◦ Employees often differ in their needs. ◦ Managers often don’t, or may not accurately

perceive, what employees want◦ Managers have limited flexibility in offering

economic rewards.◦ The reward that may prove to be most

motivating for some people are often difficult to use.

◦ Motivation is a function of understanding needs, tensions, wants, incentives, and a perception of

the environment.

Reporting Evaluation Criteria:Reporting Evaluation Criteria: Delivery1. Organization, systematic and logical presentation of report

=1,22. Clarity of voice, grooming and poise.=1,2

Content1. Correctness of processing and interpretation of data =1,22. Clear presentation=1,23. Conciseness of presentation =1,24. Appropriate data presented =1,2,3

Audio-visual aids1. Use of audio-visual aids to facilitate presentation=1,2 Mastery and Tact1. Ability to answer relevant questions=1,22. Attitude towards criticism and suggestion=1,2,3

CONTROLLING/EVALUATING CONTROLLING/EVALUATING

the process by which managers

attempt to see that actual activities conform to planned activities

performance is measured & corrective action is taken to ensure the accomplishment of organizational goals

Basic Components:1. Establishing standards, objectives and methods for measuring performance2. measuring actual performance3. Comparing results of performance with standards & objectives & identifying strengths &areas for correction4. Acting to reinforce strengths or

successes & taking corrective action as necessary

Nature & Purpose

1. Establishes trust and commitment to the system by all personnel through the use of an effective communication system

2. Clarifies organization & individual objectives

3. Presents uniform & fair standards with precise definitions of each standard, goal & objective

4. Compares expectancy with performance

Control Control MechanicsMechanics1. Standards of Care

◦Yardsticks for gauging the quality and quantity of services.

◦Established criteria of performance, planning goals, strategic plans, physical or quantitative measurements of products, units of service, labor hours, speed, cost, capital, revenue, program and intangible standards.

◦An acknowledged measure of comparison for quantitative or qualitative value, criterion or norm, a standard rule or test on which a judgment or decision can be based.

2. Total Quality Management (TQM) – a way of ensuring customer satisfaction through the involvement of all employees in learning how to reliably produce and deliver quality goods and services.

◦ “way” means .. it’s a process◦ customer satisfaction◦ involvement of all employees◦ quality goods and services

- a work ethic involving everyone in the organization. The client is the focus.

Primary Goal: To improve internal and external customer satisfaction through quality control.

Components of TQM:1. Quality Planning

2. Quality Teams 3. Quality in Daily Work ( or

operations)

Principles of TQM1. Customer Satisfaction2. Management by Facts (“speaking with facts”)

3. Respect for People4. P-D-C-A (Plan-Do-Check-Act)

The real meaning of Quality is TOTAL QUALITY which means:

integrity of function and composition doing “right things right”

The Quality Grid

Right Things Wrong

Ordered the right equipment but installed incorrectly

Right Things Right

Ordered the right equipmentand installed correctly

Wrong Things Wrong

Ordered the wrong equipment and installed incorrectly

Wrong Things Right Ordered

Ordered the wrong equipment but installed correctly

2.1 Elements:2.1.1 Decentralization2.1.2 Participatory management – making decisions at lower levels in the

organizational hierarchy2.1.3 Matrix management – free-form organizational structures.2.1.4 Management by Objectives (MBO) -

every person or group in a work setting has a specific, attainable and measurable

objectives that are in harmony with those of the organization.2.1.5 Statistical analyses2.1.6 Team building

2.1.7 Quality circles – participatory management technique that uses statistical analysis of activities that uses statistical analysis of activities to maintain quality products.2.1.8 Theory Z (consensual decision- making) – the leadership style is a democratic one which includes decentralization, participatory management, employee involvement and an emphasis on quality of life.

2.2 Quality assurance – defines performance measurements and compares actual processes and outcomes to clinical and satisfaction indicators.

2.3 Quality control – involves performance management and maintenance and includes systematic methods of ensuring conformity to a desired standard or norm.

2.4 Quality improvement – concerned with performance development and is

ongoing. Involved with fixing now, preventing

3. Nursing Audit – an examination, a verification or an accounting

of predetermined indicators. The three basic forms are:

3.1 Structure audit – focuses on the setting in which care takes place: physical facilities, equipment, caregivers, organization, policies, procedures and medical records are measured by means of checklist.

3.2 Process audit – implements indicators for

measuring nursing care to determine whether nursing standards are met. Generally task-oriented

3.3 Outcome audit – evaluates nursing performance in terms of establishing

client outcome criteria: may either be

concurrent or retrospective

Control TechniquesControl Techniques

1. Nursing rounds – cover issues like patient care, nursing practice and

unit management

2. Nursing operating instructions – policies which become standards

for evaluation as well as controlling techniques

3. Ganti charts – depict a series of events essential to the completion of a project or program

4. Critical control points and milestones – specific points in a master evaluation plan at which the nurse judges whether the objectives are being met, qualitatively and quantitatively.

5. Program Evaluation and Review Technique (PERT) – uses a network of activities, each of which is represented as a step on a chart. Includes time measurement, an estimated budget and calculation of the critical path (the sequence of events that would take the longest time to finish)

6. Benchmarking – technique whereby an organization seeks out the best practice in its industry so as to improve its performance.

It is a standard or point of reference, in measuring or judging quality, values and cost.

Change Process

Purposeful, designed effort to bring about improvement in a system with the assistance of a change agent.

Theories of Change

1. Lewin’s Theory – change happens in these stages:

1.a Unfreezing- felt need for change 1.b Moving – gathers information for change & implementing the change 1.c Refreezing – change are integrated

& stabilized as part of the system

2. Roger’s theory: 5 phases 2.a Awareness 2.b Interest 2.c Evaluation 2.d Trial 2.e Adoption

3. Reddin’s Theory: 7 techniques change can be accomplished: 3.a Diagnosis

3.b Mutual setting of objectives3.c Group emphasis 3.d Maximum information

3.e Discussion of implementation 3.f Use of ceremony and ritual

3.g Resistance interpretation

4. Havelock’s theory: 6 phases

4.a Building a relationship4.b Diagnosing the problem

4.c Acquiring the relevant Resources

4.d Choosing the solution

4.e Gaining acceptance 4.f Stabilization and self-renewal

5. Spradley’s Model: 8 phases 5.1 Recognize the symptoms

5.2 Diagnose the problem5.3 Analyze alternative solutions

5.4 Select the change5.5 Plan the change5.6 Implement the change5.7 Evaluate the change5.8 Stabilize the change

Three possible situations that may occur before change happens

Restraining force

Driving force

Dynamic Equilibrium‘Status Quo’

Desired Change Undesired Change

DECISION MAKING

‘Deciding to Change’

UNFREEZING

‘Desiring to Change‘Felt Need’

MOVING

‘ImplementingThe Change’

REFREEZING

‘Stabilizing theChange

TrueTrue or or FalseFalse

1. Lack of conflict is a sign of a healthy group

False

2. A conflict exists whenever incompatible activities exist.

True

3. Conflicts are usually destructive to a group

False

4. Conflicts that are not openly expressed and constructively resolved will be expressed indirectly and persist.

True

5. Conflicts can and should be avoided whenever possible

True

6. It is not possible to teach people how to deal with conflicts effectively.

False

7. Ignoring conflicts usually causes them to dissipate and go away

False

8. Conflicts are valuable and even

necessary to a group

True

9. Conflicts are destructive to relationships

Not Usually

10. Conflicts help you understand what

you are like as a person

True

11. A conflict uses up energy and thus decreases a group’s ability to work effectively

Not Usually

C O N F L I C TC O N F L I C TMANAGEMENTMANAGEMENT

Types of Conflict

1. Conflict within individual / intrapersonal – occurs when the leader is confronted with two or more incompatible demands

2. Conflict between organizations – restricted to issues pertaining to competition

3. Conflict with health organizations/ interpersonal & intergroup – maybe due to:3.1 difference between Management &

staff3.2 need to share resources3.3 interdependence of work activities in

the organization3.4 differences in values & goals among

departments & personnel regarding delivery of nursing care

Sources of Conflicts:Conflicting Perceptions Individuals disagree because they perceive events differentlyDiffering Ideas Individuals have ideas that clash (e.g. women ordination)Conflicting Values Individuals embrace different set of values that influence their perceptions and

judgment (e.g. competency, spirituality)

Aggressive Behavior Individuals assert their rights while knowingly or unknowingly deny other’s theirs. ‘the nail that sticks out is nailed down’

Personality ClashesPersonality traits of people create friction

Communication Problems (can be very disastrous) Semantic, noise, lack of

clarification

Structural Problems Line authority, specialization

Human Factors Personality, self-esteem,

budgets, we-they dichotomy

Approaches to Conflict Approaches to Conflict ResolutionResolution

1. Competition and Power – if the nurse’s primary concern is work accomplishment, with little regard for staff relationships

2. Smoothing – a more diplomatic method; the nurse has high concern for relationships & a secondary concern for work accomplishment

3.Avoidance – low regard for both relationships &

work accomplishment; nurse does not take a position regarding the conflict.

“If we don’t talk about the problem, it will go away.”

.

4. Compromise

– each side makes concessions. Is moderately assertive &

cooperative but produces a lose-lose situation because each side gives up something in order to gain something.

This is a weak resolution method

5. Collaboration – a constructive process in which the parties involved recognize that

conflict exist, confront the issue and openly

try to solve the problem that has

arisen between them. The outcome is integrative problem solving

4 Suggestions

1. Avoidance (Rabbits – flee away) I lose, You Lose!

2. Competition ( Bull - confronts ) I Win, You Lose!

3. Adaptation ( Camellon – highly adapts) I Lose, You Win!

4. Cooperation ( Bee ) - I Win, You Win!

* There is no standardized conflict resolution but it depends upon the

situation

Functions of Functions of ManagementManagement

PLANNINGORGANIZINGDIRECTINGCONTROLLING / EVALUATING

PLANNINGPLANNINGElements of Planning

a. Forecastingb. Setting the Vision, Mission,

Philosophy, Goals & Objectivesc. Development & Scheduling Program

d. Preparing the Budget

e. Establishing Nursing Standards,

Policies and Procedures

Elements of Planning

ORGANIZINGORGANIZING

Elements of Organizing

1. Setting up the Organizational Structure

2. Staffing 3. Scheduling 4. Developing Job Description

Characteristics of Organizational ChartCharacteristics of Organizational Chart

1. Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload2. Chain of Command – lines indicate who reports to whom & by what authority

3. Type of work to be Performed – indicated

labels or descriptions for the boxes

Characteristics of Organizational ChartCharacteristics of Organizational Chart

4. Grouping of Work Segment – shown by

the clusters of work groups

5. The level of Management, which indicate individual & entire management hierarchy, regardless of where an individual appears on the chart.

Organizing PrinciplesOrganizing Principles

1. Unity of Command – responsible to only one Superior2. Scalar principle – authority &

responsibility should flow in clear unbroken lines from the highest to the lowest executive.

3. Homogenous Assignment or Departmentation - workers performing similar assignment are grouped together for a common purpose

4. Span of Control – the # of workers that a supervisor can effectively manage should be limited depending upon the pace & pattern of the working area

5. Exception Principle – recurring decisions should be handled in a routine manner by a lower-level manager. Unusual matters/problem should be referred to higher levels.

DIRECTINGDIRECTING Element: A. Delegating

Modalities of Nursing Care,

Systems of Nursing Care, Patterns of Nursing Care

Modalities of Nursing Modalities of Nursing CareCare

1. Functional Nursing 2. Total Care / Care Nursing3. Team Nursing Team Nursing

4. Primary Nursing 5. Modular Method 6. Case Management

Elements of Elements of DirectingDirecting

B. Utilizing / Revising/ Updating Nursing

Service Policies and Procedures

C. Supervision

D. Communication

Elements of DirectingElements of Directing

E. Coordination

F. Staff Development

G. Decision Making

H. Motivating

CONTROLLING/CONTROLLING/EVALUATINGEVALUATING Control Mechanics

1. Standards of Care 2. Total Quality Management (TQM 3. Nursing Audit