lec 1 prelim nursing leadership and management
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NURSING LEADERSHIP &
MANAGEMENT
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Leadership the process of influence in which the
leader influences others toward goal
achievement
is the effort to envision and inspirechanges
A social transaction in which one
person influences others.
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LEADERSHIP
Process of influencing the behavior or
actions of a person or group to attain
desired objectives
A dynamic, interactive process that
involves three dimensions: leader,
follower and the situation
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Leader the one who leads, conducts or guides
the process
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Lead to go with or ahead of so as to show
the way; guide
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A Leader is one others followwillingly and voluntarily
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TYPES OF LEADERS
Informal leader
Does not have official sanction to
direct activities of others; chosen bythe group itself
Usually become leaders because of
age, seniority, especialcompetencies, an invitingpersonality or ability tocommunicate with and counsel
others
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TYPES OF LEADERS
Informal leader
Play a valuable role if their behavior
and influence are congruent withthe goals of the organization.
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Formal or appointed
chosen by administration, and givenofficial or legitimate authority to act
Ex. The elected and appointed officers
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Theories of Leadership
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Great Man TheoryArgues that few people are born to begreat leaders who are well rounded &
simultaneously instrumental &supportive
Many finds this theory unattractivebecause of the premise that leaders are
born not made, which suggests that
leadership cannot be developed
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Charismatic theory
Leader inspires others by obtaining
emotional commitment from followers
and by arousing feelings of loyalty &enthusiasm
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Robert House - found that thisleaders have st rong convic t ion &
high sel f conf idence & fo l lowers
has the similar belief with thecharismatic leader thus showing
signs of unquest ion ing acceptance
& obedience
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Bernard Bass - it sometimes leads
into bl ind obedience but a
t ransformational leaders use it to
mot ivate members
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Jay Conger & Kanungo (1998) -Theyfound out that char ismais more of an
at t ribut ional phenomenon
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Charm is an inspirational
quality
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Trait Theory Early works in this area maintained
that traits are inherited, but later
theories suggest that the t rai ts can be
obtained through learning &experience
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Leaders are born, notcreated.
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Leadership Traits
Task-Oriented
Relationship-Oriented
Participative Leadership
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Leadership Traits
Task-Oriented
behaviors includes planning,
scheduling, &coordinating activities.
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Relationship-Oriented
includes being friendly & considerate,
showing trust & confidence, expressingappreciation & providing recognition
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Participative Leadership
enlists associates participation in
making decisions
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Situational
Leadership Theory
Predicts the most appropr iate
leadership sty le from the level of
matur i ty of the fo l lowers
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Contingency Theory leadership style will be effect ive&ineffect ive depending on the
si tuat ion
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Path-Goal Theory derived from the expectancy theorywhere people act as they do
because they expecttheir behavior
to produce sat isfactory resu l ts
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In path-goal relationship, the leaderfacil i tates task accompl ishmentby
minim izing obst ruct ionto the goals
(structured activity), & by rewardingfo l lowersfor completing their task
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staff associates are introduced as avariable where in staff associates
wi th high need for achievement
probably will prefer a task o rientedleader, but peop le w ith high need
for aff i l iat ion will prefer a
considerate leader
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Transactional
Leadership an exchange posture that identi f iesthe needsof the followers & provides
reward in exchange for expected
performance
a contract for mutual benefits that has
contingent rewards
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Transformational
Leadership Promotes employee development &
attend to their needs by mot ivat ing,
inspi r ing, & inf luencing the
fo l lowers
Leader serves as a ro le modelwho
provides a sense of direction &encourages self management
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described it in terms of charisma &intellectual stimulation
transformational leaders change theorganization by real igning the
organizations cul turewith the new
vis ion, & rev is ion of assumpt ions,values, & norms
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Integrative Leadership
Model Obviously there is no one bestleadership sty le. Leaders are rarely
totally people oriented or task
oriented.
One should be aware of h is own
behavior & learn to adapt.
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Styles of Leadership
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Democratic
is part ic ipatory, with the author i tydelegated to others, influential by
having close and personal
relat ionsh ip w i th the subord inates
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Bureaucratic
is done acco rding to pro cedu re orpol icy. Its more of a po l ice off icer
than a leader and managesby the
book .
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Laissez-Faire
Is passive & permissive, nondirective,inactive. Chaos is most l ike ly to
developbecause members may work
independently
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Elements of Ledearship
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Vision
Provides direction to the influence
process towards a successfully goal.
Act as a bridge between the current
state and a future state.
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Influence
The ability to obtain followers,
compliance or request.
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Authority
Legitimate power to direct others
right to expect or secure compliance
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Power
Is defined as the ability to efficiently
and effectively exercise authority andcontrol through personal,
organizational and social strength.
Ability to impose the will of one personor group to bring about certain
behaviors.
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Sources of power
Expert power it is derived from the
knowledge & skills one possess
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Legitimate power is derived from the
position one holds in a group &
indicates authority but not sufficient asones only source of power
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Referent power derived from respect
& trust coming from any individual
group or organization. It is also callednetworking.
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Reward power it comes from the
ability to recognize others for
complying by compensate throughmeans of benefits, time off, desired
gifts, promotions or increase in pay or
responsibility.
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Coercive power is based on fear of
punishment if one fails to conform
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Connection power it comes from
coalition & interpersonal relationship
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Informational power it comes from
knowledge & access to information.
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Review
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THEORIES OF LEADERSHIP
TRAIT THEORY
*leaders are born with inherited
tasks
*envisioning goals, affirming valuesserving as a symbol
QUALITIES/TRAITS OF A
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QUALITIES/TRAITS OF A
LEADER
Intelligence: judgment, knowledge
and fluency of speech
Personality: adaptability, alertness,
creativity, cooperativeness, personal
integrity, self confidence, emotional
balance and control, independence
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QUALITIES OF .
Abilities: ability to enlist cooperation,
popularity and prestige,
sociability/interpersonal skills, social
participation, tact and diplomacy
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GREAT-MAN THEORY
Leaders are born and not made
Great leaders will arise when there is
a great need
Ex. King of Spain
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BEHAVIORAL THEORY
Successful leadership is based in
definable, learnable behavior
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PARTICIPATIVE LEADERSHIP
People are more committed to actions
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SITUATIONAL THEORY
The best action of leader depends on
range of situational factors
*motivation
*capability of followers
performance of leader and follower
attitudes, needs and expectations
SITUATIONAL LEADERSHIP
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SITUATIONAL LEADERSHIP
THEORY
Depends on the level of the maturity of
individual
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CONTINGENCY THEORY
Leaders ability to lead is contingent
upon situation.
a.leadership member relation
b.task structure
c.position power
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TRANSACTIONAL LEADESHIP
People are motivated by reward and
punishment
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TRANSFORMATIONAL THEORY
People will follow a person who
inspires them
A person with vision and passion
Value based leadership
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PATH-GOAL THEORY
Leaders has certain objectives and
initiates their followers to attain their
own objectives
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STRATEGY THEORY
BASED ON HUMAN HANDLINGSKILLS OF LEADERS Strategy 1 attention thru vision
Strategy 2 meaning thru communication
Strategy 3 - trust thru positioning
Strategy 4 - deployment of self thrupositive self regard
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CHARISMATIC THEORY
Charm and grace are needed to
create followers
Self belief
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STYLES OF LEADERSHIP
1. AUTHORITARIAN/AUTOCRATI C
Strong control over the group ordirective approach
Concern with task accomplishments
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2. DEMOCRATIC OR PARTICIPATIVE
Leaders focuses on involving
subordinates in decision making
People oriented
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3. LAISSEZ FAIRE OR PERMISSIVE
Delegating approach
Little or no direction is provided to
subordinates
BASES OF POWER FOR
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BASES OF POWER FOR
LEADERS
Legitimate/authority power granted byan official position
Referent potential influence one hasbecause of the strength of relationships
between leaders and followers
Expert gained thru the position of
special knowledge, wisdom, sound
judgment, good decision skills, skills or
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Informational power exists when an
individual have information that others
must have to accomplish particular
goals
Connection power based on having
connections or associations withothers who are powerful
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Coercive power or punishment power
manager control the groups through
fears, threats and sanctions
Reward power this is achieved
through influencing others because of
ones control over desired resources
COMPONENTS OF EFFECTIVE
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COMPONENTS OF EFFECTIVE
LEADERSHIP
Understanding of the individual
strength, weaknesses and potential
Knowledge of basic ingredients for
leadership and management
Systematic use of self to get things
done at the right time
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Leadershipis the essence of professionalism andshould be considered an essential component of
all nurses and other professionalroles
Joyce Clifford
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MANAGEMENT
Art of getting things done thru people
Process that involves guidance,direction of a group of people toward
organizational goals or objectives
Process thru which the objectives of
an organization are accomplished by
utilizing human, physical and technical
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Management
the act of planning, organizing, directing
(leading), controlling (evaluating).
is a process by which a cooperative groupdirects actions towards common goals
is a process of coordinating and allocating
resources toachieve organizational goal
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Manager
a person that creates and maintainsan internal environment in an
enterprise in which individual work
together as a group
M i
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Managing
accomplishing the goals of the groupthrough effective and efficient use of
resources
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MANAGEMENT ROLES
Information role monitor,
disseminator, spokesperson
Interpersonal role- figurehead,
leaders, liaison
Decisional roles entrepreneur,
disturbance handler, resource
allocator, negotiator
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MANAGEMENT LEVELS
FIRST LEVEL Supervises the
operative employee
MIDDLE LEVEL plan and coordinate
activities of the organization.
TOP LEVEL manages the
organization as a whole.
C i f L d &
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Comparison of Leaders &
Managers
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Leadership Management
Motto Do the right things Do things rightChallenge Change ContinuityFocus Purpose Structures & proceduresTime Frame
Future
Present
Methods Strategies SchedulesQuestions Why? Who, What, When, Where
& How?Outcomes Journeys DestinationsEvaluate
Human Potential Performance
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MANAGEMENT THEORY
Purposes of Theory
1. Provide a stable focus of understanding
what we experience
2. Enable us to communicate freely
3. Challenge us to keep learning of our
world
PRINCIPLES OF
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PRINCIPLES OFMANAGEMENT
(MODERN ERA)
Scientific Classical Human Relations Behavioral
Scientific
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Scientific
ManagementFocused on the best way to do atask
- Eff ic iencyprovided information on:standards
time & motion studies
task analysis
job simplification
productivity incentives
FREDERICK TAYLOR (1856-1915)
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FREDERICK TAYLOR (1856 1915)
FATHER OF SCIENTIFICMANAGEMENT
Used stopwatch studies & applied the
principles of:
observation
measurement
scientific comparison
to determine the most efficient way to
accomplish a task
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Reduced wasted effort Set standard for performance
Encourage specialization
Stressed the selection of qualifiedworkers who could be developed for a
particular job.
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Monistic Theory
FRANK GILBRETH(1868-1924)LILIAN GILBRETH(1878 1972)
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LILIAN GILBRETH(1878-1972)
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Pioneers in time and motion studies
Emphasized the benefits of:
job simplificationestablishment of work standards
effects of the incentives wage plan
fatigue on work performance
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First to use motion picture films toanalyze workers emotions
Developed a micro chronometer
Henry Gantt (1861-1919)
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y ( )
Disciple of Taylor, was concerned w/problems of efficiency
Refined previous work rather than
introduce new concepts Developed a task and bonus
remuneration plan
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Argued for:more humanitarian approach
placed emphasis on servicerather than profit objectives
recognize useful non-monetaryincentives
CLASSIC ORGANIZATON
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CLASSIC ORGANIZATON
Deductive rather than inductive
-views the organization as a whole
rather than focusing sole ly onproduction
-focused on: planning
organizingcontrolling
Henry Fayol (1841 1925)
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Henry Fayol (1841-1925)
Father of Management Process School
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Studied the functions of managers andconcluded that management is
universal
A believer in the division of work , he
argued that special izat ion inc reases
eff ic iency
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Believed that workers:should be allowed to think
implement plans
be adequately remunerated fortheir services
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Encourage devt of group harmonythrough equal treatmentand stabi l i ty
of tenu refor personnel
a place for everything and
everything in i ts p lace.
FAYOLS MANAGEMENT
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PRINCIPLES
Division of Labor the more peoplespecialize, the more efficient they canperform
Authority management needs to beable to give orders so that they canget things done.
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Discipline members in anorganization need to respect the rulesand regulation that govern theorganization
Unity of command subordinatesshould receive orders from only one
superior
Unity of direction member of any
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y yorganization should have only oneobjectives
Subordination of Individual Interestto the Common Good give way for
the interest of everybody.
Remuneration workers should be
paid according/commensurate to thework they perform.
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Centralization managers should
retain the final responsibility butshould at the same time give theirsubordinate enough time and authorityto do their job.
Hierarchy the line of authority in anorganization runs in order of rank.
Order materials and people shouldbe at the right time and at the right
place
Equity people in the organizationshould be treated with equity and
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should be treated with equity andjustice
Stability of Staff the greater theturn-over rate, the less workers are
efficient
Initiative subordinate should begiven the freedom to do their
work/conceive plans even thoughsome mistakes occur
Espirit de Corps good relationship
Max Weber (1864 1920)
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Max Weber (1864-1920)
Father of OrganizationalTheory
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Conceptualized bureaucracy w/
emphasis on rules instead of
individuals and competency overfavoritism as the mos t effic ient basis
of organization
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Conceptualized a structure of
author i ty that would facilitate the
accompl ishment of theorgan izat ional object ives
Basis Of Authority
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Basis Of Authority
1. Traditional Authority
2. Charisma
3. Rational/Legal Authority
Human Relations
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Human Relations
Stresses the SocialEnvironment
-focused on the effect ind ividualshaveon the success or fa i lure of an
organization
Chester Barnard (1886-
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1961)
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Studied the func t ions of execut iveswhile he was a manager for the New
Jersey bell telephone system
He defined the managers
responsibilities
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1. Defining Objectives
2. Acquiring Resources
3. Coordinating Activities
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Stressing the importance ofcooperation b/w management and
labor, he noted that the degree of
cooperat ion depends on the non-
f inanc ial inducement
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Stressed the role of in formalorganizat ion fo r
aiding communication
meeting individuals needs maintaining cohesiveness
Mary Parker Follett (1868-
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1933)
Mother of Modern Management
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Stressed the importance ofcoordinating the psychological and
sociological aspect of management
Perceived the organizat ion as a
social sys temand managementas
social process
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She considered subordinat ion
offensive
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Distinguished between power w/othersand power over othersand
indicated that legi t imate power is
produced by a circular behavior
whereby super iorand subordinates
mutually inf luenceone another.
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The law of the situation dictates that a
person does no t take orders from
another person but f rom thesi tuat ion
Elton Mayo (1810-1949)
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Elton Mayo (1810 1949)
Author of The Hawthorne Studies
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Though criticized for poor research
methods, the HawthorneStudies
stimulated considerable interest inhuman problems on the job
lighting had li t t le effect onproduction
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Work norms obviously had more
influence than wage incentive
Kurt Lewin (1890-1974)
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Kurt Lewin (1890 1974)
Study of Group Dynamics
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maintained that groups have
personal i t ies of their own;
composi te of the memberspersonal i t ies
advocated democrat ic superv is ion
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Identified the three types of leadersAuthorat
Democrat
Laissez-Faire
Jacob Moreno (1892-1979)
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( )
Developed Sociometryto analyze
group behavior
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Claimed that people are either:attracted to
repulsed by
indifferent towards others Developed the sociogram to chart
pairings of preferences for others
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Contributed to: psychodrama (individual therapy)
sociodrama ( related to social and cultural
roles)
and role playing techniques
for the analysis of interpersonal
relations
Behavioral Science
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emphasizes the use of scient i f icprocedures to study the
psychological , sociological , and
anthropological aspects of human
behavior in organization
Abraham Maslow (1908-1970)
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Abraham Maslow (1908 1970)
Hierarchy of NeedsTheory
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Initiated the Human Behavioral School in
1943
He outlined a hierarchical structure for
human needs classified into fivecategories:
1. Physiological
2. Safety
3. Belonging
4. Esteem
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Once needs are met, newer
and more mature ones mustemerge
Frederick Herzberg(1923-
2000)
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2000)
Factors in the job can raise the level ofperformance and meet the higher
order needs
Job-content (factors in the job) ex:
achievement, recognition, growth =
mot ivators
Job-context (surrounding environmental
factors) ex: supervision, company policy,working conditions = hygiene factors
Douglas McGregor (1906-
1964)
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1964)
Theory X and Y
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Developed the managerialimplications ofMaslows Theory
Notes that ones style of managementis dependent on ones philosophy of
humans
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Theory Xmanagers emphasis onthe goal of the organization
People dislike & will avoid work
Workers must be directed, controlled,
coerced, threatened
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Theory Y emphasis is on the goal ofthe individual
People do not inherently dislike work
Work can be a source of satisfaction Workers have self direction, self-
control, responds to rewards for the
accomplishment of goals
William Ouchi
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Theory Z
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Published Theory Z: How American
Business Can Meet the Japanese
Chal lengein 1981
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Japanese organization lifetime employment
Slow evaluation & promotion
Non-specialized career paths Implicit control mechanisms
Collective decision-making &
responsibility Wholistic concern
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US organization Short-term employment
Rapid evaluation & promotion
Specialized career paths
Explicit control mechanisms
Individual decision-making
Individual responsibility
Segmented concern
Richard Pascale & Anthony
Athos
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Athos
Gave a more extensive discussion of
the Art o f Japanese Management:
App l icat ion for Amer icanExecut ivesin 1981.
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Explain that organization in the UStend to savor strategy, structure,
and systems, whereas the Japanese
organization focus on staff, ski l ls,
sty le, and superord inate goals
Rensis Likert (1903-1981)
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Theory of Management is based on his work atthe University of Michigans Institute for Social
Research
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He identified 3 types of variables in
organization
1. Causal
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Includes: Leadership behavior
Organizational structure
Policies
Controls
2. Intervening
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These are: Perceptions
Attitudes
motivations
3. End-result
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Includes: Measures of profits
Costs
Productivity
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Managers may act in ways harmful tothe organization because they
evaluate end results to the exclusion
of intervening variables.
Managerial Grid
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Managerial Grid
B
(1,9)
E
(9,9)
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C
(5,5)
A
(1,1)
D
(9,1)
Vertical concern for people Horizontal concern fro production
Behavioral Science
Robert Blake (1918) & Jane Mouton (1930)
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Maintained that there are 2 critical dimensions
of leadership1. Concern for people
2. Concern for production
They depicted these on a 9 x 9 or 81 squaremanagerial grid. The vertical axis represents
the managers concern for people, & the
horizontal axis represents concern forproduction. The 5 basic styles are to each
corner & in the middle
A. Impoverished Manager
( )
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(1,1)
lack of concern for both people &
production
B. Country Club Manager
(1 9)
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(1,9)
thoughtful & friendly but lack concern forproduction
C. Organization Man
M (5 5)
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Management (5,5)
represents a moderate concern for bothpeople & production but not at the sametime
D. Authority-Obedience
(9 1)
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(9,1)
efficiency in operation but lacks concernfor human element
E T M t (9 9)
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E. Team Management (9,9)
the optimal managerial style. These managersintegrate their concern for people & production
Skills of a Manager
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Accdg to Robert Katz Technical ski l ls knowledge and
proficiency in activities involving
methods, procedures and process. It
also involves working w/ tools and
specific techniques to achieve the
desire result.
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Human ski l ls the ability to work w/people. It is the creation of work
environment in w/c people feel secure
and free to express their opinion.
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Conceptual ski l ls the ability to seethe over-all pictures to identify
important elements in a situation and
to understand the relationship among
the elements
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Summeremphasized Knowledge factors
Attitude factors
Ability factors
Roles of Managers
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INTERPERSONAL ROLE
Symbol
Leader Liaison
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INFORMATIONAL ROLE
Monitors Information
Disseminates Information Spokesperson or Representative
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DECISIONAL ROLE
Entrepreneur or Innovator
Troubleshooter Negotiator
I. PLANNING
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Forecasting or setting the broad outlineof work to be done
-Why it will be done?
-What action is necessary?
-Where it will be done?
-When it will be done?
-Who will do it?
-How it will be done?
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Defined as pre-determining a courseof action in order to arrive at a desired
result.
It is the continuous process of
assessing, establishing goals and
objectives, implementing and
evaluating them, and subjecting these
to change as new facts are known.
PRINCIPLE OF PLANNING
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Always based and focused on thevision, mission, philosophy, and
clearly defined objectives of the
organization
Provison for proper analysis would
indicate a revision to make it more
effective
Pervasive within the entire
organization covering the various
departments, services and the
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Utilizes all available resources Must be prcised in its scope and
nature. It should be realistic and
focused on its expected outcomes.
Should be time-bound with short- and
long- range plans.
Projected plans must be documented
for proper dissemination to all
concerned for implementation and
evaluation
Scope of planning
Supervisors
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Supervisors
- formulate policies, rules and regulations,methods and procedures
-coordinates nursing activities
-translate strategies and procedures into
specific objectives and program Head nurses
- schedule daily and weekly plans for theadministration of patient care for his orher unit
- directly responsible for the actualproduction of nursing services
CHARACTERISITCS OF GOOD
PLAN
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Based on clearly defined objectives It should be simple
It should provide for the proper
analysis and classification of action It should be flexible
It should be balance
It should make use of all availableresources
REASONS FOR PLANNING
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Increases the chance of success byfocusing on results not activities
Forces analytic thinking and
evaluation of alternatives Establish a framework for decision
making
Orient people to action than reaction Includes day to day and future
focused managers
REASONS FOR PLANNING
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-Helps avoid crisis management andprovide decision making flexibility
-Provide a basis for managing
organizational and individual
performance
-Increases employee involvement and
improves communication
-Cost effective
STAGES OF PLANNING
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1. Develop the purpose or missionstatement, goals, objectives,
philosophy
Vision organization future role and
function, something to strive for.
Mission purpose of existence and reasonbehind organizational structure
Philosophy statements of shared values and
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Goals statement of intent derived from
the purposes of the organization, usually
stated broadly and generally
Objectives specific aims, purposes ortargets that will have to be accomplished
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2. Collect and analyze data - externaland internal forces
3. Assess for the strength (opportunitiesthat will facilitate effectiveness and
achievement of goals and
weaknesses (threats that will impede
achieving goals and objectives)
4. Write realistic and general statements
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of goal
5. Identify strategies to achievespecified goals
6. Develop a timetable foraccomplishing each objectives
7. Provides guideline for developingoperational and functional plans
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8. Put plans to work/implement
9. Provide for formative evaluation
reports before, during and after theplan is implemented
BUDGET (AS A TOOL FOR
PLANNING)
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Budget
operational management plan related to
income and expenses for division of time;allocated resources necessary for future
expenditures
PREREQUISITES TO
BUDGETING
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Sound organizational structure withclear line of authority and
responsibility
Managerial support
Formal policies and procedures mustbe reflected in the budgetary manual
PUPOSES OF BUDGETING IN
NURSING SERVICE
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To plan the objective, programs,activities of the nursing service and
finance to accomplish them.
To motivate nursing workers through
analysis of actual experience.
To serve as standards.
Types of Budget
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Capital Operational
Personnel or manpower
Flexible
Cash flow
Fixed ceiling
COSTS
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Fixed cost - not related to volume andremain constant.
Variable cost - related to volume and
varies according to different factors. Direct cost - related to providing
product service.
Indirect cost - incurred in support ofproviding products service.
PROCEDURENURSING
SERVICE
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1. Determine productivity goal
2. Forecast workload
3. Budget patient care hours
4. Budget patient care hours andstaffing
5 Plan for nonproductive hours
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6. Chart productive time
7. Estimate the cost of supplies and
services
8. Anticipate capital expense
II. ORGANIZING
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Grouping of activities, providingassignments, supervising, defining
means of coordinating activities to
accomplish goals and objectives The process of establishing formal
authority which includes developing
job descriptions by defining thequalifications and functions of
personnel.
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Elements of Organizing
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It include setting up: Organizational structure
Staffing
Scheduling Developing job decription
CHARACTERISTICS OF
ORGANIZATIONAL STRUCTURE
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Division of work in which each boxesrepresent an individual responsible for
a given part of the organizations
workload
Chain of command, with lines
indicating who reports to whom andwhy what authority
CHARACTERISTICS
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The type of work performed, indicatedby the labels or description for each
boxes
The grouping of work segmentsshown by the cluster of work groups
The level of management, which
indicate individual and entiremanagement hierarchy
COMPONENTS OF
ORGANIZATIONAL STRUCTURE
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People
Purpose
structure
BASIC TYPES OF O.S.
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Informal consists of the personaland social relationship of the members
in the organization
Formal describes the positions,
responsibilities and those occupying
the positions and their relationshipsamong them
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PATTERNS/FORMS OF
ORGANIZATIONAL STRUCTURE
1. Vertical or Tall Chart/Centralized Structure
D i t th Chi f E ti t th t
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Depicts the Chief Executive at the top
with line of authority flowing down the
hierarchy.DIRECTOR
CN
SN SNSN
NANA NA
2. Horizontal or Flat Chart/Decentralized Structure
D i t th t th t /
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Depicts the manager at the top w/ a
wide span of control
CN
SN SNSN
NA NA NANANA
SN SN
3. Concentric or CircularChart
h t d fl f
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shows outward flows of
communication from center
SN SN
SN
CN
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3 General Types of
Organizational Chart:
1. Line Organizational/Bureaucratic/
I th i l t d t di t t f
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Is the simplest and most direct type of
organization in which position has
general authority over the lower
position in the hierarchy.DIRECTOR
CHIEF NURSE
SN SNSN
ADVANTAGES
1. Maintain
DISADVANTAGES
1. Neglects special
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simplicity.2. Makes clear
division of
authority.3. Encourage
speedy action
planning2. Overworks key
people
3. Depends uponretention of a few
key people
2. FunctionalOrganizational
Is one here each nit is responsible
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Is one where each unit is responsible
for a given part of the organizations
workload. There is a clear delineation
of roles and responsibilities which are
actually interrelated
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ADVANTAGES1. Relieves line
executive ofroutine
DISADVANTAGES1. Makes relationship
more complex2 Makes limits of
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routinespecializeddecision
2. Provides
frameworks forapplying expertknowledge
3. Relieves press of
need for largenumber of well-roundedpersonnel
2. Makes limits ofauthority of eachspecialist a difficultcoordination
3.Teach towardcentralization oforganization.
3. Staff Organization
Is purely advisory to the line structure
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Is purely advisory to the line structure
w/ no authority to put
recommendations into action.
DIRECTOR
CHIEF NURSE
TRAINING OFFICER
SNSN SN
ADVANTAGES
1. Enables specialist
to give expert
DISADVANTAGES1. Continues in
organization even
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to give expert
advise
2. Frees the line
executive of
detailed analysis3. Affords young
specialist a mass
training
if its function arenot clear
2. Reduces expertpower to place
recommendationinto action
3. Tends towards
centralization ofthe organization
4. Flat Organization /Horizontal organization
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Category Flat Pyramidal
Number of Levels Fewer More
Span of control Broad Narrow
Delegation Greater Lesser
Authority Decentralized Centralized
Control overSubordinates
Lesser More
Type Modern Traditional
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STAFFING
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Is the process of determining andproviding the acceptable number
and mix of nursing personnel to
produce a desired level of care tomeet the patients demand.
Assigning competent people to fill
designated for the organizationalstructure
STEPS IN STAFFING
Determine the number and types of
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Determine the number and types of
personnel needed
Recruit Personnel
Interview
Induct or Orient the Personnel
Job Offer
Staffing Pattern
Is a plan that articulates how many and what
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Is a plan that articulates how many and what
kind of staff are needed by shift and day tostaff a unit or department
Some of a these consideration in the
development of staff pattern are: Benchmarking
Regulatory Requirements
Skill Mix
Staff Support
Historical Information
Patient Classification System
Measurement tool used the nursing
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Measurement tool used the nursing
workload for a specific patient or
group of patients over a specific
period of time. Patient care is
classified according to:
Self care or minimal care patients
Intermediate or moderate care
Total care patients eg bedridden
Intensive care patients
NURSING CARE MODEL
1 CASE METHOD or TOTAL PATIENT
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1. CASE METHOD or TOTAL PATIENT
CARE nurse works directly with
patient, family, physician and other
health care staff implementing a plan
of care.
2. FUNCTIONAL METHOD also task
nursing and this method is task and
procedure oriented. Nurses areassigned to selected functions.
3 TEAM NURSING which evolved
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3. TEAM NURSING which evolved
from functional nursing , a team of
nursing personnel provides total
patient care to a group of patients.
4. PRIMARY NURSING METHOD thismethod represents total nursing care
directed by a nurse on a 24 hours
basis, from the moment of admissionto discharge with ARA.
5 PROGRESS CLIENT CARE client are
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5. PROGRESS CLIENT CARE client are
evaluated with respect to the level orintensity of care needed.
6. MANAGED CARE METHOD involves
unit based care that is organized toachieve specific patient outcomes with in
her stay in the unit.
7. PRACTICE PARTNERSHIP the senior
and junior staff member share patient careresponsibilities
8 CASE MANAGEMENT METHOD this is
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8. CASE MANAGEMENT METHOD this is
a model for identifying , coordinating, andmonitoring the implementation of service to
achieve desired patient care outcomes
within a specified period of time.
9. MODULAR METHOD in this method, the
RN provides direct nursing care with
assistance of aides. This is modified team &
primary nursing method where RN providesleadership, support and instruction.
COMPUTING FOR THE NUMBER
OF NURSING PERSONNEL
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When computing for the nursing personnel,one should ensure that there is sufficient staffto cover:
1. All shifts
2. Off-duties
3. Holidays
4. Leaves
5. Absences
6. Time for Staff Development
ACCORDING TO R.A. 5901 OTHERWISE
KNOWN AS THE FORTY-HOUR WEEK
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KNOWN AS THE FORTY HOUR WEEK
LAW, EMPLOYEES WILL WORK FOR
40HRS/WK:
1. FOR HOSPITALS WITH100-BED CAPACITY OR
MORE
2. COMMUNITY POPULATIONOF AT LEAST 1 MILLION
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HOWEVER, A NURSE WILL RENDER48HRS/WK WITH ONLY 1 OFF-DUTY A
WEEK IF:
1. HOSPITALS WITH LESSTHAN 100-BED CAPACITY
2. COMMUNITIES WITH LESS
THAN 1 MILLION
POPULATION
THERE ARE BENEFITS ENJOYED BY THE
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PERSONNEL REGARDLESS OF THEWORKING HOURS. AS PER CIVIL
SERVICE COMMISSION MEMORANDUM
CIRCULAR NO. 6, SERIES OF 1996,
GOVERNMENT EMPLOYEES ARE
GRANTED 3 DAYS WHICH MAY BE SPENT
FOR:
1. BIRTHDAYS
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2. WEDDINGS3. ANNIVERSARIES
4. FUNERALS (MOURNING)
5. RELOCATION6. ENROLMENT/GRADUATION
LEAVE
7. HOSPITALIZATION
8. ACCIDENT LEAVES
Total number of working hours and non-working days and hours of nursing personnel
per year.
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Rights & privileges given
each personnel/year
Working
hr/wk
48 hrs
Working
hr/wk
40 hrs
1. Vacation leave
2. Sick leave
3. Legal holidays
4. Special holidays
5. Special privileges
15
15
10
2
3
15
15
10
2
3
Cont.
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6. Off duties/ R.A. 5901
7. Continuing Education Prog.
Total Non-working days/year
Total Working days/ year
Total Working hours/ year
104
3
152
213
1,704
52
3
100
265
2,120
To compute for relievers needed, the
following should be considered:
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1. Ave. number of leaves taken each year---- 15
Vacation Leave --------------------------------10
Sick Leave--------------------------------------- 5
2. Holidays ---------------------------------------------- 123. Special Privileges --------------------------------- 3
4. Continuing Education Program for
Professionals ------------------------------------- 3
Total Average Leaves 33
To determine the relieversneeded:
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33 (ave # of days an employee is absent)213 or 265
(# of working days/year that each
employee serves)= 0.15 (15%) for persons who work
40hrs/wk
= 0.12 (12%) for persons who work48hrs/wk
To distribute the staff byshifts:
Morning shift = 45 51% (0.45 0.51)
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Morning shift 45 51% (0.45 0.51)
Afternoon shift= 34 47% (0.34 0.47)
Night shift = 15 18% (0.15 0.18)
***Note: In the Philippines, thedistribution usually followed is 45%
(0.45) for the morning shift, 37% (0.37)
for the afternoon shift and 18% (0.18)
for the night shift.
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STAFFING FORMULA
1. Categorize the patients according tolevels of care. Multiply the total # of
patients by the % of patients at each
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level of care.Ex. Find the # of nursing personnel needed
for 250 bed capacity in a tertiary hospital
250 (pts) x .30 = 75 pts need L1250 (pts) x .45 = 112.5 pts need L2
250 (pts) x .15 = 37.5 pts need L3
250 (pts) x .10 = 25 pts need L4
2. Find the # of nursing care hrs (NCH)
needed by patients at each level of care/
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day.75 pts x 1.5 (NCH at L1) =112.5 NCH/day
112.5 pts x 3 (NCH at L2) =337.5 NCH/day
37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day
25 pts x 6 (NCH at L3) =150 NCH/day
Total = 768.75 NCH/day
3. Find the total NCH needed by givennumber of patients or bed capacity/year.
768.75 x 365 (days) = 280,593.75
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( y ) ,NCH/year
4. Find the actual number of working hoursrendered by each nursing personnel/year.
8 (hrs/day) x 213 (working days/year)=1,704 (working hrs/year)
5. Find the total # of nursing personnel
needed. (immediate, reliever, totalpersonnel)
a. Total NCH/year = 280,593.75 = 165
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working hrs/yr 1,704
b. Relief x total immediate nsg personnel
165 x 0.15 = 25
c. Total nsg. Personnel needed
165 + 25 = 190
6. Categorize the nursing personnel intoprofessional and non-professional.
190 x .65 = 124 professional nurses
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p
190 x .35 = 66 nursing attendants
190 nursing personnel
7. Distribute by shift
124 x .45 = 56 nurses on AM shift
124 x .37 = 46 nurses on PM shift
124 x .18 = 22 nurses on Night shift
124 nurses
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66 x .45 = 30 nsg attendants on AM shift66 x .37 = 24 nsg attendants on PM shift
66 x .18 = 12 nsg attendants on Night shift
66 nursing attendants
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SCHEDULING
SCHEDULE It is a timetable showing planned work
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g p
days and shift for nursing personnel.
Scheduling is to assign working days
and days off to the nursing personnel
so that adequate patient care isassured.
ASSESSING A SCHEDULINGSYSTEM
1. Ability to cover the needs of the unit.
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y
2. Quality to enhance the nursing
personnels knowledge, training and
experience.
3. Fairness to the staff
4. Stability
5. Flexibility
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Modified workweeks
include systems of scheduling
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y g
personnel such as 10-hour and
12-hour shifts, weekend
alternative, team rotation, andflexible hours.
Self-scheduling
is a method of scheduling in
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g
which the nurse manager
determines the needs per day and
shift and the nursing staff
schedule themselves to meet
these needs.
(Exhibit 7-8 p. 106)
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Productivity
is a system of measuring worker
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y g
output and is commonly defined
as outputs divided by inputs.
Temporary workers
are contract workers hired from a
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staffing agency for a period of
time that may be for one to
several days or weeks.
Temporary workers are not
employees of the health care
agency where they work.
Manager behavior
Oversees staffing activities
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through human resource
management that includes use of
a patient classification system and
provision of qualified nursing
personnel in adequate numbers to
meet patient care needs.
Leader behavior
Uses input from employees to
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develop and implement a staffing
philosophy and staffing policies
that inspire personnel to work to
their maximum level of
productivity.
Basic to planning for staffing of a divisionof
nursing is the fact that qualified nursing
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personnel must be provided in sufficientnumbers to ensure adequate, safe
nursing care
for all patients 24 hours a day, 7 days aweek,
52 weeks a year. Each staff ing planmust be
tai lored to the needs of the agency
and canno t
be determ ined w ith a simple worker-
(Exhibit)
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(Exhibit 7-7 p. 105)
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Components of patientclassification system Classification categories
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Factor Prototype
Guidelines
Average care time for a patient in each
category Method for calculating required staffing,
personnel mix, and required nursing carehours
o e approac es o
nurse staffing and
scheduling
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10-hour shift
12-hour shift
Weekend alternative
Flex timeOthers
Productivity
Is commonly defined as output /
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input
Percent productivity
= required staff hours / providedstaff hours x 100
Staffing activities
include recruitment, hiring,
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assignment, scheduling,
calculating turnover, preparing
payroll, developing and
administering policies, and related
activities.
Human ResourceDepartment involves tasks like interviewing, hiring,
hi t ti f t t d
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coaching, retention of state andperformance evaluation/appraisal
Personnel
are persons employed in an agency or
d t t
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department
Recruitment
the process of enlisting personnel for
l t th f hi i
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employment; the process of hiring
Selection
the process of choosing or selecting
did t di t th i
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candidates according to theirqualifications to the job; the process of
elimination
Retention
capacity to retain employees once
th hi d
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they are hired
Modes of Recruitment Employee recommendation
W d f th
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Word of mouthAdvertisement
Flyers
Newsletter Bulletin
Posters
Career Days
Job Fairs
Placement
Screening Potential Staff
Philosophies in the screening process:Th h ld t li t
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The manager should screen out applicants
who do not fit the agencys image.
The manager should try to fit the job to a
promising applicant.
Usually the manager should try to fit the
applicant to the job.
App l ication Forms and Resumes
Determine whether the applicant
meets minimal hiring requirements.
F i h b k d d t f l i
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Furnish background data useful in
planning the selection interview.
Obtain names of references who may
be contacted for additional informationabout the applicants work experience
and general character.
Collect information for personneladministration (SSN, # of dependents
etc.).
Letter o f Reference
Inter ie
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Interview face to face contact between the job
seeker and a person with full authority
to fill the position under discussion. The purpose of the interview is to
obtain information, to give information,
and to determine if the applicantmeets the requirements for the
position.
Types of Interview
Directive interviewuses closed-ended
question
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questionNon-directive interviewthe applicant
narrates himself.
Structure interviewthe interviewer uses
pre-prepared guidelines for interview.Group interviewseveral applicants or
interviewees are interviewed together.
Board interviewconducted by selected
member of the personnel to an
applicant.
Test Used in Selection of Applicant
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Aptitude Testmeasures capacity on
potential ability to learn
Psychomotormeasures strength and
coordinationJob knowledge
Proficiencymeasures how well theapplicants can do a simple work
Psychological testmeasures personalitycharacteristics
JOB DESCRIPTION
Are specifications of duties, conditions
and requirements of a particular job
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and requirements of a particular jobprepared through a careful job
analysis and also called performance
description which includes: Job title
Job relationship
Performance description
EMPLOYEE DISCIPLINE
Is a process of generating employee
compliance to institutional rules and
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compliance to institutional rules andregulation
DISCIPLINARY PROBLEMS Problems tend to occur when there is
methodological weakness, such as when
the manager lacks skill in interviewing or
documentation, or when there is aprocedural omission, such as poor
application of discipline
Step to AddressingDisciplinary Problems Coaching a day to day process of helping
employees improve their performance
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employees improve their performance.
Confrontation is a communication
technique used to address specific issuessuch as violation of policy or procedure.
Disciplinary Conference using a
combination of directive and non- directivetechnique in order to minimize stress during
interview
Steps of ProgressiveDisciplineMeans the adherence to the principle of due
process and fair treatment of subordinates
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process, and fair treatment of subordinates.There different measures are:
1. Counseling
2. Verbal reprimand3. Written reprimand
4. Short suspension
5. Longer suspension
6. Discharge/dismissal/termination
III. DIRECTING
Issuance of assignments, orders and
instructions that permits the worker
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instructions that permits the workerwhat is expected of the to achieve
organizational goals and objectives
Delegating
is getting the work done through
employees
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employees.
Is the process by which a manager
assigns specific task/duties to workers
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assigns specific task/duties to workerswith commensurate authority to
perform the task.
The worker in return assumes
responsibility & is held accountable for
its result.
2 Important Criteria inDelegation
1 Ability of the worker to carry out the
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1. Ability of the worker to carry out thetask.
2. Fairness not only to the employeebut to the team as a whole.
Principles of Delegation
Select the right person
Delegate both interesting &
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Delegate both interesting &
uninteresting task
Provide staff with enough time to learn
Delegate gradually
Delegate in advance
Consult before delegating
Avoid gaps & overlaps
Nursing Care
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Nursing CareAssignments/ Modalities
of Nursing Care or
System/Pattern ofNursing Care
Primary Extension of principle of decentralization
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Extension of principle of decentralization Nursing process driven
Primary nurses and associate nurses
24-hour coverage Greater patient and staff satisfaction
Advantages 1) patient & family are able
to develop trusting relationship with RN;
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to develop trusting relationship with RN;2) there is defined accountability &responsibility; 3) there isholistic/continuity of care.
Disadvantages 1) high cost becausethere is a higher RN skill; 2)proximity of patient assignment; 3)overlappingof staff functions; 4) nursepatient ratio must be realistic.
Case Method
1:1 nurse/patient ration
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1:1 nurse/patient ration
Examples include private duty, ICU,
Community Health Nurse
Similar to Primary, however, no AssociateRN
The nurse is responsible for the total care
of the patient for the shift shes working
Advantages 1) consistency of one
individual caring for the patient for the
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individual caring for the patient for thewhole shift; 2) more opportunity to
observe & monitor the patient.
Disadvantages 1) the nurse may not
have the same patient the next day; 2)
it does not serve the purpose ofdecentralization.
Functional Nursing
divides the work to be done & every
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divides the work to be done & every
member is responsible for his actions
best system that can be used if there aremany patient & professional nurses are
few
Advantages of functional nursing are
that 1) work is done fast; 2) workers
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that 1) work is done fast; 2) workerslearn to work fast; 3) they gain skill
faster in that particular task.
Disadvantages include 1)
fragmentation of nursing care
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fragmentation of nursing caretherefore holistic care is not achieved;
2) patient cannot identify who their
real nurse is; 3) nurse-patientrelationship is not fully developed;
4) evaluation of nursing care is poor &
outcomes are rarely documented, and6) it is hard to find a specific person to
answer the relatives questions.
Joint Practice (Team Nursing /
Modular Nursing )
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Modular Nursing ) More than modality
Involves nurses and physicians
collaborating as colleaguesAgreed upon protocols to manage care in
primary settings
Modular nursing is a kind of team nursing
that divides the area into modules of
patient, with each module cared by a
team of nurses.
Advantage 1) work is shared with
others
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others
Disadvantages 1) patient receives
fragmented, depersonalized care;2) communication is complex; 3)
accountability & responsibility is
shared which can cause confusion; 4)these factors affects RNs
dissatisfaction.
Case Management
Clinical system with accountability for
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Clinical system with accountability forindividual or group through continuum ofcare
Negotiating
Procuring
Coordination of services and resources
RESPONSIBILITIES IN DIRECTING
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1. Promotive improve systems
2. Preventive anticipate problems &difficulties
3. Corrective institute measures tocorrect problems
4. Regulatory preserve existingassignments
CHANGE PROCESS
Change purposeful designed effortto bring about improvements in a
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Change purposeful, designed effortto bring about improvements in a
system, with the assistance of change
agent
THEORIES OF CHANGE
REDDINS THEORY suggested seven
techniques by which change can be
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techniques by which change can beaccomplished
1. Diagnosis
2. Mutual setting of objectives3. Group emphasis
4. Maximum information
5 Di i f i l t ti
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5. Discussion of implementation
6. Use of economy and ritual
7. Resistance interpretation
LEWINS THEORY
Unfreezing stage the nurse is
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Unfreezing stage the nurse ismotivated by the need to create
change
Moving stage the nurse will gatherinformation
Refreezing stage changes are
integrated and stabilized as part of thevalue system
ROGERS THEORY
1. awareness
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1. awareness
2. interest
3. evaluation
4. trial
5. adoption
MOTIVATION
Forces that make or propels one to acti t i
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Forces that make or propels one to actin a certain way.
Individual desire and responses toevents which prompts extraordinary
effort to attain goal and enthusiasm
LEVELS OF MOTIVATION
EXTRINSIC MOTIVATION
anticipated rewards or avoidance of
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anticipated rewards or avoidance ofnegative consequences in the
performance of action
INTRINSIC satisfaction derived fromthe action itself
TRANSCENDENTAL recognition of
the usefulness of action to some otherperson
THEORIES OF MOTIVATION
CONTENT THEORY motivation factors orneeds within a person
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needs within a person
1. Maslows Needs Theory
2. Alderfers theory (Existence, Relatedness,Growth) ERG
3. Herzbergs Theory two factor theory
Di ti fi h i i ( t i i ) l j b
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a. Disatisfiers or hygienic (extrinsic) salary, jobsecurity, working condition, relationships
b. Satisfiers or non hygienic (intrinsic)achievement, recognition, reward,advancement, work itself
4. McClelland theory affiliation, achievement
and power
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p
5. Monistic/scientific theory salary as the
best motivating factor
PROCESS THEORY
1. Arousal theory focuses on internal
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yprocess that mediate the effect of work
performance
2. Expectancy theory focuses on
peoples expectation that their efforts will
result in good performance and valued
results
3. Equity theory focuses on fair treatment
DECISION MAKING
A systematic, sequential process of
choosing
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gamong alternatives & putting those
choices
into action
STEPS
1. Identify problem
2 Prioritize problem
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2. Prioritize problem
3. Gather and analyze situation related
to problem
4. Evaluating all alternatives
5. Select an alternative for
implementation
IV. CONTROLLING
The process by which managers
attempt to measure if actual activities
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pconform to planned activities
A process wherein the performance is
measured and corrective action istaken to ensure the accomplishment
of organization goal
STEPS IN CONTROL PROCESS
Establish standards and criteria
Measure performance
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Compare results with standards
Match with standards?
YES do nothing or improve
NO - take corrective action
PERFORMANCE
APPRAISAL/EVALUATION
SYSTEM Process of evaluating employees
performance against standards
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p g To determine job competence
Enhance staff development and
motivate employee discover employees aspirations and
recognize accomplishments
Improve communication
Aid managers in counseling and
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g gcoaching
Determine training and dev. needs of
staff Inventories of talent
Legal purposes
METHODS OF EVALUATION
Anecdotal records objective description of
behaviorR ti l
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Rating scale
Ranking
Self appraisal/self rating Peer review
Paired comparison
Forced - choice
Subordinates
Team evaluation multiple raters
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Behavior anchored list specific
description of good, average and good
performance
Essay evaluation describe strength and
weaknesses of employee
Critical incident describe effective and
effective behavior of employee
PROBLEM AREAS OFEVALUATION
Subordinates have not been motivated
to want to change
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g People are unable to make change
Subordinates become resentful and
anxious when merit system is applied
COMMON ERRORS OFEVALUATION
Halo error allowing one trait to
influence the evaluation of others orf f f
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rating of all traits on the basis of first
impression
Horn error the evaluator ishypercritical
Contrast error managers rate the
nurse opposite the way they perceivethemselves
Leniency of error
Central tendency error
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y
Racial bias
System design and operating
problems focuses on the method(system) and process (operating) of
evaluation
Overgeneralization Recency of Events error
TOTAL QUALITYMANAGEMENT Systematic process to improve
outcomes based on customers needsDoing the right thing
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Doing the right thing
-meeting the needs of the customer
-building quality performance into thework process
-employ scientific approach toassessment and problem solving
QUALITY ASSURANCE PROG
Process of establishing a standards of
excellence of intervention and takingt t th t h ti t
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steps to ensure that each patient
receives the expected level of care
Fulfillment of social contract betweensociety and professions
QUALITY NURSING CARE
Presence of all
elements/characteristics specified inthe standards
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the standards.
FRAMEWORK OF QA
1.Structure instrumentalities in thedelivery of care (personnel, suppliesetc)
2. Process how the service was
delivered3. Outcome results expected of the
service
NURSING AUDIT
Official examination of: nursing
records, physical facilities, personneli l d i ti t
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involved in patient care
Tool to analyze and evaluate nurses
bedside records and physical facilities Serves as a means of improving
nursing care by revealing existing
deficiencies
STANDARD OF CARE
Yardstick for gauging the quality and
quantity of service
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Describes the quality of service
Ex. Nurses are professional in dealing
with clients
CRITERIA
Measures the quality of care or
standards
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Standard: Nurses are professional in
dealing with clientsCriteria : greets them with
corresponding smiles
always attend to their needs
Thank You!
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Thank You!