NCM 107-A Nursing Leadership & NCM 107-A Nursing Leadership & Management, Nursing JurisprudenceManagement, Nursing Jurisprudence

June 15, 20129:00 am

Conceptual Paradigm of Leadership & Management

GOALS - Usually established at the beginning of any

planned undertaking- A desired aim or condition toward which one

is willing to work.- Generally provides direction to an individual,

group or organization.

Goals may be:INDIVIDUAL GOALS - are personal goals; usually

based on one’s desires in life.GROUP GOALS – it pertains to what the individual

members of the group or organization desire to achieve as a group or an organization.

ORGANIZATIONAL GOALS - are management goals of an organization that are established to justify its existence.

GOALS

GOALS MUST BE:S - SpecificM - MeasurableA - AttainableR - RelevantT - Time BoundedE - Efficient & EffectiveR - Rewarding

THEORIES & PRINCIPLES• Various theories & principles of leadership &

management help provide the basis for accomplishing a goal.

• THEORIES• 1. Scientific Management Theory

2. Systematic Management Theory3. Organizational Theory4. Social Process5. Hawthorne Effect6. Management by Objectives

• 7. Management as Decision Making• 8. Managerial Roles• 9. Hierarchy of Needs• 10. Motivation Hygiene Theory• 11. Theory of X & Theory of Y• 12. Theory Z

THEORIES

MANAGEMENT PROCESSES & FUNCTIONS

• It is the application of creative problem solving strategies. – 4 functions of management• Planning• Organizing• Directing• controlling

EFFECTIVE & EFFICIENT

• Leadership should be efficient & effective• EFFICIENT – ability to minimize the use of time and

resources in achieving organizational objectives.-Performing or functioning in the best possible

manner with the least waste of time and effort.• EFFECTIVE – ability to determine whether

appropriate objectives are met.

• Attainment of a goal usually precedes the use of resources.

• 7 M’s • 1. money 5. methods• 2. men 6. moment• 3. machine 7. manager• 4. materials

RESOURCES

• 1. PLANNING – the selection and sequential ordering of tasks required to achieve an organizational goal.

• - pre determining a course of action in order to arrive at a desired result.• Concerned with defining goals for future organizational

performance and deciding on the tasks and resources to be used in order to attain those goals.• Deciding in advance what to do, how to do a particular

task, when to do it and who is to do it.

NURSING MANAGEMENT PROCESS

COMPONENTS OF PLANNING

GOOD PLANNING

• – involves a continous process of assessment of goals and objectives, implementation and evaluation of change as new facts become known.

• PROCESS OF GOOD PLANNING

“A well plan is half done”

POOR PLANNING• Is the failure to set goals make assessments or provide for

implementation or to anticipate any possible change in

circumstances. INDICATORS OF POOR PLANNING

• Delivery dates are not met• Machines are idle• Material is wasted• Some nurses are overworked, others are underworked• Skilled nurses doing unskilled work• Nurses are fumbling on jobs for which they have not been

trained• There is quarreling, bickering, buck-passing and confusion.

“Failing to plan is planning to fail”

PLAN• Is a living document which can be changed

based on the prevailing circumstances.PRINCIPLES OF PLANNING

1. Planning is always based & focused on the vision, mission, philosophy & clearly defined objective of the organization.

2. Planning is a continous process.3. Planning should be pervasive within the entire organization.4. Planning utilizes all available resources5. Planning must be precise in its scope & nature6. Planning should be time- bounded7. Projected plans must be documented

IMPORTANCE OF PLANNING

1. Planning leads to the achievement of goals & objectives.2. Planning gives meaning to work.3. Planning provides for effective use of available resources.4. Planning helps in coping with crises.5. Planning is cost-effective.

6. Planning is based on past & future activities.7. Planning leads to the realization of the need to change.8. Planning provides basis for control.9. Planning is necessary for effective control .

CHARACTERISTICS OF A GOOD PLAN

1. Be precise with clearly- worded objective, including desired results & method for evaluation.

2. Be guided by policies, procedures affecting the planned action.

3. Indicate priorities.4. Develop actions that are flexible & realistic in terms of avail.

Personnel, equipment, facilities & time.5. Develop a logical sequence of activities & time.6. Include the most practical methods for achieving each

objective.7. Pervade the whole organization.

STEPS IN PLANNING

1. Diagnosis2. Objective/ goal setting3.Means identification4.Debate on proposals5.Decision making6.Tasking7.Evaluation

TYPES OF PLANS

• STRATEGIC PLAN – the process of defining strategy or direction, and making decisions on allocating its resources to pursue this strategy.– It is a process for determining where an organization is

going over the next year or- more typically 3 to 5 years.

It deals with at least one of the 3 questions:1. What do we do?2. For whom do we do it?3. How do we excel?

• OPERATING PLANS – pertain to activities in specific departments or organization.- generally shorter in time frame-involve the middle & lower level managers

• CONTINOUS OR ROLLING PLANS – involves mapping out the day to day activities.- this is the task of the staff nurse who has to devise & implement NCP for pts.

KEY COMPONENTS OF STRATEGIC PLANNING

1. Defining and understanding the vision, mission, values & strategies of the institution.VISION – it outlines the organization’s future roles and functions; what the organization want to be; it is a long term view and concentrates on the future.MISSION – defines the fundamental purpose of the organization; allows everyone to understand why an organization exists.

PHILOSOPHY – statement of beliefs & values that direct the organization’s life or practice.VALUES – are beliefs that are shared among the stakeholders of an organization. FORECASTING – is looking into the future; weighing the unknown values in the situation and using them as basis for an educated guess about the future.

2. Set objectives/ goals and determine results desiredOBJECTIVES – is the backbone of one’s goals and philosophy ; these are the battle planGOALS – a specific aim to target to be attained within a short time span of a year; the end to be accomplished

3. Conduct a situation analysis ( SWOT )- analysis of the internal factors attributed to the organization and external factors beyond control of the organization.

4. Develop & schedule strategies, programs/ projects/activities; set the time frame

STRATEGY – it is the course of action created to achieve a long term goal; the art of the general”. ( called as the road map); techniques,methods or procedure

PROGRAMS – are activities put together to facilitate attainment of some desired goals.

TIME MANAGEMENT – finding the most efficient way to do it.

TIME SAVING TECHNIQUES, DEVICES & METHODS TO BETTER USE OF TIME

1. Conduct an inventory of your activities.2. Set goals and objectives and write them down.3. With the use of calendars, executive planners, logs or journals, write

waht you expect to accomplish yearly, monthly, weekly or daily.4. Break down large projects into smaller parts5. Devote few minutes at the beginning of each day for planning.6. Organize your workspace so it is functional.7. Close your door when you need to concentrate.8. Learn to delegate.9. In a meeting, define the purpose clearly before starting10. Take or return phone calls during specified time.11. Develop effective decision- making skills12. Take rest breaks and make good use of your spare time.

EFFECTS OF MISMANAGEMENT OF TIME

• Work is rushed and becomes substandard• Deadlines are missed• Bad choices are made• Employees suffer from fatigue• Employees personal lives and relationships are

adversely affected

5. Preparing the Budget

• BUDGET- is the annual operating plan, a financial “road map” and plan which serves as an estimate of future costs and a plan for utilization of manpower, material and other resources.– A plan for future activities expressed in

operational as well as financial or monetary terms.BUDGETING – systematic financial translation of a

plan; allocation of resources; a tool, for planning, monitoring & controlling cost & meeting expenses.

COMPONENTS OF BUDGET

1. REVENUE BUDGET – summarizes the income which management expects to generate during the planning period.

2. CASH BUDGET – amount of money received; planned cash receipts & disbursements, cash balances.

3. OPERATING BUDGET – composed of the revenue and the expense budget.

4. CAPITAL BUDGET – consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period.

6. Establishing Nursing standards, policies & procedures

STANDARDS – indicate the minimal level of achievement acceptable to meet the set objectives.

• Nursing StandardsExample: Standards of Nsg. Practice by ANSAP

1981

• POLICIES – are defined as standing plans used repeatedly, or guides or basic rules that govern action at all levels in the organization.

• Nursing Service PoliciesExample : Admissions – receiving, consent,

notifying doctor, care of patients

• PROCEDURES – are defined as a more specific guide to action than policy.

• Nursing ProceduresExample: Discharge of Patient

ORGANIZING

- it is the process of establishing formal authority.- it involves setting up the organizational structure through identification of groupings, roles & relationships.- it includes developing job descriptions by defining the qualifications and functions of personnel.

ORGANIZATION

– consists of the structure & process which allow the agency to enact its philosophy & utilize its conceptual framework to achieve its goal.

– it is the backbone of management.– it is the form of every human association for the

attainment of a common purpose.– it is a form of identifying roles and relationships of

each staff in order to delineate specific tasks or functions that will carry out organizational plans & objectives.

ORGANIZATIONAL CHART

– is a line drawing that shows how the parts of an organization are linked.

ELEMENTS OF ORGANIZINGI. Setting up the organizational structure

- facilitates the development of roles & relationships to enable the achievement of goals.

ORGANIZATIONAL STRUCTURE

– refers to the process by which a group is formed, its channels of authority, span of control & lines of communication.

– is a process in which a group is formed including its Authority, Responsibility and Accountability ( ARA), span of control, and lines of communication.

PURPOSES OF SETTING UP AN ORGANIZATIONAL STRUCTURE

• It informs members of their responsibilities so that they may carry them out.

• It allows the manager & the individual workers to concentrate on his/her specific role & responsibilities.

• It coordinates all organizational activities so there is minimal duplication of effort or conflict.

• It reduces the chances of doubt & confusion concerning assignments.

• It avoids overlapping of functions because it pinpoints responsibilities.

• It shows to whom & for whom the are responsible.

CHARACTERISTICS OF ORGANIZATIONAL CHART

1. DIVISION OF WORK – each box represents the individual or sub-unit responsible for a given task of the organization’s work load.

2. CHAIN OF COMMAND –lines indicate who reports to whom and by what authority.

3. Type of Work to be performed – indicated by labels or descriptions for the boxes.

4. Grouping of Work Segments – shown by the clusters of work groups.

5. Levels of Management – indicate individual & entire management hierarchy.

PRINCIPLES OF ORGANIZING

1. UNITY OF COMMAND – refers to the structure an employee has one superior & there is only one manager or leader.

2. SCALAR PRINCIPLES OF HIERARCHY- authority & responsibility flow in clear lines from the highest executive to the lowest.

3. HOMOGENEOUS ASSIGNMENT/ DEPARTMENTATION – workers performing similar assignments are grouped together for a common purpose.

PRINCIPLES OF ORGANIZING

4. SPAN OF CONTROL – member of workers that a supervisor can effectively manage.

5. EXCEPTION PRINCIPLE – recurring decisions should be handled in a routine manner by lower level managers; whereas problems involving unusual matters should be referred to higher level.

6. DECENTRALIZATION/ PROPER DELEGATION OF AUTHORITY – process of conferring specified decision making to the lower levels of the organization.

PATTERNS OF ORGANIZATIONAL STRUCTURE

1. TALL OR CENTRALIZED STRUCTURE/ VERTICAL – It is when the span of control is narrow and there are many management levels & there are many managers.

- Responsible for only a few subordinates, so there is a narrow span of control

- There are many levels of communication.

ADVANTAGES OF TALL STRUCTURE

• The quality of performance will improve due to close supervision.

• Discipline will improve.• Superior - Subordinate relations will improve.• Control and Supervision will become easy and convenient.• The manager gets more time to plan and organize the future

activities.• The efforts of subordinates can be easily coordinated.• Tall Organization encourages development of staff.• There is mutual trust between superior and subordinates.

DISADVANTAGES OF TALL STRUCTURE

• Tall Organization creates many levels of management.• There are many delays and distortion in communication.• Decisions and actions are delayed.• It is very costly because there are many managers. The

managers are paid high salaries.• It is difficult to coordinate the activities of different levels.• There is strict supervision. So the subordinates do not have

any freedom.• Tall Organisation is not suitable for routine and standardized

jobs.• Here, managers may became more dominating.

SAMPLE OF TALL STRUCTURE

2. FLAT OR DECENTRALIZED/ HORIZONTAL STRUCTURE

• Characterized by fewer levels and a broad span of control

• Decision- making is spread among many people.• Communication from lower to higher levels is easy

and direct.• is characterized by fewer levels of management, low

burearucratic costs, higher motivation of employees (empowerment), more communication between managers and employees

ADVANTAGES OF FLAT STRUCTURE

• Flat Organization is less costly because it has only few managers.

• It creates fewer levels of management.• Quick decisions and actions can be taken because it has only a

few levels of management.• Fast and clear communication is possible among these few

levels of management.• Subordinates are free from close and strict supervision and

control.• It is more suitable for routine and standardized activities.• Superiors may not be too dominating because of large

numbers of subordinates.

DISADVANTAGES OF FLAT STRUCTURE

• There are chances of loose control because there are many subordinates under one manager.

• The discipline in the organization may be bad due to loose control.

• The relations between the superiors and subordinates may be bad. Close and informal relations may not be possible.

• There may be problems of team work because there are many subordinates under one manager.

• Flat organization structure may create problems of coordination between various subordinates.

• Efficient and experienced superiors are required to manage a large number of subordinates.

• It may not be suitable for complex activities.• The quality of performance may be bad

DISADVANTAGES OF FLAT STRUCTURE

SAMPLE OF FLAT ORGANIZATION STRUCTURE

TYPES OF ORGANIZATIONAL STRUCTURE

• 1. LINE ORGANIZATION/ BUREAUCRATIC/ PYRAMIDAL– This structure shows each position general

authority over the lower position in the hierarchy.– Commonly found in large health care facility.– Clearly defined superior-subordinate relationship– ARA and power are concentrated at the top

2. FLAT ORGANIZATION/ HORIZONTAL

• It is a decentralized type.• Flattened scalar chain and fewer levels of

position• Used for less complex organizations with

authority decentralized and with several managers supervising large work groups.

• Applicable only in smaller organizations or units within larger organizations

3. STAFF ORGANIZATION

• is by nature purely advisory to the line structure with no authority to place recommendations into action.

4.FUNCTIONAL ORGANIZATION – permits a specialist to aid line position within a limited and clearly defined scope of authority.

5.AD HOC ORGANIZATION – modification of the bureaucratic structure and is used as a temporary basis to facilitate completion of a project within a formal line organization.

6. MATRIX ORGANIZATION – designed to focus on both products and function. It has both the vertical and horizontal chain of command. - it is the most complex organizational structure.

7. SHARED GOVERNANCE ORGANIZATION – one of the most radical and idealistic type of organizational structure developed in 1980’s as an alternative to traditional pyramidal/ centralized structure.

8. LATERAL ORGANIZATION – is one of coordination & colaboration between and among nursing staff and hospital staff.

II. STAFFING

• Is the process of determining & providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patient’s demand.

• The process of assigning competent people to fill the roles designated for the organizational structure through recruitment, selection & development.

STEPS IN STAFFING

• Determine the number & types of personnel needed.

• Recruit personnel• Interview• Induct or orient the personnel• Job offfer

STAFFING PATTERN

• Is a plan that articulate how many & what kind of staff are needed by shift & day to staff in a unit or department.

PATIENT CLASSIFICATION SYSTEM ( PCS ) – a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time.

• PATIENT ACUITY – measurement of nursing workload that is generated for each patient.

PATIENT CARE CLASSIFICATION1.“ SELF CARE” OR MINIMAL CARE PATIENTS –

are capable of carrying activities of daily living ( ADL)

2.INTERMEDIATE OR MODERATE CARE – requires some help from nursing staff with special treatment or certain aspects of personal care

3. TOTAL CARE PATIENTS – are usually those who are bedridden & who lack strength & mobility to do average daily living.

4. INTENSIVE CARE PATIENTS – are those who are critically ill and in constant danger of death or serious injury.

NURSING CARE MODELS

• Is the framework for nursing care delivery in any setting or design that meets the particular needs of a group of health care givers & clients.

1.THE CASE METHOD OR TOTAL PATIENT CARE- original model of nursing care delivery- RN is responsible for all aspects of care of one or more patients.

CASE METHOD / TOTAL PATIENT CARE

- the complete care includes treatment, medications & NCP.- RN gives total patient care within her shift.

ADVANTAGE:- RN can better see & attend to the total needs of

clients & the continuity of care can be facilitated with ease.

- Client’s interaction & rapport with the nurse are well developed & client’s needs are monitored

DISADVANTAGES:

• RN spend more time doing tasks that could be done more cost – effectively by less – skilled person.

SAMPLE OF TOTAL PATIENT CARE

2. THE FUNCTIONAL METHOD

• Also called as “task Nursing”• Developed in response to national shortage in

1940’s• This gave way to widespread use of LPN & UAP

to deliver nursing care.• Needs of a group of patients are broken down

into taks, which are assigne to RN’s, LPN’s, UAP’s.

FUNCTIONAL METHOD

• This method is task & procedure oriente.• Used wherein there are too many patients in

proportion to available RN.• Nurses are assigned to different functions

such as VS, Tx, medication

ADVANTAGES :

• Nurses who are oriented this way become skilled in performing assigned tasks.

• Individual aptitude & experience improves.• Less equipment is neeed• Time is save• Task- oriented approach improves both

productivity & organization

DISADVANTAGES:

• Patients cannot identify who their nurse is

3. TEAM NURSING

• It evolved from functional nursing.• Team nursing personnel provides total patient

care to a group of patients.• Comprehensive nursing care becomes the

responsibility of the entire team.

ADVANTAGES:• The constant group work fosters a feeling of participation and

belongingness• The workload is balanced and shared with the division of

labor• Each member of the team has the opportunity to learn from

colleagues• There is also a variety in the daily assignment• Helps maintain interest in client’s well being and is cost

effective.• Patient is able to identify personnel due to the continuity of

care• Barriers between clients and nurses can be minimized• Everyone gets to contribute to the care plan

SAMPLE OF TEAM NURSING

4. PRIMARY NURSING METHOD

• Was designed to place RN back at the patients bedside.

• Decentralized decision-making by staff nurses is the core principle of this method with ARA for nursing care allocated to staff nurses at the bedside.

• This method represents total nursing care directed by a nurse on a 24 hour basis from the moment of admission to discharge with ARA

ADVANTAGES:

• Nurse sees the client and family as one system an ARA is increased.

• Nurse uses a wide range of skills, knowledge and expertise an develops creativity

• Increases trust and satisfaction by the clients• Excellent communication between the primar nurse an

associate nurses• Primary nurses are able to hold associate nurses

accountable for implementing nursing care as prescribed.

DISADVANTAGE

• Critically ill patients may have several primary care nurses because of transfers to different units that may disrupt the continuity of care inherent in the model.

Patient

Other health provider PRIMARY NURSE

Charge Nurse

Associate Nurse Associate Nurse

5. CASE MANAGEMENT METHOD

• Model for identifying, coordinating and monitoring the implementation of services needed to achieve desired patient care outcomes within a specified period of time.

• Care is directed by a case manager focused on achievement of outcome and appropriate time frame and resources.

• Used to organize patient care according to diagnoses.

Case Manager

Patient Caseload

Caregivers Caregivers Caregivers

6. PRACTICE PARTNERSHIP

• In this model, the RN & assistant agree to be practice partners.

• They work together with the same schedule and the same group of patients.

• It is an efficient way of using a mixture of skills of professionals & non- professional staff with differing levels of expertise.

ADVANTAGE:• Offer more continuity of care and

accountability for patient care• Less expensive for the organization and more

satisfying personally for the partners.• DISADVANTAGE:• Tends to decrease the ratio of professional

nurses to non- professional staff• There is the potential for the junior member

of the team to assume more responsibility than may be appropriate

RN PARTNER

PATIENTS

GUIDELINES FOR DETERMINING THE NURSING PERSONNEL NEEDED

• STEP 1 – Determine type of hospital whether it is primary, secondary or tertiary

• STEP 2 – Find the total number of nursing care hours ( NCH ) needed by the patients at each category level.

• STEP 3 – Categorize patients according to levels of care.

• FULL TIME EQUIVALENT ( FTE )– It is the formula that uses nursing care hours and

annual hours of work provided by one Full –Time Equivalent. It is a measure of the work commitment of a full-time employee.

– Full time employee works 5 days a week or 40 hours per week for 52 weeks a year.

FORMULA:X = total Nursing care hours x days in a year

total annual hours per one FTE

• FORTY HOUR WEEK LAW– This formula is based on the National league of

Nurses or R.A. 5901 otherwise known as the Forty Hour Week Law

– FORMULA ;ABO X NCH = TOTAL NUMBER OF PERSONNEL IN 24 HOURSNo. Of working Hrs.

• FORTY HOUR/ WEEK – for personnel working in hospitals with 100 bed capacity or over or which are located in a 1 Million population in the community.

• 48 HOURS / week – for personnel who work in agencies with lesser bed capacity or which are located in communities with less the 1 M population.

STAFFING FORMULA

• 1. Categorize the patients according to levels of care needed.

250 x .30 = 75 – patients needing minimal care250 x .45 = 112.5 – pts. Needing moderate care250 x .15 = 37.5 – pts need intensive care250 x .01 = 25 – pts. Need highly specialized care

2. Find the number of nursing care hours (NCH ) needed by patients at each level of care per day.75 pts. X 1.5 ( NCH needed at Level I )=112.5 NCH/ DAY112.5 pts. X 3 ( NCH needed at Level II )=337.5 NCH/ DAY37.5 pts. X 4.5 ( NCH needed at Level III) = 168.75 NCH/DAY

25 pts x 6 ( NCH needed at Level IV ) = 150 NCH/ DAYTOTAL – 768.75 NCH/DAY

3. Find the total NCH needed by 250 patients per year768.75 x 365 ( days/year ) = 280,593.75

NCH/yr.4. Find the actual working hours rendered by

each nursing personnel per year.8 (hrs/day) x 213 ( working days/yr)

= 1,704 ( working hrs/yr)

5. Find the total number of nursing personnel needed.a. Total NCH /yr = 280, 593.75

working hrs./ yr. 1, 704 = 165b. Reliever x total nsg. personnel

Divide 33( ave. Number of days an employee is absent per year) by the number of working days per year that each employee serves.

165 x .15 = 25 ( relievers needed )c. Total nursing personnel needed

165 + 25 = 190 6. Categorize to professional & non-

professional personnel. 190 x .65 = 124 prof. 190 x .35 = 66 non prof.

7. Distribute by shifts124 nurses x .45 = 56 nurses on AM shift124 nurses x .37 = 46 nurses on PM shift124 nurses x .18 = 22 nurses on night shift

66 attendants x .45 = 30 – AM SHIFT66 attendants x . 37 = 24 – PM shift66 attendants x .18 = 12 – night shift

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