NSG 129: Nursing Leadership and Management

NURSING LEADERSHIP & MANAGEMENT determining the most appropriate type of patient
care delivery, and grouping activities to meet unit
Leadership – behaviour and Management - process goals.
attitude Staffing consist of recruiting, interviewing, hiring, and
The act of influencing and The process of leading and orienting staff. Scheduling, staff development,
motivating a group of people to directing an organization to employee socialization, and team building.
act in the same direction meet its goals through the use Directing consists of motivating, managing conflict, delegating,
towards achieving a common of appropriate resources. communicating, and facilitating
goal. Controlling functions include performance appraisals, fiscal
do not have delegated legitimate source of power due accountability, quality control, legal and ethical
authority but obtain their power to the delegated authority control, and professional and collegial control.
through other means, such as
influence 14 PRINCIPLES OF MANAGEMENT
focus on group process, emphasize control, decision 1. Division of work allows specialization
information gathering, making, decision analysis, and right to command balanced with
2. Authority
feedback, and empowering results responsibility and accountability
others employees will only obey orders if
have goals that may or may greater formal responsibility 3. Discipline management play their part by providing
not reflect those of the and accountability for good leadership
organization rationality and control than there should only be one boss with no
4. Unity of command
leaders conflicting lines of command
people engaged in the same kind of
DEVELOPMENT OF MANAGEMENT THEORIES 5. Unity of direction activities must have the same objectives
in a single plan
SCIENTIFIC MANAGEMENT 6. Subordination of the goals of the firms are always
Frederick W. Taylor  “father of scientific management” individual interest to paramount.
 Work should be studied scientifically to determine the general interest
method of task performance that would yield maximum 7. Remuneration payment is an important motivator
work output with minimum work expenditure. 8. Centralization or depends on the condition of business and
 Work should be studied, every methods and steps before Decentralization the quality of its personnel
acting 9. Scalar chain/line of refers to the number of levels in the
 Efficient to task authority hierarchy
Four overriding principles of scientific management: both material order (minimizes lost time &
1. Traditional “rule of thumb” means of organizing work useless handling of materials) and social
10. Order
must be replaced with scientific methods. order (organization and selection) are
2. A scientific personnel system must be established so that necessary.
workers can be hired, trained, and promoted based on employees should be treated well to
their technical competence and abilities. 11. Equity achieve
3. Workers should be able to view how they “fit” into the equity
organization and how they contribute to overall 12. Stability of tenure job security and career progress are
organizational productivity. of personnel important for employees to work better
4. The relationship between managers and workers should allow personnel to show their initiative, it
be cooperative and interdependent, and the work should 13. Initiative may be a source of strength for the
be shared equally. organization
management should foster the moral
14. Esprit de corps
BUREAUCRACY of employees
Max Weber (1922)
THEORY OF SOCIAL AND ECONOMIC ORGANIZATION PARTICIPATION MANAGEMENT
 advocated bureaucracy Mary Parker Follett (1926) was one of the first theorists to suggest
 Need for legalized, formal authority and consistent rules participative decision making or participative management.
and regulations for personnel in different positions  Managers should have authority with, rather than over,
employees.
MANAGEMENT FUNCTIONS
Henry Fayol (1925)  first identified the management functions of ILLUMINATION STUDIES
planning, organization, command, coordination, and control Elton Mayo and his Harvard associates (1927-1932)
 look at the relationship between light illumination in the
factory and productivity.
indicated that people respond to the fact that they
Hawthorne
are being studied, attempting to increase whatever
effect
behavior

THEORY X AND Y
Douglas McGregor (1960)
ACTIVITIES OF MANAGEMENT  X and Theory Y, posited that managerial attitudes about
Luther Gulick (1937)  expanded on Fayol’s management employees can be directly correlated with employee
functions in his introduction of the “ Seven Activities of Management ” satisfaction.
- planning, organizing, staffing, directing, coordinating, reporting, Theory X managers Theory Y managers
and budgeting. believe that their employees are believe that their workers enjoy
Activities of Management: basically lazy, need constant their work, are self-motivated,
Planning determines philosophy, goals, objectives, policies, supervision and direction, and and are willing to work hard to
procedures, and rules; carrying out long-and short- are indifferent to organizational meet personal and
range projections; determining a fiscal course of needs. organizational goals.
action; and managing planned change
Organizing establishes the structure to carry out plans,
NSG 129: Nursing Leadership and Management

Laissez-faire characterized by the following behaviors:

leader  Is permissive, with little or no control.
 Motivates by support when requested
by the group. Provides little or no
direction.
 Uses upward and downward
communication between members of
the group.
 Disperses decision making throughout
the group.
 Places emphasis on the group.
 Does not criticize.

CONTINGENCY APPROACH
Fiedler (1967)
EMPLOYEE PARTICIPATION  suggests that no one leadership style is ideal for every
Chris Argyris (1964), managerial domination causes workers to situation.
become discouraged and passive.  Interrelationships between the group’s leader and its
 If self-esteem and independence needs are not met, members were most influenced by the manager’s ability
employees will become discouraged and troublesome or to be a good leader
may leave the organization.
SITUATIONAL APPROACH
Management Theories (Summary) Hersey and Blanchard (1977)
Theorist Theory  Tridimensional leadership effectiveness model predicts
Taylor Scientific management which leadership style is most appropriate in each
Weber Bureaucratic organizations situation on the basis of the level of the followers’
Fayol Management functions maturity.
Gulick Activities of managements  As people mature, leadership style becomes less task
Follet Participative management focused and more relationship oriented.
Mayo Hawthorne effect
McGregor Theory X and Y TRANSACTIONAL AND TRANSFORMATIONAL APPROACH
Argyris Employee participation Burns (2003)
 both leaders and followers have the ability to raise each
DEVELOPMENT OF LEADERSHP THEORIES other to higher levels of motivation and morality.
 There are two primary types of leaders in management
GREAT MAN THEORY Transactional Transformational
 From Aristotelian philosophy, asserts that some people Traditional manager, concerned committed, has a vision, and is
are born to lead, whereas others are born to be led. with the day-to-day operations able to empower others with
 Great leaders will arise when the situation demands it. this vision
 Focuses on  Identifies common
TRAIT THEORY management tasks values
 assume that some people have certain characteristics or  Is committed  Is a caretaker
personality traits that make them better leaders than  Uses trade-offs to  Inspires others with
others. meet goals vision
 Does not identify  Has long-term vision
shared values  Looks at effects
 Examines causes  Empowers others
 Uses contingency 
reward

EXEMPLARY LEADERSHIP
LEADERSHIP STYLES
Kouzes and Posner's Five Practices for Exemplary Leadership
Lewin and White
Democratic exhibits the following behaviors:
1. Modeling the way: Requires value clarification and self-
leader  Less control is maintained.
awareness so that behavior is congruent with values.
 Economic and ego awards are used to
2. Inspiring a shared vision: Entails visioning which inspires
motivate.
followers to want to participate in goal attainment.
 Others are directed through
3. Challenging the process: Identifying opportunities and
suggestions and guidance.
taking action.
 Communication flows up and down.
4. Enabling others to act: Fostering collaboration, trust, and
 Decision making involves others.
the sharing of power.
 Emphasis is on “we” rather than “I” and
5. Encouraging the heart: Recognize, appreciate, and
“you.”
celebrate followers and the achievement of shared goals.
 Criticism is constructive.
- Dili sa tanan oras bright ta hahahaha
Authoritarian characterized by the following behaviors:
-
leader  Strong control is maintained over the
INTEGRATING LEADERSHIP AND MANAGEMENT
work group.
 Others are motivated by coercion. Gardner (1990) asserted that integrated leader-managers possess
 Others are directed with commands. six distinguishing traits:
 Communication flows downward.
 Decision making does not involve 1. They think longer term.
others. 2. They look outward, toward the larger organization.
 Emphasis is on difference in status (“I” 3. They influence others beyond their own group.
and “you”). 4. They emphasize vision, values, and motivation.
 Criticism is punitive 5. They are politically astute.
6. They think in terms of change and renewal.
NSG 129: Nursing Leadership and Management

 Weaknesses – are those internal attributes that challenge an

organization in achieving its objectives.
 Opportunities – are external conditions that promote
Leadership Theories (Summary) achievement of organizational objectives.
Theorist Theory  Threats – are external conditions that challenge or threaten
Aristotle Great Man theory the achievement of organizational objectives.
Lewin and White Leadership styles
Fiedler Contingency leadership
Henry and Blanchard Situational leadership theory -
maturity
Burns Transactional and
Transformational leadership
Gardner The integrated leader-manager

POWER
 defined as the capacity to act or the strength and
potency to accomplish something. [huhu bubu ka gurl why naay meet]
 The manager who is knowledgeable about the wise use
of authority, power, and political strategy is more THE PLANNING HIERARCHY
effective at meeting personal, unit, and organizational
goals.
Types of Power
Reward power obtained by the ability to grant favors or reward
others with whatever they value
Punishment or based on fear of punishment if manager’s
coercive power expectations are not met
Legitimate the power gained by a title or official position
power within an organization
Expert power gained through knowledge, expertise, or
experience
Referent power is power that a person has because others
identify with that leader or with what that leader
symbolizes ( jesus, allah, something convincing
ang power) (believing his or her goals)
Charismatic is distinguished by some from referent power
power (kpop, music industry …) VISION
Informational is obtained when people have information that  Vision statements are used to describe future goals or aims
power others must have to accomplish their goal of an organization.
 It conjures up a picture for all group members of what they
MANAGEMENT PROCESS: PLANNING want to accomplish together.
 An organization will never be greater than the vision that
FOUR MODES OF PLANNING guides it.

MISSION
Modes of Planning
 The mission statement is a brief statement identifying the
Reactive occurs after a problem exists reason that an organization exists.
Inactivism seek the status quo  It identifies the organization’s constituency and addresses its
utilize technology to accelerate change position regarding ethics, principles, and standards of
and are future oriented practice.
Preactivism
(envisioning the change by doing
whatever you can)
PHILOSOPHY STATEMENT
attempt to plan the future of their
Interactive or Proactive  The philosophy flows from the purpose or mission statement
organization rather than react to it
and delineates the set of values and beliefs that guide all
actions of the organization.
FORECASTING  It is the basic foundation that directs all further planning
 involves trying to estimate how a condition will be in the toward that mission.
future.  The organizational philosophy provides the basis for
 Takes advantage of input from others, gives sequence in developing nursing philosophies at the unit level and for
activity, and protects an organization against undesirable nursing service as a whole.
changes.
GOALS AND OBJECTIVES
STRATEGIC PLANNING  Goals and objectives are the ends toward which the
 examines an organization’s purpose, mission, philosophy, organization is working.
and goals in the context of its external environment.  Objectives are similar to goals in that they motivate people
 Complex organizational plans that involve a long period to a specific end and are explicit, measurable, observable or
(usually 3 to 10 years) are referred to as long range or retrievable, and obtainable.
strategic plans.
POLICIES AND PROCEDURES
SWOT ANALYSIS  Policies are plans reduced to statements or instructions that
 also known as TOWS Analysis, was developed by Albert direct organizations in their decision making.
Humphrey at Stanford University in the 1960s and 1970s  These explain how goals will be met and guide the general
course and scope of organizational activities.
SWOT definitions:
 Strengths – are those internal attributes that help an Policies also can be implied or expressed:
organization to achieve its objectives. IMPLIED EXPRESSED
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 neither written nor  delineated verbally or system’s long-term behavior (butterfly effect).
expressed verbally in writing
 usually developed over  may include a formal BUDGET
time and follow a dress code, policy for  a financial plan that includes estimated expenses as well as
precedent sick leave or income for a period of time.
vacation time, and  Accuracy dictates the worth of a budget; the more accurate
For example, a hospital may disciplinary the budget blueprint, the better the institution can plan the
have an implied policy that procedures most efficient use of its resources
employees should be
encouraged and supported in Types of Budgets
their activity in community, Workforce or largest of the budget expenditures because
regional, and national health- personnel budget health care is labor intensive.
care organizations. reflects expenses that change in response to
the volume of service, such as the cost of
Operating budget
electricity, repairs and maintenance, and
 PROCEDURES are plans that establish customary or supplies
acceptable ways of accomplishing a specific task and plan for the purchase of buildings or major
delineate a sequence of steps of required action. Capital budget equipment, which include equipment that has
 Identify the process or steps needed to implement a policy a long life (usually greater than 5 to 7 years)
and are generally found in manuals at the unit level of the
organization. MANAGEMENT PROCESS: ORGANIZING
RULES
ORGANIZATIONAL STRUCTURE
 Rules and regulations are plans that define specific action or
Formal Structure Informal Structure
nonaction.
 Existing rules should be enforced to keep morale from  Through  generally a naturally
breaking down and to allow organizational structure. departmentalization and forming social network of
work division, provides a employees
framework for defining  It is the informal structure
CHANGE THEORY
managerial authority, that fills in the gaps with
Kurt Lewin (1951)
responsibility, and connections and
1. identified three phases through which the change agent
accountability. relationships that illustrate
must proceed before a planned change becomes part of
 Roles and functions are how employees network
the system:
defined and systematically with one another to get
Three Phases:
arranged, different people work done.
occurs when the change agent convinces members have differing roles, and
Unfreezing of the group to change or when guilt, anxiety, or rank and hierarchy are
concern can be elicited. evident.
the change agent identifies, plans, and implements
Movement appropriate strategies, ensuring that driving forces RELATIONSHIPS AND CHAIN OF COMMAND
exceed restraining forces
the change agent assists in stabilizing the system  The organization chart defines formal relationships within
Refreezing
change so that it becomes integrated into the status the institution
phase
quo
MANAGERIAL LEVELS
Stages of change and responsibilities of the change agent:
STAGE 1 – UNFREEZING  Top-level managers look at the organization as a whole,
1. Gather data. coordinating internal and external influences, and generally
2. Accurately diagnose the problem. make decisions with few guidelines or structures.
3. Decide if change is needed.  Middle-level managers coordinate the efforts of lower levels
4. Make others aware of the need for change; do not of the hierarchy and are the conduit between lower and top-
proceed until the status quo has been disrupted and the level managers.
need for change is perceived by the others.  First-level managers are concerned with their specific unit’s
5. work flow.
STAGE 2 – MOVEMENT
1. Develop a plan. Top level Mid-level First level
2. Set goals and objectives. Chief nurse Unit Charge nurse
3. Identify areas of support and resistance. supervisor Team leader
4. Include everyone who will be affected by the change in Department Primary nurse
its planning. head
5. Set target dates. Scope of Look at Integrating Focus
6. Develop appropriate strategies. responsibility organization unit level day- primarily on
7. Implement the change. as a whole to-day needs day-to-day
8. Be available to support others and offer encouragement as well as with needs at unit
through the change. external organizational level
9. Use strategies for overcoming resistance to change. influences needs
10. Evaluate the change. Primary Strategic Combination Short-range,
11. Modify the change, if necessary. planning focus planning of long-and Operational
STAGE 3 – REFREEZING shortrange planning
1. Support others so that the change continues planning
Communicatio Top-down Upward and More often
CHAOS THEORY n flow but receives downward upward;
Edward Lorenz (1960s) subordinate with great generally relies
 discovered that even tiny changes in variables often feedback centrality on middle level
dramatically affected outcomes. both directly managers to
 Even small changes in conditions can drastically alter a and via transmit
NSG 129: Nursing Leadership and Management

middle-level communication FUNCTIONAL METHOD

managers to top-level  Functional nursing is efficiency-based; tasks are completed
managers quickly, with little confusion regarding responsibilities.
 Allow care to be provided with a minimal number of RNs

TYPES OF ORGANIZATIONAL STRUCTURES

Bureaucratic commonly called line structures or line
organizational organization
designs
Ad hoc design a modification of the bureaucratic structure
and is sometimes used on a temporary
basis to facilitate completion of a project
within a formal line organization
Matrix organization focus on both product and function.
structure Function is described as all the tasks
required to produce the product, and the
product is the end result of the function. 
Service line which can be used to address the
organization shortcomings that are endemic to traditional
TEAM NURSING
large bureaucratic organizations
 Ancillary personnel collaborate in providing care to a group
Flat organizational are an effort to remove hierarchical layers
of patients under the direction of a professional nurse.
designs by flattening the chain of command and
 As the team leader, the nurse is responsible for knowing the
decentralizing the organization
condition and needs of all the patients assigned to the team
and for planning individual care

MODULAR NURSING
 uses a mini-team (two or three members with at least one
member being an RN), with members of the modular nursing
team sometimes being called care pairs.
 Patient care units are typically divided into modules or
districts and assignments are based on the geographical
location of patients
ORGANIZING PATIENT CARE
PRIMARY NURSING
Traditional Patient Care Delivery Methods  The primary nurse assumes 24-hour responsibility for
 Total patient care planning the care of one or more patients from admission or
 Functional nursing the start of treatment to discharge or the treatment’s end.
 Team and modular nursing  During work hours, the primary nurse provides total direct
 Primary nursing care for that patient.
 Case management  when the primary nurse is not on duty, associate nurses,
who follow the care plan established by the primary nurse,
TOTAL PATIENT CARE provide care
 Nurses assume total responsibility during their time on duty
for meeting all the needs of assigned patients.
 Sometimes referred to as the case method of assignment
because patients may be assigned as cases

CASE MANAGEMENT
 A collaborative process of assessment, planning, facilitation
 and advocacy for options and services to meet an
individual’s health needs through communication and
NSG 129: Nursing Leadership and Management

available resources to promote quality cost-effective result of changes in the type of work they do, the scope of
outcomes. responsibility they hold, or in the work setting itself.
 Nurses address each patient individually, identifying the
most cost-effective providers, treatments, and care settings
possible

MANAGEMENT PROCESS: STAFFING STAFFING

 The leader-manager recruits, selects, places, and
indoctrinates personnel to accomplish the goals of the CENTRALIZED STAFFING,
organization  where staffing decisions are made by personnel in a central
office or staffing center.
STEPS IN STAFFING DECENTRALIZED STAFFING
1. Determine the number and types of personnel needed to  the unit manager is often responsible for covering all
fulfill the philosophy, meet fiscal planning responsibilities, scheduled staff absences, reducing staff during periods of
and carry out the chosen patient care delivery system decreased patient census or acuity, preparing monthly unit
selected by the organization. schedules, and preparing holiday and vacation schedules.
2. Recruit, interview, select, and assign personnel based on
established job description performance standards. MINIMUM STAFFING RATIO
3. Use organizational resources for induction and orientation. National Nurses United (2010–2013). RN to patient ratios. Retrieved
4. Ascertain that each employee is adequately socialized to June 9, 2013
organization values and unit norms.
5. Use creative and flexible scheduling based on patient care UNIT STAFFING RATIO
needs to increase productivity and retention Critical care/ICU 1:2
Operating room 1:1
RECRUITMENT Labor and delivery 1:2
 Is the process of actively seeking out or attracting applicants Antepartum 1:4
for existing positions and should be an ongoing process Pediatrics 1:4
 A leadership role in staffing includes identifying, recruiting, Medical-surgical 1:5
and hiring gifted people Emergency department 1:4
SELECTION
PATIENT CLASSIFICATION SYSTEM
 Is the process of choosing from among applicants the best-
Category I 1 – 2 hours of nursing care/day
qualified individual or individuals for a particular job or
Self care
position.
Category II 3 – 4 hours of nursing care/day
 Involves verifying the applicant’s qualifications, checking his
Minimal care
or her work history, and deciding if a good match exists
between the applicant’s qualifications and the organization’s Category III 5 – 6 hours of nursing care/day
expectations. Intermediate care
Category IV 7 – 8 hours of nursing care/day
PLACEMENT Modified intensive care
 The nurse leader is able to assign a new employee to a Category V 10 – 14 hours of nursing care/day
position within his or her sphere of authority, where the Intensive Care
employee will have a reasonable chance for success.
 Proper placement fosters personal growth, provides a FORMULA FOR STAFFING
motivating climate for the employee, maximizes productivity, National League for Nurses Formula for Staffing
and increases the probability that organizational goals will
be met. ABO X NCH
=¿ Total no. of nursing service
INDOCTRINATION
No . of working hours
 Planned, guided adjustment of an employee to the personnel for 24
organization and the work environment.
 INDUCTION, the first phase of indoctrination includes all Where:
activities that educate the new employee about the ABO = Average Bed Occupancy
organization and employment and personnel policies and NCH = Nursing Care Hours
procedures. No. of working hours: 8 Based on RA 5901
 ORIENTATION activities are more specific for the position. The 40 working hours per week law
 The purpose of the orientation process is to make the
employee feel like a part of the team. Standard values for NCH:
 This will reduce burnout and help new employees become Medical = 3.4
independent more quickly in their new roles OB = 3.0
Surgical = 3.4
STAFF DEVELOPMENT Pedia = 4.6
 The better trained and more competent the staff, the fewer Mixed MS = 3.5
the number of staff required, which in turn saves the Nursery = 2.8
organization money and increases productivity. Percentage of Professionals to Non-Professionals
 Staff development activities are normally carried out for one Professionals - 60%
of three reasons: to establish competence, to meet new Non-Professionals - 40%
learning needs, and to satisfy interests the staff may have in
learning in specific areas. Percentage of Distribution per Shift
Morning - 45%
SOCIALIZATION Afternoon - 37%
 SOCIALIZATION refers to a learning of the behaviors that Night - 18%
accompany each role by instruction, observation, and trial
and error. Sample:
 RESOCIALIZATION occurs when individuals are forced to
learn new values, skills, attitudes, and social rules as a Staffing for an OB Ward: 30-bed capacity Percentage of
NSG 129: Nursing Leadership and Management

Professionals to Non-Professionals

Herzberg’s Two-Factor Theory

Frederick Herzberg (1977)
 believed that employees can be motivated by the work
itself and that there is an internal or personal need to
meet organizational goals.

Vroom’s Expectancy Model

Victor Vroom (1964)
 looks at motivation in terms of the person’s valence, or
preferences based on social values. • A person’s
expectations about his or her environment or a certain
event will influence behavior.

MANAGEMENT PROCESS: DIRECTING

DIRECTING
 MOTIVATION is the force within the individual that
influences or directs behavior.
 Leaders should apply techniques, skills, and knowledge of
motivational theory to help workers achieve what they want
out of work.

TYPES OF MOTIVATION
INTRINSIC EXTRINSIC
 Comes from within the  Comes from outside the McClellands’s Three Basic Needs
individual individual David McClelland (1971)
 Often influenced by family  Rewards and  examined what motives guide a person to action.
unit and cultural values reinforcements are given Achievement-oriented actively focus on improving what is;
to encourage certain people they transform ideas into action,
behaviors and/or levels of judiciously and wisely, taking risks when
achievement necessary.
Affiliation-oriented focus their energies on families and
MOTIVATIONAL THEORIES people friends; their overt productivity is less
because they view their contribution to
Maslow’s Hierarchy of Needs and Theory of Human Motivation society in a different light from those
Maslow (1970) who are achievement oriented.
 people are motivated to satisfy certain needs, from basic Power-oriented people are motivated by the power that can be
survival to complex psychological needs, and people gained as a result of a specific action.
seek a higher need only when the lower needs have They want to command attention, get
been met. recognition, and control others.

McGregor’s Theory X and Theory Y

Douglas McGregor (1960)
 examined the importance of a manager’s assumptions
about workers on the intrinsic motivation of the workers.

Operant Conditioning and Behavior Modification

Skinner (1953)
 demonstrated that people could be conditioned to
behave in a certain way based on a consistent reward or 
punishment system
NSG 129: Nursing Leadership and Management

 The leader who actively listens gives genuine time and

COMMUNICATION attention to the sender, focusing on verbal and nonverbal
 Communication is “the exchange of thoughts, messages, or communication.
information, by speech, signals, writing, or behavior.”  The leader must continually work to improve listening skills
 Occur on at least two levels: verbal and nonverbal. by giving time and attention to the message sender.

CLIMATES OF COMMUNICATION Offer greetings and establish positive

G Greeting
Internal Climate External climate environment
Includes internal factors such as Includes external factors such Listen without interrupting and pause to
R Respectful listening
the values, feelings, as the weather, temperature, allow others to think
temperament, and stress levels timing, status, power, authority, Summarize message to make sure it
R Review
of the sender and the receiver and the organizational climate was heard accurately
itself Recommend or Seek additional information as
R request more necessary
COMMUNICATION PROCESS information
Recognize that a collaborative
R Reward exchange has occurred by offering
thanks

SOCIAL NETWORKING
American Nurses Association. (2011, September). Principles for social
networking and the nurse

1. Nurses must not transmit or place online individually

identifiable patient information.
2. Nurses must observe ethically prescribed professional
patient–nurse boundaries.
3. Nurses should understand that patients, colleagues,
institutions, and employers may view postings.
4. Nurses should take advantage of privacy settings and seek
CHANNELS OF COMMUNICATION to separate personal and professional information online.
Upward the manager is a subordinate to higher 5. Nurses should bring content that could harm a patient’s
communication management privacy, rights, or welfare to the attention of appropriate
authorities.
Downward the manager relays information to subordinates
6. Nurses should participate in developing institutional policies
communication
governing online conduct.
managers interact with others on the same
Horizontal hierarchical level as themselves who are
DELEGATION
communication managing different segments of the
 Delegation is getting work done through others or as
organization
directing the performance of one or more people to
the manager interacts with personnel and
accomplish organizational goals.
Diagonal managers of other departments and groups who
 The mark of a great leader is when he or she can recognize
communication are not on the same level of the organizational
the excellent performance of someone else and allow others
hierarchy
to shine for their accomplishments.
flows quickly and haphazardly among people at  “Getting somebody to do the task”
Grapevine
all hierarchical levels and usually involves three  “Leaders are self-actualize”
communication
or four people at a time
5 RIGHTS OF DELEGATION
COMMUNICATION SKILLS
1. Right task
Assertive allows people to express themselves in direct,
2. Right circumstances
communication honest, and appropriate ways that do not
3. Right person
infringe on another person’s rights
4. Right direction/communication
Passive occurs when a person suffers in silence although 5. Right level of supervision
communication he or she may feel strongly about the issue “mugawas nisa board exam”!!!!
Aggressive is generally direct, threatening, and
communication condescending Criteria for Delegation to an Unlicensed Personnel
1. Frequently recur in the daily care of a client or group of
COMMUNICATION TOOLS
clients
2. Are performed according to an established (standardized)
SBAR
sequence of steps
Introduce yourself and the patient and 3. Involve little or no modification from one client-care situation
S Situation briefly state the issue that you want to to another
discuss 4. May be performed with a predictable outcome
Describe the background or context 5. Do not inherently involve ongoing assessment,
(patient’s diagnosis, admission date, interpretation, or decision making which cannot be logically
B Background
medical diagnosis, and treatment to separated from the procedure(s) itself
date) 6. Do not endanger the health or well-being of clients
Summarize the patient’s condition and 7. Are allowed by agency policy/procedures
A Assessment
state what you think the problem is
Identify any new treatments or changes CONFLICT RESOLUTION
R Recommendation ordered and provide opinions or
recommendations for further action

LISTENING SKILLS
NSG 129: Nursing Leadership and Management

the other party to win

Smoothing
Avoiding
Collaborating
 Conflict is generally defined as the internal or external
discord that results from difference in ideas, values, or
feelings between two or more people.
 Conflict is neither good nor bad, and it can produce growth
or destruction, depending on how it is managed.
CATEGORIES OF CONFLICT
occurs between two or more groups of
Intergroup conflict
people, departments, and organizations
occurs within the person. It involves an
Intrapersonal
internal struggle to clarify contradictory
conflict
values or wants
happens between two or more people with
Interpersonal differing values, goals, and beliefs and may
conflict be closely linked with bullying, incivility, and
mobbing
INTERPERSONAL CONFLICT
Bullying repeated, offensive, abusive, intimidating, or insulting
behaviors; abuse of power; or unfair sanctions that
make recipients feel humiliated, vulnerable, or
threatened, thus creating stress and undermining
their self-confidence (Townsend, 2012)
Incivility behavior that lacks authentic respect for others that
requires time, presence, willingness to engage in
genuine discourse and intention to seek common
ground (Clark, 2010).
Mobbing occurs when employees “gang up” on an individual.
Workplace When bullying, incivility, and mobbing occur in the
violence workplace
one party in a conflict attempts to pacify the
other party or to focus on agreements rather
than differences – see objectively both sides
parties involved are aware of a conflict but
choose not to acknowledge it or attempt to
resolve it – not advisable if gainit pa ang ulo
hahahaha but can help in most volatile situation
(NEGATIVE)
all parties set aside their original goals and work
together to establish a supraordinate or priority
common goal
NEGOTIATION
 Each party gives up something, and the emphasis is on
accommodating differences between the parties.
 The very least for which a person will settle is often referred
to as the bottom line.
 Negotiation is psychological and verbal. The effective
negotiator always appears calm and self-assured.
COLLECTIVE BARGAINING
 Collective bargaining involves activities occurring between
organized labor and management that concern employee
relations.
 Management that is perceived to be deaf to the workers’
needs provides a fertile ground for union organizers,
because unions thrive in a climate that perceives the
organizational philosophy to be insensitive to the worker
TIME MANAGEMENT
 Time management is making optimal use of available time.
 Good time management skills allow an individual to spend
time on things that matter

Think before you speak, think before you act to avoid conflict – be
careful!!
Miscommunication can lead to conflict
CONFLICT PROCESS
- Problem with conflict process if nay psychological problem
ang kalaban!!!

PROCRASTINATION
6 STEPS OF PROCRASTINATION

CONFLICT RESOLUTION STRATEGIES

Compromising each party gives up something it wants
one party pursues what it wants at the expense
Competing of the others (CAN BE NEGATIVE OR
POSITIVE) TIME WASTERS
Cooperating one party sacrifices his or her beliefs and allows
NSG 129: Nursing Leadership and Management

1. Technology (Internet, gaming, e-mail, and social media  The individual is the focal element on which production
sites) and service depend (i.e., it must be a customer-
2. Socializing responsive environment) and that the quest for quality is
3. Paperwork overload an ongoing process
4. A poor filing system
5. Interruptions

MANAGEMENT PROCESS: CONTROLLING

QUALITY CONTROL

 QUALITY CONTROL refers to activities that are used to

evaluate, monitor, or regulate services rendered to
consumers.
 HEALTH-CARE QUALITY is the degree to which health
services for individuals and populations increase the
likelihood of desired health outcomes and are consistent
with current professional knowledge.
Hallmarks of effective quality control programs:
1. Support from top-level administration.
2. Commitment by the organization in terms of fiscal and
human resources.
3. Quality goals reflect search for excellence rather than
minimums.
4. Process is ongoing (continuous).

TOYOTA PRODUCTION SYSTEM
 is a production system built on the complete elimination
of waste and focused on the pursuit of the most efficient
production method possible.
 Health-care organizations that use TPS would have
caregivers not only attempt to directly solve problems at
the time they occur, but it would also have them
determine the root cause of the problem, so that the
likelihood of the problem recurring would be minimized.

Quality Control Process

[picture below]

PERFORMANCE APPRAISALS

 Performance appraisals let employees know the level of

NURSING AUDIT
 Audit is a systematic and official examination of a record,
process, structure, environment, or account to evaluate
performance.
 Auditing in health-care organizations provides managers
with a means of applying the control process to determine
the quality of services rendered
TYPES OF NURSING AUDIT
are performed after the patient receives the
Retrospective audits
service
are performed while the patient is receiving
Concurrent audits
the service
attempt to identify how future performance
Prospective audits
will be affected by current interventions
reflect the end result of care or how the
Outcome audits patient’s health status changed as a result
of an intervention.
are used to measure the process of care or
how the care was carried out and assume
Process audits that a relationship exists between the
process used by the nurse and the quality of
care provided.
includes resource inputs such as the
Structure audit environment in which health care is
delivered
QUALITY IMPROVEMENT MODELS
TOTAL QUALITY MANAGEMENT
 also referred to as continuous quality improvement
(CQI), is a philosophy developed by Dr. W. Edward
Deming.
their job performance as well as any expectations that the
organization may have of them.
 If employees believe that the appraisal is based on their job
description rather than on whether the manager approves of
them, they are more likely to view the appraisal as relevant.
PERFORMANCE APPRAISAL TOOLS
Trait rating scales Rates an individual against some standard
Job dimension Rates the performance on job requirements.
scales
Behaviorally Rates desired job expectations on a scale of
anchored rating importance to the position
scales
Rates the performance against a set list of
Checklists
desirable job behaviors.
Essays A narrative appraisal of job performance.
An appraisal of performance by the
Self-appraisals
employee.
Management by Employee and management agree upon
objectives goals of performance to be reached.
Assessment of work performance carried
Peer review
out by peers.
EFFECTIVE COACHING
 Be specific, not general, in describing behavior that needs
improvement.
 Be descriptive, not evaluative, when describing what was
wrong with the work performance.
 Be certain that the feedback is not self-serving but meets the
needs of the employee.
 Direct the feedback toward behavior that can be changed.
 Use sensitivity in timing the feedback.
 Make sure that the employee has clearly understood the
feedback and that the employee’s communication has also
been clearly heard
NSG 129: Nursing Leadership and Management

[LEGAL BASES NA ANG NEXT MING GINA TRANSCRIBE PA NAKO

SO KULANG NI]
NSG 129: Nursing Leadership and Management

PROFESSIONAL STANDARDS
STANDARDS OF NURSING PRACTICE NURSE RESEARCHER
 Investigates problems to improve nursing care and to further
1. Safe & quality nursing practice define and expand the scope of nursing practice.
2. Management of resources & environment  Employed in an academic setting, hospital, or independent
3. Health education professional or community service agency.
4. Legal responsibility
5. Ethico – moral responsibility SCHOOL HEALTH NURSE
6. Personal & professional development  Goal – Superior educational success by enhancing school
7. Quality improvement health
8. Research Functions:
9. Record management • Direct caregiver
10. Communication • Case finder
11. Collaboration & teamwork • Consultant
• Counselor
LEGAL BASES • Health Educator
• Researcher.
Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002”
 Board shall monitor & enforce quality standards of nursing OCCUPATIONAL HEALTH NURSE
practice necessary to ensure the maintenance of efficient, Specialty practice that provides for and delivery of health and safety
ethical and technical, moral and professional standards in programs and services to workers, worker population and community
the practice of nursing taking into account the health needs groups.
of the nation. Functions:
• Promotion and restoration of health
Significance of core competency standards: • Prevention of illness and injury and
• Protection from work related and environmental hazards.
 Unifying framework for nursing practice, education,
regulation PARISH NURSE
 Guide in nursing curriculum development  The role that gathers in churches, cathedrals, temples,
 Framework in developing test syllabus for nursing profession mosques, and acknowledge common faith traditions.
entrants  Respond to health and wellness needs within the context of
 Tool for nurses’ performance evaluation populations of faith community.
 Basis for advanced nursing practice, specialization
 Framework for developing nursing training curriculum Functions:
 Public protection from incompetent practitioners  Provider of spiritual care
 Yardstick for unethical, unprofessional nursing practice  Health Counselor
 Health Advocate
NOVICE TO EXPERT  Health Educator
 Facilitator of Support Groups
 The Benner Model is designed to emphasize the skill  Trainer or Volunteers
acquisition of health care professionals (Benner, 2001)  Liaison to community resources and referral agent
 NOVICE, a new practitioner’s practice is driven by rules and
tends to provide task focused care. PUBLIC HEALTH NURSE
 ADVANCED BEGINNERS, providers have developed safe  A registered nurse with special training community health
practice but lack a strong knowledge base to found their Function:
practice and management skills.  Health Advocate
 COMPETENT PROVIDER, NPs will find they can prioritize  Care Manager
and begin to use past experiences to form their care.  Referral Resource
 PROFICIENT PROVIDERS have a good sense of what their  Health Educator
patient situation is and can prioritize needs and routinely  Direct Primary Caregivers
predict accurate outcomes.  Communicable Disease Control
 EXPERT PROVIDERS, NPs are confident, have an  Disaster Preparedness
extensive knowledge base and will be able to quickly grasp
complex patient situations. PRIVATE DUTY NURSE
 A registered nurse or a licensed practical nurse who provide
EXPANDED ROLES FOR NURSES nursing services to patients at home or any other setting in
accordance with physician orders.
ADVANCED PRACTICE NURSE (APN)
 The most independent functioning nurse. HOME CARE NURSE
 Has a master’s degree in nursing, advanced education in  A nurse who provides periodic care to patients within their
pharmacology and physical assessment, and certification home environment as ordered by the physician.
and expertise in specialized area of practice.
Functions:
CLINICAL NURSE SPECIALIST  Health Maintenance
 Nursing expertise in a specialized area of practice (medical-  Education
surgical nursing, psychiatric and mental health nursing,  Illness Prevention
pediatric nursing, community health nursing, gerontologic  Diagnosis and treatment of disease.
nursing).  Palliation and rehabilitation.
NURSING ADMINISTRATOR
 Manages client care and the delivery of specific nursing HOSPICE NURSE
services within a health care agency.  Provides a family centered care and allows clients to live
 Begins with positions such as the charge nurse or assistant and remain at homes with comfort, independence and
nurse manager, then nurse manager of a specific patient dignity, while alleviating the strains caused by terminal
care area. phase i.e. at the time of death.
NSG 129: Nursing Leadership and Management

Functions:
 Pain & symptom control.
 Spiritual Care
 Home Care and impatient Care
 Family Conferences
 Co-ordination of Care
 Bereavement Care

REHABILITATION NURSE
 A nurse who specializes in assisting persons with disabilities
and chronic illness to attain optimal function, health and
adapt to an altered life style.

NURSE EPIDEMIOLOGIST
 Monitors standards and procedures for the control and
prevention of infectious diseases and other conditions of
public health significance including nosocomial infections.

NURSING ORGANIZATIONS
 Ang Nars
 Association of Deans of Philippine Colleges of Nursing
(ADPCN)
 Association of Diabetes Nurse Educators of the
Philippines (ADNEP)
 Association of Nursing Service Administrators of the
Philippines (ANSAP)
 Association of Private Duty Nurse Practitioners
Philippines (APDNPP)
 Critical Care Nurses Association of the Philippines
(CCNAPI)
 Gerontology Nurses Association of the Philippines
(GNAP)
 Military Nurses Association of the Philippines (MNAP)
 Mother and Child Nurses Association of the
 Philippines (MCNAP)
 National League of Philippine Government Nurses
(NLPGN)
 Occupational Health Nurses Association of the
Philippines (OHNAP)
 Operating Room Nurses Association of the Philippines
(ORNAP)
 Mother and Child Nurses Association of the Philippines
(MCNAP)
 National League of Philippine Government Nurses
(NLPGN)
 Occupational Health Nurses Association of the
Philippines (OHNAP)
 Operating Room Nurses Association of the Philippines
(ORNAP)
 Renal Nurses Association of the Philippines (RENAP)
 Society of Cardiovascular Nurse Practitioners of the
Philippines (SCVNPPI)
 Philippine Association of Public Health Nursing Faculty
 Psychiatric Nursing Specialists Foundation of the
Philippines
 Integrated Registered Nurses of the Philippines (IRNUP)

References:
Marquis, B. L., & Huston, C. J. (2011). Leadership Roles and
Management Functions in Nursing: Theory and Application.
Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.