LEADERSHIP AND MANAGEMENT

A. LEADERSHIP
 The process of influencing the actions of a person or group to attain desired objectives.

NURSING LEADERSHIP
 The process whereby a nurse influence one or more persons to achieve specific goals in the
provision of nursing care for one or more patients.

B. THEORIES of LEADERSHIP

1. Great Man Theory

 Leaders are born and not made, which suggests that leadership cannot be developed.
Few people are born with necessary characteristics to be great.

2. Charismatic Theory
 People maybe leaders because they are charismatic but relatively little is known about
this intangible characteristics most agree that it is an inspirational quality that makes
others feel better in their presence.

3. Trait Theories
 Assume that a person must have certain innate abilities, personality traits or other
characteristics in order to be a leader.
 Traits could be obtained through learning and experience.

4. Situational Theory
 Suggests that the traits required of a leader differ according to varying situations.

5. Contingency Theory
 Leadership style will be effective or ineffective depending on the situation.

6. Path – Goal Theory

 The leader facilitates task accomplishment by minimizing obstruction to the goals and
by rewarding followers for completing their tasks.

C. KINDS of LEADERSHIP

1. Transactional Leadership
 Is an exchange posture that identifies needs of followers and provides rewards to meet
those needs in exchange for expected performance.
2. Transformational Leadership
 Promotes employee development, attends to needs and motives of followers, inspires
through optimism, influences changes in perception, provides intellectual stimulation and
encourages follower creativity. It is a cooperative process – focused networking.

D. LEADERSHIP STYLE
 Is how a leader uses interpersonal influences to accomplish goals.

1. Autocratic
a. Leader – focused
b. Leader maintains strong control, makes the decisions and solves all problems.
c. Leader dominates the group
d. Leader commands rather than makes suggestions or seeks input

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 2. Democratic
a. Also called participative leadership
b. Based on the belief that every group members should have input into development of
goals and problem solving
c. Leader acts primarily as a facilitator and a resource person
d. Leader is concerned for each member of the group
e. More participative and much less authoritarian than autocratic

3. Laissez – faire
a. Leader assumes a passive, nondirective and inactive approach
b. Leadership responsibilities are either assumed by the members of the group or
completely relinquished
c. All decision making is left to the group, with the leader giving little if any guidance,
support or feedback.
d. Behavior by the group may be permissible due to the leader’s lack of limit setting and
stated expectations

4. Situational
a. Utilizing a combination of styles based on current circumstances and events
b. Leadership styles are assumed according to the needs of the group and tasks to be
achieved.

E. LEADERSHIP QUALITIES

1. Communication
a. Listens actively to others
b. Communicates in an assertive manner, speaks directly and honestly to others
c. Differentiates aggressive, passive and assertive behavior to communicate appropriately
in a given situation

2. Credibility
a. Enhances a nurse’s accountability
b. Individuals who perform well are those who can influence others

3. Critical Thinking
a. An individual with an open minded, questioning attitude
b. The ineffective leader is one who falls into routine ways of thinking without even being
aware of what is happening

4. Initiating action
a. Initiates measures to solve problems
b. Puts ideas into action and demonstrates flexibility
c. If an approach is ineffective, the leader is not hesitant to try another approach

5. Risk Taking
a. Involves taking actions to solve problems
b. Risk – taking activities are goal directed

6. Persuasiveness and influence

a. Motivates and inspires others to achieve goals
b. Understands how to use power effectively and does not dominate but rather motivates
others

F. POWER
 Ability to do or act and results in the achievement of desired results
 Powerful people are able to modify behavior and influence others to change, even when
others are resistant to change

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  Effective nurse leaders use power to improve the delivery of care and to enhance the
profession

Types of Power
Reward Ability to provide incentives
Coercive Ability to punish
Referent Based on attraction; others wanting to associate with one
Expert Based on having an expert knowledge base and skill level
Legitimate Based on a position in society
Personal Derives from a high degree of self confidence
Informational Occurs when one person provides explanations about why another
should behave in a certain way.

Empowerment
 An interpersonal process of enabling others to do themselves
 Occurs when individuals are better able to influence what happens to them
 Involves open communication, mutual goal setting and decision making
 Nurse can empower clients through advocacy

A. MANAGEMENT
 The accomplishment of tasks either by ones self or by directing others.

B. MANAGEMENT THEORIES

1. Scientific Management Theory

a. Frederick Taylor – Father of scientific management
 Through the use of stopwatch studies, he applied the principles of
observation, measurement and scientific comparison to determine the most
efficient way to accomplish a task. Taylor conducted time and motion studies
to time workers, analyze their movements and set work standards.

b. Frank and Lillian Gilbreth

 Also did pioneering work in time and motion studies. They emphasized the
benefits of job simplification and the establishment of work standards, as well
as the effects of the incentive wage plans and fatigue on work performance.

c. Henry Gantt – Concerned with problems of efficiency.

 He contributed to scientific management by refining previous work rather than
introducing new concepts.

2. Classic Organization
a. Henri Fayol – Father of the Management Process School; Management is universal.
 All managers, regardless of the type of organization of their level in
organization or their level in organization, have essentially the same task:
planning, organizing, issuing orders, coordinating and controlling.

b. Max Weber – Father of Organization Theory

 He conceptualized a structure of authority that would facilitate the
accomplishment of the organizational objectives.

c. James Mooney
 Believed management to be the technique of directing people and
organization the technique of relating functions.
d. Lyndall Urwick
 His conceptual framework blended scientific management and classic
organization theory into the beginnings of classic management theory. He
described the managerial process as planning, coordinating and controlling

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 and he popularized such concepts as the balance of authority with
responsibility, span of control, unity of command, use of general and special
staffs, the proper use of personnel, delegation and departmentalization.

3. Human Relations Theory – Stresses the social environment.

a. Chester Barnard
 Stressing the importance of cooperation between management and labor, he
noted that the degree of cooperation depends on nonfinancial inducements,
which informal organization can help provide. Formal channels of
communication must be known and should be as short as possible.

b. The Hawthorne Studies

 Conducted at the Chicago Hawthorne plant of Western Electric by
researchers from Harvard University under the direction of the psychologist
Elton Mayo (1880 – 1949) and reported by the sociologist Fritz Rothlesberger,
the studies investigated the effects of changes in illumination of productivity.

c. Kert Lewin – Developed Field Theory of Human Behavior

 Maintained that groups have personalities of their own: composites of the
member’s personalities. He showed that group forces can overcome individual
interests.

4. Behavioral Science
a. Abraham Maslow
 Initiated human behavioral school; development of a hierarchy of needs
theory.

b. Frederick Herzberg
 Develop a taxonomy of job situations based on research that has contributed
to a better understanding of human motivation.

c. Douglas McGregor
 He notes that one’s style management is dependent on one’s philosophy of
humans and categorizes those assumptions as Theory X and Theory Y.
 In Theory X the manager’s emphasis is on the goal of the organization.
The theory assumes that people dislike work and will avoid it;
consequently, workers must be directed, controlled, coerced and
threatened so that organizational goals can be met. According to Theory
X, most people want to be directed and to avoid responsibility because
they have little ambition.
 In Theory Y the emphasis is on the goal of the individual. It is the
manager’s assumption that people do not inherently dislike work and that
work can be a source of satisfaction.

d. William Ouchi
 Explained Japanese organizations focus on staff, skills, style and
superordinate goals.

e. Richard Pascale and Anthony Athos

 Explain that organizations in the US tend to favor strategy structure and
systems.

f. Chris Argyris
 Focused his research on the coexistence of personal and organizational
needs, found that individuals give priority to meeting their own needs.

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C. PRINCIPLES of MANAGEMENT

1. Responsibility of Command
 The manager is responsible for all the actions both good and bad of those under his
command.

2. Chain of command/Scalar Process

 The arrangement of persons through whom responsibility passes

3. Channel of communication
 Every individual should be able to tell the lines of authority from the divisional organizational
chart
4. Unity of Command
 Each individual should report to one and only one boss

5. Principles of Authority- Responsibility and Accountability

Authority - a leader’s right to decide and command
Responsibility - the obligation of an individual, to do the task that has been assigned to
her
Accountability - the responsibility of an individual to answer all the actions he has done

6. Principle of Delegation
 Decision-making and task should be delegated down the chain of command

7. Span of Control
 No individual can manage if too many persons report to him. An ideal span of control is 8
reporting persons not less than 4

8. Hierarchial Level
 More than 5 levels of workers from the top man to the lowest level employee is too heavy
with management

9. Principle of Definition
 It is the job of the manager to ascertain that each worker has a clear idea of what is
expected

10. Job Descriptions or Performance Responsibilities

 Precise job content, activities, ,responsibilities and results expected from the various roles

11. Orientation
 The formal process of appraising the new employee of the organization and her place in it

D. MANAGEMENT FUNCTIONS and PROCESSES

Planning Determining objectives and identifying methods that lead to

achievement of those objectives
Organization Using resources (human and material) to achieve predetermined
outcomes
Directing Guiding and motivating others to meet the expected outcomes
Controlling Using performance standards as criteria for measuring success and
taking corrective action
Decision making Identifying a problem and deciding which alternative(s) can best
achieve the objectives

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I. PLANNING
 Making future projections to achieve desired results.

2 Kinds
1. Long range or strategic planning
 Extends 3 to 5 years into the future.
 Determines the direction of the organization, allocates resources and
determines time frames.

2. Short range or operational planning

 Short range planning that deals with day to day maintenance activities
 Done in conjunction with budgeting usually a few months before the new
fiscal year.

PLANNING TOOLS

1. Vision – mental image of something not actually visible

Example:
GENERAL HOSPITAL VISION STATEMENT

The vision for General Hospital is to be the preeminent health care provider in the
region by doing the following
 Being the premier full – service, integrated health care delivery network that
provides a continuum of health services,
 Creating an environment that exceeds the expectations of our customers
 Developing creative solutions to the challenges facing us

2. Values – is the worth, usefulness or importance of something.

Example:
The guiding values for General Hospital are
as follows:
 Quality
 Compassion
 Fairness
 Integrity
 Innovation

3. Purpose or Mission Statement – an aim to be accomplished, mission statement.

Example:

The mission of General Hospital is to

deliver comprehensive health care
services to promote physical and mental
health; to prevent disease, injury and
disability and to promote healing of the
body, mind and spirit.

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 4. Philosophy – statement of beliefs and values that directs behavior.

Example:
PHILOSOPHY OF GENERAL HOSPITAL

General Hospital is committed to assessing and

meeting the physical, emotional, spiritual,
environmental, social and rehabilitative health
needs of the citizens in the region. The worth,
dignity and autonomy of individuals (customers,
employees and others) are recognized, as is each
individual’s right to self – direction and responsibility
for one’s own life.

5. Goals and Objectives

Goal – the end to be accomplished
Objective – something aimed at or striven for, things done to achieve the goals.

Example:
Goal
Develop and implement staff development
programs to meet the need for increased
knowledge.

Objectives
To develop and implement at least 12 staff
development programs by the end of the fiscal year.

6. Policies – means for accomplishing goals and objectives

7. Procedures – chronological sequence of steps within a process

PLANNING STEPS

1. Fore cast
2. Set objectives
3. Develop and schedule programs
4. Prepare budget
Budget – is a plan for the allocation of resources and control for ensuring that
results comply with the plans.

Types of Budget

1. Operating Budget
 Provides an overview of an agency’s functions by projecting the
planned operations usually for upcoming year
 Deals primarily with salaries, supplies and contractual services,
other expenses – (spending such as travel, training, dues, rental,
repairs, depreciation.

2. Capital Expenditure Budgets

 Related to long term planning
 Include physical changes such as replacement or expansion of
the plant, major equipment and inventories.

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II. ORGANIZING
 Establishing formal authority

ORGANIZATIONAL STRUCTURE – Kinds

a. Formal
 Furnishes the formal framework in which management process takes place.

Organizational Chart – depicts the formal organizational relationships, areas of

responsibility, persons to whom one is accountable and channels of
communication.
 Chain of Command – formal line of authority
 Centrality – indicates the location of a position in an organization where
frequent communication occurs.
 Unity of Command – represented by the vertical solid line between
positions on an organizational chart – indicates one person has one
boss
 Authority – is the official power to act. Power to direct the work of others.
 Responsibility – is a duty or an assignment
 Accountability – is a moral responsibility – manager may delegate
responsibility but always remain accountable.

b. Informal Organization
 Comprises personal and social relationships that do not appear on the
organizational chart
 Might include; a group that usually takes break together, work together
on a practical unit, or takes a class together.

METHODS of ORGANIZING CLIENT CARE

1. Case Method
 Assignment of clients to a nurse for specific period of time.
 One nurse is assigned to give comprehensive total care to a single client while on
duty.

2. Functional Method
 Assignment of selected functions or tasks for a particular period of time on several
patients.
Ex. A nurse assigned to give all medications, another to perform nursing procedures
and treatments etc.

3. Team Nursing
 Accommodating several categories of nursing personnel in meeting the
comprehensive individualized needs of patient. Usually the professional nurse
provides the leadership to the group of care – givers in planning the care of patients.

4. Primary Nursing
 Nursing care directed by a nurse on 24 hours basis.

III. DIRECTING
 Actuating efforts to accomplished goals

a. Decide – problem solving and decision making process

Approaches to Decision Making
1. Meddling through
2. Satisfying approach
3. Optimizing approach

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 b. Develop people – provide staff development
c. Communicate – to ensure understanding via various routes
d. Coordinate – unite personal services
e. Supervise – harmonize goals through guidance
f. Utilize, revise, update policies and procedures

IV. CONTROLLING
 Assisting or regulating performances

Specify criteria and standards

Standards – level of performances that management can expect of Person

Types of Standards
1. Structure – the management used to organize and deliver care
2. Process – the actual nursing procedures
3. Outcome – measuring the results of nursing care

a. Monitor and Evaluate nursing care services

Quality Assurance – monitoring the compliance with established standards

Nursing Audit - assuring documentation of the quality of nursing care in keeping with
standards established by the agency, nursing department and the professional
governmental and accrediting groups

Purposes
1. Prioritize nursing care
2. Promote optimum nursing care
3. Identify deficiencies in the organization and administration of nursing care
4. To correct such deficiencies thru education and administration change
5. To increase performance to assure that improvements have been maintained

b. Performance Appraisal – a method of acquiring and processing information needed to

improve the individual worker’s performance and accomplishments.

E. RESOURCES
 Something to which one resorts for comforts or help to gain one end

a. Major Resources
a. Money d. Machines
b. Manpower e. Space
c. Materials

b. Inventory
 Refers to stick of various supply items keep on hand to provide a service to users, to
feed a production line, to provide goods for sale or demand while waiting for further
deliveries

Methods:
 Periodic or physical inventory
 Perpetual inventory

c. Cost Containment
 The goal is to keep costs within acceptable limits for volume, inflation and other
acceptable parameters

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