Professional Documents
Culture Documents
2bpatigas Hencm119 Module2 First Sem 2021 2022
2bpatigas Hencm119 Module2 First Sem 2021 2022
CONAHS
COURSE MODULE IN
NURSING
LEADERSHIP AND
MANAGEMENT
1st Semester; A.Y. 2022 – 2023
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 1
COURSE FACILITATOR: MAGDALENA G. PATIGAS, RN, LPT,
MAN
FB/MESSENGER: MAGDALENA PATIGAS
Email: maggietingson@gmail.com
2
Phone No: 09810571009
MODULE
MISSION
To produce glocally viable graduates through innovative learning and research environment and
GOAL
INSTITUTIONAL OUTCOMES
5. Manifest abilities and willingness to work well with others either in the practice of one’s
profession or community involvement without compromising legal and ethical
responsibilities and accountabilities.
Welcome to the second semester of School Year 2020-2021! Welcome to the College of
Arts and Sciences and welcome to NONESCOST!
Despite of all the happenings around us, there is still so much to be thankful for and one
of these is the opportunity to continue learning.
You are right now browsing your course module in GE103, The Contemporary World. As
you read on, you will have an overview of the course, the content, requirements and
other related information regarding the course. The module is made up of 3 lessons.
Each lesson has seven parts:
LEARNING ACTIVITIES – To measure your learnings in the lesson where you wandered
I encourage you to get in touch with me in case you may encounter problems while
studying your modules. Keep a constant and open communication. Use your real names
in your FB accounts or messenger so I can recognize you based on the list of officially
enrolled students in the course. I would be very glad to assist you in your journey.
Furthermore, I would also suggest that you build a workgroup among your classmates.
Participate actively in our discussion board or online discussion if possible and submit
your outputs/requirements on time. You may submit them online through email and
messenger. You can also submit hard copies. Place them in short size bond paper inside
a short plastic envelop with your names and submit them in designated pick-up areas.
I hope that you will find this course interesting and fun. I hope to know more of your
experiences, insights, challenges and difficulties in learning as we go along this course. I
am very positive that we will successfully meet the objectives of the course.
May you continue to find inspiration to become a great professional. Keep safe and God
bless!
Course
HENCM 119
Number
Course Title Nursing Leadership and Management
Application of concepts, principles, theories and methods of management
and leadership, as well as, the ethico-moral, legal and professional
responsibilities of a nurse. The students are expected to perform beginning
Course
professional management and leadership skills, and apply sound ethico-
Description
moral and legal decision-making in the hospital and community-based
settings. Students are likewise expected to comply to the professional
standards of nursing practice.
No. of Units 4 units
Pre-requisites HENCM115, HENCM116, HENCM 117
Course 1. Discuss the principles of leadership and management
Intended 2. Apply the principles learned in organizing and conducting a seminar.
Learning 3. Apply management and leadership principles in providing direction to
Outcomes manage a nursing service in any health care setting.
4. Adhere to establish norms of conduct based on the Philippine Nursing Law
and other legal, regulatory and institutional requirements relevant to safe
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 8
nursing practice.
5. Apply nursing practice tools, guidelines and/or frameworks on leadership
and management skills for effective delivery of programs and services in
specific group of clients in the community setting.
Content MODULE 1
Coverage
LESSON 1
CONCEPTS OF LEADERSHIP AND MANAGEMENT
A. Management
Organization
Leadership
Nursing Management
B. Managerial/ Leadership Roles as a beginning Nurse Practitioner
1. Concepts
2. Theories
3. Qualities/ competencies of a nurse manager/ leader
4. Roles and Responsibilities
Principles of Management Leadership and Management Theories
a) Early Leadership theories
b) Early management theories
LESSON 2
OVERVIEW OF THE FUNCTIONS OF MANAGEMENT
A. Planning
Reasons for planning
Types of planning
Strategic Planning
Tactical Planning
Operational Planning
Hierarchy of Planning
Scope of Planning
Modes of Planning
Tools for Planning
Proactive vs. Reactive planning
LESSON 3
B. BUDGETING
Budgeting process
Fiscal Planning
Types of budget
Costing out of nursing services
Cost effectiveness
Health care financing
Resource Management
ABC Inventory
Time Management
Maximizing personal time
Maximizing managerial time
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 9
Maximizing organization time
LESSON 4
C. ORGANIZING
Organizational theories
Types of Organizational Structure, Hierarchy, Models
Organizational chart
Organizing patient care
Job design
Job description
LESSON 5
D. STAFFING
Recruitment, Selection, Placement
Scheduling
Predicting Staffing needs
Skill mix
LESSON 6
STAFF DEVELOPMENT
Continuing Professional Development
MODULE 2
LESSON 1
DIRECTING
Tools in directing
Elements of directing
Leading community health programs
Shared governance
Power and Politics
DELEGATION
Effective delegation
LESSON 2
MOTIVATION INTRINSIC AND EXTRINSIC MOTIVATION
Theories of motivation
LESSON 3
COMMUNICATION
Communication process
Channels of communication
Communication systems
Barriers to communication
Communication skills
Organizational, interpersonal and group communication
Organizational communication strategies
Improving communication
Nursing Informatics
LESSON 4
DECISION MAKING PROCESS / CHANGE AND CONFLICT
Decision making tools and theories
Change Process
Handling resistance to change
Planned change
Conflict management
Types of conflict
Managing conflict
Work-related stress
Enhancing self-esteem
MODULE 3
LESSON 1
CONTINUOUS QUALITY IMPROVEMENT AND RISK MANAGEMENT
Creating a patient safety culture
Standards of Nursing Practice
Quality Assurance/Quality improvement
Variance report/sentinel events
Accreditation
JCAHO/JCIA, Phil Health, Hospital Accreditation Commission
Nursing Audit
Other CHED quality assurance initiatives
LESSON 2
A. ETHICO-MORAL RESPONSIBILITY
1. Review
1.1 basic ethical principles
1.2 Code of ethics for nurses
LESSON 3
B. LEGAL RESPONSIBILITIES
1. Nursing legislation
1.1 Phil Nursing Law
1.2 Health related laws affecting nursing and health
1.3 Labor laws
Work contracts
Collective bargaining
Nurses and labor unions
1.4 Legal issues in nursing practice
1.1 Breach of contract
1.2 Negligence
1.3 Professional negligence/malpractice
1.4 Wills
1.5 Crimes related to nursing practice
1.6 Nurses and evidence
1.7 Privileged communication
1.8 Nurses as witness
LESSON 4
C. PERSONAL AND PROFESSIONAL RESPONSIBILITIES
1. Nursing as a profession
Professional Decorum
2. Roles and responsibilities of a beginning nurse practitioner
3. Career development
Job Search/job leads
Preparing for an interview
Developing a professional portfolio
4. Emerging opportunities
Fields of specialization
Expanded roles of nurses
Issues and trends in nursing
5. Nursing Associations:
Accredited Professional nursing organization: PNA
Specialty organizations
Interest groups
LESSON 5
PROFESSIONAL ADVOCACY
REFENRENCES REFERENCES:
TEXTBOOK:
T1 - American Psychological Association (2010). Publication manual of
the American Psychological Association. (6th ed.). Washington, D.C: APA.
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 12
ISBN-13: 978-1433805615
T2 - Hook, L. (2018) Leddy & Pepper's Professional Nursing. (9th ed.).
New York: Wolters Kluwer. ISBN:978-1496351364
T3 -Huston, C. (2017, LWW) Leadership Roles and Management
Function in Nursing_Theory and Application -libgen.lc.pdf
T4 - Korniewicz, D.(2015) Nursing Leadership and Management. The
Advanced Practice Role. DesTech Publications.USA.ISBN:978-1-60595-158-
4
T4 - Marquiz, B. & Huston, C. (2017) Leadership Roles and
Management Functions in Nursing.Theory and Application.Wolter
Kluwer.Philadelphia.9th ed. ISBN 9781496349798
T5 - Murray, E. (2017) Nursing Leadership and Management for
Patient Safety and Quality Care.F.A.Davis Company.Philadelphia.ISBN
9780803630215
T6 - Potter, P., Stockert, P., Perry, A. G., Hall, A. (2017) Fundamentals
of Nursing 9th Ed.Elsevier.Singapore ISBN: 978-9-8145-7095-4
OTHER REFERENCES:
R1 – Copy of VMGO
R2 - Academy of Management Journal 2018, Vol. 61, No. 4, 1467–
1491. https://doi.org/10.5465/amj.2016.0662 TO DELEGATE OR NOT TO
DELEGATE: GENDER DIFFERENCES IN AFFECTIVE ASSOCIATIONS
AND BEHAVIORAL RESPONSES TO DELEGATION MODUPE AKINOLA
Columbia University ASHLEY E. MARTIN Stanford University KATHERINE
W. PHILLIPS Columbia University
R3 - American Sentinel, “Nurse Management vs Nurse Leadership:
What’s the Difference?” February 29,
2020: https://www.americansentinel.edu/blog/2020/02/29/leadership-
management-in-nursing-whats-the-difference/
ONLINE REFERENCES:
OR1 –https://www.slideshare.net/jofred/nursing-leadership-
management-54826140
OR2 - https://www.toppr.com/guides/business-management-and-
entrepreneurship/nature-of-management-and-its-process/managerial-roles/
OR3- https://online.maryville.edu/blog/leadership-roles-and-
management-functions-in-nursing/
OR4 - https://www.iedunote.com/management
OR5 - https://www.usa.edu/blog/nursing-leadership-and-management/
FILMS/ videos:
F1 - https://www.youtube.com/watch?v=V2K4VqkfRaM&t=918s
F2 - https://www.youtube.com/watch?
v=NzBqJNh8z2U&list=TLPQMjUwODIwMjGfsZ-rOmrYOg&index=7
1. Active class participation (online discussion board, FB Closed group
account)
Course 2. Submit all activities required
Requirements 3. Quizzes
4. Final Output
5. Examinations
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 13
Prepared by: MAGDALENA G. PATIGAS, RN, LPT, MAN
Reviewed and Approved by:
College of Science and Technology under its Learning Continuity Plan on Flexible
Teaching-Learning modalities.
part of this module is not authorized without the permission from the faculty-author
LESSON
1 DIRECTING
4
HOURS
. how we feel about and enjoy our work is crucial to how we perceive the quality of our
lives.
—Jo Manion
. . . whether you think you can or whether you think you can’t, you’re right.
—Henry Ford
3. Delineate how the work of manager motivates the working contribution within the organization.
Directing.
Directing sets in motion the action of people because planning, organizing, and staffing are the
mere preparations for doing the work.
Act of issuing of orders, assignments, instructions, to accomplish organizational goals and
objectives.
Direction is an aspect of management that deals directly with influencing, guiding, supervising,
and motivating staff for the achievement of organizational goals.
A director of nursing, otherwise known as a nurse director, is a registered nurse who leads the
administrative work of an organization in the health sector. Nurses in this field combine their clinical
experience, education, and managerial skills to ensure the smooth running of a health care
organization.
https://bestaccreditedcolleges.org/articles/how-to-become-a-nursing-director-education-and-
career-roadmap.html
Elements of Directing
1. Communication
2. Delegation
3. Motivation. Whatever influences our choices and creates direction, intensity, and persistence in our
behavior. To inspire, stimulate, and encourage staff.
4. Coordination. Arranging in proper order. It creates harmony in all activities to facilitate success of
work
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 18
5. Evaluation
6. Supervision: To oversee the work of staff. Supervision is the act of coaching, reflecting, and directing
work and workers.
7. Leadership: To guide and influence the work of staff in a purposeful direction.
Delegation
Act of assigning to someone else a portion of the work to be done with corresponding authority,
responsibility and accountability (ARA).
According to ANA, it is the transfer of responsibilities for the performance of the task from one
person to another
Much of the work of manager is accomplished by transferring the responsibilities to subordinates
1. Manager delegate routine task so that they are free to handle problems that are more complex or
require higher level of expertise
2. Delegate routine task if someone else is better prepared or has greater expertise or knowledge in
solving the problems
Underdelegating – systems from the manager’s false assumptions that delegation maybe
interpreted as a lack of ability on his part to do the job correctly and competently. Reasons are:
o Managers believe that they can do the work faster and better
o Managers believe that the responsibility may be rejected if delegated
Overdelegating – subordinates become overburdened which may lead to dissatisfaction and low
productivity. Reasons are:
o Managers who are lazy
o Manager who are overburdened and exhausted
Improper Delegation – delegating at the wrong person, time, tasks and beyond the capability of the
subordinates.
1. Plan ahead
2. Identify necessary skills and levels
3. Select most capable personnel
4. Communicate goal clearly
5. Empower the delegate
6. Set deadlines and monitor progress
7. Model the role and provide guidance
8. Evaluate performance
Interview a Nurse Leader. Submit your work through our goggle classroom.
Guide question will be provided; you may add pertinent information related to the topic.
Position:
Affiliating Agency:
5
HOURS
Motivation is the force within the individual that influences or directs behavior. Because motivation comes
from within the person, managers cannot directly motivate subordinates. The leader can, however, create an
environment that maximizes the development of human potential. Management support, collegial influence,
and the interaction of personalities in the work group can have a synergistic effect on motivation. The leader
manager must identify those components and strengthen them in hopes of maximizing motivation at the unit
level.
3. recognize the need to create a work environment in which both organizational and individual needs
can be met
5. describe the links between risk taking, innovation, creativity, and employee empowerment
6. recognize the complexity of using incentives and rewards so that they motivate rather than
demotivate
10. describe the constraints managers face in creating a climate that will motivate employees
12. describe the advantages and disadvantages of promoting from within an organization versus
recruiting externally for advancement opportunities
13. develop increased self-awareness about personal motivation and the need for “self-care” to remain
motivated in a leadership or management role
Class sharing. Think back when you were a child. What rewards did your parents use to promote good
behavior? Was your behavior more intrinsically or extrinsically motivated?
Motivation is the force within the individual that influences or directs behavior.
The term used to describe an employee’s emotional commitment to the organization and its goals is
employee engagement.
“This emotional commitment means engaged employees actually care about their work and their
company. They don’t work just for a paycheck, or just for the next promotion, but work on behalf of
the organization’s goals” (Kruse, 2012, para. 3). Custom Insight (2016) agrees, suggesting that
employee engagement is the extent to which employees feel passionate about their jobs, are
committed to the organization, and put discretionary effort into their work.
Intrinsic motivation comes from within the person, driving him or her to be productive
Extrinsic motivation occurs when individuals are motivated to perform a behavior or engage in an
activity to earn a reward or avoid punishment (Cherry, 2016b).
Theories of motivation
Motivational Theory
Maslow
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 24
Maslow (1970) believed that people are motivated to satisfy certain needs, ranging from basic survival to
complex psychological needs, and that people seek a higher need only when the lower needs have
been predominantly met.
Strategies in motivation
Video related to: How to Motivate People, Transform Business, and Be a True Leader
https://www.youtube.com/watch?v=V2K4VqkfRaM&t=918s (54:05)
Employee engagement is not the same thing as employee satisfaction. Engaged employees
are emotionally committed to the organization and the achievement of its goals. Employee
satisfaction only indicates how happy or content employees are (Custom Insight, 2016, Huston, 2017).
Video: This Is Why You Don't Succeed - Simon Sinek on The Millennial Generation (35:05)
https://www.youtube.com/watch?v=NzBqJNh8z2U&list=TLPQMjUwODIwMjGfsZ-rOmrYOg&index=7
Leadership Roles
2. Identifies the individual and collective value system of the unit and implements a reward system
that is consistent with those values
3. Fosters employee engagement and thus emotional commitment to the goals of the organization
4. Listens attentively to individual and collective work values and attitudes to identify unmet needs
that
8. Devotes time and energy to create an environment that is supportive and encouraging to the
discouraged individual
10. Develops a unit philosophy that recognizes the unique worth of each employee and promotes
reward systems that make each employee feel successful
11. Demonstrates through actions and words a belief in subordinates that they desire to meet
organizational goals
12. Is self-aware regarding own enthusiasm for work and takes steps to remotivate self as necessary
Management Functions
6. Creates the tension necessary to maintain productivity while encouraging subordinate job
satisfaction
8. Demonstrates and communicates sincere respect, concern, trust, and a sense of belonging to
subordinates
9. Assigns work duties commensurate with employee abilities and past performance to foster a sense of
accomplishment in subordinates
10. Identifies achievement, affiliation, or power needs of subordinates and develops appropriate
Self-actualized people:
6. Have purpose
9. Share deep relationships with a few but also feel identification and affection towards the entire human
race
Because of Maslow’s work, managers began to realize that people are complex beings, and rather than just
being motivated by economics, their many needs motivating them at any one time.
Video related to: Abraham Maslow and the Hierarchy of Needs - Content Model of Motivation
https://www.youtube.com/watch?v=gz5zNx3KnrE (9:16)
Skinner
B. F. Skinner was another theorist in this era who contributed to the understanding of motivation,
modification demonstrated that people could be conditioned to behave in a certain way based on a
consistent reward or punishment system.
Skinner called those elements that encourage behavior reinforcers, and those responses that
decrease the likelihood of behavior punishers (McLeod, 2015).
Environmental influences that neither encouraged nor discouraged behavior were known as
neutral operants (McLeod, 2015)
Neutral Operants: Responses from the environment that neither increase nor decrease the probability
of a behavior being repeated
Reinforcers: Responses from the environment that increase the probability of a behavior being
repeated. Reinforcers can be either positive or negative.
Punishers: Responses from the environment that decrease the likelihood of a behavior being repeated.
Video related to: BF Skinner: Operant Conditioning: Rewards & Punishments - EXPLAINED in 4
minutes
https://www.youtube.com/watch?v=m4BX6QxE-6c
Skinner’s Operant Conditioning: Rewards & Punishments
Herzberg
Frederick Herzberg (1987) believed that employees can be motivated by the work itself and that there
is an internal or personal need to meet organizational goals. He believed that separating personal
motivators from job dissatisfiers was possible. This distinction between hygiene or maintenance factors
and motivator factors was called the motivation–hygiene theory or two-factor theory.
https://www.youtube.com/watch?v=f_qyDfZYfXQ&t=44s (8:54)
Video related to: Frederick Herzberg and the Two-factor Theory - Content Models of Motivation
https://www.youtube.com/watch?v=f_qyDfZYfXQ
Motivation is not the opposite of de-motivation. That's the conclusion that Frederick Herzberg came
to. Rather, he recognized there are two sets of factors: 1. Motivators, and 2. Hygiene factors I this
video, we'll examine Frederick Herzberg's Two-factor Theory. t is one of the most important models
in the psychology of motivation. So, it's a vital model for every manager to know about and
understand.
1. Hygiene factors. These are factors that do not motivate us. But the absence of hygiene factors
will de-motivate us. Hygiene factors tend to be external to the work we do:
- Policies
- Administration
- Salary
- Supervision
- Working conditions
- status
2. Motivators are things we do celebrate. When our employer or manager offers these, they motivate
us. Motivators tend to be intrinsic in our relationship with our work: - Achievement - Recognition -
Good work - Responsibility - Advancement - Growth
Herzberg also identified what he called 'KITA' factors - KITA standing for 'Kick-in-the-ass'
Vroom
2. operant conditioning, which focuses on observable behaviors, the expectancy model says
that a person’s expectations about his or her environment or a certain event will influence
behavior.
In other words, people look at all actions as having a cause and effect; the effect may be
immediate or delayed, but a reward inherent in the behavior exists to motivate risk taking.
Managers using the expectancy model must become personally involved with their employees
to understand better the employees’ values, reward systems, strengths, and willingness to take
risks.
Video related to: Victor Vroom and Expectancy Theory: Process of Model of Motivation
https://www.youtube.com/watch?v=WDgF7Avijlc (7:40)
Victor Vroom offers us a powerful process model of motivation: expectancy Theory. It's less well-
known than it should be. Expectancy Theory won't tell you what motivates people. B ut it will tell you
why motivation sometimes works, and why it sometimes fails.
McClelland
David McClelland (1971) examined what motives guide a person to action, stating that people are motivated
1. Achievement-oriented people actively focus on improving what is; they transform ideas into action, judiciously
and wisely, taking risks when necessary.
2. affiliation-oriented people focus their energies on families and friends; their overt productivity is less
because they view their contribution to society in a different light from those who are achievement oriented.
*Research shows that women generally have greater affiliation needs than men and that nurses generally
have high affiliation needs.
3. Power-oriented people are motivated by the power that can be gained as a result of a specific action.
*McClelland theorizes that managers can identify achievement, affiliation, or power needs of their
employees and develop appropriate motivational strategies to meet those needs.
Video related to: David McClelland and Three Motivational Needs - Content Theories of
Motivation
https://www.youtube.com/watch?v=jxNhGE3gPcA (8:12)
For my money, David McClelland gave us one of the most useful models of motivation, for use
in the workplace. McClelland identified three motivational needs. Each of these allows us to
motivate different people to do the same task, by appealing to the need that they feel most
strongly.
Gellerman
Saul Gellerman (1968)
Methods to motivate:
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 29
stretching, involves assigning tasks that are more difficult than what the person is used to doing.
This includes personal and professional development in areas of vocational knowledge, skills, and
expertise.
In addition, unleashing their imagination, ingenuity, and creativity often results in their contributions to
the
Employee engagement is not the same thing as employee satisfaction. Engaged employees
are emotionally committed to the organization and the achievement of its goals. Employee
satisfaction only indicates how happy or content employees are (Custom Insight, 2016).
8.1
Have you been told by someone that she/ he had been inspired by you?
Review your use of KITA factors. What can you do to reduce negative KITAs and increase your
use of positive KITAs?
3 COMMUNICATION
4
HOURS
. . . the difference between the right word and the almost right word is the difference
between lightning and a lightning bug.
—Mark Twain
https://books.google.com.ph/books?
hl=en&lr=&id=SwndCwAAQBAJ&oi=fnd&pg=PP1&dq=communication+in+nursing&ots=Y_po44yguw&si
g=jSWc5kuMSQSUjfiiLNtbzcGAtyA&redir_esc=y#v=onepage&q=communication%20in
%20nursing&f=false
Learning objectives
1. Define Communication
2. Describe the five components of the communication process.
3. Analyze factors influencing the communication process.
4. Discuss the types of communication and their characteristics.
5. Differentiate between therapeutic and nontherapeutic communication.
6. Identify barriers to effective communication.
7. Differentiate between nursing documentation and other forms of written communication.
8. Discuss technology as a form of communication.
Barriers in Communication
1. Physical Barriers
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 33
Environmental factors that prevent or reduce the opportunities for communication. Ex:
Distance and Noise
2. Social and Psychological Barriers
Blocks or inhibitors of communication that rise from the judgment, emotions, social
values of people.Ex: stress, trust, fear, defensiveness
Internal climate (values, feelings, temperament and stress levels) and external climate
(weather, timing, temperature, lack of validation to the message).
3. Semantics
Words, figures, symbols, penmanship and interpretation of the message through signs
and symbols.
4. Interpretations
Defects in communication skills by verbalizing, listening, writing, reading and telephony
Leadership Roles
1. Understands and appropriately uses both the formal and informal communication network
in the organization
2. Communicates clearly and precisely in language that others will understand
3. Is sensitive to the internal and external climate of the sender or receiver and uses that
awareness in sending and interpreting messages
4. Observes and interprets appropriately the verbal and nonverbal communication of
followers
5. Role models assertive communication and active listening
6. Demonstrates congruency in verbal and nonverbal communication
7. Recognizes status, power, and authority as barriers to manager–subordinate
communication and uses communication strategies to overcome those barriers
8. Role models the use of social networking principles that promote collaboration, shared
decision making, and evidence-based practice, while protecting patient rights and
confidentiality
9. Seeks a balance between technological communication options and the need for human
touch; caring; and one-on-one, face-to-face interaction
10. Maximizes group functioning by keeping group members on course, encouraging the shy,
controlling the garrulous, and protecting the weak
Management Functions
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 34
1. Understands and appropriately uses the organization’s formal communication network
2. Determines the appropriate communication mode or combination of modes for optimal
distribution of information in the organizational hierarchy
3. Prepares written communications that are clear and uses language that is appropriate for
the message and the receiver
4. Consults with other departments or disciplines in coordinating overlapping roles and group
efforts
5. Differentiates between “information” and “communication” and appropriately assesses the
need for subordinates to have both
6. Prioritizes and protects client and subordinate confidentiality
7. Ensures that staff and self are trained to appropriately and fully utilize technological
communication tools
8. Establishes a technology-enabled communication infrastructure that leverages the benefits
of social media while minimizing the risks
9. Uses knowledge of group dynamics for attaining goals and maximizing organizational
communication.
Communication begins the moment that two or more people become aware of each other’s
presence.
In all communication, there is at least one sender, one receiver, and one message. There is
also a mode or medium through which the message is sent—for example, spoken, written,
or nonverbal.
The internal climate includes the values feelings, temperament, and stress levels of the
sender and the receiver.
The external climate also includes status, power, and authority as barriers to manager–
subordinate communication. Weather conditions, temperatures timing, and the
organizational climate itself are parts of the external climate.
Differences in gender, power, and status significantly affect the types and quality of
organizational and unit-level communication.
Channels of Communication
Because large organizations are so complex, communication channels used by the manager
may be upward, downward, horizontal, diagonal, or through the “grapevine.”
In diagonal communication, the manager interacts with personnel and managers of other
departments and groups such as physicians, who are not on the same level of the
organizational hierarchy. Although these people have no formal authority over the manager,
this communication is vital to the organization’s functioning. Diagonal communication tends to
be less formal than other types of communication.
The most informal communication network is often called the grapevine. Grapevine
communication flows quickly and haphazardly among people at all hierarchical levels and
usually involves three or four people at a time.
*Senders have little accountability for the message, and often, the message becomes
distorted as it speeds along. Given the frequency of grapevine communication in all
organizations, all managers must attempt to better understand how the grapevine works in
their own organization as well as who is contributing to it.
Grapevine communication is subject to error and distortion because of the speed at which it
passes and because the sender has little formal accountability for the message.
Silence
Silence can also be used as a means of nonverbal communication. This supports the old adage
that even silence can be deafening.
The following section identifies other nonverbal clues that can occur with or without
verbal communication.
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 38
Space
The study of how space and territory affect communication is called proxemics (Cherry,
2016).
All of us have an invisible zone of psychological comfort that acts as a buffer against
unwanted touching and attacks. The degree of space we require depends on who we are
talking to as well as the situation we are in. It also varies according to cultural norms.
Some cultures require greater space between the sender and the receiver than others. In
the United States, between 6 and 18 inches of space is typically considered appropriate
only for intimate relationships, between 18 inches and 4 feet is appropriate for personal
interactions, between 4 and 12 feet is common for social exchanges, and more than 12 feet
is a public distance (Cherry, 2016).
Environment
The area where communication takes place is an important part of the communication
process.
Communication that takes place in a superior’s office is generally taken more seriously than
that which occurs in the cafeteria.
Appearance
Much is communicated by our clothing, hairstyle, use of cosmetics, and attractiveness. Care
should be exercised, however, to be sure that organizational policies regarding desired
appearance are both culturally and gender sensitive.
Eye Contact
Unfortunately, eye contact over the last 10 to 15 years has plummeted as a result of
individuals looking down at their smart devices when they are supposedly communicating
with other people (Decker, 2013) says, “If you don’t have eye communication, you flat out
don’t have communication” (para. 2). That is because this nonverbal clue is associated
with sincerity.
Posture
Posture and the way that you control the other parts of your body are also extremely
important as part of nonverbal communication. For example, Cherry (2016) suggests that
sitting up straight may indicate that a person is focused and paying attention to what’s
going on.
Sitting with the body hunched forward, on the other hand, can imply that the person is
bored or indifferent. Crossing arms across one’s chest may suggest defensiveness or
aggressiveness. Moreover, the weight of a message is increased if the sender faces the
receiver; stands or sits appropriately close; and, with head erect, leans toward the receiver.
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 39
Gestures
A message accented with appropriate gestures takes on added emphasis. Too much
gesturing can, however, be distracting. For example, hand movement can emphasize or
detract from the message. Gestures also have a cultural meaning. Some cultures are more
tactile than others. Indeed, the use of touch is one gesture that often sends messages that
are misinterpreted by receivers from different cultures.
Vocal Expression
Vocal expression isn’t just about the tone of your voice; it combines a number of things.
Vocal expression is about how you deliver your message with words and how you express
those words. When have good vocal expression, you can convey emotion and character to
your audience simply by your pitch, your pronunciation, and the speed at which you speak.
Your voice has its own personality, and it’s influenced by your natural pitch. It’s the reason
some people sound powerful or articulate and others sound brash or squeaky. Some
people have a wide pitch range, which allows them to be incredibly expressive. Others have
a very small range, which leads them to be monotonous. When you understand your
natural pitch range, you can work with it and use it to your advantage when you’re
speaking.
Your tone is what you use to carry emotion in your voice. Think about how your tone
changes when you are happy, angry, sad, or surprised. Tone plays a big role in vocal
expression, and it’s limited only by your natural pitch.
Here are some things you can start doing today to improve your vocal expression:
Practice breathing techniques. Breathe from deep within your diaphragm, not just from
your lungs. Place your dominant hand on your stomach and notice where it moves in and
out. That’s your diaphragm. When you breathe from it, your tone improves because you are
taking in and expelling more oxygen.
Practice speaking slower. It’s common for people to speak faster when they’re nervous.
If you think you’re speaking slow enough, record yourself using a recorder or your phone
and you’ll most likely see that you are speaking too quickly to be understood clearly.
Practice taking a pause. This goes along with speaking slower. If you have a hard time
slowing your speaking pace down, take deliberate pauses throughout your presentation and
force yourself to slow down.
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 40
Practice working your pitch range. You know how high and low your voice can go. How
can you use that range to make your presentation for expressive and interesting?
Reflect. Reflect the speaker’s message back to him or her. Focus on the affective components
of the aggressor’s message. This helps the aggressor to evaluate whether the intensity of his
or her feelings is appropriate to the specific situation or event.
Repeat the assertive message. Repeated assertions focus on the message’s objective content.
They are especially effective when the aggressor overgeneralizes or seems fixated on a
repetitive line of thinking.
Point out the implicit assumptions. This involves listening closely and letting the aggressor
know that you have heard him or her. In these situations, managers might repeat major points
or identify key assumptions to show that they are following the employee’s line of reasoning.
Question. When the aggressor uses nonverbal clues to be aggressive, the assertive person can
put this behavior in the form of a question as an effective means of helping the other person
become aware of an unwarranted reaction.
SBAR and ISBAR (adds identification as first step) are strategies that have been developed
to address this problem.
SBAR, first used in the Navy to standardize important and urgent communication in nuclear
submarines and further developed by Kaiser Permanente, is an easy-to-remember tool that
provides a structured, orderly approach in providing accurate, relevant information in
emergent patient situations as well as routine handoffs
Handoffs (verbal exchange of information, which occurs between two or more health-care
providers about a patient’s condition, treatment plan, care needs, etc.) typically occur both
at change of shift and when patients are transferred to different units.
Perkins and Brizee (2013) suggest that business memos should be composed of the
following components:
Header (includes the to, from, date, and subject lines): one eighth of the memo
Source: American Nurses Association. (2011). Principles for social networking and the nurse.
Silver Spring, MD: Author; National Council of
State Boards of Nursing. (2011). White paper: A nurses’ guide to the use of social media.
Chicago, IL: Author. Retrieved June 16, 2013, from
http://www.nursingworld.org/FunctionalMenuCategories/AboutANA/Social-Media/Social-
Networking-Principles-Toolkit/6-Tips-for-Nurses-
Using-Social-Media-Poster.pdf
Prepare a short video (of a minimum 3 minutes-5 MINUTES) performing the handoffs of your
cared patient. Submit through our goggle classroom. (50 points as additional for your quiz)
5
HOURS
Change and conflict are ever present in health care today, thanks to constantly evolving
technology, new regulations, changing public expectations, increasing environmental concerns,
and heavy demand on scarce resources. In turn, nurses must be knowledgeable about the change
process and understand that conflict can result when the process is ineffective. In the dynamic
environment of health care, change is inevitable and unpredictable, and it affects staff, patients,
and the organization overall. Historian and critical feminist Joan Wallach Scott states, “Those who
expect moments of change to be comfortable and free of conflict have not learned their history”
(Quote Garden, 2016). Change in the work environment can create uncertainty and elicit
emotional responses from employees (Bowers, 2011; Murray; 2017)
In this lesson, traditional and emerging change theories and models are discussed. In
addition, guidelines for managing change and innovation and conflict are covered. Knowledge,
skills, and attitudes related to the following core competencies are included in this lesson: patient-
centered care and teamwork and collaboration.
CHANGE THEORIES
Change is a dynamic process that results in altering or making something different. Change can
be planned or unplanned.
1. Planned change is purposeful, calculated, a collaborative, and it includes the deliberate
application of change theories (Mitchell 2013; Roussel, 2013; Murray, 2017). Change that is purposeful
and planned is usually well receive by staff.
2. unplanned change occurs when the need for change is sudden an necessary to manage a crisis.
Unplanned change can cause anxiety and stress among staff members.
Successful nurse leaders and managers manage unplanned change “through effective
communication, adaptability, coordination, and the ability to remain grounded” (Erickson, 2014;
Murray, 2017).
Highly effective nurse leaders and managers develop high-functioning, empowered teams whose
members know what is expected, remain calm during crisis, and do what is right for the patients
(Erickson, 2014; Murray, 2017).
Closely related to and frequently an integral part of change is innovation, the process of creating
something new after thoughtful analysis of a phenomenon or situation.
Planned change is best carried out using a theoretical framework or model (Mitchell, 2013;
Shirey, 2013; Murray, 2017).
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 48
The situation at hand and the type of change being implemented help determine the appropriate
theory or framework to apply, lead, and manage the process, and this approach can result in a
sustainable change (Shirey, 2013; Murray, 2017)
There are eight main change management models organizations turn to for
inspiration.
1. Lewin's change management model.
2. The McKinsey 7-S model.
3. Kotter's change management theory.
4. ADKAR change management model.
5. Nudge theory.
6. Bridges transition model.
7. Kübler-Ross change management framework.
The most common change theories and models used fall into two categories:
1. The unfreezing stage is the point at which it is determined that change is needed, and driving
and restraining forces are identified.
The change agent must create a sense of urgency to change, strengthen the driving
forces, and weaken the restraining forces for successful change.
During this stage, nurse leaders and managers can help prepare staff members for the
change by helping them recognize the need for change, building trust, and actively
engaging staff in the change process.
Motivation to change occurs in this stage.
3. The refreezing stage involves stabilizing the change and achieving equilibrium.
The innovation is incorporated into the routine.
The change becomes the new norm. In this stage, nurse leaders and managers should
reinforce the change through formal and informal processes including policies,
procedures, standards of care, and other common tools used throughout the
organization.
This stage is crucial to sustaining change over time.
The model follows these seven steps (Lippitt, Watson, & Wesley, 1958; Mensik, 2014
Mitchell, 2013):
1. Diagnosing the problem involves identifying the need for the change and recruiting
others to assist with data collection.
Effective communication is critical in the first phase to avoid miscommunication through
the grapevine. Nurse leader and managers can spearhead drafting a plan for change at this
time.
2. Assessing the motivation and capacity for change is actually assessing the unit or
organization for readiness to change.
Nurse leaders and managers must communicate with those affected by the change,
respond to concerns, provide rationale for the change, and identify possible resistance to
the change.
3. Assessing the change agent’s motivation and resources must be done for successful
4. Selecting progressive change objectives involves clearly defining the change, establishing
realistic goals, and developing a plan for change.
Nurse leaders and managers actively assess their team and delegate appropriate
responsibilities during this phase of the process.
5. Choosing an appropriate role for the change agent and implementing the plan for
change comprise one of the final steps.
It is important that nurse leaders and managers remain flexible during this stage.
6. Maintaining the change after it has started and as it is being incorporated into
the unit or organization culture is critical.
Nurse leaders and managers monitor the stability of the change as it becomes part of the
system.
Communication and feedback are critical during this phase to avoid regressing to the
previous state.
7. Terminating the helping relationship once the process has stabilized occurs when
the change agent withdraws from the process and the change is evaluated.
Nurse leaders and managers continue monitoring and evaluating the change for
sustainability.
The role of the change agent is extremely important in Lippitt’s model.
Nurse leaders and managers most often function in the change agent role and are
responsible to drive “the innovation into everyday practice” (Mensik, 2014; Murray, 2017)
He describes eight stages of the change process that can help nurse leaders and
managers manage change cognitively as well as emotionally (Kotter, 1996; Murray, 2017):
2. Creating the guiding coalition means putting together a group with the necessary
power to lead the change and getting everyone to work together. Identifying
key staff members and empowering them to participate in the change process is
important for nurse leaders and managers during this stage.
3. Developing a vision and strategy means creating a vision to direct the change effort.
Nurse leaders and managers spend time during this stage making the vision
clear and understandable for everyone.
7. Consolidating gains and producing more change include using increased credibility
to change systems and processes that do not fit the vision. This stage also involves
hiring, promoting, and developing those who can implement the vision, as well
as reinvigorating the process with new projects and themes.
Nurse leaders and managers are seen in Kotter’s model as important during the
various phases of the process because of their keen communication skills, ability
to anchor the vision of the change, and skill in persuading staff members to embrace
the change (Salmela et al., 2013; Murray, 2017).
Chaos Theory
word chaos is derived from the Greek language and means “formless matter.” However,
even when a system may appear chaotic and disorderly, there is actually an underlying
complex order.
Chaos theory is nonlinear and unpredictable, and it explains why a small change in one
area can have a large effect across an organization. This is also known as the “butterfly
effect,” or the notion that the flapping of a butterfly’s wings in one part of the world can
have a major impact, such as a hurricane or tsunami, on the other side of the world
(Crowell, 2011; Mensik, 2014; Porter-O’Grady & Malloch, 2010; Murray, 2017).
Nurse leaders and managers must be aware of the complexity of health care, the unit,
and the organization. Further, they must understand that, because of multiple factors,
decisions made can result in changes that were unintended.
Learning organization theory was first described by Senge (1990), who suggested
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 55
that to excel, future organizations will need to “discover how to tap people’s commitment
and capacity to learn at all levels in an organization”. He called on
leaders to move away from traditional authoritarian “controlling organizations” to
learning organizations. In a learning organization, all staff members are involved in
problem-solving and implementing change and innovation, and this involvement
enables the organization to respond quickly to chaos.
Senge (1990) defined a learning organization as an “organization where people continually
expand their capacity to create the results they truly desire, where new and expansive
patterns of thinking are nurtured, where collective aspiration is set free, and where people
are continually learning how to learn together”.
Senge identified systems thinking, personal mastery, mental models, building shared vision,
and team learning as five disciplines that organizations need to adopt and practice to become
learning organizations.
The more learning that occurs, the more aware the members become of what they can still
learn.
In health care, adopting the five disciplines has the potential to result in high-quality and safe
patient care.
Nurse leaders and managers who help staff members see the larger system build an
understanding of complex problems. This understanding enables staff members to
develop long-term changes and work together to impact the whole system, rather
than pursuing symptomatic fixes to parts of the whole (Senge, Hamilton, & Kania, 2015). In
turn, change and innovation can be sustained over time.
2. Why: The why of change is a reasonable rationale for the change. A lack of
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 56
understanding for the reason for change can result in resistance and unsuccessful
implementation of the change and innovation. Given the complexity of health
care and the limited resources today, change and innovation should be evidence
based and linked to patient safety, quality health care, and improving the work
environment.
3. What: The what of change is the actual change or innovation being implemented.
Identifying what to change is determined after the rationale for the change is
clear. Change and innovation may involve revising or creating policies, processes,
procedures, and/or standards. Keep in mind that implementing the specific
change may require additional resources and technology as well as education
and competency development for staff.
4. When: The when of change is determining at what point to start the change
process and how long it will take to achieve the change. The timing for change
can be directed by the impetus behind the change. However, when to change is
best determined by those who will be most involved with or impacted by the
outcome of the change.
5. How: The how of change involves the techniques or processes needed for successful
and sustainable change.
Conflict
internal and external discord that results in from differences in ideas, values or feelings
between 2 or more people. It arises because of differences in economic and
professional values.
Is a state of disharmony among people and occurs when people have differing views.
Unmanaged conflict can result in decreased staff morale, increased turnover, poor-
quality patient care, increased health-care costs, and patient dissatisfaction (Losa
Iglesias & De Bengoa Vallejo, 2012; Murray, 2017).
Common factors that result in conflict can be related to personnel issues, work
environment, power struggles, differing value systems, and leadership and
management styles (Padrutt, 2010; Murray, 2017).
Nurse leaders and managers must strive to promote “ongoing evaluation and continuous
improvement of conflict resolution skills” (ANA, 2016, p. 49).
Nurse leaders and managers spend close to one-fourth of their time in conflict
management activities (Padrutt, 2010; Rundio & Wilson, 2013; Valentine, 2001).
Findings from one study suggest that interpersonal conflicts in the workplace should be
confronted directly, constructively, and together with those involved (Mahon & Nicotera,
2011).
Nurses in general are highly unlikely to confront conflict and respond by avoidance or
withdrawal (Mahon & Nicotera, 2011).
Poorly managed conflict can pose additional problems in the workplace such as job
dissatisfaction, depression, increased turnover, compromised patient safety, and
aggression.
Types of Conflict
1. Intrapersonal Conflict
Is an internal conflict, or a conflict coming from within a person.
2. Interpersonal Conflict
Occurs when there is a disagreement between or among two or more people.
The disagreement can be related to differing values, ethics, goals, beliefs, or priorities
Interpersonal conflict is very common in the workplace.
3. Intergroup Conflict. This level of conflict occurs between different groups within a larger
organization or those who do not have the same overarching goals.
4. Organizational Conflict
Organizational conflict can result when there is disagreement between staff and
organizational policies and procedures, standards, or changes being made.
1. The avoiding strategy involves withdrawing or hiding from the conflict. The strategy is not
always effective in resolving conflict and just postpones the conflict. Because the conflict is not
resolved, it may reappear again later.
2. Accommodating involves sacrificing one’s own needs or goals and trying to satisfy another’s
desires, needs, or goals. This strategy does not resolve conflict and may result in future
conflict.
3. Individuals who use the competing strategy pursue their own needs, desires, or goals at the
expense of others. The competitor wants to win and is not cooperative. This strategy is power
driven and can result in aggression
1. Mutual respect: Those involved in the conflict may need a reminder to be respectful and
focus on the issue and not the other person.
2. Needs versus wants: The nurse leader and manager must help those involved
differentiate between what they need and what they want.
3. Compassion and empathy: Those involved in the conflict may need assistance
understanding each other and hearing the other person’s position.
4. Staying in the “I”: The nurse leader and manager reminds those involved to focus
on “I” statements and avoid using “you” statements and avoid blaming.
A successful nurse leader and manager identifies conflict, works with those
involved to manage and/or resolve the issues, and moves on (Porter-O’Grady
& Malloch, 2013; Murray, 2017).
ADKAR
The ADKAR Model of change is a well-known and widely used tool that helps you analyze your
change and better understand it.
The word “ADKAR” is an acronym for the five outcomes an individual needs to achieve for
a change to be successful: Awareness, Desire, Knowledge, Ability and Reinforcement. This
powerful model is based on the understanding that organizational change can only happen when
individuals change.
To create awareness for why the change is needed, communicate the rationale from
different angles, preferably with personal stories. People don’t need another “bullet list”— they
prefer to listen to true stories about what challenges there are in the current state and what
could be achieved in the desired state.
Enabling open dialogue between people is important to have them reflect, ask questions,
and share their own examples and experiences. You can also conduct video interviews with
customers or employees to showcase various perspectives and make a strong case for the
change.
Social learning is key to spreading knowledge in your organization and create value. Don’t
just send people off to a course, but make sure you have the structure and tools in place for
them to implement new ideas.
While knowledge is about theory and understanding, ability is all about how you can get
things done.
What’s hindering people from contributing to the change? There are several reasons
people might feel unable to participate. By keeping your ear to the ground, you’ll be able to
identify and monitor potential barriers. Ask people how things are going, and what they’ve been
working on. You might discover they don’t know how to prioritize their tasks, or they can’t get in
touch with the right people. They might feel limited by their own personal skills, by time, or by
structures in your organization.
As a leader, encourage people to believe in themselves and their abilities. Give people
credit even if they fail, as they’ll learn from their mistakes. While it’s hard to discuss weaknesses
in the workplace, make it clear that there should be no shame in asking for help.
A major challenge with organizational development is making change stick. How can you
ensure things don’t go back to how they were before?
To sustain the change, keep talking about how things are progressing, celebrate
milestones, and share success stories. Continuously share messages and stories about the
change—whether it’s a video from a happy customer or a quotation from an employee—to
ensure people understand how the change is working, and what still needs to be done.
Encourage managers to follow up with employees in 1-on-1 meetings. Give people the
opportunity to talk about any obstacles that arise to ensure they can be addressed right away.
Even with these models in place, research shows it’s still incredibly difficult to succeed
with change. The ADKAR model tells you what you need for successful change management. But
you still need to know how to communicate the work to be done and effectively involve and
inspire people throughout the whole process.
Howspace is a digital platform that can help you put all these building blocks into action.
Participants can take an active role in the change process by using one central platform to share
their thoughts and collaborate.
https://www.howspace.com/resources/how-to-take-the-adkar-model-from-theory-to-
practice
Summary
Nurse leaders must be able to manage conflict and help facilitate conflict resolution. The
collaborative approach, pursuing a win-win, is an example of how looking at conflict as an
opportunity to strengthen relationships can lead to positive results. Implementing this approach
This document is a property of
NONESCOST
Unauthorized copying, uploading, and / or editing is prohibited. (For Classroom Use Only) Prepared by: Magdalena G. Patigas, RN, LPT, MAN
Module 2 | Page 63
properly should have the result of not only resolving the conflict at hand but doing so in a way
that benefits staff and the broader team environment.
https://www.aapacn.org/article/conflict-resolution-achieving-the-win-win/
Think about a recent experience that involved some type of change on your part.
1. What category of adopters do you fall under?
2. Do you believe you need improvement in how you respond to change?
3. List two or three strategies you can use to improve your response to change.