Hand-outs L& M 1 to 4
1. Leadership - The act of influencing and motivating a group of
people to act in the same direction towards achieving a
common goal.
2. Management - The process of leading and directing an
organization to meet its goals through the use of appropriate
resources.
LEADERSHIP MANAGEMENT:
 Do not have delegated authority but obtain their power
through other means, such as influence
 Legitimate source of power due to the delegated authority
 Focus on group process, information gathering, feedback,
and empowering others
 Emphasize control, decision making, decision analysis,
and results
 Have goals that may or may not reflect those of the
organization
 Greater formal responsibility and accountability for
rationality and control than leaders
3. Frederick W. Taylor “Father of Scientific Management”
4 Overriding Principles of Scientific Management:
1. Traditional “rule of thumb” means of organizing work
must be replaced with scientific methods.
2. A scientific personnel system must be established so
that workers can be hired, trained, and promoted based on
their technical competence and abilities.
3. Workers should be able to view how they “fit” into the
organization and how they contribute to overall
organizational productivity.
4. The relationship between managers and workers should
be cooperative and interdependent, and the work should
be shared equally.
4. Theory of Social and Economic Organization
Bureaucracy
• Need for legalized, formal authority and consistent
rules and regulations for personnel in different
positions
5. Henri Fayol (1925), first identified the management functions
of planning, organization, command, coordination, and
control.
6. Luther Gulick (1937) expanded on Fayol’s management
functions in his introduction of the “Seven Activities of
Management” - planning, organizing, staffing, directing,
coordinating, reporting, and budgeting.
7. Mary Parker Follett (1926) was one of the first theorists to
suggest participative decision making or participative
management.
 Managers should have authority with, rather than over,
employees.
8. Elton Mayo and his Harvard associates (1927-1932), look
at the relationship between light illumination in the factory and
productivity.
 Hawthorne effect indicated that people respond to the
fact that they are being studied, attempting to increase
whatever behavior.
9. Douglas McGregor (1960), X and Theory Y, posited that
managerial attitudes about employees can be directly
correlated with employee satisfaction.
 Theory Y managers believe that their workers enjoy their
work, are self-motivated, and are willing to work hard to
meet personal and organizational goals. Theory X
managers believe that their employees are basically lazy,
need constant supervision and direction, and are
indifferent to organizational needs.
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10. Chris Argyris (1964), managerial domination causes workers
to become discouraged and passive.
 If self-esteem and independence needs are not met,
employees will become discouraged and troublesome or
may leave the organization.
11. The Great Man Theory, from Aristotelian philosophy,
asserts that some people are born to lead, whereas others are
born to be led.
 Great leaders will arise when the situation demands it.
12. Trait Theories assume that some people have certain
characteristics or personality traits that make them better
leaders than others.
13. Democratic Leader exhibits the following behaviors:
 Less control is maintained.
 Economic and ego awards are used to motivate.
 Others are directed through suggestions and guidance.
 Communication flows up and down.
 Decision making involves others.
 Emphasis is on “we” rather than “I” and “you.”
 Criticism is constructive.
14. Authoritarian Leader characterized by the following
behaviors:
 Strong control is maintained over the work group.
 Others are motivated by coercion.
 Others are directed with commands.
 Communication flows downward.
 Decision making does not involve others.
 Emphasis is on difference in status (“I” and “you”).
 Criticism is punitive.
15. Laissez-faire Leader characterized by the following
behaviors:
 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.
16. Fiedler’s (1967), Contingency Approach, suggests that no
one leadership style is ideal for every situation.
 Interrelationships between the group’s leader and its
members were most influenced by the manager’s ability to
be a good leader.
17. Hersey and Blanchard (1977), developed a Situational
Approach to leadership.
 Tridimensional leadership effectiveness model
predicts which leadership style is most appropriate in each
situation on the basis of the level of the followers’ maturity.
 As people mature, leadership style becomes less task
focused and more relationship oriented.
18. Burns (2003), suggest that both leaders and followers have
the ability to raise each other to higher levels of motivation and
morality. There are 2 primary types of leaders in
management:
 The traditional manager, concerned with the day-to-day
operations, was termed a transactional leader.
 The manager who is committed, has a vision, and is able
to empower others with this vision was termed a
transformational leader.
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19. Transactional Leader:  The manager who is knowledgeable about the wise use of
 Identifies common values authority, power, and political strategy is more effective at
 Is a caretaker meeting personal, unit, and organizational goals.
 Inspires others with vision a. Reward power is obtained by the ability to grant favors or
 Has long-term vision reward others with whatever they value.
 Looks at effects b. Punishment or coercive power is based on fear of
 Empower others punishment if manager’s expectations are not met.
20. Transformational Leader: c. Legitimate power is the power gained by a title or official
 Focuses on management tasks position within an organization.
 Is committed d. Expert power is gained through knowledge, expertise, or
experience.
 Uses trade-offs to meet goals
e. Referent power is power that a person has because
 Does not identify shared values
others identify with that leader or with what that leader
 Examines causes
symbolizes.
 Uses contingency reward
f. Charismatic power is distinguished by some from
21. Kouze’s and Posner’s 5 Practices for Exemplary
referent power.
Leadership:
g. Informational power is obtained when people have
 Model the Way
information that others must have to accomplish their
 Inspire a Shared Vision goals.
 Challenge the Process 24. MODES OF PLANNING DESCRIPTION:
 Enabling Others to Act a. Reactive occurs after a problem exists
 Encourage the Heart b. Inactivism seek the status quo
22. Gardner (1990) asserted that integrated leader-managers c. Preactivism utilize technology to accelerate change and
possess six distinguishing traits: are future oriented
 Influence others beyond their own group d. Interactive or Proactive attempt to plan the future of their
 Emphasize vision, values, and motivation organization rather than react to it
 Think longer term e. Forecasting involves trying to estimate how a condition
 Look outward, toward the larger organization will be in the future.
 Politically astute • Takes advantage of input from others, gives
 Think in terms of change and renewal sequence in activity, and protects an organization
23. Power is defined as the capacity to act or the strength and against undesirable changes.
potency to accomplish something.
 Hand-outs L& M 1 to 4
• Strategic planning examines an organization’s
purpose, mission, philosophy, and goals in the
context of its external environment.
• Complex organizational plans that involve a long
period (usually 3 to 10 years) are referred to as
long-range or strategic plans.
25. SWOT Analysis, also known as TOWS Analysis, was
developed by Albert Humphrey at Stanford University in
the 1960s and 1970s. SWOT definitions:
 Strengths are those internal attributes that help an
organization to achieve its objectives.
 Weaknesses are those internal attributes that challenge
an organization in achieving its objectives.
 Opportunities are external conditions that promote
achievement of organizational objectives.
 Threats are external conditions that challenge or threaten
the achievement of organizational objectives.
26. Vision statements are used to describe future goals or aims
of an organization.
 It conjures up a picture for all group members of what they
want to accomplish together.
 An organization will never be greater than the vision that
guides it.
27. The mission statement is a brief statement identifying the
reason that an organization exists.
 It identifies the organization’s constituency and addresses
its position regarding ethics, principles, and standards of
practice.
28. The philosophy flows from the purpose or mission statement
and delineates the set of values and beliefs that guide all
actions of the organization.
 It is the basic foundation that directs all further planning
toward that mission.
 The organizational philosophy provides the basis for
developing nursing philosophies at the unit level and for
nursing service as a whole.
29. Goals and objectives are the ends toward which the
organization is working.
 Objectives are similar to goals in that they motivate people
to a specific end and are explicit, measurable,
observable or retrievable, and obtainable.
30. Policies are plans reduced to statements or instructions that
direct organizations in their decision making.
 These explain how goals will be met and guide the general
course and scope of organizational activities.
Policies also can be implied or expressed:
 Implied policies, neither written nor expressed verbally,
have usually developed over time and follow a precedent.
For example, a hospital may have an implied policy that
employees should be encouraged and supported in their
activity in community, regional, and national health-care
organizations.
 Expressed policies are delineated verbally or in writing.
Expressed policies may include a formal dress code,
policy for sick leave or vacation time, and disciplinary
procedures.
31. Procedures are plans that establish customary or acceptable
ways of accomplishing a specific task and delineate a sequence
of steps of required action.
 Identify the process or steps needed to implement a policy
and are generally found in manuals at the unit level of the
organization.
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32. Rules and regulations are plans that define specific action
or non-action.
 Existing rules should be enforced to keep morale from
breaking down and to allow organizational structure.
33. Kurt Lewin (1951) identified three phases through which the
change agent must proceed before a planned change becomes
part of the system:
 Unfreezing occurs when the change agent convinces
members of the group to change or when guilt, anxiety, or
concern can be elicited.
 Movement, the change agent identifies, plans, and
implements appropriate strategies, ensuring that driving
forces exceed restraining forces.
 Refreezing phase, the change agent assists in stabilizing
the system change so that it becomes integrated into the
status quo.
Stages of change and responsibilities of the change
agent:
 STAGE 1—UNFREEZING
1. Gather data.
2. Accurately diagnose the problem.
3. Decide if change is needed.
4. Make others aware of the need for change; do not proceed
until the status quo has been disrupted and the need for
change is perceived by the others.
 STAGE 2—MOVEMENT
1. Develop a plan.
2. Set goals and objectives.
3. Identify areas of support and resistance.
4. Include everyone who will be affected by the change in its
planning.
5. Set target dates.
6. Develop appropriate strategies.
7. Implement the change.
8. Be available to support others and offer encouragement
through the change.
9. Use strategies for overcoming resistance to change.
10. Evaluate the change.
11. Modify the change, if necessary.
 STAGE 3—REFREEZING
1. Support others so that the change continues.
34. Edward Lorenz (1960s), discovered that even tiny changes
in variables often dramatically affected outcomes.
 Even small changes in conditions can drastically alter a
system’s long-term behavior (butterfly effect).
35. A budget is a financial plan that includes estimated expenses
as well as income for a period of time.
 Accuracy dictates the worth of a budget; the more
accurate the budget blueprint, the better the institution can
plan the most efficient use of its resources.
 Workforce or personnel budget - largest of the budget
expenditures because health care is labor intensive.
 Operating budget reflects expenses that change in
response to the volume of service, such as the cost of
electricity, repairs and maintenance, and supplies.
 Capital budgets plan for the purchase of buildings or
major equipment, which include equipment that has a long
life (usually greater than 5 to 7 years).
36. Roles and functions are defined and systematically
arranged, different people have differing roles, and rank and
hierarchy are evident.
 Formal structure, through departmentalization and work
division, provides a framework for defining managerial
authority, responsibility, and accountability.
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 Informal structure is generally a naturally forming social
network of employees.
 It is the informal structure that fills in the gaps with
connections and relationships that illustrate how
employees network with one another to get work done.
 The organization chart defines formal relationships
within the institution.
o Top-level managers look at the organization as a
whole, coordinating internal and external influences,
and generally make decisions with few guidelines or
structures.
o Middle-level managers coordinate the efforts of lower
levels of the hierarchy and are the conduit between
lower and top-level managers.
o First-level managers are concerned with their specific
unit’s work flow.
38. Bureaucratic organizational designs are commonly called
line structures or line organizations.
 Ad hoc design is 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.
39. Matrix organization structure focus on both product and
function. Function is described as all the tasks required to
produce the product, and the product is the end result of the
function.
MATRIX ORGANIZATION STRUCTURE:
 Service line organization, which can be used to address
the shortcomings that are endemic to traditional large
bureaucratic organizations.
 Flat organizational designs are an effort to remove
hierarchical layers by flattening the chain of command and
decentralizing the organization.
FLAT ORGANIZATIONAL DESIGNS:
 Traditional Patient Care Delivery Methods - Nurses
assume total responsibility during their time on duty for
meeting all the needs of assigned patients.
 Total Patient Care - Sometimes referred to as the case
method of assignment because patients may be assigned
as cases.
40. Functional nursing - Ancillary personnel collaborate in
providing care to a group of patients under the direction of a
professional nurse.
 As the team leader, the nurse is responsible for knowing
the condition and needs of all the patients assigned to the
team and for planning individual care.
41. Team and modular nursing - 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.
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 Patient care units are typically divided into modules or
districts and assignments are based on the geographical
location of patients.
42. Primary nursing - The primary nurse assumes 24-hour
responsibility for planning the care of one or more patients from
admission or the start of treatment to discharge or the treatment’s
end.
 During work hours, the primary nurse provides total direct
care for that patient.
 When the primary nurse is not on duty, associate nurses,
who follow the care plan established by the primary nurse,
provide care.
43. 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 available resources to promote quality cost-
effective outcomes.
 Nurses address each patient individually, identifying the
most cost-effective providers, treatments, and care
settings possible.
44. Staffing - The leader-manager recruits, selects, places, and
indoctrinates personnel to accomplish the goals of the
organization.
Steps in Staffing:
1. Determine the number and types of personnel needed to
fulfil the philosophy, meet fiscal planning responsibilities,
and carry out the chosen patient care delivery system
selected by the organization.
2. Recruit, interview, select, and assign personnel based on
established job description performance standards.
3. Use organizational resources for induction and orientation.
4. Ascertain that each employee is adequately socialized to
organization values and unit norms.
5. Use creative and flexible scheduling based on patient care
needs to increase productivity and retention.
45. Recruitment - is the process of actively seeking out or
attracting applicants for existing positions and should be an
ongoing process.
 A leadership role in staffing includes identifying,
recruiting, and hiring gifted people.
46. Selection - is the process of choosing from among applicants
the best-qualified individual or individuals for a particular job
or position.
 Involves verifying the applicant’s qualifications, checking
his or her work history, and deciding if a good match exists
between the applicant’s qualifications and the
organization’s expectations.
47. Placement - The nurse leader is able to assign a new
employee to a position within his or her sphere of authority,
where the employee will have a reasonable chance for
success.
 Proper placement fosters personal growth, provides a
motivating climate for the employee, maximizes
productivity, and increases the probability that
organizational goals will be met.
48. Indoctrination - Planned, guided adjustment of an employee
to the organization and the work environment.
 Induction, the first phase of indoctrination includes all
activities that educate the new employee about the
organization and employment and personnel policies and
procedures.
 Orientation activities are more specific for the position.
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o The purpose of the orientation process is to make 53. Minimum Staffing Ratio National Nurses United (2010-
the employee feel like a part of the team. 2013) RN to patient ratios, Retrieved June 9, 2013
o This will reduce burnout and help new employees
become independent more quickly in their new
roles.
49. Staff Development -The better trained and more competent
the staff, the fewer the number of staff required, which in turn
saves the organization money and increases productivity.
 Staff development activities are normally carried out for
one of three reasons: to establish competence, to meet
new learning needs, and to satisfy interests the staff
54. Patient Classification System
may have in learning in specific areas.
50. Socialization refers to a learning of the behaviors that
accompany each role by instruction, observation, and trial and
error.
51. Resocialization occurs when individuals are forced to learn
new values, skills, attitudes, and social rules as a result of
changes in the type of work they do, the scope of
responsibility they hold, or in the work setting itself.
52. Staffing
 Centralized staffing, where staffing decisions are made 55. Formula For Staffing
by personnel in a central office or staffing center.
 Decentralized staffing, the unit manager is often
responsible for covering all scheduled staff absences,
reducing staff during periods of decreased patient census
or acuity, preparing monthly unit schedules, and preparing
holiday and vacation schedules.
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(Solve) Problem: Staffing for an OB Ward: 30-bed capacity
Percentage of Professionals to Non-Professionals
Given: Staffing for an OB-Gyne Ward: 30-bed capacity
30 x 3.0 = 90 = 11 nursing service personnel for 24 hours
8 8
Percentage of Professionals to Non-Professionals: 60% X 11 = 7
Non-Professionals: 40% X 11 = 4
56. Management Process:
57. 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 Comes from within the individual
o Often influenced by family unit and cultural values
 EXTRINSIC Comes from outside the individual
o Rewards and reinforcements are given to
encourage certain behaviors and/or levels of
achievement
58. Motivational Theories:
A. Maslow’s Hierarchy of Needs and Theory of Human
Motivation
 Maslow (1970), people are motivated to satisfy certain
needs, from basic survival to complex psychological
needs, and people seek a higher need only when the lower
needs have been met.
B. 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.
C. 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.
D. 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.
E. McClellands’ Three Basic Needs
 David McClelland (1971) examined what motives guide a
person to action.
 McClellands’ Three Basic Needs:
o Achievement-oriented people actively focus on
improving what is; they transform ideas into action,
judiciously and wisely, taking risks when necessary.
o 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.
o Power-oriented people are motivated by the power
that can be gained as a result of a specific action. They
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want to command attention, get recognition, and
control others.
F. 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.
59. Communication is “the exchange of thoughts, messages, or
information, by speech, signals, writing, or behavior.”
 Occur on at least two levels: verbal and nonverbal.
Climates of Communication:
 Internal climate - Includes internal factors such as the
values, feelings, temperament, and stress levels of the
sender and the receiver
 External climate - Includes external factors such as the
weather, temperature, timing, status, power, authority, and
the organizational climate itself
Channels of Communication:
 Upward communication, the manager is a subordinate
to higher management.
 Downward communication, the manager relays
information to subordinates.
 Horizontal communication, managers interact with
others on the same hierarchical level as themselves who
are managing different segments of the organization.
 Diagonal communication, the manager interacts with
personnel and managers of other departments and groups
who are not on the same level of the organizational
hierarchy.
 Grapevine communication flows quickly and
haphazardly among people at all hierarchical levels and
usually involves three or four people at a time.
Communication Skills:
 Assertive communication allows people to express
themselves in direct, honest, and appropriate ways that do
not infringe on another person’s rights.
 Passive communication occurs when a person suffers in
silence although he or she may feel strongly about the
issue.
 Aggressive communication is generally direct,
threatening, and condescending.
 Passive–aggressive communication is an aggressive
message presented in a passive way. This person feigns
withdrawal in an effort to manipulate the situation.
Communication Tools- S.B.A.R.:
 S - SITUATION Introduce yourself and the patient and
briefly state the issue that you want to discuss
 B - BACKGROUND Describe the background or context
(patient’s diagnosis, admission date, medical diagnosis,
and treatment to date)
 A - ASSESSMENT Summarize the patient’s condition and
state what you think the problem is
 R - RECOMMENDATION Identify any new treatments or
changes ordered and provide opinions or
recommendations for further action
Listening Skills: (GRRRR)
 The leader who actively listens gives genuine time and
attention to the sender, focusing on verbal and nonverbal
communication.
 The leader must continually work to improve listening skills
by giving time and attention to the message sender.
• G - GREETING Offer greetings and establish positive
environment
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 R - RESPECTFUL LISTENING Listen without
interrupting and pause to allow others to think
 R - REVIEW Summarize message to make sure it was
heard accurately
 R - RECOMMEND OR REQUEST MORE
INFORMATION Seek additional information as
necessary
 R - REWARD Recognize that a collaborative exchange
has occurred by offering thanks
60. Principles of Social Networking and the Nurse
 Nurses must not transmit or place online individually
identifiable patient information.
 Nurses must observe ethically prescribed professional
patient–nurse boundaries.
 Nurses should understand that patients, colleagues,
institutions, and employers may view postings.
 Nurses should take advantage of privacy settings and
seek to separate personal and professional information
online.
 Nurses should bring content that could harm a patient’s
privacy, rights, or welfare to the attention of appropriate
authorities.
 Nurses should participate in developing institutional
policies governing online conduct.
61. Delegation is getting work done through others or as directing
the performance of one or more people to accomplish
organizational goals.
 The mark of a great leader is when he or she can
recognize the excellent performance of someone else and
allow others to shine for their accomplishments.
5 Rights in Delegation
 Right task
 Right circumstances
 Right person
 Right direction/communication
 Right level of supervision
Criteria for DELEGATION to UNLICENSED PERSONNEL
1. Frequently recur in the daily care of a client or group of
clients
2. Are performed according to an established (standardized)
sequence of step
3. Involve little or no modification from one client-care
situation to another
4. May be performed with a predictable outcome
5. Do not inherently involve ongoing assessment,
interpretation, or decision making which cannot be
logically separated from the procedure(s) itself
6. Do not endanger the health or well-being of clients
7. Are allowed by agency policy/procedures
62. Conflict Resolution:
 Conflict is generally defined as the internal or external
discord that results from differences 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
 Intergroup conflict occurs between two or more groups
of people, departments, and organizations. • Intrapersonal
conflict occurs within the person. It involves an internal
struggle to clarify contradictory values or wants.
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 Interpersonal conflict happens between two or more
people with differing values, goals, and beliefs and may be
closely linked with bullying, incivility, and mobbing.
Interpersonal Conflict
 Bullying is 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 is 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. • When bullying, incivility, and mobbing occur in
the workplace, this is known as workplace violence.
Conflict Resolution Strategies
 Compromising each party gives up something it wants
 Competing one party pursues what it wants at the
expense of the others
 Cooperating one party sacrifices his or her beliefs and
allows the other party to win
 Smoothing one party in a conflict attempts to pacify the
other party or to focus on agreements rather than
differences
 Avoiding parties involved are aware of a conflict but
choose not to acknowledge it or attempt to resolve it
 Collaborating all parties set aside their original goals and
work together to establish a supraordinate or priority
common goal
63. 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.
64. 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.
65. Time management is making optimal use of available time.
 Good time management skills allow an individual to spend
time on things that matter.
Time Wasters:
 Technology (Internet, gaming, e-mail, and social media sites)
 Socializing
 Paperwork overload
 A poor filing system
 Interruptions