Bachelor of Science in Nursing 4Y

NCMB419 LEC: BSN 4th YEAR MIDTERMS

WEEK 7: STAFFING ii. Training
• 3rd phase of the management process iii. Overtime of existing staff
• Recruits, selects, places, indoctrinates personnel iv. Lost Revenues
• Promotes personnel development v. Increased Nurse Patient Ratio
• The process of determining and providing the acceptable Creating Cultures of Retention in Organizations
number and mix of nursing personnel to produce a desired level 1. Providing leadership and management training
of care to meet the patient’s demands 2. Delegating authority to nurse managers, and staff nurses
- Physical resources 3. Nurse autonomy
- Financial resources 4. Greater control over practice
- Human resources 5. Nurse participation in organizational policy decisions
Steps of Staffing Responsibilities 6. Good nurse – physician relationships
1. Determine the number and types of personnel needed Steps Of - address issues and concerns
Staffing Responsibilities - improve communication
2. Recruit, interview, select and assign personnel based on - impossible if nurse is incompetent
established job description 7. Setting staffing levels
3. Use organizational resources for induction and orientation - skill appropriate to patient acuteness
4. Employee is socialized to organizational values 8. Adopting zero tolerance policies for abusive behaviors
5. Develop a program of staff education 9. Minimize paperwork
6. Use creative and flexible scheduling 10. 10.Limiting the use of mandatory overtime
Nursing Shortage Nursing managers plays a pivotal role in the retention of nurses.
- Patient Safety (Anthony, Standing, & Glick, 2005)
- Diminishes hospital’s capacity to treat patients Interview
- Diminishes hospital’s capacity to treat patients It is the foundation for selecting people for positions
- Contributes to emergency department overcrowding  STRUCTURED
- Reduced number of staffed beds - Requires greater planning
- Reduced number of staffed beds - Questions are prepared in advanced
- Cancellation of elective surgeries o address specific job requirements
- Reduced number of staffed beds o skills and qualities
- Cancellation of elective surgeries o applicant’s experience
- Discontinuation of services o willingness and motivation
How A Manager Should Respond To Shortages - Utilized for critical positions
• Budget constraints  UNSTRUCTURED
• Type of patient care management used - Requires little planning
- Primary - Questions are not prepared in advanced
- Secondary o Tell me about yourself.
- Tertiary o What is your greatest strength?
• Type of patient care management used - Questions are not prepared in advanced
• Education and knowledge level of staff to be recruited o What is your greatest weakness?
- Recruitment Is the process of actively seeking out or attracting o How will our company benefit by having you as an
applicants for existing positions employee?
Goals and Objectives = Quality Employees - Not so critical job positions
Recruitment Methods Selection
1. Employee Recommendations - Is the process of choosing from among applicants the best
2. Word of mouth qualified individuals for a particular job or position
3. Advertisements o Verifying the applicant’s qualifications
4. Fliers o Checking his or her work history
5. Placement Services
 The Final Selection
• The Recruiter 1. Notification about the applicants’ decision
1. Should know the needs of the organization 2. A timely written of notice to those applications that are
2. Can represent the institution eliminated
3. Can relate well to people 3. Informing of the benefits, compensation and placement
• The NURSE Recruiter 4. Informing of the pre-employment procedures
1. Separate entity 5. Confirm in writing the intention to accept the position
2. Assigned to Nurse Managers
Placement
3. Decentralization is important - Assigning an employee to a position and unit within the
4. Comes with great responsibility
manager’s sphere of authority
• Retention - Interest of specialization
- Begins with how much the organization does or does not
- Adjustment of an employee to the organization
value the staff
Indoctrination
- Happens when the organization is able to create a work
- Establish favorable employee attitudes
environment that makes staff want to stay
- Continues until the employee has been socialized to the norms
Nurse Turnover
and values of the work group
Groupthink is a phenomenon where people tend to confirm with
 Induction - The first phase of indoctrination
group decisions to avoid feeling outcast, leading to errors in decision o General information about the organization
making. o Developed by the personnel department
1. Expensive o Signed by new employees
a. Costly  Orientation - The second phase of indoctrination
i. HR expenses o More specific for the position

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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
 1st day – personnel dept. - Disadvantage
 2nd day – staff development dept.  Nurse’s talents are confined
 3rd day – specific dept. • Case Management - the nurse work across agencies
 Socialization - The third phase of indoctrination - interdisciplinary approach is used
o Acquires the technical skills - entire episode of illness is the focus
o Knowledge of the kinds of behavior Patient Classification
o Attitudes and values that make conformity - System Group patients according to specific characteristics that
o Role Model - Worthy of imitation measure acuity of illness
o Preceptor - Provides knowledge, emotional support, • Category I- Self care: requires 1 – 2 hours of nursing
clarification of role expectations care/day
o Mentor - Assist the protégé in attaining expert status • Category II - Minimal care: requires 3 – 4 hours of nursing
Staff Development care/day
1. Training • Category III - Intermediate care: requires 5 – 6 hours of
- Organized method of ensuring that people have knowledge nursing care/day
and skills • Category IV - Modified intensive care: requires 7 – 8
o Simulation hours of nursing care/day
o OJT • Category V - Intensive care: requires 10 – 14 hours of
o Lectures nursing care/day
2. Education Making Patient Assignments
- More formal and broader in scope - Patient needs
3. Coaching - Available staff
4. Team building - Job descriptions
Why Training & Education are neglected? - Scope of practice for licensed nurses
1. Institutional barriers - Scope of functions
2. Load of work National League for Nurses Formula for Staffing
3. Readiness of the staff to learn • ABO X NCH = Total # of Nursing Service Personnel for 24
4. Motivation of learning hours # of working hrs
5. Time • Where:
6. Manager’s initiative - ABO = Average Bed Occupancy
Assessing Staff Development Needs - NCH = Nursing Care Hours
1. Performance review - # of working hours = 8 Based on RA 5901 (The 40
2. Peer evaluation Working Hours per Week Law)
3. Self – administered checklists • Standard values for NCH
Staffing Needs & Scheduling Policies - Medical = 3.4
• Ascertain adequate numbers of nurses - OB = 3.0
• Have an appropriate mix of personnel - Surgical = 3.4
• Who is responsible in meeting staffing needs? - Pedia = 4.6
- First- and middle-level managers - Mixed MS = 3.5
• Scheduling - Nursery = 2.8
- Centralized - Made by personnel in a central office • % of Professionals to Non-professionals
o Advantages
 Fairer to all employees
 Frees the middle – manager of the burden
- Decentralized - Unit manager is responsible
o Advantages
 Understands the unit and staff intimately
 Able to take personal scheduling requests - Distribution per shift
 Decrease nurse attrition o Morning = 45%
o Disadvantages o Afternoon = 37%
 Staff will be treated unequally o Night = 18%
 Unit manager may be viewed as granting rewards • Staffing for an OB Ward: 30 Beds
- Cyclical - Allows long-term knowledge of future work - Nursing personnel for 24 hours
schedules
NURSING CARE DELIVERY SYSTEMS
• Case Method - Total patient care is provided by one nurse on - % of Professionals to Non-professionals
each shift - Professionals: 11 X 0.6 = 7
• Functional Nursing - Personnel of different skill levels are used - Non-professionals: 11 X 0.4 = 4
according to the complexity of the patient care needs
- Distribution per shift
- Task oriented o Professionals Non – Professionals
- Team members under the supervision of HN (RN) o AM 7 X 0.45 = 3 4 X 0.45 = 2
• Team Nursing Care - is provided through team effort o PM 7 X 0.37 = 3 4 X 0.37 = 1
Achievement of goals through group action o NIGHT 7 X 0.18 = 1 4 X 0.18 = 1
• Primary Nursing - RNs give total patient care to 4 – 6 patients - Summary of Staffing
and has 24 – hour responsibility o Shift Professionals Non - Professionals
- Advantages o Morning 3 2
 Accountability o Afternoon 3 1
 Continuity of care o Night 1 1
 Number of errors reduced o TOTAL 7 4
 Shorter hospital stay o Nursing Personnel for 24 hours = 11

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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
Week 8: ORGANIZING Types of Organizational Structures
- 2nd phase of the management process • Bureaucratic Structure
- Relationships defined - Line structures
- Procedures outlined - Line organizations
- Equipment readied - Staff organizations
- Tasks assigned - FOUND WHERE? large health care facilities
- Establishing a formal structure that provides the best possible - USED BY? People with routine jobs
coordination or use of resources to meet unit objectives - Advantages
- Purposes o authority and responsibility are clearly defined
o Member responsibilities o simplicity of relationships
o Specific Roles o efficiency
o Coordination of activities - Disadvantages
o Avoids overlapping of function o Monotonous
o Shows to whom and for whom they are responsible o Alienate workers
Organization o Restricts upward communication
• Formed when number of workers is large enough to require a • Ad Hoc Design
supervisor Fayol (1949) - Has no illustration
• Accomplish more work than can be done by individual effort - Temporary basis
• Organizational Structure - To overcome the inflexibility of a line organization
- Group is formed • Matrix Structure
- Identify lines of communication - Designed to focus on both product and function
- Means for channeling authority and making decisions - Function is described as all the tasks required to produce
- Formal structure the product
o generally highly planned - Product is the end result of the function
o provides a framework for defining managerial - Has a formal vertical and horizontal chain of command
authority, responsibility, and accountability - Advantages
o roles and functions are defined o Less formal rules
o Work specializations identified o Fewer levels of hierarchy
- Informal structure - Disadvantages
o generally social in nature o Decision making can be slow
Organizational Chart o Confusion and frustration
- Depict organization’s structure Roles and expectations Defines • Pyramidal
formal relationships Departments identified - Hierarchical organizational structure
Chain Of Command - Pyramid shaped systems
- Formal line of authority and communication - REMEMBER: THE HIGHER YOU ARE UP THE
- Unbroken lines PYRAMID The MORE Power, responsibility, and
 Solid lines authority YOU HAVE
 Can be horizontal or vertical • Flat
o Solid Horizontal lines - similar spheres of - An effort to remove hierarchical layers
responsibility & power Shared Governance
o Solid Vertical lines Denote the official chain of - Empowerment of people in the decision-making system
command - Shared among board members, nurses, physicians, and managers
o top has the greatest decision – making authority, the - Participatory management is the foundation
least at the bottom - Centralization Decisions are made at the top levels
- Broken lines - Decentralization Decision-making are diffused throughout the
 Dotted lines organization
 Represent staff positions o Increases morale and promote interpersonal relationships
 Provide information and assistance o Fosters informality and democracy in management and
 Limited organizational authority brings decision making closer to the action
Unity Of Command o Flexibility is increased
- Vertical solid lines between people o Communication is swift and effective
- Denotes that there is 1 boss for 1 staff o Helps determine accountability
- Authority - The power to direct the work of others o Eases the issues on succession planning
- Responsibility - A duty or an assignment o Releases the manager from the burden of daily
- Accountability - A moral responsibility administration
• Span Of Control Decision making in a hierarchy
- The number of subordinates a manager can direct - Decision making needs to be decentralized
efficiently and effectively • Scalar Chain
- The manager’s abilities - The decision-making hierarchy
- The employee's maturity • External Stakeholders
- Task complexity - Organizations to be viewed as a part of a greater
- Geographic location community of stakeholders
- Level in the organization - Have interest in what the organization does and may
• Centrality influence its general performance
- frequent communication occurs • Advantages Of Org Charts
- Employees at the center are able to receive more 1. Contributes to sound organizational structure
information than those more peripherally located 2. Maps lines of decision making authority
- Middle managers has the broad view of the organization 3. Shows formal lines of communication
4. Shows how people fit into an organization

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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
5. Helps people understand their assignments WEEK 10 & 11: DIRECTING
• Disadvantages Of Org Charts - 4th phase of the management process
1. Does not show informal structure - coordinating or activating
2. Limited in their ability to depict each line position’s degree - “doing – phase”
of authority - managers direct the subordinates.
3. Becomes obsolete very quickly COMPONENTS
4. Does not define responsibility and accountability MOTIVATION
Committee Structure Force WITHIN the individual that influences and directs the behavior
- Informal function of others.
- Assist with management functions - Humanistic managers
- Increases staff participation - PERSONAL and ORGANIZATIONAL goals are met
- Generate ideas and creative thinking to solve operational - Motivational Theory - Workers are being motivated primarily
problems by economic factors
- Improve services and often improve the quality and quantity of o Intrinsic motivation comes from within, while extrinsic
work accomplished motivation arises from external factors. When you are
- Must be appropriately organized and led intrinsically motivated, you engage in an activity because
Factors to consider when organizing committees you enjoy it and get personal satisfaction from doing it.
1. Composed of committed people When you are extrinsically motivated, you do something in
2. Members has a variety of work experience and educational order to gain an external reward.
backgrounds
3. Ideal is 6-8 members
4. Clearly outlined responsibilities and reporting mechanisms
5. Assignments given ahead of time, with clear expectations that
assigned work will be discussed at the next meeting
6. Should have written agendas and effective committee chairs
- Example Committees
o Patient Safety, Quality Assurance, Ethics and
Grievance, Training / Continuing Education, Blood
Transfusion, HIV, Therapeutics, Infection Control,
Disaster and Emergency, Critical Care, Clinical
Records, Research
WEEK 9: PRINCIPLES IN ORGANIZING
1. Scalar Principle
- Short and clear chain of command
2. Principle of Flexibility - B.F. Skinner - Behavior that is rewarded will be repeated;
- Adaptable to changing situations Behavior that is punished is extinguished.
3. Principle of Authority - Frederick Herzberg - The Motivation to work
- Clearly defined authority o Motivators / Satisfiers - achievements, recognition,
4. Principle of Delegation possibility for growth, work itself, responsibility
- Authority, rights, and power should be equal to o Hygiene / Maintenance factors - supervision, job security,
responsibility working conditions, remuneration, interpersonal relations,
5. Principle of Unity of Command company policies
- Each person having only one boss - Vroom - Employees expectations about their environment or a
6. Principle of the Span of Control certain event will influence their behavior
- The number of subordinates a manager can direct - McClelland
efficiently and effectively o Achievement
7. Principle of Unity of Objectives o Affiliation
- Defined very clearly for each department, each section, and o Power
each position o enhance self – esteem and reputation
8. Principle of Efficiency - Gellerman
- Ensure optimum utilization of resources o Stretching assigning tasks that are more difficult than what
9. Principle of Division of Work the person is used to doing
- Create effective departmentation as per work and task o Participation actively draw employee into decisions
10. Principle of Unity of Direction affecting their work
- All subordinates will be receiving the same direction in - Motivating Climate
their respective works o Employees are an organization’s most valuable asset
11. Principle of Simplicity o Noticing employee contribution may lead to increased
- Activities and the system of an organization should be organizational retention
simple and easy to understand o Organization must be cognizant of the need to offer
12. Principle of Responsibility incentives at a level where employees value them
- The superior makes themselves accountable for their o Recognize employee’s values
authority o Significant association of employees sense of
13. Principle of Balance accomplishment, equality, being imaginative, helpful, self-
- Proper and reasonable balance in works and activities controlled with work satisfaction (Prothero, Marshall,
14. Principle of Specializations Fosbinder, Hendrix, 2000)
- Every person is confined to a single and particular job o Consider the manner in which first-line manager
communicates with employees

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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
o Positive reinforcement “The communication skills you
showed today as an advocate for Mr. Cruz were excellent. I
think you made a significant difference in his care.”
o “We often forget that the only way to achieve our goals is
through the people who work with us” (Kerfoot, 2001)
o Shared governance, empowerment, participative
management can have a direct impact on motivation
o Finding joy at work is a shared responsibility Connections,
Love of work, Achievement, Recognition
o The attitude and energy level of managers directly affect
the attitude and productivity of their employees
o Lee (2000) states that, “motivation, mentoring, and
empowerment aren’t just management jargon: they should
be resources you use everyday”
COMMUNICATION
- Forms the CORE of management activities and cuts across all
phases of the management process
- Must be systematic, have continuity, and be fully integrated into
the organizational structure
- The most critical leadership skills
- Necessary for continuity and productivity
- Complex exchange of thoughts, ideas and information
• Communication Process
o If you are the sender, you should determine what receivers
see and hear
• Variables Affecting Organizational Communication
o Formal organizational structure
o People at lower level
o Characteristics of large organization
o Spatial Distance
o Subgroups
o Relationships
o Constant flux
• Communication Strategies
1. Assess organizational communication
2. Recognize who will be affected by decisions that are made
3. Seek for feedback
4. Ensure that the message is understood
5. Utilize multiple communication methods
6. Continually communicate with subordinates and provide
necessary information only
• Channels of Communication
- Downward communication - traditional line of
communication
- Upward communication - a means of motivation
- Horizontal communication - personnel of the same level
- Diagonal communication - not of the same level
- The grapevine - most informal method of communication
co-existing with formal channels.
• Communication Modes
- Written communication
- Face-to-face communication
- Nonverbal communication
- Telephone communication
Written Communication
- Used most often - Job descriptions, appraisals, memos
- A learned skill that improves with practice
- Reflects managerial abilities
Formal Business Letter
1. Know what you want to say
2. Put people into your writing
3. Use action words
4. Write plainly
5. Use few words as possible
6. Use simple, direct sentences
7. Give the reader direction
8. Arrange the material logically
9. Use paragraphs to lead readers
10. Connect your thoughts
11. Be clear
12. Express similar thoughts in similar ways
Memos
- Distributed internally within the organization
- To inform, instruct, recommend, document
1. Make the main point at the beginning
2. Essential information only
3. Should be written simply
4. Use headings
Interpersonal Communication
1. Non-verbal communication
- “What you do speaks so loudly that I cannot hear what you
say” Ralph Waldo Emerson
- Nonverbal Clues
o Space - The space between the speaker and the
receiver influences what is communicated
 Distance implies lack of trust or warmth
 Distance increase power and status
o Environment - Proper venue makes it more formal
Generally taken seriously
o Appearance - Defines the impact of dress and
appearance on role perception and power
o Eye contact - Associated with sincerity
 Invites interaction
 Breaking eye contact
 One of the key components of effective body
language
o Posture - If you slouch, shuffle, or stoop
 If you wave your arms, clear your throat a lot, or
pull your hair or earlobes
 If you sit or stand with crossed or folded arms, or
with your hands inside your pockets
 Sender should face the receiver, stand or sit
appropriately close and with head erect, leans
toward the receiver
o Gestures - Can emphasize or distract the message
o Facial expression - Effective communication needs a
facial expression that agrees with your message
o Timing - Hesitation often diminishes the effect of your
statement and may imply untruthfulness
o Tone, volume & inflection - Always convey
confidence and clarity, Speaking rapidly, Speaking in
a monotone voice
2. Verbal
- Assertive communication - Allows people to express
themselves in a direct, honest, and appropriate ways
o Do not infringe on another person’s rights
o “I” statements
o Congruent verbal and nonverbal messages
o Avoid expressing their opinions or feelings
- Passive communication - Avoid expressing their opinions
or feelings The person is in silence although he or she may
feel strongly about the issue
- Aggressive communication - People express themselves in
a direct and often hostile manner that infringes another
person’s rights.
o Winning at all costs
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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
o Demonstrates self-excellence
- Passive – Aggressive communication - Is an aggressive
message presented in a passive way
o Feigns withdrawal in an effort to manipulate the
situation
- Assertive vs. Aggressive
o Reflect - Helps the aggressor to evaluate whether the
intensity of his or her feelings is appropriate to the
specific situation or event
o Repeat the assertive message - Effective when the
aggressor overgeneralizes or seems fixated on a
repetitive line of thinking
o Point out the implicit assumptions- Listening closely
and letting the aggressor know that you have heard
him or her
o Restate the message by using assertive language -
Rephrase the aggressor’s language to diffuse the
emotion. “You” rather “I”
o Question - Put the behavior in the form of a question
by helping the other person become aware of an
unwarranted reaction
Strategies to Promote Effective Verbal Communication
- Use proper titles of respect
- Be aware of subtle linguistic messages
- Avoid derogatory remarks
- Do not compare their employment opportunities and conditions
to people in their country of origin
- Avoid phrases that will suggest inferiority and offensive to
others
- Consider uniqueness and individuality
3. Listening skills
- The active process of listening is vital for interpersonal
communication
- effectiveness
- Should be approached as an opportunity to learn
appreciation for a cultural perspective of the organization
Kerfoot, 1998
- A leader who actively listens gives genuine time and
attention to the sender
Group Communication
• Forming
- Identification of boundaries of interpersonal behaviors
- Establish DEPENDENCY relationships with leaders and
co-members
- Determine what is acceptable behavior
• Storming
- Members polarized into subgroups
- Conflict issues
• Norming
- Group cohesion
- Conflict and resistance are overcome
• Performing
- Interpersonal structure focuses on task and its completion
- Roles become flexible and functional
- Energies are directed to task performance
Task Roles of Groups
• Initiator - Proposes or suggests group goals or redefines the
problem
• Information seeker - Searches for the factual basis for the
group’s work
• Information giver - Offers an opinion of what the group’s view
of pertinent values should be
• Opinion seeker - Seeks opinion that clarify or reflect the value
of other member’s suggestions
• Elaborator - Gives examples or extends meanings of suggestions
given and how they could work
• Coordinator - Clarifies and coordinates ideas, suggestions, and
activities of the group
• Orienter - Summarizes decisions and actions; identifies and
questions departures from predetermined goals
• Evaluator - Questions group accomplishments and compares
them to a standard
• Energizer - Stimulates and prods the group to act and raises the
level of its actions
• Procedural technician - Facilitates group action by arranging the
environment
• Recorder - Records the group’s activities and accomplishments
Group-Building and Maintenance Roles
• Encourager - Accepts and praises all contributions, viewpoints
and ideas
• Harmonizer - Resolves conflict
• Compromiser - Yields his or her position in a conflict situation
• Gatekeeper - Promotes open communication
• Standard setter - Evaluates standards
• Group commentator - Provides feedback to the group
• Follower - Accepts group ideas
Individual Roles of Group Members
• Aggressor - Expresses disapproval of other’s values or feelings
• Blocker - Expresses negative points of view and resurrects dead
issues
• Recognition seeker - Works to focus positive attention to
himself or herself
• Self – confessor - Uses the group setting as a forum for personal
expression
• Playboy - Remains uninvolved and demonstrates cynicism, non-
chalance, or horseplay
• Dominator - Attempts to control and manipulate the group
• Help seeker - Uses expressions of personal insecurity, confusion
or self – deprecation to manipulate sympathy from members
• Special interest pleader - Cloaks personal prejudices or biases by
ostensibly speaking for others
The Impact of Technology on Communication
- Collaborative practice will involve a community of
electronically connected practitioners providing a richer and
more scientific foundation for practice Richards, 2001
- May help to balance the constraints being placed on other
patient-care resources
- Offers new ways to pull information together and fulfill its
potential as a nursing resource
- Use of internet as an information source and communication
tool
Confidentiality
- Nurses have a duty to maintain confidential information
- This confidentiality can be breached legally only when ONE
PROVIDER SHARE INFORMATION about a patient
- Computerization was seen as the most serious threat to medical
privacy
- RA 10173 - Data Privacy Act of 2012
MANAGING CONFLICT
- The internal or external discord between 2 or more people
- It is an expected outcome
- Differences in professional values
- Competition among professionals
- Scarce resources
- Restructuring
- Poorly defined role expectations
- Recognize it in its early stages and actively intervene
History of Conflict Management
• Avoided at all costs
• Ignored, denied and dealt immediately and harshly
• Could be avoided if employees were taught the one right way to
do things
• Accepted passively and perceived as normal and expected
• Managers resolve it rather than prevent it
• Necessity and actively encouraged to promote to produce
organizational growth
• Too little conflict results in organizational stasis
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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
• Too much conflict reduces the organization’s effectiveness and - Competing - One party pursues what it wants at the expense of
eventually immobilizes employee the others
• The responsibility for determining and creating an appropriate o WIN – LOSE
level of conflict on the individual unit often falls to the manager o One party has more information or knowledge
• Avoidance and suppression is non – productive - Cooperating - Opposite of competing, also termed as
• Confront and manage accommodating
Categories of Conflict o One party sacrifices his or her beliefs and allows the other
1. Intrapersonal - Occurs within the person party to win
- Involves an internal struggle to clarify contradictory values o WIN – LOSE
or wants o Actual problem is usually not solve
2. Interpersonal – Horizontal violence or bullying o Sullivan (2004) suggests that sometimes it is advisable to
- Happens between 2 or more people with differing goals, lose a battle if the payoff helps you to win the war.
values and beliefs - Smoothing - One person “smoothes” others involved in the
o Burnout conflict in an effort to reduce the emotional component of the
o Stress conflict
o Absenteeism o Get someone to accommodate or cooperate with another
o Turnover party
3. Intergroup – Occurs between 2 or more groups of people, o Focus on agreements rather than differences
departments or organizations o Rarely results in resolution of the actual conflict
Conflict Process - Avoiding - Parties involved are aware of a conflict but choose
• Latent not to acknowledge it or attempt to resolve it
- Implies the existence of antecedent conditions o Should be solved by people other than you
- Ripe for conflict o One party is more powerful than the other
- Anticipate antecedent conditions o The problem will solve itself
• Perceived - Collaborating - Is an assertive and cooperative means of
- Substantative conflict resolution
- Intellectualized and often involves issues and roles o WIN – WIN solution
- Conflict can be resolved at this stage o With a supraordinate common goal
- Awareness o Focus remains on problem solving
• Felt o Mutual respect
- Occurs when the conflict is emotionalized o Open and honest communication
- Affective conflict o Equitable
• Manifest o Shared – decision making powers
- Overt conflict - Situation itself -
- Action is taken - Urgency of the decision
- Many individuals are uncomfortable with or reluctant to - Power and status of the players
address conflict - Importance of the issue
o fear of retaliation - Maturity of people involved
o fear of ridicule Common Causes of Organizational Conflict
o fear of alienating others • Disrupt working relationships and lower productivity - Identify
o do not have the right to speak up the cause and resolve
o past negative experiences • Poor communication
- Male tend to respond more aggressively toward conflict • Inadequately defined organizational structure
- Female are more apt to try to avoid conflicts or to pacify • Individual behavior
them • Unclear expectations
• Conflict aftermath • Individual interests
- Positive • Group interests
- Negative • Operational/Staffing changes
• Diversity in gender, culture, age
Managing Unit Conflict
• Confrontation - urge subordinates to attempt to handle their
own problems
- recommend face-to-face communication for resolving
conflicts
- Slug-it-out
- “What feels like a bomb on paper may feel like a feather in
person” (Smith, 2003)
• Third – party consultation - Managers as a neutral party
- All parties should be motivated to solve the problem
• Behavior Change - reserved for serious cases of dysfunctional
conflict
- develop self – awareness and behavior
• Responsibility Charting - delineate the function and
Conflict Management responsibility of roles
- The optimal goal in resolving conflict is creating a WIN-WIN - manager must clearly define ultimate responsibility
SOLUTION for all involved • Structure Change - transferring or discharging people
- Compromising - Each party gives up something it wants - creating policies
o Many see as an optimum conflict resolution strategy
o LOSE – LOSE • Soothing one party - temporary solution

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 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
- use relaxation techniques or meditation address underlying • Set deadlines and monitor progress - set time lines
problem later • Model the role - provide guidance
NEGOTIATING - convey a feeling of confidence and encouragement
- Collaborating in its most creative form • Evaluate performance - provide feedback
- Competing in its most poor form - evaluate the employee’s performance
- Frequently resembles compromise • Reward accomplishment - the mark of a great leader is when he
- Day-to-day conflict is resolve with negotiation or she can recognize the excellent performance of someone else
- WIN – WIN and allow others to shine (Dye, 2000)
• Before the Negotiation - the more recognition team members receive, the more
- Do your homework recognition will be given to their leader (Dye, 2000)
- Determine starting point Delegation as a Function of Professional Nursing
- Look for hidden agendas • RNs are expected to be expert delegators
• During the Negotiation • RNs assumes the roles of supervisors
- Avoid using destructive negotiation techniques • Unlicensed Assistive Personnel
- Maintain Composure - Unlicensed people who are trained to function in an
- Role Model assistive role to the licensed RN
• After the Negotiation - Institutions effort to contain spiraling healthcare costs
- Restate - Reasons: Cost and Nursing shortage
- Recognize - Advantage: free RNs from tasks and assignments
- Disadvantage: increases the scope of liability
DELEGATION
- The RN must be aware of the job description, knowledge
- Getting work done through others directing the performance of base, and demonstrated skills of each person
one or more people o patient assessment
- An essential element of the directing phase o nursing diagnosis
- a necessity o care planning
- synonymous with productivity o patient teaching
- accountability o patient outcome evaluation
- delegator WEEK 12: CONTROLLING
- delegate  comparing the actual performance with the set standards of the
- done if someone else is better prepared company to ensure that activities are performed
- provide learning opportunities for subordinates  a way to learn and grow, both personally and professionally
- subordinates who are not delegated enough responsibility may Management Controlling Functions
become bored, nonproductive, ineffective  Periodic evaluation of philosophy, mission, goals and objectives
Purposes of DELEGATION  Measurement of individual and group performance against
1. It maximizes the utilization of every health care worker preestablished standards
2. Ensure proper delegation of responsibilities and tasks  Monitoring of expenses and use of supplies
3. It uses latent abilities of personnel that contribute to their growth  Auditing of patient goals and outcomes
and development Quality
5 Rights of DELEGATION
 specific type of controlling activities that are used to
1. Right task - One that is delegable for a specific person
evaluate, monitor, or regulate services rendered to consumers
2. Right circumstances - Appropriate setting, resources
3. Right person - is delegating the right task to the right person to  ensure quality nursing care while meeting intended goals
be performed on the right person
4. Right direction / communication - Clear, concise description Components of Effective Quality Control Programs
of the task  Support from top level administration
5. Right supervision - Monitoring and feedback  Commitment by the organization in terms of fiscal and human
Common Delegation Errors resources
• Underdelegating  Search for excellence
- False assumption of the manager that he lacks ability to do  Continuous
the job correctly The Quality Control Process
- Lack of trust in the subordinates  The standard is determined
- Fear that subordinates will resent having work delegated to  Information is collected
them  Corrective action
- Lack of experience in the job Standards
- Excessive need of the manager to be perfect  serves as a guide for practice
• Overdelegating  Characteristics
- Transfer the burden of managers to their subordinates  Predetermined
- Poor managers of time  Established
- May decrease productivity  Communicated to
• Improperly delegating  Accepted by used as a measurement tool
- Delegating at the wrong time, to the wrong person or for  used as a measurement tool guide individual practitioner in
the wrong reason performing safe and effective care
- Responsibilities that are beyond the capability of the person Standards of Practice
Effective Delegating  Assessment
• Plan ahead - identify tasks to be completed
 Diagnosis
• Identify necessary skills and levels - identify qualifications
 Outcomes identification
• Select most capable personnel - identify qualified person
• Communicate goal clearly - managers shows the way  Planning
• Empower the delegate - delegate the authority and responsibility  Implementation
 Evaluation

8
 NURSING LEADERSHIP & MANAGEMENT 4th YEAR: MIDTERMS
Standards of Professional Practice  How does MY organization differ from exemplary
 Quality of practice organizations?
o enhances the quality and TQM (Total Quality Management)
o effectiveness of nursing practice  Dr. W. Edward Deming
 Education - attains knowledge and competency  The individual is the FOCAL element
 Professional practice evaluation - peer evaluation  ACTIONS ARE PREVENTIVE / PROACTIVE
 Collegiality - contributes to the professional development of  “DO THE RIGHT THING, THE RIGHT WAY, THE FIRST
peers TIME”
 Collaboration - collaborates with the patient, family and others  “There is always a ROOM for improvement”
 Ethics - integrates ethical provisions The Principles of Tqm
 Research - integrates research findings 1. Create a constancy of purpose.
 Resource utilization - safety, effectiveness, cost and impact on 2. A philosophy of continual improvement.
nursing practice 3. Focus on improving process not on inspection of product.
 Leadership - in the professional practice setting 4. End of awarding business on price alone, minimize cost by
AUDIT awarding it to a single supplier.
 a quality control tool 5. Improve constantly every process for planning production and
 systematic and official examination of record, process, structure service.
3 Types of Audit 6. Institute Job training and retraining.
1. Retrospective audits - after the patient receives the service 7. Develop leadership in the organization.
2. Concurrent audits - while patient is receiving the service 8. Drive out fear by encouraging employees to participate.
3. Prospective audits - attempts to identify future performance 9. Foster interdepartmental cooperation
Most Frequently used AUDITS in QC 10. Eliminate targets for the workforce
1. Outcome audit - the end result of care 11. Focus on quality. Eliminate Quota system
2. Process audit - measure the process of care assume that a 12. Promote teamwork. Eliminate the annual rating or merit system.
relationship exists between the process used by the nurse and the 13. Charge all with implementing the TQM package
quality of care provided
3. Structure audit - assumes that a relationship exists between
quality care and appropriate structure

HALO EFFECT
 allowing one trait to influence the evaluation of another trait
 basing ratings to general impression
HORN EFFECT
 the evaluator is hypercritical perfectionist
 good workers on a weak team gets low rate than if they were
working on a better team
 a recent mistake may off set a year’s good work
 managers vent irritation by lowering the rating
CONTRAST EFFECT
 rate the employee opposite from the way the evaluator
perceives oneself
LENIENCY
 a manager rates his/her staff “above average”
RECENCY ERROR
 based largely on the employee’s recent behavior
 stereotyping
Quality
 a process of evaluation that is applied to the health care
- Charles E.
system and the provision of health care services by health
care workers
 a continuous, on-going measurement and evaluation process

 Process of measuring products, practices and services