NURSING LEADERSHIP AND MANAGEMENT

NURSING LEADERSHIP Levels of Proficiency Years of

→ A process of influencing followers towards a common Experience
goal Novice 0-1
• Leader is goal-oriented Advanced beginner 1-2
What is the main function of a psychiatric nurse? Competent 2-3
A. Facilitator Proficient 3-5
B. Coordinator- engages in an interdisciplinary • Holistic understanding of the
approach patient
A. Influence Expert ↑5
C. Motivate
4. Bureaucratic
Interdisciplinary approach vs. Multidisciplinary • BUreaucratic- policy-centered style of leadership
→ They are both collaborative but the difference is the o Policies created by a group of experts
creation of an integrated plan of action o Policy- instructions to guide decision making
→ Multidisciplinary- observe with other professions and
• (x) trust in the leaders and followers, only believes
make known their observations but will not contribute to
the plan of action
policies
→ Interdisciplinary- observes, gives opinions, and • BUss- hierarchy is highly respected because of
contribute to plan of action the implementation process, sabi ni boss ‘yan eh
• Better approach • BUk-based- Book-based- policies are scientific

What is the main function of a community health nurse? Leadership Theories

A. Facilitator- you let the community do it for them,
you just guide them
B. Coordinator
C. Influence
D. Motivate
What is the main function of a leader psychiatric nurse?
A. Facilitator
B. Coordinator- engages in an interdisciplinary
approach
C. Influence
D. Motivate
What is the main function of a leader in community health
nurse?
A. Facilitator- you let the community do it for them,
you just guide them
B. Coordinator
C. Influence
D. Motivate
What is the main function of a leader in all nursing field? A
priority question
A. Influence- going beyond the sphere of competence
• When you influence, you motivate and
persuade
B. Motivate
C. Persuade Does not go beyond the sphere of influence
• When you motivate and persuade you do
not necessarily influence
D. All of the above
Styles of Leadership
→ Lewin’s styles of leadership
1. Democratic- the leader and the followers decide, the
followers can initiate here
• Participative style of leadership- the leader asks
for suggestions, the leader initiates the process
• High trust and confidence on the followers
• Followers: competent and proficient
2. Autocratic- the leader decides
• High in security
• Kampante na unified ang action because only one
decides
• Swift action, high productivity rate, stable
management
• Morale is high because they want follow because
they trust their leaders—morale comes from the
strength of a leader
• Followers: novice and advanced beginner
3. Laissez-faire- the follower decides
• Permissive style of leadership
• AKA ultraliberal—bahala na mga followers mo
• Followers: expert
• These leaderships are adopted depending on the
level of proficiency of the followers
o Use the Patricia Benner’s level of proficiency
→ Great man/ Aristotelian- leaders are born with
necessary characteristics to be great
→ Trait- traits are inherited, leadership must be molded
by learning and experience
→ Charismatic- inspire people
• Primary goal- to obtain emotional commitment
• Elusive- what may be charismatic to you may not
be charismatic to me vice versa, relative in
character
→ Path goal
• Penned by Robert Hours
• Minimize obstructions towards the goal
• Rewarding the followers if only a part and not the
concept
• Different from country club since its concept is to
look at the comfort of the followers
• Paano ba pumunta sa house? Through the path
hehe
→ Transactional
• I will rub your back, you rub mine
• Contractual in character
• Started with BF Skinner’s operant conditioning-
susundin ka lang nung dog incase ipeperform mo
yung stimulus
• Satisfy the need and you will get what you want
→ Transformational
• Best theory of leadership
• The leader empowers the follower to change
• (+) visions
Board Question
→ Discharge teaching was done, how to determine if it
was effective? Change should occur→ behavioral
change
Mastectomy Acceptance
→ Disturbed body image may occur→ behavioral change
→ Initial indication for effective discharge teaching- look
→ Most indicative of an effective DT/ behavioral change-
touch
If a patient refuses:
→ Educate first- resistance is an indication of anxiety d/t
lack of information
→ If the patient still resists, accept the decision of the
patient
→ Document the resistance
→ Contingent approach
• Fred Fiedler
• Adaptive style because the situation will dictate as
to what mechanisms will be done
o Situational leadership may be answered if
adaptive does not appear in the choices
Sources of Power Conflict
→ Power- the official authority to make a person follow a → Most common cause of conflict is break in the
certain directive chain of communication
• To solve, reattach the chain of communication
→ Position Conflict Resolution Status Assertive Cooperative
→ Authority- the legitimate authority to act, dapat (Lumaban
mayroong pinanggagalingan ang authority ng tao ka ba?)
→ Personal Avoidance
• A- aware that
there is conflict Lose-
Position Power
• A- do not lose
→ Legitimate power- power came from the very position, acknowledge the
you are respecting the authority of the power of the conflict
title of the person Smoothing
→ Coercive power- power comes from the capacity to • When you agree
inflict or impose punishment with something→
• Negative sanction power continue
Lose-
→ Reward power- authority comes from the capacity to • When you don’t
lose
give incentives, rewards, or positive sanctions agree with
something→
stop talking
Personal Power about it
→ Power comes from the characteristics of a person Compromise
→ Referent power- comes from the connection or • Shed off a right
association with powerful persons of both parties
→ Information power- a person holds unique information • Rights removed
that other persons need to accomplish their goal should be of
→ Charismatic power- obtain emotional commitment by equal value
Lose-
inspiring people • Meeting half way
lose
→ Expert power- a person has necessary knowledge and • Different from
negotiation
technical expertise in a certain field
because rights
waived can be of
Communication not the same
→ Encoder- sender value
→ Decoder- receiver Competition
→ Channel- vehicle or mode • A zero-sum
You are
→ Feedback- best way to determine if the effectivity of game Win-
winning at
communication • Forcing lose
the expense
• Only one should
of the other
win
Lines of Communication
Accommodation
→ Downward- superior→ inferior
• Cooperative
• Main function- directive Lose-
conflict
• E.g., memorandum—the most important win
resolution
characteristic is that the content must be clear • ACO nalang
o Memorandum creates an accountability, to be Collaboration
fair to the person whom it is addressed to • One of the
should be free of any ambiguity. Kapag hindi key concepts of
clear, hindi makakacreate ng accountability the BON in their
o Statements should be concise, legible last BON
newsletter
• Policy-making (manual)
• Best conflict
• Bulletin board- for information dissemination resolution
• Company emails- designated for information measure
dissemination • Original goal of
→ Upward- inferior→ superior both parties will
• Main function- reportive be dissolved and
• Incident report- confidential/ privileged both will create a
→ Lateral/ horinzontal- employee→ employee supra-ordinate
goal (overriding
• Main function- endorsement
guide for their
• Endorsement during the change of shifts courses of
• Peer review action)→ shared
These three should belong to the same line of service, goal/ Win-
differences are the ranks accomplished win
→ Diagonal- communication from different lines of goal (should not
service have an S in the
• Quality circle- all ranks are covered, with one boards)
representative • You need
members to
o Different members of different fields include
meet the goal
→ Grapevine- fastest informal means of communication which is to solve
• Two most common topics- salary increase and the problem,
laying off/ retrenchment how will it be
→ Outward- one is within the organizational structure the solved? A group
other should be outside must be
• Discharge teaching (nurse to patient) formed→ after
If a patient absconds (tumakas), validate if the patient really solving, (1)
absconded→ If yes, look at the nature of the risk→ if psych shared vision
patient and is at high risk, (+) safety concern→ alert the PNP (unity will occur)
and the Mayor’s office because the patient is a threat in the or (2) identity
local government issues (I want to
be myself, I do
 not want to be a Phases of Leadership Change
part of that 1. Unfreezing
group) may • (+) Awareness of change
occur
• You have to make the people recognize that there
• A group with
needs to be a change
shared vision
and unity will
2. Moving
create a team • Time that you have to instill the changes that you
want to do
Group vs. team • Actual process of change
Group- to solve a 3. Refreezing
problem, after this • Stability or the integration with change
group will disband
Team- to solve a Leader Manager
problem, after solving Do right things Motto Do things right
a problem you will • Quality • Quality
create a
improvement- assurance-
superordinate goal/
client-centered procedure-
shared vision and will
response centered
not disband
• Procedure will • Stick with the
adjust to the procedure
Mintzberg conflict resolution welfare of the regardless of
→ Validate the existence of conflict patient the welfare of
→ If (+) conflict, state the rules on how to resolve the the patient
conflict Change Challenge Continuity of
• Most important rule- no positional bargaining, you existence
cannot get the other party to go with what you want Purpose-oriented/ Focus Procedure
(you are asking the other party to surrender their rights) goal-oriented
→ Confront→ document→ report Futuristic/ prospective Time Present, kung ano
Frame meron ngayon ‘yun
Additional notes lang ang titingnan
→ UAP (unlicensed assistive personnel) are now called Strategies Methods Schedules
NAP (nursing assistive personnel) Why Questions What, when, where,
→ The orderly looks at the bag of one patient who • Explorative actions and how
underwent operation, what should the nurse do? Call • They are more
the attention or to continue to monitor (make sure that concerned by you
the orderly is going to do something first), but if the acted that way
orderly holds the bag; call the attention. The only Journey Outcomes Destination/
person with authority to hold the patient’s belonging is • Importante matuto outcome
only the staff nurse who is taking care of the patient sila along the way
Potential of one entity Human Actual capabilities of
Decision Making Types a person
→ Trying to choose a final course of action With or without Authority Always
• You can have decision-making without problem
solving (done when (+) identification of root NURSING MANAGEMENT
causes) → Planning
• Critical thinking is different from problem solving→ • Indirectly states that there is controlling
disciplined thinking because it is evidence-based → Directing- motivation of the staff
• Decision making can be done even without critical • Indirectly states that there is
thinking • Organizing- actual allocation of human resources
→ Operational Work of the subordinates
• Products or service-oriented decision making Planning
• Checks the inventory of materials → Thinking ahead
• Day-to-day decision-making process → Forecast- predict the condition of this specific item in
→ Swallow hard the future
• Making a decision against the will of the decider → What should you think of ahead? Standards—will
→ Considered become norm of conduct
• There is a conduct of consultation • It must be established by authorities/ experts→
• Consensual decision-making BON/ PRC
o A collective judgment of the group • Should be acceptable to the governed—the
→ 10-second governed should be informed
• Time-pressured decision making • Standards are used to define accountability
• Used when (+) time constraints (primary responsibility)
• Every part of the key activity you need to decide • Will become the basis whether the objectives
e,g., kulang pala yung pera sa pagpapagawa ng during the planning are accomplished
bahay kasi habang dinidelay, lalong tumataas ang
bayad, kaya you need to decide immediately Levels of
Manageme RN Skills Plan
Decision Making Models nt
→ Collegial- collective judgment of the group Top • Chief Personal Strategic-
nurse • highl long term
→ Cybernetic- updated type of decision-making plan (3-7
• VP for y
• EBPs nursing refin years)
• Uses the best available evidence at the time of service ed
decision-making skills
→ Political- majority rule Middle • Nursing Planning and Intermedia
→ Garbage can- previously scratched out/ scrapped supervisor organizing te planning
ideas are now the basis of decision • Head skills→ (2-3 years)
• But the idea can be modified nurse conceptual
• Independe
nt clinical
 nurse • Salaries of trabahador, whether marami ka ipagawa
specialist or konti same pa rin ang salary
Low • Charge Technical Operation → Flexible- budget that depends on the volume of the
nurse skills al (day-to- products or services
• Staff day, 1 • Cost of materials, depende gaano karami
nurse week to 1 ipagagawa
• Licensed year)
practical → Capital
nurses/ • 5-7 years of expectancy of the acquired
technical
equipment
vocational
nurse/ • Long-term, machineries, lands
licensed → Personal/ personnel
vocational • Manpower budget
nurse • Salaries
• Personal services- term in the government
Anything that requires critical thinking should be done by o Salary- regular payment
the nurse o Wage- piece rate basis- per hour, per project,
→ If the NAP assessed something wrong, should report to per day
the RN, still needs to be validated do not report to the
→ Operational
physician immediately
→ LVN can give medications—but not all, some states do • Contingent on the products or services so offered
not allow parenteral medication administration • Changes everyday
→ Routine activities can be done → Fixed
→ What drug should be delegated to LVN? • Periodical in character
• Dopamine- critical assessment is needed • Paid every month
• Lanoxin- N- 0.5-2 ng/ mL, assessment is still • Electricity and water bills
needed → Cash
• Lithium- narrow therapeutic value0- 0.5-1.5
• Unexpected expenses
• TCA- take about 2-3 weeks before it takes effect,
do not require much critical thinking
Models of Planning
Types of Strategic Planning → Gantt chart
→ Vision- future roles and functions • Time table
• End to be accomplished • Compares the time allotted and the task
accomplished
• Focus- institution or the group itself
→ PERT flow
→ Mission- statement of existence, Mi= Me
• Reasons for the existence of the organization • Program evaluation review technique
→ Goals and objectives • Key activities and key events are placed and then
the time (optimal, leeway, and pessimistic times
• Goals- concerned more with the general targets
are placed)
• Objectives- specific targets
o Leeway- allowable margin of freedom or
o Should be SMART
variation
• Focus- individual personnel
o Optimal- shortest delay
→ Policies and procedures
o Pessimistic- longest delay
• Policies- instructions to guide the decision-making
→ Critical pathway/ Clinical pathway
process
• PERT flow in the clinical setting
• Procedures- sequence of steps to standardize the
• Critical thinking is ONLY used here—disciplined
process
thinking backed up by evidence
• Discipline is the virtue applied in policies and
→ SWOT analysis/ TOWS
procedures, walang kwenta and policies and
• Strength, weakness, opportunity, threats
procedures if hindi mo naimplement nang tama
• Strategic planning
• SW- responsibility of the internal organization
Is discipline and punishment?
→ Discipline- molding of the mind for the conduct of the • OT- responsibility of the external organization
process itself → Decision tree
• General Key • Algorithm are based on the outcomes attached to
alternatives
→ Punishment- effect/ consequence of the failure to follow are looked every alternative
the discipline upon • For every alternative there is a tied outcome
→ Decision grid
→ Philosophy • Every key alternative is judged based on the set of
• Values and beliefs of the organization common criteria for every option that is adopted
• Organizational culture- values and beliefs UNIQUE by the decision-maker
to a certain organization Confirmation bias is a problem for all these models of
What do you call the process of integrating one self to planning, hindi pa tapos ang planned action pero may
the culture of an organization? Cultural assimilation or ineexpect na na outcome
acculturation
Organizing
Budgeting Types of Authority
→ A plan to allocate resources—assets, liabilities, → Line- permanent position not the
expenses, and revenues/ income person holding the position
→ Most important criterion of a budget—cost effectivity, • Solid line is used because it creates accountability
you get your money’s worth • (+) authority to direct
• Staff nurses and head nurses
→ Cost containment- balancing of the cost and return of → Staff- temporary position
income • No accountability
→ Fiscal/ accounting responsibility- individual • Authority is only up unto recommendation and
responsible for every expense, asset, liability, revenue, advisory only
and income
• Ad hoc groups- only for a specific undertaking
→ Rigid budget- will not vary on the volume of products or
services
Principles
Scalar Chain/ Chain of Command
→ Flow of authority from top to bottom
Centrality
→ Flow of authority from top to bottom and bottom to top
→ Middle level management is very important because
the middle level is the conduit of the top and bottom
• E.g., the nurse manager will receive feedback
from rank-and-file staff and receive memo from
the top management
→ If communication in the middle level is unclear or
disrupted principal’s syndrome will occur
• Anxiety for being called by the top management
without knowing why you are being called
Unity of Purpose
→ Common goal principle
→ Any member of the organization must work towards
the common goal
Principle of peripheral command, those at the ends of the
organization receive more inaccurate orders leading to
confusion. Dagdag bawas na kasi kapag parating na sa dulo
→ Accountability is still well defined
→ Staff should all be nurses
Functional Nursing
→ Task- oriented mode of staffing
→ More concerned with the hierarchical division of labor
→ Tasks are divided not the number of patients
→ 6 RNs: 24-50 pts
→ No continuity of care d/t rotation of tasks
→ May cause confusion to the patient
Team Nursing
→ Team leader should always be an RN
→ Five members are needed
→ 5 RNs: 20-50 pts
→ Possible: 2 RNs, 3 NAP
• Members do not need to be all nurses, can have
NAP members so long as supervision is done by
the nurse
→ Cost- effective measure (lower pays for the NAP)
Modular
→ Primary + team nursing

Unity of Command Directing

→ To avoid chaos principle Delegation
→ There should only be one source of → Primary purpose is to empower
command, accountability is well → Tasks that are not expected from you but you are
defined given because you are qualified to do
→ If A makes a mistake, A and C are → Task- can be delegated
accountable → Authority- can be delegated
→ Responsibility- can be delegated
Span of Control • Can attach to a normal prudent person
→ Range of authority → Accountability is never delegated
→ Ideal range of span of control: 4-6 employees* • Only the licensed person can be accountable,
because they have standards already
Esprit de Corps → Delegator (person who gives the instructions)
→ Team solidarity → Delegate/e (given the responsibility)
→ The body should move with the spirit
Assignment
Security of Tenure → Primary purpose is to potentiate
→ A person may not be removed from work without any → Job description is the basis
cause → Expected tasks that you need to do
→ Cause first before removal
→ Protection of employees Delegation Guidelines
→ Detailed and routine tasks are the only tasks that
Allocation per Shift should be delegated
Professional Non-Professional → Anything that requires critical thinking cannot be
Morning 45% delegated (HEMA)
Sa umaga pumutok and .45
• Routine ambulation
Afternoon 37%
Night 18%
• Nursing process (RN→ NAP)
Sa gabi pinutukan o H- health teaching
Convert the percentage to ▪ But this can be delegated to an LPN
decimal points Everything that a nurse does can be done by an LPN except
for blood transfusions and IV medications especially to
pediatric patients unless they have a separate certification
for it
o E- evaluation
o M- medications
→ If the personnel are only mentioned and no number,
o A- assessment
use 65% and 35%
→ Tasks that can be delegated to floating nurses
→ Make sure to round off, walang kalahating tao
• Parity of task principle- the customary nursing
interventions that s/he already does should be
Modes of Staffing
delegated to the floating nurse
Case Method
• E.g., from a surgical ward, delegate wound
→ The oldest mode of staging
dressing
• Traditional nursing
• Do not accept a delegate task if you do not have
→ AKA total patient care
the competency to do it
→ 1 RN: 1 pt
→ Best advantage- accountability because only one Controlling and Evaluation
nurse handled the patient → Accomplishments are evaluated against the
→ ICU setting predetermined standards set during the planning
phase
Primary Nursing
→ 24/7, from admission to discharge Continuing Quality Improvement
→ 1 RN: 4-6 pts, not expandable to limit accountability → Theory of Dr. Edward Deming
→ Donabedian framework
• Structure- hospital (including mission and vision)
• Process- staffs
o Easiest to innovate
• Outcome- patients
→ F- find a process to improve
→ O- organize a team to understand the process
→ C- clarify the current data/ present knowledge as to
that process (EBP)
→ U- understand the variabilities of the process
• What are the possible variables that may affect the
process it self
• Pareto principle- manipulate a certain cause
that will lead to a huge impact
o 80/20 rule- phenomenon that states that
roughly 80% of outcomes come from 20% of
causes
• Modify your focus efforts to have focus results
→ S- solve/ select the solution
• P- plan- what to implement
• D- do- do what is not done
• C/S- check/ study- did the result change when the
act was implemented
• A- act- continue, reinforcement of the act
• This is cyclical
→ There is no such thing as utopian state, everything can
be improved

Quality Assurance
→ The hospital will evaluate the staff using external
instruments
→ The staff will not be involved
Formal
→ Peer review- same rank will evaluate a person
→ Quality circle- different ranks will evaluate a person
→ Nursing audit- a certain committee that will be created
by the hospital (technical committee)
• May be external or internal
Performance appraisal
→ The staff will be evaluated and will contribute to the
evaluation process