nursing

nursing administration
bureaucratic
leader ship and manage ment
leadership democratic

Reported by:
Dialysis Unit Staff and O.R. Staff
NURSING ADMINISTRATION

 Nursing Administrator – Registered

nurse whose primary responsibility is the
management of health care delivery
services and who represents nursing
service.
 Levels of Nursing Administrative Practice

1. Nurse Executive - overall management of nursing

service (practice, education, research, administration,
etc.)
Functions:
Leadership
Development
Implementation
Evaluation

2. Nurse Manager - advocating and allocating

available resources to facilitate effective, efficient, safe
and compassionate care based on standards of
practice
LEADERSHIP AND MANAGEMENT

 I. Leadership
-The ability to direct or motivate others towards
the achievements of predetermined goals which
the leader may work towards influencing
individuals or group.

- Ability to influence others to perform or work to

the best of their ability.
 Nursing Leadership
- Ability of the nurse to influence others to deliver
the best nursing care system to one or more patients.

 Styles of Leadership
a. Autocratic/ Authoritarian
b. Democratic
c. Laissez Faire
d. Bureaucratic
e. Charismatic
 II. Management
It involves the coordination and integration of
resources (human/financial) through activities
that would accomplish specific goals and
objectives.

Management Position - Position in which

individual is appointed.
 Nursing Management
- Universal (Fayol)

- Process by which a cooperative group directs

action towards common goals. It involves
techniques by which a distinguish group of people
coordinates the services of the people.

- Process of coordinating actions and allocating

resources to achieve organizational goal.
 Levels of Management

Nursing
Level Hospital
Service

Top CEO/Directors Chief Nurse

Supervisors/Directo Nursing
Middle
rs of services Supervisors

1st level Managers of Units Head Nurses

 Roles of a Nurse Manger

1. Information Processing Role - manage information

needs
a. Monitor
b. Disseminator
c. Spoke person
2.Interpersonal Role – manage relationship with people
a. Figure heads
b. Leader
c. Liaison
3. Decision making Role – Taking actions when making
decisions
a. Entrepreneur
b. Disturbance handler
c. Allocates resources
d. Negotiator
 Difference Between Leaders and Managers
Variable Leader Manager
a. appointment may or may not be formal and legitimate
appointed
b. influence as long as the followers carry out previous task
want
c. authority as long as the followers both power and
want authority
d. relations relates personally in an relates according to
initiative manner their roles by enabling
where to act.
e. reward by personal By fulfilling
achievement organizational goals by
fostering collaborations
among members.
Do things right Do the right thing.
 Henri Fayol - Father of Management Process.

There are always 4 tasks:

a. planning
b. organizing
c. directing
d. controlling

Henri Fayol
(1841-1925)
 Henri Fayol’s 14 principles
a. Division of labor
b. Principles of authority.
c. Principles of discipline
d. Unity of command
e. Unity og direction
f. Subordination of individual interest for the common good.
g. Centralization and decentralization
h. Hierarchy.
i. Scalar process.
j. Orders
k. Equity
l. Stability- security of tenure.
m. Principle of initiative.
n. Remunerations/ compensation.
o. Esprit de corp.
 Four Management Functions
 A. Planning
-Predetermining the course of action
-Precede all other task
-Answers: What, Who, Why, When and How
- What to do
- Why do it
- Who is to do it
- When to do it
- How to do it
I. Purpose:
1. For achievements of goals and objectives.
2. Makes work meaningful.
3. Provide effective use of material resources.
4. Helps cope with crisis.
5. It leads to realization of the need for change.
 II. Kinds of Planning
1. Strategic Planning (Long Range)
- Defines the direction and growth of the organization.
- Ask the vital question: What are the right thingd to do?
- Prepared in the Upper level management
- Long term (3-5 yrears)

2. Operational Planning (Short Range)

- pertains to activities in specific departments of an
organization
- Ask the question: How does one do things right
- deals with tactics or techniques for accomplishing
things.
- prepared by middle or lower level managers
3.Continuous or Rolling Plan
- day to day activities
- task of staff nurse
- ex: modifying nursing care plan.

III. Tools
1. Vision
2. Mission
3. Values
4. Philosophy
5. Goals
6. Policies
7. Procedures
8. Rules
IV. Elements of Planning
1. Forecasting
2. Set Objectives
3. Strategies and Time Frame
4. Budget
5. Establishing procedures, policies and standards.

V.Steps
1. Clarify your problem.
2. Forecast.
3. Long range strategic plan.
4. Determine alternate plan.
5. Select you propose plan.
6. Check and evaluate your propose plan.
 Planning for Quality Assurance – is a process of
planning a target degree of excellence and taking
action to ensure that each patients receive the agreed
level of care.

1. Chart Audit
2. Quality circle
3. Patient care concurrent audit.
4. Peer review.
5. Critical care indicators.
6. Professional standard setting.
 Time Management
- a technique for allocating one’s time to setting
goals.
- Assigning priorities, identifying, and
eliminating wasted time and using managerial
technique to accomplish goals effectively.
- How you use you time.
 Principles
1. Planning for contingencies
2. Listing task
3. Inventory
4. Sequencing
5. Setting and keeping deadlines
6. Deciding on how much time will be spent
7. Delegate
 Tools in Project Management
1. Gantt Chart
- Shows task and schedule information
- Both management tool and communication
tool.

2. Pert Chart (Performance Evaluation and

Review Technique)

3. CPM (Critical Path Method)

- can calculate time and cost
- tool to analyze a project and determining
duration based on identification of critical path
through an activity network.
  B. Organizing
Utilization persons, method, policies, and procedures arrange
in a systematic process through delegation of function and
responsibilities for the accomplishment of goal.
Components
1. Responsibility
2. Accountability
3. Delegation
4. Coordination
5. Cooperation
Principles
1. Unity of command
2. Scalar principle
3. Excemption
4. Continuing responsibility
5. Centrality
 Concepts
1. Roles
2. Power
3. Status
4. Authority
5. Communication – transmission of opinions,
information, and intention between and among I
ndividuals.
a. it outline administrative control
b. use the policy making and planning.
c. use to evaluate strength and weakness or
present structure.
d. shows the relationship with other agencies.
e. use to orient new personnel in the
organization.
 Organization

- Consist of the structure and process which allow

the agency to enact its philosophy and utilize its
conceptual framework to achieve its goals.

- Refers to a body of persons , methods, policies

and procedures arranged in systematic process
through the delegation of functions and
responsibilities to accomplish its purpose.
MAJOR CATEGORIES OF ORGANIZATION

1. Formal Organization
- is a system of well defined jobs, each with a
measure of authority, responsibility and
accountability
- is designed to enable the people of the
enterprise to work most effectively in
accomplishing objectives.

2.Informal Organization
- Refers to largely to what people do because
they are human personalities.
- People work together because of their likes and
dislikes
Organizational Structure
Is a process in which a group is formed its channels authority,
responsibility and accountability, span of control and lines of
communication.

Patterns of Organizational Structure:

1.TALL OR CENTRALIZED STRUCTURE:
Responsible for only a few subordinates, there is narrow span
of control
Vertical nature of stucture, there are many levels of
communication.
2. FLAT OR DECENTRALIZED STRUCTURE:
Characterized by few levels and broad span of control, where
decision making is spread among many people.
Communication from lower to higher levels is easy and direct.
 Organizational Chart – a drawing that shows how the
parts of organization are linked.

TYPES OF ORGANIZATIONAL STRUCTURE:

1.LINE ORGANIZATION:
-Is the simplest and most direct type of organization
which shows that each position has general authority over
the lower position in the hierarchy.

-it is commonly found in large health care facilities.

-there is clearly defined superior – subordinate

relationships.

- authority, responsibility, accountability are

concentrated at the top.
 LINE ORGANIZATIONAL STRUCTURE

Chief Nurse
Executive

Clinical Nurse Nurse Nurse

Nurse Manager Manager Manager
Specialist

Staff Staff Staff

Nurse Nurse Nurse
2.FLAT ORGANIZATION:
It is a decentralized type, there is flattened scalar chain and
fewer levels of position.
Also known as horizontal organization, refers to an
organizatioal structure with fewer or no levels of intervention
between management and staff.

3. STAFF ORGANIZATION:
Is purely advisory to line structure with no authority to put
recommendation into actions.
EXAMPLE: Training and Research

4. FUNCTIONAL ORGANIZATION:
-where its unit is responsible for a given part of the
organization’s workload
-there is clear delineation of roles and responsibilities which
are actually interrelated.
 FUNCTIONAL ORGANIZATION STRUCTURE

CEO

Nursing Dietary Pharmacy Storeroom

Staffing – the process of determining the acceptable of mix
nursing personnel to produced a desired level of care and
meet the demand of care.

System of Assignment
1. Case Method - one on one; 1:1 - RN’s

2. Primary Nursing - 24 hours nursing.

3. Functional Nursing - division of labor: RN’s

4. Team Nursing - Pro and Non Pro

- Pro nurse will supervise the activity of non
pro.

5. Modular - Combination of primary and team.

Patient Classification System – it is a means of
categorizing the present patients on the basis of certain care
needs that can clinically observe by the nurse.

4 Categories

1. CAT I – Minimal care, Convalescence

2. CAT II – Moderate care,
- from emergency case, ex: patient coming from
O.R/R.R
- monitoring
3. CAT III – Maximum care
4. CAT IV – Intensive care (ICU)
 C. Directing
- Putting plans into action.
- Directing is the act of issuing
of orders, assignments,
instructions to accomplish the
organization’s goals and objectives.

Decision making – choosing option toward resolution of

problems/ achievements of goal.

1. Freedom to decide.
2. Capacity to make wise decision.
3. Your will on motivation and commitment to choose.
Elements of Directing

Delegation
- Technique of time management
- Major element of directing
- Nurse managers get the work done through their
employees with corresponding authority, responsibility
and accountability.

Priorities for delegation (Hansten and Jackson )

1. Know your world (practice, organization)
2. Know your organization (communication channels,
collaboration, resolution)
3. Know your practice ( professional, technical,
amenity, based on outcomes)
4. Know yourself (barriers, benefits)
5. Know your delegate (competency, motivation)
Reason for delegating
1. Assigning routine task
2. Assigning task for which nurse manager does not
have time.
3. Problem solving
4. Change in the nurse manager own job emphasis.
5. Capability Building

Common delegation errors

1. Underdelegating
2. Overdelegating
3. Improper delegation
 Supervision
is the process of guiding and directing the work to be done. It
entails motivating and encouraging the staff to participate in
activities to meet goals and objectives and personal
development, and in helping the staff to do their work better.
Supervisor- to most workers the supervisor is presumed as the
management because of her constant presence and close
association with them. For this reason, the supervisor is in a
position to exert strong influence in motivating individuals under
her supervisory jurisdiction.
Responsibilities of supervisors
a. Supervisors have the duty to teach and motivate the staff as
well as facilitate their work
b. They should delegate work responsibilities and be available
for consultation
c. They should perform assessment and evaluation of work
performance and conditions
Staff Development
-is a planned experience to help employees perform
effectively and to enrich their competence in practice,
education, administration and research.

Functions of staff development

a. To maintain staff efficiency and effectiveness
b. To create quality employees
c. To meet the staff needs and address their problems,
such as deficiencies in knowledge, skills and attitude
d. To motivate them and improve their self confidence
e. To help prepare them for greater responsibilities
e.g. in planning, orientation, continuing education- in
service, patient education, advisory and research
Coordination
- this activity links the different components of an
organization and leads them toward goal achievement.
- it creates harmony on all activities to facilitate success
of work. In a well coordinated organization, everything
has been delegated to guard against leaving loose ends

Collaboration
- the manager and the health care staff together with
the other members of the health care team all participate in
the decision making process. Sometimes they join forces
with another as the medical group or larger group, like
another health care team or one fulfilling a different role for
this purpose
 Communication
- is the process of exchanging information from sender
to receiver hoping that the messenger sent was
received as intended by the sender.

Elements of Communication

1. Sender – initiator of communication.

2. Receiver – receives information and translate it to
meaningful action.
Barriers to effective communication
1. Physical Barriers
2. Social/Psychological barriers
3. Semantics
4. Interpretations
Evaluation
- a desired result of any employee bahavior is effective
job performance. An important role of the manager is to
determine performance in advance and state desired
outcome of what has been done
- the purpose of evaluation is to determine how far or
how many of the organization’s objectives were
accomplished.

Purposes of Evaluation
a. provide constructive feedback
b. determine progress and worthiness of individual
nurse for greater responsibilities
c. serve as basis for promotion and increase in salary
or other similar rewards
Process of Directing
1. Analyze or identify the solution.
2. Developed alternatives.
3. Compare your alternatives.
4. Rate the risk.
5. Select the best alternatives.
6. Get into gear make it operative.
D. Controlling
- evaluating, using of performance standards as criteria
of measuring success and taking corrective actions,
assessing or regulating performance.
- an ongoing function of nursing management that occurs
during planning, organizing and directing activities.
- A continuous process.
- It includes policies, rules, procedures, self- control or
self- regulation, discipline, rounds, reports, audits,
evaluation devices, task analysis and quality control.
 Controlling Process
Expressed as: Ss + Sa + F + C = I
Where: Standards set + Standards applied + Feedback +
Correction yield= Improvement
Functions:
1. Monitoring and evaluate nursing care services.
2. Performance Appraisal – method of acquiring and
processing needed to improve the individual working
performance and accomplishment.
3. Standards – levels of performance that management
expects.

3 Types of Standard
a. structured – organized and deliver care.
b. process – actual nursing procedure.
c. outcomes – measuring result of nursing care.
Nursing Audit – documented the quality of nursing care in
keeping with the standards establish by the agency, nursing
service department.

Elements of Control
- Mechanical
- Sociological

Stages of Control

1. A predetermined definition of standards for level of

performance.
2. Measurement of current performance against the
standards. Corrective actions when indicated.
Good Control

1. Reflect the nature of activity.

2. Report errors promptly.
3. Be forward-looking.
4. Point out exceptions at critical points.
5. Be objective.
6. Be flexible.
7. Reflect the organizational pattern.
8. Be economical.
9. Be understanding
10.Indicate corrective actions.
The Evolution of Management Theory
 Classical
CLASSICAL Scientific
SCIENTIFIC Human
HUMAN Relations
RELATIONS Behavioral
BEHAVIORAL
A. Henri Fayol A. Frederick Taylor A. Mary Follete A. Abraham Maslow
- Father of - Father of Scientific - Law of situation - Hierarchy of needs
management management B. Elton Mayo - Satisfying needs for
- 4 Task: - principles of - Hawthorne Effect better productivity.
1. Planning observation and - 3 human factor that B. Herbert, Frederick
2. Organizing management affectsproductivity - 3 motivations
3. Directing - Harmonious 1. attention 1. achievements
4. Controlling relationship bet. labor 2. care 2. recognition
- 14 Principles in and management. 3. recognition 3. potential for
management B. Lilian and Frank C.Kurt Lewin growth
B. Max Weber Gilbreth - Different leadership
- Father of -Time and motion styles
Bureaucratic studies. D. Jacob Moreno
Organization -Job simplification - Effects of individual
- Command comes -Effects of establish work differences in
from 1 person plan and fatigue Interpersonal
- Rule instead of C. Henry Gantt relationship.
individual competence. -Problem of efficiency
C. Mooney -Gannt chart
- 2 Task only: -Pert chart
1.Directing and
Organizing
D. Urwick
- 3 task:
1. Planning
2. Coordinating
3. Controlling
LET HIM THAT
WOULD MOVE
THE WORLD,

FIRST MOVE
HIMSELF…

- Socrates
AUTHORITARIAN
(AUTOCRATIC)

I want both of you to. . .

PARTICIPATIVE
(DEMOCRATIC)

Let's work together to solve this. . .

LAISSEZ FAIRE
(DELEGATIVE)

You two take care of the problem while I go…

Bureaucratic Leadership Style
Style:
Everything is done
according to Leader Characteristics:
procedure or policy manages
“by the book”
Exercises power by
exercising fixed rules
Tends to relate
impersonally to staff