The act of influencing The process of leading

and motivating a and directing an

group of people to act organization to meet
in the same direction its goals through the
towards achieving a use of appropriate
common goal. resources.
 LEADERSHIP MANAGEMENT
• do not have delegated authority • legitimate source of power due
but obtain their power throughto the delegated authority
other means, such as influence
• focus on group process, • emphasize control, decision
information gathering, feedback,
making, decision analysis, and
and empowering others results
• have goals that may or may not
• greater formal responsibility and
reflect those of the organization
accountability for rationality and
control than leaders
• Henri Fayol (1925), first
identified the management
functions of planning,
organization, command,
coordination, and control.
• 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.
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.
thoritarian Leader characterized by the following behav
trong 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.
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.
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.
Hersey and Blanchard (1977), developed a Situational
Approach to leadership.
ridimensional leadership effectiveness model predicts wh
eadership 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.
• Burns (2003), suggest that both leaders and followers
have the ability to raise each other to higher levels of
motivation and morality.
ere are two 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.
 TRANSACTIONAL LEADER TRANSFORMATI0NAL LEADER
Identifies common values Focuses on management tasks
Is a caretaker Is committed
Inspires others with vision
Uses trade-offs to meet goals
Has long-term vision Does not identify shared values
Looks at effects Examines causes
Empowers others Uses contingency reward
uzes and Posner’s Five Practices for Exemplary Leadersh
zes and Posner’s Five Practices for Exemplary Leadersh
 MODES OF PLANNING DESCRIPTION
Reactive occurs after a problem exists
Inactivism seek the status quo
Preactivism utilize technology to accelerate
change and are future oriented
nteractive or Proactive attempt to plan the future of the
organization rather than react to it
• Forecasting involves trying to
estimate how a condition will
be in the future.
• Takes advantage of input from
others, gives sequence in
activity, and protects an
organization against
undesirable changes.
• 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.
 SWOT Analysis, also known as TOWS Analysis, was
developed by Albert Humphrey at Stanford University i
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.
 SWOT definitions:
• Opportunities are external conditions that promote
achievement of organizational objectives.
• Threats are external conditions that challenge or
threaten the achievement of organizational objectives.
• Formal structure, through departmentalization and work
division, provides a framework for defining managerial
authority, responsibility, and accountability.
• Roles and functions are defined and systematically
arranged, different people have differing roles, and rank
and hierarchy are evident.
• 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.
• Top-level managers look at the organization as a whole,
coordinating internal and external influences, and
generally make decisions with few guidelines or
structures.
• Middle-level managers coordinate the efforts of lower
levels of the hierarchy and are the conduit between
lower and top-level managers.
• First-level managers are concerned with their specific
unit’s work flow.
 TOP LEVEL MID LEVEL FIRST LEVEL
Chief nurse Unit supervisor Charge nurse
Department head Team leader
Primary nurse
Scope of Look at Integrating unit- Focus primarily on
responsibilityorganization as a level day-to-day day-to-day needs
whole as well as needs with at unit level
external influencesorganizational
needs
 TOP LEVEL MID LEVEL FIRST LEVEL
Primary Strategic planning Combination of Short-range,
planning focus long- and short- Operational
range planning planning
CommunicationTop-down but Upward and More often
flow receives downward with upward; generally
subordinate great centrality relies on middle
feedback both level managers
directly and via to transmit
middle-level communication to
managers top-level managers
• The leader-manager recruits, selects, places, and
indoctrinates personnel to accomplish the goals of
the organization.
1. Determine the number and types of personnel
needed to fulfill 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.
• 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.
• 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.
• 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.
 • 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
• The purpose of the orientation process is to make the
employee feel like a part of the team.
• This will reduce burnout and help new employees
become independent more quickly in their new roles.
• 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 may have in learning in specific areas.
 • Socialization refers to a learning of the behaviors that
accompany each role by instruction, observation, and
trial and error.
• 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.
• Centralized staffing, where staffing decisions are made
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.
 National Nurses United (2010–2013). RN to patient ratios. Retrieved June 9, 2013

UNIT STAFFING RATIO

Critical care/ICU 1:2
Operating room 1:1
Labor and delivery 1:2
Antepartum 1:4
Pediatrics 1:4
Medical–surgical 1:5
Emergency department 1:4
 Category I
1 – 2 hours of nursing care/day
Self care
Category II 3 – 4 hours of nursing care/day
Minimal care
Category III 5 – 6 hours of nursing care/day
Intermediate care
Category IV 7 – 8 hours of nursing care/day
Modified intensive care
Category V 10 – 14 hours of nursing care/day
Intensive care
 National League for Nurses Formula for Staffing

ABO X NCH= Total no. of nursing service

No. of working hours personnel for 24 hours

Where: Standard values for NCH:

ABO = Average Bed Occupancy Medical = 3.4 OB = 3.0
NCH = Nursing Care Hours Surgical = 3.4 Pedia = 4.6
No. of working hours: 8 Based on RA 5901
Mixed MS = 3.5 Nursery = 2.8
The 40 working hours per week law
Percentage of Professionals to Non-Professionals
Professionals - 60%
Non-Professionals - 40%

Percentage of Distribution per Shift

Morning - 45%
Afternoon - 37%
Night - 18%
 Staffing for an OB Ward: 30-bed capacity
Percentage of Professionals to Non-Professionals
 Staffing for an OB Ward: 30-bed capacity

30 x 3.0 = 11 nursing service

8 personnel for 24 hours

Percentage of Professionals to Non-Professionals

Professionals - 60% x 11 = 7
Non-Professionals - 40% x 11 = 4
 Distribution per Shift

SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS

AM AM
PM PM
NOC NOC
 Distribution per Shift

SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS

AM 7 X 0.45 = 3 AM 4 X 0.45 = 2
PM 7 X 0.37 = 3 PM 4 X 0.37 = 1
NOC 7 X 0.18 = 1 NOC 4 X 0.18 = 1
• 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.
 INTRINSIC EXTRINSIC
Comes from within the Comes from outside the
individual individual
Often influenced by familyRewards and reinforcements
unit and cultural values are given to encourage certain
behaviors and/or levels of
achievement
American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

• Right task
• Right circumstances
• Right person
• Right direction/communication
• Right level of supervision
1. Frequently recur in the daily care of a client or group
of clients
2. Are performed according to an established
(standardized) sequence of steps
3. Involve little or no modification from one client-care
situation to another
4. May be performed with a predictable outcome
North Carolina Board of Registered Nursing (2013)
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

North Carolina Board of Registered Nursing (2013)

 Quality control refers to activities that are
used to evaluate, monitor, or regulate
services rendered to consumers.
• Health-care quality is the degree to which
health services for individuals and
populations increase the likelihood of
desired health outcomes and are consistent
with current professional knowledge.
Hallmarks of effective quality control programs:
1. Support from top-level administration.
2. Commitment by the organization in terms of fiscal and
human resources.
3. Quality goals reflect search for excellence rather than
minimums.
4. Process is ongoing (continuous).
• Audit is a systematic and official
examination of a record, process,
structure, environment, or account
to evaluate performance.
• Auditing in health-care
organizations provides managers
with a means of applying the
control process to determine the
quality of services rendered.
• Retrospective audits are performed after the patient
receives the service.
• Concurrent audits are performed while the patient is
receiving the service.
• Prospective audits attempt to identify how future
performance will be affected by current interventions.
• Outcome audits reflect the end result of care or how the
patient’s health status changed as a result of an
intervention.
• Process audits are used to measure the process of care or
how the care was carried out and assume that a
relationship exists between the process used by the
nurse and the quality of care provided.
• Structure audit includes resource inputs such as the
environment in which health care is delivered.
Nursing is to nurture and care...
patient's life is in our hands,
so love our profession...
ITS A CALLING!
 rquis, B. L., & Huston, C. J. (2011). Leadership Roles and Management Functions in Nurs
eory and Application. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins