BSN4 Leadership & Management Notes PDF

LEADERSHIP & MANAGEMENT LEADERSHIP AND MANAGEMENT IN NURSING DEFINITION Ability to support others Leadership Desire to lead o The pro...

LEADERSHIP & MANAGEMENT LEADERSHIP AND MANAGEMENT IN NURSING DEFINITION Ability to support others Leadership Desire to lead o The process of leading or influencing a group of Intelligence people to accomplish goals o Subject-based Intelligence Management o People-based Intelligence o The process of dealing with or controlling things or people. It includes planning, organizing, directing and WAYS TO BECOME A LEADER controlling (PODC). 1. Make a commitment to a lifelong learning 2. Learn to write well DIFFERENTIATING LEADERSHIP FROM 3. Join a professional nursing association MANAGEMENT 4. Get involved in the community LEADERSHIP MANAGEMENT 5. Teach Doing the right thing Doing things right 6. Get politically involved Getting other people Getting other people to do what 7. Get certified to want to do they do not want to do 8. Serve on committees in your organization something 9. Give yourself a break Working on the Working within the system 10. Be proud to be a nurse system Does not have to Occupy formal position in an BASIC ROLES PERFORMED BY LEADERS occupy a formal organization Create an Inspiring Vision and Lead by Example managerial position o Establish shared values and set an example. Empower, Inspire and Energize People Inspiring, developing, Administering, maintaining, o Be enthusiastic, create a positive work environment. relying on people, relying on the system, requiring o Empower people, delegate authority requiring trust control Build and Lead a Team o Use team approach, facilitate cooperation, and TYPES OF LEADERSHIP involve everyone. Formal Leader o Trust your group and rely on their judgment. o A person who has given authority by virtue of his position to influence other members of the BASIC ROLES PERFORMED BY MANAGERS organization to achieve organizational goals. Interpersonal Informal Leader o As a symbol because of the position he occupies o A person who has no formal authority to influence o As a manager who hires, trains and fires others but possess special skills & talent to influence o As a liaison between contracts & lead other members of the organization. Informational o As one who monitors information CHARACTERISTICS OF LEADERS o Disseminates information from both external and Have a wider variety of roles than managers internal sources o As spokesperson or representative of the organization Focus on information gathering, feed backing, and empowering others Decisional o As entrepreneur, disturbance handler, allocator Emphasize interpersonal relationships o As trouble-shooter who handles unexpected Direct willing followers situations Have goals that may or may not reflect those of the o As negotiator when conflicts arise organization SKILLS OF A LEADER CHARACTERISTICS OF MANAGERS Inspires and Motivates Others Result or outcome oriented o As a leader, you are best able to help the members of Feel rewarded when accomplishing organizational goals your team connect what they do to the impact it has Interpreter and enforcer of unit and policy on customers and communities. Uses a combination of leadership styles Displays High Integrity and Honesty o Great leaders are honest and transparent, and have CORE VALUES OF AN EFFECTIVE LEADER high integrity-they do what they say they are going to Guiding vision do, and they walk their talk. Passion Integrity Solves Problems and Analyzes Issues Curiosity o What is required is not only excellent analytical Flexibility abilities, but also above-average people skills. Self-confidence  Drives for Results Acts as coach, Acts as boss o Great leaders have a higher level of perseverance facilitator, and servant and drive than most anyone else, and they can be Creates change Maintains stability counted on to get things done. Creates culture of Creates a culture of Communicates Powerfully and Prolifically integrity effectiveness o Great leaders communicate with their people often, Focuses on emotional Focuses on emotional distance and in a variety of different ways. connectedness Builds Relationships Open mind Expert mind o The stronger your relationships, the better a leader Listens Talks you will be. Displays Technical or Professional Expertise o The best leaders build on their technical and POWER professional skills over time, becoming valuable Is one’s capacity to influence others experts in their field and skilled at leading their team. o Reward Displays a Strategic Perspective ▪ Comes from the ability to reward others for complying. o Great leaders have a long-term vision of the future, and they avoid getting bogged down in the here and o Coercive ▪ Is the opposite of reward power and is based on now. fear of punishment if one fails to conform. Develops Others o Legitimacy o Just as they work to continuously develop and build ▪ Official position in the organizational hierarchy. their own technical and professional expertise, the o Referent best leaders set aside time to develop their work ▪ Is based on identification with a leader and what force. that leader symbolizes. Innovates o Expertise o The ability to innovate is a key skill for great leader. ▪ Gain through knowledge, skills and attitude. o Information SKILLS OF A MANAGER ▪ Comes from knowledge and access to Technical and Professional Skills information. o Relate to the proficiency in performing an activity in o Connection the correct manner with the right technique. ▪ Comes from coalitions and interpersonal Human Relationship Skills relations. o Pertain to dealing with people and how to “get along” with them. KINDS OF POWER Conceptual Skills Exploitative o Deal with the ability to see individual matters as they o Is the most destructive type. It subjects people to relate to the total picture whatever use the power holder chooses o Develop creative ways of identifying pertinent factors Manipulative o Respond to big problems o Is influence over another person that may have been invited because of the person’s desperation and DIFFERENCES BETWEEN A LEADER AND anxiety. MANAGER Competitive LEADER MANAGER o Is energy used against another. Innovates Administers Nutrient Original Copy o Such as parent’s caring for their children or teacher’s Develops Maintains caring for students, Integrative Focuses on People Focuses on systems o Is cooperative power with others. Inspires trust Relies on control AUTHORITY Long – range Short – range perspective The right to direct others perspective Legitimate power and is determined by: Asks what and why Asks how and when o Rules - legitimize authority. Eyes on the horizon Eyes on the bottom line o Role - position or office. Originates Imitates o Relations - related to credibility, obtained through Challenges status Accepts status quo knowledge and expertise. quo His or her own person The classic good soldier FORMS OF AUTHORITY Creates vision and Plans and budgets Line Authority strategy o Direct supervisory authority from superior to Allows room for Generally directing and subordinate. others to grow and controlling ▪ Chain of command – unbroken line of reporting change relationships that extends through the entire Reduces boundaries Creates boundaries organizations. Relationship with Relationship with people is ▪ Unity of command – states that each person in people is based on based on position power an organization should take orders from and personal power reports to only one person.  ▪ Span of control – number of employees that HERSEY AND BLANCHARD’S THEORY should be placed under the direction of one Leadership style is based on the level of the follower’s leader-manager. maturity Staff Authority The effective leader changes or adapts her or his o Based on expertise and which usually involves leadership style to match the follower’s needs and advising line managers. attempts to increase the follower’s level of maturity Team Authority o Granted to committees or work teams involved in an INTERACTIONAL LEADERSHIP THEORIES organization’s daily operations. TRANSFORMATIONAL TRANSACTIONAL Identifies common Does not identify shared HISTORICAL DEVELOPMENT OF LEADERSHIP values values THEORY Cooperative Competitive GREAT MAN THEORY Process Focus Task Focus From Aristotelian philosophy, asserts that some people Attend to the needs & Identify the needs of followers are born to lead whereas others are born to be led. motives of followers Role models Caretakers TRAIT THEORY Provide sense of Focus on day-to-day Assumes that some people have certain characteristics or direction operation personality traits that make them better leaders than Self-management Management by exception others. MOTIVATIONAL THEORIES BEHAVIORAL THEORIES Reinforcement Theory Developed by Kurt Lewin o Based on the research of B.F. Skinner, views motivation as learning AUTHORITARIAN LEADER o Leaders are more effective when they can control or Leadership is based on centralized decision making even manipulate the consequences of a follower’s The leader makes decision & expects subordinates to behavior obey Expectancy Theory The leader uses his power to command others & to control o People’s expectations about a situation also help them determine their behavior Communication flows downward Equity Theory Emphasis is on “I” and “You” o The degree of perceived fairness in the work situation Criticism is punitive (castigatory, disciplinary, corrective & is the key to job satisfaction and worker effort. retaliatory Path Goal Theory o The leader facilitates task accomplishment by DEMOCRATIC LEADER minimizing obstructions to the goals and by rewarding followers for completing their tasks. Leader allows others to participate in decision making and to share authority CURRENT CONTEMPORARY THEORIES Economic and ego awards are used to motivate CHARISMATIC THEORY Others are directed through suggestions and guidance Communication flows up and down Leaders who have charisma are able to make an Emphasis is on “We” emotional connection with their followers Criticism is constructive SERVANT LEADERSHIP THEORY LAISSEZ - FAIRE Leaders wants to serve others rather than being served Leader refers decision making to his followers Often permissive & tends to be distant or uninvolved SCIENTIFIC MANAGEMENT THEORIES Provides little or no direction FREDERICK TAYLOR “FATHER OF SCIENTIFIC Uses upward and downward communication between MANAGEMENT THEORY” members Postulated that if workers could be taught the “one best Places emphasis on the group way to accomplish a task,” productivity would increase. Does not criticize o Applied the principles of observation, measurement and scientific comparison to determine the most SITUATIONAL / CONTINGENCY LEADERSHIP efficient way to accomplish a task through the use of MARY PARKER FOLLET’S “LAW OF SITUATION” stopwatch studies. Four Principles The leadership style vary according to the situation or the o Traditional “rule of thumb” work methods based on a employees involved scientific study of the tasks. o A scientific personnel system must be established so FIEDLER’S THEORY workers can be hired, trained, and promoted based A leader's behavior depends on the interaction of the on their technical competence and abilities. leaders’ personality and the particular needs of the o Workers should be able to view how they “fit” into the situation organization and how they contribute to overall organizational productivity.  o The relationship between managers and workers o Remuneration should be cooperative and interdependent, and work ▪ Employees receive fair payment for services should be shared equally. o Centralization ▪ Consolidation of management functions; FRANK AND LILLIAN GILBRETH decisions are made from the top. Also did a pioneering work in time and motion studies o Scalar Chain (line of authority) ▪ Formal chain of command running from top to Emphasized the benefits of job simplification and the bottom of the organization establishment of work standards, as well as the effects of o Order the incentive wage plan on work performance. ▪ All materials and personnel have prescribed values and places, and they must remain there HENRY GANTT o Equity Introduced the Gantt chart, which is useful in evaluating ▪ Equality of treatment progress of several activities that are carried out o Personnel Tenure simultaneously and must coalesce in order to reach a ▪ Limited turnover of personnel; lifetime particular goal by an established target date. employment for good workers o Initiative ▪ Thinking out a plan and do what it takes to make it happen o Esprit de corps ▪ Harmony, cohesion among personnel LUTHER GULLICK Expanded on Fayol’s management functions in his introduction of the “Seven Activities of Management”(POSDCORB): o Planning o Organizing o Staffing CLASSICAL THEORIES o Directing MAX WEBER o Coordinating Father of “Bureaucratic Theory” o Reporting o Emphasis on rules, regulations & structure within the o Budgeting organization to increase efficiency o Focused on employee competence as the basis for HUMAN RELATIONS THEORISTS hiring and promotion ELTON MAYO o Proposed “bureaucracy” as organizational design Founder of the “Human Relations Movement” Characteristics of Bureaucracy He conducted the Hawthorne studies, wherein he o A clear division of labor discovered that when management paid special attention o A well-defined hierarchy of authority in which to workers, productivity was likely to increase. superiors are separated from subordinates o Bureaucrats are not free to act in any way they please. CHESTER BARNARD o A system of procedures for dealing with work Known for the “Acceptance Theory of Authority” and situations must exist said that authority depends on the acceptance by the followers. HENRI FAYOL He said that formal channels of communication must be “Father of Systematic Management” known and should be as short as possible. o He identified the management functions of planning, organization, command, coordination, and control. BEHAVIORAL SCIENCE THEORIES Principles of Management ABRAHAM MASLOW o Specialization of Labor Father of “Humanistic Psychology” ▪ Encourages continuous improvement in skills and o Theorized that man’s various needs form a hierarchy the development of improvements in methods starting with their more basic needs. o Authority ▪ The right to give orders and the power to exact FERDINAND HERZBERG obedience Came up with the “Two-Factor Theory” o Discipline o Two factors that influence people: ▪ No slacking or bending of rules ▪ Hygiene – negatively influence people. o Unity of command ▪ Motivation – results in satisfaction and ▪ Each employee has one and only one boss psychological growth. o Unity of direction ▪ A single mind generates a single plan and all play their part in that plan DOUGLAS MCREGOR’S o Subordination of Individual Interests THEORY X THEORY Y ▪ When at work, only work things should be PROPOSES THAT MAN IS pursued or thought about Lazy Is responsible  Unmotivated Creative Irresponsible Self-possessed Unintelligent Self-directed Not interested to work Problem solver WILLIAM OUCHI Formulated Theory Z o Collective Decision Making o Long Term Employment o Slower but more predictable promotions o Indirect Supervision o Holistic concern for employees Tends to promote stable employment, high productivity & high employee morale/satisfaction 7 Basic Criteria that Characterized Japanese “Seven S”: o Hard S: superordinate goals strategy structure system o Soft S: staff, skills, style RENSIS LIKERT Four types of management systems: Impoverished Management o A. Exploitative-authoritative o Low Results/ Low People ▪ Decisions are imposed on subordinates ▪ Manager is ineffective. ▪ Motivation is characterized by threats ▪ Low regard for creating systems that get the job ▪ High levels of management have great done. responsibilities, lower levels have none ▪ With little interest in creating a satisfying team ▪ Very little communication and no joint teamwork environment o B. Benevolent-authoritative ▪ Results are inevitably disorganization, ▪ Leadership is condescending to employees dissatisfaction and disharmony ▪ Motivation is mainly by rewards Authority - Compliance Management ▪ Managerial personnel feel responsibility but lower o High results/Low people levels do not ▪ Strong focus on task, but with little concern for ▪ There is little communication and little teamwork people. o C. Consultative ▪ Focus on efficiency, including the elimination of ▪ Leadership is by superior who have substantial people wherever possible. but not complete trust in their subordinates ▪ This manager views people as tools of ▪ Motivation is by rewards & some involvement production. Workers are paid to do what they are ▪ Responsibility for setting goals is fairly general told without questioning. ▪ There is some communication and moderate Country Club Management amount of teamwork o High people/Low results o D. Participative ▪ Care and concern for the people, with a ▪ Superiors have complete confidence in their in comfortable and friendly environment and their subordinates collegial style. But a low focus on task may give ▪ Motivation is based on economic rewards questionable results. ▪ Personnel at all levels feel responsibility Middle of the Road Management ▪ Much communication ,substantial amount of o Medium results/Medium people cooperative teamwork ▪ A weak balance of focus on both people and the work. Doing enough to get things done, but not ROBERT BLAKE AND JANE MOUTON pushing the boundaries of what may be possible Developed the “Managerial Grid” Team Management o Which describes concern for people and concern for o High results /High people production ▪ Managers are passionate about their work and does the best they can for the people they work with. ▪ Create an environment based on trust and respect which leads to high satisfaction, motivation and excellent results  MANAGEMENT PROCESS PRINCIPLES OF PLANNING Planning Documented o Thinking ahead VMGO & Philosophy o Making future projections to achieve desired results Continuous Process Organizing Persuasive within the organization o Establishing formal authority Utilizes all available resources Controlling Precise in its scope &nature o Assessing/regulating performance Time bound Directing o Actuating efforts to accomplish goals IMPORTANCE OF PLANNING Provides for effective use of available resources PLANNING: Provides the basis for control THINKING AHEAD MAKING FUTURE PROJECTIONS Helps coping with crises TO ACHIEVE DESIRED RESULTS Leads to the realization of the need for change Develop and schedule programs; define activities needed Leads to achievement of goals/objectives and set time frame Gives meaning to work Set objectives; determine results desired Cost Effective Prepare budget; allocate resources Based on past and future activities Forecast; estimate future Establish policies, procedures , define course of action and methods ORGANIZING: ESTABLISHING FORMAL AUTHORITY Set up organizational structure, identify groupings, roles, relationships Determine staff needed; develop & maintain staffing patterns distribute in areas as needed Develop job descriptions; define qualifications and functions of personnel DIRECTING: ACTUATING EFFORTS TO ACCOMPLISH GOALS Utilization of nursing modalities through nursing process Communicate; ensure common understanding via various TYPES OF PLANNING routes Tactical Planning Utilize/revise/update policies and procedures o Process of taking the strategic plan & breaking it Supervise; harmonize goals thru guidance down into specific, short-term activities and plans Coordinate; unite personnel and services o Covers the period from today through to end of year Develop people; provide staff development programs three Decide/make judgment Strategic Planning o Long range-plan CONTROLLING: o Usually 3-10 years ASSESSING/REGULATING PERFORMANCE o Once or twice a year Specify criteria and standards utilize performance o Focuses on vmgo, & philosophy standards Monitor and evaluate nursing care or utilization of DIFFERENCES: resources STRATEGIC TACTICAL Performance appraisal; assess interpret correct apply PLANNING PLANNING discipline Done by upper Done by lower level management management Emphasizes Emphasizes analyzing the analyzing the future everyday functioning of the organization Based primarily on a Based on known circumstances prediction of the that exist within the organization future SWOT ANALYSIS STRENGTHS Are those internal attributes that help an organization to achieve its objectives o Highly-skilled clinical staff  o Hospital has a strong philosophy of openness, ▪ Example: ‘To provide quality education for the sharing and commitment to increasing patient total development of health care providers who confidence are valued for excellence in practice, research & o Good nurse-physician relationship extension.’’ o Excellent patient satisfaction scores Philosophy Statement o A statement of beliefs and values that direct one’s WEAKNESSES life or one’s practice Are those internal attributes that challenge an organization o Flows from the purpose or mission statement and in achieving its objectives delineates the set of values and beliefs that guide o Low rate of BSN prepared nurses all actions of the organization o Nurses not available to meet patients ▪ Example: The Nursing Division believes that : o Not enough staff time to plan more events “Man is a unique rational individual with dignity o Staff not clear of their role in the patient relationship and worth whose needs & rights are to be o Services too stretched for additional activity respected in his lifetime throughout the continuum of health, illness, recovery or death OPPORTUNITIES irrespective of his beliefs, color, political Are external conditions that promote achievement of affiliation. organizational objectives Goal Statement o Nursing vacancy rate is 7% o Desired result toward which effort is directed, aim of o Active volunteer committee willing to plan and philosophy organize events o It should be measurable and ambitious but realistic o Head Nurse is willing to flex clinic times to free up ▪ Example: “To produce globally competitive health clinical staff time care providers who can create a culture of o Location of the hospital serves large population innovation in the practice of the profession & assume responsibility in harmony with values, THREATS rights & dignity Are external conditions that challenge or threaten the Objectives achievement of organizational objectives o More specific than goals ; identify how and when the o High turnover of new graduates within 2 years of goal is to be accomplished employment o Explicit, measurable, observable or retrievable, and o Economic conditions is affecting ability to meet obtainable budget o Have a specific time frame o Lack of technology advancement and updates o Example: services ▪ Offer a baccalaureate program in nursing which is CHED compliant ▪ Ensure that curricular program is reviewed yearly SIMPLE RULES FOR SWOT ANALYSIS: & every five years Be realistic about the strengths and weaknesses of your ▪ Ensure that 100% of the faculty members are organization Be clear about how the present organization differs from what might be possible in the future C. DEVELOPING AND SCHEDULING PROGRAMS, Be specific about what you want to accomplish STRATEGIES; SET THE TIME FRAME Always apply SWOT in relation to your competitors Strategies o Techniques, methods or procedure Keep SWOT short and simple Programs Remember that SWOT is subjective o Activities put together to achieve desired goals Time Management ELEMENTS OF PLANNING o Manager’s most important resource A. FORECASTING Trying to estimate how a condition will be in the future D. BUDGETING Looking into the future and deciding in advance where the A financial plan that estimates expenditures and revenues agency would like to be and what is to be done in order to by an agent for a stated future period. get there It includes estimated expenses as well as income for a period of time. B. SETTING THE VISION, MISSION, PHILOSOPHY, Fiscal planning requires flexibility, ongoing evaluation, and GOALS & OBJECTIVES revision. Vision Statement o Used to describe future goals or aims of an COMPONENTS OF BUDGET organization o Gives the organization something to strive for Cash Budget ▪ Example: “A premier College of Nursing o Forecasts the amount of money received proactively preparing professional health care o Consists of beginning cash balance, estimates of the providers who will strengthen & improve the receipts and disbursements, and the estimated health of communities worldwide.” balance for a given period corresponding to that of the Mission Statement operating and capital budgets. o Outlines the agency’s reason for existing, who the Operating budget target clients are and what services will be provided o Deals with salaries, supplies, employee benefits, in- service education, travels to professional meetings,  books, periodicals, supplies, repairs and BUDGETING METHODS maintenance. Incremental Budgeting o The operating budget is composed of the revenue o A budget prepared using a previous budget or actual and the expense budget. performance as a basis incremental amounts added Capital Expenditure for the new budget period o Consists of accumulated data for fixed assets that are o It encourages “spend up to the budget” to ensure expected to be acquired during the budgeted period. reasonable allocation in the next period o Include estimated costs and sources of funds for o It leads to a “spend it “ or “lose it” mentality expected replacements, improvements and additions Zero-Based Budgeting to fixed assets. o Managers who use this method must rejustify their program or needs every budgeting cycle BENEFITS DERIVED FROM BUDGETARY PROCESS o Justifies in detail the cost of all programs, both both Planning old and new in every annual budget preparation o Budgeting stimulates thinking in advance o The money you take in and money you spend should o It leads to specific planning such as the volume & equal out to zero type of services to be rendered & revenue to be Flexible Budgeting derived o Budgets that adjust automatically over the course of o Budget preparation stimulates action and interaction. the year depending on variables such as volume, Coordination labor costs, and capital expenditures o Has a balancing effect on the total organization. o Most health care institutions adopt this method o Encourages exchange of information. Ideas are Performance Budgeting traded thus fostering interest in and understanding of o Reflects the input of resources and the output of the budgetary process. services for each unit of an organization. o The budget process stimulates team play or team o Practice of developing budgets based on the approach. relationship between program levels and expected Controlling results from that program o Budgeting gives the administration an opportunity to evaluate the thinking of the budget contributor E. ESTABLISHES POLICIES AND PROCEDURES o Comparison between actual expenditures and Policies budgeted standards can be made with little or no o Broad guidelines that govern the action of workers effort. and supervisors at all levels o Budgeting tends to define fixed and agreed upon o Statement of expectations that sets boundaries for goals. action taking and decision making o Implied policies ▪ Is neither written nor expressed verbally, have usually developed over time and follow a precedent. o Expressed policies ▪ Are delineated in writing Procedures o Specific directions for implementing written policies o Delineate a sequence of steps of required action o Identify the process or steps needed to implement a policy and are generally found in manuals at the unit level of the organization Rules o Plans that define specific action or non-action o Describe situations that allow only one choice of action o Rules are fairly flexible, so the fewer rules, the better OVERCOMING BARRIERS TO PLANNING The organization can be more effective if movement within it is directed at specified goals and objectives. Because a plan is a guide to reach a goal, it must be flexible and allow for readjustment as unexpected events occur. The manager should include in the planning process all people and units that could be affected by a plan. Plans should be specific, simple, and realistic because a vague plan is impossible to implement. Know when to plan and when not to plan. Good plans have built-in evaluation checkpoints so that there can be a midcourse correction if unexpected events occur.  NURSING MANAGEMENT FUNCTION: ELEMENTS OF ORGANIZING ORGANIZING A.SETTING UP THE ORGANIZATIONAL STRUCTURE Organizing Organizational Structure o Involves establishing a formal structure that provides o A system used to define hierarchy within an the best possible coordination for the use of organization resources to accomplish unit objectives o Outlines the roles, responsibilities, relationships o Determines what tasks are to be done, who is to do between individuals within an organization these, how the tasks are to be grouped, who reports to whom & what decisions are to be made ORGANIZING PRINCIPLES Unity of Command o Although employees may interact with many different employees in the performance of their duties, they should report to only one superior. Scalar Principle or Hierarchy o Authority and responsibility should flow in clear unbroken lines from the highest executive to the lowest. o In scalar chain, the following must be observed: ▪ When responsibility for a particular job is delegated to a subordinate, the latter should have authority over resources needed to accomplish the task; ▪ When responsibility for a particular job is delegated to a subordinate, the superior’s own responsibility is in no way diminished and ▪ When a person is delegated the authority for FIVE MAJOR CHARACTERISTICS OF AN action, he is accountable for his actions to the ORGANIZATIONAL CHART: person that delegated him such. Division of Work – each box represents the individual or Homogenous Assignment or Depart mentation sub-unit responsible for a given task of the organization’s o Workers performing similar assignments are grouped work load. together for a common purpose. Chain of Command – lines indicate who reports to whom Span of control and by what authority. o Refers to the number of employees that should be Type of Work to be Performed – indicated by labels or placed under the direction of one leader-manager. descriptions for the boxes. Exception Principle Grouping of Work Segments – shown by the clusters of o Recurring decisions should be handled in a routine work groups manner by lower-level managers whereas problems Levels of Management – indicating individual and entire involving unusual matters should be referred to the higher level. management hierarchy. Decentralization or Proper Delegation of Authority o The process of conferring specified decision making SYMBOLS IN ORGANIZATIONAL CHART to the lower levels of the organization. TYPES OF ORGANIZATION CLASSIFIED BY NATURE OF AUTHORITY Position or rank Line Organization o The simplest and most direct type of organization in Staff or Functional Relationship which each position has general authority over the lower position in the hierarchy. o In this structure, authority and responsibility are clearly defined, which leads to efficiency and simplicity of relationships. Types of Organization Classified by Nature of Authority Line relationship in terms of authority; direct line Informal organization Coordinating o Refers to horizontal relationships rather than vertical. This is composed of small groups of workers with Reporting and communicating similar interests. Staff organization o Purely advisory to the line structure with no authority TYPES OF ORGANIZATIONAL STRUCTURE to put recommendations into action Line Structure/Bureaucratic/ Pyramidal Functional organization o Traditional, highly centralized o One where each unit is responsible for a given part of o Oldest and simplest form with the principle of chain of the organization’s workload. command o Each position has general authority over the lower position  Flat Organizational Structure o Removes the hierarchical layers by flattening the scalar chain and decentralizing the organization o More authority and decision making can occur Free-form Structure o “Matrix organization” o Facilitates efficiency and effectiveness through cooperation o Has formal vertical and horizontal chain of command TWO COMMONLY USED TYPES OF ORGANIZATIONAL STRUCTURE IN NURSING Flat or decentralized o Modern, fewer levels of hierarchy, broader span of control, greater delegation, lesser control over subordinates Ad Hoc Design Pyramidal or centralized o Used temporarily to facilitate completion of a project o Traditional, more levels of hierarchy, narrower span of within a formal line organization control, lesser delegation, more control over o Dissolved after a project is completed subordinates B. STAFFING The process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patient’s demand. Two Types of Addressing Staffing Needs: o Decentralized staffing ▪ Unit managers are the one scheduling decisions ▪ The staff feels more in control of their work environment because they are able to take personal scheduling requests directly to their immediate supervisor. o Centralized staffing ▪ Staffing decisions are made by personnel in a central office  ▪ Manager’s role is limited to making minor adjustments and providing input. ▪ Fairer to all employees because policies tend to be employed more consistently and impartially. ▪ Allows for the most efficient or cost effective use of resources. Patient care classification o Method of grouping patient according to the amount and complexity of their nursing care requirements and the nursing time and skills they require. To develop a workable patient classification system, the nurse manager must determine the following: o The no. of categories into which the patients should be divided o The characteristics of patients in each category; o The type and number of care procedures that will be needed o The time needed to perform these procedures CATEGORIES/ LEVELS OF CARE Level I: Self-care or Minimal Care o Patient can take a bath on his own, feed himself perform his activities of daily living o Under this category are patients about to be discharged, those in non-emergency, newly admitted & requires little treatment/observation o Average amount of nursing care hours per patient per day is 1.5H o Ratio of professional to non-professional nursing personnel is 55:45 Level II: Moderate Care or Intermediate Care COMPUTING FOR THE NUMBER OF NURSING o Need some assistance in bathing, feeding or ambulating for short period of time. PERSONNEL NEEDED o Extreme symptoms of their illness must have subside There should be sufficient staff to cover all shifts, off- or have not yet appeared, vital signs ordered up to duties, holidays, leaves, absences, and time for staff three times per shift, intravenous fluids or blood development programs transfusion RA 5901 (Forty Hour Week Law), provides that employees o Semi-conscious and exhibiting some psychosocial or working in hospitals with 100-bed capacity and up will social problems work only 40 hours a week o Average nursing care hours per patient per day is 3H Employees working in hospitals with less than 100-bed and the ratio of professional to non-professional capacity will work 48 hours a week and therefore will get personnel is 60:40 only one off-duty a week Level III: Total, Complete or Intensive Care This is quite clear in the Exemplary Note of RA 5901 o Completely dependent upon the nursing personnel which states: o Provided with complete bath, are fed, may or may not o As compared with the other employees and laborers, be unconscious, with marked emotional needs, with these hospital and health clinic personnel are over- vital signs more than 3x shift, with continuous oxygen worked despite the fact that their duties are more therapy, and with chest or abdominal tubes delicate in nature. If we offer them better working o Average Nursing Care hours needed/patient/day is conditions, it is believed that the "brain drain", that our 4.5 hours country suffers nowadays as far as these personnel o Ratio of professional to non-professional is 65:35 are concerned will be considerably lessened. Level IV: Highly Specialized Critical Care o The fact that these hospitals and health clinics o Need maximum nursing care personnel perform duties which are directly o Need continuous treatment and observation concerned with the health and lives of our people o With many medications, IV piggy backs; vital signs does not mean that they should work for a longer every 15-30 minutes; hourly output period than most employees and laborers. o There are significant changes in doctor’s orders and o They are also entitled to as much rest as other o Each patient may need care of up to 6– 7 hours or workers. Making them work longer than is necessary more per day may endanger, rather than protect the health of their o Ratio of professionals to non-professionals also range patients. Besides, they are not receiving better pay from 70:30 to 80:20 than the other workers. o Therefore, it is just and fair that they may be made to enjoy the privileges of equal working hours with other workers except those excepted by law. (Sixth Congress of the Republic of the Philippines, Third Session, House of Representatives, H. No. 16630)  o Categorize to professional and non-professional personnel. Ratio of professionals to non-professionals in a tertiary hospital is 65:35 o Distribute by shifts: 45% am, 37% pm, 18% night DISTRIBUTION BY SHIFTS Morning or Day Shift = 45 - 51% Afternoon Shift = 34 – 37 % SCHEDULING Night Shift = 15 – 18% Schedule is a timetable showing planned workdays and shifts for nursing personnel STAFFING FORMULA Factors considered in making schedules: o Different levels of nursing staff Find the number of nursing personnel needed for 250 o Adequate coverage for 24 hours, seven days a week patients in tertiary hospital. o Staggered vacations & holidays o Categorize the patients according to levels of care o Weekends needed o Long stretches of consecutive working days o Evening and night shifts o Floating Types of scheduling o Centralized schedule: is done by one person, usually the Chief Nurse or her designate o Decentralized schedule: is done either by the supervisor or head/senior nurse of the particular unit o Find the number of nursing care hours (NCH) needed o Cyclical schedule: Covers a designated number of by patients at each level of care per day. weeks called the cycle length and is repeated thereon. Advantages of cyclical schedule: ▪ It is fair to all ▪ It saves time as the schedule does not have to be redone every week or two. ▪ It enables the employees to plan ahead for their personal needs preventing frequent changes in schedule. ▪ Scheduled leave coverage such as vacation, o Find the total NCH needed by 250 patients per year – holidays, and sick leaves are more stable. Total NCH/day x days/year ▪ Productivity is improved ▪ A four-week cyclical schedule: o Find the actual working hours rendered by each nursing personnel/year – (hrs/day)(working days/year) o Find the total number of nursing personnel needed MODALITIES OF CARE Nursing care assignments Sometimes called: o Modalities of nursing care  o Systems of nursing care Primary Nursing o Patterns of nursing care o A registered nurse is responsible for the total care of o Nursing care models a small group of patients from admission to discharge. A. Functional Nursing o Secondary or associate nurses execute the nursing o Task-oriented in which a particular nursing function is care plan during the afternoon and night shifts and on assigned to each worker days when the primary nurse is off-duty. o This method divides the work to be done with each o Assume a 24-hour responsibility for nursing care person being responsible to the Head or Senior Nurse o Advantages ▪ It allows most work to be accomplished in the Modular Method shortest time possible. o A modification of team and primary nursing ▪ Workers learn to work fast o It differs from team nursing in that the registered ▪ Because the tasks are repetitive, they gain skills nurse provides direct nursing care with the assistance faster in that particular task. of aides o Disadvantages o It is similar to primary nursing in that each pair or trio ▪ Fragmentation of nursing care and therefore of nursing personnel is responsible for the care of holistic care is not achieved. patients from admission to discharge. ▪ Nurse’s accountability and responsibility are diminished. C. DEVELOPING JOB DESCRIPTION ▪ Patients cannot identify who their “real nurse” is A job description is a statement that sets the duties and ▪ Nurse-patient relationship is not fully developed responsibilities of a specific job. ▪ Evaluation of nursing care is poor and outcomes It includes the needed characteristics or qualifications of are rarely documented. the individual to perform such duties successfully ▪ It is difficult to find a specific person who can o Contents of a job description answer the patient’s or relative’s questions ▪ Identifying Data Total Care or Case Nursing ▪ Job Summary o One nurse is assigned to one patient for the delivery ▪ Qualification Requirements of total care ▪ Job Relationships o The nurse gives total care within her shift & her point ▪ Specific and Actual Functions and Activities of entry is anytime during the course of the illness o Uses of job description o The one-on-one pattern is a common assignment for ▪ For recruitment and selection of qualified private duty nurses, in special care units such as the personnel; critical care or those in isolation. ▪ For job placement ▪ As an aid in evaluating the performance of an employee ▪ To identify training needs ▪ As basis for staffing ▪ For classifying levels of nursing functions according to skills level required Sample job description (POSITION TITLE: STAFF NURSE/NURSE I) o DEFINITION: The Staff Nurse is a professional nurse responsible for rendering wholistic nursing care to Team Nursing patients in assigned areas. o Decentralized system of care in which a qualified o QUALIFICATION REQUIREMENTS: Education: professional nurse leads a group of nursing personnel Bachelor of Science in Nursing; License: Registered in providing for the nursing needs of a group of Nurse patients/clients through participative effort o JOB SUMMARY: The Staff Nurse provides direct o The team leader assigns patients and tasks to team nursing care to patients towards the promotion of members according to job descriptions. health, prevention of diseases, restoration of health, alleviation of suffering, and assisting the dying to face death with dignity and in peace. o EMPLOYMENT VARIABLES: Professional affiliation with professional nursing associations. o JOB RELATIONSHIPS: Promoted to: Senior Nurse/Nurse II; Responsible to: Senior Nurse/Nurse II o FUNCTIONS: ▪ Patient care management: The staff nurse shall initiate and perform nursing care services to meet  the needs of patients in assigned areas/units Delegate gradually, delegate in advance utilizing the nursing process; Assesses the Consult before delegating. individual’s needs for nursing care based on the Avoid gaps & overlaps. patient’s history, results of physical, diagnostic, and laboratory examinations.; Infers correct STEPS TO ENSURE EFFECTIVE DELEGATION nursing diagnosis. ▪ Hospital and nursing service policies and Plan ahead regulations: Observes hospital and nursing Identify necessary skills and levels service rules, regulations and policies Select most capable personnel ▪ Learning experiences of nursing and Communicate goal clearly midwifery students: Coordinates with Clinical Empower the delegate Instructors the activities of the affiliating students; Set deadline and monitor progress Demonstrates good nursing in the way he or she Model the role and provide guidance cares for patients. Evaluate performance ▪ Orientation of non-professional workers in Reward accomplishment the unit: Participates in the orientation of new, non-professional nursing personnel NURSING TASKS THAT CANNOT BE DELEGATED ▪ Research and studies: Participates in/initiates Performing an initial patient assessment and subsequent nursing research and studies assessments or nursing interventions that require ▪ Professional responsibilities: Takes initiative specialized nursing knowledge, judgment, and/or skill and responsibility for membership in professional Identifying nursing care goals & developing the nursing organizations and participates actively in their plan of care in conjunction with the patient and/or family programs and activities Formulating nursing diagnosis Updating patient’s plan of care DIRECTING Providing patient education to patient and/or family Doing phase of management Evaluating a patient’s progress, or lack thereof, toward This includes issuance of orders, assignments & achieving desired goals and outcomes instructions that enable the nursing personnel to Discussing patient issues with physician understand what are expected of them Directions must be complete, understandable and given Administering medications in a logical order Documenting patient’s assessment & response to therapeutic interventions A. ELEMENTS OF DIRECTING Providing direct nursing care Delegation o Defined as getting the work done through others DIRECT PATIENT CARE ACTIVITIES THAT MIGHT o Transferring to a competent individual the authority BE DELEGATED to perform a selected nursing task in a selected Vital Signs situation o BP, RR, temperature, and PR o Obtaining daily weight COMMON DELEGATING ERRORS o Applying leads and connecting to cardiac monitor Underdelegating o Obtaining 12-lead ECG o Manager’s false assumption that delegation maybe o Performing chest compressions in life support interpreted as a lack of ability on their part to do the situations job correctly or completely Intake and Output o The manager’s desire to complete the whole job by o Measuring and recording I/O himself or herself o Collecting specimens o A lack of trust in the subordinates because managers Activities of Daily Living believe that they can do better and faster than anyone o Performing total or partial bed bath else o Performing perineal care Overdelegating o Washing patient’s hair o Some managers are poor managers of time, spending o Performing mouth care most of it just trying to get organized o Changing linen and assisting with making occupied o Managers feel insecure in their ability to perform a bed task Nutrition Improper delegation o Feeding the patient o Delegating at the wrong time, to the wrong person, or o Calculating and recording calorie count for the wrong reason. Skin Care o Delegating tasks and responsibilities that are beyond o Performing back care the capability of the person to whom they are being o Performing skin prep for operative procedure delegated or that should be done by the manager Activity and Mobility o Assisting in ambulating patient PRINCIPLES OF DELEGATION o Performing passive and active range of motion exercises Selecting the right person to whom the job is to be o Turning and repositioning patient delegated o Assisting with transfers Delegate both interesting & uninteresting tasks. Respiratory Support Provide subordinates with enough time to learn. o Setting up oxygen  o Assisting patient with using an incentive spirometer Spot checking of charts through nursing audits; o Assisting patient with coughing and deep breathing Asking the patients about the care they receive; exercises Looking into the general condition of the units; o Performing oral suctioning using an oral suction Getting feedback from co-workers or other supervisors or device relatives; Procedures Asking questions discretely to find out the problems they o Setting up patient room (suction canisters, cables for encounter in the wards or drawing out suggestions from continuous cardiac monitoring, tubing for chest tubes) the workers for improvement of their work or work o Orienting patient to room environment situation. o Obtaining necessary supplies for sterile procedure o Discontinuing peripheral intravenous catheter PARTICIPATORY MANAGEMENT o Performing postmortem care There is a mutual trust & support B. REVISING/UPDATING NURSING SERVICE Increased accountability of the Head Nurse & of employees through self-supervision POLICIES & PROCEDURES Increased effectiveness & productivity due to high morale Policies and procedures are the standing plans of and teamwork organization Increased commitment and recognition of contribution Promote consistency of action & stability Speed up decision making MANAGEMENT LEVELS IN NURSING Conserve time by setting standards Categories of policies: those that apply to o Patients o Personnel o Environment where patients are cared for & where personnel work o Relationships with other disciplines or departments C. SUPERVISION Providing guidelines for the accomplishment of a task with initial direction & periodic inspection of the actual accomplishment of the task Appraises not only the quantity & quality of work performed, but also the time within which the work is accomplished D. MOTIVATION QUALITIES OF GOOD SUPERVISION The force within the individual that influences strength or Good technical, managerial and human relation skills; direction of behavior Ability to communicate well in the both spoken and written Action that people take to satisfy unmet needs language; ability to listen; It is the willingness to put effort into achieving a goal or Firmness with flexibility to adjust to the needs of the reward to decrease the tension caused by the need situation; Fairness in dealing with employees; INTRINSIC MOTIVATION Familiarity with hospital and nursing policies that affect Comes within the person and driving the person to be patient care productive Good decision-making skills; To be intrinsically motivated at work, the worker must Willingness to grow and develop; value job performance and productivity Ability to accept changes and consider them as Directly related to a person’s level of aspiration challenges; Dignified and pleasing personality; EXTRINSIC MOTIVATION Ability to motivate employees and provide opportunities for continuing professional growth and development; and Enhanced by job environment or external rewards Advocacy for nurses and nursing. The reward occurs after the work has been completed One of the most powerful motivators a manager can use is PRINCIPLES OF GOOD SUPERVISION through positive reinforcement o Simple approaches that use positive reinforcement: Requires adequate planning and organization ▪ Positive reinforcement must be specific or Gives autonomy to workers depending on their relevant to a particular performance. competency, personality and commitment ▪ The positive reinforcement must occur as close Stimulates the worker’s ambition to grow into effectiveness to the event as possible. Creates an atmosphere of cordiality and trust ▪ Both large and small achievements should be Considers the strengths and weaknesses of employees acknowledged Strives to make the unit an effective learning situation ▪ Rewards should be unpredictable and Considers equal distribution of work intermittent. TECHNIQUES IN SUPERVISION Observation of the worker while making the rounds; STRATEGIES TO MOTIVATE PEOPLE PURPOSE OF COMMUNICATION Have clear expectations for workers, and communicate Facilitate work these expectations effectively. Increase motivation Be fair and consistent when dealing with all employees. Effect change Be a firm decision maker using an appropriate decision- Optimize care making style. Increase worker satisfaction Develop the concept of teamwork. Facilitate coordination Integrate the staff’s needs and wants with the Promote trust organization’s interests and purpose. Know the uniqueness of each employee Remove traditional blocks between the employee and the work to be done. Provide experiences that challenge or “stretch” the employee and allow opportunities for growth. When appropriate, request participation and input from all subordinates in decision-making. Whenever possible, give subordinates recognition and credit. Be certain that employees understand the reason behind decisions and actions. Reward desirable behavior; be consistent in how you handle undesirable behavior. Let employees exercise individual judgment as much as possible. Create a trustful and helping relationship with employees. Let employees exercise as much control as possible over their work environment. Be a role model for employees. Clear lines of communication Simple, exact and concise messages ensure E. COMMUNICATION understanding of the message to be conveyed The transmission of information, opinion and intentions Feedback is essential to effective communication between and among individuals Communication thrives best in a supportive environment Complex exchange of thoughts, ideas, or information on at Utilize various modes of communication, may be formal or least two levels: verbal and non-verbal informal, written or verbal In communication, there is at least one sender, one Adequate and timely communication of work related receiver, and one message. There is also a mode or issues or changes should be done to enhance compliance medium through which the message is sent, such as verbal, written, or nonverbal. TYPES OF COMMUNICATION Verbal communication Written communication Non-verbal communication o Personal appearance o Intonation of the voice o Facial expression o Posture & gait o Touch Medium/mode of communication o Written communication o Oral communication o Nonverbal communicatio ELEMENTS OF NONVERBAL COMMUNICATION Downward communication Space: between sender and receiver influences what is o From superior to subordinate, which may pass communicated through various levels of management. Environment: the area where the communication takes o Communication aims to impart what the personnel place is an important part of the communication process need to know, what they are to do and why they are to do these Appearance: much is communicated by clothing, o Includes policies, rules and regulations, memoranda, hairstyles, cosmetics, and attractiveness handbooks, interviews, job descriptions, and performance appraisal. Gestures: too much gesturing can be destructing Upward communication o From subordinates and goes upward o In the form of feedback to show the extent to which downward communication has been received, accepted, and implemented o Examples: discussions between subordinates and superiors, grievance procedures, written reports, incident reports, and statistical reports Eye Contact: this nonverbal clue is often associated with sincerely eye contact that invites interaction Posture: slouching, shuffling or stopping send a message that a person is indifferent Facial Expression: effective communication requires a facial expression that agrees with the message Horizontal communication o Flows between peers, personnel or departments on the same level o Used most frequently in the form of endorsements, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services Timing: hesitation often diminishes the effect of your statement or implies untruthfulness. Vocal Clues: such as tone, volume, and inflection Outward communication FOUR-DIMENSIONAL FLOW OF COMMUNICATION o Deals with information that flows from the caregivers IN NURSING CARE to the patients, their families, BARRIERS TO COMMUNIC