NCM 107A – Nursing Leadership and Management PDF

BACHELOR OF SCIENCE IN NURSING: NCM 107A – NURSING LEADERSHIP and MANAGEMENT COURSE MODULE COURSE UNIT WEEK 1 1 1 Introduction to Nursing Manageme...

BACHELOR OF SCIENCE IN NURSING: NCM 107A – NURSING LEADERSHIP and MANAGEMENT COURSE MODULE COURSE UNIT WEEK 1 1 1 Introduction to Nursing Management  Discuss the course and unit objectives  Comprehend study guide prior to attending the class  Actively participate in all classroom discussion  Accomplish and submit assigned course unit task on time. At the end of this unit, the students are expected to: Cognitive: 1. Discuss the functions of a nurse manger / leader in all health care setting. 2. Compare and contrast the roles and responsibilities of a nurse manager and nurse leaders 3. Comprehend the different theories of leadership and management. 4. Develop essential task performed by the managers to clinical practice. Affective: 1. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi- cultural teams 2. Join actively in class discussions and group activities. 3. Appreciate and support one’s opinion and comments toward each other 4. Engage in life-learning with a passion to keep current with national and global developments 5. Accept responsibility for life-learning, own personal development and maintenance of competence. Psychomotor: 1. Demonstrate leading and managing behaviors as important functions of a professional nurse. 2. Apply essential task performed by managers in a variety of settings. 3. Use appropriate technology for effective and efficient managerial role. INTRODUCTION Nursing Management is a guide for nurses who wants to learn the concepts behind Nursing Management. This will also guide nurses to organizing, staffing, scheduling directing and controlling, it also deals with the application of the concepts, principles, theories and methods of developing nursing leaders and managers in the hospital or any settings. Management is an old French term its means “the directing”. There are many definition of management is. It is a universal process. It is the process of coordinating and supervising personnel and resources to accomplish organizational goals. Also it is to design and maintain an internal environment in which people working together in groups. That can perform effectively and efficiently towards the attainment of group goals. Management is being use in running a business, practice ones’ profession, and day to day interaction. A thorough knowledge in management includes: time, resources and workforce. According to Venson, (2010) management is a process by which a cooperative group directs actions towards common goals, it involves technique by which a distinguished group of people coordinates the services of people. It also includes moral and ethical standards in the selection of right ends toward which managers should strive. There are three-fold concept to emphasize the broader scope of management, (Harbizon and Myers) Economic source is one of the factors of production together with land, and capital. Industrialization increases, management is substituted by labor and capital. Management of a firm determines to a large extent, its productivity and profitability. System of authority, management first develops with top individuals determining the course of action for the rank and file. The constitutional management emphasizes definite and consistent concern for policies and procedures in dealing with the working group. A line toward a democratic and participative approach follows as employee receive higher education. Class and status system this is from sociologist’s point of view that managers have become an elite group of brains and education. This class is based on education and knowledge. Managers continue to expand their horizons in an effort to attain the ultimate in life or goal. THEORIES OF MANAGEMENT EARLY MANAGEMENT A. Scientific Management Theory (1900-1930) Frederick W. Taylor, the “father of scientific management’ Taylor postulated the workers could be taught “one best way to accomplish a task” productivity would increase. He called these principles scientific management. The following are the four principles of scientific management: 1. Traditional “Rule of Thumb” means organizing work must be replaced with scientific methods. Give allotted time to workers in accomplishing their task. 2. Workers can be hired, trained and promoted based on their competence and abilities. 3. Employees are entitled of receiving financial rewards, and incentives for worked accomplished because he viewed humans as “economic animals’ motivated solely by money. 4. Maintain good interpersonal relationship between the workers and managers they should be cooperative and interdependent and the work should be shared equally. Frank and Lilian Gilbreth – “The First Lady of Management”  Use motion picture to develop work efficiency.  “Therbligs” - 17 classification of hand movements.  Develop Job Simplification. Subject of the book “Cheaper by the Dozen Henry Gantt – Disciple of Frederick Taylor  Develop Gantt Chart Advocates for a humanitarian management  B. Classical Organization Theories Henry Fayol (1925) identified management functions of planning, organization, command, coordination, and control Luther Gulick (1937) expanded on Fayol’s’ management functions he mentioned that they are “seven activities in management” staffing, directing. Coordinating. Reporting, and budgeting-POSDCORB. Often times Managers considered this as the process of management. He also believes that management should be taught in school. Management Process: a. Planning it is determining philosophy, goals and objective, policies, procedures and rules. b. Organizing it includes establishing the organizational structure to carry out plans Determining the most appropriate type of patient care delivery. c. Staffing functions consist of recruiting interviewing, hiring and orienting staff. d. Directing it includes several staffing functions such as motivating, managing conflict. Delegating, communicating, facilitating collaboration. e. Controlling functions include performance appraisals. Fiscal accountability, quality control, legal and ethical control. Max Weber – is the “Father of Organizational Management” He developed the organizational chart. According to him there are 3 basis of authority traditional, charismatic and rational authority. Lyndal Urwick she combined the theories of Taylor and Fayol to develop the classic Organizational Theory”, popularized the term “span of control and unity of command. C. Human Relation Management (1930-1970) Mary Parker Follett (1926) one of the first theorist to suggest basic principles of what today would be called participative decision making or participative management She believed that managers should have authority with one another, rather than over employees, that solution could be easily be found that could satisfied both employee without dominating each other. Elton Mayo and his Harvard associates conducted a study done at the Hawthorne Works of the Western Electric Company near Chicago, they found out that if workers give special attention productivity increases, regardless of the environmental conditions. This Hawthorne effect shown that people respond that they are being studied, they felt that whatever behavior they attempted they still continue to warrant attention. Employee knows that they are being evaluated by management. Jacob Moreno – developed a system of pairings called Sociometry, believes that people are attracted to, repulsed by or just indifferent towards each other. D. Behavioral Science Abraham Maslow – developed the Hierarchy of Needs  Physiologic Needs  Safety and Security Needs  Love and Belonging Needs  Self-Esteem Needs  Self- Actualization Frederick Herberzg – develop taxonomy of job situation.  Believes in job satisfiers/ motivation factor and dissatisfies/ hygiene factor William Ouchi – develop Theory Z by comparing the Japanese organization to the American organization. Douglas McGregor (1960) theorizing that managerial attitude about employees this could be correlated to employee’s satisfaction. He labeled Theory X and theory Y. Theory X, manager’s beliefs that their employee are basically lazy. William Blake – develop the Managerial Grid Types of Managers in Managerial Grid  Impoverish Manager  Country Club Manager  Organizational Man Manager   Authority Obedient Manager  Team Manager CONTEMPORARY MANAGEMENT Contemporary approach means new, recent or current approaches in the field of management. EXAMPLE: The way company was running 100 years ago is different from today. However, one steel company today might say they use “contemporary management” meaning they use the same type of management that other steel companies use today. Contingency Approach A management approach the recognizes organizations as different, which means they face different situations (contingencies) and require different ways of managing. Assumes there is no best way to manage.  The environment impacts the organization and managers must be flexible to the act to environmental changes.  The way the organization is designed and control systems selected defend on the environment. Technological environments change rapidly, so must managers. Situational characteristics are called contingencies. The contingencies include  Circumstances in the organization’s external environment.  The internal strengths and weaknesses of the organization.   The values, goals, skills, and attitudes of managers and workers in the organization.  The types of tasks, resources, and technologies the organization uses. System Approach A set of interrelated and interdependent parts arranged in a manner that produces a unified whole Process closed system: system that are not influence by and do not interact with their environment. Open system: systems that interact with their environment  The contingency perspective refutes universal principles of management by stating that a variety of factors, both internal and external to the firm, may affect the organization’s performance.  Therefore, there is no “one best way” to manage and organize because circumstances vary. Levels of Management 1. Top Level Manager – look at the overall operation of the organization. - Coordinate internal and external affairs of the organization. - Makes the major decisions - Determines the organization’s mission/ vision statement, philosophy, policies and procedures. - Creates goals and allocate resources. 2. Middle Level Manager – coordinates activities of different department - Receives policies from the top-level manager. - Makes specific objectives and programs. 3. First Level Manager – directly responsible for the actual production of services. - Act as a link between the higher-level managers and non-managers. Skills of a Manager according to Katz 1. Technical Skill – knowledge and proficiency in activities involving methods, procedures and process. 2. Human Skill – ability to work with people - Create a harmonious working relationship. 3. Conceptual Skill – ability to see the overall picture to identify important elements in a situation and to understand the relationship among the elements. And identifying pertinent factors, responding to the big problems, and discarding irrelevant facts. Other approach according to Summer 1. Knowledge factors refer to ideas, concepts, or principles that can be expressed and are accepted because they have logical proofs. 2. Attitude factors relate to those beliefs, feelings, and values that may be used on emotions and may not be subjected to conscious verbalization. 3. Ability factor skill, art, judgement, and wisdom. They abstract factors but they direct one’s thinking to factors that can be developed by the individual manager who takes time to consider them. Roles of a Manager 1. Interpersonal Role, the manager acts as: A. Symbol because of the position he/she occupies and consists of such duties as signing of papers/documents required by the organization. B. Leader, who hires, trains, encourages, fires, remunerates, and judges C. Liaison Officer between outside contacts such as community, suppliers and the organization 2. Informational Role, the manager does; A. Disseminates Information, from both external and internal sources B. Monitors information C. Spokesperson or representative of the organization. He/she represents the subordinates to superiors and the upper management to the subordinates. 3. Decisional Role makes him/her A. Problem Solver/ Trouble Shooter, who handles unexpected situations such as resignation of subordinates, firing or subordinates, and loss of clients B. Innovator/ Entrepreneur a designer to improve projects that direct and control change in the organization C. Negotiator when conflict arise LEADERSHIP It is important to remember though that a job title alone does not make a person leader. Only a person’s behavior determines if he or she holds a leadership role. The manager is a person who brings things about the one who accomplishes, has the responsibility, and conducts. A leader is the person who influences and guides direction, opinion, and course of action. There are several definitions of what leadership is: A process of influence in which the leader influences others toward goal achievement The process of influencing the activities of an organized group in its efforts toward goal setting and goal achievement Is about creating change. It involves establishing a direction, aligning people through empowerment, motivating and inspiring them toward producing  useful change and achieving the mission. It Is the vital ingredient that transforms a crowd into a functioning, useful organizations. Nursing Leadership – process whereby nurse influences one or more persons to achieve a specific goal in the provision of quality nursing care. COMPARISON BETWEEN LEADERSHIP AND MANAGEMENT Leaders need to do the right things, are challenged by change, focus on purposes and have a future time frame. Managers do things right are challenged by continuity and focus on structures and procedures in a present time frame. They ask who, what, when, where and how as the use schedules to get to the destinations and evaluate human performance. Manager  Are assigned a position by the organization.  Have a legitimate source of power due to delegated authority that accompanies their position  Have a specific duties and responsibilities they are expected to carry out.  Emphasize control, decision making, decision analysis, and results.  Manipulate people, the environment, money, time, and other resources to achieve the goals of the organization.  Have a greater format responsibility and accountability for rationality and control than leaders.  Direct willing and unwilling subordinates. Leaders  Often do not have delegated authority but obtain power through other means, such as influence.  Have a wider variety of roles than managers.   Focus on group process, information gathering, feedback, and empowering others.  May or may not be part of the formal hierarchy of the organization.  Emphasize interpersonal relationship  Direct willing followers  Have goals that may or may not reflect those of the organization. DIFFERENT LEADERSHIP THEORIES: THE EVOLUTION OF LEADERSHIP THEORY transformational theory situational theory behavioral theory Trait theory ______________________________________________ 1950 1960 1970 1980 1990 DIFFERENT THEORIES OF LEADERSHIP EARLY LEADERSHIP 1. Great Man theory: (1900-1940)  Leaders are born.  Leaders display both instrumental (technical) and supportive (socially oriented) leadership behavior  Great leaders arise when situation demands it. 2. Trait Theory:  Traits are inherent (before). Traits can be learned (now)  Identified traits: energy, affection, enthusiasm, ambition, aggressiveness, decisiveness, self-assurance, self-confidence, friendliness, affection, honesty, fairness, loyalty, dependability, technical mastery, teaching skill.. 3 Charismatic Theory  Leaders possess charisma (an inspirational quality that some leaders possess that makes others feel better in their presence.) 4.Situational Theory: Traits required of a leader differ according to varying situations (variables)  Variables: personality of the leader performance requirements of both the leader and followers attitudes, expectations and needs of the leader and followers a. Degree of interpersonal contact possible b. Time pressures c. Physical environment d. Organizational structure e. Influence of the leader outside the group Nature of the organization 4. Contingency Theory: (Fred Fiedler, 1960s) According to Fiedler no leadership style is ideal for every situation. The interrelationship between the group’s leader and its members were most influenced by the manager’s ability to be a good leader.  3 aspects of a situation that structure the leaders: a. Leader-member relations- assessed through Group Atmosphere Scale 8 7 6 5 4 3 2 1 1. Friendly unfriendly 2. Accepting rejecting 3. Satisfying frustrating 4. Enthusiastic unenthusiastic 5. Productive non productive 6. Warm cold 7. Cooperative uncooperative 8. Supportive hostile 9. Interesting boring 10. Successful unsuccessful b.Task structure:  High if it’s easy to define and measure a task  Low if it’s difficult to define a task and to measure progress toward its completion  4 criteria to determine the degree of task structure: 1) goal clarity; 2) extent to which a decision can be verified knowing who is responsible for what; 3) multiplicity of goal paths, number of solutions 4) specificity of solution, number of correct answers  b. Position power- authority inherent in a position (use rewards and punishment) Note; Fiedler says that one can predict the most productive leadership styles 1. Task is structured, leader disliked, then diplomatic 2. Task is ambiguous, leader is liked, then seek cooperation 3. Accepting, considerate leadership style probably will be most productive. 6.Path goal Theory:  People act as they do because they expect their behavior to produce satisfactory results  Structured activities were more productive and successful 7. Situational Leadership Theory (Paul Hersey & Kenneth Blanchard) (1950-1980)  Predicts the most appropriate leadership style from the level of maturity of the followers through the four quadrant model, a horizontal continuum registers low emphasis on the accomplishment of tasks on the left side to emphasis on task behavior on the right side  The vertical continuum depicts low emphasis on interpersonal relationships at the bottom to high emphasis on relationships at the top  The lower left quadrant represents laissez -faire type of leadership with little concern for production or relationships  LEADERSHIP STYLES BY HERSEY & BLANCHARD 1. DIRECTING STYLE:  This is a high task, low relationship style and is effective when subordinates are low in motivation and ability 2. COACHING STYLE:  This is a high-task, high relationship style and is effective when subordinates have adequate motivation but low ability 3. SUPPORTING STYLE:  This is a low-task, high-relationship style and is effective when subordinates have adequate ability but low motivation 4. DELEGATING STYLE:  This is a low-task, low-relationship style and is effective when subordinates are very high in ability and motivation. 8.Transactional Theory  Exchange posture that identifies needs of followers and provides rewards to meet those needs in exchange for expected performances  Leaders focuses on a day-to-day operation 9. BEHAVIORAL THEORY Is a management philosophy that evaluates leaders according to the actions they display in the work place. To be effective leader is to learn a certain set of behaviors. A leadership theory developed, researchers changed from studying what traits the leader had and placed emphasis on what he or she did, the leadership style of leadership. 3 LEADERSHIP STYLES (Kurt Lewin, et al 1930) His breathrough occurred when he and White (9151) and Lippitt (1960) identified with common leadership styles. 1. Authoritarian  Uses positional and personal power  Demanding and controlling  Emphasis is on difference in status ( “I” and you “you”).  Others are directed/ motivated with commands  Critism is punitive  Communications flow up & downward  Decision making does not involve others 2. Democratic  Allows for group governance through collaboration or group efforts  Situation of trust and openness  Decision making involves others  Less control is maintained  Economic and ego rewards are used to motivate.  Emphasis is on “we” rather than I and you.  Criticism is constructive  3. Laissez-faire  Leaving workers without direction and supervision and allows them to plan  Leader uninvolved, disinterested, withdrawn.  Permissive with little or no control  Uses upward and downward communication between members of the group  Places emphasis on the group  Does not criticize ` CONTEMPORARY LEADERSHIP 1. Transformational theory :  Promotes employee development  Attends to needs and motives of followers  Inspires through optimism  Influences changes in perception  Provides intellectual stimulation Encourages followers’ creativity 2. Servant Leadership They are more concerned with the needs of other than themselves and lead through their service. They foster a service inclination in others that promotes collaboration, teamwork, and collective activism. 3. Authentic leader A leader manager arsenal, in order to lead, leaders must be true to themselves and their values and act. Authentic or congruent leadership theory differs from traditional transformational leadership theory. 4. Thought leader Applies to a person who is recognized among his or her peers for innovative ideas and demonstrates the confidence to promote those ideas POWER the ability to impose the will of one person or group to bring certain behaviors in other person or groups.  Reward Power it is the leader or manager’s power comes from the ability to reward others for complying.  Coercive Power based on a fear of punishment if one fails to conform., an opposite of reward power,  Legitimate Power the right of the manager or leader to influence and the staff member an obligation to accept that influence.  Referent Power is based on identification with a leader and what that leader symbolizes. The leader is admired and exerts influence because the followers desire to be like the leader.   Expert Power gained through knowledge, skills, information, experience and competence. Their expertise gains people respect and compliance.  Information Power comes from knowledge, access to information, and the sharing of information. It is especially powerful when others need the information.  Connection Power comes from formal or informal coalitions and interpersonal relations and links to prestigious and influential people within and outside of the organization. Effectiveness extent wo which desired outcomes are attained through use of intervention. Efficiency the relationship between monetary value of resources expanded and monetary value of results achieved. Achieving the best results with least cost. Management the process of getting work done through others Manager one who carries out predetermined policies, rules and regulations with official sanction or act. CU 1 CASE SCENARIO: Two entry-level staff nurses were hired for the pediatric unit. Both worked 8-hour shifts; Corrine on the afternoon shift and Judy at night. Whenever they meet, they would often compare their experience. Corrine felt she was learning rapidly, gaining clinical skills, and beginning to feel at ease with her colleagues. Judy, however, still felt unsure of herself and often isolated. “There have been times that I am the only registered nurse on the unit all night. The nursing aide is really experienced, but that is not enough. I wish I could work with an experienced nurse as you are doing.” she told Corrine.  “Judy, you are not even done with your 3-month orientation program,” said Corrine. “You should never be left alone with all the pediatric patients. Neither of us is ready for that kind of responsibility. And how will you get the experience you need with no experienced nurses to help you? You must relay this concern to our nurse manager.” “I have tried several times already, but she’s never available. She leaves all the shift assignments to her assistant. I’m not sure she even reviews the schedule before it’s posted.” “You will have to try harder to reach her. Maybe you could stay past the end of your shift one morning and meet with her,” suggested Corrine. “If something happens when you are the only nurse on the unit, you will be held responsible.” TASK ESSAY: After the discussion of the course unit Module Please read and answer the following questions, submit your answers on line in canvas within the week.. (30 points) 1. In your own words, summarize the problem that Corrine and Judy are discussing. To what extent is this problem due to a failure to lead? Who has failed to act? 2. What style of leadership was displayed by Corrine, Judy, and the nurse manager? How effective was their leadership? Did Corrine’s leadership differ from that of Judy and the nurse manager? In what way does it differ? 3. 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