NCMB419 LEC & RLE PRELIM (1).pdf

NCMB419 LEC & RLE: Exam Week 06 BSN 4TH YEAR 1ST SEMESTER PRELIM 2023...

NCMB419 LEC & RLE: Exam Week 06 BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Bachelor of Science in Nursing 4Y1 Professor: Ma. Diosul Roque, MAN, RN & Evangeline Orata, MAN, RN, RM Prelim Topics: Decisional Introduction to Nursing Leadership Management - Entrepreneur or Innovator Patient Health Care Delivery System - Trouble shooter Evidence-Based Practices in Nursing Management Ethico-Legal and Moral Considerations in Nursing Theories of Management Leadership Management Four Principles of Scientific Management Organizational Communication 1) Traditional “Rule of Thumb” – means organizing work must be replaced with scientific methods. Give allotted INTRODUCTION TO NURSING LEADERSHIP AND time to workers in accomplishing their task. MANAGEMENT 2) Workers can be hired, trained and promoted based on their Leadership and Management competence and abilities. Leadership 3) Employees are entitled of receiving financial rewards, and - Viewed by some as one of managements many function incentives for worked accomplished because he viewed Management humans as “economic animals’ motivated solely by money. - It is a universal process 4) Maintain good interpersonal relationship between the - use in business, practice of one’s profession and even workers and managers they should be cooperative and day to day personal affairs interdependent, and the work should be shared equally. - The process of coordinating and supervising personnel Scientific Management and resources to accomplish organizational goals. 1) Frederick Taylor Manager - Father of scientific management - A person who has responsibility for the activities of - How people work other people in an organization. - theories of management do not remain static. - Taylor’s system of work improvement consisting of the Three-Fold Concept to Emphasize, The Broader Scope of following steps: Management, (Harbizon And Myers) 1) Controlled observation of the worker’s performance 1) Economic source – Is one of the factors of production through time and motion study together with land, and capital. Industrialization increases, 2) Scientific selection of the best man or woman to management is substituted by labor and capital. perform each job. Management of a firm determines to a large extent, its 3) Training the selected worker to perform job task. productivity and profitability. 4) Paying the worker to a differential rate. 2) System of authority – management first develops with top 5) Appointing a few of the most highly skilled workers individuals determining the course of action for the rank to managerial positions and to planning and and file. The constitutional management emphasizes preparing the task of workers. definite and consistent concern for policies and 6) Appointing a foremen for each aspect of the work. procedures in dealing with the working group. A line toward 2) Frank Gilbreth and Lillian Gilbreth a democratic and participative approach follows as - They emphasized the benefits of job simplification and employee receive higher education. the establishment of work standards, as well as the 3) Class and status system – this is from sociologist’s point effects of the incentive wage plans and fatigue on work of view that managers have become an elite group of performance. brains and education. This class is based on education - The Gilbreths were among the first to use motion- and knowledge. Managers continue to expand their picture films to analyze worker’s motion. horizons in an effort to attain the ultimate in life or goal. - Lillian Gilbreth is known as the first lady of management. 3) Henry Gantt Role of Manager - Developed Gantt Chart - Advocates for humanitarian management Interpersonal - Concerned with problems of efficiency. He contributed - Symbol to scientific management by refining pervious work - Leader rather than introducing a new topic. - Liaison Classical Organization Theories Information 1) Henry Fayol - Monitors - Process management – planning, organizing, - Disseminates coordinating, and controlling known as the “father of - As spokes person the management process school J.A.K.E 1 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 - He studied the functions of the managers and - This Hawthorne effect shown that people respond that concluded that management is universal. they are being studied, they felt that whatever behavior - Fayol’s14 principle of management: they attempted they still continue to warrant attention. a) Division of work Employee knows that they are being evaluated by b) Authority and responsibility management. c) Discipline 3) Jacob Moreno d) Unity of command - He developed a system of pairings called Sociometry, e) Unity of direction believes that people are attracted to, repulsed by or just f) Subordinate of individual interest to general interest indifferent towards each other. g) Remuneration of personnel Behavioral Science h) Centralization 1) Abraham Maslow i) Scalar chain (Line of Authority) - Described humans as “wanting” organisms that satisfy j) Order their basic needs in a specific sequence. k) Equity - According to Maslow, higher level needs do not l) Stability of tenure of personnel emerge as motivators until lower level needs satisfied. m) Initiative 2) Frederick Herzberg n) Esprit de corps (pride and honor shared by the - Proposed two-factor motivational need theory:>hygiene members of the group) factors are termed “dissatisfiers”>motivating factors Management Process are termed “satisfiers” Planning it is determining philosophy, goals and objective, 3) Douglas Mcgregor policies, procedures and rules. - Douglas McGregor (1960) theorizing that managerial Organizing it includes establishing the organizational attitude about employees this could be correlated to structure to carry out plans. Determining the most employee’s satisfaction. appropriate type of patient care delivery. - He labeled Theory X and theory Y Staffing functions consist of recruiting interviewing, hiring 4) William Blake and orienting staff. - Develop the Managerial Grid Directing it includes several staffing functions such as - Types of Managers in Managerial Grid motivating, managing conflict. Delegating, communicating, - Impoverish Manager facilitating collaboration. - Country Club Manager Controlling functions include performance appraisals. - Organizational Man Manager Fiscal accountability, quality control, legal and ethical - Authority Obedient Manager control. - Team Manager 1) Max Webber - the “Father of Organizational Management” Country Club Management – Thoughtful attention to - He developed the organizational chart. needs of people for satisfying relationship. - According to him there are 3 types of authority: Impoverished Management – Exertion of minimum effort Traditional to get required work done in appropriate to sustain Charismatic organization membership. Rational Authority. Team Management – Work accomplishment is from 2) Lynd Allurwick committed people: interdependence - She combined the theories of Taylor and Fayol to Authority Obedience – Efficiency in operation results from develop the classic Organizational Theory”, popularized arranging conditions of work in such away that human the term “span of control and unity of command.” elements interfere to a minimum degree. Human Relation Management Organization Man Management – Adequate organization 1) Mary Follet performance is possible through balancing. - Mary Parker Follett (1926) one of the first theorist to suggest basic principles of what today would be called Types of Managers In Managerial Grid participative decision making or participative Impoverish Manager – Low Production and Low People management Middle-Of-The-Road Leadership – Medium Production - Managers should have authority with one another, and Medium People rather than over employees, that solution could be Produce or Perish Leadership – High Production and Low easily be found that could satisfied both employee People without dominating each other. Country Club Style Leadership – High People and Low 2) Elton Mayo Production - They found out that if workers give special attention Team Manager – High Production and High People productivity increases, regardless of the environmental conditions. J.A.K.E 2 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Contemporary Management Leader Levels of Management - Often do not have delegated authority but obtain power Top Level Manager – look at the overall operation of the through other means, such as influence. organization. - Have a wider variety of roles than managers. Middle Level Manager – coordinates activities of different - Focus on group process, information gathering, feedback, department and empowering others. First Level Manager – directly responsible for the actual - Mayor may not be part of the formal hierarchy of the production of services. organization. Skills of a Manager - Emphasize interpersonal relationship Technical – relate to the proficiency in performing an - Direct willing followers activity in the correct manner w/ right technique. - Have goals that may or may not reflect those of the Human – dealing w/ the people and how to get along w/ organization. them Conceptual – ability to see individual matters as they Leadership Theories relate to the total picture & to dev creative ways of Great Man theory: (1900-1940) identifying pertinent factors, responding to the big prob, - Leaders are born. and discarding irrelevant facts - Leaders display both instrumental (technical) and According to Summer supportive (socially oriented) leadership behavior Knowledge – factors refer to ideas, concepts, or principles - Great leaders arise when situation demands it. that can be expressed and are accepted because they have Trait Theory logical proofs. - Traits are inherent (before). Traits can be learned (now) - Identified traits: energy, affection, enthusiasm, ambition, Attitude – factors relate to those beliefs, feelings, and aggressiveness, decisiveness, self-assurance, self- values that may be used on emotions and may not be confidence, friendliness, affection, honesty, fairness, subjected to conscious verbalization. loyalty, dependability, technical mastery, teaching skill. Ability – factor skill, art, judgement, and wisdom. They Charismatic Theory abstract factors but they direct one’s thinking to factors - Leaders possess charisma (an inspirational quality that that can be developed by the individual manager who takes some leaders possess that makes others feel better in their time to consider them. presence.) Roles of a Manager Situational Theory Interpersonal - Traits required of a leader differ according to varying Conceptual situations (variables) Decisional - Variables: o Personality of the leader Leadership o Performance requirements of both the leader and - Is the act of influencing group to follow a certain course of followers action. o Attitudes, expectations and needs of the leader and - A process of influence in which the leader influences followers others toward goal achievement. Contingency Theory: (Fred Fiedler, 1960s) - Is about creating change. It involves establishing a - According to Fiedler no leadership style is ideal for every direction, aligning people through empowerment, situation. motivating and inspiring them toward producing useful - The interrelationship between the group’s leader and its change and achieving the mission. members were most influenced by the manager’s ability to - Nursing Leadership – Process where by nurse influences be a good leader. one or more persons to achieve a specific goal in the - 3 aspects of a situation that structure the leaders provision of quality nursing car. - Leader-member relations – assessed through - Group Atmosphere Scale Comparison Between Leader and Manager Manager - Areas signed 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. - 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. J.A.K.E 3 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 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: Goal clarity; Extent to which a decision can be verified knowing who is responsible for what; Multiplicity of goal paths, number of solutions Specificity of solution, number of correct answers Position power – authority inherent in a position (use rewards and punishment) Fiedler says that one can predict the most productive leadership styles Task is structured, leader disliked, then diplomatic. Task is ambiguous, leader is liked, then seek cooperation. Accepting, considerate leadership style probably will be Transactional Theory most productive. - Exchange posture that identifies needs of followers and Path Goal Theory provides rewards to meet those needs in exchange for - People act as they do because they expect their behavior expected performances to produce satisfactory results. - Leaders focuses on a day-to-day operation - Structured activities were more productive and successful. Behavioral Theory Situational Leadership Theory (Paul Hersey & Kenneth - Is a management philosophy that evaluates leaders Blanchard) according to the actions they display in the work place. - Predicts the most appropriate leadership style from the - To be effective leader is to learn a certain set of behaviors. level of maturity of the followers through the four quadrant - A leadership theory developed, researchers changed from model, a horizontal continuum registers low emphasis on studying what traits the leader had and placed emphasis the accomplishment of tasks on the left side to emphasis on what he or she did, the leadership style of leadership. on task behavior on the right side. - The vertical continuum depicts low emphasis on Leadership Styles interpersonal relationships at the bottom to high emphasis 1) Authoritarian on relationships at the top. - Rigid leader and uses leadership role as an instrument - The lower left quadrant represents laissez -faire type of of power. leadership with little concern for production or - Makes all decision relationships. - Strong control is maintained over the work group - Leadership Styles by Hersey & Blanchard: - Others are motivated by coercion 1) Directing Style – This a high task, low relationship style - Others are directed with command and is effective when subordinates are low in 2) Democratic motivation and ability. - Fair and logical uses the leadership role to stimulate 2) Coaching Style – This is a high-task, high relationship others to achieve collective goal. style and is effective when subordinates have adequate - Less control is maintained motivation but low ability. - Economic and ego awards are used to motivate 3) Supporting Style – This is a low-task, high-relationship - Others are directed through suggestion and guidance. style and is effective when subordinates have adequate 3) Laissez-Fair ability but low motivation. - Passive and unproductive, usually assumes the role of 4) Delegating Style – This is a low-task, low-relationship participant. style and is effective when subordinates are very high in - Observer and exerts a little control or guidance. ability and motivation. Contemporary Leadership Transformational Theory o Promotes employee development o Attends to needs and motives of followers o Inspires through optimism o Influences changes in perception o Provides intellectual stimulation o Encourages followers’ creativity J.A.K.E 4 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Power – Ability to impose the will of one person or group to 4) Take into account all the direct, indirect and unit activities. bring certain behaviors in other person or groups. 5) Consider the geographical location of the unit and the Reward Power – It is the leader or manager’s power assigned duties to save nurse’s time and effort. comes from the ability to reward others for complying. 6) Must be balanced among nursing staff. Coercive Power – based on a fear of punishment if one 7) Never to assign the same task to more than one nurse. fails to conform., an opposite of reward power Characteristics of Effective Assignment Legitimate Power – The right of the manager or leader to 1) Definite and easily understood. influence and the staff member an obligation to accept 2) Simple that influence. 3) Clear. Referent Power – based on identification with a leader 4) Signed. and what that leader symbolizes. The leader is admired 5) Written. and exerts influence because the followers desire to be like 6) Posted in advance. the leader. Expert Power – Gained through knowledge, skills, Process of organizing patient care: information, experience and competence. Their expertise - The head nurse or the nurse in charge should carry out gains people respect and compliance. their duties and responsibilities through applying the Information Power – Comes from knowledge, access to following steps: information, and the sharing of information. It is especially powerful when others need the information. Connection Power – Comes from formal or informal 1) Planning – a process of developing a course of action for coalitions and interpersonal relations and links to meeting the needs of patients. In planning, the head nurse prestigious and influential people within and outside of the decides what should be done, when, how, where, by whom organization. and to whom. 2) Assigning – Assignment of patient and nursing activities PATIENT CARE DELIVERY SYSTEM are written in the assignment sheet by the head - One important function of the professional nurse at the nurse/nurse in charge, based on the principles of first-line management position of nursing service assignment. department is organizing the activities of the staff into a 3) Leading – Includes issuing instructions, motivation, and workable pattern to meet patient needs. She/he should coordination of activities, by making rounds, checking establish effective relationships between the activities to performance and conducting conferences. be performed, the workers to perform them. 4) Evaluating – By reviewing nursing performance and patient - Assignment – refers to “a written delegation of duties to progress to be compared by the assignment and nursing care for a group of patients by trained personnel assigned care plan. to the unit. 5) Reporting – The head nurse prepares a nursing unit report Purposes of Assignment “e.g. shift report” which includes patient’s needs, special 1) To delegate the work to be done to the nursing personnel. observations, census, bed number, all critically ill and 2) To gain the cooperation of the nursing personnel by post-operative patients, patients’ needs special knowing and accepting the acceptance of the work to be preparation on the on-coming shift, abnormal change in done patient’s condition, data concerning, admission, discharge, 3) To produce high quality level of nursing care. transfer and death. 4) Improve stability of the environment 5) Minimize uncertainty. Nursing Care Delivery Models 6) To improve the communication skills between staff - Is the method used to provide care to patients. members, team spirit and responsibility and leadership - Each model has advantages and disadvantages, and no abilities. single method is ideal. 7) To know nursing roles or duties in advance. - It is a method to evaluate patient care and save money. 8) To minimize the level of working overload. - Managers must examine the following when selecting Principles of Personnel Assignment model 1) Made by the head nurse or nurse in charge for each individual nurse. 2) Based on: Nursing needs of each patient and approximate time required to care for him. The capabilities, skill level, previous experience and the interest of the staff members. Job description. 3) Planned weekly, and revised daily if necessary, to assure continuity of care. J.A.K.E 5 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 - The premise of the case method is that one nurse provides total care for one patient during the entire work period. - Is used in critical care setting where one nurse provides total care to one or two critically ill patients. - Note: Total patient care nursing is sometimes referred to as the case method of assignment because patients were assigned as cases Nurse Manager’s role When using the case method, the manager must consider the expense of system, weigh the expense of RN versus (LPNS, UAPS). Decide if patient care required RN care or care provided by (LPNS, UAPS). Traditional Models of Care Direct care nurse’s role: 1) Total Patient Care (Case Method) Provide Holistic care (physical, emotional) to a group of 2) Team Nursing patients during defined work time. 3) Modular Nursing 4) Functional Nursing The nurse must complete the functions of care 5) Primary Nursing (assessment, personal hygiene and teaching the KEY TERMS patient\ and family) Registered Nurses (RNs) No delegation of tasks. Unlicensed Assistive or nursing Personnel (UAPs) Advantages Licensed Practical Nurses (LPNs) Provides nurses with high autonomy and responsibility. Licensed vocational Nurses (LVNs) One nurse gives all care to the same patient(s) for the Total Patient Care (Case Method) entire shift that lead to satisfaction of patients. - Total patient care is the oldest mode of organizing patient Assigning patients is simple and direct and does not care. require the planning. - Provided in the patient’s home, and the nurse was Continuous, holistic, expert nursing care. responsible for cooking, house cleaning, and other Total accountability for the nursing care of the assigned activities specific to the patient and family, in addition to patient(s) for that shift. traditional nursing care. Continuity of communication with the patient, family, - Great Depression of the 1930’s people can no longer afford physician(s), and staff from other departments. home care and began using hospitals. The lines of responsibility and accountability are clear. - Nurses and students also became caregivers in hospitals The nurse, patient , and family usually trust one another and in public health agencies. and work together toward specific goal. - 1930’s and 1940’s – hospitals grew and provided total care Changes in the patient’s status can be easily noticed. continued as the primary means of organizing patient care. Critical care units or Post anesthesia recovery areas. Disadvantages RNs spend some time doing tasks that could be done more cost-effectively by less skilled persons. To maintain quality care, this method requires highly skilled personnel. There is little opportunity for Supervision or observations. The greatest disadvantage of total patient care delivery occurs when the nurse is inadequately prepared to provide total care to the patient. In the early history of nursing, only RNs provided care; now a variety of nursing care personnel, many of whom have no license and limited education, work with patients. During nursing shortages, many hospitals assign healthcare workers who are not RNs to provide most of the nursing care. Because the co-assigned RN may have a heavy patient load, little opportunity for supervision exists. This potentially could result in unsafe care. J.A.K.E 6 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Functional Nursing (TASK) Advantages - Evolved primarily as a result of World War II (1940) and the The staff become very efficient and effective at performing rapid construction of hospitals. Nursing shortage their regular assigned tasks. developed and ancillary personnel were needed to assist in Tasks are completed quickly. patient care. Little confusion regarding responsibilities. - The number of registered nurses (RNs) serving in the armed Unskilled workers can be trained to perform specific tasks. forces during World War II depleted the supply of nurses at Allow care to be provided with a minimal number of home. As a result of this loss of RNs, the composition of registered nurses (cost effective). nursing staffs in hospitals changed. Functions well in areas such as: - Staff that had been composed almost entirely of: o The Operating Room. Registered Nurses (RNs) o Long -Term Care Facilities. Unlicensed Assistive Personnel (UAPs) o Ambulatory clinics. Licensed Practical Nurses (LPNs) o In crises and emergencies situations. - a method by which staff member (licensed and unlicensed) Disadvantages perform specific tasks for a large group of patients rather than care for specific patients. Fragmentation of care. Lack of holistic understanding of the patient (spiritual and psychological needs). Problems with follow-up and patient progress. Use of unlicensed assistive personnel (UAPs) to deliver nursing care. Because some workers feel unchallenged and under stimulated in their roles, (low job satisfaction). Employees focus only on their own efforts, with less interest in overall results. Patients become confused with many different care providers. Patient’s response to care is difficult to assess. Critical changes in patient status may go unnoticed. Can lead to Patient and family dissatisfaction and frustration. Economical means of providing care - Many nurse administrators believe that assigning low-skill tasks to UAPs frees the professional nurse to perform more highly skilled duties and is therefore more economical (This is true if quality care and holistic care are not regarded as essential) - Advantages Large number of tasks in short period. Unskilled person can be trained to one specific task. Cost effective to mix staff. - Disadvantages Nurse Manager’s Role Fragmented patient care. Must be sensitive to the quality of patient care delivered Poor communication among staff members. and the institution’s budgetary constraints. Less control of quality. Achieving patient outcomes. Professional nurse dissatisfaction. By using effective management and leadership skills, can Team Nursing improve the staff’s perception of their lack of - Developed in the 1950s in an effort to decrease the independence. problems associated with the functional organization of Rotate assignments among staff. patient care. Staff meetings should be conducted frequently. This - Developed that reduced the fragmented care that encourages staff to express concerns and empowers them accompanied functional nursing. with the ability to communicate about patient care and - Ancillary personnel collaborate in providing care to a group functions. of patients under the direction of a professional nurse. Direct Care Nurse’s Role Nurses are educated to care for the patient holistically and providing only a fragment of care to the patient. Do the tasks that are usually assigned by the charge nurse. J.A.K.E 7 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 collecting some data) that do not require the expertise of an RN. It allows patient care needs requiring more than one staff member, such as patient transfers from bed to chair, to be easily coordinated. Is usually associated with democratic leadership. Group members are given as much autonomy as possible when performing assigned tasks. Although the team shares responsibility and accountability collectively. High job satisfaction. Disadvantages Assignments may not be equal if they are based on patient acuity or may be monotonous if nurses continuously care for patients with similar conditions (e.g., all patients with hip replacements). Problems in delegation and communication are the most Nurse Manager’s Role common reasons why team nursing is less effective than it Teaching, and coordinating patient activities. theoretically could be. Responsible for more than one unit. Are associated primarily with improper implementation Determine which nurse are competent and interested in rather than with the philosophy itself. becoming a charge nurse or a team leader. A great deal of time is needed for the team leader to Provide an adequate staff mix. communicate, supervise, and coordinate team members. Orient team members to the team nursing system. Continuity of care may suffer due to changes in team Providing continuing education. members, leaders, and patient assignments. No one person considers the total patient. Charge Nurse’s Role There may be role confusion and resentment against the Act as a liaison between the team leaders and other team leader, who staff may view as more focused on healthcare provider. paperwork and less directed at the physical or real needs Provide support for the teams on a shift by shift. of the patient. Team Leader’s Role Modular Nursing Developing or updating nursing care plans. - A mini-team (2-3 members approach). Delegate the work. - Members are sometimes called “care pairs”. Supervise, and coordinate team members. - A small team requires less communication, allowing Assisting team members. members better use of their time for direct patient care Resolving problems encountered by team members. activities. Follow up with members to evaluate the quality of care the patients assigned to their team. Facilitates patient care conferences. Direct Care Nurse’s Role Team nursing uses the strengths of each caregiver. Some nurses become known for their expertise in some tasks (IV), will start IV for patients under the guidance and supervision of the team leader. Direct patient care activities under the direction of the team leader. Primary Nursing Nurse acts as a responsible for knowing the condition and - A cultural revolution occurred in the united states during needs of all the patients assigned to the team and for the 1960s. The revolution emphasized individual rights, this planning individual care. revolution influenced the nursing profession. Searching for Advantages quality of patient care led to this model as a method to Improve patient satisfaction. increase RN accountability for. Cost effectiveness for the agency. - An adaptation of the case method, as a method for Organizational decision making occurring at lower levels. organizing patient care delivery in which one RN functions Allows members to contribute their own special expertise autonomously as the patient’s primary nurse throughout or skills. the hospital stay brought the nurses back to direct patient It allows the use of LPNs and UAPs to carry out some care. functions (e.g., making beds, transporting patients, J.A.K.E 8 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 - The primary nurse assumes 24-hour responsibility for Nurses develop skill in primary nursing care delivery, they planning the care of one or more patients from admission feel challenged and rewarded. or the start of treatment to discharge or the treatment’s 24-hour accountability for nursing care activities by one end. nurse - Provide the patient and the family with coordinated, High job satisfaction. comprehensive, continuous care. Decrease the number of unlicensed nurses. - Care is organized, using the nursing process. All staff are RN (professional staff) - A nursing Staff comprised totally of RNs. Motivation - Clear communication among the patient, the physician, Autonomy the associate nurses, and other team members. Disadvantages - Example: A patient is admitted to a medical unit with pulmonary Nurse may not have the experience or educational edema. background. His primary nurse admits him and then provides a Lie primarily in improper implementation. written plan of care. When his primary nurse is not It requires excellent communication between the primary working, an associate nurse implements the plan. nurses and associate nurses. Associate Nurses Primary nurses must be able to hold associate nurses accountable for implementing the nursing care as Is an RN who has been delegated to provide care to the prescribed. patient according to the primary nurse’s specification. Because of transfers to different units, critically ill patients When the primary nurse is not on duty. may have several primary care nurses, disrupting the If the patient develops additional complications, the continuity of care inherent in the model. associate nurse notifies the primary nurse. This method is difficult to implement because of the Provides input to the patient’s plan of care. degree of responsibility and autonomy required of the Is the only type of patient care delivery that requires a one primary nurse. to one relationship between a nurse and a patient with Many nurses may be uncomfortable in this role or initially responsibility for planning and managing care clearly lack the experience and skills necessary for the role. established. It sometimes has been difficult to recruit and retain enough RNs, especially in times of nursing shortages. In times of shortage (not be the model of choice). The Integrated Model of Care Practice Partnership - Introduced by Marie Manthey in 1989. - An RN and assistant (UAP, LPN or less experienced RN agree to be practice partners. - Work together with same schedule and the same group of patients. Nurse Manager’s Role Unit quality manager. Delegation. Budget controller. - Senior RN direct the work of the junior partner according to Decision making. partner’s abilities. Ac as role model, consultant, coach. - Two partners work in concern with patients. Direct care nurse’s role - Seniors perform selected patient care activities and delegates less ones to the junior. Caregiver, Decision maker, Teacher, Care coordinate, - Advantages manager. Improved continuity of care. Primary nurse depend on associate nurse. Offered an efficient way of nursing skills of a mix of Changing in the plan can be made by the associate different levels of experiences. Nurse in coordination with the primary nurse. Less expensive for the organization. Advantages Satisfying professionally for the partners. Improved continuity, quality and coordination of care. - Disadvantages Decentralization of nursing care decisions, authority, and Increase number of UAP and decrease ratio of responsibility to the staff nurse. professional nurses to non-professional. Patient and family are satisfied with the care. J.A.K.E 9 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Potential for junior team members to assume too much preadmission work-ups are completed and that the responsibility than appropriate. patient is being admitted at the appropriate time to Case Management facilitate follow-up through on problems. - Is a process of coordinating healthcare by planning, 2) Case Managers in Private Practice: facilitating and evaluating interventions across levels of - focus on a particular group of clients. For example, the care to achieve measurable cost and quality outcomes geriatric case manager focuses on managing care for - It may be within the wall of hospitals or beyond the walls. them. - It became a popular and effective method to manage Critical Pathway shortened lengths of stay for patients while achieving - Successful case management relies on critical pathways desired patient outcomes and to prevent expensive to guide care. The term critical path, also called a care map, hospital re-admissions. refers to the expected outcomes and care strategies developed by the collaborative practice team. - It provides direction for managing the care of a specific patient during a specified time period. - Comprehensive pre- printed standard plan reflecting ideal course of treatment for diagnosis or procedure especially with relatively predictable outcomes. - The critical pathway may need to be revised or additional data may be needed before changes are made. - Advantages: Accommodate unique characters and conditions of The Case Manager patients. - The case manager may help the family to identify all the Reduce costs and length of stay. options for care and treatment, ask questions to obtain Use appropriate sources. greater understanding of the overall problem, and work - Disadvantages: with the family in the decision- making process. The private The critical pathway may need to be revised or case manager is paid by the client or family usually based additional data may be needed before changes are on the hours of service provided. made. - The case manager role requires not only advanced nursing The critical path must include a means to identify skills but also managerial and communication skills. variances easily and to determine whether the outcome - Professional nurse assigned responsibility for this process. has been met. - Follow the patient from the diagnostic phase through Differentiated Practice hospitalization, rehabilitation and back to home care. - a method that sorting nursing practice roles, function and Advantages work based on education, experience, and competence or For the patient: some combination of them. Establishing and achieving a set of “expected” or - Nursing competencies are generally measured in three standardized patient care outcomes for each patient. areas: technical skills, communication and management Facilitating early patient discharge or discharge within an of care or leadership skills. appropriate length of stay. - Advantages: Using the fewest possible appropriate health care Nurses are allowed to work in specialized roles for resources to meet expected patient care outcomes. which they were educated, leading to greater career Facilitating the continuity of patient care through satisfaction. collaborative practice of diverse health professionals. - Disadvantages: For the nurse: Nurses who have experience, knowledge and capability Enhancing nurse’s professional development and job to function beyond their original education may not satisfaction. recognized. Facilitating the transfer of knowledge of expert clinical Organizations that have determined minimal staff of novice staff. educational requirements for RN positions may have Assists with decision-making by ensuring that plans are difficulty in recruiting staff with the requisite credentials. made in advance for the next needed step. and helps to ensure that the patient receives care that will achieve the most positive outcomes in the most efficient manner. This process helps to eliminate costly delays in progress. Case Manager’s Approaches 1) Case Mangers Employed by the Hospitals: - follow a patient from the time admission is planned through the time of discharge. This case manager might plan the admitting process to ensure that all J.A.K.E 10 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 the nurse: Beginning Nurses’ Role on Client Care, Beginning Nurses’ Role on Management and Leadership and Beginning Nurses’ Role in Research as well as four types of clients of the nurse. With the promulgation of the 2012 NNCCS, the succeeding stage is its implementation and evaluation in both nursing education and nursing service in all settings. Goals and objectives of the Project This goal blended well with the goal of the ILO project to improve Nursing Education and practice through the dissemination of materials and training of nurses. Specifically, the project aims to: 1) Establish the team and system for implementing the project. 2) Develop and implement the training design and materials aligned with the revised NNCCS competencies. 3) Pilot the training course in Luzon, Visayas and Mindanao. 4) Recommend strategies to address sustainability concerns. Significance: 1) Basic Nursing Education Program in the Philippines through CHED 2) Competency-based test framework development of course syllabi and test questions for “entry level” nursing practice in the board licensure examination for nurses. 3) Standards of professional nursing practice in various setting in the Philippines. 4) All related evaluation tools in various practice settings in the Philippines. 10 KEY PHASES EVIDENCE-BASED PRACTICES IN NURSING MANAGEMENT Phase 1 – Work Setting scenario National Nursing Care Competency Standards (NNCCS) Phase 2 – Validation studies of roles and - Developed for Nursing Practice in 2001, through the responsibilities/Benchmarking initiative of the Professional Regulation Commission-Board Phase 3 – Integrative review of out puts from the validation of Nursing (PRC-BON) which created a National Task Force strategies for Core Competency Standards Development. Phase 4 – Core competency consensual validation - The project was completed in 2005 after a series of Phase 5 – Conduct of public hearing workshops, consultations, and discussions among Phase 6 – Promulgation of the revised and modified core representatives of nursing practice, nursing education and competency standards. community health nursing. Phase 7 –Printing of the revised and modified core 11 Core Competencies Nursing competency standards. 1) Safe and quality nursing care Phase 8 – Training in the implementation of the revised core 2) Communication competency standards. 3) Collaboration and teamwork Phase 9 – Implementation of the revised core competency 4) Health education standards. 5) Legal responsibility Phase 10 – Evaluation of effectiveness of the revised core 6) Ethico-moral responsibility competency standards. 7) Personal and professional development 8) Quality improvement Patient Care Safety Standards 9) Research What is safety? 10) Management of resources and environment - It is one aspects of quality where quality includes not only 11) Record management. avoiding, preventable harm, but also making appropriate In the foreword of the 2012 NNCCS, Professional care available providing effective services to those who Regulation Commission Chair T.R. Manzalastated: could benefit from them and not providing ineffective or “Out of this lengthy process emerged the Revised Nursing harmful services. Core Competency Standards, emphasizing the three roles of - to prevent harm to patients, their families and friends, healthcare professionals, contract of service workers, J.A.K.E 11 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 volunteers, and the many other individuals whose activities Patient Centered Care and Empowerment of bring them into an environment. Consumers Key Elements of Patient Safety - Patients must be at all centers of patient safety Leadership initiatives and must be partners in all aspects of the - Leadership and political commitment are essential at process. the health facility level where patient safety becomes Patient centered care and patient safety is a national an integral component of quality care. priority and core agenda - The Leadership shall address strategic priorities for - To improve quality care in all health institutional development. - To protect patients, form faulty system - Its culture and infrastructure, engage its various stakeholders, communicate and build awareness. Importance of Safety in Healthcare Institutional Development 1) Improve patient satisfaction and clinical outcomes. - Approaches to institutionalize patient safety and quality 2) Ensure accuracy of patient’s identification. in the health facilities will have to consider the 3) Enhance the effectiveness of communication among following: healthcare personnel. o Financial and human resource. 4) Improve the safety of using medications. o Facility and equipment management. 5) Reduce the risk of health care associated infections. o Strengthen management responsibility. 6) Reduce the risk of harm resulting from injuries. o Authority and competency. 7) Increases awareness of occupational health and o Formulate standards of what is expected from environmental control like ergonomically designed health providers; communicates; provide training. workplace. o Enforce the standards that comes with the policies 8) Workers must be trained to. Workers also must be and give the patients voice through a feedback convinced why it is important to pay attention. To prevent system or a patient satisfaction survey and be educated about the benefits in terms of reduced Reporting System pain and discomfort of adopting good practices and work - The National Patient Safety Committees shall develop methods. and institutionalize a pro-active reporting and learning 9) A stronger gonomics integration prevents injuries and system that requires its leadership to encourage increases productivity. Together, they make the workplace reporting of events. safer and reduce costs. Feedback and Communication - Performance feedback and benchmarking mechanism: 5 Ways to Improve Staff Safety in Healthcare o To communicate leadership responses 1) Promote a culture of safety o To the reports shall be established 2) Measure the performance of safety protocols o To demonstrate communication 3) Optimize staff scheduling o To patient safety and ensure continues improvement. 4) Improve patient handling Adverse Event Prevention and Risk Management 5) Use safer medical equipment - Risk and reduction strategies thorough patient - Risk assessment Nursing Actions to Improve Patient Safely - Patient feedback survey health technology assessment 1) Knowledge and implementation about healthcare policies and safety assessment code and procedures. Disclosure of Reported Serious Events 2) Open communication and teamwork among all other - The reporting system ensures confidentiality of health care providers. individual cases. 3) Review the medication rights before giving the - The events can be made available to the public through medications. disclosure of results of investigation, summary reports 4) Engage in creating and updating reporting system to avoid or annual reports that summarize events and actions a blaming culture, taken. 5) Involve in research and evidence-based activities for better Professional Development decision-making. - Training and supervision of the healthcare staff to 6) Be updated on all life-saving certification like CPR, improve their decision and clinical judgments is BLS,ACLS, PALS, NALS and other Nursing Specialty imperative. Certification Programs. - It is necessary to instill standard norms of behavior of 7) Engage in hospital committees to make the healthcare courtesy, promptness and efficiency among the health system safe, effective and patient-centered. care workers and improve the quality of service given to 8) Be responsible in reporting all errors and near misses not patients. only for the patient to prevent sentinel and adverse events to happen again. 9) Ensure better lighting and less clutter in the work areas. J.A.K.E 12 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 Standards of Professional Nursing Practice (American SECTION 2 Nurses Association, 2015) - To assume this responsibility, registered nurses have to Standards of Practice gain knowledge and understanding of man’s cultural, - The Standards of Practice describe a competent level of social, spiritual, physiological, psychological, and nursing care as demonstrated by the critical thinking model ecological aspects of illness, utilizing the therapeutic known as the nursing process. process. - The nursing process includes the components of - Cultural diversity and political and socio-economic status assessment, diagnosis, outcomes identification, planning, are inherent factors to effective nursing care. implementation, and evaluation. Accordingly, the nursing SECTION 3 process encompasses significant actions taken by - The desire for the respect and confidence of clientele, registered nurses and forms the foundation of the nurse’s colleagues, co-workers, and the members of the decision-making. community provides the incentive to attain and maintain Standard 1. Assessment the highest possible degree of ethical conduct. Standard 2. Diagnosis Standard 3. Outcome identification ARTICLE II: Registered Nurses and People Standard 4. Planning SECTION 4 Standard 5. Implementation 1) Values, customs, and spiritual beliefs held by individuals Standard6. Evaluation shall be respected. Standard7. Ethics 2) Individual freedom to make rational and unconstrained decisions shall be respected. Standard8. Education 3) Personal information acquired in the process of giving Standard9. Evidence-based practice and research nursing care shall be held in strict confidence Standard10. Quality of practice SECTION 5 Standard11. Communication 1) consider the individuality and totality of patients when they Standard12. Leadership administer care. Standard13. Collaboration 2) respect the spiritual beliefs and practices of patients Standard14. Professional practice evaluation regarding diet and treatment. Standard15. Resource utilization 3) uphold the rights of individuals. Standard16. Environmental health 4) take into consideration the culture and values of patients in providing nursing care. However, in the event of conflicts, ETHICO-LEGAL AND MORAL CONSIDERATIONS IN their welfare and safety must take precedence. NURSING LEADERSHIP MANAGEMENT Code of Ethics for Registered Nurses (Board of Nursing) ARTICLE III: Registered Nurses and Practice Code of Ethics for Nurses SECTION 6 - WHEREAS, the Board of Nursing (BON) has the power to 1) Human life is inviolable. promulgate a Code of Ethics for Registered Nurses in 2) Quality and excellence in the care of the patients are the coordination and consultation with the accredited goals of nursing practice. professional organization (Sec. 9, (g), Art III of (Republic 3) Accurate documentation of actions and outcomes of Act) No. 9173, known as the “Philippine Nursing Act of delivered care is the hallmark of nursing accountability. 2002); SECTION 7 - WHEREAS, in the formulation of the Code of Ethics for 1) Know the definition and scope of nursing practice which Registered Nurses, the Code of Good Governance for the are in the provisions of R. A. No. 9173, known as the Professions in the Philippines was utilized as the principal “Philippine Nursing Act of 2002” and Board Res. No. 425, basis thereof: All the principles under the said Code were Series of 2003, the “Rules and Regulations Implementing adopted and integrated into the Code of Ethics as they the Philippine Nursing Act. of 2002”, (the IRR). apply to the nursing profession; 2) Be aware of their duties and responsibilities in the practice of their profession as defined in the “Philippine Nursing Act ARTICLE I: PREAMBLE of 2002” and the IRR. SECTION 1 3) Acquire and develop the necessary competence in - Health is a fundamental right of every individual. The knowledge, skills, and attitudes to effectively render Filipino registered nurse, believing in the worth and dignity appropriate nursing services through varied learning of each human being, recognizes the primary responsibility situations. to preserve health at all costs. 4) If they are administrators, be responsible in providing - This responsibility encompasses promotion of health, favorable environment for the growth and developments of prevention of illness, alleviation of suffering, and Registered Nurses in their charge. restoration of health. However, when the foregoing are not 5) Be cognizant that professional programs for specialty possible, assistance towards a peaceful death shall be certification by the BON are accredited through the Nursing his/her obligation. Specialty Certification Council (NSCC). J.A.K.E 13 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 6) Sees to it that quality nursing care and practice meet the 2) conform with group activities as those of a health team optimum standard of safe nursing practice. should be based on acceptable, ethico-legal standards. 7) Ensure that modification of practice shall consider the 3) contributes to the professional growth and development of principles of safe nursing practice. other members of the health team. 8) If in position of authority in a work environment, be 4) actively participates in professional organizations. normally and legally responsible for devising a system of 5) not act in any manner prejudicial to other professions. minimizing occurrences of ineffective and unlawful nursing 6) honor and safeguard the reputation and dignity of the practice. members of nursing and other professions; refrain from 9) Ensure that patients’ records shall be available only if they making unfair and unwarranted comments or criticisms on are to be issued to those who are professionally and their competence, conduct, and procedures; or not do directly involved in their care and when they are required by anything that will bring discredit to a colleague and to any law. member of other professions. SECTION 8 7) respect the rights of their co-workers. - Registered Nurses are the advocates of the patients: they shall take appropriate steps to safeguard their rights and ARTICLE V: Registered Nurses, Society, And Environment privileges. SECTION 14 SECTION 9 1) The preservation of life, respect for human rights, and 1) respect the “Patients’ Bill of Rights” in the delivery of promotion of healthy environment shall be a commitment nursing care. of a Registered Nurse. 2) provides the patients or their families with all pertinent 2) The establishment of linkages with the public in promoting information except those which may be deemed harmful to local, national, and international efforts to meet health and their well-being. social needs of the people as a contributing member of 3) upholds the patients’ rights when conflict arises regarding society is a noble concern of a Registered Nurse. management of their care. SECTION 15 SECTION 10 1) be conscious of their obligations as citizens and, as such, - Registered Nurses are aware that their actions have be involved in community concerns. professional, ethical, moral, and legal dimensions. They 2) be equipped with knowledge of health resources within the strive to perform their work in the best interest of all community and take an active role in primary health care. concerned. 3) actively participates in programs, projects, and activities SECTION 11 that respond to the problems of society. 1) performs their professional duties in conformity with 4) lead their lives in conformity with the principles of right existing laws, rules regulations measures, and generally conduct and proper decorum. accepted principles of moral conduct and proper decorum. 5) project an image that will uplift the nursing profession at all 2) not allow themselves to be used in advertisement that times. should demean the image of the profession (i.e. indecent exposure, violation of dress code, seductive behavior, etc.). ARTICLE VI: Registered Nurses and The Profession 3) declines any gift, favor or hospitality which might be SECTION 16 interpreted as capitalizing on patients. 1) Maintenance of loyalty to the nursing profession and 4) not demand and receive any commission, fee or preservation of its integrity are ideal. emolument for recommending or referring a patient to a 2) Compliance with the by-laws of the accredited physician, a co-nurse or another health care worker; not to professional organization (PNA), and other professional pay any commission, fee or other compensations to the organizations of which the Registered Nurse is a member is one referring or recommending a patient to them for a lofty duty. nursing care. 3) Commitment to continual learning and active participation 5) avoids any abuse of the privilege relationship which exists in the development and growth of the profession is with patients and of the privilege access allowed to their commendable. property, residence or workplace 4) Contribution to the improvement of the socio-economic conditions and general welfare of nurses through ARTICLE IV: Registered Nurses and Co-Workers appropriate legislation is a practice and a visionary mission. SECTION 12 SECTION 17 1) The Registered Nurse is in solidarity with other members of 1) be members of the Accredited Professional Organization the healthcare team in working for the patient’s best (PNA). interest. 2) strictly adheres to the nursing standards. 2) The Registered Nurse maintains collegial and collaborative 3) participates actively in the growth and development of the working relationship with colleagues and other health care nursing profession. providers. 4) strives to secure equitable socio-economic and work SECTION 13 conditions in nursing through appropriate legislation and 1) maintains their professional role/identity while working other means. with other members of the health team. 5) assert for the implementation of labor and work standards. J.A.K.E 14 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 ARTICLE VII: Administrative Penalities, Repealing Clause, Kinds of Contracts And Effectivity Formal Contract – Refers to an agreement among parties SECTION 18 involved and is required to be in writing by some special - The Certificate of Registration of Registered Nurse shall laws. either be revoked or suspended for violation of any Informal Contract – one which is concluded as the result provisions of this Code pursuant to Sec. 23 (f), Art. IV of R. of a written document or correspondence where the law A. No. 9173 and Sec. 23 (f), Rule III of Board Res. No. 425, does not require the same to be written, or as the result of Series of 2003, the IRR. oral and spoken discussion between the parties or conduct between the parties, evidence and intention to contract. The International Council Of Nurses (ICN) Code of Ethics Voidable Contract – An agreement which is enforceable For Nurses by law at the option of one or more of the parties thereto, - An international code of ethics for nurses was first adopted but not at the option of the other or others, is a voidable by the International Council of Nurses (ICN) in 1953. contract. - It has been revised and reaffirmed at various times since, Void Contract – Contract which ceases to be enforceable most recently with this review and revision completed in by law becomes void, when it ceases to be enforceable. 2012. Unenforceable Contract – A contract which cannot be enforced is a valid contract in law, but is incapable of proof, The ICN Code of Ethics for Nurses has four principal and therefore cannot be enforced in the Court of Law. elements that outline the standards of ethical conduct Executed Contract – Where both the parties have 1) Nurses and people performed their obligation, it is an executed contract. Even - Nurse’s primary professional responsibility is to people when one party to the contract has performed his share of requiring nursing care. the obligation, the contract is executed through to the 2) Nurses and practice other party is still under an outstanding obligation to - Nurses carries personal responsibility and perform his part of the promise. accountability for nursing practice Executory Contract – Here neither party to the contract - Maintaining competence by continual learning. has performed his share of the obligation, for example, 3) Nurses and the profession both the parties have yet to perform their promises, the - The nurse assumes the major role in: determining and contract is executory. implementing acceptable standards of clinical nursing Express Contract – When the terms of a contract are practice, management, research and education. reduced in writing or are agreed upon by spoken words at - The nurse is active in: the time of its formation, the contract is express. a) Developing a core of research-based professional Implied Contract – The terms of a contract are inferred knowledge. from the conduct or dealing between the parties. When the b) Developing and sustaining a core of professional proposal or acceptance of any promise is made otherwise values. than in words, the promise is said to be implied. 4) Nurses and co-workers Quasi-Contract – Quasi contracts raise out of obligation - The nurse sustains a collaborative and respectful enjoyed by one person from the voluntary acts of the other relationship with co-workers in nursing and other fields. which are not intended to be performed gratuitously. - The nurse takes appropriate action to safeguard individuals, families, and communities when their Contingent Contract – A contingent is one in which a promise is conditional, and the contract shall be health is endangered by a co-worker or any other performed only on the happening of some future uncertain person. even illustrations. - The nurse takes appropriate action to support and guide Requisites of a Contract co-workers to advance ethical conduct. 1) To have a contract, two or more persons must participate. 2) The parties involved must give consent to the contract. Contract 3) The object which is the subject matter of the contract must - a meeting of minds between two persons whereby one be specified such as: binds himself, with respect to the other, to give something a) all things which are not outside the commerce of man; or to render some service b) all rights which are not in transmissible; - A contract is a promise or a set of promises which the law c) future inheritance in cases expressly authorized by law; recognizes as a duty and when that duty is not performed, and the law provides a remedy. d) all services which are not contrary to law, morals, good - When a nurse enters into a contract with and employer, it customs, public order, and public policy. is usually an agreement to be paid a certain amount of 4) The cause of obligation is established. The time, price, and money and be provided certain benefits in exchange for subject matter are expressed. Generally, the length of time such services. of a contract for services is at least equal to the period for which wages or salaries are payable. Thus, if one is J.A.K.E 15 of 34  NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER PRELIM 2023 engaged on yearly rates, the length of time of the contract relationship to acquire high salary or other options as will be at least one year. property, such contract is invalid as it is illegal. 5) Contracting parties must have the legal capacity to enter 5) Those obtained through material misrepresentation. into a contract. They must Aside from fraud, material misrepresentation may permit a) be of legal age; a person to avoid or cancel a contract. Suppose a b) be of sound mind; midwife applied as nurse in an agency and was soon c) not be under the influence of intoxicating drugs, or fear found not to be a registered nurse, the contract that she of bodily harm; and. not be suffering from physical signed becomes illegal because she misled the employer disability such as those who are mentally incompetent. that she is a nurse. - Married women have the full capacity to go into a Breach of Contract contract except in some cases when it is specified that - Breach of contract is failure to perform an agreement, the husband should agree to such a contract. whether expressed or implied, without cause. - Examples are in selling or mortgaging of property. - The following constitute breach of contract for nursing Married female nurses will need written consent from services: their husbands if they are going to work abroad. Prevention of performance. Inexistent Contract Failure to perform because of inconvenience or The following contracts are void or inexistent from the