Nursing Leadership and Management PDF (NCM 119)

NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 NURSING LEADERSHIP AND MANAGEMENT Conce...

NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 NURSING LEADERSHIP AND MANAGEMENT Concept of 3 E’s Leadership is the act of influencing and motivating a group of people o Efficiency to act in the same direction towards achieving a common goal. o Effectiveness Do not have delegated authority but obtain their power through o Economy other means, such as influence. Restricted focus – weakness of machine model Focus on group process, information gathering, feedback, and Concerned with optimizing effort at the shop or operator level and empowering others. therefore utilizes micro approach Have goals that may or may not reflect those of the Work should be studied scientifically to determine the methos of organization. task performance that would yield maximum work output with minimum work expenditure. Management is the process of leading and directing an organization to meet its goals through the use of appropriate resources. FOUR OVERRIDING PRINCIPLES OF SCIENTIFIC Legitimate source of power due to the delegated authority. MANAGEMENT Emphasize control, decision making, decision analysis, and 1. Traditional “rule of thumb” means of organizing work must be results. replaced with scientific methods. Greater formal responsibility and accountability for rationality 2. A scientific personnel system must be established so that and control than leaders. workers can be hired, trained, and promoted based on their technical competence and abilities. MANAGEMENT: Some Definitions 3. Workers should be able to view how they “fit” into the Process that involves the coordination of human and material organization and how they contribute to overall organizational resources towards the accomplishment of certain objectives. productivity. Accomplishment of objectives through efforts of other people. 4. The relationship between managers and workers should be Process by which the execution of a given purpose is put into cooperative and interdependent, and the work should be shared operations and supervised. equally. Management can be seen as: BUREAUCRATIC ORGANIZATIONS / BUREAUCRATIC MODEL o A process o A profession Max Weber (1922): Theory of Social and Economic Organization o A factor of production advocated Bureaucracy. He popularized the model. o A field of study Need for legalized, formal authority and consistent rules and o A group of people that supervise an organization regulations for personnel in different positions Relies on rational set of structuring guidelines, such as rules and ORGANIZATIONS: Definitions procedures, hierarchy, and a clear division of labor. Social units (or human groupings) deliberately constructed and The bureaucracy is a formal organization. reconstructed to seek specific goals (Talcott Parsons) Max Weber’s Bureaucratic characteristics Is a system of consciously coordinated personal activities of ✓ Division of Labor forces with specific goals (Barnard) ✓ Fixed authority and official jurisdiction ✓ Hierarchal arrangement of officers MANAGEMENT THEORIES ✓ Written formal rules SCIENTIFIC MANAGEMENT THEORY ✓ Impersonality ✓ Specialization Frederick W. Taylor’s “One Best Way” from his time and motion ✓ Security of tenure studies Weber's rules (criteria on how to construct organizations Taylor is the Father of Scientific Management 1. Organizations are impersonal and are subject to authority Machine Model – viewed man as a means of production rather 2. Organized in clearly defined hierarchy of offices than the end (economic man model) 3. Each office has area of competence Productivity at the level of the worker (skills, physical attributes) 4. Office is filled by way of a free contractual relationship and His management said reduced wasted efforts, set standards for there is free selection for the positions performance, encourage specialization and, stress the selection 5. Technical qualification is basis of selection of qualified workers who could be developed for a particular job. 6. Members are remunerated by fixed salaries; right to Basic Principles of the Machine Model pensions; salary scale according to rank; right to resign o Division of labor and specialization 7. Office is sole primary occupation of the members o Unity of command and centralization of decision-making 8. Office constitutes a career with a promotion system o One way authority 9. Official work separated from ownership of the means of Narrow span of control administration  NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 10. Members subject to strict and systematic discipline and 6. Subordination of individual interest to general interest: the control in the conduct of the office goals of the firms are always paramount. 7. Remuneration: payment is an important motivator. ADMINISTRATIVE MANAGEMENT THEORY / MGT. FUNCTIONS 8. Centralization of Decentralization: depends on the condition of By Henri Fayol (1841 – 1925) who first identified the business and the quality of its personnel. management functions of planning, organization, command, 9. Schalar chain/line of authority: refers to the number of levels coordination, and control. in the hierarchy. Treated administration as a process as opposed to the 10. Order: both material order (minimizes lost time and useless prevailing practice wherein administration is under control handling of materials) and social order (organization and of specialists. selection) are necessary. According to Fayol, administrative management was concerned 11. Equity: employees should be treated well to achieve equity. or focused on the formal organization structure and the 12. Stability of tenure of personnel: job security and career delineation of the basic processes of general management: progress are important for employees to work better. o Planning – examining the future and drawing up the plan of 13. Initiative: allow personnel to show their initiative, it may be a action source of strength for the organization. o Organizing – building up the structure, material, human 14. Esprit de corps: management should foster the moral of the resources of the undertaking employees. o Command – maintaining activity among the personnel o Coordination – binding together PARTICIPATIVE MANAGEMENT o Control – conformity Mary Parker Follett (1926) was one of the first theorists to suggest participative decision making or participative SEVEN ACTIVITIES OF MANAGEMENT management. Luther Gulick (1937) expanded on Fayol’s management Managers should have authority with, rather than over, functions in his introduction of the “Seven Activities of employees. Management” – planning, organizing, staffing, directing, Humanism – Creation and development of human centered coordinating, reporting, and budgeting. organizations to fulfill the needs and wants of the human personality. MANAGEMENT PROCESS Mary Parker Follet viewed management as a social process and 1. Planning determines philosophy, goals, objectives, policies, the organization as a social system procedures, and rules; carrying out long and short-range projections; determining a fiscal course of action; and managing ILLUMINATION STUDIES planned change. Elton Mayo and his Harvard associates (1927-1932), look at the 2. Organizing establishes the structure to carry out plans, relationship between light illumination in the factory and determining the most appropriate type of patient care delivery, productivity. and grouping activities to meet unit goals. Elton Mayo – one of fathers of human relations movement. 3. Staffing consists of recruiting, interviewing, hiring, and orienting Hawthorne effect indicated that people respond to the fact that staff. Scheduling, staff development, employee socialization, they are being studied, attempting to increase whatever and team building. behavior. 4. Directing consists of motivating, managing conflict, delegating, Hawthorne Studies – Conducted by Western Electric industrial communicating, and facilitating collaboration. engineers to examine the effect of various illumination levels on 5. Controlling functions include performance appraisals, fiscal workers productivity accountability, quality control, legal and ethical control, and Mayo concluded that behavior and sentiments were closely professional and collegial control. related, that group influences significantly affected individual behavior, that group standards established individual worker’s 14 PRINCIPLES OF MANAGEMENT output, and that money was less a factor in determining output 1. Division of work: allows specialization. than group standards 2. Authority: right to command balanced with responsibility and accountability. THEORY X AND Y 3. Discipline: employees will only obey orders if management play Douglas McGregor (1960), X and Theory Y, posited that their part by providing good leadership. managerial attitudes about employees can be directly correlated 4. Unity of command: there should only be one boss with no with employee satisfaction. conflicting lines of command. o Theory X managers believe that their employees are 5. Unity of direction: people engaged in the same kind of basically lazy, need constant supervision and direction, and activities must have the same objective in a single plan. are indifferent to organizational needs. Essentially negative  NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 view of people- little ambition, dislike work, avoids Trend continues until system splits, combines with another responsibility, and needs to be closely directed to work complex system or falls apart entirely. effectively Chaos theory emphasizes the need for nurse leaders to be o Theory Y managers believe that their workers enjoy their comfortable with uncertainty and ambiguity, as healthcare work, are self-motivated, and are willing to work hard to environments are often dynamic and evolving. meet personal and organizational goals. Positive view – people can exercise self- direction, accept responsibility CONTINGENCY THEORY and consider work to be as natural as rest or play. Theory Asserts that when managers make a decision, they must take Y assumptions best captured true nature of workers and into account all aspects of the current situation. should guide management practice. The best style depends on the situation. “It depends” approach EMPLOYEE PARTICIPATION Most important managerial skills are Chris Argyris (1964), managerial domination causes workers to ✓ Decision-making become discouraged and passive. ✓ Inter- personal skills If self-esteem and independence needs are not met, employees ✓ Communication will become discouraged and troublesome or may leave the ✓ Negotiating skills organization. ✓ Delegating CONTINGENCY MANAGEMENT THEORY MANAGEMENT FUNCTIONS Fred Fiedler - Planning, Organizing, Directing, and Controlling. Proposed that the traits of a leader were directly related to how effectively he led. 1. Planning There’s a set of leadership traits handy for every kind of Occurs in various ways and at all levels situation. It means that a leader must be flexible enough to adapt Setting organizational goals to the changing environment. Development of strategies for achieving the goals of org. There is no one specific technique for managing an standards, levels of equality, need to be met in completing organization. the tasks A leader should be quick to identify the particular management 3 kinds of Planning: style suitable for a particular situation. o Strategic Planning – long-range The primary component of Fiedler’s contingency theory is LPC o Practical Planning – the least preferred co-worker scale. LPC is used to assess o Contingency Planning – an alternative course of action how well oriented a manager is. when the primary plans don’t achieve the goals. CONTEMPORARY / MODERN THEORIES 2. Organizing QUANTUM THEORY The way the organization allocates resources, assigns Each person needs to be acknowledged for his or her own talent tasks, and goes about accomplishing goals and potential, and each needs to be acknowledged and helped Shown by organizational chart to grow in all possible kinds of ways. The leader is the one responsible to facilitate growth among his 3. Directing subordinates. Supervising or leading workers to accomplish organization’s Approaches leadership through lens provided by new science objectives and naturally-occurring events Involves Recognizes interplay among all members of a group as a critical ✓ Making assignments factor in determining outcomes ✓ Assisting workers to carry out assignments Quantum leadership skills include a willingness to learn and ✓ Interpreting organizational policies change while confronting dependencies from the past and ✓ Informing workers of how well they are performing practicing "tough love" toward others by speaking honestly. 4. Controlling CHAOS THEORY Evaluation activities that a manager must perform Recognizes that events are rarely controlled. Process of determining if the company’s goals and Suggests that systems become more complex and also more objectives are being met. volatile and must expend more energy to maintain the complexity.  NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 THE NURSE MANAGER IN THE HEALTH FACILITY CLASSIFICATIONS NURSE MANAGERS (Sullivan and Decker, 1988) 1. PUBLIC HEALTH NURSE MANAGER 1. Perform these roles simultaneously: Directs, manages, supervises and coordinates program Subordinates development, fiscal management and programs and activities of Superiors the district’s health care programs Customer service representative Provides innovations in services and programs 2. Key leadership position directly related to the delivery of Collaborates and contracts for activities with other health care nursing care professionals and outside agencies CHARACTERISTICS OF AN INTEGRATED LEADER-MANAGER 2. CLINICAL NURSE MANAGER (Gardner, 1990) Provides direction and clinical supervision of patient care in a They think long term. particularly assigned area in the hospital They look outward, toward the larger organization. Be a professional caregiver with clinical and supervisory They influence others beyond their own group. experience that promotes an atmosphere that is responsive to They emphasize vision, values and motivation. the need of the patients, nursing and medical staff They are politically astute. Promotes the philosophy, goals and objectives of the hospital They think in terms of change and renewal LEVELS JOB DESCRIPTION OF A NURSE MANAGER (Sullivan and a. First-Line Manager Decker, 1988; Marquis and Huston, 2006) Oversees employees Position Purpose – serves as the official supervisor of an assigned Deals with immediate problems in daily operations, division and functions to: plan, direct, coordinate, implement, control, organizational needs and employee’s personal needs evaluate and improve the quality of patient care delivered. Motivates staff to achieve goals of organization Represents staff to upper administration Specific Responsibilities: Plans and executes administrative programs within the b. Middle Manager framework of total nursing service program. Coordinates with actions of lower hierarchal employees Interviews, selects, formally evaluates and terminates nurses in Serves as channel between lower and top-level managers the unit. Carries out day to day operations but still involved in some Establishes standards, goals, objectives, priorities and facilities long-term planning and establishing unit policies change based on the needs of patients and their families, physicians and staff based on the results of various c. Top Manager recommendations. Looks at organization in broader context, coordinates Holds regularly scheduled staff meetings, which provide internal and external influences opportunities for discussion of division problems, orientation to Determines philosophy of organization new projects, procedures, changes in care approaches, etc. Sets policies Contributes to creating a work climate that encourages positive Creates goals and policies for resource allocation staff morale, motivation and commitment. Less involved in day-to-day operations Supervises the allocation of division resources while remaining accountable to an established budget. d. Charge Nurse Controls work time schedules for entire staff and makes the Liaison to the nurse manager, assisting in shift-by-shift scheduling adjustments when necessary. coordination and promotion of quality patient care as well Equitably delegates patient care/division maintenance as efficient use of resources. assignments and authority according to perceived strengths and Often troubleshoots problems, assists in decision making limitations of subordinates and maintaining accountability. Role model, mentor, educator Advocates for both patient and staff and convince the May have more informal power than manager administration of the need and value of individualized care. Evaluates the quality of care provided alongside the standards e. Staff Nurse and policies. Not formally a manager Supervises others to ensure safe, quality patient care.  NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 THE NATURE OF MANAGERIAL WORK (Henry Mintzberg) TYPES OF ORGANIZATIONAL STRUCTURE 1. INTERPERSONAL ROLES a. Figurehead - performs ceremonial duties 1. Line Organization/Bureaucratic/Pyramidal b. Leader - Defines work environment and responsible for There is clearly defined superior-subordinate relationship subordinate’s work Power are concentrated at the top c. Liaison - Expands outside information sources and networks 2. Flat/Horizontal Organization Decentralized type 2. INFORMATIONAL ROLES Applicable in small organization a. Monitor- Internally seeks information about organization Nurses become productive and directly involved in the b. Disseminator- Shares information within organization decision-making skills c. Spokesperson – shares information outside organization Workers become satisfied 3. DECISIONAL ROLES 3. Functional Organization a. Entrepreneur – Seeks ways to solve problems/ improve Permits a specialist to aid line position within a limited and organizations; initiates change clearly defined scope of authority b. Disturbance handler – responds to problem c. Resource allocator – manages time and coordinates 4. Ad Hoc Organization efforts Modification of bureaucratic structure d. Negotiator- mediates resources/ decisions with outside forces 5. Matrix structure Focus on both product and functions ORGANIZING Most complex Determine what tasks are to be done, who is to do these, Has both vertical and horizontal chain of command and how the tasks are to be grouped, who reports to whom and line of communication what decisions are to be made. Form of identifying roles and relationships of each staff in order to delineate specific tasks or functions that will carry STAFFING out organizational plan and objectives. Process of assigning competent people to fulfill the roles designated for the organizational structure through recruitment, PROCESS COVERAGE selection and development, induction and orientation of the new Identifying and defining basic tasks staff of the goals, vision, mission, philosophy etc. Delegation of authority and assigning responsibility Establishing relationships STAFFING PROCESS THREE FORMS OF AUTHORITY Preparing to Recruit Attracting a Staff 1. LINE AUTHORITY – Direct supervisory authority from Recruiting and Selecting a Staff supervisor to subordinates ✓ Chain of command STAFFING PATTERN – plan that articulates how many and what kind ✓ Unity of command of staff are needed/shift or per day in unit or in department. ✓ Span of control 2. STAFF AUTHORITY – Based on expertise and involves TWO WAYS OF DEVELOPING A STAFFING PARTNER advising line managers. Determine the # of NCH needed/patient o Generating the full-time equivalents of an employee 3. TEAM AUTHORITY – Granted to committees or work teams Determine the N-P ratio in providing nursing care in daily operations. o 1.0 FTE = works 5 days/week, 8 hours/day ORGANIZATIONAL CHART o 0.5 FTE = part time employee who works 5 days/2 weeks Drawing that shows how the parts of the organization are linked Depicts the organization’s structure CONSIDERATIONS IN STAFFING PATTERN 1. Benchmarking – Management tool for seeking out the best practice in one’s industry so to improve one’s performance. 2. Regulatory Requirements 3. Skill Mix 4. Staff Support 5. Historical Information  NCM 119 NURSING LEADERSHIP AND MANAGEMENT FIRST SEMESTER | 2024 - 2025 TYPES OF STAFFING 1. Case method 2. Functional Nursing 3. Team nursing 4. Modular/District nursing 5. Primary nursing 6. Case management 7. Collaborative 8. Managed care PATIENT CLASSIFICATION SYSTEM Measuring tool used to articulate the nursing workload for specific patient or group of patients over a specific time. Patient Acuity Patient Care is Classified According to: - Self-care or minimal care patients - Intermediate or moderate care - Total care patients - Intensive care patients SCHEDULING Timetable showing planned work days and shifts for nursing personnel. ISSUES TO CONSIDER IN SCHEDULING STAFF: Patient type and acuity Number of patients Experience of Staff Support available to the staff SHIFTING VARIATIONS 1. Traditional Shifting Patterns 3 shift (8-hr shift) 12-hr shift 10-hr shift 2. Weekend option (Part 2 Baylor) 3. Rotating work shift 4. Self-scheduling 5. Permanent work shift 6. Floaters – “on-call” 7. Block/Cyclical work shift 8. Variable work shift FORTY HOUR WEEK LAW Based on R.A. 5901 No work, no pay 2-wk sick leave and off duty for 2 days Special Holidays – with pay