NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua 1. Trait theory 2. Great Man Theory 3. Charismatic Theory 4. Frederick Taylor 5. Frank and Lillian Gilbreth 6. Henry Gantt 7. Henri Fayol 8. Max Weber 9. Elton Mayo Hawthorne Studies 10. Kurt Lewin change theory 11. Abraham Maslow 12. Frederick Herzberg 13. Douglas McGregor 14. Ouchi Theory Z 15. Peter Drucker – MBO 16. Fred Fiedler Contingency theory 17. Robert House – Path Goal T. 18. Lashbrook Work Unit Culture
Mission 1. CLMMRH 2. BOLMSH Vision TLJPH 3. SVH Organizational Chart/Structure 4. Bac CHD Staffing – Nursing Service 5. PHO (Interlocal H Zones) 6. NORFI/VRHD Personnel
I. The Nurse in the Organization
A. The Center of the Work World is ME
o Your work world begins with ME o You are quite literally, the center of your work world o You are unique, thus your job situation is unique
4 Attributes
My Internal Environment My External Environment My Responsibilities
My Values My Motivation My Knowledge My Skill
Personal attributes that influence 1 your work world NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua A1. My Values
o Have an unrecognized influence upon your philosophy and actions as a nurse o Affects your life and your work. o My values are acquired subconsciously during early years and remain relatively unchanged all of your life o My values Answer 3 important question . What you believe in? . What is most important to you? . What is your attitude toward yourself and others?
L O V E O F G O D
12 15 22 5 15 6 7 15 4 = 101
N U R S I N G
14 21 18 19 9 14 7 = 102
A2. My Motivations answers 2 things Causes you to do what To select one course of
you do action instead of another
My Motivations
A3. My Knowledge
o It has been said that chance favors the prepared mind o This is a way of saying that you make your own luck o These care certain requisites for experiencing personal satisfaction from your work o Gives you confidence in your ability – acquired through study and experience
L – Labor
U – Under
C – Complete
K – Knowledge
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua A4. My Skills
o Involves competencies not only knowing what to do but being able to do it well
Composition of Apperceptive mass
- Education - Training - Life experience - Parental influence - Religion - Prejudices - Beliefs
B. Stephen Covey’s Seven Habits of Highly Effective People
- Primary objective is to help people and organizations realize the need to increase their effectiveness - Focused on leadership and development for organizations
Habit
- Knowledge, skill and desire are the essential elements to transform a behavior into a habit - Increasing the skills that enhance the potential for forming habits is possible
B1. Inside Out Approach
- Individuals who want to influence others effectively must start with themselves - An organization must begin with its people
B2. Paradigm
- Our paradigms or perceptions of people influence the way we treat them - Paradigm Shift – change in thinking that comes when we gain additional insight and understanding
B3. Emotional Bank Account
- Metaphor for the amount of TRUST that exist in a relationship
Classification of Interaction Deposit Withdrawal o Build and repair o Lessen relationship relationships o Kindness and courtesy o Unkindness and discourtesy o Keeping promises o Breaking promises o Honouring expectations o Violating expectations o Loyalty to the absent o Disloyalty, duplicity o Making apologies o Pride, conceit, arrogance *Have more deposits than withdrawal in our relationship
Stephen Covey
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - If you want small changes, world on you behavior - If you want quantum leap changes, work on your paradigms
B4. Types of Behaviors
Reactive
- People who allow outside influences to control their responses - Moods, feelings, circumstances, biases, prejudices, prejudgment –> outside influences
Stimulus –> Reaction (Based on outside influences)
Observer of Life – comment, complain, argue, find fault (aggressive or submissive – let things happen)
Proactive
- People who used the margin of freedom to make choices that best apply to their values
Stimulus ------Margin of Freedom (behavior and values)---> Reaction
Author of Life (Assertive Person – makes things happen) – participate, get involved, cooperate
Reactive Proactive o People who allow outsid influences to control o People who use the margin of freedom to make their responses choices that best apply to their values o Moods, feelings, circumstances, biases, o Author of his life prejudices, prejudgment o Make things happen o Observer of his life o Optimistic o There’s nothing I can do o Let’s look at our alternatives o That’s just the way I am o It’s possible o He makes me so mad o It’s OK o They won’t allow that o I prefer o I have to do that Language of o It’s alright Language of o I can’t, it’s hard Reactive o I will Proactive o I must o I’m able o Let things happen o Foresight o Bahala na o Assertive o Submissive o aggressive Comparison of behaviors exhibited by passive, assertive and aggressive nurses
Passive Assertive Aggressive Low Self-Esteem High Self-Esteem High-Low Self-Esteem Feels Pity Feels self-worth Mixed feelings of worth Shy, withdrawn Forthright Forward and attacking Apologetic Open and honest Hostile, manipulative Denies rights and needs of self and Acts in best interest of self, Demands needs be gratified for self patients/clients patients/clients and others Feels victimized Feels or peer level Feels must fight for rights Allows situation to control rather Controls situations Attacks situations than controlling situation 4
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua C. Habit is to become PROACTIVE
The Image of Nursing
What is the product that nurses deliver? NURSING CARE
The things to do in order for nurses to be well accepted:
- Project an image of wellness - Self confidence - Professionalism
D. New Impacts of Your Changing Work (Evolution of the Health Care System)
- Change has become a cardinal feature of the way we live - Consider the following factors in connection with the work world
D1. Community
- Health status of our society is changing - Growing older population (home for the aged) - Increase birth rate (day care centers, birthing centers) - Increase life expectancy (wellness centers)
The characteristics of the general public:
- Now more urban - Better educated - More affluent - Subject to new health hazards
Social Problems include the following:
- Drug addiction (Self Help Centers) - Alcoholism - Environmental pollution (CHN) - Sexually transmitted diseases - CV diseases - Death from suicide, homicide and accidents
D2. Socio cultural
- People view health not just as the absence of disease but also as the individual’s capacity to live happily and productively - More emphasis is being directed toward primary care and how to stay well than on secondary and tertiary care
Alternatives to the traditional health care system:
- Extensive home health care 5
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - Health maintenance organizations - Free clinics - Hospice movement (terminal and chronic illness care) - Self care, self help, holistic health - Some nurses are incorporative alternatives in their patient teaching - Meditation, diet therapy
D3. Economic
- Increasing cost of health care
T o manage a cost-effective patient unit nurses must consider what effect the following items have on the nursing budget:
- Supplies - Equipments - Personnel policies - Hiring practices - Type of staffing - Modality of nursing being practiced
D4. Business
- Technology has invaded the health care field from all sides - This has caused increased costs and increased specialization of providers
D5. Political
- Health care is the most regulated industry - Mandatory “Certificate of Need” - The hospital must develop a document that supports the need for the project - The local health system agency (HSA) review board decides whether the hospital can move ahead with its plan - Nurses need to participate to provide a nursing perspective
D6. Professional
a. Credentialing; issue in public accountability and social protection o Licensing o Certification o Accreditation
b. Entry Into Practice o What educational background does a person need to enter the practices of nursing? LPN, BSN, MN, PhD o CGFNS, TOEFL, IELTS, TSE, TWE, NCLEX
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua c. Mandatory Continuing Education o One way to assure the public of the continued competence of practicing nurses o Earn CE units for renewal o 20 CEU/Per year x 3 years = 60 CEU for renewal d. Malpractice Insurance
e. Collective Bargaining f. Moving into a bargaining agent position (union)
Image of Nursing
- Image Problems/Wreckers - Image Improvement/Boosters
Image Problems
- Complains about - Their work - Their hours - Their salaries
Visible signs of little energy, little enthusiasm
- Anger - Apathy - Burnout
Signs of chronic disillusionment/image wreckers
- Complaining - Back-biting (doctors)
Image inconsistencies
- Smoking - Obesity - Sedentary lifestyles
Image Improvement/Image Boosters
- Nurses need to move toward a positive, assertive orientation of personal control and empowerment and away from a defensive survival/subservient mentality
When a positive self-image is combined with appropriate marketing techniques, a favorable public image can be projected such as
- Professional manners:
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - Good public relations at the bedside, home, community - Providing service in a manner in which you would want to be served - Encourage career ladder and advancement - Proactive nursing involvement
II. The Effective Nurse Leader and Manager
A. Difference Between Leadership from Management
Leader Manager 1. May or may not have official appointment to the 1. Appointed officially to the position by the position. institution or organization. 2. Has power and authority to enforce decision 2. Has power and authority to enforce decision by only if the followers are willing. virtue of the position in the organization. 3. Influences others either formally or informally. 3. Carries out predetermined policies, procedures, rules and regulations. 4. Interested in risk taking and exploring new 4. Maintains an orderly, controlled, rational, ideas. equitable structure. 5. Relates to people personally, and in an 5. Relates to people according to roles, job empathetic manner. function, duties and responsibilities. 6. Feels rewarded from personal achievement. 6. Feels rewarded when fulfilling organizational goals, mission, vision.
B. Types of Leaders
- Formal o officially appointed and chosen by the administration o Given the legitimate power and authority to act in behalf of the group o E.g. Class Mayor, USG President - Informal Leader o Just chosen by the group itself o Because of: age, seniority, special competencies, inviting personalities, ability to communicate, ability to counsel others o E.g. Social Groups, Church Organizations, Renewal Groups, Political Group, Work Group
C. Leaders and Managers Have Power and Authority
Power
- Ability to impose the will of one person or group to bring about certain behaviors in others.
Authority
- The legitimate right to act and to give commands
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua D. According to: French and Raven (2 Social Scientist)
Description of Organizational Power by French and Raven
Legitimate Power
- Given to a person by the organization because of position in the hierarchy (from top to bottom) o E.g. DON – Director of Nursing, CEO, COO, President/Chancellor, Chairman-Board of Trustees
Reward Power
- Based on the ability to control and administer rewards to others for compliance with the leader’s orders or request o E.g. Promotion, salary increase, benefits and privileges, merit, recognition, honouring, awards, tributes, appreciation
Coercive Power
- Ability to use punishment on others for non-compliance with management orders or directives o E.g. Suspension, termination, expulsion, reprimand, isolation, community work, payment of damages, revocation of license, remedial
Expert Power
- Derived from some special ability, skills or knowledge demonstrated by the individual o E.g. Dialysis nurse, cardiac surgical nurse,
Referent Power
- Based on a certain attractiveness or appeal of one person to another - Based on a person’s connection as relationship with another powerful person o E.g. a nurse who is cooperative, helpful, respectful, hardworking is referent to the head nurse
E. Hierarchy of Management Skills
Level Conceptual Human Technical Top 47% 35% 18% Middle 31% 42% 27% First/Entry 18% 35% 47% *The highly complex skill put in, more pay.
Levels of Manager
Top Level Middle Level First Level o Generally make decision with the o Conducts day to day o Concerned with a specific help of few guideline or structures operations with some unit’s work flow o Coordinate internal and external involvement with ong term o Deal with immediate day to influences planning and policy making day operations problems o View the organization as a whole o Supervisor, Unit Manager, o Case Manager, NP, Team o CEO, COO, NO, VP, Directors Head Nurse Leader, Charge Nurse
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua Responsibilities of Nurse Manager regardless of title within the nursing department:
Patient Care Management Operational Management Human Resource Management o Assess problems and needs o Budgeting o Teaching o Problem identification o Controlling expenses o Counseling o Planning of care o Staffing o Facilitating o Teaching o Providing supplies o Rounds, conferences o Treatments o Scheduling o Continuing education o Medications o Committees o Bulletin boards o Clinical conferences o Communicating o Journals o Evaluating results o Coordinating o Career mobility o Planning, evaluating o Peer review performance o Research o Meetings o In service programs o Auditing
F. Leadership Styles
Style
- The way in which something is said or done - A particular form of behavior directly associated with an individual
Leadership Style
- How a leader uses interpersonal influences to accomplish goal
Authoritarian Democratic Laissez-Faire Degree of Freedom Little Freedom Moderate Freedom Much Freedom Degree of Control High Control Moderate Control No Control Decision Making By the Leader Leader and Group By the group or by no one Together Assumption of Primarily the Leader Shared Abdicated Responsibility Output of the Group High Quantity, Good Creative, High Quality Variable, May be Poor Quality Quality Efficiency Very Efficient Less efficient than authoritarian Inefficient Closed System Open System Permissive system
Nurse Manager Nurse Manager Followers
Followers Followers Nurse Manager
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua G. Components of an Effective Nurse Leader/Manager
Goals Skills and Knowledge Self Awareness Communication Energy Action = Leader
G1. Goals: End Product of all Our Efforts – desire to be Achieve (the Brain)
Individual Goal – personal goal
Group Goal – college, unit, department goal
Institutional Goal – organizational goal, environmental goal
1. Goals should be congruent with each other – goals should be aligned (IndividualGroupInstitutional) 2. Goals should be meaningful 3. Goals Should be acceptable to all
G2. Skills and Knowledge (Hands and Feet)
o Critical Thinking skills – do not accept what others are telling you (Skills) o Interpersonal Skills – know the persons you work with (Knowledge)
G3. Self Awareness (Eyes, Ear, Nose)
G4. Communication
Heart
o Active listening o Encourage the flow of information (degree of transparency) o Provide feedback o Linkages and networking
G5. Energy (GI Tract)
o Restorative energy – positive charging o Draining energy – low charging
G56. Action (Musculoskeletal)
III. Theoretical/Conceptual Basis for Leadership and Management
A. Early Leadership Theories
A1. Trait Theory
1. Assumes that a person have certain innate abilities, personality traits, or other characteristics in order to be a leader 2. It assumes that “leaders are born, not made”, expressing the fundamental belief of the trait theory a. Physical Characteristics o Height and appearance is important 11
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua b. Personality o An extrovert is at better advantage than introvert c. Skills and Abilities o A leader is more intelligent than its group members, manipulative, courageous d. Social Abilities o A leader is able to relate to other persons and participate in social groups
A2. The Great Man Theory
1. This theory states that certain people happen to be at the right place at the right time and it was the events of the their time that made them great 2. Being a member of the royalty or a well to do family, well known family, has tremendous influence of being a leader 3. History of the world is but the biography of great men – Thomas Carlyle a. Julius Caesar b. Alexander the Great c. Adolf Hitler d. Napoleon Bonaparte e. Joan of Arc f. Jose Rizal g. Ninoy Aquino h. Indira Gandhi i. Abraham Lincoln
A3. The Charismatic Theory
- Charisma is an inspirational quality possessed by some people that makes others feel better in their presence - A charismatic leader inspires others by obtaining emotional commitment from the followers and arousing strong feelings of loyalty and enthusiasm - A charismatic leader perceive themselves as having supernatural purpose and destiny and the followers idolize and worship them leads to a phenomena called Blind Obedience that leads to outcomes such as cult killings, physical sacrifices, emotional surrender, group suicide, terroristic attacks
B. Early Management Theories
B1. Scientific Management Theories
Frederick Winslow Taylor
- Considered as the Father of Scientific Management - Why is it considered scientific? Because he uses and introduces principles involving measurement, observation, comparison RESEARCH – Time and Motion Studies - He used a stopwatch to determine the best way to perform a job - Principles of Scientific Management a. Selection and training of workers b. Observation and control 12
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua c. Supervision of workers utilizing the proper tools and equipment d. Proper compensation for the work and the job that they do
Frank/Lillian Gilbreth
- Frank – brick layer - Lillian – professor of psychology - Their theory is finding the best method or way to perform a given task - In order to increase efficiency and increase productivity - Based on a study, they have introduced the word therblig is the name of a set of fundamental motions required for a worker to perform a manual operation or task o Search, find, select, grasp, hold, position, assemble, use, disassemble, inspect, transport, transport loaded, transport unloaded, pre-position for next operation, release load, unavoidable delay, avoidable delay, plan, rest to overcome fatigue - Because of the therbligs, gave an idea of a new science that came out called Ergonomics - They have 12 children, they are the inspiration for the book Cheaper by the Dozen - Died at the age of 94 to manage the family of 12
Henry Gantt
- Mechanical engineer, management consultant, involved in 2 major projects in the US o Hoover Dam – between California and Nevada o Interstate Highways – connecting 1 state to another - Gantt Chart o Gantt chart provides a graphical overview and schedule of all activities, elements, work of a project or program o A Gantt Chart Should depict the following . The relationship of work to be done . The persons responsible for the work . Time expected for work to be done . The overall objective of the work - The following are the procedures to be done o Gather data o Analyze the data o Develop a plan o Implement the plan o Evaluate and give feedback, modify if necessary
B2. Classic Organization
Henri Fayol
- He is a French industrialist - Father of the Management Process School - Proponent/author of the administrative or management process
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua 5 Primary Functions of Management 1. Planning 2. Organizing 3. Commanding (Staffing) 4. Coordinating 5. Controlling - Author of the 14 principles of management See handouts - Person responsible for endorsing that management be taught in college
Max Weber
- German Social Scientist - Known as the Father of Organizational Theory - He coined the word Bureaucracy - Characteristics 1. Clear division of labor or work. All work is divided into units, departments, bureau. 2. Well defined hierarchy of authority, superiors are separated from subordinates 3. Impersonal rules, or impersonality of relationship. There is separation between the person and work. “Walang kaibigan, walang kamag-anak, bayan muna.” – Erap “Pare, walang personalan, trabaho lamang” – FPJ 4. A system of procedures in dealing with work situation. E.g. USLS enrolment procedure 5. There are rights and duties and responsibilities attached to a position 6. Selection for employment and promotion is based on technical competence. “It’s not what you know, but whom you know” that destroyed bureaucracy
B3. Human Relations Theories
Elton Mayo
- Harvard Professor - Conducted the Hawthorne Studies – study of workers in the electric company near Chicago 1927-1932 - Working Conditions 1. Physical Set-up 2. Values of the organization 3. Rules and regulation 4. Policies and procedures 5. Persons you work with – most important - The Illumination Study – variable is light
Kurt Lewin
- Jewish psychologist that migrated from Germany to the US - He studies group behavior and group dynamics o The Father of Gestalt Psychology
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua . He stated that groups have personalities of their own and has control over their output. “Tell me who your friends are and I will tell you who you are.” “Birds of the same feather, flock together.” - He is the proponent for the Change Theory a. Phases 1. Unfreezing – getting ready to change 2. Changing – a process called transition 3. Refreezing – Establishing stability b. Factors o Driving Force – push o Restraining Force – pull c. To prevent reaction to change 1. Education 2. Communication 3. Participation 4. Facilitation 5. Support 6. Manipulation
C. Contemporary Leadership/Management Theories
C1. Motivational Theories
A. Abraham Maslow
- Hierarchy of Needs - Was an American psychologist who studied the needs or motivations of the individual. He differed from previous theorists in that he focused on the total person, not just one facet of the person, emphasized health instead of simply illness and problems - Maslow formulated the HIERARCHY OF NEEDS, in which he used a pyramid arrangement to illustrate the basic drives or needs that motivate people - Spiritual Self Actualization Ego Needs Social Needs Security Needs Body Needs - Human beings are motivated by unsatisfied needs - If a level of need is satisfied, it no longer motivates humans
B. Frederick Irving Herzberg
- An American Psychologist - Motivation-Hygiene Theory - Born: April 18, 1923in Massachusetts
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua Died: January 18, 2010
Motivators Achievement Recognition Work itself Responsibility Advancement Personal Growth
Hygiene (or “maintenance”) factors Status Security Relationship with Subordinates (superior, peers subordinate Personal life relationship with peers salary Work conditions relationship with supervisor Company policy and administration supervision
Motivators (higher order needs job content can motivate/raise performance)
Hygiene factors are merely a launch pad – when damaged or undermined we have no platform, but in themselves they do not motivate
Lower order needs job context cannot motivate, often a source of dissatisfaction
C. Douglas McGregor
- Known for his motivational theory of work and management based on the concept of Theory X and Theory Y, described in his book The Human Side of Enterprise - Theory X o The organization human being has an inherent dislike of work and will avoid it, if he can. Because of their dislike for work, most people must be controlled and threatened before they will work hard enough o The organization human prefer to be directed, dislikes responsibility, is unambiguous and desires security above everything o This assumption lies behind most organizational principles today and give rise to both to tough management with punishment, tight control and soft management, which aim harmony and work - Theory Y o Control and punishment are not the only ways to make people work o If a job is satisfying, then the result will be commitment to the organization
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua o Imagination, creativity and ingenuity can be used to solve work problems by large number of employees o The expenditure of physical and mental effort in wok is as natural as play and rest
D. William Ouchi
- A researcher in business management - Professor, University of California - Author of the book THEORY Z - Born in Honolulu, Hawaii - Theory Z o Theory Z is a hybrid management approach combining Japanese management philosophies with US culture o Represents a humanistic approach to management o The best way to motivate is through collective decision making, long term job security and humanistic management style - 7 S o 4 Soft S . Staff (Holistic Concern for Employees) . Skills (Cross-functional career paths) . Style (Relatively Slow Evaluation) o 3 Hard S . System (Balance Explicit and Implicit Control Mechanism) . Structure (Individual Responsibility) . Strategy (Consensual, Participative Decision making)
E. Peter Drucker (died Nov. 11 2005)
Management By Objectives
- Known for MBO - Drucker identifies 3 areas of managements a. Managing a Business b. Managing the Managers c. Managing the Workers - The concept is objectives are developed in every level of management in the hierarchy, and in each unit of the organization - E.g. Direct Selling Association Avon 2011 500 Million sales for 2011 in the National Levels Avon Negros Occidental 250 Million Franchise Managers 50 Million Agents 100Thousand sales ***50Million from Jan-May, June-December – profit - Motivation: Objectives
C2. Interactional Theories
A. Fred A. Fiedler’s Contingency Theory
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - Contingency – an unexpected event or somethi9ng which is dependent - In this theory, Fiedler believes that the effectiveness of leadership vary depending on the situiationNo best leadership style, it is the situation that calls for the applicable style - Austrian Psychologist - The Groups performance depends on the following o Leadership styles
2 Classifications
1. Task Oriented 2. People Oriented o Situational Favourableness 1. Leader-Member Relations – member relations – degrees to which a leaders is accepted by group members Good or poor 2. Task Structure – extent to which the task is defined, with clear goals and procedures Structured or unstructured
3. Position Power – ability of a leader to control subordinates Strong or weak 4. Orientation/Consideration Task oriented or relation oriented .e
B. Robert House Path Goal Theory
- This theory assumes that the leader clarifies the path the employees wish to take and the goal they want to reach - See hand outs
C. Lashbrook Work Unit Culture
- The interaction between the manager and staff that can lead to a productive work environment or to an unproductive environment - Objective: to create a (+) work unit culture 5 Areas 1. Mission Q: Why am I here? 2. Goals Q: Where am I going? 3. Feedback Q: How am I doing? 4. Rewards Q: What’s in it for me? 5. Support Q: What happens if I need help?
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua IV. The Management Process
A. Plan
A1. Process
- It is a process of setting goals and choosing the means to achieve the goal - It bridges the gap between where you are going and where you want to go - An intellectual process based on facts and information, NOT emotions and wishes - A continuous process, it never stops – to ensure that decisions and proper use of resources, people, and environment all towards the future
Integrating Nursing and Management Process
Nursing Process Management Process Planning Assessing Planning Planning Organizing Staffing Implementing Organizing Evaluating Directing Controlling A2. Hierarchy of Plans
- Mission Statement Founder Top Level Manager Board of Trustees or Directors (President/Chancellor)
- Long range (Developmental 10+ years) Strategic Plans Top and Middle Level Manager Pres. VC/VP. Deans
- Short Range (5 years or less, annual plans, semestral, quarterly monthly, daily) Operational Plans Middle and first Level Manager (Deans, Level Chairs, Department Chair, Coordinator)
A3. Assessment
a. Tangible and Intangible Elements
Tangible – visible, can be touched, can be measured
Intangible –those that cannot be seen, physically touched, but has a marked impact on organizational life
Tangible Intangible o Buildings o Cognitive o Grounds - Knowledge o Equipment - Thinking o Cost - Planning o Work performance - Problem solving o Policies/procedures - Brainstorming o Statistics - Research o Patient care records - Group dynamics o Professional development programs - Focused group discussion o Safety measures - recollections
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua o Signs and symptoms o Affective - Motivation - Fear - Security - Traditions - Social/ethical values - Emotions/attitudes - Anxiety, fear, contentment, warmth b. Strategic Planning
SWOT – Strengths, Weakness, Opportunities and Threats
- External Assessment Opportunities, Threats - Internal Assessment Weakness, Strengths
c. 3P’s in Management 3M
Personnel Manpower
Physical Plant (Buildings, grounds, equipments facilities) Materials, Machine, Money
Policies and Procedures Methods
A4. Priority Setting
1. Threats to life, dignity, integrity
= Hemorrhage, child abuse, broken side rail, schedule of meds or treatment
2. Threats to destructive changes (INDIVIDUAL, FAMILY, COMMUNITY)
= cancer, communicable diseases, air pollution, emotional disturbance, air pollution, emotional disturbance
= INDIVIDUAL, FAMILY, COMMUNITY
3. Threats to normal growth and development
= nutrition, exercise, immunization dental care
A5. Major Concepts and Definitions
o Strategic – long range planning; 3-5 years into the future o Operational Planning – short range planning; deals with day to day maintenance activities o Belief – conviction that certain things are true o Vision – mental image of something not actually visible, for now, but in the future o Value – the worth, usefulness, or importance of something o Mission – an aim to be accomplished; mission statement o Philosophy – statement of beliefs and values that directs behavior o Goal – the end to be accomplished o Objective – something aimed at or striven for; things done to achieve the goal 20
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua o Policy – governing plan for accomplishing goals and objectives o Procedure – chronological sequence of steps within a process o Protocols – documents of agreement
Nursing care Plan
- Provides records of nursing needs for a particular patient
B. Organize
- Establishing formal structure; for o Coordination of resources o Determination of position and job description - De
B1. Types of Health Care Organizations
a. Profit/Proprietary (exists for profit) – where they got the money to operate
- This organization is managed by a Businesses - Sale of bones/shares - Insurance payments o HMO – Health Maintenance Organization - Government reimbursement o Phil Health b. Not for Profit/non proprietary
- Voluntary - Charitable - Religious - Public/government operated agency
LGU
- Municipal Health Unit County Local - Provincial Health Unit State Region - City Health Unit - Regional Health Unit - National Health Unit Federal Ministry
B2. Organizational Structure
- Furnishes the formal framework on which the management prcess takes place - Is a way of grouping or forming relationship - It depicts the following o Channel of authority, responsibility and accountability and accountability o Span of control
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua o Lines of communication o Depicts formal organization pattern
B3. Organizational Chart
- a drawing that shows how the parts of the organization are linked together
It should depict the ff:
- Division or clusters of work - Chain of command - Type or clusters of work - Level or hierarchy of management
B4. Forms of Organizational Structure a. Centralized
Advantages
- Highly cost effective - Concentrated range of skills - Eliminates duplication of efforts
Disadvantages
- Becomes large and more complex - Does not readily adapt to change - Obtaining decision require more time
Decentralized
Advantages
- Structures are broken down into smaller units - Authority delegated to those closer to majority - Have a voice in decision making - Increase communication interdepartmentally - Better interpersonal relationships - Problem solving allows greater imagination and creativity
Disadvantage
- Initial cost of staffing
Matrix +
- Benefits of both centralized and decentralized control are used - Provides for both vertical and lateral coordination across departments - Applies specialized skills to solve problem 22
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - Interdisciplinary cooperation b. Flat ___
- Horizontal development - Shortens administrative distance (top to bottom) - Communications are direct, simple, fast, minimize distortions - Places tremendous pressure on each manager because of the amount of authority, responsibility - Overburdened manage
Tall |
- Vertical development - Lends to authoritarianism, require rapid changes and precise coordination - Levels are expensive because of large number of executives needed with high salaries
Concentric
- A chart that shows an outward flow of authority from the center moving outward, therefore the smaller the circle, it refers to the top level management c. Line and Staff relationship
Line
- A chain of command - Direct line between manager and staff depicted by solid line in the chart - Associated with direct achievement of organizational objectives
Staff
- Supports line authority - Either advisory or service in nature - Depicted in a dashed line - - - - - Handles details, offers counsel - Functions through influence for they do not have authority to accept, use, modify or reject plans
Chief Nurse
Head Nurse
Orderly Staff Nurse Nurse Aid
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua
Hospital Administrator Chief Nurse - Assistant Chief Nurse - Nurse Trainer/Educator Clinical Nurse Specialist Nurse Supervisor
D. Bureaucratic vs. Human Relations
Bureaucratic – conservative, technical, scientific approach
Human Relations – democratic, participative, liberal
B5. New Trends/Issues
5.1 Lean Manning/Lean Staffing
- Cut down costs
5.2 Mergers
5.3 Contract Work
- Job-out - Outsourcing
5.4 Pooling of Resources
- Nurses pool
C. Staff
Staff involves the following
- Selection of personnel - Formulating assignment system - Determination of staff schedules - Containing the cost while providing high quality care
C1. Categories of Nursing Personnel
Registered Nurse (RN)
- BSN graduate
Expanded Roles
Nurse Practitioner *** expanded roles 24
NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - A nurse practitioner receives special training in patient management to a select group of clients - Family NP (Home Health Nurses) - Pediatric NP - Psychiatric-Mental Health NP - Cardiac NP - Outpatient basis, clinic, home health, hospital unit -
Clinical Nurse Specialist ***expanded roles
- Receives additional education from a college or university in order to render high quality care and case management - Hospital Based
Unlicensed Assistive Personnel (UAP’s) – respondeat superior – licensed personnel are responsible
- Nurse Aid/Assistant/Orderly - Nurse Clerk (Ward Secretary or Ward Clerk) - Nurse Tech - Nurse attendant - Clinical Ladder o 1 year – Aide o 2 years – Practical N or Vocational N o 3 years – LPN/LVN o 4 years – BSN-RN
C2 Assignment Systems a. Case Method of Assignment
- Each patient is assigned to a nurse for total patient care while on duty - This assignment is ideal it is simple, it is direct - This assignment requires highly skilled professionals that are highly paid
E.g. Private duty nurse, ICU nurse
Drawing b. Functional Method of Assignment
- Implements division of labor/work - Procedural descriptions and clearly defined assignments - ***holistic care is not achieved...therefore there is fragmentation of care - ***work can be very repetitive c. Team Method
- Charge Nurse Team leader Nursing Staff Patients/Clients
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NCM 205 Nursing Leadership and Management – Ms. Loresita Antonia Chua - Advantage: Quality nursing care - ***St. Luke’s - -
- - - - -
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