NURSING LEADERSHIP & MANAGEMENT

Leadership
the process of influence in which the leader influences others toward goal achievement is the effort to envision and inspire changes A social transaction in which one person influences others.

LEADERSHIP

Process of influencing the behavior or actions of a person or group to attain desired objectives A dynamic, interactive process that involves three dimensions: leader, follower and the situation

Leader

the one who leads, conducts or guides the process

Lead

to go with or ahead of so as to show the way; guide

A Leader is one others follow willingly and voluntarily

TYPES OF LEADERS

Informal leader
Does not have official sanction to direct activities of others; chosen by the group itself Usually become leaders because of age, seniority, especial competencies, an inviting personality or ability to communicate with and counsel others

TYPES OF LEADERS

Informal leader
Play a valuable role if their behavior and influence are congruent with the goals of the organization.

 Formal

or appointed

chosen by administration, and given official or legitimate authority to act Ex. The elected and appointed officers

Theories of Leadership

Great Man Theory

Argues that few people are born to be great leaders who are well rounded & simultaneously instrumental & supportive Many finds this theory unattractive because of the premise that leaders are born not made, which suggests that leadership cannot be developed

Charismatic theory

Leader inspires others by obtaining emotional commitment from followers and by arousing feelings of loyalty & enthusiasm

Robert House - found that this leaders have strong conviction & high self confidence & followers has the similar belief with the charismatic leader thus showing signs of unquestioning acceptance & obedience

Bernard Bass - it sometimes leads into blind obedience but a transformational leaders use it to motivate members

Jay Conger & Kanungo (1998) -They found out that charisma is more of an attributional phenomenon

Charm quality

is

an

inspirational

Trait Theory

Early works in this area maintained that traits are inherited, but later theories suggest that the traits can be obtained through learning & experience

Leaders created.

are

born,

not

Leadership Traits
Task-Oriented Relationship-Oriented

Participative Leadership

Leadership Traits

Task-Oriented
behaviors includes scheduling, coordinating activities. planning, &

Relationship-Oriented
includes being friendly & considerate, showing trust & confidence, expressing appreciation & providing recognition

Participative Leadership
enlists associates making decisions participation in

Situational Theory

Used task behavior & relationship behavior in relation to the followers readiness, called maturity to emphasize the importance of the maturity level of the followers, & the leader needs to adapt leadership styles accordingly

Situational Leadership Theory

Predicts the most appropriate leadership style from the level of maturity of the followers

Contingency Theory

leadership style will be effective & ineffective depending on the situation

Path-Goal Theory

derived from the expectancy theory where people act as they do because they expect their behavior to produce satisfactory results

In path-goal relationship, the leader facilitates task accomplishment by minimizing obstruction to the goals (structured activity), & by rewarding followers for completing their task

staff associates are introduced as a variable where in staff associates with high need for achievement probably will prefer a task oriented leader, but people with high need for affiliation will prefer a considerate leader

Transactional Leadership

an exchange posture that identifies the needs of the followers & provides reward in exchange for expected performance a contract for mutual benefits that has contingent rewards

Transformational Leadership

Promotes employee development & attend to their needs by motivating, inspiring, & influencing the followers Leader serves as a role model who provides a sense of direction & encourages self management

described it in terms of charisma & intellectual stimulation transformational leaders change the organization by realigning the organizations culture with the new vision, & revision of assumptions, values, & norms

Integrative Leadership Model

Obviously there is no one best leadership style. Leaders are rarely totally people oriented or task oriented. One should be aware of his own behavior & learn to adapt.

Styles of Leadership

Autocratic

involves centralized decision making, with the leader making the decision & using power to command & control others

Democratic

is participatory, with the authority delegated to others, influential by having close and personal relationship with the subordinates

Bureaucratic

is done according to procedure or policy. Its more of a police officer than a leader and manages by the book.

Laissez-Faire

Is passive & permissive, nondirective, inactive. Chaos is most likely to develop because members may work independently

Elements of Ledearship

Vision
Provides direction to the influence process towards a successfully goal. Act as a bridge between the current state and a future state.

Influence

The ability to obtain followers, compliance or request.

Authority
Legitimate power to direct others right to expect or secure compliance

Power
Is defined as the ability to efficiently and effectively exercise authority and control through personal, organizational and social strength. Ability to impose the will of one person or group to bring about certain behaviors.

Sources of power

Expert power it is derived from the knowledge & skills one possess

Legitimate power is derived from the position one holds in a group & indicates authority but not sufficient as ones only source of power

Referent power derived from respect & trust coming from any individual group or organization. It is also called networking.

Reward power it comes from the ability to recognize others for complying by compensate through means of benefits, time off, desired gifts, promotions or increase in pay or responsibility.

Coercive power is based on fear of punishment if one fails to conform

Connection power it comes from coalition & interpersonal relationship

Informational power it comes from knowledge & access to information.

Review

THEORIES OF LEADERSHIP

TRAIT THEORY
*leaders are born with inherited tasks *envisioning goals, affirming values serving as a symbol

QUALITIES/TRAITS OF A LEADER

Intelligence: judgment, knowledge and fluency of speech Personality: adaptability, alertness, creativity, cooperativeness, personal integrity, self confidence, emotional balance and control, independence

QUALITIES OF .

Abilities: ability to enlist cooperation, popularity and prestige, sociability/interpersonal skills, social participation, tact and diplomacy

GREAT-MAN THEORY

Leaders are born and not made Great leaders will arise when there is a great need Ex. King of Spain

BEHAVIORAL THEORY

Successful leadership is based in definable, learnable behavior

PARTICIPATIVE LEADERSHIP

People are more committed to actions

SITUATIONAL THEORY

The best action of leader depends on range of situational factors *motivation *capability of followers performance of leader and follower attitudes, needs and expectations

SITUATIONAL LEADERSHIP THEORY

Depends on the level of the maturity of individual

CONTINGENCY THEORY

Leaders ability to lead is contingent upon situation. a.leadership member relation

b.task structure

c.position power

TRANSACTIONAL LEADESHIP

People are motivated by reward and punishment

TRANSFORMATIONAL THEORY

People will follow a person who inspires them A person with vision and passion
Value based leadership

PATH-GOAL THEORY

Leaders has certain objectives and initiates their followers to attain their own objectives

STRATEGY THEORY

BASED ON HUMAN HANDLING SKILLS OF LEADERS

Strategy 1 attention thru vision Strategy 2 meaning thru communication Strategy 3 - trust thru positioning Strategy 4 - deployment of self thru positive self regard

CHARISMATIC THEORY

Charm and grace are needed to create followers

Self belief

STYLES OF LEADERSHIP
1.

AUTHORITARIAN/AUTOCRATI C
Strong control over the group or directive approach Concern with task accomplishments

2. DEMOCRATIC OR PARTICIPATIVE
Leaders focuses on involving subordinates in decision making People oriented

3. LAISSEZ FAIRE OR PERMISSIVE

Delegating approach Little or no direction is provided to subordinates

BASES OF POWER FOR LEADERS

Legitimate/authority power granted by an official position Referent potential influence one has because of the strength of relationships between leaders and followers Expert gained thru the position of special knowledge, wisdom, sound judgment, good decision skills, skills or

Informational power exists when an individual have information that others must have to accomplish particular goals Connection power based on having connections or associations with others who are powerful

Coercive power or punishment power manager control the groups through fears, threats and sanctions Reward power this is achieved through influencing others because of ones control over desired resources

COMPONENTS OF EFFECTIVE LEADERSHIP

Understanding of the individual strength, weaknesses and potential Knowledge of basic ingredients for leadership and management Systematic use of self to get things done at the right time

Leadership is the essence of professionalism and should be considered an essential component of all nurses and other professional roles

Joyce Clifford

MANAGEMENT

Art of getting things done thru people

Process that involves guidance, direction of a group of people toward organizational goals or objectives

Process thru which the objectives of an organization are accomplished by utilizing human, physical and technical

Management
the act of planning, organizing, directing (leading), controlling (evaluating). is a process by which a cooperative group directs actions towards common goals is a process of coordinating and allocating resources to achieve organizational goal

Manager

a person that creates and maintains an internal environment in an enterprise in which individual work together as a group

Managing

accomplishing the goals of the group through effective and efficient use of resources

MANAGEMENT ROLES

Information role monitor, disseminator, spokesperson

Interpersonal role- figurehead, leaders, liaison Decisional roles entrepreneur, disturbance handler, resource allocator, negotiator

MANAGEMENT LEVELS

FIRST LEVEL Supervises the operative employee MIDDLE LEVEL plan and coordinate activities of the organization. TOP LEVEL manages the organization as a whole.

Comparison of Leaders & Managers

Leadership
Motto Challenge Focus Time Frame Methods Questions Outcomes Evaluate Human

Management

Do the right things Do things right Change Purpose Future Strategies Why? Journeys Potential Continuity Structures & procedures Present Schedules Who, What, When, Where & How? Destinations Performance

MANAGEMENT THEORY
Purposes of Theory
1. Provide a stable focus of understanding what we experience 2. Enable us to communicate freely

3. Challenge us to keep learning of our world

PRINCIPLES OF MANAGEMENT (MODERN ERA)

Scientific Classical Human Relations Behavioral

Scientific Management
-

Focused on the best way to do a task Efficiency provided information on: standards time & motion studies task analysis job simplification productivity incentives

FREDERICK TAYLOR (1856-1915)

FATHER OF SCIENTIFIC MANAGEMENT

Used stopwatch studies & applied the principles of: observation measurement scientific comparison to determine the most efficient way to accomplish a task

 Reduced

wasted effort Set standard for performance Encourage specialization Stressed the selection of qualified workers who could be developed for a particular job.

Monistic Theory

FRANK GILBRETH(1868-1924) LILIAN GILBRETH(1878-1972)

Pioneers in time and motion studies Emphasized the benefits of: job simplification establishment of work standards effects of the incentives wage plan fatigue on work performance

First to use motion picture films to analyze workers emotions Developed a micro chronometer

Henry Gantt (1861-1919)

Disciple of Taylor, was concerned w/ problems of efficiency Refined previous work rather than introduce new concepts Developed a task and bonus remuneration plan

Argued for: more humanitarian approach placed emphasis on service rather than profit objectives

recognize useful non-monetary incentives

CLASSIC ORGANIZATON
Deductive rather than inductive -views the organization as a whole rather than focusing solely on production -focused on: planning organizing controlling

Henry Fayol (1841-1925)

Father of Management Process School

Studied the functions of managers and concluded that management is universal

A believer in the division of work , he argued that specialization increases efficiency

 Believed

that workers: should be allowed to think implement plans be adequately remunerated for their services

Encourage devt of group harmony through equal treatment and stability of tenure for personnel

place for everything everything in its place.

and

FAYOLS MANAGEMENT PRINCIPLES

Division of Labor the more people specialize, the more efficient they can perform

Authority management needs to be able to give orders so that they can get things done.

Discipline members in an organization need to respect the rules and regulation that govern the organization Unity of command subordinates should receive orders from only one superior

Unity of direction member of any organization should have only one objectives
Subordination of Individual Interest to the Common Good give way for the interest of everybody. Remuneration workers should be paid according/commensurate to the work they perform.

Centralization managers should retain the final responsibility but should at the same time give their subordinate enough time and authority to do their job. Hierarchy the line of authority in an organization runs in order of rank. Order materials and people should be at the right time and at the right place.

Equity people in the organization should be treated with equity and justice

Stability of Staff the greater the turn-over rate, the less workers are efficient
Initiative subordinate should be given the freedom to do their work/conceive plans even though some mistakes occur

Espirit de Corps good relationship

Max Weber (1864-1920)

Father of Organizational Theory

Conceptualized bureaucracy w/ emphasis on rules instead of individuals and competency over favoritism as the most efficient basis of organization

Conceptualized a structure of authority that would facilitate the accomplishment of the organizational objectives

Basis Of Authority
1.

Traditional Authority Charisma Rational/Legal Authority

2.

3.

Human Relations
Stresses the Social Environment -focused on the effect individuals have on the success or failure of an organization

Chester Barnard (18861961)

Studied the functions of executives while he was a manager for the New Jersey bell telephone system

He defined responsibilities

the

managers

1.

Defining Objectives Acquiring Resources Coordinating Activities

2.

3.

Stressing the importance of cooperation b/w management and labor, he noted that the degree of cooperation depends on the nonfinancial inducement

Stressed the role organization for

aiding communication meeting individuals needs maintaining cohesiveness

of

informal

Mary Parker Follett (18681933)

Mother of Modern Management

Stressed the importance of coordinating the psychological and sociological aspect of management

Perceived the organization as a social system and management as social process

She considered offensive

subordination

Distinguished between power w/ others and power over others and indicated that legitimate power is produced by a circular behavior whereby superior and subordinates mutually influence one another.

The law of the situation dictates that a person does not take orders from another person but from the situation

Elton Mayo (1810-1949)

Author of The Hawthorne Studies

Though criticized for poor research methods, the Hawthorne Studies stimulated considerable interest in human problems on the job
lighting had production little effect on

Work norms obviously had more influence than wage incentive

Kurt Lewin (1890-1974)

Study of Group Dynamics

maintained that groups have personalities of their own; composite of the members personalities
advocated democratic supervision

Identified the three types of leaders

Authorat Democrat Laissez-Faire

Jacob Moreno (1892-1979)

Developed Sociometry to analyze group behavior

Claimed that people are either: attracted to repulsed by indifferent towards others Developed the sociogram to chart pairings of preferences for others

Contributed to:
psychodrama (individual therapy) sociodrama ( related to social and cultural roles) and role playing techniques

for the analysis relations

of

interpersonal

Behavioral Science

emphasizes the use of scientific procedures to study the psychological, sociological, and anthropological aspects of human behavior in organization

Abraham Maslow (1908-1970)

Hierarchy of Needs Theory

Initiated the Human Behavioral School in 1943 He outlined a hierarchical structure for human needs classified into five categories: 1. Physiological 2. Safety 3. Belonging 4. Esteem

Once needs are met, newer and more mature ones must emerge

Frederick Herzberg(19232000)

Factors in the job can raise the level of performance and meet the higher order needs
Job-content (factors in the job) ex: achievement, recognition, growth = motivators Job-context (surrounding environmental factors) ex: supervision, company policy, working conditions = hygiene factors

Douglas McGregor (19061964)

Theory X and Y

Developed the managerial implications of Maslows Theory Notes that ones style of management is dependent on ones philosophy of humans

Theory X managers emphasis on the goal of the organization

People dislike & will avoid work Workers must be directed, controlled, coerced, threatened

Theory Y emphasis is on the goal of the individual People do not inherently dislike work Work can be a source of satisfaction Workers have self direction, selfcontrol, responds to rewards for the accomplishment of goals

William Ouchi

Theory Z

Published Theory Z: How American Business Can Meet the Japanese Challenge in 1981

Japanese organization lifetime employment Slow evaluation & promotion Non-specialized career paths Implicit control mechanisms Collective decision-making & responsibility Wholistic concern

US organization
Short-term employment Rapid evaluation & promotion Specialized career paths Explicit control mechanisms Individual decision-making Individual responsibility Segmented concern

Richard Pascale & Anthony Athos

Gave a more extensive discussion of the Art of Japanese Management: Application for American Executives in 1981.

Explain that organization in the US tend to savor strategy, structure, and systems, whereas the Japanese organization focus on staff, skills, style, and superordinate goals

Rensis Likert (1903-1981)

Theory of Management is based on his work at the University of Michigans Institute for Social Research

He identified 3 types of variables in organization

1. Causal

Includes:
Leadership behavior Organizational structure Policies Controls

2. Intervening

These are:
Perceptions Attitudes motivations

3. End-result

Includes:
Measures of profits Costs Productivity

Managers may act in ways harmful to the organization because they evaluate end results to the exclusion of intervening variables.

Managerial Grid

B (1,9)

E (9,9)

C (5,5)

A (1,1) Vertical concern for people

D (9,1) Horizontal concern fro production

Behavioral Science Robert Blake (1918) & Jane Mouton (1930) Maintained that there are 2 critical dimensions of leadership 1. Concern for people 2. Concern for production They depicted these on a 9 x 9 or 81 square managerial grid. The vertical axis represents the managers concern for people, & the horizontal axis represents concern for production. The 5 basic styles are to each corner & in the middle

A. Impoverished Manager (1,1)

lack of concern for both people & production

B. Country Club Manager (1,9)

thoughtful & friendly but lack concern for production

C. Organization Man Management (5,5)

represents a moderate concern for both people & production but not at the same time

D. Authority-Obedience (9,1)
efficiency in operation but lacks concern for human element

E. Team Management (9,9)

the optimal managerial style. These managers integrate their concern for people & production

Skills of a Manager
Accdg to Robert Katz Technical skills knowledge and proficiency in activities involving methods, procedures and process. It also involves working w/ tools and specific techniques to achieve the desire result.

Human skills the ability to work w/ people. It is the creation of work environment in w/c people feel secure and free to express their opinion.

Conceptual skills the ability to see the over-all pictures to identify important elements in a situation and to understand the relationship among the elements

Summer emphasized
Knowledge factors Attitude factors Ability factors

Roles of Managers

INTERPERSONAL ROLE Symbol Leader Liaison

INFORMATIONAL ROLE
Monitors Information Disseminates Information Spokesperson or Representative

DECISIONAL ROLE Entrepreneur or Innovator Troubleshooter Negotiator

I. PLANNING

Forecasting or setting the broad outline of work to be done -Why it will be done? -What action is necessary? -Where it will be done? -When it will be done? -Who will do it? -How it will be done?

Defined as pre-determining a course of action in order to arrive at a desired result. It is the continuous process of assessing, establishing goals and objectives, implementing and evaluating them, and subjecting these to change as new facts are known.

PRINCIPLE OF PLANNING
Always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization Provison for proper analysis would indicate a revision to make it more effective Pervasive within the entire organization covering the various departments, services and the

Utilizes all available resources Must be prcised in its scope and nature. It should be realistic and focused on its expected outcomes. Should be time-bound with short- and long- range plans. Projected plans must be documented for proper dissemination to all concerned for implementation and evaluation

Scope of planning
Supervisors - formulate policies, rules and regulations, methods and procedures -coordinates nursing activities -translate strategies and procedures into specific objectives and program Head nurses - schedule daily and weekly plans for the administration of patient care for his or her unit - directly responsible for the actual production of nursing services

CHARACTERISITCS OF GOOD PLAN

Based on clearly defined objectives It should be simple It should provide for the proper analysis and classification of action It should be flexible It should be balance It should make use of all available resources

REASONS FOR PLANNING

Increases the chance of success by focusing on results not activities Forces analytic thinking and evaluation of alternatives Establish a framework for decision making Orient people to action than reaction Includes day to day and future focused managers

REASONS FOR PLANNING

-Helps avoid crisis management and provide decision making flexibility -Provide a basis for managing organizational and individual performance -Increases employee involvement and improves communication -Cost effective

STAGES OF PLANNING
1.

Develop the purpose or mission statement, goals, objectives, philosophy

Vision organization future role and function, something to strive for.
Mission purpose of existence and reason behind organizational structure
Philosophy statements of shared values and

 Goals statement of intent derived from the purposes of the organization, usually stated broadly and generally Objectives specific aims, purposes or targets that will have to be accomplished

2. Collect and analyze data - external and internal forces 3. Assess for the strength (opportunities that will facilitate effectiveness and achievement of goals and weaknesses (threats that will impede achieving goals and objectives)

4. Write realistic and general statements of goal 5. Identify strategies to achieve specified goals 6. Develop a timetable for accomplishing each objectives 7. Provides guideline for developing operational and functional plans

8. Put plans to work/implement 9. Provide for formative evaluation reports before, during and after the plan is implemented

BUDGET (AS A TOOL FOR PLANNING)

Budget
operational management plan related to income and expenses for division of time; allocated resources necessary for future expenditures

PREREQUISITES TO BUDGETING

Sound organizational structure with clear line of authority and responsibility

Managerial support

Formal policies and procedures must be reflected in the budgetary manual

PUPOSES OF BUDGETING IN NURSING SERVICE

To plan the objective, programs, activities of the nursing service and finance to accomplish them.
To motivate nursing workers through analysis of actual experience. To serve as standards.

Types of Budget
Capital Operational Personnel or manpower Flexible Cash flow Fixed ceiling

COSTS
Fixed cost - not related to volume and remain constant. Variable cost - related to volume and varies according to different factors. Direct cost - related to providing product service. Indirect cost - incurred in support of providing products service.

PROCEDURE NURSING SERVICE

1. Determine productivity goal
2. Forecast workload 3. Budget patient care hours

4. Budget patient care hours and staffing 5. Plan for nonproductive hours

6. Chart productive time

7. Estimate the cost of supplies and services 8. Anticipate capital expense

II. ORGANIZING
Grouping of activities, providing assignments, supervising, defining means of coordinating activities to accomplish goals and objectives The process of establishing formal authority which includes developing job descriptions by defining the qualifications and functions of personnel.

PURPOSES

To sustain the philosophy, achieve the mission and vision and objectives of the organization Show the part each person shall work in the organization

Elements of Organizing
It include setting up: Organizational structure Staffing Scheduling Developing job decription

CHARACTERISTICS OF ORGANIZATIONAL STRUCTURE

Division of work in which each boxes represent an individual responsible for a given part of the organizations workload Chain of command, with lines indicating who reports to whom and why what authority

CHARACTERISTICS
The type of work performed, indicated by the labels or description for each boxes The grouping of work segments shown by the cluster of work groups The level of management, which indicate individual and entire management hierarchy

COMPONENTS OF ORGANIZATIONAL STRUCTURE

People Purpose structure

BASIC TYPES OF O.S.

Informal consists of the personal and social relationship of the members in the organization Formal describes the positions, responsibilities and those occupying the positions and their relationships among them

PATTERNS/FORMS OF ORGANIZATIONAL STRUCTURE

1. Vertical or Tall Chart/ Centralized Structure

Depicts the Chief Executive at the top with line of authority flowing down the hierarchy.
DIRECTOR

CN

SN

SN

SN

NA

NA

NA

2. Horizontal or Flat Chart/ Decentralized Structure

Depicts the manager at the top w/ a wide span of control

CN

SN NA

SN NA

SN NA

SN NA

SN NA

3. Concentric or Circular Chart

shows outward flows of communication from center

SN

CN

SN

SN

3 General Types of Organizational Chart:

1. Line Organizational / Bureaucratic/

Is the simplest and most direct type of organization in which position has general authority over the lower position in the hierarchy.
DIRECTOR

CHIEF NURSE

SN

SN

SN


1.

2.

3.

ADVANTAGES Maintain simplicity. Makes clear division of authority. Encourage speedy action

1.

2.
3.

DISADVANTAGES Neglects special planning Overworks key people Depends upon retention of a few key people

2. Functional Organizational

Is one where each unit is responsible for a given part of the organizations workload. There is a clear delineation of roles and responsibilities which are actually interrelated

 1.

2.

3.

ADVANTAGES Relieves line executive of routine specialized decision Provides frameworks for applying expert knowledge Relieves press of need for large number of wellrounded personnel

1. 2.

3.

DISADVANTAGES Makes relationship more complex Makes limits of authority of each specialist a difficult coordination Teach toward centralization of organization.

3. Staff Organization

Is purely advisory to the line structure w/ no authority to put recommendations into action.
DIRECTOR TRAINING OFFICER CHIEF NURSE

SN

SN

SN

 1.

2.

3.

ADVANTAGES Enables specialist to give expert advise Frees the line executive of detailed analysis Affords young specialist a mass training

1.

2.

3.

DISADVANTAGES Continues in organization even if its function are not clear Reduces expert power to place recommendation into action Tends towards centralization of the organization

4. Flat Organization / Horizontal organization

Category Number of Levels Fewer Span of control Delegation Authority Control over Subordinates Type Broad Greater Decentralized Lesser Modern Flat Pyramidal More Narrow Lesser Centralized More Traditional

STAFFING
Is

the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demand. Assigning competent people to fill designated for the organizational structure

STEPS IN STAFFING
Determine the number and types of personnel needed Recruit Personnel Interview Induct or Orient the Personnel Job Offer

Staffing Pattern
Is a plan that articulates how many and what kind of staff are needed by shift and day to staff a unit or department Some of a these consideration in the development of staff pattern are: Benchmarking Regulatory Requirements Skill Mix Staff Support Historical Information

Patient Classification System

Measurement tool used the nursing workload for a specific patient or group of patients over a specific period of time. Patient care is classified according to: Self care or minimal care patients Intermediate or moderate care Total care patients eg bedridden Intensive care patients

NURSING CARE MODEL

1.

2.

CASE METHOD or TOTAL PATIENT CARE nurse works directly with patient, family, physician and other health care staff implementing a plan of care. FUNCTIONAL METHOD also task nursing and this method is task and procedure oriented. Nurses are assigned to selected functions.

3. TEAM NURSING which evolved from functional nursing , a team of nursing personnel provides total patient care to a group of patients. 4. PRIMARY NURSING METHOD this method represents total nursing care directed by a nurse on a 24 hours basis, from the moment of admission to discharge with ARA.

5. PROGRESS CLIENT CARE client are evaluated with respect to the level or intensity of care needed. 6. MANAGED CARE METHOD involves unit based care that is organized to achieve specific patient outcomes with in her stay in the unit. 7. PRACTICE PARTNERSHIP the senior and junior staff member share patient care responsibilities

8. CASE MANAGEMENT METHOD this is a model for identifying , coordinating, and monitoring the implementation of service to achieve desired patient care outcomes within a specified period of time. 9. MODULAR METHOD in this method, the RN provides direct nursing care with assistance of aides. This is modified team & primary nursing method where RN provides leadership, support and instruction.

COMPUTING FOR THE NUMBER OF NURSING PERSONNEL

When computing for the nursing personnel, one should ensure that there is sufficient staff to cover: 1. All shifts 2. Off-duties 3. Holidays 4. Leaves 5. Absences 6. Time for Staff Development

ACCORDING TO R.A. 5901 OTHERWISE KNOWN AS THE FORTY-HOUR WEEK

LAW, EMPLOYEES WILL WORK FOR

40HRS/WK: 1. FOR HOSPITALS WITH 100-BED CAPACITY OR MORE

2. COMMUNITY POPULATION
OF AT LEAST 1 MILLION

HOWEVER, A NURSE WILL RENDER 48HRS/WK WITH ONLY 1 OFF-DUTY A WEEK IF: 1. HOSPITALS WITH LESS THAN 100-BED CAPACITY 2. COMMUNITIES WITH LESS

THAN 1 MILLION
POPULATION

THERE ARE BENEFITS ENJOYED BY THE PERSONNEL REGARDLESS OF THE WORKING HOURS. AS PER CIVIL SERVICE COMMISSION MEMORANDUM

CIRCULAR NO. 6, SERIES OF 1996,

GOVERNMENT EMPLOYEES ARE GRANTED 3 DAYS WHICH MAY BE SPENT FOR:

1. BIRTHDAYS 2. WEDDINGS

3. ANNIVERSARIES
4. FUNERALS (MOURNING) 5. RELOCATION 6. ENROLMENT/GRADUATION LEAVE

7. HOSPITALIZATION
8. ACCIDENT LEAVES

Total number of working hours and nonworking days and hours of nursing personnel per year.

Rights & privileges given each personnel/year 1. 2. 3. 4. 5. Vacation leave Sick leave Legal holidays Special holidays Special privileges

Working hr/wk 48 hrs 15 15 10 2 3

Working hr/wk 40 hrs 15 15 10 2 3

Cont.
6. Off duties/ R.A. 5901 7. Continuing Education Prog. Total Non-working days/year Total Working days/ year Total Working hours/ year 104 3 152 213 1,704 52 3 100 265 2,120

To compute for relievers needed, the following should be considered:

1. Ave. number of leaves taken each year---- 15
Vacation Leave --------------------------------10 Sick Leave--------------------------------------- 5

2. Holidays ---------------------------------------------3. Special Privileges --------------------------------4. Continuing Education Program for Professionals ------------------------------------Total Average Leaves

12 3

3 33

To determine the relievers needed:

33 (ave # of days an employee is absent) 213 or 265 (# of working days/year that each employee serves) = 0.15 (15%) for persons who work 40hrs/wk = 0.12 (12%) for persons who work 48hrs/wk

To distribute the staff by shifts:

Morning shift = 45 51% (0.45 0.51) Afternoon shift= 34 47% (0.34 0.47) Night shift = 15 18% (0.15 0.18) ***Note: In the Philippines, the distribution usually followed is 45% (0.45) for the morning shift, 37% (0.37) for the afternoon shift and 18% (0.18) for the night shift.

STAFFING FORMULA

Categorize the patients according to levels of care. Multiply the total # of patients by the % of patients at each level of care. Ex. Find the # of nursing personnel needed for 250 bed capacity in a tertiary hospital 250 (pts) x .30 = 75 pts need L1 250 (pts) x .45 = 112.5 pts need L2 250 (pts) x .15 = 37.5 pts need L3 250 (pts) x .10 = 25 pts need L4
1.

2. Find the # of nursing care hrs (NCH) needed by patients at each level of care/ day. 75 pts x 1.5 (NCH at L1) =112.5 NCH/day 112.5 pts x 3 (NCH at L2) =337.5 NCH/day 37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day 25 pts x 6 (NCH at L3) =150 NCH/day Total = 768.75 NCH/day

3. Find the total NCH needed by given number of patients or bed capacity/year. 768.75 x 365 (days) = 280,593.75 NCH/year 4. Find the actual number of working hours rendered by each nursing personnel/year. 8 (hrs/day) x 213 (working days/year)= 1,704 (working hrs/year) 5. Find the total # of nursing personnel needed. (immediate, reliever, total personnel)

a.

b.

c.

Total NCH/year = 280,593.75 = 165 working hrs/yr 1,704 Relief x total immediate nsg personnel 165 x 0.15 = 25 Total nsg. Personnel needed 165 + 25 = 190

6.

7.

Categorize the nursing personnel into professional and non-professional. 190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants 190 nursing personnel Distribute by shift 124 x .45 = 56 nurses on AM shift 124 x .37 = 46 nurses on PM shift 124 x .18 = 22 nurses on Night shift 124 nurses

66 x .45 = 30 nsg attendants on AM shift 66 x .37 = 24 nsg attendants on PM shift 66 x .18 = 12 nsg attendants on Night shift 66 nursing attendants

SCHEDULING

SCHEDULE
It is a timetable showing planned work days and shift for nursing personnel. Scheduling is to assign working days and days off to the nursing personnel so that adequate patient care is assured.

ASSESSING A SCHEDULING SYSTEM

1.

2.

3.
4. 5.

Ability to cover the needs of the unit. Quality to enhance the nursing personnels knowledge, training and experience. Fairness to the staff Stability Flexibility

Cyclic staffing
sets a basic time pattern that is repeated in cycles.

(Exhibit 7-9 p. 107)

Modified workweeks
include systems of scheduling personnel such as 10-hour and 12-hour shifts, weekend alternative, team rotation, and flexible hours.

Self-scheduling
is a method of scheduling in which the nurse manager determines the needs per day and shift and the nursing staff schedule themselves to meet these needs.

(Exhibit 7-8 p. 106)

Productivity
is a system of measuring worker output and is commonly defined as outputs divided by inputs.

Temporary workers
are contract workers hired from a staffing agency for a period of time that may be for one to several days or weeks. Temporary workers are not employees of the health care agency where they work.

Manager behavior
Oversees

staffing activities through human resource management that includes use of a patient classification system and provision of qualified nursing personnel in adequate numbers to meet patient care needs.

Leader behavior
Uses

input from employees to develop and implement a staffing philosophy and staffing policies that inspire personnel to work to their maximum level of productivity.

Basic to planning for staffing of a division of nursing is the fact that qualified nursing personnel must be provided in sufficient numbers to ensure adequate, safe nursing care for all patients 24 hours a day, 7 days a week, 52 weeks a year. Each staffing plan must be tailored to the needs of the agency and cannot be determined with a simple worker-

(Exhibit)

(Exhibit 7-7 p. 105)

Components of patient classification system

Classification categories
Factor Prototype

Guidelines Average care time for a patient in each category Method for calculating required staffing, personnel mix, and required nursing care hours

Modified approaches to nurse staffing and scheduling

10-hour

shift 12-hour shift Weekend alternative Flex time Others

Productivity
Is

commonly defined as output / input Percent productivity = required staff hours / provided staff hours x 100

Staffing activities
include recruitment, hiring, assignment, scheduling, calculating turnover, preparing payroll, developing and administering policies, and related activities.

Human Resource Department

involves tasks like interviewing, hiring, coaching, retention of state and performance evaluation/appraisal

Personnel

are persons employed in an agency or department

Recruitment

the process of enlisting personnel for employment; the process of hiring

Selection

the process of choosing or selecting candidates according to their qualifications to the job; the process of elimination

Retention

capacity to retain employees once they are hired

Modes of Recruitment
Employee recommendation Word of mouth Advertisement Flyers Newsletter Bulletin Posters Career Days Job Fairs Placement

Screening Potential Staff

Philosophies in the screening process:

The manager should screen out applicants who do not fit the agencys image. The manager should try to fit the job to a promising applicant. Usually the manager should try to fit the applicant to the job.

Application Forms and Resumes Determine whether the applicant meets minimal hiring requirements. Furnish background data useful in planning the selection interview. Obtain names of references who may be contacted for additional information about the applicants work experience and general character. Collect information for personnel administration (SSN, # of dependents etc.).

Letter of Reference Interview face to face contact between the job seeker and a person with full authority to fill the position under discussion. The purpose of the interview is to obtain information, to give information, and to determine if the applicant meets the requirements for the position.

Types of Interview Directive interview uses closed-ended question Non-directive interview the applicant narrates himself. Structure interview the interviewer uses pre-prepared guidelines for interview. Group interview several applicants or interviewees are interviewed together. Board interview conducted by selected member of the personnel to an applicant.

Test Used in Selection of Applicant Aptitude Test measures capacity on potential ability to learn Psychomotor measures strength and coordination Job knowledge Proficiency measures how well the applicants can do a simple work Psychological test measures personality characteristics

JOB DESCRIPTION

Are specifications of duties, conditions and requirements of a particular job prepared through a careful job analysis and also called performance

description which includes: Job title Job relationship Performance description

EMPLOYEE DISCIPLINE

Is a process of generating employee compliance to institutional rules and regulation

DISCIPLINARY PROBLEMS Problems tend to occur when there is methodological weakness, such as when the manager lacks skill in interviewing or documentation, or when there is a procedural omission, such as poor application of discipline

Step to Addressing Disciplinary Problems

Coaching a day to day process of helping employees improve their performance. Confrontation is a communication technique used to address specific issues such as violation of policy or procedure. Disciplinary Conference using a combination of directive and non- directive technique in order to minimize stress during interview

Steps of Progressive Discipline

Means the adherence to the principle of due process, and fair treatment of subordinates. There different measures are: 1. Counseling 2. Verbal reprimand 3. Written reprimand 4. Short suspension 5. Longer suspension 6. Discharge/dismissal/termination

III. DIRECTING

Issuance of assignments, orders and instructions that permits the worker what is expected of the to achieve organizational goals and objectives

Delegating
is getting the work done through employees.

Is the process by which a manager assigns specific task/duties to workers with commensurate authority to perform the task. The worker in return assumes responsibility & is held accountable for its result.

2 Important Criteria in Delegation

1.

Ability of the worker to carry out the task. Fairness not only to the employee but to the team as a whole.

2.

Principles of Delegation
Select the right person Delegate both interesting & uninteresting task Provide staff with enough time to learn Delegate gradually Delegate in advance Consult before delegating Avoid gaps & overlaps

Nursing Care Assignments/ Modalities of Nursing Care or System/Pattern of Nursing Care

Primary
Extension of principle of decentralization Nursing process driven Primary nurses and associate nurses 24-hour coverage Greater patient and staff satisfaction

Advantages 1) patient & family are able to develop trusting relationship with RN; 2) there is defined accountability & responsibility; 3) there is holistic/continuity of care. Disadvantages 1) high cost because there is a higher RN skill; 2) proximity of patient assignment; 3) overlapping of staff functions; 4) nurse patient ratio must be realistic.

Case Method
1:1 nurse/patient ration Examples include private duty, ICU, Community Health Nurse Similar to Primary, however, no Associate RN The nurse is responsible for the total care of the patient for the shift shes working

Advantages 1) consistency of one individual caring for the patient for the whole shift; 2) more opportunity to observe & monitor the patient. Disadvantages 1) the nurse may not have the same patient the next day; 2) it does not serve the purpose of decentralization.

Functional Nursing
divides the work to be done & every member is responsible for his actions best system that can be used if there are many patient & professional nurses are few

Advantages of functional nursing are that 1) work is done fast; 2) workers learn to work fast; 3) they gain skill faster in that particular task.

Disadvantages include 1) fragmentation of nursing care therefore holistic care is not achieved; 2) patient cannot identify who their real nurse is; 3) nurse-patient relationship is not fully developed; 4) evaluation of nursing care is poor & outcomes are rarely documented, and 6) it is hard to find a specific person to answer the relatives questions.

Joint Practice (Team Nursing / Modular Nursing )

More than modality Involves nurses and physicians collaborating as colleagues Agreed upon protocols to manage care in primary settings Modular nursing is a kind of team nursing that divides the area into modules of patient, with each module cared by a team of nurses.

Advantage 1) work is shared with others Disadvantages 1) patient receives fragmented, depersonalized care; 2) communication is complex; 3) accountability & responsibility is shared which can cause confusion; 4) these factors affects RNs dissatisfaction.

Case Management
Clinical system with accountability for individual or group through continuum of care Negotiating Procuring Coordination of services and resources

RESPONSIBILITIES IN DIRECTING
1. 2. 3. 4.

Promotive improve systems Preventive anticipate problems & difficulties Corrective institute measures to correct problems Regulatory preserve existing assignments

CHANGE PROCESS

Change purposeful, designed effort to bring about improvements in a system, with the assistance of change agent

THEORIES OF CHANGE
REDDINS THEORY suggested seven techniques by which change can be accomplished
1. Diagnosis 2. Mutual setting of objectives 3. Group emphasis

4. Maximum information 5. Discussion of implementation 6. Use of economy and ritual 7. Resistance interpretation

LEWINS THEORY Unfreezing stage the nurse is motivated by the need to create change Moving stage the nurse will gather information Refreezing stage changes are integrated and stabilized as part of the value system

ROGERS THEORY 1. awareness 2. interest 3. evaluation 4. trial 5. adoption

MOTIVATION

Forces that make or propels one to act in a certain way. Individual desire and responses to events which prompts extraordinary effort to attain goal and enthusiasm

LEVELS OF MOTIVATION
EXTRINSIC MOTIVATION anticipated rewards or avoidance of negative consequences in the performance of action INTRINSIC satisfaction derived from the action itself TRANSCENDENTAL recognition of the usefulness of action to some other person

THEORIES OF MOTIVATION
CONTENT THEORY motivation factors or needs within a person
1. Maslows Needs Theory 2. Alderfers theory (Existence, Relatedness, Growth) ERG

3.

Herzbergs Theory two factor theory

a. Disatisfiers or hygienic (extrinsic) salary, job security, working condition, relationships

b.

Satisfiers or non hygienic (intrinsic) achievement, recognition, reward, advancement, work itself

4.

McClelland theory affiliation, achievement and power

5. Monistic/scientific theory salary as the best motivating factor

PROCESS THEORY
1. Arousal theory focuses on internal process that mediate the effect of work performance
2. Expectancy theory focuses on peoples expectation that their efforts will result in good performance and valued results 3. Equity theory focuses on fair treatment

DECISION MAKING
A systematic, sequential process of choosing among alternatives & putting those choices into action

STEPS
1. Identify problem 2. Prioritize problem 3. Gather and analyze situation related to problem 4. Evaluating all alternatives 5. Select an alternative for implementation

IV. CONTROLLING
The process by which managers attempt to measure if actual activities conform to planned activities A process wherein the performance is measured and corrective action is taken to ensure the accomplishment of organization goal

STEPS IN CONTROL PROCESS

Establish standards and criteria

Measure performance
Compare results with standards

Match with standards? YES do nothing or improve

NO

- take corrective action

Process of evaluating employees performance against standards To determine job competence Enhance staff development and motivate employee discover employees aspirations and recognize accomplishments

PERFORMANCE APPRAISAL/EVALUATION SYSTEM

Improve communication Aid managers in counseling and coaching Determine training and dev. needs of staff Inventories of talent Legal purposes

METHODS OF EVALUATION

Anecdotal records objective description of behavior Rating scale Ranking Self appraisal/self rating Peer review Paired comparison Forced - choice

Subordinates Team evaluation multiple raters Behavior anchored list specific description of good, average and good performance Essay evaluation describe strength and weaknesses of employee Critical incident describe effective and effective behavior of employee

PROBLEM AREAS OF EVALUATION

Subordinates have not been motivated to want to change People are unable to make change Subordinates become resentful and anxious when merit system is applied

COMMON ERRORS OF EVALUATION

Halo error allowing one trait to influence the evaluation of others or rating of all traits on the basis of first impression Horn error the evaluator is hypercritical Contrast error managers rate the nurse opposite the way they perceive themselves

Leniency of error Central tendency error Racial bias System design and operating problems focuses on the method (system) and process (operating) of evaluation Overgeneralization Recency of Events error

TOTAL QUALITY MANAGEMENT

Systematic process to improve outcomes based on customers needs Doing the right thing -meeting the needs of the customer -building quality performance into the work process -employ scientific approach to assessment and problem solving

QUALITY ASSURANCE PROG

Process of establishing a standards of excellence of intervention and taking steps to ensure that each patient receives the expected level of care Fulfillment of social contract between society and professions

QUALITY NURSING CARE

Presence of all elements/characteristics specified in the standards. FRAMEWORK OF QA 1. Structure instrumentalities in the delivery of care (personnel, supplies etc) 2. Process how the service was delivered 3. Outcome results expected of the service

NURSING AUDIT
Official examination of: nursing records, physical facilities, personnel involved in patient care Tool to analyze and evaluate nurses bedside records and physical facilities Serves as a means of improving nursing care by revealing existing deficiencies

STANDARD OF CARE
Yardstick for gauging the quality and quantity of service Describes the quality of service Ex. Nurses are professional in dealing with clients

CRITERIA

Measures the quality of care or standards

Standard: Nurses are professional in dealing with clients Criteria : greets them with corresponding smiles always attend to their needs

Thank You!