NCM 107-A Nursing Leadership & Management, Nursing Jurisprudence

June 15, 2012 9:00 am

Conceptual Paradigm of Leadership & Management

Resources
7 Ms

Effective & Efficient Leadership

GOAL

Theories & Principles

Management Process & Functions

GOALS
- Usually established at the beginning of any planned undertaking - A desired aim or condition toward which one is willing to work. - Generally provides direction to an individual, group or organization.

Goals may be: INDIVIDUAL GOALS - are personal goals; usually based on ones desires in life. GROUP GOALS it pertains to what the individual members of the group or organization desire to achieve as a group or an organization. ORGANIZATIONAL GOALS - are management goals of an organization that are established to justify its existence.

GOALS
GOALS MUST BE: S - Specific M - Measurable A - Attainable R - Relevant T - Time Bounded E - Efficient & Effective R - Rewarding

THEORIES & PRINCIPLES

Various theories & principles of leadership & management help provide the basis for accomplishing a goal. THEORIES 1. Scientific Management Theory 2. Systematic Management Theory 3. Organizational Theory 4. Social Process 5. Hawthorne Effect 6. Management by Objectives

THEORIES
7. Management as Decision Making 8. Managerial Roles 9. Hierarchy of Needs 10. Motivation Hygiene Theory 11. Theory of X & Theory of Y 12. Theory Z

MANAGEMENT PROCESSES & FUNCTIONS

It is the application of creative problem solving strategies.
4 functions of management
Planning Organizing Directing controlling

EFFECTIVE & EFFICIENT

Leadership should be efficient & effective EFFICIENT ability to minimize the use of time and resources in achieving organizational objectives. -Performing or functioning in the best possible manner with the least waste of time and effort. EFFECTIVE ability to determine whether appropriate objectives are met.

RESOURCES
Attainment of a goal usually precedes the use of resources. 7 Ms 1. money 5. methods 2. men 6. moment 3. machine 7. manager 4. materials

NURSING MANAGEMENT PROCESS

1. PLANNING the selection and sequential
ordering of tasks required to achieve an organizational goal.
- pre determining a course of action in order to arrive at a desired result. Concerned with defining goals for future organizational performance and deciding on the tasks and resources to be used in order to attain those goals. Deciding in advance what to do, how to do a particular task, when to do it and who is to do it.

COMPONENTS OF PLANNING
PLANNING What to do? How to do it? Who is to do it?

GOOD PLANNING
involves a continous process of assessment of goals and objectives, implementation and evaluation of change as new facts become known. PROCESS OF GOOD PLANNING
evaluation assessment

well plan is half done

implementation Establishment of goals & objectives

POOR PLANNING
Is the failure to set goals make assessments or provide for implementation or to anticipate any possible change in circumstances. INDICATORS OF POOR PLANNING Delivery dates are not met Machines are idle Material is wasted Some nurses are overworked, others are underworked Skilled nurses doing unskilled work Nurses are fumbling on jobs for which they have not been trained There is quarreling, bickering, buck-passing and confusion.
Failing

to plan is planning to fail

PLAN
Is a living document which can be changed based on the prevailing circumstances.
1. PRINCIPLES OF PLANNING Planning is always based & focused on the vision, mission, philosophy & clearly defined objective of the organization. Planning is a continous process. Planning should be pervasive within the entire organization. Planning utilizes all available resources Planning must be precise in its scope & nature Planning should be time- bounded Projected plans must be documented

2. 3. 4. 5. 6. 7.

IMPORTANCE OF PLANNING
1. 2. 3. 4. 5. Planning leads to the achievement of goals & objectives. Planning gives meaning to work. Planning provides for effective use of available resources. Planning helps in coping with crises. Planning is cost-effective.

6. Planning is based on past & future activities. 7. Planning leads to the realization of the need to change. 8. Planning provides basis for control. 9. Planning is necessary for effective control .

CHARACTERISTICS OF A GOOD PLAN

1. Be precise with clearly- worded objective, including desired results & method for evaluation. 2. Be guided by policies, procedures affecting the planned action. 3. Indicate priorities. 4. Develop actions that are flexible & realistic in terms of avail. Personnel, equipment, facilities & time. 5. Develop a logical sequence of activities & time. 6. Include the most practical methods for achieving each objective. 7. Pervade the whole organization.

STEPS IN PLANNING
1. Diagnosis 2. Objective/ goal setting 3. Means identification 4. Debate on proposals 5. Decision making 6. Tasking 7. Evaluation

TYPES OF PLANS
STRATEGIC PLAN the process of defining strategy or direction, and making decisions on allocating its resources to pursue this strategy.
It is a process for determining where an organization is going over the next year or- more typically 3 to 5 years.

It deals with at least one of the 3 questions: 1. What do we do? 2. For whom do we do it? 3. How do we excel?

 OPERATING PLANS pertain to activities in specific departments or organization. - generally shorter in time frame -involve the middle & lower level managers CONTINOUS OR ROLLING PLANS involves mapping out the day to day activities. - this is the task of the staff nurse who has to devise & implement NCP for pts.

KEY COMPONENTS OF STRATEGIC PLANNING

1. Defining and understanding the vision, mission, values & strategies of the institution. VISION it outlines the organizations future roles and functions; what the organization want to be; it is a long term view and concentrates on the future. MISSION defines the fundamental purpose of the organization; allows everyone to understand why an organization exists.

PHILOSOPHY statement of beliefs & values that direct the organizations life or practice. VALUES are beliefs that are shared among the stakeholders of an organization. FORECASTING is looking into the future; weighing the unknown values in the situation and using them as basis for an educated guess about the future.

2. Set objectives/ goals and determine results desired OBJECTIVES is the backbone of ones goals and philosophy ; these are the battle plan GOALS a specific aim to target to be attained within a short time span of a year; the end to be accomplished

3. Conduct a situation analysis ( SWOT )- analysis of the internal factors attributed to the organization and external factors beyond control of the organization.
S
W O T

Distinct Efficient Skilled

Market share Superior reputation

Vulnerability Adequacy of resources Technologies available

Possible new customers Status of competitors Possibilities of growth

New competitors Shortage of resources Changing needs of the customers New regulations

4. Develop & schedule strategies, programs/ projects/activities; set the time frame

STRATEGY it is the course of action created to achieve a long term goal; the art of the general. ( called as the road map); techniques,methods or procedure PROGRAMS are activities put together to facilitate attainment of some desired goals. TIME MANAGEMENT finding the most efficient way to do it.

TIME SAVING TECHNIQUES, DEVICES & METHODS TO BETTER USE OF TIME

1. 2. 3. Conduct an inventory of your activities. Set goals and objectives and write them down. With the use of calendars, executive planners, logs or journals, write waht you expect to accomplish yearly, monthly, weekly or daily. 4. Break down large projects into smaller parts 5. Devote few minutes at the beginning of each day for planning. 6. Organize your workspace so it is functional. 7. Close your door when you need to concentrate. 8. Learn to delegate. 9. In a meeting, define the purpose clearly before starting 10. Take or return phone calls during specified time. 11. Develop effective decision- making skills 12. Take rest breaks and make good use of your spare time.

EFFECTS OF MISMANAGEMENT OF TIME

Work is rushed and becomes substandard Deadlines are missed Bad choices are made Employees suffer from fatigue Employees personal lives and relationships are adversely affected

5. Preparing the Budget

BUDGET- is the annual operating plan, a financial road map and plan which serves as an estimate of future costs and a plan for utilization of manpower, material and other resources. A plan for future activities expressed in operational as well as financial or monetary terms. BUDGETING systematic financial translation of a plan; allocation of resources; a tool, for planning, monitoring & controlling cost & meeting expenses.

COMPONENTS OF BUDGET
1. REVENUE BUDGET summarizes the income which
management expects to generate during the planning period. 2. CASH BUDGET amount of money received; planned cash receipts & disbursements, cash balances. 3. OPERATING BUDGET composed of the revenue and the expense budget. 4. CAPITAL BUDGET consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period.

6. Establishing Nursing standards, policies & procedures

STANDARDS indicate the minimal level of achievement acceptable to meet the set objectives. Nursing Standards Example: Standards of Nsg. Practice by ANSAP 1981

 POLICIES are defined as standing plans used repeatedly, or guides or basic rules that govern action at all levels in the organization. Nursing Service Policies Example : Admissions receiving, consent, notifying doctor, care of patients

 PROCEDURES are defined as a more specific guide to action than policy. Nursing Procedures Example: Discharge of Patient

ORGANIZING

- it is the process of establishing formal authority. - it involves setting up the organizational structure through identification of groupings, roles & relationships. - it includes developing job descriptions by defining the qualifications and functions of personnel.

ORGANIZATION
consists of the structure & process which allow the agency to enact its philosophy & utilize its conceptual framework to achieve its goal. it is the backbone of management. it is the form of every human association for the attainment of a common purpose. it is a form of identifying roles and relationships of each staff in order to delineate specific tasks or functions that will carry out organizational plans & objectives.

ORGANIZATIONAL CHART
is a line drawing that shows how the parts of an organization are linked.
ELEMENTS OF ORGANIZING I. Setting up the organizational structure - facilitates the development of roles & relationships to enable the achievement of goals.

ORGANIZATIONAL STRUCTURE
refers to the process by which a group is formed, its channels of authority, span of control & lines of communication. is a process in which a group is formed including its Authority, Responsibility and Accountability ( ARA), span of control, and lines of communication.

PURPOSES OF SETTING UP AN ORGANIZATIONAL STRUCTURE

It informs members of their responsibilities so that they may carry them out. It allows the manager & the individual workers to concentrate on his/her specific role & responsibilities. It coordinates all organizational activities so there is minimal duplication of effort or conflict. It reduces the chances of doubt & confusion concerning assignments. It avoids overlapping of functions because it pinpoints responsibilities. It shows to whom & for whom the are responsible.

CHARACTERISTICS OF ORGANIZATIONAL CHART

1. DIVISION OF WORK each box represents the individual or sub-unit responsible for a given task of the organizations work load. 2. CHAIN OF COMMAND lines indicate who reports to whom and by what authority. 3. Type of Work to be performed indicated by labels or descriptions for the boxes. 4. Grouping of Work Segments shown by the clusters of work groups. 5. Levels of Management indicate individual & entire management hierarchy.

PRINCIPLES OF ORGANIZING
1. UNITY OF COMMAND refers to the structure an employee has one superior & there is only one manager or leader. 2. SCALAR PRINCIPLES OF HIERARCHY- authority & responsibility flow in clear lines from the highest executive to the lowest.
3. HOMOGENEOUS ASSIGNMENT/ DEPARTMENTATION

workers performing similar assignments are grouped together for a common purpose.

PRINCIPLES OF ORGANIZING
4. SPAN OF CONTROL member of workers that a supervisor can effectively manage. 5. EXCEPTION PRINCIPLE recurring decisions should be handled in a routine manner by lower level managers; whereas problems involving unusual matters should be referred to higher level. 6. DECENTRALIZATION/ PROPER DELEGATION OF AUTHORITY process of conferring specified decision making to the lower levels of the organization.

PATTERNS OF ORGANIZATIONAL STRUCTURE

1. TALL OR CENTRALIZED STRUCTURE/ VERTICAL It is when the span of control is narrow and there are many management levels & there are many managers. - Responsible for only a few subordinates, so there is a narrow span of control - There are many levels of communication.

ADVANTAGES OF TALL STRUCTURE

The quality of performance will improve due to close supervision. Discipline will improve. Superior - Subordinate relations will improve. Control and Supervision will become easy and convenient. The manager gets more time to plan and organize the future activities. The efforts of subordinates can be easily coordinated. Tall Organization encourages development of staff. There is mutual trust between superior and subordinates.

DISADVANTAGES OF TALL STRUCTURE

Tall Organization creates many levels of management. There are many delays and distortion in communication. Decisions and actions are delayed. It is very costly because there are many managers. The managers are paid high salaries. It is difficult to coordinate the activities of different levels. There is strict supervision. So the subordinates do not have any freedom. Tall Organisation is not suitable for routine and standardized jobs. Here, managers may became more dominating.

SAMPLE OF TALL STRUCTURE

2. FLAT OR DECENTRALIZED/ HORIZONTAL STRUCTURE

Characterized by fewer levels and a broad span of control Decision- making is spread among many people. Communication from lower to higher levels is easy and direct. is characterized by fewer levels of management, low burearucratic costs, higher motivation of employees (empowerment), more communication between managers and employees

ADVANTAGES OF FLAT STRUCTURE

Flat Organization is less costly because it has only few managers. It creates fewer levels of management. Quick decisions and actions can be taken because it has only a few levels of management. Fast and clear communication is possible among these few levels of management. Subordinates are free from close and strict supervision and control. It is more suitable for routine and standardized activities. Superiors may not be too dominating because of large numbers of subordinates.

DISADVANTAGES OF FLAT STRUCTURE

There are chances of loose control because there are many subordinates under one manager. The discipline in the organization may be bad due to loose control. The relations between the superiors and subordinates may be bad. Close and informal relations may not be possible. There may be problems of team work because there are many subordinates under one manager. Flat organization structure may create problems of coordination between various subordinates.

DISADVANTAGES OF FLAT STRUCTURE

Efficient and experienced superiors are required to manage a large number of subordinates. It may not be suitable for complex activities. The quality of performance may be bad

SAMPLE OF FLAT ORGANIZATION STRUCTURE

TYPES OF ORGANIZATIONAL STRUCTURE

1. LINE ORGANIZATION/ BUREAUCRATIC/ PYRAMIDAL
This structure shows each position general authority over the lower position in the hierarchy. Commonly found in large health care facility. Clearly defined superior-subordinate relationship ARA and power are concentrated at the top

2. FLAT ORGANIZATION/ HORIZONTAL

It is a decentralized type. Flattened scalar chain and fewer levels of position Used for less complex organizations with authority decentralized and with several managers supervising large work groups. Applicable only in smaller organizations or units within larger organizations

3. STAFF ORGANIZATION
is by nature purely advisory to the line structure with no authority to place recommendations into action. 4. FUNCTIONAL ORGANIZATION permits a specialist to aid line position within a limited and clearly defined scope of authority. 5. AD HOC ORGANIZATION modification of the bureaucratic structure and is used as a temporary basis to facilitate completion of a project within a formal line organization.

6. MATRIX ORGANIZATION designed to focus on both products and function. It has both the vertical and horizontal chain of command. - it is the most complex organizational structure.

7. SHARED GOVERNANCE ORGANIZATION one of the most radical and idealistic type of organizational structure developed in 1980s as an alternative to traditional pyramidal/ centralized structure. 8. LATERAL ORGANIZATION is one of coordination & colaboration between and among nursing staff and hospital staff.

II. STAFFING
Is the process of determining & providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demand. The process of assigning competent people to fill the roles designated for the organizational structure through recruitment, selection & development.

STEPS IN STAFFING
Determine the number & types of personnel needed. Recruit personnel Interview Induct or orient the personnel Job offfer

STAFFING PATTERN
Is a plan that articulate how many & what kind of staff are needed by shift & day to staff in a unit or department. PATIENT CLASSIFICATION SYSTEM ( PCS ) a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time.

 PATIENT ACUITY measurement of nursing workload that is generated for each patient. PATIENT CARE CLASSIFICATION 1. SELF CARE OR MINIMAL CARE PATIENTS are capable of carrying activities of daily living ( ADL) 2. INTERMEDIATE OR MODERATE CARE requires some help from nursing staff with special treatment or certain aspects of personal care

3. TOTAL CARE PATIENTS are usually those who are bedridden & who lack strength & mobility to do average daily living. 4. INTENSIVE CARE PATIENTS are those who are critically ill and in constant danger of death or serious injury.

NURSING CARE MODELS

Is the framework for nursing care delivery in any setting or design that meets the particular needs of a group of health care givers & clients. 1. THE CASE METHOD OR TOTAL PATIENT CARE - original model of nursing care delivery - RN is responsible for all aspects of care of one or more patients.

CASE METHOD / TOTAL PATIENT CARE

- the complete care includes treatment, medications & NCP. - RN gives total patient care within her shift. ADVANTAGE: - RN can better see & attend to the total needs of clients & the continuity of care can be facilitated with ease. - Clients interaction & rapport with the nurse are well developed & clients needs are monitored

DISADVANTAGES:
RN spend more time doing tasks that could be done more cost effectively by less skilled person.

SAMPLE OF TOTAL PATIENT CARE

CHARGE NURSE

STAFF NURSE

STAFF NURSE

STAFF NURSE

STAFF NURSE

PATIENT A

PATIENT B

PATIENT C

PATIENT D

2. THE FUNCTIONAL METHOD

Also called as task Nursing Developed in response to national shortage in 1940s This gave way to widespread use of LPN & UAP to deliver nursing care. Needs of a group of patients are broken down into taks, which are assigne to RNs, LPNs, UAPs.

FUNCTIONAL METHOD
This method is task & procedure oriente. Used wherein there are too many patients in proportion to available RN. Nurses are assigned to different functions such as VS, Tx, medication

ADVANTAGES :
Nurses who are oriented this way become skilled in performing assigned tasks. Individual aptitude & experience improves. Less equipment is neeed Time is save Task- oriented approach improves both productivity & organization

DISADVANTAGES:
Patients cannot identify who their nurse is
CHARGE NURSE

RN MEDICATION NURSE

RN ADMISSION NURSE

LPN TREATMENT NURSE

PATIENTS ASSIGNED TO THEM

3. TEAM NURSING
It evolved from functional nursing. Team nursing personnel provides total patient care to a group of patients. Comprehensive nursing care becomes the responsibility of the entire team.

ADVANTAGES:
The constant group work fosters a feeling of participation and belongingness The workload is balanced and shared with the division of labor Each member of the team has the opportunity to learn from colleagues There is also a variety in the daily assignment Helps maintain interest in clients well being and is cost effective. Patient is able to identify personnel due to the continuity of care Barriers between clients and nurses can be minimized Everyone gets to contribute to the care plan

SAMPLE OF TEAM NURSING

CHARGE NURSE
Team Module Leader Team/ Module Leader Team/ Module Leader

RN, LPN, UAP

RN, LPN, UAP

RN, LPN, UAP

Patients

Patients

Patients

4. PRIMARY NURSING METHOD

Was designed to place RN back at the patients bedside. Decentralized decision-making by staff nurses is the core principle of this method with ARA for nursing care allocated to staff nurses at the bedside. This method represents total nursing care directed by a nurse on a 24 hour basis from the moment of admission to discharge with ARA

ADVANTAGES:
Nurse sees the client and family as one system an ARA is increased. Nurse uses a wide range of skills, knowledge and expertise an develops creativity Increases trust and satisfaction by the clients Excellent communication between the primar nurse an associate nurses Primary nurses are able to hold associate nurses accountable for implementing nursing care as prescribed.

DISADVANTAGE
Critically ill patients may have several primary care nurses because of transfers to different units that may disrupt the continuity of care inherent in the model.

Other health provider

PRIMARY NURSE

Charge Nurse

Patient

Associate Nurse

Associate Nurse

5. CASE MANAGEMENT METHOD

Model for identifying, coordinating and monitoring the implementation of services needed to achieve desired patient care outcomes within a specified period of time. Care is directed by a case manager focused on achievement of outcome and appropriate time frame and resources. Used to organize patient care according to diagnoses.

Case Manager

Patient Caseload

Caregivers

Caregivers

Caregivers

6. PRACTICE PARTNERSHIP
In this model, the RN & assistant agree to be practice partners. They work together with the same schedule and the same group of patients. It is an efficient way of using a mixture of skills of professionals & non- professional staff with differing levels of expertise.

ADVANTAGE:
Offer more continuity of care and accountability for patient care Less expensive for the organization and more satisfying personally for the partners. DISADVANTAGE: Tends to decrease the ratio of professional nurses to non- professional staff There is the potential for the junior member of the team to assume more responsibility than may be appropriate

RN

PARTNER

PATIENTS

GUIDELINES FOR DETERMINING THE NURSING PERSONNEL NEEDED

STEP 1 Determine type of hospital whether it is primary, secondary or tertiary STEP 2 Find the total number of nursing care hours ( NCH ) needed by the patients at each category level. STEP 3 Categorize patients according to levels of care.

 FULL TIME EQUIVALENT ( FTE )

It is the formula that uses nursing care hours and annual hours of work provided by one Full Time Equivalent. It is a measure of the work commitment of a full-time employee. Full time employee works 5 days a week or 40 hours per week for 52 weeks a year. FORMULA: X = total Nursing care hours x days in a year total annual hours per one FTE

 FORTY HOUR WEEK LAW

This formula is based on the National league of Nurses or R.A. 5901 otherwise known as the Forty Hour Week Law FORMULA ;
ABO X NCH = TOTAL NUMBER OF PERSONNEL IN 24 HOURS
No. Of working Hrs.

 FORTY HOUR/ WEEK for personnel working in hospitals with 100 bed capacity or over or which are located in a 1 Million population in the community. 48 HOURS / week for personnel who work in agencies with lesser bed capacity or which are located in communities with less the 1 M population.

STAFFING FORMULA
1. Categorize the patients according to levels of care needed. 250 x .30 = 75 patients needing minimal care 250 x .45 = 112.5 pts. Needing moderate care 250 x .15 = 37.5 pts need intensive care 250 x .01 = 25 pts. Need highly specialized care

2. Find the number of nursing care hours (NCH ) needed by patients at each level of care per day. 75 pts. X 1.5 ( NCH needed at Level I )=112.5 NCH/ DAY 112.5 pts. X 3 ( NCH needed at Level II )=337.5 NCH/ DAY 37.5 pts. X 4.5 ( NCH needed at Level III) = 168.75 NCH/DAY 25 pts x 6 ( NCH needed at Level IV ) = 150 NCH/ DAY TOTAL 768.75 NCH/DAY

3. Find the total NCH needed by 250 patients per year 768.75 x 365 ( days/year ) = 280,593.75 NCH/yr. 4. Find the actual working hours rendered by each nursing personnel per year. 8 (hrs/day) x 213 ( working days/yr) = 1,704 ( working hrs/yr)

5. Find the total number of nursing personnel needed. a. Total NCH /yr = 280, 593.75 working hrs./ yr. 1, 704 = 165 b. Reliever x total nsg. personnel Divide 33( ave. Number of days an employee is absent per year) by the number of working days per year that each employee serves.

165 x .15 = 25 ( relievers needed ) c. Total nursing personnel needed 165 + 25 = 190 6. Categorize to professional & nonprofessional personnel. 190 x .65 = 124 prof. 190 x .35 = 66 non prof.

7. Distribute by shifts 124 nurses x .45 = 56 nurses on AM shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x .18 = 22 nurses on night shift 66 attendants x .45 = 30 AM SHIFT 66 attendants x . 37 = 24 PM shift 66 attendants x .18 = 12 night shift