NCM 205 Nursing Leadership and Management Ms.

Loresita Antonia Chua

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18.

Trait theory Great Man Theory Charismatic Theory Frederick Taylor Frank and Lillian Gilbreth Henry Gantt Henri Fayol Max Weber Elton Mayo Hawthorne Studies Kurt Lewin change theory Abraham Maslow Frederick Herzberg Douglas McGregor Ouchi Theory Z Peter Drucker MBO Fred Fiedler Contingency theory Robert House Path Goal T. Lashbrook Work Unit Culture

1. CLMMRH 2. BOLMSH TLJPH 3. SVH 4. Bac CHD 5. PHO (Interlocal H Zones) 6. NORFI/VRHD I. The Nurse in the Organization

Mission Vision Organizational Chart/Structure Staffing Nursing Service Personnel

A. The Center of the Work World is ME o o o Your work world begins with ME You are quite literally, the center of your work world 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 your work world

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

A1. My Values o o o Have an unrecognized influence upon your philosophy and actions as a nurse Affects your life and your work. 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 12 N 14

O 15 U 21

V 22 R 18

E 5 S 19 I 9

O 15 N 14

F 6 G 7 = 102

G 7

O 15

D 4 = 101

A2. My Motivations answers 2 things Causes you to do what you do To select one course of action instead of another

My Motivations

A3. My Knowledge o o o o It has been said that chance favors the prepared mind This is a way of saying that you make your own luck These care certain requisites for experiencing personal satisfaction from your work Gives you confidence in your ability acquired through study and experience

L Labor U Under C Complete K Knowledge 2

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 Coveys Seven Habits of Highly Effective People 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 Primary objective is to help people and organizations realize the need to increase their effectiveness Focused on leadership and development for organizations

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 Build and repair o Lessen relationship relationships Kindness and courtesy o Unkindness and discourtesy Keeping promises o Breaking promises Honouring expectations o Violating expectations Loyalty to the absent o Disloyalty, duplicity Making apologies o Pride, conceit, arrogance
*Have more deposits than withdrawal in our relationship

o o o o o o

Stephen Covey 3

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 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 Moods, feelings, circumstances, biases, o Author of his life prejudices, prejudgment o Make things happen Observer of his life o Optimistic Theres nothing I can do o Lets look at our alternatives Thats just the way I am o Its possible He makes me so mad o Its OK They wont allow that o I prefer Language of Language of I have to do that o Its alright Reactive Proactive I cant, its hard o I will I must o Im able Let things happen o Foresight Bahala na o Assertive Submissive aggressive Comparison of behaviors exhibited by passive, assertive and aggressive nurses Assertive High Self-Esteem Feels self-worth Forthright Open and honest Acts in best interest of self, patients/clients Feels or peer level Controls situations Aggressive High-Low Self-Esteem Mixed feelings of worth Forward and attacking Hostile, manipulative Demands needs be gratified for self and others Feels must fight for rights Attacks situations 4

o o o o o o o o o o o o o o

Passive Low Self-Esteem Feels Pity Shy, withdrawn Apologetic Denies rights and needs of self and patients/clients Feels victimized Allows situation to control rather than controlling situation

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 individuals 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

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: 7

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 1. May or may not have official appointment to the position. 2. Has power and authority to enforce decision only if the followers are willing. 3. Influences others either formally or informally. 4. Interested in risk taking and exploring new ideas. 5. Relates to people personally, and in an empathetic manner. 6. Feels rewarded from personal achievement. Manager Appointed officially to the position by the institution or organization. Has power and authority to enforce decision by virtue of the position in the organization. Carries out predetermined policies, procedures, rules and regulations. Maintains an orderly, controlled, rational, equitable structure. Relates to people according to roles, job function, duties and responsibilities. Feels rewarded when fulfilling organizational goals, mission, vision.

1. 2. 3. 4. 5. 6.

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

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 leaders 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 persons 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 Top 47% Middle 31% First/Entry 18% *The highly complex skill put in, more pay. Levels of Manager Top Level o Generally make decision with the help of few guideline or structures o Coordinate internal and external influences o View the organization as a whole o CEO, COO, NO, VP, Directors Middle Level Conducts day to day operations with some involvement with ong term planning and policy making Supervisor, Unit Manager, Head Nurse First Level Concerned with a specific units work flow Deal with immediate day to day operations problems Case Manager, NP, Team Leader, Charge Nurse 9 Human 35% 42% 35% Technical 18% 27% 47%

o o o

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

Responsibilities of Nurse Manager regardless of title within the nursing department: Patient Care Management o Assess problems and needs o Problem identification o Planning of care o Teaching o Treatments o Medications o Clinical conferences o Evaluating results Operational Management o Budgeting o Controlling expenses o Staffing o Providing supplies o Scheduling o Committees o Communicating o Coordinating o Planning, evaluating performance o Meetings o Auditing Human Resource Management o Teaching o Counseling o Facilitating o Rounds, conferences o Continuing education o Bulletin boards o Journals o Career mobility o Peer review o Research o In service programs

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 Little Freedom High Control By the Leader Primarily the Leader High Quantity, Good Quality Very Efficient Closed System Nurse Manager Followers Democratic Moderate Freedom Moderate Control Leader and Group Together Shared Creative, High Quality Less efficient than authoritarian Open System Nurse Manager Followers Laissez-Faire Much Freedom No Control By the group or by no one Abdicated Variable, May be Poor Quality Inefficient Permissive system Followers Nurse Manager

Degree of Freedom Degree of Control Decision Making Assumption of Responsibility Output of the Group Efficiency

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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 (IndividualGroupInstitutional) 2. Goals should be meaningful 3. Goals Should be acceptable to all G2. Skills and Knowledge (Hands and Feet) o o Critical Thinking skills do not accept what others are telling you (Skills) Interpersonal Skills know the persons you work with (Knowledge) with each other goals should be aligned

G3. Self Awareness (Eyes, Ear, Nose) G4. Communication Heart o o o o Active listening Encourage the flow of information (degree of transparency) Provide feedback Linkages and networking

G5. Energy (GI Tract) o o Restorative energy positive charging 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. Its 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 15

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 o

Imagination, creativity and ingenuity can be used to solve work problems by large number of employees 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 7S 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. Fiedlers Contingency Theory 17

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 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: Whats in it for me? 5. Support Q: What happens if I need help? 18

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 Assessing Planning Implementing Evaluating 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)

Management Process Planning Planning Organizing Staffing Organizing Directing Controlling

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 o o o o o o o o o o Buildings Grounds Equipment Cost Work performance Policies/procedures Statistics Patient care records Professional development programs Safety measures o Intangible Cognitive - Knowledge - Thinking - Planning - Problem solving - Brainstorming - Research - Group dynamics - Focused group discussion - recollections 19

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

Signs and symptoms

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 3M Manpower

c. 3Ps in Management Personnel

Physical Plant (Buildings, grounds, equipments facilities) Materials, Machine, Money Policies and Procedures 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 o o o o o o o o Strategic long range planning; 3-5 years into the future Operational Planning short range planning; deals with day to day maintenance activities Belief conviction that certain things are true Vision mental image of something not actually visible, for now, but in the future Value the worth, usefulness, or importance of something Mission an aim to be accomplished; mission statement Philosophy statement of beliefs and values that directs behavior Goal the end to be accomplished Objective something aimed at or striven for; things done to achieve the goal 20 Methods

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

o o o

Policy governing plan for accomplishing goals and objectives Procedure chronological sequence of steps within a process 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 Provincial Health Unit City Health Unit Regional Health Unit National Health Unit County State Local Region

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 21

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

o o

Lines of communication 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 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 Becomes large and more complex Does not readily adapt to change Obtaining decision require more time

Disadvantage 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 Initial cost of staffing

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

b. Flat ___ Tall | Concentric -

Interdisciplinary cooperation

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

Vertical development Lends to authoritarianism, require rapid changes and precise coordination Levels are expensive because of large number of executives needed with high salaries

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 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 A chain of command Direct line between manager and staff depicted by solid line in the chart Associated with direct achievement of organizational objectives

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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 C. Staff Staff involves the following Selection of personnel Formulating assignment system Determination of staff schedules Containing the cost while providing high quality care Nurses pool

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 (UAPs) 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 25

NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

Advantage: Quality nursing care ***St. Lukes

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