NCM 107-A Nursing Leadership & Management, Nursing JurisprudenceJune 15, 20129:00 am

Conceptual Paradigm of Leadership & Management

GOALS Usually established at the beginning of any planned undertakingA 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.

GOALSGOALS MUST BE:S- SpecificM- MeasurableA- AttainableR- RelevantT- Time BoundedE- Efficient & EffectiveR- Rewarding

THEORIES & PRINCIPLESVarious theories & principles of leadership & management help provide the basis for accomplishing a goal.THEORIES1. Scientific Management Theory2. Systematic Management Theory3. Organizational Theory4. Social Process5. Hawthorne Effect6. Management by Objectives

7. Management as Decision Making8. Managerial Roles9. Hierarchy of Needs10. Motivation Hygiene Theory11. Theory of X & Theory of Y12. Theory ZTHEORIES

MANAGEMENT uses delegated authority within a formal organization to organize, direct and control subordinates .It refers to the middle and lower levels of hierarchy and is often the implementing body.Is a process of getting things done through people.Function that must be performed in any organization

Managers do things right- Leaders do the right thing

NURSING MANAGEMENTIs the process of working through staff members to be able to provide comprehensive care to the patient.This includes planning, organizing, directing and controlling.

KEY CONCEPTS IN NURSING MANAGEMENTADMINISTRATION- is the higher level of hierarchy.It is the policy making body and as such sets the policy for the organization.EXECUTIVE OFFICERS- are administrators who occupy the highest positions in an organizationADMINISTRATIVE OFFICERS are those in the middle level.Chosen for their conceptual skills LINE MANAGERS/HEAD NURSES are those in the first level.Chosen for their interpersonal skills

Workers are chosen for their technical skills.

ORGANIZATIONArrangement of people and resources working in a planned manner toward specified strategic goals.

MISSIONOutlines the purpose of the agencyIdentifies the clientsAllows everyone to understand why an organization existsIt is the soul of an organization

VISIONA mental image or the power of imagination to see something that is not actually visible.An organizations dream of what it wants to be in the futureIt outlines the organizations future role and functionsGives the agency something to strive for

PHILOSOPHYDescribes the vision of an organization.A statement of beliefs and values that direct the organizations life or practice.Propels the sense of purpose and reason behind its structure and goalsIt explains beliefs and gives direction to how the mission or purpose is achieved.States the beliefs and values of an organization.

OBJECTIVESAre specific and concrete in terms of results to be achievedIt is the backbone of ones goals and philosophy.Are action commitments through which its mission and philosophy will be achieved.State the specific and measurable goals to be accomplished.The battle plan

GOALRelates to ones aspirations, purpose and visionA specific aim to target to be attained within a short time span of a year.

THEORYA coherent group of assumptions put forth to explain a relationship between two or more observable facts.

1. Scientific Management Theory

Frederick Taylorone best practiceManagement & Labor both wantTo increase productivity

2. Systematic Management Theory

Henri FayolFather of SystematicManagement.18 principles of mgt:

3. Organizational Theory

Max WeberAdvocatedBureaucracy

4. Social ProcessMary Parker FolletManagement asSocial process

5. Hawthorne Effect

Elton Mayo/Fritz Roethlisberger

6. Management by Objectives

Peter DruckerFather of ModernCorporate mgt.

7. Management as Decision Making

Herbert SimonOptimizing economic manSatisfying administrative man

8. Managerial RolesHenry Mintzberg10 Basic ManagerialRoles

9. Hierarchy of Needs

Abraham MaslowFather of humanisticPsychology5 levels of needs

10. Motivation Hygiene Theory

Ferdinand Herzberg2 factor theory Hygiene Motivation-

11. Theory of X & Theory of Y

Douglas McGregorTheory X negative view Dislike workIrresponsibleRequires close supervisionTo do their job.

Theory Y positive view - industrious , responsible - creative , self control

12. Theory ZWilliam OuchiJapanese mgt. approachPresenting solutions to Problems of HRM.Attempts to incorporate & Integrate the best of American ( theory A ) andJapanese ( Theory J) ofMgt

MANAGEMENT PROCESSES & FUNCTIONSIt is the application of creative problem solving strategies. 4 functions of managementPlanningOrganizingDirectingcontrolling

EFFECTIVE & EFFICIENTLeadership should be efficient & effectiveEFFICIENT 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.

Attainment of a goal usually precedes the use of resources.7 Ms 1. money- budget 5. methods-body of technique for investigating phenomena.2. men- human resources6. moment-time; time management3. machine-devices7. manager-person responsible for planning & directing the work of a group4. materials-physical resourcesRESOURCES

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.NURSING MANAGEMENT PROCESS

COMPONENTS OF PLANNING

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

A well plan is half done

POOR PLANNINGIs the failure to set goals make assessments or provide for implementation or to anticipate any possible change in circumstances. INDICATORS OF POOR PLANNINGDelivery dates are not metMachines are idleMaterial is wastedSome nurses are overworked, others are underworkedSkilled nurses doing unskilled workNurses are fumbling on jobs for which they have not been trainedThere is quarreling, bickering, buck-passing and confusion.

Failing to plan is planning to fail

PLANIs a living document which can be changed based on the prevailing circumstances.PRINCIPLES OF PLANNINGPlanning 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 resourcesPlanning must be precise in its scope & naturePlanning should be time- boundedProjected plans must be documented

IMPORTANCE OF PLANNING

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

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

STEPS IN PLANNING1. Diagnosis2. Objective/ goal settingMeans identificationDebate on proposalsDecision makingTaskingEvaluation

TYPES OF PLANSSTRATEGIC 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:What do we do?For whom do we do it?How do we excel?

OPERATING PLANS pertain to activities in specific departments or organization.- generally shorter in time frame-involve the middle & lower level managersCONTINOUS 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 PLANNINGDefining 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.

Set objectives/ goals and determine results desiredOBJECTIVES is the backbone of ones goals and philosophy ; these are the battle planGOALS 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.

4. Develop & schedule strategies, programs/ projects/activities; set the time frameSTRATEGY 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 procedurePROGRAMS 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 TIMEConduct 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.Break down large projects into smaller partsDevote few minutes at the beginning of each day for planning.Organize your workspace so it is functional.Close your door when you need to concentrate.Learn to delegate.In a meeting, define the purpose clearly before startingTake or return phone calls during specified time.Develop effective decision- making skillsTake rest breaks and make good use of your spare time.

EFFECTS OF MISMANAGEMENT OF TIMEWork is rushed and becomes substandardDeadlines are missedBad choices are madeEmployees suffer from fatigueEmployees personal lives and relationships are adversely affected

5. Preparing the BudgetBUDGET- 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 BUDGET1. REVENUE BUDGET summarizes the income which management expects to generate during the planning period.CASH BUDGET amount of money received; planned cash receipts & disbursements, cash balances.OPERATING BUDGET composed of the revenue and the expense budget.CAPITAL BUDGET consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period.

6. Establishing Nursing standards, policies & proceduresSTANDARDS indicate the minimal level of achievement acceptable to meet the set objectives.Nursing StandardsExample: 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 PoliciesExample : Admissions receiving, consent, notifying doctor, care of patients

PROCEDURES are defined as a more specific guide to action than policy.Nursing ProceduresExample: 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.

STRATEGIC PLANNING PROCESSMISSION outlines the purpose (aim) of the agency ( provides health care )Allows everyone to understand why an organization existsA call to live out something that matters or is meaningful.It is the soul of an organization

VISION is a mental image or the power of imagination to see something that is not actually visibleIt outlines the organizations future role & functionsGives the agency something to strive for.An organizations dream of what it wants to be in the future.

PHILOSOPHY describes the vision of an organizationIt is the statement of beliefs and values that direct organizations life or practice.Statement of belief based on core values.Propels the sense of purpose and reason behind its structure and goals.

OBJECTIVES is the backbone of ones goals and philosophyIt states the specific and measurable goals to be accomplishedAre action commitments through which its mission and philosophy should be achieved.Are the battle plan , the stepping stones on the path towards the achievement of his goal. A goal may have one or many objectives.

GOAL the end to be accomplishedRelates to ones aspirations, purpose, and vision.

SWOT ANALYSIS is the assumptions and facts on which a plan will be based.STRENGTH a distinctive competence, resource or skill that provides the organization with competitive advantage in the market place.

WEAKNESS a negative internal condition that can lead to a lowering of the organizations performance.OPPORTUNITIES a current or future condition in the environment that is favorable to an organizations current or potential output.THREAT a current or future condition in the environment that is unfavorable to an organizations current or potential output.

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.

Activity :SITUATION FOR SWOT ANALYSISAssignment:Design a framework showing the interconnectedness between an organizations philosophy,vision- mission, goals and objectives, and its management process affecting healthcare services.Develop an action plan to combat or prevent Dengue , Diarrhea, Pneumonia, TB, AGE in your chosen locality .

ORGANIZATIONAL CHART is a line drawing that shows how the parts of an organization are linked.

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

PRINCIPLES OF ORGANIZING1. 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 ORGANIZINGSPAN OF CONTROL member of workers that a supervisor can effectively manage.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.DECENTRALIZATION/ PROPER DELEGATION OF AUTHORITY process of conferring specified decision making to the lower levels of the organization.

PATTERNS OF ORGANIZATIONAL STRUCTURETALL 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 STRUCTUREThe 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 STRUCTURETall 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 STRUCTURECharacterized by fewer levels and a broad span of controlDecision- 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 STRUCTUREFlat 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 STRUCTUREThere 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.

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

DISADVANTAGES OF FLAT STRUCTURE

SAMPLE OF FLAT ORGANIZATION STRUCTURE

TYPES OF ORGANIZATIONAL STRUCTURE1. LINE ORGANIZATION/ BUREAUCRATIC/ PYRAMIDALThis structure shows each position general authority over the lower position in the hierarchy.Commonly found in large health care facility.Clearly defined superior-subordinate relationshipARA and power are concentrated at the top

2. FLAT ORGANIZATION/ HORIZONTALIt is a decentralized type.Flattened scalar chain and fewer levels of positionUsed 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.FUNCTIONAL ORGANIZATION permits a specialist to aid line position within a limited and clearly defined scope of authority.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.

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.

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. STAFFINGIs 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 STAFFINGDetermine the number & types of personnel needed.Recruit personnelInterviewInduct or orient the personnelJob offfer

STAFFING PATTERNIs 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 SELF CARE OR MINIMAL CARE PATIENTS are capable of carrying activities of daily living ( ADL) INTERMEDIATE OR MODERATE CARE requires some help from nursing staff with special treatment or certain aspects of personal care

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

NURSING CARE MODELSIs the framework for nursing care delivery in any setting or design that meets the particular needs of a group of health care givers & clients.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

2. THE FUNCTIONAL METHODAlso called as task NursingDeveloped in response to national shortage in 1940sThis gave way to widespread use of LPN & UAP to deliver nursing care.Needs of a group of patients are broken down into tasks, which are assigned to RNs, LPNs, UAPs.

FUNCTIONAL METHODThis method is task & procedure oriented.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 neeeded.Time is saveTask- oriented approach improves both productivity & organization

DISADVANTAGES:Patients cannot identify who their nurse is

3. TEAM NURSINGIt 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 belongingnessThe workload is balanced and shared with the division of laborEach member of the team has the opportunity to learn from colleaguesThere is also a variety in the daily assignmentHelps maintain interest in clients well being and is cost effective.Patient is able to identify personnel due to the continuity of careBarriers between clients and nurses can be minimizedEveryone gets to contribute to the care plan

SAMPLE OF TEAM NURSING

4. PRIMARY NURSING METHODWas 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 creativityIncreases trust and satisfaction by the clientsExcellent communication between the primar nurse an associate nursesPrimary nurses are able to hold associate nurses accountable for implementing nursing care as prescribed.

DISADVANTAGECritically 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.

PatientOther health providerPRIMARY NURSECharge NurseAssociate NurseAssociate Nurse

5. CASE MANAGEMENT METHODModel 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 ManagerPatient CaseloadCaregiversCaregiversCaregivers

6. PRACTICE PARTNERSHIPIn 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 careLess expensive for the organization and more satisfying personally for the partners.DISADVANTAGE:Tends to decrease the ratio of professional nurses to non- professional staffThere is the potential for the junior member of the team to assume more responsibility than may be appropriate

RNPARTNERPATIENTS

GUIDELINES FOR DETERMINING THE NURSING PERSONNEL NEEDEDSTEP 1 Determine type of hospital whether it is primary, secondary or tertiarySTEP 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 LAWThis formula is based on the National league of Nurses or R.A. 5901 otherwise known as the Forty Hour Week LawFORMULA ;ABO X NCH= TOTAL NUMBER OF PERSONNEL IN 24 HOURSNo. 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 FORMULA1. Categorize the patients according to levels of care needed.250 x .30 = 75 patients needing minimal care250 x .45 = 112.5 pts. Needing moderate care250 x .15 = 37.5 pts need intensive care250 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/ DAY112.5 pts. X 3 ( NCH needed at Level II )=337.5 NCH/ DAY37.5 pts. X 4.5 ( NCH needed at Level III) = 168.75 NCH/DAY25 pts x 6 ( NCH needed at Level IV ) = 150 NCH/ DAYTOTAL 768.75 NCH/DAY

Find the total NCH needed by 250 patients per year768.75 x 365 ( days/year ) = 280,593.75 NCH/yr.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)

Find the total number of nursing personnel needed.a. Total NCH /yr = 280, 593.75working hrs./ yr. 1, 704 = 165b. Reliever x total nsg. personnelDivide 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 needed165 + 25 = 190 6. Categorize to professional & non- professional personnel. 190 x .65 = 124 prof. 190 x .35 = 66 non prof.

7. Distribute by shifts124 nurses x .45 = 56 nurses on AM shift124 nurses x .37 = 46 nurses on PM shift124 nurses x .18 = 22 nurses on night shift

66 attendants x .45 = 30 AM SHIFT66 attendants x . 37 = 24 PM shift66 attendants x .18 = 12 night shift

III. SCHEDULINGIt is a timetable showing planned work days & shifts for nursing personnel.FACTORS TO CONSIDER IN MAKING SCHEDULEDifferent levels of nursing staff.Adequate coverage for 24 /7.Staggered vacations & holidays.Long stretches & consecutive working days.Cross training/ orientation to complimentary units

TYPES OF SCHEDULINGCENTRALIZED one person, usually the Chief nurse or her designate, assigns the nursing personnel.DECENTALIZED shift & off duties are arranged by supervising nurse or Head or Senior Nurse of the particular unit.3. SELF SCHEDULING a staff or unit collectively decides & implements the monthly work scheduleADVANTAGES:- increases job satisfaction- cooperative spirit/ teamwork- decrease absenteesm- decrease personnel turn-overDISADVANTAGES:- increases amount of time staff may spend on scheduling

4.ROTATING WORK SHIFT scheduling system that involves frequency of alternating between days & nights or 3 shift within 7 days.5. PERMANENT SHIFT refers to regularity of duties of staff.6. BLOCK OR CYCLICAL SCHEDULE - refers to the repetition of the same schedule.

A four- week cyclical schedule

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PERSONNELSMTWTHFSSMTWTHFSSMTWTHFSSMTWTHFS

Head/Senior Nursexxxxxxxx

Staff Nursexxxxxxxxx

Nsg. Att. 1xxxxxxxx

Nsg. Att. 2xxxxxxxx

Staff Nursexxxxxxxx

Nsg. Att.xxxxxxxx

Staff Nursexxxxxxxx

Nsg. Att.xxxxxxxx

General Reliever, Staff Nurse3-113-1111-7xx3-1111-711-7x7-33-113-1111-7xx7-33-113-1111-711-7xx3-1111-711-7x7-33-11

Nsg. Att.3-1111-7x7-33-1111-7x7-33-11x11-711-7x3-11x7-311-7x3-113-1111-711-7x7-33-113-1111-7x

PERSONNEL

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OTHER CONSIDERATIONS:Minimal Off during MondaysAM SHIFT provided with Head Nurse, staff nurse, 2 attendantsPM & NIGHT SHIFT RN attendants are provided with relievers.Relievers of night shift are given off duty before pm shiftStaff actuall involved in pt. Care, it is advisable that their work days be not more than 4-5 consecutive days.

ACTIVITYMake a schedule of your staff in surgical ward with the following Staff :1 Head Nurse4 Staff Nurse/ Registered Nurse5 Nursing Attendant

IV. DEVELOPING JOB DESCRIPTIONJOB DESCRIPTION is a statement that sets the duties & responsibilities of a specific job.Also called as performance descriptionsSpecification of duties, conditions & requirements of a parrticular job.It includes the characteristics or qualifications of the individual to perform such duties successfully.It is an impt. Mgt. Tool to make certain that responsibilities are wisely delegated, that wok is efficiently distributed, that talents are fully used & morale is maintained.

CONTENTS OF JOB DESCRIPTION1.CONTENTS:Identifying dataPosition Title: Staff NurseDepartment : NursingSupervisors title: Head/ Senior Nurse

2. Job Summary includes the essential features of the job that distinguish it from the others.Qualification Requirements educational preparation, training & experience necessary to fill the position.Job relationships Source of workersSpecific & actual functions & activities.

PURPOSES OF JOB DESCRIPTIONRecruitment & selection of qualified personnelJob Placement, transfer & dismissalGuidance & directionAid in the Evaluation of performance of employeeReduction of conflict & frustrationAvoidance of overlapping dutiesFacilitating working relationships with outside bodiesServing as basis for the employees salary range

3. DIRECTINGAct of issuing of orders, assignments, instructions to accomplish the organizations goals & objectives.Involves the process of getting the organizations work done.Getting the work done through others.In nursing, it is giving orders and directions to others to attain quality patient care.

DIRECTINGIt is the final major step taken be the nurse manager to ensure that the organizations goals are accomplished.Ensure that she has assigned the work properly and gotten the right person for each task.

CHARACTERISTICS OF GOOD DIRECTIONSDirections must be clear, concise, consistent and complete.The person giving directions must explain the rationale well and make certain that it is understood.The person giving directions must speak distinctly and slowlyAvoid giving too many directions at one time;you should personalize directions; and always check to make sure directions have been followed.

TOOLS IN DIRECTINGNURSING CARE PLAN primary tool of nursing directors/supervisor; it outlines the nursing care to be provided to a patient; it is a set of actions the nurse will implement to resolve nursing problems identified in assessment.POLICIESSTANDARDSSTANDARD OPERATING PROCEDURE(SOP)RULES & REGULATIONS

ELEMENTS OF DIRECTING1. Delegation2. Supervision3. Staff Development4. Coordination5. Collaboration6. Communication7. Evaluation

The authority was delegated to me for this patient and, by assuming this responsibility for the patient, I will then be accountable for this patients care

- Phyllis Frank & Marjorie Price, 1980

ELEMENTS OF DIRECTINGDELEGATION is the act of assigning to someone else a portion of the work to be done with corresponding ARA- it is a tool that the nurse manager use, to build moral among the staff- skill to be learned & mastered starting with learning what cannot be delegated & can be delegatedASSIGNMENT is a task done without authorityDELEGATION is a task done with ARA.

4 RIGHTS OF DELEGATIONTASK the right task should be within the scope of the persons practice and consistent with the job description.PERSON the right person should have: - appropriate license or certificateappropriate job descriptionDemonstrated skill COMMUNICATION- right communication should be clear, complete, concise & correct.FEEDBACK- right feedback should ask for input, get the persons recommended solution to the problem, and recognize the persons efforts.

ASPECTS OF DELEGATION( ARA)1. AUTHORITY - Delegation of authority - Authority is the power to make final decisions & commands- People with delegated authority perform for the managerThey need authority of sufficient scope to include all related activities without frequent consultation with their managerThe manager maintains control over the delegated authority and may recall it.2. RESPONSIBILITYAssignment of responsibilityResponsibility denotes obligationIt refers to what must be done to complete a task and the obligation created by the assignment.

ASPECTS OF DELEGATION3. ACCOUNTABILITYCreation of accountabilityAccountability refers to liabilityStaff given responsibility are accountable to their managerManagers are accountable for the performance of the task, selection of the person to complete it, and both the staff associates and their own performance

PURPOSES OF DELEGATIONSaves time It can help develop othersIt maximizes the use of the talents of staff associatesUses latent abilities in personnel that contribute to their growth and developmentInvolvement of staff tends to increase motivation and commitment to accomplish goalsIt reduces managerial cost.

GUIDELINES FOR EFFECTIVE DELEGATIONGive a clear description of what it is you want the employee to do.Share with the employee the outcome you expect and by whenDiscuss the degree of responsibilities and authority that the employee will haveAsk the employee to summarize the main points of the task that has been delegated.

AREAS TO BE DELEGATEDRoutine tasksTasks for which you dont have timeProblem solvingChange in your own job emphasisCapability building

WHAT CANNOT BE DELEGATED?Overall ARAFinal evaluation of staff performanceCorrecting & disciplining staffActivities which the nurse to whom the task is delegated does not know how or does not want to do because the job is unpleasant hot potatoDELEGATED TASKS MUST BE:- based on policies; job descriptions; capabilities of workers

WHY MANAGERS DO NOT WANT TO DELEGATE?

Mistakes in delegation can be costlyFailure to delegate wisely increases management costs & contributes to personnel dissatisfactionFear on the part of the manager of her own ability to delegateFear of losing control of the staffFear of failing to get others do the workFear of cristicism

COMMON DELEGATION ERRORSUNDERDELEGATING this stems from the managers false assumption that delegation may be interpreted as the lack of ability on his or her part to do the job correctly or completely- manager manifests his desire to do the job by himself- TRUST issues & lack trusts in his subordinates- fears that subordinates will resent the work delegated to them- occurs when the manager lacks experience in the job.

2. OVERDELEGATINGIt unnecessarily burdens the subordinates the with tasks that are either inconsequential or irrelevant to the delivery of the goal

3. IMPROPER DELEGATING it is the delegation of tasks & responsibilities beyond which the person cannot perform properly.

CASE OF DELEGATIONHead Nurse A , assigns licensed Nurse B to do an intravenous ( IV) line to patients. Nurse B goes around with students nurses C & D. Nurse B does the same procedure. However, Nurse B noted that C & D , when assisting, can do the job. Without the knowledge of Head Nurse A, Nurse B allows student nurses C & D to administer the IV line.Did Head Nurse A delegate authority correctly?Does Nurse B have the right to delegate tasks?Who assumes accountability in case a problem or complication arises?

II. SUPERVISIONIs the process of guiding & directing the work to be done.Came from the Greek word supervide which means to oversee or view directlyIt entails motivating & encouraging the staff to participate in activities to meet goals & objectives and personal development, and in helping the staff to do their work better.

PRINCIPLES OF GOOD SUPERVISIONGood supervision is focused on the improvement of work rather than upgrading the workerIt is based on lines of authority, VMGOFocuses on 3 areas of skill: conceptual, technical, interpersonalIt is cooperatively planned & accepts both challenge & change with subordinatesIt uses a democratic process to facilitate :effective communication, continous improvement of staff, respect for individuality of each member that bring harmonious relationship

RESPONSIBILITIES OF SUPERVISORTeach & motivate the staff & facilitate their workDelegate work responsibilities and be available for consultationPerform assessment and evaluation of work performance and conditions.

III. STAFF DEVELOPMENTIs a planned experience to help employees perform effectively and to enrich their competence in practice, education, administration and researchRetraining employees for better performance in areas of skills, knowledge & attitude ( SKA )

FUNCTIONS OF STAFF DEVELOPMENTMaintain self efficiency and effectivenessCreate quality employeesMeet the staffs needs and address their problems such as deficiencies in knowledge, skills & attitudesMotivate them and improve their self confidenceHelp prepare them for greater responsibilities

In- Service Training vs. Continuing Education

IN-SERVICE TRAININGCONTINUING EDUCATIONScopeTrainingSkills enhancementProfessional & personal development that relates to professional & organizational developmentOriented towards improving performance of staff and conforming to organizational needsTend to meet high performance level needs of the staffStrengthen knowledge, skills and attitudeaimImproved patient care through upgrading of services renderedPromote development of KSA for enhancement of nursing practicenatureLess formalFormal- seminar workshopLearning experiencePlanned & incidentalPlanned, structured learningdurationshorterLongersettingWithin the agencyWithin, outside the agencycostShouldered by the agencyPaid by the individual nurseresponsibilityagencyIndividual nurse

IV. COORDINATIONTo work or act together harmoniouslyLinks or unites the different components of an organization and leads them toward goal achievement.Creates harmony on all activities to facilitate success of work.

COORDINATION WITH MEDICAL SERVICEShould know the medical staff & scheduled time of roundsShould know the patients in the unit, diagnosis, conditions, medical plan of care& treatmentAdequate feedback on the progress of the patients conditionRegular conferences encountered in the ward and with the patient care.

COORDINATION WITH THE ADMINISTRATIVE SERVICEIt pertains to both human and material resourcesnurses participate in budget planning for staffing,facilities & material resourcesRepairs and maintenance of equipment, requisition of supllies, linens etc.Training on the use of the new equipments

COORDINATION WITH THE LABORATORY SERVICERequests for lab examsAssistance to lab tech during routine blood examsLabeling of the different specimens like urine, stool, sputum, csfPreparations of pts. For relevant examinations

COORDINATION WITH RADIOLOGY SERVICERequests for x-ray examPreparation for the different proceduresAllergies to dyes should be indicated

COORDINATION WITH THE PHARMACYPolicies regarding the procurement of drugs are formulated jointly by the admin., medical and nursing services and the pharmacy.

COORDINATION WITH THE DIETARY SERVICE- Head nurse is responsible for forwarding the diet list of the patients in the units

COORDINATION WITH THE MEDICAL SOCIAL SERVICEReferring patients with psycho-socio economic problems.Examples of these are indigent patients needing materials or financial assistance, medicines etc.COORDINATION WITH THE MEDICAL RECORDS SERVICE- Nurses are responsible for accurate documentation and completeness of the patients chart- pts. & relatives are not allowed to bring the chart- Nurses are not allowed to release information about the patient

COLLABORATIONTo work jointly with others; synchronization of activities which results in efficient, smooth and harmonious flow of work.The manager and the health care staff together with the other members of the health care team all participate in the decision making process. Sometimes they join forces with another as the medical group or larger group, like another health care team or one fulfilling a different role for this purpose.

COMMUNICATIONCommunication ensures common understanding via various routes. It is a process by which a message is sent, received and understood as intended. It is the transmission of information, opinions and intentions between and among individuals.The goal of proper communication is to narrow the gap between the intended and the received message.

FLOW OF COMMUNICATIONDOWNWARD COMMUNICATION may come in forms of policies, manuals and guidelines for information and compliance of everyone in the organization. Memoranda, job descriptions, performance appraisals, are other forms of downward communication.UPWARD COMMUNICATION usually comes from subordinates to top management. It is done in the form of feedback informing the administration as to the effect of the downward communication- the extent to which it has been received and acted upon.(grievance procedures, incident or situational reports)

FLOW OF COMMUNICATIONLATERAL COMMUNICATION is being observed between employees, personnel, units or department on similar level. It comes out in various forms like endorsements between shifts, nursing rounds, conferences or meeting or in making referrals between service departments.OUTWARD COMMUNICATION deals with info that flows from the caregivers to the patients, their families, relatives, visitors and the community. Patients should understand the nature of their illness, the medical and the prescribed nursing plans of care so that they could participate in the decisions regarding these. It also involves how employees value their work.

FOUR DIMENSIONAL FLOW OF COMMUNICATION IN NURSING CARE

PRINCIPLES OF EFFECTIVE COMMUNICATIONPrinciple of ClarityPrinciple of objectivePrinciple of understanding the receiverPrinciple of consistencyPrinciple of completenessPrinciple of feedbackPrinciple of time

Types of CommunicationSPOKEN WORDS it involves spoken wordsWRITTEN WORDS must be clear, correct, complete and concisePHYSICAL EXPRESSION or SIGNIFICANT GESTURES transmission of message without the use of words

NON- VERBAL COMMUNICATIONPersonal appearance- appearance of a person gives the general impression of his personality and self concept.Intonation of the voice should be soft & gentle; should not be irritating to the ear.Facial Expression a friendly smile establishes immediate rapport with the client and invites trust & confidence in the nurse.Posture & gait it indicates his physical wellness, his emotions and attitude towards his clients.Touch way of caring.

BARRIERS TO EFFECTIVE COMMUNICATION1. PHYSICAL BARRIER these are environmental factors that prevent or reduce the opportunities for communication. Ex. Distance, noise2. SOCIAL/PSYCHOLOGICAL BARRIERS they are blocks or inhibitors to communication that rise from the judgments, emotions and social values of people. Ex. Stress, trust, fear, defensiveness

BARRIERS TO COMMUNICATION3. SEMANTICS these are words, figures, symbols, penmanship, interpretation of messages through signs & symbols. Symbols may have a variety of meaning and the symbol is chosen from among the many.4. INTERPRETATIONS- these are defects in communication skills of verbalizing, listening, writing, reading & telephoning.

THE AIM OF COMMUNICATION IS TO HAVE PEOPLE STOP SOMETHING THEY ARE NOW DOING, DO SOMETHING THEY ARE NOT NOW DOING, OR CHANGE THE WAY THEY ARE NOW DOING SOMETHING.

ANONYMOUS

EVALUATION

Is to recognize and further develop strengths, minimize weaknesses.It provide security for patients, personnel, agency & the community.Develop a fair employment practice and performance appraisal process that is in accordance with the law.It includes assessing & regulating performance in accordance with the plans that have been adopted, instructions issued & the principles established.

PURPOSES OF EVALUATIONProvide constructive feedbackDetermine progress and worthiness of individual nurse for greater responsibilitiesServe as basis for promotion and increase in salary or other similar rewards.

TYPES OF EVALUATIONOUTCOME OR PRODUCT EVALUATION takes note of the response of patients after nursing care is donePROCESS EVALUATION nursing actions are examined, to determine if client goals have been met or have not been met.STRUCTURE EVALUATION goal is to obtain feedback on the systems such as financial & material resources, nursing personnel, policies & procedures

METHODS OF MEASURING PERFORMANCEINFORMAL incidental Observation of performance while the worker is engaged in performing nursing care.FORMAL is accomplished regularly and methodically by collecting objective facts that can demonstrate the difference between what is expected and what is done.Essay appraiser writes a paragraph or more about the workers strengths, weakness and potentials.

Checklist compilation of all nursing performances expected of a worker.Ranking evaluator ranks the employees according to how he or she fared with co- workers with respect to certain aspects of performance or qualificationsRating scale- includes a series of items representing the different tasks or activities in the nurses job description

Forced choice comparison the evaluator is asked to choose the statement the best describes the nurse being evaluated.Anecdotal recording describes the nurses experience with a group or a person or in validating technical skills and interpersonal relationships.

CONFLICT MANAGEMENTCONFLICT is a natural, inevitable conditions & is after a prerequisite to change in people and organizations.Means a clash between two opposing and oftentimes hostile parties.

LEADERSHIPIs a social influence or a persons ability to move other people to act.Process of interaction in which the leader influences others toward goal achievement.Ability to inspire people to make a total, willing and voluntary commitment to accomplishing or exceeding organizational goals.

NURSING LEADERSHIPIs defined as the process where the nurse influences one or more persons to achieve specific goals in the provision of nursing care one or more patients.Concept of nsg. Leadership ( traits & actions)L-lead, love, learnE-enthusiastic, energeticA-assertive, achieverD-dedicated, desirousE-efficient & effectiveR-responsible, respectful

Difference between a Leader & Manager

LEADERMANAGERMay or may not have official appointment to the positionOfficially appointedVested with power and authority by the groupVested with power and authority by the organizationInfluence others toward goal settingImplements predetermined goals, policies, rules and regulationsInterested in risk taking and exploring new ideasMeasures the risks to be taken in line with the expected results, hence an orderly, controlled performance must be carried outRelates to people personallyRelates to people according to their roleFeels rewarded by personal achievementFeels rewarded when accomplishing organizational missions or goalsMay or may not be as successful as managersAre managers as long as the appointment holds

DIMENSIONS OF LEADERSHIPLEADER is the one who initiated leadership.FOLLOWER is not a passive agent in leadership. Leads herself by assuming responsibilities thus influencing her own performance.TYPES OF FOLLOWERSAlienated followers- are independent and critical yet passive in their behavior resulting in psychological and emotional distance with their leaders. They are potentially disruptive and a threat to the health of the organization.

TYPES OF FOLLOWERSSHEEP FOLLOWERS are dependent and uncritical. They simply do as they are told by the leaders.YES PEOPLE are dependent or uncritical, but very active in their behavior. Never question, challenge the leaders ideas or proposals .Most dangerous to a leader because the are most likely to give a false positive and give no warning of potential pitfalls.

TYPES OF FOLLOWERSSURVIVOR FOLLOWERS are the least disruptive and lowest- risk followers.The perpetually sample the wind.Their motto is Better safe than sorryEFFECTIVE FOLLOWERS are self leaders and do not require close supervision.They recognize that to be an effective leader, one needs good followers.Leaders cannot exist without good followers.

LEADERSHIP THEORIESI. TRAIT THEORIES- focused on leadership traitsIt assumes that a person must have certain innate abilities or personality traits in order to be a leader.1.GREAT MAN THEORY - it assumes that the capacity for leadership is inherentGreat leaders are born, not madeIn this theory, great leaders are heroic, mythic and destined to rise to leadership when needed.Ex. Abraham Lincoln, Genghis Khan, Aristotle, Kings Of Great Britain

LEADERSHIP THEORIES2.TRAIT THEORY assume that people inherit extraordinary qualities and traits that make them better suited to leadership.They believe that leaders were born; they have special traits that make them leaders like tireless ambition, zest for life, great orator skills, irresistible good looks and extremely persuasive.Ex. Pope John Paul II, Mother Theresa, Margaret Thatcher, Nelson Mandela and Gandhi

COMMON TRAITS OF LEADERSPOSITIVE TRAITS leaders with positive traits bring people to progressThey transcend their own traits to people who will become positive leaders themselvesThey are cheerful, forgiving, intelligent, good looking men and women among others.

Effective leaders build leaders while leading

COMMON TRAITS OF A LEADERNEGATIVE TRAITS leaders who have negative traits take people to destruction.They destroy rather than buildThey are not able to grow good leaders but followers who go after each otherThey are bitter, aggressive, loud-mouthed, sullen and ugly people.

TRAITS & SKILLS OF LEADERS BY STOGDILL

TRAITSSKILLSAdaptable to situationsClever ( Intelligent )Alert to social environmentConceptually skilledAmbitious and achievement- orientedCreativeAssertiveDiplomatic and tactfulCooperativeFluent in speakingDecisiveKnowledgeable about group taskDependableOrganized( administrative ability)Dominant ( desire to influence others)PersuasiveEnergetic ( high activity level)Socially skilledPersistentSelf-confidentTolerant to stressWilling to assume responsibility

TRAITS OF A LEADERS ACCORDING TO REEVES ( 2001)Emotional Stability & composureCalm, confident & predictable, particularly when under stressAdmitting errorOwning up to mistakes, rather than putter energy to covering upGood interpersonal skillsAble to communicate and persuade others without resort to negative or coercive tacticsIntellectual breadthAble to understand a wide range of areas, rather than having a narrow area of expertise

TRAITS OF LEADERS ACCORDING TO GARDNERDecisivenessTrustworthinessSelf-confidenceCapacity to motivate peopleSkill in dealing with peopleTask competence

LEADERSHIP THEORIES3. INDIVIDUAL CHARACTER THEORY traits determine whether or not a person can be an effective leader.These people have innate character that made them great leaders.Distinctive physical & psychological individual characteristics account or leadership effectivenessEx. Naturally taller, attractive, intelligent, self reliant, creativeNapoleon Complex describes an alleged type of inferiority complex affecting people

LEADERSHIP THEORIESII.BEHAVIORAL THEORIES were concerned with what leaders do and act rather than who the leader is.Actions of the leaders and not their mental qualities or traits make them leaders.Based on the belief that great leaders are made not born.People can be taught to become leaders through experience & observation

BEHAVIORAL THEORIES1. KURT LEWIN ( 1890 1947 ) a psychologist who proposed that the workers behavior is influenced by interactions between the personality, the structure of the primary work group and the socio- technical climate of the workplace.LEADERSHIP STYLESAUTHORITARIAN /AUTOCRATIC considered as classical approachShe does not consult other nurses or co-employees, nor are they allowed to give any input in decision making.Subordinates are expected to obey orders without receiving any explanations.Subordinates are motivated by rewards & punishments

KURT LEWIN THEORYAUTOCRATIC LEADERSHIP STYLE rely on threats & punishment to influence others.They do not trust employees.Can be the best style for emergency situations.2. BUREAUCRATIC LEADERSHIP STYLE it is where the nurse-leader manager manages by the book- everything must be done according to procedure or policy.- more of a police officer than a leader- she enforces the rules.

BUREAUCRATIC LEADERSHIP STYLEEFFECTIVE WHEN:Routine tasks are performedCertain standards or procedures are to be understoodEmployees are working with dangerous or delicate equipment that requires a definite set of procedures to operateSafety or security training is being conductedEmployees are performing tasks that require handling cash.

DEMOCRATIC LEADERSHIP STYLEAlso called the participative style It encourages employees to be part of the decision making.Subordinates are well informed about everything that affects their work.They share in the decision- making and problem solving responsibilities.The leader is required to be a coach who has the final say but gathers information from the staff members before making a decision.Can produce high quality and high quantity work for long periods of timeSubordinates like the trust they receive, respond with cooperation, team spirit and high morale

DEMOCRATIC LEADERS:Develops plans to help employees evaluate their own performanceAllows employees to establish goalsEncourages employees to grow on the job and be promotedRecognizes and encourages achievementShares the problem solving and decision-making to the staffEncourages team building & participation

LAISSEZ-FAIRE LEADERSHIP STYLE Also known as the hands- off styleNo establish goals or policiesAbstain from leading their staffThere is little or no direction form the leaderSubordinates has as much as freedom as possible.All authority or power is given to the employees & they must determine goals, make decisions and resolve problems on their own.Leaders wants everyone to feel good

EFFECTIVE STYLE TO USE WHEN:Employees are highly skilled, experienced & educatedEmployees have pride in their work and the drive to do it successfully on their ownOutside experts, such as staff specialists or consultants are being usedEmployees are trustworthy and experienced.

KURT LEWIN THEORYFIELD THEORY OF HUMAN BEHAVIORHe believed that people act the way they do depending on self-perceptions and their environments.He proposed that CHANGE undergoes 3 stages:First stage: UNFREEZING involved overcoming inertia and dismantling the existing mind set. Defense mechanisms have to be bypassed. Replace the previous culture learned with the new one.

CHANGE PROCESSSecond stage: CHANGE OCCURS a period of confusion and transition. Old ways are being challenged but there is no clear picture to replace them with, yet they may be ready to accept new role.Third stage: RE-FREEZING new mindset is crystallizing and ones comfort level is returning to previous levels. They have internalized new roles and can adapt to new environment & culture.

CHANGE PROCESS by Kurt Lewin

STAGECHARACTERISTICSORGANIZATIONAL IMPACTUNFREEZINGPeople in the organization made aware of problems/performance gap and need for changeThe diagnosis stage is often driven by a change agentChangingPeople experiment with new workplace behavior to deal with need changeThis intervention stage features specific training plans for managers and employeesRe- FreezingPeople employ new skills and attitudes and are rewarded by organizationChanges are institutionalized in the corporate culture.

CHRIS AGRYLISIs an organizational psychologist who sought to study the way people in organizations act and react with each otherHe studied the patterns of reasoning that explains ones behavior.Developed the concept: Ladder of Inference & Double Loop Learning

LADDER OF INFERENCEBased on the idea that individuals interpret data to make meaning and make sense of it.

SINGLE LOOP LEARNINGIs the repeated attempt at the same problem, with no variation of method & without ever questioning the goal PLANDOCHECKADJUST

DOUBLE LOOP LEARNINGSaw learning as a process of detecting & correcting errors.Focus on solving problems that are complex and ill- structured and with change as problem- solving advances. An individual, organization or entity is able, having attempted to achieve a goal on different occasions to modify the goal in the light of experience or possibly even reject the goal

DOUBLE- LOOP LEARNING

DOADJUSTTHINK AGAINCHECKPLANASSUME

ALVIN TOFFLERA futurist known for his works discussing the digital revolution, communications revolution, corporate revolution and technological singularity.Examined technology and its impact to the world and the reaction of and changes in society.He categorized changes in cultural behavior and civilization in terms of waves such as First Wave, Second Wave & Third Wave.

ALVIN TOFFLER- believed that post-industrial society and age of information and knowledge, aging societies will be using new medical technologies from self-diagnosis to instant analysis of ailments to self-administered therapies that will be delivered by nanotechnology instead of doctors and nurses.- Society needs people who take care of the elderly and who know how to be compassionate and honest. Society needs people who work in hospitals. Society needs all kinds of skills that are not just cognitive; they are emotional, they are affectional. You cannot run society on data and computers alone.

RENSIS LIKERTBest known for his development of the Likert Scales and the Linking Pin Model

LIKERT SCALELikert Scale determine level of agreement and disagreement of a respondent to a set of questions that could be objective or subjective in nature.1. Strongly agree2. Disagree3. Neither agree nor disagree4. Agree5. Strongly agree

LINKING PIN MODEL- is a concept of ideal work relationship of workers in an organization.Also, used concept of family for a desirable interaction with strong personal relations between work areas above and below management for an effective organization.Synergize efforts and competency of workers would achieve its goals and objectivesGives special attention to the impact of leaders behaviours on workers motivation and the performance of groups which led him to identify the Four Systems Approach ( 4 Main Styles of Leadership )

EXPLOITATIVE- AUTHORITATIVELeast effective performanceManagers show little confidence in staff associates and ignore their ideasStaff associate do not feel free to discuss their jobs with the managerResponsibility for organizations goal is at the top ; goals are established through orders

BENEVOLENT- AUTHORITATIVEThe manager is condescending to staff associatesStaff associates ideas are sometimes sought but they do not feel very free to discuss their jobs with the managerTop management & middle management are responsible for setting goalsDecisions are made at the top with some delegationStaff associates are occasionally consulted for problem solving

CONSULTATIVEThe manager has substantial confidence in staff associatesTheir ideas are usually sought and they feel free to discuss their work with the managerResponsibility for setting goals is fairly generalManagers are quite familiar with the problem faced by their staff associates.

PARTICIPATIVEAssociated with the most effective performanceManagers have complete confidence in their staff associatesIdeas are always soughtManagers are very well informed about the problems faced by their staff associate and decision making is well integrated throughout the organization with full involvement of staff associates.

ROBERT R. BLAKE & JANE MOUTONDeveloped the Managerial Grid Model which attempts to conceptualize management in terms of relations & leadership style.The grid consists of 2 behavioral dimensions & 5 different leadership stylesThe most effective leadership is characterized by the combination of high concern for production with high concern for people.Behaviors can be task- oriented or person- oriented, and effective or ineffective.

2 BEHAVIORAL DIMENSIONS CONCERN FOR TASK OR PRODUCTION the leader cares little about people and operates in fear of something going wrong.The leaders focus is on achieving results & productivity. CONCERN FOR PEOPLE leader cares little about productivity and operates wholly from a desire to be loved & approved of.

3 THINGS TO REMEMBERLeaders lay somewhere along the continuum of concern for productivity to concern for people.There is no one best way of leadershipDifferent styles are needed for different situations.

LEADERSHIP STYLESIMPOVERISHED STYLE ( 1,1)Leaders have low concern for both people and production. This style is used to avoid getting into trouble.Main concern is not to be held responsible for any mistakes, which results in less innovative decisionsLeader is indifferent, non- committal, resigned & apatheticLeaders just do enough to keep their jobRESULTS: disorganization, dissatisfaction, disharmony among people due to lack of effective leadership; leader tries to stay in the same post for a long time.

COUNTRY CLUB STYLE ( 1, 9)

Leader has a high concern for people and a low concern for productionLeaders who use this style pay much attention to the security and comfort of the employees with the hope that this would increase performance.Leader is attentive to his/her peoples needs and has developed satisfying relationships and work culture, but at the expense of achieving resultsLeaders is agreeable, non- confrontational, comforting, uncontroversial RESULTS: usually friendly but not necessarily that productive

PRODUCE/PERISH STYLE ( 9,1)Leaders have a high concern for production, and a low concern for peopleLeaders find employee needs unimportantThey provide their employees with money and expect performance back.They pressure their employees through rules and punishments to achieve the company goals.Leader concentrates almost exclusively on achieving results.They just view people as a commodity to be used to get the job doneConflict is resolved by suppressing it; leadership is controlling, demanding and over-powering

RESULTS: This dictatorial style is based on Theory X of Douglas McGregor and is commonly applied by companies on the edge of real or perceived failure.Used in case of crisis managementIt is costly because of the high labor turn- over.

MIDDLE OF THE ROAD STYLE( 5,5,)Leaders using this style try to balance between company goals & workers needs.They give some concern to both people & productionLeader is a compromiser who wants to maintain the status quo and avoid any problemsLeader is aware of and wants to focus on productivity but not at the expense of the morale of her team.RESULTS: leader compromises in which neither production and peoples needs are met

TEAM STYLE ( 9,9)Leader who use this style rely heavily on making employees feel as a constructive part of the organizationLeader pays high concern both to people & productionLeaders encourage teamwork and commitment among employeesLeader is characterized as open- minded, flexible and one who inspires involvementRESULTS: leaders achieves high work performance through leading his people to become dedicated to the organizational goalsThere is a high degree of participation and teamwork, which satisfies the basic need of people to be involved & committed to their work

ROBERT HOUSEPATH-GOAL THEORY leader can affect the performance, satisfaction, and motivation of a group through rewards, clarification of path to goals and removal of obstacles in work performance.

TRANSACTIONAL LEADERSHIP THEORYLeader motivates the followers by appealing to their own self- interest.Its principles are to motivate by means of the exchange process.Transactional behavior focuses on the accomplishment of tasks and good worker relationships in exchange for desirable rewards.

TRANSFORMATIONAL LEADERSHIP THEORYThe most effective and beneficial leadership behavior to achieve long term success and improved performance.A person with this leadership style is a true leader who inspires her team constantly with shared vision of the future.

SQUARING THE PROMISES AND REALITY BY DR. HAROLD J. SALAJEREMIAH 29:11 For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future.

CONFLICTIs a natural & inevitable conditions and is often a prerequisite to change in people and organizations.Levels:INTRAPERSONAL- within one individualINTERPERSONAL within two or more individualsINTRAGROUP within one groupINTERGROUP- between two or more groups

RESULTS OF CONFLICTConflict can provide greater sensitivity to an issue which can stimulate the interest & curiosity of others.Conflict can increase creativity.Conflict can help people recognize the legitimate differences within an organizationConflict can be a powerful motivator to improve performance & effectivenessDisagreements can make aware of costs vs. benefits of a particular service or technique.

TYPES OF CONFLICTCOMPETITIVE occurs when two or more groups attempt the same goals & only one group can attain themA victory for one side and a loss for the otherDISRUPTIVE takes place in an environment filled with fear & anger and stress- there is no mutually acceptable set of rules and the goal of each party is the elimination of its opponent.

CONFLICT RESOLUTIONDOMINANCE & SUPPRESSION ( win-lose strategy) method that represses rather settles conflictRESTRICTION- an autocratic , coercive style that often leads to an indirect & destructive expression of conflictSMOOTHING BEHAVIOR a more diplomatic way of suppressing conflict wherein one persuades the opponent to give in to the other side.

CONLICT RESOLUTIONAVOIDANCE BEHAVIOR creates a situation in which there are no differences.MAJORITY RULE resolves conflict by majority voteCOMPROMISE/ CONSENSUS- a method where each side agrees upon solutions that meet everyones needs

CONLICT RESOLUTIONINTEGRATIVE PROBLEM SOLVING constructive process in which the parties involved recognize that conflict exists and openly try to solve the problemA WIN-WIN STRATEGY focuses on goals & attempts to meet the needs of both partiesA LOSE-LOSE STRATEGY one which neither side wins;

CONLICT RESOLUTIONCONFRONTATION regarded as the most effective means of resolving conflict in which it is brought out in the open and attempts are made to resolve it through knowledge & reasonNEGOTIATION a technique where conflicting parties give & take on various issues

CONTROLLINGUse of formal authority to assure the achievement of goals & objectivesPerformance is measured & corrective action is taken to ensure the accomplishment of organizational goals.It involves assisting, regulating, monitoring & evaluating individual & group performance.

TYPES OF CONTROLFEEDFORWARD CONTROLS focus on operations before they begin.Goal is to prevent anticipated problems.

CONCURRENT CONTROLSApply to processes as they are happeningEnacted while work is being performed

TYPES OF CONTROLFEEDBACK CONTROLS Focus on the results of operations.RESOURCE CONTROLSTime ( deadline), materials ( inventory), equipment ( protection of the equipment), cost ( cost standards), employee performance ( absences, tardinessFINANCIAL CONTROLSFacilitate achieving the organizations profit motive

TYPES OF CONTROLOPERATIONS CONTROL Methods assess how efficiently & effectively an organizations transformation processes.NURSING ROUNDSPay particular attention to issues of patient care & nursing practiceQUALITY ASSURANCEMonitors compliance with established standardsNURSING AUDITConsists of documentation of the quality of nursing care in relation to the standards established by the nursing department

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