Leadership Management

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NURSING LEADERSHIP AND MANAGEMENT

Edited by MAHMOOD AHMED RN.BSN
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NURSING LEADERSHIP AND MANAGEMENT

YEAR THREE GENERAL NURSING
ACCORDING TO THE CURRICULUM OF PAKISTN NURSING COUNCIL
TABLE OF CONTENTS UNIT. 1: Describe leadership and management..... Definition of leadership ... Definition of management ... UNIT. 2: Describe the different types of leadership... Types of leadership.. - Autocrat...... - Democrat - Laissez-faire... UNIT. 3: Identify factors affecting leadership. Cultural-social background ... Education . Experience ... Social political and economic factors .. Societal expectations ... UNIT. 4: Describe the qualities of a leader Knowledge and skills .. Behaviour Flexibility ... Adaptability Loyalty Dependability ..... Diplomacy .. Motivation .. Communication skills .. UNIT.5: Identify decision making skills of a leader Concepts of decision making .. Communication of decisions to others UNIT. 6: Determine staff and patients needs in relation to management of the
nursing ward...
5 5 5 11 11 11 11 11 13 13 13 13 13 13 14 14 15 15 15 15 15 15 15 15
16 16 17
18 Staff needs ... 18 Level of staff motivation 18 Staff strengths and limitations . Setting priorities for patient care . - determine needs - Plan care - implement care . - Evaluation . UNIT. 7: Determine the minimum physical resources necessary to manage a ward. 24
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Identification of needs . 24 Plan distribution of work activities and assignments . 25 Staff scheduling ... 25
UNIT. 8: Compare different method of patient care, for advantages and disadvantages. Functional method of assignments .. Team nursing/Patient-centered method .. Primary nursing .. Case nursing /management. UNIT. 9: Communication . Purpose in management .. Written nursing records .. Communication between members of health care team .. UNIT. 10: Identify communication problems in management.. Communication issues . Conflict management .. UNIT.11: Discuss strategies to maintain staff. Maintain staff .. Recognition and awards .. In-service education Orientation of new workers UNIT. 12: Discuss delegation of responsibility, co-ordination, teaching, supervision and advisory skills. Delegation of responsibility Co-ordination of ward activities . Supervision of staff Advisory skills Teaching of in-service education UNIT.13: Identify components of evaluation of staff.. Purpose of evaluation .. Strategies for evaluation . Constructive feedback . Advising for improvement .. Evaluation of staff ... Patient care .. Unit management Glossary of Terms:.
27 27 27 28 29 30 30 34 34 35 35 37 37 39 39 40 41 32 42 43 44 44 46 47 47 47 47 48 48 48 48 53
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UNIT No: 1 LEDERSHIP AND MANAGEMENT

LEADERSHIP: A process of influencing the activities of either an individual or a group in an effort to achieve goals in a given situation.(Hersey, Blanched, Johnson, 2001) It is a process of affecting people so that they will strive willingly toward group goals. A leader needs to know about oneself, the job, the organization, the business, and the world.(Tomey, 2000) Leadership is the process or set of rules or activities used by a person to influence the others (individuals or groups) in an effort to achievement or certain goals in a given situation. Leadership does not involve authority in exploiting the potential of an individual. Leadership does not believe in leading but supporting the followers from behind according to situation. What is a leader? The person having the ability to influence other to achieve his goals is called a leader. Leadership functions: Planning, Initiating, controlling, supervising, supporting and maintaining informing and evaluating Functions of leadership: 1. Planning: Means of allocation of resources in the constraints of time and space to achieve an aim or objective. 2. Initializing functions: to introduce his plan to the group members. 3. Supervising and controlling: leadership has o supervise and control the performance of the group members/ subordinates workers/ employees. e.g. Inspecting work, monitoring performance, managing time well. 4. Supporting And Motivating Functions: -Such as helping, participation, listening, suggestions, encouraging and creating team spirit, motivating a group towards action, get co operation satisfying interpersonal needs. 5. Informing Functions: - The leader should ensure that the necessary information is available or easily attainable, such as new information, receiving informations from group members answering the questions. 6. Evaluating Function: Means finding out the value of some thing 7. Staffing Functions: Such as hiring The Workers, developing the job description. 8. Training & Developing Functions: Such as coaching arrangement for training. 9. Processing Paper Work Functions: such as writing letters, memos; reports, books keeping etc. 10. Disciplining and Punishing Functions: Such as enforcing rules and policies, notice letters, demotions, criticism and feed back 11. Socialism: - Such as informal joking around. 12. Interacting with out siders:-Such as contact with customers and suppliers. MANAGEMENT Definition of Management: Management comes from organizational structure; it promotes stability, order, and problem solving within the structure. A process of working with and through individuals and groups and other sources (such as equipments, capital and technology to accomplish organizational goals.(Hersey, Blanched, Johnson, 2001) The coordination and integration of resources through planning, organizing, coordinating, or directing and controlling to accomplish specific institutional goals .(Huber, 2000) Management is the process of achieving organizational goals by engaging in the four major functions of planning, organizing, leading and controlling. Means supervision of work and implementation of work is known as management. Management is a process, which help in doing the work in a proper manner.
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Management means supervision of an activity in all subjects. Management means carrying out work in planned manner and at the planned time is also known as management. Doing some work in a better manner is known as management. Management means the better Use of resources. Managements mean better utilization of resources, for problem solving. Management means management of all possible resources, to ensure proper Implementation work Management is a process of affective utilization of resources, which are carried out within a given time. Management means to organize and use the resources (people; money, and things) of an organization to achieve its goal. Management is the process of getting the work done through others properly and within budget or resources. Management is the process of achieving organizational goals by engaging in the four major functions of planning, organizing, leading and controlling. Functions of Management: Planning: the process of setting goals and deciding that how best to achieve them. Organizing: the process of allocating and arranging human and nonhuman resources so that the plans can be carried out successfully. Leading is the process of influencing others to engage in the work behaviors necessary to reach the organizational goals. Controlling: The process of regulating the organizational activities so that actual performance conforms to expected organizational standards and goals. Principle of Management 1. Objectives. 2. Learning from experience 3. Division of labour. 4. Delegation 5. Substitution of Resources. 6. convergence of work 7. Functional determine structure. 8. Management by exception. Resources of management 1. Man Power/ People Resources. 2. Money Resources. 3. Time Resources. 4. Equipments Resources. 5. Drug Resources. 6. Paper Work Resources. 7. Space Resources. FACTORS AFFECTIG ON MAMNAGEMENT 1. Institutional structure 2. Institutional objectives. 3. Task factor. 4. environmental factor 5. social factor 6. People factor.
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Manager An individual employed by an organization, responsible and accountable for efficiently accomplishing the goals of the organization. Administration is a direction to a group in various activities. Human resources Realization of goals
Input Physical and technical resources
Output
SYSTEMS VIEW OF MANAGEMENT Nursing Management The coordination and integration of nursing resources by applying the management process to accomplish nursing care and service goals and objectives.(Huber, 2000) All managers perform 5 functions: Planning Organizing Staffing Leading Controlling Development of Management Thought Theorist Theory Year of Publication Taylor Scientific management 1911 Weber Bureaucratic organizations 1922 Fayol Management functions 1925 Gulick Activities of management 1937 Follett Participative management 1926 Mayo Hawthrone effect 1927 McGregor Theory X and Theory Y 1960 Argyris Employee participation 1964 (Source: Marquis & Huston, 2000)
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DIFFERENCE BETWEEN LEADERSHIP AND MANAGEMENT LEADERSHIP Leadership is an interpersonal relationship in which the leader employees specific behaviors and strategies to influence the individuals and groups towards setting goals and attaining them in specific situation MANAGEMENT Management refers to coordination and integration of resources through planning, organizing, controlling and directing to accomplish specific organizational goals and objectives.
DIFFERENCE BETWEEN LEADER AND MANAGER 1 2 LEADER Leaders do not have delegated authority but obtain their power through influence. Have wider roles than the managers MANAGER Managers have an assigned position in a formal organization.
Have a legitimate source of power due to delegated authority that accompanies their position 3 Leaders are not the part of formal Are necessarily the members of a formal organizations organization. 4 Focus on group process, gathering Emphasize control .decision, decision information, feed back and analysis and results. empowering others. 5 Emphasize interpersonal relationship Manipulate the individuals, the environment, money, time and other resources to achieve organizational goals. 6 Direct willing workers. Direct willing and unwilling subordinates 7 No formal responsibility for Have a greater responsibility for rationality rationality and control and control than leaders in the organization. 8 People follow leaders on voluntary People follow managers due to their basis requirements. Comparison of Leadership and Management Leadership Management Motto Do the right things Do things right Challenge Change Continuity Focus Purpose Structure and procedures Time frame Future Present Methods Strategies Schedule Questions Why Who, what, where & how Outcomes Journeys Destination Human Potential Performance (Tomey, 2000) Managers are people who do things right, and leaders are people who do the right thing. ~ Warren Bennis and Burt Nanus
THEORIES OF LEADERSHIP:
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DEFINITION OF THEORY: A theory is a set of ideas that explain the nature or behavior of some thing. A theory is based on facts or observable and potential behaviors. 1. GREAT MAN THEORY: Great man theorist explained leadership on the basis of inheritance. They believe that leaders are born not made. They born in Instrumental and supportive leadership behaviors. Instrumental behavior includes Planning, organizing and controlling activities of followers specially obtaining and allocating resources as people equipment, funds, space and material. Supportive leadership behavior includes social orientation and permit participation and consultation from followers for decisions that effect then beside these qualities. According to great man theory there are other qualities as Intelligent Courageous Self controlled and Decisive These qualities can be polished to some extent by experience and supervision. 2. TRAIT THEORY: Trait theory does not totally agree with the perception that all qualities a leader possessed are in born. This believes the qualities can be taught and learned also yet they say these must be some traits i.e. Physical traits (height, appearance + Weight). Personal traits (Skills, wisdom, judgment, intelligence etc). Social traits (Tact, patience, trust, status and ability to participate).
Some of the leadership traits are Adaptable Ambitious Amusing Brave Brilliant Clever Competent Cooperative Decisive Diplomatic Enthusiastic Fair Fluent Friendly Health Humorous Industrious Loyal Sincere Reliable
3. SITUATIONAL THEORY. Situation theories propose that traits for leadership vary with the situation because the kind of leadership needed , depends upon the situation. A person may be a leader in one situation and a follower in another. The theory says leadership is the process of influencing the group in a particular situation. 4. FIEDLERS CONTINGENCY THEORY 1967: Fiedler (1967) says leader behavior is dependent on three variables: a. Task Structure (simple, easy to solve, clear). b. Positions power (of the leader in a situation). c. Leaders / Members relation. If the leaders behavior with subordinate is cordial and he possesses power or a position on a particular situation and the work is easy and the leader is most effective.
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5. HERSEY AND BLANCHARED SITUATIONAL THEORY: Heresy and Blanchard consider leaders behavior to be adjusted according to situation using the following three variables: a. Maturity of subordinates (The individual skills and confidence). b. Situation. c. Style of leadership: According to the Heresy and Blanchard a leader within a given situation adopts an agreeable style of leadership keeping in view the Maturity of subordinates. 6. PATH GOAL THEORY: The leaders are the persons who motivate the subordinates and determine the goals and then smooth the path way to achieve those goals playing through following variables: a. Situation. b. Motivation of the follower. c. Leadership style. In other words the leader enhances task accomplishment by minimizing obstructions and encouraging subordinates motivation by offering followers through rewards for completing their task. (Mariner Tomay 1992) 7. CHARISMATIC THEORY. This theory says a charismatic leader is usually confident and has a sense of purpose and possesses the ability to articulate the objectives and ideas for which the followers have already psychologically prepared. The charismatic leader arouses strong feeling of loyally and enthusiasm by inspiring and obtaining emotional commitment from follower. Charismatic theorist links leadership to the personal character and quality which induce others to follow him. Quaid-e-Azam is a good example of charismatic leader. 8. TRANSFORMATIONAL LEADERSHIP THEORY. Burns defines transformational leadership as a process in which both the leader and followers raise one another to higher levels of motivation and morality. The leader strives to elevate the consciousness of followers by applying to higher ideas and moral values such as humanitarianism, equality justice and peace.
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TYPES OF LEADERSHIP:
UNIT NO.02
There are different types of leadership on the basis of: A. Styles of leadership B. Personal characteristics of leader. C. Formality
A . STYLES OF LEADERSHIP :
DEFINITION: Style refers to the approach or manner a leader uses to influence workers behavior in various situations the following are the common styles of leadership. 1. AUTOCRATIC STYLE: This is also known as authoritative or directive style. An autocratic leader tends to be task oriented. Also known as directive or authoritarian style. An authoritative leader emphasis is on the task as compared to people who perform the work (Task oriented). He believes himself to be supreme and expects others to obey him. He keeps the power of decision to himself and does not allow anyone to share his authority. He thinks the workers are our all creative. Until very brilliant not effective because of not sharing and accommodating others view. Because of lack of trust and confidence over the subordinates, it leads into frustration and dissatisfaction among subordinates. 2. DEMOCRATIC STYLE. .This is called also participative or consultative style. A democratic leader is people oriented focusing on human relation teamwork. A democratic leader is people oriented and thinks human relation, team work and developing effective work group as prime importance. He does not hold authority but share, it with workers and all the people feel a bond their contribution towards achievement of organizational goals. This is an ideal state emphasizing on providing a congenial environment, job satisfaction and increased productivity. However, when the subordinates lacks in interaction with superiors, it may not give very good result. It also some time cause frustration if workers are not consulted even for petty matters. 3. LAISSEZ FAIRE STYLE. (FREE REIN STYLE) .In this style the leader does not have an established policy and do not hold responsibility or involve deliberately rather expects subordinates to plan, initiate and coordinate their activities. There is not central control and permits freedom to its subordinate. The style is good where the group members are motivated and highly skilled however it is ineffective in a health care set up with different profession. It is a looser system of control and may lead to a conflictive situation and anarchy. 4. BURACRATIC STYLE. The bureaucratic style refers to the business or job according to the already out lined policy. He is not creative and tends to work on the policy guide lines. He shows no flexibility. Lacks to decide unless a standard procedure is available. 5. MODIFYING STYLE. The style of a leader in which he is neither so rigid like an autocrats or bureaucrat nor as flexible as a democratic leader. He plans and implements things suitable to him. Unlike autocrat or bureaucratic leader he communicates with staff
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listens and asks about their ideas once he meets the staff he implements things as he had already planned. 6. PARENTAL STYLE. The leaders who are never harsh to followers and is least bothered about discipline. He exercises loose control and staff obedience and rewarded. The style is useful till such time when there a problem arises and when the problem arises the leader goes ineffective. 7. MULTICRATIC LEADERSHIP. A leader who does not believe in any particular style of leadership he values a blend of style flexible enough to influence people to achieve a specified goal.
B . LEADERSHIP TYPES BASED ON PERSONAL CHARACTERISTICS:

1. TRAINED LEADERSHIP. The leader can be prepared by training him for a job e.g. the nurse are trained before appointing her as ward sister. 2. EMERGENT LEADERSHIP. A person who is not trained for a particular job but emerges from with in the group his personal ability in a particular situation. 3. CHARACTERISTIC LEADERSHIP. A person with personal special characters, attracts people and inspire them to follow him.
C . TYPES OF LEADERSHIP BASED ON FORMALITY

1. FORMAL LEADERSHIP. An officially designated leader to a position i.e. Matron, Head Nurse etc. 2. INFORMAL LEADERSHIP. When a team leader is officially designated as a group leader i.e. the nurses of the hospital mutually selects a staff nurse to present their problem to the administration. This is called an informal leadership.
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UNIT NO: 3 FACTORS AFFECTING LEADERSHIP:

Factors affecting leadership can be broadly divided into two groups. A. Personal Factors. B. Environmental Factor. A . Personal Factors.Personal factors include: 1. . Age. Age plays a vital role in shaping leadership. 2. Sex. The leadership is also influence by gender. In some aspect of leadership males are more effective which in some fields females are more influential. 3. Heredity. Certain hereditary factors play a determining role in leadership. 4. Education. Education is the very important factor. It polishes the minds and gives understanding and power of judgment and rationality. An educated person has also a different approach and flexible attitude to solution of problems. An education person is able to handle people tactfully and can tackle a hard situation in a brilliant manner. An illiterate person has always a blunt crude approach with out any flexibility. He is unable to export and take full work from individuals potentials. 5. SOCIO - ECONOMIC FACTOR. Sound economic background results concentration of mind thus makes good decision. The leader does not indulge in malpractice and unfair means. An economically sound mind can easier deal with a critical and complicated situation. 6. An economical unsound and worried person lives in a tense state and can not handle a difficult situation. 7. SOCIO - CULTURAL FACTOR. The family and cultural background of a leader who belongs to a political minded family can prove to be a very successful leader against of an oppressed and suppressed leadership, in a stable and democratic environment a leader freely exercising his will. B . .ENVIRONMENTAL FACTORS. 1. SOCIAL FACTORS: A society consists of customs, traditions, laws, superstitions, religions, norms and values. A leader can not isolate him from the society. Therefore all the social factors of society affect him. A person may be a leader who should belong to the same type of the society whose traditions, religion, culture, norms and values and customs are same and acceptable to the leader and he does not have different view from the society. 2. POLITICAL FACTORS: Political factors also affect the quality of leadership. The people will not be able to exercise their free will in a politically unstable country, but in politically stable country the quality of leadership will be different. People will be opening minded and will think in a positive way. And in a democratic society the people can express their views freely in front of society. 3. EXPECTATION OF SOCIETY. The leader is guided by the expectation of society in exercising and practicing leadership. The society expects that a leader commits no mistakes and is expected to perform wonders. In case he fails to meet the society expectations, he is rejected. The leader some time knows a better solution but hesitates and restricts to decide if the society differs to his opinion.
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UNIT NO: 4
QUALITIES OF LEADERS:
A good leader possesses and displays certain skills and qualities. These can broadly be divided in three groups. 1. 2. 3. Task related skills. Team related skills. Personal qualities. TASK RELATED SKILLS (QUALITIES): 1. 2. 3. 4. 5. The leader should be trained and proficient in his job. Takes initiatives and sets clear objectives. He is capable of making good and timely decision. He should be persistent in his work. He should not depend on conventional methods but be able for creative changes. TEAM RELATED SKILLS: 1. 2. 3. 4. 5. 6. 7. 8. 9. A leader should treat the subordinate as human and share their feeling of joy and sorrow. He should be able to protect the interests of his followers. He should be flexible in making and while dealing with subordinate. He should himself be motivated and able to motivate others. He should be able to coordinate, delegate and integrate the workers. He should be impartial. He should encourage self criticism so that one can learn from mistakes. He should also keep his words. He should be social and develop personal contacts. PERSONAL QUALITIES OF LEADER. Following is the list of certain personal qualities of a leader: Adaptable Aggressive Ambitious Amusing Brave Healthy Organized Cooperative Industrious Self reliant Entertaining Enthusiastic Fair Frank Fluent Open minded Competent Intelligent Reliable Devoted Kind Loyal Mature Neat Noble Clever Imaginative Persistent Diplomatic Just Sympathetic Tactful Versatile Well informed Brilliant Humorous Original Decisive Insightful Sincere
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Besides these a leader should be having these qualities: Advocacy Conflict Resolution Tolerance of Uncertainty Persuasiveness: The ability to sell your idea initiate. Tolerance of Freedom: Freedom to subordinates and patience and tolerance on their mistakes. Consideration: Providing comfort and well being to subordinates. Predictive Accuracy: Ability of anticipating possible integration bringing people together consideration of superiors.
SOME OTHER SPECIAL QUALITIES OF A LEADER:

1. ADAPTABILITY. A leader should be static but must have the quality of monocrability and shall be adaptable to the new situation on environment. 2. FLEXIBILITY. Flexibility and clear thinking during crises are critical characters of todays leader. 3. LOYALTY. personality. Loyalty to the group and profession is another milestone in the leader
4. DEPENDABILITY:A leader is dependable by the followers, someone can trust his words and promises and can be realized by his followers. 5. DIPLOMACY.(well orientation to current situations) A leader plans, listens to group and has the fun of appealing his sentiments to communicate his view point effectively in his own interests in front of others. 6. MOTIVATION. A leader is capable of creating an environment and giving an understanding to his followers to behave in a desired direction 7. COMMUNICATION SKILL. A leader has always a good communication skills and able to integrate his group through effective communication.
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UNIT NO: 5 DECISION MAKING

DECISION MAKING. The process of establishing criteria, by which alternative courses of action are developed and selected. It means settlement, conclusion or passing of judgment. The Decision-Making Process Managers are constantly called upon to make decisions in order to solve problems. Decision making and problem solving are ongoing processes of evaluating situations or problems, considering alternatives, making choices, and following them up with the necessary actions. Sometimes the decision-making process is extremely short, and mental reflection is essentially instantaneous. In other situations, the process can drag on for weeks or even months. The entire decision-making process is dependent upon the right information being available to the right people at the right times. The decision-making process involves the following steps: 1. Define the problem. 2. Identify limiting factors. 3. Develop potential alternatives. 4. Analyze the alternatives. 5. Select the best alternative. 6. Implement the decision. 7. Establish a control and evaluation system. Define the problem The decision-making process begins when a manager identifies the real problem. The accurate definition of the problem affects all the steps that follow; if the problem is inaccurately defined, every step in the decision making process will be based on an incorrect starting point. One way that a manager can help determines the true problem in a situation is by identifying the problem separately from its symptoms. Identify limiting factors All managers want to make the best decisions. To do so, managers need to have the ideal resources information, time, personnel, equipment, and supplies and identify any limiting factors. Realistically, managers operate in an environment that normally doesnt provide ideal resources. For example, they may lack the proper budget or may not have the most accurate information or any extra time. So, they must choose to satisfice to make the best decision possible with the information, resources, and time available. Develop potential alternatives Time pressures frequently cause a manager to move forward after considering only the first or most obvious answers. However, successful problem solving requires thorough examination of the challenge, and a quick answer may not result in a permanent solution. Thus, a manager should think through and investigate several alternative solutions to a single problem before making a quick decision. One of the best known methods for developing alternatives is through brainstorming, where a group works together to generate ideas and alternative solutions. The assumption behind brainstorming is that the group dynamic stimulates thinking one persons ideas, no matter how outrageous, can generate ideas from the others in the group. Ideally, this spawning of ideas is contagious, and before long, lots of suggestions and ideas flow. Brainstorming usually requires 30 minutes to an hour.
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Analyze the alternatives The purpose of this step is to decide the relative merits of each idea. Managers must identify the advantages and disadvantages of each alternative solution before making a final decision. Evaluating the alternatives can be done in numerous ways. Here are a few possibilities: _ Determine the pros and cons of each alternative. _ Perform a cost-benefit analysis for each alternative. _ Weight each factor important in the decision, ranking each alternative relative to its ability to meet each factor, and then multiply by a probability factor to provide a final value for each alternative. Regardless of the method used, a manager needs to evaluate each alternative in terms of its _ Feasibility Can it be done? _ Effectiveness How well does it resolve the problem situation? _ Consequences What will be its costs (financial and non financial) to the organization? Select the best alternative After a manager has analyzed all the alternatives, she must decide on the best one. The best alternative is the one that produces the most advantages and the fewest serious disadvantages. Sometimes, the selection process can be fairly straightforward, such as the alternative with the most pros and fewest cons. Other times, the optimal solution is a combination of several alternatives. Sometimes, though, the best alternative may not be obvious. Thats when a manager must decide which alternative is the most feasible and effective, coupled with which carries the lowest costs to the organization. Probability estimates, where analysis of each alternatives chances of success takes place, often come into play at this point in the decision-making process. In those cases, a manager simply selects the alternative with the highest probability of success. Implement the decision Managers are paid to make decisions, but they are also paid to get results from these decisions. Positive results must follow decisions. Everyone involved with the decision must know his or her role in ensuring a successful outcome. To make certain that employees understand their roles, managers must thoughtfully devise programs, procedures, rules, or policies to help aid them in the problem-solving process. Establish a control and evaluation system Ongoing actions need to be monitored. An evaluation system should provide feedback on how well the decision is being implemented, what the results are, and what adjustments are necessary to get the results that were intended when the solution was chosen. In order for a manager to evaluate his decision, he needs to gather information to determine its effectiveness. Was the original problem resolved? If not, is he closer to the desired situation than he was at the beginning of the decision-making process? If a managers plan hasnt resolved the problem, he needs to figure out what went wrong. A manager may accomplish this by asking the following questions: _ was the wrong alternative selected? If so, one of the other alternatives generated in the decision-making process may be a wiser choice. _ was the correct alternative selected, but implemented improperly? If so, a manager should focus attention solely on the implementation step to ensure that the chosen alternative is implemented successfully.
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_ was the original problem identified incorrectly? If so, the decision-making process needs to begin again, starting with a revised identification step. _ has the implemented alternative been given enough time to be successful? If not, a manager should give the process more time and re-evaluate at a later date. COMMUNICATION OF DECISION. Whenever a matter is resolved it should be made public and communicated to the subordinates.
DECISION MAKING IN NURSING:

Decision making is a critical thinking process for choosing the best actions to meet a desired goal. CONDITIONS FOR DECISION MAKING: 1. FREEDOM. Means the individual who makes decision must be free from any pressure. 2. RATIONALITY. Means the optimal decision is made and that it is consistent with the decision makers values and preferences. 3. VOLUNTARILY. It makes a choice voluntarily. STEPS OF DECISION MAKING: 1. Identify the purpose:The nurse identifies why a decision is needed and what needs to be determined. 2. Set the Criteria:In setting criteria three questions must be answered. a. What needs to be achieved. (Reflect of pain) b. What needs to be preserved. (Physical, cognitive, psychological functions comfort, central nervous system) c. What needs to be avoided, central nervous system, depression, nausea? 3. Weigh the criteria. The decision makers sets priorities or rank activities or services in order of importance from least important to most important as they relate to specific situation an activity may be important in one situation and of less importance in another situation. 4. Seek alternatives. The decision maker identifies all possible ways to the criterion. In clinical situation the alternatives may be selected from a range of Nursing interventions or client care strategies. 5. Test alternatives. The nurse analysis the alternatives to ensure that there is no objective rationale in relation to the established criteria for choosing one strategy over the other. 6. Trouble shoot. In trouble shoot the nurse tries to determine what might go wrong as a result of a decision and develops plans to prevent, maximize, or overcome any problem. 7. Evaluate the action. In evaluating the strategies used, the nurse determine how effective they were and whether they achieved the initial purpose.
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METHODS OF MAKING DECISION:

There are five methods of decision making. 1. OWN DECISION WITH OUT DETAILED EXPLANATION. Decision is made without prior discussion and consultation and no special meetings or memorandum is used to explain decision. 2. OWN DECISION WITH DETAILED EXPLANATION. Same as above but later on manager explains the problem and the reason for choice a memo or in a special meeting. 3. PRIOR CONSULTATION WITH SUBORDINATES. Before the decision is made, the manager explains the problem to his subordinates and asks their advice and help, the manager then makes the decision by himself. His final choice may or may not reflect subordinates influence. 4. JOINT DECISION MAKING WITH SUBORDINATES. Managers and their subordinates together analyze the problem and come to decision. Subordinates have much influence over the final choice of the managers. 5. DELEGATION OF DECISION TO SUBORDINATE. A manager asks his subordinates to make the decision regarding a particular problem. He may or may not request the subordinates to report the decision to him. The managers seldom veto the subordinates decision.
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UNIT NO. 6 STAFF NEEDS

For proper and right performance of a unit, the ward manager or a Head nurse should know that: 1. Every member of the staff must be given a job description on one hand. A staff member is expected to fulfill certain responsibilities. This is necessary that every staff member be given his specific job clearly. 2. If a staff member is expected to fulfil his responsibility. He/ She should be provided favorable condition, suitable accommodation and necessary equipments by the ward sister. 3. Every staff member should be provided with necessary help and guidance. 4. The staff members should be trusted upon him /her to work without any close supervision of the ward sister. 5. Staff in general and un-experienced staff in particular be appreciated for their performance by the ward nurse.
LEVELS OF STAFF
Different level of staff is employed in a ward which performs duties under the supervision of a Head nurse or ward manager: 1. STAFF NURSE: a. Who plans access, implement and evaluate the needs of patient. b. She also organizes, directs, supervises, teaches and evaluates other team member. c. Coordination of other staff. 2. CLINICAL NURSE: A Nurse specialist in a particular field i.e. Emergency, OT. ICU etc. Because of special knowledge she knows more than staff nurse thus can identify patients needs and therefore select better intervention. STUDENT NURSES. Need to be allocated work to gain practical experience. However, they are working under supervision of seniors. This becomes the responsibility of ward sister to allocate assignment to each of the above category of staff maintaining the treatment and case at a required standard. esides the above there is a Night Staff also which directly do not fall under the supervision of ward sister. However, the ward sister should have a clear liaison with night supervision and coordinates with night staff in regard to use and replacement of resources required for patients during day or night. This includes proper management of equipment and drugs.
PATIENTS NEEDS
The key figure in meeting patients need is ward sister, various patients needs are: 1. Proper assessment of his condition, disease or disability and finding that extend his illness. 2. Proper treatment in accordance with assessment is another requirement. 3. Good attitude and behavior needs to be extended to patients. Good behavior of the staff ensures earliest recovery of the patient. 4. Preparing patients mentally for joining the family and community. 5. A patient needs privacy for himself and his visitors which visit him. 6. Provision of maximum comfort and rest. Note: The fulfillment of patients needs revolve around the ward nurse which is supposed to fulfill that needs through the joint efforts of the broad team.
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MOTIVATION OF STAFF
This is the responsibility of ward Nurse to satisfy and motivate her ward team through her role i.e.: 1. She should provide free and tension free environment to her team members and other hospital staff. 2. She tries to extend her fullest cooperation not only to Nursing staff but to all those who are involved with patient case. 3. To motivate staff she should practice fair and indiscriminative behavior with every staff member. 4. She should also assign the jobs to the staff seeing their potentials, skills and aptitude. She gives every one to excel his knowledge. 5. She must have to observe patience on minor mistakes and to delegate authority and responsibility to her juniors. 6. Loyalty from staff is respected by their leader and the staff feels pride to work under such seniors. 7. The junior staff should be motivated and encouraged to make their future. Managers/leaders and motivation Getting the best from people, achieving results through individuals and teams, maintaining consistent high performance, inspiring oneself and others into action, these all depend on the skills of motivation. Self-motivation can be as difficult as motivating others and you cannot have one without the other. Rules in motivating people 1. Be motivated yourself 2. Select people who are highly motivated 3. Treat each person as an individual 4. Set realistic and challenging targets 5. Remember that progress motivates 6. Create a motivating environment 7. Provide fair rewards 8. Give recognition MOTIVATING ENVIRONMENTS IN NURSING: Workers expectations are clear Managers are fair & consistent Managers are firm decision makers Concept of teamwork is developed Staff needs & wants are integrated with organizations Each employee is seen as a unique individual by the manager No traditional blocks between the employee & work to be done Work experiences are challenging or stretch employees Participative decision making used if appropriate Recognition & credit are given whenever possible Supervisor functions as role model Employees understand decisions & actions Desirable behavior is rewarded Employees allowed to exercise individual judgment Trust & helping relationship between management & staff
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Employees have as much control as possible over work environment The six motivating factors that lead to job satisfaction were identified by Herzberg as being: 1. Achievement o Specific successes, such as the successful completion of a job, solutions to problems, vindication and seeing the results of your work 2. Recognition o Any act of recognition, whether notice or praise (separating recognition and reward from recognition with no reward) 3. Possibility of growth o Changes in job where professional growth potential is increased 4. Advancement o Changes which enhance position or status at work 5. Responsibility o being given real responsibility, matched with necessary authority to discharge it 6. The work itself o The actual doing of the job or phases of it. Herzbergs Motivation hygiene theory In Herzbergs research (published in his 1959 book The Motivation to Work), fourteen factors were identified to be the sources of good or bad feelings: 1. Recognition 2. Achievement 3. Possibility of growth 4. Advancement 5. Salary 6. Interpersonal relations 7. Supervision technical 8. Responsibility 9. Company policy and administration 10. Working conditions 11. Work itself 12. Factors in personal life 13. Status 14. Job security
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UNITNO.7
IDENTIFICATION OF NEEDS Hospitals exist to meet the patients' needs for treatment and rehabilitation .Ward is a place where the patient is retained for hospitalization and to provide every comfort to the patient needed for his recovery. The basic needs of a patient who is hospitalized are as follows: 1. An accurate assessment of the patients condition. Disease or disability 2. An appropriate and effective action should 3. providing the maximum degree of comfort and happiness for the patient 4. prepare the patient for his return to the community HUMAN RESOURCES: THE PERSONS INVOLVED IN PATIENT CARE The ward manager or a Head Nurse should know about the persons working in the wards for taking care of the patients. 1. The ward team: Staff nurses, Students, Nursing assistants, Aid nurses and sanitary workers 2. Administration: Director/Medical superintendent, Deputy Director, Nursing superintendent, Assistant Nursing superintendent 3. Doctors: Consultants, Registrars, Medical officers and House Offices 4. Nursing staff: Clinical instructors, Evening and Night supervisors and Staff nurses 5. Paramedical staff Staff of pharmacy, Laboratory, Operation Theater, technicians, X-Ray and physiotherapy. 6. The supporting staff: Staff of Maintenance department, central supply, Store keepers, Kitchen staff, Laundry staff, records room, Security guards and sanitary inspector 7. Other people: Patients' attendants, different social welfare agencies personnel, Family doctors, Home nurses and Health visitors.
MINIMUM PHYSICAL RESOURCES NECESSARY TO MANAGE WARD

The resources available in wards are as follow: 1. SPACE AVAILABLE & BEDS ARRANGEMENT:
a. Beds be arranged in the way that there are easily being seen from the nursing station and they should be easily approachable by the staff.
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b. c.
They should be distantly spread in the ward to avoid cross infection. The Beds should provide maximum privacy to patients.
2.
LOCATION OF BATHROOM & TOILETS: These should be nearer and accessible to patients, beds and there should be no any obstruction in approaching by patient. The path should be well lighted to avoid any fall of patients or accidents. It must also have plenty of water supplies. KITCHENS: Kitchens should also be near to patients beds. These should always be kept clean and free from wastes and insects. However, noise and activities in kitchen should not be disturbing for patients. WARD CORRIDORS & VERANDAS: These should be spacious and open to facilitate and maintain easy access of stores, supplies and equipments to ward easily. LIGHTING & VENTILATION: The wards design should be such to have maximum natural light and should also have cross ventilation. In case natural ventilation is not available mechanical ventilation i.e. AC, exhaust fans etc is also provided. Every bed and patients needs a special dim light over the bed so as not to disturb other patients and which can be used by patients himself and can also be used by nursing staff conveniently. The light illumination at night may be sufficient to carry out nursing care activities but not disturbing for patient. WALLS & FLOORS: These should be good looking because it helps in early recovery of patient. These should be cleaned all the time. There should be not dropped of water and dirt on the floor to avoid filling and accidents by patients. They should be clean, moped and preferably without carpet etc as these lead to the growth of infection. The floor should be made such that it could be easily cleaned.
3.
4. 5.
6.
7.
ISOLATION UNITS / CUBICLES. Although the concepts of cubicles has almost ceased because isolation wards / hospitals are almost separate from general wards. However, a ward must have a short detectable part as cubicles for isolation cases. PATIENT,S ATTENDANCE AT BED SIDE. Although the patients need to be attended by the staff very promptly. However, the provision of call bells system facilitates the patient to call the staff when needed. TREATMENT ROOM IN WARD. A room with necessary equipment, cupboards and medication shall be made available to patients and it must be able to accommodate a bed for patient comfort etc. The room must have sufficient light, electric points for electronic equipment and it should be kept clean.
8.
9.
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10.
WAITING & VISITING ROOM. A ward shall have a waiting room for patients which accomplices attractively decorated and furnished with suitable furniture. It may also accommodate the relatives of seriously ill patient.
7.2
PLANNING AND ORGANIZATION OF WORK ACTIVITIES IN WARD

There are few guiding principles for ward sister to organize work: 1. The work should be purposeful and beneficial for patients and again should provide opportunity of learning for students nurses. 2. It should be planned and performed according to approved standards. 3. The equipment necessary should be made available and easily accessible. 4. The skills of the staff should be appropriately. 5. Every work should be performed on time. 6. The work should be planned in a right place. As provision of treatment in a treatment room instead of open ward minimizes chances of infection. 7. While deploying staff on different days and time, the workload may be taken in account. 8. The flow of work should be logically sequenced. 9. The normal activities of a particular ward should be carried as a routine which may differ from ward to ward set by the ward sister.
RESOURCES SHOULD BE MATCHING WITH DEMANDS

The resources of the ward should match the demands. These resources should be in terms of number of staff available, their respective experience, competence and time available.
7.3 STAFF SCHEDULING:

1. Staff in the hospital is always short so the skill and time available from staff should not be wasted. 2. Skilled nurses should appropriately be used. 3. Skilled labour shall not be wasted for the works which other people can do. 4. The staff should be on duty in accordance of the need. 5. The largest number of staff shall be available on busy day or busy time of the day. 6. Equality and justification in assigning jobs be exercised. 7. The duty roster should be maintained to facilitate off duty to every employee.
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UNIT NO. 08
MODES OF ORGANIZING PATIENT CARE: Nursing staff is allocated to provide nursing care in hospitals setting in various forms depending on the number of patients ,health care environment , policies and the needs of the patients. Five primary means of organizing nursing care delivery are 1. Total patient care 2. Functional nursing 3. Team and modular nursing 4. Primary nursing 5. Case management (Burns,1998). 1. Total Patient Care Most oldest mode of patient care Total responsibility of patient care 19th Century Nursing House Cleaning, Washing clothes Much like contemporary private duty ( Nelson, 2000). Total Patient Care Nursing Structure Charge Nurse
Nursing staff
Nursing staff
Nursing staff
Patient
Patient
Patient
Advantages Patient receives holistic care High autonomy and responsibility Disadvantages Inadequately trained or prepared to provide total care Unlicensed Nurses Little opportunity for supervision resulting unsafe care Total Patient Care Structure 2. Functional Nursing Evolved in world war II Unskilled workers were trained Nurses are Assigned certain task tasks to save time Examples of functional nursing task are checking blood pressure, administrating medication, changing linens, and bathing patients. RNs are managers of care rather than direct care provider. (Nelson, 2000, p.156)
Leadership and Management
Functional Nursing organization Structure Charge Nurse
RN Medication nurse
RN Treatment nurse
Clerical /House keeping
Patient Functional Nursing Advantages Economical Tasks completed on time Few RNs are required Nurses are free for more complex task Disadvantages Quality of care is compromised Low job satisfaction Fragmented Care Examples: Operating room and long term facilities 4. Team Nursing
In 1953, Eleanor Lambertson and her colleagues proposed a system of team nursing Developed to decrease the problems associated with the functional organization of patient care RN as team leader Team consists of RN, LPNs and aides not more the five persons. RN assesses, plans, and evaluates care and delegates tasks according to the skill needed to perform them.
Team Nursing Organization Structure Charge Nurse
Team leader
Team leader
Team leader
Nursing staff
Nursing staff
Nursing staff
Patient
Patient
Patient
Team Nursing
Advantages Team shares accountability and responsibility collectively Democratic Leadership Use knowledge about each member skills Disadvantages Time is required for planning Errors, Fragmented care 4. Primary nursing Primary nursing is developed in 1970s. It is a method of nursing practice which emphasizes continuity of care by having one nurse (often teamed with a nursing assistant provides complete care for a small group of patients in a nursing unit of a hospital. The "primary nurse" is responsible for coordinating all aspects of care for the same group of patients throughout their stay in a given area. Primary Nursing Structure PHYSICIAN CHARGE NURSE PRIMARY NURSE HOSPITAL RESOURCE
PATIENT /CLIENT
ASSOCIATE NURSE (EVENING)
ASSOCIATE NURSE (NIGHT)
ASSOCIATE NURSE (AS NEEDED DAYS)
Primary Nursing Advantages Job satisfaction is high Challenged and rewarded Responsibility and Autonomy Disadvantages Incompetent Primary Nurse Expensive Not cost-effective to have RNs doing non-nursing tasks
5. Case Management: case nursing was a traditional pattern of giving care. Case management now is latest and advanced work design proposed to meet patient needs. Case management can be defined as a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options and services to meet an individuals health needs through communication and available resources to promote quality, cost-effective outcomes. (Glettler & Leen,1996). Case Management Blends team and primary care. RN is case manager (often is a MSN) Tends to utilize critical pathways as the basis for the care plan RNs on all three shifts make sure the plan is carried out Utilizes the team approach with nurse extenders Case Management Advantages Tries to free RN from doing non-nursing functions Seems to produce improved patient and nurse satisfaction Encourages the nurses for a patient-centered approach. Disadvantages Requires a lot of coordination across all disciplines Requires the organizational structure to increase nursings accountability. Summary Total patient care, utilizing the case method of assignment, is the oldest form of patient care organization and is till widely used today Functional nursing organization requires the completion of task by different nursing personnel Team nursing organization uses a leader who coordinates team members in the care of group patients. In the primary nursing a nurse is responsible for coordinating all aspects of care for the same group of patients throughout their stay in a given area. Case management is collaborative process that assesses plans, implements, coordinates, monitors and evaluates options and services to meet an individuals health need through communication and available resources to promote quality, cost effective outcomes.
UNIT NO . 09
Communication
Communication is the flow of information and ideas (message) from one person or organization (sender) to another person or organization (receiver) Interchange of information between two or more people. Exchange of ideas, feelings, attitude and thoughts. Process of transmission and reception of message. Process of sending and receiving messages by means of the symbols, words, signs, gestures or other actions. What does Communication Do? Transmission of feeling or a more personal and social interaction between people. Express the feelings to fulfill the desired needs. Achieve and satisfies the objectives. Reduce extra burden to clarify the goals. How to communicate? Talking Listening Writing Reading Painting Dancing Story telling Gestures or body actions. Purposes / The Significance of Communication in the Management Process Organizations are totally reliant on communication. Communication is the heart of all organizations. Without communication, organizations would not function. If it is diminished or hampered, the entire organization suffers. When communication is thorough, accurate, and timely, the organization tends to be vibrant and effective. Communication is central to the entire management process for four primary reasons: Communication is a linking process of management. Communication is the way managers conduct the managerial functions of planning, organizing, staffing, directing, and controlling. Communication is the primary means by which people obtain and exchange information. Decisions are often dependent upon the quality and quantity of the information received. If the information on which a decision is based is poor or incomplete, the decision will often be incorrect. The most time-consuming activity a manager engages in is communication. Managers spend between 70 to 90 percent of their time communicating with employees and other internal and external customers. Information and communication represent power in organizations. An employee cannot do anything constructive in a work unit unless he or she knows what is to be done, when the task is to be accomplished, and who else is involved. The staff members who have this information become centers of power. BENEFITS OF COMMUNICATION Builds confidence Gives job satisfaction Decrease absenteeism Eliminates grievances Essence of promotion Develops reputation of organization
PRINCIPLES OF COMMUNICATION
Communication is a two-way process of giving and receiving information through any number of channels. Whether one is speaking informally to a colleague, addressing a conference or meeting, writing a newsletter article or formal report, the following basic principles apply: Know your audience. Know your purpose. Know your topic. Anticipate objections. Present a rounded picture. Achieve credibility with your audience. Follow through on what you say. Communicate a little at a time. Present information in several ways. Develop a practical, useful way to get feedback. Use multiple communication techniques. Principles of Communication in nursing: 1. Information giving in not communication. (Receiver providing feed back to sender) 2. Responsibility for clarity resides with the sender. (Nurse Manager makes message to staff clearly) 3. Simple and exact language should be used. 4. Feedback should be encouraged. (Message has been accurately interpreted is to obtain feedback) 5. The Sender must have credibility. (Effecting on the desired outcome) 6. Acknowledgement of others is essential; 7. Direct channels of communication are best. Because; Immediate feed back Reduce the chances of misunderstanding Read the body language and facial expression. Conclude the discussion. COMMUNICATION PROCESS SIMPLE MODEL
SENDER MESSAGE RECEIVER
SOPHISTICATED/ COMPLEX MODEL

Sender (Ideas) Message s (Encode s) Transmissio ns (Signals) Recipien t (Decode s) Receiver
(Meaning
Feedbac k
Basic Elements/Components of communication Sender - originator of the message Message - information transmitted; may have both latent and manifest content. Receiver recipient of the message. Feedback receiver's response to the message, indicating understanding.
For successful communication, the nurse must be available to listen to the client. Steps of Communication process o Thinking (ideas or feeling within) o Encoding (convert by words, symbols) o Transmitting (Channels) o Perceiving ( uses of senses) o Decoding ( received understandable from) o Feed back (essential for received message) o Action ( action taken as a result)
1. 2.
Channels of Communication: Medium through the message is transmitted: Almost Visual, auditory and kinesthetic uses. ( Neurolinguistic Programming NLP ) Audio-visual media: Direct verbal instruction, speeches, meetings, conferences, workshop, transparencies, slides, audio and video and Mass media like radio, TV, Cinema, theaters etc. Interactive media: Telephone, intercom, Internet, public address system, closed circuit television, and letter correspondence etc. Print or written media: Fax, e-mail, letters, memos, reports, instructional manuals, bulletin board items, news letters and mass media, news papers, magazines, books, booklets, journals, brochures, pamphlets, leaflets, handbills, banners, postures, billboards etc. Organizational communication: 1. Formal Communication; Organized and planned communication in the form of meetings, forum or health education sessions. 2. Informal Communication: Un planned communication e.g. people meet in daily life. Direction /Flow of Organizational communication: Vertical Communication: in Vertical communication, the messages flow in a downward or an upward direction. a message exchange between two or more levels of the organizational hierarchy. Downward communication (When messages are sent from higher authorities to the lower levels of management and subordinates). Upward communication (When messages are sent from lower levels of management or subordinates to the higher level of management or authorities) Horizontal Communication: It is lateral or diagonal message exchange either within work unit boundaries, involving peers who report to the same supervisor, or across work-unit boundaries, involving individuals who report in different supervisors. (Among people with similar status, as nurse to nurse) Diagonal Communication: (Different level of organizational chart to make plan i.e. discharge and admission plan) TYPES OF COMMUNICATION Two traditional modes of Communication: Verbal and Non verbal communication: Verbal : Speaking words to convey message, this is conscious process. Non verbal; Appearance of facial expression, postures, gait, body movements, position, gestures, and touch, eye contact, Actions speak louder than words ANGER, WEAPING
This process is unconscious and difficult to control. 3. Electronic Communication: Persons interact through technology rather than traditional communication. Using the Varity of technologies including telephone, voice mail and e-mail Factors influencing communication process: Ability of the communicator Perceptions Personal space Territoriality Role relationship and purposes Time and place setting Attitudes Emotion and self- esteem Objectives and content of the message. Needs, culture and language Attitude of sender and receiver Understanding of receiver Time and setting Relationship between sender and receiver Status of receiver and sender Difference in age, sex etc. Feedback Barriers to Effective Communication Distrust, Threat & Fear Close Minds Emotions Distractions Information Overload Favourable or unfavourable information Difference in Perception
Other barriers that tend to hinder or disrupt effective communication include: Wrong timing Divergent backgrounds of the participants Differences in education, formal and informal Differences in interest in the message Differences in IQ Differences in language levels and usage Lack of mutual respect among participants Difference in such factors as age, sex, race, class and culture Mental and/or physical stress at time of communication Environmental conditions at time of communication Little or no chance for feedback or interaction Little or nor experiential overlap few, if any, common experiences Lack of skill on part of communicator (poor writer or speaker) Lack of skill on part of communicatee (poor reader or listener) Lack of information in message (empty message) Lack of commitment in message or in policy behind it
Inadequate preparation or insufficient knowledge of the subject Group political differences (protocol, etc.) Overpowering attitude of communicator Differences in language levels between source and audience Physical disabilities (speech, hearing, etc.) Inappropriate use of channel.
Functions of Communication Information Education Motivation Persuasion Counseling Rising morals Health development Health development Organization Enhance productivity Conflict resolution Written nursing records In nursing the records of different departments are kept in various forms Written nursing records such as registers of Daily attendance of staff Records of all staff members biographical data Leave and absent record Records of letters issued from higher management In wards the records are kept in registers of patients admission discharge and death registers Daily, weekly or monthly indents of drugs and other utilities Patients care plans (nursing care plans) Daily attendance of staff of ward Now a day the records are also kept in computerized network which is easily approachable to all departments of the hospital. Communication between health members: Health workers communicate through different sources such as Letters from higher management Circulars Internal telephone communication Daily, weekly or monthly meetings Seminars, symposium and different teaching learning sessions
UNIT. NO. 10
Issues / Obstacles in Facilitating Communication: Health professionals who do not listen to what their clients are saying: Avoid underlying feelings; Remain on a more cognitive than affective level; Who tell their clients what to do, or tend to moralize and be judgmental, are communicating on an ineffective level. Let's look at the following ineffective communication techniques or obstacles. Stereotypical Comments
These comments are non-therapeutic and include cliches' and other trite expressions that are virtually meaningless. Problems can also occur when clients have concrete thinking, because many stereotypical comments rely on abstract understanding. These comments are often culture-specific and therefore will make no sense to people with different cultural backgrounds. Example: Professional: "How are you today?" Client: "Bad today. I wish I were dead." Professional: "Every dark cloud has a silver lining." "Everybody has had bad days." Changing the Topic Sometimes the professional feels uncomfortable with a topic and doesn't really know how to handle it; she then changes the topic to one that is not relevant to the client at that particular time. Clients may feel that what they are saying is not important. This puts the professional in charge of what is being discussed and the client will feel "I'm not being listened to." Belittling Expressed Feelings When the professional minimizes the feelings that the client expresses, it gives the message that they are being ignored and that their problems are of little/no significance. Failure to Listen Failure to really listen what the client is saying, can be most devastating to the development of trust in the therapeutic relationship. Failure to listen gives the client a message of "I'm bored", "You're not of value", and so forth. The professional must be constantly aware of placing the needs of the client above their own. Probing/Prying This occurs when the professional fails to respect the client's decision to be private (at that point and time) about feelings and thoughts. Prying is another manifestation of this and can occur when the professional attempts to uncover material irrelevant to the client's main and important message, which he is not ready to reveal. Prying can be destructive to the therapeutic relationship as the client feels he cannot trust the nurse. The only real purpose prying has is to satisfy the need for control and power and most probably, gratification of their own needs. Parroting Parroting differs from paraphrasing where you use similar words to give back to the client. Parroting is the repetition of the client' words and phrases in an attempt to reflect or paraphrase parroting is the extreme of these techniques, and non-therapeutic. Clients also do not progress in understanding and communication will come to an end. Parroting is then in actual fact telling the client: "I'm not listening to you ..." False Reassurance These statements often reassure the professional more than the client, especially if the professional is uncertain of how to manage the situation. Reassurance negates fears and feelings of clients and acts as if you know better than they do. Advice Giving This is not giving factual information where the client can use it and make a decision. Advice giving takes away the client's power to make decisions and gives them an inferior status. Telling the client what to do, results in the client feeling alone and powerless.
Being Judgmental/Moralizing These statements actually tell the client that they should do as you do, or think. The statements are directive and the professional is using approving or disapproving statements to promote more dependency than independency in the relationship. These types of statements negate the self-worth of the client. The message given is that of You need me, without me you cannot help yourself." Imposing Values This technique demands that clients' share your values and prejudices. This is moralizing and the professional often doesnt try and understand the values of the client. Making Assumptions
Another obstacle is the making of assumptions based on own frame of reference. To avoid making assumptions about what is said, the professional must seek clarification on the communicated message. Everything that is communicated has a particular significance for each individual in a particular setting at a certain point in time. Double/Multiple Questions These are definite obstacles in communication, as they tend to confuse clients. They don't know which question to answer first and really feel as though they are being cross-examined. Disagreeing Disagreeing at any point in time denies your client the right to think and feel as they do and to express it. They feel as though they are only allowed to verbalize what will be acceptable to the professional and this will provide no opportunity for client self-growth. Defending By defending, the client is prevented to express opinions and feelings. Often the professional can feel threatened by the client's comments. Defending statements deliver the message "you do not have the right to complain or express an opinion." Absence of Channels Sometimes professional-client interactions demand special skills on the part of the professional. There may be a lack of common language, the patient may be apathetic, sensory impaired or non-communicative. Although interpreters can be utilized to overcome this barrier, the importance of non-verbal communication is highlighted by this barrier. Data-collection is still severely limited by the lack of a common language. Improve your communication skills o You must be in social contact with the other person or people o You must want to communicate o It is better to risk familiarity than be condemned to remoteness o The best way to empower others is to impart information (along with the delegated authority to make decisions and act on the information given) o Get out of your office meet, listen, provide information and give people the context in which they operate to communicate and encourage o Good communication is the core of customer care o Remember customers (and suppliers) communicate with others about you o To communicate with your customers you must handle complaints (as an organisation) as personally as possible by a meeting or phone call in preference to letter or fax; you must listen to what customers suggest and communicate product/service changes/developments with them in advance o Presentation skills are important in communicating with colleagues as well as customers/clients o Meetings, internal and external are key indicators of a persons communication (including listening) skills o Communication is a business requirement: establish proper systems and ensure all use them o Remember the equation: size + geographical distance = communication problems o Communicate with poor performers to improve their contribution and in appraisals be truthful, helpful and tactful o Help others to improve their communication skills o Assess your own communication skills and strive to improve them bit by bit. (Also, assess the communication skills of colleagues and identify areas for improvement).
Conflict
o "Conflict is a clash between hostile or opposing parties". Conflicts occur everyday in a wide variety of situations ranging from emotional disputes between two colleagues to disputes between departments about lines of authority to legal disputes involving several organizations.
SOURCES OF CONFLICT Conflict may develop from a number of antecedent's sources, including the following: 1. Incompatible goals 2. Distributions of resources when individual have high expectations of rewards. 3. Regulations when an individual's need for autonomy conflicts with another's needs for regulating mechanisms. 4. Personality traits, attitudes and behaviors. 5. Interest in outcomes. 6. Values. 7. Roles when two individuals have equal responsibilities but actual boundaries are unclear or when they are required to simultaneously fulfil two or more roles that present inconsistent or contradictory expectations. 8. Tasks, when outputs of one individual or group, become inputs of one individual or group, or outputs are shared by several individuals or groups. TYPES OF CONFLICT: Karen john devised a typology that includes three types of conflict. 1. Task content conflict 2. Emotional conflict 3. Administrative conflict Task content conflict: The first type refers to disagreements about the actual task being .performed by organizational members. The focus in this type of conflict is on differing opinions pertaining to the task, rather than the goals of the people involved. Emotional conflict: Emotional conflict is an awareness of interpersonal incompatibilities among those working together on a task. It involves negative emotions and dislike of the other people involved in the conflict.
Administrative conflict: As defined as awareness by the involved parties that there are controversies about how task accomplishment will proceed. Disagreements about individual responsibilities and duties are examples of administrative conflict. Conflict isnt always negative; conflict is inevitable, natural, and even healthy whenever people work together. Conflict can be an effective means for everyone to grow, learn, and become more productive and satisfied in the workplace. What is unhealthy, however, is unresolved conflict that is allowed to fester and become a hindrance to a productive team. Common causes of conflict include employee competition; differences in objectives, values, or perceptions; disagreements about roles, work activities, or individual styles; and breakdowns in communication. As a result, conflict management is a big part of managing individuals or teams. To manage conflict, a manager must analyze the conflict situation to determine the cause and severity, and then develop a strategy for action. Strategy options include the following: _ Avoidancewithdrawing from or ignoring conflict. _ Smoothingplaying down differences to ease conflict.
_ Compromisegiving up something to gain something. _ Collaborationmutual problem solving. _ Confrontationfor verbalization of disagreements. _ Appeal to team objectiveshighlighting the mutual need to reach a higher goal. _ Third-party interventionasking an objective third party to mediate. Remember that conflict should be looked upon as an opportunity. When conflict is identified early, managers can prevent small issues from escalating into major, long-term wars in the workplace.
UNIT. NO. 11
MAINTAIN STAFF A ward incharge should know about the management of ward. To continue constant working environment in a ward the staff should be managed in a proper arranged schedule. Ward incharge should be capable of assessing the personal qualities and potentials of each individual and be aware of the basic functions and responsibilities of each member. The off-duty should be so planned that trained staff is available at all the times The planning, organizing, maintaining discipline, implementing and evaluating nursing care by assessing the needs of different patients are the basic responsibilities of the ward incharge. Some points should be remembered Maintain all the staff according to requirement such as number of patients and ward functions. More persons during the time of rush of patients such as OPD time and day care surgeries etc. Intensive care units need more staff and general wards need less staff. Skilled staff should be assisted with unskilled or new staff and students Assign tasks to the staff members according to their job description All staff should show their recognition through uniform, hospital card and a badge with clear name and designation.
Doctors should wear gown and female nurses should wear white uniform with an over coat and male nurses wear white paint shirt or shalwar qameez (as PNC rules) or wear uniform according to hospital policy and paramedical staff wear recognized uniform. All the incidents happened by the staff should be immediately reported to the Head nurse or ward manager at first. If the problem is serious, it should be reported to the higher authorities for further management and action. ADVISORY SKILLS Always use proper and respectable words for any staff member. Call to staff with name and designation to seniors and lower staff only with name. Always assign duties according to the job descriptions. Assign important procedures and tasks to the skilled staff. Advice unskilled staff to observe the procedures initially and then allow them to do these procedures in the presence of a skilled person and if they perform well and satisfactory then allow them to do it by themselves. Do not speak slang language in any situation for any one. Give advice in privacy on specific issues and some issues may be discussed without pointing out a person if the issues / matters are related to the patient health. Report only the issues to the higher authorities that you can not resolve. Do not blame your seniors and institute for any type of issue in front of the patients or unconcerned persons. Never shout or call loudly to any person in the ward in front of patients or any other unconcerned person. Always be justice and avoid favouritism of any member Appreciate to members on their good performance. Recognition and awards REWARDS AND PUNISHMENT Awarding is a process of appreciation and motivation of workers. it enhances the motivation to their working and increases productivity. There are many forms of awarding staff members on their good performance or any special task completion. Appreciation letters Shields Best performance award / best achievement award Promotion to the senior post which increases pay and allowances; increase income. Some institutes allow their employees for further higher studies in services Leave with full pay on completion of a year without any remarkable incidence. A bonus after a year. PUNISHMENT: Punishment is usually applied after the individual has engaged in an undesirable behavior in an organization. It may be necessary under sonic circumstances, particularly if the undesirable behavior has a serious impact on the organization or endangers others. Factors of punishment Absenteeism Leaving station without informing senior responsible person Misbehave or misconduct with any staff member Mishandling of ward equipments or utilities Patients life threatening practice Involving in any illegal or immoral activities Reporting .Evaluation of the matter Conduct inquiry Issuance of office orders and explanations If found faulty
Issuance of memorandum Letters of pay and allowances deduction Show cause notice Suspending from service Termination from service
STAFF DEVELOPMENT
Although one might have acquired basic knowledge to day a work, yet he might have not been able to perform the job. To assist these newly employed people in learning specific skills to perform that job is called staff development. Staff development includes the following steps: 1. ASSESSMENT. Learning needs skills, ability and knowledge are assessed. 2. PLANNING. Finding resources, marking needs and methods. 3. IMPLEMENTATION: a. Learners. b. Educators. c. Material. d. Methods. 4. EVALUATION: a. Cost effective. b. Achievement. c. Transfer of learning. IN SERVICE EDUCATION / STAFF DEVELOPMENT: It is a continuing liberal education "of the whole person to develop his potential fully. It deals with aesthetic senses, as well as technical and professional education, and may include orientation preceptorship, mentorship skills, checklists, internships, in-service education, courses, conferences, seminars, journal or book clubs, programmed learning and independent study and refresher courses. For development of staff, education is provided to improve their knowledge and ability to perform job related skills which is also called In Service Education. Much of the development job is done by education department but we concentrate on the job instruction technique. Staff development can be divided into Internal (on the unit) and external (off the unit). 1. INTERNAL SOURCE. Includes on job instruction, work shops for the unit Nurses and in service education programme. 2. EXTERNAL SOURCE. Includes formal workshops presented by department of Education and all other educational activities done outside the hospital including college courses conferences and continuing education work shop. 3. ON JOB INSTRUCTIONS: Includes assigning new employees to experienced nurses, Preceptors or Nurse Manager. The learners are expected to learn the job by observing the experienced employee and by performing an actual task under supervisor. It is cost effective and learners learn and also provide some necessary Nursing service. It reduces the possible expenses on external resources (professional educators). 4. AUDIO- VIDEO TECHNIQUE. Increased size of health case institutions, rapid technological advances and number of people requiring instruction needs audio/ video techniques as film, closed circuit T.V, audio tapes ,video tapes recording, computer assigned instruction and
interactive video interactions. These save much of teacher time. Viewers are told in advance and what they will see. Follow up discussion is important. ORIENTATION OF NEW WORKERS: Orientation is a familiarization with the adaptation to an environment. This reduces the anxiety of the employee into a new environment. It can be done by personnel department employees for all new employees. It includes a history of the organization, the vision, purpose, and structure, working hours, holiday time, vacation, sick time, pay days, performance standards and evaluation, labor contracts, grievance procedures, parking facilities, eating facilities, health services and education opportunities. Orientation is important and the manager introduces the nurse to the new job, agency policies, facilities and coworkers. Communicating regulations and exactly what it expected of the nurse diminishes uncertainty, relieves anxiety, and prevents unnecessary misunderstandings. This can be done through a preceptor also. Preceptor provides a mean to orientation and socialization. Preceptor performs roles for the new comers, stands as a teacher, resource person, councilor, role model and evaluator.
UNIT NO. 12 DELEGATION OF RESPONSIBILITY

DEFINITION. The process by which responsibility and authority for performing tasks is assigned to individual. It involves assigning tasks, determining expected results and granting authority to the individuals to accomplish these tasks. PURPOSES OF DELEGATION: 1. To achieve results through the efforts of others. 2. To evaluate team members abilities and performances by delegating both task and authority. 3. Delegation enables superiors to perform some other jobs. STAGES IN DELEGATION PROCESS. 1. 2. 3. 4. 5. There are five steps in delegation process. Analyzing the delegates job as to decide what could be delegated. Analyzing weakness to decide as to what job could be delegated to him. Determine the specific tasks to subordinates to be delegated. Delegating appropriate tasks to subordinates. Providing feed back to subordinate and following up to see if the task has been accomplished.
DELEGATORS ROLE: 1. Exercise control broadly.
2. 3. 4. 5.
Let others make mistakes one learn from mistakes. Allow the delegate to exercise authority. Establish and agree upon the results and standards of performance for delegated duties. Encourage ideas give staff members the opportunity to discuss their ideas.
RESPONSIBILITIES OF DELEGATE: 1. Take initiative: Revise methods for achieving goals. 2. Relate to the manager: Plan the task and progress and share the problems are with delegators. 3. Accept the delegation realistically. 4. Set a feed back system: To keep the manager informed. 5. Carry out the task.
BARRIERS TO EFFECTIVE DELEGATION

The manager who delegates must know about the possible obstacles, which can be broadly categorized as organizational, employees and supervisor related barrier. 1. ORGANIZATIONAL BARRIERS: a. Structural barriers: Organizational charts may reflect job titles and reporting channels but they do not reflect the degree of delegation. b. A non descriptive job description may be lengthy or short but ambiguous job description hinder effective delegation. 2. FUNCTIONAL BARRIERS. Organization history makes the delegate apprehensive if a. Such delegation resulted in failure. b. Delegation without proper authority hinders delegation. c. Any confusion in job may also result confusion in delegation. 3. EMPLOYEES RELATED BARRIER: a. Fear of failure and lack of self confidence may lead to reluctance by employee to accept responsibility. b. Lack of Guidance: If the superiors or delegators do not provide guidance. c. Responsibility: Some employees avoid accepting any more responsibility. 4. SUPERIORS RELATED OBSTACLES: a. Lack of knowledge. Inadequate organizational skills. b. Insecurity. c. Fear. d. Desire for personal recognition. e. Inadequate or insufficient role model. HOW TO DELEGATE: 1. Prepare: Assess your strength, limitations and feeling about power, leadership authority and delegating. Also work the willingness of subordinates.
2. 3. 4. 5. 6.
Plan the delegated task, the standards for its achievement, required monitoring activity and resources needed. Select the task: Identify the activity or task to be delegated. Selected the person. Communicate and clarify any difficulty and misunderstanding. Assign and monitor. Evaluate.
COORDINATION OF WARD ACTIVITIES:

Coordination of ward activities is a crucial management function performed by ward Head nurse. The incharge nurse uses available resources both human and others coordinate to meet the objectives. Coordination activities include orientation of new staff, ongoing staff development, composing, staffing, schedules and providing technical direction. This also includes strategies for reducing absenteeism etc. The coordination activities also include monitoring of the patients, for the quality of care provided, staff members who deliver the care and the administration that provides the structure and policies for delivering the care. In such a setting the staff becomes motivated becomes creative and contributes to the organization. In short we define coordination, interlinking the multiple activities in a way that any thing which needs to be done, is done correctly and timely and that there is clear cut division of work without any overlapping the responsibilities of two workers etc. SUPERVISION OF STAFF: Supervision is the process of directing and supporting staff so that they may perform their duties effectively. Supervision provides leadership, guidance, support, training and assistance in the identification and solution of problems so that service quality may continually improve. Clinical Supervision is an exchange between practicing professionals and students to enable the development of professional skills. Coordination of Basic work activities according to plans and procedures to ensure that all works have been done is called supervision. Supervision also includes provision of guidance and training to staff to make them competent in their professional work. CLINICAL SUPERVISOR Clinical Supervisor is a very experienced person, who acts as a role model for the students in a carefully planned system of learning. Foci of Clinical Supervision Monitoring Teaching Ethical knowledge and behavior Clinical competence Personal functioning Attention to client welfare The Supervisors Roles (Skill development) The supervisor as a teacher, mentor, role model, trainer/instructor: Evaluates clinical interactions Identifies and reinforces effective actions Teaches and demonstrates counselling techniques Explains the rationale for strategies and interventions
Interprets significant events Positive Supervisory Traits Competence Fairness Diligence Caution Recognition and respect for power differential Supervisor as Professional Parent Socialization Professional etiquette Wisdom Experience Supervisory Feedback Timeliness Thoughtful presentation Adequacy Strengths and weaknesses Documentation Oral/written Acknowledgement of receipt by trainee Advisory skills/ Points to Remember The person being evaluated is under considerable personal stress Treat all with fairness and dignity Allow due process and discussion Clarify in advance Outcome goals Evaluation criteria Time lines Penalties/adverse consequences What Do Trainees Want? Expertise Trustworthiness Assistance with personal growth Teaching technical skills Communication of expectations Timely feedback What Frustrates Trainees Ambiguity in responsibilities and roles Lack of feedback Some Principles of Supervision All care staff should have a nominated supervisor, whose name should be entered in their personal development file. Staff should be given a say as to who their supervisor will be. All care and nursing staff should have at least one formal supervision session of at least one hour duration every two months.
Some Principles of Supervision Supervision time should be planned, protected and uninterrupted. Sessions should be held in private and should be entirely confidential. Supervision time should be taken while on duty, but at a time that is convenient to other staff on duty and to service users There should be agreement between supervisor and supervisee about how they will conduct their supervision sessions. Some interrelations with Supervision Communication systems Quality control Grievance and disciplinary processes Process and style of management Whats Important? To the staff member ongoing support, instruction & improvement To the Patient the likelihood of receiving a better service
Tangible Benefits of Supervision Improved service to clients Higher practitioner job satisfaction Less burnout Decreased staff turnover Lower administration costs New skills learnt Improved staff communication Improved client outcomes? Needs research Characteristics of Successful Supervisors The Super-Supervisor will be: Ethical. Well-informed. Knowledgeable in his / her theoretical orientation Clinically skilled. Articulate Empathic Gentle Accepting Challenging Characteristics of Successful Supervisors Stimulating Provocative Reassuring Encouraging Possess a good sense of humour A good sense of timing Be innovative Solid
Exciting Laid back but not all at the same time. Maslow 1986 Summary Clinical Supervision is a tool to be used for specifying, planning and organizing work. It can be helpful for individualized, supervision clinical setting is important. Nursing standard for each health agency developed by nurses representing all heretical levels. So it develops professional competency and confidence for student nurses while fulfilling their academic requirements and in health services it influence in future action.
TEACHING OF IN SERVICE EDUCATION

An education program is designed to upgrade the knowledge or skills of an employee for example an employer might offer an in-service program to inform nurses about a new piece of equipment. Due to dynamic nature and influx of new theories and technologies introducing in nursing services, it is necessary for ward nurses and senior staff leaders to facilitate the subordinate learners, learning by allocating sometime during the duty hours to teach the juniors the necessary skills to ensure their professional growth. Teaching and learning while serving is called in service education.
CHAPTER. 13 EVALUATION
DEFINITION. Evaluation is derived from the Latin term that means to VALUE Evaluation involves judgments or placing a value on something. In brief evaluation is a process for judging the value of an action. Evaluation is the 5th important function of management and nursing process. Why we evaluate: To improve programme To justify staff and Budget allocations Keeping in view the Improvement noted. PURPOSES OF EVALUATION: 1. To know our performance, weaknesses and to improve it. 2. To know whether our performance is goal directed. 3. To know how for our Nursing intervention is effective. 4. In health care setting evaluation makes nurses accountable for their actions. STRATEGIES FOR EVALUATION 1. PERFORMANCE APPRAISAL. Also known as staff performance evaluation. This is formal evaluation of employees behavior which allows staff member to discus employees behavior and revise strategies to modify it to the desired behavior. 2. QUALITY ASSURANCE. Health care organization are accountable for delivering best possible care for which Quality assurance programs are developed to monitor and evaluate the Quality appropriateness of patient care provided by Nursing Service to Patients. 3. UTILIZATION REVIEW. Utilization review programs focus on how will each resource is used in medical and nursing facilities.
4. RISK MANAGEMENT. Evaluation in organization is also used to constantly review their facilities to decrease the organization risk for mis-hap incidents or accidents. CONSTRUCTIVE FEED BACK: The purpose of evaluation of an employee is to correct his undesired behavior to desired one. Giving feed back to employee must be positive and constructive. Feed back is guided by four rules: 1. RIGHT PURPOSE:Should convene on improvement of performance, efficiency, motivation and feed back that finds faults, criticizes no positive result. 2. RIGHT TIME: Give positive comment immediately and save negative comments until you can communicate privately. Give positive feed back publicly and reserve negative feed back. Dont describe as what is wrong but emphasize what to do to improve. 3. TREAT WITH RESPECT. Give feed back with respect, fosters a more accepting attitude and positive response. 4. PLAN FOR GROWTH. Feed back should include at least one suggestion to encourage growth. Growth of an employee increases when communicating spirit is established. Advising for improvement: Managers often do poor jobs of providing employees with performance feedback. When providing feedback, managers should do the following: o Focus on specific behaviors rather than making general statements o Keep feedback impersonal and goal-oriented o Offer feedback as soon after the action as possible o Ask questions to ensure understanding of the feedback o Direct negative feedback toward behavior that the recipient can control EVALUATION OF STAFF: Nurses are engaged in multidimensional activities to rate on these activities. An appraisal devise is developed which analyses following components: 1. TRAITS / PERSONAL CHARACTER. Normally appraisal system focuses on ability and stability to handle stress. A Nurse Manager assigns subordinates on the bases of initiative, job knowledge and ability to work with others. 2. RESULTS. Some organizations base their appraisal on result which is an ideal system. 3. BEHAVIORAL CRITERIA. In recent years health care institutions have adopted behavior oriented performance appraisal system which focuses on what actually an employee does. 4. MIXED CRITERIA.Nursing service believes in providing best care has therefore developed a mixed typed appraisal system. The employees are evaluated keeping in view the traits result and behavior separately developing a mixed type of criteria. EVALUATION OF PATIENT CARE: Evaluation of the effectiveness of a care plan is an essential step in professional Nursing. Evaluation patient care plan is divided into: 1. EVALUATION OF NURSING PROCESS. This is also called audit of nursing care. Nursing process evaluation, step by step analysis of decision made for each phase in the nursing model a set of standard have to be developed to create evaluation tools for each phase of the Nursing process. Model evaluation includes evaluation of the following: a. The accuracy of Patient assessment. b. The logic of selected diagnosis. c. The fitness of the goal selected.
d. e.
The adequacy of therapy planning. The skills demonstrated in applying therapy.
2. EVALUATION OF PATIENT OUTCOME. In group data patient out come needs to be evaluated at various stages of the recovery process. Some illnesses or conditions present clearly defined stages, where as some diseases recovery phases may not clear. Evaluation is made against an already set standard. Cross sectional and longitudinal studies are carried out for adequate evaluation out come. - unit management: In unit management a Head nurse or a ward manager should evaluate that. all the people are working properly Punctuality of time and discipline Patient care is being provided with standard quality. Workers are satisfied with job and performance. Frequently ask about their suggestions for changes to improve quality care.
LEVELS OF MANAGEMENT IN NURSING Two leaders may serve as managers within the same company but have very different titles and purposes. Large organizations, in particular, may break down management into different levels because so many more people need to be managed. Typical management levels fall into the following categories: Top level: Managers at this level ensure that major performance objectives are established and accomplished. Common job titles for top managers include chief Nursing superintendent (CNS), Nursing superintendent (NS), Principal. These senior managers are considered executives, responsible for the performance of an organization as a whole or for one of its significant parts. Middle level: Middle managers report to top managers and are in charge of relatively large departments or divisions consisting of several hospitals; nurse managers and Head Nurses. Middle managers develop and implement action plans consistent with hospital objectives, such as increasing staff performance and improve nursing care. Low level: The initial management job that most people attain is typically a firstline management position, such as a team leader or supervisor a person in charge of smaller work units composed of hands-on workers. Job titles for these first-line managers vary greatly, but include such designations as department head, group leader, and unit leader. First-line managers ensure that their work teams or units meet performance objectives, such as a charge nurse is responsible o control the work in a unit through his or her subordinates. SKILLS NEEDED BY MANAGERS Certain skills, or abilities to translate knowledge into action that results in desired performance, are required to help other employees become more productive for all types of managers.. These skills fall under the following categories: Technical: This skill requires the ability to use a special proficiency or expertise to perform particular tasks. Top level Managers possess technical skills. Managers acquire these skills initially through formal education and then further develop them through training and job experience. Technical skills are most important at lower levels of management. Human: This skill demonstrates the ability to work well in cooperation with others. Human skills emerge in the workplace as a spirit of trust, enthusiasm, and genuine involvement in interpersonal relationships. A manager with good human skills has a high degree of self-awareness and a capacity to understand or empathize with the feelings of others. Some managers are naturally born with great human skills, while others improve their skills through classes or experience. No matter how human skills are acquired, theyre critical for all managers because of the highly interpersonal nature of managerial work. Conceptual: This skill calls for the ability to think analytically. Analytical skills enable managers to break down problems into smaller parts, to see the relations among the parts, and to recognize the implications of any one problem for others. As managers assume ever higher responsibilities in organizations, they must deal with more ambiguous problems that have long-term consequences. Again, managers may acquire these skills initially through formal education and then further develop them by training and job experience. The higher the management level, the more important conceptual skills become. Although all three categories contain skills essential for managers, their relative importance tends to vary by level of managerial responsibility. Business and management educators are increasingly interested in helping people acquire technical, human, and conceptual skills, and develop specific competencies, or specialized skills, which contribute to high performance in a management job.
Following are some of the other skills and personal characteristics of managers. Leadership ability to influence others to perform tasks Self-objectivity ability to evaluate yourself realistically Analytic thinking ability to interpret and explain patterns in information Behavioral flexibility: ability to modify personal behavior to react objectively rather than subjectively to accomplish organizational goals. Oral communication ability to express ideas clearly in words Written communication ability to express ideas clearly in writing Personal impact ability to create a good impression and instill confidence Resistance to stress ability to perform under stressful conditions Tolerance for uncertainty ability to perform in ambiguous
MORALE Definition: Moral is composite of feelings, attitudes and sentiments that contribute to the general Feelings of satisfaction Moral is involved in every thing that makes a job satisfying (such as: with his job, Workers Boss, organization and environment). Moral is psychological phenomenon closely rela1ed to leadership and group functioning. Moral cannot be judged directly. Types of morals: High Morals: Moral is high when the people are fully satisfied A person is satisfied with his work, if he is successful. Low Morale: moral is low when the people are not satisfied with their jobs. Measurement of morale: Morale surveys: theses are conducted through the questionnaires. Some moral indicators such as absenteeism, quality record, medical record, waste of resources, grievances. Factors Affecting on morale: Persona Factors: - Such as of structure of organs nature of work, working conditions, compensation. worker group, supervision Organizational factors: such as intelligence, physical health, social structure etc. Way of building the Morale Proper style of leadership: such as Autocratic, democratic, etc according to the situation. Participating in the decision making: Participating in the decision making will increase the high Morale. Avoid Monotony Of Work: - Monotony in work can be overcome by transferring people from one job to another hob after a reasonable, period of time. Working with informal Leader: - To build Morale by working with informal leader. working conditions: - working conditions should be provided good to build the Moral. Opportunities: opportunities must be provided for the progress as promotion or raise in salary to build moral.
THINKING
DEFINITION. Thinking means to use the mind in an active way to form connected ideas. A cognitive process of solving problems and decision making based on rearranging of acquired knowledge gathered in mind. It involves varieties of process i.e. Perceiving, concept formation, reasoning remembering, producing and understanding language. Decision making, problem solving and creativity.
INFORMATION PRESENTATION. According to Allan Paivio information is in two separate but interacting system of a real of pictures and concrete items and abstract ideas, spoken and written words. LEVEL OF THINKING: 1. CONSCIOUS LEVEL. The level of mind engaged with current and present awareness. 2. FORE CONSCIOUS LEVEL. A level of mind where the ideas are stored and which can be recalled easily. 3. UNCONSCIOUS LEVEL. The level of mind where the ideas and events are completely forgotten and are able to be recalled. However, it provides bases and influences our current behavior. THINKING TYPES: Thinking a broadly divided into two types: 1. CONVERGENT THINKING. The ability of selecting and converging a correct solution from the different alternatively which present them selves from the environment is called convergent thinking. 2. DIVERGENT THINKING. The ability of an individual to generate as many as solution as possible. This quality is associated with creativity. A divergent thinker always think about the environment. NOTE:Both the above types of thinking is must for a manager to create an environment suitable for achievement of organization objectives. MODES OF THINKING: 1. ANALYSIS. Analysis is derived from a greek work meaning resolution into simple parts. Means the study of something by examining its parts and their relationship. The method is used by studying something going into prose and cones of the component parts of a thing understanding their relationship making the whole. In other words it goes into the sources from which the components arises. 2. SYNTHESIS. It is Greek word means putting together of parts or elements. 3. EVALUATION. It means thinking about something in relation to values and standards. CREATIVE THINKING. Creativity or original thinking is a major components of critical thinking. This can be defined as thinking that results in the development of new ideas and products of creativity in problem solving and decision making is described as ability to develop and implement new better solution. The creative process emphasizes on uniqueness of the solution. TOOLS OF CREATIVE THINKING: 1. BRAIN STORMING. A session of creative group is conducted, the problem in hand is described and the thinkers are asked to present their solution. Four rules are followed in this technique: a. No criticism is posed during the brain storming session. b. It is tried that as many solution as required on granted. c. Encourage unique and new solution. d. Try to improve previous ideas. 2. FORE CASTING. Predicting future potentials, out comes, choices are clarified. The process of forecasting involves placing each potential scenario in one of the four categories. STEPS OF CREATIVE THINKING: 1. STIMULUS. Critical or creative thinking does not come in mind by itself. It comes through reasoning and curiosity of mind in response to a question. According to Rudyard Kipling I keep six working men They taught me all I know. These names are what, why and when and how, where and who.
2. EXPLORATION. We use the knowledge we already know and rearrange it to create new ideas and things certain measures can improve our this skills: a. One should try to increase ideas. b. The idea generated must be given sometime of incubation. c. Through divergent thinking to generate more ideas. 3. PLANNING: a. The stage includes defining the task so that the purpose of thinking can be understood. b. We should collect a lot many information. c. We should discuss our thinking with others through which it can be improved. 4. ACTIVITY. This is the step in which we put idea to productivity. In this we think what could be the use of idea, where does it lead to, how can it be put to reality. 5. REVIEW. When an idea is conceived some period should be kept aside for evaluation and review. MOTIVATION
A motive is an impulse that causes a person to act. Motivation is an internal process that makes a person move toward a goal. Motivation, like intelligence, cant be directly observed. A state of mind in which a person views any particular task or goal Action individuals take to satisfy unmet needs Catalyst to move individuals towards goals Intrinsic and Extrinsic Motivation A motivation may be intrinsic, extrinsic, or both. Intrinsic motivation is the motivation to act for the sake of the activity alone. For example, people have intrinsic motivation to write poetry if they do it simply because they enjoy it. Extrinsic motivation, on the other hand, is the motivation to act for external rewards. For example, people have extrinsic motivation to write if they do so in the hopes of getting published, being famous, or making money. Intrinsic: comes from within the individual Extrinsic: enhanced by job environment or external rewards Motives or needs: wants, drives or impulses Activity: basic unit of human behavior Motivation to work: the degree to which members of an organization are willing to work Motivated employees more likely to be productive NEED SATISFACTION MODEL Schweiger, 1980 First a need is felt Then there is a behavior or response The goal is either attained or blocked MASLOWS HIERARCHY OF NEED THEORY In the 1970s, the psychologist Abraham Maslow suggested that people are motivated by a hierarchy of needs: First, most basic level: physiological needs, such as the need for food, water, safety, and security. Second level: needs for social interaction, such as the need to belong. Third level: needs for esteem, which includes the need for respect from oneself and others. Fourth level: needs for Self-actualization, or realizing ones full potential. Maslow believed people pay attention to higher needs only when lower needs are satisfied. Human needs in a hierarchy from the most basic survival to complex psychological Maslows theory applies to people in general & not specific to work & organizational behavior MASLOWS HIERARCHY OF NEEDS THEORY Physiological drives Safety & security needs Belonging needs Esteem & ego needs Self-actualization needs Perceiving: 1. To become aware of directly through any of the senses, especially sight or hearing. 2. To achieve understanding of; apprehend 3. Become aware or conscious of (something); come to realize or understand. 4. Become aware of (something) by the use of one of the senses, esp. that of sight Reward: A reward may refer to: Bounty (reward), reward, often money, offered as an incentive; Reward website, website that offers rewards for performing tasks ... Initiative
1. 2. 3. 4.
The power or ability to begin or to follow through energetically with a plan or task; enterprise and determination. A beginning or introductory step; an opening move: took the initiative in trying to solve the problem. The power or right to introduce a new legislative measure. The right and procedure by which citizens can propose a law by petition and ensure its submission to the electorate. Morale: Emotional or mental condition with respect to cheerfulness, confidence, zeal, etc., esp. in the face of opposition, hardship, etc.: the morale of the troops ... Rating scale: A rating scale is an instrument that requires the rater to assign the rated object that have numerals assigned to them. All the rating scales can be classified into the four classifications. Resource management: In organizational studies, resource management is the efficient and effective deployment for an organization's resources when they are needed.
GLOSSORY OF TERMS
Acceptance theory of management: principle that emphasizes the willingness of subordinates to accept those with authority to act. Accountability: the answering for ones actions and accepting the consequences. Affirmative action: a plan that requires employers to make an extra effort to hire and promote people who belong to a protected group. Authority: the formal and legitimate right of a manager to make decisions, issue orders, and allocate resources to achieve organizational goals. Behavioral management theory a method that focuses on people as individuals with needs (also known as the human relations movement). Body language: actions, gestures, and other aspects of physical appearance that can be a powerful means of transmitting messages (also known as body language). Boundary spanning: the process of gathering information from the external environment to identify current or likely events and determine how those events will affect the organization. Brainstorming: an idea-generating process that encourages the development of alternatives while withholding criticism of those alternatives. Bureaucracy: a form of organization based on logic, order, and legitimate use of formal authority. Centralized organization: authority is concentrated at the top of the organization. Chain of command: a line of authority that links all persons in an organization and defines who reports to whom. Charismatic power: influence that result from leadership characteristics that command identification, respect, and admiration from subordinates (also known as charismatic power). Classical administrative: the branch of classical management theory that emphasizes the flow of information in organizations. Classical management theory: a theory, developed during the Industrial Revolution that proposes one best way to perform tasks. Classical management theory developed into two separate branches: the classical scientific school and the classical administrative school. Classical scientific: a branch of the school of classical management theory, whose emphasis is on increasing productivity and efficiency. Closed system : An organization that interacts little with its external or outside environment. Coercive power: authority to punish or recommend punishment. Communication: the exchange of ideas, messages, or information, by speech, signals, or writing. Compensation: all work-related payments, including wages, commissions, insurance, and other benefits. Competitive advantage: any aspect of an organization that distinguishes it from its competitors in a positive way. Condition of certainty: situation that occurs when the decision maker has perfect knowledge of all the information needed to make a decision. Content theory: identifies physical or psychological conditions that act as stimuli for human behavior. Contingency planning: development of alternative courses of action that can be implemented if and when the original plan proves inadequate because of changing circumstances. Contingency theory: this principle examines the fit between the leader and the situation and provides guidelines for managers to achieve an effective fit (also known as situational theory). Continuous process: a system that produces goods by continuously feeding raw materials through highly automated technology. Control: the systematic process of regulating organization activities to make them consistent with the expectations established in plans, targets, and standards of performance. Concurrent control: method of regulation applied to processes as they are happening. Cost-leadership strategy: system that focuses on keeping costs as low as possible through efficient operations and tight controls. Crisis problem: an unexpected problem that has the potential to lead to disaster if not resolved quickly and appropriately. Cross-functional teams: groups of experts in various specialties (or functions) who work together on solutions to organizational problems. Decentralized organizations: firms that consciously attempt to spread authority to the lowest possible levels. Decision tree: a diagram that analyzes hiring, marketing, investment, equipment purchases, pricing, and similar decisions. Decision trees assign probabilities to each possible outcome and calculate payoffs for each decision path. Delegation: the downward transfer of authority from a manager to a subordinate. Demographics: measurements of various characteristics of the people and social groups who make up a society. Development plans: a series of steps that can help employees acquire skills to reach long-term goals, such as job promotions. Differentiation strategy: a plan whereby a company attempts to set the organizations products or services apart form those of other companies. Division of labor: the degree to which organizational tasks are divided into separate jobs (also known as the division of labor). Embargo: a prohibition on trade in a particular area. Employee benefits: legally required or voluntary compensation provided to employees in addition to their salaries. Empowerment: giving individuals in organization autonomy.
Expectancy theory: a motivational theory stating that the three factors that influence behavior are the value of the reward, the relationship of the reward to performance, and the effort required for performance Expert power: a leaders special knowledge or skills regarding the tasks performed by followers. Exporting: selling of an organizations products to a foreign broker or agent. Feed forward controls: method used to identify and prevent defects and deviations from standards. Financial audits: formal investigations to ensure that procedures, policies, laws, and ethical guidelines are followed in the handling and reporting of financial activities. Financial ratio analysis: the relationship between specific figures on an organizations financial statements; helps explain the significance of those figures. Financial statements: reports that provide management with information to monitor financial resources. First-line management: the lowest level of management. Flexiplace: a work arrangement that allows at least a portion of scheduled work hours to be completed outside of the office, with work at home as one of the options. Flextime: work an employment alternative that allows employees to decide, within a certain range, when to begin and end each work day. Force-field analysis: a technique to implement change by determining which forces drive change and which forces resist it. Formal structure: the hierarchical arrangement of tasks and people within an organization. Functional authority: authority to make decisions about specific activities undertaken by personnel in other departments. Functional structure: an organizational design that groups positions into departments on the basis of the specialized activities of the business. Functional teams: work groups that perform specific organizational functions with members from several vertical levels of the hierarchy. Grapevine: the informal communications network within an organization (also known as social network and informal channels). Horizontal job loading: a type of job redesign that increases the variety of tasks a position includes. Human relations movement: see behavioral management theory. Incentive pay: links compensation and performance by paying employees for actual results, not for seniority or hours worked. Income statement: a report that presents the difference between an organizations income and expenses to determine whether the firm operated at a profit or loss over a specified time. Informal channels: the informal communications network within an organization . Informal organization: the pattern, behavior, and interaction that stems from personal rather than official relationships. Interpersonal communication: real- time, face-to-face, or voiceto-voice conversation that allows immediate feedback. Intrapreneurship: organizational culture that allows employees flexibility and authority in pursuing and developing new ideas. Job analysis: a study that determines all tasks and qualifications needed for each position. Job description: a written statement of a jobs requirements, processes, and rationale. Job enlargement: a type of job redesign that increases the variety of tasks a position includes (also known as horizontal job loading). Job enrichment: a type of job redesign that not only includes an increased variety of tasks, but also provides the employee with more responsibility and authority (also known as vertical job loading). Job rotation: temporarily assigning employees to different job, or tasks to different people, on a rotating basis.
Job sharing: process in which one full-time job is split between two or more persons (also known as twinning). Joint venture: a business relationship formed between a domestic and foreign firm. Kaizen: a Japanese term used in the business setting to mean incremental, continuous improvement. Leading: establishing and influencing others to follow a specific direction. Learning organizations: firms that utilize people, values, and systems to continuously change and improve performance based on the lessons of experience. Legitimate power: vested authority stemming from a formal management position in an organization. Licensure agreement: contract that grants one firm the right to make or sell another companys products. Line authority: a managers right to direct the work of his or her employees and make decisions without consulting others. Liquidity ratios: measurements of an organizations ability to generate cash. Management: the process of administering and coordinating resources effectively, efficiently, and in an effort to achieve the goals of the organization. Management information systems (MIS): collects, organizes, and distributes data in such a way that the information meets managers needs. Manager: a person responsible for the work performance of one or more other persons. Mass production: a system used to manufacture a large number of uniform products in an assembly line. Means-end chain: the effective design of organizational goals that encourages the accomplishment of low-level goals as a way of achieving high-level goals. Mechanistic structure: a highly bureaucratic organizational method, with centralized authority, detailed rules and procedures, a clear-cut division of labor, narrow span of controls, and formal coordination. Mission statement: a document that describes what an organization stands for and why it exists. Motion study: research designed to isolate the best possible method of performing a given job. Multinational corporations (MNC): organizations operating facilities in one or more countries. Need theory: a construct of motivation based upon physical or psychological conditions that act as stimuli for human behavior. Network structure: an operating process that relies on other organizations to perform critical functions on a contractual basis. Nonverbal communication: actions, gestures, and other aspects of physical appearance that can be a powerful means of transmitting messages (also known as body language). Open system: a method in which an individual or organization must interact with various and constantly changing components in both the external and internal environments. Operational goals: specific, measurable results expected from first-level managers, work groups, and individuals. Operational plan: developed by a first level supervisor as the means to achieve operational objectives in support of tactical plans. Organic structure: a management system founded on cooperation and knowledge-based authority. Organization: a group of individuals who work together to accomplish a common goal. Organizational change: a significant change that affects an entire company. Organizational chart: a pictorial display of the official lines of authority and communication within an organization. Organizational climate: the byproduct of organizational culture; it is the barometer for determining the morale of the employees.
Organizational culture: an organizations personality. Organizational design: the creation or change of an organizations structure, the configuration and interrelationships of positions and departments. Organizational development (OD): a plan that focuses on changing an entire organization by changing processes and organizational culture. Organizing: the process of establishing the orderly use of resources by assigning and coordinating tasks. Orientation: a socialization process designed to provide necessary information to new employees and welcome them into the organization. Performance appraisal: a formal, structured system designed to measure an employees job performance against designated standards. Philosophy of management: a managers set of personal beliefs and values about people and work. Plan: a blueprint for goal achievement that specifies the necessary resource allocations, schedules, tasks, and other actions. Planned change: the deliberate structuring of operations and behaviors in anticipation of environmental forces. Planning: the act of determining the organizations goals and defining the means for achieving them. Privacy laws: legal rights of employees regarding who has access to information about their work history and job performance. Procedure: a set of step-by-step directions that explain how activities or tasks are to be carried out. Process theories: rationales that attempt to explain how workers select behavioral actions to meet their needs and determine their choices. Profitability ratios: measurements of an organizations ability to generate profits. Quality: reflects the degree to which a goods or services meets the demands and requirements of the marketplace. Quantitative approach: using quantitative techniques, such as statistics, information models, and computer simulations, to improve decision making. Queuing theory: a rationale that helps allocate services or workstations to minimize customer waiting and service cost. Quotas: government regulations that limit the import of specific products within the year. Recruitment: activities an organization uses to attract a pool of viable candidates. Re-engineering: redesigning processes requiring input from every employee in the company to achieve dramatic improvements in cost, quality, service, and speed. Referent power: influence that result from leadership characteristics that command identification, respect, and admiration from subordinates (also known as charismatic power). Resources: the people, information, facilities, infrastructure, machinery, equipment, supplies, and finances at an organizations disposal. Reward power: the authority to reward others. Risk: the environment that exists when a manager must make a decision without complete information. Rule: an explicit statement that tells a supervisor what he or she can and cannot do. Satisfice: the making of the best decision possible with the information, resources, and time available. Scalar principle: a system that demonstrates a clearly defined line of authority in the organization that includes all employees. Selective perception: the tendency to single out for attention those aspects of a situation or person that reinforce or appear consistent with ones existing beliefs, values, or needs.
Self-fulfilling prophecy: a belief that a manager can, through his or her behavior, create a situation where subordinates act in ways that confirm his or her original expectations. Simulation: a broad term indicating any type of activity that attempts to imitate an existing system or situation in a simplified manner. Situational theory: : this principle examines the fit between the leader and the situation and provides guidelines for managers to achieve an effective fit. Small-batch: production manufacturing of a variety of custom, made-to-order products. Social network: the informal communications network within an organization . Strategic change: revision that takes place when a company changes its tactics (strategy)possibly even its mission statementto achieve current goals. Strategic plan: an outline of steps designed with the goals of the entire organization as a whole in mind, rather than with the goals of specific divisions or departments. Structural change: variation that occurs when a company changes its procedures, policies, and rules, and as a result, its organizational structure. Structured problems: familiar, straightforward, and clear difficulties with respect to the information needed to resolve them. Tactical plan: steps detailing the actions needed to achieve the organizations larger strategic plan. Tariffs: taxes placed on imports and/or exports in response to a political event. Team structure: organizational design that places separate functions into a group according to one overall objective. Technology: the knowledge, machinery, work procedures, and materials that transform inputs into outputs. Telecommuting: a work arrangement that allows at least a portion of scheduled work hours to be completed outside of the office, with work at home as one of the options (also known as Flexiplace). Total Quality Management (TQM): a philosophy that states that uniform commitment to quality in all areas of the organization promotes a culture that meets consumers perceptions of quality. Twinning: process in which one full-time job is split between two or more persons. Unity of command: principle that states that an employee should have one and only one supervisor to whom he or she is directly responsible. Unstructured problems: difficulties that involve ambiguities and information deficiencies and often occur as new or unexpected situations. Validity: proof that the relationship between a selection device and some relevant job criterion exists. Vertical job loading: a type of job redesign that not only includes an increased variety of tasks, but also provides the employee with more responsibility and authority . Vision: the ability of the leader to bind people together with an idea. Wholly-owned subsidiary: a foreign firm owned outright, or with a controlling interest, by an out-of-country firm. Work specialization: the degree to which organizational tasks are divided into separate jobs (also known as the division of labor). Zero defects: a program that emphasizes doing it right the first time.

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NURSING LEADERSHIP AND MANAGEMENT

NURSING LEADERSHIP AND MANAGEMENT

UNIT No: 1 LEDERSHIP AND MANAGEMENT

Input Physical and technical resources

B . LEADERSHIP TYPES BASED ON PERSONAL CHARACTERISTICS:

C . TYPES OF LEADERSHIP BASED ON FORMALITY

UNIT NO: 3 FACTORS AFFECTING LEADERSHIP:

SOME OTHER SPECIAL QUALITIES OF A LEADER:

UNIT NO: 5 DECISION MAKING

DECISION MAKING IN NURSING:

METHODS OF MAKING DECISION:

UNIT NO. 6 STAFF NEEDS

MINIMUM PHYSICAL RESOURCES NECESSARY TO MANAGE WARD

PLANNING AND ORGANIZATION OF WORK ACTIVITIES IN WARD

RESOURCES SHOULD BE MATCHING WITH DEMANDS

7.3 STAFF SCHEDULING:

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Functional Nursing organization Structure Charge Nurse

Clerical /House keeping

Team Nursing Organization Structure Charge Nurse

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ASSOCIATE NURSE (EVENING)

ASSOCIATE NURSE (NIGHT)

ASSOCIATE NURSE (AS NEEDED DAYS)

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SOPHISTICATED/ COMPLEX MODEL

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UNIT NO. 12 DELEGATION OF RESPONSIBILITY

DELEGATORS ROLE: 1. Exercise control broadly.

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BARRIERS TO EFFECTIVE DELEGATION

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COORDINATION OF WARD ACTIVITIES:

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TEACHING OF IN SERVICE EDUCATION

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The adequacy of therapy planning. The skills demonstrated in applying therapy.

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