NCM 107-A Nursing

Leadership & Management,

Nursing Jurisprudence
June 15, 2012
9:00 am

Conceptual Paradigm of
Leadership &
Management

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

Goals may be:

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

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

THEORIES & PRINCIPLES

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

THEORIES

7. Management as Decision Making

8. Managerial Roles
9. Hierarchy of Needs
10. Motivation Hygiene Theory
11. Theory of X & Theory of Y
12. Theory Z

MANAGEMENT

uses delegated authority within a formal organization

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

Managers do things right- Leaders do the right

thing

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

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

Workers are chosen for their technical skills.

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

MISSION
Outlines the purpose of the agency
Identifies the clients
Allows everyone to understand why
an organization exists
It is the soul of an organization

VISION
A mental image or the power of
imagination to see something that is
not actually visible.
An organizations dream of what it
wants to be in the future
It outlines the organizations future role
and functions
Gives the agency something to strive
for

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

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

GOAL
Relates to ones aspirations, purpose
and vision
A specific aim to target to be
attained within a short time span of a
year.

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

1. Scientific Management
Theory
Frederick Taylor
one best
practice
- Management &
Labor both want
To increase
productivity

2. Systematic Management
Theory
Henri Fayol

Father of Systematic
Management.
18 principles of mgt:

3. Organizational Theory
Max Weber
Advocated
Bureaucracy

4. Social Process
Mary Parker Follet
Management as
Social process

5. Hawthorne Effect
Elton Mayo/Fritz Roethlisberger

6. Management by
Objectives
Peter Drucker
Father of Modern
Corporate mgt.

7. Management as Decision
Making
Herbert Simon
Optimizing economic man
Satisfying administrative man

8. Managerial Roles
Henry Mintzberg
10 Basic Managerial
Roles

9. Hierarchy of Needs
Abraham Maslow
Father of humanistic
Psychology
5 levels of needs

10. Motivation Hygiene

Theory
Ferdinand Herzberg
2 factor theory
Hygiene
Motivation-

11. Theory of X &

Theory of Y
Douglas McGregor
Theory X negative view
Dislike work
Irresponsible
Requires close supervision
To do their job.

Theory Y positive view

- industrious , responsible
- creative , self control

12. Theory Z
William Ouchi
Japanese mgt. approach
Presenting solutions to
Problems of HRM.
- Attempts to incorporate &
Integrate the best of
American ( theory A ) and
Japanese ( Theory J) of
Mgt

MANAGEMENT
PROCESSES &
FUNCTIONS
It is the application of creative
problem solving strategies.
4 functions of management

Planning
Organizing
Directing
controlling

EFFECTIVE & EFFICIENT

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

RESOURCES
Attainment of a goal usually precedes
the use of resources.
7 Ms
1. money5. methodsbudget

technique for investigating

phenomena.

2. men 3. machine-

human resources

planning &

body of

devices

6. moment7. manager-

directing the work of a group

4. materials-

physical resources

time; time management

person responsible for

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

COMPONENTS OF
PLANNING

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

well plan
is half
done

POOR PLANNING
Is the failure to set goals make assessments or provide
for implementation or to anticipate any possible change

in circumstances.

Failing

to plan
is planning to
fail

INDICATORS OF POOR PLANNING

Delivery dates are not met
Machines are idle
Material is wasted
Some nurses are overworked, others are
underworked
Skilled nurses doing unskilled work
Nurses are fumbling on jobs for which they have
not been trained
There is quarreling, bickering, buck-passing and
confusion.

PLAN
Is a living document which can be
changed based on the prevailing
circumstances.

PRINCIPLES OF PLANNING
1. Planning is always based & focused on the vision,
mission, philosophy & clearly defined objective of
the organization.
2. Planning is a continous process.
3. Planning should be pervasive within the entire
organization.
4. Planning utilizes all available resources
5. Planning must be precise in its scope & nature
6. Planning should be time- bounded

IMPORTANCE OF
PLANNING
1. Planning leads to the achievement of goals &
objectives.
2. Planning gives meaning to work.
3. Planning provides for effective use of available
resources.
4. Planning helps in coping with crises.
5. Planning is cost-effective.
6. Planning is based on past & future activities .
7. Planning leads to the realization of the need to change.
8. Planning provides basis for control.
9. Planning is necessary for effective control .

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

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

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

It deals with at least one of the 3 questions:

1.What do we do?
2.For whom do we do it?
3.How do we excel?

 OPERATING PLANS pertain to activities in

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

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

PHILOSOPHY statement of beliefs &

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

2. Set objectives/ goals and determine

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

3. Conduct a situation analysis

( SWOT )- analysis of the internal factors
attributed to the organization and
external factors beyond control of the
organization.

4. Develop & schedule strategies,

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

TIME SAVING TECHNIQUES,

DEVICES & METHODS TO
BETTER USE OF TIME
1.
2.
3.

Conduct an inventory of your activities.

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

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

5. Preparing the Budget

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

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

6. Establishing Nursing standards,

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

 POLICIES are defined as standing

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

 PROCEDURES are defined as a

more specific guide to action than
policy.
Nursing Procedures
Example: Discharge of Patient

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

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

 VISION is a mental image or the

power of imagination to see
something that is not actually visible
It outlines the organizations future role
& functions
Gives the agency something to strive
for.
An organizations dream of what it
wants to be in the future.

 PHILOSOPHY describes the vision of

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

 OBJECTIVES is the backbone of ones

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

 GOAL the end to be accomplished

Relates to ones aspirations, purpose, and
vision.

SWOT ANALYSIS is the assumptions and

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

 WEAKNESS a negative internal condition

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

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

 Activity :SITUATION FOR SWOT ANALYSIS

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

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

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

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

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

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

similar assignments are grouped together

for a common purpose.

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

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

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

DISADVANTAGES OF
TALL STRUCTURE

Tall Organization creates many levels of management.

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

SAMPLE OF TALL
STRUCTURE

DECENTRALIZED/
HORIZONTAL
STRUCTURE
Characterized by fewer levels and a broad span

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

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

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

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

SAMPLE OF FLAT
ORGANIZATION
STRUCTURE

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

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

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

6. MATRIX ORGANIZATION designed

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

7. SHARED GOVERNANCE ORGANIZATION

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

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

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

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

 PATIENT ACUITY measurement of

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

3. TOTAL CARE PATIENTS are usually

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

NURSING CARE MODELS

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

CASE METHOD / TOTAL

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

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

SAMPLE OF TOTAL
PATIENT CARE

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

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

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

DISADVANTAGES:
Patients cannot identify who their
nurse is

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

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

SAMPLE OF TEAM
NURSING

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

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

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

Other health
provider

PRIMARY NURSE

Charge
Nurse

Patient

Associate Nurse

Associate Nurse

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

Case Manager

Patient Caseload

Caregivers

Caregivers

Caregivers

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

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

RN

PARTNER

PATIENTS

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

 FULL TIME EQUIVALENT ( FTE )

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

 FORTY HOUR WEEK LAW

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

 FORTY HOUR/ WEEK for personnel

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

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

2. Find the number of nursing care hours (NCH )

needed by patients at each level of care per
day.
75 pts. X 1.5 ( NCH needed at Level I )=112.5 NCH/ DAY
112.5 pts. X 3 ( NCH needed at Level II )=337.5 NCH/ DAY
37.5 pts. X 4.5 ( NCH needed at Level III) = 168.75
NCH/DAY

25 pts x 6 ( NCH needed at Level IV ) = 150 NCH/ DAY

TOTAL 768.75 NCH/DAY

3. Find the total NCH needed by 250

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

5. Find the total number of nursing

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

165 x .15 = 25 ( relievers needed )

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

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

III. SCHEDULING
It is a timetable showing planned work days
& shifts for nursing personnel.
FACTORS TO CONSIDER IN MAKING SCHEDULE
1.Different levels of nursing staff.
2.Adequate coverage for 24 /7.
3.Staggered vacations & holidays.
4.Long stretches & consecutive working days.
5.Cross training/ orientation to complimentary units

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

4.ROTATING WORK SHIFT scheduling

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

A four- week cyclical

schedule

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

ACTIVITY
Make a schedule of your staff in
surgical ward with the following
Staff :
1 Head Nurse
4 Staff Nurse/ Registered Nurse
5 Nursing Attendant

IV. DEVELOPING JOB

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

CONTENTS OF JOB
DESCRIPTION
1.CONTENTS:
Identifying data
Position Title: Staff Nurse
Department : Nursing
Supervisors title: Head/ Senior
Nurse

2. Job Summary includes the essential

features of the job that distinguish it
from the others.
3. Qualification Requirements
educational preparation, training &
experience necessary to fill the position.
4. Job relationships Source of workers
5. Specific & actual functions & activities.

PURPOSES OF JOB
DESCRIPTION

Recruitment & selection of qualified personnel

Job Placement, transfer & dismissal
Guidance & direction
Aid in the Evaluation of performance of
employee
Reduction of conflict & frustration
Avoidance of overlapping duties
Facilitating working relationships with outside
bodies
Serving as basis for the employees salary range

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

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

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

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

ELEMENTS OF
DIRECTING

1.
2.
3.
4.
5.
6.
7.

Delegation
Supervision
Staff Development
Coordination
Collaboration
Communication
Evaluation

 The authority was delegated to me

for this patient and, by assuming this
responsibility for the patient, I will
then be accountable for this patients
care
- Phyllis Frank & Marjorie
Price, 1980

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

4 RIGHTS OF
DELEGATION
TASK the right task should be within the scope
of the persons practice and consistent with the
job description.
PERSON the right person should have:
appropriate license or certificate
appropriate job description
Demonstrated skill

COMMUNICATION- right communication should

be clear, complete, concise & correct.
FEEDBACK- right feedback should ask for input,
get the persons recommended solution to the
problem, and recognize the persons efforts.

ASPECTS OF DELEGATION
( ARA)
1. AUTHORITY
- Delegation of authority
- Authority is the power to make final decisions & commands
- People with delegated authority perform for the manager
- They need authority of sufficient scope to include all related
activities without frequent consultation with their manager
- The manager maintains control over the delegated authority
and may recall it.

2. RESPONSIBILITY
Assignment of responsibility
Responsibility denotes obligation
It refers to what must be done to complete a task and the
obligation created by the assignment.

ASPECTS OF
DELEGATION
3. ACCOUNTABILITY
Creation of accountability
Accountability refers to liability
Staff given responsibility are accountable to their
manager
Managers are accountable for the performance of
the task, selection of the person to complete it,
and both the staff associates and their own
performance

PURPOSES OF
DELEGATION
Saves time
It can help develop others
It maximizes the use of the talents of staff
associates
Uses latent abilities in personnel that
contribute to their growth and development
Involvement of staff tends to increase
motivation and commitment to accomplish
goals
It reduces managerial cost.

GUIDELINES FOR
EFFECTIVE DELEGATION
Give a clear description of what it is you
want the employee to do.
Share with the employee the outcome
you expect and by when
Discuss the degree of responsibilities and
authority that the employee will have
Ask the employee to summarize the main
points of the task that has been
delegated.

AREAS TO BE
DELEGATED

Routine tasks
Tasks for which you dont have time
Problem solving
Change in your own job emphasis
Capability building

WHAT CANNOT BE
DELEGATED?

Overall ARA
Final evaluation of staff performance
Correcting & disciplining staff
Activities which the nurse to whom the task
is delegated does not know how or does not
want to do because the job is unpleasant
hot potato
DELEGATED TASKS MUST BE:
- based on policies; job descriptions;
capabilities of workers

WHY MANAGERS DO NOT

WANT TO DELEGATE?
Mistakes in delegation can be costly
Failure to delegate wisely increases
management costs & contributes to
personnel dissatisfaction
Fear on the part of the manager of her
own ability to delegate
Fear of losing control of the staff
Fear of failing to get others do the work
Fear of cristicism

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

2. OVERDELEGATING
It unnecessarily burdens the
subordinates the with tasks that are
either inconsequential or irrelevant to
the delivery of the goal
3. IMPROPER DELEGATING it is the
delegation of tasks & responsibilities
beyond which the person cannot
perform properly.

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

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

PRINCIPLES OF GOOD
SUPERVISION
Good supervision is focused on the
improvement of work rather than upgrading
the worker
It is based on lines of authority, VMGO
Focuses on 3 areas of skill: conceptual,
technical, interpersonal
It is cooperatively planned & accepts both
challenge & change with subordinates
It uses a democratic process to facilitate
:effective communication, continous
improvement of staff, respect for individuality
of each member that bring harmonious

RESPONSIBILITIES OF
SUPERVISOR
Teach & motivate the staff &
facilitate their work
Delegate work responsibilities and be
available for consultation
Perform assessment and evaluation
of work performance and conditions.

III. STAFF DEVELOPMENT

Is a planned experience to help
employees perform effectively and to
enrich their competence in practice,
education, administration and
research
Retraining employees for better
performance in areas of skills,
knowledge & attitude ( SKA )

FUNCTIONS OF STAFF
DEVELOPMENT
Maintain self efficiency and effectiveness
Create quality employees
Meet the staffs needs and address their
problems such as deficiencies in
knowledge, skills & attitudes
Motivate them and improve their self
confidence
Help prepare them for greater
responsibilities

In- Service Training vs.

Continuing Education
IN-SERVICE
TRAINING

CONTINUING
EDUCATION

Training
Skills enhancement

Professional & personal

development that relates to
professional &
organizational development

Oriented towards improving

performance of staff and
conforming to
organizational needs

Tend to meet high

performance level needs of
the staff
Strengthen knowledge,
skills and attitude

aim

Improved patient care

through upgrading of
services rendered

Promote development of
KSA for enhancement of
nursing practice

nature

Less formal

Formal- seminar workshop

Learning experience

Planned & incidental

Planned, structured learning

duration

shorter

Longer

setting

Within the agency

Within, outside the agency

cost

Shouldered by the agency

Paid by the individual nurse

Scope

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

COORDINATION WITH
MEDICAL SERVICE
Should know the medical staff &
scheduled time of rounds
Should know the patients in the unit,
diagnosis, conditions, medical plan of
care& treatment
Adequate feedback on the progress of
the patients condition
Regular conferences encountered in the
ward and with the patient care.

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

COORDINATION WITH
THE LABORATORY
SERVICE
Requests for lab exams
Assistance to lab tech during routine
blood exams
Labeling of the different specimens
like urine, stool, sputum, csf
Preparations of pts. For relevant
examinations

COORDINATION WITH
RADIOLOGY SERVICE
Requests for x-ray exam
Preparation for the different
procedures
Allergies to dyes should be indicated

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

COORDINATION WITH THE DIETARY

SERVICE
- Head nurse is responsible for forwarding
the diet list of the patients in the units

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

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

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

FLOW OF
COMMUNICATION

DOWNWARD COMMUNICATION may come in

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

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

FOUR DIMENSIONAL FLOW OF

COMMUNICATION IN NURSING
CARE

PRINCIPLES OF
EFFECTIVE
COMMUNICATION
Principle of Clarity
Principle of objective
Principle of understanding the
receiver
Principle of consistency
Principle of completeness
Principle of feedback
Principle of time

Types of Communication
SPOKEN WORDS it involves spoken
words
WRITTEN WORDS must be clear,
correct, complete and concise
PHYSICAL EXPRESSION or
SIGNIFICANT GESTURES
transmission of message without the
use of words

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

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

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

THE AIM OF COMMUNICATION IS

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

ANONYMOUS

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

PURPOSES OF
EVALUATION
Provide constructive feedback
Determine progress and worthiness
of individual nurse for greater
responsibilities
Serve as basis for promotion and
increase in salary or other similar
rewards.

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

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

 Checklist compilation of all nursing

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

 Forced choice comparison the

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

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

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

NURSING LEADERSHIP

Is defined as the process where the nurse

influences one or more persons to achieve
specific goals in the provision of nursing care one
or more patients.
Concept of nsg. Leadership ( traits & actions)
L lead, love, learn
E enthusiastic, energetic
A assertive, achiever
D dedicated, desirous
E efficient & effective
R responsible, respectful

Difference between a
Leader & Manager
LEADER

MANAGER

May or may not have official

appointment to the position

Officially appointed

Vested with power and authority

by the group

Vested with power and authority

by the organization

Influence others toward goal

setting

Implements predetermined goals,

policies, rules and regulations

Interested in risk taking and

exploring new ideas

Measures the risks to be taken in

line with the expected results,
hence an orderly, controlled
performance must be carried out

Relates to people personally

Relates to people according to

their role

Feels rewarded by personal

achievement

Feels rewarded when

accomplishing organizational
missions or goals

May or may not be as successful

Are managers as long as the

DIMENSIONS OF
LEADERSHIP
LEADER is the one who initiated leadership.
FOLLOWER is not a passive agent in
leadership.
Leads herself by assuming responsibilities
thus influencing her own performance.

TYPES OF FOLLOWERS
Alienated followers- are independent and
critical yet passive in their behavior resulting in
psychological and emotional distance with
their leaders. They are potentially disruptive
and a threat to the health of the organization.

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

TYPES OF FOLLOWERS
SURVIVOR FOLLOWERS are the least
disruptive and lowest- risk followers.
The perpetually sample the wind.
Their motto is Better safe than sorry

EFFECTIVE FOLLOWERS are self leaders and

do not require close supervision.
- They recognize that to be an effective
leader, one needs good followers.
- Leaders cannot exist without good followers.

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

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

COMMON TRAITS OF
LEADERS
POSITIVE TRAITS leaders with positive
traits bring people to progress
They transcend their own traits to people who
will become positive leaders themselves
They are cheerful, forgiving, intelligent, good
looking men and women among others.
Effective leaders build leaders while leading

COMMON TRAITS OF A
LEADER
NEGATIVE TRAITS leaders who have
negative traits take people to
destruction.
They destroy rather than build
They are not able to grow good leaders
but followers who go after each other
They are bitter, aggressive, loudmouthed, sullen and ugly people.

TRAITS & SKILLS OF

LEADERS BY STOGDILL
TRAITS

SKILLS

Adaptable to situations

Clever ( Intelligent )

Alert to social environment

Conceptually skilled

Ambitious and achievementoriented

Creative

Assertive

Diplomatic and tactful

Cooperative

Fluent in speaking

Decisive

Knowledgeable about group task

Dependable

Organized( administrative ability)

Dominant ( desire to influence

others)

Persuasive

Energetic ( high activity level)

Socially skilled

Persistent
Self-confident
Tolerant to stress

TRAITS OF A LEADERS
ACCORDING TO REEVES ( 2001)
Emotional Stability & composure
Calm, confident & predictable, particularly
when under stress
Admitting error
Owning up to mistakes, rather than putter
energy to covering up
Good interpersonal skills
Able to communicate and persuade others
without resort to negative or coercive tactics
Intellectual breadth
Able to understand a wide range of areas, rather
than having a narrow area of expertise

TRAITS OF LEADERS
ACCORDING TO GARDNER

Decisiveness
Trustworthiness
Self-confidence
Capacity to motivate people
Skill in dealing with people
Task competence

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

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

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

KURT LEWIN THEORY

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

BUREAUCRATIC
LEADERSHIP STYLE
EFFECTIVE WHEN:
Routine tasks are performed
Certain standards or procedures are to be
understood
Employees are working with dangerous or
delicate equipment that requires a definite
set of procedures to operate
Safety or security training is being conducted
Employees are performing tasks that require
handling cash.

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

DEMOCRATIC LEADERS:
Develops plans to help employees
evaluate their own performance
Allows employees to establish goals
Encourages employees to grow on the job
and be promoted
Recognizes and encourages achievement
Shares the problem solving and decisionmaking to the staff
Encourages team building & participation

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

EFFECTIVE STYLE TO USE

WHEN:
Employees are highly skilled,
experienced & educated
Employees have pride in their work and
the drive to do it successfully on their
own
Outside experts, such as staff specialists
or consultants are being used
Employees are trustworthy and
experienced.

KURT LEWIN THEORY

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

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

CHANGE PROCESS

by Kurt

Lewin
STAGE

CHARACTERISTICS

ORGANIZATIONAL
IMPACT

UNFREEZIN People in the organization made

G
aware of problems/performance
gap and need for change

The diagnosis stage is

often driven by a
change agent

Changing

People experiment with new

workplace behavior to deal with
need change

This intervention
stage features
specific training plans
for managers and
employees

ReFreezing

People employ new skills and

attitudes and are rewarded by
organization

Changes are
institutionalized in the
corporate culture.

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

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

SINGLE LOOP LEARNING

Is the repeated attempt at the same
problem, with no variation of method
& without ever questioning the goal
DO
PLAN

CHECK

ADJUS
T

DOUBLE LOOP LEARNING

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

DOUBLE- LOOP
LEARNING
ASSUM
E

D
O
PLAN

CHECK
ADJUS
T

THINK
AGAIN

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

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

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

LIKERT SCALE
Likert Scale determine level of
agreement and disagreement of a
respondent to a set of questions that could
be objective or subjective in nature.
1. Strongly agree
2. Disagree
3. Neither agree nor disagree
4. Agree
5. Strongly agree

LINKING PIN MODEL

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

EXPLOITATIVEAUTHORITATIVE
Least effective performance
Managers show little confidence in
staff associates and ignore their ideas
Staff associate do not feel free to
discuss their jobs with the manager
Responsibility for organizations goal is
at the top ; goals are established
through orders

BENEVOLENTAUTHORITATIVE
The manager is condescending to staff
associates
Staff associates ideas are sometimes sought but
they do not feel very free to discuss their jobs
with the manager
Top management & middle management are
responsible for setting goals
Decisions are made at the top with some
delegation
Staff associates are occasionally consulted for
problem solving

CONSULTATIVE
The manager has substantial confidence
in staff associates
Their ideas are usually sought and they
feel free to discuss their work with the
manager
Responsibility for setting goals is fairly
general
Managers are quite familiar with the
problem faced by their staff associates.

PARTICIPATIVE
Associated with the most effective
performance
Managers have complete confidence in their
staff associates
Ideas are always sought
Managers are very well informed about the
problems faced by their staff associate and
decision making is well integrated
throughout the organization with full
involvement of staff associates.

ROBERT R. BLAKE &

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

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

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

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

COUNTRY CLUB STYLE

( 1, 9)
Leader has a high concern for people and a low
concern for production
Leaders who use this style pay much attention to
the security and comfort of the employees with
the hope that this would increase performance.
Leader is attentive to his/her peoples needs and
has developed satisfying relationships and work
culture, but at the expense of achieving results
Leaders is agreeable, non- confrontational,
comforting, uncontroversial
RESULTS: usually friendly but not necessarily that
productive

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

 RESULTS: This dictatorial style is based

on Theory X of Douglas McGregor and is
commonly applied by companies on the
edge of real or perceived failure.
Used in case of crisis management
It is costly because of the high labor
turn- over.

MIDDLE OF THE ROAD

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

TEAM STYLE ( 9,9)

Leader who use this style rely heavily on making
employees feel as a constructive part of the organization
Leader pays high concern both to people & production
Leaders encourage teamwork and commitment among
employees
Leader is characterized as open- minded, flexible and
one who inspires involvement
RESULTS: leaders achieves high work performance
through leading his people to become dedicated to the
organizational goals
There is a high degree of participation and teamwork, which
satisfies the basic need of people to be involved & committed to
their work

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

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

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

SQUARING THE
PROMISES AND REALITY
BY DR. HAROLD J. SALA
JEREMIAH 29:11

For I know the plans I have

for you, declares the Lord,
plans to prosper you and not
to harm you, plans to give
you hope and a future.

CONFLICT
Is a natural & inevitable conditions and
is often a prerequisite to change in
people and organizations.
Levels:
INTRAPERSONAL- within one individual
INTERPERSONAL within two or more
individuals
INTRAGROUP within one group
INTERGROUP- between two or more groups

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

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

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

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

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

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

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

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

CONCURRENT CONTROLS
Apply to processes as they are happening
Enacted while work is being performed

TYPES OF CONTROL
FEEDBACK CONTROLS
Focus on the results of operations.
RESOURCE CONTROLS
Time ( deadline), materials ( inventory),
equipment ( protection of the equipment),
cost ( cost standards), employee
performance ( absences, tardiness
FINANCIAL CONTROLS
Facilitate achieving the organizations profit
motive

TYPES OF CONTROL
OPERATIONS CONTROL
Methods assess how efficiently & effectively an
organizations transformation processes.
NURSING ROUNDS
Pay particular attention to issues of patient care &
nursing practice
QUALITY ASSURANCE
Monitors compliance with established standards

NURSING AUDIT
Consists of documentation of the quality of nursing care in
relation to the standards established by the nursing
department