NURSING LEADERSHIP & MANAGEMENT

Leadership
the process of influence in which the leader influences others toward goal achievement y is the effort to envision and inspire changes y A social transaction in which one person influences others.
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LEADERSHIP
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Process of influencing the behavior or actions of a person or group to attain desired objectives A dynamic, interactive process that involves three dimensions: leader, follower and the situation

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Leadership
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the process of influence in which the leader influences others toward goal achievement

Leader
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the one who leads, conducts or guides the process

Lead
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to go with or ahead of so as to show the way; guide

A Leader is one others follow willingly and voluntarily .

an inviting personality or ability to communicate with and counsel others . seniority. especial competencies. chosen by the group itself Usually become leaders because of age.TYPES OF LEADERS y Informal leader Does not have official sanction to direct activities of others.

.TYPES OF LEADERS y Informal leader Play a valuable role if their behavior and influence are congruent with the goals of the organization.

and given official or legitimate authority to act Ex.y Formal or appointed chosen by administration. The elected and appointed officers .

Theories of Leadership .

which suggests that leadership cannot be developed .Great Man Theory Argues that few people are born to be great leaders who are well rounded & simultaneously instrumental & supportive Many finds this theory unattractive because of the premise that leaders are born not made.

Charismatic theory y Leader inspires others by obtaining emotional commitment from followers and by arousing feelings of loyalty & enthusiasm .

y Robert House .found that this leaders have strong conviction & high self confidence & followers has the similar belief with the charismatic leader thus showing signs of unquestioning acceptance & obedience .

it sometimes leads into blind obedience but a transformational leaders use it to motivate members .y Bernard Bass .

y Jay Conger & Kanungo (1998) -They found out that charisma is more of an attributional phenomenon .

´Charm qualityµ is an inspirational .

Trait Theory y Early works in this area maintained that traits are inherited. but later theories suggest that the traits can be obtained through learning & experience .

not .´Leaders created.µ are born.

Leadership Traits Task-Oriented y Relationship-Oriented y y Participative Leadership .

& coordinating activities. . scheduling.Leadership Traits y Task-Oriented behaviors includes planning.

expressing appreciation & providing recognition . showing trust & confidence.y Relationship-Oriented includes being friendly & considerate.

y Participative Leadership enlists associates participation in making decisions .

& the leader needs to adapt leadership styles accordingly . called maturity to emphasize the importance of the maturity level of the followers.Situational Theory y Used task behavior & relationship behavior in relation to the follower·s readiness.

Situational Leadership Theory y Predicts the most appropriate leadership style from the level of maturity of the followers .

Contingency Theory y leadership style will be effective & ineffective depending on the situation .

PathPath-Goal Theory y derived from the expectancy theory where people act as they do because they expect their behavior to produce satisfactory results .

the leader facilitates task accomplishment by minimizing obstruction to the goals (structured activity). & by rewarding followers for completing their task .y In path-goal relationship.

y staff associates are introduced as a variable where in staff associates with high need for achievement probably will prefer a task oriented leader. but people with high need for affiliation will prefer a considerate leader .

Transactional Leadership y an exchange posture that identifies the needs of the followers & provides reward in exchange for expected performance a contract for mutual benefits that has contingent rewards y .

Transformational Leadership y Promotes employee development & attend to their needs by motivating. & influencing the followers Leader serves as a role model who provides a sense of direction & encourages self management y . inspiring.

values. & norms y . & revision of assumptions.y described it in terms of charisma & intellectual stimulation transformational leaders change the organization by realigning the organization·s culture with the new vision.

Integrative Leadership Model y Obviously there is no one best leadership style. One should be aware of his own behavior & learn to adapt. Leaders are rarely totally people oriented or task oriented. y .

Styles of Leadership .

with the leader making the decision & using power to command & control others .Autocratic y involves centralized decision making.

with the authority delegated to others. influential by having close and personal relationship with the subordinates .Democratic y is participatory.

Chaos is most likely to develop because members may work independently .LaissezLaissez-Faire y Is passive & permissive. nondirective. inactive.

Power & Authority .

Authority y Legitimate power to direct others .

Power y It is one·s capacity to influence others .

Sources of power y Expert power ² it is derived from the knowledge & skills one possess .

y Legitimate power ² is derived from the position one holds in a group & indicates authority but not sufficient as one·s only source of power .

y Referent power ² derived from respect & trust coming from any individual group or organization .

y Reward power ² it comes from the ability to recognize others for complying .

y Coercive power ² is based on fear of punishment if one fails to conform .

y Connection power ² it comes from coalition & interpersonal relationship .

y Informational power ² it comes from knowledge & access to information .

affirming values serving as a symbol .THEORIES OF LEADERSHIP y TRAIT THEORY *leaders are born with inherited tasks *envisioning goals.

QUALITIES/TRAITS OF A LEADER y Intelligence: judgment. emotional balance and control. self confidence. cooperativeness. knowledge and fluency of speech Personality: adaptability. independence y . creativity. personal integrity. alertness.

tact and diplomacy . sociability/interpersonal skills. popularity and prestige. social participation.QUALITIES OF ««. y Abilities: ability to enlist cooperation.

GREAT-MAN THEORY GREATy y Leaders are born and not made Great leaders will arise when there is a great need Ex. King of Spain y .

BEHAVIORAL THEORY y Successful leadership is based in definable. learnable behavior .

PARTICIPATIVE LEADERSHIP y People are more committed to actions .

SITUATIONAL THEORY y The best action of leader depends on range of situational factors *motivation *capability of followers performance of leader and follower attitudes. needs and expectations .

SITUATIONAL LEADERSHIP THEORY y Depends on the level of the maturity of individual .

leadership member relation b.task structure c.position power . a.CONTINGENCY THEORY y Leaders· ability to lead is contingent upon situation.

TRANSACTIONAL LEADESHIP y People are motivated by reward and punishment .

TRANSFORMATIONAL THEORY y People will follow a person who inspires them A person with vision and passion Value based leadership y y .

PATH-GOAL THEORY PATHy Leaders has certain objectives and initiates their followers to attain their own objectives .

deployment of self thru positive self regard .STRATEGY THEORY y BASED ON HUMAN HANDLING SKILLS OF LEADERS Strategy 1 ² attention thru vision Strategy 2 ² meaning thru communication Strategy 3 .trust thru positioning Strategy 4 .

CHARISMATIC THEORY y Charm and grace are needed to create followers Self belief y .

AUTHORITARIAN/AUTOCRATI C Strong control over the group or directive approach Concern with task accomplishments .STYLES OF LEADERSHIP 1.

DEMOCRATIC OR PARTICIPATIVE Leaders focuses on involving subordinates in decision making People oriented .2.

3. LAISSEZ ² FAIRE OR PERMISSIVE Delegating approach Little or no direction is provided to subordinates .

MULTICRATIC The leader identify which style of leadership a particular situation requires .4.

skills or ability y y .BASES OF POWER FOR LEADERS y Legitimate/authority ² power granted by an official position Referent ² potential influence one has because of the strength of relationships between leaders and followers Expert ² gained thru the position of special knowledge. sound judgment. good decision skills. wisdom.

y Informational power ² exists when an individual have information that others must have to accomplish particular goals Connection power ² based on having connections or associations with others who are powerful y .

y Coercive power or punishment power ² manager control the groups through fears. threats and sanctions Reward power ² this is achieved through influencing others because of one·s control over desired resources y .

weaknesses and potential Knowledge of basic ingredients for leadership and management Systematic use of self to get things done at the right time y y .COMPONENTS OF EFFECTIVE LEADERSHIP y Understanding of the individual strength.

´Leadership is the essence of professionalism and should be considered an essential component of all nurses and other professional rolesµ Joyce Clifford .

MANAGEMENT y y Art of getting things done thru people Process that involves guidance. y . direction of a group of people toward organizational goals or objectives Process thru which the objectives of an organization are accomplished by utilizing human. physical and technical resources.

y is a process by which a cooperative group directs actions towards common goals y is a process of coordinating and allocating resources to achieve organizational goal y .Management the act of planning. directing (leading). organizing. controlling (evaluating).

Manager y a person that creates and maintains an internal environment in an enterprise in which individual work together as a group .

Managing y accomplishing the goals of the group through effective and efficient use of resources .

liaison Decisional roles ² entrepreneur. negotiator y y . leaders. resource allocator.figurehead. disturbance handler.MANAGEMENT ROLES y Information role ² monitor. spokesperson Interpersonal role. disseminator.

MANAGEMENT LEVELS y FIRST LEVEL ² Supervises the operative employee MIDDLE LEVEL ² plan and coordinate activities of the organization. TOP LEVEL ² manages the organization as a whole. y y .

Comparison of Leaders & Managers .

When. Where & How? Destinations Performance . What.Leadership Motto Challenge Focus Time Frame Methods Questions Outcomes Evaluate Human Management Do the right things Do things right Change Purpose Future Strategies Why? Journeys Potential Continuity Structures & procedures Present Schedules Who.

Challenge us to keep learning of our world .MANAGEMENT THEORY Purposes of Theory 1. Enable us to communicate freely 3. Provide a stable focus of understanding what we experience 2.

PRINCIPLES OF MANAGEMENT (MODERN ERA) ‡ ‡ ‡ ‡ Scientific Classical Human Relations Behavioral .

Scientific Management - ´Focused on the best way to do a taskµ Efficiency provided information on: standards time & motion studies task analysis job simplification productivity incentives .

FREDERICK TAYLOR (1856-1915) (1856€ ´FATHER OF SCIENTIFIC MANAGEMENTµ y Used stopwatch studies & applied the principles of: observation measurement scientific comparison to determine the most efficient way to accomplish a task .

.€ Reduced wasted effort € Set standard for performance € Encourage specialization € Stressed the selection of qualified workers who could be developed for a particular job.

y ´Monistic Theoryµ .

FRANK GILBRETH(1868-1924) GILBRETH(1868LILIAN GILBRETH(1878-1972) GILBRETH(1878- .

y y Pioneers in time and motion studies Emphasized the benefits of: job simplification establishment of work standards effects of the incentives wage plan fatigue on work performance .

y First to use motion picture films to analyze worker·s emotions Developed a micro chronometer y .

was concerned w/ problems of efficiency y Refined previous work rather than introduce new concepts y Developed a task and bonus remuneration plan y .Henry Gantt (1861-1919) (1861Disciple of Taylor.

y Argued for: more humanitarian approach placed emphasis on service rather than profit objectives recognize useful non-monetary incentives .

CLASSIC ORGANIZATON ´Deductive rather than inductiveµ -views the organization as a whole rather than focusing solely on production -focused on: planning organizing controlling .

Henry Fayol (1841-1925) (1841- Father of Management Process School .

y Studied the functions of managers and concluded that management is universal A believer in the division of work . he argued that specialization increases efficiency y .

€ Believed that workers: should be allowed to think implement plans be adequately remunerated for their services .

µ € ´a .y Encourage dev·t of group harmony through equal treatment and stability of tenure for personnel place for everything and everything in its place.

y . the more efficient they can perform Authority ² management needs to be able to give orders so that they can get things done.FAYOL·S MANAGEMENT PRINCIPLES y Division of Labor ² the more people specialize.

y Discipline ² members in an organization need to respect the rules and regulation that govern the organization Unity of command ² subordinates should receive orders from only one superior y .

y y .y Unity of direction ² member of any organization should have only one objectives Subordination of Individual Interest to the Common Good ² give way for the interest of everybody. Remuneration ² workers should be paid according/commensurate to the work they perform.

y Centralization ² managers should retain the final responsibility but should at the same time give their subordinate enough time and authority to do their job. Order ² materials and people should be at the right time and at the right place. y y . Hierarchy ² the line of authority in an organization runs in order of rank.

y Equity ² people in the organization should be treated with equity and justice Stability of Staff ² the greater the turnover rate. y y y . the less workers are efficient Initiative ² subordinate should be given the freedom to do their work/conceive plans even though some mistakes occur Espirit de Corps ² good relationship must be maintain in the organization.

Max Weber (1864-1920) (1864- Father of Organizational Theory .

y Conceptualized bureaucracy w/ emphasis on rules instead of individuals and competency over favoritism as the most efficient basis of organization .

y Conceptualized a structure of authority that would facilitate the accomplishment of the organizational objectives .

.Basis Of Authority 1. 3. Traditional Authority Charisma Rational/Legal Authority 2.

Human Relations ´Stresses the Social Environmentµ -focused on the effect individuals have on the success or failure of an organization .

Chester Barnard (1886(18861961) .

y Studied the functions of executives while he was a manager for the New Jersey bell telephone system He defined the manager·s responsibilities y .

Defining Objectives Acquiring Resources Coordinating Activities 2. .1. 3.

he noted that the degree of cooperation depends on the non-financial inducement .y Stressing the importance of cooperation b/w management and labor.

y Stressed the role organization for aiding communication meeting individual·s needs maintaining cohesiveness of informal .

Mary Parker Follett (1868(18681933) Mother of Modern Management .

y Stressed the importance of coordinating the psychological and sociological aspect of management Perceived the organization as a social system and management as social process y .

y She considered ´offensiveµ subordination .

.y Distinguished between power w/ others and power over others and indicated that legitimate power is produced by a circular behavior whereby superior and subordinates mutually influence one another.

y The law of the situation dictates that a person does not take orders from another person but from the situation .

Elton Mayo (1810-1949) (1810- Author of The Hawthorne Studies .

the ´Hawthorne Studiesµ stimulated considerable interest in human problems on the job ´lighting had productionµ little effect on y .y Though criticized for poor research methods.

y Work norms obviously had influence than wage incentive more .

Kurt Lewin (1890-1974) (1890- Study of Group Dynamics .

composite of the member·s personalities advocated democratic supervision y .y maintained that groups have personalities of their own.

y Identified the three types of leaders Authorat Democrat Laissez-Faire .

Jacob Moreno (1892-1979) (1892- Developed ´Sociometryµ to analyze group behavior .

Claimed that people are either: attracted to repulsed by indifferent towards others y Developed the sociogram to chart pairings of preferences for others y .

y Contributed to: psychodrama (individual therapy) sociodrama ( related to social and cultural roles) and role playing techniques for the analysis of interpersonal relations .

Behavioral Science y emphasizes the use of scientific procedures to study the psychological. sociological. and anthropological aspects of human behavior in organization .

Abraham Maslow (1908-1970) (1908- Hierarchy of Needs Theory .

Physiological 2. Belonging 4. Safety 3.y y Initiated the Human Behavioral School in 1943 He outlined a hierarchical structure for human needs classified into five categories: 1. Self-actualization . Esteem 5.

´Once needs are met. newer and more mature ones must emergeµ .

recognition. company policy.Frederick Herzberg(1923Herzberg(19232000) y Factors in the job can raise the level of performance and meet the higher order needs Job-content (factors in the job) ex: achievement. working conditions = hygiene factors . growth = motivators Job-context (surrounding environmental factors) ex: supervision.

Douglas McGregor (1906(19061964) Theory X and Y .

y Developed the managerial implications of Maslow·s Theory Notes that ones style of management is dependent on one·s philosophy of humans y .

threatened . controlled.y Theory X ² manager·s emphasis on the goal of the organization People dislike & will avoid work Workers must be directed. coerced.

y Theory Y ² emphasis is on the goal of the individual People do not inherently dislike work Work can be a source of satisfaction Workers have self direction. self-control. responds to rewards for the accomplishment of goals .

William Ouchi Theory Z .

y Published Theory Z: How American Business Can Meet the Japanese Challenge in 1981 .

y Japanese organization ´lifetime employmentµ Slow evaluation & promotion Non-specialized career paths Implicit control mechanisms Collective decision-making & responsibility Wholistic concern .

y US organization Short-term employment Rapid evaluation & promotion Specialized career paths Explicit control mechanisms Individual decision-making Individual responsibility Segmented concern .

.Richard Pascale & Anthony Athos y Gave a more extensive discussion of the Art of Japanese Management: Application for American Executives in 1981.

y Explain that organization in the US tend to savor strategy. skills. and superordinate goals . and systems. style. structure. whereas the Japanese organization focus on staff.

Rensis Likert (1903-1981) (1903- Theory of Management is based on his work at the University of Michigan¶s Institute for Social Research .

y He identified 3 types of variables in organization .

Causal y Includes: Leadership behavior Organizational structure Policies Controls .1.

2. Intervening y These are: Perceptions Attitudes motivations .

End-result Endy Includes: Measures of profits Costs Productivity .3.

y ´Managers may act in ways harmful to the organization because they evaluate end results to the exclusion of intervening variables.µ .

Managerial Grid .

5) A (1.9) C (5.9) E (9.1) concern fro production .1) Vertical concern for people Horizontal D (9.B (1.

Concern for production They depicted these on a 9 x 9 or 81 square managerial grid. & the horizontal axis represents concern for production. The 5 basic styles are to each corner & in the middle . The vertical axis represents the managers concern for people. Concern for people 2.Behavioral Science Robert Blake (1918) & Jane Mouton (1930) Maintained that there are 2 critical dimensions of leadership 1.

Impoverished Manager (1.1) lack of concern for both people & production .A.

9) thoughtful & friendly but lack concern for production .B. Country Club Manager (1.

5) represents a moderate concern for both people & production but not at the same time . Organization Man Management (5.C.

Authority-Obedience Authority(9.1) efficiency in operation but lacks concern for human element .D.

E. These managers integrate their concern for people & production .9) the optimal managerial style. Team Management (9.

Skills of a Manager Accdg to Robert Katz y Technical skills ² knowledge and proficiency in activities involving methods. It also involves working w/ tools and specific techniques to achieve the desire result. procedures and process. .

y Human skills ² the ability to work w/ people. . It is the creation of work environment in w/c people feel secure and free to express their opinion.

y Conceptual skills ² the ability to see the over-all pictures to identify important elements in a situation and to understand the relationship among the elements .

Summer emphasized Knowledge factors Attitude factors Ability factors .

Roles of Managers y INTERPERSONAL ROLE Symbol Leader Liaison .

y INFORMATIONAL ROLE Monitors Information Disseminates Information Spokesperson or Representative .

y DECISIONAL ROLE Entrepreneur or Innovator Troubleshooter Negotiator .

I. PLANNING y Forecasting or setting the broad outline of work to be done -Why it will be done? -What action is necessary? -Where it will be done? -When it will be done? -Who will do it? -How it will be done? .

Scope of Planning y Strategic planning based on mission of the institution .

schedule daily and weekly plans for the administration of patient care for his or her unit . rules and regulations.Scope of planning y y Supervisors . methods and procedures -coordinates nursing activities -translate strategies and procedures into specific objectives and program Head nurses .formulate policies.directly responsible for the actual production of nursing services .

CHARACTERISITCS OF GOOD PLAN Based on clearly defined objectives y It should be simple y It should provide for the proper analysis and classification of action y It should be flexible y It should be balance y It should make use of all available resources y .

REASONS FOR PLANNING Increases the chance of success by focusing on results not activities y Forces analytic thinking and evaluation of alternatives y Establish a framework for decision making y Orient people to action than reaction y Includes day to day and future focused managers y .

REASONS FOR PLANNING -Helps avoid crisis management and provide decision making flexibility y -Provide a basis for managing organizational and individual performance y -Increases employee involvement and improves communication y -Cost effective y .

goals.STAGES OF PLANNING 1. objectives. Develop the purpose or mission statement. philosophy Mission ² purpose of existence and reason behind organizational structure Philosophy ² statements of shared values and beliefs .

Goals ² statement of intent derived from the purposes of the organization. purposes or targets that will have to be accomplished . usually stated broadly and generally Objectives ² specific aims.

external and internal forces 3. Collect and analyze data .2. Assess for the strength (opportunities that will facilitate effectiveness and achievement of goals and weaknesses (threats that will impede achieving goals and objectives) .

Develop a timetable for accomplishing each objectives 7. Write realistic and general statements of goal 5. Provides guideline for developing operational and functional plans .4. Identify strategies to achieve specified goals 6.

Provide for formative evaluation reports before.8. Put plans to work/implement 9. during and after the plan is implemented .

allocated resources necessary for future expenditures .BUDGET (AS A TOOL FOR PLANNING) y Budget operational management plan related to income and expenses for division of time.

PREREQUISITES TO BUDGETING y Sound organizational structure with clear line of authority and responsibility Managerial support Formal policies and procedures must be reflected in the budgetary manual y y .

PUPOSES OF BUDGETING IN NURSING SERVICE y To plan the objective. To motivate nursing workers through analysis of actual experience. To serve as standards. activities of the nursing service and finance to accomplish them. y y . programs.

Types of Budget Capital y Operational y Personnel or manpower y Flexible y Cash flow y Fixed ceiling y .

related to volume and varies according to different factors.related to providing product service. y . y Direct cost .incurred in support of providing products service.COSTS Fixed cost .not related to volume and remain constant. y Variable cost . y Indirect cost .

y COST MANAGEMENT ² what can be done to manage cost y . and why. when.COST CONTAINMENT COST AWARENESS y COST FAIRS y COST MONITORING ² focuses on how much will be spent. where.

y . technology or services not necessary needed. reporting and monitoring. y COST REDUCTION ² spending less for goods or services y COST CONTROL ² effective use of available resources through careful planning. forecasting.COST INCENTIVES ² motivation and rewards y COST AVOIDANCE ² not buying supplies.

Budget patient care hours and staffing 5. Budget patient care hours 4.PROCEDURE ² NURSING SERVICE 1. Plan for nonproductive hours . Determine productivity goal 2. Forecast workload 3.

Anticipate capital expense . Chart productive time 7. Estimate the cost of supplies and services 8.6.

defining means of coordinating activities to accomplish goals and objectives . supervising. providing assignments. ORGANIZING y Grouping of activities.II.

PURPOSES y To sustain the philosophy. achieve the mission and vision and objectives of the organization Show the part each person shall work in the organization y .

with lines indicating who reports to whom and why what authority y .CHARACTERISTICS OF ORGANIZATIONAL STRUCTURE y Division of work in which each boxes represent an individual responsible for a given part of the organization·s workload Chain of command.

CHARACTERISTICS«« The type of work performed. indicated by the labels or description for each boxes y The grouping of work segments shown by the cluster of work groups y The level of management. which indicate individual and entire management hierarchy y .

COMPONENTS OF ORGANIZATIONAL STRUCTURE y y y People Purpose structure .

responsibilities and those occupying the positions and their relationships among them y . y Informal ² consists of the personal and social relationship of the members in the organization Formal ² describes the positions.S.BASIC TYPES OF O.

Project management 4. Freeform 2. Task force 5. STRUCTURES y y Hierarchic or bureaucratic model Adaptive or organic model 1. Matrix .FORMAL ORG. Collegial 3.

ORGANIZATIONAL CHART y Diagrammatic representation of the organizational structure .

2.Types according to depiction 1. 3. Positional ² position is indicated Functional ² duties and responsibilities Structural ² agency is shown .

3 General Types of Organizational Chart: .

DIRECTOR CHIEF NURSE SN SN SN . Line Organizational y Is the simplest and most direct type of organization in which position has general authority over the lower position in the hierarchy.1.

Encourage speedy action y 1.y 1. DISADVANTAGES Neglects special planning Overworks key people Depends upon retention of a few key people . 3. 2. 3. 2. Makes clear division of authority. ADVANTAGES Maintain simplicity.

Functional Organizational y Is one where each unit is responsible for a given part of the organization·s workload. There is a clear delineation of roles and responsibilities which are actually interrelated .2.

3. 2. DISADVANTAGES Makes relationship more complex Makes limits of authority of each specialist a difficult coordination Teach toward centralization of organization. .y 1. ADVANTAGES Relieves line executive of routine specialized decision Provides frameworks for applying expert knowledge Relieves press of need for large number of wellrounded personnel y 1. 2. 3.

DIRECTOR TRAINING OFFICER CHIEF NURSE SN SN SN .3. Staff Organization y Is purely advisory to the line structure w/ no authority to put recommendations into action.

DISADVANTAGES Continues in organization even if its function are not clear Reduces expert power to place recommendation into action Tends towards centralization of the organization .y 1. ADVANTAGES Enables specialist to give expert advise Frees the line executive of detailed analysis Affords young specialist a mass training y 1. 3. 2. 2. 3.

FORMS OF ORGANIZATIONAL CHART .

1. Vertical or Tall Chart y Depicts the Chief Executive at the top with line of authority flowing down the hierarchy. DIRECTOR CN SN SN SN NA NA NA .

2. Horizontal or Flat Chart y Depicts the manager at the top w/ a wide span of control CN SN SN SN SN SN NA NA NA NA NA .

3. Concentric or Circular Chart y shows outward flows of communication from center SN CN SN SN .

STAFFING y Is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patient·s demand. .

.y The Hospital Nursing Service Administration Manual of the Department of Health has recommended the following nursing care hours (NCH) for patients in the various nursing units of the hospital.

to Nonprof ratio 60:40 60:40 60:40 .4 Prof.5 3. Medical 3. CASES 1. Nursing Care Hours / patient / day according to classification of patients by units.Table 1. Surgical NCH/Pt/day 3.4 3. General Medicine 2.

Pediatrics 6. ER/ICU/RR 8. Obstetrics 5. CCU 3.0 4.Cont.0 60:40 70:30 55:45 70:30 80:20 . 4.8 6.6 2. Pathologic Nursery 7.0 6.

Patient classification systems (PCS) «quantify the quality of nursing care by matching patients· needs to numbers and kinds of nursing personnel using time as the unit of measure. .

A nurse manager must determine the following: y Number of categories in which the pt should be divided y Characteristics of pts per category y Type & number of care procedures that will be needed by a pt per category y Time needed to perform these procedures that will be required .

Levels of care patients.5 6. NCH/pt/ day 1.5 3.0 7 or higher L1 self care or minimal care L2 moderate or intermediate L3 total or intensive care L4 highly specialized or critical care Ration prof to non-prof 55:45 60:40 65:35 70:30 80:20 .0 4.Levels of Care of NCH/pt/day & ratio or prof & non-prof non- Table 2.

.Percentage of Nursing Care Hours Period of NCH at each levels of care depends on the setting in which the care is being given.

those nonemergency.CLASSIFICATION CATEGORIES y Level I.5 NCH/ 55:45 ration prof and non prof .1. . newly admitted do not exhibit unusual symptoms.patient about to discharge. feed himself and perform his ADL.patient can take a bath on his own. .SELF CARE or MINIMAL CARE . and requires little tx/observation or instruction.

observation & instructions.3 NCH / 60:40 ration prof & non-prof . periodic tx.MODERATE CARE or INTERMEDIATE CARE .extreme symptoms of their illness must have subside or have not yet appeared.patients under this level need some assistance.slight emotional needs. w/ V/S ordered up to 3x/shift. .Level II. . intravenous fluid or blood transfusion. are semiconscious and exhibiting some psychological or social problems. .

they are with marked emotional needs. may be on continuous O2 therapy.Level III. w/ or w/o hypo or hypertension & cardiac arrhythmia. w/ chest or abdominal tubes.COMPLETE or INTENSIVE CARE . w/ V/S more than 3x/shift.6 NCH / 65:35 Ration prof & non-prof .patients in this category are completely dependent upon the nursing personnel. . .require close observation at least 30 mins for impending hemorrhage. .

6-9 NCH / 70:30 to 80:20 .Level IV. w/ many medication.patients need continuous tx & observation.V/S q 15-30 mins.HIGHLY or IVSPECIALIZED CARE .Need maximum nursing care. IV piggy banks. hourly output. . .

10 25 45 20 . care Primary 70 25 5 Secondary 65 30 5 Tertiary 30 45 15 10 Special T. Type of Minimal Moderate Intensive Highly hospital care care care Spl.Table 3. Percentage of patients at various levels of care per type of hospital.

Time for Staff Development .COMPUTING FOR THE NUMBER OF NURSING PERSONNEL When computing for the nursing personnel. Absences 6. Holidays 4. Leaves 5. Off-duties 3. one should ensure that there is sufficient staff to cover: 1. All shifts 2.

ACCORDING TO R.A. 5901 OTHERWISE KNOWN AS ´THE FORTY-HOUR WEEK ´THE FORTYLAWµ, EMPLOYEES WILL WORK FOR 40HRS/WK: 1. FOR HOSPITALS WITH 100100-BED CAPACITY OR MORE 2. COMMUNITY POPULATION OF AT LEAST 1 MILLION

HOWEVER, A NURSE WILL RENDER 48HRS/WK WITH ONLY 1 OFF-DUTY A OFFWEEK IF: 1. HOSPITALS WITH LESS THAN 100-BED CAPACITY 1002. COMMUNITIES WITH LESS THAN 1 MILLION POPULATION

THERE ARE BENEFITS ENJOYED BY THE PERSONNEL REGARDLESS OF THE WORKING HOURS. AS PER CIVIL SERVICE COMMISSION MEMORANDUM CIRCULAR NO. 6, SERIES OF 1996, GOVERNMENT EMPLOYEES ARE GRANTED 3 DAYS WHICH MAY BE SPENT FOR:

1. BIRTHDAYS 2. WEDDINGS 3. ANNIVERSARIES 4. FUNERALS (MOURNING) 5. RELOCATION 6. ENROLMENT/GRADUATION LEAVE 7. HOSPITALIZATION 8. ACCIDENT LEAVES

Table 4.

Total number of working hours and non-working days and hours of nursing nonpersonnel per year.

Rights & privileges given each personnel/year 1. 2. 3. 4. 5. Vacation leave Sick leave Legal holidays Special holidays Special privileges

Working hr/wk 48 hrs 15 15 10 2 3

Working hr/wk 40 hrs 15 15 10 2 3

Cont.
6. Off duties/ R.A. 5901 7. Continuing Education Prog. Total Non-working days/year Total Working days/ year Total Working hours/ year 104 3 152 213 1,704 52 3 100 265 2,120

12 3.15 Vacation Leave --------------------------------10 Sick Leave--------------------------------------.3 Total Average Leaves 33 . the following should be considered: 1.5 2.To compute for relievers needed. Special Privileges --------------------------------. Ave.3 4. Continuing Education Program for Professionals ------------------------------------. number of leaves taken each year---. Holidays ---------------------------------------------.

12 (12%) for persons who work 48hrs/wk .To determine the relievers needed: 33 (ave # of days an employee is absent) 213 or 265 (# of working days/year that each employee serves) = 0.15 (15%) for persons who work 40hrs/wk = 0.

To distribute the staff by shifts: Morning shift = 45 ² 51% (0. 37% (0.51) y Afternoon shift= 34 ² 47% (0. the distribution usually followed is 45% (0.18) for the night shift.34 ² 0.18) ***Note: In the Philippines.37) for the afternoon shift and 18% (0.45) for the morning shift.15 ² 0.47) y Night shift = 15 ² 18% (0.45 ² 0. y .

STAFFING FORMULA .

Categorize the patients according to levels of care. Ex.15 = 37.30 = 75 pts need L1 250 (pts) x .1. Multiply the total # of patients by the % of patients at each level of care.5 pts need L3 250 (pts) x .10 = 25 pts need L4 .45 = 112. Find the # of nursing personnel needed for 250 bed capacity in a tertiary hospital 250 (pts) x .5 pts need L2 250 (pts) x .

5 (NCH at L1) =112.2. 75 pts x 1.5 pts x 4.5 pts x 3 (NCH at L2) =337. Find the # of nursing care hrs (NCH) needed by patients at each level of care/ day.75 NCH/day .5 (NCH at L3)=168.5 NCH/day 112.5 NCH/day 37.75 NCH/day 25 pts x 6 (NCH at L3) =150 NCH/day Total = 768.

Find the total # of nursing personnel needed. 768.75 NCH/year 4.75 x 365 (days) = 280. total personnel) .593.704 (working hrs/year) 5. (immediate. Find the actual number of working hours rendered by each nursing personnel/year. reliever. Find the total NCH needed by given number of patients or bed capacity/year. 8 (hrs/day) x 213 (working days/year)= 1.3.

704 Relief x total immediate nsg personnel 165 x 0. b.593. c. Total NCH/year = 280.75 = 165 working hrs/yr 1.15 = 25 Total nsg.a. Personnel needed 165 + 25 = 190 .

35 = 66 nursing attendants 190 nursing personnel Distribute by shift 124 x .6. 7.45 = 56 nurses on AM shift 124 x . Categorize the nursing personnel into professional and non-professional.65 = 124 professional nurses 190 x .18 = 22 nurses on Night shift 124 nurses . 190 x .37 = 46 nurses on PM shift 124 x .

18 = 12 nsg attendants on Night shift 66 nursing attendants .37 = 24 nsg attendants on PM shift 66 x .45 = 30 nsg attendants on AM shift 66 x .66 x .

SCHEDULING .

SCHEDULE
It is a timetable showing planned work days and shift for nursing personnel. y Scheduling is to assign working days and days off to the nursing personnel so that adequate patient care is assured.
y

ASSESSING A SCHEDULING SYSTEM
1. 2.

3. 4. 5.

Ability to cover the needs of the unit. Quality to enhance the nursing personnel·s knowledge, training and experience. Fairness to the staff Stability Flexibility

Cyclic staffing
«sets a basic time pattern that is repeated in cycles.

(Exhibit 7-9 p. 107) 7-

Modified workweeks
«include systems of scheduling personnel such as 10-hour and 12hour shifts, weekend alternative, team rotation, and flexible hours.

Self-scheduling Self«is a method of scheduling in which the nurse manager determines the needs per day and shift and the nursing staff schedule themselves to meet these needs.

(Exhibit 7-8 p. 106) 7-

Productivity «is a system of measuring worker output and is commonly defined as outputs divided by inputs. .

Temporary workers are not employees of the health care agency where they work.Temporary workers «are contract workers hired from a staffing agency for a period of time that may be for one to several days or weeks. .

Manager behavior y Oversees staffing activities through human resource management that includes use of a patient classification system and provision of qualified nursing personnel in adequate numbers to meet patient care needs. .

.Leader behavior y Uses input from employees to develop and implement a staffing philosophy and staffing policies that inspire personnel to work to their maximum level of productivity.

safe nursing care for all patients 24 hours a day. . 52 weeks a year.Basic to planning for staffing of a division of nursing is the fact that qualified nursing personnel must be provided in sufficient numbers to ensure adequate. 7 days a week. Each staffing plan must be tailored to the needs of the agency and cannot be determined with a simple workerpatient ratio or formula.

(Exhibit) .

(Exhibit 7-7 p. 105) 7- .

and required nursing care hours . personnel mix.Components of patient classification system y Classification categories Factor Prototype y y y Guidelines Average care time for a patient in each category Method for calculating required staffing.

Modified approaches to nurse staffing and scheduling y 10-hour shift y 12-hour shift y Weekend alternative y Flex time y Others .

Productivity commonly defined as output / input y Percent productivity = required staff hours / provided staff hours x 100 y Is .

assignment. . scheduling. calculating turnover.Staffing activities «include recruitment. developing and administering policies. and related activities. hiring. preparing payroll.

Human Resource Department y involves tasks like interviewing. retention of state and performance evaluation/appraisal . hiring. coaching.

Personnel y are persons employed in an agency or department .

Recruitment y the process of enlisting personnel for employment. the process of hiring .

the process of elimination .Selection y the process of choosing or selecting candidates according to their qualifications to the job.

Retention y capacity to retain employees once they are hired .

Modes of Recruitment Employee recommendation y Word of mouth y Advertisement y Flyers y Newsletter y Bulletin y Posters y Career Days y Job Fairs y Placement y .

Screening Potential Staff y Philosophies in the screening process: x The manager should screen out applicants who do not fit the agency·s image. x The manager should try to fit the job to a promising applicant. . x Usually the manager should try to fit the applicant to the job.

Collect information for personnel administration (SSN.). Furnish background data useful in planning the selection interview. Obtain names of references who may be contacted for additional information about the applicant·s work experience and general character.y Application Forms and Resumes Determine whether the applicant meets minimal hiring requirements. . # of dependents etc.

Letter of Reference y Interview face to face contact between the job seeker and a person with full authority to fill the position under discussion. The purpose of the interview is to obtain information. y . and to determine if the applicant meets the requirements for the position. to give information.

.Types of Interview Directive interview ² uses closed-ended closedquestion NonNon-directive interview ² the applicant narrates himself. Structure interview ² the interviewer uses prepre-prepared guidelines for interview. Group interview ² several applicants or interviewees are interviewed together. Board interview ² conducted by selected member of the personnel to an applicant.

Test Used in Selection of Applicant Aptitude Test ² measures capacity on potential ability to learn Psychomotor ² measures strength and coordination Job knowledge Proficiency ² measures how well the applicants can do a simple work Psychological test ² measures personality characteristics .

PATIENT CLASSIFICATION SYSTEM y PURPOSES 1. 5. For staffing Program costing and formulating budget Track changes in patient care methods Determine values for productivity equation Determine quality . 3. 4. 2.

DIRECTING y Issuance of assignments.III. orders and instructions that permits the worker what is expected of the to achieve organizational goals and objectives .

Delegating «is getting the work done through employees. .

y . The worker in return assumes responsibility & is held accountable for its result.y Is the process by which a manager assigns specific task/duties to workers with commensurate authority to perform the task.

Ability of the worker to carry out the task. Fairness not only to the employee but to the team as a whole. .2 Important Criteria in Delegation 1. 2.

Principles of Delegation Select the right person y Delegate both interesting & uninteresting task y Provide staff with enough time to learn y Delegate gradually y Delegate in advance y Consult before delegating y Avoid gaps & overlaps y .

Nursing Care Assignments/ Modalities of Nursing Care or System/Pattern of Nursing Care .

y Primary Extension of principle of decentralization Nursing process driven Primary nurses and associate nurses 24-hour coverage Greater patient and staff satisfaction .

y Advantages 1) patient & family are able to develop trusting relationship with RN. y . 2) proximity of patient assignment. 4) nurse patient ratio must be realistic. 3) overlapping of staff functions. Disadvantages 1) high cost because there is a higher RN skill. 2) there is defined accountability & responsibility. 3) there is holistic/continuity of care.

y Case Method 1:1 nurse/patient ration Examples include private duty. ICU. Community Health Nurse Similar to Primary. no Associate RN The nurse is responsible for the total care of the patient for the shift she·s working . however.

y Advantages 1) consistency of one individual caring for the patient for the whole shift. y . Disadvantages 1) the nurse may not have the same patient the next day. 2) more opportunity to observe & monitor the patient. 2) it does not serve the purpose of decentralization.

y Functional Nursing divides the work to be done & every member is responsible for his actions best system that can be used if there are many patient & professional nurses are few .

y Advantages of functional nursing are that 1) work is done fast. 2) workers learn to work fast. . 3) they gain skill faster in that particular task.

.y Disadvantages include 1) fragmentation of nursing care therefore holistic care is not achieved. and 6) it is hard to find a specific person to answer the relative·s questions. 3) nurse-patient relationship is not fully developed. 2) patient cannot identify who their ´real nurseµ is. 4) evaluation of nursing care is poor & outcomes are rarely documented.

y Joint Practice (Team Nursing / Modular Nursing ) More than modality Involves nurses and physicians collaborating as colleagues Agreed upon protocols to manage care in primary settings Modular nursing is a kind of team nursing that divides the area into modules of patient. . with each module cared by a team of nurses.

y Advantage 1) work is shared with others Disadvantages 1) patient receives fragmented. y . 4) these factors affects RN·s dissatisfaction. depersonalized care. 2) communication is complex. 3) accountability & responsibility is shared which can cause confusion.

y Case Management Clinical system with accountability for individual or group through continuum of care Negotiating Procuring Coordination of services and resources .

2. Promotive ´improve systemsµ Preventive ´anticipate problems & difficultiesµ Corrective ´institute measures to correct problemsµ Regulatory ´preserve existing assignmentsµ . 4. 3.RESPONSIBILITIES IN DIRECTING 1.

designed effort to bring about improvements in a system. with the assistance of change agent .CHANGE PROCESS y Change ² purposeful.

Mutual setting of objectives 3.THEORIES OF CHANGE REDDINS THEORY ² suggested seven techniques by which change can be accomplished 1. Group emphasis . Diagnosis 2.

Use of economy and ritual 7.4. Resistance interpretation . Maximum information 5. Discussion of implementation 6.

LEWIN·S THEORY y Unfreezing stage ² the nurse is motivated by the need to create change y Moving stage ² the nurse will gather information y Refreezing stage ² changes are integrated and stabilized as part of the value system .

awareness 2. interest 3. adoption . evaluation 4. trial 5.ROGERS· THEORY 1.

Individual· desire and responses to events which prompts extraordinary effort to attain goal and enthusiasm y .MOTIVATION y Forces that make or propels one to act in a certain way.

LEVELS OF MOTIVATION EXTRINSIC MOTIVATION ² anticipated rewards or avoidance of negative consequences in the performance of action y INTRINSIC ² satisfaction derived from the action itself y TRANSCENDENTAL ² recognition of the usefulness of action to some other person y .

Maslow·s Needs Theory 2.THEORIES OF MOTIVATION CONTENT THEORY ² motivation factors or needs within a person 1. Relatedness. Alderfer·s theory ² (Existence. Growth) ERG .

job security. recognition. work itself b. Herzberg·s Theory ² two factor theory a. Disatisfiers or hygienic ² (extrinsic) salary. reward.3. relationships Satisfiers or non hygienic ² (intrinsic) achievement. advancement. working condition. .

Monistic/scientific theory ² salary as the best motivating factor . McClelland theory ² affiliation. achievement and power 5.4.

PROCESS THEORY
1. Arousal theory ² focuses on internal process that mediate the effect of work performance 2. Expectancy theory ² focuses on people·s expectation that their efforts will result in good performance and valued results 3. Equity theory ² focuses on fair treatment

DECISION MAKING
A systematic, sequential process of choosing among alternatives & putting those choices into action

STEPS
1. Identify problem 2. Prioritize problem 3. Gather and analyze situation related to problem 4. Evaluating all alternatives 5. Select an alternative for implementation

IV. CONTROLLING
The process by which managers attempt to measure if actual activities conform to planned activities y A process wherein the performance is measured and corrective action is taken to ensure the accomplishment of organization goal
y

STEPS IN CONTROL PROCESS
Establish standards and criteria Measure performance Compare results with standards

Match with standards? YES NO ² do nothing or improve - take corrective action

Process of evaluating employee·s performance against standards y To determine job competence y Enhance staff development and motivate employee y discover employee·s aspirations and recognize accomplishments
y

PERFORMANCE APPRAISAL/EVALUATION SYSTEM

Improve communication y Aid managers in counseling and coaching y Determine training and dev. needs of staff y Inventories of talent y Legal purposes y .

choice .METHODS OF EVALUATION y y y y y y y Anecdotal records ² objective description of behavior Rating scale Ranking Self appraisal/self rating Peer review Paired comparison Forced .

average and good performance Essay evaluation ² describe strength and weaknesses of employee Critical incident ² describe effective and effective behavior of employee .y y y y y Subordinates Team evaluation ² multiple raters Behavior ² anchored ² list specific description of good.

PROBLEM AREAS OF EVALUATION Subordinates have not been motivated to want to change y People are unable to make change y Subordinates become resentful and anxious when merit system is applied y .

COMMON ERRORS OF EVALUATION Halo error ² allowing one trait to influence the evaluation of others or rating of all traits on the basis of first impression y Horn error ² the evaluator is hypercritical y Contrast error ² managers rate the nurse opposite the way they perceive themselves y .

Leniency of error y Central tendency error y Racial bias y System design and operating problems ² focuses on the method (system) and process (operating) of evaluation y Overgeneralization y Recency of Events error y .

TOTAL QUALITY MANAGEMENT Systematic process to improve outcomes based on customers· needs y Doing the right thing -meeting the needs of the customer -building quality performance into the work process -employ scientific approach to assessment and problem solving y .

QUALITY ASSURANCE PROG Process of establishing a standards of excellence of intervention and taking steps to ensure that each patient receives the expected level of care y Fulfillment of social contract between society and professions y .

Structure ² instrumentalities in the delivery of care (personnel. Outcome ² results expected of the service y . supplies etc) 2.QUALITY NURSING CARE Presence of all elements/characteristics specified in the standards. Process ² how the service was delivered 3. FRAMEWORK OF QA 1.

physical facilities. personnel involved in patient care y Tool to analyze and evaluate nurses· bedside records and physical facilities y Serves as a means of improving nursing care by revealing existing deficiencies y .NURSING AUDIT Official examination of: nursing records.

STANDARD OF CARE Yardstick for gauging the quality and quantity of service y Describes the quality of service y Ex. Nurses are professional in dealing with clients y .

CRITERIA y Measures the quality of care or standards Standard: Nurses are professional in dealing with clients Criteria : greets them with corresponding smiles always attend to their needs .

Thank You! .

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