LEADERSHIP

Nursing Leadership y style or process whereby a person is called by a nurse lead

er were influence of group of people called his followers for the purpose of att
aining only one goal/objective. Principle for Effective Leadership y Unity of Co
mmand ± one group given by one leader y Unity of Direction ± one group should always
have one objective y Subordination of your personal to your general interest ± pa
tient first policy o R ± rescue your patient o A ± alert the fire alarm o C ± confine
the fire in one area o E ± extinguisher application o Esprit d¶ corp/team spirit - F
ault of one is the fault of all y Respondeat Superior/Command responsibility o l
et the master or the superior answer for the negligence of his subordinates in h
alf of his patient who suffer from injury or death. o you can delegate responsib
ility but not the accountability Theories of Nursing Leadership y Great-Man theo
ry ± born as a leader y Trait theory ± develop characteristics or born with the char
acteristics o 3 traits of a leader y P ± personality (adaptability, independence,
creative/assertive, advocate) ability to adjust to the need of the pt y I ± intell
igence (proper judgment, proper decision making, proper communication) y A ± abili
ty ± (influence others, respect others, participate and cooperate) Proper way to i
nfluence is thru health teaching y Charismatic theory ± becomes a leader because o
f the charm y Situational theory/case to case basis o a person can be a leader i
n one situation but only a follower in another situation. (eg. becomes a leader
in where he specializes) Leadership styles y Authocratic/Authoritarian/dictatori
al/´hard´ leader o unilateral style of leadership. Only the leader here performs the
decision making without getting the inputs from his members. o One sided style
of leadership Behavior : A ± apathy ± insensitive to others B ± Boisterous speech C ± co
nsistency D ± Dominating E ± Exploitative behavior F ± ferocious behavior, to coerce o
r compel the group to follow him o not a good style of leadership but only best
style during emergency or intensive crisis y Permissive, ultra-liberal, laissez
faire, free-rein o Loose style of nursing leadership. o Giving excess freedom or
liberality towards your subordinates if to lenient in your subordinates, there
will be control and power = negligence y Democratic/participative o best style o
f leadership. Mutual style of nursing leadership 5 Power of a Good Leader y Legi
timate/ Formal/ exclusive Power o Exercise because you are appointed to a higher
position y Expert Power o You acquire extra ± ordinary skills, talent or ability
y Referent Power o Charisma and charm y Reward Power o + power for the part of t
he leader o gives rewards, bonus, promotion, compensation y Coercive Power o ± pow
er on the part of the leader o reprimand, suspend, terminate ABC¶s skills, qualiti
es and abilities y A ± Authority o basis of the leader to delegate tasks, responsi
bilities, jobs to be performed by his subordinates o 2 types of authority  Centra
lized ± top to bottom for proper management  Decentralized ± Bottom, to manage direct
ly y B ± Behavioral o S ± specialized body of knowledge and skills to do safe care
o o o
P ± patient centered A ± accountability ± liable for the results of your actions C ± con
fidentiality ± nurse-patient relationship  Exceptions to confidentiality of the con
tract : y P ± patient consent, if there is y I ± inform/report to healthcare team fo
r purpose of precautionary measures y C ± Communicable disease o RA 3573 Law on No
tifiable Disease o 24 ± Polio/ Measle o 1 Week ± SAD/ HIV/Tetanus Neonaturom y C ± Cri
mes o Child Abuse 48 hours, Baranggay, NGO y E ± ethics
IV THERAPIST: Old RN, Training, 50 Insertion, ANSAP New RN, Training y C ± Communi
cation skill o transfer of information with understanding o Communication barrie
rs/communication backlog ± eg. Dialect differences, noise, deaf, high level of anx
iety, hallucinating D ± Decision making skills o Steps  identify the problem  identi
fy person affected  gather options/alternative y brainstorming y delphitechnique ±
gathering solutions outside the group (eg. specialized nurse)  choose and impleme
nt  Evaluation E ± Ethics o Principles o Principle of Autonomy  independent judgment
or decision making  in all situation the pt himself is the one who should decide
for his own care  Consent y respect the decision of the pt y explain the risk to
the patient/SO y waiver - a legal doc when the pt refuse for treatment. o Princ
iple of Veracity  telling the truth to the patient  #1 the patient has the right t
o know from the PHYSICIAN (not the nurse) o Principle of Double Effects  if the p
t is made to choose between 2 equal danger and he only needs to choose one, choo
se the one that will produce one good effect and less evil effect. o Principle o
f Beneficence  doing good to the patient (eg. providing therapeutic communication
, providing privacy) o Principle of Non-Maleficence  do no harm  3 types of Harm y
Physical ± negligence by commission y Mental ± assault and battery y Moral ± slander
and libel o Principle of Justice  Prioritize the needs of the patient.  To be able
to provide nursing care to the patient, provide the nursing process.  Nursing Pr
ocess characteristics : y A ± acceptable universally y B - based patients assessme
nt needs y C ± client focused y D ± dynamics ± base on the ever changing needs of the
pt y E ± equitable care y F ± familiarity/rapport to the patient y G ± goal directed t
owards solving the assess needs of the patient (SMART) o Principle of Respect/In
violability of life  Suicide and abortion is violation of this principle F ± Face/s
olve Conflicts o any clash of ideas resulting to crisis o Methods of resolving c
onflict  avoidance ± by paying attention  smoothing ± appealing to ones conscience and
kindness  unilateral action ± use of forced fear or threat  negotiation ± best method
in resolving conflict. The head nurse should offer negotiation between conflict
ing parties.
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NURSING MANAGEMENT
NURSING MANAGEMENT  choosing the right person and giving them the appropriate tas
k for the purpose of achieving their goal/objective in achieving total care Fred
erick Taylor¶s Scientific Management Theory  Elements o choosing the appropriate pe
rson (TAO) o choosing the appropriate team o choosing the appropriate training o
choosing the appropriate tools Human Relations theory  the be a good manager, th
ere should be a good interpersonal relationship between the leader and follower
Douglas Mc Gregor¶s Motivational theory  Theory X o Negative workers o negligence,
inefficient, ineffective workers  Theory Y o Positive workers o diligent, effecti
ve, efficient worker  theory X should be given focus because they are prone to ne
gligence and malpractice. Max Weber¶s Bureaucratic/ authoritarian Theory  whoever i
s on the top would perform the management function  centralized Elton Mayto¶s Behav
ioral Theory  overtime pay, rest day, day off  provide physical needs of the worke
rs  Hawthorne¶s Effect o If workers knows they are observed they become more effici
ent Henry Fayol¶s Principle of Management  Unity of Command ± one leader, one command
 Unity of Direction ± one group should always have one goal  Remuneration of Person
nel ± patient first policy  Esprit de corps ± team spirit  Command responsibility/Resp
ondeat Superior ± let the superior answer the fault of his subordinates even harm
or death  Balance between centralization and decentralization  Security tenure  Del
egation of responsibility  Proper Compensation of workers o RA 7305 (Magna Carta
Law) ± salary grade 50 P13,000/month o Overtime pay ± additional of 25%/hr o Night D
ifferential ± additional of 10%/hr o Legal holiday ± x 2 o Philhealth - Benefit of w
orker both related and non-related work (aesthetic, dental and cosmetics are not
included) o Maternity leave ± 60days leave is NSD, 78days if CS only to first 4 p
regnancy only to legitimate spouse o Paternity leave ± 7day/1week leave o Senior C
itizen¶s Act ± 20% discount 5 steps in Management Process  Planning stage o looking a
head of time. o Formulating future goals/objective o Types of plan  Standard/Oper
ational Plan (NCP) y plans for everyday or ordinary activities  Strategic/Conting
ency Plan y plan used during sudden or acute crisis  Long-range/future Plan y pla
ns which you can¶t evaluated immediately. y Usually last months or yrs. y Used for
chronic pt which requires longer period of care. o Stages of Planning Process  M
ission ± present reason when established your organization  Vision - statement of y
our future purpose of your future organization  Philosophy ± set of values and beli
efs of your organization  Goal ± general statement of your purpose  Objectives ± more
specific statement of your purpose  Policies ± set of rules and regulations in your
organization

Procedures y Budgeting ± proper allocation of your resources o 3 types  Personnel y
Compensation for salaries of workers  Operational y everyday use of equipment an
d facilities (gloves, water, electricity)  Capital y long term use equipment (MRI
, CT Scan, hospital beds, hospital buildings)



Organizing o 4 stages  Organize your team RN Subordinates y Duties of the RN y On
ly assessment can perform the nurse y Only the nurse can perform HT y Only the n
urse should explain the procedure to the patient y Preparation, administration,
treatment of drugs to the patient y The nurse can only perform evaluation y The
nurse can only do judgment  Delegate Task y They can only delegate to subordinate
s the Routinary task (standard, unchanging procedure) eg. monitoring of I&O, bat
hing, ambulating, toileting, shampooing, transporting, feeding, clothing, wiping
y Stable patient - predictable outcome (eg. postmortem care with direct supervi
sion of the nurse only) y Supervision ± need guidance  Staff Schedule/ Staffing y S
chedules (How many hours) o Traditional ± 8hrs a day/40hrs/wk o Ten hour shift/4 d
ays a week o Baylor plan ± it consist of two shifting nurses  traditional ± mon-fri 8
hrs  2nd shift ± 12hr shift during weekends o Part-time work ± fewer working hours pe
r day and may choose the day or work. Less than 8hrs job o On ± call ± during shorta
ge of nurses/staff but increase in the number of patients.  Methods of Nursing ca
re Delivery y Different Methods o Primary ± 24hrs a day  Primary nurse is the only
nurse who is responsible to make a care plan of the patient from the moment of a
dmission till the moment of discharge. (eg. private duty nurse or special nurse)
o Functional Method  DOH format/government hospitals  Assign nurse : y Duty/task
y One nurse, one task y Highly recommended during a period of shortage of nurses
and budget  poorest method of delivery because communication is hindered o Case
Method/Case Nursing  provide total care within your shift. Used in ICU department
 C ± Case Method  T ± total care to the patient  O ± one is to one ratio Directing/Deleg
ation stage o a job or a task is done or performed by another perform for you o
What you cannot delegate:  you cannot delegate total control of the procedure  you
can¶t delegate discipline of subordinates or staff members.  Confidential task  Tec
hnical task  Medical task performing surgical procedure is done by the doc not th
e nurse Coordination/Collaboration o the nurse needs to collaborate to other mem
bers of the health care team. o Multi-interdisciplinary approach ± to be able to p
rovide holistic approach to the patient. o Types of Collaboration  Interpersonal/
Intradepartmental y One patient, one unit. y Collaboration between one nurse to
another healthcare team in one unit/department y Eg. MI patient - nurse, dietary
, specialized in cardio  Interdepartmental y 4 units in one hospital.

Coordination of the patients care between 2-more units/departments but still und
er one same hospital or institution y Eg. patient due for appendectomy is transf
erred to the OR  Inter Agency/Institutional y Coordination of patient¶s care betwee
n 2 or more hospitals/health care institution for the benefit of the patient y E
g. lying ± in due for C/S and was transferred to a hospital Evaluation/Controlling
o stage wherein you determine whether or not your plans for your patient is met
or achieved o Methods of evaluating staff performance  Checklist y it is being e
valuated higher than you. (eg. nurse manager/supervisor or head nurse)  Nursing r
ounds y it is being evaluated higher than you. (eg. Nurse manager/supervisor or
head nurse) y Psychiatric ward is not done by nursing rounds  Peer review y same
rank or level is being evaluated you y poor method  Performance appraisal y the p
atient evaluates you y best method in evaluation y