Nursing Leadership and Management

Leadership Effectiveness
 the use of one’s skill to influence others  able to accomplish your objectives within the resource
parameters
Kinds of Influence:  “doing the right things”
1. Assertiveness  related to leadership
 standing up for oneself and other’s without violating Efficiency
the rights of others  able to accomplish you objectives/ production of results
 Ex. You have chosen me as your leader... with minimum waste of time and effort
2. Rationality  “doing the things right”
 trying to convince someone by using reason, logic, or  related to management
supporting information Management
 Ex. We should do this because we need to give to the - Is the process of planning, organizing, directing and
patient total quality care controlling human and physical resources and technology
3. Ingratiation to achieve organizational goals / objectives?
 making an individual feel important or good before
making a request 7 Basic resources of management
4. Exchange 1. Manpower
 offering an exchange of favor 2. Money
5. Sanction 3. Machine
 coercive authority o bigger equipment; capital expenses; to start a
 give punishment for noncompliance or reward for business; costs more
compliance 4. Materials
6. Blocking o lesser/minor equipment; operation of
 backing up a request with a threat to damage an organization or unit
individual’s opportunity for advancement 5. Methods – process
 not really the best 6. Moment/Minutes – time management
7. Coalition 7. Market
 getting co-workers to back-up a request
8. Upward appeal ADMINISTRATION MANAGEMENT
 obtaining formal or informal support of a higher-up - Those at the top level of - Directly responsible to the
organization production of services
Levels of Leadership - Focus on establishing - Midline and lower levels of
- Personhood goals and on integrating hierarchy
o Respect work units to achieve the - Directs and guides the
o People follow because of what you are and organization’s mission operations of the
what you represent organization
- People Development Upper level manager:
o Reproduction - Primary responsible for establishing organizational goals
o People follow because of what you have done and strategic plans for the entire division of nursing
for them - Director of Nursing Services, Chairman, Executive Vice-
- Production President
o Results - 24/7 responsibility
o People follow because of what you have done Middle level manager:
for the organization - Usually coordinate nursing activities of several units
- Permission - Supervisor, coordinator, clinical nurse managers, case
o Relationships managers
o People follow because they want to - 24/7 responsibility
- Position First level manager:
o Rights - Directly responsible for the actual production of nursing
o People follow because they have to services; acts as links between higher level managers and
non-managers
Types of Leader - Head nurse (nurse manager), charge nurse (informal),
1. Formal team leader, primary nurse
 officially appointed, elected Authority
 managers - Legitimate right to give command, to make decisions
2. Informal - Ability to impose his or her with another person or group
 chosen by the group Power
 those who initiate an action - Ability to get results
- Given with authority
Management
 getting things done Powers a manager/leader may possess
 it is the process of getting activities completed efficiently - Legitimate power – based on position given
and effectively with and through people; production - Reward power - reward/incentives
 is the process of planning, organizing, directing and - Coercive power- give sanctions or punishment
controlling human and physical resources - Expert power
- Referent power
o Charisma – innate personality trait
o Connection

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 Nursing Leadership and Management
- Self (Personal) power – based on individual’s maturity, LEADERSHIP STYLES
credibility, reputation, experience, gender 1. Autocratic
- Information power – based on the individual’s access to  Makes decisions alone
valued data  Task oriented
 Power with coercion
Levels of Nurse Managers  Proves useful (even necessary) in crisis situation
1. Upper Level Manager  Authoritarian or exploitative style of leadership
 primary responsible for establishing  Satisfaction is low
organizational goals and strategic plans for the  Effective when needed for immediate action
entire division of nursing  High productivity, less satisfaction of workers
 director of nursing service, chairman, executive  2 Types accdg. to Rensis Likert (Systems 4 approach):
vice president i. Exploitative-authoritative
 nurse executives  Have little trust in employees and exclude
 Policy making body of an organization them in decision making
 oversee the activities of the lower levels ii. Benevolent-authoritative
2. Middle Level Manager  Are kind to employees but still do not
 usually coordinates nursing activities of several involve them in decision making
units  They ask the members
 supervisor, coordinator, clinical nurse managers,
case managers 2. Democratic
 oversee the activities of the lower levels  Involve their followers in decision making
3. First Level Managers  People oriented
 directly responsible for the actual production of  Leads to increase productivity and job satisfaction
nursing services  There is compliance
 acts as links between higher level managers and  Participative/Consultative
non-managers  2 Types accdg. Rensis Likert (Systems 4 approach):
 head nurse (nurse manager), charge nurse, team i. Consultative-democratic
leader, primary nurse  Seek employees advice about decisions
ii. Participative-democratic
Authority  Value employee involvement, teamwork
 legitimate right to give commands, to make decisions and seek advice in decision making
Power
 ability to get results 3. Laissez-faire
 ability to impose his or her will on another person or group  Loose and permissive
 Ultraliberal
MANAGERS LEADERS  Foster freedom for everyone and wants everyone to
Appointment Are appointed May or may not be happy
officially to positionhave official  Results in low productivity and employee frustration
appointment to  Most beneficial to a staff of highly motivated
position professionals
Power and Have power and As long as followers
Authority authority to enforce are willing 4. Bureaucratic
Goals Carry out Influnce others,  Lacks a sense of security and depends on established
predetermined either formally or rules and policies
policies, rules and informally  Tends to relate impersonality to staff
regulations  Avoids decision making without standards or norms for
Risk-taking Maintain an orderly, Interested in risk- guidance
controlled, rational taking and  Needed when discipline should be imposed
and equitable exploring new ideas
structure Types of Behaviour
Relationship According to their In an intuitive and 1. Passive or Non-assertive
with people own roles emphatic manner 2. Assertive – stand for oneself but doesn’t violate rights of
Self-reward When fulfilling From personal others
organizational achievements 3. Aggressive – violates rights of others
missions orgoals
THEORIES OF MANAGEMENT
Success as If they are May or may not be
1. Frederick Taylor
manager reappointed; successful manager
manager as long as  “Theory of Scientific Management”
appointment holds  Observed people in an electric plant
 Time and motion studies
 One best way to do the job
7 Basic Skills Required of a Leader/Manager
2. Max Weber
1. Conceptual skills
 The ideal form of organization is “Bureaucracy”
2. Technical skills
 With hierarchies—with rules and regulations
3. Human relations
3. Luther Gulick
4. Administrative skills
 Introduced the 7 activities of management as
5. Communication skills
“POSDCORB” - planning, organizaing, staffing,
6. Analytical skills
directing, coordinating, reporting.
7. Decision making skills

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 Nursing Leadership and Management
4. Henry Fayol  Rules of Delegation to Unlicensed Staff
 Developed the principles management and o Do not delegate the functions of
functions of management assessment, teaching, evaluation and
nursing judgement
 Fayol’s 14 Principles of Management: o Delegate activities that involve
i. Division of labor-you should know your job standard, unchanging procedures
ii. Authority, responsibility (pure obligation to o Delegate care of stable patients with
do the task to the best of your ability), and predictable outcomes; assessment as
accountability long as stable
iii. Unity of command  Task that may not be delegated
iv. Unity of direction – one path, goal, objective o Assessment
v. Scalar chain of authority and o Interpretation of data
communication-highest to lowest level; o Care of invasive lines
channels of communication o Performing triads during emergencies
vi. Interest of the whole organization over o Making a nursing diagnosis
interest of the individual o IV insertion
vii. Equity and justice
viii. Order (hierarchy, everything in order, in their  Span of Control
place) o Number of persons that the leader can
ix. Stability or tenure of personnel – rapid effectively manage
turnover would not benefit the organization o If noob-small span of control muna
x. Initiative-right to make their own projects,  PODC
decisions
xi. Centralization- upper level of hierarchy 5. Mary Follet
makes decision  Exercise power WITH people rather than power
xii. Discipline- follows rules over people
xiii. Remuneration - compensation  Participatory management
xiv. Teamwork and esprit de corps 6. Elton May
 “Hawthorne Effect”
 Command responsibility  Tendency of people to perform as expected
o Leader responsible for acts of because of special attention
subordinate  Should show concern to subordinates to increase
o Respondeat superior level of performance
7. Kurt Lewin
 Principle of Definition  3 phases of behaviour change
o Every employee must have a job o Unfreezing-identify what needs to be
description changed
o Changing – practicing, doing
 Principle of delegation o Refreezing- integrating into your daily
o Entrusting responsibility to others and to activities
create accountability for results 8. Peter Drucker
 Delegation  Management by objectives (MBO)
o Provides learning opportunities for  Be able to achieve your goals by having
subordinates objectives
o Increases power 9. Herbert Simon
o Cannot delegate total responsibility  2 approaches to decision making
o Do not delegate responsibility without o Optimizing-choosing the best possible
authorityg alternative; longer time to achieve
o Don’t just delegate boring jobs o Satisfying- first workable acceptable
 For nurses, delegation is not an option but a solution
necessity 10. Henry Mintzberg
 Proposed the managerial roles
 5 Rights of Delegation  Interpersonal roles
o Right Person o Figurehead role
o Right Task o Leader role
o Right Circumstance o Liaison role
o Right Direction/Communication  Informational Roles
o Right Supervision o Monitor
o Dissemination
 Causes of Underdelegating o Spokesman
o Waste of time to explain  Decision Roles
o Believes that no one else can do the o Entrepreneur
job o Disturbance handler
o Fear- fear of criticism, fear of failing to o Negotiator
get others to follow him o Resource allocator role
o The need to control or be perfect
o Enjoys the personal satisfaction
o Gained from doing the work herself

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 Nursing Leadership and Management
MOTIVATIONAL THEORIES  Fiedler’s Contingency theory
1. Maslow’s Hierarchy of Needs o Matches leadership style to situational
2. Douglas McGregor’s Theory X and Y factors
 Theory X o Good relationship with subordinates
o Man is lazy, dislike work, unmotivated o Knowledge is needed to accomplish a
 Theory Y task, use of relationship, power
o Man is self-motivated, enjoy their work  Situational Theory by Hersey and Blanchard
3. William Ouchi (Theory Z) o Depends on the situation-may be
 Involved workers are key to inc. productivity follower or leader
4. Ferdinand Herzberg o Considers the person’s readiness and
 Hygienic factors- working environment willingness
 Motivation factors-work itself 4. Path Goal Theory
o Give them work they really know  People act as they do because they expect their
behaviour to produce satisfactory results
Hygenic factors Motivation factors  Leader rewards followers for completing their task
(working environment) (work itself) 5. Contemporary Leadership Theory
- Adequate salary - Achievement  Collaboration and teamwork
- Appropriate supervision - Recognition Transactional Leadership
- Good interpersonal - Appropriate  Interaction between leaders and followers are
relations responsibility essentially economic- use rewards trade offs
- Safe and tolerable working - Opportunity for Transformational Leadership
condition advancement and  Focusing on change through its commitment to
- Job security achievement its vision
- Agency policies and  Empowering the subordinates
procedures Servant Leadership Theory (Greenleaf, 1977)
 Leaders put serving others as number one priority
THEORIES OF LEADERSHIP Shared Leadership/Governance
1. Trait Theories – who the leader is  Several individuals and subordinate share the
 Great Man Theory (Aristotelian) responsibility in achieving the organization’s
o Leaders are born, not made goals
 Charismatic Theory Quantum Leadership
 Trait Studies  Should be updated, innovative and creative
o integrity, intelligence, initiative, industry  Initiate to update himself
o popularity, sociability, dependability Multiple Intelligence
2. Behavioral Theories – what leader can do  Recognizes the different abilities affect
 Lewin, Lippit and White leadership
o Leadership Styles Emotional Intelligence
 Rensis Liker  Understand feelings of others
o Systems 4 approach Cultural Bridges
 Blake and Mouton  Leaders/managers must become culturally
o Managerial Grid sensitive
o Country Club-high concern for people,
low on results FUNCTIONS/PROCESSES OF MANAGEMENT
o Impoverished-low concern for people
and results PLANNING
o Middle of the road - Deciding in advance what, where, how, when and who is
o Authority Compliance-high concern for to do future actions
results, low for people - Is a continuous process of assessing, establishing goals and
o Team- high concern for people and objectives, implementing and evaluating them which is
results subject to change as new facts are known

1,9 9,9 4 Planning modes:

Managemen Managemen 1. Reactive Planning – occurs after a problem exists;
t t done in response to a crisis
Country Club Team 2. Inactivism – a type of conventional planning
5,5 where the person considers the STATUS QUO as
Managemen stable environment
t 3. Preactivism – utilizes technology to accelerate
Middle of the change and is future-oriented; do not value
Road experience and the past; future is always
1,1 9,1 preferable
Managemen Managemen 4. Interactivism or Proactive – considers the past,
t t present and future; done in anticipation of
Impoverished Authority changing needs
compliance

3. Contingency-Situational Theories
 Adapts leadership style depending on situation

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 Nursing Leadership and Management
Levels of Planning in Nursing:  Budgeting Methods
1. Strategic Planning o Incremental
 3-5 years years or more  Flat percentage increase method
 In charge of whole organization  Consider the inflation rate (around
 CEO, division heads, chief nurse 20%)
 Exists farther in the future  Multiply the current year expenses
by the inflation rate
2. Intermediate Planning
 6 months-2 years o Zero-based
 Supervisors, clinical specialist  Requires managers to justify in
detail the cost of all programs both
3. Operational Planning and and new
 1 week-1 year o Sunset Budget
 Managers of nursing units, head nurse, charge  Is designed to self-destruct within
nurse, primary care nurse, team leader the prescribed period to ensure
cessation of the funder program by
Scope of Planning a predetermined date
1. Forecast  Are fixed expenses that cannot be
 Estimate the future recovered even if a program is
 Short or long range projections cancelled
 Vision
o Mental image of something not actually *Participation by nursing personnel in planning and
visible, dreams, aspirations controlling budget leads to cost consciousness
 Mission
o Purpose or brief statement identifying  Time Management
reasons why organization exists o Making optimal use of available time
 Philosophy o More work with less time
o Articulates a vision and provides statement o Work smarter not harder
beliefs and values that guide one’s practice  3 Steps in Time management
 External and Internal Assessment o Establish priorities
o SWOT Analysis o Finish one task before beginning another
 Know the strength to overcome the o Reprioritize
weaknesses; Know the  External Time Wasters
opportunities to overcome the o Telephone interruptions
threats o Socializing
2. Set Goals/Objectives o Meetings
 Goals-broad o Incomplete coworkers
o Achieve goals through OBJECTIVES o Paperworks and readings
 Objectives- specific  Internal Time Wasters
o SMART o Procrastination
o Behavioral o Poor planning
3. Develop and Schedule Strategies, Programs, Activities. Set time o Inability to say NO
frame. o Failure to set objectives
 Strategy o Inability to delegate
o Overall plans of the higher management
system 5. Establish polices, control standards and evaluation procedures
 Programs  First step in evaluation
o Series of activities that function together to  Standards
facilitate attainment of some desired goals o Indicate the minimal level of achievement
4. Prepare Budget accepted to meet the objectives
 Allocation of resources or systematic plan of meeting o Pre-determined level of excellence that
expenses serves as a guide for practice
 Purpose is TO SET operating cost limits  Types of Standards
 Approaches/Systems of Budgeting o Structure
o Centralized-upper level makes the budget  Those that focus on the structure or
o Decentralized- middle and lower level management system used to
managers sets the budget then gives to deliver care including number and
upper level management categories of personnel
o Process
 Types of Institutional Budget  Refers to actual procedure, those
o Capital Budget activities engage in to administer
 Lands, buildings, major equipments care
 greater than 50,00 o Outcome
o Operating Budgets  Result of the procedures and
 Includes cost of supplies, minor nursing care
equipment repairs and overhead  What results (if any) occurred as a
expenses result of specific intervention
o Manpower Budgets
 Salaries and wages

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 Nursing Leadership and Management
 Policies o Flat, decentralizaed
o Are guides of basic rules that define the  Systematic delegation of power
general course and scope of activities and responsibility to middle and
 Procedures lower levels of the organization
o Step by step guide to action o Matrix
 Rules  A second structure overlies the first
o Describe the situation that allow only one creating two directions for lines of
choice of action authority, accountability and
communication

ORGANIZING
 Involves establishing a formal structure to provide for the FLAT PYRAMIDAL
coordination of resources to accomplish objectives Authority Decentralized Centralized
# of levels Fewer More
Scope of Organizing Span of Control Broad Narrow
1. Organizational Structure Delegation Greater Lesser
 Refers to the way a group is formed including its: Control over Lesser More
CHANNELS OF AUTHORITY, SPAN OF CONTROL AND subordinates
LINES OF COMMUNICATION Type Modern Traditional
 Is a mechanism through which work is arranged and
distributed among members of the organization to 2. Staffing
achieve goals and objectives
 Assigning people to fill roles designed for the
 Organizational Relationship organizational structure
o Formal or Reporting-straight line  Process of determining and providing the accepting
o Informal or coordinating- broken line personnel to produce a desired level of care to meet
the patient’s demand
Organization  Steps:
 signifies an institution or a functional group with a formal o Recruitment
intentional structure of roles or positions o Selection/interview
o Hiring
Organizational Culture o Induction and orientation
 consist of norms and traditions maintained  Complete requirements you
 deep rooted assumptions, beliefs and values that are
haven’t made
handed down from one generation to another
 Organizing Patient Care
 3 types of culture  5 Primary Means of Organizing Care For Patient
o Positive culture
Delivery :
 Proactive and interactive to meet their
1. Total Patient Care or Case Method
satisfaction needs – based on
 Oldest mode of organizing patient care
humanism, achievement, self-  Nurses assume total responsibility for
actualization meeting the needs of all the patients
o Passive-agressive
assigned
 Based on approval, dependent, and
avoidance norms 2. Functional
o Aggressive-defensive
 Evolved as a result of WW2
 Based on power, oppositional,
 Task-oriented
competitive, and perfectionistic norms
3. Team
Organizational Climate  Term by RN
 is the own perception of characteristics of an organization
 Ancillary personnel collaborate in
 behaviour, attitudes and feelings of personnel providing care to a group of patients
 Types of Organization by nature of Authority  Requires extensive team
o Line organization communication and regular team
 Each position has general authority
planning
over the lower position in the
hierarchy 4. Modular
 Backbone of the organization
 Like team nursing, but uses a smaller
o Staff/Matrix
team (buddy system)
 Purely advisory, with no authority to  Pairs professional nurse with ancillary
place recommendations to action nurse
o Functional
 A specialist aid line positions within
5. Primary Care
a limited and clearly defined  From admission to discharge
scope of authority  As originally designed, requires an all-RN
staff
 Forms/Patterns of Organizational Structure  24 hours responsibility for planning the
o Tall, pyramidal, or Centralized care of one or more patients
 Systematic retention of power and  During work hours, the primary nurse
responsibility at higher levels of
provides direct care to those patients
organization

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 Nursing Leadership and Management
 Job Title
 Managed care – an agency or corporation contracts  Job relationship
with a group of providers to deliver specific services  Performance description
for a limited cost per enrollee

 Case Management DIRECTING

 Refers to a service carried out by professionally
trained individual who provides and or
coordinates health or social services
 Coordinates care throughout an episode of
illness
 Critical pathways-tools or guidelines that direct Scope of Directing
care by identifying expected outcomes
 Even before and after discharge 1.
2.
 Population-based health Care/ Disease Management
 Focus is on the covered lives or populations
of patients with chronic illness rather than on
individual illness
 Explaining what is to be done, to whom, at what time, how
and why
 Is the issuance of assignments, orders and instructions that
permit the worker to understand what is expected of him
Delegation
Supervision
 Guiding and directing the work to be done, helping
the individual do his work better
 Assess the capability of the individual if he needs
supervision

 Differentiated Nursing Practice 3. Coordination

 Delineates nursing roles based on their skills,  Develop linkages/network
knowledge, educational level and  Interdepartmental coordination
motivation o Medical team
o Radiology Dept.
 Patient-focused Care  Preparation for a procedure
 Is a delivery model that brings all services  Time schedules for special exams
and care at the bedside  Proper notification of the nursing
service upon complication of
 Patient Classification System procedures
o A method of grouping patients according to
the amount and complexity of their nursing o Lab Services
care o Administrative Services
o Self-Care- 1.5 hours; patients are capable of  Chief Nurse
carrying out ADLs  Recruitment
o Intermediate- 3 hours; requires some help  Promotion
from the nursing staff with special  Procurement of supplies and
treatments, or certain aspects of personal equipment
care; IVs, colostomy  Budget preparation
o Total Care-4.5 hours; a bedridden patient
who lacks strength and mobility to do ADLs o Medical Records
o Intensive care- 4.5-6.5; a critically ill patient  Safeguarding
who is in constant danger of death or serious  Maintaining
injury  Processing medical records

 Scheduling o Dietary Service

o A timetable showing planned work days and  Notification of new admission
shifts of a nursing personnel  Patient transfers
 Discharges
 40 hour per week load (RA 5901) – less than 1,000,000  Specialty items for VIP admissions
but more than 5,000 they can be required for 48 hours and employees
o 8 hours X 5 days
o 10 hours X 4 days o Medical Social Services
o 12 hours X 3 days  Patient’s record
 Health education for patient,
 Types of Scheduling: relatives and watchers
o Centralized – upper level schedule  Referrals for patients in need of
o Decentralized-senior nurses schedule blood, medicine, financial and
o Cyclical/Block- 2 week period same material assistance
schedule. With off for a weekend
o Permanent Shifts- o Pharmacy
o Variable-floaters  The pharmacy should provide the
nursing service with the established
 More nurses in the morning. 45%, 37% and 18% hospital Drug Formulary including
effective and administration of
3. Job Descriptions medicines through the Unit drug
 Are specifications of duties, conditions and Dose System (UDDS)
requirements of a particular job, also called
performance description

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 Nursing Leadership and Management
 Principles:  Categories of Conflict
o Responsbilities of each dept./ service should o Interpersonal
be clearly defined and understood by all  Also known as horizontal violence
o Policies, guidelines, SOPs on or bullying
interdepartmental relationships should be o Intrapersonal
made available to all o Intergroup
o Schedules of different dept. should be  Conflict Resolution Outcomes
synchronized and adhered to o Win-win
4. Communication o Win-lose
 Process by which a message is sent, received and o Lose-lose
understood as intended
 Ensuring common understanding  Ways of Resolving Conflict
 Flow of Communication o Avoiding
o Downward-highest to lowest  Parties are aware of a conflict but
 Memos choose not to acknowledge it or
 Directives attempt to resolve it
o Upward-lowest to highest  Lose-lose
 Incident reports o Compromise
o Horizontal- peer groups  Each party gives up something it
 Endorsement wants
 Types of Communication  Lose-lose
o Formal o Competing
 passes through the hierarchy  One party pursue what it wants
o Informal regardless of the cost to others
 no agenda needed  Win-lose
o Verbal o Accommodating
 Conferences  One party sacrifices his beliefs and
 Endorsement wants to allow the other party to
 staff meetings win
 change of shift reports  Lose-win
o Written o Smoothing
 patient’s chart  An individual attempts to reduce
 memos the emotional component of the
 directives conflict
 manuals of operation  Win-lose
o Grapevine (Informal) o Majority Rule
 effective nurse manager uses the  Trying to resolve conflict by majority
grapevine advantageously by rule
maintaining an open and trusting  Win-lose
relationship through the use of o Dominance and Suppression
formal communication channels  One side is forced to give way to
and by giving pertinent information the other side
to liaison, influential or key people  Loser is left feeling angry and
 Tell one then it the one told will tell frustrated
another  Win-lose
 Risk for distortion of message; o Collaborating
correct immediately  An assertive and cooperative
means of conflict resolution
 Barriers to Effective Communication whereby all parties set aside their
o Physical Barriers- environmental factors original goals and work together a
 Distance supraordinate or common priority
 Noise goal.
 Ventilation  Win-win
o Social-psychologic- from judgements,
emotions and social values of people such  Organizational Stresses
as lack of trust and respect o Task demands
 Transference of patients  Are associated with the specific
 Emotionally unstable task
o Interpretation of meanings and semantics  A nurse called during cardiac
 Oral arrest
 Written- POS o Role demands
 Repeat order to doctor in  Stress may result when there is role
telephone orders ambiguity
o Physical demands
5. Management of Conflict  Back strains, feet problems, allergy
 Conflict to some solution
o The internal or external struggle as a result of o Interpersonal demands
differences in ideas, values, or beliefs of two  Associated with relationships within
or more people organizations

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 Nursing Leadership and Management
 Benchmarking
6. Staff Development o Is a technique whereby an organization
 In-service training programs seeks out the BEST PRACTICE in its
o Orientation industry to improve its performance
o Skills training
o Leadership training 2. Monitor and evaluate nursing care services utilizing various
o FREE methods
 Continuing education programs  Quality Assurance
o Seminars o Monitoring compliance with established
o Workshops standards
o Symposiums  Total Quality Management
o Specialty nursing trainings o Also referred to as continuous quality
o Given by other accredited agencies improvement
 PNA, Heart Centre o Doctor Edward Deming
o With payment from nurse o Focus is on doing the doing the right
things, the right way, the first time, all
7. Decision Making the time and problem prevention,
 Decision-making tools planning, not inspective and reactive
o Gantt chart problem solving
 tool used to visualize multiple tasks  Nursing Audit
that need to be done o Method for assuring documentation of
o Decision tree quality of nursing care in keeping with
 graphic tool to visualize established standards
alternatives available, chance o Types:
events and probable  Open chart review or concurrent
consequences process- patient is still in the
o CPM (Critical Path Method) hospital; check charting;
 calculate time estimate for observation of patient care
activities  Closed chart review or
o PERT (Program Evaluation and Review retrospective process- patient is
Technique)- identifying key activities in a discharged
project, sequencing activities in a flow
diagram  Performance Appraisal
 Review previous activities before o Evaluated by supervisors
moving forward o Method of evaluating accomplishments
to help employees improve his work
CONTROLLING methods
 Assessing/regulating performance o When done correctly, it is one of the
 Process of seeing that actual expenditures and activities greatest tools an organization has to
conform to plan develop and motivate staff
 Quality Control o When done poorly, it has the potential
o Activities that evaluate, monitor, or regulate to discourage and demotivate
services rendered to consumers
 Types of evaluation responses
Total Quality Management o Free Response Report
Management  Comment in writing on the
Quality Improvement quality of the nurse’s
Improvement performance
Quality Assurance o Performance Checklist
Prevention  Indicate in a checklist the
Quality Control behaviour desired in the
Inspection performance
o Simple Ranking
Scope of Controlling  Employee is ranked in relation
to his co-workers
1. Establish standards for measuring performance o Graphic Rating
 No one set of standards fits all organization  Use graph or a numerical
 Standards must be SMART scale
 Criteria/Indicators of Standards o Forced-choice Comparison
o Characteristics used to measure  Choose from a group of
performance weighted descriptive
 Audits Frequently used in Quality Control statements those that best
o Structure Audit describe the nurse
o Process Audit
o Outcome Audit  Common Errors of Evaluation
o Halo error
 Good things done
overshadow errors

University of Santo Tomas – College of Nursing / JSV

 Nursing Leadership and Management
o Horn’s
 Poor performance  Four Common Steps in Progressive Discipline
overshadowed good 1. Informal reprimand or verbal
performance admonishment
 underrated 2. Formal reprimand or written
o Logical error admonishment
 First impression 3. Suspension from work without
o Central tendency error pay
 All treated as average 4. Termination
o Leniency error
 Given mercy rating 4. Meeting change confidently
 Planned Change
 Quality Program Evaluation o Overt-one that people are aware of
o FOCUS-PDCA model o Covert- hidden or occurs without the
o Provides a systematic method to study individual’s awareness.
a work process for improvement. It  May be gradual or sudden
includes:
 Find a process to improve  Unplanned Change
 Organize a team that knows o Is an alteration imposed by external
the process events or persons and occurs when
 Clarify current knowledge of unexpected event, force or reaction
the process  All major change brings feelings of achievement,
 Understanding causes of loss and stress
process variation
 Select the process  Change Agent Strategies
improvement o Empirical-rational
 Plan the improvement  People are willing to adapt or
 Do data collection, data change if it is justified and if
analysis and improvement they are shown how they can
 Check data process benefit from the change
improvement and costumer o Normative-reeducative
outcome  Are based on the assumption
 Act to maintain and continue that people act according to
improvement their commitment to socio-
cultural norms
3. Employee discipline  Staff development through
 Is the process of generating employee training groups
compliance with the institutional rules and o Power-coercive
regulations  When you comply to the
 Problem employees: rule breakers, marginal plans, direction of the more
employees (working but do not exert effort to powerful
improve), and chemically or mentally impaired  Strikes, sit-ins, negotiations
 Principles of disciplinary action
o Have a positive attitude 5. Legal and ethical control
 If they are treated as suspects
they are more likely to provide
the trouble that the manager
anticipates
o Investigate carefully
o Be prompt
o Protect privacy
o Focus on the act
o Enforce rules carefully. Use extreme
caution in instituting disciplinary
measures
o Be flexible
o Take corrective, constructive actions
o Should be progressive in nature
preceded with counselling
 Counselling
 Verbal reprimand
 Written reprimand
 Short suspension
 Long suspension
 Dismissal/Discharge

University of Santo Tomas – College of Nursing / JSV