COLLEGE OF NURSING

LEARNING MODULES

COURSE CODE: NCM 107A

COURSE TITLE: Nursing Leadership and Management

PRE – REQUISITES: Fourth Year Standing

NO. OF UNITS: 4 units

CONTACT HOURS: 72 hours

PLACEMENT: 4th Year First Semester

COURSE DESCRIPTION: Application of concepts, principles, theories and methods of management and
leadership, as well as, the ethico-moral, legal and professional responsibilities
of a
nurse. The students are expected to perform beginning professional
management
and leadership skills, and apply sound ethico-moral and legal decision-making
in
the hospital and community-based settings. Students are likewise expected to
comply to the professional standards of nursing practice.

MODULE 1: CONCEPTS OF LEADERSHIP

OVERVIEW OF THE MODULE
The health care system is undergoing exponential change. Nurses are faced with
internal and external pressures that affect the functioning of the profession.
Changes in nursing roles and settings carry implications for how nursing care is
delivered and by whom. To cope with the complexity inherent in health care, it is
imperative that nurses become strong leaders. Nurses must take part in directing the
health care system, or risk having no voice in what it becomes. Nurses need to be
skilled collaborators who can lead interdisciplinary teams to accomplish great
things. This lesson examines some key concepts related to becoming a nurse leader
and manager.

LEARNING OUTCOMES Given actual clinical setting with minimal supervision the students will:
1. Distinguish the different concepts of leadership used in nursing management
2. Integrate principles and concepts of leadership in managing clients and teams
3. Critique the leadership theories as applied in nursing and health setting
resources to achieve expected health outcomes.
4. Discern the qualities of a good leader.

TERM PRELIM
WEEK 1-2 weeks
TIME ALLOTMENT 4 hours/week
CONTENTS Leadership
Refer to:
a. distinguished people in an organization (could be a president or the
highest-ranking officer of the company)
b. an ability - “the art of inducing subordinates to accomplish their
assignments with zeal of confidence.
c. a relationship- the relationship in which one-person (the leader) influences
others to work together willingly on related tasks to attain goals desired by
the leader and or group.

Leadership - is the state where a person or a group of persons is able to

influence others to agree on a goal and work towards it

That leadership occurs only:

 When the leader has successfully influenced the follower towards agreeing
on a goal and working towards it.
 For without the agreement and the effort of others to pursue the goal one
cannot speaks of any follower and the leader without a follower is no
leader and his leadership is not established.
Difference between a leader and a manager
 The leader is measured by how much influence he has in stimulating
people to strive towards an objective.
 The manager is measured by how much he has attained an objective using
not only human resources but non-human resources (money, materials,
methods, machine and time) as well.
 Leaders may or may not have official appointment to the position
 Managers are appointed officially to the position Leaders have power
and authority to enforce decisions only as long as followers are willing to
be led.
 Managers have power or authority to enforce decision
 Leaders influence others toward goal setting either formally or informally
 Managers carry out predetermined policies, rules and regulations
 Leaders interested in risk taking and exploring new ideas
 Managers maintain an orderly, controlled, rational and equitable
structure
 Leaders relate to people in an intuitive and empathetic manner
 Managers relate to people according to the roles
 Leaders feel rewarded from personal achievements
 Managers feel rewarded when fulfilling organizational mission/goal
 Leaders may or may not be as successful as managers
  Managers are managers as long as the appointments holds

NOTE:
 To be a good manager, one has to have leadership capabilities.
 A good leader, though, need not to be a good manager.
 A leader is a good leader because he can cause and direct people to move
towards an objective. But he can be at the same time the lousiest manager
because he is inefficient in the use of other resources. He does not have
any coherent plan. He has the slightest idea of proper control and
scheduling.
 A manager who is super-efficient but handicapped by poor leadership may
not stand a chance of becoming an effective manager, especially if his job
calls for a lot of interaction with people. There is no way he can cover up
and ignore the deficiency because to be able to use the non-human
resources for company purposes, the manager has first to activate or
inspire people . It is his people that do the dirty work that actually and
physically manipulate the resources for a given goal.

THEREFORE:
 A manager desiring to keep his job or anticipating to move up the
organization ladder, must learn and continue to sharpen his leadership
skills.

Manager - Leader
 Managers who are leaders choose and limit goals. They focus on
creating spirit and in doing so, they develop committed constituents.
 Manager –leaders empower their constituents
 Mistakes are tolerated by manager –leaders who challenge constituents to
realize their potential.
 Manager-leaders, they are concerned with modeling appropriate behavior
as symbols of values and norms.
 Effective manager- leaders are technically capable and provide assurance
in crises.
 Good leaders, like good managers, provide visionary inspiration,
motivation and direction. Good managers, like good leaders attract and
inspire. People want to be led rather than managed. They want to pursue
goals and values they consider worthwhile. Therefore, they want leaders
who respect the dignity, autonomy and self-esteem of constituents.

Theories of Leadership

1. Trait Theories - assumes that the capacity for leadership is inherent – that
great leaders are born, not made. Assumes that a person must have a
certain innate ability, personality traits or other characteristics in order to
be a leader.

2. “Great Man” Theory - tremendous influence of some well-known people

has actually determined or changed the course history. Some believe that
these people possessed characteristics that made them great leaders. Such
as important historical groups such as Caesar Alexander, Hitler, Gandhi,
 have been studied to find the characteristics that made these men leaders
of their time. The term “Great Man” was used because, at the time,
leadership was thought of primarily as a male quality, especially in terms
of military leadership.

3. Behavioral Theory - based upon the belief that great leaders are made,
not born. Focuses on the actions of leaders, not on mental qualities or
internal states. According to this theory, people can learn to become
leaders through teaching and observation. The primary difference between
the trait and behavioral theories are concerned with what a leader does
rather than who is the leader.

4. Situational Theory
a. Contingency Theory (Fred Fiedler) -in the contingency model,
three situational variables are used to predict the favorability of a
situation for the leader: the leader's interpersonal relations with
group members, the leaders' legitimate power, and the task
structure.

Three Situational Variables

a.1. Leader-member relations- the personal relationships between
the leader and the members of the group. (The better the
relationships, the more favorable the situation).

a.2. Degree of task structure- how specifically the job can be defined
so that everyone knows exactly what to do. (The more structured
the task, the more favorable the situation).

a.3. Position Power- the leaders place within the organization and the
amount of authority and power given to the leader. Position power
may be strong or weak; it does not reflect the strength of the
individual leader’s personality; rather it measures the leader’s
status in the organization. (The greater the position power,
the more favorable the situation).

b. Path -Goal Theory (Robert House) - Robert House's Path Theory,

introduced in 1971, is concerned with motivation and productivity.
According to this theory, the motivational function of management
is to help employees see the relationship between personal and
organizational goals, clarify the "paths" to accomplishing these
goals, remove obstacles to goal achievement, and reward
employees for the work accomplished.

c. Contemporary Leader-Manager Theories

(Theories X and Y Douglas McGregor)
 d. Theory Z (Ouchi) /participative approach to management Ouchi
(1981) expanded and enlarged on theory Y and the democratic approach to
leadership to create what he calls theory Z. Like theory Y, Theory Z has a
humanistic viewpoint and focuses on developing better ways tom motivate
people, assuming that this will lead to increased satisfaction and
productivity.

Theory Z was developed in part from a study of successful Japanese

organizations. It was adapted to the American culture, which is
different in some ways but similar in its productivity goals and
advanced technology. Elements of theory Z include collective
decision-making, long-term employment, slower but more
predictable promotions, indirect supervision, and a holistic concern
for employees.

5. Motivation Theories

a. Need Hierarchy Theory (Maslow) - Maslow (1943; 1954) stated that a

lower level need is prerequisite, or controls behavior until it is satisfied, and
then the next higher need energizes and directs behavior. Maslow's need theory
is frequently used in nursing to provide an explanation of human behavior. A
patient’s needs are viewed in this hierarchical order, with nursing care directed
toward meeting the lower level needs before addressing higher needs.

Abraham Maslow’s Hierarchy of Needs

 Self-actualization
personal growth and fulfillment

Belongingness and Love needs

family, affection, relationships, work group, etc

Safety needs
protection, security, order, law, limits, stability, etc
etc

b. Two Factor theories- Hertzberg (Theory of Job satisfaction) -

Hertzberg
enlarged on the theory Y approach by dividing the needs that affect a
person's motivation to work into two sets of factors: those that affect
dissatisfaction and those that affect satisfaction. He first set, called
hygiene
factors are those factors that meet a person's need to avoid pain,
insecurity,
and discomfort. If not met, the employee is dissatisfied. The second set,
called motivation factors are those that meet needs to grow
psychologically, when met, the employee feels satisfied. These are distinct
and independent factors according to Hertzberg. Meeting hygiene needs
will
not increase satisfaction, and meeting motivation needs will not
reduce dissatisfaction.

The hygiene factors include:

* Adequate salary
* Appropriate supervision
* Good interpersonal relationships
* Safe and tolerable working conditions (including reasonable policies and
procedures)

The motivation factors include:

* Satisfying, meaningful work
* Opportunities for advancement and achievement
* Appropriate responsibility
* Adequate recognition

c. Achievement Need Theory (McClelland) McClelland claimed that human

needs
are socially acquired and that humans feel basic needs for achievement,
 affiliation, and power.

Need for achievement is the drive to exceed one’s former accomplishments,

to
perform an activity more skillfully or effectively than before. A person with
high. Achievement need to spend much time thinking about how to improve
personal performance, how to overcome obstacles to improvement, and what
feelings will result from success and failure. McClelland claims that a person
with high achievement need to set moderate, realistic goals, enjoy problem-
solving activities, and desires concrete feedback on performance.

The need for affiliation consists of a desire for friendship, love, and
belonging
that causes a person to spend much time and planning how to establish
friendly
personal relations. Persons' with high affiliation need are sensitive to others'
feelings, support others ideas, and prefer jobs involving conversational give
and
take.

Need for power is the desire to control the means of influencing others and
resisting control by others. Persons with high power need to spend much time
thinking about how to gain authority, dominate decisions, and change others'
behavior. Such persons are likely to be articulate, demanding, and
manipulative
in dealing with peers and subordinates

d. Equity Theory (Adams) - Adams's (1965) equity theory of motivation

suggests
that an employee continuously compares her or his work inputs (skill, effort,
time) and outcomes (status, pay, privileges) with those of other employees. The
Employee perceives inequity whenever her/his rewards are disproportionate to
those received by other employees for the same amount of input. Feelings of
inequity motivate an employee to resolve the inequity by reducing input,
attempting to increase outcomes, selecting a different comparison worker, or
resigning. Equity does not in any way imply equality; rather, it suggests that
those
employees who bring more to the Job deserve greater rewards.

e. Expectancy Theory (Victor Vroom) - Victor Vroom's expectancy theory of

human Motivation indicates that a person's attitude and behavior are shaped by
the degree to which they facilitate the attainment of valued outcomes.
According to Vroom's theory, the amount of an employee's job effort depends
on
her or his perception of the relationship between good performance and specific
outcomes

Leadership Styles

1. Autocratic Leadership
 Concern for task accomplishment
 Seldom get ideas and opinions from subordinates
 Most effective in crisis situations
 “ Centric” leader
 Theory X by McGregor
 Boss centered
 Workers are lazy, need to be coerced, cannot be trusted,
indifferent
 Subordinates are more interested in financial incentives
  Workers fear the leader

2. Democratic, Participative, Consultative Leadership

 People oriented
 Collaborative spirit and joint effort exists
 Open communication prevails
 Performance standards exists
 Theory Y by McGregor
* Workers are ambitious
* Greater job satisfaction
* Few feelings of hostility and frustration
* Greater employee responsibility
* High productivity
* Desirable form of management

3. Permissive, Ultraliberal, or Laissez-Faire (allow to do)

• “let alone’ style of leadership
• Workers lack central direction and control
• “free-rein” leader
• Effective in highly motivated professionals
• Not useful in highly structured organizations
• Motivates by support when requested
• Disperses decision making to the group
• Provides little or no direction at all

4. Participative Style
• A compromise between authoritarian and democratic styles.
• Manager presents analysis of problems and proposals for action to
members of the work group, then makes final decisions.
• Most positive effects on employees with high need for
independence but strong authoritarian values
• Preferred when employee involvement in planning is needed to
overcome resistance and increase motivation but employees are not
sufficiently skilled in group dynamics to permit democratic style.

SERVANT LEADERSHIP
• is life and leadership in the service of the LORD
• Nurse leaders should use their gifts from God according to the grace
given to them. They should talk of God’s message if they are gifted
with the talent to speak in proportion to their faith: (if to serve they
should serve; if to teach they should teach; if to encourage people they
do so. They should share with others generously; if they have the
authority, they should work hard and they should show act of mercy
with cheerfulness. Romans 12:6-8)
• Servant Leadership in nursing is selfless commitment and devotion to
duty. It recognizes the necessity of
providing holistic care to the patient physically and spiritually. Nurse
leaders are duty –bound in the
promotion of spiritual environment or their patients.

TRANSFORMATIONAL LEADERSHIP
 • A transformational leader is one who “commits people to action, who
converts followers into leaders, and who may convert leaders into
agents of change”.
• Transformational leaders do not use power to control and repress
constituents. These leaders instead empower constituents to have vision
about the organization and trust the leaders so they work for goal that
benefit the organization and themselves.
• In nursing, empowerment can result in improved patient care, fewer
staff sick days, and decreased attrition.

• Nurses who are transformational leaders have staff with higher job
satisfaction and who stay in the organization for longer periods

REFERENCES: TEXTBOOKS:
Leadership roles and management functions in nursing 9th edition (2017), Marquis,
Philadelphia, Kluwer
OTHER REFEENCES:
Prioritization, delegation and assignment: practice exercise for the NCLEX
examination 4th Edition (2019), La Charity
Leadership for Health Professionals: Theory, Skills and Applications 3rd Ed (2018),
Burlington, Jones and Bartlett
Quality Improvement: A guide for integration in nursing (2018), Finkelman,
Burlington, Jones and Bartlett
Leadership and Management in Healthcare 3 rd Ed (2017), Gopee, N., London,
SAGE
JOURNALS:
Research and Theory in Nursing Practice
Nursing: The Peer Reviewed Journal of Clinical Excellence
Philippine Journal of Nursing Education
ELECTRONIC DATA BASE SUBSRIPTIONS:
Expanded Academic ASAP (Foreign Journal)
Philippine E-journals
Gale virtual library reference (E-book and E-references)

LEARNING ACTIVITIES/ I. Guided by this Rubric please answer the study guide questions below
ASSESSMENT WITH RUBRICS
5pts 4pts 3pts 2pts
 COMPLETION
Number of All questions At least 85% of 60% - 70% of Less than half of
questions successfully the questions the questions the questions
successfully completed were were were
completed successfully successfully successfully
completed completed completed

TYPES OF
RESPONSES

Response to All of the Most of the Sporadic but Less than half of
questions are responses were answers to the more than half the answer were
written in complete written in questions were of the answers written in
sentences complete written in were written in complete
sentences complete complete sentences
sentences sentences

QUALITY OF
RESPONSES

Quality of works Not sloppy, very Not sloppy and Somewhat Very sloppy and
(neatness) and legible, work is fairly legible, sloppy but can illegible. Work
conventions exemplary, has work consist of read some of the consist of too
adhered to it less than 4 5-9 spelling or writing. Work many spelling or
spelling or grammatical consist of 10-15 grammatical
grammatical error spelling or error
errors grammatical
error

ACCURACY

Answers / Close to 100% About 80% of About 60% of Less than half of
responses are on of the questions the questions are the questions are the questions are
point (correct) and are correct or correct or on accurate or on properly
well thought-out on-point, very point. Well point. Fairly answered with
well thought out thought out well thought out. little thought
responses

STUDY GUIDE QUESTIONS:

1. Why is it important for nurses to be a good leader? What qualities have
you observed from nurses of the units /wards (during you Level III
Rotation) that exemplify effective leadership in action? How do you think
these behaviors might have improved that outcomes of their patient?
2. Review the various leadership theories discusses in this module Which one
might apply to leading in today’s healthcare environment? Support your
answer with specific examples
3. Select an individual whose leadership skills you particularly admire. What
are some qualities and behavior that this individual displays? How do
these relate to the leadership theories discussed in this module? In what
ways could you emulate this person?

II. Given the following scenarios answer the following questions below guided
by this Rubric

CRITERIA PERFECT SCORE SCORE

Understanding of what the problem is and 25
where it may have arisen from.
 Identification of different facets of the 25
problem where possible interpretation
/discussion/ presentation; detailed analysis of
the problem.

For each solution is there a what, why and 25

how explanation for each proffered solution.

Application of the different introduced 25

principles, concepts, solutions to solve the
problem at hand.
TOTAL 100

Two new associate-degree graduates were hired for the pediatric unit. Both
worked three 12-hour shifts a week, Jan in the day-to-evening shift and Ronnie at
night. Whenever their shifts connected, they would compare notes on their
experience. Jan felt she was learning rapidly, gaining clinical skills and beginning
to feel at ease with her colleagues. Ronnie, however, still felt unsure of herself and
often isolated. “There have been times,” she told Jan, “that I am the only registered
nurse on the unit all night. The aides and LPNs are really experienced, but that’s
not enough. I wish I could work with an experienced nurse as you are doing.”
“Ronnie, you are not even finished with your 3-month orientation program,” said
Jan. “You should never be left alone with all these sick children. Neither of us is
ready for that kind of responsibility. And how will you get the experience you need
with no experienced nurses to help you? You must speak to our nurse manager
about this.” “I know I should, but she’s so hard to reach. I’ve called several times,
and she’s never available. She leaves all the shift assignments to her assistant. I’m
not sure she even reviews the schedule before it’s posted.”
“You will have to try harder to reach her. Maybe you could stay past the end of
your shift one morning and meet with her,” suggested Jan. “If something happens
when you are the only nurse on the unit, you will be held responsible.”

1. In your own words, summarize the problem that Jan and Ronnie are
discussing. To what extent is this problem due to a failure to lead? Who has
failed to act?

2. What style of leadership was displayed by Ronnie and the nurse manager?
How effective was their leadership? Did Jan’s leadership differ from that of
Ronnie and the nurse manager? In what way?

3. In what ways has Ronnie been an effective follower? In what ways has
Ronnie not been so effective as a follower?

4. If an emergency occurred and was not handled well while Ronnie was the
only nurse on the unit, who would be responsible? Explain why this person or
persons would be responsible.

5. If you found yourself in Ronnie’s situation, what steps would you take to
resolve the problem? Show how the leader characteristics and behaviors
found in this chapter support your solution to the problem.

MODULE 2: OVERVIEW OF THE FUNCTION OF MANAGEMENT

OVERVIEW OF THE MODULE

LEARNING OUTCOMES
TERM

WEEK

TIME ALLOTMENT

CONTENTS

REFERENCES

LEARNING ACTIVITES /
ASSESSMENT WITH RUBRICS