LEADERSHIP THEORIES

NURSING 1) GREAT MAN THEORY

❒ Great leaders are born & not made
LEADERSHIP & ❒ Leaders are in the DNA
❒ E.g. Royal families
MANAGEMENT 2) TRAIT THEORY
❒ Persons have certain innate abilities,
personality traits or other characteristics to
LEADERSHIP & MANAGEMENT be leader
LEADERSHIP/ MANAGEMENT/ a) Physical attributes
leaders managers b) Intelligence attributes
influencing the behavior Directs actions towards 3) CHARISMATIC THEORY
or actions of a person or common goals ❒ Leaders possess an inspirational quality and
group to attain to the emotional commitment from followers
desired objectives
❒ E.g. Religious leaders, Politicians
May or may not have Holds an assigned
4) CONTINGENCY THEORY/SITUATIONAL
recognized authority in position
the organization THEORY
❒ Leader’s ability to lead depends upon the
Power to influence others Decision making powers situation
Effective communication Control over certain
5) PATH GOAL THEORY
and interpersonal skills processes
❒ Focuses on motivation and productivity
❒ Positive Reinforcement (Rewards) increases
CHANGE: STRATEGIES the repetition of a GOOD behavior
a) EMPIRICAL-RATIONAL ❒ Negative Reinforcement (Punishment)
❒ Objective Data decreases the repetition of a BAD behavior
❒ Logic & Reason ❒ E.g. Improving attendance and punctuality of
❒ E.g. you encourage your friend to stop staffs:
smoking, how would you do it? ✔ Giving recognition
✔ “Smoking is detrimental to your 6) TRANSACTIONAL THEORY
health and it causes lung disease” ❒ Reward & punishment
b) NORMATIVE-REEDUCATIVE ❒ NOT long-lasting
❒ Teaching to adapt more socially 7) TRANSFORMATIONAL THEORY
acceptable alternatives ❒ Inspirational
❒ E.g. Smoking 🡪 Chewing Gum ❒ Transforms personalities and behaviors of a
c) POWER-COERCIVE person within
❒ With force
❒ E.g. Graphic images in the cigarette boxes

KURT LEWIN’S THEORY OF CHANGE

1) Unfreezing
❒ Realization a need for change
2) Moving
❒ Planning & implementation of the change
❒ E.g. Using 10 cigarette packs to 7 packs
3) Refreezing
❒ New habit/behavior becomes stable and
is integrated in one’s life
LEADERSHIP STYLES
A. THEORY X & THEORY Y
AUTOCRATIC DEMOCRATIC LAISSEZ-FAI
RE ❒ Theorized by: Douglas McGregor
THEORY X THEORY Y
Bureaucratic Consultative Ultraliberal/
Permissive Goal of organization Goal of individual
People dislike work and Seek responsibility &
STRONG LESS control NO control will avoid it display imagination
control
Workers have no Workers have
Gives order Offer suggestion Non-directive ambition but desire self-direction
Does the Makes Gives up security
decision suggestions decision Motivation by fear & Motivation by praise &
making threats recognition
LEADER does The GROUP NO planning
the planning does the
B. BLAKE-MOUTON MANAGERIAL GRID
planning
Directive Participative Uninvolved ❒ Theorized by: Robert Blake & Jane Mouton
Foster Foster Foster chaos ❒ People & Production
Dependence independence
MOST effective Most desirable Effective in
in crisis form of highly
intervention management motivated
professionals

MANAGEMENT THEORIES
1) Scientific Management
2) Classic Organization
3) Human Relations
4) Behavioral Science
 ❒ To present a clear picture of the many causal
relationships between outcomes and the
contributing factors in those outcomes.

C. PRINCIPLES OF MANAGEMENT
1) PARETO PRINCIPLE (80-20 PERCENT RULE)
❒ 80%: Output/Results
❒ 20%: Inputs/Efforts
2) PRINCIPLE OF LEAST EFFORT
❒ People choose for convenience
❒ Creates processes in least efforts for
convenience of people

GANTT CHART
❒ Made by: Henry Gantt
❒ To graphically depict the timeline fort
PDCA (Plan, Do, Check, Act)
long-term and complex projects, enabling a
❒ To control and continuous improvement of
team to gauge its progress
processes and products

MANAGEMENT ROLES
SIPOC (Suppliers, Inputs, Process, Outputs, Customers) 1) INTERPERSONAL
❒ To identify the basic elements or variables in a 1) Acts as a representative
process 2) INFORMATIONAL
2) Acts as a source & channel of information
3) DECISIONAL
3) Acts as a troubleshooter & decision maker

FUNDAMENTALS SKILLS OF MANAGERS

❒ According to KATZ,
1) TECHNICAL
✔ Use right techniques
✔ Proficiency
2) HUMAN
✔ Communication & interpersonal skills
FISHBONE DIAGRAM (Ishikawa Diagram) 3) CONCEPTUAL
✔ To see details
PLANNING
❒ Decide in advance
❒ Predetermined course of action to an
organization
❒ Forecast estimated future
❒ Set objectives
❒ Develop and schedule programs
❒ Prepare budget allocate resources 2) INTERMEDIATE PLANNING
❒ Establish policies. Procedures, definite course ⮚ MEDIUM term
of action ⮚ 6 months -1 year
❒ SCOPE: 3) OPERATIONAL PLANNING
1) STRATEGIC PLANNING ⮚ SHORT term

⮚ LONG term ⮚ Daily, weekly, monthly, quarterly

⮚ 2-5 years ⮚ Direct patient care
⮚ VISION: FUTURE plans ⮚ Scheduling & staffing
⮚ MISSION: Reason or existence
BUDGET: PRINCIPLES OF ORGANIZING
❒ Final road map that estimates future costs 1) Unity of Command
and a plan for utilization of resources ❒ Designated to ONE leader
1) OPERATING BUDGET 2) Scalar Principle/Hierarchy
a) REVENUE BUDGET: ❒ Chain of Command
✔ expected outcome ❒ Staff Nurse 🡪 Head Nurse 🡪 Nurse
b) EXPENSE BUDGET: Supervisor 🡪 Chief Nurse
✔ Supplies (replenishable), utilities, 3) Departmentalization
employee’s salary, etc. ❒ Homogenous Assignment
2) CASH BUDGET: 4) Span of Control
❒ actual cash flow ❒ Scope of Authority
3) CAPITAL EXPENDITURE BUDGET: 5) Decentralization
❒ expensive items but used long term ❒ POWER is distributed
❒ E.g. machines, infrastructure, etc.

ORGANIZING
❒ Establishing formal authority
❒ Authority
❒ Accountability
✔ Being answerable for one’s own actions
❒ Responsibility ORGANIZATIONAL CHART
✔ Obligation to perform a task ❒ DIAGRAMMATIC PRESENTATION of the
❒ Set-up organizational structure organizational structure
❒ Identify groupings, roles and relationships ❒ A line drawing that represents the
❒ Determine staff needed relationship of the staff.
❒ Develop description
❒ Define qualifications and functions of personnel STAFFING
❒ Allocating acceptable number of nursing and
non-nursing personnel
❒ Process of determining and providing the
acceptable
MANAGEMENT LEVELS
SCHEDULING
1) TOP ❒ Timetable showing planned work days and
✔ Chief Nurse shifts for nursing personnel
✔ Administrators of the Hospital
2) MIDDLE PATIENT CARE CLASSIFICATION
✔ Nurse supervisors ❒ Method of grouping patients according to
amount and complexity of nursing
✔ Clinical managers
requirement
✔ Clinical coordinators
LEVEL 1: MINIMAL ❒ For discharge
3) FIRST
❒ Non-emergency
✔ Head nurses
❒ 1.5 hours per day
✔ Senior nurses
4) OPERATIONAL LEVEL 2: MODERATE ❒ Same help with
✔ Frontliners ADLs, IV, VS
✔ Staff nurses ❒ 3x/shift
✔ Nursing attendants ❒ 2hours per day
 LEVEL 3: ❒ Completely ✔ Staff Nurses to Chief Nurse
TOTAL/INTENSIVE dependent ✔ E.g. Incident report, Grievance
❒ VS every 40 (complaints)
minutes 3) HORIZONTAL
❒ 6 hours per day ✔ Within the same level
✔ Staff Nurses-Staff Nurses
✔ E.g. Endorsement (End of shift Report)
LEVEL 4: CRITICAL ❒ Continuous 4) OUTWARD
observation ✔ Outside to other organization
❒ 6-9 hours or ✔ Staff Nurse to Patient
higher per day 5) GRAPEVINE
✔ E.g. Hearsays, gossips, rumors
RATIO OF PROFESIONALS AND
NON-PROFESSIONALS DELEGATION
LEVEL I 55:45 ❒ Process by which a manager assigns specific
LEVEL II 60:40 tasks/duties to workers with commensurate
LEVEL III 65:35 authority to perform the jobs.
LEVEL IV 70:30 or 80:20
WHAT CANNOT BE DELEGATED?
1) Overall responsibility, authority &
DISTRIBUTION PER SHIFT
Accountability
AM 45%
2) Sign one’s name
PM 37%
NIGHT 18% 3) Evaluation ort taking necessary corrective or
disciplinary action
4) To maintain morale of staff
DIRECTING 5) Those too technical
❒ Issuance of orders, assignments, and 6) Those that involve trust and confidence
instructions that enable the nursing personnel
❒ Delegating nursing care assignments NURSING CARE ASSIGNMENT
❒ Utilize/revise/update policies and procedures 1) FUNCTIONAL NURSING
❒ Supervise harmonize goals through guidance
❒ Divide work to be done
❒ Coordinate unite personnel and services
❒ Communicate ensure common understanding 2) TOTAL CARE NURSING
❒ Develop people, provide staff development ❒ Nurse responsible for total care for
programs meeting all needs of assigned patients for
❒ Decide, make judgment the shift
❒ E.g. ICU units
3) TEAM NURSING
ELEMENTS OF DIRECTING ❒ 1 nurse leads a group of nursing
1) U 4) PRIMARY NURSING
❒ Accountability stays in ONE nurse
❒ 24/7
COMMUNICATION ❒ 1 nurse: 4-6 patients (small group)
1) DOWNWARD 5) CASE METHOD
✔ TOP to BOTTOM ❒ Crosses all settings
✔ Chief Nurse to Staff Nurses ❒ Stays with patient on their entire period
✔ E.g. Performance appraisal of illness
2) UPWARD
✔ BOTTOM to TOP SUPERVISION
 ❒ Providing guidelines for the accomplishment ACCOMODATION ONE PARTY GIVES UP
of a task or activity with initial direction and TO THE OTHER SIDE
periodic inspection (WIN-LOSE SITUATION)
COMPROMISE MEETING HALFWAY
STAFF DEVELOPMENT
(LOSE-LOSE BOTH PARTIES GIVE UP
❒ Providing structure and assistance for SITUATION)
employees to learn more COLLABORATION BOTH PARTIES
1) ORIENTATION: for new employees MUTUALLY HELP EACH
2) IN-SERVICE EDUCATION: provide by (WIN-WIN SITUATION) OTHER
employers
3) SPECIALTY COURSES: COMPETITION CONTEST
4) FORMAL EDUCATION: Master’s Degree,
(WIN-LOSE SITUATION)
Doctoral Degree

CONTINUING PROFESSIONAL DEVELOPMENT CONTROLLING

(CPD) ❒ Performance appraisal
❒ PRC license validity for renewal: 3 years on the ❒ Quality Assurance
birthdate of the nurse ❒ Nursing audit
❒ Attending seminars, trainings, etc.
❒ RA 10912: CPD Act of 2016 PERFORMANCE APPRAISAL: TARGET🡪 Employees
❒ CPD Units needed for Nurses: 15 CPD Units 1) Checklists
❒ CPD Units needed for OFW Nurses: EXEMPTED 2) Rankings
❒ CPD Units needed for PWD + Senior Nurses: 10 3) Rating scales
CPD Units 4) Anecdotal recording
❒ CPD Units needed for Newly Licensed Nurses: 5) Essay (Narrative)
EXEMPTED
❒ CPD COUNCIL: accredits units needed PEER REVIEW
✔ Chairperson: BON ❒ Audit done by peers evaluating another job
✔ 2 Members: performance of the employees of the same
1) PNA rank against accepted standards.
2) ADPCN
QUALITY ASSURANCE
CONFLICT MANAGEMENT 1) Structure Criteria
❒ Conflict (clash between two opposing parties) ✔ Looks at physical and philosophical
TYPES OF CONFLICT attributes
INTERPERSONAL CONFLICT WITH OTHERS ✔ E.g. manpower, budget, organizational
INTRAPERSONAL CONFLICT WITH ONE’S SELF structure
INTERGROUP CONFLICT WITH OTHER 2) Process
GROUP ✔ Standards and protocols
INTRAGROUP CONFLICT WITHIN THE
3) Outcome
GROUP
✔ Patient condition
✔ Patient satisfaction
TOTAL QUALITY MANAGEMENT (TQM)
CONFLICT RESOLUTION
TYPES OF CONFLICT RESOLUTION ❒ Involves EVERYONE
AVOIDANCE IGNORING CONFLICT
CONTINUOUS QUALITY IMPROVEMENT (CQI)
(LOSE-LOSE ❒ Done regularly and continuously
SITUATION)
PATIENT CARE AUDIT
❒ Evaluates patient in the nursing care services 4 ELEMENTS OF INFORMED CONSENT:
received ❒ Voluntarily given
1) CONCURRENT ❒ By one who has the capacity & competence to
understand
✔ Confined/Admitted patients
❒ That he must be given enough information to
2) RETROSPECTIVE be the ultimate decision maker
✔ Discharged patients A. COMPETENCE
❒ Ability to think rationally
❒ LEGAL CAPACITY: 18 years old
❒ MINORS: Order of Preference
a) Parents
b) Judicially Appointed Guardian
c) Grandparents
d) Siblings at legal age
e) Nearest relative (e.g. uncle, auntie)
f) State/Government (e.g. medical
director, social worker)
✔ DOCTRINE OF PARENS PATRIAE
❒ MENTALLY INCOMPETENT:
a) Legal Spouse (Married)
b) Children at Legal age
c) Parents
d) Judicially Appointed Guardian
e) Grandparents
f) Siblings at legal age
g) Nearest relative (e.g. uncle, auntie)
h) State/Government (e.g. medical
director, social worker)
❒ ILLITERATE (cannot read & write):
a) Read the consent form verbatim
(Doctor)
B. UNDERSTANDING
❒ Comprehends the procedure
❒ ASSESS: Ask open-ended questions
C. PRESENTATION
❒ Put it on an understandable manner
D. VOLUNTARINESS
❒ Freedom of the patient to decide
❒ Most important element
❒ Patient is ultimate decision maker

DISCIPLINARY MEASURES RIGHT TO REFUSE

1) Counseling & Oral Warning ❒ Continues even after signing the consent
2) Written Warning
3) Suspension
4) Termination / Dismissal
 ❒ It is important to verify that the client is 1) HEALTH is a fundamental right
aware of the pros and cons of refusal and is 2) Nurses have FOUR FUNDAMENTAL
making an informed decision RESPONSIBILITIES:
a) Promote health
❒ Notify healthcare provider at the client’s
b) Prevent illness
refusal c) Restore health
❒ Document the refusal at the chart d) Alleviate suffering
3) The need for nursing is UNIVERSAL
ADVANCED DIRECTIVES:
❒ Allow specify aspects of care they wish to ARTICLE 2: NURSE – PEOPLE
receive should they become unable to make 1) Confidentiality
2) Autonomy
or communicate their preferences
3) Respect
1) Living Will a) Values
✔ Provides specific instructions about b) Customs
what medical treatment the client c) Spiritual Beliefs
chooses to omit or refuse in the event 4) Safety
that the client is unable to make those
decisions ARTICLE 3: NURSES – PRACTICE
1) Human life is INVIOLABLE
✔ E,g, DNR, ventilator support
2) Quality and Excellence in Care (Goal of
2) Healthcare Proxy Nursing Practice)
✔ Appoint someone on the specific 3) SCOPE of practice (RA 9173)
instructions 4) Accurate documentation (for legal basis)
5) Dimensions of care:
DNR orders a) Moral
b) Legal
❒ Renews order for 24 hours
c) Professional
❒ take effect after a cardiac or respiratory arrest 6) Rights and Privileges of patients

RA 10173: DATA PRIVACY ACT ARTICLE 4: NURSE – CO-WORKERS

❒ Health information is a sensitive personal 1) Solidarity (good relationship of the
information healthcare team)
2) Collegial and Collaborative Working
relationship
CONFIDENTIALITY
❒ Situations when confidential information may ARTICLE 5: NURSES, THE SOCIETY AND
be revealed: ENVIRONMENT
a) When patient permits 1) Establishes linkages (benchmarking)
b) Medico-legal cases 2) Maintain a safe environment
c) Communicable cases & public safety ARTICLE 6: NURSES AND PROFESSIONAL
may be jeopardized 1) Maintain LOYALTY in nursing profession
2) Laws & Organizations
d) To members oif the health team if
a) Accredited Professional Organization (APO)
relevant to his care − Philippine Nurses Association
e) Article 3, Section 3(1) of the 1987 (PNA)
Constitution of the Philippines 3) COMMITMENT to continual learning and
active participation
CODE OF ETHICS FOR NURSES a) Continuous Professional Development
⮚ Board of Nursing: Board Resolution No. 220 (CPD)
Series of 2004 b) Service Training
⮚ PROMULGATION OF THE CODE OF ETHICS c) Advance Education
FOR REGISTERED NURSES
ARTICLE 7: ADMINSTRATIVE PENALTIES,
ARTICLE 1: PREAMBLE REPEALING CLAUSE, AND EFFECTIVITY
 1) Revocation or Suspension of license for
violation of any provisions of the Code of
Ethics

HALLMARK OF NURSING ACCOUNTABILITY

❒ ACCURATE DOCUMENTATION