1.

Division and specialization of labor

2. Organizational structure
LESSON 1: ORGANIZING 3. Chain of command
4. Span of control
ORGANIZING
❖ In this phase, relationships are
defined, procedures are outlined,
equipment is readied, and tasks are
assigned.
• Formal structure
• Accomplish objectives

❖ The process of coordinating the work

to be done within an organization
❖ It involves identifying the work of the
organization, dividing the labor,
HUMANISTIC THEORY
developing the chain of command,
● Major assumption of this theory is
and assigning authority
that people desire social relationships,
❖ It involves identifying the work of the
respond to group pressures, and
organization, dividing the labor,
search for personal fulfillment
developing the chain of command,
and assigning authority in healthcare: • Developed as a result of the Hawthorne
➢ Mission Effect
➢ Organizational structure • Led organizational theorists to focus on
➢ Delivery systems the social aspects of work and
➢ Job descriptions organizational design
➢ Skill mix
SYSTEMS THEORY
➢ Staffing pattern
● organization is a complex,
❖ is a collection of people working
sociotechnical, open system
together under a defined structure to
achieve predetermined outcomes Systems can be closed or open
using financial, human, and material
resources.

ORGANIZATIONAL THEORIES
Ancient Sumerian civilization, around 5000
b.c.
● Earliest recorded example of
organizational thinking CONTINGENCY THEORY
UNEXPLORED ● organizational performance can be
The early Egyptians, Babylonians, Greeks, enhanced by matching an
and Romans also gave thought to how organization’s structure to its
groups were organized. Organizational environment
theory remained largely ● organizations differ with respect to
unexplored until the Industrial Revolution the environments they face, the levels
during the late 1800s and early 1900s, of training and skills of their
caregivers, and the emotional and
CLASSICAL THEORY physical needs of patients
● Classical approach to organizations
focuses almost exclusively on the CHAOS THEORY
structure of the formal organization ● Stresses the importance of change
Classical theory is built around four elements: within organizations. Change is the
 stimulation of the organization, and it
is constant in healthcare today.
● The life cycle of an organization is fully
dependent on its adaptability and
response to changes in its
environment.

COMPLEXITY THEORY
● Originated in the computational
sciences when scientists noted that
random events interfered with
expectations
● The theory is useful in health care ORGANIZATIONAL STRUCTURE & CHART
because the environment is raging Are they the same?
with randomness and complex tasks ● Organizational Chart depict an
organization’s structure
ORGANIZATIONAL DESIGN ● a picture of an organization
➢ is the process of designing, defining or
adapting the organizational structure. COMPONENTS OF ORGANIZATIONAL
➢ A formal, guided process for STRUCTURE
integrating the people, information
and technology of an organization. ORG STRUCTURE
1. FORMAL
PRINCIPLES ORGANIZATIONAL DESIGN: 2. INFORMAL
1. Division of labor
● Departmentalization
● Specialization
2. Unity of command
● Line of command
● One superior
3. Authority and responsibility
● Line and staff authority
● Authority and power
4. Span of Control
● Levels of control
● Centralization and decentralization
5. Contingency Factors COMPONENTS
● Environment and technology 1. Relationships & Chain of Command
● Knowledge of technology: task 2. Span of Control
variability & problem analyzability 3. Managerial Levels
4. Centrality
ORGANIZATIONAL STRUCTURE
● describes the arrangement of the Relationships & Chain of Commando
work group. - depicted on a chart by unbroken
● a rational approach for designing an (solid) lines. It defines formal
effective organization. relationships within the institution,
lines of communication and authority
- Line positions can be shown by solid
horizontal or vertical lines.
 executive head
officer Primary
Director nurse
Chief financial
officer Focus is on Focus
integrating primarily on
Look at unit-level day-to-day
organization day-to-day needs at unit
as a whole as needs with level
well as organization
external al needs
influences

Primary Strategic Combination Short-range,

planning planning of long- and operational
focus short-range planning
planning

Communica More often Upward and More often

tion flow top-down but downward upward;
receives with great generally
subordinate centrality relies on
feedback both middle-
directly and level
via managers
middle-level to transmit
managers communicati
on to
top-level
managers

Span of Control Centrality

- The number of people directly - refers to the location of a position on
reporting to any one manager an organization chart where frequent
- there is an inverse relation between and various types of communication
the span of control and the number of occur
levels in hierarchy in an organization COMMUNICATION:
- effective and open communication in
Managerial Levels all forms thread that binds the
1. Top-level managers organization together
2. Middle-level managers
3. First-level managers

Directions of communication:
● Downward
Levels of Managers ● Upward
Examples Top Level Middle Level First Level ● Lateral/Horizontal
● Grapevine
Scope of Chief nursing Unit Charge
responsibili officer supervisor nurse
ty
Chief Department Team leader
 Line Structure
- Bureaucratic organizational designs
- Structures or line organizations
- Staff Organizations (with staff
authority)

Advantages and Limitations of

Organizational Charts
ADVANTAGES
1. Maps lines of decision-making Ad Hoc Design
authority. ● a modification of the bureaucratic
2. Helps people understand their structure
assignments and those of their ● sometimes used on a temporary basis
coworkers. to facilitate completion of a project
3. Reveals to managers and new within a formal line organization
personnel how they fit into the
organization. Flat Design
4. Contributes to sound organizational ● refers to an organization structure
structure. with few or no levels of management
5. Shows formal lines of communication. between management and staff level
employees
LIMITATIONS Adv.
1. Shows only formal relationships. - a single manager or supervisor would
2. Does not indicate degree of authority. oversee a large number of
3. Are difficult to keep current. subordinates and have a wide span of
4. May show things as they are supposed control
to be or used to be rather than as - elevates the employees' level of
they are. responsibility in the organization
5. May define roles too narrowly. - improves the coordination and
6. Possibility exists of confusing communication between employees
authority with status encourage easier decision-making
process among employees
TYPES OF ORGANIZATIONAL STRUCTURES
TYPES
1. Line Structure
2. Ad Hoc
3. Flat Design
4. Functional
5. Matrix
6. Hybrid structure Functional Structure
7. Service Line organization ● Employees are grouped in
8. Shared Governance departments by specialty, with similar
 tasks being performed by the same
group
● All nursing tasks fall under nursing
service

Hybrid Structure

Matrix
● designed to focus on both product
and function
- (Function) Staff education and ● combines both functional and
adequate staffing produce divisional structure
good patient outcomes - divides its activities into
(Product) departments that can be either
● has a formal vertical and horizontal functional or divisional
chain of command ● can provide simultaneous
coordination within product divisions,
can improve alignment between
corporate and service/product goals
Shared Governance
● allows staff nurses significant control
over major decisions about nursing
practice Lesson 2: STAFFING
- Decisions are made by
consensus, rather than by the
manager's order or majority Staffing is the process of determining and
rule providing the acceptable number and mix of
● nurses participate in an accountable nursing personnel to produce a desired level
forum to control their own practice of care to meet the patients’ demand
within the health care organization
PURPOSE OF STAFFING ACTIVITIES

Decision-Making Organizational within the Provide each nursing unit with an

Hierarchy appropriate and acceptable number of
workers in each category to perform the
Decision-Making hierarchy nursing tasks required.
● Scalar chain
● Can determine where decisions are FACTORS AFFECTING STAFFING
made within the organizational
hierarchy 1. type, philosophy, objectives of the hospital
● Decision-Making hierarchy and the nursing service
Organizations either have: 2. the population served or kind of patients
served
● Centralized decision making
3. the number of patients and severity of
- few managers at the top of the
their illness
hierarchy make the decisions
4. availability and characteristics of the
and the emphasis is on
nursing staff
top-down control
5. administrative policies such as rotation,
● Decentralized decision making
weekends, and holiday off-duties
- diffuses decision making
6. standards of care desired
throughout the organization
7. layout of various nursing units and
and allows problems be solved
resources available within the department
by the lowest practical
8. Budget
managerial level
9. professional activities and priorities in non
patient activities
10. teaching program or the extent of staff
involvement in teaching activities
11. expected hours of work per annum of each
employee
12. patterns of work schedule

Staffing Process
1. Recruitment & Selection
2. Orientation & Placement
3. Promotion & Transfer
4. Remuneration
5. Training & Development
6. Performance Evaluation
1. RECRUITMENT & SELECTION
RECRUITING
● the process of actively seeking out or
attracting applicants for existing
positions.
● an ongoing process in order to meet
demand and provide an adequate
supply of nurses at any given time
Manager’s Involvement in Recruiting
Depends on:
1. Size of company
2. Existence of personnel department
3. Presence of nurse recruiter
4. Use of centralized or decentralized nursing
department
SELECTION
● the process of choosing from among
the applicants the best-qualified
individual or individuals for a
particular job or position.
● involves verifying the applicant’s
qualifications, checking his/her work
history, and deciding if a good match
exists between the applicant’s
qualifications and the organization’s
expectations
Orientation & Placement
PLACEMENT
● putting the person on the job for
which he is selected. It includes
introducing the employee to his
job.
● Introduction:
○ the planned, guided
adjustment of an employee
to the organization and the
work environment
● It Seeks to:
1. establish favorable
employee attitudes toward
the organization, unit, and
department
2. provide the necessary
information and education
for success in the position
3. instill a feeling of belonging
and acceptance
PLACEMENT OF STAFF
PROPER PLACEMENT:
a. fosters personal growth
b. provides a motivating climate for
the employee
c. maximizes productivity
d. organizational goals have better
chances of being met
(RA 9173 Nurses with Master’s degree in
Nursing are easily placed in position)
INAPPROPRIATE PLACEMENT:
a. frustration
b. poor quality of work
c. reduced organizational efficiency
d. rapid turn-over
e. poor image for the agency
ORIENTATION
● provides information about the
activities more specific for the position
○ make the employee feel like a
part of the team.
PLACEMENT
● Employee Introduction Content:
a. organization’s history, mission,
and philosophy
b. Service and service areas
c. Organizational Structure
d. Employee’s responsibilities to
the organization
e. Organization’s responsibilities
to the employee
f. Payroll information
g. Rules of conduct
h. Tour of the facility
i. Schedule and staffing (plus its
policies)
j. Benefit plans (such as
insurance and pensions)
k. Safety programs
l. Staff development programs
 m. Promotion and transfer
policies
n. Employee appraisal system
o. Workload assignments
p. Paperwork/forms used
q. Specific legal requirements
r. Introduction to fellow
employees
Training and Development
Staff Development
● Is the process directed towards the
personal and professional growth of
nurses and other personnel while they
are employed by a healthcare agency
2 components
1. Education
2. Training
ASSESSING STAFF DEVELOPMENT NEEDS
● establish competence
● meet new learning needs
● satisfy interests the staff may have in
learning specific areas.
Performance Evaluation
Employee appraisal (used since 1920)
● using the appraisal as a tool to
promote employee growth
Performance evaluation process for Staff
Performance Evaluations are to:
a) Provide employees with feedback to
improve or maintain job performance.
b) Identify areas for employee
development.
c) Set performance standards and goals
for the next review period.
Promotion and Transfer
● Promotion is defined as the movement
of an employee from one position to
another position of a higher pay
grade or salary.
● Transfer is defined as the movement of
an employee from one position to
another position at the same pay
grade level or similar salary.
Internal Mobility
● Internal Mobility is necessary to
match the employee’s skill and
requirements with the requirements of
the job and those of the organization
continuously.
Why is there a Need for Internal Mobility:
● Changes in job structure, job design,
job grouping changes in technology,
mechanization etc, resulting in the
encasement of job demand.
● Expansion and diversification of
production or operations
● Adding different lines of auxiliary
supportive activities
● Taking up geographical expansion
and diversification
● Introduction of creative and
innovative ideas in all the areas of
management resulting in increased
job demands
Need for Internal Mobility :
● Changes in employee skill, knowledge,
abilities, aptitude, values etc.
● Changing demands of trade unions
regarding protecting the interests of
their members.
● Chancing government role in human
resource development
● National economic and business
trends and their impact on job design
and demands.
● Problem of maintenance of
interpersonal relations and sound
human relations
● Social and religious conditions of the
employees or the region.
Purpose of Internal Mobility :
1. To improve the effectiveness of the
organization
2. To maximize the employee efficiency
3. To ensure discipline and
4. To adopt organizational changes
PROMOTION & TRANSFER
a. within a Department
b. Between Departments
c. When Initiated by the Employee
PATIENT CLASSIFICATION SYSTEM ii. General Ward 3.5 60:40

1. “Self-care” or Minimal Care Patients iii. Pediatric 4.6 70:30

2. Intermediate or Moderate Care
iv. Pathologic 2.8 55:45
3. Total Care Patients Nursery
4. Intensive Care Patients
v. Medical 3.4 60:40

1. “Self-care” or Minimal Care Patients vi. OB 3.0 60:40

- capable of carrying out activities of
daily living (ADL) Convalescing, no vii. ICU/ER/RR 6.0 70:30
longer requires intensive, moderate, or
viii. CCU 6.0 80:20
maximum care
➔ Require dx studies, Table 1 - A
➔ Minimal therapy
➔ Awaiting elective surgery, B. DISTRIBUTION PER SHIFT
➔ Home environment temporarily makes SHIFT PERCENTAGE
discharge undesirable
AM 45%

2. Intermediate or Moderate Care PM 37%

- requires some help from the nursing
staff with special treatments. NIGHT 18%

- minimal to moderately ill Table 1 - B

- Recovering from immediate effects of
a serious illness or operation C. PERCENTAGE OF PATIENTS IN VARIOUS
- May be ambulatory for short periods LEVELS OF CARE
(needs assistance)
Types of Minimal Moderate Intensive Highly
3. Total Care Patients Hospital Care Care Care Spl. Care
- those who are bedridden and who lack
Primary 70 25 5 -
strength and mobility to do average Hospital
daily living.
- Needs close attention Secondar 65 30 5 -
y Hospital
- Requires nurse to initiate, supervise,
and perform most of the activities Tertiary 30 45 15 10
- Requires frequent medication Hospital

Special 10 25 45 20
4. Intensive Care Patients Tertiary
- those who are critically ill and in Hospital

constant danger of death or serious Table 1 - C

injury. Acutely ill patients w/ high level
of nurse dependency D. CATEGORIES OF PATIENT
- Unstable condition w/c requires Level of Care NCH Needed/ Prof: Non Prof
frequent evaluation with adjustment pt./day

of therapy Level I
Self-Care or 1.50 55:45
STAFFING FORMULA Minimal Care

Level II
Requirements: Moderate or 3.0 60:40
Intermediate Care

A. STANDARD VALUE OF NURSING CARE Level III

Total or Intensive 4.5 65:35
Cases/Patients NCH/pt/day Prof. to Care
Non-Prof Ration
Level IV
i. Surgery 3.4 60:40
Highly Specialized 6.0 70:30
TOTAL NCH/DAY X DAYS/YEAR = NCH PER
or Critical Care 7.0 or higher 80:20 YEAR
768.75 X 365 (DAYS/YEAR) = 280,593.75
Table 1 - D NCH/YEAR
F. TOTAL NUMBER OF WORKING AND
NON-WORKING DAYS AND HOURS OF 4. FIND ACTUAL WORKING HOURS NEEDED
NURSING PERSONNEL PER YEAR BY EACH NURSING PERSONNEL / YEAR

HRS/DAY X WORKING DAY/YEAR = WORKING

HRS/YEAR

8 (hrs/day) X 213* (WORKING DAY/YEAR) =

1,704 WORKING HRS/YEAR
*Refer table 1 - F

5. FIND THE TOTAL NUMBER OF NURSING

PERSONNEL NEED
a. TOTAL NCH/YEAR (280,593.75*) ÷
WORKING HRS/YEAR (1,704*) = 165
RELIEVERS
b. RELIEF x CONSTANT % = NSG
PERSONNEL
165 X 15% = 25 NSG PERSONNEL
Table 1 - F (CONSTANT: 15% FOR 40 HRS/WK & 48 HRS/WK)
c. RELIEVERS + NSG PERSONNEL = TOTAL
STEPS FOR COMPUTING THE STAFF NEEDED NSG PERSONNEL NEEDED
IN THE IN-PATIENT UNIT OF THE HOSPITAL 165 + 25 = 190 TOTAL PERSONNEL
NEEDED
*Refer Find NCH PER YEAR and table 1 - F
1. CATEGORIZE PATIENT ACCDG. TO LEVEL
OF CARE
6. DETERMINE PROF FROM NON-PROF
PERSONNEL
TOTAL PERSONNEL X PROF/NONPROF RATIO
= TOTAL PROF OR NONPROF PERSONNEL
● 190 X 65% = 124 PROFESSIONAL
● 190 X 35% = 68 NON PROFESSIONAL

Table 2 - A 7. DISTRIBUTE PER SHIFT

Refer table 1 - C for the percentage use in calculation
SHIFT PRO NON PRO
2. FIND THE NURSING CARE HOURS (NCH)
NEEDED AM (45%) 56 30

PM (37%) 46 24

NOC (18%) 22 12

TOTAL: 124 66

SCHEDULING
Table 2 - B
Refer table 1 - D for NCH/PT./DAY SCHEDULING - A schedule is a timetable
showing planned work days and shifts for
3. FIND NCH PER YEAR nursing personnel.
 5. Specific and Actual Functions and
Factors to Consider in Making a Schedule Activities
1. Different levels of the nursing staff
2. Adequate coverage for 24 hours, 7 days a USES OF JOB DESCRIPTION
week 1. For recruitment and selection of qualified
3. Staggered vacations and holidays personnel
4. Weekends 2. To orient new employees to their jobs
5. Long stretches of consecutive working 3. For job placement, transfer or dismissal
days 4. As an aid in evaluating the performance of
6. Evening and night shifts an employee
7. Floating 5. For budgetary purposes
6. For determining departmental functions
and relationships to help define the
Assessing a Scheduling System organizational structure
1. Ability to cover the needs of the shift 7. For classifying levels of nursing functions
2. Quality to enhance the nursing personnel’s according to skill levels required.
knowledge, training and experience 8. To identify training needs
3. Fairness to the staff. 9. As basis for staffing
4. Stability 10. To serve as a channel of communication.
5. Flexibility
LESSON 3: DIRECTING
TYPES OF SCHEDULING DIRECTING
1. Centralized Schedule ● the function of guiding, inspiring,
2. Decentralized Schedule overseeing
3. Cyclical Schedule and instructing people towards
accomplishment of organizational
goals.
SCHEDULING VARIABLES ● is the “doing” phase of management,
1. Length of scheduling period whether 2 or 4 requiring the leadership and
weeks management skills necessary to
2. Shift rotation accomplish the goals of the
3. Week-ends off organization
4. Holiday off ● Managers direct & support work of
5. Vacation leave
their subordinates
6. Special days
7. Scheduled events in the hospital , training
COMPONENTS
programs, or meetings
1. Leadership & Supervision
8. Job categories
2. Motivation
9. Continuing professional education (CPE)
3. Communication
programs
4. Managing Conflict / Negotiating Directing
5. Collective Bargaining
JOB DESCRIPTION
Theories Of Leadership
JOB DESCRIPTION - JD is a statement that
Styles Of Leadership
sets the duties and responsibilities of a
specific job.
Leadership Formal And Informal

ROLES IN SUPERVISION
CONTENTS OF A JOB DESCRIPTION ➢ Guides
1. Identifying Data ➢ Direct
2. Job Summary ➢ Facilitates
3. Qualification Requirements ➢ Motivates
4. Job Relationships ➢ Teaches
POWER
EXPERT Knowledge
• the ability to influence other people despite
their resistance and may be actual or CHARISMATIC Personal
potential, intended or unintended
INFORMATIONAL The need for
SOURCES OF POWER information
1. POSITIONAL
Power awarded or granted to a person THE AUTHORITY-POWER GAP
If authority is the right to command, then,
2. PERSONAL "Why do workers sometimes not follow
Power derived from followers orders?"
● people in power are prone to dismiss
TYPES or, at the very least, misunderstand the
1) REWARD viewpoints of those who lack authority
2) COERCIVE or PUNISHMENT Gap that sometimes exists between a position
3) LEGITIMATE of authority and subordinate
4) EXPERT
5) REFERENT / CHARISMATIC ● Narrow Authority-Power Gap
6) INFORMATIONAL ○ more power subordinates
perceive a manager to have,
1. REWARD the smaller the gap
➔ is obtained by the ability to grant ● Wide Authority-Power Gap
favors or reward others with whatever ○ if subordinates perceive a
they value manager to have lesser power
2. COERCIVE or PUNISHMENT ○ Organizational chaos
➔ based on fear of punishment ○ Decreased productivity
3. LEGITIMATE
➔ position power MOTIVATION
4. EXPERT ● is the force within the individual that
➔ gained through knowledge, expertise, influences or directs behavior.
or experience
○ involves the action people take
5. REFERENT / CHARISMATIC
to satisfy unmet needs. It is the
➔ Power that a person has because
willingness to put effort into
others identify with that leader or
achieving a goal or reward to
➔ with what that leader symbolizes
decrease the tension caused by
personal charisma - charisma is a
the need.
more personal type of power
6. INFORMATIONAL
MOTIVATION TYPES:
➔ obtained when people have
INTRINSIC
information that others must have to
● Comes from within the person
accomplish their goals
EXTRINSIC
● Comes from outside the individual
SOURCES OF POWER
TYPE SOURCES
INTRINSIC EXTRINSIC
REFERENT Association with
● Comes from ● Comes from
others
within the outside the
individual individual
LEGITIMATE Position
● Often ● Rewards and
influenced by reinforcemen
COERCIVE Fear
family unit ts are given
and cultural to encourage
REWARD Ability to grant
values certain
favors
 ● Generational Differences and
behaviors
and/or levels Motivation
of ● The Relationship Between the
Achievement Employee and Supervisor

● Leaders can create an environment COMMUNICATION

that maximizes the development of ● communication impacts all
human potential management activities and cuts
● Leader-manager must identify across all phases of the management
components and strengthen them in process
hopes of maximizing motivation ○ nurse-leader needs to
communicates
MOTIVATION ○ must have excellent
● Human beings have needs that interpersonal communication
motivate them. skills
● Leader focuses on the needs and ● Organizational communication is even
wants of individual workers and uses more complex than interpersonal or
motivational strategies appropriate group communication
for each person and situation. ○ more communication channels
○ more individuals to
Leader often faces tremendous challenges in communicate with
accurately identifying individual and ○ more information to transmit
○ new technologies
collective motivators.
● communication as “the exchange of
MOTIVATIONAL THEORIES thoughts, messages, or information,
by speech, signals, writing, or
● Traditional management philosophy
behavior.”
premised that high productivity means
greater monetary incentives for the ○ Two levels:
worker, and workers are viewed as ■ Verbal
being motivated primarily by ■ Nonverbal
economic factors.
○ shift from traditional CLIMATE in COMMUNICATION
management philosophy to a
greater focus on the human INTERNAL - includes the values, feelings,
element and worker temperament, and stress levels of the sender
satisfaction as factors in and the receiver
productivity
THEORIES EXTERNAL - external factors such as the
1. MASLOW weather, temperature, timing, status, power,
2. SKINNER authority, and the organizational climate
3. HERZBERG itself
4. VROOM
5. MCLELLAND
6. GELLERMAN
7. MCGREGOR

MOTIVATING CLIMATE
- organizational climates or attitudes
that directly influence worker morale
and motivation
● Incentives & rewards
CHANNELS of COMMUNICATION
Upward - from subordinate to superior
Downward - from superior to subordinate
Horizontal - from peer to peer
Diagonal - between individuals at difeering
hierarchy levels and job classifications
Grapevine - informal, haphazard, and
random, usually involving small groups
COMMUNICATION MODES
WRITTEN - Written messages (memos, reports,
e-mail, and texting) allow for documentation.
FACE-TO-FACE - Oral communication is rapid
but may result in fewer people receiving the
information
TELEPHONE - Rapid & responsive, but does
not allow the receipt of nonverbal messages
NONVERBAL - includes facial expression,
body movements, and gestures and is
commonly referred to as body language
ELEMENTS NONVERBAL COMMUNICATION
SPACE - The degree of space we require
depends on who we are talking to as well as
the situation we are in. To some distance may
imply a lack of trust or warmth
ENVIRONMENT - The area where
communication takes place is an important
part of the communication process
APPEARANCE - Much is communicated by our
clothing, hairstyle, use of cosmetics, and
attractiveness
EYE CONTACT - invites interaction and
emotional connection. Can signals to your
listeners that you are not interested in them
and that you are not engaged in the
conversation
POSTURE - Posture and the way that you
control the other parts of your body are also
extremely important as part of nonverbal
communication
GESTURES - appropriate gestures takes on
added emphasis
FACIAL MODES EXPRESSION & TIMING -
Effective communication requires a facial
expression that agrees with your message.
VOCAL EXPRESSION - Vocal clues such as
tone, volume, and inflection add to the
message being transmitted
VERBAL COMMUNICATION SKILLS
- All communication is either assertive
or passive
1. Assertive
● allows people to express themselves in
direct, honest, and appropriate ways
● expressed clearly and firmly by using
“I” statements as well as direct eye
contact and a calm voice
2. Passive
● occurs when a person suffers in
silence although he or she may feel
strongly about the issue
3. Aggressive
● generally direct, threatening, and
condescending
● communication style typically creates
enemies, leads to unstable
relationships
4. Passive- Aggressive
● an aggressive message presented in a
passive way
● involves limited verbal exchange (often
with incongruent nonverbal behavior)
by a person who feels strongly about a
situation
Communication: Listening Skills
- most people hear or actually retain
only a small amount of information
given to them
- Communication failure is a common
root cause of medical error
Communication: Listening Skills
How to become a better listener:
1. Be aware of how own experiences,
values, attitudes, and biases affect
how message is receive and perceive.
 2. Must overcome the information and ● Synonymous with productivity
communication overload inherent in
the middle-management role. Reasons for Delegating:
3. Must continually work to improve 1. Managers delegate routine tasks so
listening skills by giving time and they are free to handle problems that
attention to the message sender. are more complex
2. If someone else is better prepared or
Communication: GRRRR as a Tool has greater expertise or knowledge
3. Employees’ personal and professional
G Greeting Offer greetings and
establish positive development
environment
Principles of Delegation
R Respectful Listen without 1. Select the right person to whom the
Listening interrupting and job is to be delegated.
pause to allow 2. Delegate both interesting and
others to think
uninteresting tasks.
R Review Summarize 3. Provide subordinates with enough
message to make time to learn.
sure it was heard
accurately Strategies for SUCCESSFUL DELEGATION
1. Plan ahead
R Reccomment or Seek additional 2. Identify necessary skill and education
request more information as
information necessary levels to complete delegated task
3. Select capable personnel
R Reward Recognize that a 4. Communicate goals clearly
collaborative 5. Empower the delegate
exchange has 6. Set deadlines & monitor progress
occurred by 7. Monitor the role & provide guidance
offering thanks
8. Evaluate performance
9. Reward accomplishment
Communication: Please Read
IMPACT OF TECHNOLOGY ON WHAT CANNOT BE DELEGATED
CONTEMPORARY ORGANIZATIONAL 1. Overall responsibility, authority, and
COMMUNITY accountability for satisfactory
● Internet completion of all activities in the unit.
● Hospital Information System 2. Authority to sign one’s name is never
● Wireless; LAN delegated.
● Social Media & Organizational 3. Evaluating the staff and or taking
Communication necessary corrective or disciplinary
action.
Delegation
● Getting work done through others Five Rights of Delegation
● Giving someone else the authority to 1. RIGHT TASK
complete a task or action on your ● Should be within the scope of the
behalf, (Huston, 2009). person’s pratice and consistent with
● A “transfer or hand-off to a competent the job description.
individual, the authority to perform a
task/activity in a specific 2. RIGHT PERSON
setting/situation” (Winstead, 2013). ● Right person is delegating the right
● Is a skill that must be taught and task to the right person to be
practiced for proficiency performed on the right person.
● An essential element of the directing ● Should have the appropriate license
phase or certificate, job description.
 3. RIGHT CIRCUMSTANCE ● the internal or external discord that
● Appropriate patient setting, available results from differences in ideas,
resources, and other relevant factors values, or feelings between two or
considered. more people.
● also created when there are
4. RIGHT DIRECTION/COMMUNICATION differences in economic and
● Clear, concise description of the task, professional values and when there is
including its objective, limits, and competition among professionals.
expectations. ● Conflict is neither good nor bad, and
it can produce growth or destruction,
5. RIGHT LEVEL of SUPERVISION depending on how it is managed,
● Appropriate monitoring, evaluation, (Marquis)
intervention, as needed, and feedback.

Aspects/Elements of Delegation
1. RESPONSIBILITY
● Denotes obligation

2. AUTHORITY
● The power to make final decisions and
give commands.

3. ACCOUNTABILITY
● Refers to liability

Common Delegating Errors

1. UNDERDELEGATING
● False assumptions that delegating is a
lack of ability of a manager to do the Categories of Conflict
job correctly or completely 1. INTERGROUP
● lack of trust in the subordinates 2. INTRAPERSONAL
● often feel as though they must give up 3. INTERPERSONAL
control BULLYING
● Some novice managers find it difficult ● repeated, offensive, abusive,
to assume the manager role intimidating, or insulting behaviors;
● fail to anticipate the help they will abuse of power; or unfair sanctions
need that make recipients feel humiliated,
● not enough time to explain or teach. vulnerable, or threatened, thus
creating stress and undermining their
2. OVERDELEGATING self-confidence
● poor managers of time, spending
most of it just trying to get organized INCIVILITY
● feel insecure in their ability to perform ● behavior that lacks authentic respect
a task. for others that requires time,
3. IMPROPER DELEGATING presence, willingness to engage in
● delegating at the wrong time, to the genuine discourse and intention to
wrong person, or for the wrong reason seek common ground
● delegating tasks and responsibilities
that are beyond the capability of the MOBBING
person ● when employees “gang up” on an
individual.
CONFLICT MANAGEMENT
Conflict 5 STAGES of CONFLICT
 1. LATENT CONFLICT ● used to manage a conflict situation.
2. PERCEIVED CONFLICT ● occurs when one party in a conflict
3. FELT CONFLICT attempts to pacify the other party or
4. MANIFEST or OVERT CONFLICT to focus on agreements rather than
5. CONFLICT AFTERMATH differences
5. Avoiding
● parties involved are aware of a conflict
but choose not to acknowledge it or
attempt to resolve it
6. Collaborating
● an assertive and cooperative means
of conflict resolution that results in a
win–win solution.

CONFLICT RESOLUTION BETWEEN

Sources of Conflict
1. Cultural differences
2. Different facts
3. Separate pieces of information
4. Different perception of the event
5. Defining the problem differently
6. Divergent views of power and authority
7. Role conflicts
8. Number of organizational levels
9. Degree of association
10. Parties dependent on others
11. Competition for scarce resources
12. Ambiguous jurisdictions
13. Need for consensus
14. Communication barriers
15. Separation in time and space
16. Accumulation of unresolved conflict
COMMON CONFLICT RESOLUTION
STRATEGIES
1. Compromising
● each party gives up something it
wants
2. Competing
● when one party pursues what it wants
at the expense of the others
3. Cooperating/accommodating
● the opposite of competing. In the
cooperating approach, one party
sacrifices his or her beliefs and allows
the other party to win
4. Smoothing
MEMBERS in the WORKPLACE
1. Confrontation
2. Third-party consultation
3. Behavior change
4. Responsibility charting
5. Structure change
6. Soothing one party
NEGOTIATION
● frequently resembles compromise
when it is used as a conflict resolution
strategy
● each party gives up something, and
the emphasis is on accommodating
differences between the parties
● Although negotiation implies winning
and losing for both parties, there is no
rule that each party must lose and win
the same amount. The focus in
negotiation should be to create a
win–win situation
BEFORE
1. Be prepared mentally by having done your
homework.
2. Determine the incentives of the person you
will be negotiating with.
3. Determine your starting point, trade-offs,
and bottom line.
4. Look for hidden agendas, both your own
and the parties with whom you are
negotiating.
DURING
1. Maintain composure.
2. Ask for what you want assertively.
3. Role model good communication skills
(speaking and listening), assertiveness, and
flexibility.
4. Be patient and take a break if either party
becomes angry or tired during the
negotiation.
5. Avoid using destructive negotiation
techniques, but be prepared to counter them
if they are used against you.
2. A need to demonstrate individualism and
promote social status
3. A belief that professionals should not
unionize
4. An identification with management’s
viewpoint
5. Fear of employer reprisal
6. Fear of lost income associated with a strike
or walkout

AFTER
1. Restate what has been agreed upon, both
verbally and in writing.
2. Recognize and thank all participants for
their contributions to a successful
negotiation.

COLLECTIVE BARGAINING
• Collective bargaining involves activities
occurring between organized labor and
management that concern employee
relations.

• such activities include the negotiation of

formal labor agreements and day-to-day
interactions between unions and
management

• It is true that unions and collective

bargaining are very much a part of many
nurses’ lived experiences.

EMPLOYEE MOTIVATION TO JOIN OR

REJECT UNIONS

● REASONS WHY NURSES JOIN

UNIONS
1. Increase the power of the individual
2. To increase their input into organizational
decision-making
3. To eliminate discrimination and favoritism
4. Because of a social need to be accepted
5. Because they are required to do so as part
of employment
6. Because they believe it will improve patient
outcomes and quality of care

● REASONS WHY NURSES DO NOT

WANT TO JOIN UNIONS
1. A belief that unions promote the welfare
state and oppose the system of free
enterprise