NURSING LEADERSHIP, MANAGEMENT – DR. GLENN A.

GUIRA
CTU-CCMC-CN (Power Development Review Center)
INTENSIVE REVIEW
Balcueva, Irene Grace M.

NURSING LEADERSHIP & MANAGEMENT ▪ Productivity goals → services rendered to

patients
▪ To ensure patient’s satisfaction from the
LEADERSHIP services given
LEADERSHIP
• Core skill of a particular nurse LEADERSHIP AND MANAGEMENT
• Intrinsic personality traits • Are intertwined concepts
o Trait within us • Are different
o Traits we carry within us o “married but unique”
• Learned leadership skills o Different concepts but works together to ensure the
o “engagement” goals, mission, etc. of the organization will be
o Learned in the classroom, curriculum accomplished.
• Characteristics of the situation • Difficult to discuss one without the other
• Intrinsic + learned skills = is what makes you a leader
A good manager also should be a good leader.
LEADER
• Guides people and groups to accomplish common goals Leadership Management Skills
o Role model to the younger/newer ones by mere • Improving skills in one area will enhance abilities in the other
presence o Growth through exposure
• Influences the beliefs, opinions, or behaviors of a person, • Through experience
group, or groups of people o If opportunity is given, then grab it
o Motivates to follow o Makes you a better nurse
• Can be learned and developed
NURSE LEADER • Complementary
• Is able to inspire others on the health care team to make patient o Complement with one and another
education an important aspect of all care activities
POWER AND AUTHORITY
Leadership Qualities • Nurse manager has:
• Unique personality characteristics, o Authority – formal right to direct others granted by the
• Exceptional clinical expertise, organization;
• Relationships with others in the organization. ▪ Right to give the kind of order or schedule
because it is the job of a manager
MANAGEMENT o Power – ability to motivate people to get things done
with or without the formal right granted by the
MANAGEMENT organization
• Coordinates people, time, and supplies to achieve desired ▪ Ex. by giving rewards
outcomes o Ability to influence others to accomplish goals
o Coordination of people and time → ex. scheduling ▪ Ensure goals and objectives will be
properly accomplished through motivation
o Ex. provide resources to efficiently run the workplace
24 hours FORMAL AND INFORMAL LEADERSHIP
• Involves problem-solving and decision-making processes
o When there is conflict, there is problem → then this is
Formal leadership practices by:
solved by the nurse manager
• Nurse manager
Manager’s Responsibility o Has functions needed to be performed
o Overlooks if all nursing activities are implemented
• Involves 24-hour responsibility in the hospital/work place
o Ensures that documentation are done properly
• Maintain control of the day-to-day operations,
• Supervisor
o To remain everything in order
• Charge nurse,
• Achieve established goals and objectives
• Coordinator and gives the authority to act by the organization
MANAGER
Informal Leadership is exercised by the person who:
Organizes
• Has no official or appointed authority to act
Plans − For easier recognition o They are “chosen” because of their unique
− Organize by groupings characteristics, but there is no paper/contract
Who is to do it involved
What is to be done
− Assign people to do •
− Easier to manage Is able to persuade
specific tasks • Is able to influence others in the work group
How it is to be done o To ensure targets are met → improvement
• Strategies the nurse manager can use to work with informal
NURSE MANAGER leaders
• Will have appointed management position within the
organization with responsibilities to perform administrative LEADERSHIP AND MANAGEMENT THEORIES
tasks: 1. Leadership Trait Theory
o Planning staffing requirements, 2. Interactional Leadership Theories
o Performing employee performance appraisals, 3. Transformational Leadership
▪ Quality is implemented 4. Management Theory
o Controlling use of supplies and time, 5. Organizational Theory
o Meeting budget and productivity goals.
▪ Projected budget is important to meet goals

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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
Leadership, Management, And Organizational Theories 1. Planning
• Provide the building blocks on which to build effective nursing • Includes defining goals and objectives,
management practices and skills • developing policies and procedures;
o create policies to meet your objectives
Contemporary Theories of Leadership o there should be “manual” of procedures → to let
− Marquis and Huston, 2000 everyone know what to do
− Depends on several variables, including: • determining resource allocation;
o ensures the operation of the organization is
1. Organizational culture continuous
▪ Helps you determine how you will work with them • and developing evaluation methods.
2. Values of the leader o Development of evaluation tools
▪ Important to know the head/owners/CEO of an
organization/hospital 2. Organizing
▪ Important to know how the head works • Includes identifying the management structure to
3. Values of the followers accomplish work
4. Influence of the leader/manager o With the use of organizational structure
▪ Focuses on how do they inspire you o Know who to communicate/report/complain
5. Complexities of the situation issues or problems
▪ Know how complex the work is • determining communication processes, and
6. Work to be accomplished o Verbal/non-verbal/written communication
7. Environment o Upward communication – superior
▪ Know the place you are working o Downward communication – subordinates
o Horizontal – similar rank
Transformational Leaders • coordinating people, time, and work.
• Identify and clearly communicate vision and direction 3. Directing
o Vision – looking at the best position in the future
• Encourages employees to accomplish goals and
o Visionary – doing something to prevent problems in
objectives
the future
o Skills must match to their position
• Empower the work group to accomplish goals and achieve the
• involves communicating, delegating, motivating, and
vision
managing conflict.
o Delegation
o Allow other people in the organization to make
4. Controlling (Evaluation)
decisions because you trust your employees
• Analyzes results to evaluate accomplishments and
• Impart meaning and challenge to work
includes evaluating employee performance
• Are admired and emulated
• analyzing financial activities
o Wanted to improve nurses in the hospital
o budget must be allocated to achieve their goals
o Take good care of the career of nurses
• monitoring quality of care
o Makes sure that nurses are properly trained
o ensures safe and quality nursing care
• Provide mentoring to individual staff members based on need
Transactional Leaders ROLES OF THE NURSE MANAGER
• Wait until problems occur then deal with the problem • Customer Service Provider
o Problem solving is done when problem already arises o Providing service or care to customers (patient or
• Monitor work performance and correct as needed; or clients)
• Focus on day-to-day operations and are comfortable with the ▪ Relieve their discomfort
status quo (the existing state of affairs). ▪ To restore health
o No change is made o Nurse must keep customer service first and foremost
o Contented with what is available; with what is there as the motivator of all plans and activities
o If change is made, EVERYTHING needs to be o Without customers, the organization will go out of
changed business
• Reward staff for desired work (“I’ll do x in exchange for you
doing y.”) • Team Builder
o Specific to those who do well in work o A team is a group of people organized to accomplish
the necessary work of an organization.
Management Theory o Teams have become important in the changing health
• Behavioral theories explain aspects of management and care environment
leadership based on behaviors of managers/leaders and o Teams bring together a range of people with different
followers. knowledge, skills, and experiences to meet customer.
o Management is evolving as we continue to perform
functions in the organization ✓ First Level Function of the Nurse: ADPIE
Organizational Theory
• Provides framework for understanding complex organizations, • Resource Manager
• Helps to understand the management process o Resources include the personnel, time, and supplies
needed to accomplish the goals of the organization
▪ Human resources – important to implement
MANAGEMENT FUNCTIONS: (MAJOR)
particular nursing activities → facilitation of
goals of the organizations (ex. Manpower
Planning → janitor, nursing aides, etc.)
▪ Materials – disposables
Organizing ▪ Supplies – needed everyday to ensure
continuity of service
Directing ▪ Equipment – machines that are of long-
term use (ex. X-ray machine, aircon)
o Nurse manager has the responsibility – effectively
Controlling manage resources in providing safe, effective patient
care in an economic manner.
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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
➢ Three Types of Budgets: ILLUMINATION STUDIES
1. Personnel – allocates funds for salaries, overtime, benefits, • Elton Mayo and has Harvard associates (1927-1932), look at
staff developments and training, and employee turnover costs the relationship between light illumination in the factory and
▪ Everything the hospital spends in behalf of the productivity.
employees o Productive when there is LIGHTS
2. Operating budget – allocates funds for daily expenses such as • Hawthorne effect indicated that people respond to the fact that
utilities, repairs, maintenance, and patient care supplies they are being studies, attempting to increase whatever
▪ Budget need to operate in an activity behavior.
▪ Utilities – paid periodically (ex. electricity, water,
internet, telephone bills)
THEORY X AND Y
3. Capital budget – allocates funds for construction projects
and/or long-life equipment such as cardiac monitors, • Douglas McGregor (1960), X and Theory Y, posited that
defibrillators, and computer hardware; capital budget items are managerial attitudes about employees can be directly correlated
generally more expensive than operating supplies. with employee satisfaction.
▪ Not easily produced o Employee X – lazy, not productive, doesn’t want to
▪ Ex. Building, hospital beds, machines → important to work, only does minimal work but wants to receive
ensure that we provide the care that they need the same salary as industrious workers
o Employee Y – very hardworking, industrious, does
• Decision Maker many responsibilities and receives same amount of
• Problem Solver salary as employee X
• Change Agent
THEORY X THEORY Y
Theory X managers believe that Theory Y managers believe that
14 PRINCIPLES OF MANAGEMENT
their employees are basically their workers enjoy their work, are
1. Division of work – allows specialization lazy, need constant supervision self-motivated, and are willing to
2. Authority – right to command balanced with responsibility and and direction, and are indifferent work hard to meet personal and
accountability to organizational needs organizational goals.
▪ Right to give orders
3. Discipline – employees will only obey orders if management Considered as assets of the
play their part by providing good leadership. organization; actual contribution
▪ Without discipline, there will be disorder
4. Unity of command – there should only be one boss with no
conflicting lines of command. EMPLOYEE PARTICIPATION
▪ Use the chain of command • Chris Argyris (1964), managerial domination causes workers to
▪ Report only to one superior → immediate superior become discouraged and passive.
o Directly above you • If self-esteem and independence needs are not met, employees
5. Unity of direction – people engaged in the same kind of will become discouraged and troublesome or may leave the
activities must have the same objectives in a single plan organization.
▪ Smooth flow of organization
▪ Everybody is guided to avoid confusion LEADERSHIP THEORIES
6. Subordination of individual interest to general interest – the GREAT MAN THEORY
goals of the firms are always paramount
▪ The interest of majority is much more important • The Great Man Theory, from Aristotelian philosophy, asserts
7. Remuneration – payment is an important motivator that some people are born to lead, whereas others are born to
8. Centralization or Decentralization – depends on the condition be led.
of business and the quality of its personnel o Can contribute to the accomplishment of vision and
▪ Centralization – only one person will make the mission of an organization
decision • Great leaders will arise when the situation demands it.
▪ Decentralization – many will make decisions
9. Scalar chain/Line of authority – refers to the number of levels TRAIT THEORY
in the hierarchy. • Trait theories assume that some people have certain
10. Order – both material order (minimizes lost time and useless characteristics or personality traits that make them better
handling of materials) and social order (organization and leaders than others.
selection are necessary.
▪ Arrangement of things in order Intelligence Adaptability Ability
11. Equity – employees should be treated well to achieve equity. Knowledge Creativity Able to enlist
12. Stability tenure of personnel – job security and career cooperation
progress are important for employees to work better Judgment Cooperativeness Interpersonal skills
▪ Work efficiently Decisiveness Alertness Tact
▪ Follow ethical principles Oral fluency Self-confidence Diplomacy
13. Initiative – allow personnel to show their initiative, it may be a
Emotional Personal Integrity Prestige
source of strength for the organization.
Intelligence
14. Esprit de corps – management should foster the moral of
Independence Emotional balance Social Participation
employees
and control
▪ Cohesion (united as a whole)
Personable Risk taking Charisma
▪ Teamwork ; United

MANAGEMENT STYLES LEADERSHIP STYLES

• According to Likert, there are three leadership styles:
PARTICIPATIVE MANAGEMENT
DEMOCRATIC LEADER
• Mary Parker Follett (1926) was one of the first theories to
suggest participative decision making or participative • Less control is maintained
management. • Economic and ego awards are used to motivate
• Managers should have authority with, rather than over, • Others are directed through suggestions and guidance
employees. • Communication flows up and down
• Decision making involves others
• Emphasis is on “we” rather than “I” and “you”
• Criticism is constructive

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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
AUTHORITARIAN LEADER
• Strong control is maintained over the work group.
• Others are motivated by coercion
• Others are directed with commands
• Communication flows downward
o Superior to subordinate; subordinates will just follow
• Decision making does not involve others
• Emphasis is on difference in status (“I” and “you”).
o No suggestion is accepted, only “I” am the best
• Criticism is punitive.
o Result into punishment
LAISSEZ-FAIRE LEADER
• “let us be independent”
• Is permissive, with little or no control
• Motivates by support when requested by the group
• Provides little or no direction
• Uses upward and downward communication between members
of the group
o Able to communicate because of their expertise
• Disperses decision making throughout the group
• Places emphasis on the group
• Does not criticize
LEADERSHIP APPROACHES
CONTINGENCY APPROACH
• Fiedler’s (1967), Contingency Approach, suggests that no one
leadership style is ideal for every situation.
• Interrelationships between the group’s leader and its members
were most influenced by the manager’s ability to be a good
leader.
• There should be other plans/options (plan a, b, c).
SITUATIONAL APPROACH
• Hersey and Blanchard (1977), developed a Situational
Approach to leadership.
• Tridimensional leadership effectiveness model predicts which
leadership style is most appropriate in each situation on the
basis of the level of the followers’ maturity.
• As people mature, leadership style becomes less task focused
and more relationship oriented.
EXEMPLARY LEADERSHIP
(Kousez & Posner’s Five Practices for Exemplary Leadership)
1. Modeling the way – requires value clarification and self-
awareness so that behavior is congruent with values.
2. Inspiring a shared vision – entails visioning which inspires
followers to want to participate in goal attainment.
3. Challenging the process – identifying opportunities and taking
action.
4. Enabling others to act – fostering collaboration, trust, and the
sharing of powers.
5. Encouraging the heart – recognize, appreciate, and celebrate
followers and the achievement of shared goals
INTEGRATING LEADERSHIP AND MANAGEMENT
• Gardner (1990) asserted that integrated leader-managers
posses six distinguishing traits:
1. They think longer term.
2. They look outward, toward the larger organization.
3. They influence others beyond their own group.
4. They emphasize vision, values, and motivation.
5. They are politically astute.
▪ Good role models
6. They think in terms of change and renewal.
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POWER
• Power is defined as the capacity to act or the strength and
potency to accomplish something.
• The manager who is knowledgeable about the wise use of
authority, power, and political strategy is more effective at
meeting personal, unit, and organizational goals.
Types of Power
• Reward power is obtained by the ability to grant favors or
reward others with whatever they value.
• Punishment or coercive power is based on fear of
punishment if manager’s expectations are not met.
• Legitimate power is the power gained by a title or official
position within an organization.
• Expert power is gained through knowledge, expertise, or
experience.
• Referent power is power that a person has because others
identify with that leader or with what that leader symbolizes.
• Charismatic power is distinguished by some referent power.
• Informational power is obtained when people have information
that others must have to accomplish their goals.
FUNCTIONS OF PLANNING
FOUR PLANNING MODES
MODES OF PLANNING DESCRIPTION
1. Reactive Occurs after a problem exists
2. Inactivism Seek the status quo
- don’t change what is there
3. Preactivism Utilize technology to accelerate
change and are future-oriented
4. Interactive or Proactive Attempt to plan the future of their
organization rather than react to it
FORECASTING
• Involves trying to estimate how a condition will be in the future.
• Takes advantage of input from others, gives sequence in
activity, and protects an organization against undesirable
changes.
o Studies the older trends to plan a condition in the
future.
STRATEGIC PLANNING
• Examines an organization’s purpose, mission, philosophy, and
goals in the context of its external environment.
• Complex organizational plans that involve a long period (usually
3-10 years) are referred to as long-range or strategic plans.
SWOT ANALYSIS
− Also known as TOWS analysis
− Was developed by Albert Humphrey at Stanford University in
the 1960s and 1970s.
− Strengths, Weakness, Opportunities, Threats
SWOT definitions:
• Strengths are those internal attributes that help an organization
to achieve its objectives.
• Weaknesses are those internal attributes that challenge an
organization in achieving its objectives.
o Wake up call for improvement
• Opportunities are external conditions that promote
achievement of organizational objectives.
• Threats are external conditions that challenge or threaten the
achievement of organizational objectives.
o “competition”
NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA

PLANNING HIERARCHY CHANGE THEORY

1. Vision • Kurt Lewin (1951) identified three phases through which the
− Statement is used to describe future goals or aims of change agent must proceed before a planned change becomes
an organization part of the system:
− It is a picture for all group members of what they want • Unfreezing occurs when the change agent convinces members
to accomplish. of the group to change or when guilt, anxiety, or concern can be
2. Mission elicited.
− Brief statement identifying the reason that an o There is a need for change.
organization exists • Movement, the change agent identifies, plans, and implements
− It identifies the organization’s constituency and appropriate strategies, ensuring that driving forces exceed
addresses its position regarding ethics, principles, restraining forces.
and standards of practice. o Introducing a new system
• Refreezing phase, the change agent assists in stabilizing the
3. Philosophy Statement system change so that it becomes integrated into the status
− The philosophy flows from the purpose or mission quo.
statement and delineates the set of values and beliefs o Accept change and utilize into the system
that guide all actions of the organization. o Minimize error/problems
− It is the foundation that directs all further planning o Perform quality/excellence
toward that mission
− The organization philosophy provides the basis for
developing nursing philosophies at the unit level and
for nursing service as a whole.

4. Goals and Objectives

− Goals and objective are the ends toward which the
organization is working
− Objectives are similar to goals in that they motivate
people to a specific end and are explicit, measurable,
observable or retrievable, and obtainable.

Goals – broad and non-measurable

Objectives – specific and measurable

5. Policies and Procedures

➢ Policies
− Policies are plans reduced to statements or
instructions that direct organizations in their decision
making.
− These explain how goals will be met and guide the
general course and scope of organizational activities.

Policies can be IMPLIED or EXPRESSED:

o Implied policies – neither written nor expressed
verbally, have usually developed over time and follow
a precedent. For example, a hospital may have an
implied policy that employees should be encouraged
and supported in their activity in community, regional,
and national health-care organizations.
o Expressed policies – are delineated verbally or in
writing. Expressed policies may include a formal
dress code, policy for sick leave, or vacation time,
and disciplinary procedures.

➢ Procedures
− Procedures are plans that establish customary or
acceptable ways of accomplishing a specific task and
delineate a sequence of steps of required action.
− Identify the process or steps needed to implement a
policy and are generally found in manual of
procedures at the unit level of the organization.

6. Rules
− Rules and regulations are plans that define specific
action or non-action.
− Existing rules should be enforced to keep morale
from breaking down and to allow organizational
structure.
− Maintains order within the organization (if not
followed, then it might cause disorder)

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