NURSING 105

NURSING MANAGEMENT
Madeline N. Gerzon, RN, MM Clinical Instructor

WELCOME AGAIN TO NCM 105 NURSING MANAGEMENT!!!

Madeline N. Gerzon, RN, MM Instructor

House Rules
           

Sit alphabetically Start the day with morning prayer Come on time Come in complete uniform All cellphones must be in your bags and in silent mode No gum during the class Break time is strictly 15 mins Come prepared (meaning read…read…read) Submit written assignment on time, late papers will be considered 75% Ask permission if you have to go to CR Participate during discussion Talk when you have been recognized already

Key Concepts in Management
Structure Function Authority Accountability Hierarchy Planning Organizing Directing Controlling Staffing Budgeting

Productivity Leadership Power Delegation Efficiency Effectiveness

What comes into mind when you talk about management?

What comes into mind when you talk about management?
People Function Organization VMG Processes Policies Procedures Communication Structure Authority Responsibility Resources

What is MANAGEMENT?

  

Process of designing and maintaining an environment in which individuals , working together in groups, efficiently accomplish certain goals or aims Manager carries out PODC, POSLC Applies at all levels of organization Concerned with productivity; effectiveness and efficiency

Koontz and Weihrich

MANAGEMENT (???)
 

Is just one component of leadership Is the coordination and integration of resources through planning, organizing, directing, and controlling in order to accomplish specific institutional goals and objectives
Sullivan and Decker 1988

Understanding Functions of Management

Analysis of management is facilitated by breaking it down into five managerial functions/processes
    

Planning Organizing Staffing Leading Controlling

Understanding Functions of Management

Roles of managers (Mintzberg)
Interpersonal roles •Figurehead role •Leader role •Liaison role Informational roles •Recipient role •Disseminator role •Spokeperson role

Understanding Functions of Management

Roles of managers (Mintzberg)
Decision roles •Entrepreneurial role •Disturbance-handler role •Resource allocator role •Negotiator role

Why Management is essential for any Organization?

  

Managers are charged with the responsibility of taking actions that will make it possible for individuals to make their best contributions to group objectives Applies to small or large organization Profit or non-profit organizations Manufacturing or service industries

Who are the managers that you know?

Goals of Managers?
Profit org Non-profit org

Surplus

Money Time Materials Personal dissatisfaction
e. g. VS I&O Bedmaking

Goals of Managers?
Productivity
Productivity = Outputs Inputs
(within time period, quality considered)

•Increasing O with same I •Decreasing I but maintaining same O •Increasing O and decreasing I to change ratio favorably
Effectiveness Efficiency

Management: An Art or a Science?
Managing as practice is an ART

Organized knowledge underlying the practice is the SCIENCE

Understanding Organizational Structure and Function

Relationships within organizations

Chain of Command Path of authority and accountability from one individual at the bottom of the organization to the very top administrative authority This is also referred to Hierarchy e.g. nurse-HN-NS-CN

Relationships within organizations

Components of Chain of Command  Layers or levels – simple to complex  Flow communication – errors, gaps  Interpersonal relationship – formal,
informal

Relationships within organizations
Span of Control
Refers to number of subordinates and different tasks for which a person in authority is responsible

Narrow Span of Control Responsible for only a few people and one or two tasks areas Broad Span of Control Responsible for many people and a variety of tasks areas

Organizational Charts

 

A diagram of organization that clearly presents its formal structure with persons and departments and their relationships to one another Large organization commonly have OC Small may operate informally, OC may not be available

Organizational Charts

Tells size of the organization and its chain of command Shows relationships between units or departments Boxes represent individuals or a department Solid lines represent communication

Limitations of Organizational Charts
Does not show informal structure  Cannot depict degree of authority  Becomes obsolete quickly  Does not define responsibility and accountability

Organizational Charts

Authority Accountability

Vertical line represents responsibility of Individuals to supervise others officially

Organizational Charts

Organizational Charts

Horizontal solid lines connect individuals at the same level in the organization and have official relationship

Organizational Charts

Organizational Charts

Dotted lines represent communication relationships in which neither individual has direct authority or accountability to the other and they do not have the same supervisor

Organizational Charts

Organizational Charts
Lines of Authority
  

Represent the responsibility of individuals to supervise officially Downward direction Shows authority over those who are lower on the chart and connected by solid lines

Organizational Charts
Lines of Accountability
  

Reporting relationships Upward direction means accountable to individual in the higher level Taken together means chain of command

Types of Organizational Structure
Tall or Centralized Structure Flat or Decentralized Structure Matrix Structure Parallel Organizations

Types of Organizational Structure
Tall or Centralized Structure
 

  

Usually narrow Decision-making authority and power held by few persons in central positions Persons in authority are responsible for only few subordinates May have many levels Communication must travel through the levels

Types of Organizational Structure
Tall or Centralized Structure

Advantages *ability to be an expert *use less skilled individuals *close supervision *top management are spared from unnecessary communication *top people have great deal of control and are the decision makers

Types of Organizational Structure
Tall or Centralized Structure

Disadvantages *skilled individuals may end up doing nothing *the supervised might become stifled *communication is difficult, it passes many layers *implementation of decision may become delayed

Types of Organizational Structure
Flat or Decentralized Structure

Have few levels and broad span of control Decision-making is spread out among many people No close supervision because supervisor is responsible for many people Communication is easy and direct

Types of Organizational Structure
Flat or Decentralized Structure
Advantages  Simple communication patterns-less distortion  Speed in responding t problems  Individuals have opportunities to develop their own abilities  Communication is easy and direct

Types of Organizational Structure
Flat or Decentralized Structure
Disadvantages
    

Broad span of control may result to No close supervision because supervisor is responsible for many people Person in charge may have hard time to process communication since its numerous Supervisor may lack expertise because of wide operation Greater need for ongoing education

Types of Organizational Structure Matrix Structure
 

Either tall or flat Unique – second structure overlies the first Overlying structure represents a special relationship of individuals that is not part of chain of command Recent innovation in health care organization

Types of Organizational Structure Parallel Organizations
   

Employees collective bargaining organization But does not integrate with official organization Has its own officers and representatives Draw on the board

Organizational Function
Organization functions according to what it has set to do which are stated in…..  Philosophy Statement and VMG  Job descriptions  Policies and Procedures

Organizational Function
Philosophy Statement  Reflects the purpose of organization  States beliefs and values that are basic to its operation  May include list of goals or objectives

Organizational Functions
VMG  Vision – how the organization envisions itself, desires of organization  Mission – broad general goals that describes its purpose in the community  Goals – are broad statements of overall intent of the organization

Organizational Function
Job descriptions

Help define organizational structure and function Describes responsibilities of each individual or position in the organization May not give complete description of everything an individual does as part of his/her job (ex. ER nurse and SA nurse)

Organizational Function
Policies and Procedures  Official statements that guide the behavior of individuals in the organization  Are written (manual) as required by law and accrediting institutions  Hospitals have general policies and procedures that guide the behavior or the entire organization  Hospitals have many policies and procedures carefully written out in detail

Organizational Function
Policies and Procedures

Serve as legal safeguard for the organization by establishing standards for practice Nursing policies and procedures are formulated by committees or nurses Provide support for good practice and quality control

What is an Informal Organization?
 

   

Arise to meet social needs of the people within an organization Provide ease of relationships (?) and ways to accomplish desired outcomes In a form of “barkada” system (helping one another) Providing communication Preserving values Informal leaders

Problems of IO
    

Detrimental to formal organization May resist needed change May tolerate mediocrity Sometimes it is closed, newcomers become outsiders May disseminate rumors and inaccurate information “grapevine”

Organizational Climate
Effects of Policies
Formal policies describe expected behaviors of individuals in the organization Theory X – people don’t like to work, they are motivated by material gain, and w/out supervision they will not work e.g. vandi clock to punch in and out

Organizational Climate
Effects of Policies

Theory Y – people find work intrinsically rewarding, motivated by many factors other than material gain

e.g. submits statements of the specific shifts worked, no monitoring of lunches, breaks, etc

Theory Z – operates on the basis of longterm employment, loyalty between employer and employee and strong collective value system

Organizational Climate
Effect of Supervisory Behavior

 

Manner how supervisors carry out policies contribute to organizational climate Personality of supervisor General method of interacting with subordinates Some supervisors create an atmosphere of suspicion and fear (criticisms and unwillingness
to tolerate)

Organizational Climate
The informal organization culture and climate
  

Individuals relate on a personal basis High level of competition (+) Relationships (first name basis, surname)

Understanding Management

Management is……

Process of designing and maintaining an environment in which individuals , working together in groups, efficiently accomplish certain goals or aims (koontz & Weihrich) Is the coordination and integration of resources through planning, organizing, directing, and controlling in order to accomplish specific institutional goals and objectives (Sullivan and Decker)

Management is……
  

the art of getting things done through people getting the right things done at the right time the process or form of work that involves the guidance or direction of a group of people toward organizational goals or objectives

What is Nursing Management?
Relates to planning , organizing, staffing, directing and controlling the activities of a nursing enterprise or division of nursing departments and of the subunits of the departments

Types of Management
  

Authoritarian management style Democratic management style Laissez-Faire management style Multicratic leadership

Types of Management
Authoritarian management style
 

Autocratic Manager makes most of the decisions in isolation Found in bureaucratic organizations that reinforce centrality of authority and reliance upon formal rules

Types of Management
Authoritarian management style

Managers issue orders and expect to be obeyed Authority derives from position power tied to official hierarchical title Authoritarian managers will have subordinate support if they are involved in overall goals and process

Types of Management
Authoritarian management style
     

Strong control is maintained Others are motivated by coercion Others are directed with command Communication is downwards “I” and “You” Punitive criticism

Types of Management
Authoritarian management style Advantages
   

Results to well-defined group actions Decision making can be done expeditiously Appropriate when immediate action is needed Authoritarian managers will have subordinate support if they are involved in overall goals and process

Types of Management
Authoritarian management style
Disadvantages  Subordinates don’t have stake in achievement/failure of management goals  Employee may subvert goals  Managers issue orders and expect to be obeyed  Authority derives from position power tied to official hierarchical title

Types of Management
Democratic Management Style  Involves subordinates in decision making  Democratic managers see themselves as coworkers  Stresses importance of communication and consensus  Promotes autonomy and growth

Types of Management
Democratic Management Style  Manager leads by providing information, suggesting direction and being supportive of coworkers  Function best in less centralized and where there is less reliance on formal rules and policies  Emphasis “We”  Constructive criticism

Types of Management
Democratic management style Advantages  Coworkers are consulted  Coworkers have input on decision making  Employees are involved in all the processes prior to decision making  It is appropriate if decision at hand does not require urgent action

Types of Management
Democratic management style Disadvantages  Decision becomes lengthy process  Coworkers not confident in participating in decision making  Employees may think manager is not capable to DM

Types of Management
Democratic management style Disadvantages  Employees think they are made to do something they are not paid for  If decision not implemented employees think their time is wasted

Types of Management
Laissez-Faire  Permissive management  Least structure and control  Requires coworkers to make own goals, decisions  Managers provide maximum support and freedom for workers

Types of Management
Laissez-Faire  Provision of little or no direction  Communication upward and downward  DM is dispersed throughout group  Criticism withheld

Types of Management
Laissez-Faire Advantages  Providing maximum support and freedom  Allows practice of high levels of independence

Types of Management
Laissez-Faire Disadvantages  Not possible to let workers arrive at an individual decisions about patient care  Because of multidisciplinary care, decision must be centralized

Types of Management
Multicratic

 

One skill of a manager is identifying which style a particular situation requires Combines the best of all approaches Provides maximum structure when the situation requires

Levels of Management
  

Top level managers Middle-level managers First-level managers

Levels of Management
Top level managers  Looks at the whole organization  Coordinate internal and external influences  Makes decisions with few guidelines  COO, CEO, CN, DNS, CNO

Levels of Management
Responsibilities of top-level managers  Determining philosophy  Setting policies  Creating goals and priorities for resource allocation  Need great leadership, not part of day-to-day operation

Levels of Management
Middle-level managers  Coordinates effort of lower levels of the hierarchy  Conduit between lower and top-level managers  Carry out day-to-day operation  Involved in long term planning  Establishing unit policies  Nurse supervisors, head nurse, unit managers

Levels of Management
First-level managers  Concerned with specific unit workflow  Deal with immediate problems in daily operations

Levels of Management
  

Top level managers Middle-level managers First-level managers

POSTTEST
Answer the following as fast as you can:  What is management? (3 pts)  What are the processes of management? (4 items)  Define Organizational chart (2 pts)  Give at least 2 functions of the organizational chart (2 items)  What are the types of organizations? (4 pts)  Give 2 advantages of Tall organization (2 items)  Give at least 2 disadvantages of Tall organization (2 items)  Give 2 advantages of Flat organization (2 items)  Give at least 2 disadvantages of Flat organization (2 items)  Organizational functions are usually stated in these 3 documents  Organizational climate is shaped according to 3 factors

Differentiating the Leader and Manager

Similarities and Differences
Leaders
May

Managers
Appointed

or may not have official appointment to the position Have power and authority enforce decisions only so long as followers are willing to be led Influence others toward goal setting, either formally or informally Interested in risk-taking and exploring new ideas Relate to people personally in an intuitive and empathetic manner Feel rewarded from personal achievements May or may not be successful as managers

officially to the

position Have power and authority to enforce decisions
Carry

out predetermined policies, rules and regulation
Maintain

an orderly, controlled, rational and equitable structure Relate people according to their roles Feel rewarded when fulfilling organizational mission or goals Are managers as long as appointment holds

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