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 Productivity
Hierarchy Leadership
Power
Planning Delegation
Organizing Efficiency
Directing Effectiveness
Controlling
Staffing
Budgeting
What comes into mind when
you talk about management?
What comes into mind when
you talk about management?

People Processes Structure

Function Policies Authority

Organization Procedures Responsibility

VMG Communication 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 (within time period, quality considered)

Inputs

•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 long-

term 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 Managers
May or may not have official Appointed officially to the
appointment to the position position
Have power and authority Have power and authority to
enforce decisions only so long enforce decisions
as followers are willing to be led
Influence others toward goal Carry out predetermined
setting, either formally or policies, rules and regulation
informally
Interested in risk-taking and
Maintain an orderly,
exploring new ideas controlled, rational and
Relate to people personally in
equitable structure
an intuitive and empathetic Relate people according to
manner their roles
Feel rewarded from personal
Feel rewarded when fulfilling
achievements organizational mission or goals
May or may not be successful
Are managers as long as
as managers appointment holds