Nursing Leadership and Managment 2014 Modified Note

NURSING LEADERSHIP
AND MANAGEMENT
By:
S/r Eleni Tesfaye(BSC,MPH)
Course syllabus
Module name:
 Nursing leadership and management
Module code
 Nurs-M3173
Target group
 Third year comprehensive BSC nursing
students
Prerequisite
All modules
03/11/2022 Nursing leadership and managment 2
Status of the module: core
ECTS: 5
Duration: 12 weeks
Components of module
- Nursing leadership and management
theory……..3ECTS
- Nursing leadership and management
practicum (project)( 2 ECTS)

Allotted time…………………135hours
Interactive lecture hours……..32hrs
Project hours ………………......80hrs
Student self study hours……..23hrs

Module description
• This module is designed to comprehensive

nursing students to equip them with
knowledge ,skills and attitude needed to
lead and manage nursing care services.

Module objective
• At the end of this module, students will be

able to describe ,analyze and apply basic
principles of nursing service administration
and leadership in Ethiopian healthcare
system

Module outcome
Upon the completion of this module, students will
be able to:
 analyze and apply principles and functions of
management
 describe concept of nursing service administration
and leadership
 discusses and analyze the principle of leadership in
the health sector

Module outcome
 apply nursing service administration and

leadership principles
 demonstrate amerit-based
selection,appointing,managing and leading
the human resource

Module outcome cont…
 describe basic principles involved in

management of resources
 Analyze the principle of change and involve
in implementation of change
 plan and perform quality assurance on
nursing care service
 identify the major risk areas in nursing
service and manage it
 Lead group dynamics and team sprit
 Analyze and apply advocacy role in nursing
care service
 analyze and resolve conflict within and /or
out of organization
 Analyze and apply the discipline measures

 manage nursing care and service,
education ,training and staff development
program
 create motivating working environment to
assure quality nursing service
 effectively manage time and financial
resource of an organization
 utilize organizational communication
appropriately
• Design and conduct project on health service
of the organization
• Explain and demonstrate managerial role at
different organization level
• Identify and discuss the merit and demerit
of leadership types
• Apply the attributes and principles of critical
thinking in both clinical and leadership areas

Teaching –learning methods
• interactive lecture and discussion
• Small group learning activities: assignmnt
exercise
• Individual reading assignment
• Group discussion
• Student presentation
• Group project presentation

Assessment methods
• Quiz and test ……………..12%
• Assignment presentation …………………..10%
• Written
exam………………………………………..45%
• Project
………………………………………………….33%

Module schedule
Week Contents Assign
ed
hours
1st Introduction to nursing service management 4hrs
week -Definition of management and nursing service administration
-Types of manager
-Managerial skills
-Management functions and managerial roles
-Concepts and applications of leadership in the health sector
2nd Nursing service administration and leadership principles 4hrs
week -Organizational structure of nursing services
-Nursing care delivery models
-Nursing round and patient handover
-Clinical supervision in nursing services
-Role of nurse at different levels of nursing service administration

Week Contents Assigned
hours
3rd Nursing service administration and leadership principles 4hrs
week -Nurse advocacy role (concept, principles and rationales)
-Quality assurance and risk management of nursing services
Leadership
Styles of leadership
Application to nursing profession
4th Resource management 4hrs

week human resource management
 acquisition and recruitment
 selection
Induction and orientation
Retention
development

Week contents Assigne
d hours
5th Resource management 4hrs
week -Discipline
-Delegation
-Performance appraisal
-Motivation
-Promotion and training
6th Financial resource management 4hrs
week -Concept of budget in health
-Types of budget
-Approach of budgeting
Time and resource management
-Concept of time management
-Planning time arrangements(timetable,schedule,roster)
-Common time waster
-Principles of time management
Materials and equipment managment

Wee Contents Assigne
k d
hours
7th group dynamics and teamwork 4hours

week -Types of group
-Phases of group development
-Managing group dynamics
-Types and styles of decision making
-Factor influencing decision making
-Concept of teamwork and team sprit
Organizational communication
-Concept of organizational communication
-Types of communication
-Levels and pattern of communication
-Factors influencing organizational communication

Week contents Assigned hours
8th Conflict management 4hrs

week  definition and concepts
Sources of conflict
 explain types of conflict
Discuss stages of conflict
Explain approaches to conflict resoultion
Introduction to planning and implementing change
Definition and concepts of change
Purpose of change and areas of change influencing
health care today
Change strategies
Rules that should be followed in implementing change
Leaders as change agents
Change management
Reason for change
Change process(steps)

Week Contents Assigned hours
9th week Stress managment

-Definition and concepts
-Source of stress
-Consequence of stress
-Managing stress
Critical thinking
-Definition and concepts
-Components
- critical reflection
- critical reasoning
- judgment
- methods of problem solving
10th Final exam
week f
11th-12th Nursing service project 80 hours
week Planning and conducting project on nursing
service and leadership areas

References
1. AmsaleCherie andBerhane G/kidan.Lecture note of
nursing leadership and management,AddissAbaba
university,2005.
2. Management sciences for health(MSH).managers who
lead.MSH,2005
3. JiraC.health planning for healthscience students.carter
center;2003.
4. Haile mariam D.Exploring alternatives for financing
health care in Ethiopia .An introductory review
article .Ethiopia Journal of health development
2001;15(3):153-163
References
5. Judith dweyer, Pauline stanton,project and
managment in health and community
service,2005,new work
6. Anthony R. Kovner and Duncan
neuhauser .Health service management 8th
edition
7. Pankhurst R.An introduction to medical
history of Ethiopia with apostscript by Asrat
woldeyes.Trenton,NewJersey;1990
References
8.B.L marquis ,C.Jhuston, leadership role and management
function in Nursing (theory and application 4th edition)
9. Sullivan ,J.E(1992)effective mangment in Nursing 3rd
edition
10. StevensW.F .managment and leadership in Nursing 5th
edition
11. Goddard .Priciple of nursing administration 3rd edition
12. Nursing leadership and management lecture notes
13. Health service management lecture notes for health
science students.

Unit one
Introduction to nursing
service management
Definitions
Management-
It is the process of planning, organizing,
Staffing ,leading and controlling the work
of organization members and of using all
available organizational resources to reach
stated organizational goals.

Definition of Management cont…
• It is the process of reaching organizational

goals by working with and through
people and other organizational
resources.

Definition of Management cont…
The definition of management is based on two
principles
• Commitment to achieve goal
• importance of people and other resources
• This means that people are the most important
resource for getting things done.

ADMINISTRATION
• It is determination of major activities in
organization.
Functionally:-
• It is the laying down of the general purpose

of the organization.

ADMINISTRATION cont…
• Framing of its major policies.
• Formulation of general plan of procedure
• Inauguration of broad program

• Approval of specific major projects that fall
within the general program.

Management VS Administration
• Administration is determinative and

management is essentially executive.
• As we go down the hierarchical ladder, the
administrative function became less and less
and the management function becomes more
and more.
The following figure clearly demonstrates
this point
Administration Example
• President
• Vice President
• Schools
• Department
Management
• Units

Nursing service administration
• It is a coordinated activity, which provides all

of the facilities necessary for the rendering
of nursing service to clients.
• Nursing service administration is the
system of activities directed toward the
nursing care of clients.
Nursing service administration
• the establishment of over-all goals and
policies within the aims of the health agency
and provision of organization, personnel,
and facilities to accomplish this goals in the
most effective and economical manner
through cooperative efforts of all members
of the staff, coordinating the service with
other departments of the institution.

Nursing service
• It is the process composed of the set of

interrelated social and technical and
functional activities occurring within a
formal organizational setting to accomplish
predetermined objectives through
utilization of human and other resources.
Types of manager
• Nursing service managers are people who
appointed to positions of authority, which
enable others to perform their work
effectively, who have responsibility for
resource utilization and who are
accountable for work results and can be
proud of their organizations and what
they do.

Classifications of managers
Managers are classified by their level in the

organizational hierarchy such as;-
• Top level
• Middle level
• First line/front line/ or supervisory

management
Top level manager
• Managers who have authority over and

responsibility for the entire organization.
• For example, nursing administrators, board
of directors, Presidents and vice presidents

Middle level manager
• Managers who have authority over and
responsibility for a specific segment, in
contrast to the organization as a whole and
act as a liaison between top-level managers
and first level managers.
• For example, directors of nursing,
supervisory staffs and department heads

First line/front line/ or supervisory management
• Manager who generally report to middle level

managers have authority over and are
responsible for overseeing specific work for
a particular group of works
• For example, head nurses and staffs

Common attributes of managers
• Regardless of level, managers have several
common attributes; they are:

• Formally appointed to positions of authority
• Charged with directing and enabling others
to do their work effectively
• Responsible for utilizing resources
• Accountable to superiors for results

The differences between levels of managers are :-
 the degree of authority
 the scope of responsibility and

 Organizational activity at each level

Managerial skills
• Managers can also be differentiated by the extent

to which they use certain skills each management
skill is used varies with the manager’s position
in the organizational hierarchy; degree of
authority, scope of responsibility; and
number, type, and skills of subordinates.

Types of managerial skills
• Effective managers utilize three distinct

types of skills:-
Conceptual
 human relations and

technical skills

Conceptual skills
• This reflects the mental abilities of managers to
visualize the complex interrelationships in work
place.
• These skills permit managers to understand how
the various factors in particular situations fit
together and interact with one another

Conceptual skills cont…
• Senior managers use disproportionately
more conceptual skills in their jobs than do
middle level or first line managers. These
include :

Conceptual skills cont…
• recognizing and evaluating multiple complex issues
and understanding their relationships
• engaging in planning and problem solving that
profoundly affect the health service organization, and
• Thinking globally about the organization and its
environment.

Human relation/interpersonal
• These are abilities of managers to get along well

with other people, to understand them, and to
motivate them in the work place.
• All managers use human relation skills because

they accomplish work through people.
• Human relations skills include motivation,

leadership and communication
03/11/2022 Nursing leadership and managment
skills. 47
Technical Skills
• Managers’ abilities to use the methods,

processes, and techniques of managing.
• First line managers tend to use job related
technical skills, or skills that involve
specialized knowledge.

Fig 1 Managerial skills

Management function and managerial
roles
Management functions of a nurse manager

• Success of management depends on learning
and using the management functions.
• Function is a broad area of responsibility
composed of many activities aimed at
achieving a predetermined objective
Functions of Management Includes:-
1. Planning……………………..Planning (p)
2. Organizing
3. Staffing Implementation (I)

4. Directing
5. Controlling…………………Evaluation (E)

Managerial functions cont...
• In addition to these three broad sequential

functions (PIE).
 Two continuous functions of management are:-
Communication
Decision- Making

Planning
• It is the first and fundamental function of

management.
• It is determining the long-and short-term
objectives (ends) of the institution or unit
and the actions (means) that must be taken
to achieve these objectives.
Purpose of planning
It gives direction to the organization.

 It improves efficiency.
It eliminates duplication of efforts.
 It concentrates resources on important
services.
 It reduces guess work.
It improves communication and
coordination of activities
The planning hierarchy
• Planning responsibilities are different for
managers at each organizational level.
Strategic planning
• The process of determining what an
organization intends to be in the future and
how it will get there.
• It is finding the best future for your
organization and the best path to reach that
destination.
Strategic planning cont…
• Top-level managers, formulate long-term
strategic planning to reinforce the firm’s
mission (the mission clarifies organizational
purpose)
• Strategic plans are specified for five years
period or more; but circumstances dictate
the planning horizon.

Tactical planning
• Middle management is responsible for
translating strategies into shorter-term
tactics.
• Tactical plans are often specified in one-year
increments. Eg. annual budget.
• Translating strategic plans into measurable
tactical objectives is important because
most strategic objective is rather vague.

Operational planning
• It is accomplished by fist-line managers.
• It is most concerned with budgets, quotas
and schedules. These are refinements of
tactical objectives in which work is defined
and results are measured in small
increments.
• Time horizon for operational planning is
very short.

Operational planning cont…
• Most plans at this level reflect operational cycles.
• Operational objective are:
- Narrow in scope
- Short-lived
- Subject to sadden change

Planning process
• Formal planning process consists of 5

guidelines
• Situation audit or environmental assessment:
• Establish Objectives:
• Involve management and staff
• Develop alternatives:
• Communicate plans:
Planning cont….
• Managers communicate plans into two
categories:-
• Standing use plans- are those that are used on a
continuous basis to achieve consistently repeated
objectives. Standing plans take the form of:
policies, procedures and rules
• Single use plans-are those that are used once to
achieve unique objectives or objectives that are
seldom repeated. They are communicated
through: programs ,budget and schedule
Approaches to planning
• There are three distinct approaches that describe
who has the responsibility for formulating plans:
1. Centralized top down planning- is the
traditional approach to planning in which a
centralized group of executives or staff assumes
the primary planning responsibility.

Approaches to planning cont…
2. Bottom-up planning- is an approach that
delegates planning authority to division and
department managers, who are expected to
formulate plans under the general strategic
umbrella of organizational objectives.
3. Team planning- is a participative approach to
planning where by planning teams comprising
managers and staff specialties initiate plans
and formulate organizational objectives.

Organizing
• It is the process of arranging and allocating

work, authority, and resources among
organization members to achieve goals. It
involves establishing authority and
responsibility relationship; division of work.

Steps of organizing process
There are six steps in the organizing process:
1. Establish overall objectives
2. Formulate supporting objectives, policies
and plans
3. Identify and classify activities
3. Group the activities
4. Delegate
5. Tie the groups together horizontally and
vertically
Staffing
• The human resource management process of
ensuring that competent employees are selected
for the right place (job) at the right time..
• It is a complex activity that involves ensuring
that the ratio of nurse to patient provides quality
care
• The nurse manager decides how many and
what type of personnel are required to
provide care for patients.

Staffing cont…
• Usually the overall plan for staffing is determined
by nursing administration.
• The nurse manager is in a position to monitor how
successful the staffing pattern is as to provide
input into needed change.
• The situation of a nursing shortage and the high
activity level of admitted patients to acute care
areas complicate this process.
• Staffing depends directly on the workload or patient
care needs.
Directing\leading motivating, and communicating/:
• The process of directing and influencing the

task related activities of group members or
an entire organization.
• It is a function of the manager that gets
work done through others.

Concepts of directing
• Directing includes five specific concepts;
Giving directions
• It is the first activity of directing
• Directions should be clear, concise and consistent
and should confirm to the requirements of the situation.
• The manager should be aware of the tone of the
directives.
• Different types of situations require different
emphasis. For example, emergency situation calls for
different variation of voice than does a routine request.

Concepts of directing cont…
 Supervising
• It is concerned with the training and discipline of the work
force.
• It also includes follow up to ensure the prompt
execution of orders.
 Leading
• It is the ability to inspire and to influence others to the
attainment of objectives

Concepts of directing cont…
 Motivating
• It is the set of skills the manager uses to help
the employee to identify his/her needs and
finds ways within the organization to help
satisfy them.
 Communicating
• It involves the what, how, by whom, and why
of directives or effectively using the
communication process.
Controlling
• It is the regulation of activities in

accordance with the plan.
• It is a function of all managers at all levels.
• Its basic objective is to ensure that the task

to be accomplished is appropriately
executed
Controlling cont…
• It involves ;establishing standards of
performance, determining the means to be used
in measuring performance, evaluating
performance, and providing feedback of
performance data to the individual.
• Controlling is not manipulation, rigid, tight, and
autocratic or oppression.
Mechanism of controlling
1. Determining objectives (standards) against which

performance can be measured can be stated.
2. Specific measures have to be established to

determine whether these objectives are met.
3. The actual accomplishment of the objectives

would be measured in relation to the standard
and
Mechanism of controlling cont…
4. Information would be fed back to the

individual. Then
5. Corrective action could be taken

Managerial roles
• Roles are defined as the behavior or

activities associated with a management
position because of its authority and status.

Categories of managerial roles
• Henery Mintzberg isolated ten roles; his
believes are common to all managers.
• These roles have been grouped into three
major categories:
- Interpersonal Roles (3)
- Informational Roles (3)
- Decisional Roles (4)

Interpersonal role
• There are three interpersonal roles
A. Figurehead
• All managers, but especially senior managers, are

figureheads because they engage in ceremonial
and symbolic activities such as greeting visitors
and making speeches at organizational events.

Interpersonal role cont…
B. Liaison
• It involves formal and informal internal
and external contacts.
• Serving as a link in a horizontal (as well as
vertical) chain of communication.

Interpersonal role cont…
C. Leader/Influencer
• It includes activities inherent in the directing
function, the purpose of which is to motivate
and lead.
• Motivating subordinates to get the job
done properly.
Informational role
• There are three informational roles
A. Monitor/Nerve center: Serving as a focal point for

non-routine information; receiving all types of
information
B. Disseminator:-Transmitting selected
information to subordinates.
C. Spokesperson:-Transmitting selected
information to outsiders
Decisional Roles
• There are four decisional roles of a manager
• Entrepreneur
• Designing and imitating changes within the organization.
• Disturbance handler
• Taking corrective action in non-routine situations.
• Resource allocator
• Deciding exactly who should get what resources.
• Negotiator
• Participating in negotiating sessions with other parties (e.g.
unions) to make sure the organization’s interests are
adequately represented

Concept and principles of management
ELENI TESFAYE (RN,BSC,MPH)

Concept and principles of
management cont...
• In the process of fulfilling his/her managerial

duties, the manager would apply the following
concepts and principles.
Monday, April 5, 2021 Nursing service administration 84

1. Concepts
• Effectiveness: the amount of the intended objectives
that have been attained
• Efficiency: the degree to which the program
• achieved its result at the lowest possible cost
• Economy of scarce resources
• Work relations should be designed and structured to

support each other towards the achievement of
objectives.

Concepts cont...
• Information: management needs information to

make the right decision, at the same time
information handicap management, if it is not,
the right kind, at the right time and in the right
hand.

Principles of management
Management by objectives:- management

sees that objectives are specified and then that
they are achieved.

Principles of management cont…
The objective should state :
• What is to be accomplished?
• How much of it?

• Where it is to be done?
• When it is to be completed?
• Therefore, a clear statement of objectives makes
it possible to evaluate how effective one is in
approaching and
Monday, April 5, 2021
reaching the objectives.
Nursing service administration 88
Learning from experiences: -

• Analysis of the results between the objectives
and achievement made, i.e. it gives feed back.
Division of labor:
• Management attempts to bring about balance
of work among different people concerned.

Substitution of resources:
• Often when the resources that are normally used
to provide service become scarce or too
expensive, different resources may be used to
provide the intended results.

Convergence of work:
• Working relations should contribute to the
success of each activities and so, to generate
effectiveness.

These working relations of activities are:

• The logical relation with each other
• Time relation or sequence
• Spatial relations between activities
• Functional and structural working relation between
people.

Functions determine structure :-

• When the work is defined; the function and
duties of the individual members of the team are
clearly defined and known to all, the working
relation follow. The exact nature of authority will
be clearly delineated on the structure.

Delegation :
• It takes place when some body’s authority is
lent, to enable that person to take responsibility
when the occasions arise.

Management by exception :
• In effect, it means two things:
 Do not overload with routine, unnecessary information, be
selective.
 Make big decision first, priority in decision
 In short, management by exception means
Selective in information
Priority in decision

Shortest decision path :
- This principles deal with issues:

• Who should make which decision?
• When and where?
- Decision must be made as closely as possible in time

and place to the object of decision and to those
affected by it.
Effectiveness In effective
Efficient
Inefficient

Effectiveness In effective
Efficient Reach to goal Not reach to

No wastages of the goal
resource No wastages of
resource
Inefficient Reach to goal  Not reach to

Wastages of the goal
resource  Wastages of
resource

• Management strives for low resources waste
(high efficiency) and high goal attainment (high
effectiveness).
• Management must keep organizational goals
clearly in mind at all times.

Efficiency
- The ability to minimize the use of

resources in achieving organizational
objectives.

Efficiency cont...
• The basic concept of efficiency, as the word is
understood in common usage by almost everyone, is
quite simple: get the 'most' out of scarce resources.
• Do not waste resources
• Produce each output at least cost
• Produce the types and amounts of output which

people value most

Concepts and applications of
leadership in the health sector
• Leadership is the ability to continuously
influence a team of individuals and
encompasses many important traits. While
Management is the overall direction and
oversight of the work activities of a team,
• leadership focuses on the ongoing motivation,
engagement and productivity of a team.

What are leadership concepts?
• Leadership concepts refer to factors that
leaders consider when applying a
leadership style and overseeing a team of
individuals.
• leadership concepts help professionals
understand what kind of skills and
character traits to develop in order to
advance in leadership roles.

Types of leadership concepts
• Honesty and integrity: . Individuals who are
honest and trustworthy make effective leaders
• Ability to resolve conflict: Strong conflict
resolution skills are necessary to perform
effectively in a leadership role
• Two-way communication: provides leaders
with valuable insight from diverse members of
their teams while they offer constructive
feedback and mentorship to their staff.
• Adaptability: strong leaders who are
adaptable to different situations are highly
successful at networking, building motivated
teams and keeping their teams engaged.
• Self-awareness: Leaders who understand
their limits, know when to seek support and
have experience with regulating their
emotions and reactions make effective
managers and supervisors.
• Empathy: Compassion, understanding
others' feelings and listening to others'
perspectives creates trust, which will lead to
higher job satisfaction since employees are
comfortable and confident in their leader.

• Vision: ability to initiate and influence
change are essential concepts of managing a
team.
- the ability to motivate, inspire and engage
others, and leaders who exhibit these
visionary traits are often highly successful.

• Diplomacy:the skills leaders need to navigate
the workplace as both a team or department
manager and their boss's employee.

N.B
• The following examples of leadership
concepts provide insight into to build a style
of leadership that you can use as a guide to
develop your ability to lead a team
effectively:
- "Be, know do" leadership concept
- Two component concept

-"Be, know do" leadership concept
• It outlines several approaches to developing your
abilities as a strong leader.
• Be professional and hold yourself accountable.
• Know and be aware of yourself and others and
understand how others respond to different
situations and events.
• Know your job and understand what's expected of
you, both from your supervisors and the team
you're leading.
• Do provide mentoring and direction for your team.

Two components concept
• A leader isn't a leader without followers
• Leaders must build relationships and
engage with their followers in order to keep
that team motivated and engaged.
• a leader must create a community of shared
interests, ideas and inputs that lead the team
and entire organization to meet objectives and
achieve success.

Two components concept
• Several approaches to strengthening the
relationship between these two components
include:
- Team building activities
- Mentorship programs
- Training sessions
- Paired work projects

Unit two
NURSING SERVICE ADMINISTRATION
AND
LEADERSHIP PRINCIPLES
Organizational structure of nursing
services
Organization:
- It is a group of people working together,
under formal and informal rules of behavior,
to achieve a common purpose.
- It refers to a procedures, policies, and
methods involved in achieving the common
purpose. Thus, organization is both a
structure and a process.

Organizational structure
• It is the lines of authority, communication, and
delegation; can be formal or informal.
• Different types of interconnecting lines signify
different types of relationships.
• E.g, a solid line; indicate direct authority or
command giving relationship, a dashed line or
broken or dotted line; indicates a consulting
relationship with no prescribed frequency of the
structure to collaborate for planning or control
purpose.
Organizational process
• is refers to the methods used to achieve
organizational goals.
• An organization's formal structure is depict
in its organizational chart that provides a
"blueprint," shows formal relations,
functions and activities.

Purpose of defining organization diagram
• to clarify chain of command

• to clarify span of control
• to clarify official communication channels
and
• Linkage for all department personnel

Organizational structure of nursing
services
• The organizational structure should
provide:-
- Effective work system
- Network of communication
- Identity to individual and the organization
- Foster job satisfaction

Types of organizational structure
• The organization contains both Formal

structure and informal structure

Formal organizational structure
• It describes position, tasks, responsibilities

and relationships among people in their
position in different departments in the
organization and presented in diagrammatic
form called organizational chart

Characteristics of informal
organizational structure
• It helps members to meet its personal
objective and provide social satisfaction
• It has its own channel of communications,
which may distribute information more
broadly and rapidly than the formal
communication system
• Supervisors should be aware of its existence,
study its operating techniques, and use it to
meet the organizational objectives.
Organizational characteristics
1.Span of control:- refers to the number of
employees a manager can effectively oversee
Mostly top executive cannot manage as many
employees’ managers at lower levels.
• Theoretically, A 1:3 supervisory ratio is common at
the top of an organization; a 1:6 ratio is common at
the middle; and a 1:20 or larger ratio is common at
the base.
• The effective span of control for each manager
depends on work pace and pattern of workers skill
and knowledge, the amount of work in
interdependence.
• The top executive must supervise managers of
different specialties; although mid level and first level
managers supervise workers in the same specialty
that performs similar tasks often in a common work
area.
• When span of control is too broad, the manager
has insufficient time to observe and cannot
evaluate performance or give feed back.
• On the other hand, too narrow span of control
has time to supervise each one closely, and too
close supervision discourages subordinates
problem solving independent judgment and
creative thinking.Nursing leadership and managment

03/11/2022 126
Organizational Principles
1. The principle of unity of Command
2. The principle of Requisite Authority
3. The Principle of Continuing Responsibility

Organizational Concepts
1. Responsibility
2. Authority
3. Delegation
4. Accountability-

Types of Formal Organization
Structures
• Line Pattern/Relationship
• Line and Staff Pattern/Relationship/in

an Organization
• Matrix Organizational Structure
• Functional Line and Staff Pattern

Line Pattern/Relationship
• This is the oldest and simplest type of formal
organization chart.
• It is a straightforward, direct chain of
command with superior subordinate
relationships.
• It is more efficient than other structures
• The typical line pattern is divided laterally into
segments representing different nursing
specialties.
Line Pattern/Relationship cont….
• The perspective of workers differs from the
bottom to the top of the structure.
• Workers at the base of pyramids-
- Nursing assistants
- staff nurses perform the basic work of
nursing mission, i.e. direct patient care.

Line Pattern/Relationship cont….
• Employees in the middle of the structure-
- head nurses, patient care coordinators,
supervisors are responsible for professional
decision-making and direction of day to day
operations.
• Personnel at the top of the structure-
- Vice president or director and assistant directors
are responsible for non-programmed decision
making, such as goal setting, program planning, and
performance evaluation
Advantages of Line Pattern
It is easy to orient new employees
Easy to manage, because orders can be

transmitted quickly;
 Well established division of labor;
There is a clear-cut work specialization and role

separation.
Disadvantage of line pattern
• communication difficulties among

specialists
• it is rigid
• causes passivity and dependence in staff
members and autocratic behavior in
managers.

Disadvantage of line pattern cont…
• It is characterized by weak integration of different

divisions or departments. Interaction is only on the
same division and there is no lateral
communication.
• Head nurses will never seek advice from a more
experienced head nurse in a different clinical
division to resolve a patient care.
Board of director
LINE OF AUTHORITY
Hospital administrator
Director of Nursing
Supervisor of nursing Supervisor of nursing
Head nurse Head nurse Head nurse Head nurse
Staff Staff Staff Staff Staff Staff Staff Staff

nurse nurse nurse nurse nurse nurse nurse nurse

Line and Staff Pattern/Relationship/in an
Organization
• Line functions are those that direct responsibility
for accomplishing the objectives of a nursing
department.
• For the most, part they are filled with registered
nurses licensed assistant nurses or other types of
nurses.
• Staff functions are those that assist the line in
accomplishing the primary objectives of nursing.
They include clerical, personnel, budgeting, and
finance, staff development, and research.
Line and Staff Pattern cont…
• The relationship between line and staff are a matter
of authority.
• Line has authority for direct supervision of
employees, while staff provides advice and counsel.
• To make staff effective, top management ensures
that line and staff authority relationships are
clearly defined.
• Personnel of both should work to make their
relationships effective; they attempt to minimize
friction by increasing mutual trust and respect.

Advantage of a line and staff pattern
• It is that key management functions that

the chief executive has neither skill nor
time to execute well are delegated to
functional experts who can devote full
time to the assigned function without
being distracted by responsibilities of
day today management of personnel and
material.

Disadvantage of line and staff pattern
• It is that staff officers have less power

than line officers, because the latter direct
the basic operations. Furthermore, staff
officers must stand quietly in the
background, while line managers receive
recognition for improvements. Staff
positions are also located at the periphery
of formal structure, which casts incumbents
in the role of social isolates.
Matrix Organizational Structure
• This Pattern is a complex construct in which
and employee may be responsible to two or
more bosses for different aspects of work.
• In this pattern, a staff nurse stationed on a
given patient unit is responsible to the head
nurse of that unit but also to a case manager
who oversees the clinical progress of her
patients. It could also be through vertical and
horizontal coordination.
Matrix Organizational Structure cont…
• Potential problems with a matrix type organization

can easily be discerned. If, for example, the head
nurse and the case manager give conflicting orders
to the staff nurse, the job may be indefensible, or a
manipulative staff nurse may play his/her two
bosses off against each other.

Functional Line and Staff Pattern
• A third type of formal organization structure

is the functionalized line and staff
organization.
• In this structure, staff officers are no longer
purely advisory but have some command
authority over line employees.
Functional Line and Staff Pattern
• The director of in-service may have the
authority to decide how much
indoctrination training and what type of
orientation each new nurse must receive
and when orientation classes will be held.

Functional Line and Staff Pattern Cont…
• The director of quality improvement may

have the authority to assign selected staff
nurses to gather data on critical indicators
of care quality, regularly submit quality
monitoring reports, and remedy identified
problems.

Functional Line and Staff Pattern Cont…
• As a nursing organization increases in size,

it may evolve from a pure line, to a line and
staff, and finally, to a functional line and staff
structure.

Advantage Functional Line and Staff
Pattern
• The expert responsible for a specified
management function, such as staffing,
policies, quality improvement, or staff
development, has authority to command
line managers to implement needed actions
that relate to the expert’s specified function.

Nursing care delivery models
• Nursing care can be carried out through a

variety of organizational methods.
• The model of nursing care used varies
greatly from one facility to another and
from one set of patient circumstances to
another..
Nursing care delivery models
Means of organizing nursing care for
patient care delivery
1.total patient care

2.functional nursing
3.team and modular nursing
4. primary nursing
5.case management
151

1. Total Patient Care
 Oldest mode of organizing patient care
 Nurse assumes total responsibility for

meeting the needs of all assigned patients
during his or her time on duty.
 most familiar method.
152

Advantages of total Patient Care
 High Autonomy and responsibility.
 Assigning patients is simple and direct and

does not require planning that the other
methods of patient care delivery require.
 Lines of responsibility and accountability are
clear

Total….
Theoretically patient receives holistic and
un fragmented care.
Disadvantage: when the nurse is
inadequately trained or prepared to
provide total care to the patient provision
of holistic care is questionable .
• Charge
Nurse-NursesPatients/clients
154

2.Functional Nursing
Uses relatively unskilled workers who have been
trained to complete certain tasks
 Care is assigned by task rather than by patient
 E.g: checking blood pressures, changing linens,
bathing patients.
 No continuity of care .
 People are assigned to do tasks for clients’
needs
 RNs become managers of care rather than direct
care providers—“care through others.”
155

Functional……
Advantages
Tasks are completed quickly .
little confusion regarding
responsibilities.
 care provided with a minimal
number of registered nurses
156

Functional….
Disadvantages:
May lead to fragmented care and possibility of
overlooking priority patient needs
Workers may feel unchallenged and under
stimulated=low job satisfaction
May not be cost-effective due to the need for
many coordinators.
Employees often focus only on their own
efforts, with less interest in overall results.
157

Functional….
 IV meds nurse
Charge nurse PO meds nurse
 Asst. vital signs Patients/Clients
Astt. personal care)
158

3.Team Nursing
 personnel collaborate to provide care to a
group of patients under the direction of a
professional nurse.
 Requires an extensive team, communication
and regular team planning conferences
 “More holistic approach to care because
conferences are planned regarding patient’s
needs
159

Team …
 Team should not consist of more than 5
members,
 There is “some opportunity for quality of
care.”
 Became popular in the 1960’s.
 Developed in an effort to decrease the
problems associated with functional
organization of nursing care.
160

Team…
Advantages:
 Allows members to contribute their own
special expertise
 Recognizing the individual worth of the
employees .
 team members autonomy result in high
job satisfaction
161

Team…
Disadvantages:
• Can lead to blurred lines of responsibility,
errors, and fragmented patient care.
• Need for excellent communication and
coordination skills
162

Team..
Charge Nurse RN Team

Leader Nursing Staff
Patients/Clients
163

4.Primary Care Nursing
 Model that provides the best quality of care
 Requires a nursing staff comprised totally of
RNs
 RN’s have 24-hour responsibility
 RN primarily assumes 24-hour responsibility
for planning of care of one or more patients
from the start of treatment to discharge
164

Primary…..
 During work hours, primary nurse
provides direct care for those patients
 Considered best model of care by the
nursing profession
 Has more appeal professionally, but some
hospitals believe this model is too
expensive
 Associate nurses provide care to patients
when the primary nurse is not on duty
165

Primary…
Advantages:
• Job satisfaction is high
• Once nurses develop skill in primary
nursing care delivery, they feel
rewarded and challenged
166

Primary……
Disadvantages
 Inadequately prepared or incompetent
primary nurse may be incapable of
coordinating a multidisciplinary team or
identifying complex patient needs.
167

Disadvantage …
 Many nurses may be uncomfortable in the

role or initially lack necessary experience
and skills
 Sometimes it is difficult to recruit and
retain enough professionals.
168

5. Case Management:
• Collaborative process that assesses, plans,

implements, coordinates, monitors, and evaluates
options and services to meet an individual’s health
needs through communication and available
resources to promote quality, cost-effective
outcomes
169

Case management ..
• Coordinates care throughout an episode of
illness
• Focuses on individual clients, not
populations of clients
170

Case….
 CMs Medical All med. Patients
CMs Pediatric All pedi patients
Nursing Admin. CMs OB  All OB patients
CMs Surgical All surg. patients
171

Nursing round and patent handover
• Nursing is an integral part of medical services in a

hospital, and its mission is to provide the continuum
of care based services throughout the life cycle.
• Nursing round and nursing handover are substantial
elements in providing nursing services and ensure
patients’ safety.

Nursing round cont…
• Nursing round and nursing handover are
synergic series which can improve the quality
of health services.
• Management role and function are needed in
managing nursing round, starting from
planning, organizing, instructing, supervising,
and monitoring.
 Therefore, nurse manager can increase the
quality and standards of health care services
• In nursing round, nurses visit patients to
gain information, make a nursing plan,
discuss nursing problems, and evaluate the
nursing care.
• The nursing round will improve nurses' skill
and knowledge, and enable them to know
the needs or problems of service
management in the field

• Nursing round is a strategy to develop
autonomy, take a decision, create the team’s
operative relation, and provide nurses’
professional status

• By implementing nursing round, patients’
satisfaction will increase five times more than
not implementing it (Febriana, 2009). Nurses'
satisfaction was influenced by several factors,
such as autonomy, organization policy,
assignment requirements, interaction,
professional status, and retain .
• Therefore, the role of top management, which
can motivate and facilitate round is required.
• Nursing Round has enabled shared by
learning across all levels of nursing staff,
information giving, clinical updates and case
review providing an opportunity for focused
professional development which has the
potential to have a positive effect on patient
care

• In nursing round, intense communication
between nurses and patients occurs.
• It results in a collaboration which alleviates
nursing errors .
• Synergic connection with nursing handover
becomes the most essential in conducting
handing over responsibility of care for
patients

Types of nursing rounds
• There are 4 types of nursing rounds in hospital
1. Nurse matrons’ round
2. Nurse management round
3. Patient comfort round

4. Teaching round

Nurse matrons’ round
• matrons' rounds, which can provide senior

nurses with the opportunity to achieve key
aspects of their role. these include ensuring
professional and clinical nursing
standards, improving infection control.

Nurse management rounds
• this round involve the nurse in charge of
the shift seeing each patient. and it gives
the nurse manager an overview of the
condition and needs of all the patients on
the wards and the ability of staff to meet
these needs. also these rounds have
potential benefits for patients, relatives, for
the nursing team and for other healthcare
professionals.
Patient comfort rounds (pcrs)
• are an important part of maintaining and
monitoring the fundamental aspects of
individual patient care. they should be
carried out at 2-hour intervals whenever
possible, commencing after lunchtime and
continuing for the rest of the day. at night
time,

Patient comfort rounds (pcrs)
• pcrs should be carried out before patients
go to sleep and again in the early morning. it
may be necessary to carry out more regular
care to some patients.
• the purpose of pcrs is to maintain a regular
review of the patient nursing needs, support
the nursing process and evaluate nursing
care

Teaching rounds
• nurses learn in a variety of ways: through courses and
accredited program's, seminars, conferences, self-directed
study and so on.
• one of the most effective ways, however, is to participate in
special clinical teaching rounds. these are aimed at all
learners, whether pre-registration students or qualified
staff.
Teaching round cont…
• teaching round is to learn from direct

patient contact with facilitation from an
experienced nurse teacher. and also to teach
and evaluate nursing care. it is useful in
developing clinical practice, evidence-based
care
Nursing handover
• Nursing handover is a professional and
accountable process of handing over the
responsibility of all cares for patients or
from a group of patients for others or a
professional group. This is conducted
temporarily or permanently, and thus,
patients receive satisfaction from nursing
care .

Nursing handover cont …
• Nursing handover is planned as a way to
provide relevant information for each nurse
in each shift handover. Furthermore, it gives
direction to inform the patients' condition,
aims and plan of nursing, treatment, and
care priority

• Nursing handover is a routine performed by a
nurse during shift handover to continuously
monitor patients’ care in a hospital .
• Nursing shift handovers consider being a
pattern of communication that is applied in
everyday clinical nursing practice, to be
fulfilled the goals of organization, continuity,
consistency, and safety of care that nurses
provide to patients .
• Communication errors frequently occur in

nursing handover, and thus, it becomes a
priority aiming to protect patients’ safety
and prevent any unexpected occurrence.

• Effective, punctual, accurate, completed,
unambiguous, and understandable
communication will decrease errors and
increase patients’ safety

Management responsibilities
• A nurse manger has responsibility for

compliance with the clinical handover. The
operational leadership of handover and
allocation of nurses to patients is usually the
role of the manager.

A nurse manager has the responsibility to
ensure that the following principles are
applied:-
• Patient care, as required, continues while handover
is occurring
• The Electronic Medical Record (EMR) is available
for nurses
• The venue, starting times and duration of the
handover are set
• Group handover reflects time available and clinical
demands of the shift (e.g. large group with all
nurses commencing their shift or in smaller groups
of nurses working in a pod)
Mangers responsibility cont…
• Nurses have a clear understanding of the structure
and expectations of handover
• Disruptions are minimized
• All relevant nurses attend handover
• ISBAR is the format used to structure
communication
• Allocation of patients to suitable competent nurses
• Audits of the handover process are completed as
required

Patient hand over
• Group Handover (inpatient, ward based)
• Bedside Handover (inpatient, ward based)
• Break Handover (inpatient, ward based)

• Transfer of patient within the hospital (for
procedure, treatment or to another ward)

Clinical supervision in
nursing services
Clinical supervision
• is a process of professional support and
learning in which nurses are assisted in
developing their practice through regular
discussion time with experienced and
knowledgeable colleagues (Fowler 1996). ...
Clinical supervision enables nurses to
discuss patient care in a safe, supportive
environment.

Types of Clinical Supervision
• There are a variety of ways that clinical
supervision is completed within the nursing
field.
• There are no definitive ways of completing
sessions, as it depends largely on where you
work and what your employer's policies are.

One-to-one supervision.
• This type of supervision is strictly between a nurse
and a clinical supervisor.
• In this form of supervision, the nurse and their
supervisor will work closely and typically share the
same field of specialty, such as emergency room
nursing or midwifery.
• This type of clinical supervision allows trust to
develop between the supervisor and the nurse.
• They can share feedback on how to improve nursing
skills without the judgment of their peers.
One-to-one peer supervision.
• This type of supervision is between two nurses of
equal status, taking it in turns to supervise each
other. The benefit of this type of supervision is
that there is no supervisor or authority figure in
the process, so it encourages independence and
the strengthening of problem-solving techniques.
• It should be noted that this type of supervision is
not appropriate for inexperienced nurses, or
nurses that may require a more structured level of
clinical supervision.
Group supervision.
• This type of supervision involves a group of nurses

who meet with one clinical supervisor and share
important components of their caseloads. For
example, each nurse will take turns presenting a case
to the group and then receive feedback on how to
improve nursing skills or treatment ideas.
• This type of supervision allows a nurse to receive
multiple perspectives of their case, which in turn
provides them with the ability to stay open-minded
during the supervision process.
Peer group supervision.
• Similar to that of one-to-one peer supervision, this style of
supervision allows for a group nurses of equal status to
meet and discuss their caseloads or challenges they are
experiencing. With this type of supervision, the nurses must
be careful, as sessions can easily become too informal,
taking the attention away from what needs to be discussed.
• On the other hand, it allow nurses to discuss their personal
experiences without anyone being in charge. This style of
supervision can allow each nurse in the group to be more
forthcoming with each other as there is no authority figure
in the mix.

Quality assurance and risk
management of nursing services

• Accountability is the obligation to provide
an estimate for one’s actions to the persons
who delegated authority for that action.
• The conscious nurse exhibits accountability
toward her/his employer, the patient, and
government agency that pays for the patient
health care.
A nursing care Outcome is the end result of a
nursing intervention, a measurable change in the
state of a patient’s health that is as a circumstance
by nursing action
A criterion is the value free name of a variable
that is known to be a reliable indicator of quality
Example, nurses educational preparation affect the
quality of patient care decisions.

• A standard is the desired quantity, quality, or
level of performance that is established as a
criterion against which worker performance will
be measured.
• A nursing department might establish a standard
that requires 100 percent of nurse managers to
earn a bachelor’s by a target date.

• A norm is current level of performance
of a selected work group with reference to
a given criterion.
• Example, a norm for writing nursing
diagnosis in the ward for each patient
within 12 hours of admission is 50 percent.

• An Objective is a goal toward which effort is
directed.
• To be effective, an objective should be expressed in
observable, measurable terms and should include
target date for fulfillment
• For example, “By January, 1995, all head nurses
will be certified trainers of cardiopulmonary
resuscitation.”
• A Critical clinical indicator is a quantitative
measure that can be used as a guide to monitor
and evaluate the quality of important patient care
activities.
• The effectiveness of a particular nursing
intervention is the extent to which desired outcomes
are attained through the use of the intervention.

Quality Assurance Process
Quality assurance process is the systematic process of
evaluating the quality of care given in a particular unit
or institution.
It involves setting standards, determining criteria to
meet those standards, data collection, evaluating how
well the criteria have been met, making plans for
change based on the evaluation, and following up on
implementation for change.

Setting Standards:-
• The nursing profession should have to
design standards of nursing practice that are
specific to the patient population served (for
example, the American Nurses Association
has set up a Standards of Nursing Practice
based on nursing process).

• These standards could serve as the
foundation upon which all other measures
of quality assurance are based. An
example of a standard is: Every patient will
have a written care plan.

Determining Criteria:-
• After standards of performance are
established, criteria must be determined that
will indicate if the standards are being met
and to what degree they are met.
• Just as with standards of care, criteria must be
general as well as specific to the individual unit.

• One criterion to demonstrate that the
standards regarding care plans for every
patient are being met would be:- A nursing
care plan is developed and written by a nurse
within 12 hours of admission.
• This criterion, then, provides a measurable
indicator to evaluate performance.

Data Collection:-
• The actual collection of data is the third step in
quality assurance.
• Sufficient observations and random samples are
necessary for producing reliable and valid
information
• A useful rule is that 10 percent of the institutional
patient population per month should be sampled.

Evaluating Performance
• Several methods can be used to evaluate
performance.
• These include reviewing documented records,
observing activities as they take place,
examining patients, and interviewing patients,
families, and staff.

Monitoring Nursing Care
In addition to the individual patient care activities
described, another component of quality assurance
is the ongoing monitoring of nursing care.
Several methods are used to monitor nursing care.
These include the nursing audit, peer review,
utilization review, and patient satisfaction.

Nursing Audit can be retrospective or concurrent.
 A retrospective audit is conducted after a patient’s
discharge and involves examining records of a large
number of cases.
 Recommendations for change can be made from the
perspective of many patients with similar care
problems and with the spectrum of care considered.

• A concurrent audit is conducted during the
patient’s course of care; it examines the
care being given to achieve a desirable
outcome in the patient’s health and evaluates
the nursing care activities bearing provided.
• Changes can be made if they are indicated
by patient outcomes.

Peer Review:-
 occurs when practicing nurses determine the
standards and criteria that indicate quality care
and then assess performance against these.
In this case, nurses are the “experts” at knowing
what the indicators of quality care and when
such care has been provided.

Patient Satisfaction
It is using a questionnaire and asking the
patient to fill out before leaving the institution.
Such questionnaire includes care given in a
timely fashion and other variables in the
environment that contribute to recovery rather
than standards of professional care.

Risk management
• Risk is a function of the likelihood of a
given threat-source’s exercising at a
particular potential
• vulnerability, and the resulting impact of
that adverse event on the organization.
221
03/11/2022 S/r Eleni Tesfaye(RN, BSC,MPH)

Risk management involves
Identify Hazards (risk). Identify hazards to

the force. Consider all aspects of current
and future situations, environment, and
known historical problem areas.
222
Monday, April 5, 2021 Nursing service administration

Assess hazard
• Organizations use risk assessment to :-
• determine the extent of the potential threat

and the risk associated .
• The output of this process helps to identify
appropriate controls for reducing or
eliminating risk during the risk alleviation
process 223

Assessment of probability
• Frequent - Occurs often, continuously
experienced.
• Likely - Occurs several times.
• Occasional - Occurs sporadically.
• Seldom - Unlikely, but could occur at some
time.
• Unlikely - Can assume it will not occur.
224

Assessment of Severity
• Catastrophic : Death or permanent total
disability, system loss, major property
damage.
• Critical : Permanent , partial disability,
temporary and total disability in excess of 3
months, major system damage, significant
property damage.
225

Severity…..
• Marginal : Minor injury, lost workday accident,

compensable injury or illness, minor system
damage, minor property damage.
• Negligible: First aid or minor supportive medical
treatment, minor system impairment.
226

Develop Controls and Make Risk Decisions.
• Develop control measures that eliminate the

hazard or reduce its risk. As control
measures are developed, risks are
reevaluated until all risks are reduced to a
level where benefits outweigh potential
cost. 227

Implement Controls
Implementing controls , involves

• prioritizing,
• evaluating, and
• implementing the appropriate risk-reducing

controls recommended from the risk
assessment process.
Cont…
• N.B : the elimination of all risk is usually
impractical or close to impossible, it is the
managers to use the least-cost approach
and implement the most appropriate
controls to risk to an acceptable level, with
minimal adverse impact on the
organization’s resources.

Risk control options
• Risk Assumption. To accept the potential risk and
continue operating
• Risk Avoidance. To avoid the risk by eliminating
the risk cause and/or consequence
• Risk Limitation. To limit the risk by implementing
controls that minimize the adverse impact
• Risk Transference. To transfer the risk by using
other options to compensate for the loss, such as
purchasing insurance
230

EVALUATION AND SUPERVISION
• the risk management process is ongoing and

evolving.
• this section emphasizes the good practice and
need for an ongoing risk evaluation and
assessment and the factors that will lead to a
successful risk management program.
231

Unit three
Leadership and management theories
Leadership
• Leadership is a process of directing and

influencing task-related activities of group
members.
233
Leadership theories
1. Great Man" Theory :
• assume that the capacity for leadership is
inherent –
• that great leaders are born, not made.
• describe great leaders as heroic, mythic and
destined to rise to leadership when needed.
• The term "Great Man" was used because, at the
time, leadership was thought of primarily as a
male quality, especially in terms of military
leadership. 234
2. Trait Theories:
• assume that people inherit certain qualities

and traits that make them better suited to
leadership.
235
3. Contingency Theories:
• According to this theory, no leadership style

is best in all situations. Success depends
upon a number of variables, including the
leadership style, qualities of the followers
and aspects of the situation.
236
4. Situational Theories:
• propose that leaders choose the best course

of action based upon situational variables.
• Different styles of leadership may be more
appropriate for certain types of decision-
making.
237
5. Behavioral Theories:
• are based upon the belief that great leaders
are made, not born.
• Rooted in behaviorism, this leadership
theory focuses on the actions of leaders not
on mental qualities or internal states.
• According to this theory, people can learn to
become leaders through teaching and
observation.
238
6. Participative Theories
• suggest that the ideal leadership style is one
that takes the input of others into account.
• These leaders encourage participation and
contributions from group members and help
group members feel more relevant and
committed to the decision-making process.
• In participative theories, however, the leader
retains the right to allow the input of others.
239
7. Transactional Leadership
• People are motivated by reward and

punishment.
240
8. Transformational Leadership
People will follow a person who inspires

them.
• A person with vision and passion can
achieve great things.
• The way to get things done is by injecting
enthusiasm and energy.
241
Leadership style
• Leading; is guiding, directing, controlling of

resources towards the achievement of
organizational goal.
• Leadership style is the manner and approach
of providing direction, implementing plans,
and motivating people. 242
Styles …..
three major leadership styles.
Authoritarian or autocratic
Participative or democratic
Delegative or Free Reign
• Although good leaders use all three styles, with

one of them normally dominant, bad leaders tend
to stick with one style. 243
1 Authoritarian (autocratic)
• leaders tell their employees what they done
• Some of the appropriate conditions to use it is
when you have all the information to solve the
problem, you are short on time, and your
employees are well motivated.
• The authoritarian style should normally only be
used on rare occasions.
• If you have the time and want to gain more
commitment and motivation from your employees,
then you should use the participative style.
244
Participative (democratic)
• This style involves the leader including one or more
employees in the decision making process
• However, the leader maintains the final decision making
authority.
• Using this style is not a sign of weakness, rather it is a sign
of strength that your employees will respect.
• used when you have part of the information, and your
employees have other parts.
• leader is not expected to know everything
• needs knowledgeable and skillful employees.
245
3 Delegative (free reign)
• leader allows the employees to make the decisions.
• However, the leader is still responsible for the decisions
that are made.
• used when employees are able to analyze the situation
and determine what needs to be done and how to do it.
• This is not a style to use so that you can blame others
when things go wrong,
• rather this is a style to be used when you fully trust and
confidence in the people below you.
• Do not be afraid to use it, however, use it wisely!
• NOTE: This is also known as lais…sez faire (or lais…ser
faire), 246
Unit 4
Human resource management
• HR:-consist of all people who perform its

activities.
• HRM:-is the process of acquiring and retaining
the organization's human resource.
247
HRM
 Acquisition of human resource includes
human
• resource planning
• recruitment
• selection and
• orientation
248
Human resource planning
• Assessing Current Human Resources
• Assessing Future Human Resource Needs
• Developing a Program to Meet Needs
 through
• We have found the gap, how do we fill this
void?
• How much time should we spend on
identifying the right person? 249
 Staff needs in organizations are driven by
 Organizational growth:
 occurs through increased demand for services,
 Higher occupancy,
 facility expansion and
 the addition of new services
 Employee turnover: through
 resignation
 discharge and
 retirement 250
Recruitment
• Process of locating, identifying, and

attracting capable candidates
• Can be for current or future needs
• Critical activity for some corporations.
251
What sources do we use for
recruitment ?
• Internal Searches
• School Placement
• Employee Referrals
• advertisement
• Employment Agencies
• Employee Leasing(transfer of an individual to
other organization when an organization
specialized in human resource management )
252
Selection
• Selection is the process of choosing for
employment.
• It is to choose among the applicants using
job qualification as a guide.
• The essence of selection is to determine
whether an applicant is suited for the job in
terms of training, experience and abilities
253
Selection
 Sources of information for selection
• Application forms
• pre employment interviews
• Testing
254
Selection Model
Step 1. Analysis of the vacant job(s)-

 Using job analysis procedures the vacant
job(s) are studied to find the knowledge,
skills and abilities needed for job success.
255
• Many problems in personnel selection stem
from the fact that there is often inadequate
understanding of the job and its
requirements
• The best person is best only in so far as
he/she optimally meets these requirements
256
Step2: Selection of criterion and
predictor:
• this step involves two procedures.
• First, job analysis, a criterion of job success
is chosen.
• always, the criterion must be a sensitive
indicator of work quality.
• Secondly, a predictor must be chosen
257
Step 3: Measuring performance
• -After the criterion and predictor have

been chosen,
• the worker's performance is measured on
both variables.
258
Step 4: Assessing the predictor's
Validity
• determine if differences in predictor scores

correspond with differences in criterion
scores, that is, does the predictor have
validity?
259
Step 5: Determining the predictor's
Utility
• It is to determine how useful it will be in improving

the quality of the work force
 Step 6: Reanalysis-
• Any personnel selection program should be
periodically reevaluated to see if changing
employment conditions have altered the predictor
criterion relationship 260
4. Orientation
 After selection, induction and orientation
occur.
• Orientation programes include information
about
• the organization,
• organizational structure,
• philosophy and objectives of the
organization,
261
Orientation …
• rules and regulations,
• universal precautions enrolling new

employees in benefit plans,
• issuing an identification badge are typically
carried.
262
Orientation ..
 Advantage
• Builds employees sense of identification
with the health service organization
• Helps the gain acceptance by fellow workers
• Give them a clear understanding of the
many things??? they need to know
• Enables the new employee to become
familiar with the entire organization as well
as their own work area and department
263
5. Retention
 Retention activities include
• performance appraisal,
• placement
• training and development,
• discipline and corrective counseling,
• compensation and benefit administration,
• safety, and health.
264
Personnel Training
• Personnel training should contribute to the goals
of both the organization and the individual.
• Training is a management tool designed to
enhance organization's efficiency.
• However, in the process of attaining
organizational goals, many individual goals can
also be attained.
265
Assessing training needs
• Assessing training needs usually involves a

three-step process
266
1. Organizational analysis
 It is the study of an entire organization-
• its objectives,
• its resources and the
• way in which it allocates resources to attain its
goals. 267
 Organizational analysis can take several forms.
One form is that of a personnel audit for
manpower planning.
• A personnel audit is an inventory of the
personnel assets of an organization and
• projection of the kinds and numbers of
employees who will be required in the future. 268
Organizational …
• A second approach to organization analysis

involves indicators of organizational
effectiveness.
• These are examined to see if training could
improve the organization's performance
269
2. Operational analysis
• is the orderly and systematic collection of data
about
• an existing or potential task or a cluster of tasks that
define a job.
• It examines the task or job requirements regardless
of the person holding the job.
• It determines what an employee must do to
perform the job properly.
 Operational analysis is most directly concerned
with what training should cover 270
3. Personnel analysis
 directed toward learning,
• whether the individual employee needs
training and what training he/she needs.
• It is concerned with ascertaining how well a
specific employee is carrying out his/her tasks
and
• with determining what skills must be
developed,
• what knowledge acquired, and 271
Personnel analysis…
• what attitudes cultivated if the employee is to
improve his/her job performance.
• A large portion of person analysis involves
diagnosis.
• We want to know not only how well people are
performing but also why they are performing at that
level.
• Personnel analysis involves appraising an
employee’s performance, objective records and
diagnostic achievement tests. 272
Training types ..
• On job training , example job rotation
• Off job training or
• Pre-service training
• In service training
273
Performance Appraisal
• Performance appraisal is a systemic review

of an individual employee's performance on
the job, which is
• used to evaluate the effectiveness of his/her
work
274
Purpose:
• Provide information upon which to base
management decisions regarding
salary raises,
 promotions,
 transfers,
Suspension or
Discharges (separation) 275

Purpose
• Helps to assist employees in their personal
development
• help to assess the effectiveness of hiring and
recruiting practices
• help to identify training and development
needs of the employees
276
Common Problems in
Performance Appraisal
• Performance appraisal may be viewed as
demanding too much from supervisors.
It is difficult for a first line supervisor to know
what each of 20, 30 or more subordinating is
doing
• Standards and rates tend to vary widely,
some raters are hard graders and others easy
277
graders.
Problems…
 appraiser may replace organizational
standards with personal values and bias
 standards by which employees think being
judged are sometimes different from those
superiors actually use
 The validity of ratings may be reduced by
the supervisor's resistance to making the
ratings,
278
Characteristics of an Effective Performance Appraisal
• Relate performance appraisal to the job

description
• Understanding the criteria for evaluation
279
Tools of performance appraisal
1. Rating scales-the tool consists of
 a behavior or characteristics to be rated
and
 some type of scale
 indicate the degree to which the person
being evaluated demonstrates that
behavior
280
Tools..
2. The checklist-
it describes the standard of performance
and
the rater indicates by placing a checkmark
in a column
if the employee demonstrates the behavior
281
Tools …
3. Management by objective-
 focuses on the evaluator's observations of
the employee's performance as measured
against very specific predetermined goals
 that have been jointly agreed upon by the
employee and the evaluator. 282
Performance appraisal methods
 Written essays that describe an employee’s

performance and suggestions for
improvement
 require no complex forms or extensive
training.
But a good or bad appraisal may depend as
much on the writing skill of a manager as on
the actual performance of an employee.
283
Methods
 critical incidents method,

appraiser writes down what an employee did
that was especially productive or
counterproductive.
The key is to cite specific and key behaviors.
284
Methods
 graphic rating scales,
 performance factors are listed such as quantity
and quality of work, depth of knowledge, or
initiative.
 The appraiser then rates each factor on an
incremental scale.
 This method cannot provide the depth of
information of essays or critical incidents,
 but it is less time consuming to develop and
administer, and
 yields results that can be quantified. 285
Methods …
 Behaviorally anchored rating scales BARS
combine the critical incidents and graphics
rating scale approaches.
 The appraiser rates employees on items
along a continuum.
The points along the scale are examples of
actual on-the-job behavior rather than
general descriptions or traits.
286
Methods ..
 A 360-degreereview seeks feedback for the
person being rated from a variety of sources:
such as peers, supervisors, and customers.
Research shows that 360-degree appraisals
offer more accurate feedback,
 empower employees,
reduce subjective factors in evaluation, and
develop leadership in an organization
287
Delegation
03/11/2022 S/r Eleni Tesfaye(RN, BSC,MPH) 288

Definition and principles of Delegation
Delegation: is the process of assigning part or

all of one person’s responsibility to another
person or persons

Principles of delegation
• Assigning responsibility to others does not
lessen your responsibility
• Never assign a task to someone because the
task is unpleasant to you.
• Delegate only if you have confidence that the
member is capable of handling the task.
• When delegating, be sure to back up the
member when his or her authority is called
into questions.
Principles of delegation cont…
• Even though you may be able to do the task better

or faster, delegating allows others to grow.
• Delegating often includes teaching someone how
to do as task—what better way to ensure that
others can run the group when you’re gone?

Principles of delegation cont…
• Delegating can be a significant motivator in
retaining members, it gives them a sense of
accomplishment when a task is successfully
completed.
• Delegation is most successful when someone
expresses an interest in the task, when he or she
has a specific skill which would suit the task
Difference between delegation and
work allocation
Delegation
Task allocation
• isn’t just a matter of telling
someone else what to do. • Allocating tasks does not instil
• When you delegate you
transfer the task, the the same level of
responsibility and the
authority for getting the job empowerment delegation
done to the expected standard. does, but sometimes it is more
• To delegate you need to have
provided the person with applicable than delegation
some freedom to carry out the
task • is giving someone instruction

Benefits of delegation
• It helps to foster working environment
• allows people to grow in the job by enabling them
to gain experience to take on higher
responsibilities.
• builds trust
• contributes to retention
• It is a very helpful aid for succession, planning,
personal development - and seeking and
encouraging promotion.

Steps of successful delegation
1. Define the task: make sure you are clear on what you
are delegating.
2. Select the individual

3. Assess ability and training needs
4. Explain the reasons
5. State required results - What must be achieved? How

will the task be measured?
Steps cont…
6. Consider resources required
7. Agree deadlines - When must the job be
finished? Or if it is on-going, will there be
review dates?
8. Support and communicate
9. Feedback on results - it is essential to let the
person know how they are doing, and
whether they have achieved their aims.

Promotions, transfers, and
separation.
Promotion:
• Refers to a higher position and responsibility.
• It should be fair or merit based.
• Some employees may be bypassed and this could lead to
decrement in morale and resentfulness
• Discrimination may also occur by sex, race, age, and
minority.
Transfers
• It refers to shift to other positions with out change in
status or pay.
 For experience
 To fill vacancies
 To keep promotion ladders open
 To keep individuals interested in the job
 Sometimes, for those with inadequate performance

Discipline, demotion and separation
• Discipline:
– It is applied when the organizations policy is
violated
– It is the process of developing policies, rules and
procedures relating to employees conduct and
behaviors and steps in taking disciplinary actions
(ensure their observance).

Steps in taking disciplinary actions
– Warning
– Reprimand
– Probation
– Suspension
– Disciplinary transfer
– Demotion & discharge
N.B. For poor performance, separation is better than
letting the employee stay on the job.

GROUP DYNAMICS AND TEAM WORK
Group Dynamics
• Communication skills are only one aspect of leadership
development, the other is knowledge of Group dynamics.
• Group dynamics include the study of how people form and
function within a group structure.
• The group becomes a unit when it shares a common goal
and acts in union to either achieve or thwart (frustrate) the
accomplishment of theS/rgoal.
03/11/2022 Eleni Tesfaye(RN, BSC,MPH) 301
Managing groups
An Effective Group
• Has a clear understanding of its goals
• Is flexible in selecting its procedure as it works
toward its goals.
• Has achieved a high degree of communication
and understanding among its members.
• Achieves an appropriate balance between
group productivity and the satisfaction of
individual needs. 302
03/11/2022 NURSING SERVICE ADMINISTARION

Managing…..
• Provides for sharing of leadership
responsibilities.
• Has a high degree of cohesiveness
(attractiveness to its members).
• Makes intelligent use of the differing
abilities of its members
303

Basic Stages of Group Development
1. Forming (Getting Acquainted)

Is first stage characterized by a sense of
 uncertainty
 awkwardness
 perhaps anxiety.
 Participants may be unsure of what to do and
how to do it.
304

Stage …
2. Storming (Struggling Forward) –
The next stage is characterized by
• individual assertive behavior which may
result in some group instability.
• Participants have begun to feel comfortable
enough with their new environment to take
some risks in revealing more of their
personalities.
305

Stage ….
3. Norming (Becoming Personal)
This stage is characterized by
• a growth of affection and establishment of
personal relationships.
• Participants will begin to take responsibility for
resolving conflicts and strengthening
friendships
306

Stage …
4.Performing (Working Together)
This stage is characterized by
• harmony among group members.
• Participants look outwards to see how other people in
the group are doing to make sure all are supported.
• Decision making and problem solving will be shared
within the group.
• At this stage the group is mature enough to attend to its
own needs both in terms of task and relationship
matters. 307

Stage …
5.Transference - This final part of the group
process
• It is important that participants be able to
transfer the things which they have learned
This is accomplished through the debriefing
process.
308

Group Decision Making Process
• Set goal(s) & prioritize them

• Brainstorm options for achieving goals
• Evaluate the different options and examine how the
options meet the goal(s)
• Form committee
• Decide on an option using one of the following criteria
 Best serves highest priority goals
 Best serves all goals
 Serves goals without creating any negative outcomes
 Creates the least negative outcomes 309

Team building
• team is a special type of group
• having small number preferable 8-12 people
• who are interacting and influencing each
other to work for a common goal.
• The members have attitudes of willingness to
work and active participation.
310

Team …
TYPES OF TEAM
A formal team; are deliberately organized by managers
Example
• Command team ;composed of manager and
employees, report to the manager.;
• Committee ; to carry out specific activity relatively for
a long period.
• Task force; formed to address a specific problem.
B. informal team ;emerge when ever people come
together and interact regularly. 311

Managing conflict
 These differences can be between
• individuals or
• between sub-groups within the group.
 Many times the conflict is due to lack of
communication between people.
If people understand the needs, values,
perceptions, etc. of others in the group, then
conflict can often be avoided.
312

Conflict ….
 one of the important roles of the leaders is
• to set the tome of the trip and introduce the
basic goals, norms and values .
• This gives all of the participants a common
understanding of what is expected and can
help prevent conflict.
313

conflict…..
• two major goals take into account when dealing
with conflict situations:
• Achieving personal goals (task orientation)
• Keeping good relationships with the other persons
(relationship orientation).
But
• These two issues may run up against one another.
• Dealing with balancing of these two goals is
important. 314

Dealing with Conflict
• When faced with an interpersonal conflict,

some of the techniques to resolve or mediate
are .
• Compensation - ask yourself if the behavior you
are seeing is compensation for something else.
• Accept the person but you don't have to accept
the behavior.
• Quickly correct inappropriate language
315

Styles of conflict management( modern)
1. win-loss method ; is based on force and

personal goal are satisfied.
• Usually attained by use of force.
2. Loss-loss method; neither parties are satisfied
3. Win –win method ; the most constructive
type
• But most difficult to attain.
316

Tips for Managing Workplace
• Build good relationships before conflict occurs
• Do not let small problems escalate; deal with them as
they arise
• Respect differences
• Listen to others’ perspectives on the conflict situation
• Acknowledge feelings before focussing on facts
• Focus on solving problems, not changing people
• If you can’t resolve the problem, turn to someone who
can help
• Remember to adapt your style to the situation and
persons involved 317

Managing change
Most organizations to day find them selves in
undertaking a number of projects as part of change
efforts directed at
• organizational restructuring ,
• quality improvement and
• employee empowerment.
Three major drivers of change are
• technology,
• information availability and
• growing population.
318

Stages of change
Are three stages
1.Unfreezing stage; is awaring stage.
• It is necessary because before any change can
occur, people must believe the change is needed.
Responsibilities of the change agent
 Gathering data
 Accurately diagnosing the problem
 Deciding if change is needed
 Making others aware of the need for change
319

Stages ….
2.Movement stage :
in this stage the change agent
• identifies ,
• plans and
• implements appropriate strategies
320

Stages….
Responsibilities of the change agent
• Developing plan
• Setting goals and objectives
• Identifying areas of support and resistance
• Setting target dates
• Developing appropriate strategy
• Implementing change
• Evaluating the change
• Modifying the change if necessary 321

Stages …..
3.Refreezing stage; during the refreezing stage
the change agent
• assists in stabilizing the system change,
• so it becomes integrated in to the status quo.
• For refreezing to occur the change agent
must be supportive and reinforce the
individual adaptive efforts of those
affected by the change. 322

CHANGE STRATEGIES
Are three strategies
1. Rational empirical strategies ;human are
rational beings who will change when given
factual information documenting the need
for change .
• This type of strategy is used when there is
little anticipated resistance to the change or
when change is perceived as reasonable.
323

Strategies..
2.Nomativ reductive strategy; the change agent
assumes humans are social animals more
easily influenced by others than by fact.
• Change agent gains power by skill in
interpersonal relation ship
• Not require legitimate powerbase
324

Strategies ….
3.power coercive strategy; are based on the
application of power by
• legitimate authority,
• economic sanctions or
• political clout of the change agent
Note; resistance is the excepected response to
change
325

Ten Principles of Change Management
• Address the “human side” systematically
• Start at the top
• Involve every layer
• Make the formal case
• Create ownership 326

Ten Principles ……..
• Assess the cultural landscape
• Address culture explicitly
• Prepare for the unexpected
• Speak to the individual
• Communicate the message 327

Stress management
• o
328

WHAT IS STRESS?
• Stress is mind and body’s response or
reaction to a real or imagined threat, event
or change.
• The threat, event or change are commonly
called stressors.
• Stressors can be internal (thoughts,
beliefs, attitudes or external (loss, tragedy,
change).
329

LEVELS OF STRESS
1. EUSTRESS :
- Eustress or positive stress occurs when level of
stress is high enough to motivate you to move into
action to get things accomplished.
330

2. DISTRESS
• Distress or negative stress occurs when level

of stress is either too high or too low and body
and/or mind begin to respond negatively to the
stressors.
331

Myths About Stress
1: All stress is bad.
 No, there's good and bad stress.
 Good stress is excitement, thrills, etc.
 The goal is to recognize personal signs of bad
stress and deal with them.
332

Myths ….
5: The busier I am, the better I'm using my
time.
 Look out! You may only be doing what's
urgent, and not what's important.
333

Myths …
6: I feel very harried, busy, so I must have
a time management problem.
 Not necessarily. You should verify that
you have a time management problem.
 This requires knowing what you really
want to get done and if it is getting done or
not.
334

Myth….
7: I feel OK, so I must not be stressed.

 In reality, many adults don't even know when
they're really stressed out until their bodies tell
them so.
 They miss the early warning signs from their body,
for example, headaches, still backs, twitches, etc.
335

STAGES OF STRESS
1. ALARM STAGE: This experience or perception

disrupts body’s normal balance and
immediately body begins to respond to the
stressor(s) as effectively as possible.
336

Alarm …
Example :
• Cardiac - increased heart rate
• Respiratory - increased respiration
• Skin - decreased temperature
• Hormonal - increased stimulation of
adrenal genes which produce an adrenal
rush.
337

2. RESISTANCE STAGE
• During this stage body tries to cope or adapt to

the stressors by beginning a process of repairing
any damage the stressor has caused.
• Your friends, family or co-workers may notice
changes in you before you do so it is important to
examine their feedback to make sure you do not
reach overload. 338

Resistance ….
EXAMPLES:
• Behavior indicators include: lack of enthusiasm for
family, school, work or life in general, withdrawal,
change in eating habits, insomnia, hypersomnia,
anger, fatigue.
• Cognitive Indicators include: poor problem solving,
confusion, nightmares, hyper-vigilance. 339

RESISTANCE STAGE
MORE EXAMPLES
Emotional indicators include:
 tearfulness
 fear
 anxiety
 panic
 guilt
 agitation
 depression
 overwhelmed. 340

3. EXHAUSTION STAGE
• During this stage the stressor is not being

managed effectively and the body and mind
are not able to repair the damage.
• Example: Digestive disorders, withdrawal,
headaches, tension, insomnia, loss of temper.
341

Major Causes of Workplace Stress
1. Not knowing what you want or if you're

getting it - poor planning.
2. The feeling that there's too much to do.
3. Not enjoying the job.
4. Conflicting demands on the job.
5. Insufficient resources to do the job.
6. Not feeling appreciated.
342

Common Symptoms of Poor Stress and Time Management
1. Irritability.
2. Fatigue.
3. Difficulty of concentrating.
4. Forgetfulness.
5. Loss of sleep. This affects everything else
6. Physical disorders: eg, headaches,
rashes, cramps, etc.
7. At worst, withdrawal and depression. 343

Wise Principles of Good Stress and Time Management
1. recognize signs for being overstressed or

having a time management problem.
2. Verify that you really have a problem.
3. time planning
4. Focus on results, not on business.
344

Simple Techniques to Manage Stress
There are lots of things people can do to

cut down on stress.
1. Talk to someone. You don't have to fix the
problem, just report it.
2. Notice if any of the muscles in your body are
tense.
3. Ask your boss if you're doing OK. This
simple question can make a lot of difference
and verify wrong impressions. 345

Simple techniques……
4. Delegate.
6. Use basic techniques of planning,
problem solving and decision making.
7. Write weekly status reports.
8. Do something you can feel good about.

346

STRESS RATING SCALE
• The following are events that occur in the life of a

college student. Place a check in the left-hand column
for each of those events that has happened to you
during the last 12 months.
___ Death of a close family member - 100 points
____ Jail term - 80 points

____ Final year or first year in college - 63 points
____ Pregnancy (to you or caused by your) - 60 points
____ Severe personal illness or injury - 53 points
____ Marriage - 50 points
____ Any interpersonal problems - 45 points 347

Stress rating scale ..
____Financial difficulties - 40 points
____ Death of a close friend - 40 points
____ Arguments with your room mate (more than every
other day) - 40 points
____ Major disagreements with your family - 40 points’
____ Major change in personal habits - 30 points
____ Change in living environment - 30 points
____ Beginning or ending a job - 30 points
____Problems with your boss or professor - 25 points
____ Outstanding personal achievement - 25 points
____ Failure in some course - 25 points
____ Final exams - 20 points 348

Stress rating…….
____ Increased or decreased dating - 20 points
____ Changes in working conditions - 20 points
____ Change in your sleeping habits - 18 points
____ Several-day vacation - 15 points
____ Change in eating habits - 15 points
____ Family reunion - 15 points
____ Change in recreational activities - 15 points
____ Minor illness or injury - 15 points
____ Minor violations of the law - 11 points
• Score: _________________ 349

INTERPRETING YOUR SCORE
• Less than 150 points: relatively low stress level in

relation to life events
• 150 - 300 points : borderline range
• Greater than 300 points : high stress in relation to
life events
• Note: From Girdano, D.A., Everly, G. S., Jr., &

Dusek, D. E. (1990). Controlling stress and tension
(3rd edition), ENnglewood Cliffs, NJ: Prentice Hall.
350

CRITICAL THINKING
Critical thinking is related to evaluation

• has broader scope than decision making
and problem solving
• components of critical thinking includes
reasoning and creative analysis.
351

Critical thinking
352

Problems solving
• is part of decision making that focuses on
analyzing difficult situation
Step of Problem Solving Strategy
1.Specify the problem
• identify it as specifically as possible.
 It involves evaluating the present state and
determining how it differs from the goal state.
353

Problem ….
• 2.Analyze the problem

• analyzing the problem involves learning as much as you can
about it.
• It may be necessary to look beyond the obvious, surface
situation, to stretch your imagination and reach for more
creative options.
• seek other perspectives
• be flexible in your analysis
• consider various strands of impact
• brainstorm about all possibilities and implications
• research problems for which you lack complete information..
354

Problem ….
3. Formulate possible solutions
• identify a wide range of possible solutions.
• try to think of all possible solutions
• be creative
• consider similar problems and how you have
solved them
355

Problem …..
4. Evaluate possible solutions - weigh the
advantages and disadvantages of each
solution.
5.Choose a solution - consider 3 factors:
• compatibility with your priorities
• amount of risk
• practicality
356

Keys to Problem Solving
• Think aloud - problem solving is a cognitive, mental process.

• Thinking aloud or talking yourself through the steps of
problem solving is useful.
• Hearing yourself can facilitate the process.
• Allow time for ideas to "gel" or consolidate. If time permits,
give yourself time for solutions to develop.
• Distance from a problem can allow you to clear your mind
and get a new perspective.
• Talk about the problem - describing the problem to someone
else and talking about it can often make a problem become
more clear and defined so that a new solution will surface
357

Decision making
• is a complex cognitive process often defined as
choosing a particular course of action.
• Decision making has much in common with problem
solving.
• In problem solving you identify and evaluate solution
paths
• in decision making you make a similar discovery and
evaluate alternatives. 358

Decision…
• consider the outcome in both the short term and the
long term.
• Compare alternatives based on how easily you can
accomplish each.
• Evaluate possible negative side effects.
• Consider the risk involved in each.
• Be creative
• An important part of decision making is to predict both

359
short-term and long-term outcomes for each alternative.
Decision Making Models
1 Rational decision making models
• This is the most popular type of model
• based on a cognitive judgment of the pros
and cons of various options.
• selecting the most logical and sensible
alternative that will have the desired effect.
Rational decision making models
• can be quite time consuming and
• often require a lot of preparation in terms of
information gathering
360

2.Seven step decision making model
are designed to firstly identify the frame of the

decision.
• Based on the information available,
alternatives are generated.
• Further information is then gathered about
these alternatives in order to choose the best
one
361

Steps
• Identify a problem
• Gather information
• Analyze the situation
• Develop options
• Evaluate alternatives
• Select a preferred alternative

362
• Act on the decision

3 .Intuitive decision making models
Some people consider these decisions to

• be unlikely coincidences,
• lucky guesses, or
• hocus-pocus (magic)
• but it is Intuitive.
363

4. Recognition primed decision making model
• describes that in any situation there are

cues or hints that allow people to
recognize patterns.
• Based on the pattern, the person chooses
a particular course of action.
364

5. The ultimate decision making model
• The ultimate model
• rapidly assimilate the available information in a

situation,
• bring all the relevant learning and past experiences
• decide what to do, while knowing for certain that
you're making the right decision.
365

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NURSING LEADERSHIP

03/11/2022 Nursing leadership and managment 3

03/11/2022 Nursing leadership and managment 4

• This module is designed to comprehensive

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• At the end of this module, students will be

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 apply nursing service administration and

 describe basic principles involved in

03/11/2022 Nursing leadership and managment 10

03/11/2022 Nursing leadership and managment 12

03/11/2022 Nursing leadership and managment 13

03/11/2022 Nursing leadership and managment 14

03/11/2022 Nursing leadership and managment 15

4th Resource management 4hrs

03/11/2022 Nursing leadership and managment 16

03/11/2022 Nursing leadership and managment 17

7th group dynamics and teamwork 4hours

03/11/2022 Nursing leadership and managment 18

8th Conflict management 4hrs

03/11/2022 Nursing leadership and managment 19

9th week Stress managment

03/11/2022 Nursing leadership and managment 20

03/11/2022 Nursing leadership and managment 23

03/11/2022 Nursing leadership and managment 25

• It is the process of reaching organizational

03/11/2022 Nursing leadership and managment 26

03/11/2022 Nursing leadership and managment 27

• It is the laying down of the general purpose

03/11/2022 Nursing leadership and managment 28

• Framing of its major policies.

• Formulation of general plan of procedure

• Inauguration of broad program

03/11/2022 Nursing leadership and managment 29

• Administration is determinative and

03/11/2022 Nursing leadership and managment 31

• It is a coordinated activity, which provides all

03/11/2022 Nursing leadership and managment 33

• It is the process composed of the set of

03/11/2022 Nursing leadership and managment 35

Managers are classified by their level in the

• First line/front line/ or supervisory

• Managers who have authority over and

03/11/2022 Nursing leadership and managment 37

03/11/2022 Nursing leadership and managment 38

• Manager who generally report to middle level

common attributes; they are:

• Accountable to superiors for results

 the degree of authority

 the scope of responsibility and

03/11/2022 Nursing leadership and managment 41

• Managers can also be differentiated by the extent

03/11/2022 Nursing leadership and managment 42

• Effective managers utilize three distinct

 human relations and

03/11/2022 Nursing leadership and managment 43

• This reflects the mental abilities of managers to

visualize the complex interrelationships in work

• These skills permit managers to understand how

the various factors in particular situations fit

together and interact with one another

• Senior managers use disproportionately