This discusses the basic theories and principles in nursing administration, leadership and management.

1. NURSING LEADERSHIP
AND MANAGEMENT
RYAN MICHAEL FLORES ODUCADO
PhD ©, MAN, MAEd, RN, USRN, RM, CRN

3. PRE TEST ACTIVITY
1. MONITORING
2. MISSION
3. STAFFING
4. POLICY
MAKING
5. AUDIT
6. JOB
DESCRIPTION
7. QUALITY
ASSURANCE
8. SUPERVISION
9. DISCIPLINE
10.BUDGETING

4. MANAGEMENT LEADERSHIP
PROCESS OF
GETTING THINGS
DONE THROUGH
PEOPLE
PROCESS OF
INFLUENCING
OTHERS

5. MANAGEMENT LEADERSHIP

6. MANAGER LEADER

7. PRACTICE TEST
1.Do things right
2.Emphasizes interpersonal
relationship
3.Seeks change
4.Inspires and motivate others
5.Have an assigned position
within the organization

8. TWO OR MORE
PERSON engaged in
a SYSTEMATIC and
COORDINATED effort
to PRODUCE GOODS
AND SERVICE
Form of every
HUMAN
ASSOCIATION for
attainment of
COMMON
PURPOSE

9. ATTAINMENT OF
OBJECTIVES
POOLING OF
RESOURCES
LEARNING,
COMPENSATION
AND SERVICE

10. The Organization and Its Environment
The Broad Environment
Socio-cultural
Forces
Economic
Forces
Technological
ForcesThe Task Environment
The Organization
Owners/ Board of Directors
Managers
Employees
Government Agencies
& Administrators
Suppliers
Competitors Unions
Local
Communities
Activist
Groups
Customers
Political &
Legal Forces

12. SWOT ANALYSIS
• a method of analyzing an ORGANIZATION’S
COMPETITIVE SITUATION that involves
assessing organization’s
STRENGTHS
WEAKNESSES
OPPORTUNITIES
THREATS

15. STRENGTHS
• Expertise personnel
• Qualifications personnel
• Financial status
• Quality of patient care
WEAKNESSES
• Understaffed
• Poor capital
• Scarcity of supplies and
resources
OPPORTUNITIES
• Increase demands
• Improve or new facilities
• Recruitment personnel
• Referrals
• New health program
THREATS
• Competition
• Decrease patient load
• Low patient satisfaction
• Increase of charges
• Legal threats

16. TYPES OF ORGANIZATIONS
ORIENTED TO
ECONOMIC
PRODUCTION
ORIENTED TO
POLITICAL
GOALS
INTEGRATIVE
ORGANIZATION
PATTERN
MAINTENANCE
ORGANIZATION
Allocation of
power in
society
Cultural,
education &
expressionAdjustments
of conflicts
Production
of goods
and services

18. • INITIATING STRUCTURE
Job/task-centered leadership
Concern for production
the degree to which a leader structures the roles of the
followers by setting goals, giving directions, setting
deadlines and assigning tasks
• CONSIDERATE LEADER BEHAVIOR
Employee-centered
Concern for people
the extent to which a leader is friendly, approachable,
supportive and shows concern for people/employees
LEADERSHIP BEHAVIORS

19. ADMINISTRATION

21. MANAGEMENT
UTILIZING OR
ALLOCATING
RESOURCES
Manpower
Money
Material
Machine
Minute
Milieu
Methods
THROUGH
FUNCTIONS
Planning
Organizing
Directing
Controlling
ACHIEVE
GOALS
Production of
goods and
services
COMPETENT
QUALITY
NURSING
CARE

22. NURSING
MANAGEMENT• The PROCESS of working through human and
physical, technical resource to provide CARE,
CURE and COMFORT to patients/clients
• A relationship of inputs and outputs in which the
workers, physical resource and technology are
merged to bring about the ORGANIZATIONAL
GOALS for DELIVERY OF QUALITY NURSING
CARE
• Performing functions of GOVERNANCE and
DECISION-MAKING within organizations
employing NURSES.

23. MANAGEMENT PRINCIPLES
Management by
OBJECTIVE
Management by
EXCEPTION
Management by
CONTINGENCY

24. EXECUTIVE
MIDDLE LEVEL
FIRST LINE
RANK AND FILE/GRASSROOTS
CHIEF NURSE
Policy Making
Strategic PlanningSUPERVISOR
Program Implementation
Securing influx of patients
HEAD NURSE
Direct Implementation
STAFF NURSES
Direct beside care

25. MANAGERIAL ROLES (Henry
Mintzberg)
1. INTERPERSONAL
a. FIGURE HEAD
b. LEADER
c. LIAISON
2. INFORMATIONAL
a. MONITOR
b. DISSEMINATOR
c. SPOKESPERSON
3. DECISIONAL
a. ENTREPRENEUR
b. DISTURBANCE HANDLER
c. RESOURCE ALLOCATOR
d. NEGOTIATOR
an organized set of behavior that is
associated with a particular office or position

26. PRACTICE TEST
1. CHANGE AGENT
2. SEEKS INFORMATION
3. MAINTAINS NETWORKS OF
CONTACTS
4. TRANSMIT INFORMATION
EXTERNALLY
5. SYMBOLIC FUNCTION
6. MOTIVATOR

27. MANAGEMENT
KNOWLEDGE, SKILLS,
PERFORMANCE

28. MANAGEMENT KNOWLEDGE
Include INFORMATION ABOUT
AN INDUSTRY and its
Technology
Company policies and
practices
Company goals and plans
Personalities of key
organization members
Important suppliers and
costumer

29. MANAGEMENT
SKILLS(Robert Katz)
1. CONCEPTUAL SKILLS
 Ability to visualize the organization as a whole,
analyze cause and effect of situation
2. TECHNICAL SKILLS
 Job specific knowledge to perform a task
3. HUMAN SKILLS
 Ability to work well with others

30. Skill Type Needed by Manager Level
Top
Managers
Middle
Managers
Line
Managers
Conceptual Human Technical

31. EFFECTIVENESS
EFFICACYEFFICIENCY
PRODUCTIVITY
Doing the right thing
Doing the things right Making things possible

32. MAJOR VIEWPOINTS IN DEVELOPMENT
OF MODERN MANAGEMENT
I. Classical Viewpoint
A. Scientific management
B. Administrative management
C. Bureaucratic Management
II. Behavioral Viewpoint
A. Early Behaviorists
B. Hawthorne studies
C. Human Relation Movement
III. Quantitative Viewpoint
A. Operations research
B. Operations management
C. Management information
science’
IV. Contemporary Viewpoint
A. Systems theory
B. Contingency theory
C. Emerging views

33. CLASSICAL VIEWPOINT
• Emphasis : EFFICIENCY, TASK ORIENTATION,
EFFECTIVE OPERATION, HIGH INDIVIDUAL
PRODUCTIVITY
• Promote managers RIGID YET FAIR CONTROL of
employees and employee’s STRICT OBEDIENCE
TO THOSE IN AUTHORITY
• Overlooks the social needs of workers
• MECHANISTIC and PERSONAL

34. SCIENTIFIC MANAGEMENT
Emphasizes the SCIENTIFIC STUDY OF WORK
METHODS = IMPROVE WORKER EFFICIENCY
Major Contributors:
FREDERICK TAYLOR
FRANK AND LILIAN GILBRETH
HENRY GANTT

35. FREDERICK W. TAYLOR (1856 - 1915)
• FATHER OF SCIENTIFIC
MANAGEMENT
• Study work scientifically to determine the
“ONE BEST WAY” to perform each task

36. HENRY GANTT (1861 - 1919)
• Developed the “GANTT CHART”
– graphically illustrates a project from START
to FINISH including time intervals for interim
steps
“Workers should be provided with the means to
find their JOB as a source of both
INCOME and PLEASURE”

38. BUREAUCRATIC MANAGEMENT
• MAX WEBER
– FATHER OF ORGANIZATION
THEORY
• Organization to OPERATE IN A
RATIONAL MANNER
• Organizations with HIERARCHICAL
STRUCTURE are most effective

39. ADMINISTRATIVE MANAGEMENT
Focused on principle that can be used by
managers to COORDINATE THE INTERNAL
ACTIVITY OF ORGANIZATION
Major Contributors:
HENRI FAYOL
LUTHER GULLICK
LYNDAL URWICK

40. HENRI FAYOL (1845 - 1925)
• “FATHER OF OPERATIONAL
MANAGEMENT THEORY”
• “FUNCTIONAL APPROACH” to
management

41. FUNCTIONS OF MANAGEMENT
PLANNING = EXAMINING FUTURE
ORGANIZING = PROVIDING RSOURCES AND
BUILDING STRUCTURE to carry out the activities of the
organizations
DIRECTING = COMMANDING
COORDINATING = UNIFYING & HARMONIZING
CONTROLLING = VERIFYING that everything occurs
in accordance with plans, instructions, established principles
and expressed command.

42. 14PRINCIPLES
1. Division of Work
2.Authority
3.Remuneration
4.Initiative
5.Unity of Command
MANAGEMENT

43. 14PRINCIPLES
6. Subordination of
individual interest
7.Unity of Direction
8.Scalar Chain
9.Equity
10.Centralization
MANAGEMENT

44. 14PRINCIPLES
11. Stability of Personnel
Tenure
12.Order
13.Discipline
14.Esprit de Corps
MANAGEMENT

45. LUTHER GULLICK & LYNDALL URWICK
• Suggested a classification of activities in
different function of management
POSDCORB
7 ADMINISTRATIVE ACTIVITIES

46. P
O
LANNING
S
D
CO
R
B
RGANIZING
TAFFING
IRECTING
MMUNICATING
EPORTING
UDGETING

47. BEHAVIORAL VIEWPOINT
• A perspective on management that emphasizes the
importance of attempting to UNDERSTAND THE
VARIOUS FACTORS THAT AFFECT HUMAN
BEHAVIOR in organization
• Focuses on ORGANIZATIONAL PRODUCTIVITY
rather than on individual production
MORALE = PRODUCTIVITY

48. Major Contributors:
MARY PARKER FOLLETT
ELTON MAYO
ABRAHAM MASLOW
DOUGLAS MCGREGOR
FREDERICK TAYLOR

49. MARY PARKER FOLLETT (1868-1933)
• Management as SOCIAL PROCESS
• “POWER WITH” rather than “POWER OVER”
• INTEGRATIVE UNITY = OPERATE AS A
FUNCTIONAL WHOLE
• Managers & workers = PARTNERS

50. ELTON MAYO/FRITZ ROETHLISBERGER
• HAWTHORNE STUDIES
• SOCIAL CLIMATE = INFORMAL
• Phenomenon based on the concept that human
factors like attention, care and recognition and not
just physical work environment influence
productivity.
• HAWTHORNE EFFECT
– Tendency for people to perform as expected
because of special attention given to them

51. HUMAN RELATIONS MOVEMENT
• Emphasized CONCERN TO WORKERS
HUMAN RELATIONS
INTEGRATION OF PEOPLE into a work situation in
way that
MOTIVATES them to
WORK PRODUCTIVILY, COOPERATIVELY, with
ECONOMIC, PSYCHOLOGICAL AND SOCIAL
SATISFACTION.
• Focus: WORKERS AS SOCIAL CREATURES
• COMMUNCATION and GROUP DYNAMICS

52. CONTEMPORARY VIEWPOINT
SYSTEMS THEORY
SITUATIONAL THEORY
QUALITY VIEWPOINT
THEORY Z

53. SYSTEMS THEORY
• Approach to solving problems within a framework of
INPUTS, PROCESS, OUTPUT & FEEDBACK
• SYSTEM
– a collection of things or beings or people that are
inter-related in complex ways and form an
identifiable whole; a group of interacting bodies
under the influence of related forces
• ALL ORGANIZATIONS ARE OPEN SYSTEM
THAT INTERACT WITH THEIR ENVIRONMENT

54. • MAN
• MONEY
• MACHINE
• MOMENT
• MATERIALS
INPUT
• PLANNING
• ORGANIZING
• DIRECTING
• CONTROLLING
THROUGHPUT • PRODUCTS
• SERVICES
OUTPUT
ENVIRONMENT
FEEDBACK

55. CONTIGENCY VIEWPOINT
• SITUATIONAL APPROACH
• means “IT DEPENDS”… appropriate
action depends of the particular parameters of the
situation
• Task of the manager is to identify:
– WHICH TECHNIQUE will
– in a particular SITUATION
– under a particular CIRCUMSTANCES
– at a particular TIME,
– BEST contribute to the attainment of management goals

56. QUALITY MANAGEMENT
• QUALITY
– how well a product or service does what it is
supposed to do
• TOTAL QUALITY MANAGEMENT
– philosophy that emphasizes a commitment to excellence
• CONTINUOUS QUALITY MANAGEMENT
– Process of CONTINUALLY IMPROVING PRODUCT
AND SERVICES QUALITY so as to achieve the HIGH
LEVELS OF CUSTOMER SATISFACTION and build
stronger customer loyalty.

57. W. Edward Deming (1900-1993)
• “GODFATHER OF THE QUALITY MOVEMENT”
• TQM Characteristics:
Client focus
Total organization involvement
Use of quality tools and statistics for measurement
Key processes for improvement identified
• DEMING believed that poor quality is 85% of
management problems and 15% worker problem

58. WILLIAMS OUCHI
• PARTICIPATIVE APPROACH (THEORY Z)
• Humanistic nature that focuses on finding better
ways to motivate people in order to increase worker
satisfaction therefore productivity

59. 7 “S” BASIC CRITERIA
SUPRAORDINATE GOALS: hold organization together
STRATEGY: method of doing things
STRUCTURE: physical plant and facilities
SYSTEM: coherence of all parts for common goal
STAFF: concern for the right people
SKILLS: developing and training people
STYLE: manner of handling people

61. MOST BASIC AND FUNDAMENTAL
ACTIVITY
ALL OTHER FUNCTIONS DEPENDS
Mental process of DECISION MAKING
and FORECASTING
CONTINUOUS PROCESS OF
ASSESSING

62. Involves the CHOICE OF GOALS & OBJECTIVES
along with:
MISSION & VISION
PHILOSOPHY
STRATEGIES
PROGRAMS & PROJECTS
PROCEDURES
POLICIES
RULES
STANDARDS
necessary for the accomplishment of these objectives.

63. COMPONENTS OF
PLANNING

64. MISSION/VISION
PHILOSOPHY
GOALS
OBJECTIVES
PLANSSINGLE-USE STANDING
PROGRAMS
PROJECTS
POLICIES
RULES
PROCEDURES
Purpose Future role or
function
Beliefs & values
Target or end results
Specific
General
Means
Non Recurring Recurring

65. WHY, HOW and CAN of PLANNING
WHAT to do? NURSING ACTIVITIES
WHY do it? RATIONALE
WHERE to do it? VENUE
WHEN to do it? TIME FRAME
WHO to do it? PROF or NON-PROF
HOW to do it? METHODS, TECHNIQUES
HOW MUCH? BUDGETING
For WHOM? RECIPIENTS/CLIENTELE
CAN?
•

66. REACTIVIST
• AFTER A PROBLEM EXISTED
• Dissatisfaction with the current
situation
• RETURNING to previous situation
• Done in RESPONSE TO CRISIS
• Hasty decisions and mistakes
• Problems dealt separately
INACTIVIST
• CONVENTIONAL PLANNING
• STATUS QUO
• PREVENTING CHANGE and
MAINTAINING CONFORMITY
• CHANGE OCCUR SLOWLY
PREACTIVIST
• UTILIZE TECHNOLOGY to
accelerate change
• FUTURE ORINTED
• Unsatisfied with the past or
present
• DO NOT VALUE EXPERIENCE
PROACTIVIST
• INTERACTIVE PLANNING
• plan the future rather than to react
• DYNAMIC
• Key requirement = ADAPTATION
• Done in anticipation of changing
needs

67. PRINCIPLES OF PLANNING
Based VISION, MISSION, PHILOSOPHY and
clearly defined OBJECTIVES
Must be PRECISE IN SCOPE, REALISTIC, &
TIME BOUND
UTILIZES ALL AVAILABLE RESOURCES
Pervasive within the ENTIRE
ORGANIZATION
WELL COMMUNICATED
CONTINUOUS
FLEXIBILE

68. PURPOSES OF PLANNING
Sets STANDARDS to facilitate effective
CONTROL
Gives DIRECTION & leads SUCCESS OF
GOALS
Reduces IMPACT OF CHANGE and COPE
WITH CRISIS
Reduces WASTE and REDUNDNACY
Provides for EFFECTIVE USE OF
RESOURCES
COST EFFECTIVE
Gives MEANING to WORK

69. TYPES OF PLANNING
• ACCORDING TO STRUCTURE OF ORGANIZATION
– CENTRALIZED
– DECENTRALIZED
• ACCORDING TO SCOPE/COVERAGE & LEVEL
– STRATEGIC
– TACTICAL
– OPERATIONAL
• ACCORDING STABILITY
– MASTER OR STRATEGIC
– CONTINGENCY

70. STRATEGIC TACTICAL OPERATIONAL
LONG TERM
> 3-5 YEARS
INTERMEDIATE
MEDIUM RANGE
< 5 YEARS
SHORT TERM
< 1 YEAR
TOP
MANAGEMENT
MIDDLE
MANAGEMENT
FRONTLINE
MANAGEMENT
RIGHT THINGS
TO DO
HOW TO DO
RIGHT THINGS
DAY-to-DAY
activities
MASTER DEPARTMENT ROLLING &
CONTINUOUS

71. STANDARDMINIMUM LEVEL OF ACHIEVEMENT
ACCEPTABLE TO MEET OBJECTIVES
Agreed-on level of performance
Characteristics:
1. Predetermined
2. Established by an authority and are
accepted by those affected by the standards
3. Used as a measurement tool and therefore
must be measurable and achievable

72. STRUCTURE
• Management
system used to
deliver care
SETTING
EQUIPMENT
POLICIES
PHILOSOPHY
OBJECTIVES
BUILDING
FINANCE
STAFFING
PATTERN
PROCESS
• Activities
nurses perform
when giving
care
STEPS IN THE
NURSING
PROCESS
ACTUAL
NURSING
PROCEDURE
OUTCOME
• Designed to
measure the
results on
nursing care
RESPONSES
CHANGES IN
HEALTH
STATUS,
KNOWLEDGE
AND ATTITUDE
MODIFICATION
OF S/SX
SATISFACTION
COMPLIANCE
TO TX

73. BUDGETING
• FISCAL PLANNING
• SYTEMATIC FINANCIAL
TRANSLATION OF A PLAN
• process of QUANTITATIVE planned
original activities
• Planning and controlling COST &
EXPENSES
• COST CONTAINMENT: effective and
efficient delivery of services while
generating needed revenues for
continued organizational productivity

74. • the QUANTITATIVE STATEMENTS prepared
through the budgeting process may include such
figures as PROJECTED INCOME,
EXPENDITURES and PROFITS
• ACCURACY = BETTER USE OF RESOURCES
• BEST PREDICTION, A PLAN, NOT A RULE
• REQUIRES FLEXIBILITY, ONGOING
EVALUATION, REVISION

75. REVENUE
Income
EXPENSE
Cost
PROFIT

76. TYPES OF BUDGET
DIRECT COST: directly related to patient care within a
managers unit; (salary, supplies)
INDIRECT COST: not explicitly related but is necessary
to support care; (electricity and maintenance)
FIXED EXPENSES: DON’T VARY in volume; (rent,
monthly salary)
VARIABLE EXPENSES: increase or decrease
depending on the number of patients (cost of supplies,
patient meals, laundry of linens)
CONTROLLABLE COST: controlled and varied by
managers; staffing pattern and mix
UNCONTROLLABLE COST: equipment depreciation,
supplies, overtime in response in emergency

77. EXPENSE
BUDGET
MANPOWER
BUDGET
OPERATING
BUDGET
CAPITAL
EXPENDITURE
BUDGET

78. BUDGETING METHODS
INCREMENTAL BUDGETING
FLAT PERCENTAGE INCREASE
Simple, quick but generally inefficient (don’t contain
cost and no need to prioritize programs and services
Multiplying current year expenses by a certain figure
(inflation rate or consumer price index)
ZERO-BASED BUDGETING
Rejustify program, does not assume funding in the
past; labor intensive
SETTING FUNDING PRIORITIES; DECISION
PACKAGES

80. PARETO PRINCIPLE
• Vilfredo Pareto
• KEY CONCEPT IN TIME MANAGEMENT
20 % focused efforts results in
80 % outcomes
80 % unfocused efforts results in
20 % outcomes
• KEY: focus effort on the activities that will get
maximum results

82. Pareto Diagram
• Graphical overview of the process problems, in
ranking order of the most frequent, down to the
least frequent, in descending order from left to
right.
• Illustrates the frequency of fault types and
prioritizes problem areas (you can decide which
fault is the most serious or most frequent
offender)
• Called the "vital few over the trivial many" rule

83. TIME MANAGEMENT PRINCIPLES
• Based on the principles of:
COMMUNICATING
PLANNING
DELEGATING

84. TIME WASTERS
 External Sources
• Interruptions by phone, staff,
visitors
• Doing work that could be
delegated
• Doing unnecessary paperwork
• Socializing
 Internal Sources
• Lack of objectives
• Failure to establish priorities
• Inability to make decisions
• Failure to plan and organize
work
• Inability to delegate
•
TIME SAVERS
• Learning to set priorities
• Organizing work
• Delegate
• Avoiding interruptions
• Avoiding wasted motions – learning
to be dexterous
• Evaluating all paper work,
procedures etc and eliminating the
unnecessary ones
• Avoiding procrastination
• Using computer, tape recorder, etc
whenever possible
• Using the waste basket

85. ORGANIZING

86. Involves establishing a FORMAL
STRUCTURE that provides the
COORDINATION of resources to
accomplish objectives, established
policies & procedures, and determines
position qualification and description.
WAY WORK IS ARRANGED &
ALLOCATED
SYSTEMATIC ARRANGEMENT OF
THE ELEMENTS OF MANAGEMENT

87. COMPONENTS OF
ORGANIZING

88. IMPORTANCE OF ORGANIZING
• PROMOTES COLLABORATION &
NEGOTIATION among the individual in the group
 Improves the effectiveness & efficiency of
communication within the organization.
• CREATES CLEAR-CUT LINES OF AUTHORITY &
RESPONSIBILITY in an organization
 Improves the activating & controlling
function of the manager.

89. PRINCIPLES OF
ORGANIZING
SPAN OF CONTROL
CHAIN OF COMMAND
UNITY OF COMMAND
DELEGATION OF AUTHORITY
HOMOGENEITY OF ASSIGNMENT

90. SPAN OF CONTROL
the number of subordinates and different task for
which a person in authority is responsible
NARROW Span of Control
 few people and 1 – 2 task areas
BROAD Span of Control
 many people and a wide variety of task area
Factors to be considered:
Level of managerial experience of the manager
Skill level of employees
Stability of the work unit or department
Level of morale among the employees
Type of work managed

91. UNITY OF COMMAND
RESPONSIBLE TO ONLY ONE SUPERIOR
SCALAR PRINCIPLE
HIERARCHY
CHAIN OF COMMAND
authority and responsibility should flow in clear
unbroken lines from the highest executive to the
lowest.

92. • HOMOGENOUS ASSIGNMENT
SIMILAR ASSIGNMENT
DEPARTMENTALIZATION
workers performing similar assignments are grouped
together for a common purpose
Promotes the specialization of activities, simplifies
the administrator’s work, maintain effective control
• DECENTRALIZATION
PROPER DELEGATION OF AUTHORITY
process of conferring specified decision making to
the lower levels of organization

93. ORGANIZATIONAL
ORGANIZATIONAL STRUCTURE
ORGANIZATIONAL CHART

94. ORGANIZATIONAL DESIGN
a formal, guided process for integrating the people,
information, and technology of an organization
Refers to the process by which a group is formed, its
formal working relationship, its channels of
authority, span of control and lines of
communication
ORGANIZATIONAL STRUCTURE
Formal mechanism through which the organization is
managed
Framework within which people act
The basic plan which the manager draws up to help in
achieving the objective

95. INFORMAL STRUCTURE
Unplanned and covert
Consist of personal and social relationships
It is not reflected in the organizational chart
FORMAL
Planned and made public
Describes position, the responsibilities of those
occupying the position, and the working
relationships
Two basic forms:
1. HIERARCHIC OR BUREAUCRATIC MODEL
2. ADAPTIVE OR ORGANIC MODEL

96. CATEGORY FLATTALL
Vertical/Pyramidal Horizontal
Number of Levels
Span of Control
Delegation
Authority
Control
Communication
Type Traditional Modern
Many Few
Narrow Broad
Lesser Greater
Centralized Decentralized
Greater Lesser
Complex
Decision Making Delay Speed
Simplified

97. ORGNIZATIONAL CHART
• A line diagram that depicts the broad outlines
of an organization’s structure
• Shows how parts of the organization are linked
Uses:
1. It outlines administrative control
2. It is used for policy making and planning
3. It is used to evaluate strengths and weaknesses of
present structure
4. It shows the relationship with other departments
and agencies
5. It is used to orient new personnel to the
organization

98. LILIA DELICANA
Chief Nurse
VERGIE GUBATANGA
Assistant Chief Nurse
KRISTEL ORQUILA
Nurse Supervisor
WILLIAM FRED ITALIA
Assistant Nurse Supervisor
RANNIE INGADA
Medical Ward Head Nurse
DG TANINAS
Nurse Educator
ROSANA BELO
Dean
Line Authority
Command & control
Staff Authority
Service, advice, support
Box
Position & placement
CARIELLE RIO
Surgical Ward Head Nurse
Solid or broad
Straight line
Chain of command
Broken line
Lines of coordination

99. Job Analysis
• The procedure for determining the duties and skill
requirements of a job and the kind of person who
should be hired for it
2 Products:
JOB DESCRIPTION
 A list of a job’s DUTIES, FUNCTIONS &
RESPONSIBILTIES (performance description) and
reporting relationships & supervisory responsibilities (job
relationship)
JOB SPECIFICATION
 A list of a job’s “HUMAN REQUIREMENTS”, position and
qualification (job title)

100. STAFFING
• the process of determining and providing HUMAN
RESOURCES to fill the roles designated in the organization
through
RECRUITMENT: Enlisting personnel for employment
SELECTION: Evaluating and choosing from among job
candidate
INDOCTRINATION: Induction, Orientation and
Socialization
TRAINING and DEVELOPMENT
TRANSFER &
SEPARATION of personnel to accomplish the goals of
the organization.

101. STAFFING PATTERN
• Involves deciding
– WHAT TYPE (MIX) and
– HOW MANY (NUMBER) personnel are
needed to provide adequate and
quality patient or client care (produce
desired level of care)
– 24 hours a day, 7 days a week and 52
weeks a year (SCHEDULE) and meet
the patients demand for care.

102. STAFF MIX
MIX OF PERSONNEL
SKILL MIX
• Determine the RATIO or mix of nursing personnel
(professionals to paraprofessionals) who will
provide care.

103. SCHEDULING
• Defined as the time table indicating planned WORK
DAYS, DAYS OFF and SHIFTS of nursing
personnel
Purpose:
Appropriate coverage of the job to be done
Equitable distribution of workers
Provide adequate patient care

104. ADEQUATE APPLICANT POOL
PREEMPLOYMENT SCREENING
COMPLETION OF APPLICATION
REFERENCE CHECKS, TEST, PE, INTERVIEW
EMPLOYER DECISION
NOTIFICATION OF APPLICATNTS

105. • INDUCTION
• ORIENTATION: process of familiarizing the new employees
& his /her place in the organization
• SOCIALIZATION/ENCULTURALIZATION: process by
which a person acquires the technical skills of his or her
society, knowledge of the kinds of behavior, attitude and
values that make CONFORMITY
A successful orientation helps speed transition by:
building the employees identification with the
organization
helping the employee become acquainted with fellow
personnel
providing the employee with important information
about the organization

106. PATIENT CLASSIFICATION SYSTEM
WORKLOAD MEASUREMENT TOOL
PATIENT ACUITY TOOL
a method of grouping patients according to the amount
and complexity of there nursing care requirement
(articulate nursing workload) that can be clinically
observed by the nurse
PATIENT ACUITY: measure of nursing workload
that is generated for each patient (need or
dependency)
SICKER ACUITY
NURSING
CARE

107. CLASSIFICATION OF PCS (Seago)
CRITICAL INDICATOR or CRITERION TYPE
 Uses broad indicators such as bathing, diet, grooming,
medications and positioning to categorize patient care
activities
SUMMATIVE TASK TYPE
 Requires the nurse to note the frequency of occurrence
of specific activities, treatments, and procedures for each
patient.
 ASKING THE NURSE for nursing time requirement

108. FACTORS AFFECTING THE
REQUIREMENTS FOR NURSING CARE
 ACUITY OF PATIENTS ILLNESS
 DEGREE OF DEPENDENCY
 COMMUNICABLITY OF THE ILLNESS
 REHABILITATION NEEDS, SPECIAL
TREATMENTS AND PROCEDURES

109. PATIENT CLASSIFICATION SYSTEM
CATEGORY
Category 1: MINIMAL CARE/SELF-CARE
Category 2: MODERATE CARE/INTERMEDIATE CARE
Category 3: MAXIMUM/TOTAL/COMPLETE
Category 4: INTENSIVE/CRITICAL/HIGHLY SPECIALIZED

110. Category 1: MINIMAL CARE/SELF-CARE
– Patient are capable of carrying out all activities of daily
CONVALESCING
REQUIRES DIAGNOSTIC STUDIES
LESS FREQUENT OBSERVATION AND DAILY
CARE FOR MINOR CONDITION
AWAITING ELECTIVE SURGERY
Category 2: MODERATE CARE/INTERMEDIATE CARE
– Given to patient who are moderately ill
– Require nursing supervision or some assistance,
ambulating and caring for their own hygiene

111. Category 3: MAXIMUM/TOTAL/COMPLETE
– Patient need close attention throughout shift
– MONITORING; BEDRIDDEN
– Patient requires nursing to initiate, supervise, and
perform MOST of their activities or who require
FREQUENT and COMPLEX medication and treatment
Category 4: INTENSIVE/CRITICAL/HIGHLY SPECIALIZED
– ACUTELY ILL patients who have high level of NURSE
DEPENDENCY, including those requiring INTENSIVE
nursing care and are in CONSTANT DANGER OF DEATH

112. CLIENT CARE DELIVERY SYSTEM
MANNER OF ORGANIZING PATIENT CARE
ASSIGNMENT SYSTEM FOR STAFFING
NURSING CARE MODALITY
PATTERNS OF NURSING CARE

113. Nursing
Care
Modalities
CASE
FUNCTIONAL
TEAMPRIMARY
DISTRICT

114. CASE
METHOD
CHARGE
NURSE
STAFF
NURSE
PATIENT
STAFF
NURSE
PATIENT
 TOTAL PATIENT CARE
 ONE- to-ONE
 OLDEST METHOD
 CONSTANT CARE for a
SPECIFIED PERIOD OF
TIME
 MANY nurses & FEW
patients
 Common to private
duty nurses, ICU,
educational purposes

115. CHARGE
NURSE
RN
MEDICATION
NURSE
RN
ADMISSION
NURSE
PATIENTS
LPN
TREATMENT
NURSE
NURSE
ASSISTANT
(HYGIENE &
BATHING)

116. FUNCTIONAL
NURSING TASK-ORIENTED METHOD
 Based on DIVISION OF LABOR
 PARTICULAR NURSING FUNCTION
 MANY patient, FEW nurse
 NO NURSE is responsible for total care of any
patient
 EFFICIENCY: accomplishment of most work in the
shortest amount of time
 Disadvantage: FRAGMENTED NURSING CARE

117. CHARGE
NURSE
TEAM
LEADER
RN, LPN,
UNA
PATIENTS
TEAM
LEADER
RN, LPN,
UNA
PATIENTS
 Goal achievement through
GROUP ACTION
 DECENTRALIZATION
 PATIENT CENTERED CARE
 Feature: NURSING CARE
CONFERENCE
 TL: RN = responsible for
coordinating the total care of
a block of patients
 Size of team: 3-5 nursing
staff for 10 - 20 patients in
general hospital units
 BEST CARE AT LOWEST
COST

118. CHARGE
NURSE
PATIENT
ASSOCIATE
NURSE
ASSOCIATE
NURSE
OTHER
HEALTH
PROVIDER
HEAD
NURSE
PHYSICIAN

119. PRIMARY NURSING
• RELATIONSHIP-BASED NURSING
• ASSURES COMPREHENSIVE & CONTINUITY OF
DIRECT CARE
• PRIMARY NURSE: responsible for the nursing care
of patient 24 HOURS a day FROM ADMISSION
TO DISCHARGE
• Small group: 4-6 PATIENTS
• The PN consult HEAD NURSE
• Disadvantage: requires the entire staff to be RNs
which increases staffing and costs

120. PRIMARY NURSING
A
A
A
C
C
Accountability
Authority
Autonomy
Comprehensiveness
Continuity

121. DISTRICT NURSING
• GEOGRAPHIC ASSIGNMENT OF PATIENT
• Modification of TEAM and PRIMARY NURSING
• Module: 5 - 6 rooms ( 10 - 20 patients ) side by
side along a hall: group of cubicles / room around
the nurses station
• Each RN, assisted by paraprofessional delivers as
much care as possible to a group of patients; RN
plans care for all patient in the module

122. FTE: Full-Time Equivalent
The measure of work commitment of a
full-time employee
1.0 FTE = 40 hours per week
RA 5901
1.0 FTE means a person works
 8 hours a day
 5 days a week
 40 hours per week
 for 52 weeks each year
 Total = 2,080 hours

123. NHPPD:
Nursing Hours Per Patient Day
Standard measure that quantifies the
nursing time available to each patient per
nursing staff member
For example, for a 24 hours period, a unit
has 20 patients, with 5 nursing staff
available on each shift
5 staff per shift x 3 shifts = 15 total staff
15 staff x 8 hours per shift = 120 nursing
hours available for 20 patients
6 hours per patient

124. NIGHT 18%
AM 45%
PM 37%

125. TYPES OF SCHEDULING
CENTRALIZED SCHEDULING
– Based on the MASTER STAFFING PATTERN that is
carried out by 1 person who plans and coordinate the
schedule
– Made by CHIEF NURSE
– Coordination is able to make necessary changes in the
rotation in case of illness or emergencies
DECENTRALIZED SCHEDULING
– Middle and lower level managers have the authority and
responsibility to secure adequate personnel for their unit
– Done by HEAD NURSE

126. SELF SCHEDULING
PERMANENT SCHEDULING
ALTERNATING/ROTATING WORKSHIFT
 personnel have alternating work hours among
days, evening and nights
BLOCK/CYCLICAL SCHEDULING
 staffing pattern repeat itself every 4 – 6 weeks
VARIABLE SCHEDULING
determining the number and mix of staff based on
patient needs
FLEX TIME

127. Syndrome of
EMOTIONAL EXHAUSTION
DEPERSONALIZATION, and
REDUCED PERSONAL
ACCOMPLISHMENT
which happens as a result of the
CHRONIC EMOTIONAL STRAIN of
working extensively with other
human beings, particularly when
they are troubled.

128. • Burn out is related to:
Absenteeism
Turnover
Performance deterioration
Decreased productivity
JOB DISSATISFACTION
• Acknowledge their own feelings and seek
assistance accordingly, practice health seeking
behavior and find social supports
• Supportive workplace can protect against burn out
• Most important is SELF CARE
• Separate work and personal life

130. ISSUANCE OF ASSIGNMENT,
ORDERS AND INSTRUCTIONS that
permit the worker to understand what is
expected of him or her, and the
GUIDANCE AND OVERSEEING of the
worker so that he or she can contribute
effectively and efficiently to the
attainment of organizational objectives.
DOING PHASE OF MANGEMENT
ACTIVATING PHASE

131. COMPONENTS OF DIRECTING

132. ABILITY TO….
INFLUENCE
MOVE
PERSUADE

134. Factors to Consider in the Choice of Leadership Style
• MANAGER’S LEADERSHIP STYLE AND
EXPECTATIONS
– manager’s background, knowledge, values, experiences
• FOLLOWER’S CHARACTERISTICS AND
EXPECTATIONS
– knowledge, competency and level of workers
– attitudes and needs of the follower
• WORK SITUATION
1. Leader-member relations = how well they get along
2. Task structure/accomplishment = nature of job
3. Position power = extent of power; how legitimate

135. (Kellerman)
• ALIENATED: independent and critical yet passive
in their behavior resulting in psychological and
emotional distance with their leader
• SHEEP: dependent and uncritical; do as they are
told by leaders
• YES PEOPLE: dependent or uncritical, but very
active in their behavior
• SURVIVORS: “Better safe than sorry”
• EFFECTIVE FOLLOWERS: self leaders, no
supervision needed

136. COMMUNICATION
AUTHORITY POWER
Exchange of information
Right to do or act Ability to do or act
LEADERSHIP

137. Ideation
Encoding
Transmission
Receiving
Decoding
Response

138. UPWARD
DIAGNOAL
DOWNWARD
LATERAL
Lines of Communication
SUPERIORS
Motivating
SUBORDINATES
Directive
PEERS,
BETWEEN
DEPARTMENTS
& PERSONNEL
Frequently used to
coordinate activities
OUTWARD
PATIENTS
FAMILY
COMMUNITY

139. KINDS OF INFLUENCE
(Kipnis & Schmidt)
ASSERTIVENESS
INGRATIATION
 Makes another FEEL IMPORTANT
ACTING HUMBLY OR FRIENDLY
BEFORE MAKING A REQUEST
RATIONALITY
 Convincing of the MERITS OF A
DETAILED PLAN
 BLOCKING
 Hostile influence, with THREAT of or
ACTUAL CUTTING OFF FROM
COMMUNICATIONOR INTERACTION

140. KINDS OF INFLUENCE
(Kipnis & Schmidt)
COALITION
 COLLECTIVE influence, “BACK UP”
SANCTION
 PUNISHMENT & REWARD on case
of cooperation, BEHAVIOR BASED
EXCHANGE
 OFFERING A FAVOR or PERSONAL
SACRIFICE as an incentive for the
performance of the request
UPWARD APPEAL
– Obtaining SUPPORT FROM THE
HIGHER UP to push someone into
action

141. 
COERCIVE POWER

142. EXPERT POWER
CONNECTION POWER
INFORMATION POWER

143. PRACTICE TEST
 Ms. Green, a staff nurse, was well liked by all the staff.
They listened and often agreed with her suggestion.
 Mr. Orange, the director of a health agency, blocked the
promotions if staff exceeded their budget by 2%.
 The vice president of nursing has the right to set
budget.
 The nursing aid intimidated the new nurse manager
because she was more familiar with unit procedures.
 The head nurse gave the staff nurses choice
assignments when their quality assurance ratings
improved significantly.
 The chief nurse was seen by her colleagues having
lunch with the chief of hospital.

144. • LEADERSHIP STYLES
– THE WAY A LEADER GENERALLY BEHAVE
TOWARDS HIS FOLLOWERS
1. OPEN SYSTEM – democratic
2. CLOSED SYSTEM – autocratic
3. PERMISSIVE SYSTEM – laissez-faire

145. AUTOCRATIC DEMOCRATIC LAISSEZ-FAIRE
Strong control Less control No control
Give orders Offer suggestions Non directive
Make decisions Give suggestions Relinquishes decision
making to other
Leader does planning Participative No plans
Directive Participative Passive, uninvolved;
inactive; ultraliberal
Foster dependency Foster independence Fosters chaos
Good quantity and
quality of output but
little autonomy,
creativity and
motivation
Works when members
are knowledgeable,
skilful
Can work with very
mature, autonomous
workers

146. PRACTICE TEST
• Strong control
• Participative
• Passive
• Fosters independence
• Involves group in
decision making
• Directive
• Close System
• No plans
• Free rein
• Make decisions all
• Chaos is likely to
develop unless with
leader
• Ultraliberal
• Permissive system
• Give orders
• Little autonomy &
creativity

147. MANAGERIAL GRID
Robert Blake and Jane Mouton
• 9 x 9 matrix outlining different
management/leadership styles
• two key dimensions of managerial behaviors
are depicted on grid:
 Concern for production (horizontal axis)
 Concern for people (vertical axis)
• in each dimension the manger’s relative level of
concern is rated on a scale of 1 – 9

149. PRACTICE TEST
• “I AM A MIDDLE OF THE ROAD NURSE AND
AVOID CONTROVERSY OR TAKING SIDES.”
• “THE HOSPITAL PROVIDES ME WITH A JOB
WHICH IS ALL I ASK.”
• “I CONSULT WITH THE STAFF MEMBERS TO
WORK ON MUTUAL GOALS.”
• “I AM A STAFF MEMBER’S FRIEND AND WILL
DO ANYTHING FOR THEM TO LIKE ME.”
• “I EXPECT STAFF MEMBERS TO DO WHAT I
THINK THEY OUT TO DO.”

150. THEORIES OF LEADERSHIP
• CHARISMATIC THEORY
– Behavioral tendencies and personal characteristics of
leaders that create an exceptionally strong relationship
between them and their followers
• GREAT MAN’s THEPRY
– “Leaders are born and not made”
• TRAIT THEORY
– Effective leadership possess a similar set of traits
(relatively stable characteristics, such as abilities,
psychological motives or consistent patterns of
behaviour)

151. CORE TRAITS OF LEADER
VISION = foreseeing possibilities
PASSION = being enthusiastic about the future
INTEGRITY = self awareness, trusted
CURIOSITY = daring, risk taker
FLEXIBILITY
INTELLIGENCE
Ability SUPPORT others
SELF-CONFIDENCE
DESIRE to lead

152. CONTIGENCY THEORY
• FRED FIEDLER
• Refuted the ideal leadership style theory; identifies
three aspects of a situation that structure the
leader’s role:
– LEADER-MEMBER RELATIONS: involve the amount of
confidence and loyalty the followers have in their leader
– TASK STRUCTURE: high of it is easy to define and
measure a task
– POSITION POWER: authority inherent in a position, the
power to use rewards and punishment, and the
organizations support of one’s decision

155. PATH-GOAL THEORY
• ROBERT J. HOUSE
• According to the, leaders can change and adapt
their leadership styles CONTIGENT TO THE
SUBORDINATE they are leading or the
ENVIROMENT in which that subordinates work.

156. LIFE CYCLE(SITUATIONAL) THEORY
• PAUL HERSHEY AND KENNETH BLANCHARD
• MOST appropriate leadership styles from the
LEVEL OF MATURITY of followers
• TASK SITUATION & LEVEL OF GROUP
MATURITY
• GROUP MATURITY: psychological and job
maturity and involves COMMITMENT and
COMPETENCE to perform required tasks

157. SELLING
TELLING
PARTICIPATING
EMPOWERING

158. RENSIS LIKERT 4 SYSTEMS OF LEADERSHIP
AUTHORITATIVE PARTICIPATIVE
SYSTEM I
EXPLOITIVE
AUTHORITATIVE
SYSTEM II
BENEVOLENT
AUTHORITATIVE
SYSTEM III
CONSULTATIVE
DEMOCRATIC
SYSTEM IV
PARTICIPATIVE
DEMOCRATIVE
DECISION
MAKING:
ALL at TOP MOST at TOP Some at LOW
Dispersed
Group process
MOTIVATION
Coercion & threat Economic rewards
and ego motives
+ others such as
desire for new
experiences
Economic with
GROUP
participation
COMMUNICATION
Downward Most downward;
selected
Up and down;
cautious
All directions; open,
frank
CONTROL
ALL at Top Primarily TOP Top but idea
solicited
Shared

159. TRANSACTIONAL LEADERSHIP
• Leader motivates followers by appealing TO THEIR
OWN SELF-INTEREST
• Motivate by means of EXCHANGE PROCESS
• It is a contract for MUTUAL BENEFIT that has
contingent reward
• Leader sets goals for employees, focuses on day-
day operations and uses management by
exception
• COMPETITIVE, TASK-FOCUSED

160. TRANSFORMATIONAL LEADERSHIP
• MOST EFFECTIVE and BENEFICIAL, to achieve
LONG-TERM SUCCESS and IMPROVE
PERFORMANCE
• Promotes EMPLOYEE DEVELOPMENT
• Inspires her team constantly with A SHARED
VISION
• Spend a lot of TIME COMMUNICATING
• Tend to DELEGATE

161. TRANSACTIONAL TRANSFORMATIONAL
Hierarchy Networking
Competitive Cooperative
Task focus Process focus
Exchange posture Promote employee
development
Identify needs of follower Attend to needs and motives
of followers
Exchange for expected
performance
Influence change in perception
Caretaker Role model
Set goals for employees Individualized consideration
Focus on day-to-day operation Provide sense of direction

162. EMOTIONAL INTELLIGENCE (EQ)
IN NURSING LEADERSHIP
• “It requires ability to relate to others if the
leader truly wants to achieve desired results”
• Emotional Intelligence
– defined as a person’s self-awareness, self-confidence,
self control, influence and integrity, and a person’s ability
to communicate, influence, initiate change and accept
change
• Leaders who do not develop EQ have difficulty in
building good relationships with others

163. SELF
AWARENESS
• Self confidence
SOCIAL
AWARENESS
• Empathy
SELF
MANAGEMENT
• Self control
RELATIONSHIP
MANAGEMENT
• Influence
SELF SOCIAL
RECOGNITIONREGULATION

165. NEED/CONTENT THEORIES
• contend that we behave the way to do because we
have internal needs that are attempting to fulfil
• Specify what motivates individuals (i.e. the content
of needs)
– HIERARCHY OF NEEDS THEORY
– ERG THEORY
– TWO-FACTOR THEORY
– ACQUIRED NEEDS THEORY

166. MASLOW’S HIERARCHY OF NEEDS

167. TWO FACTOR THEORY
(FREDERICK HERZBERG)
HYGIENE FACTORS
• EXTERNAL
• WORK CONTEXT
• DISSATISFIERS
• Supervision, company
policy, working condition,
pay, fringe benefits, status,
job security, effect on
personal life
MOTIVATING FACTORS
• INTERNAL
• JOB CONTENT
• MAINTENANCE
• Achievement, recognition,
work itself, responsibility,
advancement, potential
for growth

169. PRACTICE TEST
• Happy with being able to help others
• Confident of job security
• Intellectually stimulated and challenged
• Paid adequately
• Given opportunity to progress intellectually
• Learning new skills
• Communicated by the administration
• Given the chance to schedule working hours
• Qualifying for more responsibility
• Working with adequate staffing

171. COGNITIVE/PROCESS THEORIES
• Attempt to isolate the thinking patterns that we use
in whether or not to behave in a certain way
• Focus the thought processes associated with
motivation
EXPECTANCY THEORY
EQUITY
GOAL SETTING THEORY

172. EXPECTANCY THEORY
• VICTOR VROOM
• Success of goal- setting in motivating performance
depend on establishing goals that have appropriate
attributes or characteristics (i.e. specific,
measurable, challenging, attainable, relevant to the
major work of the organization, time-limited)
• We consider three main issues before we expend
the effort necessary to perform at given level:

173. “What is the probability
that I can perform at the
required level if I try?”
“What is the probability that
my good performance will
lead to desired outcomes?”
“What value I place on
potential outcomes?”

175. Reinforcement Theory
• Operant conditioning theory or behaviorism
• B.F. Skinner
• argues that our behavior can be explained by
consequences in the environment and therefore, it
is not necessary to look for cognitive explanations
• relies heavily on the LAWS OF EFFECT
• BEHAVIOR MODIFICATION ( the use of
techniques associated with reinforcement theory)

176. • Positive Reinforcement
– increasing a desired behavior that involves providing
pleasant, rewarding consequences to encourage that
behavior
• Negative Reinforcement
– increasing a desired behavior that involves providing a
noxious stimuli so that an individual will engage in the
desired behavior in order to stop the noxious stimuli
• Extinction
– withholding a previously available positive consequences
associated with a behavior in order to decrease that
behavior
• Punishment
– providing negative consequences in order to decrease or
discourage a behavior

178. • Responsible, creative, self-
possessed, has self-
direction and control,
enjoys work
• Work by opportunities to
interact with their superiors
than by financial rewards
• INDIVIDUAL GOALS
• SUPPORTIVE,
RELATIONSHIP-ORIENTED
• lazy, unmotivated ,
irresponsible, not too
intelligent, dislike work
• Will work hard as they must
to keep their jobs
Manager emphasis:
• ORGANIZATIONAL GOALS
Management style:
• AUTOCRATIC, DIRECTIVE,
TASK-ORIENTED
Douglas McGregor

180. JOB REDESIGN TO INCREASE MOTIVATION
• JOB ROTATION
– periodically moving workers from one specified job to
another
• JOB ENLARGEMENT
– increasing in the number of different tasks that a worker
performs within one particular job; JOB SCOPE: increase
JOB BREATH; reduce monotony
• JOB ENRICHMENT
– increasing in he number of tasks in a particular job and
giving the workers the authority and control to make
meaningful decisions about their work; JOB DEPTH
– provide productive climate and high morale

181. • Sharing of
AUTHORITY and
RESPONSIBILITY
with subordinates
and holding them
ACCOUNTABLE for
their performance

182. DELEGATION
AUTHORITY
RESPONSIBILITY
ACCOUNTABILTIY
Right to do or act
Obligation
What must be done
Liability
Answerability
Accept consequence of one’s actions

183. ASSIGMENTS
• Describes the DISTRIBUTION OF
WORK that each staff member is to
accomplish on a given shift or work
period.
• “WORK PLANS”

184. 5 Rights of DELEGATION
(Hansten, 2004)
CIRCUMSTANCES: rules, scope, area of practice,
client condition, preferred client results.
TASK: should be within the scope of the person’s
practice and consistent with the job description
PERSON: licensure, certification, job description,
demonstrated skill & competence
COMMUNICATION, DIRECTION: (A C’s) clear,
concise, correct, & complete
SUPERVISION: oversee ongoing process and results,
reviewing staff performance, updates and “checkpoint”
meetings, should ask for input, get person’s
recommended solution to problem, and recognize
persons effort

186. • Employee is CAPABLE OF DOING THE JOB.
• Delegate BOTH interesting and uninteresting
tasks.
• Delegate GRADUALLY.
• Delegate IN ADVANCE.
• CONSULT before delegating.
• Avoid gaps and overlaps.

187. COMMON
DELEGATING ERRORS• UNDERDELEGATION: manager’s false
assumption of delegation; overburdens the
manager
• OVERDELEGATION: overburdens the
subordinates; because of poor time
management, insecurity
• IMPROPER DELEGATION: delegating at the
wrong time, to the wrong person, for a wrong
reason; delegating beyond the capability;
delegating without adequate information

188. AREAS NOT TO BE DELEGATED
POWER TO DISCIPLINE and EVALUATE
STAFF.
MAINTAINING MORALE.
OVERALL CONTROL and ARA.
Authority to SIGN ONE’S NAME .
Jobs that are TOO TECHNICAL

189. SUPERVISION
• SUPERVIDE = OVERSEE or VIEW DIRECTLY
• Overseeing the activities of others
• It consist of inspecting the work of another, and
either correcting or improving the adequacy of
performance
• It is the active process of directing, guiding and
influencing the outcome of a person’s
performance of an activity
• The provision of GUIDANCE and DIRECTION
OVERSIGHT, EVALUATION and FOLLOW UP.

191. • Process of CONTINUOUSLY
REGULATING, MONITORING or
EVALUATING organizational
activities so that actual
performance conforms to expected
organizational standards and goals

192. COMPONENTS OF
CONTROLLING

193. COPING WITH UNCERTAINTY
DELETING IRREGULARITIES
IDENTIFYING OPPORTUNITIES
HANDLING COMPLEX SITUATIONS
DECENTRALIZING AUTHORITY

194. • STRATEGIC CONTROL
– monitoring critical environment factors to ensure that
strategic plans are implemented as intended, assessing
the effects of organizational strategic actions, and
adjusting such plans when necessary
• TACTICAL CONTROL
– assessing the implementation of tactical plans at
department levels, monitoring associated periodic
results, and taking corrective action as necessary
• OPERATIONAL CONTROL
– Involves processing the implementation of operating
plan, monitoring day-to-day results, and taking corrective
action when required

195. TYPES OF CONTROLS
• PRELIMINARY
• PRECONTROL
• ANTICIPATORY
• PREVENTIVE
• STEERING
• INPUTS
FEEDFORWARD
• SCREENING
• YES-NO
CONTROL
• PROCESS
(ONGOING
ACTIVITIES,
PRODUCTION,
TRANSFORMATION
PROCESS)
CONCURRENT • POST ACTION
• OUTPUT
FEEDBACK

196. QUALITY
ASSURANCE
 “DOING IT RIGHT”
 ASSESS/MEASURE
PERFORMANCE
 Whether performance
meet standard
 Improve if not meeting
the standard
QUALITY
IMPROVEMENT
 “DOING THE RIGHT
THING”
 MEET CUSTOMER’S
NEEDS
 Build /Assess work
process
 CONTINUOUS or
ONGOING
improvement
performance

197. • PDCA cycle
• FOCUS methodology
• Benchmarking
• Regulatory requirements
• Sentinel Events monitoring
• Balanced scorecard concept

198. PDCA Cycle
?WHAT –trying to accomplish
?HOW – change is an improvement
?WHAT – changes will result in
improvement

199. PLA
N
DO
CHE
CK
ACT
Develop a change,
test, activity
aimed for
improvement
Carry change,
test out – small
scale
Study the results.
What was learned?
What can be predicted?
Adopt the change,
send through cycle
again, under
different conditions
or abandon the idea

200. The Methodology
for
Performance Improvement
F ocus on an opportunity for improvement
O rganize a team
C larify the current process
U nderstand the degrees of change needed
S elect a solution for improvement

201. • Tool or process
of measuring and
seeking out the
BEST products,
practices, &
services against
BEST
PERFORMING
organizations to
IMPROVE
PERFORMANCE

202. • Preparing for accreditation survey – used to
begin improvement strategies
• Adverse SENTINEL EVENT
– unexpected occurrence causing death or
serious physical or psychological injury
• Analysis – provides opportunities for
improvement
• Linking sentinel event review – identifies
strategies for future events
• KEY: sharing of information to all

203. • Progress measurement – balance
between:
1. MEDICAL
2. PATIENT SATISFACTION
3. COST OUTCOMES
• Change in an area must be evaluated –
how it affects balance of another

204. COST OF CARE
PATIENT CLINCAL
STATUS
PATIENT
FUNCTIONAL STATUS
PATIENT
SATISFACTION

205. PERFORMANCE APPRAISAL
• EVALUATING PERFORMANCE OF
EMPLOYEE
• Compare an individual’s job
performance against standard or
objective developed for the
individual’s position
• May be:
1. FORMAL - regular and methodical
2. INFORMAL - incidental observation
&/or recording of work performance

206. CHARACTERISTICS OF AN EFFECTIVE
PERFORMANCE APPRAISAL SYSTEM
• ADMINISTERATIVE SUPPORT
– Creates the staff time and budget
• RELATION TO JOB DESCRIPTION
– An employee should be evaluated on the basis of what is
expected to accomplish within the organization
• CLEAR CRITERIA FOR EVALUATION
– The criteria must evolve from the job
• IDENTIFIED EVALUATORS
– The employees must be evaluated by the immediate
supervisor

207. PERFORMANCE EVALUATION TOOLS
• NARRATIVE OR ESSAY TECHNIQUE
– Paragraph or more outlining and employee’s strength,
weaknesses and potential
• RATING SCALES
– Consists of a set of behavior to be rated and some type
of scale that will indicate the degree to which the person
being evaluated demonstrates each behavior
• CHECKLIST
– Rater indicates by placing a check mark in a column
whether the employee demonstrates the behavior

208. PROBLEMS OF
PERFORMANCE APPRAISAL
• Time-consuming
• A one-way process
• Use of inappropriate method
• Concentration on faults
• Confusion of current performance with
promotability

209. • LOGICAL ERROR
– Based on first impression of rater
• CENTRAL TENDENCY ERROR
– Rates staff as average
• LENIENCY ERROR
– Propensity to overlook mistakes of workers
• HALO-EFFECT
– Rate workers same in all performance measures
based on their positive characteristics
• HORN’S EFFECT
– Rating employee very low because of an error
committed
• HAWTHORNE’S EFFECT

210. • RATING SCALE
– (e.g. QUALPAC- quality of patient care scale)
• CHECKLIST
– a compilation of all performance expected
• PEER REVIEW
– evaluation of worker by peers
• QUESTIONNAIRE

211. • Systematic and official
examination of a record,
process, structure,
environment, or account
to evaluate performance

212. • PATIENT CARE AUDIT – patient care is
observed and evaluated; (Patient Care
Satisfaction Surveys)
– CONCURRENT: observed and evaluated
through rounds and interview; while patient is
receiving service
– RETROSPECIVE: questionnaires; review of
chart; after receiving care
– PROSPECTIVE: attempt to identify how future
performance will be affected by current
interventions
• NURSING CARE AUDIT - examination of
documentation of are quality nursing care
(review of clinical records of client)

213. LABOR-MANAGEMENT RELATIONS
• LABOR RELATIONS
– Relationship between the employees and management
• UNION
– Workers, who act together, seeks to promote and protect
the mutual interest of every member through collective
bargaining
• COLLECTIVE BARGAINING
– Formal negotiation of working conditions
• GRIEVANCE PROCESS
– Formal expressions of misunderstandings or disputes;
contract violations; or inadequate labor agreement

214. • STRIKE
– Concerted work stoppages
• LOCK OUT
– shutdowns or the suspension or cessation of business
operations
• WORKPLACE ADVOCACY
– Activities undertaken to address problems in their
everyday work setting
• WHISTLEBLOWING
– Act in which an individual discloses information regarding
violation of law, rule, regulation, or substantial and
specific anger to public health or safety

215. Means that
management uses
to bring employees
BEHAVIOR UNDER
CONTROL.

216. • PREVENTIVE DISCIPLINE
– Encourage to follow standards so that infractions do
not occur
– Making standards known and understood in advance
• CORRECTIVE DISCIPLINE
– Follow after infraction of a rule
– Disciplinary action
• PROGRESSIVE DISCIPLINE
– Stronger penalties for repeated offenses
– Give opportunity for self correction

217. • The SELECTION from among
ALTERNATIVES of a course of
action to attain original goals.
• Every action springs from a
decision.
• Encompasses change, conflict,
group dynamic and communication.

218. 1. Identifying the main problem
2. Generating alternative source and
assess all options
3. Weigh all options against set
standards or criteria
4. Test possible options
5. Consider consequences of the
decision
6. Make final decision
7. Monitor and evaluate

219. • V.H. VROOM AND P.W. YETTON
• Suggests how leaders can determine the appropriate
amount of employee participation when making
decisions
• AUTOCRATIC decisions: leaders make decision by
themselves
• CONSULTATIVE decisions: leaders share problems
with subordinates; still make the decisions
• GROUP decisions: leaders share the problem with
subordinates and then have the group make the
decisions

220. • HERBERT SIMON
• All employees at all levels make decisions as
information processor
• OPTIMIZING STRATEGY = Economic Man
– EXAMINING ALL SOLUTIONS, BEST ALTERNATIVE
POSSIBLE with BEST POSSIBLE OUTCOME
• SATISFICING STRATEGY = Administrative Man
– SOLUTION NOT IDEAL BUT DOES MEET MINIMAL
STANDARDS satisfying acceptance; WHAT IS ENOUGH TO
WORK OUT
• MUDDLING THROUGH STRATEGY
– BRINGS RELIEF OF THE IMMEDIATE PRESSURE without
attempting to deal with all the issues involved in the
problem situation.

221. DECISION MAKING TOOLS
• Decision Grids
• Pay-off Tables
• Decision Trees
• Consequence Table
• PERT
• Simulations
• Models
• Brainstorming
• Brain writing
• Checklist
• Step ladder
techniques
• Nominal technique
• Delphi technique

222. QUANTITATIVE DECISION – MAKING
TOOLS/MODELS/AIDS
• DECISION GRIDS
– Allows one to visually examine the alternatives
and compare each against each criteria.
– Useful when:
• changing the method for managing care on a unit
• selecting a candidate to hire from a large interview
pool

224. • PAY-OFF TABLES
– The decision aid that fall in this category have a COST-
PROFIT-VOLUME RELATIONSHIP and are very helpful
when some quantitative information is available.
• DECISION TREES
– Graphic method that visualizes the alternatives available,
outcomes, risks and information needed for a specific
problem over a period.
– SHOW ALL THE OUTCOMES AND BENEFITS OF A
PARTICULAR DECISION

227. • CONSEQUENCE TABLE
– Uses to demonstrate how various alternatives create
different consequences.
• PERT
– Program Evaluation and Review Technique
– Tool to determine the timing of decisions
– Show amount of time taken and the sequence of events
needed to complete the project

228. • SIMULATIONS
– uses models and games to simplify problems by
identifying the basic components ad using trial and error
to determine a solution.
• MODELS
– represents most commonly objects, events, processes or
systems, developed to describe, explain, predict
phenomenon.
• BRAINSTORMING
– -used to create a free flow of ideas; works best for simple
and specific problem.
• BRAINWRITING
– free association and recording of ideas with verbal
interaction.

229. • STEPLADDER TECHNIQUE
– Initially, 2 group members try to solve a problem; then a
3rd member is added, etc.
• CHECKLIST
– Used to assemble criteria on a checklist, sort it, prioritize
it, and eliminate items and add others.
• NOMINAL GROUP TECHNIQUE
– Members write their ideas down, present their ideas,
discuss the ideas, and then vote on the ideas
• DELPHI GROUP TECHNIQUE
– Allows members who are dispersed over a geographical
area to participate in decision making without meeting
face to face.

230. C
O
N
F
L
I
C
T

231. • A situation that exists
when there are
DIFFERENCES of opinion
or opposing views among
persons, groups, and
organizations
• Struggle or strain between
2 OPPOSING FACTORS

232. • INTRAPERSONAL
• INTERPERSONAL
 INTRAGROUP – within group
 INTERGROUP – between two or more groups
• ORGANIZATIONAL – originate in the structure and
function of the organization
1. Vertical
2. Horizontal

233. LATENT
PERCEIVE FELT
MANIFEST
RESOLUTION
AFTERMATH
Phase of Anticipation
Antecedent change
Cognitive awareness
Intellectualize
Affective awareness
Internalize
Action Taken
Overt behavior

234. AVOIDER
Passive
Withdrawing,
Denying,
Suppression
Lose-Lose
TOUGH BATTLER
Aggressive
Competing,
Forcing, Coercion,
Win-Lose
FRIENDLY HELPER
Non-aggressive
Accommodating,
Cooperating,
Smoothing
Lose-Win
PROBLEM SOLVER/
DYNAMIC
Assertive
Confronting, Negotiating
Collaborating
Win-Win
COMPROMISER
No clear outcome

235.  Substituting one thing for
another
 Process of making
something different from
what it was
 Wholesale change of a
system is never good
 Implement gradually
 Communicate change
 Participative

236. STAGES OF CHANGE:
Force Field Analysis (Kurt Lewin)
REFREEZING
Have internalized new role and adapt to new culture or environment, changes
are institutionalized in the corporate culture
CHANGE
People experiment with new behavior to deal with change, period of confusion
and transition, old ways are challenge but no clear picture to the new role
UNFREEZING
Overcoming “mind set”, replace previous culture with new one, people made
aware of problems/performance and need for change

237. • PERSONAL
– Made voluntarily for an individual’s particular reason
• PROFESSIONAL
– Voluntarily and planned change in job description or
obtaining credentials to further individual career
goals
• ORGANIZATIONAL
– Planned change undertaken to improve outcomes,
financial standing, or meet other organizational goals

238. STATEGIES FOR MANAGING CHANGE
• EMPIRICAL-RATIONAL
– Assume people are willing to adopt change when it’s
justified and determine how he can benefit from it
• NORMATIVE RE-EDUCATIVE
– Assume humans as social animal more easily
influenced by others than by facts; focuses on non-
cognitive determinants of behaviors
• POWER COERCIVE
– Involve compliance to the less powerful with the
leadership, plans and direction of the more powerful

239. INNOVATORS
People who enjoy the
challenge that change
brings and often instigate
or implement change
EARLY ADOPTERS
Open to change, will work
with change that is brought to
them but are not as change-
focused as the innovators
EARLY MAJORITY
People who enjoy the
status quo but who will
adopt change earlier than
average, to avoid being left
behind
LATER MAJORITY
Slower to adopt to
change; often expresses
reluctance about or
skepticism
LAGGARDS
Last people to adopt to
change; maybe suspicious
of change, prefer stability
and tradition REJECTORS
People who openly
oppose or reject
change

242. GROUP vs. TEAM
Merriam Webster:
• GROUP: a number of individuals ASSEMBLED
together or having some unifying relationship.
• TEAM: a number of persons ASSOCIATED
together in work or activity.
Collins Dictionary:
• GROUP: a number of persons BOUND together by
common social standards, interests, etc.
• TEAM: a group of people ORGANIZED to work
together.

244. Stages of Group Development

245. Individual Roles of Group Members
1. Aggressor: expresses disapproval of others’
values or feelings through jokes, verbal attacks, or
envy.
2. Blocker: persists in expressing negative points of
view and resurrects dead issues.
3. Recognition seeker: works to focus positive
attention to himself or herself.
4. Self-confessor: uses the group setting as a forum
of personal expression.

246. Individual Roles of Group Members
5. Playboy: remains uninvolved and demonstrates
cynicism, nonchalance, or horseplay
6. Dominator: attempts to control and manipulate
the group.
7. Help seeker: Uses expressions of personal
insecurity, confusion, or self-deprecation to
manipulate sympathy from members.
8. Special interest pleader: cloaks personal
prejudices or biases by ostensibly speaking for
others.

248. REFERENCES
• Aspires, C. et al. (2005). Leader and management in nursing theories,
concepts, principle and practices.
• Beltran, E. & Tan, C. (2009). Leadership and management in nursing.
• Carroll, P. 2007. Nursing leadership and management a practice guide.
• Camano, F. (1998). Introduction to nursing management functions.
• Heidenthal, P.K. 2003. Nursing leadership and management.
• Marquis, B. & Huston, C. (2006). Leadership roles and management
functions in nursing theory and application.
• Newstorm, J. (2007). Organizational behavior human behavior at work.
• Simms, L. et al. 2005. Professional practice of nursing administration.
• Venzon, L & Nagtalon, J. (2006). Nursing management towards quality
care.

249. THANK YOU!!!