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L E A D E R S H I P.

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1 L E A D E R S H I P

2 LEADERSHIP the process of influencing & persuasion of the
actions of a person or group to attain the goal dynamic, interactive process that involves the leader, follower and the situation.

3 What Is Leadership? Leadership
The ability to influence a group toward the achievement of goals Management Use of authority inherent in designated formal rank to obtain compliance from organizational members Both are necessary for organizational success © 2009 Prentice-Hall Inc. All rights reserved.

Leadership is the conception of a goal and a method of achieving it; the mobilization of the means necessary for attainment; and the adjustment of values and environmental factors GOAL METHOD MEANS VALUES ENVIRON-MENTAL FACTORS Philosophy Vision Mission Objectives Management Functions Planning Organizing Directing Controlling Resources Money Tools Equipments Character of the Leader & the Followers Organization - its purpose - structure - its values Nature of the tasks to be performed Social Economic Political To achieve this conception the Leader has to utilize * Leadership Style * Managerial Skills * Managerial Roles * Motivation * Planned Change * Conflict Management

5 MANAGEMENT the art of getting things done through people
to forecast and plan, to organize, command, coordinate and to control.

6 MAN – still an element of management
… the efficient, effective use of organizational resources through people MAN – still an element of management AGE – old and young should be together MENT (AL) – do not stop learning

7 Management: Process Profession Science Art Class of People

8 Management Theories: Early
Scientific Management (Taylor, ) PRINCIPLES: Scientific personnel system-hired, trained and promoted based on their technical competence and abilities. Workers view how they “fit” into the org. to contribute org. productivity. Relationship bet. Managers (“functional foremen”-plan, prepare, supervise) and workers (to do work)-cooperative/interdependent-work shared equally. PRODUCTIVITY AND PROFITS ROSE DRAMATICALLY

9 Bureaucracy (Weber, 1922)Organizational theory
CHARACTERISTICS: (Danna, 2006) “legal-rational” authority to issue commands Formality, low autonomy, a climate of rules, division of labor, specialization, standardized procedures, written specifications, memoranda and minutes, centralization, controls and emphasis on a high level of efficiency and production.

10 Systematic MANAGEMENT (FAYOL, 1925)
POCCC (command, coordination, control) GULICK (1937)-EXPANDED –POSDCORB (mnemonic) Simplified Nursing Process Management Process Functions Assessing Planning Planning Planning/Staffing/Organizing Implementing Organizing/Directing Evaluation Controlling

11 Scenario: A nurse –manager spent part of the day working on the budget (planning) , meet with the staff about changing the patient care management delivery system from primary care to team nursing (Organizing), altered the staffing policy to include 12- hour shifts (staffing), held a meeting to resolve a conflict between nurses and physicians (directing), and gave an employee a job performance evaluation (controlling). Not only would the nurse-manager be performing all phases of the management process, but each function has a planning, implementing, and controlling phase.

12 Theories Focused on Human Relations

13 Human Relations/Participative Management (Follett, 1930-1970)
Participative decision making /humanistic management-emphasizing integration of people (“human element) into a work situation rather than machines. HAWTHORNE EFFECT (MAYO, 1953) Conducted experimental study on relationship of social factors to productivity: It was found out that physical factors were decidedly not the sole determinants of productivity Results revealed that that interaction among workers and participation in informal social groups had a great impact on individual behavior and productivity.

14 Theory X and Theory Y (McGregor,1960) (managerial attitudes about employees can be directly correlated with employee satisfaction) Theory X Manager- believes their employees are basically lazy, need constant supervision and direction, indifferent to organizational needs. Theory Y Manager – believes their employees enjoy their work, are self motivated, willing to work hard to meet personal and organizational goals.

15 Theory Z (Ouchi, 1981) –motivate people
Characteristics: Collective decision making, Long term employment Slower but more predictable promotions Indirect supervision holistic concern for the workers. Soft “S” (staff, skills, Style) Hard “S” (superordinate goals, strategy, structure, sysyems)

16 TQM (Total Quality Management,1986)
Premises that the individual is the focal element on which production and service depend (customer-responsive environment) and that the quest for quality is an ongoing process. Identifying and doing the right things, the right way, the first time, problem- preventing planning-not inspection and reactive problem solving-lead quality outcomes. Never-ending process, everything & everyone in the organization are subject to continuous improvement efforts. No matter how good the service is, problems-approached in a preventive/proactive mode –crisis mngt. Unnecessary. Customer needs and experiences with the product are constantly evaluated.

17 Empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity. Quality is placed before profit, well implemented TQM program attracts more customers, increased profit margins and financially healthier organization.

18 TQM Principles (Deming, 1986)
Create a constancy of purpose for the improvement of products and service. Adopt a philosophy of continual learning. Focus on improving processes, not on inspection of product End the practice of rewarding business on price alone; instead, minimize total cost by working with a single supplier. Improve constantly every process for planning, production, and service. Institute job training and retraining. Develop the leadership in the organization Drive out fear by encouraging employees to participate actively in the process Foster interdepartmental cooperation and break down barriers between departments. Eliminate slogans, exhortations, and targets for the workforce Focus on quality and not just quantity; eliminate quota systems if they are in place Promote teamwork rather than individual accomplishments. Eliminate the annual rating or merit system Educate/train employees to maximize personal development Change all employees with carrying out the TQM package.

DIVISION OF WORK- specialization makes employees-more efficient-more/better outputs. AUTHORITY- managers give orders, goes with responsibility. DISCIPLINE - good discipline-clear understanding between management and workers about organization’s rules, and judicious use of penalties for infractions of the rules. UNITY OF COMMAND – each employee should receive orders only from one superior. UNITY OF DIRECTION – for each group of organizational activities having the same objective, direction comes from one manager using one plan. SUBORDINATION OF INDIVIDUAL INTEREST TO THE GENERAL INTEREST- employee or group of employees’ interest should not precede over the interests of the whole organization. RENUMERATION –employee must be paid a fair wage for their services rendered.

20 CENTRALIZATION – degree subordinates involvement in decision making
CENTRALIZATION – degree subordinates involvement in decision making. Centralized (Management), or decentralized (subordinates). SCALAR CHAIN- the line of authority from top management to the lowest ranks in the organization . ORDER- people and materials are in the right place at the right time. EQUITY & Justice- fair and just treatment; no favoritism. STABILITY OF TENURE-orderly personnel planning to ensures that replacements are available to fill vacancies. INITIATIVE – whenever employees are allowed to originate and carry out plans, they are expected to exert high levels of efforts. ESPRIT DE CORPS- promotion of team spirit builds harmony and unity within the organization. Motivation of personnel – allowed to work in problem solving/decision making(Tan & Beltran, 2009).

Leadership Roles Figurehead –performance of ceremonial duties Leader-direct involvement to approve decisions and choose managerial team Liaison- dealing with outside people Informational Roles Monitor- receipt and sending of information for control purposes. Dissemination- sharing of information, collected as monitor, with subordinate. Spokesman-speaks for his department

22 Decisional Roles Entrepreneurial – involvement with constant addition or deletion of new projects Disturbance handler- attention to problems arising out. Resource allocator- of an argument to negotiation of a labor allocation of budgets, time, and information Negotiator- ranges from negotiating contract.

CONCEPTUAL – individual’s mental ability to coordinate a variety of interests and activities. Thinks critically and able to conceptualize how things could be. VISIONARY INTERPERSONAL – individuals’ preferred ways of using language, the degrees to which they listens, and their ways on responding to others. TECHNICAL- tools, procedures, and techniques that are unique to the nurse manager’s specialized situation. Master of the job-viewed as a source of help. AN EXPERT.

24 A nurse manager performs these management functions to deliver health care to patients. Nurse managers or administrators work at all levels to put into practice the concepts, principles and theories of nursing management. They manage the organizational environment to provide a climate optimal to provision of nursing care by the clinical nurses.

25 Nursing administration
the application of the art and science of management to the discipline of nursing.

26 Nursing management the process by which nurse managers practice their profession. also the group of nurse managers who manage the nursing organization.

27 Who Needs Nursing Management?

28 All types of health-care organizations, including nursing homes, hospitals, home health-care agencies, ambulatory care centers, student infirmaries, and many others, need nursing management. Even the nurse working with one client and family needs management knowledge and skills to help people work together to accomplish a common goal. A primary nurse working with several clients prioritizes their care to assist time to improve health or, sometimes, peaceful death.

29 Nursing Management Functions:
IN nursing, management relates to performing the four basic functions (Processes): or Planning – provides the framework for performance Organizing – in order to establish order and systematically achieve the goals Directing – focuses on leading the staff in the most effective manner possible Controlling – evaluates performance against established standards

30 P O D S C P O D S C P O D S C Universality of Management
Top Management P O D S C Middle Management P O D S C First-Line Management Amount of Emphasis on Management Function P - Planning S - Staffing O - Organizing C - Controlling D - Directing

31 P L A N N I N G pre-determining a course of action in order to arrive at a desired result. the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known. While planning is largely conceptual, its results are clearly visible.

32 is a thinking or conceptual act that is frequently committed to writing – if plan is not written down, they probably won’t be implemented. is primary to all other activities or functions of management is an important management function that helps reduce the risks of decision making problem solving, and effecting planned change.

33 nursing managers who learns to PLAN will aim for maximum utilization of all resources – money, supplies, equipment, and personnel.

34 Principles of Planning:
Always based and focused on the VMP, and clearly defined objectives of the organization. Continuous process to be more effective. Pervasive within the entire organization (departments, services, level of management) to provide maximal cooperation and harmony. Utilizes available resources Precise in its scope and nature, realistic and focused on expected outcome. Time –bound (short/long range plan) Projected plans-documented for proper dissemination to all concerned for implementation and evaluation as to the extent of its achievement.

35 CHARACTERISTICS of PLANNING (Levey and Loomba,1984)
Purposeful - analysis of both external/internal factors, objective process Process Oriented – continuous Hierarchical in nature-all members contribute to the process in their own ways Future directed- forecasts of economic, needs and demands of patients, direction of political forces Multi-dimensional- key dimensions: time (short range/<1 yr, medium range/<5yrs, long range/>5yrs), organizational(departmental), functional area, orientation (internal/external), scope (strategic, tactical, implementation plan)

36 Importance of Planning : It
leads to the achievement of goals & objectives gives meaning to work provides for effective use of available resources & facilities helps in coping with crises is cost-effective is based on the past & future activities discovers the need for change necessary for effective control orients people to action, instead of reaction increases the chances of success by focusing on results, not on activities increases employee involvement & improves communication

37 Scope of Planning Top Management ( Nursing Directors, Chief Nurses, Directors of Nursing & their assistants) - Set the over-all goals and policies of the organization. - Scope of responsibility is the over-all management of the organization. Middle Management ( Nursing Supervisors) -Direct the activities that actually implement the broad operating policies such as staffing and delivery of services to the units headed by the Senior or head Nurses. - Formulation of policies, rules and regulations, methods and procedures for personnel for intermediate level planning for ongoing activities and projects are done in coordination with top management and those in the lower level. Lower or first level management (Head Nurses or Senior Nurses (including Charge Nurses or team leaders) - do the daily schedules, or weekly plans for the administration of direct patient care in their respective units

38 Administrator Supervisors Head Nurses/ Senior Nurses Staff Nurses / Nursing Attendant

39 Proportions of Management skills needed at
Conceptual Human Tech- nical Top Management Conceptual Human Technical Middle Management Con- ceptual Human Technical First-Line Management Proportions of Management skills needed at Different levels of management

40 Concerned with broad-based, long-range decisions that affect the entire organization; therefore, conceptual skill is most important at that level Top Management Focuses basically on her or his group, Therefore, the need for conceptual skill is at a minimum First-Line Management The need to be able to understand and work with people is important at all levels, but the first-line manager’s position places a premium on human skill requirements because of the great number of employee interactions required Human Skill

41 4 -Types of Planner: Reactive-planning occurs after a problem exists, done in response to a crisis, lead to hasty decisions and mistakes. Inactivist- consider status quo, spend a great deal of energy preventing change and maintaining conformity Preactive-utilize technology to accelerate change, future oriented Proactice/interactive-consider the past, present, and future, and attempt to plan the future of their organization rather than react to it, dynamic and adaptive to the environment

42 Types of Planning: SWOT Analysis Tactical/short-term
Strategic/long range- forecasts the future success of an org. by matching and aligning all its capabilities with its external opportunities (Marquis & Huston,2006). SWOT Analysis (a tool frequently used to conduct environmental assessments. STRENGTHS,WEAKNESSES,OPPORTUNITIES, THREATS) Tactical/short-term Where is the org going? How it is going to get there?

43 Planning Process:(Tomey, 2005)
External Assessment (Opportunities/Threats) Internal Assessment (Strengths/Weaknesses) Priority Strategic issues and programs VValuesMPG (Strategic-org./Operational-unit) Objectives Strategies (timeliness/plans) Policies Procedures Implementation Evaluation (Production/operations/finance/ marketing)

44 Elements of Planning: Forecasting
- estimates the future, including the environment in which the plan will operate. - It includes who the patients are – their customs, beliefs, language/dialect barriers, public attitude and behavior, the acuity of their conditions/illnesses, the kind of care they will receive; the number and kind of personnel (professional and non-professional); and the resources-equipment, facilities, supplies needed

45 Nursing Standards, Policies and Procedures
1. Nursing Standards – this can supply professionally desirable norms against which the department’s performance can be measured. Areas for improvement are identified, and a plan of action to correct this be made and implemented. 2. Nursing Service Policies – are broad guidelines for the managerial decisions that are necessary in organizational and departmental planning. - they govern the action of workers and supervisors at all levels and are intended to achieve pre-determined goals. - they serve as basis for future actions and decisions, help coordinate plans, control performance, and increase consistency of action by increasing the probability that different managers will make similar decisions when independently facing similar situations.

46 Three General Areas in Nursing that requires POLICY formulation
areas in which confusion about the locus of responsibility might result in neglect or mal performance of an act necessary to a patient’s welfare, areas pertaining to the protection of patients and families’ rights e.g right to privacy, property rights, areas involving personnel management and welfare

47 Characteristics of Good Policies
1. written and understandable and known by those who will be affected by them. 2. comprehensive in scope, stable, flexible so they can be applied to different conditions that are not so diverse that they require different set of policies. 3. consistent to prevent uncertainty, feelings of bias, preferential treatment and fairness. 4. realistic and prescribe limits 5. should allow for discretion and interpretation by those responsible for it. Example of Nursing Service Policies 1. Admissions – Receiving, consent, notifying doctor, care of patients 2. Doctor’s Orders – written, verbal, telephone 3. Reporting On or Off-Duty – Information given in leaving unit

48 1) related to job situations such as
3. Nursing Procedures are specific directions for implementing written policies. Two areas where procedures are needed: 1) related to job situations such as reporting complaints or disciplinary instances, 2) involves patient care

49 C. Development & Scheduling
Program - programs are determined, developed and targeted within a time frame to reach the goals and objectives set. D. Preparing the Budget is a plan for allocation of resources based om preconceived needs for a proposed series of programs to deliver patient care.

50 Components of Budget Cash Budget – estimating the amount of
money received form patients and allocating it to cash disbursement required to meet obligations promptly as they come. Operating Budget – salaries, supplies, drugs & pharmaceuticals, etc… Capital Expenditure Budget – consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period

51 Time Management – is a technique for
Time and Planning: Time Management – is a technique for allocation of one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goals efficiently.

52 Barriers to Planning: No specified goals and objectives.
Not flexible plan No communication, coordination and involvement of people. Not SMARTER Overplan and underplan No final evaluation at the end of the plan


54 Hospital A: “ Our mission is to ensure the highest
CRITICAL THINKING- Examine these two mission statements and then respond to the questions that follow. Hospital A: “ Our mission is to ensure the highest

55 ORGANIZING the grouping of activities for the purpose of achieving objectives. it shows the part each person will play in the general social pattern as well as the responsibilities, relationships and standards of performance.

56 Theories: Classical (1890s) –components (organizational structure, specialization of labor, chain of command, span of control); flat organizational structure. Neoclassical (Humanistic,1930s) –employees are given satisfactory working conditions and opportunities to socialize with other employees .IMPROVE JOB SATISFACTION/MORE MOTIVATED Systems Theory – org. viewed as a whole mix of intertwined elements: input (employees, pts materials, money, equipment), throughputs (work), output (product ) Chaos Theory - change is inevitable, employees must learn to adapt and excel to remain employable. Contingency Theory- org. structure match the working of the environment, flexible, varies based on the needs of the org. and the leader.

57 Organizational Characteristics
Organization at Work People/ Job Culture Goals Supervision/Structure

58 Organizing Principles
1. Unity of Command – responsible to only one superior. 2. Scalar principle – authority & responsibility should flow in clear unbroken lines from the highest to the lowest executive. 3. Homogenous Assignment or Departmentation - workers performing similar assignment are grouped together for a common purpose. 4.Span of Control- the # of workers that a supervisor can effectively manage should be limited depending upon the pace & pattern of the working area 5. Exception Principle -recurring decisions should be handled in a routine manner by a lower-level manager. Unusual matters/problem should be referred to higher levels. 6. Decentralization or Proper Delegation of Authority

59 Organizational Structure
process or way a group is formed, its channels of authority, span of control and lines of communication mechanism through which work is arranged & distributed among the members of the organization so that the goals can be logically achieved. Organizational Chart – a line drawing that shows how the parts of an organization are linked.

60 It establishes the following:
Organizational Chart- outlines the formal working relationships and the way people interact within the given structure. Displays the decision making authority w/in the org., illustrating who has the power to make and enforce decisions for the org. It establishes the following: Formal lines of authority - the official power to act. Responsibility – the duty or assignment Accountability – the moral responsibility

61 Characteristics of Organizational Chart
Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload. 2. Chain of Command – lines indicate who reports to whom & by what authority. Type of work to be Performed - indicated labels or descriptions for the boxes. 4.Grouping of work segment- shown by the clusters of work groups 5.The level of Management, which indicate individual & entire management hierarchy, regardless of where an individual appears on the chart.

62 Figure: Organizational Chart of Nursing Division With Assistant Chief Nurses for Nursing Training and Research and for Clinical Areas

63 Chief of Hospital Chief Nurse
Ass. Chief Nurse Trng & Research Ass. Chief Nurse Clinical Service Supervising Nurse Spl. Services Supervising Nurse Clinical Services Supervising Nurse Instructor Senior Nurses Senior Nurses Nurse Instructors Staff Nurses Staff Nurses Nursing Attendants Nursing Attendants

64 Figure: An Organizational Structure Showing the Relationship of the Nursing Service / Division with the College of Nursing

65 Institutional Workers
Medical Center Chief Chief Nurse Dean of Affiliating Colleges Ass. Chief Nurse Clinical Coordinators Supervising Nurses Supervising Nurse Ins Clinical Instructors Senior Nurses Nurse Instructors Staff Nurses Trainees Nsg. & Midwifery Affiliates Midwives Nursing Attendants Institutional Workers

66 Types of Organizational Structure
1. Hierarchical / line organization - oldest and simplest form associated with the principle of chain of command, bureaucracy, vertical control and coordination, levels differentiated by function & authority & downward communications - has authority for direct supervision of employees 2. Staff organization -assists the line in accomplishing the primary objectives of the unit - provides advice and counsel - includes clerical, personnel, budgeting & finance, staff development, research & specialized clinical consulting

67 3. Free –Form/ Matrix - super imposes a horizontal program over the traditional vertical hierarchy. personnel from functional depts. are assigned to a specific program or project & become responsible to 2 bosses – a program manager & the functional dept. head. - actually an interdisciplinary team of core & extended members - e.g. “task force”, “ad hoc committee” - the expert is the authority that leads the team 4. Flat/horizontal - few or no levels of intervention between management and staff

68 Difference between flat and pyramidal structure.
CATEGORY FLAT PYRAMIDAL No. of Levels Fewer More Span of Control Broad Narrow Delegation Greater Lesser Authority Decentralized Centralized Control over Subordinates Type Modern Traditional

69 Patient Classification System (PCS)
method of grouping patients according to the amount and complexity of their nursing care requirements, of nursing time & skill they require. serves in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.

70 Purposes for classifying patients: For/ to
1. staffing. Perceived patient needs can be matched with available nursing resources 2. program costing & formulation of the nursing budget 3. tracking changes in patient care needs 4. determine values for the productivity equation: output divided by input. 5. determine quality

71 Orem’s Self-Care Theory Self Care Capabilities
Deficit Nursing Systems Intense Work for the Patient Intense Work for the Nurse NURSE PATIENT Partially Compensatory Educative / Supportive Wholly Compensatory 71

72 Types of Patient Classification Systems:
Descriptive – narrative descriptive of various degrees of care required by a particular patient A.1 Checklist – lists down patient problems according to patient acuity. A1.1. Self-care A.1.2 Minimal care A.1.3 Moderate Care A.1.4 Extensive care A.1.5 Intensive care

73 A.2 Time-based – lists patient needs according to level of acuity and ascribe the amount of nurse-time needed to meet the needs A.2.1 Minimal A.2.2 Partial A.2.3 Acute A.2.4 Complex The number of categories in a patient classification may range from 3 to 4, which is the most popular, to 5 or 6. These classes relate to the acuity of illness and care requirements, such as minimal, moderate, or intensive care.

74 Other factors affecting the classification system would relate to the patient’s capability to meet his physical needs to ambulate, bathe, feed himself, instructional needs including emotional support. Patient care classifications have been developed primarily for medical, surgical, pediatrics, and obstetrical patients in acute care facilities.

75 Classification Categories
Level I – Self Care or Minimal Care – Patient can bathe, feed and perform ADL. Level II – Moderate Care or Intermediate Care – Patient needs some assistance in ADL, ambulating up and about for short periods of time, Level III – Total, Complete or Intensive Care – Patients are completely dependent upon the nursing personnel.

76 Level IV – Highly Specialized Critical Care -
- Patients maximum nursing care, they need continuous treatment, observation, many medications, IV piggy backs, vital signs q 15- 30 mins. hourly output; - significant changes in doctor’s orders more than care hours / patient /day may range from 6-9 or more.

77 Ratio of Prof. to Non-Prof
Levels of Care NCH Needed Per Patient/ Day Ratio of Prof. to Non-Prof Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care 1.5 3 4.5 6 7 or higher 55:45 60:40 65:35 70:30 80:20

78 Percentage of Nursing Care Hours The percentage of nursing care hours at each level of care also depends on the setting in which the care is being given.

79 Percentage of Patients in Various Levels of Care
Types of Hospital Minimal Care Moderate Intensive Highly Specialize Care Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital 70 65 30 10 25 45 5 15 - 20

80 The Forty-Hour Week Law, Republic Act
5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies located in communities with less than one million popu- lation,will work 48 hours/week and therefore will get only one off-duty a week

81 2. Staffing the acceptable # & mix of personnel to
– the process of determining & providing the acceptable # & mix of personnel to produce a desired level of care to meet patient’s demand for care.

82 Types of Staffing Centralized – done by the nursing director who develops a master plan for nursing personnel; an impersonal approach

83 2.Decentralized – the managers of individual nursing units have more control over the budget, resources, and process. 3. Mixed or Preference Scheduling – Flexible can be combined with self scheduling.

84 Methods of Staffing Pattern
Conventional – centralized- decentralized combination; oldest and most common 2. Cyclical – staffing pattern repeats itself every 4 – 6 wks or wks, etc. 2.a 40 hrs/4 days – 40 hrs a wk is worked in 4 days, followed by a block of off duty time 2.b Seven days off, 7 on – a 10 hr day is worked for 7 days, followed by 7 days off

85 Criteria for staffing patterns depends on: 1
Criteria for staffing patterns depends on: 1. Existing organizational structure & Standards 2. Availability of job descriptions or performance responsibilities which spell out precise job content, including duties, activities to be performed, responsibilities & results expected from the various roles by the organization.

86 Staffing Study Scheduling Plan Budgeting Plan Position Control Plan
Nursing Management Information System Master Staffing Planning Scheduling Plan Budgeting Plan Position Control Plan Components of the Staffing Process SOURCE: Reprinted from Topics in Health Care Financing. Vol. 6, No. 4, p. 15

87 work days and shift for nursing personnel
3. Scheduling – a timetable showing planned work days and shift for nursing personnel

88 Types of Scheduling: Centralized – Chief Nurse or designate do assigns the personnel to the hospital units Decentralized – Chief Nurse or designate assigns personnel but supervising Nurse/ Head or Senior arranged the shift and off duties Cyclical – Covers designated number of wks. (cycle length) - it assigns required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements, the staff preference, then, education, training and experience.

89 The following scheduling variables should be considered: a
The following scheduling variables should be considered: a. Length of scheduling period whether 2 or 4 weeks b. Shift rotation c. Week-ends off d. Holiday offs e. Vacation leaves f. Special days ( birthdays, wedding anniversaries, etc.) g. Scheduled events in the hospital training programs, meetings, etc. h. Job categories i. Continuing Professional Education (CPE) programs

90 Advantages of Cyclical Schedule 1. It is fair to all 2
Advantages of Cyclical Schedule 1. It is fair to all 2. It saves time as the schedule does not have to be redone every week or two 3. It enables the employees to plan ahead for their personal needs preventing frequent changes in the schedule. 4. Scheduled leave coverage such as vacation, holidays and sick leaves are more stable 5. Productivity is improved

91 Factors Considered in Making Schedules
a. the different levels of the nursing staff - adequate mix of nurses and nursing attendants should be observed so that they only assume duties they are legally responsible for, according to their positions, education, training and experiences. b. adequate coverage for 24 hours, seven days a week c. staggered vacations and holidays - not everybody can enjoy the holiday off on exactly the same day that these occur; schedules for holidays are staggered at least once a month - Vacations (whether forced or requested) are likewise staggered to ensure adequate coverage at all times.

92 d. weekends – Weekends are scheduled in such a way that everyone
gets a fair share of at least one week-end off a month. Saturdays and Sundays tend to have lower requirements since there are lesser medical rounds, fewer medical orders and lower patient census. e. long stretches of consecutive working days are to be avoided as much as possible because it might affect the health of the nursing personnel. Afternoon and night shifts are more difficult than the day shifts. Nursing personnel should get their fair share of these things including The ‘relief ’ duty for the three shifts periods. f. evening and night shifts requirements for staff are usually lower than in the morning shift g. floating

93 Some problems that occur in the schedules:
* busy units may require additional help * unscheduled absences may occur and suddenly a staff may be pulled out from her regular area of assignment to cover for another unit. - in order to minimize problems as a result of emergency assignments cross training and/ or orientation to complementary units is advised.

94 Modalities of Patient Care
Primary nursing - total care of an individual is the responsibility of one nurse. 2. Team nursing – a group of nurses work together to fulfill the full functions of professional nurse, to be led by one nurse 3. Case method/total Patient Care – provides one-to-one RN-to client ratio & constant care for a specified period of time. 4. Functional Method/Task nursing – the oldest nursing practice modality - task oriented method: 1 nurse for giving medicines - no one is responsible for total care of any patient - it accomplishes the most work in the shortest amount of time. 5. Modular Nursing –RN provides direct nursing care with assistance of aides.

95 Developing Job Description
– a statement that sets the duties and responsibilities of a specific job.

96 CONTENTS: (Uses) Identifying Data: Position Title: Department:
Supervisor’s Title: Job Summary-essential features of the job that distinguish it from the others. Qualification Requirements Job Relationship – source of workers Specific and Actual Functions and Activities

97 DIRECTING - the issuance of orders, assignments and instructions that enables the nursing personnel to understand what are expected of them.

98 Element: A. Delegating - getting the work done through subordinates
– assigning specific tasks/duties to workers with commensurate authority to perform the job

99 What Cannot Be Delegated:
Overall responsibility, authority, accountability Authority to sign one’s name is never delegated Evaluating the Staff/or taking necessary corrective/ disciplinary action Responsibility for maintaining morale/ encouragement of staff Too technical jobs and those that involves trust and confidence

100 NURSING CARE ASSIGNMENT (sometimes called
NURSING CARE ASSIGNMENT (sometimes called.. ) Modalities of Nursing Care, Systems of Nursing Care, Patterns of Nursing Care

101 1. Functional Nursing – Task oriented - best system that can be used when there are many patients and few professional nurses.

102 Patients Lines of Authority: Head / Senior Nurse R.N. Medication R.N.
Treatment Nsg. Attendant Hygienic Care Housekeeper Linen Attendant Patients

103 Total Care / Care Nursing
– 1 nurse: 1 patient (private duty nursing) - the nurse is accountable for her own actions - this works best when there are plenty of nurses and patients are few - nurses may not be familiar with patients in other areas

104 Head / Senior Nurse Staff Nurse Patient Total Care / Care Nursing

105 Team Nursing – decentralized system giving care through participative effort
assigning patients and task according to job description leader has the responsibility for coordinating the total care of a group of patient (Team Conference – the heart of team nursing) if not fully implemented, it can lead to fragmentation of care in this method only team leader has significant responsibility and authority & care may resemble functional method if the leader does not keep members informed

106 Charge Nurse Team Leader Team Nursing Staff Nurse Clients

107 Primary Nursing – a form assigning patient care responsibilities is an extension of the principle of decentralization. Each RN is responsible for the total care of a small group of patient from admission to discharge. nurse assumes 24 hours responsibility for nursing care Secondary or associate nurses executes the nursing care plan during afternoon and night shifts or day when the primary nurse is off-duty.

108 Secondary/ Ass. Nurse PM Secondary/ Ass. Nurse Nite Secondary/ Ass.
Physician Head Nurse Hospital and Community Resources Primary Nurse Patient/ Client Secondary/ Ass. Nurse PM Secondary/ Ass. Nurse Nite Secondary/ Ass. Nurse Relief Lines of Authority in Primary Nursing

109 Modular Method - Modification of team
and primary nursing - RN provide direct nursing care with assistance of aides Case Management – responsible for assessment of patient and family

110 B. Utilizing / Revising/ Updating
Nursing Service Policies and Procedures

111 C. Supervision – to inspect, guide, evaluate,
improve work performance of employees Leading – actuating efforts to accomplish goals; supervision or overseeing work of employees; and coordinating or unifying personnel and services among others. Managers at different levels of institutional hierarchy are referred to in different terms: Management Levels in Nursing


113 D. Communication - the transmission of
information, opinions, and intentions between and among individuals. - It binds the organization together to ensure common under-standing Purposes: * facilitate work * increase motivation * effect change * optimize care * increase worker satisfaction and facilitate coordination

114 Lines of Communication
a. Downward – from superior to the subordinate which may pass through various levels. e.g. policies, rules and regulations, memos, handbooks, interviews, job descriptions, and performance appraisal b. Upward – emanates from subordinates to superior, usually in the form of feedback and does not flow as easily as downward communication. e.g. discussions between subordinates and superiors, grievance procedures written reports, incident reports and statistical reports.

115 c. Horizontal – or lateral – flows from between peers, personnel or departments on the same level. e.g. endorsements, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services d. Outward – deals with information that flows from the care-givers to the patients, his family, relative, visitors and the community. e.g. information about the nature of their illness, medical and nursing plans of care

116 Communication can be enhanced by carefully choosing the words or information you wish to convey, by creating an environment that promotes its acceptance, by avoiding preconceived opinions and biases about a person, by listening to and understanding the other person’s point of view and by being open and supportive. Most people learn to communicate through example. Nurse managers should promote a responsive communication climate in their units.

117 E. Coordination synchronization of activities with the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious work flow. coordination also prevents overlapping of functions, enhances good working relationships and work schedules are finished on time.

118 e.g Coordination with the Medical Service, Administrative Service, Laboratory Service (Nothing by Mouth After Midnight For Fasting Blood Sugar in AM ), Radiology Service ( For Chole-GI Series in AM! Pls. withhold Breakfast Until Aft Exam), Pharmacy Service, Dietary Service, Medical Records, Community Agencies, Other Institutions and Civic Organization

119 F. Staff Development- to improve performance of employee
Orientation In-service education Continuing education Organization development

120 Decision Making - A decision is a course of action that is consciously chosen from available alternatives for purpose of achieving a desired result. Most people rise to the top of their chosen careers share a common characteristics: they are decisive. They make decisions and are not afraid to take risks.

121 Five Steps in Decision Making Definition of the Problem
Analysis of the Problem Development of an Alternative solution Selection of the solution Implementation and follow-up If the solution is proved to be unsatisfactory, the whole process of decision making is repeated and the entire problem is reviewed.

122 Decision Making Stages:
Intelligence Design Choice e.g SWOT ANALYSIS: S – Strength, W – Weakness, O – Opportunities, T – Threat

123 H. Motivating MOTIVATION Is a skill in aligning employee and organizational interest so that behavior results in achievement of employee wants simultaneously with attainment of organizational objectives. Many managers claim that motivating employees is their most difficult daily task. Managers must stimulate workers to release their energies constructively toward the accomplishment of assigned tasks.

124 Common practical problems encountered by managers include the following:
Employees often differ in their needs. Managers often don’t, or may not accurately perceive, what employees want Managers have limited flexibility in offering economic rewards. The reward that may prove to be most motivating for some people are often difficult to use. Motivation is a function of understanding needs, tensions, wants, incentives, and a perception of the environment.

125 Reporting Evaluation Criteria:
Delivery Organization, systematic and logical presentation of report =1,2 Clarity of voice, grooming and poise.=1,2 Content Correctness of processing and interpretation of data =1,2 Clear presentation=1,2 Conciseness of presentation =1,2 Appropriate data presented =1,2,3 Audio-visual aids Use of audio-visual aids to facilitate presentation=1,2 Mastery and Tact Ability to answer relevant questions=1,2 Attitude towards criticism and suggestion=1,2,3

the process by which managers attempt to see that actual activities conform to planned activities performance is measured & corrective action is taken to ensure the accomplishment of organizational goals

127 Basic Components: 1. Establishing standards, objectives and methods for measuring performance 2. measuring actual performance 3. Comparing results of performance with standards & objectives & identifying strengths &areas for correction 4. Acting to reinforce strengths or successes & taking corrective action as necessary

128 Nature & Purpose 1. Establishes trust and commitment to the system by all personnel through the use of an effective communication system 2. Clarifies organization & individual objectives 3. Presents uniform & fair standards with precise definitions of each standard, goal & objective 4. Compares expectancy with performance

129 Control Mechanics 1. Standards of Care
Yardsticks for gauging the quality and quantity of services. Established criteria of performance, planning goals, strategic plans, physical or quantitative measurements of products, units of service, labor hours, speed, cost, capital, revenue, program and intangible standards. An acknowledged measure of comparison for quantitative or qualitative value, criterion or norm, a standard rule or test on which a judgment or decision can be based.

130 2. Total Quality Management (TQM) – a way of ensuring customer satisfaction through the involvement of all employees in learning how to reliably produce and deliver quality goods and services. “way” means .. it’s a process customer satisfaction involvement of all employees quality goods and services

131 - a work ethic involving everyone in the organization
- a work ethic involving everyone in the organization. The client is the focus. Primary Goal: To improve internal and external customer satisfaction through quality control. Components of TQM: 1. Quality Planning 2. Quality Teams 3. Quality in Daily Work ( or operations)

132 1. Customer Satisfaction
Principles of TQM 1. Customer Satisfaction 2. Management by Facts (“speaking with facts”) 3. Respect for People 4. P-D-C-A (Plan-Do-Check-Act) The real meaning of Quality is TOTAL QUALITY which means: integrity of function and composition doing “right things right”

133 Wrong Things Right Ordered
The Quality Grid Right Things Wrong Ordered the right equipment but installed incorrectly Right Things Right Ordered the right equipment and installed correctly Wrong Things Wrong Ordered the wrong equipment and installed incorrectly Wrong Things Right Ordered Ordered the wrong equipment but installed correctly

134 2.1 Elements: 2.1.1 Decentralization
2.1.2 Participatory management – making decisions at lower levels in the organizational hierarchy 2.1.3 Matrix management – free-form organizational structures. 2.1.4 Management by Objectives (MBO) - every person or group in a work setting has a specific, attainable and measurable objectives that are in harmony with those of the organization. 2.1.5 Statistical analyses 2.1.6 Team building

135 2.1.7 Quality circles – participatory management technique that uses statistical analysis of activities that uses statistical analysis of activities to maintain quality products Theory Z (consensual decision- making) – the leadership style is a democratic one which includes decentralization, participatory management, employee involvement and an emphasis on quality of life.

136 2.2 Quality assurance – defines performance measurements and compares actual processes and outcomes to clinical and satisfaction indicators. 2.3 Quality control – involves performance management and maintenance and includes systematic methods of ensuring conformity to a desired standard or norm. 2.4 Quality improvement – concerned with performance development and is ongoing. Involved with fixing now, preventing

137 3. Nursing Audit – an examination, a verification or an accounting of
predetermined indicators. The three basic forms are: 3.1 Structure audit – focuses on the setting in which care takes place: physical facilities, equipment, caregivers, organization, policies, procedures and medical records are measured by means of checklist.

138 3.2 Process audit – implements indicators for measuring nursing care to determine whether nursing standards are met. Generally task-oriented 3.3 Outcome audit – evaluates nursing performance in terms of establishing client outcome criteria: may either be concurrent or retrospective

139 Control Techniques 1. Nursing rounds – cover issues like patient care, nursing practice and unit management 2. Nursing operating instructions – policies which become standards for evaluation as well as controlling techniques

140 3. Ganti charts – depict a series of events essential to the completion of a project or program 4. Critical control points and milestones – specific points in a master evaluation plan at which the nurse judges whether the objectives are being met, qualitatively and quantitatively.

141 5. Program Evaluation and Review Technique (PERT) – uses a network of activities, each of which is represented as a step on a chart. Includes time measurement, an estimated budget and calculation of the critical path (the sequence of events that would take the longest time to finish) 6. Benchmarking – technique whereby an organization seeks out the best practice in its industry so as to improve its performance. It is a standard or point of reference, in measuring or judging quality, values and cost.

142 Change Process Purposeful, designed effort to bring about improvement in a system with the assistance of a change agent.

143 Theories of Change 1. Lewin’s Theory – change happens in these stages: 1.a Unfreezing- felt need for change 1.b Moving – gathers information for change & implementing the change 1.c Refreezing – change are integrated & stabilized as part of the system

144 2. Roger’s theory: 5 phases 2. a Awareness 2. b Interest 2
2. Roger’s theory: 5 phases 2.a Awareness 2.b Interest 2.c Evaluation 2.d Trial 2.e Adoption

145 3. Reddin’s Theory: 7 techniques change can be accomplished: 3.a Diagnosis 3.b Mutual setting of objectives 3.c Group emphasis 3.d Maximum information 3.e Discussion of implementation 3.f Use of ceremony and ritual 3.g Resistance interpretation

146 4. Havelock’s theory: 6 phases 4. a Building a relationship 4
4. Havelock’s theory: 6 phases 4.a Building a relationship 4.b Diagnosing the problem 4.c Acquiring the relevant Resources 4.d Choosing the solution 4.e Gaining acceptance 4.f Stabilization and self-renewal

147 5. Spradley’s Model: 8 phases 5. 1 Recognize the symptoms 5
5. Spradley’s Model: 8 phases 5.1 Recognize the symptoms 5.2 Diagnose the problem 5.3 Analyze alternative solutions 5.4 Select the change 5.5 Plan the change 5.6 Implement the change 5.7 Evaluate the change 5.8 Stabilize the change

148 Three possible situations that may occur before change happens
Restraining force Driving force Dynamic Equilibrium ‘Status Quo’ Desired Change Undesired Change DECISION MAKING ‘Deciding to Change’ UNFREEZING ‘Desiring to Change ‘Felt Need’ MOVING ‘Implementing The Change’ REFREEZING ‘Stabilizing the Change

149 1. Lack of conflict is a sign of a healthy group
True or False 1. Lack of conflict is a sign of a healthy group False 2. A conflict exists whenever incompatible activities exist. True

150 3. Conflicts are usually destructive to a group
False 4. Conflicts that are not openly expressed and constructively resolved will be expressed indirectly and persist. True

151 5. Conflicts can and should be avoided whenever possible
True 6. It is not possible to teach people how to deal with conflicts effectively. False

152 7. Ignoring conflicts usually causes them to dissipate and go away
False 8. Conflicts are valuable and even necessary to a group True

153 Not Usually True 9. Conflicts are destructive to relationships
10. Conflicts help you understand what you are like as a person True

154 11. A conflict uses up energy and thus decreases a group’s ability to work effectively
Not Usually


156 Types of Conflict 1. Conflict within individual / intrapersonal – occurs when the leader is confronted with two or more incompatible demands 2. Conflict between organizations – restricted to issues pertaining to competition

157 3. Conflict with health organizations/ interpersonal & intergroup – maybe due to:
3.1 difference between Management & staff 3.2 need to share resources 3.3 interdependence of work activities in the organization 3.4 differences in values & goals among departments & personnel regarding delivery of nursing care

158 Sources of Conflicts: Conflicting Perceptions Individuals disagree because they perceive events differently Differing Ideas Individuals have ideas that clash (e.g. women ordination) Conflicting Values Individuals embrace different set of values that influence their perceptions and judgment (e.g. competency, spirituality)

159 Aggressive Behavior Individuals assert their rights while knowingly or unknowingly deny other’s theirs. ‘the nail that sticks out is nailed down’ Personality Clashes Personality traits of people create friction Communication Problems (can be very disastrous) Semantic, noise, lack of clarification

160 Structural Problems Line authority, specialization Human Factors Personality, self-esteem, budgets, we-they dichotomy

161 Approaches to Conflict Resolution
1. Competition and Power – if the nurse’s primary concern is work accomplishment, with little regard for staff relationships 2. Smoothing – a more diplomatic method; the nurse has high concern for relationships & a secondary concern for work accomplishment

162 “If we don’t talk about the problem,
3.Avoidance – low regard for both relationships & work accomplishment; nurse does not take a position regarding the conflict. “If we don’t talk about the problem, it will go away.” .

163 4. Compromise – each side makes concessions
4. Compromise – each side makes concessions. Is moderately assertive & cooperative but produces a lose-lose situation because each side gives up something in order to gain something. This is a weak resolution method

164 5. Collaboration – a constructive process in which the parties involved recognize that conflict exist, confront the issue and openly try to solve the problem that has arisen between them. The outcome is integrative problem solving

165 1. Avoidance (Rabbits – flee away) I lose, You Lose!
4 Suggestions 1. Avoidance (Rabbits – flee away) I lose, You Lose! 2. Competition ( Bull - confronts ) I Win, You Lose! 3. Adaptation ( Camellon – highly adapts) I Lose, You Win! 4. Cooperation ( Bee ) - I Win, You Win! * There is no standardized conflict resolution but it depends upon the situation

166 Functions of Management

167 PLANNING Elements of Planning a. Forecasting
b. Setting the Vision, Mission, Philosophy, Goals & Objectives c. Development & Scheduling Program

168 Elements of Planning d. Preparing the Budget e. Establishing Nursing Standards, Policies and Procedures

169 ORGANIZING Elements of Organizing 1. Setting up the Organizational Structure 2. Staffing 3. Scheduling 4. Developing Job Description

170 Characteristics of Organizational Chart
1. Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload 2. Chain of Command – lines indicate who reports to whom & by what authority 3. Type of work to be Performed – indicated labels or descriptions for the boxes

171 Characteristics of Organizational Chart
4. Grouping of Work Segment – shown by the clusters of work groups 5. The level of Management, which indicate individual & entire management hierarchy, regardless of where an individual appears on the chart.

172 Organizing Principles
1. Unity of Command – responsible to only one Superior 2. Scalar principle – authority & responsibility should flow in clear unbroken lines from the highest to the lowest executive. 3. Homogenous Assignment or Departmentation - workers performing similar assignment are grouped together for a common purpose

173 4. Span of Control – the # of workers that a
supervisor can effectively manage should be limited depending upon the pace & pattern of the working area 5. Exception Principle – recurring decisions should be handled in a routine manner by a lower-level manager. Unusual matters/problem should be referred to higher levels.

174 Systems of Nursing Care,
DIRECTING Element: A. Delegating Modalities of Nursing Care, Systems of Nursing Care, Patterns of Nursing Care

175 Modalities of Nursing Care
1. Functional Nursing 2. Total Care / Care Nursing 3. Team Nursing Team Nursing 4. Primary Nursing 5. Modular Method 6. Case Management

176 Elements of Directing B. Utilizing / Revising/ Updating Nursing Service Policies and Procedures C. Supervision D. Communication

177 Elements of Directing E. Coordination F. Staff Development G. Decision Making H. Motivating

Control Mechanics 1. Standards of Care 2. Total Quality Management (TQM 3. Nursing Audit

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