NURSING LEADERSHIP &

MANAGEMENT
Leadership
 the process of influence in which the
leader influences others toward goal
achievement
 is the effort to envision and inspire
changes
 A social transaction in which one
person influences others.
LEADERSHIP
 Process of influencing the behavior or
actions of a person or group to attain
desired objectives

 A dynamic, interactive process that

involves three dimensions: leader,
follower and the situation
Leader
 the one who leads, conducts or guides
the process
Lead
 to go with or ahead of so as to show
the way; guide
“A Leader is one others follow
willingly and voluntarily”
TYPES OF LEADERS
 Informal leader

◦ Does not have official sanction to

direct activities of others; chosen by
the group itself

◦ Usually become leaders because of

age, seniority, especial
competencies, an inviting
personality or ability to
communicate with and counsel
others
TYPES OF LEADERS
 Informal leader

◦ Play a valuable role if their behavior

and influence are congruent with
the goals of the organization.
 Formal or appointed

◦ chosen by administration, and given

official or legitimate authority to act

Ex. The elected and appointed officers

Theories of Leadership
Great Man Theory
Argues that few people are born to be
great leaders who are well rounded &
simultaneously instrumental &
supportive

Many finds this theory unattractive

because of the premise that leaders are
born not made, which suggests that
leadership cannot be developed
Charismatic theory
 Leader inspires others by obtaining
emotional commitment from followers
and by arousing feelings of loyalty &
enthusiasm
 Robert House - found that this
leaders have strong conviction &
high self confidence & followers
has the similar belief with the
charismatic leader thus showing
signs of unquestioning acceptance
& obedience
 Bernard Bass - it sometimes leads
into blind obedience but a
transformational leaders use it to
motivate members
 Jay Conger & Kanungo (1998) -They
found out that charisma is more of an
attributional phenomenon
 “Charm is an inspirational
quality”
Trait Theory
 Early works in this area maintained
that traits are inherited, but later
theories suggest that the traits can be
obtained through learning &
experience
 “Leaders are born, not
created.”
Leadership Traits

 Task-Oriented
 Relationship-Oriented
 Participative Leadership
Leadership Traits

 Task-Oriented
◦ behaviors includes planning,
scheduling, &
coordinating activities.
 Relationship-Oriented
◦ includes being friendly & considerate,
showing trust & confidence, expressing
appreciation & providing recognition
 Participative Leadership
◦ enlists associates participation in
making decisions
 Situational Theory
 Used task behavior & relationship
behavior in relation to the follower’s
readiness, called maturity to emphasize
the importance of the maturity level of the
followers, & the leader needs to adapt
leadership styles accordingly
Situational
Leadership Theory
 Predicts the most appropriate
leadership style from the level of
maturity of the followers
Contingency Theory
 leadership style will be effective &
ineffective depending on the
situation
Path-Goal Theory
 derived from the expectancy theory
where people act as they do
because they expect their behavior
to produce satisfactory results
 In path-goal relationship, the leader
facilitates task accomplishment by
minimizing obstruction to the goals
(structured activity), & by rewarding
followers for completing their task
 staff associates are introduced as a
variable where in staff associates
with high need for achievement
probably will prefer a task oriented
leader, but people with high need
for affiliation will prefer a
considerate leader
Transactional
Leadership
 an exchange posture that identifies
the needs of the followers & provides
reward in exchange for expected
performance

 a contract for mutual benefits that has

contingent rewards
Transformational
Leadership
 Promotes employee development &
attend to their needs by motivating,
inspiring, & influencing the
followers

 Leader serves as a role model who

provides a sense of direction &
encourages self management
 described it in terms of charisma &
intellectual stimulation

 transformational leaders change the

organization by realigning the
organization’s culture with the new
vision, & revision of assumptions,
values, & norms
Integrative Leadership
Model
 Obviously there is no one best
leadership style. Leaders are rarely
totally people oriented or task
oriented.

 One should be aware of his own

behavior & learn to adapt.
Styles of Leadership
Autocratic
 involves centralized decision
making, with the leader making the
decision & using power to
command & control others
Democratic
 is participatory, with the authority
delegated to others, influential by
having close and personal
relationship with the subordinates
Laissez-Faire
 Is passive & permissive, nondirective,
inactive. Chaos is most likely to
develop because members may work
independently
Power & Authority
Authority

 Legitimate power to direct others

Power

 It is one’s capacity to influence others

Sources of power
 Expert power – it is derived from the
knowledge & skills one possess
 Legitimate power – is derived from the
position one holds in a group &
indicates authority but not sufficient as
one’s only source of power
 Referent power – derived from respect
& trust coming from any individual
group or organization
 Reward power – it comes from the
ability to recognize others for
complying
 Coercive power – is based on fear of
punishment if one fails to conform
 Connection power – it comes from
coalition & interpersonal relationship
 Informational power – it comes from
knowledge & access to information
THEORIES OF LEADERSHIP

 TRAIT THEORY

*leaders are born with inherited

tasks

*envisioning goals, affirming values

serving as a symbol
QUALITIES/TRAITS OF A
LEADER
 Intelligence: judgment, knowledge
and fluency of speech

 Personality: adaptability, alertness,

creativity, cooperativeness, personal
integrity, self confidence, emotional
balance and control, independence
QUALITIES OF …….

 Abilities: ability to enlist cooperation,

popularity and prestige,
sociability/interpersonal skills, social
participation, tact and diplomacy
GREAT-MAN THEORY
 Leaders are born and not made

 Great leaders will arise when there is

a great need

 Ex. King of Spain

BEHAVIORAL THEORY

 Successful leadership is based in

definable, learnable behavior
PARTICIPATIVE LEADERSHIP

 People are more committed to actions

SITUATIONAL THEORY

 The best action of leader depends on

range of situational factors
*motivation
*capability of followers
performance of leader and follower
attitudes, needs and expectations
SITUATIONAL LEADERSHIP
THEORY
 Depends on the level of the maturity of
individual
CONTINGENCY THEORY

 Leaders’ ability to lead is contingent

upon situation.
a.leadership member relation

b.task structure

c.position power
TRANSACTIONAL LEADESHIP

 People are motivated by reward and

punishment
TRANSFORMATIONAL THEORY

 People will follow a person who

inspires them

 A person with vision and passion

 Value based leadership

PATH-GOAL THEORY

 Leaders has certain objectives and

initiates their followers to attain their
own objectives
STRATEGY THEORY

 BASED ON HUMAN HANDLING

SKILLS OF LEADERS
◦ Strategy 1 – attention thru vision

◦ Strategy 2 – meaning thru communication

◦ Strategy 3 - trust thru positioning

◦ Strategy 4 - deployment of self thru

positive self regard
CHARISMATIC THEORY

 Charm and grace are needed to

create followers

 Self belief
STYLES OF LEADERSHIP

1. AUTHORITARIAN/AUTOCRATI C

◦ Strong control over the group or

directive approach

◦ Concern with task accomplishments

2. DEMOCRATIC OR PARTICIPATIVE

◦ Leaders focuses on involving

subordinates in decision making

◦ People oriented
3. LAISSEZ – FAIRE OR PERMISSIVE

◦ Delegating approach

◦ Little or no direction is provided to

subordinates
4. MULTICRATIC

◦ The leader identify which style of

leadership a particular situation requires
BASES OF POWER FOR
LEADERS
 Legitimate/authority – power granted by
an official position

 Referent – potential influence one has

because of the strength of relationships
between leaders and followers

 Expert – gained thru the position of

special knowledge, wisdom, sound
judgment, good decision skills, skills or
 Informational power – exists when an
individual have information that others
must have to accomplish particular
goals

 Connection power – based on having

connections or associations with
others who are powerful
 Coercive power or punishment power
– manager control the groups through
fears, threats and sanctions

 Reward power – this is achieved

through influencing others because of
one’s control over desired resources
COMPONENTS OF EFFECTIVE
LEADERSHIP
 Understanding of the individual
strength, weaknesses and potential

 Knowledge of basic ingredients for

leadership and management

 Systematic use of self to get things

done at the right time
“Leadership is the essence of professionalism and
should be considered an essential component of
all nurses and other professional roles”

Joyce Clifford
MANAGEMENT

 Art of getting things done thru people

 Process that involves guidance,

direction of a group of people toward
organizational goals or objectives

 Process thru which the objectives of

an organization are accomplished by
utilizing human, physical and technical
 Management
 the act of planning, organizing, directing
(leading), controlling (evaluating).
 is a process by which a cooperative group
directs actions towards common goals
 is a process of coordinating and allocating
resources to
achieve organizational goal
Manager
 a person that creates and maintains
an internal environment in an
enterprise in which individual work
together as a group
Managing
 accomplishing the goals of the group
through effective and efficient use of
resources
MANAGEMENT ROLES

 Information role – monitor,

disseminator, spokesperson

 Interpersonal role- figurehead,

leaders, liaison

 Decisional roles – entrepreneur,

disturbance handler, resource
allocator, negotiator
MANAGEMENT LEVELS

 FIRST LEVEL – Supervises the

operative employee

 MIDDLE LEVEL – plan and coordinate

activities of the organization.

 TOP LEVEL – manages the

organization as a whole.
Comparison of Leaders &
Managers
 Leadership Management

Motto Do the right things Do things right

Challenge Change Continuity

Focus Purpose Structures & procedures
Time Frame Future Present
Methods Strategies Schedules
Questions Why? Who, What, When, Where
& How?
Outcomes Journeys Destinations

Evaluate Potential Performance

Human
MANAGEMENT THEORY
Purposes of Theory

1. Provide a stable focus of understanding

what we experience

2. Enable us to communicate freely

3. Challenge us to keep learning of our

world
PRINCIPLES OF
MANAGEMENT
(MODERN ERA)

• Scientific
• Classical
• Human Relations
• Behavioral
Scientific
Management
“Focused on the best way to do a
task”

- Efficiency provided information on:

standards
time & motion studies
task analysis
job simplification
productivity incentives
FREDERICK TAYLOR (1856-1915)

 “FATHER OF SCIENTIFIC
MANAGEMENT”

 Used stopwatch studies & applied the

principles of:
observation
measurement
scientific comparison
to determine the most efficient way to
accomplish a task
 Reduced wasted effort
 Set standard for performance
 Encourage specialization
 Stressed the selection of qualified
workers who could be developed for a
particular job.
 “Monistic Theory”
FRANK GILBRETH(1868-1924)
LILIAN GILBRETH(1878-1972)
 Pioneers in time and motion studies

 Emphasized the benefits of:

job simplification
establishment of work standards
effects of the incentives wage plan
fatigue on work performance
 First to use motion picture films to
analyze worker’s emotions

 Developed a micro chronometer

Henry Gantt (1861-1919)

 Disciple of Taylor, was concerned w/

problems of efficiency
 Refined previous work rather than
introduce new concepts
 Developed a task and bonus
remuneration plan
 Argued for:
more humanitarian approach

placed emphasis on service

rather than profit objectives

recognize useful non-monetary

incentives
CLASSIC ORGANIZATON
“Deductive rather than inductive”

-views the organization as a whole

rather than focusing solely on
production
-focused on: planning
organizing
controlling
 Henry Fayol (1841-1925)

“Father of Management Process School”

 Studied the functions of managers and
concluded that management is
universal

 A believer in the division of work , he

argued that specialization increases
efficiency
 Believedthat workers:
should be allowed to think
implement plans
be adequately remunerated for
their services
 Encourage dev’t of group harmony
through equal treatment and stability
of tenure for personnel

 “a place for everything and

everything in its place.”
FAYOL’S MANAGEMENT
PRINCIPLES
 Division of Labor – the more people
specialize, the more efficient they can
perform

 Authority – management needs to be

able to give orders so that they can
get things done.
 Discipline – members in an
organization need to respect the rules
and regulation that govern the
organization

 Unity of command – subordinates

should receive orders from only one
superior
 Unity of direction – member of any
organization should have only one
objectives

 Subordination of Individual Interest

to the Common Good – give way for
the interest of everybody.

 Remuneration – workers should be

paid according/commensurate to the
work they perform.
 Centralization – managers should
retain the final responsibility but
should at the same time give their
subordinate enough time and authority
to do their job.

 Hierarchy – the line of authority in an

organization runs in order of rank.

 Order – materials and people should

be at the right time and at the right
place.
 Equity – people in the organization
should be treated with equity and
justice

 Stability of Staff – the greater the

turn-over rate, the less workers are
efficient

 Initiative – subordinate should be

given the freedom to do their
work/conceive plans even though
some mistakes occur

 Espirit de Corps – good relationship

 Max Weber (1864-1920)

“Father of Organizational
Theory”
 Conceptualized bureaucracy w/
emphasis on rules instead of
individuals and competency over
favoritism as the most efficient basis
of organization
 Conceptualized a structure of
authority that would facilitate the
accomplishment of the
organizational objectives
Basis Of Authority
1. Traditional Authority

2. Charisma

3. Rational/Legal Authority
Human Relations
“Stresses the Social
Environment”

-focused on the effect individuals have

on the success or failure of an
organization
Chester Barnard (1886-
1961)
 Studied the functions of executives
while he was a manager for the New
Jersey bell telephone system

 He defined the manager’s

responsibilities
1. Defining Objectives

2. Acquiring Resources

3. Coordinating Activities
 Stressing the importance of
cooperation b/w management and
labor, he noted that the degree of
cooperation depends on the non-
financial inducement
 Stressed the role of informal
organization for
◦ aiding communication
◦ meeting individual’s needs
◦ maintaining cohesiveness
 Mary Parker Follett (1868-
1933)

“Mother of Modern Management”

 Stressed the importance of
coordinating the psychological and
sociological aspect of management

 Perceived the organization as a

social system and management as
social process
 She considered subordination
“offensive”
 Distinguished between power w/
others and power over others and
indicated that legitimate power is
produced by a circular behavior
whereby superior and subordinates
mutually influence one another.
 The law of the situation dictates that a
person does not take orders from
another person but from the
situation
 Elton Mayo (1810-1949)

Author of “The Hawthorne Studies”

 Though criticized for poor research
methods, the “Hawthorne Studies”
stimulated considerable interest in
human problems on the job

 “lighting had little effect on

production”
 Work norms obviously had more
influence than wage incentive
Kurt Lewin (1890-1974)

Study of “Group Dynamics”

 maintained that groups have
personalities of their own;
composite of the member’s
personalities

 advocated democratic supervision

 Identified the three types of leaders
◦ Authorat
◦ Democrat
◦ Laissez-Faire
Jacob Moreno (1892-1979)

Developed “Sociometry” to analyze

group behavior
 Claimed that people are either:
attracted to
repulsed by
indifferent towards others
 Developed the sociogram to chart
pairings of preferences for others
 Contributed to:
◦ psychodrama (individual therapy)
◦ sociodrama ( related to social and cultural
roles)
◦ and role playing techniques
for the analysis of interpersonal
relations
Behavioral Science
 emphasizes the use of scientific
procedures to study the
psychological, sociological, and
anthropological aspects of human
behavior in organization
Abraham Maslow (1908-1970)

“Hierarchy of Needs
Theory”
 Initiated the Human Behavioral School in
1943

 He outlined a hierarchical structure for

human needs classified into five
categories:
1. Physiological
2. Safety
3. Belonging
4. Esteem
“Once needs are met, newer
and more mature ones must
emerge”
Frederick Herzberg(1923-
2000)
 Factors in the job can raise the level of
performance and meet the higher
order needs
◦ Job-content (factors in the job) ex:
achievement, recognition, growth =
motivators
◦ Job-context (surrounding environmental
factors) ex: supervision, company policy,
working conditions = hygiene factors
Douglas McGregor (1906-
1964)

“Theory X and Y”
 Developed the managerial
implications of Maslow’s Theory

 Notes that ones style of management

is dependent on one’s philosophy of
humans
 Theory X – manager’s emphasis on
the goal of the organization
◦ People dislike & will avoid work
◦ Workers must be directed, controlled,
coerced, threatened
 Theory Y – emphasis is on the goal of
the individual
◦ People do not inherently dislike work
◦ Work can be a source of satisfaction
◦ Workers have self direction, self-
control, responds to rewards for the
accomplishment of goals
William Ouchi

“Theory Z”
 Published Theory Z: How American
Business Can Meet the Japanese
Challenge in 1981
 Japanese organization
◦ “lifetime employment”
◦ Slow evaluation & promotion
◦ Non-specialized career paths
◦ Implicit control mechanisms
◦ Collective decision-making &
responsibility
◦ Wholistic concern
 US organization
◦ Short-term employment
◦ Rapid evaluation & promotion
◦ Specialized career paths
◦ Explicit control mechanisms
◦ Individual decision-making
◦ Individual responsibility
◦ Segmented concern
Richard Pascale & Anthony
Athos

 Gave a more extensive discussion of

the Art of Japanese Management:
Application for American
Executives in 1981.
 Explain that organization in the US
tend to savor strategy, structure,
and systems, whereas the Japanese
organization focus on staff, skills,
style, and superordinate goals
 Rensis Likert (1903-1981)

Theory of Management is based on his work at

the University of Michigan’s Institute for Social
Research
 He identified 3 types of variables in
organization
1. Causal
 Includes:
◦ Leadership behavior
◦ Organizational structure
◦ Policies
◦ Controls
2. Intervening
 These are:
◦ Perceptions
◦ Attitudes
◦ motivations
3. End-result
 Includes:
◦ Measures of profits
◦ Costs
◦ Productivity
 “Managers may act in ways harmful to
the organization because they
evaluate end results to the exclusion
of intervening variables.”
Managerial Grid
 B E
(1,9) (9,9)

C
(5,5)

A D
(1,1) (9,1)

Vertical – concern for people Horizontal – concern fro production

Behavioral Science
Robert Blake (1918) & Jane Mouton (1930)
Maintained that there are 2 critical dimensions
of leadership
1. Concern for people
2. Concern for production
They depicted these on a 9 x 9 or 81 square
managerial grid. The vertical axis represents
the managers concern for people, & the
horizontal axis represents concern for
production. The 5 basic styles are to each
corner & in the middle
A. Impoverished Manager
(1,1)

lack of concern for both people &

production
B. Country Club Manager
(1,9)

thoughtful & friendly but lack concern for

production
C. Organization Man
Management (5,5)

represents a moderate concern for both

people & production but not at the same
time
D. Authority-Obedience
(9,1)

efficiency in operation but lacks concern

for human element
E. Team Management (9,9)

the optimal managerial style. These managers

integrate their concern for people & production
Skills of a Manager
Accdg to Robert Katz
 Technical skills – knowledge and
proficiency in activities involving
methods, procedures and process. It
also involves working w/ tools and
specific techniques to achieve the
desire result.
 Human skills – the ability to work w/
people. It is the creation of work
environment in w/c people feel secure
and free to express their opinion.
 Conceptual skills – the ability to see
the over-all pictures to identify
important elements in a situation and
to understand the relationship among
the elements
Summer emphasized
◦ Knowledge factors
◦ Attitude factors
◦ Ability factors
Roles of Managers
 INTERPERSONAL ROLE

◦ Symbol
◦ Leader
◦ Liaison
 INFORMATIONAL ROLE

◦ Monitors Information
◦ Disseminates Information
◦ Spokesperson or Representative
 DECISIONAL ROLE

◦ Entrepreneur or Innovator
◦ Troubleshooter
◦ Negotiator
I. PLANNING

 Forecasting or setting the broad outline

of work to be done
-Why it will be done?
-What action is necessary?
-Where it will be done?
-When it will be done?
-Who will do it?
-How it will be done?
Scope of Planning

 Strategic planning
based on mission of the institution
Scope of planning
 Supervisors
- formulate policies, rules and regulations,
methods and procedures
-coordinates nursing activities
-translate strategies and procedures into
specific objectives and program
 Head nurses
- schedule daily and weekly plans for the
administration of patient care for his or
her unit
- directly responsible for the actual
production of nursing services
CHARACTERISITCS OF GOOD
PLAN
 Based on clearly defined objectives
 It should be simple
 It should provide for the proper
analysis and classification of action
 It should be flexible
 It should be balance
 It should make use of all available
resources
REASONS FOR PLANNING

 Increases the chance of success by

focusing on results not activities
 Forces analytic thinking and
evaluation of alternatives
 Establish a framework for decision
making
 Orient people to action than reaction
 Includes day to day and future
focused managers
REASONS FOR PLANNING
 -Helps avoid crisis management and
provide decision making flexibility
 -Provide a basis for managing
organizational and individual
performance
 -Increases employee involvement and
improves communication
 -Cost effective
STAGES OF PLANNING

1. Develop the purpose or mission

statement, goals, objectives,
philosophy

◦ Mission – purpose of existence and reason

behind organizational structure

◦ Philosophy – statements of shared values and

beliefs
◦ Goals – statement of intent derived from
the purposes of the organization, usually
stated broadly and generally

◦ Objectives – specific aims, purposes or

targets that will have to be accomplished
2. Collect and analyze data - external
and internal forces

3. Assess for the strength (opportunities

that will facilitate effectiveness and
achievement of goals and
weaknesses (threats that will impede
achieving goals and objectives)
4. Write realistic and general statements
of goal

5. Identify strategies to achieve

specified goals

6. Develop a timetable for

accomplishing each objectives

7. Provides guideline for developing

operational and functional plans
8. Put plans to work/implement

9. Provide for formative evaluation

reports before, during and after the
plan is implemented
BUDGET (AS A TOOL FOR
PLANNING)
 Budget

◦ operational management plan related to

income and expenses for division of time;
allocated resources necessary for future
expenditures
PREREQUISITES TO
BUDGETING
 Sound organizational structure with
clear line of authority and
responsibility

 Managerial support

 Formal policies and procedures must

be reflected in the budgetary manual
PUPOSES OF BUDGETING IN
NURSING SERVICE
 To plan the objective, programs,
activities of the nursing service and
finance to accomplish them.

 To motivate nursing workers through

analysis of actual experience.

 To serve as standards.
Types of Budget
 Capital
 Operational
 Personnel or manpower
 Flexible
 Cash flow
 Fixed ceiling
COSTS

 Fixed cost - not related to volume and

remain constant.
 Variable cost - related to volume and
varies according to different factors.
 Direct cost - related to providing
product service.
 Indirect cost - incurred in support of
providing products service.
COST CONTAINMENT

 COST AWARENESS
 COST FAIRS
 COST MONITORING – focuses on
how much will be spent, where, when,
and why.
 COST MANAGEMENT – what can be
done to manage cost
 COST INCENTIVES – motivation and
rewards
 COST AVOIDANCE – not buying
supplies, technology or services not
necessary needed.
 COST REDUCTION – spending less
for goods or services
 COST CONTROL – effective use of
available resources through careful
planning, forecasting, reporting and
monitoring.
PROCEDURE – NURSING
SERVICE
1. Determine productivity goal

2. Forecast workload

3. Budget patient care hours

4. Budget patient care hours and

staffing

5. Plan for nonproductive hours

6. Chart productive time

7. Estimate the cost of supplies and

services

8. Anticipate capital expense

II. ORGANIZING

 Grouping of activities, providing

assignments, supervising, defining
means of coordinating activities to
accomplish goals and objectives
PURPOSES

 To sustain the philosophy, achieve the

mission and vision and objectives of
the organization

 Show the part each person shall work

in the organization
CHARACTERISTICS OF
ORGANIZATIONAL STRUCTURE
 Division of work in which each boxes
represent an individual responsible for
a given part of the organization’s
workload

 Chain of command, with lines

indicating who reports to whom and
why what authority
CHARACTERISTICS……

 The type of work performed, indicated

by the labels or description for each
boxes
 The grouping of work segments
shown by the cluster of work groups
 The level of management, which
indicate individual and entire
management hierarchy
COMPONENTS OF
ORGANIZATIONAL STRUCTURE
 People

 Purpose

 structure
BASIC TYPES OF O.S.

 Informal – consists of the personal

and social relationship of the members
in the organization

 Formal – describes the positions,

responsibilities and those occupying
the positions and their relationships
among them
FORMAL ORG. STRUCTURES

 Hierarchic or bureaucratic model

 Adaptive or organic model

1. Freeform
2. Collegial
3. Project management
4. Task force
5. Matrix
ORGANIZATIONAL CHART

 Diagrammatic representation of the

organizational structure
Types according to depiction

1. Positional – position is indicated

2. Functional – duties and
responsibilities
3. Structural – agency is shown
3 General Types of
Organizational Chart:
1. Line Organizational
 Is the simplest and most direct type of
organization in which position has
general authority over the lower
position in the hierarchy.
DIRECTOR

CHIEF NURSE

SN SN SN
 ADVANTAGES  DISADVANTAGES
1. Maintain 1. Neglects special
simplicity. planning
2. Makes clear 2. Overworks key
division of people
authority. 3. Depends upon
3. Encourage retention of a few
speedy action key people
2. Functional
Organizational
 Is one where each unit is responsible
for a given part of the organization’s
workload. There is a clear delineation
of roles and responsibilities which are
actually interrelated
 ADVANTAGES  DISADVANTAGES
1. Relieves line 1. Makes relationship
executive of more complex
routine 2. Makes limits of
specialized authority of each
decision specialist a difficult
2. Provides coordination
frameworks for 3. Teach toward
applying expert centralization of
knowledge organization.
3. Relieves press of
need for large
number of well-
rounded
personnel
3. Staff Organization
 Is purely advisory to the line structure
w/ no authority to put
recommendations into action.
DIRECTOR

TRAINING OFFICER

CHIEF NURSE

SN SN SN
 ADVANTAGES  DISADVANTAGES
1. Enables specialist 1. Continues in
organization even
to give expert
if its function are
advise not clear
2. Frees the line 2. Reduces expert
executive of power to place
detailed analysis recommendation
3. Affords young into action
specialist a mass 3. Tends towards
training centralization of
the organization
FORMS OF ORGANIZATIONAL
CHART
1. Vertical or Tall Chart
 Depicts the Chief Executive at the top
with line of authority flowing down the
hierarchy.
DIRECTOR

CN

SN SN SN

NA NA NA
 2. Horizontal or Flat Chart
 Depicts the manager at the top w/ a
wide span of control
CN

SN SN SN SN SN

NA NA NA NA NA
3. Concentric or Circular
Chart
 shows outward flows of
communication from center
SN

CN

SN SN
STAFFING
 Is
the process of determining and
providing the acceptable number
and mix of nursing personnel to
produce a desired level of care to
meet the patient’s demand.
 The Hospital Nursing Service
Administration Manual of the
Department of Health has
recommended the following
nursing care hours (NCH) for
patients in the various nursing
units of the hospital.
Table 1. Nursing Care Hours / patient /
day according to classification of patients by
units.

CASES NCH/Pt/day Prof. to Nonprof

ratio
1. General 3.5 60:40
Medicine
2. Medical 3.4 60:40

3. Surgical 3.4 60:40

Cont.

4. Obstetrics 3.0 60:40

5. Pediatrics 4.6 70:30

6. Pathologic 2.8 55:45

Nursery
7. ER/ICU/RR 6.0 70:30

8. CCU 6.0 80:20

 Patient classification
systems (PCS)

…quantify the quality of nursing care

by matching patients’ needs to
numbers and kinds of nursing
personnel using time as the unit of
measure.
A nurse manager must determine
the following:
 Number of categories in which the
pt should be divided
 Characteristics of pts per category
 Type & number of care procedures
that will be needed by a pt per
category
 Time needed to perform these
procedures that will be required
Table 2. Levels of Care of patients,
NCH/pt/day & ratio or prof & non-prof

Levels of care NCH/pt/ day Ration prof to

non-prof
L1 self care or 1.5 55:45
minimal care
L2 moderate or 3.0 60:40
intermediate
L3 total or 4.5 65:35
intensive care
L4 highly 6.0 70:30
specialized or 7 or higher 80:20
critical care
Percentage of Nursing Care
Hours
Period of NCH at each
levels of care depends on the
setting in which the care is being
given.
 CLASSIFICATION CATEGORIES

 Level
I- SELF CARE or
MINIMAL CARE
- patient can take a bath on his own, feed
himself and perform his ADL.
- patient about to discharge, those non-
emergency, newly admitted do not exhibit
unusual symptoms, and requires little
tx/observation or instruction.
- 1.5 NCH/ 55:45 ration prof and non prof
Level II- MODERATE CARE or
INTERMEDIATE CARE

- patients under this level need some

assistance.
- extreme symptoms of their illness must
have subside or have not yet appeared.
- slight emotional needs, w/ V/S ordered
up to 3x/shift, intravenous fluid or blood
transfusion, are semiconscious and
exhibiting some psychological or social
problems; periodic tx, observation &
instructions.
- 3 NCH / 60:40 ration prof & non-prof
 Level III- COMPLETE or
INTENSIVE CARE

- patients in this category are completely

dependent upon the nursing personnel.
- they are with marked emotional needs,
w/ V/S more than 3x/shift, may be on
continuous O2 therapy, w/ chest or
abdominal tubes.
- require close observation at least 30
mins for impending hemorrhage, w/ or w/o
hypo or hypertension & cardiac
arrhythmia.
- 6 NCH / 65:35 Ration prof & non-prof
Level IV- HIGHLY or
SPECIALIZED CARE

- Need maximum nursing care.

- patients need continuous tx &
observation; w/ many medication, IV
piggy banks; V/S q 15-30 mins; hourly
output.
- 6-9 NCH / 70:30 to 80:20
Table 3. Percentage of patients at
various levels of care per type of hospital.

Type of Minimal Moderate Intensive Highly

hospital care care care Spl. care
Primary 70 25 5 -
Secondary 65 30 5 -
Tertiary 30 45 15 10
Special T. 10 25 45 20
 COMPUTING FOR THE NUMBER
OF NURSING PERSONNEL
When computing for the nursing personnel,
one should ensure that there is sufficient staff
to cover:
1. All shifts
2. Off-duties
3. Holidays
4. Leaves
5. Absences
6. Time for Staff Development
ACCORDING TO R.A. 5901 OTHERWISE
KNOWN AS “THE FORTY-HOUR WEEK
LAW”, EMPLOYEES WILL WORK FOR
40HRS/WK:
1. FOR HOSPITALS WITH
100-BED CAPACITY OR
MORE
2. COMMUNITY POPULATION
OF AT LEAST 1 MILLION
HOWEVER, A NURSE WILL RENDER
48HRS/WK WITH ONLY 1 OFF-DUTY A
WEEK IF:
1. HOSPITALS WITH LESS
THAN 100-BED CAPACITY
2. COMMUNITIES WITH LESS
THAN 1 MILLION
POPULATION
THERE ARE BENEFITS ENJOYED BY THE
PERSONNEL REGARDLESS OF THE
WORKING HOURS. AS PER CIVIL
SERVICE COMMISSION MEMORANDUM
CIRCULAR NO. 6, SERIES OF 1996,
GOVERNMENT EMPLOYEES ARE
GRANTED 3 DAYS WHICH MAY BE SPENT
FOR:
1. BIRTHDAYS
2. WEDDINGS
3. ANNIVERSARIES
4. FUNERALS (MOURNING)
5. RELOCATION
6. ENROLMENT/GRADUATION
LEAVE
7. HOSPITALIZATION
8. ACCIDENT LEAVES
Table 4. Total number of working hours
and non-working days and hours of nursing
personnel per year.

Rights & privileges given Working Working

each personnel/year hr/wk hr/wk
48 hrs 40 hrs
1. Vacation leave 15 15
2. Sick leave 15 15
3. Legal holidays 10 10
4. Special holidays 2 2
5. Special privileges 3 3
Cont.

6. Off duties/ R.A. 5901 104 52

7. Continuing Education Prog. 3 3
Total Non-working days/year 152 100
Total Working days/ year 213 265
Total Working hours/ year 1,704 2,120
To compute for relievers needed, the
following should be considered:

1. Ave. number of leaves taken each year---- 15

◦ Vacation Leave --------------------------------10
◦ Sick Leave--------------------------------------- 5
2. Holidays ---------------------------------------------- 12
3. Special Privileges --------------------------------- 3
4. Continuing Education Program for
Professionals ------------------------------------- 3
Total Average Leaves 33
 To determine the relievers
needed:
33 (ave # of days an employee is absent)
213 or 265
(# of working days/year that each
employee serves)
= 0.15 (15%) for persons who work
40hrs/wk
= 0.12 (12%) for persons who work
48hrs/wk
 To distribute the staff by
shifts:
 Morning shift = 45 – 51% (0.45 – 0.51)
 Afternoon shift= 34 – 47% (0.34 – 0.47)
 Night shift = 15 – 18% (0.15 – 0.18)
***Note: In the Philippines, the
distribution usually followed is 45%
(0.45) for the morning shift, 37% (0.37)
for the afternoon shift and 18% (0.18)
for the night shift.
STAFFING FORMULA
1. Categorize the patients according to
levels of care. Multiply the total # of
patients by the % of patients at each
level of care.
Ex. Find the # of nursing personnel needed
for 250 bed capacity in a tertiary hospital
250 (pts) x .30 = 75 pts need L1
250 (pts) x .45 = 112.5 pts need L2
250 (pts) x .15 = 37.5 pts need L3
250 (pts) x .10 = 25 pts need L4
2. Find the # of nursing care hrs (NCH)
needed by patients at each level of care/
day.
75 pts x 1.5 (NCH at L1) =112.5 NCH/day
112.5 pts x 3 (NCH at L2) =337.5 NCH/day
37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day
25 pts x 6 (NCH at L3) =150 NCH/day
Total = 768.75 NCH/day
3. Find the total NCH needed by given
number of patients or bed capacity/year.
768.75 x 365 (days) = 280,593.75
NCH/year
4. Find the actual number of working hours
rendered by each nursing personnel/year.
8 (hrs/day) x 213 (working days/year)=
1,704 (working hrs/year)
5. Find the total # of nursing personnel
needed. (immediate, reliever, total
personnel)
a. Total NCH/year = 280,593.75 = 165
working hrs/yr 1,704
b. Relief x total immediate nsg personnel
165 x 0.15 = 25
c. Total nsg. Personnel needed
165 + 25 = 190
6. Categorize the nursing personnel into
professional and non-professional.
190 x .65 = 124 professional nurses
190 x .35 = 66 nursing attendants
190 nursing personnel
7. Distribute by shift
124 x .45 = 56 nurses on AM shift
124 x .37 = 46 nurses on PM shift
124 x .18 = 22 nurses on Night shift
124 nurses
66 x .45 = 30 nsg attendants on AM shift
66 x .37 = 24 nsg attendants on PM shift
66 x .18 = 12 nsg attendants on Night shift
66 nursing attendants
SCHEDULING
SCHEDULE
 It is a timetable showing planned work
days and shift for nursing personnel.
 Scheduling is to assign working days
and days off to the nursing personnel
so that adequate patient care is
assured.
ASSESSING A SCHEDULING
SYSTEM
1. Ability to cover the needs of the unit.
2. Quality to enhance the nursing
personnel’s knowledge, training and
experience.
3. Fairness to the staff
4. Stability
5. Flexibility
Cyclic staffing
…sets a basic time pattern that is
repeated in cycles.
(Exhibit 7-9 p. 107)
Modified workweeks
…include systems of scheduling
personnel such as 10-hour and
12-hour shifts, weekend
alternative, team rotation, and
flexible hours.
Self-scheduling
…is a method of scheduling in
which the nurse manager
determines the needs per day and
shift and the nursing staff
schedule themselves to meet
these needs.
(Exhibit 7-8 p. 106)
Productivity
…is a system of measuring worker
output and is commonly defined
as outputs divided by inputs.
Temporary workers
…are contract workers hired from a
staffing agency for a period of
time that may be for one to
several days or weeks.
Temporary workers are not
employees of the health care
agency where they work.
Manager behavior
 Oversees staffing activities
through human resource
management that includes use of
a patient classification system and
provision of qualified nursing
personnel in adequate numbers to
meet patient care needs.
Leader behavior
 Uses input from employees to
develop and implement a staffing
philosophy and staffing policies
that inspire personnel to work to
their maximum level of
productivity.
Basic to planning for staffing of a division
of
nursing is the fact that qualified nursing
personnel must be provided in sufficient
numbers to ensure adequate, safe
nursing care
for all patients 24 hours a day, 7 days a
week,
52 weeks a year. Each staffing plan
must be
tailored to the needs of the agency
and cannot
be determined with a simple worker-
(Exhibit)
(Exhibit 7-7 p. 105)
Components of patient
classification system
 Classification categories
◦ Factor
◦ Prototype
 Guidelines
 Average care time for a patient in each
category
 Method for calculating required staffing,
personnel mix, and required nursing care
hours
 Modified approaches to
nurse staffing and
scheduling

 10-hour shift
 12-hour shift
 Weekend alternative
 Flex time
 Others
Productivity
 Is commonly defined as output /
input
 Percent productivity
= required staff hours / provided
staff hours x 100
Staffing activities
…include recruitment, hiring,
assignment, scheduling,
calculating turnover, preparing
payroll, developing and
administering policies, and related
activities.
Human Resource
Department
 involves tasks like interviewing, hiring,
coaching, retention of state and
performance evaluation/appraisal
Personnel
 are persons employed in an agency or
department
Recruitment
 the process of enlisting personnel for
employment; the process of hiring
Selection
 the process of choosing or selecting
candidates according to their
qualifications to the job; the process of
elimination
Retention
 capacity to retain employees once
they are hired
 Modes of Recruitment
 Employee recommendation
 Word of mouth
 Advertisement
 Flyers
 Newsletter
 Bulletin
 Posters
 Career Days
 Job Fairs
 Placement
Screening Potential Staff
 Philosophies in the screening process:
 The manager should screen out applicants
who do not fit the agency’s image.
 The manager should try to fit the job to a
promising applicant.
 Usually the manager should try to fit the
applicant to the job.
 Application Forms and Resumes
◦ Determine whether the applicant
meets minimal hiring requirements.
◦ Furnish background data useful in
planning the selection interview.
◦ Obtain names of references who may
be contacted for additional information
about the applicant’s work experience
and general character.
◦ Collect information for personnel
administration (SSN, # of dependents
etc.).
 Letter of Reference
 Interview
◦ face to face contact between the job
seeker and a person with full authority
to fill the position under discussion.
◦ The purpose of the interview is to
obtain information, to give information,
and to determine if the applicant
meets the requirements for the
position.
Types of Interview

Directive interview – uses closed-ended

question
Non-directive interview – the applicant
narrates himself.
Structure interview – the interviewer uses
pre-prepared guidelines for interview.
Group interview – several applicants or
interviewees are interviewed together.
Board interview – conducted by selected
member of the personnel to an
applicant.
Test Used in Selection of Applicant

Aptitude Test – measures capacity on

potential ability to learn
Psychomotor – measures strength and
coordination
Job knowledge
Proficiency – measures how well the
applicants can do a simple work
Psychological test – measures personality
characteristics
PATIENT CLASSIFICATION
SYSTEM
 PURPOSES

1. For staffing
2. Program costing and formulating budget
3. Track changes in patient care methods
4. Determine values for productivity
equation
5. Determine quality
III. DIRECTING
 Issuance of assignments, orders and
instructions that permits the worker
what is expected of the to achieve
organizational goals and objectives
Delegating
…is getting the work done through
employees.
 Is the process by which a manager
assigns specific task/duties to workers
with commensurate authority to
perform the task.

 The worker in return assumes

responsibility & is held accountable for
its result.
 2 Important Criteria in
Delegation

1. Ability of the worker to carry out the

task.

2. Fairness not only to the employee

but to the team as a whole.
Principles of Delegation
 Select the right person
 Delegate both interesting &
uninteresting task
 Provide staff with enough time to learn
 Delegate gradually
 Delegate in advance
 Consult before delegating
 Avoid gaps & overlaps
 Nursing Care
Assignments/ Modalities
of Nursing Care or
System/Pattern of
Nursing Care
 Primary
◦ Extension of principle of decentralization
◦ Nursing process driven
◦ Primary nurses and associate nurses
◦ 24-hour coverage
◦ Greater patient and staff satisfaction
 Advantages 1) patient & family are able
to develop trusting relationship with RN;
2) there is defined accountability &
responsibility; 3) there is
holistic/continuity of care.

 Disadvantages 1) high cost because

there is a higher RN skill; 2)
proximity of patient assignment; 3)
overlapping of staff functions; 4) nurse
patient ratio must be realistic.
 Case Method
◦ 1:1 nurse/patient ration
◦ Examples include private duty, ICU,
Community Health Nurse
◦ Similar to Primary, however, no Associate
RN
◦ The nurse is responsible for the total care
of the patient for the shift she’s working
 Advantages 1) consistency of one
individual caring for the patient for the
whole shift; 2) more opportunity to
observe & monitor the patient.

 Disadvantages 1) the nurse may not

have the same patient the next day; 2)
it does not serve the purpose of
decentralization.
 Functional Nursing
◦ divides the work to be done & every
member is responsible for his actions

◦ best system that can be used if there are

many patient & professional nurses are
few
 Advantages of functional nursing are
that 1) work is done fast; 2) workers
learn to work fast; 3) they gain skill
faster in that particular task.
 Disadvantages include 1)
fragmentation of nursing care
therefore holistic care is not achieved;
2) patient cannot identify who their
“real nurse” is; 3) nurse-patient
relationship is not fully developed;
4) evaluation of nursing care is poor &
outcomes are rarely documented, and
6) it is hard to find a specific person to
answer the relative’s questions.
 Joint Practice (Team Nursing /
Modular Nursing )
◦ More than modality
◦ Involves nurses and physicians
collaborating as colleagues
◦ Agreed upon protocols to manage care in
primary settings
◦ Modular nursing is a kind of team nursing
that divides the area into modules of
patient, with each module cared by a
team of nurses.
 Advantage 1) work is shared with
others

 Disadvantages 1) patient receives

fragmented, depersonalized care;
2) communication is complex; 3)
accountability & responsibility is
shared which can cause confusion; 4)
these factors affects RN’s
dissatisfaction.
 Case Management
◦ Clinical system with accountability for
individual or group through continuum of
care
◦ Negotiating
◦ Procuring
◦ Coordination of services and resources
RESPONSIBILITIES IN DIRECTING

1. Promotive “improve systems”

2. Preventive “anticipate problems &
difficulties”
3. Corrective “institute measures to
correct problems”
4. Regulatory “preserve existing
assignments”
CHANGE PROCESS

 Change – purposeful, designed effort

to bring about improvements in a
system, with the assistance of change
agent
THEORIES OF CHANGE
REDDINS THEORY – suggested seven
techniques by which change can be
accomplished
1. Diagnosis
2. Mutual setting of objectives
3. Group emphasis
4. Maximum information

5. Discussion of implementation

6. Use of economy and ritual

7. Resistance interpretation
LEWIN’S THEORY
 Unfreezing stage – the nurse is
motivated by the need to create
change
 Moving stage – the nurse will gather
information
 Refreezing stage – changes are
integrated and stabilized as part of the
value system
ROGERS’ THEORY
1. awareness
2. interest
3. evaluation
4. trial
5. adoption
MOTIVATION

 Forces that make or propels one to act

in a certain way.

 Individual’ desire and responses to

events which prompts extraordinary
effort to attain goal and enthusiasm
LEVELS OF MOTIVATION
 EXTRINSIC MOTIVATION –
anticipated rewards or avoidance of
negative consequences in the
performance of action
 INTRINSIC – satisfaction derived from
the action itself
 TRANSCENDENTAL – recognition of
the usefulness of action to some other
person
THEORIES OF MOTIVATION

CONTENT THEORY – motivation factors or

needs within a person

1. Maslow’s Needs Theory

2. Alderfer’s theory – (Existence, Relatedness,

Growth) ERG
3. Herzberg’s Theory – two factor theory

a. Disatisfiers or hygienic – (extrinsic) salary, job

security, working condition, relationships

b. Satisfiers or non hygienic – (intrinsic)

achievement, recognition, reward,
advancement, work itself
4. McClelland theory – affiliation, achievement
and power

5. Monistic/scientific theory – salary as the

best motivating factor
PROCESS THEORY
1. Arousal theory – focuses on internal
process that mediate the effect of work
performance

2. Expectancy theory – focuses on

people’s expectation that their efforts will
result in good performance and valued
results

3. Equity theory – focuses on fair treatment

DECISION MAKING
A systematic, sequential process of
choosing
among alternatives & putting those
choices
into action
STEPS

1. Identify problem
2. Prioritize problem
3. Gather and analyze situation related
to problem
4. Evaluating all alternatives
5. Select an alternative for
implementation
IV. CONTROLLING
 The process by which managers
attempt to measure if actual activities
conform to planned activities
 A process wherein the performance is
measured and corrective action is
taken to ensure the accomplishment
of organization goal
STEPS IN CONTROL PROCESS
Establish standards and criteria

Measure performance

Compare results with standards

Match with standards?

YES – do nothing or improve

NO - take corrective action

 PERFORMANCE
APPRAISAL/EVALUATION
SYSTEM
 Process of evaluating employee’s
performance against standards
 To determine job competence
 Enhance staff development and
motivate employee
 discover employee’s aspirations and
recognize accomplishments
 Improve communication
 Aid managers in counseling and
coaching
 Determine training and dev. needs of
staff
 Inventories of talent
 Legal purposes
METHODS OF EVALUATION
 Anecdotal records – objective description of
behavior
 Rating scale
 Ranking
 Self appraisal/self rating
 Peer review
 Paired comparison
 Forced - choice
 Subordinates
 Team evaluation – multiple raters
 Behavior – anchored – list specific
description of good, average and good
performance
 Essay evaluation – describe strength and
weaknesses of employee
 Critical incident – describe effective and
effective behavior of employee
PROBLEM AREAS OF
EVALUATION
 Subordinates have not been motivated
to want to change
 People are unable to make change
 Subordinates become resentful and
anxious when merit system is applied
COMMON ERRORS OF
EVALUATION
 Halo error – allowing one trait to
influence the evaluation of others or
rating of all traits on the basis of first
impression
 Horn error – the evaluator is
hypercritical
 Contrast error – managers rate the
nurse opposite the way they perceive
themselves
 Leniency of error
 Central tendency error
 Racial bias
 System design and operating
problems – focuses on the method
(system) and process (operating) of
evaluation
 Overgeneralization
 Recency of Events error
TOTAL QUALITY
MANAGEMENT
 Systematic process to improve
outcomes based on customers’ needs
 Doing the right thing
-meeting the needs of the customer
-building quality performance into the
work process
-employ scientific approach to
assessment and problem solving
QUALITY ASSURANCE PROG
 Process of establishing a standards of
excellence of intervention and taking
steps to ensure that each patient
receives the expected level of care
 Fulfillment of social contract between
society and professions
QUALITY NURSING CARE
 Presence of all
elements/characteristics specified in
the standards.
FRAMEWORK OF QA
1. Structure – instrumentalities in the
delivery of care (personnel, supplies
etc)
2. Process – how the service was
delivered
3. Outcome – results expected of the
service
NURSING AUDIT
 Official examination of: nursing
records, physical facilities, personnel
involved in patient care
 Tool to analyze and evaluate nurses’
bedside records and physical facilities
 Serves as a means of improving
nursing care by revealing existing
deficiencies
STANDARD OF CARE
 Yardstick for gauging the quality and
quantity of service
 Describes the quality of service
 Ex. Nurses are professional in dealing
with clients
CRITERIA
 Measures the quality of care or
standards

Standard: Nurses are professional in

dealing with clients
Criteria : greets them with
corresponding smiles
always attend to their needs
Thank You!