Nursing Administration

ADMINISTRATIVE
PROCESS IN NURSING
THE PHILIPPINE WOMENS UNIVERSITY
and its Affiliate Schools for Men and Women
Taft Avenue, Manila
COURSE OVERVIEW
Administrative Process in Nursing is a pre-requisite to the course Nursing Administration. Its purpose is to
provide general knowledge and understanding of the basic concepts, theories, principles and administrative
processes. The topics include the theoretical and conceptual bases for leadership and management, human
behavior and relationships in organization. The administrative and management process forms the major focus
in the discussion these are Planning, Organizing, Directing/Leading and Controlling.
This course module is designed for graduate students enrolled in the Philippine Womens University (PWU)
Distance Education Graduate Program.
GENERAL OBJECTIVES
At the end of the course, you will have acquired a general knowledge and understanding of concepts and
processed applied in nursing administration. Specifically, you will be able to:
Trace the history of management and leadership theories

Discuss management and leadership principles and their application to nursing administration
Describe and compare the X, Y, Z theories
Discuss at least four factors that affect human behavior and relations in an organization
Describe the components of effective management
Discuss the nature, types, process, principles, and strategies of planning
Describe the different leadership style
Describe the leadership attributes of an effective nurse manager
Discuss the principles and process of organizing
Describe a bureaucratic organization
Describe an environment that is conductive to worker satisfaction
Differentiate between the traditional and decentralized organizational structures
Name at least six directing activities of a nurse manager/supervisor
Define Management by Objectives (MBO)
Discuss the basic principles of successful communication
Identify and explain at least five barriers to communication
List the steps in decision making
Discuss the problem-solving process and similarities to the nursing process
Name factors to be considered in delegating
Name and compare the five approaches to conflict resolution
Discuss the purposes, principles, phases and techniques of controlling
Discuss the structure and process of an evaluation system
Distinguish between quality assurance and quality improvement
____________________________________
Administrative Process in Nursing
Enumerate at least four contemporary health care issues that affect the administration of nursing service and
nursing education.
Recognize and appreciate the management role of the nurse
REQUIREMENTS
The following are required in order to pass the course:
1. Completion of assessment exercises and learning activities at the end of each lesson
2. Submission of a term paper at the end of the course
3. Submission of five annotated by bibliography
TABLE OF CONTENTS
Page
Module 1
Module 2
Module 3
Management and Leadership Theories
..
Lesson 1 Management Theories: (Five Era)

Lesson 2 Leadership Theories
Lesson 3 Concept of Leadership
..
..
..
2
10
13
Introduction to Management
..
15
Lesson 1
Lesson 2
Lesson 3
Lesson 4
..
..
..
16
18
20
21
Four Major Management Process
..
22
Lesson
Lesson
Lesson
Lesson
..
..
..
23
25
28
..
30
..
32
Lesson 1 Organizing
Lesson 2 Organizational Structure
Lesson 3 Human Resource Development
..
..
..
33
34
38
Directing / Leading
..
39
1
2
3
4
Definition
Effective Management and Leadership
Major Functions of Nursing Service
Personal Factors Affect Nursing
Administration
Planning
Phases of Planning
Types of Planning
Planning Relative to Nursing
Administration/Nursing Education
Module 4
Module 5
____________________________________
Lesson
Lesson
Lesson
Lesson
Lesson
Lesson
Lesson
Lesson
Lesson
Lesson
1 Leadership
2 Communication
3 Supervision
4 Delegation
5 Principle of Problem
6 Motivation
7 Effecting Change
8 Management of Conflict
9 Team Building
10 Productivity; Efficiency and
Effectiveness
Lesson 11 Professionalism in an Organization
Module Six
Controlling / Evaluating
Lesson 1 Controlling / Evaluating
Lesson 2 Ten (10) Characteristics of Good
Control System:
Lesson 3 Tools of Controlling
Module Seven
..
..
..
..
..
..
..
..
..
45
48
50
52
56
61
63
67
71
..
..
75
79
..
85
..
86
..
..
87
88
Issues / Trends in Health Care Environment.. 95
Lesson 1 The Health Care Environment

Lesson 2 Health Care Issues
Lesson 3 Trends in the Nursing Profession
Bibliography
____________________________________
..
..
..
96
97
100
ADMINISTRATIVE PROCESS IN NURSING
MODULE ONE
MANAGEMENT AND LEADERSHIP
THEORIES
SPECIFIC OBJECTIVES
At the end of the course, the graduate students will be able to:
1.
2.
3.
4.
5.
6.
Identify the 5 ERA of management theories

Understand the advocacy of each theorist and apply in nursing situations
Identify the 5-styles of leadership
Explain the different theories which are basic to understanding people
Describe the factors that affect human behavior and human relations in an organization.
Understand the new concepts of leadership.
Unit I Introduction
Review of the different Management/Leadership Theories and Concept in an Organization; Elements and
Principle.
LESSON 1 - MANAGEMENT THEORIES: (FIVE ERA)
I. Classical ERA
A. Frederick Taylor Father of Scientific Management
Advocacy: 6 steps in Systems of Management
1.
2.
3.
4.
5.
6.
Scientific study of the task

Scientific selection and training of workers
Cooperation between management and labor (workers)
Work is divided between managers and workers
Workers paid according to the rate production
Appointment of a foreman/supervisor for each aspect of work.
B. Gilbert Frank - Principles of Economic Motion.

Advocacy:
1. Job Simplification
2. Establish work standards
3. Develop flow chart
4. Establish written instructions
5. Merit System and promotion
C. Gantt Henry
Advocacy: Efficiency
1. Refine previous work, than introduce new concept
2. Service rather than profit
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4
3. Job security and job development

4. Developed Gantt Chart for programming.
D. Henri Fayol - Father of Management Process
Advocacy: 14 Principles
Task of Managers : POLC
1. Division of work
2. Authority and Responsibility
3. Discipline
4. Unity of Command
5. Unity of Direction
6. Subordination of Individual interest
7. Remuneration of Service
8. Centralization
9. Scalar Chain of Authority
10. Order
11. Equity
12. Stability of Tenure
13. Initiative
14. Esprit de Corps
E. Max Weber - Father of Organization
Advocacy: Bureaucracy
3 Basis of Authority
1. Traditional Authority
2. Charismatic Authority
3. Rational Legal Authority
Organizational Structure
Pyramid, Hierarchical, Vertical, tall
People are guided by:
1. Stiff Rules and Regulation
2. Specialization of Task
3. Appointment of Merit
4. Impersonal Climate
F. Mooney James - Management is the technique of managing people.
Advocacy 4 Universal Principles of Management.
1. Conditional and synchronization of activities for good accomplishment
2. Function effects of performance of ones job description
3. Scalar Process organizes
4. Authority into Hierarchy
G. Urwick Lyndall - Managerial Process: Planning and Coordinating
Advocacy (Concept) Blending Scientific Management, Classic Organization and Classic Management
Theory.
Balance authority with responsibility
1. Span of Control
____________________________________
2.
3.
4.
5.
6.
H.
Unity of Command
Use of general and specific staff
Proper use of personnel
Delegation
Departmentalization
Chris Argyris Co-existence of personal and organizational needs; individuals give priority to their
own needs.
Advocacy:
Maturity Theory
Maturity of followers increases the leadership of the manager.
1.
2.
3.
Manager should help the workers achieve self-actualizations as this will help ones personality to grow
from PASSIVITY and Dependence to ACTIVITY and Independence.
Highly structured environment will cause 3 possible reactions.
1. Escape (flight)
2. Fight
3. Adapt
Rigid structure and stringent rules of typical bureaucracy block Maturational Changes.
II. Behavioral ERA Motivation Theories

A. Abraham Maslow Hierarchy of Needs
B. Herzberg, Frederick 2 factors Theories
1.
Motivators
2.
Hygiene Factors
C. Victor Vroom Expectancy Theory
Behavior explain in terms of individuals goals and choices and expectations of achieving these goals
People can determine which outcomes they prefer and make realistic estimates of their chances of
obtaining them.
Motivation = Expectancy (E) Valence (V) x Instrumentality (I)
M=ExVxI
D. Alderfer Clayton ERG Theory (Existence, Relatedness, and Growth) Theory
E. Staw, Barry Intrinsic and Extrinsic Motivations
Performing a task has intrinsic and extrinsic valence
Motivation is reduced if individual does not value intrinsic or extrinsic outcomes or if

rewards are low.
Intrinsic intrinsically motivated behavior is stimulated by peoples needs for feeling

competent and self-determining.
F. McCleland, David Needs Theory
3 Human motives:
1. Achievement
2. Affiliation
3. Power
G. Adams, Jo Sacy et al: Equity Theory
People assess their performance and attitude by comparing
Contribution to work and benefits derived.

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6
H. B.F. Skinner : Reinforcement Theory is needed depending on the human behavior in previous (+) or (-)
outcomes.
1. Reinforcement Technique are positive
2. Reinforcement negative with holes
3. Reinforcement and Punishment.
III. Human Relation ERA:
A.
Chester Bernard Organization is a social system
Focus: Psychosocial Aspect of organization and management and function of the executives.
Functions of the Executives:
1. Maintenance of the organization; communication with loyalty and capability
2. Securing of essential services from individuals
3. Formulation and definition of purpose of the organization
B.
Elton Mayo Hawthrone Study Human Behavior in work situation.

Factors that affect workers productivity:
1. Physical environment
2. Support from fellow workers
3. Norms established by workers group
4. Opportunity and participation in D-making
5. Recognition from administration.
C.
Mary Follett Psychological and Sociological Aspect of Management

Management a social process that consists primarily of motivating individuals and group to work
towards a common end.
Stress a factor that exists in management thus the need for coordination.
Managers must be aware that each employee is a complex collection of emotions, belief, attitudes
and habits.
Employee desires to be motivated
Motivates performance; NOT demand it.
Successful leadership skills is the result of training and possessing specific

personality traits
Understands what motivates people to work.
D.
E.
McGregor - Theory X and Theory Y.

Kurt Lewin - Field Theory of HR
Believes that
Workers behavior is influenced by interaction between workers
- Personality
- Structure of primary work group
- Solid Technical climates of the work place.
Behavior and attitude change occur in 3 stages

1. Unfreezing
2. Movement to change
3. Refreezing
New attitude learned must be supported by everyone
____________________________________
F.
Toffler, Alvin - Future Shock
Physical and psychological distress occur from over-loading

Individuals physical adaptive system and D-making process called Future
Shock
To minimize Future Shock is to develop the mechanism and techniques to guide

the direction of change and to the pressure of change.
G.
Herbert, Alvin Focus Business and Service instructions as Networks of D-makers.

2 Approaches to Decision-making:
1. Optimizing (Economic Man) Decision
2. Satisfying (Administrative Man) Decision
H.
Henry Minstzberg : Roles of Managers

1. Interpersonal Roles
Figure Head represents Head of Agency

Header Trains and hires subordinates.
Liason communicates with persons outside her vertical command.
2. Information Roles
1.1 Figure Head represents Head of Agency
1.2 Disseminator distributes some information.
1.3 Spokesman directs work-related information to persons outside of his own work unit.
3. Decisional Roles
Entrepreneur develops and promotes new projects
Disturbance Handler responds involuntarily to high pressure disturbance.
Resource Allocator determines how much total financial, personnel, supply and equipment
needed
Negotiator confers with group or individuals inside and outside the client for the purpose of facilitating
complex or controversial issues.
IV. Contemporary ERA
(Focus in Leadership)
A. Charlotte, McDaniel Transformational Theory of Leadership
This is built on transactional qualities found in day-to-day management
Brings out the best in the followers
Cascading effect. Followers exhibit leadership qualities similar to the leader.

B. Schein Interactional Theory of Leadership
Father of Corporate Culture.

3 - levels of Culture:
1. Artifacts visible things in the corporation
2. Espoused Valves e.g. Teamwork
3. Basic understanding assumption
____________________________________
Leadership
behavior
is
generally
determined
by
the
relationship between
- Believes that people are very complex and variable; and have multiple motives for doing things.
- Peoples performance and productivity are affected by the nature of the task and by her/his ability,
experience and motivations.
- No single leadership strategy is effective in any situation.
Leadership Exchange involves three (3) basic elements:

1.
Leader personality, perception and abilities
2.
Followers Their personalities, perceptions and abilities.
3.
The Situation within the leader, and the followers function; formal and informal
group norms; size and density.
C. Greenleef, Robert Servant Leadership
Servant leaders put serving others (employee, customers, community) as priority.

Abilities:
1. Listen and truly understand
2. Keep open mind; hear without judgment.
3. Deal with ambiguity and complex issues
4. Honesty sharing critical challenges
5. Clear on goal
6. Ability to be servants, helpers and teacher first, then a leader.
7. Always think before reacting
8. Choosing words carefully
9. Use foresight and intuition
10. Seeing things as a whole, sensing relationship and connections.
D. Filipino Style and Leadership Philippine Bureaucracy has the tendency to be autocracy the so
called Autocracy in Bureaucracy.
Leadership and Management skills should be integrated

- Using experimental learning exercise designed to increase whole-brain thinking.
- Demonstrating the leadership components in all management functions
- Using a scientific approach to problem solving.
E. Ouchi, William Participative leadership Theory Z
Rank and file participates in DV. System Approach:

A. Rensis, Likert Four (4) Leadership Systems:
1.
Exploitative, Coercive, Authorative,

Worker is regarded as market commodity can be paid with money
Poor performance; high absentee rates, high production cost; low quality
2.
Benevolent Authoritative Leader makes the decision with the welfare of the people in
minds.
3.
Consultative leader is more democratic with 2-way communication and feedback
flows in both direction.
4.
Participative leader has complete confidence and trust in the employees; always
obtains and uses their ideas and opinion. Communication is a 2-way process.
-
LESSON 2 LEADERSHIP THEORIES

____________________________________
There are Eight (8) classifications of Leadership Theories

I.
Traits Approach
1. Trait Theory selection is based on physical, mental and psychological characteristics.
2. The Great Man Theory (by Aristotle) Few people are born with necessary characteristics top be great.
Some people are born to lead; some are born to be led (Senge and Garner; 1990)
3. Charismatic Theory (By Robert House) Charismatic leaders has four (4) personal characteristics:
Dominance
Self Confidence
Need for influence and power
Conviction of moral righteousness

II.
Behavioral theories
1. Kurt Lewin Three (3) Leadership Style
- Autocratic
- Democratic
- Laissez-faire
- Multicratic (according to Ridese & Hartly 2008)
Emphasize on groups personalities
More heads are better than one
Autocratic leadership promotes hostility, aggression and decrease initiative

2. Likert et al Three (3) types of leadership behaviors
- Task-oriented behavior
- Relationship oriented behavior
- Participative leadership behavior
He supports the human relation theory

- Benefits of positive attitude towards people
- Development of the workers
- Satisfaction of their needs
- Commitment thru participation
3. Blake and Moutons Managerial Grid in a matrix, 9.9 position is the most effective leaders
The grid describe individual leadership as function of 2-variables:

- Concern for people
- Concern for production
III.
Situational Theories
1. Path Goal Theory (By Robert House) Derived from Expectancy Theory which believed that people
act as they do, because they expect their behavior to produce satisfactory result.
The leaders clarify and set the goals of the subordinates and help them find the best path for
achieving their goals.
2. Contingency Theory (By Fred Fedler) leadership style will be effective or ineffective depending on the
situation.
Member Leader relation
Task Structure
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10
Position Power
3. Leadership Continuum (By Tannenbaun & Schmidt) Leadership style varies:
Boss-centered
Subordinate-centered
4. Normative Theory of Leadership and D-making (By Vroom and Yetton) Use Decision Three Model
the most effective leadership style depends on the characteristics of both the situation and the follower.
5. Situational Leadership Theory (By Hersey & Blanchard) Predicts that the most appropriate leadership
style from the level of maturity and readiness of the follower and the demands of the situation.
IV.
Attributional Model leaders only exists only as individuals perception of the situation, rather
than as objective fact.
V.
Substitute for Leadership (By Kerr and Jermier) - certain individual task and organizational
variables prevent leaders from affecting subordinates attitudes and behavior at all.
VI.
Transactional Leadership (By Edward Hollander) Leadership process is best understood as the
occurrence of mutually satisfying transactions among leaders and followers.
VII.
Integrative Leadership Model (By Gardner) Leaders are rarely totally people and task oriented.
Leadership requires adaptive behavior.
VIII.
Integrative Leadership Model (By Gardner) Leaders are rarely totally people and task oriented.
Leadership requires adaptive behavior.
LESSON 3
1.
2.
3.
4.
5.
CONCEPT OF LEADERSHIP:
Leadership can be learned and cultivated.

Leadership are not necessarily charismatic. Charisma may be result of effective leadership.
Leadership is not limited to those on top but can occur at all levels of the organization.
Leadership is not so much of the exercise of power, but the improvement of others.
Effective leaders are not born but develop over time through knowledge and by using appropriate
sets of skills.
LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor.
1. Observe an organization (this may be the organization where you work).
a) Is the organization task or relationship oriented? Please elaborate.
b) Cite at least five (5) instances where any of the management-leadership theories you learned in
this module were applied in decision making. Be specific in your explanation.
c) Describe the interactions between managers and the employees. Take note of leadership styles of
managers.
d) Identify some socio-cultural factors that are affecting interactions in the organization.
e) Give examples of how the human basic needs described by Maslow are being met.
2. Compare the democratic style of leadership to the authoritarian and laissez-faire styles.
3. Compare Theory X, Y, and Z. Which one would you prefer in your organization? Why?
4. Describe at least three factors that affect human behavior.
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11
5. Describe a transformational leader. Do you know of anybody in the nursing profession who is a
transactional leader?
MODULE TWO
INTRODUCTION TO MANAGEMENT
SPECIFIC OBJECTIVES
At the end of this module, the graduate students will be able to:
1.
2.
3.
4.
5.
Define different terms used in management,

Identify the managers task
Understand the elements of effective management
Interpret Nursing Management principles
Discuss the major functions of hospital nursing service
LESSON 1 1.
2.
3.
4.
5.
DEFINITION
Management is the process of working with and through people/others to achieve organizational
objectives in a changing environment.
Is the process of obtaining and organizing resources and of achieving objectives through other
people.
Is planning, organizing, leading and controlling.

Nursing Management is the process of working through nursing staff members to provide care, and
comfort to patients. This can be viewed as a relationship of inputs and outputs in which the workers,
physical resources and technology are merged to bring about the organizational goals for delivery of
quality nursing care.
Management Process - consists of achieving organizational objectives through planning, organizing,
directing and controlling human and physical resources and technology.
Manager is a person appointed officially to the position whose function is to plan, organize, lead and
control.
Has the power and authority to enforce decisions.
Carries pre-determined policies, rules and regulations.
Relates to people according to their roles
Maintains an orderly, controlled, rational and equitable

structure.
Leader is a person who enables to work together to achieve the objectives set for certain purpose.
Influences others towards good setting either formally or

informally.
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12
Interested in risk-taking and exploring new ideas.

Relates to people personally in an intuitive and emphatic
manner.
Have no official appointment to a position in the organization.
6.
Leadership the process of empowering people thru persuasion. It is one of the functions of
management.
7.
Organizational Culture the totality of an organizations belief, history, Taboos, formal and informal
relationship and communication pattern.
Management Defined
Management is understood more clearly when the managers/leaders/administrators tasks are defined.
According to Fayol (1970), the managers activities and functions are planning, organizing, coordinating, and
controlling. (The description and definitions of these functions will be discussed later). Judging from these
functions, one can see that the manager works through others. The managers main responsibility is to ensure
that the organizations goals are achieved through the performance of specific tasks by its members. Mintzberg
(1975) described four types of roles that managers fill in. These are: interpersonal, informational, decisional,
and entrepreneurial. The interpersonal role includes ceremonial duties, leadership, and the role of liaison. The
informational role includes scanning the environment for any useful information and seeking to improve work
methods. The decisional role includes deciding how to allocate resources, as well as negotiating and handling
disturbances. Finally, the manager is also an entrepreneur, always alert to new ideas and opportunities to
improve the effectiveness and profitability of the organization or unit.
From these descriptions of the managers tasks Tappen (1995) summarized the components of effective
management and these are: leadership, planning, direction, monitoring, development, recognition,
representation. Tappen further stated that the effective manager is one who:
1.
2.
3.
4.
5.
6.
7.
Assumes leadership of the group.

Actively engages in planning the current and future work of the group.
Provides direction to staff members regarding the way the work is to be done.
Monitors the work done by staff member to maintain quality and productivity.
Recognizes and rewards quality and productivity.
Fosters the development of every staff member.
Represents both administration and staff members needed in discussions and negotiations with others.
LEADERSHIP
REPRESENTATION
PLANNING
DIRECTION
NURSE
MANAGER
DEVELOPMENT
RECOGNITION
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13
MONITORING
LESSON 2 -
EFFECTIVE MANAGMENET AND LEADERSHIP
Covey (1989) is the author of the best seller, The Seven Habits of Highly Effective People, differentiated
effective management and leadership. According to him, effective management is putting first things first.
Leadership on the other hand decides what first things are. It is management that puts them first, day-by-day,
moment-by-moment. Management is discipline.
Nursing Management
In nursing, management relates to planning, organizing, staffing, (leading) and controlling (evaluating)
the activities of a nursing enterprise or division of nursing departments and of the sub-units of the departments.
Nurse Managers performs these management functions to deliver health care to the patients. Swansburg (1993)
identified thirteen general principles of nursing management and these are:
1. Nursing management is planning.
2. Nursing management is the effective use of time.
3. Nursing management is decision making.
4. Meeting patients nursing care needs is the business of the nurse manager.
5. Nursing management is the for mutation and achievement of social goals.
6. Nursing management is organizing
7. Nursing management devotes function, social position or rank, a discipline, and a field of study.
8. Nursing management is the effective organ of the division of nursing of the organization and of society
in which it functions
9. Organizational culture reflects values and & beliefs
10. Nursing management is directing or leading
11. A well-managed division of nursing motivates employees to perform satisfactorily.
12. Nursing management is efficient communication
13. Nursing management is controlling or evaluating
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14
LESSON 3 - MAJOR FUNCTIONS OF NURSING SERVICE

1.
2.
3.
4.
5.
Patient Care
Administrative Practices
Nursing Personnel Management
Physical environment
Interdepartment/Institutional Relationship
Figure 3: FUNCTIONS OF A HOSPITAL NURSING SERVICE
CARE OF PATIENTS
PERSONNEL
MANAGEMENT
PHYSICAL
ENVIRONMENT
1.
Determine kind and amount of

nursing care needed for individualized
nursing care.
1.
Determine
categories
number of positions needed.
and
1.
Plan
for
allocation
and
utilization of space for all nursing
functions and motivations.
2.
Provide
for
day-to-day
fluctuation of nursing care needs.
2.
Determine qualifications and

provide job descriptions.
2.
Determine needs and provide for

necessary equipment and supplies.
Provide for special nursing care

of critically all patients.
3.
Make and maintain a staffing

pattern.
3.
Provide for continuity in nursing

care on the ward and in the community
4.
Simplify
and
standardize
nursing procedures and techniques.
5.
3.
4.
5.
6.
Maintain a recruitment program

and appoint personnel.
Evaluate
personnel.
performance
Evaluate
effectiveness
of
existing physical environment and
recommend changes, improvements and
adjustments.
RELATIONSHIPS
1.
Develop plans to
interpret nursing to and coordinate
activities with hospital groups.
a.
b.
c.
d.
4.
Administrative Officers
Professional Personnel
Hospital Departments
Within nursing service
Provide for association with

community groups.
b.
educational
(colleges, universities)
Professional
organizations
(physicians, dietitians, pharmacist)
Instruct patients in their own

care.
6.
7.
8.
Provide
opportunities
for
growth and development of personnel
through programs of education.
d.
Provide working conditions and

recommend economic consideration
which provide for job satisfaction.
1.
Develop
organizational structure.
2.
Plan,
organize,
direct, and coordinate administrative
activities.
a. set standards for patient care, and
other nursing functions.
institutions
of
c.
ADMINISTRATIVE
PRACTICE
Service
organizations
(philanthropic societies)
b. Assign responsibility and delegate

authority.
c. Provide
for
participation.
directed
group
d. Establish nursing programs

conferences for direction
supervisory personnel.
of
of
e. Establish systems for reporting and

recording of all functions.
Establish and maintain complete

personnel record.
f. Interpret nursing needs and problems

to administrative officers and other
hospital personnel.
g. Provide channels for methods of
communication within nursing
services the hospital & community.
h. Identify areas needing study and plan
for research.
i. Prepare and administer the nursing
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20
budget.
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21
LESSON 4 - PERSONAL FACTORS AFFECT NURSING

ADMINISTRATION
1. Knowledge
2. Skills
3. Attitudes
4. Values
5. Motivation
6. Human Relation
LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor
1. Differentiate a leader from a manager; management from leadership.
2. Observe a nurse manager in your work place and note the different management activities she perform
an identified by Tappen.
3. Discuss how effective management could be achieved.
4. Discuss fully the 5 major functions of nursing service
5. Discuss the personal factors that affect nursing administration.
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21
MODULE THREE
FOUR MAJOR MANAGEMENT PROCESS
SPECIFIC OBJECTIVES
At the end of the discussion of the four major management processes, the graduate student will be
able to:
1. Discuss each major management process as it relates to nursing management
2. Identify the principles in each of the processes that guide them in the application in the nursing
situations
3. Distinguish each of the 4 management processes from each other and understand the sequence in their
application
4. Discuss the importance of planning, organizing, directing and controlling
LESSON 1 -
PLANNING
Definition
The first element of management is planning. Fayol (1949) defined it as making a plan of action for a
foreseeable future. Douglas (1988) stated that planning is having a specific aim or purpose and mapping out a
program or method beforehand for accomplishment the goal. Alexander (1978) defined planning as deciding
in advance what to do, how to do it, when to do it, and who is to do it. Another definition was given by Steiner
(1969) who defined planning as a process beginning with objectives, defining strategies, policies, and detailed
plans to achieve them, achieving an organization to implement decision; and including a review of performance
and feedback to introduce a new planning cycle. Planning is a basic function of all managers. It is a systematic
process that is based on sound management theory.
An important aspect of planning is forecasting a process which includes assessing the present situation,
identifying its weaknesses, recognizing the driving forces in the environment, constructing possible alternative
future scenarios, identifying the preferred future, developing a plan of action, implementing the plan, and
evaluating the implementation.
Purpose and Benefits of Planning
There are many reasons for planning. Douglas (1988) identified eight purposes of planning:
1.
2.
3.
4.
5.
6.
7.
8.
It leads to success in achieving goals and objectives.

It gives meaning to work.
It provides for effective use of available personnel and facilities.
It helps in coping with crisis situations.
It is cost-effective.
It is based on past and future, thus helping reduce the element of change.
It can be used to discover the need for change.
It is needed for effective control.
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Douglas (1988) mentioned the activities of planning as assessment by collection, classification, analysis,
interpretation, and translation of data; strategic planning; development of standards, identification of needs
and priority setting; management by objectives; and formulation of policies, rules, regulations, methods, and
procedures.
Principles of Planning:
1. Precedes all other processes of management
2. Contributes to the objectives
3. Pervasive exist at all levels
4. Efficient that boost the moral of the staff
5. Innovative
6. Flexible
7. Goal Directed
8. Action-centered
9. Establish priorities
10. Cost effective
LESSON 2 -
PHASES OF PLANNING
Phase 1: Developing the Plan

The first step in developing the plan is to establish its purpose. It is important to be clear about the
purpose of planning to avoid confusion. However, the purpose my be stated in broad terms until a broad
thorough assessment of the situation / problem is done. An example of a purpose of a health plan that is stated
in a broad term is: Reduce children and adult morbidity rates in Barangay Uno.
When assessing the situation/problem, information to confirm or revise the identified problem is needed.
Situational variables or factors that affect the problem, as well as anticipated response to change are also
identified. When the problem and environmental situations are alreadyu assessed, objectives are formulated.
The objectives should be written as measurable outcomes so that they can later serve as guidelines for
evaluation. An example of a specific objectives formulated from the above purpose it: The occurrence of
communicable diseases among children in Barangay Uno will be reduced by 50% in 1999, 80% in 2000, and
100% by 2002.
Generating alternative solutions is the next step in developing the plan. In generating alternative
solutions, a climate of open mindedness and positive thinking is important. Consultation with internal and
outside experts, searching the literature and results of surveys are helpful to the planner. Brainstorming is
another way of generating solutions. Brainstorming among those involved or may be affected by the planning
is recommended as the sessions can encourage them to participate and to be open to the ideas of others. Several
alternative solutions may be generated and each of them are analyzed before a course of action is selected. Pros
and cons of each option are identified and analyzed objectively.
Pilot studies, use of scenarios and simulations are utilized to test the chosen alternatives or options.
These are done especially in big scale projects where failure of the plan in the actual setting can become costly.
In summary, the steps in developing a plan are as follows:
1. Establishing a purpose
2. Analyzing the situation which includes problem verification, identifying situational variables and the
anticipated response to change.
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23
3. Formulating objectives.
4. Generating alternative solutions.
5. Analyzing alternatives and selecting course of action.
According to Donavan (1975), planning has many benefits. Among these are:
a) satisfactory outcomes of decisions;
b) improved functions in emergencies;
c) assurance of economy of time, space, and materials; and,
d) the highest of personnel
Donovan included decision making, philosophies, and objectives as key elements in planning.
For planning to be successful there are factors to be considered (Swansburg, 1995). The managers
should have knowledge of the following:
1. Characteristics of planning
2. Elements of the planning process.
3. Strategic or long-range planning process.
4. Tactical or short-range planning process-functional versus operational
5. Planning standards
6. Application of the planning processes and standards to the work situation.
The manager must also have skill in bringing the planning process up to the standard set, where there are
deficiencies.
Characteristics of Planning
Tappen (1995) describes planning as the component of effective management that is hardest to do and
easiest to ignore. This is because it deals primarily with the future and can easily be postponed.
Planning is based on objectives. Simplification and standardization characterize it. In other words, first
and foremost good plans are based on objectives, they must be simple, they must have standards, must be
flexible, must be balanced and must use available resources.
Planning requires decision making, that is, choosing future courses of action from among alternatives. In
the practice of nursing, for example, planning includes collection, analysis, and organization of many kinds of
data that will be used to determine both the nursing care needs of patients and the management plans that will
provide the resources and processes to meet these needs. (Swansburg, 1993).
Phases of Planning
According to Tappen, planning is divided into three phases. These are:
A. Developing the plan.
B. Presenting the plan.
C. Implementing and monitoring the plan.
In this example, the hospital plans on hiring senior nursing students of an affiliated school of nursing to
work as patient care assistants. Hospital administrators believe that by hiring the students, the graduate nurses
work load can be reduced without reducing nurses patient contact and the quality of care that the patients
receive.
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24
PERT Charts, on the other hand, graphically illustrates the sequence of events and their
interrelationships, using circles for events and arrows for activities. The PERT chart is more systems oriented
than the Gantt chart. From the PERT chart, one can see how the work must flow from one event to the next and
how one activity depends on another.
Critical Path Method (CPM) is very similar to PERT except that it also identifies the critical path, that
is, the path that takes the longest time to complete and the most likely to cause a delay. With this information,
one can have a realistic estimate of when the project can be completed.
2. After organizing the project, the next step is to implement it. Here the actual implementation of the
project begins. Implementing the plan needs the supervision and direction of the planner/s and the
designated leader/s. The skill needed is leadership.
3. Monitoring the implementation comes with the implementation of the plan. The major focus monitoring is
referring to the original design to ensure that it is being followed.
4. Evaluating Outcomes. Formative and summative evaluations are used when implementing the plan.
Formative evaluation is ongoing and is done as the project is being implemented. At the end of the
implementation phase, a summative evaluation is also needed to determine how well the project has
succeeded in meeting the objectives that were developed during the first phase of planning. The result of the
evaluation will determine whether or not activities will be continued or not.
5. Revising and Updating the Plan. From the feedback obtained from the evaluation process, revisions,
improvements and updating are done. The revision may go back as far as the objectives and purpose of the
original plan. This only shows that the planning process is dynamic and continuous.
LESSON 3 -
TYPES OF PLANNING
1. Strategic Planning (Long-range)

2. Tactical Planning (short-range)
3. Operational Planning (day-to-day)
Strategic Planning
Lately, nursing leadership and health care organizations have been relying on strategic planning to
contain cost and to increase effectiveness and efficiency in health care delivery. Strategic planning is defined as
continuous, systematic process of making risk-taking decisions today with greatest possible knowledge of their
effects on the future; organizing efforts necessary to carry out these decisions and evaluating results of these
decisions against expected outcome through reliable feedback mechanism (Swansburg,1993). Strategic
planning in nursing is concerned with what the division of nursing should be doing. Its purpose is to improve
allocation of scarce resources, including time and money, and to manage the division of nursing for
performance. It includes analysis of projected technological advances, the internal and external environments,
the nursing and health care market and industry, the economics of nursing health care, availability of human and
material resources, judgments of top management, and other factors. Among the benefits of strategic planning is
the giving of a sense of direction to all managers and practitioners of nursing within the organization.
Phase Two: Presenting the Plan
The second phase of planning is presenting the plan itself. Occasionally, one may be able to proceed
directly from developing the plan to its implementation. But usually, plans for projects are presented to
administration/management for approval. When this becomes necessary, the planner needs to be persuasive in
convincing others to accept the plan and to obtain approval by administrators. To be acceptable, the plan must
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25
be presented in an organized manner. The problem, the background or the situation that brought about the
problem, and of course, the well-prepared plan to resolve the problem must be presented clearly. The delivery of
the presentation must be done convincingly and professionally. Aside from being persuasive, the planner must
be concise and direct to the point. The plan itself must be presented in a professional manner.
Phase Three: Implementation and Monitoring
The third phase of planning is the implementation and monitoring of the plan. It includes the following
steps:
1. Organizing the implementation
Organizing the implementation of a plan includes:
a) Identifying and arranging activities according to sequence;
b) Setting target dates for completing each activity;
c) Assignment of responsibilities to particular individuals; and
d) The allocation of resources.
There are techniques that have been developed to organize and monitor implementation of proposed
plans depending on how elaborate they are. Schedules, Gantt charts; program evaluation and review technique
(PERT), and the critical path method (CPM) are some of them. Among these methods, schedules are the
simplest and the more often used. Schedules organize work on the basis of time and assigned staff members,
leaving out details of staff to be done. Schedules are easy to make and use, and they form the basis for the more
complex methods.
The Gantt chart, which is actually a highly developed schedule, specifies in detail the tasks to be
performed and the time they are expected to be completed. An example of a Gantt chart follows:
Task
Hire
Train
Pilot in Unit A
Implement in
all units
Evaluate
---}
Assigned Person
JFD & STAFF
CGD & STAFF
HNA
HN
Jan. / Feb. / March / Apr / May / June / July / Aug / Sept / Oct / Nov / Dec.
------------------}
--------------------}
------------------------}
-----------------------------------}
All Head nurses

and staff Dev
LESSON 4 -
--------------------------------------}
PLANNING RELATIVE TO NURSING

ADMINISTRATION/NURSING EDUCATION
Forecasting: Estimates the future in terms of:

1. Environment
2. Types of patients/customers
3. Public attitude
4. Kind of Personnel
5. Resources
6. Services needed
7. Productive use of people, money, materials
8. innovations
9. Social responsibilities
Barriers to Planning:
1. Lack of
2. Lack of flexibility
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26
3.
4.
5.
6.
7.
Non-involvement of workers
Poor time management
Vogue plans
No specific time target
Plans that are not periodically motivated
LEARNING ACTIVITIES
Answer the following and submit your professor
1.
2.
3.
4.
Discuss the guidelines in planning.

Analyze the different phases of planning.
Differentiate strategic planning from operational planning. Give example of each.
If given a chance & plan for a nursing service, what are the forecasting aspects test you have to discuss?
MODULE FOUR
SPECIFIC OBJECTIVES
At the end of the module, the graduate students will be able to:
1.
2.
3.
4.
5.
6.
Give an example dividend or situation to show how organizing benefited your work performance
Describe the activities involved in organizing
Discuss and understand Bureaucracy and identify its advantages and disadvantages
Discuss the principles of organizing
Describe the structure and climate of the organization when your work
Understand the significances of the lines of authority
LESSON 1 -
II. ORGANIZING
Definitions of organizing. Organizing is identifying the organizational needs from mission
statements and objectives and from observations of work performed, and adapting the organizational design and
structure to meet these needs. Like planning, organizing is primarily a thinking act. (Swansburg, 1993) It is the
process of designing the machine (Urwick in Swansburg, 1993). During the organizing process, activities are
grouped, responsibility and authority are determined, and working relationships are established to enable both
the organization and the employees to realize their common objectives.
Principle of organizing
Four principles of organizing named by Swansburg are:
1. The Principle of Chain of Command. The principle of chain of command denotes centralized
authority and corresponding authority. This principle states that to be satisfying to members,
economically effective, and successful in achieving their goals, organizations are established with
hierarchical relationships within which authority flows from top to bottom. Most government,
religious and military entities, as well as health institutions are organized this way. In the more
modern organizations however, the chain of command is flat, with line managers and technical and
clerical staff providing support services.
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27
2. The Principle of Unity of Command. The unity of command principle states that an employee has
one supervisor/leader and one plan for a group of activities with the same objective. In nursing,
primary nursing and case management support the principle of unity of command. This principle is,
however, being modified by emerging organizational theory.
3. The Principle of Span of Control. This principle states that a person should be a supervisor of a
group that he or she can effectively supervise in terms of numbers, functions, and geography. This
principle is flexible because the more trained an employee is the less supervision is needed, while
those still under training need more supervision to prevent mistakes.
4. The Principle of Specialization. The concept of division of labor or the differentiation among kinds
of duties springs from this principles. The principle states that each person should perform a single
leading function.
Process or Organizing
1.
2.
3.
4.
5.
6.
Establish the organizations objectives and structure

Formulate supporting objectives, policies and plan.
Identify and classify activities necessary to accomplish the objectives; task are assigned.
Grouping the activities relative to the human and material resources needed
Delegating the head of each group the authority necessary to perform the activities
Tying together the group horizontally or vertically through authority relationship.
LESSON 2 - ORGANIZATIONAL STRUCTURE

The organizational structure furnishes the formal framework in which organizing takes place. The
organizational structure provides work system, network of communications and identity to individuals and the
organization. An organization has both formal and informal components. The informal aspect comprises the
personal and social relationships in the organization. It provides the social control of behavior among its
members. Management must be aware of its presence because of its importance especially in disseminating
correct information through its grapevine. A good manager can take advantage of the informal organizations
operating technique and to use it to achieve common goals and objectives. The formal aspect, on the other hand,
is defined by executive decision determined by planning. A bureaucratic structure is a formal organizational
design. It facilitates large-scale administration by coordinating the work of many personnel. It is associated
with subdivision, specialization, technical qualifications, rules and standards, impersonality, and technical
efficiency.
1.
Organizational structures may either be traditional or decentralized. The traditional

organizational structure is a vertical one, with the authority, power, and decision-making vested in one
person at the top. Many managers agree that this is an efficient, cost-effective way of getting the job
done. Decisions are made quickly, few leaders are required, and much power is vested in a central
figure. A disadvantage of this structure is that communication in the organization is greatly impeded.
Personnel are informed of changes but are not involved in planning the change. This results in the lack
of formal power of personnel, notably of nurses in the traditionally structured hospital Circular Model
organizations (Rowland, 1996). The decentralized organization, on the other hand, is characterized by a
horizontal structure in which decision-making responsibility, authority are at the lowest possible level in the
organization. The organization that is decentralized is usually vital, dynamic, and growth oriented. It is flexible
and adjusts easily to changes. It has the potential for adapting established standards, policies, and procedures to
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28
their special needs without creating confusion. A major disadvantage of decentralization is the risk of losing
coordination brought about by broadening the scope of authority and responsibility.
Different Formal Structure:
2. Flat Organizational Structure
3. Hierarchical (Bureaucratic) Model
4. Adhocracy Model
5. Matrix Model
Bureaucracy
This term coined by Max Weber evolved from the early principle of administration including those of
organizing. It is highly structured and usually includes no participation by the governed. The principles of chain
of command, unity of command, span of control, and specialization support bureaucratic structures. A strong
point of bureaucratic organizations is their ability to produce employees who are competent and responsible.
They perform by uniform rules and conventions, are accountable to one manager who is an authority, maintain
social distance with supervisors and clients, thereby reducing favoritism and promoting impersonality, and
receive rewards based on technical qualifications, seniority and achievement. (Swansburg, 1993). The
characteristics of bureaucracy include formality, low autonomy, division of labor, specialization, standardized
procedures, written specifications, memos and minutes, centralization, controls, and emphasis on a high level of
efficiency and production. These characteristics frequently lead to complaints about red tape, and to procedural
delays and general frustration.
Role Theory
Role theory supports the chain of command and unity-of-command principles. Role theory indicates that
when employees face inconsistent expectations and lack of information they will experience role conflict,
leading to stress, dissatisfaction and ineffective performance. Role conflict and ambiguity can be reduced when
management provides:
1. Certainty about duties, authority, allocation of time, and relationship with others.
2. Guides, directives, policies, and ability to predict sanctions as outcomes of behavior.
3. Increased need fulfillment;
4. Structure and standards;
5. Facilitation of teamwork;
6. Toleration of freedom;
7. Upward influence;
8. Consistency;
9. Good, prompt communication and information;
10. Using the chain of command;
11. Prompt decision;
12. Personal development;
13. Formalization;
14. Planning;
15. Receptiveness to ideas by top management;
16. Coordinating work plans;
17. Adapting to change;
18. Adequacy of authority.
Organizational Climate
A work environment that is conducive to worker satisfaction and productivity is a major concern in
every organization. Swansburg (1993) identified the following as activities that promote positive climate in
health care and nursing organizations:
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29
1. Develop the organizations mission, goals, and objectives with input from practicing nurses. Include
their personal goals.
2. Establish trust and openness through communication that includes prompt and frequent feedback and
stimulates motivation.
3. Provide opportunities for growth and development, including career development and continuing
education programs.
4. Promote teamwork.
5. Ask participating nurses to state their satisfactions and dissatisfactions during meetings and
conferences and through surveys;
6. Market the nursing organization to the practicing nurses, other employees, and the public.
7. Follow through on activities involving practicing nurses.
8. Analyze the compensation system for the entire nursing organization and structure it to reward
competence, longevity, and productivity.
9. Promote self-esteem, autonomy, and self-fulfillment for practicing nurses, including feelings that
their work experiences are of high quality.
10. Emphasize programs to recognize practicing nurses contributions to the organizations.
11. Assess unneeded threats and punishments and eliminate them.
12. Provide job security with an environment that enables free expression of ideas and exchange of
opinions without threat of recrimination, which occur, which may occur as negative performance
reports, negative counseling, confrontation, conflict, or job loss.
13. Be inclusive in all relationships with practicing nurses.
14. Help practicing nurses to overcome their shortcomings and develop their strengths.
15. Encourage and support loyalty, friendliness, and civic consciousness.
16. Develop strategic plans that include decentralization of decision making and participation by
practicing nurses.
17. Being a role model of performance desired off practicing nurses.
Team Building
Having high morale, enthusiasm, self-confidence, good self-esteem, are some of the terms associated
with team building. The objective of team building is to establish an environment of cohesiveness, high morale,
and enthusiasm, the feeling of being cared of, self-worth among employees. In a nursing unit, the first step in
team building is to determine why nursing employees are unhappy or dissatisfied. Once problems and
dissatisfactions are identified and prioritized, a calendar should be established for addressing them. It is best to
prepare a brief management plan that includes the problems, objectives, actions the team can accomplish on its
own authority, actions needing management support, persons assigned specific responsibilities, target dates and
list of accomplishments. The plan should be communicated to the entire staff of the nursing unit, department or
division. Evaluation should occur continuously. Recognition of the individuals worth and contributions to the
organization through praise and commendations is an important morale builder.
LESSON 3 -HUMAN RESOURCE DEVELOPMENT
Conduct Training Needs Assessment

Prepare different training programs as per identified training
needs.
LEARNING ACTIVITIES
Answer the following and submit to your professor.
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30
1. Differentiate the principles of chain of command from the principles of unity of command; formal
organization form informal organization.
2. How can stress stress be avoided in the work place?
3. How can you make up the work environment be conducive to promoting positive climate in fee
organization
4. What is the significance of a solid line and the broken line in an organizational structure?
MODULE FIVE
III.
DIRECTING / LEADING
SPECIFIC OBJECTIVES
At the end of this module, the graduate students will be able to;
1. Discuss the basic principles of the different actuating activities of the manager under the directing /
leading process.
2. Demonstrate leadership characteristics even to a limited extent.
3. Main harmoniously relationship in an organization from understanding of the basic principles in
communication
4. Appreciation & perform supervisory functions.
5. Slows ability to delegate tasks to her subordinates
6. Able to do problem solving / decision-making--typically
7. Understand the sources of conflict and how to resolve them.
8. Appreciate change management and its importance in nursing service
9. Gain knowledge on how to conduct team building
10. Associate the proper attitude of being a professional nurse
11. Understand productivity and how it is applied to nursing service
12. Understand the role of motivation in the behaviors of the subordinates.
Behavioral Foundation of directing/leading:
1. Leadership
2. Communication
3. Supervision
4. Delegation
5. Problem-solving/D-making process
6. Conflict Management
7. Change Management
8. Team Building
9. Professionalism
10. Productivity/Efficiency and effectiveness
11. Motivation
In modern management, command and coordination are labeled directing. In nursing, directing is a
physical act of nursing management, the interpersonal process by which nursing personnel accomplish the
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31
objectives of nursing. (Swansburg, 1993). It is the process of applying the management plans to accomplish
nursing objectives. It is the process by which nursing personnel are inspired or motivated to accomplish work.
In describing the directing functions of management, Fayol (in Swansburg, 1993) stated that managers must
know how to handle people and must be able to defend their point of view with confidence and enthusiasm.
He must know the personnel, eliminate the incompetent, be well versed in binding agreements with employees,
set a good example, conduct periodic audits, confer with chief assistants to focus on unity of direction, not
become mired in detail, and have as a goal unity, energy, initiative and loyalty among employees. Fayol
defined coordination as creating harmony among all activities to facilitate the working and success of the unit.
Directing also called command by Urwick, (1944 in Swansburg, 1993), protects the general interest of
the organization by seeing to it that individual interests do not interfere with the general interest.
Rowland and Rowland (1994) stated that directing is closely interrelated with leadership. According to
them, the activities of directing include those of delegating, communication, training and motivation. The
managers choice of leadership style is a major factor in exercising the directing function.
Another term used synonymously with directing is implementing. The activities under implementing
include supervision, making assignments and giving directions, evaluation, and leadership and interpersonal
relationships with coworkers, dissemination, giving assignments, motivating workers, and maintaining morale
(Kron, 1987).
Other writers (in Swansburg, 1993) refer to directing in terms of theories of leadership effectiveness,
group dynamics, values and value conflicts, effective interpersonal transactions, working with teams, and
managing teams in organizations, development of personnel and supervision of work. Sources for directions
include standards, procedure and policy manuals, job descriptions arrived at through job analysis.
Three of the major elements of directing are embodied in supervision of nursing personnel and these are:
motivation, leadership, and communication. These elements are discussed in more detail in other parts of these
course.
Directing activities of nurse managers/supervisors. In nursing management, twelve activities related
to the directing function of a nurse manager have been identified by Douglas (1988). These are:
1. Formulating objectives for care that are realistic for the health agency, patient, client, and nursing
personnel.
2. Giving first priority to the needs of the patients/clients assigned to the nursing staff.
3. Providing for coordination and efficiency among departments that provide support services.
4. Identifying responsibility for all activities under the purview of the nursing staff.
5. Providing for safe, continuous care.
6. Considering the need for variety in task assignment and for development of personnel.
7. Providing for the leaders availability to staff members for assistance, teaching, counsel, and
evaluation.
8. Trusting members to follow through with their assignments.
9. Interpreting protocol for responding to incidental requests.
10. Explaining procedure to be followed in emergencies.
11. Giving clear, concise, formal and informal directions.
12. Using a management control process that assesses the quality of care given and evaluates individual
and group performance given by nursing personnel.
Thirty one tasks had been identified as tasks of first line nurse managers/supervisors in a research done
by Beaman (1986). Among these are:
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32
Assist in service to prepare orientation schedule.

Discuss the program of orientation with the new member.
Decide when orientation is complete.
Write counseling reports and discuss them with staff members.
Terminate after approval has been obtained.
Submit time schedule for three shifts.
Assign patients, teams for day shifts.
Make recommendations about budget to nursing administration.
Calculate nursing hours used and justify them.
Call in extra help when needed.
Prepare reports about budget variances.
Make daily patient rounds.
Attend and participate in first-line nursing management meetings.
Conduct meetings with own staff for problem solving and learning.
Set goals for individual units.
Participate in setting goals for the nursing department.
Discuss unit problems with physicians regularly.
Participate in all levels of quality assurance, including designing studies, collecting data, and
preparing reports.
Work Assignments
One of the fundamental managerial functions is giving assignments. Giving assignments require
consideration of many factors, the most important of which are the abilities of the employee and the fairness of
the assignment. It is important for employee morale and self-esteem if given an assignment where her/his
strength can be utilized. Other factors that must be considered in giving assignments include efficiency,
continuity, staff preferences, and learning opportunities for staff members. While a supervisor/nurse manager
tries to follow these rules, there are other factors in the environment which can deter her/him from making a fair
assignment. These can include staff shortages, special requests from various staff members, and unpleasant or
undesirable work that must be done.
A nurse manager must consider the persons job description when making assignments. A job
description is a formal, written description of the work expected of an individual. A job description defines what
is expected of a person in a particular position and consequently what that person can expect of other people in
their positions. This information is particularly helpful when there is some disagreement about what a persons
responsibilities are.
A broader responsibility of a nurse manager/supervisor and related to giving assignments is scheduling.
The variety of approaches in scheduling such as 12-hour shifts, 8-hour shifts, weekend relievers, 4-day weeks,
temporary pools, job sharing shows how complex this task is. Rapid turn over, retrenchment, use of temporary
personnel, the increasingly high tech nursing interventions make staffing and scheduling more complicated. All
these, in addition to meeting the needs and wishes of individual staff members as for example, in the emergency
need of a staff for off-duty, can make managing difficult. An approach being used to reduce the number of
conflicts arising from staffing and scheduling is the use of participative management. This allows staff members
as a whole to plan their schedules, thus assuming their share of responsibility for keeping their unit adequately
staffed.
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33
Monitoring
Once assignments and directions are given to staff members, a nurse manager just dont sit back and
wait for results. The effective nurse manager monitors her areas progress regularly. The manager has
responsibility to several constituencies, each with their own concerns. The three major ones are the nursing
services staff/nursing school faculty, clients/students, nursing service/school administration. In addition, the
manager must also consider other groups such as other departments or units, the community, the nursing
profession, support staff, and so forth.
The nurse manager monitors her individual staff members functioning and performance. Some items to
consider in monitoring the work of individual work members include: absenteeism, late arrivals, early
departures, adherence to professional standards, adherence to standards of ethical behavior, conformity to legal
standards of practice, excellence in provision of patient care, excellence in recording patient care and its
outcomes, ability to work with other staff members, pursuit of professional growth, leadership.
In monitoring a nursing unit as a whole the following are monitored by the nurse manager: patient
census, incidence of infection, incidence of falls, decubiti and so forth, injuries to staff, relationship with other
departments, comparison with other units, cost over runs, staff requirements, compliance with regulatory
requirements, compliance with professional standards. In monitoring, both formal and informal methods are
used including direct observation, peer review, formal performance appraisals, and a variety of specific reports,
the budget and so forth. (Tappen, 1995). Swansburg (1993) listed thirteen standards for evaluating the directing
functions of nurse managers. These are:
1. Managers have established a medium by which nursing workers feel free to ask for advice, counsel,
and consultation.
2. Needed written directions are available in the form of policies, procedures, standards of care, job
analysis, job descriptions, job standards, and nursing care plans.
3. A training program is in effect when it meets nursing employees needs as they perceive them. They
participate.
4. Nurse managers periodically work evening, night, weekend, and holiday shifts to keep abreast of
clinical and administrative behaviors peculiar to these shifts.
5. Supervisors are competent in needed knowledge and skills of administration and clinical
specialization.
6. The nurse administrator has operationalized ANA Standards for Organized Nursing Services and
Responsibilities of Nurse Administrators across All Settings.
7. The nurse managers have operationalized the ANA Standards of Nursing Practice.
8. Nurse managers are knowledgeable about and apply the appropriate Standards of the Joint
Commission on Accreditation of Healthcare organizations and other appropriate accrediting body.
9. The nurse administrator uses techniques of operation analysis.
10. Nurse managers use a system of management by objectives.
11. The nurse administrators work with the consent and knowledge of patients, and solicit input from
consumers regarding nursing services desired.
12. Nursing unit personnel are organized into and working as direct care personnel and clerical personnel
13. Nurse managers use the physical plant to the best advantage for patients and personne
A nurse manager gives recognition and rewards, which can be either positive or negative, being careful
to reward desired rather than undesirable behavior. The manager herself and her staff must continue to grow and
develop as professionals. She must give opportunities for this growth and development and ensures that the
environment of the unit is conducive to the implementation of new ideas.
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34
Management by Objectives
Management by Objectives (MBO) as a directing element was advocated by noted management experts
Peter Drucker and George Ordiorne. The latter defined it as:
A process whereby the superior and subordinate managers of an organization jointly identify
its common goals, define each individuals major areas of responsibility in terms of the results
expected of him, and use these measures as guides for operating the unit and assessing the
contribution of each of its members. (1974)
Ordiorne further stated that MBO, as a system for making organizational structure work, to bring about
vitality and personal involvement in the hierarchy by means of statements of what is expected from everyone
involved and measurement of what is actually achieved. It stresses ability and achievement rather than
personality.
MBO allows people to control their own performance, to measure themselves, and to exercise selfcontrol.
LESSON 1 - LEADERSHIP
1.
2.
3.
4.
5.
New concept of Leadership

Leadership can be learned and cultivated.
Leadership are not necessarily charismatic. Charisma may be the result of effective leadership.
Leadership is not limited to those on top position, but can occur at all levels of the organization.
Leadership is not so much of the exercise of power, but the improvement of others.
Effective leaders are not born but develop over time through knowledge and by using appropriate
sets of skills.
Both Directing and Leading are based on Power
Power is defined as the capacity to ensure the results of an activity within the expected outcome.
Kinds of Power:
1. Reward Power based on incentives that the manager/leader can provide.
2. Informational Power based on who knows what in an organization and the degree to which access to
information can be controlled.
3. Punishment or Coercive Power based on the negative things that a leader might do to the member of
the group depending on the degree of infraction committed.
4. Legitimate Power based on the authority delegated to the manager by virtue of her/his job and position
within the hierarchy.
5. Expert Power based on the particular knowledge and skills that the manager possesses and shares with
her subordinates.
6. Referent Power based on the administration and respect for an individual as person. This largely
comes from leaders personal qualities
To achieve the goal of the leadership function in nursing service, four processes must be performed:
1. Establishing a mission statement that is reflected in long range, strategic, operational plans; resource
allocation, organization policies; the process of leadership starts with establishing and promulgating
the organizations mission and renewing and revising it as necessary.
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35
2. Organizing, directing, and staffing patient care and support services in a manner that is
commensurate with the scope of services offered.
3. Implementing, coordinating, integrating patient care and support services throughout the
organization.
4. Establishing expectations, planning and managing processes to measure, assess, and improve the
performance of the organizations governance, management, clinical and support processes.
Thus, effective leadership defines a strategic plan that is consistent with the organizations mission and
vision. It clearly communicates the mission, vision and plan throughout the organization. It fulfills the
organizations vision by providing the framework to accomplish the goals of the strategic plan.
Leadership in health care organizations
Health care organizations are value driven. Their leaders establish and nurture the appropriate service
values. Eight ways in which they can do this is as follows:
1. Communicating a vision The effective manager must be able to articulate a clear vision for the
organization. Whatever the source, the manager has to personally own the vision; otherwise, the
manager will fail to inspire others.
2. Having a commitment to the development of others. In many ways, managing others means the
development of others. In this role, the manager is more a mentor, educator, and coach than a boss.
3. Establishing values It is the leaders job to discover and declare what his or her organization stands
for, establish a morality that becomes the standards for others, and declare this in clear and inspiring
terms.
4. Learning The environment in which health care organizations is rapidly changing, and so they
must be open to new knowledge. The leader must look beyond organizational boundaries by using
environmental assessments, long range planning, SWOT (strength, weakness, opportunities, threats)
analysis, portfolio analysis, focus groups, strategic management, to name a few.
5. Establishing priorities and direction. Establishing priorities adds focus. Leadership establishes
strategic direction and this focuses the organizations efforts on addressing its priorities.
6. Solving problems The effective manager understands the real difference between real problems
and pseudo problems.
7. Balancing interests Health care organizations are composed of and associated with myriad interest
groups: employees, physicians, nurses, the community, patients, suppliers, the media, and
politicians. The effective health care manager works balance the interest of all, especially to the
benefit of the largest good.
8. Working for the public benefit Although organizational benefit is a goal of each manager, health
care mangers typically place community benefit and patient benefit at the top.
Leadership Attributes of Nurse-Executives
Leadership attributes of nurse-executives include administrative competence with adequate educational
background, business skills, and clinical expertise combined with a global understanding of leadership
principles. To be effective, she must have the leadership traits associated with leadership effectiveness:
intelligence, personality, and abilities. Traits related to intelligence include judgment, decisiveness, knowledge,
and fluency of speech. Leaders who are perceived to be knowledgeable and competent in their areas of work are
respected and can serve to inspire subordinates to excel in performance.
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36
Personality includes adaptability, alertness, creativity, cooperativeness, personal integrity, selfconfidence, emotional balance and control, and independence (nonconformity). Leaders with these traits can
easily motivate workers to achieve the goals of the organization
LESSON 2 - COMMUNICATION
The process of transference and understanding of meaning.

Communication Process:
Senders
Ideation
Response
Encoding
Transmission
Decoding
Receiving
Receiving
Transmission
Decoding
Encoding
Response
Receiver
Communication Process:
1. Communication takes place only when the receiver of the manager understands it the way the sender
intended for it to understood.
2. Meaning are in people
3. Always validate your perceptions and assumptions you make about other peoples behavior as well as
your own.
4. What to say and do; how you say and do them reflect your perceptions, values, belief, and needs.
5. Your self-concept shows in your communication behavior, so develop a healthy and positive selfconcept.
6. Avoid fault finding in others. Always look for the good in them an in the situations you get into.
7. You pack your own chute. This means that you choose you own set of behavior. So avoid blaming
others for your actions, reactions and feelings; Own them!
8. Be proactive rather than reactive. Good and solicit feedback
9. Learn to listen to and trust others.
10. Remember the goal of communication is to build mutual understanding in order to have faster and
better relationship between and among people.
PRINCIPLES OF COMMUNICATION
1.
2.
3.
4.
5.
6.
7.
Information giving is not communication. Communication requires that the receiver provides feedback
to the sender.
Responsibility for clarity resides on the sender
Simple and exact language should be used.
Feedback should be encouraged. Common resource of misunderstanding is lack of feedback.
The sender must have credibility
Acknowledgement of others is essential
Direct channels of communication is preferable to written or phone communication.
BARRIERS AND BREAKDOWN IN COMMUNICATION

1. Lack of planning
2. Unclarified Assumption
3. Semantics Distortion
4. Poorly expressed messages
5. Differences in language, cultures, etiquette
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37
6. Poor transmission channel

7. Poor listening and premature evaluation
8. Impersonal communication
9. Distrust
10. Insufficient period of adjustment to change
11. Information overload
LESSON 3 - SUPERVISION
An enabling process in which the supervision helps the staff

member achieve her own purpose as well as those of the organization
The art of utilizing certain techniques in helping, guiding,

assisting, counseling, motivating, controlling, facilitating, inspiring and liberating the subordinates.
PRINCIPLES OF SUPERVISION
1. Focus on the improvement of the work, rather than up-grading the worker.
2. Know and provide supervision based on the needs of every individual.
3. Provide utmost cooperation (from the supervisor)
4. Employ democratic technique
5. Stimulate the staff to continuous improvement
6. Respect individuality
7. Create an atmosphere where the staff is free and can function at her own level.
8. Dont coerce and subjugate the minds of the staff.
9. Avoid the use of I, but use We.
10. The supervisor must be able to follow and to lead.
KEY CONCEPT OF SUPERVISION
1. Supervisors must add strength to an organization by serving as the linking in between lower level group
and the executive level of management
2. Supervisor must bring to their work a unique coordination of technical competence; individual energy,
and the ability to get along with people and moderate them.
3. Performance of supervisors will be judged by how well they manage the resources assigned to them and
the results they get from them in a way of output, quality and cost control.
4. Supervisory management job generally requires three (3) skills:
1. Human Relation Skills
2. Technical Relation Skills
3. Conceptual Skills
5. Supervisor must balance their skills too much in one direction is likely to be self-delegating.
6. Supervision is not a position, it is dynamic process of getting things done thru people.
GOAL OF SUPERVISION IN NURSING SERVICE
1.
2.
3.
To attain quality of care for each patient

To develop the potentials of the workers
Productivity, efficient and effective performance
SUPERVISORY TECHNIQUES
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38
Observation of staff in action

May demonstrate selected care procedures
Assists in the staff as needed
Private conference with individual staff as needed
Spot checking of selective activities at regular intervals
Rounds with individual staff or group; discuss problems
encountered.
QUALITIES OF GOOD SUPERVISORS
Ambitious for self-improvement

Self-starter
Able to critically think
Able to communicate clearly
Able to organize
Have Moral Integrity
Ability to work with and thru people
Willing to tackle and make tough decisions
Dynamic and have ability to inspire others
Should like people
Balance personality
LESSON 4 -DELEGATION
Definition:
Delegation is the process by which a manager assigns specific task to the workers with commensurate authority
to perform the job. The worker assumes responsibility for the satisfactory performance and results.
Transfer of responsibility for the performance of an activity from one individual to another, with the former
retaining the accountability for the outcome.
Purpose of Delegation
1. Trains and develops staff members for greater opportunities, making them more committed and satisfied
in the job.
2. Saves time on the part of the manager.
3. Maximize the use of the talent of the staff.
4. Assign routine tasks
5. Staff capability building
Principles of Delegation:
1. Give clear description and instruction of what is to be done.
2. Share with the employee the outcome of the delegated task.
3. Discuss with the employee the degree of responsibilities and authority that is allowed to him. Allow
autonomy by monitor the performance.
4. Ask the employee to recount what are the main points of the task delegated to him.
5. Manager to over-see/follow-up the progress of the delegated task.
____________________________________
39
6. Ultimate accountability for the delegated task rest on the door of the task and the manager who
delegated the task.
7. Give credit; NOT blame to the worker
8. Dont take back delegated tasks.
9. Say Please, Thank you after; sign of gratitude and respect to the employee.
Five (5) Rights of Delegation:
1. Right Tasks
2. Right Person
3. Right Direction/Communication
4. Right Supervision
5. Right Circumstances.
Five (5) Elements of Delegation:
1. Select capable people
2. Communicate
3. Set control point
4. Provide tools and authority
5. Make help available
Steps in Delegation
1. Describe the tasks/projects/procedures to be done.
2. Relay the description of the tasks
Establish check points

a. Policies/standards
b. Allocate Resources
c. Time Frame
d. Rounds
3. Establish dialogue before, during and after for feedback on:
a.
Clarification
b.
Attitudes/feelings of all staff with the tasks
c.
Judgment of delegation
What Should be Delegated?
1. Routine tasks
2. Delegated tasks that allows employees to grow professionally
3. Delegated tasks to more qualified employees
What not to Delegate:
1. Hot Potatoes (Confidential matters)
2. Power to discipline the staff
3. Accountability
4. Over-all control of the unit
5. Highly technical job
6. Hiring and firing employees
7. Signing your name as manager.
Barriers to Delegation:
1. Myself Fallacy I can do better
____________________________________
40
2. Lack of ability to direct

3. Absence of control that warm impending difficulties.
4. Aversion to taking a risk
Problems in delegating
Delegating is difficult when staffing is inadequate, the work is difficult or unpleasant, and the team
members are not ready or are immature (Tappen, 1995). There are tasks too, that cannot be delegated. Examples
of these are: the power to discipline, the responsibility for maintaining morale, jobs that are too technical, or
duties involving a trust or confidence.
The delegation of work to another presumes a superior-subordinate relationship. For this reason, many
nurse-leaders hesitate to delegate. They assume a greater share of the work, resulting in being overburdened.
Tappen (1995) has this to say:
Leader-managers who cannot delegate responsibility to their team members are
always very busy. They usually need to be in three places at once and are often seen rushing
from one crisis to another because they do not have time to deal with a problem before it
becomes a crisis. Perhaps because they have so much practice, they are very good at dealing
with crises but they do not do much planning. These leader-managers are frequently heard
saying how busy they are, and it is hard to make an appointment with them. When they area
away from work for more than a day or two, the team falls apart because no one else on the
team knows how to handle many of the teams regular functions. Team members dont know
anything about these ordinary routines because the leader always does them.
These difficulties may be due to any of the following reasons:
First, some leaders do not even realize they have a problem delegating. They believe they are
hardworking, dedicated people (which they are), and do not realize how much they limit the effective
functioning of the team.
Others simply do not trust their team members and believe that in order to do the job well, they
themselves, have to do it.
For others, the need to retain control or to dominate others is so strong that they cannot let other team
members share the leadership role or even become proficient. Consciously or unconsciously, they
withhold needed knowledge and information from team members as a means of control.
Ways to Delegate Successfully
According to Swansburg (1993), the following is a list of ways for nurse managers to delegate
successfully:
1. Train and develop subordinates. It is an investment. Give them reasons for the task, authority,
details, opportunity for growth, and needed instructions if needed.
2. Plan ahead. It prevents problems.
3. Control and coordinate the work of subordinates. Do not peer over their shoulders. Develop ways of
measuring accomplishments of objectives.
4. Visit subordinates periodically. Spot potential problems of morale, disagreement, and grievance.
5. Coordinate to prevent duplication of effort.
6. Solve problems and think about new ideas. Emphasize employees solving their own problems.
7. Accept delegation as desirable.
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41
8. Specify goals and objectives.

9. Know subordinates capabilities and match the task or duty to the employee. Be sure the employee
considers it important.
10. Agree on performance standards. Relate managerial references to employee performance.
11. Take an interest.
12. Assess results. Expect what is clearly and directly asked for as the deadline set for completing and
reporting arrives. The nurse manager should accept the fact that employees will perform delegated
tasks in their own style.
13. Give appropriate rewards.
14. Do not take back delegated tasks.
LESSON 5 - PRINCIPLE OF PROBLEM
1.
To resolve problems affecting organization efficiency, the Manager should separate large problems
from small ones, use policy to solve the smaller problems, and conserve managerial time for solving
major problems.
The Manager should delegate smaller problems to subordinates and teach them to solve these by
applying existing agency rules.
In solving operational problems, the Manger should consult internal and external experts, so that
solutions will be based on current knowledge.
Problem solutions are most effective when the Manager approaches problems in relaxed fashion and
refuses to solve problems under stress
It is impossible to anticipate all eventualities or expect 100% accuracy in diagnosing and resolving
problems. Therefore it is unwise to agonize over selecting a solution.
Provide an opportunity for people to raise problems in work.
Solve problems by taking and listening to people.
Always conduct interviews in private. Be sure you cant be overhead.
Never prejudge. To prejudge is to be prejudiced. What you think is a disciplinary matter that could be
a domestic problem, and the individual might need counseling?
2.
3.
4.
5.
6.
7.
8.
9.
DIFFERENT APPROACHES TO PROBLEM SOLVING

1. SERIAL APPROACH they tackle problems in sequence, completely resolving one before turning to
next.
2. SURVEY survey all existing problems, rank them by importance and solve one at a time in order of
priority.
3. GROUP PROBLEM according to the resources it is needed to investigate and remedy each, then
resolve a group of related problems simultaneously.
A. Tackle problems in sequence as they arise, resolving each problem before undertaking the next step of
problem solving.
1
7
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42
4
2
8
9
B.
10
Survey all existing problems, order them, and handle first one, then another, according to priority.
1a
1
2a
2b
5a
5c
5b
C.
Depart from primary data search to consider related issues.

STEP
1. Define the problem
CHARACTERISTICS
Differentiate facts from
opinion.
Specify underlying
causes.
Tap everyone involved
for information
State the problem
explicitly.
Identify what standard is
violated
Determine whos
problem it is.
2. Generate alternatives
solution
Avoid stating the

problem as a disguised solution.
Postpone evaluating
alternatives
Be sure all involved
individuals generates alternatives
Specify alternatives that
are consistent with goals.
Specify both short-term
and long term alternatives.
Build on others ideas
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43
Specify alternatives that
solve the problem.

3. Evaluate and select
alternative.
Evaluate relative to an
optimal standard.
Evaluate systematically.
Evaluate relative to goals
Evaluate main effects
and side effects
State the selected
alternative explicitly.
4. Implement and follow
up on the solution
Implement at the proper

time and in the right sequence.
Provide opportunities for
feedback
Engender acceptance at
those who are affected.
Establish an ongoing
monitoring system.
Evaluate based on
problem solution.
METHODS OF PROBLEMS SOLVING

Trial and error is the simplest technique, but is time consuming and may not be effective especially if the
problem is complex.
1. Scientific Experimentation involves studying the situation under controlled condition often using
trial period or pilot projects.
2. Multistage critique study the action of the principals before, during and after the event.
3. Metaphor-based analysis translate the problem into a different sphere to obtain a fresh view point.
4. Purposeful Inaction chooses not to do anything when intervention is indicated.
DECISION MAKING
Decision-Three is a mathematical tool that defects related decision points and outcome probabilities
as an interconnecting network of nods branches. A manager can objectively analyze available courses of
actions determine the cost effectiveness of different actions and select the alternatives yielding the best
outcome for the cost.
1. Brain storming a process of group interaction to stimulate members to develop many new ideas
within a short time.
2. Nominal Group To minimize the effect of status difference on decision-making, the nominal group
techniques combined non-interactive and interactive members in the deliberation.
3. Delphi-Survey-Decision makers never meet face-to-face. They remain anonymous through out a
multicycle decision process.
4. Fishbowling is a method of group decision making that improves decision quality. The decision
maker sits at the center chair in a circle. This provides for reasoned orderly Decision-making by
eliminating distraction cross talk and irrelevant decision.
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44
Decision-Making:
The systematic process, as a sequential process of choosing

among alternatives and putting the best choice into action.
Three (3) Models in decision-Making:
1. Normative Model (Lancastor and Lancaster)
Seven (7) Steps in this analytical Model:
Define and analyze problem

Identify all available alternative
Evaluate the pros and cons of each alternative.
Rank the alternatives.
Select the alternative that maximizes situation
Select the alternative that maximizes situation
Implement the decision
Follow-up outcome.
2. Decision Three Model (Mages and Brown)

3. Descriptive Model (Serison)
Seven (7) Steps in Descriptive Method:
1. Establish acceptable goals.
2. Define subjective perceptions of the problem.
3. Identify acceptable alternatives
4. Evaluate each alternative
5. Select the alternative
6. Implement the decision
7. Follow-up the outcome.
Five (5) General Steps of the D-Making Process:
1. Identify the problem
2. Gather and analyze information related to the solution.
3. Evaluate all alternatives
4. Action and implement selected alternative.
5. Monitor the implemented and evaluate outcome.
Pitfalls of Decision-Making:
1. Inadequate Fact-finding
2. Time constraints
3. Poor communication
4. Failure to systematically follow the steps of Decision-making process will likely results in un
anticipated results.
LESSON 6 - MOTIVATION
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45
Is an individuals inner state that causes him or her to behave in a way that ensures the accomplishment of some
goal.
Motivation Behavior Model
Needs/Values
Motivation
Goal
Behavior
The Porter-Lawler Model of Motivation

Value of
Rewards
Ability to do a
Specific Task
Perceived Equitable
Rewards
Performance
Accomplishment
Effort
Perceived
Effort-Reward
Probability
Intrinsic
Rewards
Perception of
Task Required
Satisfaction
Extrinsic
Rewards
Principles of Motivating/inspiring Others

1.
2.
3.
4.
5.
6.
7.
Know employees needs and expectations

To be treated fairly as a human being
To be provided with work that suits their ability
To have opportunities for self-development and promotion
For employers promises to be kept
To know what is expected of them
To be rewarded equitably
To have a friendly and safe working environment
Positive thoughts motivate
Enjoyment motivates
Feeling important motivates
Success motivates
Clarity motivates
Personal benefits motivates
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46
LESSON 7 - EFFECTING CHANGE

Introduction
Using the nursing program evaluation results in implementing changes as well as for long-range planning ranks
a high priority of successful administration cannot be limited to the day-to-day operations of the institution. Of
all the leadership positions in the nursing field, the director of nursing is in the most strategic position to effect
needed innovations in nursing.
Three (3) Types of Change
1. Structural Change affects the organizational process such as alterations in authority charts, budget
procedures, or rules and regulations.
2. Technological Change affects the physical environment and work practices or systems.
3. People-oriented change affects the performance and conduct of employees, such as the introduction
of different training schemes, appraisal systems, sets of standards or promotional devices.
Three (3) Phases of Change
1. Unfreezing is the development of a need to change through problem awareness. Despite identifying
the problem, a person must believe there can be an improvement before he or she is wiling to change.
2. Moving is working towards change by identifying the need to change, exploring the alternatives,
defining goals and objectives, planning how to accomplish the goals and implementing the plan for
change.
3. Refreezing is the integration of the change into ones personality and consequent stabilization of
change. Personnel use old behaviors after change effort cease. Relate changes in neighboring systems,
momentum to perpetuate the change, and structural alterations, which support the procedural change, are
stabilizing factor
IMPLEMENTATION
Various organizational approaches used to introduce change.
I. Unilateral Approach authoritative decisions are made at the top of the power structure and handed
downward.
1. By decree an impersonal announcement handed down by the top echelon and it is one way
declaration of intention usually phrased in memo. Policy statement or lecture, Automatic
compliance with authority will produce changes behavior and anticipated improvement.
Example: memo on uniforms.
2. By replacement key positions are to be filled up by more effective new personnel. This is used
when the decree approach is insufficient but the upper authority control and mandate to bring about
change at the bottom organizational level.
Example: If a staff nurse is poor in her performance replace her.
3. By structure a formal mechanism for change that relies on a redesign of the organizational
pattern, with the assumption that the creation of new or different slots will result in improved
performance.
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47
II. Shared Power

1. By group decision making a two phase approach where upper authority identifies the problem but
subordinate debate and select the most appropriate solution for stimulating change. The
participation in the change decision increases support and commitment.
Example: The issue of staffing pattern to solve understanding.
2. By group problem solving the two functions of problem identification and solution are faced by
the subordinate discussion group in recognition of their practical experience and knowledge of the
issue at hand.
III. Delegated Power
1. By case discussion a generalized discussion of a situation aimed at developing problem solving
skills which can be applied by personnel to carry out changes.
Example: A case of a staff nurse who showed improvement in her performance and got a high
rating.
2. By sensitivity sessions a psychologically oriented method which doesnt deal with task-oriented
problems or changes but places emphasis on social or interpersonal processes. Led by professional
trainer, members of the group develop self-awareness and insight on the attitudes of others. This
increased understanding is expected to lessen to informal and self-initiated change.
Example: Stress management lecture for the staff nurses.
GUIDELINES FOR IMPLEMENTING CHANGE
Change is more acceptable:
1.
When it is understood than when it is not.
2.
When it does not threaten security than when it does.
3.
When those affected helped to create it than when it has been externally imposed
4.
When it results from an application of previously established impersonal principles than when it is
dictated by personal order.
5.
When it follows a series of successful changes than when it follows a series of failures.
6.
When it is inaugurated after prior change has been assimilated than when it is inaugurated during the
confusion of others major change.
7.
If it has been planned than if it is experimental.
8.
With people new on the job than with people old on the job.
9.
With people who share in the benefits of change than with those who do not.
10.
If the organization has been trained to plan for improvement than if the organization is accustomed to
states procedures.
GUIDELINES FOR IMPLEMENTING INNOVATIONS
1.
Identify strengths and areas needing improvement. The systematic evaluation plan should provide
direction and valuable information. Avoid the attitude of change for the sake of change.
Example: Change in uniforms
2.
Develop a master plan with target dates for time of accomplishment of different aspects. This serves as
the blueprints.
3.
Ensure staff involvement People tend to support what they help plan.
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48
4.
Define the constraints under which you must operate in terms of money, time, skill of staff, equipment
and clinical facilities.
5.
Identify and analyze the choices for there is more than one way to get an objective.
- cost effective quality care-hire nursing staff or give incentive or overtime pay.
6.
Consider all the ratifications of the change. Innovations that are helpful in one area may have
undesirable side effects in other areas.
Example: In the operating room, the last OR case is 2:00 Oclock except for emergency
7.
Plan for evaluation it should start at the beginning of your process and continue throughout.
8.
Make failure acceptable Risk taking is associated with change and not succeeding should not become
degrading to individuals.
9.
Bring out hidden agendas so that real issues can be handled when working with staff. Promoting
change is not threatening the autonomy and security of individuals.
10.
Brainstorm and try to identify alternatives when deadlocks occur.

Example: Shifting by 3 shifts or flexitime.
11.
Try not to have a final or set decision in a small group that will result in defensiveness when
recommendations are presented to the total group and suggestions are offered. Label materials Draft 1,2,3
or Working Copy
12.
Maintain a perspective Remember, theres nothing like a little experience to upset a theory.
LESSON 8 - MANAGEMENT OF CONFLICT

Definition:
Conflict is defined as all kinds of apposition or antagonistic interaction based on scarcity of power, resources, or
social position and different value structures.
Four Approaches to Understanding the Nature of Conflict
1.
Interpersonal Conflict (within the individual). There is ambivalence disordered perception, feeling
and behavior which are associated with psychiatric problems.
2.
Inter-actional sociological approach Focus on group behavior and interactional phenomenon with a
group.
3.
Anthropological approach emphasizes the stress of culture acclimatization, value, and cultural
conflicts and relates to personality and environment.
____________________________________
49
4.
Economic-Political Approach emphasizes conflicts related to political concerns, power, games,

coalition as well as political and economic processes. These is always a perceptual difference between
rich and poor.
Types of Conflict:
1. Intrapersonal Conflict or Role Conflict
2. Interpersonal Conflict
3. Intergroup or Inter organizational Conflict.
Sources of Conflict
1. Power different sources
2. Situational different interaction; with divergent views of power and authority.
Effect of Conflict
1. Functional or Constructive Conflict support the goals of the organization and improves organizational
performance.
2. Dysfunctional Conflict interaction hinders organizational performance.
CONFLICT OUTCOMES
Functional Conflict Outcome
Conflict
Awareness
of the
problem
Increase effort and improve performance

Enhance creativity
Personal Development and growth
Heed to
resolved the
problem
Adaptation to
innovation
Change
Dysfunctional Conflict
Conflict
Indecision
Resistance to change
Emotional outburst
Increased political maneuvering
Inability to
confront
Tension rise
communication
____________________________________
Problem
solving
50
conflict
Stagnation
or Decline
breakdown
Coordination
failed. Impaired
Decision- making
F. Benefits and Cost of Conflict

Benefit
Cost
1. Energy and enthusiasm
1. Tension and anxiety
2. Diagnostic Value
2. Causes maybe overlooked
3. Creation of new and

creative solution
3. Rigidity in position
4. Focus on task
4. Decline in cooperation
and teamwork
5. Feedback
5. Loss of self-esteem
G. How is Conflict Managed by the managers depends on the:

1.
2.
3.
4.
Ability to disguise the nature and sources of conflict.

Ability to initiate confrontation and discussion with conflict parties
Ability to engage in active listening so as to hear all points of views.
Ability to choose the rights approach towards conflict resolution
STRATEGIES FOR MANAGING CONFLICT

Accommodating/
smoothing.
Collaborating/
Confronting
High for people
Low for task
High for people
Low for task

Compromising / Bargaining
Get job done balance with
Maintaining morale
Lose-Lose
Avoidance / Withdrawal
Low for people
Low for task

____________________________________
Lose - Lose
Competetive / use power

Concern for
accomplishment, but
Authoritarian
Win - Lose
51
Concern for Task Achievement

LESSON 9 TEAM BUILDING
A.
Definition:
As we experience changes as cost cutting, and downsizing within the health care teamwork
becomes an important concept. Health care organizations are being restructured around teams. This restructuring appears to be a comfortable fit since most of the work in health care organization is already
performed by groups or people responsible for different functions. With all the focus in individual, we still
need individual to work together in groups to accomplish goal.
Groups is a member of individuals assembled together or having some unifying relationship.
Team is a member of persons associated together in specific work or activity
A group of people with high degree of interdependence geared

toward the achievement of a goal or a task.
Kinds of Teams:
1. Effective Team is characterized by its clarity of purpose, informality and congeniality, commitment
and high level of participation.
2. Ineffective Team are often dominated by a few members leaving others bored, resentful or
uninvolved.
Leaders tend to be autocratic and rigid and the teams communication style maybe overly stiff and formal.
B.
Group Development (by Tuckman)

1. Forming members first come together with emphasis:
Making acquaintances
Sharing information
Testing each other
- Group members attempt to discover which interpersonal behavior are acceptable or unacceptable
to the groups
- Process of sensing out the environment.
2. Storming high degree of intergroup conflict can usually be expected as group members attempt to
develop a place for themselves and to influence the development of group norms and roles.
- Issues are discussed more openly and efforts are made to clarify group goals.
3. Norming Group begins to develop a sense of oneness
- Norms emerge to guide individual behavior.
- Group members come to accept fellow members and develop a unity of purpose that binds them.
4. Performing - developing separate roles for various members
- Role differentiation emerges to take advantage of task specialization in order to facilitate good
attainment.
- Group focuses attention to the task.
5. Adjourning a socialization stage the group joined each other and individually express their feelings
to the group and what they feel doing activities together.
C.
Group Norms:
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52
1.
2.
3.
4.
5.
6.
7.
Cooperation among team members are expected.

Everyone has a role on the team and is provided with a clear expectation of his role.
Decision are made by majority role.
Team members will be held accessible for assignments.
Team members are expected to meet deadlines.
Team members will begin and end in time.
Competition between members/department is not necessary.
D.
Teams Concept:
1. Communication openness
Members conduct interpersonal relationship with their peers in thoughtful supportive ways.
Members are able to resolved conflicts among themselves and do so in ways that enhance rather than inhibit
their working together.
People must be willing to confront issues and to openly express their ideas and feelings
2. Mission
Team must have a purpose that is a plan, aim or intension
Special work or service to which the team must be 100% committed.
3. Willingness to cooperate
3.1 An individuals intention to participate without any conditions - commitment
E.
Suggestions that Help Develop Team Work:
1. Be inclusive and Welcome Diversity
2. Recognize Habits and Behaviors
3. Teamwork is the fluid process that challenges the status duo.
4. Focus on strength and applaud the efforts of others.
5. Appreciate the risk members take.
6. Bring your best to the team.
7. Build Trust by Building Relationship.
Teamwork is a new experience for some members who come to the group without a positive expectation
because theyve never experienced teamwork. Where members find themselves and each other enough to show
the content of their toolboxes, with all the positives and negatives, the group has the potential to work as a team.
THE TEAM BUILDING PROCESS

Team Leader
Agenda
(Problem)
Group Advice
of the Problem
Diagnosis
Identification of Problem
____________________________________
Factors
Full Group
Participation
53
Communication
Role Clarification
Leadership Style
Organizational Structure
Interpersonal Friction
Discussion and
Choice of Problem
Solution
Implementation
of Solution
(Change
LESSON 10 -
Group Commitment
To solution
Interpersonal Support
Interpersonal Trust
Enhances
PRODUCTIVITY; EFFICIENCY AND EFFECTIVENESS
One may equate productivity to the increased members of admissions; or to the member of surgical operations;
or many of the involved in the dollars or pesos that come in; or maybe to the number of personnel you have
trained; or even to the number of researches that you have done. All these actually are considered products or
outputs because in essence productivity is dependent on the organizations mission and vision.
A. Productivity is defined by the formula:
Productivity =
Output
Input
O = Increase Quantity + Quality
I = Decrease resources (man, money, materials)
Nursing Productivity Frameworks
(By Jelinek and Dennis)
ENVIRONMENT
Input
Nursing
Such as:personnel
Equipment
Supplies
Process
Patient
Care
Such as:
Delivery
Systems
Leadership
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Management54
Output
Patients
Days
Such as:
Hours of Care
Procedures done
Visits Made
B. Nursing Productivity Measures

1. Resources per patient day.
- Labor Productivity Nursing Hours per Patient Day
- Total actual salary cost of nursing personnel divided by total patient days for the same
period.
2. Degree of Occupation measured informally using the busyness scale wherein the Nurse
Manager observes the unit staff and makes a judgment as to the ratio of the staff and the
work load.
- To date, is computed scientifically by determining the clinical status of the patient and the
nursing care hour needed by each patient in a certain clinical level of illness.
C. Improving Nursing Productivity:
1. Change in use of inputs.
Matching supply with demand

- Careful use of personnel
Making staff substation (use of assistive personnel)
Control the use of supplier and equipment.

2. Change in the care process
10 hours shift
12 hours shift
Routine activities
3. Documentation different methods of charting
Paperless charting
DAR method
Clinical Pathway
Etc.
4. Calculating Cost.
Compare new and old rate systems
Determine cost-effective caring
Cost-Benefit Analysis
5. Measure the Outcome
Quantity
Quality
Innovation Beneficial
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55
6. Separate Nursing change from room charges.

7. Use group counseling and teaching method.
8. Recognize the need to do better.
9. Giving passes/rewards for good performance.
10. Seek new approaches to old problems and improve products and services.
11. Attention to doing the right things the right way.
EFFECTIVITY
There is no one best ways to structure and organization for it to become effective. There are many
variables to be considered, such as the size of organization, the capability of its human resources and the
commitment level of its workers. However, certain minimal requirements can be identified:
1. The structure should be clearly defined so that employees know where they belong and where to go for
assistance.
2. The goal should be to build the fewest possible management levels and the shortest possible chain of
command. This eliminates friction, stress and inertia.
3. The unit staff needs to be able to see where their tasks fit common tasks of the organization.
4. Organizational structure should enhance not impede communication
5. Organizational structure should facilitate decision making that results in the greatest work performance.
6. Staff should be organized in a manner that encourages informal groups to develop a sense of community
and belonging
7. Nursing services should be organized to facilitate the department of future leaders.
EFFICIENCY
Efficiency simply means being able to perform the required tasks/s in the right way. It always goes hand in
hand affectivity. One will not be effective without being efficient and vice versa.
An efficient nurse is an effective nurse.
For an employee to be efficient, he must first and foremost be able to work in a safe environment, be given
by management all the necessary tools to be used and enhance his positivity.
LESSON 11 -
PROFESSIONALISM IN AN ORGANIZATION
Professional Change change in position or job such as obtaining education or allow one to be
prepared for a future position.
A.
Strategies for professional growth:
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56
1. Cross training floating or training nurses to new areas. It is important for nurses to be
articulate about their competencies for a new patient population if they are asked to float.
Managers should make sure that they assign nurses according to their competency level.
2. Identify a mentor - the new nurse must communicate willingness to learn and grow in which
they approach a prospective mentor who could teach them techniques and procedures in nursing
rather than wait to be approached by one. An ideal mentor is the one who is willing to support
and counsel other nurses when asked.
3. Clinical Ladder program established by some organizations to encourage nurse to earn
promotions and gain recognition and increased pay by meeting specific requirements. Some
offer nurses the opportunity to seek promotion in a specific track, within a clinical, educational,
or managerial focus.
B.
Characteristics of a Powerful Professional Practice:

1. Nurse with powerful practice acknowledge their unique role in the provision of patient centered
and family centered care.
The power of clinical nurses is significantly
enhanced by the therapeutic, interpersonal
relationships nurse establish with patients and
families and by a nurses expertise in relieving
the burden of disease and helping patients and
families cope with the continuum of health and
illness
2. Nurses with a powerful practice commit to continuous learning through education, skill
development, and evidence-based practice.
All of the nurse leaders identified knowledge and expertise as an essential element of the nurses
power based and underscored the importance of continuous learning. Nurses who are powerful, they
said, continuously seek new knowledge and based their practice on evidence. The educational level
of nurses was also viewed as an essential element of a powerful professional practice. The nurse
leaders agreed that attaining a BSN is essential, and that more education generally leads to greater
power.
3. Nurses with a powerful practice demonstrate professional comportment and recognize the
critical nature of presence.
The nurse leaders noted that the professional comportment of nurses their behavior and how
they carry themselves is a key component of nursing power. Openness, transparency,
____________________________________
57
authenticity, honesty, and integrity are some of the characteristics that the nurse leaders are
associated with powerful nurses.
The nurse leaders also commented that the way nurses use language, particularly how they refer
to themselves, can enhance or detract from their professional image. Nurses in powerful
practices consistently acknowledge their own professional status and that of others by using first
and last names during introductions, and by avoiding phrases, such as I am only a nurse, or
she is just a nurse, that diminish individual nurses and profession of nursing as a whole. The
nurse, said the nurse leaders, brings a unique skill set, knowledge, and prospective to the care
team, executive table, research tem, or faculty a contribution that nurses, themselves must not
doubt since self-confidence is linked to power. That said, nurses must work to sustain their
credibility by maintaining competency and remaining current in their practice and by
remembering that they are professional who work with others to meet the best interests of the
patient and family.
4. Nurses with a powerful practice value collaboration and partner effectively with colleagues in
nursing and other discipline.
Many of the nurse leaders cited the ability to collaborate with nursing colleagues and those
outside of nursing hallmark of effective nursing leadership and a characteristics of powerful
nursing practice. They noted that collaborating does not mean acquiescing or giving in. Not does
it mean competing or engaging in divisive actions and behaviors. Rather it involves authentic,
transparent discussion, debate, and deliberation and striving to reach consensus driven
outcomes. A powerful professional, according to the nurse leaders, works well with others, is
fair, and has opinions and perspectives that are sought out by others. Leading the participating
on teams and partnering with others are essential to sound, expert nursing practice and are
critical elements of a nurses power base.
5. Nurses with a powerful practice position themselves to influence decisions and resources
allocation.
A number of the nurse leaders observed that powerful nurses typically position themselves to
provide direction, input, and information about decisions affecting their practice, including
decisions related to resources allocation. Such nurses recognize that decisions regarding staffing,
technology to support practice, salaries, wages, and other factors that affect the practice
environment should be in hands of nursing professionals who work in that environment should
be in hands of nursing professionals who work in that environment; and if they are not powerful
nurses question whether it is because the organization does not value professional practice.
6. Nurses with a powerful practice strive to develop an impeccable character; to be inspirationally
compassionate, and to have a credible, sought-after perspective.
A number of the nurse leaders observed that nurses with a powerful practice are grounded by a
set of values and principles that they freely share with others and that guide their decisions and
actions. The values and principles also help foster compassion, make the nurses less fearful and
more open to others ideas, and help nurses stay in the course during times that may be
tumultuous for patients and families colleagues. Nurses who are open to others and who use a
values-based approach also find that others often seek out their perspective; this not only brings
the nurse more power, but is the antithesis of using power as a coercive strategy.
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58
7. Nurses with powerful practice recognize that the role of the nurse leader is to pave the way of
nurses voice to be heard and to help novice nurses develop into powerful professionals.
Many of the nurse leaders noted that helping novice nurses develop a voice that is based on
professional credibility and expertise is a responsibility of a nurse leader at the unit, practice,
program and institutional levels. Powerful nurses, they said, recognize this and know that by
fostering a nurses professional development they promote the power of the individual nurse,
enhance their own power, and strengthen the power of the individual nurse, enhance their own
power, and strengthen the power of nursing as a profession. Powerful nurses in leadership
position also avoid using phrases such as, My nursing staff, or My faculty. Although
unintentional, phrases like this suggested that a nurse is subservient to others and can diminish
the professional stature of the individual.
8. Nurses with a powerful practice evaluate the power of nursing and the nursing department in
organizations they enter by assessing the organizations mission and values and its commitment
to enhancing the power or diverse perspective.
Many of the nurse leaders observed that nurses with a powerful practice tend to seek out and
work in environments that support nurses and nursing practice, and that are led by strong nurse
leaders who are themselves respected and valued by the institution. Such organizations place a
high value on nurse and nursing care and, by designing, upholding and contributing to the power
of nurses that practice within them.
All of the nurse leaders agreed that institutions that value diversity and respect are more likely to
value nursing and are stronger organizations as result. They noted that in organizations where
the power of nursing is diminished, nurse leaders and nursing staff must develop strategic plans
that promote respect and diversity, and must work to elevate the nursing profession and nursing
practice through leadership development, establishing a strong research base, and creating
programs that foster the professional development of nurses at all levels.
During the discussions, the nurse leaders described their experiences in their current places of
work and compare and contrasted these to their experience in general and in other organizations.
While all but one nurse leader described their current nursing department and nurse leaders as
powerful, perceptions of the power of nursing seemed to vary across organizations. For
example, in the comprehensive cancer center where the cure of cancer through research was
the dominant mission, nurses felt less powerful than in the academic medical center where
patient care was the prominent mission and nurses role in round-the-clock care of patients
gave them the greater power as a group and as individuals (this was particularly true for nurses
who had established themselves as expert, compassionate professionals). Nurse leaders from the
university/college setting noted that the power based of nurses in academic setting depends on
the dean of the school of nursing and on the mission of the college/university. These two factors,
they said, play a significant role in determining the nursing schools esteem and credibility
within the organization.
Many of the insights gained through discussions with nurse leaders complement and expand on
observations about nursing power that are discussed in the literature. Like Hagbaghery et al
(2004), the researchers found that knowledge, self-confidence, and supportive management are
important factors related to nursing power and to using power effectively. ANA discussions also
highlighted that link that others have noted between power and professionalism and underscored
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59
how the actions and behaviors of individual nurses affect the collective power of nursing as a
profession.
Beyond this, the nurse leaders participating in their discussions emphasized the important of the
relationships that nurse have with patients and families, and described how these relationships
are central to the power based of individual nurses and the profession. Nurses enhance their
power and assure that the power of professional nursing practice is realized across all setting by
focusing on patients and families and on improving patients and family centered outcomes; by
sharing information and communicating effectively with colleagues; by using their knowledge of
patients, families and treatment plans to assure safe, high quality care; and by consistently
demonstrating professionalism in their interaction with patients, families and other members of
the team. Nurses knowledge of the health care delivery system is also a source of power. When
coupled with their clinical expertise and strong collaborative skills, this knowledge allows nurses
to play an active role in making the acre delivery more patient and family centered. A powerful
nurse one who is confident in her knowledge of what patients and families need and her ability
to respond to those needs is an invaluable asset to organizations who place a premium on high
quality care and who strive to put patients and families at the center of what they do.
Nurses who recognize and use their power are more apt to achieve personal and professional
goals and help the nursing profession meet its goals of serving society and advancing nursing
practice, education, and research. Developing a colleagues who are willing to serve as role
models and mentors. As they consider the insights they gleaned from their discussions with the
nurse leaders, they realized that students in their Fast-Track BSN-to-PhD program would benefit
from two mentors: one to mentor them through the research process, and another to offer
guidance and mentoring in the areas of nursing practice and leadership. In addition, the
researchers realized that the characteristics of powerful practice from a framework that will help
the programs mentors as they work with less experienced nurses to create a powerful practice
and presence. The researchers believe the framework will also be useful to any nurse who is
interested in enhancing his or her own practice, advancing the nursing profession, or influencing
the organizations that provide care and that train the nurses of tomorrow.
Table, Properties of a Powerful Professional Nursing Practice

Nurses who have developed a powerful nursing practice.
Acknowledge their unique role in the

provision of patient and family centered care
Commit to continuous learning through
education, skill development, and evidence-based practice
Demonstrate professional comportment
and recognize the critical nature of presence
Value
collaboration
and
partner
effectively with colleagues in nursing and other disciplines
Actively
position
themselves
to
influence decisions and resource allocation
Strive to develop an impeccable
character, to be inspirational, compassionate, and have credible,
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60
sought-after perspective (the antithesis of power as a coercive strategy)

Recognize that the role of the nurse
leader is to pave the way for nurses voices to be heard and to help
novice nurses develop into powerful professionals
Evaluate the power of nursing and the
nursing department in organizations they enter by assessing the
organizations mission and values and its commitment to enhancing
the power of diverse perspectives.
LEARNING ACTIVITIES
1.
Observe the communication pattern in your own place of work and answer the following questions:
a. What media of communication are used to keep staff informed?
b. Described the communication climate. Would you say it is supportive or defensive? Justify you
answer.
c. Describe any area of concern that related to communication gap. Suggest ways to improve this
condition.
d. Identify at least three barriers to communication.
2.
Compare the nursing process with the problem solving process.
3.
Describe the steps of the problem solving process.
4.
Describe the relationship between problem solving and decision making.
5.
You have just been promoted to be the Director of Nursing of a 200-hundred bed capacity private urban
hospital. In your first meeting with the owner of the hospital you were informed that the hospital is in
financial difficulty. Nursing Service, as its share in the cost cutting measures implemented by the
hospital, needs to cut each budget. The amount being asked is equivalent to the salaries of four staff
nurses or two supervisors.
a. What other information do you need to make decision?
b. Describe the decision making steps that you will use.
6.
List at least three (3) pitfalls of decision making.
7.
Describe two problem solving techniques.
MODULE SIX
CONTROLLING / EVALUATING
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61
SPECIFIC OBJECTIVES
At the end of the discussion of this module, the graduate students will be able to;
1.
2.
3.
4.
gain knowledge on how to control the nursing service operations.

appreciate the importance of controlling / Evaluating
implement control tools in managing nursing service.
identify different control operations.
LESSON 1 Definition
CONTROLLING / EVALUATING
By Urwick
Controlling is evaluating in seeing that everything is being carried out in accordance with
the plan which have been designed and the principles which have been laid down.
By Fayol
Control is verifying whether everything that occurs is in conformity with the plan
adopted.
Concept Related to the following:

1.
2.
3.
4.
5.
Evaluating to find out the results

If standards were followed
Gantt Chart to show it was monitored and done according to the time table set.
Performance refers to the quality and quantity that was accomplished.
Benchmarking to find out if the job done could be parallel to those same job or even better as
expected.
Principles of Controlling
1. Principles of uniformity ensure that controls are related to the organizational structure.
2. Principles of comparison ensure that controls are stated in terms of the standards of performance
required.
3. Principles of exceptions provide measures that identify exceptions to the standards.
Controlling Process
1. Establish standards for all elements of management in terms of expected and measurable outcomes;
these are the yardsticks by which achievement of objectives are measured.
2. Apply the standard by collecting date and measuring the activities of nursing management
comparing standards with the actual care.
3. Make improvement deemed necessary from the feedback. Connect deviation remedial actions must
be undertaken.
4. Keep the process continuous for all areas.
Formula: Ss + Sa + F + C = I
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62
Where : Standard Set + Standard Applied + Feedback + Connection = Improvement

LESSON 2 - TEN (10) CHARACTERISTICS OF GOOD
CONTROL SYSTEM:
1. Reflect the nature of the activity
2. Report errors prompt/timely
3. Forward-looking and comprehensive
4. Point out expectations at critical points
5. Objective, specific and appropriate
6. Flexible
7. Reflect organizational pattern; reflect authority and responsibility pattern.
8. Economical
9. Use understanding devices
10. Indicate corrective actions
Types of Control:
1. Anticipatory Control seeing problem coming, in time to do something about them. Planned and
preventive measures can save time, money, errors, and many headaches.
2. Concurrent - deals with the present rather than the future or past. It involves monitoring and
adjusting ongoing activities to ensure compliance with the standards.
3. Feedback Control involves with gathering information about an ongoing or competed activity and
taking steps to improve that activity in the future.
Requirements for Control:
1. Setting standards
2. Monitoring performance
3. Connecting Directions
LESSON 3 -
TOOLS OF CONTROLLING
1. Standards:
1.1 Three (3) Components
- Structure standards
- Process standards
- Outcome standards
1.2 Categories of Standards
- Physical standards
- Cost standards
- Capital standards
- Revenue standards
- Program standards
2. Performance Evaluation
Performance the degree of accomplishment of task that make-up an employees job.
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63
Determinants of Performance
1. Effort
2. Abilities
3. Role Perception
Principles of Evaluation
1. Performance evaluation must be based on job description and performance standards
2. Adequate and representative sampling of staff behavior should be observed in the process of
evaluation (use anecdotal record)
3. Staff to review her job description prior to education conference.
4. Documenting employees performance should include both satisfactory and the needing
improvement.
5. Evaluation review/conference should be scheduled at the convenience of both the evaluator
and the persons being evaluated.
Errors Made in Performance Appraisal
1. Leniency
2. Central Tendency
3. Recency
4. Halo Effect
5. Horn Effect
6. Self-aggrandizing Effect
7. Contrast Error
8. Sunflower Effect
9. Temperament Effect
10. Guessing Error
4. Budget (Planned Budget versus Budget Realized at the end of the year)
5. Discipline aims as distractive and connective to improve performance of the staff.
4.1 Principles of Disciplinary Actions:
o Positive Attitude of the staff
o Investigate carefully
o Be prompt
o Protect Privacy
o Advise employee when the schedule for evaluation is
o Take corrective, consultative action
o Follow-up (re-evaluate if behavior is continuous to be on negative).
o Protect privacy of the employee
4.2 Progressive disciplinary Action
Five (5) Steps

Termination
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64
Suspension
Written
Reprimand
Verbal
Reprimand
Counseling
Disciplinary Action must be:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progressive
Fit the offense committed
Assistance should be used in administering disciplinary action
Protect privacy
Clear and specific
Objective
Firm in the decision
Nurse manager should consult her supervision for consistency
Nurse Manager should build respect, trust and confidence in her ability to handle discipline.
6. Nursing Rounds
Rounds cover such issue as patient care, nursing practice and unit management.
7. Records on Reports
Administrative tools used in collecting data towards the attainment of objectives of the organization
or unit.
Accurate, adequate, updated
Clear, brief, concise
Provide relevant facts for study
Filed chronologically
8. Quality Control
This specific type of controlling that refers to the activities that are used to evaluate, monitor and
regulate services to health care customers.
9. Nursing Audit
Types of Audit
1. Structure Audit
2. Process Audit
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65
3. Outcome Audit
Types of Audit in terms of occurrence:
1. Retrospective Audit
2. Concurrent Audit
3. Prospective Audit
10. Inventory
It is an administrative tool designed to control supplies and equipment by listing the names, description,
number and location of supplies and equipment.
Purpose of Inventory:
1.
2.
3.
4.
5.
6.
7.
To determine if standards are maintained

To serve as basis for the revision of standards and systems
To recommend proper action on obsolete and surplus materials
To determine operational status of equipment
To prepare plan for repair of replacement
To determine proper location of supplies, materials and equipment
To gather factual information to serve as basis sound procurement planning
Kinds of Inventory
1.
Perpetual Inventory recording is done as supplies were used and replenished, thus indicating
the number of supplies on hand at a time.
2.
Physical Inventory the actual counting made at designed intervals to connect accumulative
errors resulting from breakage or deterioration.
3.
Fixed equipment annually

Movable equipment monthly
Instruments weekly
Narcotics daily
To set standards relative to the quality and kind of supply and equipment kept with the unit for:
Clinical Services
Needs of patients
Bed capacity
Needs and demand at a given time
Frequency of items used in emergency situations
The overall objectives of any material control process as:
1.
2.
3.
To maintain inventory supply

Minimize inventory cost
To provide information for decision making
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66
11. Quality Improvement

Total quality management (TQM), continuous quality improvement (CQI), quality assurance (QA),
utilization review (UR), are methods for evaluating health care and are all concern about maintaining quality
while constraining costs in healthcare organizations. Quality assurance (QA) is an older term for a system
of procedures used to evaluate nursing care and to give feedback to the providers of this service in order to
improve it. Quality improvement or QI is the newer term used for a more comprehensive, broader-based
approach to evaluating care. One important difference is that quality improvement focuses on whole
systems, not just the performance of individual practitioners.
The process of quality improvement follows the problem solving pattern and the systems approach in
looking at the quality of care given by the healthcare system being studied. Continuous quality
improvement is a continuing cyclical process.
Quality improvement address one or more of these three domains, namely: structure, process and outcome.
Structure evaluation involves looking at how the setting, the conditions, and the environmental factors affect
the quality of care. Process evaluation examines the activities and behaviors of the nurse. Outcome
measures demonstrate changes in the behaviors and attitudes of the clients.
Quality improvement uses norms, criteria and standards as measures in the evaluation process. Among the
mechanisms used include chart audit and review, patient interview and inspection, postcare questionnaires
and interview, staff interview or observation, group conferencing.
Quality improvement programs are directed toward assuring some degree of excellence as defined by those
responsible for the program and toward assuring accountability by health care providers by the quality of
care they provide (Hawkins & Thibodeau, 1996).
At the unit level, a quality improvement project begins with assignment of responsibility and identification
of an area for study. Once the scope of care is defined, the problem is further analyzed in terms of its
important aspects, generally accepted standards of care, indicators that the standards have been meet, and
criteria for deciding whether or not they were sufficiently met.
Quality improvement on an institutional level on the other hand, is primarily an administrative
responsibility. The first step is a statement of the organizations philosophy of quality improvement. Next,
the mechanisms to implement quality improvement need to be set up. Involvement of and representation
across departments and of everyone who comes into contact with the patient as a hallmark of total quality
management. Once mechanisms are in place, continuous quality improvement begins. The administrative
body evaluates the effectiveness of the organizations continuous quality improvement efforts and results,
revises the process as needed, and proceeds with the cycle again as shown in the diagram that follows:
ESTABLISH PHILOSOPHY
EVALUATE
EFFECTIVENESS
____________________________________
SET UP
MECHANISMS
67
ACT ON CQI
RECOMMENDATION
INITIATE CQI
THE CONTINUOUS QUALITY IMPROVEMENT CYCLE
LEARNING ACTIVITIES
1.
2.
3.
4.
5.
6.
7.
8.
Discuss at least two purposes of controlling.

Describe three principles of controlling.
Name the characteristics of a good control/evaluation system.
Discuss the importance of Standards in improving the quality of care given by nurses.
Differentiate among structures, process, outcome.
Discuss the purpose and the process of quality of improvement.
What are the goals of cost containment?
What cost containment measures are being used in your organization? Do you think they are reasonable
and fair?
9. Describe the performance appraisal used in your organization. How does it compare with the
performance appraisal describe in this module?
10. Discuss the advantages and disadvantages of peer review. What are your feelings about being evaluated
by a peer?
11. Describe the disciplinary measures used in your organization. Do you agree with the methods used and
the penalties imposed?
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68
MODULE SEVEN
ISSUES / TRENDS IN HEALTH CARE
ENVIRONMENT
SPECIFIC OBJECTIVES
At the end of the module, the graduate students will be able to:
1.
2.
3.
Be aware of the health care environment as effected by social, political, economic & technological
advances.
Appreciate the current health issues in health care delivery system.
Gain knowledge on the development of nursing in the health care delivery system.
LESSON 1
THE HEALTH CARE ENVIRONMENT
Broad social, political, economic, and technological changes are affecting the delivery of health care
systems, the leadership needed, the nursing profession in general.
The society of today is very different from the time when health care was provided by the family, by the
neighborhood herbolario or comadrona. These days, we go to hospitals. The hospitals maybe ultra modern
and funded by their wealthy benefactors and clients or, they may be small community hospitals substantially
supported by the government. Advances in science and technology allow us to avail of progress tremendous
benefits. For example, researches in the medical and related fields have brought about the discovery and
utilization of antibiotics, immunizations, vitamins and other wonder drugs that are now used to promote health,
prevent the spread of infectious diseases, cure existing diseases, alleviate pain, and in general, allow us to enjoy
a healthy and comfortable life.
Improved sanitation and water system, the availability of modern therapeutic modalities such as insulin,
dialysis, joint replacements, heart valve replacement, organ transplants and so forth, result in a population who
enjoy longer lives and productivity.
But, along with the advances brought about by modernization and industrialization, also comes
problems in society. In general, modern society is afflicted with conditions that demand much from social
services and of health care. Some of these conditions include unemployment, homelessness, substandard
housing conditions, poverty, broken homes, rise in the number of single parents, domestic and other forms of
violence, increasing number of elderly and handicaps, accessibility of harmful drugs, all of which can result in
an unhealthy and sick individual.
The health care systems are burdened with taking care of diseases never before known as Alzheimers
disease, Acquired Immunodeficiency Syndrome (AIDS), drug-resistant tuberculosis, as well as of taking care of
the increasing number of people, mostly elderly, who are suffering form chronic diseases (cancer, heart, stroke,
diabetes, arthritis, and so forth).
The workplace environment for health care workers has undergone change, too. There is a wide range of
possible threats to the safety and well being of healthcare workers brought about by technological advances and
violence in society. These risks include exposure to potentially lethal chemical, infectious and radioactive
agents as well as violence from the patients and others, especially when the place of work is located in an
unsafe area in the inner city. Exposure to Aids is a concern for many nurses. Of 32 documented cases in the US
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69
(Tappen, 1995), of healthcare workers acquiring an HIV infection in the workplace in the United States, 12
were nurses. Another source of concern is exposure to tuberculosis. Tuberculosis, once considered under
control, has become a deadlier threat recently as more drug resistant strains appear.
Responding to the challenge brought about by these changes in the healthcare environment and the
healthcare workplace means major reforms in the delivery and management of the health care system. It means
making healthcare not only available but affordable to a socially and economically diverse population. It means
a health care workforce who is ready and prepared to meet the advances of modern society and its
accompanying problems. It also means making the workplace environment safe and secure for health care
workers.
LESSON 2
HEALTH CARE ISSUES
Rising cost of health care

The increased use of technological is necessarily accompanied by a rapid increase in health care costs.
Global economic crisis and recession are making the situation even worse than what it was when economic
conditions were better. For the poor, unemployed and uninsured, access to health care is almost next to
impossible. Even countries who are supposed to be rich like the United States are not spared from this problem.
It is for this reason that every president of that country from Kennedy to Clinton seriously addressed this issue.
Hillary Clinton made heath care reform her pet project immediately after her husband took over the presidency.
The primary objective of health care reform is to provide coverage for everyone, regardless of their ability to
pay. Emphasis should be on health promotion and disease prevention. Primary care, acute care, and long term
care, including mental health and reproductive health, should be covered first. Dental, vision, and hearing are
also important. In the health care reform of Mrs. Clinton, taxes of various kinds combined with strict costs
control have been suggested. Health care reforms, no matter how minimum, needs money and would entail a
share of the national budget. Her proposed health care reform was a major endeavor that called for a large
budget allocation which would increase taxes and naturally cut allocations for other government projects. After
fighting very hard to garner support, she finally abandoned her Health Reform Plan when the Senate rejected it,
mostly for political reasons.
The problem of making health care services accessible to all

The poor has difficulty accessing appropriate health care mostly because of its enormous cost. And the
cost is still rising. For example, the US healthcare cost increased from 10% of a gross national product (GNP) in
1990 to 14% in 1993. It is projected that by the year 2000, it will rise to as high as 24%. No data of this sort was
obtained for the Philippines. But based from experience, one can attest that health care cost is definitely rising.
It is a fact that the Philippines has not developed self-reliance in health care (Balita, 1999). According to Dr.
Tamayo (Balita, 1999), the best and only solution to address the bad health care is for us Filipinos to help each
other and work hand and hand for full implementation of the National Health Insurance Program as provided
under Republic Act 7875 which has been enacted in 1995 and supposed to be implemented starting 1999. This
program is going to be compulsory. It is envisioned to be integrated and comprehensive approaches to health
development. It endeavors to make essential goods, health and other social services available to all the people at
affordable cost with priority to the underprivileged, sick, elderly, disabled, women and children. Most
importantly, it will provide free medial care to paupers. An important aspect of this program is the Botica sa
Barangay. Botica sa Barangay is already being implemented in the city of Manila.
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70
Projects showing the governments attention to the growing number of elderly are the senior citizen
programs implemented both nationwide and locally. For example, the program that provides twenty percent
discount for food, medicines, transportation, has received very favorable responses from the older people.
Needless to say, the costs of heath promotion, prevention of diseases and in general the costs of delivering
health care to all people will be coming from taxes of various kinds as well as savings from other different
sources, such as reducing administrative costs.
Controlling cost is clearly a key issue in health care. And, controlling health care costs entails good
management. For the nurse managers, it means delivering nursing care efficiently and effectively. To make
organizations work, it must be able to sustain itself financially, to say the least. To be sustainable, organizations
have to be ran by people with business and management savvy. It is not unusual therefore, for health care
organizations to hire nurses who hold business degrees (mostly MBA) to occupy top management positions.
These days, we often hear nurse managers using the terms down-sizing, cost cutting measures, strategic
planning and most recently, the preeminent business performance technique for the 90s called
reengineering.
Competition, profitability and market share are the issues cited most frequently by senior executives for
turning to the business process of reengineering. Reengineering has invaded healthcare organizations and has
replaced outsourcing, downsizing, restructuring, and automation. What is reengineering? According to
Manganelli and Klein (1994), reengineering is the rapid and radical design of strategic, value-added business
processes and systems, policies and organizational structures that support them to optimize the work flows
and productivity in an organization. From this definition of reengineering, one can deduce that in the process of
reengineering and the other methods of controlling health care costs, some services may be cut off and some
key personnel (nurses included) may be laid off.
Managed Care. This is one of the approaches suggested to reduce health care costs. Managed care is an
approach to providing a range of services in such a way that use of services and resulting costs are carefully
controlled, that is, well-managed. Managed care is a term used to describe health care subsystem in which
services are administered in order to enhance their efficient and effective use. The primary purpose of these
business ventures is to deliver, finance, buy and sell health care services as economically as possible. Managed
care systems are also known collectively as alternative delivery systems, consist of administrators, providers,
and the physical facilities in which health care is delivered. The hospitals are oftentimes the focal point of
managed care organizations.
Several different administrative structures are characteristic of managed care arrangements. Some of the
more common structures include health maintenance organizations (HMOs), independent practice association
(IPAs), and preferred provider organizations (PPOs). HMOs are usually organized in one of two ways. The
first is the staff model in which HMO employees provide health care services and also function as
administrative personnel. The second, called the group model, consists of a medical group that accepts a
contract from an HMO to provide health care services for its participants. Regardless of their structures, the
primary purpose of HMOs is to limit costs by decreasing referrals to specialists, restricting diagnostic studies,
and decreasing client hospitalization. Reducing the number of hospitalizations is accomplished, in part, through
the provision of health promotion and illness prevention services.
PPOs are another type of managed care organization that can be sponsored by providers, insurance
companies, or employers. Contracts are established with a limited number of health care facilities and
professionals, and lower-than-customary rates are sometimes negotiated. In an attempt to contain costs,
providers may be required to adhere to PPO utilization guidelines.
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71
Group Practice arrangements are outgrowths of the managed-care system. Group arrangements are
thought to be advantageous for a number of reasons. Catalano (1996) cited some of them. First, they preserve
the ideal private entrepreneurship while cutting overhead. Second, they are attracted to providers who prefer to
hire professional managers. This arrangement enables practitioners to spend more time caring for clients and
less time worrying about the mechanics of running a business. Group practice arrangements are also appealing
because they offer providers more time off, better client coverage, and professional camaraderie. Finally, group
practice frequently employ an array of specialists and clients are offered convenient, centralized, and
comprehensive services.
Managed care as a health care system is fast becoming the dominant approach to health care delivery.
LESSON 3
TRENDS IN THE NURSING PROFESSION
The profession of nursing is a vital part of the health care system. Any change in the system brings about
change in the profession. Nursing, as a profession, continues to stand to the challenge of the times. There was a
time when empowerment, accountability, independence of practice, professional collaboration were only
concepts to be studied and goals to be achieved, now they have become integral to the practice and development
of the profession. Nurses in the advanced practice roles such as nurse practitioners can and do establish their
own independent practices. These nurses have professional autonomy, at the same time that they enjoy
collaboration with colleagues in the health care system. They are likewise, empowered by their own education
and expertise in their chosen field. In return, they are personally accountable for the service they render.
Change in the healthcare system has a major impact on how, where, and even who practice nursing
(Catalino, 1996). Nurses will need to get involved in decisions about where healthcare is going. They need to
band together as a profession and exert potential power that they have access to politicians, physicians, hospital
administrators, and insurance companies in shaping the future of their profession.
Future trends in the nursing profession suggest a move towards empowerment (Tappen, 1995). The term
power has many meanings. From the standpoint of nursing, power is probably best defined as the ability or
capacity to exert influence over another person or group of persons. In other words, power is the ability to
control, by virtue of ones authority to sway or influence others towards ones viewpoint (Hawkins and
Thibodeau, 1996). Empowerment refers to the increased amount of power that an individual, or group, is either
given or gains. Empowerment allows nurses to become more active in the political arena. Some of them run for
political offices or have managed political campaigns. Sources of power that nurses should consider using in
their practice include referent, expert, reward, coercive, legitimate, collective (Tappe, 1995).
Referent source of power depends on establishing and maintaining a close personal relationship with
someone. Nurses often obtain power from this source when they establish and maintain good therapeutic
relationships with their clients. Clients take medications and tolerate treatments more willingly from nurses with
whom they enjoy good relationships. Likewise, nurses who have good collegial relationships with other nurses,
other departments, and physicians are often able to obtain what they want from these individuals or groups, in
providing care of clients.
The expert source of power derives from the amount of knowledge, skill or expertise that an individual
or group of individuals has. Nurses should have at least a minimal amount of this type of power because of their
education and experience. Increasing the level of education and experience, therefore, should increase expert
power. Nurses in advanced practice roles, nurse educators, clinical specialists, nurse practitioners and nurse
managers are examples of nurses who are endowed with expert power. Their additional education and
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experiences provide them with the ability to practice skills at a higher level than nurses prepared at the basic
education level. Nurses access this expert source of power when they use their expertise to teach, counsel,
motivate clients to follow a plan of care. Also, by demonstrating their knowledge of the clients recovery, nurses
increase the amount of respect they are given by physicians.
The reward source of power depends on the ability of one person to grant another some type of reward
for specific behavior or change in behavior. The rewards may take the form of praises, promotions, raises,
expanded privileges, and eradication of punishments. The reward source of powers is also the underlying
principle in the process of behavior modification. For example, nurses, in their day to day provision of care can
give a client extra praise for good compliance and for cooperating in their plans of care. The flip-side of the
reward source is the coercive source. The ability to withhold rewards, to threaten, to punish are examples of
coercive power. Needless to say, nurses minimally use this for the reason that they are non-therapeutic.
The legitimate source of power depends on a legislative or legal act that gives the individual or
organization a right to make decisions they might not otherwise have the authority to make. In nursing, the state
board of nursing has access to the legitimate source of power because of its establishment under the nurse
practice act of that state. The licensed nurse uses legitimate source of power by virtue of her being licensed.
The collective source of power is often employed in a broader context than individual client care and is
the underlying source for many other sources of power. For individuals who belong to professions, the
professional organization is the focal point for this source of power. The main goal of any organization is to
influence those policies that affect the members of the organization. Having all these sources of power
available, nurses, individually or as a group, are getting themselves more empowered. There other ways of
increasing power for the profession. By uniting themselves in a nationwide association or group, nurses can
weld a great deal of power to influence others. The professional associations like the ANA in the United States
have been and are still influencing legislators and legislating. Another way of gaining power is by becoming
involved in political activities, locally and nationally.
Nursings progress toward professionalism include improved image, higher salaries, increased
recognition of advanced nursing practice, and support for nursing research (Tappen, 1995).
For years, nurses have been portrayed in demeaning ways. Nurses have been portrayed magazines and
television as obese, scary person toting a large syringe, or as sex maniacs chasing after doctors or getting into
bed with patients, and so on. In 1990, an image campaign by the Ad Council (Tappen, 1995) in cooperation with
nursing organization was launched. The project used television, radio, and print media to disseminate facts
about nursing education and practice. An portrayed a nurses busy morning activities which include saving a
life. It ended with a question asking, What have you done this morning? A letter-writing campaign by the
major nursing organizations and their members was successful in getting a television series canceled. This
series had portrayed nursing students as so overwhelmingly preoccupied with sex and romantic adventures that
viewers wondered where they get their time to study and attend classes.
Higher salaries and the opportunities to travel and work in other countries have definitely attracted more
in the profession of nursing. New graduate nurse salaries are among the highest of any new college graduate in
the United States. The profession had definitely become more attractive that seven years ago, when a number of
business establishments closed shop, many of the employees who lost their jobs turned to nursing as a second
career. In a school of nursing in the East Coast where this writer taught, the average age of students was 35 and
many of them were already professionals in other fields.
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Recognition of Advance Nursing Practice. Advanced practice status, such as nurse practitioner or
clinical nurse specialist, has been recognized in many states by completion of certification examination
developed by professional organizations. Eligibility to take these examinations includes minimum hours of
classroom and supervised clinical study and course content. To attain this status, more and more practicing
nurses pursue advance courses to occupy expanded roles as nurse educators, nurse clinicians, nurse researchers,
clinical specialist, administrators, or nurse practitioners.
Support of Nursing Research. More nurses are going into research and they find this new area of nursing
practice gratifying. Many nurses get promoted and get other recognition for going into research. Research
positions for nurses are opened in hospitals and other healthcare organizations. Funding can be applied for by
nurses who venture in research. Research findings are utilized in the evidence based nursing practice. Without
nursing research there will never be any change in nursing practices.
LEARNING ACTIVITIES
1. Discuss how the worldwide social, political, economic, and technological advances affect the delivery of
health care.
2. From what you know about the current health issues and problems in the delivery of health care in the
Philippines, what health care reforms do you recommend?
3. Trace and evaluate the professional progress of the nursing profession in the Philippines.
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74
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ADMINISTRATIVE

Trace the history of management and leadership theories

Management and Leadership Theories

Lesson 1 Management Theories: (Five Era)

Four Major Management Process

Issues / Trends in Health Care Environment.. 95

Lesson 1 The Health Care Environment

ADMINISTRATIVE PROCESS IN NURSING

Identify the 5 ERA of management theories

Scientific study of the task

B. Gilbert Frank - Principles of Economic Motion.

3. Job security and job development

II. Behavioral ERA Motivation Theories

Performing a task has intrinsic and extrinsic valence

Motivation is reduced if individual does not value intrinsic or extrinsic outcomes or if

Intrinsic intrinsically motivated behavior is stimulated by peoples needs for feeling

People assess their performance and attitude by comparing

Contribution to work and benefits derived.

Elton Mayo Hawthrone Study Human Behavior in work situation.

Mary Follett Psychological and Sociological Aspect of Management

Employee desires to be motivated

Motivates performance; NOT demand it.

Successful leadership skills is the result of training and possessing specific

Understands what motivates people to work.

McGregor - Theory X and Theory Y.

Behavior and attitude change occur in 3 stages

New attitude learned must be supported by everyone

Toffler, Alvin - Future Shock

Physical and psychological distress occur from over-loading

To minimize Future Shock is to develop the mechanism and techniques to guide

Herbert, Alvin Focus Business and Service instructions as Networks of D-makers.

Henry Minstzberg : Roles of Managers

Figure Head represents Head of Agency

This is built on transactional qualities found in day-to-day management

Brings out the best in the followers

Cascading effect. Followers exhibit leadership qualities similar to the leader.

Father of Corporate Culture.

Leadership Exchange involves three (3) basic elements:

C. Greenleef, Robert Servant Leadership

Servant leaders put serving others (employee, customers, community) as priority.

Leadership and Management skills should be integrated

Rank and file participates in DV. System Approach:

Exploitative, Coercive, Authorative,

LESSON 2 LEADERSHIP THEORIES

There are Eight (8) classifications of Leadership Theories

Need for influence and power

Conviction of moral righteousness

Emphasize on groups personalities

More heads are better than one

Autocratic leadership promotes hostility, aggression and decrease initiative

He supports the human relation theory

The grid describe individual leadership as function of 2-variables:

Member Leader relation

3. Leadership Continuum (By Tannenbaun & Schmidt) Leadership style varies:

Leadership can be learned and cultivated.

ADMINISTRATIVE PROCESS IN NURSING

Define different terms used in management,

Is planning, organizing, leading and controlling.

Has the power and authority to enforce decisions.

Carries pre-determined policies, rules and regulations.

Relates to people according to their roles

Maintains an orderly, controlled, rational and equitable

Influences others towards good setting either formally or

Interested in risk-taking and exploring new ideas.