Nursing Leadership & Management

1. 1. JOFRED M. MARTINEZ, RN, MAN NG Review and Training Center, Inc. Iloilo City,
Philippines CONCEPTS, PRINCIPLES, THEORIES AND METHODS OF DEVELOPING
NURSING LEADERS AND MANAGERS IN THE HOSPITAL AND COMMUNITY-BASED
SETTINGS

2. 2. The process of leading and directing an organization to meet its goals through the use of
appropriate resources. The act of influencing and motivating a group of people to act in the
same direction towards achieving a common goal.

3. 3. LEADERSHIP MANAGEMENT • do not have delegated authority but obtain their power
through other means, such as influence • legitimate source of power due to the delegated
authority • focus on group process, information gathering, feedback, and empowering others
• emphasize control, decision making, decision analysis, and results • have goals that may or
may not reflect those of the organization • greater formal responsibility and accountability for
rationality and control than leaders

4. 4. “father of scientific management”

5. 5. Four overriding principles of scientific management: 1. Traditional “rule of thumb” means

of organizing work must be replaced with scientific methods. 2. A scientific personnel system
must be established so that workers can be hired, trained, and promoted based on their
technical competence and abilities. 3. Workers should be able to view how they “fit” into the
organization and how they contribute to overall organizational productivity.

6. 6. Four overriding principles of scientific management: 4. The relationship between

managers and workers should be cooperative and interdependent, and the work should be
shared equally.

7. 7. Theory of Social and Economic Organization Bureaucracy • Need for legalized, formal
authority and consistent rules and regulations for personnel in different positions
8. 8. • Henri Fayol (1925), first identified the management functions of planning, organization,
command, coordination, and control.
9. 9. • Luther Gulick (1937) expanded on Fayol’s management functions in his introduction of
the “Seven Activities of Management” - planning, organizing, staffing, directing, coordinating,
reporting, and budgeting.
10. 10. • Mary Parker Follett (1926) was one of the first theorists to suggest participative decision
making or participative management. • Managers should have authority with, rather than
over, employees.
11. 11. • Elton Mayo and his Harvard associates (1927-1932), look at the relationship between
light illumination in the factory and productivity. • Hawthorne effect indicated that people
respond to the fact that they are being studied, attempting to increase whatever behavior.
12. 12. • Douglas McGregor (1960), X and Theory Y, posited that managerial attitudes about
employees can be directly correlated with employee satisfaction.
13. 13. Theory Y managers believe that their workers enjoy their work, are self-motivated, and
are willing to work hard to meet personal and organizational goals. Theory X managers
believe that their employees are basically lazy, need constant supervision and direction, and
are indifferent to organizational needs.
14. 14. • Chris Argyris (1964), managerial domination causes workers to become discouraged
and passive. • If self-esteem and independence needs are not met, employees will become
discouraged and troublesome or may leave the organization.
15. 15. THEORIST THEORY Taylor Scientific management Weber Bureaucratic organizations
Fayol Management functions Gulick Activities of management Follet Participative
management Mayo Hawthorne effect Mcgregor Theory X and Y Argyris Employee
participation
16. 16. • The Great Man Theory, from Aristotelian philosophy, asserts that some people are born
to lead, whereas others are born to be led. • Great leaders will arise when the situation
demands it.
17. 17. • Trait Theories assume that some people have certain characteristics or personality
traits that make them better leaders than others.
18. 18. Democratic Leader exhibits the following behaviors: • Less control is maintained. •
Economic and ego awards are used to motivate. • Others are directed through suggestions
and guidance. • Communication flows up and down. • Decision making involves others. •
Emphasis is on “we” rather than “I” and “you.” • Criticism is constructive.
19. 19. Authoritarian Leader characterized by the following behaviors: • Strong control is
maintained over the work group. • Others are motivated by coercion. • Others are directed
with commands. • Communication flows downward. • Decision making does not involve
others. • Emphasis is on difference in status (“I” and “you”). • Criticism is punitive.
20. 20. Laissez-faire Leader characterized by the following behaviors: • Is permissive, with little
or no control. • Motivates by support when requested by the group. • Provides little or no
direction. • Uses upward and downward communication between members of the group. •
Disperses decision making throughout the group. • Places emphasis on the group. • Does
not criticize.
21. 21. • Fiedler’s (1967), Contingency Approach, suggests that no one leadership style is ideal
for every situation. • Interrelationships between the group’s leader and its members were
most influenced by the manager’s ability to be a good leader.
22. 22. • Hersey and Blanchard (1977), developed a Situational Approach to leadership. •
Tridimensional leadership effectiveness model predicts which leadership style is most
appropriate in each situation on the basis of the level of the followers’ maturity. • As people
mature, leadership style becomes less task focused and more relationship oriented.
23. 23. • Burns (2003), suggest that both leaders and followers have the ability to raise each
other to higher levels of motivation and morality. There are two primary types of leaders in
management. • The traditional manager, concerned with the day-to-day operations, was
termed a transactional leader. • The manager who is committed, has a vision, and is able to
empower others with this vision was termed a transformational leader.
24. 24. TRANSACTIONAL LEADER Identifies common values Is a caretaker Inspires others with
vision Has long-term vision Looks at effects Empowers others TRANSFORMATI0NAL
LEADER Focuses on management tasks Is committed Uses trade-offs to meet goals Does
not identify shared values Examines causes Uses contingency reward
25. 25. Kouzes and Posner’s Five Practices for Exemplary Leadership
26. 26. Kouzes and Posner’s Five Practices for Exemplary Leadership
27. 27. Gardner (1990) asserted that integrated leader-managers possess six distinguishing
traits:
28. 28. THEORIST THEORY Aristotle Great Man theory Lewin and White Leadership styles
Fiedler Contingency leadership Hersey and Blanchard Situational leadership theory Burns
Transactional and transformational leadership Gardner The integrated leader-manager
29. 29. • Power is defined as the capacity to act or the strength and potency to accomplish
something. • The manager who is knowledgeable about the wise use of authority, power,
and political strategy is more effective at meeting personal, unit, and organizational goals.
30. 30. • Reward power is obtained by the ability to grant favors or reward others with whatever
they value. • Punishment or coercive power is based on fear of punishment if manager’s
expectations are not met. • Legitimate power is the power gained by a title or official position
within an organization. • Expert power is gained through knowledge, expertise, or
experience.
31. 31. • Referent power is power that a person has because others identify with that leader or
with what that leader symbolizes. Charismatic power is distinguished by some from referent
power. • Informational power is obtained when people have information that others must
have to accomplish their goals.
32. 32. MODES OF PLANNING DESCRIPTION Reactive occurs after a problem exists
Inactivism seek the status quo Preactivism utilize technology to accelerate change and are
future oriented Interactive or Proactive attempt to plan the future of their organization rather
than react to it
33. 33. • Forecasting involves trying to estimate how a condition will be in the future. • Takes
advantage of input from others, gives sequence in activity, and protects an organization
against undesirable changes.
34. 34. • Strategic planning examines an organization’s purpose, mission, philosophy, and goals
in the context of its external environment. • Complex organizational plans that involve a long
period (usually 3 to 10 years) are referred to as long- range or strategic plans.
35. 35. • SWOT Analysis, also known as TOWS Analysis, was developed by Albert Humphrey at
Stanford University in the 1960s and 1970s. SWOT definitions: • Strengths are those internal
attributes that help an organization to achieve its objectives. • Weaknesses are those internal
attributes that challenge an organization in achieving its objectives.
36. 36. SWOT definitions: • Opportunities are external conditions that promote achievement of
organizational objectives. • Threats are external conditions that challenge or threaten the
achievement of organizational objectives.
37. 37. • Vision statements are used to describe future goals or aims of an organization. • It
conjures up a picture for all group members of what they want to accomplish together. • An
organization will never be greater than the vision that guides it.
38. 38. • The mission statement is a brief statement identifying the reason that an organization
exists. • It identifies the organization’s constituency and addresses its position regarding
ethics, principles, and standards of practice.
39. 39. • The philosophy flows from the purpose or mission statement and delineates the set of
values and beliefs that guide all actions of the organization. • It is the basic foundation that
directs all further planning toward that mission. • The organizational philosophy provides the
basis for developing nursing philosophies at the unit level and for nursing service as a whole.
40. 40. • Goals and objectives are the ends toward which the organization is working. •
Objectives are similar to goals in that they motivate people to a specific end and are explicit,
measurable, observable or retrievable, and obtainable.
41. 41. • Policies are plans reduced to statements or instructions that direct organizations in their
decision making. • These explain how goals will be met and guide the general course and
scope of organizational activities.
42. 42. Policies also can be implied or expressed: • Implied policies, neither written nor
expressed verbally, have usually developed over time and follow a precedent. For example,
a hospital may have an implied policy that employees should be encouraged and supported
in their activity in community, regional, and national health-care organizations. • Expressed
policies are delineated verbally or in writing. Expressed policies may include a formal dress
code, policy for sick leave or vacation time, and disciplinary procedures.
43. 43. • Procedures are plans that establish customary or acceptable ways of accomplishing a
specific task and delineate a sequence of steps of required action. • Identify the process or
steps needed to implement a policy and are generally found in manuals at the unit level of
the organization.
44. 44. • Rules and regulations are plans that define specific action or nonaction. • Existing rules
should be enforced to keep morale from breaking down and to allow organizational structure.
45. 45. • Kurt Lewin (1951) identified three phases through which the change agent must
proceed before a planned change becomes part of the system: • Unfreezing occurs when the
change agent convinces members of the group to change or when guilt, anxiety, or concern
 can be elicited. • Movement, the change agent identifies, plans, and implements appropriate
strategies, ensuring that driving forces exceed restraining forces.
46. 46. • Refreezing phase, the change agent assists in stabilizing the system change so that it
becomes integrated into the status quo.
47. 47. Stages of change and responsibilities of the change agent: STAGE 1—UNFREEZING 1.
Gather data. 2. Accurately diagnose the problem. 3. Decide if change is needed. 4. Make
others aware of the need for change; do not proceed until the status quo has been disrupted
and the need for change is perceived by the others.
48. 48. Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 1.
Develop a plan. 2. Set goals and objectives. 3. Identify areas of support and resistance. 4.
Include everyone who will be affected by the change in its planning.
49. 49. Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 5.
Set target dates. 6. Develop appropriate strategies. 7. Implement the change. 8. Be available
to support others and offer encouragement through the change.
50. 50. Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 9.
Use strategies for overcoming resistance to change. 10. Evaluate the change. 11. Modify the
change, if necessary.
51. 51. Stages of change and responsibilities of the change agent: STAGE 3—REFREEZING 1.
Support others so that the change continues.
52. 52. • Edward Lorenz (1960s), discovered that even tiny changes in variables often
dramatically affected outcomes. • Even small changes in conditions can drastically alter a
system’s long-term behavior (butterfly effect).
53. 53. • A budget is a financial plan that includes estimated expenses as well as income for a
period of time. • Accuracy dictates the worth of a budget; the more accurate the budget
blueprint, the better the institution can plan the most efficient use of its resources.
54. 54. • Workforce or personnel budget largest of the budget expenditures because health care
is labor intensive. • Operating budget reflects expenses that change in response to the
volume of service, such as the cost of electricity, repairs and maintenance, and supplies. •
Capital budgets plan for the purchase of buildings or major equipment, which include
equipment that has a long life (usually greater than 5 to 7 years).
55. 55. • Formal structure, through departmentalization and work division, provides a framework
for defining managerial authority, responsibility, and accountability. • Roles and functions are
defined and systematically arranged, different people have differing roles, and rank and
hierarchy are evident.
56. 56. • Informal structure is generally a naturally forming social network of employees. • It is
the informal structure that fills in the gaps with connections and relationships that illustrate
how employees network with one another to get work done.
57. 57. • The organization chart defines formal relationships within the institution.
58. 58. • Top-level managers look at the organization as a whole, coordinating internal and
external influences, and generally make decisions with few guidelines or structures. • Middle-
level managers coordinate the efforts of lower levels of the hierarchy and are the conduit
between lower and top-level managers. • First-level managers are concerned with their
specific unit’s work flow.
59. 59. TOP LEVEL MID LEVEL FIRST LEVEL Chief nurse Unit supervisor Department head
Charge nurse Team leader Primary nurse Scope of responsibility Look at organization as a
whole as well as external influences Integrating unit- level day-to-day needs with
organizational needs Focus primarily on day-to-day needs at unit level
60. 60. TOP LEVEL MID LEVEL FIRST LEVEL Primary planning focus Strategic planning
Combination of long- and short- range planning Short-range, Operational planning
Communication flow Top-down but receives subordinate feedback both directly and via
middle-level managers Upward and downward with great centrality More often upward;
generally relies on middle level managers to transmit communication to top-level managers
61. 61. • Bureaucratic organizational designs are commonly called line structures or line
organizations. • Ad hoc design is a modification of the bureaucratic structure and is
sometimes used on a temporary basis to facilitate completion of a project within a formal line
organization. • Matrix organization structure focus on both product and function. Function is
described as all the tasks required to produce the product, and the product is the end result
of the function.
62. 62. MATRIX ORGANIZATION STRUCTURE
63. 63. • Service line organization, which can be used to address the shortcomings that are
endemic to traditional large bureaucratic organizations. • Flat organizational designs are an
effort to remove hierarchical layers by flattening the chain of command and decentralizing
the organization.
64. 64. FLAT ORGANIZATIONAL DESIGNS
65. 65. Traditional Patient Care Delivery Methods • Total patient care • Functional nursing •
Team and modular nursing • Primary nursing • Case management
66. 66. • Nurses assume total responsibility during their time on duty for meeting all the needs of
assigned patients. • Sometimes referred to as the case method of assignment because
patients may be assigned as cases.
67. 67. • Functional nursing is efficiency-based; tasks are completed quickly, with little confusion
regarding responsibilities. • Allow care to be provided with a minimal number of RNs.
68. 68. • Ancillary personnel collaborate in providing care to a group of patients under the
direction of a professional nurse. • As the team leader, the nurse is responsible for knowing
the condition and needs of all the patients assigned to the team and for planning individual
care.
69. 69. • Modular nursing uses a mini-team (two or three members with at least one member
being an RN), with members of the modular nursing team sometimes being called care pairs.
• Patient care units are typically divided into modules or districts and assignments are based
on the geographical location of patients.
70. 70. • The primary nurse assumes 24-hour responsibility for planning the care of one or more
patients from admission or the start of treatment to discharge or the treatment’s end. • During
work hours, the primary nurse provides total direct care for that patient. • When the primary
nurse is not on duty, associate nurses, who follow the care plan established by the primary
nurse, provide care.
71. 71. • A collaborative process of assessment, planning, facilitation and advocacy for options
and services to meet an individual’s health needs through communication and available
resources to promote quality cost-effective outcomes. • Nurses address each patient
individually, identifying the most cost-effective providers, treatments, and care settings
possible.
72. 72. • The leader-manager recruits, selects, places, and indoctrinates personnel to
accomplish the goals of the organization.
73. 73. 1. Determine the number and types of personnel needed to fulfill the philosophy, meet
fiscal planning responsibilities, and carry out the chosen patient care delivery system
selected by the organization. 2. Recruit, interview, select, and assign personnel based on
established job description performance standards.
74. 74. 3. Use organizational resources for induction and orientation. 4. Ascertain that each
employee is adequately socialized to organization values and unit norms. 5. Use creative
and flexible scheduling based on patient care needs to increase productivity and retention.
75. 75. • Is the process of actively seeking out or attracting applicants for existing positions and
should be an ongoing process. • A leadership role in staffing includes identifying, recruiting,
and hiring gifted people.
76. 76. • Is the process of choosing from among applicants the best-qualified individual or
individuals for a particular job or position. • Involves verifying the applicant’s qualifications,
checking his or her work history, and deciding if a good match exists between the applicant’s
qualifications and the organization’s expectations.
77. 77. • The nurse leader is able to assign a new employee to a position within his or her
sphere of authority, where the employee will have a reasonable chance for success. • Proper
placement fosters personal growth, provides a motivating climate for the employee,
maximizes productivity, and increases the probability that organizational goals will be met.
78. 78. • Planned, guided adjustment of an employee to the organization and the work
environment. • Induction, the first phase of indoctrination includes all activities that educate
the new employee about the organization and employment and personnel policies and
procedures.
79. 79. • Orientation activities are more specific for the position. • The purpose of the orientation
process is to make the employee feel like a part of the team. • This will reduce burnout and
help new employees become independent more quickly in their new roles.
80. 80. • The better trained and more competent the staff, the fewer the number of staff required,
which in turn saves the organization money and increases productivity. • Staff development
activities are normally carried out for one of three reasons: to establish competence, to meet
new learning needs, and to satisfy interests the staff may have in learning in specific areas.
81. 81. • Socialization refers to a learning of the behaviors that accompany each role by
instruction, observation, and trial and error. • Resocialization occurs when individuals are
forced to learn new values, skills, attitudes, and social rules as a result of changes in the
type of work they do, the scope of responsibility they hold, or in the work setting itself.
82. 82. • Centralized staffing, where staffing decisions are made by personnel in a central office
or staffing center. • Decentralized staffing, the unit manager is often responsible for covering
all scheduled staff absences, reducing staff during periods of decreased patient census or
acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules.
83. 83. UNIT STAFFING RATIO Critical care/ICU 1:2 Operating room 1:1 Labor and delivery 1:2
Antepartum 1:4 Pediatrics 1:4 Medical–surgical 1:5 Emergency department 1:4 National
Nurses United (2010–2013). RN to patient ratios. Retrieved June 9, 2013
84. 84. Category I Self care 1 – 2 hours of nursing care/day Category II Minimal care 3 – 4 hours
of nursing care/day Category III Intermediate care 5 – 6 hours of nursing care/day Category
IV Modified intensive care 7 – 8 hours of nursing care/day Category V Intensive care 10 – 14
hours of nursing care/day
85. 85. National League for Nurses Formula for Staffing Where: ABO = Average Bed Occupancy
NCH = Nursing Care Hours No. of working hours: 8 Based on RA 5901 The 40 working
hours per week law ABO X NCH No. of working hours Total no. of nursing service personnel
for 24 hours= Standard values for NCH: Medical = 3.4 OB = 3.0 Surgical = 3.4 Pedia = 4.6
Mixed MS = 3.5 Nursery = 2.8
86. 86. Percentage of Professionals to Non-Professionals Percentage of Distribution per Shift
Morning - 45% Afternoon - 37% Night - 18% Professionals - 60% Non-Professionals - 40%
87. 87. Staffing for an OB Ward: 30-bed capacity Percentage of Professionals to Non-
Professionals
88. 88. Staffing for an OB Ward: 30-bed capacity 30 x 3.0 8 11 nursing service personnel for 24
hours= Percentage of Professionals to Non-Professionals Professionals - 60% x 11 = 7 Non-
Professionals - 40% x 11 = 4
89. 89. Distribution per Shift SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS AM AM
PM PM NOC NOC
90. 90. Distribution per Shift SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS AM 7 X
0.45 = 3 AM 4 X 0.45 = 2 PM 7 X 0.37 = 3 PM 4 X 0.37 = 1 NOC 7 X 0.18 = 1 NOC 4 X 0.18
=1
91. 91. • Motivation is the force within the individual that influences or directs behavior. • Leaders
should apply techniques, skills, and knowledge of motivational theory to help workers
achieve what they want out of work.
92. 92. INTRINSIC EXTRINSIC Comes from within the individual Comes from outside the
individual Often influenced by family unit and cultural values Rewards and reinforcements
are given to encourage certain behaviors and/or levels of achievement
93. 93. Maslow’s Hierarchy of Needs and Theory of Human Motivation • Maslow (1970), people
are motivated to satisfy certain needs, from basic survival to complex psychological needs,
and people seek a higher need only when the lower needs have been met.
94. 94. Operant Conditioning and Behavior Modification • Skinner (1953) demonstrated that
people could be conditioned to behave in a certain way based on a consistent reward or
punishment system.
95. 95. Herzberg’s Two-Factor Theory • Frederick Herzberg (1977) believed that employees can
be motivated by the work itself and that there is an internal or personal need to meet
organizational goals.
96. 96. Vroom’s Expectancy Model • Victor Vroom (1964), looks at motivation in terms of the
person’s valence, or preferences based on social values. • A person’s expectations about his
or her environment or a certain event will influence behavior.
97. 97. McClellands’s Three Basic Needs • David McClelland (1971) examined what motives
guide a person to action.
98. 98. McClellands’s Three Basic Needs • Achievement-oriented people actively focus on
improving what is; they transform ideas into action, judiciously and wisely, taking risks when
necessary.
99. 99. McClellands’s Three Basic Needs • Affiliation-oriented people focus their energies on
families and friends; their overt productivity is less because they view their contribution to
society in a different light from those who are achievement oriented.
100. 100. McClellands’s Three Basic Needs • Power-oriented people are motivated by the
power that can be gained as a result of a specific action. They want to command attention,
get recognition, and control others.
101. 101. McGregor’s Theory X and Theory Y • Douglas McGregor (1960) examined the
importance of a manager’s assumptions about workers on the intrinsic motivation of the
workers.
102. 102. • Communication is “the exchange of thoughts, messages, or information, by
speech, signals, writing, or behavior.” • Occur on at least two levels: verbal and nonverbal.
103. 103. Internal climate Includes internal factors such as the values, feelings,
temperament, and stress levels of the sender and the receiver External climate Includes
external factors such as the weather, temperature, timing, status, power, authority, and the
organizational climate itself
104. 104. • Upward communication, the manager is a subordinate to higher management.
• Downward communication, the manager relays information to subordinates. • Horizontal
communication, managers interact with others on the same hierarchical level as themselves
who are managing different segments of the organization.
105. 105. • Diagonal communication, the manager interacts with personnel and managers
of other departments and groups who are not on the same level of the organizational
hierarchy. • Grapevine communication flows quickly and haphazardly among people at all
hierarchical levels and usually involves three or four people at a time.
106. 106. • Assertive communication allows people to express themselves in direct,
honest, and appropriate ways that do not infringe on another person’s rights. • Passive
communication occurs when a person suffers in silence although he or she may feel strongly
about the issue.
107. 107. • Aggressive communication is generally direct, threatening, and
condescending.
108. 108. • Passive–aggressive communication is an aggressive message presented in a
passive way. This person feigns withdrawal in an effort to manipulate the situation.
109. 109. S SITUATION Introduce yourself and the patient and briefly state the issue that
you want to discuss B BACKGROUND Describe the background or context (patient’s
diagnosis, admission date, medical diagnosis, and treatment to date) A ASSESSMENT
Summarize the patient’s condition and state what you think the problem is R
 RECOMMENDATION Identify any new treatments or changes ordered and provide opinions
or recommendations for further action
110. 110. • The leader who actively listens gives genuine time and attention to the sender,
focusing on verbal and nonverbal communication. • The leader must continually work to
improve listening skills by giving time and attention to the message sender.
111. 111. G GREETING Offer greetings and establish positive environment R
RESPECTFUL LISTENING Listen without interrupting and pause to allow others to think R
REVIEW Summarize message to make sure it was heard accurately R RECOMMEND OR
REQUEST MORE INFORMATION Seek additional information as necessary R REWARD
Recognize that a collaborative exchange has occurred by offering thanks
112. 112. 1. Nurses must not transmit or place online individually identifiable patient
information. 2. Nurses must observe ethically prescribed professional patient–nurse
boundaries. 3. Nurses should understand that patients, colleagues, institutions, and
employers may view postings. AmericanNurses Association. (2011, September). Principles
for social networking and the nurse.
113. 113. 4. Nurses should take advantage of privacy settings and seek to separate
personal and professional information online. 5. Nurses should bring content that could harm
a patient’s privacy, rights, or welfare to the attention of appropriate authorities. 6. Nurses
should participate in developing institutional policies governing online conduct.
AmericanNurses Association. (2011, September). Principles for social networking and the
nurse.
114. 114. • Delegation is getting work done through others or as directing the performance
of one or more people to accomplish organizational goals. • The mark of a great leader is
when he or she can recognize the excellent performance of someone else and allow others
to shine for their accomplishments.
115. 115. • Right task • Right circumstances • Right person • Right
direction/communication • Right level of supervision American Nurses Association (ANA) and
the National Council of State Boards of Nursing (NCSBN)
116. 116. 1. Frequently recur in the daily care of a client or group of clients 2. Are
performed according to an established (standardized) sequence of steps 3. Involve little or
no modification from one client-care situation to another 4. May be performed with a
predictable outcome North Carolina Board of Registered Nursing (2013)
117. 117. 5. Do not inherently involve ongoing assessment, interpretation, or decision
making which cannot be logically separated from the procedure(s) itself 6. Do not endanger
the health or well-being of clients 7. Are allowed by agency policy/procedures North Carolina
Board of Registered Nursing (2013)
118. 118. • Conflict is generally defined as the internal or external discord that results from
differences in ideas, values, or feelings between two or more people. • Conflict is neither
good nor bad, and it can produce growth or destruction, depending on how it is managed.
119. 119. • Intergroup conflict occurs between two or more groups of people,
departments, and organizations. • Intrapersonal conflict occurs within the person. It involves
an internal struggle to clarify contradictory values or wants. • Interpersonal conflict happens
between two or more people with differing values, goals, and beliefs and may be closely
linked with bullying, incivility, and mobbing.
120. 120. • Bullying is repeated, offensive, abusive, intimidating, or insulting behaviors;
abuse of power; or unfair sanctions that make recipients feel humiliated, vulnerable, or
threatened, thus creating stress and undermining their self-confidence (Townsend, 2012). •
Incivility is behavior that lacks authentic respect for others that requires time, presence,
willingness to engage in genuine discourse and intention to seek common ground (Clark,
2010).
121. 121. • Mobbing occurs when employees “gang up” on an individual. • When bullying,
incivility, and mobbing occur in the workplace, this is known as workplace violence.
122. 122. Compromising each party gives up something it wants Competing one party
pursues what it wants at the expense of the others Cooperating one party sacrifices his or
her beliefs and allows the other party to win Smoothing one party in a conflict attempts to
pacify the other party or to focus on agreements rather than differences
123. 123. Avoiding parties involved are aware of a conflict but choose not to acknowledge
it or attempt to resolve it Collaborating all parties set aside their original goals and work
together to establish a supraordinate or priority common goal
124. 124. • Each party gives up something, and the emphasis is on accommodating
differences between the parties. • The very least for which a person will settle is often
referred to as the bottom line. • Negotiation is psychological and verbal. The effective
negotiator always appears calm and self-assured.
125. 125. • Collective bargaining involves activities occurring between organized labor and
management that concern employee relations. • Management that is perceived to be deaf to
the workers’ needs provides a fertile ground for union organizers, because unions thrive in a
climate that perceives the organizational philosophy to be insensitive to the worker.
126. 126. • Time management is making optimal use of available time. • Good time
management skills allow an individual to spend time on things that matter.
127. 127. 1. Technology (Internet, gaming, e-mail, and social media sites) 2. Socializing 3.
Paperwork overload 4. A poor filing system 5. Interruptions
128. 128. • Quality control refers to activities that are used to evaluate, monitor, or
regulate services rendered to consumers. • Health-care quality is the degree to which health
services for individuals and populations increase the likelihood of desired health outcomes
and are consistent with current professional knowledge.
129. 129. Hallmarks of effective quality control programs: 1. Support from top-level
administration. 2. Commitment by the organization in terms of fiscal and human resources. 3.
Quality goals reflect search for excellence rather than minimums. 4. Process is ongoing
(continuous).
130. 130. • Audit is a systematic and official examination of a record, process, structure,
environment, or account to evaluate performance. • Auditing in health-care organizations
provides managers with a means of applying the control process to determine the quality of
services rendered.
131. 131. • Retrospective audits are performed after the patient receives the service. •
Concurrent audits are performed while the patient is receiving the service. • Prospective
audits attempt to identify how future performance will be affected by current interventions.
132. 132. • Outcome audits reflect the end result of care or how the patient’s health status
changed as a result of an intervention. • Process audits are used to measure the process of
care or how the care was carried out and assume that a relationship exists between the
process used by the nurse and the quality of care provided. • Structure audit includes
resource inputs such as the environment in which health care is delivered.
133. 133. • Total Quality Management, also referred to as continuous quality improvement
(CQI), is a philosophy developed by Dr. W. Edward Deming. • The individual is the focal
element on which production and service depend (i.e., it must be a customer-responsive
environment) and that the quest for quality is an ongoing process.
134. 134. • Toyota Production System is a production system built on the complete
elimination of waste and focused on the pursuit of the most efficient production method
possible. • Health-care organizations that use TPS would have caregivers not only attempt to
directly solve problems at the time they occur, but it would also have them determine the root
cause of the problem, so that the likelihood of the problem recurring would be minimized.
135. 135. • Performance appraisals let employees know the level of their job performance
as well as any expectations that the organization may have of them. • If employees believe
that the appraisal is based on their job description rather than on whether the manager
approves of them, they are more likely to view the appraisal as relevant.
136. 136. Trait rating scales Rates an individual against some standard. Job dimension
scales Rates the performance on job requirements. Behaviorally anchored rating scales
Rates desired job expectations on a scale of importance to the position. Checklists Rates the
performance against a set list of desirable job behaviors.
137. 137. Essays A narrative appraisal of job performance. Self-appraisals An appraisal of
performance by the employee. Management by objectives Employee and management
agree upon goals of performance to be reached. Peer review Assessment of work
performance carried out by peers.
138. 138. • Be specific, not general, in describing behavior that needs improvement. • Be
descriptive, not evaluative, when describing what was wrong with the work performance. •
Be certain that the feedback is not self-serving but meets the needs of the employee. • Direct
the feedback toward behavior that can be changed.
139. 139. • Use sensitivity in timing the feedback. • Make sure that the employee has
clearly understood the feedback and that the employee’s communication has also been
clearly heard.
140. 140. 1. Safe & quality nursing practice 2. Management of resources & environment 3.
Health education 4. Legal responsibility 5. Ethico – moral responsibility 6. Personal &
professional development 7. Quality improvement
141. 141. 8. Research 9. Record management 10. Communication 11. Collaboration &
teamwork
142. 142. Legal bases: • Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002” •
Board shall monitor & enforce quality standards of nursing practice necessary to ensure the
maintenance of efficient, ethical and technical, moral and professional standards in the
practice of nursing taking into account the health needs of the nation.
143. 143. Significance of core competency standards: • Unifying framework for nursing
practice, education, regulation • Guide in nursing curriculum development • Framework in
developing test syllabus for nursing profession entrants • Tool for nurses’ performance
evaluation
144. 144. Significance of core competency standards: • Basis for advanced nursing
practice, specialization • Framework for developing nursing training curriculum • Public
protection from incompetent practitioners • Yardstick for unethical, unprofessional nursing
practice
145. 145. • The Benner Model is designed to emphasize the skill acquisition of health care
professionals (Benner, 2001).
146. 146. • Novice, a new practitioner’s practice is driven by rules and tends to provide
task focused care. • Advanced beginners, providers have developed safe practice but lack a
strong knowledge base to found their practice and management skills. • Competent provider,
NPs will find they can prioritize and begin to use past experiences to form their care.
147. 147. • Proficient providers have a good sense of what their patient situation is and
can prioritize needs and routinely predict accurate outcomes. • Expert providers, NPs are
confident, have an extensive knowledge base and will be able to quickly grasp complex
patient situations.
148. 148. ADVANCED PRACTICE NURSE (APN) • The most independent functioning
nurse. • Has a master’s degree in nursing, advanced education in pharmacology and
physical assessment, and certification and expertise in specialized area of practice.
149. 149. CLINICAL NURSE SPECIALIST • Nursing expertise in a specialized area of
practice (medical-surgical nursing, psychiatric and mental health nursing, pediatric nursing,
community health nursing, gerontologic nursing).
150. 150. NURSING ADMINISTRATOR • Manages client care and the delivery of specific
nursing services within a health care agency. • Begins with positions such as the charge
nurse or assistant nurse manager, then nurse manager of a specific patient care area.
151. 151. NURSE RESEARCHER • Investigates problems to improve nursing care and to
further define and expand the scope of nursing practice. • Employed in an academic setting,
hospital, or independent professional or community service agency.
152. 152. SCHOOL HEALTH NURSE Goal – Superior educational success by enhancing
school health.
153. 153. SCHOOL HEALTH NURSE Functions: • Direct caregiver • Case finder •
Consultant • Counselor • Health Educator • Researcher
154. 154. OCCUPATIONAL HEALTH NURSE • Specialty practice that provides for and
delivery of health and safety programs and services to workers, worker population and
community groups.
155. 155. OCCUPATIONAL HEALTH NURSE Functions: • Promotion and restoration of
health • Prevention of illness and injury and • Protection from work related and environmental
hazards.
156. 156. PARISH NURSE • The role that gathers in churches, cathedrals, temples,
mosques, and acknowledge common faith traditions. • Respond to health an wellness needs
within the context of populations of faith community.
157. 157. PARISH NURSE Functions: • Provider of spiritual care • Health Counselor •
Health Advocate • Health Educator • Facilitator of Support Groups • Trainer or Volunteers •
Liaison to community resources and referral agent.
158. 158. PUBLIC HEALTH NURSE • A registered nurse with special training community
health.
159. 159. PUBLIC HEALTH NURSE Function: • Health Advocate • Care Manager •
Referral Resource • Health Educator • Direct Primary Caregivers • Communicable Disease
Control • Disaster Preparedness
160. 160. PRIVATE DUTY NURSE • A registered nurse or a licensed practical nurse who
provide nursing services to patients at home or any other setting in accordance with
physician orders.
161. 161. HOME CARE NURSE • A nurse who provides periodic care to patients within
their home environment as ordered by the physician.
162. 162. HOME CARE NURSE Functions: • Health Maintenance • Education • Illness
Prevention • Diagnosis and treatment of disease. • Palliation and rehabilitation.
163. 163. HOSPICE NURSE • Provides a family centered care and allows clients to live
and remain at homes with comfort, independence and dignity, while alleviating the strains
caused by terminal phase i.e. at the time of death.
164. 164. HOSPICE NURSE Function: • Pain & symptom control. • Spiritual Care • Home
Care and impatient Care • Family Conferences • Co-ordination of Care • Bereavement Care
165. 165. REHABILITATION NURSE • A nurse who specializes in assisting persons with
disabilities and chronic illness to attain optimal function, health and adapt to an altered life
style.
166. 166. NURSE EPIDEMIOLOGIST • Monitors standards and procedures for the control
and prevention of infectious diseases and other conditions of public health significance
including nosocomial infections.
167. 167. • Ang Nars • Association of Deans of Philippine Colleges of Nursing (ADPCN) •
Association of Diabetes Nurse Educators of the Philippines (ADNEP) • Association of
Nursing Service Administrators of the Philippines (ANSAP)
168. 168. • Association of Private Duty Nurse Practitioners Philippines (APDNPP) •
Critical Care Nurses Association of the Philippines (CCNAPI) • Gerontology Nurses
Association of the Philippines (GNAP) • Military Nurses Association of the Philippines
(MNAP)
169. 169. • Mother and Child Nurses Association of the Philippines (MCNAP) • National
League of Philippine Government Nurses (NLPGN) • Occupational Health Nurses
Association of the Philippines (OHNAP) • Operating Room Nurses Association of the
Philippines (ORNAP)
170. 170. • Philippine Hospital Infection Control Nurses Association (PHICNA) • Philippine
Nurses Association (PNA) • Philippine Nursing Informatics Association (PNIA) • Philippine
Nursing Research Society (PNRS) • Philippine Oncology Nurses Association (PONA) •
Philippine Society of Emergency Care Nurses (PSECN)
171. 171. • Renal Nurses Association of the Philippines (RENAP) • Society of
Cardiovascular Nurse Practitioners of the Philippines (SCVNPPI) • Philippine Association of
Public Health Nursing Faculty • Psychiatric Nursing Specialists Foundation of the Philippines
• Integrated Registered Nurses of the Philippines (IRNUP)
172. 172. Nursing is to nurture and care... patient's life is in our hands, so love our
profession... ITS A CALLING!
173. 173. Marquis, B. L., & Huston, C. J. (2011). Leadership Roles and Management
Functions in Nursing: Theory and Application. Philadelphia: Wolters Kluwer Health/Lippincott
Williams & Wilkins.