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Leadership and Management abilities, and reward each one’s merit w/o arousing

Ma. Irma C. Bustamante, RN, PhD jealousies and disturbing harmonious relations.
Definitions Theories of Management
Leadership is the ability to influence people. • Frederick Taylor: Theory of Scientific
Management is the process of getting work done Management states that work should be studied
through others. scientifically to determine the method of task
Comparison performance that would yield maximum work output
LEADER MANAGER with minimum work expenditure.
• May not have • Have assigned position • Henri Fayol: 14 Principles of Management
delegated authority. within organizations • Max Weber: Theory of Social and Economic
• Obtains power • Obtain power through Organization advocated bureaucracy
through influence delegated authority
• Mary Follett: emphasized training and suggested
• Possess a wide • Expected to carry out that manager and employees should analyze the
variety of roles specific functions situation and take orders from the situation.
• May not be a part of • Always a part of the
• Elton Mayo & Fritz Roethlisberger: much more
the formal formal organization
than the physical environment affects work
organization • Emphasize control, productivity. Factors such as support from fellow
• Focus on group decision making, workers, norms established by work group,
process, information decision analysis & opportunity to participate in decision making &
gathering, feedback, results. recognition are important.
& empowering others. • Manipulate people and
• Kurt Lewin: Field Theory of Human Behavior
• Emphasize resources to achieve
describes the process of attitude and behavior
interpersonal goals
change which are unfreezing, changing, and
relationships • Direct willing and refreezing.
• Direct willing unwilling subordinates
followers • Have greater formal
• Douglas McGregor: Theory X and Theory Y.
Theory X assumes that the average individual
• Have goals that may responsibility &
dislikes work & will avoid it, prefers to be directed, &
or may not reflect the accountability for
more interested in financial than personal gains
formal organization control
therefore they must be force & threatened. Theory Y
assumes that work is as natural as play, workers
have self control and self direction, and accepts
14 Management Principles
Henri Fayol
1. Division of work: allows specialization. Individuals • Frederick Herzberg: Two-factor Theory identified
two factors which motivate employees. Motivators or
build up experience and improve their skills making
satisfiers include achievements, recognition,
them more productive.
possibility for growth, and status. Hygiene or
2. Authority: right to command balanced with
maintenance factors or dissatisfiers are salary,
responsibility and accountability
supervision, job security, working conditions, and
3. Discipline: employees will only obey orders if interpersonal relations.
management play their part by providing good
• Chris Argyris: The rigid structure and stringent
rules of bureaucracy block normal maturational
4. Unity of command: there should only be one boss changes and encourages passivity & dependency
with no conflicting lines of command. therefore diminishing job satisfaction.
5. Unity of direction: people engaged in the same
• Rensis Likert: System 4 Approach to
kind of activities must have the same objectives in a
Organizational Development – superiors and
single plan.
subordinates demonstrate trust in each other,
6. Subordination of individual interest to general information flows freely, group participation,
interest: the goals of the firms are always decisions made at all levels
• Herbert Simon: Two approaches to decision
7. Remuneration: payment is an important motivator. making – Optimizing approach used by the
8. Centralization or Decentralization: this depends economic man where he seeks to achieve the
on the condition of the business and the quality of its greatest possible gain from each management
personnel decision. Satisficing approach used by the
9. Scalar chain/line of authority: refers to the number administrative man where one looks not at the best
of levels in the hierarchy. It should not be over solution to a problem but one that is good enough.
stretched and consist of too many levels • Alvin Toffler: emphasized the increasing speed of
10. Order: both material order (minimizes lost time & change and the too rapid arrival of the future leading
useless handling of materials) and social order to “future shock”, a physical and psychological
(achieved through organization and selection) are distress process. People must design personal and
necessary. change regulators to decelerate change by
11. Equity: a combination of kindness and justice is modifying reactions.
needed. Employees should be treated well to • Henry Mintzberg: identified the manager’s roles as
achieve equity. interpersonal, informational, and decision roles.
12. Stability of tenure of personnel: job security and • William Ouchi: Theory Z involves lifetime
career progress are important for employees to work employment, collective decision making, decision
better. High turnover affects the organization from within, non-specialized career paths.
13. Initiative: allow personnel to show their initiative, it Management Process
may be a source of strength for the organization. Planning: thinking ahead and making future projections
14. Esprit de corps: management should foster the to achieve desired results. It involves:
moral of employees. There is a need to coordinate 1. Forecasting
effort, encourage keenness, use each person’s 2. Setting objectives
3. Developing schedules and programs A value is a quality having intrinsic worth for a society or
4. Preparing budgets and allocating resources an individual.
5. Establishing policies and procedures
Vision provides a picture of the future. It is an
Management Process imagination or a dream.
Organizing: establishing formal authority. It involves: Healthy visions:
1. Setting up the organizational structure 1. Stretch the possible
2. Determining the staff needed 2. Are grounded in reality
3. Developing job descriptions 3. Require courage
4. Are based on sound values and ethics
Directing or leading: actuating efforts to accomplish
goals. It involves: Goals and objectives are the ends toward which the
1. Decision making organization is working. All philosophy must be
2. Developing people translated into goals and objectives if they are to result
3. Communicating into action. Thus, goals and objectives operationalize the
4. Coordinating philosophy.
5. Supervising
6. Utilizing, revising, & updating policies A goal is the desired result toward which effort is
7. Delegating directed.
8. Conflict management
Objectives motivate people to specific end and are
Controlling: assessing and regulating performances. It explicit, measureable, observable,retrievable and
involves: attainable.
1. Specifying criteria and standards
2. Monitoring and evaluating. Example: BON Mission
3. Performance appraisal MISSION
4. Total quality management The BON shall unwaveringly pursue the
advancement of nursing development in the country
1. Providing leadership, information, options,
PLANNING scenarios and lobby efforts to targeted
Ma. Irma C. Bustamante, RN, PhD decision makers and stakeholders
2. Ensuring adherence to professional, ethical
Planning is deciding in advance what to do; who is to do and legal standards as mandated by existing
it; and how, when, and where it is to be done. regulatory laws
3. Unifying the nursing sector through good
Planning Together governance
4. Fostering linkages with the domestic and
Kinds of planning international stakeholders
Strategic planning or long range planning extends from Example: BON Core Values
3 – 5 years. CORE VALUES
1. Love of God
Operational planning or short range planning extends 2. Caring as the core of
from a few months to a year. nursing
Strategic planning Compassion
Purposes – It clarifies the following: Confidence
1. Beliefs and values Conscience
2. Strengths and weaknesses Commitment
3. Opportunities and threats Example: BON Core Values
4. Direction of the organization CORE VALUES
EFFICIENCY 3. Love of People
Respect for the dignity of persons regardless of
Strategic planning process race, color, or creed
Situational analysis 4. Love of Country
Development of: Patriotism
1. Purpose or mission statement Civic duty, social responsibility
2. Philosophy and good governance
3. Vision Preservation and enrichment of our
4. Goals culture and environment
5. Objectives Example: BON Vision
Organizations exist for a purpose. The mission is a The Board of Nursing under the guidance of the
brief statement identifying the reason why an Almighty, with its unquestionable integrity and
organization exists and its future aim or function. This commitment, envisions itself to be the ultimate
statement identifies the organization’s constituency and authority in regulating the nursing profession in the
addresses its position regarding ethics, principles, and Philippines and to lead nursing development to its
standards of practice. highest level of excellence.

The philosophy flows from the mission statement and Forecasting

delineates the set of values and beliefs that guide all Forecasting is estimating the future.
actions of the organization. It is the basic foundation that It is setting the outline of work to be done.
directs all further planning towards the mission. It is the primary process of selecting and relating facts,
making use of assumptions regarding the future, and
formulating activities necessary to achieve the desired number of products or service units to be generated,
results. based on this, the cost per unit can be determined and
the budget projected.
Policies are plans reduced to statements or instructions Performance based budgeting (PBB): use statements
that direct organizations in their decision making. of missions, goals and objectives to explain why the
They are derived from the organization’s philosophy, money is being spent. It is a way to allocate resources to
goals, and objectives. achieve specific objectives based on program goals and
They direct individual behavior towards the measured results. The elements are:
organizational mission and define broad limits. 1. Result: the final outcome
It provides management with a means of internal control. 2. Strategy: ways to achieve the final outcome
3. Activity/outputs: what is actually done to achieve the
Policies final outcome.
Implied policies are neither written nor expressed
verbally. They are developed over time and follow a Zero based budgeting (ZBB): a method where all
precedent. expenses must be justified for each new period. It starts
from a "zero base" and every function within an
Expressed policies are delineated verbally or in writing. organization is analyzed for its needs and costs.
They promote consistency of actions. Budgets are then built around what is needed for the
upcoming period, regardless of whether the budget is
Procedures higher or lower than the previous one.
Procedures are plans that establish customary or
acceptable ways of accomplishing a specific task and Allocation of resources
delineate a sequence of steps of required action. Allocation of resources involves the minimal use of
They identify the process needed to implement the money, manpower, materials, machines, space and time
policy. (moment) to get the job done in a specified period.
They are found in manuals of the organization.
Cost effectiveness
Programs Cost effectiveness is the result of careful fiscal
A program is a planned sequence and combination of planning.
activities designed to achieve specified goals. It does not mean inexpensive.
It normally involve: equipment, materials, money, It means getting the most for your money or that the
personnel, and time. product is worth the price.
The term project is often used interchangeably with A beautiful quote
program in the academic circle. Even the most rational approach
is defenseless
Budget if there isn’t the will to do what is right.
A budget is an itemized summary of probable expenses Aleksandr Isayevich
and income for an organization over a period of time. Solzhenitsyn
The outcome of budgeting is maximal use of resources Russian Novelist
to meet organizational short and long term needs. Nobel Prize in
Literature (1970)
Types of budgets
Personnel budget: expenditure used for the work force
Operating budget: reflects expenses that change in Ma. Irma C. Bustamante, RN, PhD
response to the volume of service. It includes daily
expenses, cost of electricity, repairs, maintenance, and Organizational structure
supplies. An organizational structure refers to the way a group
is formed, its lines of communication, and its means for
Capital expenditure budget is composed of major channeling authority, and making decisions.
actuations and short term budgeting components. Each organization has a formal and an informal
Examples are purchase of buildings, major equipments organizational structure.
that has long life (5 to 7 years).
The formal structure is generally highly planned and
Types of budget system publicized.
Centralized budgeting: budgets are derived and It provides a framework for defining managerial
imposed by the comptroller and administration of the authority, responsibility, and accountability.
organization. Roles and functions are defined and systematically
arranged, different people have different roles, rank and
Decentralized budgeting: budgets are prepared by hierarchy are evident.
those who must implement them e.g. middle level
managers. Informal structure is generally social in nature with
blurred or shifting lines of authority and accountability.
Approaches to budget development People need to be aware that informal authority and
Open-ended budget: managers are given no explicit lines of communication exist in every group, even when
guidelines regarding budget amounts and are allowed to they are never formally acknowledged.
submit whatever amounts they consider necessary to
run the department. Types of organizational structures
Bureaucratic organizational designs are commonly
Fixed-ceiling budget: is constrained by the amount that called line structures or line organizations.
is specifically stated for each department Authority and responsibility are clearly defined which
leads to efficiency and simplicity of relationships.
Work measurement and unit costing: requires that a Bureaucratic structure
measuring criterion be established to determine the
Types of organizational structures It includes in-service, courses, conferences, seminars,
The ad hoc design is a modification of the bureaucratic journal and book clubs, programmed learning, and
structure and is sometimes used on a temporary basis to independent studies.
facilitate completion of a project within a formal line
organization. In-service training is the education for employees to help
It is a means of overcoming the inflexibility of line them develop their skills in a specific discipline or
structure and serves as a way for professionals to occupation.
handle the increasingly large amount of information. Continuing education refers to the post college
education that individuals engage in to enhance their
A hierarchical organizational structure is a pyramid professional growth.
shaped systems that arranges the relations between the
entities within an organization in a top-down way. Staffing
Power, responsibility, and authority are concentrated at Some turnover is normal and may be desirable because
the top of the pyramid and decisions flow from the top it infuses the organization with fresh ideas.
downwards. Excessive and unnecessary turnover is expensive and
may reduce the ability of the organization to achieve its
Hierarchical/Pyramidal goals.

A matrix organization structure is designed to focus on Retention may be enhanced if there is a close fit
both product and function. between what the nurse is seeking in employment and
Function is described as all the tasks required to what the organization can offer.
produce the product.
The product is the end result of the function. Nursing care delivery
Typical Matrix Structure Case method: each patient is assigned to a nurse for
Matrix Organization total patient care while that nurse is on duty.
Functional nursing: involves regimentation of tasks or
Flat organizational designs are an effort to remove functions.
hierarchal layers by flattening the scalar chain and Team nursing: utilizes the knowledge and skills of
decentralizing the organization. professional nurses to supervise auxiliary nursing staff at
More decision making and authority can occur where the different levels.
work is being carried out.
Flat Organizational Structure Primary nursing: features a nurse who gives total
patient care to 4 – 6 patients while she is on duty and
Shared governance’s aim is the empowerment of remains responsible for the care of those patients 24/7
people in the decision-making system. throughout the patient’s hospitalization.
The organization’s governance is shared among board Private duty nursing: nurses provide total patient care
members, nurses, physicians, and managers. while on duty to patients who directly pay them for
Participatory management is the foundation for shared professional services.
Nurse case manager: works to ensure that quality
Staffing health care is being delivered in an efficient, cost-
Staffing is the process of determining and providing the effective manner to individual patients as they move
acceptable number and mix of nursing personnel to from setting to setting within the health care system. A
produce a desired level of care to meet the patient’s Nurse Case Manager usually specializes in the delivery
demands. of care to a specific population, such as adults, families,
children, the elderly, AIDS patients, patients with
Staffing involves the selection of personnel and cardiovascular disease, etc.
assignment systems and the determination of staffing
It involves recruitment, selection, orientation, personnel The primary role of a case manager is to coordinate the
development, retention, and retirement. (in lay man’s continuity of care and to ensure that patients get the
terms it is from hiring to firing) proper treatment at the proper time to maximize health
and minimize hospitalization.
Recruitment is the process of actively seeking out or
attracting applicants for existing positions. Clinical pathways delineate a predetermined written
A leadership role in staffing includes identifying, plan of care for a particular health problem. They specify
recruiting, and hiring gifted people. desired outcomes and transdisciplinary intervention.
Patient classification system
Selection is the process of choosing from among
applicants the best qualified individual (s) for a particular Category I – Self care: requires 1 – 2 hours of nursing
job or position. care/day
This happens after the applications were completed and Category II – Minimal care: requires 3 – 4 hours of
the interviews have been completed. nursing care/day
Category III – Intermediate care: requires 5 – 6 hours
Introduction provides the employee with general of nursing care/day
information about the organization, whereas orientation Category IV – Modified intensive care: requires 7 – 8
activities are more specific for the position. hours of nursing care/day
The purpose of the orientation process is to make the Category V – Intensive care: requires 10 – 14 hours of
employee a part of the team thereby increasing the nursing care/day
probability of productivity and retention.
Job description
Staff development is the continuing liberal education of Job descriptions are derived from job analysis and are
the whole person to develop her potential fully. affected by job evaluation and design.
It deals with the aesthetic senses as well as spiritual,
technical and professional education.
They contain specifications that are the requirements for • Ability to lead
the job, major duties and responsibilities, and the • Ability to guide
organizational relationships of the given position. • Ability to show the way
The title of the job indicates the major responsibilities
and sets that job apart from others.
Making patient assignments
Assignments are based on: Types of Leaders
1. Patient needs • Formal leader is a member of organization who has
2. Available staff given authority by virtue of his position to influence
3. Job descriptions other members of organization to achieve
4. Scope of practice for licensed nurses organizational goals.
5. Scope of functions • An informal leader has no formal organizational
authority to influence others but possesses special
National League for Nurses skills and talent to influence and lead other members
Formula for Staffing of organization.
ABO X NCH = Total # of Nursing
# of working hrs Service Personnel Continuum of Leadership Behavior
for 24 hours Leadership theories
Where: • Great man theory: its premise is leaders are born
ABO = Average Bed Occupancy and not made
NCH = Nursing Care Hours • Charismatic theory: a person may be a leader
# of working hours = 8 Based on RA 5901 because of charisma, an inspirational quality
The 40 Working Hours per Week Law
• Trait theory: traits are inherited but may be
improved by learning and experience. Traits are:
energy, drive, enthusiasm, ambition, decisiveness,
Formula for Staffing
self-assurance, self-confidence, friendliness,
Standard values for NCH
honesty, dependability, & mastery.
Medical = 3.4 OB = 3.0
• Leadership theories
Surgical = 3.4 Pedia = 4.6
Mixed MS = 3.5 Nursery = 2.8 • Later research on trait theory found other traits:
intelligence, initiative, creativity, emotional maturity,
communication skills, persuasion, perceptive, &
Formula for Staffing sociable
% of Professionals to Non-professionals • Situational theories: traits required of a leader
differ according to varying situations.
Formula for Staffing • Leadership theories
% Distribution per Shift • Contingency theory: Fred Fiedler identified 3
Morning = 45% aspects of a situation that structure the leader’s role.
Afternoon = 37% They are:
Night = 18% 1. Leader-member relations
2. Task structure
Staffing for an OB Ward: 30 Beds 3. Position power
30 X 3.0 = 11 nursing personnel • Leadership theories
8 for 24 hours • Path-goal theory: (Robert House) the leader
% of Professionals to Non-professionals facilitates task accomplishment by minimizing
Professionals: 11 X 0.6 = 7 obstruction to the goals and by rewarding
Non-professionals: 11 X 0.4 = 4 followers for completing their tasks.
Staffing for an OB Ward: 30 Beds • Life-cycle theory: predicts the most appropriate
Distribution per Shift leadership style from the level of maturity of the
Professionals Non-professionals followers
AM: 7 X 0.45 = 3 4 X 0.45 = 2 • Integrative leadership model: leadership
PM: 7 X 0.37 = 3 4 X 0.37 = 1 behavior needs to be adaptive.
Night: 7 X 0.18 = 1 4 X 0.18 = 1 •
Staffing for an OB Ward: 30 Beds • Transformational leadership: is a leadership
Summary of Staffing: OB Ward 30 Beds style where one or more persons engage with
others in such a way that leaders and followers
Types of Scheduling raise one another to higher levels of motivation
Centralized: one person, usually the DON or a and morality. It was described by James
designate assigns personnel schedule MacGregor Burns in 1978.
Decentralized: the supervisor or head nurse do the • “Selling style”
Cyclical schedule: a cycle of shift is repeated e. g. • Transactional leader: works through creating
Afternoon to Morning to Night to Reliever clear structures whereby it is clear what is
Remember required of their subordinates, and the rewards
People who have given up are ruled by their darkest that they get for following orders.
mistakes, worst failures, and deepest regrets. If you • Allocates work to a subordinate, they are
want to be successful, then be governed by your finest considered to be fully responsible for it, whether
thoughts, your highest enthusiasm, your greatest or not they have the resources or capability to
optimism, and your most triumphant experiences. carry it out. When things go wrong, then the
John C. Maxwell subordinate is considered to be personally at
fault, and is punished for their failure (just as
they are rewarded for succeeding). “Telling
Directing style”
Ma. Irma C. Bustamante, RN, PhD
Leadership qualities for directing
• Servant leadership: Greenleaf (1977) says that Nothing is more difficult, and therefore more precious,
true leadership "emerges from those whose than to be able to decide. - Napoleon
primary motivation is a deep desire to help
others." Servant leadership is a very moral Communication
position, putting the well-being of the followers • All management process involve
before other goals. communication.
• • Forms: verbal and non-verbal
• Principles of servant leadership defined by the • Process: Sender Message
Alliance for Servant Leadership are: Receiver
• Transformation as a vehicle for personal and
institutional growth. • Downward communication: traditional line of
• Personal growth as a route to better serve communication from the superior to the
others. subordinate. It helps coordinate activities at
• Enabling environments that empower and different levels.
encourage service. • Upward communication: provides a means of
• Service as a fundamental goals. motivating and satisfying personnel by allowing
• Trusting relationships as a basic platform for employee input.
collaboration and service. • Lateral communication or horizontal
• Creating commitment as a way to collaborative communication is between personnel of the
activity. same level.
• Community building as a way to create • Diagonal communication occurs between
environments in which people can trust each individuals or departments that are not of the
other and work together. same level.
• Nurturing the spirit as a way to provide joy and • The grapevine: informal methods of
fulfillment in meaningful work. communication co-existing with formal channels.
• It moves fast and is often distorted, fragmentary,
• Autocratic: leader has total control and incomplete.
• Democratic: leader shares power with the
people • Barriers to communication:
1. Personal/emotional
• Bureaucratic: leader bases leadership on
2. Physical/environmental
implementing rules
3. Semantic
• Laissez faire: leader is permissive • Improving communication
• Multicratic: leader uses different styles and is 1. Ideas should be clarified
situation based 2. Consider the setting
• Guess the leadership style 3. Be organized
• Guess the leadership style 4. Actions speak louder than words
• Guess the leadership style 5. Listen
• Levels of Leadership: • Conflict
Dr. John C. Maxwell • A conflict is present when an inner or an outer
• Power struggle occurs regarding ideas, feelings or
• Power actions.
• Power is the ability to impose the will. • Conflict
• The different forms of power are (French and • Kinds of conflict:
Raven, 1959) 1. Intrapersonal – conflict within the individual
1. Legitimate power: given by virtue of position. 2. Interpersonal – between individuals
Authority is the legitimate right to give commands. 3. Interdepartmental – between departments
2. Reward power: based on the ability to give rewards 4. Intradepartmental – within departments
3. Coercive power: based on the ability to give 5. Extrainstitutional – between organizations
• Power Conflict resolution
• Forms of power…cont • Competition/Power: there is an all out effort to
4. Expert power: based on a special ability, win regardless of the cost. It reflects a strong
knowledge, or skill demonstrated by an individual. Ex. stance to defend important principles or protect
“Knowledge is power.” vulnerable parties.
5. Referent power: based on the attractiveness or • Smoothing: diplomatic way – relationships are
appeal of one person to another or based on a persons
connections or relationship with another powerful
• Avoidance: not taking a position regarding the
• Is this true?
• Decision making • Compromise: each side makes a concession. It
is used when time pressures require quick
• Decision making is the process of selecting
solution or when each party is firmly committed
one course of action from alternatives.
to different views.
• Decision making process
• Identify the problem • Collaborative problem solving: a constructive
• Explore alternatives process in which the parties involved recognize
• Choose the most desirable alternative that conflicts exist, confronts the issue, and
• Implement decision openly try to solve the problem that has arisen
• Evaluate results between them. It builds understanding
• Decision tree • Accommodation: is used when the other
• A decision tree is a graphic method that can person really does have a better idea.
help visualize the alternatives available, Agreement is reached.
outcomes, risks, and information needs for a • Controlling
specific problem. • Ma. Irma C. Bustamante, RN, PhD
• Quality control Europe, the Middle East and South America,
• Quality control is a specific type of controlling and is seeking to expand its business further.
that include activities that evaluate, monitor or • Accreditation
regulate services rendered to consumers • ISO (International Organization for
• Quality control Standardization) is the world's largest
• Effective quality control entails: developer and publisher of International
• 1. Program needs to be supported by top level Standards.
administrators. • ISO is a network of the national standards
• 2. Sincere commitment by the institution as institutes of 157 countries, one member per
evidenced by fiscal and human resource country, with a Central Secretariat in Geneva,
support. Switzerland, that coordinates the system.
• 3. Presence of a developed quality control • Accreditation
criteria • PACUCOA – Philippine Association of Colleges
• Quality control process and Universities Commission on Accreditation
• Determine criterion or standard • PAASCU – Philippine Accrediting Association of
• Collect information if the standard has been met. Schools, Colleges, and Universities.
• Educational or corrective action is taken if the • Performance Appraisal
standard has not been met. • Performance appraisal is an assessment of
• Standard how well employees perform the duties of their
• A standard is a predetermined level of job as delineated by the job description.
excellence that serves as a guide for practice. • If done fairly, it increases the employees
• Characteristics: motivation because it identifies areas where one
• 1. Predetermined can improve.
• 2. Established by authority • Methods
• 3. Communicated to and accepted by people • Anecdotal notes are objective descriptions of
affected by the standard. behaviors recorded on paper.
• Standards • Rating scales locates behavior at a point on a
• Standards of Nursing Practice: Code continuum.
• PNA of
• Ranking forces the appraiser to rank staff in
• Standards of Safe Nursing Practice: Ethics
descending order from highest to lowest even if
she does not feel there is a difference.
• CMO # 5 s. 2008: CHED – TCNE PNA
• Methods
• RA 9173: Nursing Law ICN
• Audits
• Management by Objectives (MBO) is a tool for
effective planning and appraisal. It emphasizes
• While standards provide the yardstick for
the achievement of objectives instead of
measuring quality, audits are measurement
personality characteristics. It focuses attention
on individual achievement, motivates individuals
• An audit is a systematic and official examination
to accomplish and measures performance in
of record, process, structure, environment, or
terms of results. Main
account to evaluate performance.
• proponent: Peter
• Audits
• Drucker
• Retrospective audits are performed after the • Pitfalls to avoid in appraisal
client receive the service. • Halo effect occurs when the appraiser lets one
• Concurrent audits are performed while the or two positive aspects of the assessment or
client is receiving the service. behavior of the employee unduly influence all
• Prospective audits attempt to identify how other aspects of the employee’s performance.
future performance will be affected by current • Pitfalls to avoid in appraisal
interventions • Horn effect occurs when the appraiser allows
• Audits negative aspects of the employee’s performance
• Outcome audits determine what results to influence the assessment to such an extent
occurred as a result of specific nursing that other levels of job performance are not
interventions to clients. accurately recorded.
• Process audits are used to measure the • Pitfalls to avoid in appraisal
process of care and how the care was carried • Central tendency is hesitancy on the part of the
out. appraiser to risk true assessment and therefore
• Structure audit monitors the structure or setting rate all employees as average.
in which patient care occurs. • Pitfalls to avoid in appraisal
• Accreditation • First impression error is making initial positive
• Accreditation is the voluntary process of being or negative judgment and allow that first
certified as meeting the minimum requirements impression to color or distort one’s evaluation.
as designated by an accrediting agency. • Pitfalls to avoid in appraisal
• It engages the organization in meeting high • Stereotyping error is the tendency to
quality standards, implementing a continuous generalize across groups and ignore individual
improvement process, and engaging in quality differences.
assurance through internal and external review. Delegation
• Accreditation • Delegation is the process of assigning work
• Joint Commission International, or JCI, is one from one organizational level to another or from
of the groups providing international healthcare superior to subordinate.
accreditation services to hospitals around the • It is transferring the responsibility of performing
world and brings income into the US-based a nursing activity to another person while
parent organisation. This not-for-profit private retaining accountability for the outcome.
company currently accredits hospitals in Asia, • Delegation
• It is a tool that may be used by the registered 1. Predetermined
professional nurse to allow unlicensed assistive 2. Established by authority
personnel (UAP) to provide standardized routine 3. Communicated to and accepted by people affected
health services under the supervision of the by the standard.
nurse when permitted by the Nurse Practice Act Standards
and supported by the nurse’s clinical judgment Standards of Nursing Practice: Code
to be appropriate. PNA of
• Delegation Standards of Safe Nursing Practice: Ethics
Purposes ANSAP
• It maximizes the utilization of every health care CMO # 5 s. 2008: CHED – TCNE PNA
worker and ensure proper delegation of RA 9173: Nursing Law ICN
responsibilities and tasks Audits
• It uses latent abilities of personnel that While standards provide the yardstick for measuring
contribute to their growth and development. quality, audits are measurement tools.
• Delegation: Definitions An audit is a systematic and official examination of
• Accountability: Being responsible and record, process, structure, environment, or account to
answerable for actions and inactions of self or evaluate performance.
others in the context of delegation. Audits
• Delegator: The person making the delegation.
• Delegatee: The person receiving the delegation. Retrospective audits are performed after the client
• Delegation: Definitions receive the service.
• Supervision: The provision of guidance or
Concurrent audits are performed while the client is
direction, evaluation and follow-up by the
receiving the service.
licensed nurse for accomplishment of a nursing
task delegated to unlicensed assistive
Prospective audits attempt to identify how future
performance will be affected by current interventions
• Unlicensed Assistive Personnel (UAP): Any Audits
unlicensed personnel, regardless of title, to
whom nursing tasks are delegated
Outcome audits determine what results occurred as a
• 5 Rights of Delegation
result of specific nursing interventions to clients.
1. Right Task
One that is delegable for a specific patient. Process audits are used to measure the process of
care and how the care was carried out.
2. Right Circumstances
Appropriate patient setting, available resources, and Structure audit monitors the structure or setting in
other relevant factors considered. which patient care occurs.
• 5 Rights of Delegation
• 3. Right Person Accreditation
Right person is delegating the right task to the Accreditation is the voluntary process of being certified
right person to be performed on the right person. as meeting the minimum requirements as designated by
4. Right Direction/Communication an accrediting agency.
Clear, concise description of the task, including its It engages the organization in meeting high quality
objective, limits and expectations. standards, implementing a continuous improvement
• 5 Rights of Delegation process, and engaging in quality assurance through
• 5. Right Supervision internal and external review.
Appropriate monitoring, evaluation, intervention, Accreditation
as needed, and feedback.
Joint Commission International, or JCI, is one of the
groups providing international healthcare accreditation
Controlling services to hospitals around the world and brings income
Ma. Irma C. Bustamante, RN, PhD into the US-based parent organisation. This not-for-profit
Quality control private company currently accredits hospitals in Asia,
Quality control is a specific type of controlling that Europe, the Middle East and South America, and is
include activities that evaluate, monitor or regulate seeking to expand its business further.
services rendered to consumers
Quality control ISO (International Organization for Standardization) is
Effective quality control entails: the world's largest developer and publisher of
1. Program needs to be supported by top level International Standards.
administrators. ISO is a network of the national standards institutes of
2. Sincere commitment by the institution as evidenced 157 countries, one member per country, with a Central
by fiscal and human resource support. Secretariat in Geneva, Switzerland, that coordinates the
3. Presence of a developed quality control criteria system.

Quality control process PACUCOA – Philippine Association of Colleges and

Determine criterion or standard Universities Commission on Accreditation
Collect information if the standard has been met.
Educational or corrective action is taken if the standard PAASCU – Philippine Accrediting Association of
has not been met. Schools, Colleges, and Universities.

Standard Performance Appraisal

A standard is a predetermined level of excellence that Performance appraisal is an assessment of how well
serves as a guide for practice. employees perform the duties of their job as delineated
Characteristics: by the job description.
If done fairly, it increases the employees motivation Mrs. Agusto called for a meeting with the supervisors to
because it identifies areas where one can improve. discuss understaffing and the need to hire new nurses.
They are engaging in:
Methods A. Planning
Anecdotal notes are objective descriptions of behaviors B. Organizing
recorded on paper. C. Directing
Rating scales locates behavior at a point on a D. Controlling
continuum. To be able to provide a temporary remedy to
Ranking forces the appraiser to rank staff in descending understaffing, Mrs. Agusto delegated her supervisors to
order from highest to lowest even if she does not feel have the nurses on the floors divide the tasks to finish
there is a difference. the work. What nursing care delivery has been utilized?
Management by Objectives (MBO) is a tool for A. Case method
effective planning and appraisal. It emphasizes the B. Functional method
achievement of objectives instead of personality C. team Nursing
characteristics. It focuses attention on individual D. Primary nursing
achievement, motivates individuals to accomplish and What style of leadership is being utilized by Mrs.
measures performance in terms of results. Main Agusto?
proponent: Peter Drucker A. Autocratic
Pitfalls to avoid in appraisal B. Bureaucratic
C. Democratic
Halo effect occurs when the appraiser lets one or two D. Laissez faire
positive aspects of the assessment or behavior of the Miss Manuel, one of the supervisors, decided to hold a
employee unduly influence all other aspects of the journal club in her units once a week. Which aspect of
employee’s performance. directing is involved?
Pitfalls to avoid in appraisal A. Coordinating
Horn effect occurs when the appraiser allows negative B. Developing people
aspects of the employee’s performance to influence the C. Communicating
assessment to such an extent that other levels of job D. Supervising
performance are not accurately recorded. How can Miss Manuel identify the weaknesses and
Pitfalls to avoid in appraisal strengths of the nurses under her supervision?
Central tendency is hesitancy on the part of the A. Through performance appraisal
appraiser to risk true assessment and therefore rate all B. Through interviews with doctors
employees as average. C. Through interviews with patients
Pitfalls to avoid in appraisal D. Through a course audit
First impression error is making initial positive or Mrs Agusto has been hearing unfavorable stories about
negative judgment and allow that first impression to color one of her head nurses. These came from the staff and
or distort one’s evaluation. some nursing aids. This communication is:
Pitfalls to avoid in appraisal A. Downward communication
Stereotyping error is the tendency to generalize across B. Lateral communication
groups and ignore individual differences. C. Diagonal Communication
D. Grapevine
Quick Checks
Leadership and Management
Ma. Irma C. Bustamante, RN, PhD
Mrs. Agusto has just been appointed as Chief Nurse of a
150 bed hospital because she is the only one from
among the nursing service personnel with an MAN. As
such, she is a:
A. Leader
B. Manager
C. Both
D. Neither
After 6 months of service, with good performance, Miss
Rosario has been classified as permanent employee.
This is in line with which management principle?
A. Scalar chain
B. Remuneration
C. Equity
D. Stability of tenure
The process of attitude and behavior change described
as unfreezing, change, and refreezing was developed
A. Kurt Lewin
B. Frederick Taylor
C. Douglas McGregor
D. Alvin Toffler
When Mrs. Agusto engages in setting objectives and
preparing the budget for the nursing service department,
she is doing:
A. Planning
B. Organizing
C. Directing
D. Controlling