NURSING LEADERSHIP &

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

A dynamic, interactive process that

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

◦ Does not have official sanction to

direct activities of others; chosen by
the group itself

◦ Usually become leaders because of

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

◦ Play a valuable role if their behavior

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

◦ chosen by administration, and given

official or legitimate authority to act

Ex. The elected and appointed officers

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

Many finds this theory unattractive because

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

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

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

a contract for mutual benefits that has

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

Leader serves as a role model who

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

transformational leaders change the

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

One should be aware of his own behavior

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

Legitimate power to direct others

Power

It is one’s capacity to influence others

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

TRAIT THEORY

*leaders are born with inherited tasks

*envisioning goals, affirming values

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

Personality: adaptability, alertness,

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

Abilities: ability to enlist cooperation,

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

Great leaders will arise when there is a

great need

Ex. King of Spain

BEHAVIORAL THEORY

Successful leadership is based in

definable, learnable behavior
PARTICIPATIVE LEADERSHIP

People are more committed to actions

SITUATIONAL THEORY

The best action of leader depends on

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

Leaders’ ability to lead is contingent upon

situation.
a.leadership member relation

b.task structure

c.position power
TRANSACTIONAL LEADESHIP

People are motivated by reward and

punishment
TRANSFORMATIONAL THEORY

People will follow a person who inspires

them

A person with vision and passion

Value based leadership

PATH-GOAL THEORY

Leaders has certain objectives and

initiates their followers to attain their own
objectives
STRATEGY THEORY

BASED ON HUMAN HANDLING

SKILLS OF LEADERS
◦ Strategy 1 – attention thru vision

◦ Strategy 2 – meaning thru communication

◦ Strategy 3 - trust thru positioning

◦ Strategy 4 - deployment of self thru positive

self regard
CHARISMATIC THEORY

Charm and grace are needed to create

followers

Self belief
STYLES OF LEADERSHIP

1. AUTHORITARIAN/AUTOCRATI C

◦ Strong control over the group or directive

approach

◦ Concern with task accomplishments

2. DEMOCRATIC OR PARTICIPATIVE

◦ Leaders focuses on involving subordinates in

decision making

◦ People oriented
3. LAISSEZ – FAIRE OR PERMISSIVE

◦ Delegating approach

◦ Little or no direction is provided to

subordinates
4. MULTICRATIC

◦ The leader identify which style of leadership a

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

Referent – potential influence one has because

of the strength of relationships between leaders
and followers

Expert – gained thru the position of special

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

Connection power – based on having

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

Reward power – this is achieved through

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

Knowledge of basic ingredients for

leadership and management

Systematic use of self to get things done

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

Joyce Clifford
MANAGEMENT

Art of getting things done thru people

Process that involves guidance, direction

of a group of people toward organizational
goals or objectives

Process thru which the objectives of an

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

Informationrole – monitor, disseminator,

spokesperson

Interpersonal role- figurehead, leaders,

liaison

Decisional roles – entrepreneur,

disturbance handler, resource allocator,
negotiator
MANAGEMENT LEVELS

FIRST LEVEL – Supervises the operative

employee

MIDDLE LEVEL – plan and coordinate

activities of the organization.

TOP LEVEL – manages the organization

as a whole.
Comparison of Leaders &
Managers
 Leadership Management

Motto Do the right things Do things right

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

Evaluate Potential Performance

Human
MANAGEMENT THEORY
Purposes of Theory

1. Provide a stable focus of understanding what

we experience

2. Enable us to communicate freely

3. Challenge us to keep learning of our world

PRINCIPLES OF
MANAGEMENT
(MODERN ERA)

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

- Efficiency provided information on:

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

 “FATHER OF SCIENTIFIC MANAGEMENT”

Used stopwatch studies & applied the

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

Emphasized the benefits of:

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

Developed a micro chronometer

Henry Gantt (1861-1919)

Disciple of Taylor, was concerned w/

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

placed emphasis on service

rather than profit objectives

recognize useful non-monetary

incentives
CLASSIC ORGANIZATON
“Deductive rather than inductive”

-views the organization as a whole rather

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

“Father of Management Process School”

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

A believer in the division of work , he

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

 “a place for everything and everything

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

Authority – management needs to be able

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

Unity of command – subordinates should

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

Subordination of Individual Interest to

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

Remuneration – workers should be paid

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

Hierarchy – the line of authority in an

organization runs in order of rank.

Order – materials and people should be at

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

Stability of Staff – the greater the turn-

over rate, the less workers are efficient

Initiative– subordinate should be given

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

Espiritde Corps – good relationship

must be maintain in the organization.
 Max Weber (1864-1920)

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

2. Charisma

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

-focused on the effect individuals have on

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

He defined the manager’s responsibilities

1. Defining Objectives

2. Acquiring Resources

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

“Mother of Modern Management”

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

Perceived the organization as a social

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

Author of “The Hawthorne Studies”

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

“lighting had little effect on production”

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

Study of “Group Dynamics”

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

advocated democratic supervision

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

Developed “Sociometry” to analyze group

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

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

He outlined a hierarchical structure for human

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

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

Notes that ones style of management is

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

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

Gave a more extensive discussion of the

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

Theory of Management is based on his work at

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

C
(5,5)

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

Vertical – concern for people Horizontal – concern fro production

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

lack of concern for both people & production

B. Country Club Manager
(1,9)

thoughtful & friendly but lack concern for

production
C. Organization Man
Management (5,5)

represents a moderate concern for both people

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

efficiency in operation but lacks concern for

human element
E. Team Management (9,9)

the optimal managerial style. These managers

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

◦ Symbol
◦ Leader
◦ Liaison
INFORMATIONAL ROLE

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

◦ Entrepreneur or Innovator
◦ Troubleshooter
◦ Negotiator
I. PLANNING

Forecasting or setting the broad outline of work

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

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

Increases the chance of success by

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

1. Develop the purpose or mission

statement, goals, objectives, philosophy

◦ Mission – purpose of existence and reason

behind organizational structure

◦ Philosophy – statements of shared values and

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

◦ Objectives – specific aims, purposes or targets

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

3. Assess for the strength (opportunities that

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

5. Identify strategies to achieve specified

goals

6. Develop a timetable for accomplishing

each objectives

7. Provides guideline for developing

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

9. Provide for formative evaluation

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

◦ operational management plan related to

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

Managerial support

Formal policies and procedures must be

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

To motivate nursing workers through

analysis of actual experience.

To serve as standards.

Types of Budget
Capital
Operational
Personnel or manpower
Flexible
Cash flow
Fixed ceiling
COSTS

Fixed cost - not related to volume and

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

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

2. Forecast workload

3. Budget patient care hours

4. Budget patient care hours and staffing

5. Plan for nonproductive hours

6. Chart productive time

7. Estimate the cost of supplies and services

8. Anticipate capital expense

II. ORGANIZING

Grouping of activities, providing

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

To sustain the philosophy, achieve the

mission and vision and objectives of the
organization

Show the part each person shall work in

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

Chain of command, with lines indicating

who reports to whom and why what
authority
CHARACTERISTICS……

The type of work performed, indicated by

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

Purpose

structure
BASIC TYPES OF O.S.

Informal – consists of the personal and

social relationship of the members in the
organization

Formal – describes the positions,

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

Hierarchic or bureaucratic model

Adaptive or organic model

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

 Diagrammatic representation of the

organizational structure
Types according to depiction

1. Positional – position is indicated

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

CHIEF NURSE

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

TRAINING OFFICER

CHIEF NURSE

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

CN

SN SN SN

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

SN SN SN SN SN

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

CN

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

CASES NCH/Pt/day Prof. to Nonprof

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

3. Surgical 3.4 60:40

Cont.

4. Obstetrics 3.0 60:40

5. Pediatrics 4.6 70:30

6. Pathologic 2.8 55:45

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

8. CCU 6.0 80:20

 Patient classification
systems (PCS)

…quantify the quality of nursing care by

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

Levels of care NCH/pt/ day Ration prof to

non-prof
L1 self care or 1.5 55:45
minimal care
L2 moderate or 3.0 60:40
intermediate
L3 total or 4.5 65:35
intensive care
L4 highly 6.0 70:30
specialized or 7 or higher 80:20
critical care
Percentage of Nursing Care Hours
 
Period of NCH at each levels
of care depends on the setting in which
the care is being given.
 CLASSIFICATION CATEGORIES
Level
I- SELF CARE or
MINIMAL CARE
- patient can take a bath on his own, feed
himself and perform his ADL.
- patient about to discharge, those non-
emergency, newly admitted do not exhibit
unusual symptoms, and requires little
tx/observation or instruction.
- 1.5 NCH/ 55:45 ration prof and non prof
Level II- MODERATE CARE or
INTERMEDIATE CARE

- patients under this level need some

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

- patients in this category are completely

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

- Need maximum nursing care.

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

Type of Minimal Moderate Intensive Highly

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

Rights & privileges given Working Working

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

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

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

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

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

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

Directive interview – uses closed-ended

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

Aptitude Test – measures capacity on

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

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

The worker in return assumes

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

1. Ability of the worker to carry out the

task.

2. Fairness not only to the employee but to

the team as a whole.
Principles of Delegation
Selectthe right person
Delegate both interesting & uninteresting
task
Provide staff with enough time to learn
Delegate gradually
Delegate in advance
Consult before delegating
Avoid gaps & overlaps
Nursing Care Assignments/
Modalities of Nursing Care
or System/Pattern of
Nursing Care
Primary
◦ Extension of principle of decentralization
◦ Nursing process driven
◦ Primary nurses and associate nurses
◦ 24-hour coverage
◦ Greater patient and staff satisfaction
Advantages 1) patient & family are able to
develop trusting relationship with RN; 2)
there is defined accountability &
responsibility; 3) there is holistic/continuity
of care.
 
Disadvantages 1) high cost because there is
a higher RN skill; 2) proximity of
patient assignment; 3) overlapping of staff
functions; 4) nurse patient ratio must be
realistic.
Case Method
◦ 1:1 nurse/patient ration
◦ Examples include private duty, ICU,
Community Health Nurse
◦ Similar to Primary, however, no Associate RN
◦ The nurse is responsible for the total care of
the patient for the shift she’s working
Advantages 1) consistency of one
individual caring for the patient for the
whole shift; 2) more opportunity to
observe & monitor the patient.

Disadvantages 1) the nurse may not have

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

◦ best system that can be used if there are many

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

Disadvantages 1) patient receives

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

1. Promotive “improve systems”

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

Change – purposeful, designed effort to

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

5. Discussion of implementation

6. Use of economy and ritual

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

Forces that make or propels one to act in

a certain way.

Individual’ desire and responses to events

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

CONTENT THEORY – motivation factors or

needs within a person

1. Maslow’s Needs Theory

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

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

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

security, working condition, relationships

b. Satisfiers or non hygienic – (intrinsic) achievement,

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

5. Monistic/scientific theory – salary as the best

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

2. Expectancy theory – focuses on people’s

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

3. Equity theory – focuses on fair treatment

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

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

Measure performance

Compare results with standards

Match with standards?

YES – do nothing or improve

NO - take corrective action

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

Standard: Nurses are professional in dealing

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