Intensive Leadership and
Management
Sunday, September 18, 2022 8:15 AM
- Nursing leadership (influence) - process whereby a nurse influences one or more
persons to achieve specific goals in the provision of nursing care for one or more
patients
- Nursing management - process of working through the nursing staff personnel or
members to provide care, cure, and comfort to patient
- Differences between leader and manager
- Leader
§ Appointment: may or may not have official appointment
§ Power: as long as the followers are willing to follow
§ Relationship: in intuitive and empathetic manner
§ Reward: rewarded from personal achievement
§ Position: may or may not be successful
§ Rules: interested in risk taking and exploring new ideas
§ Others: influence others toward goal setting
- Manager
§ Appointment: officially appointed
§ Power: have power and authority to enforce decision
§ Relationship: relate to people according to rule
§ Reward: fulfill organizational mission
§ Position: managers as long appointment holds
§ Rules: carry out predetermined policies rules and regulations
§ Others: maintain an orderly controlled national equitable structure
1. Scientific management
- Frederick W. Taylor
- Proposed set of techniques to increase the efficiency and productivity of each worker
(use of machine improves efficiency of workload)
- ECMO (extracorporeal membrane oxygenation)
- Raisins - not for patients with kidney disorders
- K+: 6 meq/L - criteria for dialysis
2. Fayol’s Management Theory
- Henri Fayol
- Father of modern management theory/management process
- 14 principles of management
- Division of labor - according to their knowledge and expertise
- Authority - managers need to be able to give orders so that they can get things
done (guidance)
- Discipline - members in the organization need to respect the rules and organization
that govern them
- Unity of command - each employee must receive his/her instructions about a
particular operation from 1 person
- Unit of direction - those operation within the organization that have the same
objectives should be directed with only one plan.
- Subordination of individual interest to common goal - in any undertaking the interest
of the employees should not take precedence over the interest of the organization
as a whole
Remuneration - compensation for work should be fair to both employee and
employers (salary).
- Centralization - the management should be neutral
- Scalar chain - related to hierarchy steps (from top to lowest)
- Order - well-defined work order to have a favorable work culture
- Equity - employees should be treated equally
- Stability - job security (it is the duty of the management to offer job security)
- Initiative - management should support and encourage the employees to take
initiative (doing something even not instructed)
- Espirit de corps - team spirit
3. Bureaucratic organizational theory
- max weber
- Contributed to the development of a classical approach to organizational design
4. Behavioral school
- Elton mayo
- Hawthorne effect - individual reacts differently when they know they are being observed
5. Motivational theory
- Douglas Mcgregor
- Developed the theory X and theory Y
- Theory X - inherently lazy (umiiwas sa trabaho)
- To exercise strict control over his subordinate to ensure that the work is carried out
properly
- Theory Y - loves work (ano pong pwede gawin?)
- To provide opportunities for the subordinates to be creative and productive and to
encourage growth and provide guidance
- Leadership theories
1. The great man theory - leaders are born, not made (ex. monarchy of England)
2. Trait theory - you are born with a characteristic of a leader
3. Situational theory - depends on the situation
4. Contingency theory - depends on 3 things
i. Task structure - nakadepende sa structure/task nga gina-provide ang
effectivity sa work
ii. Position power - work na ihatag kay naay power (maningil ang janitor para
magbayad sa tuition)
iii. Relationship - success ang work if with good relationship
5. Path goal theory - focus is in the achievement of goals
1. Planning
- forecasting of events, making decisions, setting goals, setting og priorities, developing
policies and standard
- Types of planning:
1. Strategic planning - long range goals or long term goals (to be a provider of open
brain surgery in the year 2050)
2. Operational planning - deals with day to day maintenance of activity (food, supplies,
etc.)
- Mission - ensure accessibility and quality of health care to improve the quality of life of all
Filipinos, especially the poor (reason for the organization’s existence, states the services
the organization will provide)
- Philosophy - reflects the values and beliefs of the organization
- Ex. The medical center is guided by the following beliefs:
- the clients are the reason for the hospital’s existence. Therefore, all service are
directed toward their care and rehabilitation
- The health personnel’s concern for the quality of their services constitutes the heart
of their responsibility to the public.
- Objective - to provide the best possible health care services to its clients in a high quality
setting conducive to attaining its vision as center of wellness and a standard medical
center
- goals - what you want to achieve (longer time frame, may not be measurable,
broader than objectives)
- Objectives - how you are going to achieve the goal (short term, measurable,
specific
- Types of budget
1. Direct cost - directly related to patient care within a managers unit (salary, supplies)
2. Indirect cost - not explicitly related but is necessary to support care (electricity &
maintenance)
3. Fixed expenses - they dont vary in volume (rent, monthly salaries)
4. Variable expenses - increase or decrease depending on the number of patients
(cost of supplies, patient meals, laundry of linens)
5. Controllable cost - controlled and varried by managers (staffing pattern and mix
personnel)
6. Uncontrolled cost - equipment depreciation (overtime in response to emergency)
2. Organizing
- Grouping of activities for the purpose of achieving objectives
- To accomplish the goals and objectives of the organization efficiently human and
material resources are essential.
- Types of organizational structure
i. Informal
- consist of personal and social relationships among members of the organization
- meets the needs of individual with similar backgrounds
ii. Formal
- describes the positions responsibilities of those occupying the positions, and the
working relationships among the various units or department
- PNA, SNAP
- Types of organization classified by nature of structure
i. Line organization - simplest and the most direct type in which position has general
authority over the lower positions in the in the hierarchy
ii. Informal organization - refers to horizontal relationships
iii. Staff organization - purely advisory - broken line - they are there purely for advisory
(guidance councilor)
iv. Functional organization - each unit is responsible for a given part of the org (unit of
dietitian, radiologist, etc.)
- Types of organizational chart
i. Vertical chart/tall structure
- depicts the chief executives at the top with lines of authority following down the
hierarchy
ii. Horizontal chart/flat chart
- depicts the manager at the top with a wide span of control
- communication in this structure is direct simple and fast with minimal distortions of
message since the distance between top and lower level is shorter
- Principles of organization
i. Communication - top to bottom
§ downward communication - top to bottom (ex. termination, memo, etc)
§ upward communication - bottom to top (ex. incident report, resignation, etc.)
§ diagonal communication - communicate to other offices (from one unit to
another unit/department)
- termination must have verbal warning, written warning, suspension and
termination
§ horizontal level of communication - same level (from one staff nurse to
another)
ii. Unity of command
iii. Span of control (ex. CI:student ratio) - above supervisory position (1:6), below
supervisory (1:8)
iv. Specialization (OR, ICU, OB)
3. Staffing
- process of determining and providing the acceptable number and mix of nursing
personnel to produce a desired level of care and to meet the patient’s demand
- staffing is formed through:
1. Recruitment: enlisting of personnel for employment
2. Selection process: evaluation of transcript, board rating, choosing
3. Indoctrination: induction, orientation
4. Training and development
5. Transfer and separation - assigning to other unit
- Nursing care delivery system
1. Case system - oldest method
- Pros: total patient care
- Cons: different nurse, different shifts, different days (not for alzheimer’s and autistic
patient “my child doesn’t want to hug me”, problems with social interaction but there
is one skill they are very good at - needs structured environment)
2. Functional system - many patients and many nursing aides, but less number of
nurses (task are divided)
- Pros: efficiency
- Cons:
§ nurses do managerial work
§ Nursing aides do patient care
3. Team nursing - nurses are divided into groups
- Pros: team effort
§ Frees patient care coordinator to manage the unit
§ Nursing care plan
- Cons: time needed to coordinate delegate work
4. Primary nursing - ICU
- Associate nurse: ang pumalit sayo
- Pros: RNs give total patient care
§ Primary nurse has 24 hr responsibility
§ Accountability in place
- Cons: confines nurses talents to a limited number of patients
§ Associate nurse may change care plan without discussing with primary nurse
- Common errors in evaluation
1. Halo error - one trait to influence the evaluation of one unit
2. Horns error - the evaluator is perfectionist
- Leadership styles:
§ Autocratic - leader
§ Democratic - by the people
- Styles of leadership
- Authoritarian/autocratic leadership style
§ High concerns for task accomplishment but low concern for the people who
perform these task
- Democratic leadership styles
§ People oriented focuses on human aspects and builds effective teamwork
- Permissive or laissez-faire leadership style
§ Leaders appointed as managers
§ Leaves workers without direction, supervision or coordination
