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NCM 205 Nursing Leadership and Management Ms. Loresita Antonia Chua

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1. Trait theory2. Great Man Theory3. Charismatic Theory4. Frederick Taylor5. Frank and Lillian Gilbreth6. Henry Gantt7. Henri Fayol8. Max Weber9. Elton Mayo Hawthorne Studies10.Kurt Lewin change theory11.Abraham Maslow12.Frederick Herzberg13.Douglas McGregor14.Ouchi Theory Z15.Peter Drucker MBO16.Fred Fiedler Contingency theory17.Robert House Path Goal T.18.Lashbrook Work Unit Culture

1. CLMMRH2. BOLMSH

TLJPH

3. SVH4. Bac CHD5. PHO (Interlocal H Zones)6. NORFI/VRHD

I. The Nurse in the Organization

A. The Center of the Work World is ME

o Your work world begins with MEo You are quite literally, the center of your work worldo You are unique, thus your job situation is unique

4 Attributes

Mission

Vision

Organizational Chart/Structure

Staffing Nursing Service

Personnel

Personal attributes that influence

your work world

My Values My Motivation My Knowledge My Skill

My Internal EnvironmentMy External Environment

My Responsibilities

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A1. My Values

o Have an unrecognized influence upon your philosophy and actions as a nurseo Affects your life and your work.o My values are acquired subconsciously during early years and remain relatively unchanged all of your

life

o My values Answer 3 important question What you believe in? What is most important to you? What is your attitude toward yourself and others?

L O V E O F G O D

12 15 22 5 15 6 7 15 4 = 101

N U R S I N G

14 21 18 19 9 14 7 = 102

A2. My Motivations answers 2 things

A3. My Knowledge

o It has been said thatchance favors the prepared mind

o This is a way of saying that you make your own lucko These care certain requisites for experiencing

personal satisfaction from your work

o Gives you confidence in your abilityacquired through study and experience

L Labor

U Under

C Complete

K Knowledge

Causes you to do what

you do

To select one course of

action instead of another

My Motivations

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A4. My Skills

o Involves competenciesnot only knowing what to do but being able to do it wellComposition of Apperceptive mass

- Education-

Training- Life experience- Parental influence- Religion- Prejudices- Beliefs

B. Stephen Coveys Seven Habits of Highly Effective People

- Primary objective is to help people and organizations realize the need to increase their effectiveness- Focused on leadership and development for organizations

Habit

- Knowledge, skill and desire are the essential elements to transform a behavior into a habit- Increasing the skills that enhance the potential for forming habits is possibleB1. Inside Out Approach

- Individuals who want to influence others effectively must start with themselves- An organization must begin with its people

B2. Paradigm

- Our paradigms or perceptions of people influence the way we treat them- Paradigm Shift change in thinking that comes when we gain additional insight and understanding

B3. Emotional Bank Account

- Metaphor for the amount of TRUST that exist in a relationshipClassification of Interaction

Deposit Withdrawal

o Build and repairrelationships

o Kindness and courtesyo Keeping promiseso Honouring expectationso Loyalty to the absento Making apologies

o Lessen relationshipo Unkindness and discourtesyo Breaking promiseso Violating expectationso Disloyalty, duplicityo Pride, conceit, arrogance

*Have more deposits than withdrawal in our relationship

Stephen Covey

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- If you want small changes, world on you behavior- If you want quantum leap changes, work on your paradigms

B4. Types of Behaviors

Reactive

- People who allow outside influences to control their responses- Moods, feelings, circumstances, biases, prejudices, prejudgment> outside influencesStimulus> Reaction (Based on outside influences)

Observer of Life comment, complain, argue, find fault (aggressive or submissive let things happen)

Proactive

- People who used the margin of freedom to make choices that best apply to their valuesStimulus -------Margin of Freedom (behavior and values)---> Reaction

Author of Life (Assertive Person makes things happen) participate, get involved, cooperate

Reactive Proactive

o People who allow outsid influences to controltheir responses

o Moods, feelings, circumstances, biases,prejudices, prejudgment

o Observer of his lifeo Theres nothing I can doo Thats just the way I amo He makes me so mado They wont allow thato I have to do thato I cant, its hardo I musto Let things happeno Bahala nao Submissiveo aggressive

o People who use the margin of freedom to makechoices that best apply to their values

o Author of his lifeo Make things happeno Optimistico Lets look at our alternativeso Its possibleo Its OKo I prefero Its alrighto I willo Im ableo Foresighto Assertive

Comparison of behaviors exhibited by passive, assertive and aggressive nurses

Passive Assertive Aggressive

Low Self-EsteemFeels Pity

Shy, withdrawn

Apologetic

Denies rights and needs of self and

patients/clients

Feels victimized

Allows situation to control rather

than controlling situation

High Self-EsteemFeels self-worth

Forthright

Open and honest

Acts in best interest of self,

patients/clients

Feels or peer level

Controls situations

High-Low Self-EsteemMixed feelings of worth

Forward and attacking

Hostile, manipulative

Demands needs be gratified for self

and others

Feels must fight for rights

Attacks situations

Language of

Reactive

Language of

Proactive

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C. Habit is to become PROACTIVE

The Image of Nursing

What is the product that nurses deliver? NURSING CARE

The things to do in order for nurses to be well accepted:

- Project an image of wellness- Self confidence- Professionalism

D. New Impacts of Your Changing Work (Evolution of the Health Care System)

- Change has become a cardinal feature of the way we live- Consider the following factors in connection with the work worldD1. Community

- Health status of our society is changing- Growing older population (home for the aged)- Increase birth rate (day care centers, birthing centers)- Increase life expectancy (wellness centers)The characteristics of the general public:

- Now more urban- Better educated- More affluent- Subject to new health hazards

Social Problems include the following:

- Drug addiction (Self Help Centers)- Alcoholism- Environmental pollution (CHN)- Sexually transmitted diseases- CV diseases- Death from suicide, homicide and accidents

D2. Socio cultural

- People view health not just as the absence of disease but also as the individuals capacity to live happilyand productively

- More emphasis is being directed toward primary care and how to stay well than on secondary andtertiary care

Alternatives to the traditional health care system:

- Extensive home health care

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- Health maintenance organizations- Free clinics- Hospice movement (terminal and chronic illness care)- Self care, self help, holistic health- Some nurses are incorporative alternatives in their patient teaching- Meditation, diet therapy

D3. Economic

- Increasing cost of health careT o manage a cost-effective patient unit nurses must consider what effect the following items have on

the nursing budget:

- Supplies- Equipments- Personnel policies- Hiring practices- Type of staffing- Modality of nursing being practiced

D4. Business

- Technology has invaded the health care field from all sides- This has caused increased costs and increased specialization of providers

D5. Political

- Health care is the most regulated industry- Mandatory Certificate of Need- The hospital must develop a document that supports the need for the project- The local health system agency (HSA) review board decides whether the hospital can move ahead with

its plan

- Nurses need to participate to provide a nursing perspectiveD6. Professional

a. Credentialing; issue in public accountability and social protectiono Licensingo Certificationo Accreditation

b. Entry Into Practiceo What educational background does a person need to enter the practices of nursing? LPN, BSN,

MN, PhD

o CGFNS, TOEFL, IELTS, TSE, TWE, NCLEX

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c. Mandatory Continuing Educationo One way to assure the public of the continued competence of practicing nurseso Earn CE units for renewalo 20 CEU/Per year x 3 years = 60 CEU for renewal

d. Malpractice Insurancee. Collective Bargainingf. Moving into a bargaining agent position (union)

Image of Nursing

- Image Problems/Wreckers- Image Improvement/BoostersImage Problems

- Complains about- Their work- Their hours- Their salaries

Visible signs of little energy, little enthusiasm

- Anger- Apathy- Burnout

Signs of chronic disillusionment/image wreckers

- Complaining- Back-biting (doctors)

Image inconsistencies

- Smoking- Obesity- Sedentary lifestyles

Image Improvement/Image Boosters

- Nurses need to move toward a positive, assertive orientation of personal control andempowerment and away from a defensive survival/subservient mentality

When a positive self-image is combined with appropriate marketing techniques, a favorable public image

canbe projected such as

- Professional manners:

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- Good public relations at the bedside, home, community- Providing service in a manner in which you would want to be served- Encourage career ladder and advancement- Proactive nursing involvement

II. The Effective Nurse Leader and Manager

A. Difference Between Leadership from Management

Leader Manager

1. May or may not have official appointment to theposition.

2. Has power and authority to enforce decisiononly if the followers are willing.

3. Influences others either formally or informally.4. Interested in risk taking and exploring new

ideas.

5. Relates to people personally, and in anempathetic manner.

6. Feels rewarded from personal achievement.

1. Appointed officially to the position by theinstitution or organization.

2. Has power and authority to enforce decision byvirtue of the position in the organization.

3. Carries out predetermined policies, proceduresrules and regulations.

4. Maintains an orderly, controlled, rationalequitable structure.

5. Relates to people according to roles, jobfunction, duties and responsibilities.

6. Feels rewarded when fulfilling organizationagoals, mission, vision.

B. Types of Leaders

- Formalo officially appointed and chosen by the administrationo Given the legitimate power and authority to act in behalf of the groupo E.g. Class Mayor, USG President

- Informal Leadero Just chosen by the group itselfo Because of: age, seniority, special competencies, inviting personalities, ability to communicate,

ability to counsel others

o E.g. Social Groups, Church Organizations, Renewal Groups, Political Group, Work GroupC. Leaders and Managers Have Power and Authority

Power

- Ability to impose the will of one person or group to bring about certain behaviors in others.Authority

- The legitimate right to act and to give commands

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D. According to: French and Raven (2 Social Scientist)

Description of Organizational Power by French and Raven

Legitimate Power

- Given to a person by the organization because of position in the hierarchy (from top to bottom)o E.g. DON Director of Nursing, CEO, COO, President/Chancellor, Chairman-Board of Trustees

Reward Power

- Based on the ability to control and administer rewards to others for compliance with the leaders orders orrequest

o E.g. Promotion, salary increase, benefits and privileges, merit, recognition, honouring, awardstributes, appreciation

Coercive Power

- Ability to use punishment on others for non-compliance with management orders or directiveso E.g. Suspension, termination, expulsion, reprimand, isolation, community work, payment of

damages, revocation of license, remedial

Expert Power

- Derived from some special ability, skills or knowledge demonstrated by the individualo E.g. Dialysis nurse, cardiac surgical nurse,

Referent Power

- Based on a certain attractiveness or appeal of one person to another- Based on a persons connection as relationship with another powerful person

o E.g. a nurse who is cooperative, helpful, respectful, hardworking is referent to the head nurseE. Hierarchy of Management Skills

Level Conceptual Human Technical

Top 47% 35% 18%

Middle 31% 42% 27%

First/Entry 18% 35% 47%

*The highly complex skill put in, more pay.

Levels of Manager

Top Level Middle Level First Level

oGenerally make decision with thehelp of few guideline or structures

oCoordinate internal and externalinfluences

oView the organization as a wholeoCEO, COO, NO, VP, Directors

o Conducts day to dayoperations with some

involvement with ong term

planning and policy making

o Supervisor, Unit Manager,Head Nurse

o Concerned with a specificunits work flow

o Deal with immediate day today operations problems

o Case Manager, NP, TeamLeader, Charge Nurse

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Responsibilities of Nurse Manager regardless of title within the nursing department:

Patient Care Management Operational Management Human Resource Management

o Assess problems and needso Problem identificationo Planning of careo Teachingo Treatmentso Medicationso Clinical conferenceso Evaluating results

o Budgetingo Controlling expenseso Staffingo Providing supplieso Schedulingo Committeeso Communicatingo Coordinatingo Planning, evaluating

performance

o Meetingso Auditing

o Teachingo Counselingo Facilitatingo Rounds, conferenceso Continuing educationo Bulletin boardso Journalso Career mobilityo Peer reviewo Researcho In service programs

F. Leadership Styles

Style

- The way in which something is said or done- A particular form of behavior directly associated with an individual

Leadership Style

- How a leader uses interpersonal influences to accomplish goalAuthoritarian Democratic Laissez-Faire

Degree of Freedom Little Freedom Moderate Freedom Much Freedom

Degree of Control High Control Moderate Control No Control

Decision Making By the Leader Leader and Group

Together

By the group or by no one

Assumption of

Responsibility

Primarily the Leader Shared Abdicated

Output of the Group High Quantity, Good

Quality

Creative, High Quality Variable, May be Poor

Quality

Efficiency Very Efficient Less efficient than

authoritarian Inefficient

Closed System Open System Permissive system

Nurse Manager Followers

Nurse ManagerFollowers Followers

Nurse Manager

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G. Components of an Effective Nurse Leader/Manager

Goals Skills and Knowledge Self Awareness Communication Energy Action = LeaderG1. Goals: End Product of all Our Efforts desire to be Achieve (the Brain)

Individual Goal personal goal

Group Goal college, unit, department goal

Institutional Goal organizational goal, environmental goal

1. Goals should be congruent with each other goals should be aligned(IndividualGroupInstitutional)

2. Goals should be meaningful3. Goals Should be acceptable to all

G2. Skills and Knowledge (Hands and Feet)

o Critical Thinking skills do not accept what others are telling you (Skills)o Interpersonal Skills know the persons you work with (Knowledge)

G3. Self Awareness (Eyes, Ear, Nose)

G4. Communication

Heart

o Active listeningo Encourage the flow of information (degree of transparency)o Provide feedbacko Linkages and networking

G5. Energy (GI Tract)

o Restorative energy positive chargingo Draining energy low charging

G56. Action (Musculoskeletal)

III. Theoretical/Conceptual Basis for Leadership and Management

A. Early Leadership Theories

A1. Trait Theory

1. Assumes that a person have certain innate abilities, personality traits, or other characteristics in orderto be a leader

2. It assumes that leaders are born, not made, expressing the fundamental belief of the trait theorya. Physical Characteristics

o Height and appearance is important

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b. Personalityo An extrovert is at better advantage than introvert

c. Skills and Abilitieso A leader is more intelligent than its group members, manipulative, courageous

d. Social Abilitieso A leader is able to relate to other persons and participate in social groups

A2. The Great Man Theory

1. This theory states that certain people happen to be at the right place at the right time and it was theevents of the their time that made them great

2. Being a member of the royalty or a well to do family, well known family, has tremendous influence ofbeing a leader

3. History of the world is but the biography of great men Thomas Carlylea. Julius Caesarb. Alexander the Greatc. Adolf Hitlerd. Napoleon Bonapartee. Joan of Arcf. Jose Rizalg. Ninoy Aquinoh. Indira Gandhii. Abraham Lincoln

A3. The Charismatic Theory

- Charisma is an inspirational quality possessed by some people that makes others feel better in theirpresence

- A charismatic leader inspires others by obtaining emotional commitment from the followers andarousing strong feelings of loyalty and enthusiasm

- A charismatic leader perceive themselves as having supernatural purpose and destiny and the followersidolize and worship them leads to a phenomena called Blind Obedience that leads to outcomes such

as cult killings, physical sacrifices, emotional surrender, group suicide, terroristic attacks

B. Early Management Theories

B1. Scientific Management Theories

Frederick Winslow Taylor

- Considered as the Father of Scientific Management- Why is it considered scientific? Because he uses and introduces principles involving measurement,

observation, comparison RESEARCH Time and Motion Studies

- He used a stopwatch to determine the best way to perform a job- Principles of Scientific Management

a. Selection and training of workersb. Observation and control

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c. Supervision of workers utilizing the proper tools and equipmentd. Proper compensation for the work and the job that they do

Frank/Lillian Gilbreth

- Frankbrick layer- Lillian professor of psychology- Their theory is finding the best method or way to perform a given task- In order to increase efficiency and increase productivity- Based on a study, they have introduced the word therblig is the name of a set of fundamental motions

required for a worker to perform a manual operation or task

o Search, find, select, grasp, hold, position, assemble, use, disassemble, inspect, transport,transport loaded, transport unloaded, pre-position for next operation, release load,

unavoidable delay, avoidable delay, plan, rest to overcome fatigue

- Because of the therbligs, gave an idea of a new science that came out called Ergonomics- They have 12 children, they are the inspiration for the book Cheaper by the Dozen- Died at the age of 94 to manage the family of 12

Henry Gantt

- Mechanical engineer, management consultant, involved in 2 major projects in the USo Hoover Dam between California and Nevadao Interstate Highways connecting 1 state to another

- Gantt Charto Gantt chart provides a graphical overview and schedule of all activities, elements, work of a

project or program

o A Gantt Chart Should depict the following The relationship of work to be done The persons responsible for the work Time expected for work to be done The overall objective of the work

- The following are the procedures to be doneo Gather datao Analyze the datao Develop a plano Implement the plano Evaluate and give feedback, modify if necessary

B2. Classic Organization

Henri Fayol

- He is a French industrialist- Father of the Management Process School- Proponent/author of the administrative or management process

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5 Primary Functions of Management

1. Planning2. Organizing3. Commanding (Staffing)4. Coordinating5. Controlling

- Author of the 14 principles of managementSee handouts

- Person responsible for endorsing that management be taught in collegeMax Weber

- German Social Scientist- Known as the Father of Organizational Theory- He coined the word Bureaucracy- Characteristics

1. Clear division of labor or work. All work is divided into units, departments, bureau.2. Well defined hierarchy of authority, superiors are separated from subordinates3. Impersonal rules, or impersonality of relationship. There is separation between the person and

work. Walang kaibigan, walang kamag-anak, bayan muna. Erap Pare, walang personalan

trabaho lamang FPJ

4. A system of procedures in dealing with work situation. E.g. USLS enrolment procedure5. There are rights and duties and responsibilities attached to a position6. Selection for employment and promotion is based on technical competence. Its not what you

know, but whom you know that destroyed bureaucracy

B3. Human Relations Theories

Elton Mayo

- Harvard Professor- Conducted the Hawthorne Studies study of workers in the electric company near Chicago 1927-1932- Working Conditions

1. Physical Set-up2. Values of the organization3. Rules and regulation4. Policies and procedures5. Persons you work with most important

- The Illumination Studyvariable is lightKurt Lewin

- Jewish psychologist that migrated from Germany to the US- He studies group behavior and group dynamics

o The Father of Gestalt Psychology

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He stated that groups have personalities of their own and has control over their outputTell me who your friends are and I will tell you who you are. Birds of the same

feather, flock together.

- He is the proponent for the Change Theorya. Phases

1. Unfreezing getting ready to change2. Changing a process called transition3. Refreezing Establishing stability

b. Factors

o Driving Force pusho Restraining Force pull

c. To prevent reaction to change

1. Education2. Communication3. Participation4. Facilitation5. Support6. Manipulation

C. Contemporary Leadership/Management Theories

C1. Motivational Theories

A. Abraham Maslow

- Hierarchy of Needs- Was an American psychologist who studied the needs or motivations of the individual. He differed

from previous theorists in that he focused on the total person, not just one facet of the person

emphasized health instead of simply illness and problems

- Maslow formulated the HIERARCHY OF NEEDS, in which he used a pyramid arrangement to illustratethe basic drives or needs that motivate people

-Spiritual

Self Actualization

Ego Needs

Social Needs

Security Needs

Body Needs

- Human beings are motivated by unsatisfied needs- If a level of need is satisfied, it no longer motivates humans

B. Frederick Irving Herzberg

- An American Psychologist- Motivation-Hygiene Theory- Born: April 18, 1923in Massachusetts

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Died: January 18, 2010

Motivators

Achievement

Recognition

Work itself

Responsibility

Advancement

Personal Growth

Motivators (higher order needs job content can motivate/raise performance)

Hygiene factors are merely a launch pad when damaged or undermined we have no platform, but in

themselves they do not motivate

Lower order needs job context cannot motivate, often a source of dissatisfaction

C. Douglas McGregor

- Known for his motivational theory of work and management based on the concept of Theory X andTheory Y, described in his book The Human Side of Enterprise

- Theory Xo The organization human being has an inherent dislike of work and will avoid it, if he can.

Because of their dislike for work, most people must be controlled and threatened before they

will work hard enough

o The organization human prefer to be directed, dislikes responsibility, is unambiguous anddesires security above everything

o This assumption lies behind most organizational principles today and give rise to both to toughmanagement with punishment, tight control and soft management, which aim harmony and

work

- Theory Yo Control and punishment are not the only ways to make people worko If a job is satisfying, then the result will be commitment to the organization

Hygiene (or maintenance) factors

Status Security Relationship with Subordinates (superior, peers subordinate

Personal life relationship with peers salary

Work conditions relationship with supervisorCompany policy and administration supervision

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o Imagination, creativity and ingenuity can be used to solve work problems by large number ofemployees

o The expenditure of physical and mental effort in wok is as natural as play and restD. William Ouchi

- A researcher in business management- Professor, University of California- Author of the book THEORY Z- Born in Honolulu, Hawaii- Theory Z

o Theory Z is a hybrid management approach combining Japanese management philosophieswith US culture

o Represents a humanistic approach to managemento The best way to motivate is through collective decision making, long term job security and

humanistic management style

- 7 So 4 Soft S

Staff (Holistic Concern for Employees) Skills (Cross-functional career paths) Style (Relatively Slow Evaluation)

o 3 Hard S System (Balance Explicit and Implicit Control Mechanism) Structure (Individual Responsibility) Strategy (Consensual, Participative Decision making)

E. Peter Drucker (died Nov. 11 2005)

Management By Objectives

- Known for MBO- Drucker identifies 3 areas of managements

a. Managing a Businessb. Managing the Managersc. Managing the Workers

- The concept is objectives are developed in every level of management in the hierarchy, and in each unit othe organization

- E.g. Direct Selling AssociationAvon 2011 500 Million sales for 2011 in the National Levels Avon Negros Occidental 250 Million Franchise Managers 50 Million Agents 100Thousand sales

***50Million from Jan-May, June-Decemberprofit

- Motivation: ObjectivesC2. Interactional Theories

A. Fred A. Fiedlers Contingency Theory

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- Contingency an unexpected event or somethi9ng which is dependent- In this theory, Fiedler believes that the effectiveness of leadership vary depending on the situiationNo

best leadership style, it is the situation that calls for the applicable style

- Austrian Psychologist- The Groups performance depends on the following

o Leadership styles2 Classifications

1. Task Oriented2. People Oriented

o Situational Favourableness1. Leader-Member Relations member relations degrees to which a leaders is accepted

by group members

Good or poor2. Task Structure extent to which the task is defined, with clear goals and procedures

Structured or unstructured3. Position Power ability of a leader to control subordinates

Strong or weak4. Orientation/Consideration

Task oriented or relation oriented .eB. Robert House Path Goal Theory

- This theory assumes that the leader clarifies the path the employees wish to take and the goal theywant to reach

- See hand outsC. Lashbrook Work Unit Culture

- The interaction between the manager and staff that can lead to a productive work environment or toan unproductive environment

- Objective: to create a (+) work unit culture5 Areas

1. MissionQ: Why am I here?

2. GoalsQ: Where am I going?

3. FeedbackQ: How am I doing?

4. RewardsQ: Whats in it for me?

5. SupportQ: What happens if I need help?

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IV. The Management Process

A. Plan

A1.Process

- It is a process of setting goals and choosing the means to achieve the goal- It bridges the gap between where you are going and where you want to go- An intellectual process based on facts and information, NOT emotions and wishes- A continuous process, it never stops to ensure that decisions and proper use of resources, people, and

environment all towards the future

Integrating Nursing and Management Process

Nursing Process Management Process

Assessing

Planning

Implementing

Evaluating

Planning

Planning

Organizing

Staffing

Organizing

Directing

Controlling

A2. Hierarchy of Plans

- Mission Statement Founder Top Level Manager Board of Trustees or Directors (President/Chancellor)- Long range (Developmental 10+ years) Strategic Plans Top and Middle Level ManagerPres. VC/VP. Deans- Short Range (5 years or less, annual plans, semestral, quarterly monthly, daily) Operational Plans Middle

and first Level Manager (Deans, Level Chairs, Department Chair, Coordinator)

A3. Assessment

a. Tangible and Intangible Elements

Tangible visible, can be touched, can be measured

Intangiblethose that cannot be seen, physically touched, but has a marked impact on organizational life

Tangible Intangible

o Buildingso Groundso Equipmento Costo Work performanceo Policies/procedureso Statisticso Patient care recordso Professional development programso Safety measures

o Cognitive- Knowledge- Thinking- Planning- Problem solving- Brainstorming- Research- Group dynamics- Focused group discussion- recollections

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o Signs and symptoms o Affective- Motivation- Fear- Security- Traditions- Social/ethical values- Emotions/attitudes- Anxiety, fear, contentment, warmth

b. Strategic Planning

SWOT Strengths, Weakness, Opportunities and Threats

- External Assessment Opportunities, Threats- Internal AssessmentWeakness, Strengths

c. 3Ps in Management

Personnel

Physical Plant (Buildings, grounds, equipments facilities)

Policies and Procedures

A4. Priority Setting

1. Threats to life, dignity, integrity

= Hemorrhage, child abuse, broken side rail, schedule of meds or treatment

2. Threats to destructive changes (INDIVIDUAL, FAMILY, COMMUNITY)

= cancer, communicable diseases, air pollution, emotional disturbance, air pollution, emotionadisturbance

= INDIVIDUAL, FAMILY, COMMUNITY

3. Threats to normal growth and development

= nutrition, exercise, immunization dental care

A5. Major Concepts and Definitions

o Strategic long range planning; 3-5 years into the futureo Operational Planning short range planning; deals with day to day maintenance activitieso Belief conviction that certain things are trueo Vision mental image of something not actually visible, for now, but in the futureo Value the worth, usefulness, or importance of somethingo Mission an aim to be accomplished; mission statemento Philosophy statement of beliefs and values that directs behavioro Goal the end to be accomplishedo Objective something aimed at or striven for; things done to achieve the goal

3M

Manpower

Materials, Machine, Money

Methods

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o Policy governing plan for accomplishing goals and objectiveso Procedure chronological sequence of steps within a processo Protocols documents of agreement

Nursing care Plan

- Provides records of nursing needs for a particular patientB. Organize

- Establishing formal structure; foro Coordination of resourceso Determination of position and job description

- DeB1. Types of Health Care Organizations

a. Profit/Proprietary (exists for profit)where they got the money to operate

- This organization is managed by a Businesses- Sale of bones/shares- Insurance payments

o HMO Health Maintenance Organization- Government reimbursement

o Phil Healthb. Not for Profit/non proprietary

- Voluntary- Charitable- Religious- Public/government operated agencyLGU

- Municipal Health Unit- Provincial Health Unit- City Health Unit- Regional Health Unit- National Health Unit

B2. Organizational Structure

- Furnishes the formal framework on which the management prcess takes place- Is a way of grouping or forming relationship- It depicts the following

o Channel of authority, responsibility and accountability and accountabilityo Span of control

County

State

Federal

Local

Region

Ministry

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o Lines of communicationo Depicts formal organization pattern

B3. Organizational Chart

- a drawing that shows how the parts of the organization are linked togetherIt should depict the ff:

- Division or clusters of work- Chain of command- Type or clusters of work- Level or hierarchy of management

B4. Forms of Organizational Structure

a. Centralized

Advantages

- Highly cost effective- Concentrated range of skills- Eliminates duplication of efforts

Disadvantages

- Becomes large and more complex- Does not readily adapt to change- Obtaining decision require more time

Decentralized

Advantages

- Structures are broken down into smaller units- Authority delegated to those closer to majority- Have a voice in decision making- Increase communication interdepartmentally- Better interpersonal relationships- Problem solving allows greater imagination and creativity

Disadvantage

- Initial cost of staffingMatrix +

- Benefits of both centralized and decentralized control are used- Provides for both vertical and lateral coordination across departments- Applies specialized skills to solve problem

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- Interdisciplinary cooperationb. Flat ___

- Horizontal development- Shortens administrative distance (top to bottom)- Communications are direct, simple, fast, minimize distortions- Places tremendous pressure on each manager because of the amount of authority, responsibility- Overburdened manage

Tall |

- Vertical development- Lends to authoritarianism, require rapid changes and precise coordination- Levels are expensive because of large number of executives needed with high salaries

Concentric

- A chart that shows an outward flow of authority from the center moving outward, therefore thesmaller the circle, it refers to the top level management

c. Line and Staff relationship

Line

- A chain of command- Direct line between manager and staff depicted by solid line in the chart- Associated with direct achievement of organizational objectives

Staff

- Supports line authority- Either advisory or service in nature- Depicted in a dashed line - - - -- Handles details, offers counsel- Functions through influence for they do not have authority to accept, use, modify or reject plans

Chief Nurse

Head Nurse

Orderly Staff Nurse Nurse Aid

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D. Bureaucratic vs. Human Relations

Bureaucratic conservative, technical, scientific approach

Human Relations democratic, participative, liberal

B5. New Trends/Issues

5.1 Lean Manning/Lean Staffing

- Cut down costs5.2 Mergers

5.3 Contract Work

- Job-out- Outsourcing

5.4 Pooling of Resources

- Nurses poolC. Staff

Staff involves the following

- Selection of personnel- Formulating assignment system- Determination of staff schedules- Containing the cost while providing high quality care

C1. Categories of Nursing Personnel

Registered Nurse (RN)

- BSN graduateExpanded Roles

Nurse Practitioner*** expanded roles

Hospital AdministratorChief Nurse

Assistant Chief NurseNurse Trainer/Educator

Clinical Nurse SpecialistNurse Supervisor

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- A nurse practitioner receives special training in patient management to a select group of clients- Family NP (Home Health Nurses)- Pediatric NP- Psychiatric-Mental Health NP- Cardiac NP- Outpatient basis, clinic, home health, hospital unit-

Clinical Nurse Specialist***expanded roles

- Receives additional education from a college or university in order to render high quality care and casemanagement

- Hospital BasedUnlicensed Assistive Personnel (UAPs)respondeat superiorlicensed personnel are responsible

- Nurse Aid/Assistant/Orderly- Nurse Clerk (Ward Secretary or Ward Clerk)- Nurse Tech- Nurse attendant- Clinical Ladder

o 1 year Aideo 2 years Practical N or Vocational No 3 years LPN/LVNo 4 years BSN-RN

C2 Assignment Systems

a. Case Method of Assignment

- Each patient is assigned to a nurse for total patient care while on duty- This assignment is ideal it is simple, it is direct- This assignment requires highly skilled professionals that are highly paidE.g. Private duty nurse, ICU nurse

Drawing

b. Functional Method of Assignment

- Implements division of labor/work- Procedural descriptions and clearly defined assignments- ***holistic care is not achieved...therefore there is fragmentation of care- ***work can be very repetitive

c. Team Method

- Charge Nurse Team leader Nursing Staff Patients/Clients

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- Advantage: Quality nursing care- ***St. Lukes--

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L and M

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