Nursing Leadership and Management PDF

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Nursing Leadership and Management Leadership the use of one’s skill to influence others Kinds of Influence: 1. Assertiveness • standing up for oneself and other’s without violating the rights of others • Ex. You have chosen me as your leader... 2. Rationality • trying to convince someone by using reason, logic, or supporting information • Ex. We should do this because we need to give to the patient total quality care 3. Ingratiation making an individual feel important or good before making a request 4. Exchange offering an exchange of favor 5. Sanction • coercive authority • give punishment for noncompliance or reward for compliance 6. Blocking • backing up a request with a threat to damage an individual’s opportunity for advancement • not really the best 7. Coalition • getting co-workers to back-up a request 8. Upward appeal • obtaining formal or informal support of a higher-up Levels of Leadership - Personhood o Respect o People follow because of what you are and what you represent - People Development o Reproduction o People follow because of what you have done for them - Production o Results o People follow because of what you have done for the organization Permission o Relationships o People follow because they want to Position o Rights o People follow because they have to Types of Leader 1. Formal • officially appointed, elected • managers 2. Informal • chosen by the group • those who initiate an action

Nursing Leadership and Management Management • getting things done • it is the process of getting activities completed efficiently and effectively with and through people; production • is the process of planning, organizing, directing and controlling human and physical resources

Effectiveness • able to accomplish your objectives within the resource parameters • “doing the right things” • related to leadership Efficiency • able to accomplish you objectives/ production of results with minimum waste of time and effort • “doing the things right” • related to management Management - Is the process of planning, organizing, directing and controlling human and physical resources and technology to achieve organizational goals / objectives? 7 Basic resources of management 1. Manpower 2. Money 3. Machine o bigger equipment; capital expenses; to start a business; costs more 4. Materials o lesser/minor equipment; operation of organization or unit 5. Methods – process 6. Moment/Minutes – time management 7. Market ADMINISTRATION MANAGEMENT - Those at the top - Directly responsible level of organization to the production of services - Focus on establishing goals - Midline and lower levels of hierarchy and on integrating work units to achieve - Directs and guides the operations of the the organization’s organization mission Upper level manager: Primary responsible for establishing organizational goals and strategic plans for the entire division of nursing Director of Nursing Services, Chairman, Executive VicePresident

Nursing Leadership and Management 24/7 responsibility Middle level manager: Usually coordinate nursing activities of several units Supervisor, coordinator, clinical nurse managers, case managers 24/7 responsibility First level manager: Directly responsible for the actual production of nursing services; acts as links between higher level managers and non-managers Head nurse (nurse manager), charge nurse (informal), team leader, primary nurse Authority Legitimate right to give command, to make decisions Ability to impose his or her with another person or group Power Ability to get results Given with authority -

Powers a manager/leader may possess Legitimate power – based on position given Reward power - reward/incentives Coercive power- give sanctions or punishment Expert power Referent power o Charisma – innate personality trait o Connection Self (Personal) power – based on individual’s maturity, credibility, reputation, experience, gender Information power – based on the individual’s access to valued data Levels of Nurse Managers 1. Upper Level Manager • primary responsible for establishing organizational goals and strategic plans for the entire division of nursing • director of nursing service, chairman, executive vice president • nurse executives • Policy making body of an organization • oversee the activities of the lower levels 2. Middle Level Manager • usually coordinates nursing activities of several units • supervisor, coordinator, clinical nurse managers, case managers • oversee the activities of the lower levels 3. First Level Managers • directly responsible for the actual production of nursing services • acts as links between higher level managers and non-managers • head nurse (nurse manager), charge nurse, team leader, primary nurse Authority •

legitimate right to give commands, to make decisions

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ability to get results ability to impose his or her will on another person or group

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Nursing Leadership and Management MANAGERS LEADERS Appointment Are appointed May or may not have officially to official position appointment to position Power and Have power As long as Authority and authority followers are to enforce willing Goals Carry out Influnce others, predetermined either formally policies, rules or informally and regulations Risk-taking

Maintain an orderly, controlled, rational and equitable structure Relationship According to with people their own roles

Self-reward

Success as manager

When fulfilling organizational missions orgoals If they are reappointed; manager as long as appointment holds

Interested in risktaking and exploring new ideas

In an intuitive and emphatic manner From personal achievements

May or may not be successful manager

7 Basic Skills Required of a Leader/Manager 1. Conceptual skills 2. Technical skills 3. Human relations 4. Administrative skills 5. Communication skills 6. Analytical skills 7. Decision making skills

Nursing Leadership and Management LEADERSHIP STYLES 1. Autocratic • Makes decisions alone • Task oriented • Power with coercion • Proves useful (even necessary) in crisis situation • Authoritarian or exploitative style of leadership • Satisfaction is low • Effective when needed for immediate action • High productivity, less satisfaction of workers • 2 Types accdg. to Rensis Likert (Systems 4 approach): i. Exploitative-authoritative Have little trust in employees and exclude them in decision making ii. Benevolent-authoritative ▪ Are kind to employees but still do not involve them in decision making ▪ They ask the members 2. Democratic • Involve their followers in decision making • People oriented • Leads to increase productivity and job satisfaction • There is compliance • Participative/Consultative • 2 Types accdg. Rensis Likert (Systems 4 approach): i. Consultative-democratic ▪ Seek employees advice about decisions ii. Participative-democratic ▪ Value employee involvement, teamwork and seek advice in decision making 3. Laissez-faire • Loose and permissive • Ultraliberal • Foster freedom for everyone and wants everyone to be happy • Results in low productivity and employee frustration • Most beneficial to a staff of highly motivated professionals 4. Bureaucratic • Lacks a sense of security and depends on established rules and policies • Tends to relate impersonality to staff • Avoids decision making without standards or norms for guidance • Needed when discipline should be imposed Types of Behaviour 1. Passive or Non-assertive 2. Assertive – stand for oneself but doesn’t violate rights of others 3. Aggressive – violates rights of others

Nursing Leadership and Management THEORIES OF MANAGEMENT 1. Frederick Taylor • “Theory of Scientific Management” • Observed people in an electric plant • Time and motion studies • One best way to do the job 2. Max Weber • The ideal form of organization is “Bureaucracy” • With hierarchies—with rules and regulations 3. Luther Gulick Introduced the 7 activities of management as “POSDCORB” - planning, organizaing, staffing, directing, coordinating, reporting. 4. Henry Fayol • Developed the principles management and functions of management •

Fayol’s 14 Principles of Management: i. Division of labor-you should know your job ii. Authority, responsibility (pure obligation to do the task to the best of your ability), and accountability iii. Unity of command iv. Unity of direction – one path, goal, objective v. Scalar chain of authority and communication-highest to lowest level; channels of communication vi. Interest of the whole organization over interest of the individual vii. Equity and justice viii. Order (hierarchy, everything in order, in their place) ix. Stability or tenure of personnel – rapid turnover would not benefit the organization x. Initiative-right to make their own projects, decisions xi. Centralization- upper level of hierarchy makes decision xii. Discipline- follows rules xiii. Remuneration - compensation xiv. Teamwork and esprit de corps

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Command responsibility o Leader responsible for acts of subordinate o Respondeat superior

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Principle of Definition o Every employee must have a job description

Principle of delegation o Entrusting responsibility to others and to create accountability for results Delegation o Provides learning opportunities for •

Nursing Leadership and Management

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subordinates o Increases power o Cannot delegate total responsibility o Do not delegate responsibility without authorityg o Don’t just delegate boring jobs For nurses, delegation is not an option but a necessity

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5 Rights of Delegation o Right Person o Right Task o Right Circumstance o Right Direction/Communication o Right Supervision

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Causes of Underdelegating o Waste of time to explain o Believes that no one else can do the job o Fear- fear of criticism, fear of failing to get others to follow him o The need to control or be perfect o Enjoys the personal satisfaction o Gained from doing the work herself

Rules of Delegation to Unlicensed Staff o Do not delegate the functions of assessment, teaching, evaluation and nursing judgement o Delegate activities that involve standard, unchanging procedures o Delegate care of stable patients with predictable outcomes; assessment as long as stable Task that may not be delegated o Assessment o Interpretation of data o Care of invasive lines o Performing triads during emergencies o Making a nursing diagnosis o IV insertion •

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Span of Control o Number of persons that the leader can effectively manage o If noob-small span of control muna PODC

5. Mary Follet • Exercise power WITH people rather than power over people • Participatory management 6. Elton May • “Hawthorne Effect” • Tendency of people to perform as expected because of special attention • Should show concern to subordinates to increase level of performance 7. Kurt Lewin 3 phases of behaviour change o Unfreezing-identify what needs to be changed o Changing – practicing, doing o Refreezing- integrating into your daily activities

Nursing Leadership and Management 8. Peter Drucker • Management by objectives (MBO) • Be able to achieve your goals by having objectives 9. Herbert Simon 2 approaches to decision making o Optimizing-choosing the best possible alternative; longer time to achieve o Satisfying- first workable acceptable solution 10. Henry Mintzberg • Proposed the managerial roles • Interpersonal roles o Figurehead role o Leader role o Liaison role • Informational Roles o Monitor o Dissemination o Spokesman • Decision Roles o Entrepreneur o Disturbance handler o Negotiator o Resource allocator role MOTIVATIONAL THEORIES 1. Maslow’s Hierarchy of Needs 2. Douglas McGregor’s Theory X and Y • Theory X o Man is lazy, dislike work, unmotivated • Theory Y o Man is self-motivated, enjoy their work 3. William Ouchi (Theory Z) Involved workers are key to inc. productivity 4. Ferdinand Herzberg • Hygienic factors- working environment • Motivation factors-work itself o Give them work they really know Hygenic factors (working environment) -

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Adequate salary Appropriate supervision Good interpersonal relations Safe and tolerable working condition Job security Agency policies and procedures

Motivation factors (work itself) - Achievement - Recognition - Appropriate responsibility - Opportunity for advancement and achievement

THEORIES OF LEADERSHIP 1. Trait Theories – who the leader is • Great Man Theory (Aristotelian) o Leaders are born, not made • Charismatic Theory • Trait Studies

Nursing Leadership and Management o integrity, intelligence, initiative, industry o popularity, sociability, dependability 2. Behavioral Theories – what leader can do • Lewin, Lippit and White o Leadership Styles • Rensis Liker o Systems 4 approach • Blake and Mouton o Managerial Grid o Country Club-high concern for people, low on results o Impoverished-low concern for people and results o Middle of the road o Authority Compliance-high concern for results, low for people o Team- high concern for people and results 1,9 Managemen t Country Club

9,9 Managemen t Team 5,5 Managemen t Middle of the Road

1,1 Managemen t Impoverished

9,1 Managemen t Authority compliance

3. Contingency-Situational Theories • Adapts leadership style depending on situation • Fiedler’s Contingency theory o Matches leadership style to situational factors o Good relationship with subordinates o Knowledge is needed to accomplish a task, use of relationship, power • Situational Theory by Hersey and Blanchard o Depends on the situationmay be follower or leader o Considers the person’s readiness and willingness 4. Path Goal Theory • People act as they do because they expect their behaviour to produce satisfactory results • Leader rewards followers for completing their task 5. Contemporary Leadership Theory • Collaboration and teamwork

Nursing Leadership and Management Transactional Leadership Interaction between leaders and followers are essentially economic- use rewards trade offs Transformational Leadership • Focusing on change through its commitment to its vision • Empowering the subordinates Servant Leadership Theory (Greenleaf, 1977) • Leaders put serving others as number one priority Shared Leadership/Governance Several individuals and subordinate share the responsibility in achieving the organization’s goals Quantum Leadership • Should be updated, innovative and creative • Initiate to update himself Multiple Intelligence • Recognizes the different abilities affect leadership Emotional Intelligence • Understand feelings of others Cultural Bridges Leaders/managers must become culturally sensitive FUNCTIONS/PROCESSES OF MANAGEMENT PLANNING Deciding in advance what, where, how, when and who is to do future actions Is a continuous process of assessing, establishing goals and objectives, implementing and evaluating them which is subject to change as new facts are known 4 Planning modes: 1. Reactive Planning – occurs after a problem exists; done in response to a crisis 2. Inactivism – a type of conventional planning where the person considers the STATUS QUO as stable environment 3. Preactivism – utilizes technology to accelerate change and is future-oriented; do not value experience and the past; future is always preferable 4. Interactivism or Proactive – considers the past, present and future; done in anticipation of changing needs

Levels of Planning in Nursing:

Nursing Leadership and Management 1. Strategic Planning • 3-5 years years or more • In charge of whole organization • CEO, division heads, chief nurse • Exists farther in the future 2. Intermediate Planning • 6 months-2 years • Supervisors, clinical specialist 3. Operational Planning • 1 week-1 year • Managers of nursing units, head nurse, charge nurse, primary care nurse, team leader Scope of Planning 1. Forecast • Estimate the future • Short or long range projections • Vision o Mental image of something not actually visible, dreams, aspirations • Mission o Purpose or brief statement identifying reasons why organization exists • Philosophy o Articulates a vision and provides statement beliefs and values that guide one’s practice • External and Internal Assessment o SWOT Analysis Know the strength to overcome the weaknesses; Know the opportunities to overcome the threats 2. Set Goals/Objectives • Goals-broad o Achieve goals through OBJECTIVES • Objectives- specific o SMART o Behavioral 3. Develop and Schedule Strategies, Programs, Activities. Set time frame. • Strategy o Overall plans of the higher management system • Programs o Series of activities that function together to facilitate attainment of some desired goals 4. Prepare Budget • Allocation of resources or systematic plan of meeting expenses • Purpose is TO SET operating cost limits • Approaches/Systems of Budgeting o Centralized-upper level makes the budget o Decentralized- middle and lower level managers sets the budget then gives to upper level management

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Types of Institutional Budget o Capital Budget ▪ Lands, buildings, major equipments ▪ greater than 50,00 o Operating Budgets ▪ Includes cost of supplies, minor equipment repairs and overhead expenses o Manpower Budgets ▪ Salaries and wages Budgeting Methods o Incremental ▪ Flat percentage increase method ▪ Consider the inflation rate (around 20%) ▪ Multiply the current year expenses by the inflation rate o

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Zero-based ▪ Requires managers to justify in detail the cost of all programs both and and new Sunset Budget ▪ Is designed to self-destruct within the prescribed period to ensure cessation of the funder program by a predetermined date ▪ Are fixed expenses that cannot be recovered even if a program is cancelled

*Participation by nursing personnel in planning and controlling budget leads to cost consciousness •

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Time Management o Making optimal use of available time o More work with less time o Work smarter not harder 3 Steps in Time management o Establish priorities o Finish one task before beginning another o Reprioritize External Time Wasters o Telephone interruptions o Socializing o Meetings o Incomplete coworkers o Paperworks and readings Internal Time Wasters o Procrastination o Poor planning o Inability to say NO o Failure to set objectives o Inability to delegate

5. Establish polices, control standards and evaluation procedures • First step in evaluation • Standards o Indicate the minimal level of achievement accepted to meet the objectives o Pre-determined level of excellence that serves as a guide for practice • Types of Standards o Structure Those that focus on the structure or management system used to deliver care including number and categories of personnel

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Process ▪ Refers to actual procedure, those activities engage in to administer care Outcome ▪ Result of the procedures and nursing care ▪ What results (if any) occurred as a result of specific intervention

Policies o Are guides of basic rules that define the general course and scope of activities Procedures o Step by step guide to action Rules o Describe the situation that allow only one choice of action

ORGANIZING Involves establishing a formal structure to provide for the coordination of resources to accomplish objectives Scope of Organizing 1. Organizational Structure • Refers to the way a group is formed including its: CHANNELS OF AUTHORITY, SPAN OF CONTROL AND LINES OF COMMUNICATION • Is a mechanism through which work is arranged and distributed among members of the organization to achieve goals and objectives • Organizational Relationship o Formal or Reporting-straight line o Informal or coordinating- broken line Organization • signifies an in...