NURSING LEADERSHIP AND MANAGEMENT  Not all leaders are managers.

 “Managers are people who do thing right and

leaders are people who do the right thing” (Bennis
CONCEPT OF LEADERSHIP AND MANAGEMENT IN NURSING
and Nanus)

 According to Bennis and Nanus, there are three

DIFFERENCE IN LEADERSHIP AND MANAGEMENT fundamental qualities that effective leaders share:

 Managers 1. A guiding vision – leaders focus on a professional

and purposeful vision that provides direction toward the
 Have assigned position within the formal preferred future
organization.
2. Passion – it is the inspiring enthusiasm expressed
 Have legitimate source of power due to delegated by the leader to effectively endeavour the group in
authority that accompanies their position. achieving a common goal
 Are expected to carry out specific functions duties 3. Integrity – based on knowledge of self, honesty,
and responsibilities and maturity that is developed through experience and
growth.
 Emphasize control, decision analysis and results
Leadership Characteristics:
 Manipulates people, the environment, money, time
and other resources to achieve organizational goals  Intelligence
 Have a greater formal responsibility and  Self- confidence
accountability for rationality and control and leaders
 Determination
 Direct willing and unwilling subordinates
 Integrity
 Leaders
 Sociability
 Often do not have delegated authority but obtain
their power through other means, such as influence Leadership Roles:

 Have a wider variety of roles than do managers  Decision Maker = Coach

 May not be part of the formal organization  Communicator = Counselor

 Focus on group process, information gathering,  Evaluator = Teacher

feedback and empowerment
 Facilitator = Critical thinker
 Emphasize interpersonal relationship
 Risk Taker = Buffer advocate
 Direct willing followers
 Mentor = Visionary
 Have goals that may or may not reflect those of the
 Energizer = Forecaster
organization
Leadership Theories:

 Behavioral Approach Theories:

Leadership
(KURT LEWIN & COLLEAGUES)
 Commonly defined as a art of influencing others
towards achieving common goal which involve the  Three leadership styles:
participations of a leader and followers.
1. Autocratic leadership – is a leadership style that is
 Each persons has a potential to become a leader sometimes called directive or bureaucratic that uses coercion
in the exercise of his power that is centered to accomplishing
 Formal leadership – when a person is in a position of
the task rather than the people who perform the task
authority or is assigned such role within an
organization that connotes influences, such as a 2. style that is focused on human aspects and build
clinical nurse specialist. teamwork, interaction between leaders and subordinates is
open, friendly and trusting.
 Informal leader – is an individual who demonstrates
leadership by influencing others to achieve their 3. Laissez-faire leadership – is a style of leadership that the
common goal even if she or he is not the designated leader do not give direction to the member of the group, he
leader of the group. avoids responsibility by relinquishing power to his
subordinates.
 Contingency Theories – is a style of leaders in which
decisions of the leader is based on the actual situation of the
time. According to Fielder, contingency theory,
accomplishing a task greatly depend on the interrelationship
between the group’s leader and its member.

• Leader – member relationship – are the feeling and

attitudes of followers regarding acceptance, trust and
credibility of the leader

 Contingency Theories

• Task structure – refers to the degree to which work is

defined, with specific procedures and explicit directions

• Position power – is the degree of formal authority and

influence associated with the leader.

 Hersey and Blanchard’s Situational Theory – the

group with low maturity, whose members are unable
or unwilling to participate or are unsure needs a
telling leadership style leader to provide direction
and close supervision.

• Telling leadership style – high task behavior and low

relationship behavior

• Selling leadership style – a high task and high

relationship style

 a match for groups with to moderate maturity who

are unable but willing and confident but needs clear
direction and supportive feedback to get the task
done.

• Participating leadership style – a low task and high

relationship style

 is a leadership style recommended for groups with

moderate to high maturity who are able but
unwilling or unsure and who needs support a
encouragement to get the task done.

• Delegating leadership style – a low task and low

relationship style

 used with groups of followers with high maturity,

are able and ready to participate and can engage in
the task without direction or support.

 Maturity - means, followers readiness; assessed in

order to select one of the four leadership style for a
situation.

 Path – Goal Theory – the leader works to motivate

followers and influence goal accomplishment.

 by using the appropriate style of leadership for the

situation (i.e., directive, supportive, participative or
achievement oriented) the leader makes the path
towards the goal easier for followers.
 Environmental Contingency
Factor
 Task Structure
 Formal Authority
system
 Work Group
Leader’s Behaviour Outcome
 Directive
 Performance
 Supportive
 Satisfaction
 Participative
 Achievement Oriented

Subordinate Contingency
Factor b) Transformational Theory
 Transformational leaders motivates others by
 Loose of Control
behaving in accordance with values, providing a

 Experience vision that reflects mutual values, and empowering

others to contribute.
  Perceive Ability
Directive Style of Leadership – provides structure through
 Bennis & Nanus describe this as one who commits
direction and authority, with the leader focusing on the task and
getting the job done. people to action, who converts followers into leaders
and who converts leaders into agents of charge”
 Supportive Style of leadership – relationship oriented, with the
leaders providing encouragement, interest and attention. Essential Qualities of a Nurse Leaders:

 Participative Leadership – means that the leader focuses on The nurse leader should have:
involving followers in the decision making process.  Intellectual, technical and administrative skills
 Achievement-Oriented Style – provides high structure and  Integrity, honesty, ability to work with others
direction with high support through considerable behavior.
 Tact and emotional stability
Contemporary Approaches:
 Ability to win the support and loyalty of fellow-
 a) Charismatic Theory – leaders displays self-confidence workers
strength in their convictions, and communicate high
expectations and their confidence in others, have a positive and  Good human relationship with co-workers
powerful effect on people and organization.
NURSING MANAGEMENT
b) Transformational Theory – defined as a process of which
SCIENTIFIC MANAGEMENT
“leaders and followers raise one another to higher level of
motivation and morality” (Burns). FREDERICK TAYLOR -

(FATHER OF SCIENTIFIC MANAGEMENT)

 Postulate that if workers could be taught;

“One best way to accomplish a task”, productivity would

increase”.

 Principles of Scientific Management:

 Traditional “Rule of Thumb” means, organizing work must

be replaced with scientific method.

 A scientific personnel system must be established so

workers can be hired, trained and promoted.
 Workers should be able to view how they fit into the  Theory X: leaders must direct and control as
registration and how they contribute to overall motivation result from reward and punishment.
organizational productivity.
 Theory Y: leaders remove obstacles as workers have
 The relationship between managers and workers should be self-control, self-discipline; their reward is their
cooperative and interdependent, and work should be shared involvement in work.
equally.
 Theory Z: collective decision making, long-term
 Lilian Gilbert - said, Train the workers, use of proper tools employment, mentoring, holistic concern and use of
and equipment; use of incentives; use of motion studies to quality circles to manage service and quality; a
make the work easier. humanistic style of motivation based on Japanese
organization.
 Bureaucratic Theory:
 Definition of Management:
 Max Waber (German Sociologist) – saw the need for
legalized, formal authority and consistent rules and  An art of planning, organizing, staffing, directing and
regulations for personnel in different positions. controlling.

 The defining characteristics was that is was an  Process by which a cooperative group directs action
institutional methods of applying general rules to toward common goals.
specific cases, thereby making the actions of
 Involve techniques by which a distinguished group of
management fair and predictable.
people coordinates the service of the people.
 Division of labor, hierarchy of authority and chain of
 Includes moral and ethical standards in the selection of
command, rationality, impersonal management, use
right ends.
of merit and skill as basis for promotion/ rewards;
use of rules and regulations, focus on exacting work  Role of Managers:
processes; career service, salaried managers.
1. Interpersonal role
SCIENTIFIC MANAGEMENT
 Shows the manager as a symbol because of the
 Management Theory: position he occupies and coupled with duties and
responsibilities.
 Human relation – this era developed the concepts of
participatory and humanistic management,  As a leaders who hires, trains, encourages, fires,
emphasizing people rather than machines. remunerates and judge.
 Elton Mayo and his Colleagues discovered that when 2. Informational role:
management paid special attention to workers,
productivity was likely to increase, regardless of the  As one who monitors information
environmental working condition.
 Disseminates information from both external and
 “Hawthorne effect” indicated that people respond to internal source.
the fact that they are being studied, attempting to
Decisional role:
increase whatever behavior they feel will continue to
warrant the attention.  A trouble-shooter who handles unexpected situation
such as recognition and firing subordinates and losing
 Selected content of motivation theories:
clients.
 Abraham Maslow – Heirarchy of satisfaction of
 As negotiator when crises arise.
physiological safety, belonging, ego and self-
actualization needs.  Fundamental skills of a Manager:

 Selected content of motivation theories:  Technical skills – relate to the proficiency in performing
an activity in the correct manner with the right
 Frederick Herzberg – (Two Factor Theory) – Hygiene –
techniques.
maintenance factor = prevent job disqualification:
 Human relation skills – pertains to dealing with people
provides adequate salary and supervision, safe and
and how to get along with them.
tolerable working conditions.
 Conceptual skill – deals with the ability to see
 Motivators = job satisfaction:
individual matters as they relate to the total picture
Satisfying and meaningful work, development and to develop creative ways of identifying pertinent
opportunities, responsibility and recognition. factors, responding to the big problems, and
discarding irrelevant facts.
 Motivation Theories:
 Management level in nursing: 4. How – How the job be done? What are the steeps to
be followed in doing the procedure? How will
resources be used including time, personnel and cost.

5. Who – is a question of who has been doing the job,

who else can do it and is more than one person
involve?

6. Why – a question of why this procedure and steps

necessary to be done? Why by this person, this time
and place?

7. Can – can some steps or equipment be eliminated?

Can this activity be efficiently combined with other
operations? Can somebody else do it better? Can we
get a machine to help? Can we get enough money?

 Contingency Planning

 The identification and management of the many

 Management Functions of the Nurse: problems that interfere with getting work done
1. Planning  Reactive in response to a crisis or proactive in
2. Organizing anticipation of problems or in response to
opportunities
3. Directing
 Strategic Planning
4. Controlling
Refers to defining and prioritizing long- term objectives of
PLANNING the organization and developing strategic for
implementation
 Defined as pre-determining a course of action in
order to arrived at a desired result. It is a continuous Strategic planning is future oriented focusing on plans for
process of assessing, establishing goals and the next 2 – 5 years
objectives, implementing and evaluating them, and
subjecting these to change as new facts are known.  Principles of Planning

 Decision making are inherent in planning. 1. Always based and focused on the vision, mission,
philosophy and clearly defined objectives of the
 Four Stages of Planning: organization
1. Establish objectives ( goals) 2. A continuous process
2. Evaluate present situation and predict future trends 3. Should be pervasive within the entire organization
and events covering the various departments, services, and the
various levels of management to provide maximal
3. Formulate a planning statement ( means)
cooperation and harmony.
4. Convert the plan into an action statement
4. Utilizes all available resources
 The Planning Formula:
5. Must be precise in its scope and nature, realistic and
1. What – a question of what should or has been done, focused on its expected outcome
a statement of the problem which includes the
6. Should be time- bounded within short and long range
equipment and supplies needed, the necessary
plan
procedure, sequence and efficient methods to be
use. 7. Projected plans must be documented for proper
dissemination
2. When – means time, when should the job be done?,
when was it formerly done and when could it be  Characteristics of a Good Plan
done?
1. Precise with clear- worded objectives
3. Where – it is a place where the job be done? Where
the activity occur? To include storage of supplies / 2. Guided by policies and/or procedures affecting the
materials and cleaning of equipments. planned action

3. Indicate priorities
4. Develop actions that are flexible and realistic in terms  Statement of beliefs and values that direct one’s life
of available personnel, equipment, facilities and time or one’s practice

5. Develop a logical sequence of activities  The sense of purpose of the organization and the
reason behind the structure and goals
6. Include the most practical methods of achieving each
objective GOALS AND OBJECTIVES

7. Pervade the whole organization  Differ in that goals are more general and the cover a
broad area, objective ,on the other hand tend to be
 Barriers of Planning:
more specific and are concrete.
 Lack of knowledge of the philosophy, goals and
 Elements of Planning
objectives
 Forecasting: - helps managers look into the future
 Lack of understanding of the significance of planning
and decide in advance as to where the agency would
process
like to be and what is to be done in order to get
 Time management for planning there. It includes: environments, customs & belief,
public attitude and behavior, illnesses and barriers.
 Lack confidence in formulating their plans
 Budgeting: - is a plan for future activities express in
 Fear that planning would bring about unwanted operation as well as financial or monetary terms.
changes A financial “Road Map” which serves as an estimate
of future cost and a plan for utilization of manpower,
material and other resources to cover capital projects
in the operating programs.

 Elements of Planning:  Type of Budget:

Vision Statement  A Nursing Budget: - is a plan of allocation of

resources based on preconceived needs for a
 Outline the organization’s future role and function proposed series of programs to deliver patient care
 Gives something to strive for during one fiscal year.

Vision:  A Hospital Budget: is a financial plan to meet future

service expectations which are derived from the best
A Center of Excellence in Instruction, Research, judgment of the need of the community. These
Technology, Extension, Athletics and the Arts. translates to manpower needs, equipment and
supplies.
Mission Statement
 Component of Budget:
 Outlines the agency’s reasons for existing (whether
hospital or health care) who the target clients are(  Cash Budget: - Forecasts the amount of money
poor, the needy, the meddle or upper class) and what received: beginning cash balance, estimates of the
services will be provided ( In- patient, out- patient, receipts and disbursement and estimated balance for
emergency) a given period
 MISSION:  Capital Expenditure Budget: is a intended for the
procurement of addition fixed assets, estimated cost
The School of Nursing shall generate competent,
of fixed assets replacement, improvements and
compassionate professional nurses committed to:
upgrade.
a. Practice high standard of nursing care utilizing
 Operating Budget: - budget intended for salaries,
research and evidence-based practice that are
supplies, contractual services, employee benefits,
culturally appropriate and sensitive;
laundry service, drugs and pharmaceuticals, in-
b. Be actively involved in local, national and global service education, travel, meeting, books, periodicals
issues affecting nursing, people’s health and the & magazines and repair and maintenance.
environment;
 The Local Government Code:
c. Ongoing holistic growth and development of the self
 The legal basis to consider in operating develop
and others.
hospitals is the Local Government Code (LGC) of 1991.
Philosophy
 Section 18 of the Department of Health Rules and
 Describes the mission Regulations Implementing the LGC of 1991 (the “DOH
Rules”) assigns to the Local Government Units (LGUs) the
 management and operation, among others of provincial, 17. Affiliation of nursing or medical students e.g.
district, municipal and city hospitals. Funds to support Inexperienced students need more equipment and
the operation shall come the city, province and national supplies
government and other government owned or controlled
corporations which are task by law to establish and  Time Management – is allocating one’s time through
maintain health services and facilities. the setting of goals assigning priorities to reach its
goal efficiently.

 Principles of time management –

 Plan to anticipate problems that will arise

 Elements of Planning
 Task to be accomplished should be done in
 Costing out of Nursing Services: - Nursing service needs
are determined by many factors which the staff should sequence and should be prioritized
be aware of as budget planning proceeds.  Elements of Planning
1. The type of patient (medical, surgical, maternity,  Principles of time management –
pediatric, communicable disease and or chronically ill),
length of stay in the hospital, and the acuteness of the  Setting deadlines in one’s work
illness.
 Avoid procrastination
2. The size of the hospital and its bed capacity.
 Delegates task
3. The physical outlay of the hospital, the size and plan of
 Stress management
the ward or units, the Nurse’s Station, Treatement
rooms, etc;  Stress is a nonspecific reaction that people have to
demands from the environment that pose a threat
4. Personnel policies:
a) Salaries paid to various types of nursing personnel Hans Selye – General adaptation syndrome.
including pay for overtime or shift differential.
Type of Stress:
b) The extent of vacation and sick leaves, holidays
 Enstress – positive stress
c) Provision for staff development programs including
instructional staff  Distress – negative stress

5. The grouping of patients such as those in specialized The Nature of Stress:

areas and intensive care units, etc
 When the degree of stress is equal to the
6.The standard of nursing e.g., the kind and amount of degree of ability to accommodate it, the
care to be given as if affects the number of hours of organism is in the state of equilibrium.
bedside care
 The experience of stress is subjective and
7. The methods of performing nursing care whether individualized.
simple or complex
Causes of Stress:
8. The method of documentation
• Organizational Factor: - Stress that resulted from job
9. The proportion of nursing care provided by – related factors such as task overload, conflicting
professional nurses and those given by non- task, inability to do the task assigned because of lack
professionals of preparation or experience and unclear or
10. The amount and quality of supervision available and insufficient information regarding assignment.
provide
11. The efficiency of job description and job classification • Interpersonal Factors

Role – a set of expectations about behaviour ascribed to a

12. The methods of patients assignment, whether specific position in society.
functional case, team or primary
13. The amount and kind of labor-saving devices, Managing of Stress:
equipment and intercommunication system
14. The amount of centralized service provided, sterile • Personal Methods: - one of the first steps in
supply, central oxygen service and linen supply managing stress is to recognize stressors in the
15. The nursing service requirements of the ancillary environment and control them.
department: clinic, admitting office and emergency
rooms • Organizational Methods: - Managers should explore
16. The reports required by administration whether simple work related causes of stress in order to eliminate it.
or complex
 ORGANIZING

Types of Organization Classified by Nature of Authority:

1. Line organization – is the simplest and most direct

type of organization in which each position has
general authority over the lower position in the
hierarchy.

(ex : clinical & administration)

2. Informal organization – refers to horizontal

relationship rather than vertical. This composed of
small groups of workers with similar interests.
3. Staff organization – is purely to the line structure
with no authority to put recommendations into
action.

(ex: training & research)

4. Functional organization – is one where each unit is

responsible for a given part of the organization’s
workload. There is clear delineation of rules and
responsibilities which are actually interrelated.

(ex: All Standing and Ad Hoc Committees)

STAFFING

 The process of determining and providing the

acceptable number and mix of nursing personnel to
produce a desired level of care to meet patient’s
demand.

 Purpose: to provide each nursing unit with an

appropriate and acceptable numbers of workers in
each category to perform the nursing task required.

Factors Affecting Staffing:

1. The type, philosophy, objectives of the hospital and the

nursing service.

2. The population being served or the kind of patients

being served whether pay or charity.

3. The number of patients and severity of their illness –

knowledge and ability of nursing personnel aare
matched with the actual care needs of patients.

4. Availability and characteristics of the nursing staff,

including education, level of preparation, mix of
personnel, number and position.

5. Administrative policies such as rotation, weekends and

holiday off-duties.

6. Standards of care desired which should be available

and clearly spelled out. Institutions may utilize the
ANSAP’s Standard of Nursing Practice; PRC-ANSAP’s
Standard of Safe Nursing Practice and / or the
hospitals themselves may formulate / develop their
own standard;
 7. Layout of the various nursing units and resources
available within the department such as adequate
equipment, supplies and materials.

8. Budget including the amount allotted to salaries, fringe

benefits, supplies, materials and equipment.

9. Professional activities and priorities in non-patient

activities like involvement in professional
organizations, formal education development,
participation in research and staff development

10. Teaching program or the extent of staff involvement

in teaching activities

11. Expected hours of work per annum of each

employee. This is influenced by the 40-hour week law

12. Patterns of work schedule- traditional 5-days per

week, 8 hours per day; 4 day a week, ten hours per
day and three days off; or 3 ½ day of 12 hours per day
3 ½ days off per week.

Patient Care Classification System:

To develop a workable classification system, the nurse managers

must determine the following:

1. The number of categories into which the patients should be

divided

2. The type and number of care procedures that will be needed by

a typical patient in each category

3. The characteristics of patients in its categories

4. The time needed to perform these procedures that will be

required by a typical patient in each categories Computing for the Number of Nursing Personnel Needed

When computing for the number of nursing personnel in the

various nursing unit of the hospital, one should ensure that
Patient Care Classification Categories: there is sufficient staff to over all shift, off-duties, holidays,
leaves, absences, and time for staff development programs.
Level I – Self Care or Minimal Care – Patient can take a bath on
his own, feed himself and perform his activities of daily living. Republic Act 5901 (The forty-Hour Week Law)
provides that employees working in hospitals with 100-bed
Level II – Moderate Care or Intermediate Care – Patients
capacity and up will work only 40 hours a week. This also
under this level need some assistant in bathing, feeding or
applies to employees working in agencies with at least one
ambulating for short periods of time.
million population.
Level III – Total, Complete or Intensive Care – Patients under
Employees working in agencies with lees than 100-
this category are completely dependent upon the nursing
bed capacity or located in communities with lees than one
personnel. They are provided complete bath, are fed and
million population will work 48 hrs a week and get 1-off duty
provided other needs.
a week.
Level IV – Highly Specialized Critical Care – Patients under this
Benefits to be enjoyed personnel regardless of
level need maximum nursing care with a ratio of 80
working hrs duty is stated in Civil Service Commission as per
professionals to 20 non-professionals. Patient needs
Memorandum Circular No 6, series of 1996 to include
continuous treatment and observation: with many
others.
medications and vital signs in every 15 to 30 minutes.
 To compute for the staff needed in the In-Patient units of
the hospital, the following steps are considered:

1. Categorize the number of patients according to the

levels of care needed. Multiply the total number of
patients by the percentage of patients at each level
of care (whether minimal, intermediate, intensive or
highly specialized).

TO ILLUSTRATE:

Problem Solving: (SAMPLE)

 Find the number of nursing personnel needed for 250

patients in a tertiary hospital

NOTE !!

 Although an employee is entitled to 15 days sick leave, 12

holidays, 3 days for continuing education, plus 3 days of
special privileges 0r 48 days, he or she gets only average of
33 days leave per year.

Relievers Needed

 To compute for relievers needed, the following should

be considered:

 Average number of leaves taken per year - -

15

o Vacation leave - - 10
2. Find the total number of nursing care hours needed by
o Sick leave - - - 5 th patients at each category level.

 Holidays - - - 12 a) Find the number of patients at each level by

the average number of nursing care hour
 Special Privileges as per CSC MC #6 s. 1996 - - needed per day.
3
b) Get the sum of the nursing care hour needed
 Continuing Education Program for Professionals - at the various level.
3

Total Average Leave - - - 33

 To determine the relievers needed, divide 33 (the

average number of days an employee is absent per
year) by the number of working days per year that
each employee serves (whether 213 or 265).

 This will be 0.15 per person who works 40 hours per

week and 0.12 per person for those working 48 hours
per week.

 Multiply the computed reliever per person by the

computed number of nursing personnel. This will give
the total numbers of relievers needed.

Distribution by Shifts:

 In the Philippines the distribution followed is:

 45 percent for the morning shift,

 37 percent for the afternoon shift,

 18 percent for the night shift

Staffing Formula:
 TO ILLUSTRATE:

Problem Solving: (SAMPLE)

6. Categorize to professionals and non-professionals.

Ratio of professionals to non-professionals in a
tertiary hospital is 65:35.

Sample Formula:

190 X .65 = 124 Professional Nurses

190 X .35 = 66 Nursing Attendants

6. Distribute by shift

TO ILLUSTRATE:

Problem Solving: (SAMPLE)

6. Distribute by Shift

Sample Formula:

124 nurses X .45 = 56 nurses on AM shift

124 nurses X .37 = 46 nurses on PM shift

124 nurses X .18 = 22 nurses on night shift

Total 124 nurses

66 Nsg attendant X .45 = 30 Nsg attendants on AM shift

66 Nsg attendant X .37 = 24 Nsg attendants on PM shift

5. Find the total number of nursing personnel needed.
60 Nsg attendant X .18 = 12 Nsg attendants on night
a. Divide the total number of nursing care needed per year shift
by the actual number of working hours rendered by an
Total 66 Nursing Attendant
employee per year.
NOTE !!
b. Find the numbers of relievers. Multiply number of
nursing personnel needed by 0.15 (for those working 40 It should be noted that the above personnel are only for
hrs per week) or by 0.12 (for those working 48 hrs per the in-patients. Therefore, additional personnel should be
week). hired for those in supervisory and administrative positions
and for those in special units such as the Operating Room,
c. Add the number of relievers to the number of nursing
Delivery Room, Emergency Room and Out-Patient
personnel needed.
Department.

Placement:

 Proper placement fosters personal growth, provides a

motivating climate for the employee, minimizes
productivity and organizational goals have better
chances of being met.

 Employees who are placed in areas of their interest

adapt faster. Their feet are lighter, and, they are a lot
happier than those placed in areas which are not of
interest to them.

Scheduling :

 A schedule is a timetable showing planned

6. Categorize the nursing personnel into professionals and work days and shifts for nursing personnel.
non-professionals. Multiply the number of nursing
personnel according to the ratio of professionals to Factors Considered in Making Schedules:
non-professionals.
 Different levels of the nursing staff; adequate coverage  Length of scheduling period whether 2 or 4 weeks
for 24 hours, seven days a week; staggered vacations
 Shift rotation, Week- ends off
and holidays; weekends; long stretches of
consecutive working days; evening and night shifts;  Holidays off, Vacation leaves
and floating.
 Special days ( birthdays, weddings)
 An adequate mix of nurses and nursing attendants
should be observed so they only assume duties that  Scheduled events in the hospital
they are legally responsible for according to their
 Job categories
positions, education, training, and experience
 Continuing professional education
 Afternoon and nightshifts requirements for staff are
usually lower than in the morning shift. Advantages of Cyclical Schedule:

 Vacations, whether forced or requested are likewise  Fair to all

staggered to ensure adequate coverage at all time
 Saves time as the schedule does not have to be
 Long Stretches of consecutive working days should redone every week or two
be avoided as much as possible because it might
affect the health of the nursing personnel. Afternoon  Enables the employees to plan ahead for their
and night shift are more difficult than the day shift. personal needs

 Busy units may require additional help. Unscheduled  Scheduled leave coverage such as vacation,
absences may require a staff to be pulled out from holidays, and sick leaves are more stable
her regular area of assignment to cover for another  Productivity is improved
unit.
Rotating work shift

 It is desirable that there be an equal share of morning,

Assessing Schedule System: afternoon and night shifts, as prolonged night shifts
 Ability to cover the needs of the unit may affect the health of the personnel.

 Quality to enhance the nursing personnel’s DIRECTING

knowledge, training and experience  Directing is the issuance of orders, assignments and
 Fairness of the staff instructions that enable the nursing personnel to
understand what are expected of them.
 Stability
 It includes supervision and guidance so that in doing
 Flexibility there jobs well, nurses can maximally contribute to
the organization’s goals in general and to the nursing
Types of Scheduling
service objectives in particular.
 Centralized Schedule
 Elements of Directing
 One person, usually the Chief Nurse or her
 Delegating
designate, assigns the nursing personnel to the
various units of the hospital. This includes the shifts  The transfer of responsibility for performance of a task
on duty and off - duty from one person to another.

 Decentralized Schedule  Delegation also trains and develops staff members who
desires greater opportunities and challenges in their
 The Shift and off – duties are arranged by the
work making them more committed and satisfied in
Supervising Nurse or Senior Nurse of the particular
their jobs.
unit
 Principles of Delegation
 Cyclical Schedule
1. Select the right person to whom the job is to be
 Covers a designated number of weeks called the
delegated.
cycle length and is repeated thereon. It assigns the
required number of nursing personnel to each 2. Delegate both interesting and uninteresting tasks.
nursing unit consistent with the unit’s patient care
requirements, the staff preference, education, 3. Provide subordinates with enough time to learn.
training and experience. 4. Delegate gradually.
Scheduling variables should be considered: 5. Delegate in advance
6. Consult before delegating

7. Avoid gaps and over-lapping

 What Cannot Be Delegated:

1. Over-all responsibility, authority and accountability for  Total Care or Case Nursing: One nurse is assigned to
satisfactory completion of all activities in the unit. one patient for the delivery of total care. The nurse
plans, coordinates, implements, evaluates and
2. Authority to sign one’s name is never delegated.
documents the nursing care she has given during her
3. Evaluating the staff and / or taking necessary corrective shift. She provides holistic care to her patient and is
or disciplinary action. accountable for her own action.

4. Responsibility for maintaining morale or the Advantages:

opportunity to say a few words of encouragement to
 Continuous nursing care
the staff especially he new ones.
 Total accountability for the nursing care of the assigned
5. Jobs that are too technical and those that involve trust
patient for that shift.
and confidence.
 Continuity of communication with the patient, family
 Nursing Care Assignment:
and staff from other departments.
 Nursing care assignment may be called by various
Disadvantages:
terms, it is sometimes called modalities of nursing
care, systems of nursing care or patterns of nursing  RN spend some time doing tasks that could be done,
care. more cost effectively by les skilled person.

 Historically, four basic methods are used in the  Team Nursing: Is a decentralized system of care in
assignment of nursing care: function, total care which a qualified professional nurse leads a group of
(formerly termed as case nursing), team nursing and nursing personnel in providing for the nursing needs
primary nursing. of a group of patients / clients through participative
effort.
 Functional Nursing: This kind of nursing modality is
task-oriented in which a particular nursing function is  Team leader assigns patients and tasks to team
assigned to each worker. One registered nurse may members according to job descriptions. Leader is
be responsible for giving medications, another nurse responsible for coordinating the total care of a group of
for admission and discharges while nursing patients.
attendants change linen, provide hygienic care.
Advantages:
Advantages:
 Allows the use of less prepared staff members to carry
 Allows more work to be accomplished in the shortest out some functions
time possible
 Allows patient care needs requiring more than one
 Workers learn to work fast. member.

 Because the tasks are receptive they gain skills faster in Disadvantages:
that particular task.
 Large amount of time is needed for the team leader to
Disadvantages: maintain effective communication.

 Fragmentation of nursing care therefore holistic care is  Continuity of care may be diminished
not achieved
 Role confusion and resentment
 Nurse’s accountability and their responsibility are
 Decreased control over their assignments.
diminished.

 Patients cannot identify who their real nurse is.

 Primary Nursing: a form of assigning responsibilities for

patient care, is an extension of the principle of
decentralization of authority.
  Each registered nurse is responsible for the total and goals in life shaped earlier on by parents and
care of a small group of patients from admission to peers.
discharge.
 Extrinsic Motivation is enhanced by the environment
 The primary nurse assesses the patient’s needs for or external rewards. This may come in the form of
care, set care goals, writes nursing care plan and promotion increases in salary, added benefits, or
administer it, evaluates the outcome of care and external rewards.
makes necessary changes or adjustments.

Advantages:
 Motivational Theories:
 Knowledge based model
A. Need theory:
 Decentralization of nursing care decisions, authority
1. Abraham Maslow’s Hierarchy of Needs – shows that
and responsibility is of the staff nurse.
people are motivated to satisfy certain needs
 Improved continuity and coordination care. beginning from basic physiological needs to complex
psychological needs.
 24-hrs accountability for nursing care activity by one
nurse.  The first level of this needs includes physiological
need for survival such as food, sleep, clothing and
 Increased nurse, patient & physician satisfaction.
shelter.
Disadvantages:
 The second level is safety, security and protection
 Requires excellent communication needs. The employee needs to be free from physical
harm and deprivation of basic physiological needs.
 Disruption of the continuity of care
 The third level is the need to belong which relates
 Staff nurses are neither compensated nor legally to affiliation or sense of belonging, affection,
responsible for patient care outside their working closeness and intimacy.
hours
 The fourth level is esteem and ego needs. These are
 Expensive and ineffective because many tasks cloud needs to achieve independence, respect and
be done by lease skilled persons. recognition from others. Recognition is an
important motivation in nursing.

2. Two Factor Theory:

Motivation
Frederic Herzberg (1991) is credited with developing
 All human beings are motivated by different goals,
two-factor theory of motivation which was first published in
ambitions, and aspirations. A motive is a need or
1968. Hygiene factor relate to the working conditions such
desire that incites and directs a person’s actions.
salary, quality of supervision.
Motivation according to Mills, is a force within the
individual that influences strength or direction of
behavior.
These factor are growth-producing motivations for
 Intrinsic Motivation comes from within the person employees and prevent lost productivity due to
driving him to be more productive. Intrinsic dissatisfaction.
motivation is directly related to a person’s aspirations
 Hygiene factors are called “dissatisfiers”. Nurse effects change optimizes patient care increase works’
managers need to use both of these factors to recruit and satisfaction and facilitates coordination.
retain staff.
 Principles of Effective Communication:
3. McClelland’s Three Basic Needs Theory:
1. Clear lines of communication serve as the linking
David McClelland (1976) identifies three basic needs process by which part of the organization are unified
that people posses in varying degrees: achievement, power towards goal achievement.
and affiliation.
2. Simple, exact and concise message ensures
The need for achievement is a strong desire to understanding of the message to be conveyed.
overcome challenge, to excel, to grow, to advance or to
3. Feedback is essential to effective communication,
succeed.
mutual interaction is required.
The need for power is the desire to be in control and to
4. Communication thrives best in a supportive
get others to behave contrary to what they would naturally
environment which encourages positive values
do.
among its personnel.
The need for affiliation is the desire to work in a pleasant
5. A managers communication skills is vital to the
environment and the desire for friendly, close relationships.
attainment of the goals of the organization.
B. Expectancy Theory:
6. Adequate and timely communication of work-related
Victor Vroom’s expectancy theory on human motivation (1964) issues or changes that may affect jobs enhance
indicates that felt needs of individuals in work setting are compliance.
increased if a person perceives positive relationship between
 Types of Communication:
effort and performance.
1. Verbal communication – involves spoken words. The
C. Operant Theory:
speaker must be able to speak slowly, enunciating
B.F. Skinner’s Operant Theory (1969) suggests that an the words clearly. Only relevant information should
employee’s work motivation is controlled by conditions in the be conveyed to prevent confusion.
external environment instead of internal needs and desires.
2. Written communication – should be written clearly,
Human exhibits two types of behavior: Respondent and
correct, complete and concise. Ambiguous terms
Operant.
should be avoided to prevent misunderstanding.
 Respondent Behavior - results from direct stimulation.
3. Non-verbal communication – is a transmission of
 Operant Behavior – occurs in the absence of any message w/out the use of words, people often times
apparent external stimulation. use facial expressions, gestures, touch, body
language or vocal tones.
When followed by consequences the increase or
decrease the likelihood of these behaviors’ recurrence, the
consequence is termed a “reinforcer”. A reinforcer may be
positive or negative. Positive- increases the probability that
behavior will be replaced. Negative – is a consequence that if
removed, increases the probability that the behavior will be
replaced.

D. Equity Theory:

Jo Stacy Adams (1960) and others studied perception of

equity and inequity. They found that employees assess
fairness by considering their input and the psychological,
social and financial rewards in comparison with those others.
Perceived inequity causes tension which is found to be
proportionate to the magnitude of the perceived tension. A
manager should be attentive to the perceived equity of the
reward system.

 Communication:
 Coordination and Collaboration:
 Communication is the transmission of information,
 Coordination - unites personnel and services towards a
opinions, and intentions between and among
common objective.
individuals. It facilitates work increases motivation,
  Synchronization of activities among the various  Compromise: - both parties seek expedient,
services and department enhances collaborative acceptable answers for the short periods when the
efforts resulting in efficient, smooth and harmonious goals are only moderately important and the parties
flow of work. have equivalent power.

 Decision Making:  Competition: - the supervisor or the nurse manager

exerts power at the subordinate’s expense. It is
 Decision – is a course of action that is consciously
expressed through suppression of conflict through
chosen from available alternatives for the purpose of
authority-obedience approach.
achieving a desired result. The process itself can be
described in five steps:  Smoothing: - where disagreements are ignored so
that surface harmony is maintained in a state of
1. Definition of the problem
peaceful co-existence.
2. Analysis of the problem
 Withdrawing: - from the conflict simply means that
3. Development of an alternative solution one party is removed thereby making it possible to
resolve the issue.
4. Selection of the solution
 Forcing: - is a method that yields an immediate end to
5. Implementation and follow-up the conflict but leaves the cause of the conflict
unresolved. A superior can issue orders but the
 Conflict and Conflict Management:
subordinate will lack commitment to the demanded
 Conflict – means a clash between two opposing and action.
oftentimes hostile parties.
 Supervision:
 Conflict that is managed instead of being ignored or
 The word “supervise” comes from the word
suppressed can be used effectively. It can stimulate
“supervide” means “ To oversee or view directly”
competition, identify pertinent differences within the
which result is the attainment of a service that is both
institution, and serve as powerful motivator for
efficient or effective.
positive change.
 Supervision – is providing guidelines for the
 Types of Conflict:
accomplishment of a task or activity with initial
 Overt – direction and periodic inspection of the actual
accomplishment of the task or activity.
 Covert –
 Qualities of Good Supervision:
 Vertical –
 Good supervision requires:
 Horizontal –
1. Good technical, managerial and human
 Intrapersonal – relation skills.
 Intergroup - 2. Ability to communicate well in both spoken
 Sources of Conflict: and written language; ability to listen.

Human interactions that relate to conflict are characterized by: 3. Firmness with flexibility to adjust to the needs
of the situation.
 Competition –
4. Fairness in dealing with employees.
 Domination –
 Good supervision requires:
 Provocation -
1. Familiarity with hospital and nursing policies
 Conflict Resolution: - Common approaches to the that affect patients care.
management of conflict are:
2. Good decision-making skills.
 Avoidance: - is a methods commonly used by groups
who do not want to do something that may interfere 3. Willingness to grow and develop
with their relationship. 4. Ability to accept changes and consider them as
 Accommodation: - means self-sacrifice. The person challenges.
neglects his own needs to meet the goals of the other  Good supervision requires:
party.
1. Dignify and pleasing personality
 Collaboration: - inspires mutual attention to the
problem and utilizes the talents of all parties.
 2. Ability to motivate employees and provide 1. The evaluation must be based on the behavioral
opportunities for continuing professional standards of performance which the position
growth and development. requires.

3. Advocacy for nurses and nursing. 2. In evaluating performance, there should be enough
time to observe employee’s behavior.
 Principles of Good Supervision:
3. The employee should be given a copy of the job
1. Good supervision requires adequate planning and
description, performance standards and evaluation
organizing which facilitate cooperation, coordination
form before the scheduled evaluation conference.
and synchronization of services.
4. Employee’s performance appraisal should include both
2. Good supervision gives autonomy to workers
satisfactory and unsatisfactory result with specific
depending on their competency, personality and
behavioral instances to exemplify these evaluative
commitment.
comments.
3. Good supervision stimulate the worker’s ambition to
5. Areas needing improvement must be priorities to
grow into effectiveness.
help the worker up-grade his or her performance.
4. Good supervision creates an atmosphere of cordiality
6. The evaluation conference should be scheduled and
and trust. It creates a suitable environment for
conducted at a convenient time for the rater and the
productive work.
employee under evaluation, in a pleasant
5. Good supervision considers the strength and surrounding and with ample time for discussion.
weaknesses of employees.
7. The evaluation report and conference should be
6. Good supervision strives to make the unit an effective structured in such a way that it is perceived and
learning situation. accepted positively as a means of improving job
performance.
7. Good supervision considers equal distribution of work
considering age, physical condition and competence.  Characteristics of an Evaluation Tool:

8. Techniques in Supervision:  The evaluation tool should be objective, reliable and

sensitive. Objectivity means that the evaluation tool
Supervisory techniques includes observation of the worker is free from bias. Reliability refers to the accuracy or
while making the rounds; spot checking of charts through precision of the tool such that it will produce the
nursing audits; asking the patient about the care they received same results if administered twice.
and getting feedbacks.
 Basic Components of the Control Process:
CONTROLLING
 The control process may be divided into the following
 Controlling or Evaluating is an on-going function of basic components:
management which occur during planning, organizing
and directing activities. 1. Establishment of standards, objectives and
methods for measuring performance.
 Reasons For Conducting Evaluation:
2. Measurement of actual performance
1. Evaluation ensures that quality nursing care is provided
3. Comparison of results of performance with
2. It allows for the setting of sensible objectives and standards and objectives and identifying strengths
ensure compliance with them. and areas for correction and / or improvements.
3. It provides standards for establishing comparisons. 4. Action to reinforce strengths or successes
4. It provides visibility and a means for employees to 5. Implementation of corrective action as necessary.
monitor their own performance.
 Establishment of Standards for Measuring
5. It highlights problems related to quality care and Performance :
determines the areas that require priority attention.
 There are three types of performance standard:
6. It provides an indication of the costs of poor quality.
1. Standard on structure – are those that focus on
7. It justifies the use of resources the structure or management system used by the
agency to deliver care.
8. It provides feedback for improvement.
2. Process standard – refers to decisions and actions
 Evaluation Principles:
of the nurse relative to the nursing process which
are necessary to provide good nursing care.
  There are three types of performance standard: 6. Concentration on the strength and weaknesses to
improve individual performance.
3. Outcome standards – are designed to measure the
results of care provided in terms of changes in the 7. Encouragement of feedback from the rated
health status of clients served, changes in the level of employees about their performance needs and
their knowledge, skills, attitudes and satisfaction of
interest.
those served including the members of the nursing and
health team. 8. Provision for initiating preventive and corrective
action and making adjustments to improve
 Performance Appraisal:
performance.
 Performance appraisal is a control process in which
 Methods of Measuring Performance:
employee’s performance is evaluated against
established standards.  Methods of performance may done both formally
and informally.
 Purposes of Performance Appraisal:
 Informal appraisal - may consist of incidental
Performance appraisal is used to:
observation of performance while the worker is
1. Determine salary standards and merit increases. engaged in performing nursing care or by responses
made by workers during conferences.
2. Select qualified individuals for promotion or transfer.
 Formal appraisal - is accomplished regularly and
3. Identify unsatisfactory employees for demotion or methodically by collecting objectives facts that can
termination. demonstrate the difference between what is
4. Make inventories of talents within the institution. expected and what is done.

5. Determine training and developmental needs of  Methods of Measuring Performance:

employees.  Methods of Formal Appraisal:
6. Improve the performance of work groups by  Essay – The appraiser writes a paragraph or more
examining, improving and correcting interrelationship about the worker’s strengths, weaknesses and
between members. potentials.
7. Improve communication between supervisors and  Checklists – is a compilation of all nursing
employees and reach an understanding on the performances expected o a worker. The
objectives of the jobs. appraiser’s task is to mark the appropriate column
8. Establish standards of supervisory performance. whether the worker does or does not show the
desired behavior.
9. Discover the aspirations of employees and reconcile
these with the goals of the institution.  Ranking – The evaluator ranks the employees
according to how he or she fared with co-workers
10. Provide “employee recognition” for with respect to certain aspects of performance or
accomplishments. qualifications.

11. Inform employees “where they stand”.  Rating Scales – Includes a series of items
representing the different tasks or activities in the
 Factors Contributing to an Effective Performance
nurse’s job description or the absence or the
Appraisal System:
presence of desired behaviors and the extent to
1. Compatibility between the criteria for individual which these are possessed.
evaluation and organizational goals.
 Forced-Choice Comparison – the evaluator is
2. Direct application of the rated performance to asked to choose the statement that best describes
performance standard and objectives expected of the the nurse being evaluated.
worker.
 Anecdotal Recording – records that describes the
3. Development of the behavioral expectations which nurse’s experience with the group of persons, or in
have been mutually agreed upon by both the rater validating technical skills and interpersonal
and the worker. relationship.

4. Understanding the and effective utilization of  Quality Assurance:

procedure of the rater.
 Is a process of evaluation that is applied to the health
5. Rating of each individual by the immediate care system and the provision of health care services
supervisor. by health workers.
 Principles Underlying Quality Assurance Effort:  Quality Circles –May be define as a group of
workers doing similar work who meet regularly,
 There are certain principles upon which effective
voluntarily, on normal working time, under the
quality assurance programs are based:
leadership of their supervisor to analyze and solve
1. All health professionals should collaborate in the work related problems and recommend solution to
effort to measure and improve care. the management.

2. Coordination is essential in planning a comprehensive  Utilization of Results -

quality assurance program.
 The nursing staff in the unit is given a feedback on
3. Resources expenditure for quality assurance is the results of the quality assurance study. This
appropriate. maybe oral or written and is directed to the staff
who administers the care or their immediate
4. There should be focus on critical factors such as supervisor. Positive feedback reinforces desirable
functions and activities that promise to yield the performance. Negative feedbacks should tactfully
greatest health and financial benefits to reveal be conveyed in a face-to-face situation so that the
significant findings. assessment result may easily be clarified.
5. Quality patient care is accurately evaluated through  ETHICO-MORAL RESPONSIBILITY
adequate documentation.
 TYPES OF ETHICAL ISSUES: There are many terms
6. The quality to achieve nursing objectives depends used to describe moral issues by nurses such as: -
upon the optimal functioning of the entire nursing moral indifference, moral uncertainty, moral
process and its effective monitoring. distress, moral outrage and ethical dilemmas.
7. Feedback to practitioners is essential to improve  Moral Indifference – occurs when an individual
practice. questions why morality in practice is even
necessary.
8. Peer pressure provides the impetus to effect
prescribed changes based on the result of assessment  Moral Uncertainty or Moral Conflict – occurs
and needed improvements on the quality of care. when an individual is assure which moral principles
or values apply and may even include uncertainty as
9. Reorganization in the formal organizational structure
to what the moral problem is.
may be required if assessment reveals the need for a
different pattern of health care.  Moral Distress – occurs when the individual knows
the right thing to do but organizational constraints
10. Collection and analysis of data should be utilized to
make it difficult to make the right course of action.
motivate remedial action.
 Moral Outrage – occurs when an individual
 Nursing Audit Committee:
witnesses the immoral act of another but feels
 A nursing audit committee is composed of a powerless to stop it.
representative from all level of nursing staff. The
 Ethical Dilemma – is the most difficult of all moral
audit team usually designates a day within a week to
issues which may be described as being forced to
be the audit day, however nurses do not know which
choose between two or more undesirable
unit will be audited.
alternatives.
 Patient Care Audit – Patient care audit may be
BASIC ETHICAL PRINCIPLES (REASONING):
concurrent or retrospective.
 Autonomy (Self-determination) – a from of
 A concurrent Audit – is one of which patient
personal liberty (autonomy), is also called freedom
care is observed and evaluated through:
of choice or accepting the responsibility for one’s
1. A review of the patients’ charts while the choice.
patient is still confined in the hospital.
 Beneficence (Doing Good) – This principle states
2. Observation of the staff as patient care is given. that the action one takes should be done in an
effort to promote good.
3. Inspection of patients and / or observation of
the effects of patient care where the focus is on  Paternalism – This principle is related to
the patient. beneficence in that one person assumes the
authority to make a decision for another.
 Peer Review – Patient care audits may be done by
peers evaluating another job performance against  Autonomy (Self-determination) – a from of personal
accepted standards. liberty (autonomy), is also called freedom of choice or
accepting the responsibility for one’s choice.
 Beneficence (Doing Good) – This principle states that the
action one takes should be done in an effort to promote
good.

 Paternalism – This principle is related to beneficence in

that one person assumes the authority to make a
decision for another.

 Fidelity (Keeping Promise) – refers to the moral

obligation that individual should be faithful to their
commitments and promises.

 Confidentiality (Respecting Privil

TYPES OF LAW AND COURTS

 THREE DIFFERENT TYPES OF COURT CASES A NURSE

MAYBE INVOLVED:

 The types of court cases are:

a. Criminal Cases: - the individual faces charges

generally filed by the state or federal attorney
general for cases committed against an individual or
society.

b. Civil Cases: - one individual sues another for money

to compensate for a perceived loss. The judge or
jury must believe that it was more likely than not
that the accused individual was responsible for the
injuries of the complainant or described as
preponderance of the evidence.

c. Administrative Cases: - an individual is sued by a

state or federal governmental agency assigned the
responsibility of implementing governmental
programs.