NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWIFERY*MEDTECH

LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM

NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

HANDOUTS
LEADERSHIP & MANAGEMENT
Prepared by: Prof. Raymund Kernell Manago, RN

INTRODUCTION
Decision Making: process of selecting a logical choice from options
Problem-solving: analyzing a difficult situation
- Nursing Process is problem-solving model (ADPIE)
Critical Thinking: actively and skillfully conceptualizing, applying, analyzing, synthesizing, and evaluating
information to reach an answer or conclusion
Elements of Decision Making -
Define objectives.
- Gather data.
- Take time.
- Generate many alternatives.
- Think logically.
- Act decisively.

Leadership vs Management
Leadership: taking risks, achieving shared goals, inspiring others
Management: directing organization through manipulation of resources Roles
Leader Manager
Power through influence (Directs Legitimate power by authority (Directs
willing followers) willing and unwilling subordinates)

May not be part of formal org Position in formal organization (Job

title)
Focus: inspiring others Focus: getting work done
Greater roles Expected duties

Leadership Theories
1) Great Man/ Trait Theory
- Leaders are born, not made
- Leaders arise when situation demands.

2) Leadership Styles
- Authoritarian
- Strong control through commands.
- Downward communication
- Sole decision-making
- Emergency situations
- e.g. armed forces

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

- Democratic
- Control through guidance.
- Upward and downward communication
- Collective decision making
- Takes longer time
- Laissez-faire
- Little/no control and direction
- Communication and decision making among members
- Reqts: (1) highly motivated, (2) self-directed members

3) Situational/Contingency Leadership
- Leadership style based on situation

4) Interactional Leadership
- Reactive: focuses on past, crisis-driven
- Responsive: team player
- Proactive: future-oriented
- High-performance: maximum productivity, worker satisfaction

5) Transactional vs Transformational Leadership

- Transactional: traditional, day-to-day leader
- Transformational: visionary, empowering

Management Theories

1) Scientific Management (Frederick Taylor)

- One best way to do task, increase productivity
- Financial incentive

2) Bureaucracy (Max Weber)

- Strict rules and regulations, increase efficiency

3) Management Functions (Henri Fayol)

- POSDC (Planning, Organizing, Staffing, Directing, Controlling)

4) Participative management (Mary Follett)

- Managers have authority with, not over, employees.
- People > machines
- Hawthorne effect desired

5) Theories X and Y (Douglas McGregor)

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

- Theory X: lazy and indifferent employees

- Theory Y: willing and self-motivated employees

PLANNING
- Deciding in advance - Choosing among alternatives - Reduce uncertainty and risk.
- Failing to plan, planning to fail.

Strategic Planning
- Long-term (3 to 10 years), complex

Operational Planning
- Short-term (< 3 years), less complex
- Daily basis/ Per shift

SWOT analysis
- Strengths: internal advantage
- Weakness: internal disadvantage
- Opportunities: external advantage
- Threats: external disadvantage

Planning Hierarchy

1) Vision: future aims

- “What do you want to be?”
- e.g., “By 2020, Hospital X will be the leading center for cancer in the Philippines.”

2) Mission: reason for existence

- “What do you want to do?”
- e.g. “Hospital X is a tertiary care facility that provides evidence-based, holistic care to all patients.”

3) Philosophy: set of values and beliefs

- “What do you believe in?”

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

- e.g. “Hospital X believes that…”

Goals and Objectives
Desired result
Goal: general, Objectives: specific
“What do you want to happen?”

4) Policies: Guide for decision-making

- “How should you behave?”
- Expressed: written policies
- Implied: expected

5) Procedures: Step-by-step plan for doing specific tasks

- “How should you do it?”

6) Rules: Do’s and don’ts

- Allows organizational structure
- “Should you do it?”

Planned Change
- Deliberate effort to make something happen.
o No change: Organizational Aging (e.g. Kodak, Blackberry)

- Change agent o Person skilled in planned change o Inside- often trusted,

may be biased
o Outside- often rejected, more objective
- Change Theory o Unfreezing: (+) awareness of need to
change o Movement: gradual implementation of change, takes time
o Refreezing: stabilizing change, support, 3-6 months

- Driving and Restraining Forces o Driving forces: push to change o

Restraining forces: pull away from change

- Stages of Change Model o Precontemplation: no intention to change o

Contemplation: considers change o Preparation: plans for change o Action:
implements behavior change
o Maintenance: maintains change, avoids relapse

- Change Strategies o Rational-Empirical: use of current research, most

effective o Normative-Reeducative: peer pressure, interpersonal influence o
Power-Coercive: use of authority and rules, “Accept or leave.”

Time Management

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

 Optimal use of available time.

 3 Basic Steps
• Plan and prioritize tasks o Time and Activity Plan o To-do lists: Do now, do later, don’t do
• Complete tasks
• Reprioritize
 Time wasters
• Technology
• Socializing
• Poor filing
• Interruptions o Keep protected time.

Fiscal Planning
- Budget o Cost-effectiveness: good value for money

o Fixed vs Variable budget

 Fixed: does not change, e.g. building mortgage
 Variable: changes, e.g. supplies, water bill o Direct vs Indirect Costs
 Direct: for production goods/service
 Indirect: for expenses not related to product

- Types of budget o Personnel

 Salary of staff
 Largest budget: health care is labor-intensive o Operating
 Day-to-day costs
 Maintenance, bills, supplies o Capital
 Equipment and real property
 Long-term, expensive o Petty cash
 Emergency, repairs

ORGANIZING

- Establishing a structure that improves coordination to achieve objectives

- Organizational Structure o Formal vs Informal
 Formal: positions and power
 Informal: employee relationships

- Components o Chain of Command

 Formal paths of communication and authority
 Line positions: legitimate authority (solid lines)
 Staff positions: advisory positions, no legit authority, (broken lines)

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

o Unity of Command: employees report to 1 boss only (vertical solid line)

o Span of Control
 No. of people directly reporting to manager
 Higher span, flatter structure
 Lower span, taller structure
o Managerial Levels
▪ Top-level
• Strategic planner
• Policy making
• Chief nurse
▪ Middle-level
• Facilitate communication between top and first-level
• Nursing supervisor
▪ First-level
• Operational planner
• Day-to-day operations
• Head nurse

- Types of Organizational Structures o Bureaucratic/ Line

▪ Tall
• Centralized
• Decision making at top
• Narrower span of control
▪ Flat
• Decentralized
• Decision making where work is done
• Wider span of control o Ad Hoc
 Temporary
 Project-based o Matrix
 2 managers: (1) Functional, (2) Product

- Power
o Effect based on how it is used.
o Types of Power
 Reward: granting favors/rewards
 Coercive: fear of punishment
 Legitimate
• Formal position/title
• Authority is source of power

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

• Authority =/= Power

• Limit commands
 Expert: knowledge, expertise
 Referent: association with powerful people
 Charismatic: personal influence
 Informational: knowledge that others do not have

- Patient Care Delivery Methods o Total Patient Care or Case Method Nursing
 Nurse is responsible to meet all needs of assigned patients
 Oldest, common
 Reqt: Highly skilled staff o Functional Method
 Based on tasks, not patients
 E.g. BP monitoring, Medications, Hygiene o Team Nursing
 Staff follow the team leader (nurse)
 Max. 5 per team
 Reqt: Team leader is efficient and organized o Modular Nursing
 Mini-team (3 members)/ Care pairs (2 members)
 Smaller teams o Primary Nursing
 24-hour care
 Admission to discharge
 Associate nurse: substitute when primary nurse is off-duty
 Reqt: Primary nurse is self-directed o Case Management
 Collaborative: Multidisciplinary action plan (MAP)
 Goal: Cost-effective outcomes
 Reqt: Case manager

STAFFING

- Healthcare as labor-intensive
- First step: Determine staffing needs o Use history to predict future.
 Economy improves → Shortage
 Economy declines → Excess (d/t global recession)

- Staffing Functions (ReSePI) o Recruitment

 Active search for applicants
 Ongoing process
 Turnover: replacement of new staff
• No turnover: stagnation

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

• Low turnover: retention, staff development

• High turnover: expensive, decreased patient safety

o Selection
▪ Requirements
• Minimal Criteria: minimum
• Preferred Criteria: ideal
▪ Interview
• Types o Unstructured: not prepared, most common o Semi-structured:
focused, directed o Structured: strict, specific
• Same interviewer: Higher reliability
• Different interviewers: Lower reliability
▪ Evaluation
• JOB DESCRIPTION: avoid under/overqualified applicants
• Personal bias: minimize
• NEVER ask discriminatory questions.
o Age, race, marital status, sexual preference, etc.
 Background Check: Check references, verify credentials
 Preemployment Testing: Personality and psychiatric tests ▪
Physical Examination: physical reqts for the job
o Placement o Assignment to
department
o Proper placement → efficiency

o Indoctrination: Adjustment of employee to organization

(IOS) o Induction
 General information
 Employee handbooks o Orientation
 Specific information for position
 Promote belongingness of employee
 Personnel policies: first-level manager (head nurse) o
Socialization
 Learning the behaviors associated with role

- Staff Development o Purpose: competence to perform assigned duties o Competence: having

abilities to meet job requirements o First step: Determine learning needs o 2 Components:
 Training: knowledge, skills, and attitude (KSA) for a job, immediate
use
 Education: more formal, long-term use o Preceptor vs Mentor
 Preceptor: short-term, provides knowledge and emotional support ▪
Mentor: long-term, assists in career development

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

- Staffing Needs o Centralized vs Decentralized Staffing

 Centralized: Human resources dept, objective
 Decentralized: Head nurse/ supervisor, flexibility
- Scheduling Options o 8hrs/shift or 40 hrs/week
▪ Other countries: 12hrs/shift

o Float pools
 Per diem employees
 Flexible: Higher pay, no benefits
 Reqt: Orientation to unit, Core competencies

o Flextime
 Time schedules based on staff
 Difficult for manager

o Self-scheduling
 Daily schedules based on staff
 Difficult for manager

- Workload Measurement o Nursing Care Hours per Patient-Day (NCH/PPD) = Nursing hours worked
in 24 hours / Patient Census - Exercise:
AM shift: 4 RNs, 1 ward clerk
PM shift: 3 RNs
Night shift: 3 RNs
Patient Census: 30
NCH/PPD=2.93

DIRECTING (THE “DOING” PHASE)

- Motivation: force that directs behavior, central force in directing o Intrinsic vs Extrinsic Motivation
 Intrinsic: from within,
personal values
 Extrinsic: from without,
rewards o Promotion → motivation
o Self-care → burnout

- Communication: exchange of thoughts through speech or signals.

o Communication Process

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

o Verbal vs Nonverbal
 Verbal: use of words (written or spoken)
 Non-verbal: body language

- Channels of Communication o Upward: subordinate to superior o Downward: superior to

subordinate o Horizontal: peer to peer o Diagonal: different levels and jobs o Grapevine: informal,
random, source of rumor

- Nonverbal Communication o Silence: use therapeutically o Space (Proxemics)

 Intimate: 0 to <18 inches
 Personal: 18 inches to < 4 feet
 Social: 4 to < 12 feet
 Public: >12 feet o Appearance and posture o Eye contact
o Gestures and facial expressions o Note: verbals and non-verbals must be congruent.

- Verbal communication o Assertive: direct, honest, acceptable. “I” statements o Passive: silence,
avoids conflict o Aggressive: threatening, bullying o Passive-aggressive: aggressive message
conveyed passively.

- ISBAR: communication tool to patient safety (Used in referrals) o Introduction: name, ward
 [I am staff nurse Baby of Medical
Ward] o Situation: chief complaint
 [Patient X is experiencing fever with
temperature of 39.5 C.] o Background: patient info
 [Patient X is 28 y/o male with
hemophilia A.] o Assessment: other findings
 [He also has chills, pallor, and
restlessness.] o Recommendation: suggested action
 [I recommend that we administer
paracetamol intravenously.]
- Listening skill o
Best communication skill
o Communication failure: common cause of medical error

- Delegation o Getting work done through others o Accountability: retained o Responsibility:

transferred

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

o Pros: (1) productivity, (2) Can handle more complex problems, (3) empowers staff o
Cons: risk for improper/ overdelegating

o 5 Rights of Delegation
 Right task
 Right circumstance
 Right person
 Right direction
 Right level of supervision
o Delegation to LVN
and UAP Do’s ✓
LVN/LPN
- Administering medications except via intravenous, intrathecal, intraosseous, or endotracheal route -
Enteral or tube feedings
- Ostomy care
- Inserting and removing Foley catheters
- Oral suctioning
- Non-complex sterile procedures
- UAP tasks

UAP:
- Routine vital signs (No admission)
- Hygiene
- Feeding without oral/swallowing problems
- Basic life support - Postmortem care
- ADLs, Ambulation, turning
- Elimination, Monitoring I&O
- Obtaining specimens

Don’ts X
- ADPE, except routine assessment
- Baseline/Admission assessment
- Health teaching/Discharge Planning
- Nursing judgment
- Not within scope of practice

- Conflict Resolution
 Conflict
• d/t differences in values and backgrounds
• Pro: Opportunity for growth, productivity
• Con: May cause dysfunction, productivity

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

 Conflict resolution strategies (Goal: Win-win solution)

• Collaborating: set aside differences and work together, win-win
• Compromising: parties give up something, lose-lose
• Competing: one party intends to win. win-lose
• Accommodating: one party sacrifices. Win-lose
• Smoothing: reducing the severity of problem, temporary
• Avoiding: no resolution, temporary

 Conflict Management
• Individual o Knowledge/skill: Educate o Behavior: Allow verbalization
• Group o Call a ward/group meeting

CONTROLLING

- Tasks: (1) Performance measured against standards,

(2) Correct actions

- Standard vs Criteria o Criteria: parameter (e.g.

normal adult HR)
o Standard: specific value (e.g. 60-100bpm)

- Quality Control o Activities to monitor and regulate

services
o Hallmarks
 Support by top-level admin
 Financial and HR support
 Quality goals
 Continuous process o Benchmarking: measuring services against best-
performing organizations.

- Performance Appraisal vs Nursing Audit o Criteria: Job

description o Performance appraisal: nurse-centered
o Nursing Audit: patient-centered, chart
- Evaluation o Structure: resources, e.g. environment, staffing (human
resources) o Process: how care is delivered, e.g. medications
o Outcome: end-result, e.g. health status

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LET*PSYCHOMET*RESPIRATORY THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT

- Quality Assurance vs Quality Improvement o Quality

Assurance: maintaining quality
o Quality Improvement: upgrading quality

- Quality Improvement Models o Total Quality

Management (TQM)
▪ Aka Continuous Quality Improvement (CQI)
▪ Customer-focused, Prevention-oriented ▪
QI is a never-ending process.

o Toyota Production System (TPS)

 Maximum quality and efficiency
 Eliminate waste

o Six Sigma Approach o Safety management,

performance improvement
o DMAIC
 Define
 Measure
 Analyze
 Improve
 Control

- Problem Employees o Marginal employees: minimal

work quality o Impaired employees: NO work
accomplishment
 Chemical: drug or alcohol addiction
 Psychological: psychiatric problem o Actions
 Impaired d/t disease: Support and counselling
 Undesirable conduct, rule-breaking: Progressive discipline o Progressive
Discipline
 Steps
• Verbal reprimand: informal
• Written reprimand: formal
• Suspension
• Dismissal

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