Emergency Nursing ● By definition, emergency care is care that must be rendered

(Chapter 71 in Brunner and Suddarth 12th edition) without delay.

Emergency Nursing ● In an emergency department, several patients with diverse
● Is one of the most challenging specialties in nursing. It health problems, some life threatening, some not; may
requires nurses to manage ambiguity and rapid changes in present to the ED simultaneously.
pace and intensity of work, and to have knowledge of a
significant number of clinical presentations, disease, and Triage
conditions. ● From the french word trier meaning “to sort”.
● In the daily routine of the emergency department, triage is
Emergency Management used to sort patients into groups based on the severity of
● Emergency management traditionally refers to care given to their health problems and the immediacy with which these
patients with urgent and critical needs. problems must be treated.
● However, because many people lack access to health care, ● The term triage may have originated during the Napoleonic
the emergency department (ED) is increasingly used for non- wars from the work of Dominique Jean Larrey.
urgent problems, therefore, the philosophy of emergency ● The term was used further during World War 1 by French
management has broadened to include the concept that an doctors treating the battlefield wounded at the aid stations
emergency is whatever the patient or the family considers it behind the front.
to be. ● Those responsible for the removal of the wounded from the
● Care that must be rendered without delay. battlefield or their care afterwards would divide the victims
● The strengths and roles of nursing and medicine are into 3 categories:
complementary in an emergency situation. ○ Those who are likely to live regardless of what care
○ Appropriate nursing and medical interventions are they receive.
anticipated based on assessment data. ○ Those who are unlikely to live regardless of what
● Members of the emergency health care staff work as a team care they receive.
in performing the highly technical, hands-on skills required ○ Those for whom immediate care might make a
to care for patients in emergency situations (Emergency positive difference in outcomes.
Nurses Association, 2013).
Triage Objectives
Emergency Nurse ● Ensure early recognition, assessment of patient’s condition,
● Expert in assessing and identifying patients’ health care and prioritization of treatment according to severity of the
problems in crisis situations. conditions.
● Has had specialized education, training, experience, and ● Reduce unnecessary delay of treatment.
expertise in assessing and identifying patients’ health care ● Give brief first aid advice.
problems in crisis situations. ● Initiate immediate diagnostic tests, intervention, and nursing
● In addition, the emergency nurse establishes priorities, treatment.
monitors and continuously assesses patients who are acutely ● Allow effective utilization of staff and resources by allocating
ill and injured. patients to appropriate treatment areas according to their
● They also support and attend to families, supervise allied conditions.
health personnel, and educate patients and families within a ● Relieve congestion and confusion by controlling and
time limited, high pressure care environment. improving patient flow.
● Nursing interventions are accomplished interdependently, in ● Improve patient staff relationships and departmental image
consultation with or under the direction of a physician or through greeting and communication during the process of
advanced practitioner, such as a nurse practitioner or triage.
physician assistant. ● Promote public relationship by immediate interview with
patient.
Seek emergency care for: ● Enable direct communication with pre-hospital care
Large numbers of people seek emergency care for serious, life providers.
threatening conditions such as: ● Provide documentation: patient’s condition, time of triage,
● Cardiac dysrhythmias and preliminary treatment given in triage.
● Acute coronary syndrome ● To provide staff training and decision making.
● Acute heart failure
● Pulmonary edema Basic Triage System (Berner, 2005)
● Stroke A basic and widely used triage system that has been in use for many
years, has 3 categories:
Issues in Emergency Nursing Care ● Emergent
● Documentation of consent and privacy. ● Urgent
● Limiting exposure to health risks. ● Non-urgent
● Violence in the emergency department.
● Providing holistic care. 1. Emergent
● Highest priority.
Emergency nursing is demanding because of the diversity of ● Life threatening conditions.
conditions and situations that present unique challenges. These ● Must be seen immediately.
challenges may include: 2. Urgent
● Legal issues ● Serious health problems but not immediately life-
● Occupational health and safety risks threatening.
● Must be seen within 1 hour.
ED staff have the challenge of providing holistic care in the
context of fast paced, technology driven environments in which 3. Non-urgent
serious illness and death are encountered on a daily basis. ● Episodic illnesses that can be addressed within 24 hours
without increased morbidity.
Nursing in Disasters
● Another filed in emergency nursing. Comprehensive Triage System: 5 Level System
● With the increasing use of weapons and terror, and mass A more refined, comprehensive triage system which
destruction, both internationally and at home, the recognizes that EDs are used for both emergency and routine health
emergency nurse must recognize and treat patients exposed care. This system has 5 levels:
to biologicl and other weapons, anticipating nursing care in 1. Resuscitation
the event of a mass casualty incident, from natural causes or 1. Emergent
terrorist event. 2. Urgent
3. Nonurgent
Principles of Emergency Care 4. Minor
● Triage
● Assess and intervene
 ● The increased number of triage levels assist the triage nurse 2. Black or deceased: injuries are extensive and chances of survival are
to more precisely determine the needs of the patient and unlikely even with definitive care.
the urgency for treatment. ● The victim is unresponsive with penetrating head wounds,
● This 5 level triage system is currently used throughout the high spinal cord injury, wounds involving multiple
world (US, Aus, UK, Canada). anatomical sites and organs, 2nd or 3rd degree burns in
excess of 60% of total body surface area, seizures and
1. Resuscitation vomiting within 24 hours after radiation exposure, profound
● Need treatment immediately to prevent death. shock, fix dilated pupils.

2. Emergent 2. Red or immediate: a patient having injury which are life-threatening

● Patients may deteriorate rapidly and develop a major, life but survivable with minimal intervention
threatening situation. 4. Sucking chest wound, airway obstruction secondary to
● Require time sensitive treatment. mechanical use, shock, hemothorax, asphyxia, unstable
chest and abdominal wounds, incomplete amputation, open
3. Urgent fractures of long bones, 2nd or 3rd degree burns of 15-40%
● Patients have non-life threatening conditions but require total body surface area.
two or more resources to provide their care.
● If these patient’s vital signs deviate significantly from their 4. Yellow or delayed (priority #2): victims may have injuries which are
baseline, they may require up triaging to the emergent significant and require medical care but can wait hours without threat
category. to life or limb.
● Stable wounds without evidence of significant hemorrhage,
4. Nonurgent soft tissue injury, fracture requiring orif debridement, most
● Patients have non-life threatening conditions and likely need eye minor injuries.
only one resource to provide for their needs.
Military Triage
5. Minor 1. Naval combat situation
● Have no life threatening conditions and likely require no ● Triage officer must weigh the tactical situation with supplies
resources to provide for their evaluation and management. on hand and the realistic capacity of the medical personnel,
● Ever-changing. dependent upon the situation.
Resources ● Must attempt to do the maximum good for maximum
● Include imaging studies, IV/IM medications, invasive number of casualties.
procedures.
● Insertion of an indwelling catheter is an example of a one 2. United States Military Triage
resource procedure. ● Class I: Patients who require minor treatment and can return
● Use of moderate sedation is a two resource procedure to duty in a short period of time.
because it requires frequent monitoring and IV medications. ● Class II: Patients whose injuries require immediate life
sustaining measures.
Triage ● Class III: Patients for whom definitive treatment can be
● An advanced skill where emergency nurses are spending delayed without loss of life or limb.
many hours learning to classify different illnesses and ● Class IV: Patients requiring such extensive care beyond
injuries to ensure that patients most in need of care do not medical personnel capability and time.
needlessly wait.
● Protocols may be followed to initiate laboratory or x-ray In-Hospital Triage
studies. 1. Black/Expectant
● While the patient is in the triage area, collaborative ● Patients who are severely injured that will die of their
protocols are developed and used by the triage nurse based injuries possibly in hours or days.
on his or her level of experience. ● Include: large area burns, severe trauma, lethal radiation
dose, or in a life-threatening medical crisis.
Emergency department vs Disaster triage ● Unlikely to survive given the care available such as cardiac
● Routine Triage: directs all available resources to the patients arrest, septic shock, severe head or chest wounds.
who are most critically ill regardless of potential outcome.
● Field Triage: scarce resources must be used to benefit the 2. Red/Immediate
most people possible. ● Require immediate surgery or other life-saving intervention.
● Have first priority for surgical teams or transport to
Assess and Intervene advanced facilities.
● Second principle of emergency care. ● Cannot wait but are likely to survive with immediate
● Priorities of emergency care includes Priorities of Emergency treatment.
Care: stabilization, provision of critical treatments, and
prompt Transfer to the appropriate setting to the ward, 3. Yellow/Observation
private room, ICU, or OR. ● Condition that is stable for the moment but requires
watching by trained persons and frequent re-triage.
Simple Triage and Rapid Treatment (START) ● Need hospital care and would receive immediate priority
● For start triage: expectant who are beyond help, injured who care under normal circumstances.
can be helped by immediate transportation, the injured
who’s transport can be delayed, and those with minor 4. Green/Wait (walking wounded)
injuries who need help less urgently. ● Require a doctor’s care in several hours or days.
● Can be performed by lightly trained lay and emergency ● May wait for a number of hours or be told to go home and
personnel in emergencies but not intended to supersede or come back the next day.
instruct medical personnel or techniques. ● May include: broken bones without compound fractures,
many soft tissue injuries.
Algorithm for START Triage
1. Quick assessment: essential for patient’s survival. 5. White/Dismiss (walking wounded)
2. Treat victim: may call bystanders to assist you in giving initial ● Have minor injuries.
care. ● First aid and home care are sufficient and doctor’s care is not
3. When you have the color, tag patient, and move on. required.
● Injuries are along cuts, scrapes, or minor burns.
1. Green (priority #3) : The patient is having injuries which are minor
and treatment can be delayed hours to days. Psychological Considerations
● Extremity fractures, minor burns, sprains, smaller serrations Approach to Family
without significant bleeding, behavioral or psychological ○ Understand & accept the basic anxieties of the acutely ill or
disorders. traumatized patients.
 ○ Understand and support the patient’s feelings concerning
loss of control. 5. Assess signs and symptoms of poisoning and tissue damage.
○ Treat the unconscious patient as if conscious (explain what ● Pain and burning sensation
you are doing before administering intervention). ● redness or burns in the mouth or throat
○ Be prepared to handle all aspects of acute illness and ● dysphagia, vomiting, and drooling
trauma.
○ Allow the family to relive the events, actions, and feelings in 6. Assess health history and Determine age and weight.
proceeding admission to the emergency department.
○ Deal with reality as gently as quickly as possible. 7. Measures to remove the toxin or decrease its absorption.
○ Assist family to cope with sudden and unexpected death. ● Patient is given water or milk to drink for dilution (not
○ Encourage emergency department staff to discuss amongst indicated if with acute airway edema or obstruction, or
themselves their reaction to the event to share intense evidence of esophageal, gastric, or intestinal burns or
feelings for review and support. perforation.
● Use of emetics: Syrup of Ipecac - to induce vomiting if
Environmental Emergencies: Other Emergencies patient is alert, but never with corrosive poisons.
● Gastric lavage - for obtunded patients, gastric aspirate is safe
A. Poison and sent for toxicology.
★ Poison is any substance that when ingested, inhaled, ● Activated charcoal - if poison is absorbed by charcoal on the
absorbed, applied to the skin, or produced within the body in surface of its particles, and allowed to pass with stool.
relatively small amounts injures the body by its chemical ● Cathartic when appropriate - an antagonist to reverse the
action. effects of toxin.
● Poisoning from inhalation and ingestion of toxic materials, ● Administration of specific antidotes.
both intentional and unintentional, constitutes a major ● Other measures may include diuresis, dialysis, or
health hazard and an emergency situation. hemoperfusion - hemoperfusion is similar to dialysis but the
● Toxicology - study of harmful effects of various substances cartridge contains charcoal (monitor vital signs, fluid-
on the body so even drugs when taking excess it can cause electrolyte balance, high potential and cardiac dysrhythmias,
non therapeutic result. seizures are possible).
● Even drugs when taken in excess, can cause non-therapeutic
results. Nursing Alert for Poisoning
1. The Local Poison Center
Types of Ingested Poisons: ★ Should be called if an unknown toxic agent has been taken
1. Ingested Poison: Food Poisoning or if it is necessary to identify an antidote for a known toxic
★ A sudden illness due to the ingestion of contaminated food agent.
or drink. ● Cagayan de Oro: Northern Mindanao Medical Center
★ Food poisoning, such as botulism or fish poisoning, may (NMMC) is our local poison center. Other medical facilities
result in respiratory paralysis and death are probably still in the process of having their own poison
● Botulism, a serious form of food poisoning, requires centers (same with the animal bite center) because its
continual surveillance. establishment is part of the requirements of the Department
● The key to treatment is determining the source and type of of Health.
food poisoning. If possible, the suspected food be brought to
the medical facility and a history obtained from the patient 2. Vomiting is NEVER induced after ingestion of caustic substances
and family. (acid or alkaline) or petroleum distillates.

2. Ingested Poison: Corrosive Poisons Inhaled Poison: Carbon Monoxide Poisoning

★ Corrosive poisons include ALKALINE and ACID that cause ● Inhaled carbon monoxide binds to hemoglobin as
tissue destruction after coming into contact with mucous carboxyhemoglobin, which does not transport oxygen.
membranes. ● Manifestations: CNS symptoms predominate
● Swallowed poisons may be corrosive-may produce ○ Headache, muscular weakness, palpitation,
immediate or delayed effects; can be accidental or dizziness, confusion.
intentional. ○ The symptoms can progress to coma.
● Alkaline examples- lye, potassium carbonate, drain cleaners, ● Result of industrial or household incidents or attempted
toilet bowl cleaners, bleach, non-phosphate detergents, and suicide.
button batteries. ● Implicated in more deaths than any other toxin except
● Acid examples- toilet bowl cleaners, pool cleaners, rust alcohol.
remover, and battery acid. ● Incomplete hydrocarbon combustion.
● The cerebral blood flow need of oxygen- cerebral hypoxia.
Treatment Goals for Poisoning Oxygen saturation is not valid because hemoglobin is well
a. Remove or inactivate the poison before it is absorbed. saturated with carbon monoxide, not oxygen.
b. Provide supportive care in maintaining vital organ systems. ● A pale skin color is not a reliable sign.
c. Administer specific antidotes to neutralize specific poison.
d. Implement treatment to hasten the elimination of the
poison. Management of Carbon Monoxide Poisoning
1. Get to fresh air immediately - open all doors and windows;
Assessment for Poisoning loosen all tight clothing.
1. Use ABCs (Airway, Breathing, Circulation) 2. Perform CPR as necessary or if required.
● Control of airway and ventilations are essential. 3. Administer oxygen: 100% or oxygen under hyperbaric
● If it’s cerebral or renal damage, the patient’s prognosis pressure - this is to reverse the carboxyhemoglobin; reverse
depends on its management of ABC. hypoxia and eliminate the carbon monoxide; watch out for
permanent brain damage.
2. Monitor VS (vital signs), LOC (level of consciousness), ECG 4. Monitor patient continuously - to prevent chilling, wrap
(electrocardiogram), and urine output. patients with blankets; keep the patient quiet as possible
○ For the measures to stabilize the cardiovascular and do not give alcohol or permit patients to smoke.
functions, shock may result from cardiodepressant 5. Psychiatric consult if due to suicide attempt.
action of the substance from venous pulling or
reduce circulating volume from increased capillary Skin Contamination Poison: Chemical Burns
permeability; Thus, you monitor the urine output. ● Skin contamination poisoning- injuries from exposure to
You can insert a foley bag catheter (FBC). chemicals.
● Severity of the injury depends upon the mechanism of action
3. Assess laboratory specimens of the substance, the penetrating strength and
4. Determine what, when, and how much substance was ingested. concentration, and the amount of skin exposed to the agent.
● Determine the concentration of the poison, details of the
event, identify the poison.
 ● May be challenging because of the large possible variations ● When and How the wound occurred -essential because a
of offending agents with diverse actions and metabolic treatment delay exceeding 3 hours increases infection risk.
effects. ● Extent of damage to underlying structures -using aseptic
technique, the clinician inspects the wound for foreign body.
Management of Chemical Burns ● Sensory, Motor, and Vascular function changes - might
1. Determine the Substance indicate complications.
● if lye or white phosphorus, it must be brushed off the skin ● Primary assessment - if bleeding is significant, assess for
dry to prevent explosion or deepening of the burn. shock; inverted triangle; restlessness; skin pale, cold, and
diaphoretic.
2. Immediately flush the skin with running water ● Assessing for arterial or venous bleeding.
● Flush from a shower hose or faucet
● Clothing is removed
● Prolonged lavage may be done

3.Protect health care personnel from substance

● Especially if burn if extensive or if the agent is toxic and still
present

4. Standard burn treatment (antimicrobial agent, debridement,

tetanus prophylaxis)
● Those appropriate for the chemical burn size and location 1. Arterial Bleeding
must be considered ○ Spurting blood
○ Pulsating flow
5. May require plastic surgery ○ Bright red color
● This is for further wound management 2. Venous Bleeding
○ Steady, slow flow
6. Follow-up care includes reexamination of the area at 24 hours, 72 ○ Dark red color
hours, and 7 days 3. Capillary Bleeding
● Reexamining is necessary due to the risk of underestimating ○ Slow, even flow
the extent and depth of injury
Wound Cleansing
Nursing Alert for Chemical Burns 1. Hair around the wound - clipped or shaved
1. H2O should NOT be applied to burns from lye or white phosphorus ● It is anticipated that hair will interfere with wound closure.
● Application may cause EXPLOSION or Deepening of burn. ● Head, eyebrows are never shaved.

2. All evidence of these chemicals should be brushed off the patient 2. Clean area around the wound with NSS or Polymer agent (Shur-
before flushing occurs. Clens)
● Skin is drenched immediately with running water ● 50 mL or cc per inch
● If grossly contaminated, wound may need to be cleaned with
B. Wound surgical scrub (may anesthetize first).
● Injury to the Soft Tissues may involve skin and underlying
subcutaneous tissues and muscles. 3. Antibacterial agents: Povidone- Iodine or Hydrogen Peroxide
● Primary Goal: to restore the physical integrity and function ● Not allowed to get deep into wound without thorough
of the injured tissue, with minimal scarring and without rinsing.
infection. (+ to control severe bleeding). ● Use only for initial cleansing because it may injure exposed
● Proper Documentation - documentation of the and healthy tissue resulting in further injury.
characteristics of the wound is essential and may be needed
for future forensic evidence. 4. Assist with cleaning and debriding the wound
○ Precise descriptions
○ Correct terminology 5. Hemostasis: clamped or cauterized
○ Photographs (if possible) - provide accurate visible ● Anesthetics may be used if indicated.
depiction of wound important for exigent wounds
(wounds that would eventually heal). + Additional Information:
● Wounds involving injury to soft tissues can vary from minor ● Gently irrigate copiously with isotonic solution to remove
tears to severe crushing injuries. dirt.
● May be classified as: ● Devitalized tissue and foreign matters are removed because
○ Closed - without break in the skin; examples are they impede healing and encourage infection.
ecchymosis, hematoma ● The dressing may serve as a splint and also as a reminder to
○ Open - break in the skin happens the patient that the area is injured.

Types of Wound Primary Closure

The difference between the two (puncture and penetration) is the ● Wound is sutured or stapled by the physician and would
severity or the depth of penetration. depend on:
1. Stab ○ Nature of the wound
● incision of the skin with well-defined edges, usually caused ○ Time since the injury was sustained
by a sharp instrument; a stab wound is typically deeper than ○ Degree of contamination
long. ○ Vascularity of tissues
● Repair without delay yields the fastest healing.
2. Cut ● Wound closure begins when subcutaneous fat is brought
● incision of the skin with well-defined edges, usually longer together loosely with a few sutures to close off the dead
than deep. space, then subcuticular layer, then epidermis.
● Sutures are placed near the wound edge with the skin edges
3. Punctured level to promote optimal healing and easy removal.
● Pointed object can be penetrating only or with perforating. ● Then sterile strips of reinforced microporous tape or a
● Generally do not cause serious external bleeding but there bonding agent may be used to close clean superficial
may be significant internal bleeding and damage to vital wounds.
organs for stab.
Delayed Primary Closure
4. Amputation ● Indicated if tissue has been lost or there is a high potential
● Traumatic cutting or tearing of a finger, toe, arm, or leg. for infection.
● Granulate on its own without surgical closure (this is the
Assessment of Wound secondary intent).
● Steps:
 ○ Thin layer of gauze covered by an occlusive a. Always remember that we have to consider our
dressing - to ensure drainage and prevent pulling own safety.
of exudate.
○ Split-thickness cadaver or porcine xenografts - to D. Alcohol Intoxication
stimulate the function of epithelium. ● A multisystem toxin and CNS depressant causes drowsiness,
○ The wound is splinted in a functional position - to impaired coordination, slurring of speech, sudden mood
prevent motion and decrease the possibility of changes, aggression, belligerence, grandiosity, uninhibited
contractures. behavior and even death.
● Wound may be sutured if there are no signs of suppuration. ● Alcohol is a psychotropic drug that affects mood, judgment,
● Antibiotics - to prevent infection behavior, concentration, and level of consciousness.
● The site is immobilized and elevated - to limit the ● Many drinkers are young adults.
accumulation of fluid to the interstitial spaces of the wound ● Prevalence is high, returning frequently to the emergency
(posterior mold). department and frustrates the teen.
● Tetanus prophylaxis - given if the last tetanus toxoid is more ● Management requires patience and thoughtful accurate long
than 5 years ago or immunization is unknown. term treatment.
● Health teaching about signs and symptoms of infection:
○ Sudden persistent pain Treatment Goal:
○ Fever or chills ● Maintain airway and observe for CNS depression and
○ Bleeding hypotension.
○ Rapid swelling ○ Breathing pattern, rest, keep warm with blanket.
○ Foul odor ● Rule out other potential causes of behaviors.
○ Drainage ○ Assess for hypoglycemia, hypovolemia, or other
○ Redness surrounding the wound neurologic problems.
○ Discuss how pain subsides within 24 hrs ● Use a nonjudgmental, calm manner.
○ Firm, consistent, accepting, and reasonable
Management attitude.
1. Direct Pressure ○ Alcohol interferes with the thought process.
● Controls external bleeding. ● Patient may need sedation if noisy or belligerent.
● Cover with sterile dressing & apply direct pressure. ○ Monitor for signs of hypotension and decreasing
● If dressing is soaked, reinforce px to not to remove. LOC.
● Pressure bandage may be applied then assess for pulse distal ● Examine for withdrawal delirium, injuries, and evidence of
to dressing. other disorders.
○ May cause trauma to non-alcoholic people.
2. Elevation ○ Pulmonary infection is also common.
● Controls bleeding ● Hospitalized to a detoxification center, recovery and
● Do not raise limb if function is suspected rehabilitation.
● Elevate after treatment for the first 48 hrs

3. Pressure points
● Used when direct pressure and elevation can’t control E. Violence, Abuse, and Neglect
bleeding. ● Domestic violence is the leading cause of death in young,
● Used if the wound is due to a protruding bone or embedded african american women.
object. ● Young women are likely to suffer non-lethal violent acts that
result in a visit to emergency departments.
4. Expose the wound ● Men and people with disabilities are also victims of domestic
● Remove clothing if necessary violence and abuse.
● Do not remove any impaled objects ● Older abuse take many forms of physical and psychological
abuse, neglect, violation of rights, and financial abuse.
5. Assess for concomitant injuries ● Emergency Departments are often the first place where
6. Assess for vascular status victims of family violence, abuse or neglect go to seek help.
7. Perform Neurological Assessment ● 25% of all women will be in domestic violence sometimes
during their life.
Management: Drug Overdose ● 1-2 million elders are abused and neglected annually.
● Clinical manifestations vary with substance
● Treatment goals: Clinical Manifestations
○ Support respiratory and cardiovascular function. ● They may present with physical injuries.
○ Enhance clearance of the agent. ● Health problems: anxiety, insomnia and GIT symptoms
○ Provide safety of patients and staff. related to stress.
● IV drug users at high risk for: HIV infection, Hep B and C, ● They usually do not identify their abuser.
tetanus. ● A multiple injuries that are in various stages of healing and
an the explained explanation does not fit the picture.
C. Substance Abuse ● Neglect should be investigated whenever a dependent
● Misuse of specific substances to alter mood or behavior e.g. person with adequate resources and the designated care
drugs and alcohol. provider shows evidence of inattention to hygiene, nutrition,
● Drug abuse if it is used other than legitimate medical or to known medical needs.
purposes. ○ Malnutrition
● People who abuse IV drugs are at increased risk. ○ dehydration
● Manifestations vary with substance use but the underlying
principles are essentially the same. Assessment
Ideal position to provide early detection and intervention for victims
Rave Parties requires awareness of the signs and symptoms. The nurse must be
● Large scale parties attended by teenagers involved in drug skilled in interviewing techniques to elicit information.
use. ● I noticed that you have a number of bruises. Can you tell me
● Multidrug or ecstasy produces harmless high, may be even how they happened? Has anyone hurt you?
combined with viagra. ● You seem frightened. Has anyone ever hurt you?
○ Sildenafil (Viagra) - inc. risk for blood borne ● Sometimes patients tell me that they have been hurt by
disease. someone at home or at work. Could this be happening to
you?
Treatment Goal: ● Are you afraid of anyone at home or work, or of anyone with
A. Support respiratory and CV functions. whom you come in contact?
B. Enhance clearance of agent. ● Has anyone failed to help you to take care of yourself when
C. Provide for safety of the patient and staff. you needed help?
 ● Has anyone prevented you from seeing friends or other ○ Some victims may never fully recover and go on to
people whom you wish to see? develop chronic stress disorders and phobias.
● Have you signed papers that you did not understand or did
not wish to sign? Management
● Has anyone forced you to sign papers against your will? ● Goals are to provide support, reduce emotional trauma, and
● Has anyone forced you to engage in sexual activities within gather evidence for possible legal proceedings.
the past year? ○ Give sympathetic support and aim at encouraging
● Has anyone prevented you from using an assistive device the px to gain a sense of control over her life.
within the past year? ● Privacy and sensitivity must be respected.
● Has anyone you depend on refused to help you take your ● Reassurance about anxiety and asked whether a support
medicine, bathe, groom, or eat within the past year? person may be called.
● Community resources.
Management ● The patient should never be left alone.
● Primary concern: Safety and Welfare of the patient. ○ Throughout stay in ED, hysteria, stoicism or
● May require a multidisciplinary approach. feelings of overwhelm - support and caring are
○ Treatment focuses on consequences of the crisis crucial.
and prevention of further injury. ● Consent.
○ Work collaboratively to develop and implement a ○ Consent must also be taken for examination.
plan for meeting the px needs. ○ Taking of photographs and release of findings to
● Patients should be separated from abusing or neglecting police.
people whenever possible. ● History taking and documentation.
○ If px is in immediate danger. ○ History is obtained only if the px have not already
● Referral to a shelter. talked yet to a police officer or a social worker; can
○ Most appropriate but many shelters are be verbatim.
inaccessible most especially here in our country. ● Collection of forensic evidence.
● Mandatory reporting laws require health care workers to ● Head to Toe assessment: pelvic and rectal exam.
report suspected child or elder abuse to an official agency. ● Specimen Collection.
● Treating potential consequences of rape.
F. Sexual Assault A. Associated injuries
● Rape is forced sexual acts, especially if these acts involve B. Prophylaxis against STD
vaginal or anal penetration. C. Postcoital contraceptive medication
● Perpetrators or victims may either be male or female D. Antiemetic
● How the patient is received and treated in the Emergency E. Cleansing douche, mouthwash, fresh clothing.
Department is important to his or her psychological well F. Ask if client has taken a bath, douched, brushed
being. teeth, changed clothes, urinated, or defecated
● Patient should be seen immediately; most hospitals have a since the attack as this may alter the
written protocol that addresses the patient’s physical and interpretation.
emotional needs as well as collection of forensic evidence. G. Client is helped to undress and clothing is placed in
● Crisis intervention begins as soon as the patient enters the a separate paper bag, not plastic bags because
facility; the patient should be seen immediately. they retain moisture promoting molds which
destroy evidence.
Management Goals: H. Injuries in head or neck , breast, thighs, back, and
● Provide support buttocks.
● Reduce emotional trauma I. Dried semen, stains, or broken fingernails, oral
● Gather available evidence for possible legal proceedings exam, and culture are being observed.
● Nurses may be SANE certified
● Physical exam
● Specimen collection ENVIRONMENTAL EMERGENCY
● Treating consequences: STIs, pregnancy 1. Heat Stroke
● Encourage follow-up care 2. Hypothermia; Frostbite
3. Near Drowning
Sexual Assault Nurse Examiner 4. Decompression Sickness
● Complements the ED staff and can spend more time with 5. Anaphylactic Reaction
both patient and police officers investigating the incident. 6. Latex Allergy
● In our city, we have an ER nurse who has the opportunity to 7. Injected Poison (Stinging Insects)
become a trained SANE. 8. Snake Bites
● Training in forensic evidence collection, history taking and
documentation, ways to approach patients and family. 1. Heat Stroke
● Learning photographic methods and use of colposcopy. Acute Medical Emergency
○ A test to take a closer look at your cervix. ● Cause: Failure of the heat-regulating mechanisms of the
● Evidence collected through photography, video, and analysis body.
of specimens enables us to identify motile and non motile ● Extended heat waves with high humidity.
sperm and infectious organisms. ● Symptoms:
○ Red skin
G. Rape Trauma Syndrome ○ Increased heartbeat/heart rate
Patients reaction to rape; acute stress reaction to a life-threatening ○ Vomiting
situation. ○ Weakness
○ Tremor
Phases of psychological reaction: ○ Headache
● Acute disorganization phase ● Failure of heat-regulating mechanisms: CAN CAUSE DEATH!
○ Express state in which shock, disbelief, fear, guilt,
humiliation, anger, bad emotions are controlled Types:
and feelings are masked as victims appear ● Nonexertional: Prolonged exposure to an environmental
composed. temperature >39.2 C (102.5 F).
● Denial phase ● Exertional: Caused by strenous activity that occurs in hot
○ Unwillingness to talk. environments.
● Heightened anxiety phase ● Other people can tolerate this because it is up to the body’s
○ Fear, flashbacks, sleep disturbances, hyper way of adapting to the environment.
alertness, psychosomatic reactions that is
consistent with PTSD. Who are AT RISK?
● Reorganization
○ Incident is put into perspective.
 ● People not acclimated to heat; older or very young people; ● The trauma from exposure to freezing temperatures and
ill or debilitated people; and persons taking some actual freezing of the tissue fluids in the cell and intercellular
medications are at high risk. spaces.
○ Elderly ● It may happen to your feet, hands, nose, and ears.
○ Very young people ● First degree: redness and erythema
○ Unable to care for themselves ● Fourth degree: full depth tissue destruction which goes
○ Chronic diseases deeper to subcutaneous tissue.
○ Those taking certain medications
○ Healthy individuals - due to how our bodies adapt Primary Assessment and Interventions:
to the heat. Some may tolerate it, some may not.

Emphasis on manifestations of:

● Central nervous system dysfunctions
● Elevated temperature of around 39 C or higher
● Hot, dry skin
● Anhidrosis
1. Airway, Breathing, and Circulation of the client (ABCs)
● Tachypnea
● If there are any noted unusualities, we have to
● Hypotension
report it immediately for immediate action.
● Tachycardia
2. Deficits coexisting: hypothermia or underlying condition.
HEAT EXHAUSTION vs HEAT STROKE
● This is very opposite with your heat stroke
● The patient suffering from frostbite may
experience hypothermia or underlying conditions.
First Aid
● Call emergency service
3. Protect frostbitten tissue while performing other
● Take immediate action to cool the person.
interventions.
Subsequent Assessment:
Management

● Move to a cooler place

● Drink water if able
● Take a cold shower
● Use cold compresses
○ Armpits, wrists, ankles, and groin
● Remove clothing 1. Frostnip:
● Spraying/sprinkle with cool water ● History of gradual onset
● Use a fan ● Skin appears white
● Monitor patient’s status carefully ● Numb, pain-free
● Administer oxygen (as needed and per doctor’s order)
● Intravenous infusion therapy
● Urine output (monitor)
● Supportive care
● Medications (with doctor’s order): anticonvulsant,
potassium, sodium bicarbonate, benzodiazepines.
○ Patients suffering from heat stroke may also
experience fluid-electrolyte imbalances.
2. Superficial Frostbite:
● Damage limited to the skin and subcutaneous tissue.
Environmental Emergency: Frostbite
● Skin appears white and waxy
● Palpation: skin feels stiff but underlying tissue is pliable, soft,
● A trauma due to exposure to freezing causing actual freezing
and normal “bounce”.
of tissue fluids in the cell and the cellular spaces = cellular
● Absent sensation.
damage.
● Areas: earlobes, cheeks, nose, hands, and feet.
● May be classified as: frostnip (initial response), superficial
frostbite, deep frostbite.
● Common manifestations:
○ Hard, cold, and insensitive to touch - may appear
white or mottled or may turn red and painful as
rewarmed.
● The extent of injury is not always initially known. 3. Deep Frostbite:
● Skin appears white, yellow-white, or mottled blue-white.
Management: ● Palpation: surface feels frozen and underlying tissue feels
● Controlled but rapid rewarming around 37-40 C circulating frozen and hard.
bath for 30-40 minute intervals. ● Affected part: completely insensitive to touch.
● Analgesics for pain if a patient experiences pain. Do not
massage or handle.
● If feet are involved, do not walk.

General Interventions:

● From the image you can see the normal skin to a severe case
of frostbite.
 GENERAL INTERVENTIONS:
Goal: Rewarm without precipitating cardiac dysrhythmias
A. Supportive Measures
- Gentle and careful handling of patient; continue monitoring
of core temperature.
B. Rewarming Techniques
- Depends on the degree of hypothermia.
- Passive External Rewarming (several blankets, removal of
all wet clothing etc.).
1. Frostnip may be treated by placing a warm hand over the chilled - Active External Rewarming (warm water immersion; warm
area. hot water bottles).
2. Leave the frostbitten area alone until definitive rewarming is - Active Core Rewarming (i.e. inhalation of warmed,
undertaken. Pad the extremity to prevent damage from trauma. humidified O2 by mask or ventilator; warmed IVFs; warmed
3. Gently handle the affected part. gastric lavage; warmed peritoneal dialysis etc).
4. Remove all constricting clothing and jewelries.
5. Rewarming: Environmental Emergency: Near Drowning
● Fairly large Tepid water bath immersing the affected part ● Also known as Immersion Syndrome.
without touching the side or bottom. ● Clients who initially survive suffocation submersion in a
● If clothing, socks, or gloves are frozen to the extremity, leave water or fluid medium.
them and remove after rewarming. ● Immersion Syndrome is the immersion into cold water that
● Slow rewarming is less effective leads to cardiac dysrhythmias.
● Dry heat NOT recommended ● Freshwater drowning is more common than saltwater
● Rewarming is complete when the area is warm to touch and drowning.
pink or flushed. ➔ Around 90% of drowning occur in fresh water such
● DON’T rub or massage = ice crystals will lacerate the tissue. as swimming pools, bathtubs, and rivers.
○ Let the frozen area melt. ➔ This partly because of the chemistry of water and
how it relates to osmosis.
6. Pharmacologic interventions: ➔ How it works: drowning involves suffocating while
● Narcotic (pain control) in water so you don’t even need to breathe in the
water for this to occur but if you do inhale salt
7. Protect thawed part from infection; if blisters occur– keep intact. water, the high salt concentration prevents the
8. Sterile gauze or cotton between affected fingers/toes to absorb water from crossing into lung tissue.
moisture. ➔ If you drown in salt water, it’s because you can’t
9. Aseptic technique during dressing changes; loosely apply dressing. get oxygen or expel carbon dioxide.
➔ Breathing in all salt water acts as a physical barrier
10. Elevate to control swelling. between the air and your lungs. If the salt water is
11. Foot cradle. removed, you can breathe again.
12. Physical exam - check for concomitant injury, dehydration, alcohol
coma, fat embolism, immobility. Factors that increase the risk: Near Drowning
13. Restore balance (check for dehydration and Hypovolemia). ● Alcohol or drug ingestion
● The doctor will order to give IV fluids. ● Overestimation of swimming skills
14. Whirlpool bath - aid in circulation, debride dead tissue, prevent ● Hypothermia
injury. ● Hyperventilation
15. Escharotomy (incision through the eschar) - prevent further tissue ● Extreme fatigue
damage, allow normal circulation, permit joint motion. ● Sudden acute illness
16. Fasciotomy (incision in fascia to release pressure on the muscles, ● Head or spinal cord injury
nerves, blood vessels) = treat compartment syndrome. ● Hypoglycemia
17. Hourly ROM of the affected digits.
● To better promote circulation on the affected part. Ultimate result of Near Drowning: Pulmonary Edema
18. Avoid tobacco use. ● Both freshwater and saltwater wash out alveolar surfactant.
● May hinder faster recovery of patients. ● Freshwater changes the surface tension of the surfactant.
19. Serial lab (U/A, serum enzymes) to monitor rhabdomyolysis and ● Loss of surfactant leads to alveolar collapse, intrapulmonary
renal failure due to frostbite. shunting, decreased lung compliance, and hypoxemia.
● Per doctor’s order. ● Poor perfusion and hypoxemia → acidosis and pulmonary
edema.
Environmental Emergency: Hypothermia
● Hypothermia may be seen with frostbite and treatment
takes precedence. So physiologic changes in all organ
systems, then monitor continuously.
● Internal core temperature is s 35°C or less.
● Older adults, infants, persons with concurrent illness,
homeless people, and trauma victims are at risk.
● Alcohol ingestion increases susceptibility to suffer X-ray result of a near drowning case
hypothermia. ● Near drowning also compromises respiratory system. →
hypoxia, hypercapnia, cardiac arrest, and severe alterations
May be classified as: in fluid and electrolyte balance.
1. Mild
- Shivering and mental confusion
2. Moderate CLINICAL MANIFESTATIONS of Near Drowning
- Shivering stops and confusion increases ● Unconscious or awake BUT restless and with chest pain or
3. Severe headache
- There may be paradoxical undressing in which a person ● Vomiting of fluids
removes his or her clothing. ● Hypothermia
- Increased risk of the heart stopping. ● Cardiac: tachycardia, hypotension, dysrhythmias
● Pulmonary: pink frothy sputum caused by pulmonary edema
Management of the Patient With Hypothermia
● Use ABCs (Airway, Breathing, Circulation) What to do? How to handle near drowning cases?
● Remove wet clothing, rewarm, supportive care. 1. Call for help.
● Note: cold blood returning from the extremities has high 2. Somebody will try to swim towards the victim then get
levels of lactic acid → can cause potential cardiac him/her out of the water.
dysrhythmias and electrolyte disturbances. 3. Do CPR
4. Check for the heart if it goes back.
 5. Report to the nearest hospital for further management. ● For patients who are awake and alert = ok to travel by
ground ambulance or by automobile.
OUTCOME MANAGEMENT of Near Drowning ● Assess patient; document changes.
● ABCs (Airway, Breathing, Circulation). ● If aspiration is suspected, other treatment may be
● Spinal cord Injury suspected = immobilize the patient. prescribed.
● Perform CPR if needed.
● History: length of submersion, water tension, associated Allergic Reactions
injury, type of water. ● An inappropriate, often harmful response of the immune
● Assess LOC, respiratory effort or adventitious breath sounds system to normally harmless substances.
(can see possible signs of pulmonary edema). ● Hypersensitive reaction to an allergen initiated by
● Open airway while maintaining spinal immobility. immunologic mechanisms that is usually mediated by IgE
● Assess for hypoxia (manifestations: confusion, irritability, antibodies.
lethargy/unconsciousness). ● Allergen is the substance that causes the allergic response.
● Remove client’s wet clothing & wrap client in warm blanket; ● Atopy refers to IgE mediated diseases; such as allergic
rewarm slowly (to prevent hypothermia). rhinitis that have a genetic component.
● Once vital functions are stabilized, correct acid-base or lyte ● Manifestation of tissue injury resulting from interaction
abnormalities. between an antigen and an antibody.
● V/S and check for any additional injuries (spinal injury from ● Body encounters allergens that are types of antigens
diving, air embolism from scuba diving, seizures). ● Body’s defenses recognize antigens as foreign.
● For respiratory insufficiency: intubation and ventilate w/ ● Series of events occurs in an attempt to render the invader
100% O2 and 5 to 10 PEEP to prevent alveolar collapse. harmless, destroy them, and remove them from the body.
● Surfactant level may remain low for up to 48 to 72 hours
especially after freshwater aspiration. Immunoglobulins and Allergic Response
● If client is breathing, provide support with non-rebreather ● Antibodies (IgE. IgD, IgG, IgM, and IgA) formed by
mask; maintain O2 sat above 90%. lymphocytes and plasma cells.
➔ Allows for the delivery of higher concentration of ● IgE antibodies are involved in the allergic disorders.
oxygen. ● IgE molecules bind to an allergen and trigger mast cells or
➔ The reservoir bag is inflated greater than two- basophils. These cells then release chemical mediators such
thirds full of oxygen at a rate of 15 L/min. as histamine, serotonin, kinins, SRSA, and neutrophil factor.
➔ Approximately one-third of the air from the ○ These substances cause the reaction seen in
reservoir is depleted as the patient inhales, and it allergic response.
is then replaced by the flow from the oxygen
supply. Role of B cells and T Cells in Allergic Response
➔ If the bag becomes completely deflated, the ● B cells; also known as B lymphocyte
patient will no longer have a source of air to ○ Programmed to produce one specific antibody.
breath. ○ Stimulates production of plasma cells; antibody
production.
Environmental Emergency: Decompression Sickness ○ Results in outpouring of antibodies.
● DCS also called “the bends”. ● T cells; also known as T lymphocyte
● Occurs in patients who have engaged in diving, high-altitude ○ Assist B cells.
flying or flying in commercial aircraft within 24 hours after ○ Secrete substances that destroy target cells and
diving. stimulate macrophages.
● DCS results from nitrogen bubbles trapped in the body; may ○ Digest antigens and remove debris.
occur in joints and muscle spaces → musculoskeletal pain,
numbness, or hypoesthesia. Allergic Reaction
➔ Hypesthesia: reduced sense of touch or sensation; ● Allergen triggers the B cell to make IgEantibody, which
partial loss of sensitivity to sensory stimuli. attaches to the mast cell. When that allergen reappears, it
● Nitrogen bubbles can become air emboli → stroke, paralysis, binds to the IgEand triggers the mast cell to release its
or death may happen. chemicals.
● Recompression is necessary – may necessitate low-altitude
flight to the nearest hyperbaric chamber. Type I: Anaphylactic Reaction
● Characterized by vasodilation, increased capillary
Assessment and Diagnosis Findings: Decompression Sickness permeability, smooth muscle contraction, and eosinophilia.
● History from the patient or diving buddy, evidence of rapid ● Systemic reactions may involve laryngeal stridor,
ascent, loss of air in the tank, recent alcohol intake or lack of angioedema, hypotension, and bronchial GI or uterine
sleep, flight within 24 hours after diving. spasm.
● Signs and symptoms: Joint or extremity pain, numbness, ● Local reactions are characterized by hives.
hypesthesia, loss of ROM. ● Examples of type 1 reactions:
● Neurologic symptoms: stroke, spinal cord injury (indicates ○ Extrinsic asthma
air embolism). ○ Allergic rhinitis
● CP Arrest may occur with severe DCS. ○ Systemic anaphylaxis
● Because of hypoxia – patients seldom survive. ○ Reactions to insect stings
● Rapid transfer of patients to hyperbaric chambers is
necessary. Type II Cytotoxic Reactions
● Involves binding either the IgG or the IgM antibody to a cell
Hyperbaric chamber therapy (HbO2) bound antigen.
● When a patient is given 100 oxygen under pressure, ● May lead to eventual cell and tissue damage.
hemoglobin is saturated but the blood can be ● The reactions is the result of mistaken identity.
hyperoxygenated by dissolving oxygen within the plasma. ● When the system identifies a normal constituent of the body
● The patient can be administered systemic oxygen via two as a foreign and activates the complement cascade.
basic chambers: Type A: multiplace and Type B: monoplace; ● Example:
both types can be used for routine wound care. ○ Myasthenia Gravis
○ Good pasture syndrome
MANAGEMENT: Decompression Sickness ○ Pernicious anemia
● Patent airway and ventilation (100% O2) ○ Hemolytic disease of the newborn
● Chest X-Ray ○ Transfusion reaction
● Cardio and Neuro Systems supported. ○ Thrombocytopenia
● Air embolism suspect: Lower HOB, remove wet clothing and
keep patient warm. Type III: Immune Complex Reaction
● Transfer to nearest hyperbaric chamber. ● Marked by acute inflammation resulting from formation and
● If air port is necessary, low-altitude flight is needed (below deposition of immune complexes.
1000 feet).
 ● Joints and kidneys are particularly susceptible to this kind of ● Implicated in rhinitis, conjunctivitis, contact dermatitis,
reaction which is associated with systemic lupus urticarial, asthma, anaphylaxis.
erythematosus, serum sickness, nephritis, and rheumatoid ● Prevalence has been decreasing due to the use of nonlatex
arthritis. gloves.
● Some s/sx: ● 8% to 17% of healthcare workers are affected.
○ Urticaria ● Healthcare providers have died from anaphylaxis related to
○ Join pain latex allergy as per report; latex-free gloves are provided for
○ Fever nurses who have latex allergy.
○ rash ● Significant observation of allergy to latex: itching, redness,
○ Adenopathy or swollen glands rash; severe anaphylaxis can occur.
● Treatment must be rapid, latex product MUST be removed
Type IV: Delayed or Cellular Reaction promptly.
● Occurs 1-3 days after exposure to an antigen.
● Reaction results in tissue damage involves activity by Injected Poison: Insect Stings
lymphocytes, macrophages, and lysozymes. ● Insect stings or bites are injected poisons that can produce
● Erythema and itching are common. either local or systemic reactions.
● Examples: ● Local reactions: pain, erythema, edema.
○ Contact dermatitis ● Systemic reactions usually begin within minutes and
○ Graft vs host disease produce mild to severe and life-threatening reaction.
○ Hashimoto’s thyroiditis
○ Sarcoidosis Clinical Manifestations
● Generalized Urticaria
Assessment of Patients With Allergic Reactions ● Itching
● History and manifestations; comprehensive allergy history. ● Malaise
● Diagnostic tests ● Anxiety
○ CBC: eosinophil count ● Severe Bronchospasm
○ Total serum IgE ● Shock
○ Skin tests: prick, scratch, and intradermal ● Death

Intradermal Testing Management

● Performing a small bleb. ● Stinger removal
● Wound care
● No scratching please!
Interpretation of Reactions ● Ice application
● Oral antihistamine and analgesic
● Epinephrine
● Health education

1. Ice packs
2. Elevate extremity
3. .Oral anti – Histamine
4. Clean wound – soap & water or antiseptic solution
● Negative wheal: as you form a bleb, if the wheal does not go
5. Tetanus Prophylaxis
out from the form.
6. Patient education: epinephrine, emergency bracelets;
● The bigger the wheal, the bigger chances that the patient is
instructions when sting occurs; avoiding exposures.
having a reaction.

Management of Allergic Disorders

Snake Bites
Two types of reactions: Atopic and Nonatopic
● Daylight hours into early evening during summer months.
● Atopic
● Pit vipers: rattlesnake, copperheads, coral snakes.
○ Asthma, allergic rhinitis, atopic dermatitis
● Upper extremity
○ Familial
● Envenomation
● Nonatopic
○ Process by which venom is injected into some
○ Lack genetic component
animal by the bite or sting of a venomous animal.
○ Latex
● Bites by these snakes may result in envenomation, an
injected poisoning.
Medications to Treat Allergic Reactions
● Oxygen, if respiratory assistance is needed
● Epinephrine used for anaphylactic reactions
● Histamines
● Corticosteroids

Prevention and Management of Anaphylaxis

● Screen and prevent
● Treat respiratory problems, oxygen, intubation, and Primary Assess and Interventions:
cardiopulmonary resuscitation as needed 1. ABCs
● Epinephrine 1:1000 subcutaneously 2. Severe envenomation = neurotoxicity (respiratory paralysis,
● Auto injection system: EpiPen shock, coma, and death)
● May follow with IV epinephrine
● IV fluids

Anaphylactic Reaction
● Acute systemic hypersensitivity reaction that occurs within
seconds or minutes after exposure to certain foreign
substances.
● Medications
● Insect stings
● Foods

Latex Allergy
● Allergic reaction to natural rubber proteins.
 ○ Those who are unemployed, divorced, widowed, or
living alone.
○ Those showing signs of significant depression (e.g.,
weight loss, sleep disturbances, somatic complaints,
suicidal preoccupation).
○ Those with a history of a previous suicide attempt,
suicide in the family, or psychiatric illness.
Psychiatric Emergencies
- Part of emergency nursing is caring for clients with Signs and Symptoms of Potential Suicide
Psychiatric Emergencies. ● Communication of suicidal intent
● History of a previous suicide attempt, with risk being much
Psychiatric Emergencies greater in these cases.
● Psychiatric emergencies often arise in non-psychiatric ● Famiy history of suicide
settings and give rise to stress for all persons involved. They ● Loss of a parent at an early stage
may be life threatening and must therefore be treated and ● Specific plan for suicide
managed. ● A means to carry out the plan
● Psychiatric emergencies are often but not always caused by
mental illness. They require action without delay to save the Emergency Management
patient and other persons from mortal danger or other Focuses:
serious consequences. ● Treating the consequences of the suicide attempt (e.g.,
● Immediate treatment directed against the acute gunshot wound, drug overdose)
manifestation is needed both to improve the patient’s ● Preventing further self injury
objective symptoms and to prevent behavior.
● An urgent, serious disturbance of behavior, affect, or
thought that makes the patient unable to cope with life Terrorism, Mass Casualties, and Disaster Nursing
situations and interpersonal relationships.
● Patient may present at the ED: Terrorism
○ Overactive or violent The Global Terrorism Database (2017) describes three criteria:
○ Underactive or depressed, or ● Criterion I: The act must be aimed at attaining a political,
○ Have suicidal behaviors economic, religious, or social goal.
● Criterion II: There must be evidence of an intention to
PATIENTS WHO ARE OVERACTIVE coerce, intimidate, or convey some other message to a
● Disturbed, uncooperative, and paranoid behavior and those larger audience (or audiences) than the immediate victims.
who feel anxious and panicky may be prone to assaultive ● Criterion III: The action must be outside the context of
and destructive impulses and abnormal social behavior. legitimate warfare activities.
● Intense nervousness, depression, and crying.
● Disturbed and noisy behavior may be exacerbated or Chemical Terrorism
compounded by alcohol or drug intoxication. ● The use of toxic nature of selected substances to cause
death or injury.
Interventions for Overactive Patients ● Chemical Warfare (CW) agents may cause injury via the
- The immediate goal is to gain control of the situation. If the respiratory route, through the skin, or by ingestion.
patient is potentially violent, security should be nearby. ○ Nerve agents (e.g., sarin)
Restraints are used as a last resort and only as prescribed. ○ Blood agents (e.g., cyanide)
- Approaching the patient with a composed, confident, and ○ Lung irritants (e.g., chlorine gas)
firm manner is therapeutic and has a calming effect.
- Interventions are the following: Biological Terrorism
● Deliberate use of pathogens to infect persons through
1. Introduce yourself by name. respiratory and ingestion routes causing death or injury.
2. Tell the patient, “I am here to help you.” ● e.g. Anthrax and smallpox.
3. Repeat the patient’s name from time to time.
4. Speak in one-thought sentences and be consistent. Radioactive Terrorism
5. Give the patient space and time to slow down. ● The use of radiological weapons to cause damage or injury.
6. Show interest in, listen to, and encourage the patient to talk ● e.g. Nuclear weapons
about personal thoughts and feelings.
7. Offer appropriate and honest explanations. Disaster Nursing
● Refers to a situation in which a health professional, usually a
Post-Traumatic Stress Disorder registered nurse or nurse practitioner, responds to a crisis
● The development of characteristic symptoms after a situation
psychologically stressful event.
● E.g., rape, combat, motor vehicle crash, natural catastrophe, Incident Command System (ICS)
terrorist attack. ● Is a command structure that implements perimeters and
areas to optimize responder safety and patient flow, as well
PTSD Symptoms as the preservation of evidence and environment
● Intrusive thoughts and dreams
● Phobic avoidance reaction (avoidance of activities that Mass Casualty Incident
arouse recollection of the traumatic event) ● An incident in which emergency medical services resources
● Heightened vigilance are overwhelmed by the number and severity of casualties.
● Exaggerated startle reaction ● In all types of MCIs, the nurse will be expected to exercise
● Generalized anxiety the following:
● Societal withdrawal 1. Assessment and triage of patient’s condition for priority care
2. Provision of care, treatment, and health protection
PATIENTS WHO ARE UNDERACTIVE OR DEPRESSED 3. Appropriate utilization of nursing service personnel
Patients who are Suicidal 4. Detection of changes in the event environment to organize
● Attempted suicide is an act that stems from depression. activities to modify or eliminate health hazards
● E.g., loss of a loved one, loss of body integrity or status, poor 5. Dealing with mass casualties if necessary
self-image
● Males are at greater risk Hospital Incident Command System (HICS)
● Others at risk are: ● Is an incident management framework that can be used to
○ Older adults organize a disaster plan and response
○ Young adults ● Reflects the same basic principles of command and control,
○ People who are enduring unusual loss or stress chain of command, predefined positions, established
reporting and communication relationships, use of common
 nomenclature, expandability and contractility of the scale of ○ Resources should not be unnecessarily exhausted.
the operation, and span of control as does the national ICS The person who decides when the facility resumes
daily activities is clearly identified.
Hospital Emergency Preparedness Plans i. After-action report or corrective plan
● Is a comprehensive emergency operations plan that covers ○ Facilities often see increased volume of patients
all phases of the disaster and competent staff who know after an incident. So incident response critique and
their roles in executing the plan a debriefing for all parties involved, immediately
● The cornerstone of emergency management is to first and again at a later date
protect life, then property, then the environment. j. A plan for practice drills
○ Practice drills that include community participation
Phases of Emergency Planning allowfor troubleshooting any issues before a real-
1. Mitigation Measures life incident occur
● Have structural mitigation and non-structural mitigation k. Anticipated resources
● Structural Mitigation ○ Food and water must be available for staff,
○ efforts include those that the hospital performed families, and all others who may be in the facility
through the construction or alteration of the for an extended period
physical environment through engineered l. Mass casualty incident (MCI) planning
solutions ○ includes such issues as planning for mass fatalities
○ Example 1: employing disaster resistant and morgue readiness.
construction or structural modifications such as m. An education for all of the above
hardening ○ A strong education plan for all personnel regarding
○ Example 2: Detection system, the radiation each step of the plan allows for improved
monitors at the hospital portals readiness and additional input for fine-tuning of
● Non-structural Mitigation Measures the EOP.
○ Are those that the hospital undertakes by
modifying human behaviors or processes Personal Protective Equipment
○ These may include regulatory measures, staff ● Is the clothing and respiratory gear designed specifically to
awareness, and educational programs protect the healthcare provider while he or she is caring for
2. Preparedness Efforts a contaminated patient
● To effectively manage the full spectrum of emergency
incidents that a hospital may face, hospital emergency Sequence in wearing PPE:
managers—in collaboration with the institution’s emergency 1. Gown
management committee comprising members of every a. Full cover torso from neck to knees, arms to end of
clinical, operational, and financial department—must wrists, and wrap around the back
develop and maintain a comprehensive, effective emergency
management plan. 2. Mask or respirator
● This will help hospitals to prepare disaster and emergency a. Secure ties or elastic bands at middle of head and
situations neck
3. The Response Phase b. Fit flexible band to nose bridge
● Often, the most visible and well supported by outside c. Fit snug to face and below chin
resources of the emergency management plans’ activities d. Fit-check respirator
are those that fall under the response phase
● Efforts include those measures taken when an emergency 3. Goggles or face shield
incident occurs and may involve care for patients, staff, and a. Place over face and eyes and adjust to fit
visitors: to limit injuries, loss of life, and damage to the
physical environment.
4. Recovery Function 4. Gloves
● The primary goal of recovery efforts is to restore core a. Extend to cover wrist of isolation band
services and normal operations.
● From a hospital planning perspective, the institution’s ● Sequence in Removing PPE:
recovery actions and implementation activities for its core ○ Gloves
financial, human resources, and support services should also ○ Goggles / Faceshield
be addressed. ○ Gown
○ Mask / Respirator
Emergency Operations Plan ● Perform hand washing immediately after removing PPE
Essential components of the plan
a. An activation response (Activation Measures) Hazardous Materials
○ This activation response of the facility means ● Is any substance with the potential to harm people, property
where, how, and when the response is initiated or the environment. This includes not only chemicals but
b. An internal and external communication plan also biological, radiological, nuclear, and explosive
○ Important for coordination purposes substances.
c. A plan for coordinated patient care
○ Important for the possible transfer of the patient Classification of Hazardous Materials
to other facilities Class 1: Explosives
d. Security plans ● The explosives category includes any items or materials that
○ This is a key to answer chaotic situations can rapidly detonate or conflagrate as the result of a
e. Identification of external resources chemical reaction.
○ Important to identify resources such as local and
national, to properly utilize these resources Class 2: Gasses
f. A plan for people management and traffic flow ● Substances with a vapor pressure and those that are
○ Includes strategies to manage the patient, the completely gaseous.
public, the media, and the personnel
○ A designated person is delegated to manage these Class 3: Flammable Liquids
groups ● They are defined as liquids, liquids containing solids in
g. Data management strategy solution, or mixtures of liquids.
○ A data management plan, for every aspect of the
disaster, will save time Class 4: Flammable Solids
○ A backup system for documenting, tracking, and ● Self-reactive substances that may undergo strong
staffing is developed if the facility utilizes exothermic reactions or solid desensitized explosions are
electronic health record also included in this category.
h. Demobilization response
Class 5: Oxidizing Substances, Organic Peroxides
 ● Oxidizers are substances that may contribute to or cause BLAST INJURIES
combustion by yielding oxygen as the result of a chemical Phases of Blast Injury
reaction. 1. Primary
● Results from pressure wave
Class 6: Toxic Substances and Infectious Substances ● Common Injuries:
● Infectious substances are materials that are known to or ➢ Pulmonary barotraumas, including pulmonary
likely to contain pathogens such as viruses, bacteria, contusions
parasites, fungi, and other microorganisms that can cause ➢ Head injuries, including concussion, other severe
disease in humans and animals. brain injuries
➢ Tympanic membrane rupture, middle ear injury
Class 7: Radioactive Material ➢ Abdominal hollow organ perforation, hemorrhage
● This class includes materials that contain radionuclides. 2. Secondary
● Results from debris from the scene or shrapnel from the
Class 8: Corrosives bomb
● Include substances that disintegrate or degrade other ● Common Injuries:
materials on contact by way of chemical action. ➢ Penetrating trunk, skin, and soft tissue injuries
➢ Fractures, traumatic amputations
Class 9: Miscellaneous Hazardous Materials 3. Tertiary
● Some hazardous materials do not fall into any of the first ● Results from pressure wave that causes the victim to be
eight categories. thrown
● Common Injuries:
Decontamination ➢ Head injuries
● Is the process of removing or neutralizing a hazard from the ➢ Fractures, including skull
environment, property or life form. 4. Quaternary
● Its goal is to reduce or remove the hazardous agent while ● Results from pre-existing conditions exacerbated by the
maintaining safety and to prevent further contamination to force of the blast or by post blast injury complications
people and the environment. ● Common Injuries:
➢ Severe injuries with complex injury patterns-
Decontamination Methods burns, crush injuries, head injuries
1. Physical Removal ➢ Common pre-existing conditions that become
● Remove clothing: clothing removal is decontamination – exacerbated- COPD, asthma, cardiac conditions,
encourage victims to remove clothing at least to their diabetes, and hypertension
undergarments.
● Flush with water or aqueous solutions. Natural Disasters
● Absorb contaminating agent with absorbent materials (e.g. ● Are catastrophic events with atmospheric, geological, and
rub with flour followed by wet tissues or use a military M291 hydrological origins that can cause fatalities, property
resin kit for spot decontamination of skin only). damage, and social environment disruption.
● Scrape bulk agent with a wooden stick (e.g. tongue Common natural disasters:
depressor or popsicle stick). ● Earthquake
● Note: Follow all of these with full decontamination at a ● Flood
medical treatment facility. ● Droughts
● Hurricane/Tornados
2. Chemical Deactivation
● Water or soap wash: chemical warfare agents have a Stress Reactions
generally low solubility and slow rate of diffusion in both Post- traumatic Stress Disorder
freshwater and seawater. Therefore, the major effect of ● The development of characteristic symptoms after a
water and water combined with soap (especially alkaline psychologically stressful event (e.g., rape, combat, motor
soaps) is via a slow breakdown of the compound (e.g. vehicle crash, natural catastrophe, terrorist attack),
hydrolysis) or through dilution of the agent and mechanical Symptoms
force of the wash. When other chemical deactivation means ● intrusive thoughts and dreams,
are not available, washing with water or soap and water is a ● phobic avoidance reaction
good alternative. ● heightened vigilance,
● Chemical solutions: in the event of an emergency, you may ● exaggerated startle reaction,
be directed to perform decontamination with other chemical ● generalized anxiety
deactivation agents. These vary depending on the chemical ● societal withdrawal
warfare agent and may include alkaline solutions of
hypochlorite. Critical Incident Stress Management
Critical Incident Stress Debriefing (CISD)
3. Hydrolyzing Agent ● is a formalized, structured method whereby a group of
● Alkaline hypochlorite is effective for hydrolyzing VX and G rescue and response workers reviews the stressful
agents. experience of a disaster
● was developed to assist first responders, it was not meant
BIOLOGICAL WARFARE for the survivors of a disaster or their relatives
Common Biologic Weapons ● was never intended as a substitute for therapy
1. ANTHRAX ● designed to be delivered in a group format and meant to be
● Incubation 1-6 days incorporated into a larger, multicomponent crisis
● Skin contact, GI ingestion, inhalation intervention system
● Skin lesions, fever, nausea and vomiting, abdominal pain, Debriefing
diarrhea ● is a formal version of providing emotional and psychological
● Respiratory symptoms that mimics influenza support immediately following a traumatic event
● Treatment= Penicillin V, Erythrocin ● its goal is to prevent the development of post-traumatic
stress disorder and other negative sequelae.
2. SMALLPOX ● mostly involve a single session which might last between
● Virus, Incubation 12 days one and three hours, in the days immediately following a
● Extremely contagious; spread by direct contact, by contact traumatic event is often provided in groups.
with clothing or linens, or by droplets person-to-person
● Manifestations: High fever, malaise, headache, backache,
Nurses’ Role in Disaster and Emergency
and prostration; after 1 to 2 days a maculopapular rash
● Assess the needs of the whole community, including
appears on the face, mouth, pharynx, and forearms
potentially at-risk populations, as the event unfolds based on
● Treatment is supportive care with antibiotics for any
the information available.
additional infection
 ● Conduct surveillance activities within the health department ● Provides mock experiences tremendous value in applying
as well as in cooperation with in-hospital infection control leadership and management theory
practitioners to control the spread of communicable disease. ● The text includes numerous opportunities for readers to
● Assure the health and safety of themselves as well as their experience the real world of leadership and management
fellow responders. ● Some of these learning situations called learning exercises:
● Maintain communication with local, state, or federal ○ case studies
agencies, assuring the accurate dissemination of information ○ writing exercises
to colleagues and the public-at-large. ○ Specific management or leadership problems
● Operate points of distribution (POD), mass countermeasures ○ Staffing and budgeting calculations
centers as ○ Group discussion or problem-solving situations
● Provide on-site triage of victims as needed. ○ Assessment of personal attitudes and values
● Some exercises include:
119 LEC WEEK 3 & 4 ○ Opinions
Decision Making, Problem Solving, Critical Thinking, and Clinical ○ Speculations
Reasoning: Requisites for Successful Leadership and Management ○ Value judgements
● All of the learning exercises require some degree of critical
Nurses constantly face numerous decisions to make problems to solve; thinking, problem solving, decision making, or clinical
these are part of the usual nursing care activities and are not easy reasoning
tasks

Developing critical thinking, problem solving, and decision-making

skills enables nurses to see all sides of an issue, look for creative
alternatives and approaches to solve problems and make well thought Marquis-Huston Critical Thinking Teaching Model
out decisions. The effect is a stronger organization and more
competent leader and manager.

Decision Making
● A complex, cognitive process of choosing a particular course
of action
● the thought process of selecting a logical choice from
available options
● This implies that doubt exist in several courses of action and
a choice is made to eliminate uncertainty
● This model assists in achieving desired learner outcomes
Problem Solving
Basically, the model comprises four overlapping spheres,
● A part of decision making; a systematic process focusing on
each being an essential component for teaching
analyzing a difficult situation involving higher order
leadership and management.
reasoning and evaluation
1. Didactic Theory Component
● Many educators use problem solving and decision making
a. such as the material that is presented in each
synonymously but there is a small difference between the
chapter
two: although decision making is the last step in the problem
2. A formalized approach to problem solving and decision
solving process; it is possible for decision making to occur
making must be used.
without the full analysis required in problem solving
3. Use of group process
○ problem solving attempts to identify the root
a. which can be accomplished through large and
problem in situations
small groups and classroom discussion
○ Much time and energy are spent on identifying the
4. The material must be made real for the learner so that the
real problem
learning is internalized.
a. This can be accomplished through writing
Critical Thinking
exercises, personal exploration, and values
● “Reflective thinking”
clarification, along with risk taking, as case studies
● Related to evaluation and has a broader scope than decision
are examined
making and problem solving
● Disciplined thinking that is clear, rational, open-minded, and
Characteristics of a Critical Thinker
informed by evidence
● Insight
● Involves reflecting on the meaning of statements, examining
● Intuition
the offered evidence and reasoning, and forming
● Empathy
judgements about facts
● Willingness to take action
Clinical Reasoning
Whatever definition of critical thinking is used, most agree that it is
● Integrating and applying different types of knowledge to
more complex than problem solving or decision making
weight, critically think about arguments, and reflect on the
● it involves higher reasoning and evaluation
process used to arrive at diagnosis
● has both cognitive and affective components
● Nurses today must have higher order thinking skills to
identify patient problems and to direct clinical judgements
Insight, intuition, empathy, willingness to take action are additional
and actions that result in positive patient outcomes
components of critical thinking. These same skills are necessary to
● When nurses integrate and apply different types of
some degree in decision making and problem solving
knowledge to weigh evidence, critically think about
arguments, and reflect on the process used to arrive at a
Qualities of Successful Decision Makers
diagnosis → CLINICAL REASONING
● Self-aware
○ Clinical reasoning uses both knowledge and
○ Improving self-awareness will help increase
experience to make decisions at the point of care
emotional intelligence and understand the internal
● The process by which nurses and other clinicians collect
factors that drive one’s decision making process
cues, process information, come to an understanding of a
○ how we make decisions, how we make choices,
patient problem or situation, plan and implement
why we make these choices we do, and what
interventions, evaluate outcomes, and reflect on and learn
we’re driven in certain contexts are all pieces of
from the process
the larger puzzle that make up who we are
● Courageous
Experiential Learning
○ Courage requires the ability to face our fears and
● Provides mock life experiences to learn from
take action despite them
● Allows learners to apply leadership and management theory
○ Fear is a natural and a necessary feeling that is
● Promotes whole brain thinking and improved problem-
often useful in decision making to give us a natural
solving skills
necessary caution
 ● Sensitive ○ The accusation of information begins with
○ May be the most noticeable to us personally identifying the problem or the occasion or the
○ We process sensory information more carefully decision and continues throughout the problem-
because we use areas of our brain that are solving process.
associated with more complex processing ○ Often the information is unsolicited but most
○ Our awareness of subtleties is useful in an infinite information is soothed actively.
number of ways: from simple pleasure in life to ○ In addition human values tremendously influence
strategizing our response based on our awareness our perceptions therefore as problem solvers
of other non-verbal cues, that they may no idea gather information they must be vigilant that their
they are giving off about their mood or own preferences and those of others are not
trustworthiness mistaken for facts.
● Energetic
○ Psychological effects of decision fatigue can vary Questions That Should Be Asked in Data Gathering #1
potentially leading to difficulty making right Acquiring information always involves people and a new tool or
decisions, impulse buying, or other avoidance mechanism is invaluable to human error. Questions that should be
behavior asked in data gathering are:
○ If our brain is worn down, it may cause us to ● What is the setting?
become more reckless with our decision making or ● What is the problem?
not think things through ● Where is it a problem?
● Creative ● When is it a problem?
○ If a decision maker is going to produce novel ● Who is affected by the problem?
alternatives when solving a problem, then he or
she is going to need a little creativity to help the Questions That Should Be Asked in Data Gathering #2
process along ● What is happening?
○ It allows the decision maker to more fully appraise ● What are the consequences of the problem? Which of these
and understand the problem sometimes in ways are most serious?
others can see it ● Why is it happening? What are the causes of the problem?
Can I prioritize the causes?
Types of Decision Making ● What are the basic underlying issues? Areas of conflict?
● Recurrent and routine problem solving
○ Routine decisions are of repetitive nature and Identify a poor decision you made recently because of faulty data
hence require relatively little consideration. It may gathering
be seen that basic decisions generally relate to ● Was this poor decision made because necessary information
strategic aspects was intentionally or unintentionally withheld from you?
○ Routine decisions are related to tactical aspects of
an organization Frequent Errors Made in Decision Making #3
● Satisficing ● Failure to use science, logic, and empirical evidence in
○ A decision making strategy that aims for a making decisions
satisfactory or adequate results rather than ○ Use an evidence-based approach to gain
optimal solution knowledge and insight into managerial and
○ instead of maximum exertion towards attaining leadership decision making.
the ideal outcome, it focuses on pragmatic effort ○ Individuals must reach outside their current sphere
when confronted with task of knowledge in solving the problems presented in
● Maximizing or optimal mode this chapter.
○ Is a style of decision making characterized by ○ Some data gathering sources include textbooks,
seeking the best option through an exhaustive periodicals, experts in the field, colleagues and
search through alternatives current research.
○ Contrasted with satisficing in which individuals ○ Indeed most experts agree that the best practices
evaluate options until they find one that is good in nursing care and decision making are also
enough evidence based practice that's according to
○ An optimal decision is a decision that leads to at Prevost and ??, 2020.
least as good, unknown, or expected outcome as ○ Evidence-based decision making and evidence-
all other available decision options. It is an based practice should be viewed as imperative for
important concept in decision theory all nurses today as well as for the profession in
○ In order to compare the different decision general.
outcomes, one commonly assigns a utility value to
each of them Frequent Errors Made in Decision Making #4
● Not considering enough alternatives
Princess (11:52) - 24:58 ○ So generate numerous alternatives. The definition
Frequent Errors Made in Decision Making of decision making implies that there are at least
two choices in every decision.
No clear objective or goal for decision #1 ○ Unfortunately many problem solvers limit their
● No clear objective or goal for decision choices to two when many more options usually
○ If you don't know where you're going, how will you are available.
get the objective? ○ Remember that one alternative in each decision
○ Objectives are important because they convert should be the choice not to do anything.
visions into clear-cut measurable targets. ○ When examining decisions to be made by using a
○ Clear goals and objectives allow employees to formal process, it is often found that the status
monitor their own progress all year round and quo is the right alternative.
correct their efforts as necessary. ○ The greater the number of alternatives that can be
○ A decision that is made without a clear objective in generated, the greater the chance that the final
mind or a decision that is inconsistent with one's decision will be sound.
philosophy is likely to be a poor quality decision.
○ Sometimes the problem has been identified but Frequent Errors Made in Decision Making #5
the own objectives are set. ● Faulty logic or “crooked thinking”
Frequent Errors Made in Decision Making #2 ○ Think logically. During the problem solving process,
● Faulty data gathering one must draw inferences from information.
○ Gather data carefully because decisions are based ○ An inference is a part of deductive reasoning.
on knowledge and information available to the People must carefully think through the
problem solver at the time the decision must be information and the alternatives.
made one must learn how to process and obtain ○ Faulty logic at this point may lead to poor quality
accurate information. decisions.
 ○ Primarily, people think illogically in three ways: ● A decision variable is an unknown in an optimization
over generalizing, affirming the consequences, and problem. It has a domain which is a compact representation
arguing from analogy. of the set of all possible values for the variable.
Frequent Errors Made in Decision Making #6 ● Decision variable types are references to objects whose
● Not assessing or ignoring the quality of the decision making exact nature depends on the underlying optimizer of a
that is required model. Before we continue, let us reflect on the questions
○ Choose and act decisively. It is not enough to posted. If we all use the same decision making or problem-
gather adequate information. solving model and are given the same information, will we
○ Think logically and select from among many all reach the same decision? Why or why not?
alternatives and be aware of the influence of one's
values. Innovation and Creativity: Critical Aspects of Problem Solving and
○ In the final analysis, one must act. Many Decision Making #1
individuals delay acting because they do not want ● Creativity and innovation are two related but separate
to face the consequences of their choices such as if notions and each is required for workplace success.
managers granted all employees requests for days ● Creativity doesn't lead to company inventions and growth,
off then they would have to accept the innovation does. However, innovation doesn't happen
consequences of dealing with short staffing. without creative people on board so generating creativity
○ Many individuals choose to delay acting because means allowing people to think outside the box and go
they lack the courage to face the consequences of against the norm sometimes.
their choices. ● Creativity and innovation are two words that are constantly
thrown around in brainstorming sessions, corporate
Frequent Errors Made in Decision Making #7 meetings, and company mission statements.
● Lack of self-awareness
○ Self-awareness is the ability to recognize one's Innovation and Creativity: Critical Aspects of Problem Solving and
own feelings as it happens to accurately perform Decision Making #2
self-assessments and have self-confidence. It is the ● New research suggests that gender also plays a role in how
keystone of emotional intelligence individuals make decisions.
○ Goldman (Goleman?) 1998 argued that all ● Although some debate continues as to whether these
individuals have a rational thinking mind and an differences are more gender role based than gender-based.
emotional feeling mind and both influence action. ● Research suggests however that men and women do have
The goal then in e.i, is emotional literacy being. different structures and wiring in the brain and that men and
○ Self-awareness about one's emotions and women may use their brains differently.
recognizing how the influence influences ● For example, Harvard researchers have found that parts of
subsequent action. the frontal lobe responsible for problem solving and decision
making and the limbic cortex responsible for regulating
Frequent Errors Made in Decision Making #8 emotions are larger in women 's (Edmonds, 2018??)
● Too much time spent identifying the problem ● Men also have approximately 6.5 times more grey matter in
○ Mismanagement of time severely compromises an the brain than women but women have about 10 times
organization's productivity and results in negative more white matter than men. Researchers believe that men
effects across the board from the manager to the may think more with their grey matter whereas women
rank and file. think more with the white matter. This use of white matter
○ When time is mismanaged, work is rushed and may allow a woman's brain to work faster than a man's
becomes substandard. Deadlines are missed but that's according to Hus as cited in Edmonds, 2018.
choices are made. Employees suffer from fatigue
and even the nurses personal lives and What Is Your Risk Quotient in Decision Making?
relationships are adversely affected. ● Ask yourself how much risk you are willing to take.
● Example: Apply for a new job but are getting conflicting
Frequent Errors Made in Decision Making #9 advice regarding whether your qualifications are appropriate
● Refusal to act for this particular job. Do you take the emotional and
○ It may help the reluctant decision maker to professional risk of applying and not getting it or do you take
remember that even though decisions often have the risk for professional growth regardless of whether you
long-term consequences and far-reaching effects, get the job or not?
they are not usually cast in stone. ● For example, moving out of ICU was a big risk because I was
○ Often judgments found to be ineffective or in my comfort zone in ICU.
inappropriate can be changed by later evaluating
decisions, managers can learn more about their
abilities and where the problem solving was faulty. Right Brain vs Left Brain Dominance #1
However decisions must continue to be made. ● Brain hemisphere dominance and thinking styles are ways of
○ Although some are of poor quality because evaluating information and alternatives on which we base
through continued decision making people our final decision constitutes a thinking skill.
develop improved decision making skills. ● Individuals think differently, some think systematically and
are often called analytical thinkers whereas others think
Frequent Errors Made in Decision Making #10 more intuitively.
● Using outcome only for evaluation ● About 30 years ago, researchers first began arguing that
○ Using outcome only for evaluation or outcome most people have either right or left brain hemisphere
evaluation is defined as a type of measurement dominance.
used to determine the success or failure of a ● They suggested that analytical, linear, left-brain thinkers
program or project. process information differently from creative, intuitive,
○ Outcome evaluation conclusions are based on the right-brain thinkers.
statistical analysis of quantitative measures. ● Left-brain thinkers were supposed to be better at processing
language, logic, and numbers whereas right-brain thinkers
Frequent Errors Made in Decision Making #11 excelled at non-verbal ideation and creativity.
● It is not enough to gather adequate information, think Right Brain vs Left Brain Dominance #2
logically, select from among many alternatives, and be ● Some people fail to use any type of systematic examination
aware of the influence of one’s values. In the final analysis, of the problem or its alternatives for solution.
one must act. ● Noer (2018) suggests that the existence of left or right brain
dominance is too simplistic; stated that newer studies failed
Decision-Making Variables to find evidence that individuals have stronger left or right
● If we all use the same decision-making or problem-solving sided brain networks.
model and are given the same information, will we all reach ● Cherry (2019) agrees suggesting that recent research has
the same decision? Why or why not? shown that the brain is not nearly as dichotomous as once
 thought. (e.g. abilities in Math are strongest when both 5. Select the appropriate solution.
halves of the brain work together) 6. Implement the solution.
● Indeed, both sides of the brain collaborate to perform a 7. Evaluate the results.
broad variety of tasks and the two hemispheres
communicate through the corpus callosum. Nursing Process: A Problem-Solving and Decision-Making Model
● Cherry also notes that it is true that some brain functions 1. Assess
occur in one or the other side of the brain. Language tends 2. Diagnose
to be on the left and attention more on the right. But people 3. Plan
don’t tend to have a stronger left or right sided brain 4. Implement
network. 5. Evaluate
Right Brain vs Left Brain Dominance #3
● Instead, they rely on discrete, often unconscious processes ● The nursing process, developed by Ida Jean Orlando in the
known as heuristics. late 1950s, provides another theoretical system for solving
● Heuristics refer to using a “trial-and-error” or “rule-of- problems and making decisions.
thumb” approach to problem solving. ● Originally a four-step model (assess, plan, implement, and
➢ They are practical mental shortcuts and are not evaluate) diagnosis was delineated as a separate step, and
expected to provide perfect or optimal problem most contemporary depictions of this model now include at
solving. least five steps.
➢ They provide a more immediate solution to the
decision at hand.
➢ This is particularly true for uncertain or emergent
situations where knowledge, time, and resources
are limited.
● Parish (2018) notes that most people don’t actually stop to
think, they just take their first thought and run with it. That’s
because most individuals rely on discrete, often unconscious
process, known as heuristics to make decisions.
Figure 1.2 Feedback mechanism of the nursing process.
Comparison of Economic & Administrative Man ● As a decision-making model, the greatest strength of the
Rational and administrative decision making nursing process may be its multiple venues for feedback.
● For many years, it was widely believed that most managerial ● When the decision point has been identified, initial decision
decisions were based on a careful, scientific, and objective making occurs and continues throughout the process via a
thought process and that managers made decisions in a feedback mechanism.
rational manner.
● In the late 1940s, Herbert A. Simon's work revealed that Strategies for the New Nurse to Promote Evidence-Based Best
most managers made many decisions that did not fit the Practice
objective rationality theory. ● Given that human lives are often at risk, nurses then should
● Simon (1965) delineated two types of management decision feel compelled to use an evidence-based approach in
makers: the economic man and the administrative man. gathering data to make decisions regarding their nursing
● Managers who are successful decision makers often attempt practice.
to make rational decisions, much like the economic man. 1. Keep abreast of the evidence—subscribe to professional
● Because they realize that restricted knowledge and limited journals and read widely.
alternatives directly affect a decision’s quality, these 2. Use and encourage use of multiple sources of evidence.
managers gather as much information as possible and 3. Use evidence not only to support clinical interventions but
generate many alternatives. also to support teaching strategies.
Economic Man 4. Find established sources of evidence in your specialty—do
● Makes decisions in rational manner not reinvent the wheel.
● Has complete knowledge of problem or situation 5. Implement and evaluate nationally sanctioned clinical
● Considers all alternatives practice guidelines.
● Has systematic ordering of alternatives 6. Question and challenge nursing traditions and promote a
● Selects maximizing choice spirit of risk taking.
Administrative Man 7. Dispel myths and traditions not supported by evidence.
● Knowledge is fragmented 8. Collaborate with other nurses locally and globally.
● Is impossible to accurately predict future consequences 9. Interact with other disciplines to bring nursing evidence to
● Considers multiple alternatives but not all the table.
● Makes decisions that are good enough
● Final choice is satisficing Decision-Making Tools
➢ There is always some uncertainty in making decisions.
To Make Better Decisions ➢ However, management analysts have developed tools that
● Use a systematic decision-making process whenever provide some order and direction in obtaining and using
possible. information or that are helpful in selecting who should be
● Decision making process is a series of steps taken by an involved in making the decision.
individual to determine the best option or course of action ● Decision grids
to meet their needs. - Allows one to visually examine the alternatives and compare
● In a business context, it is a set of steps taken by managers each against the same criteria
in an enterprise to determine the planned path for business
initiatives and to set specific actions in motion.
Steps to good decision making:
1. Identify your goal.
- One of the most effective decision making strategies is to
keep an eye on our goal.
2. Gather information for weighing our options
3. Consider the consequences
4. Make your decision ● Payoff tables
5. Evaluate your decision. - Have a cost-profit-volume relationship and are very helpful
when some quantitative information is available, such as an
The Traditional Problem-Solving Process item’s cost or predicted use.
1. Identify the problem. ● Decision trees
2. Gather data to identify the causes and consequences of the - Decisions are often tied to the outcome of their events,
problem. management analysts have developed decision trees.
3. Explore alternative solutions. - Figure 1.4 compares the cost of hiring regular staff with the
4. Evaluate each alternative. cost of hiring temporary employees.
 Leaders Managers

- Empower others; maximize - Guide, direct, and motivate

workforce. others.

- Needed to implement the - Intervene when goals are

planned change that is part of threatened.
system improvement.
- Emphasize control.

● Consequence tables ● But it can be said that every manager should be a leader.
- Demonstrate how various alternatives create different ● Fowler, 2015 agrees, suggesting that not only are the
consequences. differences between leadership and management difficult to
- Lists the objectives for solving a problem down one side of a verbalize, but for the clinical nurse, it is even more difficult
table and rates how each alternative would meet the desired to work out what particular hat you should be wearing when
objective. trying to lead and manage a team through a busy shift.
● Clinicians often act as both leaders and managers in a clinical
setting. Even if not officially recognized as doing so, their
success in these roles is critical to high level unit functioning
and the attainment of patient goals.
● Fowler suggests that clinical leaders must continually find an
intersection between good leadership and management
● Logic models skills to be successful.
- Schematics or pictures of how programs are intended to
operate Leadership
- The sychamtic typically includes resources, processes, and ● Leadership is the art of getting work done through others
desired outcomes and depicts exactly what the relationships willingly.
are between the three components. ● Leaders are in the front, moving forward, taking risks, and
● Program Evaluation and Review Technique (PERT) challenging the status quo.
- A popular tool to determine the timing of decisions ● Leaders are individuals who take risks, attempt to achieve
- Developed by the Booz-Allen-Hamilton organization and the shared goals, and inspire others to action.
U.S. Navy in connection with the Polaris missile program. ● Those individuals who choose to follow a leader do so by
- PERT is a flowchart that predicts when events and activities choice, not because they have to.
must take place if a final event is to occur. ● Stoner, 2018 notes that leadership impact depends on the
ability to influence people, not the ability to command,
coerce, or manipulate.
● You can recognize a leader by the response of their
followers.
● A job title alone does not make a person a leader. Only a
person’s behavior determines if he or she occupies a
leadership position.
● The manager is the person who brings things about, the one
who accomplishes, has responsibility, and conducts. A leader
on the other hand, is the person who influences and guides
direction, opinion, and course of action.

Leaders
Chapter 2: Classical Views of Leadership and Management ● Often do not have delegated authority but obtain their
● Various theories and principles of leadership and power through other means, such as influence.
management help provide the basis for accomplishing a ● Have a wider variety of roles than managers and may have
goal. They remove the uncertainty in leading and managing. different personal goals.
● The knowledge acquired from learning the theories and ● Are frequently not part of the formal organization.
principles of leadership and management contributes to an ○ Leaders may or may not be part of the formal
empowered nurse leader and manager. One simply has to organization.
activate such knowledge that was learned beforehand to ● Focus on group process, information gathering, feedback,
address work related issues. and empowering others.
● This chapter first artificially differentiates between ● Leaders emphasize interpersonal relationships.
management and leadership, focusing on theory ● Leaders direct willing followers.
development in each field of study. ● Leaders have goals that may or may not reflect those of the
● The need to develop nursing leadership skills has never been organization.
greater than it is today. What contemporary factors are
driving this need for nursing leadership skills? Managers
● Are always assigned a position within the organization.
Management Process ● Have a legitimate source of power due to the delegated
● Henry Fields in 1925 first identified the management authority that accompanies their position.
functions of planning, organization, command, coordination, ● Are expected to carry out specific functions.
and control. ● Have specific duties and responsibilities they are expected to
● Luther Gulick in 1937 expanded on Fields management carry out.
functions in his introduction of the 7 activities of ● Emphasize control, decision making, decision analysis, and
management, which includes: results.
○ Planning, organizing, staffing, directing, ● Manipulate people, the environment, money, time, and
coordinating, reporting, and budgeting. other resources to achieve organizational goals.
○ As denoted by the mnemonic POSDCORB, ● Have greater formal responsibility and accountability for
although often modified as either by including rationality and control than leaders.
staffing as a management function or renaming ● Direct willing and unwilling subordinates.
elements.
● These functions or activities have changed little over time. Good Leaders and Managers
Eventually, theorists began to refer to these functions as the ● Kerr, 2015 suggests that there are 10 important distinctions
management process. between leaders and managers, and these differences must
be understood and recognized so that an organization can
Leadership vs. Management leverage each to the fullest.
 ● One leadership inspires change, while management ● Organizing establishes formal authority. It sets up the
manages transformation. organizational structure by identifying groupings, roles, and
● Leadership requires vision, while management requires relationships within the agency. This is depicted in an
tenacity. organizational chart.
● Leadership requires imagination, while management ● The job description defines the qualifications and scope of
requires specifics. responsibilities, relationships, and authorities of the
● Leadership requires abstract thinking, while management personnel.
requires concrete data.
● Leadership requires the ability to articulate, while 3. Staffing
management requires the ability to interpret. ● Consists of recruiting, interviewing, hiring, and orienting
● Leadership requires an aptitude to sell, while management staff. Scheduling, staff development, employee socialization,
requires an aptitude to teach. and team building are also often included as staffing
● Leadership requires an understanding of the external functions.
environment, while management requires an understanding ● Staffing includes determining the staff needed, this
of how work gets done inside organizations. developing and maintaining a staffing pattern.
● Leadership requires risk taking, while management requires ● The process covers recruiting, selecting, orienting, and
self discipline. developing personnel to accomplish the goals of the
● Leadership requires confidence in the face of uncertainty, organization.
while management requires blind commitment to ● The selected personnel are then distributed in the various
completing the task at hand. areas of the agency, where they are qualified to belong.
● Leadership is accountable to the entire organization, while ● Staffing schedules are made to meet the needs of the
management is accountable to the team. clients, personnel, and agency.

4. Directing
Good Leaders Good Managers
● Directing sometimes includes several staffing functions.
However, these functions usually entail human resource
- Envision the future. - Coordinate resources
management responsibilities, such as motivating, managing
- Communicate their - Optimize resource use
conflict, delegating, communicating, and facilitating
visions. - Meet organizational
collaboration.
- Motivate followers goals and objectives.
● Directing, or leading actuates efforts to the accomplishment
- Lead the way - Follow rules
of goals. This includes utilization of various modalities of
- Influence others to - Plan, organize, control
nursing care through the nursing process.
accomplish goals. and direct
● Updating policies and procedures, supervising personnel to
- Inspire confidence - Use reward and
harmonize work through adequate guidance and leadership,
- Take risks punishment effectively
coordinating personnel and services towards a common
- Empower followers to achieve
goal, communicating via various routes to ensure common
- Master change organizational goals.
understanding, developing people by providing staff
development programs, and making sound decisions.
The Management Process
● In many ways, the management process is similar to the 5. Controlling
nursing process. Both processes are cyclic and many ● Includes performance appraisals, fiscal accountability.
different functions may occur simultaneously. Quality control, legal and ethical control, and professional
● Suppose that a nurse manager spent part of the day working and collegial control.
on the budget, that is planning. ● Controlling leads to the assessment and regulation of
● Meet with the staff about changing the patient care performance of workers.
management delivery system from primary care to team ● To ensure the attainment of objectives, certain standards
nursing, that is organizing. are utilized to measure performance, monitor and evaluate
● Alter the staffing policy to include 12 hour shifts, that is nursing care, including the utilization of resources.
staffing. ● Control promptly reveals deviations from set plans and
● Held a meeting to resolve a conflict between nurses and standards, necessitating immediate corrective measures,
physicians, that is directing. actions, and or discipline.
● Gave an employee a job performance evaluation, that is
controlling. Management Theory Development
● Not only would the nurse manager be performing all phases ● The human relations era of management science brought
of the management process, but each function has a about a great interest in the study of workers.
planning, implementing, and controlling phase. Just as nurse ● Many sociologists and psychologists took up this challenge,
practice requires that all nursing care has a plan and and their work in management theory contributed to our
evaluation, so too does each function of management. understanding about worker motivation.
● By the late 1960’s, there was a growing concern that the
1. Planning human relations approach to management was not without
● Encompasses determining philosophy, goals, objectives, its problems. Most people continued to work in a
policies, procedures, and rules; carrying out long and short bureaucratic environment, making it difficult to always apply
range projections; determining a fiscal course of action; and a participatory approach to management.
managing planned change. ● The human relations approach was time consuming and
● While planning is the first function, one must recognize that often resulted in unmet organizational goals.
it permeates into the other functions that are dependent on ● In addition, not every employee liked working in a less
it. structured environment. This resulted in a greater
● By forecasting, one can estimate the future; by setting recognition of the need to intertwine management and
objectives, the results to be achieved can be determined by leadership than ever before.
developing and scheduling programs. ● Taylor - scientific management
● The activities needed within a set time frame can be defined ● Weber - bureaucratic functions
by preparing the budget, tools, and resources, which can be ● Fayol - management organizations
allocated while establishing policies and procedures that will ● Gulick - activities of management
define the course of action and standards. ● Follett - participative management
● Mayo - Hawthorne effect
2. Organizing ● McGregor - theory X and theory Y
● Includes establishing the structure to carry out plans, ● Argyris - employee participation
determining the most appropriate type of patient care
delivery, and grouping activities to meet unit goals. Scientific Management (1900 - 1930)
● Other functions involve working within the structure of the ● Frederick W. Taylor, the father of scientific management,
organization and understanding and using power and was a mechanical engineer in the Midvale and Bethlehem
authority appropriately. Steel Plants in Pennsylvania in the late 1800s.
 ● Frustrated with what he called “systematic soldering”, ● Mayo and his colleagues discovered that when management
where workers achieve minimum standards doing the least paid special attention to workers productivity was likely to
amount of work possible. increase regardless of the environmental working conditions
● Taylor postulated that if workers could be taught the 1 best ● This hawthorne effect indicated that people respond to the
way to accomplish a task, productivity would increase. fact that they are being studied attempting to increase
○ Taylor called these principles “scientific whatever behavior they feel will continue to warrant the
management”. attention
● The 4 overriding principles of scientific management are: ● Mayo in 1953 also found that informal work groups, it is the
○ Traditional rule of thumb means of organizing socially informal work environment that factors in
work must be replaced with scientific methods. By determining productivity and Mayo recommended more
using time and motion studies, and the expertise employee participation in decision making
of experienced workers, work can be specifically
designed to promote greatest efficiency of time Theory X and Theory Y by Douglas McGregor
and energy. ● McGregor in 1960 reinforced these ideas by theorizing that
○ A scientific personal system must be established so managerial attitudes about employees and hence how
that workers can be hired, trained, and promoted management treat those employees can be directly
based on their technical competence and abilities. correlated with employee satisfaction - He labeled this
Taylor thought that each employee’s abilities and theory X and theory Y
limitations can be identified so that the worker ● Theory X managers believe that their employees are
could be best matched to the appropriate job. basically lazy, need constant supervision and direction and
Workers should be able to view how they fit into are indifferent to organizational needs; Theory Y managers
the organization, and how they contribute to the believe that their workers enjoy their work, are self-
overall organizational productivity. This provides motivated and are willing to work hard to meet personal and
common goals and a sharing of the organizational organizational goals
mission.
○ One way Taylor thought that this could be Emerging Theories: 1970 - present
accomplished was the use of financial incentives as The Evolution of Leadership Theory
a reward for work accomplished. Because Taylor ● Because strong management skills were historically valued
viewed humans as economic animals, motivated more than strong leadership skills, the scientific study of
solely by money, workers were reimbursed leadership did not begin until the 20th century
according to their level of production rather than ● Early works focus on broad conceptualizations of leadership
by an hourly wage. such as the traits or behaviors of the leader, contemporary
○ The relationship between managers and workers research focuses more on leadership as a process of
should be cooperative and interdependent. The influencing others within an organizational culture, and the
work should be shared equally. The roles however, inter interactive relationship of the leader and follower
were not the same. The role of managers and ● To better understand newer views about leadership it is
functional foremen, is to plan, prepare, and necessary to look at how leadership theory has evolved over
supervise. The worker was to do the work. the last century
Great Man Trait Theories
Bureaucracy: Max Weber ● Were the basis for most leadership research until the mid-
● About the same time that Taylor in 1911 was examining 1940s
worker tasks, Max Weber, a well/known german sociologist
● The great man theory, from Aristotelian philosophy asserts
began to study large-scale organizations to determine what
that some people are born to lead whereas others are born
made some workers more efficient than others -> webber
be led. It also suggests that great leaders will arise when the
saw the need for legalized formal authority and consistent
situation demands it
rules and regulations for personnel in different positions ->
● Trait Theories assume assume that some people have
then proposed bureaucracy as an organizational design
certain characteristics or personality traits that make them
● Was written in 1922 in response to what he perceived as a
better leaders than others
need to provide more rules, regulations, and structure
● To determine the traits that distinguish great leaders
within organizations to increase efficiency
researchers studied the lives of prominent people
● Much of weber's work and bureaucratic organizational
throughout history. The effect of followers and the impact of
design are still evident today in many healthcare institutions
the situation were ignored, although trait theories have
Human Relations Management #1: 1930-1970
obvious shortcomings such as:
● During the 1920s worker unrest developed. The industrial
revolution had resulted in great numbers of relatively ○ Neglect the impact of others or the situation on
the leadership role
unskilled laborers working in large factories and specialized
● Are leaders born or are they made?
tasks. This, management scientists and organizational
○ Contemporary opponents of trade theories argue
theorists began to look at the role of worker satisfaction in
however that leadership skills can be developed
production
not just inherited that is not to say that some
● This human relations era developed the concepts of
people don't have certain characteristics or
participatory and humanistic management emphasizing the
personality traits that make it easier for them to
people rather than the machines
lead
● Mary Parker Follett 1926: one of the first theorist to suggest
○ Leadership skills can be learned although some
basic principles of what today would be called participative
individuals have certain characteristics or
decision making or participative management
personality traits that may make it easier for them
○ In her essay, the giving of orders, Follett’s believed
to assume leadership roles. For example Houston
that managers should have authority with rather
2018 notes that some people, even at a very young
than over employees. This solutions can be found
age are more fearless. Others are just naturally
that satisfy both sides without having one side
more outgoing, they're more curious and take
dominate the other
more risks. But not all leaders need to be
The Human Relations Era #2
gregarious by nature.
● Attempted to correct what was perceived as the major
■ There is lots of room for quiet leadership
shortcoming of the bureaucratic system, a failure to include
in fact some of the most effective
the human element
leaders are individuals who didn’t seek
● Studies done that Hawthorne works of the western electric
out that rule, the simply grew into it
company near Chicago between 1927 and 1932 played a
because they stopped for what had to be
major role in this shifting focus
done when no one else would
○ Studies conducted by Elton Mayo and his Harvard
associates began as an attempt to look at the
Contingency Leadership Styles #1
relationship between the light illumination in the
● Includes behavioral theories
factory and productivity
The Hawthorne Studies by Elton Mayo ● 1940-1980: during the human relations era, many behavioral
and social sciences studying management also studied
 leadership. For example, McGregor’s 1960 theories had as ○ Identifying this concept as Transformational
much influence on leadership research as they did on Leadership, Burns maintained that there are two
management science primary types of leaders in management:
● As leadership theory developed, researchers moved away 1. the traditional manager: concerned with
from studying what traits leaders had and placed emphasis the day to day operations
on what he or she did 2. transformational leader: manager who is
● A breakthrough occurred when Lewin (1951) and Lippitt and committed, has a vision and can
White (1960) isolated common leadership styles. Later, empower others with his or her own
these tests came to be called: Authoritarian, Democratic and vision
Laissez-faire ○ Similarly, Bass and Avolio (1994), suggested that
● Authoritarian Leadership transformational leadership leads followers to
○ Results in well-defined group actions that are levels of higher morals because such leaders do
usually predictable, reducing frustration in the the right thing for the right reason, treat people
work group and giving members a feeling of with care and compassion, encourage followers to
security. be more creative and innovative, and inspire
○ Productivity is usually high but creativity, self- others with their vision. This new shared vision
motivation and autonomy are reduced provides the energy required to move towards the
○ Frequently found in very large bureaucracies such future
as the armed forces ○ Similarly, the American Heart Nurses Association
● Democratic leaders California (2019) suggests that leaders do more
than delegate, dictate, and direct. They help others
○ Seek input from their followers and include them
achieve their highest potential
in decision making whenever possible
Klutzes and Posner’s Five Practices for Exemplary Leadership (2017)
○ Stoker (2018) suggests that when you ask a person
for his or her ideas or to help you solve the ● Furthered the work on transformational leadership in the
past decade
problem, you're sending the message that you
value the person's ideas and experience and you ● Suggests that exemplary leaders foster a culture in which
are also creating a learning opportunity to hear relationships between aspiring leaders and willing followers
something you need to know can thrive. This requires five practices:
○ Appropriate for groups work together for 1. Modeling the way: Requires value clarification and
extended periods, promotes autonomy and self-awareness so that behavior is congruent with
growth in individual workers values
○ Democratic leadership is particularly effective 2. Inspiring a shared vision: entails visioning that
when cooperation and coordination between inspires followers to want to participate in goal
groups are necessary attainment
○ Studies have shown however that democratic 3. Challenging the process: identifies opportunities
leadership may be less efficient quantitatively than and taking action
authoritative leadership because it is non-directed 4. Enabling others to act: fosters collaboration, trust
leadership and the sharing of power
● Laissez-faire, permissive or free rein 5. Encouraging the heart: recognizes, appreciates,
○ Can be frustrating. Group apathy and disinterest and celebrates followers and achievement of
can occur however when all group members are shared goals
highly motivated and self-directed, this leadership ● Suggests that when these five practices are employed
style can result in much creativity and productivity anyone can further their ability to lead others to get
lasers extraordinary things done
○ Appropriate when problems are poorly defined
and brainstorming is needed to generate BOOK: Marquis, B.L., & Huston, C.J. (2021). Leadership Roles & Management
Functions in Nursing (10th ed.). Wolters Kluwer
alternative solutions ★ Points with a star bullet were used in the PPT presentation
○ For some time theorists believe that leaders had a
predominant leadership style and used it Chapter 3: Twenty-First-Century Thinking About Leadership and
consistently. During the late 1940s and early 1950s Management
however, theorists began to believe that most
leaders did not fit a textbook picture of any one Introduction: Managerial Responsibilities
style but rather fell somewhere on a continuum ● The new managerial responsibilities placed on organized
between authoritarian and Laissez-faire nursing services call for nurse administrators who are
● Theorists came to believe that leaders move dynamically knowledgeable, skilled, and competent in all aspects of
along the continuum in response to each new situation. This management.
recognition was a forerunner to what is known as situational ● Now more than ever, there is a greater emphasis on the
or contingency leadership business of healthcare, with managers being involved in the
financial and marketing aspects of their respective
Contingency Leadership Styles #2 departments.
● 1950-1980: the idea that leadership style should vary ● Managers are expected to be skilled communicators,
according to the situation or individuals involved was first organizers, and team builders and to be visionary and
suggested almost 100 years ago by Mary Parker Follett, one proactive in preparing for emerging new threats such as
of earliest management consultants and among the first to domestic terrorism, biological warfare, and global
view an organization as a social system of contingencies pandemics.
○ Her ideas published in a series of books between
1896 and 1933 were so far ahead of their time that Introduction: 21st Century
they did not gain appropriate recognition in the ● Struck (2018) points out that the 21st century has seen a
literature until the 1970s breakdown of some of the long-standing barriers that define
○ Her law of the situation which said that the leadership.
situation should determine the directives, given ● For example, individuals holding high positions of power
after allowing everyone to know the problem was traditionally tended to be distant from those they serve.
contingency leadership in its humble origins ● Today, anyone can find a way to communicate with almost
● Transactional Leader and Transformational Leadership anyone else through new technologies. Such individuals no
○ Similarly, Burns (2003), a noted scholar in the area longer have the zones of privacy that separated their
of leader-follower interactions, was among the personal and professional life.
first to suggest that both leaders and followers ● The new trends are part of a transformational change
have the ability to raise each other to higher levels brought by digital technology.
of motivation and morality
Introduction: Nursing and Leadership
 ● Throughout history, nursing has been required to respond to strength-based leadership training group found significant
changing technological and social forces. positive changes in the children regarding internal areas of
● In the last decade alone, a growing elderly population, functioning and social skills, anger management skills, and
health-care reform, reductions in federal and state school attitude.
government reimbursement as well as commercial ● Just changing the framework in which the children were
insurance, and new quality imperatives such as value-based approached from “at risk” to “at promise” seem to make a
purchasing and pay for performance have resulted in major difference.
redesigns of most health-care organizations.
B. Level 5 Leadership
● The concept of Level 5 Leadership was developed by Jim
Factors Affecting Health-Care Trends
Collins and published in his classic book, Good to Great: Why
Some Companies Make the Leap . . . and Others Don’t
● Growing elderly population
(Collins, 2001).
● Health-care reform
● Collins (2001) studied 1,435 companies to determine what
● Reductions in reimbursements
separates great companies from good companies. What he
● New quality imperatives
found was that five levels of leadership skill may be present
● Shift in care to community settings
in any organization.
● Technological advances
● Truly great organizations, however, typically have leaders
● Shift to customer-focused care
who possess the qualities found in all five levels.
● Thus, not only do Level 5 leaders have the knowledge to do
● In addition, the locus of care continues to shift from acute the job but they also have team building skills and can help
care hospitals to community and outpatient settings, groups achieve shared goals.
innovation and technological advances are transforming the ● They also though demonstrate humility and seek success for
workplace, and organizational cultures are increasingly the team, rather than for self serving purposes, a core
focusing on externally regulated, safety-driven, customer- component of another 21st-century leadership theory
focused care. known as Servant Leadership.
● All of these changes have brought about a need for leader- ● Level 5 leaders also know when to ask for help, accept
managers to learn new roles and develop new skills. responsibility for the errors they or their team make, and are
incredibly disciplined in their work.
New Thinking About Leadership and Management
● Given the current health-care system and organizational
Jim Collins’s Level 5 Leadership
complexity, most 21st-century nurse leader-managers will
need to improve and add to their leadership skill toolbox to
Level 1: Highly Capable Individual
meet emerging challenges in the coming decade.
● In addition, they will be required to embrace new roles in
● Leader makes high-quality contributions to their work;
new settings.
possesses useful levels of knowledge; and has the talent and
● Some leader-managers, however, will undoubtedly try to
skills needed to do a good job
use a traditional top-down hierarchical approach in leading
and managing others but will likely find that it no longer
Level 2: Contributing Team Member
works well, if at all.
● Instead, they must seek out more participatory,
● Leader uses knowledge and skills to help their team succeed;
transdisciplinary, and collaborative models which are not
works effectively, productively, and successfully with other
easy to develop.
people in their group
● For example, new research on leadership, including full-
range leadership theory, is rediscovering the importance of
Level 3: Competent Manager
organizational context, levels of analysis, and potential
boundary conditions on transformational leadership.
● Leader is able to organize a group effectively to achieve
● Indeed, many recent leadership and management concepts
specific goals and objectives
focus on the complexity of the relationship between the
leader and the follower and much of the leadership research
Level 4: Effective Leader
emerging in the second decade of the 21st century builds on
the interactive leadership theories developed in the latter
● Leader is able to galvanize a department or organization to
part of the 20th century.
meet performance objectives and achieve a vision
● As a result, concepts have emerged as part of the leader-
manager’s repertoire for the 21st century such as:
Level 5: Great Leader
a. Strengths-based leadership
b. Level 5 Leadership
● Leader has all of the abilities needed for the other four levels,
c. Servant leadership
plus a unique blend of humility and will that is required for
d. Principal agent theory
true greatness
e. Human and social capital theory
★ Level 5 Leadership is characterized by knowledge, team
f. Emotional intelligence (EI)
building skills, the ability to help groups achieve goals,
g. Authentic leadership
humility, and the empowerment of others through servant
h. Thought leadership
leadership.
i. Quantum leadership
● Level 5 leaders also possess qualities found in the four other
levels of leadership.
A. Strengths-Based Leadership and the Positive Psychology
● It is not necessary to pass sequentially through each
Movement
individual level before becoming a level 5 leader but the
★ Strengths-based leadership, which grew out of the positive
leader must have the skills and capabilities found in each level
psychology movement (began in the late 1990s), focuses on
of the hierarchy to be a top performing leader.
the development or empowerment of workers’ strengths as
opposed to their weaknesses or areas of needed growth.
● Thus, strengths-based leadership is part of the development C. Servant Leadership
of positive organizational scholarship, which focuses on ● Although Greenleaf (1977) developed the idea of servant
successful performance that exceeds the norm and leadership more than 35 years ago, it continues to greatly
embodies an orientation toward strengths and developing influence leadership thinking in the 21st century.
collective efficacy in organizations ● In more than four decades of working as director of
★ Research suggests that using a strengths-based approach, leadership development at AT&T, Greenleaf noticed that
even at a young age can have a profound impact on the most successful managers lead in a different way from
ability of individuals to self-manage and to regulate their traditional managers.
emotions. ★ These managers, which he termed servant leaders, put
● A study by Dennison, Danielle, Groberg, Kavanaugh, and serving others, including employees, customers, and the
Mayfield (2018) of 5th and 7th graders exposed to a brief community, as the number one priority.
 ● This choice between personal advantage and organizational ● Gabriel (2018) suggests that many people overestimate their
advantage speaks to the heart of servant leadership. EI because they think that it is the ability or tendency to
★ The win-win is challenging when you win later and others nice, it’s not. Instead it is about being empathetic; being able
win sooner. In addition, servant leaders foster a service to look at situations from alternative points of view; being
inclination in others that promotes collaboration, teamwork, open-minded; bouncing back from challenges; and pursuing
and collective activism. goals despite challenges.
● Ken Blanchard, author of Servant Leadership in Action: How ● Some proponents of EI have suggested that having EI may
You Can Achieve Great Relationships and Results notes even more critical to leadership success than Intellectual
however that although servant leadership is about leading Intelligence or IQ.
from the ground up, it still requires leadership and that ● Emotional intelligence is critical for building a cooperative
aspect is often forgotten (Cruz, 2018). and effective team.
● Servant leaders must still create and communicate their
vision, direction, and goals. Five Components of Emotional Intelligence
● Followers must be clear about what the leader is trying to Goldman (1998) in his best seller, Working with Emotional
accomplish as well as their values and goals. Intelligence, built in his work his identification of 5 components of EI:
● Once that is clear, the pyramid can be turned upside down ● Self-awareness: The ability to recognize and understand
so that the leader can begin to help. one’s moods, emotions, drives, as well as their effects on
● Followers live according to the vision of values and goals and others.
be successful. ● Self-regulation: The ability to control or redirect disruptive
★ Remember that followers are an important part of the impulses or moods as well as the propensity to suspend
leadership equation judgment.
● Motivation: A passion to work for reasons that go beyond
D. Principal Agent Theory money or status. A propensity to pursue goals with energy
● Principal agent theory, which first emerged in the 1960s and and commitment.
1970s, is another interactive leadership theory being actively ● Empathy: The ability to understand and accept the
explored in the 21st century. emotional makeup of other people.
● Occurs when one person (the agent) can make decisions on ● Social skills: Proficiency in handling relationships and
behalf of another person (which is the principal). building networks and ability to find common ground.
● In this situation, there are issues of moral hazard and
conflicts of interest. G. Authentic Leadership
★ This occurs because not all followers (agents) are inherently ● Another emerging leadership theory for the contemporary
motivated to act in the best interest of the leader or leader manager’s arsenal is that of authentic leadership, also
employer (the principal). known as Congruent Leadership.
● This is because followers may have an informational ● Authentic leadership suggests that in order to lead, leaders
(expertise or knowledge) advantage over the leader as well must be true to themselves and their values and act
as their own preferences, which may deviate from the accordingly.
principal’s preferences. ● Integrity is conformance between what leaders profess and
● The risk then is that agents will pursue their own objectives how they actually act.
or interests instead of that of their principal.
Francesca Gino’s Eight Principles of Rebel Leadership
E. Human and Social Capital Theory Thought leadership and rebel leadership, relatively new leadership
theory to emerge in the 21st century is that of thought leadership,
Human Capital
which is applied to a person who is recognized among his or her peers
for innovative ideas and who demonstrates the confidence to promote
★ represents the capability of the individual
those ideas. Thus, thought leadership refers to any situation in which
○ Refers to the collective skills, knowledge, or other
one individual convinces another to consider a new idea, product or
intangible assets of individuals that can be used
way of looking at things.
to create economic value for the individuals, their
Gino’s Eight Principles of Rebel Leadership are:
employers, or their community
● Seek out the new.
○ Human capital can refer to a group’s collective
● Encourage constructive dissent.
knowledge, skills, and abilities.
● Open conversations—don’t close them.
● Reveal yourself– and reflect.
Social Capital
● Learn everything—then forget everything.
● Find freedom in constraints.
★ represents what a group can accomplish together
● Lead from the trenches.
● Foster happy accidents (mistakes may unlock a
● The traditional view of employees as costs is not obsolete. breakthrough).
● Instead, employees are now viewed as assets or capital that
can be developed and nurtured. Characteristics of Agile Leadership
● Human capital theory suggests that individuals and/or Another newer leadership theory is Agile Leadership, a term borrowed
organizations will invest in education and professional from the software world. Agile leaders have the ability and agility to
development if they believe that such an investment will think in many ways so that they can be:
have a future payoff. ● Fast, flexibile, and adaptable decision making.
● For example, a health-care organization that provides tuition
reimbursement for nurses to go back to school to earn The Center for Agile Leadership (2018) concurs noting that agile
higher degrees is likely doing so in anticipation that a more leaders are inclusive, democratic leaders who exhibit a greater:
highly educated nursing staff will result in increased quality ● Openness to ideas and innovation.
of care and higher retention rates—both of which should
translate into higher productivity and financial return. Agile leaders listen deeply and ask powerful questions to gain insights
and make the right decisions to help the organization move forward
F. Emotional Intelligence through problems. Agile leaders also quickly adapt to situations as
Another leadership theory gaining prominence in the 21st century is they come along and are flexible and open to change and growth. In
the EI or Emotional Quotient. addition, agile leaders demonstrate agility with their employees.
● Refers to the ability to use emotions effectively and is Indeed, agile leadership was proposed to meet the needs of the
required by leaders/managers in order to enhance their millennial workforce, which has different needs, different wants, and
success. different motivators than any generation before them.
● This refers to the ability to perceive, understand, control ● Inclusive and democratic approach to followers.
one’s emotions as well as those of others.
● Gabriel (2018) suggests that it is our EIs that give us the H. Thought Leadership
ability to read our instinctive feelings and those of others. ● Thought leadership refers to any situation whereby one
● It also allows us to understand and label emotions as well as individual convinces another to consider a new idea,
express and regulate them. product, or way of looking at things.
 ● In other words, thought leadership is the expression of ideas ● Leading and managing in the 21st century promises to be
that demonstrate that you have expertise in a particular field more complex than ever before, and leader-managers will
area or topic. be expected to have a greater skill set than ever before.
● Many executives and business leaders try to become ○ Contemporary leader managers then, are
thought leaders in their respective fields. It takes dedication, challenged not only to know and be able to apply
patience, strategy, and education. classical leadership and management theory but
● Most thought leaders not only have a command of their also to keep abreast of new insights, new
subject area, they are passionate about it and eager to share management decision making tools, and new
their knowledge with others to benefit a company, research in the field.
organization, or cause. ○ It is more important than ever that leader
● Thought leaders attract followers not by any promise of managers be able to integrate leadership roles and
representation or empowerment but by their risk taking and management functions and that some balance be
vision in terms of being innovative. achieved between industrial age leadership and
● Thought leaders are informed opinion leaders and the go to relationship age leadership skills.
people in their fields of expertise. They become the trusted ○ The key to organizational success will likely be
sources who move and inspire people with innovative ideas; having enough highly qualified and visionary
turn ideas into reality; and know and show how to replicate leader managers to steer the course.
their success.
● Over time, they create a dedicated group of friends, fans, STRATEGIC PLANNING
and followers to help them replicate and scale their ideas
into sustainable change, not just in an industry nature across WHAT IS PLANNING
an entire ecosystem. P- process of establishing goals
● SMART (Specific, Measurable, Attainable, Realistic, Time-
I. Quantum Leadership bounded)
● This is another relatively new leadership theory that is being L- leads to change with known facts
used by leader manager to better understand dynamics of ● If you have a plan, it means it will actually lead to change
environments, such as healthcare. (change is the only constant thing in this world)
● This theory emerged in the 1990s builds on transformational ● Without adaptation to change we might be left behind
leadership. ● When we plan, use evidence-based facts as the basis of our
● Suggests that the environment and context in which people planning
work is complex and dynamic and that this has a direct A- A forecasting of events
impact on organizational productivity. ● You have this vision in your mind on things that will actually
● This is especially true during periods of rapid change and be expected of what will happen of the organization in the
needed transition. end because you have a plan prior to that.
● Because the healthcare industry is characterized by rapid N- need to find answers to Wh & H questions
change, the potential for intraorganizational conflict is high. ● What, Where, When, Who, Why, How
● Porter O’Grady and Malus (2015) suggest that because the ● You have to make you have the answers to these questions
unexpected is becoming the normative, the quantum leader as the basis for the planning
must be able to address and unsettle the space between
present and future and resolve these conflicts appropriately. VARIOUS PLANNING SAMPLE
● In addition, they suggest that the ability to respond to the ● Business planning
dynamics of crisis and change is not only an inherent ● Program planning
leadership skill but must now also be inculcated within the ● Career planning
very fabric of the organization and its operation. ● Performance planning
Comparing Industrial and Relationship Age Leadership ● Disaster planning
● Management planning
- Focus for this subject
- Planning is the first step in our management function

PLANNING MODES
R- reactivism
● Occurs after a problem exists.
● From the word REACT: a problem has already existed; it is
done in response to a crisis
● Because there is dissatisfaction with the current situation,
planning efforts are directed at returning the organization to
a previous, more comfortable state.
● In considering all these emerging leadership theories, it ● Problems are dealt with separately without integration with
becomes apparent that a paradigm shift has taken place the whole organization.
early in the 21st century: a transition from industrial age ● Because it is done in response to a crisis, this type of
leadership to relationship age leadership. planning can lead to hasty decisions and mistakes.
● Scott (2006) condensed that Industrial Age Leadership focus ● Probably commit several mistakes especially when you are
primarily on traditional hierarchical management structures, going to react immediately with the occurrence of a
skill association, competition, and control. These are the situation
same skills traditionally associated with management. I - inactivism
● Relationship Age Leadership focuses primarily on the ● Type of conventional planning where the person considers
relationship between the leader and his or her followers on the status quo as a stable environment
discerning common purpose working together cooperatively ● Formula in identifying the status quo: N/2 + 1 → majority
and seeking information rather than wealth. (e.g. 10 members in a group; 10/2 is 5; 5 + 1 is 6; Status quo
● The table differentiates between the Scientific/Industrial Age is 6.)
and the Relationship/Information Age. ● Inactivists seek the status quo, and they spend their energy
● Tamara McCleary, a speaker, author, and business expert preventing change and maintaining conformity.
suggests that employee engagement is the key to ● There is a majority decision
relationship building in the 21st century. ● When changes do occur, they occur slowly and
● To build this engagement, McCleary invests time, energy, incrementally.
and passion into caring about employees. She also P- pre-activism
constantly checks to see whether her plans, decisions, and ● Preactive planners utilize technology to accelerate change
actions are building relationships effectively and she refines and are future oriented.
those actions if they don’t. ● Unsatisfied with the past or present, preactivists do not
○ McCleary’s 3 step action plan for engaging value experience and believe that the future is always
employees to build relationships is shown in preferable to the present.
display 3.8 in the textbook.
 ● FOCUS: Future and utilize technology to help make a ● Long-range planning for health-care organizations
decision historically has been accomplished by top-level managers
I- inter-activism and the board of directors, with limited input from middle-
● Proactive planning. level managers.
● Planners who fall into this category consider the past, ● To give the strategic plan meaning and to implement it
present, and future and attempt to plan the future of their successfully, input from subordinates from all organizational
organization rather than react to it. levels may be solicited.
● Because the organizational setting changes often, ● There is increasing recognition, however, of the importance
adaptability is a key requirement for proactive planning. of subordinate input from all levels of the organization to
● Proactive: flexible, adaptable, and highly innovative give the strategic plan meaning and to increase the
● Proactive planning occurs, then, in anticipation of changing likelihood of its successful implementation.
needs or to promote growth within an organization and is ● The first-level manager is generally more involved in long-
required of all leader-managers so that personal as well as range planning at the unit level.
organizational needs and objectives are met. ● However, because the organization’s strategic plans affect
unit planning, managers at all levels must be informed of
LEVELS OF PLANNING IN NURSING organizational long-range plans so that all planning is
S- strategic planning coordinated.
● Development plan ● All organizations should establish annual strategic planning
● Futuristic in nature conferences, involving all departments and levels of the
● Contingency or the plan for possible disasters or calamities hierarchy; this action should promote increased
● Occur 3-5 years or more effectiveness of nursing staff, better communication
● The ones involved are the chief executive officers, chief between all levels of personnel, a cooperative spirit relative
operations officers, division/department heads, and chief to solving problems, and a pervasive feeling that the
nurses departments are unified, goal directed, and doing their part
● It exists further in the future; sometimes it will be extended to help the organization accomplish its mission.
after 5 or 10 years
I- intermediate planning PURPOSE OF PLANNING
● Done in 6 months - 2 years D-Directs the organization
● Involve department heads in the nursing service such as the ● If there is a proper plan, it directs where the organization is
supervisors, head nurses, and clinical specialists going
O- operational planning I-Improves management functions
● Done 1 week to 1 year ● Management function starts with planning, therefore when
● Managers of the nursing unit, head nurses, charge nurse, you have a very wonderful plan, there will be an expected
primary care nurse, and team leader are involved good management functions
● Most common example: Nursing Care Plan (NCP) because it R-Resources are maximized
is a day-to-day basis ● Effective utilization of the resources available
E-Effective measure for controlling
STEPS IN STRATEGIC PLANNING ● It is very important to make sure that there is a “best plan”
S- set up clearly define purpose because that will be good in the controlling aspect of the
● It is the best time to have your MISSION organization
● Mission is the reason of your existence C-Cost effective phase of management
T- think of realistic goals T-Total enhancement of human resource
● Vision, Mission, Goals (VMG) ● Best resource in the organization: human resource or the
R- re-align purposes & operations personnel
● There is a need to make sure that there is realignment of the
purposes and operational activities in your organization
because it will be significant that this realignment will adapt
to the current situation of your organization SWOT Analysis
A- allow communication to flow ● There are many effective tools that assist organizations in
● Up and down communication strategic planning, one of the most commonly used in
● Vertical or horizontal healthcare is the utilization of SWOT Analysis. It involves
T- the sense of ownership identification of:
● Take into consideration that all of the members in your ○ S - trengths
organization has the ownership of the plan ○ W - eaknesses
● The ownership itself can avoid possible blaming in the end ○ O - pportunities
E- elicit strategies to goals ○ T - hreats
● There are strategies that will be employed to achieve the
goals that we wanted in the organization ● SWOT analysis can also be known as TOWS.
● These strategies will be of help in the achievement of the ● Developed by Albert Humphrey at the Stanford University in
goals that has been prepared ahead of time the 1960s and early 1970s
G- give the most effective use ● The first step in SWOT analysis is to make sure that there is a
● Ensure that the most effective use is made of the desired end state or objective
organization’s resources ● The desired end objective is defined
● Appropriate resources and it is properly maximized ● SWOT are being discovered and listed
I- initiate a base of progress ● The decision makers must then decide if the objective can be
● Progress of the specific planning achieved; If not, a different objective is selected and the
● This can be measured using the standard objective process then repeats.
formulation → SMART ● Important: there should be an applicable objective prior to
C- change has to be mechanized proceeding to another objective
● Make sure that the people will adapt to change in the
organization Components of SWOT Analysis
S- solid consensus of direction ● Strength
● Make sure that all of you are one in the journey together ○ internal attributes that help an organization to
● Building of consensus as to where the organization is going achieve its objectives
● Everyone needs to be involved in the strategic planning ○ What are you considered best of?
○ Characteristics that are actually at par of other
WHO SHOULD BE INVOLVED IN STRATEGIC PLANNING organizations
T- top level managers ● Weaknesses
O- officers/board of directors ○ Internal attributes that challenge an organization
P- personnel in first-level management in achieving its objectives
○ Challenge; probably a limitation. This limitation
can be addressed because the organization will be
 doing its best in order to achieve what is best for ● C - Collect Vital Data
the organization ● D - Develop Action
● E - Evaluate Plan
● Opportunities
○ External conditions that promote achievement of Scopes of Planning
organizational objectives Talks about the planning hierarchy
○ Diverse opportunities available in the community 1. Forcast
or organization for these people to grow ○ Estimate the future
● Threats ○ Short or long range projections
○ Threats in the achievement of organizational ○ Important as it will give us an opportunity to take
objectives into consideration the journey of the organization
○ It will be important to as much as possible limit the that we are going to be in or belong
threats in our organization for it might actually
affect the effectiveness or quality of the output at
the end of the planning

Simple Rules of SWOT analysis (SWOTSS)

S-
● Strengths and weaknesses should be realistic
● It should be realistic as it would be the flow or direction of
your people or subordinates ● It becomes broader as you move along the bottom part of
the planning hierarchy
W-
● What might be possible in the future must be clear 1. Vision/Mission
● It is important to make sure that you know the difference ○ Vision is the description of the future goals or aims
between the possibilities of the future in your organization of the organization. It is a description in words that
(has to be written) conjures up a picture for all group members for
O- what they want to accomplish together.
● Observe specific goals needs to be accomplished ■ Critical as organization leaders recognize
● This will be the basis of the achievement of your that the organization will never be
organization’s plan greater than the vision that guides it
T- ■ In the board exam, the most common
● To apply SWOT with competitors question that talks about vision is going
● SWOT analysis has to be applied against a competitor and to be your imagined future
that competitor is going to be the basis where your ○ Mission is the brief statement, typically no more
organization is as of the moment than 3 or 4 sentences, identifying the reason that
S- organization exists
● SWOT is short and simple ■ In the board exam; the question that has
● No flowery words been talking about your mission is the
reason of existing (the purpose why the
S- organization exists)
● SWOT is subjective ■ Identifies the organization’s constituency
● Based on how you feel, what is existing, and the response of and aggresses its position regarding
the people involved in the SWOT analysis ethics, principles, and standards of
practice
Balanced Scorecard ■ The reason why you are existing as an
● Another way of evaluating the planning organization
● originally developed by Dr. Robert Kaplan of Harvard 2. Philosophy
University and Dr. David Norton in the early 1990s ○ Flows from the purpose or mission statement and
● A tool that is highly assistive in strategic planning dealinates a set of values and beliefs
● Measures alined individual, departmental, organizational ○ The most common question in the board
goals and identify an entirely the new processes for meeting examination of your philosophy is values and
customers and shareholder’s objectives beliefs
● All of the measures are considered to be related and ○ Guides all actions of the organization
because the measures are assumed to eventually lead to ○ Basic foundation that directs all further planning
outcomes, overemphasis on financial measures is avoided → toward that mission
the scorecard is then balanced and the outcomes are ○ A statement of philosophy can usually be found in
imbalanced policy manuals at the institution or is available
● Also allow organizations to align their strategic activities with upon request
the strategic plan ○ Different types of Philosophy
● The best balanced score cards are not static, it has to be ■ Organizational Philosophy is providing
proactive sets of measurements that instead reflect the you the basis for developing nursing
dynamic nature of the organizational environment because philosophies at the unit level and for
the balanced scorecard is able to translate strategy into nursing service as a whole. It talks about
action. the entire organization
● It is an effective tool for translating an organization’s ■ Nursing Service Philosophy is addressing
strategic vision into a clear and realistic objective the fundamental beliefs about nursing
● Metrics and nursing care. It also talks about the
○ Performance indicators quality, quantity, and scope of nursing
○ Collect data services and how nursing specifically will
○ Analyze data meet the organizational goals
● Organizational perspectives ■ Unit Philosophy adapted the nursing
○ Financial service philosophy. This specifies how
○ Customers nursing care, provided on the unit, will
○ Processes correspond with nursing service as as
○ Learning and growth organizational goal
3. Goal
○ Defined as the desired result toward which effort
is directed
Phases in Planning ○ It is the aim of the philosophy
This will guide us on what is expected of us in the organization ○ Goals are broad. These are the general objectives.
● D - Determine Objective 4. Objectives
 ○ Similar to goals as they motivate people to a ○ Describe the situation that allow only one choice
specific end and are explicit of action
○ These are the specific objectives
○ Follows the SMART method in identifying the Types of Standards
objectives (Specific, Measurable, Attainable, These standards will be the basis for evaluation of the plan
Realistic, Time-bounded)
5. Policies S - structure
○ Plans reduced to statements or instructions that ● Those that focus on the structure or management system
direct organizations in their decision making use to deliver care including number and categories of
○ These comprehensive statements, derived from personnel
organization’s philosophy, also including the goals ● Common in the board examination; when talking about
and objectives will help in explaining how goals will structure standards: equipment, building, other tangible
be met and guide the general course and scope of things
organizational activities (focusing more on ● Evaluate and have an inventory
objectives) P - Process
○ Types of Policies ● Actual procedure itself
■ Implied Policies are neither written nor ● Those activities that engage in to administer care
expressed verbally. It is already ● Board exam; asked about process: it is the steps, procedure,
considered to be implied. It is developed or methods
over time and follow a precedent O - Outcome
■ Expressed Policies delineated verbally or ● The result of the procedure and nursing care
in writing . Most organizations have ● Usually, you will be asked on what results occurred as a
written policies that are readily available result of the interventions
for people to read, at the same time this ● Evaluation aspect of planning
will promote consistency of action. May
include the following: dresscode, policy Overcoming Barriers to Planning
for sick leave, disciplinary procedures, B - be able to establish goals
etc A - allows flexibility of plan
6. Procedures R - remember to include all affected people by a plan
○ Plans established customary or acceptable ways of R - realistic, specific, and simple plan
accomplishing a specific task and delineate a I - initiate when to plan
sequence of steps of required action. Established E - evaluation checkpoints are built-in
procedures save staff time or facilitate delegation, R - re-evaluate at the end of the plan
reduce cost, increased productivity, and provide a
means of control Integrating Leadership Roles and Management Functions in Planning
○ Identifies the process or steps needed to Leadership
implement a policy and are generally found in the ● P - personally prepared
manuals at the unit level of the organization ● L - leads sensitivity
○ There will be a specific set of procedures that are ● A - appraise accurately
included in the manual and it will be the basis for ● N - need to take risks
the people or subordinates to follow, especially in Management
the performance of specific procedures that will ● N - needs theory expertise
usually follow the standards steps in a given ● I - Initiate unit assessment
procedure ● N - needs to be receptive
7. Rules ● G - gives emphasis to vision, mission, philosophy
○ Rules and regulations
○ Plans that define a specific action or nonaction. Planned Change
○ Generally included as part of policy and procedure Sir Joseph B. Abang
statements, rules describe situations that allow
only one choice of action. (prioritization) “The nature of leadership is resistance and change.” - Scott Mabry
○ Rules are fairly inflexible, so the fewer rules, the ● If there is leadership, there will be an accompaniment of
better. resistance due to presence of change.
○ Existing rules, however, should be enforced to ● Planned change is ‘overt’ meaning the people are aware of
keep morale from breaking down and to allow this change.
organizational structure. ● Planned change is also ‘covert’ meaning hidden or occurs
without the people’s awareness.
Scopes of Planning ● Planned change may be gradual or sudden.
2. Set Goals or Objectives ● If there is unplanned change, there is an alteration imposed
○ Goals - broad by external factors and it occurs with unexpected
■ Achieve goals through objectives event/force/reaction.
○ Objectives - specific ● Major change may bring feelings of achievement, loss or
■ SMART feelings of stress.
■ Behavioral (Bloom’s Taxonomy)
3. Develop and Schedule Strategies, Programs, Activities. Set Planned Change
time frame ● In contrast to accidental change or change by drift, it results
○ Strategy from a well thought out and deliberate effort to make
■ Overall plans of the higher management something happen.
system ● It is a deliberate action or application of the knowledge and
○ Programs skills of a leader to bring change.
■ Series of activities that function together ● Successful leader manager must be well-rounded in the
to facilitate attainment of some desired presence of the change theories and be able to apply these
goals theories appropriately in response to the implementation of
4. Prepare Budget change.
○ Allocation of resources or systematic plan of
meeting expenses 1. Change Agents
○ Purpose is to set operating cost limits a. Persons who are skilled in the theory and
5. Policies implementation of planned change.
○ Are guides of basic rules that define the general b. People who deal appropriately with conflict
course and scope of activities regarding conflicted human emotions and to
6. Procedures connect and balance all aspects of the organization
○ Step by step guide to action that would be affected by the change.
7. Rules 2. Types of Change
 a. Personal ● M-make a plan
○ What you want to change in your own ○ That plan will be the basis of identifying whether
self. or not that a particular plan will be feasible in the
b. Professional implementation of change.
○ Academic preparations or skill expertise ● O-often set goals
c. Organizational ● V-verify support/resistance
○ Manager is the change agent ○ Identify areas of support and resistance because it
○ Having change in the organization e.g., will be your basis on whether you should focus on
leadership positions, creating new the support or resistance.
departments ● E- everyone is included
3. Strategies of Change Agents ○ Include everyone that will be affected by the
a. Power coercive change because it will be the basis of the people
○ When you comply to the plans and at the whether to participate, support, or resist.
same time direction of the more ● M- make target dates
powerful ○ Make time tables and decide on the dates that will
○ E.g., Strikes, sit ins, negotiations, give you the best time on when to have this
creations of unions. specific change implemented.
b. Empirical rational ● E- enhance strategies
○ People are willing to adapt or change if it ○ Important in the implementation of change.
is justified and they are shown how they ● N- now implement change
can benefit from the change. ○ The best time to implement change. Implement
○ Based from logic data and evidence- the strategies or techniques that you want to
based practice employ now.
○ Since it talks about rational, it has to be ● T- to offer support to others
logic in nature ○ Be available to support others where you are going
c. Normative reeducative to encourage others through the implementation
○ Based on the assumption that people act of change.
according to their commitment to ● S- strategize to resistance
sociocultural norms ○ Use strategies in order for you to overcome the
○ Focused on the norm presence of resistance.
○ E.g., staff training ● T- take time to evaluate
○ Will be the basis of the thing that you are going to
Kurt Lewin's Phases of Planned Change (Change Theory) have in mind especially if you need to have the
● Unfreezing change entirely.
○ When a change agent convinces members of the ● O- opt to modify if needed
group to change ○ Modify if there is so much resistance from the
○ When guilt, anxiety, and concerns can be elicited people involved in change.
so that people become discontented and aware of
a change to need. Responsibilities of Change Agent (unfreezing)
○ NO change is going to occur yet because you are ● Support others for change to continue
still introducing change ○ You have to support and empower others so that
● Movement/changing they are given the opportunity to grow while
○ Change agent is focused more on planning, change is being implemented.
identifying, and implementing appropriate
strategies that ensure driving forces exceed Forces in Planned Change
restraining forces. Two forces used by the change agent in the implementation of
○ Trying to identify the best action to be change. Kurt Lewin, 1951 theorized that people maintain status quo or
implemented in order for the change to occur. equilibrium or balance by the simultaneous occurrence of these
● Refreezing driving forces. There should be a balance between these forces to
○ Change agent assists in establishing the system so succeed in the planned change.
that it becomes integrated in the status quo. ● Driving - force that push towards change
○ There is already acceptance of the entire majority. ○ These are the facilitators
○ If refreezing is incomplete, the change will be ○ Advance a system toward change
infective and the pre-change behavior will resume. ○ A force that push towards change
○ At this stage, you have to make sure that the ● Restraining - force that pulls away change
majority is adapting to the change that has ○ These are the barriers
happened. ○ Force that pulls away/impede change

Responsibilities of Change Agent (unfreezing) Stages to Change Model (Barrows? and Meads?, 2009)
● S- sufficient data gathering Stage 1: Precontemplation
○ Data that will prove that there is a need for change ● The individual has no intentions to change his or her
to occur. behavior in the foreseeable future.
○ Without this, people will not believe you and not ● There is no need for that person to change because there is
trust you. no intention at all.
● T- take time to diagnose ● Part of unfreezing
○ Accurate diagnosis of the need for change is Stage 2: Contemplation
essential. ● Individuals consider making a change but have not yet made
○ Without that, it means that you will not be able to a commitment to take action.
succeed. ● Where unfreezing will usually occur.
● O- observe & decide if change is needed Stage 3 Preparation
○ Thinking about the possibility that there is a need ● Transition from unfreezing to movement
for you to decide from the solution or present ● Movement stage
alternatives especially if there is a need for change. ● Individual intends to make action in the short term future
● P- promote awareness to others Stage 4 Action
○ Often involves deliberate tactics to raise the ● When the individual actively modifies his or her behavior.
group’s discontent level in order for you to ● Probably adapting to change already
proceed to the next stage until the status quo has ● Part of movement stage
been disrupted. Stage 5 Maintenance
○ Need for change is perceived by others. ● Individual work to maintain changes made during the action
○ Introduce vital information to others. stage and prevent relapse.
● Refreezing stage
Responsibilities of change agent (movement)
Behaviors in Response to Change ● People will be of help if they are engaged especially in the
● Innovators implementation of the planne change
○ Love change and thrives on it.
○ They first recognize the problem, they already Nonlinear Dynamics
have a solution that they tried and they are eager ● Complex Adaptive Systems(CAS) Theory
to share how the solution worked. ○ The relationship of elements or agents within any
○ Base their change ideas on creative and critical system is nonlinear.
thinking and analytical observation ○ These elements are constantly in play to change
○ Includes insight, scientific literature the environment or outcomes.
○ Play an important role in the diffusion process ○ Nonlinear means that it has this inverse
○ Managers identify innovators in the unit - more relationship. It means that they will not go
innovators in the unit, it will lead to a visionary and together.
progressive environment ○ The relationship of elements is not going together
○ Think about staff members who frequently come ○ There will be instances that there is a great impact
to you with problems with driving and restraining forces which are
● Early adopters present in nonlinear dynamics.
○ Staff to approach first with a new idea ● Chaos Theory
○ They quickly see the benefit of the change and go ○ Finding the underlying order in random data
with it; fine-tuning it to increase viability ○ You are going to identify the most relevant data or
○ Have the greatest degree of opinion and can the underlying cause why these people are
influence the majority resistant to change.
○ ‘Change champions’
○ Managers can identify these people by doing daily Integrating Leadership Roles and Management Functions in Planned
operations and staff interaction Change
● Early majority Leadership
○ The staff who eventually go along with the flow P-proactive inventor/creator
sooner than others ● Create something new
● Late majority L-look for trends and changes
○ The staff who eventually go along with the flow ● take into consideration what are the trends/norms in the
○ May go along together with early majority community
● laggards A-ability to articulate & tenacious
○ Staff that want no part in change ● You have to know how to articulate the purpose of that
○ Exhibit the greatest resistance change in the organization
○ Require great motivation to make them change N-need to retain a big picture focus
such as formal policies, integrating certain ● Go for what is actually the vision
behaviors for the mandatory N-need to be confident, flexible
○ As a manager, you must focus on these people as E-environmental factors evaluated
they might actually resist change ● These factors could actually be a hindrance to planned
● Rejecters change
○ People that will not adapt with change because D-do proactive preparations
the focus of this people is that they don't want ● Be responsive with what is actually occuring in the
change community
○ Will not support the planned change
Management
Planned Change as Collaborative Process C-cognizant of forces
P-people meet to discuss ● Have the knowledge or be aware of the restraining or driving
● Let people be involved in the discussion forces
R-rule to include all affected H-has clear process understanding
● Rule to include everyone especially in the discussion ● Make sure that you know the process and methods
O-openly develop goals implemented
● Achievement of the things that you want in the organization A-a mechanic to implement change
C-change interest is defined ● In leadership, you are the inventor or creator but here in
● There has to be a definition of the greater interest of all management, you are the mechanic where you will be the
E-empower early adopter one to implement it
● This early adopter will usually be of help especially in N-needs to be a proactive agent
convincing other people to follow change. Through this, it ● Be responsive
would be easier for you to achieve the change (from the G-generally can apply work change
laggards and may even change the motivation of the ● Apply professional and organizational change in your
rejecters. organization
S-share perceptions E-engage resources for change
● Share to all ● Involve resources for your planned change for your
S-support open conversation organization
● Essential because it will be of help in making sure that these ● Integration of leadership roles and management function in
people will actually voice out their feelings your planned change
● Discouragement or dissatisfaction can be discussed with
properly Time Management

Leader-Manager as Role Model Pareto Principle

M-models of change ● 20% focused effort with 80% outcome.
● You have to be the role model as a leader ○ This exemplifies work smartly, 20% focus has a
● You yourself have to adapt to the presence of that change greater percentage of outcomes in the end.
O-offer positive views ● 80% unfocused effort with 20% outcome.
● Help people adjust with change ○ This means that the person focuses on things that
● Tell them the positive outcome of the change are not that important, which will yield only 20%
D-deal it with confidence of the outcome.
● It is essential that you are not confuse of your decision ○ Work harder.
● You have to deal with it with confidence so that the people
will also have the interest to adapt to change Time Management
E-embrace it as challenge ● T - to have more work in less time.
● In order for you to limit the presence of resistance ○ You are accomplishing the most important tasks
L-level up engagement on a daily basis, and you are having your work in
the least time possible.
 ● I - increase opportunity for advancement. ○ You prioritize things that are highly important.
○ You will be able to proceed to another work as you ● O - observed designated workspace
are already done with the previous one. ○ As much as possible you need to have a workspace
● M - making optimal use of available time. at home. This will help in the management of your
○ Time is precious, if you will not do something with time.
your time, you will not be able to repeat time, and ● D - develop my wellness routine
you are not able to do what is lacking because you ○ Even if the time is very short, you have to make
wasted your time. sure that you focus on your wellness routines such
● E - exert work that is smarter not harder. as brisk walking for 15-30 minutes.
● U - utilized an effective time inventory
4 Steps in Time Management ○ Time inventory - following a planner that will serve
1. T - time to establish priorities as your guide in the things you are going to do for
● It is important for you to make sure that there are priorities the day.
in the things you have to do. This will guide you on what to ● C - communicate with family and friends
do first and last. ○ It is vital for productivity to increase conversations
● Prioritization is making sure that the most important with significant people.
activities are performed ahead of time compared to those ○ It is essential to socialize.
that are less important. ● T - taking my break outside
○ Go outside, breathe fresh air.
2. I - into finishing a task ● I - initiate eating meals on time
● As much as possible, you have to do a task first before ○ For you to be progressive and productive, you
proceeding to another. have to be physiologically satisfied.
● V - very open for feedbacking
3. M - move to another task ○ In time management, you are expected to be open
● If you are done performing a task, then you now have the for feedback, especially for the things you have
opportunity to move to another task. already done.
● I - initiate limits of time wasters
E - examine and re-prioritize ○ This will prevent you from wasting your time.
● When you have already examined that you were able to ● T - tasks are being prioritized well
perform the task when, this means that you are capable of ○ You have to make sure that you have prioritized
re-prioritizing your activities. your tasks on what are your priorities.
○ Work smart, not hard.
Priority Setting ● Y - your support system is of value
● Take into consideration these 3 levels of prioritization: ○ If you have a support system in your family, this
○ Don’t do - you avoid doing these things because will be of great help especially in making sure that
they are time consuming and not a priority. you are productive in the utilization of your
○ Do later - set the activity aside for later. A form of available time.
procrastination. ● In order for us to say that we value our time well, there has
○ Do now - if you have available time, do the task to be an increase in productivity.
immediately. Do not waste time, as time is
precious. External Time Wasters
● It is important to limit this as it takes up much of our time.
Procrastination 1. W - workers are incomplete
● “Maniana habit” ● Especially if you have trainings or meetings, you will not be
● You are setting aside or putting off something until future able to start on time because the employees are incomplete.
time.
● Postpone or delay needlessly. 2. A - all about paper works
● This is what happens when the value of doing something 3. S - socializing with coworkers
else outweighs the value of doing it now. ● Chit chat with friends can waste your time.
● Filling your day with low priority tasks. It means that you are
not that aware of the most important things you are 4. T - telephone interruptions
supposed to do. ● Especially if you are near the telephone, there will be
● People usually procrastinate because these activities are instances that you will be affected by frequent calls.
unpleasant, so they do not want to do those activities.
● People also procrastinate because they do not know where 5. E - existing meetings
to start and what to begin. ● Especially if you are occupying high positions in the
● The third reason for procrastination is disorganization. A organization, it is expected that you have scheduled
person is disorganized on the things they have to do. meetings that you are expected to attend. It is required by
● We have to make sure to prevent procrastination by: the organization.
○ Deciding the task that has to be done - make sure
you have prioritized your tasks. Internal Time Wasters
○ Set a timer - to make sure you are doing tasks 1. W - with delegation failure
smartly. ● It means that you are not familiar with delegating tasks, and
○ Work on tasks until the time rings - make sure that this affects your time management.
there is an indicator of when you are supposed to
finish the task. 2. A - a failure to set objectives
○ Take a short, 5 minute break if you are done with a ● Make sure that you have an objective, as this will help you in
task. making sure that you know what to prioritize.
○ Take 15-30 minute breaks, especially if you are
planning to take your lunch or take meals. 3. S - some with poor planning
● As much as possible, procrastination has to be eliminated in ● Sometimes for individuals who has poor planning, their time
our system because we are wasting our time on things that management will also be affected.
are not important.
4. T - the inability to say NO
Productivity ● If you always say yes, your time will be compromised.
● P - participate in training for self-sufficiency 5. E - exercising procrastination (ngano exercise, basin exorcise?
○ It is important for you to enhance your knowledge HAHA)
on time management as this will help you develop
and grow more, and fulfill your self-sufficiency Benefits of Time Management
needs. 1. Greater productivity and efficiency
● R - re-organize work ● You will be able to prioritize things, you become productive,
○ Priority setting effective and efficient in what you are doing.
 ● Refers to effective and efficient delivery of services while
2. Professional Reputation generating needed revenues for continued organizational
● This will build trust, reputation, and credibility as a productivity.
professional, especially if you can work smartly and not ● Is the responsibility of every healthcare provider.
hardly. ● The viability of most healthcare organizations depends on
their ability to use fiscal resources wisely.

3. Experience less stress Being cost effective however, is not the same as being
4. Increased opportunity for advancement inexpensive. Cost effective means producing good results for the
● If you have properly worked and planned your activities, you amount of money spent. In other words, the product is worth the
have more time for self sufficiency trainings. price. In fiscal planning, we focus more on quality, not quantity.

5. Greater opportunity to achieve important activities in life Basics of Budgets

● This is a way of developing yourself as a professional. ● Budgets:
○ Fixed
6. Less missed deadlines ○ Variable
7. Less inefficient workflow ○ Controllable
● There is an efficient flow of work because you have properly ○ Non controllable
planned what to do with your time. ● Because a budget is the best prediction of plan and not a
rule, fiscal planning requires flexibility, ongoing and revision.
8. Good quality of work ● In budgets, expenses are classified as either fixed or variable,
and either controllable or non controllable.
Integrating Leadership Roles and Management Functions in Time
Management Fixed Expenses
Leadership ● These expenses do not vary with volume.
● T - to focus on self value system ● Examples:
○ Make sure that you focus on how to value time ○ Building’s mortgage payments
properly. ○ Manager’s salary
● I - interpersonal communications
○ There has to be building up of communication Variable Expenses
between colleagues and coworkers. ● Varies with volume.
● M - model to followers with time ● The expenses themselves vary because it is focused on the
○ If you are good in time management, your volume.
followers will also follow what you are doing with ● Examples:
your time. ○ Payroll of hourly wage employees - since you
● E - effective self-awareness cannot know in advance how much they are going
○ Time management will give us an opportunity to to be paid.
say that we are aware or oriented on time and ○ Cost of supplies (office supplies).
dates.
Controllable Expenses
Management ● Can be controlled or varied by the manager.
● K - keep time as productivity related ● Ex: the unit manager can control the number of personnel
○ As much as possible, you make sure that you are working on a certain shift or the staffing.
utilizing your time well. ● Controlling the number of people working in the area, or
● E - enhance cooperation on time use individuals you can control.
○ There has to be proper utilization of time and
cooperation from members of the organization. Non Controllable Expenses
● E - elicit time management analysis ● Cannot be controlled by the manager.
○ If you are not satisfied with the way you manage ● The manager cannot control the equipment depreciation
your time, it is best if you re-prioritize things and and the number and types of supplies needed by patients
balance tasks that are important. overtime that occurs in response to emergencies.
● P - prioritize activities ● Caused by contingency activities, how much of the resources
○ Work smartly, not hardly. used is not controlled.
● E - eliminate time wasters
● R - remember the value of time Types of Budget
○ Remember that time is precious and it is the most ● Capital budget
important thing we can offer to our organization. ● Operating budget
● Manpower budget
FISCAL PLANNING
Which of these budgets is the most important budgeting to do in fiscal
Fiscal Planning planning? Answer: Manpower budget
● Is not intuitive, but is a learned skill that improves with ● This is the most important element in fiscal planning.
practice.
● It is expected that a person will learn about it, especially if it How can we say that that is considered a capital budget? Answer:
is developed through training. based on how much the equipment cost. If it is greater than 50,000, it
is considered a capital budget.
Approaches or Systems of Budgeting
● Centralized Capital Budget
● Decentralized ● Examples: land, building, major equipment and supplies.
● If the budget itself is more than 50,000.
Centralized Budgeting
● The upper level makes the budget. Operating Budget
● The top level management is the one making the budget ● Includes day to day expenses such as the cost of supplies,
itself. minor equipment repairs, and overhead expenses.
Manpower Budget
Decentralized Budget ● Focus is on the salaries, wages, and benefits of the
● Middle and lower level managers set the budget and give it employees.
to the upper level management. ● This type is the most important type to take into
● The unit heads or unit managers are the one who do the consideration in fiscal planning.
budgeting.
Budgeting Methods
Cost Containment ● Incremental budgeting
 ● Zero-based budgeting Cost Containment
● Flexible budgeting ● Awareness - you are aware of the budget that you have
● New performance budgeting prepared; this is one way of making sure that you contain
● Sunset budgeting what are inclusive of the budget
● Fairness - there has to be justice, fairness and equality of
Incremental Budgeting budget
● Also known as flat percentage budgeting. ● Monitoring - focuses on how much will be spent, where will
● There is a flat percentage increase method. you spend it, when, and why will you spend it
● Considering the inflation rate (ex: 20%), then you are going
● Management - what can be done to manage the cost
to multiply the current expenses by the inflation rate. Then
● Incentives - talks about the motivation and rewards
there will be an incremental or flat percentage increase.
especially for those who are doing well in the organization,
● Simplest method of budgeting.
especially staff
● Multiplying the current year expenses by a certain figure.
○ Usually the inflation rate or the consumer price ● Avoidance - focused on not buying supplies, technologies, or
index. services not necessarily needed
● Although this method is simple and quick, it requires little ● Reduction - spending less on goods and services, specially on
budgeting. cost cutting
● It is generally inefficient fiscally because there is no ● Control - effective use of available resources through careful
motivation to contain costs and no need to prioritize planning, forecasting, reporting and monitoring
programs and services.
● Hospitals have historically used incremental budgeting in Personnel Budget Computation
fiscal planning. Patterns of work
● 5 days/ week; 8h/day; 2 days off = 40 hr/week
Zero-Based Budgeting ● 4 days/week; 10 h/day; 3 days off
● It requires the managers to justify in detail the cost of all ● 3 1/2 days/week; 12h/day; 3 1/2 days off
programs both the old and the new in comparison.
● This is based on the requirement of the law (RA 5901 or 40
● Managers must re-justify their needs every budgeting cycle.
hour week law) wherein employees will work for 40 hours,
● This method does not automatically assume that because a
specifically for hospitals with 100-bed capacities or more
program has been funded in the past, it will continue to be
also for community population of at least 1 million
funded.
○ However, a nurse will render 48 hours per week
● Thus the budgeting process is labor intensive for nurse
with only one off duty a week if the hospital is less
managers and the use of decision packages to set priorities
than 100-bed capacity, and communities with less
is a key feature of zero based budgeting.
than 1 million population
Flexible Budgeting ○ There are benefits enjoyed by the personnel
● Budgets that are flexed up or down over the year depending regardless of the working hours as per Civil Service
on the volume. Commission Memorandum Circular Number 6,
● This automatically calculates what the expenses should be Series of 1996.
and given the volume that is occuring. ○ Government employees are granted 3 days which
● This works well in many healthcare organizations as a result may be spent for birthdays, weddings,
of changing census, especially if there is an increase in the anniversaries, funerals, relocation, enrollment,
number of patients in the hospital and manpower needs that graduation, accident leave
are difficult to predict despite historical forecasting tools.
● This budgeting is adaptable and is focused on what the Patient Classification
situation demands. ● Important for computation of nursing hours. In fiscal
planning you need to know how to compute for the nursing
New Performance Budgeting care hours of your patient because in that case you will be
● Emphasizes outcomes and results instead of activities or able to identify how much nsg care hours is required per
outputs. patient per day
● The focus of this budgeting is on the outcomes or evaluation
criteria. NCH/P/D RN:NRN
● The manager would budget as needed to achieve specific
Level 1: self care or minimal care 1.5 55:45
outcomes and would evaluate budgetary success
accordingly. Level 2: moderate or 3.0 60:40
● The focus is all about identifying the outcomes first and then intermediate
use it as a basis for budgeting. Level 3: total or intensive care 4.5 65:35
Level 4: highly specialized or 6.0 70:30
Sunset Budgeting critical care 7 or higher 80:20
● Designed to self destruct within the prescribed period to
Legend:
ensure cessation of the funded program. ● NCH/P/D: nursing care hours per patient per day
● If you are done funding the program and if the program ● RN/NEN: RN to non-RN
itself is already done, the funding is also done.
Levels
Steps in Budgetary Process Level 1
1. B - budget Coverage: make sure it covers requirements of ● Patient can take a bath on his own, feed himself and
organization perform his ADLs, and pt is about to be discharged, those
2. U - use cost effective budget: make sure there is utilization considered to be non-emergency, and newly-admitted do
of available resources because it shows effectiveness of not exhibit unusual symptoms and require little treatment or
budget instruction
3. D - develop budget in ways: there has to be an application of
different ways and methods of budgeting Level 2
4. G - generate monitoring need to make sure there is a ● Patients who require some level of assistance and extreme
monitoring tool that will be focused on identifying if budget symptoms of their illness must subside or have not yet
is effective with the requirement appeared or probably in the incubation period
5. E - enhance periodic review: important to have periodic ● Pt with emotional needs with vital signs ordered up to three
budgeting because it will give the organization an overview times per shift, requires also intravenous fluid or blood
on how effective you are in your budgeting transfusion, are semi-conscious or exhibiting psychological
6. T - to be accountable: you are answerable of the result or problems, there is need for periodic treatment, observation,
outcome of your budgeting, there is no blaming and instructions

Level 3
 ● Pt completely dependent on nursing personnel and they are ● PM: 34-47% of personnel
marked with emotional needs, with vital signs monitoring ● NOC (Night Shift): 15-18%
more than 3x per shit, on continuous oxygenation therapy ● Here in the Philippines:
with chest tubes or abdominal tubes and this requires close ○ AM: 45%
observation of at least 30 minutes for impending
○ PM: 47%
hemorrhage with or without hypotension or hypertension,
○ NOC: 18%
and those with cardiac arrhythmias

Standard Computation Formula

Level 4
Example. 250 patients in a tertiary hospital
● Pt requires maximum nsg care, patient needs continuous
1. Categorize patient per level
treatment and observation with many medications, IV
(1) 250 x 0.30 = 75 Level I
piggybacks, and v/s are 15-30 minutes hourly output
(2) 250 x 0.45 = 112.5 Level II
(3) 250 x 0.15 = 37.5 Level III
Staffing
(4) 250 x 0.1 = 25 Level IV

% of Patient at Various Level of 2. Find the nursing care hours (NCH) per patient per level
scare (1) 75 X 1.5 = 112.5 NCH/day for L-I
Types of Hospital Level Level Level Level (2) 112.5 X 3 = 337.5 NCH/day for L-II
1 2 3 4 (3) 37.5 X 4.5 = 168.75 NCH/day for L-III
Primary 70% 25% 5% - (4) 25 X 6 = 150 NCH/ day for L-IV
▶ Sum total is 786.75 NCH per patient per day
Secondary 65% 30% 5% -
Tertiary 30% 45% 15% 10% 3. Find the total NCH by 250 patients/year
Special 10% 25% 45% 20% 786.75 X 365 days = 280, 593.75 NCH/year for 250 patients
Note: Level 4 requires intensive care unit
4. Find the actual working hours by each Registered Nurse (RN)
Nursing Care Hours/Cases 8 h/day X 213 (40 h/week duty) d/year= 1704 working hours

NCH/ RN:NRN 5. Find the number of personnel. Divide the total # of nursing
P/D care hours per year by total # of working hours of a nurse
General Medicine 3.5 60:40 working in a 40h/week duty
(1) 280, 593.75 / 1704= 165 personnel
Medical 3.4 - (2) 0.15 (from relievers if 40/week) x 165 personnel =
Surgical 3.4 - 25 relievers needed
Obstetrics 3.0 - ▶ 165 + 25 = 190 personnel needed
Pediatrics 4.6 70:30 (RN to Nursing Assistant)
6. Categorize to RN and NA (nursing attendants)
Pathologic Nursery 2.8 - (1) 190 x 0.65 = 124 RN
ER/ICU/special areas 6.0 70:30 (2) 190 x 0.35 = 66 NA
Critical care unit 6.0 80:20 (RN to Nursing Assistant) *since tertiary hospital is 65:35 for RN per
non-RN
7. Distribute by shifts
Personnel Privileges
(1) 124 X 0.45 = 56 RN AM
(2) 66 X 0.45= 30 NA AM
Rights and privileges Working hr/week Working hr/week
given each 48 hours 40 hours
personnel/year
(3) 124 X 0.37 = 46 RN PM
(4) 66 X 0.37= 24 NA PM
Vacation leave 15 15
(5) 124 X 0.18 = 22 RN NOC
Sick Leave 15 15 (6) 66 X 0.18= 12 NA NOC

Integrating Leadership Roles and Management Functions in Fiscal

Legal holidays 10 10
Planning
● Leadership
Special holidays 2 2 ○ F - flexible and creative: fiscal planning has to be
flexible will adapt to the requirements of the
Special privileges 3 3 institution
○ I - initiate vision for future needs
Off duties/R.A. 5901 104 52 ○ S - skilled in identifying alternatives: there has to
be choices that you will allow others to follow
○ C - continue acting proactively: you have to
Continuing Education 3 3
Program proactive and responsive to the needs of time
○ A - anticipate budget constraints: possibility of
constraints present if it talks about budget
Total non-working 152 100 ○ L - lead in meeting patient need: specially in
days/year delivering quality care
● Management
Total Working 213 265
○ F - fiscal planning understanding: know theories
days/year
about fiscal planning
Total working 1,704 2,120 ○ I - initiate adequate staffing: important because it
hours/year will give us vital information about how to properly
staff our institution
○ S - sensitive to organizations climate: specially on
Computing the Number of Relievers
requirement of human resource
● Thirty-three (33) days average # of leaves divide it with 213 ○ C - cost effective in meeting goals: make sure to
for 40 hour/week or 265 for 48 hours/week work meet goals with effective use of resources
○ The result is 0.15 (15%) - 40 hours/week ○ A - articulate unit needs
○ The result is 0.12 (12%) - 48 hours/week ○ L - lead a skillful monitoring aspect
Distribution of Shifts
● AM: 45-51% of personnel are required CAREER PLANNING
“Career Plans are about where you are today and, more importantly, ○ Entails our theories and nursing theories
where you’re going tomorrow” -Phil McPeck ● A- altruism
● With this note, it tells us that career planning is going to ○ Means that we are one in a team
direct our journey or path to where we should be in the ● C- code of ethics
future ○ We have our code of ethics for Filipino nurses that
● It is important because career planning is essential as it gives will actually guide us on the things that are norm
you the destiny or destined future and the things that are expected of us to do that
will not violate the bill of rights, ethical principles
Career Planning ● A- autonomy
According to definition, career is an occupation or profession ○ Means that we are self-determined, independent
● It’s an Occupation because you get a salary; you are being from other professions- we will not depend on
paid because you’ve done something. them based on their decision making
● It’s a Profession because you’ve been through trainings and ● D- distinct culture
competency evaluation for you to prove that indeed you are ○ We have our distinct culture
a professional. ○ Women will be wearing their cap
According to Shirey, there are three stages of career ○ Men will be wearing badges
1. Promise Stage ○ Both will be wearing white uniforms, scrub suits
● for the first 10 years after you finish your course ○ We have our distinct celebration such as our
● in this case, you are trying your best to establish your name, capping and badging ceremony, pinning ceremony
you create your own brand ○ These are going to be distinct in our profession
● at the same time, it will give you an opportunity on what ● A- accountability
field you really want to dwell on for the remaining years of ○ It is very important to have accountability because
your career we have to be answerable of the actions that we
2. Momentum Stage do
● 11-29 years ○ Whatever outcomes our action is going to have,
● Refers to the peak level of your career we are answerable to that
● Gives you the utmost achievement in life with regards to
your career Professional Nursing
3. Harvest Stage When you talk about professional nursing, you talk about the
● 30-40 years following (Mnemonic: COST)
● Going to be with regards to your prime experience ● C- compensation
● If you exceed more than 40 years you will be considered as ○ We work because we want to be compensated
legacy clinicians because you are already an expert in the ○ As much as possible there must be compensation
field especially on your specific field of nursing because of work
● There are actually 301 careers in nursing (will not be ● O- opportunity/privilege
discussed, but we will rather talk about how to plan your ○ To be a nurse is a privilege, it is not given to all
career for your future) ● S- service orientation
Is Nursing a Profession or a Vocation? ○ In our heart, there has to be heart of service
When referring to a profession, there’s a mnemonic that you can because we focus more on rendering care to our
remember (EUT 😭): patient and at the same time, it will give us the
● E - extensive educational preparation opportunity to give it all without even counting the
○ Tells us that we are actually being trained, returns to it
mentored in order for us to achieve this level that ● T- task performance
we have now ○ It is expected that when you are going to have
● U - use of skills, knowledge, attitude your professional nursing, you are going to
● T - teaching, training, mentoring, coaching perform a task- that task must be evaluated by
○ When you talk about teaching, it is a profession your organization
because you have been taught of a knowledge
○ When you talk about training, it means that you Patricia Benner’s Level of Nursing Expertise
have been taught of a skill According to Patricia Benner, there are actually 5 levels of nursing
○ When you talk about mentoring, it means that you expertise (Mnemonic: NACPE)
are being evaluated because of your skill ★ The most common question in the board exam is about Patricia
○ When you talk about coaching, you have been Benner’s NACPE
coached and questioned-you have to defend (on ● N - novice (no experience)
that note, it implies that you have a body of ★ Common in the board exam, when you talk about
knowledge) novice, the keyword you are going to look for is
the word virgin, virgin nurse
When referring to a vocation, there’s another mnemonic you can ○ A virgin nurse is a novice nurse because it has no
remember (CDO): experience at all
● C - calling to serve ○ A beginner with no experience and is taught
○ Vocation implies that you have been called to general rules to help perform tasks
serve; to do this and to do that ○ Rules are context free, independent of specific
● D - desire is strong cases, and applied universally
● O - occupation ○ However, rules cannot express which task are
most relevant in life or when exceptions are
For Mr. Abang, Nursing is both a vocation and a profession because if needed
you are not being called to serve the sick in the sick room, of course ● A - advance beginner (at least 1)
you will not be able to provide the therapeutic touch that this patient ○ Common in the board exam, when you talk about
requires from you-that will actually be of help for their healing advance beginner, the keyword you are going to
look for is the word advancing education, enrolled
Criteria of a Profession in master’s degree programs
The following are the criteria to say that a particular thing is a ○ Has at least 1 year of experience
profession (Mnemonic: ABACADA): ○ Means that the focus is probably engaging into
● A- authority advanced education (the nurse may have
○ Means that is is considered to be a legitimate proceeded to graduate studies or enrolled in a
power master’s program)
○ When one is authorized, it means that we are ○ Demonstrates acceptable performance and has
obliged or authorized to perform gained prior experience in actual situations to
activities/interventions without the permission of recognize a recurring, meaningful proponents
the doctor- because of course we have our ○ Principles based on experience begin to be
independent nursing interventions formulated to guide actions
● B- body of knowledge ● C - competent (at least 2-3)
 ★ Common in the board exam, when you talk about ○ There is a need to assess if there is the presence of
competent, the keyword you are going to look for career development in the organization because it
is the word complex care is the basis if you are going to participate.
○ Experience is at least 2-3 years ● N-need to develop strategies
○ Typically a nurse with 2-3 years of experience and ○ Identifies whether or not training or the program
job in the same area or in similar day to day will benefit you as a professional
situations ● A-assess outside opportunities
○ They gain perspective from planning, on actions, ○ Very important because it will identify if this career
based on conscious, abstract, and analytical development is going to give you an opportunity
thinking- these help to achieve greater efficiency outside of the institution
and organization ● L-leads to making new plans
● P - proficient (at least 5) ○ Career development will usually help you in
★ Common in the board exam, when you talk about making new plans if you are going to move to a
proficient, the keyword you are going to look for is greener pasture or if you are looking for
the word holistic care opportunities that will compensate you better
○ It requires at least 5 years of experience compared to your current organization
○ Perceives and understands situations as a whole
○ Focus more on holistic understanding of an Organizational Roles and Responsibilities for Career Development
improved decision making These are the responsibilities of the organization, especially for the
○ Learn from experiences and what to expect in career development of their employees: (Mnemonic: ORGANISE)
certain situations and how to modify plans ● O-often disseminate career information
● E - expert (at least 10) ○ As much as possible, create and disseminate
★ Common in the board exam, when you talk about information to all employees in the institution
expert, the keyword you are going to look for is especially if there is a development or opportunity
the word intuitive; they have a clinical eye that is present
○ They will have at least 10 years of experience ● R-regular posting of all job openings
○ Expert nurses no longer rely on principles, rules, or ○ Job postings and hiring must be seen on the
guidelines to connect situations and determine bulletin board
actions ● G-give support and encouragement
○ Much more background of experience and has ○ Support and encourage the employees to (for
intuitive grasp of clinical situations example) apply for a managerial position
○ Performance is fluid, flexible, and highly proficient ● A-assess employees career needs
○ Assess needs on what they want for personal
Justifications for Career Development growth
Why do we need to have career development? (Mnemonic: JUSTIFY) ● N-needs provided for employee development
● J-justly reduced employee attrition ○ Make sure that training will be provided such as
○ Means that there will be a decrease in your in-service education
disappointments, discouragements, of the ● I-integrates employees and organizational needs
employees especially at work ○ Integrate them especially on the needs of the
○ This will help them plan for their future field of organization
expertise ● S-service related training
● U-usual equality of employment opportunity ○ To increase the employees’ expertise and keep
○ When you have your career development, that will them abreast of the trends, especially on their
give you justice competencies
● S-several opportunities for employees growth ● E-establish, design, implement career path
○ If there will be career development, it is essential ○ Ask employees regarding their career path in the
for you to have opportunities because it will help future9
in growing your competencies as a registered
nurse Career Coaching
● T-there is improved quality of work life Why is there a need for us to have career coaching?
○ If you have a good career development, it means ● Career coaching
that you will experience quality of life both ○ involves helping others to identify professional
personal and professional goals and career options, and then deciding a
● I-improved competitiveness career to better achieve those goals
○ Especially if you’re going to have your career ● Long-term career coaching
development, you are going to become ○ is a plan management action that occurs over the
competitive especially for those who are also in duration of employment
the field ○ If you are employed in an institution for this
● F-fosters new skills acquisition number of years, you are going to have this long-
○ Career development increases your skills and term career coaching
expertise ○ Because this type of coaching occurs or is covered
● Y-you promote evidence-based practice over a long time, it is frequently neglected and less
○ Means that you are expected to have career managers use a systematic scheduling plan and a
development form for documentation
What are the steps in Career Coaching?
Personal Roles and Responsibilities for Career Development 1. Gathering Data
Mnemonic: PERSONAL ● Gather data from the organization, whether there’s a need
● P-personally setting up goals for you to have this career coaching.
○ If you want to have career development, you have 2. Asking what is possible
to establish your own goal ● Ask what type of coaching is required or needed by the
● E-evaluate individual plan people in the organization
○ You have to make sure that your plan is properly 3. Conducting the coaching session
evaluated ● The coaching session is not about teaching them what to do
● R-re-emphasized actions based on plans but you are going to ask them and lead them towards their
○ You need to make sure that there is emphasis on career path
the actions based on what is planned
● S-self-assess interests, skills Management Development
○ If that interest is strong, that will direct you to the In management development, we have two things to remember:
development of this career development 1. In-service education
● O-organizational opportunity assessment ○ These are trainings, programs, activities that are
offered by your institution for free
 ○ Example: St. Joseph Medical City is offering a free 6. Infectious diseases - offered at San Lazaro Hospital, our
updates on CPR to all employees who belong to center for infectious diseases.
the code blue team 7. Orthopaedic and rehabilitation - offered at Philippine
2. Continuing education Orthopaedic Center.
○ In general, if you are participating in any program 8. Trauma and emergency - offered in the East Avenue Medical
that will improve your competency, that is Center.
continuing education 9. Operating room - offered in National Kidney and Transplant
○ In-service education can also be a continuing Institute and Philippine Heart Center.
education (but to differentiate, in-service 10. Anesthesia care - offered in the East Avenue Medical Center,
education is purely provided to the institution Philippine Heart Center, Quirino Memorial Center, and Jose
employing you) Reyes Memorial Medical Center.
○ For continuing education, this is offered outside The Department of Health Nurse Certification Program will be offered
the institution and you will be the one to pay for it to all Filipino Registered Nurses, as well as for nurses with special
○ You are participating in an activity outside of your temporary permit from the Professional Regulation Commission. These
organization and it is not free are the 10 specialty certification program here in the Philippines.
Many nurses feel that they lack the knowledge and experience
necessary to become a manager. That’s why it’s very important to Benefits of Professional Certification
have this management development to help people in an organization What does the professional certification do to us?
to have a background knowledge with regards to management. 1. C - common sense of accomplishment
● As much as possible, if you are participating in a
Continued Competency professional certification, you are going to have
● Refers to Continuing Professional Development (CPD) this self sufficiency and self accomplishment. It is a
● In our Republic Act No. 913, it is called our Continued form of an achievement on your part.
Professional Education or (CPE) but in Republic Act No. 2. E - experienced increased self-confidence
10912, otherwise known as the “Continuing Professional 3. R - revalidated competence
Development (CPD) Act of 2016,” it is referred to as CPD. ● This professional certification will actually improve
● CPD includes seminars or training that will be attended by your nursing competencies.
professional nurses as a basic requirement for the renewal 4. T - there is greater autonomy
of their license. ● That will increase your self determination and
● CPD Requirements authority.
According to CPD or RA 10192, 5. I - increased credibility
● General Transitory Period: The general transitory period is ● That is expected of you.
the implementation of this law started in 2017, and of 6. F - financially/salary incentives
course, if you are going to renew your license in that period, ● If you are participating in a certification program,
then you are required to submit at least 30% of the you might as well experience increase rate.
requirements. In 2018, 60%, then in 2019, 100%. 7. I - increased career opportunities
○ July - December 2017 (30%) ● Probably if you are in trauma nursing, that will
○ 2018 (60%) actually provide you with career opportunities to be
○ 2019 onwards (100%) part of the special areas.
Because of the pandemic, the CPD has been waived until December 8. E - empowered and more positive
2021. CPD or CPE more properly refers to trainings, which are linear ● Because of course, you know already what to do. You
and formal. Training objectives are usually focused on learning a are expected to be more empowered.
particular skill or set of skills to improve professional competence. 9. D - delivered improved patient outcomes
CPD refers to both training and knowledge, skills, attitude
development significantly relevant to capability and competency in Just remember, if you are talking about professional certification, our
one’s profession. PRC uses both terms, CPE and CPD. If you are talking goal here is to make sure that we will be able to deliver the best
about your CPE, probably that is talking about your training, such as possible quality of care that the patient needs from us. That is the
masters program. CPD that is gonna be for training. This is all about most important thing that we need to have especially when we talk
the general transitory period of your CPD requirement. about the benefits of having your professional certification program.

When it comes to the number of units required, this is also common in Reflective Practice & Professional Portfolio
the board, PRC Resolution… As much as possible, you have to have your portfolio with you or your
● Pursuant to Resolution No. 10 s. 2017 of PRBON form 201 or file 201 in your organization.
(Professional Regulatory Board of Nursing), the following is ● Reflective practice - actually gonna be a process or:
the transitory period for compliance: ○ Assessment of one’s own practice
○ Jan-Dec 2017: 0 units ○ Identify and seek learning opportunities to
○ Jan-Dec 2018: 15 units ○ Promotes continued competence
○ Jan-Dec 2019: 45 units Inherent in the process is the evaluation and incorporation of this
Of course you will be able to participate in trainings in different fields, learning into one’s practice. Self-assessment is gaining popularity as a
and of course you will be getting 5 units or 5 credit units for that and it way to promote professional practice and maintain competence.
will be accumulated until you reach 45 units. But of course, as what Of course, when you talk about reflective practice, that is one way of
was mentioned earlier, for this year for 2021 until December 2021, the assessing your own practice. At the same time, when you assess that,
credit units or CPD is actually waived. That is all about the CPD or you are going to identify and seek learning opportunities with that
continued competency. reflection, and of course, that will promote continued competence. Of
course, often it is done through the use of:
Professional Specialty Certifications in PH ● Professional portfolio - for competence and assessment. And
We will not talk about professional certifications outside of the of course professional portfolio, which all nurses should
country, but we focus more in the Philippines. There are 10 maintain especially in your form 201 can be described as:
professional certifications in the Philippines, which was launched by ○ Collection of materials that document
the Department of Health last September 24, 2013, and this is a competencies or skill competencies and also…
certification program. ○ Illustrate nurse expertise
1. Cardiovascular - offered in the Philippine Heart Center. You This professional portfolio will typically contain a number of core
are going to receive certification for that. components such as your biographical information; educational
2. Renal - offered in the National Kidney Transplant Institute or background; certifications achieved; your employment history;
the NKTI. resume; and competence record or checklist; personal and professional
3. Pulmonary - focus of this is in the Lung Center of the goals; professional development experiences; presentation
Philippines. consultations; and publications; professional and community activities;
4. Mental health - offered in the National Center for Mental honors and awards; letters of thanks from patients, families, peers,
Health. organizations, and others. That is part of your professional portfolio
5. Maternal and child - offered at Dr. Jose Fabella Memorial which is gonna be derived after you are going to have your reflective
Hospital. practice.
Career Planning & The New Graduate Nurse ○ You are selling yourself when you are creating your
It is very important to have a career plan. As much as possible when resume. As much as possible you must create the
you finish your course, you are need to pass the board examination. most positive image of yourself.
These are the criteria for you in the selection of your employers. ● S - Somewhat distinguishes self from the masses of
● First employment selection is based on: applicants
○ Strong reputation - look for the credibility ○ This resume is also very important because it
○ Shared governance distinguishes your edge from the other applicants
○ Positive work cultures - the work culture really who are also applying for this position.
affects the people working in the organization. ● U - Usually decisions for promotion is made
○ Reputation of excellence ○ Based on your updated resume, it will also be the
● Functions of mentors/preceptors basis of your promotion.
○ High quality role model ● M - Makes impression to employers why you are special.
○ Evidence-based decision making ○ This will provide the employer with the impression
○ Sound clinical practice of why they need to hire YOU.
As much as possible, there have to be these characteristics for your ● E - Ensure current & professionally made
mentors and preceptors. ○ You have to make sure that you have an updated
There was a question when you talk about the employment in the resume with you always because this will give us
board examination: How long wil you stay with your first employment? the opportunity to say that you are improving
At least 2 years. The first year is adjustment, and the second year is yourself professionally because you have
looking for greener pastures. participated with trainings, programs, and
activities that will increase your self-sufficiency.
New Graduate Participation in Professional Associations
When you talk about new graduate participation in professional Resume Guidelines
associations, there are associations that you need to be a member of. ● R - Resume is 1-2 pages long
But the most common question of the board examination is: What are ○ As much as possible, it has to be limited to this.
organization/association should a graduate nurse be a member of Compared to your curriculum vitae, wherein the
(pinaka first)? number of pages is varied, for a resume it has to
● Alumni association - not a professional association, but it is be 1-2 pages only.
an association wherein the professional should have to be a ● E - Ensure clear & concise writing
member of, especially because it will give them the altruism ○ As much as possible, there has to be no flowery
or solidarity of the graduates of the school. words, make it direct to the point.
● Philippine Nurses Association (PNA) - the accredited ● S - Specify the desired job
professional organization (APO) and all newly registered ○ What you are applying for (staff nurse, chief
nurses are required to be a member of PNA. We have to be a nurse).
member of PNA because this is for the welfare of the Filipino ● U - Use single font easy to read (font size 12)
nurses in the Philippines and outside of the country. There ○ Ideally font size 12, standard formal Arial or Times
are so many organizations in the Philippines that pertain to New Roman.
nurses. Of course, they have to be accredited by the PNA. ● M - Make use of bullets
● Association of Deans of Philippine Colleges of Nursing ○ As much as possible, make sure it is in bullet form,
(ADPCN) - this is an association of deans of the colleges of not paragraphs. Because if it is in paragraphs, that
nursing in the Philippines. will actually be very difficult for the employers to
● Association of Nursing Service Administrators of the read.
Philippines (ANSAP) - this is an association for those ● E - Elaborate qualifications
occupying a managerial position in the hospital. ○ As much as possible, you have to elaborate your
● National League of Philippine Government Nurses (NLPGN) - experiences because it is the basis of your
this will be those working in public institutions. employers to hire you especially on the specific
● Operating Room Nurses Association of the Philippines position.
(ORNAP) ● G - Generally not requiring personal information
I will be attaching a link or file that contains a list of other ○ You don’t need to put your sex, gender, age,
organizations in the Philippines that are accredited by the PNA (wala address, religion, and vital statistics on your
sa PLP section sa E-Learn zzz). resume. Get rid of that as much as possible.the
most important thing to include is your complete
Transition to Practice Programs name and contact details.
There are studies being conducted in which they are comparing ● U - Unify strong points
graduates of nursing to those who, after passing the board ○ As much as possible, focus on your strength
examination, will immediately work as registered nurses. If you are because that will actually let the employer have
going to compare that with those in the medical field or in medicine, the impression that this is the best candidate for
they will still have their residences, externships, and internships. So this position.
there is a debate that is ongoing right now, especially if the new ● I - Introduce accomplishments properly
graduate nurses will have their residences, externships, and ○ As much as possible, you are going to introduce
internships prior to the board. examination. But this is a very long you have been awarded or achieved an award
process and there is ample time for deliberation before (Dean’s lister, board topnotcher).
implementation. ● D - Do utilize good grammar
● Residences ○ There are some applications nowadays which you
● Externships can actually use to check the grammar of your
● Internships output.
● E - Eliminate confidence inspiring words
Resume Preparation ○ Because that is already very common (gasgas pas
As of this time, we are done with the preparation of the career gasgas).
planning. We are now going to focus on how you are going to ● L - Look for heavy white paper
formulate your resume. ○ As much as possible use WHITE paper.
The Difference between a Resume and a Curriculum Vitae: ● I - Include splash of colors
1. Curriculum Vitae - this presents a full history of your ○ Employ your creativity and innovativeness in the
academic credentials. The length of your document is creation of your resume.
variable. ● N - Need to have a cover letter
2. Resume - presents a concise picture of your skills and ○ It is accompanied by this. This will tell us that you
qualifications for specific positions. The length tends to be are interested in applying for such a position.
shorter and dictated by years of experience. According to the ● E - Express professional goal
board examination, resume has to be 1-2 pages only. ○ Expressing professional goals such as when you
● R - Representation of oneself are going to be accepted, you are going to grow,
○ You have to make sure that that represents you. or stay in that organization for that period of time.
● E - Ensures creating a positive image ● S - Sure only to list people whom you know well
 ○ For the references, put in there people you've
known well for the past 2-5 years.
○ Do not include anymore people whom you do not
talk to anymore. Because when the employer calls
this reference person, the person might tell them
na di na kayo nagkikita, then there might be a
problem.
A common question in the board examination here is when you are
going to have your interview, what will you wear? Formal attire or
semi-formal attire.
● Choices are: type a uniform (white uniform), scrub suit. But
when you go to an interview wear formal or semi-formal
always.

Integrating Leadership Roles and Management Functions in Career

Planning & Development
LEADERSHIP
● C - Consider own values to career decisions
○ Very important to make sure we have our own
beliefs and practices that guides our decision-
making.
● A - Allows genuine interest in career development
○ As much as possible, you have to be genuine. You
have to have a strong desire to grow. Especially in
your career.
● R - Rewarded present leader during training
○ As much as possible, there is going to be a reward
if you are to participate in a training program.
● E - Encouraged potential leaders
○ This career planning encourages potential leaders,
especially for them to assume their future roles.
● E - Empower advance in career
○ Have their specialties or certification programs.
● R - Re-develop leadership skills
○ This is one way of making sure that they are going
to possess the best leadership skills required for
the position.

MANAGEMENT
● C - Career information dissemination
○ Very important for everyone to know.
● A - Allot time in posting job opening
○ That will actually further the recruitment process.
● R - Requires developed system
○ For the hiring and staffing needs.
● E - Ensures career development
○ For people in your unit or in your institution.
● E - Encourage long term coaching
○ Involve people in career coaching.
● R - Reconsider transfers
○ It means that if you want to be transferred to a
specialized unit, or specialized department, then
that is going to be part of your management
function especially on the career development
aspect.