Prepared by:Adrian R. Adriano, R.N., R.M., M.A.N.
An interpersonal process to effect change on the behavior of others Process by which a nurse influence one or more person to achieve specific goals in the provision of nursing care in one or more patients The process of envisioning a new and better world, communicating that vision to others, motivating others and enticing them to join in efforts to realize the vision, thinking in a different way, challenging the status quo, taking risks, and facilitating change.
Often do not have delegated authority but obtain their power through other means, such as influence Have a wider variety of roles than managers do May or may not be a part of the formal organization Focus on group process, information gathering, feedback, and empowering others Emphasize interpersonal relationships Direct willing followers Have goals that may or may not reflect those of the organization.
Great Man Theory ◦ Asserts that some people are born to lead, whereas others are born to be led ◦ This theory assumed that all leaders were men and all were great (i.e of the noble class).
Trait Theory ◦ Assume that some people have certain characteristics or personality traits that make them better leaders than others ◦ Studies revealed that these leaders possessed multiple characteristics of commonalities.
Charismatic Theory ◦ Possession of a quality that sets one person apart from others: supernatural, superhuman, endowed with exceptional qualities or powers ◦ Theses qualities are said to be magnetic, persuasive and fascinating.
Situational Theory ◦ Embodies the idea that the right thing to do depended on the situation the leader was facing ◦ Involves assessing the nature of the task and the follower‟s motivation or readiness to learn.
Transformational Theory ◦ The true nature of leadership is not the ability to transform followers to become more self-directed in all they do. ◦ “Look for potential motives in followers, seek to satisfy higher needs, and engage the full person of the follower”.
Behavioral Theory ◦ Also called functional theories theory ◦ Concerned with what a leader does rather than who the leader is.
Autocratic Leadership ◦ Also known as Authoritarian/Directive ◦ Strong control is maintained over the work group ◦ Others are motivated by coercion ◦ Others are directed with commands ◦ Communication flows downward ◦ Decision making does not involve others ◦ Emphasis is on difference in status (“I” and “YOU” ◦ Criticism is punitive .
Democratic Leadership ◦ Also called Participative ◦ Less control is maintained ◦ Economic and ego awards are used to motivated ◦ Others are directed through suggestions and guidance ◦ Communication flows up and down ◦ Decision making involves others ◦ Emphasis is on “WE” rather than “I” and “YOU” ◦ Criticism is constructive.
Laissez-Faire Leadership ◦ Also called Ultraliberal/Permissive ◦ Permissiveness, with little or no control ◦ Motivation by support when requested by the group or individuals ◦ Provision of little or no direction ◦ Communication upward and downward flow among members of the group ◦ Emphasis on the group ◦ Criticism is withheld.
Formal or Informal Formal Leaders ◦ Appointed by organization and given office or legitimate authority to act Informal Leaders ◦ Don‟t have official power to direct activities of others ◦ Mostly based on seniority.
Reward Power ◦ Based upon the incentives the leader can provide for group members to influence behavior by granting rewards.
Coercive Power ◦ Based in influencing behavior through the negative things a leader might do to individual group members or the group as a whole by withholding rewards or applying sanctions ◦ The manager may obtain compliance through threats of transfer, layoff, demotion, or dismissal.
Legitimate Power ◦ Power of position ◦ Authority is called legitimate power ◦ Power gained by a title or official position within an organization ◦ Legitimate power has inherent in it the ability to create feelings of obligation or responsibility.
Referent Power ◦ The power a person has because others identify with the leader or with what the leader symbolizes ◦ Also occurs when one gives another person feelings of personal acceptance or approval ◦ Perception based on personal charisma, the way the leader talks or acts, the organization to which he or she belongs, or the people with whom he or she associates.
Expert Power ◦ Based upon particular knowledge and skill not possessed by staff members ◦ Gained through knowledge, expertise, or experience ◦ This type of power is limited to a specialized area.
Informational Power ◦ Based upon “who knows what” in an organization and the degree to which they can control access to that information by other individuals ◦ Obtained when people have information that others must have to accomplish their goals.
Self Power ◦ Also referred to as feminist power ◦ The power a person gains over his or her own life – and maintains that this power is a personal power that comes from maturity, ego, security in relationships, and confidence in one‟s impulse.
UNPLANNED CHANGE vs PLANNED CHANGE Unplanned Change ◦ Usually haphazard and the results can be unpredictable ◦ Example: Change as a result of natural disaster Planned Change ◦ Change that results from a well thought-out and deliberate effort make something happen ◦ Intended, purposive attempt by individual, group and organization.
COVERT vs OVERT Covert Change ◦ Is hidden or occurs without the individual‟s awareness Overt Change ◦ Change about which a person is aware.
Kurt Lewin ◦ Identified three phases through which the change agent (a person skilled in the implementation of planned change) must proceed before a planned change becomes part of the system and recognize forces which interplay any potential change Driving forces – factors that encourage or facilitate the change Restraining forces – factors that obstruct change.
Unfreezing ◦ The change agent unfreezes forces that maintain the status quo ◦ People become discontented and aware of a need to change ◦ Necessary because before any change can occur, people must believe the change is needed ◦ Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited.
Moving ◦ The change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces ◦ Because change is such a complex process, change should be implemented gradually therefore it requires a great deal of planning and intricate timing.
Refreezing ◦ During this stage, the change agent assists in stabilizing the system change so it becomes integrated into the status quo ◦ If refreezing is incomplete, the change will be ineffective and the pre-change behaviors will be resumed ◦ Because change needs at least 3 to six months before it will be accepted part of the system, change should never be attempted unless the change agent can make a commitment to be available until the change is complete.
Moving Unfreezing Develop a plan ◦ Gather data Set goals and objectives ◦ Diagnose the problem Identify areas of support and ◦ Decide if change is needed resistance Include everyone who will ◦ Make others aware of the be affected by the change need change Set target dates Develop appropriate strategies Refreezing Implement the change Support others so the Use strategies to overcoming resistance change remains. Evaluate the change Modify the change, if necessary
Equilibrium ◦ Characterized by high energy and emotional and intellectual balance Denial ◦ Individual denies reality of the change. Negative changes occur in physical, cognitive, and emotional functioning Anger ◦ Energy is manifested by rage, envy, and resentment Bargaining ◦ In an attempt to eliminate the change, energy is expended by bargaining Chaos ◦ Characterized by diffused energy, feelings of powerlessness, insecurity, loss of identity.
Depression ◦ Defense mechanisms are no longer operable. No energy left to produce results Resignation ◦ Change accepted passively but without enthusiasm Openness ◦ Some renewal of energy in implementing new roles or assignments that have resulted from the change Readiness ◦ Willful expenditure of energy to explore new event Reemergence ◦ person again feels empowered and begins initiating projects and ideas.
Innovators ◦ Enthusiastic, energetic people who thrive on change Early adopters ◦ Open top receive new ideas but are less obsessed to changes Early majority ◦ “Be not last to start, nor the first by which the new is tried”.
Late majority ◦ Skeptical to innovations, frequently express their negative views Laggards ◦ Last to adopt an innovation because they are accustomed to tradition Rejecters ◦ Openly oppose innovation and actively encourage others to do so.
The tendency for something to resist change even when a surprisingly large amount of effort is applied.
Process of reaching organizational goals by working with and through people and other organizational structures Series of systematic, sequential, or steps directed towards the achievement of organizational goal The process of planning, organizing, directing , coordinating and influencing the operation of an organization to obtain desired result and enhanced total performance.
Top Level Managers ◦ Develop goals, strategic plans, company policies, and make decisions on the direction and make decisions on the direction of the business ◦ Board of directors, presidents and vice presidents.
Middle Level Managers ◦ Accountable to the top management for their department‟s functions and devote more time to organizational and directional function ◦ Directors of nursing, supervisory staff, department heads.
First Level/Front Line Managers ◦ Focus on controlling and directing, possess the responsibility of assigning tasks, guiding and supervising employees‟ day to day activities ◦ Head nurse.
Interpersonal ◦ Connects one person to another, as a leader who hires, trains, encourages ◦ Figurehead ◦ Liaison ◦ Influencer.
Informational ◦ Disseminates about existing rules and regulation as the representative or spokesperson of the organization ◦ Monitor ◦ Disseminator ◦ Spokesperson.
Decision Role ◦ A trouble shooter who handles unexpected situations such as resignation of subordinates, firing and losses clients and negotiator when conflict arise ◦ Entrepreneur ◦ Disturbance handler ◦ Resource allocator ◦ Negotiator.
Technical Skills ◦ Proficiency in performing an activity in the correct manner with the right techniques Human relation Skills ◦ Dealing with people and how to get along with them Conceptual Skills ◦ Ability to see individual matters as they relate to the total picture and to develop creative ways.
Scientific Management ◦ Frederick Winslow Taylor known as the father of scientific management ◦ Focuses on principles on increasing the productivity of workers based on managing time, materials, and work specialization based on scientific manner ◦ Tao – get right person ◦ Training ◦ Tool ◦ Treatment.
Behavioral Theories ◦ Elton Mayo known for his HAWTHORNE EFFECT ◦ Believes that increasing employees productivity deals with overtime pay, rest day, day off ◦ Provides physical needs of workers like rest and recreation.
Bureaucratic Management ◦ Max Weber a German sociologist who developed what was known as the “ideal bureaucracy” ◦ Whoever is on top would perform management functions ◦ Centralized.
General Administrative Theory ◦ Henri Fayol believes in certain principles of management ◦ Unity of command ◦ Unity of direction ◦ Subordination ◦ Esprit de corps ◦ Chain of command ◦ Channels of communication ◦ Command responsibility ◦ Security of tenure ◦ Remuneration.
Japanese Management Style ◦ The theory Z of William Ouchi who introduced Japanese management to the western world ◦ He believes in lifetime management, slow evaluation and promotion, collective decision making, collective responsibility, and holistic concern for employees.
Theory X and Y ◦ Formulated by Douglas McGregor who believes that there two types of employees ◦ Theory X is the negative worker ◦ Theory Y are positive workers.
Motivation-Hygiene Theory ◦ Also called two-factor theory formulated by Frederick Herzberg Intrinsic (Motivator) – growth, advancement, responsibility, work itself, recognition, achievement Extrinsic (Hygiene) – status, relationship with subordinates, personal life, work conditions, and administration.
Planning ◦ Determining the long-term and short-term objectives (ends) of the institution or unit and the actions (means) that must be taken to achieve these objectives ◦ The first and fundamental function of management because all other management functions are dependent on it ◦ Deciding what is done, when it is done, how it is done and who is to do it.
Long-term Planning ◦ Strategic planning are specified for three to five years ◦ Determine the direction of the organization, allocates resources and determine time frame ◦ Done by top managers ◦ Involves SWOT analysis (Strength, Weakness, Opportunities, and Threat).
Intermediate Planning ◦ 6 months to 3 years ◦ Done by the middle manager.
Short Range ◦ Deals with the day to day maintenance activities ◦ Done by the first level manager.
Mission – a brief statement identifying the reason that an organization exists Vision – the future aim or function of the organization Philosophy – states the purpose and delineates the set of values and beliefs that guide all actions of the organization Goals – ends to be accomplished Objectives – something aimed at or strived for things done to achieve goal Rules and regulations – plans that define specific action or non-action.
A plan for all the allocation of resources and a control for ensuring that results comply with the plans.
Capital Budget ◦ Estimates of expenditure for adding, replacing or improving buildings or equipments for the budget period ◦ Buildings, major equipments.
Operating Budget ◦ Also known as recurrent budget which is the estimates of operating expenses, estimates of operating revenues, and estimates of activity ◦ Supplies, electricity expenses, water expenses, repairs and maintenance.
Cash Budget ◦ Also referred to as cash-on-hand and petty cash ◦ Budget planned to make adequate funds available as needed and to use any extra funds.
Personnel Budget ◦ Also called labor budget ◦ Budget which estimates the cost of direct labor necessary to meet the organization‟s objectives ◦ It includes recruitment, hiring, assignment, lay off and discharge of personnel.
Terminologies ◦ Cost Containment – to keep cost within acceptable limits for volume, inflation, and other acceptable parameters ◦ Cost Awareness – focuses on employees‟ attention on cost ◦ Cost Monitoring – focuses on how much will be spent, where, when, and why.
The act of planning and exercising conscious control over the amount of time spent on specific activities ◦ TIME IS A NON-RENEWABLE RESOURCE ◦ Set goals ◦ Ranked goals and plan strategies to achieve them ◦ Plan schedule.
Principle of Time Management ◦ Effective communication ◦ Ability to plan effectively ◦ Delegation Efficiency – doing the right task Effectively – doing the right task correctly.
Organizing ◦ Mobilizing human and material resources so that institutional objectives can be achieved ◦ The arranging of component parts into functioning wholes.
An organization is a group of people working together, under formal and informal rules of behavior, to achieve a common purpose.
An organizational chart provides the „blueprint‟ of depicting formal relations, functions, and activities Used to clarify chain of command, span of control, official communication process, and linkage for all department personnel.
Interconnecting lines ◦ Line – indicates direct authority or command giving relationship ◦ Broken line – indicates consulting relationship with no prescribed frequency of the structure to collaborate for planning or control purpose.
Status – rank given to person Accountability – the internalized responsibility whereby an individual agrees to be morally for the consequences of his actions Responsibility – the obligation to perform the assigned tasks Authority – the official power to act Power – capacity to act or potency to accomplish something.
Unity of Command - there can only be one superior to avoid confusion Scalar Principle – flow from higher to lower authority Departmentalization- grouping of workers with similar assignment Span of Control – number of people that can be directly supervised (4-6) Decentralization – proper delegation of authority.
The management activity that provides for appropriate and adequate personnel to fulfill the organization‟s objectives The nurse manager decides how many and what type of personnel are required to provide care for patients.
Centralized chief nurse– done by the Decentralized – done by supervisors or head nurse Cyclical – covers a designated number of weeks and repeated there on.
Patient Care Classification ◦ Level I – (minimal) for discharge/convalescing patient ◦ Level II – (moderate) needs some assistance of activities of daily living ◦ Level III – (complete) completely dependent; those who need close attention throughout the shift ◦ Level IV – (specialized) continuous monitoring .
Total patient care/case method ◦ The oldest mode of organizing patient care ◦ Nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients.
Primary Nursing/relationship-based nursing ◦ Nursing care directed by a nurse in a 24-hour basis ◦ Increase job satisfaction, improves continuity of care, allows independent decision making, supports direct nurse-client communication, encourages discharge planning, improves quality care ◦ Increase personnel costs, requires properly trained nurses to carry out system principles.
Functional Nursing ◦ Task oriented and very useful in emergency situation ◦ Reduces personnel costs ◦ Fragments nursing care, decreases job satisfaction, decrease personal contacts with patients, limits continuity of care.
Team Nursing ◦ One nurse will lead a group of nurses ◦ Increases job satisfaction, increase cost effectiveness ◦ Decreases personal contact with client, limits continuity of care.
Case Management ◦ Focuses on attainment of outcomes within effective time frame by a case manager and this is done prior to admission and spans for about 2-3 weeks discharge ◦ Improves nurse responsiveness to clients changing needs, improves continuity of care, increase nurse‟s job satisfaction ◦ Increase personnel costs.
The study of how people perform and function within a group structure The group becomes a unit when it shares a common goal and acts in union to either achieve or thwart the accomplishment of the goal ◦ Primary Groups – composed of individuals who interact on “face-to-face” basis, and the relationships are personal ◦ Secondary Groups – are larger and more impersonal groups who are organized around formal rules, procedures, policies and other regulations.
Aggressor - expresses disapproval of others‟ values or feelings through jokes, verbal attacks, envy Blocker – Persists in expressing negative points of view and resurrects dead issues Recognition Seeker – works to focus positive attention on himself Playboy – remains uninvolved with everything Dominator – attempts to control and manipulates the group Help Seeker – use expressions of personal insecurity, confusion, or self-deprecation.
Forming – during the initial stage the group forms and learns the behavior acceptable to the group Storming – as the group becomes more comfortable with one another they begin to assert their individual personalities Norming – the conflicts that arouse in the previous stages are addressed and hopefully resolved Performing – is a stage by which a group begins to operate as a unit Adjourning – is a time for a temporary group to wrap up activities.
Stimulate the production and generation of creative ideas of groups ◦ Generate new ideas about an issue ◦ Welcomes free thinking and facilitate open expression ideas ◦ Withhold any evaluation or criticism of the ideas that are expressed ◦ Build and improve on ideas already expressed.
Directing ◦ The function of the manager that gets work done through others which involves giving direction, supervising, leading, motivating, and communicating.
Transferring a tasks to a component individual What Cannot Be Delegated ◦ Overall responsibility, authority, accountability, and completion of all activities in the unit ◦ Authority to sign one‟s name ◦ Jobs that are too technical ◦ Sterile procedure ◦ Initial and terminal assessment ◦ Unstable patient.
Right person Right task Right amount of time Delegate in advance Delegate gradually Consult first before delegating Avoid gaps and overlaps .
Decision Making ◦ A choice made between two or more alternatives wherein the manager chooses the best alternative to reach the predetermined objective.
Ends-Means ◦ Ends – deals with the determination of desired individual or organizational results to be achieved ◦ Means – decisions deal with strategic or operational programs, activities that will accomplish desired results.
Administrative-Operational ◦ Administrative – decisions made by senior management, which have significant impact throughout the organization ◦ Operational – generally made by mid level and first line managers and address day to day operational activities of a particular organization.
Programmed-Non-programmed ◦ Programmed – repetitive and routine in nature ◦ Non-programmed – unique and non-routine.
The transfer or information and understanding from one person to another ◦ Verbal – use of spoken words ◦ Non-verbal – facial expressions, gestures, body language and touch.
Ideation – the idea or thought to be conveyed to an individual or group Encoding – the manner in which the message is conveyed Transmission – actual expression of the message Receiving – the manner in which the receiver gets the message Decoding – receivers understanding of the message Response – or feedback.
Elements of communication ◦ Sender – a person or group who wishes to convey a message to another ◦ Message – that which is being conveyed ◦ Receiver – the listener, observer ◦ Feedback – response, message that the receiver returns to the sender.
Vertical Communication ◦ Downward – information and other types of communication are sent by superiors to subordinates ◦ Upward – when employees or managers who are subordinate to top level management send message up through the chain of command Horizontal Communication ◦ When people communicate on the same level in the organization structure Diagonal Communication ◦ Interactions of different levels in the organization.
Formal Communication ◦ Follows the formal line of authority in the organization‟s hierarchy Informal Communication ◦ Occurs between people at the same or different levels of the organizational hierarchy but do not represent formal lines of authority.
Proxemics – the study of distance between people in their interaction ◦ Intimate – physical contact – 1.5 ft ◦ Personal – 1.5 – 4 ft ◦ Social – 4 – 12 ft ◦ Public – 12 ft and beyond.
Assertive ◦ Says directly and clearly what is on your mind based on self- respect and consideration for other people Passive ◦ Communicating viewed as being uninvolved or unable to share thoughts which may be withdrawn, shy or purposely withholding Aggressive ◦ Concerned only with the rights of one position and may be loud, inappropriate, confronting or hostile.
Clarify your ideas before communicating to others Consider the setting, both physical and psychological Consult with others when necessary to be exact and objective Be mindful of the overtones as well as the message itself Take the advantage to convey something to help, value, or praise the receiver Follow up your communication Be sure your actions support communication Be an active listener Give credit for the contributions of others Be assertive when expressing your views.
An expressed struggle between at least two interdependent parties, who receive incompatible goals, scarce rewards, and interference from the other party in achieving their goals.
Win-Lose ◦ It is not the optimal way of resolving conflicts because one of the participants losses Lose-Lose ◦ The strategy which everyone would like to avoid, lose-lose is not an intentional choice, but they end up with this outcome when other strategies fail Win-Win ◦ Strategy which allows both individuals to feel they have accomplished all or part of their goal.
Intrapersonal ◦ Conflict within an individual Interpersonal ◦ Those that arise between two individuals Intragroup ◦ Those that arise from the members of the same group Intergroup ◦ Those that arise between groups.
Methods employed to resolve or suppress a conflict by all parties‟ agreement or else by the defeat of one party.
Avoidance ◦ A style characteristic of individuals who are passive and who do not want to recognize a conflict ◦ These person generally prefer to ignore conflict situations rather than confront them directly.
Competition ◦ A conflict style characteristic of individuals who are highly assertive about pursuing their own goals but uncooperative in assisting others to reach their goals ◦ These individuals attempt to resolve a struggle by controlling or persuading others in order to achieve their own ends.
Accommodation ◦ A conflict style that is unassertive but cooperative ◦ Attends very closely to the needs of others and ignores his or her own needs ◦ A way for individuals to move away from the uncomfortable feelings of struggle that conflict inevitably produces.
Compromising ◦ Compromise is a positive conflict style because it requires that individuals attend to others‟ goals as well as their own ◦ Compromise reminds us of the golden rule: “Do unto others as you would have them do unto you”.
Collaborating ◦ The most preferred of the conflict styles, which requires both assertiveness and cooperation ◦ It involves attending fully to other‟s concerns while not sacrificing or suppressing one‟s own concern ◦ Although this is the most preferred style, it is still the hardest to achieve.
Conflict Resolution ◦ Smoothing ◦ Other persons are involved trying to “smooth” the conflict to reduce emotional component of the conflict.
Controlling ◦ The regulation of activities in accordance with the plan which ensures that the tasks to be accomplished is appropriately executed.
Performance Appraisal ◦ A systemic review of an individual employee‟s performance on the job, which is used to evaluate the effectiveness of his/her work using: ◦ Rating scales ◦ Checklist ◦ Peer review ◦ Ranking ◦ Patient survey ◦ Management by objective.
System Standard ◦ Refers to the instrumentalities like equipment and setting Process Standard ◦ Refers to the nursing care given to clients Outcome Standard ◦ Refers to the desired results.
A process of continuously improving a system by data gathering Total quality management – involvement of all employees in the improvement of the quality of every product or service Benchmarking – comparing your institution with the best.
Quality Assurance ◦ Evaluation of services to make sure that it meets the standard ◦ Nursing audit – review of patients chart ◦ Peer review – evaluation between staff nurses ◦ Quality circle – a group of workers who meet regularly under the leadership of a supervisor who analyze and solve work related problems.
The manager administers; the leader innovates The manager maintains; the leader develops The manager focuses on system and structure; the leader focuses on people The manager relies on control; the leader inspires trust The manager has short-range view; the leader has long- range perspective The manager asks how and when; the leader asks what and why.
The manager has his eye on the bottom line, the leader has his eye on the horizon The manager accepts the status quo; the leader challenges it The manager is the classic good soldier; the leader is his own person The manager does things right; the leader does the right thing.