Nursing Leadership and Management

JOFRED M. MARTINEZ, RN, MAN NG Review and Training Center, Inc. Iloilo City, Philippines

CONCEPTS, PRINCIPLES, THEORIES AND METHODS OF DEVELOPING NURSING LEADERS AND MANAGERS IN THE HOSPITAL AND COMMUNITY-BASED SETTINGS

The act of influencing and motivating a group of people to act in the same direction towards achieving a common goal.

The process of leading and directing an organization to meet its goals through the use of appropriate resources.

LEADERSHIP

MANAGEMENT

• do not have delegated authority • legitimate source of power due but obtain their power through to the delegated authority other means, such as influence • focus on group process, • emphasize control, decision information gathering, feedback, making, decision analysis, and and empowering others results • have goals that may or may not reflect those of the organization

• greater formal responsibility and accountability for rationality and control than leaders

scientific management”

“father of

Four overriding principles of scientific management: 1. Traditional “rule of thumb” means of organizing work must be replaced with scientific methods.

2. A scientific personnel system must be established so that workers can be hired, trained, and promoted based on their technical competence and abilities. 3. Workers should be able to view how they “fit” into the organization and how they contribute to overall organizational productivity.

Four overriding principles of scientific management:

4. The relationship between managers and workers should be cooperative and interdependent, and the work should be shared equally.

Theory of Social and Economic Organization Bureaucracy • Need for legalized, formal authority and consistent rules and regulations for personnel in different positions

• Henri Fayol (1925), first identified the management functions of planning, organization, command, coordination, and control.

• Luther Gulick (1937) expanded on Fayol’s management functions in his introduction of the “Seven Activities of Management” planning, organizing, staffing, directing, coordinating, reporting, and budgeting.

• Mary Parker Follett (1926) was one of the first theorists to suggest participative decision making or participative management. • Managers should have authority with, rather than over, employees.

• Elton Mayo and his Harvard associates (1927-1932), look at the relationship between light illumination in the factory and productivity. • Hawthorne effect indicated that people respond to the fact that they are being studied, attempting to increase whatever behavior.

• Douglas McGregor (1960), X and Theory Y, posited that managerial attitudes about employees can be directly correlated with employee satisfaction.

Theory X managers believe that their employees are basically lazy, need constant supervision and direction, and are indifferent to organizational needs.

Theory Y managers believe that their workers enjoy their work, are self-motivated, and are willing to work hard to meet personal and organizational goals.

• Chris Argyris (1964), managerial domination causes workers to become discouraged and passive. • If self-esteem and independence needs are not met, employees will become discouraged and troublesome or may leave the organization.

THEORIST Taylor Weber Fayol Gulick Follet Mayo Mcgregor Argyris

THEORY Scientific management Bureaucratic organizations Management functions Activities of management Participative management Hawthorne effect Theory X and Y Employee participation

• The Great Man Theory, from Aristotelian philosophy, asserts that some people are born to lead, whereas others are born to be led. • Great leaders will arise when the situation demands it.

• Trait Theories assume that some people have certain characteristics or personality traits that make them better leaders than others.

Democratic Leader exhibits the following behaviors: • Less control is maintained. • Economic and ego awards are used to motivate. • 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.

Authoritarian Leader characterized by the following behaviors: • 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.

Laissez-faire Leader characterized by the following behaviors: • Is permissive, with little or no control. • Motivates by support when requested by the group. • Provides little or no direction. • Uses upward and downward communication between members of the group. • Disperses decision making throughout the group. • Places emphasis on the group. • Does not criticize.

• Fiedler’s (1967), Contingency Approach, suggests that no one leadership style is ideal for every situation. • Interrelationships between the group’s leader and its members were most influenced by the manager’s ability to be a good leader.

• Hersey and Blanchard (1977), developed a Situational Approach to leadership. • Tridimensional leadership effectiveness model predicts which leadership style is most appropriate in each situation on the basis of the level of the followers’ maturity. • As people mature, leadership style becomes less task focused and more relationship oriented.

• Burns (2003), suggest that both leaders and followers have the ability to raise each other to higher levels of motivation and morality. There are two primary types of leaders in management. • The traditional manager, concerned with the day-to-day operations, was termed a transactional leader. • The manager who is committed, has a vision, and is able to empower others with this vision was termed a transformational leader.

TRANSACTIONAL LEADER Identifies common values Is a caretaker Inspires others with vision Has long-term vision Looks at effects Empowers others

TRANSFORMATI0NAL LEADER Focuses on management tasks Is committed Uses trade-offs to meet goals Does not identify shared values Examines causes Uses contingency reward

Kouzes and Posner’s Five Practices for Exemplary Leadership

Kouzes and Posner’s Five Practices for Exemplary Leadership

Gardner (1990) asserted that integrated leader-managers possess six distinguishing traits:

THEORIST

THEORY

Aristotle Lewin and White Fiedler Hersey and Blanchard

Great Man theory Leadership styles Contingency leadership Situational leadership theory Transactional and transformational leadership The integrated leader-manager

Burns Gardner

• Power is defined as the capacity to act or the strength and potency to accomplish something. • The manager who is knowledgeable about the wise use of authority, power, and political strategy is more effective at meeting personal, unit, and organizational goals.

• Reward power is obtained by the ability to grant favors or reward others with whatever they value. • Punishment or coercive power is based on fear of punishment if manager’s expectations are not met. • Legitimate power is the power gained by a title or official position within an organization. • Expert power is gained through knowledge, expertise, or experience.

• Referent power is power that a person has because others identify with that leader or with what that leader symbolizes. Charismatic power is distinguished by some from referent power. • Informational power is obtained when people have information that others must have to accomplish their goals.

MODES OF PLANNING

Reactive Inactivism Preactivism Interactive or Proactive

DESCRIPTION

occurs after a problem exists seek the status quo utilize technology to accelerate change and are future oriented attempt to plan the future of their organization rather than react to it

• Forecasting involves trying to estimate how a condition will be in the future. • Takes advantage of input from others, gives sequence in activity, and protects an organization against undesirable changes.

• Strategic planning examines an organization’s purpose, mission, philosophy, and goals in the context of its external environment.

• Complex organizational plans that involve a long period (usually 3 to 10 years) are referred to as longrange or strategic plans.

• SWOT Analysis, also known as TOWS Analysis, was developed by Albert Humphrey at Stanford University in the 1960s and 1970s. SWOT definitions: • Strengths are those internal attributes that help an organization to achieve its objectives. • Weaknesses are those internal attributes that challenge an organization in achieving its objectives.

SWOT definitions: • Opportunities are external conditions that promote achievement of organizational objectives. • Threats are external conditions that challenge or threaten the achievement of organizational objectives.

• Vision statements are used to describe future goals or aims of an organization. • It conjures up a picture for all group members of what they want to accomplish together. • An organization will never be greater than the vision that guides it.

• The mission statement is a brief statement identifying the reason that an organization exists. • It identifies the organization’s constituency and addresses its position regarding ethics, principles, and standards of practice.

• The philosophy flows from the purpose or mission statement and delineates the set of values and beliefs that guide all actions of the organization. • It is the basic foundation that directs all further planning toward that mission. • The organizational philosophy provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole.

• Goals and objectives are the ends toward which the organization is working. • Objectives are similar to goals in that they motivate people to a specific end and are explicit, measurable, observable or retrievable, and obtainable.

• Policies are plans reduced to statements or instructions that direct organizations in their decision making. • These explain how goals will be met and guide the general course and scope of organizational activities.

Policies also can be implied or expressed: • Implied policies, neither written nor expressed verbally, have usually developed over time and follow a precedent.

For example, a hospital may have an implied policy that employees should be encouraged and supported in their activity in community, regional, and national health-care organizations.

• Expressed policies are delineated verbally or in writing.

Expressed policies may include a formal dress code, policy for sick leave or vacation time, and disciplinary procedures.

• Procedures are plans that establish customary or acceptable ways of accomplishing a specific task and delineate a sequence of steps of required action. • Identify the process or steps needed to implement a policy and are generally found in manuals at the unit level of the organization.

• Rules and regulations are plans that define specific action or nonaction. • Existing rules should be enforced to keep morale from breaking down and to allow organizational structure.

• Kurt Lewin (1951) identified three phases through which the change agent must proceed before a planned change becomes part of the system: • Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. • Movement, the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces.

• Refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo.

Stages of change and responsibilities of the change agent: STAGE 1—UNFREEZING 1. Gather data. 2. Accurately diagnose the problem. 3. Decide if change is needed. 4. Make others aware of the need for change; do not proceed until the status quo has been disrupted and the need for change is perceived by the others.

Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 1. Develop a plan. 2. Set goals and objectives. 3. Identify areas of support and resistance. 4. Include everyone who will be affected by the change in its planning.

Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 5. Set target dates. 6. Develop appropriate strategies. 7. Implement the change. 8. Be available to support others and offer encouragement through the change.

Stages of change and responsibilities of the change agent: STAGE 2—MOVEMENT 9. Use strategies for overcoming resistance to change. 10. Evaluate the change. 11. Modify the change, if necessary.

Stages of change and responsibilities of the change agent: STAGE 3—REFREEZING 1. Support others so that the change continues.

• Edward Lorenz (1960s), discovered that even tiny changes in variables often dramatically affected outcomes. • Even small changes in conditions can drastically alter a system’s long-term behavior (butterfly effect).

• A budget is a financial plan that includes estimated expenses as well as income for a period of time. • Accuracy dictates the worth of a budget; the more accurate the budget blueprint, the better the institution can plan the most efficient use of its resources.

• Workforce or personnel budget largest of the budget expenditures because health care is labor intensive. • Operating budget reflects expenses that change in response to the volume of service, such as the cost of electricity, repairs and maintenance, and supplies. • Capital budgets plan for the purchase of buildings or major equipment, which include equipment that has a long life (usually greater than 5 to 7 years).

• Formal structure, through departmentalization and work division, provides a framework for defining managerial authority, responsibility, and accountability. • Roles and functions are defined and systematically arranged, different people have differing roles, and rank and hierarchy are evident.

• Informal structure is generally a naturally forming social network of employees. • It is the informal structure that fills in the gaps with connections and relationships that illustrate how employees network with one another to get work done.

• The organization chart defines formal relationships within the institution.

• Top-level managers look at the organization as a whole, coordinating internal and external influences, and generally make decisions with few guidelines or structures. • Middle-level managers coordinate the efforts of lower levels of the hierarchy and are the conduit between lower and top-level managers. • First-level managers are concerned with their specific unit’s work flow.

TOP LEVEL

Scope of responsibility

MID LEVEL

Chief nurse

Unit supervisor Department head

Look at organization as a whole as well as external influences

Integrating unitlevel day-to-day needs with organizational needs

FIRST LEVEL Charge nurse Team leader Primary nurse Focus primarily on day-to-day needs at unit level

TOP LEVEL

MID LEVEL

FIRST LEVEL

Primary Strategic planning planning focus

Combination of long- and shortrange planning

Short-range, Operational planning

Communication Top-down but flow receives subordinate feedback both directly and via middle-level managers

Upward and downward with great centrality

More often upward; generally relies on middle level managers to transmit communication to top-level managers

• Bureaucratic organizational designs are commonly called line structures or line organizations. • Ad hoc design is a modification of the bureaucratic structure and is sometimes used on a temporary basis to facilitate completion of a project within a formal line organization. • Matrix organization structure focus on both product and function. Function is described as all the tasks required to produce the product, and the product is the end result of the function.

MATRIX ORGANIZATION STRUCTURE

• Service line organization, which can be used to address the shortcomings that are endemic to traditional large bureaucratic organizations. • Flat organizational designs are an effort to remove hierarchical layers by flattening the chain of command and decentralizing the organization.

FLAT ORGANIZATIONAL DESIGNS

Traditional Patient Care Delivery Methods • Total patient care • Functional nursing • Team and modular nursing • Primary nursing • Case management

• Nurses assume total responsibility during their time on duty for meeting all the needs of assigned patients. • Sometimes referred to as the case method of assignment because patients may be assigned as cases.

• Functional nursing is efficiency-based; tasks are completed quickly, with little confusion regarding responsibilities. • Allow care to be provided with a minimal number of RNs.

• Ancillary personnel collaborate in providing care to a group of patients under the direction of a professional nurse. • As the team leader, the nurse is responsible for knowing the condition and needs of all the patients assigned to the team and for planning individual care.

• Modular nursing uses a mini-team (two or three members with at least one member being an RN), with members of the modular nursing team sometimes being called care pairs. • Patient care units are typically divided into modules or districts and assignments are based on the geographical location of patients.

• The primary nurse assumes 24-hour responsibility for planning the care of one or more patients from admission or the start of treatment to discharge or the treatment’s end. • During work hours, the primary nurse provides total direct care for that patient. • When the primary nurse is not on duty, associate nurses, who follow the care plan established by the primary nurse, provide care.

• A collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes. • Nurses address each patient individually, identifying the most cost-effective providers, treatments, and care settings possible.

• The leader-manager recruits, selects, places, and indoctrinates personnel to accomplish the goals of the organization.

1. Determine the number and types of personnel needed to fulfill the philosophy, meet fiscal planning responsibilities, and carry out the chosen patient care delivery system selected by the organization. 2. Recruit, interview, select, and assign personnel based on established job description performance standards.

3. Use organizational resources for induction and orientation. 4. Ascertain that each employee is adequately socialized to organization values and unit norms. 5. Use creative and flexible scheduling based on patient care needs to increase productivity and retention.

• Is the process of actively seeking out or attracting applicants for existing positions and should be an ongoing process. • A leadership role in staffing includes identifying, recruiting, and hiring gifted people.

• Is the process of choosing from among applicants the best-qualified individual or individuals for a particular job or position. • Involves verifying the applicant’s qualifications, checking his or her work history, and deciding if a good match exists between the applicant’s qualifications and the organization’s expectations.

• The nurse leader is able to assign a new employee to a position within his or her sphere of authority, where the employee will have a reasonable chance for success. • Proper placement fosters personal growth, provides a motivating climate for the employee, maximizes productivity, and increases the probability that organizational goals will be met.

• Planned, guided adjustment of an employee to the organization and the work environment. • Induction, the first phase of indoctrination includes all activities that educate the new employee about the organization and employment and personnel policies and procedures.

• Orientation activities are more specific for the position. • The purpose of the orientation process is to make the employee feel like a part of the team. • This will reduce burnout and help new employees become independent more quickly in their new roles.

• The better trained and more competent the staff, the fewer the number of staff required, which in turn saves the organization money and increases productivity. • Staff development activities are normally carried out for one of three reasons: to establish competence, to meet new learning needs, and to satisfy interests the staff may have in learning in specific areas.

• Socialization refers to a learning of the behaviors that accompany each role by instruction, observation, and trial and error. • Resocialization occurs when individuals are forced to learn new values, skills, attitudes, and social rules as a result of changes in the type of work they do, the scope of responsibility they hold, or in the work setting itself.

• Centralized staffing, where staffing decisions are made by personnel in a central office or staffing center. • Decentralized staffing, the unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census or acuity, preparing monthly unit schedules, and preparing holiday and vacation schedules.

National Nurses United (2010–2013). RN to patient ratios. Retrieved June 9, 2013

UNIT

STAFFING RATIO

Critical care/ICU Operating room Labor and delivery Antepartum Pediatrics Medical–surgical Emergency department

1:2 1:1 1:2 1:4 1:4 1:5 1:4

Category I Self care Category II Minimal care Category III Intermediate care Category IV Modified intensive care Category V Intensive care

1 – 2 hours of nursing care/day 3 – 4 hours of nursing care/day

5 – 6 hours of nursing care/day 7 – 8 hours of nursing care/day 10 – 14 hours of nursing care/day

National League for Nurses Formula for Staffing ABO X NCH Total no. of nursing service = personnel for 24 hours No. of working hours Where: ABO = Average Bed Occupancy NCH = Nursing Care Hours No. of working hours: 8 Based on RA 5901 The 40 working hours per week law

Standard values for NCH: Medical = 3.4 OB = 3.0 Surgical = 3.4 Pedia = 4.6 Mixed MS = 3.5 Nursery = 2.8

Percentage of Professionals to Non-Professionals Professionals - 60% Non-Professionals - 40%

Percentage of Distribution per Shift Morning - 45% Afternoon - 37% Night - 18%

Staffing for an OB Ward: 30-bed capacity Percentage of Professionals to Non-Professionals

Staffing for an OB Ward: 30-bed capacity 30 x 3.0 8

=

11 nursing service personnel for 24 hours

Percentage of Professionals to Non-Professionals Professionals - 60% x 11 = 7 Non-Professionals - 40% x 11 = 4

Distribution per Shift SHIFT AM PM NOC

PROFESSIONALS

SHIFT AM PM NOC

NON-PROFESSIONALS

Distribution per Shift SHIFT AM PM NOC

PROFESSIONALS 7 X 0.45 = 3 7 X 0.37 = 3 7 X 0.18 = 1

SHIFT AM PM NOC

NON-PROFESSIONALS 4 X 0.45 = 2 4 X 0.37 = 1 4 X 0.18 = 1

• Motivation is the force within the individual that influences or directs behavior. • Leaders should apply techniques, skills, and knowledge of motivational theory to help workers achieve what they want out of work.

INTRINSIC Comes from within the individual

EXTRINSIC Comes from outside the individual

Often influenced by family unit and cultural values

Rewards and reinforcements are given to encourage certain behaviors and/or levels of achievement

Maslow’s Hierarchy of Needs and Theory of Human Motivation • Maslow (1970), people are motivated to satisfy certain needs, from basic survival to complex psychological needs, and people seek a higher need only when the lower needs have been met.

Operant Conditioning and Behavior Modification • Skinner (1953) demonstrated that people could be conditioned to behave in a certain way based on a consistent reward or punishment system.

Herzberg’s Two-Factor Theory • Frederick Herzberg (1977) believed that employees can be motivated by the work itself and that there is an internal or personal need to meet organizational goals.

Vroom’s Expectancy Model

• Victor Vroom (1964), looks at motivation in terms of the person’s valence, or preferences based on social values. • A person’s expectations about his or her environment or a certain event will influence behavior.

McClellands’s Three Basic Needs • David McClelland (1971) examined what motives guide a person to action.

McClellands’s Three Basic Needs • Achievement-oriented people actively focus on improving what is; they transform ideas into action, judiciously and wisely, taking risks when necessary.

McClellands’s Three Basic Needs • Affiliation-oriented people focus their energies on families and friends; their overt productivity is less because they view their contribution to society in a different light from those who are achievement oriented.

McClellands’s Three Basic Needs • Power-oriented people are motivated by the power that can be gained as a result of a specific action. They want to command attention, get recognition, and control others.

McGregor’s Theory X and Theory Y • Douglas McGregor (1960) examined the importance of a manager’s assumptions about workers on the intrinsic motivation of the workers.

• Communication is “the exchange of thoughts, messages, or information, by speech, signals, writing, or behavior.” • Occur on at least two levels: verbal and nonverbal.

Internal climate

Includes internal factors such as the values, feelings, temperament, and stress levels of the sender and the receiver

External climate

Includes external factors such as the weather, temperature, timing, status, power, authority, and the organizational climate itself

• Upward communication, the manager is a subordinate to higher management. • Downward communication, the manager relays information to subordinates.

• Horizontal communication, managers interact with others on the same hierarchical level as themselves who are managing different segments of the organization.

• Diagonal communication, the manager interacts with personnel and managers of other departments and groups who are not on the same level of the organizational hierarchy.

• Grapevine communication flows quickly and haphazardly among people at all hierarchical levels and usually involves three or four people at a time.

• Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person’s rights. • Passive communication occurs when a person suffers in silence although he or she may feel strongly about the issue.

• Aggressive communication is generally direct, threatening, and condescending.

• Passive–aggressive communication is an aggressive message presented in a passive way. This person feigns withdrawal in an effort to manipulate the situation.

S

SITUATION

B

BACKGROUND

A

ASSESSMENT

R

Introduce yourself and the patient and briefly state the issue that you want to discuss Describe the background or context (patient’s diagnosis, admission date, medical diagnosis, and treatment to date) Summarize the patient’s condition and state what you think the problem is

Identify any new treatments or changes RECOMMENDATION ordered and provide opinions or recommendations for further action

• The leader who actively listens gives genuine time and attention to the sender, focusing on verbal and nonverbal communication. • The leader must continually work to improve listening skills by giving time and attention to the message sender.

G R R R R

Offer greetings and establish positive environment RESPECTFUL Listen without interrupting and pause to LISTENING allow others to think Summarize message to make sure it was REVIEW heard accurately RECOMMEND OR REQUEST Seek additional information as necessary MORE INFORMATION

GREETING

REWARD

Recognize that a collaborative exchange has occurred by offering thanks

American Nurses Association. (2011, September). Principles for social networking and the nurse.

1. Nurses must not transmit or place online individually identifiable patient information. 2. Nurses must observe ethically prescribed professional patient–nurse boundaries.

3. Nurses should understand that patients, colleagues, institutions, and employers may view postings.

American Nurses Association. (2011, September). Principles for social networking and the nurse.

4. Nurses should take advantage of privacy settings and seek to separate personal and professional information online. 5. Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities. 6. Nurses should participate in developing institutional policies governing online conduct.

• Delegation is getting work done through others or as directing the performance of one or more people to accomplish organizational goals. • The mark of a great leader is when he or she can recognize the excellent performance of someone else and allow others to shine for their accomplishments.

American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

• Right task

• Right circumstances • Right person

• Right direction/communication • Right level of supervision

1. Frequently recur in the daily care of a client or group of clients 2. Are performed according to an established (standardized) sequence of steps 3. Involve little or no modification from one client-care situation to another 4. May be performed with a predictable outcome North Carolina Board of Registered Nursing (2013)

5. Do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure(s) itself 6. Do not endanger the health or well-being of clients 7. Are allowed by agency policy/procedures

North Carolina Board of Registered Nursing (2013)

• Conflict is generally defined as the internal or external discord that results from differences in ideas, values, or feelings between two or more people.

• Conflict is neither good nor bad, and it can produce growth or destruction, depending on how it is managed.

• Intergroup conflict occurs between two or more groups of people, departments, and organizations. • Intrapersonal conflict occurs within the person. It involves an internal struggle to clarify contradictory values or wants. • Interpersonal conflict happens between two or more people with differing values, goals, and beliefs and may be closely linked with bullying, incivility, and mobbing.

• Bullying is repeated, offensive, abusive, intimidating, or insulting behaviors; abuse of power; or unfair sanctions that make recipients feel humiliated, vulnerable, or threatened, thus creating stress and undermining their self-confidence (Townsend, 2012). • Incivility is behavior that lacks authentic respect for others that requires time, presence, willingness to engage in genuine discourse and intention to seek common ground (Clark, 2010).

• Mobbing occurs when employees “gang up” on an individual. • When bullying, incivility, and mobbing occur in the workplace, this is known as workplace violence.

Compromising

each party gives up something it wants

Competing

one party pursues what it wants at the expense of the others

Cooperating

one party sacrifices his or her beliefs and allows the other party to win

Smoothing

one party in a conflict attempts to pacify the other party or to focus on agreements rather than differences

Avoiding

parties involved are aware of a conflict but choose not to acknowledge it or attempt to resolve it

Collaborating

all parties set aside their original goals and work together to establish a supraordinate or priority common goal

• Each party gives up something, and the emphasis is on accommodating differences between the parties. • The very least for which a person will settle is often referred to as the bottom line. • Negotiation is psychological and verbal. The effective negotiator always appears calm and self-assured.

• Collective bargaining involves activities occurring between organized labor and management that concern employee relations. • Management that is perceived to be deaf to the workers’ needs provides a fertile ground for union organizers, because unions thrive in a climate that perceives the organizational philosophy to be insensitive to the worker.

• Time management is making optimal use of available time. • Good time management skills allow an individual to spend time on things that matter.

1. Technology (Internet, gaming, e-mail, and social media sites) 2. Socializing 3. Paperwork overload 4. A poor filing system 5. Interruptions

• Quality control refers to activities that are used to evaluate, monitor, or regulate services rendered to consumers. • Health-care quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Hallmarks of effective quality control programs: 1. Support from top-level administration. 2. Commitment by the organization in terms of fiscal and human resources. 3. Quality goals reflect search for excellence rather than minimums. 4. Process is ongoing (continuous).

• Audit is a systematic and official examination of a record, process, structure, environment, or account to evaluate performance. • Auditing in health-care organizations provides managers with a means of applying the control process to determine the quality of services rendered.

• Retrospective audits are performed after the patient receives the service. • Concurrent audits are performed while the patient is receiving the service. • Prospective audits attempt to identify how future performance will be affected by current interventions.

• Outcome audits reflect the end result of care or how the patient’s health status changed as a result of an intervention. • Process audits are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided. • Structure audit includes resource inputs such as the environment in which health care is delivered.

• Total Quality Management, also referred to as continuous quality improvement (CQI), is a philosophy developed by Dr. W. Edward Deming. • The individual is the focal element on which production and service depend (i.e., it must be a customer-responsive environment) and that the quest for quality is an ongoing process.

• Toyota Production System is a production system built on the complete elimination of waste and focused on the pursuit of the most efficient production method possible. • Health-care organizations that use TPS would have caregivers not only attempt to directly solve problems at the time they occur, but it would also have them determine the root cause of the problem, so that the likelihood of the problem recurring would be minimized.

• Performance appraisals let employees know the level of their job performance as well as any expectations that the organization may have of them. • If employees believe that the appraisal is based on their job description rather than on whether the manager approves of them, they are more likely to view the appraisal as relevant.

Trait rating scales

Rates an individual against some standard. Job dimension scales Rates the performance on job requirements. Behaviorally anchored rating Rates desired job expectations on scales a scale of importance to the position. Checklists Rates the performance against a set list of desirable job behaviors.

Essays Self-appraisals

Management by objectives

Peer review

A narrative appraisal of job performance. An appraisal of performance by the employee. Employee and management agree upon goals of performance to be reached. Assessment of work performance carried out by peers.

• Be specific, not general, in describing behavior that needs improvement. • Be descriptive, not evaluative, when describing what was wrong with the work performance. • Be certain that the feedback is not self-serving but meets the needs of the employee. • Direct the feedback toward behavior that can be changed.

• Use sensitivity in timing the feedback. • Make sure that the employee has clearly understood the feedback and that the employee’s communication has also been clearly heard.

1. 2. 3. 4. 5. 6. 7.

Safe & quality nursing practice Management of resources & environment Health education Legal responsibility Ethico – moral responsibility Personal & professional development Quality improvement

8. Research 9. Record management 10. Communication 11. Collaboration & teamwork

Legal bases: • Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing Act 2002” • Board shall monitor & enforce quality standards of nursing practice necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation.

Significance of core competency standards: • Unifying framework for nursing practice, education, regulation • Guide in nursing curriculum development • Framework in developing test syllabus for nursing profession entrants • Tool for nurses’ performance evaluation

Significance of core competency standards: • Basis for advanced nursing practice, specialization • Framework for developing nursing training curriculum • Public protection from incompetent practitioners • Yardstick for unethical, unprofessional nursing practice

• The Benner Model is designed to emphasize the skill acquisition of health care professionals (Benner, 2001).

• Novice, a new practitioner’s practice is driven by rules and tends to provide task focused care. • Advanced beginners, providers have developed safe practice but lack a strong knowledge base to found their practice and management skills. • Competent provider, NPs will find they can prioritize and begin to use past experiences to form their care.

• Proficient providers have a good sense of what their patient situation is and can prioritize needs and routinely predict accurate outcomes. • Expert providers, NPs are confident, have an extensive knowledge base and will be able to quickly grasp complex patient situations.

ADVANCED PRACTICE NURSE (APN) • The most independent functioning nurse. • Has a master’s degree in nursing, advanced education in pharmacology and physical assessment, and certification and expertise in specialized area of practice.

CLINICAL NURSE SPECIALIST • Nursing expertise in a specialized area of practice (medical-surgical nursing, psychiatric and mental health nursing, pediatric nursing, community health nursing, gerontologic nursing).

NURSING ADMINISTRATOR • Manages client care and the delivery of specific nursing services within a health care agency. • Begins with positions such as the charge nurse or assistant nurse manager, then nurse manager of a specific patient care area.

NURSE RESEARCHER • Investigates problems to improve nursing care and to further define and expand the scope of nursing practice. • Employed in an academic setting, hospital, or independent professional or community service agency.

SCHOOL HEALTH NURSE Goal – Superior educational success by enhancing school health.

SCHOOL HEALTH NURSE

Functions: • Direct caregiver • Case finder • Consultant • Counselor • Health Educator • Researcher

OCCUPATIONAL HEALTH NURSE • Specialty practice that provides for and delivery of health and safety programs and services to workers, worker population and community groups.

OCCUPATIONAL HEALTH NURSE Functions: • Promotion and restoration of health • Prevention of illness and injury and • Protection from work related and environmental hazards.

PARISH NURSE • The role that gathers in churches, cathedrals, temples, mosques, and acknowledge common faith traditions. • Respond to health an wellness needs within the context of populations of faith community.

PARISH NURSE

Functions: • Provider of spiritual care • Health Counselor • Health Advocate • Health Educator • Facilitator of Support Groups • Trainer or Volunteers • Liaison to community resources and referral agent.

PUBLIC HEALTH NURSE • A registered nurse with special training community health.

PUBLIC HEALTH NURSE

Function: • Health Advocate • Care Manager • Referral Resource • Health Educator • Direct Primary Caregivers • Communicable Disease Control • Disaster Preparedness

PRIVATE DUTY NURSE • A registered nurse or a licensed practical nurse who provide nursing services to patients at home or any other setting in accordance with physician orders.

HOME CARE NURSE • A nurse who provides periodic care to patients within their home environment as ordered by the physician.

HOME CARE NURSE

Functions: • Health Maintenance • Education • Illness Prevention • Diagnosis and treatment of disease. • Palliation and rehabilitation.

HOSPICE NURSE • Provides a family centered care and allows clients to live and remain at homes with comfort, independence and dignity, while alleviating the strains caused by terminal phase i.e. at the time of death.

HOSPICE NURSE

Function: • Pain & symptom control. • Spiritual Care • Home Care and impatient Care • Family Conferences • Co-ordination of Care • Bereavement Care

REHABILITATION NURSE • A nurse who specializes in assisting persons with disabilities and chronic illness to attain optimal function, health and adapt to an altered life style.

NURSE EPIDEMIOLOGIST • Monitors standards and procedures for the control and prevention of infectious diseases and other conditions of public health significance including nosocomial infections.

• Ang Nars • Association of Deans of Philippine Colleges of Nursing (ADPCN) • Association of Diabetes Nurse Educators of the Philippines (ADNEP) • Association of Nursing Service Administrators of the Philippines (ANSAP)

• Association of Private Duty Nurse Practitioners Philippines (APDNPP) • Critical Care Nurses Association of the Philippines (CCNAPI) • Gerontology Nurses Association of the Philippines (GNAP) • Military Nurses Association of the Philippines (MNAP)

• Mother and Child Nurses Association of the Philippines (MCNAP) • National League of Philippine Government Nurses (NLPGN) • Occupational Health Nurses Association of the Philippines (OHNAP) • Operating Room Nurses Association of the Philippines (ORNAP)

• Philippine Hospital Infection Control Nurses Association (PHICNA) • Philippine Nurses Association (PNA) • Philippine Nursing Informatics Association (PNIA) • Philippine Nursing Research Society (PNRS) • Philippine Oncology Nurses Association (PONA) • Philippine Society of Emergency Care Nurses (PSECN)

• Renal Nurses Association of the Philippines (RENAP) • Society of Cardiovascular Nurse Practitioners of the Philippines (SCVNPPI) • Philippine Association of Public Health Nursing Faculty • Psychiatric Nursing Specialists Foundation of the Philippines • Integrated Registered Nurses of the Philippines (IRNUP)

Nursing is to nurture and care... patient's life is in our hands, so love our profession... ITS A CALLING!

Marquis, B. L., & Huston, C. J. (2011). Leadership Roles and Management Functions in Nursing: Theory and Application. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.