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ORGANIZING in Nursing Management
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ORGANIZING in Nursing ManagementPresentation subtitle
The Story of the Donkey Stuck in a Well
One day a farmer’s donkey fell down into a well.
The donkey cried piteously for hours as the farmer tried to figure out what to do.
Finally, the farmer decided the animal was old, and the well
needed to be covered up anyway; it just wasn’t worth it
to retrieve the donkey.
He invited all his neighbors to come over and help him. They all grabbed
a shovel and began to shovel dirt into the well. At first, the donkey realized what was happening and
cried even more loudly in panic and fear.
Then, to everyone’s amazement the donkey quieted down.
A few shovel loads later, the farmer looked down the well. He was astonished at what he saw.
With each shovel of dirt that hit hisback, the donkey was doing something amazing.
He would shake off the dirt and take a step up.
As the farmer’s neighbors continued to shovel dirt on top of the donkey, he would shake it off and take
another step up.
Pretty soon, everyone was amazed as the donkey stepped up over the edge of the well and happily
trotted off!
Life is going to shovel dirt on you, all kinds of dirt. The trick to getting out of the well is to shake it off and
take a step up. Each of our troubles is a steppingstone. We can get out of the deepest wells
just by not stopping, never giving up! Shake it off and take a step up.
Remember the five simple rules to be happy:
Free your heart from hatred – Forgive.Free your mind from worries – Most never happen.
Live simply and appreciate what you have.Give more.
Expect less
Organizing the Nursing ServiceAll but which of the following does not define the process of organizing in
nursing management?A. Consist of the structure and process which allows the agency to enact its
philosophy and utilize its conceptual framework to achieve a goal.B. It refers to a body of persons, methods, policies and procedures arranged
in a systematic process through the delegation of function and responsibilities for the accomplishment of purpose.
C. It is the process of establishing formal authorityD. It helps the manager look into the future and decide in advance where
the agency would like to be and what is to be done.
Organizing is;• Is the process of determining the activities to
be performed, arranging these activities to administrative units, as well as assigning managerial authority and responsibilities to people employed in the organization.
• This is a process of forming a system into an organic whole, giving it an orderly structure, framing and making arrangement for its working order. As an undertaking it involves cooperation.
• This is a process where personnel job description, qualifications and functions are distinctly defined and specified for work efficiency in the organization.
What is an ORGANIZATION?
An organization is defined as a system of interrelated resources, including environment, materials, supplies and behavior of people, that performs a task which has been differentiated into several distinct subsystem.
Planned groupings of people to accomplish a specific purpose
Is an organized body, system or society where members harmoniously work together to achieve organization goals.
ORGANIZATION
GOALS
PEOPLE
STRUCTURE
CULTURE
JOB
SUPERVISION
Types of Organization Classified by Nature of Authority
1) Line Organization- each position has general authority over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal)
2) Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization)
3) Staff Organization- purely advisory to the line structure with no authority to put recommendations into action.
4) Functional Organization – each unit is responsible for a given part of the organization’s workload.
TYPES OF ORGANIZATIONAL STRUCTURE
1) Line Organization/ Bureaucratic/ Pyramidal- shows that each position has general authority over the lower position of the hierarchy.- Power are concentrated at the top.
TYPES OF ORGANIZATIONAL STRUCTURE
2. Flat Organization
- refers to an organizational structure with
few or no levels of intervention
between management
and staff.
TYPES OF ORGANIZATIONAL STRUCTURE
3. Staff Organization- purely advisory
to the line structure with no
authority to place
recommendations into action.
TYPES OF ORGANIZATIONAL STRUCTURE
4. Functional Organization
- permits a specialist to aid
line position within a limited
and clearly defined scope
authority.
Is a line drawing which shows how the part of the organization are linked. It depicts the formal organizational relationship, areas of responsibility and person to whom one is accountable;
A. Budgetary Chart C. Organizational Chart
B. Hierarchy D. Structural Plant
ORGANIZATIONAL CHART
Organizational chart is a line drawing that shows how the parts of an
organization are linked.The organization chart establishes the following:
■ Formal lines of authority—the official power to act
■ Responsibility—the duty or assignment■ Accountability—the moral responsibility
ORGANIZATIONAL RELATIONSHIP
1.FORMAL RELATIONS
2.INFORMAL RELATIONS
ORGANIZATIONAL RELATIONSHIP
1. FORMAL RELATIONS
Formal structure, through
departmentalization and work division, provides a
framework for defining managerial authority,
responsibility and accountability..
ORGANIZATIONAL RELATIONSHIP
2. INFORMAL RELATIONS
Informal structure is generally social,
with blurred or shifting lines of
authority and accountability.
All but which of the following activities is not included
under Organizing?1. Budgeting2. Staffing3. Scheduling 4. Developing Job description5. Organizational Structure6. Forecasting
A. 1,2,3 only C. 2,4,5
B. 2,3,4,5 D. 3,4,5,6
SETTINGN UP THE ORGANIZATIONAL STRUCTURE:
The creation of an organizational system compatible with the philosophy, conceptual
framework and goals of the organization.
Understanding the organizational structure as a whole facilitates the development of roles
and relationships to enables the achievement of goals.
Importance of Organizational Structure
It enables members what their responsibilities
It frees the manager and the individual workers to concentrate on their respective
roles and responsibilities It Coordinates all organization activities so
there is minimal duplication of effort or conflict.
Avoids overlapping of function because it pinpoints responsibilities.
Shows to whom and for whom they are responsible
The successful setting up of the organizational structure enables an
organization to achieve;1. Information of members of their
responsibilities2. Allowing the manager to
concentrate on his/her role3. Avoid overlapping of functions 4. Shows to whom and for whom they
are responsible5. Create an environment that raise
frictionA. All of these C.
1,2,5,4B. None of these D. 4,3,2,1
ORGANIZATIONAL TYPE OF AUTHORITIES Line Authority entitles a supervisor to direct an
individuals work. Direct type of authority over the lower position.
Staff Authority is the authority created to support, assist recommend and generally reduce the supervisors' responsibilities. “Purely advisory”
Mrs. Chao has recently been designated as adviser on nursing matters to the Secretary of the DOH. Mrs. Chao’s
relationship is indiacted in the organizational chart by;
A. RectangleB. Straight LineC. BoxD. Broken Line
One of the things that Nurse Mila noticed when she entered the office of the Chief
Nurse is the Hospital’s Organizational Chart. Formal authority in an
organizational chart is indicated by a;A. BoxB. RectangleC. Broken LineD. Straight Line
Characteristics of Organizational Chart
1. Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload.
2. Chain of Command – lines indicate who reports to whom & by what authority.
3. Type of work to be Performed - indicated labels or descriptions for the boxes.
4.Grouping of Work Segment- shown by the clusters of work groups5.The level of Management, which indicate individual & entire
management hierarchy, regardless of where an individual appears on the chart.
Difference Between Flat and Pyramidal Structure.
CATEGORY FLAT PYRAMIDAL
No. of Levels Fewer MoreSpan of Control Broad NarrowDelegation Greater LesserAuthority Decentralized CentralizedControl over Subordinates
Lesser More
Type Modern Traditional
Flat or Decentralized Structure
Advantages• Communication
patterns are simplified,
problems tend to be addressed with
ease and efficiency.• Employees have
autonomy and increased job
satisfaction within this type of
structure
Disadvantages
• Supervisor spend less time with each
worker• Supervisors may
lack expertise in the variety of
operations and may end up
making inappropriate
decisions
Authority is the right to act or make decision without the approval of the higher administrator.
Accountability mean taking full responsibility for the quality of work and behavior while engaged in the practice of the profession.
Responsibility is the obligation to perform the assigned tasks
Power is the ability to influence another to behave in accordance with one's wishes
Status is the rank bestows on a person in accord with the groups estimation of the person value, significance to the group.
Communication is the transmission of information between persons
Board QuestionWhich of the following pertains to the principle of DELEGATION except;
a. When responsibility for a particular job is delegated to a subordinate, the latter should have authority over resources needed to accomplish the task
b. When a particular task has been delegated to a subordinate the supervisors own authority is diminished to that of the subordinates
c. When a person bestowed the authority for action, he is accountable for his actions to the person that bestowed him such.
d. If a particular tasked has been delegated to a subordinate the superior’s own responsibility is no way diminished
Board QuestionDecentralization or proper delegation of authority is best describe by the
following;a. The number of workers that a supervisor can effectively manage
should be limited, depending upon the pace and pattern of the working area
b. At the top of the structure a ratio of 1:6 ratio of supervisor-worker is common, while at the base of the organization a 1:10 ratio is common
c. Workers performing similar assignments are grouped together for a common purpose.
d. Conferring specified decision making to the lower levels of organization
MEDICINE
Medical Center Chief
MEDICAL DIVISION NURSING DIVISION ADMINISTRATIVE DIVISION
ANXILLARY CLINICAL CLINICAL SPECIAL AREA BUDGET PHARMACY
PERSONNEL DIETARY
SUPPLY HOUSE KEEPING
AUDIT LAUNDRY
MAINTENANCE SOCIAL SERVICE
COLLECTING TRANSPORT
ORERICU
DR/NICU
LABORATORY
RADIOLOGY
DENTAL
SURGERY
EENT
ORTHO
OB GYNE
PEDIA/OPD
ORGANIZATIONAL STRUCTURE OF A
HOSPITAL NURSING DIVISION/SERVICES
Chief of Hospital
Chief Nurse
Ass. Chief NurseTrng & Research
Ass. Chief NurseClinical Service
SupervisingNurse Instructor
Nurse Instructors
Supervising NurseClinical Services
Supervising NurseSpl. Services
Senior Nurses Senior Nurses
Staff Nurses Staff Nurses
Nursing Attendants Nursing Attendants
AN ORGANIZATIONAL STRUCTURE SHOWING RELATIONSHIP OF THE
NURSING SERVICE/DIVISION WITH THE COLLEGE OF
NURSING
Medical Center Chief
Chief Nurse
Ass. Chief Nurse
Supervising Nurses
Senior Nurses
Supervising Nurse Ins
Nurse Instructors
Staff Nurses Trainees
Nsg. & Midwifery Affiliates
Midwives
Nursing Attendants
Institutional Workers
Dean of AffiliatingColleges
Clinical Coordinators
Clinical Instructors
Traditional Hierarchical Structure
Chief of Hospital
CHIEF NURSE
SUPERVISING NURSE
STAFF NURSE
NURSING ATTENDANT
Staffing Process of determining and providing the
acceptable number and mix the nursing personnel to produce desired level of care to meet the patients demand.
To provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required.
Factors Affecting Staffing The type, philosophy and objective of the hospital and the nursing The population serve or the kind of patient served whether pay or charity The number of patients and the severity of their illness-knowledge Administrative policies such as rotation, weekends and holiday off duties Standards (ANSAP, PRC ANSAPS Standards of Safe Nursing Practice) Layout of the various units Budget Expected hours of work per annum of each employee. (40 hours week
law) Pattern of work schedule
The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies located in communities with less than one million population, will work 48 hours/week and therefore will get only one off-duty a week.
Nursing Care Hour as per Patient Per Day According
to Classification of Patients by Units
Cases/ Patients NCH/Pt./Day Prof. to Non Prof. ratio
General Medicine 3.5 60:40
Medical 3.4 60:40
Surgical 3.4 60:40
Obstetrics 3.0 60:40
Pediatrics 4.6 70:30
Pathologic Nursery 2.8 55:45
ER/ICU/RR 6.0 70:30
CCU 6.0 80:20
Patient Classification System (PCS)
method of grouping patients according to the amount and complexity of their nursing care requirements, of nursing time & skill they require.
serves in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.
Purposes for Classifying Patients
1. Staffing. Perceived patient needs can be matched with available nursing resources 2. Program costing & formulation of the nursing budget 3. Tracking changes in patient care needs 4. Determine values for the productivity equation: output divided by input. 5. Determine quality
Classification Categories
Level I – Self Care or Minimal Care – Patient can bathe, feed and perform ADL.
Level II – Moderate Care or Intermediate Care – Patient needs some assistance in ADL, ambulating up and about for short periods of time,
Level III – Total, Complete or Intensive Care – Patients are completely dependent
upon the nursing personnel.
Level IV – Highly Specialized Critical Care - Patients maximum nursing care, they
need continuous treatment,
observation, many medications, IV piggy backs, vital
signs q 15- 30 mins. hourly output;
Significant changes in doctor’s orders more
than care hours / patient /day may range
from 6-9 or more.
Levels of Care NCH Needed Per Patient/ Day
Ratio of Prof. to Non-Prof
Level I Self Care or Minimal CareLevel II Moderate or Intermediate Care
Level III Total or Intensive Care Level IV Highly Specialized or Critical Care
1.5
3
4.5
6 7 or higher
55:45
60:40
65:35
70:3080:20
Percentage of Nursing Care Hours
The percentage of nursing care hours at each level of care also depends on the setting in which
the care is being given.
Percentage of Patients in Various Levels of Care
Types of Hospital Minimal Care
ModerateCare
IntensiveCare
Highly Specialize
Care
Primary Hospital
Secondary Hospital
Tertiary Hospital
Special Tertiary Hospital
70
65
30
10
25
30
45
25
5
5
15
45
-
-
10
20
The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100 bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. Employees working in agencies located in communities with less than one million population, will work 48 hours/week and therefore will get only one off-duty a week.
Total Number of Working and Non Working Days and Hours of a Nursing Personnel Per Year
Rights an d Privilege Given Each Personnel Per Year
Working Hours Per Week
40 HOURS 48 HOURS
VACATION LEAVE 15 15
SICK LEAVE 15 15
LEGAL HOLIDAYS 10 10
SPECIAL HOLIDAYS 2 2
SPECIAL PRIVILEDGE 3 3
OFF DUTIES (RA 5901) 104 52
CEP 3 3
TOTAL NON WORKING DAYS PER YEAR
152 100
TOTAL WORKING DAYS PER YEAR 213 265
TOTAL WORKING HOURS PER YEAR
1704 2120
Relievers NeededTo determine the relievers needed use the
following;For person working 40 Hours a week =0.15Foe person working 48 Hours a week=0.12
Distribution of Shift 45 percent for the AM shift
37 percent for the AFTERNOON shift
18 percent for the NIGHT shift
Activity: Find the Nursing personnel needed for;
250 patients in a tertiary hospital
40 Hours per week
The Formula Categories the numbers of patient according to the levels of
care needed. Multiply the total number of patient by the percentage of patient at each level of care.
Find the total number of nursing care hour needed by the patient at each category level.
Find the number of patients at each level by the average number of nursing care hours per day
Get the sum of the nursing care hours needed at the various levels
Find the actual number of nursing care hours needed by the given numbers of patients. Multiply the total nursing care hours needed per day by the total number of days in a year.
The Formula Find the actual number of working hours rendered by each
nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year.
Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year
Find the number of relievers. Multiply the numbers of nursing personnel needed by 0.15 (40 hours), 0.12 (48 hours)
Add the number of relievers to the number of nursing personnel needed
The Formula
Categorize the nursing personnel into professional and non-professional. Multiply the number of nursing personnel according to the ratio of professional to non professional.
Distribute by shift.
The Story of the MULE
"God created the mule, and told him, 'You will be Mule, working constantly from dusk to dawn,
carrying heavy loads on your back. You will eat grass and you lack intelligence. You will live for 50 years. The mule answered: 'To live like this for 50 years is too much. Please, give me no more than
20.' And it was so.
Then God created the dog, and told him, 'You will be Dog, and hold vigilance over the dwellings of Man, to whom you will be his greatest companion. You will eat his table scraps and live for 25 years.
And the dog responded, 'Lord, to live 25 years as a dog is too much. Please, no
more than 10 years.' And it was so.
God then created the monkey, and told him, 'You are Monkey, and you shall
swing from tree to tree, acting like an idiot. You will be funny, and you shall
live for 20 years. And the monkey responded, 'Lord, to live 20 years as the clown of the world is too much.
Please, Lord, give me no more than 10 years.' And it was so.
Finally, God created Man and told him, 'You are Man, the only rational being that walks the earth. You will use your
intelligence to have mastery over the creatures of the world. You will dominate the earth and live for 20 years.' And the man responded, 'Lord, to be Man for only 20 years is too
little. Please, Lord, give me the 20 years the mule refused, the 15 years the dog refused, and the 10 years the monkey
rejected.' And it was so.
And so God made Man to live 20 years as a man, then marry and live 20 years like a mule working and carrying heavy loads on his back. Then, he
is to have children and live 15 years as a dog, guarding his house and eating the leftovers after they empty the pantry; then, in his old age, to
live 10 years as a monkey, acting like a clown to amuse his grandchildren."
Types of Staffing
1. Centralized – done by the nursing director who
develops a master plan for nursing personnel; an impersonal approach
2. Decentralized – the managers of individual nursing
units have more control over the budget, resources, and process.
NOTE:
It should be noted that the personnel computed are only for those in patients. Therefore, additional personal should be hired for those in supervisory and administrative position and for those in the special units.
o Head Nurse should be provided for every nursing unit.
o Nursing Supervisors is provided .o Roomed in babies should be provided with additional
staff
PLACEMENT
Placement is the assigning employees to a position or area.Proper placement foster personal growth, provides a motivating
climate for the employee, maximizes productivity and organizational goals.
SCHEDULINGo A timetable showing planned work days and shift for nursing
personnel.
FACTORS CONSIDERED IN MAKING SCHEDULES: Different level of the nursing staff Adequate coverage for 24 hours Staggered vacations and holidays Weekends Long stretches of consecutive working days Evening and night shifts Floating
Assessing a Scheduling System:o Ability of the needs of the unitso Quality to enhance the nursing personnel’s
knowledge, training and experienceo Fairness to the staffo Stabilityo FlexibilityTypes of Scheduling:Centralized – Chief Nurse or designate do assigns
the personnel to the hospital units
Decentralized – Chief Nurse or designate assigns personnel but supervising Nurse/ Head or Senior arranged the shift and off duties
Cyclical - Covers designated number of wks. (cycle length)
- it assigns required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements, the staff preference, then, education, training and experience.
Advantages of Cyclical Schedule
1. It is fair to all2. It saves time as the schedule does not
have to be redone every week or two3. It enables the employees to plan ahead
for their personal needs preventing frequent changes in the schedule.
4. Scheduled leave coverage such as vacation, holidays and sick leaves are more stable
5. Productivity is improved
Developing the Job Description
Developing Job Description – a statement that sets the duties and responsibilities of a
specific job.
Contents of Job DescriptionIdentifying Data:
Position Title:Department:Supervisor’s Title:
Job Summary-essential features of the job that distinguish it from the others.
Qualification Requirements
Job Relationship – source of workers
Specific and Actual Functions and Activities
WHAT WOULD YOU DO FIRST IF YOU WERE IN A SITUATION WHERE:
INTERPRETATION
FAMILY SEX WEALTH
FRIENDS & RELATIVES CAREER & JOB
Test Your STRESS Levels
DIRECTINGo Directing is getting the work done through others.
It is management of people which is the heart of the administrative process to be properly understood and practice by a nurse manager.
o Giving orders and directions to others to attain quality patient care.
o Directing is the issuance of assignments, orders and instructions that help the nursing personnel to understand what are expected of them.
Elements of Directing
i. Delegationii. Utilization of Policies and Proceduresiii. Supervision of Personneliv. Coordination of Servicev. Communicationvi. Staff Development and Making of Decision
Delegation is the process of by which a manager assigns specific task/duties to workers with commensurate authority to perform the job.
Principle of Delegation Select the right person to whom the job is to be
delegated Delegate both interesting and uninteresting tasks Provide subordinates with enough time to learn Delegate gradually Delegate in advance Consult before delegating Avoid gaps and overlaps
Do you think that all matters be delegated?
There are matters that cannot be delegated.1. Overall responsibility, authority and
accountability2. Authority to sign one’s name 3. Evaluating the staff and or taking necessary
corrective or disciplinary action4. Responsibility for maintaining morale or the
opportunity to say a few words of encouragement to the staff especially the new ones
5. Jobs that are too technical and those that involve trust and confidence
Why Nurse Managers fails to DELEGATE?
These may be due to lack of confidence in their staff
Feeling that only they could do the task better and faster
They may fear loss of control if some of their duties are delegated
NURSING CARE ASSIGNMENT (sometimes called.. )
Modalities of Nursing Care Systems of Nursing Care Patterns of Nursing Care
Four Basic Methods of Nursing Care
• Functional Nursing• Total Care or Case Method• Team Nursing• Primary Nursing
Functional Nursing
Task oriented in which particular nursing function is assigned to each workers
This method divides the work to be done with each person being responsible to the Head Nurse or Senior Nurse
The best system to use when there are many patients and professional nurses are few.
Advantages'1. It allows most work to be accomplish in a
short possible time2. Workers learn to work fast3. They gain skills faster in the particular task
Functional Nursing
Disadvantages: Holistic care is not achieved Nurse's accountability are diminished Patient cannot identify who their “real
nurse” Nurse patient is not fully developed It is difficult to find a specific person who
can answer the patient’s or relative’s questions
Head / Senior Nurse
R.N.Medication
R.N.Treatment
Nsg. AttendantHygienic Care
HousekeeperLinen Attendant
Patients
Lines of Authority
Staff Nurse
Patient
Head / Senior Nurse
Total Care / Case Nursing
Ö In the Total Care or Case Method of nursing care one nurse is assigned to one patient for the delivery of total care.
Ö The nurse plans, coordinates, implements, evaluates and documents the nursing care
Ö The nurse is accountable for his/her own actions.Ö He/she provides holistic care to the patients
Charge Nurse
Team Leader
Staff Nurse
Clients
Team Nursing
TEAM NURSING
• Decentralized system giving care through participative effort
• Assigning patients and task according to job description
• Leader has the responsibility for coordinating the total care of a group of patient (Team Conference – the heart of team nursing)
• If not fully implemented, it can lead to fragmentation of care
• In this method only team leader has significant responsibility and authority & care may resemble functional method if the leader does not keep members informed
Physician Head Nurse Hospital and Community
Resources
Primary NursePatient/ Client
Secondary/ Ass. Nurse PM
Secondary/ Ass.Nurse Nite
Secondary/ Ass.Nurse Relief
Lines of Authority in Primary Nursing
Each registered nurse is responsible for the total care of small group of patients from admission to discharge.
Since primary nurse assumes a 24 hours responsibility for nursing care, secondary or associate nurse executes the nursing care during afternoon, night and on days when primary nurse is off duty.
Authority, autonomy and accountability rest with the primary nurse.
The primary nurse is responsible for in caring for 4 to 6 patients on a 24 hour basis throughout the hospitalization
Patient are provided with continuous care even when the primary nurse is off duty.
Modular Method Modification of team and primary nursing RN
provide direct nursing care with assistance of aides
Case Management The case manager is responsible for assessment of
patient and family
Supervision
“Supervide” which means to “Oversee or View Directly” Providing guidelines for the completion of a task or activity with initial
direction and periodic inspection. It is the active process of directing, guiding and influencing the outcome
of a person’s performance of an activity It “appraises”
Techniques in SUPERVISION: OBSERVATION WHILE MAKING THE ROUNDS SPOT CHECKING THE CHART ASKING THE PATIENT ABOUT THE CARE THEY RECEIVE LOOKING INTO THE GENERAL CONDITION OF THE UNITS GETTING FEEDBACK FROM CO-WORKERS
What are the Good Qualities if Supervision?
• Good Technical Skills• Ability to communicate• Firmness with flexibility to adjust to the needs of the
situation• Fairness in dealing with the situation• Good decision making skills• Willingness to grow and develop• Pleasing personality• Ability the motivate employee• Advocacy for nurses and nursing
Reginald was terribly overweight, so his doctor placed him on a strict diet. "I want you to eat regularly for two days, then skip a day, and repeat this procedure for two weeks. The next time I see you, you'll have lost at least five pounds," his doctor assured him.
When Reginald returned he shocked his doctor by having lost almost twenty pounds. "Why, that's amazing," the doctor said, greatly impressed. "You certainly must have followed my instructions."
Reginald nodded, "I'll tell you what though, I thought I was going to drop dead on the third day."
"Why, from hunger?" asked his doctor.
"No, from all that skipping.
Lesson: A different perspective can yield better results. Therefore, learn to be open to all possibilities. Do not short-change potential results with narrow, limited thinking.
LEADINGLeading ad defined by Webster means “to guide to go
before and show the way”. Leadership in nursing is necessary to guide nursing personnel to a specific goal.
What is that GOAL???To provide quality nursing care to the patient.
Leadership is the act of developing people.
WHAT IS THE DIFFERENCE BETWEEN LEADERS AND MANAGERS????
LEADERS AND MANAGERS
A manager is a title that can be given that signifies a position – a leader is a title that other people give you.
Managers Demand Respect – Leaders Command Respect Managers Have Subordinates – Leaders Have Followers Managers administer - Leaders innovate Managers demand - Leaders command Managers maintain - Leaders develop Managers focus on systems – Leaders focus on people Managers strive for control – Leaders inspire trust Managers have short-term view – Leaders have a long-term
goal Managers are focused on the bottom line – Leaders are
focused on potential Managers imitate - Leaders originate Managers do things right – Leaders do the right thing Managers state their position – Leaders earn their position
“All Managers are Leaders, but all Leaders
are not Managers.”What are the GOOD Qualities of a
LEADER?
Leadership style: Autocratic Democratic permissive
AUTOCRATIC LEADERSHIP
• This is all called directive or bureaucratic. In its most extreme form it implies a leader who uses coercion in the exercise of his/her power.
• Autocratic leadership style is often considered the classical approach. It is one in which the manager retains as much power and decision-making authority as possible. The manager does not consult employees, nor are they allowed to give any input. Employees are expected to obey orders without receiving any explanations. The motivation environment is produced by creating a structured set of rewards and punishments.
• This leadership style has been greatly criticized during the past 30 years. Some studies say that organizations with many autocratic leaders have higher turnover and absenteeism than other organizations.
Studies say that autocratic leaders:--Rely on threats and punishment to influence employees--Do not trust employees--Do not allow for employee inputYet, autocratic leadership is not all bad. Sometimes it is the most effective
style to use.
Autocratic leadership style is effective when:--New, untrained employees who do not know which tasks to perform or
which procedures to follow--Effective supervision can be provided only through detailed orders and
instructions--Employees do not respond to any other leadership style--There are high-volume production needs on a daily basis
--There is limited time in which to make a decision--A manager’s power is challenged by an employee--The area was poorly managed--Work needs to be coordinated with another department or organization
The autocratic leadership style should not be used when:
--Employees become tense, fearful, or resentful
--Employees expect to have their opinions heard
--Employees begin depending on their manager to make all their decisions
--There is low employee morale, high turnover and absenteeism and work stoppage
D e m o c r a t I c Democratic leadership is people oriented. It focuses on human
aspects and builds effective teamwork. Interaction between the leader and the subordinate is open, friendly and trusting.
The democratic leadership style is also called the participative style as it encourages employees to be a part of the decision making. The democratic manager keeps his or her employees informed about everything that affects their work and shares decision making and problem solving responsibilities. This style requires the leader to be a coach who has the final say, but gathers information from staff members before making a decision.
Democratic leadership can produce high quality and high quantity work for long periods of time. Many employees like the trust they receive and respond with cooperation, team spirit, and high morale.
Typically the democratic leader:--Develops plans to help employees evaluate their own performance--Allows employees to establish goals--Encourages employees to grow on the job and be promoted--Recognizes and encourages achievement.Like the other styles, the democratic style is not always appropriate. It is most
successful when used with highly skilled or experienced employees or when implementing operational changes or resolving individual or group problems.
The democratic leadership style is most effective when:--The leader wants to keep employees informed about matters that affect them.--The leader wants employees to share in decision-making and problem-solving
duties.--The leader wants to provide opportunities for employees to develop a high sense
of personal growth and job satisfaction.--There is a large or complex problem that requires lots of input to solve.--Changes must be made or problems solved that affect employees or groups of
employees.--You want to encourage team building and participation.
Laissez-Faire Leadership Style
The laissez-faire leadership style is also known as the “hands-off¨ style. It is one in
which the manager provides little or no direction and gives employees as much
freedom as possible. All authority or power is given to the employees and they must
determine goals, make decisions, and resolve problems on their own.
This is an effective style to use when:
--Employees are highly skilled, experienced, and educated.--Employees have pride in their work and the drive to do it successfully on
their own.--Outside experts, such as staff specialists or consultants are being used
--Employees are trustworthy and experienced.
This style should not be used when:
--It makes employees feel insecure at the unavailability of a manager.
--The manager cannot provide regular feedback to let employees know how well they are doing.--Managers are unable to thank employees for
their good work.--The manager doesn’t understand his or her responsibilities and is hoping the employees
can cover for him or her.
Leadership POWER
An essential part of leadership or management is to influence the people you manage so that they do what you want them to do. The influence of a leader will depend on a variety of
factors including their personality and of those around them. For the purposes of this article we will refer to the people that the leader is managing or leading as followers. The
influence of a leader over his followers is often referred to as power. Below we will explore the different types of power a
leader may have.
Reward Power
• This type of influence is created when the leader is able to offer a reward to his followers for completing tasks/behaving in a certain manner. Rewards in the workplace can take a variety of forms from chocolates, gift vouchers and holidays to promotions, commission and pay rises.
• This type of power needs to be used carefully to prevent followers becoming accustomed to rewards and refusing to complete routine tasks without a reward. Generally rewards should not be offered, to follower employees to complete duties which are a normal part of their role. This is because as an employee they are under a contractual obligation to complete these tasks and they are already rewarded for this through their salary.
Coercive Power
• This is the opposite of reward power because this power is based on the leader having control over what happens if followers do not act as required. If followers do not undertake the action required, the leader will impose a penalty. Penalties take a variety of forms including withdrawal of privileges, job losses, verbal abuse, and delayed or loss of promotion. In all cases the leader will need to choose the penalty carefully to prevent breaking the law or being the subject of an employment tribunal.
• Coercive powers should be used carefully; overuse can lead to unhappy employee followers. Unhappy followers can be negative or unmotivated, they may resign or adopt a “work to rule” attitude. Work to rule is where employees refuse to undertake any duties (or adopt working practices) that are not stated in their contract.
Legitimate PowerThis is the power that a leader has when the followers believe that
the leader has “a right” to instruct them and that they have an obligation to follow instructions. Sometimes legitimacy power is created by the leader’s job title (such as captain, doctor, or area manager), combined with the follower’s belief that the job title gives the leader the right to give them orders.
Referent PowerThis is created when the followers believe that the leader possess
qualities that they admire and would like to possess. The followers identify with their leader and attempt to copy their leader. As referent power is dependant on how the follower views the personality of their leader, a leader will not have referent power over every follower they lead. Some leaders will have referent power over just a few, whilst others such as Ghandi have lead millions through their personality and charisma.
Expert PowerAs the title suggests a leader has expert power when the followers believe that the leader has “expert” knowledge or skills that are relevant to the job or tasks they have to complete. Often an experienced member of the team or staff in an organisation, can have expert power even though they are not a supervisor or manager.
• Reward power needs follower to believe leader will reward them.
• Coercive power needs follower to believe leader will punish them.
• Legitimate power needs follower to believe leader has right to instruct them.
• Referent power need follower to believe leader has desirable qualities.
• Expert power need follower to believe leader is an expert.
“Trust men and they will be true to you; treat them greatly and they
will show themselves to be great.”
MOST LIKELY OUTCOMES OF LEADER POWER & INFLUENCE
• RESISTANCECOERCIVE
• COMPLIANCELEGITIMATE
REWARD
• COMMITMENTEXPERT
REFERENT
EXPERT POWER– ACT CONFIDENT AND DECISIVE– KEEP INFORMED– DON’T THREATEN SUBORDINATES’ SELF-ESTEEM – BE
APPROACHABLE– WILLING TO SHARE YOUR KNOWLEDGE WITH OTHERS
REFERENT POWER– TREAT SUBORDINATES FAIRLY– DEFEND SUBORDINATES’ INTERESTS– BE SENSITIVE TO SUBORDINATES’ NEEDS & FEELINGS
LEGITIMATE POWER– BE CORDIAL, POLITE, AND CONFIDENT– MAKE APPROPRIATE REQUESTS– FOLLOW PROPER CHANNELS– EXERCISE POWER REGULARLY AND ENFORCE COMPLIANCE
REWARD POWER– VERIFY COMPLIANCE AND ACCOMPLISHMENTS– OFFER REWARDS FOR DESIRED ACTIONS AND BEHAVIORS– OFFER CREDIBLE REWARDS THAT ARE DESIRED BY SUBORDINATES
COERCIVE POWER– INFORM SUBORDINATES OF RULES AND PENALTIES– UNDERSTAND THE SITUATION BEFORE ACTING & WARN BEFORE
PUNISHING– ADMINISTER PUNISHMENT CONSISTENTLY & PUNISH IN PRIVATE
Theories of Leadership
• Situational Leadership in this approach the leader behaves according to a given situation which may vary from one setting to the other. The theory considers a person’s qualities and motivation, the role expectations of the group, and the social forces at work such as the external factors that bring forth the leadership potentials.
• “Contingency” leadership style is one in which the leader’s style matches the situation and its needs.
FIVE KINDS OF LEADERS
1. The natural leader who become a leader in spite of himself or herself 2. The charismatic leader who is an authentic hero in the eyes of his followers3. The rational leader who is consistent and persistent in what he/she thinks
is right4. The consensus leader who is perceived to be acceptable to all5. The leader by force who dominate by force and fear.
• The Trait Theory of Leadership describe the personal and mental characteristics which are associated with successful leaders. Trait theory is based on the belief that leaders are born with certain qualities.
• Leaders are gifted with certain qualities that are developed and show in their ability to get along with people, persuade them to course of action.
• Similar in some ways to "Great Man" theories, trait theories assume that people inherit certain qualities and traits that make them better suited to leadership.
The GREAT MAN Theory
• assume that the capacity for leadership is inherent – that great leaders are born, not made.
• These theories often portray great leaders as heroic, mythic and destined to rise to leadership when needed.
• The term "Great Man" was used because, at the time, leadership was thought of primarily as a male quality, especially in terms of military leadership. Learn more about the great man theory of leadership.
Servant Leadership
• Robert Greenleaf• Servant Leadership is a recent theory of leadership that argues
that the most effective leaders are “servants of their people”• Servant leaders get results for their organization through whole-
hearted attention to their followers and followers’ needs. Unlike many approaches to leadership, which offer suggestions on how top-level leaders can influence and motivate those further down the hierarchy, servant leaders puts its emphasis on collaboration, trust, empathy and ethics.
• The leader should be a servant first, leading from a desire to better serve others and not to attain more power. The assumption is that if leaders focus on the needs and desires of followers, follower will reciprocate through increased teamwork, deeper engagement and better performance.
• Ten Characteristics of SERVANT Leader: listening, empathy, healing, awareness, persuasion, conceptualization, foresight, stewardship, commitment to the growth of others, and building community.
Charismatic Leader
• Charismatic leadership is leadership based on the leader's ability to communicate and behave in ways that reach followers on a basic, emotional way, to inspire and motivate
• It's difficult to identify the characteristics that make a leader "charismatic", but they certainly include the ability to communicate on a very powerful emotional level, and probably include some personality traits.
• Developing "charisma" is difficult, if not impossible for many people, but luckily charismatic leadership is not essential to be an effective leader. Many other characteristics are involved in leading effectively, and there is significant evidence to indicate that it simply is not necessary to have this elusive charisma to lead others well.
C o m m u n i c a t I o n
• Communication is the transmission of information, opinions and interactions between and among individuals.
• Communication facilitates work, increases motivation, effect change, optimizes patient care, increase workers satisfaction and facilitates coordination.
• It helps promote trust between the health personnel and those of client; provides both client and personnel satisfaction.
Principles of Effective Communication
• Clear lines of communication serve as the linking process by which parts of the organization is unified towards achievement.
• Simple, concise and exact messages ensures understanding of the message to be conveyed.
• Feedback is essential to effective communication.• A managers communication thrives best in a
supportive environment which encourage positive value among its personnel.
• A managers communication skills is vital to the attainment of the goal of the organization.
• Adequate and timely communication of work related issues or changes that may affect the jobs enhance compliance.
NURSE
UPWARDTo Supervisor
HORIZONTALPeers and the
Members of the Healthcare Team
DOWNWARDSubordinates
OUTWARDPatient, Family,
Community
Downward CommunicationThe traditional line of communication is from superior to subordinates which may pass through level of management.
Upward CommunicationUpwards communication emanates from the subordinates and goes upward. Upward communication does not flow as easy as the downward communication.
Horizontal CommunicationFlows between peers, personnel or departments on the same level.
Outward CommunicationDeals with information that flows from the caregiver to the patients, their families, relatives, visitors and the community. Outward communication also involves how employee value their work.
Coordination• Unites personnel and services towards a
common objective. Synchronization of activities among the various services or departments enhances collaborative efforts resulting in efficient, smooth and harmonious flow of work.
• Promotes overlapping of functions, promotes good working relationship and work schedule are accomplished as targeted.
Coordination• Coordination with the Medical service• Coordination with the Administrative
Service• Coordination with the Laboratory
Services• Coordination with the Radiology Service• Coordination with the Pharmacy Service• Coordination with the Dietary Service• Coordination with the Medical Social
Services• Coordination with the Medical Records
Servives• Coordination with the Community
Agency, Other Institution and Civic Organization
