NCM 119

NCM 119 : NURSING LEADERSHIP AND MANAGEMENT

1st SEMESTER | 2024-2025| Ms. Lea Guico

1. Individual - personal goals, can be a simple

A. CONCEPTS OF LEADERSHIP & and complex one
MANAGEMENT 2. Group goals - organizational goal or in a
smaller scale
LEADERSHIP 3. Organizational goals- goal of the
management, short or long term goal.
➔ The use of one’s skill to influence others
➔ Establishing directions
● Can be short or long term
➔ Action of leading people
➔ Process of influencing the activities Kinds of influence
1. Assertiveness - standing up for oneself
LEADER
- When carrying order we must clarify
Lead 2. Rationality - trying to convince someone using
➔ individuals who are out front, taking risks, reason and logic
attempting to achieve shared goals, and 3. Ingratiation - making an individual feel
inspiring others to action. important when making a request
➔ Those individuals who choose to follow a - Act humbly first when requesting
leader do so by choice, not because they 4. Exchange - offer a personal sacrifice, offering
have to. favors to grant request
DIMENSIONS OF LEADERSHIP 5. Sanction - coercive authority
- Leader can give punishment
6. Blocking - backing up a request with a threat to
LEADER - FOLLOWER - SITUATION damage
● Dynamic and interactive 7. Coalition - ask other team member to back up
● Depends on followers needs you , find others who can approve
● Situation- work, demands,task 8. Upward appeal - obtaining formal or informal
consent
Characteristics of leaders TYPES OF LEADER
● Often do not have delegated authority but obtain 1. Formal
their power through other means, such as ● officially appointed, elected
influence. ● managers
● Have a wider variety of roles than managers. 2. Informal
● May or may not be part of the formal ● chosen by the group
organization. ● those who initiate an action
● Focus on group process, information gathering,
feedback, and empowering others.
● Emphasize interpersonal relationships. LEADERSHIP FLAWS
● Direct willing followers. 1. A lack of energy and enthusiasm
● Have goals that may or may not reflect those of 2. Acceptance of their own mediocre
the organization. performance
GOALS 3. Lack of a clear vision and direction
4. Having poor judgment
Is the desired aim or condition toward which one is
5. Not collaborating
willing to work

NCM 119: NURSING LEADERSHIP AND MANAGEMENT 1

 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

6. Not walking the talk

7 BASIC RESOURCES OF MANAGEMENT
7. Resisting new ideas
8. Not learning from mistakes 1. Manpower
9. A lack of interpersonal skills 2. Money
10. Failing to develop others 3. Machine o bigger equipment; capital
expenses; to start a business; costs more
COMMON LEADERSHIP ROLES 4. Materials o lesser/minor equipment;
★ Decision maker operation of organization or unit
★ Communicator 5. Methods – process
★ Evaluator 6. Moment/Minutes – time management
★ Facilitator 7. Manager
★ risk taker LEVELS OF MANAGEMENT
★ Mentor
1.Upper level manager:
★ Energizer
- Primary responsible for establishing
★ Priority setter
organizational goals and strategic plans for
★ Forecaster
the entire division of nursing
★ Influencer
- Director of Nursing Services, Chairman,
★ Creative problem solver
Executive Vice President
★ Change agent
- 24/7 responsibility
★ Diplomat
2. Middle level manager
★ Role model
- Usually coordinate nursing activities
★ Innovator
of several units
★ Encourager
- Supervisor, coordinator, clinical
★ Coach
nurse managers, case managers
★ Counselor
- 24/7 responsibility
★ Teacher
3. First level manager
★ Critical thinker
- Directly responsible for the actual
★ Buffer
production of nursing services; acts
★ Advocate
as links between higher level
★ Visionary
managers and non-managers
★ Director
- Head nurse (nurse manager),
charge nurse (informal), team
MANAGEMENT leader, primary nurse
● Focus on tasks such as planning, MANAGER
organizing, directing and controlling human
and physical resources and technology to
Authority
achieve organizational goals / objectives
- legitimate right to give commands, to make
decisions
MANAGER
- Managing people in the organization Power
- Make sure employees know what they are - ability to get results
doing and organizational operations run - ability to impose his or her will on another
smoothly person or group

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Understanding how works get done in org.

POWER A LEADER/MANAGER MAY POSSESS
● Requires self discipline
● Blind commitment to complete task at hand
● Legitimate power – based on position ● Accountable to the team
given , bestowed upon a leader or manager
with hierarchy position, most important kind
COMPARISON BETWEEN LEADERS AND MANAGERS
of power
● Reward power - reward/incentives , can
give benefits such as promotion and time LEADER
off. ● do not have delegated authority
● Coercive power- give sanctions or ● Have a wider variety of roles than
punishment managers
- ability to punish subordinates for ● Focus on group process, information
noncompliance gathering, feedback, and empowering
● Expert power – influence thru knowledge others
possession ● May or may not be part of the formal
● Referent power hierarchy of the organization
- Charisma (innate personality trait) ● Emphasize interpersonal relationships
- Relationship and Connection on higher Direct willing followers
authority ● Have goals that may or may not reflect
● Information power – based on the those of the organization
individual’s access to valued data
MANAGER
● Assigned a position by the organization
Distinctions between LEADERS and ● Have a legitimate source of power due to
MANAGERS
delegated authority that accompanies their
LEADER position
● Inspires change ● Have specific duties and responsibilities
● Requires vision they are expected to carry out Emphasize
● Requires imagination control, decision making, decision analysis,
● Requires abstract thinking and results
● Requires ability to articulate ● Manipulate people, the environment,
● Requires an aptitude to sell money, time, and other resources to
● understanding of external environment achieve the goals of the organization
● Requires risk taking ● Have a greater formal responsibility and
● confidence in the face of uncertainty accountability for rationality and control than
● Accountable to the organization leaders
● Direct willing and unwilling subordinates
MANAGER REMEMBER!
● Manages transformation
● Requires tenacity ➔ “Leadership is doing the right thing while
● Requires specifics management is doing things right.”
● Requires concrete data
● Requires ability to interpret ➔ The terms management and leadership
● Requires an aptitude to teach refer to the functions and relationships

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Decisiveness
while the terms leaders and managers refer
● Alertness
to the actor or agent of leadership and
● Tact
management.
● Oral fluency
● Diplomacy
➔ The integration of both leadership and
● Prestige
management skills is critical to the long
● Independence
term viability of today’s health-care
● Emotional balance and control
organizations.
● Social participation
● Personable
B. LEADERSHIP THEORIES ● Risk taking
● Charisma
● Skilled communicator
1. Early leadership THEORIES ● Critical thinking
The great man theory/trait theories (1900-1940) ● Collaborative priority setting
- The basis for most leadership research until ● Intelligence
the mid 1940s ● Adaptability
● Ability
● Knowledge
THE GREAT MAN THEORY
● Creativity
- from Aristotelian philosophy, asserts that
● Able to enlist cooperation
some people are born to lead, whereas
● Cooperativeness
others are born to be led.
● Interpersonal skills
- suggests that great leaders will arise when
● Self-confidence
the situation demands it.
● Personal Integrity
- who the leader is

Ex. Abraham lincoln - free from slavery BEHAVIORAL THEORIES (1940-1980)

Aristotle - What leadership style does this leader
William Shakespeare have?

TRAIT THEORY Kurt lewin (1951)

- assume that some people have certain isolated 3 primary leadership styles:
characteristics or personality traits that
make them better leaders than others. 1. Authoritarian/autocratic
- What the leader can do 2. democratic
Ex. Mother teresa 3. laissez-faire
Pope John Paul
Authoritarian leader is characterized by the ff
CHARACTERISTICS ASSOCIATED WITH behaviors
LEADERSHIP ● Makes decisions alone
● Proves useful in crisis situations.
● Emotional intelligence ● High productivity, less satisfaction of
● Able to enlist cooperation workers
● Judgment ● Others are directed with commands.

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Communication flows downward.

● Criticism is punitive. Fred Fiedler (1967)
DEMOCRATIC LEADER EXHIBITS FF BEHAVIORS - Leadership style should adapt to the
➔ Less control is maintained. situation at hand and the team.
➔ awards are used to motivate.
➔ Others are directed through suggestions SITUATIONAL LEADERSHIP THEORY
and guidance. Paul Hersey & Kenneth Blanchard (1977)
➔ Communication flows up and down. - Depends on the situation
➔ Decision making involves others. - Considers the person’s readiness and
➔ Emphasis is on “we” rather than I and you. willingness
➔ Criticism is constructive.
LAISSEZ-FAIRE LEADERSHIP
2.CONTEMPORARY leadership THEORIES
● Is permissive, with little or no control
● Motivates by support when requested by
the group or individuals INTERACTIONAL LEADERSHIP THEORY
● Provides little or no direction (1970-present)
● Uses upward and downward - leadership behavior is generally determined
communication between members of the by the relationship between the leader’s
group personality and the specific situation.
● Disperses decision making throughout the - a leader take it upon themselves to include
group others as much as possible by delegating
● Places emphasis on the group tasks.
● Does not criticize Ex. Toyota company
Edgar Schein (1970)
SITUATIONAL & CONTINGENCY LEADERSHIP ● Developed culture model- can be used to
(1950-1980) understand and shape an organization’s
● Situational- focuses on adapting to the culture.
current situation
● Contingency-predict and prepares for
possible future situation

CONTINGENCY LEADERSHIP THEORY

Robert Blake & jane mouton (1964)
- identifies different styles of leadership
based on concern for people versus
concern for task production. ( managerial
grid)

● Culture model -artifacts, values,

assumptions

Edwin hollander (1978)

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Highlights the leader – followership Bass and Avolio (1994)

relationship as central to effective - Leader influence followers and inspire them
leadership. to perform beyond their perceived
● ‘Doing things with people not to people’ capabilities.
in a 2 way influence relationship
James Kouzes and barry Posner (2012)
Hollander (leadership exchange involves 3 - exemplary leaders foster a culture in which
basic elements) relationships between aspiring leaders and
1. The leader willing followers can thrive.
2. The followers
3. The situation KOUZES & POSNER 5 practices for exemplary
leadership
William G. ouchi (1981) 1. Model the way
● Theory z (Japanese style management) 2. Inspire a shared vision
● aims to develop a workforce that is loyal 3. Challenge the process
towards the organization throughout its 4. Enable others to act - teamwork,
career. collaboration, trust
Rosabeth Moss Kanter (1977) 5. Encourage the heart
● A leader must develop relationships with a
variety of people and groups within the S Gerhard Huber (2015)
organization in order to maximize job - collective empowerment.
empowerment and be successful. - both the leader and the people they are
● Manager should share information, leading, are working together to achieve a
spreading knowledge and ideas shared goal

TRANSFORMATIONAL LEADERSHIP THEORY American Nurses Association (2016)

James Mcgregor Burns (2003) - leaders do more than delegate, dictate &
direct
2 primary types of leaders in management - help others achieve their highest potential.
1. The transactional leader- the traditional
manager, concerned with the day-to-day REMEMBER!
operations. ● Transactional leaders focus on tasks and
2. Transformational leader- is committed, getting the work done.
has a vision, and is able to empower others ● Transformational leaders focus on vision
with this vision. and empowerment.

SERVANT LEADERSHIP
REMEMBER!
● Transactional leaders focus on tasks and
Robert GREENLEAF (1977)
getting the work done.
- Leaders put serving others as number one
● Transformational leaders focus on vision
priority
and empowerment.
Ex. Abraham Lincoln, Mother Theresa, Dalai lama,
Pope John Paul, Martin Luther King
TRANSFORMATIONAL LEADERSHIP

NCM 119: NURSING LEADERSHIP AND MANAGEMENT 6

 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Organizing
FULL-RANGE LEADERSHIP THEORY ● command
● Leading
Bass and Avolio (1993) ● controlling

- a full range leader could apply principles of Bureaucratic management theory

three specific styles of leadership at any
given time: transformational, transactional, ● Max weber (1846-1920) - father of modern
and laissez-faire. organization)
- Well known german sociologist
NURSING LEADERSHIP ● Needs formal authority in organization
The process where the nurse influences one or ● Consistent rules and regulation
more persons to achieve specific goals in the
provision of nursing care of one or more patients. ● The ideal form of organization is
“Bureaucracy”
- In military and armed forces
C. MANAGEMENT THEORIES
● With hierarchies- with rules & regulations to
increase efficiency
1. EARLY management THEORIES
Traditional management methods MANAGEMENT FUNCTIONS
● Scientific Luther Gulick- expanded on Fayol’s management
● Bureaucratic functions in the “7 activities of management”
● General administrative
“POSDCORB” - planning, organizing, staffing,
Scientific management theory (1900-1930) directing, coordinating, reporting & Budgeting.
● Frederick Winslow Taylor (1911) - father
of scientific management and a mechanical 2. CONTEMPORARY management THEORIES
engineer.
● Conducted Time and motion studies Human relations management (1930-1970)
● One best way to do the job/accomplish the ● This era developed the concepts of
task participatory & humanistic management,
● Result: Productivity and profits rose emphasizing people rather than machines.
dramatically
● Said that We humans are motivated solely
by money
THEORY
MANAGEMENT FUNCTIONS
● Henri fayol (1841-1925) ● Participative
first identified the management functions of ● Hawthorne effect
planning, organization, command, coordination, ● Theory x & Y
and control.
PARTICIPATIVE MANAGEMENT
MANAGEMENT PROCESS Mary Parker Follet (1926)
● Functions - developed Participatory management
● Planning - Mother of Modern management

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

- “The art of getting things done through

people” REMEMBER!
- People is the most important comodity in
any business, institutions and organization
➔ The human relations era of management
- It discuss the importance and discuss the
science brought about a great interest in
positive
the study of workers that contributed to our
understanding about worker motivation.
HAWTHORNE EFFECT

ELTON MAYO (1953)

Conceptual paradigm of leadership &
● When management paid special attention to management
people; productivity will increase
● More employee participation in decision
making
● They go to the factory and they check the
light of the factory in how it increase the
productivity of worker
● People respond to the fact that they are
being a study.

THEORY X & THEORY Y

DOUGLAS MCGREGOR (1960)

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

Chris argyris (1964)

● supported McGregor (1960) & Mayo (1953)
that managerial domination causes workers
to become discouraged and passive.

● stressed the need for flexibility within the

organization and employee participation in
decision making.

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● It is a predetermined course of action

NURSING MANAGEMENT intended to facilitate the accomplishment of
FUNCTIONS a task, work or mission.

TYPES OF PLANS
PLANNING
1. STRATEGIC PLANS.
A management function, concerned with defining
● the sum total or outcome of the processes
goals for future organizational performance and
by which an organization engages in work
deciding on the tasks and resources to be used in
analysis, goal setting and strategy
order to attain those goals.
formulation for the purpose of
organizational growth and development.
- deciding in advance what to do, how to do a
● This type of plan defines the direction and
particular task, when to do it, and who is to do it.
growth of the organization.
● usually prepared in the upper levels of
management and serve as the basis for
operational plans.

Steps in Strategic Planning:

A.  Assess the environment - This requires a

broad area of the organizations current
environment.
GOOD PLANNING
B. SWOT Analysis - A tool frequently used to
conduct environmental assessments; such as
- involves a continuous process of assessment,
new equipment and technology, escalating cost
establishment of goals and objectives,
and prestige of the company and its impact to
implementation and evaluation of change as new
society.
facts become known Assessment (Douglass,
2006). S- Strengths - Refers to assessment of internal
environment.
POOR PLANNING
W-Weaknesses - Unmet goals and objectives of
-is the failure to set goals, make assessments of the organization as a result of inadequate planning
provide for implementation or to anticipate any and controlling
possible change in circumstances.
O-Opportunities - Assessment of external
environment that provide sources of improvement
PLANS or change.

● is a living document which can be changed T-Threat - These are factors that may pose
based on the prevailing circumstances. hazards, barriers to improvement or change.

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

C. Assessment of the Community as ● It provides for effective use of available

Stakeholder personnel and facilities.
● It helps nurses cope with crises and
● A stakeholder is any person, group or problems calmly and efficiently.
organization that has vested interest in the ● It reduces the element of change.
program or project under review.
● All potential stakeholders must be
ELEMENTS / SCOPE OF PLANNING
considered to ensure that their needs are
incorporated in the plan.
1. Forecasting or estimating the future
D. Other Methods of Assessment: 2. Setting goals and objectives
3. Developing strategies and setting the time
• Focus group interaction - consists of small frame
group of individuals selected due characteristics. to 4. Preparing the budget and allocation of
common resources
5. Establishing policies, procedures and
• Surveys and questionnaires that will be used to standards
gather ideas and opinions.
1. Forecasting or estimating the future
● Advisory boards that are selected from
various constituents affected by a proposed In making forecasts, the planner should consider
program. three (3) things:
● Review of literature and similar programs in
order to identify potential problems, pitfalls ● The agency where the planner is working
and successes. ● The community being served by the
● Review of best practices that will be used agency,
for evidence-based innovations and coming ● The goals of care.
from other organizations. successes
Forecasts must be supported:
2. OPERATIONAL PLANS.
● facts or evidences,
● usually pertain to activities in specific ● reasonable estimates of time and resources
departments of an organization. ● accurate reflection of policies and future
● The plan's main question is "how does one plans.
do things right?"
2. Set Goals / Objectives and Determine Results
● It deals with tactics or techniques for
Desired
accomplishing these things.
● They are generally shorter in time frame
● Goals are broad statements of intent
(e.g. one year), and usually involve the
derived from the purposes of the
middle and lower level managers.
organization.
● Objectives are specific behavior or tasks
REASONS FOR PLANNING set for the accomplishment of a goal.

● It leads to success in the achievement of

goals and objectives.

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

3. Develop and Schedule Strategies,

Programs/Projects /Activities; Set the Time
Frame

● Strategy is the techniques, methods, or

procedure by which the overall plan of the
higher management of the agency achieve
desired objectives.
● Programs are activities put together to
facilitate attainment of some desired goals, Performance Evaluation and Review Technique
● Time Management manager should (PERT)
allocate it as efficiently as possible
● Mismanagement of time compromises an Is a network system model for planning and control
organization's productivity and results in which involves identifying key activities, sequences
negative effects them in a flow diagram and assigning a specific
duration for each phase of work
Principles of Time Management

"There is always time for everything if you like

to find the time”

Basic Principles to cultivate good time

management habits

1. Planning for contingencies.

2. Listing of tasks.
3. Inventory
Critical Path Method or CPM
4. Sequencing
5. Setting and keeping deadlines.
Is a network system model for planning and control
6. Deciding on how time will be spent
which involves identifying key activities, sequences
7. Delegate
them in a flow diagram and assigning a specific
duration for each phase of work
Multitasking results when time is not enough or
properly allocated to be able to finish task.

Tolls in Project Management

Gantt charts show task and schedule information.

The tasks are numbered and listed vertically. A bar
shows the starting date and projected completion
date of each task.
4. Prepare the Budget and Allocation of
Resources

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

● Budgeting is defined as a systematic 4. Program Budget - cost are computed for a

financial translation of a plan. program as a whole or the entire program
- the allocation of scarce resources itself
on the basis of forecasted needs for 5. Zero-based Budget- a zero based Budget-
proposed activities over a specified justifies in detail the cost of all programs,
period of time. both old and new, in every annual budget
preparation.
Approaches in Budgeting 6. Sunset Budget - designed to self destruct
within a prescribed period to ensure
1.Centralized Budget
cessation of the funded program at a
predetermined date.
2. Decentralized Budget

Components of Total Institutional Budget Factors in Budgeting Planning

● The type of patients.
1. Manpower Budget - This consists of the ● The kind or class of the hospital
wages and salaries of the regular ● The policies on personnel and equipment
employees and the fees paid to outside ● Standard of nursing care and nursing
registries through which the institution supervision
contracts short term employees.
2. Capital Expenditure Budget - This 1. Patient - the nature of the patients needs is
involves the large expense of purchasing of in primary consideration in budget planning.
lands, buildings, and major equipment These needs are determined by the
meant for long term use. condition of the patient, the length of stay in
3. Operational Budget - This includes the the hospital and the acuteness of the illness
cost of supplies, minor equipment repair 2. Hospital or Health Care Facility - the
and maintenance as well as other overhead available facilities and resources with which
expenses. to address the needs of the patients are
also factors in budget planning
Types of Institutional Budget Depending on ➢ size of the hospital
Management Philosophy ➢ Physical layout
➢ Size of wards or units
1. Open Ended Budget - characterized by a ➢ Nurses station
single cost estimate for each program in the ➢ Other relevant facilities and
proposed unit. resources available
1. Fixed Ceiling Budget - is one in which the
uppermost spending limit is set by the top 3. Personnel - iot is important to be well-
2. Flexible budget - contains several financial acquainted with personnel policies in place,
plans for each level of activity or for such as the salaries paid to nursing
different operating conditions. This type of personnel, leave benefits enjoyed by the
budget can be adjusted or manipulated. personnel.
3. Performance Budget - is based on the 4. Standard of Nursing care and
functions involved in the operation Supervision - This consist of the cost of
budgeted training and maintaining personnel and
acquiring equipment that will be needed by

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

the health care facility, based on the volume 6. Lack of willingness to engage in new
of patients and the nature of their needs. activities that planning produces:
7. Existence of the situation, they prefer to act
Tolls in Budgeting and Management of on immediate problems that give them
Resources immediate feedback.
1. The budgeting process of the organization
2. Determine the number of full-time
equivalent of nurses necessary to stuff the ORGANIZING
unit.
3. Compute the salary and non-salary budget
ORGANIZATION
including salary increases and other various
- Is the form of every humans association for
factors.
the attainment of a common purpose
4. Monitor the variances over the budget
(Mooney 1939)
period and identify negative variances
- An act of putting into systematic
responding promptly and appropriately.
relationships those elements and activities
5. Understand the extraneous factors such as
essential to the satisfaction of the purpose
changes in technology or direct or indirect
cost that may be assigned to their budget.
- A form of identifying rules and relationships
6. Encourage the staff to monitor resources
of each staff in order to delineate specific
used including time and supplies
tasks or functions that will carry out
organizational plans and objectives.
5. Establish Policies Procedures and standards
Policies are defined as standing plans used
- The process of identifying and grouping the
repeatedly or guides or basic rules that govern
work to be performed, defining and
action at all levels in the organization
delegating responsibility and authority and
establishing relationships for the purpose of
Procedures are defined as a more specific guide to
enabling the people to work most effectively
action than policy where each step is listed
together in accomplishing objectives (Allen,
2008).
Resistance in Planning
1. Lack of knowledge of the philosophy, goals
The process involves
and operations of the organization
1. Identification and definition of the basic
2. Lack of understanding of the significance of
tasks of individuals at work such as
planning, that success or failure of work
staffing and creation of job descriptions;
activities relate directly to the quality of a
2. Delegation of authority and assignment of
plan.
responsibility to ach member of the team for
3. Lack of proper appreciation of use of time
the accomplishment of activities
for planning : they erroneously perceive that
3. Establishing relationships of people by
time spent on planning would be better
providing a system of vertical and horizontal
spent on addressing day-to-day concerns
communication through hierarchical
4. Lack of confidence and fear of failure;
relationships to bind and coordinate all the
5. Lack of openness to change that they
activities to be done.
believe planning may entail;

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 NCM 119
NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

Characteristics of an Organization
- It is a formal structure, the official
arrangement of positions or working
1. Division of work where each box
relationships that will coordinate efforts of
represents an individual or sub- unit
workers of diverse interest and abilities.
responsible for a given task
2. Chain of command with lines indicating
who reports to whom and by what authority. Patterns of Organizational Structure
3. Type of work segments, shown by clusters
of work groups differentiated from one another ● Tall or Centralized Structure
4. Levels of management indicating hierarchical ― are characterized by a narrow span of
relationships control, where supervisors are responsible for only
a few subordinates.
― due to its vertical nature, this structure
Principles of Organizational Design
involves many levels of communication.
These principles on which sound organizational
― Communication can be difficult, and messages
design is founded are the following
often fail to reach the top effectively. ― Workers
tend to be boss - oriented due to close
1. Division of Labor promotes
supervision.
departmentalization and specialization ,
which results in a more efficient
• Flat or Decentralized Structure
performance of a unit.
― feature few levels and a broad span of control,
2. Unity of command, whether it follows a
decision - making is spread among many people,
line of command or vests it in one superior
making communication easy and direct.
command or vests it in one superior
― this structure shortens the administrative
ensures a unity of vision.
distance between top and lower levels,
3. Authority and responsibility determine
― facilitates fast problem - solving and response,
the line and staff authority, which delineates
― encourages workers to develop their abilities
the distribution of power.
and autonomy.
4. Span of control determines the extent of
control in each level , area or unit within the system
, as well as whether it is centralized or
decentralized
5. Contingency factors the environment and
technology or knowledge of team members, which
deals with task variability and problem analyzability.

ORGANIZATIONAL STRUCTURE

- A process in which a group is formed

including its authority, responsibility and
accountability(ARA), span of control and
lines of communication.

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

Types of Organizational Structure

• Line Organization/Bureaucratic/Pyramidal .
In a line organization, there is a clearly defined
superior - subordinate relationship. Authority and
power are concentrated at the top.

• Ad Hoc Organization . is a modification of the

bureaucratic structure, often created for specific
projects or purposes.

• Matrix Structure . focuses on both products and

functions, making it the most complex type. It
incorporates both vertical and horizontal chains of
• Flat/Horizontal Organization . A decentralized command and lines of communication.
type, flat organizations are applicable in small
organizations. Nurses become more productive
and directly involved in decision - making
processes, leading to greater worker satisfaction.

ORGANIZATIONAL CULTURE
• The personality of the organization comprised of
the assumptions, values, norms and tangible signs
of the corporation
• Different types of organizational culture:
• Functional Organization . This structure allows ➔ The tough - guy macho culture
specialists to assist line positions within a limited ➔ The work hard/pay hard culture
and clearly defined scope of authority. ➔ The bet your company culture
➔ The process culture

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
1st SEMESTER | 2024-2025| Ms. Lea Guico

Considerations in Staffing Pattern

STAFFING
1. Benchmarking – is used to seek out the best
● Process of assigning competent people to practices within the healthcare industry to improve
fill the roles designated for the performance.
organizational structure through
recruitment, selection and development 2. Regulatory Requirements - Staffing patterns
must adhere to mandated regulations, such as
Why staffing is importance? those outlined in relevant legislative acts such as
1. Getting qualified and skilled people into the RA 5901 ( An Act Prescribing Forty Hours a Week
team. of Labor for Government and Private Hospitals or
2. Roles become clearer and the workload works Clinic Personnel )
become lesser.
3. There is an improvement in the morale and job 3. Skill Mix - refers to the percentage or ratio of
satisfaction. professionals to non - professionals within the staff.
4. It helps the organization diversify its talent ensures a balanced team with the necessary
profile and hence aids with company growth. expertise and support staff, allowing RNs to focus
on complex patient tasks while nursing assistants
handle more routine duties.
STEPS IN STAFFING
1. Determine the number and types of personnel 4. Staff Support. This support allows nurses to
needed (manpower planning) dedicate more time to patient care rather than
2. Recruit personnel administrative duties.
3. Interview
4. Induct or orient personnel 5. Historical Information. Reviewing historical
5. Job offer data on quality and staff perceptions regarding the
effectiveness of previous staffing patterns is
STAFFING PATTERN crucial. This historical review helps in planning and
─ is a plan that articulates how many and what kind adjusting staffing levels to meet future demands
of staff are needed by shift and day to staff a unit more effectively.
or department.

1. Determining Nursing Care Hours required per

Patient Classification System
patient - For example, if each patient needs an
average of 6 hours of nursing care per day and ─ measurement systems in nursing that reflect
the unit has 20 patients, the total nursing care actual patient care needs for staffing purposes.
hours needed per day would be 120 hours.
Patient Care Classification
2. Calculating Full time Equivalents (FTEs) - 1. Self - Care or Minimal Care . These patients
For instance, 1.0 FTE represents a full - time are capable of performing activities of daily living
employee who works 5 days a week, 8 hours a (ADLs) independently, such as hygiene and meals.
day, totaling 40 hours a week. Conversely, 0.5
FTE corresponds to a part - time employee 2. Intermediate or Moderate Care . Patients in
working 5 days every 2 weeks, totaling 20 hours a this category require some assistance from the
week. nursing staff for special treatments or specific

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
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aspects of personal care. (IV Fluids, catheters, or 2. The Functional Method . This method is task
on respirators) and procedure oriented. It is used when there are
3. Total Care . These patients are bed ridden and too many patients in proportion to available RN.
lack the strength or mobility to perform ADLs. The RN learns to work fast because activities are
significant mobility restrictions. repetitious, and her technical skills amplified.
4. Intensive Care : Critically ill and in constant
danger of death or serious injury.

NURSING CARE MODELS

─ is the framework for nursing care delivery in any

setting, or design that meets the particular needs The advantages of Functional Method are:
of a group of health care givers and clients. a. Nurses who are oriented this way become skilled
in performing assigned tasks;
1. The Case Method or Total Patient Care. This b. Individual aptitude and experience improves;
is actually the original model of nursing care c. Less equipment is needed;
delivery, in which a registered nurse is responsible d. Time is saved; and
for all aspects of care of one or more patients . e. Task - oriented approach improves both
productivity and organization.

Often, in this approach, patients can not identify

who their nurse is

3. Team Nursing . In team nursing which evolved

from functional nursing, a group of nursing
personnel provides total patient care to a group of
patients.

Advantage a. The RN leads a group of many health workers,

• The nurse can better see and attend to the total including students.
needs of clients and the continuity of care can b. This group is centered through participation
be facilitated with ease. efforts.
c. The personnel work together to identify, plan,
• The client's interaction and rapport with the nurse implement and evaluate comprehensive client -
are well - developed, and the client's needs are centered nursing care toward a common goal of
monitored carefully, with the result that both the providing quality client care.
client and his or her relatives feel secure. d. It is oriented towards the decentralization of a
nursing unit and of the Head Nurse's authority.
Disadvantage e. Comprehensive nursing care with authority,
• RNs spend some time doing tasks that could be responsibility and accountability becomes the
done more cost - effectively by less - skilled responsibility of the entire team.
persons.

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
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higher patient load requires more nursing staff to

ensure each patient receives adequate attention
and care.
• Experience of Staff . The skill and experience
levels of the staff should match the complexity of
patient care required.
• Support Available to the Staff . The availability
of support personnel, such as nursing assistants
and administrative staff, affects how nursing duties
are distributed.
• Shifting Variations . Different shift patterns are
utilized to meet both patient care needs and staff
preferences. These variations can help in
maintaining a balanced and effective workforce.
Advantages of Team Nursing:
a. The constant group work fosters a feeling of Shifting Patterns
participation and belonging. 1. 3 Shift (8 - hour shift) . Commonly used to
b. The workload is balanced and shared with the provide 24 - hour care, this pattern divides the day
division of labor for each team member. into three 8 - hour shifts.
c. Each member of the team has the opportunity to 2. 12 - hour Shift . This pattern involves longer
learn from other team members or team shifts with fewer workdays, often preferred by
colleagues. nurses who enjoy having more consecutive days
d. There is also a variety in the daily assignment. off.
e. It also helps maintain interest in client's well 3. 10 - hour Shift . Less common but offers a
being and is cost effective. balance between 8 and 12 - hour shifts.
f. The patient is able to identify who their nurses 4. Weekend Option . Staff works primarily on
are due to the continuity of care. weekends, which can be ideal for nurses who
g. Barriers between nurses and clients can be prefer or need weekdays off.
minimized since care is well coordinated. 5. Rotating Work Shift . Shifts rotate between day,
h. Everyone gets to contribute to the care plan. evening, and night, allowing all staff to experience
different times of day.
6. Self - Scheduling . Staff members create their
SCHEDULING own schedules, promoting autonomy and job
satisfaction.
- process of creating a timetable that 7. Permanent Work Shift . Staff work consistent
outlines the planned work days and shifts shifts without rotation, providing stability and
for nursing personnel. predictability.
8. Floaters . Staff who are “on - call” to fill in as
Issues to Consider in Scheduling Staff needed. Floaters provide critical support during
• Patient Type and Acuity . Different patients unexpected absences or increased patient loads,
require varying levels of care, significantly ensuring that the unit remains adequately staffed at
impacting how staff is allocated. all times.
• Number of Patients . The total patient count
directly influences the number of staff needed. A

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
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JOB DESCRIPTIONS EMPLOYEE DISCIPLINE

• Specifications of duties , conditions, and • Process of generating employee compliance to
requirements of a particular job prepared the institutional rules and regulations.
through a careful job analysis.
• Also called as performance descriptions Purposes of Employee Discipline
Used primarily for the purpose of: 1. Creates order and smooth transition during shifts
• Recruitment and breaks.
• Placement and transfer 2. Helps nurses to perform their tasks better
• Guidance and direction 3. Provides direction for delinquent employees
• Evaluation of performance
• Reduction of conflict and frustration Employees' discipline policies must be
• Avoidance of overlapping of duties communicated to the stakeholders.
• Facilitation working relationships with outside
bodies Principles of Discipline
• Serves as basis for salary range 1. Discipline should be done privately, promptly
and consistently
Contents of Job Descriptions 2. It should be progressive in nature
1. Job Title – position and necessary qualification 3. It should be preceded with counseling
2. Job relationships – degree of supervision , 4. Disciplinary procedures should be instituted with
line and staff responsibilities and reporting extreme caution
mechanisms imposed on the worker
3. Performance or Job Description – catalogue Steps to Address Discipline Problems
of the assigned tasks and responsibilities of the 1. Coaching
worker 2. Confrontation
3. Disciplinary conference

Steps of Progressive Discipline

1. Counseling
2. Verbal reprimand
3. Written reprimand
4. Short suspension
5. Longer suspension
6. Discharge/dismissal

Tools/Techniques for Terminating Staff

1. Inform the HRD and the administration
beforehand
2. State the offending behavior and the reason for
termination
3. Explain the proposed termination process
4. Termination must have the approval of higher
authorities
5. Arrange the employee to be escorted out
6. Report back to the HRD and administration

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NURSING CARE PLAN

DIRECTING A Nursing Care Plan outlines the nursing
care to be provided to a patient.
- is the act of issuing of orders, assignments,
instructions to accomplish the organization's goals ― It is a set of actions the nurse will implement to
and objectives. resolve patient problems identified by assessment.
― It guides in the ongoing provision of nursing
- it involves the process of getting the care and assists in the evaluation of that care.
organization's work done.
- it entails explaining what is to be done, to whom Characteristics of the Nursing Care Plan
and by whom, at what time, how and why it is to 1. It is primarily concerned with patient needs and
be done. problems such as signs or objective data,
symptoms or subjective data gathered by the
Characteristics of Good Directions nurse through her contact with the patient.
1. Directions must be clear, concise, consistent and 2. It focuses on nursing actions which are designed
complete. to solve or minimize the patients' existing problem
and prevent potential risks.
2. The person giving directions must explain the 3. It is a product of a deliberate systematic process
rationale well and make certain that it is based on scientific principles and standards of
understood. nursing practice.
4. It relates to the future actions and interactions.
3. The words used in giving directions indicate their 5. It is based upon identifiable health and nursing
importance. problems.
6. Its focus is holistic. Considering all aspects of
4. The person giving directions must speak care, be it physical, emotional, psychological,
distinctly and slowly. Directions must be given in sociological or spiritual among others.
logical manner and prioritize the tasks directed to 7. It aims to meet all the needs of the patients or
be done by importance and time. service user in terms of promotive, curative,
rehabilitative and restorative process of care.
5. It is important, furthermore to,
a. Avoid giving too many directions at one time; Elements of the Nursing Care Plan
b. Personalize directions; The nursing care plan may consist of the following:
c. Always check to make sure directions have been ― a NANDA nursing diagnosis with related factors,
followed; and ― subjective and objective data that support the
d. Provide feedback for actions done. diagnosis,
― specified outcome goals and objectives to be
Tools In Directing achieved including deadlines and nursing
― The primary tool is the nursing care plan as a intervention.
whole.
Elements of Directing
― Policies, 1. delegation;
― Standards, 2. supervision;
― Standard Operating Procedures, 3. staff development;
― Rules and Regulations. 4. coordination;

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5. collaboration; 3. Fear on the part of the management to fully

6. communication; comprehend the task to be accomplished may
7. evaluation. inhibit the manager to delegate the task .
4. Fear of losing control of the staff .
1. DELEGATION 5. Fear of failing to get others do the work.
― is the act of assigning to someone else a 6. Fear of criticism. Based on command
portion of the work to be done with corresponding responsibility, when task delegated are not done
authority, responsibility and accountability (ARA). as expected.
― It is also a skill to be learned and mastered,
• beginning with learning what cannot be The manager who enjoys the personal satisfaction
delegated gained from doing the work herself will likewise
• what will be delegated not be inclined to delegate the work.
• to whom should it be delegated.
― It is one of the core concepts of management Common Delegation Errors
leadership. a. Underdelegating
b. Overdelegating
“The person delegated to do the tasks remains c. Improper Delegating
accountable for the result of the delegated
work.” Steps in Effective Delegating
1. Plan Ahead.
What cannot be delegated 2. Identify Necessary Skills and Levels.
― the overall ARA, 3. Select the Most Capable Personnel.
― the final evaluation of staff performance, 4. Communicate Goals Clearly.
― correcting and disciplining staff, 5. Empower the Delegate.
Delegated tasks must be based on policies, job 6. Set Deadlines and Monitor Progress.
description and capabilities of workers . 7. Model the Role and Provide Guidance.
8. Evaluate Performance.
Why is there a Need to Delegate
1. Delegation can save money and time . Key Concepts in Effective Delegation
2. Helps in building skills of subordinates . • Motivation - influences our choices and drives
3. Motivate people to perform higher level tasks . the direction, intensity, and persistence of our
4. Train people to prepare for greater behavior. (personal fulfillment, professional
responsibilities . recognition, and the desire to provide excellent
5. Allow next in line staff to do the job in the patient care)
absence of the manager . • Supervision
6. Groom successors since nobody is • Coordination
indispensable .
2. SUPERVISION
Why Managers do not want to Delegate ― is the process of guiding and directing the work
1. Mistakes in delegation can be costly . to be done.
2. Failure to delegate wisely increases ― motivating and encouraging the staff to
management costs and contributes to personnel participate in activities to meet goals and
dissatisfaction . objectives and personal development and in
helping the staff to do their work better.

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
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― is a planned experience to help employees

Principles of Good Supervision perform effectively and efficiently, and to enrich
a. Good supervision is focused on the their competence in practice, education,
improvement of work rather than upgrading the administration and research.
worker. ― retraining personnel for better performance in
areas of skill, knowledge and attitude (SKA).
b. It is based on lines of authority, organizational
philosophy, vision/mission, the job description, Functions of Staff Development
policies and standards, the needs of the individual. a. Maintain staff efficiency and effectiveness;
b. Create quality employees;
c. Good supervision focuses on development of c. Meet the staff's needs and address their
the three areas of skill: problems, such as deficiencies in knowledge, skills
• Conceptual – enhance knowledge through and attitude.
adequate information and feedback. d. Motivate them and improve their self -
• Technical – refinement of skills through in - confidence, knowledge and skills
service trainings and seminars. e. Help prepare them for greater responsibilities
• Interpersonal – develop communication skills
through constant dialogues and conferences. In - service Training and Continuing Education

d. It is cooperatively planned by both management In - service Training

and staff, and accepts both challenge or change. ― education for employees to help them develop
their skills in a specific discipline or occupation .
e. It uses a democratic process to facilitate: ― is conducted during a break in the individual's
• Effective communication; work schedule .
• Continuous improvement of staff;
• Respect for the individuality of each staff Continuing Education Program
member; and therefore ― a specific learning activity generally
• Bring about harmonious relationship and a characterized by the issuance of a certificate or
conducive social, psychological and physical continuing education units (CEU)
atmosphere.

f. The ultimate goal of good supervision is to

provide safe, effective, quality care.

Responsibilities of Supervisors
• teach and motivate the staff,
• facilitate their work performance
• delegate work responsibilities
• be available for consultation
• perform assessment and evaluation of work
performance, including environmental conditions
4. COORDINATION
work and supervision.
― This activity links the different components of
an organization and leads them toward goal
3. STAFF DEVELOPMENT achievement.

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― involves arranging activities to create harmony Barriers to Effective Communication

and facilitate success. a. Physical Barriers . These are environmental
― effective coordination ensures team members factors that prevent or reduce the opportunities for
work together efficiently to provide optimal patient communication (example; distance and noise)
care.
b. Social/Psychological Barriers . They are
5. COLLABORATION blocks or inhibitors to communication that rise from
― The manager and the health care staff together the judgments, emotions and social values of
with the other members of the health care team people (example; stress, trust, fear,
all participate in the decision making process. defensiveness)
― Sometimes they join forces with another as the
medical group or larger group, like another health c. Semantics . These are words, figures, symbols,
care team or one fulfilling a different role for this penmanship, interpretation of messages through
purpose. signs and symbols. Symbols may have a variety of
meaning and the symbol is chosen from among
6. COMMUNICATION the many.
― ensures common understanding via various
routes. d. Interpretations . These are defects in
― a process by which a message is sent, received communication skills of verbalizing, listening,
and understood as intended. writing, reading and understanding.
― The goal of proper communication is to narrow
the gap between the intended and the received Dimensional Flow of Communication in
message. Nursing Service

Some of the Ways to Communicate

− involve informal talks,
− planned appointments,
− telephone calls,
− inter office memos,
− letters,
− reports,
− informal staff meeting,
− planned conferences,
− mass meetings or general assemblies, Management Levels in Nursing Service
− bulletin board notices, a. top level - the director and the administrator of
− posters, nursing services.
− exhibits, b. middle level - nurse supervisors and area
− displays, managers
− visual aids c. first line managers - the head nurses, unit
− email managers, senior staff nurses,
− online chats d. operating level - staff nurses, student nurses,
− web blogs nursing attendants.
− social media
− constitute alternative forms of communication 7. EVALUATION

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NCM 119 : NURSING LEADERSHIP AND MANAGEMENT
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― A desired result of any employee behavior is

effective job performance. 1. Intrapersonal or within one individual
― An important role of the manager is to 2. Interpersonal or within two or more individuals
determine performance in advance and state 3. Intragroup or within one group
desired outcome of what has been done. 4. Intergroup or between two or more groups

Purposes of Evaluation Results of Conflict

− Determine how far or how many of the 1. Can provide greater sensitivity to an issue which
organization's objectives were accomplished. stimulates the interest and curiosity of others;
− Provide constructive feedback 2. Can increase creativity by acting as a stimulus
− Determine progress and worthiness of individual for developing new ideas or identifying methods
nurse for greater responsibilities for solving problems;
− Serve as basis for promotion and increase in 3. Can help people recognize the legitimate
salary or other similar rewards differences within an organization;
− Recognize and further develop strengths; 4. Can also be a powerful motivator to improve
− Minimize weaknesses of the staff; performance and effectiveness; and
− Provide security for patients, personnel, agency 5. Can make parties aware of costs versus
and the community; and benefits of a particular service or technique
− Develop a fair employment practice and
performance appraisal process that is in Two Main Types of Conflict
accordance with the law. 1. Competitive Conflict. occurs when two or
more groups attempt the same goals and only one
Different Types of Evaluation group can attain them. It is defined by a victory for
a. Outcome or product evaluation, which takes one side and a loss for the other.
note of the response of patients after nursing − The process by which such conflict is resolved is
care is done. determined by a set of rules.

b. Process evaluation, nursing actions are 2. Disruptive Conflict . takes place in an

examined, to determine if client goals have been environment filled with fear, anger and stress.
met or have not been met. There is no mutually acceptable set of rules and
the goal of each party is the elimination of its
c. Structure evaluation, the goal is to obtain opponent.
feedback on the systems in terms of financial and
material resources, nursing personnel, policies
CONFLICT RESOLUTION
and procedures.

1. Dominance and Suppression. The use of win

CONFLICT - lose strategy is a method that represses rather
than settles conflict, creating a win - lose situation
― is a natural, inevitable condition in organizations
in which the loser is left feeling angry and
and is often a prerequisite to change in people and
antagonistic.
organizations.
― is a consequence of real or perceived
2. Restriction is an autocratic, coercive style that
differences in goals, values, ideas, attitudes,
often leads to an indirect and destructive
beliefs, feelings and actions.
expression of conflict.

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- performance is measured and corrective action is

3. Smoothing Behavior is a more diplomatic way taken to ensure the accomplishment of
of suppressing conflict wherein one persuades organizational goals.
the opponent to give in to the other side. - it involves assisting, regulating, monitoring, and
evaluating individual and group performance.
4. Avoidance Behavior creates a situation in
which there seems to be differences existing Principles of Controlling
between one another. An individual withdraws or 1. A Critical Few , meaning that fewer people
walk away from the source of conflict. involved in control brings about the best results.
2. A defined Point of Control or a centralization
5. Majority Rule resolves conflict by majority vote. or decentralization of authority.
3. Self - control or Discipline , which translates to
6. Compromise or Consensus Strategy is a personal acceptance of responsibility and
method where each side agrees upon solutions accountability.
that meet everyone's needs.
KINDS OF FORMAL CONTROL
7. Integrative Problem - solving is a constructive
process in which the parties involved recognize 1. Pre - action Control. this is controlling by
that conflict exists and openly try to solve the means of personal supervision and
problem. utilizing control checks consisting of
policies and procedures for any given task
8. A Win - Win Strategy focuses on goals and or function.
attempts to meet the needs of both parties.
2. Post - action Control. this is controlling
9. A Lose - Lose Strategy is one in which neither as the task or function is being performed
side wins; the settlement reached is unsatisfactory or may have been performed and
to both sides. correcting deviations from standards or
plans.
10. Confrontation is regarded as the most
effective means of resolving conflict in which it is
Types of Control
brought out in the open and attempts are made to
1. Feedforward Controls . focus on operations
resolve it through knowledge and reason.
before they begin. Their goal is to prevent
anticipated problems.
11. Negotiation is a technique where conflicting
parties give and take on various issues and
2. Concurrent Controls. apply to processes as
arrange solutions that may offer best to both
they are happening, enacted while work is being
parties.
performed.

CONTROLLING 3. Feedback controls. focus on the results of

operations. They guide future planning, inputs,
- is the use of formal authority to assure the and process designs.
achievement of goals and objectives.
Characteristics of Effective Controls

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1. Control systems must be designed appropriately THE CONTROL PROCESS

to be effective.
2. When control standards are not flexible or Steps in the control process
unrealistic, employees cannot focus on the 1. Establish and Specify Criteria and Performance
organization's goals. Standards

3. Control systems must prevent, not cause, the 2. Monitor and Measure Performance of Nursing
problems they were designed to detect. Care Services and Evaluate it against the
Standards through Records, Report and
Designing Effective Control Systems Observation
1. Control at all levels in the healthcare delivery 3. Compare Performance with Standards, Models
system. All nursing units must have a standard or Criteria to Determine Deviations or Differences
control system. in Performance

2. Acceptability of those who will enforce the 4. Enact Remedial Measures or Steps to Correct
decisions. The nurse manager's manner of Deviations or Errors
influence on her staff to comply with the policies 1. Establish and Specify Criteria and
or procedures. Performance Standards

3. Flexibility of the enforcers and the a. Standards . created when objectives are set
implementors to enforce decisions based on during the planning process.
practical situations. • is any guideline established as basis for
measurement.
4. Accuracy. Steps or mechanisms of control
must be clear and vivid with significant b. Time Controls . relate to deadlines and time
implications. constraints.

5. Timeliness. Activities are planned with time c. Financial Controls . facilitate achieving the
target set. organization's profit motive. One method of
financial control is budgeting.
6. Cost effectiveness. Resources used are well
maintained and enough or adequate to meet the d. Operations control . methods assess how
needs of the unit. efficiently and effectively an organization's
transformation processes create goods and
7. Understandability. Policies and procedures are services.
simple, easy to understand and can be
implemented with less difficulty. e. Statistical process control is the use of
statistical or mathematical methods and
8. Balance between Theory of Objectivity and procedures to determine whether production
Subjectivity, and practice - based system. operations are being performed correctly, to detect
any deviations, and to find and eliminate their
9. Coordinated with planning, organizing and causes
leading.

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f. The Just - in - Time System is the timely information, extensive coverage and the ability to
application of materials for use in case nurses read between the lines.
need it for patient care such as giving of
medication for the illness of a patient. 3. Compare Performance with Standards,
Models or Criteria to Determine Deviations
2. Monitor and Measure Performance of or Differences in Performance
Nursing Care Services and Evaluate it against
the Standards through Records, Report and Techniques to improve performance based on
Observation feedbacks

Techniques for monitoring and measuring a. The Program Evaluation and Review Technique
service. (PERT) employs a matrix that uses network of
activities represented in a chart, including the
a. Nursing Rounds. Nurses pay particular goals or product desired, time management,
attention to issues of patient care and nursing budget and estimation of critical paths.
practice. This will also find out if the needs and
problems of patients are met or unmet. b. Benchmarking seeks out the best so as to
improve its performance. It provides a standard or
b. Quality Assurance monitors compliance of point of reference in measuring or judging such
nursing personnel with established standards in factors as quality, values and cost.
terms of nursing care given to patients.
4. Enact Remedial Measures or Steps to Correct
c. Nursing Audit consists of documentation of Deviations or Errors
the quality of nursing care in relation to the
standards established by the nursing department. a. Correction of deviations or errors.
• It prioritizes nursing care by promoting optimum b. A Master Control Plan
nursing care. c. Take necessary action.
• It can identify deficiencies in the organization and
administration of nursing care
Characteristics of the Control Process
• It may also be used to increase performance to
1. The control process is cyclical which means it is
assure that improvements have been maintained.
never finished.
2. Controlling often leads to management
How data was collected to measure actual
expecting employee behavior to change.
performance
3. Control is both anticipatory and retrospective.
4. Ideally, each person in the health care delivery
• Written data might include time cards, production
views control as his or her responsibility.
tallies, inspection reports and sales tickets.
5. Controlling builds on planning, organizing and
• Personal observation, statistical reports, oral
leading.
reports and written reports can be used to
measure performance.
I. PERFORMANCE APPRAISAL
− appraisal is a method of acquiring and
• Management by walking around or observation of processing information needed to improve the
employees working, provides unfiltered individual's performance and accomplishments .

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− the purpose of the evaluation is to assess the 5. Hawthorne Effect. The behavior of the ratee
appropriateness, adequacy, effectiveness and changes simply because he is observed by the
efficiency of services . The methods used may be rater. The ability of the rater to closely observe the
anecdotal records, checklist, rating scale, ranking ratee is challenged by the knowledge he/she has
among others . of the ratee.

Performance Appraisal Tools 6. Horn's Effect. This occurs when rating an

1. Trait Rating Scale. This is a method of rating a employee very low because of an error
person against a set standard which may be the committed.
job description, desired behavior and personal
trait. II. TOTAL QUALITY MANAGEMENT (TQM)
2. Job Dimension Scale. It focuses on job − is a management approach for an organization,
requirements and the quality work performance focused on quality, based on the participation of all
3. Behaviorally Anchored Rating Scale (BARS). its members and aimed at long-term success
This focuses on desired behaviors to improve through customer satisfaction and benefits to all
performance. members of the organization and to society .
4. Checklist. It is composed of behavioral − is aimed at embedding awareness of quality in all
statements that represent desirable behavior. organizational processes .
5. Peer Review. It is a collegial evaluation of the
performance done to promote excellence in The three basic principles of TQM are to :
practice and offer information, support, guidance, 1. Focus on achieving customer satisfaction;
criticism and direction to one another. 2. Seek continuous and long - term improvement in
6. Self - Appraisal. This tool allows the employee all the organization's processes and outputs; and
to evaluate his own performance. 3. Take steps to ensure the full involvement of the
entire workforce in improving quality.
Common Errors in Appraisal
1. Halo Effect . This has a tendency to overrate TQM is composed of three paradigms :
staff based on the rater's first impression of the 1. Total : Involving the entire organization, the
ratee. entire chain, and/or product or outcome life cycle.

2. Logical Error . It is often based on first 2. Quality : With its usual characteristics, with all
impressions of the rater to the ratee. its complexities to meet total client satisfaction.

3. Central Tendency Error . this rates the staff 3. Management : The system of managing the
as average. This is used by the rater when organization with steps like Planning, Organizing,
feedback tools are inadequate and when there's Controlling, Leading, Staffing, Provisioning and the
no sufficient time for the rater to observe the ratee. like.

4. Leniency Error. there is the propensity to In Japan, TQM comprises four process
overlook or observe the weaknesses and mistakes namely:
of the person being evaluated leading to an 1. Kaizen - Focuses on "Continuous Process
inaccurate picture of the job performance. Improvement", to make processes visible,
repeatable and measurable.

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2. Atarimae Hinshitsu – The idea that "things will

work as they are supposed to" for example, a pen
will write.

3. Kansei - Examining the way the user applies the

product leads to improvement in the product itself.

4. Miryokuteki Hinshitsu - The idea that "things

should have an aesthetic quality " for example, a
pen will write in a way that is pleasing to the
writer".

III. DEVELOPMENT OF STANDARDS

− Standard is a pre - determined level of

excellence that serves as a guide to practice .
− Organizational standards outline the level of
acceptable practice within the institution while
nursing audit is a measurement tool used to
provide the yard stick for measuring quality care .

TYPES OF STANDARD

1. Structure Standards
− Standards that focus on the structure or
management system used by an agency to
organize and deliver nursing care, including the
number and categories of nursing personnel who
provide that care

2. Process Standards
− Standards that refer to actual nursing care
procedures or those activities engaged in by
nurses to administer care.

3. Outcome Standards
− These are standards that are designed for
measuring the results of nursing care. Other
means of monitoring and measuring include
Conflict Management, Budgeting and Discipline.

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