NCM 105: Nursing Leadership and Management

LEADERSHIP
Leadership is the process of influencing the activities of an organized group in its effort towards goal setting and goal achievement. It involves inspiring, enlivening, and encouraging others to follow willingly, voluntarily, and cooperatively to meet this goal with zeal and confidence and to their greatest potential. Various Definitions of Leadership It is a process of persuasion and example by which an individual induces group to take work and action that is accord to with the leaders purposes or a shared purposes of all (Gardner) It is a process by which a person inspires a group of constituents to work together using appropriate means to a common mission and goal (Holloman) It is a process of directing and influencing the task-related activities of group members (Stoner) It is a process of social transaction in which the person influences others (Merton) It is a process of stimulating to strive willingly to attain organizational objectives giving them the experience to attain the common objectives and satisfactions with the type of leadership provided (Flores) It is a process of empowering beliefs and teaching others to top their full capabilities by shifting the beliefs that have been limiting them (Robbins) It is a process of influence in which leader influences, inspires, enlivens, or encourages others towards goal achievement (Yukl) It is a process in which leaders make vision so palpable and seductive that everybody is willing to sign on (Bennis)

GOAL
LEADER SOCIAL MILIEU characteristics / personality CHARACTERISTICS OF AN ORGANIZATION purpose / structure / nature of the task (situation in which leadership is exercised) FOLLOWERS ECONOMIC MILIEU

personality of the group (attitudes, needs, and other personal characteristics of the group) POLITICAL MILIEU Figure 1. Conceptual Paradigm on the Working Variables of Leadership (Based on McGregor, 1960)

Robert C. Rea

NCM 105: Nursing Leadership and Management LEADER ROLES Risk taker Influencer Change agent Good communicator Mentor Critical thinker Good listener Forecaster Energizer Visionary Problem solver Role model

CONSIDERATIONS IN AN EFFECTIVE LEADERSHIP (by Merton) 1. 2. 3. 4. Person receiving the communication understands it Person has the resources to do what is being asked for in the communication Person believes that the behavior being asked is consistent with personal interest and values Person believes it is consistent with the purposes and values of the organization

THREE DIMENSIONS OF LEADERSHIP LEADER + MEMBERS + SITUATION

Leadership (with influence as an instrumental part) is a result of the relationship between the environment, the organizational structure, the group members and the leader. TWO TYPES OF LEADERS 1. Formal leader person in legitimate or official authority to act in sanctioned or assigned role 2. Informal leader does not have official sanction to direct activities of others; usually chosen by the group members THREE STYLES OF LEADERS (according to Kurt Lewin) Autocratic Maintains strong control Gives orders Makes decision Leader does the planning Directive Fosters dependency Authoritarian leaders tend to be directive, critical, punitive, and give themselves higher position than the members which in turn reduces open communication and trust. This type of leadership tends to get good quantity and quality of output but little autonomy, creativity, or self-motivation. Autocratic leadership can be used in emergencies when the leader knows what to do but this does not

Democratic Maintains less control Offers suggestions Gives suggestions Group does the planning Participative Fosters independence The democratic leader involves the group in the decision making process and makes suggestions instead of orders. This participation then leads to increased motivation and creativity. Democracy works when the members are knowledgeable, skillful, and work well with others. It may be a tedious and is less efficient than the autocratic

Laissez-faire No control Nondirective Abdicates decision-making No planning Uninvolved Fosters chaos Laissez-faire leaders are very permissive, nondirective, passive, and inactive. Members may work independently. Chaos is likely to develop unless an informal leader arises to the situation. Laissez-faire can work with very mature, autonomous workers, but is more likely to be inefficient and unproductive

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NCM 105: Nursing Leadership and Management

develop people. method.

THEORIES OF LEADERSHIP 1. Great Man Theory o holds that some people are born to lead, while others are born to be led o indicates that few people are born with the necessary characteristics to be great o great and effective leaders in any situation possess both instrumental and supportive leadership behavior. Instrumental activities: planning, organizing, and controlling the activities of subordinates to achieve goals Supportive leadership: socially-oriented, and allows for participation and consultation from subordinates for decisions that concerns them 2. Trait Theory o Traits earlier thought to be inherited but later research indicates that traits could be obtained through learning and experience o Leadership traits are: energy, drive, enthusiasm, ambition, aggressiveness, decisiveness, selfassurance, self-confidence, friendliness, affection, honesty, fairness, loyalty, dependability, technical mastery, and teaching skills. o Some common leadership traits: Leaders need to be more intelligent than the group they lead Must possess initiative, ability to perceive, and start the courses of action not conceived by others Creativity and originality Emotional maturity and integrity Adequate communication skills Persuasive to gain consent of followers Perceptive to distinguish allies from opponents and place subordinates in suitable positions Participative in social activities

Intelligence traits perceive Personality traits knows how to knowledge and competence in a motivate workers to achieve specific job which is the one of the organizational goals most important factors in a leaders effectiveness to enable the nurse manager to relate well and inspires subordinates to perform well. fluency of speech adaptability decisiveness alertness knowledge creativity judgment cooperativeness personal integrity self-confidence nonconformity emotional balance and control

Ability traits technical and administrative talents to demonstrate understanding and achieve workers understanding and motivation for achieving organizational goals enlist cooperation and prestige sociable good interpersonal skills tactful diplomatic enhances collective unity among members of the system to achieve its goal

Robert C. Rea

NCM 105: Nursing Leadership and Management independence facilitates leadership capability of a nurse manager so he/she is able to motivate people

3. Behavioral Theory o Argues that it is not who the leader is, but how the leader behaves o Two Basic Leader Behavior (Michigan & Ohio State University) 1. Employee-centered leadership effective leadership with focus on the human needs of subordinates 2. Job-centered leadership less effective because their focus is on schedule, costs, and efficiency resulting in a lack of attention to developing work groups and high performance goals Two Dimensions of Leadership Behavior Initiating Structure Consideration o Emphasis is on the work to be done, the task, and o Focus is on employment and emphasizes production relating and getting along with people o Concerned with how the work is organized and on the o Concerned with creating trust and respect and achievement of goals (planning, directing, others and members contribution establishing deadlines and details of how wok is to be done) o For example: nurse-leaders talk to coo For example: nurse manager provides a manual for job workers, empathetic and show interest in descriptions, personal policies, and procedures them as people 4. Situational Theory o Assumes that a leader should help followers grow in their readiness to perform new tasks as long as they are able and willing to go The skill in which the leader applies the three basic tools of leadershipautocratic, democratic, and laissez-faire techniquesdetermines the leaders personal success as a leader, that is matching the appropriate leadership style to the individuals or groups level of task-relevant readiness. Readiness or maturity is ones ability and motivation to perform particular task. It is addressed in order to select one of the four leadership styles as enumerated below (Hersey & Blanchard): 1. Telling leadership groups with low maturity with members unable or unwillingly to participate or are unsure. Leaders role is to provide direction and close supervision 2. Selling leadership groups with low to moderate maturity who are unable but are willing and confident. Leader can give clear direction and supportive feedback to get the task done 3. Participating leadership groups with moderate to high maturity who are able but unwilling or unsure. Leader can give support and encouragement 4. Delegating leadership groups with high maturity who are able and ready to participate and can engage in the task without direction or support Framework of Situational Leadership as applied to Benners model of novice to expert (based on Dreyfus & Dreyfus model of skill acquisition in nursing) specified that there are tasks, competencies, and outcomes that practitioners can be expected to have acquired based on the five levels of experience Robert C. Rea 4

NCM 105: Nursing Leadership and Management 1. Novice nurse practitioners who are task-oriented and focused 2. Advance beginners nurses who are able to demonstrate marginally acceptable performance 3. Competent nurses nurses performing the same role for two to three years who have developed the ability to view their actions as part of the long-range goal set for their patients. Their conscious and deliberate planning skills promote efficiency and organization. 4. Proficient nurses nurses who look at situations as a whole rather than a series of tasks. They have learned from their experiences the need to develop a plan of care for a patient to be guided from point A to point B and that in typical situations a patient is expected to manifest specific behaviors to achieve specific goals. Once those behaviors are not exhibited within a certain period of time or time frame, it implies that changes should be done in the care plan. 5. Expert nurses nurses whose expertise is so embedded in their practice as they intuitively know what is happening with their patients. 5. Motivational Theory o Motivation is a concept used to describe both the extrinsic conditions that stimulate certain behavior and the intrinsic responses that demonstrate behavior in human beings. Content theories of motivation focus on factors or needs within a person that energize, direct, sustain, and stop the behavior. Deficiencies in needs stimulate people to seek and achieve goals to satisfy those needs. 6. Path-Goal Theory o Derived by Robert House from Expectancy Theory, which argues that people act as they do because they expect their behavior to produce satisfactory results. o People are motivated when they believe that they are able to carry out the work and when they thin k their contribution will lead to the expected outcome and that the rewards for their efforts are valued and meaningful. o The leader facilitates task accomplishment by minimizing obstructions to the goals and by rewarding followers task completion. Leaders motivate followers and influence goal accomplishment using the appropriate style of leadership for the situation to make the path toward the goal easier for the followers. 1. Directive style leaders provide structure through direction and authority with focus in getting the job done 2. Supportive style reaction-oriented providing encouragement, interest, and attention 3. Participative style focuses on involving followers in decision-making 4. Achievement-oriented provides high structure and direction through consideration of behavior 7. Contingency Theory o States that there are other factors in the environment which influence outcomes as much as leadership style. This theory views the pattern of leader behavior as dependent upon the interaction of personality of the leader and the needs of a situation or how favorable the situation is towards the leader which involves leader-member relationships, degree of task structure, and leaders position of power. o Identified three aspects of a situation that is structure leaders role: Leader-membership relationship are feelings and attitudes of followers regarding acceptance, trust, and credibility of the leader Good leader-member relation followers respect, trust, and have confidence in the leader Poor leader-member relationship reflects distrust, lack of confidence and respect, and dissatisfaction with the leader by the followers Task structure the degree to which the work is defined with specific procedures, explicit directions, and goals. Robert C. Rea 5

NCM 105: Nursing Leadership and Management High task structure easy to define and measure a task; involves routine, predictable, clearly defined work tasks Low task structure difficult to define the task and to measure the progress towards its completion; involves work that is not routine, predictable, or clearly defined like creative, artistic, or qualitative research activities Position Power the degree of formal authority and influence associated with the leader; authority inherent in a position, the power to use rewards and punishment and the organizations support of leaders decision High power position favorable for the leader Low power position unfavorable for the leader Effective task-directed leader concerned with task accomplishment Most effective intermediate or moderate range of favorableness, human relation leader, concerned about people 8. Transformational Leadership assumes that power is the basic energy to initiate and sustain action translating intention into reality (Bennis & Nanus) Leaders commit people to action, convert followers into leaders, and may convert leaders into agents of change. Competencies for dynamic and effective transformational leadership include: Management of attention leaders possess a vision or sense of outcomes or goals which are mutually developed, are based on a sense of quality, appeal to values and emotions and are feasible yet challenging; ability of leader to create focus or clear picture of an outcome Management of meaning leaders inspire commitment thus, must communicate their vision and create culture that sustains vision. All elements must enhance the worth of individuals, allow creativity and appeal to the values of nurses; ability to translate their ideas unto symbols with real meaning Management of trust leaders whose judgment is sound and consistent and whose decisions are based on the fairness, equity, and honesty are always respected. People would much rather follow individuals they can count on, even when they disagree with their viewpoint, than people they agree with but who shifts positions frequently. Ability of leader to inspire trust in other by contributing to integrity of organization Management of self knowing ones skills and using them effectively. Nurse leaders need to master the skills of leadership because mastery reduces stress and burnout. It is critical that nurse leaders recognize their lack of management skills and then take responsibility to their own continuing education. Ability to recognize own strengths and weaknesses 9. Transactional Leadership an exchange posture that identifies needs of followers and provides rewards to meet those needs in exchange for expected performance. It is a contract for mutual benefits that has a contingent rewards. The leader is a caretaker who sets goals for employees, focus on a day-today operations, and uses management by exception. It is a competitive, task-focused approach that takes place in hierarchy. Differences between Transactional and Transformational Leaders Transactional Hierarchy Competitive Task-focused Exchange posture Identify needs of followers Transformational Networking Cooperative Process-focused Promote employee development Attend to needs and motives of followers

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NCM 105: Nursing Leadership and Management Provide rewards to meet goals Exchange for expected performance Contract for mutual benefits Contingent rewards Caretaker Set goals for employees Focus on day-to-day operation Management by exception Inspire through optimism Influence exchange in perception Provide intellectual stimulation Encouragement of followers creativity Role model Individualize consideration Provide sense of direction Encouragement of self-management

10. Charismatic Theory is based on the inspirational quality possessed by individuals that others feel better in their presence. They set example by their behavior, communicate high expectations to followers and express confidence in them, and arouse motives for the groups mission. Servant Leadership according to Robert Greenleaf, is life and leadership in the Lord. Leaders use their gifts from God according to the grace given to them, share with others generously; if they have the authority, they should work hard and should show acts of mercy with cheerfulness. Defining Characteristics: A servant leader has the ability to: Listen on a deep level and to truly understand (listening) Keep an open mind and hear without judgment Deal with ambiguity, paradoxes, and complex issues Honestly share critical challenges with parties and ask for their inputs which is more important than personally providing solution Be clear on goals and good at pointing the direction without giving orders Be a servant, helper, and teacher first, and then a leader (stewardship) Be always thinking before reacting Choose work carefully so as not to damage others being led Use foresight and intuition See things whole and sense relationships and connections Focus on long-term management that involves slower promotions and less direct supervision. Organizations invest in its employees and addresses both home and work issues creating a path for career development

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NCM 105: Nursing Leadership and Management

LEADERSHIP STYLES IN PHILIPPINE SETTING 1. Autocratic centralized decision making; leader makes the decision with the use of power to command and control others 2. Democratic leader participates with authority delegated to others; uses expert power and power base afforded by having close personal relationships 3. Laissez-faire passive and permissive ; leader defers decision making 4. Bureaucratic leader acts as a representative of the power and prestige of the entire structure; leader is vested with definite authority in his official role FILIPINO BEHAVIOR PATTERN AND VALUES SYSTEM AFFECTING THE FILIPINO LEADERSHIP STYLE 1. Bahala na or pagwawalang bahala manifested negatively as: Pasensiya or pagtitimpi resignation to and acceptance of failures and shortcomings Suerte relating everything to fate Overdependence on authority Resiliency or capacity to adapt to misfortune with tendency to return to old ways and forgetting lessons of past misfortunes Pagtitiis to endure a hard life without complaint and with complete resignation to such fate Manyana habits putting off for later what can be done now Filipino Time propensity to be late for appointments Ningas-kugon tendency for sudden outburst of enthusiasm at the start of any endeavor followed by equally abrupt loss of interest come what may attitude one can leave matters as they are; no need to exert effort because the supernatural spirits or Bathala will take care of everything for anybody Mixing pleasure with work leading to failure to distinguish one from another Talagang ganyan ang kapalaran (Thats life!) eats up ones sense of responsibility and personal accountability; gives one a false sense of self-confidence to proceed even unsoundly in the belief that somehow one will manage to get by Segurista demands demonstration of assured success 2. Person-oriented Hiya (shame or embarrassment) development of the capacity for this feeling is encouraged by the family since the threat of experiencing it is considered an effective means of obtaining approved behavior Utang na loob (obligation) feeling which develops when someone has received a favor from another; cannot be repaid by money. Repayment is expected by the donor but in a form decided at some future time by the donor

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NCM 105: Nursing Leadership and Management Pakikisama (going along together) Practice of galang or respect the result of the definition of rights and obligations which are inherent in the structural positions of individuals in the Filipino kinship system Practice of using go-betweens (lakad system) arrange or fix things for someone Practice of bata system (relationship between superior and subordinate) a protg, favored individual, close fiend, comrade to rely on time of need Amor-propio (self-esteem) leads to smooth interpersonal relationship with his subordinates, fellow managers, and even competitors. The core of which is the need to be treated as a person and not as an object

3. High respect and regard for women the Pinay Power becomes very evident in Filipino organizations 4. Application of bureaucracy constitute an essential part of Filipino life because the chief function is reinterpreted is to strengthen the traditional norms of society through the evolution of a unique synthesis of the rational and the traditional 5. Personalism identifies leadership with benevolences; focuses not so much on what a person does as in who he is; not so much on what the person knows as whom he knows and who knows him not as much on the objective reality of things as on the way things are actually perceived 6. Dangal (honor), puri (modesty), utang na loob (sense of gratitude) considers moral dimensions of his actions, solutions, and decisions. Sense of gratitude to the people who supported the company at the early stage may make him/her decide to retain an employee even if his/her skills and knowledge are no longer needed 7. Great zeal for professionalism and education pursue masters and doctoral degree which entail great sacrifices in them considering their busy schedule and work

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NCM 105: Nursing Leadership and Management

MANAGEMENT
Management - came from the word to manage (Henri Fayol) - to manage is to forecast and plan, to organize, to command, and to control Forecast to foresee and provide mean in examining future and drawing up a plan of action Organize building up the dual structure which is a material and human undertaking Command binding together, unifying, and harmonizing all activities and efforts Control seeing that everything occurs in harmony with established rules and expressed demand Management process of working with and through others to achieve organizational objectives in a changing environment planning, directing, coordinating, and controlling including leadership, giving direction, developing staff, monitoring operation, giving rewards fairly, and representing both staff members and administration as needed set process of obtaining and organizing resources, building up dual structure (skills and people) and of achieving objective through people a set of interactive process through which the utilization of resources results in the accomplishment of organizational objectives a body of knowledge existing the process of science and art Management as a Process also a series of systematic, sequential, or instances of overlapping steps directed toward the achievement of organizational goals and objectives Importance of Management to facilitate the act to achieve certain objective and goal to deliver quality nursing care to our patients Features: time dimensions reflecting the dynamic nature of management (includes time frame) recognition that one major task of management is the integration of the efforts of group or organization Interpersonal involve communication either written or verbal Technical involve external factor and physical resources Purposeful group It includes not only the goal definition but the direction and purpose

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NCM 105: Nursing Leadership and Management Management is a Science Because achievement is required through the scientific method which implies an empirical measurement of data casual links among phenomena log organization of external structure and conclusions validated through experimentation Management is an Art Because it involves getting one done through people Problems are adaptive through individual style based on creativity, judgment, intuition, and experience instead of the visual systematic method of science Difference between Leadership and Management Motto Challenge Focus Time Frame Methods Questions Outcomes Focuses on Human LEADERSHIP Do the right thing Change / innovation Purposes Future Strategies Why? Journey Potential MANAGEMENT Do thing right Continuity Structures, process, and procedures Present Schedules Who, what, when, where, and how? Destinations / goals Performance

LEADERS Do the right thing Are interested in effectiveness Innovate Develop Focus on people Rely on trust Align people with a direction Emphasize philosophy, core values, and shared goals Have a long-term view Ask what and why Challenge the status quo Focus on the future Have their eyes on the horizon Develop visions and strategies Seek change Take risks Inspire people to change Use person-to-person influence

MANAGERS

Do things right Are interested in efficiency Administer Maintain Focus on systems and structure Rely on control Organize and staff Emphasize tactics, structure, and systems Have a short-term view Ask how and when Accept the status quo Focus on the present Have their eyes on the bottom line Develop detailed steps and timetables Seek predictability and order Avoid risks Motivate people to comply with standards Use position-to-position (superior-to-subordinate) influence Inspire others to follow Require others to comply Operate outside of organizational rules, regulations, Operate with organizational rules, regulations, policies, policies, and procedures and procedures Take initiative to lead Are given a position

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NCM 105: Nursing Leadership and Management

Management Theories Scientific Management Frederick Taylor Lillian and Frank Gilbreth Henry Gantt Classic Organization Henri Fayol Max Weber Human Relation Mary Parker Follett Elton Mayo Kurt Lewin Behavioral Science Abraham Maslow Frederick Herzberg Douglas McGregor William Ouchi Chris Argyris Rensis Likert Peter Drucker

Scientific Management Theory guided and characterized by scientific procedures and approaches to solve managerial problems area of focus is productivity and profit 1. Frederick Taylor generally recognized as the father of scientific management believed that an organization is like a machine to be run efficiently through the use of stopwatch studies, applied the principles of observation, measurement, and scientific comparison to determine the most efficient way to accomplish a task conducted time-and-motion studies to time workers, analyze their movements, and set work standards found that the same result could be obtained in less time with fewer or shorter motions the most productive workers were hired threw aside rule-of-thumb judgments and developed systematic approach to determine most efficient means of production considered management function to be planning working conditions and methods had to be standardized to maximize production managements responsibility is to select and train workers rather than allow them to choose their own jobs and methods and train themselves Four Principles of Taylor 1. develop science for each mans work - scientifically designed to be efficient 2. select and train workers effectively and scientifically by means of technical competence and abilities 3. accomplish work objectives through cooperation of management and labor 4. divide responsibility more equitable between managers and workers - needs to have cooperation and interdependently - give and take - work should be shared equally

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NCM 105: Nursing Leadership and Management Outcomes reduced wasted efforts set standards for performance encouraged specialization stressed the selection of qualified workers who could be developed for a particular job 2. Frank and Lillian Gilbreth also did pioneering work in time-and-motion studies emphasized the benefits of job simplification and the establishment of work standards, as well as effects of the incentive wage plans and fatigue on work performance his system of speed work eliminated haste and also increased work output by cutting out unnecessary motions workers could be paid higher wages because they accomplished more in a shorter time among the first to use motion-picture films to analyze workers motion Lillian Gilbreth is known as the first lady of management 3. Henry Gantt a disciple of Taylor, also was concerned with problems of efficiency preferred to refine previous work rather than introducing new concept developed the Gantt chart, a forerunner of PERT (program evaluation and review technique) chart, depicts the relationship of the work planned or completed on one axis to the amount of time needed or used on the other developed a task and bonus remuneration plan whereby workers received a guaranteed days wage plus a bonus for production above the standard to stimulate higher performance recommended that workers be selected scientifically and provided with detailed instructions for their tasks argued for a more humanitarian approach by management, placing emphasis on service rather profit objectives, recognizing useful nonmonetary incentives such as job security and encouraging staff development Classic Organization deductive rather than inductive, views the organization as a whole rather than focusing solely on production managerial activities are classified as planning, organizing, and controlling 1. Henri Fayol known as the father of the management process school concluded that management is universal all managers, regardless of the type of organization or their level in the organization, have essentially the same tasks: planning, organizing, issuing orders, coordinating, and controlling believed in the division of work and argued that specialization increases efficiency encouraged development of group harmony through equal treatment and stability of tenure of person firm believer in order advocated a place for everything and everything in its place argued that management be taught in college 14 Management Principles 1. Division of work the more people specialized, the more efficiently they can perform 2. Authority and Responsibility the right to give command and order and power to exact obedience 3. Discipline obedience to agreement between parties in the firm must be exercised; manager in the organization needs to respect the rules and agreement that govern the organization

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NCM 105: Nursing Leadership and Management 4. Unity of Command employees should receive orders from only one superior 5. Unity of direction each group activities having the same purpose should operate under one head and one plan; operation within organization should have the same object (should be directed by one superior) 6. Subordination of individual interest to general interest or common goal the overall objective that the group seeks to achieve takes precedence over the objective of the individual 7. Remuneration of personnel compensation for works should be based on systematic attempt to reward 8. Centralization () and decentralization () role of subordinates in decision making; involves the degree to which subordinates participate in decision making 9. Scalar chain / hierarchy / line of authority a graded chain of authority from top to bottom through which all communication flow 10.Order the material and human instrument of business must be arranged logically; material should be rin the right place and right time 11.Equity enforcement of established rules tempered by the sense of blindness and justice should prevail in the organization; both friendly and fair to everyone 12.Stability of tenure of personnel tough management should implement practices which encourage the longterm commitment of employee particularly manages to firm 13.Initiative employees must be encouraged to think through and implement a plan of action; freedom to conceive and carry out plan even if some mistakes result 14.Esprit de corps unity of effort through harmony of interest; promote team spirit to promote sense of unity 2. Max Weber earned the title father of organization theory conceptualized bureaucracy with emphasis on rules instead of individuals and on competence over favoritism as the most efficient basis for organization conceptualized a structure of authority that would facilitate the accomplishment of organizational objectives Three Bases of Authority 1. Traditional authority accepted because it seems things have always been that way, such as rule of a king in a monarchy 2. Charisma strong personal convection 3. Rational, legal authority rational in formal organizations because the person has demonstrated the knowledge, skill, and ability to fulfill the position recognized that if subordinates do not believe a person is qualified for the position, they may not accept that persons authority suggested the avoidance of traditional and charismatic leadership through systematic selection of personnel administrators are chosen for their competence their authority is clearly defined they are given legal means of exercising their authority continuity of administration is provided Characteristics: 1. tasks are specialized 2. people are appointed by merit on promotion because of their ability 3. career opportunities are provided 4. authority and responsibility are clear 5. activities are routine

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NCM 105: Nursing Leadership and Management 6. rational climate exists Conditions in Webers Bureaucracy administrators are appointed not elected administrators are career officials who work for fixed salaries and do not own what they administer they are subject to strict rules which are applied impersonally and uniformly all personnel are selected for competence the division of labor, authority, and responsibility is clearly defined positions are organized into hierarchy Advantages produce competent and responsible employees employees perform by uniform rules and conviction accountability to ones authority social distance with supervisors and clients reduce favoritism, promotes personality rewards and incentives given based in technical qualification, seniority, and achievement Disadvantages red tape complaints heard and experiences observable procedural delays inevitable frustrations among employees and clients Human Relations focused on the effect individuals have on the success or failure of organization stresses the social environment source of control, motivation, and productivity chief concerns are individuals, group process, interpersonal relations, leadership, and communication managers encourage workers to develop their potential and help them meet their needs for recognition, accomplishment, and sense of belonging 1. Mary Follett stressed the importance of coordinating the psychological (more on human behavior) and sociological (interaction with other people / individuals) aspects of management believed that managers should be aware that each employee is a complex collection of emotions, beliefs, attitudes, and habits one of the first theorists to success the principle of Participative Decision Making or Participative Management considered subordination offensive the law of situation dictates that a person does not take orders from another person but from the situation advocated that managers study the total situation to achieve unity because she believed that control would be obtained through cooperation among all of the elements, people, and material Cooperation Spirit of Unity Self-control Seen by Follett as the key to Productivity Democratic way of life

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NCM 105: Nursing Leadership and Management 2. Elton Mayo discovered that when special attention is given to workers by management, productivity is likely to increase regardless of changes in the working condition informal work groups and informal social environment among employees which allow for group decision making have a great influence on productivity proposed that improvements be made by making the structure less formal and by permitting employees participation in decision making meaning theres human factors such as care and attention and recognition for employee not just the physical environment discovered the Hawthorne Effect Hawthorne Effect phenomena of being observed or studied resulting in changes in behavior improvement in performance by workers resulting from awareness that experimental attempts are made to bring improvement 3. Kurt Lewin advocated the three leadership styles advocated democratic supervision his research indicates that democratic groups in which participants solve their own problems and have the opportunity to consult with the leader are most effective autocratic leadership promotes hostility and aggression or apathy and decreases initiative Behavioral Science emphasized the importance of maintaining a positive attitude towards people, training managers, fitting supervisory action to the situation, meeting employees needs, promoting employees sense of achievement, and obtaining commitment through participation in planning and decision making 1. Abraham Maslow developed the hierarchy of needs theory Self actualization
(self-fulfillment, achievement of full capacities

Self-esteem needs
(self-respect, positive selfevaluation, regard by others)

Love and Belongingness

(affectionate relations with others acceptance by ones peers, companionship, recognition as a group member)

Safety and Security Needs

(freedom from danger, threat, and deprivation such as physical harm, economic distress, ill health)

Robert C. Rea

Physiological Needs most important and most necessary for survival

(oxygen, water, food, sleep, sex, and activity)

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NCM 105: Nursing Leadership and Management

Father of motivation who determined that people can best be understood through the study of human needs and their influence in behavior Once a need is satisfied, it is no longer a motivator, and the next need becomes prepotent 2. Frederick Herzberg Motivated Hygiene theory or Two-Factor Motivational Need theory Intrinsic Motivators / Satisfiers - can raise the level of performance and meet the higher-order needs Achievement Recognition Work itself Responsibility Adjustment Potential for growth Extrinsic / Dissatisfiers / Hygiene Factors - cannot motivate but can lower performance and cause job dissatisfaction Supervision Companys policy Working conditions Interpersonal relationship with superiors, peers, and subordinates Status Job security Effect on ones personal life

3. Douglas McGregor Theory of X and Y or human side of the enterprise Noted that ones style of management depends on ones philosophy of mans Theory X managers emphasis is on the goal of the organization assumes that people dislike work and will avoid it workers must be directed, controlled, coerced, and threatened so that organizational goals can be met mot people want to be directed and to avoid responsibility because they have little ambition desire security managers will do the thinking and planning with little input form staff associates lack desire to improve quality noncreative money is the reason for working believes achievement is irrelevant He works to survive but no dream in life Theory Y Emphasis is on the goal of individual views human nature positively

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NCM 105: Nursing Leadership and Management assumes that people do not inherently dislike wok and that work can be source of satisfaction workers have self-direction and self-control necessary for meeting their objectives and will respond to rewards for the achievement of those goals believe that under favorable conditions, people seek responsibility and display imagination, ingenuity, and creativity human potentials are only partially used allow participation give general rather than close supervision support jib enlargement use positive incentives such as praise and recognition exercise self-control work is natural enjoy responsibility value achievement with potential imagination and creativity want to improve quality 4. William Ouchi published Theory Z (Japanese form of Participative Management) focuses in better way of motivating people through their involvement Characteristics: long-term employment / lifetime slow evaluation and promotion more implicit and less formalized control system have written plan or goal personal concern for the employee cross functional rotation (participation) some degree of participative decision making emphasis on individual responsibilities Reasons: cooperation collective decision making practice increase workers production enhance job satisfaction; solving identified problems

Focus: Four Soft Ss of Management staff workers skills capability of organization style how managers achieve goal superordinate goals guide posts Three Hard Ss of Management system mechanism whereby information is circulated through the organization structure organization itself strategy plan of action

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NCM 105: Nursing Leadership and Management 5. Chris Argyris focused on the coexistence of personal and organizational needs found out that individuals give priority to meeting their own needs managers can make job more meaningful by taking advantage of peoples talents and letting them participate in planning, goal setting and problem solving psychological energy theory 6. Rensis Likert Participative Management Theory believed that effective managers are highly sensitive to their staff associates and use communication to keep the working as a unit foster supportive relationship among all members

Four Types of Management Systems: 1. Exploitative-Authoritative managers show little confidence in staff associates and ignores their ideas staff associates do not feel free to discuss job responsibility for organizational goal is in the top goals are established through orders what little communication is used is directed downward, and is often inaccurate and is accepted with suspicion managers do not know about their staff associates problems decisions are made with input from below policing and punishment are used as control function by top administration workers strongly resist the organizations goal and develop an informal organization of their own 2. Benevolent-Authoritative the manager is condescending to staff associates staff associates ideas are sometimes sought, but they do not feel very free to discuss their jobs with their managers the top management and middle management are responsible for setting set goals there is little communication, and it is mostly directed downward after being censored by manager and is received with some suspicion decision are made at the top with some delegation managers do have some knowledge of the staff associates situation staff associates are occasionally consulted for problem solving goals are established through orders with some comment invited and moderate resistance received rewards and punishment are used as control functions by top administration 3. Consultative manager has substantial confidence in staff associates their ideas are sought, and they feel free to discuss their work with the manager responsibility for setting goals is fairly general there is considerable communication, both upward and downward but it has limited accuracy and is accepted with some caution managers are quite familiar with the problems faced by their staff associates broad policy is set at the top with delegation Robert C. Rea 19

NCM 105: Nursing Leadership and Management goals are set after discussion; and there is decision making throughout the organization control functions are delegated to lower levels where reward and self guidance are used sometimes an informal organization resists the formal goals 4. Participative associated with the most effective performance managers have complete confidence in their staff associates staff associates ideas are always sought, and they feel completely free to discuss their jobs with their manager goals are set at all levels there is great deal of communication upward, downward, and sideways that is accurate and received with an open mind managers are very well-informed about the problems faced by their staff associates decision making is well integrated throughout the organization with full involvement of staff associates because goals are established through group action, there is little or no resistance to them there is not an informal organization resisting the goals of the formal organization control is widely shared through the use of self-guidance and problem solving 7. Peter Drucker management is a tool for effective planning and appraisal introduced management by objectives as directing element and made famous by George Odiorne Management by Objectives process whereby the superior and the subordinate managers of an organization jointly identifies its goals, define each individuals major areas of responsibility in terms of the results expected of him and use these measures as guide for operating the unit and assessing the contribution of each members Problems: top management is not supportive inconsistent among managers goals are too easy and attainable conflict of goals and policies accountability beyond control of subordinates lack of commitment of subordinates Objectives: simple focus on what is important genuinely created from the bottom up MBO is a living contract not form-driven exercise

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NCM 105: Nursing Leadership and Management

NURSING MANAGEMENT
NURSING MANAGEMENT - a process of coordinating actions and allocating resources to achieve organizational goals of the health care delivery system 1. Planning - philosophy, goals, objectives, policies, procedures and rules carry out short and long range production, determining of fiscal course of action and planning 2. Organizing - establishing structures to carry out plans, determining the most appropriate of pt. care delivery and grooming activities to meet unit goals, working in the structure of org. and understanding and using power and authority 3. Staffing recruiting, interviewing, hiring, orienting the staff, scheduling, staff development, employee socialization 4. Directing - leading human resource management responsibility a. motivating b. managing conflicts c. delegating d. communicating e. facilitating collaboration 5. Controlling - evaluation fiscal accountability, performance, appraisals, quality control, legal and ethical control, professional and collegial control *long-term goal - strategic planning; 3-year development plan *short term goal - tactical planning LEVELS OF MANAGEMENT 1. Top Level manager - executive CEO, generally made decision and the help of few guidelines or structure to coordinate internal and external influences 2. Middle - supervisor; unit manager, vice president, conduct day to day operations with some involvement long term planning and policy 3. First level - case manager, team leader, nurse practice.. concern with specific units and deal with immediate day to day operations problem Robert C. Rea 21

NCM 105: Nursing Leadership and Management

PRINCIPLES OF NURSING MANAGEMENT 1. Nursing Management is planning -necessary to all activities -should be written -decrease the risk of decision making and problem solving -planning is tentative 2. Nursing Management is effective use of time -use your time effectively: systematic 3. Nursing Management is decision making -you have to know the advantage and disadvantages 4. Meeting patients nursing care needs is the business of the nurse manager -patients are the starting point of our responsibilities 5. Nursing Management is the formulation and achievement of social goal -community extension-voluntarism -community health nurse-meet the needs of poor people and large community 6. Nursing Management is organizing -to identify organizational need thru assessment, mission, vision and objectives FOUR BUILDING BLOCKS OF NURSING MANAGEMENT 1. Unit 2. Department 3. Executive officer leader 4. Operational Level organizational structure 7. Nursing Management denotes a function, social position or rank, a discipline and a field of study 8. Nursing Management is the active organ of the division of nursing of the organization and of the society in which it functions -exist for the good of the people 9. Organizational culture reflects values and beliefs -nursing staff are working together; united 10. Nursing Management is directing and leading -accomplish the object of nursing leadership style 11. A well manage division of nursing motivates employee to perform satisfactory -job satisfaction 12. Nursing Management is effective communication -to decrease misunderstanding to have common understanding to have unity of direction and effort -receiving new nurses 13. Nursing Management is controlling or evaluating -evaluating the implementation of action plan LEVELS OF SKILLS MANAGEMENT IN NURSING 1. Conceptual

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NCM 105: Nursing Leadership and Management - refers to an individual mental ability to coordinate a variety of interests and act - includes in abstract, analyze and critical thinking 2. Interpersonal - human skills - pertains to how something is done to working with people and to ones abilities to work with others in the achievement of goals - different people has different attitude - includes motivation, selection, manipulation, good communication, techniques 3. Diagnostic - ability to determine by analysis and examination the nature and circumstances of particular condition or situation - difficult to acquire 4. Technical Skills - are the tools, procedures and techniques that are unique to the nurse manager specialize to a situation - thru practice and experiences 5. Coach and Mentor Skills - day to day hands on process that helps employee to recognize opportunities and ways to improve performance and capabilities mutually acceptable action creating a supportive, healthy climate and influencing employees to change their behavior

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