Nursing Leadership and Management: Ma. Christina B. Celdran - Oraa, PHD RN Assistant Professor

Nursing Leadership and Management
Ateneo de Zamboanga University

College of Nursing
Nursing Leadership and Management (NCM 107)
Changes in Health Care:
1. Paying for health care:

a. Pay for Performance-Prevent medical mistakes (such as falls; wrong site surgeries; avoidable
infections; pressure ulcers.
2. Demand for Quality:
a. Quality Initiatives – patient satisfaction survey
b. b. The Leapfrog Group- rewarding health care organization that demonstrate quality outcome
measures. Performing hospital for high risk procedures
c. Benchmarking - Compares organization data with similar organizations. Outcome indicators are
identified that can be used to compare performance across discipline. Results can address areas of
weakness & enhance areas of strength.
d. d. Evidenced-Based Practice (EBP) - Knowledge integrated with clinical experience & the patient
values to clinical care.
Similar to nursing process:
1. Identify the clinical question
2. Acquire the evidence
3. Evaluate evidence
4. Apply the evidence
5. Assess the outcome.
Evolving Technology
a. Electronic Health Records (EHR) - Fully integrated system to manage communication & reduce
redundancies.
b. Virtual Care or “Telehealth” (Formerly Telemedicine) - technology to assess, intervene &
monitor patients at a distance.
c. Robotics- laser guided can deliver supplies to pharmacy, Central supply, and requested supplies to
nsg. units; monitor & report pts.changes & condition.
d. Communication Technology- website & social media.
Nursing Leadership:
Nurse leader
• Is able to inspire others on the health care team to make patient education an important aspect of all care
activities.
Leadership qualities:
• Unique personality characteristics,
• Exceptional clinical expertise,
• Relationships with others in the organization.
Management -
• Coordinates people, time, and supplies to achieve desired outcomes, Involves problem-solving and
decision-making processes.
• Is a process by which a cooperative group directs actions towards common goals. (Venzon, 2010)
Managers responsibility:
 Maintain control of the day-to-day operations, achieve established goals and objectives.
Ma. Christina B. Celdran – Oraa, PhD RN

Assistant Professor Page 1
Leader - “power”
 Empowering others  Inspiring
 Good nursing communication  Interpersonal skills
 Influencing others  Risk-taker
 Motivating
Manager “formal role” or “in control”

 work of others  Meeting the goals and objectives
 Decision-making  Following rules
 Control over processes  Uses reward and punishment effectively
 Coordinating resources (financial and
personnel)
Difference between Leadership and Management
Manager Leader
 Give answers  Ask questions
 Criticize mistakes  Call attention to mistakes indirectly.
 Forget to praise  Reward even the smallest improvement
 Focus on the bad  Emphasize the good
 Want the credit  Give credit to the teams
 Process of getting things done through  Process of influencing others
people
Principles of Management
 Nursing management should be based on planning because through the planning, leaders
can reduce the risk of decision-making, effective problem solving and planning.
 Nursing management implemented through effective use of time.
 Nursing management will involve decision making.
 Meet the nursing care needs of patients is the focus of attention of the nurse manager to
consider what the patient saw, thought, believe and desire.
 Nursing management should be organized.
The briefing is an element of nursing management activities covering the delegation,

supervision, coordination and control of the implementation of the plans that have been
organized.
Nursing management using effective communication.

A – Announce your presence
W – Welcome the patient
A – Ask if there is anything the patient needs
R – Review what was done and explain when the next service will be
E – Exit with a kind word
CPD - Staff development is important to be implemented as a preparatory effort implementing

nurses occupy a higher position or manager attempts to improve employee knowledge.
Control is an element of nursing management that includes an assessment of the implementation
of the plan has been created, providing instruction and establish principles.
Henry Fayol’s Fourteen Principles of Management

1. Division of work
The object of division of work is to derive the benefits from the principle of
specialization which can be applied not only in technical work, put in all other work as
well. Work should be divided among individuals and groups to ensure that effort and
attention are focused on special portions of the task. Fayol presented work specialization
as the best way to use the human resources of the organization. When employees are
specialized, output can increase because they become increasingly skilled and efficient.
2. Authority and responsibility
Henry Fayol finds Authority and responsibility to be related with the latter arising from
the former. An ideal manger is expected to have official authority arising from official
positions as well as his inherent personal authority. Authority was defined by Fayol as the
right to give orders and the power to exact obedience. Responsibility involves being
accountable, and is therefore naturally associated with authority. Managers must have the
authority to give orders, but they must also keep in mind that with authority comes
responsibility
3. Discipline
A successful organization requires the common effort of workers. Penalties should be
applied judiciously to encourage this common effort. “Discipline is what the leaders
make it” through the observance of agreements, because agreements spell out to
formalities of discipline. Three requisites of discipline are
(a) Good supervisors at all levels,
(b) Clear and fair agreements, and
(c) Judicious application of penalties of sanctions.
4. Unity of Command
This principle requires than employee should receive orders form one superior only. Dual
command wreaks havoc in all concerns, “since authority is undermined, discipline in
jeopardy, order disturbed and stability threatened.”
5. Unity of direction
Fayol discussed this principle of unity of direction in a different way from that of unity of
command. While unity of direction is concerned with the functioning of the body
corporate, unity of command is only concerned with the functioning of personnel at all
levels. For the accomplishment of a group of activities having the same objective, there
should be one head and one plan. “A body with two heads is in the social as in the animal
sphere a monster, and has difficulty in surviving. The entire organization should be
moving towards a common objective in a common direction.
6. Subordination of individual interest to general interest
The interests of one person should not take priority over the interests of the organization
as a whole. Common interest must prevail over individual interest, but some factors like
ambition, laziness, weakness and others tend to reduce the importance of general interest.
7. Remuneration of personnel
As the prices of services rendered remunerations should be fair and satisfactory to both
the parties. Many variables, such as cost of living, supply of qualified personnel, general
business conditions, and success of the business, should be considered in determining a
worker‟s rate of pay. Employee satisfaction depends on fair remuneration for everyone.
This includes financial and non-financial compensation.
8. Centralization
Fayol defined centralization as lowering the importance of the subordinate role.
Everything which goes to increase the importance of the subordinate‟s role is
decentralization, everything which goes to reduce it is centralization. The question of
centralization or decentralization holds the key to the utilization of all faculties of the
personnel. The degree to which centralization or decentralization should be adopted
depends on the specific organization in which the manager is working.
9. Scalar chain
It is the chain of superiors or the line of authority form the highest executive to the lowest
one for the purpose of communication. The need for swift action should be reconciled
with due regard to the line of authority by using “gang plank” or direct contact. The

existence of a scalar chain and adherence to it are necessary if the organization is to be

successful. Employees should be aware of where they stand in the organization‟s
hierarchy, or chain of command.
10. Order
This is a principle of organization relating to things and persons material order requires
“a place for everything and everything in its place” and social demands the engagement
of “the right man in the right place.”
11. Equity
Equity is greater than justice since it results from the combination of kindliness and
justice. The application of equity requires much good sense, experience and good nature
with a view to securing devotion and loyalty form employees. All employees should be
treated as equally as possible.
12. Stability of tenure of personnel
Stability of tenure is essential to get an employee accustomed to doing a new work and to
enable him in performing it well. Instability of tenure is an evidence of bad running of
affairs.
13. Initiative
The freedom to purpose a plan and to execute it is what is known as initiative that
increases zeal and energy on the part of human beings. Since initiative is one of “the
keenest satisfactions for an intelligent man to experience.” Fayol advised managers to
secure as much initiative from employees as possible.
14. Esprit de corps
This is an extension of the principle of unity of command whereby team work is ensured.
To maintain proper esprit de corps in the organization, personality politics and abuse of
written and communications are to be guarded against.
II -Scope of Management
• KNOWLEDGE
• Management is an Economic Resource
• ORDERS
• System of Authority
• ELITE GROUP
• Class and status system
1. Management is an Economic
Resource:
• Production/land/labor/capital
• Substitute for labor and capital (increase industrialization)
2. System of Management
• Determining the course of action for the rank and file
• Policies and procedures in dealing with working groups
• Trends is towards a democratic and participative approach
3. Class and status system:
• Managers have become a :Elite group”
• Entrance is based on education and knowledge
III-ROLES, SKILLS & QUALITIES OF LEADER & MANAGER
Roles Skills Qualities

By: Mintsberg” According to “Katz” According to “Summer”
1. Interpersonal Role: Technical Skill Knowledge
2. Informational role: Human Relation skill Attitude
3. Decisional Role: Conceptual Skills Ability
Nurse manager –
• embody nurse executive roles

• Typically report to a superior in nursing, director, chief nursing officer, or vice president
of nursing
• Responsible for functions of the unit:
o Staffing, employee satisfaction
o Safety and quality
o Customer satisfaction
o Budgeting
ROLES OF A MANAGER by Mintsberg

1. Interpersonal Role - Manager as a symbol because of the position he/she occupies
2. Informational role:
• Monitors information
• Disseminates information from external and internal sources
• As spokesperson or representative of the organization
• Represents the subordinates to superiors and upper management to the subordinates
3. Decisional Role:
• Makes manager as entrepreneur or innovator
• Problem discoverer/design to improve projects
• Trouble shooter (resignation of subordinates/ firing
• Negotiator when conflicts arise.
VII-FUNDAMENTAL SKILLS OF MANAGER

1. Technical Skill - relate to the proficiency in performing an activitiy in the correct
manner with the right techniques
2. Human Relation skill - pertains to dealing with people and how to get along with them
3. Conceptual Skills – ability to see individual matters as they relate to the total picture/
creativity in responding to big problems/discarding irrelevant facts
According to “Summer” - emphasizes 3 qualities a manager should have:

Knowledge – refers to ideas, concepts, or principles that can be expressed and are accepted
because they have
logical proofs.
Attitude – relate to beliefs, feelings, and values
• Interest in one‟s work
• Confidence in one‟s mental competence,
• Desire to accept responsibility,
• Respect for the dignity of one‟s associates
Ability – skill, art, judgement, and wisdom.

IV- NURSING LEADERSHIP AND MANAGEMENT THEORIESLEADERSHIP

THEORIES
1. "Great Man" Theories:
• leadership is inherent – that great leaders are born, not made
2. Trait Theories:
• Similar in some ways to "Great Man" theories, trait theories assume that people
inherit certain qualities and traits that make them better suited to leadership.
Traits and Skills of Leader by Stogdill
Traits Skills
 Adaptable to situations  Clever (intelligent)
 Alert to social environment  Conceptually skilled
 Ambitious and achievement-
 Creative
oriented
 Assertive  Diplomatic and tactful
 Cooperative  Knowledgeable about group task
 Decisive  Organized (Administrative ability)
 Dependable  Persuasive
 Dominant (Desire to influence
 Socially skilled
others}
 Persistent
 Self -confident
 Tolerant of Stress
 Willing to assume responsibility
Common traits of Leaders

1. Positive – bring people to progress. They transend their own traits to people who will
become leaders themselves.
2. Negative – take people to destruction. They destroy rather than build. Are not able to grow
good leaders, but followers who go after each other.
3. Contingency Theories - Contingency theories of leadership focus on particular variables
related to the environment that might determine which particular style of leadership is best suited
for the situation.
4. Situational Theories - propose that leaders choose the best course of action based upon
situational variables.
• Different styles of leadership may be more appropriate for certain types of decision-
making.
5. Behavioral Theories - are based upon the belief that great leaders are made, not born. Rooted
in behaviorism,
• This leadership theory focuses on the actions of leaders not on mental qualities or
internal states. People can learn to become leaders through teaching and observation.
3 Leadership Styles: Kurt Lewin categorized Leadership Styles as:

a. AUTHORITARIAN STYLES
a. Strong control
b. Motivated by coersion
c. Directed with commands
d. Communication flows downward
e. Decision making does not involve others

f. Uses “I” and “YOU”
g. Criticism is punitive
b. DEMOCRATIC LEADER
a. Less control
b. Economic & ego awards are used to motivate
c. Directed through suggestion and guidance
d. Communication flows up or down
e. Decision making involves others
f. Emphasis on “we” rather than “I” & You”
g. Criticism is constructive
c. LAISSEZ-FAIRE LEADER
a. Permissive, with little or no control
b. Motivate by support
• when requested by group or individuals
c. Provides little or no direction
d. Uses upward or downward
• communication between
• members of the group
e. Disperses decision making
• throughout the group
f. Places emphasis on the group
g. Does not criticize
6. Participative Theories - Suggest that the ideal leadership style is one that takes the input of
others into account.
7. Management Theories - Management theories, also known as transactional theories, focus

on the role of supervision, organization and group performance.
 8. Relationship Theories - Relationship theories, also known as transformational

theories, focus upon the connections formed between leaders and followers. It motivate
and inspire people by helping group members see the importance and higher good of the
task.
TRANSACTIONAL & TRANSFORMATIONAL THEORIES
Transactional Leader Transformational Leader

• Focuses on management task • Identifies common values
• Is a caretaker • Is committed
• Uses trade-offs to meet goals • Inspire others with vision
• Does not identifies shared values • Has long term vision
• Examines causes • Looks at effects
• Uses contingency rewards • Empower others
MANAGEMENT THEORIES
1. Scientific Management Theory - Frederick W. Taylor – “Father of Scientific
Managementbelieves that if workers could be taught one best way to accomplish task,
productivity will be increased.
2. Systematic Management Theory - Henry Fayol – “Father of Systematic Management
Theory” introduced the management principles to promote order & raise worker‟s
morale, thereby improving efficiency & accountability in the system.

3. Organizational Theory - Max Weber – “Father of Theory of Social & Economic

Organization “
a. Advocated Bureaucratic Organizations based on hierarchy of authority, division of
work based on specialization of function.
4. Alvin Toffler - Emphasize the increasing speed of change in the society and described as
a sickness called “future shock” to which increasing number of citizens are subjected by
this rapid arrival of the future.
a. Advocates that individuals identity, principles for planning and facing their
activities improve their coping abilities
Toffler recommended Coping skills in dealing with rapid change:

1. Periodic introversion
2. Consciously speeding up or slowing down.
3. Utilizing various technique.
4. Deliberately decreasing the cognition load by voluntarily forgetting unimportant
information.
5. Diminishing the decision broadens any preparation on delegating decision.
6. Constantly disconnecting from overwhelming personal relationship.
7. Building stability zone into one‟s personal life in order to buffer the effects of instability
in other areas.
Rensis Likert
Best known for his Likert Scale & Likert Pin Model
1. Likert Scale - a scale measurement to determine the level of agreement & disagreement
of a respondent to a set of questions that could be objective or subjective. The format:
1. Strongly disagree
2. Disagree
3. Neither agree nor disagree
4. Agree
5. Strongly agree
2. Linking Pin Model - “Family Concept”
• is a concept of ideal work relationship of workers in the organization.
“Family Concept” to characterize the desirable social interaction & encouraged strong personal
relationships to achieve common purposes & goals.
3. Theories focus on Human Relation - Mary Parker Follet – “Participative
Management” conceived of management as social process focused on the motivation of
individuals & groups alike towards achieving a common goal.
5. Hawthorne Effect - Elton Mayo & Fritz Roethlisberger

• Hawthorn Effect refers to a momentary change in a worker‟s environment, the response
usually being an improvement.
6. Theory of X and Y - Douglas McGregor – developed the Human Relations School of

Management.
• Theory X - managers believe employee are basically lazy.
• Theory Y - managers believe that workers enjoy their work & sefl motivated.
7. Theory Z - William G. Ouchi – characterized Japanese “Seven S” or Hard “S”
1. Super ordinate goals 5. Staff
2. strategy 6. Skills
3. Structure 7.Style
4. Systems
REACTION PAPER

In your duty area where you are assigned for 3 days, identify and described the leadership
style of the supervisor/headnurse/nurse manager.
VIII-NURSE MANAGER IN A HEALTH CARE FACILITY
Nursing Management - is the process of working through nursing staff to provide care, cure,
and comfort to patients.
Patient Care Management - is the act of helping patient control their own health care by
the following.
1. Informing patients of requirement of health
2. Guiding patient to accept and understand temporary and permanent limitations caused by
illness.
3. Caring for patient when he cannot for himself
4. Teaching him to care for himself
Manager - is one who carries out predetermined policies and rules with official sanction to act.
FUNCTIONS OF A NURSE MANAGER

• Carefully assesses a situation
• Sets goals for clients or personnel, then establishes priorities and identifies resources
• Structures the work load
• Guides and stimulates clients and personnel
• Measures and documents the activities of clients or personnel
• Uses rewards and disciplinary actions
Four (4) Major Functions of Management Process:

1. Planning
2. Organizing
3. Directing
4. Controlling
PLANNING : Managers plan a focus on deciding what to do. The planning process provides
framework for performance.
 Team leader of a group of nursing personnel is concerned with number and kinds of
patients to care for
 Nursing staff‟s qualification to provide care,
 Geographical location of patient,
 Physical resources available to get the job done.
ORGANIZING: Managers must decide how do it. She must organize to establish order &
systematically achieve the goals for provision of care.
 Team leader would establish authority to act with responsibility and accountability
relationship, informing each person of her assignment.
CONTROLLING: Team leader controls or evaluates performance against established standard
of performance
 examining indicators of effectiveness and efficiency through patients/ clients, and
 Investigate problem that may have developed in communication, resources allocation,
and interpersonal relationships.
DIRECTING: Team leader directs performance. She focuses on leading nursing staff in the
most effective manner possible.
 The team leader concentrates on how the assignments are being accomplished.
 She considers skills of members, knowledge of what they are doing, members motivation
and interpersonal relationship
 Examines her own leadership style as it relates to goal achievement.

OTHER FUNCTIONS :NURSE MANAGERS

 Excellence in Nursing clinical practice Managing human , monetary and other resources
needed to provide excellent patient care
Is accountable for:
 Facilitating the development of nursing and health care personnel and delivery of patient
care
 Ensuring that all standards of care practiced in that area are in compliance with Nurse
Practice Acts and regulatory/government standards of care (PRC)
 Developing strategic planning that supports the department or units
 or disciplines to ensure the delivery of the highest quality patient care
NURSE MANAGER ROLES :

1. First line manager: STAFF NURSE
 Primarily supervises other non managerial staff and monitors the quality of care the
staff provide to aeg.
Key tasks of first-line-manager:
 Preparing orientation in collaboration with nurse educators
 Submitting time schedules for nursing shifts
 Staff assignments
First line manager: SUPERVISOR
 Responsible for motivating staff to meet organizational goal
 Planning, coordinating and staff evaluation.
Key tasks of first-line-manager:
 Budget recommendations to nursing administration based on unit‟s needs
 Calculating amount of staff needed/when on leave/other emergency situations
 Making daily rounds
 Conducting meeting with staff
 Employment reviews (include counselling report and termination)
 Setting goals for ind‟l aeg care
 Participating in QAP (Quality Assurance Program)
 Maintain clinical knowledge through reading participating in CEP etc
2. Middle-level manager:
 The Nurse Director supervises first-level-manager, within the geographic or
specialty area
 Responsible for all activities in the areas
 Spends more time in planning, coordinating negotiating and evaluating (less time in
supervising staff)
Key tasks of Middle-level manager:
 Assessment: observe whether policies and objective are meeting the needs of aeg and
staff that provide care
 Planning: set short term and long term goals for aeg care/ revise polices if needed
 Organization: put plans into action(via delegation and committee work)
 Control: analyse results of implementation/consider changes that need to be made/
facilitates research development.
3. Executive-level manager
• The chief nurse executes or vice-president of aeg care services spends the lowest
amount of time in supervision.
 Time is spent in planning and making policies
 More responsible for establishing overall organizational goal
Key tasks of Executive –level manager:
 Assessment: understand the organization‟s internal env./culture and the
external environment.
 Planning: forecast trends in health care/costsreimbursement/developing
responsive strategic planning

 Organization: brings together the appropriate mix of staff, other resources etc.
Based on assessment and strategic planning.
 Control: evaluates nursing policies, programs & services to ensure that they
are consistent with organization‟ mission and objectives
1. CHARGE NURSE (resource nurse)

 Expanded staff nurse role with some managerial responsibilities
 Maybe a permanent or rotating assignment
 Liaison to the nurse manager particularly on off shifts
 Assisting in shift coordination, trouble shooting problems/ helping staff members with
decisions and prioritizing care
 Has more limited authority and limited scope of responsibilities
 May or may not be involve with evaluation(depending on organization)
2. STAFF NURSE:
 Uses managerial and leadership skills to work with other nurses and assistive personnel
 Mgt responsibilities include supervising to ensure quality patient care/delegating tasks
appropriately and motivating staff
IX - The Setting
• WHO
• defines the hospital
o as “an integral part of a social and medical organization
Functions of Setting:
1. To provide medical care
2. Center for the training of health workers and for bio-social research
Republic act 4226 known as „Hospital Licensure Law

• defines Hospital as “a place primarily to the maintenance and operation of facilities for
the diagnosis, treatment and care of individuals suffering from illness, disease, or
deformity, or in need of obstetrical or other medical and nursing care.”
Classification of Hospitals and Other Health Facilities:

A.O.no. 2005-0029 Dated 12, 2005 amended A.O. no. 70A series 2004
re: Revised Rules and Regulations governing the registration, Licensure, and Operation
of Hospitals and Other Health Facilities in the Philippines.
Classification of Hospitals and

Health Facilities: A.O.no. 2005-0029 Dated 12, 2005 amended A.O. no. 70A series 2004
re: Revised Rules and Regulations governing the registration, Licensure, and Operation of
Hospitals and Other Health Facilities in the Philippines.
Classification of Hospitals and Health Facilities:

1. General or Special
a. General - means a hospital operated and maintained either partially or wholly by the
national, provincial, municipal or city government or other political subdivision, or by any
department, division, board or other agency thereof. Eg. PGH & Quirino Memorial Medical
Center.
b. Special =primarily engaged in the provision of specific clinical care and management.
It must have ancillary support services appropriate for a given service capability.
Eg. National Kidney and transplant institute
Lung Center of the Philippines
Philippine Children‟s Medical Center
San Lazaro Hospital
2. Service Capability
a. Hospital
Level - I
a) Emergency hospital c) General administrative
b) Clinical services services
a) Provides nursing care
Level – 2
a) Non- departmentalized c) Appropriate administrative
b) Clinical services and ancillary services).
d) Nursing care
Level 3
a) Departmentalized Hospital
b) Clinical services
c) Appropriate administrative and services (tertiary clinical laboratory, second level
radiology and pharmacy).
d) Nursing care provided in Level 3 hospitals as well as continuous and highly
specialized critical care.
Other health facilities
1. Birthing Home- a health facility that provides maternity service on pre-natal and post-
natal care, normal spontaneous delivery, and care of the newborn babies.
2. Psychiatric Care facility - – a health facility engaged in the care of mentally ill patients.
a. Acute-Chronic- provides medical service, nursing care, pharmacological
intervention for mentally ill aeg.
b. Custodial - – provides long-term care,including basic human services such as food
shelter, to chronic mentally ill patients
Ownership and Control

1. Government hospitals – are operated and controlled either partially or wholly by the
national, provincial, municipal or city government or other political subdivision, board or
other agency thereof.
Example:
National – directly under the Office of the President : PGH and those under the DOH – as
the
National Center for Mental Health , Philippine Orthopedic Center.
Regional – Batangas Regional Hospital
Provincial – Bulacan integrated Provincial Hospital
City – Ospital ng Maynila, Quezon city General Hospital,
Municipal Hospital – Don Formilleza Menorial Hospital
2. Private or Non-Government Hospitals – are privately-owned established and operated with
funds, raised capital or other means by private individuals, associates, corporations, religious
organizations, firms, companies or joint stock corporations.
Examples:
Missionary – Mary Johnston Hospital, Our Lady of Lourdes Hospital, Iloilo Mission
Hospital
Civic organization – Quezon Institute run by Philippine Tuberculosis Society
Community – Romero community Hospital
Private – St.lukes Hospital, Capitol Medical Center
Training hospitals =is a departmentalized hospital with accredited Residency training
Program in one or more specified specialty or discipline. Example: Dr. Jose Reyes
Memorial Medical Center, tondo Medical Center, Quirino Memorial Medical Center, and
St. Lukes Medical Center.
A non-training hospital – may be departmentalized but without a accredited Residency
Training Program in one or more specialty disciplines.
MODULE 2: PLANNING
Planning
• Pre-determining a course of action in order to arrive at a desired result.

• It is a continous process of Assessing, establishing Goals and Objectives, Implementing

and Evaluating them & subjecting these change as new facts are known.
PRINCIPLES OF PLANNING
• Based and focused on the vision, mission, philosophy, and clearly defined objectives
of the organization.
• A continuous process. (Revision / flexibility to be done to make it more effective)
• Should be pervasive within the entire organization.
• Planning utilizes all available resources.
• Must be precise in its scope and nature. It should be realistic and focused on its
expected outcomes.
• Planning should be time-bound.
• Must be documented for proper dissemination to all concerned for implementation and
evaluation.
IMPORTANCE OF PLANNING
• Planning leads to the achievement of goals and objectives.
• Planning gives meaning to work.
• Planning provides for effective use of available resources and facilities.
• Planning helps in coping with crises. Hospitals should provide for disaster plans.
Plan:
• Planning leads to the realization of the need for change.
• Planning provides the basis for control.
• Planning is necessary for effective control.
• Planning is cost effective.
• Planning is based on past & future activities.
Why Managers Fail To Plan?

• Lack of knowledge of the philosophy, goals, and objectives of the agency,
• Lack understanding of the significance of the planning process
• No time management
• Lack of confidence in formulating plans
• Fear that planning may bring about unwanted changes
Major Aspect of Planning

• Should contribute to objectives
• Precedes all other processes of management.
• Pervades all levels.
• Should be efficient.
Characteristics of a Good Planning

• Be precise with clearly-worded objectives, including desired results and methods for
evaluation;
• Be guided by policies and/or procedures affecting the planned action;
• Indicate priorities
• Develop actions that are flexible and realistic in terms of available personnel, equipment,
facilities, and time;
• Develop a logical sequence of activities;
• Include the most practical methods for achieving each objectives; &
• Pervade the whole organization.
All planning involves choice: A necessity to choose from among alternatives.

• Definition of Planning
o “Marquiz” deciding in advance what to do; who is to do; and how, when, and
where it is to be done.
o “Douglas” defines planning as having a specific Purpose.
o “Minsberg” = is one approach to strategy making
o “Porter-O‟Grady” = represents specific activities that lead to achievement of
objectives
POOR PLANNING:
Indicators of poor planning:
1. Delivery dates are not met.
2. Machines are idle.
3. Material is wasted.
4. Nurses are overworked or underworked.
5. Skilled nurses doing unskilled work.
6. Nurses are fumbling on jobs w/c they have not been trained.
7. There is quarrelling, bickering, buck- passing & confusion
Characteristics of a Plan:
a. Future
b. Actions
c. Organizational identification
Types of Plan:
• Strategic plan – “What are the right thing to do?”
• Operating plans – “How does one do things right?”
• Continuous or rolling plan – Mapping out the day to day activities
Four modes of planning:

1. Reactive Planning – active attempt to turn back their clock to the past. The past no
matter how bad, is much preferable to the present.
2. Inactivism - Attempt to present. Seek status quo (or current state). Much preferable than
to the past or future.
3. Pre-activism - Attempt to predict the future. And then to plan for that predictable future.
Utilizes technology to accelerate change.
4. Interactive or pro-active - considers the past, present & future. Anticipation of
changing needs.
Elements of Planning Forecast

1. Environments
2. Clients
3. Personnel
4. Resources
II- Setting the Vision, Mission, Philosophy, Goals, Objectives

• Vision - Outlines the organization future roles and function.
• Mission - Outlines the agency‟s reason for existing (Target clients & services provided)
• Philosophy - Describe the vision. A statement of beliefs & values that directs one life &
practice.
• Goals - Are more general and defined as broad statements derived from the purposes of
the organization.
• Objectives - Are more specific behavior or tasks set for the accomplishment of a goal.
 III – Develop and Schedule Strategies, Programs/ Projects/Activities

• Strategy – is the techniques, methods or procedures by which the overall plan of the
higher management achieved desired objectives.
• Programs - are activities put together to facilitate attainment of the desired goal, such
as development programs, outreach programs, discharge teaching program.
MODULE 3 - Planning
Barriers to Planning: Despite the benefits of planning, many nurse-manager avoid it
because they lack:
• Knowledge of the philosophy, goals & operations of the organization.
• Understanding of the significance of planning, that success or failure of work activities
relate directly to the quality of a plan.
• Proper appreciation of use of time for planning.
• Confidence and fear of failure
• Openness to change that they believe planning may entail.
• Willingness to engage in new activities that planning produces.
• Insights into the exigencies of the situation, they prefer to act on immediate problems that
give them immediate feedback.
Overcoming Barriers to Planning:
• Forecasting or estimate the future
• Setting objectives & goals
• Developing strategies & setting the time frame.
• Preparing the budget and allocation of resourceful
• Establish policies, procedures & standards
THE PLANNING HIERARCHY

I. Purpose or Mission Statement: Outlines what the organization plans to accomplish,
 Identifies the purpose or reason why an organization exists
 May be short as a single clause or sentence
 Identifies the group or (constituency) to whom the services are directed
 Indicate its purpose
 Guides the planning
 Is of highest priority in the planning hierarchy because it
influences the development of an organizational Mission philosophy,
goals objectives and policies/ procedures/ rules.
Philosophy
THE PLANNING HIERARCHY – with the plans at the top Goals

influencing all the plans that follow.
 The hierarchy broadens at lower levels, representing Objectives an
increase in the number of planning components.
Policies
 Planning components at the top of the
hierarchy are more general and the lower Procedures
components are more specific.

Rules
II. The Organization Philosophy

Statement:
 Philosophy flows from the “purpose of the mission” statement
 and provides a statement of beliefs and set of values that are basic to the operation of the
organization, service or unit.
Philosophy - It is the basic foundation that directs all further planning toward that mission.
[Tuck,Harris & Baliko]- that the values and principle set forth in the philosophy provide the
provide the parameters for decision making in determining what is critical to an organization.
• Can usually be found in policy manuals at the institution or is available on request.
• Organizational philosophy provides the basis for developing nursing philosophies at the
unit level and for nursing service as whole.
• It is the basic foundation that directs all further planning toward that mission.
• Also include a listing of goals or objectives
• Is the basic foundation that directs all further planning toward that mission.
• Man is a unified dimension, rationale and free, a bio-psycho-socio-cultural and spiritual
being created in the image and likeness of God with individual aspirations, which are
influenced by the stages of development, life experience, society, culture and
technological advances. Man constantly interacts with his family, community as a
holistic being.
Health:
• Is a dynamic state and a process of being and becoming whole and using one‟s powers to
the fullest extent.
• It is not merely the absence of pathologic conditions.
• It is self-responsibility while it is a basic human right.
• It is influenced by socio-economic-political-education and spiritual dimensions.
• It is socially determined thus it is achieved people empowerment.
Nursing:
• Is an indispensable profession predicated on the ideals of service for the promotion
of health, prevention of illness, restoration of health, alleviation of suffering and
provision of spiritual environment. It utilizes the nursing process and regulated by
ethico-legal, moral principles.
III. Goals and Objectives:

• May be defined as the desired result toward which effort is directed
• It is the aim of the philosophy.
• “Are ends towards which the organization is working.”
GOALS :
• The college aims to form students into nurses who are compassionate, competent,
committed, confident, caring, conscientious, and a critical-thinking generalist.
OBJECTIVES:
• Can focused either on the desired process or outcome
• Objectives are similar to goals in that they “motivate people to a specific end and are
explicit, measurable, observable, or retrievable and obtainable
• Are more specific and measurable than goals because they identify how and when the
goals to be accomplished.
• Objectives can focus either on the Desired Process or the Desired Result.
• Process obj. are written in terms of the method to be used.
Policies and Procedures:

• Policies are plans reduced to statement or instructions that direct the organization in their
decision making
• A designated plan or course of action to be taken in a specific situation.
POLICIES can be:
• Implied - neither written or expressed
• Expressed policies – written policies that are available to all and promote consistency of
action.
• Procedures: are plans that establish customary or acceptable ways of accomplishing a
specific task and delineate a sequence of steps of required action.

• Identify the process or stages needed to implement a policy and are generally found in
manuals at the unit level of organization.
• Established procedures save staff time, facilitate delegation, reduce cost, increase
productivity and provide a means of control
Rules and Regulations:
 Are plans that define specific actions or non-actions.
 Generally included as part of policy and procedures statement
Rules = describe situations that allow only one choice of action.
POINTS to remember for successful organizational planning

1. The organization can be more effective if movement within it is directed at specified
goals and objectives.
2. Because a plan is a guide to reach a goal, it must be flexible and allow for readjustment
as unexpected event occur.
3. 3. The manger should include in the planning process people and units that could
be affected by the course of action.
4. 4. Plans should be specific, simple and realistic.
5. Know when to plan and when not to plan
6. Good plans have built in evaluation, checkpoints so there can be a mid-course correction
if unexpected events occur.
7. A final evaluation should always occur at the end of the plan.
The Planning Formula by Kron

1. WHAT - What has been done?
• What should be done?
• What equipment and supplies have been used or are needed?
• What steps are necessary in the procedure?
• What sequence of activities was previously used?
• What other efficient methods may be used?
2. WHEN – When should the job be done?
• When was it formerly done?
• when could it be done?
3. 3. WHERE – Where is the job to be done?
• Where does an activity occur in relation to those activities immediately preceding and
following it?
• Where could supplies be stored, cleaned, and so forth?
4. 4. HOW – How will the job be done?
• What are the steps to be followed in doing the procedure?
• How will the time and energy of personnel be used?
• How much will it cost?
• How much time will it require?
5. WHO – Who has been doing the job?
• Who else could do it?
• Is more than one person involved?
6. WHY - To each of the questions, ask why.
• Why is this job, this procedure, this step necessary?
• Why is this done in this way, in his place, by this person?
7. CAN – Can some steps or equipment be eliminated?
• Can this activity be efficiently combined with other operations?
• Can somebody else do it better?
• Can we get a machine to help?
• Can we get enough money?

STRATEGIC PLANNING IN THE ORGANIZATION

 Planning has several dimensions – 2 of these dimensions are:
1. Time span
2. Complexity or Comprehensiveness
- Complex organizational plans that involve a long period (3-10 yrs.) are referred to
as long range or strategic planning.
Four Basic Features of Strategic Planning :

1. A clear statement of the organization mission
2. The identification of the agencies external constituencies or stakeholders and the
determination of assess of the agency‟s purpose and operations
3. The delineation of the agency‟s strategic goals and objective typically in a 3-5 year
plan.
4. The development of strategies to achieve the goals
MODULE 4 – PLANNED CHANGED

3 major Drive Change
• Technology
• Information
• Growing population
Planned changed - Occurs because of an intended effort by a change agent to deliberately move
the system.
• A change agent - is one who works to bring about a change.
• Is the person responsible for moving others who are affected by the change through its
stages.
Leadership Roles & Management Functions in Planned Change
Leadership role – is visionary in identifying areas of needed change in the organization and the
health care system
• Demonstrates risk taking is assuming the role of change agent solves resistance to change
• Demonstrate flexibility in goal setting in a rapidly changing healthcare system
• Anticipates and creatively problem solves resistance to change
• Serves as a role model to subordinates during planned change by viewing chage as
challenge and opportunity for growth.
• Role models high level interpersonal communication skills in providing support for
followers undergoing rapid or difficult change.
• Demonstrates creativity in identifying alternatives to problems
• Demonstrate sensitivity to timing in proposing planned change
• Takes steps to prevent aging in the organization and to keep nursing current with the new
realities of nursing practices
Management functions – forecast unit needs with the understanding of the organizations and
units legal, political, economic, social, and legislative climate
• Recognizes the need for planned change and identifies the options and resources
available to implement that change.
• Appropriately assesses the driving and restraining forces when planning for change
• Identifies and implements appropriate strategies to minimize or overcome resistance to
change
• Seeks subordinates input in planned change and provides them with adequate information
during the change process to give them some feeling of control.

• Supports subordinates input in planned change and provides them with adequate
information during the change process to give them some feelings of control.
• Identifies and uses appropriate change strategies to modify the behavior of subordinates
as needed
• Periodically assesses the unit/department for signs of organizational aging and plans
renewedal strategies.
Change theories
- Developed by KURT LEWIN (1990‟s)
– identified three phases through which the Change agent must proceed before a planned
change becomes part of the system:
Stages of Planned Change

1. Unfreezing stage: the change agent unfreezes forces that maintains the status quo.
 People becomes discontented and aware of the need to change
 For effective change to occur, the change agent needs to have made a thorough
assessment of the extent of and interest to change/ the nature and depth of motivation/ the
environment in which the change will occur.
2. Movement/CHANGING: the change agent identifies, plans, and implements appropriate
strategies ensuring that driving forces exceed restraining forces.
 Change should be implemented gradually
 Any change must allow enough time for those involved
3. Refreezing : the change agent assists in stabilizing the system change so it becomes
integrated into the status quo.
 For refreezing to occur, the change must be supportive and reinforce the individual
adaptive efforts of those affected by the change.
Murphy (1999) - Contemporary model , suggest there are 4 predictable stage that people pass
through when exposed to change:
1. Resistance
2. Confusion,
3. Exploration
4. Commitment
Stages & responsibility ten emotional phases of the change process by: Perlman and
Takacs
1. Unfreezing stage
• Gather data
• Accurately diagnose the problem
• Decide if change is needed
• Make others aware of the need for change
2. Movement/CHANGING:
• Develop a plan
• Set goals and objectives
• Identify areas of support and resistance
• Include everyone who will be affected by the change in its planning
• Set target dates
• Develop appropriate strategies
• Implement the change
• Be available to support others and offer encouragement through the change
• Evaluate the change
• Modify the change if necessary
3. Refreezing
• Support others so the change remains
Perlman and Takacs (1990) identified 10 emotional phases of the change process
1. Equilibrium 2. Denial

3. Anger 7. Resignation
4. Bargaining 8. Openness
5. Chaos 9. Readiness
6. Depression 10. Re-emergence
Driving and Restraining Forces

 Driving forces – are the forces that push the system toward the change.
 Restraining forces – are the forces that pull the system away from the changes
CHANGE STRATEGIES
3 commonly used strategies for Effective change by Bennis, Benne, and Chinn (1969)
1. Rational-Emperical Strategies:
 The change agent assumes that resistance to change comes from ignorance or
superstition
 Human are rational being who will change when given factual information documenting
the need for change.
2. Narrative and Re-educative Strategies:
 Uses group norms to socialize and influence people so change will occur
 The change agent assumes human are social animals, more easily influenced by others
than by facts.
 Change agent gains power by skill in interpersonal relationship
3. Power-coercive strategies:
 Base on the application of power by legitimate authority, economic or political clout of
the change agent.
MODULE 5 – TIME MANAGEMENT
3 steps in Time Management

1. Time be set aside for planning and establishing priorities.
2. Completing the highest-priority task whenever possible and finishing the tasks before
beginning another.
3. Reprioritizing the tasks to be accomplished based on new information received
Leadership Roles and Management Functions in Nursing
Leadership Roles Management functions
1. Is self-aware regarding personal blocks 1. Appropriately prioritizes day-to-day

and barriers to efficient time management. planning to meet short term and long term
unit goals.
2. Functions as a role model, supporter, and 2. Builds time for planning into the work
resource person to subordinates in setting schedule.
priorities.
3. Assist followers in 3. Analyzes how time is managed on the
working cooperatively unit level using job analysis time and
to maximize time use. motion studies.
4. Prevents and/or filters in working 4. Eliminates environmental barriers to
cooperatively to maximize time use. effective time mgt. for unit staff.
5. Role models flexibility in working 5. Handles paperwork promptly and

cooperatively with other people whose efficiently and maintains a neat work area.
primary time mgt. style is different.

6. Presents a calm & reassuring demeanor 6. Breaks down large tasks into smaller
during periods of high unit activity. ones that can more easily be acom-
plished by unit members.
7. Utilizes appropriate technology to
facilitate timely communication &
documentation.
8. Discriminates between inadequate
staffing and inefficient use of time when
time resources are inadequate to complete
assigned tasks
Time Management Principles:

1. Planning anticipates the problems that will arise from actions without thought.
2. Tasks to be accomplished should be done in sequence and should be prioritized according
to importance.
3. Setting deadlines in one‟s work and adhering to them is an excellent exercise in self-
discipline.
4. Deferring, postponing, or putting off decisions, actions or activities can become a habit
which oftentimes cause lost opportunities and productivity, generating personal or
interpersonal crises.
5. Delegation permits a manager to take authority for decision making and to assign tasks to
the lowest level possible consistent with his judgment, facts and experience
Davies (1980) state the following symptoms of time mismanagement

 Rushing
 Chronic vacillation between unpleasant alternatives
 Fatigue and listlessness with hours of non-productive activity
 Constantly missed deadlines
 Insufficient time for rest and or personal relationship
 Feeling overwhelmed by details and demands, among others
VACARRO (2001) 5 Priority Setting- Traps:

1. “ WHATEVER HITS FIRST”
 An individual simply responds to things as they happen rather than thinking first and
then act.
2. “ PATH AT LEAST RESISTANCE”
 The individual makes an erroneous assumption that it is always easier to do a task by
himself & fails to DELEGATE appropriately.
3. “ SQUEEKY WHEEL”
 The individual falls prey to those who are most vocal about their urgent needs/requests.
4.“ DEFAULT”
 An individual feels obligated to do the tasks that no one else has come forward to do.
5.“ INSPIRATION”
 The individual wait until they become inspired to accomplish the tasks.
 Some tasks are not inspiring and the manager recognizes that the only thing that will
complete these tasks is HARDWORK and appropriate ATTENTION to the matter.
Simple means of prioritizing is to Divide Request into 3 categories
1. “DON’T  Taken cared of by themselves or

DO”  Problems that are already outdated or
 Problems/tasks that can be accomplished by someone else

2. “ DO  Items which reflect trivial problems

LATER”  Those that don’t have immediate deadlines or
 Those that may be PROCRASTINATED (Procrastination
means to put off something else until a future time, to
postpone, or delay needlessly)
2. “ DO Major causes of Procrastination:
LATER”  performance anxiety
 Low frustration tolerance
 Resentment of working conditions
 Escapism, over-preparation, overs-working
 Poor working conditions
 Over-commitment & rationalizing
3. DO NOW”  Reflect a unit‟s day to day operational needs
MANAGING TIME AT WORK:

 Daily Planning Actions to help Manager identify and Utilize time as a resource:
1. At start of each workday:
 Identify key priorities to be accomplished
 Identify what specific actions to be taken
2. Determine the level of achievement you expect for each prioritized tasks.
3. Assess the staff assigned to work with you.
 Assign work that must be delegated to staff members
 Clearly expect expectations you may have about HOW and WHAT a delegated tasks
must be completed.
4. Review the short term and long term plans of the unit regularly
5. Allow time at several points throughout the day and at the end of the day to assess
progress in meeting established daily goals.
TAKING BREAKS:
Strongman and Burts (2000) studies of students says:
 Hunger/ thirst
 Boredom
 Feeling tired
 Lack of concentration
 Mental exhaustion
Important as they allow workers to REFRESH both physically and mentally
Kriegel (2002) says that when individuals are:

 Overworked,  longer hours on the job do not necessarily produced the desired outcomes.
 Working longer at a rushed pace not only increases the potential for stress and burnout but
also results in more mistakes.
DEALING WITH INTERRUPTIONS

 Lower level manage experience more Interruptions than Higher
level-manager.
 First and middle manager –are more involve in daily planning than higher-level
managers and interact with the subordinates.

TIME WASTERS (External)

 Telephone interruptions  Lack of adequately described policies and
 Socializing procedures
 Meetings  Incompetent co-workers
 Lack of information  Poor filing system
 Lack of feedback  Paper work and readings
INTERNAL TIME WASTERS:

 Procrastination  Management by
 Poor planning crisis
 Failure to establish  Haste
goals/objectives  Indecisiveness
 Inability to delegate  Open door policy
 Inability to say NO
3 Time wasters that warrant Special attention:

1. Socializing
 Don‟t make self overly accessible  Be brief
 Interrupt  Use coffee breaks and lunch hours
 Avoid promoting socialization for scheduling
2. Paperwork overload
3. Poor filling system – keeping correspondence organized in easily retrievable files
Personal Time management :

 “ refers to the knowing of self”
Hansten and Washburn (1998) suggests the three(3) primary areas of practice that consume the
time of RN‟s:
1. Professional practice
2. Technical Practice
3. Amenity Care
Giger and Turner(1994) suggests that Most people have tendencies towards Either:
MONOCHRONIC POLYCHRONIC
 People prefer to do one thing at a  They do Two or More things

time simultaneously
 Monochromic people tend to begin  They tend to change plans

and finish projects on time
 Borrow and lend things frequently
 Have clean and organized desks as
 Emphasize relationship rather than tasks
a result of handling each piece of
paperwork only once  Builds linger term relationships
 Are highly structured

MODULE 6 – Decision Making, Problem Solving and Critical Thinking

A Challenge:
Please define3 sentence definition of:
• Decision Making
• Problem Solving
• Critical thinking
Problem solving:
• W/c include a decision making step, is focus on trying to solve an immediate problem,
w/c can be viewed as a gap between “what is” and “what should be”
• Is a systematic process that focuses on analyzing a difficult situation, problem solving
always includes a decision-making step.
Decision Making
• Is a purposeful and goal directed effort that uses a systematic process to choose among
options.
• is a complex, cognitive process often defined as choosing a particular course of action.
(Webster‟s definition) to “judge or settle”
Critical Thinking:
• Refers to the intensity and complexity of decisions that are needed.
• Is a high level cognitive process, and both skills (decision making & problem solving)
can be improved with practice.
ELEMENTS OF DECISION MAKING

• Critical thinking, intuitive thinking “gut feeling”, and reflective thinking are incorporated
throughout the decision-making process.
Steps of Decision-Making Process

Step 1: Identify the need for a decision.
Step 2: determine the goal or outcome.
Step 3: identify alternatives or actions along with the benefits & consequences of each
action.
Step 4: Decide which action to implement.
Step 5: Evaluate the decision.

FOUR ACCEPTABLE PROBLEM-SOLVING MODELS:

Theoretical approaches to problem solving and decision making
1. Traditional Problem- Solving Model = is widely used and is perhaps the most well known
of the various models.
Seven steps of Traditional Problem-Solving
1. Identify the problem.
2. Gather data to analyze the causes and consequences of the problem.
3. Explore alternative solutions.
4. Evaluate the alternatives.
5. Select the appropriate solution.
6. Implement the solution.
7. Evaluate the results.
Weakness of Problem-solving Model:
- Less effective because of time constraint.
- Lack of an initial objective-setting step.
2. Managerial Decision-Making Model
• A modified traditional model, eliminates the weakness of the traditional model by adding
a goal-setting step.
Harrison (1981) has delineated the following steps in the managerial decision-making
process:
 Set objectives.  Choose.
 Search for alternatives.  Implement.
 Evaluate alternatives.  Follow up and control.
Nursing Process
• Provides another theoretical system for solving problems and making decisions.
Educators have identified the nursing process as an effective decision-making model.
Comparing the Decision-Making Process with the Nursing Process
Decision-Making Process Simplified Nursing Process
 Identify the decision Assess

 Collect data
 Identify criteria for decision Plan
 Identify alternatives
 Choose alternative Implement
 Implement alternative
 Evaluate steps in decision Evaluate
3. Intuitive Decision-Making Model

Recently identifies one characteristics of an expert critical thinker that intuition can be
overpowered by emotions.

4. The Moral Decision- Making Model

• Developed model for an ethical decision making incorporating the nursing process and
principle of biomedical ethics.
• Useful in clarifying ethical problems that result from conflicting obligation.
This model is represented by the mnemonic MORAL

M- Manage the dilemma - - collect data about the ethical problem and who should be involve in
decision- making process.
O – Outline Options - - identify alternatives, and analyze the causes and consequences of each.
R – Review criteria and resolve - weigh the options against the values of those involved in the
decision.
A - Affirm position and Act. - Develop the implementation strategy
L - look back - evaluate the decision making.
SWOT Analysis
S – STRENGHT
W – WEAKNESS
O – OPPORTUNITIES
T – THREATS
STRENGHTS
 Familiar with the healthcare system.
 Clinically competent and has received favorable performance appraisals
 Good communication skills; well like by her peers.
 Recently completed 12-lead electrocardiogram (ECG) interpretation class
WEAKNESS
 Has not attended the critical care class
 Has had prior unresolved conflict with one of the surgeons who frequently admit to the
intensive care unit (ICU).
 Is uncertain whether she wants to work full time, 12 hour shifts.
OPPORTUNITIES
 Anticipated staff openings in the ICU in the next several months.
 Critical care course will be offered in 1 month.
 Advanced cardiac life support (ACLS) course is offered four times a year.
 A friend who already works in the ICU has offered to mentor her.
THREATS
 Possible bed closures in another critical care unit may results in staff transfers, thus
eliminating open positions.
 Another medical surgical nurse is also interested in transferrring
Cause and Effect Diagram or The Fishbone Diagram

Fishbone analysis diagram is a simple tool that is used to understand the root cause of a problem.
By this technique we can identify the areas due to which the quality is not achieved.
The following. Categories can be described as;
1. Manpower (People) 4. Materials
2. Method 5. Measurement
3. Machine 6. Environment

CRITICAL ELEMENTS IN DECISION MAKING

1. Define objectives clearly
2. Gather data carefully
3. Generate many alternatives
4. Think logically
People think illogically primarily in three ways:
a. Overgeneralizing
b. Affirming consequences
c. Arguing from analogy
5. Choose and act decisively
INDIVIDUAL VARIATIONS IN DECISION MAKING:

1. Gender = women neuro density is higher than men w/c tend to accomplish more task.
2. Values = “ Individual decisions are based on each person‟s value system”
3. Life experience = “past experiences which includes education and decision-making
experience”
4. Individual preference = Choosing alternatives, one alternatives may be preferred over
another.
5. Individual ways of thinking and decision making
• Some think systematically – analytical thinkers
• Others think intuitively – right or left hemisphere dominance.
• Analytical linear – left brain thinkers process information differently than creative
• Intuitive – right-brain thinkers. Intuition is the ability to understand the possibilities
inherent in a situation.
Suggestions to help decrease individual subjectivity and increase objectivity in decision

making:
1. Values - one who is confuse about his own values may affect his decision
making ability.
2. Life experience – “lack of experience refers as “reason in transition”
o Use available resources
o Involved other people
o Analyze decisions later to assess their success.
3. Individual preferences
• Self-awareness , honesty and risk taking.

4. Individual ways of Thinking

• People making decision alone are frequently handicapped because they are not able to
understand problem fully or make decision from both an analytical and intuitive
perspective.
• In most organization, both types of thinkers may be found.
QUALITIES OF SUCESSFUL DECSION MAKERS

• Courage • Energy
• Sensitivity • Creativity
EFFECTS OF ORGANIZATIONAL POWER IN DECISION MAKING

A. Powerful people in organization
B. People with little Power
C. Powerful capable of inhibiting the preferences of less powerful.
Rational and administrative Decision Making

• Most managerial decisions were based on a careful, scientific, and objective thought
process and managers made decisions in a rational manner.
• Most managers made many decisions that did not fit the objective rationality theory.
Two types of management decision maker:

o Economic man
o Administrative man
Comparing Economic Man with the administrative Man
Economic Administrative
 Makes decision ia very rational  Makes decisions that are good enough.
manner
 Has complete knowledge of the  Because complete knowledge is not

problem or decision situation. possible, knowledge is always
fragmented.
 Has a complete list of possible  Because consequences of

alternatives. alternatives occur in the future, they
are impossible to predict accurately.
 Has a rational system of  Usually chooses from among a few

ordering preference of alternatives, not all possible ones.
alternatives.
 Selects the decision that will  The final choice is “satisfying” rather
maximize utility function. than maximizing.
MANAGEMENT DECISION-MAKING TECHNOLOGY

1. Quantitative Decision – Making Tools:
1.1 Decision Grids:
• “allows one to visually examine the alternatives and compare each against the
same criteria
1.2 Pay-Off tables:

• Cost-profit volume relationship

• very helpful when some quantitative information is available such as item‟s cost or
predicted use.
1.3 Decision trees
• used to plot a decision over time,
• “ allows visualization of various outcomes”
1.4 Program evaluation and review technique
o A popular tool to determine the timing of decisions
o A flowchart that predicts when events and activities must take place if a final event is
to occur.
Pitfalls in using decision-making tools

• The is a strong tendency for managers to favor first impressions when making a decision.
• Tendency to called confirmation biases. – tendency to affirm one‟s initial impression and
preferences as other alternatives are evaluated.
Minimizing Pitfalls
• Choosing the correct decision making style and involving others when appropriate.
Variables to determine decision-making style
1. The information rule
2. The goal congruence rule
3. The unstructured problem rule
4. The acceptance rule
5. The conflict rule
CRITICAL THINKING
• A composite of knowledge, attitudes, skills, an intellectually discipline process.
• Also, the ability to assess a situation by asking open-ended questions about the facts and
assumptions that underlie it and use the personal judgement and problem solving ability
in deciding how to deal with it.
Critical thinking competencies

1. General critical thinking competencies
2. Specific critical thinking competencies
3. Specific critical thinking competencies
Components of Critical Thinking:
 Reasoning and Creative analysis
 Insight,
 Intuition,
 Empathy,
 Willingness to take action
Characteristics of a Critical Thinker

• Open to new • Flexible • Creative
ideas • Empathic • Insightful
• Intuitive • Caring • Willing to take action
• Energetic • Observant • Outcome-directed
• Analytical • Risk-taker • Willing to change
• Persistent • Resourceful • Knowledgeable
• Assertive • “out of the box” thinker
• Communicator


Nursing Leadership and Management: Ma. Christina B. Celdran - Oraa, PHD RN Assistant Professor

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Nursing Leadership and Management

Ateneo de Zamboanga University

Changes in Health Care:

1. Paying for health care:

Ma. Christina B. Celdran – Oraa, PhD RN

The briefing is an element of nursing management activities covering the delegation,

Nursing management using effective communication.

CPD - Staff development is important to be implemented as a preparatory effort implementing

Henry Fayol’s Fourteen Principles of Management

Ma. Christina B. Celdran – Oraa, PhD RN

Ma. Christina B. Celdran – Oraa, PhD RN

existence of a scalar chain and adherence to it are necessary if the organization is to be

III-ROLES, SKILLS & QUALITIES OF LEADER & MANAGER

Roles Skills Qualities

• embody nurse executive roles

ROLES OF A MANAGER by Mintsberg

VII-FUNDAMENTAL SKILLS OF MANAGER

According to “Summer” - emphasizes 3 qualities a manager should have:

Ma. Christina B. Celdran – Oraa, PhD RN

IV- NURSING LEADERSHIP AND MANAGEMENT THEORIESLEADERSHIP

Traits and Skills of Leader by Stogdill

Common traits of Leaders

3 Leadership Styles: Kurt Lewin categorized Leadership Styles as:

e. Decision making does not involve others

7. Management Theories - Management theories, also known as transactional theories, focus

 8. Relationship Theories - Relationship theories, also known as transformational

TRANSACTIONAL & TRANSFORMATIONAL THEORIES

Transactional Leader Transformational Leader

Ma. Christina B. Celdran – Oraa, PhD RN

3. Organizational Theory - Max Weber – “Father of Theory of Social & Economic

Toffler recommended Coping skills in dealing with rapid change:

5. Hawthorne Effect - Elton Mayo & Fritz Roethlisberger

6. Theory of X and Y - Douglas McGregor – developed the Human Relations School of

Ma. Christina B. Celdran – Oraa, PhD RN

VIII-NURSE MANAGER IN A HEALTH CARE FACILITY

FUNCTIONS OF A NURSE MANAGER

Four (4) Major Functions of Management Process:

Ma. Christina B. Celdran – Oraa, PhD RN

OTHER FUNCTIONS :NURSE MANAGERS

NURSE MANAGER ROLES :

Ma. Christina B. Celdran – Oraa, PhD RN

1. CHARGE NURSE (resource nurse)

Republic act 4226 known as „Hospital Licensure Law

Classification of Hospitals and Other Health Facilities:

Classification of Hospitals and

Classification of Hospitals and Health Facilities:

Ownership and Control

Ma. Christina B. Celdran – Oraa, PhD RN

• It is a continous process of Assessing, establishing Goals and Objectives, Implementing

Why Managers Fail To Plan?

Major Aspect of Planning

Characteristics of a Good Planning

All planning involves choice: A necessity to choose from among alternatives.

Ma. Christina B. Celdran – Oraa, PhD RN

Four modes of planning:

Elements of Planning Forecast

II- Setting the Vision, Mission, Philosophy, Goals, Objectives

 III – Develop and Schedule Strategies, Programs/ Projects/Activities