NURSING MANAGEMENTMelchor Felipe Q. Salvosa, R.N., M.A.N.

What is ManagementManagement uses delegated authority within a formal organization to organize, direct and control subordinates so nursing services are coordinated. It refers to middle and lower levels of hierarchy and is often the implementing body. Is a process of getting things done through people. It supervises people and uses resources in doing the tasks. Is responsible for initiating steps by which organizational goals and objectives are accomplished.

What is ManagementManagement necessarily exerts influence over its subordinates. Influence therefore implies a host of managerial actions such as motivation, power and leadership. Exercises leadership to be both efficient and effective as it aims to be successful in attaining its goals and objectives.

Management the act of planning, organizing, directing (leading), controlling (evaluating). is a process by which a cooperative group directs actions towards common goals is a process of coordinating and allocating resources to achieve organizational goal

Manager

a person that creates and maintains an internal environment in an enterprise in which individual work together as a group

Managing

accomplishing the goals of the group through effective and efficient use of resources

Nursing Managementis the process of working through staff members to be able to provide comprehensive care to the patient This includes planning, organizing, directing and controlling.

Managerial LeadershipIs a process of directing and influencing a task related activity of group members. It involves people and unequal distribution of power among leaders and group of people. It involvesinfluencing subordinates in a variety of ways.

System of Nursing Management Process

KEY CONCEPTS IN NURSING MANAGEMENTADMINISTRATION is the higher level of hierarchy. It is the policy making body and as such sets the policy for the organization.

TOP LEVEL manages the organization as a whole. Executive officers MIDDLE LEVEL plan and coordinate activities of the organization. Administrative officers, Chief Nurses FIRST LEVEL Supervises the operative employee. Line Managers and Head Nurses

LEVELS OF MANAGEMENTA nurse manager must accomplish the work of the organization Work emerges from roles and functions of the job Each organization develops differing levels of management and titles for management staff Most healthcare organizations use leadership titles: nurse executives, nurse managers, and charge nurses (see Figure 2-3) 1. First-Level Manager or Unit Manager: responsible for day-today activities or tasks of a specific work group; manager directs professional and ancillary staff members 2. Middle-Level Manager: responsible for supervising first-level managers and acting as a liaison between first-level manager and upper-level manager 3. Upper-Level Manager or Executive: responsible for developing strategic goals and direction for the organization

The administration is what clearly designates and delegates one's authority, responsibility and accountability (ARA) in the organization.

KEY CONCEPTS IN NURSING MANAGEMENTORGANIZATION arrangement of people and resources working in a planned manner toward specified strategic goals.

1. It comprises the structure and process of a group working together to achieve an identified goal.

2. It is also a body of persons, method, policies and procedures arranged in a systematic manner through delegation of functions and responsibilities for the accomplishment of a purpose.

3. As a process, it establishes formal authority, sets up the structure through identification of groupings, roles and relationships. 4. The organization established has the task of determining staff needed and distributing them in various areas as needed. It formulates the job description of each.

KEY CONCEPTS IN NURSING MANAGEMENTVISION outlines the organization's future role and functions. It gives the agency something to strive for.

San Pablo Colleges College of NursingVISION A center of excellence that develops, harnesses and promotes individuals who critically think, create and act positively for the betterment of Filipino family, community and the larger society.

KEY CONCEPTS IN NURSING MANAGEMENTMISSION outlines the purpose of the agency, and in this case, the purpose of the hospital or the organization that provides health care. In determining the organization's mission, it identifies who the clients are. is the soul of an organization.

San Pablo Colleges College of NursingMISSION The mission of the San Pablo Colleges is the total personality development of the learners geared towards better quality of Filipino life through the acquisition of knowledge, skills and values formation, thus, making them productive and active members of society, quality professionals with universal proficiency.

Both vision and mission must be clear, engaging, and attainable. It must touch deeper values and hopes to motivate the entire health personnel belonging to the organization.

KEY CONCEPTS IN NURSING MANAGEMENTPHILOSOPHY describes the vision of an organization. It is a statement of beliefs and values that direct the organization's life or practice It explains beliefs and gives direction to how the mission or purpose is achieved.

San Pablo Colleges College of NursingPHILOSOPHY The College of Nursing believes in the total personality development of a student nurse to become productive member of the health care system, the community and the world with love of God, caring attitude for people, scientifically informed, socially and culturally aware, committed and technically competent.

KEY CONCEPTS IN NURSING MANAGEMENTOBJECTIVES It is the backbone of one's goals and philosophy are action commitments through which its mission and philosophy will be achieved. state the specific and measurable goals to be accomplished

San Pablo Colleges College of NursingGENERAL OBJECTIVE Upon completion of the program graduate nurses demonstrate total personality as equipped with professional competencies to assume responsibility for professional development and utilize research findings in the practice of the nursing profession

San Pablo Colleges College of NursingSPECIFIC OBJECTIVES The program aims to produce nurses with the following competencies: 1. Acquire a holistic understanding of the human person as a bio-psycho cultural being with focus on the concepts of health and illness 2. Demonstrate the competencies in the key areas of responsibilities of a beginning professional nurse. 3. Observe a research attitude in the application of the nursing process.

MANAGEMENT ROLES

Information role monitor, disseminator, spokesperson

Interpersonal role- figurehead, leaders, liaison Decisional roles entrepreneur, disturbance handler, resource allocator, negotiator

Nursing Management Role1. Establishes objectives and goals for one's area of responsibility and communicates with persons responsible for attaining them 2. Organizes and analyzes tasks, activities, decisions, and relationships needed and divides them into manageable tasks 3. Motivates and communicates with individuals responsible for various tasks through teamwork 4. Strives for excellence in clinical practice of nursing and delivery of client care on the selected unit or area within the healthcare institution 5. Manages human, fiscal, and other resources needed for clinical nursing practice and client

Nursing Management Role6. Facilitates development of licensed and unlicensed nursing and healthcare personnel 7. Ensures institutional compliance with professional, regulatory, and government standards of care 8. Provides strategic planning as related to unit(s) or area(s), department, and organization as a whole 9. Facilitates cooperative and collaborative relationships among disciplines/departments to ensure the delivery of effective, quality client care

Purposes of the Nursing Management Process

To achieve scientifically-based, holistic, individualized care for the patient;

To achieve the opportunity to work collaboratively with patients and others;To achieve continuity of care.

Characteristics of the Nursing Management Process1. Systematic - It has an ordered sequence of activities and each activity depends on the accuracy of the activity that precedes it and influences the activity following it. 2. Dynamic - It has greater interaction and overlapping among the activities and each activity is fluid and flows into the next activity. 3. Interpersonal - It ensures that nurses are patient-centered rather than task-centered and encourages them to work to help patients use their strengths to meet human needs.

Characteristics of the Nursing Management Process4. Goal-Directed - It is a means for nurses and patients to work together to identify specific goals related to wellness promotion, disease and illness prevention, health restoration, coping and altered functioning, which are most important to the patient, and to match them with the appropriate nursing actions. 5. Universally Applicable - It allows nurses to practice nursing with well or ill people, young or old, in any type of practice setting.

Comparison of Leaders & Managers

LeadershipMotto Challenge Focus Time Frame Methods Do the right things Change Purpose Future Strategies

ManagementDo things right Continuity Structures & procedures Present Schedules

QuestionsOutcomes

Why?Journeys

Who, What, When, Where & How? Destinations Performance

Evaluate Human

Potential

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGER

A. A nurse manager must: 1. Be results or outcome oriented 2. Use problem solving, critical thinking, and team building when confronting clinical, economic, and personnel issues on daily basis 3. Be responsible for interpreting, enforcing, and supervising the unit/organization's policy, procedures, and regulations

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGER B. Nurse manager scope ofresponsibility 1. Clinical excellence: ensuring high-level quality nursing care delivery 2. Provide for organization, coordination, and control of human, fiscal, and other resources 3. Strategic development and planning a. Ensure compliance with professional, regulatory, and governmental requirements and standards b. Provide for cross-discipline (or interdisciplinary) collaborative practice

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGER C. Influence and power1. Nurse leader must have ability to influence attitudes, actions, and behaviors of others to promote change and enhance the culture of the organization 2. Power is the potential ability to influence others 3. Power is based upon an individual's honor, respect, loyalty, and commitment D. Nurse leader power requires: 1. Knowing about strengths and talents of followers 2. Knowing personal and professional values and visions 3. Demonstrating interpersonal competence 4. Knowing how to enlarge one's sphere of influence and connectedness

ESSENTIAL CHARACTERISTICS OF ANof power E. Types EFFECTIVE MANAGER1. Reward power: ability of the leader to provide rewards or incentives 2. Coercive power: ability of the leader to withhold or punish 3. Legitimate power: granted to an individual who occupies a specific position within an organization 4. Expert power: recognition of leader's knowledge, experience, and expertise 5. Referent power: respect and regard for the leader's character and talents 6. Charismatic power: ability to inspire and attract others

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGERF. Using power 1. Nurse leaders apply their power base and use power effectively within their sphere of influence to make decisions and build consensus 2. Power never is abused or misused, but seeks to use: a. Persuasion over coercion b. Patience over impatience c. Compassion over confrontation (see Box 2-2 for rules on using power)

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGERRULES FOR USING POWER

1. Use the least amount of power you can to be effective in your interactions with others. 2. Use power appropriate to the situation. 3. Learn when not to use power. 4. Focus on the problem, not the person. 5. Make polite requests, never arrogant demands. 6. Use coercion only when other methods don't work. 7. Keep informed to retain your credibility when using your expert power. 8. Understand you may owe a return favor when you use your connection power.

Source: E. J. Sullivan. (2004). Becoming influential: A guide for nurses {p. 35). Upper Saddle River, NJ:Prentice Hall. Reprinted by permission.

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVE MANAGER

G. Competencies of the nurse manager 1. Critical thinking: a composite of knowledge, attitudes, and skills; ability to assess situation by asking open-ended questions about facts and assumptions that underlie it and use personal judgment and problem-solving ability in deciding how to deal with it

ESSENTIAL CHARACTERISTICS OF AN EFFECTIVEsystematic process 2. Problem solving: using a MANAGERto solve a problem 3. Decision making: a purposeful and goaldirected effort using a systematic process to choose among options 4. Team building: supporting the efforts and work of a number of people associated together by specific tasks or activities 5. Delegation: achieving performance of care outcomes for which an individual is accountable and responsible by sharing activities with others who have appropriate authority to accomplish the work

ESSENTIAL CHARACTERISTICS OF Collaboration: an interdisciplinary type of 6. AN EFFECTIVE MANAGERproblem solving that forms an equal power base on the client's behalf 7. Professional and staff development: promoting further professional growth in work-related knowledge, skills, and abilities 8. Change agent: an individual with formal or informal legitimate power whose purpose is to initiate, champion, and direct the change process 9. Managing human and fiscal resources (people and money) to achieve outcomes that are consistent with the organization's mission and purpose

MANAGEMENT THEORYPurposes of Theory1. Provide a stable focus of understanding what we experience 2. Enable us to communicate freely

3. Challenge us to keep learning of our world

Early Management Theories

THEORIES EMPHASIZING ORGANIZATIONAL STRUCTURE

Scientific Management Theory

FREDERICK TAYLOR (1856-1915)

an American, developed the Theory of Scientific Management in order to address the growing need to improve industrial production.

FREDERICK TAYLOR (1856-1915)

Used stopwatch studies & applied the principles of: observation measurement scientific comparison to determine the most efficient way to accomplish a task

1. Selection of the best man for a particular task based on the results of the scientific study; 2. Training of the chosen workers for their designated tasks and the appropriate adjustment of their pay; and 3. Filling of the managerial positions with the more highly skilled workers, in particular, a foreman being appointed to each specific work unit.

The Basic Component of this Theory1. Analysis and synthesis of the elements of the operation through time and motion studies; 2. Scientific selection of workers; 3. Training of workers;

4. Proper tools and equipment; and5. Proper incentives and payment.

Systematic Management Theory

Henry Fayol (1841-1925)

a Frenchman, called the father of' Systematic Management devised the traditional operational school of management. guiding behavior in each management situation with appropriate principles made management more effective. management principles with the aim of setting up a structure that would both promote order and raise worker's morale, thereby improving efficiency and accountability in the system.

FAYOLS MANAGEMENT PRINCIPLES

Division of Labor the more people specialize, the more efficient they can perform

Authority management needs to be able to give orders so that they can get things done.

FAYOLS

PRINCIPLES OF MANAGEMENT

Organizational Theory

Max Weber (1864-1920)

German, known as the father of the Theory of Social and Economic Organization, propounded similar principles of management, although what he advocated was a complex form of bureaucracy based on hierarchy of authority, division of work based on specialization of function.

Conceptualized emphasis on individuals and favoritism as the of organization

bureaucracy with rules instead of competency over most efficient basis

Conceptualized a structure of authority that would facilitate the accomplishment of the organizational objectives

The responsibilities and rights of the workers in Weber's system were governed by very specific rules rather than individuals. Organization of workers were based on their individual competencies.

Early Management Theories

THEORIES FOCUSED ON HUMAN RELATIONS

Social Process

Mary Parker Follett (1868-1933)

an American conceived of management as a social process focused on the motivation of individuals and groups alike towards achieving a common goal.

The idea was based on collaboration and cooperation, rather than the exercise of the manager's power and authority, and particular attention was devoted to what motivated the worker. Under the theory, the manager did not give orders to the rank-and-file employee, but rather worked together with him to study a given situation and take the best action based on the specific needs present in such situation.

Elton Mayo (1880-1949) and Fritz Roethlisberger (18981974)

Hawthorne effecta momentary change of behavior or performance in response to a change in a worker's environment, the response usually being an improvement. identify any type of brief spike in productivity, and the theory is that, at least momentarily, people are more productive when they feel appreciated or when watched.

Productivity was affected by both the physical and social environment, including:

1. The ability or opportunity to participate in decision making with the administration, and 2. The recognition from administration

Contemporary Leader Manager Theories

Management by Objectives

Peter Drucker (19092005) is the father of modern corporate management, which is a consensual process where both management and rank-and-file meet in order to understand and agree on the organization's objectives.

Management as Decision MakingHerbert Simon (19162001) posited the view that in hospitals and other service institutions, decisions are made by employees at all levels of organization, forming a network of decision-makers.

He named optimizing and satisfying as two distinct approaches to decision-making. Optimizing meant the search for the best alternative possible, an approach used by Simon's "economic man." Satisfying meant using the first workable solution and was applied by Simon's "administrative man."

Managerial Roles

Henry Mintzberg (1975), names three basic roles of the typical manager, namely interpersonal, informational and decision-making roles.

Roles of Managers

INTERPERSONAL ROLE a figurehead, a leader and a liaison inside and outside the organization.

Symbol Leader Liaison

INFORMATIONAL ROLE involved monitoring the organization, sharing information observed and finally serving as a spokesperson. Monitors Information Disseminates Information Spokesperson or Representative

DECISIONAL ROLE Entrepreneur or Innovator Troubleshooter Disturbance handler Negotiator

MOTIVATIONAL THEORIES

Abraham Maslow (1908-1970)

father of humanistic psychology theorized that man's various needs form a hierarchy starting with their more basic needs.

Initiated the Human Behavioral School in 1943 He outlined a hierarchical structure for human needs classified into five categories: 1. Physiological 2. Safety 3. Belonging 4. Esteem

Once needs are met, newer and more mature ones must emerge

In a nursing management setting the relevance of such a theory is that the nurses should first look to a patient's basic needs, e.g., food, clothing, water, shelter, and sleep, before she can take care of his other needs. This makes for more efficient and effective operation in the organization.

A practical application of this theory would be to give nurses flexible working hours, which by freeing them from the constraints of more fixed working hours, may give them leeway to manage their time, and increase their productivity.

Motivation Hygiene Theory

Frederick Irving Herzberg (April 18, 1923 January 19, 2000) born in Massachusetts was an American psychologist who became one of the most influential names in business management. He is most famous for introducing job enrichment and the Motivator-Hygiene theory.

Motivation Hygiene TheoryFrederick Herzberg (1959) came up with the Two Factor Theory, which posits that two factors influence people: hygiene factors and motivation factors. Hygiene factors are those which can negatively influence people while motivation factors can result in their satisfaction and psychological growth.

Douglas McGregor (1906-1964)

Theory X and Y

Developed the human relations school of management He developed two theories dubbed Theory X and Theory Y, which worked on two different sets of assumptions.

Theory X proposes that man is: 1. Lazy 2. unmotivated, 3. irresponsible, 4. unintelligent, and 5. not interested to work.

Under Theory Y, man is: 1. responsible, 2. creative, 3. self-possessed, 4. self-directed, and 5. a problem-solver.

Theory X managers emphasis on the goal of the organization People dislike & will avoid work Workers must be directed, controlled, coerced, threatened

Theory Y emphasis is on the goal of the individual People do not inherently dislike work Work can be a source of satisfaction Workers have self direction, selfcontrol, responds to rewards for the accomplishment of goals

William Ouchi

Theory Z

Published Theory Z: How American Business Can Meet the Japanese Challenge in 1981 This humanistic nature focuses on finding better ways to motivate people in order to increase worker satisfaction and therefore productivity.

Ouchi expounded on the 7 basic criteria that characterized the Japanese' "Seven S":Hard S

1. superordinate goals, or those which hold the organization together; 2. strategy or method of doing things; 3. structure - concern with the physical plant and facilities; and 4. systems - coherence of all parts of the organization for a common goal.Soft S 5. staff- concern for the right people to do the job; 6. skills - developing and training people; and 7. style - the manner of handling peers, subordinates and superiors.

Theory Z has the following important elements. 1. Collective decision making 2. Long term employment 3. Slower but more predictable promotions 4. Indirect supervision 5. Holistic concern for employees

Behavioral Science

emphasizes the use of scientific procedures to study the psychological, sociological, and anthropological aspects of human behavior in organization

Richard Pascale & Anthony Athos

Gave a more extensive discussion of the Art of Japanese Management: Application for American Executives in 1981.

Explain that organization in the US tend to savor strategy, structure, and systems, whereas the Japanese organization focus on staff, skills, style, and superordinate goals

Rensis Likert (1903-1981)

Theory of Management is based on his work at the University of Michigans Institute for Social Research

He identified 3 types of variables in organization

1. Causal

Includes: Leadership behavior Organizational structure Policies Controls

2. Intervening

These are: Perceptions Attitudes motivations

3. End-result

Includes: Measures of profits Costs Productivity

Managers may act in ways harmful to the organization because they evaluate end results to the exclusion of intervening variables.

Managerial Grid

B (1,9)

E (9,9)

C (5,5)

A (1,1) Vertical concern for people

D (9,1) Horizontal concern fro production

Behavioral Science Robert Blake (1918) & Jane Mouton (1930) Maintained that there are 2 critical dimensions of leadership 1. Concern for people 2. Concern for production They depicted these on a 9 x 9 or 81 square managerial grid. The vertical axis represents the managers concern for people, & the horizontal axis represents concern for production. The 5 basic styles are to each corner & in the middle

A. Impoverished Manager (1,1)lack of concern for both people & production

B. Country Club Manager (1,9)thoughtful & friendly but lack concern for production

C. Organization Man Management (5,5)represents a moderate concern for both people & production but not at the same time

D. Authority-Obedience (9,1)efficiency in operation but lacks concern for human element

E. Team Management (9,9)the optimal managerial style. These managers integrate their concern for people & production

Skills of a ManagerAccdg to Robert Katz Technical skills knowledge and proficiency in activities involving methods, procedures and process. It also involves working w/ tools and specific techniques to achieve the desire result.

Human skills the ability to work w/ people. It is the creation of work environment in w/c people feel secure and free to express their opinion.

Conceptual skills the ability to see the over-all pictures to identify important elements in a situation and to understand the relationship among the elements

Summer emphasized Knowledge factors Attitude factors Ability factors

TOTAL QUALITY MANAGEMENT (TQM)

Total Quality Management (TQM) is a management approach for an organization, centered on quality, based on the participation of all its members and aiming at long-term success through customer satisfaction, and benefits to all members of the organization and to society. TQM is aimed at embedding awareness of quality in all organizational processes.

The three basic principles of TQM are to: 1. Focus on achieving customer satisfaction; 2. Seek continuous and long-term improvement in all the organization's processes and outputs; and 3. Take steps to ensure the full involvement of the entire work force in

TQM is composed of three paradigms: 1. Total: Involving the entire organization, supply chain, and/or product life cycle 2. Quality: With its usual definitions, with all its complexities 3. Management: The system of managing with steps like Plan, Organize, Control, Lead, Staff, provisioning and the like.

Principles of TQM and Quality Improvement

1. Quality Managemen systems is organized best within a flat, democratic organizational structure 2. Nurse leaders and staff are committed to quality improvement as a philosophy and a process 3. Qualty management seeks to improve systems and processes while removing individual blame 4. Customers are respected, valued and define quality 5. Total quality improvement processes focus upon achieving outcomes 6. Care decisions are always based upon data

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