Nursing

Leadership and
Management

MANAGEMENT
Definition / Description
Management a process of
coordinating actions and allocating
resources to achieve organizational goals







Nursing management - is performing leadership
functions of governance and decision-making
within organizations employing nurses. It
includes processes common to all management
like planning, organizing, staffing, directing and
controlling.

LET HIM THAT
WOULD MOVE
THE WORLD,
FIRST MOVE
HIMSELF.

- Socrates
Universal Principles of Management
1. Authority the right to give orders and
the power to exact obedience
2. Specialization of labor specialization
encourages continuous improvement
in skills and the development and
improvements in methods
3. Discipline No slacking, bending of
rules. The workers should be obedient
and respectful of the organization
4. Unity of Command Each employee
has one and only one boss to give
instructions or assignments

5. Unity of Direction a single mind generates
a single plan and all play their part in that plan
but only one person is in charge of the groups
activities
6. Subordination of Individual Interests when at
work , only work things shall be pursued or
thought about
7. Remuneration Employees receive fair
treatment or compensation for services, not
what the company can get away with
8. Centralization of Authority Consolidation of
management functions, decisions are made
from the top, producing uniformity of actions,
reduces errors in performance of tasks
9. Chain of Command formal chain of command
running from top to bottom of the organization
10. Decentralization of authority focuses on
importance of human elements, those at lower
levels are encouraged to participate in decision-
making
11. Material and social order All materials and
personnel have prescribed values and places,
embodied in the institutions policies and
regulations, and they must remain there
12. Equity and Justice Fair and just treatment
( but not necessarily identical treatment) no
favoritism
13. Personnel tenure limited turn-over of
personnel. Lifetime employment for good
workers, granting security of tenure and
permanent status after satisfactory performance
14. Initiative thinking out a plan and do what it
takes to make it happen

15. Scalar chain- interconnectedness of
people within the organization from top
to bottom
16. Hierarchy line of authority

17. Motivation of personnel as rational
beings, personnel must be allowed to
work their minds in problem-solving and
decision-making
18. Esprit de Corps harmony, cohesion
among personnel, principle of unity of
command must be observed

Theories of Management
The different theories of
management are classical
management theory, behavioral
management theory, quantitative
management theory, systems
management theory, contingency
management theory, and quality
management theory.

The classical management theory
focuses on finding the one best way to
perform and manage task.
The behavioral management theory
recognizes employees as individuals
with concrete human needs, as parts of
work groups, and members of a larger
society.
The quantitative management theory
uses quantitative tools to help plan and
control nearly everything in an
organization.



The systems management theory holds
that an organization comprises various
parts that must perform tasks
necessary for the survival and proper
functioning of the system as a whole.
The contingency management theory is
based on the premise that managers
preferred actions or approaches depend
on the variables of the situations they
face.
The quality management theory states
that the essence of the quality of any
output is its ability to meet the needs of
the person or group.
Management Process

Leadership Defined

Leadership combines:
intrinsic personality traits,
learned leadership skills,
characteristics of the
situation.
Leader -
guides people and groups
to accomplish common
goals,
influences the beliefs,
opinions, or behaviors of a
person, group, or groups
of people.
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 Defined
Management -
coordinates people, time, and
supplies to achieve desired
outcomes,
involves problem-solving and
decision-making processes.
Managers responsibility:
maintain control of the day-
to-day operations,
achieve established goals and
objectives.








Manager
plans
organizes
what is to be
done

who is to do
it
how it is to be done
Nurse manager
will have:
an appointed management position
within the organization with
responsibilities to perform
administrative tasks:
planning staffing
requirements,
performing employee
performance appraisals,
controlling use of supplies and
time,
meeting budget and
productivity goals.
Leadership
and Management

are intertwined
concepts,

are different,

difficult to discuss
one without the other .
A good manager also should be
a good leader
Leadership,
management
skills:
- complementary;
- can be learned
and developed:
through
experience,
improving skills
in one area will
enhance abilities
in the other.
Power and Authority
Nurse manager has
authority - formal right to direct
others granted by the
organization,
power - ability to motivate
people to get things done with or
without the formal right granted
by the organization,
ability to influence others to
accomplish goals.
Formal and
Informal Leadership
Formal leadership practices by:
nurse manager,
supervisor,
charge nurse,
coordinator and gives the
authority to act by the
organization.
Informal Leadership

is exercised by the person who

has no official or appointed
authority to act,
is able to persuade,
is able to influence others in the
work group,
strategies the nurse manager can
use to work with informal
leaders.
Leadership and
Management Theory

Leadership Trait Theory
Interactional Leadership
Theories
Transformational
Leadership
Management Theory
Organizational Theory
Leadership,
management, and
organizational theories
provide the
building blocks
on which to
build effective
nursing
management
practices and
skills.
Contemporary theories of
leadership
depends on several variables,
including (Marquis and Huston,
2000):
1. Organizational culture.
2. Values of the leader.
3. Values of the followers.
4. Influence of the
leader/manager.
5. Complexities of the situation.
6. Work to be accomplished.
7. Environment.
Transformational leaders
Identify and clearly communicate
vision and direction.
Empower the work group to
accomplish goals and achieve the
vision.
Impart meaning and challenge to
work.
Are admired and emulated.
Provide mentoring to individual
staff members based on need.
Transactional leaders
Focus on day-to-day operations
and are comfortable with the
status quo (the existing state of
affairs).
Reward staff for desired work
("I'll do x in exchange for you
doing y").
Monitor work performance and
correct as needed; or
Wait until problems occur and
then deal with the problem.
Management Theory
Behavioral theories explain
aspects of management and
leadership based on behaviors of
managers/leaders and followers.
Organizational Theory
provides a framework for
understanding complex
organizations,
helps to understand the
management process.





Management
Functions
Planning
Organizing
Staffing
Directing
Controlling
Planning includes defining goals and
objectives, developing policies and
procedures; determining resource
allocation; and developing
evaluation methods.
Organizing includes identifying the
management structure to accomplish
work, determining communication
processes, and coordinating people,
time and work.
Staffing includes those activities
required to have qualified people
accomplish work such as recruiting,
hiring, training, scheduling and
ongoing staff development.
Directing encourages employees
to accomplish goals and
objectives and involves
communicating, delegating,
motivating, and managing
conflict.
Controlling analyzes results to
evaluate accomplishments and
includes evaluating employee
performance, analyzing
financial activities, and
monitoring quality of care.

Roles of the Nurse
Manager
Customer Service
Provider
Team Builder
Resource Manager
Decision Maker and
Problem Solver
Change Agent



Customer Service Provider
Providing service or care to
customers (patient or clients).
Nurse must keep customer
service first and foremost as the
motivator of all plans and
activities.
Without customers, the
organization will go out of
business.

Team Builder

A team is a
group of
people
organized to
accomplish
the
necessary
work of an
organization.


Teams have become
important in the changing
health care environment.

Teams bring together a
range of people with
different knowledge, skills,
and experiences to meet
customer.

Resource Manager
Resources include the
personnel, time, and supplies
needed to accomplish the
goals of the organization.
Nurse manager has the
responsibility - effectively
manage resources in
providing safe, effective
patient care in an economic
manner.

Three Types of Budgets
1. Personnel
Allocates funds for salaries, overtime,
benefits, staff development and training,
and employee turnover costs

2. Operating budget
Allocates funds for daily expenses such as
utilities, repairs, maintenance, and
patient care supplies
3. Capital budget
Allocates funds for construction projects
and/or long-life equipment such as
cardiac monitors, defibrillators, and
computer hardware; capital budget items
are generally more expensive than
operating supplies.
Decision Maker and
Problem Solver
components of effective
leadership and management
in clinical patient care.
Problem solving is focused
on solving an immediate
problem and
decision maker includes
a decision-making step.
Nursing process =
problem-solving
process includes :
assessment,
analysis and diagnosis,
planning,
implementation,
evaluation;
has proven to be effective to
manage the complex decisions.

ASSESSMENT
Gather information about the
situation
Identify the problem; separate the
symptoms
Identify people and groups
involved
Identify cultural and environmental
factors
Encourage input from involved
parties

ANALYSIS AND
DIAGNOSIS
Analyze results of
information gathered
Identify, clarify, and
prioritize the actual problem
(s)
Determine if intervention is
appropriate
PLANNING
Identify as many solutions as
possible
Elicit participation from people or
groups affected
Review options and consider
safety, efficiency, costs, quality,
and legal issues
Consider positive and negative
outcomes
Remain open-minded and flexible
when considering options

IMPLEMENTING
Communicate plans to
everyone affected
Be sure plans, goals, and
objectives are clearly
identified
Maintain open, two-way
communication with staff
Support and encourage
compliance among all staff
EVALUATION
Identify evaluation criteria in the
planning
Identify who is responsible for
evaluation, what will be
measured, and when it will take
place
Maintain open communication
with all involved
Was the decision successful?
What might have made it better?
The nurse - change agent

is responsible for guiding
people
through the change process
and needs
to develop an understanding
about the nature of change
and effective change
strategies.
1. Change should be
implemented only for good
reason.
2. Change should always be
planned and implemented
gradually.
3. Change should never be
unexpected or abrupt.
4. All people who may be
affected by the change should
be involved in planning for
the change.
The most important
responsibility for the nurse
in any leadership or
management
role is to create an environment of
caring - caring for staff members as
well as for patients and families.
Staff members who believe that
their manager sincerely cares
about them and the work they do
are able to pass that feeling of
caring on to their patients and
other customers.
Caring for the staff members can
be demonstrated through
(McNeese-Smith, 1997):

Offering sincere positive
recognition for both individuals
and teams.
Praising and giving thanks for a
job well done.
Spending time with staff
members to reinforce positive
work behaviors.
Meeting the staff member's
personal needs whenever
possible, such as
accommodating scheduling
needs for family events and
being flexible in times of
illness.
Providing guidance and
support for professional and
personal growth.
Maintaining a positive,
confident attitude and a
pleasant work environment.


LEADERSHIP AND MANAGEMENT
SKILLS AND BEHAVIORS

Hersey and Blanchard (1988) have
identified that effective leadership and
management requires skills in three
major areas:
Technical skillssuch as
clinical expertise and nursing
knowledge.
Human skillsthe ability and
judgment to work with people
in an effective leadership
role.
Conceptual skillsthe
ability to understand
the complexities of the
overall organization

and where one's own
area of management fits
into the overall
organization.