Nursing Leadership & Management

JOFRED M. MARTINEZ, RN, MAN
NG Review and Training Center, Inc.
Iloilo City, Philippines
CONCEPTS, PRINCIPLES, THEORIES AND METHODS OF DEVELOPING NURSING
LEADERS AND MANAGERS IN THE HOSPITAL AND COMMUNITY-BASED SETTINGS

The process of leading
and directing an
organization to meet
its goals through the
use of appropriate
resources.
The act of influencing
and motivating a
group of people to act
in the same direction
towards achieving a
common goal.

LEADERSHIP MANAGEMENT
• do not have delegated authority
but obtain their power through
other means, such as influence
• legitimate source of power due
to the delegated authority
• focus on group process,
information gathering, feedback,
and empowering others
• emphasize control, decision
making, decision analysis, and
results
• have goals that may or may not
reflect those of the organization
• greater formal responsibility and
accountability for rationality and
control than leaders

“father of
scientific management”

Four overriding principles of scientific management:
1. Traditional “rule of thumb” means of organizing work must
be replaced with scientific methods.
2. A scientific personnel system must be established so that
workers can be hired, trained, and promoted based on
their technical competence and abilities.
3. Workers should be able to view how they “fit” into the
organization and how they contribute to overall
organizational productivity.

Four overriding principles of scientific management:
4. The relationship between managers and workers should
be cooperative and interdependent, and the work
should be shared equally.

Theory of Social
and Economic Organization
Bureaucracy
• Need for legalized, formal authority
and consistent rules and regulations
for personnel in different positions

• Henri Fayol (1925), first
identified the management
functions of planning,
organization, command,
coordination, and control.

• Luther Gulick (1937) expanded on
Fayol’s management functions in
his introduction of the “Seven
Activities of Management” -
planning, organizing, staffing,
directing, coordinating, reporting,
and budgeting.

• Mary Parker Follett (1926) was
one of the first theorists to suggest
participative decision making or
participative management.
• Managers should have authority
with, rather than over, employees.

• Elton Mayo and his Harvard
associates (1927-1932), look at the
relationship between light
illumination in the factory and
productivity.
• Hawthorne effect indicated that
people respond to the fact that they
are being studied, attempting to
increase whatever behavior.

• Douglas McGregor (1960),
X and Theory Y, posited that
managerial attitudes about
employees can be directly
correlated with employee
satisfaction.

Theory Y managers believe that
their workers enjoy their
work, are self-motivated, and
are willing to work hard to
meet personal and
organizational goals.
Theory X managers believe that
their employees are basically
lazy, need constant
supervision and direction,
and are indifferent to
organizational needs.

• Chris Argyris (1964), managerial
domination causes workers to
become discouraged and passive.
• If self-esteem and independence
needs are not met, employees will
become discouraged and
troublesome or may leave the
organization.

THEORIST THEORY
Taylor Scientific management
Weber Bureaucratic organizations
Fayol Management functions
Gulick Activities of management
Follet Participative management
Mayo Hawthorne effect
Mcgregor Theory X and Y
Argyris Employee participation

• The Great Man Theory, from
Aristotelian philosophy, asserts
that some people are born to lead,
whereas others are born to be led.
• Great leaders will arise when the
situation demands it.

• Trait Theories assume that some people have certain
characteristics or personality traits that make them
better leaders than others.

Democratic Leader exhibits the following behaviors:
• Less control is maintained.
• Economic and ego awards are used to motivate.
• Others are directed through suggestions and guidance.
• Communication flows up and down.
• Decision making involves others.
• Emphasis is on “we” rather than “I” and “you.”
• Criticism is constructive.

Authoritarian Leader characterized by the following behaviors:
• Strong control is maintained over the work group.
• Others are motivated by coercion.
• Others are directed with commands.
• Communication flows downward.
• Decision making does not involve others.
• Emphasis is on difference in status (“I” and “you”).
• Criticism is punitive.

Laissez-faire Leader characterized by the following behaviors:
• Is permissive, with little or no control.
• Motivates by support when requested by the group.
• Provides little or no direction.
• Uses upward and downward communication between
members of the group.
• Disperses decision making throughout the group.
• Places emphasis on the group.
• Does not criticize.

• Fiedler’s (1967), Contingency Approach,
suggests that no one leadership style
is ideal for every situation.
• Interrelationships between the group’s
leader and its members were most
influenced by the manager’s ability to
be a good leader.

• Hersey and Blanchard (1977), developed a Situational
Approach to leadership.
• Tridimensional leadership effectiveness model predicts which
leadership style is most appropriate in each situation on
the basis of the level of the followers’ maturity.
• As people mature, leadership style becomes less task
focused and more relationship oriented.

• Burns (2003), suggest that both leaders and followers
have the ability to raise each other to higher levels of
motivation and morality.
There are two primary types of leaders in management.
• The traditional manager, concerned with the day-to-day
operations, was termed a transactional leader.
• The manager who is committed, has a vision, and is able
to empower others with this vision was termed a
transformational leader.

TRANSACTIONAL LEADER
Identifies common values
Is a caretaker
Inspires others with vision
Has long-term vision
Looks at effects
Empowers others
TRANSFORMATI0NAL LEADER
Focuses on management tasks
Is committed
Uses trade-offs to meet goals
Does not identify shared values
Examines causes
Uses contingency reward

Kouzes and Posner’s Five Practices for Exemplary Leadership

Gardner (1990) asserted that integrated leader-managers
possess six distinguishing traits:

THEORIST THEORY
Aristotle Great Man theory
Lewin and White Leadership styles
Fiedler Contingency leadership
Hersey and Blanchard Situational leadership theory
Burns
Transactional and
transformational leadership
Gardner The integrated leader-manager

• Power is defined as the capacity to
act or the strength and potency to
accomplish something.
• The manager who is knowledgeable
about the wise use of authority,
power, and political strategy is more
effective at meeting personal, unit,
and organizational goals.

• Reward power is obtained by the ability to grant favors
or reward others with whatever they value.
• Punishment or coercive power is based on fear of
punishment if manager’s expectations are not met.
• Legitimate power is the power gained by a title or
official position within an organization.
• Expert power is gained through knowledge, expertise,
or experience.

• Referent power is power that a person has because
others identify with that leader or with what that
leader symbolizes. Charismatic power is distinguished
by some from referent power.
• Informational power is obtained when people have
information that others must have to accomplish
their goals.

MODES OF PLANNING DESCRIPTION
Reactive occurs after a problem exists
Inactivism seek the status quo
Preactivism utilize technology to accelerate
change and are future oriented
Interactive or Proactive attempt to plan the future of their
organization rather than react to it

• Forecasting involves trying to
estimate how a condition will
be in the future.
• Takes advantage of input from
others, gives sequence in
activity, and protects an
organization against
undesirable changes.

• Strategic planning examines an organization’s purpose,
mission, philosophy, and goals in the context of its
external environment.
• Complex organizational plans that involve a long
period (usually 3 to 10 years) are referred to as long-
range or strategic plans.

• SWOT Analysis, also known as TOWS Analysis, was
developed by Albert Humphrey at Stanford University in
the 1960s and 1970s.
SWOT definitions:
• Strengths are those internal attributes that help an
organization to achieve its objectives.
• Weaknesses are those internal attributes that challenge
an organization in achieving its objectives.

SWOT definitions:
• Opportunities are external conditions that promote
achievement of organizational objectives.
• Threats are external conditions that challenge or
threaten the achievement of organizational objectives.

• Vision statements are used to describe
future goals or aims of an organization.
• It conjures up a picture for all group
members of what they want to
accomplish together.
• An organization will never be greater
than the vision that guides it.

• The mission statement is a brief
statement identifying the reason
that an organization exists.
• It identifies the organization’s
constituency and addresses its
position regarding ethics,
principles, and standards of
practice.

• The philosophy flows from the purpose or mission
statement and delineates the set of values and beliefs that
guide all actions of the organization.
• It is the basic foundation that directs all further planning
toward that mission.
• The organizational philosophy provides the basis for
developing nursing philosophies at the unit level and for
nursing service as a whole.

• Goals and objectives are the
ends toward which the
organization is working.
• Objectives are similar to goals in
that they motivate people to a
specific end and are explicit,
measurable, observable or
retrievable, and obtainable.

• Policies are plans reduced to statements or instructions
that direct organizations in their decision making.
• These explain how goals will be met and guide the general
course and scope of organizational activities.

Policies also can be implied or expressed:
• Implied policies, neither written nor expressed verbally,
have usually developed over time and follow a precedent.
For example, a hospital may have an implied policy that employees should be
encouraged and supported in their activity in community, regional, and national
health-care organizations.
• Expressed policies are delineated verbally or in writing.
Expressed policies may include a formal dress code, policy for sick leave or
vacation time, and disciplinary procedures.

• 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 steps needed to
implement a policy and are generally
found in manuals at the unit level of
the organization.

• Rules and regulations are plans that define specific action or
nonaction.
• Existing rules should be enforced to keep morale from
breaking down and to allow organizational structure.

• Kurt Lewin (1951) identified three phases through which
the change agent must proceed before a planned change
becomes part of the system:
• Unfreezing occurs when the change agent convinces
members of the group to change or when guilt, anxiety, or
concern can be elicited.
• Movement, the change agent identifies, plans, and
implements appropriate strategies, ensuring that driving
forces exceed restraining forces.

• Refreezing phase, the change agent assists in stabilizing the
system change so that it becomes integrated into the status
quo.

Stages of change and responsibilities of the change agent:
STAGE 1—UNFREEZING
1. Gather data.
2. Accurately diagnose the problem.
3. Decide if change is needed.
4. Make others aware of the need for change; do not
proceed until the status quo has been disrupted and
the need for change is perceived by the others.

STAGE 2—MOVEMENT
1. Develop a plan.
2. Set goals and objectives.
3. Identify areas of support and resistance.
4. Include everyone who will be affected by the change
in its planning.

STAGE 2—MOVEMENT
5. Set target dates.
6. Develop appropriate strategies.
7. Implement the change.
8. Be available to support others and offer encouragement
through the change.

STAGE 2—MOVEMENT
9. Use strategies for overcoming resistance to change.
10. Evaluate the change.
11. Modify the change, if necessary.

STAGE 3—REFREEZING
1. Support others so that the change continues.

• Edward Lorenz (1960s), discovered that even tiny
changes in variables often dramatically affected
outcomes.
• Even small changes in conditions can drastically alter a
system’s long-term behavior (butterfly effect).

• A budget is a financial plan that
includes estimated expenses as
well as income for a period of time.
• Accuracy dictates the worth of a
budget; the more accurate the
budget blueprint, the better the
institution can plan the most
efficient use of its resources.

• Workforce or personnel budget largest of the budget
expenditures because health care is labor intensive.
• Operating budget reflects expenses that change in
response to the volume of service, such as the cost of
electricity, repairs and maintenance, and supplies.
• Capital budgets plan for the purchase of buildings or
major equipment, which include equipment that has a
long life (usually greater than 5 to 7 years).

• Formal structure, through departmentalization and work
division, provides a framework for defining managerial
authority, responsibility, and accountability.
• Roles and functions are defined and systematically
arranged, different people have differing roles, and rank
and hierarchy are evident.

• Informal structure is generally a naturally forming social
network of employees.
• It is the informal structure that fills in the gaps with
connections and relationships that illustrate how
employees network with one another to get work done.

• The organization chart
defines formal
relationships within
the institution.

• Top-level managers look at the organization as a whole,
coordinating internal and external influences, and
generally make decisions with few guidelines or
structures.
• Middle-level managers coordinate the efforts of lower
levels of the hierarchy and are the conduit between
lower and top-level managers.
• First-level managers are concerned with their specific
unit’s work flow.

TOP LEVEL MID LEVEL FIRST LEVEL
Chief nurse Unit supervisor
Department head
Charge nurse
Team leader
Primary nurse
Scope of
responsibility
Look at
organization as a
whole as well as
external influences
Integrating unit-
level day-to-day
needs with
organizational
needs
Focus primarily on
day-to-day needs
at unit level

TOP LEVEL MID LEVEL FIRST LEVEL
Primary
planning focus
Strategic planning Combination of
long- and short-
range planning
Short-range,
Operational
planning
Communication
flow
Top-down but
receives
subordinate
feedback both
directly and via
middle-level
managers
Upward and
downward with
great centrality
More often
upward; generally
relies on middle
level managers
to transmit
communication to
top-level managers

• Bureaucratic organizational designs are commonly called line
structures or line organizations.
• Ad hoc design is a modification of the bureaucratic structure
and is sometimes used on a temporary basis to facilitate
completion of a project within a formal line organization.
• Matrix organization structure focus on both product and
function. Function is described as all the tasks required to
produce the product, and the product is the end result of the
function.

• Service line organization, which can be used to address the
shortcomings that are endemic to traditional large
bureaucratic organizations.
• Flat organizational designs are an effort to remove
hierarchical layers by flattening the chain of command
and decentralizing the organization.

Traditional Patient Care Delivery Methods
• Total patient care
• Functional nursing
• Team and modular nursing
• Primary nursing
• Case management

• Nurses assume total
responsibility during their
time on duty for meeting all
the needs of assigned
patients.
• Sometimes referred to as
the case method of assignment
because patients may be
assigned as cases.

• Functional nursing is
efficiency-based; tasks are
completed quickly, with
little confusion regarding
responsibilities.
• Allow care to be provided
with a minimal number of
RNs.

• Ancillary personnel collaborate
in providing care to a group of
patients under the direction of a
professional nurse.
• As the team leader, the nurse is
responsible for knowing the
condition and needs of all the
patients assigned to the team
and for planning individual care.

• Modular nursing uses a mini-team (two or three
members with at least one member being an RN),
with members of the modular nursing team
sometimes being called care pairs.
• Patient care units are typically divided into modules
or districts and assignments are based on the
geographical location of patients.

• The primary nurse assumes 24-hour responsibility for
planning the care of one or more patients from admission or
the start of treatment to discharge or the treatment’s end.
• During work hours, the primary nurse provides total direct
care for that patient.
• When the primary nurse is not on duty, associate nurses,
who follow the care plan established by the primary nurse,
provide care.

• A collaborative process of assessment, planning,
facilitation and advocacy for options and services to
meet an individual’s health needs through
communication and available resources to promote
quality cost-effective outcomes.
• Nurses address each patient individually, identifying
the most cost-effective providers, treatments, and
care settings possible.

• The leader-manager recruits, selects, places, and
indoctrinates personnel to accomplish the goals of
the organization.

1. Determine the number and types of personnel
needed to fulfill the philosophy, meet fiscal planning
responsibilities, and carry out the chosen patient care
delivery system selected by the organization.
2. Recruit, interview, select, and assign personnel based
on established job description performance
standards.

3. Use organizational resources for induction and
orientation.
4. Ascertain that each employee is adequately socialized
to organization values and unit norms.
5. Use creative and flexible scheduling based on patient
care needs to increase productivity and retention.

• Is the process of actively seeking out or attracting
applicants for existing positions and should be an
ongoing process.
• A leadership role in staffing includes identifying,
recruiting, and hiring gifted people.

• Is the process of choosing from among applicants the
best-qualified individual or individuals for a
particular job or position.
• Involves verifying the applicant’s qualifications,
checking his or her work history, and deciding if a
good match exists between the applicant’s
qualifications and the organization’s expectations.

• The nurse leader is able to assign a new employee to
a position within his or her sphere of authority,
where the employee will have a reasonable chance
for success.
• Proper placement fosters personal growth, provides a
motivating climate for the employee, maximizes
productivity, and increases the probability that
organizational goals will be met.

• Planned, guided adjustment of an employee to the
organization and the work environment.
• Induction, the first phase of indoctrination includes all
activities that educate the new employee about the
organization and employment and personnel policies
and procedures.

• Orientation activities are more specific for the position.
• The purpose of the orientation process is to make the
employee feel like a part of the team.
• This will reduce burnout and help new employees
become independent more quickly in their new roles.

• The better trained and more competent the staff, the
fewer the number of staff required, which in turn
saves the organization money and increases
productivity.
• Staff development activities are normally carried out
for one of three reasons: to establish competence, to
meet new learning needs, and to satisfy interests the
staff may have in learning in specific areas.

• Socialization refers to a learning of the behaviors that
accompany each role by instruction, observation, and
trial and error.
• Resocialization occurs when individuals are forced to
learn new values, skills, attitudes, and social rules as
a result of changes in the type of work they do, the
scope of responsibility they hold, or in the work
setting itself.

• Centralized staffing, where staffing decisions are made
by personnel in a central office or staffing center.
• Decentralized staffing, the unit manager is often
responsible for covering all scheduled staff absences,
reducing staff during periods of decreased patient
census or acuity, preparing monthly unit schedules,
and preparing holiday and vacation schedules.

UNIT STAFFING RATIO
Critical care/ICU 1:2
Operating room 1:1
Labor and delivery 1:2
Antepartum 1:4
Pediatrics 1:4
Medical–surgical 1:5
Emergency department 1:4
National Nurses United (2010–2013). RN to patient ratios. Retrieved June 9, 2013

Category I
Self care
1 – 2 hours of nursing care/day
Category II
Minimal care
Category III
Intermediate care
Category IV
Modified intensive care
Category V
Intensive care

National League for Nurses Formula for Staffing
Where:
ABO = Average Bed Occupancy
NCH = Nursing Care Hours
No. of working hours: 8 Based on RA 5901
The 40 working hours per week law
ABO X NCH
No. of working hours
Total no. of nursing service
personnel for 24 hours=
Standard values for NCH:
Medical = 3.4 OB = 3.0
Surgical = 3.4 Pedia = 4.6
Mixed MS = 3.5 Nursery = 2.8

Percentage of Professionals to Non-Professionals
Percentage of Distribution per Shift
Morning - 45%
Afternoon - 37%
Night - 18%
Professionals - 60%
Non-Professionals - 40%

Staffing for an OB Ward: 30-bed capacity

Staffing for an OB Ward: 30-bed capacity
30 x 3.0
8
11 nursing service
personnel for 24 hours=
Professionals - 60% x 11 = 7
Non-Professionals - 40% x 11 = 4

Distribution per Shift
SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS
AM AM
PM PM
NOC NOC

Distribution per Shift
SHIFT PROFESSIONALS SHIFT NON-PROFESSIONALS
AM 7 X 0.45 = 3 AM 4 X 0.45 = 2
PM 7 X 0.37 = 3 PM 4 X 0.37 = 1
NOC 7 X 0.18 = 1 NOC 4 X 0.18 = 1

• Motivation is the force within the individual that
influences or directs behavior.
• Leaders should apply techniques, skills, and
knowledge of motivational theory to help workers
achieve what they want out of work.

INTRINSIC EXTRINSIC
Comes from within the
individual
Comes from outside the
individual
Often influenced by family
unit and cultural values
Rewards and reinforcements
are given to encourage certain
behaviors and/or levels of
achievement

Maslow’s Hierarchy of Needs and
Theory of Human Motivation
• Maslow (1970), people are
motivated to satisfy certain needs,
from basic survival to complex
psychological needs, and people
seek a higher need only when the
lower needs have been met.

Operant Conditioning and
Behavior Modification
• Skinner (1953) demonstrated that
people could be conditioned to
behave in a certain way based on
a consistent reward or
punishment system.

Herzberg’s Two-Factor Theory
• Frederick Herzberg (1977)
believed that employees can
be motivated by the work
itself and that there is an
internal or personal need to
meet organizational goals.

Vroom’s Expectancy Model
• Victor Vroom (1964), looks at
motivation in terms of the
person’s valence, or preferences
based on social values.
• A person’s expectations about his
or her environment or a certain
event will influence behavior.

McClellands’s Three Basic Needs
• David McClelland (1971)
examined what motives guide
a person to action.

• Achievement-oriented people actively focus on
improving what is; they transform ideas into action,
judiciously and wisely, taking risks when necessary.

• Affiliation-oriented people focus their energies on
families and friends; their overt productivity is less
because they view their contribution to society in a
different light from those who are achievement
oriented.

• Power-oriented people are motivated by the power that
can be gained as a result of a specific action. They
want to command attention, get recognition, and
control others.

McGregor’s Theory X and Theory Y
• Douglas McGregor (1960)
examined the importance of
a manager’s assumptions
about workers on the intrinsic
motivation of the workers.

• Communication is “the
exchange of thoughts,
messages, or information, by
speech, signals, writing, or
behavior.”
• Occur on at least two levels:
verbal and nonverbal.

Internal climate
Includes internal factors such as the
values, feelings, temperament, and stress
levels of the sender and the receiver
External climate
Includes external factors such as the
weather, temperature, timing, status,
power, authority, and the
organizational climate itself

• Upward communication, the manager is a subordinate
to higher management.
• Downward communication, the manager relays
information to subordinates.
• Horizontal communication, managers interact with
others on the same hierarchical level as themselves
who are managing different segments of the
organization.

• Diagonal communication, the manager interacts with
personnel and managers of other departments and
groups who are not on the same level of the
organizational hierarchy.
• Grapevine communication flows quickly and
haphazardly among people at all hierarchical levels
and usually involves three or four people at a time.

• Assertive communication allows people to express
themselves in direct, honest, and appropriate ways
that do not infringe on another person’s rights.
• Passive communication occurs when a person suffers
in silence although he or she may feel strongly about
the issue.

• Aggressive communication is generally direct,
threatening, and condescending.

• Passive–aggressive communication is an aggressive
message presented in a passive way. This person
feigns withdrawal in an effort to manipulate the
situation.

S SITUATION
Introduce yourself and the patient and
briefly state the issue that you want to
discuss
B BACKGROUND
Describe the background or context
(patient’s diagnosis, admission date,
medical diagnosis, and treatment to date)
A ASSESSMENT
Summarize the patient’s condition and state
what you think the problem is
R RECOMMENDATION
Identify any new treatments or changes
ordered and provide opinions or
recommendations for further action

• The leader who actively listens
gives genuine time and attention
to the sender, focusing on verbal
and nonverbal communication.
• The leader must continually work
to improve listening skills by
giving time and attention to the
message sender.

G GREETING
Offer greetings and establish positive
environment
R
RESPECTFUL
LISTENING
Listen without interrupting and pause to
allow others to think
R REVIEW
Summarize message to make sure it was
heard accurately
R
RECOMMEND OR REQUEST
MORE INFORMATION
Seek additional information as necessary
R REWARD
Recognize that a collaborative exchange has
occurred by offering thanks

1. Nurses must not transmit or place online individually
identifiable patient information.
2. Nurses must observe ethically prescribed
professional patient–nurse boundaries.
3. Nurses should understand that patients, colleagues,
institutions, and employers may view postings.
AmericanNurses Association. (2011, September). Principles for social networking and the nurse.

4. Nurses should take advantage of privacy settings and
seek to separate personal and professional
information online.
5. Nurses should bring content that could harm a
patient’s privacy, rights, or welfare to the attention of
appropriate authorities.
6. Nurses should participate in developing institutional
policies governing online conduct.
AmericanNurses Association. (2011, September). Principles for social networking and the nurse.

• Delegation is getting work done through others or as
directing the performance of one or more people to
accomplish organizational goals.
• The mark of a great leader is when he or she can
recognize the excellent performance of someone else
and allow others to shine for their accomplishments.

• Right task
• Right circumstances
• Right person
• Right direction/communication
• Right level of supervision
American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN)

1. Frequently recur in the daily care of a client or group
of clients
2. Are performed according to an established
(standardized) sequence of steps
3. Involve little or no modification from one client-care
situation to another
4. May be performed with a predictable outcome
North Carolina Board of Registered Nursing (2013)

5. Do not inherently involve ongoing assessment,
interpretation, or decision making which cannot be
logically separated from the procedure(s) itself
6. Do not endanger the health or well-being of clients
7. Are allowed by agency policy/procedures
North Carolina Board of Registered Nursing (2013)

• Conflict is generally defined as the
internal or external discord that
results from differences in ideas,
values, or feelings between two or
more people.
• Conflict is neither good nor bad, and
it can produce growth or destruction,
depending on how it is managed.

• Intergroup conflict occurs between two or more groups of
people, departments, and organizations.
• Intrapersonal conflict occurs within the person. It involves
an internal struggle to clarify contradictory values or
wants.
• Interpersonal conflict happens between two or more
people with differing values, goals, and beliefs and may
be closely linked with bullying, incivility, and mobbing.

• Bullying is repeated, offensive, abusive, intimidating, or
insulting behaviors; abuse of power; or unfair sanctions
that make recipients feel humiliated, vulnerable, or
threatened, thus creating stress and undermining their
self-confidence (Townsend, 2012).
• Incivility is behavior that lacks authentic respect for others
that requires time, presence, willingness to engage in
genuine discourse and intention to seek common
ground (Clark, 2010).

• Mobbing occurs when employees “gang up” on an
individual.
• When bullying, incivility, and mobbing occur in the
workplace, this is known as workplace violence.

Compromising each party gives up something it wants
Competing one party pursues what it wants at the
expense of the others
Cooperating one party sacrifices his or her beliefs and
allows the other party to win
Smoothing one party in a conflict attempts to pacify the
other party or to focus on agreements rather
than differences

Avoiding parties involved are aware of a conflict but
choose not to acknowledge it or attempt to
resolve it
Collaborating all parties set aside their original goals and
work together to establish a supraordinate or
priority common goal

• Each party gives up something, and
the emphasis is on accommodating
differences between the parties.
• The very least for which a person will
settle is often referred to as the
bottom line.
• Negotiation is psychological and
verbal. The effective negotiator always
appears calm and self-assured.

• Collective bargaining involves activities occurring
between organized labor and management that
concern employee relations.
• Management that is perceived to be deaf to the workers’
needs provides a fertile ground for union organizers,
because unions thrive in a climate that perceives the
organizational philosophy to be insensitive to the worker.

• Time management is
making optimal use of
available time.
• Good time management
skills allow an individual to
spend time on things that
matter.

1. Technology (Internet, gaming,
e-mail, and social media sites)
2. Socializing
3. Paperwork overload
4. A poor filing system
5. Interruptions

• Quality control refers to activities that are
used to evaluate, monitor, or regulate
services rendered to consumers.
• Health-care quality is the degree to which
health services for individuals and
populations increase the likelihood of
desired health outcomes and are consistent
with current professional knowledge.

Hallmarks of effective quality control programs:
1. Support from top-level administration.
2. Commitment by the organization in terms of fiscal and
human resources.
3. Quality goals reflect search for excellence rather than
minimums.
4. Process is ongoing (continuous).

• Audit is a systematic and official
examination of a record, process,
structure, environment, or account
to evaluate performance.
• Auditing in health-care
organizations provides managers
with a means of applying the
control process to determine the
quality of services rendered.

• Retrospective audits are performed after the patient
receives the service.
• Concurrent audits are performed while the patient is
receiving the service.
• Prospective audits attempt to identify how future
performance will be affected by current interventions.

• Outcome audits reflect the end result of care or how the
patient’s health status changed as a result of an
intervention.
• Process audits are used to measure the process of care or
how the care was carried out and assume that a
relationship exists between the process used by the
nurse and the quality of care provided.
• Structure audit includes resource inputs such as the
environment in which health care is delivered.

• Total Quality Management, also referred to
as continuous quality improvement (CQI),
is a philosophy developed by Dr. W.
Edward Deming.
• The individual is the focal element on
which production and service depend
(i.e., it must be a customer-responsive
environment) and that the quest for
quality is an ongoing process.

• Toyota Production System is a production system built on
the complete elimination of waste and focused on the
pursuit of the most efficient production method possible.
• Health-care organizations that use TPS would have
caregivers not only attempt to directly solve problems at
the time they occur, but it would also have them
determine the root cause of the problem, so that the
likelihood of the problem recurring would be minimized.

• Performance appraisals let employees
know the level of their job performance
as well as any expectations that the
organization may have of them.
• If employees believe that the appraisal
is based on their job description rather
than on whether the manager approves
of them, they are more likely to view the
appraisal as relevant.

Trait rating scales Rates an individual against some
standard.
Job dimension scales Rates the performance on job
requirements.
Behaviorally anchored rating
scales
Rates desired job expectations on
a scale of importance to the
position.
Checklists Rates the performance against a
set list of desirable job behaviors.

Essays A narrative appraisal of job
performance.
Self-appraisals An appraisal of performance by
the employee.
Management by objectives Employee and management agree
upon goals of performance to be
reached.
Peer review Assessment of work performance
carried out by peers.

• Be specific, not general, in describing behavior that
needs improvement.
• Be descriptive, not evaluative, when describing what
was wrong with the work performance.
• Be certain that the feedback is not self-serving but
meets the needs of the employee.
• Direct the feedback toward behavior that can be
changed.

• Use sensitivity in timing the feedback.
• Make sure that the employee has clearly understood
the feedback and that the employee’s communication
has also been clearly heard.

1. Safe & quality nursing practice
2. Management of resources & environment
3. Health education
4. Legal responsibility
5. Ethico – moral responsibility
6. Personal & professional development
7. Quality improvement

8. Research
9. Record management
10. Communication
11. Collaboration & teamwork

Legal bases:
• Article 3 Sec.9 (c) of R.A. 9173/ “Philippine Nursing
Act 2002”
• Board shall monitor & enforce quality standards of
nursing practice necessary to ensure the maintenance
of efficient, ethical and technical, moral and
professional standards in the practice of nursing
taking into account the health needs of the nation.

Significance of core competency standards:
• Unifying framework for nursing practice, education,
regulation
• Guide in nursing curriculum development
• Framework in developing test syllabus for nursing
profession entrants
• Tool for nurses’ performance evaluation

Significance of core competency standards:
• Basis for advanced nursing practice, specialization
• Framework for developing nursing training
curriculum
• Public protection from incompetent practitioners
• Yardstick for unethical, unprofessional nursing
practice

• The Benner Model is
designed to emphasize
the skill acquisition of
health care professionals
(Benner, 2001).

• Novice, a new practitioner’s practice is driven by rules
and tends to provide task focused care.
• Advanced beginners, providers have developed safe
practice but lack a strong knowledge base to found
their practice and management skills.
• Competent provider, NPs will find they can prioritize
and begin to use past experiences to form their care.

• Proficient providers have a good sense of what their
patient situation is and can prioritize needs and
routinely predict accurate outcomes.
• Expert providers, NPs are confident, have an extensive
knowledge base and will be able to quickly grasp
complex patient situations.

ADVANCED PRACTICE NURSE (APN)
• The most independent functioning nurse.
• Has a master’s degree in nursing, advanced
education in pharmacology and physical assessment,
and certification and expertise in specialized area of
practice.

CLINICAL NURSE SPECIALIST
• Nursing expertise in a specialized area of practice
(medical-surgical nursing, psychiatric and mental
health nursing, pediatric nursing, community health
nursing, gerontologic nursing).

NURSING ADMINISTRATOR
• Manages client care and the
delivery of specific nursing services
within a health care agency.
• Begins with positions such as the
charge nurse or assistant nurse
manager, then nurse manager of
a specific patient care area.

NURSE RESEARCHER
• Investigates problems to improve
nursing care and to further define and
expand the scope of nursing practice.
• Employed in an academic setting,
hospital, or independent professional
or community service agency.

SCHOOL HEALTH NURSE
Goal – Superior educational
success by enhancing school
health.

SCHOOL HEALTH NURSE
Functions:
• Direct caregiver
• Case finder
• Consultant
• Counselor
• Health Educator
• Researcher

OCCUPATIONAL HEALTH NURSE
• Specialty practice that provides
for and delivery of health and
safety programs and services
to workers, worker population
and community groups.

OCCUPATIONAL HEALTH NURSE
Functions:
• Promotion and restoration of health
• Prevention of illness and injury and
• Protection from work related and environmental hazards.

PARISH NURSE
• The role that gathers in
churches, cathedrals, temples,
mosques, and acknowledge
common faith traditions.
• Respond to health an wellness
needs within the context of
populations of faith community.

PARISH NURSE
Functions:
• Provider of spiritual care
• Health Counselor
• Health Advocate
• Health Educator
• Facilitator of Support Groups
• Trainer or Volunteers
• Liaison to community resources and referral agent.

PUBLIC HEALTH NURSE
• A registered nurse with
special training
community health.

PUBLIC HEALTH NURSE
Function:
• Health Advocate
• Care Manager
• Referral Resource
• Health Educator
• Direct Primary Caregivers
• Communicable Disease Control
• Disaster Preparedness

PRIVATE DUTY NURSE
• A registered nurse or a
licensed practical nurse who
provide nursing services to
patients at home or any
other setting in accordance
with physician orders.

HOME CARE NURSE
• A nurse who provides
periodic care to patients
within their home
environment as ordered
by the physician.

HOME CARE NURSE
Functions:
• Health Maintenance
• Education
• Illness Prevention
• Diagnosis and treatment of disease.
• Palliation and rehabilitation.

HOSPICE NURSE
• Provides a family centered care
and allows clients to live and
remain at homes with comfort,
independence and dignity,
while alleviating the strains
caused by terminal phase i.e.
at the time of death.

HOSPICE NURSE
Function:
• Pain & symptom control.
• Spiritual Care
• Home Care and impatient Care
• Family Conferences
• Co-ordination of Care
• Bereavement Care

REHABILITATION NURSE
• A nurse who specializes in
assisting persons with disabilities
and chronic illness to attain
optimal function, health and
adapt to an altered life style.

NURSE EPIDEMIOLOGIST
• Monitors standards and
procedures for the control and
prevention of infectious diseases
and other conditions of public
health significance including
nosocomial infections.

• Ang Nars
• Association of Deans of Philippine Colleges of Nursing
(ADPCN)
• Association of Diabetes Nurse Educators of the
Philippines (ADNEP)
• Association of Nursing Service Administrators of the
Philippines (ANSAP)

• Association of Private Duty Nurse Practitioners
Philippines (APDNPP)
• Critical Care Nurses Association of the Philippines
(CCNAPI)
• Gerontology Nurses Association of the Philippines
(GNAP)
• Military Nurses Association of the Philippines (MNAP)

• Mother and Child Nurses Association of the
Philippines (MCNAP)
• National League of Philippine Government Nurses
(NLPGN)
• Occupational Health Nurses Association of the
Philippines (OHNAP)
• Operating Room Nurses Association of the Philippines
(ORNAP)

• Philippine Hospital Infection Control Nurses
Association (PHICNA)
• Philippine Nurses Association (PNA)
• Philippine Nursing Informatics Association (PNIA)
• Philippine Nursing Research Society (PNRS)
• Philippine Oncology Nurses Association (PONA)
• Philippine Society of Emergency Care Nurses (PSECN)

• Renal Nurses Association of the Philippines (RENAP)
• Society of Cardiovascular Nurse Practitioners of the
Philippines (SCVNPPI)
• Philippine Association of Public Health Nursing Faculty
• Psychiatric Nursing Specialists Foundation of the
Philippines
• Integrated Registered Nurses of the Philippines
(IRNUP)

Nursing is to nurture and care...
patient's life is in our hands,
so love our profession...
ITS A CALLING!

Marquis, B. L., & Huston, C. J. (2011). Leadership Roles and Management Functions in Nursing:
Theory and Application. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Nursing Leadership & Management

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