NURSING LEADERSHIP, MANAGEMENT – DR. GLENN A.

GUIRA
CTU-CCMC-CN (Power Development Review Center)
INTENSIVE REVIEW
Balcueva, Irene Grace M.

NURSING LEADERSHIP & MANAGEMENT ▪ Productivity goals → services rendered to

patients
▪ To ensure patient’s satisfaction from the
LEADERSHIP services given
LEADERSHIP
• Core skill of a particular nurse LEADERSHIP AND MANAGEMENT
• Intrinsic personality traits • Are intertwined concepts
o Trait within us • Are different
o Traits we carry within us o “married but unique”
• Learned leadership skills o Different concepts but works together to ensure the
o “engagement” goals, mission, etc. of the organization will be
o Learned in the classroom, curriculum accomplished.
• Characteristics of the situation • Difficult to discuss one without the other
• Intrinsic + learned skills = is what makes you a leader
A good manager also should be a good leader.
LEADER
• Guides people and groups to accomplish common goals Leadership Management Skills
o Role model to the younger/newer ones by mere • Improving skills in one area will enhance abilities in the other
presence o Growth through exposure
• Influences the beliefs, opinions, or behaviors of a person, • Through experience
group, or groups of people o If opportunity is given, then grab it
o Motivates to follow o Makes you a better nurse
• Can be learned and developed
NURSE LEADER • Complementary
• Is able to inspire others on the health care team to make patient o Complement with one and another
education an important aspect of all care activities
POWER AND AUTHORITY
Leadership Qualities • Nurse manager has:
• Unique personality characteristics, o Authority – formal right to direct others granted by the
• Exceptional clinical expertise, organization;
• Relationships with others in the organization. ▪ Right to give the kind of order or schedule
because it is the job of a manager
MANAGEMENT o Power – ability to motivate people to get things done
with or without the formal right granted by the
MANAGEMENT organization
• Coordinates people, time, and supplies to achieve desired ▪ Ex. by giving rewards
outcomes o Ability to influence others to accomplish goals
o Coordination of people and time → ex. scheduling ▪ Ensure goals and objectives will be
properly accomplished through motivation
o Ex. provide resources to efficiently run the workplace
24 hours FORMAL AND INFORMAL LEADERSHIP
• Involves problem-solving and decision-making processes
o When there is conflict, there is problem → then this is
Formal leadership practices by:
solved by the nurse manager
• Nurse manager
Manager’s Responsibility o Has functions needed to be performed
o Overlooks if all nursing activities are implemented
• Involves 24-hour responsibility in the hospital/work place
o Ensures that documentation are done properly
• Maintain control of the day-to-day operations,
• Supervisor
o To remain everything in order
• Charge nurse,
• Achieve established goals and objectives
• Coordinator and gives the authority to act by the organization
MANAGER
Informal Leadership is exercised by the person who:
Organizes
• Has no official or appointed authority to act
Plans − For easier recognition o They are “chosen” because of their unique
− Organize by groupings characteristics, but there is no paper/contract
Who is to do it involved
What is to be done
− Assign people to do •
− Easier to manage Is able to persuade
specific tasks • Is able to influence others in the work group
How it is to be done o To ensure targets are met → improvement
• Strategies the nurse manager can use to work with informal
NURSE MANAGER leaders
• Will have appointed management position within the
organization with responsibilities to perform administrative LEADERSHIP AND MANAGEMENT THEORIES
tasks: 1. Leadership Trait Theory
o Planning staffing requirements, 2. Interactional Leadership Theories
o Performing employee performance appraisals, 3. Transformational Leadership
▪ Quality is implemented 4. Management Theory
o Controlling use of supplies and time, 5. Organizational Theory
o Meeting budget and productivity goals.
▪ Projected budget is important to meet goals

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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
Leadership, Management, And Organizational Theories 1. Planning
• Provide the building blocks on which to build effective nursing • Includes defining goals and objectives,
management practices and skills • developing policies and procedures;
o create policies to meet your objectives
Contemporary Theories of Leadership o there should be “manual” of procedures → to let
− Marquis and Huston, 2000 everyone know what to do
− Depends on several variables, including: • determining resource allocation;
o ensures the operation of the organization is
1. Organizational culture continuous
▪ Helps you determine how you will work with them • and developing evaluation methods.
2. Values of the leader o Development of evaluation tools
▪ Important to know the head/owners/CEO of an
organization/hospital 2. Organizing
▪ Important to know how the head works • Includes identifying the management structure to
3. Values of the followers accomplish work
4. Influence of the leader/manager o With the use of organizational structure
▪ Focuses on how do they inspire you o Know who to communicate/report/complain
5. Complexities of the situation issues or problems
▪ Know how complex the work is • determining communication processes, and
6. Work to be accomplished o Verbal/non-verbal/written communication
7. Environment o Upward communication – superior
▪ Know the place you are working o Downward communication – subordinates
o Horizontal – similar rank
Transformational Leaders • coordinating people, time, and work.
• Identify and clearly communicate vision and direction 3. Directing
o Vision – looking at the best position in the future
• Encourages employees to accomplish goals and
o Visionary – doing something to prevent problems in
objectives
the future
o Skills must match to their position
• Empower the work group to accomplish goals and achieve the
• involves communicating, delegating, motivating, and
vision
managing conflict.
o Delegation
o Allow other people in the organization to make
4. Controlling (Evaluation)
decisions because you trust your employees
• Analyzes results to evaluate accomplishments and
• Impart meaning and challenge to work
includes evaluating employee performance
• Are admired and emulated
• analyzing financial activities
o Wanted to improve nurses in the hospital
o budget must be allocated to achieve their goals
o Take good care of the career of nurses
• monitoring quality of care
o Makes sure that nurses are properly trained
o ensures safe and quality nursing care
• Provide mentoring to individual staff members based on need
Transactional Leaders ROLES OF THE NURSE MANAGER
• Wait until problems occur then deal with the problem • Customer Service Provider
o Problem solving is done when problem already arises o Providing service or care to customers (patient or
• Monitor work performance and correct as needed; or clients)
• Focus on day-to-day operations and are comfortable with the ▪ Relieve their discomfort
status quo (the existing state of affairs). ▪ To restore health
o No change is made o Nurse must keep customer service first and foremost
o Contented with what is available; with what is there as the motivator of all plans and activities
o If change is made, EVERYTHING needs to be o Without customers, the organization will go out of
changed business
• Reward staff for desired work (“I’ll do x in exchange for you
doing y.”) • Team Builder
o Specific to those who do well in work o A team is a group of people organized to accomplish
the necessary work of an organization.
Management Theory o Teams have become important in the changing health
• Behavioral theories explain aspects of management and care environment
leadership based on behaviors of managers/leaders and o Teams bring together a range of people with different
followers. knowledge, skills, and experiences to meet customer.
o Management is evolving as we continue to perform
functions in the organization ✓ First Level Function of the Nurse: ADPIE
Organizational Theory
• Provides framework for understanding complex organizations, • Resource Manager
• Helps to understand the management process o Resources include the personnel, time, and supplies
needed to accomplish the goals of the organization
▪ Human resources – important to implement
MANAGEMENT FUNCTIONS: (MAJOR)
particular nursing activities → facilitation of
goals of the organizations (ex. Manpower
Planning → janitor, nursing aides, etc.)
▪ Materials – disposables
Organizing ▪ Supplies – needed everyday to ensure
continuity of service
Directing ▪ Equipment – machines that are of long-
term use (ex. X-ray machine, aircon)
o Nurse manager has the responsibility – effectively
Controlling manage resources in providing safe, effective patient
care in an economic manner.
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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
➢ Three Types of Budgets: ILLUMINATION STUDIES
1. Personnel – allocates funds for salaries, overtime, benefits, • Elton Mayo and has Harvard associates (1927-1932), look at
staff developments and training, and employee turnover costs the relationship between light illumination in the factory and
▪ Everything the hospital spends in behalf of the productivity.
employees o Productive when there is LIGHTS
2. Operating budget – allocates funds for daily expenses such as • Hawthorne effect indicated that people respond to the fact that
utilities, repairs, maintenance, and patient care supplies they are being studies, attempting to increase whatever
▪ Budget need to operate in an activity behavior.
▪ Utilities – paid periodically (ex. electricity, water,
internet, telephone bills)
THEORY X AND Y
3. Capital budget – allocates funds for construction projects
and/or long-life equipment such as cardiac monitors, • Douglas McGregor (1960), X and Theory Y, posited that
defibrillators, and computer hardware; capital budget items are managerial attitudes about employees can be directly correlated
generally more expensive than operating supplies. with employee satisfaction.
▪ Not easily produced o Employee X – lazy, not productive, doesn’t want to
▪ Ex. Building, hospital beds, machines → important to work, only does minimal work but wants to receive
ensure that we provide the care that they need the same salary as industrious workers
o Employee Y – very hardworking, industrious, does
• Decision Maker many responsibilities and receives same amount of
• Problem Solver salary as employee X
• Change Agent
THEORY X THEORY Y
Theory X managers believe that Theory Y managers believe that
14 PRINCIPLES OF MANAGEMENT
their employees are basically their workers enjoy their work, are
1. Division of work – allows specialization lazy, need constant supervision self-motivated, and are willing to
2. Authority – right to command balanced with responsibility and and direction, and are indifferent work hard to meet personal and
accountability to organizational needs organizational goals.
▪ Right to give orders
3. Discipline – employees will only obey orders if management Considered as assets of the
play their part by providing good leadership. organization; actual contribution
▪ Without discipline, there will be disorder
4. Unity of command – there should only be one boss with no
conflicting lines of command. EMPLOYEE PARTICIPATION
▪ Use the chain of command • Chris Argyris (1964), managerial domination causes workers to
▪ Report only to one superior → immediate superior become discouraged and passive.
o Directly above you • If self-esteem and independence needs are not met, employees
5. Unity of direction – people engaged in the same kind of will become discouraged and troublesome or may leave the
activities must have the same objectives in a single plan organization.
▪ Smooth flow of organization
▪ Everybody is guided to avoid confusion LEADERSHIP THEORIES
6. Subordination of individual interest to general interest – the GREAT MAN THEORY
goals of the firms are always paramount
▪ The interest of majority is much more important • The Great Man Theory, from Aristotelian philosophy, asserts
7. Remuneration – payment is an important motivator that some people are born to lead, whereas others are born to
8. Centralization or Decentralization – depends on the condition be led.
of business and the quality of its personnel o Can contribute to the accomplishment of vision and
▪ Centralization – only one person will make the mission of an organization
decision • Great leaders will arise when the situation demands it.
▪ Decentralization – many will make decisions
9. Scalar chain/Line of authority – refers to the number of levels TRAIT THEORY
in the hierarchy. • Trait theories assume that some people have certain
10. Order – both material order (minimizes lost time and useless characteristics or personality traits that make them better
handling of materials) and social order (organization and leaders than others.
selection are necessary.
▪ Arrangement of things in order Intelligence Adaptability Ability
11. Equity – employees should be treated well to achieve equity. Knowledge Creativity Able to enlist
12. Stability tenure of personnel – job security and career cooperation
progress are important for employees to work better Judgment Cooperativeness Interpersonal skills
▪ Work efficiently Decisiveness Alertness Tact
▪ Follow ethical principles Oral fluency Self-confidence Diplomacy
13. Initiative – allow personnel to show their initiative, it may be a
Emotional Personal Integrity Prestige
source of strength for the organization.
Intelligence
14. Esprit de corps – management should foster the moral of
Independence Emotional balance Social Participation
employees
and control
▪ Cohesion (united as a whole)
Personable Risk taking Charisma
▪ Teamwork ; United

MANAGEMENT STYLES LEADERSHIP STYLES

• According to Likert, there are three leadership styles:
PARTICIPATIVE MANAGEMENT
DEMOCRATIC LEADER
• Mary Parker Follett (1926) was one of the first theories to
suggest participative decision making or participative • Less control is maintained
management. • Economic and ego awards are used to motivate
• Managers should have authority with, rather than over, • Others are directed through suggestions and guidance
employees. • Communication flows up and down
• Decision making involves others
• Emphasis is on “we” rather than “I” and “you”
• Criticism is constructive

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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA
AUTHORITARIAN LEADER POWER
• Strong control is maintained over the work group. • Power is defined as the capacity to act or the strength and
• Others are motivated by coercion potency to accomplish something.
• Others are directed with commands • The manager who is knowledgeable about the wise use of
• Communication flows downward authority, power, and political strategy is more effective at
o Superior to subordinate; subordinates will just follow meeting personal, unit, and organizational goals.
• Decision making does not involve others
• Emphasis is on difference in status (“I” and “you”). Types of Power
o No suggestion is accepted, only “I” am the best • Reward power is obtained by the ability to grant favors or
• Criticism is punitive. reward others with whatever they value.
o Result into punishment • Punishment or coercive power is based on fear of
punishment if manager’s expectations are not met.
LAISSEZ-FAIRE LEADER • Legitimate power is the power gained by a title or official
• “let us be independent” position within an organization.
• Expert power is gained through knowledge, expertise, or
• Is permissive, with little or no control experience.
• Motivates by support when requested by the group • Referent power is power that a person has because others
identify with that leader or with what that leader symbolizes.
• Provides little or no direction
• Charismatic power is distinguished by some referent power.
• Uses upward and downward communication between members
of the group • Informational power is obtained when people have information
o Able to communicate because of their expertise that others must have to accomplish their goals.
• Disperses decision making throughout the group
• Places emphasis on the group FUNCTIONS OF PLANNING
• Does not criticize
FOUR PLANNING MODES
LEADERSHIP APPROACHES
MODES OF PLANNING DESCRIPTION
CONTINGENCY APPROACH 1. Reactive Occurs after a problem exists
• Fiedler’s (1967), Contingency Approach, suggests that no one 2. Inactivism Seek the status quo
leadership style is ideal for every situation. - don’t change what is there
• Interrelationships between the group’s leader and its members
were most influenced by the manager’s ability to be a good 3. Preactivism Utilize technology to accelerate
leader. change and are future-oriented
• There should be other plans/options (plan a, b, c).
4. Interactive or Proactive Attempt to plan the future of their
SITUATIONAL APPROACH organization rather than react to it
• Hersey and Blanchard (1977), developed a Situational
Approach to leadership. FORECASTING
• Tridimensional leadership effectiveness model predicts which • Involves trying to estimate how a condition will be in the future.
leadership style is most appropriate in each situation on the
• Takes advantage of input from others, gives sequence in
basis of the level of the followers’ maturity.
activity, and protects an organization against undesirable
• As people mature, leadership style becomes less task focused changes.
and more relationship oriented. o Studies the older trends to plan a condition in the
future.
EXEMPLARY LEADERSHIP
(Kousez & Posner’s Five Practices for Exemplary Leadership)
STRATEGIC PLANNING
1. Modeling the way – requires value clarification and self-
• Examines an organization’s purpose, mission, philosophy, and
awareness so that behavior is congruent with values.
goals in the context of its external environment.
2. Inspiring a shared vision – entails visioning which inspires
followers to want to participate in goal attainment. • Complex organizational plans that involve a long period (usually
3. Challenging the process – identifying opportunities and taking 3-10 years) are referred to as long-range or strategic plans.
action.
4. Enabling others to act – fostering collaboration, trust, and the SWOT ANALYSIS
sharing of powers. − Also known as TOWS analysis
5. Encouraging the heart – recognize, appreciate, and celebrate − Was developed by Albert Humphrey at Stanford University in
followers and the achievement of shared goals the 1960s and 1970s.
− Strengths, Weakness, Opportunities, Threats
INTEGRATING LEADERSHIP AND MANAGEMENT
• Gardner (1990) asserted that integrated leader-managers SWOT definitions:
posses six distinguishing traits: • Strengths are those internal attributes that help an organization
to achieve its objectives.
1. They think longer term. • Weaknesses are those internal attributes that challenge an
2. They look outward, toward the larger organization. organization in achieving its objectives.
3. They influence others beyond their own group. o Wake up call for improvement
4. They emphasize vision, values, and motivation. • Opportunities are external conditions that promote
5. They are politically astute. achievement of organizational objectives.
▪ Good role models • Threats are external conditions that challenge or threaten the
6. They think in terms of change and renewal. achievement of organizational objectives.
o “competition”

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NURSING LEADERSHIP & MANAGEMENT – DR. GLENN A. GUIRA

PLANNING HIERARCHY CHANGE THEORY

1. Vision • Kurt Lewin (1951) identified three phases through which the
− Statement is used to describe future goals or aims of change agent must proceed before a planned change becomes
an organization part of the system:
− It is a picture for all group members of what they want • Unfreezing occurs when the change agent convinces members
to accomplish. of the group to change or when guilt, anxiety, or concern can be
2. Mission elicited.
− Brief statement identifying the reason that an o There is a need for change.
organization exists • Movement, the change agent identifies, plans, and implements
− It identifies the organization’s constituency and appropriate strategies, ensuring that driving forces exceed
addresses its position regarding ethics, principles, restraining forces.
and standards of practice. o Introducing a new system
• Refreezing phase, the change agent assists in stabilizing the
3. Philosophy Statement system change so that it becomes integrated into the status
− The philosophy flows from the purpose or mission quo.
statement and delineates the set of values and beliefs o Accept change and utilize into the system
that guide all actions of the organization. o Minimize error/problems
− It is the foundation that directs all further planning o Perform quality/excellence
toward that mission
− The organization philosophy provides the basis for
developing nursing philosophies at the unit level and
for nursing service as a whole.

4. Goals and Objectives

− Goals and objective 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.

Goals – broad and non-measurable

Objectives – specific and measurable

5. Policies and Procedures

➢ Policies
− 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 can be IMPLIED or EXPRESSED:

o 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.
o 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
− 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 manual of
procedures at the unit level of the organization.

6. Rules
− Rules and regulations are plans that define specific
action or non-action.
− Existing rules should be enforced to keep morale
from breaking down and to allow organizational
structure.
− Maintains order within the organization (if not
followed, then it might cause disorder)

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