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GLOBAL CITY INNOVATIVE COLLEGE
3/F Bonifacio Technology Center, 31st Street Corner 2nd Ave., Crescent Park West, Bonifacio Global City, Taguig City
COLLEGE OF NURSING AND INTERNATIONAL HEALTH STUDIES
EARLY LEADERSHIP AND MANAGEMENT THEORIES characteristics found in trait studies included intelligence, skill,
initiative, assertiveness, persistence, ability to relate to other
Over the years, a number of leadership and management theories, people, a strong sense of self, ability to tolerate stress, ability to
have been developed to describe and predict how people influence take the consequences of decision, originality or creativity. Also,
each others’ behavior in work situations. Two early leadership intelligence and initiative are the two most often cited. A limitation
theories are Trait and Behavioral theories while early management of the trait theories are on its focus on the traits of the leader,
theories are Scientific Management and Human Relations theories. rather than on what the leader does. Other elements of the
leadership-management situation such as the environment, the
Trait theories. work itself and the other people in the situation are not given
importance.
Trait theories assume that a person has to have certain innate
abilities,
personality traits and other characteristics in order to be a leader. Behavioral Theories.
What this theory is saying is that leaders are born and that without
these certain innate characteristics and abilities a person cannot
These group of theories are sometimes called the functional
be a leader. The implication to education is that no amount and
theories
quality of education can make a leader out of a person who is not
of leadership. Rather than focusing on the traits of the leader,
naturally endowed with leadership characteristics.
behavioral theories are concerned with what the leader does.
One of the trait theories is the Great Man Theory. According to
Authoritarian-Democratic-Laissez-Faire Styles. In the
this theory, the tremendous influence of some well-known people
1930’s, Lewin, Lippitt and White (Tappen, 1995) did a research on
has actually determined or changed the course of history. Some of
the interaction between leaders and group and found that the
these people included Hitler, Napoleon, Castro, some kings and
leader could substantially influence the climate and outcomes of
queens. The Great Man theory assumes that the country’s
the group. The leaders’ behaviors were divided into three distinct
condition is due to the influence of the ruler’s abilities, ignoring the
patterns called leadership styles: authoritarian, democratic and
possibility that the condition of the country could have affected the
laissez-faire.
success of their ruler. The opposite of this theory is that these
people became “great” because they happened to be in the right
The authoritarian leader maintains strong control over the
place at the right time, and that the circumstances and events of
people in the group. The control may be benevolent and
their time made them great.
considerate or paternalistic or it may be dictatorial. The leader
gives orders and commands and expects group members to obey.
Individual Characteristics. A different version of the Trait theory
Decision-making is done by the leader alone. This style of
emerged when some
leadership emphasizes the difference in status between the
people associated certain physical characteristics to leadership.
leaders and the group members.
For example, it is still sometimes believed that tall individuals are
better leadership material than short individuals because they
Authoritarian leadership has some good points and some
seem stronger, dominating and imposing. Another example, is that
limitations. Some good points are: It is suitable in an emergency
the most outspoken person in a group is often chosen as the
when clear directions and fast actions are needed. It is also useful
leader. Other characteristics most often associated with being a
when the group is large and there is a need to get a job done in a
good leadership material are courage, intelligence and possession
hurry. With an authoritarian leadership, procedures and group
of skills. Several research and studies have been made to
actions are well defined and usually predictable. However,
determine what exactly are the traits of good leaders. So far,
creativity, autonomy, and self-motivation are stifled. It discourages
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independence and growth of the individual members. 1. Integration

2. Communication
Democratic Leadership on the other hand, allows the individual 3. Production emphasis
group members to participate in decision making and encourages 4. Representation (speaking for the group)
them to be creative and independent. The democratic leader, 5. Fraternization
rather than issuing orders and commands, makes suggestions to 6. Organization
guide the work of the group. Control is shared with the group 7. Evaluation
members. In a democratic leadership, group members are less 8. Initiation
dependent on the leader, and they seem to be more committed to 9. Domination
the goals which they themselves, together with their leader,
participated in setting. But while individual group members’ The nine categories were later reduced to two major
satisfaction and growth are met in a democratic leadership, categories:
moststudies show that democratic leadership is not as efficient as Initiating Structure includes task-related functions as assigning
authoritarian leadership members particular tasks and criticizing poor work. Initiating
(Tappen, 1995). While the work done by a democratic group is structure also includes behaviors that clarify roles, organize work,
more creative and the group is more self-motivated, the define procedures, and moving the group towards its goal.
democratic style is also more cumbersome. Since group members
participate in decision making, disagreements are likely to happen.
Because disagreements have to be resolved, completions of jobs Consideration includes relationship-oriented functions such as
are oftentimes delayed. This can be frustrating to people who finding time to listen to team members and doing personal favors
wants to have a job done as fast as possible. To solve this for team members. It also includes behaviors that build trust and
dilemma, many leaders combine autocratic with democratic show respect for the individual group members. These categories
leadership, have been used in many research studies and in evaluation of
with the leader making the final decisions after the leader has leaders bothby superiors and subordinates and it was found out
taken into consideration the opinions of other members. that both categories have a significant effect on
leadership effectiveness. For example, in a study of 238 nurses
The laissez-faire leader is passive, non-directive and inactive. working in 14 neonatal intensive care units, Duxbury and
The leader leaves almost all the control and decision making to the associates (1984) looked at the relationship between job
group. He/she is permissive, set not limits, provides minimal or no satisfaction, staff burnout, and head nurse leadership style. The
direction, guidance or encouragement. In a laissez faire group, study showed a strong relationship between job
members act independently of each other. The goals are unclear. satisfaction and high consideration and less relationship between
When all group members are highly selfdirected and motivated, these factors and staff burnout. It was also found out that burnout
laissez-faire can help them become more creative and productive. was highest when the headnurse style was one of high structure
However, in most situations, laissez-faire is unproductive, and low consideration.
inefficient, and unsatisfactory.
Task versus Relationship Orientation. These are closely
Leader Behavior Descriptions. Between 1940 and 1950, related to the initiating structure and consideration categories
Hemphill, Halpin and Winer, among with other researchers discussed earlier. Two kinds of leaders are identified and these are
(Tappen, 1995) studied and categorized leader behavior and the taskoriented leader and the relationship-oriented leader.
functions.Nine categories came out from numerous studies and
these are: Task-oriented leaders are concerned with getting the work done.
Relationship-oriented leaders focus on interpersonal relationships
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and are concerned with activities that meet group members’ framework. The “Hawthorne effect” mentioned in these studies
needs. The managerial grid developed by Blake and Mouton in described how other people’s
1964 (Tappen, 1995), shows various combinations of high and low behavior improve when you give them some kind of extra
concern for people and high and low concern forproduction. attention.
Theories discussed so far are early leadership theories. The early The function of the manager according to the human relations
management theories are to be discussed now. These are Taylor’s theorists is principally to obtain the cooperation of the workers in
Scientific Management and Human Relations theories. order to get them to work toward the goals of the organization. The
employees’ attitudes, hopes, fears, personal problems, sensitivity
Taylor’s Scientific Management. This theory centers on ways to to differences in status, and ideas about fair treatment have a
increase productivity and efficiency of each worker. Time studies strong influence on their responses to management.
were done to determine the amount of time a certain task is done. Therefore, recognizing their needs and concerns is necessary to
Ways to make tasks easier and ways to get them done in the least gain their acceptance and
possible time were studied. cooperation.
The basic components of early scientific management include: Henri Fayol.
1. Analysis and synthesis of the elements of operation; Henri Fayol (1949) identified the administrator’s activities or
2. Scientific selection of the worker; functions as planning, organizing, coordinating, and controlling.
3. Training of the worker; “To manage is to forecast and plan, to organize, to command, to
4. Proper tools and equipment; coordinate and to control. To foresee and provide means,
5. Proper incentives. examining the future and drawing up the plan of action. To
organize means building up the dual plan of action. To organize
means building up the dual structure, material, and human of the
Some of the characteristics expected of a manager, according to undertaking. To command means binding together, unifying and
the Scientific Management harmonizing all activity and effort. To control means seeing that
theory, include: everything occurs in conformity with established rule and
expressed demand.” (Fayol, as quoted in Swansburg,
1. Someone who knows very well the work that is being done in the 1993)
department;
2. Someone who is a good disciplinarian;
3. Someone who is able to get work through and out of the . Fayol listed the principles of management as follows:
department quickly;
4. Someone who is cautious; 1. Division of work
5. Someone who is able to keep track of innumerable details. 2. Authority
3. Discipline
Human Relations Theory. 4. Unity of Command
5. Unity of direction
The managerial skills needed according to this school of thought 6. Subordination of individual interests to the general interest
include 7. Remuneration
understanding human behavior, counselling, motivating, leading, 8. Centralization
and communicating with workers. The Hawthorne studies of Mayo 9. Scalar chain
and his associates (Tappen, 1995), were made within this 10. Order
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11. Equity work place is not physically comfortable. If hot and humid, instead
12. Stability of tenure of personnel of focusing on their jobs
13. Initiative the staff may be concentrating on staying cool. Nurses who skip
14. Esprit de corps meals because of the number of patients assigned to them will
have difficulty doing their work well. A nurse who is suffering from
Another theorist in the development of the science and art of pain or menstrual discomfort will have difficulty concentrating.
management was L. Urwick (1994). He described three principles Management must recognize these
of administration as investigation, appropriateness, and needs and meet them.
organization of resources. He stated that all scientific procedure is
based on investigation of facts and that this investigation takes Highest level,Lowest level
effects in planning. Urwick further stated that administrative skill is
a practical art that improves with practice and requires hard study The next level in the hierarchy of human basic needs is safety
and thinking. Modern management theory have evolved from the andsecurity. Physical safety, the sense of security and stability
work of Fayol, Urwick and many of the early management and belong to this level. There have been cases where crimes and
leadership theories. Nurse Managers soon find out that they need violence are committed against employees in the workplace and
to learn tomerge theories of human relations, personnel on their way to work. Nurses who work in the psychiatric units and
management and otherdisciplinesinto a unifying forcefor effective in high crime areas are prone to being victims of violence. Other
management. threats to safety are exposure to infection, including the AIDS virus
through needle-sticks and being splashed with infected blood and
CONTEMPORARY LEADER-MANAGER THEORIES body fluids. Management has the responsibility to make the work
place safe by ensuring that safety measures are practiced. An
The modern leader-manager theories include the Motivational important facet of this level is the individual’s need to feel secure
theories of Maslow, McGregor’s X and Y theories, theory Z, and stable about his/her job. An employee who fears losing his job
Behavioral Management; the Situational theories; Interactional because of impending company retrenchment feels insecure.
theories and the Transformational Leadership theory. An employee whose work schedule is poorly planned will not have
the feeling of stability. Persons need constancy in their lives and in
Maslow’s Hierarchy of Needs. Maslow’s theory on the hierarchy their workplace. In a hospital setting, providing regular hours, clear
of needs brought about many changes in management and standards for quality care, and continuity of patient assignments
leadership thinking and practice. Each of the changes intends to are just some ways of
meet one or more basic needs of the individual worker. Individuals providing security and stability in the workplace. A part of feeling
have basic needs that need to be secure is being able to feel that one is allowed to be dependent on
satisfied before they can work toward achieving higher goals. others for assistance when the need arises. New nurses need to
These basic human needs form a hierarchy beginning with the feel secure about being able to ask senior nurse for guidance and
lowest and most basic physiologic needs, working through safety assistance. They have a need to feel secure when asking for help
and security needs, love, belonging and esteem to the highest in learning the new job, solving difficult problems, and even in
level, which is self-actualization. The lifting heavy patients. Unfortunately, many senior nurses interpret
illustration below shows this hierarchy: Self-Actualization the asking for assistance as a weakness on the part of the new
EsteemLove and Belonging Safety and Security Physiologic nurses who, being new hires, happen to be still on probation. It is
the leader’s function to ensure that adequate
In a work setting, the physiologic needs of the workers must be assistance and support are available to people at work and to
met in order to do their job well. For example, in a hospital unit, create an atmosphere where asking for help is acceptable.
the nurses’ performance of their job can be affected if the nurses’
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The third level of the hierarchy are love and belongingness.

Being loved and the need to belong are integral to human nature.
A person whose love and belonging needs are not met feels lonely,
rejected and alienated, and therefore, job performance may be
adversely affected. According to Maslow, (Tappen, 1995), a warm Theories X & Y. McGregor’s (1960) theories X and Y are two
and accepting workplace can help satisfy these needs. different and contrasting approaches to leadership, based on
opposite beliefs about human nature.
Self-esteem is the next level in the hierarchy of needs. A person
with good self-esteem feels useful, adequate, competent, Theory X is based on the belief that the ordinary person is lazy,
independent, and autonomous. Self-esteem or self-worth increases unmotivated, irresponsible, not too intelligent, prefers to be
if it is based on who a person is rather than on her position or role. directed, rather than act independently. According to this theory,
Thus, a director or nursing who people do not really like to work and do not care about meeting
derives satisfaction on her power and position but is unsatisfied organizational goals. They work only to keep their jobs, they avoid
with herself, may have a less firmer self-esteem than a staff nurse taking more responsibility, and without supervision, most workers
whose sense of worth is based on who she really is. To help would come in late, goof most of the day and produce sloppy and
increase self-esteem, management needs to provide the careless work. Based on these assumptions about human nature,
opportunities to use employees’ talents and abilities, and to the leader must necessarily be controlling and directing to ensure
express genuine recognition for jobs well done. A nurse manager that the work is done properly. There is a need for close
can show appreciation through several ways such as merit raises, supervision and that instructions must be given in details. Rewards
promotions, letters of commendations, giving the employees and punishments are used.
frequent feedback on staff nurses’ performance.
Theory Y is the opposite of Theory X. Theory Y states that people
can be motivated to complete their work with little or no
The highest level of the hierarchy of needs is Self-Actualization. supervision. They can be creative, trustworthy, enthusiastic, find
Self-actualization is the growth and development of a person to his work rewarding. The negative traits described by Theory X are due
or her full potential. According to Maslow, a person does not to poor leadership and management, and that they are symptoms
pursue to satisfy this need until the lower needs of the hierarchy that employees needs for belonging, recognition, and
are met. A person who is starving, has no roof over his head, or if a selfactualization are not being met. Theory Y leadership does not
person is threatened with physical harm, is not happy with his job, focus on control, direction, reward and punishment. Rather it
does not feel loved, or, if a person has damaged ego, will not seek removes obstacles, provide guidance and encourage growth.
to satisfy this human need because he/she is still focusing on
resolving the lower needs. Some qualities that result from the Theory Z. This theory was developed by Ouchi (Tappen, 1995).
satisfaction of the need for self-actualization include being This theory, which was based on Theory Y and the democratic
perceptive, accepting, spontaneous, natural, autonomous, secure, approach to leadership, was tested in Japanese
unselfish, philosophic, creative, flexible, satisfied, mature, highly businessorganizations and was later adapted to American culture.
functional. Theory Z has a humanistic viewpoint and focuses on developing
There are ways to promote self-actualization in the workplace. The better ways to motivate people. A number of American
leader must encourage innovation, provide opportunity for organizations known for being well-managed use elements of
enhancing current skill, include staff in decision making, encourage Theory
staff to develop their own goals and job descriptions, offer Z. These elements include collective decision-making, long term
challenging work. employment, slower but more predictable promotions, indirect
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supervision, and a holistic concern. Trust, fair treatment, motivation to perform a certain task is based on a person’s
commitment, loyalty are all characteristics of theory Z. expectation that doing his work will result in a desired outcome
and that personal satisfaction or reward will be achieved as a
Hygiene and Motivation Factors (Herzberg). Like Theory Z, result of this outcome. What the person will do is to first try to
the Hygiene and Motivation Factors theory expanded on Theory Y. estimate his ability to carry out the task, set goals, recognize
This time, the needs that affect a person’s motivation to work are obstacles to doing the job, estimate the amount of support he can
classified into two sets of factors: expect from his manager. He also makes assumptions about the
kind of reward he can expect after completing the task. The leader
Hygiene Factors are those factors that meet a person’s need to who adopts this theory must be quick to recognize and anticipate
avoid pain, insecurity, and discomfort. If not met, the employee expectations (goals). The leader must provide support and clear
becomes dissatisfied. Hygiene factors include adequate salary, the path by removing obstacles to achieving the goal(s). The
appropriate supervision, good interpersonal relationship, safe and leader must also point out the connection between doing the work
tolerable working conditions. and receiving the rewards.
Motivation Factors meet needs to grow psychologically. When The situational theories indicated that there are situational
met employees feel satisfied. Motivation factors include satisfying determinants in the management leadership environment. Some of
and meaningful work, opportunities for advancement, and these are: The task to be done; group size, position in the group,
achievement, appropriate responsibility, adequate recognition. communication networks, social status, interpersonal stress,
designation of leadership, organizational
Behavioral Management. structure.
Interactional Theories. These theories describe the interactions

Behavioral Management is based on the stimulus-response among the four elements of the leader-manager situation. These
explanation of human behavior and uses rewards to influence and elements are the leader-manager, the group/coactors, the work,
control employee behavior. Among the proponents of this and the environment. Examples of interactions studied were
approach are Miller and Drucker (1978). An example given by between leader and group, the work-unit culture and the leader-
Tappen (1995) is as follows: If an employee took too long to manager, elements of a leader situation, complex man and
complete daily reports, the behavioral management approach to organizations.
this problem would be to remove any distractions that interfere
with the report writing, set reasonable goals for gradually reducing Transformational Leadership. The leadership model of this
the time it takes to write a report, and reinforce improvement by theory is divided into three categories, namely: transformational,
giving rewards such as intermittent praise. Salary increases, free transactional, and non-leadership.
lunches, and gift items are alternative rewards. Proponents of this
approach believe that it is a more suitable approach for a work Identified as transformational factors are:
setting than the humanistic ones. 1. Charisma. Charismatic leaders are highly respected by their
followers. They set high standards and challenge their staff to go
Situational Theories. These theories give importance to the beyond their level of effort.
environment. The Contingency and Path-Goal are situational 2. inspirational Motivation. The leader-manager shares a vision
theories. The Contingency Theory contends that the effectiveness with the staff that appeals to their emotions and ideals.
of a certain style of leadership is contingent on factors in the 3. I ntellectual Stimulation. The leader-manager stimulates
environment. Situational factors affect success or failure of followers to question the status quo, to think critically about what
leadership. A leadership style that is effective in one situation may they are doing and why.
be a failure in another situation. Path-Goal theory states that the
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4. I ndividualized Consideration. The leader-manager takes a significant effect on productivity. What affected production
facilitative approach. The uniqueness of each employee is significantly were group norms,
recognized and assignments are based on ability and needs. leading the researchers to conclude that work norms rather than
physical and wage incentives had the more influence on
Transactional Factors: production.
5. C ontingent reward. Rewards match the employee’s
achievements. The leader-manager emphasizes mutual agreement Two assumptions about behavior need to be considered in
on goals. understanding human interactions and dynamics in any
6. M anagement by exception. Leader-managers using organization (Tappen, 1995). The assumptions are:
management by exception react when a problem occurs. They
tend to use negative feedback more than positive feedback. They 1. All human behavior has some kind of meaning.
are more punitive than facilitative. 2. Although the meaning of a particular behavior may be obscure
to the observer, it is still assumed to have purpose for the person
Non-leadership Factor: performing the action. Every behavior is a reflection of the whole
7. L aissez faire. This is a negative characteristic of a leader. It is person: his physical, emotional, intellectual, spiritual states. If a
described as an absence of person feels distressed or in physical pain, his behavior will reflect
leadership. his present state. And every person has his own way of coping with
stress.
HUMAN BEHAVIOR AND RELATIONS

IN ORGANIZATIONS
While classic organization and management theory concentrates

on the physical environment, human relations theory stresses the
social environment. The chief concerns of the human relations
movement are the individuals; group process, interpersonal
relations, leadership, and communication. Managers encourage
workers to develop their potential and help them meet their needs Factors Affecting Human Behavior.
for recognition, accomplishment, and sense of belonging.
Cooperation between management and labor is stressed and the A factor that affects human behavior is the way a person copes
role of informal organizations for aiding communications, meeting with stress. The purpose of coping mechanisms is to protect one’s
individual needs, and maintaining cohesiveness is recognized. The ego from perceived threat. Some coping mechanisms are
importance of coordinating the psychological and social aspects of deliberative and some are non-deliberative. Non-deliberative
management is stressed. The Hawthorne studies stimulated mechanisms are below awareness and
considerable interest in human problems on the job. This study their connection to the perceived threat is not always apparent.
was conducted at the Chicago Hawthorne plant of Western Electric Although helpful, excessive use of any of the coping mechanisms is
by researchers from Harvard University under the direction of the considered harmful.
psychologist Elton Mayo, investigated the effects of changes in
illumination on productivity. The experimental study concluded The way and the extent to which people make use of coping
that lighting, the length of work breaks, temperature and humidity, mechanisms differ. For example, when people believe that they
length of workdays and workweek, refreshments showed no lack a particular ability, they may try to compensate by excelling in
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another area. A short and insignificant person for instance, may Substitution. Less desired but socially accepted behavior are
make up with the deficiency by substituted for more desired but less socially accepted behavior.
developing a loud and resonant voice. In addition to compensation, An example is when one substitutes an unrequited crush over a
other non-deliberative coping mechanisms that people resort to married co-employee with excessive eating.
when confronted by stress, problem or threat are:
Identification. Identification involves experiencing the same
Repression. This is a complete blocking of certain feelings or feelings as another person. People identify with persons they
thoughts from awareness because they are unacceptable or admire; oftentimes modeling the way the admired person talks and
intolerable in some way. For example, a dutiful daughter may behaves. Modeling the professional skill of senior nurses and
repress anger towards a mother whose sickness curtails her instructors is being used to advantage by nursing education and
personal freedom and social life. nursing service as a teaching strategy.
Denial. Denial is blocking from awareness something painful or

threatening in the environment. For example, a student who is The deliberative mechanisms are what people use to avoid
failing may still believe that everything is going well in school. discomfort, reduce tension, and solve problems in a more
straightforward and self-explanatory behaviors. Some of these
Suppression is a more deliberate form of repression. It is mechanisms are: seeking comfort and reassurance, dancing,
temporarily putting aside a disturbing feeling or thought until it can listening to music, crying, swearing, laughing, eating, smoking, use
be handled. In short the person tells herself, “I’ll think about it of stimulants, relaxation techniques, exercising, ventilating and
later.” discussing a problem, taking one problem at a time; drawing on
past experiences, becoming passive, aggressive, taking stock of
Displacement is a commonly used defense mechanism in the resources, sleeping, repetitive activity.
workplace and in people’s personal life. A person who cannot
express anger towards a spouse may unleash the feeling by being Most of these activities are helpful, but when
irritable towards another employee. one activity is overused or misused it can become harmful. An
important factor that can explain a person’s behavior is his
Projection. This is manifested in many ways in a work situation. A motivation.
nurse manager may blame her own failure to manage her floor
well to her staff’s alleged inefficiency. Maslow’s theory of motivation is based on the idea that some
human needs are more basic than others. These more basic needs
must be at least partially filled before a person has sufficient
energy and motivation to work toward gratifying the higher needs.
Withdrawal. This is the avoidance from a painful or threatening A more extensive discussion of Maslow’s
situation.
Rationalization. Rationalization is the use of an explanation that Another important factor that influence human behavior in any
is logical and reasonable but not the real reason for the behavior. organization are the roles they play. According to Tappen (1995),
For example, an employee who dislikes social activities, will roles are social prescriptions for behavior. They specify what kind
explain failure to attend the company Christmas party by giving a of behavior is appropriate for a person who has a specific position
logical explanation. within a group.
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Roles
can also be described as the actual (rather than prescribed)

behavior or a person occupying a specific position within a group. LEARNING ACTIVITIES
Occupying certain roles can bring about stress in a number of
ways. Conflicts can arise within a particular role or between roles. Answer the following and submit your typewritten
A nurse who has just been promoted to a supervisory position may answers/reactions to your professor.
have some stress when dealing with former co-employees and
friends, who are now her subordinates. She may not know whether 1. Watch the Movie Coach carter and utilize the following
to act formally or in a chummy way with them. Some roles are questions and imagine thatthe TEAM is an organization.
vague and a person may be confused about what is expected from
him. Clarifying and differentiating roles can eliminate role conflicts a) Is the TEAM task or relationship oriented? Please
and ambiguities. Stress may be experienced if the role expectation
elaborate.
is not congruent with the person’s usual pattern of behavior. This
happens, for example, when a highly technical nurse who has no
experience in managing people, is suddenly expected to do as well b) Cite at least five (5) instances where any of the
as a nurse manager. Some roles demand too much of management-leadership theories you learned and was able
theindividual, or that an individual may find that they may either to applied in the story, were applied in decision making. Be
be overqualified or not competent enough for a certain role.There specific in your explanation.
are a number of ways to reduce role stress. Problem solving, which
includes identifying the role stress involved and finding alternative c) Describe the interactions between coach and the team
actions has been found to be the more effective way members . Take note of leadership styles of managers.
Role bargaining which involves negotiations between the d) Identify some socio-cultural factors that are affecting
individual involved and those who established the role interactions in the organization.
expectations can also be used to reduce role stress.
e) Give examples of how the human basic needs described by
Culture is also a factor that influence human behaviour Maslow are being met.
. Culture includes all the learned patterns of beliefs, values, and 2. Compare the democratic style of leadership to the
behaviors common to a group or society. Culture affects how a authoritarian and laissez-faire styles
person interacts with co-employees and with leaders. Since cultural
patterns vary in many ways, including beliefs about the nature of 3. Compare Theory X, Y, and Z. Which one would you prefer in
people, time orientation, relationships to people in authority, the team ? Why?
languages, modes of thinking, preferred leadership and
management styles, leader-managers need to 4. Describe at least three factors that affect human behavior.
learn to work with people of diverse culture.
5. Describe a transformational leader. Do you know of anybody
in the nursing profession who is a transactional leader?
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3. Provides direction to staff members regarding the way the work

INTRODUCTION TO MANAGEMENT is to be done.
4. Monitors the work done by staff member to maintain quality and
Management and Administrative Process productivity.
5. Recognizes and rewards quality and productivity.
In this course, the terms management and administrative process 6. Fosters the development of every staff member.
are used interchangeably. However, you will observe that the term 7. Represents both administration and staff members needed in
management is the preferred term, simply because textbooks and discussions and negotiations with others.
references used it more often.
Effective management and Leadership
Management Defined
Covey (1989) is the author of the best seller, The Seven Habits of
Management is understood more clearly when the Highly Effective People,differentiated effective management and
manager’s/leader’s/administrator’s tasks are defined. According to leadership. According to him, effective management is putting first
Fayol (1970), the manager’s activities and functions are planning, things first. Leadership on the other hand decides what “first
organizing, coordinating, and controlling. (The description and things” are. It is management that puts them first, day-by-day,
definitions of these functions will be discussed later). Judging from moment-by-moment. Management is discipline.
these functions, one can see that the manager works through
others. The manager’s main responsibility is to ensure that the Nursing Management
organization’s goals are achieved through the performance of In nursing, management relates to planning, organizing, staffing,
specific tasks by its members. Mintzberg (1975) described four (leading) and controlling (evaluating) the activities of a nursing
types of roles that managers fill in. These are: interpersonal, enterprise or division of nursing departments and of the subunits
informational, decisional, and entrepreneurial of the departments. Nurse Managers performs these management
functions to deliver health care to the patients. Swansburg (1993)
. The interpersonal role includes ceremonial duties, leadership, and identified thirteen general principles of nursing management and
the role of liaison. The informational role includes scanning the these are:
environment for any useful information and seeking to improve
work methods. The decisional role includes deciding how to 1. Nursing management is planning.
allocate resources, as well as negotiating and 2. Nursing management is the effective use of time.
handling disturbances. Finally, the manager is also an innovator, 3. Nursing management is decision making.
always alert to new ideas and opportunities to improve the 4. Meeting patients’ nursing care needs is the business of the
effectiveness and profitability of the organization or unit. From nurse manager.
these descriptions of the manager’s tasks Tappen (1995)
summarized the components of effective management and these LEADERSHIP IN NURSING MANAGEMANNT, RECOGNITION,
are: leadership, planning, direction, monitoring, development, PLANNING DIRECTION, MONITORING, REPRESENTATION,
recognition, representation. Tappen further stated that the DEVELOPMENT
effective manager is one who:
5. Nursing management is the formulation and achievement of
1. Assumes leadership of the group. social goals.
2. Actively engages in planning the current and future work of the 6. Nursing management is organizing.
group. 7. Nursing management denotes a function, social position or rank,
a discipline, and a field of study.
10
8. Nursing management is the active organ of the division of 7. It can be used to discover the need for change.
nursing, of the organization, and of society in which it functions. 8. It is needed for effective control
9. Organizational cultures reflect values and beliefs.
10. Nursing management is directing or leading. Douglas (1988) mentioned the activities of planning as assessment
11. A well-managed division of nursing motivates employees to by collection, classification, analysis, interpretation, and translation
perform satisfactorily. of data; strategic planning, development of standards,
12. Nursing management is efficient communication. identification of needs and priority setting; management by
13. Nursing management is controlling or evaluating. objectives; and formulation of policies, rules, regulations, methods,
and procedures.
According to Donovan (1975), planning has many benefits.

Among these are:
PLANNING
The first element of management is planning. Fayol (1949) defined
a) Satisfactory outcomes of decisions;
it as making a plan of action for a foreseeable future. Douglas
b) Improved functions in emergencies;
(1988) stated that “planning is having a specific aim or purpose
c) Assurance of economy of time, space, and materials; and,
and mapping out a program or method beforehand for
d) The highest of personnel
accomplishment of the goal”. Alexander (1978) defined planning
as “deciding in advance what to do, how to do it, when to do it, and
Donovan included decision making, philosophies, and objectives as
who is to do it.” Another definition was given by Steiner (1969)
key elements in planning. For planning to be successful there are
who defined planning as a process beginning with objectives,
factors to be considered (Swansburg, 1995). The managers should
defining strategies, policies, and detailed plans to achieve them,
have knowledge of the following:
achieving an organization to implement decisions; and including a
review of performance and feedback to introduce a new planning
1. Characteristics of planning.
cycle. Planning is a basic function of all managers. It is a
2. Elements of the planning process.
systematic process that is based on sound management theory
3. Strategic or long-range planning process.
An important aspect is forecasting, a process which includes
4. Tactical or short-range planning process – functional versus
assessing the present situation, identifying its weaknesses,
operational
recognizing the driving forces in the environment, constructing
5. Planning standards
possible alternative future scenarios, identifying the preferred
6. Application of the planning processes and standards to the work
future, developing a plan of action, implementing the plan, and
situation
evaluating and implementation.
The manager must also have skill in bringing the planning process
up to the standard set, where there are deficiencies.
Purpose of Planning
There are many reasons for planning. Douglas (1988) identified Characteristics of a Good Planning
eight purposes of planning:
1. It leads to success in achieving goals and objectives. Tappen (1995) describes planning as the component of effective
2. It gives meaning to work. management that is hardest to do and easiest to ignore. This is
3. It provides for effective use of available personnel and facilities. because it deals primarily with the future and can easily be
4. It helps in coping with crisis situations. postponed. Planning is based on objectives. Simplification and
5. It is cost-effective. standardization characterize it. In other words, first and foremost
6. It is based on past and future, thus helping reduce the element good plans are based on objectives, they must be simple, they
of change.
11
must have standards, must be flexible, must be balanced and must An example of a specific objective formulated from the above
use available resources. Planning requires decision making, that is, purpose is: The occurrence of communicable diseases among
choosing future courses of action from among alternatives. In the children in Barangay Ususan
practice of nursing, for example, planning includes collection, will be reduced by 50% in 1999, 80% in 2000, and 100% by 2012
analysis, and organization of many kinds of data that will be used
to determine both the nursing care needs of patients and the Generating alternative solutions is the next step in developing
management plans that will provide the resources and processes the plan. In generating alternative solutions, a climate of open-
to meet these needs.(Swansburg,1993). mindedness and positive thinking is important. Consultation with
internal and outside experts, searching the literature, results of
Phases of Planning surveys are helpful to the planner. Brainstorming is another way of
According to Tappen, planning is divided into three phases. These generating solutions. Brainstorming among those involved or may
are: be affected by the planning is recommended as the sessions can
A. Developing the plan. encourage them to participate and to be open to the ideas of
B. Presenting the plan. others. Several alternative solutions may be generated and each of
C. Implementing and monitoring the plan. them is analyzed before a course of action is selected. Pros and
cons of each option are identified and analyzed objectively.
Pilot studies, use of scenarios and simulations are utilized to test

the chosen alternatives or options. These are done especially in big
scale projects where failure of the plan in the actual setting can
become costly. In summary, the steps in developing a plan are as
follows:
Phase One: Developing the Plan 1. Establishing a purpose

2. Analyzing the situation which includes problem verification,
The first step in developing the plan is to establish its identifying situational
purpose. It is important to be clear about the purpose of planning variables and the anticipated response to change.
to avoid confusion. However, the purpose may be stated in broad 3. Formulating objectives
terms until a broad thorough assessment of the situation/problem 4. Generating alternative solutions
is done. An example of a purpose 5. Analyzing alternatives and selecting course of action
of a health plan that is stated in a broad term is: Reduce children
Phase Two: Presenting the Plan
and adult morbidity rates in Barangay Ususan . When assessing
the situation/problem, information to confirm or revise the
The second phase of planning is presenting the plan itself.
identified
Occasionally, one may be able to proceed directly from developing
problem is need. Situational variables or factors that affect the
the plan to its implementation. But usually, plans for projects are
problem, as well as anticipatedresponse to change are also
presented to administration/management for approval. When this
identified. When the problem and environmental situations are
becomes necessary, the planner needs to be persuasive in
already assessed, objectives are formulated. The objectives should
convincing others to accept the plan and to obtain approval by
be written as measurable outcomes so that they can later serve as
administrators. To be acceptable, the plan must be presented in an
guidelines for evaluation.
organized manner. The problem, the background or the situation
that brought about the problem, and of course, the well-prepared
plan to resolve the problem must be presented clearly. The
12
delivery of the presentation must be done convincingly and Task Assigned Person Jan. / Feb. / March / Apr / May / June /
professionally. Aside from being persuasive, the planner must be July / Aug / Sept / Oct / Nov / Dec.
concise and direct to the point. The plan itself must be presented Hire JFD & STAFF ------------------}
in a professional manner. Train CGD & STAFF --------------------}
Phase Three: Implementation and Monitoring
Pilot in Unit A HNA ------------------------}
Implement in
The third phase of planning is the implementation and monitoring all units
of the plan. It includes the following steps: HN -----------------------------------}
Evaluate
1. Organizing the implementation ---}
All Head nurses
Organizing the implementation of a plan includes: and staff Dev
a) Identifying and arranging activities according to sequence; In this example, the hospital plans on hiring new RN of an
b) Setting target dates for completing each activity; affiliated school of nursing to work as patient care assistants.
c) Assignment of responsibilities to particular individuals; and Hospital administrators believe that by hiring the students, the
d) The allocation of resources. newly graduate nurses’ work load can be reduced without reducing
nurses’ patient contact and the quality of care that the patients
There are techniques that have been developed to organize and receive.
monitor implementation of proposed plans depending on how
elaborate they are. Schedules, Gantt charts; program evaluation PERT Charts, on the other hand, graphically illustrates the
and review technique (PERT), and the critical path method (CPM) sequence of events and their interrelationships, using circles for
are some of them. Among these events and arrows for activities. The PERT chart is more systems
methods, schedules are the simplest and the more often used. oriented than the Gantt chart. From the PERT chart, one can see
Schedules organize work on the basis of time and assigned staff how the work must flow from one
members, leaving out details of staff to be done. Schedules are event to the next and how one activity depends on another.
easy to make and use, and they form the basis for the more
complex methods. Critical Path Method (CPM) is very similar to PERT except that it
also identifies the critical path, that is, the path that takes the
longest time to complete and the most likely to cause a delay. With
this information, one can have a realistic estimate of when the
project can be completed.
The Gantt chart, which is actually a highly developed schedule,

specifies in detail the tasks to
be performed and the time they are expected to be completed. An
example of a Gantt chart follows: 2. After organizing the project, the next step is to
implement it.
13
Here the actual implementationof the project begins. through reliable feedback mechanism” (Swansburg,1993).
Implementing the plan needs the supervision and direction of the Strategic planning in nursing is concerned with what the
planner/s and the designated leader/s. The skill needed is division of nursing should be doing. Its purpose is to improve
leadership. allocation of scarce resources,
including time and money, and to manage the division of nursing
3. Monitoring the implementation for performance. It includes analysis of projected technological
4. advances, the internal and external environments, the nursing and
comes with the implementation of the plan. The major focus health care market and industry, the economics of nursing health
monitoring is referring to the original design to ensure that it is care, availability of human and
being followed. material resources, judgments of top management, and other
5. Evaluating Outcomes. factors. Among the benefits of strategic planning is the giving of a
6. sense of direction to all managers and practitioners of nursing
Formative and summative evaluations are used when within the organization.
implementing the
plan. Formative evaluation is ongoing and is done as the project is ORGANIZING
being implemented. At the end of the implementation phase, a
summative evaluation is also needed to determine how well the
project has succeeded in meeting the objectives that were Definitions of organizing. Organizing is identifying the
developed during the first phase of planning. The result of the organizational needs from mission statements and objectives and
evaluation will determine whether or not activities will be from observations of work performed, and adapting the
continued or not. organizational design and structure to meet these needs. Like
planning, organizing is primarily a thinking act. (Swansburg, 1993)
5. Revising and Updating the Plan. It is the process of designing the machine (Urwick inSwansburg,
1993). During the organizing process, activities are grouped,
From the feedback obtained from the evaluation process, responsibility and authority are determined, and working
revisions, improvements and updating are done. The revision may relationships are established to enable both the organization and
go back as far as the the employees to realize
objectives and purpose of the original plan. This only shows that their common objectives.
the planning process is dynamic
and continuous. Principle of organizing; Four principles of organizing named by
Swansburg are:
Strategic Planning
1. The Principle of Chain of Command. The principle of chain of
Lately, nursing leadership and health care organizations have been command denotes centralized authority and corresponding
relying on strategic planning to contain cost and to increase authority. This principle states that to be satisfying to members,
effectiveness and efficiency in health care delivery. Strategic economically effective, and successful in achieving their goals,
planning is defined as “continuous, systematic process of making organizations are established with hierarchical relationships within
risk-taking decisions today with which authority flows from top to bottom. Most government,
greatest possible knowledge of their effects on the future; religious and military entities, as well as health institutions are
organizing efforts necessary to carry out these decisions and organized this way. In the more modern organizations however,
evaluating results of these decisions against expected outcome the chain of command is flat, with line managers and technical and
clerical staff providing support services.
14
2. The Principle of Unity of Command. The unity of command A bureaucratic structure is a formal organizational design. It
principle states that an employee has one supervisor/leader and facilitates large-scale administration by coordinating the work of
one plan for a group of activities with the same objective. In many personnel. It is associated with subdivision, specialization,
nursing, primary nursing and case management support the technical qualifications, rules and standards, impersonality, and
principle of unity of command. This principle is, however, being technical efficiency.
modified by emerging organizational theory.
Organizational structures may either be traditional or
3. The Principle of Span of Control. This principle states that a decentralized. The traditional organizational structure is a vertical
person should be a supervisor of a group that he or she can one, with the authority, power, and decision-making vested in one
effectively supervise in terms of numbers, functions, and person at the top.
geography. This principle is flexible because the more trained an
employee Many managers agree that this is an efficient, cost-effective way of
is the less supervision is needed, while those still under training getting the job done. Decisions are made quickly, few leaders are
need more supervision to prevent mistakes. required, and much power is vested in a central figure.
4. The Principle of Specialization. The concept of division of A disadvantage of this structure is that communication in the
labor or the differentiation among kinds of duties springs from this organization is greatly impeded. Personnel are informed of
principles. The principle states that each person should perform a changes but are not involved in planning the change.
single leading function.
This results in the lack of formal power of personnel, notably of
Organizational Structure nurses in the traditionally structured hospital organizations
(Rowland, 1996).
The organizational structure furnishes the formal framework in
which organizing takes place. The organizational structure provides The decentralized organization, on the other hand, is
work system, network of communications and identity to characterized by a horizontal structure in which decision-making
individuals and the organization. An organization has both formal responsibility, authority are at the lowest possible level in the
and informal components. organization.
The informal aspect comprises the personal and social The organization that is decentralized is usually vital, dynamic,
relationships in the organization. It provides the social control of and growth oriented. It is flexible and adjusts easily to changes. It
behavior among its members. has the potential for
adapting established standards, policies, and procedures to their
Management must be aware of its presence because of its special needs without creating confusion.
importance especially in disseminating correct information through
its “grapevine”. A major disadvantage of decentralization is the risk of losing
coordination brought about by broadening the scope of authority
A good manager can take advantage of the informal organization’s and responsibility.
operating technique and to use it to achieve common goals and
objectives. The formal aspect, on the other hand, is defined by Bureaucracy
executive decision determined by planning.
15
This term coined by Max Weber evolved from the early principle of The head nurse participated in my orientation. __________
administration including those of organizing. It is highly structured __________ __________
and usually includes no participation by the governed. I feel that I am part of the team. __________ __________ __________
My introduction and supervision of the medication system
The principles of chain of command, unity of command, span of were satisfactory. __________ __________ __________
control, and specialization support bureaucratic structures. A I found the progression of team member, team leader,
strong point of bureaucratic organizations is their ability to produce and introduction to charge responsibilities helpful to my
employees who are competent and responsible. growth on the unit. __________ __________ __________
I feel comfortable with most of the nursing procedures
They perform by uniform rules and conventions, are accountable performed in my unit. __________ __________ __________
to one manager who is an authority, maintain social distance with I was made to fell welcome at the hospital. __________ __________
supervisors and clients, thereby reducing favoritism and promoting __________
impersonality, and receive rewards based on technical My team leading experiences here at the hospital was
qualifications, seniority and achievement. (Swansburg, 1993). beneficial. __________ __________ __________
More follow up by the inservice coordinator should
The characteristics of bureaucracy include formality, low have been carried out. __________ __________ __________
autonomy, division of labor, specialization, standardized I feel that I needed additional time for the head nurse
procedures, written specifications, memos and minutes, to explain and demonstrate problem-solving techniques. __________
centralization, controls, and emphasis on a high level of efficiency __________ __________
and production. I found it difficult to move from the orientation unit to
my permanently assigned patient area. __________ __________
These characteristics frequently lead to complaints about red tape, __________
and to procedural delays and general frustration. Who appeared to be your best source for the questions you had?
___________________________________________________________________
Exhibit 1 ______________________________
ORIENTEE’S EVALUATION OF ORIENTATION PROGRAM Discuss briefly any suggestions or comments you may have
(To be completed after four weeks on permanent unit)
Instructions: Please answer the following questions. If you mark “sometimes,” please explain on the regarding your orientation time.
back of this page. ___________________________________________________________________
______________________________
Yes No Sometimes
__________________________________________________
I found that my questions were readily answered by __________ _______________________________________________
__________ __________ Sources: myna Armstrong. “Bridging the Graduation and
personnel. Employment, “journal of nursing administration. November/
I found the orientation time moving too slowly. __________ December 1974. Reprinted
__________ __________ with permission.
The inservice coordinator assisted me in my adjustment to
be unit. __________ __________ __________ ______________________________
I was given enough time and explanations to learn Nursing
“routines” before starting evenings or nights. __________ __________
__________
Topics Instructor
Date/Initial
16
Clinician _______________________________________________________
Date/Initial ____________________________
Employee _______________________________________________________
Date/Initial ____________________________
POLICIES/PROCEDURES _______________________________________________________
Admissions ____________________________
Transfers _______________________________________________________
Dischargers ____________________________
Surgery(preoperative and postoperative care) _______________________________________________________
Death ____________________________
Intake/output Instructor:___________________
Isolation/infection control Clinician:_________________
Transcribing physician orders Employee:___________________
Blood transfusions Source: Ann Haggard, Hospital Orientation Handbook for Nurses
IV therapy and Allied
Medication administration Health Professionals, Aspen Publishers, Inc. 1984.
Narcotic control
Fire procedure
Evacuation/disasters
Code blue procedures
Nursing care plans
Suctioning
Oxygen administration
Exhibit 2
Operative site/stomadhexive ORIENTEE’S INSERVICE/CONFERENCE
Feeding tubes EVALUATION FORM
Electrical safety Name of
Progress Session___________________________________________
Notes:_________________________________________________ _ Date__________
_____________________________ Instructor_______________________________________
_______________________________________________________ Name(optional)____________________
____________________________ Rate the effectiveness of this presentation (place
_______________________________________________________ a check in the appropriate box):
____________________________ Excellent
_______________________________________________________ 1234
____________________________
17
Poor
5 Comments
Instructor’s organizations of subject material
Instructor’s knowledge of subject
Presentation of material
Teaching methods
Instructor’s responsiveness to group
What parts of the class were especially helpful
you? _________________________________________
__________________________________________________
_________________________________
What information provided can you apply to your
role/job?
__________________________________________________
________________________________
What suggestions do you have for improvement?
___________________________________________
__________________________________________________
_________________________________
I actively participated in the class ( i.e., listened, asked questions,
participated in discussions) (Please a check on the appropriate
line).
Role Theory
_______Agree _________Neutral ___________Disagree
Courtesy of Rochester Methodist, Rochester, Minnesota.
Role theory supports the chain of command and unity-of-command
______________________________ principles. Role theory indicates that when employees face
Nursing Administration inconsistent expectations and lack of information they will
experience role conflict, leading to stress, dissatisfaction and
ineffective performance. Role conflict and ambiguity can be
reduced when management provides:
1. Certainty about duties, authority, allocation of time, and

relationship with others.
2. Guides, directives, policies, and ability to predict sanctions as
outcomes of behavior.
3. Increased need fulfillment;
18
4. Structure and standards; 7. Follow through on activities involving practicing nurses.

5. Facilitation of teamwork;
6. Toleration of freedom; 8. Analyze the compensation system for the entire nursing
7. Upward influence; organization and structure it to reward competence, longevity, and
8. Consistency; productivity.
9. Good, prompt communication and information;
10. Using the chain of command; 9. Promote self-esteem, autonomy, and self-fulfillment for
11. Prompt decision; practicing nurses, including feelings that their work experiences
12. Personal development; are of high quality.
13. Formalization;
14. Planning; 10. Emphasize programs to recognize practicing nurses’
15. Receptiveness to ideas by top management; contributions to the organizations.
16. Coordinating work plans;
17. Adapting to change; 11. Assess unneeded threats and punishments and eliminate them.
18. Adequacy of authority.
12. Provide job security with an environment that enables free
Organizational Climate expression of ideas and exchange of opinions without threat of
recrimination, which occur, which may occur as negative
A work environment that is conducive to worker satisfaction and performance reports, negative counseling, confrontation, conflict,
productivity is a major concern in every organization. Swansburg or job loss.
(1993) identified the following as activities that promote positive
climate in health care and nursing organizations: 13. Be inclusive in all relationships with practicing nurses.
1. Develop the organization’s mission, goals, and objectives with 14. Help practicing nurses to overcome their shortcomings and
input from practicing nurses. Include their personal goals. develop their strengths.
2. Establish trust and openness through communication that 15. Encourage and support loyalty, friendliness, and civic
includes prompt and frequent feedback and stimulates motivation. consciousness.
16. Develop strategic plans that include decentralization of

2. Provide opportunities for growth and development, including decision making and participation by practicing nurses.
career development and continuing education programs.
17. Being a role model of performance desired off practicing
nurses.
3. Promote teamwork.
Team Building
5. Ask participating nurses to state their satisfactions and
dissatisfactions during meetings and conferences and through
Having “high morale”, enthusiasm, self-confidence, good self-
surveys;
esteem, are some of the terms associated with team building.
6. Market the nursing organization to the practicing nurses, other
employees, and the public.
19
The objective of team building is to establish an environment of

cohesiveness, high morale, and enthusiasm, the feeling of being
“cared of”, self-worth among employees. In a nursing unit,
the first step in team building is to determine why nursing

employees are unhappy or dissatisfied. Once problems and
dissatisfactions are identified and prioritized, a calendar should be
established for addressing them. It is best to prepare a brief
management plan that includes the problems, objectives, actions
the team can accomplish on its own authority, actions needing
management support, persons assigned specific responsibilities,
target dates and list of accomplishments.
The plan should be communicated to the entire staff of the nursing

unit, department or division. Evaluation should occur continuously.
Recognition of the individual’s worth and contributions to the

organization through praise and commendations is an important
morale builder.
LEARNING ACTIVITIES II
20
Answer the following and submit your typewritten

answers/reactions to your professor. Traditional? In what ways? Describe both the formal and the
informal structure.
1. in you respective RLE rotation could you site a specific
example/incident that illustrates the difference between 12. If you were a manager, what team building activities
leadership and management. will you engage in to promote high morale, enthusiasm, good self-
esteem and self-confidence among your staff?
2. Name and briefly explain each of the components
ofeffectivemanagement that you observe in your RLE rotations.
3. .Describe the characteristics of an effective nurse manger

in your RLE rotations.
4. Give an example of how “forecasting” has made a

difference in your own planning your RLE rotations as part
of LMR duties in respective areas.
5. Give an example/incident to show how work planning has

benefited your work performance.
6. Describe the activities involved in planning.
7. Describe the phases of planning.
8.Why is “strategic planning” popular among nursing/health

care organization management?
9. What do you understand by “bureaucracy”? What are its

advantages/disadvantages?
10. Using your respective RLE rotation link a discussion

regarding the following principles of organizing:
a) Chain of command
b) Unity of command
c) span of control
d) Specialization.
11. Describe the structure and climate of the organization

where you work. Is it decentralized?
21
2. Having a commitment to the development of others. In many

ways, managing others means the development of others. In this
THE PROCESS OF LEADERSHIP role, the manager is more a mentor, educator, and coach than a
boss.
To achieve the goal of the leadership function in nursing service, 4.Establishing values – It is the leader’s job to discover and declare
four processes must be performed: what his or her organization stands for, establish a morality that
becomes the standards for others, and declare this in clear and
1. Establishing a mission statement that is reflected in long range, inspiring terms.
strategic, operational
plans; resource allocation, organization policies; the process of 5. Learning – The environment in which health care organizations is
leadership starts with establishing and promulgating the rapidly changing, and so they must be open to new knowledge.
organization’s mission and renewing and revising it as necessary. The leader must look beyond organizational boundaries by using
environmental assessments, long range planning, SWOT (strength,
2. Organizing, directing, and staffing patient care and support weakness, opportunities, threats) analysis, portfolio analysis, focus
services in a manner that is commensurate with the scope of groups, strategic
services offered. Management, to name a few.
3.Implementing, coordinating, integrating patient care and support 6. Establishing priorities and direction. Establishing priorities adds
services throughout the organization. focus. Leadership establishes strategic direction and this focuses
the organization’s efforts on addressing its priorities.
4.Establishing expectations, planning and managing processes to
measure, assess, and improve the performance of the 7. Solving problems – The effective manager understands the real
organization’s governance, management, clinical and support difference between real problems and pseudo problems.
processes. Thus, effective leadership defines a strategic plan that
is consistent with the organization’s mission and vision. It clearly 8.Balancing interests – Health care organizations are composed of
communicates the mission, vision and plan throughout the and associated with myriad interest groups: employees,
organization. It fulfills the organization’s vision by providing the physicians, nurses, the community, patients, suppliers, the media,
framework to accomplish the goals of the strategic plan. and politicians. The effective health care manager works balance
the interest of all, especially to the benefit of the largest good.
Leadership in health care organizations
9. Working for the public benefit – Although organizational benefit
Health care organizations are value driven. Their leaders establish is a goal of each manager, health care mangers typically place
and nurture the appropriate service values. Eight ways in which community benefit and patient benefit at the top.
they can do this is as follows:
Leadership Attributes of Nurse-Executives
1. communicating a vision – The effective manager must be able to
articulate a clear vision for the organization. Whatever the source, Leadership attributes of nurse-executives include administrative
the manager has to personally own the vision; otherwise, the competence with adequate educational background, business
manager will fail to inspire others. skills, and clinical expertise combined with a global understanding
of leadership principles.
22
To be effective, she must have the leadership traits associated

with leadership effectiveness: intelligence, personality, and In modern management, command and coordination are labeled
abilities. Traits related to intelligence include judgment, directing. In nursing, directing is a physical act of nursing
decisiveness, knowledge, and fluency of speech. management, the interpersonal process by which nursing
personnel accomplish the objectives of nursing. (Swansburg,
Leaders who are perceived to be knowledgeable and competent in 1993). It is the process of applying the management plans to
their areas of work are respected and can serve to inspire accomplish nursing objectives. It is the process by which nursing
subordinates to excel in performance. Personality includes personnel are inspired or motivated to accomplish work. In
adaptability, alertness, creativity, cooperativeness, personal describing the directing functions of management,
integrity, self-confidence, emotional balance and control, and
independence (nonconformity). Fayol (in Swansburg, 1993) stated that managers must know how
to handle people and must be able
Leaders with these traits can easily motivate workers to achieve to defend their point of view with confidence and enthusiasm. “He
the goals of the organization. must know the personnel, eliminate the incompetent, be well
versed in binding agreements with employees, set a good
Abilities include ability to enlist cooperation, popularity and example, conduct periodic audits, confer with chief assistants to
prestige, interpersonal skills, social participation tact, and focus on unity of direction, not become mired in detail, and have
diplomacy. In most nursing situations, the leader is appointed by as a goal unity, energy, initiative and loyalty among employees”.
the hospital or nursing administration. Too often the leader is
appointed as supervisor solely for his/her Fayol defined coordination as creating harmony among all
clinical expertise, rather than leadership abilities. activities to facilitate the working and
success of the unit.
This point to the importance of leadership training among
supervisors. Nurse executives should teach managers and Directing also called command by Urwick, (1944 in Swansburg,
prospective leaders the nature of 1993), protects the general interest of the organization by seeing
leadership, leadership skills and to put them in proper environment to it that individual interests do not interfere with the general
to learn to become not just managers but manager-leaders. interest.
According to Swansburg (1993), persons who are only managers Rowland and Rowland (1994) stated that directing is closely
control. Managers who are leaders create commitment. They interrelated with leadership. According to them, the activities of
create a work unit that stands out. Nurse Managers should learn to directing include those of delegating, communication, training and
practice leadership behaviors that stimulate motivation within their motivation.
constituents, practicing professional nurses and other nursing
personnel. The manager’s choice of leadership style is a major factor in
exercising the directing function.
These behaviors will include promotion of autonomy, decision-
making, and participative management by Another term used synonymously with directing is “implementing”.
professional nurses. The activities under implementing include “supervision, making
assignments and giving directions, evaluation, and leadership and
interpersonal relationships with co-workers, dissemination, giving
assignments, motivating workers, and maintaining morale” (Kron,
THE DIRECTING PROCESS 1987).
23
6.Considering the need for variety in task assignment and for

Other writers (in Swansburg, 1993) refer to directing in terms of development of personnel.
theories of leadership effectiveness, group dynamics, values and
value conflicts, effective interpersonal transactions, working with 7.Providing for the leader’s availability to staff members for
teams, and managing teams in organizations, development of assistance, teaching, counsel, and evaluation.
personnel and
supervision of work. 8.Trusting members to follow through with their assignments.
Sources for directions include standards, procedure and policy 9. Interpreting protocol for responding to incidental requests.
manuals, job descriptions arrived at through job analysis.
Three of the major elements of directing are embodied in 10. Explaining procedure to be followed in emergencies.
supervision of nursing personnel and these are: motivation,
leadership, and communication. These elements are discussed in 11. Giving clear, concise, formal and informal directions.
more detail in other parts of these courses.
12. Using a management control process that assesses the quality
of care given and evaluates individual and group performance
given by nursing personnel. Thirty one tasks had been identified as
tasks of first line nurse managers/supervisors in a research done
by Beaman (1986). Among these are:
Directing activities of nurse managers/supervisors  Assist in service to prepare orientation schedule.

 Discuss the program of orientation with the new member.
. In nursing management, twelve activities related to the directing  Decide when orientation is complete.
function of a nurse manager have been identified by Douglas  Write counselling reports and discuss them with staff members.
(1988). These are:  Terminate after approval has been obtained.
 Submit time schedule for three shifts.
1.Formulating objectives for care that are realistic for the health  Assign patients, teams for day shifts.
agency, patient, client, and nursing personnel.  Make recommendations about budget to nursing administration.
 Calculate nursing hours used and justify them.
2. Giving first priority to the needs of the patients/clients assigned  Call in extra help when needed.
to the nursing staff.  Prepare reports about budget variances.
 Make daily patient rounds.
3. providing for coordination and efficiency among departments  Attend and participate in first-line nursing management
that provide support services. meetings.
 Conduct meetings with own staff for problem solving and
4.Identifying responsibility for all activities under the purview of learning.
the nursing staff.  Set goals for individual units.
 Participate in setting goals for the nursing department.
5.Providing for safe, continuous care.  Discuss unit problems with physicians regularly.
 Participate in all levels of quality assurance, including designing
studies, collecting data,
and preparing reports.
24
All these, in addition to meeting the needs and wishes of individual

Work Assignments staff members as for example, in the emergency need of a staff for
off-duty, can make managing difficult.
One of the fundamental managerial functions is giving
assignments. Giving assignments require consideration of many An approach being used to reduce the number of conflicts arising
factors, the most important of which are the abilities of the from
employee and the fairness of the assignment. staffing and scheduling is the use of participative management.
This allows staff members as a whole to plan their schedules, thus
It is important for employee morale and self-esteem if given an assuming their share of responsibility for keeping their unit
assignment where her/his strength can be utilized. Other factors adequately staffed.
that must be considered in giving assignments include efficiency,
continuity, staff preferences, and learning opportunities for staff
members. Monitoring
While a supervisor/nurse manager tries to follow these rules, there
are other factors in the environment which can deter her/him from
Once assignments and directions are given to staff members, a
making a fair assignment.
nurse manager just don’t sit back and wait for results. The
effective nurse manager monitors His area’s progress regularly.
These can include staff shortages, special requests from various
staff members, and unpleasant or undesirable work that must be
The manager has responsibility to several constituencies, each
done.
with their own concerns. The three major ones are the nursing
services staff/nursing school faculty, clients/students, nursing
A nurse manager must consider the person’s job description when
service/school administration. In addition, the manager must also
making assignments. A job description is a formal, written
consider other groups such as other departments or units, the
description of the work expected of an individual.
community, the nursing profession, support staff, and so forth.
A job description defines what is expected of a person in a
The nurse manager monitors her individual staff members’
particular position and consequently what that person can expect
functioning and performance. Some items to consider in
of other people in their positions.
monitoring the work of individual work members include:
absenteeism, late arrivals, early departures, adherence to
This information is particularly helpful when there is some
professional standards, adherence to standards of ethical
disagreement about what a person’s responsibilities are. A broader
behavior,
responsibility of a nurse manager/supervisor and related to giving
assignments is scheduling.
conformity to legal standards of practice, excellence in provision
of patient care, excellence in recording patient care and its
The variety of approaches in scheduling such as 12-hour shifts, 8-
outcomes, ability to work with other staff members, pursuit of
hour shifts, weekend relievers, 4-day weeks, temporary pools, job
professional growth, leadership.
sharing shows how complex this task is. Rapid turn over,
In monitoring a nursing unit as a whole the following are monitored
retrenchment, use of temporary personnel, the increasingly high
by the nurse manager: patient census, incidence of infection,
tech nursing interventions make staffing and scheduling more
incidence of falls, decubiti and so forth, injuries to staff,
complicated.
relationship with other departments, comparison with other units,
cost over runs, staff requirements, compliance with regulatory
requirements, compliance with professional standards. In
25
monitoring, both formal and informal methods are used including 13. Nurse managers use the physical plant to the best
direct observation, peer review, formal performance appraisals, advantage for patients and personnel. A nurse manager gives
and a variety of specific reports, the budget and so forth. (Tappen, recognition and rewards, which can be either positive or negative,
1995). being careful to reward desired rather than undesirable behavior.
Swansburg (1993) listed thirteen standards for evaluating the The manager herself and her staff must continue to grow and
directing functions of nurse managers. develop as professionals. She must give opportunities for this
growth and development and ensures that the environment of the
These are: unit is conducive to the implementation of new ideas.
1. Managers have established a medium by which nursing
workers feel free to ask for advice, counsel, and Management by Objectives
consultation. Management by Objectives (MBO) as a directing element was
2. Needed written directions are available in the form of advocated by noted management experts Peter Drucker and
policies, procedures, standards of care, job analysis, job George Ordiorne. The latter defined it as:
descriptions, job standards, and nursing care plans.
3. A training program is in effect when it meets nursing “A process whereby the superior and subordinate managers of an
employees’ needs as they perceive them. They participate. organization jointly identify its common goals, define each
4. Nurse managers periodically work evening, night, individual’s major areas of responsibility in terms of the results
weekend, and holiday shifts to keep abreast of clinical and expected of him, and use these measures as guides for operating
administrative behaviors peculiar to these shifts. the unit and assessing the contribution of each of its members.”
5. Supervisors are competent in needed knowledge and skills (1974)
of administration and clinical specialization.
6. The nurse administrator has operationalized ANA Ordiorne further stated that MBO, as a system for making
Standards for Organized Nursing Services and Responsibilities of organizational structure work, to bring about vitality and personal
Nurse Administrators across All Settings. involvement in the hierarchy by means of statements of what is
7. The nurse managers have operational the ANA Standards expected from everyone involved and measurement of what is
of actually achieved. It stresses ability
Nursing Practice. and achievement rather than personality. MBO allows people to
8. Nurse managers are knowledgeable about and apply the control their own performance, to measure themselves, and to
appropriate Standards of theJoint Commission on Accreditation of exercise self-control.
Healthcare organizations and other appropriate accrediting body.
9. The nurse administrator uses techniques of operation

analysis.
10. Nurse managers use a system of management by DELEGATING
objectives.
11. The nurse administrators work with the consent and Delegating is a major element of the directing function of nursing
knowledge of patients, and solicit input from consumers regarding management. It is an effective management competency by which
nursing services desired. nurse managers get the work done through theiremployees
12. Nursing unit personnel are organized into and working as (Tappen, 1995). The delegation of responsibility and assignment of
direct care personnel and clerical personnel work is a basic
26
function of the leader-manager that may be more complicated in specialist, education specialist, nurse instructors, and so forth.
healthcare fields than in any other fields because of the diversity of
caregivers. Those tasks requiring special or complex knowledge are assigned
only to the professionals on the team. A nurse manager must
Delegation to ancillary personnel of many of the tasks that used to remember that in addition to being accountable for her own work,
be done by nurses is one of the price-cutting measures that many she is also accountable for work delegated to others. Not only are
health care there different kind and levels of caregivers. There are also
organizations resort to. individual strengths and weaknesses. Individuals should not be
assigned to tasks they cannot do, regardless of their professional
The use of “nurse extenders” such as clerks, respiratory level. For this reason, the nurse manager must know her
technicians, laboratory technicians, pharmacy technicians, dietary employees’ weaknesses and strengths.
technicians, LPNs, patient care assistants and so forth makes
delegation imperative.
Priorities.
Reasons for delegating Certain tasks or projects are given priority over others. The
According to Swansburg (1993) there are five reasons for priority rating is based on client needs, team needs, and
delegating. These are: organizational and community demands. For example, attending to
a patient whose blood pressure suddenly shoots up takes priority
1. Assigning routine tasks. over charting.
2. Assigning tasks for which the nurse manager does not have tie.
3. Problem solving. Or when one of the team members suddenly go on emergency
4. Changes in nurse manager’s own job emphasis. leave some of her important tasks are delegated. For example
5. Capability building. when one downtown hospital suffered a power outage, doctors,
nurses, administrators along with other less placed personnel, took
Two criteria are of paramount importance in the delegation of the task of bringing patients’ food trays by using the stairs.
responsibility, one primarily related to the task, the other to team
relationships. These are the same criteria considered when making Efficiency and Continuity are the two other task related factors
assignments, that is, the individual must have the ability to carry that should be considered in delegating.
out the task, and the assignment must be fair.
Relationship Factors:
Task-Related Factors:
Fairness
Ability. To appropriately delegate assignments, the nurse
manager need to know the knowledge, skills, legal definitions, and means evenly distributing the workload so that no one has
job descriptions for each health care discipline represented in her substantially more or less work than the others. Because the
team, for example, professional nurses, licensed practical nurses, workload is not completely predictable, what begins as a fair
patient care assistants, and so forth. assignment may sometimes need to be adjusted in order to
balance the changing workload.
It is also necessary to be able to differentiate between the
different levels of caregivers within each discipline, for example,
critical care nurses, clinical
27
Being fair means distributing the work so that no one gets all the hesitate to delegate. They assume a greater share of the work,
enjoyable tasks or all the unpleasant tasks. Being fair also means resulting in being overburdened.
an equitable amount of consideration for each team member.
Tappen (1995) has this to say: “Leader-managers who cannot
This includes consideration of requests for: special assignments or delegate responsibility to their tea members are always very busy.
vacation time, adequate recognition for the contribution of each They usually need to be in three places at once and are often seen
team member, and equal sharing of rewards as well as hard work. rushing from one crisis to another because they do not have time
Being unfair in giving assignments can easily cause resentments to deal with a problem before it becomes a crisis.
among team members.
Giving special consideration can oftentimes be interpreted as Perhaps because they have so much practice, they are very good
favoritism. It is a good idea for thenurse manager to discuss the at dealing with crises but they do not do much planning.
reason/s for giving special consideration with team members, to
avoid misunderstandings. These leader-managers are frequently heard saying how busy they
are, and it is hard to make an appointment with them. When they
Other task-related factors are: area away from work
for more than a day or two, the team falls apart because no one
Learning opportunities – challenging assignments can motivate else on the team knows how to handle many of the team’s regular
the team members individually or as a whole to grow functions. Team members don’t know anything about these
professionally; ordinary routines because the leader always does them.”
Health and well being of team members – very stressful jobs

should be rotated among team members to keep their stress level These difficulties may be due to any of the following
at a tolerable level; reasons:
First, some leaders do not even realize they have a problem
Compatibility – some individuals do not work well together; delegating.
Preferences – when they do not conflict with the other criteria for They believe they are hardworking, dedicated people (which they
delegating responsibility, the preferences of individual team are), and do not realize how much they limit the effective
members should be considered. functioning of the team.
Problems in delegating Others simply do not trust their team members and believe that in
order to do the job well, they themselves, have to do it.
Delegating is difficult when staffing is inadequate, the work is
difficult or unpleasant, and the team members are not ready or are For others, the need to retain control or to dominate others is so
immature (Tappen, 1995). There are tasks too, that cannot be strong that they cannot let other team members share the
delegated. Examples of these are: the power to discipline, the leadership role or even become proficient. Consciously or
responsibility for maintaining morale, unconsciously, they withhold needed knowledge and information
jobs that are too technical, or duties involving a trust or from team members as a means of control.
confidence.
The delegation of work to another presumes a superior- Ways to Delegate Successfully

subordinate relationship. For this reason, many nurse-leaders
28
According to Swansburg (1993), the following is a list of ways for 13. Give appropriate rewards.
nurse managers to delegate successfully:
14. Do not take back delegated tasks.
1. Train and develop subordinates. It is an investment. Give
them reasons for the task, authority, details, opportunity for growth,
and needed instructions if needed.
2. . Plan ahead. It prevents problems.
3. Control and coordinate the work of subordinates. Do not

peer over their shoulders. Develop ways of
measuring accomplishments of objectives.
4. Visit subordinates periodically. Spot potential problems of

morale, disagreement, and grievance.
5. Coordinate to prevent duplication of effort.
6. Solve problems and think about new ideas. Emphasize

employees solving their ownproblems.
7. Accept delegation as desirable. LEARNING ACTIVITIES—III”

8. Specify goals and objectives. answers/reactions to your professor.
9. Know subordinates’ capabilities and match the task or duty 1. Read the philosophy and mission statement of
to the employee. Be sure the employee considers it Hospital assignment at present RLE rotation ,Examine how
important. its mission
Statement reflects the following:
10. Agree on performance standards. Relate managerial
references to employee performance. a) Long range and strategic plans;
b) Resource allocation;
11. Take an interest. c) Organizational policies;
12. Assess results. Expect what is clearly and directly asked for 2. Comment and elaborate on the following:
as the deadline set for completing and reporting arrives. a) Leader managers who cannot delegate responsibility to their
The nurse manager should accept the fact that employees team members are always very busy.
will perform delegated tasks in their own style. b) Health care organizations are value driven organizations;
c) It is a leader’s function to communicate a vision;
29
3. Observe the nurse executives in your place of work.

What are the attributes that make them leaders? Classify
the attributes according to:
a) Administrative competence;
b) Personality and traits;
c) Ability to motivate.
4. From your observations and experience,

a) What responsibilities are often delegated by nurse
managers?
b) Have you observed any problem/s arising from these
delegations? What do you think are the possible reasons for these
problems?
5.Discuss the ways of delegating successfully.
6. Discuss the advantages of Management by Objectives (MBO).

7. Describe the factors to be considered in making assignments.
8. What problems confront the nurse manager when making
staffing schedules?
THE COMMUNICATION PROCESS
Principles for successful communication
There are three basic principles for successful communication.

These are:
1. Successful communication involves a sender, a receiver and a
medium.
2. Successful communication occurs when a message is received.
3. Successful managers achieve successful communication.
Steps of communication
The communication process involves six steps:
Ideation > Encoding > Transmission > Receiving > Decoding >
Response –
30
Response < Decoding < Receiving < Transmission < Encoding < The individual works within traditional management principles of
Ideation begins when someone who senses a need to chain of
communicate, develops an idea, or selects information to share. command, line of authority, and span of control. Equality:
The purpose of communication may be to inform, persuade management by objectives (MBO) supports equality by
command, inquire, or entertain. encouraging two-way Communication in which both supervisor and
employee evaluate progress and make future plans. Superiority:
Encoding, the second step, involves putting meaning into pyramids, hierarchies, and chains of command support superiority.
symbolic forms: speaking, writing, or nonverbal behavior. Descriptive evaluation with managemen analysis and employee
input The employee gets information at specific intervals and when
Transmission of the message is the third step. Transmission of indicated.
the message can be affected by interference such as garbled
speech, unintelligible use of words, noise, and illegible handwriting Traditional evaluation with one-way communication done on an
annual basis. Spontaneity. Strategy is kept at managerial planning
In receiving, the receiver’s senses of seeing and hearing are level. Problem orientation emphasizes joint view Bringing
activated. employee into the process. Control emphasizes supervisor’s view.
Decoding of the message is the fifth step. The receiver defines Provisionalism encourages adaptation and experimentation.
words and interprets gestures during the transmission of speech.
Certainty is dogmatic. Empathy indicates concern and respect. Use
Response, or feedback, is the final step. It is important for the to counteract neutrality by using nontraditional management
sender to know that the message has been received and techniques.
accurately interpreted. Neutrality indicates nonconcern. It is fostered by orientation to
number as in
Climate for Communication outcomes, profits and even standardization of orientation
The communication climate should be in harmony with the procedures.
organization’s culture and should be used to encourage positive
values among employees. Figure 1 shows the characteristics of a Characteristics of Supportive versus a Defensive
supportive versus a defensive communication climate (Swansburg, Communication
1993).
How are information disseminated? There are various ways of
ANOTHER WORD FOR GIVING AND RECEIVING INFORMATION communicating information and among these are:
NEEDED FOR INTELLIGENT ACTION IS COMMUNICATIONS.
THE TERM FEEDBACK IS USED TO DESCRIBE HOW A Meetings of all kinds are a media for communication, often for the
SUPERVISOR MAY TEST THE EFFECTIVENESS OF HIS OR HER purpose of disseminating information to a large number of people.
COMMUNICATION. Supervisors or managers at all levels are media for
communication. They relay information most often to their
Supportive Climate Defensive Climate subordinates. Oral communication or face-to-face communication
is the most common form used by executives, who spend a
The individual is free to talk to managers at any level of the substantial amount of their time listening, talking, and
organization without fear of retribution of any kind. Opportunities communicating.
for this are planned and made known to the entire staff.
Verbal messages are said
31
to be 7% word choice, 38% oral presentation, 55% facial person for the presentation. Wear clothes that present you
expression. (Caruth, 1986). An best. Good presentation will help you to be relaxed.
advantage of face-to-face communication is that each person can
respond directly to others. One must remember that the larger the 5. Be on time and use time effectively.
group, the less effective is face-to-face communication 6. Speak to be heard. Use your voice, varying pitch, volume, rate,
and tone for planned
1.Summarizes techniques use in preparing and giving an oral effect. Practice pronouncing words with which you have trouble.
presentation. Writing is one of the most common medium of Make your presentation sound natural even if you read it.
communication in all fields and in all areas of life. It comes
memos,publications, letters, and so forth. 5. Use body language effectively. Maintain eye contact.
2.Prepare carefully. What is the goal of presentation? To inform? 6. Adapt to audience feedback, being sensitive to listeners’
To persuade? Entertain? It can be a combination of these and to be interests and moods. Be prepared to answer questions. Repeat
effective should probably combine at least two, such as questions before answering. Treat your audience with respect
entertainment with information or persuasion. in every way and they will view you as genuine.
3.Prepare the presentation carefully. Make an outline and 1.Be sensitive to the needs and desires of those who will read what
develop the content to fit the outline. What is the purpose of the you are writing. Arouse and maintain the reader’s interest by
presentation? Did you select the topic or was it given to you? In appealing to the mind and emotions. You-centered rather than I-
both instances clarify the purpose with the organizers or the event centered communications are interesting to the reader or listener.
or whoever has engaged you to do the presentation. Prepare an If you are addressing a particular person, put that person’s name in
introduction that will gain attention. Remember, words convey the salutation as well as in the body of the letter or memo. Make
feelings, attitudes, opinions, and facts. Use them to turn the an effort to please the receiver by using tact, respect, good
audience on, not off. Support the main points in the body of the manners and courtesy.
presentation with specific examples. Select and use visual aids to
support the key points of the presentation effectively. 2. Aim to create mental pictures using language that is suitable to
the experience and knowledge level of the receiver.
They are an extension of your presentation designed to appeal to
the senses and increase reception. Know who the audience will be 3. Do not repeat anecdotes frequently or the reader will be
and tailor the message to it. Provide useful material. insulted. Avoid
overcommunication, overdetailing, and redundancy. Necessary
Plan for audience participation with questions or appropriate repetition can be achieved by using pleasant and meaningful
exercises to involve the listeners. Tie the message together with examples, illustrations, paraphrasing, and summaries. Repetition is
interval summaries and effective conclusion. If you plan to speak essential to the mastery of a skill.
extemporaneously, make notes on cards or put outlines on visual
aid such as a poster, a chalkboard, an overhead transparency, or a 4.Express yourself in clear, simple language.
slide projection screen.
5. Make yourself accessible to the reader by positively and
4. Prepare the environment beforehand. Surroundings are courteously requesting a response. Encourage response by giving
important and should be as attractive as possible. If you want return address, phone number, return envelope and so forth.
to speak from a podium, make sure it is in place. Prepare your
32
7. Use the format of a newspaper story: accuracy, brevity, clarity, The following are important things to remember to improve
and empathy. Here is an example of a memo form: communication:
1.Communication is achieving understanding between the sender
8.. Break up a solid page of print with a variety of forms: underline, and the receiver of a message. It also means sharing information.
space, italicize, capitalize, enumerate, etc. It is important that ideas be clear before one speaks.
9.. Back up what you write by what you do; build a reputation for 2.Communication is basic to all human activity. Words are means
integrity. of conveying meanings; however, real meanings are in people.
10.. Organize your material. Outline key points; compile data into 3.There are very practical differences in the effectiveness of one-
groups according to commonality. Arrange materials in a logical way, impersonal, and two-way communications. Words spoken
sequential order, that is, chronological, cause-effect relationship, face-to-face are better understood. Telephone conversations are
increasing complexity. Tie groups together using transitional effective, but lack the rapport of person-to-person exchanges. The
devices, (first, later, finally): guide words (as a result, therefore, on whole person communicates.
the other hand). Link communication with the previous message by
referring to date, subject, and sender of correspondence. Furnish
appropriate excerpts from the past correspondence. 4.Cooperation and communication in an organization go hand-in-
hand. When there is mutual respect between people, spelling out
Barriers to Effective Communication rules and procedures for communicating is unnecessary.
According to Marriner-Tomey (1992), faulty reasoning and poorly 5. There are several barriers to effective communications. These
expressed messages are the major barriers to communication. include failure to listen with respect and understanding, lack of skill
Messages are poorly expressed when there is lack of clarity and in feedback, and misinterpreting the meaning of words used by the
precision resulting from inadequate vocabulary, poorly chosen speaker. It is also common practice to listen to what we want to
words, jargon, and awkward hear, and tune out things we do not want to hear.
sentence structures.
6.Communication is management’s chief problem. The supervisor
Faulty reasoning results in poor organization of ideas and lack of should accept the challenge to communicate more effectively and
coherence. to improve all forms of communication.
Talking too fast or too slow, slurring words, and not emphasizing
important points lead to faulty transmission of ideas. Also, 7.The supervisor may often plan for and conduct meetings. The
communication is difficult when the sender uses words with which planning phase is critical and may determine the success or the
the receiver is not familiar. If the sender lacks information or omits failure of a meeting.
facts she does not know, it is likely
that messages passed are distorted and filtered. 8. Speaking before groups usually requires extra effort. Stage
fright may never disappear completely, but it can be controlled.
People’s own biases, their perceptions, values, attitudes, beliefs
and assumptions can affect one’s perception of the message
Improving Communication Improving Communications
33
 Communications is achieving understanding between the sender laboratory and treatment results, staffing, scheduling, nurses’
and the receiver of a message. It also means sharing information – notes, patient assessments, patient medication profiles, patient
the creation of understanding. education, quality monitoring are just some of the application in
 Communication is basic to all human activity. Words are means nursing practice and management. Information system that is
of conveying meanings; however, real meanings are in people. geared specifically toward assisting nurse managers in performing
 There are very practical differences in the effectiveness of one- management functions is the
way, impersonal, and two-way
communications. Words spoken face-to-face are better understood. Nursing Management
Telephone conversations are effective, but lack the rapport of Information System (NMIS)
person-to-person exchanges. The whole person communicates.
 Cooperation and communication in an organization go hand-in- THE PROBLEM SOLVING PROCESS
hand. When there is mutual Problem solving is a series of steps designed to help organize the
respect between people, spelling out rules and procedures for information available in order to come up with the best possible
communicating is unnecessary. solution to a problem. It is a deliberate, thoughtful way to deal with
an immediate situation that is creating some kind of difficulty for
which there is no readymade
 There are several barriers to effective communications. These solution. It is a process to find answers to questions.
include failure to listen with respect and understanding, lack of skill
in feedback, and misinterpreting the meanings of words used by Problem solving is the basis of the nursing process. Following is a
the speaker. It is also common practice to listen to what we want comparison of the problem-solving and nursing processes:
to hear, and tune out
things we do not want to hear. Problem solving Collect data Define problem Select
 Communication is management’s chief problem. The supervisor Strategies Take action Evaluate results
should accept the challenge to communicate more effectively and
to improve all forms of communication.
Nursing
 The supervisor may often plan for and conduct meetings. The process Assessment Diagnosis Plan Implementation
planning phase is critical and may determine the success or the Evaluation
failure of a meeting. Comparison of the Problem-Solving and
 Speaking before groups usually requires extra effort. Stage
fright may never disappear completely, but it can be controlled.
Nursing Process
The problem solving steps of collecting data, defining the problem,
selecting strategies and evaluating results are very similar to the
Hospital Information System
nursing process steps of assessment, diagnosis, planning,
implementation and evaluation. Problem solving is simply the more
Information age has arrived and is here to stay. Already the
general application of the steps in the nursing process.
computer is essential in the management of communication needs.
Computers are affecting practice, administration, education and
STEP ONE: Assessment/Collect Data. This includes systematic
research. Hospital Information Systems (HISs) are large, complex
collection, organization, and analysis of data into related
computer systems designed to help communicate and manage the
information that may be associated with a specific problem or
information needs of a hospital. Nursing applications are many,
need. It involves logical fact finding, questioning sources, and
mostly to communicate with one another information about patient
differentiating between objective facts
needs and treatment plans. Order entry, nursing care plans,
and subjective feelings, opinions and assumptions.
34
The Delphi and nominal group techniques are two types of group
STEP TWO: Diagnosis/Define the Problem. Once data are techniques that have been found to be successful in group problem
collected, they are analyzed. Knowledge and experience guide in solving. In the Delphi technique only the leader knows the identity
analysis. Patterns in the data, clues to the underlying dynamics of of members. Questionnaires are completed by each member,
the situation, factors at work are looked into. A summarizing consolidated, and recirculated until a consensus emerges. This is
statement to define the problem is made. especially useful when group members are experts, physically
separated from each other. Electronic mail has eliminated the
STEP THREE: Plan/Select strategies. Planning involves several primary limitation of this technique by reducing the amount of time
phases. In nursing, priorities are determined and goals as well as required for sending and tabulating the questionnaires. The
measurable objectives are set, and then interventions are planned. nominal group technique avoids development of a self-proclaimed
Similarly, in management, step three involves breaking the expert by combining independent activity with interacting group
problem into components structures at specific points in the problem solving process.
and establish priorities, develop alternative courses of action. Individuals first generate solutions for a problem independently,
Determine probable outcomes for each alternative, decide which then present and defend the alternatives individually. Each person
course of action is best in relation to resources, goals, risks, and may be questioned for clarification but not criticized. The group
the like, and decide on a plan of action with a timetable for leader collects the written ideas; after group members interact to
implementation. reach agreement, each group member ranks each option silently
and independently. Group size to five to ten members is
suggested.
THE DECISION-MAKING PROCESS

Very much related to the problem solving process is the process of
STEP FOUR: Implementation/Take action.
decision making. The first step in decision making is to identify the
problem. Problem solving involves making decisions. All of us have
This is the step in the process that is most likely to be delegated to
problems and all of us make decisions. Some of our decisions
subordinates. Implementation requires knowledge and skills
involve simple everyday problems, but as professional nurses,
appropriate to specific selected alternatives. Here the selected
many of our decisions in the clinical field involve
strategy is applied in solving the problem. As the plan is put into
complicated problems, a few of them even involving life and death
action, the result will show whether or not to proceed with it. It
situations.
maybe that more data may be needed to arrive at a better
solution.
STEP FIVE: Evaluation/Evaluate the results. Evaluation, the

Definition
final stage in problem solving, includes determining how closely
goals and objectives were met, the success of failure of actions
Lancaster and Lancaster (1982) define decision-making as a
taken in resolving the problem, and whether the plan should be
systematic, sequential process of choosing among alternatives and
terminated because the problem is resolved or continued, with or
putting the choice into action. Decision making method may simply
without modification.
involve listing all of the factors for and against a particular
decision, assign weights to each
Group Problem Solving
factor, summing these weights for each list, then see whether the
pro or con comes out best, or it may be more complicated as when
35
the problem is not so well defined or when multiple goals exist,

such as keeping hospital costs down but improving quality. As a 1.Usually decision making begins with awareness of the need to
tool of management, decision making permits the best selection make a decision. For example, a manager maybe confronted with
among alternatives for the efficient, effective allocation of limited the problem of whether or not to retain or terminate a problematic
human and other resources. When used as management tool, it is employee.
the manager’s responsibilities to first of all have clear objectives,
then to be able to see variations among paths that lead to these 2.Analyze the situation in terms of desired outcomes, that is
objectives. She should identify alternatives for correcting determine the goal of the decision making process.
deviations involved and finally, to look at implications of the
alternatives before making the final 3. Develop alternatives. There are at least two possible actions: to
decision. act or not to take action. In some cases, there are more. For
example, in filling a position on a management level, the manager
Rowland and Rowland (1994) identify four types of decision might do any of the following:
and their characteristics:
a) leave the position unfilled
1.Considered – These are major decisions and they have a heavy b) b) promote someon
impact on the overall operation of the organization. These c) c) hire from outside
decisions tend to be complicated, require data gathering proceed d) d) ask for volunteer
from multiple alternatives, seeks dissent as a method of winnowing e) e) set up a test to make it possible to grade the
alternatives, and need extended time to resolve.
qualifications of applicants.
2. Operational – These are day-to-day, continuing decisions that
3. Compare alternatives, considering their advantages and
ensure smooth flow of operations. They have immediate and
disadvantages. A decision making grid may be usedto sort out and
intermediate impact.
weigh multiple factors.
3. Interpersonal relationship – These decisions, also called “swallow
hard decisions”, oftentimes make the decision maker feel
5. Rate the risk. In decision making, the usual situation is one in
uncomfortable. They are difficult but necessary decisions. They
which every alternativeincludes an uncertainty factor, thus the
usually affect others in the organization. Ten seconds decisions
decision maker can never be sure that a decision is completely
– These are “now” decisions oftentimes made alone, requiring
satisfactory.
quick thinking. Oftentimes these decisions bring the operation
together and keep it ready, alive and running well.
6. Select the best alternative/evaluate options. It is possible
however, that no alternative seems to be satisfactory because of
any of the following:
a) no alternative’s desirable. The riskiness of all alternatives, for

example, may persuade the manager not to take action;
b) merge two or more alternatives;
c) the “resource factor”. For example, one equipment may be more
efficient, but another may be more preferred because it is less
Process of Decision Making
expensive.
The process of decision making involves six steps:
36
7. After a decision has been made, it must be made operative. decision cannot be remedied by simply replacing or retracing.
However, the process ofdecision making does not stop there. Test Accordingly, a complete revision, of the original plan may be done.
running the chosen alternative can reduce risks and uncertainties.
Implementation
In implementing the result of the decision making process, the
following are to be considered:
1.Commitment. Those involved must move ahead on the decided

course without further hesitations or doubts.
CONFLICT MANAGEMENT
2.Announcement. When a decision is stated with resolution,
confidence and optimism, its chances of success are considerably Conflict in the workplace is no longer considered harmful or
increased, as compared to a reaction of doubts, hesitation, gloom, inherently bad; instead it is expected in a dynamic organizational
and pessimism. environment. It is seen as a normal aspect of interpersonal
relations in organizations and is believed that when handled
3.Personnel. Who gets to do what in putting a decision to work is correctly, it can be managed and resolved to achieve beneficial
often a crucial factor. outcomes. Among its beneficial outcomes are:
4.Time. Exactly when to start a plan, what deadline to set, and a) a friction can be a motivator for change and growth;
what pace to adopt must be clearly spelled out. b) it can be a medium for airing problems; c) a dynamic force for
preventing stagnation.
5. Responsibility. The manager may either want to stand at the
helm or to delegate to make sure that the implementation of the Definition
decision remains on course. Sometimes decision making may not
have a successful outcome. According to Restifo (1998), conflict can be defined as a struggle
between opposing or incompatible behaviors, needs or feelings
A common cause of this is when acceptance of those involved in within one person or between two or more people. It can range
its implementation has not been obtained. It may be that from a subtle lack of support or disagreement to sabotage and
information about the decision has not been disseminated violence.
properly, or that the person/s responsible to spearhead the
implementation fails to lead. When decisions go sour for any In the past, conflict in the workplace was regarded as
reason, the manager must first of all recognize the failure. dysfunctional, representing a breakdown in communication and
would either go away by itself or be resolved with someone
There is nothing to be gained by clinging to a losing condition. The winning and someone losing.
manager must accept the losses, analyze the causes, and try to
recoup what he or she can. Levels of Conflict
Nurses who work in healthcare organizations encounter three
Reversing can make it possible for the manager to retrace steps levels of organizational conflict namely:
back to the misstep and then begin a new series of subsequent
steps. She/he can then replace any weak link. In some instances, a 1.Intrapersonal conflict – A nurse can experience intrapersonal
conflict when confronted with two or more incompatible demands.
37
According to Restifo (1998) nurses who experience on-the-job

They may include ethical dilemmas, role conflict, work overload, conflict go through a series of identifiable stages:
and uncertainty about job expectations. It may also occur when a
nurse is unable to reconcile a need for professional autonomy and 1.Disbelief is often the first emotional reaction, particularly when
an obligation to conform to the rules of the organization (Douglas, others are disagreeing with values that are held in high regard.
1992).
2.Disconnectedness is characterized by feeling bewildered.
An ethical dilemma for instance occurs when an operating room
pro-life nurse unexpectedly finds herself working with a physician 3.Obsession with the situation soon develops as the nurse’s focus
who performs early termination ofpregnancy on the pretext that narrows. The nurse may spend much of the day thinking about the
the mother’s health is in danger, when in the nurse’s perception, it problem, and wake up at night wondering what to do.
is not
4.Frenzied activity is a common way of dealing with the
. Another example of a nurse experiencing intrapersonal conflict is obsession and reducing the bitterness, frustrations and pain that
one who constantly finds herself rendering unsafe patient care may be evoked by the conflict. The nurse keeps herself busy with
because of understaffing but cannot afford to resign from her job. new tasks and projects.
5. Self-evaluation. As the search for clues subside, self-

2.. Interpersonal conflict occurs between two or more people evaluation begins. The nurse either begins to recover a sense of
when one person perceives or values a situation differently than balance or experiences symptoms of burnout, withdrawal, apathy,
the other. and depression.
When there is incompatibility of values and goals, conflicts are 6.Purposeful alienation is providing emotional space between
likely to occur. Examples are when employees clash about how a the nurse and colleagues, a temporary reaction to deep conflict
job should be done, when employees disagree about job priorities that provides for self-preservation.
and expectations.
7. Gain insight. Once the conflict is resolved, and if is processed
Conflicts of this kind can also be caused by defiant behavior, positively, the nurse may gain insight into personal shortcomings
crowded space, physician authority. and gain experience for managing future conflict.
3.Intergroup conflict occurs between two or more groups, and Common Approaches to Conflict Resolution
may result from competition among departments within a single
health care facility or from rivalry among several organizations. Five common approaches to conflict resolution have been
Factors contributing to conflict in health care facilities include identified:
divergent management and staff perspectives; competition for
limited resources, such as staff, space, equipment, and funds new 1.Competition is “winner takes all” attempt at complete
policies and procedures, employee layoffs, change and even the dominance, resulting in a winlose situation. Sometimes this
threat of change. approach may be the only way to achieve a necessary change
when an emergency occurs and there is no time for discussion,
Common reactions to conflict when unpopular changes need to be implemented or when other
strategies for altering the status quo have failed. For example,
38
there is no time to settle disagreements when the patient needs odds with each other, but can’t be compromised. It maintains the
emergency care and someone has to take charge of the situation. relationship of the involved factions by merging their experiences
and feelings to explore creative alternatives that each side may
2.Accommodation is the opposite of competition and results in a not have thought of on their own.
lose-win situation. This occurs when one person gives in and yields
to the other. This approach is often used when preserving Successful conflict resolution starts with identifying the
relationships, encouraging others to express themselves and learn problem and desired behavior or outcome, and then
by their actions. For example, this approach can be used by two confronting the conflict. The procedure for conflict
nurse managers when deciding which team gets the float nurse. resolution are as follows:
One of the nurse managers might concede to the other manager
after listening to each other’s reasons. 1. Identify the root problem and clarify issues surrounding values,
purposes, and goals.
3. Avoidance results in a lose-lose situation. This occurs when one 2. Encourage a free exchange of ideas, feelings, and attitudes, and
side avoids the problem, is uncooperative, and denies that a cultivate an atmosphere of trust.
problem exists, or withdraws from the situation. In a survey done 3. Search for alternative ways to resolve the problem.
in three hospitals in the US, it was found out that regardless of 4. Ask for help from outside sources as needed.
institutional or demographic characteristics, nurses used avoidance 5. Set up a means for evaluation of possible solutions.
as a primary strategy for conflict resolution (Fowler, 1993). 6. Keep interacting until all parties agree to a solution. A
Although avoidance may be a lose-lose approach, there may collaborative approach requires a willing participation from both
be instances when its use is appropriate. Examples of situations parties, an atmosphere of
when avoidance can resorted to are: acceptance, and open and honest communication. Encourage full
expression of positive and negative feelings. (Douglas, 1992).
a) where others may resolve the conflict more effectively; b) both
parties
see the issue as minor;
c) if both parties see the need to cool off.
4. Compromise involves negotiation, tradeoffs, and swapping.

Each person gets something, but in return gives something else up
in the process, resulting in a win-lose win-lose situation for the two
sides. Compromise is best suited to cases where there is need to
reach agreement between equally empowered sides that seek to Discipline
achieve competing goals. Here conflict is resolved by finding a
common ground to achieve a temporary settlement that at least The nurse manager must be well versed with the organization’s
partially satisfies each party’s objectives while rules and regulations to use discipline in managing or preventing
preserving the relationship. For example, a nurse may agree to conflict. Discipline is the last resort in correcting undesirable
exchange weekend schedule with another nurse. employee behavior. The following are rules to follow when
instituting employee discipline (Swansburg, 1993):
5. Collaboration occurs when each party meets the problem head
on with equal concern for both the issues and maintenance of a
working relationship. This results in a win-win situation. 1.Discipline should be progressive.
Collaboration is an approach that preserves objectives that are at
39
2 The punishment should fit the offense, be reasonable, and a. What form communication are used to keep staff informed?
increase in severity for violation of the same rule. b. Describe the communication climate. Would you say it is
supportive or
3.Assistance should be used in administering discipline. defensive? Justify your answer.
c. Describe any area of concern that relates to communication gap.
4.Tact should be used in administering discipline. Suggest ways to improve this condition.
d. Identify at least three barriers to communication.
5. The best approach for each employee should be determined.
Managers should be consistent and should not show favoritism. 2. Compare the nursing process with the problem solving
process.
6.The individual should be confronted and not the group.
Disciplining group for a member’s violation of rules and regulations 3. Describe the steps of the problem solving process.
makes them angry and defensive, increasing conflict.
8. Discipline should be clear and specific. 4. Describe the relationship between problem solving and
decision making.
9. It should be objective, sticking to facts
5. You have just been promoted to the Director of Nursing of
a 200-hundred bed capacity private urban hospital. In your
10. It should be firm sticking to the decision. first meeting with the owner of the hospital you were
informed that the hospital is in financial difficulty. Nursing
11. Discipline produces varied reactions. If emotions are running Service, as its share in the cost cutting measures
too high, a second meeting should be scheduled. implemented by the hospital, needs to cut each budget.
The amount being asked is equivalent to the salaries of
11. The nurse manager performing the discipline should consult four staff nurses or two supervisors
with her supervisor. One should expect to be overruled sometimes. .
Knowing the boundaries of authority and the supervisor will avoid a. What other information do you need to make a decision?
most overrules. b. Describe the decision making steps that you will use.
12. A nurse manager should build respect, trust, and confidence in 6. List at least three (3) pitfalls of decision making.
her ability to handle discipline. Discipline is also used as a control
measure. 7. Describe two problem solving techniques.
8. Identify at least three sources of conflict in your place of

LEARNING ACTIVITIES IV” work.
answers/reactions to your professor.
9. Cite one example for each level of organizational conflict.
1. Observe the communication pattern in your own respective
RLE area and answer the following questions:
40
10. Describe the common approaches to conflict resolution

used by nurses in you respective RLE assignment, Describe
the decision making steps that you will use.
11. List at least three (3) pitfalls of decision making.
12. . Describe two problem solving techniques.
13. . Identify at least three sources of conflict in your

respective RLE assignment
14. . Cite one example for each level of organizational conflict

15. . Describe the common approaches to conflict resolution
used by nurses in your workplace.
41
suffering form chronic diseases (cancer, heart, stroke, diabetes,

arthritis, and so forth).
THE HEALTH CARE ENVIRONMENT

Broad social, political, economic, and technological changes are
affecting the delivery of health care systems, the leadership The workplace environment for health care workers has undergone
needed, the nursing profession in general. change, too. There is a wide range of possible threats to the safety
and well being of healthcare workers brought about by
The society of today is very different from the time when health technological advances and violence in society. These risks include
care was provided by the family, by the neighborhood “herbolario” exposure to potentially lethal chemical, infectious and radioactive
or “comadrona”. These days, we go to hospitals. agents as well as violence from the patients and others, especially
when the place of work is located in an unsafe area in the inner
The hospitals maybe ultra modern and funded by their wealthy city.
benefactors and clients or, they may be advances in science and
technology allow us to avail of progress’ tremendous benefits. For Exposure to Aids is a concern for many nurses. Of 32 documented
example, researches in the medical and related fields have cases in the US (Tappen, 1995), of healthcare workers
brought about the discovery and utilization of antibiotics, acquiring an HIV infection in the workplace in the United States, 12
immunizations, vitamins and other wonder drugs that are now were nurses. Another source of concern is exposure to
used to promote health, prevent the spread of infectious diseases, tuberculosis. Tuberculosis, once considered under control, has
cure existing diseases, alleviate pain, and in general, allow us to become a deadlier threat recently as more drug resistant strains
enjoy a healthy and comfortable life. appear.
Improved sanitation and water system, the availability of modern Responding to the challenge brought about by these changes in
therapeutic modalities such as insulin, dialysis, joint replacements, the healthcare environment and the healthcare workplace means
heart valve replacement, organ transplants and so forth, result in a major reforms in the delivery and management of the health care
population who enjoy longer lives and productivity. But, along with system. It means making healthcare not only available but
the advances brought about by modernization and affordable to a socially and economically diverse population. It
industrialization, also comes problems in society. In general, means a health care workforce who is ready and prepared to meet
modern society is afflicted with conditions that demand much the advances of modern society and its accompanying problems. It
from social services and of health care. Some of these conditions also means making the
include unemployment, homelessness, substandard housing workplace environment safe and secure for health care workers.
conditions, poverty, broken homes, rise in the number of single
parents, domestic and other forms of violence, increasing number
of elderly and handicaps, HEALTH CARE ISSUES
ccessibility of harmful drugs, all of which can result in an Rising cost of health care
unhealthy and sick individual.
The increased use of technological is necessarily accompanied by a
The health care systems is burdened with taking care of diseases rapid increase in health care costs. Global economic crisis and
never before known before, such as Alzheimer’s disease, Acquired recession are making the situation even worse than what it was
Immunodeficiency Syndrome (AIDS), drug-resistant tuberculosis, as when economic conditions were better. For the poor, unemployed
well as of taking care of the increasing number of people, mostly and uninsured, access to health care is almost next to impossible
elderly, who are
42
. Even countries who are supposed to be rich like the United States This program is going to be compulsory. It is envisioned to be an
are not spared from this problem. It is for this reason that every integrated and comprehensive approach to health development. It
president of that country from Kennedy to Clinton seriously endeavors to make essential goods, health and other social
addressed this issue. Hillary Clinton made heath care reform her services available to all the people at affordable cost with priority
pet project immediately after her husband took over the to the underprivileged, sick, elderly, disabled,
presidency. women and children. Most importantly, it will provide free medial
care to paupers.
The primary objective of health care reform is to provide coverage
for everyone, regardless of their ability to pay. Emphasis should be An important aspect of this program is the “Botica sa Barangay”.
on health promotion and disease prevention. Primary care, acute “Botica sa Barangay” is already being implemented in the city of
care, and long term care, including mental health and reproductive Manila.
health, should be covered first. Dental, vision, and hearing are also
important. In the health care reform taxes of various kinds Projects showing the government’s attention to the growing
combined with strict costs control have been suggested. Health number of elderly are the senior citizen programs implemented
care reforms, no matter how minimum, needs money and both nationwide and locally. For example, the program that
would entail a share of the national budget. Her proposed health provides twenty percent discount for food, medicines,
care reform was a major endeavour that called for a large budget transportation, has received very favorable responses
allocation which would increase taxes and naturally cut allocations from the older people.
for other government projects. After fighting very hard to garner
support, she finally abandoned her Health Reform Plan when the
Senate rejected it, mostly for political reasons.
Needless to say, the costs of heath promotion, prevention of
The problem of making health care services accessible to diseases and in general the costs of delivering health care to all
all people will be coming from taxes of various kinds as well as
savings from other different sources, such as reducing
The poor has difficulty accessing appropriate health care mostly administrative costs.
because of its enormous cost. And the cost is still rising. For
example, the US healthcare cost increased from 10% of a gross
national product (GNP) in 1990 to 14% in 1993. It is projected that Controlling cost is clearly a key issue in health care. And,
by the year 2000, it will rise to as controlling health care costs entails good management. For the
high as 24%. No data of this sort was obtained for the Philippines. nurse managers, it means delivering nursing care efficiently and
But based from experience, one can attest that health care cost is effectively. To make organizations work, it must be able to sustain
definitely rising. It is a fact that the Philippines has not developed itself financially, to say the least. To be sustainable, organizations
self-reliance in health care (Balita, 1999). According to Dr. Tamayo have to be ran by people with business and management savvy. It
(Balita, 1999), the best and only is not unusual therefore, for health care organizations to hire
solution to address the bad health care is for us Filipinos to help nurses who hold business degrees (mostly MBA) to occupy top
each other and work hand and hand for full implementation of the management positions. These days, we often hear nurse managers
National Health Insurance Program as provided under Republic Act using the terms “down-sizing”, “cost cutting measures”, “strategic
7875 which has been enacted in 1995 and supposed to be planning” and most recently, the preeminent business
implemented starting 1999. performance technique for the 90’s’ called “reengineering”.
Competition, profitability and market share are the issues cited
most frequently by senior executives for turning to the business
43
process of reengineering. Reengineering has invaded Halthcare independent practice association (IPA’s), and preferred provider
organizations and has replaced outsourcing, downsizing, organizations (PPO’s). HMO’s are usually organized in one of two
restructuring, and automation. ways. The first is the staff model in which HMO employees provide
health care services and also function as administrative personnel.
What is reengineering? According to Manganelli and Klein (1994), The second, called the group model, consists of a medical group
reengineering is the rapid and radical design of strategic, value- that accepts a contract from an HMO to provide health care
added business processes – and systems, policies and services for its participants. Regardless of their structures, the
organizational structures that support them – to optimize the work primary purpose of HMO’s is to limit costs by decreasing referrals
flows and productivity in an to specialists, restricting diagnostic studies, and decreasing client
organization. From this definition of reengineering, one can deduce hospitalization. Reducing the number of hospitalizations is
that in the process of reengineering and the other methods of accomplished, in part, through the provision of health promotion
controlling health care costs, some services may be cut off and and illness prevention services. PPO’s are another type of
some key personnel (nurses included) may be laid off. managed care organization that can be sponsored by providers,
insurance companies, or employers. Contracts are established with
Managed Care. This is one of the approaches suggested to a limited number of health care facilities and professionals, and
reduce health care costs. Managed care is an approach to lower-than-customary rates are sometimes negotiated. In an
providing a range of services in such a way that use of services attempt to contain costs, providers may be required to adhere to
and resulting costs are carefully controlled, that is, well-managed. PPO utilization guidelines.
Managed care is a term used to describe health care subsystem in
which services are administered in order to enhance their efficient
and effective use. Group Practice arrangements are outgrowths of the managed-care
system. Group arrangements are though to be advantageous for a
number of reasons. Catalano (1996) cited some of them. First, they
preserve the ideal private entrepreneurship while cutting
overhead. Second, they are attracted to providers who prefer to
hire professional managers.
The primary purpose of these business ventures is to deliver,
finance, buy and sell health care services as economically as This arrangement enables practitioners to spend more time caring
possible for clients and less time worrying about the mechanics of running a
business. Group practice arrangements are also appealing because
. Managed care systems are also known collectively as alternative they offer providers more time off, better client coverage, and
delivery systems, consist of administrators, providers, and the professional camaraderie. Finally, group practice frequently
physical facilities in which health care is delivered. employ an array of specialists and clients are offered convenient,
centralized, and comprehensive services. Managed care as a
The hospitals are oftentimes the focal point of managed care health care system is fast becoming the dominant approach to
Organizations Several different administrative structures are health care
characteristic of managed care arrangements. delivery.
Some of the more common structures include health maintenance TRENDS IN THE NURSING PROFESSION
organizations (HMOs),
44
The profession of nursing is a vital part of the health care system. Referent source of power depends on establishing and
Any change in the system brings about change in the profession. maintaining a close personal relationship with someone. Nurses
Nursing, as a profession, continues to stand to the challenge of the often obtain power from this source when they establish and
times. maintain good therapeutic relationships with their clients.
There was a time when empowerment, accountability, Clients take medications and tolerate treatments more willingly
independence of practice, professional collaboration were only from nurses with whom they enjoy good relationships. Likewise,
concepts to be studied and goals to be achieved, now they have nurses
become integral to the practice and development of the profession. who have good collegial relationships with other nurses, other
Nurses in the advanced practice roles such as nurse practitioners departments, and physicians are often able to obtain what they
can and do establish their own independent practices. want from these individuals or groups, in providing care of clients.
These nurses have professional autonomy, at the same time that The expert source of power derives from the amount of
they enjoy collaboration with colleagues in the health care system. knowledge, skill or expertise that an individual or group of
They are likewise, empowered by their own education and individuals has. Nurses should have at least a minimal amount of
expertise in their chosen field. In return, they are personally this type of power because of their education and experience.
accountable for the service they render. Changes in the healthcare
system have a major impact on how, where, and even who practice Increasing the level of education and experience, therefore,
nursing (Catalino, 1996). Nurses will need to get involved in should increase expert power. Nurses in advanced practice roles,
decisions about where healthcare is going. They need to band nurse educators, clinical specialists, nurse practitioners and nurse
together as a profession and exert potential power that they have managers are examples of nurses who are endowed with expert
access to politicians, physicians, hospital administrators, and power.
insurance companies in shaping the future of their profession.
Their additional education and experiences provide them with the
Future trends in the nursing profession suggest a move towards ability to practice skills at a higher level than nurses prepared at
empowerment (Tappen, 1995). The term power has many the basic education level. Nurses access this expert source of
meanings. From the standpoint of nursing, power is probably best power when they use their expertise to teach, counsel, motivate
defined as the ability or capacity to exert influence over another clients to follow a plan of care. Also, by demonstrating their
person or group of persons. In other knowledge of the client’s recovery, nurses increase the amount of
words, power is the ability to control, by virtue of one’s authority to respect they are given by physicians.
sway or influence others towards one’s viewpoint (Hawkins and
Thibodeau, 1996).
The reward source of power depends on the ability of one person
Empowerment refers to the increased amount of power that an to grant another some type of reward for specific behaviors or
individual, or group, is either given or gains. Empowerment allows changes in behavior. The rewards may take the form of praises,
nurses to become more active in the political arena. promotions, raises, expanded privileges, and eradication of
punishments. The reward source of
Some of them run for political offices or have managed political powers is also the underlying principle in the process of behaviour
campaigns. Sources of power that nurses should consider using in modification. For example, nurses, in their day to day provision of
their practice include referent, expert, reward, coercive, legitimate, care can give a client extra praise for good compliance and for
collective (Tappe, 1995). cooperating in their plans of care. The flip-side of the reward
source is the coercive source. The
45
ability to withhold rewards, to threaten, to punish are examples of used television, radio, and print media to disseminate facts about
coercive power. nursing education and practice. An
portrayed a nurse’s busy morning activities which include saving a
Needless to say, nurses minimally use this for the reason that they life. It ended with a question asking,
are non-therapeutic.
“What have you done this morning?” A letter-writing campaign by
The legitimate source of power depends on a legislative or legal the major nursing organizations and their members was successful
act that gives the individual or organization a right to make in getting a television series canceled.
decisions they might not otherwise have the authority to make. In
nursing, the state board of nursing has access to the legitimate This series had portrayed nursing students as so overwhelmingly
source of power because of its establishment under the nurse preoccupied with sex and romantic adventures that viewers
practice act of that state. The licensed uses legitimate source of wondered where they get their time to study and attend classes.
power by virtue of her being licensed. Higher salaries and the opportunities to travel and work in other
countries have definitely attracted more in the profession of
The collective source of power is often employed in a broader nursing. New graduate nurse salaries’ are among the highest of
context than individual client care and is the underlying source for any new college graduate in the United States.
many other sources of power
. For individuals who belong to professions, the professional Recognition of Advance Nursing Practice. Advanced practice
organization is the focal point for this source of power. status, such as nurse practitioner or clinical nurse specialist, has
The main goal of any organization is to influence those policies that been recognized in many states by completion of certification
affect the members of the organization. Having all these sources of examination developed by professional organizations
power available, nurses, individually or as a group, are getting
themselves more empowered. Eligibility to take these examinations includes minimum hours of
There other ways of increasing power for the profession. By uniting classroom and supervised clinical study and course content. To
themselves in a nationwide association or group, nurses can weld a attain this status, more and more practicing nurses pursue
great deal of power to influence others. advance courses to occupy expanded roles as nurse educators,
nurse clinicians, nurse researchers, clinical specialist,
The professional associations like the ANA in the United States administrators, or nurse practitioners. Support of Nursing
have been and are still influencing legislators and legislating. Research. More nurses are going into research and they find this
Another way of gaining power is by becoming involved in political new
activities, locally and nationally. Nursing’s progress toward area of nursing practice gratifying. Many nurses get promoted and
professionalism include improved image, higher salaries, increased get other recognition for going into research. Research positions
recognition of advanced nursing practice, and support for nursing for nurses are opened in hospitals and other healthcare
research (Tappen, 1995). organizations. Funding can be applied for by nurses who venture in
research.
For years, nurses have been portrayed in demeaning ways. Nurses
have been portrayed magazines and television as obese, scary
person toting a large syringe, or as sex maniacs chasing after
doctors or getting into bed with patients, and so on. In 1990,
an image campaign by the Ad Council (Tappen, 1995) in

cooperation with nursing organization was launched. The project
46
LEARNING ACTIVITIES V

answers/reactions to your professor.
1. Discuss how the worldwide social, political, economic, and

technological advances affect the delivery of health care.
2. From what you know about the current health issues and
problems in the delivery of health care in the Philippines,
what health care reforms do you recommend?
3. 3. Trace and evaluate the professional progress of the
nursing profession in the Philippines.
BIBLIOGRAPHY
Alexander, E. Nursing Administration in the Health Care System. St.
Louis: CV Mosby, 1978.
Beaman, A. What Do First-Line Nursing Managers Do? Journal of
Nursing Adminstration. 16, 6-9.
1986.
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GLOBAL CITY INNOVATIVE COLLEGE

independence and growth of the individual members. 1. Integration

The basic components of early scientific management include: Henri Fayol.

The third level of the hierarchy are love and belongingness.

Interactional Theories. These theories describe the interactions

HUMAN BEHAVIOR AND RELATIONS

While classic organization and management theory concentrates

Denial. Denial is blocking from awareness something painful or

can also be described as the actual (rather than prescribed)

3. Provides direction to staff members regarding the way the work

According to Donovan (1975), planning has many benefits.

Pilot studies, use of scenarios and simulations are utilized to test

Phase One: Developing the Plan 1. Establishing a purpose

The Gantt chart, which is actually a highly developed schedule,

1. Certainty about duties, authority, allocation of time, and

4. Structure and standards; 7. Follow through on activities involving practicing nurses.

16. Develop strategic plans that include decentralization of

The objective of team building is to establish an environment of

the first step in team building is to determine why nursing

The plan should be communicated to the entire staff of the nursing

Recognition of the individual’s worth and contributions to the

Answer the following and submit your typewritten

3. .Describe the characteristics of an effective nurse manger

4. Give an example of how “forecasting” has made a

5. Give an example/incident to show how work planning has

6. Describe the activities involved in planning.

7. Describe the phases of planning.

8.Why is “strategic planning” popular among nursing/health

9. What do you understand by “bureaucracy”? What are its

10. Using your respective RLE rotation link a discussion

11. Describe the structure and climate of the organization

2. Having a commitment to the development of others. In many

To be effective, she must have the leadership traits associated

6.Considering the need for variety in task assignment and for

Directing activities of nurse managers/supervisors  Assist in service to prepare orientation schedule.

All these, in addition to meeting the needs and wishes of individual

9. The nurse administrator uses techniques of operation

Health and well being of team members – very stressful jobs

The delegation of work to another presumes a superior- Ways to Delegate Successfully

2. . Plan ahead. It prevents problems.

3. Control and coordinate the work of subordinates. Do not

4. Visit subordinates periodically. Spot potential problems of

5. Coordinate to prevent duplication of effort.

6. Solve problems and think about new ideas. Emphasize

7. Accept delegation as desirable. LEARNING ACTIVITIES—III”

3. Observe the nurse executives in your place of work.

4. From your observations and experience,

5.Discuss the ways of delegating successfully.

6. Discuss the advantages of Management by Objectives (MBO).

THE COMMUNICATION PROCESS

Principles for successful communication

There are three basic principles for successful communication.

Improving Communication Improving Communications

THE DECISION-MAKING PROCESS

STEP FIVE: Evaluation/Evaluate the results. Evaluation, the

the problem is not so well defined or when multiple goals exist,

a) no alternative’s desirable. The riskiness of all alternatives, for

1.Commitment. Those involved must move ahead on the decided

According to Restifo (1998) nurses who experience on-the-job

5. Self-evaluation. As the search for clues subside, self-

4. Compromise involves negotiation, tradeoffs, and swapping.

8. Identify at least three sources of conflict in your place of