NCM-107

Leadership and Nursing

Management
Leadership

Leader – person who influences and guides

direction, opinion and course of action.

Leadership
a process of influence
a point of polarization for group
cooperation (Chapin)
a management skill that focuses on the development and
deployment of vision, mission and strategy as well as the creation
of a motivated workforce (Bitpipe)
Leadership Roles

• Decision maker
• Communicator
• Evaluator
• Facilitator
• Risk taker
• Mentor
• Energizer
• Coach
• Counselor
Other characteristics of leaders:

• Leaders often do not have delegated authority

but obtain their power through other means,
such as influence.
• Leaders have a wider variety of roles than do
managers.
• Leaders may or may not be part of the formal
organization.
• Leaders focus on group process, information
gathering, feedback and empowering others.
Characteristics associated with Leadership

• Intelligence
• Knowledge
• Judgment
• Decisiveness
• Oral fluency
• Emotional intelligence
• Independence
• Personable
• Adaptability
• Leadership Theories:
• 1. Great Man Theory
• From Aristotelian philosophy.
• Asserts that some people are born to lead
whereas others are born to be led.
• Suggests that great leaders will arise
when the situation demands it.
•  Ex. Kings of great
Britain,Aristotle,Abraham Lincoln
• 
• 2. Trait Theory
• Assume that some people have certain
characteristics or personality traits that
make them better leaders than others.
• They have ambition,great oratory
skills,good looks,and persuasive.
• Ex. Pope John Paul, Mother Theresa,
Margaret Thatcher,Gandhi because of the
special traits they possess
Common TRaits of Leaders
• 1. Positive Traits-They bring people to progress.
Transcend their own traits to people who will
become positive leaders themselves. They are
cheerful,intelligent,and good looking
• 2.Negative Traits-They take people to
destruction. They destroy rather than build.
They are not able to grow good leaders but
followers, who go after each other. They are
bitter, aggressive, loud mouth and ugly people
• 3. Behavioral Theory
• Developed by Kurt Lewin, White and
Lippitt
• Leadership styles: Authoritarian,
Democratic and Laissez-faire
Leadership Assumed Leader
style employee characteristic
motivator
Autocratic External forces -Task accomplishment
(authoritarian) (power & rather than
authority) relationship
-use directive behavior
-makes decision alone
-exercises power w/
coercion
-expect respect &
obedience fr. staff
Leadership Assumed Leader
style employee characteristic
motivation
Democratic Internal drives -primarily concerned
(participative) and impulses w/ human relations &
team work
-communication is
open & two way
-spirit of collaboration
& joint effort that result
to staff satisfaction
Leadership Assumed Leader
style employee characteristic
motivation
Permissive Internal drives & -Few established
(laissez-faire) impulses policies
-abstain from leading
-not useful in highly
structure organization
Bureaucratic External force -Lack sense of security
-Tends to relate
impersonally to staff
-Apply fixed & inflexible
rules
-avoids decision making
w/o standards or norms
for guidance
• 4. Situational Theory/Contingency Theory
• Situational theories propose that leaders
choose the best course of action based
upon situational variable.
• Different styles of leadership may be
more appropriate for certain types of
decision-making.
Situational Theory/Contingency
Theory
• It is also called Contingency theory because the
leadership style will be dependent on the
situation that a leader is faced at the moment.
Among the proponents are Paul Hersey,
Kenneth Blanchard,Fred Fiedler,Vroom and
Yetton and Robert House
4 Leadership Styles(S1-S4)-D1-D4
• S1: Directing/Telling Leaders- The leader
defines the role and tasks of the follower and
supervises them closely. Decisions arew made by
the leader and announced, so communication is
largely one-way
• S2: Coaching/ Selling Leaders-The leader still
defines roles and tasks, but seeks ideas and
suggestions form the followers. Decisions
remain the leaders’s prerogative, but
communication is much more two -way
• S3-Supporting/Participating Leaders
• -The Leader passes day-to-day decisons such as
task allocation and processes to the follower. The
leader facilitates and takes part in decisions but
control is with the follower.
• S4-Delegating Leaders
• Leaders are still involved in decisions and
problem solving, but control is with the follower.
The follower decides when and how the leader
will be involved.
Levels of maturity:
M1 – person is unwilling and unable to perform the job.
M2- person is unable but willing to perform the job.
M3 – person is able but unwilling to perform the job.
M4 – person is able and willing to perform the job.
• 5. Contingency Theory
• Contingency theories of leadership focus
on particular variables related to the
environment that might determine which
particular style of leadership is best
suited for the situation.
• According to this theory, no leadership
style is best in all situations.
• Success depends upon a number of
variables, including the leadership style,
qualities of the followers, and aspects of
the situation.
CONTINGENCY THEORIES
- suggests that managers adapt their leadership
styles in relation to changing situation.

A. Fiedler’s Contingency Theory

- leader is most effective when he/she matches
leadership styles to situational factors.

3 Situational Factors of leadership

1. Manager – follower relationship (good – poor)

2. Task structure ( high – low)
3. Manager power ( strong to weak)
• 6. Kanter Theory
• Organizational structure shapes leader
effectiveness
• Asserted that title and position authority
were no longer sufficient to mold a
workplace where subordinates are
encouraged to think for themselves and
instead managers must learn to work
synergistically with others.
• 7. Contemporary Leadership Theories-It
describes relationship between leaders
and followers in which a distinct set of
competencies is used to allow the
relationship to achieved shared goals.
• 
• Transactional Leader=the leader
functions as a caretaker and sets goal for
the followers. They focus on the
maintenance and management of on
going and routine work.Focuses on
management tasks

• Example:Hospital owners exchange

• Example:Hospital owners exchange status and
wages for the work effort of the nurse employee.
• Transformational Leader=
• Identifies common values
• A person with this style is a true leader, who
inspires her team constantly with a shared vision
of the future.
• Motivates followers to perforn their full potential
over time by influencing change.
• 8. The Integrated Leader-Manager Theory
• Managers and leaders were integrated to
function at their greatest potential.
• 6 distinguishing traits:
• 1. They think longer.
• 2. They look outward, toward the larger
organization.
• 3. They influence others beyond their own
group.
• 4. They emphasize vision, values and
motivation.
• 5. They are politically astute.
• 6. They think in terms of change and
renewal.
9. Charismatic Theory

According to House, leaders who have charisma

(leadership qualities that inspire follower’s
allegiance and devotion) are able to make
emotional connection with their followers,
display enormous self-confidence and are able
to get others to have confidence in them.
10. Motivational Theories

Sometimes called process theories because they

are designed to do more than just explain
behavior.

4 key motivational theories:

A. Reinforcement theory

• Based on the research of B. F. Skinner, views

motivation as learning, person becomes
conditioned to associate a behavior with
consequence (either positive or negative
reinforcement).
B. Expectancy theory

• People’s expectations about a situation also

help determine their behavior, in nursing, the
“expectation” is often one of being taken for
granted, being overworked and not receiving
recognition for extra effort or a job well done.
C. Equity theory

• The degree of perceived fairness in the work

situation is the key to job satisfaction and
workers effort.
D. Goal setting theory

• In contrast to expectancy and equity theory,

suggests that people don’t spend effort for
rewards or task outcomes, but to accomplish
the goal itself.
11. Wheatley’s “new leadership” concept

Developed by Margaret Wheatley, the

organization is a living entity whose different
parts are interdependent on each other for the
entire organization to thrive.
Kinds of influence:

Assertiveness – able to stand up for her own rights without

violating those of others.
Ex. The nurse clarifies orders if in doubt before carrying out

Ingratiation – makes another feel important or good before

making a request.
The person acts humbly or is friendly before making a request

Rationality – involves convincing someone of the merits of a

detailed plan which is usually supported by
information,reasoning or logic
Blocking – a hostile form of influence where an
individual achieves the goal of influencing another
person either with the threat of or the actual act of
cutting off from communication or interaction the
other person intended to be influenced.
Coalition – collective form of influence where a person
gets several co-workers
to “back her up” when making a request. The person
is said to coalesce with other individual to show a
strong front of solidairy
6. Sanction – influence hinged on the promise of
punishment in case of non-cooperation and
reward in case of cooperation. This is the kind
of influence that is behavior based
7. Exchange – offering a favor or a personal
sacrifice as an incentive for the performance of
the request.
8. Upward appeal - obtaining support from a
higher-up to push someone into action.
Ex. A nurse talk to the manager to make sure that
Efficient leadership

The ability to maximize time and use of

resources in achieving organizational objectives
which will yield maximum output.
It is doing things right the first time.
It is more concerned with the 7 M’s
The 7 M’s

1. Money- refers to the budget that would be

allocated for an undertaking
Ex. How much would it cost to buy a latex gloves
for a medical mission
2. Men-refer to the human resources that are
needed to achieve the goal.
Ex. How many additional nurses will be added to
complete the nursing staff unit?
The 7 M’s
3. Machine-devices that help the organizations by
either performing tasks faster or doing work that
humans cannot.
- anything that makes work easier
ex. mechanical ventillator, microscope, ultrasounds,
computers
4. Materials- these are physical resources used as
inputs in any care process. They can be raw
materials or finished materials.
Ex. Cottons,syringes, stethoscope
The 7 M’s
5. Methods- refer to the body of techniques for
investigating phenomena acquiring new knowledge.
Ex. methods of preventing ill healthand/or treating ill
health such as methods to prevent ulcers, hip
fractures due to falls,constipation.
6. Moment- refers to the time as a resource.If healing
takes time,then a time constraint will greatly
reduced the amount of time to recover from
sickness.
The 7 M’s
• 7. Manager -is another important resource. A
manager is the person responsible for planning and
directing the work of the group individuals,
monitoring their work and taking corrective action.

• The above 7M’s are important to the fullfillment of

personal goal,group and organizational goal.Said
goals will not be achieved when any of these 7
resources are lacking.
Effective leadership

The ability to determine appropriate objectives

for the group or organization to ensure
appropriate and accurate results.
Concern with output or results of performance.
It is doing the right thing at the right time.
Types of followers adapted from Kellerman:

1. Alienated – independent and critical yet

passive; potentially disruptive and a threat to
the health organization.
2. Sheep – are dependent and uncritical; they
simply do as they are told.
3. Yes people – dependent or uncritical but very
active behavior; the most dangerous because
they most likely give a false positive reaction.
4. Survivors – the least disruptive and lowest risk
followers; their motto “Better safe than sorry”
5. Effective followers – self-leaders and do not
require close supervision.
4 essential qualities of effective followers:
• self-management
• commitment
• competence
• courage
Management

 The process of leading and directing all part of

an organization, often a business, through the
deployment and manipulation of resources.
 The act, manner or practice of managing,
handling, supervision or control is another
description of management.
Managers then typically:

 Have an assigned position within the formal

organization.
 Have a legitimate source of power due to the
delegated authority that accompanies their
position.
 Are expected to carry out specific functions,
duties and responsibilities.
 Emphasize control, decision making, decision
analysis and results.
 Manipulate people, the environment, money,
time and other resources to achieve
organizational goals.
 Have a greater formal responsibility and
accountability for rationality and control than
leaders.
 Direct willing and unwilling subordinates
Management Theories:

1. Scientific Management
 Established by a mechanical engineer
Frederick Taylor, the “Father of scientific
management”.
 Postulated that if workers could be taught the
“one best way to accomplish a task”,
productivity would increase.
4 Overriding principles of scientific management:

1. Traditional “rule of thumb” means organizing

work must be replaced with scientific
methods.
2. A scientific personnel system be established so
that workers can be hired, trained and
promoted based on their technical
competence and abilities.
3. Workers would be able to view how they “fit”
into the organization and how they contribute
to overall organizational productivity.
4. The relationship between managers and
workers should be cooperative and
interdependent and the work should be
shared equally.
2. Bureaucratic Organizations

 Developed by a German sociologist, Max

Weber, studied large-scale organizations to
determine what made some workers more
efficient than others.
3. Management Functions

 Developed by a French mining engineer Henri

Fayol, the “Father of Modern Management”.
 Identified the management functions of
planning, organization, command, coordination
and control.
4. Activities of Management

 Luther Gulick, expanded on Fayol’s

management functions.
 Introduced the 7 activities of management as
denoted by mnemonic POSDCORB.
POSDCORB

P – Planning
O – Organizing
S – staffing
D – Directing
CO – Coordinating
R – Reporting
B – Budgeting
5. Human Relations Management

 Human relation era developed the concepts of

participatory and humanistic management,
emphasizing people rather than machines.

A. Participative management or Participative

decision making
 Suggested by Mary Parker Follett, believes that
managers should have authority with, rather
than over, employees.
B. Hawthorne effect

 The studies, conducted by Elton Mayo and his

Harvard associates.
 Indicated that people respond to the act that
they are being studied, attempting to increase
whatever behavior they fell will continue to
warrant the attention.
C. Theory X and Theory Y

 Reinforced by Douglas Mc Gregor, that the

managerial attitude about employees can be
directly correlated with employees satisfaction.
 Theory X employees:
 avoid work if possible
 dislike work
 must be directed
 have little ambition
 avoid responsibility
 need threats to be motivated
 need close supervision
 are motivated by rewards and punishments
 Theory Y employees:
 like and enjoy work
 are self-directed
 seek responsibility
 are imaginative and creative
 have underutilized intellectual capacity
 need only general supervision
 are encouraged to participate in problem
solving
D. Employee Participation
Chris Argyris stressed the need for flexibility
within the organization and employee
participation in decision-making.

6. Motivational theory
 Emphasized that worker output was best when
workers were treated humanely.
 Most well-known motivation theories:
A. Maslow’s hierarchy of needs
 Stated that people are motivated to satisfy
certain needs, ranging from basic survival to
complex psychological needs.

B. Skinner’s operant conditioning and behavior

modification
 People can be conditioned to behave in a
certain way based on a consistent reward or
punishment system.
C. Herzberg’s hygiene or maintenance factors
 Maintained that motivators or job satisfiers are
present in the work itself and encourage people
to want to work and to do that work.

D. Vroom’s expectancy model

 People’s expectations about their environment
or a certain event will influence their behavior.

E. McClelland’s studies
 Motivated by 3 basic needs: achievement,
affiliation and power.
F. Gellerman’s stretching
 To energize people to enjoy the beauty of
pushing themselves beyond what they think
they can do.

G. McGregor’s Theory X and Theory Y

 Shows the importance of manager’s
assumptions about workers on the intrinsic
motivation of the workers.
H. Ouchi’s Theory Z
 The best way to motivate is through collective
decision-making, long- term job security, use of
quality circles and humanistic management
style.

I. Theory M
 For management, people are motivated to
work highly complex factors that maybe
biological, psychosocial, social or economic.
7. Total Quality Management (TQM)
 Emphasizes doing the right thing for customers
and the end result of this method is to satisfy
customer.
 Japanese criteria of TQM:
1. monetary incentives for workers
2. things will work out as they are supposed to
3. user’s feedback as basis for product
improvement
4. things should have aesthetic quality
8. Management By Objectives (MBO)
 A process of agreeing upon objectives within an
organization so that management and
employees agree to the objectives and
understand what they are.

Principles of Management
According to Fayol:
1. Division of work – specialization of labor;
encourages continuous improvement in skills
and methods.
2. Authority – the right to give orders and the
power to exact obedience.
3. Discipline – no slacking, bending of rules.
4. Unity of command – each employee has one
and only one boss to give instructions or
assignments.
5. Unity of direction – a single mind generates a
single plan and all play their part in that plan
but only one person is in-charge of the group’s
activities.
6. Remuneration – wage for the services rendered
to the organization.
7. Subordination of individual interests to the
general interest – an employee or group of
employee’s interests should not precede over
the interests of the whole organization.
8. Centralization – decisions are made at the top;
produces uniformity of action.
9. Decentralization – increases motivation of
nurses at lower levels since they are asked to
participate in decision-making.
10. Scalar chain – interconnectedness of people
within the organization from top to bottom.
11. Order – people and materials are in the right
place at the right time.
12. Equity & justice – fair and just treatment
13. Stability of tenure – limited turnover of
personnel.
14. Initiative – thinking out a plan and do what it
takes to make it happen.
15. Esprit de corps – promotion of team spirit
builds harmony and unity within the
organization.
Nursing Management
 A set of activities with a group of people which
involves managerial functions.
 Is establishing vision and goals, communicating
and guiding others in accomplishing these vision
and goals.
 Is facilitative, participative and empowering
others on how visions and goals are established
and carried out.
General Principles of Nursing Management:
1. Is planning
2. Is the effective use of time
3. Is decision-making
4. Meeting patient’s nursing care needs is the
business of the NM
5. Is the formulation and achievement of social
goals
6. Is organizing
7. Is the active organ of the division of nursing, of
the organization and of the society in which it
functions
8. Denotes a function, social position or rank, a
discipline and a field of study.
9. Organizational cultures reflect values and
beliefs
10. Is directing and leading
11. A well-managed division of nursing motivates
employees to perform satisfactorily
12. Is efficient communication
13. Is controlling and evaluating
Comparison of Leadership and Management
Leadership Management
Motto Do the right Do things right
things
Challenge Change Continuity
Focus Purposes Structures and
procedures
Time frame Future Present
Methods Strategies Schedules
Questions Why? Who, what,
when, where and
how?
Outcomes Journeys Destinations
Human Potential Performance
DEFINITION/
DESCRIPTION OF
MANAGEMENT
Management

 The process of leading and directing all part of

an organization, often a business, through the
deployment and manipulation of resources.
 The act, manner or practice of managing,
handling, supervision or control is another
description of management.
Managers then typically:

 Have an assigned position within the formal

organization.
 Have a legitimate source of power due to the
delegated authority that accompanies their
position.
 Are expected to carry out specific functions,
duties and responsibilities.
 Emphasize control, decision making, decision
analysis and results.
 Manipulate people, the environment, money,
time and other resources to achieve
organizational goals.
 Have a greater formal responsibility and
accountability for rationality and control than
leaders.
 Direct willing and unwilling subordinates
Nursing Management
 A set of activities with a group of people which
involves managerial functions.
 Is establishing vision and goals, communicating
and guiding others in accomplishing these vision
and goals.
 Is facilitative, participative and empowering
others on how visions and goals are established
and carried out.
•UNIVERSAL PRINCIPLES
OF MANAGEMENT
General Principles of Nursing Management:
1. Is planning
2. Is the effective use of time
3. Is decision-making
4. Meeting patient’s nursing care needs is the
business of the NM
5. Is the formulation and achievement of social
goals
6. Is organizing
7. Is the active organ of the division of nursing, of
the organization and of the society in which it
functions
8. Denotes a function, social position or rank, a
discipline and a field of study.
9. Organizational cultures reflect values and
beliefs
10. Is directing and leading
11. A well-managed division of nursing motivates
employees to perform satisfactorily
12. Is efficient communication
13. Is controlling and evaluating
8. Management By Objectives (MBO)
 A process of agreeing upon objectives within an
organization so that management and
employees agree to the objectives and
understand what they are.

Principles of Management
According to Fayol:
1. Division of work – specialization of labor;
encourages continuous improvement in skills
and methods.
2. Authority – the right to give orders and the
power to exact obedience.
3. Discipline – no slacking, bending of rules.
4. Unity of command – each employee has one
and only one boss to give instructions or
assignments.
5. Unity of direction – a single mind generates a
single plan and all play their part in that plan
but only one person is in-charge of the group’s
activities.
6. Remuneration – wage for the services rendered
to the organization.
7. Subordination of individual interests to the
general interest – an employee or group of
employee’s interests should not precede over
the interests of the whole organization.
8. Centralization – decisions are made at the top;
produces uniformity of action.
9. Decentralization – increases motivation of
nurses at lower levels since they are asked to
participate in decision-making.
10. Scalar chain – interconnectedness of people
within the organization from top to bottom.
11. Order – people and materials are in the right
place at the right time.
12. Equity & justice – fair and just treatment
13. Stability of tenure – limited turnover of
personnel.
14. Initiative – thinking out a plan and do what it
takes to make it happen.
15. Esprit de corps – promotion of team spirit
builds harmony and unity within the
organization.
•ROLE OF MANAGER
• MINTSBERG- Groups the basic roles performed
by managers as Interpersonal, informational, and
decisional.

• INTERPERSONAL ROLE shows the manager

• 1. as a symbol because of the position he/she
occupies and consists of such duties as signing
papers/documents required by organization
• 2. AS A LEADER- who hires, trains, encourages,
fires, remunerates and judges
• 3.AS A LIAISON between outside contacts such
as community, suppliers and the organization

• B. INFORMAL ROLE-
• 1. as a Manager-as a. one who monitors
information, b. dessiminates information c. as
spokesperson or representative of the
organization
•STRATEGIC
•PLANNING
 PLANNING

Critically important to and precedes all other

management functions.
 Without adequate planning, the management
process fails and organizational needs and
objectives cannot be met.
 Deciding in advance what to do; who is to do it;
and how, when and where it is to be done.
 All planning involves choosing among
alternatives.
 A proactive and deliberate process that reduces
risk and uncertainty.
Encourages unity of goals and continuity of
energy expenditure.

4 Planning modes:
1. Reactive – occurs after a problem exists.
2. Inactivism – seeking the status quo and
spending energy preventing change and
maintaining conformity.
3. Preactivism – utilizing technology to
accelerate change and are future oriented.
4. Interactive or Proactive – considers the past,
present and future and attempting to plan the
future of their organization rather than react
to it.
Steps in planning:
1. Determining objectives
2. Collecting data
3. Developing a plan of action
4. Evaluation
Types of planning:
A. According to duration
1. Strategic or long range planning
2. Operational or short range planning
B. According to approach
1. Top-down
2. Bottom-up
C. Other types
1. One type planning
2. Stand by planning
3. Back-up planning
4. Functional planning

Effective tools that assist in Strategic planning:

1. SWOT Analysis – most commonly used in
health organizations; also known as TOWS
analysis, developed by Albert Humphrey at
Stanford University in the 1960’s and
1970’s.
S – Strengths – are those internal attributes that
help an organization to achieve its
objectives.
W – Weaknesses – are those internal attributes
that challenge an organization in
achieving its objectives.
O – Opportunities – are external conditions that
promote achievement of
organizational objectives.
T – Threats – are external conditions that
challenge or threaten the
achievement of organizational
objectives.
Simple Rules for SWOT Analysis:
Be realistic about the strengths and
weaknesses of your organization.
 Be clear about how the present
organization differs from what might be
possible in the future.
 Be specific about what you want to
accomplish
 Always apply SWOT in relation to your
competitors.
 Keep SWOT short and simple.
 Remember that SWOT is subjective.
2. Balanced Scorecard
 developed by Robert Kaplan and David
Norton in the early 1990’s, this is highly
assistive in strategic planning.
 develop metrics (performance
measurement indicators), collect data and
analyze that data from four organizational
perspectives: financial, customers,
internal business processes and learning
and growth.
 avoids an overemphasis on financial
results as the primary measure of an
organization’s health and performance.
Organizational Planning: The Planning
Hierarchy

1. Vision – used to describe future goals or

aims of an organization.
2. Purpose or Mission – brief statement
identifying the reason that an organization
exists.
3. Philosophy – delineates the set of values and
beliefs that guide all the actions of the
organization; can be found in policy manuals
at the institution or is available on request.
 Organizational philosophy – provides the
basis for developing nursing philosophies at
the unit level for nursing service as a whole.
 Nursing service philosophy – should
address fundamental beliefs about nursing
and nursing care; the quality, quantity and
scope of nursing services; and how nursing
specifically will meet organizational goals.
 Unit philosophy – specifies how nursing
care provided on the unit will correspond
with nursing service and organizational goals.
 Values – beliefs that guide behavior.
4. Goals – the desired result toward which
effort is directed; measurable and ambitious
but realistic.
5. Objectives – motivate people to a specific
end and are explicit, measurable, observable
or retrievable and obtainable.
 Strategies – identify how the organization
will attain the vision.
6. Policies – are plans reduced to statements or
instructions that direct organization in their
decision-making; a statement of expectation
that sets boundaries for action taking and
decision-making.
 Implied policies – neither written nor
expressed verbally, have usually developed
over time and follow a precedent.
 Expressed policies – delineated verbally or
in writing.
7. Procedures – are plans that establish
customary or acceptable ways of
accomplishing a specific task and delineate a
sequence of steps of required action.
8. Rules and regulation – are plans that define
specific action or non-action.