NURSING LEADERSHIP AND MANAGEMENT 1

INTRODUCTION TO LEADERSHIP  Input

AND MANAGEMENT  Output
 Throughput
BASIC CONCEPTS OF  Feedback
NURSING LEADERSHIP AND  Negative Entropy
MANAGEMENT  Cyclical- Ludwif von
 ORGANIZATION- set of Bertanffy
coordinated  Equifinality- concept of
activities/forces multiple paths to a
common end state
Individuals, groups, families  Integration/
and communities are clients Coordination
of health care organization  Integration And
Coordination Arm
 Administration
DIMENSIONS OF HEALTH  Management
CARE ORGANIZATION  Supervision

1. Nomothetic dimension-
institution, roles and COMMON TO ALL IS THE
expectations CONCEPT OF LEADERSHIP
2. idiographic dimension-  Administration
individual, personality and – Over-all direction
needs disposition – Over-all machinery
– Directing the whole
Reason why people organize: enterprise
– attainment of objectives – With aim for efficiency.
– pooling of resources Effectivity, economy,
– learning and productivity
compensation/service
 Management

Types of Health Care – Getting things done

Organization through people
– Concerned with specific
 Ownership (Public, Private, aspect of organization
Mixed PPP) – Part and parcel of
 Stocks (Stock/Profit, Non- administration
Stock/Non-Profit)
 Levels of Care (Primary,
Secondary, Tertiary, M’S IN
Special Tertiary) MANAGEMENT/ELEMENTS (7)
 Manpower- human
resources that are needed
CHARACTERISTICS OF to achieve the goal.
HEALTH CARE ORGANIZATION

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 Money- budget that would  Machinist
be allocated for an  Relationist
undertaking.  Revisionist
 Materials- physical  Situationist
resources used as an input
in the nursing process.
 Machines- devices that
help the organization by SELECTED THEORIES IN
either performing tasks MANAGEMENT
faster or doing work that
humans cannot. 1. Scientific Management
 Methods- body of Theory (Specialization)
techniques for  Frederick Taylor-
investigating phenomena, engineer and
acquiring new knowledge, management expert,
or correcting and Father of Scientific
integrating previous Management
knowledge.  Proposed a set of
 Market/clientele- techniques to increase
 Moment- time resource efficiency and productivity
 Manager- person of each worker
responsible for planning  He timed and analyzed the
and directing the work of movement of each worker
individuals, monitoring performing a series of
their work, and taking jobs, and designed the
corrective action when quickest and best method
necessary. to make a task easier.

PRINCIPLES OF MANAGEMENT Fundamental Principles of

 MBO- management by Scientific Management
objectives – The development of a true
 MBC- management by science of management,
contingency/situation so that for example, the
 Management by exception best method for
 Management by performing each task
experience could be determined.
 Division of labor – The scientific selection of
 Convergence principle worker, so that each
 Substitution of resources worker will be given
 Delegation of authority responsibility for the task
 Shortest decision path for which he or she is best
suited.
MANAGEMENT SCHOOLS OF
THOUGHT

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– The scientific education 2. Authority- managers need to
and development of the be able to give orders so that
worker. they can get things done.
– The intimate, friendly
cooperation between 3. Discipline- members in an
management and labor. organization need to respect
the rules and agreement that
 He concluded that govern the organization.
productivity will increase 4. Unity of Command-Each
with careful, systematic employee must receive his or
design of workplace her instructions about a
conditions, work methods, particular operation from only
and proper training and one person. If an employee
instruction of workers. was responsible to more than
 He proposed higher wages one supervisor, conflict in
to each worker with high instructions and confusion of
productivity. authority would result.
5. Unity of Direction-Those
2. Modern Management operations within the
Theory (systematic) organization that have the
 Henri Fayol (1841-1925), same objective should be
industrialist, real father of directed by only one manager
modern management using one plan.
theory
 Believed that “with 6. Subordination of
scientific forecasting and Individual Interest to the
proper methods of Common Good-In any
management, satisfactory undertaking, the interest of
results were inevitable”. the employees should not
 Management is not a take precedence over the
personal talent, but a skill. interests of the organization
 Identified 14 principles of as a whole.
management, which he
7. Remuneration-
claims not an absolute,
Compensation for work done
but flexible and can be
should be fair to both
applied in any setting.
employees and employers
14 Principles of Management:
1. Division of Labor- the more 8. Centralization/
people specialize, the more Decentralization.-
efficiently they can perform Decreasing The role of
their work. (Homogeneity of subordinates in decision
Assignment) making is centralization;
increasing their role is
decentralization.

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a. Managers, although 3. Bureaucratic Organization
retaining final Theory
responsibility, need
to give their  Max Weber-Sociologist,
subordinates like Taylor and Fayol,
enough authority to contributed to a classical
do their jobs approach to organizational
properly. design.
9. Hierarchy-The line of  They believed that
authority in an organization, organizations with a
often represented today by hierarchical structure are
the neat boxes and line of most efficient and
organization chart, runs in effective.
order of rank from top  Weber named the
management to the lowest structure bureaucracy.
level of enterprise.( CHAIN OF
COMMAND,LINE OF Characteristics of
AUTHORITY) Bureaucratic Organizations:
[Link]-Materials and people ● Tasks are specialized.
should be in the right place at ● People are appointed by
the right time. People in merit or promotion
particular should be in their because of their ability
jobs or positions most suited and not because of
for them. favoritism and whim.
[Link] and justice - ● Career opportunities for
Managers should be both the members are
friendly and fair to provided.
subordinates. ● Authority and
responsibility are clearly
[Link] of Staff- A high specified.
employee turnover rate is not ● Activities are routinized.
good for efficient functioning ● A rational and impersonal
of an organization climate exists.
[Link]-Subordinates
should be given the freedom 4. Behavioral School
to conceive and carry out
their plans, even when some  Elton Mayo (1880-1949),
mistakes result. Harvard professor
 Made a study of human
14. Motivation and esprit behavior at the Hawthorne
de corps- harmony, cohesion Plant of Western Electric
among personnel. Co from 1927-1932.
 Studied on how changes in
the physical work

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environment like intensity - Peter Drucker: father of
of lightning would affect modern corporate
productivity. management
 It was found out that - Consensual process where
changes in output could both management and rank-
be attributed to physical and-file meet in order to
changes. understand and agree on the
 Mayo and his associates organization’s objectives.
introduced a number of
factors such as increasing Management as decision
wages, having coffee making
breaks, shortening - Herbert Simon
workdays and introducing ○ 2 approaches to decision
rest [Link] making:
continued to improve. ■ Optimizing- search for
 He noted that special best alternative
attention given to workers (economic man)
developed group pride ■ Satisfying-using the first
that motivated them to workable solutions
improve their work (administrative man)
performance.
5. Motivational Theory
Hawthorne Effect  Douglas Mc Gregor
- Phenomenon based on the expressed two sets of
concept that human factors human nature
like attention, care and  He developed Theory X
recognition and not just and Theory Y
physical work environment
influence productivity.
Theory X
Social Process Theory ● average person is
- Mary Follet- collaboration inherently lazy
and cooperation ● doesn't like to work and
- Manager did not give will avoid work if he can
orders to the rank-and-file ● he works to survives
employee, but rather ● avoid taking more
worked together with responsibility prefers to be
them to study a given directed rather than act
situation and take the best independently
action based on the ● has little, or no ambition
specific needs present in ● not too intelligent
such situation. ● above all warrants security

Management by Objectives Task of Manager:

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● Theory X- to exercise strict 2. Strategy- method
control over his of doing things
subordinates to ensure 3. Structure- concern
that work is carried out with the physical
properly. plant and facilities
4. Systems-coherence
of all parts of the
Theory Y organization for a
● Views human nature common goal.
positively.
● People do not inherently o Soft “S”
dislike work, but rather 5. Staff- concern for
work as a source of the right people to
satisfaction. do the job
● Work itself can be 6. Skills-developing
motivating and rewarding. and training people
● Average person can learn 7. Style- manner of
not only to accept handling peers,
responsibility, but to seek subordinates and
it. superiors.

Task of Manager in Theory Y

Motivation and Hygiene
● To provide opportunities
for the subordinates to be Theory
creative, and productive,  Ferdinand Herzbergs-
and to encourage growth Two Factor Theory
and provide guidance. Hygiene Factors:
1. Salary
2. Supervision
3. Relations
Theory Z- William Ouchi 4. Safe and tolerable
- This humanistic nature working condition
focuses on finding better
ways to motivate people in
order to increase worker Motivation factors:
satisfaction and therefore, 1. Satisfying meaningful
productivity. work
2. Opportunities for
● 7 basic criteria Japanese advancement and
seven “S” achievement
○ Hard “S” 3. Appropriate responsibility
1. Superordinate 4. Adequate recognition
goals- holds
organization Hygienic Motivation
factors factors

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Adequate Satisfying it is completely
salary meaningful independent of others.
work  All organizations interact
Appropriate Opportunities with their environment.
supervision for  They are independent of
advancement their external environment
and for their existence.
achievement
Good Appropriate
interpersonal responsibility Basic input-output Model
relations ● Input from external
Safe and Adequate environment-people,
tolerable recognitions capital and managerial
working skills, technical knowledge
conditions and skills
● Task of the manager-to
transform these inputs
Hierarchy of NEEDS into outputs through major
● Abraham Maslow functions of management
which entail planning,
organizing, staffing,
directing, and controlling.

6. Systems Approach
 System is defined as a set
of assemblage of
interconnected
independent things that
form a complex whole. Leadership Concepts
 These things may be (p26)
physical, like part of an ● Leadership- ability to
engine; biological, like influence others to seek
parts of the human body; defined objectives
or theoretical, like ● Ability to move others
concepts, principles and ● Ability to persuade others
techniques. ● A function and not a role
 A system is considered or title
open if it interacts with its ● Dimensions of leadership
environment, and closed if ○ Leader → Follower
→ Situation

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independent, critical
Types of Followers: (28) thinkers and will fight for
1. Alienated- independent, what they believe is right.
passive, disruptive
2. Sheep- dependent,
uncritical, do as told Elements of Leadership (30)
3. Yes people- most ● Authority
dangerous, dependent, ● Power
uncritical, but active ○ French and raven
4. Survivors- least sources of power:
disruptive, lowest risk, ■ Legitimate power-
better safe than sorry bestowed upon a
5. Effective- self-leaders, leader by a given
good follower position in the
hierarchy of an
4 Essential qualities of effective organization.
followers: (29) ■ Expert power-
1. Self-management: the derived from special
key to being a good abilities or skills
follower is to think for unique to the leader.
oneself and to work well ■ Coercive power-
without close supervision. leader’s ability to
Effective nurses see punish subordinates
themselves as being for non-compliance
capable as their leaders. with his directives.
2. Commitment: effective ■ Reward power-
followers are committed to manager’s ability to
something beyond give rewards to
themselves. To a his/her subordinates
committed nurse, the for compliance with
leader facilitates making his/her orders or
progress toward achieving requests.
a goal. ■ Referent- based on
3. Competence and focus: relationships and
effective followers build connections.
their competence and ■ Information-
focus their efforts for derived from being
maximum impact. well-informed and up-
Competence centers on to-date.
mastering skills that will
be useful to the ● Basic
organization. components/Elements of
4. Courage: effective leadership:
followers establish ○ Vision- provides
themselves as direction to the
influence process.

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○ Influence- the ability to significant contribution
obtain followers, to the well-being of the
compliance, or request. group.
○ Authority- right to
expect or secure
compliance. Formula for Effective Leadership:
○ Power- ability to ● Knowledge, attitudes and
efficiently and skills in leadership
effectively exercise ● Therapeutic use of self
authority and control ● Good interpersonal
through personal, relations equals effective
organizational and leadership
social strength. ● Leadership cannot be
○ Responsibility- taught, it is learned
corresponding
obligation and
accountability answers Kinds of Influence: (32)
for all actions done. 1. Assertiveness- one
○ Accountability- sends direct messages to
answering for the result others and is able to stand
of one’s actions or up for her own rights
omissions. without violating those of
others.
● Power triangle: 2. Ingratiation- where an
○ Communication- apex individual makes another
of the power triangle. fee important or good
Communication holds before making a request.
utmost importance. 3. Rationality- convincing
Power is transmitted someone of the merits of a
through the way the detailed plan.
leader communicates to 4. Blocking- hostile form of
her followers. influence where an
Communication may be individual achieves the
good or bad depending goal of influencing another
on whether the person either with the
message was received threat of or the actual act
or not. of cutting off from
○ Influence- communication or
○ Recognition- a interaction the other
leader’s good deeds are person intended to be
recognized by the influenced.
group. It is the group 5. Coalition- collective form
that vests power on the of influence where a
leader because of what person gets several co-
they perceive to be her

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workers to “back her up” comes in all sizes,
when making a request. ages, shapes, and
6. Sanction- promise of conditions. A true
punishment leader is
7. Exchange- offering a faor distinguishable
or a personal sacrifice. through the
8. Upward appeal- consistently superior
obtaining support from top performance of her
management subordinates.
5. Personhood-
statesmanship,
Levels of leadership actualization
according to Act of Influence: o Only a proven leader
(34) may arrive at this level
1. Position- Title, and reap rewards that
intimidation are eternally
o First level of satisfying. The higher
leadership. The only a leader climbs along
influence a nurse can the five levels the
have at this level is longer it takes to
that which comes with reach to the next
the title. level.
2. Permission- relationship
level Characteristics of a Leader:
o It is based on how well
people know the 1. Do not have delegated
leader. authority
3. Production- result 2. May or not may not part of
oriented the formal organization
o Level of products and 3. Emphasize interpersonal
results. The biggest relationships
difference between 4. Direct willing followers
level 3 and 2 is that on 5. Have goals that may or
the “relationship” may not reflect those of
level, people get the organization
together for the sake
of it, while on the
“results” level, there is LEADER
a purpose for coming ● Inspires
together, or a desired ● May or may not have
result or outcome. official appointment
4. People development- ● Group vests power and
empowerment level authority
o According to Robert ● Influences other towards
Townsend, a leader goal setting

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● Risk taker and explorer of should bring both
new ideas enthusiasm and proficiency
● Relates to people to her assigned tasks, not
personally only for the sake of the task
● Rewarded by personal itself but for the benefit of
achievement those around her.
● May or may not be as
successful as managers A- Assertive, achiever
- A nurse should always know
MANAGER the reasons for doing things.
She should know not only
● Applies
what things should be done
● Officially appointed
but also why things must be
● Organization vests power
don’t
and authority
- A nurse should remember
● Implements goals
that there is a difference
● Measures risk to control
between being assertive as
performance
opposed to being
● Related to people as to
submissive. Being assertive
roles
means being able to:
● Rewarded by goal
o Express one’s feelings
accomplishment
● Are managers as long as o Choose how one will
the appointment holds act
them o Speak up for one’s
● Does the thing right rights when it is
appropriate
o Enhance one’s self-
Traits of a good leader: (22) esteem, to help
oneself develop self-
L- Lead, love, learn
confidence,
- She must act as the leader of o Disagree when one
the team when her skills and thinks it is important
experience level call for it. o Carry out plans for
She should also know how to modifying one’s
love because of the number behavior and asking
of diversity of patients she others to change their
will serve, none of whom she offensive behavior
can choose. Finally, she (Bower)
should be able to constantly
learn. D- Dedicated, desirous

E- Enthusiastic, energetic - She must be committed to

what she is doing. She
- A nurse must be able and should also have the desire
willing t work hard. She to pursue higher learning to

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continuously grow to procedure or policy. If
professionally. it is not covered by the
book, the nurse leader-
E- Efficient and effective manager refers to the
- A nurse should be able to do next level above her. The
right thigs and to do the bureaucratic nurse
things right. She should be leader-manager is really
certain in all her actions. She more of a police officer
should avoid ambiguity. than a leader. She
enforces the rules.
R- Responsible and respectful ○ Democratic- also called
the participative style as
- Her responsibility is directed
it encourages employees
to the patient. She is highly
to be part of the decision
respected by the people she
making. They share in
is leading.
the decision making and
problem-solving
Styles of Leadership: (47) responsibilities.
○ Laissez-faire- “hands-
● Continuum of leadership off style.” There is little
● Boss centered → or no direction from the
subordinate leader and the nursing
○ Autocratic- considered staff has much given
the classical approach. It freedom as possible. All
is one in which the nurse authority or power is
leader-manager retains given to the employees
as much power and and they must determine
decision-making goals, make decisions,
authority as possible. and resolve problems on
She does not consult the their own.
other nurses or co-
employees, nor are they
allowed to give any input According to Getzel’s and
in decision makinh. Guba:
Autocatic leaders rely on
● Nomothetic
threats and punishment
● Idiographic
to influence others, they
● Transactional
do not employees, yet,
● Paternalistic
autocratic leadership is
● Dynamic
not all bad.
● Benevolent autocrat
○ Bureaucratic- where
the nurse leader-
manager manages “by According to Managerial
the book”. Everything Grid/Blake and Muoton:
must be done according

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● According to task and ○ A. Great Man Theory
relations concerns: ○ B. Personality Trait Theory
○ Impoverished (traits and skills)
leader/avoider- low ■ Positive traits
task low relations ■ Negative traits
○ County club/friendly ○ C. Individual Character
helper- low task Theory (physical and
high relations psychological
○ Middle of the characteristics)
road/compromiser- ● Behavioral Theories
balance of task and ○ A. Field Theory of Human
relations Behavior (LEWIN)
○ Task centered/tough ■ Authoritarian,
battler- high task democratic, laissez-faire
low relations ○ B. Ladder of Influence and
○ dynamic/team Double Loop Learning
centered/problem or Model (Chris Argyris)
solver- high task ○ C. WAVE theory (Alvin
high relations Toffler)
○ D. Likert Scale and Linking
Pin Model (Rinses Likert)
Hofstede Contingency Model:
● Based on situation and ● Leadership Style by Likert:
maturity level of the 1. Exploitative- Authoritative
subordinate: a. Least effective
○ Maturity level 1- Telling performance
○ Maturity level 2- Selling b. FISTS is used,
○ Maturity level 3- CENTRALIZED and
Consulting/participating DOWNWARD, VERY FAR
○ Maturity level 4- SOCIAL DISTANCE
Delegating 2. Benevolent-Authoritative
● Types of Leader: a. Reward system,
○ Formal restricted upward
○ Informal communication,
● Behavior of leaders: selective delegation,
○ Passive or Non-assertive condescending to staff
○ Aggressive associates
○ Assertive 3. Consultative
● Face of Leadership a. Rewards and
○ Rational punishment,
○ Emotional Confidence in staff,
suggestions are
Leadership Theories and Models: sought, wide decision
making involvement
● Trait theories 4. Participative

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a. Most effective ● NETWORKING,COOPERATI
b. Complete confidence VE,PROCESS FOCUS
with staff, ideas always ● EMPLOYEE DEVELOPMENT
sought, aopen and ● ATTENDS TO NEEDS AND
communication in all MOTIVES
directions ● INSPIRES
● ROLE MODEL
CONTEMPORARY ● SENSE OF DIRECTION
LEADERSHIP THEORIES ● SELF-MANAGEMENT
● INFLUENCE CHANGE IN
1. Transactional leadership- PERCEPTION
exchange ● INTELLECTUAL
a. Contingent Reward- STIMULATION
incentives
b. MBE (Management
by Exception)- Servant Leadership (Robert
punishment, GreenLeaf)
correction
● Leader as steward of
c. Active Management
resources
by Exception-
● A good leader should
monitoring
serve first
d. Laissez- faire
○ Empathy
Leadership- hands-
○ Listening
off
○ Healing
○ Awareness
2. Transformational ○ Persuasion
Leadership- employee ○ Conceptualization
empowerment and development ○ Foresight
○ Stewardship
Transactional: ○ Commitment
○ Team building
● HIERARCHY,
COMPETITIVE,TASK FOCUS
● EXCHANGE POSTURE Emotional Intelligence in
● IDENTIFY NEEDS Nursing Leadership
● REWARDS
● CARETAKER ● Daniel Goleman
● DAY TO DAY OPERATIONS ● Attribute of EQ:
● MANAGEMENT BY 1. Self-awareness
EXCEPTION 2. Self-management or
● EXCHANGE FOR self-regulation
PERFORMANCE 3. Motivation
● CONTRACT FOR BENEFITS 4. Empathy
Transformational: 5. Social skills
● Four quadrant model of
EQ:

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○ Recognition preceptorships are
quadrant: encouraged
1. Self-
awareness
2. Social Motivation
awareness ● Definition
○ Regulation quadrant ○ Ability to stir people
3. Self- into action
management ○ Factors that initiate
4. Relationship and direct behavior
management ○ Mobilizes or
● Self-quadrant: energizes human
1. Self-awareness behavior
2. Self-management ● Sources of motivation:
● Social Quadrant: ○ Intrinsic motivation
1. Social awareness (internal)
2. Relationship ○ Extrinsic motivation
management (external)

Multiple Intelligence in Motivational Theories:

Nursing Leadership (Howard
Gardner) a. Content Theories:
i. Instinct theory-
1. Linguistic- word inherited or innate
2. Logical-mathematical- ii. Need theory
number, reasoning Need theories:
3. Spatial-picture
4. Kinesthetic-body 1. ABRAHAM MASLOW’S
5. Musical-music HIERARCHY OF NEEDS.
6. Interpersonal-people 2. The Two Factor Theory by
7. Intrapersonal-self Herzberg
8. Naturalist- nature 3. Mc Clelland’s Three Basic
Need Theory
4. Douglas Mc Gregor Theory
Quantum Leadership X and Y
● PORTER-O’GRADY AND 5. Theory Z by William Ouchi
MALLOCH (2003)
● Change dominates the HERZBERGS
climate
● Control is not an issue Hygiene Factors:
● Dynamic leadership
● Creativity and innovations 1. Salary
are encouraged 2. Supervision
● Educational advancement, 3. Relations
mentoring and

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4. Safe and tolerable working ○ Reinforcement or
condition Behavior Modification)
○ Response-consequence
connection is learned
Motivation factors: ■ Positive- praise,
1. Satisfying meaningful reward,
work commendation (to
2. Opportunities for strengthen desired
advancement and behavior)
achievement ■ Negative- used to
3. Appropriate responsibility inhibit
4. Adequate recognition ● Punishment
● Extinction
● Shaping (fixed or
David Mc Clelland variable
ratio/interval)
1. Achievement
2. Affiliation
3. Power

Process Theories:
1. Expectancy Theory (Victor
Vroom)
2. Operant Theory (BF
Skinner) Reinforcement
3. Equity Theory (Jo Stacy
Adams)
4. Goal Setting Theory (John
Locke)
5. Competent Theory

● Expectancy Theory
○ Beliefs and
consequences
○ 3 components:
perception of 3 things:
■ Expectancy-
belief/probability
■ instrumentality -
performance/
probability
■ Valence- value of an
outcome
● Operant conditioning

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