Study Guide:

DIRECTING: This includes delegation of work to be performed, utilization of policies and

procedures, supervision of personnel, coordination of services, communication, staff
development, and decision-making.
- Issuance of orders, assignments, and instructions that enable the nursing personnel to
understand what are expected of them.
- It actuates effort to accomplish a task. It is the connecting link between organizing for
work and getting the job done.
-
Directions:
• Must be complete, understandable and given in a logical order.
• Written directions prevent misunderstandings.
• Allowing staff members to ask questions clarify the aspects of the directions that
are not completely understood.
• Clear directions, follow-up and supervision help maintain quality of work.
Directing Includes:
• Delegation of work to be performed
• Utilization of policies and procedures
• Supervision of personnel
• Coordination of services
• Communication
• Staff development
• and Making Decisions

Delegation

- Delegating is the process by which a manager assigns specific tasks/duties to workers

with commensurate authority to perform the job. The worker in return assumes
responsibility for its satisfactory performance and is held accountable for its results.
- However, the ultimate responsibility and accountability rest with the Manager who
delegates the task. The Manager is accountable to his/her own superiors for getting the
job done right and on time.
- By delegating well-defined tasks and responsibilities, the nurse manager can be freed of
valuable time that can well be spent on planning and evaluating nursing programs and
activities.
- Delegation also trains and develops staff members who desire greater opportunities
and challenges in their work making them more committed and satisfied in their jobs.

Criteria of paramount importance in delegation are the worker's job description, his/her
knowledge base, his/her ability to carry out the task, and fairness not only to the employee but
to the team as a whole.
Principles of delegation:

Select the right person to whom the job is to be delegated. Make sure that the employee is
capable of doing the job. Give the employee the accountability and authority to do the job.
Delegate both interesting and uninteresting tasks. Uninteresting jobs can be used to challenge,
motivate, and increase a person's performance and commitment. Interesting jobs draw out the
best among employees and inspire them to higher achievement.
Provide subordinates with enough time to learn. Expertise can be achieved through training
and experience.
Delegate gradually. New employees may not be able to assume full responsibilities as
employees who have stayed longer on the job.
5. Delegate in advance. Specify goals and objectives to be met within a set time frame. Describe
the specific results expected out of the activities to be performed.
Consult before delegating. Clarification minimizes problems and promotes teamwork.
7. Avoid gaps and overlaps. A gap occurs when a job is left out with no one taking
responsibility; an overlap happens when two or more people have responsibility for the same
job, causing confusion and low morale.

What cannot be Delegated?

1. Overall responsibility, authority, and responsibility for satisfactory completion

of all activities in the unit.
2. The authority to sign one’s name is never delegated.
3. Evaluating the staff and/or taking necessary corrective or disciplinary action .
4. Responsibility for maintaining morale or the opportunity to say a few words of
encouragement to the staff especially to new ones.
5. 5. Jobs that are too technical and those that involve trust and confidence.

Why Nurse Managers Do not Delegate?

• Lack of confidence in their staff
• ·Feeling that only they could do the task better and faster
• ·Fear of loss of control if some of their duties are delegated
• In return, subordinates may be apprehensive in accepting delegated tasks for
fear of criticism, ineptitude, or incompetence
• ·Insecurities may be avoided through open communication

Nursing Care Assignment

Nursing care assignment may be called by various terms.
This is sometimes called modalities of nursing care, systems of nursing care, or patterns of
nursing care.
Four basic methods:
• Functional
• Total care (formerly termed as case nursing)
• Team nursing
• Primary nursing.

Functional Nursing

Itis task-oriented in which a particular nursing function is assigned to each worker.

This method divides the work to be done with each person being responsible to the Head or
Senior Nurse.
It is the best system that can be used when there are many patients and professional nurses are
few. It is suitable only for short-term use. If continued, it fragments the care of patients to tasks
only.

Advantages ;
1) it allows most work to be accomplished in the shortest time possible;
2) workers learn to work fast; and
3) because the tasks are repetitive they gain skill faster in that particular task. There is also
greater control over work activities and'it is aimed at conservation of workers and cost.

Disadvantages;
1) fragmentation of nursing care and therefore holistic care is not achieved;
2) nurses' accountability and responsibility are diminished;
3) patients cannot identify who their "real nurse" is;
4. nurse-patient relationship is not fully developed;
5) evaluation of nursing care is poor and outcomes are rarely documented; and
6) it is difficult to find a specific person who can answer the patient's or relatives' questions.
Total Care or Case Nursing
one nurse is assigned to one patient for the delivery of total care. The one-on-one pattern is a
common assignment for private duty nurses, for nurses in special care units such as the critical
care units or those in isolation, and for nursing students. However, this method works best when
there are plenty of nurses and patients are few. Also, nurses may not be familiar with patients in
other areas.

Team Nursing
Is a decentralized system of care in which a qualified professional nurse leads a group of nursing
personnel in providing for the nursing needs a group of patients / clients through participative
effort.

• Team leader assigns patients and tasks to team members according to job
descriptions. The team leader is responsible for coordinating the total care of a
group of patients.
• The intent of team nursing is to provide patient-centered care. The patients'
nursing care needs are identified and met through nursing diagnosis and
implementation of planned care.
• The heart of team nursing is the team conference. Through team planning, the
contributions of all team members are recognized and priority is given to
eliminating their weaknesses. Through supervision, the team leader identifies the
nursing care goals and focuses on attaining them through guidance and setting
of high standards of care.
• If not fully implemented, team nursing can lead to fragmentation of care. Also,
finding time for team conferences and care planning is sometimes difficult to
attain. In this method, only the team leader has significant responsibility and
 authority, and care may resemble functional method if the leader does not keep
members informed.

Primary Nursing
as a form of assigning responsibilities for patient care, is an extension of the principle of
decentralization of authority. Each registered nurse is responsible for the total care of a small
group of patients from admission to discharge.

• The primary nurse assesses the patient's needs for care, sets care goals, writes a
nursing care plan, administers care according to that plan, evaluates the
outcomes of care, and makes the necessary changes or adjustments as
necessary.
• Since the primary nurse assumes a 24-hour responsibility for nursing care,
secondary or associate nurses execute the nursing care plan during the afternoon
and night shifts and on days when the primary nurse is off-duty.
• The primary and secondary nurses are freed from administrative and
housekeeping responsibilities to maximize their time for patient care.
• Authority, accountability, and autonomy rest with the primary nurse.
The Head Nurse's role in this kind of assignment shifts from taskmaster, decision-maker and
coordinator of patient care to role model, consultant, and quality control expert for the
primary nurse in the unit.

The advantages of primary nursing include provision of or increased autonomy on the part of
the nurse thereby increasing motivation, responsibility, and accountability, it assures continuity
of care, makes available the increased knowledge of the patient's psychosocial and physical
needs, leads to increased rapport and trust between the nurse and the patient thereby
establishing therapeutic relationship, improves communication with members of the health
team; and eliminates the use of nursing aides in the provision of direct nursing care.

However, some claim that primary nursing increases staffing and costs since all aspects of
patient care are done by the professional nurse. Studies show that money is also saved when
non-nursing duties are performed by persons other than professional nurses.

Other Nursing Assignment:

Modular Method
Modular nursing is a modification of team and primary nursing.
• It differs from team nursing in that the registered nurse provides direct nursing care with the
assistance of aides.
• The professional nurse provides leadership, support, and instruction to the non-professional
nursing personnel.

It is similar to primary nursing in that each pair or team of nursing personnel is responsible for
the care of patients from admission to discharge, following discharge, and throughout any
subsequent admissions to the same institution.\

The greatest responsibility falls on the registered nurse who assesses the patient's needs, plans
and implements care, and assesses outcomes including guiding and instructing his/ her
partners.

Case Management
Case management is a system of patient care delivery that focuses on the achievement of
outcomes within effective and appropriate time frames and resources.

• It focuses on an entire episode of illness, crossing all settings in which the patient receives
care
• Care is directed by a case manager who ideally is involved in a group practice.

The case manager has responsibility and authority for planning, implementing, coordinating
and evaluating care for the patient throughout the period of illness.
Case Management tools:
1. Critical Path diagnosis
2. Case Manager Plan.

SUPERVISION

"supervide" which means

"to oversee or view directly.“ for the ATTAINMENT OF A SERVICE THAT IS BOTH EFFICIENT
AND EFFECTIVE.

• Providing guidelines for the accomplishment of a task or activity with initial

direction and periodic inspection of the actual accomplishment of the task or
activity
• It is the active process of directing, guiding, and influencing the outcome of a
person's performance of an activity.

LEGAL IMPLICATIONS: for DELEGATION AND SUPERVISION

Doctrine of respondeat superior which means

"let the superior answer for the acts of the subordinate."
The nurse who delegates is responsible for the acts of the subordinate and may incur liability if
found negligent in the process of delegating and supervising.

GOOD QUALITIES OF SUPERVISION

1. good technical, managerial and human relation skills;

2. ability to communicate well in both spoken and written language and ability to
listen;
3. firmness with flexibility to adjust to the needs of the situation;
4. fairness in dealing with employees;
5. familiarity with hospital and nursing policies that affect patient care;
6. good decision-making skills;
7. willingness to grow and develop;
8. ability to accept changes and consider them as challenges;
9. dignified and pleasing personality;
10. ability to motivate employees and provide opportunities for continuing professional
growth and development; and
11. advocacy for nurses and nursing.

PRINCIPLES OF GOOD SUPERVISION

1. Adequate planning and organization
 2. Gives autonomy to workers depending on their competency, personality, and
commitment
3. Stimulates the worker's ambition to grow into effectiveness.
4. Creates an atmosphere of cordiality and trust
5. Considers the strengths and weaknesses of employees.
6. Strives to make the unit an effective learning situation
7. Considers equal distribution of work considering age, physical condition, and
competence

Techniques in Supervision
A technique is a way of doing something.
• Techniques vary with the personality and ability of the individuals who are being supervised,
the activities that are being performed under supervision and the immediate circumstances.
• Any technique used for supervision must be based on sound democratic psychological
principles which takes account the nurses individuality...

Individual and group conference

2. Anecdotal record
3. Supervision of nursing procedure
4. Reassurance
5. Incidental teaching
6. Observation (Check List) and rating scale
7. Written Policies.

LEADING
• means to guide, to go before and show the way. (Webster Dictionary)
• Leadership is the art of developing people.
• "Leading," as defined in Webster Dictionary, means "to guide, to go before and
show the way.“
• Leadership in nursing is necessary to guide nursing personnel to a specific goal,
that is, the provision of quality nursing care to their patients.
• Leadership is the art of developing people.
• Leadership activities include directing which is actuating efforts to accomplish
goals; supervising or overseeing work of employees; and coordinating or unifying
personnel and services among others.
•

Situational Theory of Leadership

The theory considers a person's qualities and motivations, the role expectations of the group,
and the social forces at work such as the external factors that bring forth the leadership
potential.
FIVE KINDS OF LEADERS
1. The natural leader who becomes a leader in spite of himself/ or herself. He or she does not
seek the role but the group thrusts the leadership upon him/her by the tide of events.
2. The charismatic leader who is an authentic hero in the eyes of his/her followers. To them
he/she can do no wrong. He or she inspires people to make sacrifices for the cause they
represent.
3. The rational leader who is consistent and persistent in what he/she thinks is right.
4. The consensus leader who is perceived to be acceptable to all.
5. The leader who dominates by force and fear. He/She is ruthless in suppressing opposition.
He/She does not reign long. This type of leadership contains within itself the seeds of self
destruction.

Fiedler and Chemers state that in the work situation, the manager's leadership style and
expectations, and the followers' characteristics and expectations blend together and form a
productive combination.

• The nurse manager assesses each nurse's needs and determines which leadership
behaviors will help the nurse to do the work with the fewest problems.
• The nurse manager first considers the staff nurse's ability then determines the
nurse's willingness.
• The nurse manager, in a particular situation, either tells or teaches the staff
what to do and explains the benefits in learning from a new situation.
• He/She participates with the subordinate in doing a special procedure that the
subordinate is not familiar with.
• He/She delegates a more experienced staff to work with the employee until the
latter gains the skill and competence in performing a new task.

Trait theory of
leadership

• Kelly (1994) describes the personal, physical, and mental characteristics which
are associated with successful leaders.
• Trait theory is based on the belief that leaders are born with certain qualities that
properly develop to enable them to be successful leaders.

A broad classification of the six categories of traits is as follows:

• Physical characteristics such as age, built, height, weight, bearing
• Background information which includes education, social status, experient
• Intelligence --- knowledge, judgement, ability
• Personality --- decisiveness, authoritarianism,extroversion,
alertness,aggressiveness, enthusiasm,independence, self- confidence
• Task- oriented characteristics ---persistence,responsibility, achievement need,
initiative
• Social characteristics--- supervisory activity, popularity, prestige, tact, diplomacy
 • According to this theory, leaders are gifted with certain qualities that are
developed and which show in their ability to get along well with people and
persuade them to a course of action. They have forceful personalities, possess
integrity, and are efficient in their work.

THEORY Z:

• Theory by Ouchi
• It expands on Theory Y and emphasizes a democratic leadership approach,
emphasizing humanistic viewpoint and focuses on developing better ways of
motivating people.
Characteristics:
Collective decision making
• The opinion of each and every member of the group is taken.
Long-term employment
• Employees are usually employed by only one organization during the entire
career.
Slower Promotion
• Slower promotion allows time for the evaluation of the employee’s long-time
contribution to the organization.
Indirect Supervision
• Supervision is subtle.
Holistic concern
• Trust, fair treatment, strong commitment to the organization.

Leadership Qualities:

1. A leader possesses a striking physical personality and is energetic.

2. A leader possesses a sense of purpose and direction. A leader knows his or her own
personal objectives and those of the group. He/She is able to set goals and move
towards that direction.
3. A leader has the power of ready speech. He/She is able to communicate in both written
and spoken language.
4. A leader is enthusiastic about the purpose of the group and is devoted to its cause.
5. A leader has keen insight into the human nature of people.
He/She has faith and trust in the people he/she leads.
6. A leader displays courage and persistence even in the face of opposition.
7. A leader is decisive. He/She uses independent judgment and does not hesitate to consult
others when needed.
8. A leader is cheerful and even-tempered.
9. A leader shows technical mastery that inspires others to do above average performance in
their jobs.
10. A leader is intelligent, versatile, and has a keen sense of humor.
11. A leader has moral vision, integrity, and idealism.
Leadership Styles:

The extent to which the leader influences his/her subordinates in achieving their objectives of
patient care, depends on the leadership style he/she exhibits. A style is a way in which
something is said or done. It is a particular form of behavior associated with the individual.
Leadership styles are basic approaches to management.
The most common leadership styles are autocratic, democratic, permissive, and situational.

Autocratic Leadership
• The autocratic leader gives orders and expects adherence to policies and procedures.
Subordinates are expected to follow without question. This style provides strong
motivation and psychological regard for the leader. It is most effective in crisis situations
when highly specialized skills are required and options for activities are limited. It is used
to bring order out of chaos.
• This style is sometimes called "centric" because the leader makes the decision for the
group. He/She is the center of attention.
• If the follower makes a decision, the leader questions him/her, implying that there is a
better way of doing things known only to him/her.
• The autocratic style of leadership is also called Theory X by McGregor. This is boss-
centered.
• The leader thinks all workers are lazy, need to be coerced and threatened with
punishment, indifferent to organizational goals, resistant to change, not very bright and
cannot be trusted, want to avoid responsibility and are more interested in financial
incentives than personal achievement.
• Workers fear the leader. They become blind followers and most often they avoid their
leader.

Democratic, Participative, or Consultative Leadership

• Democratic leadership is people-oriented.
• It focuses on human aspects and builds effective teamwork.
• Interaction between the leader and subordinates is open, friendly, and trusting.
• Collaborative spirit and joint efforts exist. It allows governance through group
participation in decision making, open communication prevails.
• According to McGregor this style of leadership is called Theory Y.
• The leader considers workers as ambitious. He/She does not resist change, is creative,
exercises self direction and self control.
• There is cohesiveness among members, greater job satisfaction, and few feelings of
hostility and frustration.
• This style will satisfy higher human needs resulting in greater employee responsibility
which in turn leads to high productivity. It is the most desirable form of management.
• The democratic leader is also called "radic" leader because he/she radiates out to
encompass the needs of others.
Permissive, Ultraliberal, or Laissez-faire Style of Leadership:

• The laissez-faire or "let alone" style of leadership is one in which the leader who is
appointed manager abdicates leadership responsibility and leaves workers without
direction, supervision, or coordination.
• The workers lack central direction and control.
• This style of leadership is effective in highly motivated professionals, like those in
research, where independent thinking is rewarded.
• It is not useful in organizations that are highly structured such as the healthcare delivery
system where organization and control form the baseline of most operations.
• This kind of leader is permissive with little or no control, motivates by support when
requested by the group or individual, puts emphasis on the group, does not criticize,
disperses decision making within the group, and provides little or no direction at all.

Leadership Skills
Skills in personal behavior - This requires sensitivity to the feelings of others, identification with
the needs of the group, acceptance of other people's suggestion rather than criticizing or
ridiculing them, and helping others feel important and needed.
Communication skills - This means the ability to listen attentively to the opinions of others, to
establish positive communication within group, and to make sure everyone understands what
are expected of them. It also includes getting feedback from followers and recognizing that
everyone may have important contributions to make.
Organization skills.- This includes willingness to assist the group in making short- and long-
range plans and objectives; to share responsibilities and opportunities; to implement plans,
follow up, and evaluate results, and to participate in problem solving.
Skills in self analysis - This means awareness of personal motivations, of own strengths and
weaknesses, and willingness to improve them. It also includes assisting the group in recognizing
and utilizing the Filipino values essential to caring for their patients.

Essential Qualities of Nurse Leaders:

Intellectual, technical, and administrative skills;
•Integrity, honesty, ability to work with others:
•Tact and emotional stability;
•Ability to win the support and loyalty of fellow-workers;
•Good human relationships with co-workers.

Decision Making:

• Decision-making is described as the process of choosing a course of action from

multiple alternatives to achieve a specific goal or outcome. In nursing, this often
 involves making choices that affect patient care, resource allocation, and staff
management.
Importance of Decision-Making:
• Effective decision-making is essential for ensuring patient safety and quality care. Nurse
leaders must make timely and informed decisions to address the complexities of patient needs
and healthcare environments.

Types of decision:

• Routine Decisions/Programmed : Day-to-day choices that are often straightforward.

• Complex Decisions/Unprogrammed: Involving multiple factors and requiring thorough
analysis, such as ethical dilemmas or resource management issues.

Decision Making Model:

This structured decision-making model involves the following steps:

D: Define the problem.
E: Establish criteria for a successful outcome.
C: Consider all possible alternatives.
I: Identify the best alternative.
D: Develop and implement a plan.
E: Evaluate the outcome.

A structured framework that helps nurses identify problems, gather information, evaluate
alternatives, and make informed choices.

Factors Influencing Decision-Making:

Several factors can influence decision-making, including:

•Data and Evidence: Utilizing clinical guidelines, research findings, and patient data to inform
decisions.
•Team Input: Collaborating with team members to gather diverse perspectives and insights.
•Ethical Considerations: Balancing patient autonomy, beneficence, and justice when making
decisions that impact care.

Key Components of Decision-Making:

1. Evidence-Based Decision-Making:
Decisions should be informed by the best available evidence, including clinical guidelines,
research, and data. Leaders in nursing management must rely on evidence-based practice to
ensure patient safety and high-quality care.
Example: A nurse manager might review recent studies to decide on implementing a new
protocol for infection control in the unit.
2. Collaborative Decision-Making:
Involving staff and team members in decision-making encourages a sense of ownership,
improves morale, and leads to better solutions. This approach aligns with democratic leadership
styles, where input is valued from everyone.
Example: During a staffing shortage, the nurse leader might gather input from nurses to identify
the most effective shift scheduling changes.

3. Ethical Decision-Making:
Nurse leaders must consider ethical principles such as autonomy, beneficence, and justice when
making decisions, particularly when dealing with sensitive patient care issues or conflicts among
staff.
Example: When facing an end-of-life care decision, a nurse manager needs to respect the
patient’s wishes and balance those with the healthcare team’s concerns.

4. Critical Thinking and Problem-Solving:

Effective decision-making requires critical thinking skills, including analyzing situations,
anticipating outcomes, and identifying potential risks. Leaders should be able to break down
complex problems and find practical solutions.
Example: A nurse manager dealing with high patient acuity must quickly allocate resources and
redistribute the nursing staff to ensure patient safety

5. Delegation and Prioritization:

Nurse leaders often have to make decisions about which tasks can be delegated to others and
which require their direct involvement. Prioritizing tasks based on urgency and importance is a
key component of effective leadership.
Example: In a busy unit, a nurse manager may delegate routine patient assessments to
experienced nurses while focusing on coordinating care for critically ill patients.

6. Communication in Decision-Making:
Clear communication is essential in ensuring that decisions are understood and implemented by
the team. Nurse leaders must be able to explain the rationale behind decisions to gain buy-in
from staff and ensure smooth execution
Example: If a new patient care policy is introduced, the nurse manager must communicate the
change effectively to all nursing staff, explaining the benefits and addressing concerns.

7. Resource Management:
Decision-making often involves managing resources such as staffing, budget, and equipment.
Nurse managers need to balance competing priorities, ensuring that resources are used
efficiently without compromising patient care.
Example: A nurse leader may need to decide how to allocate overtime hours to nurses while
staying within budget constraints and meeting patient care demands.

Leadership Roles of a Professional Nurse

Academe:
• Educator: Professional nurses in academic settings develop and deliver nursing curricula,
teach theoretical and clinical courses, and assess student learning. They also foster
critical thinking and clinical reasoning among students.
• Mentor: Mentoring involves guiding nursing students or novice faculty, providing
support in their professional development, and sharing knowledge and experiences to
foster growth.
• Curriculum Developer: This role entails designing, updating, and evaluating nursing
education programs to ensure they meet current healthcare standards and incorporate
evidence-based practices.
• Administrator: In administrative roles, nurse leaders manage nursing programs, oversee
faculty, handle budgeting, ensure accreditation compliance, and promote the integration
of research and practice in education.
Research
• Principal Investigator: As lead researchers, nurses design and conduct studies to
advance nursing knowledge and improve patient outcomes. This includes securing
funding and managing research teams.
• Research Coordinator: This role involves overseeing research projects, ensuring
compliance with regulatory standards, managing data collection, and facilitating
communication among stakeholders.
• Advocate for Evidence-Based Practice: Nurse leaders promote the integration of
research findings into clinical practice, advocating for the use of evidence to enhance
patient care and policy development.

Service:

• Clinical Leader: Clinical leaders manage nursing teams, facilitate communication, and
ensure that quality and safety standards are met. They are responsible for decision-
making in clinical environments.
• Mentor: In clinical settings, experienced nurses mentor new graduates and less
experienced colleagues, providing guidance on best practices and professional
development.
• Policy Developer: Nurses contribute to developing and implementing clinical policies,
protocols, and procedures that govern nursing practice, ensuring they align with
organizational goals and patient needs.
• Interprofessional Collaborator: This role involves working with a multidisciplinary team
to provide holistic patient care, improving communication and collaboration among
healthcare professionals.
Community
• Health Educator: Nurses in the community provide education on health promotion,
disease prevention, and healthy lifestyles through workshops, seminars, and outreach
programs.
 • Advocate: Community nurses identify health needs within populations and advocate for
resources, services, and policies that address those needs, often working with local
organizations and policymakers.
• Program Director: In this capacity, nurses lead and manage community health
programs, coordinating efforts to improve public health outcomes, often targeting
specific health issues or demographics.
• Community Organizer: This role involves mobilizing community members, fostering
partnerships, and creating initiatives that empower individuals and promote health
equity

Professional Organizations:

• Manager/Administrator: Nurse leaders in management roles oversee nursing

operations, staffing, budgeting, and strategic planning within healthcare organizations
to ensure efficient service delivery.
• Change Agent: Nurse leaders drive change initiatives, advocating for innovative
practices, process improvements, and cultural shifts within healthcare settings to
enhance patient care and staff engagement.
• Quality Improvement Leader: In this role, nurses implement quality improvement
initiatives, measure outcomes, and analyze data to improve clinical practices and patient
safety.
• Strategic Planner: Nurse leaders participate in long-term planning processes, aligning
nursing services with the overall goals of the organization and adapting to changes in
the healthcare landscape.

Power
the ability to impose the will on others to bring about certain behaviors.
Most important ingredient of a leader or manager in an organization.
Power may also be conceptualized as “one’s ability to get things done through mobilizing
resources and to get and use whatever it is that a person needs for the goals he or she is
attempting to meet”

Types of Power:

1. Legitimate Power: Derived from the position a nurse hold in a group and it indicates the
nurses degree of authority.
2. Expert Power: Derived from knowledge and skills they possess.
3. Referent Power: Power derived from how much others respect and like any individual, group,
or organization.
4. Connection Power: Power that comes from personal and professional relationships enhancing
one’s resources and capacities.
5. Reward Power: U sing reward to influence people to change behavior, incentives the leader
can provide for the subordinates and value by the group.
6. Coercive Power: The ability to administer of punishment or disciplinary action against
others to influence them in changing behavior.
7. Personal power = authenticity, trust, integrity. Based on authenticity, trust, integrity
8. Symbolic power = what you symbolize. Based on the reputation of one’s workplace,
profession.

Empowerment in Nursing Leadership: The process of enabling nurses to take control of

their professional practice, fostering a sense of autonomy, confidence, and decision-making
capacity. An empowered nursing workforce leads to increased job satisfaction, better patient
outcomes, and enhanced team collaboration. Leaders who empower nurses provide them
with the tools, resources, and authority to practice effectively, make decisions, and address
challenges within their scope of practice.

Structural Empowerment Theory by Kanter (1993): According to Kanter Rosabeth Moss,

empowerment is not a personal trait but a result of access to specific structural
components within an organization. It emphasizes the role of organizational structures in
empowering employees.

The following factors can empower nurses under this theory:

1. Access to Information: Nurses need knowledge about the organization, patient care
practices, and any relevant updates.
2. Access to Resources: Having the necessary resources, such as time, supplies, and
equipment, to perform their job effectively.
3. Access to Support: Nurses must have guidance from leadership and peers, providing
feedback and reinforcement.
4. Access to Opportunities: Nurses should have opportunities for growth, development,
and recognition through education, promotion, or special projects.

Psychological Empowerment Theory (Conger & Kanungo, 1998):

It focuses on an individual’s sense of empowerment rather than the organizational structure.

Psychological empowerment refers to the intrinsic motivation and self-efficacy an individual
feels when they believe they can perform their job competently.

Following factors can empower nurses under this theory:

1. Meaning: Nurses must feel that their work is meaningful and aligned with their values.
2. Competence: Nurses must believe they have the skills and knowledge required to
perform their job well.
3. Self-determination: Nurses must have autonomy or control over their work, allowing
them to make decisions and solve problems.
 4. Impact: Nurses need to feel that their work makes a difference, influencing
organizational outcomes and patient care

Disempowerment:

It refers to the process or state where nurses feel stripped of their autonomy, confidence,
and decision-making capacity.
This results in diminished motivation, engagement, and effectiveness in their professional
practice.
Disempowerment occurs when nurses are not provided with the resources, authority, or
support they need to carry out their roles successfully, leading to frustration, job
dissatisfaction, and a sense of helplessness.

Key Characteristics:

Lack of Autonomy: Nurses feel they have little control over their practice, unable to make
decisions or act independently within their roles.
• Limited Access to Resources: Nurses may be deprived of essential tools, time,
information, or equipment necessary to provide quality care, leading to burnout and
stress.
• Absence of Support: A lack of guidance from leadership or a non-collaborative team
environment can create feelings of isolation and helplessness.
• Inadequate Opportunities for Growth: When nurses do not have opportunities to
develop professionally, such as through education or advancement, they may feel stuck
or undervalued.
• Low Morale: Disempowered nurses may feel demotivated, lacking the enthusiasm or
confidence needed to engage in their work.

Effects:
• Poor Job Satisfaction: Disempowerment can lead to a decline in morale, which, in turn,
results in lower job satisfaction and increased turnover.
• Reduced Quality of Care: When nurses feel disempowered, they may not be as proactive
in-patient care, leading to potential negative outcomes for patients.
• Increased Burnout: Without autonomy and support, disempowered nurses are more
prone to burnout, which can further reduce their ability to perform effectively.
• Limited Innovation: Nurses who feel disempowered are less likely to engage in creative
problem-solving or suggest improvements, which can stifle innovation in care delivery.

Five categories of Leader Empowering Behaviors:

• Enhancing the meaningfulness of work

Ø Leaders frequently emphasize how nurses’ work is important and valued.
Ø “Your work really makes a difference to the quality of patient care.”
• Fostering participation in decision-making
Ø Leaders regularly ask for staff input and follow through on collaborative staff decisions.
Ø Nurse leaders have frequent formal and informal conversations with staff during daily
huddles, staff meetings, walkabouts, and 1-on-1s.
Ø “Tell me your ideas about this new technology.”
• Facilitating goal accomplishment
Ø Leaders provide resources, such as continuing education/certification opportunities for
staff to accomplish their goals.
Ø “You show a lot of aptitude in care of critically ill patients. Would you like to take critical
care certification courses?”
• Fostering confidence of staff
Ø Leaders express a “you can do” attitude.
Ø In the example above (goal accomplishment) the leader says:
• “I think you can be very successful in this area of nursing.”
• Promoting freedom from bureaucratic restraints
Ø Leaders eliminate unit-level policies that are outdated, obsolete.
Ø “Let’s form a governance council of nurses to review our unit policies and eliminate ones
that are outdated.”

Theoretical Triad in the Organization:

The Reciprocal Role

The effectiveness of an organization can be determined on the basis of how well followers
follow.
We often find ourselves occupying two roles: one of leader, another as follower; when we
have subordinates, we also have bosses

Some individuals choose to stay in follower roles and serve as team players who gain
satisfaction from helping accomplishing the goals of the organization in that role

FOLLOWERSHIP Followership is not a passive role. On the contrary, the most valuable
follower is a; 1. skilled 2. self-directed professional 3. one who participates actively in
determining the group's direction4. invests his or her time and energy in the work of the
group 5. thinks criti-cally, and advocates for new ideas

The quality of the Followers

1. They manage themselves well
2. They are committed to the organization and to the purpose, principle, or person outside
themselves
3. They build their competence and focus their efforts for maximum impact
4. They are courageous, hones, and credible

Being a good follower

1. Invest in yourselves
2. Clearly identify your responsibilities as follower
3. Clearly identify your expectation of the leader
4. Support your leader and your group
5. Provide stimulation for your leader and your group
6. Follow channels of communication and responsibility\

According to Venzon and Nagtalon (2006), fellowship/followership in leading includes:

Active Participation: Fellows actively provide feedback and solutions, helping leaders make
informed decisions based on frontline experiences.
Collaboration and Teamwork: Nurses work with leaders to implement care, solve problems,
and ensure effective team efforts for quality care.
Supportive Challenge: Fellows question and challenge leaders when needed, helping
refine decisions and improve outcomes.
Empowerment: Leaders empower followers by building their confidence and skills, allowing
them to take initiative and leadership roles.

Communication:

Is the transmission of information, opinions, and intentions between and among individuals.

Purposes of Communication:
It facilitates work
increases motivation effects change
optimizes patient care
increases workers’ satisfaction
facilitates coordination
It helps promote trust between the health
personnel and the clients.
it provides basis for leadership action.

Communication Process:

Communication in Nursing:

Nurses who provide care uses communication as they assess patient’s needs, make
nursing care plans, and implement and evaluate the effectiveness of such care. They
utilizes communication in health teaching especially in motivating patients and their
families to assume primary responsibility of their own health care.

Principles of Effective Communication:

[Link] lines of communication serve as the linking process by which parts of the
organization are unified toward goal achievement.
2. Simple, exact, and concise messages ensure understanding of the messages to be
conveyed.
3. Feedback is essential to effective communication.
4. Communication thrives best in a supportive environment which encourages positive
values among its personnel.
5. A managers’ communication skill is vital to the attainment of the goals of the
organization.
 6. Adequate and timely communication of work-related issues or changes that may affect
jobs enhances compliance.

Types of Communication:

. Verbal Communication
• Involves spoken words.
• The speaker must be able to speak slowly, enunciating words clearly.
• Words that can be clearly understood should be used instead of too technical terms.
• Only relevant information should be conveyed to prevent confusion.
2. Written Communication
• Must be clear, correct, complete and concise.
• This should be written in words that are clearly understood by the reader.
• It comes in the form of memoranda, hospital orders, documentation, records and
reports, policies, procedures
3. Non-verbal communication
• Transmission of message without the use of words.
• People oftentimes unconsciously use facial expressions, gestures, touch, body language,
or vocal tones.

Forms of Non Verbal Communication:

1. Personal Appearance - The appearance of a person gives the general impression of

his/her personality and self concept.
2. Intonation of the voice - The intonation of the nurses’ voice should be soft and gentle.
3. Facial Expression - A friendly smile establishes immediate rapport with the client and
invites trust and confidence in the nurse.
4. Posture and Gait - The nurse’s posture and gait indicate his/her physical wellness,
emotions, and attitude towards the clients.
5. Touch - A way of caring. A gentle touch conveys a caring person. A rough touch indicates
insensitivity to the patients and unresponsiveness to their needs.

Four Dimensional Flow of Communication in Nursing Care

Downward: flows from superior to subordinate, often through multiple management levels.
It is primarily directive, coordinating activities at different levels.
Purpose: to inform personnel about what they need to know, what to do, and why they
should do it.
Examples include:
Policies, rules, and regulations
Memoranda and handbooks
Interviews and job descriptions
Performance appraisals.

Upward: Flows from subordinates to superiors, typically as feedback on how well directives
are received and implemented.
Often less frequent due to subordinates' hesitation or inability to express thoughts.
Supervisors and Head Nurses play a critical role in facilitating upward communication.
Tactful questioning and observation help detect misunderstandings and ensure effective
implementation.
Examples include: Discussions, grievance procedures Written, incident, and statistical
reports.

Horizontal: Flows between peers, personnel, or departments at the same level.

Commonly used for endorsements, shift changes, nursing rounds, meetings, and
interdepartmental referrals.
Open communication ensures better coordination and cooperation, leading to a smooth
workflow.
Outward: Involves communication from caregivers to patients, families, visitors, and the
community.
Ensures patients understand their illness, treatment plans, and nursing care to participate in
decisions.
The organization’s public image is shaped by how well employees convey its philosophy,
mission, and policies.
Positive communication about work can lead to supportive families.
Job satisfaction is linked to open communication, positive
employee-supervisor interactions, and performance feedback.

Barriers To Communication:

Professional nurses are required to communicate patient information to other members of

the nursing team. Although this may sound easy, there are many potential barriers to
communication.
These barriers may be physical, psychological, semantic, or even gender-related.

1. Physical Barriers
2. Psychological Barriers
3. Semantic Barriers
4. Gender Barriers

Physical Barriers
Physical barriers to communication include extraneous noise, too much activity in the area
where the communication is taking place, and physical separation of the people trying to
engage in verbal interaction.
Psychological Barriers
Psychological "noise," such as increased anxiety, may interfere with the ability to pay
attention to the other speaker. Social values, emotions, judgments,and cultural influences
also impede communication. Previous life experiences and preconceived ideas about other
cultures also influence how people communicate.
Semantic Barriers
Semantic refers the meaning of words. Sometimes, no matter how great the effort, the
message just does not get across.
Gender Barriers
Men and women develop dissimilar communication skills and are inclined to communicate
differently. Often, they give different meanings to conveyed information or feelings. This
may be related to psychosocial development.

Barriers to communication among health-care providers and health-care provider

recipients:

. Low Health Literacy

 Individuals who lack the skills necessary to acquire and use health-care information are
less likely to manage their chronic conditions and/or medication regimens effec-tively. For
this reason they utilize health-care facilities more frequently and have higher mortality
rates.
2. Cultural Diversity
Nurses work in environments rich in cultural diversity. This diversity exits among both
professionals and patients. Culture affects communication in how the content is conveyed,
emphasized, and understood. These factors affect how the communicators between
individuals occurs simultaneously as the nicators process and act on the information.
Cultural Competence
Cultural competence affects the way health-care providers interact with each other and with
the populations they service. Cultural competence includes a set of similar behaviors,
attitudes, and policies that, when joined together, enable individuals or groups to work
effectively in cross-cultural situations.

4. Interprofessional Communication Education of Health-Care Providers

Challenges exist when communicating with professionals in other disciplines. Some
difficulties in interprofessional communication are related to the use of concepts and
terminology common to one specific discipline but not well understood by members of
other professions. This interferes with another professional's understanding of the meaning
or value of the situation.

Coordination

It unites personnel and services toward a common objective

-Prevents overlapping of functions, promotes good working relationships, and ensures work
schedules are accomplished as targeted
At the unit level, supervising nurses and head/senior nurses coordinate their work with
other departments, services and units by conveying clearly-defined policies, standard
operating procedure s, policies, and guidelines using proper channels of communication.

Coordination with the Medical Service

NURSES’ ROLE WITH MEDICAL STAFF:
• Nurses should be familiar with the medical staff and their schedules
• the must know:
• patients’ conditions
• diagnosis and treatment plans
• participate in care planning for each individual patient
nurses’ ACTIVE ROLE IN PATIENT CARE: BEYOND IMPLEMENTING CARE
Nurses must actively participate in the planning of care.
- Use feedback on patient responses to treatments and medications.
- Report issues like drug unavailability or adverse reactions immediately.
nurses’ ACTIVE ROLE IN PATIENT CARE:CONFERENCES AND PROBLEM SOLVING
Regular meetings help resolve patient care challenges.
- Mutually satisfactory solutions are discussed.

Coordination with the ADMINISTRATIVE Service

Focus Areas:
Both human and material resources. - Nurses help with:
1. Budget planning for staffing and materials.
2. Maintenance and preventive care of equipment.
3. Inventory management to avoid shortages and wastage.
KEY TASKS: Proper scheduling of equipment maintenance.
- Preventive maintenance to avoid costly repairs.
- Training staff on the use of new equipment.

Coordination with the LABORATORY Service

Laboratory Exam Request: Nurses forward lab exam requests to the Lab Unit.
- Proper collection of specimens (blood, urine, etc.) and delivery to the laboratory
PREPARAING PATIENTS: Patients are briefed on special preparations, e.g., fasting for certain
tests.
- Attach reminders to patient charts for clarity.

Coordination with the RADIOLOGY Service

X-RAY AND IMAGING REQUESTS: Requests for X-rays and other imaging procedures are
forwarded to the Radiology Service.

Special Preparations:
Nurses should check patient allergies and inform the radiology team if needed.
- Nurses help in attaching bed tags with special instructions like fasting or food restrictions
before exams.
- ASSISTANCE SHOULD BE MADE BEFORE AND AFTER THE SCHEDULED TIME AND PROCEDURE.

Coordination with the Pharmacy Service

Drug Procurement Policies: Formulated by Administrative, Medical, Nursing Services, and

Pharmacy; distributed to all nursing units for guidance.
Hospital Drug Formulary: Pharmacy provides the formulary and ensures the efficient
administration of drugs using the Unit Drug Dose System (UDDS).
Pharmacy Hours: 24-hour pharmacy: Drugs are provided as prescribed.
Limited Hours:
• Emergency drugs are stocked for night and afternoon shifts, with consumption
reported the next day.
Narcotics
• Prescibed on yellow sheets with the patient’s and physician’s details.
• Stocking discouraged, but if necessary, narcotics are locked, and the Head Nurse
holds the key.
 • Usage recorded and endorsed at shift changes, with reports sent to the
pharmacy.
•
Clinical pharmacies : Manned by clinical pharmacists who prepare medications.
• Nurses must verify drugs, their doses, and possible reactions before
administration.
• Nurses are liable for mistakes if they fail to exercise proper care and judgment.

Coordination with the dietary service

• Diet List: Head Nurse forwards patients’ diet lists, considering special diets, food
allergies, preferences, and religious restrictions.
• Nutrition Counseling: Patients needing special diet instructions are referred to a
Nutritionist.
• Diet Preparation: Dietary Service prepares and delivers meals. Nurses ensure the
correct diet reaches the correct patient.
• Feeding Assistant: Nurses help patients with feeding when needed and observe
their appetite and satisfaction with the food.
• Feedback: Nurses provide feedback on meal timing, presentation, and patient
comments to the Dietary Service.
• Pre-Discharge Planning: Special diet instructions are given before discharge for
patients who need it, considering seasonal foods and patient preferences.

coordination with the Medical Social Service

• Nurses coordinate with the Medical Social Service by referring patients with
psycho-socio-economic problems.
• Volunteer civic groups, such as those providing reading materials to patients or
those who need spiritual services of a priest or a minister of their faith usually
coordinate their service through the Medical Social Service.

coordination with the Medical Records Service

• Nurses are not allowed to release any information about the patient. This is the
responsibility of the Medical Records Officer/Librarian.
• Discharged patient’s charts are forwarded to the medical records within 24
hours.
• Nursing Audits ensure quality of documentation.
• Retrospective audits are performed on discharge patients’ charts.
Coordination with Community Agencies, Other Institutions, and Civic Organizations
• Two-way referrals are made so that the hospital can have a feedback on the
action taken by the agency to whom the patient is referred.
• Patients are often referred to the health center nearest their residence upon
their discharge from the hospital for follow-up.
• Hospitals with no facilities for special examinations link with tertiary hospitals
which have these facilities.
 • Civic organizations or religious groups offer their services through visitations,
providing religious services, donations of medicines, or making of dressing.

STAFF DEVELOPMENT (Please refer to Scanned Venzon’s Book)

Motivational Theories

NEED THEORIES

Abraham Maslow’s Hierarchy of Needs

is a psychological theory that describes the stages of human needs, starting from the most basic
and progressing towards the most complex. Maslow proposes that individuals are motivated to
fulfill these needs in a hierarchical order, with lower-level needs needing to be met before
higher-level needs become prominent.

The first level of these needs includes physiological need for survival such as food, sleep,
clothing, and shelter. When these needs are met, other levels of needs emerge and dominate.

The second level includes need for safety, security, and protection. The employee needs to be
free from physical harm and deprivation of basic physiological needs. He/ She needs a
secured shelter where he/she can establish a family. Employee benefits are aimed at security
needs.

The third level is the need to belong which relates to affiliation or sense of belonging, affection,
closeness, and intimacy. These are social needs. In nursing work groups, social support and
cohesion are examples of belonging needs.

The fourth level includes esteem and ego needs. These are needs to achieve independence,
respect, and recognition from others. Satisfaction of esteem needs results in prestige, self-
confidence, power, and feeling of usefulness. Recognition is an important motivation in nursing.

At the apex of the pyramid is the need for self-actualization-the need to maximize one's
potential and achieve a sense of personal fulfillment, competence, and accomplishment

2. The Two-Factor Theory

Frederick Herzberg (1991)
is credited with developing a two-factor theory of motivation which was first published in 1968.
Hygiene factors
relate to the working conditions such as salary, quality of supervision, job security, interpersonal
relations policies, and supervision. These factors are growth-producing motivations for
employees and prevent lost productivity due to dissatisfaction. These hygiene factors are called
"dissatisfiers."
Motivating factors
relate to the job itself and include opportunities for growth and development and
advancement; added responsibilities, challenging aspects of work, recognition, and
achievement. These factors are called "satisfiers."

Nurse managers should utilize hygiene and motivational factors to recruit and retain staff, as
hygiene is essential for work success and motivational factors inspire work performance.

McClelland's Three Basic Needs Theory

This theory identifies three basic needs that people possess in varying degrees: achievement,
power, and affiliation.
The Need for Achievement refers to a strong desire to overcome challenges, excel, grow,
advance, or succeed. Individuals with a high need for achievement set moderate but achievable
goals, take personal responsibility for finding solutions to problems, and have a strong desire for
making progress.
The Need for Power is the desire to be in control and to get others to behave contrary to what
they would naturally do. Individuals with a high need for power spend much time thinking
about how to gain authority, dominate decisions, and change others' behavior. They are
articulate, demanding, and manipulative in dealing with peers and subordinates.
The Need for Affiliation is the desire to work in a pleasant environment and to have friendly,
close relationships. Individuals with a high need for affiliation seek out meaningful friendships,
want to be respected and liked, avoid decisions that oppose the group, and are more interested
in high morale than productivity.

II. EXPECTANCY Theory

Victor Vroom's expectancy theory of human motivation (1964) indicates that felt needs of
individuals in work settings are increased if a person perceives a positive relationship between
effort and performance. Motivated behavior is further increased if there is a positive
relationship between good performance and outcomes or rewards, particularly when these are
valued.

Applied to nursing, expectancy is the perceived probability of satisfying a particular need based
on past experience. Therefore, managers need to provide specific feedback about positive
performance.

B.F. Skinner's Operant Theory (1969)

• Focuses on how external environmental conditions influence human behavior,
particularly in the context of motivation.
• Unlike theories that emphasize internal needs and desires, Skinner's theory
posits that external consequences shape and regulate behavior.
• The theory differentiates between two types of behavior: “Respondent behavior
and Operant behavior.”

Respondent behavior - results from direct stimulation. No learning involved—it’s simply a

reaction to an external stimulus that has an automatic response.
 • Example: If a nurse manager suddenly hears a loud emergency alarm in the
hospital (stimulus), they will instinctively react by rushing to the area without
thinking.
Operant behavior - occurs in the absence of any apparent external stimulation. This type of
behavior is what we engage in when we anticipate specific results based on previous outcomes.
Whether a behavior is repeated or avoided in the future depends on the consequences it
produces—whether positive or negative.

• Positive reinforcer - Increases the probability that the behavior will be repeated.
⚬ Example: A praise from the Head Nurse for a work well done increases
the likelihood that satisfactory performance will likely be repeated.
• Negative reinforcer - A consequence that if removed, increases the probability
that the behavior will be repeated.
⚬ Example: If a Head Nurse reprimands a staff nurse for failure to put a side
rail on the bed of an elderly confined patient, the nurse will likely put side
rails to all elderly confined patients. The reprimand is a negative
reinforcer and will likely remind the nurse to comply with unit policies/job
requirements.

EQUITY THEORY
• Developed by J. Stacy Adams in 1960
• It explores how employees assess fairness by considering their input and the
psychological, social and financial rewards in comparison with those of others.
• Perceived inequity causes tension which is found to be proportionate to the
magnitude of the perceived tension.
• These feelings motivate an employee to resolve the inequity by reducing input,
changing the basis of comparison or by resigning.
• If the comparison is equal, the person feels he/she is treated fairly.

Conflict: Conflict is a dynamic process. it is a type of behaviour involving to or more parties in

opposition to each other
Conflict is inevitable in organizations due to complex relationships and interactions.
• It signals the need for problem-solving, clarifying objectives, and defining group norms and
boundaries.

Types of Conflict:

Covert conflict - it results in harbored feelings that drain both physical and pshycological
energy, however once conflict is acknowledge, energy and resources can be channelled to
dealing and resolving.

Vertical conflict
Differences in opinions between superiors and subordinates are cause most ofter by inadequacy
in communication, opposing interest and lack of shared persecption and attitude. The
supervisors often controls the behaviour of subordinates thus causing resistance from the
latter , which in turn makes the superior aassert his/her position and power through impersonal
bureaucratic rules.

Horizontal or line and staff conflict – arises as a common struggle or strife between
departments or services wherein the degree of independence and collaboration determines the
success in achieving sahred goals and objective , lack consensus in between these department
and tha clash of personalities also affect teamwork resulting in conflict.
Behavioural standpoint – it is a “perceived” condition that exists between two parties (e.g.
individuals, groups, department) when one or more parties perceive goal incompatibility and
some opportunity for interfering with goal achievement of the other.

Process standpoint – conflict can be defined as “what occurs when real or perceived conflict
exist in goal, values, ideas, attitudes, beliefs , feelings, or action of two or more parties. It can
occur within one individual (intrapersonal); between two or more individual (interpersonal);
within one group (intra group) between two or more groups (intergroup)”.

Intrapersonal – example is when a had nurse is told not to schedule overtime for nurses but
feels that shortage of nursing personal greatly affects the quality of nursing care resulting in
dissatisfaction of the clients
Interpersonal – may arise example between the nursing director and the finance director who
do not agree on the resources (both material and human ) needed by the nursing service due to
cost cutting measures.
Intra group – manifested in feelings of unfairness over distribution of assignments, off duties
and holidays among the staff, iff individuals and /or group cannot meet the expectation exacted
on them, they become disenchanted. Their ego is threatened and unacceptable behaviour is
manifested
Intergroup – may be caused by differences in opinion of the nursing staff of the unit and that of
the clinical instructors in preparing for the clinical learning experiences of the nursing students.
Staff nurses claim that nursing students do not meet their role expectation while the clinical
instructors claim that staff nurses are not good role models themselves.

Conflict Management (refer to Venzon’s Scanned Book)