D Ay 1

Preparing Nurses as Nurse Managers

By

Nhelia B. Perez RN MSN

In Ancient Japan, when a new student seeks

admission to study at a monastery, he is

required to have an audience with the

master, a sort of pre-entrance interview if you

will.

One day, an intelligent student, appeared before the master for such a session. As they sat

together, the young man started to impress the master with his knowledge and

accomplishments.

When the master offered tea to him, he continued to speak without acknowledging the master; so absorbed was he in his own

cleverness.

Blah blah blah blah blah blah

All of a sudden, he jumped up, reacting to the hot tea

flooding over the tabletop and dripping onto his legs.

“Master!” he shouted. “The cup is overflowing!”

The master continued pouring the tea, spilling it on the floor. Then he

replied, “So are you. Please come back when you are empty and in

need of my teaching.”

Think of your brain as the cup in the story. If you’ll fill it up with your ego, you’ll never get

more knowledge in.

Keep your mind humble and open to new ideas. You’ll learn much more in the process, and continue to develop as a human being.

As Ray Kroc, As Ray Kroc, founder of Mc founder of Mc Donald’s once Donald’s once

said, “When you said, “When you are green, you are green, you will grow; but will grow; but

when you ripen, when you ripen, you will rot and you will rot and

fall.” fall.”

• Taking place without a structured organization, like the nursing service;

• Directed towards the attainment of aims and objectives;

• Achieved through the efforts of other people, &

• Using system and procedures

…PROCESS

It is a series of systematic, sequential or instances of

overlapping steps directed toward the achievement of organizational goals and objectives; an effective

integration of the efforts of members of a purposeful group.

… PROFESSION

… SCIENCE

… AN ART

… A CLASS OF PEOPLE

Principles of Management

Division of Work

Authority

Discipline

Unity of Command

Principles of Management

Unity of Direction

Subordination of individual interests to the general

interestRemuneration

Centralization

Scalar chain

Principles of Management

Order Equity

Stability of Tenure

Initiative

Esprit de Corps

The ultimate test of management is:

THEORIES OF MANAGEMENT

SCIENTIFIC MANAGEMENT THEORY

Developed by Frederick Taylor

Viewed workers as inefficient

Management is characterized and guided by the application of scientific

approaches to solve managerial problems in business and industry.

PRINCIPLES OF SCIENTIFIC MANAGEMENT

• Developed a science for each component of work

• Scientifically select and train workers

• Actively cooperates with workers

• Divide work equally between workers and management

General Administrative Theory

• Developed by Henry Fayol

• Described management as universal set of activities

• Focuses on division of labor, clear hierarchy, rules and impersonal relations

Human Relations

• Idea surfaced in early 2oth century

• Focused on the notion that work is done by people

• Need to focus on human element

• Maslow and Motivation and Theory X and Y

Bureaucracy

Coined by Wax Weber

Highly structure form of administration and usually includes no participation by the governed.

Work within the principle of chain of command, unity of command, span

of control, and specialization.

Advantages of Bureaucratic Management• Competent and responsible employees are produced.• Employees perform by uniform rules and conventions• Employees are accountable to one manager who is an

authority.• They maintain social distance with supervisors and

clients.• Favoritism is reduced and impersonality is promoted.• Rewards and other incentives are provided to employees

based on technical qualifications, seniority and achievement.

Disadvantages of Bureaucratic Management

•Complaints about red tape are frequently heard and experienced.

•Procedural delays are observable

•General frustrations among employees and clients are inevitable.

Characteristics of Bureaucracy

•FORMALITY

•LOW AUTONOMY

•A CLIMATE OF RULES AND CONVENTIONALITY

•DIVISION OF LABOR

•SPECIALIZATION

•STANDARDIZED PROCEDURES

•WRITTEN SPECIFICATION

•MEMORANDA AND MINUTES

•CENTRALIZATIONS

•CONTROLS

•EMPHASIS ON HIGH LEVEL OF EFFICIENCY AND PRODUCTION.

HUMAN RELATIONS

Integration of people into a work situation in a way that motivates them to work productively.

Signifies the individual worker as the source of control.

Conceptualized by Levey and Loomba in 1984

THEORY OF MOTIVATION - Hygiene

Written by Herzberg

Aimed at giving a sound foundation to the more humanistic schools.

Motivational factors are necessary so that employees would perform adequately on the job.

Theory X and Theory Y

Coined by Mc Gregor

Theory X – the traditional view on direction and control

Theory Y – the integration of individual and operational goals.

Theory of X Manager assumes:

… the average person has an inherent dislike for work and will avoid it if possible

… must be coerced, controlled, directed, and threatened with punishment to get the work done

… prefers to be directed, wishes to avoid responsibility, has relatively little ambition and wants security above all.

Theory Y Manager assumes:

•The expenditure of physical and mental effort in work is as natural as play or rest.

•External control and the threat of punishment are not the only means for bringing about effort toward organizational objectives.

•Commitment to objectives is a function of the rewards associated with their achievement.

•The average human being learns under proper conditions, not only to accept but to seek responsibility.

•The capacity to exercise a relatively high degree of imagination, ingenuity and creativity in the solutions of organizational problems is widely, not narrowly distributed in the population.

•Under the conditions of modern industrial life, the intellectual potentialities of the average human being are only partially utilized.

THEORY M FOR MANAGEMENT

• Allen (1973) believe that most managers avoid extremes in their belief in people.

• People are motivated to work by highly complex factors that may be biological, psychological, social, or economic; to name only a few possibilities.

• Some people dislike responsibility and prefer to be led; others are ambitious and want to be leaders; the majority fall somewhere in between.

Theory Z

• Participative Management Model• Spearheaded by Ouichi in 1978• Characteristics

* long-term (lifetime) employment* slowed down rates of evaluation and promotion.* more implicit and less formalized control systems;* personal concern for the employee* cross functional rotation;* some degree of participative consensual decision making, and* emphasis on individual responsibility.

TQM (Total Quality Management)

• Introduced by Deming

• Key to quality is reducing variations.

• Everyone gets involve with quality

• Get it right first time

• Consumer is the most important part of the production line.

ROLE OF MANAGERS

• Interpersonal

• Informational

• Decisional

You are the nurse-manager in the Medical Unit. A 16 year old patient diagnosed with IDDM was admitted due to

uncontrolled increase in blood sugar. The staff found him to be a cooperative patient. However, being a member of a

large clan, members of his family often come and visit him and bringing him foods he should not eat.

The nursing staff came to you on two occasions complaining of the family’s non-compliance to hospital visits and

unauthorized food.

Yesterday, the family members came to you and complained about hospital visitor policies and what they took to be

rudeness of two different staff members. You spent time talking and explaining to them and when they left, they

seem to be agreeable and understanding.

Last night, a staff nurse informed the family that only two (2) family members can stay and if they won’t follows the

orders, the nurse will call for hospital security.

This morning, the patient’s parents have suggested that they will take him home if this is not resolves. The patient’s

blood sugar is still uncontrolled.

Develop a plan of action to solve this problem. First, select three

desired objectives for solving the problem then proceed to

determine what would you do that would enable you to meet your

objectives.

Manpower

Machine

Materials

Money

Moment

Feedback

Survey

Interview

Reading

Research

Education

The Process of Management using a system approach

INPUT MANAGEMENT PROCESS OUTPUT

Efficiency

Client Satisfaction

Business

Owner Satisfaction

PLANNING ORGANIZING DIRECTING CONTROLLING

1. Planning

2. Organizing

3. Directing

4. Coordination

5. Control

The Managerial Activity is divided into five (5) Elements

of Management

• Sincerity

• Simplicity

• Prudence

• Justice

• Understanding & Open-mindedness • Serenity • Staidness • Cheerfulness • Caring

* Do things right * Are interested in efficiency * Administer * Maintain * Focus on systems and structure

* Do the right thing * Are interested in effectiveness * Innovate * Develop * Focus on people

* Rely on control

* Organize and staff

* Emphasize tactics,

structure and systems

* Have a short term view

* Ask how and when

* Accept the status quo

* Rely on trust

* Align people with a direction *

* Emphasize philosophy, core

values,

and shared goals

* Have a long term view

* Ask what and why

* Challenge the status quo

* Focus on the present

* Have their eyes on the bottom line * Develop detailed steps and timetable* Seek predictability and order * Avoid risks

* Focus on the future * Have their eyes on the horizon line * Develops vision and and strategies * Seek change * Take risks

* Motivate people to comply

with standards

* Use position-to-position

(superior-to- subordinate)

influence

* Require others to

comply

* Operate within organizational

rules, regulations, policies

and procedures

* Are given a position

* Inspire people to change

* Use person-to-person

influence

* Inspire others to follow

* Operate outside of

organizational rules,

regulations, policies and

procedures

* Take initiative to lead

Proportion of Management Effort Devoted to the five (5) functions of management

TOP

MIDDLE

FIRST-LINE

P O D S C

P O D S C

P 0 D S C

MANAGEMENT

LEVELS

Continuum of Managers Decision Making Authority

Use of Authority

By the Manager Area of Freedom

For Subordinates

Managers make

decisions and

announces it

Managers sells

decision

Managers present

ideas and invite

question

Managers present tentative decisions subject to questions

Managers present

problems, gets

suggestions and get

decisions

Managers define limits; ask group to make decisions

Manager permits

subordinates to function

within limits defined by superior

1 2 3 4 5 6 7

Autocratic Consultative Participative Democratic Laissez-faire

CHANGE FOR

INDIVIDUAL ORGANIZATION

PRODUCTIVITY

SOCIAL TRANSFORMATION

SELF

Values

Personalizing

Humanizing

Concepts

TheoriesSkills

Techniques

Person

Orientedness

Awareness of Purpose

SILR

COMMUNIC

ATION

COMMUNICATION

STRATEGIES

Benefits

Concern for soft stuff

Positive Outlook

Innovation as an

Interest

Management by wandering

around

Reflecting & Mirroring

Participative Management

Advocating Values

Visibility of Top Mgt

Counselling

Quality Circle

Closing Isolation

gaps

Team buildin

g

Synergistic Management

Being ethically

moral

Pssst…

Do you want to hear a

story?

The Japanese have always loved fresh fish. But the waters close to Japan have not held fish for

decades. So to feed the population, fishing boats got bigger and went farther than ever.

The farther the fisherman went, the longer it took to bring in the fish. If the return trip took more than a few days, the fish were not fresh. The Japanese

did not like the taste.

To solve this problem, fishing companies installed freezers on their boats. They would catch fish & freeze

them at sea. Freezers allowed the boats to go farther & stay longer.

However, the Japanese could taste the difference between fresh & frozen fish &

they did not like frozen fish. So prices were low for these fishes. This is not fresh

fish!

So fishing companies installed fish tanks. They would catch the fish & stuff them in the tanks, fin to fin. After a little thrashing around, the fish stopped moving. They

were tired & dull, but still alive. Unfortunately, the Japanese could still

taste the difference.

Because the fish did not move for days, they lost their fresh-fish taste. The Japanese preferred the lively

taste of fresh fish, not sluggish fish. that does not taste like fresh fish

So factories solve this problem…

To keep the fish tasting fresh, Japanese fishing companies still put

the fishes in tanks, but now they add a shark to each tank. The shark eats a

few fishes, but most of the fishes arrive in a very lively state. The fishes

are C H ALLE N G E D .

Instead of avoiding challenges, jump into them.

Beat the heck out of them. Enjoy the game. If your challenges are too large or too numerous-

DON’T GIVE UP!

Failing makes you tired. Instead, reorganize. Find more determination, more knowledge, more help. If you

have met your goals, set bigger goals.

Don’t create success and lie in it. You have resources, skills & abilities to make a

difference.

The benefits of a CHALLENGE- the more intelligent, persistent & competent you are, the more you enjoy a good problem. If your challenges are the correct sizes, and if you

are steadily conquering those challenges, you are happy. You think of your challenges & get

energized. You are excited to try new solutions. You have fun. . . You are ALIVE!

As soon as you reach your goals, such as finding a wonderful mate, starting a successful company, paying off a debt or whatever, you might lose your passion. You don’t need to work so hard so you

relax. You experience the same problem as lottery winners who waste their money, wealthy heirs

who never grow up & bore homemakers who get addicted to prescription drugs.

It was observed by L. Ron Hubbard in the early 1950s, “Man thrives, oddly enough, only in the presence of a

challenging environment.”