NURS 412-001: Nursing Management

Pam O'Hara

elastic thinking

generating new ideas. Not analytical, but creative. Spontaneous

Changing leadership and management in the 21^st century

• Changes in Healthcare- quality, safety, and patient focus are biggest issues

• Financial Element- state & federal funding change our policies. Reimbursement thru Medicare/Medicaid; insurance; healthcare policy.

• Emerging New threats- terrorism, pandemics, warfare

• leaders & managers must be at forefront & be knowledgeable to guide nursing practices. They must know about financing and marketing, ab the nursing shortage, research healthcare reform, turnover rates, quality recruitment, deal with political aspects of nursing, creating shared governance models; maintain high-quality practice, skilled communication, organization, team-building; be visionary, innovative, proactive (reactive doesn’t fix anything later!

• subordinates are more likely to adhere to manager’s rules if the manager uses a shared governance model bc they want their voices to be heard.

4 leadership domains

• Strategic Thinking- has staff thinking ab the future, setting long-term goals. Analytical

• Influence- has an impact on staff, staff wants to follow and get behind them. Good communication, self-assured, thrive in being in command

• Relationship Building- gets groups to collaborate. Infuse connectedness, thrive on harmony & inclusion, positivity

• Execution- good translator of an idea. Work out what needs to be done & execute it. Achievers, disciplined, responsible, planning

follower’s (staff) needs

• Trust

• Compassion

• Stability- knowing leader has their back

• Hope

strengths-based leadership

Focuses on successful performance that:

-exceeds the norm

-Orientation towards strengths- don’t need to be well-rounded; focus on their STRENGTH

-Developing collective efficacy (ability to achieve result)

-Surround themselves with the “right” people- ppl that help with their weak areas

Total Patient Care or Case Method Nursing

RN has responsibility for patient

• most used

• doesn’t always work if the RN is not skilled enough, or if the client’s primary nurse changes throughout their stay

• provide the direct care to that patient

• ex- in a home care setting - the same nurse comes every time

Level 5 Leadership

If you have one of these in a company, it makes a company great.

• Level 1: Highly Capable Individual- lots of talent & skill, good work habits

• Level 2: contributing team member- sue their skills to work effectively with the team

• Level 3: competent manager- organize unit, meets unit’s needs

• Level 4: effective leader- inspire organization to meet objectives or achieve a vision

• Level 5: great leader (Executive)- you must have all 4^ plus you must have humility (don’t let others do something you wouldn’t do)

servant leadership

Number one priority is to serve others.

• humility very important

• commitment to clients & others

Principal Agent Theory

Principal = leader

Agent= follower= employees. Doesn’t always act in the best interest of the leader.

^can be a conflict of interest. The agent may want to do something different than what the principal wants them to do.

It is imperative for the principal to come up with incentives so the agents follow the rules.

Human and Social Capital Theory

Invests time & money into professional development, but only if they think it will pay off in the future.

- If I give all employees a $2500 educational stipend where they can take more classes, will this help my unit? Will they stay here? Will it be a waste of money?

• research proves BSN degrees are better, so companies will put employees thru school

emotional intelligence

Emotional intelligence – regulating & expressing your emotions

Self-regulation- controlling your own emotions, not being impulsive

Empathy- the ability to understand other’s emotions. (Sympathy is feeling bad for somebody)

authentic leadership

• Being true to oneself

• doing lots of self-reflection

• self-disciplined

• Following your internal values and beliefs

• Not Letting Peer pressure or any External forces change what you feel is morally right

• transparency & self-awareness

thought leadership

• Innovative Ideas- future-oriented

• Risk Taking- plan an idea & go for it

• Visionary

Reflective Thinking and Practice

• Reflect on progress and setbacks- is this process working? why or why not?

• Adjust the course of action based on best EBP

• Flexible and responsive to change in best practices

quantum leadership

• Built on quantum physics. Reality is erratic & unpredictable

• Change is constant. These leaders think ahead bc they know the future is uncertain

• Complex and dynamic. They ask & encourage questions

• willing to work with entire team so they can be productive

clinical reasoning vs critical thinking

Clinical reasoning – critical thinking, but it’s based on clinical experiences / practice, reasoning thru healthcare situations. You can do critical thinking without being in nursing, in other professions.

Theoretical Approaches to Problem Solving and Decision Making

-Traditional Problem Solving = ID problem, gather data to ID consequences & info ab the problem, explore alt solutions, evaluate alternatives, select appropriate solution, implement it, eval results

-Managerial Decision-Making Models = DON’T find problem first. They set the objective first of what they want to happen. Research different ways to meet that objective, compare & contrast diff options & consequences, implement action plan

-Nursing Process = ADPIE. Assess situation, diagnose problem, plan, implement, eval

-Integrated Ethical Problem-Solving Model = ID an ethical problem, collect info to analyze situation, develop alternatives & analyze & compare them, select the best alternative and justify it, evaluate outcomes, prevent similar problems

-Intuitive Decision-Making Model = done by expert nurses.

Individual Influences in Decision Making and Overcoming Them

-gender: men think rationally, women use emotions

-Values: everyone grew up with different communities, customs, etc

-Life experience: past hx with this issue sways nurse’s decision-making

-Individual preference: how you live your life, how you deal with situations

-Thinking styles: concrete thinking (by the book), emotional thinking, out of the box thinking

types of thinkers

• analytical thinkers (left-sided): highly organized

• big picture thinkers (right-sided), and emotional

decision making tools

-Decision Grids- similar to tree. Helps decisions with arrows to diff consequences

-Payoff Tables- looks at impact of decision to see the payoff or loss, are we profiting or in the red? We want High impact but easy to implement

-Decision Trees- similar to grid. Looks like a family tree. Used to make decisions in a systematic way

-Consequence Tables- shows how manager chooses to make a decision & the consequences

-Logic Models- uses visual aids to help see relationships.

-^look at examples of each

delegation

“Getting work done through others or directing the performance of one or more people to accomplish organizational goals”

“Is and essential element of the directing phase the management process”

“Delegation synonymous with productivity”

Reasons to delegate:

1. To free up time.

2. Someone else might perform the job better. (ex- IV team may be better)

3. Learning opportunities.

delegation errors:

1. Underdelegating: nurses may think that delegating tasks suggests that they can’t do the task. Also possible: they don’t trust others; it’s just easier if they do it themself; they don’t know how to delegate; don’t know how to lead others

2. Overdelegating: nurses may have poor time management & delegate everything; unconfident in their own skills

3. Improper Delegating: delegating late in the day when you’re already behind; asking someone who’s not licensed to do the task; to an unstable pt

5 rights:

• right circumstance

• right task

• right person

• right directions & communication

• right supervision & evaluation

^don’t delegate what you can PEAT (plan, eval, assess, teach). follow-up teaching can be done by the LPN

LPN responsibilities

able to do UAP duties (but not always the best option).

they cannot do RN high-level tasks like PEAT skills.

They do continuing care, IVs but not first-time or high-risk IVs

duties of the UAP

under supervision of RN / LPN

• cannot delegate tasks

• ADLs: ambulation, bathing, mouth care, feeding, turning, toileting, basic ostomy care, linen changes, VS if stable, I&Os but not of IVs, weights. NO MEDS or INVASIVE PROCEDURES

• special training for blood draws, EKGs, blood sugars

• don’t do any of this if it’s HIGH-RISK

manager vs leader

Manager

• Management: “The organization and coordination of the activities inside a business in order to achieve defined objectives”

• Transformation, Tenacity, Specific, Data-driven, Interpretation, Understanding of Inside the Organization, Self-discipline, Commitment, Accountability

• Assigned Position- Legitimate Source of Power; Specific Duties, have control in the unit; Direct Everyone

Leader

• Leadership: “Someone who leads through various means and has many characteristics”

• Inspires, Visionary, Imagination, Abstract Thinker, Ability to Articulate, Understanding of the External Environment, Risk Taker, taking initiative, Confident, Accountability

• Fatal Flaws: •“I will do it myself”. •“I’m not doing that, no matter what management says”. •Sitting at the desk while others are “sinking”. •“I do what is required of me”. But never goes above and beyond. •“I don’t have time to teach you that, they have a class for that”.

• Delegated Authority; Influence; Wider Variety of Roles; may or may not be within formal hierarchy of the organization (usually not); Focus on Group Process and Empowerment; Interpersonal Relationships; Direct Willing Followers; Have Goals That May or May Not Reflect Those of the Organization

scientific management

traditional management.

• paid based on outcomes. not salary

management functions

POSD CORB

• planning- setting goals, making policies, determining procedures

• organizing- ensures goals are being met, determines best type of pt care

• staffing

• directing / delegating- communication, managing conflict, ensure collaboration

• coordinating- quality improvement, performance appraisals

• reporting

• budgeting

the hawthorne effect

if people know they’re being watched, they’ll adjust their behaviors

theory x vs theory y

theory x- managers think all workers are lazy (just like my bummy ex)

theory y- employees will be productive to meet goals

Great Man Theory

some ppl are born to lead (a Great Man); while others are born to be led

behavioral theories

authoritarian / autocratic- directing, telling YOU what to do, no freedom

democratic- management has less control of the employees, communication flows up and down, decision-making involves others, emphasis on WE, constructive criticism

Laissez-faire- little to no direction from management. employees do what they want. all group members can make decisions. GROUP emphasis. no criticism. This causes frustration & disinterest in the workplace, but it does encourage productivity, creativity & motivation

transactional vs transformational leadership

transactional- focused on day-to-day

transformational- visionaries, encourages change

^both are necessary.

^Full Range leadership focuses on both of these, plus Laissez-faire leadership

improving data-driven decision making for primary prevention

• The article discusses how Colorado used youth health survey data to improve data-driven decision making for primary prevention and health equity.

• Researchers created tools to help schools and communities better understand local health data and identify risk and protective factors affecting youth health.

• The goal was to help communities use evidence-based data to guide prevention programs, policies, and resource planning before health problems develop.

functional method

(similar to team nursing & modular nursing)

cost-effective

• has different people performing different roles

• staffing based on functional method to all care for patients

• ex- RNs do care plans, assess, contact docs. LPNs do some care, dressings, some meds. UAPs do ADLs. Everyone has assigned tasks.

team nursing

(similar to functional method & modular nursing)

RN has team of ancillary staff (LPN & UAP in their team)

RN delegates to the team. May not delegate based on their skill set, it’s more based on a team. The RN tells their team what they need for the day.

Multidisciplinary Team Leader Role

RN is overseeing patient’s care, they coordinate with many other departments.

• issue: other departments may push back because of disagreements.

modular nursing

similar to team leading / functional method

RN in charge, team of LPNs / UAPs

• assignments based on location. You have your own area to cover so you’re not running all over the entire unit

primary nursing / relationship-based nursing

Primary RN devises the plan, other nurses on duty follow that plan thereafter.

interpforessional primary healthcare

everyone collaborates. team-based with several departments.

• issue: departments disagree, and there’s no one leader to say what to do. Physicians don’t want to be told what to do

case management

helps decide where the patient should reside after treatment (home? rehab?) ensures they can get their meds, insurance coverage, call doc for a different prescription if their insurance doesn’t cover it, community resources, transportation, disease management, scheduling

disease management

ensures the disease is managed in the best and most cost-effective ways.

• goal: to prevent the disease with early detection, or prevent worsening.

• •Population-Based group targets

How to select the best mode of organizing patient care

DECISIONS SHOULD BE MADE BASED ON:

• PATIENT ACUITY (level of sickness)

• SPECIFIC POPULATION (age, backgrounds)

• KNOWLEDGE AND SKILL NEEDED (what skill sets the employees have, and what skill sets they need in order to use a specific model)

NOT ON:

• ECONOMICS

• MOST POPULAR MODE

line organizational structure

simple organization on chart structure

• communication can travel from top to bottom, or from bottom to top.

matrix organizational structure

communication flows in every direction (horizontal & vertical) thru different departments.

• focuses on product & function

• can be used to solve problems - who is responsible for what

formal vs informal organizational structure

formal organizational structure

set structure. Power over others. has managerial authority.

• Board of directors → CEO → VPs → unit managers / supervisors → charge nurses → RN< PT, Resp, OT, case management

informal organizational structure

• instinctively form a social network. Unplanned structure. Spontaneous

• time-saving, effective, forms in solidarity to get work done, esp when formal structure is not working

Legal-Rational Authority

those with authority have the power to take on issues, demands, and directives

bureaucracies

Shared governance- everyone helps with decision-making. Participatory management is done by several people including RNs. becoming more popular but managers want to be in charge. Some nurses resist this bc they don’t want to be responsible for generating & sharing ideas

Division of Labor- everyone shares responsibilities

Hierarchy of Authority- managers can direct work & give rewards / consequences

Impersonality of Interpersonal Relationships- who controls the staff

Procedures to get Work Done

Rights and Duties of Positions- orientation packets, what you’re responsible for

Competency for Employment and Promotion- yearly CPR, glucometer, restraints, etc

Components of Organizational Structure

Relationships and Chain of Command

• Chain of Command → bring communication to lower level first

• Staff (Advisory)

• Unity of Command- staff report to one manager

Span of Control- how many people the manager manages

Managerial Levels

• Top Level- CEO, director,

• Middle Level- unit supervisors, carry out day-to-day operations

• First-Level- take care of unit’s organizational needs. RNs, case managers

Centrality- figures out where manager positions are on a manager chart to depict how communication should flow.

Limitations & Advantages to Organizational Charts

Limitations

• informal relationships aren’t in a chart

• line of authority may not be followed (ex- neighbors with a higher-up)

• too much responsibility on the individual

• becoming obsolete bc they’re super rigid and nobody follows them

Advantages

• authority

• specific assignments

• structure

flat organizational structure

less hierarchy, more central line of authority

• staff, VPs, CEO. (No unit managers or middle men)

service line structure

services on bottom (ex- we want to handle HF in a good way)

above that shows who handles the issue

top level (service line counsel) determines if it is an appropriate measure to take)

ad hoc design

ad hoc - temporary

ex- there’s a unit problem of GHWT. Manager may form an ad hoc committee to address the issue. After it has been formed, implemented, & resolved, the committee is dissolved.

decision making (3 types)

• hierarchy (Scalar Chain) - top management communicates to lower ranks

• centralized decision making- top management makes decisions & tells everyone else what to do

• decentralized decision making- multiple people in diff disciplines help make decisions, even in lower levels

stakeholders

anyone involved in the organization.

• internal (management, docs, RNs, aides, patients, families)

• external (medicare, medicaid, insurance, PPO, nursing homes, community, investors)

Stakeholder analysis = when you’re ab to make a big decision, you contact stakeholders to get their input. You must generate a solution that meets everyone’s needs.

organizational culture

how we do things. What is our value as a unit?

Based on: Values, Language, Traditions, Norms

• Sacred Cows - if a unit has older staff and no new incomers, you keep traditions and don’t change. These customs are called Sacred Cows.

Organizational Culture is NOT Organizational Climate

organizational climate - the general tone & attitude of the ppl on the unit

magnet status

shows organizational excellence.

ANA and ANCC help determine this

• several criteria must be met to designate an organization as Magnet status

• looks at recruitment, turnover, community involvement

power

• Gender traditions

• Power & Powerlessness. feeling powerless makes you an ineffective leader

• Types of Power

  • rewards

  • coercion - punishment for bad work

  • legitimate - authority

  • expert- someone with a lot of experience & wisdom

  • referent- associating with others who have power implies you also have power

  • charismatic- charming, compelling, has personal power bc others look up to them

people in power must know how to delegate and work as a team

authority-power gap

comes from personal issues with the manager

• employees want to be heard. If this doesn’t happen, they become disobedient

bridging the gap

• build trust & rapport between managers & staff

• managers must inform staff of changes & activities

• managers must keep promises

• empowering subordinates improves work

politics of power

Most Important Strategy: Read the Environment

Function Effectively Within the Organization

Understanding One’s Own Power

journal article: Development of a New Framework to Address Public Health Ethical Considerations in Wastewater Surveillance

• Wastewater surveillance can help detect community health threats (like infections or drug trends) early, improving public health response while protecting individual anonymity.

• The framework emphasizes balancing public health benefits with ethical concerns such as privacy, consent, stigma, and fair use of collected data.

• It recommends clear policies, community transparency, and ethical oversight to ensure wastewater data is used responsibly and equitably.

journal article: Improving Data-Driven Decision Making for Primary Prevention

• Using data helps public health professionals identify risk factors early and target prevention strategies before disease develops.

• Better data collection and analysis improve resource allocation, health outcomes, and evidence-based decision making.

• Collaboration between healthcare systems, communities, and technology tools strengthens primary prevention efforts.