Nursing Management Essay Sample

Nursing Management Essay Sample

Maslow’s Theory

Motivation pertains to the desired outcomes and circumstances that stimulate behavior or action required to fulfill them. Thus, it is one of the bases of human behaviors. It is important to understand the motivation of different individuals to be able to address their needs.  Each individual have different sets of goals.  Their actions are often geared towards fulfilling these goals.  In the business world, knowledge of this is important because companies seek to offer some satisfaction to their work force and motivate their personnel to yield higher productivity and better quality work.

Among the numerous motivational theories that are currently used, Maslow’s need hierarchy theory is one of the most common approaches.  This theory proposes that man’s basic needs are arranged in a “hierarchy of prepotency” (R.D. Agarwal, 1983).  Thus, some needs are stronger and more urgent than others. In the order of potency, man’s needs are for physiological well being, safety, love, esteem and self actualization.  The first four needs fall under the group called deficiency needs and the last as growth needs. (Greenberg, J and Baron, R. 1993) According to Maslow, a less potent need does not emerge until and unless those preceding it in the hierarchy are fairly well satisfied.  The most urgent are physiological needs.  While these are unfulfilled, the others remain dormant.  When the physiological needs are gratified, the needs for safety and security make their presence felt.  The need for an orderly, predictable world in which one feels reasonably comfortable begins to loom large.  Thus one who is experiencing grave fear or anxiety about his future safety is not much concerned with love.  The need for love or affection or belonging emerges only when the second need has been taken care of.  After the need for love comes the need for self esteem which includes prestige, recognition, status, attention, self respect, and the respect of others.

The higher group called growth needs in Maslow’s hierarchy is further divided into four namely: cognitive or the need to know and understand; aesthetic needs or the need to find order and beauty in one’s perception of the world; self-actualization or the realization of one’s potentialities or becoming what is one capable of becoming; and self-transcendence or the need to realize the self-fulfillment of others.

Equity Theory

Equity Theory is mostly attributed to John Stacy Adams. It has similarities with Maslow theory since it acknowledges that subtle and variable factors affect each individual’s assessment and perception of their relationship with their work. However, this model believed that the awareness and cognizance feature are highlighted. Adam’s theory states that when people compare themselves to others at work, they are able to see outcomes such as pay and respect as opposed to their inputs like time and effort. (Muchinsky, P. and Marchese, M., 2006) Any kind of inequality, either being over or under rewarded, leads to confusion and annoyance. Individuals who believe that others have it better off than them tend to do less work and lack motivation. Negative inequity is felt if someone feels they have been treated unfairly in comparison with his efforts and inputs. If someone feels that his or her efforts are being over-rewarded in comparison with others, it is referred to as ‘felt positive inequity’.

People who believe they are unfairly over-rewarded try to work harder to make up for it, while people who believe they are under-rewarded tend to work slower and become unproductive. Rewards in this case aren’t always monetary. Respect and responsibility are rewards that can also cause a person to ‘feel positive inequity’ or ‘feel negative inequity’.  Moreover, employees seek a fair balance between what they put into their job and what they get out of it or inputs must equal outputs. Individuals form perceptions of what constitutes a fair balance or trade of inputs and outputs by comparing one’s situation with other reference point in the market place. One is also influenced by colleagues, friends, and partners in establishing these benchmarks.  The response of each individual is dependent on the one’s own notion of his own inputs and outputs. Inputs are typically: effort, loyalty, hard work, commitment, skill, ability, adaptability, flexibility, tolerance, determination, heart and soul, enthusiasm, trust in our boss and superiors, support of colleagues and subordinates, personal sacrifice, etc. People need to feel that there is a fair balance between inputs and outputs.

Outputs are typically all financial rewards – pay, salary, expenses, perks, benefits, pension arrangements, bonus and commission – plus intangibles – recognition, reputation, praise and thanks, interest, responsibility, stimulus, travel, training, development, sense of achievement and advancement, promotion, etc. If inputs are fairly and adequately rewarded by outputs (the fairness benchmark being subjectively perceived from market norms and other comparables references) then work satisfaction is achieved and employees are motivated to continue inputting at the same level. If inputs out-weigh the outputs then dissatisfaction occurs that decreases the moral to work efficiently.  Some employees reduce effort and application and become inwardly disgruntled, or outwardly difficult, recalcitrant or even disruptive while others seek to improve the outputs by making claims or demands for more reward, or finding another job.

Motivational theories in Professional Work Dynamics

The problems that a doctor manager often faces in a team with mostly inexperienced nurses are complaints of inefficiency of novice nurses from the expert nurses and even patients and the conflicts between the experts and novices that arise from it.  The hierarchy of needs as a motivational theory is most commonly reflected in the compensation, benefits and rewards system in the work place.  For one, the expert nurses must be better compensated than the novices.  Aside from their specialty, nature of work, assumed educational attainment and experience, the expert nurses should be given higher pay for the extra work of supervising and guiding the novice nurses.  On my part as the manager, I need to inculcate to the expert nurses that these additional work of guiding, supervising or even teaching the novice nurses is part of the job design to create opportunities that would direct them to sustainable growth and development as it would give them both personal and professional advancement and fulfillment.

Hospital jobs can be made more interesting and challenging through job enlargement and job enrichment (Mathis, R. and Jackson, J.  2006) Instead of complaining, expert nurses are given the additional task to supervise novice nurses in which there is room for creativity in such non procedural tasks.  Aside from breaking boring routine work from the nurses’ jobs, it expands the employee’s opportunity to find fulfillment in their jobs for self actualization.  Subsequently, designating such tasks appropriately to the expert nurses creates teamwork which is important to prevent conflicts that may arise.  This scenario would create a clear situation that the expert nurses and the novice nurses needed each other for the advancement of their profession; the former as part of the enlargement and enrichment of their jobs and the latter as part of their needed experience to enhance their expertise. Finally, capping with the equity theory, it must be clear to all employees that the hospital is committed to the fair treatment of all workers as perceived by individual employees.

  Fair treatment includes relatively equal amount and difficulty of work, just compensation, equal opportunity to grow and equal implementation of company policies among others.  The equity theory touches on the social aspect of the work environment because it assumes comparison of oneself with other members of the company.  At the end of it all, there is a need to emphasize that the highest and biggest reward in working in hospitals that employees obtain regardless of their position or level or compensation is helping people who are sick. The very nature of jobs in hospitals gives employees i.e. nurses and doctors the opportunity to directly make a big difference in a person’s most vulnerable and helpless times – giving care to the sick.  The very nature of hospital service allows employees to give their fare share of giving care to people.  Caring just for a single person as a form of service is a noble mission that makes the world a better place. This is an intrinsic and most important motivator among hospital employees that would relate to the Maslow’s growth needs i.e. self actualization and transcendence.  Employees find meaning in their lives in pursuit of such mission.

Conflict and Active listening

Conflict occurs when there is opposition, disagreement or incompatibility between or among members of the organization. For instance, line–staff conflict pertains to disagreements between a line manager and the staff manager who is giving him or her advice e.g expert nurse over the novice nurse. The conflict can stem from differences in personal values, culture, and professional opinion among others. From a single event like a single act or decision of a person that is not in accord with that of another person, this conflict could later result to a sequence of conflicts or series of disagreements in other issues in a recurring pattern. Moreover, because the people involved in the conflict may have their individual followers, the conflict can aggravate to an organizational conflict that destroys unity and harmony among employees and is ultimately detrimental to achieving the goals of the organization.  The common ways to reduce interdepartment conflict by way of following the organizational structure of the company is through appeal to power and the chain of command, by reducing interdependence or by exchanging or mixing personnel.  (Goldsmith, J. 2005)

Critical in any conflict however is communication. In fact, some people adhered that conflicts are just a failure of communication.  Communication is the process of conveying information and idea. It is important to understand that communication is a two way process meaning the message sender is also the message receiver at the same time and vice versa.  Hence, a basic skill in communication is active listening.  Active listening is important among managers to facilitate the essence of communication as a two way process else, communication will be deemed rather as a form of abuse of authority and becomes ineffective in conveying information or resolving conflicts for that matter.  Active listening is listening for meaning for the ultimate goal of enhancing mutual understanding between the communicating parties.  Therefore, a listener is seeking to solicit good information.

In communication, non-verbal cues like body language and tone often have greater messages than the verbal part. Thus, interpersonal techniques in listening are important to remove barriers to facilitate smooth and seamless communication to better solicit rightful information and provide correct feedback.  This includes listening openly and with empathy.  Proof of authentic interest and listening is established by eye contact, facial expression, and confronting the person with an open comfortable and calm posture. (Antai-Otong, D. 2007) If the message is unclear, listener could opt to ask or rephrase the message for full comprehension. It is important to understand the message first before making any feedback either in the form of evaluation, judgment, description or suggestion.  Communication is important in resolving conflicts because it allows the manager to specifically identify the root cause of the problem of conflict and better address the situation.

Recruitment practices

Different organizations have different recruitment policies used to guide the recruitment process and evaluate the qualifications of applicants if they fit to the needs as well as the culture of the company.  Apparently, all organizations are keen of having a superior workforce. They look for people who can become assets of the company.  Every personnel, obviously, must play a critical role in the company and each one is a reflection of the organization. Recruitment therefore, is a critical step for the achievement of the company’s objective as well as in the development of the overall image of the group.

The first step in any recruitment is the identification of a need for personnel because augmenting the staff may not be necessary after all to accomplish a work.  Else, the organization will only be burden with additional overhead.  The Human Resource Department always strives for a lean organization or the optimal number of manpower that can successfully achieve the objectives of an organization is the most cost effective manner.  Identifying a need includes defining the needs, in which specific qualification, skills, attitudes and experience sought for are laid down.  (Albrecht, M., 2001) Incidentally, the need will also dictate the job description of vacancy.  Internal hiring may be done to observe courtesy to present employees who are seeking better positions and pay.  This will save the company from advertising costs and evaluation procedures as these are already immediately available to the HRD e.g. attendance, accomplishments, personal background, experience and the like.

An interview is the most common approach used by the employer often through the HR department to determine whether an applicant is suitable to their needs. (Parkinson, M., 2006) The interview is a means to review if an applicant has the necessary knowledge, skills and traits for the job.  For instance, to check the ability of the applicant to meet the time demands considering the hospital service operates 24-7, the interviewer may ask if he/ she is capable and willing to work in shifts.  The interview is also used to check if the contents in the resume of the applicant are indeed authentic.  Sometimes, questions that test the ability of the applicant to respond in the actual job through questions about job-related activities are included.  For instance, in case of emergency and all doctors are busy, how do you  assist an emergency situation.  Finally, interviews are also a means for the employer to further provide a full description of the job and to orient the potential employee to the organization.

Most companies also use psychological assessment for selection and development of potential candidates for hiring.  Personality tests are used by companies to assess a potential employee’s propensity to productivity and professional growth, leadership skills and teamwork as well as inclination to absenteeism or even theft and ability to fit to the organizational culture.  The Myers-Briggs personality test is most accepted and widely used test in the corporate world. This test which aims to identify the Jungian type of preference of the respondent has been recognized as a valid research instrument.  (Witzig, J. S., 2002).  A knowledge of one’s personality under the Myers Briggs model helps develop self-awareness for one’s self development.  Although such personality test have more detailed questions to check the direction of one’s energy; and one’s preference in processing information, making decisions and organizing or conducting one’s life, this can also be summed up by asking the long term plan or goal in life of the applicant.  This reflects the outlook and personal plans of an applicant.

Organizational design

The process in which managers develop or change their organization’s structure is called organization design, which is primarily carried out to define the work specialization of every organizational component.  (Boone, L.E and Kurtz, D.L., 2006)  Any organization starts with a simple structure, where in individual roles are basically defined.  It is characterized by minimal in specialization and formalization but maximum centralized control. When functions are defined and similar and related occupational specialties are grouped together, the phase of a functional structure is reached.  The stage of divisional structure is then achieved when these grouping become self-contained units.  An organization in which specialists from functional departments are assigned to work on one or more projects is a matrix structure.   A team-based structure is an organization that consists entirely of work groups or teams.  Finally, a boundaryless organization stage is necessary for an expanding or growing organization.   Categories created by traditional structures such as function or teams do not define or limit the organization.

Divisional organization is organizing by self-contained divisions or purposes.  In a hospital setting, this is achieved by grouping departments around a products or services e.g. pharmacy division or renal diseases division or to serve the needs of specific groups of customers e.g. pediatric division.  This type of structure is simple, apparent and logical.  It permits better focus on the product or service thus customers may obtain better and more efficient service. For the company, it helps in providing specifying standards for performance evaluation; it can be a channel for developing supervisors with expertise in a particular field and thus improve the effectiveness in the designation of responsibilities.  Its disadvantages on the other hand would include the creation of duplicity. For instance, a child with renal disease can either be in the pediatric division or renal disease division.  Such organizational structure can also decrease top management’s control as there are more divisional managers with greater span of authority and control.  And finally it can produce compartmentalization, which can cause conflicts among divisions.

Thus, hospitals also implement matrix organization in which employees are permanently assigned to one department but can simultaneously and temporarily detailed in other assignments such as in a special project, customer or special task. (Coffey, R.E and Athos, A.G., 1975). This is important in the treatment of patients that require cross functional teams in which an expert from different fields of medicine is needed in a particular medical case.  For instance, a baby with an end stage renal disease will require a pediatrician, a renal disease expert, a cardiologist, a dialysis nurse expert, nutritionist and dialectician among others.  Matrix organizations allow access to expertise and focus to the special projects and cases.  However, major disadvantages to this structure include confusion of command, creation of conflicts and power struggles, and excessive overhead for its management.

Diversity in the Workplace

In as much as modern society is characterized by a cultural diversity wherein individuals identify, associate and live within the context of their ethnicity, race, class, culture and gender, the workplace is not spared from the clashes and conflicts e.g. discrimination that diversity initiates.  A person identifies himself on a myriad and flexible groupings resulting to unique combination of various allegiances. Affirmation of these identities is necessary for a person to feel valued and acknowledged by which respect and trust is established.

The principal challenge for a manager in addressing diversity is to harmonize the differences and translate diversity into an advantage. (Jackson, S. 1992)  This entails leadership or the ability to influence others to get things done through the dedication of the diverse personnel.  It must be noted that managers as leaders must focus on people and values.  The manager must have a comprehensive perception of problems thus transcending from the detailed differences of people.  Finally, the manager must always be guided of doing the right thing which is what is universally accepted regardless of diversity.

It is sometimes inevitable to meet people who have discriminatory principles who prefer to obtain the services i.e. nurse care from people of the same color or ethnicity.  Accommodating such customer requests will be granted unless other hindrances occur such as availability or required expertise. In this manner, the manager can better serve the patient at least in his/ her perspective at the same time protects the staff for any form of discrimination.

Diversity can also be converted into an advantage through consultation in setting goals of the department or the organization as whole.  The goal or objective is the principal driving force that unites people to organize and remain cohesive. Management should establish a collective goal that reflects the individual goals of its member employees.  Through a participative approach in goal setting, the manager can help establish more comprehensive objectives that cover all the diverse and individual objectives or needs of the personnel.

Control and Evaluation

Control and evaluation is an integral function of management that pertains to the process of ensuring that individual tasks and functions are performed in accordance to the plan as agreed upon including the courses of actions, the policies to be maintained and the objectives to be fulfilled. Thus, control is ultimately aimed for achieving organization activities and is therefore future oriented.  Corollary to which, it also aims to identify any problems or deviations in the course of the plan for prevention of their occurrence and the formulation of their solutions.  Thus, control involves establishing standards or criterion for success, assessing or evaluating performance and formulating strategies to correct or rectify mistakes.

Under these premises, control and evaluation is normally integrated in the planning process. The evaluation of context, input, process and outputs is targeted to address the context of evaluation that pertains to the analysis for the determination of the general mission, goals and objectives of the program, the input evaluation which refers to the methods and resources needed to achieve the goal, the process evaluation that looks on project implementation by continued monitoring, checking how things per specified guidelines, identifying problems and conflicts that arise such as personnel, inventory, finance, among others; and the evaluation of the product or actual results by comparing actual outcomes with expected outcomes to determine the need to continue, revised or end a plan or project.

Urwick focused in control in reaction to the modern trend in business in which management delegate a great deal of the daily business of commanding and coordinating to subordinate officers.  Thus, second-line positions in an organization have become increasingly functional or specialist positions that often create conflict. (Urwick, L.1956) This also shows that control is a continuous process that is entrenched in every stage of the organizational ladder. To ensure effective control of top management, Urwick proposed that the span should be limited to five or at most six direct subordinates with interlocking functions.  Span of control refers to number of subordinates a manager can direct and handle efficiently and effectively.  This allows for efficiency and effectiveness in the taking or responsibility or the obligation to perform assigned tasks, in maintaining uniformity or the principle in which a person should report to more than one boss and evidence, which refers to the a authority or rights innate in a position to command orders and demand compliance.


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