• Management — the process of achieving organizational goals by coordinating people and resources through planning, organizing, staffing, directing, and controlling.
• Nursing management — applying that process to nursing services so that clients receive safe, effective, and efficient care.
• Leadership vs management — management is a formal, assigned role focused on systems, resources, and results; leadership is the ability to influence others toward goals and can come from any nurse. Good nurse managers need both.
• Management process (functions) used in nursing management texts: planning → organizing → staffing → directing (leading) → controlling (evaluating).

Levels of nurse managers

Katz's managerial skills

• Technical — clinical and procedural know-how; most important at the first-line level
• Human (interpersonal) — working with and through people; important at all levels
• Conceptual — seeing the organization as a whole and thinking strategically; most important at the top level

Mintzberg's managerial roles

• Interpersonal: figurehead, leader, liaison
• Informational: monitor, disseminator, spokesperson
• Decisional: entrepreneur, disturbance handler, resource allocator, negotiator

1. Classical (scientific and administrative) theories — focus on efficiency, structure, and rules

Limitation shared by classical theories: they treat workers as rational and economically motivated and neglect human and social needs.

2. Human relations and behavioral theories — focus on people

Motivation theories (Maslow, Herzberg, Vroom, Adams, Skinner) belong to this family and are covered in detail under Motivation and Empowerment.

3. Modern theories

• Systems theory (von Bertalanffy) — the organization is an open system of interdependent parts that exchanges energy with the environment: input (staff, supplies, clients, information) → throughput (nursing process, care activities) → output (client outcomes, satisfaction) → feedback (quality data, complaints) that adjusts inputs. A nursing department sharing information with other departments is interacting with its environment.
• Contingency (situational) theory — there is no one best way; the best structure or style depends on the situation (environment, technology, size, staff maturity, task structure).
• Theory Z (William Ouchi) — blends Japanese and American practices: long-term employment, collective decision-making with individual responsibility, slow evaluation and promotion, informal implicit control with formal measures, concern for the whole person, and strong organizational culture.
• Management by Objectives (MBO; Peter Drucker) — manager and staff jointly set specific, measurable objectives, the staff member works toward them with autonomy, progress is reviewed periodically, and performance is evaluated against the agreed objectives.
• Total quality management / continuous quality improvement — the whole organization continuously improves processes using data, with a client focus.

• Standardized procedures and checklists (e.g., a single pressure injury prevention protocol for all nurses) apply scientific management — they reduce variation and error.
• Clear chain of command and written policies apply bureaucratic principles and support accountability.
• Staff meetings, recognition, and team spirit apply human relations findings.
• Shared governance, unit councils, and participative scheduling apply Theory Y, Likert System 4, and Theory Z.
• Looking at a quality problem through inputs, processes, outputs, and feedback applies systems theory (e.g., high infection rates traced to supply shortages and training gaps).
• Choosing a directive style for an emergency but a participative style for planning a new program applies contingency theory.
• MBO fits annual performance appraisal: nurse and manager agree on targets such as completing a CPD course or improving documentation audit scores.

The Filipino nurse manager

• Philippine law sets minimum qualifications (RA 9173 Sec. 29): for supervisory or managerial positions — RN, at least 2 years in nursing service administration, BSN with at least 9 graduate units in management and administration, and APO membership; for chief nurse or director of nursing — additionally at least 5 years in a supervisory or managerial position and a master's degree major in nursing.
• The scope of nursing practice includes coordination with the health team and administration of nursing services (Sec. 28).

First-line nurse manager

• Plan unit goals and staffing; organize assignments and care delivery
• Direct, coach, and motivate staff; handle conflicts
• Monitor quality and safety indicators; lead improvement projects
• Manage unit resources and supplies within the budget
• Communicate between staff and upper management
• Ensure staff practice within scope, maintain licenses, and meet CPD requirements

Staff nurse

• Manage own client assignment (time, priorities, delegation)
• Participate in unit committees and quality work
• Provide feedback that helps managers improve systems

Managing change (often tested with management theory)

• Lewin: unfreezing → moving (changing) → refreezing
• Reduce resistance through participation, education, communication, and support; coercion or punishment increases resistance

• Managers are accountable for safe staffing, competent assignment, and supervision; assigning a task to someone not qualified may expose both the manager and the staff member to liability.
• Managers must verify valid PRC registration and PIC of nursing staff.
• For government nurses, the Magna Carta of Public Health Workers (RA 7305) sets working hours, allowances, and due process; managers must apply it fairly.
• Staff and client information handled by managers is protected by the Data Privacy Act (RA 10173).
• Ethical management means fairness in scheduling, promotions, and discipline (justice), and honesty in reporting (veracity).

Case 1. A new unit manager writes detailed rules, a strict hierarchy, and requires written documentation for every decision.

Theory applied: Weber's bureaucracy. Risk: rigidity and low motivation if overused.

Case 2. A manager analyzes nurses' movements during medication rounds and reorganizes supplies to cut walking time.

Theory applied: Taylor's scientific management (time-and-motion study).

Case 3. A manager says, "My staff avoid work; I need to watch them closely and threaten sanctions."

Assumption: McGregor's Theory X. Better approach for professional nurses: Theory Y — involve staff, give responsibility, recognize achievement.

Case 4. A manager uses a directive style during a code but a participative style when planning next year's training program.

Theory applied: contingency theory — the best approach depends on the situation.

• Listing motivating as one of Fayol's five functions — his functions are planning, organizing, commanding, coordinating, controlling.
• Attributing "one best way" to Fayol — it is Taylor.
• Calling the Hawthorne studies proof that lighting affects productivity — the key finding was the effect of attention and social factors.
• Thinking Theory Z emphasizes formal, explicit control — it emphasizes implicit, informal control and collective decisions.
• Treating contingency theory as "anything goes" — it requires analyzing the situation.
• Forgetting that human skills are needed at every management level.

• Management functions: planning, organizing, staffing, directing, controlling
• Katz: technical (first-line), human (all levels), conceptual (top)
• Mintzberg roles: interpersonal, informational, decisional
• Taylor: scientific management, time-and-motion, one best way, piece-rate pay
• Fayol: POCCC functions and 14 principles (unity of command, scalar chain)
• Weber: bureaucracy — hierarchy, rules, impersonality, rational-legal authority
• Mayo: Hawthorne studies → human relations, informal groups
• McGregor X/Y; Argyris maturity; Likert System 4 = participative
• Systems: input → throughput → output → feedback; open system
• Contingency: no one best way; Theory Z (Ouchi): long-term employment, collective decisions, holistic concern; MBO (Drucker): jointly set measurable objectives
• RA 9173 Sec. 29: managers 2 years + 9 graduate units; chief nurse 5 years + master's in nursing