NURSING MANAGEMENT PROCESS

PREPARED BY: AILYN B.PINEDA, RN

NURSING MANAGEMENT
Is the process of working through staff members to

be able to provide comprehensive care to the patient This includes planning, organizing, directing and controlling The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in order to provide effective, economic care to groups of patients

NURSING MANAGEMENT PROCESS

NURSING MANAGEMENT PROCESS

Purpose of the Nursing Management Process
To achieve scientifically – based, holistic,

individualized care for the patient
To achieve the opportunity to work collaboratively

with patients and others
To achieve continuity of care

Characteristics of the Nursing Management Process
Systematic Dynamic Interpersonal Goal Directed Universally Applicable

PLANNING
MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS

PLANNING
Is deciding in advance what to do, how to do a

particular task, when to do it, and who is to do it.
Is predetermining a course of action in order to

arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known

COMPONENTS OF PLANNING

PLANNING: PREDETERMINED ACTION

WHAT TO DO: -nursing activities

HOW TO DO IT: -technique, principles

WHO IS TO DO IT: -professional, nonprofessional

Nursing management -planning PRINCIPLES OF PLANNING

1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization. 2. Planning is a continuous process. 3. Planning should be pervasive within the entire organization covering the various departments, services and the various levels of management to provide maximal cooperation and harmony. 4. Planning utilizes all available resources. 5. Planning must be precise in its scope and nature. 6. Planning should be time bounded. 7. Projected plans must be documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement.

PLANNING
It leads to success in the achievements of goals and

objectives It provides meaning to work It provides for the effective use of available personnel and facilities It helps nurses cope with crises and problems calmly and efficiently It is cost effective It is based on past and future activities It reduces the element of change It is necessary for effective control

Characteristics of a GOOD PLAN
 It should have a clearly worded objectives, including

results and methods for evaluation Be guided by policies and/or procedures affecting the planned action Indicate priorities Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities and time Develop a logical sequence of activities Select the most practical methods for achieving each objective

PLANNING
 TYPES OF PLANNING:

1. STRATEGIC OR LONG-RANGE PLANNING “what are the right things to do” - usually extending 3 to 5 years into the future. 2. OPERATIONAL OR SHORT-RANGE PLANNING “how does one do things right” - deals with day to day maintenance activities. 3. CONTINUOUS OR ROLLING PLANS - similar to operating plans, involves mapping out the day-to-day activities.

ELEMENTS OF PLANNING
Forecasting or Estimate the future Set Objectives/Goals and Determine Results Desired Develop and Schedule Strategies,

Programs/Projects/Activities; Set the Time Frame Prepare the Budget and Allocation of Resources Establish Policies Procedures and Standards

Elements of Planning -Forecast or Estimate the FutureForecasting is looking into the future Refers to estimation of time series, cross sectional or

longitudinal data In making forecast, the planner should consider 3 things:
  

Agency Community affected Goals of care

Forecast must be supported by facts, reasonable

estimates and accurate reflection of policies and plans

Elements of Planning
Set Objectives/Goals and Determine Results Desired
GOALS are broad statements of intent derived from

the purposes of the organization

Is a desired aim or condition toward which one is willing to work Individual goals- are personal goals; based on one’s desired in life Group goals- may refer also to organizational goals although on a smaller scale Organizational goals- management goals of an organization that are established to justify its existence
Short term goals and long term goals

Objectives
 The objectives of the Nursing Department is congruent to its

vision as well as to the 11 key areas of responsibilities to nursing practice:  To observe ethical principles and standards that govern nursing practice. (ethico-moral-legal responsibilities)  To establish well coordinated referral system for the continuity of patient’s/ client’s care. (communication)  To assure the application of acceptable performance of functions, duties, and responsibilities of every position in the nursing department. (safe & quality nursing care, management of resources)  To encourage its nursing personnel to participate in nursing research for improving nursing care. ( research)  To utilize media for information campaign to intensify health education program. (health education)

Nursing management - ELEMENTS OF PLANNINGMISSION OR PURPOSE

- The mission statement outlines the agency’s reason for existing ( whether hospital or health care), who the target clients are ( the poor, the needy, the middle or upper class), and what services will be provided ( in-patient, out-patient, emergency). - reason for the existence of the organization (Nursing service exist to promote and maintain health)

Vision

The Board of Nursing under the guidance of

the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.

Mission
 The BON shall unwaveringly pursue the advancement

of nursing development in the country by: 1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders 2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws 3. unifying the nursing sector through good governance 4. fostering linkages with the domestic and international stakeholders

Nursing management - ELEMENTS OF PLANNINGPHILOSOPHY
- Philosophy is the sense of purpose of the organization and the reason behind its structure and goals. - Philosophy states the beliefs that influence nursing practice and beliefs about health care.

POLICIES

Policies in general, they are guidelines to help in the safe and efficient achievement of organizational objectives
PROCEDURES

Procedures are specific directions form implementing written policies

Nursing management - ELEMENTS OF PLANNING• Develop and Schedule Strategies,

Programs/Projects/Activities; Set the Time Frame Strategy is the techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives. Programs are activities put together to facilitate attainment of some desired goals.

Nursing management PLANNING
Time Management is a technique for allocation of

one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goal s efficiently

Nursing management PLANNING
 Principles of Time Management 2) Planning for contingencies-planning anticipates the

problem that will arise from actions without thought 3) Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance 4) Inventory 5) Sequencing 6) Setting and keeping deadlines- and adhering to deadline is an excellent exercise in self discipline 7) Deciding on how time will be spent

Nursing management PLANNING
Time Saving Techniques, Devices and Methods to Better Use of Time
3. Conduct an inventory of your activities. 4. Set goals and objectives and write them down. 5. With the use of calendars, executive planners, logs or journals, write what

you expect to accomplish yearly, monthly, weekly or daily. 6. Break down large projects into smaller parts. 7. Devote a few minutes at the beginning of each day for planning. 8. Organize your work space so it is functional. 9. Close your door when you need to concentrate. 10.Learn to delegate. 11. In a meeting, define the purpose clearly before starting. 12. Take or return phone calls during specified time. 13. Develop effective decision-making skills. 14. Take rest breaks and make good use of your spare time.

Nursing management PLANNING
Multitasking
 

Trying to get more things done in less time Examples: answering phone calls while driving, sending emails while in the meeting

Nursing management PLANNING
 DEVELOPING AND SCHEDULING PROGRAMS

Programs are predetermined, developed and targeted within a time frame to reach the set goals and objectives.
 The Planning Formula 5. WHAT 6. WHEN 7. WHERE 8. HOW 9. WHO 10.WHY 11.CAN

Nursing management PLANNING
• PREPARING THE BUDGET A budget is the annual operating plan, a financial “road

map” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs. A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year. A hospital budget is a financial plan to meet future service expectations.

Factors in BUDGET planning
Type of patient, length of stay in the hospital and

acuteness of illness Size of hospital and bed occupancy Physical lay out of the hospital, size and plan of the wards, units, nurse’s station, treatment rooms, etc Personnel policies
Salaries paid to various type of nursing personnel including OT pay or shift differential Extent of VL, SL, holidays Provision for staff development programs

Grouping of patients such as those in specialized

areas

Factors in BUDGET planning
Standards of nursing care: kind and amount of care

to be given as it affects the number of hours of bedside care The method of performing nursing care whether simple or complex; the method of documentation Proportion of nursing care provided by the professional nurses and those given by nonprofessionals Amount and quality of supervision available and provided; the efficiency of job description and job classification

Factors in BUDGET planning
Method of patient assignment whether functional,

case, team or primary Amount and kind of labor-saving devices and equipments Amount of centralized service provided: sterile supply , central o2 supply, linen supply Nursing service requirements of the ancillary departments: clinics, admitting office, ER Reports required by administration whether simple or complex Affiliation of nursing students or medical students

Establishing Nursing Standards, Policies and Procedures
Nursing Standards

Standard- a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which quality of practice or education can be judged Nursing Care Standard – a descriptive statement desired quality against which to evaluate nursing care Purpose of nursing standards
Improved quality of care Decrease the cost of nursing care Determine nursing negligence

Sources of nursing standards
DOH, BON, Professional Organization, Nursing Programs

Establishing Nursing Standards, Policies and Procedures
Nursing Service Policies

Policies in general are guidelines to help in safe and efficient achievement of organizational objectives There are 3 general areas in nursing which requires policy formulation. These are:
Areas in which confusion about the locus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfare Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property Areas involving matters of personnel management and welfare

Establishing Nursing Standards, Policies and Procedures
Nursing procedures

Procedures are specific directions for implementing written policies Procedures are more specific guide to action than policy

ORGANIZING
NURSING MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS

Nursing management - ORGANIZING ORGANIZING is the process of establishing formal

authority Involves setting up the organizational structure through identification of groupings, roles and relationships Determines staff needed through developing and maintaining staffing patterns and distributes them in the various areas as needed Develops job descriptions by defining the qualifications and functions of personnel

Organizing
Organizing is one way which nursing management

coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies

Nursing management - ORGANIZING PRINCIPLES OF ORGANIZATION:  Communication: effective and open communication in all forms; thread that binds the organization together

Directions of communication:
Downward Upward Lateral/Horizontal Grapevine

 Unity of Command  Span of Control  Delegation of authority  Similar Assignments  Unity of Purpose

ORGANIZATIONAL DESIGN

Organizational design is a

formal, guided process for integrating the people, information and technology of an organization.

PRINCIPLES OF ORGANIZATIONAL DESIGN
1. 2. 3. 4. 5.

Division of labor Unity of command Authority and responsibility Span of Control Contingency Factors

Nursing management - ORGANIZING ELEMENTS OF ORGANIZING 2. Organizational Structure 3. Staffing 4. Scheduling 5. Developing job descriptions

Importance of organizational structure
It enables members what their responsibilities are so

that they may carry them out It frees the manager and the individual workers to concentrate on their respective roles and responsibilities It coordinates all

Nursing management - ORGANIZING  ORGANIZATIONAL STRUCTURE 

The organizational structure refers to the process by which a group is formed its channel of authority, span of control and lines of communication.
positions or working relationships that will coordinate efforts of workers of diverse interest and abilities

 It is the formal structure, the official arrangement of

Patterns of Organizational Structure
Tall or Centralized Structure Flat or Decentralized Structure

TALL OR CENTRALIZED STRUCTURE

Responsible for only a few

subordinates, so there is a narrow span of control Because of the vertical nature of the structure, there are many levels of communication

TALL OR CENTRALIZED STRUCTURE
 Advantage  It makes use of expertise,

Disadvantage
 Transpires that the most

and allows close communication between the workers.  Supervisory individuals screen the communication.

skilled individuals end up doing nothing while actual tasks are done by those less capable.  Communication from bottom to top is often difficult, and messages do not get to the top  Workers tend to be very “boss-oriented “ because of the close contact with their supervisor.

Flat or Decentralized Structures

 Refers to an organizational

structure with few or no levels of intervention between management and staff.

Flat or Decentralized Structure
Advantages Lower likelihood of Disadvantages Supervisor spend less

messages being distorted Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction The principle of “shared governance” produces maximum potential for professional growth

time with each worker Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions

Nursing management - ORGANIZING Types of Organization Classified by Nature of Authority 3) Line Organization- each position has general authority

over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal) 4) Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization) 5) Staff Organization- purely advisory to the line structure with no authority to put recommendations into action. 6) Functional Organization – each unit is responsible for a given part of the organization’s workload.

TYPES OF ORGANIZATIONAL STRUCTURE

1)

Line Organization/ Bureaucratic/ Pyramidal - shows that each position has general authority over the lower position of the hierarchy. - ARA and power are concentrated at the top.

TYPES OF ORGANIZATIONAL STRUCTURE

2. Flat Organization - refers to an organizational structure with few or no levels of intervention between management and staff.

TYPES OF ORGANIZATIONAL STRUCTURE

3. Staff Organization - purely advisory to the line structure with no authority to place recommendations into action.

TYPES OF ORGANIZATIONAL STRUCTURE

4. Functional Organization - permits a specialist to aid line position within a limited and clearly defined scope authority.

ORGANIZATIONAL RELATIONSHIP
1. FORMAL

RELATIONS 2. INFORMAL RELATIONS

ORGANIZATIONAL RELATIONSHIP

1. FORMAL

RELATIONS - represents by
uninterrupted lines between units, showing who reports to whom.

ORGANIZATIONAL RELATIONSHIP

2. INFORMAL RELATIONS
- represented by a broken or dotted line, where power relationships are coordinated.

Nursing management - ORGANIZING • ORGANIZATIONAL CHART

- Organizational chart is a line drawing that shows how the parts of an organization are linked.

Nursing management - ORGANIZING Characteristics of an Organizational Chart 3)Division of Work 4)Chain of Command 5) Type of Work to be performed 6)Grouping of Work Segment 7) Levels of Management

Nursing management - ORGANIZING  STAFFING

Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients’ demand. The process of assigning competent people to fill the roles designated for the organizational structure through recruitment, selection and development.

- STAFFING FACTORS AFFECTING TIME REQUIREMENT

OF NURSING CARE
Patient’s acuteness of illness  Degree of dependence  Communicability of ailment

Steps in Staffing

  

Determine the Number and Types of Personnel Needed Recruitment Interview Induct or Orient the Personnel in Organization Job Offer

Centralized Staffing
 Staffing decisions for all units

are made by a central office or computer.  Tends to be fairer to employees, because policies are implemented more consistently and impartially.  Frees manager to complete other functions.  Most cost effective, because it maximizes use of human resources organization-wide.

Decentralized Staffing
 Staffing is done at unit level, frequently by

unit manager.  Allows person who knows the individual unit the best to make staffing decisions for that unit.  Allows staff to take requests directly to their own manager, which gives them increased autonomy and flexibility.  Increases the risk that employee requests may be treated unequally or inconsistently.  Time-consuming for unit manager.

NURSING CARE MODALITIES
TOTAL CARE or CASE NURSING One nurse is assigned to one patient for totality of care during his or her time on duty PDN Isolation nurse Nursing student

NURSING CARE MODALITIES FUNCTIONAL Nursing Task-oriented Particular nursing function is assigned to each nurse Time saving Worker learns w/ mastery -Medication nurse -Charge nurse -Nursing attendant

Nursing Care Modalities

PRIMARY Nursing Nurse is responsible for the total care of a small group of clients from admission to discharge

Nursing Care Modalities

TEAM Nursing The team leader assigns patients & tasks according to job descriptions

PATIENT CLASSIFICATION SYSTEM

“Self care” or Minimal Care Patients 2. Intermediate or Moderate Care 3. Total Care Patients 4. Intensive Care Patients
1.

PATIENT CLASSIFICATION SYSTEM
1.

   

“Self care” or Minimal Care Patients capable of carrying activities of daily living (ADL) Convalescing, no longer require intensive, moderate, or maximum care Require dx studies, Minimal therapy Awaiting elective surgery, Home environment temporarily makes discharge undesirable

PATIENT CLASSIFICATION SYSTEM
2. Intermediate or Moderate Care • requires some help from the nursing staff with special treatments. • Given to moderately ill
• •

Recovering from immediate effects of a serious illness or operation May be ambulatory for short periods (needs assistance)

PATIENT CLASSIFICATION SYSTEM
3. Total Care Patients  those who are bedridden and who lack strength and mobility to do average daily living.  Needs close attention
 Requires nurse to initiate,

supervise, and perform most of the activities  Requires frequent medication

PATIENT CLASSIFICATION SYSTEM
4. Intensive Care Patients  those who are critically ill and in constant danger of death or serious injury.

Acutely ill patients w/ high level of nurse dependency
 Unstable condition w/c

requires frequent evaluation with adjustment of therapy

Nursing management - STAFFING STAFFING FORMULA
Requirements: STANDARD VALUE OF NURSING CARE
Cases / Patients i. Surgery ii. General Ward iii. Pediatric iv. Pathologic Nursery v. Medical vi. OB vii. ICU/ER/RR viii.CCU NCH/pt/day 3.4 3.5 4.6 2.8 3.4 3.0 6.0 6.0 Prof. to Non-Prof Ratio 60:40 60:40 70:30 55:45 60:40 60:40 70:30 80:20

Nursing management - STAFFING Distribution Per Shift

SHIFT AM PM NIGHT

PERCENTAGE 45 % 37% 18%

Nursing management - STAFFING CATEGORIES OF PATIENT
Levels of Care
Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care

NCH Needed /pt./ day 1.50

Prof: Non Prof 55:45

3.0 4.5 6.0 7.0 or higher

60:40 65:35 70:30 80:20

Nursing management - STAFFING PERCENTAGE OF PATIENTS IN VARIOUS

LEVELS OF CARE
Type of Hospital Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital Minimal Care 70 65 30 10 Moderate Care 25 30 45 25 Intensive Care 5 5 15 45 Highly Spl. Care 10 20

Nursing management - STAFFING  TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND

HOURS OF NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Personnel/Yr 1. 2. 3. 4. 5. 6. 7. Vacation Leave Sick Leave Legal Holidays Special Holidays Special Privileges Off Duties as per R.A. 5901 Continuing Education Program Working Hours per Week 40 hours 48 hours 15 15 10 2 3 104 3 152 213 1,704 15 15 10 2 3 52 3 100 265 2,120

Total Non-Working Days/Year Total Working Days/Year Total Working Hours / Year

RA 5901 = 40H WK LAW

Nursing management - STAFFING Steps for Computing the Staff Needed in the in-patient

Unit of the Hospital COMPUTATION:

CASE: 250 BED CAPACITY TERTIARY HOSPITAL. HOW MANY STAFF NURSES DO WE NEED? 1. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE
 250 X 30% =  250 X 45% =  250 X 15% =  250 X 10% =

75 112.5 3.5 25

minimal care moderate care intensive care highly specialized nursing care

Nursing management - STAFFING 2. FIND THE NURSING CARE HOURS (NCH) NEEDED 75 X 1.5 (NCH @ Level I) = 112.5 NCH/day 112.5 X 3 (NCH @ Level II) = 337.5 NCH/day 37.5 X 4.5 (NCH @ Level III) = 168.75NCH/day 25 X 6 (NCH @ Level IV) = 150 NCH/day ------------------768.75 NCH/DAY

Nursing management - STAFFING 3. FIND NCH PER YEAR
 768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR

4. FIND ACTUAL WORKING HOURS NEEDED BY EACH NURSING PERSONNEL / YEAR
 8 ( hrs/day ) X 213 (WORKING DAY/YEAR)=

1,704 ( working hrs/year )

Nursing management - STAFFING 5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL
NEEDED. a. TOTAL NCH/ YEAR
= 280,593.75 = 165 WORKING HRS / YEAR 1,704

b. RELIEF x TOTAL NSG PERSONNEL 165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)

c. RELIEVERS + TOTAL # OF NURSING PERSONNEL NEEDED 165 + 25 = 190 TOTAL PERSONNEL NEEDED

Nursing management - STAFFING 6. DETERMINE PROF FROM NON PROF PERSONNEL e.g. tertiary hospital 190 X 65% = 124 PROFESSIONAL 190 X 35% = 68 NON PROFESSIONAL

Nursing management - STAFFING 7. DISTRIBUTE PER SHIFT
PROFESSIONAL(124) NON PROFESSIONAL(66)  AM (45%) 56 30
 PM (37%)  NIGHT (18%)

46 22

24 12

Nursing management - STAFFING  Placement of Staff

proper placement: a. fosters personal growth b. provides a motivating climate for the employee c. maximizes productivity d. organizational goals have better chances of being met inappropriate placement: a. frustration b. poor quality of work c. reduced organizational efficiency d. rapid turn-over e. poor image for the agency
RA 9173 nurses with Master’s degree in Nursing are easily placed in position

Nursing management - STAFFING SCHEDULING

A schedule is a timetable showing planned work days and shifts for nursing personnel.
Factors to Consider in Making a Schedule 5. Different levels of the nursing staff 6. Adequate coverage for 24 hours, 7 days a week 7. Staggered vacations and holidays 8. Weekends 9. Long stretches of consecutive working days 10.Evening and night shifts 11.Floating

Nursing management - STAFFING Assessing a Scheduling System 3. Ability to cover the needs of the shift 4. Quality to enhance the nursing personnel’s knowledge,

training and experience 5. Fairness to the staff. 6. Stability 7. Flexibility

Nursing management - STAFFING Types of Scheduling 3. Centralized Schedule 4. Decentralized Schedule 5. Cyclical Schedule

Nursing management - STAFFING SCHEDULING VARIABLES b. Length of scheduling period whether 2 or 4 weeks c. Shift rotation d. Week-ends off e. Holiday off f. Vacation leave g. Special days h. Scheduled events in the hospital , training programs, or meetings i. Job categories j. Continuing professional education (CPE) programs

Nursing management - STAFFING  DEVELOPING JOB DESCRIPTION

Job Description is a statement that sets the duties and responsibilities of a specific job. Contents of a Job Description 6. Identifying Data 7. Job Summary 8. Qualification Requirements 9. Job Relationships 10.Specific and Actual Functions and Activities

Nursing management - STAFFING Uses of Job Description 2. For recruitment and selection of qualified personnel 3. To orient new employees to their jobs 4. For job placement, transfer or dismissal 5. As an aid in evaluating the performance of an employee 6. For budgetary purposes 7. For determining departmental functions and relationships to help define the organizational structure 8. For classifying levels of nursing functions according to skill levels required. 9. To identify training needs 10.As basis for staffing 11.To serve as channel of communication.

Nursing management - DIRECTING DIRECTING
 

Plan put into action Activities
Delegation – transferring responsibility Updating policy Utilize the policy updates Supervision  Roles in Supervision
• • • • • Guides Direct Facilitates Motivates Teaches

Nursing management - DIRECTING Principles of Delegation 2. Select the right person to whom the job is to be

delegated. 3. Delegate both interesting and uninteresting tasks. 4. Provide subordinates with enough time to learn. 5. Delegate gradually. 6. Delegate in advance. 7. Consult before delegating. 8. Avoid gaps and overlaps.

Nursing management - DIRECTING What Cannot be Delegated 3. Overall responsibility, authority and accountability for

satisfactory completion of all activities in the unit. 4. Authority to sign one’s name is never delegated 5. Evaluating the staff and or taking necessary corrective or disciplinary action. 6. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones. 7. Jobs that are too technical and those that involve trust and confidence.

Nursing management - DIRECTING  Four Rights of Delegation

1. task The right task should be within the scope of the person’s practice and consistent with the job description. 2. person The right person should have the appropriate license or certificate, job description. 3. communication The right communication should be clear, concise, complete and correct. 4. feedback The right feedback should ask for input, get the person’s recommended solution to the problem and recognize the persons effort.

Nursing management - DIRECTING • Aspects of Delegation

1. Responsibility – denotes obligation 2. Authority – the power to make final decisions and give commands. 3. Accountability – refers to liability

Nursing management - DIRECTING  COMMUNICATION

Communication is the transmission of information, opinions, and intentions between among individuals. Purpose of communication 1. facilitates work 2. increases motivation 3. effects change 4. optimizes patient care 5. increases workers’ satisfaction 6. facilitates coordination

Nursing management - DIRECTING Types of Communication

1. Verbal Communication 2. Written Communication 3. Non-verbal Communication e. Personal appearance f. Intonation of the voice g. Facial expression h. Posture and gait i. Touch

Nursing management - DIRECTING Lines of Communication
UPWARD
to superior

HORIZONTAL
to peers and members of the Health Team

NURSES

OUTWARD
to patient, family and community to workers’ family and friends

DOWNWARD to subordinates

Nursing management - DIRECTING  DECISION MAKING

Decision is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result.

5 Steps in Decision Making 1. definition of the problem “ why the problem occur” 2. analysis of the problem “getting to the cause of the problem” 3. development of an alternative solution “search for and analysis of alternatives and their possible consequences” 4. selection of the solution weighing of facts and exploring alternative solutions 5. implementation and follow-up

Nursing management - DIRECTING Major Management Functions in Implementing

Decisions 1. Planning which entails consideration and selection of realistic objectives, policies and procedures. 2. Organizing which means helping personnel understand the decision and the procedures necessary for implementing the decision. 3. Staffing or the selection of the right person/s to carry out the decision 4. Controlling the environment and the group to prevent adverse effects.

Nursing management - DIRECTING Art of Decision Making: 2. Not making decision that others should make, to

preserve morale and authority; 3. Not deciding on problems that are not pertinent to matters at hand to prevent waste of time and energy; 4. Not deciding prematurely to prevent prujudice 5. Not making ineffective decisions to avoid losing the respectability of the decision maker.

Nursing management - DIRECTING CONFLICT MANAGEMENT

CONFLICTS – clash, fight, battle or struggle; it may be constructive or destructive Basis of the Conflict 1. Intrapersonal 2. Interpersonal 3. Group 4. Intergroup 5. Organizational

Nursing management - DIRECTING                 

Sources of the Conflict Cultural differences Different facts Separate pieces of information Different perception of the event Defining the problem differently Divergent views of power and authority Role conflicts Number of organizational levels Degree of association Parties dependent on others Competition for scarce resources Ambiguous jurisdictions Need for consensus Communication barriers Separation in time and space Accumulation of unresolved conflit

Nursing management - DIRECTING  Types of Conflict

1. Intrasender - conflict originates in the sender who gives conflicting instructions. 2. Intersender - conflict arises when an individual receives conflicting messages from two or more sources. 3. Interrole - conflict can occur when an individual belongs to more than one group. 4. Person-role - conflict is the result of disparity between internal and external roles.

Nursing management - DIRECTING 5. Interperson - conflict is common among people whose positions require interaction with other persons who fill various roles in the same organization or other organizations. 6. Intragroup - conflict occurs when the group faces a new problem. 7. Intergroup - conflict is common where 2 groups have different goals and can achieve their goals only at the others’ expense. 8. Role Ambiguity - a condition in which individuals do not know what is expected on them. 9. Role Overload - the person is simply unable to accomplish so much within a limited time period.

Nursing management - DIRECTING  Conflict Resolution

1. Avoidance - used by groups who do not want to do something that may interfere with their relationship 2. Accommodation - self-sacrifice 3. Collaboration - inspires mutual attention to the problem and utilizes the talents of all parties 4. Compromise - in this method, accommodation and adjustment lead to workable situations rather than to the best solution.

Nursing management - DIRECTING 5. Competition - it is an assertive position that fosters conflict resolution on the part of the subordinate. 6. Smoothing - disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence. 7. Withdrawing - one party is resolved thereby making it possible to resolve the issue. 8. Forcing - yields an immediate end to the conflict but leaves the cause of the conflict unresolved.

Nursing management - DIRECTING Rules on Mediating a Conflict Between Two or More

Parties: 1. Establish clear guidelines and make them known to all. 2. Do not postpone indefinitely. 3. Create an environment that makes people comfortable to make suggestions. 4. Keep two-way communication. 5. Stress a peaceful resolution rather than confrontation. 6. Emphasize shared interests. 7. Follow-up on the progress of the plan.

Nursing management - DIRECTING • Staff Development

Staff development is geared ultimately to organizational development.
• Orientation

Orientation is a planned and guided activities of an employee in the organization, the work environment , and in his job.

Nursing management - CONTROLLING CONTROLLING

Controlling or evaluating is an on-going function of management which occurs during planning, organizing, and directing activities. The controlling process opens opportunities for improvement and comparing performance against set standard.

Nursing management - CONTROLLING  Reasons For Conducting Evaluation 2. Evaluation ensures that quality nursing care is provided. 3. It allows for the setting of sensible objectives and ensures

compliance with them. 4. It provides standards for establishing comparisons. 5. It promotes visibility and a means for employees to monitor their own performance. 6. It highlights problems related to quality care and determines the areas that require priority attention. 7. It provides an indication of the costs of poor quality. 8. It justifies the use resources. 9. It provides feedback for improvement.

Nursing management - CONTROLLING  Principles of Evaluation. 2. The evaluation must be based on the behavioral standards of performance 3. 4. 5.

6. 7. 8.

which the position requires. The evaluation should have enough time to observe employee’s behavior. The employee should be given a copy of the job description, performance standards, and evaluation conference. The employee’s performance appraisal should include both satisfactory and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments. Areas needing improvement must be prioritized to help the worker upgrade his/her performance. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee. The evaluation report and conference should be structured in such a way that is perceived and accepted positively as a means of improving job description.

Nursing management - CONTROLLING Characteristics of an Evaluation Tool 2. Should be objective 3. Should be reliable 4. Should be sensitive

Nursing management - CONTROLLING PERFORMANCE APPRAISAL

Performance appraisal is a control process in which employee’s performance is evaluated against standards.
Purposes of Performance Appraisal 5. Determine salary standards and merit increases. 6. Select qualified individuals for promotion or transfer. 7. Identify unsatisfactory employees for demotion or

termination 8. Make inventories of talents within the institution. 9. Determine training and development needs of employee.

Nursing management - CONTROLLING 6. Improve the performance of work groups by examining, improving, correcting interrelationship between members 7. Improve communication between supervisors and employees and reach an understanding on the objectives of the job 8. Establish standards of supervisory performance. 9. Discover the aspirations of employees and reconcile these with the goals of the institution 10. Provide employee recognition 11. Inform employees where they stand.

Nursing management - CONTROLLING Methods of Measuring Performance 2. Essay 3. Checklist 4. Ranking 5. Rating Scales 6. Forced-choice Comparison 7. Anecdotal Recording

Nursing management - CONTROLLING -