Directing the Nursing Services

Directing
• Issuance of orders, assignments, and
instructions that enable the nursing personnel to
understand what are expected of them.
• Must be given in a complete, understandable,
and logical order.
• Also includes delegation of work to be
performed, utilization of policies and procedures,
supervision of personnel, coordination of
services, communication, staff development, and
making decisions.
 Elements of Directing
• Delegation
– Process by which a manager assigns specific task or
duties to workers.
– Worker resumes responsibility and accountability for
the end results
– Trains and develops staff members who desire
greater opportunities and challenges in their work
– Two elements involved: The ability of the worker to
carry out the task; and the fairness not only to the
employee but to the team as a whole.
 Principles of Delegation
• Select the right person to whom the job is to be
delegated.
• Delegate both interesting and uninteresting
tasks.
• Provide subordinates with enough time to learn
• Delegate gradually
• Delegate in advance
• Consult before delegating
• Avoid gaps and overlaps
 What cannot be delegated?
• Overall responsibility, authority, and
accountability for satisfactory completion of all
activities in the unit.
• Authority to sign one’s name is never delegated.
• Evaluating the staff and/or taking necessary
corrective or disciplinary action.
• Responsibility for maintaining morale or the
opportunity to say a few words of
encouragement to the staff especially the new
ones.
• Jobs that are too technical and those that
involve trust and confidence
 Why Nurse Managers do not
delegate.
• Nurse Manager may lack confidence on
her staff.
• Subordinates may feel apprehensive in
accepting delegated tasks for fear of
criticism and incompetence.
• Solution: Open communication. Warm and
cordial relationships.
 Nursing Care Assignment
• AKA modalities of nursing care, systems
of nursing care, or patterns of nursing care
• Four basic methods used: functional, total
care (formerly named case nursing), team
nursing, and primary nursing.
 Functional Nursing
• Task oriented.
• Division of tasks to be done with each person
being responsible to the head nurse.
• Best system where there is more patient than
professional nurses.
• Short-term use only.
• Advantage: 1. Allows most work to be
accomplished in the shortest time possible; 2.
workers learn to work fast; and 3. because tasks
are repetetive they gain skill faster
 Functional Nursing
• Disadvantages:
1. fragmentation of nursing care and therefore wholistic
care is not achieved;
2.nurses’ accountability and responsibility is diminished;
3. patients cannot identify who their “real” nurse is;
4. nurse-patient relationship is not fully developed;
5. evaluation of nursing care is poor and outcomes are
rarely documented;
6. it is difficult to find a specific person who can answer
the patient’s or relatives’ questions.
 Total Care or Case Nursing
• One nurse to one patient for the delivery of
total care.
• Provides wholistic care.
• Private duty nurses, nurses in special care
units, isolation room nurses, and for
nursing students.
 Team Nursing
• Decentralized system of care in which a qualified
professional nurse leads a group of nursing
personnel in providing for the nursing needs of a
group of patients through a participative effort.
• Team conferences and written nursing care
plans are implemented by the whole team.
• Team leader has significant responsibility and
authority.
• Somewhat like functional nursing.
Team Nursing
Charge Nurse

Team Leader

Nursing Staff

Patients/Clients
 Primary Nursing
• Each registered nurse is responsible for the total
care of a small group of patients from admission
to discharge.
• Primary nurse assesses the patients’ needs for
care, sets care goals, writes care plans,
administers care according to that plan,
evaluates the outcomes of care, and makes
necessary changes or adjustments as necessary
• Primary and secondary nurses are freed from
administrative and housekeeping duties
• Accountability , authority, and autonomy rests
with the primary nurse.
 Primary Nursing

Primary Nurse
Patient/Client

Secondary/ Ass. Secondary/Ass. Secondary/Ass.

Nurse PM Nurse night Nurse Relief
 Primary Nursing
• Head nurse’s role is consultant and quality control expert
for the primary nurse in the unit.
• Advantages
– Increased autonomy on the part of the nurse thereby increasing
motivation
– Responsibility and accountability
– Ensures continuity of care
– Makes available increased knowledge of the patient’s
psychosocial and physical needs.
– Leads to increased rapport and trust between nurse-patient thus
establishing a therapeutic relationship.
– Improves communication with the health care team and
eliminates need of nursing aids
 Primary Nursing
• Disadvantages
– Increases staffing and costs
 Other Nursing Assignments
• Modular method- modification of team and
primary nursing
– Registered nurse provides care with nursing aids.
– Each trio is responsible for a patient from admission to
discharge.
• Case Management- system of patient care
delivery that focuses on the achievement of
outcomes within effective and appropriate time
frames and resources
– Done by a case manager.
– Commonly seen in HMOs and health care plans.
Utilizing/Revising/Updating/ Nursing Service
Policies and Procedures
• Policies, procedures, rules, and
regulations are the standing plans of an
organization.
• Policies promote consistency of action and
stability.
• Procedure manual outlines a standard
technique or method of performing duties
 Communication
• The transmission of information,
opinions, and intention between
and among individuals.
• It helps promote trust between the
health personnel and those
clients.
• It provides basis for leadership
action
 Types of communication
• Verbal Communication
-involves speaking of words
• Written Communication
-must be clear, correct, complete and
concise
• Non-verbal Communication
-without using words
* Facial expression, gestures, touch, body
language, or vocal tones
 Principles of Effective
Communication
• Clear lines of communication
• Simple, exact, and concise message
• Feedback
• Communication thrives
• Manager communication skill
• Adequate and time conscious
• Personal appearance
- general impression of personality and self
concept
• Intonation of the voice
- soft and gentle
• Facial expression
- friendly smile
• Posture and gait
- physical wellness
• Touch
- way of caring
Lines of Communication

Upward

Horizontal nurses Outward

Downward
• Downward Communication
- traditional communication is from superior
to subordinate which may pass through
various level of management

• Upward Communication
- the form of feedback to show the extent
to which downward communication has
been received, accepted, and implemented
• Horizontal Communication
- flows between peers, personnel, or
departments on the same level.
- form of endorsement, shifts, nursing
rounds, journal meetings and conferences,
referrals between department and services
• Outward Communication
- deal information that flows from the
caregivers to the patient, their families,
relatives and community
- values their work