Nursing Leadership and Management: Bachelor of Science in Nursing 4

SULTAN KUDARAT EDUCATIONAL INSTITUTION, INC.
Tacurong City
Nursing Leadership and

Management
SY 2021-2022
Bachelor of Science in Nursing 4
RITZELLE ECIJA-EUGENIO, RN,RM,MAN, MHCA, CHRP
Teacher
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Resources: E-library, non-print materials in LMS
Course Requirements: Student output reflective of the integrated attainment of

course outcomes.
a. Online quiz
b. Exams
c. Video making
d. Student Portfolio
 Reflective paper per topic/lesson
 Case analysis
 Critique of selected nursing theories
Grading System: Exams 40%
Online Quiz 10%
Portfolio/module assessment 50%
Project output (paper)
Module Activity
ATTITUDE: (SUBMISSIONS OF REQUIREMENTS/project/portfolio)Rate
each item using the scale below:
Scale:
5 Performs expectations perfectly or almost perfect and complies with
themaximum requirements of the assigned task.
4 Performs expectations very satisfactorily most of the time.
3 Complies satisfactorily more than the minimum requirements of
assignedtasks.
2 Complies less than the minimum requirements of the assigned tasks.
1 Performs expectations poorly most of the time.
SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

Nursing 119 Nursing Leadership and Management
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MODULE CONTENT
MODULE TITLE: NURSING LEADERSHIP AND MANAGEMENT
MODULE DESCRIPTOR: This unit covers the knowledge, skills and attitudes required to
the concepts, principles, theories and methods of developing nursingleaders and managers
in the hospital and community-based settings.
NOMINAL DURATION: 36 hours
LEARNING OUTCOMES:
At the end of this module you MUST be able to:
1. Discuss principles of leadership and management
2. Apply the principles learned in organizing and conducting a seminar.

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INFORMATION SHEET 1
MANAGEMENT
After the lessons, you should be able to;
1. Discuss the principles and concepts in nursing management.

2. Describe the nursing management process.
3. Compare mission, vision, objectives, and philosophy.
4. Explain the relevant nursing management theories.
Introduction
THINGS ONE MUST KNOW ABOUT MANAGEMENT IN NURSING
Organizations have changed a great deal over the years, and this is more apparent
today than it has ever been. Work pace in the hospitals has become more urgent and
unceasing as with the growing population continuing to look to professional health care
providers for their health needs. New technology has also brought new waysof doing things.
Nurses must keep abreast with these continuing changes in the workplace.
To meet the constantly evolving demands of patients and other stakeholders, it has
become necessary to introduce new paradigms of management in health and nursing care.
Many health-related organizations have abandoned the traditional top- down, rigid and
hierarchical structures in favor of more flexible forms.
Today's managers who are always leaders first must deal with these continual, rapid
changes. Managers faced with a major decision must act quickly as lives hang in balance.
Management techniques must continually notice changes in the environment and
organization, assess this change and manage change. Managing change means
understanding it, adapting to it where necessary and guiding it when possible.
For purposes of this discussion, management is best defined and explained in the
context of nursing practice incorporated with organizational management. It is in thiscontext
that processes, theories and functions of management are best introduced because the
practical applications come as a matter of course.
MANAGEMENT
 art of getting things done through people and use of resources in doing task.
 process of getting activities completed efficiently and effectively with and
through people to attain goals of the organization.
 A process of coordinating actions and allocating resources to achieve
organizational goals
We can regard management as:

• Taking place within a structured organizational setting and with
prescribed roles.
• Directed towards the attainment of aims and objectives.
• Achieved through the efforts of other people; and
• Using system and procedures

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MANAGEMENT
Managerial leadership is a process of directing and influencing a task relatedactivity
of group members. It involves people and unequal distribution of power amongleaders and
group of people. It involves influencing subordinates in a variety of ways. NURSING
MANAGEMENT
The process of working through staff members to be able to provide comprehensive

care to the patient. This includes planning, organizing, directing and controlling.
KEY CONCEPTS IN NURSING MANAGEMENT
Managing successfully requires the understanding of key concepts in

management such as the difference between organization and administration, mission
and vision, goals, and objectives as well as philosophy.
ADMINISTRATION
 Administration is the higher level of hierarchy.

 The policy making body and as such sets the policy for the organization.
 Determines the aims and objectives of the organization that fully utilizes in
attaining goals and objectives:
a. Man
b. Money
c. Time
d. Power
e. Facilities
 Administration usually refers to the highest level, the policy making body ofan
organization which determines the aims And objectives of the organization.
- administration allocates resources
- Administrators who occupy the highest positions in an organization are
referred to as executive officers.
- administration is what clearly designates and delegates one's authority,
responsibility and accountability (ARA) in the organization
 Management generally refers to the middle and lower levels which serve asan
implementing body tasked with accomplishing the operation's goals and
objectives.
– management supervises the utilization of the resources and oversees

daily tasks to make sure that the goals and objectives are attained.
– middle-level are referred to as administrative officers, while those at the
first level include line managers and head nurses.
 The skill sets required for administration differs from that required for
management.
– Administrators are chosen for their conceptual skills

– managers are chosen for their interpersonal skills.
– Workers are chosen for their technical skills.

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ORGANIZATION
Organization is an arrangement of people and resources working in a planned
manner toward specific strategic goals.
1. It comprises the structure and process of a group working together to achieve an

identified goal.
2. It is also a body of persons, method, policies and procedures arranged in a
systematic manner through delegation of functions and responsibilities for the
accomplishment of a purpose.
3. As a process, it establishes formal authority, sets up the structure through
identification of groupings. roles and relationships.
4. The organization established has the task of determining staff needed and
distributing them in various areas as needed. It formulates the job description of
each.
It consists of an organizational chart or line linking the parts of an organization, its

relationships, areas of responsibilities, persons to whom one is accountable and channels
of communication are designed to visually see the lines of communication between and
among the people involved in the organization.
Above all, the organization as a people enacts its philosophy to achieve its
goals.
MISSION
A mission outlines the purpose of the agency.
the purpose of the hospital or the organization that provides health care. indetermining
the organization's mission,
identifies who the clients are.
– Is it the indigent and disadvantaged?
– Or the middle class or who can afford more than basic health care
services?
– Or is it the upper class whose resources are almost limitless?
The mission embodied by the organization provides for the kind of services that
will be given to in-patient, out-patient, or emergency cases.
An articulated mission allows everyone to understand why an organization
exists.
The history, values, and expectations of the organization are detailed.
Mission is the soul of an organization.
Nurse leaders-managers should help develop a mission that is centered on
healing.
– The mission should concentrate on key areas of high-quality
health care.
– Can also concentrate on establishing a professional work
environment that supports collegiality, improvement and
professional growth, and an understanding of the importance of
diversity and equity

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VISION
Outlines the organization's future role and functions.It
gives the agency something to strive for.
Successful in-depth health care occurs when nurse leaders managers work with
staff and the community to build a collective vision that is clear, compelling,and
connected to primary health care.
– Collective vision helps focus attention on what is important motivates
health personnel, and increases the . sense of shared responsibility for
good health.
"To choose a direction, a leader must first have developed a

mental image of a possible and desirable future state of the
organization. This image, which we call a VISION, may be as
vague in a dream or as precise as a goal or mission
statement. The critical point is that a vision articulates a view
of a realistic, credible, attractive future for the organization, a
condition that is better in some important ways than what now
exist”.
" Bennis and Nanus, 196, p. 89
 Both vision and mission must be clear, engaging, and attainable.

 It must touch deeper values and hopes to motivate the entire health personnel
belonging to the organization.
PHILOSOPHY
Philosophy describes the vision of an organization.
A statement of beliefs and values that direct the organization’s life or practice.
Propels the sense of purpose and reason behind its structure and goals.
It explains beliefs and gives direction to how the mission or purpose is
achieved.
For example, providing health services such as diagnostic, therapeutic,
preventive, health promotion, education and research may define one's
philosophy. The philosophy of nursing describes the context of nursing.
OBJECTIVES
Objectives are specific and concrete in terms of results to be achieved.The
backbone of one's goals and philosophy.
These are action commitments through which its mission and philosophy will be
achieved.
While the philosophy states the beliefs and values of an organization, objectives
state the specific and measurable goals to be accomplished
 Nothing happens until there is a plan.

– Good plans must have goals and objectives.
– Setting goals and objectives correctly goes a long way in helping
achieve organizational plans.
– Goals relate to one's aspirations, purpose and vision.
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– For example, a nurse has a goal of becoming financially independent

- this is a goal.
Objectives are the battle plan, the stepping stones on the path towards the
achievement of his goal.
Therefore, a goal may have one or many objective that the nurse would need to
fulfil to achieve his goal.
For example, to become financially independent he would need to;
1. get out of debt
2. improve his saving
3. start a business
MANAGEMENT PROCESS
The NURSING PROCESS is defined as a systematic, rational method of planning
and providing individualized nursing care. The general principles of management as
applied in the nursing process use the same objectives. The nursing management process
support the nursing process.
The NURSING MANAGEMENT PROCESS of data gathering, planning, organizing,

staffing, directing, and controlling support the nursing process of assessment, diagnosis,
planning, implementation, and evaluation. The two are squarelyidentical since it seeks to
accomplish a goal with minimum amount of time expended and done correctly the first time
it was needed.

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PURPOSE OF THE NURSING MANAGEMENT PROCESS:

1. To achieve scientifically-based, holistic, individualized care for the patient;
2. To achieve the opportunity to work collaboratively with patients and others
3. To achieve continuity of care.
CHARACTERISTICS OF THE NURSING MANAGEMENT PROCESS:

1. Systematic - It has an ordered sequence of activities and each activity
depends on the accuracy of the activity that precedes it and influences the
activity following it.
2. Dynamic - It has greater interaction and overlapping among the activities and
each activity is fluid and flows into the next activity.
3. Interpersonal - It ensures that nurses are patient-centered rather than task-
centered and encourages them to work to help patients use their strengths to
meet human needs.
4. Goal-Directed It is a means for nurses and patients to work together to identify
specific goals related to wellness promotion, disease and illness prevention,
health restoration, coping and altered functioning, which are most important to the
patient, and to match them with the appropriate nursing actions.
5. Universally Applicable - It allows nurses to practice nursing with well or ill
people, young or old, in any type of practice setting.

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Summary
1. Management uses delegated authority within a formal organization to organize,
direct and control subordinates so nursing services are coordinated. Management
is a process of getting things done through people.
2. The concept of management influence therefore implies a host of managerial
actions such as motivation, power, and leadership.
3. Managerial leadership is a process of directing and influencing a task related activity
of group members.
4. Nursing Management, then, is the process of working through staff members to be
able to provide comprehensive care to the patient.
5. Administration is the higher level of hierarchy. It is the policy making body and as
such sets the policy for the organization.
6. Organization is an arrangement of people and resources working in a planned
manner toward specified strategic goals.
7. An organizational chart is a line linking the parts of an organization, its relationships,
areas of responsibilities, persons to whom one is accountable and channels of
communication are designed to visually see the lines of communication between
and among the people involved in the organization.
8. A mission outlines the purpose of the agency, and in this case, the purpose of the
hospital or the organization that provides health care.
9. Vision, on the other hand, outlines the organization's future role and functions. It
gives the agency something to strive for.
10. Philosophy describes the vision of an organization. It is a statement of beliefs and
values that direct the organization's life or practice.
11. Objectives are specific and concrete in terms of results to be achieved. It is the
backbone of one's goals and philosophy These are action commitments through
which its mission and philosophy will be achieved.

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Activity 1. Critical Thinking. Write in a short bond paper. Bold

letters please.
1. What is your personal mission, vision, and objectives in life?
2. What philosophy guides you in your decision making?
3. Study the following mission statements and answer the questions that follow;
Mission A:
"Our mission is to ensure the highest quality of care for the patients in our community.
We believe that each patient has the right to the most innovative care that current
science and technology can provide. To that end, we have assembled a world-
renowned medical staff who will strive to ensure that the latest developments in medical
science are used to combat disease."
Mission B:
"Our mission is to provide excellence in care to all. Our health care staffs, nurses,
physicians, and other professionals believe that care can best be provided in an
atmosphere of collaboration and partnership with our patients and community. We
believe in education - for our patients, for our staff, and for future health care
providers. At all times, we strive for optimal health promotion and the prevention of
disease and disability"
I. Which of these mission statements do you think would be more likely to have
patient teaching on breast feeding?
II. Value the contributions of nursing?
III. Provide experimental therapy for cancer?
IV. Be open to scheduling routine patient care visits for uninsured patients?

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Activity 2. Encircle the correct letter of an answer.
Situation 1. Carol is the newly hired staff of St. Francis Medical Center. Miss David,
the nurse manager, scheduled her for a two weeks orientation program.
1. When Ms. David discuss the reason for the existence of St. Francis Medical
Center, she is referring to its:
a. Mission
b. Vision
c. Philosophy
d. Objectives
2. It describes the vision of the organization
a. Philosophy
b. Mission
c. Vision
d. Objectives
3. The following characteristics can be considered in management process:
i. Systematic
ii. Dynamic
iii. Goal directed
iv. Unified
a. i, ii
b. ii, iii
c. i,ii,iii
d. iii,iv
4. It is considered as the policy making body of the organization.
a. Management
b. Organization
c. Philosophy
d. Administration
5. It is considered a line which can link the parts of the organization
a. Straight line
b. Organizational chart
c. Dotted line
d. Arrow
6. In managerial leadership, it considers the following:
a. Involves influencing subordinates in variety of ways

b. Delegates responsibilities to people
c. Includes only planning
d. Considers use of powers only

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7. The purpose of nursing management process is
a. To achieve the opportunity to work collaboratively with patients and others

b. To provide safe environment to patient
c. To have basis to prepare patients
d. To be able to plan the care for patients
8. The purpose of nursing management process is
i. Planning
ii. Organizing
iii. Directing
iv. Controlling
a. i, ii
b. i, ii, iii
c. i, iv
d. i, ii, iii, iv
9. Administrators who occupy the highest position organization is referred to as:
a. Middle manager
b. Executive officer
c. Head nurses
d. Supervisor
10. Objectives are considered to be;
a. Broad purpose
b. Statement of intent
c. Specific aims and targets
d. Outlines the purpose of the organization
1. The unit manager identified in the that one of the staff nurse assigned to take care of
a chronically ill patient is poor in decision making and is always prone to commit
error. She should therefore:
a. Recommend the transfer of this staff to another unit

b. Provide closer supervision and guidance to the staff.
c. Refrain from giving her chronically ill patient.
d. Encourage the staff to enroll in the masteral program.

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INFORMATION SHEET 2 MANAGEMENT

IN NURSING: THEORIES AND MODELS
Theories and management have evolved continuously to describe the best
practices in solving creatively problems in the organizations. This information sheet 2 will
discuss the different theories of management.
EARLY MANAGEMENT THEORIES
Theories Emphasizing Organizational Structure

FREDERICK TAYLOR (1856-
1915), an American, developed the
Theory of ScientificManagement
in order to address the growing
needimprove industrial production.
The central premise of the theory is
that management and labor both
want to increase productivity, and
that it is possible to find “one best
practice” through which the worker
is able to get the most work done
for the least energy spent. The idea
was that management would train
workers in this "one best practice”
and that it would replace workers
indiscretion(Taylor, 1911).
Taylor's System of Work Improvement
The first component of this system is controlled observation of the workers'

performance done with time and motion studies to quantify the efficiency of workers with
which this task is done.
In order to determine the most efficient way to perform a given task the following
served as the basis for the:
1. Selection of the best man for a particular task based on the results of the
scientific study.
2. Training of the chosen workers for their designated tasks and the appropriate
adjustment of their pay; and
3. Filling of the managerial positions with the more highly skilled workers, in
particular, a foreman being appointed to each specific work unit.
By breaking down one complex task into several smaller subtasks, the performanceof
each worker is optimized, This theory was regarded as having made a breakthrough,

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with the criticism that intended to reduce workers to automatons or cogs in a machine
considering the elimination of discretion.
The Basic Components of this theory are:
1. Analysis and synthesis of the elements of the operation through time and
motion studies;
2. Scientific selection of workers,
3. Training of workers;
4. Proper tools and equipment; and
5. Proper incentives and payment.
Systematic Management Theory
HENRI FAYOL (1841-1925) a

Frenchman, called the Fatherof
Systematic Management
devised the traditional
operational school of
management.
He came up with the

theory that by guiding behaviorin
each management situation with
appropriate principles made
management more effective.
He introduced
management principles with the
aim of setting up a structure that
would promote order and raise
worker’s morale, thereby
improving efficiency and
accountability inthe system.

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PRINCIPLES OF MANAGEMENT
Management principles serves as a guides for managers for effective and

efficient practice.
UNIVERSAL PRINCIPLES OF MANAGEMENT

1. Authority The right to give orders and power to exact
obedience.
– managers give orders to make things done
2. Division of labor Specialization encourages continuous
improvement in skills and the development and
improvements in methods.
– specialization leads to efficient work
performance
3. Discipline No slacking, bending of rules. The worker should
be obedient and respectful of the organization.
– members of organization respect rules and
agreements that govern organization
4. Unity of command Each employee has one and only one boss to give
instructions or assignment.
– a member receives instruction form only
one superior
5. Unity of Direction A single mind generates a single plan and all play
their part in the plan but only one person is in-
charge of the group’s activities.
– common objective(s) for the entire
organization
6. Subordination of the When at work, the needs of the patients must take
common interest for the precedence over the staff nurses’ personal needs
common good in the same manner that a leader should be
concerned with the needs of the unit patients and
subordinates.
– organizational interests take precedence
over personal interests
7. Remuneration Employees receive fair payment or compensation
for services, not what the company can get away
with.
– fair compensation is based on work done
8. Centralization Consolidation of management functions.Decisions
are made from the top. This produce uniformity of
action, utilizes experts and reduces risk of errors
in the performance of tasks.
– the role of subordinates in decision-making
may be decreasing (centralization) or
increasing (decentralization)
9. chain of command Formal chain of command running from top to
bottom of the organization like military.
10. Decentralization of Focuses on the importance of human elements.
authority Increases motivation of nurses at lower levels
since the are asked to participate in decision
making.
11. Equity & Justice Fair and just treatment; no favoritism
– managers exercise fairness to subordinates

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12. Material and social All materials and personnel have prescribed
Order values and places, embodied in the institution’s
policies and regulations, and they must remain
there.
– materials and people are at the right time at
the right place
13. Personnel Tenure Limited turnover of personnel. Lifetime
employment for good workers. Granting security of
tenure or permanent status after a satisfactory
performance.
14. Initiative Thinking out plan and do what it takes to make it
happen.
– members have the freedom to conceive
and carry out their plans
15. Scalar chain Interconnectedness of people within the
organization from top to bottom.
16. Hierarchy The line of authority of the organization is the order
of rank from the top managers to the lowest
segment of the enterprise
17. Motivation of personnel Nurses are rational beings and must be allowed to
work their minds in problem solving and decision
making.
18. Esprit de corps Harmony, cohesion among personnel. To promote
esprit de corps, the principle of unity of command
should be observed and the dangers of divide and
rule and the abuse of written communication
should be avoided.
– team spirit gives a sense of unity
SULTAN KUDARAT EDUCATIONAL INSTITUTION,INC

Course: Nursing Leadership and Management BSN 4
Teacher: RITZELLE ECIJA-EUGENIO, MAN, MHcA, CHRP 2020-2021
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ORGANIZATIONAL THEORY
Max Weber (1864-1920), of Germany, known as the father of the Theory of Social and
Economic Organization, propounded similar principles of management, although what he
advocated was a complex form of bureaucracy based on hierarchy of authority, division of
work based on specialization of function.
The responsibilities and rights of the workers in Weber's system were governedby
specific rules rather than individuals. Organization of workers were based on their
individual competencies.
- bureaucracy for complex organizations

- organizations with hierarchical structure are most efficient and effective
Characteristic of bureaucratic organization
 tasks are specialized

 person is appointed by merit because of ability and not of favoritism or
whim
 career opportunities are provided
 authority and responsibility are specified
 activities are routinized
 a rational and impersonal climate exists

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THEORIES FOCUSED ON HUMAN RELATIONS

SOCIAL PROCESS
Mary Follet (1868-1933) an American conceived of management as a social process

focused on the motivation of individuals and groups alike towards achieving a common
goal.
The idea was based on collaboration and cooperation. rather than the exercise of
the manager's power and authority, arid particular attention was devoted to what motivated
the worker.
Under the theory, the manager did not give orders to the rank and-file employee,but
rather worked together with him to study a given situation and take the best action based
on the specific needs present in such situation.

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Elton Mayo (1880-1949) and Fritz Roethlisberger (1898-1974)
Mayo and Roethlisberger,

tested the assumptions of the
scientific management theory
through studies called the
Hawthorne effect. To find outthe
effects on a worker's
productivity of
different elements, they studied
the effect of physical
environment, participation in
decision making, arriving at the
conclusion that productivity
was affected by both the
physical and social
environment, including:
1. The ability or
opportunityto participate
in decision making with
the administration.
2. The recognition from administration.
The Hawthorne effect refers to a momentary change of behavior or performance in

response to a change in a worker’s environment, the response usually being an
improvement.
Changes in environmental condition resulted in a brief increase in productivity such

as;
brighter
workplace
lighting cleaner
workareas
clearing out pathways in
the office
relocating
some
workstations and etc.
Thus, the term is used to

identify any type of brief spike in
productivity, and the theory is that,
at least momentarily, people are
more productive when they feel
appreciated orwhen watched.

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CONTEMPORARY LEADER-MANAGER THEORIES
Peter Drucker (1909-2005) Father of Modern Corporate Management, which is a

consensual process where both management and rank-and-file meet in order to
understand and agree on the organization's objectives.
One example given by Drucker (1954) was the emphasis on profit and he
believed that multiple adjectives in line with this goal could organize and explain the
whole range of business phenomena.
His approach involved joint efforts between supervisors and subordinates, and a
breakdown of their respective responsibilities, goals and objectives, to be used in the
operations. Drucker believed that with carefully devised objectives and a good system for
their attainment, other concerns will fall into place.

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MANAGEMENT AS DECISION MAKING

HERBERT SIMON (1916-2001) posited the view that in hospitals and other service
institutions, decisions are made by employees at all levels of organization, forming anetwork
of decision-makers.
He named optimizing and

satisfying as two distinct
approaches to decision-making.
OPTIMIZING meant the

search for the best
alternative possible, an
approach used by Simon's
economic man.
SATISFYING, meant using the
first workable solution and was
applied by Simon's
"administrative man.
If one approach went with what

was best, this one went with what
is enough to work out.
In any case a three-step process is usually followed for arriving at the best ultimate
decision, such as:
1. Listing alternative strategies for resolving the problem

2. Determining the consequences that would follow each alternative
3. Comparative evaluation of these consequences.

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MANAGERIAL ROLES
HENRY MINTZBERG (1975), names three basic roles of the typical manager, namely;
1. Interpersonal
2. Informational
3. decision-making roles.
INTERPERSONAL ROLE, is that of a

figurehead, a leader and a liaison inside and
outside the organization.
INFORMATIONAL ROLE involved

monitoring the organization, sharing
information observed and finally serving asa
spokesperson.
DECISION MAKING ROLE, the manager isall

at once an entrepreneur, disturbance handler,
negotiator and allocator.

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MOTIVATIONAL THEORIES
As a manager, one must know the reasons why one would do something in
exchange for what one wants her to do in this light, the motivational theories of
Abraham Maslow, Ferdinand Herzberg. Douglas McGregor and William Ouchi became
popular as it tried to explain the motives of individuals.
ABRAHAM MASLOW'S HIERARCHY OF NEEDS
ABRAHAM MASLOW (1908-1970)

FATHER HUMANISTIC
PSYCHOLOGY, theorized that man's
various needs form a hierarchy starting
with their more basic needs. Maslow's
theory of hierarchy is in the shape of a
pyramid. The basic human needs such
as biological Abraham Maslow needs
form the base on whichother needs like
psychological and emotional needs are
built.
In a nursing management setting
the relevance of such a theory
is that the nurses should first look to a patient's basic needs; food, clothing, water,
shelter, and sleep, before she can take care of his other needs. This makes for more
efficient and effective operation in the organization.
Likewise, the nurse must look into her own basic minimum needs. Time sleep
food and water to ensure that she functions properly. A hungry and tired worker is not
likely to aspire to lofty goals as in an actualized worker.
А practical application of this theory would be to give nurses flexible working

hours, which by freeing them from the constraints of more fixed working hours, maygive
them leeway to manage their time, and increase their productivity.
Under Maslow's Hierarchyof

Need, there are five levels
of needs:
1. physiological
2. safety and security
3. love and belongingness,
4. need- esteem
5. self-actualization,
Each of which must be

fulfilled before the person
can go up in the hierarchy.

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FERDINAND HERZBERG'S MOTIVATION HYGIENE THEORY
Ferdinand Herzberg (1959) came up with the Two Factor Theory, which posits that
two Factors influence people:
1. hygiene factors
2. motivation factors
HYGIENE FACTORS are those which can negatively influence people.
Typical hygiene factors include:

a. working conditions
b. pay status in the organization
c. co-workers
d. Security etc..
Typical motivationfactors are:

a. achievement
b. interest in the job
c. Growth and psychological.
d. Recognition of responsibility for worketc…
Management must ensure that both sets of needs are met, directly or indirectlyby
creating a most conducive possible work environment.

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DOUGLAS MCGREGOR'S THEORY X AND Y
Douglas McGregor developed the Human Relations School of

Management. He developed two theories dubbed Theory X and Theory Y, which
worked on two different sets of assumptions.
Theory X proposes that man is:

1. lazy,
2. unmotivated
3. irresponsible,
4. unintelligent
5. not interested to work.
Because of these characteristics, they will only work properly to fulfill the
organizational goals when controlled and threatened. People prefer to be directed, hopeto
avoid responsibility, and are more interested in financial gain than personal growth.
Ultimately, theory X presupposes that people naturally dislike work and will avoid it
whenever possible.
Theory Y, on the other hand, makes completely different assumptions about human
nature.
Under this theory, man is

responsible,
creative
self-possessed
self-directed, and
a problem-solver
Exerting physical and
mental effort is second
nature to him. This theory
encourages workers to
develop their potential as
they are able to learn under
proper conditions to seek
and accept responsibility.

P a g e | 27
WILLIAM G. OUCHI'S THEORY Z
Japanese sociologist William G. Ouchi (1981) expanded and enlarged TheoryY

with a so-called Theory Z.
This humanistic nature
focuses on finding better ways to
motivate people to increase worker
satisfaction and therefore
productivity.
Ouchi expounded on the 7
BASIC CRITERIA that
characterized the Japanese'
Seven S".
HARD "S"
1. SUPERORDINATE
GOALS, or those which
hold the organization
together:
2. STRATEGY or method
3. STRUCTURE – concernof
doing things with the
physical plant and facilities
4. SYSTEMS - coherence ofall
parts of the organization for
a common goal.
SOFT "S":
5. STAFF - concern for the
right people to do the job;
6. SKILLS - developing and
training people
7. STYLE - the manner of
handling peers,
subordinates and
superiors
Theory Z has the following important elements.

1. Collective decision making
2. Long term employment
3. Slower but more predictable promotions
4. Indirect supervision
5. Holistic concern for employees
Theory Z is based on the principle that work is natural and can be a source of
satisfaction when aimed at a higher order to meet human psychological needs.
Management focused on increasing employee loyalty to the company by being concerned
about the wellbeing of the employee both on and off the job and offering life-tone security
of employment. Management emphasized stable employment and high employee morale
and satisfaction as keys to high productivity. This theory was based on Dr W Edwards
Deming's ideas on management which were rejected in the United States.

P a g e | 28
OTHER THEORIES
1. FRANK AND LILIAN GILBRETH – motion studies

In the modern world, we often wonder how we maximize our productivity,so
we can have a successful work life and also a thriving family life.
Scientific management- focused on human and technical elements

Fatigue study – systems to reduce workers’ fatigue
Time and motion study
 increase productivity
 studying workers movement
 breaking down each movement into a set of elements and
trying to find best way.
Ergonomics
 improve physical comfort
 innovation of office furniture
A Health care time and motion study is used to research and track theefficiency
and quality of health care workers. In the cases of nurses, numerousprograms have been
initiated to increase the percent of a shift nurses spend providing direct care to patients.
Prior to interventions nurses were found to spend ~20% of theirtime doing direct care. After
focused intervention, some hospitals doubled that number,with some even exceeding 70%
of shift time with patients, resulting in reduced errors, codes, and falls.

P a g e | 29
Methods
 External observer: Someone visually follows the person being observed, either
contemporaneously or via video recording. This method presents additional
expense as it usually requires a 1 to 1 ratio of research time to subject time. An
advantage is the data can be more consistent, complete, and accurate than with
self-reporting.
 Self-reporting: Self-reported studies require the target to record time and activity data.
This can be done contemporaneously by having subjects stop and start a timerwhen
completing a task, through work sampling where the subject records what theyare doing
at determined or random intervals, or by having the subject journal activities at the end
of the day. Self-reporting introduces errors that may not be present through other
methods, including errors in temporal perception and memory, as well as the motivation
to manipulate the data.
 Automation: Motion can be tracked with GPS. Documentation activities can be tracked
through monitoring software embedded in the applications used to create
documentation. Badge scans can also create a log of activity.

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2. HENRY GANTT
 scheduling
andrewarding
employees
 developed
the Gantt chart
which is a tool for
displaying the
progression of a
projectin a form of
specializedchart
 provides a
graphical illustration
of aschedule that
helps to plan,
coordinate, and
track specific tasks
in a project
Gantt Charts(G) are useful tools for analyzing and planning complex projects.
Help in planning out the tasks that need to be completed
Give a basis for scheduling when these tasks will be carried out
Allow to plan the allocation of resources needed to complete the project.
Help you to work out the critical path for a project where you must complete itby
a particular date.
When a project is under way, Gantt Charts help to monitor whether the project ison
schedule.

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4. CHESTER BARNARD
- acceptance theory of authority
- recognition of informal organization
- authority does not depend on commands, but on a reciprocal relationship; a
communication becomes authoritative by virtue of its acceptance thus authority
depends on communication.
- 3 functions of the executive
1. Establish and maintain an effective communication system
2. Hire and retain effective personnel, and
3. Motivate those personnel

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5. RENSIS LIKERT
The management theory of Rensis Likert brought a new dimension to
organizational development theory.
The Likert system made it possible to quantify the results of all the work
various theorists had been doing with group dynamics. Likert theory also
facilitated the measurement of the "soft" areas of management, such as trust and
communication.
Likert delineated the characteristics of high- and low-producing
organizations and identified the problems with traditional organizational
structures. Rensis Likert recognized FOUR MANAGEMENT STYLES, OR
SYSTEMS.
1. Exploitative-authoritative: The first system of Rensis Likert theory is

characterized by decision-making in the upper echelons of the
organization, with no teamwork and little communication other than
threats.
2. Benevolent-authoritative: This Likert system is based on a master-
servant relationship between management and employees, where
rewards are the sole motivators and both teamwork and communication
are minimal.
3. Consultative: In this style, managers partly trust subordinates, use both
rewards and involvement to inspire motivation, foster a higher level of
responsibility for meeting goals, and inspire a moderate amount of
teamwork and some communication.
4. Participative-group: This system is based on managerial trust and
confidence in employees; collectively determined, goal-based rewards; a
collective sense of responsibility for meeting company objectives;
collaborative teamwork and open communication

P a g e | 33

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6. ROBERT BLAKE AND JANE MOUTON

- Managerial Grid
- Leaders may be concerned for their people and they also must also have
some concern for the work to be done.
Country Club Team
High
management management
Middle of the
Concern for Medium road
People management
Impoverished Authority-
Low
management compliance
Low Medium High
Concern for Production (Task)
IMPOVERISHED MANAGEMENT
 Minimum effort to get the work done.
 A basically lazy approach that avoids as much work as possible.
AUTHORITY-COMPLIANCE
 Strong focus on task, but with little concern for people.
 Focus on efficiency, including the elimination of people wherever
possible.
COUNTRY CLUB MANAGEMENT

 Care and concern for the people, with a comfortable and friendly
environment and collegial style.
 But a low focus on task may give questionable results.
MIDDLE OF THE ROAD MANAGEMENT

 A weak balance of focus on both people and the work.
 Doing enough to get things done, but not pushing the boundaries of
what may be possible.
TEAM MANAGEMENT
 Firing on all cylinders:
 People are committed to task and leader is committed to people (as
well as task).

P a g e | 35
7. FRITZ ROETHLISBERGER

P a g e | 36
8. KURT LEWIN
- field theory of human behavior

- worker’s behavior is influenced by interactions between worker’s
personality, structure of primary work group and socio-ethical climate of
workplace
Change
 any alteration in the status quo, substituting one thing for another
 process of attitudes and behavior change occurs in three (3) Stages.
1. UNFREEZING
– equilibrium is upset
– change agent is motivated to create change
2. CHANGING/MOVING CHANGE
– new attitudes and behavior:
– change agent gather information, identifies problems
and search for variety of solution
3. REFREEZING
– integration of new attitudes, behavior into worker’s
personality and relationships.
– changes are integrated and stabilized as part of the
value system
Forces that influence change:
 External – influences the organization as a whole or its top administrators

 Internal – originated primarily from inside operations or results from
external changes

P a g e | 37
9. FRED EDWARD FIEDLER AND MARTIN M. CHEMERS
 Postulates that there is no best way for managers to lead.

 Situations will create different leadership style requirements for a
manager.
 The solution to a managerial situation is contingent on the factors that
impinge on the situation.
 Fiedler looked at three situations that could define the condition of a
managerial task:
a. Leader member relations - are the amount of loyalty,

dependability, and support that the leader receives from
employees
b. Task structure- in a favorable relationship the manager has a high

task structure and is able to reward and or punish employees without
any problems; in an unfavorable relationship the task is usually
unstructured and the leader possesses limited authority.
c. Position power - measures the amount of power or authority the

manager perceives the organization has given him or her for the
purpose of directing, rewarding, and punishing subordinates.

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10. ROBERT HOUSE HOUSE'S PATH-GOAL MODEL

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TOTAL QUALITY MANAGEMENT

Total Quality Management (TOM) is a management approach for an organization,
centered on quality, based on the participation of all its members and aiming at long term
success through customer satisfaction, and benefits to all membersof the organization and
to society. TQM is aimed at embedding awareness of quality in all organizational
processes.
For the Japanese, the secret of to success was the implementation of systematic
quality efforts to meet or exceed customer requirements and expectationsthe first time
and every time.
The three basic principles of TOM are to:
1. Focus on achieving customer satisfaction.

2. Seek continuous and long-term improvement in all the organization’s processes
and outputs.
3. Take steps to ensure the full involvement of the entire work force in improving
quality.
TOM IS COMPOSED OF THREE PARADIGMS
1. TOTAL: Involving the entire organization, supply chain, and/or product life
cycle
2. QUALITY: With its usual definitions, with all its complexities
3. MANAGEMENT: The system of managing with steps like Plan, Organize,
Control, Lead, Stall, provisioning, and the like.
In Japan. TOM comprises four process steps, namely:
1. KAIZEN - Focuses on "Continuous Process Improvement, to make

processes visible, repeatable and measurable.
2. ATARIMAE HINSHITSU - The idea that “things will work as they are
supposed to for example, a pen will write)
3. KANSEL - Examining the way the user applies the product leads to
improvement in the product itself.
4. MIRYOKUTEKI HINSHITSU - The idea that “things should have an
aesthetic quality” for example, a pen will write in a way that is pleasing to
the writer.
In sum, under TOM, the term total quality management defined in terms of
planning, organizing, directing, and controlling of all aspects of the management
process.

P a g e | 40
SUMMARY
1. Scientific Management theory seeks to develop the “one best practice” through
which the worker is able to maximize output for minimum energy expenditure.
2. Systematic Management theory proposes that effective management results from
selecting appropriate principles to guide behavior in each management situation.
3. MBO is a process of acting upon objectives within an organization so that
management and employees agree to the objectives and understand what theyare.
4. Abraham Maslow's theory of hierarchy of needs depicts as driven to fulfill several
different kinds of needs, with certain kinds of needs taking precedence over others.
5. Theory X proposes that man is lazy. unmotivated, irresponsible, unintelligent.
Theory Y proposes that man is responsible, creative, motivated, and self-directed.
6. Total Quality Management (TOM) is a management approach for anorganization,
centered on quality, based on the participation of all its members and aiming at long-
term success through customer satisfaction.
7. The Hawthorne effect describes a temporary change to behavior or performancein
response to a change in the environmental conditions, with the response being
typically an improvement.
8. Henri Fayol worked on the theory that effective management results fromselecting
appropriate principles to guide behavior in each management situation.

P a g e | 41
Activity 3 Critical Thinking. Write in a short bond paper.
1. Which of the management theories discussed above is most applicable to

nursing?
2. Aby Bernardo, the head nurse of Saint Gabriel Hospital in Laguna, has always
operated within traditional authoritarian management framework. Two days ago,
she announced that a TQM consultant was asked to assist in restructuringthe
entire way the hospital works and operates.
What are some of the concerns that the hospital staff members might
have about this project?
What factors currently at work might make TQM difficulty?
What changes will be needed in the organizational operation to makeTQM
work effectively?
3. Differentiate Maslow's Motivation theory and Herzberg's Hygiene-Motivation
theory.
Activity 4 . Encircle the correct letter of an answer.

1. The central premise al the scientific management theory by Frederick Taylor is
not concerned with any of the following:
a. Labor and management both desires Increasing productivity.
b. The best practice to get the most work done at the least energy spent
c. Provide considerable energy among workers
d. Training workers for desired work output
2. There is consolidation of management functions decisions emanate from the

top. This is the principle of
a. Chain of command
b. Decentralization of authority
c. Unity of command
d. Centralization of authority
3. Management as a social process focused on the individuals and groups to work

together and take best action from the situations. This is posited by;
a. Max Weber
b. Mary Follet
c. Abraham Maslow
d. Elton Mayo
4. Peter Drucker is the father of modem corporate management. His emphasis on

good management is built on
a. Management by objectives
b. Optimizing and satisfying
c. Motivation of employees
d. Social process

P a g e | 42
5. According to Henry Mintzberg, informational role refers to:
a. A leader, figurehead, and a liaison

b. An entrepreneur, negotiator, and disturbance handler
c. Spokesperson and disseminator
d. Dealer and allocator
6. A hungry and tired nurse is not likely to acquire lofty for self-actualization if her
needs are not met. This refers to what theory?
a. Hygiene and motivation theory

b. Humanistic theory
c. Organizational theory
d. Hierarchy of needs
7. McGregor's Theory X presupposes that workers are naturally:
i. Dislike work
ii. Motivated to work
iii. Irresponsible
iv. Creative
v. Lazy
a. i,iii,v
b. ii,iv,v
c. i,ii,iii
d. iii,iv,v
8. Total quality management is aimed at any of the following. Except:
a. Long term success through customer satisfaction

b. Workers' awareness of quality process
c. Centered on quantity rather than quality
d. Beneficial to the organization customers, workers, and the organization
9. The Japanese criteria of TOMS is least focused on any following:
a. Monetary incentives for workers

b. Things will work out as they are supposed to
c. Things should have aesthetic quality
d. Users feedback as basis for product improvement
10. Hygiene factors of Ferdinand Herzberg are concerned with any of the following,
except:
a. Adequate salary
b. Adequate recognition
c. Safe working conditions
d. Good interpersonal relations

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INFORMATION SHEET 3
MANAGEMENT PROCESS
After the lesson, you should be able to;
1. Create and generate quality nursing care plans.

2. Approach budgeting and allocation of resources efficiently.
3. Arrive at good quality decisions.
4. Fill up required nursing staff positions.
5. Formulate job descriptions.
6. Identify the core competencies of nurses.
7. Identify factors of a good performance evaluation.
8. Explain the approaches to management of conflict.
MANAGEMENT FUNCTIONS- PLANNING

Planning is a management
function, concerned defining goals for
future organizational performance and
deciding on the tasks and resources tobe
used in order to attain those goals. To
meet the goals, nurse managers may
develop plans such as a unit plan or a
nursing care plan.
Planning always has a purpose.

The purpose may be achievement of
certain goals or targets. Planninghelps to
achieve these goals or targets by using
the available time and resources.
“Thinking ahead; making future
projections to achieve desired
results”
DEFINITION OF PLANNING
Planning is deciding in advance what to do, how to do a particular task, when to

do it, and who is to do it. It is a cognitive process for decision-making, based on facts
and information as opposed to a manager's preferences or wishes. It must be adaptable
and flexible to current realities to ensure that the desired result is achieved.
Planning:
predetermined
action
How to do it? Who will do it?

What to do?
techniques, professional,
Nursing Activities principles nonprofessional

P a g e | 44
 Planning entails forecasting or setting the broad outline of work to be done.

 It is the primary process of selecting and relating facts, making use of
assumptions regarding the future, and formulating activities necessary to
achieve the desired results in the Nursing Service.
 It sets the direction for the other functions of management and for teamwork
 continuous action of determining in advance what to do, how to do it, when todo
it, who will do it towards where or what direction
 Effective planning involves answering certain questions that constitute the basic
elements of this activity, using the question technique with “why” as thecommon
denominator:
1. What action is necessary? Why?
2. Where will it take place? Why?
3. When will it take place? Why?
4. Who will do it? Why?
5. How will it be done? Why?
 Since planning requires forecasting, generalization, analysis, detail and
specification, it precedes action and should systematize and provide the base for
such action.
GOOD PLANNING
Good planning, involves a continuous process of assessment, establishment of
goals and objectives, implementation and evaluation of change as new facts become
known (Douglass, 1986),
ASSESSMENT
ESTABLISHMENTS
EVALUATION OF GOALS AND
OBJECTIVES
IMPLEMENTATION
PROCESS OF GOOD PLANNING

P a g e | 45
POOR PLANNING
Poor planning is the failure to set goals, assessments or provide for implementation or to
anticipate any possible change in circumstances. Some indicators of poor planning are
as follows (McLarney, 1964):
1. Delivery are not met dates

2. Machines are idle.
3. Material is wasted
4. Some nurses are overworked, others are underworked.
5. Skilled nurses doing unskilled work.
6. Nurses are fumbling on jobs for which they have not been trained.
7. There is quarreling, bickering, buck-passing, and confusion..
PLANS
A plan is a living document which can be changed based on the prevailing

circumstances. It in a predetermined course of action intended to facilitate the
accomplishment of a task, work or mission.
"Failing to plan
isplanning to
fail. "
CHARACTERISTICS OF A PLAN
A well-developed plan requires first and foremost, creative thinking andforesight.

It has three characteristics, planning must:
1. involve the future

2. Involve action, and
3. have an organizational identification the action which will be
undertaken either by the planner or someone designated by or for her.
TYPES OF PLANS
There are several types of plans. These are strategic plan, long term plan, short term
plan and continuous plan.
1. Strategic Plans
A strategic plan is one that asks the vital question:” what the right things
to do?”. They are usually around 3-5 years, long-term in nature and are based on
explicit assessments of the competitive strengths and weaknesses of the
organization. This type of plan defines the direction and growth of the
organization.

P a g e | 46
Strategic plans are usually prepared in the upper levels of management

and serve as the basis for operating plans. In a nursing care setting a strategic
plan would one which calls for increasing diversity in nursing and more recruitment.
2. Operating Plans
Operating plans usually pertain to activities in specific departments ofan

organization. The plan's main question is "how does one do things right?"It deals
with tactics or techniques do accomplishing these things. They are generally
shorter in time frame (e.g. one year), and usually involve the middleand lower
managers.
Although coordinated with each other operational plan preparedseparately

by the managers of the functional sub-units of organization. For example, the
department budget is prepared by the head nurse of a pediatric unit. Operations
planning focuses timetables, target quantities and specifies the persona responsible
for the tasks.
3. Continuous or Rolling Plans

A continuous or rolling plan, similar to operating plans, involves mappingout
the day-to-day activities. This is the task of the staff nurse who has to deviseand
implement the nursing care plan for the patients altering or modifying the plan as
necessary depending on the needs and problems of the patients and the unit to where
the plan is applicable.
REASONS FOR PLANNING

Planning is essential in nursing because:
1. It leads to success in the achievement of goals and objectives.
a. It brings about behavior that leads to desired actions and outcomes.

b. It makes the performance of tasks more meaningful.
c. It helps the nurses relate what they are doing to their professional goals.
2. It provides for the effective use of available personnel and facilities.
For example, projecting the number of nurses needed to care for a group of
patients or ordering enough supplies for u unit.
3. It helps nurses cope with crisis and problems calmly and efficiently.
Planning is a well-thought process of predicting future activities, anticipate

future problems, and plan for alternatives to prevent or cope withpotential
problems.
4. It reduces the element of change.
a. Studying what has been successful or unsuccessful can give the

manager a better idea of what to do in the future.
b. Through planning, one can discover the need for change.
c. Planning can point out opportunities for new different services.

P a g e | 47
5. Overall, it is necessary for effective control.
Planning enables the manager to design effective ways to ensure

accomplishment of goals and objectives through coordination and collaboration
between and among people and the organization and effective use of resources.
RESISTANCE TO PLANNING
Despite the many benefits of planning, many nurse-managers avoid it because they
lack:
1. Knowledge of the philosophy, goals and operations of the organization.

2. Understanding of the significance of planning, that success or failure 0f work
activities relate directly to the quality of plan.
3. Proper appreciation of use of time for planning: they erroneously perceive that
time spent on planning would be better spent on addressing day-to-day
concerns.
4. Confidence and fear of failure;
5. Openness to change that they believe planning may entail:
6. Willingness to engage in new activities that planning produces; and
7. Insights into the exigencies of the situation, they prefer to act on immediate
problems that give them immediate feedback.
Resistance to planning can be overcome by managers who are willing to be open-

minded about planning and change.
1. forecasting or estimating the future

2. setting objectives and goals,
3. developing strategies and setting the time frame:
4. preparing the budget and allocation of resources and
5. establishing policies, procedures and standards.
1. FORECAST OR ESTIMATE THE FUTURE
Forecasting is looking into the future. It is weighing the unknown values inthe
situation and using them as basis for an educated guess about the future. Prediction
is a similar, but more general term, and usually refers to estimation oftime series,
cross-sectional or longitudinal data. Risk and uncertainty are centralto forecasting
and prediction.
In making forecasts, the planner should consider three (3) things;
1. the agency
2. the community affected, and
3. the goals of care.
The forecasts must be supported by facts, Reasonable estimates andaccurate

reflection of policies and plans.

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2. SET OBJECTIVES/GOALS AND DETERMINE RESULTS DESIRED
A plan must set objectives or goals, or in other words determine

beforehand the desired result.
GOALS are defined as broad statements of intent derived from the purposes ofthe
organization.
OBJECTIVES are specific behavior or tasks set for the accomplishment of a
goal.
3. DEVELOP AND SCHEDULING STRATEGIES,

PROGRAMS/PROJECTS/ACTIVITIES; SET THE TIME FRAME
A planner must develop schedules, strategies, programs projects and/or

activities, and set the time frame for their completion in order to achieve the
objectives and goals of the organization.
STRATEGY is the techniques, methods, or procedure by which the overall plan of thehigher
management achieve desired objectives.
PROGRAMS are activities put together to facilitate attainment of some desired goals,
such as staff development programs, outreach programs, discharge
teaching programs and the likes.
TIME MANAGEMENT
The manager's single most important

resource is time. Since time is finite the
manager should allocate it as efficiently as
possible, which he can do by setting goals,
assigning priorities, and identifying and
avoiding allpossible wastes of time.
Good time management is founded

upon intelligent planning and decision-
making, and a thorough assessment of the
tasks which need to be done. It is about
efficiency and the determination of the
most effective or at least the best available
means of fulfilling a task. It is not enough
to just work hard at a given task; TIME
MANAGEMENT means FINDING THE
MOST EFFICIENT WAY TO DO IT.
Everyone has the same number of

hours in a day, but the clever time manager
can accomplish more than others because
he makes better orsmarter use of his time.

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Mismanagement of Time severely compromises an organization'sproductivity

and results in negative effects across the board, from the manager to therank-and-file.
When time is mismanaged, work is rushed and becomes substandard, deadlinesare

missed. bad choices are made, employees suffer from fatigue, and even the nurse’s
personal lives and relationships are adversely affected by the lack of time or energy to
devote to them.
PRINCIPLES OF TIME MANAGEMENT
There are a number of basic principles that managers can use to cultivate good
time-management habits.
Planning for contingencies. Think of other options or alternatives, if the desired

option is not possible.
Listing of tasks Calendar all activities. Inventory.
Looking at task done and not done.Sequencing.
Prioritizing activities
Setting and keeping deadlines. Do not procrastinate or else nothing is done.
Deciding on how time will be spent. Indicate time allotted for each activity, set
time targets.
Delegate. A portion of the task can be given to another who can equally
accomplish the task on time.
Multitasking
Multitasking is part of daily life. Whether it's driving while talking on the cell phone,
sending emails during a meeting or listening to music during work or study, multitaskinghas
become a way of life.
Nurses, doctors, parents, and even students are trying to get more things done in
less time. A nurse is asked to do a lot of things, any one of which may demand her full
attention. She often finds herself juggling tasks. A patient needs to have an IV inserted.
Another patient requires a bedpan. The head nurse is asking for a report that was due
yesterday. However, multitasking does not really make a person more efficient. It just
looks that way.

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These days, nurses have

cell phones and blackberries
to keep all appointments,
iPods to keep them company
during graveyard shifts and
computers on which to check
their emails whether office
relate or personal with
technology, thingsseem faster
and so many tasks need to get
done all at the same time.
People think they are getting
so much done at once, but in
fact are not.
The net effect of

multitasking is that when
several tasks are done at
once, some or all of them
end up being performed in a haphazard manner. This can have disastrous
consequences. Nurses, therefore, must learn to prioritize the tasks at hand even if they
have to do them one after the other, as this remains the best way to make sure that they
get done properly.
"Anyone who wants to get more work done should get mindful. Anyone who wants to have more time
should be mindful. Mindful means one thing at a time. It is how the brain works, no matter how people
try to convince themselves otherwise.”
Anonymous
TOOLS IN PROJECT MANAGEMENT
Various tools in project management have been devised such as Gantt Charts.
Performance Evaluation and Review Technique and Critical Path Method which allow
the manager to set the time frame of the project or activity meant to achieve the goalsof
the organization. Marquis and Houstori: 2006).
A. GANTT CHART
https://www.youtube.com/watch?v=fB0wsdmV3Sw
Gantt charts show task and

schedule information. The
tasks are numbered and listed
vertically. A bar showsthe
starting date and projected
completion date ofeach task.
Color or shading is sometimes
used to show how much of
each task has been completed.
It is both a management tool
and a communications tool.

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B. PERFORMANCE SITUATION AND REVIEW TECHNIQUE (PERT)

Link: https://www.youtube.com/watch?v=i160aaBX7mE
The PERT or the Performance Evaluation and Review Technique is anetwork

system model for planning and control which involves identifying key activities,
sequences them in a flow diagram and assigning a specific duration for each phase of
work.
A PERT system involves extensive research and development. Multiple time

estimates are used for each activity that allow for variation in activity, which are
assumed to be at random with assumed probability distribution ("probability').Activities
are represented as arrowed lines between nodes.
C. Critical Path Method or CPM

Link : https://iconnect007.com/index.php/download_file/view_inline/8289/
The Critical Path Method (CPM) can calculate time and cost estimates for each
activity. This method is used to create a cost estimate using either "normal” or“crash”
operating conditions. Normal operating conditions are those involving the least cost,
while crash operating conditions have much less available time than under normal
conditions.
CPM is useful where time and cost are significant factors because both can be
estimated based on past experience.
CPM is a tool to analyze a project and determine duration, based on

identification of a “critical path” through an activity network. Knowledge of the criticalpath
can permit management of the project to change duration.

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4. PREPARE THE BUDGET AND ALLOCATION OF RESOURCES
BUDGETING is defined as;
 a systematic financial translation of a plan

 the allocation of scarce resources on the basis of forecasted needs for
proposed activities over a specified period of time.
 a tool for planning, monitoring and controlling cost and meeting expenses.
A NURSING BUDGET allocates resources for nursing programs and
activities to deliver patient care during a fiscal year.
A HOSPITAL BUDGET is designed to meet future service expectations, to

provide quality patient care at minimum cost.
A BUDGET PLAN for health care institutions, which is simply a plan for
future activities, generally consists of four components;
1. REVENUE BUDGET is summarizing the income management expectsto

generate during the planning period
2. EXPENSE BUDGET is describing expected activity in operational

financial terms for a given period of time.
3. CAPITAL BUDGET outlines the programmed acquisition, disposals and

improvements in the institution's physical capacity.
4. CASH BUDGET consists of money received, cash receipts and

disbursement expected during the planning period.
TYPES OF BUDGETING
The two most basic types of budgeting are the centralized and the decentralized
approaches to budgets.
1. CENTRALIZED BUDGET - Centralized budgeting is developed and

imposed by the comptroller, administrator and/or director of nursing with little
to no consultation with lower level managers.
2. DECENTRALIZED BUDGET Decentralized budgeting, has the middle level

manager involved in the planning and budgeting process with ARA placed
on the practitioner level.
COMPONENTS OF TOTAL INSTITUTIONAL BUDGET
The components of total institutional budget are:
1. MANPOWER BUDGET - This consists of the wages and salaries of the regular
employees and the fees paid to outside registries through which the institution
contracts short-term.

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2. CAPITAL EXPENDITURE BUDGET. This involves the large employees expense

of purchasing of lands, buildings and major equipment meant for long-term use.
3. OPERATING BUDGET - This includes the cost of supplies, minor equipment repair
and maintenance as well as other overhead expenses.
TYPES OF INSTITUTIONAL BUDGET DEPENDING ON

MANAGEMENT PHILOSOPHY
There are many different types of institutional budgeting, the appropriateness of

which to a given milieu may depend on such things as the philosophy of the incumbent
management or the exigencies of a given situation.
1. OPEN-ENDED BUDGET - An open-ended budget is characterized by a single cost

estimate for each program in the proposed unit.
2. FIXED CEILING BUDGET - A fixed ceiling budget is one in which the uppermost
spending limit is set by the top executive who then asks managers to develop
budget proposals for individual units.
3. FLEXIBLE BUDGET - A flexible budget, in contrast, contains several financial plans

for each level of activity or for different operating conditions. Top management can
select the budget or shift the spending level upwards or downwards, whichever best
for optimum productivity.
4. PERFORMANCE BUDGET - A performance budget is based on the functions and

activities of personnel involved in the operation budgeted.
In a nursing care management setting this may refer to direct nursing care
activities, supervision of nursing staff, and quality control, among other things.
5. PROGRAM BUDGET. On the other hand, in a program budget costs arecomputed

for a program as a whole or the entire program itself (eg, a home careprogram, an
outreach program, etc.), rather than for individual activities or functions.
6. ZERO BASED BUDGET - A zero-based budget justified in detail the cost of all
programs, both old and new, in every annual budget preparation.
7. SUNSET BUDGET - A sunset budget is designed to self-destruct” within a

prescribed period of time.
BENEFITS OF THE BUDGETING PROCESS
There are several advantages derived from the budgeting process. Budgeting
affords planning, coordination and comprehensive control of resources.
1. Planning
 Budgeting stimulates thinking in advance.
 It leads to specific planning such as; the
volume and type of services

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the number and type of personnel

the volume and type of equipment and supplies required,the
corresponding cost.
 The process likewise stimulates action and interaction with all concerned
parties.
 From the process of budgeting one can learn a good deal about planning.
2. Coordination
 Budgeting also encourages coordination among the different persons
involved in the process, from the top to bottom.
 It has a balancing effect on the total and the expected revenue.
 The continuous exchange of information up and down the organizational
ladder is encouraged.
 The team approach is stimulated or developed.
3. Comprehensive control
 A budget fosters comprehensive control for those responsible for managing
it.
 This is because in assessing whether a budget is realistic or not, an
administrator is able to evaluate quality and initiative in performance.
 He is able to set standards and compare these standards with actual
expenditures and revenue.
 Through budgeting the manager is able to define fixed and predetermined
goals through the budget, and is also able to initiate cost consciousness.
FACTORS IN BUDGET PLANNING
Budget planning is determined by the specific type of activity for which it is

implemented. Nursing service has very specific parameters, activities and needs whichform
the basis of budget planning.
The basic factors to be considered in budget planning are the type of patients, the
kind or class of hospital, the policies on personnel and equipment, standards of nursing
care and nursing supervision.
1. Patient
The nature of the patient's needs is a primary consideration budget planning.

These needs are determined by the condition of the patient, the length of stay in the
hospital and the acuteness of the illness.
Categorizing the patient is made through the type of care given by the physician
such as medical, surgical, maternity, pediatric, and geriatric among others.The method
of patient assignment can be functional, case, team or primary. The severity of the
illness serves as the basis for length of stay in the hospital.
2. Hospital or Health Care Facility
The available facilities and resources with which to address the needs of the
patient are also factors in budget planning. In nursing management, these concerns
include the size of the hospital, specifically its bed occupancy and capacity. Bed
capacity must be enough to accommodate the possible number of patients. Other
aspects of a hospital to be considered include its physical layout, the size of wards

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and units, the Nurse's Station, the treatment rooms other relevant facilities and
resources available such as equipment and supplies.
3. Personnel
These facilities would be useless without the personnel to utilize them, and so it
is important to be well-acquainted with personnel policies in place, such as the salaries
paid to nursing personnel, leave benefits enjoyed by the personnel, ie. whether these
leaves confined to those required by law or include others, and provisions for staff
development programs including instructional staff and training structures available,
e.g. periodic seminars for staff.
Other Factors Affecting the Nursing Service Budget:
4. Training and research plans

5. Turnover rate affecting the degree and quality of supervision.
6. Methods of assignment.
7. Full implementation of the nursing process.
8. Physical layout of hospital and labor saving devices.
9. Memorandum method of reporting (simple or complex) required by the
administrator.
10. Community extension services.
11. Affiliation of nursing and allied health students.
4. STANDARD OF NURSING CARE AND SUPERVISION

This consists of the cost of training and maintaining personnel and
acquiring equipment that will be needed by the health care facility, based on
the volume of patients and the nature of their needs.
It begins with documentation of the nursing care method. She identifies

what labor-saving devices and equipment are employed which refers to reports.
The manager determines whether the method of patient assignment shall be
functional, on a case basis, on a team basis or to a primary nursing method.
She identifies what labor-saving devices and equipment are necessary.

There must be a determination of the amount of centralized service provided,
such as sterile equipment, centralized oxygen service and linen supply.
The manager determines the affiliation of nursing students or medical

students to the system, considering that as a rule, inexperienced students need
more supervision, equipment and supplies.
Tools in Budgeting and Management of Resources
There are a number of tools used in the budgeting and management of

resources:
1. The budgeting process of the organization.

2. Determine the number of full-time equivalent of nurses necessary to
staff the unit.
3. Compute the salary and non-salary budget including salary increases
and other various factors.

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4. Monitor the variances over the budget period and identity negative
variances responding promptly and appropriately.
5. Understand the extraneous factors such as changes in technology or
direct or indirect cost that may be assigned to their budget.
6. Encourage the staff to monitor resources used including time and
supplies.
5. ESTABLISH POLICIES PROCEDURES AND

STANDARDS
POLICIES are defined as standing plans used repeatedly, or guides or basic
rules that at all levels in the organization. They stem from the goals of the
organization Examples include Procedures personnel policy. nursing services
policies and the like.
PROCEDURES are defined as a more specific guide to action than policy,

while standards indicate the minimal level of achievement acceptable to meet the
sect objectives.

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MODELS OF PLANNING
Models of planning vary according to the needs and profile of theorganization.

are:
Some of these models are:
A. "basic” model
B. issue-based (or goal-based) model
C. alignment model
D. scenario planning
E. organic planning functional planning
F. cross-sectional planning
G. operational planning.
A. "BASIC" STRATEGIC PLANNING
This model is suited to small organizations with a high volume of

work but with limited to no strategic planning.
The early operation period of the organization, like the first year would bea
good time to use the model in order to familiarize the organization, like the firstyear,
would be a good time to use the model in order to familiarize the organization with
the concept and conduct of planning. Subsequent planning maybe done with more
details, phases and activities. Planning is usually carried out by top-level
management, who identifies the:
1. Purpose or mission statement.

2. Goals to be accomplished to fulfill the purpose or mission statement.
3. Specific approaches or strategies needed to reach each goal.
4. Specific action plans to implement each strategy for achieving goals.
5. Consistent monitoring and updating of the plan.
Organizations which follow thin approach may adjust their strategies to

identify additional goals to develop operations or administration of the organization.
B. Issue-Based or Goal-Based Planning
Issue-Based or Goal-Based Strategic Planning consists of the

following activities:
1. External/internal assessment to identify "SWOT (Strengths, Weaknesses,

Opportunities and Threats) of the organization.
2. Strategic analysis to identify and prioritize major issues or goals.
3. Designing major strategies or programs to address these Issues or goals.
4. Designing or updating the organization's vision, mission and values.
5. Establishment of action plans based on the organization’s objectives, resource
needs, roles and responsibilities for implementation.
6. Documentation of issues, goals, strategies or programs, and whenever
applicable, an updated mission and vision, action plans in a Strategic Plan
document, and SWOT.
7. Development of the yearly Operating Plan document from year one of the multi-
year strategic plan.

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8. Development and implementation of the Budget for year one and allocationof
funds needed to fund year two and onward.
9. The conduct of the organization's year-one operations.
10. Monitoring/reviewing/evaluating and update the Strategic Plan document.
C. Alignment Model
This model is geared towards ensuring that the organization's resources are
aligned with its mission to ensure effective operation. It is a useful strategy for
organizations that need to fine tune their operating strategies, or which mayneed to
rework their current approach. An organization with internal issues mayalso benefit
in this model.
D. Scenario Planning
Scenario planning involves identifying possible scenarios situations that the

organization may face. This model is useful in identifying strategic issues andgoals
and may be used to ensure truly concrete solutions to problems.
E. "Organic" or Self-Organizing Planning
Organic strategic planning is self-organizing, and naturalistic in

orientation, requiring repeated reference to common cultural values within the
organization
F. Functional Planning
This model deals with both the actual activities of the organization and the
administrative or internal matters thereof as well such as work, costs, and
resources.
This plan usually works in the context of an overall plan and as such hasto
be weighed against competing priorities from other programs and internal
initiatives for organizational advancement like process improvements and training,
A functional plan
a. defines tasks which may be assigned to Individuals.
b. produces clear final outputs to other similarly oriented
organizations.
c. tracks Internal operations.
d. allows for additional program requirements; and
e. allows for managing competing priorities from multiple programs.
This may be affected by non-project related work which includes change

and work includes a process for assessing plan status.
G. Cross-sectional Planning
Cross-functional planning focuses on managing the external effects on

outputs of a function. It brings together the activities of various functional in support
of a single project like a team working together. Unlike functionalplanning, which is
oriented towards moving work within a single organization, cross-functional
planning is geared towards moving work from one functional organization to
another.

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H. Operational Planning
Operational planning requires one to look at the development of the

decisions being made as they relate to the overall effectiveness of work on the
health care facility,
An operational plan defines how one will implement the action agreed
upon and monitoring these plans, what the needs are, how will one use available
resources, how one will deal with risks, and how one will ensure sustainability of
the project's achievements.
An Operational Plan incorporates all other plans, past and present, to

come up with a wholistic implementation of the plan. The key components are
integrated with the other parts of the overall Strategic Plan.

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DECISION MAKING
Nurses make decisions of varying importance every day, so the idea that
decision making can be a rather sophisticated art may at first seem strange.
However, studies have shown that most people are much poorer at decision making
than they think. An understanding of what decision-making invoices, together with
techniques, will help produce better decisions at work.
DECISION MAKING DEFINED
Decision making the process is the process of identifying and choosing

course of action from among several possible choices. This process is
influenced by the values and preferences of the decision maker (Sullivan: 2006).
The making of a decision reduces doubt. The decision is based on

information gathered by the decision-maker in implementing a workable plan
through observation, interview, and scientific inquiry.
KINDS OF DECISIONS
There are several basic kinds of decisions that a nurse manager can
possibly use while dealing with issues and problems in her unit;
1. WHETHER DECISIONS.
Whether decisions refer to the decision made before the selection of one of
several alternatives, where selection is made after weighing pros and cons.
For example, before figuring out the alternatives of what car to buy, the
decision has to be made whether or not to buy a car.
2. WHICH DECISIONS
This is the process of choosing from among several alternatives, whichare

measured based on a set of pre-defined criteria.
3. CONTINGENT DECISIONS
These are decisions that have been made but put on hold until some
conditions are met like time, energy, price, availability, opportunity, and
encouragement.
For example, I have decided to buy that car if I can get it for the right
price and/or I have decided to write that article if I can work the necessary
time for it to fit into my schedule.

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DECISION MAKING MODELS

Decision making is the hardest task a manager has to face. Depending on the
situation, the manager must know when the decision will result in a win-win, win-lose,
disagreement and collaboration or solution shaping outcome.
1. Win-Win. It is characterized by a mutual willingness in the group to come up with

solutions that are acceptable to all. This is based in part on everyone's preferred
solution to combine the self-interests and purposes of the people in the group, and
to negotiate solutions that are acceptable to all.
2. Win-Lose. In this model, some interests are advanced at the expense of others.For
example, the nurse administered all the treatments necessary despite patients’
inconvenience or discomfort during the treatment process.
3. Disagreement and Collaboration. Decisions resulting in the following elementsare

made when conflicts and disagreements are openly explored, using collaboration
and cooperation:
a. High quality decisions
b. Creative decisions
c. Decisions that are understood
d. Decisions that are accepted and owned
4. Solution Shaping. This method is focused on how to modify or amend an

unpopular proposed solution rather than attempt to pressure people into changing
their minds about the solution. This is holding the planned solution in abeyance for
further study and analysis until a justifiable solution is reached.
TOOLS IN DECISION MAKING

Decisions are made based on different factors such as time, risk and performance
possible. There is more than one way to arrive at a decision. Consequently, different tools
in decision-making have evolved to suit various managerial preferences such as
probability theory. decision trees, queuing theory and linear programming (Marquis and
Huston: 2006),
1. Probability Theory
This theory was devised to address the presence of risk or uncertainty in a

decision-making situation by looking for predictable patterns based on historical
data, thereby reducing the uncertainty. When there is limited historical precedent, it
becomes hard to apply the theory and the risk remains unchecked.

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2. Decision Trees
A Decision Tree model, which is more graphic in nature, enables the planner
to visualize alternative courses of action taking into account all factors involved like
risks, information needs and outcomes for a problem over time.
The graphic is essentially a tree shaped diagram which stars with a primary
decision that branches out into increasing numbers of alternatives, eachof which
further branches out until all possible alternative outcomes are laid out on the
diagram
The Decision Tree gives the manager a forecast of the possible results ofhis
choices and enables him to make a cost-benefit analysis of each alternative.
While most risks are independent of other risks and easier to manage, certain
risks are interconnected, and some risks only appear as a result of actionstaken from
managing an existing risk, and this is why the Decision Tree model isuseful. It is a
technique for determining overall risk associated with a series of related risks.
3. Queuing Theory
In the Queuing Theory, problems are addressed one after another and after
having determined the best balance of factors related to service. It is the
mathematical study of waiting lines (or queues).
Queuing theory is a powerful tool that helps hospitals and clinics to uncork
chronic bottlenecks in the flow of patients in the emergency department (ER), theout-
patient department (OPD), and elsewhere.
Through queuing, nurses or clinic secretaries determine how they will handle
patients seeking health care by defining the way they will be served, the order in
which they are served, and the way in which resources are divided.

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The three queuing disciplines are:
1. First in First Out (FIFO) patients are serviced according o their order of
arrival.
2. Last In First Out (LIFO) the last patient to arrive on the queue is the one
who is actually served first.
3. Processor Sharing (PS) - patients are serviced equally, i.e. they

experience the same amount of delay.
4. Linear Programming
Finally, the Linear Programming method uses matrix algebra or linear

mathematical equations to determine the best way to use limited resources to
achieve maximal results (Marquis and Huston: 2006).

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CRITICAL THINKING PROCESS IN PROBLEM SOLVING

AND DECISION MAKING
CRITICAL THINKING
Nurses constantly face numerous decisions to make and problems to solve.

These are part of the usual nursing care activities and are not easy tasks.
Developing critical thinking, problem solving, and decision-making skills enables

nurses to see all sides of an issue, look for creative alternatives and approaches to solve
problems and make well thought out decisions. The effect is a stronger organization and
more competent leader and manager (Sullivan 2006).
Critical thinking is a cognitive process of examining underlying assumptions,

interpreting, and evaluating arguments, imagining and exploring alternatives and
developing a reflective criticism for the purpose of reaching a justifiable reasoned
conclusion and correct judgment. Critical thinking consists of the following competencies
(Bandman: 1999).
1. General critical thinking competencies. This process includes scientific method,

problem solving and decision-making processes.
2. Specific critical thinking competencies. This includes those clinical situations

such as diagnostic reasoning, clinical inference, and clinical decision-making.
3. Specific critical thinking competencies are used in making nursing decisions.This

includes the use of the nursing process in stating nursing diagnosis and
formulation treatment plan.
It is a higher-level cognitive process that includes creativity, problem solving and

decision making. It is broader and involves considering a range of alternatives and
selecting the best one for the situation.
There are four suggested questions to consider when examining a problem or

making a decision.
1. What are the underlying assumptions?

2. How is evidence interpreted?
3. How are the arguments to be evaluated?
4. What are possible alternative perspectives?

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Critical thinking skills are used throughout the nursing process. Learning to be a
critical thinker requires a commitment over time, but the skills can be learned,
CHARACTERISTICS OF AN EXPERT CRITICAL THINKER

Expert critical thinkers have distinct characteristics (Ignatavicius, 2001). They
often find time to regroup and focus their thinking for a change. Analyze the following
characteristics of an expert critical thinker.
 Outcome directed or goal-oriented

 Open to new ideas or out-of-the-box thinker
 Flexible and adaptable
 Willing to change and accepts challenges
 Innovative ideas which result in new direction
 Creative and conduct researches for new interventions
 Analytical and reflective thinker
 Communicator and expressive of ideas and concerns
 Assertive, can influence people of her thoughts and ideas
 Persistent with barriers and persevering
 Caring warm and friendly
 Energetic and has the capacity to act consistent with norms
 Risk-taker, trying all possible outcomes
 Knowledgeable, rational and reasonable
 Intuitive or have clinical insights
These characteristics can be honed and developed over time. They can be
cultivated as long as one believes it is possible,
Nurses must learn to be critical thinkers in light of the fast-changing

environment. In the knowledge explosion era, only those who fail to think
for themselves fail.
DECISION-MAKING
Decision-making is an endpoint of critical thinking which leads to problem

solution using these steps:
1. Define the problem;

2. Assess all options;
3. Weigh all options against a set of criteria or standards
4. Test possible options:
5. Consider consequences of the decisions
6. Make a final decision.
When making a clinical decision, the nursing process is used for the nurse to
determine actions that will help move the client toward achievement of the expected
outcome. Nurse managers exercises clinical judgment viewed within the context of the
management process involving client care, manpower resources, and hospital resources.

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ROLES THAT MANAGERS FULFILL IN AN ORGANIZATION

Nurse Managers and their Responsibilities
LEVEL RESPONSIBILITY
Top Responsible for the overall operations of nursing services;

managers establish objectives, policies and strategies; represent the
organization in community affairs, business arrangements and
negotiations; typical titles: director of nursing services,
chairman, executive vice president
Middle Usually coordinate the nursing activities of several units,

Managers receive broad, overall strategies and policies from top
managers and translate them into specific objectives and
programs; typical titles: supervisor, coordinator
First-line Directly responsible for the actual production of nursing

Managers services; act as links between higher level managers and non
managers; typical titles: head nurse, team leader, primary care
nurse
ROLES OF NURSING PRACTICE
Roles
1. Organized set of behaviors that are attributed to a specific office or position

2. A set of prescription for the expected behavior of an individual in a position or
status category
3. Sum total of the behavior expected from a person who occupies a particular
position and status in a social pattern
Sources of Roles
1. institutional requirements
2. patient/client expectations
3. peer pressure
4. nurse’s conception of what the role implies
Role Problems
1. arise from unclear or ambiguous messages

Role Conflict
1. arise when one receives different directions from several sources

Skills required for Managerial Role
1. decision-making
2. planning
3. administrative
4. human relations

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Important Managerial Skills
1. developing peer relationships

2. carrying out negotiations
3. motivating subordinates
4. resolving conflicts
5. establishing information network
STRATEGIC PLANNING PROCESS
Leaders are proactive. They make change happen instead of reacting to change.The
future requires corporate leadership with the skills to integrate many unexpected and
seemingly diverse events into its planning. Every organization must plan for changein order
to reach its ultimate goal. Effective planning helps an organization adapt to change by
identifying opportunities and avoiding problems. It sets the direction for the other functions
of management and for teamwork. Planning improves decision-making. All levels of
management engage in planning.
Strategic Planning
 Strategic planning produces fundamental decisions and actions that shape and
guide what an organization is, what it does, and why it does it.
 It requires broad-scale information gathering, an exploration of alternatives, and an
emphasis on the future implications of present decisions.
 Top level managers engage chiefly in strategic planning or long-range planning.
They answer such questions as "What is the purpose of this organization?"
"What does this organization have to do in the future to remain competitive?"
Strategic planning is the process of developing and analyzing the organization's

mission, overall goals, general strategies, and allocating resources.
 A strategy is a course of action created to achieve a long-term goal. The time length
for strategies is arbitrary, but is probably two, three, or perhaps as many as five
years. It is generally determined by how far in the future the organization is
committing its resources.
 Goals focus on desired changes. They are the ends that the organization strivesto
attain.
Strategic Planning as a management process combine 4 basic features:
1. A clear statement of the organization’s mission

2. The identification of the agency’s external constituencies or stakeholders and the
determination of their assessment of the agency’s purposes and operations.
3. The delineation of the agency’s strategic goals and objectives, typically in 3- to5-
year plan.
4. The development of strategies to achieve the goals

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 Strategic Planning requires managerial expertise in:
1. Healthcare economics
2. Human resource management
3. Political and legislative issues affecting healthcare
4. Planning theories
 Leadership skills required:
1. sensitivity to the environment

2. ability to appraise accurately the social and political climate
3. taking the risks
 Levels of Planning:
1. Strategic Planning – Top-level management (3-5 years)

2. Intermediate Planning – Middle-level Management (6 months – 2 years)
3. Operational Planning – Lower-level Management/First-Level management(1
wk – 1 year)
The planning process is rational and amenable to the scientific approach to problem
solving. It consists of a logical and orderly series of steps. Strategic planning sets the
stage for the rest of the organization's planning. The tasks of the strategic planning
process include:
1. Define the mission.

2. Conduct a situation or SWOT analysis by assessing strengths and
weaknesses and identifying opportunities and threats.
3. Set goals and objectives.
4. Develop related strategies (tactical and operational).
5. Monitor the plan.
Define the mission.
 A mission is the purpose of the organization. It is why the organization exists. Thus,
planning begins with clearly defining the mission of the organization.
 The mission statement is broad, yet clear and concise, summarizing what the
organization does.
 It directs the organization, as well as all of its major functions and operations, to its
best opportunities. Then, it leads to supporting tactical and operational plans,which,
in turn leads to supporting objectives.
 A mission statement should be short - no more than a single sentence. It shouldbe
easily understood, and every employee should be able to recite it from memory.
 An explicit mission guides employee to work independently and yet collectively
toward the realization of the organization's potential.
 The mission statement may be accompanied by an overarching statement of
philosophy or strategic purpose intended to convey a vision for the future and an
awareness of challenges from a top-level perspective.

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Conduct a situation or SWOT analysis by assessing strengths and weaknesses

and identifying opportunities and threats.
 A situation or SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis is

critical to the creation of any strategic plan.
 The SWOT analysis begins with a scan of the external environment. Organizations
must examine their situation in order to seek opportunities and monitor
threats. Sources of information include customers (internal and external), suppliers,
governments (local, state, federal, international), professional or trade associations
(conventions and exhibitions), journals and reports (scientific, professional, and
trade). This is often called as situation audit.
 SWOT is the assumptions and facts on which a plan will be based.
 Analyzing strengths and weaknesses comprises the internal assessment ofthe
organization.
Assess the strengths of the organization. What makes the organization
distinctive? (How efficient is our manufacturing? How skilled is our
workforce? What is our market share? What financing is available? Do we
have a superior reputation?)
Assess the weaknesses of the organization. What are the vulnerable
areas of the organization that could be exploited? (Are our facilities
outdated? Is research and development adequate? Are our technologies
obsolete?) What does the competition do well?
 Analyzing opportunities and threats comprises the external assessment of the
environment.
Identify opportunities. In which areas is the competition not meeting
customer needs? (What are the possible new markets? What is the strength
of the economy? Are our rivals weak? What are the emerging technologies?
Is there a possibility of growth of existing market?)
Identify threats. In which areas does the competition meet customer
needs more effectively? (Are there new competitors? Is there a shortageof
resources? Are market tastes changing? What are the new regulations?
What substitute products exist?)
 The best strategy is one that fits the organization's strengths to opportunities in the
environment.

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Components of SWOT Analysis:

SET GOALS AND OBJECTIVES
STRENGTHS WEAKNESSES
 Management development  Scarcity of Staff

 Qualification of staffs  Financial situation
 Medical staff expertise  Cash flow position
 Facilities  Marketing efforts
 Location
 Market share
 Quality of service
OPPORTUNITIES THREATS
 Nurse recruitment  Shortage of nurses

 Physician recruitment  Decrease in patient satisfaction
 Referral patterns  Increase in accounts receivable
 New programs  Decrease in demands for services
 New markets  Regulations
 Diversification  Litigation
 Population growth  Loss of accreditation
 Improved technology
 Others: weather, peace and order
 New facilities situation
 Strategic goals and objectives are developed to bridge the gap between current
capability and the mission. They are aligned with the mission and form the basisfor
the action plans.
Goals
The desired result toward which effort is directed; it is the aim of
philosophy.
Change with time and require periodic re-evaluation and prioritization. Somewhat
global in nature but should also be measurable; ambitious butrealistic.
Should clearly delineate the desired end-product.
Long and short-term goals: services rendered, economics, use of resources
(including people, funds and facilities), innovations and social
responsibilities
 Objectives are sometimes referred to as performance goals.
similar to goals in that they motivate people to a specific end and are
explicit, measurable, observable or retrievable, and obtainable.
more specific and measurable than goals because they identify how and
when the goal is to be accomplished.
can focus either on the desired process or the desired result.
Process objectives: written in terms of the method to be used.
Result-focused objectives: specify the desired outcome

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Examples:
Process Objective – “100% of staff nurses will orient new patients to the call-light system,
within 30 minutes of their admission, by first demonstrating its appropriate use and then
asking the patient to repeat said demonstration.”
Result-Focused Objective – “All postoperative patients will perceive a decrease in their pain
levels following the administration of parenteral pain medication.”
Develop related strategies (tactical and operational)
 Tactical plans are based on the organization's strategic plan. In turn, operational
plans are based on the organization's tactical plans.
 These are specific plans that are needed for each task or supportive activity
comprising the whole.
 Strategic, tactical, and operational planning must be accompanied by controls.
 Monitoring progress or providing for follow-up is intended to assure that plans are
carried out properly and on time. Adjustments may need to be made to
accommodate changes in the external and/or internal environment of the
organization. A competitive advantage can be gained by adapting to the challenges.
TACTICAL PLANS
 Top level managers set very general, long-term goals that require more than one
year to achieve. Examples of long-term goals include long-term growth, improved
customer service, and increased profitability.
 Middle managers interpret these goals and develop tactical plans for their
departments that can be accomplished within one year or less.
 In order to develop tactical plans, middle management needs detail reports
(financial, operational, market, external environment).
 Tactical plans have shorter time frames and narrower scopes than strategic plans.
 Tactical planning provides the specific ideas for implementing the strategic plan.
 It is the process of making detailed decisions about what to do, who will do it, and how to
do it.
OPERATIONAL PLANS
 Supervisors implement operational plans that are short-term and deal with theday-
to-day work of their team.
 Short-term goals are aligned with the long-term goals and can be achieved withinone
year.
 Supervisors set standards, form schedules, secure resources, and report progress.
They need very detailed reports about operations, personnel, materials, and
equipment. The supervisor interprets higher management plans as they apply to his
or her unit. Thus, operational plans support tactical plans.
 They are the supervisor's tools for executing daily, weekly, and monthly activities.
example is a:
 budget, which is a plan that shows how money will be spent over a certain
period of time.

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 Other examples of planning by supervisors include scheduling the work of

employees
 identifying needs for staff and resources to meet future changes. Resources
include employees, information, capital, facilities, machinery, equipment,
supplies, and finances.
 Operational plans include policies, procedures, methods, and rules.
 A policy is a general statement designed to guide employees' actions in recurring

situations. It establishes broad limits, provides direction, but permits some initiative and
discretion on the part of the supervisor. Thus, policies are guidelines.
 Plans reduced to statements and instructions that direct organizations in their
decision making.
 Comprehensive statements derived from the organization’s philosophy,goals,
and objectives.
 Explain how goals will be met and guide the general course and scope of
organizational activities
Purposes:
Serve as a basis for future decisions and
actionsHelp coordinate plans
Control performance
Increase consistency of action by increasing the probability that
different managers will make similar decisions when
independentlyfacing similar situations
 Implied Policies
– Neither written nor expressed verbally
– usually developed over time and follow a precedent
– established by patterns of decisions
 Expressed Policies
– delineated verbally or in writing
– promote consistency of action
1. Oral Policies: more flexible and can be easily adjusted to changing
circumstances, however, they are less desirable than written ones
because they may not be known.
2. Written Policies: the process of writing policies reveals discrepancies
and omissions and causes the manager to think critically about the
policy, thus contributing to clarity.
 They are readily available to all in the same form

 Their meaning cannot be changed by word of mouth
 Misunderstandings can be referred to the written words
 Chance of misinterpretation is decreased
 Policy statements can be sent to all affected by them
 they can be referred to whoever wishes to check the policy
 can be used for orientation purposes
 indicate the integrity of the organization’s intention and
generate confidence in management
 Disadvantages: reluctance to change them when outdated
Policies are needed for consistency of care.
Should be comprehensive in scope, stable, and flexible so that theycan
be applied to different conditions that are not so diverse that they
require separate sets of policies.

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Top-level management is more involved in the setting oforganizational

policies (usually by policy committees)
Unit managers however, must determine how those policies will be
implemented on their units.
Input from subordinates in forming, implementing and reviewing policy
– allows the leader/manager to develop guidelines that all employees
will support and follow.
Feedback of unit-level managers is crucial to the successful
implementation of policies.
3. Emergence of Policies:
– Originated or internal policies – usually developed by top
management to guide subordinates in their functions
 Flows from objectives of the organization as defined by top
management and may be broad in scope
 Staff associates usually develop supplemental policies
– Appealed policies – decisions made from appeals of staff
associates which were brought up the hierarchy
– Imposed or external policies – thrust on an organization by
external forces (eg. Government, labor union, professional and
social groups)
 A procedure is a sequence of steps or operations describing how to carry out an

activity and usually involves a group. It is more specific than a policy and establishesa
customary way of handling a recurring activity. Thus, less discretion on the part ofthe
supervisor is permissible in its application. An example of a procedure is the sequence
of steps in routing of parts.
 Plans that establish a customary or acceptable way of accomplishing a specific
task and delineate a sequence of steps of required action.
 Identify the process or steps needed to implement a policy and are generally
found in manuals at the unit level of the organization.
 Procedure manuals provide a basis for orientation and staff development andare
ready reference for all personnel. They standardize procedures and equipment
and can provide a basis for evaluation.
 They supply a more specific guide to action than policy does.
 Established procedures save staff time, facilitate delegation, reduce cost,
increase productivity, and provide a means of control
 A method sets up the manner and sequence of accomplishing a recurring, individual

task. Almost no discretion is allowed. An example of a method is the stepsin cashing a
check.
 A rule is an established guide for conduct. Rules include definite things to do and not
to do. There are no exceptions to the rules. An example of a rule is "No Smoking."
 Plans that define specific action or nonaction
 Generally included as part of policy and procedure statements
 Describe situations that allow only one choice of action
 The least flexible type of planning hierarchy, thus, there should be as few rulesas
possible in the organization
 Existing rules however, should be enforced to keep morale from breaking
down and to allow organizational structure

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REQUISITES
orientation/directionsituational
analysis resource inventory
previous assessment results
MONITOR THE PLAN
 A systematic method of monitoring the environment must be adopted to

continuously improve the strategic planning process.
 To develop an environmental monitoring procedure, short-term standards for key
variables that will tend to validate the long-range estimates must be established.
Although favorable long-range values have been estimated, short-termguidelines
are needed to indicate if the plan is unfolding as hoped.
 Next, criteria must be set up to decide when the strategy must be changed.
Feedback is encouraged and incorporated to determine if goals and objectives are
feasible. This review is used for the next planning cycle and review.
SCOPE OF PLANNING IN THE NURSING SERVICE
1. The Role of the Chief Nurse in Planning
Planning is more critical at the top level of management. The chief nurse/director of the
Nursing Service plans for the organizational activities that are broad in scope and are
phrased in general terms. Strategic planning at this level is based on the mission of the
hospital. The assistant chief nurse is assigned to implement specific programs and
projects.
2. The Role of the Middle Manager in Planning
At the middle management level, the nursing supervisors formulate policies, rules,
regulations, methods, and procedures.
3. The Role of the First Level Managers in Planning
The senior nurse/head nurse schedules daily and weekly plans for the administration of
patient care for his/her unit.
4. Characteristics of a Good Plan (criteria set in the manual for Hospital Service
Administration)
a. It should be based on clearly-defined objectives.

b. It should be simple.
c. It should provide for the proper analysis and classification of action.
d. It should be flexible.
e. It should be balanced.
f. It should exhaust all available resources before creating new resources,
applying the principle of simplicity.

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5. Steps in Planning for a Nursing Service
5.1. Forecasting. This describes the ultimate condition of projections that provide the
general incentive and direction to planning. It anticipates the environment orsetting
where the plan will be operationalized such as:
 The Hospital. This includes the type of hospital served (primary,secondary,or

tertiary); the kind of services it offers; its philosophy, mission and goals; the
realities of size and categories of their budget (national or local).
 The Community it Serves. This includes the kind of people served, their needs,
expectations, literacy rate, economic levels, employment rates, demographic
statistics, cultural values, folkways, and services available in the community.
 The Goals of Care. The goals of care vary according to the setting of the agency
(whether preventive, rehabilitative, or curative), trends in technology, and the
changing concepts of the nurses’ roles and functions. Forecasts must be
supported by facts, reasonable estimates and accurate reflection ofpolicies and
plans.
5.2. Define the philosophy and objectives of the Nursing Service
The statement of purpose, mission, or philosophy provides the basis for the Nursing
Service’s existence. It explains the system of beliefs and values that determinethe way by
which the purpose should be achieved. A philosophy addresses those issues, which affect
the nursing personnel. The philosophy and objectives of the Nursing Service are congruent
with the philosophy and objectives of the hospital.
Reviewing institutional basis for the existence of the Nursing Service is importantin
order to come up with organizational strategy that jibes with the institutional objectives.
INSTITUTIONAL OBJECTIVES CAN BE CATEGORIZED INTO 4, NAMELY:
 Product/Service. For health care facilities, this is the most important areas
because of its relationship to patient care. The following questions are usually
asked:
o What patient care needs will be directly satisfied by the institution?
o What types of patients are to be served?
o What types of services will be offered?

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The relative importance of each of the above will depend on such factors as
whether the institution is a private or public facility, affiliated with a university or some
other type of institution, and its size and geographical location.
 Efficiency. This refers to the efficiency in the performance of the institution’s

work.
o How many resources are required per unit of care? (eg. The numberof
nurses per patient per day)
o How much time is used per procedure?
o How will the efficiency of the unit be measured (eg. Average hospital
stay, occupancy rates, hours of nursing care for a given mix of
patients)?
 Social. Objectives in this area relate to meeting the obligations that have
been established by the community or society in which the institution resides.
o Sample question: Does the hospital have objectives that relate to
health laws present in the community?
 Human Resources. This has to do with the efforts that will be made to satisfy
employee needs in order to maintain their commitment to the objectives of the
institution.
o Will specific objectives be set in the areas of nurse supervisor
development and employee attitude and satisfaction?
5.3. Identify and develop strategies, programs/projects activities. Set the time
frame. Prepare the budget.
Project Planning. This is the process applied to a specific proposal or program. It isdivided
into 3 phases, namely:
PHASE I: Developing a Plan
a. Clearly state the purpose or mission of the project.

b. Assess the situation
 Determine the kind of information needed. These information serve to:
o Validate the identified problem;
o Point out the factors affecting the problem;
o Yield an estimate of the expected responses to the change that
will result.
 Based on the information gathered, analyze the problem. Find its source
(internal or external)
c. Formulate the objectives
d. Propose alternative courses of action
e. Choose a particular course of action.

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PHASE II: Presenting the Plan
a. Obtain the approval of the concerned authority/agency for the presentation of

the plan.
b. Prepare for the presentation. Give special attention to the manner of

presentation. It should be persuasive, concise, professional, personalized and
imaginative
PHASE III: Implementing and Monitoring the Plan
a. Plan for the implementation and monitoring.

 Determine what activities should be undertaken and the sequence that must be
followed; the resources to be allocated; who are the individuals responsible for
specific tasks; who are the support systems; and, when are the target dates for
completion of each activity (use GANTT Charts, Pert Charts)
b. Direct the implementation.
c. Monitor the implementation. Refer to the original design to ensure that it is
being strictly followed.
d. Evaluate the outcome of the plan.
e. Update the plan and revise as necessary.
Budget. A financial “road map” and plan which serves as an estimate of future costs
and a plan for utilization of manpower, material and other resources to covercapital
projects in the operating program.
 It is simply a plan for future activities expressed in operational as well as financialor

monetary terms.
 The purpose of budgeting is to set operating cost limits. It guides performance, for
although it includes cost of personnel, supply, support services, travel, and building,
it is essentially a commitment to the people who utilize the resources offered.
Steps in the Budgetary Process:
1. Assess what needs to be covered in the budget.

 Budgeting is most effective when all personnel using the resources are
involved in the process.
 A composite of unit needs in terms of manpower, equipment, and operating
expenses should be compiled to determine the organizational budget
 The following may be considered in determining budgetary requirements
(source: Hospital Nursing Service Administration Manual):
a. Review of pertinent provisions in the current General Appropriations
Act.
b. Identify sources of funds (general, national, city, municipal, provincial,
special, revolving, trust).
c. Review current appropriations and actual expenditures for the current
year.
d. Study proposed changes in other departments, which might affect the
Nursing Service budget.
e. Estimate required expenditures for the coming year for supplies,
materials, equipment, repairs, and replacement.

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f. Estimate personnel salaries and benefits, as well as, savings derived
from unusual leaves.
g. Estimate cost of Human Resource Development and Research
Programs.
h. Translate these information into peso and submit the official forms of the
Chief of Hospital for approval and inclusion in the general hospital budget
2. Develop a plan.
 Fiscal-Year Budget. A budgeting cycle that is set for 12 months. This may or may
not coincide with the calendar year. It is usually broken down into quarters or
subdivided into monthly, quarterly, or semiannual periods.
 Developing the Plan for the Area of Responsibility:
i. Each senior nurse/supervising nurse develops a budget for his/her own
area of responsibility every quarter of the ensuring year with the first quarter
broken down into months.
Example: Allotment for the First Quarter - PhP 15,000.00 1st
Month - PhP 5,000.00
2nd Month - PhP 5,000.00 3rd
Month - PhP 5,000.00
ii. The plan should include the number and kind of personnel, their salaries,
fringe benefits, the number of patients to be served, the activities within the
area, and the kind of care the patients are supposed to receive.
iii. Operating expenses shall include, among other things, the number and kind
of supplies, repairs, maintenance, books, and in-service education.
3. Implementation.
 Ongoing monitoring and analysis occur to avoid inadequate or excess fundsat
the end of the fiscal year
 Each unit manager is accountable for budget deviations in his or her unit.
 Large deviations must be examined for possible causes, and remedial action
must be taken if necessary.
 If a major change in the budget is indicated, the entire budgeting process
must be repeated.
 Top-level managers must watch for and correct unrealistic budget projections
before they are implemented.
4. Evaluation.
 The budget must be reviewed regularly and must be modified as needed
throughout the fiscal year.
 Managers develop a more historical approach to budgeting as they grow
more adept at predicting seasonal.

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STANDARDS OF NURSING PRACTICE
Key Areas of
Responsibility Core Indicators
Competency
I. PATIENT CARE COMPETENCIES
1. Safe and Core Competency 1:  Identifies the health needs of the clients (individuals,
Quality Demonstrates families, population groups and/or communities)
Nursing Care knowledge base on the  Explains the health status of the clients/ groups
health /illness status of
individual / groups
Core Competency 2.  Identifies clients’ wellness potential and/or health

Provides sound decision problem
making in the care of  Gathers data related to the health condition
individuals /  Analyzes the data gathered
families/groups  Selects appropriate action to support/ enhance
considering their beliefs wellness response; manage the health problem0
and values  Monitors the progress of the action taken
Core Competency 3:  Performs age-specific safety measures in all aspects

Promotes safety and of client care
comfort and privacy of  Performs age-specific comfort measures in all aspects
clients of client care
 Performs age-specific measures to ensure privacy in
all aspects of client care
Core Competency 4:  Identifies the priority needs of clients
Sets priorities in nursing  Analyzes the needs of clients
care based on clients’  Determines appropriate nursing care to address
needs priority needs/problems
Core Competency 5:  Refers identified problem to appropriate individuals /

Ensures continuity of agencies
care  Establishes means of providing continuous client care
Core Competency 6:  Conforms to the 10 golden rules in medication
Administers medications administration and health therapeutics
and other health
therapeutics

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Core Competency 7: • Obtains informed consent

Utilizes the nursing
process as framework • Completes appropriate assessment forms
for nursing • Performs appropriate assessment techniques
7.1 Performs
• Obtains comprehensive client information
comprehensive and
• Maintains privacy and confidentiality
systematic nursing
assessment • Identifies health needs
 Includes client and his family in care planning

 Collaborates with other members of the health team
7.2 Formulates a plan of  States expected outcomes of nursing intervention
care in collaboration with maximizing clients’ competence
clients and other  Develops comprehensive client care plan maximizing
members of the health opportunities for prevention of problems and/or
team enhancing wellness response
 Accomplishes client-centered discharge plan
 Explains interventions to clients and family before

7.3 Implements planned
carrying them out to achieve identified outcomes
nursing care to achieve
 Implements nursing intervention that is safe and
identified outcomes
comfortable
 Acts to improve clients’ health condition or human
response
 Performs nursing activities effectively and in a timely
manner
 Uses the participatory approach to enhance client-
partners empowering potential for healthy life
style/wellness
7.4 Evaluates progress  Monitors effectiveness of nursing interventions

toward expected  Revises care plan based on expected outcomes
outcomes
2. Communicatio Core Competency 1:  Creates trust and confidence
n Establishes rapport with  Spends time with the client/significant others and
client, significant others members of the health team to facilitate interaction
and members of the  Listens actively to client’s concerns/significant others
health team and members of the health team
Core Competency 2:  Interprets and validates client’s body language and
Identifies verbal and facial expressions
non-verbal cues
Core Competency 3:  Makes use of available visual aids

Utilizes formal and  Utilizes effective channels of communication relevant
informal channels to client care management
Core Competency 4:  Provides reassurance through therapeutic touch,
Responds to needs of warmth and comforting words of encouragement
individuals, family, group  Provides therapeutic bio-behavioral interventions to
and community meet the needs of clients
Core Competency 5:  Utilizes telephone, mobile phone, electronic media
Uses appropriate  Utilizes informatics to support the delivery of
information technology healthcare
to facilitate
communication

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3. Collaboratio Core Competency 1:  Contributes to decision making regarding clients’

n and Establishes collaborative needs and concerns
Teamwork relationship with  Participates actively in client care management
colleagues and other including audit
members of the health  Recommends appropriate intervention to improve
team client care
 Respect the role of other members of the health team
 Maintains good interpersonal relationship with clients ,
colleagues and other members of the health team
Core Competency 2:  Refers clients to allied health team partners

Collaborates plan of  Acts as liaison / advocate of the client
care with other members  Prepares accurate documentation for efficient
of the health team communication of services
4. Health Core Competency 1:  Obtains learning information through interview,
Education Assesses the learning observation and validation
needs of the client-  Analyzes relevant information
partner/s  Completes assessment records appropriately
 Identifies priority needs
Core Competency 2:  Considers nature of learner in relation to: social,
Develops health cultural, political, economic, educational and religious
education plan based on factors.
assessed and  Involves the client, family, significant others and other
anticipated needs resources in identifying learning needs on behavior
change for wellness, healthy lifestyle or management
of health problems
 Formulates a comprehensive health education plan
with the following components: objectives, content,
time allotment, teaching-learning resources and
evaluation parameters
 Provides for feedback to finalize the plan
Core Competency 3:  Develops information education materials appropriate
Develops learning to the level of the client
materials for health  Applies health education principles in the
education development of information education materials
Core Competency 4:  Provides for a conducive learning situation in terms of

Implements the health time and place
education plan  Considers client and family’s preparedness
 Utilizes appropriate strategies that maximize
opportunities for behavior change for wellness/healthy
life style
 Provides reassuring presence through active listening,
touch, facial expression and gestures
 Monitors client and family’s responses to health
education
Core Competency 5:  Utilizes evaluation parameters

Evaluates the outcome  Documents outcome of care
of health education  Revises health education plan based on client
response/outcome/s

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II. EMPOWERING COMPETENCIES
5. Legal Core Competency 1:  Fulfills legal requirements in nursing practice

Responsibility Adheres to practices in  Holds current professional license
accordance with the  Acts in accordance with the terms of contract of
nursing law and other employment and other rules and regulations
relevant legislation  Complies with required continuing professional
including contracts, education
informed consent.  Confirms information given by the doctor for informed
consent
 Secures waiver of responsibility for refusal to undergo
treatment or procedure
 Checks the completeness of informed consent and
other legal forms
Core Competency 2:  Articulates the vision, mission of the institution where
Adheres to one belongs
organizational policies  Acts in accordance with the established norms of
and procedures, local conduct of the institution / organization/legal and
and national regulatory requirements
Core Competency 3:  Utilizes appropriate client care records and reports.
Documents care  Accomplishes accurate documentation in all matters
rendered to clients concerning client care in accordance to the standards
of nursing practice.
6. Ethico-moral Core Competency 1:  Renders nursing care consistent with the client’s bill of
Responsibility Respects the rights of rights: (i.e. confidentiality of information, privacy, etc.)
individual / groups
Core Competency 2:  Meets nursing accountability requirements as

Accepts responsibility embodied in the job description
and accountability for  Justifies basis for nursing actions and judgment
own decision and  Projects a positive image of the profession
actions
Core Competency 3:  Adheres to the Code of Ethics for Nurses and abides
Adheres to the national by its provision
and international code of  Reports unethical and immoral incidents to proper
ethics for nurses authorities
7. Personal and Core Competency 1:  Identifies one’s strengths, weaknesses/ limitations

Professional Identifies own learning  Determines personal and professional goals and
Development needs aspirations
Core Competency 2:  Participates in formal and non-formal education

Pursues continuing  Applies learned information for the improvement of
education care
Core Competency 3:  Participates actively in professional, social, civic, and
Gets involved in religious activities
professional  Maintains membership to professional organizations
organizations and civic  Support activities related to nursing and health issues
activities
Core Competency 4:  Demonstrates good manners and right conduct at all
Projects a professional times
image of the nurse  Dresses appropriately
 Demonstrates congruence of words and action
 Behaves appropriately at all times
Core Competency 5:  Listens to suggestions and recommendations
Possesses positive  Tries new strategies or approaches
 Adapts to changes willingly

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attitude towards change

and criticism
Core Competency 6:  Assesses own performance against standards of

Performs function practice
according to  Sets attainable objectives to enhance nursing
professional standards knowledge and skills
 Explains current nursing practices, when situations
call for it
III. ENHANCING COMPETENCIES
8. Records Core Competency 1:  Completes updated documentation of client care

Management Maintains accurate and  Applies principles of record management
updated documentation  Monitors and improves accuracy, completeness and
of client care reliability of relevant data
 Makes record readily accessible to facilitate client care
Core Competency 2:  Utilizes a records system ex. Kardex or Hospital
Records outcome of Information System (HIS)
client care  Uses data in their decision and policy making activities
Core Competency 3:  Maintains integrity, safety, access and security of
Observes legal records
imperatives in record  Documents/monitors proper record storage, retention
keeping and disposal
 Observes confidentially and privacy of the clients’
records
 Maintains an organized system of filing and keeping
clients’ records in a designated area
 Follows protocol in releasing records and other
information
9. Management Core Competency 1:  Identifies tasks or activities that need to be accomplished
of Organizes work load to  Plans the performance of tasks or activities based on
facilitate client care priorities
Resources  Verifies the competency of the staff prior to delegating
tasks
and  Determines tasks and procedures that can be safely
assigned to other members of the team
Environment  Finishes work assignment on time
Core Competency 2:  Identifies the cost-effectiveness in the utilization of
Utilizes financial resources
resources to support  Develops budget considering existing resources for
client care nursing care
Core Competency 3:  Plans for preventive maintenance program

Establishes mechanism  Checks proper functioning of equipment considering the:
to ensure proper - intended use - safety
functioning of equipment - cost benefits - waste creation and disposal
storage
- infection control
 Refers malfunctioning equipment to appropriate unit
Core Competency 4:  Complies with standards and safety codes prescribed by
Maintains a safe laws
environment  Adheres to policies, procedures and protocols on
prevention and control of infection
 Observes protocols on pollution-control (water, air and
noise)
 Observes proper disposal of wastes
 Defines steps to follow in case of fire, earthquake and
other emergency situations.
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IV. ENABLING COMPETENCIES
10. Quality Core Competency 1:  Identifies appropriate quality improvement

Improvement Gathers data for quality methodologies for the clinical problems
improvement  Detects variation in specific parameters i.e vital signs of
the client from day to day
 Reports significant changes in clients’
condition/environment to improve stay in the hospital
 Solicits feedback from client and significant others
regarding care rendered
Core Competency 2:  Shares with the team relevant information regarding
Participates in nursing clients’ condition and significant changes in clients’
audits and rounds environment
 Encourages the client to verbalize relevant changes in
his/her condition
 Performs daily check of clients’ records / condition
 Documents and records all nursing care and actions
implemented
Core Competency 3:  Reports to appropriate person/s significant
Identifies and reports variances/changes/occurrences immediately
variances  Documents and reports observed variances regarding
client care
Core Competency 4:  Gives an objective and accurate report on what was
Recommends solutions observed rather than an interpretation of the event
to identified problems  Provides appropriate suggestions on corrective and
preventive measures
 Communicates solutions with appropriate groups
11. Research Core Competency 1:  Specifies researchable problems regarding client care
Gather data using and community health
different methodologies  Identifies appropriate methods of research for a
particular client / community problem
 Combines quantitative and qualitative nursing design
through simple explanation on the phenomena
observed
Core Competency 2:  Analyzes data gathered using appropriate statistical tool
Analyzes and interprets  Interprets data gathered based on significant findings
data gathered
Core Competency 3: 
Recommends practical solutions appropriate to the
Recommends actions for problem based on the interpretation of significant
implementation findings
Core Competency 4:  Shares/presents results of findings to colleagues /
Disseminates clients/ family and to others
results of research  Endeavors to publish research
findings  Submits research findings to own agencies and others
as appropriate
Core Competency 5:  Utilizes findings in research in the provision of nursing
Applies research care to individuals / groups / communities
findings in nursing  Makes use of evidence-based nursing to enhance
practice nursing practice
Revised May 2009 (those in red are the latest additions to the Core Competencies and
Indicators)

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SUMMARY
Remember the following.
1. Planning is deciding in advance what to do, how to perform a particular task, when
to perform it, and who is to do it.
2. Good planning involves a continuous process of assessing, establishing goals and
objectives, implementing and evaluating change as new facts become known.
3. Planning covers the following elements.
a. forecasting or estimating the future:
b. setting objectives and goals.
c. developing strategies and setting the time frame.
d. preparing the budget and allocation of resources.
e. Establishing policies, procedures and standards.
4. A Gantt chart is a horizontal bar chart that graphically displays the time relationships
between the different tasks a project.
5. Budgeting is defined as the allocation of scarce resources on the basis of forecasted
needs for proposed activities over specified period of time.
6. PERT is a network system model for planning and control under uncertain situations
which involves identifying key activities, sequences these activities in a flow diagram
and assigning a specific duration for each phase of work.
7. Effective planning helps an organization adapt to change by identifying
opportunities and avoiding problems.

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Activity 5: Critical Thinking. Write in a short bond paper.
Jose was promoted recently as manager of a cancer care clinic, which had just
expanded its hours from 6 a.m. until 11 p.m. Jose has realized that staff nurses are
reluctant to sign up and do quality chart audits. He gathers information about quality
improvement, reviews the literature on motivation and incentives, and discusses the issue
with other nurse managers. He continues to manage the clinic, thinking about the
information he has gathered but does not consciously decide or reject new ideas. When
working on a new problem, self-scheduling for the change in hours, he realizes a
connection between the two problems.
Many nurses complain that by the time they receive the schedule the day shifts are
filled. Jose tells them that he will review the chart audits and that those nurses whoregularly
participate in quality improvement projects will receive a perk. They will be allowed to have
a first choice at selecting the schedule they want to work on a rotatingbasis. He discusses
the plan with the staff and proposes a 2 months trial period to determine whether the
solution is effective.
Identify the steps in critical thinking that Jose used to arrive at the solution.
Activity 6: Encircle the letter of the best answer.
1. It is a predetermined action to accomplish desired results:
a. Planning
b. Critical thinking
c. Decision-making
d. Problem-solving
2. A nurse manager needs to plan her activities in order to facilitate the following,
except:
a. Leads to goal attainment

b. Cope with crises and problems
c. Increases element of change
d. Effective use of available resources
3. Scope of planning which is necessary to estimate the future in terms of risks

and outcome:
a. Set objectives
b. Outline activities
c. Forecasting or predicting
d. Programming
4. Which of the following principles of time management is least effective?
a. Prioritizing
b. Delegating
c. Procrastinating
d. Planning
5. Model of planning useful in identifying strategic issues and goals to ensure truly
concrete solutions to problems:

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a. Alignment model
b. Scenario model
c. Organic model
d. Goal-based planning
6. A nurse is asked to do a lot of things in less time:
a. Multitasking
b. Prioritization
c. Delegation
d. Planning
7. Benefits of the budgeting process is not any of the following:
a. Planning in advance
b. Directing resources
c. Coordination of cost and services
d. Comprehensive control
8. A process of identifying and choosing a particular course of action from several

choices.
a. Planning
b. Critical thinking
c. Problem-solving
d. Decision-making
9. A tool in decision-making where the manager forecasts probable results of his

choices and enables him to make a cost-benefit analysis of each alternative.
a. Probability theory
b. Decision trees
c. Queuing theory
d. Linear programming

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An Organizational Analysis presented to the College of Nursingof

Sultan Kudarat Educational Institution, Inc.
TITLE OF THE CASE
(it could be the name of the Hospital/Organization and its
Department or Depending on your choice of title)
e.g. An Organizational Analysis of ( Department)of (hospital/org name)
Presented by:
Presented to:
RITZELLE ECIJA-EUGENIO, MAN, MHcA, CHRP
September 2020

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A TASK FOR YOU!
FOR THE TWO YEARS’ TIME THAT YOU ARE EXPOSED TO THE
DIFFERENT HOSPITALS, SELECT AT LEAST ONE HOSPITAL/
HEALTHCARE ORGANIZATION MAKE AN ANALYSIS.
I. FRONT PAGE
II. INTRODUCTION
III. HISTORICAL BACKGROUD OF THE INSTITUTION
a. MISSION
b. VISION
c. GOAL
d. QUALITY POLICY
NURSING SERVICE
a. VISION
b. MISSION
IV. SWOT ANALYSIS OF THE (department/area)
a. Strengths
b. Weakness
c. Opportunities of the hospital
d. Threats
V. ANALYSIS AND DISCUSSIONS
FOCUSING ON THE NURSING DEPARTMENT AND THEHEAD

ANSWER THE FOLLOWING QUESTIONS ON THE DISCUSSION.
a. How can you motivate your staff to improve and develop

their skills and knowledge in the duty?
b. How do your subordinates contribute to the improvement in
the area you are handling?
c. Are there any circumstances that they made a change in
some of the problems in the area?
d. What are the changes that you have made and what could
be the other possible changes you can make in the future?
e. How well do you involve yourself in the decision-making
process in your area?
VI. FINDINGS, RECOMMENDATIONS AND CONCLUSIONS
VII. REFERENCE

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MODULE 2
INFORMATION SHEET 4
MANAGEMENT FUNCTIONS
ORGANIZING
DEFINITIONS:
Philosophy – statement of the system of beliefs which direct the individuals in a particular
group in the achievement of their purpose
Purpose – describes the reason for being; the why of the operation
Vision – over-all purpose of the group
Mission – what is done to achieve the vision
Goals – broad statements of overall intent of an organization or individual
Objectives – specific accomplishments that indicate the goal has been met
Policies – official statements of the organization that guide the behavior of individuals
Lines of Authority – represent the responsibility of individuals supervise others officially
Lines of Accountability – represent responsibility to report to another person
Line of organization – one that has been separated from the chain of command to permit
specialization and increased effectiveness
Chain of Command – is the path of authority and accountability from one individual at the
bottom of the organization to every top administrative authority
Span of Control – the number of subordinates and different task which a person in authority is
responsible
Job description – written statements describing the responsibilities each individual or position
within the organization
Delegation – assigning some of one’s job duties ot another, together with authority needed to
carry and those duties.
II. ORGANIZING
 establishing a formal structure that provides the coordination of resources to

accomplish objectives and determine position qualification and description.
 having the right person in the right time, doing the right thing using the right method
to achieve the goals of the organization.
 Mobilizing the human and material resources of the institution so that the latter’s
objectives can be achieved.
 This is a vital part of administration. It does not embrace but instead works in
partnership with other elements of administration to achieve the purpose.
Organization is the form of every human association for the attainment of a common
purpose. (Mooney, 1939).
An act of putting into systematic relationships those elements and activities essential to
the satisfaction of the purpose
Organization serves as a facilitating agency in the achievement of the purpose
(Moehlman, 1940)

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Organization is a form of identifying roles and relationships of each staff in order to
delineate specific tasks or functions that will carry out organizational plans and objectives
(Swansburg: 1996).
It is the process of identifying and grouping the work to be performed, defining and
delegating responsibility and authority, and establishing relationships for the purpose of
enabling the people to work most effectively together in accomplishing objectives (Allen,
1998).
Organization, then, is both a function and a framework or a process and structure. It is both
a human activity and at the same time, it is a group of people. It exists and is deliberately
designed because of an objective which is geared towards efficient and effective goal
attainment.
As a process, organization refers to the building of a structure that will provide for the
separation of activities to be performed, and for the arrangement of these activities in a
framework which indicates their hierarchical importance and functional association. The
organization process is a logical process. It is one by which the manager brings order out of
chaos, removes conflicts between people over work responsibility, and establishes an
environment suitable for teamwork.
The process involves:

1. Identification and definition of basic tasks such as staffing and creation of job
descriptions;
2. Delegation of authority and assignment of responsibility for the accomplishment of
activities; and
3. Establishing relationships by providing a system of vertical and horizontal
communications through authority relationships to bind and coordinate the groupings.
As a structure, it is borne out of the process. It is deliberately constructed and evolves out of
the logical process. The organization is designed by a group and does not happen by accident;
it is designed. As in engineering or architecture, so it is in management, form follows function.
The organization must be built around the basic activities of the nursing practice. It must reflect
the:
1. Objectives and plans
2. Centers of authority
3. Environment within which it is to function, and
4. Quality of available manpower to run
CATEGORIES OF ORGANIZATION
There are two major categories of organization: the formal organization and informal
organization. The first is the result of the logical process and the second is borne out of
consideration of behavioral patterns.
1. Formal Organization
The formal organization is a system of well-defined jobs, each with a measure

of authority and responsibility and accountability. The consciously designed to enable
the people of the whole enterprise to work most effectively together in accomplishing
its objectives. The formal organization is well-defined, bounded by delegation and
relatively stable.
The formal organization is derived from the set of factors considered vital by
scientific management. It is governed by the set of principles crystallized by Taylor,
Fayol and Gantt among others.

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Sound organization facilitates administration, facilitates growth and
diversification, optimizes the use of technological resources, enhances the value of the
individual as a person, and provides an environment for creative work.
There is another form of organization which exists side by side with the formal
organization but is not visible. What one sees in the organizational chart is usually
different from what actually happens in the organization. This is the informal
organization, not easily reproduced in a chart but whose presence is simply felt by
those within the organization.
2. Informal Organization
The informal organization refers largely to what people do because they are
human personalities, and to their actions in terms of needs, emotions, and attitudes
and not in terms of procedures and regulations. In the informal organization, people
work together because of their likes and dislikes. This is reflected in the unofficial ways
in which a nurse creates a small group of collaborators officially denied to him.
People in the organization cross formal barriers and form the informal
organization. For example advise is sought from persons whose positions do not
normally entitle them to have their views considered or when groups or cliques arise
that have no formal standing in the organization and yet have an impact on the attitude
and procedures, or when informal discussions and consultations, perhaps with the
ironing out of divergent views, occur before proposals are formally presented to
management.
Under these circumstances, management does not have an option to destroy
the informal organization but should instead harness it for constructive ends.
CHARACTERISTICS OF AN ORGANIZATION
Organizations are separated from other types of associations by the following

characteristics
1. Division of work where each box represents an individual or sub-unit responsible for a
given task.
2. Chain of command with lines indicating who reports to whom and by what authority.
3. Different types of work segments, shown by clusters of work groups
4. Different levels of management indicating hierarchical relationships.
Elements:
1. general distribution of functions
– listing of activities and functions
– grouping of functions and assignments
2. classification of functions
– organizational chart
– delegation
ORGANIZATIONAL DESIGN
Organizational design is a process used to improve the probability that an organization
will be successful. It is a formal, guided process for integrating the people, information and
technology of an organization. The use of the term 'organizational structure is limited to the
framework within which people act, the basic plan which the manager draws up to help in
achieving the objective. Such framework is achieved by the organizational chart (Miner: 2005).
WHY IT IS BEING USED

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Organizational design is used to match the purposes with the operations undertaken, and
to improve collective efforts of members to ensure success.
HOW IT IS DONE
Organizational design is guided by an external facilitator whose role is to assure a systematic
process and to encourage creative thinking. Managers and members work together to define
the needs of the organization and create systems to meet those needs.
HIERARCHICAL SYSTEMS
The triumvirate of authority, responsibility and accountability are arranged in a
hierarchy, which is often known as a bureaucracy. In such systems, rules, policies and
procedures are uniformly applied to exert control over member behaviors. Activity is organized
within sub-units (bureaus or departments) in which people perform specialized functions, such
as accounting, ward Staff, ICU Staff, and the like. People who perform similar tasks are
clustered together (Swansburg: 1996).
REASONS FOR ORGANIZING
People choose to organize when they recognize that acting alone limits their ability to
achieve their goals, and that by acting as a group. they may overcome individual limitations.
1. The Best Way for an Organized Group to Succeed
The benefit of organization is maximized when the group achieves patterns of

activity that are both complementary and interdependent, which result in the
achievement of the intended outcomes. Each member of the group contributes to the
success of the group.
2. The End Result of Effective Organizational Design
The final product is an integrated system of people and resources, tailored to

the specific direction of the organization.
PRINCIPLES OF ORGANIZATIONAL DESIGN
These principles on which sound organizational design is founded are self-explanatory.
1. Division of labor promotes departmentalization and specialization, which results in a
more efficient unit.
2. Unity of command, whether it follows a line of command or vests it in one superior
which ensures a unity of vision.
3. The principle of authority and responsibility determine the line and staff of authority,
which delineates the distribution of power
4. The span of control determines the different levels of control within the system, as well
as whether it is centralized or decentralized
5. A good design always takes into account contingency factors such as environment and
technology or knowledge technology, which deals with task variability and problem
analyzability
ORGANIZATIONAL FUNCTION
the way interactions actually occur within an organization
ORGANIZATIONAL CHART
Organizational charts are fundamental to effective administration indicating the lines of
authority and responsibility, the major channels of formal communication, and the inter-
departmental, as well as, the intradepartmental relationships. For the systematic and effective
administration of the Nursing Service, the nursing department and effective administration of the
Nursing Service, the nursing department must be organized within the framework of the hospital’s
objectives and sound organizational principles.

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diagram of organization that clearly presents its formal structure with persons or
department and their relationship to one another.
Types of Organizational Charts:
i. Structural Chart. Shows the various components of the organization and outlines their
basic inter-relationships
ii. Functional Charts. Reflects the functions and duties of the components of the
organization and indicates the interrelationships of these functions. Within the boxes are
the function statements applicable to a particular segment. The statement should be
clear, inclusive and written in the present tense.
iii. Position Charts. Specifies the names, positions, and titles or ranks of the personnel,
which fit into the organizational structure.
ORGANIZATIONAL STRUCTURE
Organizational structure refers to the way a group is formed depicting its lines of
authority, span of control, and channels of communication. The establishment of formal
organizational patterns through departmentalization and division of work provides order in
administration.
The formal structure of an organization is the official arrangement of positions or working
relationships that will coordinate efforts of workers of diverse interests and abilities.
The philosophy and objectives of the nursing department and the goals of the institution
are the bases of the formal organizational structure. This structure specifies how each position
in the department is related to each other and how the entire nursing department is related to
other parts of the institution.
The task of the manager is to create an organizational structure and culture that:
1. Encourages employees to work hard and to develop supportive work attitude.
2. Allow people and groups to cooperate and work together efficiently and effectively.
Patterns of Organizational Structure in Nursing Organization
1. Tall/Centralized Structure
o Responsible for only few subordinates so there is narrow span of control

o Because of the vertical in nature, there are many levels of communication
o Communication is difficult and messages do not get to the top.
o Workers are boss-oriented because of close contact with their supervisor.

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2. Flat/Decentralized Structure
o Characterized by few levels and a broad span of control

o Communication is easy and direct
Advantages:
1. Shortens the administrative distance from the top to the lower

2. Solutions to problems are easily carried out/fast response
3. Workers developed their abilities and autonomy
Disadvantage:
1. Impractical in large organization.

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Types of Formal Organization
1. Line. This is the simplest and most direct type of organization where each position has general
authority over lower positions in the hierarchy in the accomplishment of the main goal of the
agency.
2. Staff. This is purely advisory to the line structure with no authority to put recommendations
into action.
3. Functional. This type of organization permits a specialist to aid line positions within a limited
and clearly defined scope of authority. It decreases the line manager’s problem because it
permits orders to flow directly to lower levels without going through the routine technical
problems of the line positions.
Three Forms of Authority
1. Line authority – is a direct supervisory authority from supervisor to subordinates.

o Chain of Command – unbroken line of reporting relationships that extends
through the entire organization. The line defines the chain of command and
the formal decision making structure.
o Unity of Command – within the chin states that, each person in the
organization should take orders and reports only to one person.
o Span of Control – refers to the number of employees that should be placed
under the direction of one leader-manager.
2. Staff Authority – authority that is based on the expertise and which usually involves
advising the line managers.
3. Team Authority – is granted to committees or work teams involved in an organization’s
daily operations. Work teams are group of operating employees who shared a
common vision, goals and objectives.
Line organization is the backbone of the hierarchy with the staff and functional organization
merely supplementing the line.

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RELATIONSHIPS INDIVIDUAL
Line. Those that exist between a  Chief Nurse to Supervising
superior and subordinates immediately Nurse, to Senior Nurse
and directly responsible to him/her.
Lateral. Those that exist between  Senior Nurse with doctor, social
positions in various parts of an worker and dietician
undertaking where no direct authority is
involved.
Functional. Those that arise when  Chief Nurse with the
duties are divided on a functional basis Administrative Officer, Senior
(i.e. when an individual exercises Nurse with the Clinical I(nstructor
authority on one particular subject by
special skill or knowledge.
Staff. Those, which arise when an  Supervising Nurse acting on
individual is acting as the behalf of the Chief of the Nursing
representative of a superior. This Service when the Chief Nurse is
individual is not vested with, but is
absent.
acting “for and on behalf of the person
on which the authority lies.”
Her function is one of transmission and

interpretation coupled with the duty of
ascertaining that the orders given are
carried out.
Organizational Structure
o Depicts and identifies role and expectations, arrangement of positions and working
relationships.
1. Dotted or Unbroken line – represents staff positions/staff authority (advisor to the line
managers).
2. Centrality – refers to the location of a position on an organizational chart where
frequent and various types of communication occur. Determined by organizational
distance; those with small organizational distance receive more information than those
who are more peripherally located.
3. Solid Horizontal Line – represent same positions but different functions.
4. Solid Vertical Line – chain of command form authority to subordinates (line authority)

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Managerial Levels
Level Scope of Responsibility Examples

1. Generally make
decisions with the
help of ►few
guidelines or CEO, President, V-
Top Level Managers structure. President, Chief Nursing
Officer
2. Coordinates
internal and
external influences
1. They conduct day-
day operations with Head Nurse, Department
Middle Level
some involvement, Head, Unit
Managers
long term planning Supervisor/Manager
and policy making.
1. Concerned with
specific unit
workflows. Charge Nurse, Team
First Level Managers Leader, Primary Nurse,
2. Deals with Staff Nurse
immediate day-day
problems.
Major Characteristics of an Organizational Structure

An organizational structure has 5 major characteristics:
1. Division of work where each box represents an individual or sub-unit responsible for a given
task of the organization’s workload;
2. Chain of command indicating the lines of authority;
3. Type of work performed indicated by labels or description for the boxes;
4. The groupings of work segments, shown by clusters of work groups; and
5. The levels of management, which indicate the individual and entire management hierarchy
regardless of where an individual appears on the chart.
Types of Organizational Structure

1. Line Organization/Bureaucratic/PyramidaL
There is clearly defined superior-subordinate relationship
AR ►and power are concentrated at the top
Commonly seen in large health care facilities
Decision making emanate from the top down to the subordinates.
2. Flat Organization/horizontal organization

Decentralized
Flattened scalar chain and fewer levels of positions
Used in less complex organization
Nurses become productive and directly involved in the decision making skills
Workers become satisfied

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3. Staff Organization
Staff organization is by nature purely advisory to the line structure with no authority to
place recommendation into action.
4. Functional Organization
Permits a specialist to aid line position within a limited and clearly defined scope of
authority
5. Ad Hoc Organization
Modification of bureaucratic structure

Used to temporarily facilitate completion of a project within a formal line organization.
6. Matrix structure
Focus on both product and functions

Most complex
Has both vertical and horizontal chain of command and line of communication
7. Shared Governance Organization

One of the most identical and idealistic type of organizational structure .
8. Lateral organization
One of coordination and collaboration between among nursing staff and hospital staff.
Principles of Organization
1. Unity of Command.
No member of the organization should report to more than one superior on any given
function. This prevents conflict arising from orders from different people and simplifies
superior-subordinate relationships.
Overlapping supervision may occur while line personnel personally observe the work
situation. Personnel tend to work better when they are accountable to only one supervisor.
Work-related corrections or questions observed by the administrator should be directed to the
person in charge of the unit where the finding was made or with the supervisor of the area if it
was the director or the assistant who made the observation. That observer can then respond,
explain, and discuss the matter with the worker who administered the care.
2. Proper delegation of responsibility and authority.
For work to be accomplished, responsibility and authority should be delegated.

– Responsibility is work assigned to a position.
– Authority, on the other hand, gives the one delegated the right to command a
subordinate who, in turn has an obligation to obey or perform the duties specified
by his position.
– Accountability. The organizational structure delineates responsibility. It identifies
to whom, and for whom one is responsible, and also for what one is responsible to,
as specified in the job descriptions.

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Responsibility should be accompanied by accountability, which suggests a more
carefully circumscribed and communicated responsibility.
Delegation, responsibility, and accountability are clearly interwoven.
 They form a triad that operates at every level and laterally at some levels.
 One delegates, another assumes responsibility and accounts to the delegator for the
conduct of the assignment.
Since supervisors need to concentrate on the more fundamental, difficult and abstract
issues, detailed problems can be resolved at the level at which they occurred by the first
line and middle management supervisors.
3. Span of Control.
This refers to the number of people one can directly supervise, assist, and teach to achieve
the objectives of their own jobs.
It ensures the appropriate number of persons needed to make the assignment

manageable. Some factors that affect span of control are: the number of people to be
supervised, their skills, location of work, and equipment handled.
Reports can never replace direct observation.
To safeguard responsibility, areas of responsibilities should be regularly observed first-
hand.
Administrators must therefore be personally in touch with the work of personnel for
whom they are responsible to, as well as, with the patient who are the recipients of that
work.
Moreover, supervisors remain reality-centered when they witness for themselves at the
bedside-care level the problems and frustrations, as well as successes and joys derived
from giving nursing care.
4. Departmentalization or Similarity of Assignments.
Workers of similar activities are grouped together based on the likeness of personal
qualifications or common purpose.
This includes functions that require close coordination. Departmentalization specializes

activities, simplifies the administrator’s work and maintains control.
STAFFING (SELECTION, ORIENTATION, JOB DESCRIPTION)
STAFFING
 This is the process of determining and assigning the right personnel to the right job.
 It is the largest and the most crucial aspect of administration because the quality of the
personnel and their performance will determine the degree of achieving the goals of the
Nursing Service.
 An institution’s concern for the delivery of the quality of health care is reflected in the way
it supplies human resources for the administration of that care.

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Factors and Steps in Determining Staffing Needs
1. Patient’s acuity of illness
a. Level of care
b. Degree of dependence
c. Communicability
d. Rehabilitation Needs
2. Special treatment and procedures
3. Type of hospital
4. Ratio of professional to nonprofessional nursing personnel
5. Turnover of patients and nursing personnel
6. Hospital policy
7. Budget
8. Available equipment/materials/supplies
9. Population served
Steps in Computing the Number of Staff Needed in the

In-Patient Areas of the Hospital
1. Categorize the number of patients and multiply this with the percentage at each levels of care
Formula: Total No. of Patients x % at each level of care (refer to table 2)
2. Find the total number of nursing hours needed by patients per year at each categorized level
Formula: No. of patients at each level x Average nursing hours needed per day (refer to
Table 1)
*Get the sum of the nursing hours in the various levels.
3. Find the actual number of working hours needed by these patients per year.
Formula: Total No. of Nursing Care Hours (NCH) needed/day x 365 (total no. of days in a
year)
Note: the total NCH/day is your answer in number 2 step (the sum of NCH in various levels)
4. Find the total number of nursing personnel needed.
1. Divide the total number of NCH needed by the given number of patients per year by the
actual number of working hours rendered per year (refer to table 4)
2. Find the relief. Multiply the number of nursing personnel needed by .095
3. Add the number of relievers to the number of nursing personnel needed
5. Categorize into professional and non-professionals.

Formula: No. of Nursing Personnel x Ratio of Professional to Non-professional Personnel
(Refer to Table 3)
Note: You may use only one category ratio to get the proportion of professionals and non-
professionals.
6. Distribute by shift.
Studies have shown that more nursing care is given during the morning and afternoon shifts.
The morning shift requires the most number of nursing personnel at 45%, the afternoon shift
requires about 37% and the night shift only about 18%. (CONSTANT)
AM = 45% PM = 37% NOC = 18%

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Sample Computation: Find the number of nursing personnel needed for 100 patients in a
tertiary hospital. The hospital has 40 working hours/week
Step 1. 100 patients x .40 = 40 patients needing minimal care
100 patients x .60 = 60 patients needing moderate care
100 patients x .25 = 25 patients needing intensive care
100 patients x .1 = 10 patients needing highly-specialized care
Step 2. 40 x 1.5 (NCH needed/day at level 1) = 60 NCHs needed by 40 patients
60 x 3.0 (NCH needed/day at level 2) = 180 NCHs needed by 60 patients
25 x 4.5 (NCH needed/day at level 3) = 29.5 NCHs needed by 25 patients
10 x 6 (NCH needed/day at level 4) = 60 NCHs needed by 10 patients
Total = 329.5 NCH/day
Step 3. 329.5 x 365 = 120,267.5 total NCHs needed/year
Step 4.a. 120,267.5 (NCH/Year) = 70 Nursing Personnel
1,728 (working hrs./yr.)
b. 70 Nursing Personnel x .095 = 6.65 or 7 Nursing Personnel as Relief
c. 70 + 7 = 77 Total Nursing Personnel Needed
Step 5. Professional Nurses: 70 x .60 = 42 Nurses
Non-professional Nursing Personnel/Nursing Attendants: 70 x .40 = 28
Step 6. 42 x .45 = 19 nurses on 7 – 3 shift
42 x .37 = 15 nurses on 3 – 11 shift
42 x .18 = 8 nurses on 11 – 7 shift
28 x .45 = 13 nursing attendants on 7 – 3 shift
PATIENT CLASSIFICATION SYSTEM
Patient Classification System.

This allows a more accurate computation of nursing hours needed for different categories
of patients. It is a method used for grouping patients according to the amount and complexity of
their nursing care requirements over a given period of time.
The patient classification system is not intended to provide an exact allocation of nursing
hours. Rather, it is an aid to the professional nurse manager’s judgment regarding staffing
requirements, taking into consideration all factors that influence patient care. Through
experience, observation and suitable measurement techniques, time standards can be
developed for each patient care category.
In most classification systems, patients are grouped with reference to their dependency
on caregivers or according to the time and ability required to provide the care their conditions
dictates. The purpose of any such system is to assess each patient and award each a
numerical score that quantifies the volume of effort required to satisfy his/her nursing needs. To
develop a workable patient classification system, nurse managers must:
a. determine the number of categories by which patients are to be divided;
b. determine the characteristics of a typical patient that will be needed in each category and
the time needed to perform these procedures;
c. give emotional support; and
d. provide health teaching for patient in each category.

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In most patient classification systems, patients are divided into three or four categories
based on their dependency needs and the level of personnel required to satisfy these
needs.
4-CATEGORY CLASSIFICATION SYSTEM consist of:
1) self-care or minimal care
2) practical care or moderate or intermediate care
3) total care or intensive care
4) continuous care or highly specialized care.
3-CATEGORY SYSTEM
 the total care and intensive care categories are combined.
LEVELS OF CARE NO. OF NCH NEEDED PER

PATIENT PER DAY
Level I – Minimal Care 1.5
Level II – Intermediate Care 3.0
Level III – Intensive Care/Total Care 4.5
Level IV – Highly Specialized Critical Care 6.0
Table 1
Number of Nursing Care Hours (NCH) Needed
Per Patient Per Day Per Level of Care
Level I – Self-Care or nominal care category. Under this category, the patient is capable of
carrying out daily activities as long as the nurse provides the necessary materials and supplies.
A patient who enters a hospital for diagnostic work-up that includes numerous laboratory, x-ray
and other non-invasive tests, is often a self-care patient for the duration of his work-up.
Level II – Intermediate or Moderate or Partial Care Category. Under this category, the patient
can feed, bathe, toilet and dress himself without help, but requires some assistance from the
nursing staff for special treatment or certain aspects of personal care. For example, a partial care
patient might require wound debridement or dressing, catheterization, colostomy irrigation,
intravenous fluid therapy, intramuscular or subcutaneous injection or chest physiotherapy.
The patient being prepared for surgery or has just passed through the acute post-operative
period, and convalescing from surgery may be in the patient care category.
Level III – Total Care/Intensive Care Category. Under this category, a bed-ridden patient who
lacks the strength or mobility, needs nursing assistance with all his/her daily activities, such as,
feeding, bathing, dressing, moving, positioning, eliminating, comfort-seeking and injury
avoidance.
Level IV – Critical Care. An acute or critically-ill patient who is in constant danger of death or
serious injury would require critical care.

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PERCENTAGE OF PATIENTS IN VARIOUS

LEVELS OF CARE
TYPE OF HOSPITAL Minimal Moderate Intensive Highly
Care Care Care Specialize
d Care
Primary Hospital 70 25 5
Secondary Hospital 65 30 5
Tertiary Hospital 30 – 40 50 – 60 15 – 25 5 – 10
Special Tertiary Hospital 10 – 20 20 – 30 50 – 60 20 – 30
Table 2
Percentage of Patients in Various Levels of Care Per Type of Hospital
The total number of patients receiving minimal, moderate, or intermediate and intensive care vary
depending on the type of hospitals where they are confined. Refer to table 3 for specific
percentage of patients receiving care at each level of care.
LEVELS OF CARE RATIO OF PROFESSIONAL NURSES TO
NON-PROFESSIONALS/NURSING
PERSONNEL
Level I – Minimal Care Patient 55:45
Level II – Intermediate or Moderate Care 60:40
Patient
Level III – Total Care Patients 65:35
Level IV – Highly Specialized Care Patients 70:30 or 80:20
Table 3
The Ratio of Professional Nurses to Non-Professional
Nursing Personnel in Various Levels of Care
The percentage of nursing hours to be given by professional nurses and by non-professional
nursing personnel depends on the patient’s condition and in setting in which the care is given.
Refer to table 3 for specific ratio. For tertiary hospital or intensive care patients needing highly
trained nursing personnel, the proprortion is 70:30, or even, as needed.
Determining the Number of Nursing Personnel Needed:

The number of nursing personnel to staff in the various units/departments should be
sufficient to cover the service even when part of the personnel are off-duty, absent or are on
vacation/sick leave, or off on legal holidays.
The number of working hours and off-duties in this country is largely dependent on the 40-
Hour-Per Week Law otherwise known as R.A. 5901. This law specifies that personnel working
in agencies with a population of 1 million and in hospitals with a 100 bed capacity and over,
are entitled to work 40 hours per week. On the other hand, nursing personnel who work in
agencies with less than 100 bed capacity and a population of less than 1 million, will have
to render 48 working hours a week, therefore, only getting 1 day off a week.

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The following policies as regards to work leaves are assumed to be given regardless of
the number of working hours per week:
1. 15 days each per year for vacation and sick leaves
2. 10 legal holidays per year
3. 2 special holidays per year
4. 3 days for continuing professional education per year, for a total of 45 days per year.
Rights/Privileges Given Each Working Hours/Week

Personnel 40 hrs. 48 hrs.
Days of Vacation Leave 15 15
Days of Sick Leave 15 15
Legal Holidays 10 10
Special Holidays 2 2
Continuing Education 3 3
Off Duties R.A. 5901 104 52
Total Non-working Days/Year 149 97
Total Working Days/Year 216 268
Total Working Hours/Year 1,728 2,144
Table 4
Total Number of Working Days, Non-Working Days &
Working Hours of Nursing Personnel Per Year
JOB DESCRIPTION
Job descriptions are specifications of duties, conditions, and requirements of a particular

job prepared through a job analysis. It is usually used for wages classification purposes. It is
also called performance description.
Uses of Job Description
1. For recruitment, placement, and transfer of personnel.
2. For guidance, direction, and evaluation of performance.
3. It helps reduce conflict, frustration, overlapping of duties.
4. For working relationships with outside bodies, such as, professional associations.
5. To cite as basis for salary range.
Content of Job Descriptions

1. Job Title – definition of position, qualification, requirement, job summary, educational level,
physical demands
2. Job Relationships – source of worker, promotion from and to workers supervised
3. Performance Description – performance responsibilities
SCHEDULING
Scheduling
Timetable showing planned work days and shifts for nursing personnel.

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Issues to consider in scheduling staff:
a) Patient type and acuity
b) Number of patients
c) Experience of Staff
d) Support available to the staff
Shifting Variations
a) Traditional Shifting Patterns
i. 3 shift (8 hr shift)
ii. 12 hr shift
iii. 10 hr shift
iv. Weekend option
v. Rotating work shift
b) Self-scheduling – staff makes their own schedule
i. Permanent work shift
ii. Floaters – “on-call”
Forty Hour Week Law – based on RA5901

No work, no pay
Entitled to 2-week sick leave and off duty for 2 days
Special Holidays – with pay
MODALITIES OF CARE-ORGANIZING CLIENT CARE
1. Case System (Total client care)

a. Oldest method of delivering nursing care, one-on-one relationship between nurse
and the client; intensive care units; nursing students
i. An RN is responsible for all aspects of care of one or more client
ii. The PN may be assigned to assist the RN
iii. Currently, this type of care is provided in areas requiring high level of
nursing expertise, such as the critical care unit or the post-anesthesia
recovery units
2. Functional System (task nursing)
a. Most frequently adopted method, emphasis: get tasks and procedures done;
based on concept of division of labor; medication nurse
i. Needs of clients are broken down into tasks
ii. Tasks are assigned to various levels of health care workers according to
licensure and skill
iii. Example: RNs give medications and client nursing assistants give bed
baths for one group of clients
3. Team Nursing
a. Focus on individualized patient care; involves both professional and non-
professional health personnel; total nursing care; coordinate, supervise and
ensure participation and cooperation of co-workers
i. Most common nursing-care delivery system
ii. A team of nursing personnel provides total care to a group of clients
iii. Team leaders supervise client-care teams, which usually consist of an RN,
PN, and UAP

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iv. Team leader reviews clients' plans of care and progress with team
members during team conference
4. Primary Nursing
a. Most recent method
b. Philosophy: focus is the patient instead of the task
c. Total patient care to 4-6 patients, 24 hours a day throughout hospitalization;
associate nurse; autonomy and authority
i. The RN maintains a client load of primary clients
ii. The primary nurse designs, implements and is accountable for the nursing
care of those clients during their entire stay on the unit
5. Practice partnerships
i. An RN and an assistant (UAP, PN, less-experienced RN, graduate nurse,
or nurse intern) agree to be practice partners
ii. Partners work together on same schedule with same group of clients
iii. Senior partner directs the work of the junior partner within the scope of
each partner’s practice
6. Case management
i. Model for identifying, coordinating, and monitoring the implementation of
services needed to achieve desired client outcomes within a specified
period of time
ii. Organizes client care by major diagnoses or diagnostic-related groups
(DRGs)
iii. A collaborative health care team defines the expected outcomes of care
and care strategies for a client population by defining critical paths
iv. A registered nurse manager is assigned to coordinate, communicate,
collaborate, problem solve, facilitate and evaluate client care for a group of
clients
v. Case manager usually does not provide direct client care but supervises
care provided by licensed and unlicensed nursing personnel according to a
critical path
vi. Critical pathways are plans for providing care to the client and family
1. identify desired outcomes
2. state expected amount of time and resources to be used
3. focus on specific diagnoses or procedures that are high volume and
or high resource use and therefore costly
4. promote collaboration among disciplines
vii. The essential components of case management include:
1. collaboration of all health care team members
2. identification of expected patient outcomes with time frames
3. use of principles of continuous quality improvement (CQI) and
variance analysis
4. promotion of professional practice
viii. Client involvement and participation is key to successful case management
7. Differentiated practice
i. Identifies distinct levels of nursing practice based on defined abilities that
are incorporated into job descriptions
ii. Structures nursing roles according to education, experience, and
competency

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8. Client-centered care
i. The RN coordinates a team of multifunctional unit-based caregivers
ii. All client care services are unit-based, including admission, discharge,
diagnostic testing and support services
iii. Uses UAPs to perform delegated client care tasks
A. ASSESSMENT TEST
Compute the Following. Long Bond Paper
I. As the chief nurse in the newly constructed Polytechnic Medical Center you are to find
out how many nursing and non-nursing personnel you need for the 200 bed capacity
tertiary hospital.
1. Categorize the patients according to levels of care needed

2. Find the number of nursing care hours(NCH) needed by patients at each level of care per
day
3. Find the total NCH needed by 200 patients per year
4. Find out the actual working hours rendered by each nursing personnel per year
5. Find the total number of personnel needed
6. Categorize to professional and non-professional personnel
II. As the chief nurse in the newly constructed Polymedic Hospital you are to find out how
many nursing and non-nursing personnel you need for the 75 bed capacity secondary
hospital.

day
III. As the chief nurse in the newly constructed Tacurong Hospital you are to find out how
many nursing and non-nursing personnel you need for the 120 bed capacity secondary
hospital.

day

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B. RESEARCH ON VARIOUS JOB DESCRIPTIONS AVAILABLE LOCALLY FOR
NURSES (CHIEF NURSE, OR, DR NURSE etc.). COMPARE IT WITH THOSE THAT
CAN BE FOUND IN OTHER COUNTRIES.
I. FRONT PAGE
II. INTRODUCTION
III. REVIEW OF RELATED LITERATURE ( Importance of Job Description)
IV. DISCUSSIONS (Comparison)
V. FINDINGS, RECOMMENDATIONS AND CONCLUSIONS
VI. REFERENCE

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Requirements Presented to the College of Nursing

of
Sultan Kudarat Educational Institution, Inc.
Comparison of a Job Description a Chief Nurse of
__________________________________(local hospital)_______
And
____________________(Foreign Country hospital)___________
Presented by:
__________________________________________
Presented to:
RITZELLE ECIJA-EUGENIO, MAN, MHcA, CHRP
September 2020

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INFORMATION SHEET 5
DIRECTING/LEADING
III. DIRECTING/LEADING
 getting the members/staff to integrate their efforts to achieve goal and objectives.
 This refers to the manner of delegating assignments, orders and instructions to the nursing
personnel where the latter is made aware of the work expected of him/her. The nursing
personnel should be properly guided so they can contribute effectively and efficiently to
the attainment of the nursing service goals.
 It includes collaboration, delegation, supervision, coordination, communication, and staff
development.
How do we lead?
1. formulation of policies and procedures
2. clarification of VMG, task and responsibilities
3. Work simplification
a. Unity of command
b. Levels of authority
c. Job description
4. Motivating members and improving relationships
a. Full play to initiatives and adequate guidance
b. Positive reinforcement
c. Recognition of strengths
d. Delegation as manifestation of trust
e. Personal concern to the person
f. Assistance to members
Influence tactics:
i. Assertiveness – standing up for one’s rights and rights of others without violating the
rights of others
ii. Ingratiation – making one feels important and feels good before making a request
iii. Rationality – relying on a detailed plan, reasoning or logic
iv. Sanctions – giving or preventing pay increases or promotions until one gives in to a
request
v. Exchange – offering an exchange of favors; reminding a worker of past favor or offering
to make a personal sacrifice
vi. Upward appeal – obtaining a formal or informal support of a higher up
vii. Blocking – backing up a request with a threat to damage one’s opportunity for
advancement, ignoring or not being friendly with a person until he/she gives into a
request
viii. Coalition – getting co-workers to back up a request

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LEADERSHIP THEORIES
Great Man Theory

The Great Man
Theory originated from studying

behaviors of military figures and
people in authority in the 1800s.
Thomas Carlyle, a great historian,
was heavily involved in the world,
and is popularly quoted as saying,
“The history of the world is but the
biography of great men
leaders are born and not made
few people are born with the
necessary characteristic to be great
Strengths: This theory started

the scholarship of which traits and
characteristics build great leaders.
Weaknesses: This theory lacks scientific validity and only considers men in
power. And, as 19th century-sociologist Herbert Spencer argued, great leaders
may be shaped by their society, not the other way arou nd.
Charismatic Theory
person may be a leader because of his charisma

he/she can inspire people to be loyal, obedient and committed to a vision or a cause

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Trait Theory
The Trait Theory only considers the leaders as the driving force of the
leadership process, so the leader possessing certain traits is critical to having
effective leadership.
Strengths: This approach is intuitive and understandable. It also has over a

century of supporting research.
Weaknesses: The trait list can be endless, unclear and subjective. This
approach fails to take situations and followers into account, and it’s not useful
for training purposes. Also, the characteristics attributed to leaders throughout
time have been masculine, leading to a biased list of traits that make up a
leader.
innate or inherited traits makes an individual a leader

intelligence, initiative, creativity, integrity, communication skills, emotional maturity

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Situational Theory/ Life Cycle Theory (maturity of followers)
As a leader, you first have to understand a person’s development level for a specific task or
goal in order to apply the right leadership style and provide the right amount of directive and/or
supportive behaviour.
Let’s first try to understand the development level of a person: “You need to look at two
factors to determine a person’s development level: competence and commitment. In
other words, anytime a person is not performing well without your direction, it is usually a
competence problem, a commitment problem, or both” (on page 35 in “Leadership and The One
Minute Manager”).
 Competence is a function of demonstrated knowledge and skills; can be gained through

learning and/or experience, can be developed with direction and support
 Commitment is a combination of confidence and motivation; confidence is a measure
of a person’s self-assuredness, a feeling of being able to do a task well without much
direction; motivation is a person’s interest in and enthusiasm for doing a task well

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Four combinations of competence and commitment make up the four development levels:
 Development Level 1 / Enthusiastic Beginner: you have a new task or challenge and
you want to get it solved (high commitment), however you are inexperienced (low
competence). You don’t know what you don’t know. You are eager to learn, excited and
curious, and fairly confident that learning won’t be difficult.
 Development Level 2 / Disillusioned Learner: you have acquired some competence,
but haven’t made as much progress as expected. Your commitment may have dropped
because it was harder than you thought or because you feel your efforts and progress
weren’t being acknowledged. You could become frustrated and may even be ready to
abandon the task or goal (low commitment).
 Development Level 3 / Capable but Cautious Contributor: you have demonstrated
some competence but lack confidence in doing the task by yourself. You may be self-
critical and unsure. Or you may be bored with a particular goal or task and lose
commitment that way.
 Development Level 4 / Self-Reliant Achiever: you have both high competence and
commitment; you are confident and self-motivated. You need to be valued for your
contributions. You need opportunities for growth and influence (but you don’t need much
direction or support).
The development level of a person is goal – or task – specific. It’s not an overall rating of a
person’s skills or attitude. And each development level asks for a different leadership style as
depicted:

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 Leadership Style 1: Directing for the Enthusiastic Beginner
As a situational leader, you provide a D1 person with high directive behaviour and low
supportive behaviour, i.e. you provide specific direction about goals, you show and tell a
person what, when, where, and how to do something, and then you closely monitor the
person’s performance in order to provide frequent feedback on results. If there are
decisions, you take them.
 Leadership Style 2: Coaching for the Disillusioned Learner
As a situational leader, you provide a D2 person with high directive behaviour and high
supportive behaviour, i.e. you continue to direct goal or task accomplishment but you
also explain why, you solicit suggestions, and begin to encourage involvement in
decision making. Still, you are the one to decide. Once a person has lost commitment,
providing direction is not enough, you also have to provide support and encouragement.
 Leadership Style 3: Supporting for the Capable but Cautious Contributor
As a situational leader, you provide a D3 person with low directive behaviour and high
supportive behaviour, i.e. you facilitate, listen, encourage, and support. You make
decisions together. You support the person’s efforts, listen to the suggestions, and ask
good questions to build his/her confidence in his/her competence.
 Leadership Style 4: Delegating for the Self-Reliant Achiever
As a situational leader, you provide a D4 person with low directive behaviour and low
supportive behaviour, i.e. D4 makes most decisions about what, how, and when. You
value the person’s contributions and support his/her growth.
The Situational Leadership Model, developed by Paul Hersey and Ken Blanchard, matches
quite well with my experience. With a good understanding of it, it’s easier to be an effective
leader. A person may be a leader or a follower depending on the situation
Contingency theory
Leader-member relations, task structure and position of power determine the role of the
leader
Different combinations of these behaviors lead to four distinct categories:
o Directing: high-directive, low-supportive behaviors
o Coaching: high-directive, high-supportive behaviors
o Supporting: low-directive, high-supportive behaviors

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o Delegating: low-directive, low-supportive behaviors. The contingency
theory states that followers move along the developmental continuum,
which has four development levels indicating the degree to which a follower
has the competence and commitment necessary to accomplish a goal or
activity.
o D1: low competence and high commitment: leader is excited and motivated
about a new challenge, but lacks the skills to succeed
o D2: low competence and low commitment: leader has some competence
but lacks motivation
o D3: high competence and low/variable commitment: leader has mastered
skills but has variable commitment
o D4: high competence and high commitment: leader has the skills and
motivation to complete tasks and achieve goals. An effective leader
determines where followers are on the developmental continuum and
adapts his or her leadership style to match.
Strengths: This theory is well-known, easy, intuitive and practical to use. It is
frequently utilized in leadership training and promotes tailoring follower treatment
based on development. This approach is also prescriptive, meaning that it tells
you what should or should not be done depending on the situation.
Weaknesses: This theory lacks research support, and there is ambiguity in the
development levels. The approach also fails to address demographic differences
and how they influence prescriptions.
Behavioral leadership Theory
As a reaction to the trait theories, The Behavioral Theory looks not at the traits or
abilities of leaders, but their behavior. Two behavior categories were created:

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Task behavior: facilitates goals and accomplishment of leaders and followers.
Relationship behavior: helps followers feel more comfortable around the leader
and about the organization. From this, management training in different
leadership styles became popular, including Blake and Mouton’s Managerial
Grid. This grid is based on two different behavioral dimensions to consider when
accomplishing a task:
Concern for Production: how much a leader emphasizes concrete objectives,
high productivity and organizational efficiency
Concern for People: how much a leader considers team members’ interests,
needs and areas of personal development.
From these two behavioral dimensions, there are five distinct managerial styles:
1. Impoverished Management: With low regard accomplishing tasks or creating

a motivating team environment, impoverished or “ineffective” managers ar e
mostly ineffective.
2. Country Club Management: This style of manager is mostly concerned with
the needs and feelings of team members, thinking that if team members feel
happy and secure they will work hard. In country club or “accommodating”
management the work environment is fun and relaxed, but productivity suffers
due to a lack of direction and control.
3. Middle-of-the-Road Management: These “status quo” managers try to balance
people and results, but due to the constant compromise, they fail to meet
people’s needs and deliver mediocre performance.
4. Authority-Compliance Management: Also known as “produce-or-perish
management,” in this style people’s needs are secondary to productivity. The
manager typically has strict policies and procedures and utilizing punishment
to motivate team performance. Although this style can result in initial
productivity, retention is an issue.
5. Team Management: The most effective of all the styles, “sound” managers
prioritize both team members and productivity by making sure tea m members
understand and are committed to the organization’s purpose and goals.
Strengths: This theory expands views of leadership from trait -based to action-
based, which makes it easier to teach. It also has strong research support.
Weaknesses: This theory is not linked to desirable work outcomes, and no
universally successful behaviors have been identified. Also, team management
may not always be best despite claims.
Strategy Theory
Strategic Leadership can be defined as the ability of the top level managers or
executives to determine the future courses of action and direction of the firm and motivate
the members to make efforts in that direction.
vision, communication, positioning and deployment of self through positive self-regard
This is possible by formulating and communicating the firm’s vision to the members of the
organization develops strategies – keeping in mind the organization’s internal and external
environment, aligning the strategy with its work environment initiating change needed for
the strategy implementation and influencing the employees to take part in the execution
of the strategy. It involves:

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Strategic Leadership aims at inspiring others to make those decisions that bring better
opportunities for the enterprise’s long-term success, without compromising its short-term
financial stability.
Strategic Leadership is an intricate form of leadership, wherein the strategic leaders, i.e.
managers or top-level executives design an organization structure, allocates resources, inspire
employees to follow their ideas.

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It encompasses the ability to envision, forecast and stimulate others to contribute to the
implementation of strategic change in the organization.
Strategic Leader
A strategic leader is someone who determines the organization’s strategies and actions and
makes every effort to implement it, in an intended manner.
In general, the manager acts as a strategic leader in the organization, who foresees and interprets,
the dynamic business environment and work on issues that can influence and can be
influenced by the events that occur to/with the organization.
Functions of Strategic Leader
 Setting the direction

 Strategic decision making
 Human capital management
 Translating strategies into actions
 Change Management
 Effective communication within the organization
 Ensuring efforts are made in the right direction.
 Developing strategic competencies.
 Framing policies and plans for the effective implementation of strategic decisions.
 Developing and maintaining a constructive work culture
The strategic leader has the following qualities
a. open-mindedness
b. Foresightedness
c. Accountable
d. Risk-taking ability
e. Influential
f. Discipline
g. Endurance
h. Up-to-date
i. Self-control
j. Self-Awareness.

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Roles played by the strategic leader
1. Navigator: A strategic leader identifies the major issues and its causes. Further, he/she always
look for better opportunities, to affect actions.
2. Strategist: As a strategist, he/she develops such strategies which have a long range view and
establish those objectives which suit the organization’s vision and mission.
3. Entrepreneur: A strategic leader has the risk-taking ability, who takes risks after completely
analyzing it. For this purpose, he/she always looks for opportunities and exploit them at the right
time.
4. Change Agent: As a change agent, he/she initiates changes in the organization, wherever
required. And to do so, first of all, he/she makes sure that the members of the organization
realize the need for change so that they can accept it positively and the changes are
successfully implemented.
5. Motivator: A strategic leader plays the role of a motivator, by attracting, developing,
encouraging, and retaining talent in the organization, to make sure that the organization
possess the best human resource.
6. Captivator: As a captivator, the strategic leader aims at developing passion, dedication,
persistence, and commitment towards the common goals, by influencing them in a way that
people get ready to follow the vision.
Apart from these roles a strategic leader also plays the role of a visionary, policy maker, crisis
manager, spokesperson, process integrator, mobilizer, enterprise guardian etc.

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Contemporary Theories of Leadership
Interactional Leadership Theory
Interaction is the most important component among the three. Hollander (1978)
suggested that leadership is a process of give and take. It is a social exchange where
leaders and followers continuously evaluate each other. Hollander referred the outcome
of interaction as “Idiosyncrasy Credit” which is the degree to which an individual may
deviate from the common expectancies of the group (Index of Status). Chowdhry and
Newcomb (1952) said that leaders have superior social perception which is the base of
interaction.
Leadership behavior is generally determined by the relationship
i.e. Brandt’s Interactional theory
a. autonomy and creativity by valuing and empowering followers

b. leader must accept the responsibility for the quality of outcomes and the quality of
life for followers
Characteristics of Interactional Approach
1. Interaction is social cognition that is understanding the needs of others.

2. The followers are central to this approach.
3. Leaders motivate through rewards on accomplishment of group task.
4. Positive and enthusiastic relationships are found between leader and members.
5. The followers are transformed through cascading effect of a leader’s behavior.
Advantages of Interactional Approach
1. Interactional approach helps in selecting the appropriate individual for leadership
role.

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2. The members and leader play active role in group affairs that make goal
realization easier.
3. The approach being group centric therefore a high level of satisfaction is found
among members.
Disadvantages of Interactional Approach
1. The active involvement of large number of people makes decision making process
relatively slower.
2. This approach is not suitable in the event of group polarization or disagreement
among members.
3. Leader have relatively lesser control over members.
Servant Leadership Theory

“A better society, one that is more just and more loving, one that provides greater
creative opportunity for its people.”
~Robert Greenleaf
leaders put serving others as number-one priority

The Servant Leader as an essential component of a highly effective healthcare workplace.
Crediting the work of Robert Greenleaf, the following were described by Sherman as
essential characteristics of the Greenleaf serving leadership style.
1. Listening
2. Empathy
3. Healing
4. Awareness
5. Persuasion
6. Conceptualization
7. Foresight
8. Stewardship
9. Commitment to professional development of staff
10. Building community
THE TEN PRINCIPLES OF SERVANT LEADERSHIP AS PROPOSED BY ROBERT

GREENLEAF
1. Listening
Communication is a two way process and many leaders will be very good at doing the talking
and less so at listening. Effective servant leaders are able to listen intently and respectfully to
their staff and act on the information they receive.

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2. Empathy
Servant leaders are able to deeply understand and empathize with others. It is important to
recognize and accept people for their uniqueness and understand their point of view.
3. Healing
This does not mean physically healing but rather healing on a more holistic level. This can be
achieved through discussion, coaching, mentoring and relationship-orientated leadership styles.
4. Awareness
Having a wider awareness of yourself and others is a common trait of effective servant leaders.
Understanding strengths, weaknesses and areas for development and support is crucial for
maximizing performance.
5. Persuasion
A key difference between servant leadership and other styles of leadership is that servant leaders
rely largely on persuasion and cooperation rather than authority and delegation. Servant leaders
have an ability to convince others as opposed to coercing them into compliance.
6. Conceptualization
Servant leaders have the ability to look at a problem from a conceptualizing perspective, meaning
they are able to think beyond the day-to-day realities of their work. While conceptualization is
important servant leaders also have the ability to delicately balance conceptualization and day-
to-day focus.
7. Foresight
Foresight is a characteristic which enables servant leaders to understand lessons from the past,
the realities of the present, and the likely outcomes of any future decisions.
8. Stewardship
Greenleaf’s view of all institutions was that all leaders (CEOs, staff, directors, trustees, etc.)
should play a significance role in establishing their institution in trust for the greater good of
society.
9. Commitment to the Growth of People

Servant leaders believe that people have an intrinsic value beyond that of the work they do. They
lead with a deep committed to both the personal and professional growth of each and every
individual within their organization. Ensuring staff welfare and well-being is also a big
considerations for servant leaders.
10. Building Community

Developing and maintaining an effective community is fundamental to servant leadership.
Servant leaders seek to identify ways in which social and task orientated communities can be
built amongst those who work within their organization.

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Four developmental levels of Leaders
1. Reactive level
focus on past
crisis driven
abusive to subordinate
2. Responsive
mold subordinate to work together as team
3. Proactive level
leader and followers become more future-oriented
4. High Performance Teams
maximum productivity and worker satisfaction are present
Transactional Leadership Theory
Transactional leaders set clear expectations for subordinates for their duties
and rewards.
Strengths: A popular theory.
Weaknesses: The primary limitations of this theory are that it simplifies
people’s motivations and emphasizes the importance of monetary reward
while ignoring the rest of Maslow’s Hierarchy.

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Transformational Leadership
enables the exploration of new and innovative ways to drive value and deliver real results
in a ever-changing environment
both leaders and followers have the ability to raise each other to higher motivation and
morality
vision
Inspiring team members to follow your vision is essential for transformational
leaders.
Strengths : Transformational leaders can turn around a company with low
morale and accomplish cross-organizational goals by unifying team members
under one vision.
Weaknesses : Visionaries can lack specification and actionable goals.
2 Types of Leadership according to Bennis

Transactional Transformational
Focus on management tasks Identify common values
Caretaker Committed
Trade-offs to meet goals Inspires others with vision
Shared values not identified Long term vision
Examines causes Look at effects
User contingency reward Empower others

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Shared Leadership
a philosophy and an organizational structure that allow staff nurses to lead themselves,
they make decisions at the point of care
multiple perspective and diverse strength and talents are combined to achieve goals.

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Participative Leadership Theory
How participative the leader is on a spectrum depending on how much they involve
the team in their decision making:
Exploitative Authoritative: decisions made by the leader only

Benevolent Authoritative: leader considers employees but makes decisions alone
Consultative: leader listens to employees’ ideas, but still makes the final decision
Participative: leader shows great concern for employees’ ideas and includes them
in the decision-making process.
Strengths: Team members feel valued and they can perform even when the
leader isn’t there.
Weaknesses: Decision making can take a long time, and there is a social
pressure to confirm with the group’s decision.
Correct Leadership
1. Decision made must be correct
correct analysis of concrete conditions

link to vision, mission and goals
formulation of realistic plans and instructions
2. Correct decisions must be implemented
organize efforts to realize plans

take part in implementation
3. Implemented decisions must be evaluated
work on tangible results

pay attention to content and form
draw lessons

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COMPARISON
LEADERS MANAGERS
May or may not be appointed Officially appointed
Power and authority to enforce Power and authority to enforce
decisions based on willingness of decision while in position
followers to be led
Influence others toward goal setting Carry out predetermined policies, rules
either formally or informally and regulations
Interested in risk-taking and exploring Maintain an orderly, controlled rational
new ideas and equitable structure
Relate to people personally in an Relate to people according to their
intuitive and emphatic manner roles
Feel rewarded from personal Feel rewarded when fulfilling
achievements organizational mission or goals
May or may not be successful as Managers as long as the appointment
managers holds
TYPES OF LEADERS
 Formal Leaders – appointed leaders chosen by the administration and given official or
legitimate authority to act
 Informal Leaders – do not have official sanction to direct the activities of others
LEADERSHIP STYLES
1. Authoritarian
2. Democratic
3. Laissez Faire

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Authoritarian Democratic Laissez Faire

Control Strong Less Little or none
Motivation Coercion Economic/ ego Gives support
awards when requested
Direction Commands Suggestions/guidance Little or none
Communication Downward Downward Downward
Decision making Does not involve Involve others Group
others
Focus You/I We Group
Criticisms Punitive Constructive Does not criticize
Other Styles
4. Bureaucratic
rule-centered
5. Multicratic
combines best of all styles

mediated by requirements of situation
provides maximum structure when appropriate
asks for maximum group participation when needed
gives support and encouragement to subordinates

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NINE QUALITIES AID NURSING EXECUTIVES IN MEETING THE OBJECTIVE OF

FOSTERING NEW LEADERSHIP TALENT
1. Emotional Intelligence
In clinical settings, nurse leaders work closely with trainees to help them develop emotional
intelligence. Such support helps peers to cope with the stressors that present during routine
challenges. Nurse leaders assist trainees in managing those challenges and other
counterproductive influences that can result in emotional exhaustion and poor team
collaboration.
2. Integrity
Integrity for one’s self and among charges is a primary objective for nurse leaders. Personal
integrity aids nurse practitioners in making the right choices during critical junctures in patients’
treatment plans. Additionally, effective leaders adapt to use, and teach, ethically viable
practices that enable fledgling nurse leaders to make safe and effective care decisions
intrinsically.
3. Critical Thinking
Nurse leaders guide unpolished practitioners in the use of critical thinking to develop their
ability to make decisions based on a complex array of factors. This skill is vital in a health care
environment with increasing instances of multidisciplinary collaboration. The growing trend of
autonomy for nurses also makes critical thinking a valuable professional skill for practitioners.
4. Dedication to Excellence
Nurse leaders are committed to their passion and purpose and exemplify this through their
perseverance in the caregiving setting. To foster this trait among new nurses, leaders may
assess performances quarterly. Despite the technique used to improve nurse performance, all
nurse leaders teach their charges dedication to excellence by delivering top-notch service so
that trainees can learn from their examples.
5. Communication Skills
The current multidisciplinary treatment environment greatly increases the importance of

collaboration in the care provider setting. To facilitate collaboration, nurse leaders arrange for
trainees to attend rounds while engaging with various medical professionals, such as support
staff, primary care providers, and senior executives. Some health care organizations also
establish recruitment retention teams, who might engage in these rounds with trainees.
6. Professional Socialization
During training, nurse leaders gain an intense understanding of patient-nurse dynamics. Nurse
leaders focus on developing how trainees engage with patients after the triage process.

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Effective nurse leaders identify opportunities to develop new organizational leaders during this
learning process.
7. Respect
Nurse leaders are passionate, dynamic influencers who inspire change in others and, in the
process, win the respect and trust of their charges. To accomplish this, leaders teach
communication techniques such as two-way communication and rephrasing to promote a
workplace environment where stakeholders engage each other in a productive, positive
manner. By understanding each other’s circumstances, trainees gain respect for their peers
and nurse leaders.
8. Mentorship
Nurse leaders deploy motivational strategies that cater to the individual personalities of their
trainees. By empowering trainees and guiding them toward understanding their roles as care
providers, nurse leaders cultivate an environment of continual learning. While effective nurse
leaders make every effort to identify learning opportunities, they give trainees enough
autonomy so that they do not feel micromanaged.
9. Professionalism
Nursing is a dynamic profession that requires competent, confident leadership. As

organizational leaders, these professionals represent the nursing field at nearly every
professional point of contact within the organization. This will increase in significance as nurse
leaders find themselves representing the field in the boardroom more frequently as time moves
forward.
Nursing leadership will change hands to a new generation of nursing talent over the next
decade. These professionals will play a vital role in liaising between nurses and executive
leaders in the evolving health care environment. Therefore, it is critical that nurse leaders start
cultivating their replacements now and that the new generation of nurses pursue advanced
training, such as Doctor of Nursing Practice accreditation, that will allow them to practice to the
full extent of their capabilities.
10. Learn More
Across the country, a national shortage of primary care providers has set the stage for RNs to
advance. As more states certify nurse practitioners as primary care providers, you can pursue
a new avenue of nursing to fill meaningful voids in today’s health systems.
Authority
legitimate right to give command
an officially sanctioned responsibility
Power
demonstrated ability to get results

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ability to obtain, retain and motivate people and to organize
informational and material resources to accomplish a task
BASES FOR POWER
a. Legitimate – given to the manager by the organization because of his position in the
hierarchy
b. Reward – based on the ability to control and administer rewards to others for compliance
with the leaders orders or request
c. Coercive – founded on fear depending on the ability to use punishment of other for non-
compliance with the manager’s orders
d. Expert – derived from special ability, skill or knowledge demonstrated by the individual
e. Referent – based on attractiveness or appeal of one person to another; connection or
relationship with a powerful individual
f. Self-derived from maturity, experience or gender
g. Information – based on the information the manager possesses
TOOLS IN DIRECTING
There are many tools available to a director in a nursing environment. The primary tool is the
nursing care land as a whole. The director may also use policies, standards, standard operating
procedures, and rules and regulation.
Nursing care plan
A nursing care plan outlines the nursing care to be provided to a patient. It is a set of
actions that the nurse will implement to resolve nursing problems identified by assessment. The
creation of the plan is an intermediate stage of the nursing process. It guides in the ongoing
provision of nursing care and assist in the evaluation of that care.
Characteristics of a nursing care plan

1. It focuses on actions which are designed the solve or minimize the existing problem.
2. It Is a product of a deliberate systematic process.
3. It relates to the future
4. It is based upon identifiable health and nursing problem.
5. It Focus is holistic.
6. It aims to meet all the needs of the patient or service user.
ELEMENTS OF THE NURSING CARE PLAN
The nursing care plan may consist of an American North American nursing diagnosis
Association (NANDA) nursing diagnosis with related factors and subjective and objective data
that support the diagnosis, nursing outcome, classification with specified outcomes or goals to be
achieved including the deadlines and nursing intervention classifications with specified
intervention.
ELEMENTS OF DIRECTING
Directing has seven elements these are:

1. delegation
2. supervision
3. staff development
4. coordination
5. collaboration
6. communication

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7. evaluation
1. DELEGATION
Delegation is the act of assigning to someone else a portion of the work to be done with
corresponding authority, responsibility, and accountability.
An assignment is a task done without authority while a delegation is a task done with
ARA.
It is also a skill to be learned and mastered beginning with learning what cannot be
delegated and what will be delegated and to whom.
a process by which responsibility and authority for performing tasks are transferred from
one individual to another who accepts that authority and responsibility
Delegation is to entrust responsibility and authority to others and to create accountability
for its results.
Delegation is a process of entrusting because the supervisor/administrator shares work
and decisions with others which he/she would otherwise carry alone.
Delegation involves
 Responsibility: an obligation to accomplish a task

 Accountability: accepting ownership for the results or lack of
 Authority: right to act or empower.
Elements of Delegation
1. Responsibility entails an obligation to fulfill the work assigned to a certain position.
2. People will not perform the work unless they can make decisions related to it. The more
powers and rights a supervisor/administrator can exercise with respect to the work he/she
does, including making decisions, the more completely he/she will accomplish that work.
The person given more authority to make the most of his/her own decisions enjoys his/her
work more and derives more personal satisfaction from performing it. Authority is the sum
of the powers and rights assigned to a position. In the process of work sharing to be done,
there is a need to ensure that the job is performed appropriately, and decisions are made
based on factual data.
3. Accountability is the process of establishing an obligation to perform the work and to make
a decision within set limits.
Basic Principles of Delegation

1. A clear-cut outline of duties, responsibilities and relationships should be established.
2. Authority should be delegated within specially defined limits to avoid stepping on others’
rights.
3. Define objectives and suitable measures for determining performance. The most effective
measures are based on performance standards which are checked against objectives,
programs, schedules, and budgets.
4. Delegated responsibility must be accompanied with the corresponding authority. A person
who is given a corresponding authority is encouraged to give his/her best effort in his/her
work.
5. Every supervisor is held completely accountable for the methods and results of the work
assigned to him/her. He/she is given the authority to establish plans and exercise necessary
controls within the set limits. This way, errors and deficiencies can be pinpointed
immediately.

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Steps in Delegation
1. Describe the tasks/projects procedures to be done.
2. Relay the description of the task, etc.
3. Establish checkpoints.
a. Policies/standards
b. Allocate resources
c. Time frame
d. Rounds
4. Establish dialogue before, during, and after, for feedback on:
a. clarification
b. attitude/feelings of the staff delegated with the task
c. judgment of delegation
Pointers for Proper Delegation of Work

1. Provide clear and specific instructions. Make sure that the responsibilities are
clear.
2. Give authority commensurate to responsibility.
3. Keep subordinates informed.
4. Show you have confidence in your subordinates.
5. Be loyal.
Points to Remember in Delegation

1. Authority to sign your name is never delegated.
2. Let the person who actually did the work sign it.
3. The opportunity to say a few words to new employees is never delegated.
Principles of delegation
1. A nurse can only delegate those tasks for which that nurse is responsible,
according to the specific state's nurse practice act
2. The delegator remains accountable for the task
3. Along with responsibility for a task, the nurse who delegates must also
transfer the authority necessary to complete the task
4. The delegator knows well the task to be delegated
5. Delegation is a contractual agreement that is entered into voluntarily
6. Consider the scope of practices of nursing personnel
a. registered nurses:
i. baccalaureate prepared nurses are equipped to care for
individuals, families, groups and communities in both structured
and unstructured health settings
ii. associate degree prepared nurses are equipped to care for
individuals in a structured health care environment
iii. RNs cannot delegate to unlicensed personnel:
 initial assessment of clients
 evaluation of client data
 nursing judgment
 client/family education/evaluation
 nursing diagnosis/nursing care planning
b. licensed practical or vocational nurses (LPN/VN) are equipped to
assist in implementing a defined plan of care and to perform
procedures according to protocol. Assessment skills are directed at

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differentiating normal from abnormal. Competence is in caring for
physiologically stable clients with predictable conditions.
c. unlicensed assistive personnel (UAP) have the most limited scope of
practice. They can assist in a variety of direct client care activities
such as bathing, transferring, ambulating, feeding, toileting, obtaining
measurements such as vital signs, height, weight and intake and
output. They can also perform indirect activities such as
housekeeping, transporting and stocking supplies. Steps to delegation
7. Define the task
8. Match the delegate to the task
a. determine that the task is within the scope of practice for the delegate
i. nurse practice acts: each state defines nursing practice for
registered nurses (RNs) and licensed practical/vocational
nurses (LPN/VNs)
ii. standards of practice: the American Nurses Association (ANA)
defines standards of practice for registered nurses
iii. some nursing tasks can be delegated to unlicensed assistive
personnel (UAP) to assist, but not replace, the nurse
iv. only licensed individuals have a legally determined scope of
practice
b. know the employer's role expectations
i. organizational charts
ii. policies and procedures
iii. job descriptions
iv. competency requirements
9. Communicate clearly about expectations regarding the task
a. state clearly who will do what by when and how, where and why it will
be done
b. state clearly the outcomes you expect
10. Reach mutual agreement about the task to be completed
a. the delegator validates with the delegate that an understanding exists
regarding what is to be done and the outcomes that are expected
b. discuss potential problems and solutions
11. Supervise the performance of the task
a. provide directions and clear expectations of how the task is to be
performed
b. monitor performance of the task to assure compliance with established
standards of practice, policies and procedures
c. intervene if necessary
d. ensure appropriate documentation of the task
12. Evaluate the delegation process
a. assess the degree to which nursing care needs of the client are being
met
b. review the performance by the delegate of the delegated task
c. determine the need for further instruction
d. determine the need to continue or withdraw the delegation
13. Provide feedback to individual on outcomes performance
a. review with the delegate what went right as well as what went wrong
with the process

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Five rights of delegation
1. Right task
2. Right circumstances
3. Right person
4. Right direction/communication
5. Right supervision
Client care assignments
1. Assign the right task

Joint Commission on Health Care Organizations Criteria for Making Assignments
[From NC.2.1.2] Assigning responsibility to nursing staff members for providing nursing care
to patients is based on consideration of the following seven elements:
1. Complexity of patient care: How involved is the care that is required?

2. Dynamics of the patient's status: How often is the patient's condition changing?
3. Complexity of the assessment: What is required to completely assess the patient's
condition?
4. Technology involved: Is the patient being monitored for complex or life threatening
problems? Or is complex technology involved?
5. Degree of supervision: What level of supervision is required by the nursing personnel
based on their skill and competence?
6. Availability of supervision: Is the appropriate nursing supervision available to provide
the degree of supervision determined in number 5?
7. Infection control and safety precautions: To what degree are universal precautions
enforced. Are staff competent to carry out emergency, infection control and safety
procedures?
2. Assign the task to the right person

3. The PN may assign tasks to the unlicensed assistive personnel or nursing assistants
4. Unlicensed assistive personnel (UAP) or nursing assistants cannot delegate to other
UAPs or nursing assistants
issuance of assignments, orders and instructions

doing phase
Aspects of Direction
 Technical aspects – procedures, equipment, flow sheets
 Interpersonal aspect – behavior, attitude
Four Responsibilities
1. Promotive
2. Preventive
3. Corrective Regulatory

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What cannot be delegated
Certain matters cannot be delegated such as the overall ARA. Final evaluation of the staff
performance and for correcting and disciplining staff, and such activities which the nurse to whom
the task is delegated does not know how or does not want to do because it is unpleasant. .
Delegated task must be based on policies, job description, and capabilities of workers.
WHY MANAGERS DO NOT WANT TO DELEGATE
1. Mistakes in delegation can be costly.

2. Failure to delegate Wisely increases management costs and contributes to personnel
dissatisfaction.
3. fear on the part of the director of her own ability to delegate.
4. Fear of losing control of the staff.
5. Fear of failing to get others to do the work.
6. Fear of criticism.
The manager who enjoys the personal satisfaction gained from doing the work herself were
will likewise not be inclined to delegate the work.
COMMON DELEGATION ERRORS
A. Under delegating
This stems from the manager's false assumption that delegation may be
interpreted as the lack of ability of his or her part to do the job correctly or completely.
The manager manifests his desire to do the job by himself. he has trust issues and
thus lacks the trust in his subordinates. He is insecure that he fears that subordinates
will resent the work delegated to them.
under delegating also occurs when the manager lacks experience in the job. Thus, there is
the excessive need to control and be perfect.
B. Over delegating
At the other extreme end is over delegation. It is unnecessary burden burdens

the subordinates with task that are either inconsequential or irrelevant to the delivery of
the goal. The culprit is usually poor management of time and insecurity on the part of
the nurse manager in her ability to perform the task.
C. Improper Delegating
A manager should be able to determine the talents and capacities of his

subordinates. Delegation of tasks and responsibilities beyond which the person cannot
perform properly is improper delegation.
2. SUPERVISION
This involves providing guidance and direction to the work in order to achieve a certain purpose.
In the Nursing Service, the main goal of supervision is to attain quality care for each patient and
to develop the potentials of workers for an effective and efficient performance.
A good understanding of administration, clinical competence, and democratic management are
essential in supervision. Instead of giving commands, the supervisor should persuade the worker.
Orders and commands should be given only in very rare cases.
Supervision ensures that the major goal in patient care is achieved. Today’s nursing supervision
is centered on clinical service rather than the traditional managerial service.

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Principles of Supervision:
1. Good supervision is focused on improving the staff’s work rather than upgrading
himself/herself.
2. Good supervision is based on predetermined individual needs. It requires self-study by staff
members as a starting point in their growth and development. In nursing, this means that the
staff, with the help of the senior nurse, would make an assessment of his/her own ability in
giving patient care and set goals based on his/her need for further development. Only when
both share in the assessment can they coordinate their efforts.
3. Good supervision is planned cooperatively. Objectives, methods of supervision, and criteria
for judging success in the attainment of goals are jointly established. The plan is based on the
needs of the individual staff member and varies as his/her needs change. Supervision
continuously adapts to the changing situation within the division.
4. Good supervision employs democratic methods. They adapt to the experience and ability of
the staff member and the existing situation. There is no single technique suitable for all
persons or for all circumstances. The method to achieve the desired outcome should be
selected.
5. Good supervision stimulates the staff to continuous self-improvement. Stimulation results
when the individual’s interests are aroused to lead him/her to respond with enthusiasm.
Supervision should be continuous, not periodic. It should assume that staff members are
competent and that they desire to be competent. Adequate approval, commendation, and
recognition for a job well done, encourages and challenges the individual to greater
endeavors.
6. Good supervision respects the individuality of the staff member. It accepts idiosynchrasies,
reluctance to cooperate, and antagonism as human characteristics, just as it accepts
cooperation to reasonable and energetic activities. The former are challenges, the later,
assets.
7. Good supervision helpd create a social, psychological, and physical atmosphere where the
individual is free to function at her own level.
Supervision encourages the staff member to contribute in the attainment of his/her objectives. By
aiding the staff in achieving success, his/her attitude toward supervision is improved.
Supervisory Techniques
1. Orientation
2. Efficient assignment, rotation and follow-up
3. Evaluation, guidance counseling, and promotion
4. Health service, recreation and safety
5. Staff and in-service education
3. STAFF DEVELOPMENT
Staff development is the process directed towards the personal & professional
growth of the nurses and other personnel while they are employed by a health care
agency.

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Staff development includes all training and education undertaken by an employer to
improve the occupational and personal knowledge, skills, and attitudes of employment. A
process consisting of orientation, in-service education and continuing education for the
people of promoting the development of personnel within any employment setting,
consistent with the goals and responsibilities of the employment.( ANA)
Needs for staff Development:
Social change and scientific advancement

Advancement in the field of science like medical science and technology.
to provide the opportunity for nurses to continually acquire and implement the
knowledge, skills, attitudes, ideals and valued essentials for the maintenance of high
quality of nursing care.
 As part of an individual's long-term career growth.
 To add or improve skills needed in the short term
 Being necessary to fill gap in the past performance
 To change or correct long-held attitudes of employee
 To move ahead or keep up with change.
 Fast changing technologies
 Need to increase the productivity and quality of the work.
 To motivate employees and to promote employee loyalty
 Fast growing organizations.
Goals:
1. Assist each employee (nurse) to improve performance in his/her position.
2. Assist each employee (nurse) to acquire personal and professional abilities that
maximize the possibility of career advancement.
Objectives
a. To increase employee productivity.
b. To ensure safe and effective patient care by nurses.
c. To ensure satisfactory job performance by personnel.
d. To orient the personnel to care objectives, job duties, personnel policies, and agency
regulations.
e. To help employees cope with new practice role.
f. Help employees cope with new practice role.
g. Help nurses to close the gap between present abilities and the scientific basis for nursing
practice that is broadening through research.
Function of Staff Development

a. Provide Educational activities for all nurses employed by the health care agency
directed towards change behavior related to role expectations.
b. It concerned with growth and development of personnel from their initial contact with a
healthcare agency until termination of service
Steps of staff development program

1. Assess the educational needs of all staff members
2. Set priority
3. Develop general objectives for the staff development program
4. Determine the resources needed to reach the desired objectives
5. Develop a master calendar for an entire year
6. Develop and maintain staff development record system

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7. Establish files on major educational topics
8. Regularly evaluate the staff development program
4. COORDINATION
The coordinating function of the Nursing Service serves to unite its units’ various functions with
other hospital departments and other community agencies. Coordination helps achieve the
purpose of the hospital when each department compliments the work of the other.
Communication is necessary in order to unite, facilitate and synthesize resources. Information
must be conveyed to, from, and among the personnel. Coordination is interwoven with the
following elements of administration:
1. Planning – since they are the ones working in hospital units, the nurses are involved in
planning for the hospital layouts. This includes budget, supplies and equipment.
2. Organizing – delegation, accountability and evaluation are necessary in the
synchronization of the nursing personnel’s output where each personnel participates and
articulates part of the whole.
3. Staffing – coordination in staffing does not only refer to the number of persons placed in
different positions but also in bringing about harmony between and among disciplines
where concerted efforts can best be maximized.
4. Directing – inherent in the supervisory process is the need to direct and supervise
persons charged with this responsibility to ensure all work is in pursuit of a common goal.
5. Controlling – numerous controlling devices in the Nursing Service come in the form of
rounds, policies and standards, nursing orders, written reports, manual, records, nursing
care plans and performance evaluation.
Pointers for Effective Coordination

1. Responsibilities should be clearly defined and understood by all.
2. Policies, guidelines, and SOPs on inter-departmental relationships should be established
and made available to all.
3. Channels of communications should be followed.
5. COLLABORATION
The manager and the health care staff together with the other members of the healthcare
team all participate in the decision making process. Sometimes they join forces with another as
the medical group or larger groups, like another health care team or one fulfilling a different role
for this purpose.
6. COMMUNICATION
– Cyclic process whereby a message is passed from sender to receiver

– This is the thread that binds an organization together by ensuring a common
understanding.
Official channels of the different services and between the Chief of Hospital and heads of
the different services and between individuals with the services. Organizational charts are the
basis of formal hospital communication.
Downward Communication. Flow of communication comes from higher to lower authority. In

the Nursing Service, the Chief Nurse and his/her assistant communicate with all supervising
nurses. In their absence, the person next in rank takes their place. Written communications from
the Chief Nurse to the nursing personnel are usually concerned with general hospital policies,
directives, and activities. These are coursed across the line through the supervising nurse and
the senior nurses for interpretation, when necessary.
Upward Communication. It is a two-way flow of information because it is a communication circuit

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wherein the receiver takes the message of the sender. The receiver responds back to the sender.
When a supervisor receives a communication from the Chief Nurse, he/she also gives back
written reports of information within his/her unit as to how this communication was acted upon.
The supervisor’s close association with his/her employees, allows him/her to communicate back
both in action and in words, their perception or interpretation about the communication or any
difficulty they may have encountered in implementing the communication.
If the subordinate has very little experience in communicating with supervisors, then, the head
nurse or supervisor should give the necessary guidance and encouragement.
Horizontal Communication. This is best illustrated in conferences or discussions between the
different members of the health team.
Communication is concerned with the exchange of ideas, information, and feelings. Such
exchange usually takes place during rounds and conferences. Nursing personnel need to
experience this interchange of ideas for closer understanding.
Communication also includes the discussion of the total care of patients. This is best illustrated
during conferences with other members of the health team during on-the-job training.
Types of Communication
1. Verbal Communication. This is the most effective means of communication. It provides
a means whereby the nursing personnel are best informed of plans, development,
changes, and problems within the hospital and the nursing service.
a. Patient Contact – through regular and frequent patient visits, nurses can explain to
the patients the hospital’s different services and nursing care plans for him;
b. Individual conferences – regular conferences to discuss plans, problems and
evaluation of personnel performances;
c. Group conferences – nursing committee develops nursing procedure manuals and
plans for in-service education, programs; and
d. Staff meetings – administrative matters are interpreted more effectively when
explained and discussed in group meetings.
2. Written Communication. Written communication provides a reference from which nurses
get instructions or guidance. It serves as a record of standards of practice. Written
communication should be easy to understand. Written communication comes in the
following form:
a. Memoranda or Memos – are information exchanges between individuals or groups
(i.e., Chief Nurse sends memo to supervising nurses and senior nurses to keep
nursing personnel informed of nursing activities);
b. Directives – are administrative orders, which initiate action or give instructions
during an emergency situation. Directives are used to control policy of operation
and to coordinate hospital services (example: the Chief Nurse issues out a
directive concerning standards of nursing care);
c. Manual of Operation – are written procedures and techniques of each department
which are kept on file for ready reference (example: nursing procedure manuals
which are kept at the nurses’ station for ready reference); and
d. Records and Reports – are systematized reporting and recording documents
(example: patient’s record and personnel records).

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7. EVALUATION
A desired result of any employee behavior is effective job performance. An important role
of the manager is to determine performance in advance and state desired outcome of what has
been done.
The purpose of evaluation is to determine how far or how many of the organization's
objectives were accomplished.
Purposes of Evaluation
The purposes of evaluation are to:
a. Provide constructive feedback;

b. Determine progress and worthiness of individual nurse for greater responsibilities; and
c. Serve as basis for promotion and increase in salary or other similar rewards.
Evaluation is also meant to:
a. Recognize and further develop strengths;

b. Minimize weaknesses;
c. Provide security for patients, personnel, agency and community; and the
d. Develop a fair employment practice and performance appraisal process that is in
accordance with the law.
Different Types of Evaluation
There are several kinds of evaluation in nursing care situations: a. outcome or product
evaluation; b. process evaluation; and c. structure evaluation,
a. Outcome or product evaluation which takes note of the response of patients after
nursing care is done.
b. Process evaluation, nursing actions are examined, to determine if client goals
have been met or have not been met.
c. Structure evaluation, the goal is to obtain feedback on the systems such as
financial and material resources, nursing personnel, policies and procedures.
Legally Sound Performance Evaluation
It has often happened that employees have sued their organizations over employment
decisions based on questionable performance appraisal results. Although it is nearly impossible
to be certain that an appraisal system is legally defensible, there are several steps to assure
that an appraisal system is non-discriminatory.
a. It should be in writing and carried out at least once a year
b. The information should be shared with the employee.
c. The employee should have the opportunity to respond in writing to the appraisal,
and in this connection a mechanism to appeal or question the results of the
appraisal must be allowed
d. The manager should have adequate opportunity to either directly observe the
employee's job performance during the course of the evaluation period or, in the
event of lack of adequate contact, the manager must be able to gather information
from other sources.
e. Anecdotal notes on the performance should be kept throughout the evaluation
period. These notes should be shared with the employee during the course of the
appraisal period.

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f. The evaluator should be trained to carry process, including: out the appraisal
what constitutes reasonable job performance
how to complete the form, and
how to carry out the feedback interview
As much as possible, the appraisal should focus on employee behavior and results
rather than on personal traits or characteristics such as initiative, attitude and personality
PERFORMANCE APPRAISAL/EVALUATION
 is a formal, structured system that compares employee performance to established

standards.
 the regular review and evaluation of personnel performance
 Formal: process of regular and methodical collection of objective data through setting
standards and objectives, reviewing progress, providing on-going feedback; planning for
reinforcement, deletion or correction of identified behaviors as necessary
 Informal: incidental observation and/or recording of work performance
Tools
 Trait rating scales – most widely used

 Job Dimension Scales – based on job description
 Behaviorally Anchored Rating Scales (BARS)- combine elements from critical incident
and graphic rating scale approaches. The supervisor rates employees according to items
on a numerical scale.
 Checklists
 Essays – free form review
 Self-appraisal – written summaries or portfolios of work-related accomplishments and
productivity
 Critical Incidents - The supervisor's attention is focused on specific or critical behaviors
that separate effective from ineffective performance.
 Graphic Rating Scale. This method lists a set of performance factors such as job
knowledge, work quality, cooperation that the supervisor uses to rate employee
performance using an incremental scale.
 Management by Objectives - evaluates how well an employee has accomplished
objectives determined to be critical in job performance. This method aligns objectives
with quantitative performance measures such as sales, profits, zero-defect units
produced.
 Peer review – carried out by peers rather than managers
Pitfalls in Evaluation
1. Horns effect
2. Halo effect - is a rating error that occurs when the rater's knowledge of an employee's
performance on one favorable or unfavorable incident colors the ratings on all others
3. Logical error
4. Central tendency
5. Leniency

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CHANGE PROCESS
Change means substituting one thing for another, experiencing a shift in circumstances
that causes differences or becoming different from before. Organizations can properly be viewed
from this angle, as being in a continuous process of change e.g. changing methods and systems
to improve the accomplishment of objectives, changing objectives, and retrenchment to adjust
depleted resources to meet market competitions and the of environmental factors in the health
care delivery.
FACTORS THAT INFLUENCE CHANGE
There are several forces, both external and internal, , that influence change. External
forces are events or happenings that influence the organization as a whole or its top
administration. Examples of this are population explosion, legislation, or economic forces.
Internal forces originate primarily from inside operations or are the results of external changes,
such as the composition of staffing pattern, and quality of life.
Below are steps in the change process that should be followed in changing the
organization.
STEPS IN THE CHANGE PROCESS
1. The change process begins or is initiated when one perceives a need for change.
2. This person then initiates group interaction, which is to identify external and internal
forces for change.
3. During this interaction, the beneficial activities
a. To state the problem;
b. Identify constraints;
c. List change strategies or possible approaches problem-solving
d. To select the best change strategy; and finally
e. Formulate as a group a plan for implementation develop or select tools for
evaluation.
Wholesale change of a system is never a good idea. It is important to implement any

radical change one step at a time.
After the implementation of the change it is important to then evaluate the overall results
of the change and make such adjustments as may be necessary.
STRATEGIES FOR MANAGING CHANGE

1. Empirical-Rational
Empirical-rational strategies for change management are based on the

assumption that people are rational and behave according to rational self-interest.
They assume that people are willing to adopt to change if justified and determined how
he can benefit change process. The power ingredient of this strategy is knowledge.
2. Normative Re-educative
Normative-re-educative strategies are based on the assumption that people are

consistent to their commitment to socio-cultural norms and values. For example: a
group may foster development of staff through personnel counseling, training groups,
small groups and experiential learning because a person needs to participate in her
own re-education process.
3. Power-Coercive
Power-coercive strategies involve the compliance of the less powerful with the
leadership, plans, and direction of the more powerful. These strategies use sources of
power to bring change, such as strikes, sit-ins, negotiations, conflict Confrontation, and
administration decisions and rulings. The application of power is done either by
legitimate authority, economic sanction or political clout.

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RESISTANCE TO CHANGE
Resistance to change is expected for a number of reasons, such as lack of

trust, vested interest in the status quo, fear of failure, loss of status or income,
misunderstanding and belief that the change is not necessary. The manager may then
take to handle this resistance, such as the following: steps
1. Communicate with those who oppose the change and understand the reasons for
opposition.
2. Clarify information and provide feedback. accurate
3. Be open to revisions but firm and clear about what must remain.
4. Present negative consequences of resistance.
5. Emphasize positive consequences of change and how individual will benefit (but
avoid trying too hard to convince the people with rational arguments as resistance
is often based on feelings that are not rational).
6. Keep those resisting change in face-to-face contact with supporters, encourage
proponents to empathize with their opponents, recognize valid objections and
relieve unnecessary fears.
7. Maintain a climate of trust, support and confidence
8. Create a different disturbance to distract the attention of those involved.
Making change is not easy but it is a necessary skill Go managers to create

change in her subordinates and in her place of work. Successful change agents
demonstrate certain characteristics than can be cultivated and mastered, including:
1. The ability to combine ideas from unconnected sources.
2. The ability to energize others by keeping the interest level up and demonstrating
a high personal energy level.
3. Skill in human relations can be attained with:
 Well-developed interpersonal communication
 Group management and problem-solving skill
 Skills in integrative thinking
 The ability to retain a picture focus while dealing with each part of the
system considered all factors in problem solving and decision making.
4. Sufficient flexibility to modify ideas to improve the change process, but firm
enough to resolve or resist nonproductive tampering with the planned change.
5. Enhance confidence level and the tendency to be easily discouraged.
6. Realistic or not pragmatic thinking in order to learn how to cope and adapt to
change.
7. Trustworthiness, a track record of integrity and success with other changes.
8. The ability to articulate a vision through insights and versatile thinking.
9. The ability to handle resistance through influence and support of the concerned
individuals and the factors affecting change.

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CONFLICT MANAGEMENT
MANAGING CONFLICT
Conflict
Definition according to Merriam Webster:
 strong disagreement between people, groups, etc., that results in often angry argument
 a difference that prevents agreement : disagreement between ideas, feelings, etc.
 Conflict occurs when two or more values, perspectives and opinions are contradictory in
nature and have not been aligned or agreed upon. It occurs naturally in and among groups
and individuals. It is an inevitable condition that is essential for change.
Conflict Process
Stage 1: Potential Opposition or Incompatibility

The first step in the conflict process is the presence of conditions that create opportunities for
conflict to develop. These cause or create opportunities for organizational conflict to rise.
These three conditions causes conflict:
A. Communication
 Different words connotations, jargon insufficient exchange of information and noise in
communication channel are all antecedent conditions to conflict.
 Too much communication as well as too little communication can lay the foundation for
conflict.
B. Structure
 Include variables such as size, degree of specialization in the tasks assigned to group
members, jurisdictional clarity, members/ goal compatibility, leadership styles, reward
systems and the degree of dependence between groups.
 The size and specialization act as forces to stimulate conflict.
 The larger the group and the more specialized its activities, the greater the likelihood of
conflict.
 The potential for conflicts tends to be greatest when group members are younger and when
turnover is high.
C. Personal Variables
 Certain personality types- for example individuals who are highly authoritarian and
dogmatic- lead to potential conflict.
 Difference in value systems Value differences are the best explanations of diverse
issues such as prejudice disagreements over one’s contribution to the group and rewards
one deserves.

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Stage 2: Cognition and Personalization
 Conflict must be perceived by the parties to it whether or not conflict exists is a perception
issue.
 If no one is aware of a conflict, then it is generally agreed that no conflict exists. Because
conflict is perceives does not mean that is personalized.
Example:
A may be aware that B and A are in serious disagreements but it may not make A tense or
nations and it may have no effect whatsoever on A’s affection towards B” It is the felt level , when
individuals become emotionally involved that parties experience anxiety , tension or hostility.
Stage2 is the place in the process where the parties decide what the conflict is about and
emotions plays a major role in shaping perception.
Perceived Conflict
 This is the stage at which members become aware of a problem.
 Incompatibility of needs is perceived and tension begins as the parties begin to worry about
what will happen.
 Sometimes conflict may be perceived when latent conditions are not in existence in the
system. Such a situation arises when one party perceives the other to be likely to thwart
or frustrate his/her goal.
Felt Conflict
 “Emotional involvement in a conflict creating anxiety tenseness, frustration and hostility is
known as felt conflict.”
 It is that stage when the conflict is not only perceived but actually felt and cognized.
 Parties to the conflict feel that they have some conflict among themselves.
 Parties become emotionally involved and begin to focus on differences of opinion and
opposing interest – sharpening perceived conflict.
 Internal tensions and frustration begin to crystallized around specific, define issues and
people begin to build and emotional commitment to their position.
Stage III: Intentions
 Intentions intervene among people’s perceptions and emotions and overt behaviors.
 These intentions are decisions to act in a given way.
 Intentions are separated out as a distinct stage because you have to infer the other’s intent
to know how to respond to that other’s behavior.
 A lot of conflicts are escalated merely by one party attributing the wrong intentions to the
other party.
Stage IV: Behavior
 This stage is where conflicts become visible.
 The behavior stage includes the statements, actions, and reactions made by the conflicting
parties.
 These conflict behaviors are usually overt attempts to implement each party’s intentions,
but they have a stimulus quality that is separate from intentions.
 As a result of miscalculations or unskilled enactments, overt behaviors sometimes deviate
from original intentions.
 This stage is a dynamic process of interaction.
o Ex: you make a demand on me; I respond by arguing; you threaten me; I threaten
you back; and so on
 Conflict intensities escalate as they move upward along the continuum until they become
highly destructive.
o Ex: Strikes, riots, and wars

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Stage V: Outcomes
 The action–reaction interplay among the conflicting parties results in consequences.
 May be:
o Functional  in that the conflict results in an improvement in the group’s
performance
o Dysfunctional in that it hinders group performance.
Conflict is constructive when it:
■ improves the quality of decisions,
■ stimulates creativity and innovation,
■ encourages interest and curiosity among group members,
■ provides the medium through which problems can be aired and tensions released, and
■ fosters an environment of self-evaluation and change.
Types of Conflict
o Intrapersonal: this happens when individuals do not live according to their own
values;
o Interpersonal: this happen between individuals;
o Intragroup: this happens among members of a specific group;
o Intergroup: this happens between two or more groups
1. Intrapersonal  occurs within an individual.
Example:
When an employee needs a degree to advance his/her career yet has neither resources nor the
time to go to school.
A frequently occurring intrapersonal conflict for healthcare providers is deciding how to allocate
time with patients. This requires prioritizing and using time effectively to meet the needs of all
patients. It also requires the ability to delegate effectively. This employee has an internal fight
between what the heart wants to do and what the brain says to do.
2. Interpersonal  is seen when two or more people do not agree on issues or the best way
to manage a specific problem.
Examples of interpersonal conflicts that might occur are:
o A staff member wants to take care of patients on a specific team. Staff might not
like their assignments and interpersonal conflicts might occur;
o Assignments may be heavier for the person who has been floated. This individual
might confront the person making the assignment, causing more conflicts;
o A patient becomes non-compliant with her treatment and resists the physician's
orders;
o Some staff members want to work twelve hour shifts and single parents or staff with
young children want eight hour shifts;
o Pre-scheduling to be off on holidays has created anger between employees who
have seniority and those who made their request months in advance;
o A nurse and a doctor disagree on giving specific medications to a patient with end-
stage liver disease.
3. Intragroup  Intragroup conflict occurs between individuals within a specific group.
o Intragroup conflicts are most common in workplaces that divide employees into specific
teams or departments.
o These conflicts arise from objective differences of interest, and are aggravated by
antagonistic or controlling behaviors and attitudes.
o Individuals may strive for power, position, economic incentives, value differences, or
differences in gratification of personal needs.
o Often there is a mixture of all of these and these incompatibilities may develop into
intragroup conflicts.
Some signs of intragroup conflict are:
o Talking about another team member behind her/his back in a negative manner
o A team member saying they are too busy to help another member
o A team member ignoring another member when asked a question

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o Failing to provide safe quality care
o Not completing work on-time
o Passive/aggressive behavior
o Complaining
o Finger pointing
o Not returning phone calls
o Not attending required meetings
o Verbal abuse
*Each behavior, by itself, does not necessarily indicate conflict. People don't always complete
work on time or answer all phone calls. Sometime they miss meetings. These individual behaviors
might be acceptable. A conflict is present when a behavior is taken to an extreme and causes
severe or irreparable damage. This is when the conflict has to be dealt with before a negative
outcome affects others and affects the quality of patient care.
4. Intergroup  Intergroup conflict is defined as an incompatibility of goals, beliefs, attitudes or
behaviors between groups.
o Intergroup conflict occurs between two competing or distinct groups.
o Intergroup relations between two or more groups and their respective members are often
necessary to complete the work required to operate a business.
o Many times, groups inter-relate to accomplish the organization's goals and objectives. If
these goals or objectives are not mutually compatible conflict can occur.
Example:
Members of the hospital marketing group debating with the fiscal department about the best way
to launch a new service. If the marketing group felt that advertising the new service on the internet
was best but the fiscal department felt strongly that newspapers ads were best, this would be
intergroup conflict. Some examples of intergroup conflict are listed below.
Other Examples:
o Nurse Managers perceive that certain policy and procedures are not up to date and
do not meet the needs that change has incurred, and administration is not
concerned
o Emergency room nurses feel that the lab is not working with them in providing lab
results in a timely manner
o The shared governance group perceives that the organization is more concerned
about the fiscal bottom line than providing the needed equipment to help prevent
falls
o The nursing team on a dementia unit perceive that Nurse Managers are not
supportive of their actions when dealing with patients who are non-compliant,
possibly confused, and disrespectful
*Groups have identities.

A group's sense of its particular identity will influence how it interacts with other groups.
*Goal of group:
To focus on the tasks that needs to be accomplished. Intergroup conflict causes changes to
happen, both within the groups in conflict and between them.
*Communication  is the key between groups who depend on each other. Conflict is a
common occurrence between groups, and lack of effective communication will prevent or
delay effective resolutions.
Characteristics of Conflict Situation
1. Conflicts do not just appear. Conflicts evolve.
2. Conflict is like a virus when it appears it begins to spread like crazy.
3. Conflicts are bred by differing values.
4. Conflict is energized through opposing interests.
5. Conflict is fueled by poor communications.
6. Conflict intensifies when trust breaks down.
7. Conflict is festered by incompatible goals.
8. Conflicts are encouraged by differing personalities.

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*Understanding these characteristics of conflict can help any team leader in helping to establish
a strong team. If conflict can be seen for its positive results it will aid any leader and his or her
team. Conflict can be energizing for a group when it forces people out of their comfort zones.
Conflict can introduce diversity. Diversity can be seen as a wealth of information if handled in a
healthy fashion
Management of Conflict
Nurse Managers, department heads, Charge Nurses, and Team Leaders have to develop
managerial actions and structures to minimize conflicts, and they must handle conflicts in a
constructive manner and with a positive attitude, using effective communication and listening
skills.
3 basic strategies for managing conflict (Sullivan & Decker, 2005):
o Win-lose
o Lose-lose
o Win-win
WIN-LOSE
o Win-lose scenarios often times involve groups and intragroup conflicts.
o When the group votes on an issue and majority rules there is a winner and a loser.
o This can erode the cohesiveness of a group and may diminish the group leader's authority.
o Another scenario could involve a nurse who has 30 years of seniority and wants a specific
holiday off and another new employee also requested the same holiday off. The senior
nurse refuses to give in and wants to win this argument.
LOSE-LOSE
o Lose-lose scenarios involve losses to both parties.
o This is often is the case when a union arbitrator in union contract negotiations gives
something to both parties and yet neither party gets what it wants.
WIN-WIN
o Win-win scenarios involve collaboration: all groups or parties work together to meet the
goals and objectives of all involved.
o Group consensus is reached after careful investigation of the situation, specified needs of
the group are understood by all, and a workable solution is reached.
o In this type of win-win scenario there is no voting or other traditional dispute measurement:
only the true group consensus counts.
o Everyone involved usually feels good about the outcome.
o This is seen when Nurse Managers and Nursing Supervisor work together to staff a unit
that is constantly needing help to cover their close observation or 1:1 patients while
meeting their own unit needs.
Reactions to Conflict
1. Avoidance
 People who use this technique withdraw and detach themselves from the issue.
 They do not want to assert their own perspectives nor do they want to help others resolve
the situation.
 They just want to “mind their own business.”
 People will often use avoidance if they do not have a vested interest in the situation. They
may say they are choosing to “pick their battles.”
2. Accommodating
 When a person uses this technique, they may do so in order to avoid conflict, or to help
the other person get what they want.
 A person who uses this style often gives in to others to avoid disagreements, and they may
give in to others to the extent that they compromise themselves.

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3. Competing
 When someone competes, their only interest is to resolve the conflict their way, rather than
clarifying or addressing the issue.
 They have no interest in the well-being or satisfaction of others, they just want to be “right.”
4. Compromising
 Compromising is a mutual give-and-take.
 It is often used when both parties are willing to concede and make concessions.
 It is a good strategy for when the parties want to resolve the issue quickly.
5. Collaborating
 Collaborating is when the parties work together with the goal of resolving the conflict to
everyone’s complete satisfaction.
 The parties approach the situation with a solution-oriented, “team” approach.
 This approach also results in “buy in” and a higher level of commitment.
QUALITY IMPROVEMENT /QUALITY MANAGEMENT
1. Performance Improvement/Quality Assurance

The level of nursing care provided and its effects on clients are assessed by using the nursing
process to examine client outcomes
A. Methods of assessment include audits of open and closed records, peer review,
questionnaires filled out by clients' families, and direct observation by the nurse
B. Sources of nursing care standards include state nurse practice acts and other rules and
regulations that legally define nursing
C. Nurses regularly complete performance improvement/quality assurance procedures:
 they identify standards, goals, and methods of performing quality assurance activities
 they measure actual performance
 they compare results of measured performance with standards and goals

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 they take action to correct weaknesses and reinforce strengths
Quality definition: the degree to which client care services increase the probability of desired
outcomes and reduce the probability of undesired outcomes given the current state of
knowledge
Quality Assurance
the process of establishing a target degree of excellence for nursing intervention and taking
action to ensure that each patient receives the agreed-upon level of care
Performance improvement/assurance definition: the process of attaining a new level of

performance or quality that is superior to any previous one
Total quality management definition: a management philosophy that emphasizes a commitment

to excellence throughout the organization
Six characteristics of total quality management
1. Customer/client focus
2. Focus on outcomes
3. Total organizational involvement
4. Multidisciplinary approach
5. Use of quality tools and statistics for measurement
6. Identification of key areas for improvement
Mandated by the Joint Commission on Accreditation of Health Care Organizations (JCAHO)
Nursing Audit
method for assuring documentation of the quality of nursing care in
keeping with the standards of the agency, the nursing department and
the professional, governmental and accrediting groups
Forms:
 Centralized Model
Responsibility is assumed ad confined only to one authority level
Advantages:
highly cost-effective
make management easier
Disadvantages
as the organization becomes bigger and complex, the hierarchical
arrangement becomes cumbersome
the attention of the manager becomes diluted due tp his many
responsibilities
the arrangement does not readily adapt to change
obtaining quick decisions or actions is not easy
 Decentralized or Participatory Approach

a behavioral system whereby the large structure are broken down to
small units and authority is delegated to those closer to the majority of
workers
Advantages:
reflects the interest of the workers and have a voice in decision-making
improves quality of care
promotes IPR

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increase communication departmentally and interdependently
allows problems to be solved with greater imagination and creativity
Disadvantages
not cost-effective
communication breakdown
problem with role classification
Matrix System
benefits of both centralized and decentralized controls are use
hierarchical, horizontal coordination

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INFORMATION SHEET 5
CONTROLLING
The head or president of any organization is responsible for its overall direction. Since
she/he/he cannot perform all these functions, she/he/he has to delegate to her/his subordinates
the responsibility and authority to perform certain tasks for which she/he/he is still responsible.
Thus, she/he/he must use some systems of control to enable her/his to appraise the
performance of each and every one of her/his/his subordinates. Unsatisfactory performance may
be corrected before it causes serious damage. A good control system encourages each employee
to exercise self-control. Self-control would be possible when standards or criteria for performance
exist to the point her/an employee knows the specific level of performance expected of her/his.
IV. CONTROLLING
This is fully the use of formal authority to assure the attainment of the purpose of action
possible. It leads nursing administrators to view the delivery of nursing care as the institutional
control of process that brings sick patients back to good health. It leads them to scrutinize the
nature of the devices used to control their service.
Some people react strongly against the phrase “management control”. The word itself can
have a negative connotation, e.g., it can sound dominating, coercive and heavy handed. It is now
preferred to use the term “coordinating” rather than “controlling”. But for all intents and purposes,
coordinating is controlling.
The control or coordinating function of management can be critically determinant of
organizational success.
FUNCTIONS OF CONTROL
Promotes effective use of resources.
Provides professional reinforcements.
Maintain activities and expectations.
PRINCIPLES OF CONTROL
There must be;
1. A critical few, meaning that fewer people involved in control brings out the best results.
2. A defined Point of Control or a centralization or decentralization of authority.
3. Self or Discipline, which translates to personal acceptance of responsibility and
accountability.
KINDS OF FORMAL CONTROL

The type of formal control that a manager can use maybe be grouped into:
1. Pre-action Control
This is controlling by means of personal supervision and utilizing control checks
consisting of procedures for any given task or function.
2. Post action Control
This is controlling as the task or function is being performed or may have been
performed and correcting deviations from standards or plans.
TYPES OF CONTROL
Controls are most effective when they are applied at key places. Supervisors can
implement controls before the process begins ( feedforward), during the process (concurrent),
or after it ceases (feedback).

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1. Feedforward Controls
Feedforward controls focus on operations before they begin. Their goal is to
prevent anticipated problems. An example of feedforward control is preparing all supplies
and equipment for a wound care dressing, or bedside lumbar tap, intravenous insertion,
among others, in order to determine what is lacking and other things to be done. Regular
maintenance feeds forward to prevent problems. Other examples include safety systems,
training programs and budgets.
2. Concurrent Controls
Concurrent controls apply to processes as they are happening. Concurrent
controls enacted while work is being performed include any type of material or supplies
for therapeutic care which requires direct supervision or the use of automated systems
such as computers programmed to inform the user when they have issued the wrong
command, and organizational quality programs and resources.
3. Feedback Controls
Feedback controls focus on the results of operations. They guide future planning,
inputs, and process designs. Examples of feedback controls include timely (weekly,
monthly, quarterly, annual) reports so that almost instantaneous adjustments can be
made.
CHARACTERISTIC OF EFFECTIVE CONTROL
1. Control systems must be designed appropriately to be effective.
2. When control standards are inflexible or unrealistic, employees cannot focus on the
organization's goals.
3. Control systems must prevent, not cause, the problems they were designed to detect.
Performance variance can also be the result of unrealistic standard. The natural response of
employees whose performance falls short is to blame the standard or the supervisor. If the
standard is appropriate, then it is up to the supervisor to stand his or her ground and take the
necessary corrective action.
DESIGNING EFFECTIVE CONTROL SYSTEMS
Anything that can be planned can be controlled. Controls should primarily serve the need
for which they are intended. Here are the guidelines for designing effective control systems.
1. Control at all levels in the health care delivery system. All nursing units must have a
standard control system.
2. Acceptability of those who will enforce decisions. The nurse manager's manner of
influence to her staff to comply with the policies or procedures.
3. Flexibility of the enforcers and the implementors to enforce decisions based on practical
situations.
4. Accuracy. Steps or mechanisms of control must be clear and vivid with significant
implications.
5. Timeliness. Activities are planned with time target set.
6. Cost effectiveness. Resources used are well maintained and enough or adequate to
meet the needs of the unit.
7. Understandability. Policies and procedures are simple, easy to understand and can be
implemented with less difficulty.
8. Balance between objectivity and subjectivity. Theory and practice-based system.
9. Coordinated with planning, organizing and leading.

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THE CONTROL PROCESS
STEPS IN CONTROL PROCESS
Assuming that both plans or standards and organization structure are clearly known and that the personnel
to perform the task, work, or job know the extent of their authority and responsibility, the control technique and
system that may be used to evaluate performance would be essentially the same throughout the organization.
The control process is a continuous flow between measuring, comparing and action. There are four steps
in the control process: establishing performance objectives and standards, measuring actual performance,
comparing measured performance against established objectives and standards, and taking necessary corrective
action.
1. Establish and Specify Criteria and Performance Standards These serve as the criteria against which performance
is measured and give an idea of the level of performance that managers can expect of a person. This consists
of the following:
a. Standards
Standards are created when objectives are set during the planning process. A standard is
any guideline established as the basis for measurement. It is a precise, explicit statement of
expected results from a product, service, machine, individual, or organizational unit. It is usually
expressed numerically and is set for quality, quantity and time. Tolerance is permissible deviation
from the standard.
b. Resource controls
Time controls relate to deadlines and time constraints.
Material controls relate to inventory and material yield controls. Cost controls help ensure
cost standards are met.
Equipment controls are built into the machinery, imposed on the operator to protect the
equipment or the process.
Employee performance controls focus on actions and behaviors of individuals and
groups of employees. Examples include absences, tardiness, accidents, quality and
quantity of work. Budgets control cost or expense related standards. They identify the
quantity of materials used and units to be produced
c. Financial Controls
Financial controls facilitate achieving the organization's profit motive. One method of
financial controls is budgeting, Budgets allocate resources to important activities and provide
supervisors with quantitative standards against which to compare resource consumption.
They become control tools by pointing out deviations between the standard and actual
consumption.
d. Operations Control
Operations control methods assess how efficiently and effectively an organization's

transformation processes create goods and services. Methods of transformation controls
include Total Quality Management (TQM) statistical process control and the inventory
management control.
e. Statistical Process
Control Statistical process control is the use of statistical or mathematical methods and
procedures to determine whether production operations are being performed correctly, to
detect any deviations, and to find and eliminate their causes. A control chart displays the
results of measurements over time and provides a visual means of determining whether a
specific process is staying within defined limits.

P a g e | 160
f. The Just-in-Time (JIT) System
The Just-in-Time System is the timely application of medication for the illness of a
patient, and purchased materials just in time to be transformed into parts. Communication,
coordination, and cooperation are required from supervisors and employees to deliver the
smallest possible quantities at the latest possible date at all stages of the transformation
process in order to minimize inventory costs.
2. Monitor and Measure Performance of Nursing Care Services and Evaluate it against
the Standards through Records, Reports and Observations
There are different techniques for monitoring and measuring service.
a. Nursing Rounds pay particular attention to issues of patient care and nursing
practice. This will also satisfy needs and problems met or unmet.
b. Quality Assurance monitors compliance with established standards.
c. Nursing Audit consists of documentation of the quality of nursing care in relation to
the standards established by the nursing department.
A Nursing Audit, in particular, serves many purposes.
It prioritizes nursing care by promoting optimum nursing care.
It can identify deficiencies in the organization and administration of nursing

care, and may be used to correct such deficiencies through education and
administrative change.
It may also be used to increase performance to assure that improvements have

been maintained.
Supervisors collect data to measure actual performance to determine variation from

standard.
Written data might include time cards, production tallies, inspection reports, and
sales tickets.
Personal observation, statistical reports, oral reports and written reports can be
used to measure performance.
Management by walking around, or observation of employees working, provides

unfiltered information, extensive coverage, and the ability to read between the
lines.
While providing insight, this method might be misinterpreted by employees as

mistrust. Oral reports allow for fast and extensive feedback.
Computers give supervisors direct access to real time, unaltered data, and information.
On-line systems enable supervisors to identify problems as they occur. Database programs allow
supervisors to query, spend less time gathering facts, and be less dependent on other people.
Supervisors have access to information at their fingertips. Employees can supply progress reports
through the use of networks and electronic mail.
Statistical reports are easy to visualize and effective at demonstrating relationships.
Written reports provide comprehensive feedback that can be easily filed and referenced.
Computers are important tools for measuring performance. In fact, many operating processes
depend on automatic or computer-driven control systems. Impersonal measurements can count,
time, and record employee performance.

P a g e | 161
3. Compare Performance with Standards, Models, or Criteria to Determine Deviations or
Differences
Evaluation of the performance is necessary to ensure that tasks are being carried out as
planned. Here the actual accomplishment is matched with the acceptance standard to check
if there are delays or deviations from the standard.
Comparing results with standards determines variation. Some variation can be expected
in all activities and the range of variation the acceptable variance - has to be established.
Management by exception let operations continue as long as they fall within the prescribed
control limits. Deviations or differences that exceed this range would alert the supervisor to a
problem,
There are ways or techniques for such corrections and improvements of performance
based on feedback.
a. The Program Evaluation and Review Technique (PERT) employs a matrix that uses
network of activities represented in a chart, including the goals or product desired,
time management, budget and estimation of critical paths.
b. Benchmarking, seeks out the best so as to improve its performance. It provides a
standard or point of reference in measuring or judging such factors as quality,
values and cost.
4. Enact Remedial Measures or Steps to Correct deviations or Errors
a. Correction of deviations or errors. In the performance of any given function or task,

corrections may be made by modifying the plan either by changing the number of
personnel, or by better selection and training of subordinates, or by changing the other
factors of production or by adding more materials or resources to minimize or eliminate
errors or any deviations.
b. A Master Control Plan may be used by Managers depicting its functions, goals and
objectives to be accomplished and its specific activities to ensure quality of
performance and products.
c. Take necessary action. The supervisor must find the cause of deviation from standard.
Then, he or she takes action to remove or minimize the cause. If the source of variation
in work performance is from a deficit in activity, then a supervisor can take immediate
corrective action and get performance back on track.
Also, the supervisors can opt to take basic corrective action, which would determine
how and why performance has deviated and correct the source of the deviation.
Immediate corrective action is more efficient, however basic corrective action is the
more effective.
An example of the control process is a thermostat.
Standard: The room thermostat is set at 68 degrees Fahrenheit,

Measurement: The temperature is measured.
Corrective Action: If the room is too cold, the heat comes on. If the room is too hot,
the heat goes off.
Effective control involves keeping the process continuous for all areas. This includes
management of the nursing division and each sub-unit, performance of personnel and
the final Product: the Nursing Process.
he process that guarantees plans are being implemented properly is the controlling
process. Controlling is the final link in the functional chain of management activities
and brings the functions of management cycle into full circle. This allows for the

P a g e | 162
performance standard within the group to be set and communicated.
Control allows for ease of delegating tasks to team members and as managers may
be held accountable for the performance of subordinates, they may be wise to extend
timely feedback of employee accomplishments.
CHARACTERISTICS OF CONTROL PROCESS

1. The control process is cyclical which means it is never finished.
Controlling leads to identification of new problems that in turn need to be addressed
through establishment of performance standards, measuring performance etc.
2. Controlling often leads to management expecting employee behavior to change.

Employees often view controlling negatively, no matter how positive the changes may be
for the organization.
3. Control is both anticipatory and retrospective.

The process anticipates problems and takes preventive action. With corrective action, the
process also follows up on problems.
4. Ideally, each person in the health care delivery views control as his or her responsibility.
The organizational culture should prevent a person walking away from a small, easily
solvable problem because "that isn't my responsibility." In a service driven profession, each
employee cares about each client.
5. Controlling builds on planning, organizing and leading.

Controlling is related to each of the other functions of management.
MANAGEMENT CONTROL STRATEGIES

Managers can use one or a combination of four (4) control strategies or styles:
1. Market control, which first relies primarily on budgets and rules.
2. Bureaucratic control
3. Clan control, and
4. Self-control
Each serves a different purpose. Market control is made up of external forces. Without
external forces to bring about needed control, managers can turn to internal bureaucratic or clan
control. One relies on employees wanting to satisfy their social needs through feeling a valued
part of the business.
Self-control, sometimes called adhocracy control, is complementary to market,
bureaucratic and clan control. By training and encouraging individuals to take initiative in
addressing problems on their own, there can be a resulting sense of individual empowerment,
which plays out as self-control. The self-control then benefits the organization and increases the
sense of worth to the business and the individual.
PERFORMANCE APPRAISAL TOOLS

The administrative process of controlling aims to verify whether/his everything occurred in
conformity with the plans adopted, instructions issued, and principles established. A performance
appraisal is a method of acquiring and processing information needed to individual's performance
improve the accomplishments. and It consists of setting standards and objectives against
determined standards and objectives; reviewing progress; having on-going feedback between the
appraiser and the one who is being appraised; planning for reinforcement, deletion or correction
of identified behavior as necessary. The purpose of the evaluation is to assess the
appropriateness, adequacy, effectiveness and efficiency of services. The methods used may be
anecdotal records, checklist, rating scale, ranking among others
The following are the control measures which may be utilized by the Nursing Service:

P a g e | 163
4. Quality Assurance. This is the process of establishing a standard of excellence of nursing
intervention and taking steps to ensure that each patient receives the expected level of
care.
Quality assurance is a fulfillment of the “social contract between society and
professions.” It is the Nursing Service’s responsibility to provide the clients with the best
possible care available.
In assuring quality, standards are set. Standards are desirable sets of condition and
performance considered essential in ensuring the quality of nursing care acceptable to
those responsible for its implementation. Quality nursing care is the presence of all
elements/characteristics specified in the standards relative to the structure, process and
outcome.
5. Framework for Evaluation. The evaluation of quality nursing care is determined by the
appropriate combination and interaction of structure and process. The basic assumption is
that an adequately-supported structure and process ensures the attainment of desired
outcomes.
 Structure. This refers to the basic support components of nursing which include,
among other/hiss, physical facilities, number and quality of personnel,
communication system, and staff development.
 Process. This refers to the means by which desired effects or outcomes are
intended to be achieved.
 Outcome. This refers to the desired effect as specified manifestations mobility
levels, patient knowledge, or self-care skills,.
6. Performance Appraisal. This is done to help employee improve his/her/his work methods
to ensure the achievement of organizational goals.
Some of the tools used to evaluate performance are trait rating scale, job dimension scales,
behaviorally anchored rating scale (BARS), checklist, peer review, and self-appraisal.
1. Trait Rating Scale
This is a method of rating a person against a set standard which may be the job description,
desired behavior and personal trait.
2. Job Dimension Scales

It focuses performance on job requirements and the quality work.
3. Behaviorally Anchored Rating Scale (BARS)

This focuses on desired behaviors to improve performance.
4. Checklist
It is composed of behavioral statements that represent desirable behavior.
5. Peer Review
It is a collegial evaluation of the performance done to promote excellence in practice and
offer information, support, guidance, criticism and direction to one another.
6. Self-Appraisal
This tool allows the employee to evaluate his own performance.
COMMON ERRORS IN APPRAISAL
It is not unusual to encounter errors during the appraisal. Some of these common errors
are halo effect, logical errors, central tendency errors, leniency errors, Hawthorne's effect and
Horn's effect.
1. Halo Effect
This has a tendency to overrate staff based on the rater's first impression of the rate. The
evaluation is based on the good traits or good things one sees in a person.

P a g e | 164
2. Logical Error
It is often based on first impressions of the rater to the rate.
3. Central Tendency Error

This rates the staff as average. This is used by the rater when feedback tools are
inadequate.
4. Leniency Error
There is the propensity to overlook the weaknesses and mistakes of the person being
evaluated leading to an inaccurate picture of the job performance.
5. Hawthorne Effect
The behavior of the ratee changes simply because he is observed by the rater.
6. Horn's Effect
This occurs when rating an employee very low because of an error committed.
DEVELOPMENT OF STANDARDS
Standards are not arbitrary measures of performance. It is a pre-determined level of
excellence that serves as a guide to practice. It is established by an authority communicated and
accepted by the standard. In developing a performance standard, it is mandatory that a criterion
is established and specified.
Organizational standards outline the level of acceptable practice within the institution while
nursing audit is a measurement tool used to provide the yard stick for measuring quality care.
TYPES OF STANDARDS
Standards are used to monitor and measure performance of nursing care services. These
services are then compared and evaluated against the standards through records, reports and
observations.
The different types of standards are:
1. Structure Standards
Standards that focus on the structure or management system used by an agency to
organize and deliver nursing care, including the number and categories of nursing personnel
who provide that care (e.g. a team leader is responsible for no more than 20 patients, with no
fewer than 3 team members to provide care).
2. Process Standards
Standards that refer to actual nursing care procedures or those activities engaged in by
nurses to administer care.
3. Outcome Standards
These are standards that are designed for measuring the results of nursing care. Other
means of monitoring and measuring include Conflict Management, Budgeting, and Discipline.
Evaluation Principles:
a. For a worker’s performance evaluation to be valid, it must be based on his/her/his
job description and performance standards.
b. An adequate and representative sampling of the nurses’ behavior should be
observed in the process of evaluating performance. Care must be taken to evaluate
his/her/his usual or consistent behavior. Avoid focusing on an isolated instance of
either/his extremely capable or extremely inept behavior on the part of the nurse.
c. The nurse should be provided with a copy of his/her/his job description,
performance standards and evaluation form to review prior to the scheduled
evaluation conference so that the nurse and his/her/his supervisor can discuss the
evaluation from the same frame of reference.

P a g e | 165
d. The manager should clearly indicate the areas in which the worker’s performance
is satisfactory and those which needs improvement. The supervisor should refer to
specific instances of the nurses’ satisfactory and unsatisfactory behavior to specify
exactly what types of changes are required in his/her/his performance.
e. If there is a need to improve the nurses’ performance in several areas, the manager
should indicate which areas should be given priority by the nurse.
f. The evaluation interview should be scheduled at a time convenient for both the
nurse and the manager. It should be held in a pleasant surrounding and should
allow time for both parties to ask questions and discuss the evaluation at length.
DYSFUNCTIONAL CONSEQUENCES OF CONTROL

Managers expect people in an organization to change their behavior in response to
control.
However, employee resistance can easily make control efforts dysfunctional. The
following behaviors demonstrate means by which the manager's control efforts can be
frustrated:
Game Playing
Control is something to be beaten, a game between the "boss and me and I want to win."
Resisting Control
A passive aggression or negative reaction to too much control.
Providing Inaccurate Information

A lack of understanding of why the information is needed and important leading to "you
want numbers, we will give you numbers."
Following Rules to the Letter

People following dumb and unprofitable rules in reaction to "do as I say."
Sabotaging
Stealing, discrediting other workers, chasing customers away, gossiping about the firm to
people in the community.
Playing One Manager Off Against Another

Exploiting lack of communication among managers, asking a second manager if don't
like the answer from the first manager.

P a g e | 166
MEMORY AID
I. Remember the following.
Controlling is the use of normal authority to assure the achievement of goals and objectives.
Four elements in the control process: EMCT
Nursing audit prioritizes nursing care by promoting optimum nursing care.
Five common errors made during performance appraisal are halo error, logical error, central
tendency error, leniency carrot, and Horn's Effect.
The control process is cyclical which means it is never finished.
Supervisors can implement controls before the process begins (feedforward), during the
process (concurrent), or after it ceases (feedback).
Financial controls facilitate achieving the organization's profit motive,
Some of the tools used to evaluate performance are trait rating scale, job dimension scales,
behaviorally anchored rating scale (BARS), checklist, peer review, and self-appraisal.

P a g e | 167
II. Critical Thinking. Answer what is asked.

1. Define controlling. Give an example.
2. Enumerate and briefly and explain the steps in controlling, Are they applicable to all health
care settings and every situation?
3. How does a good control system affect employees as individuals and the company as a
whole?
4. What are the criteria for effective control?
5. Why planning and controlling inseparable?
6. In what way is performance appraisal a management control system?
7. What are the kinds of formal control?
8. Give at least three issues in nursing management. How can we address those issues using
the nursing management process?


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SULTAN KUDARAT EDUCATIONAL INSTITUTION, INC.

Nursing Leadership and

Bachelor of Science in Nursing 4

RITZELLE ECIJA-EUGENIO, RN,RM,MAN, MHCA, CHRP

Resources: E-library, non-print materials in LMS

Course Requirements: Student output reflective of the integrated attainment of

Online Quiz 10%

Portfolio/module assessment 50%

Project output (paper)

ATTITUDE: (SUBMISSIONS OF REQUIREMENTS/project/portfolio)Rate

each item using the scale below:

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

NOMINAL DURATION: 36 hours

2. Apply the principles learned in organizing and conducting a seminar.

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

1. Discuss the principles and concepts in nursing management.

We can regard management as:

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

The process of working through staff members to be able to provide comprehensive

KEY CONCEPTS IN NURSING MANAGEMENT

Managing successfully requires the understanding of key concepts in

 Administration is the higher level of hierarchy.

– management supervises the utilization of the resources and oversees

– Administrators are chosen for their conceptual skills

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

1. It comprises the structure and process of a group working together to achieve an

It consists of an organizational chart or line linking the parts of an organization, its

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

"To choose a direction, a leader must first have developed a

 Both vision and mission must be clear, engaging, and attainable.

 Nothing happens until there is a plan.

– For example, a nurse has a goal of becoming financially independent

The NURSING MANAGEMENT PROCESS of data gathering, planning, organizing,

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

PURPOSE OF THE NURSING MANAGEMENT PROCESS:

CHARACTERISTICS OF THE NURSING MANAGEMENT PROCESS:

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

Activity 1. Critical Thinking. Write in a short bond paper. Bold

2. What philosophy guides you in your decision making?

II. Value the contributions of nursing?

III. Provide experimental therapy for cancer?

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

Activity 2. Encircle the correct letter of an answer.

2. It describes the vision of the organization

3. The following characteristics can be considered in management process:

4. It is considered as the policy making body of the organization.

5. It is considered a line which can link the parts of the organization

6. In managerial leadership, it considers the following:

a. Involves influencing subordinates in variety of ways

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

7. The purpose of nursing management process is

a. To achieve the opportunity to work collaboratively with patients and others

8. The purpose of nursing management process is

9. Administrators who occupy the highest position organization is referred to as:

10. Objectives are considered to be;

a. Recommend the transfer of this staff to another unit

SULTAN KUDARAT EDUCATIONAL INSTITUTION INC.

INFORMATION SHEET 2 MANAGEMENT

EARLY MANAGEMENT THEORIES

Theories Emphasizing Organizational Structure

Taylor's System of Work Improvement

The first component of this system is controlled observation of the workers'