DIRECTING PROCESS
 The “doing” phase of management.
 The “Heart” of management process
 Directing stimulates efforts to accomplish goals.
It is the connecting link between organizingwork
and getting the job done.
COORDINATION AND COMMADS (FAYOL)
 Commands get optimum result /outcome from
all employees in the interest of the whole
concern
 Creating harmony among all activities to
facilitate the working and success of the unit
DIRECTING
 -issuance of orders, assignments and
instructions that permit the nursing personnel to
understand what are expected of them and the
guidance and overseeing them, so that they can
an contribute effectively and efficiently in the
attainment of the goals of the
institution.(Douglass)
 Components include creating a motivating
climate, establishing organizational
communication, managing conflict, facilitating
collaboration, negotiating, working with unions
and complying with employment law
 Directing is a function of the manager that gets
work done through others; referred to as
coordinating or activating.
 specific concepts
• giving directions(commanding)
• supervising,
• leading,
• motivating,
• establishing organizational communication
• Managing Conflict
• facilitating collaboration
• negotiating
Giving directions is the first activity and suggests that
directions should be clear, concise and consistent and
should confirm to the requirements of the situation.The
manager should be aware of the tone of the directives.
BASIS FOR DIRECTING
• Standards- guidelines on what should andshould
not do; yardstick to provides direction
• Policy manuals
• Procedural manual
• Job description
• Influenced by physical plant and patient
distribution according to patient’s acuity
IMPORTANCE OF DIRECTING
• Guides and helps the subordinates to complete
the given task properly and as per schedule
• Provides the necessary motivation to
subordinates to complete the work satisfactorily
and strive to do the best.
• Helps in maintaining discipline and rewarding
those who do well.
• Directing involves supervision
ELEMENTS OF DIRECTING
DELEGATION
• Effective delegation is considered a core skill for
professional nursing practice globally
• The ICN (2008) maintains that nurses are
responsible for the delegation of nursing care
and supervision of assistive personnel.
• The ANA recognizes delegation as an important
skill for nurses to deliver safe and effective care
while maintaining accountability for care”
• Getting work done through others
• Directing the performance of one or more
people to accomplish organizational goals.
• Delegation requires problem-solving skills,
critical thinking skills, and clinical judgment
• the process by which a manager assigns specific
tasks/duties to subordinates with
commensurate authority to perform the job
• the work of a manager in entrusting
responsibility and authority to subordinates for
completion of a task yet creating /retaining
accountability for result.
3 ASPECTS OF DELEGATION
• Authority – the power one needs to carryout
responsibilities
• Responsibility – those things one is held
accountable for
• Accountability – the obligation to perform
responsibility and exercise authority in
conformance with understood and accepted
performance standards.
 PRINCIPLES OF DELEGATION
1. Select the right person to whom the job is to
be delegated. Know the subordinate’s
capabilities and match the task of duty tothe
employee
2. Delegate both interesting and uninteresting
tasks.
3. Provide subordinates with enough time to
learn.
4. Delegate gradually.
5. Delegate in advance
6. Consult before delegating.
7. Avoid gaps and overlaps.-coordinate
• Provides learning or ‘stretching’ opportunities
for subordinates.
• Increases power.
• Cannot delegate total responsibility.
• Do not delegate responsibility without authority.
• Delegate to the right person, at the right time,
and for the right reason.
• Say no when you must.
• Reward subordinates for jobs well done.
• Don’t just delegate boring jobs.
5 RIGHTS OF DELEGATION
1. Right Task
a. Correctly answers these question
i. a. which tasks are legally
appropriate to delegate?
ii. can I delegate these tasks based
on this organization’s policies
and procedures?
iii. Are the task within the scope of
practice of the RN UAP?
Guidance -Familiarity with the
institutional standard and Nursing
Practice Act
Use a standard and unchanging
procedure
2. Right Circumstance
a. the nurse must match the complexity of
the task with the competency level of
the delegate and the amount of
supervision needed.
b. b. Presence/availability of appropriate
equipment and resources to performthe
task
c. Providing of right supervision to the
delegate to accomplish the task,
d. Provision of favorable environment for
delegation in this situation
3. Right Person
a. Delegatee have received the training to
perform the task,
b. have previous experience or have
performed the task with a patient
c. have done the task or ever completed
the task without supervision,
d. Assess if problems have been
encountered in performing the task in
the past
4. Right Direction or Communication
a. delegator must give the right direction
and communication to the delegatee.
b. All delegators must communicate
performance expectations preciselyand
directly
c. Delegatees also need a deadline for task
completion for time-sensitive tasks
d. The delegatee also must comprehend
what, how, and when to report back
after the delegated task is complete
5. Right Supervision or Evaluation
a. Supervise all delegated task
i. Upon task completion, evaluate
the outcome of the task.
 The nurse provides feedback to
the delegate as well as
appropriate monitoring,
evaluation, and intervention as
needed
• Communication is vital to effective delegation.
The nurse must give a clear, concise description
of the task, including its objective, limits, and
expectations (NCSBN, 1995)
• Nurse leaders and managers must facilitate open
communication with all staff members and
encourage them to express concerns or refuse
an assignment, without fear of reprisal, if they
believe that they do not possess the required
skills needed to perform the task safely (ANA,
2015a)
• The nurse must provide specific directions and
clear expectations of how the task is to be
performed; in addition, the nurse should
monitor the performance, obtain and provide
feedback, intervene if needed, and ensure
proper documentation (NCSBN, 1997)
• As a management principle, delegation is
necessary to obtaining desired outcomes
through the work of nursing staff (NCSBN, 1997).
• Nurse leaders and managers must delegate
many routine tasks to allow themselves time to
handle more complex activities that require
higher level of expertise
 • For nurses, delegation is not an option, but a o Causes of Under delegating
necessity  Fear that delegation may be
• Delegation is a managerial tool for subordinate interpreted as a lack of ability to
accomplishment and enrichment. do the job completely or
correctly.
REASONS FOR DELAGATING
 A desire to complete the whole
 Assigning routine task-schedule, pts. assignment job himself or herself.
 Assigning tasks for which the nurse manager  Fear that subordinates will
does not have time. resent delegated work.
 Problem solving  Lack of experience in the job or
 Changes in the nurse manager’s own job with delegation; or the need to
emphasis control or be perfect.
 Capability building  Enjoyment of the work.
 Over delegating – occurs when the workload is
ADVANTAGES OF DELEGATION more than the delegate can accomplish in the
allotted time frame
 Frees managers to accept other responsibilities o Reasons are:
 Gives growth opportunities to employees;  Managers who are lazy
causes employees to accept accountability and  Manager who are overburdened
exercise judgment and exhausted
 May lead to better and faster decisions o Causes of Over delegating
Prerequisites To Effective Delegation  Poor managers of time who
spend too much time trying to
 Manager’s willingness to give employees get organized.
freedom to accomplish delegated tasks  Insecurity in the ability to
 Open communication between managers and perform a task.
employees  Improper Delegation – delegating at the wrong
 Manager’s ability to analyze such factors as the person, time, tasks and beyond the capability of
organization’s goals, the task’s requirements, the subordinates
and the employee’s capabilities o Causes of Improperly Delegating
 Wrong time, to the wrong
Managers who do not delegate
person, or for the wrong reason.
 Does not trust Perfectionism  Beyond the capability of the
 fear of mistakes person or something the
 Fear of mistake manager should do.
 Believe they can perform certain tasks better  Decision making without
than others providing adequate information.
 Fear of criticism When not to delegate
 Fear of own ability to delegate
 Insecurity, lack of experience, and poor o Do not delegate the power to discipline
organizational skills o Responsibility for maintaining morale
o Overall control
Common Errors in Delegation o Jobs that are too technical
o Duties involving confidence
 Under delegating –is the failure to transfer
authority for a task or the failure to provide clear Clear Communication + Delegation
direction to the delegate
o Reasons are: o Define the task clearly.
 Managers believe that they can o Delineate end results, time frame,
do the work faster and better standards.
 Managers believe that the o Delegate the objective, not the
responsibility may be rejectedif procedure.
delegated o Allow employees some creativity in
achieving the desired end product
Tasks of effective delegation
o Decide which tasks can be delegated
o Decide who should get the assignment
o Provide sufficient resources for carrying
out the delegated task
o Delegate the assignment
o Be prepared to run interference, if
necessary
o Establish a feedback system
Steps to Effective Delegation
o Assess the knowledge and skills of the
o delegate.
o Match tasks to the delegatee’s skills.
o Communicate clearly: Task, outcome,
time
o Listen attentively.
o Provide feedback
SUPERVISION
o Providing guidelines, direction &
periodic inspection of the actual
accomplishment of the task or activity.
o entails motivating and encouraging the
staff to participate in the activities to
meet the goals and objectives for
personal development in making the
work better.
IT ASSESSS
• the quantity and quality of the work performed,
• time within which the work is accomplished
• the proper utilization of resources,
• amount of assistance needed by the worker
• Need for staff development and continuing
education programs.
A nurse supervisor
• is responsible for managing staff,
• overseeing patient care and
• Ensuring adherence to established policies and
procedures.
• Acts as an interface between her staff, their
patients, and the patients' families, as well as
between her staff and the hospital’s physicians
Functions of Supervisor
• Provides technical knowledge
• Gives orders, instructions and
implements the rules
• Converts the goals, programs, policies
and
• resources into products and services
• Creates proper climate
• Arranges work assignments, determines
• procedures.
• Arranges tools and material
• Motivates workers becomes an example
• Hears complaints and helps to solve
them
• Communicates the feelings or problems
to the top management
• Controls the performance
• Recommends promotions, transfers and
pay Increase
Qualities of Good Supervisor
• Good technical, managerial and human
relation skills;
• Ability to communicate well in both spoken
and written language; ability to listen;
• Firmness with flexibility to adjust to the
needs of the situation
• Fairness in dealing with the employees;
Familiarity with hospital & nursing policies
that affect patient care
• Good decision-making skills;
• Willingness to grow and develop
• Ability to accept changes & consider them as
challenges;
• Dignified with pleasing personality;
• Ability to motivate employees & provide
opportunities for continuing professional
growth and development;
• Advocacy for nurses and nursing
Principles of Good Supervision
1. Requires adequate planning & organization
which facilitates cooperation, coordination and
synchronization of services.
2. Gives autonomy to workers depending in their
competency, personality and commitment. It
fosters the ability of each worker to think andact
for himself/herself
3. Stimulates the worker’s ambition to grow into
effectiveness. It provides for opportunities &
incentives for staff education and continuous
professional grants and development.
4. creates an atmosphere of cordiality and trust. It
creates a suitable environment for productive
work.
5. considers the strengths and weaknesses of
employees.
6. strives to make the unit an effective learning
situation. It promotes a teaching-learning
 environment where learners are stimulated to
exercise critical thinking and creativity specially
in patient care.
7. considers equal distribution of work considering
age, physical condition and competence..
TYPES OF SUPERVISION
1. Direct - through face to face talk - observation.
2. Indirect - through the help of records, reports
and through written instructions.
Techniques in Supervision
• Observation of the worker while making the
rounds
• Spot checking of charts through nursing audits
• Asking the patient about the care they receive
• Looking into the general condition of the units
• Getting feedback from co-workers
• Asking questions discretely to find out the
problems they encounter in the wards
• Drawing out suggestions from the workers for
improvement of their work situation.
• Techniques in Supervision
• Observation e. g. Ward rounds
• Interview and questioning
• Individual and group conferences
• Performance evaluation
• Verbal and written reports –anecdotal reports,
critical incident reports, confidential reports etc.
POWER
• The authority and ability to get things
accomplished.
• The capacity or potential to get others to do
something one wants them to do that they
would not ordinarily do otherwise.
• The potential of an individual or group to
influence the behavior of others.
Legitimate power
 Power that exists when a subordinate
(influencee) acknowledges that the influencer
has a “right” or is lawfully entitled to exert
influence--within certain bounds
 Legitimate Power is the power of position orrole.
Also called “formal authority”
REWARD POWER
 Power derived from the fact that one person
(influencee) has the ability to reward another
person (influencer), for carrying out orders,
which may be expressed or implied
 Reward power is therefore the second weakest
form power ; is the concept of do this and get
that.
Punishment or Coercive power
 The negative side of reward power; based onthe
influencer’s ability to punish the influencee for
non compliance of the order
 Coercive leaders rely on threats, bullying, and
“orelse” language to “motivate” those that are
beneath them; may obtain compliance thru
threats
Expert power
 Power based on the belief or understanding that
the influencer has specific knowledge orrelevant
expertise that the influencee does not
 This type of power is often the most effective
type of power
Referent power
 Power based on the desire of the influencee to
be like or identify with the influencer
 Referent Power is also the power of respect;
created through the values of the individual
 is based upon admiration and respect for an
individual as a person
Charismatic Power
 A charismatic leader is often a good
communicator and has an attractive personality
that naturally works to convince the audience
about his opinions and ideas.
 Charismatic power in leadership employsthe use
of charm to engage an audience and gather a
following
Information Power
 is based upon “who knows what” in an
organization and the degree to which they can
control access to that information by other
individuals.
 obtained when people have information that
others must have to accomplish their goals
Planned Change
 Means to be different or to alter
 Maybe Personal or organizational
 Planned change is purposeful, calculated, and
collaborative, and it includes the deliberate
 application of change theories (Mitchell, 2013;
Roussel, 2013
 Planned – entails planning and application of
strategic actions desired to promote movement
toward a desired goal
Types of Change
 Coercive change Non mutual goal setting,
imbalanced power ratio & one-sided
deliberativeness characterized coercive change -
introducing discontinuous change, whichfollows
a resistance introducing sequence and uses
power to overcome resistance,
 Emulative change Transition is fostered through
identification with and imitation of power
figures.
 Indoctrination Uses mutual goal setting, has an
imbalanced power ration and is deliberative.
Subordinates are interested in the beliefs of the
power source.
 Interactional change Mutual goal setting, fairly
equal power, but no deliberativeness
characterize this. Parties may be unconsciously
committed to changing one another
 Natural change Include accidents and acts of
God. They involve no goal setting or
deliberativeness
 Socialization change Directly related to
interactional change. An individual conformsthe
needs of the social group. When there is greater
deliberativeness on the power ration, change
becomes indoctrination.
 Technocratic change Collecting and interpreting
data bring about change. A technocrat merely
reports the findings of the analysis to bringabout
change.
 Developmental or maturational change this
occurs when you recognize a need to make
improvements to an existing situation. • aren’t
recreating the entire workflow but are instead
refining it to make it better.
 Planned changes Involves mutual goal setting
and equal power ratio and deliberativeness.
The Change Agent
 A change agent is a person who has the clout,the
conviction and the charisma to make things
happen and to keep people engaged.
 3 Good Reasons for Change
o Change to solve some problem
o Change to make work more procedures
more efficient.
o Change to reduce unnecessary workload.
Resistance: The natural and expected response to
change
Degree of resistance for each individual depends onfour
things:
1. Their flexibility to change
2. Their evaluation of the immediate situation
3. The anticipated consequences of the change
4. Their perceptions of what they have to lose and
gain
—Silber (1993)
Steps in Overcoming Resistance to Change
 Explain the change clearly and give reasons why
it is necessary-tell what’s going to happen and
why, how will it affect their current practice or
routines
 Ask the input from the employees on potential
advantages and disadvantages - involve
employees how to implement the change and
possible problem they foresee.
 Acknowledge employees concern , and give
additional information and specifics about
change. Explain the benefits, show empathyand
alleviate their concerns.
 Ask for employee support and cooperation.
Offer your help need to stress the importance of
cooperation and making a team effort.
Levin’s Force-Field Model (1951)
• Levin’s Force-Field theory - believed that change
results from two field or environmental forces:
o Driving Forces (Helping Forces) that
attempt to facilitate the change and
move it forward and
o Restraining Forces (Hindering Forces)
that attempt to impede change and
maintain the status quo
• Kurt Lewin (1951) identified three phases
through which the change agent must proceed
before a planned change becomes part of the
system:
o Unfreezing occurs when the change
agent convinces members of the group
to change or when guilt, anxiety, or
concern can be elicited.
o Movement, the change agent identifies,
plans, and implements appropriate
strategies, ensuring that driving forces
exceed restraining forces
 o Refreezing phase, the change agent
assists in stabilizing the system change
so that it becomes integrated into the
status quo.
DESCISION –MAKING
- The process of thought and action that leads to
a decision.
- is essential to problem solving
- a systematic ,sequential process of choosing
among alternatives and
o putting the choice into action (Lancaster
and Lancaster)
Pitfalls of decision making
- Managers are resistant to change involving risk
and new ideas;
- lack trust in others who will test the new areas
- Inadequate fact finding – decision must be based
on accurate information\
- Time constraints – collection of facts ,opinion
and assumptions must be completed in a timely
manner
- Poor Communication – communicating the
decision to the appropriate individual
- Failing to systematically follow the steps in
decision making process
PROCESS
1. Definition of a Problem
2. Analysis of the problem
3. Development of alternative solutions
4. Selection of the solution for implementation
5. Implementation and follow-up/ monitor and
evaluate the results of solution
Rational decision-making model
- A process that helps managers weigh
alternatives and choose the alternative with the
best chance of success
Problem Solving
- Problem solving is an active process that with a
problem and ends with a solution
- Maybe uncomplicated (simple) or complex
(more analysis needed)
- Similar to decision making and nursing process
- Nursing process applied to patient situations or
health problems while problem solving and
decision making applied to any type of problems
- The process of identifying a discrepancy
between an actual and desired state of affairs
and then taking action to resolve it
Dealing with Problems
Managerial type
• Problem avoiders – ignore information that
would otherwise signal the presence of a
problem
• Problem solvers – try to solve problems when
they arise
• Problem seekers – actively process information
and look for problems to solve or opportunities
to explore
Characteristic
• Inactive – does not want to deal with problems
• Reactive – responds to information about
problems after they occur
• Proactive – anticipates problems before they
occur
Managerial thinking
• Systematic thinking – approaching problems ina
rational and analytical fashion
• Intuitive thinking – approaches problems in a
flexible and spontaneous fashion
• Multidimensional thinking – capacity to view
many problems at once, in relationship to one
another, and across long and short time horizons
• Strategic opportunism – ability to remain
focused on long-term objectives by beingflexible
in dealing with short-term problems and
opportunities as they occur
CONFLICT
• Conflict means a clash between two opposing
and oftentimes hostile parties.
• A disruptive clash of interest objectives or
personalities, between individuals and group or
between groups.
TYPES OF CONFLICT
• Conflict is a dynamic process.
o Type of behavior involving two or more
parties in opposition to each other.
o can be overt or covert. Covert conflict is
more dangerous because it is not what it
appears on the surface.
• Conflict is either vertical or horizontal.
o vertical conflict- differences in opinions
between superiors and subordinates. –
 o Caused most often by inadequacy of
communication, opposing interest and
lack of shared perception and attitudes.
• Horizontal or line and staff conflict –
o arises as a common struggle or strife
between departments or services
wherein the degree of inter dependence
and collaboration determines the
success to achieving shared goals and
objectives
• Conflict can be viewed from
o a). Behavioral process standpoint – -
perceived condition that exists between
two parties - one or more parties
perceive goal incompatibility
o Process Standpoint - conflict can be
defined as “what occurs” when real or
perceived conflict exists in goals, values,
ideas, attitudes, beliefs, feelings or
action of two or more parties. - conflict
can occur intrapersonal; interpersonal;
intra group or inter group
INTRAPERSONAL CONFLICT
• Intrapersonal conflict is an internal conflict, or a
conflict coming from within a person.
• It involves an internal struggle to clarify
contradictory values or wants.
• An individual may be confronted with an issue or
situation that creates a sense of discomfort
within.
Interpersonal Conflict
• Interpersonal conflict happens between two or
more people with differing values, goals, and
beliefs and may be closely linked with bullying,
incivility, and mobbing= workplace violence.Also
known as horizontal violence or bullying.
Intergroup CONFLICT
• Intergroup conflict occurs between two or more
groups of people, departments, and
organizations.
Organizational Conflict
• Organizational conflict can result when there is
disagreement between staff and organizational
policies and procedures, standards, or changes
being made.
Common Conflict Resolution Strategies
Thomas & Kilman, 1977
1. AVOIDANCE
a. used by groups who do not want to do
something that may interfere with their
relationships.
b. participants never acknowledged that a
conflict arises; - allows conflictingparties
to cool down and gather information. -
neutrality is maintained at all cost
2. Compromising
a. Each party gives up something it wants.
b. an effective conflict management
strategy.
c. When compromising, everyone gives
something up, and everyone gets
something they want in return.
d. However, to be effective, those involved
must have the same power.
3. COMPETING
a. One party pursues what it wants
regardless of the cost to others.
b. The competitor wants to win and is not
cooperative.
c. This strategy is power driven and can
result in aggression.
4. ACOOMMODATING
a. One party sacrifices his or her beliefsand
wants to allow the other party to win.
b. This strategy does not resolve conflict
and may result in future conflict
c. focuses on points of agreement and
minor problems but the real problem
still exist and has to be attended to.
5. COLLABORATING
a. An assertive and cooperative means of
conflict resolution whereby all parties
set aside their original goals and work
together to establish a superordinate or
common priority goal.
b. is the best strategy to use in conflict
management because it involves a
shared approach to resolving conflict.
c. Shared goals are identified, and a
commitment to working together is
implemented by those involved.
d. Collaborating is time consuming, but it
results in the best chance of a resolution
Two Basic Dimensions Of Behavior  CHANNELS OF COMMUNICATION
o Downward
• Assertiveness the extent to which the individual  Traditional
attempts to satisfy his/her own concerns
 Primarily directive
• Cooperativeness –the extent to which the
 Satisfaction less for subordinate
individual attempts to satisfy the other person’s
 Employee handbook, reports,
concerns job descriptions
Conflict Resolution Outcomes o Upward
 Allows employee input
• The lose-lose orientation is a type of conflictthat  Staff satisfaction high
tends to end negatively for all parties involved.  Supervisor passes up
• A win-lose orientation results in one victorious  Bias and filtering increase as
party, usually at the expense of the other. information is passed upward
• The win-win orientation is one of the most  Staff meetings, suggestion box
essential concepts to conflict resolution. A win-  ORGANIZATIONAL COMMUNICATION
win solution arrived at by integrative bargaining o The goal of organizational
may be close to optimal for both parties. This communication is to convey important
approach engages in a cooperative approach information, such as regulations, policies,
rather than a competitive one and procedures. across the entire
Communication system
o Vertical communication - any
• The complex exchange of thoughts, ideas, or communication that moves up or down
information on at least two levels: verbal and the chain of command
nonverbal. (Chitty, 2001)  Downward communication -
• Precise documentation of nursing care is vital communication that flows from
because it is used by other nurses and healthcare one level of a group or
professionals in administrative records acrossan organization to a lower level is a
organization (ANA, 2010) downward communication
• Communication - transmission of information,  Assigning goals
opinions, and intentions between and among  Providing jo instructions
individuals.  Informing employees of
• Communicating - the work the manager policies and procedures
performs to create understanding among people  Pointing out problems
and help the perform effectively and efficiently. that need attention
 Offering feedback about
 Internal climate Includes internal factors such as performance
the values, feelings, temperament, and stress  Upward communication -
levels of the sender and the receiver communication that flows to a
o Values higher level in the group or
o Feelings organization
o Temperament  Providing feedback to
o Stress levels of sender and receiver higher-ups
 External climate Includes external factors suchas  Informing managers of
the weather, temperature, timing, status, power, progress towards goals
authority, and the organizational climate itself  Relaying current
o Weather conditions problems to managers
o Temperature
 Keeping managers
o Timing aware of how
o Organizational climate employees feel about
o Status, power, and authority as barriers their jobs, co-workers,
to manager-subordinate communication and the organization
 Performance reports
 Suggestion boxes
  Employee attitude
surveys
 Grievance procedures
 Superior-subordinate
discussions
 Informal gripe sessions
o Lateral communication - communication
between departments of an
organization
o Diagonal communication, the manager
interacts with personnel and managers
of other departments and groups who
are not on the same level of the
organizational hierarchy.
o Grapevine communication flows quickly
and haphazardly among people at all
hierarchical levels and usually involves
three or four people at a time.
 Communication on the
grapevine travels in multiple
directions at a rapid speed and
carries both positive and
negative information.
Leadership
 The process of influencing and supporting others
to work enthusiastically toward achieving
objectives
 Trait approach
o Attempt to understand leadership by
identifying personal characteristics of
leaders
o Assumes that leaders are born, and not
made
 Behavioral approach
o Determining what effective leadersdo—
how they delegate tasks, how they
communicate with and try to motivate
their followers, and how they carry out
their tasks
o Focus on two aspects of leadership
behavior: leadership function and
leadership style
 2 major leadership functions
o Task-related function – problem solving
function
o Group-maintenance – social functions;
include such actions as mediating
disputes and ensuring that individuals
feel valued by the group
 2 leadership styles
o Task-oriented style – closely supervise
employees to be sure the task is
performed satisfactorily
o Employee-oriented style – put more
emphasis on motivating rather than
controlling subordinates
Leadership Continuum Tannenbaun & Schmidt
• Used graphic presentation showing the trade-off
between a manager’s use of authority & the
freedom that subordinates experience as
leadership style varies from boss centered to
subordinate centered
Behavioral theories
• Ohio State Leadership Studies 1945
o A series of studies on leadership to
identify observable behaviors of leaders
instead of focusing on their traits.
o They found two critical characteristics
of leadership either of which could be
high or low or independent of one
another.
o The description of leader behavior
 Initiating structure behavior -
the extent to which a leader is
likely to define and structure his
or her role and those of
subordinates in the search for
goal attainment
 Consideration behavior - the
extent to which a leader is likely
to have job relationships
characterized by mutual trust,
respect for subordinates’ ideas,
and regard for their feelings
o effective leaders possess a strong ability
to work with others and
o build a cohesive team that is balanced
with the capability to create structure
within which activities can be
accomplished

o •
• University of Michigan(Likert, et al )
o Found 3 types of leadership behavior
that marked the difference between
effective & ineffective
 task-oriented behavior,
 relationship-oriented behavior
 Participative leadership.
• Effective leaders are highly sensitive to staff,use
communication to keep the group working as a
unit; faster supportive relationship among all
group members.
• His theory is supportive of Human Relation
theory. Nurse managers support the benefits of
positive attitudes towards people.
o Development of workers, satisfactionof
their needs & commitment through
participation
• Employee-oriented leader - one whoemphasizes
interpersonal relations
• Production-oriented leader - one who
emphasizes technical or task aspects of the job
• The Managerial Grid (Blake And Mouton)
• The grid describe individual leadership as
function of 2-variables; concern for people &
concern for production
• to identify styles of leader behavior that results
in higher performance and satisfaction of a
group
• They say that the Matrix, the 9.9 position, the
Team Management Approach, is the most
effective leadership style.
The five resulting leadership styles are as follows:
Impoverished (laissez-faire) management(1.1) –
low concern for people and low concern for tasks
or production
• Country club management(1.9) - high concern
for employees but low concern for production
• Authoritarian management(9.1) - high concern
for production and efficiency but low concernfor
employees
• Middle-of-the-road management(5.5) - an
intermediate amount of concern for both
production and employee satisfaction
• Team (democratic) management(9.9) - high
concern for both production and employee
morale/satisfaction
Contingency approach
• The view that the management technique that
best contributes to the attainment of
organizational goals might vary in differenttypes
of situations or circumstances.
• That a leadership style will be effective or
ineffective depending on the situation & has 3
aspects:. leader-member relations, task
structure, position power
• No one leadership style is ideal for every
situation. Fred Fiedler
Hersey and Blanchard (1977)
• Developed Situational Approach to leadership.
• Tridimensional leadership effectiveness model
predicts which leadership style is most
appropriate in each situation on the basis of the
level of the followers’ maturity.
• An approach to leadership that describes how
leaders should adjust their leadership style in
response to their subordinates’ desire for
achievement, experience, ability, andwillingness
to accept responsibility
Developmental stage
• Low ability; low willingness
• Low ability; high willingness
• High ability; low willingness
• High ability; high willingness
Recommended style
• Telling (directive; low support)
• Selling/coaching (directive; supportive)
• Participating/supporting (supportive; low
direction)
• Delegating (low direction; low support)
Leadership styles (situational)
1. Delegating – allowing the group to make and
take responsibility for task decisions; a low-task,
low-relationship style
2. Participating – emphasizing shared ideas and
participative decisions on task directions; a low
task, high-relationship style
3. Selling – explaining task directions in a
supportive and persuasive way; a high-task,
high-relationship style
4. Telling – giving specific task directions and
closely supervising work; a high-task, low
relationship style
Path -Goal Theory (Robert House)
• Robert House's Path Theory, introduced in 1971,
-concerned with motivation and productivity.
• the motivational function of management is to
help employees see the relationship between
personal and organizational goals, clarify the
"paths" to accomplishing these goals, remove
obstacles to goal achievement, and reward
employees for the work accomplished
• Directive leadership – letting subordinatesknow
what is expected; giving directions on what todo
and how
• Supportive leadership – doing things to make
work more pleasant; treating group members as
equals; showing concern for well-being of
subordinates
• Achievement-oriented leadership – setting
challenging goals; expecting the highest levelsof
performance; emphasizing continuous
improvement in performance
• Participative leadership – involving subordinates
•
• in decision making; asking for suggestions from
subordinates; using these suggestions when
making a decision
Transformational Leadership Burns
• A transformational leader is one who “commits
people to action, who converts followers into
leaders, and who may convert leaders into
agents of change”
Transactional leadership
• leadership that directs the efforts of others
through tasks, rewards, and structures
McGregor’s Participation Theory:
• Theory X - The assumption that employees
dislike work, are lazy, dislike responsibility, and
must be coerced to perform
• Theory Y - The assumption that employees like
work, are creative, seek responsibility, and can
exercise self-direction
MOTIVATION
• the willingness to exert high levels of effort
toward organizational goals, conditioned by the
effort’s ability to satisfy some individual need
• Need - some internal state that makes certain
outcomes appear attractive
• Satisfaction-comes from truly motivating factors
such as interesting and challenging work,
utilization of one’s capabilities , opportunity to
do something meaningfUL
Maslow’s Hierarchy of Needs and Theory of Human
Motivation
• Maslow (1970), people are motivated to satisfy
certain needs, from basic survival to complex
psychological needs, and people seek a higher
need only when the lower needs have been met.
 ERG THEORY
• The gratification of a higher-level need is,
subdued the desire to satisfy a lower-level need
increases
Existence
• Concerned with providing basic material
existence requirements
• Include what Maslow considered to be
physiological and safety needs
Relatedness
• The desire to maintain important interpersonal
relationships
• Social and status desires that require interaction
with others if they are to be satisfied
• Aligned with Maslow’s social need and the
external component of Maslow’s esteem
classification
Growth
• Intrinsic desire for personal development
• Include intrinsic component from Maslow’s
esteem category and the characteristics under
self-actualization
Herzberg’s Two-Factor Theory
• Frederick Herzberg (1977) believed that
employees can be motivated by the work itself
and that there is an internal or personal need to
meet organizational goals.
• ❑ Hygiene Factors - factors that meet a person's
need to avoid pain, insecurity, and discomfort.If
not met, the employee is dissatisfied.
o Company policy and administration
o Supervision
o Interpersonal relations
o Positive working conditions
o Status
o Salary
• ❑Motivation Factors - those that meet needs to
grow psychologically, when met, the employee
feels satisfied
o Achievement
o Recognition
o Work itself
o Responsibility
o Advancement
o Growth
• The leader manager's function is to ensure that
both sets of needs are met, some directly and
others by providing opportunities to meet them
in a conducive work environment.
McClelland’s Acquired Needs
• Need for achievement - drive to exceed one's
former accomplishments, to perform an activity
more skillfully or effectively than before.
• Need for affiliation - a desire for friendship, love,
and belonging that causes a person to spend
much time and planning how to establish
friendly personal relations.
o Persons' with high affiliation need are
sensitive to others' feelings, support
others' ideas, and prefer jobs involving
conversational give and take.
• Need for power - desire to control the means of
influencing others and resisting control byothers
o Power-oriented people are motivatedby
the power that can be gained as a result
of a specific action. - concerned with
making an impact on others, the desire
to influence others, the urge to change
people, -want to command attention,
get recognition, and control others.
GOAL
• Goal-Setting Theory
• Reinforcement Theory
o An individual’s behavior is a function of
its consequences, and not the
individual’s purpose
• REINFORCEMENT THEORY
o Positive or desired behaviors should be
rewarded or reinforced. Reinforcement
motivates, increasing strength of a
response or inducing its repetition –
o Negative reinforcement occurs when
desired behavior occurs to avoid
negative consequences of punishment.
o Behaviorist believed that people will
repeat behavior when consequencesare
positive
• Law of effect
o States that behavior followed by
pleasant consequences is likely to be
repeated; behavior followed by
unpleasant consequences is not
o Operant conditioning- the control of
behavior by manipulating its
consequences
o Positive reinforcement - provides a
favorable consequence that encourages
repetition of a behavior
 o Shaping - a systematic and progressive
application of positive reinforcement
o Negative reinforcement - occurs when
behavior is accompanied by removal of
an unfavorable consequence •
o Punishment - the administration of an
unfavorable consequence that
discourages a certain behavior
• Equity Theory
o Individuals compare job inputs and
outcomes with others, then respond to
eliminate any inequities
o Perceived equity The individual is
satisfied and does not change behavior
o Perceived inequity The individual feels
discomfort and acts to eliminate
inequity
• Expectancy Theory
o Victor H. Vroom developed the
Expectancy theory through his study of
the motivations behind decision making.
• Suggests that motivation is a product
of three factors: valence, expectancy,
and instrumentality
o Valence – the value a person assigns to
workrelated outcomes(reward)
 Make the person understand
the value of various possible
rewards and work outcomes
o Expectancy – person’s belief that
working hard will result in high task
performance
 Make the person feel
competent and capable of
achieving the desired
performance level
o Instrumentality – a person’s belief that
various outcomes will occur as a resultof
task performance
 Make the person confident in
understanding which rewards
and outcomes will follow
performance accomplishments
• Vroom’s motivation can also be expressed inthe
form of an equation as follows:
o Motivation = Valence x Expectancy x
Instrumentality
Controlling
• or evaluating is the process by which we attempt
to see that actual activities conform to planned
activities. –
• Cyclic, is an on-going function of management
which occurs during planning, organizing and
directing activities.
• Includes assessing & regulating performance in
accordance with the plans that have been
adopted, the instructions issued & the principles
established.
STEPS
• Establish standards and Methods for Measuring
Performance
o Selected points at which performance is
measured so that managers may know
about how things are going.
o understand the meaning of standards
and agree on standards chosen
• Establishing methods for Measuring
performance against standards
o Done so that deviations may be detected
in advance of their occurrence and
avoided by appropriate actions.
o Select tools that are easy to use and will
provide valid assessment
o Most commonly used methods- Task
analysis and quality control
• Compare results with standards, measuring
actual performance
o Determining whether performance
matches the standard
o It involves comparing the measured
results with the standards already set
• Match with standards?
o YES - do nothing to improve, may
assume things are under control –
o NO - take corrective action
o The corrective action could involve a
change in one or more activities of the
organization’s operations
• Task Analysis studies measure the actual process
of giving nursing care using time studies and
checklist.
• Quality Control
o a specific type of controlling—refers to
activities that are used to evaluate,
monitor, or regulate services rendered
to consumers
• Standards
o are desirable set of condition and
performance necessary to ensure the
quality of nursing, care services which
are acceptable to those instrumental to
or responsible to or maintaining them.
Types of Performance Standards
• are those that focus on structure or
management system used by an organization to
organize and deliver care , including the number
and categories of personnel who provide that
care; conditions which care was given
• Process Standards refers to actual nursing
procedure, activities engaged in by the nurse to
administer care
o E.g. Determination of the nurse patient
ratio takes into consideration the
physical, psychological, social and
spiritual need of the patients
• Outcome standards are designed for measuring
results of nursing care.
o -Responses or changes in patients
/clients condition are compared with
patients objective
o e.G Clients needs identified are met
according to the established standards
• Ss+ Sa + F+ C= I
o Standard set+ Standards applied+
Feedback+ Correction=Improvement
Manager’s role
o Assessor
 The manager observes what is
happening (or what has
occurred) during the transaction
and compares his observation
with the sets standards. = these
standards are derived from the
goals which set as part of the
planning process
o Problem– Solving and Decision making
 manager does not only
determine the reason behind
performance deviations but
must also be able to institute
necessary corrective action.
TYPES OF CONTROL
1. ACCORDING TO APPROACH
a. Control by Inspection =done when the
manager sees and checks the work
himself though direct observation
b. Control by Exception = allowing the
subordinate to evaluate his or her work
output based on the set of standards set
by the manager
2. TIME ELEMENT
Preventive control done on the onset before the
implementing process
o Focus: resources which include
manpower
o Objective: to ensure that only resources
of desired specification and/qualities
enter the process.
Concurrent control= controls that are taking place during
the implementation process.
o Focus: Operating conditions
o Objective : To ensure that the desired
conditions are maintained and problems
are corrected before they come out of
the process
Corrective control takes place at the end of the
implementation stage (after the product is finished or
after the service had been delivered.)
o Focus: Problems that occur after the
process
o Objectives: To avoid problems of the
same nature in the future
Performance Appraisal
o Performance Appraisal is a control
process in which employee's
performance is evaluated against
standards.
o most valuable tool in controlling human
resources & productivity.
o is the formal evaluation of an employee.
Each employee should be evaluated by
line supervisor by a superior, usually a
manager or supervisor.
o annual, semi-annual, or quarterly.
o The employee’s behavior is compared
with a standard describing how the
employee is expected to perform
o evaluates an employee’s skills,
achievements, and growth--or lack
thereof.
Types of Evaluation Devices
Performance Checklist
- Consist of a list of performance criteria (task in
JD) with corresponding blanks wherein an
evaluator is asked to indicate for each criterion
whether the nurse has exhibited the desired
behavior.
Behaviorally Anchored Rating Scale (BARS)
 - In BARS technique a separate rating instrument
is developed for each job to develop each tool,
staff help the manager to identify key dimension
and determine the relative weight of each
dimension for total job performance
o 1st evaluation - end of orientation
o 2nd eval. -3rd month
o 3rd eval. -6th month
o Bi- annual -q 6 mo.
o Annually - use PPMCC
Free response report
- Evaluator is asked to submit written report on
the quality of the nurse’s performance in a
particular position over a given period of time.
No direction on which performance is to
evaluated assessment is not comprehensive
Simple Ranking
- Evaluator ranked the employee according to
how he fared with his co-workers with respectto
certain aspects of performance - Maybe ranked
with regard quality of performance, to patient
care measures, quality of contribution to a
project
Forced- choice Comparison
- Evaluator is asked to choose from a group of
weighted descriptive statement those that best
describe the nurse being evaluated and those
that least described her
Self Appraisals
- Employees are asked to submit written
summaries or portfolios of their work related
accomplishment and productivity as part of self
appraisal process.
- Portfolios often provide examples of continuing
education, professional certification awardsand
recognition
Peer Review
- When peer rather than supervisor carry out
monitoring and assessing work performance
- Provide feedback that could promote growth
- Provide learning opportunities for peer
reviewers
Common Errors in Evaluation
1. Halo Error – allowing one trait to influence the
evaluation of other traits or of rating all traits on
the basis of a general impression
2. Horns Error – opposite of the halo effect and the
evaluator is hypercritical a recent mistake may
offset a year’s good work
3. Logical Error – rating a nurse high on one
characteristic because the nurse possesses
another characteristics that is logically related.
4. Contrast Error – the tendency of the managers to
rate the nurse opposite from the way they
perceive themselves. A perfectionist manager
may rate personnel lower than they should
5. Recency Error • is the rater’s tendency to allow
more recent incidents (either effective or
ineffective) of employee behavior to carry too
much weight in the evaluation of performance
over an entire rating period.
6. Central Tendency Error- is the raters’ tendency
to avoid making “extreme” judgments of
employee performance resulting in rating of all
employees in the middle part of a scale
Developing and Using Standards For Performance
Appraisal
- Performance standard is the work a manager
performs to establish criteria by which work and
results can be measured and evaluated (How
much we require), derived from JD,JA and job
evaluation
- Measure =are the yardsticks use to judge how
well you have done each accomplishment (what
to evaluate)
- General Measures= Tell what is important, in
general, about each accomplishment. They are
used when you have difficulty identifyingspecific
measures for a particular accomplishment
o Quantity: how many ,rate or volume
o Quality: how well accuracy,
completeness originality
o Cost : how much, cost limits the
employee has to work within •
o Timeliness: when deadline by which the
accomplishments will be completed
o Specific Measures = use words to
evaluate the accomplishment you want
to track. They define how will you know
whether the quantity ,quality, cost, or
timeliness standards have been met
Employee discipline systems
- Discipline – the act of influencing behavior
through reprimand
o Discipline is a part of the controlling
process in management.
 o It is a constructive and effective means
by which employees take personal
responsibility for their own performance
and behavior, this is termed as self-
discipline
- Progressive discipline – the process of tying
reprimands to the severity and frequency of
misbehavior
- Self-Discipline
o The process by which rules are
internalized and become part of the
person’s personality.
o Highest and most effective form of
discipline.
- Discipline should be administered promptly,
privately, thoroughly and consistently following
employee’s offense.
Strategies to Create an Environment of Self-Discipline
- Clearly written and communicated rules and
regulations.
- Atmosphere of mutual trust.
- Judicious use of formal authority.
- Employee identification with organizational
goals.
Constructive Discipline
- Primary focus is to assist the employee tobehave
in a manner that allows him or her to be self-
directed in meeting organizational goals
Destructive Discipline
- Arbitrarily administered and either unfair in the
application of rules or the resulting punishment.
McGregor’s (1967) Hot Stove Rule
- Forewarning- must know the rule beforehand
and be aware of the punishment
- Immediate consequences-all discipline should
be administered immediately after rules are
broken
- Consistency-each time the rule is broken, there
are immediate and consistent consequences
- Impartiality-everyone must be treated in the
same manner when the rule was broken
Four Common Steps in Progressive Discipline
1. Informal reprimand or verbal
reprimand.
2. Formal reprimand or written
reprimand
3. Suspension from work without pay.
4. Termination.
The Disciplinary Conference
1. State problem clearly.
2. Ask employee why there has been no
improvement.
3. Explain disciplinary action to be taken.
4. Describe expected behavioral change.
5. Get agreement and acceptance of the plan.
The Termination Conference
1. State the facts of the case and the reason for
termination.
2. Explain the termination process.
3. Ask for employee input and respond calmly and
openly.
4. End the meeting on a positive note, if possible
Termination
Should always be the last resort when dealing with poor
performance but is necessary for employees who
continue to break rules despite repeated warnings.
The Formal Grievance Process
- A grievance is essentially a statement of
wrongdoing.
- The steps of the formal grievance process are
generally outlined in union contract or
administrative policies.
- Generally entails progressive lodging of
complaints up the chain of command.
- If differences not settled in formal grievance, it
generally proceeds to arbitration
Correcting Performance
COACHING
- Continuous reinforcing task that are well done
and extending assistance to areas where
improvement is necessary
Performance Deficiency Coaching
- Manager actively brings areas of unacceptable
behavior or performance to the attention of the
employee and works with him or her to establish
a plan to correct deficiencies
Reflective Practice or Clinical Coaching
- Both individuals determine the agenda jointly,
with the goal of an environment of learning that
 can span the personal and professional aspects
of the employee’s experience
COUNSELLING
- Assisting and giving advice to an individual or
group for the purpose of helping them grow and
develop self-direction, self-discipline and
individual responsibility.
Job Counseling-
- deals with job related problem
- Personal Counseling- deals with
psychological ,moral, religious , social problems
affecting the individual or family
Manager’s Role in Correcting Performance
1. Employee Counseling – to facilitate where she/
he listen more than talk
2. Directive Counseling– the interviewer knows in
advance what will be discussed
a. gives advice, makes suggestions and
help individual makes meaningful
decisions
b. few and short, dished out in a take –it or
leave- it basis
c. counselor telling one what to do
3. Non -Directive Approach - allowing the
employee to have maximum freedom in
determining the course of interview
a. Provides opportunity to think through
problems out loud
4. Non coercive counseling- it is half way between
the two approaches
QUALITY ASSURANCE
QUALITY
- The degree of excellence
- Gives people with different functions in the
organization a common language for
improvement
ASSURANCE
- Achieving a sense of accomplishment and
implies a guarantee of excellence
- A formal guarantee of a degree of excellence
QUALITY OF CARE
The degree to which health services for individuals and
populations increase the likelihood of desired health
outcomes and are consistent with the current
professional knowledge.
It is the balance of benefits and harms to a client of
effectiveness and efficiency and appropriateness of care
QUALITY ASSURANCE
- A process of evaluation that is applied to the
healthcare system and the provision of health
care services by health workers.
- It promotes collegial and sharing relationships
among workers instead of a feeling of threat
when observed and evaluated. It focuses on the
care and the service the patient receives.
 "Fit for purpose" (the product should be suitable
for the intended purpose);
 "right first time" (mistakes should be eliminated).
 It is a way of preventing mistakes and defects in
manufactured products and avoiding problems
when delivering products or services to
customers
PRINCIPLES UNDERLYING QUALITY ASSURANCE EFFORTS
 All health professionals should collaborate inthe
effort to measure and improve care.
 Coordination is essential in planning a
comprehensive quality assurance program.
 Resource expenditure for quality assurance
activities is appropriate.
 There should be focus on critical factors such as
functions and activities that promise to yield the
greatest health and financial benefit to reveal
significant findings.
 Quality patient care is accurately evaluated
through adequate documentation.
 The ability to achieve nursing objectivesdepends
upon the optimal functioning of the entire
nursing process and its effective monitoring.
 Feedback to practitioners is essential to improve
practice. It perpetuates good performance and
replaces unsatisfactory interventions with more
effective methods.
 Peer pressure provides the motivation to effect
prescribed changes based on the results of
assessment and needed improvements on the
quality of care.
 Reorganization on the formal organizational
structure may be required if assessment reveals
the need for a different pattern of health care.
 Collection and analysis of data should be utilized
to motivate remedial action.
QUALITY ASSURANCE METHODS
The primary purpose of quality assurance programs in
nursing is to measure and improve the quality of nursing
delivered in the agency.
Developing Quality Assurance Criteria
 A CRITERION should be a clear statement of the
quality, quantity, or characteristic s of a chosen
variable against which acceptability of a
particular nursing intervention can be measured.
 Criteria developed for a nursing audit, care
profile analysis or peer review should be
considered a model of excellence toward with
each nurse will aim in her nursing activities
APPROACHES TO QUALITY ASSURANCE
 Structure Approach – - includes physical setting,
instrumentalities and conditions through which
nursing care is given.
 Process Approach - includes the steps in the
nursing process in compliance with established
standards of nursing practice; how the care was
carried out.
 Outcome Approach - Identifies desirable
changes in the patient’s health status includes
modification of symptoms, signs, knowledge,
attitudes, satisfaction, skill level, and compliance
with the treatment regimen.
Three Categories of Outcomes (Buppert, 2000)
 Medical Outcomes - the rate of complications,
attainment of therapeutic goals, and
improvement of functional status measures.
 Service Outcomes- - patient satisfaction,
minimal waiting times, prompt follow-up of
abnormal data, and prompt attention to patient
telephone queries.
 Cost outcomes - decreasing the cost of treating
an illness episode, decreasing hospitalization
costs, and decreasing emergency department
visit costs
Quality Control
 Activities that evaluate, monitor, or regulate
services rendered to consumers.; product
oriented activity
 focused on finding defects in the product as it is
being developed done by testing; an evaluation
process
Three Steps of the Quality Control Process:
 The criterion or standard is determined.
 Information is collected to determine if the
standard has been met.
 Educational or corrective action is taken if
the criterion has not been met.
TOTAL QUALITY MANAGEMENT
 A way to ensure customer satisfaction by
involving all employees in the improvement of
the quality of every product or service. All
systems are evaluated and improved.
 It aims to reduce waste and cost of poor quality.
Product and services should be free from defects
thereby becoming cost effective
 It is a structured system for involving an entire
organization in a continuous quality
improvement process targeted to meet and
exceed customer expectations.
 An organizational commitment to satisfying
customers through the use of an integrated
system of tools, techniques and training.
 It involves the continuous improvement of
organizational processes, resulting in high-
quality products and services.
Continuous Quality Improvement
 Continuous quality improvement, or CQI, is a
management philosophy that organizations use
to reduce waste, increase efficiency, and
increase internal (meaning, employees) and
external (meaning, customer) satisfaction.
 It is an ongoing process that evaluates how an
organization works and ways to improve its
processes.
Quality Management Heroes:
W. Edwards Deming (1982)
 With his 14-point management philosophy, was
primary responsible in training engineers in the
US to improve quality of military goods during
World War II an was a key figure in training the
Japanese
 He was the genius who revitalized Japanese
industry with his focus on Total Quality
Management and CQI
 Deming introduce the plan-do-check-act
cycle.(PDCA)
o Is a four-step model for carrying out
change. Just as a circle has no end, the
PDCA cycle should be repeated again
and again for continuous improvement
o Enables teams to avoid recurring
mistakes and improve processes.
 Walton FOCUS-PDCA meaning:
o Find the process to improve
o Organize a team that knows the process
 o Clarify current knowledge of the process
o Understand causes of process variation
o Select the process improvement
o Plan the improvement and continue
data collection
o Do the improvement, data collection,
and analysis
o Check the results and lessons learned
from the team effort
o Act to hold the gain and to continue to
improve the process
Joseph Juran ( 1981, 1989)
 His trilogy of interrelated processes of quality
planning, quality control and quality
improvement was also used to train the
Japanese. He is an advocate for total quality
management (TQM)
o Quality Planning is the activity of
developing the products and processes
required to meet customer's needs.
o Quality Control
o Quality Improvement- This processisthe
means of raising quality performance to
unprecedented levels (breakthrough).
Philip Crosby ( 1992)
 Has 14 steps that emphasize training all
employees, using teams, setting goals, and
recognizing employees for their involvement.
 doing it right the first time,” (DIRFT)
Tools and Processes for CQI:
1. Bar graph a series of bars representing
successive changes in the value of a variable or
different data set.
2. Benchmarking is a process of identifying best
practices and comparing them with the agency’s
practices to improve performance.
3. Brainstorming is a process of creating a free flow
of ideas without fear of criticism and then
thinking about the good in the wild ideas
generated.
4. Cause-and-effect diagram or Fishbone diagramis
used to identify the root causes of a problem or
outcome.
5. Check sheets are grid that can be used to collect
and classify data. They are good tools to identify
key performance indicators
6. Decision Matrix a grid that helps priorities option.
Process:
7. Histogram is a bar graph that can be used to
compare patterns of occurrence over time
8. Flow Process chart helps analyze how a task is
being performed
9. Gantt Chart is a grid with a time frame across the
top that could be in minutes, hours, days, weeks,
months, years, and decades depending on the
time frame of the process.
10. Nominal Group Technique is a process for
developing team goals and priorities.
11. Pareto Chart is a bar graph that displays
categories of data in descending order of
frequency or significance from the left to the
right.
12. Pie Chart compares relative size of differentdata
sets in a circle instead as of bars on graph.
13. Program Evaluation and Review Technique
(PERT) is a system model for planning that
identifies key activities in a project and
sequencing of those activities in a flow diagram
with duration of each phase of the program
assigned
14. Radar Charts are circular displays of beforeand-
after data to demonstrate programs made or
lost
NURSING QUALITY Assurance Activities
Audit is the activity of review when conducted on a
continuous and routine basis
1. NURSING AUDIT COMMITTEE
a. composed of representatives of all levels
of nursing staff: Training Staff Member,
Supervising Nurse, Head Nurse or Senior
Nurse, Staff Nurse
b. Utilizes the developed process or
outcome criteria to evaluate nursing
care
c. Designates a day within a week to be the
audit day.
d. in smaller hospitals the chief nurse or
her assistant may be a member
2. PATIENT CARE AUDIT
a. Topically may be of several Types:
b. An audit may focus on a particular
diagnosis such as DM
i. on a diagnostic test such as PET
Scan –
ii. on a problem such as transfer of
patient from an acute to
extended care facility or
iii. on a process such as
tracheostomy care
c. TYPES:
 i. Concurrent Audit one in which
patient care is observed and
evaluate as it is given
ii. Retrospective Patient Care -
Patient’s chart is evaluated only
after the patient’s discharge
from the health facility.
Clinical audit - measuring the quality of care we provide
against relevant standards.
3. PEER REVIEW
a. Patient care audits maybe done by peers
(employees of the same profession,rank,
setting) evaluating another’s job
performance against accepted
standards
4. Quality Circles
a. A means of motivating employees to
improve the quality of nursing care that
is delivered to the patient.
b. every member of the circle participating
to the full, carries on the activities,
utilizing problem solving techniques to
achieve control or improvement in the
work area and also help self and mutual
development in the process.
Reports
 Oral, taped or written exchanges of information
between nurses and/or members of healthteam.
- Change-of-shift-reports/Hand-over Report
o System of communication aimed at
transferring essential information and
holistic care for patients.
o Oral Report – pre-conference made at
Nurses’ station prior to the nursing
rounds - should be done quickly and
efficiently Reports
o Audio-tape report – made by the
outgoing nurse and is replayed by the
incoming nurse.
o Nursing Rounds – made at the patient’s
bedside. The patient’s care plan is
discussed.
- Telephone Reports and Orders
o no telephone orders –
o In case of emergency it should be
accurately received only “read back”and
transcribed by the receiving medical
resident in written form. –
o such orders should be sign within 24
hours by the ordering physician on his
next visit to the hospital.
- Transfer Reports
o it contains the summary of the medical
progress up to the time of transfer,
current health status, current nursing
diagnosis or health problems and care
plan or critical assessments or
interventions to be completed after
transfer and the special equipment
necessary.
Records
- Printed or written that can be as record or proof
for authorization.
- Documentation of nursing care should be
pertinent and concise and should reflect the
patient’s status.
- Nursing documentation shall address the
patient’s needs, problems, capabilities and
limitations.
- Nursing interventions provided and the patient’s
responses should be noted.
RECORDS/ FORMS
 Nursing Health History and Assessment
Worksheet B
 Graphic Flow sheets
 Medicine and Treatment Record
 Nursing Kardex - flip-over card that has two
parts: an activity and treatment section and a
nursing care plan section.
 Discharge Summary -- a special progress report
that helps ensure that a client’s discharge results
in desirable outcomes
 Nurses Progress Notes - narrative descriptionsof
patient’s progress toward goal achievement.
 SOAP Charting
 Multidisciplinary Progress Report
 Discharge Instruction
Guidelines for Good Reporting & Documentation
1. Factual- based on facts, objective not
opinion
2. Accurate- reliable, timed, dated, correct
spelling
3. Confidential- shared by members of health
team
4. Complete-concise, described nursing care
rendered
5. Current-updated, omission avoided
6. Organized- logical format of reporting
7. Ethical -described what patient did, refrain
from using terms as “uncooperative", can
use the word “refuse”
Purposes of Records
1. Communication-members of health team can
keep track of patient’s progress.
2. Legal evidence of care -description of what
happen, admissible in court as evidence
3. Education-used for study to learn the case,
disease
4. Financial Billing -finances reimbursement, HMO
5. Evaluation of quality of care rendered
6. Research & Statistical Information-client
population, frequency of disorder, complication
Documentation
 Nurses are expected to document fully,
accurately legibly and promptly their
observations and care they rendered from
admission to discharge.
 Patient’s response
 Inaccurate document –cause unnecessary delay
in the treatment, basis for lawsuits
 Rule “What was not written ,was not given or
observed
 Do not make erasures. Draw a line through the
error & write the word “mistaken entry" above
it, sign your name or initials & make correct entry
after it.
INVENTORY
 It is an administrative tool designed to control
supplies and equipment by listing the names,
description, number and location of supplies.
 Economic order quantity – method that orders a
fixed number of items every time an inventory
level falls to a predetermined point
 Just-in-time scheduling (JIT) – schedules
materials to arrive at a work station or facility
“just in time” to be used; reduces carrying costs
and maximizes use of space
 Kinds of Inventory
o Perpetual Inventory – recording is done
as soon as supplies were used and
replenished, thus indicating the number
of supplies on hand at a time.
o Physical Inventory – is the actual count
made at designated intervals to correct
accumulative errors resulting from loss,
breakages or deterioration
Project management
 Makes sure that all activities in a project are
completed on time, in the order specified, and
with high quality
Statistical quality control
 The use of statistical techniques to assist in
quality control (i.e. checking processes, material,
products, services to ensure that they meet high
standards)
LEGAL ASPECTS OF NURSING AND LIABILITIES
LAW
 the sum total of rules and regulation by which
society is governed
 Man-made and regulates social conduct in a
formal and binding way.
 Reflects society’s need , attitudes and mores” -
rules of conduct pronounced by controlling
authority and which may be enforced.
 set of rules established by a governing power to
guide actions, regulate conduct of the people
and imposed sanctions for violation or
noncompliance thereof.
Two general divisions of Law:
 Natural Law – integral part of nature because it
is immutable and inherent in the nature of man
or any element or part of the universe. -
conscience or code of moral conduct
 Positive Law – precept made and imposed by
some authority.
Branches of Law that are directly applicable to Nursingin
their Jurisdiction
 Constitutional Law – Fundamental law of the
country.
 Criminal Law – branch of law which defines
crimes threats of their nature and provides for
their punishment.
 Civil Law – branch of law that pertains “to the
organization of the family and the regulation of
the property
 Labor Law – branch of law that regulates the
relationship of employers and employee.
 Administrative Law – deals with the activities
and functions of executives.
 Civil Service Law – branch of law that deals with
civil service in all branches. G
 Case Law –a body of prevailing decision of the
Supreme Court interpreting the law and
controversies.
NURSING JURISPRUDENCE nursing profession through the institution of
measures for the attainment of the following:
 Branch of law which deals with the study of o Relevant nursing education
nursing laws, lawsuits, liabilities, legal principles,
o Humane working condition
rules and regulations, case laws and doctrines
o Better career prospect
affects nursing practice.
o Dignified existence of the FilipinoNurses.
 State guarantee – government's commitment to  TORTS –- Willful acts that are intentional and
deliver quality health care services by providing cause injury
adequate nursing personnel throughout the o INTENTIONAL - a direct violation of a
country. person’s legal rights and includes
RA 7305  Assault – unjustifiable attempt
to touch a person without
 Magna Carta of Public Health Workers consent that result in fear of
 Promote and improve the social and economic immediately harmful or
well – being of health workers. threatening contact
 To develop their skills and capabilities,  Battery – a lawful, harmful or
 To encourage those qualified and with abilities unwarranted touching of
to remain in government service. another or anything held or
Act no. 2493 of 1915 attached to a person without
consent
 History of the Philippine Nursing Law  False Imprisonment/ Illegal
 First True Nursing Law Detention -unjustifiable
 This Law also specifically prohibits the practice of detention of a person within
nursing without having been conferred or fixed boundaries or an act
obtained the proper certificate of registration intended to result in such
from the board of examiners for Nurses confinement without consentor
without authority
1921
 The hospital ensures
 Filipino Nurses Association was established(now that physical restraint
PNA) as the National Organization of Filipino will only be used to
Nurses – PNA: 1st President ± Rosario Delgado control patients who
are in danger of harming
RA 877 themselves and/ or
 Philippine Nursing law was enacted by Congress others, or for children
-for the first time, the board was composed of: – who may not be capable
three nurse, a chairman, two members with of remaining still during
additional powers and duties a procedure to ensure
immediate physical
1958 safety of patient, staff
and others.
 The president of the Philippines designated the
 Right to Privacy right to be left
last week of October every year beginning in
alone, the right to be free from
1958 as nurses’ week
unwarranted publicity and
Republic Act 7164 or the "Philippine Nursing Act of 1991 exposure to public view as well
as the right to live one’s life
 The use of nursing process as a scientific without having anyone’s name,
discipline in arriving at an appropriate nursing picture or private affairs made
action and care public against one’s will
RA 9173  Confidentiality assures the client
that information obtained by a
 Philippine Nursing Act of 2002. nurse while giving him or her
 The state responsibility – government’s care will not be communicated
responsibility to protect and imposed the to anyone who does not have a
 need to know (Cushing, 1988) or
not part of the team taking care
of the client.
o Defamation –oral or written
communication to someone that injure
the person’s reputation.
 Slander – when one damages
reputation of another by
speaking false words Example –
Voicing opinion that the patient
is Drug Dependent.
 Libel – written words or images
that injures a person's
reputation. Example – such as earthquake ,storm
judgmental, critical or
speculative written in patient's
chart (the patient is drug
dependent.)
o Negligence - omission to do something
that a reasonable person would do or
commission of an act that reasonably
prudent person would not do under
similar circumstances.
o Malpractice- The failure of a person with
professional training to act in a
reasonable and prudent manner—alsois
called professional negligence.
 Idea of improper or unskilled
care of a patient by nurse
 denotes stepping beyond one’s
authority with serious
consequences
 negligence or carelessness of
professional personnel
 refers to a negligent act of
committed in the course of
professional performance
(Lesnik, 1962)
o UNINTENTIONAL - Careless acts or
accidents that cause injury..
(negligence/malpractice)
Related Doctrines to Negligence
 Doctrine of Respondeat Superior
o “let the master answer for the action of
the subordinate”
o A law suit for negligent act performedby
the nurse will also name the employer
o Legal doctrine that holds an employer
liable for negligent acts of employees in
the course and scope of employment
oPhysician, hospital s and clinic and other
employers may be held liable for the
negligent acts of the employees
 Doctrine of Res Ipsa Loquitur
o “The thing speaks for itself”
o In some cases the harm cannot be trace
to a specific healthcare provider or
standard but does not normally occur
unless there has been a negligent act.
o A harm that results when instruments
are left in a clients during surgery
 Doctrine of Force Majeure
o “irresistible or superior force" calamities
o no person shall be responsible for their
acts which can not be foreseen or
though foreseen are inevitable.
 Good Samaritan Law
o tate that the health care providers are
protected from liability if they volunteer
their nursing skills away from the
workplace provided action taken are not
grossly negligent. (Limited to
emergencies).
o when assisting during an emergency
nurses must still observe professional
standards of care
Incompetence
 lack of ability, legal qualifications or fitness to
discharges the required duty or inability to
perform a required duty
LEGAL SAFEGUARDS
 Proper Record Keeping, Reporting, and
documentation.
a. The old adage “not documented, not
done” holds true in nursing.
b. Contemporaneous—documenting your
care at the time it was provided
c. Accurate—documenting exactly what
you did
d. Truthful—documenting only what you
actually did or observed
e. Appropriate—documenting only what
you would be comfortable discussing in
a public setting
Charting
 Charting should factual-chart what you see, not
what you think happened
  Charting should be legible with no erasures.
Corrections should be made with a single line
drawn through the error and initialed
 Informed Consent
a. is the process in which the patient
consents to undergo a procedure after
having received adequate information
about the procedure
b. Obtained only after the patient receives
full disclosure of all pertinent
information regarding the surgery or
procedure and only if the patient
understands the potential benefits and
risks associated with doing so
c. It’s a legal document and an agreement
for a proposed medical treatment or no
treatment, or for a suggested invasive
procedure.
Types of Consents
 Express consent – formal and stated
verbally or in writing
 Implied consent- agreement is
presumed or inferred from the acts of
the parties, may arise from mere
consent; this means there are no words
spoken understands it and does not
need a detailed explanation.
 Incident Reports
a. Are records of unusual or unexpected
incidents that occur in the course of
patient’s treatment.(med error, falls,
accidents involving visitors, employee or
patients and unsafe condition.
PERSONAL AND PROFESSIONAL DEVELOPMENT
A person's self-image is the personal view or
mental picture that we have of ourselves,
generally of a kind that is quite resistant to
change, depicts details that are potentially
available to objective investigation by others
(height, weight, hair color, sex, I.Q. score, is,etc.)
describes the characteristics of the self, including
such things as intelligent, beautiful, ugly,
talented, selfish, and kind
representation of our assets (strengths) and
liabilities (weaknesses)
items that have been learned by that person
about himself or herself, either from personal
experiences or by internalizing the judgmentsof
others.
License – is a legal document given by the
government that permits a person to offer tothe
public his skill and knowledge in a particular
jurisdiction where such practice would
otherwise be unlawful without a license.
R.A 9173 Purpose of Registration
To protect the health of the people by
establishing minimum standards which qualified
practitioners must meet.
Registration - is the recording of names of
persons who have qualified under the law to
practice their respective professions
Reciprocity - means mutuality in the grant and
enjoyment of privileges between persons or
nation. It is based on the principle of “do ut des’
which means that for a country to expect a favor
from another, it should be willing to give a
corresponding favor.
REVOCATION/SUSPENSION OF CERTIFICATION
For unprofessional and unethical conduct.
Roles and responsibilities of beginning nurse practitioner
Dr. Patricia Benner nursing theorist who first
developed and established the theory that
expert nurses develop their skills and
understanding of patient care over time
through a comprehensive educational base
as well as a variety of experiences.
She described 5 levels of nursing experience
as;
o Novice
o Advanced beginner
o Proficient
o Expert
o Competent
Nurse Practitioner
A Nurse Practitioner (NP) is an Advanced Practice
Registered Nurse (APRN) that has earned either
a Master's of Science in Nursing (MSN) or a
Doctor of Nursing Practice (DNP). They have
more authority than RN and have similar
responsibilities to that of a doctor.
Different Fields of Nursing
A Certified Registered Nurse Anesthetist (CRNA)
is a highly trained nurse that specializes in
assisting with anesthesia during surgeries.
Travel Nurse you want to live and work in
different settings in order to gain both
 professional and life experience by exploring 4. Nurse researcher
various settings 5. Nurse educator
Geriatric Nursing specializes in the treatment of 6. Acute care nurse practitioner
older patients in order to provide care for 7. Nurse entrepreneur
injuries or ailments, illness and maintain their 8. Operating home nurse
quality of life. In addition to caring for older 9. Travel nurse
patients, they can also anticipate future care for 10. Nurse oncologist
their patients and long-term illnesses such as 11. Nurse informatics
cancer or Alzheimer’s disease. 12. Sport nurse
Family Nurse Practitioner (FNP) specifically 13. hospice nurse
trained in primary health care services for all 14. space nurse
ages. Normal duties of a family nurse 15. Tele nurse
practitioner include diagnosing and treating 16. Cruise nurse
illnesses, physical exams, diagnostic testing and 17. Disaster nurse
prescribing medications. 18. Nurse as author
Clinical Nurse Specialist who provide direct 19. Epidemiological nurse
patient care by working with other nurses and 20. Ethicist
staff to improve the quality of care a patient The American Nurses Association (ANA)
receives. They often serve in leadership roles Founded in 1896, the American Nurses
and may educate and advise other nursing staff Association (ANA) serves as one of the oldestand
REHABILITATION NURSE as a nurse who largest professional nurse organizations in the
specializes in assisting with disabilities and country.
chronic illness to attain optimal function, health, The National League for Nursing (NLN) The NLN
and to adapt to an altered life style was founded in 1893 and is the oldest of the
OCCUPATIONAL HEALTH NURSE The professional nurse organizations in the United
occupational health nurse work in traditional States. The NLN represents nursing education in
manufacturing, industry services, construction healthcare organizations and institutions of
sites and government setting higher learning.
NURSE EPIDEMIOLOGIST- - Nurse epidemiologist Philippine Nurses Association Filipino Nurses
searches for new diseases and its reporting and Association (FNA). It was founded by Anastasia
taking part in health programs. Giron-Tupas in 1922. the only accredited
PSYCHIATRIC NURSE- - it is a branch of nursing professional organization recognized by the
that deals with mentally challenged and Professional Regulation Commission,
mentally disturbed clients and their needs. -The Membership in the PNA is mandated by the RA
role includes educator, surrogate, counselling, 9173, one of the requirements to practice
psychotherapist and advocate nursing and encourage everyone to join the PNA
DISASTER NURSING - the adaptation of
professional nursing skills in recognizing and Inactive Nurses:
meeting the nursing, physical, emotional and Nurses who have not actively practiced the
social needs resulting from a disaster profession for 5 consecutive years, are required
FORENSIC NURSE - One who is suspected to be to undergo one month of didactic training and
acquainted with the basics of forensic medicine three months of practicum
so as to handle and preserve the evidentiary
materials FORMAL Studies Leading to Degree courses
PRISON NURSE Registered nurse who works in a Baccalaureate Degree in Nursing
prison. Can either be employed directly byprison Graduate Education in Nursing
service or can work in the other areas and spend Doctoral Degree Program
part of their working week in the prison health
care Resigning and Dismissal from a position
Expanded Role Of Nurse
1. Advanced nurse practitioner A resignation letter is a document that notifies
your employer that you are leaving your job. It
2. Clinical nurse specialist
formalizes your departure from your current
3. Nurse anesthetist
 employment, and can be written as a printed
letter or an email message.
Dismissal From A Position
o Dismissal (also referred to as firing) is
the termination of employment by an
employer against the will of the
employee.
IMAGE BUILDING OF PROFESSIONAL NURSE
The image of the nurse does not simply happen. The
image is created. If nursing subscribe to this belief,
nurses should acknowledge all responsibility to
participate in shaping the admirable image of the
professional nurse!
Career Development
Should be viewed as a lifelong process involving
both the individual and the environment in
which he or she lives.
Is accomplished through self-and work
environment assessment, job analysis,
education, training, job search and acquisition,
and work experience
Career Planning
The subset of career development that
represents individual responsibility
Includes evaluating one’s strengths and
weaknesses, setting goals, examining career
opportunities, and using appropriate
developmental activities
Career Management
Know yourself (Knowing Interests, Aptitude,
Personality)
Career Awareness (Based on Interests, Aptitude,
Personality)
Take Action (Planning Education and Skills
development )
RESUME
A résumé is a one-page summary of your work
and school experiences.
Employers match your résumé against their job
openings to evaluate if you'd be a good fit.
Make your résumé a good representation of
yourself.
A header should include your name, phone
number and email address. You can also include
your mailing address, but leave it out if you plan
to post your résumé online.
Interview
a one-on-one conversation between an
interviewer and an interviewee.
Describe a formal consultation for the purpose
of evaluating the qualifications of the
interviewee for a specific position
Job Interview
- consisting of a conversation between a job
applicant and a representative of an employer
which is conducted to assess whether the
applicant should be hired.
Structured interview in which an applicant is
asked a predetermined list of questions in a
specified order; - structured interviews are
usually more accurate predictors of which
applicants will make suitable employees
Prepare for the Interview
take the time to review the most common
interview questions you will most likely be asked,
along with examples of the best answers.
Take the time to consider how you'll respond.
Interviewers will ask questions about you togain
insight into your personality and to determine
whether you're a fit for both the job and the
company.
Employers almost always ask about why you left,
or are leaving, your job
Common Interview Questions
Why should you be hired over the other
applicants? What makes you the best candidate
for the job?
to determine is whether you're qualified for the
job
Questions About Your Work History
Your work style, and how you get along with
others, including co-workers, managers, and
customers or clients is important to all
employers
Why do you want this job?
What is your philosophy of nursing?
What strengths and weaknesses do you bring to
this job?
Why should we hire you? Why us?
What is your 20-year career plan?
Can you define professionalism in nursing
practice?
What do you know about our organization?
Common Job Interview Mistakes of Applicants
1. Arriving so early you appear over-anxious.
2. Saying too much.
3. Wearing a coat/hat during the interview.
4. Wearing psychologically intimidating colors or
patterns.
5. Sitting down before the interviewer does or
addressing the interviewer by his or her first
name.
6. Asking about salary, vacation, or promotions too
early in the interview
7. Bad-mouthing or revealing confidential
information about a former or current employer.
8. Not having any questions.
9. Overstating your accomplishments.
10. Having a “what can you do for me?” attitude.
11. Being vague, rambling, or evasive, all of which
show poor communication skills.
12. Lacking clear direction regarding what you want
in your career.
13. Showing apathy or lack of motivation
After the Interview
1. Send a thank you note to the interviewer.
2. If offered the job, send a formal letter accepting
or rejecting the job.
3. Personally critique the interview experience.
Review in your mind what you did well and what
you would do differently the next time.
11 Key Areas of Responsibility / Core Competency /
Indicators
Safe and Quality Nursing Care
Core Competency 1: Demonstrates knowledge base on
the health /illness status of individual / group
Indicators
• Identifies the health needs of the clients
(individuals, families, population groups
and/or communities)
• Explains the health status of the clients/
groups
Core Competency 2: Provides sound decision making in
the care of individuals / families/groups considering their
beliefs and values
Indicators
• Identifies clients’ wellness potential and/or
health problem
• Gathers data related to the health condition
• Analyzes the data gathered
• Selects appropriate action to
support/enhance wellness response;
manage the health problem
• Monitors the progress of the action taken
Core Competency 3: Promotes safety and comfort and
privacy of clients
Indicators
• Performs age-specific safety measures in all
aspects of client care
• Performs age-specific comfort measures in
all aspects of client care
• Performs age-specific measures to ensure
privacy in all aspects of client care
Core Competency 4: Sets priorities in nursing care
based on clients’ needs
Indicators
• Identifies the priority needs of clients
• Analyzes the needs of clients
• Determines appropriate nursing care to
address priority needs/problems
Core Competency 5: Ensures continuity of care
Indicators
• Refers identified problem to appropriate
individuals / agencies
• Establishes means of providing continuous
client care
Core Competency 6: Administers medications and other
health therapeutics
Indicators
• Conforms to the 10 golden rules in
medication administration and health
therapeutics
Core Competency 7: Utilizes the nursing process as
framework for nursing
7.1 Performs comprehensive and systematic
nursing assessment
• Obtains informed consent
• Completes appropriate assessment forms
• Performs appropriate assessment
techniques
• Obtains comprehensive client information
• Maintains privacy and confidentiality
• Identifies health needs
7.2 Formulates a plan of care in collaboration
with clients and other members of the health
team
• Includes client and his family in care
planning
• Collaborates with other members of the
health team
• States expected outcomes of nursing
intervention maximizing clients’ competence
• Develops comprehensive client care plan
maximizing opportunities for prevention of
problems and/or enhancing wellness
response
• Accomplishes client-centered discharge plan
7.3 Implements planned nursing care to
achieve identified outcomes
• Explains interventions to clients and family
before carrying them out to achieve
identified outcomes
• Implements nursing intervention that is safe
and 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 toward expected outcomes
• Monitors effectiveness of nursing
interventions
• Revises care plan based on expected
outcomes
Management of Resources and Environment
Core Competency 1: Organizes work load to facilitate
client care
Indicators
• Identifies tasks or activities that need to be
accomplished
• Plans the performance of tasks or activities
based on priorities
• Verifies the competency of the staff prior to
delegating tasks
• Determines tasks and procedures that can
be safely assigned to other members of
the team
• Finishes work assignment on time 6
Core Competency 2: Utilizes financial resources to
support client care
Indicators
• Identifies the cost-effectiveness in the
utilization of resources
• Develops budget considering existing
resources for nursing care
Core Competency 3: Establishes mechanism to ensure
proper functioning of equipment
Indicators
• Plans for preventive maintenance program
• Checks proper functioning of equipment
considering the:
o intended use
o cost benefits
o infection control
o safety
- waste creation and disposal storage
• Refers malfunctioning equipment to
appropriate unit
Core Competency 4: Maintains a safe environment
Indicators
• Complies with standards and safety codes
prescribed by laws
• 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.
Health Education
Core Competency 1: Assesses the learning needs of the
client partner/s
Indicators
• Obtains learning information through
interview, observation and validation
• Analyzes relevant information
• Completes assessment records
appropriately
• Identifies priority needs
Core Competency 2: Develops health education plan
based on assessed and anticipated needs
Indicators
• Considers nature of learner in relation to:
social, cultural, political, economic,
educational and religious factors.
• Involves the client, family, significant others
and other 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, teachinglearning resources and
evaluation parameters
• Provides for feedback to finalize the plan
Core Competency 3: Develops learning materials for
health
Indicators
• Develops information education materials
appropriate to the level of the client
• Applies health education principles in the
education development of information
education materials
Core Competency 4: Implements the health education
plan
Indicators
• Provides for a conducive learning situation
in terms of time and place
• 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: Evaluates the outcome of health
education
Indicators
• Utilizes evaluation parameters
• Documents outcome of care
• Revises health education plan based on
client response/outcome/s
Legal Responsibility
Core Competency 1: Adheres to practices in accordance
with the nursing law and other relevant legislation
including contracts, informed consent.
Indicators
• Fulfills legal requirements in nursing practice
• Holds current professional license
• Acts in accordance with the terms of
contract of employment and other rules and
regulations
• Complies with required continuing
professional education
• 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: Adheres to organizational policies
and procedures, local and national
Indicators
• Articulates the vision, mission of the
institution where one belongs
• Acts in accordance with the established
norms of conduct of the institution /
organization/legal and regulatory
requirements
Core Competency 3: Documents care rendered to
clients
Indicators
• Utilizes appropriate client care records and
reports.
• Accomplishes accurate documentation in all
matters concerning client care in
accordance to the standards of nursing
practice.
Ethico-moral Responsibility
Core Competency 1: Respects the rights of individual /
groups
Indicators
• Renders nursing care consistent with the
client’s bill of rights: (i.e. confidentiality of
information, privacy, etc.)
Core Competency 2: Accepts responsibility
Indicators
• Meets nursing accountability requirements
as embodied in the job description and
accountability for
• own decision and actions
• Justifies basis for nursing actions and
judgment
• Projects a positive image of the profession
Core Competency 3: Adheres to the national and
international code of ethics for nurses
Indicators
• Adheres to the Code of Ethics for Nurses
and abides by its provision
• Reports unethical and immoral incidents to
proper authorities
Personal and Professional Development
Core Competency 1: Identifies own learning needs
Indicators
• Identifies one’s strengths, weaknesses/
limitations
• Determines personal and professional goals
and aspirations
Core Competency 2: Pursues continuing education
Indicators
• Participates in formal and non-formal
education
• Applies learned information for the
improvement of care
Core Competency 3: Gets involved in professional
organizations and civic activities
Indicators
• Participates actively in professional, social,
civic, and religious activities
• Maintains membership to professional
organizations
• Support activities related to nursing and
health issues
Core Competency 4: Projects a professional image of
the nurse
Indicators
• Demonstrates good manners and right
conduct at all times
• Dresses appropriately
• Demonstrates congruence of words and
action
• Behaves appropriately at all times
Core Competency 5: Possesses positive attitude
towards change and criticism
Indicators
• Listens to suggestions and
recommendations
• Tries new strategies or approaches
• Adapts to changes willingly
Core Competency 6: Performs function according to
professional standards
Indicators
• Assesses own performance against
standards of practice
• Sets attainable objectives to enhance
nursing knowledge and skills
• Explains current nursing practices, when
situations call for it
Quality Improvement
Core Competency 1: Gathers data for quality
improvement
Indicators
• Identifies appropriate quality improvement
methodologies for the clinical problems
• 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 9
• Solicits feedback from client and significant
others regarding care rendered
Core Competency 2: Participates in nursing audits and
rounds
Indicators
• Shares with the team relevant information
regarding clients’ condition and significant
changes in clients’ 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: Identifies and reports variances
Indicators
• Reports to appropriate person/s significant
variances/changes/occurrences immediately
• Documents and reports observed variances
regarding client care
Core Competency 4: Recommends solutions to
identified problems
Indicators
• Gives an objective and accurate report on
what was observed rather than an
interpretation of the event
• Provides appropriate suggestions on
corrective and preventive measures
• Communicates solutions with appropriate
groups
Research
Core Competency 1: Gather data using different
methodologies
Indicators
• Specifies researchable problems regarding
client care and community health
• 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 and interprets data
gathered
Indicators
• Analyzes data gathered using appropriate
statistical tool
• Interprets data gathered based on significant
findings
Core Competency 3: Recommends actions for
implementation
Indicators
• Recommends practical solutions appropriate
to the problem based on the interpretation of
significant findings
Core Competency 4: Disseminates results of research
findings
Indicators
• Shares/presents results of findings to
colleagues / clients/ family and to others
• Endeavors to publish research
• Submits research findings to own agencies
and others as appropriate
Core Competency 5: Applies research findings in
nursing practice
Indicators
• Utilizes findings in research in the provision
of nursing care to individuals / groups /
communities
• Makes use of evidence-based nursing to
enhance nursing practice 10
Records Management
Core Competency 1:Maintains accurate and updated
documentation of client care
Indicators
• Completes updated documentation of
client care
• Applies principles of record management
• Monitors and improves accuracy,
completeness and reliability of relevant data
• Makes record readily accessible to facilitate
client care
Core Competency 2: Records outcome of client care
Indicators
• Utilizes a records system ex. Kardex or
Hospital Information System (HIS)
• Uses data in their decision and policy
making activities
Core Competency 3: Observes legal imperatives in
record keeping
Indicators
• Maintains integrity, safety, access and
security of records
• Documents/monitors proper record storage,
retention 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
Communication
Core Competency 1: Establishes rapport with client,
significant others and members of the health team
Indicators
• Creates trust and confidence
 • Spends time with the client/significant others
and members of the health team to facilitate
interaction
• Listens actively to client’s
concerns/significant others and members of
the health team

Core Competency 2: Identifies verbal and non-verbal

cues
Indicators
• Interprets and validates client’s body
language and facial expressions

Core Competency 3: Utilizes formal and informal

channels
Indicators
• Makes use of available visual aids
• Utilizes effective channels of communication
relevant to client care management

Core Competency 4: Responds to needs of individuals,

family, group and community
Indicators
• Provides reassurance through therapeutic
touch, warmth and comforting words of
encouragement
• Provides therapeutic bio-
behavioral interventions to meet the needs
of clients
Core Competency 5: Uses appropriate information
technology to facilitate communication
Indicators
• Utilizes telephone, mobile phone, electronic
media
• Utilizes informatics to support the delivery of
healthcare

Collaboration and Teamwork

Core Competency 1: Establishes collaborative

relationship with colleagues and other members of the
health team
Indicators
• Contributes to decision making regarding
clients’ needs and concerns
• Participates actively in client care
management including audit
• Recommends appropriate intervention to
improve 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:Collaborates plan of care with other
members of the health team
Indicators
• Refers clients to allied health team partners
• Acts as liaison / advocate of the client
• Prepares accurate documentation for
efficient communication of services