DIRECTING
Directing is known as the act of issuing of orders,
assignments, and instructions to accomplish the
organization’s goals and objectives.
It involves the process of getting the organization’s work
done.
It entails explaining what it is to be done, to and by
whom, at what time, how and why the task should be
done.
Directing Includes:
 Delegation of work to be performed
 Utilization of policies and procedures,
 supervision of personnel,
 coordination of services,
 communicating,
 staff development,
 making decisions
Activities Related to the Directing Functions
 telling people what is to be done and explaining
how to do it
 issuing instructions and orders to subordinates
 inspiring them to contribute towards the
achievement of objectives
 supervising their activities
 providing leadership and motivation
Elements of Directing
SUPERVISION:
Comes from the word ‘supervide” meaning “to oversee
or view directly”
It’s an active process of directing, guiding and
influencing the outcome of a person’s performance of
an activity.
Praises the quantity & quality of work performed
Proper and economic utilization of resources
The amount of assistance needed by the worker
The need for staff development and continuing
education program
Legal Implications that pertain to delegation and
supervision:
The nurse whom delegates is responsible for the acts of
the subordinates “ Respondeat superior”
Supervision legally means “personally observing a
function or activity
Delegating functions or activities while retaining the
accountability
Evaluating and ensuring that the nursing care provided
is adequate and delivered appropriately
Qualities of Good Supervision
Good technical, managerial and human relation skills
Ability to communicate well in both spoken &written
language; ability to listen
Firmness and flexibility to adjust to the needs of the
situation
Fairness in dealing with employees
Familiarity with hospital and nursing policies that affect
patient’s care
Good decision making skills
Willingness to grow and develop
Ability to accept changes and consider them as
challenges
Dignified and pleasing personality
Ability to motivate employees and provide opportunity
for continuing education program
Advocacy for nurses and nursing
Principles of good Supervision
Good supervision requires adequate planning and
organization which facilitate cooperation, coordination
and synchronization of services
Gives autonomy to workers depending on their
competencies, personality and commitment
Stimulates the worker’s ambition to grow into
effectiveness
Techniques in Supervision
Observation of the workers while making the rounds
Spot checking of charts through nursing audits
Asking the patients about the care they receive
Looking into the general condition of the units
Getting feedback from co-workers or other supervisors
or relatives
Asking questions discretely
Types of Communication
 Spoken Words
 Written Words
 Physical Expression or Significant Gestures
Verbal Communication
Involves spoken words.
speak slowly, pronouncing the words clearly.
Clearly understood words.
relevant information should be conveyed.
Immediate response is determined.
Non-verbal Communication
Transmission of message without the use of words.
Such as:
 Facial expressions
 Gestures
 Touch
 body language or vocal tones
Written Communication
Must be clear, correct, complete and concise.
Written communication comes in a form of
memoranda, hospital orders, documentation, records
and reports, policies, procedures and the like.
Ambiguous terms should be avoided.
Four – dimensional Flow of Communication in Nursing
Care
Principles of Effective Communication:
Feedback is essential to effective communication
Communication thrives best in a supportive
environment
A manager’s communication skill is vital to the
attainment of the goals of organization.
Adequate and timely communication of work-related
issues or changes that may affect jobs enhances
compliance.
Flow/ Lines of Communication
Downward Communication- traditional line of
communication is from superior to subordinates which
may pass through various levels of management.
(includes policies, rules and regulations, memoranda,
interviews, handbooks, job description)
Upward Communication – emanates from subordinates
and goes upward. Usually in the form of a feedback to
show the extent to which downward communication
has received, accepted and implemented
Horizontal Communication- or lateral flows from peers,
personnel or departments on the same level. Used
frequently in the form of , relatives and the community.
Outward communication – deals with information that
flows from
Coordination – unites personnel and services towards a
common objective.
Synchronization of activities among various services and
departments enhances collaborative efforts
Barriers to Effective Communication
Too much information – people suffer from what we call
sensory overload
The message is poorly organized – communicating also
involves planning
Inaudible voice – when talking in front of a crowd be
sure that you have loud and clear voice so that
everybody will be able to hear what you are saying
Mannerisms – distract attention
Lack of understanding
Inconsistent verbal and non-verbal communication
Noise – any factors that disturbs, confuses or interferes
with communication
Differing perceptions – people who have different
backgrounds of knowledge and experience often
perceive the same phenomenon from different
perspective
Language differences – the words used must mean the
same thing to sender and receiver
Too many links in the communication process
Overcoming Barriers to Communication
 Use feedback to facilitate understanding and increase
the potential for appropriate action
 Repeat message in order to provide assurance that
they are properly received
 Use multiple channels so that the accuracy of the
information may be enhanced
 Use simplified language that are easily
understandable and which eliminates the possibility of
people getting mixed- up with meanings
COMMUNICATION:
Transmission of information, opinions and intentions
between and among individuals.
It facilitates work
Increases motivation
Effect change
Optimizes patient care
Increase workers satisfaction
Facilitates coordination
Helps promote trust between the patient and
personnel
Principles of Effective Communication:
Clear lines of communication serves as the linking
process by which parts of the organization are unified
towards goal achievement
Simple, concise and exact messages ensure
understanding of the messages to be conveyed
Downward Communication- traditional line of
communication is from superior to subordinates which
may pass through various levels of management.
(includes policies, rules and regulations, memoranda,
interviews, handbooks, job description)
Upward Communication – emanates from subordinates
and goes upward. Usually in the form of a feedback to
show the extent to which downward communication
has received, accepted and implemented
Horizontal Communication- or lateral flows from peers,
personnel or departments on the same level. Used
frequently in the form of , relatives and the community.
Outward communication – deals with information that
flows from
Coordination – unites personnel and services towards a
common objective.
Synchronization of activities among various services
and departments enhances collaborative efforts
CONTROLLING
Reasons for conducting Evaluation
Evaluation ensures that quality nursing care is provided
It allows for the setting of sensible objectives and
ensures compliance with them
It provides standards for establishing comparisons
It promotes stability and a means for employees to
monitor their own performance
Reasons for conducting Evaluation
It highlights problems related to quality care and
determines the areas that require priority attention
It provides an indication of the costs of poor quality
It justifies the use of resources
It provides feedback for improvement
Evaluation Principles:
The evaluation must be based on the behavioral
standards of performance (goals and objectives were
clearly defined and presented to the employee)
There should be enough time to observe the
employee’s behavior.
The employee should be given a copy of the job
description, performance standards and evaluation
form before the scheduled evaluation conference.
The employee’s performance appraisal should include
both satisfactory and unsatisfactory results with specific
behavioral instances to exemplify these evaluative
comments.
Evaluation Principles:
Areas needing improvement must be prioritized to help
worker upgrade his/her performance
The evaluation conference should be scheduled and
conducted at a convenient time for the rater and the
employee under evaluation
The evaluation report and conference should be
structured in such a way that it is perceived and
accepted positively as a means of improving job
performance
Characteristics of an Evaluation tool:
Objective –
Reliability –
Validity –
Sensitivity –
Basic Components of the Control Process
Establishment of standards, objectives and methods for
measuring performance
Measurement of actual performance
Comparison of results of performance with standards
and objectives and identifying strengths and areas for
correction and or improvement
Action to reinforce strengths or successes
Implementation of corrective action as necessary
Three Types of Performance Standards:
Standards or Structure – those that focus on the
structure or management system used by the agency to
deliver care.
Process standards – refers to decisions and actions of
the nurse relative to the nursing process which are
necessary to provide good nursing care.
Outcome standard - designed to measure the results of
care, provided in terms of changes in the health status
of client.
Performance Appraisal
A control process in which employees performance is
evaluated against standards.
most valuable tool in controlling human resources and
productivity.
It reflects how well the nursing personnel have
performed during a specific period of time.
Purposes of Performance Appraisal:
Determine salary and merit increase
Select qualified individuals for promotion or transfer
Identify unsatisfactory employees for demotion or
termination
Make inventories of talents within the institution
Determine training and developmental needs of
employees
Purposes of Performance Appraisal:
Improve the performance of work groups by examining,
improving correcting interrelationships between
members
Improve communication between supervisors and
employees and reach an understanding on the
objectives of the job
Establish standards of supervisory performance
Purposes of Performance Appraisal:
Discover the aspirations of employees and reconcile
these with goals of the institution
Provide employees recognition for accomplishment
Inform employees “where they stand”
Factors Contributing to an Effective Performance
Appraisal System
Compatibility between the criteria for individual
evaluation and organization goals
Direct application of the rated performance to
performance standards and objectives expected of the
workers
Development of behavioural expectation which have
been mutually agreed upon by the rater and the worker
Factors Contributing to an Effective Performance
Appraisal system
Understanding the process and effective utilization of
procedures by the rater
Rating of each individual by the immediate supervisor
Concentration on the strengths and weaknesses to
improve individual performance]
Methods of Measuring Performance:
 Essay
 Checklist
 Ranking
 Rating Scales
 Forced Choice Comparison
 Anecdotal Recording
QUALITY ASSURANCE
Assurance means – achieving a sense of
accomplishment and implies a guarantee of excellence
Quality – the degree of excellence
Assurance – formal guarantee of a degree of excellence
QUALITY ASSURANCE
became the organizational mechanism for measuring
performance against standards and reporting incidents
and errors, such as mortality and morbidity rates
consisted primarily of retrospective chart audits of
various patient diagnoses and procedures.
The method was thought to be punitive, with its
emphasis on “doing it right,”
TOTAL QUALITY MANAGEMENT
also referred to as quality improvement (QI) and
performance improvement (PI)
Quality Improvement (QI) – will be referred to as a
systematic process of organization-wide participation
and partnership in planning and implementing
continuous improvement methods to understand,
meet, or exceed customer needs and expectations and
improve patient outcomes
This proactive approach emphases “doing the right
thing” for customers.
PRINCIPLES OF QUALITY IMPROVEMENT
The priority is to benefit patients and all other internal
and external customers.
Quality is achieved through the participation of
everyone in the organization.
Improvement opportunities are developed by focusing
on the work process.
Decisions to change or improve a system or process are
made based on data.
Improvement of the quality of service is continuous
process.
DIFFERENCE BETWEEN IN FOCUS Q.A AND Q.I.
Methodologies for Quality Improvement
The plan do? study act Cycle (PDSA)
What are we trying to accomplish?
How will we know that a change in an improvement?
What changes can we make that will result in
improvement?
The FOCUS Methodology
Focus on an Opportunity for Improvement
Organize a Team
Clarify the current Process
Understand the Degree of change Needed
Select a Solution for improvement
Other Improvement Strategies
Benchmarking – is the continual and collaborative
discipline of measuring and comparing the results of key
work processes with those of the best performers.
Regulatory requirements – the Joint commission (JC)
has developed standards to guide critical activities
performed by the health care organizations
Preparation for an accreditation survey and the survey
results will provide a wealth of information and data,
which can be utilized as ideas for improvement
strategies.
Other Improvement Strategies
Sentinel Event Review – is an unexpected occurrence
involving death or serious physical or psychological
injury to a patient. Events are called sentinel because
they require immediate investigation.
Measurements - to assess and monitor outcomes,
health care organizations collect and report measures at
various levels in the organizations.
Other Improvement Strategies
Storyboard: How to share Your Story – QI teams share
their work with others using a storyboard.
Patient Satisfaction Data- health care facilities get
feedback from patients by having them fill out a
questionnaire that asks how they felt about their health
care encounter.
CONTROLLING
1. Delegation
– the process by which manager assigns specific
tasks/duties to workers with commensurate authority
to perform the job.
(ANA &) defined delegation as the transfer of
responsibility for the performance of a task from one
person to another.
(NCBSN) defines delegation as transferring to a
competent individual the authority to perform a
selected nursing task in a selected situation.
Five Rights of Delegation
1. Right Task.
One that is delegable for a specific patient.
2. Right Circumstances.
Appropriate patient setting, available resources, and
other relevant factors considered.
3. Right Person.
Right person is delegating the right task to the right
person to be performed on the right person.
4. Right Direction/Communication.
Clear, concise description of the task, including its
objective, limits and expectations.
5. Right Supervision.
Appropriate monitoring, evaluation, intervention, as
needed, and feedback.
Two Criteria are of paramount:
The ability of the worker to carry out its tasks
Fairness not only to the employee but to the team as a
whole
Reasons for Delegation
For the nurse manager
1. To free up time for planning and organizing.
2. To help the nurse manager learn how to properly and
effectively manage and develop employees.
3. To keep the nurse manager from ‘spreading
him/herself too thin’.
4. Delegation encourages open communication and
trust.
5. It can show the nurse manager a better way of
handling people and resources.
Principles of Delegation:
Select the right person to whom the job is to be
delegated
Delegate both interesting and uninteresting tasks
Uninteresting job can be used to challenged, motivate,
and increase a person’s performance and commitment
Interesting jobs- draw out the best among employees
and inspire them to high achievement.
Provide subordinates with enough time to learn
Expertise can be achieved through training and
experience.
 - Delegate gradually
New employee may not be able to assume full
responsibility as employees who have stayed longer on
the job.
- Delegate in advance
Specify goals and objectives to be met within a set time
frame.
- Consult before delegating
Clarifications minimize problems and promote
teamwork.
- Avoid gaps and overlaps
A gap occurs when a job is left out with no one taking
responsibility.
STRATEGIES TO ENSURE EFFECTIVE DELEGATION:
Plan ahead
Identify Necessary skills and levels
Select Most Capable Personnel
Communicate Goal Clearly
STRATEGIES TO ENSURE EFFECTIVE DELEGATION:
Empower the delegate
Set Deadlines and Monitor Progress
Model the Role: Provide Guidance
Evaluate Performance
Reward Accomplishment
Delegated tasks must be based on
• Policies
• Job Description
• Capabilities of Workers
Policies/Procedures/Rules and Regulations - these are
the standing Plans of an organization.
Nursing service exists for the standardization & as a
source of guidance for the nursing staff
Policies promote consistency of action and stability.
They speed up decision making
Policies conserve time by setting standards
- Uniformity of standards promotes fairness and
prevents conflicts
- Policies are usually written and made available
as manuals
- Procedure manual outlines a standard
technique or method in performing duties
- Serves as a guide for action
- Manuals are used by employees to orient them
to procedures
- Principles of Delegation
- Principle of Result Expected
Suggests that:
-every nurse manager before delegating the powers to
the subordinate should be able to clearly define the
goals as well as results expected from them
-goals and targets should be completely and clearly
defined and the standards of performance should also
be notified clearly
Principle of Parity of Authority and Responsibility
the nurse manager should keep a balance between
authority and responsibility
both of them should go hand in hand
if a subordinate is given a responsibility to perform a
task, at the same time he should be given enough
independence and power to carry out that task
effectively
Principles of Delegation
Principle of Authority level
-suggests that a nurse manager should
exercise his authority within the
jurisdiction / framework given
-before a nurse manager takes any important decision,
he should make sure that he has the authority to do so
-emphasizes the degree of authority and the level up to
which it has to be maintained
Delegation of Authority:
is an organizational process wherein, the manager
divides his work among the subordinates and give them
the responsibility to accomplish the respective tasks.
Along with the responsibility, he also shares the
authority, i.e. the power to take decisions with the
subordinates, such that responsibilities can be
completed efficiently.
Elements of Delegation of Authority
There are three major elements of delegation of
authority:
Elements of Delegation
1. Authority
- the right to delegate duties and give direction, to take
decisions and to give orders so as to achieve the
organizational objectives
Authority should be accompanied with an equal amount
of responsibility.
2. Responsibility
- is the duty of the person to complete the task assigned
to him.
A person who is given the responsibility should ensure
that he accomplishes the tasks assigned to him.
involves reliability. dependability, and the obligation to
accomplish work when assignment is accepted.
The person held responsible for a job is answerable for
it.
Differences between Authority and Responsibility
being responsible and answerable for actions or
inactions of self or others in then context of delegation.
Accountability can not be delegated.
For example, if ’A’ is given a task with sufficient
authority, and ’A’ delegates this task to B and asks him
to ensure that task is done well, responsibility rest with
’B’, but accountability still rest with ’A’. The top level
management is most accountable.
What are the Common Delegation Errosr?
- Underdelegating
- Overdelagating
- Improperly Delegating
Common Delegation Errors:
Underdelegating – manager’s false assumption:
delegation may be interpreted as the lack of ability on
his or her part to do the job correctly or completely
Manger’s desire to complete the whole job personally
due to lack of trust in the subordinates

Over delegating – Careful not to over delegate to

exceptionally competent employees, because they may
become overworked and tired, which can decrease their
productivity.

Improperly Delegating – delegation of tasks and

responsibilities beyond which the person cannot
perform properly. delegating at the wrong time, to the
wrong person, or for the wrong reason

What Cannot be Delegated?

Responsible for maintaining morale or the opportunity

to say a few words of encouragement to the staff
especially the new ones.
Jobs that are too technical and those that involve trust
and confidence.

Why Nurse Managers do not delegate?

Lack of confidence in their staff

Feels that they are the only one who can do the tasks
and much faster
Mistakes in delegation can be costly.
Failure to delegate wisely increases management costs
and contributes to personnel dissatisfaction.
Fear of losing control of the staff.
Fear of failing to get others do the work.
Fear of criticism.

Effective Delegation
Effective ways of delegation for nurse managers
• Train and develop subordinates.
• Plan ahead.
• Control and coordinate the work of subordinates but
do not peer over their shoulders.
• Follow-up by visiting subordinates frequently.
• Coordinate to prevent duplication of effort.
• Solve problems and think about new ideas.
• Accept delegation as desirable.

Effective ways of delegation for nurse managers

• Accept delegation as desirable.
• Specify goals and objectives.
• Know subordinates capabilities and match the task or
duty to the employee.
• Agree on performance standards.
• Take an interest in employees.
• Assess results.
• Give appropriate rewards.
• Do not take back delegated tasks.