NCMB419 LEC & RLE:
12
BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Bachelor of Science in Nursing 4Y1
Professor: Ma. Diosul Roque, MAN, RN & Evangeline Orata, MAN, RN, RM
Midterm Topics:
• Records Management
• Intra-Discipilinary-Interdisciplinary & Multidisciplinary &
Work Collaboration
• Nursing Management Functions
• Staffing
• Application of Research in Nursing Leadership and
Management Research
RECORDS MANAGEMENT
- Records management (RM) is the supervision and
administration of digital or paper records, regardless of
format.
- It is a systematic and effective control of records (both
paper and electronic).
- It aims to ensure that records are accurate and reliable,
can be retrieved speedily and efficiently, and efficiently,
and are kept for no longer than necessary.
- It is crucial to all organizations. Unless records are
managed efficiently it is possible to conduct business, to
account for what happened in the past, or to make
decisions are kept for no longer than necessary
- Records management activities include:
• Creation
• Receipt
• Maintenance
• Use and disposal of records
- Documentation may exist in:
• Contracts
• Memos paper files electronic files
• Reports
• Emails
• Videos
• Instant message logs or database records.
What is the concept?
- Information is "data, ideas, thoughts, or memories
irrespective of medium."
- Documents are any "recorded information or objects that
can be treated as individual units
- Records are "information created, received, and
maintained as evidence and information by an organization
or person, in pursuance of legal obligations or in the
transaction of business." Archives are those records that
have been selected for permanent preservation because of
their administrative, informational, legal and historical
value as evidence of official business.
Important of Record Management
• To provide evidence of actions and decisions
• To support accountability and transparency
• To comply with legal and regulatory obligations, including
employment, contract and financial law as well as the data
protection act and freedom of information act
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Exam Week
• To protect the interests of staff, students and other
stakeholders
• Help to address complaints or legal processes.
• To support patient choice and control over treatment and
services.
• To support day to day business of the health care delivery.
• To support evidenced based practice.
• To assist clinical and other types of audits.
• To support sound administrative and managerial decision
making.
• To support improvement in clinical effectiveness through
research.
Benefits of Record Management
• Saves time by ensuring that records can be found easily
and quickly.
• Save space by preventing records from being kept longer
than necessary.
• Saves money by reducing storage costs and maintenance
costs.
• Improves efficiently by ensuring records are readily
accessible legally.
• Improves compliance by keeping records in line with legal
and regularly requirements.
• Keeps records under control by preserving data and
preventing accumulation control of referral material.
• Improves the quality of information, providing staff with
access to accurate and reliable quality records security
• Increases the security of confidential records continuity.
• Support business continuity and risk management
• Records are managed efficiently and can be easily
assessed and used - Records are stored as cost effectively
as possible and when no longer required they are disposed
of in a timely and efficient manner.
• Complies with requirements concerning records and
records management practices to ensure compliance with
institution
• Records of longer term value are identified and protected
for historical and other research
Classification of Records
1) Active Records - a record that is regularly referenced or
required for current use.
2) Inactive Record - a record that is still needed by an
organization but not for current operations.
3) Electronic Record - a record recorded or formatted only a
computer can process.
Records
- It is a permanent written communication that documents
information relevant to a client's health care management.
- A record is a clinical, scientific, administrative and legal
document relating to the nursing care given to the
individual family and community.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023

Sample of Records Individual Staff Record

• Administrative records of Grants/Contracts - Bid - A separate set of record is needed for staff, giving details of
documents 1 their sickness and absences.
• Blueprint of facilities
• Consent forms-adult-minor Ward Records
• Endowment Fund Records - Deducting or increase in beds.
• Equipment inventory reports - Change in medical staff and non-nursing personnel for the
• General ledgers ward.
• Meeting minutes - The introduction and patient of support.
• Payroll folder
Characteristic of a Good Record and Reporting
• Contracts-purchase lease rental and etc.
Records in the Nursing Office and Unit • Accuracy
• Administrative records: organogram, job description, • Consciousness
procedure manual • Thoroughness
• Personnel records: personal files, records • Up to date
• Patient records send to medical center chief/medical • Organization
director • Confidentiality
• Leave record, duty roster, minutes of the meeting, budget • Objectivity
etc.
• Miscellaneous: circular log book, formats, etc. Purposes of Record
Principles of Record Writing • Supply data that are essential for programmed planning
• Nurses should develop their own method of expression and evaluation
and form in record writing • Provide the practitioner with data required for the
• Records should be written with clearly and appropriately application of professional services for the improvement of
• Records should contain facts based on observation family health
conversation and action • Used as tools of communication between health workers
• Select relevant facts and the recording should be neat, the family and other development personnel
complete and uniform - Records should be written • Shows the health problem in the family and other factors
immediately after an interview that affect health
• Records are confidential documents. • Indicates plan for future
Seeking and Release of Records • Provides baseline data to estimate the long term changes
• Sentinel events related to services
• Anecdotal
Administrative Purpose of Clinical Records
• Incident report
• Legal documents
• Kardex
• Research or statistics rates
• Patients chart/records
• Audit and nursing audit
• 201 file
Nurses' responsibility for record keeping and recording • Quality of care
• Keep under safe custody of nurse • Continuity of care
• No individual sheet should be separated • Informative purposes
• Not accessible to patient and visitors • Teaching purposes of students
• Strangers is not permitted to read records • Diagnostic purposes
• Records are not handed over to the legal advisors without
Importance of Records in Hospital
written permission of the administration
- For individual and Family
• Handed carefully, not destroyed
• Serve the history of the client
• Identified with bio-data of the patients such as name, age,
• Assist in the continuity of cares
admission number, diagnosis, etc.
• Evidence to support if legal issues arise
• Never sent outside the hospital without the written
administrative permission • Assess health needs: research and teaching
Nursing Administrator’s Responsibility - For the Doctor
• Protection from loss • Serve the guide for diagnosis, treatment, follow up and
evaluation
• Safeguarding its concerns
• Indicate progress and continuity of care
• Completeness
• Self-evaluation of medical practice
• Responsibility for nurse notes
• Protect doctor in legal issues - Used for teaching and
• Admission record
research
• Scientific value of the nurse notes
- For the Nurses
• Record of order carried out
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 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• Document nursing service rendered
• Planning and evaluation of service for future
improvement
• Guide for professional growth
• Communication tool between nurse and other staff
involved in the care
• Indicate plan for future
- For Authorities
• Statistical Information
• Administrative control
• Future reference
• Evaluation of care in terms of quality, quantity and
adequacy
• Help supervisor to evaluate service
• Guide staff and students
• Legal evidence of service rendered by each employee
• Provide justification of expenditure of funds
Managing Records
What is the records lifecycle
Create/ Receive
- Starts when records are either received from an external
source or created internally. The objectives of this initial
stage are:
1) Create complete and accurate records that provide
evidence of the organization's functions, activities,
decisions, transactions, procedures, etc.
2) Identify and apply an appropriate security classification
3) Distinguish between records and non-record copies or
working documents, to be able to appropriately
segregate them in the filing system
4) Place the record in an organizational classification
scheme (or file plan) either in paper (e.g. in a filing
cabinet or a binder) or in electronic version (e.g. on a
shared drive or in a system) to ensure that it's preserved
within its context.
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Active Phase
- It means that they are often used, shared between
colleague retrieved to support day-to-day business and
referred to.
• Preserve the integrity of the record, which means
ensuring that it has not been altered after completion
• Maintain its usability which means making it available
for all colleagues who need an access to the record to
do their job - Facilitate identification and preservation of
records with permanent retention
Inactive Phase
- During this stage, we should free up space in our offices to
new records, but we need to ensure keeping inactive
records handy. The objectives of this stage are:
• Identify the records that are not required to be stored in
the primary office space (paper) or systems/shared
drives (electronic)
• Organize and list them
• Transfer them to the local Records Center (for field
missions the local Records Center within mission area;
for HQ offices the ARMS Records Center)
• Retrieve only those records that are needed from time
to time
Disposition Phase
- The objectives of this stage are:
• Identify records with archival value (permanent
retention), list them, organize them
• Identify records due for disposal/destruction, list them,
gather necessary approvals for the destruction and
proceed with an environmentally friendly destruction
process
Seminar Organization
Implementing Self Care for Nurses
- More and more research and data about the physical and
mental strain of nursing have come out. This should.
prompt health care leaders to take the initiative to
acknowledge and treat this issue about nurses providing
for their self-care in a profession that is gradually taking its
toll on their physical and mental health
Increased Specialization and Career Path Options
- Psychiatry, obstetrics, gerontology is steadily growing.
- Enables nurses to develop expertise in the area in which he
or she is providing care.
- Opens the door to opportunities for career advancement.
- Patients are assured of high level of knowledge and
competence in a specific area of care.
Expanding Entrepreneurship Opportunities
- Nurses to set up their own businesses
- For nurses who value independence and autonomy,
entrepreneurship may be a good fit.
Continued Growth of Telehealth
- Patients gain access to doctors and nurses through video
and phone - consults, remote monitoring, and other
electronic communication.
- Serves as opportunity for health promotion wellness
checks, and patient care.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Increasing Need for Doctoral Education
- In the United States, the number of nurses enrolling in
doctoral education programs is growing, specifically for the
Doctor of Nursing Practice (DNP) because of the shortage
of doctors
- In the Philippines. the future of nursing may eventually
include mandate to have more doctoral degree nurses but
they are mostly in the field of education
Furthering Nursing Education Online
- Online classes in the post graduate programs are now
being offered by some universities. Pre-covid, it was an
option, but with the pandemic it is now the trend
- Gave rise to an increasing need for nurse educators.
Impact of the Looming Nursing Shortage
- As baby boomers age the demand for health care services
arrows.
Nurses Getting Involved Through Advocacy and Action
- The Code of Ethics for Nurses states that Advocacy is also
a nurse's responsibility. And as the biggest group of health
care providers locally and internationally, nurses have a
significant opportunity to express a voice in the future of
health care and the health of the nation.
Nurses needing to be Technologically Savvy
- Every day new health care technologies enter the market.
Nurses are required to adapt to these technologies in order
to improve patient care.
- Technology is introduced to reduce administration time,
increase accuracy all keeping clinician satisfaction and the
patient experience in mind.
Nurses moving in to the Community Outpatient Setting
- Shift of health care from inpatient to outpatient settings.
- Greater impact in attaining the goal of helping people to get
healthy and stay healthy.
Six Biggest Problems Facing Nursing Today
1) Staff shortages - Fewer nurses means a more hectic
workload for the nurses that are on the wards.
2) Meeting patient expectations - Because of the shortage
in manpower, nurses often feel that they do not come up
with patients' high level of expectations.
3) Long working hours - Because of the shortage in staff,
there are hospitals that opt for the 12hour shift instead of
the 8 hour shift.
4) Workplace violence - Being over fatigued, overstressed
and overworked tend to take its toll on the weary nurses,
which at times may result to conflicts.
5) Workplace hazards - The workplace can put the nurses'
physical and mental health at risk.
6) Personal health
Seminar Conceptualization
Brainstorming
1) Have a challenge ready – This will trigger creativity.
2) Focus on quantity – Come up with lots of ideas for more
choices and a better likelihood of choosing a good one.
Critically reflecting ideas during brainstorming should not
be done; collect them and move on.
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3) Don’t criticize – Slows down the idea generation process.
Encourage teammates to participate. Avoid negative
criticisms.
4) Appreciate the uncommon – Entertain ideas that are
seemingly unworkable or are unusual. Some even serve as
stepping stones to even better ideas.
5) Combine and improve – Building upon one another's ideas
is natural and normal during brainstorming, and helps you
to generate more ideas.
6) Try different methods – While brainstorming can be very
effective, different methods can be added into a
brainstorming session and possibly become even more
creative.
7) Playful environments – Help your ideas to move more
quickly, and facilitate inspiration.
8) Put them on the wall – Visualizing your ideas on a wall or a
large space that is visible to visible to all participants helps
to get everyone *on the same page" and thinking actively.
9) Break – Don't go for too long. Brainstorming can be
physically exhausting, so make sure to give yourself a
break during long sessions.
Editing and Refinement
1) Technical feasibility – Check whether the ideas works on
the platform to be used and with the technology available.
2) Market opportunity – Think about why people would
attend a planned event based in your idea.
3) Goal consideration – Whether it fits well with the set goals.
4) Business/cost restrictions – Will it work within time and
budget constraints given.
a) Preliminaries
i. Purpose and goals of event
ii. Title of event
iii. Target audience (undergrad, graduates, resident)
iv. Date and location (primary date and alternate)
v. Start and end time
vi. Number of participants and cost
vii. Program speaker
viii. Room set up (chairs, table, stage, podium)
ix. Equipment (audio, lightning)
x. Food (breakfast, lunch, dinner)
xi. Relevant (co-curricular learning outcomes)
b) Develop a realistic budget
c) Obtain necessary approvals for:
• Event registration - Includes event approval from key
persons and venue reservation. Corporate
Sponsorship.
• Inviting a guest speaker - Follow the institutional
guidelines in the choice of a speaker. (If there are
any)
• Corporate sponsorship
• External sponsorship - Seek approval for
sponsorship from any external source.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
INTRA-DISCIPLINARY, INTERDISCIPLINARY AND MULTI-
DISCIPLINARY AND WORK COLLABORATION
Collaboration
- The roots of the word collaboration, namely co-, and
elaborate, combine in Latin to mean “work to together.”
- The collaborative process involves a synthesis of different
perspective to better understand complex problems. - Is a
process by which members of various disciplines (or
agencies) share their expertise to accomplishing a
common goal
- Collaboration is the most formal inter organizational
relationship involving shared authority and responsibility
for planning, implementation, and evaluation of a joint
effort, Marquis and Huston, (2017)
- Collaboration defined as a joint communication and
decision-making process with the goal of satisfying the
health care needs of a target population. NNCCS, (2012).
- Mattessich, Murray and Monsey (2001), define
collaboration as’... a mutually beneficial and well- defined
relationship entered into by two or more organizations to
achieve common goal.
- Effects of Collaboration:
• Improved patient outcomes
• Reduced length of stay
• Cost savings
• Increased nursing job satisfaction and retention
• Improved teamwork
- Types of Collaboration:
• Interdisciplinary – the term used to indicate the
combining of two or more disciplined, professions,
department, integrated for one plan formulation usually
in regard to practice, research education, and/or
theory?
• Multidisciplinary – Refers to independent work and
decision making, such as when disciplines work side-
by-side on a problem.
• Tran disciplinary – Efforts involve multiple disciplines
sharing together their knowledge and skills across
traditional disciplinary boundaries in accomplishing
tasks or goals.
• Inter professional collaboration – Interactions of two or
more disciplines involving professionals who work
together, with intention, mutual respect, and
commitments for the sake of a more adequate
response to a human problem.
- Need for Collaboration:
• Increasing gap between nursing education and nursing
service.
• Graduate nurses often lack practical skills despite their
significant knowledge of nursing process and theory.
• Clearly, a partnership between nursing educators and
hospital nursing personnel is essential to meet the
challenge
Models of Collaboration
- Preceptor-ship model
- Mentorship model
- Lecturer practitioner model
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- Research joint appointment
- Clinical school of nursing model
- Collaborative clinical education model
Preceptorship Model
- A preceptor is teacher or instructor with special training
and he care provide practical training to an intern or staff.
- The best preceptor like to teach and they will volunteer for
the role rather than wait to be assign
- Responsibilities of the Preceptee's:
• Provide an orientation for the students
• Review agency guideline with students, especially those
that will impact the student experience directly
• Help students feel a sense of belonging in the agency
• Provide opportunities for the student to participate in
important agency functions such as meetings, outreach
events, etc. as appropriate.
• Be aware of the student's learning goals so that can be
help structure experiences that will help the student
meet goals.
• Give honest, constructive feedback to the student and
faculty supervisor as needed.
• Meet with student at frequent, regular intervals to
provide feedback, evaluate progress and resolve
problems
• Remember what may see basic or easy for the
preceptor may not be basic or simply to the student
Mentorship Model
- Mentoring is a developmental relationship in which a more
experienced person helps a less experience person.
- The Value of Mentoring: Mentoring provides:
• Retention by means of personal relationship
• Staff development and career guidance
• Job satisfaction, and a healthy workplace environment
- Roles of Mentors:
• Teacher (educational expertise)
• Guider
• Counselor (practical expertise)
• Advisor
- Mentor VS Preceptors:
• Mentor
o Older than Learner
o Possesses wisdom and experience
o Career networking
o Facilitator
o Guide
o Advisor
o Role model
o Chosen
o May have no formal preparation
o Share Life, education, work experience
o Type of relationship” close, personal friendship
o Not an evaluator
o Occurs over time
o No termination date
o Sought out by mentee
o Teaches networking
o Shares personal experiences
o Experiences are personal
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
o Mentoring relationship may be personal, academic,
or work-related.
• Preceptors
o Willing to teach and learn skills
o Expertise
o Competent practitioner
o Teaching and support
o Orientation and Socialization
o Role Model
o Selected
o Assigned to learner
o Prepared for role
o Competent practitioner
o Support needed from peers, educators, manager
o Functional not intimate relationship
o May evaluate
o Has set time limit
o Termination date
o Assigned
o Formalized orientation
o Assists in fine tuning skills
o Offers suggestions
o Work-related focus
- Mentor VS Preceptor Learner Outcomes
• Mentor
o Self-actualization
o Guide to established own place in the profession
o Enhanced problem- solving
o Personal satisfaction in sharing knowledge
• Preceptors
o Bridge theory to practice gap.
o Achievement of planned learning outcomes
o Skills and knowledge
o Anxiety reduction
Lecture Practitioner Model
- Each clinical placement gave to have named lecturer /
practitioner or clinical educator who will assist in the
organization, facilitation and supervision of the clinical
learning experience throughout the entire programs.
- Role of Lecturer Practitioner:
• Promote active discussion within the clinical setting to
encourage understanding
• Work with clinical staff to identify alternative means to
gain relevant experience
• Play an active role in overall assessment to help
student achieves the required learning outcome
Research Joint Appointments
- Is a formalized agreement between two institutions where
an individual holds a position in each institution and
carries out specific and defined responsibilities
- The goal of this approach is to use the implementation of
research findings as a basis for improving critical thinking
and clinical decision-making of nurses
- A formal agreement exists within the two organizations
regarding specific responsibilities and the percentage of
time allocated between each salary and Benefits are
shared between the two organizations
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Clinical School of Nursing Model
- The concept of a Clinical School of Nursing is one that
encompasses the highest level of academic and clinical
nursing research and education.
- The development of the Clinical School offers benefits to
both hospital and university.
- It brings academic staff to the hospital, with opportunities
for exchange of ideas with clinical nurses with increased
opportunities for clinical nursing research.
- It has a fundamental importance and close link between
the theory and practice of nursing at all levels
Collaborative Clinical Education Model
- In an effort to improve the quality of new graduate
transition, Epworth Hospital and Deakin University ran a
collaborative project (2003) founded by the National Safety
and Quality Council to improve the support base for new
graduates while managing the quality of patient care
delivery.
- The collaborative clinical Education Epworth Deakin
(CCED) model developed to facilitate:
• Clinical learning
• Promote clinical scholarship and
• Build nurse workforce capability
- Example:
• Undergraduate nursing students attending lectures at
Deakin University in the traditional manner but
completing all tutorials, clinical learning, laboratories
and clinical placements at Epworth Hospital throughput
their three year course.
• Tutorials, laboratories and clinical placements are
conducted by Epworth clinicians who are prepared and
supported by Deakin School of Nursing Faculty.
• These clinicians also support the student-preceptor
relationship in the clinical learning component of the
curriculum.
• All the models pursue collaboration as a means of
developing trust, recognizing the equal value of
stakeholders and bringing mutual benefit to both
partners on order to promote high quality research,
continued professional education and quality health
care.
• Application of these models can reduce the perceived
gap between education and service in nursing, also can
help in the development of competent and efficient
nurses for the betterment of nursing profession.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
- In a hospital setting, multidisciplinary teams, involves or
combines several academic or professional disciplines,
either formal or informal groups meet to accomplish goals
and objectives, members practice independently of one
another, each of the member is being guided by their own
professional standards however leadership always
determined by professional hierarchy.
- As illustrated above the interdisciplinary and
multidisciplinary team collaboration involves the
contribution from different departments of their services
and shared their own professional expertise to achieve
optimum health of the patient. The vital role of the nurse it
to coordinate, communicate and documents services
provided by the team as shown in the illustration.
- In a community setting, the Intra-agency, Inter-agency,
multidisciplinary and sectoral collaboration are important
in the effective and efficient delivery of health services to
the individuals, families, population groups and the
community. The nurse is responsible in maintaining
harmonious relationship within the health unit (intra-
agency) and coordinating activities of the members of the
health team to ensure achievement of group goals.
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Development of Team Work and Collaboration
Stages of Team Development
• Stage 1 Forming – The leader may seek control over the
team and exemplify styles such as “tyrant”, “superwoman”,
“party host”, or “reluctant candidate”, Members are also
characterized by dependency-seeking behaviors and will
most likely rely on the group leader. They may also take on
the roles of “scapegoat” and “helper’.
• Stage 2 Storming – Leader tries to persuade the team and
may use “salesman” ad “nice guy” styles often struggling
to be a socio—emotional leader. Team members may
demonstrate resistance. Despite persistence of
scapegoating among team members, new roles that help
reduce tension may emerge.
• Stage 3 Norming – Coalitions of member’s exercise
leadership based on previously demonstrated competence.
Members have evolved into colleagues who were able to
defer to each other’s relevant experience.
• Stage 4 Performing – Authority is exercise by coalition of
colleagues. Team members exemplify interdependence.
Tools for Facilitating Health Care Team Work
1) Task roles – Necessary for accomplishing the team’s task.
These roles are as follows:
• Initiating/energizing
• Information/opinion giving
• Information/opinion seeking
• Reality testing/clarifying
• Coordinating
• Orienting
• Procedural Technician
2) Maintenance roles – Which help the team function as a
team. Maintenance roles are:
• Harmonizing
• Gatekeeping
• Encouraging
• Following
• Climatizing
3) Individual roles – In which a team member attempts to
satisfy individual rather than team goals. A team is most
productive when all three (3) sets are managed
simultaneous. Individual roles are:
• Blocking/Aggressing
• Out of field
• Digressing
• Recognition seeking (Sullivan and Decker, 2009)
Nurse’s Role in Establishing Collaborative Relationship in
the Delivery of Health Care Program Services
1) Maintains good interpersonal relationships interagency and
inter-agency.
2) Respects the role of other team members.
3) Acts as a liaison/advocate of the client during decision
making by the inter-professional team.
- Interpersonal Relationship Defined: The term Interpersonal
Relationships refers to reciprocal social and emotional
interactions between two or more persons in an
environment and who share common interests and goals.
- Importance of Interpersonal Relationship for Nurses:
1) Helps build positive functional multidisciplinary team.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
2) Improves intra and/or inter-team communication,
coordination, and cooperation
3) Builds mutual understanding and cooperation
4) Facilitates better understanding of oneself
5) Improves decision making and problem-solving
- To maintain good interpersonal relationship in working with
a team to achieve its goal of providing safe and quality
patient/ client care, it is also important for the nurse to
appropriately respond to conflict situations. In the process,
conflict may occur within the individual (intrapersonal),
between two or more individuals (interpersonal), and
between one or more groups (intragroup).
- Categories of Conflict Conflict is a disagreement among
people involved that results from differences in ideas,
values, or feelings, differences in economic and
professional values, poorly defined role expectations and
there is competition among the professional themselves,
Filley (1975).
Nurse Interpersonal Relationship
Doctor - Nurse relationship
Nurse – Patient relationship
Nurse – Nurse relationship
- One of the most distinctive aspects of human being is that
we are social beings
- Interpersonal relationships are and have been the core of
our social system since the dawn of civilization
- Nursing is a therapeutic process and demands an
association between the nurse and the patient
- Is a strong, deep or close association or acquaintance
between two or more people that may range in duration
from brief to enduring
- Are social associations, connections, or affiliation between
two or more people
- They vary in differing levels of intimacy and sharing,
implying the discovery or establishment of common ground,
and may be centered around something(s) shared in
common
- In nursing care can be defined, based on a theory 1, as the
interaction between two or more people who communicate,
transfer values and energy from their roles in society
- Such interaction is continuous
Dynamics of Interpersonal Relationship
1) Dyad
- A Dyad consists of two interacting people
- It is the simplest of the three interpersonal dynamics
- One Person relays a message and the other listen
- It is none of the most unstable interpersonal dynamic.
The interaction ends when one constituent of the dyad
refuses to listen or share his or her message - It is also
one of the most intimate interpersonal dynamic as the
focus of listening and communication is centered on
only one person
2) Triad
- A triad consists or three interaction people.
- The members engage in the relay and reception of
thoughts and ideas.
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- It is more stable than the dyad as the third members
may act as a mediator when there is conflict between
the other two.
3) Group
- A group consist of more than three members and is a
collection of triads and dyads.
- It is the most stable form of interpersonal relationship
Purposes of the Interpersonal Relationship
1) Interpersonal relationship for an individual
- Personal growth and development
- Source of enjoyment
- Sense of security
- Context of understanding
- Interpersonal needs
- Establishing personal identity
2) Interpersonal relationship for nurses
- Building a positive functional multidisciplinary team
- Improving intra-and/or inter-team communication,
coordination and cooperation
- Building mutual understanding and cooperation
- Improved decision making and problem
3) Interpersonal relationship for patients
- Developing a sense of security and comfort
- Fostering trust and cooperation
- Facilitating communication
- Improving socialization
- Developing and maintaining positive feelings
Types of Interpersonal Relationship
1) Friendship – Theories of friendship emphasize the concept
as a freely chosen association where individuals develop a
common ground of thinking and behaving when they enter
into the relationship by including mutual love, trust respect
and unconditional acceptance for each other.
2) Love – An in formalized intimate relationship characterized
by passion, intimacy, trust and respect is called love.
Individuals in a romantic relationship are deeply attached
to each other and share a special bond
3) Platonic – A relationship between two individuals without
feelings of sexual desire for each other is called a platonic
relationship. In such a relationship, a man and a woman
are just friends and do not mixes love with friendship.
4) Family – Family communication patterns established roles
and identify and enable personal and social growth of
individuals. Family relationships can get distorted if there
is an unresolved conflict between member since other
family members have significant emotional difficulties but
fails to bring them out unless the physician or nurse
enquires.
5) Professional – Individual working for the same
organization are said to share a professional relationship
and are called colleagues. Colleagues may or may not like
each other
Types of Relationship among Health Professionals
1) Complementary Relationship
- One person is dominant and the other is submission
- Control is not divided equally between the two
participants
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
- Relationship are stable and predictable also inhibit
creativity and independent thinking
• Physician
• Nurse
2) Symmetrical Relationship
- Control is more evenly distributed between the two
participants
- Free to express their opinions
- Power struggles occurs when participants complete to
acquire or give up control
• Both Dominant
• Both Submissive
3) Parallel Relationship
- Control moves back and forth between the two
participants
- Participant take turns holding and giving control,
depending on the circumstances, rather than
competing for control
- Effective and flexible communication
• Nurse / Physician
5 types of Nurse-Physician Relationship
1) Collegial Relationships - Characterized by equal trust,
power, and respect are illustrated by the following excerpt.
2) Collaborative Relationship - Marked by mutual trust,
power, and respect.
3) Student – Teacher Relationship - Either the physician or
the nurse can be the teacher. Physicians who teach are
identified as having a lot of knowledge and “always willing
to explain or teach.
4) Friendly Stranger Relationship - Is characterized by a
formal exchange of information and a somewhat neutral
feeling tone.
5) Hostile / Adversarial Relationship - Are marked by anger,
verbal abuse, real or implied threats, or resignation.
Phases of Interpersonal Relationship
(Hildegard Peplau 1952)
1) Pre- orientation Phase
- Self-awareness of the nurse. Planning the progress of
the interaction
- Client’s medical history, age, name, address
2) Orientation Phase
- Start with an initial encounter with nurse and patient
- The fact formulation begins between the nurse and the
patient.
- The nurse clarifies his or her roles and responsibilities
within the therapeutic boundary to the patient.
- The Nurse identifies the patient’s problems and
- After developing a trustworthy relationship, the patients
start clarifying doubts, share perceptions and convey
their needs and expectation to the nurse.
- There are several factors that may affect this phase in a
nurse-patient relationship
3) Working Phase
a) Identification
- The nurse must approach the patient with empathic
understanding to perceive the patient’s current
feeling.
J.A.K.E 9 of 35
- The nurse must avoid vagueness and ambiguity by
using specific terminology rather than abstractions
in communication process
- The nurse helps the patients identify their problems
in their own context and use the available resources
to solve the problem.
- The patient’s self-esteem will be boosted by having
feeling of
b) Exploitation
- In this phase, the patient is made to understand the
problems by exploring all available avenues to solve
the problem.
- The nurse can help the patient by extending minimal
professional
- The patient start exploitation all the available
resources in spite of making requests to others to
extend help
- Finally, the patient with his or her problems
4) Termination Phase
- This is the termination of the professional relationship
that begins with convalesce and rehabilitation stage of
hospitalization
- The patient’s needs have already been met by the
collaborative efforts of the
- It psychological dependence persists between both of
them, it become difficult to resolve the transferences or
counter transferees. A nurse must aware of the
techniques to resolve it.
- The relationship must be terminated by maintain a
healthier emotional balance by both the parties
NURSING MANAGEMENT FUNCTIONS
Planning
- Defined as pre determining course of action in order to
arrive at a desired result.
- the most basic and essential activity of management
functions that decide in advance what needs to be done for
the day, month, or years ahead.
- Defined as deciding in advance what to do; who is to do it;
and how, when and where it is to be done.
Henri Fayol (1841-1925)
- The first element of management defined by Henry Fayol is
planning in which he defines as making a plan of action to
provide foreseeable future.
- According to him that plan must have unity, continuity,
flexibility, and precision. The plan should be included
annual and 1o year forecasts, taking advantage of input of
others. Planning improves experience, gives sequence in
activity, and protects business against undesirable
changes. Planning facilitates the art of handling people.
- Planning is designed for the nurse administrators who are
seeking more effective means of improving current and
future performance. It offers principles of planning and
decision-making guides in nursing practice. It deals with
those aspects of planning that directly affects the nurse
administrators on a personal as well as organizational level.
Purpose of Planning
1) Planning increases the chances of success.
2) It forces analytic thinking and evaluation of alternatives
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
3) It establishes a framework for decision making that is
consistent with top Management objectives.
4) It orients people to action instead or reaction.
5) It includes day-to-day and future-focus managing.
6) It helps to crisis management and provides decision-
making flexibility.
7) It provides a basis of for managing organizational and
individual and individual performance.
8) It increases employee involvement and improves
communication.
9) It is cost effective.
Importance of Planning
1) Leads to achievement of goals and objectives. Workers
relate what they do to meaningful results. It ensures
alignment of nursing unit/department and financial plans
with the strategic plan. Thus, increase the probability of
achieving organizational goals, vision, and mission. Also, it
establishes a framework for decision making consistent
with top management objectives.
2) Gives meaning to work. Employees or workers experience
greater satisfaction if what they do becomes meaningful to
them. Ensures safe and quality care through awareness of
individual responsibility and accountability.
3) Provides for effective use of available resources and
facilities. The best use of personnel and material resources
prevents wastage.
4) Helps in coping with crisis. Hospitals must provide for
disaster plans. It allows the workers to function more
clearly and efficiently when actual emergencies occur such
as fire, typhoons, earthquakes, or during New Year
celebrations and or other occasions when more people are
likely to get hurt. Manages risk and copes with crisis
situations.
5) Cost – effective Cost can be controlled through planning
for efficient operation. Projecting the number of operations
in a given day, including daily dressings, helps in
determining accurately the needed weekly supplies in the
surgical units so as to prevent undersupply, oversupply or
pilferages.
6) Based on facts and future activities. Evaluation of
programs. Schedules, and activities whether successful or
not, prevents and/or reduces the recurrence of problems
and provides better ideas in modifying or avoiding them.
7) Leads to realization of the need for change. Discovers the
need for change that leads to create new services and
productivity. Many of the hospitals have found out that in-
patient hospital days can greatly reduce by having the
laboratory and diagnostic work up in the Out-patient
Department. Minor surgeries are also done at the OPD so
that more hospital beds can be allotted to critically-ill
patients or for those needing specialized services.
8) Planning improves communication and team collaboration
through people involvement in planning activities.
9) Provides basis for control. It becomes the basis for
evaluating the accomplishment of the set
programs/activities.
10) Necessary for effective control. Nurse- managers evaluate
the environment or setting in which they work or where the
patients are confined and make necessary
J.A.K.E 10 of 35
recommendations to make hospital conditions more
therapeutic not only for the patients but for the workers as
well. Performance of workers and evaluation of services to
patients’ base on criteria set during the planning stage will
indicate whether standards of care are met and whether
changes are indicated.
Principles of Planning
1) Planning is always based & focused on the vision mission,
philosophy, and clearly
2) defined objectives of organization.
3) Planning is a continuous process
4) Planning should be pervasive.
5) Planning utilizes all available resources
6) Must be precise in its scope & nature
7) Should be time bound
8) Projected plan must be documented
Scope of Planning
• Top Management – set the overall goals and policies of an
organization
• Middle Management – direct the activities to actually
implement the broad operating policies of the organization
such as staffing delivery service to the units.
• Lower or First level Management – do the daily or weekly
plans for the administration or direct patient care in their
respective unit.
Major Aspects of Planning
1) Planning should contribute to objectives. It should seek to
achieve a consistent, coordinated structure of operation
focused on desired ends. Actions without plans often
result to chaos and failure.
2) Precedes all other processed of management. Without a
plan there would be nothing to organize, direct, and control.
Planning leads to easy accomplishment of the
organizational objectives which is necessary for group
effort. Planning and control are inseparable.
3) Planning pervades all level. It encompasses both higher
and lower echelons and vice versa and spreads
horizontally through peer levels and/or across services and
members of the health team.
4) Planning should be efficient. It should contribute to the
attainment of objectives not only in terms of peso value,
man –hours, units of production but should also include
individual values and group satisfaction.
Characteristics of a Good Plan
• Have clearly worded objectives
• Guided by policies and procedures
• Indicate priorities
• Develop action that are flexible and realistic
• Develop logical sequence of activities
• Include practical methods for achieving objectives
• Pervade whole organization
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Basis in Planning the Nursing Service
Forecasting
- It helps managers look into the future, including the
environment in which the plan will be executed.
- The hospital, this includes the type of hospital served (level
1, level 2, level 3, or level 4); the kind of service it offers
(general or special) its philosophy mission and goals and
categories of their budget (national or local).
- The community it serves, this includes the kind of people
served their needs, expectations, literacy rate, economic
levels, employment rates, demographic statistics, cultural
values, values and services available in the community.
- The goals of care, vary according to the needs of the
community, agency, trends in technology and in changing
needs of the community, agency, trends in technology and
in changing concepts of the nurses’ roles and functions.
- A mistake common to novice managers is a failure to
complete adequate proactive planning. Instead, many
managers operate in a crisis mode and fail to use available
historical patterns to assist them in planning. Nor do they
examine present clues and projected statistics to
determine future needs. Forecasting involves trying to
estimate how a condition will be in the future. Forecasting
takes advantage of input from others, gives sequence in
activity and protects an organization against undesirable
changes.
- Changes in technology, payment structures, and resource
availability, the manager who is unwilling or unable to
forecast accurately impedes the organization’s efficiency
and the unit’s effectiveness.
- Forecast must be supported by facts, reasonable
estimates and accurate reflection of policies and plans.
Setting the Vision, Mission, Philosophy, Goals and
Objectives
• Mission – statement outlines the agency’s reason for
existing, who the target clients are and the services will be
provided.
• Vision – statement outlines the organization’s future role
and function. It gives the agency something to strive for.
• Philosophy – is a statement of beliefs and values that
direct one’s life or one’s practice.
• Goals – are broad statements or objective that is expected
to be achieved.
• Objectives – are the action commitments through which
an organization’s mission and purpose will be achieved
and philosophy or belief sustained.
Developing and Scheduling programs
- Planning Formula:
1) WHAT
• What has been done?
• What should be done?
• What equipment and supplies have been used or are
needed?
• What steps necessary in the procedure?
• What sequence of activities was previously used?
• What other efficient methods may be used?
2) WHEN
• When should the job be done?
J.A.K.E 11 of 35
• When was it formerly done?
• When could it be done?
3) WHERE
• Where is the job to be done?
• Where does an activity occur in relation to those
activities immediately?
• preceding and following it?
• Where could supplies be stored, cleaned, and so
forth?
4) HOW
• How will the job be done?
• What are the steps to be followed in doing the
procedure?
• How will the time and energy of personnel be used?
• How much will it cost?
• How much time will it require?
5) WHO
• Who has been doing the job?
• Who else could do it?
• Is more than one person is involved?
6) WHY
• To each of the questions, ask why.
• Why is this job, this procedure, this step necessary?
• Why is this done in this way, in this place, at this
time, by this person?
• One more question can be added to make the
formula more helpful.
7) CAN
• Can some steps or equipment be eliminated?
• Can this activity be efficiently combined with other
operations?
• Can somebody else do it?
• Can we get a machine to help?
• Can we get enough money?
- Modes of Planning
1) Reactive planning occurs after a problem exists.
Because there is a dissatisfaction with the current
situation, planning efforts are directed at returning the
organization to a previous, more comfortable state.
Often times, in reactive planning, problems are dealt
with separately without integration with the whole
organization. Because it is done in response to a crisis,
this type of planning can lead to hasty decision and
mistakes.
2) Inactivism is another type of conventional planning.
Inactivists seek the status quo, and they spent their
energy preventing change and maintaining conformity.
When changes do occur, they occur slowly and
incrementally.
3) Preactivism, preactive planners utilize technology to
accelerate change and are future oriented. Unsatisfied
with the past or present, preactivists do not value
experience and believe that the future is always
preferable to the present.
4) Interactive or proactive planning. Planners who fall into
this category consider the past, present, and future and
attempt to plan the future of the organization rather
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
than react to it. Because the organizational setting
changes often, adaptability is a key requirement for
proactive planning. This also occurs in anticipation of
changing needs to promote growth within an
organization and is required of all leader-managers so
that personal as well as organizational needs and
objectives are met.
Types of Planning
Strategic Planning
- A broad continuous systematic process that emphasizes
assessment of the organizational environment both
internally and externally such as economic, political, social,
and technological factors.
- It is a management tool that helps organizations set long-
term goals, a risk-taking decision with knowledge of their
effects in the future, and evaluating the outcomes through
reliable feedback mechanism.
- It focuses on performance improvement and utilizes
strategies to accomplish the organization’s desired
outcomes
- Strategic planning forecasts the future success of an
organization by matching and aligning an organization’s
capabilities with its external opportunities. An organization
could develop a strategic plan for dealing with the nursing
shortage, preparing succession managers in the
organization, developing a marketing plan, redesigning
workload, developing partnership, or simply planning for
organizational success.
SWOT Analysis
- One effective tool that can assist in strategic planning is
SWOT analysis (identification of strengths, weakness,
opportunities, and threats) is one of the most commonly
used in health care organizations. SWOT analysis is also
known as TOWS analysis was developed by Albert
Humphrey at Stanford University in the 1960s and 1970s.
- The first step in SWOT analysis is to define the desired end
state or objective. After the desired objective defined, the
SWOT are discovered and listed. Decision makers must
then decide if the objective can be achieved in view of the
SWOTs.
- If the decision is no, a different objective is selected and
the process repeats. With the results of your analysis the
following should be included:
1) working out what you hope to achieve,
2) being objective,
3) incorporating the findings into the action plan, and 40
revisiting your findings on a regular basis.
- Perform correctly, SWOT allows strategic planners to
identify those issues most likely to impact a particular
organization or situation in the future and then to develop
an appropriate plan of action
- Strategic Planning as Management Process:
1) Clearly define the purpose of the organization.
2) Establish realistic goals and objectives consistent with
the mission of the organization.
J.A.K.E 12 of 35
3) Identify the organization’s external constituencies or
stakeholders and then determine their assessment of
the organization’s purposes and operations.
4) Clearly communicate the goals and objectives to the
organization’s constituents.
5) Develop a sense of ownership of the plan.
6) Develop strategies to achieve the goals.
7) Ensure that the most effective use is made of the
organization’s resources.
8) Provide a mechanism for informed change as needed.
9) Provide a mechanism for informed change as needed.
10) Build a consensus about where the organization is going.
- It should be noted, though, that some critics argue that
strategic planning is rarely this linear. Nor is it static.
Strategic planning instead involves various actions and
reactions that are partially planned and partially unplanned.
- Sample of 5-year Development Plan:
Operational Planning
- a detailed work plan or written blueprint in which the
objectives of a nursing unit/department are put into
measurable actions?
- It is known as a management plan.
- Some categorical areas for objectives are: patient
satisfaction, patient safety, internal process, staffing,
training and education, research, and financial.
- It is also a specific plan that supports the strategic plan by
implementing Its strategies, projects and programs. It
provides detailed information to direct its people to
perform the day to day tasks and activities in running the
nursing unit/organization. The operational plan objectives
are specific. These are concrete statements that nurse
managers seek to accomplish in terms of results.
- It includes the what (task to be undertaken), who (person
responsible), when (timeline for task completion), and how
much (amount of financial resource to carry out the task).
- The formulation and implementation of operational plan is
the responsibility of middle and front -line managers and
its done yearly. Operational planning is an upward
approach because team members actively involved in the
planning process. They are encouraged to develop
personal to-do list necessary to reach the targets or
milestones of their nursing units, (DOH, 2016).
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
- Sample of Operational Plan:
Establishing Nursing Standards, Policies, and Procedures
- Nursing Standards Institutions develop their own
standards of nursing practice, the standard of Nursing
Practice and Nursing Service Administration formulated by
the Association of the Nursing Service Administrators of
the Philippines and revised 2008.
- The established standards in an evaluation provides
professional desirable norms against which department’s
performance can be measured. Areas of improvement are
identified and a plan of action to correct is made and
implemented.
- NURSING STANDARDS, the philosophy shall be based on
the belief that the client is integral whole and that he is a
unique individual with needs that can be met through
nursing interventions.
- NURSING SERVICE POLICIES are plans reduced to
statements or instructions that direct organizations in their
decision making. It direct individual behavior toward the
organization’s mission and define broad limits and desired
outcomes of commonly recurring situations while leaving
some discretion and initiative to those who must carry out
that policy.
J.A.K.E 13 of 35
- POLICIES may also be implied or expressed. Implied
policies neither written nor expressed verbally, have
usually developed overtime and follow a precedent.
- While expressed policies are delineated verbally or
inwriting. Most organizations have many written policies
that are readily available to all people and promote
consistency of action.
- PROCEDURES are plans that establish customary or
acceptable ways of accomplishing a specific task, and
delineate a sequence of steps that required action.
Procedures identify the process or steps needed to
implement a policy and are generally found in manuals at
the unit level of the organizations, (Marquis and Huston,
2017).
- Guidelines outlining the scope and standards of practice
for specialty practice areas.
- In the mid-20th century Kurt Lewin (1951) developed
change theory, identified 3 phases in which the change
agent must proceed before a planned change becomes
part of the system:
• Unfreezing
• Movement
• Refreezing.
Unfreezing
- This occurs when the change- agent convinces members of
the group. To change or when guilt, anxiety, or concern can
be elicited. Change agent needs to have made a thorough
and accurate assessment of the extent of and interest in
change, for them to become effective as change agent.
Movement
- change agent must identifies, plans, and implements
appropriate strategies, ensuring driving forces exceed
restraining forces. Because changes are not that easy it’s
a complex process and it requires a great deal of planning
and intricate timing. Human behavior changes or attitudes
and values underlie that behavior, takes some time.
Refreezing
- during this phase the change agent assists in stabilizing the
system change so that it becomes integrated into the
status quo. For this to occur, the change agent must be
supportive and reinforce the individual adaptive behavior
efforts of those affected by the change, (Marquis and
Houston, 2017).
Budget
- Annual operating plan
- Financial “road map” and plan
- Estimate of future costs
- Plan for utilization of capital in the operating programs
- A financial plan that includes estimated expenses as well
as income for a period of time,
- Budgeting, it is the financial guideline where is the
allocation of each resources such as money, time and
people will be acquired and used. It is the financial “road
map” which projects the future costing and a plan for
manpower utilization, and other resources in line with the
operating programs.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
- A nurse manager uses his/her expertise to utilize the
efficient and effective budgetary planning and processes.
In budget preparation, the nursing services purposely
control and establish the monthly as well as the annual
financial budget plan report.
• Nursing Budget – a plan for allocation of resources
based on preconceived needs for a proposed series of
programs to deliver patient care during one fiscal year.
• Hospital Budget – a financial plan to meet future service
expectations. Budgeting translates these needs to
manpower, equipment and supplies so that both
services are provided at the highest level of quality at a
minimum cost.
Types of Budget
1) Personnel Budget
- It is the type of budget affected by personnel policies
such as salary related to position and number of days
allowed for educational and personal leave.
- This said to be the workforce budget because it is
forecasting the volume of operational staff.
- It monitors the personnel budget to determine the
needs of nursing staff either in short for long term basis.
The manager should aware of the increasing or
decreasing of patient’s volume per day/per hour or per
minute so as they would know the number of staff
nurses to be assigned., (Marquis and Huston, 2017)
2) Operating or Revenue and Expense Budgets
- This includes the daily revenues and expenses to
operate the health care institution. It deals primarily
with salaries, supplies, and contractual services.
- It is an annual budget that includes the revenues and
expenses associated with the daily activities of the
Nursing department. Provides an over view of an
agency’s functions by projecting the planned operations,
usually for the upcoming year.
3) Capital Expenditure Budgets
- Related to long range planning. Include physical
changes such as replacement, or expansion of the plant,
major equipment, and inventories.
- Considers the purchased related to the acquisitions of
the major equipment and necessities involving the
physical facilities of the Nursing services.
4) Cash Budget
- Plan to make adequate funds available as needed and
to use an extra fund profitably.
5) Flexible Budget
- budgets that adjust automatically over the course of the
year depending on variables such as volume of labor
costs and capital expenditures.
Purpose of Budgeting
1) A forecast of income and expenditure
2) A tool for decision making, to provide financial framework
3) Measured the financial report and its statistical data.
Importance of Budget
- To control the over spending of the Nursing services.
Budgeting helps you control the spending beyond the
means in related to nursing activities.
J.A.K.E 14 of 35
- To monitor income and expenses of the Nursing services.
Budgeting helps you keep on track of the income and
expenditures of the Nursing services.
- Rationalization of the financial transparency and
accountability of the Nursing services. Budgeting gives you
a precise report summary of the financial responsibilities.
Budgeting Process
Phase 1 Gathering Data
1) Study the overall past performance based on proposed
goal.
2) Gather environmental information
3) Regulates the overall expenses and revenues from the
past reports to present based on proposed budget.
Phase 2 Planning
1) Create a Budget Committee
2) Set Objectives based on strategic goals
3) Establish a program or project for future goals
4) Formulate a budget guideline to synchronize with
financial linkages
5) Settle an Operating and Capital Budget
6) Manage a budget hearing
7) Prioritize your budget based on necessity
8) Conclude your proposed budget plan
Phase 3 Approval and Execution
1) Summarized the proposed nursing service budget plan
and let the authorize finance budget committee to
review and approve the budget.
2) Make a budget plan ready for improvement in order to
calibrate any errands to the General Appropriations Act
(GGA).
3) Cascade the proposed budget plan accordingly to all
nursing unit staff and department.
Phase 4 Monitoring and Reporting
1) Observe the proper delivery or implementation of the
budget plan.
2) Make an analysis between the proposed budget and the
actual performance.
3) Clarify and justify the results to determine the
significant trends
4) Ready to make an adjustment based on the required
needs.
5) Present the financial report according to hospital policy.
Pre-Requisites for Budgeting
1) Sound organizational structure with clear lines of authority
and responsibility is needed.
2) Non monetary statistical data – such as number of
admission, average length of stay, percentage of
occupancy and number of patient days – are used for
planning and control of the budgetary process.
3) Chart of accounts are designed to be consistent with the
organizational plan.
4) Managerial support is essential for a budgetary program.
5) Formal budgeting policies and procedures should be
available in the budget manual.
Factors in Budget Planning
• Type of patient and the length of stay in the hospital.
• Bed capacity and hospital size
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• Physical plant of the hospital, design and the size of the
wards/unit and other treatment rooms.
• Personnel policies.
• Grouping of patients
• Standard of Nursing Care
• Method of performing nursing care
• Method of documentation
• Proportion of nursing care providers (professional / non-
professional)
• Amount and quality of supervision available and provided
• Competencies of job description and qualification
• Method of patient assignment
• Amount and kind of labor-saving devices and equipment
• Amount of centralized service provided
• Nursing service requirement ancillary departments
• Reports required by administration
• Affiliation of nursing students or medical students
Budgeting Methods
• Incremental Budgeting – simplest method for budgeting.
Since the budget for the next coming year may be projected,
the programs and services were not prioritized.
• Zero-Based Budgeting – the method does not
automatically claim to be funded. A set funding priority is
the main purpose of this method.
• Flexible Budgeting – this method calculates what the
expenses should be specified in the program
• Performance Budgeting – emphasizes the outcomes and
results instead of activities and outputs.
Factors in Determining Budgetary Requirement
- Asses the appropriate provision in the current General
Appropriation Act.
- Associate the sources of funds (General, national, city,
municipal…)
- Evaluate the current appropriations and actual
expenditures for the current year.
- Analyze the projected changes in other department that
will affect the nursing service budget.
- Consider the required expenditures, supplies, equipment
and material, repair and replacement for the next coming
year.
- Projects the estimated personnel salaries and benefits
including their unusual leaves.
- Assess the cost of Human Resource Development and
Research Programs.
- Render this information into peso and submit the official
forms to the Medical Center Chief for approval and
inclusion in the general budget.
The efficiency of the budget management resources
determines the productivity goal of the of the nursing service
management. It reflects the consistency of the budget costing
ability of the nurse manager.
Time Management
- It is a technique for allocating one’s time through the
setting of goals, assigning priorities, and identifying and
eleminating wasted time, and using managerial techniques
to reach goals efficiently.
J.A.K.E 15 of 35
- One of the strategies in managing the time is learn to
prioritize duties, managing and controlling crisis, reducing
stress and balancing work and personal time, (Marquis and
Houston,2017).
- Nothing is particularly hard if you divide it into small jobs. -
Henry Ford
- Things which matter most must never be at the mercy of
things that matter least. – Johann Wolfgang von Goethe
Time Management Principles
1) Planning anticipates the problem that arise from actions
without thought.
2) Tasks to be accomplished should be done in sequence and
should be prioritized
3) Setting deadlines in one’s work and adhering to
4) them is an excellent exercise in self-discipline.
5) Deferring, postponing, or putting off decisions, actions, or
activities can become a habit which oftentimes causes lost
opportunities and productivity, generating personal or
interpersonal crises.
6) Delegation permits a manager to take priority for decision
making and to assign tasks to the lowest possible
consistent with his/her judgement, facts, and experience,
(Venson, 2016).
Time-Saving Techniques, Devices, and Methods to Better
Use Of Time
1) Conduct an inventory of your activities
2) Set goals and objectives and write them down.
3) With the use of calendars, executive planners, logs or
journals, write what you expect to accomplish yearly,
monthly, weekly or daily.
4) Break down large projects into smaller parts.
5) Devote a few minutes to concentrate on one thing at a time.
6) Organize your work space so it is functional.
7) Close your door when you need to concentrate.
8) Learn to delegate.
9) In a meeting, define the purpose clearly before starting.
10) Take or return phone calls during specified time. Develop
effective decision-making skills. Do no afraid to say “no”.
11) Take rest breaks and make good use of your spare time
Three Steps to Time Management
1) Allow time to planning and establish priorities.
2) Complete the highest task whenever possible and finish
one task before beginning another.
3) Reprioritize based on the remaining tasks and on new
information that may have been received.
Organizing
Organizational Theory and Bureaucracy
- Max Weber is known as the father of organizational theory.
According to him, bureaucracy is an institutional method
for applying general rules to specific cases, making the
actions of management fair and predictable.
- Characteristics of bureaucracy are the following:
• There must be a clear division of labor.
• A well-defined hierarchy of authority must exist which
separates the superiors from subordinates.
• There must be impersonal rules and impersonality of
interpersonal relationships.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• A system of procedures for dealings with work
situations must exist.
• A system of rules covering the rights and duties of each
position must be in place.
• Selection for employment and promotion is based on
technical competence.
- Organizing is the process of establishing formal authority.
It involves setting up the organizational structure through
identification of groupings, roles and relationships,
determining staffing patterns and distributing in the various
areas as needed.
- Elements of Organizing: Setting up the organizational
structure, staffing, scheduling, and developing job
descriptions.
- Setting up the Organizational Structure:
• The creation of an organizational system compatible
with the philosophy, conceptual framework, and goals
of the organization provides the means for the
accomplishment of an organization’s purpose.
• Understanding the organizational structure as a whole
facilitates the development of roles and relationships to
enable the achievement by goals.
- Setting up the organization structure may achieve it’s
purpose:
1) It informs members of their responsibilities so that they
may carry them out
2) it allows members and the individual workers to
concentrate on his/her specific role and responsibilities
3) it coordinates all organizational activities so there is
minimal duplication of effort or conflicts.
4) it reduces the chances of doubt and confusion
increasing assignments.
5) Avoids overlapping of functions because it pinpoints
responsibilities.
6) Shows to whom and for whom they are responsible.
Other individuals that the nurse may need to be accountable
to include the immediate supervisor, the patient and family,
central administration, and the physician because all of them
participate in the nurse’s work.
Types of Organization Classified by Nature of Authority
1) Lines organization is the simplest and the most direct type
of organization in which each position has general authority
over the lower positions in the hierarchy. Example: Clinical
and Administration
2) Informal organizations refer to horizontal relationships
rather than vertical. This is composed of small groups of
workers with similar interests.
3) Staff organization is purely advisory to the line structure
with no authority to put recommendations into action.
Example: Training and Research
4) Functional organization is one where each unit is
responsible for a given part of the organization’s workload.
There is clear delineation of roles and responsibilities
which are actually interrelated. Example: All standing and
ad hoc committees
Organizational Chart
- a line drawing that shows how the parts of an organization
are linked. It depicts the formal organizational
J.A.K.E 16 of 35
relationships, areas of responsibility, persons to whom one
is accountable and channels of communications
- There are two lines in the organizational chart:
1) Unbroken Solid lines are classified into two:
a) The solid horizontal lines represent communication
between people with similar sphere of responsibility
and power but different functions.
b) The solid vertical lines between positions denote the
official chain of command and formal path of
communication and authority
2) Dotted or broken lines – represents staff position. Staff
member provides information and assistance to the
manager but has limited organizational authority. It also
provides for specialization but does not have legitimate
authority as it acts in an advisory capacity.
- Characteristics:
1) Division of Workbox – represents the individual or sub-
unit responsible for a given task of the organizations
workload. Ex: Medical Services, Hospital Operations
and Patient Support Services, Nursing Services, and
Finance Services.
2) Chain of Command – lines indicate who reports to
whom and by what authority. Ex: Flat (decentralized) or
tall (centralized) organizations
3) Type of Work to be Performed – indicated by labels or
descriptions for the boxes. Ex: Ancillary Services,
Training and education Department, and Patient Care
Services.
4) Grouping of work Segments – shown by the clusters of
work groups (departments or single units). Ex:
Operating Room and Post Anesthesia Care Unit, Labor
Room and Delivery Room Unit, Intensive Care and
Coronary Care Unit.
5) Levels of Management – indicate individual and entire
management hierarchy. Hierarchy refers to a body of
persons or things organized or classified in pyramidal
fashion according to rank, capacity or authority
assigned to vertical levels with the offices ranked in
grades, orders, or classes, one above the other. Ex: Top
management, middle management, and front-line
management.
- Kinds of Organizational Chart:
1) Structural chart shows the various components of the
organization and outlines the basic interrelationships.
2) Functional chart reflects the functions and duties of the
components of the organization and indicates the
interrelationships of these function. Within the boxes is
the function statement, which should be clear,
inclusive and written in the present tense.
3) Position chart specifies the names, positions, and titles
or ranks of the personnel.
Organizing Principles
1) Unity of Command
- Employee should be responsible to only one superior.
- Although employees may interact with many different
employees in the performance of their duties, they
should be responsible to only one superior. This is to
avoid confusion, overlapping of duties and
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
misunderstanding This method is modified by emerging
organizational theory where nurses and others are
frequently engaged in matrix organizations in which they
answer for more than one supervisor.
2) Scalar Principle/ Hierarchy / Chain of Command
- Authority and responsibility should flow in clear
unbroken lines from highest executive to the lowest.
- The other form for this is “chain of command,” usually a
military term. Proper definition and delegation of
authority and responsibility facilitate the
accomplishment of work.
- The following must be observed:
• When the job was given to a subordinate, he/she is
responsible over resources needed to accomplish
the task.
• Though a particular function is being given to a
subordinate, the responsibility of the superior is not
being diminish.
• When the subordinate was given responsibility , he
is accountable for his own actions to his/her
superior.
3) Homogenous assignment or Departmentalization
- Grouping together of employees with similar
assignments.
- Workers performing similar assignments are grouped
together for a common purpose. This promotes the
specialization of activities, simplifies the
administrator’s work, and helps maintain effective
control.
4) Span of control
- The number of workers that a supervisor can effectively
manage should be limited, depending upon the pace
and pattern of the working area.
- It also refers to span of managerial responsibility and
the number which one superior can assist, teach and
help to reach the objectives of their own jobs
5) Exception Principle
- Recurring decisions should be handled in a routine
manner by lower level managers whereas problems
involving unusual matters should be referred to the
higher level.
- Subordinates should report only unusual from normal
functioning, so that managers can limit their attention
to significant events.
6) Decentralization or Proper Delegation of Authority
- The process of pushing decision making to the lower
levels of the organization.
- Decentralization is the process of conferring specified
decision making to the lower levels of the organization.
Basic top-level decisions and policies must receive
attention at the top levels. Executives should be
developed to handle situations delegated to the, this
delegation of authority is still subject to the supervision
and control of the delegating superior. Distribution of
necessary information about critical issues is vital to
any delegation process. An executive should have
sufficient information to make a good decision.
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7) The Principle of Requisite Authority
- When a particular task is delegated to a subordinate,
the latter must also be given authority over resources
needed for task accomplishment.
- He/ She is accountable for the quality of his work.
8) The Principle of Organizational Centrality
- Nursing personnel interact with the greatest number of
other healthcare workers, receive the greatest amount
of work related information and become most powerful
in organizational structure.
9) The Principle of Esprit d’ Corps
- This means teamwork and implies that in unity, there is
strength.
Organization of the Nursing Service/ Division:
- The nursing service as an organization constitutes the
single largest group of hospital employees responsible of
setting standards for safe nursing practice, providing
quality care to the patients, and coordinating its services
with the various divisions/departments/services in the
hospital and community
- The Nursing service/division is administered by the Chief
Nurse. under her. In specialty hospital such as:
• Lung Center of the Philippines
• National Kidney Transplant Institute
• Philippines Children’s Medical Center = the heads of
the Nursing Department are Called Department
Managers. They still have a Chief Nurse under them.
• PGH -Asst. Director for nursing
• The Chief Nurse – directly responsible to the chief of the
hospital or medical center chief. Assisted by an assistant
chief nurse.
• Supervising Nurse – In charge of two or more nursing units.
• Head Nurse of Senior Nurse – Responsible for the
management of a nursing unit.
• Staff Nurse – Provides direct patient care and are assisted
by nursing attendants
• Nursing Attendants – Performs simple, routine tasks for
which they have been trained.
Forms of Organizational Structure
1) Traditional Hierarchical Structure (tall, centralized,
bureaucratic)
- This is commonly called line structure. Authority and
responsibility are clearly defined leading to simplicity of
relationships. This is associated with the principles of
command, vertical control and coordination levels, and
downward communications.
- Merits of Line Organization
1) Simplest
2) Unity of Command
3) Better discipline
4) Fixed responsibility
5) Flexibility
6) Prompt decision
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
2) Decentralized (flat, horizontal, participatory)
- The authority is shifted downwards to its divisions,
services, and units. The decision making can occur
where the work is being carried out, thereby
professionals who do the job can participate in
managing the organization.
3) Matrix
- This is designed to focus on both the product and
function. The manager of the unit responsible for a
service report both to a functional and product manager.
4) Hybrid
- A term applied to organizational structure that operate
with characteristics of different types of structures.
Organizational Structure for Devolved Hospital
- This shows a decentralized clinical structure. Authority,
responsibility, and accountability are vested on primary
care nurses who report directly to the nursing
administrator.
- The legal basis to consider in operating devolved hospitals
is the Local Government Code (LGC) of 1991. Local
government units are given full autonomy in the exercise of
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their proprietary functions and in their economic
enterprises subject to limitations provided in the code and
other applicable laws.
- Section 18 of the Department of Health Rules and
Regulations Implementing the Local Government Code of
1991 (the “DOH Rules”) gives authority to Local
Government Units regarding the management and
operation, among others, of provincial, district, municipal,
and city hospitals. Funding shall come from the share of
the province or city in the national taxes and other national
funds and funding support from the national government,
its instrumentalities and government-owned or controlled
corporations which are tasked by law to establish and
maintain health services and facilities.
Organizational Structure for Devolved Hospitals and Rural
Health Units
STAFFING
- process of determining and providing the acceptable
number and mix of nursing personnel to produce a desired
level of care to meet patient’s demand. It purpose is to
provide each unit with an appropriate and acceptable
number of workers in each category to perform the nursing
task required.
- It is the responsibility of the manager for the adequate and
well communicate staffing and scheduling policies
stressed. The manager must focus on her leadership
responsibility for developing trust through fair staffing and
scheduling procedures. Managers should do what they can
to see that employees feel they have some control over
scheduling, shift options, and staffing policies. Creating
safe staffing practices for equitable nurse-patient
assignments on a regular basis continues to a challenging
role for nurse leaders. Because staffing patterns and
scheduling policies directly affect the daily lives of all
personnel, they must be administered fairly as well as
economical, Marquis and Huston, (2017).
- Staffing is the process of hiring eligible candidates in the
organization or company for specific positions. In
management, the meaning of staffing is an operation of
recruiting the employees by evaluating their skills,
knowledge and then offering them specific job roles
accordingly. Let us find out more about what is Staffing and
what it entails along with its functions and characteristics.
- Staffing is the traditional management function of
attraction and selection of the best people and putting
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023

them on job where their talents and skills can be best Level I
utilized, and retention of these people through incentives, - Patients that can do self care or minimal care
job training and job enrichment programs, in order to - Non-emergency
achieve both individual and organizational objectives. - Requires little treatment
Factors Affecting Staffing - NCH 1.5 hours/day
1) Patient Factors - P:NP Ratio: 55:45
- Census fluctuations Level II
- Patient acuity - Moderate or intermediate care
- Level of care/degree of dependence - Requires periodic assessment and treatment
- Patient age group - NCH is 3hours/day
- Special treatment and procedure - P:NP ratio: 60:40
- Communicability Level III
- Rehabilitation - Total, Complete or Intensive Care
- Patient and family care demands/expectations - Completely dependent on the personnel for care
2) Staff Factors - NCH is 6hours/day
- Number of nursing staff available - P:NP ratio: 65:35 P
- Ratio of professional to non-professional Level IV
- Number of leaves - Highly specialized Critical Care
- Turn-over rate - Requires the maximum nursing care
- Span of supervision - Continuous assessment, treatment and evaluation
3) Nursing service factors - NCH 6-9hours/day
- Nursing care modality in use - P:NP ratio is 70:30 to 80:20
- Type of services/patient classification system
- Patterns of work schedule Republic Act 5901
- Training and staff development programs Forty Hour Week Law
- Research activities - Hospital employees working in = or > 100 bed capacity will
4) Health care organization factors work 40 hrs/week
- Type of hospital - If it is < 100 bed capacity 48hrs/week
- Services offered/population served - Number of working and non-working days and hours of
- Work time policy nursing personnel per year
- Administrative policy on weekend and holiday duty
- Presence of support services
- Nursing unit architectural design
- Availability of resources like equipment, materials and
supplies
- Technology anticipated
- Projected units of services
- Budget limitations

Patient Care Classification System

- Primary developed to determine workloads requirements
and staffing needs. It is categorizing patients on the basis
of certain needs that can be clinically observe by the nurse.
It is a method of grouping patients according to the amount
and complexity of their nursing care requirements and
nursing time and skill they require.
- Nursing care hours per patient per day according to
classification of patients by units:
- Relievers Needs – Compute for relievers needed, the
following should be considered:
1) Average numbers of leaves taken each year (15)
a. Vacation Leave (10)
b. Sick Leave (5)
2) Holidays (12)
3) Special Privileges as per CSC MC #6s. 1996 (3)
4) Continuing Education Program for Professionals (3)
Total Averages Leaves = 33
- To determine the relievers needed, divide 33 (the
average number of days an employee is absent per
year) by the number of working days per year that each
employee serves (whether 213 or 265).

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 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
- This will be 0.15 per person who works 40 hours per
week and 0.12 per person for those working 48 hours
per week.
- Multiply the computed reliever per person by the
computed number of nursing personnel. This will give
the total number of relievers needed.
Distribution By Shifts
• Morning shift (6-2) – Needs 45-51% of nursing personnel
• Afternoon shift (2-10) - 34-37%
• Night Shift (10-6) - 15-18%
- In the Philippines the distribution usually followed is 45
percent for the morning shift, 37 percent for the
afternoon shift, and 18 percent for the night shifts.
Staffing Computation Formula
- Staffing Computation, the hospital should ensure that
there is sufficient staff to cover all shift, off-duties, holidays,
leaves, absences, and time for staff development
programs.
- The Forty-Hour week Law (Republic Act 5901), provides
that employees working in hospitals with 100 bed capacity
and up will work only 40 hours a week.
Staffing Formula
To compute for the staff needed in the In-Patient unit of the
hospital the following steps are considered:
1) Categorize the number of the patients according to the
levels of care needed. Multiply the total number of
patients according to the level of percentage of patients at
each level of care. (whether minimal, intermediate,
intensive or highly specialized)
2) Find the total number of Nursing care hours needed by
the patients at each category level.
a) Find the number of patients at each level by the average
number of nursing care hours needed per day
b) Get the sum of the nursing care hours needed at the
various levels.
3) Find the actual number of nursing care hours needed
by the given number of patients. Multiply the total
J.A.K.E 20 of 35
nursing care hours needed per day by the total number of
days in a year.
4) Find the actual number of working hours rendered by
each nursing personnel per year. Multiply the number of
hours on duty per day by the actual working days per year.
5) Find the total number of nursing personnel needed.
a) Divide the total number of nursing care needed per year
by the actual number of working hours rendered by an
employee per year.
b) Find the number of relievers. Multiply the number of
nursing personnel needed by 0.15 (for those working
48hours per week)
c) Add the number of relievers to the number of nursing
personnel needed.
6) Categorize the nursing personnel into professionals
and non-professionals. Multiply the number of nursing
personnel according to the ratio of professionals to non-
professionals.
7) Distribute by shift.
Example: Find the number of nursing personnel needed for
250 patients in a tertiary hospital.
1) Categorize the patients according to level of care needed.
250patients x .30 = 75 patients needing minimal care
250 patients x .45 = 112.5 patients needing moderate
care
250 patients x .15 = 37.5 patients needing intensive care
250 patients x .01 = 25 patients needing highly
specialized care
TOTAL = 250
2) Find the number of nursing care hours (NCH) needed by
patients at each level of care per day.
75 patients x 1.5 (NCH needed at level I) = 112.5
NCH/day
112.5 patients x 3 (NCH needed at level II) = 337.5
NCH/day
37.5 patients x 4.5 (NCH needed at level III) = 168.75
NCH/day
25 patients x 6 (NCH needed at level IV) = 150 NCH/day
Total 768.75 NCH/day.
3) Find the total NCH needed by 250 patients per year.
768.5 x 365 (days/year) = 280,593.75 NCH/day
4) Find the actual working hours rendered by each nursing
personnel per year.
8 (hrs/day) x 213 (working days/year) = 1,704 (working
hours/year)
5) Find the total number of nursing personnel needed.
6) Categorize to professionals and non-professional
personnel Ratio of professionals to non-professionals in a
tertiary hospital is 65:35
190 x .65 = 124 professional nurses
190 x .35 = 66 nursing attendants
7) Distribute by shifts.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
124 nurses x .45 = 56 nurses on AM shift
124 nurses x .37 = 46 nurses on PM shift
124 nurses x .18 = 22 nurses on night shift
Total 124 nurses
66 Nsg attendants x .45 = 30 Nursing attendants on AM Shift
66 Nsg attendants x .37 = 24 Nursing attendants on PM Shift
66 Nsg attendants x .18 = 12 Nursing attendants on night shift
Total 66 Nursing attendants
Scheduling
- A schedule is a timetable showing planned work days and
shifts for nursing personnel.
- The objective in scheduling is to assign working days and
days-off to the nursing personnel so that adequate patient
care is assured.
- A desirable distribution of off-duty days can be achieved
and the individual members of the nursing team will feel
that they are treated fairly. They will also know their
schedule in advance, Venzon, (2016).
Factors Considered in Making Schedules
• different levels of the nursing staff: adequate coverage for
24 hours, seven days a week:
• staggered vacations and holidays: weekends:
• long stretches of consecutive working days: evening and
night shifts: and floating.
• An adequate mix of nurses and nursing attendants
• education, training and experiences.
• Afternoon and night shift requirements for the staff are
usually lower than in the morning shift.
• lower staff requirements on Saturdays and Sundays since
there are lesser medical rounds, fewer medical orders and
lower patient census.
• schedules for holidays are staggered at least once a month.
Vacations, whether forced or requested,
• Long stretched of consecutive working days
• Busy units may require additional help.
• Unscheduled absences may require a staff to be pulled out
from her regular area
• Job dissatisfaction and high turnovers rates.
Assessing a Scheduling System
Scheduling may vary from agency to agency, but the
scheduling system must function smoothly in terms of:
1) Ability to cover the needs of the unit a minimum required
number of staff must meet the nursing needs of the
patients in the units at all shifts:
2) Quality to enhance the nursing personnel’s knowledge,
training and experience While permanent assignment to
one unit enhances skills in caring for a particular kind of
patient (whether obstetrical, medical, surgical or
pediatrics), many nurses who have future plans of going
into teaching, or specialization or even working abroad,
would prefer to experience being assigned to various units
before settling down to a particular unit of their choice:
3) Fairness to the staff All nursing personnel should get a fair
share of weekends, holidays offs, rotation patterns for the
whole year including assignment to “difficult” or “light” or
“undesirable” units or shifts:
J.A.K.E 21 of 35
4) Stability The nursing personnel would like to know in
advance their schedule of assignment so that their
personal schedules (whether at home, social and civic
responsibilities are in harmony with each other: and
5) Flexibility the ability to handle changes brought about by
emergency leaves, scheduled or unscheduled leaves of
absences.
Types of Scheduling
1) Centralized Schedule - One person, usually the Chief
Nurse or her designate, assigned the nursing personnel to
the various units of the hospital. This includes the shifts on
duty and off-duty.
2) Decentralized Schedule – shift and off-duties are
arranged by the Supervising Nurse or Head or Senior Nurse
of the particular unit.
3) Cyclical Schedule – covers a designated number of weeks
called the cycle length and is repeated thereon. It assigns
the required number of nursing personnel to each nursing
unit consistent with the unit’s patient care requirements,
the staff’s preference, their education, training and
experience.
The following scheduling variables should be considered:
1) length of scheduling period whether 2 or 4 weeks;
2) shift rotation;
3) week-ends off;
4) holidays offs;
5) vacation leave;
6) special days (birthdays, wedding anniversary, etc);
7) scheduled events in the hospital, training programs, or
meetings;
8) job categories;
9) tardiness and;
10) continuing professional education (CPE) programs.
Advantages of Cyclical Schedule
• It is fair to all. Favoritism is minimized as all nursing
personnel get their fair share of rotation to the various
shifts.
• It saves time as the schedule does not have to be redone
every week or two.
• It enables the employees to plan ahead for their personal
needs preventing frequent changes in schedule.
• Scheduled leave coverage such as vacation, holidays and
sick leaves are more stable.
• Productivity is improved.
Directing
- Directing is the issuance of orders, assignments, and
instructions that enable the nursing personnel to
understand what are expected of them. It includes
supervision and guidance so that in doing their jobs well,
nurses can maximally contribute to the organization’s
goals in general and to the objectives of nursing service in
particular, Venzon, (2016).
- Importance of Directing:
• Establish direction in carrying out desired action
• Influence nursing personnel to follow the direction
• Initiate actions
• Integrate efforts
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023

• Become a means of motivation - Elements of Directing:

• Provide stability • Delegation
• Enable employee to cope with the changes • Supervision
• Help in efficient utilization of resources • Communication
- Purpose of Directing: • Problem solving and Decision making
• Obtain the optimum return from all staff in the interest • Motivation
of the institution
• Bring personal and professional growth of employees Delegation
• Bridge the gap of directing - Delegating is the process by which a manager assigns
• Create a direct link between the nurse managers and specific tasks/duties to workers with commensurate
the nursing personnel through effective communication authority to perform the job. The worker in return assumes
• Maintain standards of services cooperatively to develop responsibility for its satisfactory performance and is held
coordination to avoid overlapping accountable form its results.
• Assist in the problem solving of the matters concerning - Paramount importance in delegation are the worker’s job
personnel description, his/her knowledge base, his/her ability to carry
• Assess continuously the services given personnel put the task, and fairness not only to the employee but to
performance the team as a whole.
- Principles of Directing: - Importance of Delegation:
• Harmony of objectives – Employees work well when • Give subordinates a feeling of importance and motivate
they feel that their physiological and psychological them for appropriate results
needs are met. • Develop the talents and skills of the subordinates,
• Unity of command – Dual subordination brings disorder which can be used for succession planning.
and chaos, undermines authority and leads to - Purposes of Delegation:
instability. • Provide appropriate distribution of tasks for safe and
• Appropriate direction techniques – Motivation quality nursing care
techniques such as pay, incentives, awards, status, • Promote individual responsibility and accountability
promotion, etc., can increase job satisfaction, • Allow the nurse to perform more complex patient care
productivity and quality/excellence of work. and other related services
• Use of informal organization – Special attention should • Reduce workload to prevent burn out
be given to the informal organization to strengthen the • Enhance the knowledge and skills of nursing personnel
formal organization. and other health care workers
• Managerial communication – Direct and personal • Promote cost containment and effectiveness for the
contact or feedback makes supervision effective and health care facility.
motivating. - Principles of Delegation:
• Appropriate leadership style – Nurse managers to • Select the right person to whom the job is to be
influence their subordinates must provide good delegated.
leadership. • Delegate both interesting and uninteresting tasks.
• Follow through follow up – Nurse managers must • Provide subordinate with enough time to learn.
monitor as to what extent the policies framed and • Delegate gradually.
issued directions have been enforced. • Delegate in advance.
- Characteristics of Directing: • Consult before delegating.
• Initiates action – Giving directions and instructions the • Avoid gaps and overlaps.
nurse managers get the work started in the organization - Elements of Delegation:
• Continuous process – Nurse managers continuously • Responsibility
takes steps to ensure that orders and instructions are • Authority
carried out properly. • Accountability
• Takes place at every level – Directing is a pervasive - 5 Rights of Delegation:
function of all manager at all levels in all units perform it. • Right task
• Flows from top to bottom – Nurse managers direct their • Right circumstances
immediate subordinates and take directions from their • Right person
immediate superiors. • Right direction and communication
• Performance-oriented – Directing function helps • Right supervision and evaluation
converting plans to performance. - Steps in Delegation:
• Human level – Human behavior is complex and 1) Prepare
unpredictable direction function involves studying 2) Assign
workers behavior and motivating them to work their 3) Confirm understanding and commitment
best ability. 4) Monitor accomplishment against the assigned tasks

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5) Ensure accountability
- Pointers to Proper delegation of work:
• Provide clear and specific instructions
• Give authority commensurate to responsibility
• Keep subordinates informed
• Show you have confidence in your subordinates
• Be loyal
- Ways for nurse Mangers to Delegate Successfully:
• Train and develop subordinates
• Plan ahead, it prevents problems
• Control and coordinate the work of subordinate
• Visit subordinates periodically
• Coordinate to prevent duplication of effort
• Specify goals and objectives
• Solves problems
• Know subordinates’ capabilities and match the task or
duty to the employees.
• Agree on performance standards
• Take an interest
• Do not take back delegated task
- What Cannot Be Delegated:
• Overall responsibility, authority, and accountability for
satisfactory completion of all activities in the unit.
• Authority to assign one’s name is never delegated.
• Evaluating the staff and/ or taking necessary corrective
or disciplinary action.
• Responsibility for maintaining morale of 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:
• There are some reasons why nurse managers fail to
delegate.
• Lack of confidence in their staff, feeling that only they
could do the task better and faster, or fear of loss of
control if some of their duties are delegated.
Subordinates may be apprehensive in accepting
delegated task for fear of criticism, ineptitude, or
incompetence.
• Insecurities may be avoided if there is open
communication among the staff.
• Warm and cordial relationships where everyone is free
to ask questions or seek clarifications regarding of
delegated task which to them may be too difficult to
understand.
Supervision
- The word “supervision” comes from the word “supervide”
which means “to oversee or view directly.”
- Supervision is providing guidelines for the accomplishment
of a task or activity with initial direction and periodic
inspection of the actual accomplishment of the task or
activity.
- It appraises not only the quantity and quality of work
performed, but also the time within which the work is
accomplished, the proper and economic utilization of
J.A.K.E 23 of 35
resources, the amount of assistance needed by the worker,
and the need for staff development or continuing
education programs.
- The nurse who delegates is responsible for the acts of the
subordinate and may incur liability if found negligent in the
process of delegating and supervising. This is under the
doctrine of I respondeat superior which mean “let the
superior answer for the acts of the subordinate.”
- Qualities of Good Supervision:
• Good technical, managerial and human relation skills;
• Ability to communicate well in both spoken and written
language and ability tom listen;
• Firmness with flexibility to adjust to the needs of the
situation;
• Fairness in dealing with employees;
• Familiarity with hospital and nursing policies that affect
patient 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 opportunities
for continuing professional growth and development;
and
• Advocacy for nurses and nursing.
- Principles of Good Supervision:
• Good supervision requires adequate planning and
organization which facilitate cooperation, coordination,
and synchronization of services.
• Good supervision gives autonomy to workers depending
on their competency, personality, and commitment.
• Good supervision stimulates the worker’s ambition to
grow into effectiveness. Good supervision creates an
atmosphere of cordiality and trust.
• Good supervision considers the strengths and
weaknesses of employees.
• Good supervision strives to make the unit an effective
learning situation.
• Good supervision considers equal distribution of work
considering age, physical condition, and competence
- Techniques in Supervision:
• Observation of the worker while making the rounds;
• spot checking of chats 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 question discretely to find out the problems they
encounter in the wards; or
• drawing out suggestions from the workers for
improvement of their work or work situation.
Given in a soft, courteous manner, these will be taken willingly
and accepted as a challenge to improve performance. Give
harshly, especially in public, it builds up resentment, ill-will,
and poor quality of work.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Participatory Management
- Decentralization and participatory management have
changed to role of Supervision Nurses.
- They learn to delegate authority to Head Nurses, their
responsibility for unit management decreases.
- The climate of supervision changes.
- The nurses are given increasing.
- The nurses are given increasing authority to manage
themselves. Rather than direct the work force, the
Supervising Nurse assumes the role of mentor, role model
and facilitator.
- Some hospitals have changed the position of Supervising
Nurse into Clinical Coordinator or Clinical Managers.
- In participatory management there are mutual trust and
support There is increased accountability of the Head
Nurse and of employees through self-supervision. High
morale and team work result in increased effectiveness
and productivity and increased commitment and
recognized of contribution. Participation increases
individual and organizational capacities to learn, adapt,
and develop toward higher levels of excellence, Venson,
(2016).
- There are some disadvantages of participatory
management. Among these are difficulty in changing the
perception of employees about the previous authoritarian
management, occasional failure, and difficulty in fixing
responsibilities. Nurses can be more actively involved in
participatory management through job enrichment,
involvement in critical decisions that affect them, and by
providing liberal training and opening of career
opportunities, Venzon, (2016).
Coordination
- Coordination unites personnel and services toward a
common objective. Synchronization of activities among the
various services and departments enhances collaborative
efforts resulting inefficient, smooth and harmonious flow of
work.
- Supervising Nurses and Head/ Senior services coordinate
their work with other departments services or units by
conveying clearly define policies, standards operating
procedures, policies, and guidelines using the proper
channels of communication.
- Importance of Coordination:
• Ensure unity of direction
• Create stronger workforce
• Enhance employee morale and provides satisfaction
• Facilitates diverse and specialized activities
• Promote effective patient care management for general
interest
• Establish positive work environment
- Types of Coordination:
• External – Coordination with the outside parties with
whom the organization has the business connections
like government supplies, customers, etc.
• Internal – Coordination among the employees of the
same department or section.
J.A.K.E 24 of 35
• Horizontal – Coordination that takes place between
different departments.
• Vertical – Coordination that exists between
departments where the department heads are asked to
coordinate the work of the employees.
- Coordination with Hospital Services:
• Coordination with Medical Professional Services –
Nurses should know the Medical Staff in their
respective units, and their services and scheduled time
of medical rounds.
• Coordination with Administrative Service – Coordination
with the Administrative services pertains to both human
and material resources.
• Coordination with Laboratory Service – Request for
laboratory examinations are forwarded to the laboratory
unit.
• Coordination with the Radiology Service – Request for x-
ray examination are also forwarded to the x-ray service
for proper scheduling and specific instructions.
• Coordination with the Pharmacy Service – Policies
regarding the procurement of drugs must be observed.
• Coordination with the Dietary Service – Head is
responsible for forwarding the diet list of the patients in
the units.
• Coordination with the Medical social Service – Nurses
coordinate with the Medical Social Service by referring
patients with psycho-social problems.
• Coordination with Medical Records Service – Nurses
are responsible for the accurate documentation and
completeness of the patient’s charts, including their
safety and confidentiality.
• Coordination with Community Agencies, other
Institutions, and Civic Organization – Networking or
linkages with community agencies, civic organizations,
or other institutions are often necessary for continuity
of patient care.
Motivation
- Motivation is influenced by complex set of social,
professional and economic factor. Human beings are
motivated by different goals, ambitions, and aspirations.
Health worker will be motivated and express job
satisfaction if they feel that they are effective at their jobs
and performing well.
- The amount and quality of work accomplished by the
manager directly reflect their motivation and that of their
subordinates. They teach and empower their workers and
apply knowledge, skills and techniques of motivational
theories to achieve individual goals.
- Importance of Motivation:
• Put human resources into action – It is through
motivation that the human resources can be utilized by
making full use of it.
• Improves level of efficiency of employees – For getting
best of his work performance, the gap between ability
and willingness has to be filled which helps in improving
the level of performance of subordinates. This result
into:
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
o Increase productivity
o Reducing cost of operations and
o Improving overall efficiency
• Leads to achievement of organizational goals – The
goals of an organization can be achieved only when the
following factors take place:
o There is best possible utilization of resources
o There is a co-operative work environment
o The employees are goal directed and they act in a
purpose manner
o Goals can be achieved if co-ordination and co-
operation takes place simultaneously which can be
effectively done through motivation.
• Builds friendly relationship – Motivation is an important
factor which brings employees satisfaction This could
initiate the following things:
o Monetary and non-monetary incentives
o Promotion opportunities for employees
o Disincentives for inefficient employees.
• Leads to stability of work force – This is very important
from the point of view of reputation and goodwill of a
concern, DOH Manual, (2016).
Problem Solving, Decision Making
- Decision making is one of the critical roles of a manager.
Manager must be decisive; they make decisions and are
not afraid to take risks. Know when it is time to make
something, they do it, while others procrastinate and wait
for someone else to make a decision.
- Decision is a course of action that is consciously chosen
from available alternatives for the purpose of achieving a
desired result. It involves a choice utilizing mental
processes at the conscious level and is aimed at
facilitating a defined objective.
- And it is made at executive level and are more complex and
affect a greater number of people.
Five steps in decision making
1) Definition of the problem
- Situation through time and space may show a deviation
from a standard of performance. What should be done
or avoided is not what is being done or prevented.
- How to correct this deviation is the problem.
- Relevant data should be collected as to recognize the
real problem.
2) Analysis of the Problem
- Once problem has been identified, the Supervisor/Head
Nurse proceeds to investigate, gather data, and analyze
the cause and consequences of the problem.
- Prejudices and biases should not affect the decision.
- The manager should be open minded and flexible.
- Entire decision-making process should be objective to
arrive at the best solution.
- Problem analysis means getting to the cause of the
problem.
3) Developing of Alternatives Solutions/ Evaluation of
Alternatives.
- It focuses on the search for analysis of alternatives and
their possible consequences.
J.A.K.E 25 of 35
- Factors to considered in evaluating alternative
solutions are time, available resources, labor, cost of
tools and equipment to be used, and the moral and
legal implications.
4) Selection of a Solution
- After facts have been weighed and alternative solutions
have been explored, ranking of preferences is important.
- The Supervising Nurse/Head Nurse chooses the best
course to follow considering advice from others,
experience, and most importantly, logical reasoning.
- The best solution that offers a better chance for
success is then chosen.
- Decisions may mean a compromise or a combination of
two possible solutions.
Implementation and Evaluation of Results
1) Planning which entails consideration and selection of
realistic objectives, policies, and procedures.
2) Organizing which means helping personnel understand the
decision and the procedures necessary for implementing
the decision;
3) Staffing or the selection of the right person/s to carry out
the decision;
4) Controlling the environment and the group to prevent
adverse effects.
The art of decision making includes:
• Not making decision that others should make, to
preserve morale and authority;
• Not deciding on problems that are pertinent to matters at
hand to prevent waste of time and energy;
• Not deciding prematurely to prevent prejudice; and
• Not making ineffective decisions to avoid losing the
respectability of the decision maker.
Conflict Management
- In the 20th century, conflict was considered to be an
indication of poor organizational management. And can be
destructive and can be avoided at all cost. If conflict
occurs it can be ignored, denied or dealt with immediately
and harshly. During this era people believed that conflict
could be avoided if only employees were taught the one
right way to do things and dissatisfaction were expressed
and met with disapproval, Marquis & Huston, (2017).
- Conflict generally defined as the internal or external
discord that results from differences in ideas, values, or
feelings between two or more people. Because managers
have the interpersonal relationships with subordinates
having a variety of different values, beliefs, backgrounds,
and goals, conflict is an expected outcome, Marquis &
Huston, (2017
- Conflict is neither good or bad, and it can produce growth
or destruction, defending on how it is managed, Marquis &
Huston, (2017).
- Sources of Conflict:
• Differences in knowledge, skills, values, interest:
• Scarcity of resources
• Intergroup rivalry for rewards
• Role ambiguity
• Unworkable organization structure
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• Shift in organizational power base and organizational
climate and
• Unacceptable leadership styles
- Factors that provoke conflict:
• Failure to provide assistance or complete information
on patient care
• Varying perceptions of work situations can be caused
different work responsibilities
• Unstable staffing and work schedules
• Highly differentiated work positions or role change
• Disagreement over policies and procedures
• Competition for scarce resources
- Conflict Process:
1) First stage Latent Conflict implies the existence of
antecedent conditions such as short staffing and rapid
change. Could be prevented or reduced if managers
examined the organization more closely for antecedent
conditions. Example: change and budget cuts almost
create conflict.
2) Second stage perceived conflict or substantive conflict
is intellectualized and often involves issues and roles.
The person recognizes it logically and impersonally as
occurring.
3) Third stage felt conflict or affective conflict occurs when
the conflict is emotionalized. Felt emotion includes
hostility, fear, mistrust, and anger. Possible to perceive
conflict and not feel it.
4) Fourth stage manifest conflict or overt conflict, action is
taken. Action maybe withdraw, compete, debate, or
seek conflict solution. These include:
• fear of retaliation,
• fear of ridicule,
• fear of alienating others,
• a sense that they do not have the right to speak up
and
• pat negative experiences with conflict situations.
5) Final stage is aftermath there is always conflict
aftermath positive or negative. If conflict is managed
poorly, the conflict issues frequently remain and may
return later to cause more conflict, Marquis and Huston,
(2017). The aftermath of conflict may be more
significant than the original conflict if the conflict has
not been handled constructively.
Types of conflict
1) Intergroup conflict
- Occurs between two or more groups of people,
departments, and organization.
- May caused by differences in opinion of the nursing
staff of the unit and that of the clinical Instructors in
preparing for the RLE of nursing students
- Example:
• Staff nurses may claim that the nursing students do
not meet their role Expectations while the CI claim
that the staff nurses are not good role models
themselves.
• Two political affiliations with widely differing or
contradictory beliefs of nurses experiencing
J.A.K.E 26 of 35
intergroup conflict with family and work issues,
Marquis & Huston, (2017)
2) Intrapersonal conflict
- Occurs within the person, it involves an internal struggle
to clarify contradictory values or wants.
- For managers, intrapersonal conflict may result from
the multiple areas of responsibility associated with the
management role.
- When head Nurse is told not to schedule overtime for
nurses but feels that shortage of nursing personnel
greatly affects the quality of nursing care resulting to job
dissatisfaction of the clients.
- Example: Between the Nursing Director and the Finance
Director who do not agree on the resources (both
human and material) needed by the Nursing Service due
to cost cutting measures.
3) Intragroup conflict
- manifested in feelings of unfairness over distribution of
assignments, off duties and holidays among the staff.
- Example: If individuals and/or groups cannot meet the
expectations exacted on them, they become
disenchanted.
4) Interpersonal conflict
- Happens between two or more people with differing
values, goals, and beliefs
- Example: Informational differences – Role
incompatibility because of differences between goals
and responsibilities assigned to an individual and what
the individual be doing.
5) Covert conflict
- more dangerous because it is not what it appears on
the surface.
- It results in harbored feelings that drain both physical
and psychological energy.
6) Vertical conflict
- Differences in opinions between superiors and
subordinates are caused most often by inadequacy in
communication, opposing interests, and lack of shared
perceptions and attitudes.
7) Horizontal or line and staff conflict
- It happens as a common struggle or strife between
departments or services wherein the degree of
interdependence and collaboration determines the
success in achieving shared goals and objectives.
- Example: Lack of consensus between these
departments and the clash of personalities also affect
teamwork, Venzon, (2016).
Conflict Management
- Management of conflict is one of the important roles of a
nurse’s manager’s job. There are some common conflict
management strategies/ approaches to management
conflict.
- A manger recognizes which conflict
management/resolution strategy is appropriate for each
situation.
- In choosing the most appropriate strategy defends on
many variables such as: Marquis & Huston, (2017)
• The situation itself,
• the urgency of the decision,
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• the power and status of the players,
• the importance of the issue, and
• the maturity of the people involved in the conflict
1) Avoidance – The parties involved are aware of a conflict
but choose not to acknowledge it or attempt to resolve it.
Commonly used by groups who do not want to do
something that may interfere with their relationships.
Withdrawal behind walls of insulation relieves the
necessity of dealing with situations that would arouse
conflict.
2) Compromising – Each party gives up something it wants.
Both parties seek expedient, acceptable answers for short
periods when the goals are only moderately important and
the parties have equivalent power. Not to result in a “lose-
lose” situation, both parties must be willing to give up
something of equal value. Becomes “win-win” situation
when both parties perceive they have won more than other
person.
3) Competing – Is used when one party pursues what it wants
at the expense of the others. Only one party typically wins,
the competing party seeks to win regardless of the cost to
others. The supervisor or nurse manager exerts power at
the subordinate’s expense. Expressed through suppression
of conflict through authority-obedience approach. “Win-
lose” conflict resolution strategies then typically leave the
loser angry, frustrated, and wanting to get even in the
future.
4) Cooperating/ Accommodating – Self-sacrifice,
Cooperating is the opposite of competing. One party
sacrifices his or her beliefs and allows the other party to
win. The actual problem usually not solved in this win-lose
situation. Accommodating is another term used for this
strategy. The person neglects his/her own needs to meet
the goals of the other party. It is more powerful, or when
the issue is ore important to someone else. Employees
who use accommodation as a primary conflict
management strategy often develop resentment.
5) Smoothing – Is used to manage a conflict situation. It
occurs when one party in a conflict attempts to pacify the
other party or those focus on agreements rather
differences. Managers often use smoothing to get
someone to accommodate or cooperate with another party.
Smoothing rarely results in resolution of the actual conflict.
This accomplished by complimenting one’s opponent,
downplaying differences, and focusing on minor areas of
agreement.
6) Collaboration – Inspire mutual attention to the problem
and utilizes the talents of all parties. It focuses on problem
solving to find mutually satisfying solution. All parties set
aside original goals and work together “win-win” solution,
establish a subordinate or priority common goal. This is the
most effective method in conflict management.
Collaboration enhances a person’s participation indecision
making to accomplish mutual goals.
7) Forcing – a method that yields an immediate end to the
conflict but leaves the cause of the conflict unresolved.
J.A.K.E 27 of 35
Basic rules on Mediating a conflict between two or more or
parties:
• Establish clear guidelines and make them know to all.
• Do not postpone indefinitely. Select a time that is best for
all parties.
• Create an environment that makes people comfortable to
make suggestions.
• Keep a two-way communication. Encourage full expression
of positive and negative feelings with an accepting
atmosphere.
• Stress a peaceful resolution rather than confrontation.
Build a bridge of understanding.
• Emphasize shared interests. Examine solutions and select
the most acceptable to both parties.
• Follow up on the progress of the plan. Give feedback to
participants regarding their cooperation in resolving the
conflict.
In conflict management keeps conflict from escalating, makes
work productive, and helps translate conflict into a positive or
constructive force.
Time Management
- Time management defined as making optimal use of
available time. Oftentimes managers complaint or keep
telling they don’t have enough or lack of time in
accomplishing such goals. They always argue that there is
not enough time in the day to do everything that must be
done. The problem that this individual is time poor., rather
that problem is poorly using of time. One of the strategies
in managing the time is learn to prioritize duties, managing
and controlling crisis, reducing stress and balancing work
and personal time, (Marquis and Houston,2017).
- Time Management Principles:
• Planning anticipates the problem that arise from
actions without thought.
• Tasks to be accomplished should be done in sequence
and should be prioritized according to importance.
• Setting deadlines in one’s work and adhering to them is
an excellent exercise in self-discipline.
• Deferring, postponing, or putting off decisions, actions,
or activities can become a habit which oftentimes
causes lost opportunities and productivity, generating
personal or interpersonal crises.
• Delegation permits a manager to take priority for
decision making and to assign tasks to the lowest
possible consistent with his/her judgement, facts, and
experience, (Venson, 2016).
- Time-saving Techniques, Devices, and Methods to
Better Use of Time.
1) Conduct an inventory of your activities. Logging your
activities for one day would show how much time is
usually spent on each activity.
2) Set goals and objectives and write them down. Set
priorities. Plan on making things happen rather than
reacting to crises.
3) With the use of calendars, executive planners, logs or
journals, write what you expect to accomplish yearly,
monthly, weekly or daily.
4) Breakdown large projects into smaller parts.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
5) Devote a few minutes at the beginning of each day.
6) Organize your work space so its functional. Sort paper
work on your table according to priority.
7) Close your door when you need to concentrate. Agree
on a period of quiet office time.
8) Learn to delegate.
9) In a meeting, define the purpose clearly before starting.
Distribute the agenda in advance and control
interruptions during the meeting.
10) Take or return phone calls during specified time.
Maintain a telephone log so you can return calls at a
time.
11) Develop effective decision-making skills. Do no afraid
to say “no”.
12) Take a rest breaks and make good use of your spare
time. Reward yourself periodically, (Venson, 2016)
- Three Steps to Time Management:
1) Allow time to planning and establish priorities.
2) Complete the highest task whenever possible and finish
one task before beginning another.
3) Reprioritize based on the remaining tasks and on new
information that may have been received.
Controlling
- Controlling or evaluating is an ongoing function of
management which occurs during planning, organizing,
and directing activities. It includes assessing and
regulating performance in accordance with the plans
adopted, the instructions issued, and the principles
established.
- The controlling process opens opportunities for
improvement and compares performance against set
standards. It provides information about how well
processes and people function so they can be motivated to
perform better in the future.
- The means of good performance and management
includes leadership and commitment, full employee
involvement, good planning, sound strategy
implementation, measurement and evaluation, control and
improvement, and achievement and sustenance of
standards of excellence, Venzon, (2016).
Reasons for Conducting Evaluation
• It 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 visibility and means for employees to monitor
their own performance.
• If 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
• Evaluation must be based on the behavioral standards of
performance which the position requires.
J.A.K.E 28 of 35
• Evaluating performance, there should be enough time to
observe employee’s behavior.
• Employees should be given a copy of the job description,
performance standards, and evaluation form before the
scheduled evaluation conference. Areas needing
improvement must be prioritized to help the worker
upgrade his/her performance.
• Evaluating conference should be scheduled and
conducted at a convenient time for rater and the employee
under convenient time for rater and the employee under
evaluation, in pleasant surroundings, and with ample time
for discussion.
• Evaluation report and conference should be perceived and
accepted as a means of improving job performance.
Characteristics of an Evaluation Tool
• Objective – Objectivity means that the evaluation tool is
free form bias
• Reliable – accuracy or precision of the toll such that it will
produce the same results if administered twice.
• Valid – relevance of the measurement to the performance
of the employee.
• Sensitivity – That the instrument can measure fine lines of
differences among the criteria being measured.
Basic Components of the Control Process
• Established of standards, objectives, and methods for
measuring performance;
• Measurement of actual performance;
• Comparison of results performance using standards and
objectives and identifying strengths and areas for
correction and/or improvement;
• Action to reinforce strengths or successes; and
Implementation of corrective action as necessary.
Established of Standards for Measuring Performance
- Standards are desirable sets conditions and performance
necessary to ensure the quality of nursing care services
which are acceptable to those instrumental to or
responsible for setting and maintaining them.
- There are three types of performance standards: structure,
process and outcomes.
1) Standards on structure are those that focus on the
structure or management system used by the agency to
deliver care.
2) Process standards refer to decision and actions of the
nurse relative to the nursing process which are
necessary to provide good nursing care.
3) Outcome standards are designated to measure the
results of care provided in terms of changes in the
health status of clients served; changes in the level of
their knowledge, skills, and attitudes; and satisfaction
of those served including the members of the nursing
and health team, Venzon, (2016).
- Measuring Actual Performance:
• Measurement of performance is an on-going, repetitive
process with the actual frequency on the type of activity
being measured.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
• For example, nursing care to patients is continuously
monitored, whereas, a formal performance appraisal
may be done only twice a year.
• Measurements may be scheduled in advance, may be
done periodically but unannounced intervals, or may
occur at random. The purpose of measurement should
be clarified about the task and levels of are that need
attention.
- Comparing Results of Performance with Standards and
Objectives:
• Comparing the results of performance with standards
and objectives is one of the easiest steps in the control
process.
• Its performance matched standards and objectives,
managers are assured that the needs of patients are
met. However, if performance is contrary to standards
and objectives set, then necessary action should be
taken.
- Reinforcing Strengths or Successes and Taking
Corrective Action as Necessary
• Positive feedback stimulates motivation consistent high
performance, and growth of the employee. Corrective
actions are applied to improve performance.
- Responsibility of the Head / Senior Nurses:
• Being at the first level of supervision, the Head or Senior
Nurses know best whether their staff nurses perform
satisfactorily at work. Their influence has an impact on
promoting quality care to patients.
• They have the responsibility to instruct subordinates
regarding the appropriate methods and procedures in
providing nursing care.
• The feeling of responsibility to render quality
performance must be instilled in all employees for them
to follow agreed upon written procedures and use
materials and equipment correctly as instructed.
Performance Appraisal
- Performance appraisal is a control process by which
employee’s performance is evaluated against standards. It
is the most valuable tool in controlling human resources,
Venson, (2016).
- Importance of performance appraisal:
1) Determine salary standards and merit increases;
2) Select qualified individuals for promotion or transfer;
3) Identify unsatisfactory employees for demotion or
determination;
4) Make inventories of talents within the institution;
5) Determine training and developmental needs of
employees;
6) Improve the performance of work groups by examining
improving, and correcting interrelationship between
members;
7) Improve communication between supervisors and
employees and reach an understanding on the
employees and reach am understanding on the
objectives of the job;
8) Establish standards or supervisory performance;
J.A.K.E 29 of 35
9) Discover the aspirations of employees and reconcile
these with the goals of the institutions;
10) Provide “employee recognition “for accomplishments;
and
11) Inform employees “where they stand.”
Factors Contributing to an Effective Performance
Appraisal System
- The controlling process is used to promote positive and
favorable activity. Recognizing the common purposes for
which the performance evaluation system has been
created, nurse managers have the responsibility to
maintain a favorable climate that will lead to job
satisfaction.
- Some factors contributing to a successful performance
appraisal system are the following:
1) Compatibility between criteria for individual evaluation
and organization goals. The elements of the
performance evaluation system should be agreed upon
at each level of management, involvement of personnel
at all aspects of the evaluation process increases belief
in its fairness and accuracy, establishes a commitment
to the evaluation, and increase motivation to utilize the
results for improvement.
2) Direct application of the rated performance to
performance standards and objectives expected of the
worker. Predetermined toles for each member of the
health team and the set goals in terms of behavioral
objectives and success criteria (e.g. job description and
procedure manual) should be established.
3) Development of behavioral expectations which have
been mutually agreed upon by both the rater and the
worker. Participation in the formulation of goals
motivates workers to work towards their
accomplishment.
4) Understanding the process and effective utilization of
procedures by the rater. Training in the appraisal
process should be provided by the employer through in-
service education.
5) Rating of each individual by the immediate supervisor.
Appraisal is more accurate when data are familiar with
the actual performance of the worker.
6) Concentration of the strength and weaknesses to
improve individual performance. Reinforcement of
strengths in performance encourages the worker to
further improve.
7) Encouragement feedback from the rated employees
about their performance needs and interests. The
immediate supervisor if better equipped to understand
each worker. He / She does this by observation,
questioning, and listening
8) Provision for initiating preventive and corrective action
and making adjustments to improve performance. The
primary goal in the performance of all workers should
be to provide quality service to all clients.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Methods of Measuring Performance.
- Methods of performance may be done both formally or
informally. Informal appraisal may consist of incidental
observation of performance while the worker is engaged in
performing nursing care of responses made by the worker
during conferences.
- Interaction of worker with client, their families, visitors, and
co-workers should also be noted. Formal appraisal is
accomplished regularly and methodically by collecting
objective fact that can demonstrate the difference between
what is expected and what was done.
- These methods include:
• Essay – The appraiser writers a paragraph or more
about the worker’s strengths, weakness, and potentials.
It is also difficult to make comparisons because the
essays touch on different aspect of a worker’s
performance. It may also concentrate on those areas of
performance for which the supervisor has strong
feelings.
• Checklist – a compilation of all nursing performances
expected of a worker. The appraiser’s task is to mark
the appropriate column whether the worker does or
does not show the desired behavior. A quick glance at
the completed form would reveal the over-all quality of
the nurse’s performance.
• Ranking – the evaluator ranks the employees according
to how he/she fared with co-workers with respect to
certain aspects of performance or qualification. For
example, Nurse A may rank lowest in educational
requirements for the next higher position among five
candidates for promotion but may rank first in clinical
proficiency. Nurse B may rank first in educational
qualification but may rank third in clinical proficiency.
• Rating scales – includes a series of items representing
the different tasks or activities in the nurse’s job
description or the absence or presence of desired
behaviors and the extent to which these are possessed.
Example:
a) On a scale of 1 to 5, indicate the degree of the
nurse’s skill in assessing the patient’s condition
where each of the corresponding possessed.
5 - Excellent
4 - Very Satisfactory
3 - Moderately Satisfactory or Average
2 - Minimally Satisfactory
1 - Unsatisfactory
b) A descriptive graphic rating scale may be used to
describe punctuality in reporting for duty such as:
1 - Oftentimes late
2 - Sometimes late
3 - Always report on time
• Forced-choice comparison – In this method, the
evaluator is asked to choose the statement that best
describes the nurse being evaluated. The items are so
grouped that the evaluator is forced to choose from
favorable as well as unfavorable statements and to
counter the tendency towards leniency by some
evaluators. Example: Select the statement that best
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describes the nurse being evaluated and the statement
that least described him/her:
1 - Respect the ideas of orders
2 - Limited communication ability
3 - Even-tempered
4 - Capable of enduring long hours of hard work
5 - Tends to be loner
• Anecdotal records – describes the nurse’s experience
with a group or a person, or in validating technical skills
and interpersonal relationship.
Example: Miss A was on her way to take her lunch. She passed
by a patient who was reaching for her food tray but was having
a hard time as this was placed on her left side. Her right hand
had an intravenous line. Miss A stopped, positioned the food
tray comfortably and assisted the patient to eat although she
herself was late for lunch. Miss A acted in a commendable
manner.
The anecdotal records should include
(1) a description of the particular occasion,
(2) a delineation of the behavior noted including answer to
the questions who, what, why, when, where, and how, and
(3) the evaluators’ opinion or assessment of the incident or
behavior.
The descriptive notes are organized to get impressions of the
over-all behavior in a given period. Caution should therefore
be taken against the tendency to note negative more often
than positive behavior.
Quality Assurance
- According to Venzon assurance is achieving a sense of
accomplishment and implies a guarantee of excellence.
While quality is the degree of excellence. In order for the
organization to be truly effective, each must work together.
To provide quality of service, workers must accept the
responsibility that they have to do the right thing/job the
first time and every time. Each have to accept the quality is
everyone’s responsibility, Venzon, (2016).
• Quality of care is the degree to which health services for
individuals and population increases the likelihood of
desired health outcomes and consistent with the
current professional knowledge. It is balance of
benefits and harms to a client.
• Quality assurance is a process of evaluation that is
applied to the health care 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, Venzon, (2016).
• Quality improvement program in an organization is the
umbrella program that extents the many areas for the
purpose of accountability to the consumer and the
payor. The program continuous, ongoing measurement
and evaluation process that includes structure, process,
and outcome.
- Indicators are valid and reliable quantitative measures of
structure, process, and outcome that are related to one or
more dimensions of performance. It refers to measure of
performance. Clinical Indicators relate to clients.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Indicators may be focused on service, practice, or
governance.
Principles of Quality Assurance
1) All health professionals should collaborate in the effort to
measure an improve care.
2) Coordination is essential in planning a comprehensive
quality assurance program.
3) Resource expenditure for quality assurance activities is
appropriate.
4) 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.
5) Quality patient care is accurately evaluated through
adequate documentation.
6) The ability to achieve nursing objectives defends upon the
optimal functioning of the entire nursing process and its
effective monitoring.
7) Feedback to practitioners is essential to improve practice.
8) Peer pressure provides the impetus to effect prescribed
changes based on the results of assessment and needed
improvements on the quality of care.
9) Reorganization in the formal organizational structure may
be required if assessment reveals the need for a different
pattern of health care.
10) Collection and analysis of data should be utilized to
motivate remedial action.
Quality Assurance and Performance Evaluation
- Performance evaluation focuses on the worker.
- It asks questions about how well the worker satisfies the
requirements of his/her job within the organization.
Quality Assurance Methods
- The primary purpose of QA programs in nursing is to
measure and improve the quality of nursing delivered in the
agency. Methods used are concurrent and retrospective
patient care audits, patient care profile analysis, peer
review, and quality circles.
- Patient is the best, sometimes the only judge of the
interpersonal aspects of care, example, empathy and
communication including the surroundings of patients care
such as rooms and foods oftentimes called the “hotel”
services.
- Patients satisfaction is an essential goal of health care and
it’s the important part of quality care.
Developing Quality Assurance Criteria
1) Structure approach includes physical setting,
instrumentalities, and conditions through which nursing
care is given such as the philosophy and objectives, the
building, organizational structure, financial resources and
equipment.
2) Process Approach includes the steps in the nursing
process incompliance with established standards of
nursing practice.
3) Outcome Approach identifies desirable changes in the
patient’s health status such as modification of symptoms,
signs, knowledge, attitudes,  satisfaction, skill level and
compliance with the treatment regimen.
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Nursing Audit Committee
- A nursing audit committee is composed of representative
from all levels of the nursing staff: a member of the training
staff, supervising nurse, head nurse/senior nurse, and a
staff nurse.
- In smaller hospitals, the chief nurse or his assistant may be
a member of this committee.
Patient Care Audit
- Patient care audits may be concurrent or retrospective. A
concurrent audit is one which patient care is observed and
evaluated.
- Given through:
• a review of patient’s charts during confinement
• observation of the staff as patient care is given
• inspection of patients and/or observation of the effects
of patient care where the focus is on the patient, (done
during the rounds or patient interview.
- Retrospective audit is one which patient care is
evaluated through:
• review of discharged patient’s charts and
• questionnaires sent to or interviews conducted on
discharged patients.
- Peer Review
• Patient care audits may be done by peers, (employees
of same profession, rank, and setting) evaluating
another’s job performance against accepted standards.
• Peer review has the potential to increase the accuracy
of performance appraisal. It can also provide
opportunities for increased professionalism and
learning.
• The use of peer review in nursing should continue to
expand as nursing increases its autonomy and
professional status.
- The 360-Degree Evaluation
• The newest addition to performance appraisal tools, the
360-degree evaluation, includes an assessment by all
individual within the spere of influence of the individual
being appraised.
• For example: The 360-degree evaluation of a ward clerk
or unit secretary might include feedback from the
nursing staff, from patients, and from staff from other
departments who interact with that individual on a
regular basis. Most 360-degree feedback tools include
self-assessment.
- Quality Circles
• Quality circles are one of the most publicized
approaches to quality control.
• It is defined as a group of workers doing similar work
who meet regularly and voluntarily on normal working
time, under the leadership of their supervisor, to
identify, analyze, and solve work -related problems and
to recommend solutions to management.
- Utilization of Results:
• The results may be given orally or written and is directed
to the nursing staff in the unit who administers the care
or their immediate supervisors.
• Consistent positive findings deserve a commendation
from the nursing service. Negative feedback should
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
tactfully be conveyed in a face to face situation so that
assessment results may easily be clarified.
Quality Management (QM)
- It is defined as a formalized system that the documents the
structure, responsibilities and procedures required to
achieve and deliver a quality product. It describes the
standards, quality practices, resources and processes
pertinent to an organization.
Total Quality Management (TQM)
- It a way to ensure customer satisfaction by involving all
employees in the improvement of the quality of every
product or service. It aims to reduce waste and cost or
poor quality. It is a structured system for involving an entire
organization in continuous quality improvement process
targeted to meet and expected outcomes.
Principles of Quality improvement
• Leadership – establish unity of purpose and direction of
the organization.
• Customer Focus – Organizations defend on their
customers and there should understand current and future
customer need.
• Process Approach – A desired result is achieved more
efficiently when related resources and activities are
managed as a process.
• Involvement of People – People at all levels are the
essence of an organization and their full involvement
enables their abilities to be used for the organization
benefit.
• System Approach – Identifying; understanding, and
managing a system of interrelated processes for a given
objective improves the organizations effectiveness and
efficiency.
• Continuous Improvement – should be a permanent
objective of the organizations.
• Factual approach to decision making – Effective
decisions are based on the analysis of data and
information.
• Mutual Beneficial Supplier Relationships – An
organization and its suppliers are interdependent and a
mutually beneficial relationship enhance the ability of both
to create value.
Strategies in Total Quality Management
• Internal Processes – A comprehensive quality
management program is based on real evidence from
within your organization.
• Cost Reduction – Cost reductio, particularly in large-scale
organizations, is often one of the most effective fixes for
organizational performance improvement.
• Environmental effects
• QM strategies – can help you to analyze your
organization’s effect on the environment, whilst focusing
on processes that can minimize your environmental impact.
• Regulatory compliance – can be built your quality
management strategy to ensure requirements are dealt
with proactively.
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Continuous Quality Improvement (CQI)
- It is a process through which the level of quality I defined,
pursued, achieved and continuously improved through the
establishment of formal mechanism/systems and
structures within the organization.
Quality Improvement Plans (QIP)
- It is an organization’s framework for developing and
improving processes. It includes the direction, timeline,
activities, and assessment measures of quality and quality
improvement within the organization.
- Every hospital is expected to set targets aimed at making
improvements in the areas of Safety, Effectiveness, Access
and Patient-Centeredness.
- The aim of QIP is to help providers self-assess their
performance in delivering quality education and care, and
to plan future improvements.
- QIP also helps help regulatory authorities with assessing
the quality of the service.
- Things to include in QIP:
• Plan improvement initiative
• Methods
• Process measures
• Target for process methods
• Comments
- Sample of QIP: The goal is to deliver safe, high-quality
care to patients in all critical settings.
• Patient Centered Care
o Falls and injuries
o Pressures Ulcers
o Ventilators Associated Pneumonia (VAP)
o Intravascular Catheter-Related Infections
o Preventing Other health care Associated Infections
• Opportunities for Patient Safety and Quality
Improvement
o Reducing Medication Errors
o Dandoffs
• Working Conditions and Work Environment for Nurses
o Nurse fatigue and stress
o Nursing Turnover
o Teamwork
o Nursing Workload and Patient Safety
• General Resources on Nursing and Quality of Care
- Principles of Quality Improvement:
1) Work as systems and processes. To make
improvements, an organization needs to understand its
own delivery system and key processes.
2) Focus on Patients. An important measure of quality is
the extent to which patients’ needs and expectations
are met.
3) Focus on Being Part of the Team. QI is a team process,
a team harnesses the knowledge, skills, experience,
and perspective of different individuals within the team
to make lasting improvements.
4) Focus on use of the data. Data is the cornerstone of QI.
It is used to describe how well current systems are
working; what happens when changes are applied, and
to document successful performance.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Disciplinary
- Part of the controlling process in management is discipline.
Discipline meant rigid obedience to rules and regulations,
the violation of which resulted in punitive actions.
- Today, discipline is regarded as a constructive and
effective means by which employees take personal
responsibility for their own performance and behavior. This
is termed as self-discipline
- Some factors that influence self-discipline are:
• A strong commitment to the vision, philosophy, goals,
and objectives of the institution. Strong commitment
result in cohesion and teamwork which in turn
encourage within the organization.
• Laws that govern the practice of all professionals and
their respective Codes of Conduct. For all government
employees, in Civil Service Rules and Regulations as
provided for in P.D. 807 and the Code of Conduct for
Public Officials, R.A. 6713, are also to be complied with.
• Understanding the rules and regulations of the agency.
All employees are oriented on the rules, regulations,
and policies of the agency. An atmosphere of mutual
trust and confidence.
• Pressure from peers and organization. Social pressures
from co-workers and the organization demand that
workers perform their jobs to the beat of their abilities
Disciplinary Approaches
- A sound disciplinary program must be tailored to the
objectives of the institution. This should include a set of
disciplinary policies and procedures, a uniform application
of disciplinary rules, a disciplinary committee, and an
orientation program for all new employees where
expectations of appropriate performance and behavior are
emphasized.
- Successful implementation of disciplinary action is
characterized by promptness, fairness, impartiality, no
punitiveness, advance warning, and follow – through.
- Effective supervision aids supervisors in analyzing the work
problems of their subordinates. Counseling becomes part
of an oral warning session before resorting to a disciplinary
action.
Disciplinary Action
- Any employee charged for breach of the rules and
regulations, policies, and norms of conduct shall be given
due process.
- There must be existing rules of conduct governing his/her
behavior and a documentation of actual violation of such
rule must support charges.
- The employee charge must be notified in writing about the
violation and given the right to counsel.
- Disciplinary action should be progressive in nature
such as counseling and oral warning, written warning,
suspension, and dismissal.
1) Counseling and Oral Warning are best given in private
and in an informal atmosphere. The employee is given a
fair chance to air his/her side.
2) Written Warning is the second step in disciplinary
action. It is preceded by an interview similar to the oral
warning.
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3) Suspension over minor violation is given after evidence
of oral and written warnings. Although a violation is a
major infraction, suspension, rather than dismissal is
applied when management feels that the employee can
still be rehabilitated. Accurate documentation of oral
and written warnings including suspension, if done, are
necessary evidence of due process.
4) Dismissal is invoked only when all other disciplinary
efforts have failed. The Disciplinary Committee should
be very sure that the cause for dismissal conforms with
the criteria of a major discipline violation as contained
in the policy manual, and for government employees,
those contained in the Civil Service Rules and
Regulations and the codes of conduct. A review is
usually done by higher management. In the case of
government employees, this is further reviewed by their
respective departments and final affirmation is done by
the Civil Service Commission.
APPLICATION OF RESEARCH IN NURSING LEADERSHIP
AND MANAGEMENT RESEARCH
Research
- Helps nurses determine effective best practices and
improve patient care.
- Helps nursing respond to changes and challenges in the
healthcare environment, individual, family, patient and
group populations and government regulations.
Nursing research is
- Systematic inquiry designed to develop knowledge about
issues of importance to nurses, including nursing practice,
nursing education, and nursing administration - Polit and
Beck (2006)
- In this complex world of 21st century, the role of nurse
continuously evolved significantly.
- Though each role carries different responsibilities, the
primary goal of a professional nurse remains the same: to
be the client's advocate and provide optimal care on the
basis of evidence obtained through research.
Patient Satisfaction
- Is an important and commonly used indicator for
measuring the quality in health care.
- Affects clinical outcomes, patient retention, and medical
malpractice claims.
- It affects the timely, efficient, and patient centered delivery
of quality health care.
- Researches help improve client satisfaction
• Researchers demonstrated that there are differences in
satisfaction levels among different genders.
• To explore further the reasons for these differences, a
research made it separated to compare the specific
causal links between the two gender samples and to
draw broader inference from the results.
• Some findings provide support for the application of CS
study to derive customer knowledge, which also reveals
some interesting suggestions for future research.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023
Action Research
- In the health Care settings, the leadership, interpersonal,
and management skills needed to manage such change
effectively within multi-professional in a variety of health
care settings. It provides unique use of action research as
a model for planning and implementing change at the
patient-service interface.
- Example of Action Research that can be applied with
Nursing leadership and Management: Work-based
learning: a leadership development example from an
action research study of shared governance
implementation
Tracey Williamson
• Abstract Aim: An empowering action research study was
undertaken to evaluate and strengthen the implementation
of shared governance. One aim was to identify factors that
acted as aids or barriers to effective decision-making by
clinical leaders. As a work-based learning approach, action
research was expected to lead to integration of learning
into practice by researcher and participants alike.
• Background: Shared governance replaces traditional
hierarchies and requires and develops clinical leaders.
Strategies are needed to maximize learning from
introduction of such initiatives at the individual, group and
organizational level.
• Methods: Participant-observations and interviews were
undertaken with shared governance council members from
one model in north-west England.
• Results: Leadership skills and knowledge and shared
governance practices were significantly enhanced.
Preparation for council roles was considered inadequate.
Increased structured time for reflection and action
planning was indicated.
• Conclusions: Implementation of shared governance has
succeeded in developing leadership capacity. Evaluation
findings have led to improvements in the overall shared
governance model. Action research has been found to
have great utility at optimizing work-based learning. Nurse
Managers need to develop their coaching and facilitating
skills and recognize there is no "quick fix" for developing
clinical leaders. Implications include the need to support
learners in identifying and implementing changes arising
from work-based learning activities, the significant
resource implications and the need to optimize the
organizational climate if work based learning approaches
to leadership and management development are to
succeed.
Feasibility
- Can provide such data and this can validate study
procedures or identify procedures in need of revision.
- Step-by-Step Guide to Feasibility Research
1) Identify a problem and/or a question.
2) Review the literature.
3) Identify gaps in our knowledge.
4) Refine the general question, formulating a specific
research question(s).
J.A.K.E 34 of 35
5) Consider your reasons for conducting preliminary
research and determine the form it should take.
a) If you want to evaluate the feasibility of carrying out
the planned protocols and interventions of an
anticipated larger study with randomization of
participants, conduct a randomized pilot study.
b) If you want to evaluate the feasibility of using all or
part of an intervention—and, possibly, other
processes—in a proposed larger study, but without
randomizing participants, conduct a nonrandomized
pilot study.
c) If you want to evaluate aspects of data collection,
data management, the adequacy of resources to
carry out a study, or other processes to be
undertaken in an anticipated future trial (excluding
the specific intervention and exact protocol) with a
small sample, conduct a feasibility study that is not
a pilot study.
6) Design the study.
a) Choose a research design (cross sectional, cohort,
or correlation, for example).
b) Determine setting, sample size, recruitment strategy,
randomization (if appropriate), instruments, data
analysis, and procedures.
c) Ensure protection of human subjects (submit plan
for institutional review board approval).
7) Collaborate with stakeholders at the setting to minimize
disruptions and obtain support.
8) Carry out the study.
9) Analyze the results.
10) Relate the findings to plans for a future study.
a) Do results suggest it is worthwhile to pursue the
study as planned?
b) Do results provide data suggesting it would be
important to modify aspects of this study to improve
the anticipated larger study?
c) Do results provide the data needed to propose a
larger study as planned?
11) Disseminate your findings.
Journal Sharing and Reaction on Shared Governance
- Reflective Journaling Is a term that refers to documenting
your ideas, personal thoughts and experience through
writing.
- A valued tool for teaching nursing students and for
documentation, support, and generation of nursing
knowledge among experienced nurses.
- A comfortable medium for nurses to be more open about
their journey and experience. Can also be a great way to
map a nurse’s progress and achievements in his or her
nursing/clinical education as well as in their career.
Shared Responsibility for Implementing Evidence-Based
Practice
- Evidence-based practice (EBP) is the process of collecting,
processing, and implementing research findings to improve
clinical practice, the work environment, or patient
outcomes.
 NURSING LDSHP AND MGMT LEC & RLE: BSN 4TH YEAR 1ST SEMESTER MIDTERM 2023

- According to the American Nurses Association (ANA),
nursing interventions should be practical, methodical
decisions based on EBP research studies. Utilizing the EBP
approach to nursing practice helps us provide the highest
quality and most cost-efficient patient care possible.
- When evaluating EBP nursing research studies, focus on
these four criteria:
• Validity
• Reliability
• Relevance
• Outcome
- Facilitating EBP is a shared responsibility of the
professional nurse, the organization, leader managers and
the education or staff development department.
- The management team should set the example by
supporting and acknowledging nurses who participate in,
publish, or otherwise share new EBP research data that
may benefit nurses and patients in their facilities and the
community. As the field of nursing continues to evolve,
nurses must become proficient in evaluating, participating
in, and sharing EBP research with our healthcare team to
improve clinical practice and patients' outcomes.
There are 3 key steps involved in training needs analysis to
ensure your business is making the most of the process:
1) Decide On Skill Sets – To decide on the skill sets that you
require all your team members to have in order to do their
jobs properly.
2) Evaluate The Skills Of Staff – To look at all your team
members and evaluate their current skill levels in relation
to the skills you have laid out in the first stage of this
process.
3) Highlight The Skills Gap – Know what the gap is, you need
to use training to help close that gap and ensure your team
is at the level you expect them to be
YOU WILL BE A REGISTERED NURSE!
KONTING KEMBOT NLNG! KAPIT LANG!!

Training Needs Analysis

- Is a process in which the company identifies training and
development needs of its employees so that they can do
their job effectively. It involves a complete analysis of
training needs required of various levels of the organization.
- It is a process which helps the organization review the
state of their training. Its importance is to help them to
determine all the training needs to be completed in a
certain period to allow their team to complete their job as
effectively as possible.
- The purpose of training needs analysis is to identify
performance requirements and the knowledge, skills, and
abilities needed by an agency’s workforce to achieve the
requirements. An effective training needs assessment will
help direct resources to areas of greatest demand.
Three Levels of Training Needs Analysis
1) Organizational Analysis - TNA at the organizational level.
Ex: SWOT Analysis
2) Task Analysis - Tasks to be performed on the job are
analysed; Knowledge, Skills, and Abilities needed to do
those tasks are also analysed.
3) Individual Analysis - Who needs to be trained and what
training is needed.

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