Faculty of nursing Zagazig University

Nursing Administration
Hand Book
Fourth Year

Prepared by
Nursing Administration Department

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 Nursing Administration Hand Book
Prepared by:

Prof. Dr. Fatma Gouda

Prof. Dr. Magda Attia
Prof. Dr. Farida Hassona
Assistant Prof. Dr. Maha Abdeen
Assistant Prof. Dr. Wafaa Mostafa
Assistant Prof. Dr. Hosnia Abd-Elmonem
Assistant Prof. Dr. AlSayda Ibrahim
Assistant Prof. Dr. Alia Ibrahim
Assistant Prof. Dr. Aisha Elsayed
Dr. Nora Mahdy
Dr. Heba Sobhy

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 Table of content

Page
Content
number
Unit I: Roles and functions in planning
1. Introduction to nursing management 5
2. Planning 11
3. Time management 17
4. Change 30
Unit II: Roles and functions in organizing:
5. Organizing and organizational structure 42
6. Models of patient care delivery system 53
Unit III: Roles and functions in staffing:
7. Staffing 65
8. Time scheduling 73
9. Staff development 83
10. Empowerment 93
Unit IV: Roles and functions in directing:
11. Supervision 100
12. Directing 111
13. Motivation 118
14. Record & Report 126

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 15. Conflict 138
Unit V: Roles and functions in controlling:
16. Controlling 150
17. Performance Appraisal 158
18. Quality 174
Unit VI: Decision making and leadership:
19. Decision making and critical thinking 183
20. Leadership 195
21. Materials resources management 206

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 Introduction to Nursing Management

Objectives:
By the end of the lecture, the student will be able to:
1. Identify concepts of administration, management, and leadership
2. Differentiate between administration and management.
3. Differentiate between manager and leader
4. Determine skills needed for effective mangers.
5. Identify management process.
6. Differentiate between efficiency & effectiveness.
7. Explain the management levels.

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 Introduction to Nursing Management

Management moves organizations toward achievement purposes or goals by

assigning activities that organization member perform. If these activities are
designed effectively, the production of each individual worker represents a
contribution to the attainment of organizational goals. Managers strive to
encourage individual activity that will lead to reaching organizational goals and to
discourage individual activity that hinders organizational goal accomplishment.

What is administration: -

The term administration was derived from the Latin word administer which
mean "I serve" or " I minister" with relation to direction. Administration is
directing an agency to achieve its objectives.
Administration refers to the:

Overall determination of policies; setting of major objectives; the

identification of general purposes and; laying down of broad programs and projects
of an organization.

What is management?
 Management is the process / art of getting things done effectively and
efficiently, through and with other people.
 Management is a process or form of work that involves guidance or
direction of a group of people toward organizational goals or objectives.
 Management is a process of coordinating actions and allocating resources
to achieve organizational goal.

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 What is leadership?

Leadership is a process used by an individual to influence group members

toward the achievement of group goals

The relationship between management and administration:

Management and administration had been perceived by different authors as

having the same and often are used interchangeably.
Management was considered as one process by which administration
accomplish its aims. It provides the means of translating administrative
philosophy, aims and plans into reality by using available resources and by
controlling group and individual's responsibilities and activities.
Administration is more comprehensive and includes such executive
activities as setting goals and formulating policies as well as managing personnel
and materials. The director of nursing service is an administrator who set goals,
formulating policies and manages the nurses who provide care for the patient.

Difference between administration and management: -

Administration Management

► It is a decision-making function ► It is an executing function

► It decides what is to be done and when it will be ► It decides who should do it and how
done one should do it
► It is a thinking function ► It is a doing function
► Conceptual and Human Skills ► Technical and Human Skills
► influenced by public opinion, government policies, ► influenced by the values, opinions,
religious organizations beliefs of the managers

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 Difference between Managers and Leaders

Managers Leaders

► Have an assigned position within the formal
organization
► Have a legitimate source of power due to the
delegated authority that accompanies their
position
► Are expected to carry out specific functions,
duties, and responsibilities
► Direct willing and unwilling subordinates
► May not be part of the formal organization
► Often do not have delegated authority but
obtain power through other means, such as
influence.
► Have a wider variety of roles than
managers
► Direct willing subordinates only

 All managers are leaders. But not all leaders are managers
What are the skills needed for effective mangers:

1- Conceptual skills: A manger's mental ability to coordinate all of the

organization's interests & activities.
2- Interpersonal skills: A manger's ability to works with, understands,
and motivates others both individually and in a group.
3- Technical skills: A manger's ability to use the tools, procedures &
techniques of a specialized field.
4- Political skills: A manger's ability to build a power base to establish the
right connection.

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Management process:-
The word process is the series of interrelated and interdependent steps to
achieve certain objectives.
Management is considered as a process because the work of attaining
objectives through others is a series of interrelated activities and these activities is
a process by itself are essential to organizational success and are referred to as a
management functions: (Planning, organizing, staffing, directing, and controlling)
1- Planning: includes strategic planning, budgeting and financial management,
time management.
2- Organizing: includes establishing the structure, determining the most
appropriate type of patient care delivery system, understanding and using power
and authority.
3- Staffing: includes recruiting of new staff, interviewing of potentially new staff,
hiring of new staff, orienting of new staff, scheduling of staff, staff
development, and employee socialization.
4- Directing: includes motivating subordinates, managing conflict, delegating,
communicating with subordinates, and facilitating collaboration.
5- Controlling: involve conducting performance appraisals, fiscal accountability,
quality control. legal and ethical control, professional and collegial control.

Difference between Effectiveness and Efficiency:

Effectiveness and Efficiency are dealing with what we are doing and how we
are doing it. Effectiveness means doing the right task. Efficiency means doing the
task correctly and refers to the relationship between input and output. Accordingly,
you increase efficiency when you get the same output with fewer resources.

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Organizational Managerial Levels:

1) First-level or operational managers

2) Middle-level managers
3) Top-level managers;
First-level managers: -

First-level nurse managers responsible for patient care management at the

unit level and deal with immediate problems encountered in the day-to-day
operations of the unit. e.g Primary Care Nurse, Team Leader, and Charge Nurse.

Middle-level Managers: -

Middle-level managers coordinate the efforts of lower levels, they act as the
channel between employees and top-managers, more involved with day-to-day
operations. e.g. Department Heads, Supervisors, Head Nurses, Unit Managers

Top –Level Managers: -

Top –level managers responsible for management at the executive level, the
are mostly responsible for strategic planning, create the organization's goals,
overall strategy & operating polices. They also officially represent the organization
to the external environment by meeting with government officials' executives of
other organizations and so forth (Griffin, 2006, p.6) e.g. Director of Nursing
Services and Chief Nurses.

Exercise:

o Differentiate between management and administration?

o List management process?
o Determine skills needed for effective mangers?

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 Planning
Objectives:
By the end of the lecture, the student will be able to:
1. Define the planning.
2. State the purpose of planning.
3. Explain the process of planning.
4. List the characteristics of a good plan.
5. Differentiate between planning dimension.
6. List components of planning hierarchy.
7. Differentiate between mission and philosophy.
8. Differentiate between policies and procedures.
9. Differentiate between rules and regulations.
10.Apply components of the plan in the clinical setting.

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 Planning
Definition:
- Planning is the first as well as most crucial function of management and
is considered as a foundation to all other functions of management. It is
a proactive and deliberate process that reduce risk and uncertainty.
- Planning is the process of deciding in advance what to do, who is to do
it & how, when & where it is to be done.
- Planning involves selecting goals and future courses of action and
deciding how to achieve the desired results. It also encompasses
gathering and analyzing information in order to make these decisions.

Purpose of planning:
1- Planning provides direction.
2- It reduces the impact of change.
3- Planning minimizes waste and redundancy.
4- It sets the standards to facilitate control.
5- It helps in coping with crisis situation.
6- It provides for effective use of available personnel and facilities
Steps of planning:
1. Determining objectives for which the organization and its
management operate.
2. Developing policies that guide members of the organization how to
act in specific situations.
3. Determining quality and quantity of resources that are needed to
accomplish objectives, it includes manpower, equipment and
supplies.

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 4. Establishing procedures which describe specifically in details how
actions must be accomplished.
5. Formulating standards against which objectives can be evaluated.
6. Developing time for programs to accomplish organizational
objectives.
Characteristics of a Good Plan:
 Based on clearly – defined objectives.
 It should be simple, flexible, and balanced
 It should provide for the proper analysis and classification of action,
 it should establish standards.
 It should exhaust all available resources before creating new
resources.
Planning Dimensions:
According to time, planning can be classified into:
o Short range/ operational: are plans that cover from one hour to five years
o Long range/ strategic : are plans that extend from five to 15 years.
o
Planning Hierarchy
There are many types of planning, in most organizations; these plans form a
hierarchy, with the plans that follow, it consists of:
Vision:
Is a mental image or the power of the imagination to see something that is not
actually visible.

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Mission:
 Is a brief statement identifying the reason that an organization exists and its
future aim or function, Its position regarding ethics, principles, and standards
of practice.
 Mission statement Influence the philosophy, goals, and objectives of the
organization

Philosophy:
The philosophy flows from the purpose or mission statement and delineates
the set of values and beliefs that guide all actions of the organization.

Goals and objectives:

Goals and objectives are the ends toward which the organization is working.

Policies:
 Are means for accomplishing goals and objectives, explain how goals will be
achieved and serve as guides that define the general course and scope of
activities acceptable for goal accomplishment
 Policies should be comprehensive in scope, stable, written and understandable
e.g ―Employees who violate the no-smoking rule are subject to discharge

Rules:
 Rules are plans that define specific action or non-action. Rules like policies
Provide guidance, but a rule is stronger than a policy in that the guidance
given by a rule is final and definite.
 Rules are inflexible and must be obeyed, under threat of punishment, e.g
―Employee who violate the non-smoking rule are automatically discharged"

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Procedures:
► Procedures are plans that have been reduced to a sequence of steps that required
actions. Procedures identify the process or steps needed to implement a policy.
► Procedures manuals provide a basis for orientation and staff development and
are a ready reference for all personnel. Also, can provide a basis for evaluation
Application of planning by staff nurse
- Draw a nursing care plan each patient.
- Develop a daily plan for her work during whole shift.
- Determine the time for an accomplishment of her special duties.
- Determine the equipment which will be needed
Application of planning by Nurse Manager:
- Assign each staff nurse according to level of her competency.
- Check the nursing care plan for the professional nurses.
- Determine the time for the routine activities.
- Determine the time for nursing rounds
- Determine the time for the participation in medical rounds.
- Determine the time for nursing conferences.
- Determine the equipment which will be needed for the whole unite or in the time
of emergency.
Exercise:

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1- State the purpose of planning?

2- Explain the process of planning?

3- List the characteristics of a good plan?

4- Differentiate between mission and philosophy?

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 Time management

Objectives

By the end of the lecture, the student will be able to:

1-Define time management

2-Explain steps of time management.
3-Identify mistakes common to novice managers
4. Apply the time management strategies in clinical settings
5- Apply time management skills in clinical areas
6. Identify benefits of time management
7. Understand consequences of poor time management
6- Examine factors of time-wasters in clinical settings
7- Explain how to deal with interruptions
8-Differentiate between time management styles.

Major Concepts and Definitions

- It is making optimal use of available time.

Time management
- It is the act or process of planning and exercising
conscious control over the amount of time spent on
specific activities, especially to increase effectiveness,
efficiency or productivity.

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 Time management

Introduction

Time is an equally important resource. If managers are to direct employees

effectively and maximize other resources, they must first be able to find the time to
do so.

Steps of time management:

There are three basic steps to time management:

1. Allow time for planning, and establish priorities:

* The first step requires that time be set aside for planning and establishing
priorities.
2. Complete the highest priority task whenever possible, and finish one task
before beginning another:
*The second step entails completing the highest-priority task (as determined in step
1) whenever possible and finishing one task before beginning another.
3. Reprioritize based on the remaining tasks and on new information that may
have been received:
* In the final step, the person must reprioritize the tasks to be accomplished based
on new information received.
* Because this is a cyclic process, all three steps must be accomplished
sequentially.

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Mistakes common to novice managers:

Two mistakes common to novice managers are:

1. Underestimating the importance of a daily plan:

Without adequate planning, however, the manager finds getting started difficult
and begins to manage by crisis.

2- Not allowing adequate time for planning. Daily:

Setting aside time at the beginning of each day to plan the day allows the
manager to spend time on high-priority tasks. During this planning time, the
manager should review short-term, intermediate, and long-term goals and
determine what progress will be made toward these goals.

Time management skills:

1-Use Multiple To-Do Lists:
At this stage in your life, it is likely that one to-do list is not enough. Use multiple
lists to organize tasks by topic or context.
2-Break Each Large Task into Actionable Easy Tasks:
The trick to making consistent progress on your tasks, especially academic tasks, is
to separate each task into all of the smaller component tasks.
3-Prioritize Your Tasks: You do not have to do it all now. Some of it can wait a
little while, more of it can wait even longer, and some of it may never get done.
4-Seat deadlines for Yourself: Academic work entails many steps. Set a realistic
deadline for each step.
5-Be Flexible: While to-do lists are wonderful for helping you to organize and
prioritize your life, remember that there will always be interruptions and
distractions.

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6-Go with Your Flow: Consider your own biological peaks and lows. Are you a
morning person? Or are you at your best at night? Plan your day accordingly.
7- Say "No.": Sometimes we take on too much. Whether it's extra courses, job
responsibilities, or extracurricular activities, consider how important each is to you
before agreeing.
8-Make Use of Wasted Time: Have you ever noticed how much time you spend
commuting, standing in lines, and waiting (for doctors, advisors, etc.)? Carry
pocket work to make use of that time that would otherwise be wasted.

Time Management strategies:

1. Know How You Spend Your Time

A time log is a helpful way to determine how you use your time. Record what you
are doing in 15-minute intervals for a week or two. Evaluate the results:

 Did everything you needed to do get done?

 Which tasks require the most time?
 What time of day when you are most productive?
 Where is most of your time is devoted (i.e. job, family, personal,
recreation)?Identifying your most time-consuming tasks and determining
whether you are investing your time in the most important activities can help
you to determine a course of action. Having a good sense of the time
required for routine tasks can help you be more realistic in planning and
estimating how much time is available for other activities.

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2. Task list
A task list (also to-do list or things-to-do) is a list of tasks to be completed,
such as chores or steps toward completing a project. It is an inventory tool which
serves as an alternative or supplement to memory.
3 -Task list organization
Task lists are often tiered. The simplest tiered system includes a general to-
do list (or task-holding file) to record all the tasks the person needs to accomplish,
and a daily to-do list which is created each day by transferring tasks from the
general to-do list.[8]
Task lists are often prioritized:
 In his system "A" items were the most important ("A-1" the most
important within that group), "B" next most important, "C" least
important.[10]

3. Use a Planning Tool

Time management experts recommend using a personal planning tool to improve

your productivity. Personal planning tools include planners, calendars, phone apps,
wall charts, index cards, pocket diaries, and notebooks. Writing down your tasks,
schedules, and items to remember can free your mind to focus on your priorities.
Auditory learners may prefer to dictate their thoughts instead. The key is to find
one planning tool that works for you and use that tool consistently.

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4. Get Organized

Disorganization leads to poor time management. Research has shown that clutter
has a strong negative impact room on perceived well-being (Roster, 2016). To
improve our time management, get organized.

Set up three boxes (or corners of a) labeled "Keep," "Give Away," and "Toss." Sort
items into these boxes. Discard items in your ―Toss‖ box. Your "Give Away" box
may include items you want to sell, donate, or discard.

The next step is to improve the time you spend processing information. For
example, tasks such as email can eat up your day. To combat wasted time,
implement an email organization system that allows you to process the information
in each email as efficiently as possible. Use folders, flagging, or a color-coded
system to keep track of what‘s what.

5. Schedule Appropriately

Scheduling is more than just recording what must be done (e.g., meetings and
appointments). Be sure to build in time for the things you want to do. Effective
scheduling requires you to know yourself. Your time log should help you to
identify times when you are most productive and alert. Plan your most challenging
tasks for when you have the most energy. Block out time for your high priority
activities first and protect that time from interruptions.

6. Delegate: Get Help from Others

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Delegating means assigning responsibility for a task to someone else, freeing up
your time for tasks that require your expertise. Identify tasks others can do and
select the appropriate person(s) to do them. Select someone with the appropriate
skills, experience, interest, and authority needed to accomplish the task. Be
specific. Define the task and your expectations while allowing the person some
freedom to personalize the task. Check how well the person is progressing
periodically and provide any assistance, being careful not to take over the
responsibility.

7. Stop Procrastinating

People put off tasks for a variety of reasons. Perhaps the task seems overwhelming
or unpleasant. To help stop procrastination, consider ―eating the big frog first.‖ A
quote commonly attributed to Mark Twain says, ―If it‘s your job to eat a frog
today, it‘s best to do it first thing in the morning. And if it‘s your job to eat two
frogs, it‘s best to eat the big frog first.‖ Unpleasant tasks we procrastinate
completing are ―big frogs.‖ Complete these tasks as your first action of the day to
get them out of the way. Another option is to ―snowball‖ your tasks by breaking
them down into smaller segments, completing preparatory tasks, and eventually
completing the larger task at hand. Whether you choose the ―big frog first‖ or
―snowball‖ method, try building in a reward system for completed task

8. Manage Time-Wasters

Reduce or eliminate time spent in these activities by implementing some simple

tips.

Unexpected Visitors, Email , Handheld Devices

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In-Person and Virtual Meetings , Family Obligations

9. Avoid Multi-tasking

Psychological studies have shown that multi-tasking does not save time. In fact,
the opposite is often true. You lose time when switching from one task to another,
resulting in a loss of productivity (Rubinsteim, Meyer, and Evans, 2001). Routine
multi-tasking may lead to difficulty in concentrating and maintaining focus. Do
your best to focus on just one task at a time by keeping your area clear of
distractions, including turning off notifications on your devices, and set aside
dedicated time for specific tasks.

10. Stay Healthy

The care and attention you give yourself is an important investment of time.
Scheduling time to relax or do nothing helps you rejuvenate physically and
mentally, enabling you to accomplish tasks more quickly and easily. Be sure to
monitor your screen time as a part of your digital wellbeing, setting boundaries to
stay healthy.

Benefits of Time Management

The ability to manage your time effectively is important. Good time
management leads to improved efficiency and productivity, less stress,
and more success in life. Here are some benefits of managing time
effectively:
1. Stress relief

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 Making and following a task schedule reduces anxiety. As you check off
items on your ―to-do‖ list, you can see that you are making tangible
progress. This helps you avoid feeling stressed out with worry about
whether you‘re getting things done.
2. More time
Good time management gives you extra time to spend in your daily life.
People who can time-manage effectively enjoy having more time to
spend on hobbies or other personal pursuits.
3. More opportunities
Managing time well leads to more opportunities and less time wasted on
trivial activities. Good time management skills are key qualities that
employers look for. The ability to prioritize and schedule work is
extremely desirable for any organization.
4. Ability to realize goals
Individuals who practice good time management are able to better
achieve goals and objectives, and do so in a shorter length of time.
Consequences of poor time management.

1. Poor workflow

The inability to plan and stick to goals means poor efficiency. For example, if there
are several important tasks to complete, an effective plan would be to complete
related tasks together or sequentially. However, if you don‘t plan ahead, you could
end up having to jump back and forth, or backtrack, in doing your work. That
translates to reduced efficiency and lower productivity.

2. Wasted time

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Poor time management results in wasted time. For example, by talking to friends
on social media while doing an assignment, you are distracting yourself and
wasting time.

3. Loss of control

By not knowing what the next task is, you suffer from loss of control of your life.
That can contribute to higher stress levels and anxiety.

4. Poor quality of work

Poor time management typically makes the quality of your work suffer. For
example, having to rush to complete tasks at the last minute usually compromises
quality.

5. Poor reputation

If clients or your employer cannot rely on you to complete tasks in a timely

manner, their expectations and perceptions of you are adversely affected. If a client
cannot rely on you to get something done on time, they will likely take their

Factors of Time-Wasters:

A-Internal Time-Wasters:
1-Procrastination
2. Poor planning
3. Failure to establish goals and objectives
4. Failure to set objectives

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5. Inability to delegate
6. Inability to say no
7. Management by crisis
8. Haste
9. Indecisiveness
10. Open-door policy

B- External Time-Wasters:

1-Telephone interruptions
2. Socializing
3. Meetings
4. Lack of information
5. Poor communication
6. Lack of feedback
7. Lack of adequately described policies and procedures
8. Incompetent coworkers
9. Poor filing system
10. Paperwork and reading

Dealing with Interruptions:

People can be discouraged from taking up a manager‘s time with idle chatter
in several ways.
1. Don‘t make yourself overly accessible. Make it easy for people to ignore you.
2-Interrupt.When someone is rambling on without getting to the point, break in and
say gently, ―Excuse me.
3. Avoid promoting socialization.
4. Be brief.

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5. Schedule long-winded pests.
6. If you would like to chat and have the time to do so, use coffee breaks and lunch
hours for socializing.

Time Management Styles:

A-Mono-chronic Styles:
* People with a mono-chronic style prefer to do one thing at a time, whereas
people with the poly-chronic style typically do two or more things simultaneously.
* Mono-chronic people tend to begin and finish projects on time, have clean and
organized desks as a result of handling each piece of paperwork only once, and are
highly structured.

B- Poly-chronic Style:
Poly-chronic people tend to change plans, borrow and lend things frequently,
emphasize relationships rather than tasks, and build longer-term relationships.

Display a-Time Inventory

AM 5:00
………………………………………………………………………………………………
AM 6:00
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AM 6:30
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AM 7:00
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AM 7:30
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AM 8:00
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AM 8:30
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AM 9:00
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AM 9:30
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AM 10:00
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AM 10:30
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AM 11:00
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AM 11:30
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PM 12:00
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PM 12:30
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PM 1:00
………………………………………………………………………………………………
PM 1:30
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PM 2:00
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PM 2:30
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PM 3:00
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PM 3:30
………………………………………………………………………………………………
PM 4:00

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Exercises:
2- Explain steps of time management.
3- Discuss the mistakes common to novice managers
4-What are factors of time-wasters?
5-Differentiate between time management styles.
6. Explain how to deal with interruptions for effective time management.
7. List time management strategies.

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 Change
Objectives:
By the end of this lecture, the student will be able to:

1. Define change, planned change and change agent

2. List goals of planned change
3. Enumerate characteristics of change agent
4. List causes of change
5. Determine sources of resistance to change
6. Explain process of planned change
7. Differentiate between Lewin‘s three-step change model and Kotter model
8. Discuss strategies of change
9. Explain types of change
10.Use Tactics for Overcoming Resistance to Change
11.Use the role of the Leader in Planned Change
12.Apply the steps of change process in clinical area

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 Change

Major Concepts and Definitions

Change - Making things different

Planned Change - Activities that are proactive and

purposeful: an intentional, goal-
oriented activity

.
Change Agents - Is a person or group who initiates
changes or who assists these in
making modifications in themselves
or in the system.

Introduction
There are many things that force change in an organization such as the
nature of the workforce, technology, competition, economic forces, social trends,
and world politics. Organizations often face change that is unexpected and sudden
but it can also be a purposeful decision that organizations undertake. There are
ways to foster an environment that is able to adapt and change with the demands of

32
the marketplace. Planned change is engaging in activities that are proactive and
purposeful to improve the ability of the organization to handle change and to
change employee behavior. Through this process change agents, those acting as
leaders in the change process, are essential for successfully achieving the desired
change.
Goals of planned change
• Improving the ability of the organization to adapt to changes
in its environment
• Changing employee behavior
Characteristics of Change Agent:
 Ability to elicit trust and respect from executors and recipients of
change
 Credibility
 Flexibility
 Ability to maintain and articulate change vision
 Ability to communicate well
 Good manager of interpersonal relationships
 Ability to involve and empower people in change process
Causes of change:
 Economic: Changes in the way commercial markets operate, changes
in national boundaries and changes in how money flows from place to
place may work slowly to have an impact on organisations, but their
impact is inevitable.
 Social: There are many differences in the way society is organised
now compared to only thirty years ago.

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  Technological: The way we work has been changed dramatically by
the advent of cheaper computer processing power, but this isn‘t the
only technological change that the workplace has seen. For example,
new materials such as plastics and polymers have meant that products
can be produced more cheaply and quickly
 Internal: Many changes in organisations are driven by senior
management trying to increase productivity, customer satisfaction,
employee motivation or profitability.
 Commercial: The way your organisation operates may have to
change if your competitors begin to outperform you. Good managers
keep an eye on their competitors to stay up-to-date with what they‘re
doing and find out if there‘s anything that can be learned from them
Types of Change:
There are two types of change in an organization: planned change and
emergent change. ―Planned‖ change refers to initiatives that are driven ―top-
down‖ in an organization, while ―emergent‖ change refers to a situation in which
change can originate from any level in the organization.
Process of Planned Change:
Once managers and an organization commit to planned change, they need to
create a logical step-by step approach in order to accomplish the objectives.
Planned change requires managers to follow an eight-step process for successful
implementations, which is illustrated in Figure 1

34
1. Recognize the need for change. May occur at the top management
level or in peripheral parts of the organization. The change may be
due to either internal or external forces.
2. Develop the goals of the change. Remember that before any action
is taken, it is necessary to determine why the change is necessary.
Both problems and opportunities must be evaluated. Then it is
important to define the needed changes in terms of products,
technology, structure, and culture.
3. Select a change agent. The change agent is the person who takes
leadership responsibility to implement planned change. The change
agent must be alert to things that need revamping, open to good

35
 ideas, and supportive of the implementation of those ideas into
actual practice.
4. Diagnose the current climate. In this step, the change agent sets
about gathering data about the climate of the organization in order to
help employees prepare for change. Preparing people for change
requires direct and forceful feedback about the negatives of the
present situation, as compared to the desired future state, and
sensitizing people to the forces of change that exist in their
environment.
5. Select an implementation method. This step requires a decision on
the best way to bring about the change. Managers can make
themselves more sensitive to pressures for change by using networks
of people and organizations with different perspectives and views,
visiting other organizations exposed to new ideas, and using external
standards of performance, such as competitor's progress.
6. Develop a plan. This step involves actually putting together the
plan, or the ―what‖ information. This phase also determines the
when, where, and how of the plan. The plan is like a road map. It
notes specific events and activities that must be timed and integrated
to produce the change. It also delegates responsibility for each of the
goals and objectives.
7. Implement the plan. After all the questions have been answered,
the plan is put into operation. Once a change has begun, initial
excitement can dissipate in the face of everyday problems. Managers
can maintain the momentum for change by providing resources,
developing new competencies and skills, reinforcing new behaviors,
and building a support system for those initiating the change.
36
 8. Follow the plan and evaluate it. During this step, managers must
compare the actual results to the goals established in Step 4. It is
important to determine whether the goals were met; a complete
follow-up and evaluation of the results aids this determination.
Change should produce positive results and not be undertaken for its
own sake.
Change Strategies
 Power-coercive: uses authority and threat of job loss to gain
compliance with change.
 Normative-reductive: uses social orientation and the need to have
satisfactory relationships in the workplace as a method of inducing
support for change; focuses on the relationship needs of workers
 Rational-empirical: uses knowledge as power base; assumes that once
workers understand the organizational need for change or the meaning
of the change for them as individuals and the organization as a whole,
they will change
Resistance to Change
Resistance to change appears to be a natural and positive state
Forms of Resistance to Change:
 Overt and Immediate
 Voicing complaints, engaging in job actions
 Implicit and Deferred
 Loss of employee loyalty and motivation, increased errors or
mistakes, increased absenteeism
 Deferred resistance clouds the link between source and reaction
Sources of Resistance to Change

37
 Sources
Sources of
of Resistance
Resistance to
to Change
Change

E X H I B I T 18-2
E X H I B I T 18-2

Copyright © 2011 Pearson Education 18-5

There are many sources of resistance to change, as seen in the visual in this
slide. It can take the form of individual resistance, such as fear of the unknown or
security issues or organizational resistance such as threat to expertise, structural
inertia, or limited focus of change.
Tactics for overcoming resistance to Change
1. Education and Communication
a. Show those effected the logic behind the change
2. Participation
a. Participation in the decision process lessens resistance
3. Building Support and Commitment
a. Counseling, therapy, or new-skills training
4. Implementing Change Fairly
a. Be consistent and procedurally fair
5. Manipulation and Cooptation
a. ―Spinning‖ the message to gain cooperation
38
 6. Selecting people who accept change
a. Hire people who enjoy change in the first place
7. Coercion
a. Direct threats and force
Change Models:
Lewin’s Three-Step Change Model
 Unfreezing
– Change efforts to overcome the pressures of both
individual resistance and group conformity
 Move
– During this stage, actual change is implemented and new
methods or operation or new behaviors are tried
 Refreezing
– Stabilizing a change intervention by balancing driving
and restraining forces

Kotter also offers a model to look at change that builds on the initial ideas of
Lewin. He sets forth the following eight steps:
1. Establish a sense of urgency
2. Form a coalition
3. Create a new vision

39
 4. Communicate the vision
5. Empower others by removing barriers
6. Create and reward short-term ―wins‖
7. Consolidate, reassess, and adjust
8. Reinforce the changes
The Role of the Leader in Planned Change:
The leadership ―hat‖ in planned change is a critical one to wear that includes two
crucial responsibilities:
1- The vision for change:
After the leader has determined a positive vision for the future, the next step
is to successfully communicate that vision to all levels of the organization. There
is a large difference between crafting a vision for the change, and communicating
it effectively. One common problem most organizations face is there is not
enough time spent communicating the vision for change. When communicating
the vision of the future, be sure to summarize the following points in the vision
itself:
1- Things that will stay the same
2- Things that will be left behind
3- New things that we will have that we've never had before.
2- Establishing the Support Elements:
The second responsibility for a leader of planned change is to ensure that the
support elements that are necessary for the change to be successful have been
installed.
1- A realistic project plan: The leader ensures that a step-by-step plan,
usually entered into a project management software program, as well
as a risk analysis and business case analysis have been produced in the
planning phase.
41
2- An organization structure for managing the change: The leader must
ensure the structure for implementing and managing the change is
installed. The leader should establish a system that solicits
involvement and ownership of key stakeholders.
3- Internal change agents: The leader identifies and orients a coalition of
internal change agents. These agents will act as facilitators and
―cheerleaders‖ of the change.
4- A formal communication plan: The leader creates a formal
communications plan for the life of the change initiative. First, all key
stakeholders must be identified. Then, for each stakeholder the leader
develops the types of information necessary
5- A formal training plan: The leader identifies the new skills or training
necessary for the change to be successful and establishes a formal
training program to fulfill those goals.
6- Barrier removal: The leader makes a concerted effort to first identify
barriers in the environment that will inhibit or prevent the change, and
then develops action steps to systematically remove the barriers.
7- A supportive and aligned management group: In many change efforts
there is lack of alignment and support.
8- System of periodic audits and feedback: In order to map progress
against the change goals, as well as to help institutionalize the change,
the leader must install an audit process, as she/he would for quality,
customer service, or employee satisfaction purposes.

41
Exercises:
1-Explain resistance of change.
2- Explain the change model.
3-Discuss change strategies.

42
 Organizing and Organizational structure

Objectives:
By the end of the lecture, the student will be able to:
1. Define organizing, organizational structure, organizational chart, delegation,
responsibility, authority, and accountability
2. List importance of organizing
3. Differentiate between different types of relationship within the organization
4. State purpose of organizational structure
5. Differentiate between different types of formal organizational structure
6. State uses of organizational chart
7. Explain various types of organizational chart.

43
 Organizing

Organizing follows as the second phase in the management process in the

organization Phase, relationships are defined and procedure outlined, equipment
readied and assigned, organizing also involves establishing a formal structure that
provide the best possible coordination or use resources to accomplish unit
objectives.
Definition of organizing:
- It is the process of identifying the work and classifying activities, assignment
of responsibilities and delegate authority
Importance of organizing:
1. Define responsibilities and line of authority of all members of staff.
2. Arrangement of positions, and jobs within the hierarchy.
3. Creating relationships that will minimize resistance.
4. Focus on objectives, and facilitate attaining them
Principles of organizing:
Chain of command:
is the formal line of authority and communication
Unity of commands:
 Unity of commands means that there is only one person who is responsible
for controlling,
 it indicates that one person has one boss. It is presented by the vertical solid
line between positions on an organizational chart
Span of control or supervision:

44
 Span of control is the number of subordinates reporting to one manager. The
optimal span of management depends on the time requirements for management.
Managers‘ competence and qualifications and those of their staffs.
Centralization:
Decisions are made at the top level
Decentralization:
Decision making is diffused throughout the organization.it allow managers to make
decisions effectively .
Delegation:
Delegation means assigning part of the job to someone else.
There are three factors involved in delegation include:
 Responsibility: Is the obligation involved when one accepts an assigned task
 Authority: Is the power to final decision and give command, both authority
and responsibility should be equal. This power goes with the position of
manager. It resides in the position, not in the person
 Accountability: Refers to liability. The subordinates must be held
answerable to properly carry out their duties.

The organizational structure

Although planning is the key to effective management, the organizational
structure furnishes the formal framework in which the management process takes
place. The organizational structure should provide an effective work system, a
network of communications, and identity to individuals and the organization and
should consequently foster job satisfaction. The organization contains both formal
and informal structures.
Definition of organizational structure:

45
Organizational structure refers to the way in which a group is formed, it is line of
communication, and its means for channeling authority and making decisions

Purpose of organizational structure:

 To clarify who is responsible for the task and the results

 To remove obstacles to performance caused by confusion and certainty of
assignment
 To furnish decision making and communication networks
 Enable an organization to get the work done
 It ensures that the purposes, goals, and objectives of the organization are
achieved.

Types of organizational structures:

1. The formal organizational structure:

It describes positions, tasks, responsibilities and relationships among people
in their positions in the different departments in the organization, and presented in
diagrammatic form called organizational chart.
2. Informal organizational structure:
- It describes the personal and social relationships that do not appear on the
organizational chart.
- It helps members to meet their personal objectives and provides social
satisfaction.
- It also has its own channels of communication, which may distribute
information more broadly and rapidly than the formal communication
system.

46
 - The informal organizational structure is important to management, thus, the
supervisor should be aware of its existence, study its operating techniques,
and use it to meet the organizational objectives.
Types of relationship within the organization:
1. Line relation:
It refers to levels of hierarchy, superior subordinate relationships. The
superior has the right to give orders and demand accountability; it is depicted by
vertical unbroken lines/ a solid line in the organizational chart.
2. Staff relation:
Personnel have only the right to advice, assist, and support line authority in
the performance of their duties; it is depicted by dots (----) in the organizational
chart.
3. Horizontal unbroken lines represent communication between people with
similar spheres of responsibility and power but different functions.
Types of the formal organizational structure:
1- Bureaucracy (line structure):
 Bureaucratic organizational designs commonly called line structures or
line organizations those with staff authority
 It is formal, centralized and hierarchical
 Communication and decisions flow from top to bottom
Advantage:
 Promote efficiency and production
 The employee perform by the same rules and conventions
 Reduce favoritism
 Promoting impersonality
Disadvantage:

47
  Procedures delay and general frustration.
2- Adhocracy design:
The adhoc design is modification of the bureaucratic structure and is
sometimes used on temporary basis to facilitate completion of project within a
formal line organization. Ad hoc structure uses a project team or task approach and
is usually disbanded after a project is completed.
A major weakness of the Adhocracy design
 Decreased strength in the formal chain of command
 Decreased employee loyalty to the parent organization.

3- Matrix structure:
A matrix is a combination of bureaucratic structure with an adhocracy team
component. It is designed to focus on both product and function. Function is
described as all the tasks required to produce the product. The product is the end
result of the function. For example, good patient outcomes are the product, the
staff education and adequate staffing may be the functions necessary to produce
the outcome.
Advantages of matrix:
1. Improve communication through vertical and horizontal control
2. Increased organizational adaptability and flexibility to respond to
environmental changes
3. Increased efficiency of resources use
4. Increased job satisfaction with achievement and fulfillment
5. Improved interpersonal skills
Disadvantages:
48
 1. Potential conflict because of multiple lines of authority, responsibility and
relationships
2. Role ambiguity
3. Loss of control over functional disciplines as a result of a multiply
disciplinary team approach

Matrix organizational structure

4. Flat design (horizontal, participatory, decentralizing):

Flat organizational design is an effort to remove hierarchical layers by
flatting the chain of command and decentralization. Replaces the centralization of
decision making at the top of the organization and providing staff with authority at
the place of interaction with clients reflects at flat structure
Advantages:
1. Reduced ambiguity in work requirements
2. Encourage employee contribution
3. Encourage team work
4. Improve organizational communication

49
 5. Decreased absenteeism
6. Increased job satisfaction
Disadvantages:
1. There is a lacking of individual responsibility
2. Increase costs
3. Require more manager and large staff

Organizational chart
Definition of organizational chart:
 It is a diagram shows the different positions and departments and the
relationships among them.
Uses:
It is used to show:
1. The formal organizational relationships.
2. Areas of responsibility.

51
 3. Persons to whom one is accountable.
4. Channels of communication.

Disadvantages of organizational chart:

1. Charts become outdated quickly
2. Does not show informal relationship
3. Does not show duties and responsibilities
4. Poorly prepared charts might create misleading effects
Types of organizational chart
There are three types of organizational charts:
1. Vertical charts:
It shows high-level management at the top with formal lines of authority
down the hierarchy, are most common.

Vertical organizational charts

2. Horizontal charts:
It shows the high level management at the left with lower position to the
right, shows relative length of formal lines of authority and helps simplify
understanding the lines of authority and responsibility.

51
 Left to right (Horizontal) organizational chart
3. Circular charts:
It shows the high level management in the center with successive positions
in circles. It shows the outward flow of formal authority from the high level
management. It reduces status implications.

Circular organizational chart

52
Exercises:
1. Determine the importance of organizing?
2. Differentiate between different types of relationship within the organization
3. State purpose of organizational structure
4. Differentiate between different types of organizational structure
5. State uses of organizational chart
6. Explain various types of organizational chart, advantage &disadvantage of
each type

53
 Models of patient care delivery system

Objectives:
By the end of the lecture, the student will be able to:
1. Define the assignment,
2. Define assignment of client care
3. Define assignment of nursing tasks.
4. Identify the purpose of assignment.
5. List the principles of developing assignment
6. Identify the factors considered in distributing duties
7. State the characteristics of effective assignment
8. Discuss the various models of delivering patient care, advantage and
disadvantage of each model.
9. Determine the nurse manager‘s role in assignment.
10.Apply different methods of assignment in clinical area.

54
 Models of patient care delivery system
Effective management makes the organization function, and the nursing
manager has a responsibility of nursing care delivery systems that demonstrate
ways of organizing nursing‘s work. Within these systems there are advantages and
disadvantages for quality of care, use of resources, and staff growth.
Major concepts:
- Assignment: It is refers to ―a written delegation of duties to care for a group of
patients by trained personnel assigned to the unit.
- Assignment Is the allocation of client care functions and/or clients among
nurses in order to meet client care needs?
- Assignment of client care: Is a decision regarding the most appropriate care
provider for the provision of a client‘s care? The RN at the point of care retains
the overall accountability for the appropriate assignment and oversight of client
care.
- Assignment of nursing tasks: Is the selective designation of specific skills or
responsibilities to a care provider. This implies that a specific skill is within the
scope of practice of the care provider being assigned the task.

Purposes of assignment:
1. To distribute the work to be done to the nursing personnel.
2. To gain the cooperation of the nursing personnel by knowing and accepting
the acceptance of the work to be done.

Principles of personnel assignment:

1. Made by the head nurse or nurse in charge for each individual nurse.
2. Based on:
- Nursing needs of each patient and approximate time required to care for him.

55
- The capabilities, skill level, previous experience and the interest of the staff
members.
- Job description,
1. Planned weekly and revised daily if necessary to assure continuity of care.
2. All nurses have a duty to provide safe and appropriate nursing care to
clients.
3. Nurses act in a manner that is consistent with their standards of practice,
codes of ethics, scopes of practice and other relevant legislation.
4. Nurses practice within their own level of competence and seek direction and
guidance from other health care professionals when aspects of the care
required are beyond their individual competence.
5. Where two or more categories of nurses work together, safe and appropriate
care can best be achieved through collaboration and cooperation among
nurses, respecting the contributions of each professional.
6. Effective communication among nurses and within organizations is essential
in order to achieve quality client outcomes.
7. Supervise those to whom nursing activities have been delegated.
8. Determine the model of care delivery (i.e. primary nursing, team nursing or
functional nursing), the complexity of the client‘s nursing care needs; and
the context of care and the degree of direction and/or supervision available.
9. Should be in written form
10.Use simple clear words in writing assignment
11.Fix responsibility for all duties clearly with no over lapping
12.Provide for emergency situations and provide for special nursing activities
13.Give each person time and opportunity to plan her work
14.Assignment must rely on the preliminary planning
15.Arrange the various parts of the assignment in logical order
56
 16.Ensure continuity of patient care
17.Assignment should be made in accordance with the administrative policy
18.Based on accurate assessment
19.Two workers should never be assigned to do the same work
20.It should be related to previous assignment

Factors to be considered in distributing duties

1. The number, qualifications, experience and abilities of nurses
2. The number, condition and location of patients
3. Nursing needs of each patient and appropriate time required for care
4. Consider each nurse as individual
5. It should provide for new learning experiences
6. Type of service rendered should be considered
7. The availability of supplies and equipment
8. Architectural features of the unit
9. Availability of nursing service manual for policies and procedures

Characteristics of effective assignment

1. Definite and easily understood.
2. Simple.
3. Clear.
4. Signed.
5. Written.
6. Posted in advance

Choosing a Nursing Care Delivery Model

 What staffs mix is required?
 Who should make work assignments?

57
  Work assigned by task or by patient?
 How will communication be handled?
 Who will make decisions?
 Who will be responsible and accountable?
 Fit with unit//facility//organization management?

Patient Care Delivery Models or strategies:

1. Total patient care (case method).
2. Functional method.
3. Team method.
4. Modular method.
5. Primary care method.
6. Case /function method.
1- Total Patient Care (case method)
Nurse is responsible for planning, organizing, and performing all care of one
or more patients on duty. It is oldest method of organizing patient care.
Common use areas- critical care units as: intensive care unit (ICU), post-
anesthetic care unit (PACU) and as a method for teaching nursing students
Advantages
1. High degree of autonomy
2. Lines of responsibility and accountability are clear
3. Patient receives holistic, un fragmented care
4. Assigning patients is simple and direct.
5. Patients do receive non fragmented care.
6. Patients feel more secure.
7. Better relationship between the patient/consumer and the nurse.
8. The nurse feels more satisfaction.

58
 9. patient satisfaction is high
10.quality of patient care is high
Disadvantages
1. Lack of RN availability
2. This method requires highly skilled personnel.
3. It is more costly than other method.
4. Some nurses may be disqualified which hinders patient safety.
2- Functional Nursing (task nursing)
Staff members assigned to complete specific tasks for a group of patients.
Medication nurse, bedsides nurse, and admission nurse. It evolved during World
War II as a result of a nursing shortage. Unskilled workers trained to perform
routine, simple tasks, Common use area—operating room, emergencies and wards
Advantages
1. Care is provided economically and efficiently
2. Minimum number of RNs required
3. It increases efficiency because tasks are completed quickly.
4. Nurses become highly skillful and more self-confident.
5. Need less equipment and supplies
6. It is efficient when there is shortage of staff
Disadvantages
1. RN busy with managerial and non-nursing duties and practical nurses
deliver the majority of care
2. fragmented care
3. Patient may be confused with many care providers
4. Caregivers feel unchallenged
5. It decreases patient satisfaction.

59
3-Team Nursing
RN as team leader coordinates care for a group of patients' plans, supervise,
evaluate and participate in the delivery of nursing care. It evolved in the 1950s to
improve patient satisfaction. Goal was to reduce fragmented care. Team nursing
usually refers to large group of patients. Common use areas—most inpatient and
outpatient areas
Advantages
1. High-quality, comprehensive care with a high proportion of ancillary staff.
2. Development of leadership skills
3. Team members participate in decision making and contribute their own
expertise
4. Nursing conferences help problem solving and staff development.
5. It enhances team building, team members‘ support for each other.
Disadvantages
1. Continuity suffers if daily team assignments vary
2. Team leader may not have good leadership skills
3. Insufficient time for planning and communication
4. Day to day change in team member may reduce the care.
5. This can lead to blurred lines of responsibility, errors, and fragmented patient
care.
6. Very high cost
7. Need more equipment and supplies
4-Modular Nursing

Modification of team nursing Patient unit is divided into modules or units or

district, with an RN as team leader. Evolved to increase RN involvement in care.

61
Recent attempts to refine and improve team nursing have resulted in the concept of
―modular nursing,‖ which is a mini –team (two or three members) approach.

Keeping the team small and attempting to assign personnel to the same team
as often as possible should allow the professional nurse more time for planning and
coordinating team members. Additionally, a small team requires less
communication, allowing members better use of their time for direct patient care
activities.

Each small team is responsible for giving the whole nursing care to a group of
patients. Those patients receive their care from the same mini-team (module) from
their admission till discharge and must arrange for the care of their patients during
different shifts and off-duty.
Advantages
1. Useful when there are few RNs
2. Continuity of care is improved
3. RN more involved in planning and coordinating care
4. Geographic closeness and efficient communication
Disadvantages
1. Increased costs to stock each module
2. Long corridors not conducive to modular Nursing. Paraprofessional
does technical aspects of care
5-Primary Nursing
RN ―primary nurse‖ assumes 24-hour responsibility for planning, directing,
and evaluating care. It evolved in the 1970s to improve RN autonomy.
The primary nurse is responsible to plan, implement and evaluate the whole
nursing care for a small number of patients (four to six patients).

61
 She/he is responsible for those patients from the moment of admission until
discharge and even throughout next admissions. Primary nurse should arrange for
someone to care for his/ her patients during off duties. Common use areas—
hospice, home health, and long-term care settings
Advantages
1. High-quality, holistic patient care
2. Establish rapport with patient
3. RN feels challenged and rewarded
4. Increase nurse patient, and physician satisfaction
Disadvantages
1. Primary nurse must be able to practice with a high degree of
responsibility and autonomy
2. RN must accept 24-hour responsibility
3. More RNs needed; not cost-effective because many tasks should be done
by less skilled persons
4. time consuming
6-Case Management
It was first introduced in the 1970s by insurance companies. Hospitals
adopted the model in the 1980s. Value demonstrated through research Components
include: Assessment, planning, implementation, evaluation, and interaction.
Variations are found in most health care organizations.
Reserved for chronically ill patients, seriously ill patients, or long-term,
expensive cases. RN assumes a planning and evaluative role; usually not
responsible for direct care duties Supplemental form of care delivery; does not
replace direct-care model Coordinates the patient‘s care throughout the course of
an illness.

62
 The case manager has a case load of 10 to 15 patients observed from the
admission to discharged, the case manger does not provide direct pt care but
supervises the care provided by other team

7- The case / function method:

This method involves a combination of both the case and functional methods
of assignment. For example; case method for the morning shift and functional for
the afternoon and night shifts.

The nurse manager’s role:

 Ensure competent nursing care is provided to the patient
 Evaluate the nurse's ability to deliver specialized patient care
 Organize resources to insure that patients receive appropriate nursing care
 Collaborate with the staff nurse to clarify assignments, assess personal
capabilities, and jointly identify options for patient care assignments when
the nurse does not feel personally competent.
 Communicate to staff through written policies the process of making
assignment and reassignment decisions
 Provide education to staff and supervisory personnel in the decision making
process regarding patient care assignments
 Plan and budget for staffing patterns based upon patient's acuity and
priorities for care
 Provide a clearly defined written policy for immediate internal review of
proposed assignments which includes the participation of the staff involved
 Provide a grievance procedure for use by staff after the fact

Refusing an assignment

63
 - The following principles guide the nurse‘s decisions and actions when faced
with situations in which she/he is considering refusing an assignment or
discontinuing services.
- The safety and well-being of the client is of primary concern.
- Critical appraisal of the factors in any situation is the foundation of clinical
decision-making and professional judgment.
- Nurses are accountable for their own actions and decisions and do not act
solely on the direction of others.
- Nurses have the right to refuse assignments that they believe will subject
them or their clients to an unacceptable level of risk
- Nurses are not required to work extra shifts or overtime for which they are
not contracted.
- Individual nurses and groups of nurses safeguard clients when planning and
implementing any job action
- Persons whose safety requires ongoing or emergency nursing care are
entitled to have these needs satisfied throughout any job action

Exercises:
1. Apply different methods of assignment in clinical area using principles of
assignment?
2. State five advantages of case method when assigning patient and nursing
care?
3. State four advantages of team method?

64
 Staffing
Objectives:

By the end of the lecture, the student will be able to

1. Define Staffing, staffing pattern, staffing plan and staff mix.

2. Explain the goal of staffing.
3. State components of staffing.
4. Explain methods of staffing pattern determination.
5. State types of supplementary staffing pattern.
6. Identify factors affecting staffing pattern.
7. Explain the methods of staffing plan calculation.
8. Determine steps of staffing process

65
 Staffing
Nurse managers' roles are complex & demanding of the many
responsibilities and challenges the roles entail , staffing remains one of the most
pivotal to daily unit operations, to patient & family satisfaction with care and
services, and to employee satisfaction. Staffing issues often cause nurse managers
great concern.
Major concepts:
- Staffing: is a function of planning for hiring & deploying qualified personnel
to meet the needs of patients for care and services.
- Staffing: is the third element of the management process. It is refers to the
number & composition of personnel assigned to work in a unit at a given time.
- Staffing pattern: Indicates the number and mix of personnel that should be on
duty per each unit per shift, per day.
- Staffing mix: The type of staff necessary to perform the work of the
organization
- Staffing plan: Determines the number of personnel that must be hired to
deliver that staffing pattern
Goal of Staffing:
The goal of staffing is to provide the appropriate number & mix of nursing
staff (nursing care hours) to match actual patient care needs (patient care hours)
that will lead to the delivery of effective and efficient nursing care.
Components of staffing:
The staffing is composed of two components:
 The staffing pattern
 The staffing plan

66
 The staffing pattern:
For example: Staffing pattern for a single patient care unit may be as follows:
Category of personnel Days Evenings Nights
Head nurse 1 - -
Professional nurse 4 2 1
Nonprofessional nurse 2 1 1
Nursing aide 2 2 2
Total 9 5 4

Methods of determining the staffing pattern:

a- The traditional system:
The old system of determining the staff number and mix was based on the
number of beds per unit (one nurse per 4-6 beds) or on the average census per unit
(one nurse per 4 patients). These calculations ignored the fact that one group of
patients might need for more care than another group of the same number; in
addition this system shows only the number of hours worked during a day without
differentiation between patients or between the various shifts of duty. It does not
reflect either the particular needs of patients or the level of care needed. The hours
worked include direct nursing care activities and administrative and other activities.
The distribution of nurses is based on the administrator opinion of the proportion of
care that is needed on each shift.
Example:
Days---------------------------45% of the staff
Evenings----------------------35% of the staff
Nights-------------------------20% of the staff.

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 Since this system does not reflect either the particular needs of patients or
the nursing tasks to be performed, it is considered useless in providing quality care
accepted as a standards.
a- The new system (patient classification and task quantification).
This new system for determining staffing relies on data concerning patient
needs during a shift and the nursing tasks to be performed during a shift and not a
day as in the old system.
The staffing pattern is developed through:
Either a patient classification system, task quantification system or
combination of both systems.
1- Patient classification system:
Focuses on patient needs; patients are grouped according to the acuity of
their illness and the degree of their dependency on nursing time (time required to
care for them) into three or more groups/classes.
- Class1: Self care
- Class2: Partial or intermediate care
- Class3: Intensive or total care
For example: Determining number of nursing care hour by patient classification
system in unit.
Acuity level of Associate hours of Total no of hours
No of pt
care care needed for care
3 I 2 6
10 II 6 60
11 III 7 77
Total = 24 143

- No of work hours in each shift (day) =8 hours

- Total work hours in one week = 8x5 = 40 hours

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- Total annual hours per one to work = 40x52 =2080 hours
- Total no of employees needed = Total N care hours x day in year
Total annual hours per one for position
= 143 x 365 / 2080 hours = No of employment
2- Task quantification system:
Focuses on nursing tasks to be performed, common nursing tasks are either
direct care activities that done in the presence of patient such as: measuring vital
signs, giving medication….etc.
Or indirect care activities such as:
- Preparation of medications & treatments
- Documentation of nursing care and other paper work
- Housekeeping chores done by nursing staff
- Continuing education sessions
- Administrative conferences
- Development of policies and procedures
- Nonproductive time: breaks, personal talks, illness, fatigue.

Types of staffing patterns:

a- Basic and supplementary staff:
Since both methods used to determine staffing patterns are based on average
care requirements, the basic (permanent) staff for each unit will need
supplementary staff when demands for care exceed the capabilities of the basic
staff.
Methods for use of supplementary staff:
1- Borrowing method:
Borrowing staff from units that have the most to help those who have too little
2- Float staff:
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 A pool of nurses who are permanent workers but do not belong to any
special unit are used to fill in for increase in patient care activities or absence
among the unit staff.
3- On call staff:
Usually on call staff is filled with regular employees who receive extra pay
for being on call whether or not they are called; this method is useful in operating
room, ICU, & other special care units.
b- Variable staffing pattern
It is an alternate to the permanent staffing pattern. This method is not based
on the assumptions regarding the average needs of patients but the pattern is
determined daily based upon (resent needs of patients on each unit), the
information on patient needs are calculated once or twice a day and are analyzed to
give the number and mix of staff needed on each unit and each shift. Thus, the
pattern on each unit may change daily. In this method the staff of the entire
hospital is centrally distributed each shift, the calculations are done by the
computer based on data collected from the patient classification and task
quantification techniques
Factors affecting staffing pattern determination:
1- Nursing organization factors:
- Patient care objectives
- Determined levels of patient care
- Nursing unit functions
- Assignment systems
- Services to staff( training)
2- Patient factors:
- Variety of patient conditions
- Acuity & general health status
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 - Length of stay
- Patient number , fluctuation in number
- Age groups
- Care expectations
3- Staff factors:
- Job description of the division
- Education level of staff
- Experience level of staff
- Staff mix & number available.
- Absenteeism
4- Health organization factors:
- Budget available
- Personnel policies especially regarding work time
- Number of beds/units
- Support services within the organization
- Architecture layout of the unit.
The staffing plan:
- Is a mathematical calculation of how many nurses of what category
(professional and nonprofessional) must be hired in order to deliver the
required care on a yearly basis.
Methods for calculating the staffing plan
A- Using calendar days:
- Divided the number of days in a year by the number of days actually worked
per nurse per year to derive the number of staff required to fill one position
for the year, and then calculate the total number of staff needed to fill the
different positions for each category for the whole hospital.

71
 - Nurses are not working the 364 days of the year, but actually working 272
days only in a year, because the rest 92 days are considered as follows:
- Example: calculating the number of nurses needed to be hired to fill a single
professional nurse position on a day shift on a given patient care unit:
1- Calculate the actual number of days worked by a professional nurse /year (52
weeks)
a- Number of day off ( 1 day off per week) = 52 days
a- Number of vacation days = 20days
a- Number of days ill (hosp. policy) = 10 days
a- Number of days off (holiday) = 10 days
 Total number of days off = 92 days
 Actual working days/professional nurse year = 365 – 92 = 272 days.
2- Number of nurses needed to fill one position of professional nurse= 365/272
=1.33 nurses, i.e. you will need 1.33 professional nurses to fill one position.
3- Then calculate the total number needed for staffing pattern for all units. For
example if you have 100 positions then the total numbers of nurses needed
should be1.33x100=133 nurses.
Staffing process
1) Identify the type and amount of nursing care needed by the patient.
2) Determine personnel categories that have the knowledge and skills to
perform needed care measures.
3) Predicting the number of personnel in each job category that will be needed
to meet anticipated care demands.
4) Obtaining budgeted positions for the number in each job category needed to
care for the expected types and number of patients
5) Recruiting personnel to fill available applicants.

72
6) Selecting and appointing personnel from available applications.
7) Combining personnel into desired configuration, by unit and shift.
8) Orienting personnel to fulfill assigned responsibilities.
9) Assigned responsibilities for patient care to available personnel.

Exercise:

1) Explain the methods of staffing plan calculation?

2) Differentiate between borrowing staff & float staff?
3) Discuss the methods of staffing pattern determination?

73
 Time scheduling
Objectives:

By the end of the lecture, the student will be able to

1. Define the time scheduling.

2. List the objective of time scheduling.
3. Apply the principles of time scheduling in clinical area.
4. Identify Scheduling policies.
5. Differentiate between the different systems of developing time planning
scheduling.
6. Construct an example of each working time schedule.
7. Identify the working hours scheduling options.

74
 Time scheduling
Scheduling is an important responsibility of the nurse manager, where by the
personnel are assigned specific days hours of work.
The schedule means the distribution of hours to be worked by each person during
each 24 hours, seven days a week. i.e. assigning nurse specific days and specific
hours of work.
Definition of time scheduling:
- Is the distribution of hours to be worked by each person during each 24 hours,
seven days a week i.e. assigning nurse specific days and specific hours of
work.
- Is a function of implementing the staffing plan by assigning unit personnel to
work specific hours & specific days of the week.
Objective of time scheduling:
1. To provide adequate staffing to meet patient care needs according to the
philosophy and policy of the organization during a 24 hour period.
2. To ensure patient care without overstaffing or understaffing.
3. To organize work in the unit and prevent confusion by avoiding periods of
understaffing and overstaffing.
4. To maintain staff morale.
5. To achieve balanced distribution of days off.
Principles of time scheduling:
1. Enables the staff to meet the objectives, standards & policies of the
organization.
2. All staff nurses should be assigned similar duty hours as much as possible,
and days off should be equitable for all nurse.

75
 3. There must be an equitable distribution of desirable as well as undesirable
hours of duty.
4. Provides for flexibility in meeting hanging needs of nurse ( sick leaves,
vacations, and holidays)
5. Should be no accumulation of day off.
6. Should be a professional nurse on duty at all times during the 24 hour
period.
7. The head nurse is rarely off duty on Saturday, which is the beginning of the
week.
8. One day a part must be planned between days off of the head nurse and the
nurse who is to relieve her to provide for adequate reporting.
Scheduling policies:
The scheduling policies needed:
1. Time covered by each schedule
2. Dates for posting schedules.
3. Day beginning the work week
4. Number of work hours per week.
5. Beginning or ending time for shifts.
6. Number of sequential work days
7. Number of sequential days off
8. Number of weekends off per month.
9. Number of paid holidays per year
10.Number for allotting holiday time off.
11.Methods for allotting vacation time
12.The procedure for handling emergency requests for adjustment of time
schedules.
13.Frequency of shift rotation.
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Scheduling responsibility:
Traditionally the head nurse or manager is responsible for scheduling work
time for all units nursing nurse .Work schedules must be prepared several weeks in
advanced and modified at intervals to accommodate changes in patient census and
acuity and nurse illness and absence.
System of developing time schedule:
A. Centralized scheduling
B. Decentralized scheduling
C. Self-scheduling
A. Centralized scheduling:
One nurse in the nursing administration office put plan that is coverage for
all nursing units. Computer can be used for centralized scheduling.
Advantage:
 Provides a central control of staff ,i.e. nurse can be distributed in a more
balance manner among the nursing units and under staffing of over staffing
is eliminated.
 Fairness to nurses through consistent, objective and impartial application of
policies.
 Provides an overall picture of the staffing situation
 Help in making adjustments in cases of illness, emergencies or changes in
patient care needs among nursing units.
 Eliminates the nurse contact that develops between head nurse and her nurse
as it relates to nurse work schedules.
 Relieves the head nurse from time consuming duties freeing them for the
other activities.
Disadvantages:

77
  A decrease in the flexibility of staffing.
 Is the limited knowledge the centralized staffing coordinator has relative to
changing patient acuity needs or other patient related activities on the unit.
B. Decentralized scheduling:
Planned at the unit level, usually by the head nurse
Advantage:
1. Allow the head nurse to base her scheduling plan on her knowledge of the
nurse assigned to her unit.
2. Nurses feel that they get more personalization attention.
3. It is easier and less complicated when done for a small area instead of the
whole agency.
Disadvantages:
1. Each head nurse under decentralized staffing tends to develop and utilize her
own staffing pattern and so workers on various units compare schedules and
dissatisfaction may arise.
2. Sometimes makes staff members feel that the head nurse is not objective
3. Inability of the nurse manager to know the big picture related to staffing
across multiple patient care units.

C. Self-scheduling
Personnel are scheduled to work their preferred shift as much as possible to
meet the needs of the unit & balance with the needs of their coworkers.
Advantages:
1. Self -scheduling leads to more responsible nurses, and meets their goals
such as family, social life, education, child care and others.
2. It promotes staff autonomy, increase staff accountability for productivity on
the unit.

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 3. Make a staff more committed, decrease turnover, decrease absenteeism, and
increase job satisfaction
4. Increased team communication, problem solving skills can be enhanced
through the self - scheduling process.
Types of scheduling working hours:
1- Block scheduling
2- Cyclic time scheduling
3- Computerized scheduling
1- Block scheduling:
- Mean that the work schedule for a unit is planned in a block of week, i.e. days
to be worked by staff are blocked together.
- Block scheduling is done for 4-8 weeks at a time. It can be calculated easily
and has flexibility in that the next block of time does not necessarily need to
follow the pattern of the preceding block. This type of scheduling does not
provide for maximum level of care seven days a week.
Example of block time scheduling:
X: days worked:1 days off in the week
Days
s s m T w th f s s m t w th f s s m t w th f s s m t w th F
Nurses

2- Cyclic time scheduling

Cyclic time scheduling is one way of staffing to meet the requirements of
equitable distribution of hours of work and time off. A basic time pattern for a
certain number of weeks is established and then repeated in cycles while taking in
consideration the need for the proper number and mixes of nurse, continuity of
care. Cyclic time scheduling is done for four to eight weeks

79
Example of cyclic schedule
 D: Day shift
 E: Evening shift
 N: Night shift
 O: Off duty
Week (1) (2) (3) (4)
Days
s s m T w th f s s m t w th f s s m t w th f s s m t w th F
Nurses
Charge
1
2
3
4
Week (5) (6) (7) (8)
Days
Nurses
Charge
1
2
3
4

Advantages of cyclic time scheduling:

1) Once developed; it is relatively permanent schedules and requiring only
temporary adjustments.
2) Same schedule is repeatedly, so it decrease time spent on scheduling
3) Nurse know schedule in advance
4) Staff treated fairly
5) Nurse can schedule social events
Disadvantages of cyclic and block time scheduling:
1) Is relatively inflexible
2) It is not generally accepted by nurse needs related to families& educational
pursuits.
3- Computerized scheduling:

81
 Many organizations have invested in computer software designed to create
optimal schedules based on the approval staffing plans for individual units.This
type enables the user to devise a plan which considers more variables than
scheduling done by individuals.
Advantages of computerized scheduling:
1. It is saves the nurses time spent working out schedules.
2. It reduces interpersonal conflict between staff and supervisor created by
changes made in scheduling.
3. Consistent scheduling and equitable application of agency policy.
4. Unbiased
5. Cost effectiveness through reduction of clerical staff and better utilization of
professional nurses by decreasing the spent in non-patient care activities.
Types of work shifts:
There are many different types of work shifts. Shift schedules for nurse may
vary from hospital to hospital, it may be a there shift schedule such as morning
shift, afternoon shift and night shift. The most appropriate shift system for any
department depends on a number of factors most important of which is patient
activity. So the most working hours scheduling options is:
 Eight hour shifts:
This is a traditional pattern that uses 8 hour shifts for time planning for 24
hour period. The pattern may be as such:
- 7 AM to 3:30 PM
- 3 PM to11:30 PM
- 11 PM to 7:30 AM
 Ten hour shifts:
Shifts developed for the 10 hours per day are:
- 7 AM to 5:30 PM
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 - 1 PM to11:30 PM
- 9 PM to 7:30 AM
 Twelve hour shifts:
The shifts hours are usually 7 AM to 7:30 PM and 7 PM to7:30 AM It is
appropriate in ICU and due to inadequate staff.
 Irregular hours scheduling pattern:
The nurse works 10 hours, 12 hours or other irregular length shift. This system
is implemented for the services of highly trained clinical nurse specialist or for
nurse in in-service training programs.

Exercises:

1. Differentiate between the different systems of developing time planning

scheduling?
2. Construct an example of each working time schedule?

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 Staff development
Objectives:

By the end of the lecture, the student will be able to

a. Define the staff development

b. State purpose of staff development
c. State reasons for staff development
d. Recognize organizational arrangement of staff development program
e. Identify components of staff development programs
f. Discuss steps of staff development program
g. List responsibilities of staff development director

83
 Staff development

Definition:
Staff development is the process of enhancing staff performance with specific
learning activities.
Purpose of staff development:
1. Improving employee skills, it enhances personal advancement, and
occupational progress.

2. By providing educational opportunities to all nursing personnel it

improves their performance and satisfy their learning needs.

Reasons for staff development activities:

1. Changing customer expectations.

2. The introduction of new technology emphasized the need for continued

learning.

3. Accreditation requirement.

Organizational arrangement of staff development programs:

1-Centralized
In this design an agency wide staff development department is responsible for
the development of all hospital personnel, including nurses. Or when a separate
nursing education department is responsible to provide nursing development
program to all nurses in the hospital.
2-Decentralized
In this design the nursing staff development program provided at the
nursing unit level. The head nurse in each nursing unit is responsible for

84
 orientation of new nurses or to provide new knowledge, skills to the
nursing staff.
Types of staff development programs:
1- In-service education and
2- Continuing education.

I- In-service education:
It is learning experience offered to the employee while working in the
organization.

Component of in-service education:

1) Orientation program
2) Skill training program
3) Leadership development program

I- Orientation Program Contents:

Orientation is the process of acquiring a new nurse with work environment, so

she/he can relate quickly and effectively to new surroundings.
Orientation of new employees consists of two parts:
(A) Induction training Contents (standardized for all new comers to the
organization) provide the new nurse with information about:
1. Agency history, purposes and structure.

2. Employment policies and purposes.

3. Holidays, and vocations allowance.

4. Sick time and position classification.

5. Performance standards and performance evaluation.

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 6. Labor contracts, paydays.

7. Eating facilities, laundry service and educational opportunities.

(B) Job orientation:

The core of job orientation is to orient the employee to the technical
requirement of his/ her job. A well- prepared and executed job orientation
program educates the new employee about the expected, desired performance
behavior that helps in providing quality care.
Responsibilities of orientation
1- Personnel department
2- Staff development department
3- The individual unit

II- Skill training program:

Such a program is offered to both new employees and others. It is required
when new techniques and procedure are to be introduced. This program is directed
towards providing employees with basic skills and attitudes required for the job or
for revision.
Purposes of Skill Training Program:
1. Upgrade staff performance.

2. Meeting standards established for quantity and quality of performance.

3. Promote job satisfaction

4. Help nurses to be familiar with changes in methods and techniques.

5. Enable nurses to meet standards established for quality of performances.

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III- Leadership and management development program:
This program is directed towards equipping group of employees for growing
responsibilities and new positions in nursing with the objective of developing their
leadership and management competency among personnel.

2. Continuing education program:

This program aims to provide personnel with the opportunity to learn new
knowledge and skills to up to date new educational needs.
It is a formal education, which can be offered in the form of workshops,
seminars, conference or courses, with the aim of improving nurse's ability
to provide quality nursing care.

Program planning
Basic elements for designing and implementing the program
1- Identifying learning needs
2- Establishing priorities
3- Formulating objectives
4- Selecting and organizing learning materials
5- Designing plans for learning experiences
6- Selecting teaching strategies
7- Implementation
8- Evaluation
1-Identifying learning needs: Identifying learning needs is the basis for
developing staff development program
Learning need: is described as a discrepancy between what nurses know and what
they need to learn to carry out role expectations or to prepare for additional
responsibility.

87
Sources of identifying learning needs:
a. Society (e.g. presence of AIDs)
b. Organization (e.g. Hospital policy)
c. Individual (e.g. starting new nursing procedure, previous experience).
Methods of identifying learning needs:
a. -Observation of personnel performance ( direct observation of work
performance of the nurses )
b. Verbal and written communication
c. Analysis of records and reports
2-Establishing priorities
After needs are determined, they are translated into action and priorities are
established. Prioritizing needs depends on the following factors: economic factors,
time factor and abilities of nurses.
3-Formulating objectives
Once learning needs have been identified, the objectives of the program should be
stated.
Types of educational objective
1- General objective: Which are broad statements and describe those objectives
that the learner should be able to demonstrate at the end of the program. These
objectives should be stated in the introduction of the program. For example,
providing preventive and curative to the individual and the community in health
and in sickness.
2- Specific objective: Should be stated for each program session in order to reach
the general objectives of the program. These objectives describe the performance
demonstrate by the learner at the end of each program session.
4- Selecting and organizing learning materials

88
After determining program objectives, the next step is the selection of learning
materials in relation to desired objectives, principles of adult learning also
influence how learning materials are to be constructed. Adult learn best when
learning materials are well organized.
5-Designing plans for learning experiences
This step involves the actual development of the program and includes:
1-Teaching plan: In formulating teaching plan, all the behavioral objectives
should be identified as well as content and teaching methods. Also, it may be
desirable to identify the teacher and the time block. These plans should be kept as a
matter of record.
2-Time schedule: A time schedule should be used to show each instructor, trainer's
class and clinical schedule in order to determine where the staff development
educators are located and what learning offerings are scheduled for the designated
time.
3-Staff assignment: One of the best methods in making staff development is based
on clinical expertise because it is impossible for all staff development educators to
be experts in all of the clinical areas.
6- Selecting teaching strategies
Teaching strategies vary according to whether the learner must:
1-Receive information
2-Be shown objects or procedures
3-Participate actively in their own learning
Teaching strategies that are widely used for staff development program are:
1- Lectures
2- Demonstrations
3- Conferences
4- Discussion
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5- Role playing
7- Program implementation: Refers to actual presentation of the content &
learning experiences that were selected and organized during the planning phase.
It requires preparing of the climate setting and time schedule.
1- Climate setting: It refers to physical environment in relation to sound, light,
temperature and arrangement of furniture. Climate setting also refers to relation
to comfortable learning atmosphere that allows participants to know each other
also free lowing communication between clinical personnel, planners and
teacher as helper or facilitator.
2- Time schedule: Time schedule for staff development program that was
previously developed in the planning phase must be handled for both learners
and instructors. It must indicate duration of program, duration of each session,
outline of content of each session, instructor responsible for content
presentation, method of teaching used, as well as methods of evaluation.
8- Program evaluation: Evaluation is an integral part of the program. It is a
continuous and ongoing process for:
1- Measuring the extent to which the desired objectives have been met.
2- Judging the worth of the program, quality of teaching used and instructors
Types of evaluation:
1-Formative evaluation: Provide data allowing changes in the course while it is
being taught. These data facilitate adjustment of both course content and
method of teaching to meet learner's needs. It can be conducted before or during
the program.
2-Summative evaluation: Examine the achievement of specific learning
objectives as change in knowledge, practice and attitudes through measuring
practice in the clinical area and patient outcome.

91
Responsibilities of staff development director:
1. Assessment of the educational needs.

2. Set policies and procedures for the department of staff

development.

3. Develop goal and measurable objectives for the staff

development program.

4. Ensures proper planning and implementation of department

activities.

5. Supervise and direct the instructional staff assigned to the

department.

6. Ensures the availability of educational resources, and media.

7. Evaluate the effectiveness of the staff development program as

measured against the written objectives.

8. Utilizes research findings to upgrade staff development

programs.

9. Budgetary projection for the future based.

10. Collaborate with the administrative advisory staff.

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Exercises:

1. Define the staff development.

2. State purpose of staff development.
3. Discuss steps of staff development program

92
 Empowerment
Objectives:

By the end of this lecture, the students should be able to

1. Define the term of power.
2. Define the term of empowerment.
3. Identify the benefits of empowerment.
4. Explain strategies of empowerment.
5. Identify the different types of empowerment.
6. Discuss empowerment requirements.
7. Examine dimensions of empowerment

93
Major Concepts and Definitions
Power o Is the ability to influence other people despite their
resistance Using power, one person or group can
impose its will on another person or group.

Formal Power o .Results from jobs that afford flexibility, visibility

and are relevant to key organizational process...”

Informal Power: o Evolves from an individual‘s network of alliances

with sponsors, peers and subordinates both within
and outside of the organization...
Empowerment
o Is the process of increasing the capacity of
individuals or groups to make choices and to
transform those choices into desired actions and
outcomes

94
 Empowerment
Introduction
Employee empowerment is one of the most vital necessities in ensuring
optimum performance in any organization. With the rise of economies and
establishment of numerous organizations, the level of competition has increased
and these calls for the implementation of procedures that would give an
organization a competitive edge over its competitors. Nursing as a profession is
sector that need a lot of empowerment on the employers mainly cause for the facts
that it‘s a profession which is concerned with the well being of individuals in the
society.
Power: " refers to ability, and empowerment refers to feelings. Both are of
importance to nursing leaders and managers. Feeling empowered includes the
following:
■ Self-determination: Feeling free to decide how to do your work
■ Meaning: Caring about your work, enjoying it, and taking it seriously
■ Competence: Confidence in your ability to do your work well
■ Impact: Feeling that people listen to your ideas, that you can make a difference.
The following contribute to nurse empowerment:
■ Decision-making: Control of nursing practice within an organization
■ Autonomy: Ability to act on the basis of one‘s Knowledge and pertinence.
■ Manageable workload: Reasonable work assignments
■ Reward and recognition: Appreciation received for a job well done
■ Fairness: Consistent, equitable treatment of all staff the opposite of
empowerment is disempowerment.

95
 Benefits of nurses’ empowerment:
Nurses are empowered for a variety of reasons and these include:
1. To increase productivity – empowerment is effective in enhancing the
performance of nurses within institution, powerless nurses are poor performers
and hence not effective in their day to day operations.
2. Job satisfaction- giving nurse appropriate powers to decide on various issues
within the profession makes them more comfortable with their daily tasks hence
job satisfaction. This in turn translates to improved performance and hence
enhanced levels of productivity.
3. Influence on patients and colleagues- empowerment of nurses may not only be
helpful in enhancing performance of the nurses but can also give them the power
to empower other colleagues and also influence the patients under their care.
4. Empowerment in many professions nursing included is a thing that leadership
and management had ignored in the past. This resulted in the realization of
substandard services and also the lack of improvement in the lives of employees
within the organizations.
5. The attitude toward employee empowerment has however changed in the
recent years with many organizations seeking to enhance the productivity of all
the employees.
Empowerment Strategies:
1) Avoid competition for power, status, recognition
2) Delegate
3) Create and communicate a vision
4) Insist that others diligently work to achieve meaningful goals
5) Help others believe in their own worth and potential
6) Create a culture in which fear and intimidation are replaced by trust.
7) Demonstrate a willingness to be supportive of others.
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 Types of Empowerment:
 Economic- comes from having enough wealth (money) to take care of your
needs.
 Political- comes from having a say in how things are organized and how
decisions are made.
 Cultural- comes from being free to practice your culture.
 Societal- comes from all members of society being treated fairly and
equally.
 National- comes from a nation having the power to make decisions for it.

Classification of empowerment:
1. Structural Empowerment: "access to organizational structures that enable
employees to accomplish their work in meaningful ways…‖.Reflected by high
access to social structures in the organization:
 Opportunity
 Information
 Support
 Resources
 Formal power
 Informal power
Structural factors within the work environment, as opposed to inherent personality
traits or socialization experiences, influence an employee‘s perceptions of
empowerment
2. Psychological Empowerment:―…psychological state that employees must
experience for empowerment interventions to be successful…‖.
3. Empowerment—A psychological perspective
 ―Get work done through other people‖
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  Broad participation and accountability
 Involvement in decision making
 Flexible response
Dimensions of Empowerment:
 Self-efficacy : A sense of personal competence
o Belief that they have the ability to perform the task
o Belief that they are capable of putting forth the effort
o Belief that no outside obstacles will prevent them from accomplishing the task
 Self-determination : A sense of personal choice
 Choices about the methods used to accomplish a task
 Choices about the effort to be expended
 Choices about the pace of the work
 Choices about the time frame
 Personal consequences (Impact): Sense of having impact
 Feeling of active control – brings the environment into alignment with wishes
 Feeling of passive control – whishes are brought into alignment with the
environment
 Meaningfulness : Sense of value in the activity
 Value the purpose or goals of the activity
 It ‗counts‘ in the individual‘s value system
 Creates a sense of purpose, passion, or mission
 This is not the same as personal benefit
 Trust : Sense of security
* Feeling that they will be treated fairly and equitably
* Encourages the development of relationships
* Allows people to act in a confident and
* Straight forward manner
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Empowerment requirement:
☼ Shared values
☼ Shared power
☼ Defined boundaries
☼ Communication
☼ Feedback
☼ Recognition
☼ Trust

Exercise:
1. Explain strategies of empowerment.

2. Identify the different types of empowerment.

3. Discuss empowerment requirements.

4. Examine dimensions of empowerment

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 Supervision

Objectives:
By the end of the lecture, the student will be able to:

1. Define supervisor and supervision.

2. Explain purpose and function of supervision
3. Explain benefits of good supervision.
4. Apply principles of supervision.
5. Explain the supervision process.
6. Apply supervision skills
7. Differentiate between direct and indirect supervision.
8. Explain responsibilities of supervisors.
9. Analysis various methods of supervision

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111
 Supervision

Introduction:
In medical practices, the ward supervision means continuous process of
monitoring and weighing the quality of clinical care as well as environmental
issues those are prescribed and given to ensure of expected outcome of services.
Supervision is an important component of nurses' professional development and
supports nurses to ensure quality patient care.

Major concepts:
 Supervisor: Is a suitably qualified and experienced registered nurse who
supervises an individual undertaking an approved period of supervised
practice.
 Supervision: Guidance and monitoring of activities of health personnel to
ensure an acceptable level of performance.
 Professional supervision: A formal process that provides professional
support to enable practitioners to develop their knowledge and competence,
be responsible for their own practice, and promote service users‘ health,
outcomes and safety.
 Clinical supervision is a term used to describe supervision focused on
clinical practices.

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Purpose and functions of supervision:
The primary purpose of supervision is to help staff reflect on their work in
order to ensure the needs of service users and the service are addressed; and, that
the duties and responsibilities are being fulfilled in line with the policies and
procedures of the Trust.
Supervision is generally agreed to have three functions:
1. Monitoring (Normative):
Most supervisors have a responsibility to ensure that the supervisee‘s work
is appropriate, ethical and professional in the context of their work setting and the
organization in which they (usually) both work.
2. Development (Formative):
Concerned with developing the skills and ability of the supervisee to
understand work issues.
3. Support (Restorative)
Concerned with emotional reactions e.g. anxiety and distress, and other
feelings that may be evoked by the work situation
Benefits of supervision
 Improved worker retention
 Improved motivation and commitment to the organization
 Maintenance of clinical skills and quality practice
 Improved communication among workers
 Increased job satisfaction
 Self-critique of clinical and cultural practice in a safe environment
 Identification of strengths in nursing practice
 Identification of learning opportunities to enhance further development of
nursing practice

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  Prevention of burnout
 Nursing leadership development.

Principles of supervision:
1- It focuses on improvement of the work rather than punishment of staff
members.
2- It should consider the experience, ability and intelligence of the staff member
and the existing situation.
3- It should stimulate the staff to continuous self-improvement.
4- It should respect the individuality of the staff member.
 Supervision should cover the following four principal areas in the
hospital:
1. Clinical work;
2. Professional standards;
3. Personal growth and development; and
4. Evaluation of work performance.

General supervision skills

 A focus on strengths.
 Active listening skills – paying attention, verbally and non-verbally,
understanding the supervisee‘s
 Perspective and using silence to allow for self-reflection and insight.
 Explicit genuine positive regard and support.
 Use open-ended questions to encourage self-reflection.
 Awareness of power imbalance with identified ways to address these.
 Practicing (model and role play) aspects of work with a service user.
 Positive feedback.

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 Problem-solving.
Supervision process:
1- Assessment of needs of individual staff members in the light of objectives for
patients care.
2- Planning method: for meeting the objectives and for achieving personnel
improvement.
3- Carrying out the plan through direction, guidance, teaching and correction.
4- Evaluation of results and making new plans.
5- Continuous evaluation of the effects of individual effort on the quality of care
given.
Types of supervision:

Supervision may be direct or indirect.

 Direct Supervision:
The supervisor takes direct and principal responsibility for the nursing care
provided. The supervisor must be physically present at the workplace, observing at
all, times when the supervisee is providing clinical care, according to the
supervised practice plan.

The supervisee must consult with the supervisor about the nursing care before
delivering the care.

 Indirect supervision

The supervisor and supervisee share the responsibility for individual

patients. The supervisor is easily contactable and is available to observe and
discuss the nursing care the supervisee is delivering. The supervisee must inform
the supervisor at agreed intervals about the management of each patient; this may
be after delivering care.

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Responsibilities of supervisors:
 Take reasonable steps, as required by the level of supervision, to ensure that the
supervisee is practising safely. Include measures of direct observation.

 Give clear direction and constructive feedback.

 Ensure that the nurse can make contact with you when they are practising.
 Ensure that the supervisee is practising in accordance with the supervised
practice plan and work arrangements approved by the relevant state.
 Ensure that the supervisee:
 understands their legal responsibilities and the constraints within which they
must operate,
 follows the ethical principles that apply to the profession, and
 Acts in accordance with your directions as supervisor.
 Understand the significance of supervision as a professional undertaking. Your
commitment to this role includes regular, protected, and scheduled time with
the supervised nurse.
 Provide honest, accurate, and responsible reports in the approved format at
intervals determined by the supervised practice plan and levels of supervision
within these guidelines.
 Understand that your assessment of the nurse under supervision will inform the
type and amount of supervision required according to the supervised practice
plan.
 Delegate only those tasks that are:
 suitable to the role of the person being supervised, and
 Within the scope of training, competence, and capability of the supervisee.

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Responsibilities of supervisees
 Work with the supervisor to develop a supervised practice plan. The Supervised
practice plan must be submitted at the time of application or within two weeks
of commencing practice.
 Be sufficiently prepared for meetings with your supervisor.
 Participate in assessments conducted by your supervisor to help determine your
progress and future supervision needs.
 Recognise the limits of your professional competence and seek your
supervisor‘s guidance and assistance as required.
 Familiarise yourself and comply with regulatory and professional
responsibilities applicable to your practice.
 Advice your supervisor immediately of any issues or clinical incidents during
the period of supervision which could impact adversely on patient care.
 Reflect on and respond to feedback.
 Inform your supervisor of any leave or breaks in practice that may affect your
period of supervised practice.

Methods of supervision:
1- Observation.
2- Conference.

A) Observation:
Areas should be observed
- Safety measures for those who are critically ill patients.
Physical condition of patients and their progress:
 Carrying out of doctor order.

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  Result of treatment.
 Mental, comatose patients, their consciousness state from day to day.
 Patient satisfaction regarding care received.
 Dietary services.
 Preparation of O. R. visiting, diagnostic and treatment procedures.
 Availability of emergency equipment.
 Presents of hazards.
 General organization of the work.
 Method of providing care.

Techniques of observation:
1. Learn to see what to look at:
 Have some ideas about what to look for before beginning her observation.
 Consider each person as an individual.
 Try to be objective about what you see.
 Look for relationships between what you see and what the over all
situation.
 Be objective and interested.
2- Learn to listen:
Learn to listen what others are saying this includes listening for what is not
said. Workers tend to omit those ideas which make them uncomfortable or about
which they think will be criticized. Group feeling is stimulated when each
member feels to offer suggestions, knowing that she will give them thoughtful
consideration.

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3- When you observe:
Observe continuously:
 As you care for patients.
 As you work with staff.
 During your round to visit patients.
 As you do won work.
 During the reports.
 After all care has been given
B) Conference:
1) Informal conference:
There is no specific or regular time for handling these conferences, head nurse goes
around the word. Whole nurses are in action, she can raise questions about patient
condition and work.
2) Formal conference: it includes:
- Assignment conference.
- Patient centered conference.
- Nursing care plan conference
How to keep organized during conference
 Work plan must present with supervisor and not depends on
her memory.
 Give complete patient report to every person of the nursing
staff.
 Provide suggestion to in-experienced workers. -
 Provide all necessary supplies and equipment to avoid time
consuming.

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  Help each person to develop her ability to plan her own work
and use her time and organize her duties.
 Make notes included in formations that need to be recorded on
the patient chart or reengagement of duties.

Exercise:
1- Identify purposes of good supervision?
2- Discuss the principles of supervision?
3- Explain the types of supervision and supervisor

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 Directing
Objectives:

By the end of the lecture, the student will be able to:

1. Define the term directing

2. State aims of directing
3. Explain the functions of directing
4. List principles of directing
5. List characteristics of good directing
6. Explain the elements of directing.
7. Recognize application of directing by nursing personnel in clinical areas

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 Directing
Introduction:
Directing is a function of management performed by top level management
in order to achieve organizational goals. It is very important and necessary function
of management.
Management has to undertake various activities like, guide people, inspire
and lead them as well as supervision of their activity is required in order to achieve
desired results.
Definition of directing:
1. Act of issuing of orders, assignments, instructions, to accomplish
organizational goals and objectives.
2. Directing involves issuing assignments and instructions that allow workers to
clearly understand what is expected.
Aims of directing:
1. To recognize both authority of the position and authority of the immediate
situation for nurses that they work in the hospital
2. To discipline staff working together toward the attainment of the shared goals.
3. To find a good guidelines for all regular and part time workers to help in
protection of patients and employees from occupational hazards , accidental
injuries and infections.
4. To increase the productive work by using motivation to the subordinates
through increasing self-esteem and good emotional state.
5. To ensure that the principles are applied.
6. To correct mistakes.
7. To delegate responsibilities for carrying out the plan.
8. To reinforce good performance and motivate subordinates

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 9. To ensure that personnel interests do not interfere with the achievement of the
objectives.
Functions of Directing
 It guides and helps the subordinates to complete the given task properly.
 It provides the necessary motivation to subordinates to complete the work
satisfactorily and strive to do those best.
 It helps in maintaining discipline and rewarding those who do well.
 Directing involves supervision, which is essential to make sure that the work is
performed according to the orders and instructions.
Principles of directing:
1- Harmony of objectives
Directing must develop a sense of belonging in the employees so that they
can identify themselves with the organization and seek the fulfillment of their
individual objectives in the fulfillment of organizational objectives.
2-Directing of objectives:
The directing process must facilitate for employees clear understanding of
the overall objectives of the organization, their individual roles and goals and how
best to accomplish them in a productive manner.
3-Direct supervision:
Direct contact with subordinates must be maintained by each superior.
Personal touch, face to face communication and informal relationship ensure
successful directing and each subordinate feels a sense of participation when he
has a direct access to his superior, it raises employees' moral and helps in getting
a useful feedback.
4-Democratic managerial style:

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 Modern directing must adapt democratic participative managerial style
particularly when workers and subordinates are competent and desire active
participation in management of enterprise.
5-Follow through:
Successful directing depends on continuous and never ending guidance,
supervision, advice, coaching, counseling and helping subordinates in their
activities. Directing is not only telling people what to do, how to do their work but
also seeing by what way they do it.
6-Unity of commands:
The completely an employee has a reporting relationship to a single superior
the less the problem of conflict in instructions and greater the feeling of personnel
responsibility for results.

Directing involves
 Telling people what is to be done and explaining how to do it.
 Issuing instructions and orders to subordinates.
 Inspiring them to contribute towards the achievement of objectives.
 Supervising their activities; and
 Providing leadership and motivation.

Characteristics of good directing:

1. Should be reasonable:
Directing should be within the employees experience and ability as well as
the available materials, equipment, external conditions and rules.
2. Should be complete:
Instructions must be complete so as not to leave any question in the mind of
the person receiving them, any questions related to factors such as quality,
quantity, and time of performance.

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3. Should be clear:
Directions should be to the person receiving instructions
4. Should be better in written:
When subordinates have their instructions in written they can take their
time to study them especially when several individuals are directed, instructions
extended over a long period, are complex, detailed and related to important matter.
5. Should explain why:
Instructions should include why orders are given as subordinates will be in
a better position to adapt their actions and interpretations to the overall situation
and its purposes.

Elements of directing:
Directing requires the nurse manager to do the following:
 Clearly communicate performance expectations.
It is the manager's responsibility to monitor how well staff is performing
their jobs. Communicating performance expectations is an ongoing process
1. Directly observe employee performing their jobs through direct observation.
2. Communicate expectations in a respectfully two way process in which the
manager seeks first to understand staff member's perspective, feeling, and
knowledge about the issue and then to clarify the expectations in a
nonjudgmental, nonthreatening way.
3. Determine issues that may be preventing the employee from meeting
performance expectations.
 Create a motivating climate and team spirit.
Motivation is the inner drive that compels a person to act in a certain way.
Positive encouragement and support from the nurse manager are essential to create
a motivating work climate.

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 Model expected behavior.
The nurse performs the job in such a way that he or she demonstrates ideal
performance as a professional nurse; others hopefully will follow the example.
 Facilitate feedback.
Ask for feedback from your subordinates and peers about your own
performance and listen when it is offered.
Application of directing by the staff nurse:
1. Teaching for the auxiliary workers.
2. Health teaching to the patient and his family.
Application of directing by the head nurse:
The head nurse observes guide and teaches ward personnel in relation to the
following:
 Time schedule.
 The assignment of routine nursing care.
 The assignment of specific nursing care procedures.
 Nursing conference.
 Allocation of equipment and supplies.
 Orientation and in-service training.
 Housekeeping activities.
Application of direction by the matron:
The matron use direction in the following:
1-Development of policies and procedures in relation to:
 The execution of diagnostic and therapeutic orders.
 Patient care assignment administration of medication
 Charting by nursing personnel.
 The daily, monthly and annual reports.

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  Infection control
 Safety measures.
2-Delegating responsibility and authority down the line of nursing hierarchy.
3- Interdepartmental communication.
4- Intradepartmental communication.

Exercise:
1- Explain the importance of directing?
2- List principles of directing?
3- Explain the Elements of directing?
4- Discuss Consultative directing?

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 Motivation
Objectives:

By the end of the lecture, the student will be able to:

1. Define motivation.
2. List the importance of motivation.
3. Explain the motivation process.
4. Differentiate between intrinsic and extrinsic motivation.
5. Explain Leadership roles and management functions associated with
creating a motivating work climate.
6. State the qualities of a motivational leader.
7. Differentiate between Maslow, Skinner motivation and Motivational
Theories (X & Y).

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 Motivation
Introduction
The ability to lead depends on understanding what will move people to
perform. A true leader is someone who is self-motivated to achieve and able to
energize other. Motivation is the word derived from the word ‘motive‘ which
means needs, desires, wants or drives within the individuals. It is the process of
stimulating people to actions to accomplish the goals.

Major Concepts and Definitions

Is an internal feeling that can be understood only by manager
since he is in close contact with the employees? Needs, wants and desires are inter-
related and they are the driving force to act.
-It is the force within the individual that influences or directs behavior.
Importance of Motivation
1. It enhances the productivity of the company.
2. It improves quality.
3. Reducing cost of operations.
4. It enhances both human and organizational growth.
5. It enhances unity amongst the company's employees.
6. Puts human resources into action.
7. It is through motivation that the human resources can be utilized by making
full use of it.
8. Achievement of organizational goals.
9. Increase employee's satisfaction.
10.Stability of work force.

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The process of motivation consists of three stages
1) -A felt need or drive
2) -A stimulus in which needs have to be aroused
3) Engage in some kind of behavior to satisfy the need and thereby reduce the
tension. These activities directed toward achieving the goal, satisfies the
need and the process of motivation is complete.

Intrinsic versus extrinsic motivation:

Motivation involves the action people take to satisfy unmet needs .it is the
willingness to put effort into achieving a goal or reward to decrease the tension
caused by the need.
Intrinsic motivation: comes from within the person, driving him or her to be
productive, to be intrinsically motivated at work, the worker must value job
performance and productivity
Factors impact on intrinsic motivation:
1 -Parents and peers: play major roles in shaping a person's values about what he
or she wants to do and be
2-Culture background also has an impact on intrinsic motivation; some cultures
value career mobility, job success, and recognition more than others.
Extrinsic motivation is motivation enhanced by the job environment or
external rewards occur after the work has been completed.

Leadership roles and management functions associated with

creating a motivating work climate
Leadership roles:

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1. Recognizes each worker as a unique individual who is motivated by
different things
2. Identifies the individual and collective value system of the unit and
implements a reward system that is consistent with those value
3. Listens attentively to individual and collective work values and attitudes to
identify unmet needs that can cause dissatisfaction
4. Encourages workers to stretch themselves in an effort to promote self-
growth and self-actualization
5. Maintains a positive and enthusiastic image as role model to subordinates in
the clinical setting
6. Devotes time and energy to create an environment that is supportive and
encouraging to the discouraged individual
7. Demonstrates through actions and words a belief in subordinates that they
desire to meet organizational goals
8-Be fair and consistent when dealing with all employees
Management functions:
1. Uses legitimate authority to provide formal reward systems
2. Uses positive feedback to reward the individual employee
3. Develops unit goals that integrate organizational and subordinate need
4. Maintains a unit environment that eliminates or reduces job dissatisfies
4. Promotes a unit environment that focuses on employee motivators
5. Creates the tension necessary to maintain productivity while encouraging
subordinate job satisfaction
6. Cleary communicates expectations to subordinates
7. Assigns work duties commensurate with employee abilities and past
performance to foster a sense of accomplishment

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 8. Identifies achievement, affiliation, or power needs of subordinates and
develops appropriate motivational strategies to meet those needs
9. Develop the concept of team work
10. Appraise the employee performance this help the manager to provide
recognition for nurses work well done
11. Enlarging jobs or rotating duties provide employees with the
opportunities to gain new knowledge & can serve to inject increased interest
and challenge into the work.
13. Enriching job through giving nurses more responsibility to make decision
and more recognition for good performance, thus enriched jobs are more
challenging and more rewarding.
14. Provide employees with added interest and challenge, the chance to acquire
new knowledge & the opportunity to take on increase responsibility
(delegation).

Qualities of a motivational leader:

1) Have knowledge, skill& effective communication of ideas.
2) Self-confidence, commitment and energy.
3) Ability to take the action necessary to achieve goals important to others.
4) Abilities to listen, reserve judgment, give direct & positive feedback.
5) Recognize individual value through respect for others.
6) Professional practice & shared governance to produce an environment that
fosters autonomy in decision-making & provides the skills, resources &
information needed for others to make this transition.
Theories of Motivation

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Motivation theories are useful because they help to explain why people act the way
they do and how a manager can relate to individuals and workers as human beings.
Several theories of motivation are particularly relevant for work settings. Each of
these theories provides managers with useful perspective for understanding
motivational challenges and problems and ways to deal with them.

(1) Maslow (Maslow's hierarchy of needs):

Maslow (1970) believed that people are motivated to satisfy certain needs,
ranging from basic survival to complex psychological needs, and that people seek a
higher need only when the lower needs have been predominantly met.

According to Maslow theory, the needs that motivate nurses fall into five basic
categories:
1-Physiological needs: are needs required for survival: food, oxygen,
elimination, rest, exercise, sex, water and shelter.
2-Safety needs: people need physical, emotional, and financial safety, they
need a stable environment in which they are protected against the threats of
danger and deprivation.
3-Social needs: include the feeling of belonging, acceptance by one peers,
recognition as an accepted member of a group, being an integral part of the

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operation, giving and receiving friendship, nurse seek to satisfy these needs
through the time by spend with family, friends and co- workers.
4-Esteem needs: are the needs for achievement, competence, knowledge,
independence, status, recognition, prestige, respect contribute to one self-
confidence and self-esteem. Management can help meet these needs by giving
praise when it is deserved and through the use of constructive evaluation.
5-Self-actualization needs: include a feeling of accomplishment,
responsibility, importance, challenge, advancement, and new experiences and
opportunities for growth contribute to self-fulfillment.

(2) Skinner Positive Reinforcement Theory:

B.F Skinner was another theorist in this era who contributed to the
understanding of motivation, dissatisfaction, and productivity. skinner‘s (1953)
research on operant conditioning and behavior modification, demonstrated that
people could be conditioned to behave in a certain way based on a consistent
reward or punishment system. Behavior that is rewarded will be repeated, and
behavior that is punished or goes unrewarded is extinguished.

(3) Motivational Theories (X & Y)

Theory Y - a set of assumptions of how to manage individuals motivated by
higher order needs
Theory X - a set of assumptions of how to manage individuals motivated by lower
order needs
McGregor’s Assumptions about People Based on Theory X
 Naturally indolent
 Lack ambition, dislike responsibility, and prefer to be led
 Inherently self-centered and indifferent to organizational needs

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  Naturally resistant to change
 Gullible, not bright, ready dupes
McGregor’s Assumptions about People Based on Theory Y
 Experiences in organizations result in passive and resistant behaviors; they
are not inherent
 Motivation, development potential, capacity for assuming responsibility,
readiness to direct behavior toward organizational goals are present in
people
 Management‘s task—arrange conditions and operational methods so people
can achieve their own goals by directing efforts to organizational goals.

Exercise:
1- Discuss the leadership roles and management functions associated with creating
a motivating work climate.
2- List the importance of motivation.
3- Differentiate between Maslow and Skinner motivation theory.

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 Records and Reports
Objectives:
By the end of this lecture, the students should be able to:
1. Define reporting and recording.
2. Explain the importance of nursing records and reports
3. Apply principles of documentation in reporting and recording
4. Differentiate between oral and written reports
5. List Characteristics of oral and written report
6. List types of records included in nursing office
7. Explain the records used in nursing unit

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 Records and Reports
Introduction
The record and report are necessary system in every health care
organization. It must be organized to render service to the patients, health care
providers, hospital administration and society.
Major concepts:
 Reporting: Is a document form which includes both the oral and written types
of communications is used in nursing. Is a way of communicating information
meanings and ideas to others.
 Recording: Are administration tools used to clarify and prevent duplication of
the information. There are two types of records used either in nursing units or
nursing office
Importance of records and reports :
1) Provide a mean of communication among the health care providers who
contribute to patient care.
2) Used as documentary evidence of the course of the patient's illness and
treatment during hospitalization.
3) Serve as a basis for analysis, study and evaluation of the quality of care
rendered to the patient.
4) Provide clinical data for research and education.
5) Serve as a basis for planning individual patient care.
6) Provide continuity of patient care on subsequent admission of the patient.
7) Assist in protecting the legal interests of client, health organization, and health
care providers.

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Principles of documentation in reporting and recording
1) Write in ink.
2) Use the correct spelling and grammar.
3) Use standard abbreviations.
4) Write clear concise sentences
5) Say what you mean.
6) Chart promptly.
7) Note the time.
8) Chart on chorological order.
9) Document accurately, completely and objectively.
10) Sign each sentry.

Types of reports:
There are two types of report:-
1- Oral reports.
2- Written reports.
I- Oral reports:-
Are given when information is needed to be reports immediately not for
permanency. They may be based on material included in written reports.
Characteristics of oral reports:-
 Clear, concise and accurate.
 Report is essential information as quickly as possible.
 Describe objective facts, measurements and observation.
 Highlight recent or significant changes in the client condition.
 Avoid value judgments, such as good or poor by giving specific examples.
 Discuss the client and family in a professional manner.
 Give client name, room number, bed designation.

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 Give diagnosis or reason for admission.
 Give tests, therapies and results for last 24 hours.

I- Written reports:-
It includes:
1) Day, evening and night report.
2) Incident report.
3) Report of complaint.
4) Report including negligence.
5) Reports for requisition (request).
I- Day, evening and night report:-
Are written summaries of pertinent information about patient's conditions
and activities related to their care, this information includes:-
 Patient census.
 All acutely ill and post-operative patients.
 Patients with any change in general conditions as vital signs.
 Admissions, discharges, transfers and deaths during the shift.
 Patients scheduled for operations or special investigations. Two copies are
mad one remains in the unit and the other is send to the nursing services
office to provide them with information about the patient conditions and
related activities for their care.

2- Incident report:
Any happening that is not consistent with routine of hospital operation or
patient care. It may be an incident or a situation which might result in an accident,
e.g., error in medication and omission of the treatment. The forms should include:-
1) Patient name and diagnosis.
2) Admission date.

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 3) Time of incident or accident noted or reported.
4) What was done?
5) Date and signature of all individuals involved in the incident and their
professional status.

3- Report of complaint:
Serious complaints, which cannot be handled by the personal. The form
should include the following:-
1) Statement of complaint.
2) Justification as seen by the nurse.
3) Measures taken to overcome the dissatisfaction.
4) The result of action taken.
5) Date and signature.

4- Reports including negligence:-

Is a report including carelessness of regulation on the part of the nursing
personnel to the nursing office?
5- Report for requisitions:-
Written requests for supplies equipment or service to be sent from the unit to
the concerned department.
Characteristics for written reports:-
1. Have the patient name and room number on every sheet.
2. Initiate each entry with the data and time.
3. Chart after providing care, not before.
4. Chart as soon and as often as possible.
5. Chart only your own observation, care and teaching.
6. Be objective in charting.
7. Use only hard –pointed permanent black ink pens.

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8. Be timely, specific, accurate, and complete.
9. Use concise phrases; begin each phrase with a capital latter and each new topic
on a separate line.
10.Use only approved abbreviations and medical terms.
11.Use medical terminology only if you are sure of its meaning Follow rules of
grammar and punctuation.
12.Follow rules of grammar and punctuation.
13.Fill all spaces. Draw a horizontal –line in unused space.
14.Correct errors in documentation as soon as possible.
15.Do not erase the error or use correction fluid.
16.Draw a single line through any erroneous information; write the wards incorrect
entry, error, or error in charting above it along with your name and writ the
entry correctly.
A-Records used in nursing unit:-
 Patient record.
 Assignment record.
 Time schedule record.
 Patients' census record.
 Inventories record.
 Narcotics and medication records.
B-Records used in nursing office:-
 Master record of nursing hours.
 Attendance record
 Personnel record.
 Employment record.
 Evaluation record.

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A- Records used in nursing unit:-
1-Patient records:
It is an orderly written record from of patient conditions, which include
diagnostic findings, treatment and patient's progress that provide sufficient
information about the period of hospitalization and the care given. This record
should be arranged in chronological order from the current data back to the data of
admission. It includes:
a- Admission and discharge records.
Is usually the first form of medical record .The upper portion contains
information of an identifying nature, while the lower section contains a summary
of the necessary discharge data.
b- Medical and physical examination record:
The primary purpose of the medical history and physical examination is to
assist the physician in establishing a diagnosis on which to base the care and
treatment of the patient.
c- Medical progress notes:
It is a specific statements relating to the course of the disease, written and
signed by the physician. They should be written every day or even every few hours
during the acute phase of illness. All procedures performed should be recorded,
date and signed in these notes.
d- Physicians orders:
The written medical records constitute the physicians directions to the
nursing and staff covering all medications and treatments given to the patient
e- Graphic record:
Which serve to give a graphic picture of the temperature, pulse, respiration,
blood pressure, intake and output fluids, and blood glucose level.
f- Vital signs record:
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 It used to record frequent observations such as temperature, and state of
consciousness. This a special form used by nurses in case of shock, hemorrhage,
hyper or hypotension, head injury, etc.
g- Medication administration record:
Which contains a record of each medication, the patient received, including;
the dosage and administration, route, site date, and time.
h- Nurses notes:
Used by nursing personnel to record the care provided and patient responses.
They include significant and pertinent data on medication, treatment, died,
teaching, recording of observations of physical and mental condition of the patient,
abnormal condition of skin, hair, etc.
Nurse's notes begin with the admission of the patient to the unit and
should include:
 Date, time and manner of admission (wheel chair, crutches).
 Statement of apparent condition of the patient.
 Record of symptoms noted.
 Treatment instituted.
 Time and type of specimen, signed by the nurse who rendered the service.
Signature should include full name and professional status.
 Record of symptoms noted
e- Discharge plan:
Which present the plan for care after discharge data may include; dietary,
medical instruction and follow up of medical appointment or referrals.
j- Other record:
 Consultation.

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 Diagnostic finding forms: these forms contain diagnostic and laboratory data,
e.g., hematology, pathology, radiology, and x- ray test result.
 Anesthesia records.
2- Assignment records:
- This record is used for delegation of responsibility to the health personnel in
the unit. The record includes the following:
- Name of the head nurse, charge nurse or team leader.
- Name of nursing personnel assigned duties during the shift.
- Name of the patient, diagnosis and nursing care needed or special treatment,
investigation to be done.
- List of special assignments.
- Time and place of conference or meetings.
Importance of this record:
 To inform the nursing staff in writing about the patient for whose nursing care
they are responsible and for any special assignment.
 To maintain for fixing responsibilities for nursing care.
 To evaluate the nursing care given and for discussing and conducting
conference on duty conference
3- Time schedule record:
 It is a weekly or monthly record, which indicates the planned
coverage of the nursing personnel for each nursing unit. It
should be made in duplicate, one copy is retained in the unit
and the other is sent to the nursing office.
 The form should include.

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  Name of all categories of nursing personnel on the unit
including days off and vacations and the various categories of
personnel being groups for a week or for 24 hours.
4-Patient census record:
It is a daily record for each unit from which the official patient census of the
hospital is derived. It could be filled by the unit clerk under the supervision of the
head nurse. The form includes:
 Number of beds in the unit
 The census of the patients.
 This form has to be revised and sent to the proper
administrative offices. The official patient census should be
taken at fixed time of the day or night as hospital policy
indicates (12 noon).
5- Inventories record:
It is a form used for recording all articles of furniture, equipment and
instruments with the received date and quantity of each element of the articles. It
should be made periodically as hospital policy indicates. There are certain items
that need to be counted frequently, such as instruments and syringes. Furniture and
linen count is made throughout the hospital at least once a year.
B-Records used in nursing office:-
1. Master record of nursing hours: This record is derived from the time
schedule records of the nursing units and should show the distribution of
the hours for each category of nursing personnel in the hospital.
2. Attendance record
3. Personal record:
It is concerned with information about each individual nurse, assembled in a
file, which includes:
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  Copied application
 Photograph
 Basic nursing education and professional preparation
These records should be the responsibility of the assistant director, or
personnel in the nursing office and this record consists of:
a-Employment record
Includes:
 Position on employment
 Professional preparation
 Registration number
 Date of employment
 Date of promotion.
 Insurance.
 Date & reasons for termination of employment.
 Summary of nurse's achievements, weaknesses and recommendations.
 The record should be revised periodically either annually or semi-
annually for additional professional preparations
B-Evaluation record:
Is filled periodically for all nursing personnel & indicates professional
progress of the nurse.

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Exercise:
1- Define records and reports?
2- Discuss the Characteristics /guides of reports?
3- Explain the Benefits of medical records?

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 Conflict
Objectives:
By the end of this lecture, the student should be able to:
1. Define conflict.
2. List sources of organizational conflict.
3. Identify goal of conflict management.
4. Differentiate between different levels of conflict.
5. Compare between the two types of conflict
6. Explain stages of conflict
7. Identify the functional and dysfunctional results of various methods of
conflict resolution
8. Apply conflict resolution strategies.
9. Apply role of nurse leader in conflict management.

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 Conflict
Introduction

The pressures and demands of the workplace often generate conflicts among
people that can seriously interfere with their ability to work together. The health-
care system is complex and constantly changing, and various demands in the
workplace can generate conflict among staff members and others.

Definition of conflict
 Conflict is generally defined as the internal or external discord that results
from differences in ideas, values, or feelings between two or more people.
 Conflict is a state of disharmony among people and occurs when people
have differing views.
Sources of organizational conflict
 Poor communication.
 Inadequately defined organizational structure.
 Individual behavior (incompatibilities or disagreements based on differences
of temperament or attitudes).
 Unclear expectation.
 Individual or group conflicts of interest.
 Operational or staffing changes.
 Diversity in gender, culture, or age
Goal of conflict management

The goal in dealing with conflict is to create an environment in which

conflicts are dealt with in as cooperative and constructive a manner as possible,
rather than in a competitive and destructive manner.

Consequences of unmanaged and poorly managed conflict:

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Conflict, if not managed, can result in:
 Stress for all involved.
 Interfere with the ability to work together, and
 Negatively impact patient care.
 Unmanaged conflict can result in decreased staff morale.
 Increased turnover.
 Poor-quality patient care.
 Increased health-care costs, and patient dissatisfaction.
Poorly managed conflict can pose additional problems in the workplace such as job
dissatisfaction, depression, increased turnover, compromised patient safety, and
aggression.
Levels of conflict
I. Intrapersonal Conflict
Intrapersonal conflict is an internal conflict, or a conflict coming from within a
person. An individual may be confronted with an issue or situation that creates a
sense of discomfort within.

An example of intrapersonal conflict is a nurse tryingto make a decision to go

back to school for an advanced degree who may experience conflict between
personal and professional goals (e.g., balancing family life and pursuing
professional advancement). An individual nurse‘s intrapersonal conflict can affect
others on the unit, thus resulting in interpersonal conflict.

For managers, intrapersonal conflict may result from the multiple areas of
responsibility associated with the management role. Managers‘ responsibilities to
the organization, subordinates, consumers, the profession, and themselves. Being
self-aware and conscientiously working to resolve intrapersonal conflict as soon as
it is first felt is essential to the leader‘s physical and mental health.

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 II. Interpersonal Conflict
Interpersonal conflict occurs when there is a disagreement between or
among two or more people. The disagreement can be related to differing values,
ethics, goals, beliefs, or priorities. Interpersonal conflict is very common in the
workplace. An example of interpersonal conflict is a difference of opinion between
a nurse and a family member regarding a patient‘s living will.

III. Intragroup conflict

Intragroup conflict affects the entire team or teams, and as a result, all team
members suffer. Therefore, it is important that there is no intragroup conflict.
Intragroup conflicts can be classified by nature into conflicts associated with a
misunderstanding of each other's ideas and opinions; interpersonal incompatibility
as discord; conflicts in solving problems, for example, how a procedure is
performed, disagreement with the care plan. Managing such conflicts is a difficult
task and requires experience from the manager and knowledge of the team
members.

IV. Intergroup Conflict

Conflict that occurs between groups of people is called intergroup conflict.
For example, the emergency department staff may complain that patients are not
moved to the intensive care unit in a timely manner, and in turn, staff members in
the intensive care unit complain that the emergency department staff is always
demanding to transport patients before patients are discharged, thereby making
beds available.

V. Organizational Conflict
Organizational conflict can result when there is disagreement between staff
and organizational policies and procedures, standards, or changes being made. For
example, administration implements a new procedure for nurses to use when

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documenting nursing care without input from the nurses. This can cause
organizational conflict because administration implements a change without
consulting those it impacts most, nurses at the bedside.

Types of Conflict
Whether a conflict is good or bad depends on the type of conflict.
Specifically, it is necessary to differentiate between functional and dysfunctional
conflicts.
A. Functional or Constructive Conflict:
Some conflicts support the goals of the group and improve its performance;
these are functional, constructive forms of conflict. Functional conflict is defined
as the conflict that supports the goals of the group and improves its (group‘s)
performance. It is viewed as a confrontation between two ideas, goals and parties
that improves employees and organizational performance.

One of the main benefits of constructive conflict is that it gives its members
a chance to identify the problems and see the opportunities. Also, it can inspire to
new ideas, learning, and growth among individuals.

B. Dysfunctional/Destructive Conflict:
There are conflicts that hinder group performance; these are dysfunctional or
destructive forms of conflict. Conflict is inevitable and desirable in organizations,
but when not effectively handled, conflict can tear relationships apart and, thus,
interfere with the exchange of ideas, information and resources in groups and
between departments. Dysfunctional conflict hinders and prevents organizational
goals from being achieved. This conflict orientation is characterized by competing
individual interests overriding the overall interest of the business

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Stages of conflict
Before managers can or should attempt to intervene in conflict, they must be
able to assess its five stages accurately.

1. The first stage, latent conflict, implies the existence of antecedent conditions
such as short staffing and rapid change. In this stage, conditions are ripe for
conflict, although no conflict has actually occurred and none may ever occur.
Much unnecessary conflict could be prevented or reduced if managers
examined the organization more closely for antecedent conditions.
2. If the conflict progresses, it may develop into the second stage: perceived
conflict. Perceived or substantive conflict is intellectualized and often involves
issues and roles. The person recognizes it logically and impersonally as
occurring. Sometimes, conflict can be resolved at this stage before it is
internalized or felt.
3. The third stage, felt conflict, occurs when the conflict is emotionalized. Felt
emotions include hostility, fear, mistrust, and anger. It is also referred to as
affective conflict. It is address strong negative emotional responses to conflict
(hot buttons) and to practice constructive strategies when engaging in conflict.
4. In the fourth stage, manifest conflict, also called overt conflict, action is
taken. The action may be to withdraw, compete, debate, or seek conflict
resolution. Individuals are uncomfortable with or reluctant to address conflict
for many reasons. 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 past
negative experiences with conflict situations.
5. The final stage in the conflict process is conflict aftermath. There is always
conflict aftermath—positive or negative. If the conflict is managed well, people

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 involved in the conflict will believe that their position was given a fair hearing.
If the conflict is managed poorly, the conflict issues frequently remain and may
return later to cause more conflict.
Conflict management

The optimal goal in resolving conflict is creating a win–win solution for all
involved. This outcome is not possible in every situation, and often the manager‘s
goal is to manage the conflict in a way that lessens the perceptual differences that
exist between the involved parties. A leader recognizes which conflict management
or resolution strategy is most appropriate for each situation.

Common Conflict resolution strategies:

 Compromising

In compromising, each party gives up something it wants. Although many see

compromise as an optimum conflict resolution strategy, antagonistic cooperation
may result in a lose–lose situation because either or both parties perceive that they
have given up more than the other and may therefore feel defeated. For
compromising not to result in a lose–lose situation, both parties must be willing to
give up something of equal value.

Compromising definitely becomes a win–win when both parties perceive they

have won more than the other person has.

 Competing
The competing approach is used when one party pursues what it wants at the
expense of the others. Because only one party typically wins, the competing party
seeks to win regardless of the cost to others. In addition, it is entirely possible that
both parties may lose, particularly if the outcome adversely affects the subsequent

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working relationship. This is because win–lose conflict resolution strategies leave
the loser angry, frustrated, and wanting to get even in the future.

Managers may use competing when a quick or unpopular decision needs to

be made. It is also appropriately used when one party has more information or
knowledge about a situation than the other. Competing in the form of resistance is
also appropriate when an individual needs to resist unsafe patient care policies or
procedures, unfair treatment, abuse of power, or ethical concerns.

 Cooperating/Accommodating

Cooperating is the opposite of competing. In the cooperating approach, one

party sacrifices his or her beliefs and allows the other party to win. The actual
problem is usually not solved in this win–lose situation. Accommodating is another
term that may be used for this strategy.

The person cooperating or accommodating often expects some type of

payback or an accommodation from the winning party in the future. Cooperating
and accommodating are appropriate political strategies if the item in conflict is not
of high value to the person doing the accommodating.

 Smoothing

Smoothing is used to manage a conflict situation. Smoothing occurs when

one party in a conflict attempts to pacify the other party or to focus on agreements
rather than differences. In doing so, the emotional component of the conflict is
minimized. Managers often use smoothing to get someone to accommodate or
cooperate with another party. Although it may be appropriate for minor
disagreements, smoothing rarely results in resolution of the actual conflict.

 Avoiding

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 In the avoiding approach, the parties involved are aware of a conflict but
choose not to acknowledge it or attempt to resolve it. Avoidance may be indicated
in trivial disagreements, when the cost of dealing with the conflict exceeds the
benefits of solving it, when the problem should be solved by people other than you,
when one party is more powerful than the other, or when the problem will solve
itself.

The greatest problem in using avoidance is that the conflict remains, often
only to reemerge at a later time in an even more exaggerated fashion. Passive
approaches like avoidance, giving up, and accommodating are likely to result in
poor outcomes for one or both parties.

 Collaborating

Collaborating is an assertive and cooperative means of conflict resolution

that results in a win–win solution. In collaboration, all parties set aside their
original goals and work together to establish a supra ordinate goal or priority
common goal. In doing so, all parties accept mutual responsibility for reaching that
goal.

Although it is very difficult for people truly to set aside original goals,
collaboration cannot occur if this does not happen. A nurse who is unhappy that
she did not receive requested days off might meet with her supervisor and jointly
establish the supra ordinate goal that staffing will be adequate to meet patient
safety criteria. If the new goal is truly a jointly set goal, each party will perceive
that an important goal has been achieved and that the supra ordinate goal is most
important. In doing so, the focus remains on problem solving and not on defeating
the other party.

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 Collaboration is rare when there is a wide difference in power between the
groups and individuals involved. Many think of collaboration as a form of
cooperation, but this is not an accurate definition. In collaboration, problem
solving is a joint effort with no superior subordinate, order-giving–order-taking
relationships. True collaboration requires mutual respect; open and honest
communication; and equitable, shared decision-making powers.

Managing unit conflict

Managing conflict effectively requires an understanding of its origin. Unit

conflict requires that the manager facilitates conflict resolution between others.

Before beginning to help other people in a conflict situation, the leader-

manager must first analyze the appropriateness of intervening. If the issue is
extremely important to them or the organization, it is likely worth intervening. The
manager may also want to intervene if the relationship with one or both parties is
highly significant to them, even if the issue is not.

The following is a list of strategies that a manager may use to facilitate conflict
resolution between members in the workplace:

• Confrontation. Many times, team members inappropriately expect the manager

to solve their interpersonal conflicts. Managers instead can urge subordinates to
attempt to handle their own problems by using face-to-face communication to
resolve conflicts, as e-mails, answering machine messages, and notes are too
impersonal for interpersonal conflicts that can have significant conflict aftermath.

• Third-party consultation. Sometimes, managers can be used as a neutral party to

help others resolve conflicts constructively. This should be done only if all parties
are motivated to solve the problem and if no differences exist in the status or power
of the parties involved. If the conflict involves multiple parties and highly charged

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emotions, the manager may find outside experts helpful for facilitating
communication and bringing issues to the forefront.

• Behavior change. This is reserved for serious cases of dysfunctional conflict.

Educational modes, training development, or sensitivity training can be used to
solve conflict by developing self-awareness and behavior change in the involved
parties.

• Responsibility charting. When ambiguity results from unclear or new roles, it is

often necessary to have the parties come together to delineate the function and
responsibility of roles. If areas of joint responsibility exist, the manager must
clearly define such areas as ultimate responsibility, approval mechanisms, support
services, and responsibility for informing.

• Structure change. Sometimes, managers need to intervene in unit conflict by

transferring or discharging people. Other structure changes may be moving a
department under another manager, adding an ombudsman, or putting a grievance
procedure in place.

Often, increasing the boundaries of authority for one member of the conflict
will act as an effective structure change to resolve unit conflict. Changing titles and
creating policies are also effective techniques.

• Soothing one party. This is a temporary solution that should be used in a crisis
when there is no time to handle the conflict effectively or when the parties are so
enraged that immediate conflict resolution is unlikely. Waiting a few days allows
most individuals to deal with their intense feelings and to be more objective about
the issues. Regardless of how the parties are soothed, the manager must address the
underlying problem later or this technique will become ineffective.

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Role of Nurse Leaders and Managers in Addressing Conflict

Nurse leaders and managers are challenged to learn how to deal with conflict
in a way that will manage the issues at hand while maintaining positive
relationships among staff members.
1. Establishing open communication and employing active listening skills can
help nurse leaders and managers manage conflict on the unit.
2. Nurse leaders and managers need to work to engage all staff members as a
team to create safe, quality patient outcomes.
3. In addition, nurse leaders and managers must encourage positive interactions
among staff members and health-care providers as part of a healthy work
environment.
4. Nurse leaders and managers need to mediate when interpersonal or
intergroup conflict occurs to avoid negative effects on nursing care and
patient outcomes.

Exercise:
1. What is the difference between levels of conflict?
2. What are types of conflict?
3. What are the stages of conflict?
4. How can you apply conflict resolution strategies?
5. Explain role of nurse leader in conflict management?

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 Controlling
Objectives:
By the end of this lecture, the student should be able to:
1. Identify the different definitions of controlling.
2. Principles for controlling
3. Identify the controlling process.
4. Identify types of control
5. Characteristics of Control
6. What are the main barriers to successful controlling?
8. Controlling technique

9. Process of Controlling

10. Types of control technique

11. Controlling technique applied to nursing field

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 Controlling
Introduction
Controlling is the regulation of activities in accordance with the plan.
It is a function of all managers at all levels. Its basic objective is to ensure that the
task to be accomplished is appropriately executed. It involves establishing
standards of performance, determining the means to Performance, evaluating
performance, and providing feedback of performance data to the individual so
behavior can be manipulation, rigid, tight, and autocratic or oppression.
Definitions:
Controlling was defined as seeing that everything is being carried-out in
accordance with the plan which has been adopted, the orders, which have
been given, and the principles which have been laid down.
Controlling: is a process of monitoring performance and taking action to
ensure desired results.
Controlling: is the last step in the management process. It involves setting
standards, measuring performance against those standards, reporting the
results and taking corrective actions control must be understandable,
economical must lead to corrective action.

Three principles for controlling:

1. The principle of uniformity: ensure that controls are related to the
organizational structure.
2. The principle of comparison: ensure that control is stated in terms of
the standards of performance.
3. The principle of exception: provide summaries that identify
exceptions to the standards.

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Requirements that must exist before any manager can devise or maintain a
system of control are:
A) Control Requires Plans
B) Controls Require Organization Structure
C) The Basic Control Processes
A) Relationship between planning and controlling:
Planning and controlling are two separate functions of management, yet they
are closely related. The scopes of activities if both are overlapping to each other.
Without the basis of planning, controlling activities becomes baseless and without
controlling, planning becomes a meaningless exercise. Relationship between the
two can be summarized in the following points:
1. Planning proceeds controlling and controlling succeeds planning.
2. Planning and controlling are inseparable functions of management.
3. Activities are put on rails by planning and they are kept at right place
through controlling.
4. The process of planning and controlling works on systems approach which is
as follows :
Planning → Results → Corrective Action
Planning and controlling are integral parts of an organization as both are important
for smooth running of an enterprise.
Planning and controlling reinforce each other. Each drives the other function of
management
B. Controls Require Organization Structure
Since the purpose of control is to measure activities and take action to assure that
plans are being accomplished, we must also know where responsibility of an
enterprise for deviating from plans and taking action to make corrections, lies.

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  Control of activities operates through people. But we can not know where
the responsibility for deviations and needs action are, unless organizational
responsibility is clear and definite. Therefore, a major prerequisite of control
is the existence of an organization structure. The clearer, more complete, and
more integrated this structure is, the more effective control action can be.
C) The Basic Control Processes

Control techniques and systems are essential for everything done.

Controlling process:
1. Establishing objective and standards.
2. Measuring actual performance.
3. Comparing results with objectives and standards.
4. Taking necessary action.
1. Establishing objective and standards:
Because plans are the yardsticks against which controls must be revised, it follows
logically that the first step in 5the control process would be to accomplish plans.
Plan can be considered as the criterion or the standards against which we compare
the actual performance in order to figure out the deviations.
Standards are by definition is a simple criteria of performance .They are the
selected points in an entire planning program where measures of performance are
made so as to give mangers signals as to how things are going without having to
watch every step in the execution of plans.
1. Measuring actual performance:
The measurement of performance against standards should be in on a forward
looking basis so that deviations may be detected in advance by appropriate
actions .The degree of difficulty in measuring various types of organizational
performance ,of course is determined primarily by the activity being measured .
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For example, it is far more difficult to measure the performance of highway
maintenance worker than to measure the performance of student enrolled in a
college level management course.

2. Comparing results with objectives and standards:

When mangers have taken a measure of organizational performance, their next step
in controlling is to accomplish this measure against some standard.
A standard is the level of activity established to serve as a model for evaluating
organizational performance. Standards are the yardsticks that determine whether
organizational performance is adequate or inadequate
4. Taking necessary action:
After actual performance has been measured compared with established
performance slandered, the next step in the controlling process is to take corrective
action, if necessary. In other word, corrective action focuses on correcting
organizational mistakes that hinder organizational performance.
Types of control
There are three types of control:
5. Pre-control (preliminary control): Control that takes place before work is
performed is called Pre-control.
Mangers using this type of control create policies, procedures and rules aimed at
eliminating behavior that will cause undesirable work results
6. Concurrent control: refers to the control that takes place as work is performed.
It relates not only to employees performance but also to such nonhuman areas
as equipment performance and department appearance.
7. Feedback control: refers to the control that focuses on past organizational
performance. Mangers exercising this type of control are attempting to take

154
 corrective action by looking at organizational history over a specified time
period.
Characteristics of effective controlling:
1. Timelines: The control should be timely to enable the managers to correct
problems in time to improve results.
2. Cost effectiveness: the control should be economical, this means the cost of
using the controls should be less than the benefits derived from using them.
3. Acceptability: the controls should be acceptable to managers and nurses.
4. Flexibility: control should be flexible, this means that the manager should be
able to ignore a variance, if doing so, it is in the best interests of the
organization
Barriers to successful controlling
(1) Control activities can create an undesirable overemphasis on short- term
production as opposed to long - term production.
(2) Control activities can increase employees' frustration with their jobs and reduce
morale. This reaction tends to occur primarily where management exerts too much
control.
(3) Control activities can encourage the falsification of reports.
(4) Control activities can cause the perspectives of organization members to be too
narrow for the good of the organization.
(5) Control activities can be perceived as the goals of the control process rather
than the means by which corrective action is taken.
Controlling technique:
Control techniques provide managers with the type and amount of information they
need to measure and monitor performance. The information from various controls
must be tailored to a specific management level, department, unit, or operation.

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Each area within an organization, however, uses its own specific control
techniques,
Importance of control technique:
1. The proper use of the right technique facilitates control.
2. Help manger to communicate with others both inside and outside
organization.
3. Many of the techniques are used by virtually all organizations and so
represent standard business practice.
4. The technique involve deferent levels of management in the control
process and enable manger to know what is happening in the
organization
Types of controlling technique:
A) Budget: is a plan express in quantitative term
Budget types:
1- Sales budget:
2. Production budge
3. Cash Flow/Cash budget
4. Project budget
5. Revenue Budget:
6. Expenditure budget
b) Controlling technique applied to nursing field
1-Nursing round
Effective controlling technique for nurse manager, round cover such issues as
patient car, nursing practice, and unit management
2-Nursing operating instruction
Nursing operating instruction or polices become standards for evaluation as well as
controlling technique
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3-Gantt charts
Was defined as means of controlling production, it depicted serious of event
essential to the completion of project or program.

Exercise:
1. Identify types of control?
2. List characteristics of Controlling?
3. What are the main barriers to successful controlling?

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 Performance appraisal
Objectives:
By the end of the lecture, the student will be able to:
1. Define the term performance appraisal
2. List principles of performance appraisal
3. State purposes of performance appraisal
4. Discuss characteristics of good evaluation tool
5. List types of performance appraisal
6. Identify who perform appraisal
7. Discuss the process of performance appraisal
8. Discuss common problems in performance appraisal
9. Explain the different methods for appraising staff performance
10.Identify the aims of appraisal interview
11.Discuss the process of appraisal interview.
12.Communicate the different guideline for appraisal interview to head nurses
in the clinical areas.

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 Performance appraisal
Introduction:
An important managerial controlling responsibility is determining how well
employees carry out the duties of their assigned jobs. This is done through
performance appraisals, in which work performance is reviewed. Performance
appraisals let employees know the level of their job performance as well as any
expectations that the organization may have of them.
Definition of performance appraisal:
It is the process by which a manager examines and evaluates an employee
work behavior by comparing it with preset standards, documents the results of the
comparison and uses the results to provide feedback to the employee to show
where improvements are needed and why
Goals of performance appraisal:
1. Improve performance
2. Improve communication.
3. Reinforce positive behavior
4. Communicate about and ultimately correct negative or less than optimal
behaviors.
5. Provide a basis for rewards, which also is a basis for motivation.
6. Provide a basis for termination if necessary.
7. Identify learning needs and develop personnel.
Principles of effective performance appraisal:
1. Performance appraisal must be based upon job description for the position.
2. Adequate & representative sampling of nurse's behaviors should be observed in
the process of evaluating her performance.
3. The manager needs to be rewarded for developing subordinates.

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4. The manager needs skill and training in using appraisal tools effectively.
5. The employee should be evaluated by his/her superior in line organization
structure.
6. The performance appraisal must be focus on areas of strength & weakness in
the individual to improve performance.
7. Performance appraisal should focus on the employee behavior and results
rather than personal traits.
8. Appraisal should be written& carried out at least once a year.
9. The performance appraisal information should be share with the employee.
10.Paperwork & administrative support to carry out the performance appraisal
process need to be matched to organizational goals.
11.If several areas of performance need improvement, the manager should specify
which areas are to be given highest priority.
12.The manager should have adequate opportunity to observe the employee job
performance during the course of the evaluation period
Characteristic of a good evaluation tools:
1) Simplicity: easy to use & does not require complicated procedures
2) Validity: is the degree to which a tool measures what it intends to measure
the performance of tasks included in employee job description.
For example if a student is being examined on her ability to palpate lie and
presentation of a fetus an essay test is unlikely to give valid results on which
to make a judgment about the student's competence in this skill.
3) Discrimination: The tool should be capable of discriminating among
individuals according to their performance.
4) Event oriented: real behavior not employee traits comprise the items.
5) Reliability: concerns stability and consistency of results when used for a series
of measurements or used by different evaluators., if the test is given repeatedly
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 to the same group or similar groups and it yields similar results, the test is said
to be reliable.
6) Objectivity: is the ability to remove emotionally from a situation so as to
consider the facts without distortion by personal feelings.
Types of Performance Appraisal
Informing nurses of how well they are doing in their work occurs both
formally & informally.
A-Formal performance evaluation
To maintain accreditation, health care organizations are required to
administer performance evaluation for each employee at regular intervals.
Individual facilities set their own policies identifying the process and time frames.
It can be conducted:
a) Annually
b) Semiannually (every 6 months)
c) Quarterly(every 3months)
B-Informal performance evaluation
Is conducted whenever the supervisor or personal manager feels it is
necessary. It might be as simple as immediately praising the individual for
performance recognized. In form of giving frequent feedback to facilitate nurses'
coaching and development
It occurs on a routine basis and many consist of:
1. Observation of work performance.
2. Incidental face to face confrontation and collaboration with the worker.
3. Responses offered by the worker during a conference.
Who perform appraisal
1. Supervisors who rate subordinates.

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2. Subordinates who rate supervisors.
3. Peers who rate each other.

Process of performance appraisal:

1-Assess institutional and personal needs and set goals.

2- Establish objectives and time frame.

3- Assess progress

4- Evaluate progress

Common problems in performance appraisal :

1-Halo effect:
Occurs when the appraiser lets one or two positive aspects of the assessment
or behavior of the employee unduly influence all other aspects of the employee
performance (overemphasize a positive event).
2-Horn effect:
Occurs when the appraiser allows some negative aspects of the employee
performance to influence the assessment to such an extent that other levels of job
performance are not accurately recorded (Overemphasize a negative).
3-Central tendency error:
Rates all employees as average
4-Leniency strictness error:
Rater tends to assign extreme ratings of either excellent or poor.
5-Similarity error:

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 The rater uses him/ herself as a standard and gives the highest rating to those
who seem to be most like him/ her.

Methods for appraising staff performance:

There is no one performance appraisal system, which will work equally well
in all work settings. A number of techniques are available for use & more than a
method can be used.
I) Comparative methods
1. Ranking
2. Paired comparison
3. Forced distribution
II) Rating Methods:
1. Graphic rating scale
2. Numerical rating scale
3. Checklist
4. Forced choice
III) Written Methods:
1. Anecdotal record
2. Critical incident diary
3. Essay
IV) Special Methods
1. Behaviorally anchored rating scale
2. Management by objective approach
3. Peer review
4. Self-appraisal

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I) Comparative methods:
1-Ranking:
In this method the rater evaluates employees by ranking them from best to
worst on each performance dimension being considered. The supervisor
makes a list with best employee at the top and the worst at the bottom.

How to apply this method:

Select the one nurse you would regard as having most of the quality, put his
name in column I below on the first line numbered 1.Cross out his name on your
list. Consult the list again and pick out the nurse having least of this quality, put his
name at the bottom of column II, on the line numbered 20. Cross out his name on
your list, then, from the remaining names on your list, select the one nurse having
most of the quality, and put his name in the first column on line 2. Keep up this
process until all names have been placed in the scale.
Advantages:
It is a simple method.
Disadvantages:
 The size of the difference between staff is not defined.
 Ranking may be affected by rater bias.
2-Paired Comparison Method:
In this method every subordinate is compared to every other subordinate in
pairs for every trait. The frequency of time that the subordinate is rated high across
all pairs determines one final ranking.
Advantages:
 Used when limited wage increase is to be given to a few staff.

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Disadvantages:
 It became tedious when there are lots of people to compare.
 Demands considerable time of the manager.
3-Forced distribution Method:
In this method a predetermined percentages of rates are placed in various
number of performance categories (excellent, very good, good, average, fair and
poor).

Example: If we have 100 nurses to be evaluate

- 10 must be evaluated as excellent
- 10 must be evaluated as very good
- 15 must be evaluated as good
- 40 must be evaluated as average
- 20 must be evaluated as fair
- 5 must be evaluated as poor
Advantages:
- It used for deciding who is receiving pay raises.
- It may be used to overcome the leniency and central tendency errors.
- Inexpensive to design and implement in comparison to other appraisal
methods.
Disadvantages:
- Differences in nurse performance are not specified.
- Do not provide feedback about nurse strengths and weaknesses in
performance.
- It cannot undertake with a small number of nurses.

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N.B. Comparative methods: used to appraisal the employee behavior such as
initiative, dependability, appearance & proper utilization of time.
II)Rating Methods:
1-Graphic rating scale
It is the popular and widely used, because it is easy to develop and use. The
graphic rating scale involves a number of behavior statements or traits, as well as a
range of performance that ranges from unsatisfactory to outstanding that include
five point scale is very popular (1-5). Then the raters rate the subordinate by
checking the score that best describe the staff level of performance for each trait,
the circled value for each is then added up and totaled.
Advantages:
- Easy to construct
- Acceptable to raters
Disadvantages:
- Raters tend to remember recent or negative event.
- Raters differ in their standards of judgment.
- Staff is not involved in the process.

2-Numerical Rating Scale:

It usually includes numbers against a list of behaviors or factors to be
evaluated. Supervisors put a system of evaluation in the form of percentage, and
then evaluate every number accordingly.
Advantages:
- Uncomplicated
- Specifies human qualities that are known to be important in getting results.
Disadvantages:
- Raters tend to remember recent or negative incidents.

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 - Raters differ in their standards of judgment.
- Staff are not involved in the process.

3-Checklist
It consists of performance criteria for the most important tasks in the nurse
job description. The manager or the rater assesses the presence or absence of
desired characteristics or behavior.
Advantages:
- It reduce some bias
- Useful in teaching nursing procedures
- Efficient in evaluating large number of the staff
- Used to evaluate technical procedures
Disadvantages:
- It does not indicate the frequency or the degree with which the behavior
occurs.
- It needs time and effort to develop a valid check list tool.
- There are no set performance standards

4-Forced choice method

The rater is asked to select from groups of statements in behavioral terms
that best to most (fits) and least (fits) the nurse being rated. The statement are then
weighted and / scored.
Advantages:
- Reduces bias since the rater does not know scoring value for each statement
Disadvantages:
- It tends to irritate raters
- It is costly to develop

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III) Written Methods:

1-Anecdotal Behavior Record

Anecdotal behavior records are objective descriptions of behavior recorded
on plain paper or a form. The notations should include who was observed ,by
whom, when, where and doing what. The notation comprises a description of the
setting and the incident, which picture the quality of work produced. Interpretation
& recommendations may be including. It should be accurate well written in brief
manner.
Advantages:
- It gives a clear picture of the degree to which the staff member is meeting the
objectives
- It clarify the change in staff behavior pattern
- It point out the areas of inefficiencies among the staff member.
- It is used for new nurses who need special training.
Disadvantages:
- Time consuming
- Difficult to be analyzed
- Some observers have a tendency to record negative situations.

2-Critical incident method:

It requires managers to keep a running record of incidents considered critical
to job performance. Incidents that indicate either uncommonly good or undesirable
incidents for each of the staff. A discussion is held between the staff and the rater.
Advantages:
- Relates to performance elements of the job not personality traits.
- It is good for staff development & feedback.
Disadvantages:

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 - Time consuming
- Require close supervision

3-Essay Method:
The appraisal describes in narrative form an employee's strengths and areas
where improvement or growth is needed that identified in the job description.
Advantages:
- Provide an in depth review of an employee performance
- Suitable for identifying training needs (developmental needs & problem
areas).
- Reduces bias.
Disadvantages:
- Time consuming
- Depends on the writing ability of the appraisers.
- Difficult to defend in court because comments made by rater may not be
closely tied to actual job performance.
- Varies in length and content
IV) Special Methods

1-Behaviorally anchored rating scale method (B A R S)

It is an appraisal technique, sometime known as behavioral expectations
scale. It evaluates behavior relevant to the specific demands of the job & provides
examples of specific job behaviors corresponding to good, average and poor
performances. The scale ranging from one to seven and the range is from
extremely poor to extremely good.
Advantages:
- Reduce the rater error
- Provide more reliable, valid & complete data

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Disadvantages:
- Difficult to construct because it requires large number of employees in
determining the dimensions of effective performance.
- Time consuming
- Separate BARS is needed for each job.

2-Management by objective approach (MBO):

Is an excellent tool for determining an individual employee progress because
it incorporates both the employee assessment as well as the organization. The
following steps delineate how MBO can be used effectively in performance
appraisal.
- The supervisor and employees meet and agree on the principle duties and
responsibilities of employee job to achieving goals.
- The employee sets short term goals and target dates in cooperation with the
supervisor.
- Both parties agree on the criteria that will used for measuring and evaluating
the accomplishment of goals,
- Regularly, but more than once a year, the employee & supervisor meet to
discuss progress, some modification can be made to the original goals , major
obstacles that block completion of objectives are identified, the resources and
support needed from others are identified and
- During the appraisal process, the manager determines whether the employee
has met the goals. Both evaluate the outcome or the result in relation to goals.
Advantages:
- Emphasizes the future that can be changed.
- Reduces rater mistakes

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 - Contribute to nurse development
- It serve as a basis for promotion and compensation
- Reduce role ambiguity
- Create a vested interest in the employee to accomplish goals.
- Defensive feelings are minimized.
- A spirit of teamwork prevails
- Tool for effective planning and appraisal

Disadvantages:
- It is time consuming to implement
- It is difficult to implement
- The process needs to be taught and reinforcement for managers to become
proficient in applying the principles of the system.
- Highly directive and authoritarian managers find it difficult to lead employees
in this manner.
- The employee frequently attempts to set easily attainable goals.
3-Peer Review:
Is a process by which registered nurses assess and judge the performance of
professional peers against predetermined standards.
Advantages:
- Provide a feedback mechanism for sharing ideas
- Identifying areas that need further development
- Increase personal& professional growth
- Increase nurse autonomy
- Compares consistency of performance with standards
- Increase job satisfaction.
Disadvantages:

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 - It is time consuming to implement
- There is a risk of rating candidates too high or too low.
- Requires a great deal of energy.
- Staff needs to be oriented to the process.

4-Self Appraisals:
Employees are increasingly being asked to submit written summaries or
portfolios of their work related accomplishments & productivity as part of the self-
appraisal process. Portfolios often provide examples of continuing education,
professional certifications and recognitions, the employee goals and action plan for
accomplishing these goals.
Advantages:
- Promote individual growth when the person is self-aware.
- Encourage leadership behavior in employees
- Respect employee opinions.
Disadvantages:
- Avoid external feedback and performance validation.
- Staff may be fearful of punishment.
- May rate self-low to prevent disagreement with the boss.
- May evaluate self-high to influence the manager

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Exercise:
1. Discuss the different methods of performance appraisal?
2. List principles of performance appraisal?
3. Differentiate between central tendency and leniency strictness errors

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 Quality
Objectives:
By the end of this lecture, the students should be able to:
1- Define quality, quality of care, quality control and quality assurance, quality
improvement, quality management& total quality management
2- Define clinical indicator
3- Define standard& criteria
4- List principles of TQM
5- State the purposes of total quality management
6- Identify elements of quality
7- Use elements of TQM in the clinical area
8- Evaluate characteristics of standard
9- Evaluate characteristics of good criteria
10- Explain dimensions of quality
11- Differentiate between concurrent audit and retrospective audit

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 Quality
Introduction:
Because quality health care is a complex phenomenon, the factors
contributing to quality in health care are as varied as the strategies needed to
achieve this elusive goal.
Major definitions:
 Quality is defined as doing the thing right with right way from the first time
 Quality is defined as a process which seeks to attain the highest degree of
excellence in the delivery of patient care.
 Quality of care is the process of determining the degree to which patients care
services increase the probability of desired outcomes and reduce the probability
of undesired outcomes.
Quality elements or components
o Structure: Is concerned with health care setting.
o Process: Is concerned with what happens or how the care is delivered.
o Outcome: Is demonstrated by satisfaction and information.

‫عناصر الجودة‬
‫هي الموارد الالزمة لتنفيذ عملية الجودة‬ 

‫االجراءات او خطوات‬
‫العمل‬ ‫مدخالت‬
‫مخرجات‬
(Inputs)
(Outcomes) (Process) (Structure)

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Dimensions of quality
1) Technical competence:
Refers to the skills, capability, and actual performance of health provider,
managers and support staff.
(2) Access of service:
It means that health care services are unrestricted by geographic, economic
cultural and organizational barriers.
(3) Effectiveness:
The quality of health services depends on the effectiveness of services
delivery, norms and clinical guidelines.
(4) Efficiency:
Efficient services provide optimal rather than maximum care to the patient
and community; they provide the greatest benefits within the resources available.
(5) Interpersonal relation:

Refers to the interaction between providers and clients, mangers and health
care providers the health team and community.
(6) Continuity:

Continuity means that the patient received the complete range of health
services that he needs, without interruption, cessation or unnecessary repetition of
diagnosis and treatment.
(7) Safety:

It minimizing the risks of injury, infection, harmful, side effects or other

dangers related to service delivery
(8) Amenities:

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 Refers to the feature of health service that enhances patient‘s satisfaction and
willingness to return to the facility.
Quality control

Definition of quality control:

 It is a process which involves determination of the extent to which a service
matches some specified quality standards
 It is defined as Activities that evaluate, monitor, or regulate services rendered
to consumers.

Steps of the quality control process

• The criterion or standard is determined.
• Information is collected to determine whether the standard has been met.
• Educational or corrective action is taken if the criterion has not been met.

Total quality management

Definition of total quality management:

 Quality management is focused not only on product/service quality, but also
the means to achieve it. Quality management therefore uses quality assurance
and control of processes as well as products to achieve more consistent quality
 Total quality management is a comprehensive and structured approach to
organizational management that seeks to improve the quality of products and
services through ongoing refinements in response to continuous feedback
 Quality improvement is defined as the purposeful change of a process to
improve the reliability of achieving an outcome.
Purposes of Total Quality Management (TQM):
1 Increasing employee participation

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 2 Facilitating organization atmosphere of continuous quality improvement
3 Patient satisfaction
4 Improving all the process within the organization
5 Minimize the cost
6 Make the organization to the best in the field
7 Obtaining accurate patient care feedback.
8 Correcting the care deficits.
9 Motivating nursing staff to improve patient care
10 Verifying effectiveness of established nursing process.
11 Conducting nursing research related structure, process, and outcome
elements and seeking to identify effective nursing methods.
Principles of TQM:
The key principles of TQM are:
1. Management commitment:
2. Employee Empowerment
3. Fact based decision making
4. Continuous improvement
5. Customer focus

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 PDCA Cycle to Total Quality
Management
Plans are carried
Basic system out by
change by management and
management who workers
will make the cooperatively
plan to fix them

The results are The results are

analyzed and observed
lessons are noted
and prediction
made

Management commitment
1. Plan: In the planning phase, people define the problem to be addressed,
collect relevant data, and ascertain the problem's root cause.
2. Do: In the doing phase people develop and implement a solution, and decide
upon a measurement to gauge its effectiveness
3. Check: In the checking phase , people confirm the results through before and
after data comparison
4. Act: In the acting phase, people document their results; inform others about
process changes, and make recommendations for the problem.
Elements of TQM:
To be successful implementing TQM, an organization must concentrate on the
eight key elements:
1. Ethics
2. Integrity
3. Trust

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 4. Training
5. Teamwork
6. Leadership
7. Recognition
8. Communication

Quality assurance
Major definitions:
 Quality assurance is the process of measuring the actual level of the service
provided against the degree and defined standards and take positive action to
modify services when necessary.
 Clinical indicator is a quantitative measure that can be used as a guide to
monitor and evaluate the quality of important patient care activities

Quality assurance cycle

Step1 : plan

Step10 : Implement Step2 : set standards

solution

Step9 : identity who will Step3 : Communicate

Work on problem standards

Step8 : Analyze
Step4 : monitor
and study problem

Step7 : identity who will Step5 : identity and prioritize

Work on problem for improvement

Step6 : Define problem

Standard
 Is a descriptive professional statement of desired or agreed level of
performance against which the quality can be judged
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Characteristics of standard
Standard should be: Valid, reliable, clear, measurable, applicable, and achievable.

Criteria:
 Are predetermined measurable elements that will indicate if the standard is met
and to what degree it is met
Characteristics of good criteria :
 A good criteria must describe observable behavior
 State desired behavior.
 Free from irrelevant material.
 Incorporate only one action.
 Use commonly acceptable abbreviation.
 Criteria must be detail indicator of standards specific to area and type of
patient and be measurable.

Methods for monitor nursing care :

Nursing audit :
 It is the method for evaluating quality of nursing care through appraisal of the
nursing process or outcome of care as it is reflected in the patient care records.
Purposes of nursing audit:
 Evaluating nursing care
 Achieves deserved and feasible quality of nursing care
 Stimulants to better records
 Focuses on care provided and not on care provider
 Contributes to research
Types of nursing audit:
There are three type of nursing audit retrospective, concurrent, and
prospective.

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 The comparison between concurrent and retrospective audit:
Items Concurrent audit
 To assess the present care given
Purposes to the client
 Can provide information to care
giver that may after a particular
client care plan to help in
providing immediate corrective
action.
 Provide faster information to
Advantages improve care of specific client
whom the change of care
indicated.
 Uses patient records, interviews
with clients and health team
member and observation of care
given
 More costly
Disadvantages
Retrospective audit
 To assess the past care that
has already been received by
the client
 Less costly.
 Usually required less time to
be completed.
 Uses records reviews, post
care questionnaire and patient
interviews when the record is
unclear.
 The care of client whose
charts are audited not
influenced by the outcome of
retrospective audit

Exercise:

1- List principles of TQM?

2- Identify elements of quality?
3- Differentiate between concurrent audit and retrospective audit?

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 Decision-making and Critical Thinking
Objectives:
By the end of this lecture, the student should be able to:
1. Differentiate between decision-making and problem solving.
2. Define decision-making and critical thinking.
3. Differentiate between different types of decisions.
4. List factors that affect decision-making.
5. Explain decision-making models.
6. Apply process of decision-making.
7. Compare between different styles of decision-making.
8. Explain why we need to think critically.
9. Identify the characteristics of the expert critical thinker.
10.Explain elements of critical thinking.
11.Differentiate between the six cognitive skills of critical thinking.

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 Decision-making and Critical Thinking

Introduction

People, in general, make many decisions in an average day. Some decisions

are small and are made with little effort (i.e., deciding what to eat for breakfast),
whereas others may be more involved and take several days (i.e., purchasing a new
car). Regardless of how complex a decision may be, the basic elements of the
decision-making process are present.

Difference between decision-making and problem solving:

Although decision making and problem solving appear similar, they are not
synonymous. Decision-making may or may not involve a problem, but it always
involves selecting one of several alternatives, each of which may be appropriate
under certain circumstances. Problem solving, on the other hand, attempts to
identify the root problem in situations; involves diagnosing a problem and solving
it, which may or may not entail deciding on one correct solution.

Most of the time, decision-making is a subset of problem solving. However,

some decisions are not of a problem-solving nature, such as decisions about
scheduling, equipment, or in-services.

Problem solving is part of decision-making and is a systematic process that

focuses on analyzing a difficult situation. Problem solving always includes a
decision-making step.

Definitions
 Decision is a choice among alternatives.
 Decision-making is a complex, cognitive process often defined as choosing a
particular course of action.

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  Or ―It is a process of choosing the best alternatives to achieve individual and
organizational objectives‖
Types of Decisions

The types of problems nurses and nurse managers encounter and the
decisions they must make vary widely and determine the problem-solving or
decision-making methods they should use.

I. Routine decisions:
Relatively well defined, common problems can usually be solved with routine
decisions, often using established rules, policies, and procedures. For instance,
when a nurse makes a medication error, the manager‘s actions are guided by policy
and the report form. Routine decisions are more often made by first-level managers
than by top administrators.

II. Adaptive decisions:

They are necessary when both problems and alternative solutions are somewhat
unusual and only partially understood. Often they are modifications of other well-
known problems and solutions.

III. Innovative decisions:

Managers must make innovative decisions when problems are unusual and
unclear and when creative, novel solutions are necessary.

Factors influencing Decision-making

I. Internal factors
1- Decision maker's physical and emotional state.
2- Personal characteristics; values; experiences; interests, knowledge, and
attitudes.
II. External factors

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 1- Environmental conditions
2- Time
3- Decision-making options are externally limited when time is short.
III. Personality factors
1- Self-esteem and self-confidence affect whether one is willing to take risks in
solving problems or making decisions.
2- Self-awareness,
3- Energy
4- Creativity
5- Sensitivity
6- Flexibility.
The Decision-Making Models:

I. The rational decision-making model:

A series of steps that managers take in an effort to make logical, well-
grounded rational choices that maximize the achievement of objectives.

First, identify all possible outcomes, examine the probability of each alternative,
and then take the action that yields the highest probability of achieving the most
desirable outcome. Not all steps are used in every decision nor are they always
used in the same order. The rational decision-making model is thought of as the
ideal but often cannot be fully used.

Individuals seldom make major decisions at a single point in time and often
are unable to recall when a decision was finally reached. Some major decisions are
the result of many small actions or incremental choices the person makes without
regarding larger issues. In addition, decision processes are likely to be
characterized more by confusion, disorder, and emotionality than by rationality.

186
 For these reasons, it is best to develop appropriate technical skills and the capacity
to find a good balance between lengthy processes and quick, decisive action.

II. The descriptive rationality model:

It emphasizes the limitations of the rationality of the decision maker and the
situation. It recognizes three ways in which decision makers depart from the
rational decision-making model:

● The decision maker‘s search for possible objectives or alternative solutions is

limited because of time, energy, and money

● People frequently lack adequate information about problems and cannot control
the conditions under which they operate

● Individuals often use a satisficing strategy.

III. Satisficing
Satisfying is not a misspelled word; it is a decision-making strategy whereby
the individual chooses an alternative that is not ideal but either is good enough
under existing circumstances to meet minimum standards of acceptance or is the
first acceptable alternative. Many problems in nursing are ineffectively solved with
satisficing strategies.

Individuals who solve problems using satisficing may lack specific training
in problem solving and decision making. They may view their units or areas of
responsibility as drastically simplified models of the real world and be content with
this simplification because it allows them to make decisions with relatively simple
rules or from force of habit.

IV. The political decision-making model

It describes the process in terms of the particular interests and objectives of
powerful stakeholders, such as hospital boards, medical staffs, corporate officers,

187
and regulatory bodies. Power is the ability to influence or control how problems
and objectives are defined, what alternative solutions are considered and selected,
what information flows, and, ultimately, what decisions are made.

Process of decision-making

The decision-making process begins when a gap exists between what is

actually happening and what should be happening, and it ends with action that will
narrow or close this gap. The simplest way to learn decision-making skills is to
integrate a model into one‘s thinking by breaking the components down into
individual steps.

1. Gathering information involves collecting information that will direct the

decision making process. Often, gathering information involves observations. The
focus during this step is to gather data that are worthwhile and pertinent to the
decision to be made. One shortcoming for most people is the tendency to move
from observation to conclusion without enough information.

2. Analyzing information and creating alternatives often overlap with gathering

information because, in this step, information is logically arranged and put into
context for evaluation. As information is being organized, alternatives emerge.

The amount of time spent analyzing and creating alternatives is directly

related to the weight of the decision to be made.

3. Selecting a preferred alternative comes about during analysis, when often the
best alternative emerges. During this step, it is important to consider what is a
realistic and feasible alternative, keeping in mind factors such as time, money,
quality, personalities, and policies.

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4. Implementation consists of taking the selected alternative and putting it into
action.

5. Follow-up on implementation: includes communication and clarification to

ensure that staff members know what is expected of them; checking on the timing
and ensuring that the change is not overwhelming to staff because of other factors;
performing ongoing analysis and monitoring of any circumstances that may require
adjustments to the implementation plan; evaluating suggestions from others;
withdrawing a poor choice, if necessary; admitting mistakes; and, in the end,
sticking with the right decision.

Decision making styles:

It is typical for managers to primarily use one style, though some managers
use mixed styles or may switch styles depending upon the situation. Nurse

A. Authoritarian decision making, all of which focus on one person making a

decision with limited or no input from others. Only the manager makes the
decision when the authoritative style is employed.
B. Participative decision-making. Here the emphasis is on including others in the
decision-making, even if an individual must make the final decision. The
individual, however, who uses this style, would pay close attention to feedback
from others before making the final decision.
C. The flexible style: uses a small amount of data while generating multiple
alternatives and may change as information is reinterpreted.
D. Intuitive decision making: the decision maker may ignore information and
change their alternatives if it does not feel right. This is the ―gut‖ approach. A
staff member will say, ―I just had a feeling about it.‖ Again, the situation can
make a difference. When a nurse has expertise in an area, decisions may appear

189
 to be more intuitive because the nurse may feel more confident and can rely
more on a ―gut feeling,‖ though the decision is probably supported by expertise.

Critical thinking
Critical-thinking skills can be used to resolve problems rationally.
Identifying, analyzing, and questioning the evidence and implications of each
problem stimulate and illuminate critical thought processes. Critical thinking is
also an essential component of decision making.

However, compared to problem solving and decision making, which involve

seeking a single solution, critical thinking is a higher-level cognitive process that
includes creativity, problem solving, and decision making.

Definitions

 Critical thinking is the ability to think in a systematic and logical manner with
openness to question and reflect on the reasoning process used to ensure safe
nursing practice and quality care.
 Critical thinking is deliberate, purposeful, and informed outcome-focused
thinking that requires careful identification of key problems, issues, and risks
involved.
 Further, critical thinking requires specific knowledge, skills, and experience.
Sometimes referred to as reflective thinking, is related to evaluation and has a
broader scope than decision making and problem solving.
Why we need to think critically?

1- Need to make accurate and appropriate clinical decisions.

2- Need to solve problems and find solutions.
3- Need to plan care for each unique client and client problem.

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 4- When action is taken without using appropriate guiding information ,
mistakes are easily made & client wellness is at risk.
Characteristics of an Expert Critical Thinker
● Outcome-directed - Open to new ideas
● Flexible - Willing to change
● Innovative - Creative
● Analytical - Communicator
● Assertive - Persistent
● Caring - Energetic
● Risk taker - Knowledgeable
● Resourceful - Observant
● Intuitive - ―Out of the box‖ thinker

Elements of Critical Thinking

Critical thinking involves eight elements of thought:

1. The problem, question, concern, or issue being thought about by the thinker (i.e.,
what the thinker is attempting to figure out)

2. The purpose or goal of the thinking (i.e., what does the thinker hope to
accomplish?).

3. The frame of reference, point of view, or worldview the thinker holds about the
issue or problem.

4. The assumptions the thinker holds true about the issue or problem.

5. The central concepts, ideas, principles, and theories the thinker uses in reasoning
about the issue or problem.

6. The evidence, data, or information provided to support the claims the thinker
makes about the issue or problem.
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7. The interpretations, inferences, reasoning, and lines of formulated thought that
lead to the thinker‘s conclusions.

8. The implications and consequences that follow from the positions the thinker
holds on the issue or problem.

Cognitive skills for Critical Thinking

There six essential cognitive skills necessary to becoming an expert critical thinker

1. Interpretation involves clarifying data and circumstances to determine meaning

and significance. For nurse leaders and managers, interpretation reflects their
ability to comprehend the significance of a wide variety of circumstances, establish
priorities, categorize data, and clarify the related impact on people and systems.

2. Analysis is determining a problem or issue based on assessment data. Nurse

leaders and managers engage in analysis to identify relationships among structures,
processes, outcomes, and other frameworks of thought with the goals of examining
various arguments, issues, and themes and determining elements and origins of the
argument.

3. Inference is about drawing conclusions. Nurse leaders and managers draw

conclusions about situations after careful analysis and begin to form a foundation
on which an action will be based.

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4. Evaluation is determining whether expected outcomes have or have not been
met. If outcomes have not been met, evaluation also involves examining why.
Nurse leaders and managers engage in evaluation to assess the reliability and
credibility of the descriptions, perceptions, experiences, situations, and
relationships of these elements to determine their value in the overall process. The
nurse leader and manager gains confidence in the evaluation of the outcome, which
will direct decisions and actions.

5. Explanation is the ability to justify actions with evidence. Nurse leaders and
managers establish a viable explanation about the conclusions drawn during the
evaluation process. The role of the nurse leader and manager is to provide
systematic and organized reasoning behind the conclusion so that it can be
translated into a level of understanding for others.

6. Self-regulation is the process of examining one‘s practice for strengths and

weaknesses in critical thinking and promoting continuous improvement. Nurse
leaders and managers engage in self-regulation to become more informed and
refine their skills in problem identification, analysis, and inference and to develop
expert critical thinking skills.

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Exercise:
1. Explain difference decision-making and problem solving?
2. What are types of decisions, and explain differences?
3. Mention factors that affect decision-making?
4. Hoe to apply process of decision-making?
5. Compare between different styles of decision-making?
6. Why we need to think critically?
7. What are the characteristics of the expert critical thinker?
8. Explain the six cognitive skills of critical thinking?

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 Leadership
Objectives:
By the end of the lecture, the student will be able to:
1. Define leadership.
2. Define leader.
3. Define style & leadership styles.
4. List types of leadership.
5. Differentiate between leadership and management.
6. Analyses the different styles of leadership.
7. Discuss different forces affecting leadership styles.
8. State qualities of effective leader.
9. Utilize suitable leadership style according to the situation.

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 Leadership
Major concepts:
 Leadership: Is the process of influencing the behavior of either an individual
or a group, regardless of the reason, in an effort to achieve goals in a given
situation
 Leader: Is a person who interprets &suggests the goal for which a group is
working, and who guide, directs, encourages & participation of other toward
effective achievement of this goal
 Style: Style refers to the manner a leader uses to influence the group members
 Leadership style: Are defined as different combinations of task and
relationship behaviors used to influence others to accomplish goals

Types of leadership
1- Formal Leadership: when leadership practiced by a nurse with legitimate
authority conferred by the organization and described in a job description
(e.g. nurse manager, supervisor, and coordinator). It is also depends on
personal skills, but it may be reinforced by organizational authority & position.
2- Informal Leadership: when exercised by a staff member who does not have a
specified management role. Informal leadership depends primarily on one's
knowledge, status (e.g. advanced practice nurse, quality improvement
coordinator, education specialist, medical director) & personal skills in
persuading & guiding others.
Difference between leadership and Management:
Leadership & management are related, but they are not the same. Managers
& leaders differ in how they create an agenda, in how they develop a rationale for

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achieving the agenda, in how they execute plans & in the types of outcomes they
achieve.
Item Leadership Management
1-Position Position is one selected or Position is one appointed by someone
allowed by a group of higher in the organizational hierarchy
followers
2-Power base - Power base comes from - Power base is a legitimate one,
other means such as arising from the position of
personal influence authority.
(knowledge, credibility
& ability to motivate
followers)
- Do not have delegated
authority
3- Goals and visions arise Goals and visions are those prescribed
Goals/Visions from personal interests & by the organization.
passion and may not be
synonymous with the goals
of the organization.
4-Focus - Focuses on group - The focus on control, decision
process, information making, decision analysis, results&
gathering, feedback and analysis of failure
empowering others. - Manipulate personnel, the
- Emphasize interpersonal environment, money, time and other
relationships resources to achieve organizational
goals.
5-Skills learn - Over time through - Management can be learned and
experience in life taught using traditional teaching
situation. techniques.
- A good leader may not - A good manager also possesses
possess management leadership ability but this does not
skills. always occur.
6-Nature of Activities are guiding, Involves the coordinating & integrating
activity teaching, motivating& of resources through the activities of
directing the activity of planning, organizing, directing &

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 others toward attaining controlling in order to accomplish
goals specific goals and objectives within
organization.
7-Actions -Does the right thing. -Does things right.

Components of leadership
1- The leader
2- The follower
3- The situation
4- Communication
5- Goals
Styles of leadership:
The best appropriate style depends on the situation that promotes a high
level of work performance in a wide variety of circumstances as efficiently as
possible, and with the least amount of disruption.
I- Traditional leadership styles:
1. Autocratic style
2. Democratic style
3. Laissez faire style
4. Multicratic
II- Advanced style:
1- Transactional leader style
2- Transformational leader style
I- Traditional styles:
1- Autocratic style: (authoritarian, directive or restrictive)
In this style, maximum control for the leader with minimum freedom for the
group members

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Advantages:
1. Less time consuming for taking decisions.
2. Improve productivity.
3. Reduce stress due to increased control
4. Reducing frustration in the work group
5. The group member may feel secure
6. Procedures are well defined
Disadvantages:
1. Increased workload for the leader
2. Teams become dependent upon their leader
3. Group members needs for creativity, self-motivation and autonomy are not
met
4. The degree of openness and trust between leader and group members is
minimal.
5. Create hostility and dependence among followers
6. Make group members dissatisfied
7. Less commitment to organizational goals -
When is the Autocratic Leadership Style Effective?
The autocratic leadership style is useful in the following work situations:
1) In emergency situation (during cardiac arrest, fire) that requiring immediately
decisions when there is no time to ask a decision of the group member.
2) When the group members are unable or unwilling to participate in making a
decision
3) When the leader has a good and new ideas or information not present in the
followers.
4) Work environments where spans of control are wide and hence the leader has
little time to devote to each employee.
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2- Democratic style :( participative, consultative)
Democratic style focuses on involving subordinates in decision-making. An
example of democratic management might occur on a medical surgical floor.
Advantages:
1) Encourage group member to participate in decision making
2) Increase commitment, satisfaction and productivity of the group member in
their work.
3) Encourage communication & teamwork.
4) Allows for more self-motivation, more creativity, cooperation &
coordination among group members.
5) Increase the morale of the employees.
6) Encourages group member to become leaders and be involved in leadership
development.
Disadvantages:
1) Less of efficiency when the participants are lack of knowledge and skills to
make effective decisions.
2) Time consuming for taking decisions.
When Is the Democratic Leadership Style Effective
a) Democratic leadership is appropriate when the decision at hand is not one that
requires urgent action.
b) Democratic leadership is effective in professional organizations where the
emphasis is clearly on training, professional & leadership development and
quality of work performed.
3- Laissez faire style:
Maximum freedom for the group members with least leader control & is also
referred to as the delegating approach. The leader leaves group members free to set
their own goals take decisions & determine their own activities without leader
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participation. An example of laissez faire leadership might occur in an inpatient
psychiatric unit.
Advantages:
1- Providing maximum freedom for individuals
2- Increase motivation of subordinates to perform at high levels
3- It works best when group members have both personal and professional
maturity.
Disadvantages:
1. Leads to instability and disorganization.
2. An informal leader may arise who will give direction to the group.
3. The group members may act independently of each other& suffer from a
lack of cooperation and coordination.
4. Apathy & frustrating may arise
4-Multicratic style:
Combines the best of all styles and mediated by the requirements of the
situation at hand. The multicratic leader provides a maximum of structure when the
situation requires it, a maximum of group participation when needed and support
and encouragement for subordinates in all instances.
II Advanced style:
1- Transactional leader style:
The transactional leader sets goals, gives directions & uses exchange system
that follower values, such as rewards for performance or mutual support to
reinforce employee behaviors associated with meeting or exceeding established
goals.
The exchange involves three dimensions:
1-Contingent reward: provide various kinds of rewards in exchange for mutually
agreed upon goal accomplishment.
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2-Active management by exception: Involves watching for deviations from rules
and standards and taking corrective action.
3-Passive management by exception: Involves intervention only if standards are
not met.
2- Transformational leader style:
Based on the vision that the leaders shares with the group and stresses the
importance of interpersonal relationship & preparing people for change.
Transformational dimensions of leadership style
1-Charisma:
Charismatic leader are highly respected by the followers& are viewed with
reverence, dedication and awe. They set high standards, challenging their staff to
go beyond the expected level of effort.
2-Inspirational motivation:
The leader motivates and inspires followers to commit to the vision and
goals of the organization.
3-Intellectual stimulation:
The leader is focused on problem solving through the use of innovation,
creativity, and critical thinking and challenge followers to move beyond traditions
and beliefs that no longer support problem resolution to take risks and foster
innovation.
4-Individualized consideration
Is focused on the specialized attention the leader pays to an individual
followers needs.

Factors affecting leadership style:

The style of leadership used by the leader is dependent on three forces

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1-
Forces within the Leader:-
These can include:
- His/her knowledge, skills, attitude, experience &background
- Values, personal goals & group goals,
- Confidence in members
- Personality& sensitivity
- Weight of responsibility
2- Forces within the team
- Size of the group.
- Commitment to a common goal.
- Degree of maturity.
- Tolerance for Ambiguity.
- Willingness and ability to make decisions
- Values, expectations& interest
- Size of job
- Competition& confidence
- Fatigue.
3- Forces in situation:
- Traditions and values of the organization.
- Size of the organization and its structure.
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 - Time.
- Degree of which task is structured.
- Restraints of organization& environment
- Emergencies& hazards
- Justice
- Degree of stress in the situation
Qualities of an effective of leader :

1. Personal qualities such as:

- Integrity, honest, ability to cooperate, attract & motivate others
- Shows a sense of humor, tactful & friendly
- Shows a balance between work and home life or personal life
- Use his/her energy wisely.
- Perseverance (Effective leaders do not give up easily)
- Emotional control
- Conscientiousness
- Good judgment.
- Always be fair
- Willingness to help and assist,
- Self-confidence, courage and decisiveness.
- Strong self-image, a vision of the future
- Good communication skills.
2. Technical qualities like mastery over subject, expert knowledge and expertise
to work.
3. Teaching abilities, i.e. ability to communicate
4. Administrative abilities i.e. organizing, coordinating, Planning and make
decisions effectively.

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5. Ability to handle stress.
6. Awareness:
Leaders should be aware of the extent of their self- confidence, flexibility,
creativity, friendliness and must also be aware of the group, both individual
members (goals needs, abilities, values as well as his/ her feelings about belonging
to the group.
7. Advocacy:
An effective leader acts as an advocate for nursing staff, patient& nursing
students. An advocate supports, defends and maintain the cause of someone.
8. Intellectual skills
9. Quality of building human relations
10.Willingness to accept responsibilities associated with her profession.
11.Ability to work effectively with others.

Exercise:
1- Differentiate between types of leadership?
2- State the forces affecting leadership styles?
3- Explain the different styles of leadership?

215
 Material resources management
Objectives:

By the end of this lecture, the student will be able to:

1- Define material management, material resources, supplies and equipment.

2- Identify the aim of material management.
3- Explain objective of material management.
4- List elements of materials management system.
5- Explain the process of managing equipment and supplies.
6- Identify the responsibilities of the unit manager regarding material
resources.

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 Material resources Management

The function of materials management is that coordinated function

responsible to plan for, acquire, store, move & control materials to optimize the
usage of facilities and capital funds& to provide customer service in accordance
with organizational goals.
Material management: Is a scientific technique concerned with planning,
organizing g and control of flow of material from their initial purchase to
destination.
Material resources:
Material resources may be define as equipment, apparatus and supplies
procured, stocked& utilized by an organization.
Supplies:
Refers to expendable items. Expendable items are those used periodically &
recorded frequently to maintain sufficient amount on hand E. g. of supplies,
drugs, cotton, antiseptic solutions, cleaning supplies, writing
equipment,……….etc.
Equipment:
Refers to more permanent fixtures & apparatus of a non-expendable nature.
Equipment can be classified into:
1- Fixed equipment:
Fixed equipment refers to objects built into the walls & floors of the hospital
E.g. locker, locker sterilizers.
2- Movable equipment:
Movable equipment includes

217
 A. Equipment that should last for more than 5 years E.g. furniture, stretchers,
wheel chairs……………etc.
B. Equipment having less than 5 years & are capable of being replaced E. g.
syringes , linen ,bed pans ……….etc.
Aim of material management:
To ensure that:
1. The right quality of items
2. The right quantity of material
3. At the right time
4. At the right place
5. At the right cost
Objectives of material management:
1. To ensure that there is adequate stock of items required.
2. Ensures that the resources available are most effectively& efficiently
used.
3. Low purchase price (low cost): to obtain correct quality of material at
the lowest possible price to the hospital.
4. Maintaining continuous supply.
5. Maintaining quality of purchases.
6. Cordial relations with suppliers, good supplier relations also help in
obtaining the supplies on time in case of emergency requirement.
7. Development of vendors: the material department should develop a
number of vendors from time to time to ensure more sources of
supply as well as to reduce purchase cost of materials
8. Product improvement.
9. Interdepartmental harmony.

218
Elements of materials management system:
1. Material planning & programming (writing & adhering to product
specification (proper placement of items).
2. Purchasing.
3. Receiving &warehousing (all supplies).
4. Store keeping.
5. Inventory control.
6. Value analysis & standardization (evaluation all products & services).
7. Production control.
8. Transportation.
9. Material handling.
10.Disposal of scrap & surplus.
All these elements are very much applicable to hospital situation
Process of managing materials (equipment and supplies) :
1- Demand forecasting and planning:
Forecast is an estimate of demand materials expected in the future.
Development of the long term materials plan includes translating the workload
statistics into materials requirements , and projecting other data necessary to
determine the capital funds.
2- Purchasing:
Purchasing acquires materials as required to meet quality and time
schedules. The fundamental activities include selection of acceptable vendors and
negotiation of terms, placing purchase orders considering economic levels, and
expediting deliveries to meet inventory requirements. The aim of the purchasing
department is procurement of items of acceptable quality, in appropriate quantities,
at the minimum price at the right time.

219
3- Receipt & Inspection:
All the stores must be received, verified that they are as per orders, and
stored until required or otherwise disposed. Receipt is the first physical step in
material management.
The following guidelines should be followed:
- Receive the materials at a specified receiving area.
- At the point of delivery, check each item physically and count against
suppliers invoice.
- Check physical condition of materials
- If damage is detected, the transporter& vendor must be notified
immediately.
- Carry out a check against the purchase order; notify purchase section of any
discrepancies immediately.
- Carry out basic documentation immediately
- The receiving corridor should be wide enough to allow uncrating&
unpacking some of the goods before they are taken into the storeroom.
4- Ordering equipment:
Obtaining equipment & supplies from stores usually the senior staff are
authorized to order equipment & supplies as well as completing the order forms.
5- Storing:
It is recording & holding supplies& equipment in a store places, equipment
& supplies are stored in two kinds of places:
A- Stocks: is the main store of equipment & supplies that are kept but not used.
B- Shelves& cupboard: the equipment & supplies ready for use after issuing.
6- Issuing& distribution:
It is giving & holding equipment & supplies in store cupboard.
There are three procedures used in issuing equipment:
211
1- Writing the issuing in the stock book.
2- Issuing a voucher to be signed & include the following data are recorded:
A. Date of issue.
B. What is issued?
C. Where it is to be used?
D. Who is responsible?
E. Signature of person responsible for its use.

3- Inventory list of items that kept for use.

Inventory:
It is a detailed list of all equipment in unit, their specifications & standards
number or quality. The specifications make it possible to identify the article by
size, number or description, the standard indicates the quality of any equipment
that should be kept in the unit, inventory list not only gives an opportunity to
determine whether the standard has been maintained, but it provides a good chance
to dispose of excess & obsolete materials, to recommend changes in standards, to
determine the condition of the equipment, &to order repair or replacement if
necessary.
7- Controlling & maintaining equipment:
Expendable equipment must be controlled to avoid wastage but the non-
expendable equipment must be maintained kept in good working condition.
To conduct & maintain equipment the following skills are needed.
1- Convincing staff of the important of maintenance.
2- Inspection check list what are present & comparing it with the inventory list
of equipment in the unit.
3- Detecting & interpreting discrepancies (is the difference between equipment
entered on the inventory list & the equipment actually present.
8- Minimizing losses and pilferage:

211
 Pilferage is a phenomenon closely associated with materials of all types.
Stores may be pilferage by the transporter, receiving clerk, other stores personnel
and users in wards/ departments. To minimize thefts from stores, access to all
stores buildings and storage should be limited. Locking and unlocking of stores
and the handling of keys should be strictly controlled intense vigilance is
required by all materials personnel.

212
Responsibilities of the unit manager regarding material resources:
1. Supplies & equipment should be checked for specification &quantity when
received from the purchasing department.
2. Supplies & equipment should be inspected to determine completeness,
availability for use, cleanliness, safety & convenience in place.
3. There must casual supervision of staff members to assure that supplies &
equipment are being used for specific & intended purposes.
4. Supplies & equipment should be conveniently located & easily accessible to
all staff members.
5. Staff members who will use the equipment must understand its operation,
purpose &after care.
6. Make provision for ordering on an emergency basis.
7. Quantities of supplies on hand should be checked before recording.

Exercise:

1. Explain objective of material management?

2. Differentiate between supplies & equipment?
3. Explain the process of managing equipment?
4. Identify the responsibilities of the unit manager regarding material
resources?

213
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