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NCM 105

Madeline N. Gerzon, RN, MM
Clinical Instructor
Davao Doctors College
According to Machiavelli….
“There is nothing more
difficult to take in hand, more
perilous to conduct, or more
uncertain in its success, than to
take the lead in the introduction of
a new order of things”
Management Process
Consists of achieving organizational
objectives through planning, organizing,
directing, and controlling human and
physical resources and technology
Management Process


Nursing Buildings Delivery of
Allied health Grounds Quality
Supplies Nursing care
Patients/clients Equipment
Significant others
Nursing Management Process

• Planning
• Organizing
• Directing
• Controlling
Planning: a fundamental process
Planning is having a specific aim or purpose and
mapping out a program or method beforehand
for accomplishment of the goal (Douglas)

Making a plan of action to provide for the

foreseeable future (Fayol)

Planning is deciding in advance what to do, how

to do it, when to do it, and who to do it
Planning: a fundamental process
• Basic function of management
• Systematic process
• Facilitates wise use of resources and
approaches to achieve objectives
• Bridges the gap between where you are and
where you want to go
Planning is determining in advance: -

b) What is to be done?

c) How it is to be done?

d) When it is to be done?

e) Who will do it?

Reasons for Planning
• Planning leads to success in achievement of goals and
• Planning gives meaning to work
• Planning provides for effective use of available
resources and facilities
• Planning helps in coping with crisis
• Planning is cost effective
• Planning based on the past and future helps reduce the
elements of change
• By planning, one can discover the need for change
• Planning is necessary for effective control
Planning Process
Planning Process is consists of five steps

• Assessment of work situation

• Need identification and priority setting
• Management by objectives
• Implementation of the plan
• Evaluation or controlling of the plan
Steps in Planning Process
Assessment of work situation
• Tangible elements (buildings, grounds, equipment)
• Intangible elements (cognitive, affective)
• Environment (source of income, family/community
mores, geographical location, etc)
• Government vs private control (capitation plans)
• Standards (structure, process, outcome)
• Professional standard of care (qualification)
Steps in Planning Process
Need identification and priority setting
• Listing things
• Placing needs in order of priority (depends on level
of management)
• Criteria for determining priority (must and want)
Steps in Planning Process
Management by objectives
• Goals and Objectives (broad, organizational VMG)
• Process of management by objectives
(departmental planning according to objectives)
• Guidelines for MBO (SMART, resources, etc)
Steps in Planning Process
Implementation of the plan
• Developing alternative courses of action
• Nursing care planning (written)
Steps in Planning Process
Evaluation or controlling of the plan
• Results of evaluation or controlling process
• Employee participation ensures control activities
of people to meet objectives
What needs to be planned?
• Budget (finances)
• Organization
• Structure
• Change
• Implementation of change
• Decision-making
What needs to be planned?
• Plan or a schedule adjusting expenses during a
certain period to the estimated or fixed income
for that period (webster)
• Is an operational management plan, stated in
income and expense terms covering all phases
of activity for a future division of time
What needs to be planned?
Key concepts in Budget
• Revenue – income from sale of products or
• Expenses – cost of providing services
• Patient days – used to project revenue
• Fiscal Year – financial year or calendar year
• Product line – units of service
What needs to be planned?

According to Machiavelli….
“There is nothing more difficult to take in
hand, more perilous to conduct, or more
uncertain in its success, than to take the lead in
the introduction of a new order of things”
What needs to be planned?
• Need for change – profit, improve human
work, satisfy economic goals, individual
• Change theory – Lewin’s theory (unfreezing
change, moving change, refreezing change)
• Resistance to change – plan changes,
manage change
Organizing Process
• Is the grouping of activities for the purpose
of achieving objectives, the assignment of
such groupings to a manager with authority
for supervising each group, and the defined
means of coordinating appropriate activities
with other units (horizontally, vertically)
that are responsible for accomplishing
organization objectives
Organizing Process
• Involves deciding the necessary levels
of organization needed to accomplish
the objectives
• Involves putting people where they
will be most useful
• According to Urwick….. Process of
designing the machine
Organizing is the establishment of
relation ship between the

• Activities
• Persons
• Physical factors
• or we can say that organizing
– What tasks are to be done? (Activity)
– Who is to do them? (People)
– What physical resources are required?
– And who reports to whom. (Structure)
Principles of Organizing
• The principle of Chain of Command (authority
and accountability)
• The principle of Unity of Command
(1S+1L+plan=meet objectives)
• The principle of Span of Control (supervise in
terms of number, functions, and geography)
• The principle of Specialization (perform single
leading function)
Five steps in Organizing process
 Division of Labor (assigning amount of task,
time-element, rotation)
 Departmentalization (segmentation of work,
kind of activities)
 Staff positioning (Staff mix, classification of
patient, staff scheduling)
 Assigning authority or Delegation of
power (substitutes, performance of special task)
 Equalizing authority and responsibility
• Placing right people at the right time
• Assigning competent people to fill the
roles designed for the organizational
structure through recruitment,
selection, and development of
• Matching job with the people
Employment procedure
• Recruitment
• Responsibility for selection of nursing
• Induction and orientation
Staff Projection
• Projecting number of nurses needed to provide
care to patients
– Data collection – patient census, ave length of stay,
types of patients, admissions/discharges
– Patient classification –
– Staff mix
– Staff scheduling – work schedule and off meet
organizational goals with fairness and equity
among personnel – centralized or decentralized

Number of patients Minimal Partial Total

Day PM Night Day PM Night Day PM Night

1 0.17 0.14 0.10 0.27 0.15 0.07 0.36 0.30 0.20

2 0.34 0.28 0.20 0.54 0.30 0.14 0.72 0.60 0.40
3 0.51 0.42 0.30 0.81 0.45 0.21 1.08 0.90 0.60
21 3.57 2.94 2.10 5.67 30.15 1.47 7.56 6.30 4.20
22 3.74 3.08 2.20 5.94 3.30 1.54 7.92 6.60 4.40
23 3.91 3.22 2.30 6.21 3.45 1.61 8.28 6.90 4.60
24 4.08 3.36 2.40 6.48 4.00 1.68 8.64 7.20 4.80

Day shift
3 required minimal care 3 x 0.17 = 0.51
14 required partial care 14 x 0.27 = 3.78
5 required total care 5 x 0.36 = 1.80
Total # of nursing personnel 6.09
Needed to staff day shift
Modes of Organizing Patient Care

• Total Patient Care Nursing or Case Method

• Functional Nursing
• Team and Modular Nursing
• Primary Nursing
• Case management
Modes of Organizing Patient Care

Total Patient Care Nursing or Case Method

• Nurse assumes total responsibility
• Requires highly skilled personnel
• Disadvantage: if nurse is inadequately
Modes of Organizing Patient Care

Functional Nursing
• Evolved because of shortage
• Care through others
• Economical
• Allow care to be provided with min
registered nurses
• May lead to fragmented care and
overlooking patient priority needs
Modes of Organizing Patient Care

Team and Modular Nursing

• To decrease problems in FN
• Ancillary personnel collaboration
• Communication is important
• Associated with democratic leadership
Modes of Organizing Patient Care

Primary Nursing
• Relationship-based nursing
• Brought back nurse to bedside
• Also useful in other health hospices
• Requires high degree of responsibility and
• Disadvantage: inadequately prepared nurse
Modes of Organizing Patient Care

Case management
• Latest work design
• Collaborative process
Nurse Scheduling Challenges
• 24/7 coverage needed
• Workload varies by shift by skill level by unit
• Rotation to off-shifts?
• Multiple skill levels (RN, LPN, aide, etc.)
• Covering weekends
• Shortage of personnel
• Dealing with daily fluctuations in supply &
– OT, agency, part-time, float on/off unit, contingent,
send home, call-in
• Directing is the issuance of assignments,
orders, and instructions that permit the
worker to understand what is expected of
him/her, and the guidance and overseeing of
the worker so that he or she can contribute
effectively and efficiently to the attainment
of organizational objectives

• Interpersonal relationships and

communication are functions of
• “Command” and “coordination”
Directing and Nursing Management

• Directing is a physical act of nursing

management, the interpersonal process
by which nursing personnel
accomplish the objectives of nursing
• Process of applying the management
plans to accomplish nursing objectives
Elements of Directing

• Motivation
• Leadership
• Communication

As a nurse manager…..

• A major component of directing

• Managers get the work done through
the employees
• A solution to prevent overwork –
stress, anger, and aggression
Reasons for Delegating
• Assigning routine tasks
• Assigning tasks for which the nurse
manager does not have time
• Problem solving
• Changes in nurse manager’s own job
• Capability building
Techniques for Delegating

• Prepare list of duties to be delegated

• Duties ranked according to time
required to perform them
• Delegate one duty at a time
What not to delegate
• Power to discipline
• Responsibility for maintaining morale
• Overall control
• “hot potato”
• Too technical jobs
• Duties involving trust and confidence
• Verifying if everything occurs in
conformity with the plan adopted, the
instructions issued, and principles
established (Fayol)
• Seeing that everything is being carried
out in accordance with the plan

• Measurement and correction of the

performance in order to make sure that
the organization meets its objectives
and plans

In controlling function

“Administrative reviews, regulates and

controls performance to ensure that it
confirms to certain standards”
Principles of controlling

• Principle of uniformity
• Principle of comparison
• Principle of exception
Controlling and Nursing
• Major function of nursing management

• Includes coordination of numerous

activities, decision-making r/t planning
and organizing of activities
Controlling and Nursing
• Also refers to records, reports,
organizational progress towards aims
and effective use of resources
Controls as management tools

• Observations, patient charts, patients

sources of data
• Corrective actions can be corroborative,
disciplinary or educational
• Communication as information is
essential to control
10 characteristics of good control
• Must reflect the nature of activity
• Must report errors promptly
• Should be forward-looking
• Should point out exceptions at critical points
• Should be objective
• Should be flexible
• Should reflect organizational pattern
• Should be economical
• Should be understandable
• Should indicate corrective action
Controlling mechanisms
• Accreditation procedures
• Consultants
• Evaluation devices
• Rounds
• Reports
• Inspections
• Nursing audits
Methods of measurements

• Task analysis – nurse manager studies

process of giving nursing care

• Quality control – concerns

measurement of quality and effects of
nursing care
Control - Standards

• System of evaluation

• Yardsticks to measure the quantity and

quality of service
Control - Standards

• Performance standards

• Performance evaluation and quality

Controlling techniques

• Nursing rounds

• Nursing operating instructions

• Gantt charts (show on board)

Controlling Approaches

• TQM – Total quality management


• Nursing audits

• QMS, QA – quality management

system, quality assurance
In controlling function

“Administrative review, regulates and

controls performance to ensure that it
confirms to certain standards”

In leading function guide and supervise

subordinates to fulfill objective established
in planning function
Leading is divided into five steps
1. Supervision
2. Motivation
3. Communication
4. Bringing about change
5. Managing conflict
Mistakes Managers Make
1. Insensitive to others
2. Cold, aloof, arrogant
3. Betrayal of trust
4. Overly ambitions
5. Specific performance problems with the business
6. Overmanaging: unable to delegate or build a team
7. Unable to staff effectively
8. Unable to think strategically
9. Unable to adapt to boss with different style
10. Overdependent on advocate or mentor

The First Year Management
Initial Assumptions Reality

 Exercise formal authority  Cannot be “bossy”

 Manage tasks,  Manage people,
not people not tasks
 Help employees  Coach employee
do their jobs performance
 Hire and fire  Fast pace,
heavy workload

Conflict Management
• Relates to feelings, including feelings of neglect,
of being viewed as taken for granted, of treated
like a servant, being ignored, being overloaded…
• Results in overt behavior like brooding, arguing or
• In itself is neither functional (beneficial) or
dysfunctional (harmful)
Conflict management
• Can threaten harmony and balance in the
• Can also be desirable and useful depending
on how it is managed
Attitudes toward Conflict

Bureaucratic or conservative
• Conflict is unnecessary and harmful
• Reflects failure in planning and control
• Equates it to trouble, fight, unpleasant argument,
pain and tension
• Treat it with repressive and disapproving climate
Attitudes toward Conflict

Human relations approach

• Normal and frequent (human needs)
• Some conflict is desirable – search for solution =
• Concerned with human communication – resolve
• Recognize and minimize conflict to minimize
harmful aspects and maximize its benefits
Kinds of Conflict
• Conflict within individual
• Conflict between health organizations
• Conflict within health organizations
Kinds of Conflict
Conflict within individual
• Uncertainty about work expectations
• When confronted with ethical issues
• Role conflict
• Work overload
• Personal independence and conformity to
demands of organization
• Expectations exceed capability – “bluff”
Kinds of Conflict
Conflict between health organizations
• Completion of buildings
• Kinds of services
• Kinds of facilities
Kinds of Conflict
Conflict within health organizations
• Differences between management and staff
• Shared resources
• Work interdependence
• Differences in goals and values
Consequences of Conflict
• Issues as recognized and brought out in the
• Rise in group cohesion and performance
• Poor performance
• Constructive or destructive results
• Rise of leaders or new leaders
Conflict resolution
• Dominance and suppression
• Restriction
• Smoothing
• Avoidance “mutual admiration society”
• Majority rule
• Compromise “settling differences”
• Integrative problem solving
Passive, aggressive and assertive
Passive behavior
• Submissive, second-class employees
• Unable to exert influence
• Apologetic
• Avoids direct confrontation
• Feelings of helplessness and powerlessness
• Engages in self-pity
Passive, aggressive and assertive
Aggressive behavior
• Bold, attacking, hostile manner
• Accomplish purpose at expense of others
• Disagreeing, unpleasant
• Blaming, shaming, refusing to take “no”,
belittling remarks
• Humiliating and embarrassing others
• Stomping feet, banging doors, cursing,
slamming phone and crying
Passive, aggressive and assertive
Assertive behavior
• Maintaining balance between passive and
• Expressing positive and negative beliefs
• Makes choices about how, when, where,
how, who and why actions were taken
• Initiate and terminate conversation with
confidence, acts in best interest of self,
patient and members of health team
Figure: Management Skill Mixes Different
Organizational Levels
Conceptual Skills Diagnostic Skills

Top Managers



Technical Skills interpersonal Skills