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NURSING MANAGEMENT

PROCESS

PREPARED BY:
Aleli R. Cheng,RN,MAN
NURSING MANAGEMENT

Is the process of working through staff members to


be able to provide comprehensive care to the patient
This includes planning, organizing, directing and
controlling
The task of the nurse manager is to plan, organize,
direct and control available financial, material, and
human resources in order to provide effective,
economic care to groups of patients
NURSING MANAGEMENT PROCESS
NURSING MANAGEMENT PROCESS
Purpose of the Nursing Management Process

To achieve scientifically based, holistic,


individualized care for the patient

To achieve the opportunity to work collaboratively


with patients and others

To achieve continuity of care


Characteristics of the Nursing Management
Process
Systematic
Dynamic
Interpersonal
Goal Directed
Universally Applicable
PLANNING

Management function
Nursing management process
PLANNING

Is deciding in advance what to do, how to do a


particular task, when to do it, and who is to do it.

Is predetermining a course of action in order to


arrive at a desired results. It is the continuous
process of assessing, establishing goals and
objectives and implementing and evaluating them,
which is subject to change as new facts are known
COMPONENTS OF PLANNING

PLANNING:
PREDETERMINED
ACTION

HOW TO DO IT: WHO IS TO DO IT:


WHAT TO DO:
-technique, -professional, non-
-nursing activities
principles professional
Nursing management
-planning-

PRINCIPLES OF PLANNING
1. Planning is always based and focused on the vision, mission,
philosophy, and clearly defined objectives of the organization.
2. Planning is a continuous process.
3. Planning should be pervasive within the entire organization
covering the various departments, services and the various levels
of management to provide maximal cooperation and harmony.
4. Planning utilizes all available resources.
5. Planning must be precise in its scope and nature.
6. Planning should be time bounded.
7. Projected plans must be documented for proper dissemination
to all concerned for implementation and implementation as to
the extent of its achievement.
PLANNING

It leads to success in the achievements of goals and


objectives
It provides meaning to work
It provides for the effective use of available personnel and
facilities
It helps nurses cope with crises and problems calmly and
efficiently
It is cost effective
It is based on past and future activities
It reduces the element of change
It is necessary for effective control
Characteristics of a GOOD PLAN

It should have a clearly worded objectives, including


results and methods for evaluation
Be guided by policies and/or procedures affecting the
planned action
Indicate priorities
Develop actions that are flexible and realistic in terms
of available personnel, equipment, facilities and time
Develop a logical sequence of activities
Select the most practical methods for achieving each
objective
PLANNING

TYPES OF PLANNING:

1. STRATEGIC OR LONG-RANGE PLANNING


what are the right things to do
- usually extending 3 to 5 years into the future.

2. OPERATIONAL OR SHORT-RANGE PLANNING


how does one do things right
- deals with day to day maintenance activities.

3. CONTINUOUS OR ROLLING PLANS


- similar to operating plans, involves mapping out the day-
to-day activities.
ELEMENTS OF PLANNING

Forecasting or Estimate the future


Set Objectives/Goals and Determine Results Desired
Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame
Prepare the Budget and Allocation of Resources
Establish Policies Procedures and Standards
Elements of Planning
-Forecast or Estimate the Future-
Forecasting is looking into the future
Refers to estimation of time series, cross sectional or
longitudinal data
In making forecast, the planner should consider 3
things:
Agency
Community affected
Goals of care
Forecast must be supported by facts, reasonable
estimates and accurate reflection of policies and
plans
Elements of Planning
Set Objectives/Goals and Determine Results Desired
GOALS are broad statements of intent derived from the
purposes of the organization
Is a desired aim or condition toward which one is willing to work
Individual goals- are personal goals; based on ones desired in life
Group goals- may refer also to organizational goals although on a
smaller scale
Organizational goals- management goals of an organization that
are established to justify its existence
Short term goals and long term goals
Objectives

The objectives of the Nursing Department is congruent to its


vision as well as to the 11 key areas of responsibilities to nursing
practice:
To observe ethical principles and standards that govern nursing
practice. (ethico-moral-legal responsibilities)
To establish well coordinated referral system for the continuity of
patients/ clients care. (communication)
To assure the application of acceptable performance of functions,
duties, and responsibilities of every position in the nursing
department. (safe & quality nursing care, management of
resources)
To encourage its nursing personnel to participate in nursing
research for improving nursing care. ( research)
To utilize media for information campaign to intensify health
education program. (health education)
Nursing management
- ELEMENTS OF PLANNING-

MISSION OR PURPOSE

- The mission statement outlines the agencys


reason for existing ( whether hospital or health care),
who the target clients are ( the poor, the needy, the
middle or upper class), and what services will be
provided ( in-patient, out-patient, emergency).
- reason for the existence of the organization
(Nursing service exist to promote and maintain
health)
Vision

The Board of Nursing under the guidance of


the Almighty, with its unquestionable
integrity and commitment, envisions itself to
be the ultimate authority in regulating the
nursing profession in the Philippines and to
lead nursing development to its highest level
of excellence.
Mission

The BON shall unwaveringly pursue the advancement


of nursing development in the country by:
1. providing leadership, information, options,
scenarios and lobby efforts to targeted
decision makers and stakeholders
2. ensuring adherence to professional, ethical
and legal standards as mandated by existing
regulatory laws
3. unifying the nursing sector through good
governance
4. fostering linkages with the domestic and
international stakeholders
Nursing management
- ELEMENTS OF PLANNING-

PHILOSOPHY

- Philosophy is the sense of purpose of the organization and


the reason behind its structure and goals.

- Philosophy states the beliefs that influence nursing practice


and beliefs about health care.
POLICIES

Policies in general, they are guidelines to help in the


safe and efficient achievement of organizational
objectives

PROCEDURES

Procedures are specific directions form


implementing written policies
Nursing management
- ELEMENTS OF PLANNING-

Develop and Schedule Strategies,


Programs/Projects/Activities; Set the Time
Frame

Strategy is the techniques, methods, or procedure


by which the overall plan of the higher management
achieve desired objectives.

Programs are activities put together to facilitate


attainment of some desired goals.
Nursing management
PLANNING

Time Management is a technique for allocation of


ones time through the setting of goals, assigning
priorities, identifying and eliminating time wastes
and use of managerial techniques to reach goal s
efficiently
Nursing management
PLANNING

Principles of Time Management


1) Planning for contingencies-planning anticipates the
problem that will arise from actions without thought
2) Listing of task-task to be accomplished should be done in
sequence which are prioritized according to importance
3) Inventory
4) Sequencing
5) Setting and keeping deadlines- and adhering to deadline
is an excellent exercise in self discipline
6) Deciding on how time will be spent
Nursing management
PLANNING

Time Saving Techniques, Devices and Methods to Better Use of Time

1. Conduct an inventory of your activities.


2. Set goals and objectives and write them down.
3. With the use of calendars, executive planners, logs or journals, write what
you expect to accomplish yearly, monthly, weekly or daily.
4. Break down large projects into smaller parts.
5. Devote a few minutes at the beginning of each day for planning.
6. Organize your work space so it is functional.
7. Close your door when you need to concentrate.
8. Learn to delegate.
9. In a meeting, define the purpose clearly before starting.
10.Take or return phone calls during specified time.
11. Develop effective decision-making skills.
12. Take rest breaks and make good use of your spare time.
Nursing management
PLANNING

Multitasking
Trying to get more things done in less time
Examples: answering phone calls while driving, sending e-
mails while in the meeting
Nursing management
PLANNING

DEVELOPING AND SCHEDULING PROGRAMS


Programs are predetermined, developed and targeted
within a time frame to reach the set goals and objectives.

The Planning Formula


1. WHAT
2. WHEN
3. WHERE
4. HOW
5. WHO
6. WHY
7. CAN
Nursing management
PLANNING

PREPARING THE BUDGET


1. A budget is the annual operating plan, a financial road
map and plan which serves as an estimate for future
costs and a plan for utilization of manpower, material
and other resources to cover capital projects in the
operating programs.
2. A nursing budget is a plan for allocation of resources
based on preconceived needs for a proposed series of
programs to deliver patient care during one fiscal year.
3. A hospital budget is a financial plan to meet future
service expectations.
Factors in BUDGET planning

Type of patient, length of stay in the hospital and


acuteness of illness
Size of hospital and bed occupancy
Physical lay out of the hospital, size and plan of the
wards, units, nurses station, treatment rooms, etc
Personnel policies
Salaries paid to various type of nursing personnel including OT
pay or shift differential
Extent of VL, SL, holidays
Provision for staff development programs
Grouping of patients such as those in specialized
areas
Factors in BUDGET planning

Standards of nursing care: kind and amount of care


to be given as it affects the number of hours of
bedside care
The method of performing nursing care whether
simple or complex; the method of documentation
Proportion of nursing care provided by the
professional nurses and those given by non-
professionals
Amount and quality of supervision available and
provided; the efficiency of job description and job
classification
Factors in BUDGET planning

Method of patient assignment whether functional,


case, team or primary
Amount and kind of labor-saving devices and
equipments
Amount of centralized service provided: sterile
supply , central o2 supply, linen supply
Nursing service requirements of the ancillary
departments: clinics, admitting office, ER
Reports required by administration whether simple
or complex
Affiliation of nursing students or medical students
Establishing Nursing Standards, Policies and
Procedures
Nursing Standards
Standard- a practice that enjoys general recognition and
conformity among professionals or an authoritative statement
by which quality of practice or education can be judged
Nursing Care Standard a descriptive statement desired
quality against which to evaluate nursing care
Purpose of nursing standards
Improved quality of care
Decrease the cost of nursing care
Determine nursing negligence
Sources of nursing standards
DOH, BON, Professional Organization, Nursing Programs
Establishing Nursing Standards, Policies and
Procedures
Nursing Service Policies
Policies in general are guidelines to help in safe and efficient
achievement of organizational objectives
There are 3 general areas in nursing which requires policy
formulation. These are:
Areas in which confusion about the locus of responsibility might
result in neglect or malperformance of an act necessary to a
patients welfare
Areas pertaining to the protection of patients and families rights
as right to privacy and right to property
Areas involving matters of personnel management and welfare
Establishing Nursing Standards, Policies and
Procedures
Nursing procedures
Procedures are specific directions for implementing written
policies

Procedures are more specific guide to action than policy


ORGANIZING

Nursing management FUNCTION


NURSING MANAGEMENT PROCESS
Nursing management
- ORGANIZING -

ORGANIZING is the process of establishing formal authority


Involves setting up the organizational structure through identification of
groupings, roles and relationships
Determines staff needed through developing and maintaining staffing
patterns and distributes them in the various areas as needed
Develops job descriptions by defining the qualifications and functions of
personnel
Organizing

Organizing is one way which nursing management


coordinates the various activities of a department or
a unit so that the staff can get its work done in an
orderly fashion
Organizing means having qualified people and the
right materials, information and equipment needed
to deal with contingencies
Nursing management
- ORGANIZING -

PRINCIPLES OF ORGANIZATION:
Communication: effective and open communication in all
forms; thread that binds the organization together
Directions of communication:
Downward
Upward
Lateral/Horizontal
Grapevine
Unity of Command
Span of Control
Delegation of authority
Similar Assignments
Unity of Purpose
ORGANIZATIONAL DESIGN

Organizational design is a
formal, guided process for
integrating the people,
information and technology
of an organization.
PRINCIPLES OF ORGANIZATIONAL
DESIGN

1. Division of labor
2. Unity of command
3. Authority and responsibility
4. Span of Control
5. Contingency Factors
Nursing management
- ORGANIZING -

ELEMENTS OF ORGANIZING
1. Organizational Structure
2. Staffing
3. Scheduling
4. Developing job descriptions
Importance of organizational structure

It enables members what their responsibilities are so


that they may carry them out
It frees the manager and the individual workers to
concentrate on their respective roles and
responsibilities
It coordinates all
Nursing management
- ORGANIZING -

ORGANIZATIONAL STRUCTURE

The organizational structure refers to the


process by which a group is formed its channel of
authority, span of control and lines of
communication.
It is the formal structure, the official arrangement of
positions or working relationships that will coordinate
efforts of workers of diverse interest and abilities
Patterns of Organizational Structure

Tall or Centralized Structure


Flat or Decentralized Structure
TALL OR CENTRALIZED STRUCTURE

Responsible for only a few


subordinates, so there is a
narrow span of control
Because of the vertical nature of
the structure, there are many
levels of communication
TALL OR CENTRALIZED STRUCTURE
Advantage Disadvantage
It makes use of expertise, Transpires that the most
and allows close skilled individuals end up
communication between doing nothing while actual
the workers. tasks are done by those
Supervisory individuals less capable.
screen the Communication from
communication. bottom to top is often
difficult, and messages do
not get to the top
Workers tend to be very
boss-oriented because of
the close contact with their
supervisor.
Flat or Decentralized Structures

Refers to an organizational
structure with few or no
levels of intervention
between management and
staff.
Flat or Decentralized Structure
Advantages Disadvantages
Lower likelihood of Supervisor spend less
messages being distorted time with each worker
Workers develop own Supervisors may lack
abilities and autonomy expertise in the variety of
and able to see the operations and may end
organization as up making inappropriate
humanistic resulting in decisions
greater job satisfaction
The principle of shared
governance produces
maximum potential for
professional growth
Nursing management
- ORGANIZING -

Types of Organization Classified by Nature of Authority

1) Line Organization- each position has general authority


over the lower positions in the hierarchy. (also known as
Bureaucratic/Pyramidal)
2) Informal Organization- refers to horizontal relationship
rather than vertical.(Flat or horizontal organization)
3) Staff Organization- purely advisory to the line structure
with no authority to put recommendations into action.
4) Functional Organization each unit is responsible for a
given part of the organizations workload.
TYPES OF ORGANIZATIONAL STRUCTURE

1) Line Organization/
Bureaucratic/ Pyramidal
- shows that each position
has general authority over
the lower position of the
hierarchy.
- ARA and power are
concentrated at the top.
TYPES OF ORGANIZATIONAL STRUCTURE

2. Flat Organization
- refers to an
organizational structure
with few or no levels of
intervention between
management and staff.
TYPES OF ORGANIZATIONAL STRUCTURE

3. Staff Organization
- purely advisory to the
line structure with no
authority to place
recommendations into
action.
TYPES OF ORGANIZATIONAL STRUCTURE

4. Functional Organization
- permits a specialist to
aid line position within a
limited and clearly
defined scope authority.
ORGANIZATIONAL RELATIONSHIP

1. FORMAL
RELATIONS
2. INFORMAL
RELATIONS
ORGANIZATIONAL RELATIONSHIP

1. FORMAL
RELATIONS
- represents by
uninterrupted lines
between units, showing
who reports to whom.
ORGANIZATIONAL RELATIONSHIP

2. INFORMAL
RELATIONS
- represented by a
broken or dotted line,
where power
relationships are
coordinated.
Nursing management
- ORGANIZING -

ORGANIZATIONAL CHART

- Organizational chart is a line drawing that


shows how the parts of an organization are linked.
Nursing management
- ORGANIZING -

Characteristics of an Organizational Chart

1) Division of Work
2)Chain of Command
3)Type of Work to be performed
4)Grouping of Work Segment
5) Levels of Management
Nursing management
- ORGANIZING -

STAFFING

Staffing is the process of determining and


providing the acceptable number and mix of nursing
personnel to produce a desired level of care to meet
the patients demand.
The process of assigning competent people to fill the
roles designated for the organizational structure
through recruitment, selection and development.
- STAFFING -

FACTORS AFFECTING TIME REQUIREMENT


OF NURSING CARE
Patients acuteness of illness
Degree of dependence

Communicability of ailment
Steps in Staffing

Determine the Number and


Types of Personnel Needed
Recruitment
Interview
Induct or Orient the
Personnel in Organization
Job Offer
Centralized Staffing

Staffing decisions for all units


are made by a central office or
computer.
Tends to be fairer to employees,
because policies are
implemented more consistently
and impartially.
Frees manager to complete other
functions.
Most cost effective, because it
maximizes use of human
resources organization-wide.
Decentralized Staffing

Staffing is done at unit level, frequently by


unit manager.
Allows person who knows the individual
unit the best to make staffing decisions for
that unit.
Allows staff to take requests directly to their
own manager, which gives them increased
autonomy and flexibility.
Increases the risk that employee requests
may be treated unequally or inconsistently.
Time-consuming for unit manager.
NURSING CARE MODALITIES
TOTAL CARE or CASE NURSING
One nurse is assigned to one
patient for totality of care
during his or her time on duty
PDN
Isolation nurse
Nursing student
NURSING CARE MODALITIES

FUNCTIONAL Nursing
Task-oriented
Particular nursing function is assigned to
each nurse
Time saving
Worker learns w/ mastery
-Medication nurse
-Charge nurse
-Nursing attendant
Nursing Care Modalities

PRIMARY Nursing
Nurse is responsible for the total
care of a small group of clients from
admission to discharge
Nursing Care Modalities

TEAM Nursing
The team leader assigns patients &
tasks according to job descriptions
PATIENT CLASSIFICATION SYSTEM

1. Self care or Minimal Care


Patients
2. Intermediate or Moderate
Care
3. Total Care Patients
4. Intensive Care Patients
PATIENT CLASSIFICATION SYSTEM
1. Self care or Minimal Care
Patients
capable of carrying activities
of daily living (ADL)
Convalescing, no longer
require intensive, moderate,
or maximum care
Require dx studies,
Minimal therapy
Awaiting elective surgery,
Home environment
temporarily makes
discharge undesirable
PATIENT CLASSIFICATION SYSTEM
2. Intermediate or Moderate Care
requires some help from the
nursing staff with special
treatments.
Given to moderately ill
Recovering from immediate effects
of a serious illness or operation
May be ambulatory for short
periods (needs assistance)
PATIENT CLASSIFICATION SYSTEM

3. Total Care Patients


those who are bedridden
and who lack strength and
mobility to do average daily
living.
Needs close attention
Requires nurse to initiate,
supervise, and perform most
of the activities
Requires frequent medication
PATIENT CLASSIFICATION SYSTEM
4. Intensive Care Patients
those who are critically ill
and in constant danger of
death or serious injury.
Acutely ill patients w/
high level of nurse
dependency
Unstable condition w/c
requires frequent evaluation
with adjustment of therapy
Nursing management
- STAFFING -

STAFFING FORMULA
Requirements:
STANDARD VALUE OF NURSING CARE

Cases / Patients NCH/pt/day Prof. to Non-Prof


Ratio

i. Surgery 3.4 60:40


ii. General Ward 3.5 60:40
iii. Pediatric 4.6 70:30
iv. Pathologic Nursery 2.8 55:45
v. Medical 3.4 60:40
vi. OB 3.0 60:40
vii. ICU/ER/RR 6.0 70:30
viii.CCU 6.0 80:20
Nursing management
- STAFFING -

Distribution Per Shift

SHIFT PERCENTAGE
AM 45 %

PM 37%

NIGHT 18%
Nursing management
- STAFFING -

CATEGORIES OF PATIENT
Levels of Care NCH Needed /pt./ Prof: Non Prof
day
Level I 1.50 55:45
Self-Care or Minimal
Care

Level II
Moderate or 3.0 60:40
Intermediate Care

Level III 4.5 65:35


Total or Intensive Care

Level IV 6.0 70:30


Highly Specialized
7.0 or higher 80:20
or Critical Care
Nursing management
- STAFFING -

PERCENTAGE OF PATIENTS IN VARIOUS


LEVELS OF CARE
Type of Hospital Minimal Moderate Intensive Highly
Care Care Care Spl. Care

Primary Hospital 70 25 5 -

Secondary Hospital 65 30 5 -

Tertiary Hospital 30 45 15 10

Special Tertiary 10 25 45 20
Hospital
Nursing management
- STAFFING -

TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND


HOURS OF NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Working Hours per Week
Personnel/Yr 40 hours 48 hours
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off Duties as per R.A. 5901 104 52
7. Continuing Education 3 3
Program

Total Non-Working Days/Year 152 100


Total Working Days/Year 213 265
Total Working Hours / Year 1,704 2,120
RA 5901 = 40H WK LAW
Nursing management
- STAFFING -

Steps for Computing the Staff Needed in the in-patient


Unit of the Hospital
COMPUTATION:
CASE: 250 BED CAPACITY TERTIARY HOSPITAL.
HOW MANY STAFF NURSES DO WE NEED?
1. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE
250 X 30% = 75 minimal care
250 X 45% = 112.5 moderate care
250 X 15% = 3.5 intensive care
250 X 10% = 25 highly specialized
nursing care
Nursing management
- STAFFING -

2. FIND THE NURSING CARE HOURS (NCH)


NEEDED
75 X 1.5 (NCH @ Level I) = 112.5 NCH/day
112.5 X 3 (NCH @ Level II) = 337.5 NCH/day
37.5 X 4.5 (NCH @ Level III) = 168.75NCH/day
25 X 6 (NCH @ Level IV) = 150 NCH/day
-------------------
768.75 NCH/DAY
Nursing management
- STAFFING -

3. FIND NCH PER YEAR

768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR

4. FIND ACTUAL WORKING HOURS NEEDED BY


EACH NURSING PERSONNEL / YEAR

8 ( hrs/day ) X 213 (WORKING DAY/YEAR)=


1,704 ( working hrs/year )
Nursing management
- STAFFING -

5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL


NEEDED.

a. TOTAL NCH/ YEAR = 280,593.75 = 165


WORKING HRS / YEAR 1,704

b. RELIEF x TOTAL NSG PERSONNEL


165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)

c. RELIEVERS + TOTAL # OF NURSING PERSONNEL


NEEDED
165 + 25 = 190 TOTAL PERSONNEL NEEDED
Nursing management
- STAFFING -

6. DETERMINE PROF FROM NON PROF


PERSONNEL

e.g. tertiary hospital

190 X 65% = 124 PROFESSIONAL


190 X 35% = 68 NON PROFESSIONAL
Nursing management
- STAFFING -

7. DISTRIBUTE PER SHIFT

PROFESSIONAL(124) NON PROFESSIONAL(66)


AM (45%) 56 30

PM (37%) 46 24

NIGHT (18%) 22 12
Nursing management
- STAFFING -

Placement of Staff
proper placement:
a. fosters personal growth
b. provides a motivating climate for the employee
c. maximizes productivity
d. organizational goals have better chances of being met
inappropriate placement:
a. frustration
b. poor quality of work
c. reduced organizational efficiency
d. rapid turn-over
e. poor image for the agency
RA 9173 nurses with Masters degree in Nursing are easily placed in position
Nursing management
- STAFFING -

SCHEDULING
A schedule is a timetable showing planned work
days and shifts for nursing personnel.

Factors to Consider in Making a Schedule


1. Different levels of the nursing staff
2. Adequate coverage for 24 hours, 7 days a week
3. Staggered vacations and holidays
4. Weekends
5. Long stretches of consecutive working days
6. Evening and night shifts
7. Floating
Nursing management
- STAFFING -

Assessing a Scheduling System

1. Ability to cover the needs of the shift


2. Quality to enhance the nursing personnels knowledge,
training and experience
3. Fairness to the staff.
4. Stability
5. Flexibility
Nursing management
- STAFFING -

Types of Scheduling

1. Centralized Schedule
2. Decentralized Schedule
3. Cyclical Schedule
Nursing management
- STAFFING -

SCHEDULING VARIABLES
a. Length of scheduling period whether 2 or 4 weeks
b. Shift rotation
c. Week-ends off
d. Holiday off
e. Vacation leave
f. Special days
g. Scheduled events in the hospital , training programs, or
meetings
h. Job categories
i. Continuing professional education (CPE) programs
Nursing management
- STAFFING -

DEVELOPING JOB DESCRIPTION

Job Description is a statement that sets the duties and


responsibilities of a specific job.

Contents of a Job Description


1. Identifying Data
2. Job Summary
3. Qualification Requirements
4. Job Relationships
5. Specific and Actual Functions and Activities
Nursing management
- STAFFING -

Uses of Job Description


1. For recruitment and selection of qualified personnel
2. To orient new employees to their jobs
3. For job placement, transfer or dismissal
4. As an aid in evaluating the performance of an employee
5. For budgetary purposes
6. For determining departmental functions and relationships to
help define the organizational structure
7. For classifying levels of nursing functions according to skill
levels required.
8. To identify training needs
9. As basis for staffing
10.To serve as channel of communication.
Nursing management
- DIRECTING -

DIRECTING
Plan put into action
Activities
Delegation transferring responsibility
Updating policy
Utilize the policy updates
Supervision
Roles in Supervision
Guides
Direct
Facilitates
Motivates
Teaches
Nursing management
- DIRECTING -

Principles of Delegation
1. Select the right person to whom the job is to be
delegated.
2. Delegate both interesting and uninteresting tasks.
3. Provide subordinates with enough time to learn.
4. Delegate gradually.
5. Delegate in advance.
6. Consult before delegating.
7. Avoid gaps and overlaps.
Nursing management
- DIRECTING -

What Cannot be Delegated

1. Overall responsibility, authority and accountability for


satisfactory completion of all activities in the unit.
2. Authority to sign ones name is never delegated
3. Evaluating the staff and or taking necessary corrective or
disciplinary action.
4. Responsibility for maintaining morale or the opportunity
to say a few words of encouragement to the staff
especially the new ones.
5. Jobs that are too technical and those that involve trust
and confidence.
Nursing management
- DIRECTING -

Four Rights of Delegation


1. task
The right task should be within the scope of the persons
practice and consistent with the job description.
2. person
The right person should have the appropriate license or
certificate, job description.
3. communication
The right communication should be clear, concise, complete
and correct.
4. feedback
The right feedback should ask for input, get the persons
recommended solution to the problem and recognize the persons
effort.
Nursing management
- DIRECTING -

Aspects of Delegation
1. Responsibility denotes obligation
2. Authority the power to make final decisions and
give commands.
3. Accountability refers to liability
Nursing management
- DIRECTING -

COMMUNICATION
Communication is the transmission of information,
opinions, and intentions between among individuals.

Purpose of communication
1. facilitates work
2. increases motivation
3. effects change
4. optimizes patient care
5. increases workers satisfaction
6. facilitates coordination
Nursing management
- DIRECTING -

Types of Communication
1. Verbal Communication
2. Written Communication
3. Non-verbal Communication
a. Personal appearance
b. Intonation of the voice
c. Facial expression
d. Posture and gait
e. Touch
Nursing management
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Lines of Communication
UPWARD
to superior

HORIZONTAL OUTWARD
NURSES
to peers and to patient, family
members of the and community
Health Team to workers family
and friends
DOWNWARD
to subordinates
Nursing management
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DECISION MAKING
Decision is a course of action that is consciously chosen from
available alternatives for the purpose of achieving a desired
result.
5 Steps in Decision Making
1. definition of the problem
why the problem occur
2. analysis of the problem
getting to the cause of the problem
3. development of an alternative solution
search for and analysis of alternatives and their possible
consequences
4. selection of the solution
weighing of facts and exploring alternative solutions
5. implementation and follow-up
Nursing management
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Major Management Functions in Implementing


Decisions
1. Planning which entails consideration and selection of
realistic objectives, policies and procedures.
2. Organizing which means helping personnel
understand the decision and the procedures necessary
for implementing the decision.
3. Staffing or the selection of the right person/s to carry
out the decision
4. Controlling the environment and the group to prevent
adverse effects.
Nursing management
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Art of Decision Making:


1. Not making decision that others should make, to
preserve morale and authority;
2. Not deciding on problems that are not pertinent to
matters at hand to prevent waste of time and energy;
3. Not deciding prematurely to prevent prujudice
4. Not making ineffective decisions to avoid losing the
respectability of the decision maker.
Nursing management
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CONFLICT MANAGEMENT

CONFLICTS clash, fight, battle or struggle; it may be


constructive or destructive

Basis of the Conflict


1. Intrapersonal
2. Interpersonal
3. Group
4. Intergroup
5. Organizational
Nursing management
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Sources of the Conflict


Cultural differences
Different facts
Separate pieces of information
Different perception of the event
Defining the problem differently
Divergent views of power and authority
Role conflicts
Number of organizational levels
Degree of association
Parties dependent on others
Competition for scarce resources
Ambiguous jurisdictions
Need for consensus
Communication barriers
Separation in time and space
Accumulation of unresolved conflit
Nursing management
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Types of Conflict
1. Intrasender
- conflict originates in the sender who gives conflicting
instructions.
2. Intersender
- conflict arises when an individual receives conflicting
messages from two or more sources.
3. Interrole
- conflict can occur when an individual belongs to more than
one group.
4. Person-role
- conflict is the result of disparity between internal and
external roles.
Nursing management
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5. Interperson
- conflict is common among people whose positions require
interaction with other persons who fill various roles in the same
organization or other organizations.
6. Intragroup
- conflict occurs when the group faces a new problem.
7. Intergroup
- conflict is common where 2 groups have different goals and can
achieve their goals only at the others expense.
8. Role Ambiguity
- a condition in which individuals do not know what is expected on
them.
9. Role Overload
- the person is simply unable to accomplish so much within a limited
time period.
Nursing management
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Conflict Resolution
1. Avoidance
- used by groups who do not want to do something that
may interfere with their relationship
2. Accommodation
- self-sacrifice
3. Collaboration
- inspires mutual attention to the problem and utilizes
the talents of all parties
4. Compromise
- in this method, accommodation and adjustment lead to
workable situations rather than to the best solution.
Nursing management
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5. Competition
- it is an assertive position that fosters conflict resolution
on the part of the subordinate.
6. Smoothing
- disagreements are ignored so that surface harmony is
maintained in a state of peaceful co-existence.
7. Withdrawing
- one party is resolved thereby making it possible to
resolve the issue.
8. Forcing
- yields an immediate end to the conflict but leaves the
cause of the conflict unresolved.
Nursing management
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Rules on Mediating a Conflict Between Two or More


Parties:
1. Establish clear guidelines and make them known to all.
2. Do not postpone indefinitely.
3. Create an environment that makes people comfortable
to make suggestions.
4. Keep two-way communication.
5. Stress a peaceful resolution rather than confrontation.
6. Emphasize shared interests.
7. Follow-up on the progress of the plan.
Nursing management
- DIRECTING -

Staff Development
Staff development is geared ultimately to
organizational development.

Orientation
Orientation is a planned and guided activities of
an employee in the organization, the work
environment , and in his job.
Nursing management
- CONTROLLING -

CONTROLLING
Controlling or evaluating is an on-going function
of management which occurs during planning,
organizing, and directing activities.
The controlling process opens opportunities for
improvement and comparing performance against
set standard.
Nursing management
- CONTROLLING -

Reasons For Conducting Evaluation


1. Evaluation ensures that quality nursing care is provided.
2. It allows for the setting of sensible objectives and ensures
compliance with them.
3. It provides standards for establishing comparisons.
4. It promotes visibility and a means for employees to monitor
their own performance.
5. It highlights problems related to quality care and determines
the areas that require priority attention.
6. It provides an indication of the costs of poor quality.
7. It justifies the use resources.
8. It provides feedback for improvement.
Nursing management
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Principles of Evaluation.
1. The evaluation must be based on the behavioral standards of performance
which the position requires.
2. The evaluation should have enough time to observe employees behavior.
3. The employee should be given a copy of the job description, performance
standards, and evaluation conference.
4. The employees performance appraisal should include both satisfactory and
unsatisfactory results with specific behavioral instances to exemplify these
evaluative comments.
5. Areas needing improvement must be prioritized to help the worker upgrade
his/her performance.
6. The evaluation conference should be scheduled and conducted at a
convenient time for the rater and the employee.
7. The evaluation report and conference should be structured in such a way
that is perceived and accepted positively as a means of improving job
description.
Nursing management
- CONTROLLING -

Characteristics of an Evaluation Tool


1. Should be objective
2. Should be reliable
3. Should be sensitive
Nursing management
- CONTROLLING -

PERFORMANCE APPRAISAL
Performance appraisal is a control process in which
employees performance is evaluated against standards.

Purposes of Performance Appraisal


1. Determine salary standards and merit increases.
2. Select qualified individuals for promotion or transfer.
3. Identify unsatisfactory employees for demotion or
termination
4. Make inventories of talents within the institution.
5. Determine training and development needs of employee.
Nursing management
- CONTROLLING -

6. Improve the performance of work groups by examining,


improving, correcting interrelationship between
members
7. Improve communication between supervisors and
employees and reach an understanding on the objectives
of the job
8. Establish standards of supervisory performance.
9. Discover the aspirations of employees and reconcile
these with the goals of the institution
10. Provide employee recognition
11. Inform employees where they stand.
Nursing management
- CONTROLLING -

Methods of Measuring Performance


1. Essay
2. Checklist
3. Ranking
4. Rating Scales
5. Forced-choice Comparison
6. Anecdotal Recording
Nursing management
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