NURSING MANAGEMENT PROCESS

PREPARED BY: MMSANTOS R.N. MAN.

 TOPIC

III. ORGANIZATIONAL AND MANAGEMENT  A. . Concept management  1. Management
1. Factors in management 2. Principles in management



2. Administration
a. Factors b. Principles 

     

3. Leadership 4. Organization 5. Authority 6. Power
a. Forms of power

7. Responsibility 8. Divagations 9. Accountability

Organization that represent Primary and Secondary Provides PNA PMA  e. RHU       c. Financing institution Medicare GSIS/SSS d. Organization in health care system   b.B. Clinic c. Major areas and organization. Educational consultation Medical School Nursing schools b.2 Organization that provides health services a . Responsibilities in each of these organizations .1 Organization that plan for and or regulate the primary and secondary provides a DOH b.Hospitals b. Organization that provides for HCS (secondary provides) a.

Financial management j. Steps in planning g. Movements of plan f. Principle of planning h. Importance of mission. Management by objectives i.Financial management . Definition b. Aspects of planning d. Characteristics of a plan e. philosophy. gals and objectives to planning c. Management by objectives l. Management functions/processes  1. Planning a. Methods to plan the ward k.C.

. Definition b. Organization concept c. Organizing a. Principles of organization . Hospital management service  2. Organizational charts  1. 2. Type of organizational structure e. Basic characteristics d. Functions of organizational structure f. RHU management service  g.

Staffing a. Determinants of staffing patterns c. Time management f. Mixed e. Assignment systems for staffing/\modalities of staffing/\ patient care      1. Recruitment and retention b. Primary 5. Team 3. Types of staffing pattern d. 3. Conflict management . Advantages/disadvantages 2. Case 4.

Definition b. Directing a.Components of directing . 4.

Controlling a. Definition . 5.Performance appraisal d. Quality assurance c.b. Evolution and professional development .

Principles of reporting c. 6. Attributes of reporting b.Types of report d. Reporting and recording a.Good reporting technique .

.Budgeting aAdvantages b.Budgeting process c. 4. Operating or revenue and expense budgets Capital expenditure s budgets Cash budgets Labor or personal budgets Flexible budget . 5. 2. 7.Types of budget      1. 3.

Decision making tools . DEFNITION b. 4. Decision Making Systems a.

Communication Principles a. Downward d. Grapevine . Communication systems c. Upward e. Diagonal f. 5. Communication process b.

PROFESSIONAL GROWTH AND DEVELOPMENT  1. Nursing Organizations . InIn-service education  2.TOPIC IV. Continuing education  3.

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It includes processes common to all management like planning.Nursing management     is performing leadership functions of governance and decision-making within organizations decisionnurses. employing nurses. directing and controlling. It is common for RNs to seek additional education to earn a Master of Science in Nursing or Doctorate in Nursing to prepare for leadership roles within nursing. organizing. Management positions increasingly require candidates to hold an advanced degree in . staffing.

directing and controlling that utilize human . The process of setting and achieving goals through the execution of five basic management functions : planning. . organizing. financial. and material resources. staffing.

decision analysis.Characteristics of a manager       Has an assigned position within the formal organization Has a legitimate source of power due to the delegate s authority that accompanies the positions expected to carry out specific functions duties and responsibilities Emphasizes control. the environment. decision making. and results Manipulates people. time and other sources to achieve organizational goals. money . Has a greater formal responsibility and accountability for rationality and control Direct willing and unwilling subordinates .

Directing  4. Controlling .Management functions  1. Planning  2. Organizing  3.

Management Process Planning Organizing Controlling Staffing Directing .

goals. and rules carrying out long and short range projections. objectives. determining a fiscal course of action.Planning encompasses determining philosophy. and managing planned change . policies.Five functions of management process  1. procedures.

 2.

Organizing includes establishing the structure to carry out plans, determining the most appropriate type of patient care delivery, and grouping activities to meet unit goals.

 3.

Staffing functions consist of recruiting, interviewing, hiring and orienting staff. Scheduling staff development, and often employee socialization also are included as staffing functions

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Directing sometimes includes several staffing functions. However, this phase s functions usually entail human resource management responsibilities such as motivating , managing conflict, delegating, communicating and facilitating collaboration

. legal and ethical control. fiscal accountability. 5. and professional and collegial control. Controlling functions includes performance appraisals. quality control.

Integrating Nursing Process and Management process  Simplified nursing process Assessing Management Process Function PLANNING PLANNING Planning STAFFING ORGANIZING ORGANIZING DIRECTING Implementing Evaluating CONTROLLING .

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 IN GENERAL. NOT ON EMOTION OR WISHES. WHEN TO DO IT AND WHO IS TO DO IT. PLANNING IS AN INTELLECTUAL PROCESS BASED ON FACTS AND INFORMATION. . IS DECIDING IN ADVANCE WHAT TO DO.  IT IS A COGNITIVE PROCESS FOR DECISION MAKING. HOW TO DO IT.

WHO IS TO DO IT.A PROACTIVE AND DELIBERATE PROCESS THAT REQUIRES DECIDING IN ADVANCE WHAT TO DO. .AND HOW . WHEN AND WHERE IS TO BE DONE.

PLANNING  Process: Establish objectives (goals) Evaluate the present situation and predict future trends and events Formulate a planning statement (means) Convert the plan into an action statement .

Planning  Is important on both an organizational and a personal level and may be an individual or group process that addresses the questions of : WHAT WHY WHERE WHEN HOW BY WHOM .

 Employees can see that result of their labor.REASONS FOR PLANNING  Planning leads to success in achievement of goals and objectives.  It brings about behaviors that lead to desired actions and outcomes. .

.REASONS FOR PLANNING  Planning gives meaning to work.  Knowing that objectives help the employees relate what they are going to meaningful outcome and leads to greater employee satisfaction.

 Planning helps in coping with crisis. they allow the worker to function more calmly and efficiently when an actual crisis occurs. .  Available resources are used to the maximum. Plans anticipate emergencies.REASONS FOR PLANNING  Planning provides for effective use of available personnel and facilities.

REASONS FOR PLANNING 
Planning

is cost effective. Some costs can be contained through planning of nurses needed operation.  Example: projecting the number of courses needed to care for a group patients or ordering enough supplies for a unit.

REASONS FOR PLANNING 
Planning

based on the past and future helps reduce the element of change. Studying what has been successful or unsuccessful can give the manager a better idea of what to do in the future.

REASONS FOR PLANNING 
By

planning, one discover the need for change.  Planning can point out opportunities or different services.

. Managers can evaluate the environment. resources and employees effectiveness when the expected is known.REASONS FOR PLANNING  Planning is necessary for effective control.

RESISTANCE TO PLANNING Failure to plan may be attributed to the following factors:  Managers may lack knowledge of the philosophy. that success or failure of work activities relate directly to the quality of the plan . goals and working of the organization  Managers may not understand the significance of planning.

Some managers prefer to act to immediate problems because they generate immediate feedback Planning may bring unwanted change. Reluctance may exist because implementation of plans may require new activities that the individual in unwilling to engage in. fearing failure.RESISTANCE TO PLANNING     Time spent on planning often seems wasted in relation to the day to day doing of one s job Some managers may lack confidence. .

reasonable estimates and accurate reflection of policies and plans . agency  B. Forecast or estimate the future It describes the ultimate condition or projections that provide general incentive and direction to planning Should consider the:  A. Community  C. goals of care Forecast must be supported by facts.SCOPE OF PLANNING  1.

setting objectives/goals determine results desired GOALS. 2.SPECIFIC BEHAVIOR OR TASK OBJECTIVESSET FOR ACCOMPLISHMENT OF A GOAL .ARE STATEMENT OF INTENT GOALSDERIVED FROM THE PURPOSES OF THE ORGANIZATION AND THEY ARE STATED BROADLY AND IN GENERAL TERMS OBJECTIVES.

 Set the time frame. . discharge teaching program. Develop and schedule strategies. programs / projects / activities.3. outreach programs.  Strategies are overall plans of the higher management system to achieve objectives.  Programs are series of activities that function together to facilitate attainment of some desired goals  Example: staff development programs.

of plans: (according to time frame)  Long term plans 3 5 years or more  Short term plans 6 months to one year  Type .

Prepare the budget-allocate resources budgetBUDGET  ALLOCATION OF SCARCE RESOURCES ON THE BASIS OF FORECASTED NEEDS FOR PROPOSED ACTIVIIES OVERA SPECIFIED PERIOD OF TIME  A TOOL PLANNING. . 4. MONITORING AND CONTROLING COST OR A SYSTMATIC PLAN FOR MEETING EXPENSES.

of plans: (according to time frame)  Long term plans 3 5 years or more  Short term plans 6 months to one year  Type .

Strategic .PLANNING CAN BE:  A. Contingent  B.

or proactive. usually a few months before the new fiscal year. Short range . It develops the departmental maintenance and improvement goals for the coming year. .CONTINGENT PLANNING    The manager identifies and manages the many problems that interfere with getting work done. It may be reactive. in response to a crisis.operational planning is done in conjunction with budgeting. in anticipation of problems or in response to opportunities.

assigns responsibilities and determines time frames  .  It determines the direction of the organization.STRATEGIC PLANNING Refers to the process of continual assessment. It begins with in depth analysis of the internal environment s strengths and weaknesses and the external opportunities and threats so that realistic goals can be set for the proffered future.  Its purpose is to create an image of the desired future and design ways to make those plans a reality.  Long range and it extends 3 to 5 years into the future. allocates resources. planning and evaluation to guide the future.

Planning provides for effective use of available resources and facilities  4. Planning gives meaning to work  3. Planning helps in coping with crises  .IMPORTANCE OF PLANNING 1. Planning leads to the achievement of goals and objectives  2.

Planning leads to the realization of the need for change  9.  7.IMPORTANCE OF PLANNING  5. Planning provides the basis for control . Planning is cost effective  6. It prevents or reduces the recurrence of problems and provides better ideas  8. Planning is based on past and future activities.

formal organizational structure. and assigning authority. In health care. . skill mix. It is an ongoing process that systematically reviews the use of human and material resources. the mission. delivery systems. dividing the labor. and staffing patterns form the basis for the organization. developing the chain of command.ORGANIZING     Is the process of coordinating the work to be done. it involves identifying the work of the organization. job description. Formally.

 Power. . authority.  Communication abilities. and leadership style are intimately related to a manager s ability to direct.DIRECTING  Is the process of getting the organization s work done. motivational techniques and delegation skills also are important.

determining the means to be used in measuring performance. . evaluating performance and providing feedback.CONTROLLING  Involves comparing actual results with projected results.  This includes establishing standards of peformance.

Some organizations use peer review to control quality of care. Today managers share many of the control functions with the staff. . In organizing using a formal quality improvement process. staff participate in and lead the teams.  The efficient manager constantly attempts to improve productivity by incorporating techniques of quality management. evaluating outcomes and performance and instituting change as necessary. such as continuous quality improvement .

proactive approach to management . . organizing. Timmereck (200) founded that health care managers uses these classic functions extensively. This approach is used widely in all types of organizations. Planning. directing and controlling reflects a systematic . health care included.

. Mintzbergs s Behavioral description Believed that much of a manager s activity involves human relations. a premise that is supported by the contemporary leadership theories discussed previously. Mintzberg also believed managers were more reactive than proactive.

ROLE OF MANAGERS Interpersonal Role Informational Role Decisional Role .

is responsible to see that the organization s goals are accomplished efficiently.Interpersonal Role  1. and disciplining as needed. Leader  The manager defines work environment of the organization and is responsible fo the work of associates-motivating . National conferences.  The manager. 3. Figurehead Reflects the ceremonial performance of duties. Liaison deals with expanding the manager s information sources and networks outside the organization. such as welcoming new employees at orientation or attending social events. . local coalitions and professional meetings are valuable resources for obtaining information and expanding networks. associatestraining. 2. as a leader .

Informational Role  Monitor.  . and observations. gossip. the manager informally seeks information about the organization through internal networks.

Informational Role  Tours of the organization. as well as formal ad informal meetings. . allow the manager to find out how the organization is functioning and what might be needed to improve it.

Informational Role  Dissemination role either share information between work units or share information from outside the organization. .

the manager shares information with individual outside the organization and provides visibility for the organization. sharing information empowers employees and improves job satisfaction  Spokesperson. .Informational Role  Information is a source of power.

.Informational Role  Attending community meetings. offering continuing education and participating in professional organizations are examples of ways in which the manager serves as a spokesperson.

.  Reorganizing supplies. or creating new roles are examples. redesigning staff assignments.Decisional Roles  Entrepreneur constantly seeks ways to solve problems and make improvements in the organization.

nosocomial outbreaks.Decisional Roles  Disturbance handler responds to unforeseen circumstances. or missing equipment. . such as replacement of staff for sick call.

Decisional Roles  Resource allocator managers schedule their own time. and manage financial resources  Negotiator deals with outside forces mediating resources and decisions such as resolving collective bargaining disputes or helping decide on major capitol purchases. assign staff. .

Fundamental skills of a manager  Technical skills PROFICIENCY IN PERFORMING AN ACTIVTIY IN THE CORECT MANNER WITH THE RIGHT TECHNIQUE .

Human relation skills  Dealing with people and how to get along with them .

. and discarding irrelevant facts.Conceptual skill ability to see individual matters as they relate to the total picture and to develop ways of identifying pertinent factors. responding to the big problems.

3 levels represented by concentric circles  information  People  action .

Manager conceives the frame  Purpose of the job  Work needed  How it should be done .

Managing involves:  Communicating and controlling at the information  Leading and linking at the people level  Doing at the action level .

Communicating and controlling communicating Involves receiving and sharing information with others  Controlling is using information to manage the work others  .

leading  Involves encouraging and enabling othersothersindividually . as a team or as an entire organiztionorganiztion-to take effective action .

linking  Is establishing networks outside the unit in order to relay needs and exchange influence .

3rd level of work and most concrete level  Managing action by doing  DOING.directing change. handling disturbances.includes taking supervisory DOINGactionsactions. and negotiating with other departments. .

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Leading and linking people in order to encourage people to take action  Leading involves encouraging and enabling others-individually. as a team or othersas an entire organization  Linking is establishing networks outside the unit in order to relay needs and exchange influence .

HANDLING.managing action by doing  DOING INCLUDES TAKING SUPERVISORY ACTIONSACTIONS-DIRECTING. DISTURBANCES AND NEGOTIATING WITH OTHER DEPARTMENTS .

chief nursing officer.NURSE MANAGERS IN PRACTICE  First line manager may also be titled as unit manager  Middle manager as department manager  Top level nursing administrator could be named executive manager. or vice president of patient care .

regardless of their titles. all nurse managers must hold a certain competencies. Clinical titles might include professional practice leaders who are clinical specialist or nurse practitioners. .

NURSE MANAGERS COMPETENCIES  The American Organization of Nurse Executives (AONE) identified five areas of competency : Skilled communicators and Relationship builders Have a knowledge of the health care environment Exhibit leadership skills Display professionalism Demonstrate business skills .

NURSE MANAGER COMPETENCIES  STAFF NURSE  FIRST LEVEL MANAGEMENT  CHARGE NURSE  CLINICAL NURSE LEADER .

STAFF NURSE   The staff nurse supervises LPNs . other professionals and assistive personnel and so is also a manager who needs . delegation and motivation skills are indispensable. Communication . In some organization. .management and leadership skills. shared governance has been implemented and traditional management are allocated to the work team.

nurse manager or an assistant. the first level manager is usually the head nurse. Nurse manager s have 4 hour accountability for the management of a unit or area within a health care organization. In other hospital they call it as coordinator . In the hospital setting .First level management      Is responsible for supervising the work of nonmanagerial personnel and the day to day activities of a specific work unit or units With primary responsibility for motivating the staff toi achieve the organization s goal. the first level manager represents staff to upper administration and vice versa.

. Role modeling. skills. assisting in shift by shift coordination and promotion of quality patient care as well as efficient use of resources. mentoring and educating are additional roles that the charge nurse often assumes.Charge Nurse      Is an expanded staff nurse role with increased responsibility The charge nurse functions as a liaison to the nurse manager. The charge nurse usually has extensive experience. and knowledge in clinical practice and is familiar with the organization s standards and practice. The charge nurse often troubleshoots problems and assists other staff members in decision making.

. She has limited authority. The responsibilities are confined to a specific shift or task. the charge nurse functions as an agent of the manager and is accountable to the manager for any actions taken or decision made. whereas the first level manager has a 24 hour responsibility and accountability for all unit activities.

the charge nurse has a limited scope of responsibility. usually restricted tot e unit for a specific time period.  Therefore the charge nurse is an important leader and can benefit by developing the skills considered necessary for a manager.  .  The charge nurse is often key to a unit's successful functioning.Although often involved in planning and organizing the work to be done .  A charge nurse usually has considerable influence with the staff and may actually have more informal power than the manager.

but instead is a lateral integrator of care responsible for a specified group of clients within a microsystem of the health care setting.  The CNL role is designed to respond more effectively to challenges in today's rapidly changing.Clinical Nurse Leader  The CNL is not a leader per se. complex technological environment. .

and evaluates client care by coordinating. . technicians and other health professionals. The CNL designs. including licensed nurses. delegating and supervising the care provided by the health care team. implements.

AONE FIVE AREAS of COMPETENCIES  COMMUNICATION AND RELATIONSHIP BUILDING COMPETENCIES: Effective communication Relationship management Influence of Behaviors Ability to work with diversity Share decision making Community involvement Medical staff relationships Academic relationship .

 KNOWLEDGE IN THE HEALTH CARE ENVIRONMENT: Clinical practice knowledge Patient care delivery models and work design knowledge Health care economics knowledge Heath care policy Understanding of governance Understanding of evidence based practice Outcome measurement Knowledge of and dedication to patient safety Understanding of utilization management Knowledge of quality improvement and metrics Knowledge of risk management .

 LEADERSHIP SKILLS Foundational thinking skills Personal journey discipline The ability to use systems thinking Succession planning Change management .

 PROFESSIONALISM Personal and professional accountability Career planning Ethics Evidenced based clinical management practice Advocacy for the clinical enterprise and for nursing practice Active memebership in professional organization .

 BUSINESS SKILLS: Understanding of health care financing Human resource management and development Strategic Management Marketing Information management and technology .

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This climate for change produces new opportunities for nurses. never needed more in the rapidly evolving system of health care. creative change is mandatory for growth.WHY CHANGE?     Leading change is an art. Nurses are rethinking the way health care is organized and delivered. . Organizational change is essential for adaptation..

it can be threatening and a source of conflict . Change is necessary for growth. although it often produces anxiety and fear.  Even when planned.

Even when change is expected and valued.CHANGE      IS THE PROCESS OF MAKING SOMETHING DIFFERENT FROM WHAT IT WAS. . This is particularly true when change is unplanned or beyond human control. There is a sense of loss of the unfamiliar. the status quo. a grief reaction still may occur. Those who initiative and manage change often encounter resistance form those experiencing unease and possibly symptoms of anxiety and grief.

. Change is a continually unfolding process rather than an either/event. moves through a transition period. is disrupted.  The process begins with the present stae. the process begins again. and ultimately comes to a desired state. however. Once the desired state has been reached.

 The nurse . is key to stimulating the need for change and crucial for the success of planned change.  A change agent an be a role model for others by touting the positive outcomes of changechange-improved patient care. .THE NURSE AS CHANGE AGENT  Is one who works to bring about a change. as an integral part of the system.

.THE CHANGE PROCESS  Assessment Emphasis is placed n the assessment phase of change for two reasons  Without data collection and analysis.planned change will not proceed past the wouldn t it be a good idea if stage.

Develop a plan for change . Identify the problem or opportunity  2. Identify the supporters or opposers .STEPS IN THE CHANGE PROCESS  1. including time frame and resources  5. Collect necessary data and information  3. Select and analyze data  4.

Prepare to handle resistance  9.STEPS IN THE CHANGE PROCESS  6. if successful . Help people prepare for change  8. stabilize the change . Provide a feedback mechanism to keep everyone informed of the progress of change  10. Evaluate effectiveness of the change and . Build a coalition of supporters  7.

IDENTIFY THE Problem or the Opportunity  START BY ASKING THE RIGHT QUESTIONS. SUCH AS: Where are we now? What is the unique about us? What should our business be? What can we do that is different from and better than what our competitors do? What is the driving stimulus in our organization?What determines how we make our final decisions? What prevents us from moving in the direction we wish to go? What kind of change is required? .

the change agent collects data external and internal to the system. . This step is crucial to the eventual success of the planned change.  All driving and restraining forces are identified so the driving forces can be emphasized and the restraining forces reduced.Collect Data  Once the problem or opportunity has been clearly defined.

Analyze the Data  The kinds. but they are useless unless they are analyzed.  The change agent should focus more energy on analyzing and summarizing the data than on just collecting it. .  The point is to flush out resistance identify areas of consensus. and build a case for whoever option is selected. amounts and sources of data collected are important.

Planning  Planning the who.  What will be the target system for the change?  Members from this system should be active participants in the planning stage. . The more involved they are at this point. how. the less resistance there will be later. and when of the change is a key step.

Implementation  Methods to Change Individuals  Methods to change groups .

Evaluation  Evaluate effectiveness  Stabilize the change .

economic sanctions.Change Strategies  Power Coercive Strategies Based on application of power by legitimate authority . or political clout of the change agent Assumes that people are set in their ways and will change only when rewarded for the change or are forced by some other power coercive method .

Humans are rational beings who will change documenting the need for change. .RationalRational-empirical strategies  Give current research as evidence to support change.

Humans are social animals. easily influenced by others than by facts  Does not require change agent to have a legitimate power base. . Power is gained by skill in interpersonal relationship.Normative-reNormative-re-educative strategies  Use group norms to socialize and influence people so change will occur.

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