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

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

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

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

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

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

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

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

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

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

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

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

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Nursing management     is performing leadership functions of governance and decision-making within organizations decisionnurses. Management positions increasingly require candidates to hold an advanced degree in . 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. employing nurses. directing and controlling. organizing. staffing. It includes processes common to all management like planning.

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

the environment. time and other sources to achieve organizational goals. and results Manipulates people. money . decision making. 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. Has a greater formal responsibility and accountability for rationality and control Direct willing and unwilling subordinates .

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

Management Process Planning Organizing Controlling Staffing Directing .

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

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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.

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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

 5. Controlling functions includes performance appraisals. . legal and ethical control. quality control. fiscal accountability. and professional and collegial 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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HOW TO DO IT. PLANNING IS AN INTELLECTUAL PROCESS BASED ON FACTS AND INFORMATION. IS DECIDING IN ADVANCE WHAT TO DO. WHEN TO DO IT AND WHO IS TO DO IT.  IT IS A COGNITIVE PROCESS FOR DECISION MAKING. NOT ON EMOTION OR WISHES.  IN GENERAL. .

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.  It brings about behaviors that lead to desired actions and outcomes.REASONS FOR PLANNING  Planning leads to success in achievement of goals and objectives. .

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. goals and working of the organization  Managers may not understand the significance of planning. that success or failure of work activities relate directly to the quality of the plan .

fearing failure. Reluctance may exist because implementation of plans may require new activities that the individual in unwilling to engage in.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. Some managers prefer to act to immediate problems because they generate immediate feedback Planning may bring unwanted change. .

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

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

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. programs / projects / activities. discharge teaching program.3.  Set the time frame. Develop and schedule strategies.

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. MONITORING AND CONTROLING COST OR A SYSTMATIC PLAN FOR MEETING EXPENSES. 4.

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

PLANNING CAN BE:  A. Strategic . Contingent  B.

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

assigns responsibilities and determines time frames  .STRATEGIC PLANNING Refers to the process of continual assessment. allocates resources. 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.  Long range and it extends 3 to 5 years into the future.  It determines the direction of the organization.  Its purpose is to create an image of the desired future and design ways to make those plans a reality. planning and evaluation to guide the future.

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

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

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

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

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

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

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

Mintzberg also believed managers were more reactive than proactive. 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.

ROLE OF MANAGERS Interpersonal Role Informational Role Decisional Role .

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

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

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  Tours of the organization.

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

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

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

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

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

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.Decisional Roles  Resource allocator managers schedule their own time. 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. responding to the big problems.Conceptual skill ability to see individual matters as they relate to the total picture and to develop ways of identifying pertinent factors. .

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  .

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

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

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

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

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

or vice president of patient care .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. chief nursing officer.

all nurse managers must hold a certain competencies. regardless of their titles. . 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 .

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

In other hospital they call it as coordinator .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. nurse manager or an assistant. Nurse manager s have 4 hour accountability for the management of a unit or area within a health care organization. the first level manager is usually the head nurse. the first level manager represents staff to upper administration and vice versa. In the hospital setting .

and knowledge in clinical practice and is familiar with the organization s standards and practice.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. assisting in shift by shift coordination and promotion of quality patient care as well as efficient use of resources. The charge nurse often troubleshoots problems and assists other staff members in decision making. Role modeling. skills. mentoring and educating are additional roles that the charge nurse often assumes. .

whereas the first level manager has a 24 hour responsibility and accountability for all unit activities. 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. .

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

Clinical Nurse Leader  The CNL is not a leader per se. . complex technological environment. 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.

technicians and other health professionals. delegating and supervising the care provided by the health care team. including licensed nurses. and evaluates client care by coordinating. . The CNL designs. 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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creative change is mandatory for growth.. never needed more in the rapidly evolving system of health care. Organizational change is essential for adaptation. . This climate for change produces new opportunities for nurses. Nurses are rethinking the way health care is organized and delivered.WHY CHANGE?     Leading change is an art.

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

CHANGE      IS THE PROCESS OF MAKING SOMETHING DIFFERENT FROM WHAT IT WAS. . the status quo. There is a sense of loss of the unfamiliar. Even when change is expected and valued. 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. This is particularly true when change is unplanned or beyond human control.

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

is key to stimulating the need for change and crucial for the success of planned change.  The nurse .  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.

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

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

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? .IDENTIFY THE Problem or the Opportunity  START BY ASKING THE RIGHT QUESTIONS.

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

but they are useless unless they are analyzed. .  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.Analyze the Data  The kinds.  The change agent should focus more energy on analyzing and summarizing the data than on just collecting it.

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. and when of the change is a key step. how. . The more involved they are at this point. the less resistance there will be later.

Implementation  Methods to Change Individuals  Methods to change groups .

Evaluation  Evaluate effectiveness  Stabilize the change .

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 .Change Strategies  Power Coercive Strategies Based on application of power by legitimate authority . economic sanctions.

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

. 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. Humans are social animals. easily influenced by others than by facts  Does not require change agent to have a legitimate power base.

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