NAVIGATING EXCELLENCE: THE CONTROL

PROCESS IN NURSING MANAGEMENT.

SANDHYA C
NURSING TUTOR
AIIMS MANGALAGIRI
CONTROLS AS MANAGEMENT TOOL
 Controlling is measuring and correcting the performance of activities per plans
of subordinates to achieve predetermined goals and objectives.
 Control tool to detect and correct significant variations in the results of the
planned activities.
 It operates on everything, things, people and actions.
CONTROL The control process in nursing is a systematic
approach that encompasses various elements to

PROCESS IN ensure efficient and effective healthcare delivery. It

involves planning, organizing, directing, and

NURSING controlling activities to maintain a high standard of

patient care.
ESTABLISHMENT OF STANDARDS
The standards are the criteria of performance, Input (structure)
which measure the outcomes (end results) Activity (process)
These can be classified as: Output control (out comes)

Nurse administrator must see that proper standards are set to determine quality
patient care.

Primary objective of a hospital is quality patient care. Quality care can be monitored
through parameters, e.g., length of stay, bed occupancy, number of outpatient visits etc.
 Measurement of performance is done by comparing actual results
against the set standards.

The nurse administrator is responsible for overall evaluation of

nursing activities.

MEASUREMEN Each administrator has to analyse the situation based on factual

T OF information which may be gathered at the end of performance.

PERFORMANCE
Nurse administrator must assess the adequacy of resources,
appropriate technology and accurate direction for desired action.

The comparison of action with desired standard can be done by

direct observation and analyses of records and reports, anecdotal
records, nursing conference, meeting, nursing rounds, checklist etc.
 ANALYSIS OF DEVIATION
Control information should lead to investigating difficulties, promptly deciding how to overcome these
difficulties.

For example, if surgical nursing unit sets the standards that no post operative patient should develop wound
infection, and it was found that in spite of aseptic technique and good nursing care the patient were
developing wound infection.

Nurse administrator was asked for corrective actions and measures. Other factors were also evaluated, e.g.,
physical environment, operation theater Fumigation, patient’s general health etc.

It was noticed unsatisfactory hygienic conditions of ward were causing infection. Therefore, correction for
deviation by fumigating the ward was suggested.
CORRECTIVE MEASURES
 In case the standards are not met due to poor nursing care, Nursing administrator must arrange
for continuing education or in-service education programme to update the knowledge and
maintain standards.
 Corrective measures can be done in terms of:
1. Nursing personnel : orientation, in services education and continuing education.
2. Materials : equipment and supplies, inventory keeping - quality and quantity
3. Money : financial resources to be adequate for good nursing care.
 QUALITY CONTROL STEPS
Establishing Example: Setting benchmarks for response times in the emergency department, such as
Standards: ensuring that critical cases are attended to within 15 minutes.

Measurement of Example: Regularly assessing nursing staff adherence to infection control protocols through
Performance: audits and monitoring hand hygiene compliance.

Comparison to Example: Comparing the actual patient outcomes with predetermined benchmarks, such as
Standards: comparing the rate of hospital-acquired infections to the national average.

Identifying Example: Recognizing instances where medication administration deviates from established
Deviations: protocols, leading to prompt corrective actions.

Implementing
Example: Developing and implementing additional training programs for nursing staff
Corrective following an identified pattern of deviations from established standards.
Actions:
 QUALITY CONTROL STEPS
Continuous Example: Regularly reviewing patient satisfaction surveys to identify trends and areas for
Monitoring: improvement in nursing care, then implementing ongoing adjustments.

Feedback and Example: Establishing a feedback loop where nursing staff can report issues or suggest
Communication: improvements, fostering a culture of continuous improvement.

Documentation
Example: Maintaining detailed records of patient care interventions and outcomes,
and Record providing a basis for performance review and quality assessment.
Keeping:

Training and Example: Conducting regular training sessions to ensure nursing staff is updated on the
Education: latest evidence-based practices, reinforcing a commitment to high-quality care.

Incorporating
Example: Soliciting and analyzing patient feedback through surveys or focus groups to
Patient identify areas where nursing care can be improved to enhance patient satisfaction.
Feedback:
METHODS OF NURSING CONTROL
1. Quality Control
Quality control is a specific type of controlling which refers to activities that evaluate, monitor or
regulate services rendered to consumers. The goals of quality nursing care would be to ensure
effective and efficient nursing care to achieve the desired goal.
2. Nursing Standards
Standard is a predetermined baseline condition or level of excellence that comprises a model to be
followed and practiced. There are different types of standards which can be used to direct and
control nursing actions. These may be categorized as input, process and outputs.
AREAS OF CONTROL
 Preliminary control: It is creating policies, procedures
and rules to support the plans for effective functioning
to achieve desired goals. Preliminary control is used for
mainly three areas:
1. Nursing manpower control
2. Budgeting control
3. Material control
NURSING CONTROL
 Preliminary control of nursing manpower is done by
carefully identifying skills needed to perform the safe
nursing tasks and selecting best qualified nurses.
 Control techniques: Formulation of philosophy and
objectives of nursing practice.
 Philosophy of nursing service: It believes that nursing
is a professional commitment towards service to
mankind, irrespective of casts, creed, religion, age, sex,
nationality or disease etc. which provides best possible
comprehensive nursing care to all sections of society, on
sound scientific principles.
 BUDGETING
CONTROL
 Budgetary control is establishing checks and balances to
ensure that the institution is not living beyond means.
 Elements of Budget Control
 Cost awareness - Indicate the awareness amongst all the
hospital personnel and the process available to contain
them.
 Cost monitoring - Provide a mechanism to identify,
report and analyse actual expenditure against budget and
standard.
 Cost management - Establish a responsibility and
accountability system at attainment of plans.
MATERIAL CONTROL

Process of Material Control:

The material management functions
Administrator should estimate the needs
cater to plan for material, its demand,
of the nursing department in relation to
estimates, procurement, stocking and
equipment, supplies, materials
issuing to ensure availability of right
(consumable and non-consumable),
material, in right quality at right time,
make recommendations and ensure the
of right price, from right source at low
supply of items required for quality
cost.
care.
QUALITY EVALUATION SYSTEMS IN HEALTH CARE
Audit systems : structure, process and outcome Audit.

Utilization review : : (prospective, concurrent and retrospective assessment of services utilized for
client care)

Evaluation studies : studies using various models(PDCA, Donabedian )

Client’s satisfaction : telephone Interviews, verbal or written questionnaire.

Incident reviewing : wrong medication administration, negligence.

Regulatory Approaches – licensure and credentialing.

Nursing Audit
Audit is a systematic and official examination of nursing records,
process or account to evaluate performance. Nursing audit is the
process of analyzing data about nursing process of patient
outcome to evaluate the effectiveness of nursing intervention.
NURSING ROUNDS

Rounds cover issues such as

patientcare, nursing practice,
and unit management. To be
effective the results should be
discussed with appropriate
nursing personnel in a follow-up
conference. Part of
the evaluation progress takes
place as a result of the
communication occurring during
the rounds.
GUIDELINES FOR ADMINISTRATOR
Formulate objectives to
control nursing practices and
other activities.
Control action cannot be
taken on conditions when the
individual is delegated with
responsibilities and
authorities.
Controlling should be
done to improve the
performance of
institutions.
Control actions focus to
Control actions are always
ensure timely performance
planned to ensure positive
and expected goals to be
results
achieved
It is required to control
Control action should be used
with correct technique to quality of work, quantity
bring about positive changes of personnel, cost, energy
in behaviour. and time.
Control action always
ends to decisions which
are corrective in .nature.
Case Study: Enhancing Patient Satisfaction on a Surgical Ward
Scenario: Nurse Manager Sarah aims to improve patient satisfaction scores on a surgical ward. By
implementing the control process, Sarah plans and organizes staff training on effective
communication, directs nurses to implement personalized care plans, and continually monitors
patient feedback for adjustments.
1. Planning: Identifying areas for improvement in patient satisfaction.
2. Organizing: Implementing staff training sessions and assigning specific responsibilities.
3. Directing: Providing guidance on personalized patient care approaches.
4. Controlling: Regularly assessing patient feedback and making adjustments for continuous
improvement.
Case Study : Improving Nurse-to-Patient Ratios for
Enhanced Patient Care
 Scenario: Nurse Manager Linda is tasked with addressing concerns about high nurse-to-patient ratios on
a medical-surgical unit, affecting patient care quality. Laura employs the control process to improve the
situation.
1. Planning: Linda reviews current nurse-to-patient ratios, identifies areas of concern, and plans to
optimize staffing levels to align with patient acuity.
2. Organizing: She collaborates with the staffing coordinator to adjust schedules, ensuring an appropriate
number of nurses for each shift and considering the varying needs of patients.
3. Directing: Linda communicates the changes transparently to the nursing staff, emphasizing the
importance of maintaining high-quality care and ensuring staff members understand their roles in the
new staffing structure.
4. Controlling: Regularly monitoring patient outcomes, nurse workload, and feedback, Lindaa makes
data-driven adjustments to the staffing plan. She collaborates with the nursing team to assess the impact
of changes on patient care quality and makes further adjustments as needed.
Situation:
 Your nursing unit has identified areas for improvement in patient care quality.
Describe how you would utilize the control process to implement and monitor
these quality improvement initiatives.
Answer:
• The controlling element of the control process involves regular monitoring and
evaluation of patient care outcomes. By implementing quality improvement
initiatives, you can continuously assess the effectiveness of the changes, make
data-driven adjustments, and ensure that the nursing team is consistently
delivering high-quality care.
"MASTERING DELEGATION
FOR EFFECTIVE NURSING
MANAGEMENT"
 NURSE MANAGER – EMPOWER NURSES FOR EFFECTIVE PATIENT
CARE

Nurse managers are both accountable and responsible for the

care of all patients in your care unit .They delegate your
responsibility to care for a particular patient to a staff RN.

For example, suppose the staff nurse fails to consult the coverage
schedule and gives too much insulin to a diabetic patient. The Nurse
Manager can be held accountable for the error if they assigned the task
to a nurse who had never been educated to read and understand how
insulin orders were written in that hospital, or a nurse who had never
administered insulin.

The Nurse Manager was not responsible for administering the insulin,but
is responsible for knowing the skills of the staff and assigning patient
care activities to the appropriate staff member.
THREE FOUNDATIONS FOR DELEGATION

Authority
It is the right and the
power to determine,
influence or evaluate.

Responsibility
Accountability
It is the condition
It is the condition
of accepting
of being
important duties or
answerable.
obligations
What is Delegation???

Delegation is getting work done through others by It is important to differentiate between

transferring responsibility for an activity to another responsibility and accountability.
without transferring accountability for the activity.
RIGHTS OF DELEGATION
 LEGAL LIABILITY TRANSFERS WITH TRANSFER OF THE RESPONSIBILITY.

When a Nurse Manager delegates primary care for a patient to an RN, the RN is legally
obligated to give the patient an acceptable level of care.
The Nurse Manager must determine that it is reasonable and prudent to delegate a
particular task to the RN based on the
a) Nurse Manager's knowledge of the staff nurse,
b) the condition of the patient, and
c) the general state of the unit.
Otherwise, the Nurse Manager could also be held liable for the actions of the RN.
 PURPOSE OF DELEGATION

Professional growth of Makes the organization to act

To achieve Time and cost efficiently and economically
organizational savings employees and
and bring flexibility in it
goal it means imparting training
to them.

Helps in creation of managerial class

Professional growth of the manager and Delegation avoid
and develops a sense of responsibility
decrease the burden of tasks delay and helps in
in subordinate
succession
 ROLE OF NURSE MANAGER
A key role of a Nurse Manager is to delegate responsibilities to a qualified and
competent person. It is critical to realize that a qualified person may not
necessarily be competent to take over the delegated responsibility.

This is particularly true when activities are delegated to a RN. The license
qualifies the nurse to perform all activities specified. In reality, the nurse may
not have performed the activity in years, and requires revaluation before
being competent to perform the activity with the patient.

This really becomes an issue when nurses are reassigned from their
regular unit to work in a unit with different skill-level
requirements. For example, a medical-surgical nurse may be
reassigned to labor and delivery.
SIMPLE FLOWCHART TO HELP YOU FIGURE
OUT WHAT SHOULD BE DELEGATED
Critical Responsibilities Unfit
for Delegation: Essential
Tasks Requiring RN
Expertise"

Teaching Assessment

Planning Evaluating

1. Clearly understand
the complexity of the
task.
HOW TO DELEGATE A TASK
2. Know the time
required to complete
the task.
3. Know the skill
level required to
perform the task.
4. Verify that the staff member
has the skill level to perform
the task & has recent
experience performing the
task.

8. Set criteria for
evaluating the
outcome of the task.
6. Develop a
7. Establish a level of 5. Determine if the
contingency plan if
supervision required staff member has time
the desired outcome
for the task. to perform the task.
isn't achieved.

10. Confirm that the staff 11. Determine the support

9. Clearly communicate
the task to your staff
member.
members accepts and equipment the staff
responsibility to perform member needs to perform
the task the task.
COMMON DELEGATION ERRORS

UNDER
DELIGATING

IMPROPER OVER
DELEGATIN DELEGATIN
G G
 BARRIERS TO DELGATION
Barriers in the delegator /
supervisor
Personal perfectionism
Lack of faith in subordinate
Fear of subordinate
Love for Authority
Strict control
Barriers in the delegate / Barriers in the situation /
Subordinate. organization.
Lack of experience Small size of organization
Lack of competence Decreased team spirit
Lack of self confidence Lack of proper communication
Lack of incentives Confusion in responsibility and
authority
Fear of harsh criticism from supervisor
Urgency, no time to explain
Over dependence on the boss
Overload of work. Criticality of decisions
 DELEGATION SKILLS

Create an environment Create environment of Promote client Communicate Provide feedback and
of trust and co teaching and learning satisfaction effectively follow-up evaluation.
operation
 Case Study 1: Acute Care Unit

Team Continuous
Prioritization: Monitoring:
Scenario: In a busy Collaboration:
acute care unit, Nurse
Manager Sarah faces
a sudden increase in- Sarah assesses the Calls for a brief huddle Implements a system
patient admissions urgency of tasks and to communicate the for continuous
due to a flu outbreak. prioritizes patient care situation and monitoring of patients
needs. expectations clearly.
She needs to delegate and task completion.
tasks effectively to
manage the influx Delegates routine tasks
Delegates
while maintaining to experienced nurses,
responsibilities based on
Adjusts delegation as
freeing up time for needed, ensuring that
quality care. critical patient each nurse's skills, patient care remains
assessments. ensuring a collaborative consistent and
approach to manage the responsive to changing
increased workload. conditions.
 Case Study 2: New Graduate Nurse Orientation

Education and Gradual Increase in Feedback and

Training: Responsibility: Evaluation:
Scenario: Nurse
Manager James is
overseeing the
orientation of new Provides thorough
graduate nurses to a Assigns a mentor to Regularly provides
education on unit
surgical ward. He aims policies, procedures,
each new nurse for constructive
ongoing support and feedback on
to delegate and patient
guidance. performance.
responsibilities that population.
challenge and engage
the new nurses while
Delegates routine Gradually increases Conducts evaluations
ensuring patient safety. tasks to new nurses, the complexity of to identify areas for
allowing them to delegated tasks as the improvement and
practice and build new nurses gain tailors future
confidence under experience and delegations to address
supervision. demonstrate specific learning
competence. needs.
PRACTICAL APPLICATION TIPS
Clear Communication:

• Clearly articulate expectations, deadlines, and desired outcomes when delegating tasks.

Know Your Team:

• Understand the strengths, skills, and preferences of each team member for effective task assignments.

Empowerment Through Delegation:

• Delegate responsibilities that provide growth opportunities, fostering a sense of empowerment among team
members.

Regular Check-Ins:

• Schedule regular check-ins to assess progress, address concerns, and provide additional support if needed.

Flexibility in Delegation:

• Be flexible and willing to adjust delegations based on changing circumstances or unexpected events.