NURSING MANAGEMENT PROCESS PREPARED BY: AILYN B.

PINEDA, RN

NURSING MANAGEMENT Is the process of working through staff members to be able to provide comprehensive care to the patient This includes planning, orga nizing, directing and controlling The task of the nurse manager is to plan, organ ize, direct and control available financial, material, and human resources in or der 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, establis hing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known

COMPONENTS OF PLANNING PLANNING: PREDETERMINED ACTION WHAT TO DO: -nursing activities HOW TO DO IT: -technique, principles WHO IS TO DO IT: -professional, nonprofessional

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 proc ess. 3. Planning should be pervasive within the entire organization covering the various departments, services and the various levels of management to provide m aximal cooperation and harmony. 4. Planning utilizes all available resources. 5. Planning must be precise in its scope and nature. 6. Planning should be time bo unded. 7. Projected plans must be documented for proper dissemination to all con cerned 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 availa ble 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 affect ing the planned action Indicate priorities Develop actions that are flexible and r ealistic 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 exte nding 3 to 5 years into the future. 2. OPERATIONAL OR SHORT-RANGE PLANNING how do es one do things right - deals with day to day maintenance activities. 3. CONTINU OUS OR ROLLING PLANS - similar to operating plans, involves mapping out the dayto-day activities.

ELEMENTS OF PLANNING Forecasting or Estimate the future Set Objectives/Goals and Determine Results Desi red Develop and Schedule Strategies, Programs/Projects/Activities; Set the Time Frame Prepare the Budget and Allocatio n 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 goa ls- are personal goals; based on ones desired in life Group goals- may refer also to organizational goals although on a smaller scale Organizational goals- manag ement 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: T o 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 applicati on 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 researc h for improving nursing care. ( research) To utilize media for information campa ign 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 hospit al 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 exis t 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 Philip pines 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 stakeholder s 2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws 3. unifying the nursing sector through good governa nce 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 i ts structure and goals. - Philosophy states the beliefs that influence nursing p ractice and beliefs about health care.

POLICIES Policies in general, they are guidelines to help in the safe and efficient achie vement 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, met hods, or procedure by which the overall plan of the higher management achieve de sired 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 eli minating time wastes and use of managerial techniques to reach goal s efficientl y

Nursing management PLANNING Principles of Time Management 2) Planning for contingencies-planning anticipates the problem that will arise from actions without thought 3) Listing of task-task to be accomplished should be done in sequence which are prioritized according to im portance 4) Inventory 5) Sequencing 6) Setting and keeping deadlines- and adheri ng to deadline is an excellent exercise in self discipline 7) Deciding on how ti me will be spent

Nursing management PLANNING Time Saving Techniques, Devices and Methods to Better Use of Time 3. Conduct an inventory of your activities. 4. Set goals and objectives and writ e them down. 5. With the use of calendars, executive planners, logs or journals, write what you expect to accomplish yearly, monthly, weekly or daily. 6. Break down large p rojects into smaller parts. 7. Devote a few minutes at the beginning of each day for planning. 8. Organize your work space so it is functional. 9. Close your do or when you need to concentrate. 10.Learn to delegate. 11. In a meeting, define the purpose clearly before starting. 12. Take or return phone calls during speci fied time. 13. Develop effective decision-making skills. 14. Take rest breaks an d make good use of your spare time.

Nursing management PLANNING Multitasking Trying to get more things done in less time Examples: answering phone calls whil e driving, sending emails 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 5. WHAT 6. WHEN 7. WHERE 8. HOW 9. WHO 10.WHY 11.CAN

Nursing management PLANNING PREPARING THE BUDGET 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 utilizat ion of manpower, material and other resources to cover capital projects in the o perating programs. A nursing budget is a plan for allocation of resources based o n preconceived needs for a proposed series of programs to deliver patient care d uring one fiscal year. A hospital budget is a financial plan to meet future servi ce 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 ho spital, size and plan of the wards, units, nurses station, treatment rooms, etc Pe rsonnel policies Salaries paid to various type of nursing personnel including OT pay or shift dif ferential 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 perfo rming nursing care whether simple or complex; the method of documentation Proport ion of nursing care provided by the professional nurses and those given by nonpr ofessionals Amount and quality of supervision available and provided; the efficie ncy 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 Amoun t of centralized service provided: sterile supply , central o2 supply, linen sup ply Nursing service requirements of the ancillary departments: clinics, admitting office, ER Reports required by administration whether simple or complex Affiliati on of nursing students or medical students

Establishing Nursing Standards, Policies and Procedures Nursing Standards

Standard- a practice that enjoys general recognition and conformity among profes sionals or an authoritative statement by which quality of practice or education can be judged Nursing Care Standard a descriptive statement desired quality agai nst which to evaluate nursing care Purpose of nursing standards Improved quality of care Decrease the cost of nursing care Determine nursing neg ligence

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 po licy formulation. These are: Areas in which confusion about the locus of responsibility might result in negle ct or malperformance of an act necessary to a patients welfare Areas pertaining t o 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 c an get its work done in an orderly fashion Organizing means having qualified peop le and the right materials, information and equipment needed to deal with contin gencies

Nursing management - ORGANIZING PRINCIPLES OF ORGANIZATION: Communication: effec tive and open communication in all forms; thread that binds the organization tog ether Directions of communication: Downward Upward Lateral/Horizontal Grapevine Unity of Command ty of Purpose Span of Control Delegation of authority Similar Assignments Uni

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

PRINCIPLES OF ORGANIZATIONAL DESIGN 1. 2. 3. 4. 5. Division of labor Unity of command Authority and responsibility Span of Control Contingency Factors

Nursing management - ORGANIZING ELEMENTS OF ORGANIZING 2. Organizational Structur e 3. Staffing 4. Scheduling 5. 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 c oncentrate 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 it s channel of authority, span of control and lines of communication. positions or working relationships that will coordinate efforts of workers of di verse interest and abilities It is the formal structure, the official arrangement of

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 It makes use of expertise, Disadvantage Transpires that the most and allows close communication between the workers. en the communication. Supervisory individuals scre

skilled individuals end up doing nothing while actual tasks are done by those le ss capable. Communication from 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 co ntact 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 Lower likelihood of Disadvantages

Supervisor spend less

messages being distorted Workers develop own abilities and autonomy and able to s ee the organization as humanistic resulting in greater job satisfaction The princ iple of shared governance produces maximum potential for professional growth time with each worker Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions

Nursing management - ORGANIZING Types of Organization Classified by Nature of Aut hority 3) Line Organization- each position has general authority over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal ) 4) Informal Organization- refers to horizontal relationship rather than vertic al.(Flat or horizontal organization) 5) Staff Organization- purely advisory to t he line structure with no authority to put recommendations into action. 6) Funct ional 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 genera l authority over the lower position of the hierarchy. - ARA and power are concen trated at the top.

TYPES OF ORGANIZATIONAL STRUCTURE 2. Flat Organization - refers to an organizational structure with few or no leve ls 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 coordina ted.

Nursing management - ORGANIZING ORGANIZATIONAL CHART - Organizational chart is a line drawing that shows how the parts of an organiza tion are linked.

Nursing management - ORGANIZING Characteristics of an Organizational Chart 3)Divi sion of Work 4)Chain of Command 5) Type of Work to be performed 6)Grouping of Wo rk Segment 7) Levels of Management

Nursing management - ORGANIZING

STAFFING

Staffing is the process of determining and providing the acceptable number and m ix of nursing personnel to produce a desired level of care to meet the patients d emand. The process of assigning competent people to fill the roles designated fo r the organizational structure through recruitment, selection and development.

- STAFFING

FACTORS AFFECTING TIME REQUIREMENT Degree of dependence Communicability of ailment

OF NURSING CARE Patients acuteness of illness

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, becau se 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 staff ing decisions for that unit. Allows staff to take requests directly to their own manager, which gives them increased autonomy and flexibility. Increases the ris k that employee requests may be treated unequally or inconsistently. Time-consum ing for unit manager.

NURSING CARE MODALITIES TOTAL CARE or CASE NURSING One nurse is assigned to one patient for totality of c are during his or her time on duty PDN Isolation nurse Nursing student

NURSING CARE MODALITIES FUNCTIONAL Nursing Task-oriented Particular nursing functi on is assigned to each nurse Time saving Worker learns w/ mastery -Medication nurs e -Charge nurse -Nursing attendant

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

Nursing Care Modalities TEAM Nursing ns The team leader assigns patients & tasks according to job descriptio

PATIENT CLASSIFICATION SYSTEM Self care or Minimal Care Patients 2. Intermediate or Moderate Care 3. Total Care Patients 4. Intensive Care Patients 1.

PATIENT CLASSIFICATION SYSTEM 1.

Self care or Minimal (ADL) Convalescing, no re dx studies, Minimal rarily makes discharge

Care Patients capable of carrying activities of daily living longer require intensive, moderate, or maximum care Requi therapy Awaiting elective surgery, Home environment tempo 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 ambul atory for short periods (needs assistance)

PATIENT CLASSIFICATION SYSTEM 3. Total Care Patients those who are bedridden and who lack strength and mobilit y 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 o f 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 i. Surgery ii. General Ward iii. Pediatric iv. Pathologic Nurse ry v. Medical vi. OB vii. ICU/ER/RR viii.CCU NCH/pt/day 3.4 3.5 4.6 2.8 3.4 3.0 6.0 6.0 Prof. to Non-Prof Ratio 60:40 60:40 70:30 55:45 60:40 60:40 70:30 80:20

Nursing management - STAFFING Distribution Per Shift SHIFT AM PM NIGHT PERCENTAGE 45 % 37% 18%

Nursing management - STAFFING CATEGORIES OF PATIENT Levels of Care Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level I II Total or Intensive Care Level IV Highly Specialized or Critical Care NCH Needed /pt./ day 1.50 Prof: Non Prof 55:45 3.0 4.5 6.0 7.0 or higher 60:40 65:35 70:30 80:20

Nursing management - STAFFING PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CARE Type of Hospital Primary Hospital Secondary Hospital Tertiary Hospital Special T ertiary Hospital Minimal Care 70 65 30 10 Moderate Care 25 30 45 25 Intensive Ca re 5 5 15 45 Highly Spl. Care 10 20

Nursing management - STAFFING

TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND

HOURS OF NURSING PERSONNEL PER YEAR Right s and Privileges Given each Personnel/Yr 1. 2. 3. 4. 5. 6. 7. Vacation Lea ve Sick Leave Legal Holidays Special Holidays Special Privileges Off Duties as p er R.A. 5901 Continuing Education Program Working Hours per Week 40 hours 48 hou rs 15 15 10 2 3 104 3 152 213 1,704 15 15 10 2 3 52 3 100 265 2,120 Total Non-Working Days/Year Total Working Days/Year Total Working Hours / Year RA 5901 = 40H WK LAW

Nursing management - STAFFING Steps for Computing the Staff Needed in the in-pati ent Unit of the Hospital COMPUTATION: CASE: 250 BED CAPACITY TERTIARY HOSPITAL. HOW MANY STAFF NURSES DO WE NEED? 1. C ATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE 250 X 30% = 250 X 45% = 250 X 15% = 250 X 10% = 75 112.5 3.5 25 minimal care moderate care intensive care 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 PERSONNE L NEEDED

Nursing management - STAFFING 6. DETERMINE PROF FROM NON PROF PERSONNEL e.g. ter tiary 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%) NIGHT (18%) 46 22 24 12

Nursing management - STAFFING

Placement of Staff

proper placement: a. fosters personal growth b. provides a motivating climate fo r the employee c. maximizes productivity d. organizational goals have better cha nces of being met inappropriate placement: a. frustration b. poor quality of wor k 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 perso nnel. Factors to Consider in Making a Schedule 5. Different levels of the nursing staf f 6. Adequate coverage for 24 hours, 7 days a week 7. Staggered vacations and ho lidays 8. Weekends 9. Long stretches of consecutive working days 10.Evening and night shifts 11.Floating

Nursing management - STAFFING Assessing a Scheduling System 3. Ability to cover t he needs of the shift 4. Quality to enhance the nursing personnels knowledge, training and experience 5. Fairness to the staff. 6. Stability 7. Flexibility

Nursing management - STAFFING Types of Scheduling 3. Centralized Schedule 4. Dece ntralized Schedule 5. Cyclical Schedule

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

Nursing management - STAFFING

DEVELOPING JOB DESCRIPTION

Job Description is a statement that sets the duties and responsibilities of a sp ecific job. Contents of a Job Description 6. Identifying Data 7. Job Summary 8. Qualification Requirements 9. Job Relationships 10.Specific and Actual Functions and Activities

Nursing management - STAFFING Uses of Job Description 2. For recruitment and sel ection of qualified personnel 3. To orient new employees to their jobs 4. For jo b placement, transfer or dismissal 5. As an aid in evaluating the performance of an employee 6. For budgetary purposes 7. For determining departmental functions and relationships to help define the organizational structure 8. For classifyin g levels of nursing functions according to skill levels required. 9. To identify training needs 10.As basis for staffing 11.To serve as channel of communication .

Nursing management - DIRECTING

DIRECTING

Plan put into action Activities Delegation transferring responsibility Updating policy Utilize the policy update s Supervision Roles in Supervision Guides Direct Facilitates Motivates Teaches

Nursing management - DIRECTING n to whom the job is to be

Principles of Delegation 2. Select the right perso

delegated. 3. Delegate both interesting and uninteresting tasks. 4. Provide subo rdinates with enough time to learn. 5. Delegate gradually. 6. Delegate in advanc e. 7. Consult before delegating. 8. Avoid gaps and overlaps.

Nursing management - DIRECTING What Cannot be Delegated 3. Overall responsibility , authority and accountability for satisfactory completion of all activities in the unit. 4. Authority to sign ones name is never delegated 5. Evaluating the staff and or taking necessary correcti ve or disciplinary action. 6. Responsibility for maintaining morale or the oppor tunity to say a few words of encouragement to the staff especially the new ones. 7. 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 con sistent with the job description. 2. person The right person should have the app ropriate license or certificate, job description. 3. communication The right com munication should be clear, concise, complete and correct. 4. feedback The right feedback should ask for input, get the persons recommended solution to the probl em and recognize the persons effort.

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

Nursing management - DIRECTING

COMMUNICATION

Communication is the transmission of information, opinions, and intentions betwe en among individuals. Purpose of communication 1. facilitates work 2. increases motivation 3. effects change 4. optimizes patient care 5. increases workers satis faction 6. facilitates coordination

Nursing management - DIRECTING

Types of Communication

1. Verbal Communication 2. Written Communication 3. Non-verbal Communication e. Personal appearance f. Intonation of the voice g. Facial expression h. Posture a nd gait i. Touch

Nursing management - DIRECTING UPWARD to superior

Lines of Communication

HORIZONTAL to peers and members of the Health Team NURSES OUTWARD to patient, family and community to workers family and friends DOWNWARD to subordinates

Nursing management - DIRECTING

DECISION MAKING

Decision is a course of action that is consciously chosen from available alterna tives 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 a lternative solution search for and analysis of alternatives and their possible co nsequences 4. selection of the solution weighing of facts and exploring alternati ve solutions 5. implementation and follow-up

Nursing management - DIRECTING

Major Management Functions in Implementing

Decisions 1. Planning which entails consideration and selection of realistic obj ectives, policies and procedures. 2. Organizing which means helping personnel un derstand 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 - DIRECTING t others should make, to

Art of Decision Making: 2. Not making decision tha

preserve morale and authority; 3. Not deciding on problems that are not pertinen t to matters at hand to prevent waste of time and energy; 4. Not deciding premat urely to prevent prujudice 5. Not making ineffective decisions to avoid losing t he respectability of the decision maker.

Nursing management - DIRECTING

CONFLICT MANAGEMENT

CONFLICTS clash, fight, battle or struggle; it may be constructive or destructiv e Basis of the Conflict 1. Intrapersonal 2. Interpersonal 3. Group 4. Intergroup 5. Organizational

Nursing management - DIRECTING Sources of the Conflict Cultural differences Different facts Separate pieces of information Different perception of the event Defining the problem differently D ivergent views of power and authority Role conflicts Number of organizational le vels Degree of association Parties dependent on others Competition for scarce re sources Ambiguous jurisdictions Need for consensus Communication barriers Separa tion in time and space Accumulation of unresolved conflit

Nursing management - DIRECTING

Types of Conflict

1. Intrasender - conflict originates in the sender who gives conflicting instruc tions. 2. Intersender - conflict arises when an individual receives conflicting messages from two or more sources. 3. Interrole - conflict can occur when an ind ividual belongs to more than one group. 4. Person-role - conflict is the result of disparity between internal and external roles.

Nursing management - DIRECTING 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 w hen the group faces a new problem. 7. Intergroup - conflict is common where 2 gr oups 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 expect ed on them. 9. Role Overload - the person is simply unable to accomplish so much within a limited time period.

Nursing management - DIRECTING

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 - in spires mutual attention to the problem and utilizes the talents of all parties 4 . Compromise - in this method, accommodation and adjustment lead to workable sit uations rather than to the best solution.

Nursing management - DIRECTING 5. Competition - it is an assertive position that fosters conflict resolution on the part of the subordinate. 6. Smoothing - disa greements are ignored so that surface harmony is maintained in a state of peacef ul co-existence. 7. Withdrawing - one party is resolved thereby making it possib le to resolve the issue. 8. Forcing - yields an immediate end to the conflict bu t leaves the cause of the conflict unresolved.

Nursing management - DIRECTING

Rules on Mediating a Conflict Between Two or More

Parties: 1. Establish clear guidelines and make them known to all. 2. Do not pos tpone indefinitely. 3. Create an environment that makes people comfortable to ma ke suggestions. 4. Keep two-way communication. 5. Stress a peaceful resolution r ather than confrontation. 6. Emphasize shared interests. 7. Follow-up on the pro gress 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 organizatio n, the work environment , and in his job.

Nursing management - CONTROLLING

CONTROLLING

Controlling or evaluating is an on-going function of management which occurs dur ing planning, organizing, and directing activities. The controlling process open s opportunities for improvement and comparing performance against set standard.

Nursing management - CONTROLLING Reasons For Conducting Evaluation 2. Evaluation ensures that quality nursing care is provided. 3. It allows for the setting of sensible objectives and ensures compliance with them. 4. It provides standards for establishing comparisons. 5. It promotes visibility and a means for employees to monitor their own performanc e. 6. It highlights problems related to quality care and determines the areas th at require priority attention. 7. It provides an indication of the costs of poor quality. 8. It justifies the use resources. 9. It provides feedback for improve ment.

Nursing management - CONTROLLING Principles of Evaluation. 2. The evaluation mus t be based on the behavioral standards of performance 3. 4. 5. 6. 7. 8. which the position requires. The evaluation should have enough time to observe e mployees behavior. The employee should be given a copy of the job description, pe rformance standards, and evaluation conference. The employees performance apprais al should include both satisfactory and unsatisfactory results with specific beh avioral instances to exemplify these evaluative comments. Areas needing improvem ent must be prioritized to help the worker upgrade his/her performance. The eval uation conference should be scheduled and conducted at a convenient time for the rater and the employee. The evaluation report and conference should be structur ed in such a way that is perceived and accepted positively as a means of improvi ng job description.

Nursing management - CONTROLLING Characteristics of an Evaluation Tool 2. Should be objective 3. Should be reliable 4. Should be sensitive

Nursing management - CONTROLLING

PERFORMANCE APPRAISAL

Performance appraisal is a control process in which employees performance is eval uated against standards. Purposes of Performance Appraisal 5. Determine salary standards and merit increas es. 6. Select qualified individuals for promotion or transfer. 7. Identify unsat isfactory employees for demotion or termination 8. Make inventories of talents within the institution. 9. Determine training and development needs of employee.

Nursing management - CONTROLLING 6. Improve the performance of work groups by ex amining, improving, correcting interrelationship between members 7. Improve comm unication between supervisors and employees and reach an understanding on the ob jectives of the job 8. Establish standards of supervisory performance. 9. Discov er the aspirations of employees and reconcile these with the goals of the instit ution 10. Provide employee recognition 11. Inform employees where they stand.

Nursing management - CONTROLLING Methods of Measuring Performance 2. Essay 3. Che cklist 4. Ranking 5. Rating Scales 6. Forced-choice Comparison 7. Anecdotal Reco rding

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