Nursing Management 2

PREPARED BY:AILYN B.PINEDA, RN

NURSING MANAGEMENT

PROCESS

NURSING MANAGEMENT

Is the process of working through staff members to be able to provide comprehensive care to the patient

This includes planning, organizing, directing and controlling

The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in order to provide effective, economic care to groups of patients

NURSING MANAGEMENT PROCESS

NURSING MANAGEMENT PROCESS

Purpose of the Nursing Management Process

To achieve scientifically – based, holistic, individualized care for the patient

To achieve the opportunity to work collaboratively with patients and others

To achieve continuity of care

Characteristics of the Nursing Management Process

SystematicDynamicInterpersonalGoal DirectedUniversally Applicable

MANAGEMENT FUNCTIONNURSING MANAGEMENT PROCESS

PLANNING

PLANNING

Is deciding in advance what to do, how to do a particular task, when to do it, and who is to do it.

Is predetermining a course of action in order to arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known

COMPONENTS OF PLANNING

PLANNING:PREDETERMINE

D ACTION

WHO IS TO DO IT:

-professional, non-professional

HOW TO DO IT:-technique, principles

WHAT TO DO:-nursing activities

Nursing management-planning-

PRINCIPLES OF PLANNING1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization.2. Planning is a continuous process.3. Planning should be pervasive within the entire organization covering the various departments, services and the various levels of management to provide maximal cooperation and harmony.4. Planning utilizes all available resources.5. Planning must be precise in its scope and nature.6. Planning should be time bounded.7. Projected plans must be documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement.

PLANNING

It leads to success in the achievements of goals and objectives

It provides meaning to workIt provides for the effective use of available

personnel and facilitiesIt helps nurses cope with crises and problems

calmly and efficientlyIt is cost effectiveIt is based on past and future activitiesIt reduces the element of changeIt is necessary for effective control

Characteristics of a GOOD PLAN

It should have a clearly worded objectives, including results and methods for evaluation

Be guided by policies and/or procedures affecting the planned action

Indicate prioritiesDevelop actions that are flexible and realistic in

terms of available personnel, equipment, facilities and time

Develop a logical sequence of activitiesSelect the most practical methods for achieving

each objective

PLANNING

TYPES OF PLANNING:

1. STRATEGIC OR LONG-RANGE PLANNING“what are the right things to do”- usually extending 3 to 5 years into the future.

2. OPERATIONAL OR SHORT-RANGE PLANNING“how does one do things right”

- deals with day to day maintenance activities.

3. CONTINUOUS OR ROLLING PLANS- similar to operating plans, involves mapping out the day-to-day activities.

ELEMENTS OF PLANNING

Forecasting or Estimate the futureSet Objectives/Goals and Determine Results

DesiredDevelop and Schedule Strategies,

Programs/Projects/Activities; Set the Time Frame

Prepare the Budget and Allocation of Resources

Establish Policies Procedures and Standards

Elements of Planning-Forecast or Estimate the Future-

Forecasting is looking into the futureRefers to estimation of time series, cross

sectional or longitudinal dataIn 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 PlanningSet Objectives/Goals and Determine Results

Desired

GOALS are broad statements of intent derived from the purposes of the organization Is a desired aim or condition toward which one is willing to

work Individual goals- are personal goals; based on one’s

desired in life Group goals- may refer also to organizational goals

although on a smaller scale Organizational goals- management goals of an organization

that are established to justify its existence Short term goals and long term goals

Objectives

The objectives of the Nursing Department is congruent to its vision as well as to the 11 key areas of responsibilities to nursing practice:

To observe ethical principles and standards that govern nursing practice. (ethico-moral-legal responsibilities)

To establish well coordinated referral system for the continuity of patient’s/ client’s care. (communication)

To assure the application of acceptable performance of functions, duties, and responsibilities of every position in the nursing department. (safe & quality nursing care, management of resources)

To encourage its nursing personnel to participate in nursing research for improving nursing care. ( research)

To utilize media for information campaign to intensify health education program. (health education)

Nursing management- ELEMENTS OF PLANNING-

MISSION OR PURPOSE

- The mission statement outlines the agency’s reason for existing ( whether hospital or health care), who the target clients are ( the poor, the needy, the middle or upper class), and what services will be provided ( in-patient, out-patient, emergency).

- reason for the existence of the organization (Nursing service exist to promote and maintain health)

Vision

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

Mission

The BON shall unwaveringly pursue the advancement of nursing development in the country by:

1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws3. unifying the nursing sector through good governance 4. fostering linkages with the domestic and international stakeholders


PHILOSOPHY

- Philosophy is the sense of purpose of the organization and the reason behind its structure and goals.

- Philosophy states the beliefs that influence nursing practice and beliefs about health care.

POLICIES

Policies in general, they are guidelines to help in the safe and efficient achievement of organizational objectives

PROCEDURES

Procedures are specific directions form implementing written policies


• Develop and Schedule Strategies, Programs/Projects/Activities; Set the Time Frame

Strategy is the techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives.

Programs are activities put together to facilitate attainment of some desired goals.

Nursing managementPLANNING

Time Management is a technique for allocation of one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goal s efficiently


Principles of Time Management1)Planning for contingencies-planning anticipates

the problem that will arise from actions without thought

2)Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance

3)Inventory4)Sequencing5)Setting and keeping deadlines- and adhering to

deadline is an excellent exercise in self discipline6)Deciding on how time will be spent


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

1. Conduct an inventory of your activities. 2. Set goals and objectives and write them down.3. With the use of calendars, executive planners, logs or journals,

write what you expect to accomplish yearly, monthly, weekly or daily.

4. Break down large projects into smaller parts.5. Devote a few minutes at the beginning of each day for planning.6. Organize your work space so it is functional.7. Close your door when you need to concentrate.8. Learn to delegate.9. In a meeting, define the purpose clearly before starting.10.Take or return phone calls during specified time.11.Develop effective decision-making skills.12.Take rest breaks and make good use of your spare time.


Multitasking Trying to get more things done in less time Examples: answering phone calls while driving,

sending e-mails while in the meeting


DEVELOPING AND SCHEDULING PROGRAMSPrograms are predetermined, developed and

targeted within a time frame to reach the set goals and objectives.

The Planning Formula1.WHAT2.WHEN3.WHERE4.HOW5.WHO6.WHY7.CAN


• PREPARING THE BUDGET1.A budget is the annual operating plan, a financial

“road map” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs.

2.A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year.

3.A hospital budget is a financial plan to meet future service expectations.

Factors in BUDGET planning

Type of patient, length of stay in the hospital and acuteness of illness

Size of hospital and bed occupancyPhysical lay out of the hospital, size and plan of

the wards, units, nurse’s station, treatment rooms, etc

Personnel policies Salaries paid to various type of nursing personnel including

OT pay or shift differential Extent of VL, SL, holidays Provision for staff development programs

Grouping of patients such as those in specialized areas


Standards of nursing care: kind and amount of care to be given as it affects the number of hours of bedside care

The method of performing nursing care whether simple or complex; the method of documentation

Proportion of nursing care provided by the professional nurses and those given by non-professionals

Amount and quality of supervision available and provided; the efficiency of job description and job classification


Method of patient assignment whether functional, case, team or primary

Amount and kind of labor-saving devices and equipments

Amount of centralized service provided: sterile supply , central o2 supply, linen supply

Nursing service requirements of the ancillary departments: clinics, admitting office, ER

Reports required by administration whether simple or complex

Affiliation of nursing students or medical students

Establishing Nursing Standards, Policies and Procedures

Nursing Standards Standard- a practice that enjoys general recognition

and conformity among professionals or an authoritative statement by which quality of practice or education can be judged

Nursing Care Standard – a descriptive statement desired quality against which to evaluate nursing care

Purpose of nursing standards Improved quality of care Decrease the cost of nursing care Determine nursing negligence

Sources of nursing standards DOH, BON, Professional Organization, Nursing Programs


Nursing Service Policies Policies in general are guidelines to help in safe and

efficient achievement of organizational objectives There are 3 general areas in nursing which requires

policy formulation. These are: Areas in which confusion about the locus of responsibility

might result in neglect or malperformance of an act necessary to a patient’s welfare

Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property

Areas involving matters of personnel management and welfare


Nursing procedures Procedures are specific directions for implementing

written policies

Procedures are more specific guide to action than policy

NURSING MANAGEMENT FUNCTIONNURSING MANAGEMENT PROCESS

ORGANIZING

Nursing management- ORGANIZING -

ORGANIZING is the process of establishing formal authorityInvolves setting up the organizational structure through

identification of groupings, roles and relationshipsDetermines staff needed through developing and maintaining

staffing patterns and distributes them in the various areas as needed

Develops job descriptions by defining the qualifications and functions of personnel

Organizing

Organizing is one way which nursing management coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion

Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies


PRINCIPLES OF ORGANIZATION:Communication: effective and open communication

in all forms; thread that binds the organization together Directions of communication:

Downward Upward Lateral/Horizontal Grapevine

Unity of CommandSpan of ControlDelegation of authoritySimilar AssignmentsUnity of Purpose

ORGANIZATIONAL DESIGN

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

PRINCIPLES OF ORGANIZATIONAL DESIGN

1. Division of labor2. Unity of command3. Authority and

responsibility4. Span of Control5. Contingency Factors


ELEMENTS OF ORGANIZING1.Organizational Structure2.Staffing 3.Scheduling4.Developing job descriptions

Importance of organizational structure

It enables members what their responsibilities are so that they may carry them out

It frees the manager and the individual workers to concentrate on their respective roles and responsibilities

It coordinates all


ORGANIZATIONAL STRUCTURE

The organizational structure refers to the process by which a group is formed its channel of authority, span of control and lines of communication.

It is the formal structure, the official arrangement of positions or working relationships that will coordinate efforts of workers of diverse interest and abilities

Patterns of Organizational Structure

Tall or Centralized StructureFlat 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, and allows close communication between the workers.

Supervisory individuals screen the communication.

Disadvantage Transpires that the most

skilled individuals end up doing nothing while actual tasks are done by those less 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 contact with their supervisor.

Flat or Decentralized Structures

Refers to an organizational structure with few or no levels of intervention between management and staff.

Flat or Decentralized Structure

AdvantagesLower likelihood of

messages being distorted

Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction

The principle of “shared governance” produces maximum potential for professional growth

DisadvantagesSupervisor spend less

time with each worker

Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions


Types of Organization Classified by Nature of Authority

1)Line Organization- each position has general authority over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal)

2)Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization)

3)Staff Organization- purely advisory to the line structure with no authority to put recommendations into action.

4)Functional Organization – each unit is responsible for a given part of the organization’s workload.

TYPES OF ORGANIZATIONAL STRUCTURE

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


2. Flat Organization

- refers to an organizational structure with few or no levels of intervention between management and staff.


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


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


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


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


• ORGANIZATIONAL CHART

- Organizational chart is a line drawing that shows how the parts of an organization are linked.


Characteristics of an Organizational Chart

1)Division of Work2)Chain of Command3)Type of Work to be performed4)Grouping of Work Segment5)Levels of Management


STAFFING

Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients’ demand.

The process of assigning competent people to fill the roles designated for the organizational structure through recruitment, selection and development.

- STAFFING -

FACTORS AFFECTING TIME REQUIREMENT OF NURSING CARE Patient’s acuteness of illness Degree of dependence Communicability of ailment

Steps in Staffing

Determine the Number and Types of Personnel Needed

Recruitment Interview Induct or Orient the

Personnel in Organization Job Offer

Centralized Staffing

Staffing decisions for all units are made by a central office or computer.

Tends to be fairer to employees, because policies are implemented more consistently and impartially.

Frees manager to complete other functions.

Most cost effective, because it maximizes use of human resources organization-wide.

Decentralized Staffing

Staffing is done at unit level, frequently by unit manager.

Allows person who knows the individual unit the best to make staffing decisions for that unit.

Allows staff to take requests directly to their own manager, which gives them increased autonomy and flexibility.

Increases the risk that employee requests may be treated unequally or inconsistently.

Time-consuming for unit manager.

NURSING CARE MODALITIESTOTAL CARE or CASE NURSINGOne nurse is assigned to one patient for totality of care during his or her time on duty

PDNIsolation nurseNursing student

NURSING CARE MODALITIES

FUNCTIONAL NursingTask-orientedParticular nursing function is

assigned to each nurseTime savingWorker learns w/ mastery-Medication nurse-Charge nurse-Nursing attendant

Nursing Care Modalities

PRIMARY NursingNurse is responsible for the total care of a small group of clients from admission to discharge

Nursing Care Modalities

TEAM NursingThe team leader assigns patients & tasks according to job descriptions

PATIENT CLASSIFICATION SYSTEM

1. “Self care” or Minimal Care Patients

2. Intermediate or Moderate Care

3. Total Care Patients 4. Intensive Care Patients


1. “Self care” or Minimal Care Patients

capable of carrying activities of daily living (ADL) Convalescing, no longer require intensive, moderate, or maximum care

Require dx studies, Minimal therapy Awaiting elective

surgery, Home environment

temporarily makes discharge undesirable


2. Intermediate or Moderate Care

• requires some help from the nursing staff with special treatments.

• Given to moderately ill• Recovering from immediate

effects of a serious illness or operation

• May be ambulatory for short periods (needs assistance)


3. Total Care Patients those who are

bedridden and who lack strength and mobility to do average daily living.

Needs close attention Requires nurse to

initiate, supervise, and perform most of the activities

Requires frequent medication


4. Intensive Care Patients those who are critically

ill and in constant danger of death or serious injury. Acutely ill patients w/ high level of nurse dependency

Unstable condition w/c requires frequent evaluation with adjustment of therapy

Nursing management- STAFFING -

STAFFING FORMULARequirements:STANDARD VALUE OF NURSING CARE

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

i. Surgeryii. General Wardiii. Pediatriciv. Pathologic

Nurseryv. Medicalvi. OBvii.ICU/ER/RRviii.CCU

3.43.54.62.83.43.06.06.0

60:4060:4070:3055:4560:4060:4070:3080:20


Distribution Per Shift

SHIFT PERCENTAGE

AM

PM

NIGHT

45 %

37%

18%


CATEGORIES OF PATIENTLevels of Care NCH Needed /pt./

dayProf: Non Prof

Level I Self-Care or Minimal Care

Level II Moderate or Intermediate Care

Level III Total or Intensive Care

Level IV Highly Specialized or Critical Care

1.50

3.0

4.5

6.0 7.0 or higher

55:45

60:40

65:35

70:3080:20


PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CAREType of Hospital Minima

l Care

Moderate

Care

Intensive Care

HighlySpl. Care

Primary Hospital

Secondary Hospital

Tertiary Hospital

Special Tertiary Hospital

70

65

30

10

25

30

45

25

5

5

15

45

-

-

10

20


TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR

Right s and Privileges Given each Personnel/Yr

Working Hours per Week 40 hours 48 hours

1. Vacation Leave2. Sick Leave3. Legal Holidays4. Special Holidays5. Special Privileges6. Off Duties as per R.A.

59017. Continuing Education

Program

Total Non-Working Days/YearTotal Working Days/YearTotal Working Hours / YearRA 5901 = 40H WK LAW

15 1515 1510 102 23 3104 523 3

152 100213 2651,704 2,120


Steps for Computing the Staff Needed in the in-patient Unit of the Hospital

COMPUTATION: CASE: 250 BED CAPACITY TERTIARY

HOSPITAL. HOW MANY STAFF NURSES DO WE NEED?

1. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE 250 X 30% = 75 minimal care 250 X 45% = 112.5 moderate care 250 X 15% = 3.5 intensive care 250 X 10% = 25 highly specialized

nursing care


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/day25 X 6 (NCH @ Level IV) = 150

NCH/day-------------------

768.75 NCH/DAY


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 )


5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL NEEDED.

a. TOTAL NCH/ YEAR = 280,593.75 = 165 WORKING HRS / YEAR 1,704

b. RELIEF x TOTAL NSG PERSONNEL 165 X 15%=25

(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)

c. RELIEVERS + TOTAL # OF NURSING PERSONNEL NEEDED

165 + 25 = 190 TOTAL PERSONNEL NEEDED


6. DETERMINE PROF FROM NON PROF PERSONNEL

e.g. tertiary hospital

190 X 65% = 124 PROFESSIONAL190 X 35% = 68 NON

PROFESSIONAL


7. DISTRIBUTE PER SHIFT

PROFESSIONAL(124) NON PROFESSIONAL(66)

AM (45%) 56 30

PM (37%) 46 24

NIGHT (18%) 22 12


Placement of Staffproper placement:

a. fosters personal growthb. provides a motivating climate for the employeec. maximizes productivityd. organizational goals have better chances of being met

inappropriate placement:a. frustrationb. poor quality of workc. reduced organizational efficiencyd. rapid turn-overe. poor image for the agency

RA 9173 nurses with Master’s degree in Nursing are easily placed in position


SCHEDULINGA schedule is a timetable showing planned

work days and shifts for nursing personnel.

Factors to Consider in Making a Schedule1.Different levels of the nursing staff2.Adequate coverage for 24 hours, 7 days a week3.Staggered vacations and holidays4.Weekends5.Long stretches of consecutive working days6.Evening and night shifts7.Floating


Assessing a Scheduling System

1.Ability to cover the needs of the shift2.Quality to enhance the nursing personnel’s

knowledge, training and experience3.Fairness to the staff.4.Stability5.Flexibility


Types of Scheduling

1.Centralized Schedule2.Decentralized Schedule3.Cyclical Schedule


SCHEDULING VARIABLESa.Length of scheduling period whether 2 or 4 weeksb.Shift rotationc. Week-ends offd.Holiday offe.Vacation leavef. Special days g.Scheduled events in the hospital , training

programs, or meetingsh.Job categoriesi. Continuing professional education (CPE) programs


DEVELOPING JOB DESCRIPTION

Job Description is a statement that sets the duties and responsibilities of a specific job.

Contents of a Job Description1.Identifying Data2.Job Summary3.Qualification Requirements4.Job Relationships5.Specific and Actual Functions and Activities


Uses of Job Description1.For recruitment and selection of qualified personnel2.To orient new employees to their jobs3.For job placement, transfer or dismissal4.As an aid in evaluating the performance of an employee5.For budgetary purposes6.For determining departmental functions and

relationships to help define the organizational structure7.For classifying levels of nursing functions according to

skill levels required.8.To identify training needs9.As basis for staffing10.To serve as channel of communication.

Nursing management- DIRECTING -

DIRECTING Plan put into action Activities

Delegation – transferring responsibility Updating policy Utilize the policy updates Supervision

Roles in Supervision• Guides• Direct• Facilitates• Motivates• Teaches


Principles of Delegation1.Select the right person to whom the job is to be

delegated.2.Delegate both interesting and uninteresting

tasks.3.Provide subordinates with enough time to learn.4.Delegate gradually.5.Delegate in advance.6.Consult before delegating.7.Avoid gaps and overlaps.


What Cannot be Delegated

1.Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit.

2.Authority to sign one’s name is never delegated3.Evaluating the staff and or taking necessary

corrective or disciplinary action.4.Responsibility for maintaining morale or the

opportunity to say a few words of encouragement to the staff especially the new ones.

5.Jobs that are too technical and those that involve trust and confidence.


Four Rights of Delegation1. task

The right task should be within the scope of the person’s practice and consistent with the job description.2. person

The right person should have the appropriate license or certificate, job description.3. communication

The right communication should be clear, concise, complete and correct.4. feedback

The right feedback should ask for input, get the person’s recommended solution to the problem and recognize the persons effort.


• Aspects of Delegation1. Responsibility – denotes obligation2. Authority – the power to make final decisions and give commands.3. Accountability – refers to liability


COMMUNICATIONCommunication is the transmission of

information, opinions, and intentions between among individuals.

Purpose of communication1. facilitates work2. increases motivation3. effects change4. optimizes patient care5. increases workers’ satisfaction6. facilitates coordination


Types of Communication1. Verbal Communication2. Written Communication3. Non-verbal Communication

a.Personal appearanceb.Intonation of the voicec.Facial expressiond.Posture and gaite.Touch


Lines of Communication UPWARD

to superior

HORIZONTAL OUTWARD

to peers and to patient, family

members of the and communityHealth Team to workers’ family

and friends DOWNWARD to subordinates

NURSES


DECISION MAKING Decision is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result. 5 Steps in Decision Making

1. definition of the problem“ why the problem occur”

2. analysis of the problem“getting to the cause of the problem”

3. development of an alternative solution“search for and analysis of alternatives and their

possible consequences”4. selection of the solution

weighing of facts and exploring alternative solutions5. implementation and follow-up


Major Management Functions in Implementing Decisions1. Planning which entails consideration and selection of realistic objectives, policies and procedures.2. Organizing which means helping personnel understand the decision and the procedures necessary for implementing the decision.3. Staffing or the selection of the right person/s to carry out the decision4. Controlling the environment and the group to prevent adverse effects.


Art of Decision Making:1.Not making decision that others should make,

to preserve morale and authority;2.Not deciding on problems that are not

pertinent to matters at hand to prevent waste of time and energy;

3.Not deciding prematurely to prevent prujudice4.Not making ineffective decisions to avoid losing

the respectability of the decision maker.


CONFLICT MANAGEMENT

CONFLICTS – clash, fight, battle or struggle; it may be constructive or destructive

Basis of the Conflict1. Intrapersonal2. Interpersonal3. Group4. Intergroup5. Organizational


Sources of the Conflict Cultural differences Different facts Separate pieces of information Different perception of the event Defining the problem differently Divergent views of power and authority Role conflicts Number of organizational levels Degree of association Parties dependent on others Competition for scarce resources Ambiguous jurisdictions Need for consensus Communication barriers Separation in time and space Accumulation of unresolved conflit


Types of Conflict1. Intrasender

- conflict originates in the sender who gives conflicting instructions.

2. Intersender- conflict arises when an individual receives conflicting messages from two or more sources.

3. Interrole- conflict can occur when an individual belongs to more than one group.

4. Person-role- conflict is the result of disparity between internal and external roles.


5. Interperson- conflict is common among people whose positions require interaction with other persons who fill various roles in the same organization or other organizations.

6. Intragroup- conflict occurs when the group faces a new problem.

7. Intergroup- conflict is common where 2 groups have different goals and can achieve their goals only at the others’ expense.

8. Role Ambiguity- a condition in which individuals do not know what is expected on them.

9. Role Overload- the person is simply unable to accomplish so much within a limited time period.


Conflict Resolution1. Avoidance

- used by groups who do not want to do something that may interfere with their relationship2. Accommodation

- self-sacrifice3. Collaboration

- inspires mutual attention to the problem and utilizes the talents of all parties

4. Compromise- in this method, accommodation and adjustment

lead to workable situations rather than to the best solution.


5. Competition- it is an assertive position that fosters conflict

resolution on the part of the subordinate.6. Smoothing

- disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence.

7. Withdrawing - one party is resolved thereby making it

possible to resolve the issue.8. Forcing

- yields an immediate end to the conflict but leaves the cause of the conflict unresolved.


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


• Staff DevelopmentStaff development is geared ultimately

to organizational development.

• OrientationOrientation is a planned and guided

activities of an employee in the organization, the work environment , and in his job.

Nursing management- CONTROLLING -

CONTROLLINGControlling or evaluating is an on-going

function of management which occurs during planning, organizing, and directing activities.

The controlling process opens opportunities for improvement and comparing performance against set standard.


Reasons For Conducting Evaluation1.Evaluation ensures that quality nursing care is

provided.2. It allows for the setting of sensible objectives and

ensures compliance with them.3. It provides standards for establishing comparisons.4. It promotes visibility and a means for employees to

monitor their own performance.5. It highlights problems related to quality care and

determines the areas that require priority attention.6. It provides an indication of the costs of poor quality.7. It justifies the use resources.8. It provides feedback for improvement.


Principles of Evaluation.1. The evaluation must be based on the behavioral standards of

performance which the position requires.2. The evaluation should have enough time to observe employee’s

behavior.3. The employee should be given a copy of the job description,

performance standards, and evaluation conference.4. The employee’s performance appraisal should include both

satisfactory and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments.

5. Areas needing improvement must be prioritized to help the worker upgrade his/her performance.

6. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee.

7. The evaluation report and conference should be structured in such a way that is perceived and accepted positively as a means of improving job description.


Characteristics of an Evaluation Tool1.Should be objective2.Should be reliable3.Should be sensitive


PERFORMANCE APPRAISALPerformance appraisal is a control process in

which employee’s performance is evaluated against standards.

Purposes of Performance Appraisal1.Determine salary standards and merit increases.2.Select qualified individuals for promotion or transfer.3.Identify unsatisfactory employees for demotion or

termination4.Make inventories of talents within the institution.5.Determine training and development needs of

employee.


6. Improve the performance of work groups by examining, improving, correcting interrelationship between members

7. Improve communication between supervisors and employees and reach an understanding on the objectives of the job

8. Establish standards of supervisory performance.9. Discover the aspirations of employees and

reconcile these with the goals of the institution10. Provide employee recognition11. Inform employees where they stand.


Methods of Measuring Performance1.Essay2.Checklist3.Ranking4.Rating Scales5.Forced-choice Comparison6.Anecdotal Recording


Documents

Nursing Management 2