c

Ê
   
  

Introduction c
Directing is getting the work done through others. It is
cc
. Communication on management maybe
management of people which is the heart of the administrative downward, upward, and lateral or sideward.
process to be properly understood and practiced by a nurse

 This may come in forms of
manager.
Directing in nursing is giving orders and directions to others to
attain quality patient care. This function of a nurse manager is
administrative in nature which involves two major aspects,
 c
policies, manuals and guidelines for information and
compliance of everyone in the organization. Memoranda, job
descriptions, performance appraisals, and the likes are other
forms of downward communication. cc
namely: the human and technical aspects.  c

 This usually comes form
 subordinates to top management. It is done in the form of

Ê


 
Ê
  feedback informing the administration as to the effect of the


 
  downward communication-the extent of which it has been
Directing is the issuance of assignments, orders and received and acted upon.
instructions that help the nursing personnel to understand what 

cc c

 This is being observed
are expected of them. It also refers to supervision and between employees, personnel, units or departments on similar
guidance of every one in the organization so that they can level. It comes out in various forms like endorsements
efficiently and maximally contributes to the attainment of between shifts, nursing rounds, conferences, or meeting or in
organizational objectives in general and the attainment of making referrals between service departments.
quality nursing service objectives focused on quality client
care, in particular.
 Ê   
Leadership, motivation, communication, delegation and Decision making has important implications in the directing
supervision characterized the directing function of the nurse function of the nurse manager. Many authorities view
manager. decision making as the most important administrative activity
  since it is involved in the other process of administration such
Ê
  
ÊÊ

 as planning, organizing, coordinating, directing, controlling,

 and evaluating.
The nurse manager, being an administrator, affects the human Decision making is generally recognized as the heart of
relations more than anyone else in the nursing system. He or organization and the process of administration.
she is so involved with motivation, communication, daily off 
operations, and the decision-making process, being in the key 

Ê  
position to affect the human resources in the organization.
These are those which every staff
The relationship between the nurse managers and staff
members should be based on mutual trust and confidence.
 
^
c
member does in discharging duties. These duties are related to
every nurse¶s assessment of the patient¶s needs, planning and
implementing care, and evaluating of outcomes.
    Ô 

c
 This relates to the operations of a
Communication is viewed as a process of symbol using unit or department or the entire system and they are of concern
understanding, interaction, and reduction of uncertainty, to all members of the aforementioned organizational groups.
transference and transmission of information (Bormann,  
1980). 
It functions in the linking the individual to the environment Ê   
 Ê
establishing commonality, exercising power, time binding and 
 
replicating memories. 
At a general level, communication refers to a process of acting
 !" #" ! $%& $%%&
on information. %'&(")*+#(""  #$*
The encouraging climate of the organization facilitates upward "%,
communication. Staff nurses should feel a responsibility for Recognize, define, and limit the problem;
initiating upward-or lateral (sideward)-communication that is Analyze and evaluate the problem;
accurate and pertinent. Establish criteria or standards by which the solution will be
Communication is used for varied reasons and purposes by evaluated or judged as acceptable and adequate to the need;
nurse managers. Communication enhances the nurse (  !(""'& &-* .
manager¶s capability to facilitate work, enhance motivation,
*/ &"(  !#-&"/ "( ".
provide innovations, effect optimum care, add more worker /  --(  !"( &#-&$',
satisfaction and ensures coordination within the organization. Programming the solution
 Controlling the activities in the program
 Evaluating the results and the processccc
  

c
c
c


    Ê  ) A primary nurse who works with a limited number of patients
  utilizes the process of management as he or she provides and
manages the care of the patients.
Two advantages: A nurse manager who may have experienced that of being on

 the discussion provides maximum input with regard to the labor side of the management/ labor conflict may be able
the decision. to show greater empathy for his or her employees at all job

the staff members who are involved in a decision ± levels.
making process implement the decision better.
Decisions may as well be made by the nursing personnel as
there are directly with the implementation, including all other 
  

 
 
matters that are relevant to he patient¶s health care delivery 
system. 3
  c Organization consists of the structure and process
 which allow the agency to enact its philosophy and utilize its

  conceptual framework to achieve its goals. It refers to body
Management conflict are usually attributed to the customary persons, methods, policies and procedures arranged in a
ideas about what a manager performs ± planning, organizing, systematic process through the delegation of functions and
directing or leading, and controlling compared with the responsibilities for the accomplishment of the purpose.
traditional role of the worker ± doing manual labor (Myers, c Organizing is the process of establishing a formal
1970). authority. It involves setting up the organizational structure
  /&/"" through identification of groupings, roles and relationships,
Traditional organizations have conflicting views regarding determining the staff needed by developing and maintaining
role relationships between managers and workers. staffing patterns and distributing them in the various areas as
Organizational managers are the ones who have been needed. It includes developing job descriptions by defining the
presumed to possess the maturity, knowledge, ability, and qualifications and functions of personnel.
responsibility to plan, direct and control the workers activities. c An organizational chart is a line drawing that shows
Labor unions have impact in formalizing and widening the gap how the parts of an organization are linked. It depicts the
between the employer and the employees. formal organizational relationships, areas of responsibilities,
  person to whom one is accountable and channels of
 communication.

 
   
 * "-3
*0-( "+ * "% !# c setting up the organizational
$ $&** 1 c Structure
One of these factors is the rise in economic status of the less c staffing
privileged members of the employee group, together with c Scheduling
rising expectations c developing job descriptions
The second factor goes with an increasing awareness and 
acceptance by managers about the demographic pattern in '#"-3 ""-&$' /-/ ! '
organizational leadership. This concept of the job enrichment c Line Organization
for all employees, and not just he manager is one that includes c Informal Organization
not only the planning and control functions, but the doing as c Staff Organization
well (Myers, Ibid.). c Functional Organization
 
2$(!* -( 
"/ 
%0!( " ("-3 !
*c A way to encourage and let more employees to think c Division of Work
for their welfare is job enrichment. It enhances creativity, a c Chain of Command
wider range of doing or performance and more trust in the c Type of Work to be performed
employee. Job enrichment builds better interest, improved c Grouping of work segments
self-respect, and pride. Eventually, job enrichment enables c Level of management
every member to satisfy more his personal needs and as it 
happens there comes the success of agency and patient care. Ê- -*"
c / ! 'ois the right to act or make decisions



Ê
 

  without approval of higher administrators. It included the

  right to extract obedience from subordinates. In legal sense,
Being a nurse manager and a nurse manager greatly differs in authority flows down in an organization.
meanings (semantics). c Ê- -*"

c
c
c
c  / ! ' is the simplest and most
direct type in which each position has general authority over
the lower positions in the hierarchy.
c  -- #" provide advice, counsel or
technical support that may be accepted, altered, or rejected by
the line officer.
c ((/ $ 'omeans taking full responsibility for
the quality of work and behavior while engaged in the practice
of the profession.
c
"#"$ 'ois the obligation to perform the
c Budget including the amount allotted to salaries,
fringe benefits, supplies, materials, and equipment.
c Professional activities and priorities in nonpatient
activities like involvement in professional organizations,
formal educational development, participation in research and
staff development..
c Teaching program or the extent of staff involvement
in teaching activities.




 


assigned task c Expected hours of work per annum of each
c ois the ability to influence another to behave employee. This is influenced by the 40-hour week law; and
in accordance with one¶s wishes. c Patterns of work scheduleotraditional 5 days per
c   /"ois the rank a group bestows on a person in week, 8 hours per day; 4 days a week, ten hours per day and
accord with the group¶s estimation of the persons value and three days off; or 3 ½ days of 12 hours per day and 3 ½ days
significance to group goals. off per week.
c **/( ois the transmission of information Ê 
  



between persons. c Studies have shown that the morning day shift needs
 the most number of nursing personnel at 45 50 51 percent, for
3(#" the afternoon shift 34 to 37 percent,; and for the night shift 15-
c nity of Command 18 percent. In the Philippines the distribution usually followed
c Scalar principle or hierarchy is 45% for the morning shift, 37% for the afternoon shift, and
c Homogenous assignment or departmentation 18% for the night shifts.
c Span of Control 
c Exception Principle 



 
c Decentralization or the proper delegation of authority 1. Categorize the number of patients according to the levels of
 care needed. Multiply the total number of patient by the


 percentage of patients at each level of care (whether minimal,
c Staffing is the process of determining and providing intermediate, intensive or highly specialized).
the acceptable number and mix of nursing personnel to 2. Find the total number of nursing care hours needed by the
produce a desired level of care to meet the patient¶s demand. patients at each category level.
 c Find the number of patients at each level by




 

 the average number of nursing care hours needed per day.
c The type, philosophy, and objectives of the hospital c Get the sum of the nursing care hours needed
and the nursing service. at the various levels.
c The population served or the kind of patients served †1 Find the actual number of nursing care hours needed by the
whether pay or charity. given number of patients. Multiply the total nursing care hours
c The number of patients and severity of their illness needed per day by the total number of days in a year.
knowledge and ability of nursing personnel are matched with 4. Find the actual number of the working hours rendered by
the actual care needs of patients. each nursing personnel per year. Multiply the number of hours
 on duty per day by the actual working days per year.




 

 41
& !  /*$-/"#"&&1
c Availability and characteristics of the nursing staff, c Divide the total number of nursing care needed
including education, level of preparation, mix of personnel per year by the actual number of working hours rendered by
number and position. an employee per year.
c Administrative policies such as rotation, weekends c Find the number of relievers. Multiply the
and holiday off-duties. number of nursing personnel needed by 0.15 (for those
 working 40 hours per week) or by 0.12 (for those working 48



 
 hours per week).
c Standards of care desired which should be available
and clearly spelled out. Institutions may utilize the ANSAP¶S
Standards of Nursing Practice; PRC-ANSAP¶S Standards of
Safe Nursing Practice and/or the hospitals themselves may
formulate/develop their own standards.
c Layout of the various nursing units and resources
available within the department such as adequate equipment,
supplies and materials.
 c
c Add the number of relievers of the total
number of nursing personnel needed.
6. Categorize the nursing personnel into professional s and
nonprofessionals. Multiply the number of nursing personnel
according to the ratio of professionals to nonprofessionals.
7. Distribute by shifts.


It is important for a manager to consider some factors



 

 when assigning employees to a position or area where these
c
c
c
employees have very good chances for success. Proper
placement fosters personal growth provides, a motivating
climate for the employee, maximizes productivity and
organizational goals have better chances of being met.
c Inappropriate placement often result in frustration,
poor quality of work, reduce organizational efficiency, rapid
turn-over, and poor image for the agency.
 

the personnel. Many nursing personnel would prefer the
morning shift duty but this is given most frequently to senior
nurses. Permanent shifts, however, give several advantages.
The nursing personnel feel a sense of belonging with the other
personnel in the unit and in the same shifts. They are able to
adjust their family, social and recreational lives, or when day
opt to continue their formal education.
Ê  
c A schedule is a time table showing planned work
days and shifts for nursing personnel.
c The objective in scheduling is to assign
working days and days off to the nursing personnel so that
adequate patient care is assured.
 
Ê  5 morale s maintained.
c Ability to cover the needs of the unit
Ê 2Ê
 
c A job description is a statement that sets the duties
and responsibilities of a specific job. It includes the needed
characteristics or qualifications of the individual to perform
such duties successfully. It is an important management tool to
make certain that responsibilities are wisely dedicated that
work is efficiently distributed, that talent are fully used, and

c Quality to enhance the nursing personnel¶s 
2Ê
 
knowledge, trainings and experience c Identifying data
c Fairness to the staff c Job summary
c Stability c Qualification requirements
c Flexibility c Job Relationships
 c Specific and actual functions and activities
5

Ê   
c Centralized 
2Ê
 
c Decentralized scheduling c For recruitment and selection of qualified personnel.
c Cyclical Schedule c To orient new employees to their jobs.
 c For job placements, transfer or dismissal.

 Ê
Ê 
Ê   c As an aid in evaluating the performance of the
c  ! - "(!&/ #& ! !   -/ employee.
+"1 c For budgeting purposes.
c !-   1 
c +&"1 
2Ê
 
c
&'--"1 c For determining departmental functions and
c ( %"1 relationships to help define the organizational structure
c #( &'" 6$ !&'"7 && %"' c For classifying levels of nursing functions according
 (1118 to skill levels required
c (!&/& % "  ! !"# 7  c To identify training needs
#*"7* "1 c As basis for staffing
c 2$( "1 c To serve as channel of communication
c  /-""&/( *"1
 ! "** 9Ê- &%%
 Management; is ³the act, art, or manner of managing, or
 handling, controlling, direction; skill in managing; executive
Ê
5 
Ê  ability´
c It is fair to all. Favoritism is minimized as all nursing The accomplishment off an organization¶s goals by defining
of goals, organization of works, motivation of others, staffing
personnel get their fair share of rotation to the various shifts.
of the positions, the control of the labor, material and evaluate
c It saves time as the schedule does not have to be of the completed effort
redone every week or two. 
c It enables the employees to plan ahead for their ! "** 9
personal needs preventing frequent changes in schedule. Distinct process consisting of planning, organizing actuating
c Scheduled leave coverage such as vacation, holidays, and controlling performed to determine and accomplish the
and sick leaves are more stable. objective by the use of people and resources.
c Productivity is improved. Management ; is getting things done through other people
 (1979 ,AMA)
ROTATING WORK SHIFTS Management is working with and through other people to
c Rotating work shift is common in most hospitals. It is accomplish the objectives of both the organization and its
members.
desirable that there be equal share of morning, afternoon and
night shifts as prolonged night shifts may affect the heath of
c
c
c
Ê--("$  ! &- "
Places greater emphasis on human being in the organization
Focuses attention on the results to be accomplished, on
objectives rather than just a things or activities
Adds the concepts that accomplishment of the members¶
personal objectives should be integrated with accomplishment
of the organizational objectives
 One of the factors in production together with land, labor and
* !&- ("' ! ** .
Is the effective motivation of men and the efficient utilization
of resources for the attainment of predetermined objective.
Workers have to be motivated so that they perform the
assigned to them as programmed by management.
Is a technique by means of the purpose and objective of
particular human group are classified and effectuated
* , &((
Some management authorities regard management as an art,
It involves ³ proficiency in the practical application of
knowledge acquired through study, experience and
observations. It also involves application of skills and
techniques to achieve desirable results´. Managing as practice
ia an art.
* ""((
It is a body of knowledge dealing with a body of facts or truths
systematically arranged and showing the operation of
acceptable standard of laws. Organized knowledge about
management is science.
³The emphasis in any activity that is classed as an art is on
applying skills and knowledge and accomplishing of an end
Management is the process and agency which directs and
guides the operations of an organization in realizing of the
established aims.

!)-&((#  *#!"3 !$&"(#-
** 
AN ECONOMIC RESORCE
capital.
As industrialization increases , management is substituted for
labor and capital. The management resource of a firm
determines to a large extent, its productivity and profitability.
Management is used to extensively in industries experiencing
innovation.
""'" *-/ ! '
Management first develops with top individuals determining
the course of actions for the rank and file.
Humanitarian concepts have later developed paternalistic
approaches. This is followed by constitutional management
which emphasizes definite and consistent concern for policies
and procedures in dealing with the working group.
The trend toward a democratic and participative approach
follows as employees receive higher education


* "(""&"  /""'" *
Managers have become an elite group of brains and education.
Entrance to this class is based on education and knowledge.
The new managers continue to expand their horizons in the
effort to attain the ultimate in life.

through deliberate efforts.



* (""
Consist of achieving organizational objectives through INTERPERSONAL ROLES
As symbol because of the position he/she occupies and consist
planning, organizing, directing, and controlling human and of duties as signing papers
physical resources. As a leader who hires, trains, encourages, fires, remunerates,
Management process ± is self-regulating and self- correcting and judges
 As a liaison between outside contracts such as community,
supplier and rhe organization
*# (-** ** -/"
 INFORMATIONAL ROLE
Intended to assist the nurse in the patient care unit/ward A manager who monitors information
toward gaining a better understanding of factors involved in Disseminates information from both external and internal
management of patient care. resources
To solve all nursing care problems as possible when and As spokesperson or representative of the organization.
where required. She/he represents the subordinates to superiors and the upper
Intended to provide best services to the client. management to the subordinates
Optimum benefits for personnel Ê("
Essential component of professional nursing care. Makes her/him an entrepreneur or innovator, problem
Coordination of needs, new ideas, techniques , procedures
and approaches discoverer, a designer to improve projects that direct and
Smooth functioning of units to attain their goal of quality care control change in the organization.
through judicious use of available human and material A trouble-shooter who handles unexpective situations such as
resources within specific periods resignation of subordinates, firing of subordinates, and looses
 of clients

 "!#$ ** &&*"   As negotiator when conflicts arise.
Administration± is a process and gency which is responsible
for determination of the aims for which an organization and its
management are to strive, which establishes the broad policies
under whhich they are to operate and which gives general
oversight to the continuing effectiveness of te total operation
in relizing the objectives

c
c
c
There are three major activities in the cyclic management
process
Planning
Controlling
Evaluation and feedback

1  (#
1. Setting goals
Operational planning
Designing the organization in the best wa y to achieve the
goals and objectives
3. Assigning responsibilities
4. Allocating resources
 5. Designing organizational controls( timetables and measures
It permeates into other functions which are dependent on it. of the organization¶s performance as a whole)
By forecasting one can estimate the future
By setting objectives the results to be achieved can be
determined. ;;1 
By developing and scheduling programs, the activities needed A. management control ( ensuring efficient and effective use
can be defined. of resources)
By preparing budget, tools and resources can be allocated 1. Developing individual standards
while establishing polies and procedures that will define the Designing project controls (such as work plans and milestone
course of action and standards. charts)
Motivating
:3 Reviewing progress
Establishes formal authority. It set up the organizational
structure by identifying groupings, roles and relationships Solving problems
within the agency. Coaching and counseling
Job descriptions define the qualifications and scope of Performance appraisal
responsibilities, relationships and authorities of personnel. OPERATIONAL CONTROL (ensuring that specific tasks are
Staffing includes determining the staff needed, thus carried out efficiently and effectivel y )
developing and maintaining staffing pattern. The process Scheduling
covers recruiting, selecting, orienting and developing Establishing procedures
personnel to accomplish the goals of the organization.
The selected personnel are then destributed in various areas of
the agency where they are qualified to belong ;;;1  Ê
Ê
<
Staffing schedules are made to meet the needs of clients, 5
personnel and agency. 5/"!/&**$
 Once we have the goals set through strategic planning, we
Ê(  define objectives, assign responsibilities, and set up
Actuates efforts to accomplishment of goals. organizational controls for each budget cycle. We the enter
This includes utilization of various modalities of nursing care into day-to-da y process of ensuring that we meet our
through the nursing process; updating policies and procedures objectives , This is controlling, The type of control with which
Supervising of personnel to harmonize work through adequate we are nost concerned with human resource. In controlling, we
guidance and leadership. develop individual standards of performance with our
Coordinating personnel and service toward a common goal subordinates, set up specific project controls, motivate our
Communicating via various routes to ensure common employees to ful fill their responsibilities, monitor and review
understanding. progress, solve problems along the way, coach and counsel
Developing people by providing staff development programs when necessary, and finally, appraise individual performance,
Making sound decisions. At the end of the cycle we evaluate how well we did in
 achieving our objectives and prepare to begin the cycle again.
  
Leads to assessment and regulation of performance of  !$"("
There are 3 major activites; planning, controlling and during
workers. evaluation cycle and feedback.
To ensure the attainment of objectives. The circle represents the cyclic nature of the process; in others
Certain standards are utilzed to measure performance. words, these are the activities or steps an organization should
Monitor and evaluate nursing care including utilization of go through continuously usually moving through one cycle
during a budget or other designated period.
resources. The two major kinds of planning are strategic planning and
Controls promptly reveals deviations from set plans and operational planning.
standards necessitating immediate corrective measures, The major outcome of strategic planning is the setting of goals
actions and/or discipline. for the organization .The key steps in operational planning are
defining objectives and assigning responsibilities.
 When we assign responsibilities, we essentially break down
5/"!/&**$ our objectives and hand out responsibility for those pieces to
c
c
c
various units or individuals. When the assigned the same time each day, and they may prevent problems
responsibilities are fulfilled and added up , they should equal as well as solve them.
the successful accomplishment of our objectives.

 !$"( yc )
&Ê(""
Controlling enables us to make sure on a day-to-da y use basis yc Are those that are often personally
that our objectives will be met. uncomfortable to make because they ma y
The two basic t ypes of control are management control result in discomfort or uneasiness for
(ensuring efficient and effective use of resources) and subordinates or others
operation control ( the detailed scheduling and procedures that yc These can be generally classified as
become routine functions) decisions impacting interpersonal
Standards of performance are conditions that should exist
when responsibilities are carried out well. Standards of relationship± that is, decisions affecting
performance are developed for each responsibility assigned. It relationships among people in an
follows that standards of performance successfull y added organization.
together will equal the achievement of the assigned yc It is the kind of decision that is necessary-
responsibility. All achieved responsibilities added together the kind that managers are paid to make.
will equal the accomplishment of the objective. 
The major components of the system for managing for results
are defining objectives, assigning responsibilities, developing yc )(&Ê(""
standards of performance, and appraising performance yc Are those we make during daily operation,
c yc They are the decisions that bring operation
together, keep it ready, alive, and running
c well.
yc The overriding factor in a ten-second
Ê    decision is the pressure to make it quickly.
yc Decision making is choosing options that are directed
toward the resolution of organizational problems and  )ÊÊ  
the achievement of organizational goals. yc Determine first whether the situation
yc The nurse manager is a decision maker and therefore really requires one.
plays a vital role in achieving the goals and yc Determine the major objective of that
objectives of the organization. decision. Before leaping in and ³solving
 the problem´ determine first what you are

 
Ê  

yc The freedom to make decision in question
yc The capacity and ability to make a wise decision
(Doing so requires sound judgment, deliberation,
objectivit y, and experience)
yc The will, motivation and commitment to choose.
(This attribute requires volition, a conscious activit y
of the will to make a decision.)
trying to accomplish.
yc Determine what alternatives are available.
yc Once you have considered alternatives,
the last question concerns implications.
That is, what could go wrong in the future
if you pursue
yc A given course of action?
Ê   

5
Ê  
 situation you¶re trying to resolve. Before making a
yc "&& Ê("" are usually those of great
magnitude± that is, they tend to be completed and
call for considerable reflection.
They requires interaction with others, because
the perceptions and ideas of other people often
provide multiple alternatives that help in approaching
the problem situation
A CONSIDERED DECISION REQIRES TIME
yc Time to find alternatives
yc To seek other opinions
yc To get dissent
yc To determine implementation problems.
Incorporating these elements in a decision-
making situation leads to appropriate decisions that can be
implemented with minimum probability of success
1.c Analyze and Identify the situation . Clarify first the
decision, take into consideration the circumstances.
Find out what¶s wrong and why it¶s wrong before
you proceed.
2.c Develop alternatives. In ever y decision-making
circumstance, there are at least two possi ble actions,
e.g. either taking action or not. In most cases ,there
are more.
3.c Compare alternatives. There are few cases where you
are lucky enough to have one alternative that
represents the likelihood of 100 % satisfaction.
suall y each alternative has the advantages and
disadvantages. When decision. If js crucial, take time
to write out the advasntages and of each alternatives.
4.c Rate the risk. One of the differences bet ween
decision making and problem sol ving is that a proper
solution to a problem is sure ±fire. If it is indeed the
right solution, you¶ve practically sure of getting the
results desired.


yc Select the best alternative.
yc # Ê("" yc If the previous steps have been done carefull y, it is
Are those we make practically everyda y. Some possibl e that the most likely alternative becomes
of these decisions, in fact, may be made at approximately self-evident.
c
c
c
yc No alternative is desirable. The risk involved in all 
alternatives, for example, may properly persuade you 5Ê
not take any action, because no move you think of at
time promises to be successful. yc Data are analyzed to further refine the problem
yc Merge two or more alternatives statement and identify possi ble solutions or options.
yc The´ resources fact or´ may swing your decisi on. It is important to differentiate a problem from a
Alternative A may have more advantages than symptoms of a problem.
alternative B yc By distinguishing the problem from the symptoms of
yc Get into gear. After you have made a decision, make the problem , a more appropriate solution can be
it operative. identified and implemented.


  Ê    Ê  

INTERNAL FACTORS
1. Decision maker¶s physical and emotional state
2. Personal characteristics
3. Cultural, social, and philosophical background,
yc The goal of generating options is to identify as many
choices as possible
yc Being flexible, open-minded, and creative is critical
to being able to consider a range of possible options.
4. Interest, knowledge, and attitudes
EXTERNAL FACTORS
yc Environmental conditions and values
yc alues are determined by one¶s cultural, social, and
philosophical background.
yc Certain personality fact ors such as self esteem and
self confidence affect whether one is willing to take
risks in solving problems or making decisions.
CHARACTERISTICS OF AN EFFECTIE DECISION
MAKERS
yc Courage
yc Willingness to take risks,
yc Self-a wareness,
yc Energy
yc Creativity
yc Sensitivity
yc Flexibility
TIPS FOR PROBLEM SOLIING SOLING AND
DECISION MAKING
yc Seek additional information from other sources even
if it doesn¶t support the preferred action.
yc Learn how other people approach problem situations.
yc Talk to colleagues and superiors who you believe are
effective problem solvers and decision makers.
Observe these positive role models in action.
yc Read journal articles and relevant sections of
textbooks to increase your knowledge base.
yc Risk using new approaches through problem
resolution through experimentation.
PRIMARY STEPS OF DECISION MAKING
yc Define the Problem, issue, or situation ( problem
identification is influenced by information available,
by the values, attitudes and experiences of the
decision makers and by time.)
yc Assessment is done continuously throughout dynamic
process.
yc Information gathered should be valid. Accurate
relevant to the issue and timely.
c
c
  
yc The decision maker should the objectivel y weigh
each option according to its possible risks and
consequences, as well as positive outcomes that may
be derived.
yc Criteria for evaluation might include variables such
as cost, cost-effectives, time, and legal or ethical
considerations.
yc The options should be ranked in the order in which
they are likely to result in the desired goals and
objectives
yc The solution selected should be the one that is most
feasibl e and satisfactory and have the least
undesirable consequences.

yc The implementation phase should include a
contingency plan to deal with negative consequences,
shold they appear.
yc In essence, the decision maker should be prepared to
institute ³plan B´ should need arise.

 
yc It is important to establish early in the process how
evaluation and monitoring
yc will take place, who will be responsible for it, and
when it will take place.
yc In collaboration with nursing staff, the manager
would determine when follow-up surveys should be
distributed, who will be responsible for their
distribution, collection, and analysis, and how the
findings will be communicated to appropriate
personnel.
yc
yc
yc
c
< Ê)describes the expected
activity in operational and financial terms for a
given period of time.

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‡c Capital budget outlines the programmed
acquisitions, disposals and improvements in an
institution¶s physical capacity
‡c Cash budget represents the planned cash
receipts and disbursements as well as the cash
balances expected during the planning period.

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 (Categorized under the major functions of
planning, coordination and control)
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A BDGET
‡c A BDGET is the annual operating plan, a
financial ³road map´ and plan which serve as
an estimate of future costs and a plan for
utilization of manpower material and other
resources to cover capital projects in the
operating programs.
‡c A NRSING BDGET is a plan for
allocation of resources based on preconceived
needs for proposed series of programs to
deliver patient care during one fiscal year.
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‡c Hospital budget is a financial plan to meet
future serve expectations. These expectations
are derived from the best judgment of needs
manpower, equipment and supplies so that
both services are provided as the highest level
of quality at a minimum cost.
 other affected departments.
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‡c A budget is simply a plan for future activities
expressed in operational as well as financial or
monetary terms. In health care institutions,
this consists of four components-
‡c A revenue budget
‡c An expense budget
‡c A cash budget
‡c A capital budget

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‡c Summarizes the income which management
expects to generate during the planning.
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1. PLANNING
‡c A. Budgeting stimulates thinking in advance.
It anticipates future opportunities or problems
and prepares for them.
‡c B. It leads to specific planning such as the
volume and type of services to be rendered
and revenue to be derived therefrom; the
number and type of personnel required; the
cost; volume and type of supplies needed; their
cost of fixed assets when needed; cast
collect ons and disbursement.
Benefits
‡c C. Budget preparation stimulates action and
interaction. While the mechanical budgeting
process gives empirical information ,
additional benefits result from the
organizational thinking process that is
generated and the worthwhile
interrelationships that devel op.
COORDINATION
‡c A. The budgetary process has a balancing
effect on the total organization, that is, the
quantity and quality of service to be given a
patient should closel y equal the expected
revenue. If monthly trends are defined, gains
and losses can be detected. Since hospital
departments are interrelated, future plans of
one department must complement the plans of
‡c B. Budgeting encourages exchange of
information. Ideas are traded thus fostering
interest in and understanding of the budgetary
process.
‡c C. The budget process stimulates team
approach. By enabling reach team member to
contribute to organizational planning as well
as to see the results of good team play, the
budget becomes a stimulant to employee
commitment and efficiency, and an effective
guide to proper utilization of resources.
COMPREHENSIE CONTROL
‡c A. The budgeting process gives the
administration an opportunity to evaluate the
thinking of the budget contributor. Is the
budget planning realistic? Are the standards
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too high or low? The budget may be an aid in
evaluating quality and initiative in
performance.
‡c B. Once the budget standards are set
comparisons between actual expenditures and
budgeted standards can be made with little or
no effort.
‡c C. Though the budgeting process is flexible, it
tends to define fixed and agreed upon goals.
Goal setting enables the administration to
prevent persistent efforts of individuals or
groups to seek out only their own goals which
is often tend to break the hospital
organizational apart.
‡c D. Cost consciousness is enhanced throughout
the institution
FACTORS IN BDGET PLANNING
‡c 1. The type of patient (medical, surgical,
maternity, pediatric, communicable disease,
chronically ill), length of stay in the hospital
and the acuteness of the illness.
‡c 2, The size of the hospital and its bed
occupancy.
‡c 3. The physical layout of the hospital, the size
and plan of wards or units, the nurses station,
treatment rooms. Etc.
‡c 4. Personnel policies
‡c Salaries paid to various types of
nursing personnel including pay for
overtime or shift differential.
‡c The extend of vacation and sick leaves,
holidays and
‡c Provision for staff devel opment
programs including instructional staff.
‡c 5. The grouping of patients such as those in
specialized areas e.g. intensive care units
‡c 6. Standards of nursing care e.g. Te kind and
amount of care to be given as it affects the
number of hours of bedside care.
‡c 7. The method of performing nursing care
whether simple or complex.
‡c 8. The method of documentation
‡c 9. The proportion of nursing care provided by
professi onal nurse and those given by noon-
professi onals
‡c 10. The amount and quality of supervision
available and provided.
‡c 11. The efficiency of job description and job
classification
‡c 12. The method of patient assignment, whether
functional; case, team or primary.
‡c 13. The amount and kind of labor-saving
devises and equipment intercommunication
system.
‡c 14. The amount of centralized service
provided; sterile supply, central oxygen
service, linen supply.
‡c 15.The nursing service requirements of the
auxiliary departments, clinics, admitting
office, ER
‡c 16. Reports required by administration
whether simple or complex and
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‡c Affiliation of nursing students or medical
students e.g. inexperienced students need more
equipment and supplies.
THE BDGETARY PROCESS
‡c The budget committee must be well
defined. This committee can assist the
budget officer in budget preparation and in
monitoring the budget.
‡c The chief nurse his/her assistant is usually
a member of he budget committee. Within
the nursing service the chief nurse works
with the supervisors and head nurses in
preparing the budget for the nursing
service. Participation of nursing personnel
in budget preparation and control leads to
cost consciousness, awareness of he
activities, and increased cost-effectiveness.
‡c Past operations must be analyzed and
overall master staffing plan must be
reviewed . Each supervising nurse works
with head nurses to determine the staff
requirement for each unit.
‡c Any new activities/programs should be
considered such as new patient services.
Staff development programs or changes in
hospital services that affect the required
nursing services.
‡c The next step to ascertain the amount and
kind of supplies needed for the operation of
each nursing unit. A review of the fast
expenses and consumption provides data
for planning. Request of capital equipment
for the replacement of capital equipment
must be supported with documented
justification.
‡c The Chief Nurse compiles and completes
the draft of the budget and presents this to
the Budget Officer or Hospital
Administrator. A careful planned budget
presentation usually reflects favorable
action from the administration.
COMPONENTS OF BDGET
‡c The budgetary control program consists
of three major budgets;
‡c Operating budget
‡c Cash budget
‡c Capital expenditure budget
‡c These may be supplemented by other
financial plans, estimates and forecasts.
The nursing division is directly
concerned with the operating budget and
capital expenditures, it is helpful to know
what cash budget means.
CASH BDGET
‡c Forecasts the amount of money received.
It consists of the beginning cash
balance estimates of the receipts and
disbursement , and the estimated
balance for a given period
corresponding to that of operating and
capitals.
‡c The cast budget is prepared by
estimating the amount of money to be
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collect ed from patients and allocating it
to cash disbursements required to meet
obligations promptly as they come.
OPERATING BDGET
‡c Deals primarily with salaries, supplies,
contractual services, employee benefits,
laundry services drugs and pharmaceuticals,
in-service education, travels to professional
meetings, books, periodicals, professional
magazines, and maintenance, among others.
The operating budget is composed of the
revenue and expense budget.

THE CAPITAL EXPENDITRES BDGET

‡c Consists of accumulated data for fixed assets
that are expected to be acquired during the
budgeted period.
‡c These include estimated costs and sources of
funds for expected replacements,
improvements and additions to fixed assets.
‡c The cost of estimated requirements together
with the anticipated dates of acquisition should
be made in an organized manner for each areas
of responsibility.
‡c The combination of individual reports
provides information about anticipated
procurements, priorities and timing as well as
the feasibility of acquisition.

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