SURIGAO EDUCATION CENTER

Km. 2, 8400 Surigao City, Philippines

College of Allied Medical Sciences

Nursing Department
MIDTERM:

III.DIRECTING
✔ Issuance of orders, assignments, and instructions that enable the nursing personnel
to understand what are expected of them.
✔ Includes supervision and guidance so that in doing their jobs well, nurses can
maximally contribute to the organization’s goals and to the nursing in particular.
✔ Actuates efforts to accomplish goals and it is the connecting link between
organizing for work and getting the job done.
✔ Must be complete, understandable and given in logical order.
✔ Must be given in a courteous manner encourages cooperation, interest, and better
performance in their jobs.
✔ Includes delegation of work to be performed, utilization of policies and
procedures, supervision of personnel, coordination of services, communication,
staff development, and making decisions.
● Elements of Directing
a) Delegation : is a process by which a manager assigns task/
duties to workers with commensurate authority to perform the
job.
: The workers in return assumes responsibility for
its satisfactory performance and is held accountable
for its results.
Principles of delegation:
▪ Select the right person to whom the
job is to be delegated.
Make sure the employee is capable
of doing the job. Give the employee
the accountability and authority to do
the job.
▪ Delegate both interesting and
uninteresting tasks.
Uninteresting tasks can be used to
challenge, motivate, and increase a
person’s performance and
commitment
Interesting jobs draw out the best
among employees and inspire them
to higher achievement.
▪ Provide subordinates with enough
time to learn.
Expertise can be achieved through
training and experience.
▪ Delegate gradually.
New employees may not be able to
assume responsibilities as others who
stayed for long time already.
▪ Delegate in advance.
specify goals and objectives to be
met within a set time frame.
▪ Consult before delegating.
Clarification minimizes problems
and promotes teamwork.
▪ Avoid gaps and overlaps.
Gap: when a job is left with no one
taking the responsibility

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 Overlap: when two or more people
have responsibility for the same job,
causing confusion and low morale.
✔ What cannot be delegate:
1. Overall responsibility, authority and accountability for
satisfactory completion of all activities in the unit.
2. Authority to sign one’s name is never delegated.
3. Evaluating the staff/or taking necessary corrective
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. The jobs that are too technical and those that involve
trust and confidence.
b) Leading: “to guide”; “to go before”; and “show the way”
:leadership in nursing is necessary to guide personnel to a
specific goal, that is, the provision of quality nursing care to
their patients.
Leadership is the art of developing people.

Leadership Roles:

Top Administrator

Supervisors/Clinical
Managers/coordinators
Middle

First Line Head Nurses/Senior

Nurses
Operational Level
Staff nurses

Nursing
attendants
fig.4.

Management levels in nursing

● Qualities of a Leader:
o Striking physical personality.
o Possess a sense of purpose and direction.
o Has a power of ready speech.
o Is enthusiast about the purpose of a group.
o Has keen insight into the human nature of people.
o Displays courage and persistence.
o Is decisive. uses independent judgement.
o Is cheerful and even-tempered.
o Shows technical mastery that inspires others to do above
performance.
o Is intelligent, versatile, and has a sense of humor. Has
moral vision, integrity and idealism.
✔ Leadership Theories
A. Situational/Contingency Leadership Theory: the
leader behaves according to the given situation
which may vary from one setting to the other.
Consider a person’s qualities and motivations.
5 kinds of leader under this theory:
1. Natural leader: the group trust the leadership
uponhi/her by the tide of events.
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 2. Charismatic leader: authentic hero in the eyes of the
followers.
3. The rational leader; consistent and persistent in
what she/he thinks is right.
4. The consensus leader who is perceived to be
acceptable to all.
5. The leader who dominates by force and fear.
: a style that matches the situation and it’s needs.
: the nurse manager assesses each nurse’s needs and
determines which leadership behaviors will help the
nurse to do the work with the fewest problems.
Consider the ability (knowledge, experience and
skills
Consider the nurse’s willingness (confidence,
commitment, motivation, and energy).
B. Trait Theory of Leadership
“Leaders are born with certain qualities that
properly develop to enable them to be successful
leaders.
Theory Z
: byOuchi
1. Collective decision making.
2. Long term employment.
3. Slower promotion.
4. Indirect supervision.
5. Holistic concern.
Theory X
▪ Views in bureaucratic organizations
▪ Prefer security, direction, and
minimal responsibility.
▪ Coercion, threats, punishment are
necessary because people do not like
the work to be done.

Theory Y

▪ Right conditions
▪ People enjoy their work.
▪ Can show self- control and discipline.
▪ Area able to contribute creatively
▪ Motivated by ties to the group
▪ Guide for managers to take advantage of the
potential of each person.

C. Transformational Theory
By Burn(1978): leader- follower interaction
Raised to a higher levels of motivation and
morality.
TRANSACTIONAL: traditional manager
concerned with the day to day operations.
TRASFORMATIONAL: Has a vision, is
committed, and has the ability to empower others to
share.

Motivational Theories:
: motive: is a need or desire that incites and directs person’s
actions.
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 Motivation:(by Mills) is a force within individual that
influences strength or direction of behaviour.
Intrinsic motivation: comes from within the person
driving him/her to be more productive.
:to achieve is directly related to a
person’s aspirations and goals in life shaped earlier on by
parents and peers.
Extrinsic Motivation: is enhanced by environment or
external rewards.
: may come in the form of
promotions, increases in salary, added benefits, or external
rewards.
1. Need Theory: Abraham Maslow’s Hierarchy of Needs

Self-
actualization

Self -esteem

Sense of belongingness

Safety and Security

Basic physiological needs

2. Two-factor theory
By Frederick Herzberg(1991)
: hygiene factors: salary, quality of supervision, job
security, interpersonal relations policies, and
supervision.
Dissatisfiers:
3. McClelland: identifies 3 basic needs that people
possess in varying degrees.
a) Achievement – refers to a strong desire to overcome
challenge, to excel, to grow, to advance, or to
succeed
b) Power- the desire to to be in control and to get
others to behave contrary to what they would
naturally do.
c) Affiliation- is the desire to work in a pleasant
environment and the desire for friendly, close
relationships.
4. Expectancy Theory ( by Victor Vroom)
- Theory of human motivation
- Positive relationship between effort and performance.
- In nursing, expectancy theory is the perceived probability of
satisfying a particular need based on past experience.
5. Operant theory (B.F. Skinner)-motivations of
employees is controlled by conditions in the external
environment instead of internal needs and desires.
2 humanbehaviour:
1. Respondent results, from direct stimulation
2. Operant- occurs in the absence of any apparent
external stimulation.
6. Equity Theory( Jo Stacy Adams)
- Employees assess fairness by considering their input and the
psychological, social and financial awards in comparison with
those of others.
✔ Leadership Styles
a) Autocratic

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 : Directive and bureaucratic
: Leader uses coercion in the exercise of his/her
powers.
: High concerns for tasks accomplishment but low
concern for people who perform these tasks.
: No confidence and trust in his/her subordinates.
: Subordinates do not feel free to discuss their job
with their superior.
: Autocratic managers seldom get ideas and
opinions from their subordinates in solving work
problems.
: In nursing, autocratic leader gives orders and
expects adherence to policies and procedures.
: Leader makes decision for the group.
:similar to Theory X.
b) Democratic,Participative, or Consultative
leadership
: People-oriented
: focuses on human aspects and builds effective
teamwork.
:Interaction between and subordinates is open,
friendly, and trusting.
: Collaborative spirit and joint efforts exist.
: Open communication
: The leader consults her subordinates. In solving
problems and work-related decisions
: “Consultative”
: Similar to theory Y
c) Permissive, Ultraliberal, or Laissez-faire Style of
Leadership
: The workers lack direction and control
:The leader avoids responsibility by relinquishing
power to subordinates.
: The followers are allowed to engage in managerial
activities such as decision making, planning,
structuring the organization, setting goals, and
controlling the organization.
:the leader is ultraliberal
: puts emphasis on the group, does not criticize,
disperses decision making within the group, and
provides little or no direction at all.

✔ Leadership Skills:
A leader must possess:
1. Skills in Personal behaviour
2. Communication Skills
3. Organization Skills
4. Skills in Self-Analysis
✔ The nurse leader should have essential qualities
1. Intellectual, technical, and administrative skills
2. Integrity, honesty, ability to work with others
3. Tact and emotional stability
4. Ability to win the support and loyalty of fellow-workers
5. Good human relationships with others.
✔ Case Analysis
✔ Case management- strategy to improve patient care and
reduce hospital costs.
✔ Decision Making
● Decision : is a course of action that is consciously chosen from
available alternatives for the purpose of achieving a desired result
Steps in decision making process:
1. Definition of the problem.

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 2. Data gathering to aid in analysing the problem, its causes and
possible consequences.
✔ Supervisor/headnurse proceeds to investigate, analyse
causes and consequence of the problem.
✔ The one who manage the problem should not be
prejudice or bias, he/she should be open- minded and
flexible.
3. Developing/ Exploring/Evaluating possible alternative
solutions.
4. Selecting the solution
5. Implementing the solution and evaluating the results.
● Bases of Power
Sources of Power:
Expert Power- power derived from the knowledge and skills
nurses possess.
Legitimate Power- a power derived from the position a nurse
holds in a group, and it indicates the nurse’s degree of authority.
Referent Power - power derived from how much others respect
and like any individual, group, or organization.
Reward Power –the ability to reward or punish others, as well as
to create fear in others to influence them to change behaviour.
Connection Power – the extent to which nurses are connected
with others having power.
● Communication
: is the transmission of information, opinions, and intentions
between and among individuals.
: It facilitates work, increases motivation, effects change, optimizes
patient care, increases workers satisfaction and facilitates
coordination
: It helps promote trust between the health and personnel and the
clients
Principles of communication:
1. Clear
2. Simple, exact
3. Feedback is essential
4. Communication skill is vital
5. Adequate and timely communication of work-related issues.
Types of Communication
1. Spoken
2. Written
3. Physical Expression
Lines of Communication
1. Downward – superior to subordinate
2. Upward Communication – from subordinates to superior.
3. Horizontal Communication
4. Outward Communication

Upward

Horizontal
Outward
Nurses

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 Downward

● Time Management
: is a technique for allocating one’s time through the setting
of goals, assigning priorities, identifying and eliminating
wasted time, and using managerial techniques to reach
goals efficiently.
Time Saving Techniques
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,
monthy, weekly or daily.
4. Breakdown large projects to smaller parts.
5. Devote few minutes at the beginning of each day for
planning.
6. Organize your workspace so it is functional.
7. Close your door if you need to concentrate.
8. Learn to delegate.
9. In a meeting, define the purpose clearly before starting.
10. Take or return calls during specified time.
11. Develop effective decision making skills.
12. Take rest breaks and make good use of use of your
spare time.

● Conflict Management
✔ Disagreement about something of importance to
each person involved.
✔ Means a clash between two opposing and often
times hostile parties.
✔ Is a warning to the managers that something is
wrong and needs solution through problem solving
and clarification of objectives, establishment of
group norms, and determination of group
boundaries.
✔ Sources of conflicts:
▪ Competition
▪ Domination
▪ Provocation
Arises due to differences in knowledge,
skills, values, interests, scarcity of resources,
intergroup rivalry for rewards, role
ambiguity, etc.
Types of conflict:
Covert conflict – more dangerous because it
is not what it appears on the surface.
▪ Results in harboured feelings that drain both
physical and psychological energy.
Overt conflict
✔ How to resolve conflict:
1. Avoidance
2. Accommodation - self-sacrifice
3. Collaboration – mutual satisfying solution
4. In a compromise – accommodation and adjustment
5. In competition – rule of discipline
6. Withdrawing –
7. Forcing – unresolved conflict
IV. CONTROLLING/EVALUATING
1. Is an on-going function of management which occurs during planning, organizing,
and directing activities.

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2. Opens opportunities for improvement and compares performance against set
standards.
3. Provides information about how well the processes and people function so they could
be motivated to perform better in the future.
Reasons for conducting evaluation:
1. It ensures that quality nursing care is provided.
2. It allows for the setting of sensible objectives and measures compliance with
them.
3. It provides standards for establishing comparisons.
4. It promotes visibility and 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 of resources.
8. It provides feedback for improvement.
Evaluation tool
Basic components of the control process
1. Establishment of standards, objectives, and methods for measuring
performance.
2. Measurement of actual performance.
3. Comparison of results of performance using standards and objectives and
identifying strengths and areas for correction and/or improvement.
4. Action to reinforce strengths or successes
5. Implementation of corrective action as necessary.
✔ Performance Appraisal – is a control process in which employees’
performance is evaluated against standards.
It is the most valuable tool in controlling human resources and productivity
It refers how well the nursing personnel have performed during the specific
period of time.
Purposes of Performance Appraisal
1. Determine salary standards and merit increases;
2. Select qualified individuals for promotion or transfer;
3. Identify unsatisfactory employees for demotion or termination;
4. Make inventories of talents within the institution;
5. Determine training and developmental needs of employees;
6. Improve the performance of work groups by examining,
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 institution,
10. Provide “employee recognition” for accomplishments; and
11. Inform employees “where they stand”.
✔ Staff Development
- In nursing is one aspect of human resource management.
- To provide structure and assistance for employees to learn in
greater depth and to translate the knowledge, skills, abilities,
and principles learned in nursing practice within their
institution of employment.
- Orientation
- In- service education
- Specialty Courses
- Formal Education

✔ Budgeting
Budget – is an annual operating plan, a financial “road map”
and plan which serves as an estimate of future costs and a plan
for utilization of manpower, material and other resources to
cover capital projects in the operating program.
- Is simply a plan for future activities expressed in an operational
as well as financial or monetary terms.

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 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.
Hospital budget- is a financial plan to meet future service
expectations. Manpower, equipment, supplies.

4 components in health care institutions:

1. Revenue budget – summarizes the income which
management expects to generate during the planning
period.
2. Expense budget – describes the expected activity in
operational and financial terms for a given period of time.
3. Capital budget – outlines the programmed acquisitions,
disposals and improvements in an institutions physical
capacity.
4. Cash budget – represents the planned cash receipts and
disbursements as well as the cash balances expected during
the planning period.

Components of budget:
Cash Budget- forecasts the amount of money received
- Consist of the beginning cash balance, estimates of the receipts
and disbursements.
Operating budget – deals with salaries, supplies, contractual services,
employee benefits, laundry service, drugs and pharmaceuticals, in-service
education, travels to professional meetings, books, periodicals,
professional magazines, and repairs and maintenance, among others.
Capital expenditure budget – consist of accumulated data for fixed
assets that are expected to be acquired during the budgeted period.
✔ Quality Improvement/ Quality Management
- Is a process of evaluation that is applied to the health care
system and the provision of health care services by health
workers.
- It promotes collegial and sharing relationships among workers
instead of a feeling of threat when observed and evaluated.
Quality Improvement Program – in an organization is the umbrella
program that extends the many areas for the purpose of accountability to the
consumer and the payer.
Quality Assurance –means achieving a sense of accomplishment and
implies a guarantee of excellence.
Quality – the degree of excellence and assurance means formal
guarantee of a degree of excellence.
Quality of Care – is the degree to which health services for
individuals and population increases the likelihood of desired health
outcomes and are consistent with the current professional knowledge.
✔ Nursing Audit
- Nursing audit committee
- Is composed of representative from all levels of the nursing
staff:
Members:
Training nurse, supervising nurse, head/senior nurse, staff
nurse
Patient Care Audits:
- Patient care is observed and evaluated.
a. A review of discharged patients’ charts.
b. Questionnaires sent to our interviewers conducted on
discharged patients.
✔ Variance Reports
Fixed Costs – expenses that are constant and are not related to
productivity or volume.
- Building, equipment depreciation, utilities, fringe benefits, and
administrative salaries.

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Variable Costs – costs that fluctuate depending upon the volume or
census and types of care required.
- Medical and surgical supplies, drugs, laundry, and food costs
often increase with

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