Greywolfred: Roles That Managers Fulfill in An Organization

NURSING LEADERSHIP AND MANAGEMENT
1ST SEMESTER SY 2020-2021
HANDOUT # 3 PRELIMS
MANAGEMENT PROCESSES AND LEADERSHIP ROLES

PLANNING
 Is a proactive and deliberate process that requires deciding in advance what to do, who is to do it, and how,
when, where it is to be done.
ORGANIZING
 The relationships are defined, procedure is outlined, equipment is readied, and tasks are assigned.
 It establishes a formal structure; as presented in an organizational chart, to carry out plans that provide the
best possible coordination or use of resources to accomplish unit objectives.
DIRECTING
 The “doing phase” of management.
 It entails human resource management responsibilities such as motivating and facilitating collaboration.
CONTROLLING
 The performance is measured against predetermined standards of action is taken to correct discrepancies
between these standards and actual performance.
 It utilizes performance appraisal tools as devises to check on the performance of employees.
ROLES THAT MANAGERS FULFILL IN AN ORGANIZATION

1. Interpersonal Role
❖ Acts as a symbol. She occupies a position.
❖ Her duties are signing of papers/documents required by the organization.
❖ As a leader. She hires, trains, encourages, fires, remunerates, and judges the employees.
2. Informational Role
❖ Monitors information And Disseminates information
❖ Acts as a spokesperson or representative of the organization. She represents the subordinates to superiors,
and the upper management to the subordinates.
3. Decisional Role
❖ Acts as an entrepreneur or innovator, Problem discoverer, Designer to improve projects that direct and
control change in the organization.
❖ As a trouble-shooter. He handles unexpected situations such as resignation of subordinates, firing of
subordinates, and losses of clients
❖ As a negotiator when conflicts arise.
FUNDAMENTAL SKILLS OF A MANAGER

There are three fundamental skills of a manager:
1. TECHNICAL
✓ Proficient in performing skills in the right manner with the right technique
2. HUMAN
✓ The manager must know how to work with people.
3. CONCEPTUAL
✓ The manager can see the organisation.
✓ Ability to see individual matters as they relate to the bigger picture
FACTORS THAT DEVELOP MANAGERS

1. KNOWLEDGE
> This refers to the ideas, concepts or principles that can be expressed and are accepted
because they have logical proofs.
2. ATTITUDE
> this refers to the beliefs, feelings, and values that maybe based on emotions and may not
be subjected to conscious verbalization.
3. ABILITY
> refers to skill, art, judgment, and wisdom, and quick decision-making
Page 1 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

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This part of Handout 3 will be your INDIVIDUAL READING ASSIGNMENT

According to Prof. Katz, conceptual skills are mostly required by the top-level management because they spend
more time in planning, organising and problem solving.
Other skills Professor Katz recommended for a manager to possess:

a. Communication Skills
▪ Communication skills are required equally at all three levels of management. A manager must be able to
communicate the plans and policies to the workers.
▪ Similarly, he must listen and solve the problems of the workers. He must encourage a free-flow of
communication in the organization.
b. Administrative Skills
▪ Administrative skills are required at the top-level management.
▪ top-level managers should know how to make plans and policies.
▪ They should also know how to get the work done.
▪ They should be able to co-ordinate different activities of the organization.
▪ They should also be able to control the full organization.
c. Leadership Skills
▪ Leadership skill is the ability to influence human behaviour.
▪ A manager requires leadership skills to motivate the workers.
▪ These skills help the Manager to get the work done through the workers.
d. Problem Solving Skills

▪ skills are also called as Design skills.
▪ A manager should know how to identify a problem.
▪ He should also possess an ability to find a best solution for solving any specific problem.
▪ This requires intelligence, experience and up-to-date knowledge of the latest developments.
e. Decision Making Skills

▪ required at all levels of management. However, it is required more at the top-level of management.
▪ A manager must be able to take quick and correct decisions.
▪ He must also be able to implement his decision wisely.
▪ The success or failure of a manager depends upon the correctness of his decisions.
MANAGERS ROLES AND CHARACTERSITICS (MARQUIZ)

The Managers typically:
1. Have an assigned position within the formal organization.
2. Have a legitimate source of power due to the delegated authority that accompanies their position.
3. Are expected to carry out specific functions, duties, and responsibilities.
4. Emphasize control, decision making analysis, and result.
5. Manipulate people, the environment, money, time, and other resources to achieve organizational goals.
6. Have a greater formal responsibility and accountability for rationality and control than leaders
7. Direct willing and unwilling subordinates.
CHARACTERISTICS OF A LEADER
1. Often do not have delegated authority.
2. May or may not be a part of the formal organization.
3. Emphasize interpersonal relationships.
4. Direct willing followers.
5. Have goals that may or may not reflect those of the organizations.

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TYPES OR BASES OF POWER

a) Reward power – the ability to grant incentives or recognize others who can adhere to standards or
expectations.
b) Coercive power – the ability to sanction individuals who fail to conform with the standards or
expectations.
c) Legitimate power – this is formal authority based on the power inherent in one’s position.
d) Expert power – this is based on communicating the specialized knowledge and skills gained and are not
possessed by anybody.
e) Information power – this power is based on the control of information that is generated to make an
argument. This is also based on the information gained for someone who needs it.
f) Referent power – is obtained through association with others. It is the influence that leaders gain
through their formal and informal networks both inside and outside of their organizations. This is being
obtained through the follower’s loyalty, respect, and admiration to the leader.
g) Charismatic power - is the influence that is generated by a leader’s style or dynamic and powerful
persona.
h) Feminist power – gained through maturity, ego integration, confidence, and security in relationships.

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NURSING MANAGEMENT FUNCTIONS

1. PLANNING 3. STAFFING 4. CONTROLLING
2. ORGANIZING 3. DIRECTING
PLANNING
➢ Is pre-determining a course of action to arrive at a desired result.
➢ Is a continuous process of assessing, establishing goals and objectives, implementing and evaluating them,
and subjecting these changes as new facts are known. (Venzon, 2006)
➢ Planning is defined as deciding in advance what to do, who is to do it, and how, when, and where it is to be
done.
➢ Therefore, all planning involves choosing among alternatives. (Plans A, B, C) (Marquis, 2009)
EFFECTIVE PLANNING
 The manager must identify short- and long-term goals and changes needed to ensure that the unit will
continue to meet its goals.
 It requires leadership skills such as vision and creativity plans must be dreamed and envisioned.
 It requires flexibility and energy. (Marquis, 2009)
 It requires management skills as data gathering, forecasting, and transforming ideas into action. (Venzon,
2006)
SCOPE OF PLANNING
1. Top level management
 Directors, chief Nurses, and their Assistants.
 They set the over-all goals and policies of the organization.
2. Middle level management
 Supervisors
 They direct the activities of the organization to implement the broad operating policies of the
organization such as staffing and the delivery of services to the units.
3. First level management
 Senior Nurses/ Head Nurses/Team Leaders
 They do the daily and weekly plans for the administration of direct patient care in their respective
units.
ELEMENTS OF PLANNING
1. Forecasting
a. Environment – where the plans will be executed.
b. Who the client will be. What are their customs and beliefs, language/dialect barriers, public attitude and
behavior, the severity of their conditions/illnesses, the kind of care they will receive
c. The number and kind of personnel required (professional and non-professional)
d. The resources
NOTE:
* Failure to forecast accurately, impedes the organization’s efficiency and unit’s effectiveness.
* To avoid disastrous outcomes when making future professional and financial plans, managers need to stay
well informed about legal, political, and socio-economic factors affecting health care.
(Marquis, 2009)
2. Setting the vision, mission, philosophy, goals, and objectives.

Vision statement outlines the organization’s function. It gives the agency something to strive for. It is the
future aim or function of the organization.
MISSION STATEMENT: Mission statement outlines the agency’s:

a. reason for existing (hospital or clinic),
b. who the target clients are (the poor, the needy, the middle or upper class),
c. what services will be provided (in-patient, out-patient, emergency, philhealth accredited)

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 It is the highest priority because it influences the development of an organization’s philosophy goals,
objectives, policies, procedures, and rules.
SELF DIRECTED LEARNING
REMEMBER: The Philosophy describes the vision.
 It is a statement of beliefs and values that direct one’s life or RESEARCH ON THE VISION MISSION
one’s practice. AND PHILOSOPHY STATEMENTS OF
➢ In an organization, the philosophy is the sense of purpose of the THE UC COLLEGE OF NURSING.
organization and the reason behind its structure and goals. REMEMBER THESE BY HEART
➢ It is a written statement of the philosophy explains the beliefs AND MODEL THEM AS UC-CON
that shape how the mission or purpose will be achieved. STUDENTS
➢ It gives direction toward the attainment of the set goals and
objectives.
NURSING PHILOSOPHY: It is written in conjunction with the organizational philosophy, it should address
fundamental beliefs about nursing and nursing care, the quality, quantity, and scope of nursing services, and how
nursing will specifically meet organizational goals.
UNIT PHILOSOPHY
 It is adapted from the nursing service philosophy.
 It specifies how nursing care provided on the unit will correspond with nursing service and organizational
goals.
GOALS
 It is the desired result towards which effort is directed.
 It is the aim of the philosophy; should be measurable and ambitious but realistic.
OBJECTIVES
 It is like goals but are more specific and measurable and identify how and when the goal is to be
accomplished.
3. Developing and Scheduling Programs

 Programs are determined, developed, and targeted within a time frame to reach to set goals and objectives.
Formula:
What – what has been done?
- what should be done?
- what equipment are needed?
When – when should the job be done?

How - how will it be done? what steps?
- how much time and energy of the personnel will be used?
- how much will it cost?
Who - who will do the job?

- how many people?
Why - why is this procedure necessary?
Can - can some steps or equipment be eliminated?
SELF DIRECTED LEARNING

4. Establishing Nursing Standards, Policies and Procedures
Nursing Standards OR Standards of Nursing Practice in
SEARCH AND READ: THE COPY OF THE the Philippines is a joint effort of the ANSAP and PNA.
PHILIPPINE PROFESSIONAL NURSING  These standards in an evaluation process provide
PRACTICE STANDARDS. professionally desirable norms against which the

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department’s performance can be measured. (Is the standard accepted by the people?)
TYPES OF PLANNING
1. Strategic Planning
 This is to determine long term objectives of the institution and the policies will be used to achieve these
objectives. (to be done every 5 years)
 It is usually done at the executive level of management.
 It is future oriented. It forecasts the future success of an organization by matching and aligning an
organization’s capabilities and its external opportunities.
PURPOSES OF STRATEGIC PLANNING

1. Helps clarify the beliefs and values of the organization.
2. Gives direction to the organization.
3. Improves efficiency.
4. Allows adaptation to the changing environment.
5. Sets realistic and attainable objectives.
EFFECTIVE TOOL TO ASSIST IN STRATEGIC PLANNING

SWOT ANALYSIS: This tool was developed by Albert Humphrey at Stanford University (1960-1970)
1. Strengths 3. Opportunities
2. Weaknesses 4. Threats
 Strengths – are internal attributes that help an organization to achieve its goals.
Examples:
a. Expertise of nursing and medical staffs. (BGHMC)
b. Qualifications of employees
c. Abundance of medical facilities, supplies, equipments.(Notre Dame Hospital, PCDH)
 Weaknesses - are internal attributes that challenge an organization in achieving its goals.
Examples:
a. Understaffed unit c. Scarcity of equipment and supplies.
b. Inadequate finances d. Inaccurate quality of care
 Opportunities - are external conditions that promote the achievement of organizational objectives.
Examples:
1. Improved or new facilities
2. Recruitment of new qualified employees. Aligning the specialization of the employees to their
position in the company.
3. Increase wages
 Threats – are external conditions that challenge the achievement of organizational objectives.
Examples:
1. Competition 3. Low teaching load in academe
2. Low patient load for a hospital 4. Oversupply of nurses
2. Operational Planning/ Short term planning

 Well-implemented strategic planning provides the vision, direction, and goals for the organization,
but operational planning translates that strategy into the everyday execution tactics of the business
that will ultimately produce the outcomes defined by the strategy.
 Simply stated, operational planning is the conversion of strategic goals into managed execution.
3. Tactical Planning
 Involves allocating resources that enable an organization to realize stated objectives.
❖ First, executives usually are responsible for strategic plans, as they have the best bird's-eye
view of the corporation.

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 Lower-level managers have a better understanding of the day-to-day operations, and

they are usually the ones responsible for tactical planning.
❖ Second, strategic planning is concerned with the future, and tactical planning with today.
❖ Third, since we know far more about today than we do about the future, tactical plans are
more detailed than strategic plans.
 Flexibility needs to be built into tactical plans to allow for unanticipated events.
❖ For example, if your company manufactures a product, you will need to build flexibility into
your plan for machinery breakdowns and maintenance. You cannot assume you will be able
to run your machinery at full tilt all the time.
BUDGET AS PART OF THE PLANNING PROCESS

 Budget is allocation of scarce resources based on forecasted needs for proposed activities over a specified
period.
 It is the annual operating plan, a financial “road map” and plan which serves as an estimate of future costs
and a plan for utilization of manpower, and other resources to cover capital projects in the operating
programs.(Venzon,2010)
 In health care institutions, budget consists of 4 components:
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.
*It includes purchase of minor equipment, repairs of supplies or overhead expenses.
*It also includes wages, remunerations of permanent and contractual employees.
3. Cash budget Represents the planned cash receipts and disbursements as well as the cash balances
expected during the planning period.
*The amount of money received from patients, allocate it to cash disbursements required to meet
obligations promptly as they come.
4. Capital budget: Outlines the programmed acquisitions, disposals, and improvements in an

institution’s physical capacity. Requires long-range planning fixed assets to be acquired during the budgeted
period.
*It includes procurement of land, equipment, building expansion and renovation.
*It also includes short-term components of the budget purchases within the annual budget cycle
such as hospital beds, and medication carts.
TIME MANAGEMENT: Making optimal use of available time.
IMPORTANCE OF TIME MANAGEMENT

A. to reduce stress.
B. enables managers to meet personal and professional goals.
C. Allows individuals to spend time on things that matter.
BASIC STEPS IN TIME MANAGEMENT

1. Allow time for planning and establish priorities.
2. Complete the highest priority task whenever possible and finish one task before beginning another.
3. Reprioritize based on the remaining tasks and on new information that may have been received.
3. Proactive Planning
 Proactive/interactive-consider the past, present, and future, and attempt to plan the future of their
organization rather than react to it, dynamic and adaptive to the environment
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Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

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WHY HUMAN RESOURCES PLANNING IS IMPORTANT FOR NURSING
• Nursing has been on the agenda of the World Health Organization (WHO) for more than 40 years.
• The World Health Assembly resolution WHA 59.27 on ‘Strengthening Nursing and Midwifery’ expressed
serious concern at the continuing global shortage of employed nurses and midwives, and its serious
negative impact on health care.
• In many countries, nursing suffers from:
1. Numerical imbalance: geographic, occupational, specialty and institutional
2. Unethical recruitment, abusive management practices
3. Discrepancies in the types and quality of care provided
4. Misqualification (including over/ under-qualification)
5. Misutilization (including over/underutilization)
6. Inequitable access to occupational health protection or professional education
7. Demotivation
8. Absenteeism
9. High attrition
10. Unemployment
11. Delayed response to health care trends (i.e. new technology, procedures, etc.)
These issues confronting the nursing workforce need to be critically addressed to provide equitable and accessible
quality health services.
KEY POINT: Nurses, by virtue of their large number and close and continuous contact with the individual, family and
community, particularly in times of illness, have a significant role to play in national health development, especially in
scaling up health system responses for achieving the Millennium Development Goals and national or local health
targets.
• In consequence, resolution WHA 59.27 on ‘Strengthening Nursing and Midwifery’ urges Member States to
confirm their commitment to strengthen nursing and midwifery by:
A. Establishing comprehensive programs for the development of human resources which support
recruitment and retention, while ensuring equitable geographical distribution, in sufficient
numbers of a balanced skill mix, and a skilled and motivated nursing workforce within their
health services.
B. Actively involving nurses in the development of their health systems and in the framing, planning
and implementation of health policy at all levels, including ensuring that nursing is represented at
all appropriate governmental levels, and have real influence.
C. Ensuring continued progress toward implementation at country level of WHO’s strategic
directions for nursing.
D. Regularly reviewing legislation and regulatory processes relating to nursing to ensure that they
enable nurses and midwives to make their optimum contribution in the light of changing
conditions and requirements.
E. Providing support for the collection and use of nursing core data as part of national health-
information systems.
F. Supporting the development and implementation of ethical recruitment of national and
international nursing staff.
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EFFECTIVE HUMAN RESOURCE PLANNING:
1. POLICY AND PLANNING National development and health plans must provide for adequate nursing services
and expertise.
❖ Governments should strengthen those mechanisms relating to human resources policy intervention
and planning to contribute to the maintenance of adequate levels of nursing and midwifery
personnel so that health systems may function more effectively.
2. EDUCATION, TRAINING AND DEVELOPMENT Health systems are labor-intensive and require well educated
and experienced staff to function effectively.
❖ Health care provision requires that practitioners possess appropriate knowledge and skills to
respond and adapt to current and future health care priorities and needs, available resources, and
the broader factors that shape the current health systems effectively and efficiently.
❖ New and rapidly changing challenges in health care demand that the education of nursing
practitioners be continuously evaluated and updated.
❖ Other challenges include epidemiological and demographic shifts, medical and technological
advances, rising public demand, health systems reforms, and a need to surmount obstacles of
poverty, gender, and human rights.
❖ Ensuring the appropriate combinations of skills required to practice within different health delivery
contexts requires multidisciplinary and multisectoral collaboration.
❖ This element focuses on the following: coordination between education and service sectors, student
recruitment, competency-based education, multidisciplinary learning, lifelong learning culture, and
continuing education system.
3. DEPLOYMENT AND UTILIZATION Access to quality nursing and midwifery services must be improved as an
integral part of health services, including deployment and utilization, aimed at individuals, families,
communities, and particularly vulnerable populations.
❖ There is need to identify and adapt innovative management approaches to bridge gaps between the
health system and the needs of the community, specifically in terms of home-based care, palliative
care, health promotion, disease prevention, rehabilitation, and emergency care.
❖ This element focuses on the following: recruitment and retention, appropriate skill mix and
competencies, job description, workload, imbalance and equity, relevant nursing infrastructure,
effective leadership and management, good working conditions and efficiently organized work,
technical supervision systems, career advancement opportunities, incentive system, job satisfaction,
and unions.
4. REGULATION To ensure quality care and public safety, effective regulatory mechanisms are required.
❖ This element focuses on the effective regulation and management of nursing workforce migration.
5. EVIDENCE FOR DECISION- MAKING In order to ensure that the right nurse personals is in the right place with
the right skills, countries need accurate data on human resources for health.
❖ The accuracy of planning mechanisms and forecasts will depend on the quality of data available and
the expertise of the individuals interpreting them.
❖ Unfortunately, reliable information on nurse and midwifery personnel is often unavailable nationally
and remains almost non-existent internationally.
❖ Furthermore, nurse and midwifery are frequently absent from the decision-making bodies which
undertake planning exercises.
❖ Any specific efforts to improve overall workforce productivity need to be based on reliable data
about workforce level, distribution and skill mix, coupled with information on the factors thought to
be constraining better health worker performance and intelligence on potential policy options.
6. EVALUATING THE PLANNING PROCESS In addition to monitoring the implementation of the strategic plan,
nursing organizations must also be actively involved in evaluating the planning process.
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❖ Effective planning is an ongoing process and future exercises will be facilitated by considering the
constructive criticism of the parties concerned.
CONCLUSION
Human resources planning is a complex and often long-term process which requires nursing input. The
nursing leadership must be familiar with the fundamental process of human resources planning and participate
actively in its development, keeping in mind the health goals set for the population. The political will to consider and
implement change needs to be encouraged and supported if strategic planning is to be successful. In certain
countries however, the will to change is guided primarily by economic factors, and nursing organizations will need to
safeguard quality levels within the health services. The professional responsibility of nursing organizations to
stimulate and facilitate human resources studies is linked to their basic objectives, which are to improve the
community’s health status and develop the profession. The challenge is clear. The choice of potential role(s) will
depend on the national context and the organization’s resources. Nursing’s close relationship to the population in
general and the health community reinforces the need for its leadership to become involved in effective health
human resources planning.
REFERENCES:
World Health Organization (2002). Strengthening nursing and midwifery. Geneva: 54th World Health Assembly. May
2001. Resolution WHA 54.12. World Health Organization. Conceptual Framework for Management of Nursing and
Midwifery Workforce. WHO: New Delhi.
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ORGANIZING
Refers to a body of persons, methods, policies, procedures arranged in a systematic process through the delegation
of functions and responsibilities for the accomplishment of purpose. (Venzon, 2006)
 It is the process of establishing formal authority.

 It involves:
1. setting up the organizational structure through identification of groupings, roles, relationships
2. determining the staff needed by developing and maintaining staff patterns and distributing them in
the various areas as needed
3. developing job descriptions by defining the qualifications and functions of personnel
4. the grouping of activities for the purpose of achieving objectives, the assignment of such groupings
to a manager with authority for supervising each group, and the defined means of coordinating
appropriate activities with other units, horizontally and vertically, that are responsible for
accomplishing organizational objectives. (Cawaon, 1998)
ORGANIZING IN 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.
 Having qualified people and the right materials, information, and equipment needed to deal with
contingencies.
PURPOSE OF HAVING AN ORGANIZATIONAL STRUCTURE:

1. It informs members of their responsibilities so that they may carry them out.
2. It allows the manager and the individual workers to concentrate on his/her specific role and
responsibilities.
3. It coordinates all organizational activities so there is minimal duplication of effort or conflict.
4. It reduces the chances of doubt and confusion concerning assignments.
TYPES OF ORGANIZATIONS
As Classified by Nature of Authority
1. Line Organization
❖ Is the simplest and most direct type of organization in which each position has a general authority
over the lower positions in the hierarchy.
Example: Clinical and Administration
2. Informal Organization
❖ Refers to horizontal relationships rather than vertical. This composed of small groups of workers
with similar interests.
❖ Network of personal and social relationships (alliances, cliques, friendships) that arise as people
associate with other people in a work environment.
3. Staff Organization
❖ Is purely advisory to the line structure with no authority to put recommendations into action.
Example: Training and Research
4. Functional Organization
❖ each unit is responsible for a given part of the organization’s workload.
❖ There is a clear delineation of roles and responsibilities which are interrelated.
Example: Ad Hoc Committees (Committee formed for a specific task or objective, and dissolved after
the completion of the task or achievement of the objective)
ORGANIZATIONAL STRUCTURE
 Graphically represents the management structure of an organization, such as department managers and
non-management employees within a company.
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 The process by which a group is formed, its channels of authority, span of control and lines of
communication (Venzon, 2006)
5 MAJOR CHARACTERISTICS OF AN ORGANIZATIONAL CHART

An organizational chart should show the following components:
 Division of work – each box represents the individual or sub-unit responsible for a given task of the
organization’s workload.
 Chain of command – lines indicate who reports to whom and by what authority.
 Type of work to be performed – indicated by labels or descriptions for the boxes.
 Levels of management – indicate individual and entire management hierarchy.
Hierarchy refers to a body of persons or things organized or classified in pyramidal fashion according
to rank, capacity or authority assigned to vertical levels with offices ranked in grades, orders, or classes, one
above the other.
TOP LEVEL MANAGEMENT: THE CHIEF NURSE

 Scope of responsibility – looks at organization as well as external influences.
 Primary planning – Strategic planning
 Communication flow – more often from top to down but receives feedback both directly and via middle-level
managers.
MIDDLE LEVEL MANAGEMENT: THE NURSE SUPERVISOR

 Scope of Responsibility – focus is on integrating unit level day-to-day needs with organizational needs.
 Primary planning – combination of short range and long-range planning.
 Communication flow – Upward and downward with great certainty.
FIRST LEVEL MANAGEMENT: THE HEAD NURSE

 Scope of Responsibility – Focus on day-to-day at unit level.
 Primary planning focus – short range operational planning.
 Communication flow – more often upward; generally relies on middle-level managers to transmit
communication to top level managers.
PRINCIPLES OF ORGANIZING
1. Unity of command
❖ Responsible to one superior
> to avoid confusion and overlapping of duties and misunderstanding
2. Scalar principle
❖ Authority and responsibility must flow in clear unbroken lines from the highest executive to the
lowest.
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❖ Proper definition and delegation of authority and responsibility facilitate the accomplishment of
work.
❖ The employee who accepted the responsibility is accountable to his actions.
3. Homogenous assignment or Departmentation

❖ workers performing similar tasks are grouped together for a common purpose.
❖ this promotes specialization of activities, simplifies administration’s work, and helps maintain
effective control.
4. Span of control
❖ The number of workers a supervisor can manage
❖ The span of managerial responsibility
❖ The recommended ratio of supervisor – workers is = 1:6 (Venzon, 2006)
❖ The highly skilled supervisor may have a higher ratio
5.Exception Principle
❖ Decision-making is a responsibility of lower level managers in a routine manner. Problems at their
level should be solved by them; However, Unusual problems should be elevated to higher levels (use
protocols and proper line of communication)
6.Decentralization or Proper Delegation of Authority

❖ The executive at top level management delegates the responsibility and authority to the subordinate
(highly capable); however, the executive is still accountable to the result of the accomplished task.
Types of Organizational Structure

1. Informal Structure
✓ It consists of personal and social relationships among the members of the organization.
✓ It is not reflected in the organizational chart.
✓ It is through the informal structure that with little or no formal status or position may gain
recognition.
✓ This unofficial personal relationship among workers may influence their working effectiveness.
✓ It can be powerful and motivating. It includes employees’ interpersonal relationships, the formation
of primary and secondary groups, and the identification of group leaders without formal authority.
✓ These groups are important because they provide workers with a feeling of belongingness.
❖ Informal structure - has its own channel of communication called the GRAPEVINE, where information
is disseminated faster than in formal system of communication, however, information transmitted
through the grapevine may or may not be accurate.
2. Formal Structure/Line Structure

✓ describes the position, the responsibilities of those occupying the positions, and the working
relationships among the various units or departments. (Venzon, 2006)
✓ This is also called as Line structures. Max Weber called it Bureaucratic structures. (Marquis, 2009)
ORGANIZATIONAL CHART
❖ It is a drawing that shows how the parts of the organization are linked.
❖ It depicts the formal organizational relationships, areas of responsibility, person to whom one is
accountable, and channels of communication.
❖ Murray and DiCroce describe it as a graphic presentation of the chain of authority from chief executive to its
member of the organization
USES OF THE ORGANIZATIONAL CHART

 1. It outlines administrative uses.
 2. It is used for policy making and planning.
 3. It is used to evaluate strengths and weaknesses of the present structure.
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 4. It shows the relationships with other departments and agencies.

 5. It is used to orient new personnel to the organization.
TYPES OF THE ORGANIZATIONAL CHART

1. Vertical or Tall Chart/Bureaucratic/Line structure/ Line organization
 depicts the chief executive at the top with lines of authority flowing down the hierarchy.
 Authority and responsibility are clearly defined.
 It is most effective when managers desire better coordination and effective communication.
 It clearly defines the relationships between and among the different levels in the organization
 More attention is given to messages that come from managers than those from lower levels.
 Members, however, are given more opportunities to participate in decision-making activities because of
limited or small span of control.
2. Horizontal or Flat chart

 depicts the manager at the top with a wide span of control.
 Levels of management are not shown
 Employees report to one manager.
 Employees have more freedom.
 Head nurses are given more authority.
 Communication is direct, simple, and fast with minimal distortions of messages since the distance between
top and lower levels is shorter.
FLAT CHART DESIGNS:

 An effort to remove hierarchical layers by flattening the scalar chain and decentralizing the organization.
 More authority and decision making can occur where the work is being carried out.
 Flat organizational structure – remove hierarchical layers by flattening the chain of command and
decentralizing the organization.
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 When organizations are well off, it is easy to add layers to the organization inorder to get the work done; but
when the organization begins to feel a financial pinch, they often look at their hierarchy to see where they
can cut positions.
 While there are many advantages, many managers resist such change as it means their work load is greatly
increased. (marquis, 2009)
3. Circular or concentric chart

 It depicts top management in the center represented by the Board of Trustees or Directors, Chief of
Hospital, Hospital Administrator, Chief Nurse.
 The Middle and Lower level management like the supervisors, charge nurse, staff nurses are in concentric
circles.
 It shows the outward flow of formal authority that is from the center moving outward.
 It minimizes or reduces the implications of status or positions.
 It represents a conceptual rather than a functional view of the organization.
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Staffing
A. Considerations in Developing a Staffing Pattern
1. FULL-TIME EQUIVALENTS (FTEs) the work commitment of a full-time employee
2. DIRECT CARE time spent providing hands-on care to patients
3. INDIRECT CARE time spent on patient-related activities not done directly to pt.
PERCENTAGE OF PATIENTS AT VARIOUS TYPES OF HOSPITAL
Percentage of Patients per Type of Hospital

Primary Secondary Tertiary Special Tertiary
Levels of Care
Hospital Hospital Hospital Hosp
Level I 70% 65% 30% 10%
Level II 25% 30% 45% 25%
Level III 5% 5% 15% 45%
Level IV - - 10% 20%
NURSING HOURS PER PATIENT DAY (NHPPD) nursing time available to each patient by available nursing staff
NCHPPD Standard Formula = Nursing Hours Worked in 24 Hours/ Patient Census
Nursing Care Hours Per Patient

Levels of Care Description of Care
Day (NCHPPD)
Level I Self / Minimal Care 1.5
Level II Moderate / Intermediate Care 3.0
Level III Total / Complete / Intensive Care 4.5
Level IV Highly Specialized / Critical Care 6.0 or higher
WORKING HOURS PER WEEK / HOURS WORKED & AVAILABLE FOR PATIENT CARE / P RODUCTIVE HOURS
Working
Hospital Working Hours Working Days
Hours
Capacity Per Week Per Year
Per Day
100-bed capacity 40 hours
8 hours 213
and above (40-Hour Week Law RA 5901)
Less than 100 48 hours
8 hours 265
beds (1 day off duty per week)
DAYS FOR BENEFITS / NON-PRODUCTIVE HOURS
Benefits Number of Days

Sick Leave 15
Vacation Leave 15
Holidays 12
CE/CPE 3
Special Privileges 3
Total Days for Benefits Per Year 48 Days
33 Days
Actual Days for Benefits Per Year
(Used in the computation for Relievers)
SKILL MIX : ratio of Professional/RN staff to Non-professional/ other direct care staff (LPNs, Nurse Aides) varies
according to the care required and care delivery model
Ratio of Professional Staff to Non-Professional

Type of Hospital
Staff
Primary 55 : 45
Secondary 60 : 40
Tertiary 65 : 35
Special Tertiary 70 : 30 to 80:20
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STAFF DISTRIBUTION PER SHIFT
Shift Percentage Distribution of Staff

Morning 45 – 51 %
Afternoon 34 – 37 %
Night 15 – 18 %
B. Determination of Staffing Needs
Computation of Staffing Needs for a 250-bed capacity Tertiary Hospital

STEPS:
1. Determine the Number of Patients cared for in Each Level of Care
Formula:Bed Capacity x Percentage of Patients (accdg. to Hospital Type) = Number of Patients
a.Level I 250 x .30 = 75 patients needing Minimal Care

b.Level II 250 x .45 = 112.5 patients needing Intermediate Care
c.Level III 250 x .15 = 37.5 patients needing Intensive Care
d.Level IV 250 x .10 = 25 patients needing Critical Care
2. Determine the Total Nursing Care Hours Per Patient Day (NCHPPD) needed.
Formula: No. of Patients x NCHPPD = NCHPPD per Level of Care
a. Level I 75 x 1.5 = 112.50 NCHPPD

b. Level II 112.5 x 3.0 = 337.50 NCHPPD
c. Level III 37.5 x 4.5 = 168.75 NCHPPD
d. Level IV 25 x 6.0 = 150.00 NCHPPD
---------------------
758.75 Total NCHPPD
3. Determine the Total NCH needed in a Year
Formula: Total NCHPPD x Number of Days in a Year
NCH per Year = 758.75 Total NCHPPD x 365 days

= 280,593.75 NCH/Year
4. Determine the Number of Working Hours Rendered by Each Staff per Year
Formula: Number of Working Hours Per Day x Number of Working Days Per Year
Working Hours Per Year = 8 hours x 213 days

= 1,704 Working Hours Per Year
5. Determine the Number of Staff Needed

Formula: Total NCH Per Year / Working Hours Per Year
Total Staff Needed = 280,593.75 NCH / 1,704 Working Hours

= 165 Staff
6. Determine the Number of Relievers

Formula: (Total Days for Benefits / Working Days Per Year) x Total Nursing Staff Needed
No. of Relievers = (33 days / 213 days) x 165 staff

= 0.15 x 165 staff
= 25 Relievers
7. Determine the Total Number of Staff Needed

Formula: Number of Total Nursing Staff + Number of Relievers
Total No. of Staff = 165 Staff + 25 Relievers
= 190 Total No. of Staff
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8. Categorize staff according to Professional and Non-professional

Formula: Number of Staff x Ratio according to Hospital Type
No. of Professional Staff = 190 x .65

= 124 Professional Staff
No. of Non-Prof Staff = 190 x .35

= 66 Non-professional Staff
9. Distribute staff by Shifts

Formula: Number of Staff x Percentage Distribution of Shift
Professional (RNs) Non- professional (LPNs, Aides)
Morning 124 x .45 = 56 66 x .45 = 30
Afternoon 124 x .37 = 46 66 x .37 = 24
Night 124 x .18 = 22 66 x .18 = 12
10. Additional personnel should be hired for:

a. supervisory and administrative positions
b. special units’ personnel (OR, DR, ER, OPD) including personnel for rooming-in babies
c. health education services personnel
C. Scheduling
SCHEDULE
- timetable showing planned workdays and shifts for nursing personnel
OBJECTIVE
- to assign working days and days off the nursing personnel so that adequate patient care is
assured
- to achieve a desirable distribution of off-duty days can be achieved
- to enable the nursing staff to know their schedule in advance
CONSIDERATIONS IN STAFF SCHEDULING

Patient Need schedule must have staff working when work needs to be
done
schedules change when types of patients change
Patient Volume scheduling adjusts with patient volume
peaks and valleys in the census
Staff Experience and Capability e.g. adding hours if with inexperienced staff
Adequate Coverage for 24 hours, 7 days/wk

Productive and Nonproductive staggered vacations and holidays
Hours long stretches of consecutive working days
Shift Variations 8-hour, 10-hour and 12-hour shifts, weekend programs
Impact on Patient Care possible disruption of continuity of care
weekend staff should be familiar with patients and recent
care events
Financial Implications weekend programs are more expensive than traditional
staffing patterns
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METHODS
Self- Scheduling coordinated by staff nurses
must be done within boundaries

Alternating or Rotating work alternating between days and nights, rotating through all
shifts three shifts some nurses may work all three shifts within 7
days
may create stress among staff nurses and affect quality of
work
Permanent shifts provide social, educational, and psychological advantages
relieve nurses from stress and health- related problems
Block, Cyclical scheduling uses the same schedule repeatedly
staff are scheduled to work 6 successful days followed by at
least 2 days off
schedule repeats itself every 6 weeks.
Variable Staffing uses patient needs to determine the number and mix of
staff.
SHIFT VARIATIONS
Shift Work in a Week Shift Hours

5 days On Duty (40-hours) 7AM to 3:30PM; 3PM to 11:30PM; 11PM to
8-hour Shift
2 days Off 7:30AM
4 days On Duty 7AM to 5:30PM; 1PM to 11:30PM; 9PM to
10-hour Shift
14 hours Off between shifts 7:30AM
3 days On Duty
12-hour Shift 7AM to 7:30PM; 7PM to 7:30AM
4 days Off
3 days On Duty 7AM to 7:30PM (36 hours paid)
4 days Off 7PM to 7:30AM (40 hours paid)
Baylor Plan
Weekend
5 days On Duty 7AM to 3:30PM; 3PM to 11:30PM; 11PM to
Alternative
2 days Off 7:30AM
Half hour lunch break

Half-hour overlap time between shifts
EVALUATION OF SCHEDULING EFFECTIVENESS

- Ability to cover the needs of the unit
- Quality to enhance the nursing personnel’s knowledge, training, and experience
- Fairness to staff
- Stability
- Flexibility
- Adequacy of Skill Mix (outcomes are affected negatively when nurse staffing or skill mix is
inadequate)
- Provide ability for staff to communicate concerns in written and verbal form.
- Track recommended staffing versus actual staffing.
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INDIVIDUAL ADDITIONAL READING FOR Directing / Leading
a. Principles
❖ in leading, managers determine direction, state a clear vision for employees to follow, help
employees understand the role they play in attaining goals.
❖ involves a manager using power, influence, vision, persuasion, and communication skills.
❖ outcome : a high level of motivation and commitment from the employees to the
organization.
b. Lines of Communication
b1. Elements of the Communication Process
COMMUNICATION the exchange of information or opinions

an interactive process that is a means to an end
influenced by the context in which it occurs
SENDER: the “who” in communication, i.e., the person who initiates communication
MESSAGE: the “what” in communication; verbal and/or nonverbal stimuli that are taken in by the
receiver
RECEIVER: the person who takes in the message and analyzes it
FEEDBACK: the new message that is generated by the receiver in response to the sender’s original
message
CHANNELS: Visual (seeing), Auditory (hearing), Kinesthetic (touching)
MODES: Verbal: spoken
Nonverbal : facial expressions, posture, gait, body movements, position, gestures, and touch
Electronic : uses electronic media that do not have characteristics of the other modes
b2. Levels of Communication

PUBLIC: communication with a group of people with a common interest
communicator acts primarily as a sender of information
feedback is typically limited
INTRAPERSONAL: internal communication within an individual

used to process observations, analyze situations, resolve doubts, or reaffirm beliefs.
INTERPERSONAL: communication between individuals, person-to-person, or in small groups.
ORGANIZATIONAL COMMUNICATION: Avenues of communication are defined by an organization’s formal structure
❖ Downward: originates at top or upper levels of organization and works downward.

❖ Upward : originates at some level below the top of the structure and moves upward.
❖ Lateral : occurs among people at similar levels within the organization.
❖ Diagonal : when people who may be on different levels of the organization communicate with
each other.
❖ Grapevine: an informal and unstructured avenue of communication, major benefit is speed, but
its major drawback is its unreliability.
b3. Communication Skills

ATTENDING: active listening
RESPONDING: verbal and nonverbal acknowledgment of the sender’s message
CLARIFYING: communicating as specifically as possible to help the message become clear
CONFRONTING: working jointly with others to resolve a problem or conflict
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b4. Trends in Society That Impact Communication

Increasing social diversity
Changing/differing beliefs
Aging population
Shift to computerized communication
b5. Barriers to Communication

GENDER: men and women may process information differently.
CULTURE: different cultures may have different beliefs, practices, and assumptions.
ANGER: an irrational response that arises from irrational ideas
can’t-stand-it-itis, awfulizing, shoulding and musting, undeservingness and damnation
INCONGRUENT RESPONSES: when words and actions in a communication do not match the inner experience of
self and/or are inappropriate to the context.
CONFLICT: arises when ideas or beliefs are opposed.
b6. Workplace Communication

SUPERIORS: Observe professional courtesies
Dress professionally
Arrive for the appointment on time.
Be prepared to state the concern clearly and accurately
Provide supporting evidence and anticipate resistance to any requests
Separate out your need from your desires.
State a willingness to cooperate in finding a solution and then match behaviors to words.
Persist in the pursuit of a solution.
COWORKERS: Report patient information accurately, informatively, and succinctly.
SUBORDINATES: Do unto others as you would have them do unto you,

Delegate clearly and effectively,
Offer positive feedback.
PHYSICIANS/OTHER HEALTH CARE PROFESSIONALS:

Strive for collaboration, keeping the patient goal central to the discussion.
Present information in a straightforward manner.
Clearly delineate the problem and support the assertion with pertinent evidence.
Remain calm and objective even if the physician does not cooperate.
Follow the institution’s procedure for getting the patient treated and then document the
actions taken.
PATIENTS AND FAMILIES:

Use touch to communicate caring and concern.
Occasionally, language barriers will limit communication to the nonverbal mode.
Be open and honest while respecting patients and families.
Honor and protect patients’ privacy with both actions and words
MENTOR/PRODIGY: Listen, Affirm, Counsel, Encourage, Seek input from the novice.
Outline anticipated challenges with suggestions for how to manage them
Use role-playing, where the preceptor describes a theoretical situation and allows the novice
to practice her response
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c. Delegation
- Delegation is not new.
- Delegation in nursing has been emphasized and deemphasized at different periods in history.
- Delegation has not always been emphasized in nursing education.
- Delegation is essential for good working relationships.
- Organizational skills are a prerequisite for delegation.
- An understanding of patient needs is essential for appropriate delegation.
- Current staffing practices require a greater amount of delegation from the nurse.
c1. Defining Concepts

DELEGATION
- the transfer to a competent individual the authority to perform a selected nursing task in a
selected situation
- “Reassigning of responsibility for the performance of a job from one person to another.” (ANA,
1996.)
- No delegation can be complete without the following:
WHO will do WHAT by WHEN and HOW, WHERE and WHY it will be done
DIRECT DELEGATION
- usually verbal direction by the RN delegator regarding an activity in a specific situation.
INDIRECT DELEGATION
- uses an approved listing of activities/tasks established in the policies and procedures
- (may vary with different health care organizations)
SUPERVISION
- requires directly overseeing the work or performance of others, constant checking
RESPONSIBILITY
- is transferred to the Delegatee
- involves reliability, dependability, and the obligation to accomplish work an acceptable level.
ACCOUNTABILITY
- remains with the delegator
- the nurse is legally liable for her actions and is answerable for the overall nursing care of her
patients.
AUTHORITY
- when a person who has been given the right and official power by an organization to delegate.
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c2. Five Rights of Delegation
RIGHTS ASK YOURSELF

“Is the task within the scope of practice of the individual I am asking to perform it?”
The right
PERSON “Is the task relative to the education, skill, knowledge, and judgment levels of the personnel
being assigned to?”
“Can this task be delegated safely?”
The right
“Does the task carry the potential for harm?”
TASK
“Is the task highly complex and require advanced skill or a high level of problem-solving skill?”
“Is there anything about the client’s condition or the environment which would prevent the
personnel from performing the task as delegated?”
The right
CIRCUMSTANC
“Is there a higher degree of unpredictability or unidentified client needs?”
E
“Does the task require a complex level of patient interaction?”
“Have I given clear, concise directions?”
The right
DIRECTION & “Have I communicated clearly and directly what is expected in the performance:
COMMUNICATI the expected outcome of the assignment,
ON the time frame for completion,
any limitations on the assignment when the assignment is made,
the reporting and documentation of this task?”
“Do I have the requisite skills to assist the individual in completing the task as delegated?”
The right
SUPERVISION & “Have I delegated the responsibility and the authority for the performance of the care?”
EVALUATION
“Will I be available and accessible to this individual the delegated task is completed?”
TRANSCULTURAL DELEGATION
▪ the process of having personnel perform duties with the diversities of culture taken into
consideration.
▪ cultural phenomena (areas where cultures have different interpretations or preferences)
include:
Communication, Space, Social organization, Time, Environmental control, Biological
variations
Delegation Barriers
BARRIERS IN THE DELEGATOR - do-it-myself attitude

- inability to ask others
- inability to organize
- uncertainty
BARRIERS IN THE DELEGATEE - inexperience

- incompetence
- disorganization
- irresponsibility
BARRIERS IN THE SITUATION - inadequate support

- hurried atmosphere
- hostile management
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UNDER DELEGATION - usually occurs when a person is in a new job role

- trying to avoid resentment from “old guard” staff
- not knowing who to delegate to
- not knowing scope of staff duties
- seeking approval by demonstrating competency
Patient Care Delivery Models/Assignment
MODEL ADVANTAGES DISADVANTAGE

TOTAL PATIENT CARE
The nurse is responsible for the total care for her Consistency of one individual Nurse may look at the patient on a
patient assignment for the shift she is working. caring for patients for an entire shift-by-shift basis rather than on a
shift continuum of care
The RN is responsible for providing care to several
patients during a normal shift. Patient, nurse, and family can Uses a high level of RN nursing hours
develop a trusting relationship to deliver care
Nurse has more opportunity to Costlier than other models

observe and monitor patient
progress
FUNCTIONAL
Divides nursing work into functional units that are Care can be delivered to a large Lack of continuity of care
then assigned to one of the team members. number of patients
Patient may feel that care is disjointed
Each care provider is responsible for specific duties Uses other types of health care
or tasks. workers when there is a shortage
of RNs
TEAM NURSING
Assigns staff to teams that are then responsible Maximizes the role of the RN Communication is complex
for a group of patients.
Nurse is able to get work done Shared responsibility and
A unit is divided into two teams, each led by a through others accountability can cause confusion
registered nurse. and lack of accountability
Team leader supervises, coordinates all care

provided by those on the team.
Care divided into the simplest components, then

assigned to the care provider with the appropriate
level of skills
Modular Nursing Delivery System:

divides a geographic space into modules
of patients,
each module having a team of staff led by
an RN to care for them.
PRIMARY
Clearly delineates the responsibility and Patients and families are able to Cost is high due to the higher RN skill
accountability of the RN develop a trusting relationship with mix.
the nurse.
Places the RN as the primary provider of care The person making assignments
Accountability and responsibility of needs to be knowledgeable about all
Patients are assigned a primary nurse. the primary nurse with the patient the patients and staff to ensure
and family are defined. appropriate matching of nurse to
Primary nurse is responsible for developing with patient
the patient a plan of care. Such a holistic approach to care,
rather than a shift-to-shift focus, Lack of geographical boundaries
Other nurses caring for the patient follow this plan facilitates continuity of care. within the unit may require nursing
of care. staff to travel long distances at the
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Authority for decision making is unit level to care for their primary
Nurses and patients are matched according to given to the nurse at the bedside patients.
needs and abilities.
Nursing time is often used in
The primary nurse has the authority, functions that could be completed by
accountability, and responsibility to provide care other staff.
for a group of patients. Nurse-to-patient ratios must be
realistic.
Associate nurses care for the patient when the
primary nurse is not working.
PATIENT-CENTERED OR PATIENT-FOCUSED CARE
Designed to focus on patient needs rather than Most convenient for patients Can be extremely costly to
staff needs. decentralize major services in an
Expedites services to patients organization
Necessary care and services are decentralized and
brought to patients. Some perceive model as a way of
reducing RNs and cutting costs in
Staff is kept close to patients in decentralized hospitals
workstations.
Care teams are established for a group of patients

within these teams, disciplines collaborate to
ensure that patients receive the care they
need.
DIFFERENTIATED PRACTICE
Differentiated nursing practice is a care delivery Nurses can work in specialized roles Nurses who have experience,
model that sorts the roles, functions, and work of for which they were educated, knowledge, and capability to function
registered nurses according to some identified leading to greater career beyond their original education may
criteria, commonly education, clinical satisfaction. not be recognized.
experience, and competence.
Organizations that have determined
Nursing competencies are generally measured in minimal educational requirements for
three arenas: RN positions may have difficulty in
Technical skills recruiting staff with the requisite
Communication skills credentials.
Management of care or leadership skills
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DIRECTING
➢ It is a connecting link between organizing for work and getting the work done, and that it actuates
efforts to accomplish goals and objectives of the organization.
➢ In nursing, it is giving directions to others to achieve quality patient care.
➢ Douglas defines directing as “issuance of assignments, orders and instructions that permit the worker to
understand what is expected of him/her and the guidance and overseeing of the worker so that he/she
can contribute effectively and efficiently to the attainment of the organizational objectives”.
ELEMENTS OF DIRECTING
1. Delegation 4. Motivation 7. Staff Development
2. Supervision 5. Communication 8. Decision Making
3. Leading 6. Coordination 9. Conflict Management
DELEGATION – is the process by which the manager assigns specific tasks/ duties to workers with commensurate
authority to perform the job. The worker in return assumes responsibility for its satisfactory performance and is held
responsible for its results.
- It is sharing of responsibility and authority with subordinates and holding them accountable for their
performance.
- It is a skill that relies on trust that the subordinates have the necessary skill and knowledge to know
how to do the assigned task.
- It is the process that facilitates complex organizations to accomplish work through the coordinated
and differentiated efforts of others. It is the manager who uses the process of delegation.
- It is recommended to the nurse manager to use delegation as a tool to build morale among the staff
members. This involves giving of assignments to subordinates and motivating them to perform their
jobs efficiently and effectively.
ADVANTAGES:
1. The nurse manager can be freed of valuable time that can well be spent on planning and evaluating nursing
programs and activities.
2. It trains and develops staff members who desire greater opportunities and challenges in their work making
them more committed and satisfied in their jobs.
What cannot be Delegated to any subordinate?

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 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. The “hot potato”. “Do not ever make a mistake of passing one along to take yourself off the spot”.
6. Jobs that are too technical and those that involve trust and confidence.
Why Nurse Managers do not Delegate?

1. Lack of confidence in their staff, feeling that only they could do the task better and faster, and that they may
fear loss of control if some of their duties are delegated.
2. In return, the subordinates maybe apprehensive in accepting delegated tasks for fear of criticism, ineptitude,
or incompetence.
These insecurities maybe avoided through:

a. Open communication among the staff.
b. There should be warm and cordial relationships where everyone is free to ask questions or seek
clarifications regarding a delegated task which to the staff maybe too difficult to understand.
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ASPECTS OF DELEGATION
1. Responsibility – denotes obligation. It refers to what must be done to complete a task and the obligation
created by the assignment.
❖ Both the manager and the subordinate understand what the activities the latter is responsible for,
the expected results, and how the performance will be evaluated.
2. Authority – is the power to make final decisions and make commands.
❖ When a manager assigns responsibility to a subordinate, authority should also be given to enable the
subordinate to carry out the responsibility, however, the manager still maintains control over the
subordinate and may recall the authority.
3. Accountability – refers to liability. It is the fulfillment of the formal obligation to disclose to referent others
the purposes, principles, procedures, relationships, results, income, and expenditures for which one has
authority.
Guidelines for effective delegation:

1. Give a clear description of what you want the employee to do. Describe the over all scope and background
of the current task.
2. Share with the employee the outcome you expect and by when.
3. Discuss the degree of responsibilities and authority that the employee will have.
4. Ask the employee to summarize the main points of the task that has been delegated.
SUPERVISION– is overseeing the activities of others.

❖ It is inspecting the work of others, and either approving or correcting the adequacy of performance.
❖ It is to guide, evaluate, and improve work performance of employees through criteria against which
the quality and quantity of work production and utilization of time and resources are made.
❖ It encourages the development of the potentials of the workers for effective and efficient
performance.
❖ Nurse managers provide guidance and direction to workers to achieve the goals and objectives of
the institution, that of the nursing service, and the nursing units.
SUPERVISORY TECHNIQUES
1. Observation of the worker while making the rounds.
2. Spot checking of charts through nursing audits.
3. Ask patients about the care they receive.
4. Looking into the general condition of the units.
5. Getting feedback from co-workers or other supervisors or relatives.
6. Asking questions discreetly to find out the problems they encounter in the wards.
7. Drawing out suggestions from the workers for improvement of their work or work situation.
MOTIVATION
- Aimed to arouse, excite, or influence another person to have in some role or perform some actions
the person would not ordinarily do.
- It refers to some inner drives, impulse, or intention that causes one to act or believe in a certain way,
or to seek a goal.
- It is the effect of persuasive communication between a leader and a follower.
Ways to increase staff motivation:

1. Manage change properly.
a. Implement change only for a good reason. Change to solve some problems
b. Introduce change gradually. Make change at one time in your department or unit, gain cooperation
and trust of the personnel to effect change productivity.
c. Plan carefully the change and the best strategy for introducing it.
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2. Assign undesirable jobs on a rotational basis.

a. Undesirable jobs should be rotated among the staff. If this job is always given to the same best
employees, there will be feeling of inequity.
b. Provide incentives to every task completed successfully.
3. Job redesign
a. The purpose of this is to provide high degree of internal work motivation, high quality of work
performance, high satisfaction with work, and low absenteeism and turnover.
b. The best way to increase self-esteem, achievement and self-actualization is through job rotation (to
develop other skills), and enrichment (widen knowledge) to decrease boredom.
4. Provide productive climate and high morale.

a. A nursing unit maybe characterized as having a climate for high productivity, that is, the work is
usually completed at the end of each shift and patient satisfaction is good. Nurse Managers believe
that when a climate such as this exists, their efforts of motivating staff have been effective.
b. Morale implies “good spirit”, cohesiveness (stick together with unity) and group cooperation. This
will lead to productivity in pursuing goals.
COMMUNICATION– is the transmission of information, opinions, and intentions between and among individuals.
PURPOSES of Communication for Nurse Managers:

1. To facilitate work.
2. Increase motivation
3. Effect change
4. Optimize care
5. Increase worker’s satisfaction
6. Facilitate coordination
PRINCIPLES OF EFFECTIVE COMMUNICATION

1. Clear lines of communication serve as the linking process by which parts of the organization are unified
toward goal achievement.
2. Simple, exact, and concise messages ensure understanding of the message to be conveyed.
3. Feedback is essential to effective communication.
4. Communication thrives best in a supportive environment that encourages positive values among its
personnel.
5. A manager’s communication skill is vital to the attainment of the goals of the organization.
6. Adequate and timely communicating work-related issues or changes that may affect jobs enhance
compliance.
LINES OF COMMUNICATION
1. Downward communication – superior to subordinate
2. Upward communication – subordinate to superior
3. Horizontal communication – personnel of departments of the same level, and peers
4. Outward communication – patients, family, friends, worker’s family, and friends
Lines of Communication
1. Downward Communication
Traditional
Primarily directive
Coordinates the activities of different levels of the hierarchy: what to do
Examples:
Memoranda or memos employee handbook
Directives and job descriptions
Manuals of operation loudspeaker system
Records and Reports bulletin boards
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HANDOUT # 3 PRELIMS
2. Upward Communication
Allows employee input
Manger summarizes information and passes upward to the next level, filtering process
Examples:
Face-to-face discussions written reports
Grievance procedures suggestion boxes
Informers, ombudsman attitude surveys
3. Lateral communication- between departments or personnel on the same level of hierarchy. Most frequently used
in coordinating activities
Examples: Committees, conferences, and meetings
4. Diagonal Communication-between individuals or departments not of the same Level of the hierarchy. Informal in
nature
5. Grapevine- Informal method coexisting with formal communication. Rapid-uses cluster chain pathways (3-4
individuals)
Affects personnel’s work
Involves people they know
Fragmentary and incomplete
No formal lines of accountability
RECORDS AND REPORTS

- are documents may show good communication.
RECORDS – contain data or information that may be used for decision-making, recommendations or as basis for the
management of the unit and patient care.
Nurse manager should keep in mind that records must be:

1. Accurate, adequate, and up to date.
2. Clear, brief, and concise.
3. Provide relevant facts for evaluation and study.
4. Temporary or permanent. Policies should be provided for its disposition.
5. Record forms that are used for recording purposes must always be maintained.
6. Confidential records and reports must be safeguarded. The word confidential must be stamped or written
preferably in red ink.
7. Dry, sturdy storage must be provided.
8. Filed chronologically and by subjects to facilitate accessibility and effective use of data.
9. A professionally trained responsible person should be assigned in keeping records and reports.
Nursing Office records that should be kept on file:

1. Personal records of nursing personnel 7. Affiliation records
2. Assignment of personnel 8. Staff development programs
3. Daily census of patients 9. Turnover of personnel
4. Procedure manuals 10. Resignations, appointments, promotions
5. Manual of policies, administrative manuals 11. Activities of the nursing service division
6. Minutes of meetings 12. Patient’s records
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HANDOUT # 3 PRELIMS
REPORTS – are prepared accounts of important activities of the nursing service within a period.
Types of Reports:
1. Nursing office reports
a. Monthly reports on the number of nursing personnel
b. Newly hired personnel
c. New appointments, promotions
d. Transfer, retirement
e. Leaves of absences
f. Accomplishments
g. Activities
h. Trainings
i. Researches
j. Bi-annual and annual reports that include evaluation of personnel, problems and issues affecting
nursing service and recommendations for the resolutions of the problems.
2. Nursing Unit Reports – are prepared by the senior or staff nurses.

a. Reports in patient care,
b. Unusual occurrences in the unit,
c. Adequacy of supplies and equipment (inventory).
Points to consider in making reports:

1. Must be written, up-to-date, clear, and concise.
2. Channels of communication must be properly observed.
3. Must be factual and may include recommendations for actions.
4. Must be accomplished in forms adopted by the institution.
5. Verbal reports made in emergency situations should be confirmed in writing and duly signed by the person
making the report (Incidental or anecdotal report)
CONFLICT MANAGEMENT
CONFLICT - is a clash between two opposing and oftentimes hostile parties.
- Conflict is a warning to managers that something is wrong and needs solution through problem
solving and clarification of objectives, establishment of group norms, and determination of group
boundaries and limitations.
SOURCES OF CONFLICTS
1. Human interactions – competition, domination, provocation; differences in knowledge, skills, values,
interests; scarcity of resources; inter-group rivalry for rewards; role ambiguity; unworkable organizational
structure; shift in organizational power base and organizational climate; and unacceptable leadership styles.
2. Varying perceptions of work situations can be caused by different work responsibilities; unstable staffing
and work schedules; highly differentiated work positions or role change; disagreement over policies and
procedures; and competition for scarce resources.
3. Confrontation, disagreements, and anger are evidence of stress. Conflict arises because of poorly expressed
relationships including unfulfilled expectations.
4. Differences in positions in the hierarchy.
Basic rules in mediating a conflict between two or more parties:

1. Establish clear guidelines and make them known to all.
2. Do not postpone indefinitely. Select a time that is best for all parties.
3. Create an environment that makes people comfortable to make suggestions.
4. Keep a two-way communication.
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HANDOUT # 3 PRELIMS
COORDINATION– unites personnel and services toward a common objective.

- Synchronization of activities among the various services and departments enhances collaborative
efforts resulting in efficient, smooth, harmonious flow of work.
- It prevents overlapping of functions, promotes good working relationships and work schedules are
scheduled and targeted.
The Nurse should coordinate with the following departments or services of the institution:
1. Medical service 6. Dietary service
2. Administrative service 7. Medical-Social service
3. Laboratory service 8. Medical records
4. Radiology service 9. RHU, NGO, Civic organizations
5. Pharmacy service
CONTROLLING
• A Management Function in which performance is measured and corrective action is taken to ensure the
accomplishment s of organizational goals; anticipate deviations and seek to prevent them.
• It is a process the opens opportunities for improvement and comparing performance against set Standards.
• It is a means of assessing and regulating performance in accordance with the plans that have been adopted, the
instructions issued, and the principles established.
Quality Control as a process – a specific type of controlling that are referred to activities used to evaluate, monitor, or
regulate services rendered to consumers.
Components of the controlling process (Marquis, 2009)

1. Setting criteria and standards and objectives as part of the planning phase of management.
• Benchmarking is a process of measuring products, practices, and services against best-performing
organizations, as a tool for identifying desired standards of organizational performance.
• This will let the organizations determine on how and why their performance differs from these exemplar
organizations and use them as role models for standard development and performance improvement.
2. Identifying the information relevant to the criteria.

• What information is needed to measure the criteria?
An example is: the frequency of taking the vital signs, neurological assessment, dressing checks of a
postoperative patient.
3. Determining ways to collect information.

• The patient’s chart is the best source of information about the patient; however, the primary source of
information about the patient’s condition is patient himself.
4. Collecting and analyzing information.

• The frequency of taking and monitoring vital signs will give information to the nurse manager the
efficiency and proficiency of nurses about the quality or appropriateness of the nursing care.
5. Re-evaluation. It is done depending on the situation.

• If there is high rate of compliance with established standards, then the need for a short term evaluation
is low.
• If standards are consistently unmet or partially met, then frequent evaluation is indicated. However,
constant reevaluation is needed to maximal level and by eliminating problems in early stages before
productivity or quality is compromised.
Quality Assurance is achieving a sense of accomplishment and implies guarantee of excellence.

Quality is the degree of excellence and assurance is formal guarantee of a degree of excellence.
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HANDOUT # 3 PRELIMS
Quality Health Care – The Institute of Medicine defines it as the degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
There is provision of health care service, but the outcome is poor. Using the outcome as to measure care alone is
sometime ineffective because it does not give you the best result.
Control measures
Standards- are predetermined level of excellence that serves as a guide for practice.
1. Standards for practice – is a means of determining the quality of nursing that a patient
Receives.
Example: Competency Standards for Nursing Practice in the Philippines, BON
Resolution No.112 series of 2005, on Intravenous Nursing Standards of
Nursing Practice by Association of Nursing Service Administration of
The Philippines (ANSAP).
2. Organizational standards – is that level of acceptable practice within an institution.

Example: Teaching- Learning standards
3. Standardized Clinical Guidelines – is a diagnosis-based, step-by-step intervention for

Providers to follow.
Example: Nursing Process
Audit – a quality control tool; is a systematic and official examination of a record, process, structure, environment, or
account to evaluate performance.
1. Depends on when is the audit done, it can be:
a. Retrospective – is performed after patient receives service.
b. Concurrent – is performed while the patient is receiving service.
c. Prospective – is an attempt to identify how future performance will be affected by current
interventions.
2. Depends on what is audited, it can be:
a. Outcomes audit – determines what results occurred because of specific nursing intervention for
patients.
b. Process audit – is used to measure process of care or how care was carried out. It is task- oriented and
focused on whether practice standards are being fulfilled.
c. Structure audit – is an assumption that a relationship exists between quality care and appropriate
structure; includes resource inputs such as the environment in which health care is delivered.
Process standards are documented in patient care plans, procedure manuals, and nursing protocol statements.
Structure standards are set by the licensing board and accrediting bodies, ensure a safe and effective environment, but
they do not address the actual care provided.
Example: Checking the call lights are in place, staffing patterns to ensure that adequate resources are available
to meet changing patient needs.
Performance Appraisal
-control process in which employees’ performances are evaluated against
standards.
- Also referred to as merit rating or performance evaluation.
- Determines how well employees perform the duties of their job as delineated
By the job description.
Purposes:
1. Becomes the basis on which administrative decisions are made for salary increases, promotion decisions,
transfer, demotions, and termination
2. Stimulate the individual growth and development
3. Evaluates the performance of the employee
4. Becomes the basis for hiring after a probationary period
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HANDOUT # 3 PRELIMS
5. Influences or stimulate motivation.

6. Becomes the basis for decision to take disciplinary action
7. Identifies training needs for staff development
8. Serves to evaluate and improve the manager’s own performance
Guidelines on Appraising Performance- minimize conflicts and prevent problems

1. The appraisal should be in writing and carried out at least once a year
2. The performance appraisal information should be shared with the employees who should have the
opportunity to respond in writing
3. There should be a mechanism by which an employee can appeal the results of the performance appraisal
4. The supervisor should have adequate opportunity to observe the employees’ job performance
5. Notes (critical incidents) on the employee’s performance should be kept during the entire evaluation period.
These notes should be shared with the employee during the evaluation period.
6. The evaluators should be trained how to carry out the performance appraisal process
7. The performance appraisal process should be behaviorally based rather than trait-based
Performance appraisal process

1. Planning for the interview-time, date, and place
2. Interview- reviews the performance of the employee; conveys judgment about the performance, provides
guidance and support, challenges the employee to set new goals
3. Utilization of outcomes
Approaches to Appraisal
1. Analysis vs Appraisal- emphasis is to define or determine not only the strength and potentials but also his
weaknesses; focused on the future not on the past; establish realistic goals and find effective means to attain them.
2. Evaluation by subordinates- most common: top down to the lower levels: one-sided. More constructive type:
subordinates can evaluate the performance of their superiors.
Performance Appraisal Tools

1. Trait Rating Scale – rates the employee against some standards.
2. Job dimension scales – rates the employee’s performance on the job requirements.
3. Behaviorally anchored rating scales (BARS) – rates desired job expectations on a scale of importance to the position.
4. Checklist – rates the performance against a set list of desirable job description.
❖ It is a Compilation of all nursing performances expected of a worker.
❖ The appraiser’s task is to mark the appropriate column whether the worker does or does not show the
behavior.
❖ A quick glance at the completed behavior form would reveal the overall quality of the Nurse’s
performance.
5. Essay – is a narrative appraisal of job performance. The appraiser writes a paragraph about the Worker’s strengths,
weaknesses, and potentials.
6. Self-appraisal – appraisal of performance by the employee.
7. Management by Objectives – employee and management agree upon goals of performance to Be reached.
8. Peer review – is an assessment of work performance carried out by peers.
9. Ranking – the evaluator ranks the employees according to how she faired with co-workers with respect to certain
aspects of performance or qualifications.
❖ For example: Nurse A ranks lowest in educational requirements among 5 candidates for promotion but
may rank first in clinical proficiency. Nurse B ranks first in educational qualification but ranks third in
clinical Proficiency.
10 Rating Scales – include a series of items representing the different tasks or activities in the Nurse’s job description or
the absence or presence of desired behaviors and the extent To which these are possessed.
❖ Example: On a scale of 1-5, indicate the degree of the nurse’s skill in assessing the Patient’s condition
where each of the corresponding number means:
5 - Excellent
4 - Very Satisfactory
3 – Moderately satisfactory or average
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HANDOUT # 3 PRELIMS
2 – Minimally satisfactory
1 – Unsatisfactory
11. Forced-choice comparison. The evaluator is asked to choose the statement that best describes the nurse being
evaluated. The items are grouped, and the evaluator is forced to choose from favorable as well as unfavorable
statements and to counter for tendency towards Leniency by some evaluators.
❖ Example: Select the statement that best describes the nurse being evaluated and the statement that
least describes her.
1 – Respect the ideas of others
2 - Communication ability limited
3 – Even-tempered
4- Capable of enduring long hours of hard work
5 – Tends to be a loner
12. Anecdotal recording - describe the nurse’s experience with a group or person, or in validating technical skills and
interpersonal relationships. (note the example from the Book of Venzon).
Organizational Control Systems: Employee Discipline

❖ Discipline is regarded as rigid obedience to rules and regulations, the violation of which is resulted to
punitive actions. (Venzon, 2006)
❖ Discipline is defined as influencing behavior through reprimand.
❖ Progressive Discipline ties reprimand to the severity and frequency of the employee’s infractions.
❖ Positive Discipline tries to involve people more positively and directly in making decisions to improve
their behavior.
❖ Self-discipline is a constructive and effective means by which employee take personal responsibility for
her own performances and behaviors.
❖ Constructive Discipline – is assisting employee’s personal growth, providing training, education, and
molding. There is punishment in Discipline for improper behavior; however, it is carried out in a
supportive and corrective manner. This is being explained and let the employees understand that
punishment is applied because of their actions and not who they are.
❖ Destructive Discipline – is applied to push change in the employee who exhibits undesirable behavior.
This could be humiliating and demotivating the employee to peform the task which will lead to less
productivity of the employee. It is destructive because discipline is often arbitrarily administered and is
unfair either in the application of rules or in the resulting punishment.
Factors that influence self-discipline

1. A strong commitment to the vision, mission, philosophy, goals, and objectives of the institution.
2. Laws that govern the practice of all professionals and their respective Code of Conduct.
3. Understanding the rules and regulations of the agency.
4. An atmosphere of mutual trust and confidence.
Disciplinary Approaches
A. Problem solving – effective supervision aids supervisors in analyzing the work problems of their subordinates.
Counseling becomes a part of an oral warning session before resorting to a disciplinary action.
B. Disciplinary Action. All employees charged for breach of the rules and regulations, policies, and norms shall be
given due process.
➢ Counseling and oral warning
➢ Written warning
➢ Suspension
➢ Dismissal
Page 34 of 34

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NURSING LEADERSHIP AND MANAGEMENT

1ST SEMESTER SY 2020-2021

MANAGEMENT PROCESSES AND LEADERSHIP ROLES

ROLES THAT MANAGERS FULFILL IN AN ORGANIZATION

FUNDAMENTAL SKILLS OF A MANAGER

FACTORS THAT DEVELOP MANAGERS

Page 1 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

This part of Handout 3 will be your INDIVIDUAL READING ASSIGNMENT

Other skills Professor Katz recommended for a manager to possess:

d. Problem Solving Skills

e. Decision Making Skills

MANAGERS ROLES AND CHARACTERSITICS (MARQUIZ)

Page 2 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

TYPES OR BASES OF POWER

Page 3 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

NURSING MANAGEMENT FUNCTIONS

2. Setting the vision, mission, philosophy, goals, and objectives.

MISSION STATEMENT: Mission statement outlines the agency’s:

Page 4 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

3. Developing and Scheduling Programs

When – when should the job be done?

Who - who will do the job?

Why - why is this procedure necessary?

Can - can some steps or equipment be eliminated?

SELF DIRECTED LEARNING

Page 5 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

PURPOSES OF STRATEGIC PLANNING

EFFECTIVE TOOL TO ASSIST IN STRATEGIC PLANNING

2. Operational Planning/ Short term planning

Page 6 of 34 Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

 Lower-level managers have a better understanding of the day-to-day operations, and

BUDGET AS PART OF THE PLANNING PROCESS

4. Capital budget: Outlines the programmed acquisitions, disposals, and improvements in an

TIME MANAGEMENT: Making optimal use of available time.

IMPORTANCE OF TIME MANAGEMENT

BASIC STEPS IN TIME MANAGEMENT

Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

WHY HUMAN RESOURCES PLANNING IS IMPORTANT FOR NURSING

Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

EFFECTIVE HUMAN RESOURCE PLANNING:

Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021

 It is the process of establishing formal authority.

ORGANIZING IN NURSING MANAGEMENT

PURPOSE OF HAVING AN ORGANIZATIONAL STRUCTURE:

Adapted from Ms. April Anne D. Balanon-Bocato GreywolfRed

1ST SEMESTER SY 2020-2021