BACHELOR OF SCIENCE IN NURSING:

NCM 107A – NURSING LEADERSHIP

AND MANAGEMENT

COURSE MODULE COURSE UNIT WEEK

3 11 13
DIRECTING and CONTROLLING

✓ Study the course and unit objectives

✓ Understand study guide prior to attending the class
✓ Read prerequisite learning resources
✓ Partake in classroom activity
✓ Be included in weekly discussion
✓ Answer and submit course unit task
At the end of this unit, the students are expected to:

Cognitive:

1. Identify strategies that increase the likelihood of effective delegation.

2. Describe delegation as a learned skill imperative to professional nursing practice.
3. Identify leadership strategies that can be used to reduce subordinate resistance
to delegation.
4. Select and uses process, outcome, and structure audits appropriately as quality
control tools.
5. Collect and accesses appropriate sources of information in data gathering for
quality control activities.

Affective:

1. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-
cultural teams
2. Join actively in class discussions and group activities.
3. Appreciate and support one’s opinion and comments toward each other
4. Engage in life-learning with a passion to keep current with national and global
developments
5. Accept responsibility for life-learning, own personal development and
maintenance of competence.

Psychomotor:

1. Demonstrates and communicates sincere respect, concern, trust, and a sense of

belonging to subordinates.
2. Creates the tension necessary to maintain productivity while encouraging
subordinate job satisfaction.
3. Uses positive feedback to reward the individual subordinate.
The success of work is mainly ensured when nurse managers direct effectively not
discounting the usefulness of other nursing management process. In directing,
management skills are put to test, and hopefully honed for improvement. Planning,
organizing and staffing are meaningless and assume no importance if direction function
does not take place.

Directing is the issuance of orders, assignments, and instructions that enable the nursing
personnel to understand what are expected of them. It includes supervision and guidance
so that in doing their jobs well, nurses can maximally contribute to the organization’s goals
in general and to the objectives of nursing service in particular, Venzon, (2016).

Importance of Directing
❖ Establish direction in carrying out desired action
❖ Influence nursing personnel to follow the direction
❖ Initiate actions
❖ Integrate efforts
❖ Become a means of motivation
❖ Provide stability
❖ Enable employee to cope with the changes
❖ Help in efficient utilization of resources

Purpose of Directing

❖ Obtain the optimum return from all staff in the interest of the institution
❖ Bring personal and professional growth of employees
❖ Bridge the gap of directing
❖ Create a direct link between the nurse managers and the nursing
personnel through effective communication
❖ Maintain standards of services cooperatively to develop coordination
to avoid overlapping
❖ Assist in the problem solving of the matters concerning personnel
❖ Assess continuously the services given personnel performance
Principles of Directing
❖ Harmony of objectives
Employees work well when they feel that their physiological and
psychological needs are met.

❖ Unity of command
Dual subordination brings disorder and chaos, undermines authority
and leads to instability.

❖ Appropriate direction techniques

Motivation techniques such as pay, incentives, awards, status,
promotion, etc., can increase job satisfaction, productivity and
quality/excellence of work.

❖ Use of informal organization

Special attention should be given to the informal organization to
strengthen the formal organization.

❖ Managerial communication
Direct and personal contact or feedback makes supervision effective
and motivating.

❖ Appropriate leadership style

Nurse managers to influence their subordinates must provide good
leadership.

❖ Follow through follow up

Nurse managers must monitor as to what extent the policies framed
and issued directions have been enforced.

Characteristics of Directing
• Initiates action
Giving directions and instructions the nurse managers get the work
started in the organization
 • Continuous process
Nurse managers continuously takes steps to ensure that orders and
instructions are carried out properly.
• Takes place at every level
Directing is a pervasive function of all manager at all levels in all
units perform it.
• Flows from top to bottom
Nurse managers direct their immediate subordinates and take
directions from their immediate superiors.
• Performance-oriented
Directing function helps converting plans to performance.
• Human level
Human behavior is complex and unpredictable direction function
involves studying workers behavior and motivating them to work
their best ability.

ELEMENTS OF DIRECTING

• Delegation
• Supervision
• Communication
• Problem solving and Decision making
• Motivation

Delegation
Delegating is the process by which a 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 accountable form its results.

Paramount importance in delegation are the worker’s job description, his/her knowledge
base, his/her ability to carry put the task, and fairness not only to the employee but to the
team as a whole.
Importance of Delegation
❖ Give subordinates a feeling of importance and motivate them for appropriate
results
❖ Develop the talents and skills of the subordinates, which can be used for
succession planning.

Purposes of Delegation

❖ Provide appropriate distribution of tasks for safe and quality nursing care
❖ Promote individual responsibility and accountability
❖ Allow the nurse to perform more complex patient care and other related services
❖ Reduce workload to prevent burn out
❖ Enhance the knowledge and skills of nursing personnel and other health care
workers
❖ Promote cost containment and effectiveness for the health care facility.
Principles of Delegation
❖ Select the right person to whom the job is to be delegated.
❖ Delegate both interesting and uninteresting tasks.
❖ Provide subordinate with enough time to learn.
❖ Delegate gradually.
❖ Delegate in advance.
❖ Consult before delegating.
❖ Avoid gaps and overlaps.

Elements of Delegation
❖ Responsibility
❖ Authority
❖ Accountability

5 Rights of Delegation

❖ Right task
❖ Right circumstances
❖ Right person
❖ Right direction and communication
❖ Right supervision and evaluation

Steps in Delegation

• Prepare
• Assign
• Confirm understanding and commitment
• Monitor accomplishment against the assigned tasks
 • Ensure accountability
Pointers to Proper delegation of work
• Provide clear and specific instructions
• Give authority commensurate to responsibility
• Keep subordinates informed
• Show you have confidence in your subordinates
• Be loyal
Ways for nurse Mangers to Delegate Successfully:
❖ Train and develop subordinates
❖ Plan ahead, it prevents problems
❖ Control and coordinate the work of subordinate
❖ Visit subordinates periodically
❖ Coordinate to prevent duplication of effort
❖ Specify goals and objectives
❖ Solves problems
❖ Know subordinates’ capabilities and match the task or duty to the
employees.
❖ Agree on performance standards
❖ Take an interest
❖ Do not take back delegated task

What Cannot Be Delegated

There are matters that cannot be delegated. Among these are:
❖ Overall responsibility, authority, and accountability for satisfactory completion of
all activities in the unit.
❖ Authority to assign one’s name is never delegated.
❖ Evaluating the staff and/ or taking necessary corrective or disciplinary action.
❖ Responsibility for maintaining morale of the opportunity to say a few words of
encouragement to the staff especially the new ones.
❖ Jobs that are too technical and those that involve trust and confidence.

Why Nurse Managers Do Not Delegate

There are some reasons why nurse managers fail to delegate.
Lack of confidence in their staff, feeling that only they could do the task better and
faster, or fear of loss of control if some of their duties are delegated. Subordinates
 may be apprehensive in accepting delegated task for fear of criticism, ineptitude,
or incompetence.
Insecurities may be avoided if there is open communication among the staff.
Warm and cordial relationships where everyone is free to ask questions or seek
clarifications regarding of delegated task which to them may be too difficult to
understand.

Utilizing / Revising / Updating Nursing Service Policies and Procedures

Policies, procedures, rules, and regulations are the standing plans of an organization.
Nursing service exists for standardization and as a source of guidance for the nursing
staff.
Policies promote consistency of action and stability. It speeds up decision making. It helps
conserve time by setting standards. Uniformity of standards promotes fairness and
prevents conflicts. Policies as usually written and ma de their periodic review and revision
necessary.
Current and written procedure manuals should be available to all nursing personnel. A
procedure manual outlines a standard technique or method in performing duties. It serves
as guide for action. It contains detailed plans for nursing skills and includes steps in proper
sequence.
A manual is used by employees to review a procedure which is not familiar to them or
which they have not done for some time. It is used to teach new employees or orient them
to procedures that are commonly done in the institution but which the employees may not
familiar with. The manual of procedures on patient care should inform, teach, and reduce
the chances or errors.
Policies, procedures are updated by a committee of professional nurses.

SUPERVISION
The word “supervision” comes from the word “supervide” which means “to oversee or
view directly.”
Supervision is providing guidelines for the accomplishment of a task or activity with
initial direction and periodic inspection of the actual accomplishment of the task or
activity.
It appraises not only the quantity and quality of work performed, but also the time
within which the work is accomplished, the proper and economic utilization of resources,
the amount of assistance needed by the worker, and the need for staff development or
continuing education programs.
The nurse who delegates is responsible for the acts of the subordinate and may incur
liability if found negligent in the process of delegating and supervising. This is under the
doctrine of I respondeat superior which mean “let the superior answer for the acts of
the subordinate.”

Qualities of Good Supervision

Good supervision requires
• Good technical, managerial and human relation skills;
• Ability to communicate well in both spoken and written language and
ability tom listen;
• Firmness with flexibility to adjust to the needs of the situation;
• Fairness in dealing with employees;
• Familiarity with hospital and nursing policies that affect patient care;
• Good decision-making skills;
• Willingness to grow and develop;
• Ability to accept changes and consider them as challenges;
• Dignified and pleasing personality;
• Ability to motivate employees and provide opportunities for continuing
professional growth and development; and
• Advocacy for nurses and nursing.

Principles of Good Supervision

• Good supervision requires adequate planning and organization which facilitate
cooperation, coordination, and synchronization of services.
• Good supervision gives autonomy to workers depending on their competency,
personality, and commitment.
• Good supervision stimulates the worker’s ambition to grow into effectiveness.
Good supervision creates an atmosphere of cordiality and trust.
• Good supervision considers the strengths and weaknesses of employees.
• Good supervision strives to make the unit an effective learning situation.
• Good supervision considers equal distribution of work considering age, physical
condition, and competence
Techniques in Supervision
✓ observation of the worker while making the rounds;
✓ spot checking of chats through nursing audits;
 ✓ asking the patients about the care they receive;
✓ looking into the general condition of the units;
✓ getting feedback from co-workers or other supervisors or relatives
✓ asking question discretely to find out the problems they encounter in the
wards; or
✓ drawing out suggestions from the workers for improvement of their work or
work situation.
Given in a soft, courteous manner, these will be taken willingly and accepted as a
challenge to improve performance. Give harshly, especially in public, it builds up
resentment, ill-will, and poor quality of work.

Participatory Management
Decentralization and participatory management have changed to role of Supervision
Nurses.
They learn to delegate authority to Head Nurses, their responsibility for unit
management decreases.
The climate of supervision changes.
The nurses are given increasing.
The nurses are given increasing authority to manage themselves. Rather than direct the
work force, the Supervising Nurse assumes the role of mentor, role model and
facilitator.
Some hospitals have changed the position of Supervising Nurse into Clinical
Coordinator or Clinical Managers.
In participatory management there are mutual trust and support There is increased
accountability of the Head Nurse and of employees through self-supervision. High
morale and team work result in increased effectiveness and productivity and increased
commitment and recognized of contribution. Participation increases individual and
organizational capacities to learn, adapt, and develop toward higher levels of
excellence, Venson, (2016).
There are some disadvantages of participatory management. Among these are difficulty
in changing the perception of employees about the previous authoritarian management,
occasional failure, and difficulty in fixing responsibilities. Nurses can be more actively
involved in participatory management through job enrichment, involvement in critical
decisions that affect them, and by providing liberal training and opening of career
opportunities, Venzon, (2016).
 Coordination

Coordination unites personnel and services toward a common objective.

Synchronization of activities among the various services and departments enhances
collaborative efforts resulting inefficient, smooth and harmonious flow of work.
Supervising Nurses and Head/ Senior services coordinate their work with other
departments services or units by conveying clearly define policies, standards operating
procedures, policies, and guidelines using the proper channels of communication.

Importance of Coordination
• Ensure unity of direction
• Create stronger workforce
• Enhance employee morale and provides satisfaction
• Facilitates diverse and specialized activities
• Promote effective patient care management for general interest
• Establish positive work environment
Types of Coordination
• External
Coordination with the outside parties with whom the organization has
the business connections like government supplies, customers, etc.
• Internal
Coordination among the employees of the same department or
section.
• Horizontal
Coordination that takes place between different departments.
• Vertical
Coordination that exists between departments where the department
heads are asked to coordinate the work of the employees.
Coordination with Hospital Services
❖ Coordination with Medical Professional Services
Nurses should know the Medical Staff in their respective units, and their services
and scheduled time of medical rounds.
❖ Coordination with Administrative Service
 Coordination with the Administrative services pertains to both human and material
resources.
❖ Coordination with Laboratory Service
Request for laboratory examinations are forwarded to the laboratory unit.
❖ Coordination with the Radiology Service
Request for x-ray examination are also forwarded to the x-ray service for proper
scheduling and specific instructions.
❖ Coordination with the Pharmacy Service
Policies regarding the procurement of drugs must be observed.
❖ Coordination with the Dietary Service
Head is responsible for forwarding the diet list of the patients in the units.
❖ Coordination with the Medical social Service
Nurses coordinate with the Medical Social Service by referring patients with
psycho-social problems.
❖ Coordination with Medical Records Service
Nurses are responsible for the accurate documentation and completeness of the
patient’s charts, including their safety and confidentiality.
❖ Coordination with Community Agencies, other Institutions, and Civic Organization
Networking or linkages with community agencies, civic organizations, or other
institutions are often necessary for continuity of patient care.

Motivation
Motivation is influenced by complex set of social, professional and economic factor.
Human beings are motivated by different goals, ambitions, and aspirations. Health
worker will be motivated and express job satisfaction if they feel that they are effective at
their jobs and performing well.
The amount and quality of work accomplished by the manager directly reflect their
motivation and that of their subordinates. They teach and empower their workers and
apply knowledge, skills and techniques of motivational theories to achieve individual
goals.
Importance of Motivation
❖ Put human resources into action
It is through motivation that the human resources can be utilized by making full use
of it.
❖ Improves level of efficiency of employees
For getting best of his work performance, the gap between ability and willingness
has to be filled which helps in improving the level of performance of subordinates.
This result into:
• Increase productivity
 • Reducing cost of operations and
• Improving overall efficiency
❖ Leads to achievement of organizational goals
The goals of an organization can be achieved only when the following factors take
place:
• There is best possible utilization of resources
• There is a co-operative work environment
• The employees are goal directed and they act in a purpose manner
• Goals can be achieved if co-ordination and co-operation takes place
simultaneously which can be effectively done through motivation.
❖ Builds friendly relationship
Motivation is an important factor which brings employees satisfaction
This could initiate the following things:
• Monetary and non-monetary incentives
• Promotion opportunities for employees
• Disincentives for inefficient employees.
❖ Leads to stability of work force
This is very important from the point of view of reputation and goodwill of a concern,
DOH Manual, (2016).

Communication
Communication is the transmission of information opinions, and intentions between
among individuals.
It facilitates work, increases motivation, effect change, optimizes patient care, increases
workers satisfaction and facilitates coordination.
Importance of Communication
• Get the message across
• Facilitate information
• Help in rapport building
• Promote education
• Allow greater understanding
• Promote cooperation in treatment and rehabilitation
• Provide feedback
• Stimulate new ideas
Types of Communication
➢ Verbal communication
Involves spoken words.
 Examples:
• Individual conferences/ meeting
• Staff meetings
• Group conferences
• Patient contact
➢ Written communication
Examples:
• Memoranda or memos
• Directives are administrative orders
• Manuals of operation
• Records and reports.
➢ Non-verbal communication
Examples:
• Personal appearance
• Intonation of the voice
• Facial expression
• Posture and gait
• Touch
Lines of Communication
Communication is described as a two -way process, yet in an organization,
is a four dimensional.
❖ Downward communication
From superior to subordinate which may pass through various levels of
management.
❖ Upward communication
Emanates from subordinates and goes upward to superior.
❖ Horizontal communication
Horizontal or lateral communication flows between peers, personnel or
departments on the same level.
❖ Outward communication Deals with information deals with information that flows
from the caregivers to the patients, their families, relatives, visitors and the
community.

Principles of Effective Communication

❖ Clear lines of communication serve as the linking process.

❖ Simple, exact, and concise messages ensure understanding of the message to be
conveyed.
❖ Feedback is essential to effective communication.
 ❖ Communication thrives best in a supportive environment which encourages
positive values among its personnel.
❖ A manger’s communication skill is vital to the attainment of the goal of the
organization.
CONTROLLING

Controlling or evaluating is an ongoing function of management which occurs during

planning, organizing, and directing activities. It includes assessing and regulating
performance in accordance with the plans adopted, the instructions issued, and the
principles established.
The controlling process opens opportunities for improvement and compares performance
against set standards. It provides information about how well processes and people
function so they can be motivated to perform better in the future.
The means of good performance and management includes leadership and commitment,
full employee involvement, good planning, sound strategy implementation, measurement
and evaluation, control and improvement, and achievement and sustenance of standards
of excellence, Venzon, (2016).

REASONS FOR CONDUCTING EVALUATION

Evaluation plays an important role in quality and productivity improvement for

several reasons.
• It ensures that quality nursing care is provided.
• It allows for the setting of sensible objectives and ensures compliance with them.
• It provides standards for establishing comparisons.
• It promotes visibility and means for employees to monitor their own performance.
• If highlights problems related to quality care and determines the areas that require
priority attention.
• It provides an indication of the costs of poor quality
• It justifies the use of resources.
• It provides feedback for improvement.
Evaluation Principles
In order that employees may be evaluated accurately and fairly, certain principle
must be observed.
❖ Evaluation must be based on the behavioral standards of performance which the
position requires.
❖ Evaluating performance, there should be enough time to observe employee’s
behavior.
❖ Employees should be given a copy of the job description, performance standards,
and evaluation form before the scheduled evaluation conference. Areas needing
improvement must be prioritized to help the worker upgrade his/her performance.
❖ Evaluating conference should be scheduled and conducted at a convenient time
for rater and the employee under convenient time for rater and the employee under
evaluation, in pleasant surroundings, and with ample time for discussion.
❖ Evaluation report and conference should be perceived and accepted as a means
of improving job performance.

Characteristics of an Evaluation Tool

Evaluation tool should be:
• Objective
Objectivity means that the evaluation tool is free form bias
• reliable,
Reliability refers to the accuracy or precision of the toll such that it will
produce the same results if administered twice.
• Valid
Validity refers to the relevance of the measurement to the performance
of the employee.
• Sensitivity
That the instrument can measure fine lines of differences among the
criteria being measured.

BASIC COMPONENTS OF THE CONTROL PROCESS

The control process may be divided into five basic components;

❖ Established of standards, objectives, and methods for measuring performance;
❖ Measurement of actual performance;
❖ Comparison of results performance using standards and objectives and identifying
strengths and areas for correction and/or improvement;
❖ Action to reinforce strengths or successes; and
Implementation of corrective action as necessary.
 Established of Standards for Measuring Performance
Standards are desirable sets conditions and performance necessary to ensure the
quality of nursing care services which are acceptable to those instrumental to or
responsible for setting and maintaining them.
There are three types of performance standards: structure, process and outcomes.
1. Standards on structure are those that focus on the structure or management
system used by the agency to deliver care.
2. Process standards refer to decision and actions of the nurse relative to the nursing
process which are necessary to provide good nursing care.
3. Outcome standards are designated to measure the results of care provided in
terms of changes in the health status of clients served; changes in the level of their
knowledge, skills, and attitudes; and satisfaction of those served including the
members of the nursing and health team, Venzon, (2016).

Measuring Actual Performance

Measurement of performance is an on-going, repetitive process with the actual
frequency on the type of activity being measured.
For example, nursing care to patients is continuously monitored, whereas, a formal
performance appraisal may be done only twice a year.
Measurements may be scheduled in advance, may be done periodically but
unannounced intervals, or may occur at random. The purpose of measurement should
be clarified about the task and levels of are that need attention.

Comparing Results of Performance with Standards and Objectives

Comparing the results of performance with standards and objectives is one of the
easiest steps in the control process.
Its performance matched standards and objectives, managers are assured that the
needs of patients are met. However, if performance is contrary to standards and
objectives set, then necessary action should be taken.

Reinforcing Strengths or Successes and Taking Corrective Action as Necessary

 Positive feedback stimulates motivation consistent high performance, and growth of
the employee. Corrective actions are applied to improve performance.

Responsibility of the Head / Senior Nurses

Being at the first level of supervision, the Head or Senior Nurses know best whether
their staff nurses perform satisfactorily at work. Their influence has an impact on
promoting quality care to patients.
They have the responsibility to instruct subordinates regarding the appropriate
methods and procedures in providing nursing care.
The feeling of responsibility to render quality performance must be instilled in all
employees for them to follow agreed upon written procedures and use materials and
equipment correctly as instructed.

PERFORMANCE APPRAISAL
Performance appraisal is a control process by which employee’s performance is
evaluated against standards. It is the most valuable tool in controlling human
resources, Venson, (2016).
Importance 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 determination;
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 improving, and
correcting interrelationship between members;
7. Improve communication between supervisors and employees and reach an
understanding on the employees and reach am understanding on the
objectives of the job;
8. Establish standards or supervisory performance;
9. Discover the aspirations of employees and reconcile these with the goals of
the institutions;
10. Provide “employee recognition “for accomplishments; and
11. Inform employees “where they stand.”
Factors Contributing to an Effective Performance Appraisal System
The controlling process is used to promote positive and favorable activity.
Recognizing the common purposes for which the performance evaluation system has
been created, nurse managers have the responsibility to maintain a favorable climate that
will lead to job satisfaction.
Some factors contributing to a successful performance appraisal system are the
following:
1. Compatibility between criteria for individual evaluation and organization goals.
The elements of the performance evaluation system should be agreed upon at
each level of management, involvement of personnel at all aspects of the
evaluation process increases belief in its fairness and accuracy, establishes a
commitment to the evaluation, and increase motivation to utilize the results for
improvement.
2. Direct application of the rated performance to performance standards and
objectives expected of the worker.
Predetermined toles for each member of the health team and the set goals in terms
of behavioral objectives and success criteria (e.g. job description and procedure
manual) should be established.
3. Development of behavioral expectations which have been mutually agreed upon
by both the rater and the worker.
Participation in the formulation of goals motivates workers to work towards their
accomplishment.
4. Understanding the process and effective utilization of procedures by the rater.
Training in the appraisal process should be provided by the employer through in-
service education.
5. Rating of each individual by the immediate supervisor.
Appraisal is more accurate when data are familiar with the actual performance of
the worker.
6. Concentration of the strength and weaknesses to improve individual performance.
Reinforcement of strengths in performance encourages the worker to further
improve..
7. Encouragement feedback from the rated employees about their performance
needs and interests.
The immediate supervisor if better equipped to understand each worker.
He / She does this by observation, questioning, and listening
8. Provision for initiating preventive and corrective action and making adjustments to
improve performance.
The primary goal in the performance of all workers should be to provide quality
service to all clients.
Methods of Measuring Performance.
Methods of performance may be done both formally or informally. Informal appraisal may
consist of incidental observation of performance while the worker is engaged in
performing nursing care of responses made by the worker during conferences.
Interaction of worker with client, their families, visitors, and co-workers should also be
noted. Formal appraisal is accomplished regularly and methodically by collecting
objective fact that can demonstrate the difference between what is expected and what
was done.

These methods include:

• essay,
• checklist,
• ranking,
• rating scales,
• forced-choice comparison, and
• anecdotal records.
Essay
The appraiser writers a paragraph or more about the worker’s strengths, weakness, and
potentials. It is also difficult to make comparisons because the essays touch on different
aspect of a worker’s performance. It may also concentrate on those areas of performance
for which the supervisor has strong feelings.

Checklists
A checklist 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 desired behavior. A quick glance at the completed form would reveal the over-
all quality of the nurse’s performance.

Ranking
Is simple ranking, the evaluator ranks the employees according to how he/she fared with
co-workers with respect to certain aspects of performance or qualification.
For example, Nurse A may rank lowest in educational requirements for the next higher
position among five candidates for promotion but may rank first in clinical proficiency.
Nurse B may rank first in educational qualification but may rank third in clinical proficiency.

Rating Scale
A rating scale includes 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:

a. On a scale of 1 to 5, indicate the degree of the nurse’s skill in assessing the

patient’s condition where each of the corresponding possessed.
5 - Excellent
4 - Very Satisfactory
3 - Moderately Satisfactory or Average
2 - Minimally Satisfactory
1 - Unsatisfactory
b. A descriptive graphic rating scale may be used to describe punctuality in
reporting for duty such as:
1 - Oftentimes late
2 - Sometimes late
3 - Always report on time

Forced-choice Comparison
In this method, the evaluator is asked to choose the statement that best describes the
nurse being evaluated.
The items are so grouped that the evaluator is forced to choose from favorable as well as
unfavorable statements and to counter the tendency towards leniency by some
evaluators.
Example:
Select the statement that best describes the nurse being evaluated and the
statement that least described him/her:
1 - Respect the ideas of orders
2 - Limited communication ability
3 - Even-tempered
4 - Capable of enduring long hours of hard work
5 - Tends to be loner
Anecdotal Recording
The anecdotal record describes the nurse’s experience with a group or a person, or in
validating technical skills and interpersonal relationship.
Example:
Miss A was on her way to take her lunch. She passed by a patient who was
reaching for her food tray but was having a hard time as this was placed on her
 left side. Her right hand had an intravenous line. Miss A stopped, positioned the
food tray comfortably and assisted the patient to eat although she herself was late
for lunch. Miss A acted in a commendable manner.

The anecdotal records should include

(1) a description of the particular occasion,
(2) a delineation of the behavior noted including answer to the questions who, what,
why, when, where, and how, and
(3) the evaluators’ opinion or assessment of the incident or behavior.
The descriptive notes are organized to get impressions of the over-all behavior in a given
period. Caution should therefore be taken against the tendency to note negative more
often than positive behavior.

DISCIPLINARY
Part of the controlling process in management is discipline. Discipline meant rigid
obedience to rules and regulations, the violation of which resulted in punitive actions.
Today, discipline is regarded as a constructive and effective means by which
employees take personal responsibility for their own performance and behavior. This is
termed as self-discipline
Some factors that influence self-discipline are:
❖ A strong commitment to the vision, philosophy, goals, and objectives of the
institution. Strong commitment result in cohesion and teamwork which in turn
encourage within the organization.
❖ Laws that govern the practice of all professionals and their respective Codes of
Conduct.
For all government employees, in Civil Service Rules and Regulations as
provided for in P.D. 807 and the Code of Conduct for Public Officials, R.A. 6713,
are also to be complied with.
❖ Understanding the rules and regulations of the agency. All employees are
oriented on the rules, regulations, and policies of the agency. An atmosphere of
mutual trust and confidence.
❖ Pressure from peers and organization. Social pressures from co-workers and the
organization demand that workers perform their jobs to the beat of their abilities
 Disciplinary Approaches
A sound disciplinary program must be tailored to the objectives of the institution.
This should include a set of disciplinary policies and procedures, a uniform
application of disciplinary rules, a disciplinary committee, and an orientation program
for all new employees where expectations of appropriate performance and behavior
are emphasized.
Successful implementation of disciplinary action is characterized by promptness,
fairness, impartiality, no punitiveness, advance warning, and follow – through.
Effective supervision aids supervisors in analyzing the work problems of their
subordinates. Counseling becomes part of an oral warning session before resorting
to a disciplinary action.

Disciplinary Action
Any employee charged for breach of the rules and regulations, policies, and norms of
conduct shall be given due process.
There must be existing rules of conduct governing his/her behavior and a documentation
of actual violation of such rule must support charges.
The employee charge must be notified in writing about the violation and given the right
to counsel.
Disciplinary action should be progressive in nature such as counseling and oral warning,
written warning, suspension, and dismissal.
Counseling and Oral Warning
Counseling and oral warning are best given in private and in an informal atmosphere. The
employee is given a fair chance to air his/her side.

Written Warning
A written warning is the second step in disciplinary action. It is preceded by an interview
similar to the oral warning.

Suspension
Suspension over minor violation is given after an evidence of oral and written warnings.
Although a violation is a major infraction, suspension, rather than dismissal is applied
when management feels that the employee can still be rehabilitated.
Accurate documentation of oral and written warnings including suspension, if done, are
necessary evidence of due process.

Dismissal
Dismissal is invoked only when all other disciplinary efforts have failed. The Disciplinary
Committee should be very sure that the cause for dismissal conforms with the criteria of
a major discipline violation as contained in the policy manual, and for government
employees, those contained in the Civil Service Rules and Regulations and the codes of
conduct.
A review is usually done by higher management. In the case of government employees,
this is further reviewed by their respective departments and final affirmation is done by
the Civil Service Commission.
 Venzon, Lydia M. Nursing Management Towards Quality of Care, (2016)

ESSAY 20 POINTS Submit on canvas

1. Differentiate between assignment and delegation. (10points)

2. Discuss actions the manager can take to reduce the liability of supervision, particularly
when delegating tasks. (10 points)

Venzon, Lydia M. Nursing Management Towards Quality of Care, (2016)

Marquis, Bessie l. and Huston, Carol J., Leadership Roles and Management Functions
in Nursing, (2017).
Hospital and Nursing Service Manual, (2016).
 DIRECTING and
CONTROLLING
NCM 107A – NURSING LEADERSHIP AND
MANAGEMENT

http://www.free-powerpoint-templates-design.com
Check  Study the course and unit
List objectives
 Understand study guide prior
to attending the class
 Read prerequisite learning
resources
 Partake in classroom activity
 Be included in weekly
discussion
 Answer and submit course unit
task
Unit Expected Outcomes (UEOs)
At the end of this unit, the students are expected to:
Cognitive:
1. Identify strategies that increase the likelihood of effective delegation
2. Describe delegation as a learned skill imperative to professional nursing practice
3. Identify leadership strategies that can be used to reduce subordinate resistance to delegation
4. Select and uses process, outcome, and structure audits appropriately as quality control tools.
5. Colect and accesses appropriate sources of information in dta gathering for quality control activities
Affective:
1. Work effectively in collaboration with inter-, intra- and multi-disciplinary and multi-cultural teams
2. Join actively in class discussions and group activities.
3. Appreciate and support one’s opinion and comments toward each other
4. Engage in life-learning with a passion to keep current with national and global developments
5. Accept responsibility for life-learning, own personal development and maintenance of competence.
Psychomotor:
1. Demonstrates and communicates sincere respect, concern, trust, and a sense of belonging to
subordinates.
2. Creates the tension necessary to maintain productivity while encouraging subordinate job satisfaction.
3. Uses positive feedback to reward the individual subordinate.
STUDY GUIDE
Directing is the issuance of orders, assignments, and instructions that enable
the nursing personnel to understand what are expected of them. It includes
supervision and guidance so that in doing their jobs well, nurses can maximally
contribute to the organization’s goals in general and to the objectives of nursing
service in particular, Venzon, (2016).

Importance of Directing
 Establish direction in carrying out desired action
 Influence nursing personnel to follow the direction
 Initiate actions
 Integrate efforts
 Become a means of motivation
 Provide stability
 Enable employee to cope with the changes
 Help in efficient utilization of resources
Purpose of Directing

 Obtain the optimum return from all staff in the interest of the institution

 Bring personal and professional growth of employees

 Bridge the gap of directing

 Create a direct link between the nurse managers and the nursing
personnel through effective communication

 Maintain standards of services cooperatively to develop coordination

to avoid overlapping

 Assist in the problem solving of the matters concerning personnel

 Assess continuously the services given personnel performance

Principles of Directing

 Harmony of objectives
Employees work well when they feel that their physiological and psychological needs are met.
 Unity of command
Dual subordination brings disorder and chaos, undermines authority and leads to instability.
 Appropriate direction techniques
Motivation techniques such as pay, incentives, awards, status, promotion, etc., can increase job
satisfaction, productivity and quality/excellence of work.
 Use of informal organization
Special attention should be given to the informal organization to strengthen the formal
organization.
 Managerial communication
Direct and personal contact or feedback makes supervision effective and motivating.
 Appropriate leadership style
Nurse managers to influence their subordinates must provide good leadership.
 Follow through follow up
Nurse managers must monitor as to what extent the policies framed and issued directions have
been enforced.
Characteristics of Directing
 Initiates action
Giving directions and instructions the nurse managers get the work started
in the organization
 Continuous process
Nurse managers continuously takes steps to ensure that orders and
instructions are carried out properly.
 Takes place at every level
Directing is a pervasive function of all manager at all levels in all units
perform it.
 Flows from top to bottom
Nurse managers direct their immediate subordinates and take directions from
their immediate superiors.
 Performance-oriented
Directing function helps converting plans to performance.
 Human level
Human behavior is complex and unpredictable direction function involves
studying workers behavior and motivating them to work their best ability.
ELEMENTS OF DIRECTING

 Delegation
 Supervision
 Communication
 Problem solving and Decision making
 Motivation
Delegation

Delegating is the process by which a 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 accountable
form its results.

Paramount importance in delegation are the worker’s job description, his/her

knowledge base, his/her ability to carry put the task, and fairness not only to the
employee but to the team as a whole.

Importance of Delegation
 Give subordinates a feeling of importance and motivate them for appropriate
results
 Develop the talents and skills of the subordinates, which can be used for
succession planning.
Purposes of Delegation
 Provide appropriate distribution of tasks for safe and quality nursing care
 Promote individual responsibility and accountability
 Allow the nurse to perform more complex patient care and other related
services
 Reduce workload to prevent burn out
 Enhance the knowledge and skills of nursing personnel and other health care
workers
 Promote cost containment and effectiveness for the health care facility.
Principles of Delegation
 Select the right person to whom the job is to be delegated.
 Delegate both interesting and uninteresting tasks.
 Provide subordinate with enough time to learn.
 Delegate gradually.
 Delegate in advance.
 Consult before delegating.
 Avoid gaps and overlaps.
Elements of Delegation
 Responsibility
 Authority
 Accountability

5 Rights of Delegation
 Right task
 Right circumstances
 Right person
 Right direction and communication
 Right supervision and evaluation
Steps in Delegation
 Prepare
 Assign
 Confirm understanding and commitment
 Monitor accomplishment against the assigned tasks
 Ensure accountability

Pointers to Proper delegation of work

 Provide clear and specific instructions
 Give authority commensurate to responsibility
 Keep subordinates informed
 Show you have confidence in your subordinates
 Be loyal
Ways for nurse Mangers to Delegate Successfully:

 Train and develop subordinates

 Plan ahead, it prevents problems
 Control and coordinate the work of subordinate
 Visit subordinates periodically
 Coordinate to prevent duplication of effort
 Specify goals and objectives
 Solves problems
 Know subordinates’ capabilities and match the task or duty to the
employees.
 Agree on performance standards
 Take an interest
 Do not take back delegated task
What Cannot Be Delegated
 There are matters that cannot be delegated. Among these are:
 Overall responsibility, authority, and accountability for satisfactory
completion of all activities in the unit.
 Authority to assign one’s name is never delegated.
 Evaluating the staff and/ or taking necessary corrective or disciplinary
action.
 Responsibility for maintaining morale of the opportunity to say a few
words of encouragement to the staff especially the new ones.
 Jobs that are too technical and those that involve trust and
confidence.
Why Nurse Managers Do Not Delegate

There are some reasons why nurse managers fail to delegate.

Lack of confidence in their staff, feeling that only they could do the task
better and faster, or fear of loss of control if some of their duties are
delegated. Subordinates may be apprehensive in accepting delegated
task for fear of criticism, ineptitude, or incompetence. Insecurities may
be avoided if there is open communication among the staff. Warm and
cordial relationships where everyone is free to ask questions or seek
clarifications regarding of delegated task which to them may be too
difficult to understand.
Utilizing / Revising / Updating Nursing Service Policies and Procedures

Policies, procedures, rules, and regulations are the standing plans of an organization.
Nursing service exists for standardization and as a source of guidance for the nursing
staff.
Policies promote consistency of action and stability. It speeds up decision making. It helps
conserve time by setting standards. Uniformity of standards promotes fairness and
prevents conflicts. Policies as usually written and ma de their periodic review and revision
necessary.
Current and written procedure manuals should be available to all nursing personnel. A
procedure manual outlines a standard technique or method in performing duties. It serves
as guide for action. It contains detailed plans for nursing skills and includes steps in proper
sequence.
A manual is used by employees to review a procedure which is not familiar to them or
which they have not done for some time. It is used to teach new employees or orient them
to procedures that are commonly done in the institution but which the employees may not
familiar with. The manual of procedures on patient care should inform, teach, and reduce
the chances or errors.
Policies, procedures are updated by a committee of professional nurses.
SUPERVISION

The word “supervision” comes from the word “supervide” which means
“to oversee or view directly.”

Supervision is providing guidelines for the accomplishment of a task or

activity with initial direction and periodic inspection of the actual
accomplishment of the task or activity.
Qualities of Good Supervision

Good supervision requires

 Good technical, managerial and human relation skills;

 Ability to communicate well in both spoken and written language and ability
tom listen;
 Firmness with flexibility to adjust to the needs of the situation;
 Fairness in dealing with employees;
 Familiarity with hospital and nursing policies that affect patient care;
 Good decision-making skills;
 Willingness to grow and develop;
 Ability to accept changes and consider them as challenges;
 Dignified and pleasing personality;
 Ability to motivate employees and provide opportunities for continuing
professional growth and development; and
 Advocacy for nurses and nursing.
Principles of Good Supervision

 Good supervision requires adequate planning and organization which

facilitate cooperation, coordination, and synchronization of services.
 Good supervision gives autonomy to workers depending on their
competency, personality, and commitment.
 Good supervision stimulates the worker’s ambition to grow into
effectiveness. Good supervision creates an atmosphere of cordiality
and trust.
 Good supervision considers the strengths and weaknesses of
employees.
 Good supervision strives to make the unit an effective learning
situation.
 Good supervision considers equal distribution of work considering
age, physical condition, and competence
Techniques in Supervision

 observation of the worker while making the rounds;

 spot checking of chats through nursing audits;
 asking the patients about the care they receive;
 looking into the general condition of the units;
 getting feedback from co-workers or other supervisors or relatives
 asking question discretely to find out the problems they encounter in
the wards; or
 drawing out suggestions from the workers for improvement of their
work or work situation.
Given in a soft, courteous manner, these will be taken willingly and
accepted as a challenge to improve performance. Give harshly,
especially in public, it builds up resentment, ill-will, and poor
quality of work.
Participatory Management

Decentralization and participatory management have changed to role of Supervision Nurses.

They learn to delegate authority to Head Nurses, their responsibility for unit management
decreases.
The climate of supervision changes.

The nurses are given increasing.

The nurses are given increasing authority to manage themselves. Rather than direct the work
force, the Supervising Nurse assumes the role of mentor, role model and facilitator.
Some hospitals have changed the position of Supervising Nurse into Clinical Coordinator or
Clinical Managers.
Coordination
unites personnel and services toward a common objective. Synchronization of
activities among the various services and departments enhances collaborative
efforts resulting inefficient, smooth and harmonious flow of work.

Supervising Nurses and Head/ Senior services coordinate their work with other
departments services or units by conveying clearly define policies, standards
operating procedures, policies, and guidelines using the proper channels of
communication.

Importance of Coordination
 Ensure unity of direction
 Create stronger workforce
 Enhance employee morale and provides satisfaction
 Facilitates diverse and specialized activities
 Promote effective patient care management for general interest
 Establish positive work environment
Types of Coordination

 External
Coordination with the outside parties with whom the organization
has the business connections like government supplies, customers,
etc.
 Internal
Coordination among the employees of the same department or
section.
 Horizontal
Coordination that takes place between different departments.
 Vertical
Coordination that exists between departments where the
department heads are asked to coordinate the work of the
employees
Coordination with Hospital Services

 Coordination with Medical Professional Services

Nurses should know the Medical Staff in their respective units, and their services and scheduled time of
medical rounds.
 Coordination with Administrative Service
Coordination with the Administrative services pertains to both human and material resources.

 Coordination with Laboratory Service

Request for laboratory examinations are forwarded to the laboratory unit.

 Coordination with the Radiology Service

Request for x-ray examination are also forwarded to the x-ray service for proper scheduling and
specific instructions.

 Coordination with the Pharmacy Service

Policies regarding the procurement of drugs must be observed.

 Coordination with the Dietary Service

Head is responsible for forwarding the diet list of the patients in the units.
 Coordination with the Medical social Service
Nurses coordinate with the Medical Social Service by referring patients with psycho-social
problems.

 Coordination with Medical Records Service

Nurses are responsible for the accurate documentation and completeness of the patient’s
charts, including their safety and confidentiality.

 Coordination with Community Agencies, other Institutions, and Civic Organization

Networking or linkages with community agencies, civic organizations, or other institutions
are often necessary for continuity of patient care.
Motivation is influenced by complex set of social, professional and
economic factor. Human beings are motivated by different goals,
ambitions, and aspirations.

Health worker will be motivated and express job satisfaction if they feel
that they are effective at their jobs and performing well.

The amount and quality of work accomplished by the manager directly

reflect their motivation and that of their subordinates. They teach and
empower their workers and apply knowledge, skills and techniques of
motivational theories to achieve individual goals.
Importance of Motivation

 Put human resources into action

It is through motivation that the human resources can be utilized by

making
full use of it.
 Improves level of efficiency of employees

For getting best of his work performance, the gap between ability and
willingness has to be filled which helps in improving the level of
performance of subordinates.
This result into:
• Increase productivity
• Reducing cost of operations and
• Improving overall efficiency
 Leads to achievement of organizational goals
The goals of an organization can be achieved only when the following factors
take place:
• There is best possible utilization of resources
• There is a co-operative work environment
• The employees are goal directed and they act in a purpose manner
• Goals can be achieved if co-ordination and co-operation takes place
simultaneously which can be effectively done through motivation.

 Builds friendly relationship

Motivation is an important factor which brings employees satisfaction
This could initiate the following things:
• Monetary and non-monetary incentives
• Promotion opportunities for employees
• Disincentives for inefficient employees.
 Leads to stability of work force
This is very important from the point of view of reputation and goodwill of a
concern,
DOH Manual, (2016).
Communication
is the transmission of information opinions, and intentions between
among individuals.
It facilitates work, increases motivation, effect change, optimizes patient
care, increases workers satisfaction and facilitates coordination.

Importance of Communication
 Get the message across
 Facilitate information
 Help in rapport building
 Promote education
 Allow greater understanding
 Promote cooperation in treatment and rehabilitation
 Provide feedback
 Stimulate new ideas
Types of Communication
 Verbal communication
Involves spoken words.
Examples:
• Individual conferences/ meeting
• Staff meetings
• Group conferences
• Patient contact
 Written communication
Examples:
• Memoranda or memos
• Directives are administrative orders
• Manuals of operation
• Records and reports.
 Non-verbal communication
Examples:
• Personal appearance
• Intonation of the voice
• Facial expression
• Posture and gait
• Touch
Lines of Communication

Communication is described as a two -way process, yet in an organization, is a

four dimensional.
 Downward communication
From superior to subordinate which may pass through various levels of
management.
 Upward communication
Emanates from subordinates and goes upward to superior.
 Horizontal communication
Horizontal or lateral communication flows between peers, personnel or
departments on the same level.
 Outward communication Deals with information deals with information that
flows from the caregivers to the patients, their families, relatives, visitors and
the community.
Principles of Effective Communication

 Clear lines of communication serve as the linking process.

 Simple, exact, and concise messages ensure understanding of the
message to be conveyed.
 Feedback is essential to effective communication.
 Communication thrives best in a supportive environment which
encourages positive values among its personnel.
 A manger’s communication skill is vital to the attainment of the goal of
the organization.
Controlling or evaluating is an ongoing function of management which
occurs during planning, organizing, and directing activities. It includes
assessing and regulating performance in accordance with the plans
adopted, the instructions issued, and the principles established.

The controlling process opens opportunities for improvement and

compares performance against set standards. It provides information
about how well processes and people function so they can be motivated
to perform better in the future.

The means of good performance and management includes leadership

and commitment, full employee involvement, good planning, sound
strategy implementation, measurement and evaluation, control and
improvement, and achievement and sustenance of standards of
excellence, Venzon, (2016).
REASONS FOR CONDUCTING EVALUATION

Evaluation plays an important role in quality and productivity

improvement for several reasons.
 It ensures that quality nursing care is provided.
 It allows for the setting of sensible objectives and ensures compliance
with them.
 It provides standards for establishing comparisons.
 It promotes visibility and means for employees to monitor their own
performance.
 If highlights problems related to quality care and determines the areas
that require priority attention.
 It provides an indication of the costs of poor quality
 It justifies the use of resources.
 It provides feedback for improvement.
Evaluation Principles
In order that employees may be evaluated accurately and fairly, certain principle
must be observed.
 Evaluation must be based on the behavioral standards of performance which
the position requires.
 Evaluating performance, there should be enough time to observe employee’s
behavior.
 Employees should be given a copy of the job description, performance
standards, and evaluation form before the scheduled evaluation conference.
Areas needing improvement must be prioritized to help the worker upgrade
his/her performance.
 Evaluating conference should be scheduled and conducted at a convenient
time for rater and the employee under convenient time for rater and the
employee under evaluation, in pleasant surroundings, and with ample time
for discussion.
 Evaluation report and conference should be perceived and accepted as a
means of improving job performance.
Characteristics of an Evaluation Tool

Evaluation tool should be:

 Objective
Objectivity means that the evaluation tool is free form bias
reliable,
Reliability refers to the accuracy or precision of the toll such that it will
produce the same results if administered twice.
 Valid
Validity refers to the relevance of the measurement to the performance
of the employee.
 Sensitivity
That the instrument can measure fine lines of differences among the
criteria being measured.
BASIC COMPONENTS OF THE CONTROL PROCESS

The control process may be divided into five basic components;

 Established of standards, objectives, and methods for measuring
performance;
 Measurement of actual performance;
 Comparison of results performance using standards and objectives
and identifying strengths and areas for correction and/or
improvement;
 Action to reinforce strengths or successes; and
 Implementation of corrective action as necessary.
Established of Standards for Measuring Performance
Standards are desirable sets conditions and performance necessary to
ensure the quality of nursing care services which are acceptable to
those instrumental to or responsible for setting and maintaining them.
There are three types of performance standards: structure, process and
outcomes.
1. Standards on structure are those that focus on the structure or
management system used by the agency to deliver care.
2. Process standards refer to decision and actions of the nurse relative
to the nursing process which are necessary to provide good nursing
care.
3. Outcome standards are designated to measure the results of care
provided in terms of changes in the health status of clients served;
changes in the level of their knowledge, skills, and attitudes; and
satisfaction of those served including the members of the nursing
and health team, Venzon, (2016)..
Measuring Actual Performance

Measurement of performance is an on-going, repetitive process with the actual

frequency on the type of activity being measured.

For example, nursing care to patients is continuously monitored, whereas, a

formal performance appraisal may be done only twice a year.
Measurements may be scheduled in advance, may be done periodically but
unannounced intervals, or may occur at random. The purpose of measurement
should be clarified about the task and levels of are that need attention.

Comparing Results of Performance with Standards and Objectives

Comparing the results of performance with standards and objectives is one of
the easiest steps in the control process.
Its performance matched standards and objectives, managers are assured that
the needs of patients are met. However, if performance is contrary to standards
and objectives set, then necessary action should be taken.
Reinforcing Strengths or Successes and Taking Corrective Action as
Necessary
Positive feedback stimulates motivation consistent high performance, and
growth of the employee. Corrective actions are applied to improve performance.

Responsibility of the Head / Senior Nurses

Being at the first level of supervision, the Head or Senior Nurses know best
whether their staff nurses perform satisfactorily at work. Their influence has an
impact on promoting quality care to patients.
They have the responsibility to instruct subordinates regarding the appropriate
methods and procedures in providing nursing care.
The feeling of responsibility to render quality performance must be instilled in all
employees for them to follow agreed upon written procedures and use materials
and equipment correctly as instructed.
PERFORMANCE APPRAISAL
Performance appraisal is a control process by which employee’s performance is
evaluated against standards. It is the most valuable tool in controlling human resources,
Venson, (2016).
Importance 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 determination;
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 improving, and correcting
interrelationship between members;
7. Improve communication between supervisors and employees and reach an
understanding on the employees and reach am understanding on the objectives of the
job;
8. Establish standards or supervisory performance;
9. Discover the aspirations of employees and reconcile these with the goals of the
institutions;
10. Provide “employee recognition “for accomplishments; and
11. Inform employees “where they stand.”
Factors Contributing to an Effective Performance Appraisal System
The controlling process is used to promote positive and favorable activity. Recognizing the
common purposes for which the performance evaluation system has been created, nurse
managers have the responsibility to maintain a favorable climate that will lead to job
satisfaction.
Some factors contributing to a successful performance appraisal system are the following:
1. Compatibility between criteria for individual evaluation and organization goals.
The elements of the performance evaluation system should be agreed upon at each level
of management, involvement of personnel at all aspects of the evaluation process
increases belief in its fairness and accuracy, establishes a commitment to the evaluation,
and increase motivation to utilize the results for improvement.
2. Direct application of the rated performance to performance standards and objectives
expected of the worker.
Predetermined toles for each member of the health team and the set goals in terms of
behavioral objectives and success criteria (e.g. job description and procedure manual)
should be established.
3. Development of behavioral expectations which have been mutually agreed upon by
both the rater and the worker.
Participation in the formulation of goals motivates workers to work towards their
accomplishment.
4. Understanding the process and effective utilization of procedures by the rater.
Training in the appraisal process should be provided by the employer through in-
service education.
5. Rating of each individual by the immediate supervisor.
Appraisal is more accurate when data are familiar with the actual performance
of the worker.
6. Concentration of the strength and weaknesses to improve individual
performance. Reinforcement of strengths in performance encourages the worker
to further improve..
7. Encouragement feedback from the rated employees about their performance
needs and interests.
The immediate supervisor if better equipped to understand each worker.
He / She does this by observation, questioning, and listening
8. Provision for initiating preventive and corrective action and making
adjustments to improve performance.
The primary goal in the performance of all workers should be to provide quality
service to all clients.
Methods of Measuring Performance.
Methods of performance may be done both formally or informally. Informal
appraisal may consist of incidental observation of performance while the worker
is engaged in performing nursing care of responses made by the worker during
conferences.
Interaction of worker with client, their families, visitors, and co-workers should
also be noted. Formal appraisal is accomplished regularly and methodically by
collecting objective fact that can demonstrate the difference between what is
expected and what was done.

These methods include:

• essay,
• checklist,
• ranking,
• rating scales,
• forced-choice comparison, and
• anecdotal records.
Essay
The appraiser writers a paragraph or more about the worker’s strengths, weakness, and potentials. It is
also difficult to make comparisons because the essays touch on different aspect of a worker’s
performance. It may also concentrate on those areas of performance for which the supervisor has
strong feelings.

Checklists
A checklist 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 desired behavior. A quick
glance at the completed form would reveal the over-all quality of the nurse’s performance.

Ranking
Is simple ranking, the evaluator ranks the employees according to how he/she fared with co-workers
with respect to certain aspects of performance or qualification.
For example, Nurse A may rank lowest in educational requirements for the next higher position among
five candidates for promotion but may rank first in clinical proficiency. Nurse B may rank first in
educational qualification but may rank third in clinical proficiency.

Rating Scale
A rating scale includes 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 to 5, indicate the degree of the nurse’s skill in assessing the
patient’s condition where each of the corresponding possessed.
5 - Excellent
4 - Very Satisfactory
3 - Moderately Satisfactory or Average
2 - Minimally Satisfactory
1 - Unsatisfactory
b. A descriptive graphic rating scale may be used to describe
punctuality in reporting for duty such as:
1 - Oftentimes late
2 - Sometimes late
3 - Always report on time
Forced-choice Comparison
In this method, the evaluator is asked to choose the statement that best describes the nurse being
evaluated.
The items are so grouped that the evaluator is forced to choose from favorable as well as unfavorable
statements and to counter the tendency towards leniency by some evaluators.
Example:
Select the statement that best describes the nurse being evaluated and the
statement that least described him/her:
1 - Respect the ideas of orders
2 - Limited communication ability
3 - Even-tempered
4 - Capable of enduring long hours of hard work
5 - Tends to be loner
Anecdotal Recording
The anecdotal record describes the nurse’s experience with a group or a person, or in validating
technical skills and interpersonal relationship.
Example:
Miss A was on her way to take her lunch. She passed by a patient who was reaching for her food tray
but was having a hard time as this was placed on her left side. Her right hand had an intravenous line.
Miss A stopped, positioned the food tray comfortably and assisted the patient to eat although she
herself was late for lunch. Miss A acted in a commendable manner.
The anecdotal records should include

(1) a description of the particular occasion,

(2) a delineation of the behavior noted including answer to the questions

who, what, why, when, where, and how, and

(3) the evaluators’ opinion or assessment of the incident or behavior.

The descriptive notes are organized to get impressions of the over-all behavior
in a given period. Caution should therefore be taken against the tendency to
note negative more often than positive behavior.
DISCIPLINARY

Part of the controlling process in management is discipline. Discipline meant rigid

obedience to rules and regulations, the violation of which resulted in punitive actions.
Today, discipline is regarded as a constructive and effective means by which employees
take personal responsibility for their own performance and behavior. This is termed as
self-discipline
Some factors that influence self-discipline are:
A strong commitment to the vision, philosophy, goals, and objectives of the institution.
Strong commitment result in cohesion and teamwork which in turn encourage within the
organization.
Laws that govern the practice of all professionals and their respective Codes of Conduct.
For all government employees, in Civil Service Rules and Regulations as provided for in
P.D. 807 and the Code of Conduct for Public Officials, R.A. 6713, are also to be complied
with.
Understanding the rules and regulations of the agency. All employees are oriented on the
rules, regulations, and policies of the agency. An atmosphere of mutual trust and
confidence.
Pressure from peers and organization. Social pressures from co-workers and the
organization demand that workers perform their jobs to the beat of their abilities
Disciplinary Approaches

A sound disciplinary program must be tailored to the objectives of the institution.

This should include a set of disciplinary policies and procedures, a uniform
application of disciplinary rules, a disciplinary committee, and an orientation
program for all new employees where expectations of appropriate performance
and behavior are emphasized.

Successful implementation of disciplinary action is characterized by promptness,

fairness, impartiality, no punitiveness, advance warning, and follow – through.
Effective supervision aids supervisors in analyzing the work problems of their
subordinates. Counseling becomes part of an oral warning session before
resorting to a disciplinary action.
Disciplinary Action

Any employee charged for breach of the rules and regulations, policies, and
norms of conduct shall be given due process.

There must be existing rules of conduct governing his/her behavior and a

documentation of actual violation of such rule must support charges.

The employee charge must be notified in writing about the violation and given
the right to counsel.

Disciplinary action should be progressive in nature such as counseling and oral

warning, written warning, suspension, and dismissal.
Counseling and Oral Warning

Counseling and oral warning are best given in private and in an informal
atmosphere. The employee is given a fair chance to air his/her side.

Written Warning
A written warning is the second step in disciplinary action. It is preceded by an
interview similar to the oral warning.

Suspension
Suspension over minor violation is given after an evidence of oral and written
warnings. Although a violation is a major infraction, suspension, rather than
dismissal is applied when management feels that the employee can still be
rehabilitated.
Accurate documentation of oral and written warnings including suspension, if
done, are necessary evidence of due process.
Dismissal

Dismissal is invoked only when all other disciplinary efforts have failed.

The Disciplinary Committee should be very sure that the cause for
dismissal conforms with the criteria of a major discipline violation as
contained in the policy manual, and for government employees, those
contained in the Civil Service Rules and Regulations and the codes of
conduct.

A review is usually done by higher management. In the case of

government employees, this is further reviewed by their respective
departments and final affirmation is done by the Civil Service
Commission.
Dismissal

Dismissal is invoked only when all other disciplinary efforts have failed.
The Disciplinary Committee should be very sure that the cause for
dismissal conforms with the criteria of a major discipline violation as
contained in the policy manual, and for government employees, those
contained in the Civil Service Rules and Regulations and the codes of
conduct.

A review is usually done by higher management. In the case of

government employees, this is further reviewed by their respective
departments and final affirmation is done by the Civil Service
Commission.
Thank You