Roles and Functions in Directing
planning.
The book described delegation as “getting work
done through others.” Another definition could be
that delegation is directing one or more people to
complete the goals assigned. As we moved to the
hierarchy in nursing practice, we delegated tasks
to other healthcare members based on several
considerations. While delegating is considered a
learned skill, when properly executed, it is
necessary for charge nurses and managers to
boost and improve staff morale while improving
their confidence in their performance.
Delegating Pointers
• Delegator
– Direct others
– Maintains Accountability
– Monitors
– Evaluates
– Supervise
Here are several examples of delegation:
• A charge nurse (CN) delegates nursing
procedures and care to other staff but
maintains accountability for the overall
process.
• For example, A CN can delegate the tasks
of suctioning the patient in room A to
another nurse while ensuring the patient's
airway.
• -Delegate the checking of vital signs of the
patient in room B to the nursing assistant
while the CN monitors and administers
medications as prescribed.
• -Directing the clinical technician (CT) to
perform a finger stick on the patient in
room C while the CN evaluates the need
for insulin treatment.
• -Direct transport of the patient to the
radiology department by the transport
team or escort. At the same time, the CN
ascertains the patient arrives on time and
informs the physician to assist with care
• If you notice, the CN is not just delegating
the tasks but still takes the leading role in
ensuring their performance and execution.
• Delegating is part of the CN's role and
responsibility. Through delegation, it
enables the CN to maximize and utilize
the potential, skills, certifications,
credentials, and licenses of other team
members to perform the tasks aligned
with the goals set by the organizations
while still maintaining the responsibility of
coordinating and overseeing the patients
and the staff.
At the management level:
• The manager delegates the overseeing of
the unit to a nurse leader in his absence.
The nurse leader, though in charge, still
has to communicate, refer, and consult
with the manager for every decision
needed to manage the unit, as the
manager remains accountable for the
unit's overall performance.
Bottom line:
• Much of the work completed is feasible
when the tasks are appropriately
delegated. Both managers and team
members have shared governance in
accomplishing the work set before them.
Assignment or assigning requires the
distribution of work to other team members,
which requires an overall “turn-over” of
responsibility, care, and monitoring to the
assigned personnel.
Assignment Pointers
• Nurse Leader/Charge Nurse
– Distribute the tasks
– Assigns task to qualified team
member
– Provide guidance and instructions
 – The team member takes
responsibility
– Team member updates the Nurse
leader/Charge nurse
Here’s an example of an assignment:
• There are 15 patients in a Medical Surgical
ward, and four staff nurses are working.
The CN assigns four patients to each RN.
The RNs are accountable for providing
care, assisting with procedures, carrying
out orders, monitoring the assigned
patients, contacting physicians for
questions, facilitating communication with
other disciplines, and providing an update
to the CN. In assignments, the assigned
RN takes all the responsibility for the
assigned patients.
• Another example would be; The CN
assigned two clinical technicians to assist
the nurses in obtaining the vital signs of
the 15 patients. CN assigns rooms 1 to 7
to the first CT and rooms 8-15 to the
second CT. The distribution of work
assigned to other healthcare team
member is part of the role of the CN and,
by doing so, enable the team member to
execute their role based on the assigned
tasks. This arrangement is a typical
assignment performed at the bedside.
At the management level:
The manager assigns a project initiative to a
project team leader. The project team leader
works on the project by gathering data,
conducting interviews, reviewing cases,
researching, and writing the paper. By assigning
this project, it is the full responsibility of the
project team leader to fulfill all necessary steps in
completing the project.
5 Rights of Delegation
• Right Task
• Right Circumstances
• Right Person
• Right Direction/Communication
• Right level of Supervision
Just like the five rights of medication
administration (right patient, proper medication,
correct dose, right time, and right route), the
delegation has five rights to ensure its successful
delivery and implementation.
Right Task-
Defines as work that others can do.
As a Charge Nurse/Leader/Manager, identifying
what task to delegate comes first. Recognizing
who can perform the task is second. These two
go hand-in-hand. Delegating the right task to the
appropriate person with the expertise, license,
experience, and knowledge to carry out the task
will yield favorable results.
Right Circumstances-
Availability of resources, presence of manpower,
correct patient population, a clear plan of care
It is significantly vital to consider the
circumstances when delegating a task. Do I have
enough manpower to handle two combative
patients in my unit? Do I have sufficient
resources to assist in implementing the project at
hand? CN/Leaders/Managers need to utilize the
different levels of "viewing" the appropriate
circumstances when performing the right tasks.
Looking at the circumstances from 50,000 feet to
5,000 feet to 500 feet helps identify efficiency,
productivity, and timeliness of tasks.
Right Person-
"Right person delegating the right task to the
right person to deliver care to the right person"
As Leaders and managers identify the right tasks,
it is essential to acknowledge the right person to
deliver the right task to the designated patient
population to achieve better outcomes. A basic
example would be a charge nurse delegating the
tasks to care for an elderly patient to a seasoned
nurse experienced in managing complex
healthcare issues of gerontology patients.
Ensuring that the right person delegates the right
task to the right person to deliver to the right
patient is essential for the patient's continuity of
care and safety.
Right Directions/Communications-
A clear description of the task and a brief
explanation of its goals and expected outcomes.
When delegating the right tasks to the right
person for the right recipient, it is ideal for the
leader to provide a concise description of the task
and the expected outcomes after the delivery.
With proper guidance and instructions,
understanding and communication can set in.
Example- A charge nurse delegates inserting a
French 16 nasogastric tube (NGT) to an adult
patient with Chron's disease to a staff nurse to
initiate enteral feeding. The instructions would
include the staff nurse preparing the patient for
the procedure. Educate and reposition the patient
appropriately while inserting the NGT; auscultate
for bowel sounds to check for placement; inform
the MD after task completion to order imaging for
evaluation. In most cases, the teach-back
method or validation is necessary when
delegating a task requiring some complexity.
Right Level of Supervision
Proper monitoring, evaluating, overseeing,
"intervention, feedback."
Determining the right level of supervision on the
right person performing the right task to the right
person is crucial because it inhibits response or
feedback on the performance or the effectivity of
the performed task.
Delegate Effectively
• Identify skills and education level
• Plan ahead (Forecasting)
• Choose and empower the right person
• Communicate goals clearly
• Set deadlines and monitor progress
• Provide guidance
• Evaluate performance
• Reward Accomplishments
Leaders and Managers delegate the task to get
the job done. As easy as it sounds, however,
delegating requires several considerations as
every task and performance reflects directly on
the leader/manager delegating the task.
Leaders/managers must identify a team
member's skill set and educational attainment
before delegating the right tasks to ensure the
completeness of the job. For example- Delegating
the task of overseeing the unit in the absence of
the manager is usually the work of a seasoned
expert charge nurse or nurse leader who has
worked in the unit for several years, and some
are master-prepared nurses. Unfortunately,
novice nurses with less experience recently
graduated from nursing school a year or two
years ago are not contenders.
Leaders and managers forecast by studying
previous incidences, analyzing data, and
conducting necessary interviews to assist with
future plans. Forecasting is A topic we discussed
two weeks ago. Planning is a must to ensure a
successful implementation of an initiative. For
example-anticipating what the unit needs, what
the staff requires, and the available resources
and tool is part of planning.
Selecting the right person for the job is one
thing, and empowering that person is another.
Leaders and managers are not only there to
choose the right expert to do the job but also to
provide the expert with the right tools and
resources to get the job right. No matter how
good of an expert the person is, without the right
tools and resources to use and empower them,
the task remains incomplete.
Leaders and managers undergo training to utilize
practical communication tools when collaborating
with team members. Communicating with team
members and explaining the expected goals
reduce misunderstanding and conflict and create
a better and more knowledgeable team.
Identifying limitations and restrictions in the
process should be explained early on as part of
the delegated task to prepare staff for the
inevitable.
Adhering to set deadlines enables leaders and
managers to comply with the timeliness required
by upper management and is proven cost-
effective. For example, At work, time is money. A
prompt solution to reducing patient length of stay
(LOS) decreases hospitalization costs. Evaluating
set initiatives in reducing LOS enable nurse
managers and project team leader to oversee its
progress and find ways to address issues that
require further improvement.
Leaders and Managers are responsible for
providing guidance and continued coaching to
team members to improve themselves and help
develop their potential. Mentoring of staff is one
of the traits of leaders and is considered integral
in staff development and career advancement.
Finding a balance between allowing staff to
determine and assess the task and providing
guidance when needed is essential to developing
confidence and improving staff's self-esteem.
Evaluating the performances of staff every six
months and yearly is essential to monitor
professional growth, learning opportunities, and
compliance. In delegating a task, nurse
managers and leaders must assess the staff's
performance upon completion of the task to
determine if it accomplishes the goals set by the
unit or organization. Both positive and negative
feedback is necessary to determine ways to
improve the process for learning purposes.
Incentivizing staff for a well-deserved
accomplishment creates a culture of engagement
and inspires staff to do well in their work and
strive to do more. Staff engagement is critical in
staff retention, increases morale, cultivates trust
and loyalty, and is an ongoing initiative of leaders
and managers in every healthcare institution.
Effective delegation produces a well-balanced,
well-managed, and well-informed team with
significant awareness of its purposes and
expectations and works cohesively in fulfilling the
task
Delegation Errors
 Under-delegating
 Over-delegating
 Improper delegating
Delegating errors can easily produce reverse
delegation.
Delegating as a Professional Nurse
The increasing mandate of nurses and nurse
leaders to put on several leadership hats is
necessary, considering the current trend in the
healthcare industry. However, their ability to
delegate and act as delegator while offering
supervision and guidance to others is a role that
not every nurse leaders and managers are
confident in doing.
• Nurses as Leaders
• Trainings to develop leadership and
delegating skills
• Education program supportive of
informing roles and responsibilities
• A clearly defined job description
For a professional nurse to delegate tasks
effectively and efficiently, the organization must
first recognize the professional nurse as a leader.
Establishing this early on allows the professional
nurse to make his contribution and presence
known. Incorporating a clear and well-written job
description allows a better understanding of their
roles. Providing training and educational
programs to support, develop and educate
professional nurses on leadership and delegation
skills and increasing awareness of other people's
roles and responsibilities.
Directing
Directing is one of the many pivotal tasks of
nurse managers and leaders that requires
constant coordination. Innate to managers,
taking an active role in directly activating,
facilitating, and providing continued support
motivates team members to thrive and give their
best. As managers take on this “act of doing”
role” with support from leaders, they create a
motivating culture to support the team by
providing constant guidance and encouragement,
assisting in further collaboration, guiding in the
negotiation process, and adhering to corporate
laws.
Motivation
As managers continue to influence others and
take responsibility for meeting the organization's
goals, motivating team members, on the other
hand, is an individual decision and is not the
accountability of managers. Managers and
leaders continue to work together to uphold the
organization, the department, and the unit. Their
purpose is to establish a healthy environment
and promote a climate of motivation in their staff
to improve work efficiency, enhance productivity,
and retain them.
Variables of Motivation
Motivation requires actions that people take to
satisfy what they want or need. Though intrinsic
motivation comes from the individual’s decision
to take further actions to obtain their goals and
support the organization, influences from outside
sources are strong enough to either persuade or
motivate them to accomplish what they hope to
achieve.
These extrinsic factors could be the environment
where the team member works, the availability
or the lack of resources that allow them to do
their work, and the positive or negative feedback
from other team members based on their
experiences and encounters. Recognizing intrinsic
and extrinsic variables, managers and leaders
must continue to create a culture that enables
team members to grow in their skills and
advance in their careers. The more satisfied the
team members are the likelihood they will stay
and support the organization, and the less
concern for managers and leaders.
Human beings are unique. They differ in their
wants and needs and, to some extent, remain
motivated to fulfill their needs and wants. With
their differences and unique needs, they, too,
have distinct motivational sources.
Like nurses in the unit, each has different needs
and wants; hence, nurse managers and leaders
work tirelessly to meet the needs of their nurses
by providing a motivating environment to help
nurses attain their needs and satisfy their wants.
Through staff engagement, staff recognition, and
incentivizing them for their accomplishments,
nurses feel valued and appreciated, which fuels
their interest to give their best in their work.
Motivational Theory
• Maslow (1950)
• Skinner (1953)
• Herzberg (1987)
• Vroom (1964)
• McClelland (1971)
• Gellerman (1968)
• McGregor (1960)
Understanding the different motivational theorists
and their theories enables nurse managers,
leaders, and nurses to understand what
motivates them and influences their behavior.
One of my prerequisite courses in my Master's
Program is learning about the different theorists
in nursing. I was fascinated by Jane Watson's
theory on the science of caring and delivering
care which benefits both nurses and patients in
the process.
In this lecture, you will have an opportunity to
review each of these theorists and select one that
best describes what motivates or drives your
motivation as a nurse manager or nurse leader.
In a one-page, double-spaced paper, please
identify one of the six theorists and incorporate
their theory in how you direct and communicate
with your team to keep them motivated. Provide
specific examples.
 COMMUNICATION
“The most critical leadership skill”
The definition of communication, as we all know
before, is an exchange of dialogue between two
parties is the most common definition we hear
about when talking about communication.
Communication is apparent even without the
utterance of words. According to Marquis and
Huston (2021), “ Communication begins the
moment that two or more people become aware
of each other’s presence.” As we talk more
about communication, we will learn the three
mediums of communication in the following
slides. And these are verbal, non-verbal, and
written communication.
Communication precedes all management
functions, including planning, organizing, and
controlling. Communication is the most significant
aspect of the leadership process and a strong
leadership trait. Poor and ineffective
communication results in misunderstanding,
mistakes, confusion, missed opportunities, and
possible closure of an organization. However,
effective communication builds relationships,
improves processes, and fosters interpersonal
connections to improve work efficiency and
productivity.
Interpersonal Communication Skills
Nurse leaders are an integral part of the
healthcare delivery system. Their leadership roles
include communicating with payers, directors,
managers, high-profile stakeholders,
multidisciplinary teams, and healthcare decision-
makers. It is ideal for them to capitalize on and
develop interpersonal communication skills to
ascertain continuity of services and increase
productivity. As managers become confident in
their interpersonal communication skills, they
become effective advocates for changes and
continuous improvement in their unit or
department.
Key Factors in Interpersonal Communication
• Assertiveness
• Non-verbal behavior
• Active Listening
The ability to assert oneself is a leadership trait
that enables leaders to make their voices heard.
Assertiveness is a form of communication leaders
use to emphasize or make a point. Nurse leaders
must be aware of how they assert themselves
during group discussions and collaboration and
remain discreet and respectful towards others’
points of view. Non-verbal behavior can be a
barrier to communication due to the absence of
words; however, the same behavior conveys
powerful messages that could build up a
conversation or shuts it down. In most instances,
non-verbal behavior can be misinterpreted or
misunderstood. Meanwhile, active listening is a
catalyst to enhance further communication and is
helpful in interpersonal and organizational
communication.
Interpersonal Communication Skills in
action
Scenario:
At my workplace, I have exercised my
interpersonal communication skills by
collaborating with my multidisciplinary team
members two times daily with two separate units.
The team is well represented by a Hospitalist or
attending physicians, residents, physician
assistants, nurse practitioners, discharge
planners, care coordinator, social worker,
physical therapist, occupational therapist,
utilization review personnel, case management,
and the bedside nurse assigned to the patient. As
a team, we delve into our patient’s cases for an
hour and a half a day in the morning to create
care plans, identify barriers for a safe discharge,
facilitate the necessary services and care needed
by the patient and family, and coordinate
referrals to various disciplines and specialties
when necessary.
Organizational Communication
• More complex
• More communication channels
• More individuals
• More information
 • More new technologies
As nurse leaders continue to excel in their work,
they become more involved in a more challenging
role in the organization. Their confidence
increases as their skills in communication
improve. Their ability to articulate concerns and
issues to prevent confusion is more focused on a
more complex setting. They communicate with
many individuals using more channels and
processing more information using newer and
advanced technologies.
Variables Affecting Organizational
Communication
• Low-level position
• Subgroups/subcultures
• Gender
• Power
• Status
Indeed, some variables affect organizational
communication. In a vast organization, people
working at lower-level entry positions may have
yet to have the opportunity to receive the
message from managers and leaders due to the
use of several communication channels the
information goes through from the higher-ups.
They need help hearing complete and adequate
information as a result. The existence of
subgroups and subcultures in an organization
limits and restricts receipt of first-hand
information delivery as complex information
passes through more people.
All for One and One for All
Working in a fast-phased environment enables
nurse leaders to be at the forefront of the action,
where they are responsible for engaging the
team's collaboration creating a more cohesive
group to uphold the organization's goals. While in
this position, nurse leaders need to ensure they
effectively communicate while enhancing their
leadership skills and expertise in team building.
The Communication Process
The inability to identify the players, the message,
and the delivery of the message is what make
the communication process complex. The
communication process should have a SENDER
sending a MESSAGE either verbally, non-verbally,
or in writing to a RECEIVER. As communication
exchange commences, external and internal
climate affecting the sending and the receiver
directly affects the communication process,
delivery, message, interpretation, and response
to the message.
Climate in Communication
INTERNAL
-Emotions
-Beliefs
-Stress
-Values
EXTERNAL
-Timing
-Weather
-Status
-Power
The two climates in communication are greatly
affected by internal and external variables shared
by the sender and the receiver. The internal
climate focuses on the feelings, emotions, and
stress the senders and the receivers are
experiencing, which influences how the other
person delivers, interprets, and receives the
message. Whereas the external variables take
into consideration the status or power (in a
manager-to-staff setting), climate (sunny,
raining, snowing), and timing (after a busy day at
work, before going to work, etc.), which,
unfortunately, play an integral part in the overall
communication process.
Effective Communication: VALIDATE communication tool lets nurses focus on what’s
relevant in the nursing documentation, which, in
It is important for the sender and the receiver to return, assists other healthcare providers in
take extra precaution before an exchange of creating care plans.
communication takes place. Considering
differences in personalities, each person must be EXAMPLE:
sensitive to the external and internal factors,
and the type of medium of communication being S- the patient is complaining of abdominal pain
utilize(verbal, no-verbal, and written) which
B- previous readmission in the past 30 days due
affects the concept of communication than can
to abdominal pain associated with Nausea and
skewed each perception causing
Vomiting
misunderstanding and further confusions.
According to Marquis and Huston (2021), A-+ for abdominal pain at 5/10; abdomen non
validating what the receivers see or hear, by the distended, +active bowel sounds; stools are
sender, is a sign of effective communication. formed, soft, light brown in color;

Communication Tools R-placed on NPO; monitored for N/V;

administered pain medications; plan for CBC with
Providing quality patient care is health care
Diff, CMP; referral to GI team; Abdominal x ray.
practitioners' first priority. The use of
communication tools helps streamline patient
care and continued collaboration with health care ISBAR
team members. Standardizing communication I- Introduction
processes with the use of practical S-situation
communication tools is essential in the delivery of B-background
safe and timely care. A-assessment
R-recommendation
SBAR
The use of ISBAR purposely includes an
S- situation
introduction of who the patient is, what unit the
B-background patient stays at, and a short overview of the
case. This information is essential to those
A-assessment unfamiliar with the patient and the reason for the
admission. In my current practice, particularly at
R-recommendation the bedside and even how nurse leaders
document, SBAR seems to be the communication
According to Marquis and Huston (2021), the
tool for handoff.
U.S. Navy was the first group of people to utilize
SBAR purposely to streamline important As you continue to get enough experience in
communication. Incorporating practical collaborating with patients and with
communication tools in the hospital during hand- multidisciplinary team members, you will learn to
off prevents ineffective care transitions and utilize the communication tools that best describe
readmission of patients. The commonly used your encounter without compromising the overall
communication tool in my workplace during concept of the encounter.
hand-off is SBAR.
EXAMPLE:
SBAR is a straightforward, concise, and simple I- Mr. John Smith; 55 y/o; with history of DM
way of establishing communication structured type II on oral hypoglycemic medication, HTN-
enough that it contains crucial details. Nurses in controlled, newly diagnosed Crohn’s Disease,
the unit use SBAR in their documentation admitted under the service of Dr. Womer.
because it prevents redundancy in the long Admitted on 1/1/2023.
descriptional narrative. Instead, it delivers a clear
and short description of the event. This S- the patient is complaining of abdominal pain
B- previous readmission in the past 30 days due
to abdominal pain associated with Nausea and
Vomiting
A-+ for abdominal pain at 5/10; abdomen non
distended, +active bowel sounds; stools are
formed, soft, light brown in color;
R-placed on NPO; monitored for N/V;
administered pain medications; plan for CBC with
Diff, CMP; referral to GI team; Abdominal x ray
ANTICipate
A-administrative data
N-new clinical information
T-task
I-illness severity
C-contingency plans
To standardize communication during hand-off
and to provide a thorough report, the
introduction of ANTICipate comes into play with
the expectation that more valuable information is
present. Though nurses' communication doesn't
exactly present itself using ANTICipate, the
outline they utilize includes the essential
information required when delivering a complete
transition by using this type of communication
tool.
EXAMPLE:
A- Mr. John Smith; 55 y/o; with history of DM,
HTN, Crohn’s Disease, admitted under the service
of Dr. Womer. Admitted on 1/1/2023
N- the patient is complaining of abdominal pain
at 5/10; abdomen non distended, +active bowel
sounds; stools are formed, soft, light brown in
color;
T- placed on NPO; monitored for N/V;
administered pain medications; plan for CBC with
Diff, CMP;
I-+abdominal pain for the past 7 days; described
as stabbing; non radiating; medication, rest and
bowel movement did not provide relief.
C-referral to GI team; Abdominal x ray
I-PASS
I- illness severity
P-patient summary
A-action list
S-situational awareness
S-synthesis or read back
Example:
I- abdominal pain at 8/10 for seven days;
distended abdomen -negative bowel sounds;
rigid; stools are black and tarry colored; reported
vomiting of a green-colored discharge-
amounting to approx. 150cc
P-the patient is a 57-year-old male patient
admitted due to abdominal pain with Nausea and
vomiting
A- place patient on NPO; monitor for N/V;
administer pain medication every 4 hours; send
labs for CBC with Diff, CMP;
S-last pain medication was 6 hours ago, and the
pain was down to 5/10; patient reports bowel
movement to a soft, semi-formed dark brown
colored stool; remained on NPO.
S-referral to GI team; Abdominal x-ray to rule
out possible Crohn’s disease or Gastroenteritis.
“Roles and Functions in Controlling”
Quality control is an activity driven by an
organization to ensure proper evaluation,
monitoring, and regulations are not only adhered
to by staff or the organization but to ensure the
delivery of quality services and care to the
population the hospital services. The quality
control process is an ongoing process that
constitutes a continued improvement of the
organization.
“ Quality control efforts must be proactive,
not solely as a reaction to a problem”
Reference: Marquis and Huston, (2021)
CONTROLLING
• Must be supported by top-level
administration
• Fiscal commitment and human resources
• Search for excellence than minimums
• An on-going process
• Controlling is the last Role and Function of
nursing and the final step in the nursing
management process. There’s planning,
organizing, staffing, directing, and
controlling.
• Employees and staff members need to
know that they directly influence the
quality of outcomes in their workplace. For
example, if you are working in a nursing
unit, you need to know that the machine
you’re working with has been checked and
verified by experts constantly to have
passed the quality standards for the
machine to perform its task.
As nurse managers, you need to set the
standards for how your unit operates. For
example, if you want to achieve a Zero central
line-associated bloodstream infection (CLABSI) in
your unit, then you and your team should aim to
work for it.
To ensure your unit meets the criteria, you
require your staff to collect data by identifying
patients with a central line, monitor how often
the central line dressing is changed, and
communicate with the vascular access team
(VAT) to review their protocols. Do their
standards coincide with the unit's criteria? What
practices are in place to reduce central line
infection?
For any discrepancy, initiate educational
programs and support to enhance and ultimately
align set protocols based on the unit,
department, and organization's guidelines for
safety and improved outcomes.

• As an employee, you, too, undergo the

same control- such as that your managers
oversee the validity of your nursing
license, your CPR card, your yearly skills
update, and your monthly productivity.

Quality Control as a Systemic Process

Though there’s difficulty in defining quality

measurement, measuring healthcare quality
provides a different layer of complexity.
One quality control method is FOCUS PDCA,
According to Marquis and Huston (2021), to be
which supports a continued process of monitoring
effective in using quality control as a systemic
quality improvement (IQ) in every stage while
process, they came up with three simplified steps
monitoring results and giving room to enhance
utilizing both quantitative and qualitative data.
further improvement. Edward Deming, who
created this method, believes that understanding
the overall process is more beneficial for people
Quality Control to act upon it than focusing on the results.
(Quantitative and Qualitative Summary)
For Example:
The standard is determined
F- find a process to improve: To create a handoff
Data collection to assess if it meets the set tool in transitioning patient care
criteria
O- organize a team that knows the
Educate and improve processes if it fails to meet process: Nurse leaders
the guidelines
C-clarify current knowledge of the • Another great indicator of measuring
process: Developing a handoff tool improves quality care is using up-to-date, evidence-
communication and promotes efficiency in based knowledge. The IOPM came up with
transitional care and services. six indicators of quality measurement.

U- understand the variability and capability of the • Effectiveness- delivering care processes
process: A good handoff will prevent delays in backed by scientific evidence.
care and services.
• Efficiency- maximizing the quality of
S-select a plan for continuous resources that the unit can provide.
improvement: Develop a format to use as a
handoff • Equity-providing equal care regardless of
differences in opinion.
P-plan: Meet with the nurse leaders
• Patient Centeredness- meeting and
D- do: Encourage creative ideas; Submit honoring patient’s preferences and needs;
proposals delivering continued support and
education.
C-check: Assess for staff's feedback, usability,
and functionality • Safety- in terms of bodily harm.

A- act: Improve layouts; Add information; • Timeliness- provide needed care while
generate roll out to other units. minimizing delays.

Quality Measurement The Development of Standards

• Effectiveness The American Nurses Association (ANA)

developed professional standards in nursing
• Efficiency practice in 1973 and remains an influential
organization in ensuring adherence to these
• Equity
standards and best practices, mainly in the
• Patient Centeredness quality of nursing and care the patient receives
by any health care practitioner regardless of their
• Safety position.

• Timeliness ANA continues to advocate for establishing

standards in diverse fields and disciplines of
Defining quality is always an exciting topic
nursing to represent best practices and expect
because it is challenging to measure quality- and
excellence in nursing practice and performance.
achieving “quality” outcomes is difficult. The
Institute of Medicine or “IOM” suggests to
determine the quality of health, it should have at
least achieved the desired or expected outcomes. Standards as Measuring Tools
However, outcomes are only one quantifier of
• Objective
successful care but would not provide factual
information that the patient has received quality • Measurable
care. Perhaps one patient had a terrible hospital
experience yet had an incredible outcome, as • Achievable
evidenced by discharging earlier than expected.
At the same time, the patient could have had the “A predetermined level of excellence that serves
best hospital experience but, in the end, did not as a guide for practice,” standards typically
have an excellent outcome as he was still in the stream from top management leaders with the
intensive care unit longer than expected. highest authority establishing norms, policies,
and procedures and communicating to people
who recognize these guidelines in their day-to-
day work. Nurse managers and nurse leaders
reinforced standards for nurses and educated
them on what they should when use as
measuring tools.
Nurse managers exercise control by auditing the
quality of care the staff delivers to the patient; as
a result, it will serve as a basis to further improve
the current practices and to recognize the
effectiveness of the current processes in place.

Standards must be objective and supported by There are 3 types of auditing

verifiable facts. It should not rely on feelings.
 Retrospective
Standards must be measurable, recognizing their  Concurrent
variability and capability.  Prospective

Standards must be achievable and utilize Retrospective Audits- After the services was
methods to monitor progress continuously. rendered, retrospective audit is used to evaluate
how the services was delivered
The Codes, standards, regulations, compliance,
Rules, and Guidelines in nursing services Concurrent Audits- While the services is given,
establish, monitor, and promote high-quality care concurrent audit is performed to evaluate the
while managing costs and controlling resource quality of services
utilization. Similarly, using standardized clinical
guidelines or CPGs used by clinical providers Prospective Audits- Does the current
helps identify diagnosis-based step-by-step intervention affect future performance?
interventions in promoting and delivering not-so-
costly best practices.

STANDARD OF PRACTICE

 ASSESSMENT
 DIAGNOSIS
 OUTCOMES
 IDENTIFICATION
 PLANNING
 EVALUATION
 IMPLEMENTATION
 Coordination of care & Health Teaching
and Health Promotion.

Every organization is responsible for developing

its standards of practice manual. In nursing
practice, managers and nurse leaders cohesively
work as champion leaders in creating standards
of practice that best service their unit, their staff,
and the patient population they serve. These
standards of practice enable the organization to
evaluate the unit's performance, the staff's
output, and its ranking based on the national and
regional levels of measurement in nursing
practice.

AUDIT

Managers use an audit to determine an

organization's overall productivity, work
efficiency, spending, and staff performance.