NURSING MANAGEMENT

PROCESS
PREPARED BY:
AILYN B.PINEDA, RN
 NURSING MANAGEMENT
• Is the process of working through staff members to be able to provide comprehensive care to the patient
• This includes planning, organizing, directing and controlling
• The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in
order to provide effective, economic care to groups of patients
NURSING MANAGEMENT PROCESS
NURSING MANAGEMENT PROCESS
 Purpose of the Nursing Management
Process
• To achieve scientifically – based, holistic,
individualized care for the patient

• To achieve the opportunity to work

collaboratively with patients and others

• To achieve continuity of care

 Characteristics of the Nursing
Management Process
• Systematic
• Dynamic
• Interpersonal
• Goal Directed
• Universally Applicable
 PLANNING

Management function
Nursing management process
 PLANNING
• ccc
 COMPONENTS OF PLANNING

PLANNING:
PREDETERMINED
ACTION

WHAT TO DO: HOW TO DO IT: WHO IS TO DO IT:

-nursing activities -technique, principles -professional, non-
professional
 Nursing management
-planning-
PRINCIPLES OF PLANNING
1. Planning is always based and focused on the vision,
mission, philosophy, and clearly defined objectives of the
organization.
2. Planning is a continuous process.
3. Planning should be pervasive within the entire
organization covering the various departments, services and
the various levels of management to provide maximal
cooperation and harmony.
4. Planning utilizes all available resources.
5. Planning must be precise in its scope and nature.
• It leads to success in the achievements of goals and
objectives
• It provides meaning to work
• It provides for the effective use of available personnel
and facilities
• It helps nurses cope with crises and problems calmly
and efficiently PLANNING
• It is cost effective
• It is based on past and future activities
• It reduces the element of change
• It is necessary for effective control
 Characteristics of a GOOD PLAN
• It should have a clearly worded objectives, including
results and methods for evaluation
• Be guided by policies and/or procedures affecting the
planned action
• Indicate priorities
• Develop actions that are flexible and realistic in terms
of available personnel, equipment, facilities and time
• Develop a logical sequence of activities
• Select the most practical methods for achieving each
objective
 PLANNING
TYPES OF PLANNING:

1. STRATEGIC OR LONG-RANGE PLANNING

“what are the right things to do”
- usually extending 3 to 5 years into the future.

2. OPERATIONAL OR SHORT-RANGE PLANNING

“how does one do things right”
- deals with day to day maintenance activities.

3. CONTINUOUS OR ROLLING PLANS

- similar to operating plans, involves mapping out the day-to-day
activities.
 ELEMENTS OF PLANNING
• Forecasting or Estimate the future
• Set Objectives/Goals and Determine Results
Desired
• Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time
Frame
• Prepare the Budget and Allocation of
Resources
• Establish Policies Procedures and Standards
 Elements of Planning
-Forecast or Estimate the Future-
• Forecasting is looking into the future
• Refers to estimation of time series, cross sectional
or longitudinal data
• In making forecast, the planner should consider 3
things:
– Agency
– Community affected
– Goals of care
• Forecast must be supported by facts, reasonable
estimates and accurate reflection of policies and
plans
 Elements of Planning
Set Objectives/Goals and Determine Results Desired

• c
 Objectives
• The objectives of the Nursing Department is congruent to its
vision as well as to the 11 key areas of responsibilities to nursing
practice:
• To observe ethical principles and standards that govern nursing
practice. (ethico-moral-legal responsibilities)
• To establish well coordinated referral system for the continuity of
patient’s/ client’s care. (communication)
• To assure the application of acceptable performance of functions,
duties, and responsibilities of every position in the nursing
department. (safe & quality nursing care, management of
resources)
• To encourage its nursing personnel to participate in nursing
research for improving nursing care. ( research)
• To utilize media for information campaign to intensify health
education program. (health education)
 Nursing management
- ELEMENTS OF PLANNING-
MISSION OR PURPOSE

- The mission statement outlines the agency’s

reason for existing ( whether hospital or health
care), who the target clients are ( the poor, the
needy, the middle or upper class), and what
services will be provided ( in-patient, out-patient,
emergency).
- reason for the existence of the organization
(Nursing service exist to promote and maintain
health)
 Vision

• The Board of Nursing under the guidance of

the Almighty, with its unquestionable
integrity and commitment, envisions itself to
be the ultimate authority in regulating the
nursing profession in the Philippines and to
lead nursing development to its highest level
of excellence.
 Mission
• The BON shall unwaveringly pursue the advancement
of nursing development in the country by:
1. providing leadership, information, options,
scenarios and lobby efforts to targeted
decision makers and stakeholders
2. ensuring adherence to professional, ethical
and legal standards as mandated by existing
regulatory laws
3. unifying the nursing sector through good
governance
4. fostering linkages with the domestic and
international stakeholders
 Nursing management
- ELEMENTS OF PLANNING-

• PHILOSOPHY

- Philosophy is the sense of purpose of the organization

and the reason behind its structure and goals.

- Philosophy states the beliefs that influence nursing

practice and beliefs about health care.
POLICIES

Policies in general, they are guidelines to help in the

safe and efficient achievement of organizational
objectives

PROCEDURES

Procedures are specific directions form implementing

written policies
 Nursing management
- ELEMENTS OF PLANNING-
• Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time
Frame

Strategy is the techniques, methods, or

procedure by which the overall plan of the higher
management achieve desired objectives.

Programs are activities put together to facilitate

attainment of some desired goals.
 Nursing management
PLANNING
Time Management is a technique for
allocation of one’s time through the setting of
goals, assigning priorities, identifying and
eliminating time wastes and use of
managerial techniques to reach goal s
efficiently
 Nursing management
PLANNING
Principles of Time Management
1)Planning for contingencies-planning anticipates the
problem that will arise from actions without thought
2)Listing of task-task to be accomplished should be done in
sequence which are prioritized according to importance
3)Inventory
4)Sequencing
5)Setting and keeping deadlines- and adhering to deadline
is an excellent exercise in self discipline
6)Deciding on how time will be spent
 Nursing management
PLANNING
Time Saving Techniques, Devices and Methods to Better Use of Time

1. Conduct an inventory of your activities.

2. Set goals and objectives and write them down.
3. With the use of calendars, executive planners, logs or journals, write what
you expect to accomplish yearly, monthly, weekly or daily.
4. Break down large projects into smaller parts.
5. Devote a few minutes at the beginning of each day for planning.
6. Organize your work space so it is functional.
7. Close your door when you need to concentrate.
8. Learn to delegate.
9. In a meeting, define the purpose clearly before starting.
10.Take or return phone calls during specified time.
11.Develop effective decision-making skills.
12.Take rest breaks and make good use of your spare time.
 Nursing management
PLANNING

Multitasking
Trying to get more things done in less time
Examples: answering phone calls while driving,
sending e-mails while in the meeting
 Nursing management
PLANNING
DEVELOPING AND SCHEDULING PROGRAMS
Programs are predetermined, developed and targeted
within a time frame to reach the set goals and objectives.

The Planning Formula

1.WHAT
2.WHEN
3.WHERE
4.HOW
5.WHO
6.WHY
7.CAN
 Nursing management
PLANNING
• PREPARING THE BUDGET
1.A budget is the annual operating plan, a financial “road
map” and plan which serves as an estimate for future
costs and a plan for utilization of manpower, material
and other resources to cover capital projects in the
operating programs.
2.A nursing budget is a plan for allocation of resources
based on preconceived needs for a proposed series of
programs to deliver patient care during one fiscal year.
3.A hospital budget is a financial plan to meet future
service expectations.
 Factors in BUDGET planning
• Type of patient, length of stay in the hospital and
acuteness of illness
• Size of hospital and bed occupancy
• Physical lay out of the hospital, size and plan of the
wards, units, nurse’s station, treatment rooms, etc
• Personnel policies
• Salaries paid to various type of nursing personnel including OT
pay or shift differential
• Extent of VL, SL, holidays
• Provision for staff development programs
• Grouping of patients such as those in specialized areas
 Factors in BUDGET planning
• Standards of nursing care: kind and amount of care to
be given as it affects the number of hours of bedside
care
• The method of performing nursing care whether simple
or complex; the method of documentation
• Proportion of nursing care provided by the professional
nurses and those given by non-professionals
• Amount and quality of supervision available and
provided; the efficiency of job description and job
classification
 Factors in BUDGET planning
• Method of patient assignment whether functional, case,
team or primary
• Amount and kind of labor-saving devices and
equipments
• Amount of centralized service provided: sterile supply ,
central o2 supply, linen supply
• Nursing service requirements of the ancillary
departments: clinics, admitting office, ER
• Reports required by administration whether simple or
complex
• Affiliation of nursing students or medical students
 Establishing Nursing Standards,
Policies and Procedures
• Nursing Standards
– Standard- a practice that enjoys general recognition and
conformity among professionals or an authoritative statement
by which quality of practice or education can be judged
– Nursing Care Standard – a descriptive statement desired
quality against which to evaluate nursing care
– Purpose of nursing standards
• Improved quality of care
• Decrease the cost of nursing care
• Determine nursing negligence
– Sources of nursing standards
• DOH, BON, Professional Organization, Nursing Programs
Establishing Nursing Standards, Policies
and Procedures
• Nursing Service Policies
– Policies in general are guidelines to help in safe and
efficient achievement of organizational objectives
– There are 3 general areas in nursing which requires
policy formulation. These are:
• Areas in which confusion about the locus of responsibility
might result in neglect or malperformance of an act
necessary to a patient’s welfare
• Areas pertaining to the protection of patients’ and families’
rights as right to privacy and right to property
• Areas involving matters of personnel management and
welfare
Establishing Nursing Standards, Policies
and Procedures
• Nursing procedures
– Procedures are specific directions for
implementing written policies

– Procedures are more specific guide to action than

policy
 ORGANIZING

Nursing management FUNCTION

NURSING MANAGEMENT PROCESS
 Nursing management
- ORGANIZING -
• ORGANIZING is the process of establishing formal authority
• Involves setting up the organizational structure through identification of
groupings, roles and relationships
• Determines staff needed through developing and maintaining staffing patterns
and distributes them in the various areas as needed
• Develops job descriptions by defining the qualifications and functions of personnel
 Organizing
• Organizing is one way which nursing
management coordinates the various
activities of a department or a unit so that the
staff can get its work done in an orderly
fashion
• Organizing means having qualified people and
the right materials, information and
equipment needed to deal with contingencies
 Nursing management
- ORGANIZING -
PRINCIPLES OF ORGANIZATION:
Communication: effective and open communication in all
forms; thread that binds the organization together
 Directions of communication:
 Downward
 Upward
 Lateral/Horizontal
 Grapevine
Unity of Command
Span of Control
Delegation of authority
Similar Assignments
Unity of Purpose
 ORGANIZATIONAL DESIGN

• Organizational design is a
formal, guided process
for integrating the
people, information and
technology of an
organization.
PRINCIPLES OF ORGANIZATIONAL DESIGN

1. Division of labor
2. Unity of command
3. Authority and responsibility
4. Span of Control
5. Contingency Factors
 Nursing management
- ORGANIZING -
ELEMENTS OF ORGANIZING
1.Organizational Structure
2.Staffing
3.Scheduling
4.Developing job descriptions
 Importance of organizational
structure
• It enables members what their responsibilities
are so that they may carry them out
• It frees the manager and the individual
workers to concentrate on their respective
roles and responsibilities
• It coordinates all
 Nursing management
- ORGANIZING -
 ORGANIZATIONAL STRUCTURE

• The organizational structure refers to the

process by which a group is formed its
channel of authority, span of control and
lines of communication.
• It is the formal structure, the official arrangement of
positions or working relationships that will coordinate
efforts of workers of diverse interest and abilities
 Patterns of Organizational
Structure
• Tall or Centralized Structure
• Flat or Decentralized Structure
TALL OR CENTRALIZED STRUCTURE

• Responsible for only a few

subordinates, so there is a
narrow span of control
• Because of the vertical
nature of the structure,
there are many levels of
communication
TALL OR CENTRALIZED STRUCTURE
• Advantage
 It makes use of expertise,
and allows close
communication between
the workers.
 Supervisory individuals
screen the communication.
• Disadvantage
 Transpires that the most
skilled individuals end up
doing nothing while actual
tasks are done by those less
capable.
 Communication from bottom
to top is often difficult, and
messages do not get to the
top
 Workers tend to be very
“boss-oriented “ because of
the close contact with their
supervisor.
 Flat or Decentralized Structures

• Refers to an
organizational structure
with few or no levels of
intervention between
management and staff.
 Flat or Decentralized Structure
• Advantages • Disadvantages
• Lower likelihood of • Supervisor spend less
messages being distorted time with each worker
• Workers develop own
• Supervisors may lack
abilities and autonomy and
able to see the expertise in the variety
organization as humanistic of operations and may
resulting in greater job end up making
satisfaction inappropriate decisions
• The principle of “shared
governance” produces
maximum potential for
professional growth
 Nursing management
- ORGANIZING -
Types of Organization Classified by Nature of Authority

1)Line Organization- each position has general authority over

the lower positions in the hierarchy. (also known as
Bureaucratic/Pyramidal)
2)Informal Organization- refers to horizontal relationship
rather than vertical.(Flat or horizontal organization)
3)Staff Organization- purely advisory to the line structure
with no authority to put recommendations into action.
4)Functional Organization – each unit is responsible for a
given part of the organization’s workload.
 TYPES OF ORGANIZATIONAL STRUCTURE

1) Line Organization/
Bureaucratic/ Pyramidal
- shows that each position
has general authority over
the lower position of the
hierarchy.
- ARA and power are
concentrated at the top.
 TYPES OF ORGANIZATIONAL STRUCTURE

2. Flat Organization
- refers to an
organizational structure
with few or no levels of
intervention between
management and staff.
 TYPES OF ORGANIZATIONAL STRUCTURE

3. Staff Organization
- purely advisory to the
line structure with no
authority to place
recommendations into
action.
 TYPES OF ORGANIZATIONAL STRUCTURE

4. Functional Organization
- permits a specialist to
aid line position within a
limited and clearly
defined scope authority.
 ORGANIZATIONAL RELATIONSHIP
1. FORMAL
RELATIONS
2. INFORMAL
RELATIONS
ORGANIZATIONAL RELATIONSHIP

1. FORMAL
RELATIONS
- represents by
uninterrupted lines
between units, showing
who reports to whom.
 ORGANIZATIONAL RELATIONSHIP
2. INFORMAL
RELATIONS
- represented by a
broken or dotted line,
where power
relationships are
coordinated.
 Nursing management
- ORGANIZING -
• ORGANIZATIONAL CHART

- Organizational chart is a line drawing that shows

how the parts of an organization are linked.
 Nursing management
- ORGANIZING -
Characteristics of an Organizational Chart

1)Division of Work
2)Chain of Command
3)Type of Work to be performed
4)Grouping of Work Segment
5)Levels of Management
 Nursing management
- ORGANIZING -

STAFFING

Staffing is the process of determining and

providing the acceptable number and mix of
nursing personnel to produce a desired level of
care to meet the patients’ demand.
The process of assigning competent people to fill the
roles designated for the organizational structure
through recruitment, selection and development.
 - STAFFING -

• FACTORS AFFECTING TIME REQUIREMENT OF

NURSING CARE
– Patient’s acuteness of illness
– Degree of dependence
– Communicability of ailment
 Steps in Staffing

– Determine the Number and

Types of Personnel Needed
– Recruitment
– Interview
– Induct or Orient the
Personnel in Organization
– Job Offer
Centralized Staffing

• Staffing decisions for all units are made

by a central office or computer.
• Tends to be fairer to employees,
because policies are implemented more
consistently and impartially.
• Frees manager to complete other
functions.
• Most cost effective, because it
maximizes use of human resources
organization-wide.
 Decentralized Staffing
• Staffing is done at unit level, frequently by unit
manager.
• Allows person who knows the individual unit the best
to make staffing decisions for that unit.
• Allows staff to take requests directly to their own
manager, which gives them increased autonomy and
flexibility.
• Increases the risk that employee requests may be
treated unequally or inconsistently.
• Time-consuming for unit manager.
 NURSING CARE MODALITIES

TOTAL CARE or CASE NURSING

• One nurse is assigned to one patient for
totality of care during his or her time on
duty
• PDN
• Isolation nurse
• Nursing student
 NURSING CARE MODALITIES

FUNCTIONAL Nursing
• Task-oriented
• Particular nursing function is assigned to each
nurse
• Time saving
• Worker learns w/ mastery
-Medication nurse
-Charge nurse
-Nursing attendant
 Nursing Care Modalities

PRIMARY Nursing
• Nurse is responsible for the total care of
a small group of clients from admission
to discharge
 Nursing Care Modalities

TEAM Nursing
• The team leader assigns patients &
tasks according to job descriptions
 PATIENT CLASSIFICATION SYSTEM

1. “Self care” or Minimal Care

Patients
2. Intermediate or Moderate
Care
3. Total Care Patients
4. Intensive Care Patients
 PATIENT CLASSIFICATION SYSTEM
1. “Self care” or Minimal
Care Patients
• capable of carrying activities
of daily living (ADL)
Convalescing, no longer
require intensive, moderate,
or maximum care
• Require dx studies,
• Minimal therapy
• Awaiting elective surgery,
• Home environment
temporarily makes discharge
undesirable
 PATIENT CLASSIFICATION SYSTEM
2. Intermediate or Moderate Care
• requires some help from the
nursing staff with special
treatments.
• Given to moderately ill
• Recovering from immediate effects of
a serious illness or operation
• May be ambulatory for short periods
(needs assistance)
 PATIENT CLASSIFICATION SYSTEM
3. Total Care Patients
• those who are bedridden
and who lack strength and
mobility to do average daily
living.
• Needs close attention
• Requires nurse to initiate,
supervise, and perform most of
the activities
• Requires frequent medication
 PATIENT CLASSIFICATION SYSTEM
4. Intensive Care Patients
• those who are critically ill
and in constant danger of
death or serious injury.
Acutely ill patients w/ high
level of nurse dependency
• Unstable condition w/c
requires frequent
evaluation with adjustment
of therapy
 Nursing management
- STAFFING -

• STAFFING FORMULA
Requirements:
STANDARD VALUE OF NURSING CARE
Cases / Patients NCH/pt/day Prof. to Non-Prof Ratio

i. Surgery 3.4 60:40

ii. General Ward 3.5 60:40
iii. Pediatric 4.6 70:30
iv. Pathologic Nursery 2.8 55:45
v. Medical 3.4 60:40
vi. OB 3.0 60:40
vii. ICU/ER/RR 6.0 70:30
viii. CCU 6.0 80:20
 Nursing management
- STAFFING -
• Distribution Per Shift
SHIFT PERCENTAGE
AM 45 %

PM 37%

NIGHT 18%
 Nursing management
- STAFFING -

• CATEGORIES OF PATIENT
Levels of Care NCH Needed /pt./ day Prof: Non Prof

Level I 1.50 55:45

Self-Care or Minimal
Care

Level II
Moderate or 3.0 60:40
Intermediate Care

Level III 4.5 65:35

Total or Intensive Care

Level IV 6.0 70:30

Highly Specialized
7.0 or higher 80:20
or Critical Care
 Nursing management
- STAFFING -

• PERCENTAGE OF PATIENTS IN VARIOUS

LEVELS OF CAREMinimal Moderate Intensive
Type of Hospital Highly
Care Care Care Spl. Care

Primary Hospital 70 25 5 -

Secondary Hospital 65 30 5 -

Tertiary Hospital 30 45 15 10

Special Tertiary Hospital 10 25 45 20

 Nursing management
- STAFFING -
• TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF
NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Working Hours per Week
Personnel/Yr 40 hours 48 hours
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off Duties as per R.A. 5901 104 52
7. Continuing Education Program 3 3

Total Non-Working Days/Year

Total Working Days/Year 152 100
Total Working Hours / Year 213 265
RA 5901 = 40H WK LAW 1,704 2,120
 Nursing management
- STAFFING -

Steps for Computing the Staff Needed in the in-

patient Unit of the Hospital
COMPUTATION:
CASE: 250 BED CAPACITY TERTIARY HOSPITAL. HOW
MANY STAFF NURSES DO WE NEED?
1. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE 
 250 X 30% = 75 minimal care
 250 X 45% = 112.5 moderate care
 250 X 15% = 3.5 intensive care
 250 X 10% = 25 highly specialized nursing care
 Nursing management
- STAFFING -

2. FIND THE NURSING CARE HOURS (NCH) NEEDED 

• 75 X 1.5 (NCH @ Level I) = 112.5 NCH/day
• 112.5 X 3 (NCH @ Level II) = 337.5 NCH/day
• 37.5 X 4.5 (NCH @ Level III) = 168.75NCH/day
• 25 X 6 (NCH @ Level IV) = 150 NCH/day
-------------------768.75 NCH/DAY
 Nursing management
- STAFFING -

3. FIND NCH PER YEAR 

• 768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR

4. FIND ACTUAL WORKING HOURS NEEDED BY

EACH NURSING PERSONNEL / YEAR

• 8 ( hrs/day ) X 213 (WORKING DAY/YEAR)=

1,704 ( working hrs/year )
 Nursing management
- STAFFING -
5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL NEEDED.

a. TOTAL NCH/ YEAR = 280,593.75 = 165

WORKING HRS / YEAR 1,704

b. RELIEF x TOTAL NSG PERSONNEL

165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)

c. RELIEVERS + TOTAL # OF NURSING PERSONNEL

NEEDED
165 + 25 = 190 TOTAL PERSONNEL NEEDED
 
 Nursing management
- STAFFING -

6. DETERMINE PROF FROM NON PROF

PERSONNEL

e.g. tertiary hospital

190 X 65% = 124 PROFESSIONAL

190 X 35% = 68 NON PROFESSIONAL
 Nursing management
- STAFFING -

7. DISTRIBUTE PER SHIFT

PROFESSIONAL(124) NON PROFESSIONAL(66)

• AM (45%) 56 30

• PM (37%) 46 24

• NIGHT (18%) 22 12
 Nursing management
- STAFFING -
Placement of Staff
proper placement:
a. fosters personal growth
b. provides a motivating climate for the employee
c. maximizes productivity
d. organizational goals have better chances of being met
inappropriate placement:
a. frustration
b. poor quality of work
c. reduced organizational efficiency
d. rapid turn-over
e. poor image for the agency
RA 9173 nurses with Master’s degree in Nursing are easily placed in position
 Nursing management
- STAFFING -
SCHEDULING
A schedule is a timetable showing planned work
days and shifts for nursing personnel.

Factors to Consider in Making a Schedule

1. Different levels of the nursing staff
2. Adequate coverage for 24 hours, 7 days a week
3. Staggered vacations and holidays
4. Weekends
5. Long stretches of consecutive working days
6. Evening and night shifts
7. Floating
 Nursing management
- STAFFING -
Assessing a Scheduling System

1.Ability to cover the needs of the shift

2.Quality to enhance the nursing personnel’s knowledge,
training and experience
3.Fairness to the staff.
4.Stability
5.Flexibility
 Nursing management
- STAFFING -
Types of Scheduling

1.Centralized Schedule
2.Decentralized Schedule
3.Cyclical Schedule
 Nursing management
- STAFFING -
SCHEDULING VARIABLES
a. Length of scheduling period whether 2 or 4 weeks
b. Shift rotation
c. Week-ends off
d. Holiday off
e. Vacation leave
f. Special days
g. Scheduled events in the hospital , training programs, or
meetings
h. Job categories
i. Continuing professional education (CPE) programs
 Nursing management
- STAFFING -
DEVELOPING JOB DESCRIPTION

Job Description is a statement that sets the duties and

responsibilities of a specific job.

Contents of a Job Description

1.Identifying Data
2.Job Summary
3.Qualification Requirements
4.Job Relationships
5.Specific and Actual Functions and Activities
 Nursing management
- STAFFING -
Uses of Job Description
1.For recruitment and selection of qualified personnel
2.To orient new employees to their jobs
3.For job placement, transfer or dismissal
4.As an aid in evaluating the performance of an employee
5.For budgetary purposes
6.For determining departmental functions and relationships to
help define the organizational structure
7.For classifying levels of nursing functions according to skill levels
required.
8.To identify training needs
9.As basis for staffing
10.To serve as channel of communication.
 Nursing management
- DIRECTING -
DIRECTING
 Plan put into action
 Activities
 Delegation – transferring responsibility
 Updating policy
 Utilize the policy updates
 Supervision
 Roles in Supervision
» Guides
» Direct
» Facilitates
» Motivates
» Teaches
 Nursing management
- DIRECTING -
Principles of Delegation
1.Select the right person to whom the job is to be
delegated.
2.Delegate both interesting and uninteresting tasks.
3.Provide subordinates with enough time to learn.
4.Delegate gradually.
5.Delegate in advance.
6.Consult before delegating.
7.Avoid gaps and overlaps.
 Nursing management
- DIRECTING -
What Cannot be Delegated

1.Overall responsibility, authority and accountability for

satisfactory completion of all activities in the unit.
2.Authority to sign one’s name is never delegated
3.Evaluating the staff and or taking necessary corrective or
disciplinary action.
4.Responsibility for maintaining morale or the opportunity
to say a few words of encouragement to the staff
especially the new ones.
5.Jobs that are too technical and those that involve trust
and confidence.
 Nursing management
- DIRECTING -
Four Rights of Delegation
1. task
The right task should be within the scope of the person’s practice
and consistent with the job description.
2. person
The right person should have the appropriate license or certificate,
job description.
3. communication
The right communication should be clear, concise, complete and
correct.
4. feedback
The right feedback should ask for input, get the person’s
recommended solution to the problem and recognize the persons
effort.
 Nursing management
- DIRECTING -

• Aspects of Delegation
1. Responsibility – denotes obligation
2. Authority – the power to make final
decisions and give commands.
3. Accountability – refers to liability
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COMMUNICATION
Communication is the transmission of information,
opinions, and intentions between among individuals.

Purpose of communication
1. facilitates work
2. increases motivation
3. effects change
4. optimizes patient care
5. increases workers’ satisfaction
6. facilitates coordination
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Types of Communication
1. Verbal Communication
2. Written Communication
3. Non-verbal Communication
a.Personal appearance
b.Intonation of the voice
c.Facial expression
d.Posture and gait
e.Touch
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• Lines of Communication
UPWARD
to superior

HORIZONTAL OUTWARD NURSES

to peers and to patient, family

members of the and community
Health Team to workers’ family
and friends
DOWNWARD
to subordinates
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DECISION MAKING
Decision is a course of action that is consciously chosen from
available alternatives for the purpose of achieving a desired result.
5 Steps in Decision Making
1. definition of the problem
“ why the problem occur”
2. analysis of the problem
“getting to the cause of the problem”
3. development of an alternative solution
“search for and analysis of alternatives and their possible consequences”
4. selection of the solution
weighing of facts and exploring alternative solutions
5. implementation and follow-up
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Major Management Functions in Implementing
Decisions
1. Planning which entails consideration and selection of
realistic objectives, policies and procedures.
2. Organizing which means helping personnel
understand the decision and the procedures necessary
for implementing the decision.
3. Staffing or the selection of the right person/s to carry
out the decision
4. Controlling the environment and the group to
prevent adverse effects.
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Art of Decision Making:
1.Not making decision that others should make, to
preserve morale and authority;
2.Not deciding on problems that are not pertinent to
matters at hand to prevent waste of time and
energy;
3.Not deciding prematurely to prevent prujudice
4.Not making ineffective decisions to avoid losing the
respectability of the decision maker.
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CONFLICT MANAGEMENT

CONFLICTS – clash, fight, battle or struggle; it may be

constructive or destructive

Basis of the Conflict

1. Intrapersonal
2. Interpersonal
3. Group
4. Intergroup
5. Organizational
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 Sources of the Conflict
 Cultural differences
 Different facts
 Separate pieces of information
 Different perception of the event
 Defining the problem differently
 Divergent views of power and authority
 Role conflicts
 Number of organizational levels
 Degree of association
 Parties dependent on others
 Competition for scarce resources
 Ambiguous jurisdictions
 Need for consensus
 Communication barriers
 Separation in time and space
 Accumulation of unresolved conflit
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Types of Conflict
1. Intrasender
- conflict originates in the sender who gives conflicting
instructions.
2. Intersender
- conflict arises when an individual receives conflicting
messages from two or more sources.
3. Interrole
- conflict can occur when an individual belongs to more than
one group.
4. Person-role
- conflict is the result of disparity between internal and
external roles.
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5. Interperson
- conflict is common among people whose positions require interaction
with other persons who fill various roles in the same organization or
other organizations.
6. Intragroup
- conflict occurs when the group faces a new problem.
7. Intergroup
- conflict is common where 2 groups have different goals and can
achieve their goals only at the others’ expense.
8. Role Ambiguity
- a condition in which individuals do not know what is expected on
them.
9. Role Overload
- the person is simply unable to accomplish so much within a limited
time period.
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Conflict Resolution
1. Avoidance
- used by groups who do not want to do something that may
interfere with their relationship
2. Accommodation
- self-sacrifice
3. Collaboration
- inspires mutual attention to the problem and utilizes the talents
of all parties
4. Compromise
- in this method, accommodation and adjustment lead to
workable situations rather than to the best solution.
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5. Competition
- it is an assertive position that fosters conflict resolution on
the part of the subordinate.
6. Smoothing
- disagreements are ignored so that surface harmony is
maintained in a state of peaceful co-existence.
7. Withdrawing
- one party is resolved thereby making it possible to resolve the
issue.
8. Forcing
- yields an immediate end to the conflict but leaves the cause
of the conflict unresolved.
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Rules on Mediating a Conflict Between Two or More
Parties:
1. Establish clear guidelines and make them known to all.
2. Do not postpone indefinitely.
3. Create an environment that makes people comfortable
to make suggestions.
4. Keep two-way communication.
5. Stress a peaceful resolution rather than confrontation.
6. Emphasize shared interests.
7. Follow-up on the progress of the plan.
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• Staff Development
Staff development is geared ultimately to
organizational development.

• Orientation
Orientation is a planned and guided
activities of an employee in the organization,
the work environment , and in his job.
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• CONTROLLING
Controlling or evaluating is an on-going
function of management which occurs during
planning, organizing, and directing activities.
The controlling process opens
opportunities for improvement and
comparing performance against set standard.
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Reasons For Conducting Evaluation
1.Evaluation ensures that quality nursing care is provided.
2.It allows for the setting of sensible objectives and ensures
compliance with them.
3.It provides standards for establishing comparisons.
4.It promotes visibility and a means for employees to monitor their
own performance.
5.It highlights problems related to quality care and determines the
areas that require priority attention.
6.It provides an indication of the costs of poor quality.
7.It justifies the use resources.
8.It provides feedback for improvement.
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Principles of Evaluation.
1. The evaluation must be based on the behavioral standards of
performance which the position requires.
2. The evaluation should have enough time to observe employee’s behavior.
3. The employee should be given a copy of the job description,
performance standards, and evaluation conference.
4. The employee’s performance appraisal should include both satisfactory
and unsatisfactory results with specific behavioral instances to exemplify
these evaluative comments.
5. Areas needing improvement must be prioritized to help the worker
upgrade his/her performance.
6. The evaluation conference should be scheduled and conducted at a
convenient time for the rater and the employee.
7. The evaluation report and conference should be structured in such a way
that is perceived and accepted positively as a means of improving job
description.
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Characteristics of an Evaluation Tool

1.Should be objective
2.Should be reliable
3.Should be sensitive
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PERFORMANCE APPRAISAL
Performance appraisal is a control process in which
employee’s performance is evaluated against standards.

Purposes of Performance Appraisal

1.Determine salary standards and merit increases.
2.Select qualified individuals for promotion or transfer.
3.Identify unsatisfactory employees for demotion or
termination
4.Make inventories of talents within the institution.
5.Determine training and development needs of employee.
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6. Improve the performance of work groups by examining,
improving, correcting interrelationship between
members
7. Improve communication between supervisors and
employees and reach an understanding on the objectives
of the job
8. Establish standards of supervisory performance.
9. Discover the aspirations of employees and reconcile
these with the goals of the institution
10. Provide employee recognition
11. Inform employees where they stand.
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Methods of Measuring Performance

1.Essay
2.Checklist
3.Ranking
4.Rating Scales
5.Forced-choice Comparison
6.Anecdotal Recording
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