NURSING MANAGEMENT

GERARDO F. JOVEN, RN, MAN,

It is a process that involves the direction of a group of people towards organizational goals and objectives. Objectives of an organization are accomplished by utilizing human and physical resources and technology.

Principles of Management

1. Division of Work each employee has a specific job to do 2. Authority power to make decisions and give commands.

3. Discipline obedience and respect of the rules of the organization. 4. Unity of command each employee receive only from one superior.

5. Subordination of individual interests to the general interest the majority is superior to the minority.

6. Unity of direction objectives and direction comes from one manager using one plan.

7. Remuneration employees are paid a fair wage for their services. 8. Centralization degree to which subordinates are involved in decision making.

9. Scalar chain refers to the line of authority from top management to the lowest rank. 10. Order People and materials are in the right place at the right time.

11. Equity managers observe kindness and fairness to the subordinates. 12. Stability of tenure employees are retained due to their efficiency and effectiveness.

13. Initiative performing roles without being told to do so. 14. Esprit de corps team spirit builds harmony and unity within the organization.

MANAGEMENT PROCESS AND FUNCTIONS

Four Basic Managerial Functions

Planning Organizing Directing Controlling

Planning
Forecasting of events based on which decisions are made, goals are set and prioritized and policies and standards are developed.

Scope of Planning
Top Managers: Director of Nursing Services, Chief Nurses, Dean of the College of Nursing a. Responsible for the over-all operations b. Establishes objectives, policies, strategies

Middle Managers: Nurse Supervisors, Clinical Coordinators a. Coordinates nursing activities of several units b. Receives strategies and policies from top managers and translate them into specific programs.

First-line Managers: Head Nurses, Primary Care Nurses a. Directly responsible for the actual production of nursing services.

1. Strategic Planning It extends 3 5 years in the future. Begins with in-depth analysis of the SWOT so that goals can be set for the future.

2. Tactical Planning Specified in oneyear increments involves allocating available resources to specific purposes expressed in budget.

3. Operational Planning It develops the dayto-day departmental activities and improvement goals for the year.

Reasons for Planning

1. A good plan ensures that the needed resources are available to carry out initiatives identified for the organization. 2. Everyone has the same idea for where the organization is headed.

3. Increases the chances of success on results. 4. Helps avoid crisis and provides decision making flexibility. 5. Cost-effective

STAGES OF PLANNING

1. 2. 3.

4.

Develop the mission, vision, philosophy, goals and objectives. Collect and analyze data on internal and external forces. Assess strength, weaknesses, opportunities and threats. Formulate realistic goals for the organization.

5. Determine strategies to achieve identified goals. 6. Develop time table for each objectives set. 7. Provide guidelines for plans that are identified. 8. Implement plan. 9. Evaluate the plan.

Elements of Planning

1. Forecasting is the process of estimation of situations in order to accomplish plans of the organization.

2. Budgeting operational management plan stated in terms of income and expense, covering all phases of activity.

Types of Budget
1. Operating Budget goods and services the unit expects to use during the budget period.

2. Capital Expenditure Budget budgets associated with operating some major capital assets

3. Personnel Budget compensation and benefits to nursing and support personnel required to operate a unit.

4. Cash Budget depicts where cash will be spent over some near term in order to know if the organization can afford bills that must be paid soon.

Purposes of Budgeting
1. Promotes proper allocation of resources. 2. Promotes smooth and efficient organizational operation. 3. Serves as a tool for modification and changes in the organization

3. Scheduling detailing what activities to be done, the order in which they are completed, who is to do each and when they are completed.

ORGANIZING
Grouping of activities for the purpose of achieving objectives, the assignment for each grouping to a manager with authority for supervising the group.

Elements of Organizing
1. Organizational structure 2. Coordination 3. Staffing 4. Job descriptions

Organizational structure the formal framework by which job tasks are divided, grouped and coordinated.

Forms of Organizational Structure

1. Hierarchical/Line Organization - associated with principle of chain of command, bureaucracy and vertical control and coordination, levels differentiated by function and authority and downward communications.

Chief Nurse
Assistant Chief Nurse Supervisor Nurse (AM) Supervisor Nurse (PM) Supervisor Nurse (NT)

Head Nurse
Charge Nurse

Head Nurse
Charge Nurse

Head Nurse
Charge Nurse

Staff Nurse

Staff Nurse

Staff Nurse

2. Staff Organization Assists the line in accomplishing the primary objectives of the unit, provides advice and counsel, includes clerical, personnel, budgeting and finance.

Vice President for Finance

Legal Counsel Executive Secretary

Resident Accountant
Bookkeeper Purchaser Messenger

3. Free-form/Matrix Personnel from functional departments are assigned to a specific program. Example: Task Force, Ad Hoc Committee.

Over-All Chairman

Vice-Chairman

Chairman, Committee on Documentation

Chairman, Committee on Refreshments

Chairman, Committee on Program

Chairman, Committee on Invitation

Chairman, Committee on Arrangements

Members

Members

Members

Members

Members

Coordination it refers to the quality of collaboration across various departments in an organization.

Purpose: provides access to information and enable communication among people in different departments at different levels.

Staffing - It is the process of supplying the organization with the needed personnel to achieve the objectives.

Types of Staffing
1. Centralized Staffing System done by the nurse director who develops a master plan for nursing personnel. Impersonal in approach.

2. Decentralized Staffing middle and lower/first levels of management determine staffing, more personal approach.

Modalities of Patient Care

1. Primary Nursing The nurse has total responsibility for the nursing care of the patient 24 hours a day from admission to discharge. It is expensive.

2. Team Nursing a group of nurses work together to fulfill the full functions of professional nurses. The team leader has the responsibility of coordinating the total care of a block of patients.

3. Case Method provides for oneto-one RN-toclient ratio and constant care for a specified period of time.

4. Functional Method task-oriented method where nursing function is assigned to each staff nurse. One nurse is giving medications, one for VS, one managing for IV. Gives professional nursing low status in terms of responsibility.

Job Description - It is a statement that sets the duties and responsibilities of a specific job. It includes the needed qualifications of the individual to perform such duties successfully.

DIRECTING
It refers to the issuance of assignments, orders and instructions that permit the worker to understand what is expected of him.

Elements of Directing
1. 2. 3. 4. 5. 6. Delegating Supervision Change Process Conflict Resolution Decision Making Communication

Delegation transferring to a competent individual the authority to perform a selected nursing task in a given situations.

Principles of Delegation 1. Right person 2. Right tasks 3. Right time 4. Right supervision

Supervision to oversee or view directly and periodic inspection of the actual accomplishment of the task or activity.

Change Process purposeful, designed effort to bring about improvements in a system with assistance of a change agent.

Conflict Disagreement about something of importance to each person involved. It exists when an inner or outer struggle occurs regarding ideas, feelings or actions.

Approaches to Conflict Resolution

1. Competition and power if the nurses primary concern is work with little regard to personnel. 2. Smoothing nurse puts relationship with people as a primary concern rather than work accomplishment.

3. Avoidance low regard to people and work accomplishment. 4. Compromise each side makes concessions. Each side gives up something in order to gain something.

5. Collaboration a constructive process where parties recognize the conflict and confront the issue openly.

6. Accommodation when a subordinate has a better idea than other members of the organization.

Decision Making systematic and sequential process of selecting interventions from a repertoire of actions that facilitate the achievement of desired outcomes.

Communication a message is passed from sender to receiver hoping that the information exchanged will be understood.

Guidelines for Effective Communication

1. Sender source of information 2. Receiver person who receives the senders message 3. Message content of the communication 4. Encoding occurs when message is sent.

5. Transmitting channel used to communicate a message. 6. Decoding occurs when the message is received (heard). 7. Action behavior taken by the receiver as a result of the message. 8. Feedback two-way communication when sender and receiver exchange and clarify information.

Flow of Communication

1. Downward Communication comes from the superior going down to the subordinates.

2. Upward communication comes from subordinate to top management.

3. Lateral communication observed between employees and personnel on similar level.

4. Grapevine communication form of communication gained from hearsay, from informal friends and does not come from the usual formal channels.

5. Diagonal Communication a form of communication obtained by a subordinate to a superior from other units/departments.

CONTROLLING
It refers to the process by which managers evaluating to make sure that things are done as intended. Nurse managers attempt to see the actual activities conform to planned activities.

Basic Components of Controlling

1. Setting standards objectives and methods for measuring performance. 2. Measure actual performance 3. Compare performance from standards. 4. Take corrective actions as necessary.

Elements of Controlling
1. Standards 2. Performance Evaluation 3. Quality Assurance 4. Discipline

Standards are desired sets of conditions and performance necessary to ensure quality nursing care services which are acceptable for those setting and maintaining them.

Types of Standards
1. Standards on structure are those that are focused on management system used by the agency to deliver care such as number of nursing personnel, physical facilities and equipment.

2. Process standards refers to decisions and actions of the nurse relative to the nursing process necessary to provide good nursing care.

3. Outcome standards are designed to measure the results of care provided in terms of changes in the health status of clients served and satisfaction of those served.

Performance Evaluation - It is a method of observation through which the individuals efficiency is evaluated over a period of time.

Quality Assurance - It is a means of achieving accomplishment and implies a guarantee of excellence.

Quality Assurance Methods

1. Nursing Audit is a quality measurement method through evaluation of nursing care done in an unannounced manner.

2. Patient Care Audits it is done through review of charts, observation of nursing staff and observation of the effects of care to the patients.

3. Peer Review Done by peers evaluating anothers job performance against accepted standards.

4. Quality Circles a group of workers doing similar work who meet regularly, voluntarily on normal working time, to identify, analyze and solve workrelated problems and recommend solutions to management.

Discipline - It is rigid obedience to rules and regulations, the violations of which results to punitive actions.

Disciplinary Approaches
1. Counseling and Oral Warning done in private and in informal manner. Employee is counseled regarding expectations of improved performance.

2. Written Warning The employee is told of his below performance and a written warning is given.

3. Suspension It is done when management feels that employee can still be rehabilitated. Due process of law is done.

4. Dismissal when all disciplinary efforts have failed. It should be in conformity of a major violation as contained in the policy manual.

Relevant Board Exam Questions

1. Jiggy, a registered nurse, worked with her staff to develop objectives for her unit, which will establish priorities for procedures. This is an example of which of the following management processes? A. Controlling B. Directing C. Organizing D. Planning

2.

A document that describes the institutions purpose is: A. The organizational chain of command. B. The organizational chart C. The mission statement D. The strategic plan

3.

There are various responsibilities of nurses in different positions and levels. Which of the following is NOT a major responsibility of the nurse manager of a hospital ward? A. Setting standards of nursing performance B. Designing the nursing staff schedules C. Performing morning care to clients D. Coordinating and delegating of care.

4. In anticipation of a nursing shortage, the nursing management in a facility is investigating a nursing care delivery model that involves the division of tasks, with one nurse assuming the responsibility for particular tasks. This model is called: A. Total patient care B. Functional nursing C. Team nursing D. Primary nursing

5. Nurses play an integral role in the development, implementation, and evaluation of a unit or department budget in a nursing organization. An operational budget accounts for: A. The purchase of minor and major equipment. B. Construction and renovation. C. Income and expenses associated with daily activity in an organization. D. Applications of new technology to patient with chronic disorders.

6. A staff nurse made a medication error this morning and reported it to you, the charge nurse. Whats the best initial response for you to make? A. Inquire about the clients physiologic response to the error B. Remind the nurse about the importance of medication safety C. Write up an incident report D. Discuss process changes with the nurse manager

7. The nurse manager announces that the emergency department (ED) will begin benchmarking results from client satisfaction surveys. Which is the best understanding of that concept? A. The ED will compare its current scores with its previous scores B. The ED will compare the ED nurses scores with the ED physicians scores C. The ED will compare its scores with the best in the field D. The ED will compare its scores with other departments scores.

8. Rapid changes in health care environment have expanded the decision-making role of the nurse. Decision making is best described as: A. The process one uses to solve a problem. B. The process one uses to choose between alternatives. C. The process one uses to reflect on a certain situation. D. The process one uses to generate ideas.

9.

Before any memorandum or notice from the nurse director, Corazon and the other staff were already aware of the new policy regarding proper decorum. They get the information from the co-staff at the other station. This method of communication is called: A. Lateral B. Diagonal C. Grapevine D. Informal

10.

A tall organizational structure is reflective of what type of organization? A. Centralized B. Decentralized C. Wide D. Matrix

And Finally

Nurses who are managers play a critical difference every day in the lives of their patients families. By using their expert knowledge they manage and meet patient care needs.

Please text me when you pass the Nurse Licensure Examination (NLE) !!!

0933-3053795 gjoven66@yahoo.com (Facebook account)