Final Nursing Management

PUT YOUR NOTES IN ONE LONG BOND PAPER NOT FOLLOWING INSTRUCTION MEANS NO OPEN NOTES DURING THE QUIZ INSTRUCTION FOR THE QUIZ

PREPARED BY: Michael Bonito G. Tamayo, RN NURSING MANAGEMENT PROCESS

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

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

MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS PLANNING

PLANNING
Is deciding in advance what to do, how to do a particular task, when to do it, and who is to do it.
Is predetermining a course of action in order to arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known

COMPONENTS OF PLANNING PLANNING: PREDETERMINED ACTION WHO IS TO DO IT: -professional, non-professional HOW TO DO IT: -technique, principles WHAT TO DO: -nursing activities

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.
6. Planning should be time bounded.
7. Projected plans must be documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement.

PLANNING
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
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
GOALS are broad statements of intent derived from the purposes of the organization
Is a desired aim or condition toward which one is willing to work
Individual goals- are personal goals; based on one’s desired in life
Group goals- may refer also to organizational goals although on a smaller scale
Organizational goals- management goals of an organization that are established to justify its existence
Short term goals and long term goals

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)

11 key areas of responsibilities to nursing practice
Safe and quality nursing care
Management of resources and environment
Health education
Legal responsibility
Ethico-moral responsibility
Personal and professional development
Quality improvement
Research
Record Management
Communication
Collaboration and teamwork

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

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

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

Principles of Time Management
Planning for contingencies-planning anticipates the problem that will arise from actions without thought
Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance
Inventory
Sequencing
Setting and keeping deadlines- and adhering to deadline is an excellent exercise in self discipline
Deciding on how time will be spent

Time Saving Techniques, Devices and Methods to Better Use of Time
Conduct an inventory of your activities.
Set goals and objectives and write them down.
With the use of calendars, executive planners, logs or journals, write what you expect to accomplish yearly, monthly, weekly or daily.
Break down large projects into smaller parts.
Devote a few minutes at the beginning of each day for planning.
Organize your work space so it is functional.
Close your door when you need to concentrate.
Learn to delegate.
In a meeting, define the purpose clearly before starting.
Take or return phone calls during specified time.
Develop effective decision-making skills.
Take rest breaks and make good use of your spare time.

Multitasking
Trying to get more things done in less time
Examples: answering phone calls while driving, sending e-mails while in the meeting

DEVELOPING AND SCHEDULING PROGRAMS
Programs are predetermined, developed and targeted within a time frame to reach the set goals and objectives.
The Planning Formula
WHAT
WHEN
WHERE
HOW
WHO
WHY
CAN

PREPARING THE BUDGET
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.
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.
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

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

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

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

Nursing procedures
Procedures are specific directions for implementing written policies
Procedures are more specific guide to action than policy

NURSING MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS ORGANIZING

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

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
Division of labor
Unity of command
Authority and responsibility
Span of Control
Contingency Factors

ELEMENTS OF ORGANIZING
Organizational Structure
Staffing
Scheduling
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

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
Lower likelihood of messages being distorted
Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction
The principle of “shared governance” produces maximum potential for professional growth
Disadvantages
Supervisor spend less time with each worker
Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions

Types of Organization Classified by Nature of Authority
Line Organization- each position has general authority over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal)
Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization)
Staff Organization- purely advisory to the line structure with no authority to put recommendations into action.
Functional Organization – each unit is responsible for a given part of the organization’s workload.

TYPES OF ORGANIZATIONAL STRUCTURE
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.

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

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

4. Functional Organization
- permits a specialist to aid line position within a limited and clearly defined scope authority.

ORGANIZATIONAL RELATIONSHIP
FORMAL RELATIONS
INFORMAL RELATIONS

FORMAL RELATIONS
- represents by uninterrupted lines between units, showing who reports to whom.

2. INFORMAL RELATIONS
- represented by a broken or dotted line, where power relationships are coordinated.

ORGANIZATIONAL CHART
- Organizational chart is a line drawing that shows how the parts of an organization are linked.

Characteristics of an Organizational Chart
Division of Work
Chain of Command
Type of Work to be performed
Grouping of Work Segment
Levels of Management

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
“ Self care” or Minimal Care Patients
Intermediate or Moderate Care
Total Care Patients
Intensive Care Patients

“ 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

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)

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

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
Surgery
General Ward
Pediatric
Pathologic Nursery
Medical
OB
ICU/ER/RR
CCU
3.4 3.5 4.6 2.8 3.4 3.0 6.0 6.0 60:40 60:40 70:30 55:45 60:40 60:40 70:30 80:20

Distribution Per Shift
SHIFT PERCENTAGE AM PM NIGHT 45 % 37% 18%

CATEGORIES OF PATIENT
Levels of Care NCH Needed /pt./ day Prof: Non Prof Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care 1.50 3.0 4.5 6.0 7.0 or higher 55:45 60:40 65:35 70:30 80:20

PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CARE
Type of Hospital Minimal Care Moderate Care Intensive Care Highly Spl. Care Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital 70 65 30 10 25 30 45 25 5 5 15 45 - - 10 20

TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Personnel/Yr Working Hours per Week 40 hours 48 hours
Vacation Leave
Sick Leave
Legal Holidays
Special Holidays
Special Privileges
Off Duties as per R.A. 5901
Continuing Education Program
Total Non-Working Days/Year
Total Working Days/Year
Total Working Hours / Year
RA 5901 = 40H WK LAW
15 15 15 15 10 10 2 2 3 3 104 52 3 3 152 100 213 265 1,704 2,120

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% = 37.5 intensive care
250 X 10% = 25 highly specialized nursing care

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

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 )

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. TOTAL # OF NURSING PERSONNEL NEEDED + RELIEVERS
165 + 25 = 190 TOTAL PERSONNEL NEEDED

6. DETERMINE PROF FROM NON PROF PERSONNEL
e.g. tertiary hospital
190 X 65% = 124 PROFESSIONAL
190 X 35% = 68 NON PROFESSIONAL

7. DISTRIBUTE PER SHIFT
PROFESSIONAL(124) NON PROFESSIONAL(66)
AM (45%) 56 30
PM (37%) 46 24
NIGHT (18%) 22 12

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

SCHEDULING
A schedule is a timetable showing planned work days and shifts for nursing personnel.
Factors to Consider in Making a Schedule
Different levels of the nursing staff
Adequate coverage for 24 hours, 7 days a week
Staggered vacations and holidays
Weekends
Long stretches of consecutive working days
Evening and night shifts
Floating

Assessing a Scheduling System
Ability to cover the needs of the shift
Quality to enhance the nursing personnel’s knowledge, training and experience
Fairness to the staff.
Stability
Flexibility

Types of Scheduling
Centralized Schedule
Decentralized Schedule
Cyclical Schedule

SCHEDULING VARIABLES
Length of scheduling period whether 2 or 4 weeks
Shift rotation
Week-ends off
Holiday off
Vacation leave
Special days
Scheduled events in the hospital , training programs, or meetings
Job categories
Continuing professional education (CPE) programs

DEVELOPING JOB DESCRIPTION
Job Description is a statement that sets the duties and responsibilities of a specific job.
Contents of a Job Description
Identifying Data
Job Summary
Qualification Requirements
Job Relationships
Specific and Actual Functions and Activities

Uses of Job Description
For recruitment and selection of qualified personnel
To orient new employees to their jobs
For job placement, transfer or dismissal
As an aid in evaluating the performance of an employee
For budgetary purposes
For determining departmental functions and relationships to help define the organizational structure
For classifying levels of nursing functions according to skill levels required.
To identify training needs
As basis for staffing
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

Principles of Delegation
Select the right person to whom the job is to be delegated.
Delegate both interesting and uninteresting tasks.
Provide subordinates with enough time to learn.
Delegate gradually.
Delegate in advance.
Consult before delegating.
Avoid gaps and overlaps.

What Cannot be Delegated
Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit.
Authority to sign one’s name is never delegated
Evaluating the staff and or taking necessary corrective or disciplinary action.
Responsibility for maintaining morale or 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.

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.

Aspects of Delegation
1. Responsibility – denotes obligation
2. Authority – the power to make final decisions and give commands.
3. Accountability – refers to liability

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

Types of Communication
1. Verbal Communication
2. Written Communication
3. Non-verbal Communication
Personal appearance
Intonation of the voice
Facial expression
Posture and gait
Touch

Lines of Communication
UPWARD
to superior
HORIZONTAL OUTWARD
to peers and to patient, family
members of the and community
Health Team to workers’ family
and friends
DOWNWARD
to subordinates
NURSES

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

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.

Art of Decision Making:
Not making decision that others should make, to preserve morale and authority;
Not deciding on problems that are not pertinent to matters at hand to prevent waste of time and energy;
Not deciding prematurely to prevent prujudice
Not making ineffective decisions to avoid losing the respectability of the decision maker.

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

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

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.

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.

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.

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.

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.

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.

Nursing management - CONTROLLING -
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.

Reasons For Conducting Evaluation
Evaluation 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 a means for employees to monitor their own performance.
It 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 resources.
It provides feedback for improvement.

Principles of Evaluation.
The evaluation must be based on the behavioral standards of performance which the position requires.
The evaluation should have enough time to observe employee’s behavior.
The employee should be given a copy of the job description, performance standards, and evaluation conference.
The employee’s performance appraisal should include both satisfactory and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments.
Areas needing improvement must be prioritized to help the worker upgrade his/her performance.
The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee.
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.

Characteristics of an Evaluation Tool
Should be objective
Should be reliable
Should be sensitive

PERFORMANCE APPRAISAL
Performance appraisal is a control process in which employee’s performance is evaluated against standards.
Purposes of Performance Appraisal
Determine salary standards and merit increases.
Select qualified individuals for promotion or transfer.
Identify unsatisfactory employees for demotion or termination
Make inventories of talents within the institution.
Determine training and development needs of employee.

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.

Methods of Measuring Performance
Essay
Checklist
Ranking
Rating Scales
Forced-choice Comparison
Anecdotal Recording

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Final Nursing Management

by Michael Bonito Tamayo

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