directing directing directing

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DIRECTING

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Directing
The issuance of orders, assignments and
instructions that enable the nursing
personnel to understand what are
expected of them.

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Directing
Includes supervision and guidance
Actuates efforts to accomplish goals
Connecting link between organizing for
work and getting the job done

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Elements of Directing
1. Delegation
2. Utilizing/revising/updating nursing
service policies and procedures
3. Supervision of personnel
4. Coordination of services
5. Communication
6. Staff development
7. Making decisions

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Elements of Directing
1. Delegation
 Is the process by which a manager assigns
specific tasks/duties to workers with
commensurate authority to perform job.
 2 criteria are:
1. ability of worker to carry out the task
2. fairness not only to the employer but to the team as
a whole

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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

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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 disciplining
action

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What cannot be delegated?
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

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*Sharing of Experiences
Why nurse managers do not delegate?
1. Due to lack of confidence in their staff
2. Feeling that only they could do the task
better and faster
3. They fear loss of control if some of their
duties are delegated

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Nursing Care Assignment
 Also known as modalities of nursing
care, systems of nursing care, or
patterns of nursing care

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Nursing Care Assignment
Functional Nursing
 Is task-oriented in which a particular
nursing function is assigned to each
worker
 Is the best system that can be used
when there are many patients and
professional nurses are few

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Functional Nursing
Advantages:
1. Allows most work to be accomplished in
the shortest time possible
2. Workers learn to work fast
3. Because the tasks are repetitive they
gain skill faster in that particular task
4. There is greater control over work
activities

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Functional Nursing
Disadvantages
1. Fragmentation of nursing care and therefore
holistic care is not achieved
2. Nurses’ accountability and responsibility are
diminished
3. Patients cannot identify who their “real nurse”
is

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Functional Nursing
Disadvantages
4. Nurse patient relationship is not fully
developed
5. Evaluation of nursing care is poor and
outcomes are rarely documented
6. It is difficult to find a specific person who can
answer the patient’s or relatives’ questions

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Total Care or Case Nursing
One nurse is assigned to one patient for
the delivery of total care.
The nurse plans, coordinates, implements,
evaluates and documents the nursing care
she has given during her shift

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Total Care or Case Nursing
Common assignment for PDNs, ICU
nurses, Isolation room and for nursing
students
The nurse is accountable for her own
action
Works best for plenty of nurse for few
patients

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Team Nursing
Is a decentralized system of care in which
a qualified professional nurse leads a
group of nursing personnel in providing for
the nursing needs of a group of patients
through participative effort

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Team Nursing
Team leader assigns patients and tasks to
team members according to job
descriptions.
Team leader is responsible for
coordinating the total care of a group of
patients
Team conference is the heart of team
nursing

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Primary Nursing
The primary nurse assesses the patient’s
needs for care, sets care goals, writes an
NCP, administers care according to plan,
evaluates the outcomes of care, and
makes the necessary changes or
adjustments as necessary. She also
provides pre-discharge planning and
teaching

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Primary Nursing
Extension of the principle of
decentralization of authority
Secondary or associate nurse execute the
NCP during PM and night shift and when
relieving

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Primary Nursing
Advantages:
1. Increased autonomy on the part of the
nurse thereby increasing motivation,
responsibility and accountability
2. Assumes continuity of care
3. Makes available the increased
knowledge of the patient’s psychosocial
and physical needs

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Primary Nursing
Advantages:
4. Leads to increased rapport and trust
between the nurse and the patient
thereby establishing therapeutic
relationship
5. Improves communication with members
of the health team
6. Eliminates the use of nursing aides in the
provision of direct nursing care

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Modular Nursing
Is a modification of team and primary
nursing
The nurse provides direct nursing care
with the assistance of aides.
The nurse provides leadership, support
and instruction to the non-professional
nursing personnel

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Case Management
Is a system of patient care delivery that
focuses on the achievement of outcomes
within effective and appropriate time
frames and resources
It focuses on an entire episode of illness,
crossing all settings in which the patient
receives care.

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Case Management
The care manager is responsible for the
assessment of patient and family,
establishes the nursing diagnosis,
develops the NCP, delegates nursing care
to associates, activates interventions,
coordinates and collaborates with
interdisciplinary team and evaluates
outcomes of care.
Examples are prepaid health care plans
and HMOs

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Elements of Directing
2. Utilizing/Revising/Updating Nursing
Service Policies and Procedures
 Nursing service exists for standardization
and as a source of guidance for the
nursing staff.

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Elements of Directing
3. Supervision
 To supervise means to inspect, to guide,
evaluate, and improve work performance
of employees through criteria against
which the quality and quantity of work
production and utilization of time and
resources are made.

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Supervisory Techniques
1. Observation during rounds
2. Spot checking of charts through nursing
audit
3. Asking the patients about the care they
receive
4. Looking into the general condition of the
units

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Supervisory Techniques
5. Getting feedback from co-workers or
other supervisors or relatives
6. Asking questions discretely to find out
the problems they encounter in the
wards
7. Drawing out suggestions from the
workers for improvement of their work or
work situation

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Leadership
Include activities such as directing which is
actuating efforts to accomplish goals;
supervising or overseeing work of
employees; coordinating or unifying
personnel and services among others.

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Leadership Qualities
1. A leader possesses a striking physical
personality and is energetic
2. A leader possesses a sense of purpose
and direction.
3. A leader has the power of ready speech
4. A leader is enthusiastic about the
purpose of the group and is devoted to
its cause

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Leadership Qualities
5. A leader has keen insight into the human
nature
6. A leader displays courage and
persistence even in the face of
opposition
7. A leader is decisive
8. A leader is cheerful and even-tempered

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Leadership Qualities
9. A leader shows technical mastery that
inspires others to do above average
performance in their jobs
10.A leader is intelligent, versatile, and has
a sense of humor
11.A leader has moral vision, integrity and
idealism

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Leadership Styles
1. Autocratic Leadership
 Sometimes called directive or bureaucratic
 Autocratic leader:
 uses coercion in the exercise of his or her powers
 functions with high concern for task
accomplishment but low concern for the people
who perform the tasks
 has no confidence and trust in his/her subordinates

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Leadership Styles
1. Autocratic Leadership
 Autocratic leader:
 seldom gets ideas and opinions from their
subordinates in solving work problems
 gives orders and expects adherence to policies and
procedures
 This style provides strong motivation and
psychological regard for the leader

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Leadership Styles
1. Autocratic Leadership
 Autocratic leader:
 It is most effective in crisis situations when highly
specialized skills are required and options for activities
are limited.
 It is used to bring order out of chaos.
 Sometimes called “centric” because the leader makes
decision for the group. He is the center of attention.
 Also called Theory X by McGregor
 Boss-centered

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Leadership Styles
2. Democratic, Participative or
Consultative Leadership
 People-oriented
 Focuses on human aspects and builds
effective teamwork.
 Collaborative spirit and joint efforts exist.

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Leadership Styles
2. Democratic, Participative or
Consultative Leadership
 Allows governance through group participation
in decision making
 Open communication prevails
 Theory Y
 The leader is “radic”, he radiates out to
encompass the needs of others

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Leadership Styles
3. Permissive, Ultraliberal or Laissez-
faire Style of Leadership
 “let alone” style of leadership, leader abdicates
leadership responsibility and leaves workers
without direction, supervision, or coordination.
 The leader:
 avoids responsibility by relinquishing power to
subordinates
 permits his followers to engage in managerial
activities such as decision making, planning,
structuring the organizations, setting goals, and
controlling the organization
 is ultra liberal

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Leadership Styles
4. Situational Leadership
 Contingency style leadership
 Leader’s style matches the situation and its
needs.
 To accomplish the management process, the
leader must know himself, his followers and
the character of the work situation
 The situational leader must be flexible enough
to make adaptations and changes

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Leadership Styles
5. Theory Z (Ouchi)
 Enlarges the Theory Y and the democratic
approach to leadership
 Has a humanistic viewpoint and focuses on
developing better ways of motivating people.
a. Collective decision-making
b. Long-term employment
c. Slower promotion
d. Indirect supervision
e. Holistic concern

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Elements of Directing
4. Communication
 is the transmission of information,
opinions, and intentions between and
among individuals.
 has purposes:
 Facilitate work
 Increase motivation
 Effect change
 Optimize care
 Increase worker satisfaction
 Facilitate coordination

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Principles of Effective Communication
1. Clear lines of communication serve as the
linking process by which parts of the
organization are unified toward goal
achievement
2. Simple, exact and concise messages
ensure understanding of the message to
be conveyed
3. Feedback is essential to effective
communication

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Principles of Effective Communication
4. Communication thrives best in a
supportive environment which
encourages positive values among its
personnel
5. A manager’s communication skill is vital
to the attainment of the goals of the
organization
6. Adequate and timely communication of
work-related issues or changes that may
affect jobs enhance compliance

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Lines of Communications
1. Downward Communication
 Traditional line of communication from superior to
subordinate
 Communication is primarily directive and activities are
coordinated at various levels of the organization
 Communication aims to impart what the personnel
need to know, what they are to do and why they are to
do these.
 Includes communication includes policies, rules and
regulations, memoranda, handbooks, interviews, job
descriptions, and performance appraisal

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Lines of Communications
2. Upward Communication
 Emanates from subordinates and goes
upward
 Usually in the form of feedback to show the
extent to which downward communication has
been received, accepted, and implemented
 Does not flow as easily as downward
communication
 Examples are discussions between
subordinates and superiors, grievance
procedures, written reports, incident reports
and statistical reports

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Lines of Communications
3. Horizontal/Lateral Communication
 Flows between peers, personnel or
departments on the same level
 Used most frequently in the form of
endorsements, between shifts, nursing
rounds, journal meetings and conferences, or
referrals between departments or services
 Coordination of duties and cooperation among
the various departments will be maximized if
communication is open to ensure smooth work
flow

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Lines of Communications
4. Outward Communication
 Deals with information that flows from the
caregivers to the patients, their families,
relatives, visitors and the community
 Involves how employees value their work
 May be directly or indirectly communicated to
their families

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Elements of Directing
5. Coordination
 Unites personnel and services toward a
common objective
 Prevents overlapping of functions, promotes
good working relationships and work
schedules are accomplished as targeted.

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Elements of Directing
5. Coordination
 Coordination with the medical service
 Coordination with the administrative service
 Coordination with the laboratory service
 Coordination with radiology service
 Coordination with pharmacy service
 Coordination with the dietary service
 Coordination with the medical social service
 Coordination with the medical records service
 Coordination with community agencies, other
institutions and civic organizations

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Elements of Directing
6. Staff Development
 Is provided by nurse instructors under training
departments or units or by supervisors and
head-nurses
 Participation in journal meetings, case
presentations, or accessibility for consultations
eases the new employee’s transition and
integration to the agency
 “Shadowing”, “big sister” or “buddy”

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Elements of Directing
7. Decision Making
 Is a course of action that is consciously
chosen from available alternatives for the
purpose of achieving a desired result
 It involves a choice utilizing mental
processes at the conscious level and is
aimed at facilitating a defined object.

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The 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 prejudice
 not making ineffective decisions to avoid losing
the respectability of the decision maker

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Process of Decision Making:
Definition of the problem
Analysis of the problem
Development of an alternative solution
Selection of the solution
Implementation and follow-up

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Conflict Management

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Conflict
Is as inevitable as change in any
organization because of the complexity of
relationships within the organization, the
interaction among its members or their
dependence on one another.
Is a clash between two opposing and
oftentimes hostile parties.

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Conflict
Is a warning to managers that something
is wrong and needs solution through
problem solving and clarification of
objectives, establishment of group norms,
and determination of group boundaries.

59. Gerald T. Evangelista RN, MAN 59
Sources of Conflict
1. Human interactions that relate to conflict
are characterized by competition,
domination and provocation
2. Factors that provoke conflict are failure
to provide assistance or complete
information on patient care.
3. Confrontation, disagreements, and anger
4. Differences in position in the hierarchy

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Types of Conflict
According to Behavior
1. Covert conflict is more dangerous
because it is not what it appears on the
surface. It results in harbored feelings
that drain both physical and
psychological energy.
2. Overt conflict is usually seen.

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Types of Conflict
According to Hierarchical Relationships
1. Vertical conflict
 Differences in opinions between superiors and
subordinates are caused most often by inadequacy in
communication, opposing interests, and lack of shared
perceptions and attitudes
2. Horizontal or line and staff conflict
 Struggle or strife between departments or services
 Lack of consensus and clash of personalities

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Types of Conflict
According to Standpoint
1. Behavioral, it is a perceived condition that
exists between two parties when one or more
parties perceive goal incompatibility and some
opportunity for interfering with goal
achievement of the other
2. Process, conflict occurs when real or
perceived conflict exists in goals, values,
ideas, attitudes, beliefs, feelings or action of
two or more parties. It can occur intra-
personally or interpersonally & intra-group or
inter-group.

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Conflict Resolution
1. Avoidance
 Is the method commonly used by groups who
do not want to do something that may interfere
with their relationships.
 Appropriate when more information is needed
to solve the problem, when it is appropriate for
others to solve the problem or when one
wishes to reduce tension and gain composure

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Conflict Resolution
2. Accommodation
 Self-sacrifice
 Appropriate when the person is wrong, the
opponent is more powerful, or when the issue
is more important to someone else

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Conflict Resolution
3. Collaboration
 Inspires mutual attention to the problem and
utilizes the talents of all parties.
 Focuses on problem-solving to find mutually
satisfying solutions.
 Useful in situations where the goals are too
important to be compromised.
 Most effective method

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Conflict Resolution
4. Compromise
 Both parties seek expedient, acceptable
answers for short periods when the goals are
only moderately important and the parties
have equivalent power.
 Accommodation and adjustment lead to
workable situations rather than to the best
solutions
 “lose-lose” solution

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Conflict Resolution
5. Competition
 Expressed through suppression of conflict
through authority-obedience approach
 Enforces the rule of discipline
 Assertive position that fosters conflict
resolution on the part of the subordinate.

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Conflict Resolution
6. Smoothing
 Disagreements are ignored so that surface
harmony is maintained in a state of peaceful
co-existence.
 Accomplished by complementing one’s
opponent, downplaying differences, and
focusing on minor areas of agreement as if
little disagreements exist
 Appropriate for solving minor problems

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Conflict Resolution
7. Withdrawing
 Means that one party is removed thereby
making it possible to resolve the issue. It
produces the same results as smoothing.

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Conflict Resolution
8. Forcing
 Yields an immediate end to the conflict but
leaves the cause of the conflict unresolved.

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Basic rules on mediating a conflict
between 2 or more parties
1. Establish clear guidelines and make
them known to all
2. Do not postpone indefinitely. Select a
time that is best for all parties.
3. Create an environment that makes
people comfortable to make suggestions.

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Basic rules on mediating a conflict
between 2 or more parties
4. Keep a 2-way communication.
5. Stress a peaceful resolution rather than
confrontation.
6. Emphasize shared interests.
7. Follow-up on the progress of the plan.