final seminar on directing in nursing management

7/29/2019 Final Seminar on Directing in Nursing Management

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AIM:

At the end of the seminar the student will be better equipped to

perform the directing function in nursing management, by using

motivation.

Objectives:

At the end of the session the student will be able:

To understand directing as a function of nursing management.

Get an understanding of the roles and functions of various cadres in

nursing management.

To understand the characteristics/features of motivation.

To know the need of motivation of employees.

To know the steps in motivation process.

How to create & implement a strategy for motivation

To understand the model of motivation.

To get knowledge about the theories of motivation.


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To know the types of motivation.

To know about the motivational approaches.

To know about the motivational killer.

To know the importance of motivation.

To know the what is effective motivation.

To understand the techniques to build motivational climate.

To understand Role & functions of manager/administrator .

To understand the methods of motivating employees.

To know the advantages of motivation.

Understand the role of motivation in directing the employees /

subordinates.


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Directing

Introduction

Directing/Direction is a function of management performed by top level

management in order to achieve organizational goals. It is very important and

necessary function of management. Management has to undertake various

activities like, guide people, inspired and lead them as well as supervision of

their activity is required in order to achieve desired results.

Meaning and Definition

Direction consists of the process and techniques utilized in issuinginstructions and making certain that operations are carried as originally

planned.

Directing involves determining the course, giving order and instructionand providing dynamic leadershipMarshall

Activating means and moving into action- supplying simulative powerto the group- G.R Terry

Directing is the process through which a manager communicates with andinfluences other members of the organization in the pursuit of company

objectives.

Directing is said to be a process in which the managers instruct, guide andoversee the performance of the workers to achieve predetermined goals.


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Directing is said to be the heart of management process. Directing

initiates action and it is from here actual work starts. Direction is said to

be consisting of human factors. In simple words, it can be described as

providing guidance to workers is doing work. In field of management,

direction is said to be all those activities which are designed to encourage

the subordinates to work effectively and efficiently. According to Human,

Directing consists of process or technique by which instruction can be

issued and operations can be carried out as originally planned Therefore,

Directing is the function of guiding, inspiring, overseeing and instructing

people towards accomplishment of organizational goals.

The managerial function of directing is like the activities of a teacher in aclassroom. In order to teach, a teacher has to guide his students, maintain

discipline, inspire them and lead them to the desired goal. It is a very

important function in the management of any enterprise. It helps the

managers in ensuring quality performance of jobs by the employees and

achievement of organizational goals.

The Three important skills that the nurse manager must possess when they

are trying to influence the behaviour of other:-

1) Diagnose: The manager must first know the problem or the situation thatneeds direction.


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2) Adapt: - As the situation demands, the manager must try to fit themselvesinto the situation & understand it before directing others to do so.

3) Communication:- Having understood , analysised & changed theirbehaviour according to the situation the managers shall communicate to

other members to understand the situation & change their behaviour

accordingly.

Features of directing

Ongoing process: - Directing is not an intermittent function ofmanagement. It is a process of continuously guiding the behaviour of

individuals.

Not supported by rules :- Since the behaviour of an individual cannotbe predicted

through any mathematical or statistical tool, the function of directing is

purely based on possibilities of outcomes of application of behavioural

sciences & is not supported by any rules or regulations.

Directing is situational:- The force applied by the managers ininfluencing the individual behaviour changes from situation to situation.

The environment, the nature of individuals the group behaviour to

which an individual belongs, the attitude of individuals towards the

working are some of the factors that the nursing manager must keep in

mind while directing.


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Behavioural science:- Since directing deals with the human behaviour,the managers should try to study the different aspects of human

psychology to develop an understanding of how to influence this

behaviour.

Understanding of the group behaviour:- No individual can inisolation. While he is working in an organisation, he becomes the part

of the informal groups.The behaviour of a person is different as an

individual & a member of group it is therefore, essential that the

managers understand the importance & nature of group behaviour to be

able to direct effectively.

Participative in nature:- The directions issued by managers initiateaction on the part of individual to ensure greater participation of

individual in carrying out the organisational activities, they should be

made a part of the discussion & meeting where the various directive are

being discussed.

Importance of Directing

Plans remain mere plans unless they are put into action. In the absence

of direction, subordinates will have no idea as to what to do. They will probably

not be inspired to complete the job satisfactorily. Implementation of plans is,

thus, largely the concern of directing function. As a function of management,

directing is useful in many ways.


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Creation of a sound work environment:- Issuing directions in

consultation with maximum potential, willingly & enthusiastically to

contribute towards organisational goals.

Development of managers:- The managers must be personally

motivated to work in a given work environment & only thereafter should

direct others to work. The managers thus try to develop their skills &

competence to fit into a given situation & then direct others to follow.

Working of managers & others organisational members with cooperation

& harmony helps not only in prompting the skills of the members but also

enables the managers to develop themselves as potential candidates for

being promoted to higher levels of organisation structure.

Behavioural satisfaction:- As the emphasis in farming directive is on the

human behaviour & psychology, the individuals feel behaviourally

satisfied & feel personally inspired to work towards the attainment of

organisation goal.

Increase the productivity:- Personally satisfied employees contribute

towards increased output & overall efficiency of the organisation.

Achieves coordination:- Directing, described as an ongoing process

aims at continual supervision of the activities of the organisational

members. This ensures that they are working according to the planned

activities in a coordinated & an integrated manner.


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Facilitates control:- Co ordination of individuals efforts aims at

bringing the actual performance in conformity with the planned

performance. The controlling function is also thus, facilitated through

effective directing.

Facilitate growth:- An organisation where the managers direct the

individuals actions in a co ordinate & a balanced manner, is a stable &

better condition to grow & adapt itself to environment changes than the

one where direction is not effective.

Principles of direction

1) Unity of command:- One boss for one subordinate that is all directionsorders & instructions should come from only one boss, is the basic

principles that must be followed to mark direction effective. If one

subordinate receives instructions from more than one superior, there are

chances that he would not be able carry out the instructions of either of

the two.

2) Unity of direction:- One plan or related set of activities must have onlyone head. All activities related to personnel should be headed by the

personnel manager. This helps in avoiding duplication of action &

instructions, thereby economising on the use of scare resources.

3) Appropriate selection of employees:- The managers while selectingemployees must ensure that the employees are capable of adjusting


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themselves to the organisation structure & are both willing & able to

carry out the directions issued by their superior.

4) Participation: Since directing relates to influencing the behaviour ofothers, the managers should preferably follow the principle of

participation of those who have to actually carry out the directions.

5) Communication:- To make direction effective, the managers mustensure that there is a two way flow of communication between managers

& subordinates.

6) Counselling & guidance:- When the subordinate face problems incarrying out their task, the managers must provide them with necessary

counselling & guidance. This will make direction more effective as the

subordinates are free to approach their superiors for counselling.

7) Synthesis conflicting objective:- Each group of people, whether owners,managers, or labour has its own personal interest as supreme while

carrying out the organisational activities. This can lead to conflicting

interests which may hamper the overall organisational growth. Effective

directions, motivation, guidance & counselling people about the need to

consider their goals as subordinate to the overall goals shall enable the

different group of people move towards the common directions. The

conflicting objective are thus synthesized into one single plan, one

objective, one direction & one goal & that is ,to achieve the overall

organisational goals.


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8) Direct supervision:- Work by their superiors shall help them in knowingdeviations in their work performance & the ways to remove them. This

will increase their interest in the work & also their confidence & loyalty

in their supervisors.

Characteristics of Directing

1. Pervasive Function - Directing is required at all levels oforganization. Every manager provides guidance and inspiration to

his subordinates.

2. Continuous Activity - Direction is a continuous activity as itcontinuous throughout the life of organization.

3. Human Factor - Directing function is related to subordinates andtherefore it is related to human factor. Since human factor is

complex and behaviour is unpredictable, direction function

becomes important.

4. Creative Activity - Direction function helps in converting plansinto performance. Without this function, people become inactive

and physical resources are meaningless.

5. Executive Function - Direction function is carried out by allmanagers and executives at all levels throughout the working of an

enterprise; a subordinate receives instructions from his superior

only.


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6. Delegate Function - Direction is supposed to be a function dealingwith human beings. Human behaviour is unpredictable by nature

and conditioning the peoples behaviour towards the goals of the

enterprise is what the executive does in this function. Therefore, it

is termed as having delicacy in it to tackle human behavior.

Elements of Direction

1. Communication2. Supervision3. Motivation4. Leadership

These are the four essential elements of directing. We shall discuss

about the nature and significance of each of these components.


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Communication

- Complex and multifaceted phenomenon. It is the process by which

verbal and non-verbal symbols are sent, received and given meaning.

Communication word has been derived from Latin word Communis

which means common, thus communication stands for sharing of an idea in

common.

Communication is an exchange of facts, ideas, opinions or emotions by

two or more persons Newman and Summer

It is a sum of all the things one person does when he wants to create

understanding in the minds of another. It is a bridge of meaning, it involve

systematic telling, listening, and understanding Haimann


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Most Common Way to Communicate

Speaking

Writing

Body Language

Visual Images

Elements of Communication

People- minimum is 2; one will act as the sender and the other the receiver.

Messagethe content or the substance of what is being communicated, could

be an idea, feeling, instruction, fact or opinion.

Channel the medium and the manner by which the message is conveyed ;

could be verbal or non-verbal.

Feedback the reaction of the receiver to the message as conveyed through a

particular channel; measures the effectiveness of the communication.

Noiseanything that distorts the message conveyed.


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Communication Process (NOTE: EXPLAIN)

The process by which a message, encoded by a sender, is transmitted through a

medium to a receiver, who encodes the message and provides feedback.

FOUR BASIC DIRECTIONS

Downward Communication

Communication which flows from the superiors to the subordinates is known

as downward communication. In an organizational structure, the superiors

utilize their abilities to attain the desired targets which mean that they may be

engaged in issuing commands, directions and policy directives to the persons

working under them. Under downward communication, the superiors anticipate

instant recital of a job thats why it is highly directive. Katz and Kahn have

identified five general purposes of superior-subordinate communication.

a. To give specific task directives about job instructionb. To give information about organization procedures and practicesc. To provide information about the rationale of the jobd. To tell subordinates about their performancee. To provide ideological-type information to facilitate the indoctrination of

goals


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Upward Communication

Travels from subordinate to superior. The most common purpose of this

communication is to provide feedback on how well things are going. It provides

also the middle level managers the opportunity to represent their subordinates to

the upper level managers.

a. Open-Door Policy -(a communication policy in which a manager,

CEO, president or supervisor leaves their office door "open" in order to

encourage openness and transparency with the employees of that company.)

b. Complaint program

Lateral Communication

Lateral communication refers to messages conversed between people on

the same hierarchical level. For example, in terms of the workplace, if two

supervisors have a discussion or two board members raise an issue this is

known as lateral communication. The most common reason for this

communication flow is to provide coordination and teamwork.

Diagonal Communication

Occurs between people who are neither in the same department nor in the

same level of management hierarchy. In this case, someone communicate either

downward or upward with someone in another functional area. In utilizing this


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flow of communication, protocol must be observed so as not to bypass the

authority of the person concerned

EFFECTIVE METHODS OF COMMUNICATION

Methods Factors to consider

Electronics these are highly effective means of quickly reaching those withwhom you are communicating

Interaction and participation are possible and often simple for allinvolved parties

Their ease of use means that they pose a possible risk ofcommunications overload

The seemingly endless possible combinations of words, images andcolor are very powerful

Meetings If used properly; meetings can build relationships and mutual trust Meetings enable instant feedback Meetings facilitate mutual understanding Reponses can often be gauged through eye contact Preparation, planning and openness are required


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Journalism In-house publications enable a wide range of msgs and editorialtechniques

It is possible to facilitate some interaction through reader lettersand contributions.

The content of most organizations journals tends to be bland,resulting in low leadership

Internal marketing This is a powerful method of selling change to the organizationsown staff

Detailed written documents and colorful posters help to explain andsimplify complex msgs

These techniques are able to elicit very strong, immediatemotivational responses

Noticeboards Can be either official information givers, or for general use byemployees

Provide a central location in which to make information accessibleto all employees.

There is no real possibility of interactive response, and employeesmay feel uninvolved.

Telephone The telephone is not suitable for lengthy or complicated discussions The lack of physical presence may lessen the speakers


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understanding of each other

BARRIERS TO EFFECTIVE COMMUNICATION

Too much information people suffers from what we call sensoryoverload

The message is poorly organizedcommunicating also involves planning Inaudible voicewhen talking in front of a crowd be sure that you have

loud and clear voice so that everybody will be able to hear what you are

saying

Mannerismsdistract attention Lack of understanding Inconsistent verbal and non-verbal communication Noise any factors that disturbs, confuses or interferes with

communication

Differing perceptions people who have different backgrounds ofknowledge and experience often perceive the same phenomenon from

different perspective


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Too many links in the communication process Symbol with different meaning a symbol that may mean something to

the sender might mean another to the receiver.

Badly expresses message The message is not clearly expressed by thesender thats why the real message is not received by the receiver.

Faulty Translation Mistranslation from other language may affect thereal meaning of a message

Language differences the words used must mean the same thing tosender and receiver

OVERCOMING BARRIERS TO COMMUNICATION

Use feedback to facilitate understanding and increase the potential forappropriate action

Repeat message in order to provide assurance that they are properlyreceived

Use multiple channels so that the accuracy of the information may beenhanced

Use simplified language that are easily understandable and whicheliminates the possibility of people getting mixed-up with meanings.


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TO ATTAIN EFFECTIVE MANAGERIAL COMMUNICATION

1. Humanizeunderstand, appreciate and elevate the importance of humansabove other concerns

2. Harmonize establish a climate of cooperation, trust, helpfulness,confidence, belongingness and openness

3. Habitualizeput into a habit such positive practices4. Institutionalize put into practice good communication habits at the

individual level until these practices are introduced to the company or

organization as standard operating procedure

5. Acclimatizeadjust, be flexible and extra tolerant6. Modernizelearn the modern ways of communicating7. Symbolizeif words will not do, use symbols8. Empathize to understand intimately the other peoples feelings

,thoughts, motives and aspirations

9. Dualizemake your communication dual10.MinimizeKeep It short!!!!


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INFORMAL COMMUNICATION IN THE ORGANIZATION

Grapevine is an informal channel of business communication. It is called so

because it stretches throughout the organization in all directions irrespective of

the authority levels.

a. Grapevine networks1. Gossip chainhappens when one person passes informal communication to

all others in the informal organization

2. Single strand each person receives information from one individual and

passes it to another

3. Probability chainpeople randomly pass information to the other members

of the organization

4. Cluster chain people pass information to other members of the informal

organization selectively

b. Grapevine activity. People tend to engage in grapevine when:

1. People lack information

2. There is insecurity in a situation

3. People have personal interest in the situation

4. They have new information


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LEADERSHIP

- Art of getting someone else to do something that you want done because

he wants to do it (Dwight D. Eisenhower)

- Process of directing the behavior of others toward the accomplishments

of objectives.

- is one of the important parts of direction.

Leadership is the ability to secure desirable action from a group of

followers voluntarily, without the use of coercion- Alford and Beatly


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Leadership refers to the quality of the behaviour of the individual

whereby they guide people on their activities in organized efforts - Chester

Barnard

LEADING IN TIMES OF CRISIS

1. Stay calm2. Be visible3. Put people before business4. Tell the truth5. Know when to get back to business

LEADERSHIP STYLES

1. Autocratic LeadershipUnder the autocratic leadership style, all decision-making powers

are centralized in the leader, as with dictators.

Leaders do not entertain any suggestions or initiatives from subordinates.

The autocratic management has been successful as it provides strong motivation

to the manager. It permits quick decision-making, as only one person decides

for the whole group and keeps each decision to him/herself until he/she feels it

needs to be shared with the rest of the group.


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2. Participative LeadershipConsists of the leader sharing the decision-making abilities with group

members by promoting the interests of the group members and by

practicing social equality.

Consultative LeadersThis style focuses on using the skills, experiences, and ideas of

others. However, the leader or manager using this style still retains

the final decision-making power. To his or her credit, they will not

make major decisions without first getting the input from those that

will be affected.

Consensus LeadersFor leadership to occur one party must follow another party. An

exception being which requires the leader influence the followers

to aid in a common task, which would seem to eliminate the

possibility of leading people to do nothing. Which is kind of

amusing when one considers to "do nothing" is usually the decision

reached by process of consensus in the first place.

Democratic Leadersdemocratic leader A leader who maintains an egalitarian

atmosphere within the group and who is prepared to delegate

planning, decision making, and other responsibilities to followers.


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3. Free- rein LeadershipA person may be in a leadership position without providing

leadership, leaving the group to fend for itself. Subordinates are given a

free hand in deciding their own policies and methods.

4. Narcissistic leadershipThe narcissism may be healthy or destructive although there is a

continuum between the two. To critics, "narcissistic leadership

(preferably destructive) is driven by unyielding arrogance, self-

absorption, and a personal egotistic need for power and admiration.

5. Toxic leadershipA toxic leader is someone who has responsibility over a group of

people or an organization, and who abuses the leader-follower

relationship by leaving the group or organization in a worse-off condition

than when he/she first found them.

Importance of Leadership

Initiates action- Leader is a person who starts the work by

communicating the policies and plans to the subordinates from where the

work actually starts.

Motivation- He motivates the employees with economic and non-

economic rewards and thereby gets the work from the subordinates.


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Providing guidance- A leader has to not only supervise but also play a

guiding role for the subordinates. Guidance here means instructing the

subordinates the way they have to perform their work effectively and

efficiently.

Creating confidence- Confidence is an important factor which can be

achieved through expressing the work efforts to the subordinates,

explaining them clearly their role and giving them guidelines to achieve

the goals effectively. It is also important to hear the employees with

regards to their complaints and problems.

Building morale- Morale denotes willing co-operation of the employees

towards their work and getting them into confidence and winning their

trust. A leader can be a morale booster by achieving full co-operation so

that they perform with best of their abilities as they work to achieve

goals.

Builds work environment- Management is getting things done from

people. An efficient work environment helps in sound and stable growth.

Therefore, human relations should be kept into mind by a leader. He

should have personal contacts with employees and should listen to their

problems and solve them. He should treat employees on humanitarian

terms.

Co-ordination- Co-ordination can be achieved through reconciling

personal interests with organizational goals. This synchronization can be


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achieved through proper and effective co-ordination which should be

primary motive of a leader.

THEORIES OF LEADERSHIP

a. Fielders Contingency Theory- it hypothesizes that, in any given leadership situation success is

determined primarily by;

1) The degree to which the task being performed by the followers is

structured

2) The degree of position power possess by the leader

3) The type of relationship that exists between the leader and the

followers.

b. Theory X and Y Assumptionsc. Theory Z

MANAGEMENT STYLES

1. Management by crisis2. Management by exception3. Management by objectives4. Management by coaching and development


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5. Management by competitive edge6. Management by consensus7. Management by styles8. Management by walking around9. Words simplifications


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SUPERVISION AND MANAGEMENT

Supervision is defined as An art or a process by which designated individual

or group of individuals oversee the work of others and establish controls to

improve the work as well as the worker. Supervision is generally termed as an

educational process in which a person with better training or more experience

takes the responsibility of training a person with less training or less experience,

and in this educational process the leadership of the supervisor and the growth

of the supervised combine to achieve and maintain progressively the highest

level of performance of which the worker is capable. Supervision is observation

and providing feedback to ensure the quality of the program and to enable the

staff to perform to their maximum potential. Traditional approaches to


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supervision emphasized on inspecting facilities and controlling individual

performance.

OBJECTIVES OF SUPERVISION

1. To help subordinate to do their job skilfully and efficiently.

2. To develop subordinates capacity to the fullest extent.

3. To promote team work

4. To promote moral and motivation among workers.

5. To bridge the gap between personal goal and organizational goal.

PURPOSE OF SUPERVISION:

To improve the quality of work / performance.

Helping the person doing the work and develop the highest possible standard

PRINCIPLES OF SUPERVISION

1. Supervision should aim at growth in knowledge and improvement of skill of

the person.


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2. Supervision should improve the ability in thinking and adjusting to the new

situation.

3. It should help to formulate objects.

4. Good supervision stimulates their interest and effectors.

5. No undue pressure for achievement

6. Autonomy to subordinate preferred

7. Supervision should have competence

8. Supervision should have receive training

9. Decision making is encouraged

10. Free communication to required

11. No over burdening to staff

12. Good leadership by supervisor

13. Suitable climate for work

14. Give guidance

15. Supervision should encourage innovation allowing free flow of ideas and

share positive experiences of personnel


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PRINCIPLES APPLIED TO NURSING:

Supervision should be focused on the attainment of one goal, the giving of

a high quality of nursing care.

Strives to make the ward a good learning situation.

Supervision is well planned.

It should posters the ability to think and act herself.

Helps her to attain objectives stimulates interest and effort.

Encourages and challenges her to greater endeavour through adequate

approval commendation and by recognition of work well done.

To make pattern for analysis and to analyze continuously her success in

reaching the objectives.

COMMON SUPERVISORY METHODS

1.Individual

conference

2.Group

conference

3.Training

sessions

4.Review of

records

5.Evaluation

sessions

6.Direct

observation


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WHO IS SUPERVISOR?

A supervisor is a person who is primarily incharge of a section & is

responsible for both quality & quantity of production, for the efficient

performance of the equipment, & for the employees in his charge & their

efficiency, training & morale

A supervisor drives authority from the departmental head for getting work

done from the workers by using the resources of the enterprises.

He issues instructions to the workers, directs their activities & reports to the

department head on the performance of his section.

QUALITIES OF A GOOD SUPERVISOR:

Trained person

Understand the training background and ability of the supervised.

Good knowledge, the local practice

Good in health, skills in T.G & PR/t have pleasing manner.

Good listener.

Supervisor should have leads examplenory life


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Creative enthusiasm

Just impartial human, tolerant and tactful

Helpful

Good power of judgment.

Functions of Supervision:

A. Administrative:

Assignment of the work loads of individual and groups according to the level

of physical and mental competence (or) preparing the duty roaster.

Identify the needs for supplies and equipment and providing materials and

supplies to facilitate the staff performance.

Identify the problem and helps to solve.

A. Administrative B.Education

C. Communication D. Evaluative


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B. Educative:

Orientation

Teaching subordinates

Plan and conduct in service education program

Ensuring staff developments

C. Communicative

The supervision act as a communicator between the staff and authorities and

other health team members.

She facilitates communication

She should encourage free communication among persons between worker

and community representatives and members of health team.

D. Evaluative:

include identify the cause of difficulty.

.


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OTHER FUNCTIONS ARE:

Co-ordinates there of subordinates and agents and promote team worker.

Promote social contact with in the team to bring staff together and increases

group cohesiveness.

Develops mutual confidence

Raises level of motivation

Develops good IPR

Maintains R & R

Establish control over the subordinates

AS A MANAGER SUPERVISOR HAS TO PERFORM THE

FOLLOWING FUNCTIONS

performance of the worker


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STEPS IN SUPERVISION: When supervision is needed the supr has to make

plan for supervision by using certain steps to follow.

1. Defining of the job to be done

2. Selection and organization of supervisor activities based on available

resources.

3. Anticipation of difficulties

4. Establishment of criterion for evaluation determining what extent the

programme has met problem / objectives acc to plan.

Types of supervision:

(1) Direct supervisionFace to face talk with worker

Points to be considered:

- Do not loose temper

- Use democratic approach and avoid autographic

- Give workers chance to reply


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- Do not talk too much and too fast

- Be human in behavior

- Do not give instructionshaphazard way

(2) Indirect supervision: With the help of record and reports of the worker and

through written instructions. This includes:

- Ensuringcarrying out allotted work

- Analysis of monthly progressinput efforts and achievement

- Analyzing amount of work allotted

- Support and guidance.

Methods of supervision:

(1) Technical vs. creative supervision

(2) Co-operative vs. authoritarian

(3) Scientific vs. institutive

(4) Task oriented vs. employee oriented

I. TechnicalThese are basic supervisory skills and which need to be trained

group discussion and conference


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For example: techniques of service study, record construction, time study etc.

Creativeprovides maximum adaptation to the situ Ex. Instead of orientation

period of two week for each new staff member, a variable plan in both contents

and time according to the needs of each individual should formulated.

II. Cooperativefull participation of each member of the group in planning,

action and decision.

Authorization: supervision responsibility centers entirely on the supervisor,

with the staff following his / her orders.

Both are needed all to situation.

III. Scientific supervisionRelies on objective study and measurement than

personal judgment / opinion.

Intitutive supervision :It needs to maintain IPR

IV. Task oriented supervision emphasize the task more than performer.

Employee oriented: Supervisors are more concerned about worker staff their

needs and welfare than assigned tasks.

TOOLS FOR SUPERVISION

Checklist Rating scales Nurses reports

Nursing rounds


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Job descriptions Personnel policies Staff educations Problem solving approach

TECHNIQUES OF SUPERVISION

A technique is a way of doing something. Techniques vary with thepersonality and ability of the individuals who are being supervised, the

activities that are being performed under supervision and the immediate

circumstances.

Any technique used for supervision must be based on sound democraticpsychological principles which takes account the nurses individuality.

THE PROCESS OF SUPERVISION:

Stage 1: Preparation for supervision

1. A supervisor should focus on specific issue.

- Efficacy of service provided to the

- Relevant problems

- Efficacy problem utilization management of limited resources.


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2. Study of document

3. Identification of priorities

4. Preparation of a supervision schedule

Stage 2: supervision

Use tools: - Job description

- Task description

- Weekly time table

- Check list / rating for each work

As a supervisor the following duties has to be performed.

Establish contact

Review the objectives, targets and norms

Review job descriptions

Note actual / potential conflict

Observe the actual performance.

Observe the individual nursing staff carries out his/her tasks.

Identify the gaps & needs for follow up action based on feed back data

attained through the observation.


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Stage 3: Follow up of supervision

Unless actions to follow-up the gaps and needs identified during stage are taken,

supervision remains incomplete. Each supervisor must prepare a report on the

observations made during supervision. The follow-up action may include:

Organizing in-service training programmes/continuing education programmes

for the nursing personnel.

Reorganization of time table / work plan/ duty roaster.

Initiating changes in logistic support or supply system.

Initiating actions for organizing staff welfare activities.

Counseling and guidance regarding career development and professional

growth

THE EFFECTIVENESS OF SUPERVISION DEPENDS ON:

1. Human relations skill

2. Technical and Managerial knowledge

3. Leadership position

4. Improved upward relations

5. Relief from non-supervisory duties


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6. General and lose supervision

1. Human relations skill:

Supervision is mainly concerned with instructing, guiding and inspiring human

beings towards greater performance. For purpose of direction, the supervisor

has to rely on leadership, counseling, communication and other determinants of

human relations

2. Technical and Managerial knowledge:

Guidance implies a complete understanding of all work problems, for which

supervisor should have good knowledge about technical aspect of job and also

the managerial aspect

3. Leadership position

The authority of supervisor must be made commensurate with their duty so as to

make the job of supervision a satisfying, rewarding and challenging one

4. Improved upward relations

To ensure god quality of supervisors, the supervisors should be regularly

allowed to present their views and suggestions to top executive in regard to the

personnel and their works performance.


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5. Relief from non-supervisory duties

To make the supervisory duties purposeful, the supervisors are to be relieved of

many routine activities that divert their attention from the real job.

6. General and lose supervision

According to some experience, the general and loose supervision is more

productive than close supervision. Here the leader must allow freedom and

initiative to his followers for pursuing a common course of action.

PROBLEMS OF SUPERVISION

PROBLEMS IN NURSING SERVICE:

There are no perfect nursing service programs/situations without any problems

1. Shortage of nursing personnel.

2. Individual differences among personnel in interests, capacities and abilities.

3. Lack of information, insight and understanding of changes and developments

in the interest of the continuance and improvement of nursing.

4. Lack of clearly defined assignments, multiple responsibility and lack of

planning on the part of those to whom personnel is responsible

5. Outdated policies, procedures and guides to workmanship which cause them

to be disregarded and unused.


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6. Inadequate, unsafe, and defective equipment.

7. Ill health in the part of personnel

8. Undesirable personnel characteristics with special attention to attitudes.

COMMON PROBLEMS IN COMMUNITY HEALTH NURSING

SUPERVISION:

1. Problems inherent to budgeting, planning and timing.

2. Personnel problems including problems of poor performance.

3. Grievances

4. Lack of financial resources.

5. Lack administrative support

6. Staff members who are inflexible and resist any type of change

7. Assignment to projects other than those committed to perform

8. Lack of political support

9. . Staff members who do not accept or support the program goals.

10. Conflict within the nursing unit itself.


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11. Inability to proceed (for many reasons) because the timing is wrong

12. Inability to hire qualified personnel.

13. .Changes in program priorities.

14. Other issues can include anything from car rental, uniform allowance,

security of the staff within the community, need for supplies and equipment,

duplication of services provided by another organization.


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MOTIVATION

INTRODUCTION Motivation is an action that stimulates an individual to take

a course of action, which will result in an attainment of goals, or satisfaction of

certain material or psychological needs of the individual.

Motivation is a powerful tool in the hands of leaders. It can persuade convince

and propel people to act.

DEFINITION:-

Motivation is defined as Motivation is an inner impulse or an internal

force that initiates and directs the individual to act in a certain manner to satisfy

a need.


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Motivating force is a need that comes from within an individual, e.g. to make a

living, gain status and respect or to remove a source of frustration (Review of

Maslows Hierarchy of Needs). Motivation refers to the way in which urges,

drives, desires, aspirations, striving or needs direct, control or explain the

behavior of human beings. -Dalton E. McFurland

NEED FOR MOTIVATION:-

The nurse manager must realize that nurses have different personalities, work

habits, and what motivates one nurse may not motivate others. Meanwhile,

some nurses are skilled, confident, and capable of self-direction and seem to

motivate themselves, while other nurses lack self-confidence; they do their jobs

poorly and have little motivation.

The nurse manager is responsible to motivate the second group and to improve

their performance. Researchers have revealed that job performance is the result

of the interaction of two variables; the ability to perform the task and the

amount of motivation.

Job Performance = Ability + Motivation. Job dissatisfaction:

Job dissatisfaction contributes to higher turnover rates and decreased

productivity and considerable time and money are required to recruit and select

a replacement for someone who leaves the organization, it also takes time to

socialize new employee to the organizational culture, which is expensive time,


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beside that, other employees will need to carry more load to cover the needs,

and at last the kind of interruptions that results from the loss of this employee.

For all those reasons the manager should be concerned about job satisfaction of

employee, and to do that there is a need to look at the different theories.

TYPES OF MOTIVATORS

1) Intrinsic motivation: Refers to motivation that comes from within the

person, driving him or her to be productive. It is related to a persons level of

inspiration. The motivation comes from the pleasure one gets from the task

itself or from the sense of satisfaction in completing or even working on the task

rather than from external rewards.

2) Extrinsic motivation: It refers to motivation that comes from outside an

individual, i.e. enhanced by the work environment or external rewards such as

money or grades. The rewards provide a satisfaction and pleasure that the task

itself may not provide. An extrinsically motivated person will work on a task

even when they have little interest in it because of the anticipated satisfaction

they will get from the reward. e.g.- reward for a student would obtain good

grade on an assignment or in the class.


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TYPES OF MOTIVATION

1) Achievement motivation

It is the drive to peruse and attain goals. An individual with achievement

motivation wishes to achieve objectives and advance up the ladder of success.

Hence, accomplishment is important for his/her own sake and not for the

rewards that accompany it.

2) Affiliation motivation

It is a drive to relate to people on a social basis. Individuals with affiliation

motivation perform work better when they are complimented for their

favourable attitude and co-operation.

3) Competence motivation

It is the drive to be good at something, allowing the individual to perform high

quality work. Competence/skill motivated individuals seek job mastery, take

pride in developing and in using their problem solving skills and strive to be

creative when confronted with obstacles. They learn from their experiences.

4) Power motivation

It is the drive to influence people and change situations. Power motivated

people wish to create an impact on their organisation and are willing to take

risks.


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5) Attitude motivation

Attitude motivation is how people think and feel. It is their self-confidence,

their belief in themselves and their attitude to life. It is how they feel about the

future and how they react to the past.

6) Incentive motivation

It is where the people are motivated through external rewards. Here, a person or

team reaps a reward from an activity. It is the type of rewards that drive people

to work harder.

7) Fear motivation

Fear motivation coercions a person to act against will. It is instantaneous and

gets the job done more quickly. Fear motivation is helpful in the short run.

Methods of motivating employees / Motivational factors:

There are different methods which can be used for motivating employees .There

can also be treated as motivational factors/ forces/stimulators. They include

monetary & non monetary factors.

Monetary factors:

1) Salaries/wages: Money happens to be the most important motivationfactor. While determining salaries, management must give to employees


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security of income along with ability to lead respectable life. Salary

should be revised periodically to meet the cost of living.

2) Bonus: Under the bonus payment Act,1965 a company has to declarebonus whenever it earns profit. Bonus adds to annual income of the

employees & it becomes monetary incentive.

3) Incentives: When employees are paid over & above their salary, anadditional payment in recognition of better work, it is called incentive.

When incentive payment is offered, employees work hard to earn more &

they remain motivated.

4) Allowances: Management providers to employees both statutory & nonstatutory types of allowances such as medical allowance, educational

allowance, house rent allowance, recreation allowance, education

allowance & so on .These allowance act as motivators.

5) Special incentives : There are certain monetary incentives offered only todeserving employees e.g. performance bonus, attendance etc. It has a

positive impact on others because they also work hard to earn these

special incentives.

NonMonetary factors:

1) Job Security & job enrichment: Job security is useful the motivation ofemployees. Such security keeps the employee away from the tension of

becoming unemployed. Job enrichment provides an opportunity for


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greater recognition & advancement, job enrichment refers to redesign of

jobs.

2) Fair treatment to employees: Employer should give attention to theneeds, difficulties & grievance of employees. Small work groups &

effective communication are useful for solving the problems of workers.

Employees must be given decent treatment. They will be cooperative

only when they are treated with sympathy & love, affection & dignity.

Employees should also be given help in personal matters.

3) Recognition of good work: Recognition of good work at an appropriatetime gives encouragement to the employees to show better performance

in future. As an appreciation of good work, prizes rewards, promotions

etc. should be given.

4) Encouragement to self-development & career development :Employees should be given varied training facilities self- development &

also provides opportunities for career development. Every employee has a

desire to grow, develop & rise higher. This desire should be exploited

fully for motivating employees. For this, training as well as management

development programme should be introduced.

5) Delegation of authority: Due to delegation of authority, a subordinateemployee fells that superior has faith in him & also in his ability to use

authority in a proper manner. Employees get mental satisfaction when

authority is given to them. They take interest & indicative in work & try


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to prove that they are competent to work at the higher levels. Thus

delegation of authority becomes a motivating factor.

6) Congenial working condition: It is a non-functional incentive formotivation. Employees should be given various facilities & conveniences

at the work place. The work environment should be pleasant, safe &

reasonably comfortable. This creates desire to work efficiently.

7) Helpful attitude of management: The helpful attitude towards itsemployees creates a sense of affinity for the organisation. Fair treatment

to workers. Cordial industrial relations also motivate employees. Thus

,enlightened & pro-employee attitude of management acts as a motivating

factor.

8) Fair opportunity of promotion: Fair opportunity of promotion to alleligible workers is one more method useful for motivating employees.

They take interest in the work as they feel that they will be rewarded in

the form of promotions. Training facility should be provided to

employees in order to make them eligible for promotion.

9) Labour participation in management: Labour participation is useful forthe motivation of employees. Workers get higher status & better scope for

expressing their views through such participation. Even the formation of

quality circles or joint management council is useful for motivating

employees.


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10) Designation & status: When an employee is provided with abetter designation, it adds to his status. Employees are proud to reveal

their attractive & high-sounding designations.

Characteristics/Features of motivation:-

1) Psychological process: Motivation is a psychological process usefulencouraging employees to take more interest & initiative in the work

assigned. It relates to human relations.

2) Initiative by manager: The initiative for motivation is to be taken by themanager by offering guidance & also by other methods like appreciation

of good work or offering incentives.

3) Continuous activity: It is a continuous & circular process. Subordinatesneed motivation in a continuous manner as their needs & expectations

change from time to time. A manager has to study the needs of the

worker & use the technique of motivation accordingly. The process of

motivation must be made a regular & continuous one.

4) Goal- oriented & action- oriented:- Motivation diverts humanbehaviour towards certain goals. Attainment of organisational &

individual goals depends on the motivational plans.

5) Broad concept:- motivation is a comprehensive concept &cover needs,human relations & satisfaction of employees. For employee motivation


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monetary & other incentives need to be offered. Job satisfaction is one

need of subordinates & is useful for motivation.

6) Essence of management process:- Motivation is an essential function ofa manager. He has to motivate his subordinates for achieving

organisational objectives. Motivated force is an asset of business unit.

Motivation employees bring success, stability & prosperity to a business

unit.

7) Beneficial to employees & management:- Motivation offers benefits toemployees & organisation. It avoids clashes & encourages cooperative

outlook among employees. Motivation leads to cordial labour-

management relations. It provides more profit to management & better

welfare to employees.

8) Varied measures available for motivation: For motivation variousmonetary & non monetary incentives can be offered to employees by the

management. Attractive wages, welfare facilities, job security & fair

treatment are some measures of motivating employees.

Importance of motivation of employees:-

Nature of motivation

Unending process: human wants keep changing & increasing.

A psychological concept: deals with the human mind.


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Whole individual is motivated: as it is based on psychology of the

individual.

Motivation may be financial or non-financial: Financial includes

increasing wages, allowance, bonus, etc.

Motivation can be positive or negative: positive motivation means use of

incentives - financial or non-financial. E.g. of positive motivation:

confirmation, pay rise, praise etc. Negative motivation means

emphasizing penalties. It is based on force of fear. Eg. demotion,

termination.

Motivation is goal-oriented behaviour.

Motivation is an internal feeling of an individual. It cant be observed

directly; we can observe an individuals action and interpret his behaviour

in terms of underlying motives. This leaves a wide margin of error. Our

interpretation may not reveal the individuals true behaviour.

Motivation is a continuous process that produces goal directed behaviour.

The individual tries to find alternatives to satisfy his needs.

Motivation is a complex process. Individual may differ in their

motivation even though they are performing the same type of job. For

example, if two men are engaged in cutting stones for constructing a

temple, one may be motivated by the amount of wages he gets and the

other by the satisfaction he gets by performing the job.


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COMPONENTS OF MOTIVATION

Motivation comprises of three main components:

We start off by deciding what we want, which is our direction as we know

where we want to go and what we have to achieve. Then we make an effort

towards our goal. We start to do things and we continue our making the efforts

for some time and give it everything that we have. Now comes the part where

we have to be persistent with our efforts and keep doing them.

SOURCES OF MOTIVATION

1) Internal or push forces:

-esteem


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2) External or pull forces:

a. Characteristics of the job


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b. Characteristics of the work situation

REQUISITES TO MOTIVATE

We have to be Motivated to MotivateMotivation requires a goalMotivation once established, does not last if not repeatedMotivation requires RecognitionParticipation has motivating effectSeeing ourselves progressing Motivates usChallenge only motivates if you can winEverybody has a motivational fuse i.e. everybody can be motivatedGroup belonging motivates .


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In the initiation, a person starts feeling lacknesses. There is an arousal of need

so urgent, that the bearer has to venture in search to satisfy it. This leads to

creation of tension, which urges the person to forget everything else and cater to

the aroused need first. This tension also creates drives and attitudes regarding

the type of satisfaction that is desired. This leads a person to venture into the

search of information. This ultimately leads to evaluation of alternatives where

the best alternative is chosen. After choosing the alternative, an action is taken.

Because of the performance of the activity satisfaction is achieved which than

relieves the tension in the individual.

CREATING A MOTIVATING CLIMATE

As the organization has an impact on intrinsic and extrinsic motivation, it is

important to examine organizational climates or attitudes that influence workers

morale and motivation. Employees want achievement, recognition and


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feedback, the opportunity to assume responsibility, a chance for advancement,

fairness, good leadership, job security and acceptance and adequate monetary

compensation. All these create a motivating climate and lead to satisfaction in

the work place. e.g. nurses who experience satisfaction stay where they are,

contributing to organizations retention.

STRATEGIES TO CREATE A MOTIVATING CLIMATE

1. Have a clear expectation for workers and communicate effectively.

2. Be fair and consistent when dealing with all employees.

3. Be a firm decision maker.

4. Develop a team work/team spirit.

5. Integrate the staffs needs and wants with the organizations interest and

purpose.

6. Know the uniqueness of each employee.

7. Remove traditional blocks between the employee and the work to be done.

8. Provide opportunities for growth.

9. Encourage participation in decision-making.

10. Give recognition and credit.

11. Be certain that employees understand the reason behind decisions and

actions.

12. Reward desirable behaviour.


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13. Allow employees exercise individual judgement as much as possible.

14. Create a trustful and helping relation with employees.

15. Let employees exercise as much control as possible over their work

environment.

Leadership Roles and Management Function Associated With Creating A

Motivating Work Climate:- Leadership Roles:

1. Recognize each worker as unique individual who is motivated by different

things.

2. Identifies the individuals and collective value system of the unit and

implements a reward system that is consistent with those values.

3. Listen attentively to individual and collective work values and attitudes to

identify unmet collective needs that can cause dissatisfaction

4. Encourage workers to stretch themselves in an effort to promote self

growth and self actualization.

5. Maintains a positive and enthusiastic image as a role model to subordinates in

the clinical setting

6. Encourage mentoring, sponsorship and coaching with subordinates.

7. Develop time and energy to create an environment that is supportive and

encouraging to the discouraging individual.


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8. Develop a unit philosophy that recognizes the unique worth of each employee

and promote reward systems that make each employee feel like a winner.

9. Demonstrates through actions and words a belief in subordinates that they

desire to meet organizational goals.

10. Is self- aware regarding own enthusiasm for work and takes steps to

motivate self as necessary.

MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE

NURSES MOTIVATION: - The nurse manager while managing the nursing

unit will have to choose a combination of the following measures to facilitate

nurses motivation.

1) Act as a Role model (Set a good example):-

a) Set high standards in the units.

b) Maintain a positive attitude towards the work and staff.

c) Be optimistic; in other words, be aware of how difficult the job is and how it

can be done.

d) Ask for help when in need.

e) Admit mistakes.

2) Develop and maintain Good Personal Relations:-

a) Use two-way communication.

b) Be friendly, not to criticize staff in front of others and be fair.


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c) Keep a sense of humor and avoid getting angry.

d) Try to understand nurses attitudes, likes, dislike their experience, previous

training, problems in their work and needs.

These measures will help in understanding nurses behavior. Understanding is

the first step toward motivating nurses. Trust comes with understanding and it

develops slowly based on the respect and acceptance of the manager.

Motivation is based on understanding and trust.

Some guidelines for developing trust:-

a) Apply rules equally and consistently.

b) Avoid favoring some nurses over others, be fair.

c) Share informationshow respect for ideas and opinions and confidentiality.

d) Be supportive at all times.

3) Post Each Nurse where she can work best:-

The nurse is more likely to succeed and be motivated if her/his interests and

skills are considered in the assignment. Success is the best motivator.

4) Use a participative style:-


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Participation and sharing information will motivate nurses since they feel they

are taking part in decisions. Motivation requires more than physical

involvement in a job. It also demands mental and emotional involvement.

5) Guide, encourage and support continuously:-

Guidance means helping nurses in planning, evaluating their work and in

solving work and personal problems.. Encouragement means helping and

reassuring nurses regardless of the type of problems. Develop a supportive

environment by reducing physical stresses associated with the job. Support

means removing obstructions and providing nurses with satisfying work

environment which include personnel and facilities and suitable learning

materials needed to do their job.

Reward Good work:-

a) Give recognition for successful achievement of the job. Praise frequently and

informally. It can be in front of other staff.

b) Reward includes: Pay increase, promotion, training for advancement to a

higher level within a job.

c) Thank you is a type of reward that helps to increase self-confidence.

6) Build team work (Team spirit)

a) Schedule regular meetings.


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b) Make nurses feel that their job is important to the success of the team.

c) Integrate the needs and wants of the staff nurses with those of the nursing

unit.

d) Think of nurses in the unit as a group and do what is best for them.

7) Provide continuing education:-

Nurses enjoy learning new knowledge and skills or updating the existing

knowledge and skills or taking new responsibilities through continuing

education.

SYMPTOMS OF MOTIVATED NURSES:-

1. Show interest, enthusiasm and have a positive attitude.

2. Believe their work is important and work hard.

3. Work well with their supervisors and others.

4. Take part willingly in planning, implementing and evaluating their work.

5. Show responsible behaviour.

Strive to find the best way to produce optimal job performance.

THEORIES OF MOTIVATION The word motivation theory is concerned

with the processes that describe why and how the human behaviour is activated

and directed. It is considered as one of the most important areas of study in the


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field of organizational behaviour. There are two different categories of

motivation theories- the content theories and the process theories.

A) Content theories of motivation

This is also called as the Need theory. It mainly focuses on the internal factors

that energize and direct human behaviour. Some of the need theories are-

1) Abraham Maslow (1943)

Maslows theory included 5 basic needs in his theory, namely the- The

physiological needs, Safety and security needs, Love needs, self-esteem needs

and self-actualization needs. Maslow suggested that human needs are ordered in

a hierarchy from simplex to complex. Higher level needs do not emerge as

motivators until lower needs are satisfied and a satisfied need no longer

motivates behaviour.


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Physiological needs: Food, water, warmth, shelter, sleep, medicine and

education, etc. Once the physiological needs are met, the next level becomes

predominant.

Safety and security needs: These are the needs to be free of physical

danger and of the fear of losing a job, property, food or shelter. It also includes

protection against any emotional harm.


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Social needs: Since people are social beings, they need to belong and be

accepted by others. People try to satisfy their need for affection, acceptance and

friendship. After the lower needs are well satisfied, affiliation or acceptance will

emerge as dominant and the person strives for meaningful social relationship.

Esteem needs: According to Maslow, once people begin to satisfy their

need to belong, they tend to want to be held in esteem both by themselves and


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by others. This kind of need produces such satisfaction as power, prestige status

and self-confidence.

Need for self-actualization: Maslow regards this as the highest need in his

hierarchy. It is the drive to become what one is capable of becoming; it includes

growth, achieving ones potential and self-fulfilment. It is to maximize ones

potential and to accomplish something.


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2) Alderfer ERG theory

ERG theory is similar to Maslows hierarchy of needs. The existence (E) needs

are equivalent to physiological and safety needs; relatedness (R) needs to

belongingness, social and love needs. The growth (G) needs to self-esteem and

self actualization- personal achievement and self-actualization. The major

conclusions of this theory are:

satisfied than the desire to satisfy a lower need

intensifies.

satisfaction of the lower-level needs. This phenomenon is known as frustration-

regression process

3) Frederick Herzberg Two Factor need theory (1966)

Herzberg felt that job satisfaction and dissatisfaction exists on dual scales.

Workers are motivated by two types of needs/factors-

intrinsic/motivation factors

(satisfiers): challenging aspects of the work, achievement, added responsibility,

opportunities for growth and opportunities for advancement


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extrinsic/hygiene factors

(dissatisfiers): salary, status, working conditions, quality of supervision, job

security and agency policies.

According to Herzberg, the hygiene factors must be maintained in quantity and

quality to prevent dissatisfaction. They become dissatisfiers when not equitably

administered, causing low performance and negative attitudes. The motivation

factors create opportunities for high satisfaction, high motivation and high

performance. Absence of motivation factors causes a lack of job satisfaction.

4) David McClelland(1961)

David McClelland has developed a theory on three types of motivating needs:


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People with high need for power are inclined towards influence and control.

They like to be at the center and are good orators. They are demanding in

nature, forceful in manners and ambitious in life. They can be motivated to

perform if they are given key positions or power positions. In the second

category are the people who are social in nature. They try to affiliate themselves

with individuals and groups. They are driven by love and faith. They like to

build a friendly environment around themselves. Social recognition and

affiliation with others provides them motivation. People in the third category are

driven by the challenge of success and the fear of failure. Their need for

achievement is moderate and they set for themselves moderately difficult tasks.

They are analytical in nature and take calculated risks. Such people are

motivated to perform when they see atleast some chances of success.

McClelland observed that with the advancement in hierarchy the need for power


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and achievement increased rather than Affiliation. He also observed that people

who were at the top, later ceased to be motivated by this drives.

5) McGregors Theory X and Theory Y

Douglas McGregor proposed two different motivational theories- theory X and

theory Y. He states that people inside the organization can be managed in two

ways. The first is basically negative, which falls under the category X and the

other is positive, which falls under the category Y.

Assumptions of theory X:

er possible, will attempt

to avoid it.

threatened with punishment to achieve goals.

issued.

s place a greater importance on security over all other factors

and display little ambition.

Assumptions of theory Y:

-control and self-direction and if they are committed to

those goals.


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imagination, ingenuity and creativity in solving the problems of the

organization.

power

is only partly used.

On analysis of the assumptions it can be detected that theory X assumes that

lower-order needs dominate individuals and theory Y assumes that higher-order

needs dominate individuals. An organization that is run on Theory X lines tends

to be authoritarian in nature- power to enforce obedience and the right to

command. In contrast Theory Y organizations can be described as

participative, where the aims of the organization and of the individuals in it

are integrated; individuals can achieve their own goals best by directing their

efforts towards the success of the organization

B) Process theories of motivation

Process theories of motivation provide an opportunity to understand thought

processes that influence behaviour. The major process theories are- Vrooms

expectancy theory, goal-setting theory and reinforcement theory.

1) Reinforcement theory

B.F. Skinners theory (1969) suggests that an employees work motivation is

controlled by conditions in the external environment, that is, by designing the


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environment properly, individuals can be motivated. Instead of considering

internal factors like impressions, feelings, attitudes and other cognitive

behaviour, individuals are directed by what happens in the environment external

to them. Skinner states that work environment should be made suitable to the

individuals and that punishment actually leads to frustration and de- motivation.

Hence, the only way to motivate is to keep on making positive changes in the

external environment of the organization. Positive behaviour should be

reinforced or rewarded as this increase the strength of a response or induces its

repetition. Reinforcers tend to weaken over time and new ones have to be

developed. Negative reinforcement occurs when desired behaviour occurs to

avoid negative consequences of punishment. Punishment creates negative

attitude and can increase costs.

Expectancy theory of Vroom


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This theory postulates that most behaviours are voluntarily controlled by a

person and are therefore motivated. It focuses on peoples effort-performance

expectancy, or a persons belief that a chance exists for a certain effort to lead to

a particular level of performance. This theory states that motivation depends on

three variables-

Attractiveness: the person sees the outcome as desirable.

Performance-reward linkage: the person perceives that a desired outcome

will result from a certain degree of performance.

Effort-performance: the person believes that a certain amount of effort will

lead to performance.

3) J. Stacy Adams Equity theory

Third process theory and focuses on fair treatment. Persons believe that they are

being treated with equity when the ratio of their efforts to rewards equals those

of others. Equity can be achieved or restored by changing outputs, attitudes, the

reference person, inputs or outputs of the reference person or the situation.

People have a tendency to use subjective judgment to balance the outcomes and

inputs in the relationship for comparisons between different individuals.

Accordingly,


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4) Jeremy Benthams The Carrot and the Stick Approach

English philosopher, Jeremy Bentham ideas developed his ideas in the early

years of the Industrial Revolution, around 1800. Benthams view was that all

people are self-interested and are motivated by the desire to avoid pain and find

pleasure. Any worker will work only if the reward is big enough, or the

punishment sufficiently unpleasant. With this view, the carrot and stick

approach was built into the philosophies of the age. This metaphor relates to

the use of rewards and penalties in order to induce desired behaviour. It came

from the old story that to make a donkey move, one must put a carrot in front of

him or dab him with a stick from behind. Despite all the research on the theories

of motivation, reward and punishment are still considered strong motivators. In


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almost all theories of motivation, the inducements of some kind of carrot are

recognized. Often this is money in the form of pay or bonuses. Even though

money is not the only motivating force, it has been and will continue to be an

important one. The trouble with the money carrot approach is that too often

everyone gets a carrot, regardless of performance through such practices as

salary increase and promotion by seniority, automatic merit increases, and

executive bonuses not based on individual manager performance.

The stick, in the form of fearfear of loss of job, loss of income, reduction of

bonus, demotion, or some other penalty has been and continues to be a strong

motivator. It often gives rise to defensive or retaliatory behaviour, such as union

organization, poor-quality work, executive indifferences, and failure of a

manager to take any risks in decision-making or even dishonesty. However, fear

of penalty cannot be overlooked. Whether managers are first-level supervisors

or chief executives, the power of their position to give or with hold rewards or

impose penalties of various kinds gives them an ability to control, to a very

great extent, the economic and social well-being of their subordinates .

5) Goal-setting theory of Edwin Locke :-

This theory is based on goals as determinants of behaviour. The theory states

that when the goals to be achieved are set at a higher standard than, employees

are motivated to perform better and put in maximum effort. The more specific

the goals, the better the results produced. The goals must be achievable, and


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their difficulty level must be increased only to the ceiling to which the person

will commit. Goal clarity and accurate feedback increases security. It revolves

around the concept of Self-efficacy i.e. individuals belief that he or she is

capable of performing a hard task.

6) Arousal/ Cognitive Evaluation theory:-

Focuses on internal processes that mediate the effects of conditions of work on

performance. This theory states, a shift from external rewards to internal

rewards results into motivation. It believes that even after the stoppage of

external stimulus, internal stimulus survives. It relates to the pay structure in the

organization. Instead of treating external factors like pay, incentives, promotion

etc and internal factors like interests, drives, responsibility etc, separately, they

should be treated as contemporary to each other. The cognition is to be such that

even when external motivators are not there the internal motivation continues.

7) Attitude theory

Focuses on favorable attitudes of job satisfaction and job involvement leading

to high performance.

8) Attrition/self-efficacy theory

Focuses on explanations for events or behaviour. Perceptions of self efficacy

and self esteem affect performance.


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Motivational theories for Better Nursing Management

The needs of an individual are important motivators. These make the person

work with enthusiasm & interest. The significant individual needs are: * Need

for Power: Which results in a strong desire to influence staff, stimulate them to

work, making them achieve positions of leadership e.g. making the nursing

supervisor wholly responsible to take care of whole ward. The need for

achievement results in a desire to do something better or more efficiently than

others. People with a high need of achievement have an intense desire for

success & equally intense fear of failure. They want to be challenged, prefer to

assume personal responsibility to get work done and like to work for long hours.

Training and orientation (refresher) course increase this need. All the staff

working in a particular area should be given equal chance to attend the refresher

courses related to that particular area.

* Need for affiliation: - Some people derive pleasure from being loved and tend

to avoid the pain of being rejected by social group. They enjoy social

relationships, intimacy, empathise and help others in trouble. There is close

intimacy when a staff nurse is allowed to plan and decide patient care along

with ward supervisor. In order to satisfy the employees, a manger can also use

Maslow's Motivation Theory in these ways:


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* Improving physical working conditions to satisfy needs e.g. grilled door and

escorts to secure the nursing staff at night, providing rest rooms for lunch and

dinner.

* Increasing the level of training, development and skill in order to meet the self

esteem needs e.g. uniform, leave facilities, vacation to nursing students. If these

facilities are inadequate it harms their self esteem.

* Having congenial social group and peer group interaction to fulfill affiliation

needs.

* Placing the person in position which match their self concept to fulfill the self

actualization need. Job Design Job design is another motivator to satisfy, signify

and give value to employees encouraging them to perform well. Koul Jyoti

conducted a study on job satisfaction of 126 staff nurses of different hospitals in

J&K State and showed that only 8% were highly satisfied. Maximum

satisfaction was found for the work itself and with the competency of

supervision. The areas of best satisfaction were concerned with material

rewards and individual agency. The older age group and experienced persons

were found more satisfied. Work Environment There are many conditions in the

environment which could possibly effect the motivation of staff. It is seen by

Behaviour Modification Theorist that employees perform positively if

environment is favourable which is made by pay/ reward policies, democratic

leadership style, peer group interaction etc. To effect the performance of

employees, their input (e.g. efforts, training, experience, skill, education,


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seniority) should be equitable to their output e.g. pay, rights, benefits, job-

status, status symbol's (vacation, clothing, satisfactory superior). The employees

feel inequity if unrewarded or if given undesirable placement. The employees

always respond to the environment & these responses influence their behaviour.

A nursing Manager can accomplish this by using following motivational

techniques.

* Positive Reinforcement: Annual reward for better performance in the form of

money, recognition, praise, promotion etc. Give reward to the most clean and

best patient care ward on Annual days.

* Avoidance Learning: Some staff nurses improve their behaviour in order to

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final seminar on directing in nursing management

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