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PART 4 | MANAGEMENT PROCESS: OVERVIEW

Management Functions Identified

Henri Fayol (1925) first identified the management functions of planning, organization,

command, coordination, and control. Luther Gulick (1937) expanded on Fayol’s management

functions in his introduction of the “seven activities of management”- planning, organizing,

staffing, directing, coordinating, reporting, and budgeting- as denoted by the mnemonic POSDCORB.

Although often modified (either by including staffing as a management function or renaming elements), these functions or activities have changed little over time. Eventually,

theorists began to refer to these functions as the management process.

The management process, with brief descriptions of the five functions for each phase of

the management process follow:

1.) Planning encompasses determining philosophy, goals, objectives, policies, procedures, and rules; carrying out long- and short-range projections; determining a fiscal course of

action; and managing planned change.

2.) Organizing includes establishing the structure to carry out plans, determining the most

appropriate type of patient care delivery, and grouping activities to meet unit goals. Other

functions involve working within the structure of the organization and understanding and

using power and authority appropriately.

3.) Staffing functions consists of recruiting, interviewing, hiring and orienting staff.

Scheduling, staff development, employee socialization, and team building are also often included as staffing functions.

4.) Directing sometimes includes several staffing functions. However, this phase’s functions usually entail human resource management responsibilities, such as motivating,

managing conflict, delegating, communicating and facilitating collaboration.

5.) Controlling functions include performance appraisals, fiscal accountability, quality control, legal and ethical control, and professional and collegial control.

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Reading 4.1

Marquis, B. 2003, “Leadership Roles and Management Functions in Nursing”, Lippincott

Williams & Wilkins, A Wolter Kluwer Company, pp. 7-10.

The management process is similar in many ways to the nursing process. Both processes

are cyclic, and many different functions may occur simultaneously. Suppose that a nurse-manager

spent part of the day working on the budget (planning), met with the staff about changing the patient care management delivery system from primary care to team nursing (organizing), altered

the staffing policy to include 12-hour shifts (staffing), held a meeting to resolve, a conflict

between nurses and physicians (directing), and gave an employee a job performance evaluation

(controlling).

Not only would he nurse-manager be performing all phases of the management process,

but each function has a planning implementing, and controlling phase. Just as nursing practice requires that all nursing care has a plan and an evaluation, so too does each function of

management.

Reading 4.2

Clark, C. 2009, “Creative Nursing Leadership and Management”, Jones and Bartlett

Publishers, LLC., USA., pp. 32-35.

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PART 5 | MANAGEMENT PROCESS: PLANNING

A.) Introduction: What is Planning?

The purpose of this block is get familiar of the basic definitions and process under planning which includes history of strategic planning process, vision, values, mission,

philosophy, goals, objectives, strategies, policies and procedures.

Major Concepts and Definitions

Strategic Planning Long-range planning usually extending 3 to 5 years into the future

Operational Planning Short-range planning that deals with day-to-day maintenance activities

Belief Conviction that certain things are true

Vision Mental image of something not actually visible

Value The worth, usefulness, or importance of something

Mission/purpose An aim to be accomplished; mission statement

Philosophy Statement of beliefs and values that directs behavior

Goal The end to be accomplished

Objective Something aimed at or striven for; things done to achieve the goal

Policy A governing plan for accomplishing goals and objectives

Procedure Chronological sequence of steps within a process

Protocols Documents of agreement

Business Plan Plan for new ventures like new products or services

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Overview of Planning

Planning Process

There are two major types of organizational planning; long-range, or strategic, planning

and short-range, or operational, planning.

Strategic planning extends 3 to 5 years into the future. It begins with in-depth analysis of

the internal environment’s strengths and weaknesses and the external opportunities and threats so

that realistic goals can be set for the preferred future. It determines the direction of the organization, allocates resources, assigns responsibilities, and determines time frames. Strategic

planning goals are more generic and less specific that operational planning.

Nurse managers are more likely to be involved in the operational planning. Operational

planning is done in conjunction with budgeting, usually a few months before the new fiscal year.

It develops the departmental maintenance and improvement goals for the coming year.

Purpose of Strategic Planning

Strategic planning clarifies beliefs and values: What are the organization’s strengths and

weaknesses? What are the potential opportunities and threats? Where is the organization going? How is it going to get there? It gives direction to the organization, improves efficiency, weeds out

poor or underused programs, eliminates duplication of efforts, concentrates resources on

important services, improves communications and coordination of activities, provides a mind-expanding opportunity, allows adaptation of the changing environment, sets realistic and

attainable yet challenging goals, and helps ensure goal achievement.

Leaders need vision that is realistic and feasible. Development of a strategic vision involves analysis of the agency’s environment, capabilities, and resources; development and

articulation of a conceptual image; clarification of values; development of a mission statement;

identification of goals and objectives; and identification of strategies for reaching the goals.

Reading 5.1

Tomey, A. 2000. “ Guide to Nursing Management and Leadership”, Elsevier Science (Singapore) PTE LTD, pp. 175-177

5

B.) Types of Planning

B.1: Strategic Planning

Strategic Planning in nursing is concerned with what nursing should be doing. Its purpose is to improve allocation of scarce resources, including time and money, and to manage the agency

for performance. Strategic planning provides strategic forecasting from one year up to more than

twenty years. It should involve top nurse managers and representatives of all levels of nursing management and practice. It will include analysis of such factors as projected technological

advances, the internal and external environments, the nursing and health-care market and

industry, the economics of nursing and health care, availability of human and material resources,

and judgments of top management.

In today’s world, the strategic planning process is used to acquire and develop new

health-care services and product lines, including new nursing services and products. Strategic planning is also used to divest outdated services and products. Both activities present moral and

ethical dilemmas for the managers and practitioners of nursing. Strategic planning can foster

better goals, better corporate values, and better communication about corporate direction. It can

lead to changes in operating management and organization.

Strategic planning can produce better management strategy and analysis and can forecast

and mute external threats. Odiorne recommends the following process for crafting a strategic plan:

a.) Identify the major problems of your organization, determining where you are headed and where you want to be. This is “gap analysis,” a technique to examine markets, products,

customers, employees, finances, technology, and community relations. Cabinets or task

forces from each area may be helpful in doing gap analysis and identifying major

problems.

b.) Examine outside influences that relate to the key problems of your organization. Focus on

the few major issues.

c.) List the critical issues-those that affect the entire organization, have long-term impact,

and are based on irrefutable evidence rather than media hype.

d.) Rank the critical issues according to their importance to your organization and plan

accordingly: “must do” and “to do” important but not urgent.” Then divide them into

“success producers” and “failure preventers.”

e.) Decide the critical issues to all organization managers.

f.) Include time in the budget.

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B.2: Functional and Operational Planning

Operational management is the organization and directing of the delivery of nursing care.

It includes such planning as creating a budget, creating an effective organizational structure that

encompasses a quality monitoring process, and directing nurse leaders, an administrative staff, and new programs.

Nursing planning performed at a service or departmental level is referred to as functional planning. It generally relates to a specialty service within a nursing division. For example, the

staff development director would be included in development of the strategic plan but would

develop operational plans for staff development as a whole and for specific services or units.

Likewise the directore of a home-health-care agency would assist in developing the strategic plan for the company but would develop agency mission, philosophy, goals objectives and operational

plans. With decentralization, each nurse manager would develop strategic plan for her or his unit

to be integrated into the organization’s strategic plan.

Operational plans are everyday working management plans developed from both long-

range objectives and the strategic planning process and short-range or tactical plans. In development of operational objectives, new strategic objectives can emerge or old ones can be

modified or discarded. Strategic and tactical plans are made into operational plans and carried out

at all levels of nursing management, not just at the patient-care level.

B.3: Business Plans

Business plans are detailed descriptions of the process for ensuring the launching of a

new product line, project, unit, or service. Business plans meet many of the standards for strategic

planning, as they are projected over an extended time period of months or years. Their purpose is to provide sources of information for investors and decision makers within the external to the

organization, motivation, and measurement of performance. Business plans are the blueprints for

business ventures.

Reading 5.2

Swanshurg, R.C. and Swansburg R.J. 1999. “Introductory Management and Leadership for Nurses”. 2

nd ed. Massachusetts, Jones & Bartlett Publishers. pp. 73-86.

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C.) Principles of Planning

Purpose of Planning

The following are some reasons for planning:

1.) Planning increases the chances of success by focusing on results, not on activities. 2.) It forces analytic thinking and evaluation of alternatives, therefore improving decisions.

3.) It establishes a framework for decision making that is consistent with top management

objectives. 4.) It orients people to action instead of reaction.

5.) It includes day-to-day and future-focused managing.

6.) It helps to avoid crisis management and provides decision-making flexibility. 7.) It provides a basis for managing organizational and individual performance.

8.) It increases employee involvement and improves communication.

9.) I t is cost-effective.

Among the activities of planning that Douglass addresses are assessment by collection,

classification, analysis, interpretation, and translation of data; strategic planning; development of

standards; identification of needs and priority setting management by objectives; and formulation of policies, rules, regulations, methods, and procedures.

Donovan wrote that planning has several benefits, among which are satisfactory outcomes of decisions; improved functions in emergencies; assurance of economy of time, space,

and materials; and the highest use of personnel. She included decision making, philosophies, and

objectives as key elements in planning.

Characteristics of Planning

What is the nature of planning? What is so distinctive about it that requires a nurse to

have the knowledge and skills requisite to engage in planning? In an environment of changing technology; mounting costs, and multiple activities, a need exists for professional nurses to plan.

The forecasting of events and the laying out of a system of activities or actions for accomplishing

the work of nursing and of the organization are perquisites to success.

Koontz and Weihrich define planning as “selecting missions and objectives and the

actions to achieve them; [planning] requires decision making, that is, choosing future courses of

action form among alternatives.” They viewed planning as an elementary function of management. In planning, the nurse would avoid leaving events to chance; she or he would apply

an intellectual process to consciously determining the course of action to take in accomplishing

work. Donovan stated that the planning process must be deliberate and analytic to produce carefully detailed programs of action that will achieve objectives.

The nurse manager plans effectively to create an environment in which nursing personnel

will provide the nursing care desired and needed by clients. In such an environment, clinical nurses will make decisions about the form or modality of practice, and nurse managers will work

with nursing personnel to establish and meet their personal objectives while meeting the

objectives of the organization.

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According to Hodgetts, planning forces a firm to forecast the environment, gives

direction in the form of objectives, provides the basis for teamwork, and helps management to learn to live with ambiguity. It should be comprehensive, with professional nurses carefully

determining objectives and making detailed plans to accomplish them. All managers and

representative clinical nurses should provide input into strategic planning, and every unit should

have a strategic plan.

Planning involves the collection, analysis, and organization of many kinds of data (the

how) that will be used to determine both the nursing care needs of patients and the management plans that will provide the resources and processes to meet those needs.

The following are some of the kinds of data that will need to be collected and analyzed for planning purposes:

1.) Daily average patient census.

2.) Bed capacity and percentage of occupancy. 3.) Average length of stay.

4.) Number of births.

5.) Number of operations. 6.) Trends in patient populations.

7.) Trends in technology.

8.) Environmental analysis.

Reading 5.3

Swanshurg, R.C. and Swansburg R.J. 1999. “Introductory Management and Leadership

for Nurses”. 2nd

ed. Massachusetts, Jones & Bartlett Publishers. pp. 73-86.

D.) Steps in Planning

The Process in Planning: Whythe and Blair (1995) identified the following steps in the

strategic planning process (Figure 11.1):

1.) Planning the process

2.) Developing and/ or assessing the mission statement 3.) Conducting the external assessment

4.) Conducting the internal assessment

5.) Setting goals and objectives

6.) Formulating strategic options 7.) Selecting and developing strategies

8.) Developing the implementation plan

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Reading 5.4

Simms, L., Price, S., and Ervin, N. 2000. “Professional Practice of Nursing

Administration”. 3rd

ed. Delmar Publishers. pp. 198-206.

E.) Budgeting as Part of the Planning Process

A budget is a plan for the allocation of resources and a control for ensuring that results

comply with the plan. Results are expressed in quantitative terms. Although budgets are usually

associated with financial statements, such as revenues and expenses, they also may be nonfinancial statements covering output, materials, and equipment. Budgets help coordinate the

efforts of the agency by determining what resources will be used by whom, when, and for what

purpose. They are frequently prepared for each organizational unit and for each function within the unit.

Planning is done for a specific period, usually a fiscal year, but may be subdivided into

monthly, quarterly, or semiannual periods. The budgeting period is determined by the desired frequency of checks and should complete a normal cycle of activity. Budget periods that coincide

with other control devices-such as managerial reports, balance sheets, and profit-and-loss

statements-are helpful.

The extent to which accurate forecasts can be made must be considered. If the budget

forecasts too far in advance, its usefulness is diminished. On the other had, factors such as

seasonal fluctuations make it impossible to predict long-range needs from short budget periods. Managers therefore necessarily revise budgets as more information becomes available. Top

management and the board of directors also may prepare long-term budgets of 3, 5, or more

years, but these are not used as direct operating budgets.

Types of Budgets

E.1: Operating or Revenue-&-Expense Budget

The operating budget provides an overview of an agency’s functions by projecting the

planned operation, usually for the upcoming year. The operating table reveals an input-output

analysis of expected revenues and expenses. Among the factors that nurse managers might include in their operating budgets are personnel salaries, employee benefits, insurance, medical-

surgical supplies, office supplies, rent, heat, light, housing-keeping, laundry service, drugs and

pharmaceuticals, repairs and maintenance, depreciation, in-service education, travel to

professional meetings, educational leaves, books, periodicals, subscriptions, dues and membership fees, legal fees, and recreation, such a Christmas parties and retirement teas.

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Both controllable and noncontrollable expenses are projected. The manager determines

the number of personnel needed and the level of skills required of each. Wage levels and quality of materials used are other controllable expenses. Indirect expenses, such a rent, lighting, and

depreciation of equipment, are noncontrollable. The noncontrollable expenses and the probability

of rises in the material prices of labor cost during the budgetary period demand that an operating

budget include some cushion funds to provide for changes beyond the agency’s control.

The operating budget deals primarily with salaries, supplies, and contractual services.

Nonfinancial factors, such as time, materials, and space can be translated into dollar values. Work hours, nurse-patient interaction hours, units of materials, equipment hours, and floor space also

can be assigned dollar values.

Reading 5.5

Tomey, A. 2004. “Guide to Nursing Management and Leadership” (8th e.d). Mosby

Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 233-248.

11

PART 6 | MANAGEMENT PROCESS: ORGANIZING

A.) Introduction to Organizing

Each organization has both a formal and an informal structure that determine workflow

and interpersonal relationships. The formal structure is planned and publicized; the informal

structure is unplanned and covert. The nurse manager should understand and use both effectively.

The formal structure of an organization is the official arrangement of positions into

patterns of working relationships that will coordinate efforts of many workers of diverse interests

and abilities.

The formal organizational structure of the nursing department should be based upon

institutional goals and nursing philosophy and objectives. It consists of the officially agreed upon graphic table of organization, which specific how each position in the department is related to

other parts of the parent institution. The formal structure of the nursing department is a system of

power and control, a system communication, and a system for assigning tasks to the most qualified workers.

Since the director and middle managers of nursing are responsible for designing the

formal structure of the nursing organization, they should understand the effects of different structural designs on human interaction.

The informal organizational structure consists of unofficial personal relationships among workers that influence their working effectiveness. The quality of a manager’s personal

relationships with others is directly related to her leadership ability. Since the formal and informal

organizational structures are complimentary, the nurse manager may use the informal

organization to compensate for shortcomings or failures in the formal structures.

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Organizational Principles

Certain organizational principles should be observed in designing the table of organization for a nursing department and in orienting personnel to function effectively within the

structure.

The Principle of Unity of Command indicates that although an employee may interact

with many different individuals in the course of his work, he should be responsible to only one

supervisor, whose direction can be regarded as final.

The Principle of Requisite Authority indicates that when responsibility for a

particular task in delegated to a subordinate, that subordinate must also be given authority over resources needed to accomplish the task.

The Principle of Continuing Responsibility refers to the fact that when a superior delegates responsibility for a particular function to a subordinate, he in no way diminishes his

own responsibility for that function.

The Principle of Organizational Centrality refers to the fact that the greater the

number of persons with whom a given worker reacts, directly, the more information he receives, and the more powerful he becomes in the total organizational structure.

The Principle of Exceptions refers to a management practice followed in –some organizations, in a which subordinates are expected to report only departures from normal

functioning, so that managerial efforts may be limited to those processes that cannot be handled

by routine control mechanisms.

Organization Concepts

In analyzing the effects of formal organizational pattern on the nature of communication

between workers, it is helpful to understand the concepts of role, power, status, authority, centrality, and communication.

Role can be defined as the set of behaviors and attitudes expected of an individual by

those with whom he interacts. It is important to note the reciprocal or reflexive aspect of role. Because one’s role is defined by others’ expectations, the individual is strongly dependent upon

those others for this aspect of personal identity. Throughout life an individual occupies a series of

roles, which change with alterations in life’s circumstances.

As a nursing department employee, the nurse may occupy several occupational roles at

the same time. A particular head nurse is a subordinate to her supervisor, a supervisor to her own

staff nurses, a peer to other head nurses, and perhaps a committee chairperson or consultant to workers in other divisions of the organization. Because different attitudes and behaviors are

called for in the execution of each role, the head nurse just described must “change costume”

many times during a typical work day, adjusting and readjusting facial expression, body language, a tone of voice, and language to meet expectations of those significant others who have

defined each role.

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Reading 6.1

Gillies, D. 1989. Nursing Management “A System Approach”. (2nd

ed.) Saunder

Company. pp. 140-150.

B.) The Importance of Organizing

Organizing is the grouping of activities for the purpose of achieving objectives, the assignment of each grouping to a manager with authority for supervising the group, and the

defined means of coordinating appropriate activities with other units, horizontally and vertically,

that are responsible for accomplishing organizational objectives.

Organizing involves the process of deciding the levels of organization necessary to

accomplish the objectives of a nursing division, department or service, or unit. For the unit, it

would involve the type of work to be accomplished in terms of direct patient care, the kinds of nursing personnel needed to accomplish this work, and the spand of management supervision

needed.

Reading 6.2

Swanshurg, R.C. and Swansburg R.J. 1999. “Introductory Management and Leadership

for Nurses”. 2nd

ed. Massachusetts, Jones & Bartlett Publishers. pp. 356.

C.) Theories Related to Organizing

Theories about the structure and function of organizations include classical organizational

theory, developed in the late 1800s; humanistic organizational theory, which came into being during the 1920s and 1930s in part as a reaction to the mechanistic approach of classical theory;

and modern organizational theory, which is based on a systems approach. Each theory describes a

different vision of an organization and of the people, tasks, and environment that make up a

complex organization.

The study of organizational structure is accomplished by applying organizational

theories. The basic principles of current organizational theories have their roots in ancient times. Intensive research into organizational structure began during the late 19

th century and continues

today.

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Organizational theories fall into three basic categories, each of which is characterized by a prevailing school of thought. Elements of each school of thought apply to health care

organizations today. Health care organizations are major industries and as such are structured on

various principles of organizational theory.

Organizational theories have several implications for nursing. Understanding

organizational structures from historical and scientific perspectives provides a basis for effective

nursing leadership and management. Nurses must be aware of the evolution of organizational theory to be able to contribute to the organization. Knowledge of the theory or theories under

which a health care organization functions enables nurses within that organization to clarify their

individual roles and functions.

Reading 6.3

Grant, A., and Massey, V. 1999. “Nursing Leadership, Management and Research”. Springhouse Corporation, Pennsylvania. pp. 10-16

D.) Processes in Organizing

D.1: Organizational Development

Organizational development deals with changing the work environment to make it more

conductive to worker satisfaction and productivity. An underlining premise is that “people

planning” is as important as technical and financial planning. Organizational development allows

managers to attend to the psychological as well as the physical aspects of organizations. Change is the terrain by which organizational development applies.

Organizational development can sustain the favorable or desirable aspects of bureaucracy, and change can modify the undesirable aspects. There is room for directive as well

as nondirective leadership within organizations. Nurse managers have to be strong and tough in

supporting the values of clinical nurses. They have to be proactive in planning, designing, and implementing new organizational structures and work environment. The object is to develop

people not to exploit them. Organizational development emphasizes personnel growth and

interpersonal competence.

D.2: Autonomy vs. Accountability

Among the psychological and personality attributes of organizational development are

autonomy and accountability, crucial elements or nursing professionalism. A professional nurse is

obliged to answer for decisions and actions. Characteristics of professional autonomy include self-definition, self-regulation and self-governance. Professional nurses respond to demographic

changes and society to defining and reshaping the content of nursing practice. They address

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society’s needs, including the needs for increased care for the elderly and the need to control

resources. Autonomy will be strengthened by unbundling the hospital bill and by direct reimbursement for nursing services by third-party payers.

D.3: Culture

Organizational culture is the sum total of an organization’s beliefs, norms, values, philosophies, traditions, and sacred cows. It is a social system that is a subsystem of the total

organization. Organizational cultures have artifacts, perspectives, values, assumptions, symbols,

language, and behaviors that have been effective in the past.

D.4: Climate

The organizational climate is the personality of an organization, the perception and

feelings shared by members of the system. It can be formal, relaxed, defensive, cautious, accepting, trusting, and so on. It is employees’ subjective impressions or perceptions of their

organization. Practicing nurses create, or at the very least, contribute to the creation of, the

climate perceived by patients.

D.5: Team Building

The commonly used terms to describe the state of feeling of an organizational climate are

high morale and low morale. Morale is a state of mind that reflects the zeal or enthusiasm with which someone works. A person who works courageously and confidently, with the discipline

and willingness to endure hardship, would be manifesting high morale.

Low morale is evident in the person who is timid, cowardly, devious, fearful, diffident, disorderly, unruly, rebellious, turbulent, or indifferent as a result of job dissatisfaction and the

organizational milieu. Morale is a motivation factor related to productivity and quality of product

or service outcomes. Firms want high morale among employees and use activities to promote it.

A team is a group of two or more workers interdependently striving for a common

purpose or mission. The team members depend upon one another. The leader will emerge (if not

appointed) as the person sustaining the confidence of the group.

Reading 6.4

Swanshurg, R.C. and Swansburg R.J. 1999. “Introductory Management and Leadership

for Nurses”. 2nd

ed. Massachusetts, Jones & Bartlett Publishers. pp.359-373.

16

E.) Organization Structure and Design

To maintain market position by reducing the cost of health care, jobs are being redesigned, organizations are being restricted, and systems are being reengineered. Redesign

focuses on individual jobs in one setting although it may be occurring in several areas

simultaneously or consecutively. The distribution of activities, excess specialization, role overlap, and waste are examined to redesign each job to appropriate tasks and appropriate qualifications to

be efficient and effective.

It is also intended to facilitate motivation, higher-quality work, greater job satisfaction, less absenteeism, and lower turnover. Unfortunately downsizing and restructuring efforts such as

differentiated practice and shared governance often lead to resistance, job dissatisfaction, and

little motivation. People may not desire growth or changes in their jobs. Some fear the increased productivity and sense job insecurity. There may not be clarity about what is to be accomplished.

Consequently, restructuring organizations and reengineering systems are important.

Restructuring and reengineering deal with the entire organization’s structure to improve

its functioning and productivity. Restructuring changes the structure of the organization. It

naturally follows organizational affiliations, mergers, consolidations, and integrations.

Downsizing or right sizing by cutting the number of positions is also restructuring requiring redesign.

Reengineering examines the process of health care delivery to improve it. Although it is collaborative, patient centered, and data driven, it usually involves the entire organization and its

members. It is complex and often radical. Common practices have been path development,

coordination among departments, case management, implementation of patient-focused care, and development of multi-skilled workers.

The role of the nurse manager through redesigning, restricting, and reengineering

involves team building, coaching, mentoring, initiating change, reducing costs, and improving quality of care.

Reading 6.5

Tomey, A. 2004. “Guide to Nursing Management and Leadership” (8

th e.d). Mosby

Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 283-292.

F.) Staffing

Changes in assignment systems are a response to changing needs. In the 1920s the case

method and private duty nursing were popular. By 1950 functional nursing was predominant in response to the shortage of nurses. During the decade team nursing was introduced to maximize

17

use of the knowledge and skills or professional nurse through primary nursing. Case management

became popular during the 1980s, and managed competition emerged as an economic strategy guiding health care reform during the 1990s. It stimulated partners in practice, which is an

interdisciplinary team.

Case Method

In the case method each patient is assigned to nurse for total patient care while that nurse

is on duty. The patient has a different nurse each shift and no guarantee of having the same nurses

the next day. The patient care coordinator, with no obligation to assign nurses to the same patient,

supervises and evaluates all care given on the unit. Popular during the 1920s along with private duty nursing, the case method emphasized following physicians’ orders (Grohar-Murray and Di

Croce, 2003.)

Collaborative Practice

Collaborative practice can include interdisciplinary teams, nurse-physician interaction in

joint practice, or nurse-physician collaboration in caregiving. Collaboration is cooperative and

assertive. The interaction between nurses and physicians or other health care team members in collaborative practice should enable the knowledge and skills of the professions to influence the

quality of patient care provided synergistically. It is important to the managed care models that

proliferated during the 1990s.

Level of Staff

The level of staff available greatly influences the assignment system used. When there

are a few RNs and a few practical nurses, many aides are quickly oriented and used. This is an

expensive and relatively dangerous mix, because aides do not have the educational background to do most of what is required or to recognize what should be reported. After the aids have done all

they can, there is still much work to be done. Consequently, there is considerable downtime. This

staffing mix lends itself best to functional nursing.

Staffing Schedules

F.1: Centralized Scheduling

Two major advantages of centralized scheduling are fairness to employees through

consistent, objective, and impartial application of policies and opportunities for cost containment

through better use of resources (Table 13-4). Centralized scheduling is not without its critics, however. Lack of individualized treatment of employees is a chief complaint, and centralized

scheduling has brought to the surface previously unrecognized organizational and managerial

problems.

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F.2: Decentralized Scheduling

When managers are given authority and assume responsibility, they can staff their own units through decentralized scheduling. Personnel feel that they get more personalized attention

with decentralized scheduling. Staffing is easier and less complicated when done for a small area

instead of for the whole agency.

F.3: Self-Scheduling

A system that is coordinated by staff nurses (Table 13-5). It is a process by which nurses

and other staff collectively develop and implement work schedules, taking policies and variables affecting staffing, into consideration.

F.4: Alternating or Rotating Work Shifts

Although straight shifts are used by some institutions or for some personnel within institutions, rotating work shifts are common for staff nurses. The frequency of alternating

between days and evenings, or days and nights, or rotating through all three shifts varies among

institutions. Some nurses work all three shifts within 7 days.

F.5: Permanent Shifts

This relieve nurses form stress and health-related problems associated with alternating

and rotating shifts. They also provide social, educational, and psychological advantages. When

nurses are able to choose the shift that best suits their personal life, they can participate in social activities even when they require regular attendance.

F.6: Block, or Cyclical, Scheduling

It uses the same schedule repeatedly. With a 6-day forward rotation, personnel are scheduled to work 6 successive days followed by at least 2 days off. The schedule repeats itself

every 6 weeks.

Reading 6.6

Tomey, A. 2004. “Guide to Nursing Management and Leadership” (8th e.d). Mosby

Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 378-402.

19

G.) Power and Politics

Power and authority are closely related and often confused. Power is one’s capacity to influence other, whereas authority is the right to direct others. One’s power may be greater or less

than the authority of the position. Authority is obtained through position power, but several other

sources of power exist.

Types of Power

A.) Position power: Derives from organizational sources.

1.) Reward power.

– The extent to which a manager can use extrinsic and intrinsic rewards to control

other people.

– Success in accessing and utilizing rewards depends on manager’s skills.

2.) Coercive power.

– The extent to which a manager can deny desired rewards or administer punishments to control other people.

– Availability varies from one organization and manager to another.

3.) Legitimate power.

– Also known as formal hierarchical authority.

– The extent to which a manager can use subordinates’ internalized values or

beliefs that the “boss” has a “right of command” to control their behavior. – If legitimacy is lost, authority will not be accepted by subordinates.

4.) Process power. – The control over methods of production and analysis.

– Places an individual in the position of:

Influencing how inputs are transformed into outputs.

Controlling the analytical process used to make choices.

5.) Information power.

– The access to and/or control of information. – May complement legitimate hierarchical power.

– May be granted to specialists and managers in the middle of the information

system. – People may “protect” information in order to increase their power.

6.) Representative power.

– The formal right conferred by the firm to speak as a representative for a potentially important group composed of individuals across departments or

outside the firm.

– Helps complex organizations deal with a variety of constituencies.

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B.) Personal power: Derives from individual sources.

1.) Expert power.

– The ability to control another person’s behavior through the possession of

knowledge, experience, or judgment that the other person needs but does not have.

– Is relative, not absolute.

2.) Rational persuasion.

– The ability to control another person’s behavior by convincing the other person

of the desirability of a goal and a reasonable way of achieving it. – Much of a supervisor’s daily activity involves rational persuasion.

3.) Referent power.

– The ability to control another’s behavior because the person wants to identify with the power source.

– Can be enhanced by linking to morality and ethics and long-term vision.

Reading 6.7

Tomey, A. 2004. “Guide to Nursing Management and Leadership” (8th e.d). Mosby

Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 110-132.

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PART 7 | MANAGEMENT PROCESS: DIRECTING

A.) Introduction

Directing is one of the management processes that need to be fulfilled as a manager or

leader. The idea of directing is when a person has to put an output or action on the plans in order

to attain a goal. To fully understand the concept of directing, a textbook from Swansburg explained it in details.

Reading 7.1

Swansburg, R. C., & Swansburg, R. 2002, Chapter 17 The Directing (Leading) Process.

Introduction to Management and Leadership for Nurse Managers, Jones and Bartlett

Publisher, Sudbury, MA. pp. 383-384

In describing the functions of management, Fayol stated that the manager must know

how to handle people and must be able to defend his or her point of view with confidence and enthusiasm. The manager learns continuously and educates people at all levels for success in

their assigned tasks.

Fayol stated that command occurs when the manager gets “the optimum return from all

employees of his (sic) unit in the interest of the whole concern. To do this, the manager must

know the personnel, eliminate the incompetent, be well-versed in the blinding agreements with

employees, set a good example, conduct periodic audits, confer with chief assistants to focus on unity of direction, not become mired in detail; and have as a goal, unity, energy, initiative, and

loyalty among employees.

Fayol defined coordination as creating harmony among all activities to facilitate the

working and success of the unit. In modern management, command and coordination are labeled

directing or leading

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According to Urwich, it is the purpose of command and the function of directing to see

that individual interest do not interfere with the general interest. Command (directing) protects the general interest and should ensure that each unit has a competent and energetic head.

Command functions to promote esprit de corps and to carefully select a staff that can be of most

service. It was Urwich premise that bringing n a new blood rather than promoting from within

may excite resentment. Urwick indicated the need for a grievance procedure, for common rules to be observed by all, and for regulations that allow for self-discipline. Managers should explain

regulations and cut red tape. They should “decarbonizes,” that is, clean out rules and regulations

as needed.

Rowland and Rowland stated that directing “initiates and maintains action toward desired

objectives” and is “closely interrelated with leadership.” These authors suggested that a manager’s choice of leadership style will be the major factor in exercising the directing function.

Among the activities of directing are delegation, communication, training, and motivation.

Reading 7.2

Swansburg, R. C., & Swansburg, R. 2002, Introduction to Management and Leadership

for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA.

B.) Nature and Purpose

The purpose of this first study block is to develop a concept and appreciation of the

nature and the purpose of directing to the management process.

Directing is said to be the heart of management process. To better make use of this

process in management, one should learn the concept and principles of this process. Directing is

said to be a process in which the managers instruct, guide and oversee the performance of the workers to achieve predetermined goals. Planning, organizing, staffing has got no importance if

direction function does not take place.

Reading 7.3

Basavanthappa, BT, 2000, Chapter 6 Directing: Nursing Administration. Jaypee Brothers

Medical Publisher Ltd: New Delhi. pp 109.

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Nature of Direction

Direction means giving the order to start the operation for the implementations of a

policy or plan. It is the managerial effort that is applied for guiding and inspiring the working team to make better accomplishments in the organizations, so it includes the necessary guidance

and instructions for carrying out the order given, and the removal of any doubts or difficulties

which may arise in the course of execution or implementation.

Direction is concerned with seeking fullest cooperation of the personnel for the

realization of collective purpose of economic objectives of organizations and it is also concerned

with fulfilling the needs of the subordinates like physiological needs, protective needs, social needs and egoistic needs.

C.) Motivation

One of the things focus on Leadership is how to keep your subordinates motivated. A

manager has to study on how to keep people stay and pursue a nursing career although the salary is not enough here in the Philippines. The manager has to understand why some employees strive

to achieve higher performance while some employees don’t.

The concept of motivation has to be included to let the student know how to stimulate

extrinsic and intrinsic motivation in each individual. There has been various studies formulated

by the different famous theorist.

Why do people work? Why do some employees achieve high productivity whereas others

are content with mediocrity or less? What can a manager do to stimulate intrinsic and extrinsic

motivation? These questions are important to the manager. They elicit complex and uncertain answers. Unfortunately, there are no simple rules that a manager can follow to stimulate the staff.

Reading 7.4

Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 4 Motivation and Morale. Guide

to Nursing Management and Leadership, 4th ed. Singapore: Elsevier PTE Ltd. pp. 90-97

D.) Management and Leadership Styles

To make use of your directing process, one should know about what leadership or

management style can be applied to certain situations and certain group of people. To enhance ones skills, on e should have a good background on the different theory or model or styles of

leadership formulated by various leaders, theorist and managers.

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Leadership Styles

There are a number of different approaches, or 'styles' to leadership and management that

are based on different assumptions and theories. The style that individuals use will be based on a

combination of their beliefs, values and preferences, as well as the organizational culture and norms which will encourage some styles and discourage others.

Charismatic Leadership Participative Leadership

Situational Leadership

Transactional Leadership

Transformational Leadership The Quiet Leader

Servant Leadership

Reading 7.5

Straker, David. (2012, March 11) Leadership Style. Retrieved from

http://changingminds.org/disciplines/leadership/styles/leadership_styles.htm

E.) Communication Process

As nurses, we need to relay our message to our clients appropriately, to deliver the news to them and to explain to them on their health status. As a nurse manager too, we need

communication to express command and delegate important task to staff nurses. Communication

by means is important in directing. In order to relay accurate and effective communication, a nurse manager or leader should know the process of communication, basic communication skills,

communication principles and method of communication.

Reading 7.6

Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 1 Communications. Guide to

Nursing Management and Leadership, 4th ed. Singapore: Elsevier PTE Ltd. pp. 4-7.

All the manager’s functions involve communication. The communication process

involves six steps. Ideation, encoding, transmission, receiving, decoding, response. The first step, ideation, begins when the sender decides to share the content of a message with someone, senses

a need to communicate, develops an idea, or selects information to share. The purpose of

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communication may be to inform, persuade, command, inquire, or entertain. Whatever the

reason, the sender needs to have a goal and think clearly or the message may be garbled and meaningless.

F.) Decision-making Process

As part of leadership, decision-making is one essential concept that needs to be hone.

The process of deciding what is right and what benefits the situation is a task that some people

has hard relying on one self.

Decision making, the process of selecting one course of action from alternatives, is a

continuing responsibility of nurse managers. They are confronted by a variety of situations. Hospital or agency policies provide guidelines for dealing with routine situations.

Reading 7.7

Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 3 Decision-Making Process and Tools. Guide to Nursing Management and Leadership, 4

th ed. Singapore: Elsevier PTE

Ltd. pp. 56-58

G.) Delegating

Delegation is one of the most frequently overlooked responsibilities of the team leader

(Muihead & Simon 1999). Delegation is a one of the skills needed for ones manager to learned

and practiced. Many leaders lack confidence that her subordinates can actually do simple task.

To be an effective leader, he or she knows how to manage task to meet the deadline so

thus he or she needs to make use of her subordinates. The reading is an overview of what is

delegation and the leader’s role to the delegation process.

Reading 7.8

Daly, J., Speedy, S., Jackson, D. 2004. Nursing Leadership. Elsevier Australia: New

South Wales. pp. 322-324

What then is delegation? And what is the leader’s role in the process? Delegation is the simple act of providing both the authority and responsibility for performance. Another member

of the team must be given the authority to conduct the performance, and the responsibility to

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ensure that it is done correctly. This means the team member who is doing the work has the right

to make choices, make decisions, use discretion and personal methods

The next reading discussed more on the concept of the delegation. It tackles on the reasons for

delegating and the ways on effective delegation.

Reading 7.9

Swansburg, R. C., & Swansburg, R. 2002, Chapter 17 The Directing (Leading) Process. Introduction to Management and Leadership for Nurse Managers, Jones and Bartlett

Publisher, Sudbury, MA. pp. 385-386

Delegating, a technique of time management, is a major element of the directing function

of nursing management. It is an effective management competency by which nurse managers get

the work done through their employees. One of the criticisms of new nurse managers is that they emerge from clinical nurse roles and fail to identify with their management role. Theses nurses

have been rewarded for their nursing, not for their skill in leading other nurses.

Delegation is part of management; it requires professional management training and development to accept the hierarchal responsibilities of delegation.

H.) Group and Teamwork

Group: An aggregate of individuals who interact and mutually influence each other.

1.) Formal Group: clusters of individuals designated by an organization to perform

specified organizational tasks.

2.) Informal Group: groups that evolve from social interactions that are not defined

by an organizational structure.

3.) Real/Command Group: groups that accomplish tasks in an organization and are

recognized as legitimate organizational entities.

4.) Task Group: these are several individuals who work together to accomplish

specific time-limited assignments.

5.) Competing Group: groups in which members compete with each other to

achieve the same goal.

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6.) Committees or Task Forces: groups that deal with specific issues involving

several service areas.

Team:

These are real groups in which individuals must work cooperatively with each

other in order to achieve some overarching goals.

A small number of people with complementary skills, who are committed to a

common purpose, set of performance goals, and approach for which they hold themselves

mutually accountable.

It has a command or line authority to perform tasks, and membership is based on

the specific skills required to accomplish the tasks.

Group & Team Processes

A.) Elements of a Group System

1.) Activities: observable behaviours of group members.

2.) Interactions: verbal and non-verbal exchanges of words or objects among

group members.

3.) Attitudes: perception, feelings, and values held by individual group

members.

B.) Stages of Group Development

1.) Forming: the initial stage of group development in which individuals

assemble into a well defined cluster.

Tasks:

Define the purpose of the group.

Determine the goals.

2.) Storming: group members develop roles and relationships, in which

competition and conflicts may arise.

Tasks:

Roles and functions are assigned to the members.

Acknowledge and solve the conflicts that arise.

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3.) Norming: group members define goals and rules of behaviour.

Tasks:

Determine the acceptable and unacceptable behaviours and attitudes.

Develop group cohesiveness.

Explain standards or performance.

Facilitate relationship building.

4.) Performing: group members agree on basic purposes and activities, and

carry out the work.

Tasks:

Improve cooperation and the setting aside of emotions.

Provide feedback towards the work being done.

Reinforce interpersonal skills among the group.

5.) Adjourning: final stage of group development in which a group dissolves

after achieving its objectives.

Tasks:

Prepare the group for dissolution.

Facilitate closure through celebration of success.

6.) Re-forming: the group resembles after a major change in the environment

or in the goals of the group that requires the group to refocus on the

activities.

Tasks:

Explain new direction and instructions.

Provide guidance in the process of re-forming.

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PART 8 | MANAGEMENT PROCESS: CONTROLLING

A. Introduction

As the last part of the management process, controlling is one of those elements that need

to be harness among leaders or managers. This is to set the movement of the body of the

organization in one direction.

Controlling was defined by Urwick as seeing that everything is being carried out in

accordance with the plan which has been adopted, the orders which have been given, and the

principles which have been laid down.

In the reading selected by Swansburg about controlling, discusses further about

controlling with its principles being followed, the description of the controlling process, the usage of controlling as a function of the nursing management.

Reading 8.1

Swansburg, R. C., & Swansburg, R. 1996, Chapter 23 Controlling or Evaluating.

Management and Leadership for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA. pp. 551-552

The final element of management defined by Fayol was control, which he defined as:

Verifying whether everything occurs in conformity with the plan adopted, the instructions issued, and principles established. It has for its object to point out weaknesses and error in order to

rectify them and prevent recurrence.

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Controlling or evaluation was defined by Urwick as “seeing that everything is being

carried out in accordance with the plan which has been adopted, the orders which have been given, and the principles which have been laid down.”

B. Control Processes

In the control process, one should know the steps getting it done. The control process is

easy to blurt out or memorize but the application is a little rough for it needs persuasion, assertiveness and dedication to keep the group intact and keep them motivated in getting the goal.

The reading discusses the 3 basic control processes based on management by Lorenzana.

Reading 8.2

Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City,

Philippines. pp. 70

C. Types of Control

As a nurse manager, one should know the different types of control that are often

practiced in some organizations. This will be able to expound the idea on what type of control

should be appropriate with this kind of group of people in the organization. This is also a good

basis for assessment by managers in order for the manager to create a contingency plan.

The reading explains briefly and precisely the types of control that are used by different agencies.

Reading 8.3

Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling.

Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City,

Philippines. pp. 70-71

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D. Qualities of an Effective Control System

As we understand that controlling is the final element of administrative process, it is

often perceived as the hassle part of the process for which the managers has to make reports,

monitoring in every single detail within the unit, from equipment needed to as simple as medicine

stocks for the patient.

Control system is a device or tool used to manage, to command and to direct; even regulate

behaviors within the unit. In order to make a successful control system one should learn the qualities or characteristics of an effective control system.

Reading 8.4

Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling.

Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City,

Philippines. pp. 71- 72

Characteristics of an Effective Control System

An effective control system must be suitable for the activity it seeks to regulate and

should be minimum required to achieve the desire results. Over elaborate control often

fail.

The standards employed must be objective and measurable. If the standards used of

evaluating workers performance, for example, are not objective and measurable, they are

not used.

In one of the page of Swansburg’s text book, he had mentioned also a ten characteristics

of a good control system.

Reading 8.5

Swansburg, Russel C. 1996. Chapter 23 Controlling or Evaluating. Management and

Leadership for Nurse Managers.2nd

ed. Jones and Bartlett Publishers Canada: Ontario. pp. 553.

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E. Tools and Techniques

The managers should be well versed on the different control techniques or tools used in

monitoring outcomes and the progress of a project based on calendar charts and evaluating the

output. The control techniques are classified into three namely traditional, specialized and over-

all performance techniques.

The following reading is explained briefly yet direct to the point on techniques used in

controlling.

Reading 8.6

Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City,

Philippines. pp. 72- 74.

F. Quality Management

As part of the controlling process, one should keep track on the quality of each output.

For nurses, we care about the care we are giving our patients, for as simple as workers at a

factory, it goes with the same process of quality in each end product. Quality management does not aim to assure 'good quality' by the more general definition, but rather to ensure that an

organization or product is consistent.

The reading discusses the introduction, facet and principles of quality management. This will help you as a student an idea on the quality management and how it is important in the

controlling process.

Reading 8.7

Sukhija, Raman. 2009. Quality Management: An Excellence Model. Global India Publications

Pvt Ltd: New Delhi. pp.1-13