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NURSING ADMINISTRATION PROCESS

Prepared by:Jaybee Claire Santuyo

ADMINISTRATION

- Refers to the group of individuals who are in charge of creating and enforcing rules and regulations, or those in leadership positions who complete important task.

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NURSING ADMINISTRATION

-act of managing nursing duties, responsibilities, or rules.

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Standards

• Standards: “Statements that describe a level of care or nursing performance by which the quality of nursing practice can be judged.”

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Standards of Nursing Administration1. Standards of Care = statement of a competent

level of clinical nursing practice, such as identifying problems and planning & taking action to correct them

2. Standards of Performance = statement of competent role activities, such as collaboration & quality of care

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Standards of Care

Standard 1: AssessmentStandard 2: DiagnosisStandard 3: Identification of OutcomesStandard 4: PlanningStandard 5: ImplementationStandard 6: Evaluation

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Standards of Care1. Assessment: Develops, maintains, & evaluates

patient/client and staff data collection systems and processes to support the practice of nursing and delivery of patient care.

2. Diagnosis: Develops, maintains, & evaluates an environment that supports the professional nurse in analysis of assessment data and in decisions to determine relevant diagnoses

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Standards of Care (cont.)

3. Identification of Outcomes: Develops, maintains, & evaluates information processes that promote desired client-centered outcomes

4. Planning: Develops, maintains, & evaluates organizational planning systems to facilitate the delivery of nursing

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Standards of Care (cont.)

5. Implementation: Develops, maintains, & evaluates organizational systems that support implementation of the plan

6. Evaluation: Evaluates the plan and its progress in relation to the attainment of outcomes.

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Standards of Professional Performance

• Standard 1: Quality of care• Standard 2: Performance appraisal• Standard 3: Education• Standard 4: Collegiality• Standard 5: Collaboration• Standard 6: Research• Standard 7: Resource utilization

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Standards of Performance1. Quality of Care & Administrative Practice:

Systematically evaluates the quality and effectiveness of nursing practice & nursing services administration

2. Performance Appraisal: Evaluates own performance based on professional practice standards, relevant statutes & regulations & organization criteria

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Standards of Performance (cont.)

3. Education: Acquires & maintains current knowledge in administrative practice

4. Collegiality: Fosters professional environment

5. Ethics: Decisions & actions are based on ethical principles

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Standards of Performance (cont.)8. Collaboration: Collaborates with nursing staff at

all levels, interdisciplinary teams, executive officers, and other stakeholders

9. Research: Supports research & integrates it into the delivery of nursing care & administration

10. Resource Utilization: Evaluates & administers the resources of organized nursing services

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Standards met incarrying out Decision-Making

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Decision-Making

• Fundamental skill for all aspects• Traditional decision-making starts with

identifying problem• Management decision-making starts with

writing objectives--fixed end goals

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Decision-Making Grid• List alternatives down the

first column on left• For each write out

– Financial effect– Political effect– Department effect– Time

• Last column write decision about each alternative

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Standards met incarrying out Planning

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Roles & Functions: Planning

• Mission• Philosophy• Goals & objectives• Strategies to achieve goals & objectives:

programs, policies, procedures• Time management • Delegation

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Overcoming Barriers to Planning

• Goals & objectives increase effectiveness• Plan is a guide & must be flexible• Include all stakeholders in planning• Plans should be simple, specific, realistic• Planned change

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Planning: Managing Change

• STAGE 1-UNFREEZING

• STAGE 2 - MOVEMENT

• STAGE 3 - REFREEZING

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Planning: Emotional Stages of Change

1. Equilibrium2. Denial3. Anger4. Bargaining5. Chaos

6. Depression7. Resignation 8. Openness9. Readiness10. Reemergence

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Planning: Time Management

1. Prioritizes day-to-day planning to meet short-term & long-term unit goals

2. Schedules time for planning3. Analyzes others’ use of time4. Eliminates environmental barriers5. Handles paperwork promptly & efficiently

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Time management (cont.)

6. Breaks down large tasks into smaller achievable ones.

7. Uses technology for documentation & communication

8. Discriminates between inadequate staffing & inadequate time

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Planning: Examples of Specific Strategies

• Use last 30-60 minutes of day to plan next & clean desk

• Plan what you will do in each 30-60 minute block

• Number tasks in order of priority• Start with most difficult priority task & work

for set time• Plan communication with staff

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Standards met incarrying out Organizing

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Roles & Functions:Organizing Delivery of Nursing Care

• Organizational structure• Authority & power in organizations• Nursing systems• Organizing client care• Committees• Nursing informatics

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Organizing: Management Functions

1. Understand agency’s structure & personal responsibility & authority within it

2. Informs staff of unit organizational chart3. Maintains & clarifies unity of command as

possible4. Follows subordinate complaints upward5. Establishes proper span of control

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Organizing: Management Functions

6. Knowledgeable about agency culture7. Uses informal organization to meet agency

goals8. Uses committee structure for quality &

quantity of work

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Organizing: Decision-Making

• Centralized: Few managers at the top

• Decentralized: At the lowest level possible

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Organizing: Assessing Culture1. How does the organization view physical

environment?2. What is the organization’s social environment?3. How supportive is the organization4. What is the organizational power structure?5. How does the organization view safety?6. What is communication environment?7. What are organization taboos & heroes?

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Organizing: Span of Control

• “The appropriate number depends on the organization, the maturity of the subordinates, and the type of work to be done. An inappropriate span of control can result in inefficiency.”

(p. 161, Marquis & Huston, 2000)

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Organizing: Committees

• Groups who want to work on a project• Manager must give parameters--A clear

assignment with deadlines• Written agendas & chairperson• Large enough to do task; small enough to

talk• Discourage “group think”

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Organizing: Patient CareCase M ethod OR

Total Patient Care Structure

Patien ts

R N

Patien ts

R N

Patien ts

R N

C harge N urse fo r each sh ift

R N M anagerde legates to

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Organizing: Patient Care

Functional Nursing O rganizaton

Medication R N Treatm ent R NType title here

Nursing AssistantsType title here

C lerical &Housekeeping

Patients

Charge R NType title here

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Organizing: Patient CareTeam Nursing O rganization

Patients

R N, LVN ,Nursing Assistant

RN staffType title here

Patients

RN , LVN ,N ursing assistant

RN staffType title here

Charge R Neach shift

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Organizing: Patient Care• Primary Nursing

– 1 RN plans & manages care for the patient in collaboration with Associate RNs

– Interfaces with MD, Charge RN, & resources• Case Management

– All RNs use resources to expedite health; OR– A special nurses monitors & facilitates use of

resources in the agency for many patients in collaboration with their nurses

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Organizing: Informatics

• Data recording & retrieval used to– Manage care– Monitor care

• Computer/technology• RNs must be educated

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Standards met incarrying out Staffing

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Roles & Functions: Staffing

1. Personnel2. Fiscal planning/budgeting3. Staffing & scheduling4. Staff Development

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Staffing: Management Functions1. Ensures adequate, skilled workforce to meet agency

goals2. Shares recruitment responsibility3. Interviews with proper techniques4. Develops selection criteria5. Places based on agency needs & employee strengths6. Interprets employee handbook7. Participates in employee orientation.

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Staffing: Personnel• Recruiting: Actively seeking out and hiring those

who can best do job• Interviewing:

– Based on specific job criteria– Best predictor of future performance is past

performance– Give person clear information about job– Try to contradict your first impressions– More than 1 interviewer is ideal

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Staffing: Structured Interview• Motivation• Physical• Education• Work experience• Present work• Previous work• Personal characteristics & goals• Anticipated contributions to this agency

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Staffing: Orientation & Socialization

• Orientation --> Competence --> Quality

• Socialization– Introduce to others & their roles– Coach as take on role responsibilities– Recognize current skills & knowledge & build

on these

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Staffing: Scheduling• Scheduling should

– Meet agency need– Be fair to all

• Policies should include, for example– Lateness, absence, illness, emergencies– Vacations & regular time off; Special requests– Expectations for working in other areas of the

agency

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Staffing: Scheduling & Budgeting

NCH/PPD = Nursing hours in 24 hour period Patient census

• Acuity of patients calculated to adjust RNs

• Cost controlled

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Staffing: Staff Development

• Interface with educators• Own role in orientation & motivation• Preceptor program

– Identification of clinical & teaching expertise– Education of preceptor– Adjustment in assignments of preceptor & new

staff– Competence checklists

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Standards met incarrying out Directing

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Roles & Functions: Directing1. Use authority to provide reward system2. Use positive feedback as reward3. Unit goals that integrate agency & employee needs4. Environment that

– Reduces job dissatisfiers– Focuses on employee motivators

5. Maintain tension for productivity along with job satisfaction

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Roles & Functions: Directing (cont.)

6. Clear communication of expectations7. Communicates sincere respect, concern, trust, &

sense of belonging to subordinates8. Assigns work appropriate to employee

competence9. Identifies what motivates subordinates, and

develops motivational strategies to meet these.

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Directing: Communications1. Understand & use agency formal communication

network2. Uses appropriate communication mode for

distribution of information3. Prepares appropriate written communication4. Consults/coordinates with others who have

overlapping functions5. Differentiates between information &

communication and recognizes need for both.

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Directing: Communications

6. Protects subordinate confidentiality7. Prepares self & staff for use of technology8. Uses group dynamics knowledge to achieve

agency goals

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Directing: Delegation

1. Creates & follows specific job descriptions that conform to national/professional standard of care

2. Understands legal liabilities of management3. Delegates based on abilities/limits of staff4. Delegates authority appropriately to achieve goals5. Maintains periodic review of delegated task6. Recognition & rewards for task completion

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Directing: Managing Conflict

1. Anticipates & minimizes sources of conflict on unit

2. Uses authority when quick, unpopular decision must be made

3. Facilitates conflict resolution between employees4. Accepts mutual responsibilities for reaching goals5. Effectively negotiates for needed resources6. Compromises unit needs only on the noncritical

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Directing: Labor Issues

1. Uses union contract appropriately2. Administers policies fairly3. Works cooperatively with administration &

personnel when dealing with unions4. Understands laws relating to manager’s work5. Safe work environment6. Alert for discrimination7. Ensures licensing requirements met

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Standards met incarrying out Control

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Roles & Functions: Controlling1. In collaboration with others, “establishes clear-cut

measurable standards of care & determines the most appropriate method for measure [whether] those standards have been met.

2. Selects & uses process, outcome & structure audits as quality control

3. Gathers data from appropriate sources4. Determines discrepancies between performance &

standards & determine why

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Roles & Functions: Controlling

5. Uses quality findings for performance review, rewards, & development of employees

6. Educates self about state & accrediting regulations that define quality

7. Participates in “benchmarking” efforts and “best practices” initiatives.

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Controlling: QualitySTEPS1. Identify standards & expected outcomes2. What information would objectively measure these

standards/outcomes?3. Determine how & where to collect the information4. Gather information5. Compare information to standards/outcomes6. Make a judgment about quality7. Share information & take corrective action prn

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Controlling: Quality

Audits1. Structure

2. Process

3. Outcomes

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Controlling: Quality

• Total Quality Improvement (TQI or QI or QAI or CQI) is a different philosophy

• “Identifying doing the right things, the right way, the first time, and problem-prevention planning--NOT inspection and problem-solving--lead to quality outcomes”

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Controlling: Performance Appraisal1. Uses formal, established system of appraisal2. Gathers fair & objective data3. Uses to determine staff education & training needs4. Based on written standards that have been communicated5. Documents process6. Follows up on deficiencies7. Conducts appraisal in way that promotes positive outcome8. Provides continuous feedback to employees.

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Example• Part of an oncology nurse performance evaluation

tool for Professional Performance Standard 3: Education The oncology nurse acquires and maintains current knowledge in oncology nursing practice.

• Rating scale used: – 1. Performance below standards– 2. Performance meets standard– 3. Performance exceeds standard

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Professional Performance Standard 3: Education: The oncology nurse acquires and maintains current knowledge in oncology nursing practice. Criteria: Rating 1 2 3 1. Participates in ongoing educational activities (including inservices, continuing education, formal education, and experientatil learning) to expand oncology knowledge of professional issues 2. Seeks experiences to develop & maintain clinical skills

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Promoting Professionalism

• Professional standards• Professional relationships & commitment• Patient advocate• Staff education & career planning