NURSING

MANAGEMENT
PROCESS
NURSING MANAGEMENT
 Is the process of working through staff
members to be able to provide
comprehensive care to the patient
 This includes planning, organizing, directing
and controlling
 The task of the nurse manager is to plan,
organize, direct and control available
financial, material, and human resources in
order to provide effective, economic care to
groups of patients
 PLANNING ORGANIZING

CONTROLLING STAFFING

DIRECTING/
LEADING
 Purpose of the Nursing
Management Process

 To achieve scientifically – based, holistic,

individualized care for the patient
 To achieve the opportunity to work
collaboratively with patients and others
 To achieve continuity of care
 Characteristic of Nursing
Management Process
 Systematic
 Dynamic
 Interpersonal
 Goal Directed
 Universally Applicable
 PRINCIPLES OF NURSING
MANAGEMENT
1. Nursing Management is planning
2. Nursing Management is effective use of
time
3. Nursing Management is decision making
4. Meeting patient’s nursing care needs is
the business of the nurse manager
5. Nursing Management is the formulation
and achievement of social goal
6. Nursing Management is organizing

 FOUR BUILDING BLOCKS OF

NURSING MANAGEMENT
1. Unit
2. Department
3. Executive officer leader
4. Operational Level –
organizational structure
7. Nursing Management denotes a
function, social position or rank, a
discipline and a field of study
8. Nursing Management is the active
organ of the division of nursing of
the organization and of the society in
which it functions
9. Organizational culture reflects
values and beliefs
10. Nursing Management is directing
and leading
11. A well manage division of nursing
motivates employee to perform
satisfactory
12. Nursing Management is effective
communication
13. Nursing Management is
controlling or evaluating
3 LEVELS OF SKILLS MANAGEMENT IN
NURSING:

1. Conceptual skills
 refers to an individual’s mental ability to
coordinate a variety of interests and
activities.
2. Interpersonal skills
 refer to interpersonal styles which mean the
ways in which individuals interact and
communicate with others
3. Technical skills
 are the tools, procedures, and
techniques that are unique to the
nurse manager’s specialized
situation
NURSING MANAGEMENT PROCESS: focuses
on:

 Planning
 Organizing
 Staffing
 Directing or leading
 Controlling
 PLANNING
 Is deciding in advance what to do, how to
do a particular task, when to do it, and
who is to do it.
 Is predetermining a course of action in
order to arrive at a desired results.
 Components of Planning
PLANNING:
PREDETERMINED
ACTION

HOW TO DO IT: WHO IS TO DO IT:

WHAT TO DO:
-technique, -professional,
-nursing activities
principles nonprofessional

Is predetermining a course of action in order to arrive at a desired results.

It is the continuous process of assessing, establishing goals and objectives and
implementing and evaluating them , which is
subject to change as new facts are known.
PRINCIPLES OF PLANNING

1. Planning is always based and focused

on the vision, mission, philosophy, and
clearly defined objectives of the
organization.
2. Planning is a continuous process.
3. Planning should be pervasive within the
entire organization covering the various
departments, services and the various
levels of management to provide
maximal cooperation and harmony.
4. Planning utilizes all available
resources.
5. Planning must be precise in its
scope and nature.
6. Planning should be time bounded.
7. Projected plans must be
documented for proper dissemination
to all concerned for implementation
and implementation as to the extent
of its achievement
 Reasons for Planning
 It leads to success in the achievements of goals
and objectives
 It provides meaning to work
 It provides for the effective use of available
personnel and facilities
 It helps nurses cope with crises and problems
calmly and efficiently
 It is cost effective
 It is based on past and future activities
 It reduces the element of change
 It is necessary for effective control
 Characteristics of a GOOD PLAN
 Itshould have a clearly worded
objectives, including results and
methods for evaluation
 Be guided by policies and/or
procedures affecting the planned
action
 Indicate priorities
 Develop actions that are flexible and
realistic in terms of available
personnel, equipment, facilities and
time
 Develop a logical sequence of
activities
 Select the most practical methods for
achieving each objective
 TYPES OF PLANNING
1. STRATEGIC OR LONG-RANGE PLANNING
“what are the right things to do”
- usually extending 3 to 5 years into the future.
2. OPERATIONAL OR SHORT-RANGE
PLANNING
“how does one do things right”
- deals with day to day maintenance activities.
3. CONTINUOUS OR ROLLING PLANS
 - similar to operating plans, involves mapping
out the day-to-day activities.
Approaches in Planning:
 Reactive Planning – is done in response to
an existing problem.
 Increase incidence of post op infection
 Increase staff turn over
 Staff absenteeism

 Proactive Planning – done before a

problem occurs. It may done in
anticipation of changing needs or to
promote growth & excellence.
 ELEMENTS OF PLANNING
 Forecasting or Estimate the future
 Set Objectives/Goals and Determine Results
Desired
 Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time
Frame
 Prepare the Budget and Allocation of
Resources
 Establish Policies Procedures and Standards
 Elements of Planning
-Forecast or Estimate the Future-
 Forecasting is looking into the future
 Refers to estimation of time series, cross
sectional or longitudinal data
 In making forecast, the planner should consider
3 things:
 Agency
 Community affected
 Goals of care
 Forecast must be supported by facts,
reasonable estimates and accurate reflection of
policies and plans
 Elements of Planning
Set Objectives/Goals and Determine Results
Desired
 GOALS are broad statements of intent derived
from the purposes of the organization.
 Is a desired aim or condition toward which one is
willing to work
 Individual goals- are personal goals; based on one’s
desired in life
 Group goals- may refer also to organizational goals
although on a smaller scale
 Organizational goals- management goals of an
organization that are established to justify its
existence
 They are the potential result that will move the
org. closer to its vision & mission
 Objectives –
- specific aims, purposes or targets set for
accomplishment.
- Should include plan of action to facilitate the
accomplishment of needs or desired goals.
- Should answer the questions of:
 who
 What
 Where, and
 Why
 And be flexible enough to allow for changes or
elimination when they are no longer useful.
 The objectives of the Nursing Department is congruent
to its vision as well as to the 11 key areas of
responsibilities to nursing practice:
 To observe ethical principles and standards that govern
nursing practice. (ethico-moral-legal responsibilities)
 To establish well coordinated referral system for the
continuity of patient’s/ client’s care. (communication)
 To assure the application of acceptable performance of
functions, duties, and responsibilities of every position in
the nursing department. (safe & quality nursing care,
management of resources)
 To encourage its nursing personnel to participate in
nursing research for improving nursing care. ( research)
 To utilize media for information campaign to intensify
health education program. (health education)
 - ELEMENTS OF PLANNING-
MISSION OR PURPOSE
- The mission statement outlines the agency’s
reason for existing ( whether hospital or health
care), who the target clients are ( the poor, the
needy, the middle or upper class), and what
services will be provided ( in-patient, out-patient,
emergency).
- reason for the existence of the organization
(Nursing service exist to promote and maintain
health)
-What is the reason for existence?
- What do you have to offer to our clients?
- What makes us unique and distinct from
competitors?
- What we are doing and what we are going
to do in pursuit of the vision?
- Mission is broadly stated definition of:
- Who are our primary clients/ customers?
- What are the major products & services?
- What are the organization’s basic technologies?
 Mission
 The BON shall unwaveringly pursue the
advancement of nursing development in the
country by:
1. providing leadership, information, options,
scenarios and lobby efforts to targeted decision
makers and stakeholders
2. ensuring adherence to professional, ethical and
legal standards as mandated by existing
regulatory laws
3. unifying the nursing sector through good
governance
4. fostering linkages with the domestic and
international stakeholders
Vision:
 A thought, concept or objective formed by
the imagination.
 What do you want to create within a
certain period of time?
 What do you want to be?
 Where do you want to be?
 Vision

The Board of Nursing under the guidance

of the Almighty, with its unquestionable
integrity and commitment, envisions
itself to be the ultimate authority in
regulating the nursing profession in the
Philippines and to lead nursing
development to its highest level of
excellence.
 PHILOSOPHY
- Philosophy is the sense of purpose of the
organization and the reason behind its
structure and goals.
- Philosophy states the beliefs that influence
nursing practice and beliefs about health care.
- What kind of nursing service would you believe on
that will provide efficiently and effectively nursing
care according to the clients need for care?
- What staffing status should you set up towards
adequate staffing patterns base on the level of
acuity of the clients?
POLICIES
 Policies in general, they are guidelines to
help in the safe and efficient achievement
of organizational objectives.
 Policy Manual must contain all the guides
necessary to operate Nursing Service.
PROCEDURES
 Procedures are specific directions form
implementing written policies.
 Procedure Manual must contain all necessary
nursing procedure that are being performed
relative to patient care.
 Elements of Planning
Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time
Frame
 Strategy is the techniques, methods, or
procedure by which the overall plan of the
higher management achieve desired
objectives.
 Programs are activities put together to
facilitate attainment of some desired goals.
 Time Management is a technique for
allocation of one’s time through the setting
of goals, assigning priorities, identifying
and eliminating time wastes and use of
managerial techniques to reach goals
efficiently
Principles of Time Management

1) Planning for contingencies-planning anticipates

the problem that will arise from actions without
thought
2) Listing of task-task to be accomplished should
be done in sequence which are prioritized
according to importance
3) Inventory
4) Sequencing
5) Setting and keeping deadlines- and adhering to
deadline is an excellent exercise in self
discipline
6) Deciding on how time will be spent
 Time Saving Techniques, Devices and
Methods to Better Use of Time
1. Conduct an inventory of your activities.
2. Set goals and objectives and write them down.
3. With the use of calendars, executive planners, logs or
journals, write what you expect to accomplish yearly,
monthly, weekly or daily.
3. Break down large projects into smaller parts.
4. Devote a few minutes at the beginning of each day for
planning.
5. Organize your work space so it is functional.
6. Close your door when you need to concentrate.
7. Learn to delegate.
8. In a meeting, define the purpose clearly before starting.
9. Take or return phone calls during specified time.
10. Develop effective decision-making skills.
11. Take rest breaks and make good use of your spare time.
 Multitasking

 Part of daily life & becomes a way of life.

 Trying to get more things done in less time
which does not really make a person more
efficient.
Ex. Nurse is asked to do a lot of things, any one of which may
demand her full attention.
 The net effect of multi tasking, when several
task are done at once, some of them end up
being performed in a haphazard manner
which can have disastrous consequences.
DEVELOPING AND SCHEDULING PROGRAMS
 Programs are predetermined, developed and
targeted within a time frame to reach the set
goals and objectives.
 The Planning Formula
 WHAT
 WHEN
 WHERE
 HOW
 WHO
 WHY
 CAN
 Elements of Planning
Prepare the Budget and Allocation of
Resources
PREPARING THE BUDGET
A budget is the annual operating plan, a financial “road
map” and plan which serves as an estimate for future
costs and a plan for utilization of manpower, material
and other resources to cover capital projects in the
operating programs.
A nursing budget is a plan for allocation of resources
based on preconceived needs for a proposed series of
programs to deliver patient care during one fiscal year.
A hospital budget is a financial plan to meet future
service expectations.
 Factors in BUDGET planning
 Type of patient, length of stay in the hospital and
acuteness of illness
 Size of hospital and bed occupancy
 Physical lay out of the hospital, size and plan of
the wards, units, nurse’s station, treatment
rooms, etc
 Personnel policies
 Salaries paid to various type of nursing personnel
including OT pay or shift differential
 Extent of VL, SL, holidays
 Provision for staff development programs
 Grouping of patients such as those in
specialized areas
 Standards of nursing care: kind and
amount of care to be given as it affects the
number of hours of bedside care
 The method of performing nursing care
whether simple or complex; the method of
documentation
 Proportion of nursing care provided by the
professional nurses and those given by
nonprofessionals
 Amount and quality of supervision
available and provided; the efficiency of
job description and job classification
 Method of patient assignment whether
functional, case, team or primary
 Amount and kind of labor-saving devices and
equipments
 Amount of centralized service provided: sterile
supply , central o2 supply, linen supply
 Nursing service requirements of the ancillary
departments: clinics, admitting office, ER
 Reports required by administration whether
simple or complex
 Affiliation of nursing students or medical
students
 Elements of Planning
Establishing Nursing Standards, Policies &
Procedures
Nursing Standards

Standard- a practice that enjoys general recognition and

conformity among professionals or an authoritative
statement by which quality of practice or education can be
judged
Nursing Care Standard – a descriptive statement desired
quality against which to evaluate nursing care
Purpose of nursing standards
 Improved quality of care
 Decrease the cost of nursing care
 Determine nursing negligence
Sources of nursing standards
DOH, BON, Professional Organization, Nursing Programs
 Nursing Service Policies

 Policies in general are guidelines to help in safe

and efficient achievement of organizational
objectives.
 Standing plans of the nursing organization.
 They are the conceptual plans that are translated
into physical entities usually called manuals.
 Usually develop by a policy committee.
 At nursing division level, committee is made of
representatives from nursing specialist and top
nursing management.
There are 3 general areas in nursing which
requires policy formulation. These are:

 Areas in which confusion about the locus of

responsibility might result in neglect or
malperformance of an act necessary to a
patient’s welfare
 Areas pertaining to the protection of patients’
and families’ rights as right to privacy and
right to property
 Areas involving matters of personnel
management and welfare
Nursing procedures
 Procedures are specific directions for
implementing written policies
 Manual contains detailed plans for
nursing skills ( procedures) that include
steps is proper sequence.
 Procedures outline a standard technique
or method for performing duties and
serve as a guide for action.
 Phases of Planning
Phase I: Developing the Plan
 Developing a plan is to establish its purpose.
 Must be clear about the purpose of planning
to avoid confusion.
 However, purpose may be stated in broad
terms until through assessment of the
situation is done or problem is done
 Example: Reduce children & adult morbidity
rates in Brgy. Dos
 When assessing the situation/ problem:
 Information to confirm or revise the identified
problem is needed.
 When problems & environmental situations
are already assessed – objectives are
formulated.
 Objectives should be written as measurable
so that they can serve a guidelines for
evaluation.
 Example: The occurrence of communicable
diseases among children in brgy. Dos will be
reduced by 50% in 2008, 80% in 2009 and
100% by 2012.
 Phase II. Presenting the Plan:
 Plans for projects are presented to
admin/management for approval.
 Planner needs to be persuasive in
convincing others to accept the plan.
 Must be presented in organized manner
& clearly, concise and direct in
professional manner.
Phase III: Implementation & monitoring:
 Identifying & arranging activities
according to sequence.
 Setting target dates for completing each
activity
 Assignment of responsibilities to
particular individuals
 Allocation of resources
ORGANIZING:
ORGANIZING
 is the process of establishing formal authority.
 Involves setting up the organizational
structure through identification of groupings,
roles and relationships.
 Determines staff needed through developing
and maintaining staffing patterns and
distributes them in the various areas as
needed.
 Develops job descriptions by defining the
 qualifications and functions of personnel
 Organizing is one way which nursing
management coordinates the various
activities of a department or a unit so that
the staff can get its work done in an
orderly fashion.
 Organizing means having qualified people
and the right materials, information and
equipment needed to deal with
contingencies.
 6 Steps in organizing:
1. Establishing enterprise objectives
2. Formulating supporting objectives, policies and
plans
3. Identifying and classifying activities necessary
to accomplish the objectives
4. Grouping these activities in the light of human
and material resources available
5. Delegating the head of each group to perform
the activities
6. Trying together the group horizontally and
vertically, through authority relationships and
information flows.
1. Development of mission, philosophy, and
objectives
2. Development of organizational charts.
- indicates who has the legitimate power
to make decisions and who should give
and receive directions
3. Development of job descriptions
- a written account of the organizational
relationships, responsibilities, and skills
required for appointment and a resume of
duties delegated to the position by top
management
 Organizational Structure
- A framework in which the management
process is carried out in an organization

Designed to:
1. show clear lines of authority,
2. flow of communication and
3. relationships among departments, and
4. to pinpoint person/s responsible and
accountable
 Upper
levels

Middle Levels

Lower
Level
 Patterns of Organizational
Structure
 Tall or Centralized Structure
 Flat or Decentralized Structure
 TALL OR CENTRALIZED STRUCTURE

 Responsible for only a

few
subordinates, so there
is a narrow span of
control
 Because of the vertical
nature of the structure,
there are many levels
of communication
TALL OR CENTRALIZED STRUCTURE
 Flat or Decentralized Structures
 Refers to an
organizational
structure with few or
no levels of
intervention between
management and
staff, where decision
making is spread
among people.
Communication from
lower to higher levels
is easy and direct.
Flat or Decentralized Structure
Types of Organization Classified by Nature
of Authority
 Line Organization-
 Informal Organization-
 Staff Organization- Functional Organization
 Ad Hoc Organization
 Matrix Organization
 TYPES OF ORGANIZATIONAL
STRUCTURE
 Line Organization-
each position has
general authority
over the lower positions
in the hierarchy.
(also known as
Bureaucratic/Pyramidal)
Informal Organization- (Flat or horizontal
organization)
refers to horizontal
relationship rather
than vertical.
 Staff Organization –
DIRECTOR
Is purely advisory to
the line structure w/
no authority to put TRAINING OFFICER
CHIEF NURSE
recommendations
into action.
 DIRECTOR

Chief Nurse Training Officer

SN SN SN
 Functional Organization-
purely advisory to the line
CEO
structure with no authority
to put recommendations
into action

Nursing Dietary Pharmacy Storeroom

Ad Hoc Organization –
modification of the
bureaucratic structure
and used as temporary
basis to facilitate
completion of a
project within a
formal line
organization
Matrix Organization –
designed to focus on
both products and
function. It has both
vertical and
horizontal chain of
command. Most
complex organization
structure.
Concentric or Circular - shows outward
flows of communication from center

SN

CN

SN SN
 PRINCIPLES OF ORGANIZATION
Communication:
 effective and open communication in all
forms; thread that binds the organization
together.
 Directions of communication:
 Downward
 Upward
 Lateral/Horizontal
 Outward
 UPWARD
(to superior)

HORIZONTAL NURSES OUTWARD

(peer) (IFC)

DOWNWARD
( subordinates)
 Downward- ex: policies,rules,
regulations, performance appraisal
 Upward – ex: grievance procedure,
incident reports, written reports
 Horizontal/ lateral - endorsements
 Outward - image to the public
 Unity of Command – employee has one
supervisor and one plan for a group activity with
same objective.
 Span of Control - the number of employees that
one supervisor manages in an organization.
 To determine the span of control:
• Limit the number of subordinates that you can
effectively inspire, animate, direct, and
coordinate
• Note that too few immediate subordinates
result in oversupervision; too many in
undersupervision
• Be responsible for the actions of subordinates
 Delegation of authority – determine the line and
staff of authority which delineates the distribution
of power.
 Similar Assignments - responsibilities assigned
to a particular unit of an organization should be
clear-cut and well understood.
 Guidelines to follow:
• Do not assign a function to more than one independent unit of
the organization. Overlapping responsibilities causes confusion
and delay
• Assign definite and clear cut responsibilities to each member of
the organization
• Never permit an organization to grow so elaborately as to
hinder work assignment
• Assign specific, clear-cut, and similar functions to subordinates.
• Assign every necessary function to a specific individual.
 Unity of Purpose - definite plans must be
formulated based upon the objectives,
policies, standards and work procedures
previously accepted by the organization.
Every component in an organization
should work toward unity of effort and
authority and that responsibility for each
action should be decentralized to the units
and individuals responsible for the actual
performance of operations.