21.

📒PLANNING organization’s mission, philosophy,

strategic plan, goals, and objectives.
1. Planning involves several steps:
(1) identify goals and objectives to be
achieved; Mission statement describes the purpose
of the organization and the reason it exist
(2) identify resources needed (e.g.,
people, supplies,
equipment); Philosophy - set of values and beliefs that
guides the actions of the organization
(3) determine action steps; and and thus serves as the basis of all
(4) establish a timeline for the action planning.
steps and goal
achievement. New nurses should be aware of the
Without effective planning, the mission and philosophy of the employing
management process will fail. organization and understand the
relationship between their own personal
value system and that of the
organization.
Goals - measurable, observable, and
realistic.
Objectives - more specific and detail how
a goal will be accomplished with an
established target date.

Nurse managers should be able to

Essentials of Good Planning CLEARLY ARTICULATE both the
organization-wide goals and the goals of
1. yields reasonable organizational the nursing unit.
objectives and develops alternative
approaches to meet these objectives Goals and objectives MUST be
communicated to everyone who is
2. helps to eliminate or reduce the future responsible for their attainment.
uncertainty and chance
3. helps gain economical operations
Strategic Planning
4. lays the foundation for organizing
􏰀 long-range planning - 3 to 5 years into
5. facilitates coordination the future
6. helps to facilitate control Purposes:
􏰀 Identify strategies to respond to
PLANNING changes in customer needs, technology,
health care legislation, the business
Effective planning requires the nurse environment, and the community.
manager to understand the
1
􏰀 Dedicate resources to important resources available
services and new programs.
􏰀 Allocation of resources (i.e., staff,
􏰀 Eliminate duplication, waste, and supplies, time) to meet budgetary
underused services. 􏰀 Establish a requirements
timeline for a goal achievement.
􏰀 Details of Strategic Planning
Nurse manager
􏰀 organizational goals
􏰀 plan for a variety of other activities,
􏰀 allocates resources such as:
􏰀 assigns responsibilities, and 􏰀 staff development,
􏰀 determines timeframes. 􏰀 regulatory compliance,
􏰀 quality improvement
Strategic Planning 􏰀 patient safety projects
􏰀 Responsible: upper-level management
Budgeting
PLANNING 􏰀 A plan that uses numerical data to
predict the activities
Increasing emphasis to include
of an organization over a period of time
employees at all levels
􏰀 provides a mechanism for planning and
in strategic planning processes control, as well as for promoting each
unit’s needs and contributions

Operational Planning
􏰀 nurse manager is responsible for Purpose: define a road map for revenue
operational planning or the short-range and expense while identifying cash
planning needs.

􏰀 encompasses day-to-day activities of

the organization. PLANNING
Types
Example: 1. Operating budget - a combination of
PLANNING the revenue

􏰀 Nurse Manager identifies: and expense budget; forecast of the

revenue that is expected to be earned
􏰀 Number, type, and location of patients and the expenses incurred to
to be cared for
earn the revenue during the same period.
􏰀 Qualifications and abilities of nursing
and other health care staff Example: personnel costs, supplies,
equipment, and
􏰀 Type and amount of supplies and other
physical overhead expenses
2
2. Program budget - contains all the
items that are a cost in a particular care
delivery program;
competed for new programs and
expansions of existing programs of care
or services; if approved, then its budget
becomes part of the operating budget.
3. Capital budgets - summarize the
anticipated budget for the fiscal year and
usually have minimum cost to be
included; separate from the everyday
operating budget; released by the
finance department when available for
approved purchases.
Example: purchase of equipment with 3
years life span
4. Cash Budget - payments for resource
or cash outflow; monitored carefully to
ensure adequate cash to pay bills in a
timely manner and reduce the necessity
to borrow funds to pay bills.
Example: payment of salaries for work
performed.
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3
22A. ORGANIZING c. Scheduling

The nurse manager’s staffing and 􏰀 Once the variables of health-care

scheduling goals are to assure the setting, care delivery models, patient
presence of adequate, responsible, acuity, and nursing staff have been
qualified, and competent personnel who determined
will provide quality nursing care services 􏰀 staffing process continues into the
in a timely manner. development of the schedule.
􏰀 process of making the personnel work
ORGANIZING assignments for a specific period.

b. Staffing - refers to job assignments. 􏰀 communicated to the staff in a manual

format (paper and pencil) or by
computer.
Job assignments include the following:
1. volume of work assigned to Goal: uphold standards to organize
individuals, provide quality patient care services.
2. professional skills required for
particular job assignments
Consideration and variables:
3. the duration of experience in a
particular job 1. institutional policies,

category, and 2. regulatory agencies, and

4. work schedules. 3. Professional organization standards.

Staffing Process Hospitals primarily have five shifts:

1. Assessment of the current staffing o three 8-hour shifts

situation (qualification and competence o (7 a.m. to 3 p.m., 3–11 p.m., 11 p.m. to
of staff available) 7 a.m.)
2. Formulate a plan to meet future needs. 􏰀 two 12-hour shifts (7 a.m. to 7 p.m.; 7
3. Make a schedule (organized plan) of p.m. to 7a.m.).
personnel to provide patient care
services.
􏰀 Some hospitals utilize other shift times
such as 4- and 10-hour shifts.
Four Elements of Staffing Plan
1. Health care setting Work schedules can be
2. Care delivery model 4-hour,
3. Patient acuity, and 8-hour,
4. Nursing staff.
4
10-hour,
12-hour, 1. Centralized staffing - master plan is
developed as the top level of the
longer than 12-hour, or a combination. organization, frequently the central
nursing office.

Work schedules can be o offers the opportunity to oversee the

entire organization’s nursing services
􏰀 40-hour work week – fulltime activities.
employment.
Disadvantage:
􏰀 36-hour work week - full-time in some
organizations. 1. individual considerations are
minimized.
􏰀 Part time employment status can vary
by organization. 2. Decentralized staffing - a unit-based
plan with corresponding schedules
managed by the unit nurse manager.
Considerations for scheduling: 3. Mixed staffing combines centralized
􏰀 Staff should have at least two shifts off and decentralized to offer a
duty during the transition from the comprehensive overview of a facility
completion of working one shift or 8 while offering individualization for unit
hours to the starting time of a different and staff members.
shift (referred to as recovery time)
􏰀 4-week schedules shall be posted at
least 14 days prior to the beginning of
the schedule Scheduling methodologies are:

􏰀 Staff should be scheduled to be off duty 1. rotational or Cyclical scheduling,

two out of every four weekends 2. self-scheduling, and
􏰀 No nurse will be required to work more 3. Preference scheduling
than 6 consecutive days without a day off

Scheduling plans with various

􏰀 Flexible scheduling of 12 hours will be methodologies can be centralized,
in agreement with affected nurses and on decentralized, and mixed, depending on
particular units management and staff nurse
􏰀 Holiday time is rotated based on participation.
seniority

ORGANIZING
Scheduling and staffing models can be 1. Cyclical staffing is a centralized
1. centralized, system in which workdays and time off
for personnel are repeated in regular
2. decentralized, or cycles, such as every 6 weeks.
3. mixed (modified centralized staffing) 2. Self-scheduling - decentralized system
in which nursing unit can be accountable
5
for outcomes and would be self reliant for 2. hiring overtime and temporary
resources. staffing.
3. Mixed staffing combines centralized
and decentralized staffing by offering
ORGANIZING
individual units the ability to manage
regular schedules with assistance from 1. Clinical resources include
the central staffing office for shift
coverage or other clinical resources for a. STAT,
patient activity changes. Can be: b. float pool
c. admitting nurses, and
ORGANIZING d. rapid response team
a. Flexible scheduling - a strategy aimed e. temporary or supplemental
at improving retention and offers balance
and enhancement
between professional and personal-life ORGANIZING
activities. 1. STAT nurses usually with critical-care
b. Self-scheduling or preference offers experience, who respond to crisis
increased autonomy and job satisfaction. situations such as sudden cardiac arrests
(“codes”) or traumas or who provide
Daily staffing, or activation of schedule, assistance with special procedures (e.g.,
is the outcome conscious sedation, transport critically ill
of the scheduling and staffing system for patients).
a specific date and time.

STAT nurses may also be the skin and

Daily staffing - affected by the actual wound assessment team to assist
assigned nursing workload to the bedside nursing staff with prevention of
scheduled nursing staff. hospital-acquired pressure ulcers.

Daily staffing changes can be warranted 2. Float pool nurses are experienced
for various reasons such as: generalist or specialized staff available to
be assigned as needed to
1. call-ins,
any nursing unit.
2. patient care needs,
Often, these nurses can work 2 to 4
3. patient census changes, and 4. hours and move on to the next unit in
internal and external disasters. need.

Daily staffing adjustments can be c. Admitting nurses are an integral part

managed by the following options: of the patient throughput process in
acute-care settings and intake process
1. using other clinical resources
for home-health care.

6
They complete databases, initiate -=-=-=-=- =-=-=-=-=-=-=-=-=-=-=-
consults (e.g., skin care and pain =-=-=-=
management) and falls protocols, initiate
medical orders, and generally ease the
patient’s transition into hospital or home-
care settings.

d. Rapid response team, also known as

the medical emergency team, is a team
of clinicians who bring clinical expertise
to the patient bedside
System-wide action team (SWAT)
coordinated by nursing leadership in
response to increasing patient
census and acuity

e. Temporary/supplemental staffing
nurses come from agencies often
referred to as “rent-a-nurse” providers
They are paid per diem and are
reimbursed for traveling expenses.

It has great patient safety implications

because, often, credentials and
experiences are not easily verified.

The fatigue factor becomes an issue

because agency nurses also work at
another institution and do temporary
staffing for extra income.

Overtime, or extended hours, is

continuing to work beyond or before
one’s scheduled hours.
Nurses can work extended hours under
mandatory and voluntary overtime
scheduled conditions.

7
22B. ORGANIZING 3. Chain of command - formal line of
authority and responsibility
Elements of Organizing
Authority - power to guide and direct
1. Setting up the organizational structure workers within
2. Staffing their specific area.
3. Scheduling 4. Span of control - number of employees
who report to a manager or a supervisor.
4. Developing job descriptions
A wide span of control indicates that
many employees report to a supervisor;
Organizing Determines:
A narrow span means that few
􏰀 what task are to be done, employees report to one.
􏰀 who is to do these,
􏰀 how the tasks are to be grouped, Classifications
􏰀 who reports to whom and 1. Formal
􏰀 what decisions are to be made. ORGANIZING
􏰀 Highly planned and visible
a. Organizational structure 􏰀 Roles and functions are defined and
arrange systematically
􏰀 concerns the arrangement of the work
groups 􏰀 Different people have different roles 􏰀
Rank and hierarchy is evident
􏰀 intended to support the organization’s
survival and success which determines 􏰀 Provides framework for defining
accountability and responsibility managerial:
􏰀 Authority
Organizational chart 􏰀 Responsibility 􏰀 Accountability
􏰀 outlines the formal working
relationships and the way people interact
2. Informal
within the given structure.
􏰀 Unplanned often hidden
􏰀 Generally social
Components of Organizational Structure
1. Unity of Direction shows who reports
to whom and gives a pictorial view of the 􏰀 Composed of small groups of workers
organization. with similar interest

2. Division and specialization of labor - Types

employees are assigned a specific task to
complete. 1. TALL/CENTRALIZED/BUREAUCRACY
􏰀 a hierarchical structure
8
􏰀 Decision making and power held by a ORGANIZING
few people within the top level.
Difference between the Tall and Flat
􏰀 many layers of departments, and Organizational Structure
communication tends to be slow as it
travels through this type of a system.
􏰀 noted for its subdivision and
specialization of labor.

Advantage:
1. managers have a narrow span of
control and can maintain close
supervision
Disadvantage:
1. delay in decision making
2. predisposes leaders to an
Organizational Chart
autocratic style of leadership
A diagram which shows the different
positions and departments, and the
relationships among them.
2. FLAT/DECENTRALIZED STRUCTURE
Depicts an organizations structure.
􏰀 flat in nature and organizational power
is spread A picture of the organization.
􏰀 few layers in the reporting structure, Defines formal relationship within the
and managers have a broad span of institution
control.
􏰀 Communication patterns are simplified,
Uses
and problems tend to be addressed with
ease and efficiency at the level at which It shows
they occur.
1. The formal organizational
Advantage: relationships.
1. Employees have autonomy and 2. Areas of responsibility.
increased job satisfaction
3. Persons to whom one is accountable.
Disadvantage: 4. Channels of communication
1. difficult for management to process
information quickly and efficiently for the
employees. Characteristics of an effective
organizational chart:
2. Managers may be supervising areas
with which they are not familiar or have 1. Be accurate, clear, simple and
limited working experience. updated.

9
2. Shows the chain of command, lines of 8. provides starting points for planning
authority, responsibility and organizational changes.
relationships.
9. describes channels of communication.
3. All members of the department should
be notified when any change occurs.
Disadvantages:
1. Charts become outdated quickly.
Principles for drawing an accurate
organizational chart: 2. Does not show informal relationship.
1. The chart should have a clear title. 3. Does not show duties and
responsibilities.
2. It should be dated.
4. Poorly prepared charts might create
3. The higher management should be
misleading effects.
shown at the top, while most junior
positions at the end of the chart.
4. Positions of equal seniority should be 📒✒️📒✒️📒✒️📒✒️📒✒️📒✒️📒✒️📒✒️📒✒️📒✒️📒
shown at the same level.
5. For clarity, details should be well
spaced.
6. Solid lines must be used to indicate
flow of authority; staff relationships can
be shown by a dotted line.
7. Colors may be used to distinguish
between departments.

Advantages of an organizational chart:

1. provides a quick visual illustration of
the organizational structure.
2. provides help in organizational
planning.
Advantages of an organizational chart:
3. shows lines of formal authority,
responsibility and accountability.
4. clarifies who supervises whom and to
whom one is responsible.
5. emphasizes the important aspect of
each position. 6. facilitates management
development and training
7. used to evaluate strengths and
weakness of current structure.
10
23. DIRECTING 􏰀 leaders support them so they can
achieve desired outcomes
Directing
􏰀 function of the manager that gets work
done through others. MOTIVATION
􏰀 the force within the individual that
influences or directs
F. DIRECTING
􏰀 amount and quality of work
Five Specific Activities of Directing accomplished by managers directly
1. Giving directions reflects their motivation and that of their
subordinates.
􏰀 should be clear, concise and consistent
􏰀 is whatever influences our choices and
􏰀 confirm to the requirements of the creates direction, intensity, and
situation; persistence in our behavior
􏰀 Different types of situations require 􏰀 is a process that occurs pinternally to
different emphasis. influence and direct our behavior in order
to satisfy needs
2. Supervising
􏰀 concerned with the training and
discipline of the work MOTIVATION THEORIES
force; Motivation theories are not management
theories
􏰀 includes follow up to ensure the prompt
execution of orders. They are frequently considered along
with management theories.
3. Leading
􏰀 ability to inspire and to influence others
to the attainment of objectives. Two Types of Motivation Theories
4. Motivating 1. Content motivation theories define
motivation in terms of satisfaction of
􏰀 set of skills the manager uses to help
needs
the employee to identify his/her needs
and finds ways within the organization to 2. Process motivation theories define
help satisfy them. motivation in terms of rational cognitive
processes.
5. Communicating
􏰀 the what, how, by whom, and why of
directives or effectively using the MOTIVATION THEORIES
communication process.
Maslow’s Hierarchy of Needs –
Abraham Maslow
DIRECTING
􏰀 views individuals as holistic beings.
􏰀 “doing” phase of management
􏰀 Motivation occurs when needs are not
􏰀 Managers direct the work of their met.
subordinates
11
􏰀 help managers understand the The nurse is satisfied with the work itself
complexities of human behavior. but is dissatisfied with her interpersonal
relationships within the workplace
􏰀 understand why an employee with environment.
financial difficulties may not have the
motivation to undertake a complex work In order to be motivated, employees
project that might bring some personal should be satisfied both extrinsically and
acclaim. intrinsically.

ERG Theory (existence, relatedness, Theory X and Y - Douglas McGregor

growth) – Alderfer (1906–1964)
Three Categories of Workers’ Needs Theory X
1. existence needs - physiological needs Leaders must direct and control
(Maslow’s);
Motivation results from reward and
2. relatedness needs - belonging needs punishment. Employees prefer security,
(Maslow’s); and direction, and minimal responsibility, and
they need coercion and threats to get the
3. growth needs – esteem and self- job done
actualization needs (Maslow’s)

Theory Y
Two-Factor, or Motivation-Hygiene Theory
Leaders must remove work obstacles
- Frederick Herzberg because, under the right work conditions
It is built on the proposition that workers Workers have self-control and self-
have two sets of needs: discipline.
1. Intrinsic needs (or motivators) - The workers’ rewards are their
growth, advancement, responsibility, the involvement in work and in the
work itself, recognition, and opportunities to be creative
achievement.
2. Extrinsic needs (or hygiene factors) -
security, status, relationship with Theory Z - William Ouchi (1981)
subordinates, personal life, relationship
Uses collective decision making, long-
with peers, salary, work conditions, and
term employment, mentoring, holistic
relationship with supervisor, supervision,
concern, and use of quality circles to
company policy, and administration
manage service and quality.
Humanistic style of motivation based on
Example: a nurse may find herself the study of Japanese organizations.
enjoying her responsibilities and a recent
promotion while at the same time
bemoaning her coworker’s unwillingness Expectancy Theory - Victor Vroom (1964)
to be part of a team.
Three Variables that are subdivided into
Three indicators:
12
1. Force describes the amount of effort 📒✏️📒✏️📒✏️📒✏️📒✏️📒✏️📒✏️📒✏️📒✏️📒✏️📒
one will exert to reach one’s goal.
2. Valence speaks to the level of
attractiveness or unattractiveness of the
goal.
3. Expectancy is the perceived possibility
that the goal will be achieved.

can be demonstrated in the form of an

equation:
Force = Valence × Expectancy
predicts the motivation, or force, of an
individual.

Achievement Motivation Theory - David

McClelland (1971)
Employees have different motivational
needs and that managers could use
information about individual employees
to create a motivating work environment.

Achievement Motivation Theory - David

McClelland (1971) Three Need Categories
1. achievement,
2. power, and
3. affiliation.
Those who have high achievement needs
are motivated by task accomplishment.
For many, the tasks need to be
challenging, not routine
A need for power might be more fulfilled
in supervisory roles.
Those that have a high need for
affiliation have a strong need to be liked
and to work in an environment that is
friendly towards them and that involves
team work
13
23B Delegation Example: The RN degree, license, and
policy create the authority to delegate to
DELEGATION another individual in the
􏰀 process of assigning part or all of one workplace.
person’s responsibility to another person
or persons. Delegation does not change the
delegator’s accountability or
responsibility for task completion.
Purpose: Efficiency Delegator can only delegate tasks within
􏰀 No one person can do all the work that his or her scope of practice and that the
must be done responsibility for the skillful completion of
the task remains with the delegator.
alone.
􏰀 Work must be passed on, or delegated
to others. 2. A delegatee

Ultimate responsibility for the activity still 􏰀 receives direction for what to do from
belongs to the nurse leader the delegator.

As nurse managers learn to accept the The delegatee has the obligation to
principle of delegation, they become refuse to accept tasks that are outside of
more productive and come to enjoy his or her training, ability, or job
relationships with the staff. description.

DELEGATION 3. The task is the delegated activity.

The delegated activity generally should
be a routine task.
Routine tasks have predictable
outcomes, and a step-by-step method
exists to complete the task.

4. Identification of a specific client or

situation for delegated nursing care is
necessary to ensure that goals for patient
care can be met by the delegatee.

Four Components of Delegation

1. Delegator
􏰀 possesses the authority by virtue of
both position in the agency and state Rights of Delegation
government license to do certain tasks 1. Right Task:
􏰀 patient or a group of patients must be
assessed
14
􏰀 determine that an activity can be 5. Interpersonal relationships are the
delegated to a specific member of the foundation on which delegation takes
health care team. place. Two way communication,
respectful behavior and trust are
2. Right Circumstances essential to effective delegation.
􏰀 Identification of health care need(s) to Ways for Nurse Managers to Successfully
be addressed by the delegated task(s) Delegate.
and the goal or outcome to be achieved.
1. Train and develop subordinates.
3. Right Person:
2. Control and coordinate the work of
􏰀 considers the skills and abilities of subordinates, but do not go over their
individual personnel in making decisions shoulders.
about delegation of tasks.
Ways for Nurse Managers to Successfully
4. Right Communication: Delegate.
􏰀 the what, how and by when delegated 3. Follow up by visiting subordinates
tasks are to be accomplished. frequently.
5. Right Supervision: 4. Encourage employees to solve their
􏰀 monitoring and evaluation of both the own problems,
patient and the staff’s performance of and then give them the autonomy and
delegated tasks. freedom to do.
5. Assess results.
Principles of Delegation 6. Give appropriate rewards
1. Delegating assignments should be 7. Do not take back delegated tasks.
responsive to the needs of the patient
population.
2. Nurse considers the potential for harm, Barriers to Delegating
the stability of the patient’s condition,
􏰀 Preference for operating by oneself
task complexity, predictability of the
outcome and abilities of personnel to 􏰀 Demand that everyone “know all the
whom the task may be delegated and the details” 􏰀 “I can do it better myself”
degree of fallacy
supervision that will be needed. 􏰀 Lack of experience in the job or in
delegating
􏰀 Insecurity
3. Nurses only delegate aspects of care
that are consistent with the qualifications 􏰀 Fear of being disliked
and allowable scope of practice of
personnel to whom the task is delegated. 􏰀 Refusal to allow mistakes

4. The nurse retains accountability for 􏰀 Lack of confidence in subordinates

patient outcomes when making 􏰀 Perfectionism, leading to excessive
delegation decisions. control

15
􏰀 Lack of organizational skill in balancing
workloads
􏰀 Failure to delegate authority
commensurate with responsibility
􏰀 Uncertainty over tasks and inability to
explain
􏰀 Disinclination to develop subordinates
􏰀 Failure to establish effective controls
and to follow up

Barriers to Accept Delegation Delegatee

􏰀 Lack of experience
􏰀 Lack of competence
􏰀 Avoidance of responsibility
􏰀 Over dependence on the boss 􏰀
Overload of work
􏰀 Immersion in trivia
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16
23 C MANAGEMENT FUNCTIONS 2. Consultative decision procedures –
leader shares the problem either with
people individually or with group, listens
Trait Theory ideas, and then decides alone.

Four primary traits (succeed or derail) 3. Group – based decision procedures –

leader either shares problems with
1. staying calm under pressure followers as a group and then decides
alone or seeks and accepts a consensus
2. admitting errors and owning up to
mistakes
rather than covering them up Path-Goal Theory of Leadership (House &
Mitchell, 1974) helps leaders:
3. persuading others without resorting to
negative or coercive tactics * clarify the path toward goal
4. being an expert in a broad range of * remove roadblocks
areas rather than having a narrow
minded approach * increase rewards along the way

Role Theory – based on the assumptions Leadership – Member Exchange Theory

that individuals: (LMX or vertical dyad linkage theory)
explains how group leaders maintain
1. define roles for themselves and others their position by exchanging informal
based on social learning and reading agreements with their members. Leaders
have
2. form expectations about the roles that
they and others * inner circle of trusted assistants and
advisers
will play
* in – group works administrative duties
3. subtly encourage other to act within
role expectations * out – group has given low level of
influence
4. will act within the role they adopt
or choice

Normative Leadership (Vroom and Yetton,

1973) Charismatic leader
noted that situational factors could yield 􏰀 has attributes of supernatural power
unpredictable leader behavior.
􏰀 group follows direction without
question
LEADING
Decision Procedures
1. Autocratic decision procedures - leader LEADERSHIP SKILLS
decides alone and does not share the
problems with followers. 1. Critical Thinking Skills

17
􏰀 process that guides scientific 􏰀 granted by choice to a person, not to a
reasoning, the nursing process, problem position, and applies to competent
solving and decision making. professionals.
2. Decision making skills Example: Expert nurses, nurse
practitioners, clinical specialists, and
􏰀 process of selecting one best action other nurses - power based on their
from several alternatives. knowledge and expertise.
3. Problem solving skills
􏰀 involves diagnosing or identifying a 3. Reward power
problem and solving it and includes
making decisions along the way 􏰀 ability to offer rewards, which is a
potent type of power;
􏰀 promise or perception of money, goods,
services, recognition, and other
recompense in exchange for some action
that benefits the powerful person.
Example: Managers, supervisors, and
administrators
reward people with bonuses, salary
increases, promotions, and recognition.

4. Coercive power
BASES OF POWER
􏰀 physical, psychological, social, or
Common Types of Power
economic
1. Administrative (sometimes called
legitimate) or positional power 􏰀 involves the use of force in the form of
penalties and rewards to effect change;
􏰀 one serve in a line position and have
responsibility for management and 􏰀 shows a lack of respect for the
actions of other employees. autonomy of others and is seen in sexual
harassment and threats to livelihood.
Example: chief nurse executive (CNE)
Example: threat by a supervisor to fire
􏰀 has the most power relative to the whistle-blowers (people who speak out
nurses who are situated further down the about a wrong).
chart of the organization - supervisory
staff, nurse managers, and staff nurses.
5. Referent power
2. Expert power 􏰀 gained through association with a
powerful person or organization;
􏰀 influenced by results from knowledge
or expertise that is 􏰀 followed based on admiration
needed by others;

18
Example: The chair of a committee has
referent power for those who work
closely with her.

Empowerment - a sense of having both

the ability and the opportunity to act
effectively.
Empowerment - process or strategy the
goal of which is to change the nature and
distribution of power in a specific
context.

Nursing organizations seek to empower

nurses;
nursing managers and administrators
take actions to empower nurses to
achieve effective, rewarding, competent
practice.
Nurses endeavor to empower patients
to seek and adopt healthy lifestyles.

Three Required Characteristics of

Empowered Nurses
1. Raised consciousness of the social,
political, and economic realities of their
situation or environment and society.
2. A positive sense of self and self-
efficacy regarding their ability to effect,
or facilitate, change.
3. Development of skills that allow active
participation in change processes .
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
=-=-=-=-=-=-=

19
23. D. COMMUNICATION
Communication
􏰀 transfer of information and
understanding from one person to
another.
Consists of a sender, a message and a
receiver, all of which are influenced by an
environment.
Example: news that will please
Conceptual Components of subordinates, such as a bonus, would be
Communication Process delivered differently than news that
might be distressing to them, such as
upcoming layoffs

2. Horizontal communication occurs

when managers and others communicate
with people on the same level in the
organizational structure.
Example: Staff nurses communicate with
other staff nurses, or nurse managers
communicate with other managers.

COMMUNICATION
3. Diagonal Communication allows to
Modes of Communication interact with managers, physicians, and
1. Verbal communication includes Both groups of people in other departments in
face-to-face and written messages the organization who are not on the same
constitute verbal communication. level in the hierarchy

2. Nonverbal communication includes Example: a nurse executive might work

appearance, tone of voice, gestures, with the leadership of the medical staff to
body movements, glances, facial address a clinical issue.
expressions, dress, smell, proximity, and
gait

Channels of Communication
1. Vertical communication is
communication that occurs between
superiors and subordinates;

It includes downward communication-

information are sent by superiors to 4. Grapevine communication
subordinates.
20
􏰀 informal and unsanctioned information 5. Take the opportunity to convey
network within every organization” something to help, value, or praise to the
receiver
6. Follow up your communication.
The grapevine is essentially the rumor
mill in an organization. 7. Be sure your actions support your
communication.
The spread of information without regard
for the traditional networks of 8. Be an active listener.
communication.
9. Give credit for the contributions of
others when genuinely deserved.
Factors Affecting Communication in an 10. Be an assertive when expressing your
Organization view.
1. Gender
􏰀 differences in communication patterns Common Reasons for Blocks to
between males and females. Communication
2. Generational Blocks to communication - obstacles that
somehow prevent the message from
People across generations have different being delivered or understood.
socialization and experiences that
necessarily affect communication styles
and preferences.
Common Reasons for Blocks to
Bring a richness of experience and Communication
perspectives to the organization.
1. poor listening habits,
Managers should strive to create a
2. Psychological blocks
positive, empowering work environment
that is valued by all generations in the 3. environmental distractions
workforce.
4. Semantic barriers
Blocks to communication are the reason
COMMUNICATION why people leave meetings with half
messages and incomplete or inaccurate
Ten Basics for Good Communication
information.
1. Clarify your ideas before
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
communicating to others.
=-=-=-=-=-=-
2. Consider the setting, both physical and
psychological.
3. Consult with others when necessary to
be exact and objective.
4. Be mindful of the overtones as well as
the message itself.

21
23 E TIME MANAGEMENT Saves time and minimizes
procrastination.
Time Management is a way to develop
and use processes and tools for 5. Schedule the Tasks
maximum efficiency, effectiveness and Reflects priorities as well as supports
productivity. goals. Keeps track, and protects from
Involves mastery of a set of skills like stress.
setting goals, planning. Focus on what you are doing in the
Effective use of time achieves desired moment. Arrive early to plan your work.
results. 6. Do not waste time
Reduces the amount of time spent on
WHAT IS TIME MANAGEMENT? each task.
7. Managing Interruptions
Allow time for unscheduled activities or
errors .
8. Learn to say NO
9. Delegate tasks Reduces wasted time
10. Avoid procrastination
“I'll get to it later" has led to the downfall
of many good employees.
12. Schedule yourself
Make relaxation a must do

STRATEGIES FOR TIME MANAGEMENT TIME MANAGEMENT QUADRANT

1. Goal Settings Covey’s Four Quadrants for Time

Management
􏰀 know where you're going, then figure
out what exactly needs to be done, in An effective method of organizing your
what order. priorities.

2. Make a “to-do-list” Differentiates activities that are

important and urgent.
Allows to transfer tasks from your mind
into a paper, providing available space to There is a tendency to focus on things
the brain to think something else. that are urgent – and often the urgent
things are also important.
3. Prioritize tasks
Important activities have an outcome
Distinguish what is important and/or that leads to the achievement of your
urgent during the day. goals, whether these are professional or
4. Do Right personal.

Get the job done right the first time.

22
Urgent activities demand immediate -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
attention, and are often associated with =-=-=-=-=-=
the achievement of someone else's
goals.

1. Reduces Stress
Organizing the work properly and
concentrate on the most important tasks.
2. Increases Efficiency Work as per set
schedule.
3. Better Work-Home Balance
Ensures a long successful career and
avoids health troubles and family
disputes.

23
23F. CONFLICT MANAGEMENT 6. Invasion of Personal Space - example:
Crowded conditions and the constant
Conflict is a process involving two or interactions that occur at a busy nurses’
more people, where a person perceives station can increase interpersonal
the opposition of the other. tension and lead to battles over scarce
There are no conflict-free work groups work space

Small or large, conflicts are a daily

occurrence in the life of nurses and they Signs That Conflict Resolution Is Needed
can interfere with getting work done,
Feeling very uncomfortable in a situation.
Goal in dealing with conflict: create an
environment in which conflicts are dealt Members of team are having trouble
with in as cooperative and constructive a working together.
manner as possible, rather than in a Stop talking with each other.
competitive and destructive manner.
Begin “losing their cool,” attacking each
other verbally.
Common Reasons of Occurrence of
Conflict
Steps to Conflict Resolution
1. Power Plays and Competition Between
Groups – example: nurse – physician 1. Identify who is involved in or the
relationships source.
2. Increase workload – examples: are 2. Identify interests and clarify issues.
skipping lunch and unpaid overtime.
Steps to Conflict Resolution
3. Multiple Role Demands – Example:
3. Build mutual trust.
inappropriate task assignments (e.g.,
asking nurses to clean the floors as well 4. Separate the persons from the conflict
as nurse their patients) (depersonalize the conflict).
4. Threats to Safety and Security – 5. Stay in the present or look to the
example: cost saving is emphasized and future; do not dwell in the past.
staff members face layoffs, people’s
economic security is threatened 6. Avoid placing blame.

5. Scarce Resources – example: 7. Remain focused on the identified

inadequate money for pay raises, issues or problems.
equipment, supplies, or additional help 8. Discover options; brainstorm.
can increase competition between or
among departments and individuals 9. Develop objective evaluation criteria.

5. Cultural Differences – example: 10. Come to a consensus.

different beliefs about how hard a person
should work, what constitutes
productivity, and even what it means to Conflict management is the practice of
arrive at work “on time” can lead to being able to identify and handle
problems if they are not reconciled. conflicts sensibly, fairly, and efficiently.

24
Conflict Management Styles Appropriate for scenarios where
temporary solution is needed or where
1. An accommodating manager is one both sides have equally important goals.
who cooperates to
a high degree;
Approaches to Conflict Management
Effective when the other person is the
expert or has a better solution. 1. Win – win
2. Avoiding an issue is one way a 2. Win – lose
manager might
3. Lose - lose
attempt to resolve conflict.
Does not help the other staff members
reach their goals
Does not help the manager who is
avoiding the issue Cannot assertively
pursue own goals.
Works well when the issue is trivial or
when the manager has no chance of
winning.

3. Collaborating managers become CONFLICT MANAGEMENT

partners or pair up with each other to
achieve both goals; managers break free -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
of the win-lose paradigm and seek the =-=-
win-win.
Can be effective for complex scenarios
where managers need to find a novel
solution.

4. Competing: A win-lose approach:

manager is acting in a very assertive way
to achieve own goals without seeking to
cooperate with other employees, and it
may be at the expense of those other
employees.
Appropriate for emergencies when time
is of the essence.

5. Compromising: neither person or

manager really achieves what they want;
requires a moderate level of
assertiveness and cooperation.
25
23 G.. CHANGE MANAGEMENT
􏰀 Change is a part of everyone’s lives. Change and the Comfort Zone

􏰀 When change occurs too rapidly or Stages of the Change Process (Kurt
demands too much, it can make people Lewin- 1951)
uncomfortable, even anxious or stressed.

Macro and Micro Change

􏰀 macro-level (large-scale) changes that
affect virtually every health-care facility.
1. Unfreezing involves actions that create
􏰀 Medicare and Medicaid cuts readiness to change.
􏰀 large numbers of people who are 2. Change is the implementation phase,
uninsured or the actions needed to put the change
into effect.
underinsured
3. Refreezing is the restabilizing phase
􏰀 restructuring, downsizing, and staff during which the change that was made
shortages becomes a regular part of everyday
􏰀 Increasingly diverse patient populations functions.

􏰀 rapid advances in technology

􏰀 new research findings Sources of Resistance

􏰀 micro level changes to nursing units, 1. Technical concerns

teams, and individuals. 􏰀 change itself may have design flaws
􏰀 Nurses, colleagues in other disciplines, 􏰀 Resistance may be based on concerns
and patients are participants in these about whether the proposed change is a
changes. good idea.
􏰀 Example: barcodes on arm band
Change-related activities are examples
(micro-level):
2. Relation to personal needs
􏰀 Introducing a new technical procedure
􏰀 may make it more difficult for a person
􏰀 Implementing evidence-based practice to meet any or all of his or her needs
guidelines
􏰀 may threaten safety and security
􏰀 Providing new policies for staff needs.
evaluation and promotion
􏰀 Example: Staff reorganization that
􏰀 Participating in quality improvement moves some staff members to different
and patient units could challenge the belonging
safety initiatives needs of those who have close friends on
the unit but few friends outside of work.
􏰀 Preparing for surveys and safety
inspections 3. Threats to a person’s position and
power
26
􏰀 This applies to people anywhere in the 4. Dictating (forcing) change
organization, not just those at the top. 􏰀 People in authority in an organization
can simply require people to make a
􏰀 Example: reassigning of tasks change in what they are doing or can
reassign people to new positions

CHANGE MANAGEMENT CHANGE MANAGEMENT

Four phases:
1. designing the change
2. deciding how to implement the
change
3. Carrying out the actual
implementation
4. Following through

CHANGE MANAGEMENT
Lowering Resistance 􏰀 Change is an inevitable part of living
􏰀 A great deal can be done to lower and working.
people’s resistance 􏰀 How people respond to change, the
amount of stress it causes, and the
amount of resistance it provokes can be
Four categories: influenced by good leadership.
1. sharing information
􏰀 can be done on a one to-one basis, in 􏰀 Handled well, most changes can
group meetings, or through written become opportunities for professional
materials distributed to everyone growth and development rather than just
involved via print or electronic means additional stressors with which nurses
2. Disconfirming currently held beliefs and their clients have to cope.

􏰀 Providing evidence that what people -=-=-=-=- =-=-=-=-=-=-=-=-=-=-=-

are currently doing is inadequate, =-=- =-=-=-=
incorrect, inefficient, or unsafe can
increase people’s willingness to change.

3. Providing psychological safety

􏰀 reducing that threat, leaving people
feeling more comfortable with the
change.

27
23H. DECISION MAKING 3. E xplore alternative solutions.

􏰀 often thought to be synonymous with 4. Evaluate the alternatives.

management 5. Select the appropriate solution.
􏰀 both an innermost leadership activity 6. Implement the solution.
and the core of management.
7. Evaluate the results.
􏰀 Successful decision makers are self-
aware, courageous, sensitive, energetic,
and creative.
Managerial Decision-Making Models
1. Determine the decision and the
Decision making desired outcome (set objectives).
􏰀 “the thought process of selecting a 2. Research and identify options.
logical choice from the available
3. Compare and contrast these options
options.”
and their
consequences.
Problem solving
4. Make a decision.
􏰀 part of decision making
5. Implement an action plan.
􏰀 systematic process that focuses on
6. Evaluate results.
analyzing a difficult situation.
􏰀 always includes a decision-making
step. Nursing Process
1. Assessment 2. Diagnosis
Critical thinking 3. Plan
􏰀 reflective thinking, 4. Implement 5. Evalaution
􏰀 “the mental process of actively and
skillfully conceptualizing, applying,
analyzing, synthesizing, and evaluating
information to reach an answer or
conclusion”

THEORETICAL APPROACHES TO
PROBLEM SOLVING AND DECISION
MAKING
Traditional Problem-Solving Process
1. Identify the problem.
2. Gather data to analyze the causes and
consequences of the problem.

28
 􏰀 Involving others – “two heads are
better than one”
Integrated Ethical Problem Solving Model
􏰀 increasing the number of people
1. State the problem. working - increases the number of
2. Collect additional information and alternatives
analyze the problem. 􏰀 Brainstorming - think of all possible
3. Develop alternatives and analyze and alternatives
compare them. 5. Think logically
4. Select the best alternative and justify 􏰀 one must draw inferences from
your decision.
information
5. Develop strategies to successfully
implement a chosen alternative and take 􏰀 An inference is part of deductive
action. reasoning.
6. Evaluate the outcomes and prevent a 6. Choose and act decisively.
similar occurrence.
􏰀 one must act
􏰀 decisions must continue to be made
Critical Elements in Decision Making
􏰀 some - poor quality - people develop
1. Define objectives clearly. improved decision-making skills.
2. Gather data carefully.
3. Take the time necessary. INDIVIDUAL VARIATIONS IN DECISION
MAKING
4. Generate many alternatives.
1. Gender
5. Think logically.
􏰀 men may think more with their gray
6. Choose and act decisively. matter, while
women think more with the white matter.
Critical Elements in Decision Making 􏰀 allow a woman’s brain to work faster
1. Define objectives clearly. than a man’s

􏰀 Results to rich philosophy, a good- 2. Values

quality decision 􏰀 certain choices are not possible
2. Gather data carefully.
􏰀 Answers the “what”, “why”, “How” and
“when” questions
3. Take the time necessary.
􏰀 slow controlled deliberation is able to
select to correct alternative because of a person’s beliefs
4.Generate many alternatives. 􏰀 values influence perceptions, influence
information
Several techniques:
29
􏰀 gathering, information processing, and 􏰀 determine probabilities and use
final outcome historical data, such as a hospital census
􏰀 determine which problems in one’s 􏰀 used in determining how many
personal or professional life participants it would take to make an in-
service program
3. Life Experience
􏰀 more mature, the broader the
background, the more alternatives can
be identified
4. Individual Preference
􏰀 person considers one alternative
preferred over another
􏰀 certain choices involve greater
personal risk than others
5. Brain Hemisphere Dominance and
Thinking Styles
􏰀 creative, intuitive, right-brain thinkers 3. Decision Trees
􏰀 excel at nonverbal ideation and holistic
synthesizing
􏰀 Handle well on images, music, colors,
and patterns

􏰀 Analytical, linear, left-brain thinkers

􏰀 better at processing language, logic,
numbers, and sequential ordering
􏰀 Do well in mathematics, reading,
planning, and organizing

DECISION MAKING TOOLS

1. Decision Grids
􏰀 allows one to visually examine the
alternatives and compare each against
the same criteria.

2. Payoff Tables
􏰀 helpful when some quantitative
information is available

30
􏰀 decisions are often tied to the outcome
of other events
􏰀 determine the timing of decisions

􏰀 predicts when events and activities

must take place if a final event is to
􏰀 4. Consequence Tables occur.
􏰀 demonstrate how various alternatives
create different
PITFALLS IN DECISION MAKING
consequences
Confirmation biases
􏰀 how each alternative would meet the
desired objective. 􏰀 tendency to affirm one’s initial
impression and

-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
=-=-=-=-=-=-=-=-=
5. Logic Models
􏰀 are schematics or pictures of how
programs are intended to operate
􏰀 includes resources, processes, and
desired outcomes
􏰀 Depicts relationships among three
components.
5. Program Evaluation and Review
Technique (PERT)

31
23I. SUPERVISION 􏰀 Ensure every worker is carrying out
allotted work as per plan
􏰀 authoritative direction of the work of
ones subordinates. 􏰀 Analyze monthly progress report of
worker.
􏰀 a kind of teaching which involves,
advising, helping, inspiring leading and 􏰀 Providing support and guidance to all
liberating. worker
􏰀 Ensure that worker is utilizing full
capacity in job.
Major factors of the supervisor’s work
and equipment
1. Technical Purpose of Supervision

􏰀 familiarity with the know how of the 1. Inspect Performance of worker

work to be supervised. 2. Evaluate Performance of worker
2. Institutional 3. Correct / Improve Performance of
􏰀 familiarity with the policies and worker
procedures governing the work to be
supervised.
Objectives of Supervision
3. Human
1. Do job skillfully and effectively.
􏰀 ability to deal tactfully with the worker
under supervision 2. Develop the individual capacity.
3. Assist staff in meeting predetermined
work objectives.
Types
4. Promote cost effectiveness
1. Direct Supervision
5. Motivate subordinates.
􏰀 Face to face with worker
6. Identify problem and solve them.
􏰀 Important points:
7. Develop team spirit and promote team
􏰀 Do not loose temper work.
􏰀 Use democratic approach 8. Improve attitude of the member
􏰀 Do not talk too much or fast towards work.

􏰀 Be human
􏰀 Do not give instruction haphazard Supervision Criteria
way Appraisal of the ff performance elements:
􏰀 Quality of work output
2. Indirect Supervision 􏰀 Quantity of work output
􏰀 With help of record and report of 􏰀 Time use
worker
􏰀 Utilization f resources

32
􏰀 Assistance to co – worker 4. Human behavior has human
weaknesses.
􏰀 Suggestions to administrator / Co –
worker. 5. Create atmosphere of cordially and
mutual trust.
6. Plan and adopt to the changing
Factors of effective supervision conditions.
1. Human relation skill 7. Possess sound professional knowledge.
2. Technical and managerial knowledge 8. Does not give a sense that they are
3. Leadership position being supervised.

4. Improve upward relation 9. Strives to make the unit a good

learning situation
5. Relief from non supervisory duty
10. Foster the ability of each staff
6. General and loose supervision member to think and act
11. Encourages worker’s participation in
Function of Supervision decision making. Needs good
communication.
1. Orientation of newly posted staff
12. Strengthen influence downwards on
2. Assessment of workload upwards capacity
3. Assess need of supplies and 13. Process of cooperation and
equipment coordination.
4. Co-ordination with worker 14. Create suitable climate for productive
work.
5. Evaluation of worker
15. Give autonomy to workers depending
6. Helping individual to cope with
from personality, competence and
problem
characteristics.
7. Facilitate flow of communication
16. Respect the personality of the staff.
8. Raise the level of motivation
17. Stimulate the workers/staff ambitions
9. Establish control and confidence to grow in effectiveness.
10. Record Keeping 18. Focus on continued stage of growth
and development
19. Responsible for checking and
Principles of Supervision guidance.
1. Not be overburdened to any individual 20. Good leadership is part of good
or group. supervision
2. Not cause unreasonable pressure for
achievements results
Methods of Supervision
3. Diagnosis do not overestimate
understanding and memory. Technical Vs Creative Supervision

33
Co - operative Vs Authoritarian 1. Understand the duties and
supervision responsibilities
Scientific Vs Intuitive Supervision 2. Plan the execution of work
3. Divide the work among subordinates,
direct and assist
Technique of Supervision
4. Improve own knowledge as technical
1. Individual and group conference expert and leader.
2. Anecdotal record 5. Improve work method.
3. Supervision of nursing procedure 6. Train the personnel
4. Reassurance 7. Evaluate the performance of employee
5. Incidental teaching 8. Correct the mistakes and solve the
6. Observation (Check List) and rating problem of
scale employee.
7. Written Policies 9. Develop discipline among employee
10. Keep subordinate informed about
Qualities of supervisor policies and procedure of the
organization.
􏰀 Aware to rule & regulation and situation
11. Cooperate the colleagues.
􏰀 Thoroughness
12. Deal with employees suggestions and
􏰀 Fairness complaints.
􏰀 Initiative -=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
􏰀 Enthusiasm =-=-=-=-=-

􏰀 Emotional control
􏰀 Personal qualification
􏰀 Good judgment
􏰀 Sympathetic
􏰀 Intelligence
􏰀 Teaching ability
􏰀 General outlook
􏰀 Skill, knowledge and attitude required
for supervision Interpersonal &
professional skills
􏰀 Professional and technical knowledge

Duties of supervisor
34
24. MANAGEMENT FUNCTIONS Contents: layout of the firm's operating
Controlling facility, health and safety measures and
security systems.
Forms: Internship, Preceptorship,
Staff development Mentorship
􏰀 process directed towards the personal
and professional growth employees.
2. Job Orientation - process of creating
􏰀 assists individuals attain new skills and awareness with in the individual’s roles,
knowledge, gain knowledge and grow responsibilities and new relationships
professionally.

3. In-service education - planned

Importance of Staff Development educational experience - help the person
perform more effectively as a person and
1. Social change and scientific
as a worker.
advancement.
2. Opportunity to acquire and implement
the knowledge, skills, attitude, ideals and 4. Continuing education - learning
valued essential for the maintenance of activities that occurs after an individual
high quality of nursing care. has completed his basic education.
-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-
=-=-=-=
Functions of Staff Development
1. provides educational activities
2. growth and development of personnel
from employment to termination of
services.

Types of Staff Development

1. Induction training
2. Job orientation
3. In-service education
4. Continuing education

1. Induction training - initial preparation

upon taking up a post.
Goal: help new employees reach the
level of performance expected from an
experienced worker.
35
24B. MANAGEMENT FUNCTIONS Audit - systematic and official
Controlling examination of a record, process or
account to evaluate performance.
Auditing - provide a means of applying
QUALITY IMPROVEMENT / QUALITY control process to determine the quality
MANAGEMENT of service rendered.
Quality - high level of value or excellence Nursing audit – analysis of data about the
nursing process of patient outcomes to
“Quality - optimal balance between
evaluate the effectiveness of nursing
possibilities realized and a framework of
interventions
norms and values”
Concurrent nursing audit - performed
Quality care - degree to which health
during ongoing nursing care.
care increases likelihood of desired
health outcomes, and is consistent with Retrospective nursing audit - performed
current professional knowledge after discharge from the care facility,
using the patient's record.

Importance of Quality of Care

Purposes of Nursing Audit
1. Tougher Competition
1. Evaluate Nursing care given,
2. Prevent Frequent Medical Errors
2. Achievement of deserved and feasible
3. Rising Costs, Limited Health
quality of nursing care,
Expenditures
3. Stimulant to better records,
4. Rising Demands, Limited Health
Resources 4. Focus on care provided and not on
care provider,
5. Concern with Variations in Health Care
Outcomes and Costs 5. Contribute to research.
Quality Improvement - combined and
unceasing efforts of to make the changes
that will lead to better patient outcomes Advantages of Nursing Audit
(health), better system performance 1. Used as a method of measurement in
(care) and better professional all areas
development
2. Scoring system is fairly simple,
Quality Management implies managerial
oversight of quality of health care 3. Results easily understood,

When the pursuit of quality includes the 4. Assesses the work of all those involved
perspectives of internal (staff and in recording care,
funders) and external customers
(patients, payors and contractors), the
process is called total quality 5. Useful tool as part of a quality
management (TQM). assurance programme

Audit as a Tool for Quality Control Disadvantages of the Nursing Audit :

36
1. Not so useful where the nursing 3. Safety hazards - Possible exposure to
process has not been implemented, HIV and other blood borne
viruses/pathogens
2. many of the components overlap
making analysis difficult,
3. time consuming, B. harm to a patient and/or family
member or damage to patient property
4. requires a team of trained auditors,
1. Noncompliance by a patient or
5. deals with a large amount of employee
information,
2. Untoward outcomes - drug reactions
6. only evaluates record keeping - serves and IV therapy complications
to improve documentation, not nursing
care
Procedure for processing variance
reports:
Variance Reports
1. Report incident - Supervising Nurse or
All incidents, accidents, and injuries will Administrator and physician
be documented on an approved variance
report form. 2. Completion of the variance report
within 24 hours
An incident - any event that is not
consistent with the routine operation of 3. Notation of the event in the progress
the organization or the routine care of a notes not in the clinical record.
particular patient, or may have
4. Immediate notification to the
implications or be of interest to hospital
Administrator
and/or home care administration.
5. The Administrator shall be responsible
for: -
Variance Reports
a. Reviewing and reporting all variance
An accident - an act or event that occurs reports
during patient care which may cause
b. Determining causal factors
harm to the patient and/or employee.
c. Preparing a written report
d. Collecting information to use in
designing
Types of incidents/accidents
policies and procedures.
A. Safety or welfare is adversely affected
e. Presenting a report to the Professional
1. Deviations from company policies,
procedures, operating practices and
professional standards of practice Advisory Committee
2. Equipment problems, malfunctions, or
hazards
Guidelines for Processing Variance
Reports

37
1. Avoid copying a variance report
2. Do not allow any unauthorized person
to have access to variance reports
without proper authorization.
3. Do not leave sensitive information in
areas of public access
4. Do not allow sensitive information to
be distributed or placed in committee
minutes
5. Always report any unusual occurrence.

Variance reports shall be maintained for

seven (7) years.

Variance reports
􏰀 considered confidential, proprietary
information of the Agency, and are not
subject to requests for clinical records or
other such requests for information from
outside entities.
=-=-=-=-=-=—=-=-==-=-=-=-=-
=-=-=-=-=-=-

38
24C MANAGEMENT FUNCTIONS are knowledgeable about the exact
criteria by which they will be evaluated.
Controlling and Performance Evaluation

Included & communicated clearly to the

PERFORMANCE APPRAISAL worker at the time of hiring.
Able to discriminate between excellent ,
PERFORMANCE EVALUATION good & poor performance to identify area
of improvement & individual growth.
Performance appraisal can be viewed as
the process of assessing and recording
staff performance for the purpose of 3. A copy of job description, performance
making standards & evaluation form is provided
judgments about staff that lead to to review
decisions. before the evaluation.
4. Advance awareness on what will occur
Performance appraisal if

should also be viewed the employee doesn't meet expected

standards of performance.
as a system of highly interactive
5. The Evaluation period has no rule
processes which involve personnel at all
levels in differing degrees in determining 6. Self-evaluation should not be the only

job expectations, writing job descriptions, form of performance evaluation.

selecting relevant appraisal criteria,
developing assessment tools and
procedures, and collecting interpreting, PURPOSES OF PERFORMANCE
and reporting results. APPRAISAL
1. Enhances staff development &
motivate personnel toward higher
PERFORMANCE APPRAISAL achievement.
􏰀 a periodic formal evaluation of how well 2. Discovers the employee's aspiration &
the nurse has performed her duties to recognize her accomplishment.
during a specific period.
3. Improves communication
between supervisors & staff.
BASIC CONCEPTS OF PERFORMANCE
APPRAISAL 4. Improves performance.

1. The performance appraisal is a 5. Aid supervisor's coaching &

continuous process, derived directly counseling.

from the job description. 5. Determines training

2. It is very important that all employees & development needs of employee.

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5. Selects qualified nurses for 6. Performance appraisal should
advancement & salary increase. concentrate on behaviors rather than
traits.
6. Identifies unsatisfactory employee for
demotion or termination.
METHODS FOR APPRAISING
PERFORMANCE:
COMPONENTS OF PERFROMANCE
EVALUATION 1. Rating scales
1. Traits/personal characteristics The form list a number of traits,
Most performance appraisal systems as well as range of performance .
focus on personal traits and
The evaluator make a choice from
characteristics
among range of options for every
ex. stability or the ability to handle
stress. criteria assessed ,such options may
2. Results include:
o Excellent- Good – Fair – Poor.
basis of the results they produce .
o Above average - average – below
3. Productivity Measures average.
o Always – frequently – occasionally –
provision high quality patient care -
feedback seldom – never .

4. Behavioral criteria
Advantages
What the employee
1. Easy to construct.
actually does, expected behavior ,
2. It permits quantitative
analysis & comparison.
FACTORS IN CONDUCTING
PERFORMANCE APPRAISALS
1. Appraisal should be done at least once Disadvantages
yearly and it should be recorded. 1. Unclear standard.
2. Information should be shared with the 2. Often emphasized personality traits.
nurse
3. Traits are difficult to measure &
3. The supervisor should have the chance change.
to observe nurses performance .
4. A record of critical incidents should be
kept on nurses performance for the 2. Check-list method
whole period of evaluation. 􏰀 Similar in appearance &
5. Supervisors should be trained on how 􏰀 use to graphic rating scale.
to conduct the evaluation process.(what
is the acceptable performance ,how to 􏰀 The basic difference is in the type of
complete the appraisal form, and the judgment , it gives yes or no judgment .
appraisal interview)
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􏰀 It is usually evaluated by the staff 2. It might not be easy if all workers
personnel department, not the manager perform identical
doing the Check-list
tasks ,or the number of workers to be
􏰀 The final evaluation can be returned to ranked is high.
the rating manager for discussion with
employee.
4. Critical incident
􏰀 The rater keeps a running record of
Advantages
unusually or undesirable incidents for
1. Reduce some bias. each employee.
2. Useful in teaching 􏰀 Every six months a discussion is held
between the employee & the rater .
nursing procedures.
Advantages:
3. Useful for evaluating large number.
1. Related to performance
4. Expectations of performance are
clearly identified. elements of the job.
2. Good when the only
Disadvantages: purpose is counseling.
1. It does not indicate the degree with Disadvantages:
which the behavior occur.
1. Time consuming.
2. Difficult to construct.

5. Essay method
• The evaluator writes the employee's
3. Ranking method strengths and weaknesses which should
reflect the performance in relation to his
􏰀 Rank the employee in relation job description.
to his colleagues with respect
to certain aspects of performance. Advantages:
1. Allows depth analysis of performance.
Advantages: 2. Suitable for identifying training &
1. Used especially when a great benefit problem areas.
are to be 3. Meets individual differences.
given to few employees & not at all.

Disadvantages:
Disadvantages 1. Time consuming.
1. There is no standard form 2. Vary in length & content.
3. Lack objectivity.
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4. Depend on the writing ability. CHARACTERISTICS OF GOOD TOOL
5. Difficult to qualify or expressed 1. Utility
numerically.
2. Simplicity
3. Validity
6. Management by objective (MBO)
4. Reliability
In this method the supervisor & the
5. Consistency
subordinate specify the performance goal
to be attained within appropriate length 6. Stability
of time. At the end of the period ,
evaluate the outcome or the result. 7. Discrimination.

Advantages:
1. Creates interest in the employee to
accomplish goals because employee are COMMON ERRORS IN EVALUATION
able to set their own goals.
1. Ambiguous evaluation standards:
2. Minimizes defensive feeling & a spirit
of teamwork succeed & confidence. 􏰀 Most appraisal form use rating scales
that include words such as (outstanding ,
3. Great freedom is left to subordinate to above average ,satisfactory, or need
work. improvement). But different managers
4. Employees are more fairly evaluated attach different meaning to these wards.

Disadvantages:
1. The employee may attempt to set 2. Rater bias
easily attainable goals. 􏰀 Some managers allow their personal
biases to alter ratings.

6. Management by objective (MBO) 􏰀 These biases may be unpleasant

unfairness regarding sex ,color, race ,or
Advantages: religion ,as well as personal
characteristics, such as age, style of
1. Creates interest in the employee to
clothing.
accomplish goals because employee are
able to set their own goals.
2. Minimizes defensive feeling & a spirit 3-Different rater patterns:
of teamwork succeed & confidence.
􏰀 Managers (like teachers) differ in their
3. Great freedom is left to subordinate to rating styles. 􏰀 Some managers rate
work. severely, others easily.
4. Employees are more fairly evaluated
Disadvantages: 4. Halo error:
1. The employee may attempt to set 􏰀 It is the first impression effect of a
easily attainable goals. single prominent characteristics which
affect the supervisor's judgment e.g.

42
appearance ,race, social status, 2. A private room & confidential approach
position........etc. is provided.
3. Ask for a self- assessment
HOW TO OVERCOME ERRORS 4. Invite participation
1. Improve skills of the supervisor by 5. Express appreciation and start
training in method of evaluation . positively
2. Formal training program help to 6. Minimize criticism
increase appraiser ability & designed to:
7. Change the behavior, not the person
a. Make raters aware of the various types
8. Focus on solving problems
of rating errors.
9. Be supportive
b. Improve raters observational skills. c.
Training in communication skills. d.
Identify cases of supervisor's bias.
Discuss with the subordinate
3. Specific standards of performance
based on employee's job description. 1. Advancement possibilities.

4. Working record to be used as starting 2. Future pay increase.

point for monitoring progress. 3. Warning for poor performance.
5. Managers must receive appraisal form 4. Discuss any work problems that affect
& a reasonable time before evaluation performance e.g. facilities , resources,
6. Performance evaluation should be policies..........etc.
short , simple ,educative & positive for
both supervisor& subordinates.
To achieve high level of performance
7. Avoid halo effect. the supervisor must :
1. Encourage effort.
CONDUCTING THE PERFORMANCE 2. Develop abilities.
APPRAISAL INTERVIEW
3. Communicate clearly what is expected
Aims to do the job.
1. Communicates the appraisal
information to subordinates.
2. Establishes a program for
improvement.
3. Improves working relationships
between supervisor & subordinates.

How to perform the interview

1. The subordinate is given a week notice
of the date of the appraisal interview.

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