NCM 119 LEC

Nursing Leadership and Management

DIRECTING IN NURSING MANAGEMENT PROCESS
INTRODUCTION TOOLS IN DIRECTING
o Directing is the issuance of orders, assignments and o Primary tool is the NCP. Policies, standards operating
instructions that enable the nursing personnel to procedure and rules and regulations can also be tools.
understand what are expected of them. Directing includes CHARACTERISTICS OF THE NURSING CARE PLAN
supervision and guidance so that in doing a job well, 1. It focuses on actions designed to solve or minimize the
nurses can maximally contribute to the organization’s exciting problem.
goals in general and to the nursing service objectives in 2. A product of a deliberate systematic process.
particular. A manager’s important role is to help 3. Relates to the future.
subordinates perform in their best of their abilities. 4. Based upon the identifiable health and nursing problems.
DIRECTING 5. Focus is holistic.
o Directing goes beyond giving orders and instructions, it is 6. It aims to meet all the needs of the patients.
the final major step taken by the nurse manager to ensure PRINCIPLES OF DELEGATION
that the organization’s goals are accomplished. 1. Select the right person to whom the job is to be delegated.
o The manager must ensure that she has assigned the work 2. Delegate interesting and uninteresting task.
properly and that she has gotten the right person for each 3. Provide subordinates with enough time to learn.
task that needs to be accomplished. 4. Delegate gradually.
o To be able to work well, one should have a genuine 5. Delegate in advance.
interest in the task that needs to be accomplished, 6. Consult before delegating.
especially if the task is a difficult one that may require 7. Avoid gaps and overlaps.
sustained effort over a period of time. ELEMENTS OF DIRECTING
o It is also important that the employees chosen by the DELEGATION
manager are able to get along harmoniously because o it is the act of assigning to someone else a portion of the
directing employees invariably depend on the work to be done with corresponding Authority,
relationships existing among them. Responsibility and Accountability (ARA).
o This is of particular relevance in a nursing care o An assignment is a task done without authority while a
environment where continued interaction among the delegation is a task done with ARA.
various employees in the system is inevitable and WHAT CANNOT BE DELEGATED
necessary for the organization to function properly. 1. Overall responsibility, authority & accountability for
o The act of issuing of orders, assignments, instructions to satisfactory completion of all activities in the unit.
accomplish the organization’s goals and objectives. 2. Authority to sign one’s name is never delegated.
o Involves the process of getting the organization’s work 3. Evaluating the staff or taking necessary corrective or
done. disciplinary action.
o entails explaining what is to be done, to and by whom at 4. Responsibility for maintaining morale or the opportunity
what time, how and why the task should be done. to say a few words of encouragement to the staff
o Directing must be consistent with departmental policies to especially the new ones.
help personnel perform their duties safely and efficiently. 5. Job that are too technical and those that involves trust and
CHARACTERISTICS OF GOOD DIRECTING confidence.
1. Directions must be clear, concise, consistent and WHY NURSES MANAGER DO NOT DELEGATE
complete. 1. Lack of confidence feels that they only could do the task
2. Explain the rationale well and make sure it is understood. faster and better.
3. The word used indicates their importance ex: must, shall & 2. Fear of loss of control if some of their duties are delegated.
will. “may” denotes an action. “should” denotes 3. Mistakes in delegation can be costly.
recommendation or mandatory. 4. Failure to delegate wisely increases management costs
4. Speak distinctly and slowly. Directions must come across and contributes to personnel dissatisfaction.
as a request not a command, using specific tone and set 5. Fear on the part of the director, of her own ability to
of words. Prioritize the task directed to be done by delegate.
importance and time. 6. Fear of losing control of the staff.
5. Avoid giving too many directions at one time. 7. Fear of failing to get others to the work.
6. Personalize direction and make sure it has been followed. 8. Fear of criticism.

Kolayn Joanna Coline D. Montoya

NCM 119 LEC
Nursing Leadership and Management
COMMON DELEGATION ERRORS 3 – TEAM NURSING
Under delegating This stems from the managers’ o A system of care in which a qualified professional nurse
false assumption that leads a group of nurses in providing nursing needs of a
delegation may be interpreted group of patients through participative effort.
as the lack of ability on his or o Assigning of task to team members according to their job
her part to do the job correctly description.
or completely.
4 – PRIMARY NURSING
Over delegating At the other extreme end is o Responsible for the total care of a small group of patients
over delegation. It
from admission to discharge.
unnecessarily burdens the
o Assumes 24 hrs responsibility for nursing care, secondary
subordinates with tasks that
nurse executes the care
are either inconsequential or
irrelevant to the delivery of the o Plan during the afternoon and night shift and on days
goal when the primary nurse is on off duty.
Improper Delegating A manager should be able to o Primary and secondary nurses are free from administrative
determine the talents and & housekeeping responsibility.
capacities of his subordinate. o Accountability, authority and autonomy rest with the
Delegation of tasks and primary nurse. So, he communicates directly with the
responsibilities beyond which members of the health care team within the hospital and
the person cannot perform community.
property is improper SUPERVISION
delegation. o Supervision is the process of guiding and directing the
work to be done.
NURSING CARE ASSIGNMENT o It entails motivating and encouraging the staff to
1 – FUNCTIONAL NURSING participate.
o It is a task oriented in which a particular nursing function
Principles of Good Supervision
is assigned to each worker. o To most workers, the supervisor is presumed as “the
o Best use when there are many patients. management” because of her constant presence and close
o Suitable for short-term use. association with them. The following are some principles
Advantages Disadvantage of good supervision for supervisors and managers in
o Work is accomplished in a o Fragmentation of nursing general to remember.
shorter time. care so holistic care is not
a. Good supervision is focused on the improvement of
o Worker learns to work achieved.
work rather than upgrading the worker.
fast. o Nurse accountability &
b. It is based on the lines of authority, organizational
o Gaining skills faster in that responsibility is
particular task. diminished. philosophy, vision/mission; the job description,
o Patient cannot identify policies and standards, the needs of the individual.
who their “real nurse” is c. Focuses on the degree areas of skill: conceptual,
o Nurse-patient relationship technical & interpersonal.
is not fully developed. d. It is cooperatively planned, and accepts both
o Evaluation of nursing care challenge and change.
is poor. e. It uses a democratic process.
o It is difficult to find a f. The ultimate goal of good supervision is to provide
specific person who can safe, effective, quality care.
answer the patients/ g. It considers the strength & weaknesses of an
relatives’ questions.
employee.
h. Stimulates critical thinking and creativity in patient
2 – TOTAL CARE/CASE NURSING
care.
o One nurse is assigned to one client for the delivery of total
STAFF DEVELOPMENT
care.
o Staff development is a planned experience to help
o The nurse plans, coordinates, implements, evaluates and
employees perform effectively, and to enrich their
document the nursing care during the patient’s illness.
competence in practice, education, administration and
o The duty nurse will be accountable for their own action.
research it is re-training them for better performance in
areas of Skills, Knowledge, and Attitude (SKA).
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Kolayn Joanna Coline D. Montoya

NCM 119 LEC
Nursing Leadership and Management
ORIENTATION: o Coordination with Radiology service for proper scheduling
Planned & guided activities of an employee in an organization of x-rays, and other special procedure.
o It has to be done in the conference room or training room. o Coordination with the Pharmacy service for procurement
o Starts with the mission, vision, philosophy and objectives of drugs especially narcotics.
of the nursing service. o Coordination with the dietary service for the preparation
o Hospital policies on hiring, promotion, transfer, dismissal, of client’s food, list of client’s diet, special diets, preference
job description & updating of license. and restrictions.
Tour around the hospital & assigned unit. o Coordination with the Medical Social services to assist
o “Shadowing”/”big sister”/”buddy” This practice gives the clients with psycho-socioeconomic problems.
new staff chance to develop their skills and foster the o Coordination with the Medical record service for accurate
feeling of acceptance, belongingness and confidence in documentation, completeness, safety & confidentiality.
assuming duties &responsibility. o Coordination with Community Agency, institution & Civic
o Introduction to the unit personnel’s, unit policies, nursing Org. For follow ups.
standards & procedure. COMMUNICATION
o Assigning of clients, evaluation of activities, problems are o Communication ensures common understanding. It is
discussed and implementation of solution. a process by which a message is sent, received and
Assuming of greater responsibility. Mentors will instill proper values understood as intended.
and attitude. Critical thinking to new staff and to take a stand in o Some of the ways to communicate involve informal
ethical dilemmas in the unit. talks, planned appointments, telephone calls,
Give the staff opportunities to ventilate their frustration over role interoffice memos, letters, reports, informal staff
expectations, value & attitude conflict. meeting, planned conferences, mass meetings or
FUNCTIONS AND STAFF DEVELOPMENT general assemblies, bulletin board notices posters,
o Staff Development serves several functions, some of the exhibits, displays, and visual aids (Corrado, 1994).
more critical of which are to: BARRIERS TO EFFECTIVE COMMUNICATION
a. Maintain staff efficiency and effectiveness o The barriers to effective communication can be physical,
b. Create quality employees; social or psychological, semantics and interpretations.
c. Meet the staffs needs and address their problems, a. Physical Barriers – these are environmental factors
such as deficiencies in knowledge, skills and attitude; that prevent or reduce the opportunities for
d. Motivated them and improve their self – confidence; communication, for example distance and noise.
and b. Social/Psychological Barriers – they are blocks or
e. Help prepare them for greater responsibilities, e.g., inhibitors to communication that rise from the
planning, orientation, continuing education, in- judgments, emotion and social values of people for
service, patient education, advisory and research. example stress, trust, fear, defensiveness.
IN-SERVICE TRAINING AND CONTINUING EDUCATION c. Semantics – there are words, figures, symbols,
o In-service training is education for employees to help them penmanship, interpretation of messages through
develop their skills in a specific discipline or occupation. In- signs and symbols. Symbols may have a variety of
service training takes place after an individual begins her meaning and the symbolize chosen from among the
work responsibilities. many.
COORDINATION d. Interpretations – these are defects in communication
o This activity links the different components of an skills of verbalizing, listening, writing, reading and
organization and leads them toward goal achievement. It telephoning.
creates harmony on all activities to facilitate success of TYPES OF COMMUNICATION
work. In a well-coordinated organization, everything has 1. Verbal communication - Speak slowly, clearly to prevent
been delegated to guard against leaving loose ends. confusion and have immediate response.
o Coordination with the Medical services re clients plan of 2. Written communication - Clear, correct, complete and
care. concise. It comes in the form of memoranda, hospital
o Coordination with the Administrative service for repairs, orders, documentation, records, policies, and procedures.
maintenance of equipment, requisitions of supply, NON-VERBAL COMMUNICATION
monthly inventories. 1. Personal appearance 5. Touch
o Coordination with Laboratory service for special 2. Intonation of voice
procedures/preparations, collections of specimen & 3. Facial Expression
labelling. 4. Posture & gait
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Kolayn Joanna Coline D. Montoya

NCM 119 LEC
Nursing Leadership and Management
LINES OF COMMUNICATION IN NURSING SERVICE LEGALLY SOUND PERFORMANCE EVALUATION
a. Upward communication proceeds from the subordinates o It has often happened that employees have sued their
(staff nurse) to the superiors. (Grievance procedure, organizations over employment decisions based on
written report, incidental report, statistical report) questionable performance appraisal results. Although it is
b. Horizontal communication proceeds from the team to the nearly impossible to be certain that an appraisal system is
patient’s family, community workers, peers, department. non-discriminatory.
(Endorsement, rounds, meetings, referrals between dept a. It should be in writing and carried out at least once a
or services) year.
c. Downward proceeds from an authority or manager to his b. The information should be shared with employee.
subordinates. (Institutional workers) c. The employee should have the opportunity to
d. Diagonal communication/outward flows throughout respond in writing to the appraisal, and in this
different hierarchical levels. (Patient, families, relatives, connection a mechanism to appeal or question the
visitors, community) results of the appraisal must be allowed.
MANAGEMENT LEVELS IN NURSING SERVICE d. The manager should have adequate opportunity to
Top Level of management is the director and the either directly observe the employees job
administrator of nursing service. performance during the course of the evaluation
(administrative) period or, in the event of lack of adequate contact,
Middle Level is the nurse supervisors and coordinators the manager must be able to gather information from
First Line Managers consist of the head nurses, unit other sources.
managers, senior staff nurses. e. Anecdotal notes on the performance should be kept
Operating Level are the staff nurses, student nurses, nursing
throughout the evaluation period. These notes
attendants.
should be shared with the employee during the
course of the appraisal period.
EVALUATION
f. The evaluator should be trained to carry out the
o An important role of the manager is to determine
appraisal process, including.
performance in advance and state desired outcome of
 What constitutes reasonable job performance
what has been done.
 How to complete the form and
o The purpose of evaluation is to determine how far or how
 How to carry out the feedback interview
many of the organization’s objectives were accomplished.
CHANGE PROCESS
PURPOSES OF EVALUATION
o Change means substituting one thing for another,
a. Provide constructive feedback;
experiencing a shift in circumstances that causes
b. Determine progress and worthiness of individual nurse for
differences or becoming different from before.
greater responsibilities; and
STEPS IN THE CHANGE PROCESS
c. Serve as basis for promotion and increase in salary or
1. The change process begins or is initiated when one
other similar rewards.
perceives a need for change.
EVALUATION IS ALSO MEANT TO:
2. This person then initiates group interaction, which is to
a. Recognize and further develop strengths;
identify external and internal forces for change.
b. Minimize weaknesses;
3. During this interaction, the beneficial activities
c. Provide security for patients, personnel, agency and the
a. To state the problem;
community; and
b. Identify constraints;
d. Develop a fair employment practice and performance
c. List change strategies or possible approaches to
appraisal process that is in accordance with law.
problem solving;
DIFFERENT TYPES OF EVALUATION
d. To select the best change strategy; and finally
a. Outcome or product evaluation - which takes note of the
e. Formulate as a group a plan for implementation and
response of patients after nursing care is done.
or develop or select tools for evaluation.
b. Process evaluation - nursing actions are examined, to
o Wholesale change of a system is never a good idea. It is
determine if client goals have been met or have not been
important to implement any radical change one step at a
met.
time.
c. Structure evaluation - the goal is to obtain feedback on
o After the implementation of the change, it is important to
the systems such as financial and material resources,
then evaluate the overall results of the change and make
nursing personnel, policies and procedures.
such adjustments as may be necessary.

Kolayn Joanna Coline D. Montoya

NCM 119 LEC
Nursing Leadership and Management
STRATEGIES FOR MANAGING CHANGE CONFLICT RESOLUTION
Empirical- Empirical-Rational strategies for change There are several ways to achieve conflict resolution
Rational management are based on the assumption that Dominance and A method that represses rather than settles
people are rational and behave according to Suppression or conflict, creating a win-lose situation in
rational self-interest. win-lose strategy which the loser is left feeling angry and
Normative Normative-reductive strategies are based on antagonistic.
Re-educative the assumption that people are consistent to Restriction An autocratic, coercive style that often leads
their commitment to socio-cultural norms and to an indirect and destructive expression of
values. conflict.
Power- Power coercive strategies involve the Smoothing Is more diplomatic way of suppressing
Coercive compliance of the less powerful with leadership, Behavior conflict wherein on persuades the opponent
plans and direction of the more powerful. to give in to the other side.
Avoidance Creates a situation in which there are no
RESISTANCE TO CHANGE (REASONS) Behavior differences.
o lack of trust Majority Rule Resolves conflict by majority vote.
o vested interest Compromise or A method where each side agrees upon
o fear of failure Consensus solutions that meet everyone’s needs.
o loss of status or income Strategy
o misunderstanding Integrative A constructive process in which the parties
o belief that changes is not necessary. The manager may Problem-solving involved recognize that conflict exists and
then take steps to handle this resistance. openly try to solve the problem.
A Win-Win Focuses on goals and attempts to meet the
CONFLICT
Strategy needs of both parties.
o Conflict is a natural, inevitable condition and is often a
A Lose-lose Is one in which neither side wins; the
perquisite to change in people and organizations.
Strategy settlement reached to both sides.
o Conflict is a consequence of real or perceived differences
Confrontation Is regarded as the most effective means of
in goals, values, ideas, attitudes, beliefs, feelings and
resolving conflict in which it is brought out in
actions. the open and attempts are made to resolve
TYPES OF CONFLICT it through knowledge in reason.
Competitive This occurs when two or more groups attempt Negotiation A technique where conflicting parties give
conflict the same goal and only one group can attain and take on various issues.
them. It is defined by a victory for one side and Accommodation Self-sacrifice.
a loss for the other. The process by which such Collaboration Seeing mutual attention to the problem &
conflict is resolved is determined by an asset of utilized talents of all parties. Focuses on
rules. problem solving to find mutual satisfying
Disruptive This takes place in an environment filled with solutions. It is useful in situation where goals
conflict fear, anger and stress. There is no mutually are too important.
acceptable set of rules and the goal of each Competition Suppression of conflict through authority-
party is the elimination of its opponent. obedience approach. The supervisor exerts
Interpersonal This takes place between two or more power at the expense of the subordinate.
conflict individual. Smoothing Ignoring of disagreements so that harmony
Intrapersonal This occurs within one person. is maintained.
Intra group Feeling of unfairness from among the staff. Withdrawing One party is removed to resolve an issue.
Forcing An immediate end to the conflict but leaves
SOURCES OF CONFLICT the cause of the conflict unresolved.
HUMAN INTERACTION
1. Competition
TEAM BUILDING
2. Domination o A team is a group of people brought together for the
3. Provocation purpose of sharing and applying their individual skills
o Conflict arises from differences in skills, knowledge, values, towards the achievement of goals.
interest, and scarcity of resources or leadership styles. o Team Building is where the members of this team work
together toward achieving goals faster and more
productively.

Kolayn Joanna Coline D. Montoya

NCM 119 LEC
Nursing Leadership and Management

CHARACTERISTICS OF AN EFFECTIVE TEAM

1. Have define goals.
2. Work cooperatively towards achieving and collaboratively
towards achieving these goals.
3. Have agreed goals that reflect members’ needs and
values.
4. Have a good definition of its members’ roles.
THERE ARE SEVERAL TASK ROLES OF THE GROUP MEMBERS
Initiator- One, who redefines problems and offers
contributor solutions, clarifies objectives,
Suggests agenda items and maintains time limits.
Initiator- Pursues descriptive bases for the group’s work.
contributor
Information Expands information given by sharing experiences
Giver and making
Inferences.
Opinion Explores viewpoints that clarify or reflect the
Seeker values of other members’
Suggestions.
Opinion Conveys to group members what their pertinent
Giver values should be.
Elaborator Predicts outcomes and provides illustrations or
expands suggestions, clarifying
How they could work.
Coordinator Links ideas or suggestions offered by others.
Orienteer Summarizes the group’s discussions and actions.
Evaluator The quantity and quality of the group’s
critic accomplishments against
Set standards.
Energizer Motivates group to accomplish, qualitatively and
quantitatively, the group’s
Goals.
Energizer Supports group activity by arranging the
environment and providing
Necessary tools.
Recorder Documents the group’s actions and
achievements.

Kolayn Joanna Coline D. Montoya