ADMINISTRATIVE PROCESS IN NURSING
MODULE ONE
MANAGEMENT AND LEADERSHIP
THEORIES
SPECIFIC OBJECTIVES
At the end of the course, the graduate students will be able to:
1.
2.
3.
4.
5.
6.
identify the 5 ERA of management theories
understand the advocacy of each theorist and apply in nursing situations
identify the 5-styles of leadership
explain the different theories which are basic to understanding people
describe the factors that affect human behavior and human relations in an organization.
understand the new concepts of leadership.
Unit I – Introduction
Review of the different Management/Leadership Theories and Concept in an Organization; Elements
and Principle.
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LESSON 1 -
MANAGEMENT THEORIES: (FIVE ERA)
I. Classical ERA
A. Frederick Taylor – Father of Scientific Management
Advocacy: 6 steps in Systems of Management
1.
2.
3.
4.
5.
6.
Scientific study of the task
Scientific selection and training of workers
Cooperation between management and labor (workers)
Work is divided between managers and workers
Workers paid according to the rate production
Appointment of a foreman/supervisor for each aspect of work.
B. Gilbert Frank - Principles of Economic Motion.
Advocacy:
1.
2.
3.
4.
5.
Job Simplification
Establish work standards
Develop flow chart
Establish written instructions
Merit System and promotion
C. Gantt Henry
Advocacy: Efficiency
1.
2.
3.
4.
Refine previous work, than introduce new concept
Service rather than profit
Job security and job development
Developed Gantt Chart for programming.
D. Henri Fayol - Father of Management Process
Advocacy: 14 Principles
Task of Managers : POLC
1.
2.
3.
4.
5.
6.
7.
Division of work
Authority and Responsibility
Discipline
Unity of Command
Unity of Direction
Subordination of Individual interest
Remuneration of Service
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8. Centralization
9. Scalar Chain of Authority
10. Order
11. Equity
12. Stability of Tenure
13. Initiative
14. Esprit de Corps
E. Max Weber - Father of Organization
Advocacy: Bureaucracy
3 – Basis of Authority
1. Traditional Authority
2. Charismatic Authority
3. Rational – Legal Authority
Organizational Structure
Pyramid, Hierarchical, Vertical, tall
People are guided by:
1.
2.
3.
4.
Stiff Rules and Regulation
Specialization of Task
Appointment of Merit
Impersonal Climate
F. Mooney James - Management is the technique of managing people
Advocacy 4 – Universal Principles of Management
1.
2.
3.
4.
Conditional and synchronization of activities for good accomplishment
Function effects of performance of one’s job description
Scalar Process organizes
Authority into Hierarchy
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G. Urwick Lyndall - Managerial Process: Planning and Coordinating
Advocacy (Concept) – Blending Scientific Management, Classic Organization and Classic
Management Theory.
Balance authority with responsibility
1.
2.
3.
4.
5.
6.
Span of Control
Unity of Command
Use of general and specific staff
Proper use of personnel
Delegation
Departmentalization
H. Chris Argyris – Co-existence of personal and organizational needs; individuals give priority to
their own needs.
Advocacy:
1.
2.
Maturity Theory
Maturity of followers increases the leadership of the manager.
Manager should help the workers achieve self-actualizations as this will help one’s
personality to grow from PASSIVITY and Dependence to ACTIVITY and Independence.
Highly structured environment will cause 3 – possible reactions.
1. Escape (flight)
2. Fight
3. Adapt
3.
Rigid structure and stringent rules of typical bureaucracy block Maturational Changes.
II. Behavioral ERA – Motivation Theories
A. Abraham Maslow – Hierarchy of Needs
B. Herzberg, Frederick – 2 factors Theories
1. Motivators
2. Hygiene Factors
C. Victor Vroom – Expectancy Theory
Behavior explain in terms of individual’s goals and choices and expectations of achieving
these goals
People can determine which outcomes they prefer and make realistic estimates of their
chances of obtaining them.
Motivation = Expectancy (E) Valence (V) x Instrumentality (I)
M=ExVxI
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D. Alderfer Clayton – ERG Theory – (Existence, Relatedness, and Growth) Theory
E. Staw, Barry – Intrinsic and Extrinsic Motivations



Performing a task has intrinsic and extrinsic valence
Motivation – is reduced if individual does not value intrinsic or extrinsic outcomes or if
rewards are low.
Intrinsic – intrinsically motivated behavior is stimulated by people’s needs for feeling
competent and self-determining.
F. McCleland, David – Needs Theory
3 – Human motives:
1. Achievement
2. Affiliation
3. Power
G. Adams, Jo Sacy et al: Equity Theory


People assess their performance and attitude by comparing
Contribution to work and benefits derived.
H. B.F. Skinner : Reinforcement Theory is needed depending on the human behavior in
previous (+) or (-) outcomes.
1. Reinforcement Technique are positive
2. Reinforcement negative with holes
3. Reinforcement and Punishment.
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III. Human Relation ERA:
A. Chester Bernard – Organization is a social system
Focus: Psychosocial Aspect of organization and management and function of the
executives.
Functions of the Executives:
1. Maintenance of the organization; communication with loyalty and capability
2. Securing of essential services from individuals
3. Formulation and definition of purpose of the organization
B. Elton Mayo – Hawthrone Study – Human Behavior in work situation.
Factors that affect worker’s productivity:
1.
2.
3.
4.
5.
Physical environment
Support from fellow workers
Norms established by worker’s group
Opportunity and participation in D-making
Recognition from administration.
C. Mary Follett – Psychological and Sociological Aspect of Management
Management – a social process that consists primarily of motivating individuals and group
to work towards a common end.
Stress – a factor that exists in management thus the need for coordination.
Managers – must be aware that each employee is a complex collection of emotions, belief,
attitudes and habits.




Employee desires to be motivated
Motivates performance; NOT demand it.
Successful leadership skills is the result of training and possessing specific personality
traits
Understands what motivates people to work.
D. McGregor - Theory X and Theory Y.
E. Kurt Lewin - Field Theory of HR
Believes that 
Workers’ behavior is influenced by interaction between worker’s
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- Personality
- Structure of primary work group
- Solid Technical climates of the work place.

Behavior and attitude change occur in 3 stages
1. Unfreezing
2. Movement to change
3. Refreezing

New attitude learned must be supported by everyone
F. Toffler, Alvin - Future Shock



Physical and psychological distress occur from over-loading
Individual’s physical adaptive system and D-making process called “Future Shock”
To minimize Future Shock is to develop the mechanism and techniques to guide the
direction of change and to the pressure of change.
G. Herbert, Alvin – Focus – Business and Service instructions as Networks of D-makers.
2 – Approaches to D-making:
1. Optimizing (Economic Man) Decision
2. Satisfying (Administrative Man) Decision
H. Henry Minstzberg : Roles of Managers
1. Interpersonal Roles
1.1 Figure Head – represents Head of Agency
1.2 Header – Trains and hires subordinates.
1.3 Liason – communicates with persons outside her vertical command.
2. Information Roles
1.1 Figure Head – represents Head of Agency
1.2 Disseminator – distributes some information.
1.3 Spokesman – directs work-related information to persons outside of his own work
unit.
3. Decisional Roles
3.1 Entrepreneur – develops and promotes new projects
3.2 Disturbance Handler – responds involuntarily to high pressure disturbance.
3.3 Resource Allocator – determines how much total financial, personnel, supply and
equipment needed
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3.4 Negotiator – confers with group or individuals inside and outside the client for the
purpose of facilitating complex or controversial issues.
IV. Contemporary ERA
(Focus in Leadership)
A. Charlotte, McDaniel – Transformational Theory of Leadership
 This is built on transactional qualities found in day-to-day management
 Brings out the best in the followers
 Cascading effect. Followers exhibit leadership qualities similar to the leader.
B. Schein – Interactional Theory of Leadership
 Father of Corporate Culture.
3 - levels of Culture:
1. Artifacts – visible things in the corporation
2. Espoused Valves – e.g. Teamwork
3. Basic understanding assumption
 Leadership behavior is generally determined by the relationship between
-
Believes that people are very complex and variable; and have multiple motives for
doing things.
People’s performance and productivity are affected by the nature of the task and by
her/his ability, experience and motivations.
No single leadership strategy is effective in any situation.
 Leadership Exchange involves three (3) basic elements:
1. Leader – personality, perception and abilities
2. Followers – Their personalities, perceptions and abilities.
3. The Situation – within the leader, and the followers function; formal and informal
group norms; size and density.
C. Greenleef, Robert – Servant Leadership –
 Servant leaders put serving others (employee, customers, community) as priority.
Abilities:
1.
2.
3.
4.
Listen and truly understand
Keep open mind; hear without judgment.
Deal with ambiguity and complex issues
Honesty sharing critical challenges
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5. Clear on goal
6. Ability to be servants, helpers and teacher first, then a leader.
7. Always think before reacting
8. Choosing words carefully
9. Use foresight and intuition
10. Seeing things as a whole, sensing relationship and connections.
D. Filipino Style and Leadership – Philippine Bureaucracy – has the tendency to be autocracy
– the so called Autocracy in Bureaucracy.
 Leadership and Management skills should be integrated
-
Using experimental learning exercise designed to increase whole-brain thinking.
Demonstrating the leadership components in all management functions
Using a scientific approach to problem – solving.
E. Ouchi, William – Participative leadership – Theory “Z”
 Rank and file participates in D-making.
V. System Approach:
A. Rensis, Likert – Four (4) Leadership Systems:
1. Exploitative, Coercive, Authorative,
-
Worker is regarded as “market commodity” – can be paid with money
Poor performance; high absentee rates, high production cost; low quality
2. Benevolent Authoritative –
-
Leader makes the decision with the welfare of the people in minds.
3. Consultative – leader is more democratic with 2-way communication and feedback flows
in both direction.
4. Participative – leader has complete confidence and trust in the employees; always obtains
and uses their ideas and opinion. Communication is a 2-way process.
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LESSON 2 -
LEADERSHIP THEORIES
There are Eight (8) classifications of Leadership Theories
I. Traits Approach
1. Trait Theory – selection is based on physical, mental and psychological characteristics.
2. The Great Man Theory (by Aristotle) – Few people are born with necessary characteristics
top be great.

“Some people are born to lead; some are born to be led” (Senge and Garner; 1990)
3. Charismatic Theory (By Robert House) – Charismatic leaders has four (4) personal
characteristics:




Dominance
Self Confidence
Need for influence and power
Conviction of moral righteousness
II. Behavioral theories
1. Kurt Lewin – Three (3) Leadership Style



Autocratic
Democratic
Laissez-faire
Multicratic (according to Ridese & Hartly 2008)
Emphasize on groups personalities
“More heads are better than one”
Autocratic leadership promotes hostility, aggression and decrease initiative
2. Likert et al – Three (3) types of leadership behaviors

Task-oriented behavior
Relationship – oriented behavior
Participative leadership behavior
He supports the human relation theory –
- Benefits of positive attitude towards people
- Development of the workers
- Satisfaction of their needs
- Commitment thru participation
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3. Blake and Mouton’s Managerial Grid – in a matrix, 9.9 position is the most effective
leaders

The grid describe individual leadership as function of 2-variables:
-
Concern for people
Concern for production
III. Situational Theories
1. Path – Goal Theory (By Robert House) – Derived from Expectancy Theory – which believed
that people act as they do, because they expect their behavior to produce satisfactory result.

The leaders clarify and set the goals of the subordinates and help them find the best path
for achieving their goals.
2. Contingency Theory (By Fred Fedler) – leadership style will be effective or ineffective
depending on the situation.



Member – Leader relation
Task Structure
Position Power
3. Leadership Continuum (By Tannenbaun & Schmidt) – Leadership style varies:


Boss-centered
Subordinate-centered
4. Normative Theory of Leadership and D-making (By Vroom and Yetton) – Use Decision
Three Model – the most effective leadership style depends on the characteristics of both the
situation and the follower.
5. Situational Leadership Theory (By Hersey & Blanchard) – Predicts that the most appropriate
leadership style from the level of maturity and readiness of the follower and the demands of
the situation.
IV. Attributional Model – leaders only exists only as individual’s perception of the situation,
rather than as objective fact.
V.
Substitute for Leadership (By Kerr and Jermier)
- certain individual task and
organizational variables prevent leaders from affecting subordinates attitudes and behavior at
all.
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VI.
Transactional Leadership (By Edward Hollander) – Leadership process is best
understood as the occurrence of mutually satisfying transactions among leaders and
followers.
VII.
Integrative Leadership Model (By Gardner) – Leaders are rarely totally people and task
oriented. Leadership requires adaptive behavior.
VIII.
Integrative Leadership Model (By Gardner) – Leaders are rarely totally people and task
oriented. Leadership requires adaptive behavior.
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LESSON 3 -
CONCEPT OF LEADERSHIP:
1. Leadership can be learned and cultivated.
2. Leadership are not necessarily charismatic. Charisma may be result of effective leadership.
3. Leadership is not limited to those on top but can occur at all levels of the organization.
4. Leadership is not so much of the exercise of power, but the improvement of others.
5. Effective leaders are not born but develop over time through knowledge and by using appropriate
sets of skills.
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LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor.
1. Observe an organization (this may be the organization where you work).
a) Is the organization task or relationship oriented? Please elaborate.
b) Cite at least five (5) instances where any of the management-leadership theories you
learned in this module were applied in decision making. Be specific in your
explanation.
c) Describe the interactions between managers and the employees. Take note of
leadership styles of managers.
d) Identify some socio-cultural factors that are affecting interactions in the organization.
e) Give examples of how the human basic needs described by Maslow are being met.
2. Compare the democratic style of leadership to the authoritarian and laissez-faire styles.
3. Compare Theory X, Y, and Z. Which one would you prefer in your organization? Why?
4. Describe at least three factors that affect human behavior.
5. Describe a transformational leader. Do you know of anybody in the nursing profession who
is a transactional leader?
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ADMINISTRATIVE PROCESS IN NURSING
MODULE TWO
INTRODUCTION TO MANAGEMENT
SPECIFIC OBJECTIVES
At the end of this module, the graduate students will be able to:
1.
2.
3.
4.
5.
define different terms used in management,
identify the manager’s task
understand the elements of effective management
interpret Nursing Management principles
discuss the major functions of hospital nursing service
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LESSON 1 -
1.
DEFINITION
Management – is the process of working with and through people/others to achieve
organizational objectives in a changing environment.


Is the process of obtaining and organizing resources and of achieving objectives through
other people.
Is planning, organizing, leading and controlling.
2.
Nursing Management – is the process of working through nursing staff members to
provide care, and comfort to patients. This can be viewed as a relationship of inputs and
outputs in which the workers, physical resources and technology are merged to bring about
the organizational goals for delivery of quality nursing care.
3.
Management Process - consists of achieving organizational objectives through planning,
organizing, directing and controlling human and physical resources and technology.
4.
Manager – is a person appointed officially to the position whose function is to plan,
organize, lead and control.




5.
Has the power and authority to enforce decisions.
Carries pre-determined policies, rules and regulations.
Relates to people according to their roles
Maintains an orderly, controlled, rational and equitable structure.
Leader – is a person who enables to work together to achieve the objectives set for certain
purpose




Influences others towards good setting either formally or informally.
Interested in risk-taking and exploring new ideas.
Relates to people personally in an intuitive and emphatic manner.
Have no official appointment to a position in the organization.
6.
Leadership – the process of empowering people thru persuasion. It is one of the functions
of management.
7.
Organizational Culture – the totality of an organizations belief, history, Taboos, formal
and informal relationship and communication pattern.
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Management Defined
Management is understood more clearly when the manager’s/leader’s/administrator’s tasks
are defined. According to Fayol (1970), the manager’s activities and functions are planning,
organizing, coordinating, and controlling. (The description and definitions of these functions will be
discussed later). Judging from these functions, one can see that the manager works through others.
The manager’s main responsibility is to ensure that the organization’s goals are achieved through the
performance of specific tasks by its members. Mintzberg (1975) described four types of roles that
managers fill in. These are: interpersonal, informational, decisional, and entrepreneurial. The
interpersonal role includes ceremonial duties, leadership, and the role of liaison. The informational
role includes scanning the environment for any useful information and seeking to improve work
methods. The decisional role includes deciding how to allocate resources, as well as negotiating and
handling disturbances. Finally, the manager is also an entrepreneur, always alert to new ideas and
opportunities to improve the effectiveness and profitability of the organization or unit.
From these descriptions of the manager’s tasks Tappen (1995) summarized the components
of effective management and these are: leadership, planning, direction, monitoring, development,
recognition, representation. Tappen further stated that the effective manager is one who:
1.
2.
3.
4.
5.
6.
7.
Assumes leadership of the group.
Actively engages in planning the current and future work of the group.
Provides direction to staff members regarding the way the work is to be done.
Monitors the work done by staff member to maintain quality and productivity.
Recognizes and rewards quality and productivity.
Fosters the development of every staff member.
Represents both administration and staff members needed in discussions and negotiations
with others.
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LEADERSHIP
PLANNING
DIRECTION
REPRESENTATION
NURSE
MANAGER
DEVELOPMENT
MONITORING
RECOGNITION
LESSON 2 -
EFFECTIVE MANAGMENET AND LEADERSHIP
Covey (1989) is the author of the best seller, The Seven Habits of Highly Effective People,
differentiated effective management and leadership. According to him, effective management is
putting first things first. Leadership on the other hand decides what “first things” are. It is
management that puts them first, day-by-day, moment-by-moment. Management is discipline.
Nursing Management
In nursing, management relates to planning, organizing, staffing, (leading) and controlling
(evaluating) the activities of a nursing enterprise or division of nursing departments and of the subunits of the departments. Nurse Managers performs these management functions to deliver health
care to the patients. Swansburg (1993) identified thirteen general principles of nursing management
and these are:
1. Nursing management is planning.
2. Nursing management is the effective use of time.
3. Nursing management is decision making.
4. Meeting patients’ nursing care needs is the business of the nurse manager.
5. Nursing management is the for mutation and achievement of social goals.
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6. Nursing management is organizing
7. Nursing management devotes function, social position or rank, a discipline, and a field of
study.
8. Nursing management is the effective organ of the division of nursing of the organization and
of society in which it functions
9. Organizational culture reflects values and & beliefs
10. Nursing management is directing or leading
11. A well-managed division of nursing motivates employees to perform satisfactorily.
12. Nursing management is efficient communication
13. Nursing management is controlling or evaluating
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LESSON 3 1.
2.
3.
4.
5.
MAJOR FUNCTIONS OF NURSING SERVICE
Patient Care
Administrative Practices
Nursing Personnel Management
Physical environment
Interdepartment/Institutional Relationship
Figure 3: FUNCTIONS OF A HOSPITAL NURSING SERVICE
CARE OF PATIENTS
1. Determine kind and amount of nursing
care needed for individualized nursing
care.
PERSONNEL
MANAGEMENT
1. Determine categories and number of
positions needed.
PHYSICAL
ENVIRONMENT
RELATIONSHIPS
1. Plan for allocation and utilization of
space for all nursing functions and
motivations.
1. Develop plans to interpret nursing to and
coordinate activities with hospital groups.
2. Provide for day-to-day fluctuation of
nursing care needs.
2. Determine qualifications and provide
job descriptions.
2. Determine needs and provide
necessary equipment and supplies.
3. Provide for special nursing care of
critically all patients.
3. Make and maintain a staffing pattern.
3. Evaluate effectiveness of existing
physical environment and recommend
changes, improvements and adjustments.
4. Provide for continuity in nursing care on
the ward and in the community
4. Maintain a recruitment program and
appoint personnel.
for
a.
b.
c.
d.
ADMINISTRATIVE
PRACTICE
Administrative Officers
Professional Personnel
Hospital Departments
Within nursing service
2. Plan, organize, direct, and coordinate
administrative activities.
4. Provide for association with community
groups.
b. educational institutions
universities)
1. Develop organizational structure.
(colleges,
a.
set standards for patient care, and
other nursing functions.
b. Assign responsibility and delegate
authority.
5. Evaluate performance of personnel.
5. Simplify and standardize
procedures and techniques.
nursing
6. Instruct patients in their own care.
c.
6. Provide opportunities for growth and
development of personnel through
programs of education.
d. Service organizations (philanthropic
societies)
7. Provide working conditions and
recommend economic consideration
which provide for job satisfaction.
8. Establish and maintain
personnel record.
Professional
organizations
(physicians, dietitians, pharmacist)
complete
c.
Provide
for
participation.
directed
group
d. Establish nursing programs
conferences for direction
supervisory personnel.
of
of
e.
Establish systems for reporting and
recording of all functions.
f.
Interpret nursing needs and
problems to administrative officers
and other hospital personnel.
g. Provide channels for methods of
communication within nursing
services the hospital & community.
h. Identify areas needing study and
plan for research.
i.
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Prepare and administer the nursing
budget.
LESSON 4 -
1.
2.
3.
4.
5.
6.
PERSONAL FACTORS AFFECT NURSING
ADMINISTRATION
Knowledge
Skills
Attitudes
Values
Motivation
Human Relation
LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor
1. Differentiate a leader from a manager; management from leadership.
2. Observe a nurse manager in your work place and note the different management activities
she perform an identified by Tappen.
3. Discuss how effective management could be achieved.
4. Discuss fully the 5 major functions of nursing service
5. Discuss the personal factors that affect nursing administration.
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ADMINISTRATIVE PROCESS IN NURSING
MODULE THREE
FOUR MAJOR MANAGEMENT PROCESS
SPECIFIC OBJECTIVES
At the end of the discussion of the four major management processes, the graduate
student will be able to:
1. discuss each major management process as it relates to nursing management
2. identify the principles in each of the processes that guide them in the application in the
nursing situations
3. distinguish each of the 4 management processes from each other and understand the
sequence in their application
4. discuss the importance of planning, organizing, directing and controlling
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LESSON 1 -
PLANNING
Definition
The first element of management is planning. Fayol (1949) defined it as making a plan
of action for a foreseeable future. Douglas (1988) stated that “planning is having a specific aim
or purpose and mapping out a program or method beforehand for accomplishment the goal”.
Alexander (1978) defined planning as “deciding in advance what to do, how to do it, when to do
it, and who is to do it.” Another definition was given by Steiner (1969) who defined planning as
a process beginning with objectives, defining strategies, policies, and detailed plans to achieve
them, achieving an organization to implement decision; and including a review of performance
and feedback to introduce a new planning cycle. Planning is a basic function of all managers. It
is a systematic process that is based on sound management theory.
An important aspect of planning is forecasting a process which includes assessing the
present situation, identifying its weaknesses, recognizing the driving forces in the environment,
constructing possible alternative future scenarios, identifying the preferred future, developing a
plan of action, implementing the plan, and evaluating the implementation.
Purpose and Benefits of Planning
There are many reasons for planning. Douglas (1988) identified eight purposes of
planning:
1.
2.
3.
4.
5.
6.
7.
8.
It leads to success in achieving goals and objectives.
It gives meaning to work.
It provides for effective use of available personnel and facilities.
It helps in coping with crisis situations.
It is cost-effective.
It is based on past and future, thus helping reduce the element of change.
It can be used to discover the need for change.
It is needed for effective control.
Douglas (1988) mentioned the activities of planning as assessment by collection,
classification, analysis, interpretation, and translation of data; strategic planning;
development of standards, identification of needs and priority setting; management by
objectives; and formulation of policies, rules, regulations, methods, and procedures.
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Principles of Planning:
1. Precedes all other processes of management
2. Contributes to the objectives
3. Pervasive – exist at all levels
4. Efficient that boost the moral of the staff
5. Innovative
6. Flexible
7. Goal Directed
8. Action-centered
9. Establish priorities
10. Cost effective
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LESSON 2 -
PHASES OF PLANNING
Phase 1: Developing the Plan
The first step in developing the plan is to establish its purpose. It is important to be clear
about the purpose of planning to avoid confusion. However, the purpose my be stated in broad
terms until a broad thorough assessment of the situation / problem is done. An example of a
purpose of a health plan that is stated in a broad term is: Reduce children and adult morbidity
rates in Barangay Uno.
When assessing the situation/problem, information to confirm or revise the identified
problem is needed. Situational variables or factors that affect the problem, as well as anticipated
response to change are also identified. When the problem and environmental situations are
alreadyu assessed, objectives are formulated. The objectives should be written as measurable
outcomes so that they can later serve as guidelines for evaluation. An example of a specific
objectives formulated from the above purpose it: The occurrence of communicable diseases
among children in Barangay Uno will be reduced by 50% in 1999, 80% in 2000, and 100% by
2002.
Generating alternative solutions is the next step in developing the plan. In generating
alternative solutions, a climate of open mindedness and positive thinking is important.
Consultation with internal and outside experts, searching the literature and results of surveys are
helpful to the planner. Brainstorming is another way of generating solutions. Brainstorming
among those involved or may be affected by the planning is recommended as the sessions can
encourage them to participate and to be open to the ideas of others. Several alternative solutions
may be generated and each of them are analyzed before a course of action is selected. Pros and
cons of each option are identified and analyzed objectively.
Pilot studies, use of scenarios and simulations are utilized to test the chosen alternatives
or options. These are done especially in big scale projects where failure of the plan in the actual
setting can become costly. In summary, the steps in developing a plan are as follows:
1. Establishing a purpose
2. Analyzing the situation which includes problem verification, identifying situational
variables and the anticipated response to change.
3. Formulating objectives.
4. Generating alternative solutions.
5. Analyzing alternatives and selecting course of action.
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25
According to Donavan (1975), planning has many benefits. Among these are:
a)
b)
c)
d)
satisfactory outcomes of decisions;
improved functions in emergencies;
assurance of economy of time, space, and materials; and,
the highest of personnel
Donovan included decision making, philosophies, and objectives as key elements in
planning.
For planning to be successful there are factors to be considered (Swansburg, 1995). The
managers should have knowledge of the following:
1.
2.
3.
4.
5.
6.
Characteristics of planning
Elements of the planning process.
Strategic or long-range planning process.
Tactical or short-range planning process-functional versus operational
Planning standards
Application of the planning processes and standards to the work situation.
The manager must also have skill in bringing the planning process up to the standard set,
where there are deficiencies.
Characteristics of Planning
Tappen (1995) describes planning as the component of effective management that is
hardest to do and easiest to ignore. This is because it deals primarily with the future and can
easily be postponed.
Planning is based on objectives. Simplification and standardization characterize it. In
other words, first and foremost good plans are based on objectives, they must be simple, they
must have standards, must be flexible, must be balanced and must use available resources.
Planning requires decision making, that is, choosing future courses of action from among
alternatives. In the practice of nursing, for example, planning includes collection, analysis, and
organization of many kinds of data that will be used to determine both the nursing care needs of
patients and the management plans that will provide the resources and processes to meet these
needs. (Swansburg, 1993).
Phases of Planning
According to Tappen, planning is divided into three phases. These are:
A. Developing the plan.
B. Presenting the plan.
C. Implementing and monitoring the plan.
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26
In this example, the hospital plans on hiring senior nursing students of an affiliated
school of nursing to work as patient care assistants. Hospital administrators believe that by hiring
the students, the graduate nurses’ work load can be reduced without reducing nurses’ patient
contact and the quality of care that the patients receive.
PERT Charts, on the other hand, graphically illustrates the sequence of events and their
interrelationships, using circles for events and arrows for activities. The PERT chart is more
systems oriented than the Gantt chart. From the PERT chart, one can see how the work must
flow from one event to the next and how one activity depends on another.
Critical Path Method (CPM) is very similar to PERT except that it also identifies the
critical path, that is, the path that takes the longest time to complete and the most likely to cause
a delay. With this information, one can have a realistic estimate of when the project can be
completed.
2. After organizing the project, the next step is to implement it. Here the actual
implementation of the project begins. Implementing the plan needs the supervision and
direction of the planner/s and the designated leader/s. The skill needed is leadership.
3. Monitoring the implementation comes with the implementation of the plan. The major
focus monitoring is referring to the original design to ensure that it is being followed.
4. Evaluating Outcomes. Formative and summative evaluations are used when implementing
the plan. Formative evaluation is ongoing and is done as the project is being implemented. At
the end of the implementation phase, a summative evaluation is also needed to determine
how well the project has succeeded in meeting the objectives that were developed during the
first phase of planning. The result of the evaluation will determine whether or not activities
will be continued or not.
5. Revising and Updating the Plan. From the feedback obtained from the evaluation process,
revisions, improvements and updating are done. The revision may go back as far as the
objectives and purpose of the original plan. This only shows that the planning process is
dynamic and continuous.
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27
LESSON 3 -
TYPES OF PLANNING
1. Strategic Planning (Long-range)
2. Tactical Planning (short-range)
3. Operational Planning (day-to-day)
Strategic Planning
Lately, nursing leadership and health care organizations have been relying on strategic
planning to contain cost and to increase effectiveness and efficiency in health care delivery.
Strategic planning is defined as “continuous, systematic process of making risk-taking decisions
today with greatest possible knowledge of their effects on the future; organizing efforts necessary
to carry out these decisions and evaluating results of these decisions against expected outcome
through reliable feedback mechanism” (Swansburg,1993). Strategic planning in nursing is
concerned with what the division of nursing should be doing. Its purpose is to improve allocation
of scarce resources, including time and money, and to manage the division of nursing for
performance. It includes analysis of projected technological advances, the internal and external
environments, the nursing and health care market and industry, the economics of nursing health
care, availability of human and material resources, judgments of top management, and other
factors. Among the benefits of strategic planning is the giving of a sense of direction to all
managers and practitioners of nursing within the organization.
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Administrative Process in Nursing
28
Phase Two: Presenting the Plan
The second phase of planning is presenting the plan itself. Occasionally, one may be able
to proceed directly from developing the plan to its implementation. But usually, plans for
projects are presented to administration/management for approval. When this becomes
necessary, the planner needs to be persuasive in convincing others to accept the plan and to
obtain approval by administrators. To be acceptable, the plan must be presented in an organized
manner. The problem, the background or the situation that brought about the problem, and of
course, the well-prepared plan to resolve the problem must be presented clearly. The delivery of
the presentation must be done convincingly and professionally. Aside from being persuasive, the
planner must be concise and direct to the point. The plan itself must be presented in a
professional manner.
Phase Three: Implementation and Monitoring
The third phase of planning is the implementation and monitoring of the plan. It includes
the following steps:
1. Organizing the implementation
Organizing the implementation of a plan includes:
a) Identifying and arranging activities according to sequence;
b) Setting target dates for completing each activity;
c) Assignment of responsibilities to particular individuals; and
d) The allocation of resources.
There are techniques that have been developed to organize and monitor implementation
of proposed plans depending on how elaborate they are. Schedules, Gantt charts; program
evaluation and review technique (PERT), and the critical path method (CPM) are some of them.
Among these methods, schedules are the simplest and the more often used. Schedules organize
work on the basis of time and assigned staff members, leaving out details of staff to be done.
Schedules are easy to make and use, and they form the basis for the more complex methods.
The Gantt chart, which is actually a highly developed schedule, specifies in detail the
tasks to be performed and the time they are expected to be completed. An example of a Gantt
chart follows:
Task
Hire
Train
Pilot in Unit A
Implement in
all units
Evaluate
---}
Assigned Person
JFD & STAFF
CGD & STAFF
HNA
HN
Jan. / Feb. / March / Apr / May / June / July / Aug / Sept / Oct / Nov / Dec.
------------------}
--------------------}
------------------------}
-----------------------------------}
All Head nurses
and staff Dev
-}
-------------------------------------
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LESSON 4 -
PLANNING RELATIVE TO NURSING
ADMINISTRATION/NURSING EDUCATION
Forecasting: Estimates the future in terms of:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Environment
Types of patients/customers
Public attitude
Kind of Personnel
Resources
Services needed
Productive use of people, money, materials
innovations
Social responsibilities
Barriers to Planning:
1.
2.
3.
4.
5.
6.
7.
Lack of
Lack of flexibility
Non-involvement of workers
Poor time management
Vogue plans
No specific time target
Plans that are not periodically motivated
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LEARNING ACTIVITIES
Answer the following and submit your professor.
1.
2.
3.
4.
Discuss the guidelines in planning.
Analyze the different phases of planning.
Differentiate strategic planning from operational planning. Give example of each.
If given a chance & plan for a nursing service, what are the forecasting aspects test you
have to discuss?
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31
ADMINISTRATIVE PROCESS IN NURSING
MODULE FOUR
SPECIFIC OBJECTIVES
At the end of the module, the graduate students will be able to:
1. give an example dividend or situation to show how organizing benefited your work
performance
2. describe the activities involved in organizing
3. discuss and understand “Bureaucracy” and identify its advantages and disadvantages
4. discuss the principles of organizing
5. describe the structure and climate of the organization when your work
6. understand the significances of the lines of authority
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LESSON 1 -
II. ORGANIZING
Definitions of organizing. Organizing is identifying the organizational needs from
mission statements and objectives and from observations of work performed, and adapting the
organizational design and structure to meet these needs. Like planning, organizing is primarily a
thinking act. (Swansburg, 1993) It is the process of designing the machine (Urwick in
Swansburg, 1993). During the organizing process, activities are grouped, responsibility and
authority are determined, and working relationships are established to enable both the
organization and the employees to realize their common objectives.
Principle of organizing
Four principles of organizing named by Swansburg are:
1. The Principle of Chain of Command. The principle of chain of command denotes
centralized authority and corresponding authority. This principle states that to be
satisfying to members, economically effective, and successful in achieving their
goals, organizations are established with hierarchical relationships within which
authority flows from top to bottom. Most government, religious and military entities,
as well as health institutions are organized this way. In the more modern
organizations however, the chain of command is flat, with line managers and
technical and clerical staff providing support services.
2. The Principle of Unity of Command. The unity of command principle states that an
employee has one supervisor/leader and one plan for a group of activities with the
same objective. In nursing, primary nursing and case management support the
principle of unity of command. This principle is, however, being modified by
emerging organizational theory.
3. The Principle of Span of Control. This principle states that a person should be a
supervisor of a group that he or she can effectively supervise in terms of numbers,
functions, and geography. This principle is flexible because the more trained an
employee is the less supervision is needed, while those still under training need more
supervision to prevent mistakes.
4. The Principle of Specialization. The concept of division of labor or the
differentiation among kinds of duties springs from this principles. The principle states
that each person should perform a single leading function.
Process or Organizing
1.
2.
3.
4.
5.
6.
Establish the organization’s objectives and structure
Formulate supporting objectives, policies and plan.
Identify and classify activities necessary to accomplish the objectives; task are assigned.
Grouping the activities relative to the human and material resources needed
Delegating the head of each group the authority necessary to perform the activities
Tying together the group horizontally or vertically through authority relationship.
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LESSON 2 -
ORGANIZATIONAL STRUCTURE
The organizational structure furnishes the formal framework in which organizing takes
place. The organizational structure provides work system, network of communications and
identity to individuals and the organization. An organization has both formal and informal
components. The informal aspect comprises the personal and social relationships in the
organization. It provides the social control of behavior among its members. Management must be
aware of its presence because of its importance especially in disseminating correct information
through its “grapevine”. A good manager can take advantage of the informal organization’s
operating technique and to use it to achieve common goals and objectives. The formal aspect, on
the other hand, is defined by executive decision determined by planning. A bureaucratic structure
is a formal organizational design. It facilitates large-scale administration by coordinating the
work of many personnel. It is associated with subdivision, specialization, technical
qualifications, rules and standards, impersonality, and technical efficiency.
Organizational structures may either be traditional or decentralized. The traditional
organizational structure is a vertical one, with the authority, power, and decision-making vested
in one person at the top. Many managers agree that this is an efficient, cost-effective way of
getting the job done. Decisions are made quickly, few leaders are required, and much power is
vested in a central figure. A disadvantage of this structure is that communication in the
organization is greatly impeded. Personnel are informed of changes but are not involved in
planning the change. This results in the lack of formal power of personnel, notably of nurses in
the traditionally structured hospital organizations (Rowland, 1996). The decentralized
organization, on the other hand, is characterized by a horizontal structure in which decisionmaking responsibility, authority are at the lowest possible level in the organization. The
organization that is decentralized is usually vital, dynamic, and growth oriented. It is flexible and
adjusts easily to changes. It has the potential for adapting established standards, policies, and
procedures to their special needs without creating confusion. A major disadvantage of
decentralization is the risk of losing coordination brought about by broadening the scope of
authority and responsibility.
Different Formal Structure:
1.
2.
3.
4.
5.
Flat Organizational Structure
Hierarchical (Bureaucratic) Model
Adhocracy Model
Matrix Model
Circular Model
Bureaucracy
This term coined by Max Weber evolved from the early principle of administration
including those of organizing. It is highly structured and usually includes no participation by the
governed. The principles of chain of command, unity of command, span of control, and
specialization support bureaucratic structures. A strong point of bureaucratic organizations is
their ability to produce employees who are competent and responsible. They perform by uniform
rules and conventions, are accountable to one manager who is an authority, maintain social
distance with supervisors and clients, thereby reducing favoritism and promoting impersonality,
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Administrative Process in Nursing
34
and receive rewards based on technical qualifications, seniority and achievement. (Swansburg,
1993). The characteristics of bureaucracy include formality, low autonomy, division of labor,
specialization, standardized procedures, written specifications, memos and minutes,
centralization, controls, and emphasis on a high level of efficiency and production. These
characteristics frequently lead to complaints about red tape, and to procedural delays and general
frustration.
Role Theory
Role theory supports the chain of command and unity-of-command principles. Role
theory indicates that when employees face inconsistent expectations and lack of information they
will experience role conflict, leading to stress, dissatisfaction and ineffective performance. Role
conflict and ambiguity can be reduced when management provides:
1. Certainty about duties, authority, allocation of time, and relationship with others.
2. Guides, directives, policies, and ability to predict sanctions as outcomes of behavior.
3. Increased need fulfillment;
4. Structure and standards;
5. Facilitation of teamwork;
6. Toleration of freedom;
7. Upward influence;
8. Consistency;
9. Good, prompt communication and information;
10. Using the chain of command;
11. Prompt decision;
12. Personal development;
13. Formalization;
14. Planning;
15. Receptiveness to ideas by top management;
16. Coordinating work plans;
17. Adapting to change;
18. Adequacy of authority.
Organizational Climate
A work environment that is conducive to worker satisfaction and productivity is a major
concern in every organization. Swansburg (1993) identified the following as activities that
promote positive climate in health care and nursing organizations:
1. Develop the organization’s mission, goals, and objectives with input from practicing
nurses. Include their personal goals.
2. Establish trust and openness through communication that includes prompt and
frequent feedback and stimulates motivation.
3. Provide opportunities for growth and development, including career development and
continuing education programs.
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Administrative Process in Nursing
35
4. Promote teamwork.
5. Ask participating nurses to state their satisfactions and dissatisfactions during
meetings and conferences and through surveys;
6. Market the nursing organization to the practicing nurses, other employees, and the
public.
7. Follow through on activities involving practicing nurses.
8. Analyze the compensation system for the entire nursing organization and structure it
to reward competence, longevity, and productivity.
9. Promote self-esteem, autonomy, and self-fulfillment for practicing nurses, including
feelings that their work experiences are of high quality.
10. Emphasize programs to recognize practicing nurses’ contributions to the
organizations.
11. Assess unneeded threats and punishments and eliminate them.
12. Provide job security with an environment that enables free expression of ideas and
exchange of opinions without threat of recrimination, which occur, which may occur
as negative performance reports, negative counseling, confrontation, conflict, or job
loss.
13. Be inclusive in all relationships with practicing nurses.
14. Help practicing nurses to overcome their shortcomings and develop their strengths.
15. Encourage and support loyalty, friendliness, and civic consciousness.
16. Develop strategic plans that include decentralization of decision making and
participation by practicing nurses.
17. Being a role model of performance desired off practicing nurses.
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36
Team Building
Having “high morale”, enthusiasm, self-confidence, good self-esteem, are some of the
terms associated with team building. The objective of team building is to establish an
environment of cohesiveness, high morale, and enthusiasm, the feeling of being “cared of”, selfworth among employees. In a nursing unit, the first step in team building is to determine why
nursing employees are unhappy or dissatisfied. Once problems and dissatisfactions are identified
and prioritized, a calendar should be established for addressing them. It is best to prepare a brief
management plan that includes the problems, objectives, actions the team can accomplish on its
own authority, actions needing management support, persons assigned specific responsibilities,
target dates and list of accomplishments. The plan should be communicated to the entire staff of
the nursing unit, department or division. Evaluation should occur continuously. Recognition of
the individual’s worth and contributions to the organization through praise and commendations is
an important morale builder.
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37
LESSON 3 -
HUMAN RESOURCE DEVELOPMENT
 Conduct Training Needs Assessment
 Prepare different training programs as per identified training needs.
LEARNING ACTIVITIES
Answer the following and submit to your professor.
1. Differentiate the principles of chain of command from the principles of unity of
command; formal organization form informal organization.
2. How can stress stress be avoided in the work place?
3. How can you make up the work environment be conducive to promoting positive climate
in fee organization
4. What is the significance of a solid line and the broken line in an organizational structure?
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38
ADMINISTRATIVE PROCESS IN NURSING
MODULE FIVE
III. DIRECTING / LEADING
SPECIFIC OBJECTIVES
At the end of this module, the graduate students will be able to;
1. discuss the basic principles of the different actuating activities of the manager under the
directing / leading process.
2. demonstrate leadership characteristics even to a limited extent.
3. main harmoniously relationship in an organization from understanding of the basic
principles in communication
4. appreciation & perform supervisory functions.
5. slows ability to delegate tasks to her subordinates
6. able to do problem – solving / decision-making--typically
7. understand the sources of conflict and how to resolve them.
8. appreciate change management and its importance in nursing service
9. gain knowledge on how to conduct team building
10. associate the proper attitude of being a professional nurse
11. understand productivity and how it is applied to nursing service
12. understand the role of motivation in the behaviors of the subordinates.
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Administrative Process in Nursing
39
Behavioral Foundation of directing/leading:
1. Leadership
2. Communication
3. Supervision
4. Delegation
5. Problem-solving/D-making process
6. Conflict Management
7. Change Management
8. Team Building
9. Professionalism
10. Productivity/Efficiency and effectiveness
11. Motivation
In modern management, command and coordination are labeled directing. In nursing,
directing is a physical act of nursing management, the interpersonal process by which nursing
personnel accomplish the objectives of nursing. (Swansburg, 1993). It is the process of applying
the management plans to accomplish nursing objectives. It is the process by which nursing
personnel are inspired or motivated to accomplish work. In describing the directing functions of
management, Fayol (in Swansburg, 1993) stated that managers must know how to handle people
and must be able to defend their point of view with confidence and enthusiasm. “He must know
the personnel, eliminate the incompetent, be well versed in binding agreements with employees,
set a good example, conduct periodic audits, confer with chief assistants to focus on unity of
direction, not become mired in detail, and have as a goal unity, energy, initiative and loyalty
among employees”. Fayol defined coordination as creating harmony among all activities to
facilitate the working and success of the unit.
Directing also called command by Urwick, (1944 in Swansburg, 1993), protects the
general interest of the organization by seeing to it that individual interests do not interfere with
the general interest.
Rowland and Rowland (1994) stated that directing is closely interrelated with leadership.
According to them, the activities of directing include those of delegating, communication,
training and motivation. The manager’s choice of leadership style is a major factor in exercising
the directing function.
Another term used synonymously with directing is “implementing”. The activities under
implementing include “supervision, making assignments and giving directions, evaluation, and
leadership and interpersonal relationships with coworkers, dissemination, giving assignments,
motivating workers, and maintaining morale” (Kron, 1987).
Other writers (in Swansburg, 1993) refer to directing in terms of theories of leadership
effectiveness, group dynamics, values and value conflicts, effective interpersonal transactions,
working with teams, and managing teams in organizations, development of personnel and
supervision of work. Sources for directions include standards, procedure and policy manuals, job
descriptions arrived at through job analysis.
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40
Three of the major elements of directing are embodied in supervision of nursing
personnel and these are: motivation, leadership, and communication. These elements are
discussed in more detail in other parts of these course.
Directing activities of nurse managers/supervisors. In nursing management, twelve
activities related to the directing function of a nurse manager have been identified by Douglas
(1988). These are:
1. Formulating objectives for care that are realistic for the health agency, patient, client,
and nursing personnel.
2. Giving first priority to the needs of the patients/clients assigned to the nursing staff.
3. Providing for coordination and efficiency among departments that provide support
services.
4. Identifying responsibility for all activities under the purview of the nursing staff.
5. Providing for safe, continuous care.
6. Considering the need for variety in task assignment and for development of
personnel.
7. Providing for the leader’s availability to staff members for assistance, teaching,
counsel, and evaluation.
8. Trusting members to follow through with their assignments.
9. Interpreting protocol for responding to incidental requests.
10. Explaining procedure to be followed in emergencies.
11. Giving clear, concise, formal and informal directions.
12. Using a management control process that assesses the quality of care given and
evaluates individual and group performance given by nursing personnel.
Thirty one tasks had been identified as tasks of first line nurse managers/supervisors in a
research done by Beaman (1986). Among these are:


















Assist in service to prepare orientation schedule.
Discuss the program of orientation with the new member.
Decide when orientation is complete.
Write counseling reports and discuss them with staff members.
Terminate after approval has been obtained.
Submit time schedule for three shifts.
Assign patients, teams for day shifts.
Make recommendations about budget to nursing administration.
Calculate nursing hours used and justify them.
Call in extra help when needed.
Prepare reports about budget variances.
Make daily patient rounds.
Attend and participate in first-line nursing management meetings.
Conduct meetings with own staff for problem solving and learning.
Set goals for individual units.
Participate in setting goals for the nursing department.
Discuss unit problems with physicians regularly.
Participate in all levels of quality assurance, including designing studies, collecting
data, and preparing reports.
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Administrative Process in Nursing
41
Work Assignments
One of the fundamental managerial functions is giving assignments. Giving assignments
require consideration of many factors, the most important of which are the abilities of the
employee and the fairness of the assignment. It is important for employee morale and self-esteem
if given an assignment where her/his strength can be utilized. Other factors that must be
considered in giving assignments include efficiency, continuity, staff preferences, and learning
opportunities for staff members. While a supervisor/nurse manager tries to follow these rules,
there are other factors in the environment which can deter her/him from making a fair
assignment. These can include staff shortages, special requests from various staff members, and
unpleasant or undesirable work that must be done.
A nurse manager must consider the person’s job description when making assignments.
A job description is a formal, written description of the work expected of an individual. A job
description defines what is expected of a person in a particular position and consequently what
that person can expect of other people in their positions. This information is particularly helpful
when there is some disagreement about what a person’s responsibilities are.
A broader responsibility of a nurse manager/supervisor and related to giving assignments
is scheduling. The variety of approaches in scheduling such as 12-hour shifts, 8-hour shifts,
weekend relievers, 4-day weeks, temporary pools, job sharing shows how complex this task is.
Rapid turn over, retrenchment, use of temporary personnel, the increasingly high tech nursing
interventions make staffing and scheduling more complicated. All these, in addition to meeting
the needs and wishes of individual staff members as for example, in the emergency need of a
staff for off-duty, can make managing difficult. An approach being used to reduce the number of
conflicts arising from staffing and scheduling is the use of participative management. This allows
staff members as a whole to plan their schedules, thus assuming their share of responsibility for
keeping their unit adequately staffed.
Monitoring
Once assignments and directions are given to staff members, a nurse manager just don’t
sit back and wait for results. The effective nurse manager monitors her area’s progress regularly.
The manager has responsibility to several constituencies, each with their own concerns. The
three major ones are the nursing services staff/nursing school faculty, clients/students, nursing
service/school administration. In addition, the manager must also consider other groups such as
other departments or units, the community, the nursing profession, support staff, and so forth.
The nurse manager monitors her individual staff members’ functioning and performance.
Some items to consider in monitoring the work of individual work members include:
absenteeism, late arrivals, early departures, adherence to professional standards, adherence to
standards of ethical behavior, conformity to legal standards of practice, excellence in provision
of patient care, excellence in recording patient care and its outcomes, ability to work with other
staff members, pursuit of professional growth, leadership.
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Administrative Process in Nursing
42
In monitoring a nursing unit as a whole the following are monitored by the nurse
manager: patient census, incidence of infection, incidence of falls, decubiti and so forth, injuries
to staff, relationship with other departments, comparison with other units, cost over runs, staff
requirements, compliance with regulatory requirements, compliance with professional standards.
In monitoring, both formal and informal methods are used including direct observation, peer
review, formal performance appraisals, and a variety of specific reports, the budget and so forth.
(Tappen, 1995). Swansburg (1993) listed thirteen standards for evaluating the directing functions
of nurse managers. These are:
1. Managers have established a medium by which nursing workers feel free to ask for
advice, counsel, and consultation.
2. Needed written directions are available in the form of policies, procedures, standards
of care, job analysis, job descriptions, job standards, and nursing care plans.
3. A training program is in effect when it meets nursing employees’ needs as they
perceive them. They participate.
4. Nurse managers periodically work evening, night, weekend, and holiday shifts to
keep abreast of clinical and administrative behaviors peculiar to these shifts.
5. Supervisors are competent in needed knowledge and skills of administration and
clinical specialization.
6. The nurse administrator has operationalized ANA Standards for Organized Nursing
Services and Responsibilities of Nurse Administrators across All Settings.
7. The nurse managers have operationalized the ANA Standards of Nursing Practice.
8. Nurse managers are knowledgeable about and apply the appropriate Standards of the
Joint Commission on Accreditation of Healthcare organizations and other appropriate
accrediting body.
9. The nurse administrator uses techniques of operation analysis.
10. Nurse managers use a system of management by objectives.
11. The nurse administrators work with the consent and knowledge of patients, and solicit
input from consumers regarding nursing services desired.
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Administrative Process in Nursing
43
12. Nursing unit personnel are organized into and working as direct care personnel and
clerical personnel
13. Nurse managers use the physical plant to the best advantage for patients and
personnel.
A nurse manager gives recognition and rewards, which can be either positive or
negative, being careful to reward desired rather than undesirable behavior. The manager herself
and her staff must continue to grow and develop as professionals. She must give opportunities
for this growth and development and ensures that the environment of the unit is conducive to the
implementation of new ideas.
Management by Objectives
Management by Objectives (MBO) as a directing element was advocated by noted
management experts Peter Drucker and George Ordiorne. The latter defined it as:
“A process whereby the superior and subordinate managers of an organization
jointly identify its common goals, define each individual’s major areas of
responsibility in terms of the results expected of him, and use these measures as
guides for operating the unit and assessing the contribution of each of its
members.” (1974)
Ordiorne further stated that MBO, as a system for making organizational structure work,
to bring about vitality and personal involvement in the hierarchy by means of statements of what
is expected from everyone involved and measurement of what is actually achieved. It stresses
ability and achievement rather than personality.
MBO allows people to control their own performance, to measure themselves, and to
exercise self-control.
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LESSON 1 
LEADERSHIP
New concept of Leadership
1. Leadership can be learned and cultivated.
2. Leadership are not necessarily charismatic. Charisma may be the result of effective
leadership.
3. Leadership is not limited to those on top position, but can occur at all levels of the
organization.
4. Leadership is not so much of the exercise of power, but the improvement of others.
5. Effective leaders are not born but develop over time through knowledge and by using
appropriate sets of skills.


Both Directing and Leading are based on Power
Power is defined as the capacity to ensure the results of an activity within the expected
outcome.
Kinds of Power:
1. Reward Power – based on incentives that the manager/leader can provide.
2. Informational Power – based on “who knows what” in an organization and the degree to
which access to information can be controlled.
3. Punishment or Coercive Power – based on the negative things that a leader might do to
the member of the group depending on the degree of infraction committed.
4. Legitimate Power – based on the authority delegated to the manager by virtue of her/his
job and position within the hierarchy.
5. Expert Power – based on the particular knowledge and skills that the manager possesses
and shares with her subordinates.
6. Referent Power – based on the administration and respect for an individual as person.
This largely comes from leader’s personal qualities
To achieve the goal of the leadership function in nursing service, four processes must be
performed:
1. Establishing a mission statement that is reflected in long range, strategic, operational
plans; resource allocation, organization policies; the process of leadership starts with
establishing and promulgating the organization’s mission and renewing and revising
it as necessary.
2. Organizing, directing, and staffing patient care and support services in a manner that
is commensurate with the scope of services offered.
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3. Implementing, coordinating, integrating patient care and support services throughout
the organization.
4. Establishing expectations, planning and managing processes to measure, assess, and
improve the performance of the organization’s governance, management, clinical and
support processes.
Thus, effective leadership defines a strategic plan that is consistent with the
organization’s mission and vision. It clearly communicates the mission, vision and plan
throughout the organization. It fulfills the organization’s vision by providing the framework to
accomplish the goals of the strategic plan.
Leadership in health care organizations
Health care organizations are value driven. Their leaders establish and nurture the
appropriate service values. Eight ways in which they can do this is as follows:
1. Communicating a vision – The effective manager must be able to articulate a clear
vision for the organization. Whatever the source, the manager has to personally own
the vision; otherwise, the manager will fail to inspire others.
2. Having a commitment to the development of others. In many ways, managing others
means the development of others. In this role, the manager is more a mentor,
educator, and coach than a boss.
3. Establishing values – It is the leader’s job to discover and declare what his or her
organization stands for, establish a morality that becomes the standards for others,
and declare this in clear and inspiring terms.
4. Learning – The environment in which health care organizations is rapidly changing,
and so they must be open to new knowledge. The leader must look beyond
organizational boundaries by using environmental assessments, long range planning,
SWOT (strength, weakness, opportunities, threats) analysis, portfolio analysis, focus
groups, strategic management, to name a few.
5. Establishing priorities and direction. Establishing priorities adds focus. Leadership
establishes strategic direction and this focuses the organization’s efforts on addressing
its priorities.
6. Solving problems – The effective manager understands the real difference between
real problems and pseudo problems.
7. Balancing interests – Health care organizations are composed of and associated with
myriad interest groups: employees, physicians, nurses, the community, patients,
suppliers, the media, and politicians. The effective health care manager works balance
the interest of all, especially to the benefit of the largest good.
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8. Working for the public benefit – Although organizational benefit is a goal of each
manager, health care mangers typically place community benefit and patient benefit
at the top.
Leadership Attributes of Nurse-Executives
Leadership attributes of nurse-executives include administrative competence with
adequate educational background, business skills, and clinical expertise combined with a global
understanding of leadership principles. To be effective, she must have the leadership traits
associated with leadership effectiveness: intelligence, personality, and abilities. Traits related to
intelligence include judgment, decisiveness, knowledge, and fluency of speech. Leaders who are
perceived to be knowledgeable and competent in their areas of work are respected and can serve
to inspire subordinates to excel in performance.
Personality includes adaptability, alertness, creativity, cooperativeness, personal integrity,
self-confidence, emotional balance and control, and independence (nonconformity). Leaders with
these traits can easily motivate workers to achieve the goals of the organization.
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LESSON 2 -
COMMUNICATION
 The process of transference and understanding of meaning.
 Communication Process:
Senders
Ideation
Encoding
Transmission
Response
Decoding
Receiving
Receiving
Transmission
Decoding
Encoding
Response
Receiver
 Communication Process:
1. Communication takes place only when the receiver of the manager understands it the way
the sender intended for it to understood.
2. Meaning are in people
3. Always validate your perceptions and assumptions you make about other people’s
behavior as well as your own.
4. What to say and do; how you say and do them reflect your perceptions, values, belief,
and needs.
5. Your self-concept shows in your communication behavior, so develop a healthy and
positive self-concept.
6. Avoid fault finding in others. Always look for the good in them an in the situations you
get into.
7. “You pack your own chute”. This means that you choose you own set of behavior. So
avoid blaming others for your actions, reactions and feelings; Own them!
8. Be proactive rather than reactive. Good and solicit feedback
9. Learn to listen to and trust others.
10. Remember – the goal of communication is to build mutual understanding in order to have
faster and better relationship between and among people.
PRINCIPLES OF COMMUNICATION
1. Information giving is not communication. Communication requires that the receiver
provides feedback to the sender.
2. Responsibility for clarity resides on the sender
3. Simple and exact language should be used.
4. Feedback should be encouraged. Common resource of misunderstanding is lack of feedback.
5. The sender must have credibility
6. Acknowledgement of others is essential
7. Direct channels of communication is preferable to written or phone communication.
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BARRIERS AND BREAKDOWN IN COMMUNICATION
1. Lack of planning
2. Unclarified Assumption
3. Semantics Distortion
4. Poorly expressed messages
5. Differences in language, cultures, etiquette
6. Poor transmission channel
7. Poor listening and premature evaluation
8. Impersonal communication
9. Distrust
10. Insufficient period of adjustment to change
11. Information overload
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LESSON 3 -
SUPERVISION
 An enabling process in which the supervision helps the staff member achieve her own
purpose as well as those of the organization
 The art of utilizing certain techniques in helping, guiding, assisting, counseling,
motivating, controlling, facilitating, inspiring and liberating the subordinates.
PRINCIPLES OF SUPERVISION
1. Focus on the improvement of the work, rather than up-grading the worker.
2. Know and provide supervision based on the needs of every individual.
3. Provide utmost cooperation (from the supervisor)
4. Employ democratic technique
5. Stimulate the staff to continuous improvement
6. Respect individuality
7. Create an atmosphere where the staff is free and can function at her own level.
8. Don’t coerce and subjugate the minds of the staff.
9. Avoid the use of “I”, but use “We”.
10. The supervisor must be able to follow and to lead.
KEY CONCEPT OF SUPERVISION
1. Supervisors must add strength to an organization by serving as the linking in between
lower level group and the executive level of management
2. Supervisor must bring to their work a unique coordination of technical competence;
individual energy, and the ability to get along with people and moderate them.
3. Performance of supervisors will be judged by how well they manage the resources
assigned to them and the results they get from them in a way of output, quality and cost
control.
4. Supervisory management job generally requires three (3) skills:
1. Human Relation Skills
2. Technical Relation Skills
3. Conceptual Skills
5. Supervisor must balance their skills – too much in one direction is likely to be selfdelegating.
6. Supervision is not a position, it is dynamic process of getting things done thru people.
GOAL OF SUPERVISION IN NURSING SERVICE
1. To attain quality of care for each patient
2. To develop the potentials of the workers
3. Productivity, efficient and effective performance
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SUPERVISORY TECHNIQUES






Observation of staff in action
May demonstrate selected care procedures
Assists in the staff as needed
Private conference with individual staff as needed
Spot checking of selective activities at regular intervals
Rounds with individual staff or group; discuss problems encountered.
QUALITIES OF GOOD SUPERVISORS











Ambitious for self-improvement
Self-starter
Able to critically think
Able to communicate clearly
Able to organize
Have Moral Integrity
Ability to work with and thru people
Willing to tackle and make tough decisions
Dynamic and have ability to inspire others
Should like people
Balance personality
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LESSON 4 -
DELEGATION
Definition:
Delegation is the process by which a manager assigns specific task to the workers with
commensurate authority to perform the job. The worker assumes responsibility for the
satisfactory performance and results.
Transfer of responsibility for the performance of an activity from one individual to another, with
the former retaining the accountability for the outcome.
Purpose of Delegation
1. Trains and develops staff members for greater opportunities, making them more
committed and satisfied in the job.
2. Saves time on the part of the manager.
3. Maximize the use of the talent of the staff.
4. Assign routine tasks
5. Staff capability building
Principles of Delegation:
1. Give clear description and instruction of what is to be done.
2. Share with the employee the outcome of the delegated task.
3. Discuss with the employee the degree of responsibilities and authority that is allowed to
him. Allow autonomy by monitor the performance.
4. Ask the employee to recount what are the main points of the task delegated to him.
5. Manager to over-see/follow-up the progress of the delegated task.
6. Ultimate accountability for the delegated task rest on the door of the task and the
manager who delegated the task.
7. Give credit; NOT blame to the worker
8. Don’t take back delegated tasks.
9. Say “Please”, “Thank you” – after; sign of gratitude and respect to the employee.
Five (5) Rights of Delegation:
1.
2.
3.
4.
5.
Right Tasks
Right Person
Right Direction/Communication
Right Supervision
Right Circumstances.
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Five (5) Elements of Delegation:
1.
2.
3.
4.
5.
Select capable people
Communicate
Set control point
Provide tools and authority
Make help available
Steps in Delegation
1. Describe the tasks/projects/procedures to be done.
2. Relay the description of the tasks

Establish check points
a.
b.
c.
d.
Policies/standards
Allocate Resources
Time Frame
Rounds
3. Establish dialogue before, during and after for feedback on:
a. Clarification
b. Attitudes/feelings of all staff with the tasks
c. Judgment of delegation
What Should be Delegated?
1. Routine tasks
2. Delegated tasks that allows employees to grow professionally
3. Delegated tasks to more qualified employees
What not to Delegate:
1.
2.
3.
4.
5.
6.
7.
“Hot Potatoes” (Confidential matters)
Power to discipline the staff
Accountability
Over-all control of the unit
Highly technical job
Hiring and firing employees
Signing your name as manager.
Barriers to Delegation:
1.
2.
3.
4.
Myself Fallacy – “I can do better”
Lack of ability to direct
Absence of control that warm impending difficulties.
Aversion to taking a risk
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Problems in delegating
Delegating is difficult when staffing is inadequate, the work is difficult or unpleasant,
and the team members are not ready or are immature (Tappen, 1995). There are tasks too, that
cannot be delegated. Examples of these are: the power to discipline, the responsibility for
maintaining morale, jobs that are too technical, or duties involving a trust or confidence.
The delegation of work to another presumes a superior-subordinate relationship. For this
reason, many nurse-leaders hesitate to delegate. They assume a greater share of the work,
resulting in being overburdened. Tappen (1995) has this to say:
“Leader-managers who cannot delegate responsibility to their team
members are always very busy. They usually need to be in three places at once
and are often seen rushing from one crisis to another because they do not have
time to deal with a problem before it becomes a crisis. Perhaps because they
have so much practice, they are very good at dealing with crises but they do not
do much planning. These leader-managers are frequently heard saying how
busy they are, and it is hard to make an appointment with them. When they area
away from work for more than a day or two, the team falls apart because no one
else on the team knows how to handle many of the team’s regular functions.
Team members don’t know anything about these ordinary routines because the
leader always does them.”
These difficulties may be due to any of the following reasons:
First, some leaders do not even realize they have a problem delegating. They believe they
are hardworking, dedicated people (which they are), and do not realize how much they
limit the effective functioning of the team.
Others simply do not trust their team members and believe that in order to do the job
well, they themselves, have to do it.
For others, the need to retain control or to dominate others is so strong that they cannot
let other team members share the leadership role or even become proficient. Consciously
or unconsciously, they withhold needed knowledge and information from team members
as a means of control.
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Ways to Delegate Successfully
According to Swansburg (1993), the following is a list of ways for nurse managers to
delegate successfully:
1. Train and develop subordinates. It is an investment. Give them reasons for the task,
authority, details, opportunity for growth, and needed instructions if needed.
2. Plan ahead. It prevents problems.
3. Control and coordinate the work of subordinates. Do not peer over their shoulders.
Develop ways of measuring accomplishments of objectives.
4. Visit subordinates periodically. Spot potential problems of morale, disagreement, and
grievance.
5. Coordinate to prevent duplication of effort.
6. Solve problems and think about new ideas. Emphasize employees solving their own
problems.
7. Accept delegation as desirable.
8. Specify goals and objectives.
9. Know subordinates’ capabilities and match the task or duty to the employee. Be sure
the employee considers it important.
10. Agree on performance standards. Relate managerial references to employee
performance.
11. Take an interest.
12. Assess results. Expect what is clearly and directly asked for as the deadline set for
completing and reporting arrives. The nurse manager should accept the fact that
employees will perform delegated tasks in their own style.
13. Give appropriate rewards.
14. Do not take back delegated tasks.
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LESSON 5 -
PRINCIPLE OF PROBLEM
1.
To resolve problems affecting organization efficiency, the Manager should separate
large problems from small ones, use policy to solve the smaller problems, and conserve
managerial time for solving major problems.
2.
The Manager should delegate smaller problems to subordinates and teach them to solve
these by applying existing agency rules.
3.
In solving operational problems, the Manger should consult internal and external
experts, so that solutions will be based on current knowledge.
4.
Problem solutions are most effective when the Manager approaches problems in relaxed
fashion and refuses to solve problems under stress
5.
It is impossible to anticipate all eventualities or expect 100% accuracy in diagnosing and
resolving problems. Therefore it is unwise to agonize over selecting a solution.
6.
Provide an opportunity for people to raise problems in work.
7.
Solve problems by taking and listening to people.
8.
Always conduct interviews in private. Be sure you can’t be overhead.
9.
Never prejudge. To prejudge is to be prejudiced. What you think is a disciplinary
matter that could be a domestic problem, and the individual might need counseling?
DIFFERENT APPROACHES TO PROBLEM SOLVING
1. SERIAL APPROACH – they tackle problems in sequence, completely resolving one
before turning to next.
2. SURVEY – survey all existing problems, rank them by importance and solve one at a
time in order of priority.
3. GROUP PROBLEM – according to the resources it is needed to investigate and remedy
each, then resolve a group of related problems simultaneously.
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1
2
3
6
5
4
A. Tackle problems in sequence as they arise, resolving each problem before undertaking the
next step of problem solving.
1
6
7
4
2
8
9
3
10
5
B. Survey all existing problems, order them, and handle first one, then another, according to
priority.
1a
1
2
3
2a
2b
4
5
6
5a
5c
5b
C. Depart from primary data search to consider related issues.
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7
STEP
1. Define the problem
2. Generate alternatives
solution











3. Evaluate and select
alternative.
4. Implement and follow
up on the solution












CHARACTERISTICS
Differentiate facts from opinion.
Specify underlying causes.
Tap everyone involved for information
State the problem explicitly.
Identify what standard is violated
Determine who’s problem it is.
Avoid stating the problem as a disguised
solution.
Postpone evaluating alternatives
Be sure all involved individuals generates
alternatives
Specify alternatives that are consistent with
goals.
Specify both short-term and long term
alternatives.
Build on others’ ideas
Specify alternatives that solve the problem.
Evaluate relative to an optimal standard.
Evaluate systematically.
Evaluate relative to goals
Evaluate main effects and side effects
State the selected alternative explicitly.
Implement at the proper time and in the right
sequence.
Provide opportunities for feedback
Engender acceptance at those who are affected.
Establish an ongoing monitoring system.
Evaluate based on problem solution.
METHODS OF PROBLEMS SOLVING
Trial and error is the simplest technique, but is time consuming and may not be effective
especially if the problem is complex.
1. Scientific Experimentation – involves studying the situation under controlled condition
often using trial period or pilot projects.
2. Multistage critique – study the action of the principals before, during and after the
event.
3. Metaphor-based analysis – translate the problem into a different sphere to obtain a fresh
view point.
4. Purposeful Inaction – chooses not to do anything when intervention is indicated.
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DECISION – MAKING
Decision-Three – is a mathematical tool that defects related decision points and outcome
probabilities as an interconnecting network of nods branches. A manager can objectively
analyze available courses of actions determine the cost effectiveness of different actions and
select the alternatives yielding the best outcome for the cost.
1. Brain storming – a process of group interaction to stimulate members to develop many
new ideas within a short time.
2. Nominal Group – To minimize the effect of status difference on decision-making, the
nominal group techniques combined non-interactive and interactive members in the
deliberation.
3. Delphi-Survey-Decision – makers never meet face-to-face. They remain anonymous
through out a multicycle decision process.
4. Fishbowling – is a method of group decision making that improves decision quality. The
decision maker sits at the center chair in a circle. This provides for reasoned orderly
Decision-making by eliminating distraction cross talk and irrelevant decision.
Decision-Making:

The systematic process, as a sequential process of choosing among alternatives and
putting the best choice into action.
Three (3) Models in decision-Making:
1. Normative Model – (Lancastor and Lancaster)
Seven (7) Steps in this analytical Model:








Define and analyze problem
Identify all available alternative
Evaluate the pros and cons of each alternative.
Rank the alternatives.
Select the alternative that maximizes situation
Select the alternative that maximizes situation
Implement the decision
Follow-up outcome.
2. Decision Three Model (Mages and Brown)
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3. Descriptive Model (Serison)
Seven (7) Steps in Descriptive Method:
1.
2.
3.
4.
5.
6.
7.
Establish acceptable goals.
Define subjective perceptions of the problem.
Identify acceptable alternatives
Evaluate each alternative
Select the alternative
Implement the decision
Follow-up the outcome.
Five (5) General Steps of the D-Making Process:
1.
2.
3.
4.
5.
Identify the problem
Gather and analyze information related to the solution.
Evaluate all alternatives
Action and implement selected alternative.
Monitor the implemented and evaluate outcome.
Pitfalls of Decision-Making:
1.
2.
3.
4.
Inadequate Fact-finding
Time constraints
Poor communication
Failure to systematically follow the steps of Decision-making process will likely
results in un anticipated results.
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LESSON 6 -
MOTIVATION
Is an individuals inner state that causes him or her to behave in a way that ensures the
accomplishment of some goal.
Motivation – Behavior Model
Needs/Values
Motivation
Goal
Behavior
The Porter-Lawler Model of Motivation
Value of
Rewards
Ability to do a
Specific Task
Performance
Accomplishment
Effort
Perceived
Effort-Reward
Probability
Perceived Equitable
Rewards
Perception of
Task Required
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Rewards
Extrinsic
Rewards
61
Satisfaction
Principles of Motivating/inspiring Others
1. Know employee’s needs and expectations







To be treated fairly as a human being
To be provided with work that suits their ability
To have opportunities for self-development and promotion
For employer’s promises to be kept
To know what is expected of them
To be rewarded equitably
To have a friendly and safe working environment
2. Positive thoughts motivate
3. Enjoyment motivates
4. Feeling important motivates
5. Success motivates
6. Clarity motivates
7. Personal benefits motivates
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LESSON 7 -
EFFECTING CHANGE
Introduction
Using the nursing program evaluation results in implementing changes as well as for long-range
planning ranks a high priority of successful administration cannot be limited to the day-to-day
operations of the institution. Of all the leadership positions in the nursing field, the director of
nursing is in the most strategic position to effect needed innovations in nursing.
Three (3) Types of Change
1. Structural Change – affects the organizational process such as alterations in authority
charts, budget procedures, or rules and regulations.
2. Technological Change – affects the physical environment and work practices or
systems.
3. People-oriented change – affects the performance and conduct of employees, such as
the introduction of different training schemes, appraisal systems, sets of standards or
promotional devices.
Three (3) Phases of Change
1. Unfreezing – is the development of a need to change through problem awareness.
Despite identifying the problem, a person must believe there can be an improvement
before he or she is wiling to change.
2. Moving – is working towards change by identifying the need to change, exploring the
alternatives, defining goals and objectives, planning how to accomplish the goals and
implementing the plan for change.
3. Refreezing – is the integration of the change into one’s personality and consequent
stabilization of change. Personnel use old behaviors after change effort cease. Relate
changes in neighboring systems, momentum to perpetuate the change, and structural
alterations, which support the procedural change, are stabilizing factor
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IMPLEMENTATION
Various organizational approaches used to introduce change.
I. Unilateral Approach – authoritative decisions are made at the top of the power structure
and handed downward.
1. By decree – an impersonal announcement handed down by the top echelon and it is
one way declaration of intention usually phrased in memo. Policy statement or
lecture, Automatic compliance with authority will produce changes behavior and
anticipated improvement.
Example: memo on uniforms.
2. By replacement – key positions are to be filled up by more effective new personnel.
This is used when the decree approach is insufficient but the upper authority control
and mandate to bring about change at the bottom organizational level.
Example: If a staff nurse is poor in her performance replace her.
3. By structure – a formal mechanism for change that relies on a redesign of the
organizational pattern, with the assumption that the creation of new or different slots
will result in improved performance.
II. Shared Power
1. By group decision making – a two phase approach where upper authority identifies
the problem but subordinate debate and select the most appropriate solution for
stimulating change. The participation in the change decision increases support and
commitment.
Example: The issue of staffing pattern to solve understanding.
2. By group problem solving – the two functions of problem identification and solution
are faced by the subordinate discussion group in recognition of their practical
experience and knowledge of the issue at hand.
III. Delegated Power
1. By case discussion – a generalized discussion of a situation aimed at developing
problem solving skills which can be applied by personnel to carry out changes.
Example: A case of a staff nurse who showed improvement in her performance
and got a high rating.
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2. By sensitivity sessions – a psychologically oriented method which doesn’t deal with
task-oriented problems or changes but places emphasis on social or interpersonal
processes. Led by professional trainer, members of the group develop self-awareness
and insight on the attitudes of others. This increased understanding is expected to
lessen to informal and self-initiated change.
Example: Stress management lecture for the staff nurses.
GUIDELINES FOR IMPLEMENTING CHANGE
Change is more acceptable:
1.
2.
3.
4.
When it is understood than when it is not.
When it does not threaten security than when it does.
When those affected helped to create it than when it has been externally imposed
When it results from an application of previously established impersonal principles than
when it is dictated by personal order.
5. When it follows a series of successful changes than when it follows a series of failures.
6. When it is inaugurated after prior change has been assimilated than when it is inaugurated
during the confusion of others major change.
7. If it has been planned than if it is experimental.
8. With people new on the job than with people old on the job.
9. With people who share in the benefits of change than with those who do not.
10. If the organization has been trained to plan for improvement than if the organization is
accustomed to state’s procedures.
GUIDELINES FOR IMPLEMENTING INNOVATIONS
1. Identify strengths and areas needing improvement. The systematic evaluation plan should
provide direction and valuable information. Avoid the attitude of change for the sake of
change.
Example: Change in uniforms
2. Develop a master plan with target dates for time of accomplishment of different aspects.
This serves as the blueprints.
3. Ensure staff involvement – People tend to support what they help plan.
4. Define the constraints under which you must operate in terms of money, time, skill of staff,
equipment and clinical facilities.
5. Identify and analyze the choices for there is more than one way to get an objective.
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- cost effective quality care-hire nursing staff or give incentive or overtime pay.
6. Consider all the ratifications of the change. Innovations that are helpful in one area may
have undesirable side effects in other areas.
Example: In the operating room, the last OR case is 2:00 O’clock except for emergency
7. Plan for evaluation – it should start at the beginning of your process and continue throughout.
8. Make failure acceptable – Risk taking is associated with change and not succeeding should
not become degrading to individuals.
9. Bring out hidden agendas so that real issues can be handled when working with staff.
Promoting change is not threatening the autonomy and security of individuals.
10. Brainstorm and try to identify alternatives when deadlocks occur.
Example: Shifting by 3 shifts or flexitime.
11. Try not to have a “final” or “set” decision in a small group that will result in defensiveness
when recommendations are presented to the total group and suggestions are offered. Label
materials “Draft 1,2,3 or “Working Copy”
12. Maintain a perspective – Remember, there’s nothing like a little experience to upset a theory.
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LESSON 8 -
MANAGEMENT OF CONFLICT
Definition:
Conflict is defined as all kinds of apposition or antagonistic interaction based on scarcity of
power, resources, or social position and different value structures.
Four Approaches to Understanding the Nature of Conflict
1. Interpersonal Conflict (within the individual). There is ambivalence disordered
perception, feeling and behavior which are associated with psychiatric problems.
2. Inter-actional sociological approach – Focus on group behavior and interactional
phenomenon with a group.
3. Anthropological approach emphasizes the stress of culture – acclimatization, value,
and cultural conflicts and relates to personality and environment.
4. Economic-Political Approach – emphasizes conflicts related to political concerns,
power, games, coalition as well as political and economic processes. These is always a
perceptual difference between rich and poor.
Types of Conflict:
1. Intrapersonal Conflict or Role Conflict
2. Interpersonal Conflict
3. Intergroup or Inter organizational Conflict.
Sources of Conflict
1. Power – different sources
2. Situational –different interaction; with divergent views of power and authority.
Effect of Conflict
1. Functional or Constructive Conflict – support the goals of the organization and improves
organizational performance.
2. Dysfunctional Conflict – interaction hinders organizational performance.
CONFLICT OUTCOMES
Functional Conflict Outcome
 Increase effort and improve performance
 Enhance creativity
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 Personal Development and growth
Conflict
Awareness
of the
problem
Heed to
resolved the
problem
Adaptation to
innovation
Problem
solving
Change
Dysfunctional Conflict




Conflict
Indecision
Resistance to change
Emotional outburst
Increased political maneuvering
Inability to
confront
conflict
Stagnation
or Decline
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Tension rise
communication
breakdown
Coordination
failed. Impaired
Decisionmaking
68
F. Benefits and Cost of Conflict
Benefit
Cost
1. Energy and enthusiasm
1. Tension and anxiety
2. Diagnostic Value
2. Causes maybe overlooked
3. Creation of new and
creative solution
3. Rigidity in position
4. Focus on task
4. Decline in cooperation
and teamwork
5. Feedback
5. Loss of self-esteem
G. How is Conflict Managed by the managers depends on the:
1.
2.
3.
4.
Ability to disguise the nature and sources of conflict.
Ability to initiate confrontation and discussion with conflict parties
Ability to engage in active listening so as to hear all points of views.
Ability to choose the rights approach towards conflict resolution
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STRATEGIES FOR MANAGING CONFLICT
Accommodating/
smoothing.
 High for people
 Low for task
Lose - Win
Collaborating/
Confronting
 High for people
 Low for task
Win - Win
Compromising / Bargaining
Get job done balance with
Maintaining morale
Lose-Lose
Avoidance / Withdrawal
 Low for people
 Low for task
Lose - Lose
Competetive / use power
Concern for
accomplishment, but
Authoritarian
Win - Lose
Concern for Task Achievement
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LESSON 9 -
TEAM BUILDING
A. Definition:
As we experience changes as cost cutting, and downsizing within the health care – teamwork
becomes an important concept. Health care organizations are being restructured around
teams. This re-structuring appears to be a comfortable “fit” since most of the work in health
care organization is already performed by groups or people responsible for different
functions. With all the focus in individual, we still need individual to work together in
groups to accomplish goal.
Groups – is a member of individuals assembled together or having some unifying
relationship.
Team – is a member of persons associated together in specific work or activity

A group of people with high degree of interdependence geared toward the achievement of
a goal or a task.
Kinds of Teams:
1. Effective Team – is characterized by its clarity of purpose, informality and congeniality,
commitment and high level of participation.
2. Ineffective Team – are often dominated by a few members leaving others bored,
resentful or uninvolved.
Leaders tend to be autocratic and rigid and the teams’ communication style maybe overly
stiff and formal.
B. Group Development (by Tuckman)
1. Forming – members first come together with emphasis:



-
Making acquaintances
Sharing information
Testing each other
Group members attempt to discover which interpersonal behavior are acceptable or
unacceptable to the groups
Process of sensing out the environment.
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2. Storming – high degree of intergroup conflict can usually be expected as group members
attempt to develop a place for themselves and to influence the development of group
norms and roles.
- Issues are discussed more openly and efforts are made to clarify group goals.
3. Norming – Group begins to develop a sense of oneness
-
Norms emerge to guide individual behavior.
Group members come to accept fellow members and develop a unity of purpose
that binds them.
4. Performing - developing separate roles for various members
-
Role differentiation emerges to take advantage of task specialization in order to
facilitate good attainment.
Group focuses attention to the task.
5. Adjourning – a socialization stage – the group joined each other and individually
express their feelings to the group and what they feel doing activities together.
C. Group Norms:
1.
2.
3.
4.
5.
6.
7.
Cooperation among team members are expected.
Everyone has a role on the team and is provided with a clear expectation of his role.
Decision are made by majority role.
Team members will be held accessible for assignments.
Team members are expected to meet deadlines.
Team members will begin and end in time.
Competition between members/department is not necessary.
D. Team’s Concept:
1. Communication – openness
1.1 Members conduct interpersonal relationship with their peers in thoughtful
supportive ways.
1.2 Members are able to resolved conflicts among themselves and do so in ways that
enhance rather than inhibit their working together.
1.3 People must be willing to confront issues and to openly express their ideas and
feelings
2. Mission
2.1 Team must have a purpose that is a plan, aim or intension
2.2 Special work or service to which the team must be 100% committed.
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3. Willingness to cooperate
3.1 An individual’s intention to participate without any conditions - commitment
E. Suggestions that Help Develop Team Work:
1.
2.
3.
4.
5.
6.
7.
Be inclusive and Welcome Diversity
Recognize Habits and Behaviors
Teamwork is the fluid process that challenges the status duo.
Focus on strength and applaud the efforts of others.
Appreciate the risk members take.
Bring your best to the team.
Build Trust by Building Relationship.
Teamwork is a new experience for some members who come to the group without a positive
expectation because they’ve never experienced teamwork. Where members find themselves
and each other enough to show the content of their toolboxes, with all the positives and
negatives, the group has the potential to work as a team.
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THE TEAM BUILDING PROCESS
Team Leader
1
Agenda
(Problem)
Group Advice
of the Problem
2
Diagnosis
Full Group
Participation
3
Identification of Problem
Factors
Communication
Role Clarification
Leadership Style
Organizational Structure
Interpersonal Friction
4
6
5
Discussion and
Choice of Problem
Solution
Implementation
of Solution
(Change
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74
Group Commitment
To solution –
Interpersonal Support
Interpersonal Trust
LESSON 10 -
PRODUCTIVITY; EFFICIENCY AND EFFECTIVENESS
One may equate productivity to the increased members of admissions; or to the member of
surgical operations; or many of the involved in the dollars or pesos that come in; or maybe to the
number of personnel you have trained; or even to the number of researches that you have done.
All these actually are considered products or outputs because in essence productivity is
dependent on the organization’s mission and vision.
A. Productivity is defined by the formula:
Productivity =
Output
Input
O = Increase Quantity + Quality
I = Decrease resources (man, money, materials)
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Nursing Productivity Frameworks
(By Jelinek and Dennis)
ENVIRONMENT
Input
Such as:
Process
Such as:
 Nursing personnel
 Patient Care
Delivery
Systems
 Patient’s Days
 Leadership
 Procedures done
 Management
 Visits Made
 Staffing System
 Work induced
attitude
 Equipment
 Supplies
 Capital
Output
Such as:
 Hours of Care
B. Nursing Productivity Measures
1. Resources per patient day.
-
Labor Productivity – Nursing Hours per Patient Day
Total actual salary cost of nursing personnel divided by total patient days
for the same period.
2. Degree of Occupation – measured informally using the “busyness scale”
wherein the Nurse Manager observes the unit staff and makes a judgment as
to the ratio of the staff and the work load.
-
To date, is computed scientifically by determining the clinical status of the
patient and the nursing care hour needed by each patient in a certain
clinical level of illness.
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C. Improving Nursing Productivity:
1. Change in use of inputs.

Matching supply with demand
- Careful use of personnel


Making staff substation (use of assistive personnel)
Control the use of supplier and equipment.
2. Change in the care process
10 hours shift
12 hours shift
Routine activities
3. Documentation – different methods of charting




Paperless charting
DAR method
Clinical Pathway
Etc.
4. Calculating Cost.



Compare new and old rate systems
Determine cost-effective caring
Cost-Benefit Analysis
5. Measure the Outcome



Quantity
Quality
Innovation Beneficial
6. Separate Nursing change from room charges.
7. Use group counseling and teaching method.
8. Recognize the need to do better.
9. Giving passes/rewards for good performance.
10. Seek new approaches to old problems and improve products and services.
11. Attention to doing the right things the right way.
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EFFECTIVITY
There is no one “best” ways to structure and organization for it to become effective. There
are many variables to be considered, such as the size of organization, the capability of its
human resources and the commitment level of its workers. However, certain minimal
requirements can be identified:
1. The structure should be clearly defined so that employees know where they belong and
where to go for assistance.
2. The goal should be to build the fewest possible management levels and the shortest
possible chain of command. This eliminates friction, stress and inertia.
3. The unit staff needs to be able to see where their tasks fit common tasks of the
organization.
4. Organizational structure should enhance not impede communication
5. Organizational structure should facilitate decision making that results in the greatest work
performance.
6. Staff should be organized in a manner that encourages informal groups to develop a sense
of community and belonging
7. Nursing services should be organized to facilitate the department of future leaders.
EFFICIENCY
Efficiency simply means being able to perform the required tasks/s in the right way. It
always goes hand in hand affectivity. One will not be effective without being efficient and
vice versa.
An efficient nurse is an effective nurse.
For an employee to be efficient, he must first and foremost be able to work in a safe
environment, be given by management all the necessary tools to be used and enhance his
positivity.
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LESSON 11 -
PROFESSIONALISM IN AN ORGANIZATION
Professional Change – change in position or job such as obtaining education or allow
one to be prepared for a future position.
A.
Strategies for professional growth:
1. Cross training – floating or training nurses to new areas. It is important for
nurses to be articulate about their competencies for a new patient population if
they are asked to float. Managers should make sure that they assign nurses
according to their competency level.
2. Identify a mentor - the new nurse must communicate willingness to learn and
grow in which they approach a prospective mentor who could teach them
techniques and procedures in nursing rather than wait to be approached by one.
An ideal mentor is the one who is willing to support and counsel other nurses
when asked.
3. Clinical Ladder – program established by some organizations to encourage nurse
to earn promotions and gain recognition and increased pay by meeting specific
requirements. Some offer nurses the opportunity to seek promotion in a specific
track, within a clinical, educational, or managerial focus.
B. Characteristics of a Powerful Professional Practice:
1. Nurse with powerful practice acknowledge their unique role in the provision of
patient centered and family centered care.
The power of clinical nurses is significantly
enhanced by the therapeutic, interpersonal
relationships nurse establish with patients and
families and by a nurse’s expertise in relieving
the burden of disease and helping patients and
families cope with the continuum of health
and illness
2. Nurses with a powerful practice commit to continuous learning through
education, skill development, and evidence-based practice.
All of the nurse leaders identified knowledge and expertise as an essential element
of the nurse’s power based and underscored the importance of continuous
learning. Nurses who are powerful, they said, continuously seek new knowledge
and based their practice on evidence. The educational level of nurses was also
viewed as an essential element of a powerful professional practice. The nurse
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leaders agreed that attaining a BSN is essential, and that more education generally
leads to greater power.
3. Nurses with a powerful practice demonstrate professional comportment and
recognize the critical nature of presence.
The nurse leaders noted that the professional comportment of nurses – their
behavior and how they carry themselves – is a key component of nursing power.
Openness, transparency, authenticity, honesty, and integrity are some of the
characteristics that the nurse leaders are associated with powerful nurses.
The nurse leaders also commented that the way nurses use language, particularly
how they refer to themselves, can enhance or detract from their professional
image. Nurses in powerful practices consistently acknowledge their own
professional status and that of others by using first and last names during
introductions, and by avoiding phrases, such as “I am only a nurse, “or “she is just
a nurse,” that diminish individual nurses and profession of nursing as a whole.
The nurse, said the nurse leaders, brings a unique skill set, knowledge, and
prospective to the care team, executive table, research tem, or faculty – a
contribution that nurses, themselves must not doubt since self-confidence is
linked to power. That said, nurses must work to sustain their credibility by
maintaining competency and remaining current in their practice and by
remembering that they are professional who work with others to meet the best
interests of the patient and family.
4. Nurses with a powerful practice value collaboration and partner effectively with
colleagues in nursing and other discipline.
Many of the nurse leaders cited the ability to collaborate with nursing colleagues
and those outside of nursing hallmark of effective nursing leadership and a
characteristics of powerful nursing practice. They noted that collaborating does
not mean acquiescing or giving in. Not does it mean competing or engaging in
divisive actions and behaviors. Rather it involves authentic, transparent
discussion, debate, and deliberation and striving to reach consensus – driven
outcomes. A powerful professional, according to the nurse leaders, works well
with others, is fair, and has opinions and perspectives that are “sought out” by
others. Leading the participating on teams and partnering with others are
essential to sound, expert nursing practice and are critical elements of a nurse’s
power base.
5. Nurses with a powerful practice position themselves to influence decisions and
resources allocation.
A number of the nurse leaders observed that powerful nurses typically position
themselves to provide direction, input, and information about decisions affecting
their practice, including decisions related to resources allocation. Such nurses
recognize that decisions regarding staffing, technology to support practice,
salaries, wages, and other factors that affect the practice environment should be in
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hands of nursing professionals who work in that environment should be in hands
of nursing professionals who work in that environment; and if they are not
powerful nurses question whether it is because the organization does not value
professional practice.
6. Nurses with a powerful practice strive to develop an impeccable character; to be
inspirationally compassionate, and to have a credible, sought-after perspective.
A number of the nurse leaders observed that nurses with a powerful practice are
grounded by a set of values and principles that they freely share with others and
that guide their decisions and actions. The values and principles also help foster
compassion, make the nurses less fearful and more open to other’s ideas, and help
nurses stay in the course during times that may be tumultuous for patients and
families’ colleagues. Nurses who are open to others and who use a values-based
approach also find that others often seek out their perspective; this not only brings
the nurse more power, but is the antithesis of using power as a coercive strategy.
7. Nurses with powerful practice recognize that the role of the nurse leader is to
pave the way of nurses’ voice to be heard and to help novice nurses develop into
powerful professionals.
Many of the nurse leaders noted that helping novice nurses develop a voice that is
based on professional credibility and expertise is a responsibility of a nurse leader
at the unit, practice, program and institutional levels. Powerful nurses, they said,
recognize this and know that by fostering a nurse’s professional development they
promote the power of the individual nurse, enhance their own power, and
strengthen the power of the individual nurse, enhance their own power, and
strengthen the power of nursing as a profession. Powerful nurses in leadership
position also avoid using phrases such as, “My nursing staff,” or “ My faculty.”
Although unintentional, phrases like this suggested that a nurse is subservient to
others and can diminish the professional stature of the individual.
8. Nurses with a powerful practice evaluate the power of nursing and the nursing
department in organizations they enter by assessing the organization’s mission
and values and its commitment to enhancing the power or diverse perspective.
Many of the nurse leaders observed that nurses with a powerful practice tend to
seek out and work in environments that support nurses and nursing practice, and
that are led by strong nurse leaders who are themselves respected and valued by
the institution. Such organizations place a high value on nurse and nursing care
and, by designing, upholding and contributing to the power of nurses that
practice within them.
All of the nurse leaders agreed that institutions that value diversity and respect are
more likely to value nursing and are stronger organizations as result. They noted
that in organizations where the power of nursing is diminished, nurse leaders and
nursing staff must develop strategic plans that promote respect and diversity, and
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must work to elevate the nursing profession and nursing practice through
leadership development, establishing a strong research base, and creating
programs that foster the professional development of nurses at all levels.
During the discussions, the nurse leaders described their experiences in their
current places of work and compare and contrasted these to their experience in
general and in other organizations. While all but one nurse leader described their
current nursing department and nurse leaders as powerful, perceptions of the
power of nursing seemed to vary across organizations. For example, in the
comprehensive cancer center where “the cure of cancer through research” was the
dominant mission, nurses felt less powerful than in the academic medical center
where “patient care” was the prominent mission and nurses’ role in round-theclock care of patients gave them the greater power as a group and as individuals
(this was particularly true for nurses who had established themselves as expert,
compassionate professionals). Nurse leaders from the university/college setting
noted that the power based of nurses in academic setting depends on the dean of
the school of nursing and on the mission of the college/university. These two
factors, they said, play a significant role in determining the nursing school’s
esteem and credibility within the organization.
Many of the insights gained through discussions with nurse leaders complement
and expand on observations about nursing power that are discussed in the
literature. Like Hagbaghery et al (2004), the researchers found that knowledge,
self-confidence, and supportive management are important factors related to
nursing power and to using power effectively. ANA discussions also highlighted
that link that others have noted between power and professionalism and
underscored how the actions and behaviors of individual nurses affect the
collective power of nursing as a profession.
Beyond this, the nurse leaders participating in their discussions emphasized the
important of the relationships that nurse have with patients and families, and
described how these relationships are central to the power based of individual
nurses and the profession. Nurses enhance their power and assure that the power
of professional nursing practice is realized across all setting by focusing on
patients and families and on improving patients and family centered outcomes; by
sharing information and communicating effectively with colleagues; by using
their knowledge of patients, families and treatment plans to assure safe, high
quality care; and by consistently demonstrating professionalism in their
interaction with patients, families and other members of the team. Nurses’
knowledge of the health care delivery system is also a source of power. When
coupled with their clinical expertise and strong collaborative skills, this
knowledge allows nurses to play an active role in making the acre delivery more
patient and family centered. A powerful nurse – one who is confident in her
knowledge of what patients and families need and her ability to respond to those
needs – is an invaluable asset to organizations who place a premium on high
quality care and who strive to put patients and families at the center of what they
do.
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Nurses who recognize and use their power are more apt to achieve personal and
professional goals and help the nursing profession meet its goals of serving
society and advancing nursing practice, education, and research. Developing a
colleagues who are willing to serve as role models and mentors. As they consider
the insights they gleaned from their discussions with the nurse leaders, they
realized that students in their Fast-Track BSN-to-PhD program would benefit
from two mentors: one to mentor them through the research process, and another
to offer guidance and mentoring in the areas of nursing practice and leadership.
In addition, the researchers realized that the characteristics of powerful practice
from a framework that will help the program’s mentors as they work with less
experienced nurses to create a powerful practice and presence. The researchers
believe the framework will also be useful to any nurse who is interested in
enhancing his or her own practice, advancing the nursing profession, or
influencing the organizations that provide care and that train the nurses of
tomorrow.
Table, Properties of a Powerful Professional Nursing Practice
Nurses who have developed a powerful nursing practice….
 Acknowledge their unique role in the provision of patient and family
centered care
 Commit to continuous learning through education, skill development,
and evidence-based practice
 Demonstrate professional comportment and recognize the critical
nature of presence
 Value collaboration and partner effectively with colleagues in nursing
and other disciplines
 Actively position themselves to influence decisions and resource
allocation
 Strive to develop an impeccable character, to be inspirational,
compassionate, and have credible, sought-after perspective (the
antithesis of power as a coercive strategy)
 Recognize that the role of the nurse leader is to pave the way for
nurses’ voices to be heard and to help novice nurses develop into
powerful professionals
 Evaluate the power of nursing and the nursing department in
organizations they enter by assessing the organization’s mission and
values and its commitment to enhancing the power of diverse
perspectives.
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LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor.
1. Observe the communication pattern in your own place of work and answer the following
questions:
a. What media of communication are used to keep staff informed?
b. Described the communication climate. Would you say it is supportive or
defensive? Justify you answer.
c. Describe any area of concern that related to communication gap. Suggest ways to
improve this condition.
d. Identify at least three barriers to communication.
2. Compare the nursing process with the problem solving process.
3. Describe the steps of the problem solving process.
4. Describe the relationship between problem solving and decision making.
5. You have just been promoted to be the Director of Nursing of a 200-hundred bed
capacity private urban hospital. In your first meeting with the owner of the hospital you
were informed that the hospital is in financial difficulty. Nursing Service, as its share in
the cost cutting measures implemented by the hospital, needs to cut each budget. The
amount being asked is equivalent to the salaries of four staff nurses or two supervisors.
a. What other information do you need to make decision?
b. Describe the decision making steps that you will use.
6. List at least three (3) pitfalls of decision making.
7. Describe two problem solving techniques.
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ADMINISTRATIVE PROCESS IN NURSING
MODULE SIX
CONTROLLING / EVALUATING
SPECIFIC OBJECTIVES
At the end of the discussion of this module, the graduate students will be able to;
1.
2.
3.
4.
gain knowledge on how to control the nursing service operations.
appreciate the importance of controlling / Evaluating
implement control tools in managing nursing service.
identify different control operations.
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LESSON 1 -
CONTROLLING / EVALUATING
Definition
By Urwick
Controlling is evaluating in seeing that everything is being carried out in
accordance with the plan which have been designed and the principles
which have been laid down.
By Fayol
Control is verifying whether everything that occurs is in conformity with
the plan adopted.
Concept Related to the following:
1.
2.
3.
4.
5.
Evaluating to find out the results
If standards were followed
Gantt Chart – to show it was monitored and done according to the time table set.
Performance – refers to the quality and quantity that was accomplished.
Benchmarking – to find out if the job done could be parallel to those same job or even
better as expected.
Principles of Controlling
1. Principles of uniformity – ensure that controls are related to the organizational
structure.
2. Principles of comparison – ensure that controls are stated in terms of the standards
of performance required.
3. Principles of exceptions – provide measures that identify exceptions to the standards.
Controlling Process
1. Establish standards for all elements of management in terms of expected and
measurable outcomes; these are the yardsticks by which achievement of objectives
are measured.
2. Apply the standard by collecting date and measuring the activities of nursing
management comparing standards with the actual care.
3. Make improvement deemed necessary from the feedback. Connect deviation remedial
actions must be undertaken.
4. Keep the process continuous for all areas.
Formula:
Ss + Sa + F + C = I
Where : Standard Set + Standard Applied + Feedback + Connection = Improvement
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LESSON 2 -
TEN (10) CHARACTERISTICS OF GOOD
CONTROL SYSTEM:
1. Reflect the nature of the activity
2. Report errors prompt/timely
3. Forward-looking and comprehensive
4. Point out expectations at critical points
5. Objective, specific and appropriate
6. Flexible
7. Reflect organizational pattern; reflect authority and responsibility pattern.
8. Economical
9. Use understanding devices
10. Indicate corrective actions
Types of Control:
1. Anticipatory Control – seeing problem coming, in time to do something about them.
Planned and preventive measures can save time, money, errors, and many headaches.
2. Concurrent - deals with the present rather than the future or past. It involves
monitoring and adjusting ongoing activities to ensure compliance with the standards.
3. Feedback Control – involves with gathering information about an ongoing or
competed activity and taking steps to improve that activity in the future.
Requirements for Control:
1. Setting standards
2. Monitoring performance
3. Connecting Directions
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LESSON 3 -
TOOLS OF CONTROLLING
1. Standards:
1.1 Three (3) Components
- Structure standards
- Process standards
- Outcome standards
1.2 Categories of Standards
- Physical standards
- Cost standards
- Capital standards
- Revenue standards
- Program standards
2. Performance Evaluation
 Performance – the degree of accomplishment of task that make-up an employee’s
job.
 Determinants of Performance
1. Effort
2. Abilities
3. Role Perception
 Principles of Evaluation
1. Performance evaluation must be based on job description and performance
standards
2. Adequate and representative sampling of staff behavior should be observed in
the process of evaluation (use anecdotal record)
3. Staff to review her job description prior to education conference.
4. Documenting employee’s performance should include both satisfactory and
the needing improvement.
5. Evaluation review/conference should be scheduled at the convenience of both
the evaluator and the persons being evaluated.

Errors Made in Performance Appraisal
1. Leniency
2. Central Tendency
3. Recency
4. Halo Effect
5. Horn Effect
6. Self-aggrandizing Effect
7. Contrast Error
8. Sunflower Effect
9. Temperament Effect
10. Guessing Error
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4. Budget – (Planned Budget versus Budget Realized at the end of the year)
5. Discipline – aims as distractive and connective to improve performance of the staff.
4.1 Principles of Disciplinary Actions:
o Positive Attitude of the staff
o Investigate carefully
o Be prompt
o Protect Privacy
o Advise employee when the schedule for evaluation is
o Take corrective, consultative action
o Follow-up (re-evaluate if behavior is continuous to be on negative).
o Protect privacy of the employee
4.2 Progressive disciplinary Action
Five (5) Steps
Termination
Suspension
Written
Reprimand
Verbal
Reprimand
Counseling
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Disciplinary Action must be:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Progressive
Fit the offense committed
Assistance should be used in administering disciplinary action
Protect privacy
Clear and specific
Objective
Firm in the decision
Nurse manager should consult her supervision for consistency
Nurse Manager should build respect, trust and confidence in her ability to handle
discipline.
6. Nursing Rounds
Rounds cover such issue as patient care, nursing practice and unit management.
7. Records on Reports





Administrative tools used in collecting data towards the attainment of objectives of
the organization or unit.
Accurate, adequate, updated
Clear, brief, concise
Provide relevant facts for study
Filed chronologically
8. Quality Control
This specific type of controlling that refers to the activities that are used to evaluate,
monitor and regulate services to health care customers.
9. Nursing Audit
Types of Audit
1. Structure Audit
2. Process Audit
3. Outcome Audit
Types of Audit in terms of occurrence:
1. Retrospective Audit
2. Concurrent Audit
3. Prospective Audit
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10. Inventory
It is an administrative tool designed to control supplies and equipment by listing the
names, description, number and location of supplies and equipment.
 Purpose of Inventory:
1.
2.
3.
4.
5.
6.
7.
To determine if standards are maintained
To serve as basis for the revision of standards and systems
To recommend proper action on obsolete and surplus materials
To determine operational status of equipment
To prepare plan for repair of replacement
To determine proper location of supplies, materials and equipment
To gather factual information to serve as basis sound procurement planning
 Kinds of Inventory
1.
Perpetual Inventory – recording is done as supplies were used and replenished,
thus indicating the number of supplies on hand at a time.
2.
Physical Inventory – the actual counting made at designed intervals to connect
accumulative errors resulting from breakage or deterioration.




3.
Fixed equipment – annually
Movable equipment – monthly
Instruments – weekly
Narcotics – daily
To set standards relative to the quality and kind of supply and equipment kept
with the unit for:






Clinical Services
Needs of patients
Bed capacity
Needs and demand at a given time
Frequency of items used in emergency situations
The overall objectives of any material control process as:
1. To maintain inventory supply
2. Minimize inventory cost
3. To provide information for decision making
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11. Quality Improvement
Total quality management (TQM), continuous quality improvement (CQI), quality assurance
(QA), utilization review (UR), are methods for evaluating health care and are all concern
about maintaining quality while constraining costs in healthcare organizations. Quality
assurance (QA) is an older term for a system of procedures used to evaluate nursing care and
to give feedback to the providers of this service in order to improve it. Quality improvement
or QI is the newer term used for a more comprehensive, broader-based approach to
evaluating care. One important difference is that quality improvement focuses on whole
systems, not just the performance of individual practitioners.
The process of quality improvement follows the problem solving pattern and the systems
approach in looking at the quality of care given by the healthcare system being studied.
Continuous quality improvement is a continuing cyclical process.
Quality improvement address one or more of these three domains, namely: structure, process
and outcome. Structure evaluation involves looking at how the setting, the conditions, and
the environmental factors affect the quality of care. Process evaluation examines the
activities and behaviors of the nurse. Outcome measures demonstrate changes in the
behaviors and attitudes of the clients.
Quality improvement uses norms, criteria and standards as measures in the evaluation
process. Among the mechanisms used include chart audit and review, patient interview and
inspection, postcare questionnaires and interview, staff interview or observation, group
conferencing.
Quality improvement programs are directed toward assuring some degree of excellence as
defined by those responsible for the program and toward assuring accountability by health
care providers by the quality of care they provide (Hawkins & Thibodeau, 1996).
At the unit level, a quality improvement project begins with assignment of responsibility and
identification of an area for study. Once the scope of care is defined, the problem is further
analyzed in terms of its important aspects, generally accepted standards of care, indicators
that the standards have been meet, and criteria for deciding whether or not they were
sufficiently met.
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Quality improvement on an institutional level on the other hand, is primarily an
administrative responsibility. The first step is a statement of the organization’s philosophy of
quality improvement. Next, the mechanisms to implement quality improvement need to be
set up. Involvement of and representation across departments and of everyone who comes
into contact with the patient as a hallmark of total quality management. Once mechanisms
are in place, continuous quality improvement begins. The administrative body evaluates the
effectiveness of the organization’s continuous quality improvement efforts and results,
revises the process as needed, and proceeds with the cycle again as shown in the diagram that
follows:
ESTABLISH PHILOSOPHY
EVALUATE
EFFECTIVENESS
SET UP
MECHANISMS
ACT ON CQI
RECOMMENDATION
INITIATE CQI
THE CONTINUOUS QUALITY IMPROVEMENT CYCLE
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LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor.
4. Discuss at least two purposes of controlling.
5. Describe three principles of controlling.
6. Name the characteristics of a good control/evaluation system.
7. Discuss the importance of Standards in improving the quality of care given by
nurses.
8. Differentiate among structures, process, outcome.
9. Discuss the purpose and the process of quality of improvement.
10. What are the goals of cost containment?
11. What cost containment measures are being used in your organization? Do you think
they are reasonable and fair?
12. Describe the performance appraisal used in your organization.
compare with the performance appraisal describe in this module?
How does it
13. Discuss the advantages and disadvantages of peer review. What are your feelings
about being evaluated by a peer?
14. Describe the disciplinary measures used in your organization. Do you agree with
the methods used and the penalties imposed?
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ADMINISTRATIVE PROCESS IN NURSING
MODULE SEVEN
ISSUES / TRENDS IN HEALTH CARE
ENVIRONMENT
SPECIFIC OBJECTIVES
At the end of the module, the graduate students will be able to:
1.
Be aware of the health care environment as effected by social, political, economic &
technological advances.
2.
Appreciate the current health issues in health care delivery system.
3.
Gain knowledge on the development of nursing in the health care delivery system.
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LESSON 1
THE HEALTH CARE ENVIRONMENT
Broad social, political, economic, and technological changes are affecting the delivery of
health care systems, the leadership needed, the nursing profession in general.
The society of today is very different from the time when health care was provided by the
family, by the neighborhood “herbolario” or “comadrona”. These days, we go to hospitals. The
hospitals maybe ultra modern and funded by their wealthy benefactors and clients or, they may
be small community hospitals substantially supported by the government. Advances in science
and technology allow us to avail of progress’ tremendous benefits. For example, researches in
the medical and related fields have brought about the discovery and utilization of antibiotics,
immunizations, vitamins and other wonder drugs that are now used to promote health, prevent
the spread of infectious diseases, cure existing diseases, alleviate pain, and in general, allow us to
enjoy a healthy and comfortable life.
Improved sanitation and water system, the availability of modern therapeutic modalities
such as insulin, dialysis, joint replacements, heart valve replacement, organ transplants and so
forth, result in a population who enjoy longer lives and productivity.
But, along with the advances brought about by modernization and industrialization, also
comes problems in society. In general, modern society is afflicted with conditions that demand
much from social services and of health care. Some of these conditions include unemployment,
homelessness, substandard housing conditions, poverty, broken homes, rise in the number of
single parents, domestic and other forms of violence, increasing number of elderly and
handicaps, accessibility of harmful drugs, all of which can result in an unhealthy and sick
individual.
The health care systems are burdened with taking care of diseases never before known as
Alzheimer’s disease, Acquired Immunodeficiency Syndrome (AIDS), drug-resistant
tuberculosis, as well as of taking care of the increasing number of people, mostly elderly, who
are suffering form chronic diseases (cancer, heart, stroke, diabetes, arthritis, and so forth).
The workplace environment for health care workers has undergone change, too. There is
a wide range of possible threats to the safety and well being of healthcare workers brought about
by technological advances and violence in society. These risks include exposure to potentially
lethal chemical, infectious and radioactive agents as well as violence from the patients and
others, especially when the place of work is located in an unsafe area in the inner city. Exposure
to Aids is a concern for many nurses. Of 32 documented cases in the US (Tappen, 1995), of
healthcare workers acquiring an HIV infection in the workplace in the United States, 12 were
nurses. Another source of concern is exposure to tuberculosis. Tuberculosis, once considered
under control, has become a deadlier threat recently as more drug resistant strains appear.
Responding to the challenge brought about by these changes in the healthcare
environment and the healthcare workplace means major reforms in the delivery and management
of the health care system. It means making healthcare not only available but affordable to a
socially and economically diverse population. It means a health care workforce who is ready and
prepared to meet the advances of modern society and its accompanying problems. It also means
making the workplace environment safe and secure for health care workers.
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LESSON 2
HEALTH CARE ISSUES
Rising cost of health care
The increased use of technological is necessarily accompanied by a rapid increase in
health care costs. Global economic crisis and recession are making the situation even worse than
what it was when economic conditions were better. For the poor, unemployed and uninsured,
access to health care is almost next to impossible. Even countries who are supposed to be rich
like the United States are not spared from this problem. It is for this reason that every president
of that country from Kennedy to Clinton seriously addressed this issue. Hillary Clinton made
heath care reform her pet project immediately after her husband took over the presidency. The
primary objective of health care reform is to provide coverage for everyone, regardless of their
ability to pay. Emphasis should be on health promotion and disease prevention. Primary care,
acute care, and long term care, including mental health and reproductive health, should be
covered first. Dental, vision, and hearing are also important. In the health care reform of Mrs.
Clinton, taxes of various kinds combined with strict costs control have been suggested. Health
care reforms, no matter how minimum, needs money and would entail a share of the national
budget. Her proposed health care reform was a major endeavor that called for a large budget
allocation which would increase taxes and naturally cut allocations for other government
projects. After fighting very hard to garner support, she finally abandoned her Health Reform
Plan when the Senate rejected it, mostly for political reasons.
The problem of making health care services accessible to all
The poor has difficulty accessing appropriate health care mostly because of its enormous
cost. And the cost is still rising. For example, the US healthcare cost increased from 10% of a
gross national product (GNP) in 1990 to 14% in 1993. It is projected that by the year 2000, it
will rise to as high as 24%. No data of this sort was obtained for the Philippines. But based from
experience, one can attest that health care cost is definitely rising. It is a fact that the Philippines
has not developed self-reliance in health care (Balita, 1999). According to Dr. Tamayo (Balita,
1999), the best and only solution to address the bad health care is for us Filipinos to help each
other and work hand and hand for full implementation of the National Health Insurance Program
as provided under Republic Act 7875 which has been enacted in 1995 and supposed to be
implemented starting 1999. This program is going to be compulsory. It is envisioned to be
integrated and comprehensive approaches to health development. It endeavors to make essential
goods, health and other social services available to all the people at affordable cost with priority
to the underprivileged, sick, elderly, disabled, women and children. Most importantly, it will
provide free medial care to paupers. An important aspect of this program is the “Botica sa
Barangay”. “Botica sa Barangay” is already being implemented in the city of Manila.
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97
Projects showing the government’s attention to the growing number of elderly are the
senior citizen programs implemented both nationwide and locally. For example, the program that
provides twenty percent discount for food, medicines, transportation, has received very favorable
responses from the older people. Needless to say, the costs of heath promotion, prevention of
diseases and in general the costs of delivering health care to all people will be coming from taxes
of various kinds as well as savings from other different sources, such as reducing administrative
costs.
Controlling cost is clearly a key issue in health care. And, controlling health care costs
entails good management. For the nurse managers, it means delivering nursing care efficiently
and effectively. To make organizations work, it must be able to sustain itself financially, to say
the least. To be sustainable, organizations have to be ran by people with business and
management savvy. It is not unusual therefore, for health care organizations to hire nurses who
hold business degrees (mostly MBA) to occupy top management positions. These days, we often
hear nurse managers using the terms “down-sizing”, “cost cutting measures”, “strategic
planning” and most recently, the preeminent business performance technique for the 90’s’ called
“reengineering”.
Competition, profitability and market share are the issues cited most frequently by senior
executives for turning to the business process of reengineering. Reengineering has invaded
healthcare organizations and has replaced outsourcing, downsizing, restructuring, and
automation. What is reengineering? According to Manganelli and Klein (1994), reengineering is
the rapid and radical design of strategic, value-added business processes – and systems, policies
and organizational structures that support them – to optimize the work flows and productivity in
an organization. From this definition of reengineering, one can deduce that in the process of
reengineering and the other methods of controlling health care costs, some services may be cut
off and some key personnel (nurses included) may be laid off.
Managed Care. This is one of the approaches suggested to reduce health care costs.
Managed care is an approach to providing a range of services in such a way that use of services
and resulting costs are carefully controlled, that is, well-managed. Managed care is a term used
to describe health care subsystem in which services are administered in order to enhance their
efficient and effective use. The primary purpose of these business ventures is to deliver, finance,
buy and sell health care services as economically as possible. Managed care systems are also
known collectively as alternative delivery systems, consist of administrators, providers, and the
physical facilities in which health care is delivered. The hospitals are oftentimes the focal point
of managed care organizations.
Several different administrative structures are characteristic of managed care
arrangements. Some of the more common structures include health maintenance organizations
(HMOs), independent practice association (IPA’s), and preferred provider organizations (PPO’s).
HMO’s are usually organized in one of two ways. The first is the staff model in which HMO
employees provide health care services and also function as administrative personnel. The
second, called the group model, consists of a medical group that accepts a contract from an HMO
to provide health care services for its participants. Regardless of their structures, the primary
purpose of HMO’s is to limit costs by decreasing referrals to specialists, restricting diagnostic
studies, and decreasing client hospitalization. Reducing the number of hospitalizations is
accomplished, in part, through the provision of health promotion and illness prevention services.
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98
PPO’s are another type of managed care organization that can be sponsored by providers,
insurance companies, or employers. Contracts are established with a limited number of health
care facilities and professionals, and lower-than-customary rates are sometimes negotiated. In an
attempt to contain costs, providers may be required to adhere to PPO utilization guidelines.
Group Practice arrangements are outgrowths of the managed-care system. Group
arrangements are thought to be advantageous for a number of reasons. Catalano (1996) cited
some of them. First, they preserve the ideal private entrepreneurship while cutting overhead.
Second, they are attracted to providers who prefer to hire professional managers. This
arrangement enables practitioners to spend more time caring for clients and less time worrying
about the mechanics of running a business. Group practice arrangements are also appealing
because they offer providers more time off, better client coverage, and professional camaraderie.
Finally, group practice frequently employ an array of specialists and clients are offered
convenient, centralized, and comprehensive services.
Managed care as a health care system is fast becoming the dominant approach to health
care delivery.
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99
LESSON 3
TRENDS IN THE NURSING PROFESSION
The profession of nursing is a vital part of the health care system. Any change in the
system brings about change in the profession. Nursing, as a profession, continues to stand to the
challenge of the times. There was a time when empowerment, accountability, independence of
practice, professional collaboration were only concepts to be studied and goals to be achieved,
now they have become integral to the practice and development of the profession. Nurses in the
advanced practice roles such as nurse practitioners can and do establish their own independent
practices. These nurses have professional autonomy, at the same time that they enjoy
collaboration with colleagues in the health care system. They are likewise, empowered by their
own education and expertise in their chosen field. In return, they are personally accountable for
the service they render.
Change in the healthcare system has a major impact on how, where, and even who
practice nursing (Catalino, 1996). Nurses will need to get involved in decisions about where
healthcare is going. They need to band together as a profession and exert potential power that
they have access to politicians, physicians, hospital administrators, and insurance companies in
shaping the future of their profession.
Future trends in the nursing profession suggest a move towards empowerment (Tappen,
1995). The term power has many meanings. From the standpoint of nursing, power is probably
best defined as the ability or capacity to exert influence over another person or group of persons.
In other words, power is the ability to control, by virtue of one’s authority to sway or influence
others towards one’s viewpoint (Hawkins and Thibodeau, 1996). Empowerment refers to the
increased amount of power that an individual, or group, is either given or gains. Empowerment
allows nurses to become more active in the political arena. Some of them run for political offices
or have managed political campaigns. Sources of power that nurses should consider using in
their practice include referent, expert, reward, coercive, legitimate, collective (Tappe, 1995).
Referent source of power depends on establishing and maintaining a close personal
relationship with someone. Nurses often obtain power from this source when they establish and
maintain good therapeutic relationships with their clients. Clients take medications and tolerate
treatments more willingly from nurses with whom they enjoy good relationships. Likewise,
nurses who have good collegial relationships with other nurses, other departments, and
physicians are often able to obtain what they want from these individuals or groups, in providing
care of clients.
The expert source of power derives from the amount of knowledge, skill or expertise that
an individual or group of individuals has. Nurses should have at least a minimal amount of this
type of power because of their education and experience. Increasing the level of education and
experience, therefore, should increase expert power. Nurses in advanced practice roles, nurse
educators, clinical specialists, nurse practitioners and nurse managers are examples of nurses
who are endowed with expert power. Their additional education and experiences provide them
with the ability to practice skills at a higher level than nurses prepared at the basic education
level. Nurses access this expert source of power when they use their expertise to teach, counsel,
motivate clients to follow a plan of care. Also, by demonstrating their knowledge of the client’s
recovery, nurses increase the amount of respect they are given by physicians.
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The reward source of power depends on the ability of one person to grant another some
type of reward for specific behavior or change in behavior. The rewards may take the form of
praises, promotions, raises, expanded privileges, and eradication of punishments. The reward
source of powers is also the underlying principle in the process of behavior modification. For
example, nurses, in their day to day provision of care can give a client extra praise for good
compliance and for cooperating in their plans of care. The flip-side of the reward source is the
coercive source. The ability to withhold rewards, to threaten, to punish are examples of coercive
power. Needless to say, nurses minimally use this for the reason that they are non-therapeutic.
The legitimate source of power depends on a legislative or legal act that gives the
individual or organization a right to make decisions they might not otherwise have the authority
to make. In nursing, the state board of nursing has access to the legitimate source of power
because of its establishment under the nurse practice act of that state. The licensed nurse uses
legitimate source of power by virtue of her being licensed.
The collective source of power is often employed in a broader context than individual
client care and is the underlying source for many other sources of power. For individuals who
belong to professions, the professional organization is the focal point for this source of power.
The main goal of any organization is to influence those policies that affect the members of the
organization. Having all these sources of power available, nurses, individually or as a group, are
getting themselves more empowered. There other ways of increasing power for the profession.
By uniting themselves in a nationwide association or group, nurses can weld a great deal of
power to influence others. The professional associations like the ANA in the United States have
been and are still influencing legislators and legislating. Another way of gaining power is by
becoming involved in political activities, locally and nationally.
Nursing’s progress toward professionalism include improved image, higher salaries,
increased recognition of advanced nursing practice, and support for nursing research (Tappen,
1995).
For years, nurses have been portrayed in demeaning ways. Nurses have been portrayed
magazines and television as obese, scary person toting a large syringe, or as sex maniacs chasing
after doctors or getting into bed with patients, and so on. In 1990, an image campaign by the Ad
Council (Tappen, 1995) in cooperation with nursing organization was launched. The project used
television, radio, and print media to disseminate facts about nursing education and practice. An
portrayed a nurse’s busy morning activities which include saving a life. It ended with a question
asking, “What have you done this morning?” A letter-writing campaign by the major nursing
organizations and their members was successful in getting a television series canceled. This
series had portrayed nursing students as so overwhelmingly preoccupied with sex and romantic
adventures that viewers wondered where they get their time to study and attend classes.
Higher salaries and the opportunities to travel and work in other countries have definitely
attracted more in the profession of nursing. New graduate nurse salaries’ are among the highest
of any new college graduate in the United States. The profession had definitely become more
attractive that seven years ago, when a number of business establishments closed shop, many of
the employees who lost their jobs turned to nursing as a second career. In a school of nursing in
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the East Coast where this writer taught, the average age of students was 35 and many of them
were already professionals in other fields.
Recognition of Advance Nursing Practice. Advanced practice status, such as nurse
practitioner or clinical nurse specialist, has been recognized in many states by completion of
certification examination developed by professional organizations. Eligibility to take these
examinations includes minimum hours of classroom and supervised clinical study and course
content. To attain this status, more and more practicing nurses pursue advance courses to occupy
expanded roles as nurse educators, nurse clinicians, nurse researchers, clinical specialist,
administrators, or nurse practitioners.
Support of Nursing Research. More nurses are going into research and they find this new
area of nursing practice gratifying. Many nurses get promoted and get other recognition for
going into research. Research positions for nurses are opened in hospitals and other healthcare
organizations. Funding can be applied for by nurses who venture in research. Research findings
are utilized in the evidence based nursing practice. Without nursing research there will never be
any change in nursing practices.
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LEARNING ACTIVITIES
Answer the following and submit your typewritten answers/reactions to your professor.
1. Discuss how the worldwide social, political, economic, and technological advances affect
the delivery of health care.
2. From what you know about the current health issues and problems in the delivery of
health care in the Philippines, what health care reforms do you recommend?
3. Trace and evaluate the professional progress of the nursing profession in the Philippines.
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