NURSING LEADERSHIP & MANAGEMENT (NCMB 419)

MIDTERMS
● Improves efficiently by ensuring records are readily accessible
Pointers: Course Modules legally
● Improves compliance by keeping records in line with legal and
WEEK 7: RECORDS MANAGEMENT regularly requirements
● Keeps records under control by preserving data and preventing
WEEK 8: INTRA, INTER AND MULTIDISCIPLINARY AND accumulation control of ephemeral material
TEAMWORK ● Improves the quality of information, providing staff with access to
accurate and reliable quality records security
● Increases the security of confidential records continuity
WEEK 9: NURSING MANAGEMENT FUNCTIONS ● Support business continuity and risk management
● Records are managed efficiently and can be easily assessed and
WEEK 10: STAFFING used
● Records are stored as cost effectively as possible and when no
WEEK 11: APPLICATION OF RESEARCH IN NURSING longer required they are disposed of in a timely and efficient
LEADERSHIP AND MANAGEMENT manner.
● Complies with requirements concerning records and records
management practices to ensure compliance with institution
● Records of longer term value are identified and protected for
WEEK 7: RECORDS MANAGEMENT historical and other research

RECORDS MANAGEMENT (RM) RECORD

● Records management (RM) is the supervision and ● It is a permanent written communication that documents
administration of digital or paper records, regardless of format. It information relevant to a client’s health care management. E.g.
is a systematic and effective control of records (both paper and chart is a continuing account of client health care status and
electronic). It aims to ensure that records are accurate and need.
reliable, can be retrieved speedily and efficiently, and efficiently, ● A record is a clinical, scientific, administrative and legal document
and are kept for no longer than necessary. It is crucial to all relating to the nursing care given to the individual family and
organizations. Unless records are managed efficiently it is community.
possible to conduct business, to account for what happened in the SAMPLE OF RECORDS
past, or to make decisions that are kept for no longer than
necessary. ● Administrative records of Grants/Contracts
● Records management activities include the creation, receipt, ● Bid documents
maintenance, use and disposal of records. Documentation may ● Blueprint of facilities
exist in contracts, memos, paper files, electronic files, reports, ● Consent forms-adult-minor
emails, videos, instant message logs or database records. Paper ● Endowment Fund Records
records may be stored in physical boxes on premises or at a ● Equipment inventory reports
storage facility. Digital records may be stored on storage media ● General ledgers
in-house or in the cloud. ● Meeting minutes
● The goal of records management is to help an organization keep ● Payroll folders
the necessary documentation accessible for both business ● Contracts-purchase lease rental, and etc.
operations and compliance audits.
CLASSIFICATION OF RECORDS
WHAT IS THE CONCEPT?
● Active Record - a record that is regularly referenced or required
● Information is data, ideas, thoughts, or memories irrespective of for current use
● medium.” ● Inactive Record - a record that is still needed by an organization
● Documents are any “recorded information or objects that can be but not for current operations
treated as individual units ● Electronic Record - a record recorded or formatted only a
● Records are “information created, received, and maintained as computer can process
evidence and information by an organization or person, in RECORDS IN THE NURSING OFFICE AND UNIT
pursuance of legal obligations or in the transaction of business.”
● Archives are those records that have been selected for ● Administrative records: organogram, job description, procedure
permanent preservation because of their administrative, manual Personnel records: personal files, records
informational, legal and historical value as evidence of official ● Patient records sent to the medical center chief/medical director
business Leave record, duty roster, minutes of the meeting, budget etc.
Miscellaneous: circular log book, formats, etc.
IMPORTANCE OF RECORD MANAGEMENT
PRINCIPLES OF RECORD WRITING
● To provide evidence of actions and decisions To support
accountability and transparency ● Nurses should develop their own method of expression and form
● To comply with legal and regulatory obligations, including in record writing
employment, contract and financial law as well as the data ● Records should be written with clearly and appropriately
protection act and freedom of information act ● Records should contain facts based on observation conversation
● To protect the interests of staff, students and other stakeholders and action
Help to address complaints or legal processes. ● Select relevant facts and the recording should be neat, complete
● To support patient choice and control over treatment and services and uniform
To support day to day business of the health care delivery ● Records should be written immediately after an interview
● To support evidenced based practice ● Records are confidential documents.
● To assist clinical and other types of audits
● To support sound administrative and managerial decision making. SAFEKEEPING AND RELEASE OF RECORDS
To support improvement in clinical effectiveness through research 1) Sentinel events
BENEFITS OF RECORD MANAGEMENT 2) Anecdotal
3) Incident report
● Saves time by ensuring that records can be found easily and 4) Kardex
quickly 5) Patients chart/records
● Save space by preventing records from being kept longer than 6) 201 file
Necessary
● Saves money by reducing storage costs and maintenance costs

1 (Khlaryzel, Mary, Mae, Shane, Rocette)

 NURSES RESPONSIBILITY FOR RECORD IMPORTANCE OF RECORDS IN HOSPITAL
KEEPING AND RECORDING (FOR INDIVIDUAL AND FAMILY)
● Keep under safe custody of nurse ● Serve the history of the client
● No individual sheet should be separated ● Assist in the continuity of cares
● Not accessible to patient and visitors ● Evidence to support if legal issues arise
● Strangers is not permitted to read records ● Assess health needs: research and teaching
● Records are not handed over to the legal advisors without written For the Doctor
permission of the administration ● Serve the guide for diagnosis, treatment, follow up and evaluation
● Handed carefully, not destroyed ● Indicate progress and continuity of care
● Identified with bio-data of the patients such as name, age, ● Self-evaluation of medical practice
admission number, diagnosis, etc. ● Protect doctor in legal issues
● Never sent outside the hospital without the written administrative ● Used for teaching and research
permission For the Nurses
● Document nursing service rendered
NURSING ADMINISTRATOR’S RESPONSIBILITY ● Planning and evaluation of service for future improvement
● Protection from loss ● Guide for professional growth
● Safeguarding its concerns ● Communication tool between nurse and other staff involved in the
● Completeness care
● Responsibility for nurse notes ● Indicate plan for future
● Admission record For Authorities
● Scientific value of the nurse notes ● Statistical Information
● Record of order carried out ● Administrative control
● Future reference
INDIVIDUAL STAFF RECORD ● Evaluation of care in terms of quality, quantity and adequacy
● Help supervisor to evaluate service
● A separate set of record is needed for staff, giving details of their ● Guide staff and students
sickness and absences ● Legal evidence of service rendered by each employee
● Provide justification of expenditure of funds

WARD RECORD
● Reducting or increase in beds
● Change in medical staff and non-nursing personnel for the ward
The introduction and patient of support
CHARACTERISTIC OF A GOOD
RECORD AND REPORTING
● Accuracy
● Consciousness
● Thoroughness WHAT IS THE RECORDS LIFECYCLE?
● Up to date
● Organization Create/receive - starts when records are either received from an
● Confidentiality external source or created internally. The objectives of this initial
● Objectivity stage are:
● Create complete and accurate records that provide evidence of
PURPOSES OF RECORD the organization’s functions, activities, decisions, transactions,
procedures, etc.
● Supply data that are essential for programme planning and
● Identify and apply an appropriate security classification
evaluation
● Distinguish between records and non-record copies or working
● Provide the practitioner with data required for the application of
documents, to be able to appropriately segregate them in the
professional services for the improvement of family health
filing system
● Used as tools of communication between health workers the
● Place the record in an organizational classification scheme (or file
family and other development personnel
plan) either in paper (e.g. in a filing cabinet or a binder) or in
● Shows the health problem in the family and other factors that
electronic version (e.g. on a shared drive or in a system) to
affect health
ensure that it’s preserved within its context
● Indicates plan for future
● Provides baseline data to estimate the long term changes related ACTIVE PHASE
to services
Active phase It means that they are often used, shared between
ADMINISTRATIVE PURPOSE OF CLINICAL RECORDS colleagues, retrieved to support day-to-day business and referred to.
● Identify and apply an appropriate security classification
● Legal documents: poisoning, assault, rape, leaving against
● Distinguish between records and non-record copies or working
medical advice (LAMA/HAMA/DAMA)
documents, to be able to appropriately segregate them in the
● Research or statistics rates
filing system
● Audit and nursing audit
● Place the record in an organizational classification scheme (or file
● Quality of care
● plan) either in paper (e.g. in a filing cabinet or in a binder) or in
● Continuity of care
electronic version (e.g. on a shared drive or in a system) to
● Informative purposes: MEN census
ensure that it's preserved within its context
● Teaching purposes of students
● Preserve the integrity of the record, which means ensuring that it

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● Diagnostic purposes: test reports
has not been altered after completion

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 2

● Maintain its usability which means making it available for all ● Mattessich, Murray and Monsey (2001), define collaboration as’…
colleagues who need an access to the record to do their job a mutually beneficial and well- defined relationship entered into by
● Facilitate identification and preservation of records with two or more organizations to achieve common goal.
permanent retention
EFFECTS OF COLLABORATION
INACTIVE PHASE
● Improved patient outcomes
Inactive phase. During this stage, we should free up space in our ● Reduced length of stay
offices to new records, but we need to ensure keeping inactive records ● Cost savings
handy. The objectives of this stage are: ● Increased nursing job satisfaction and retention
● Identify the records that are not required to be stored in the ● Improved teamwork
primary office space (paper) or systems/shared drives (electronic)
● Organize and list them TYPE OF COLLABORATION
● Transfer them to the local Records Center (for field missions the Interdisciplinary
local Records Center within mission area; for HQ offices the ● Is the term used to indicate the combining of two or more
ARMS Records Center) disciplined, professions, department, integrated for one plan
● Retrieve only those records that are needed from time to time formulation usually in regard to practice, research education,
DISPOSITION PHASE and/or theory?
Multidisciplinary
The objectives of this stage are: ● Refers to independent work and decision making, such as
● Identify records with archival value (permanent retention), list when disciplines work side-by-side on a problem.
them, organize them Tran disciplinary
● Identify records due for disposal/destruction, list them, gather ● Efforts involve multiple disciplines sharing together their
necessary approvals for the destruction and proceed with an knowledge and skills across traditional disciplinary boundaries in
environmentally friendly destruction process accomplishing tasks or goals.
Inter professional collaboration
● Interactions of two or more disciplines involving professionals who
work together, with intention, mutual respect, and commitments
WEEK 8: INTRA, INTER AND for the sake of a more adequate response to a human problem
MULTIDISCIPLINARY AND TEAMWORK
NEED FOR COLLABORATION

COLLABORATION ● Increasing gap between nursing education and nursing service.

● Graduate nurses often lack practical skills despite their significant
● Current educational and clinical environments can be less than knowledge of nursing process and theory.
supportive of interpersonal learning interaction. Urges the nurse ● Clearly, a partnership between nursing educators and hospital
educator community to work with peers in other profession to nursing personnel is essential to meet the challenge
provide students with learning opportunities that acknowledge a MODELS OF COLLABORATION
profoundly changed health care environment. Providing ● Preceptor-ship model
educational experiences that prepare graduates for todays’ ● Mentorship model
practice is no loner an option; it is imperative to align health ● Lecturer practitioner model
professional education with the societal needs, Marquis & Huston, ● Research joint appointment
(2012). ● Clinical school of nursing model
● The nursing profession is faced with increasingly complex health ● Collaborative clinical education model
care issues driven by technological and medical advancements,
an ageing population, increased numbers of people living with I. PRECEPTORSHIP MODEL
chronic disease, and increased costs of health care services
○ Collaborative partnerships between educational institutions ● A preceptor is teacher or instructor with special training and he
and service agencies have been viewed as one way to care provide practical training to an intern or staff.
provide research which ensures an evolving health-care ● The best preceptor like to teach and they will volunteer for the role
system with comprehensive and coordinated services rather than wait to be assign
that are evidence-based, cost effective and improve RESPONSIBILITIES OF THE PRECEPTEE
health-care outcomes.
○ Considerable progress has been made in nursing over the ● Provide an orientation for the students and
past several decades, especially in the area of education. ● Review agency guideline with students, especially those that will
○ Countries have either developed new, strengthened and impact the student experience directly.
re-oriented the existing nursing educational programs in ● Help students feel a sense of belonging in the agency
order to ensure that the graduates have the essential ● Provide opportunities for the student to participate in important
competence to make effective contributions in improving agency functions such as meetings, outreach events, etc. as
people’s health and quality of life appropriate.
● Be aware of the student’s learning goals so that can be help
MEANING ● structure experiences that will help the student meet goals.
● Give honest, constructive feedback to the student and faculty
● The roots of the word collaboration, namely co-, and elaborate, supervisor as needed.
combine in Latin to mean “work to together.” That means the ● Meet with student at frequent, regular intervals to provide
interaction among two or more individuals, which can encompass feedback, evaluate progress and resolve problems
a variety of actions such as communication. Information sharing, ● Remember what may see basic or easy for the preceptor may not
coordination, cooperation, problem solving, and negotiation. be basic or simply to the student
● Teamwork and collaboration are often used synonymously.
● The collaborative process involves a synthesis of different II. MENTORSHIP MODEL
perspectives to better understand complex problems.
● An effective collaboration is characterized by building and ● Mentoring is a developmental relationship in which a more
sustaining “win-win-win” relationships. experienced person helps a less experience person
● Is a process by which members of various disciplines (or The Value of Mentoring: Mentoring provides
agencies) share their expertise to accomplishing a common goal? ● Retention by means of personal relationship
● Accomplishing this goal requires these individuals to understand ● Staff development and career guidance
and appreciate what they are contribute to the whole” ● Job satisfaction, and a healthy workplace environment
● “Collaboration is the most formal inter organizational relationship Roles of Mentors
involving shared authority and responsibility for planning, ● Teacher (educational expertise)
implementation, and evaluation of a joint effort, Marquis and ● Guider
Huston, (2017). ● Counselor (practical expertise)
● Collaboration defined as a joint communication and ● Advisor

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decision-making process with the goal of satisfying the health
care needs of a target population. NNCCS, (2012).

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 3

 ● The goal of this approach is to use the implementation of
research findings as a basis for improving critical thinking and
clinical decision-making of nurses
● In this arrangement the researcher is a faculty member at the
educational institution with credibility in conducting research and
with an interest in developing a research programs in the clinical
setting
● The Director of Nursing Research, provides education regarding
research and assists with the conduct odd Research in the
practice setting.
● She/He also lecturer or supervisor in the educational institution.
● A formal agreement exists within the two organizations regarding
specific responsibilities and the percentage of time allocated
between each salary and Benefits are shared between the two
organizations

V. CLINICAL SCHOOL OF NURSING MODEL

● The concept of a Clinical School of Nursing is one that
Encompasses the highest level of academic and clinical nursing
research and education.
● The development of the Clinical School offers benefits to both
hospital and university.
MENTORS VS PRECEPTORS ● It brings academic staff to the hospital, with opportunities for
exchange of ideas with clinical nurses with increased
opportunities for clinical nursing research.
Mentors Preceptors ● It has a fundamental importance and close link between the
theory and practice of nursing at all levels
● Older than Learner ● Willing to teach and
● Possesses wisdom and learn skills VI. COLLABORATIVE CLINICAL EDUCATION MODEL
experience ● Expertise
● Career networking ● Competent practitioner ● In an effort to improve the quality of new graduate transition,
● Facilitator ● Teaching and support Epworth Hospital and Deakin University ran a collaborative
● Guide ● Orientation and project (2003) founded by the National Safety and Quality Council
● Advisor Socialization to improve the support base for new graduates while managing
● Role model ● Role Model the quality of patient are delivery.
● Chosen ● Selected ● The collaborative clinical Education Epworth Deakin (CCED)
● May have no formal ● Assigned to learner model developed to facilitate
preparation ● Prepared for role ● Clinical learning
● Share Life, education, ● Competent practitioner ● Promote clinical scholarship and
work experience ● Support needed from ● Build nurse workforce capability
● Type of relationship” peers, educators, EXAMPLES
close, personal manager
friendship ● Functional not intimate ● Undergraduate nursing students attending lectures at Deakin
● Not an evaluator relationship University in the traditional manner but completing all tutorials,
● May evaluate clinical learning, laboratories and clinical placements at Epworth
Hospital throughput their three year course.
MENTOR VS PRECEPTOR LEARNER OUTCOMES ● Tutorials, laboratories and clinical placements are conducted
by Epworth clinicians who are prepared and supported by Deakin
School of Nursing Faculty.
Mentors Preceptors
● These clinicians also support the student-preceptor relationship in
the clinical learning component of the curriculum.
● Self-actualization ● Bridge theory to practice ● All the models pursue collaboration as a means of developing
● Guide to established gap. trust, recognizing the equal value of stakeholders and bringing
own place in the ● Achievement of planned mutual benefit to both partners on order to promote high quality
profession learning outcomes research, continued professional education and quality health
● Enhanced ● Skills and knowledge care.
problem-solving ● Anxiety reduction ● Application of these models can reduce the perceived gap
● Personal satisfaction in between education and service in nursing, also can help in the
sharing knowledge development of competent and efficient nurses for the betterment
of nursing profession

III. LECTURER PRACTITIONER MODEL STUDENTS COACHED BY CLINICIANS - NURSING

EDUCATION SUPPORTED BY CLINICAL FACILITATOR -
● Each clinical placement gave to have named lecturer / practitioner CLINICAL FACILITATORS ARE SUPPORTED BY HOSPITAL -
or clinical educator who will assist in the organization, facilitation UNIVERSITY TO STUDENTS COACHED BY CLINICIANS
and supervision of the clinical learning experience throughout the
entire programs.
Role of Lecturer Practitioner
● Promote active discussion within the clinical setting to encourage
understanding
● Work with clinical staff to identify alternative means to gain
relevant experience
● Play an active role in overall assessment to help student achieves
the required learning outcome

IV. RESEARCH JOINT APPOINTMENTS

● Is a formalized agreement between two institutions where an
individual holds a position in each institution and carries out
specific and defined responsibilities”?

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● In a hospital setting, multidisciplinary teams, involves or combines ● Procedural Technician
several academic or professional disciplines, either formal or 2) Maintenance roles which help the team function as a team.
informal groups meet to accomplish goals and objectives, Maintenance roles are:
members practice independently of one another, each of the ● Harmonizing
member is being guided by their own professional standards ● Gatekeeping
however leadership always determined by professional hierarchy. ● Encouraging
● As illustrated above the interdisciplinary and multidisciplinary ● Following
team collaboration involves the contribution from different ● Climatizing
departments of their services and shared their own professional
expertise to achieve optimum health of the patient. The vital role 3) Individual roles in which a team member attempts to satisfy
of the nurse it to coordinate, communicate and documents individual rather than team goals. A team is most productive
services provided by the team as shown in the illustration. when all three (3) sets are managed simultaneous. Individual
roles are:
● Blocking/Aggressing
● Out of field
● Digressing
● Recognition seeking (Sullivan and Decker, 2009

NURSE’S ROLE IN ESTABLISHING COLLABORATIVE

RELATIONSHIP IN THE DELIVERY OF HEALTH CARE
PROGRAMS AND SERVICES
A) A.Maintains good interpersonal relationships intra-agency and
inter-agency.
B) Respects the role of other team members.
C) Acts as a liaison/advocate of the client during decision making by
the inter- professional team. Interpersonal Relationship Defined:

The term Interpersonal Relationships refers to reciprocal social and

emotional interactions between two or more persons in an environment
and who share common interests and goals.
● In a community setting, the Intra-agency, Inter-agency, IMPORTANCE OF INTERPERSONAL
multidisciplinary and sectoral collaboration are important in the RELATIONSHIP FOR NURSES
effective and efficient delivery of health services to the individuals,
families, population groups and the community. The nurse is 1) Helps build a positive functional multidisciplinary team.
responsible in maintaining harmonious relationship within the 2) Improves intra and/or inter-team communication, coordination,
health unit (intra-agency) and coordinating activities of the and cooperation
members of the health team to ensure achievement of group 3) Builds mutual understanding and cooperation
goals. 4) Facilitates better understanding of oneself
5) Improves decision making and problem-solving
DEVELOPMENT OF TEAMWORK AND COLLABORATION
● To maintain good interpersonal relationship in working with a team
Stages of Team Development to achieve its goal of providing safe and quality patient/ client
care, it is also important for the nurse to appropriately respond to
According to Tuckman there 4 stages of Team Development. These conflict situations. In the process, conflict may occur within the
stages are important and inevitable for a team to grow, face challenges individual (intrapersonal), between two or more individuals
and difficulties effectively and deliver positive results. (interpersonal), and between one or more groups (intragroup).
● Stage 1 Forming, the leader may seek control over the team and Categories of Conflict Conflict is a disagreement among people
exemplify styles such as “tyrant”, “superwoman”, “party host”, or involved that results from differences in ideas, values, or feelings,
“reluctant candidate”, Members are also characterized by differences in economic and professional values, poorly
dependency-seeking behaviors and will most likely rely on the defined role expectations and there is competition among the
group leader. They may also take on the roles of “scapegoat” and professional themselves, Filley (1975).
“helper’.
● Stage 2 Storming, Leader tries to persuade the team and may NURSE INTERPERSONAL RELATIONSHIP
use “salesman” ad “nice guy” styles often struggling to be a
socio—emotional leader. Team members may demonstrate Doctor - Nurse relationship
resistance. Despite persistence of scapegoating among team Nurse – Patient relationship
members, new roles that help reduce tension may emerge. Nurse – Nurse relationship
● Stage 3 Norming, coalitions of member’s exercise leadership ● One of the most distinctive aspects of human being is that we are
based on previously demonstrated competence. Members have social beings
evolved into colleagues who were able to defer to each other’s ● Interpersonal relationships are and have been the core of our
relevant experience. social system since the dawn of civilization
● Stage 4 Performing Authority is exercised by a coalition of ● Nursing is a therapeutic process and demands an association
colleagues. Team members exemplify interdependence. between the nurse and the patient
TOOLS FOR FACILITATING HEALTH CARE TEAM WORK ● Is a strong, deep or close association or acquaintance between
two or more people that may range in duration from brief to
● Working together does not necessarily produce effective enduring
teamwork. ● Are social associations, connections, or affiliation between two or
● Here is a simple outline that will guide in the understanding of the more people
process of developing health care teamwork. Analysis of informal ● They vary in differing levels of intimacy and sharing, implying the
roles provides another useful tool for understanding the team discovery or establishment of common ground, and may be
process. centered around something(s) shared in common
● There are three (3) broad sets of informal roles: ● In nursing care can be defined, based on a theory 1, as the
interaction between two or more people who communicate,
1) Task roles that are necessary for accomplishing the team’s transfer values and energy from their roles in society
task. These roles are as follows: ● Such interaction is continuous
● Initiating/energizing
● Information/opinion giving DYNAMICS OF INTERPERSONAL RELATIONSHIP
● Information/opinion seeking
● Reality testing/clarifying ● Dyad
● Coordinating ● Group

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● Orienting ● Triad

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 5

1) DYAD ● Friendship is a relationship with no formalities and the
● A Dyad consists of two interacting people individuals enjoy each other’s presence
● It is the simplest of the three interpersonal dynamics 2) LOVE
● One Person relays a message and the other listen ● A in formalized intimate relationship characterized by
● It is none of the most unstable interpersonal dynamic. The passion, intimacy, trust and respect is called love.
interaction ends when one constituent of the dyad refuses ● Individuals in a romantic relationship are deeply attached to
to listen or share his or her message each other and share a special bond
● It is also one of the most intimate interpersonal dynamic as 3) PLATONIC
the focus of listening and communication is centered on ● A relationship between two individuals without feelings of
only one person sexual desire for each other is called a platonic relationship.
2) TRIAD ● In such a relationship, a man and a woman are just friends
● A triad consists or three interaction people. and do not mix love with friendship.
● The members engage in the relay and reception of ● Platonic relationship might end in a romantic relationship
thoughts and ideas. with partners developing feelings of love for each other
● It is more stable than the dyad as the third members may 4) FAMILY
act as a mediator when there is conflict between the other ● Family communication patterns established roles and
two. identify and enable personal and social growth of
3) GROUP individuals.
● A group consist of more than three members and is a ● Family relationships can get distorted if there is an
collection of triads and dyads. unresolved conflict between member sense other family
● It is the most stab le from of interpersonal relationship members have significant emotional difficulties but fails to
bring them out unless the physician or nurse enquires
5) PROFESSIONAL
I. Interpersonal relationship for an individual ● Individuals working for the same organization are said t o
share a professional relationship and are called colleagues.
Personal growth and development ● Colleagues may or may not like each other
TYPES OF INTERPERSONAL RELATIONSHIP
Source of enjoyment
1) Complementary Relationship
Sense of security 2) Symmetrical Relationship
3) Parallel Relationship
COMPLEMENTARY RELATIONSHIP
Context of understanding ● One person is dominant and the other is submission
● Control is not divided equally between the two participants
Interpersonal needs ● Relationship are stable and predictable also inhibit
creativity and independent thinking
Establishing personal identity ○ Physician
○ Nurse
SYMMETRICAL RELATIONSHIP
II. Interpersonal relationship for nurses ● Control is more evenly distributed between the two
participants
Building a positive functional multidisciplinary ● Free to express their opinions
team ● Power struggles occurs when participants complete to
acquire or give up control
○ Both Dominant
Improving intra-and/or inter-team
○ Both Submissive
communication, coordination and ○ Parallel Relationship
cooperation PARALLEL RELATIONSHIP
● Control moves back and forth between the two participants
Building mutual understanding and cooperation ● Participant take turns holding and giving control, depending
on the circumstances, rather than competing for control
● Effective and flexible communication
Improved decision making and problem ○ Nurse / Physician
5 TYPES OF NURSE-PHYSICIAN RELATIONSHIP
III. Interpersonal relationship for patients
1) COLLEGIAL RELATIONSHIPS
● Characterized by equal trust, power, and respect are
Developing a sense of security and comfort illustrated by the following excerpt
● Nurses and physicians frequently used the words peers or
Fostering trust and cooperation equals in describing these relationships.
2) COLLABORATIVE RELATIONSHIP
Facilitating communication ● Marked by mutual trust, power, respect, and
3) STUDENT – TEACHER RELATIONSHIP
● Either the physician or the nurse can be the teacher.
Improving socialization ● With residents and at times with attending physicians who
are dealing with comorbid disease outside of their specialty,
Developing and maintaining positive feelings nurses may take a teaching / guiding role
● Physicians who teach are identified as having a lot of
knowledge and “always willing to explain or teach
TYPES OF INTERPERSONAL RELATIONSHIP 4) FRIENDLY STRANGER RELATIONSHIP
● Is characterized by a formal exchange of information and a
1) Friendship somewhat neutral feeling tone.
2) Love 5) HOSTILE / ADVERSARIAL RELATIONSHIP
3) Platonic Relationship ● Are marked by anger, verbal abuse, real or implied threats,
4) Professional Relationship (Work relationship) or resignation

1) FRIENDSHIP PHASES OF INTERPERSONAL RELATIONSHIP

● Theories of friendship emphasize the concept as a freely ● Hildegard Peplau (1952) gave the interpersonal relationship
chosen association where individuals develop a common model
ground of thinking and behaving when they enter into the ○ Pre- Orientation Phase

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relationship by including mutual love, trust respect and ○ Orientation Phase
unconditional acceptance for each other.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 6

 ○ Working Phase ● According to him, that plan must have unity, continuity, flexibility,
○ Termination Phase and precision. The plan should include annual and 1o year
forecasts, taking advantage of input from others.
PRE- ORIENTATION PHASE ● Planning improves experience, gives sequence in activity, and
● Self-awareness of the nurse. Planning the progress of the protects business against undesirable changes. His concepts are
interaction that planning facilitates wise use of resources and selection of
● Client’s medical history, age, name, address best approaches to achieving objectives. Planning facilitates the
art of handling people. Because planning fails, it requires moral
ORIENTATION PHASE courage. Effective planning requires continuity of tenure. Good
planning is a sign of competence, (Marquis and Huston 2017).
● Start with an initial encounter with nurse and patient ● Planning is designed for the nurse administrators who are seeking
● The fact formulation begins between the nurse and the patient. more effective means of improving current and future
● The nurse clarifies his or her roles and responsibilities within the performance. It offers principles of planning and decision- making
therapeutic boundary to the patient. guides in nursing practice. It deals with those aspects of planning
● The Nurse identifies the patient’s problems and that directly affects the nurse administrators on a personal as well
● After developing a trustworthy relationship, the patients as organizational level
start clarifying doubts, share perceptions and convey their needs
and expectation to the nurse. PURPOSE OF PLANNING
● There are several factors that may affect this phase in a
nurse-patient relationship 1. Planning increases the chances of success.
2. It forces analytic thinking and evaluation of alternatives
WORKING PHASE 3. It establishes a framework for decision making that is consistent
with top Management objectives.
A) IDENTIFICATION 4. It orients people to action instead of reaction.
● The nurse must approach the patient with empathic 5. It includes day-to-day and future-focus management.
understanding to perceive the patient’s current feeling. 6. It helps with crisis management and provides decision-making
● The nurse must avoid vagueness and ambiguity by using flexibility.
specific terminology rather than abstractions in 7. It provides a basis for managing organizational and individual
communication process and individual Performance.
● The nurse helps the patients identify their problems in their 8. It increases employee involvement and improves
own context and use the available resources to solve the communication.
problem. 9. It is cost effective.
● The patient’s self-esteem will be boosted by having feeling of
IMPORTANCE OF PLANNING
B) EXPLOITATION
● In this phase, the patient is made to understand the problems Nurse Manager must know how to plan for the following reasons:
by exploring all available avenues to solve the problem. 1. Planning leads to the achievement of goals and objectives.
● The nurse can help the patient by extending minimal ● Workers relate what they do to meaningful results. It
professional ensures alignment of nursing unit/department and
● The patient start exploitation all the available resources in financial plans with the strategic plan.
spite of making requests to others to extend help ● Thus, increase the probability of achieving organizational
● Finally, the patient with his or her problems goals, vision, and mission. Also, it establishes a
TERMINATION PHASE framework for decision making consistent with top
management objectives.
● This is the termination of the professional relationship that begins 2. Planning is gives meaning to work.
with convalesce and rehabilitation stage of hospitalization ● Employees or workers experience greater satisfaction if
● The patient’s needs have already been met by the collaborative what they do becomes meaningful to them. Ensures safe
efforts of the and quality care through awareness of individual
● It psychological dependence persists between both of them, it responsibility and accountability.
become difficult to resolve the transferences or counter 3. Planning provides for effective use of available resources
transferees. A nurse must aware of the techniques to resolve it. and facilities.
● The relationship must be terminated by maintain a healthier ● The best use of personnel and material resources
emotional balance by both the parties prevents wastage.
4. Planning helps in coping with crises. Hospitals must
provide for disaster plans.
● It allows the workers to function more clearly and
WEEK 9: NURSING MANAGEMENT FUNCTIONS efficiently when actual emergencies occur such as fire,
typhoons, earthquakes, or during New Year celebrations
A. PLANNING and or other occasions when more people are likely to get
hurt.
● Defined as a predetermined course of action in order to arrive at a ● Manages risk and copes with crisis situations.
desired result. 5. Planning is cost effective.
● The most basic and essential activity of management functions ● Cost can be controlled through planning for efficient
that decide in advance what needs to be done for the day, month, operation. Projecting the number of operations in a given
or years ahead. day, including daily dressings, helps in determining
● Defined as deciding in advance what to do; who is to do it; and accurately the needed weekly supplies in the surgical
how, when and where it is to be done. units so as to prevent undersupply, oversupply or
● Planning, a basic function of management, is a principal duty of pilferages.
all managers, is critically important to and precedes all other 6. Planning is based on past and future activities.
management functions. ● Evaluation of programs. Schedules, and activities whether
● It is a systematic process and requires knowledgeable activity successful or not, prevents and/or reduces the recurrence
based on sound managerial theory. It entails forecasting or setting of problems and provides better ideas in modifying or
the broad outline of the work to be done. avoiding them.
● Planning is defined as deciding in advance, it directs our thinking 7. Planning leads to the realization of the need for change.
on what we expect to do, why it will be done, who is going to do it, ● Discovers the need for change that leads to creating new
and how, when and where to be done. Without adequate services and productivity.
planning, the management process fails and organizational needs ● Many of the hospitals have found out that in-patient
and objectives cannot be met. hospital days can greatly reduce by having the laboratory
● The first element of management defined by Henry Fayol is and diagnostic work up in the Out- patient Department.
planning, which he defines as making a plan of action to Minor surgeries are also done at the OPD so that more
provide for the foreseeable future. hospital beds can be allotted to critically-ill patients or for
those needing specialized services.

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 8. Planning improves communication and team collaboration
through people's involvement in planning activities. BASIS in PLANNING the Nursing Service
9. Planning provides the basis for control.
● It becomes the basis for evaluating the accomplishment of A) FORECASTING
the set programs/activities.
10. Planning is necessary for effective control, ● It.helps managers look into the future and decide in advance
● Nurse- managers evaluate the environment or setting in where the agency would like to be and what is to be done in
which they work or where the patients are confined and order to get there. Forecasts and estimates provide the bases
make necessary recommendations to make hospital for planning. Forecasts describe the ultimate conditions or
conditions more therapeutic not only for the patients but projections that provide the general incentive and direction to
for the workers as well. Performance of workers and planning. It anticipates the environment or setting where the plan
evaluation of services to patients’ base on criteria set will be operationalized such as
during the planning stage will indicate whether standards ● The hospital, this includes the type of hospital served (level 1,
of care are met and whether changes are indicated. level 2, level 3, or level 4); the kind of service it offers (general or
special) its philosophy mission and goals and categories of their
PRINCIPLES OF PLANNING budget 9 national or local).
● The community it serves, this includes the kind of people served
1. Planning is always based and focused on the vision, mission, their needs, expectations, literacy rate, economic levels,
philosophy, and clearly defined objective of organization. employment rates, demographic statistics, cultural values, values
2. Planning is a continuous process. and services available in the community.
3. Planning should be pervasive ● The goals of care vary according to the needs of the community,
4. Planning utilizes all available resources agency, trends in technology and in changing needs of the
5. Must be precise in its scope and nature community, agency, trends in technology and in changing
6. Should be time bound concepts of the nurses’ roles and functions.
7. Projected plan must be documented. ● A mistake common to novice managers is a failure to complete
SCOPE OF PLANNING adequate proactive planning. Instead, many managers operate in
a crisis mode and fail to use available historical patterns to assist
● The Top Management or the Nursing Directors, Chief Nurses or them in planning. Nor do they examine present clues and
Directors of Nursing and their assistants are the one who set the projected statistics to determine future needs. Forecasting
overall goals and policies of an organization. It’s their involves trying to estimate how a condition will be in the future.
responsibility to covers the over-all management of the Forecasting takes advantage of input from others, gives sequence
organization’s Nursing Service. in activity and protects an organization against undesirable
● The Middle management or Nursing Supervisors direct the changes.
activities to actually implement the broad operating policies of the ● Changes in technology, payment structures, and resource
organization such as staffing and delivery of services to the units. availability, the manager who is unwilling or unable to forecast
The formulation of policies, rules and regulations, methods and accurately impedes the organization’s efficiency and the unit’s
procedures for intermediate level planning for ongoing activities effectiveness.
and projects is done in coordination with top management and ● Forecast must be supported by facts, reasonable estimates and
those in the lower level. accurate reflection of policies and plans.
● At the lower or first –level management, the Head Nurses or
Senior Nurses (including Charge Nurses or team Leaders) do the B) SETTING THE VISION, MISSION, PHILOSOPHY, GOALS
daily and weekly plans for the administration of direct patient care AND OBJECTIVES.
in their respective units
● Every organization has a guiding vision and mission. Most often,
MAJOR ASPECT OF PLANNING the purpose and philosophy are explicitly stated and detailed in a
formal mission statement. This mission statement reflects the
1. Planning should contribute to objectives. organization’s values and provides the reader with and indication
● It should seek to achieve a consistent, coordinated of the behavior and strategic actions that can be expected from
structure of operation focused on desired ends. Actions that organization. Mission statement outlines the agency’s reason
without plans often result in chaos and failure. for existing (whether hospital or health care), who the target
2. Planning precedes all levels of other processes of clients are (poor, the needy, the middle or upper class), and what
management. services will be provided (in-patient, out-patient, emergency). A
● Without a plan there would be nothing to organize, direct, vision statement outlines the organization’s future role and
and control. Planning leads to easy accomplishment of the function. It gives the agency something to strive for.
organizational objectives which is necessary for group ● Most health care organizations have mission statements that
effort. Planning and control are inseparable. speak to providing high quality or excellence in patient care.
3. Planning pervades all levels. Some mission statements focus exclusively on providing care.
● It encompasses both higher and lower echelons and vice ● The mission of other organizations may be community based, and
versa and spreads horizontally through peer levels and/or these organizations consequently will focus on providing
across services and members of the health team. community outreach and population-based services to a specific
4. Planning should be efficient. community or population within a community.
● It should contribute to the attainment of objectives not only Example of Mission:
in terms of peso value, man –hours, units of production ● The Medical Center, as a public, tertiary hospital is so maintained
but should also include individual values and group as the people’s partner and improved to improve to provide
satisfaction. accessible, quality, cost effective, preventive, promote, curative,
rehabilitative health care services to the general public, especially
CHARACTERISTICS OF A GOOD PLAN
the destitute. The institution is also committed to medical, nursing,
1. Be precise with clearly-worded objectives, including desired and allied health education, training and research.
results and methods of evaluation. Example of Vision :
2. Be guided by policies and/or procedures affecting the ● The Medical Center envisions itself to become a Center
planned actions. Excellence providing holistic approach to health services. As a
3. Indicate priorities. Center of Wellness, the services provided shall enable the people
4. Develop actions that are flexible and realistic in terms to improve their health and increase control over it.
of available personnel, equipment, facilities, and time. ● A philosophy describes the vision. It is a statement of beliefs and
5. Develop a logical sequence of activities. values that direct one’s life or one’s practice. In an organization,
6. Include the most practical methods for achieving each objective. the philosophy is the sense of purpose of the organization and the
7. Pervade the whole organization. reason behind its structure and goals.
● The philosophy of nursing service dovetails with the philosophy of
● The effectiveness of a plan is enhanced by the environment in the agency. It is an intentionally chosen set of values or purposes
which the nursing personnel work. A positive climate promotes that serve as the bases for determining the means to accomplish
good working relationships and leads toward achievement of nursing objectives.
identified goals. ● Nursing philosophy may be broad and general, yet is directs

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nursing behavior, giving it a sense of purpose. Generally

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 8

 emphasized in the statement of the philosophy are the quality,
quantity and scope of service; decision making based on factual FOUR PLANNING MODES:
information; appropriate delegation of function; achievement of 1. Reactive planning — occurs after a problem exists. Because
organizational goals; vertical and horizontal communication; and there is dissatisfaction with the current situation, planning efforts
the flexibility to meet the changing needs of the organization, are directed at returning the organization to a previous, more
individuals, the community, and society in general. comfortable state. Often times, in reactive planning, problems
Example of Philosophy: are dealt with separately without integration with the whole
● The Hospital is committed to assume a vital role in health organization. Because it is done in response to a crisis, this type
promotion, disease prevention, curative, rehabilitative, and of planning can lead to hasty decision and mistakes.
primary health care in partnership with public health counterparts, 2. Inactivism — is another type of conventional planning.
the clients, families, and communities. Inactivists seek the status quo, and they spent their energy
● Organization and people who set Goals and objectives do better preventing change and maintaining conformity. When changes
than those who do not. This management truism has been proven do occur, they occur slowly and incrementally.
overtime. When a manager forms a goal, puts them in paper, and 3. Pre Activism — preactive planners utilize technology to
reviews them periodically, it forces him/her into action to try and accelerate change and are future oriented. Unsatisfied with the
accomplish them. This is true for everyone. The more person sets past or present, pre activists do not value experience and
goals and specifies objectives for each of the result areas he/she believe that the future is always preferable to the present.
likes to achieve, the more likely he/she reach these. 4. Interactive or proactive planning — Planners who fall into this
● Goals and objectives differ in that goals are more general and category consider the past, present, and future and attempt to
they cover a broad area. Objectives, on the other hand, tend to be plan the future of the organization rather than react to it.
more specific. Objectives are concrete. They are action Because the organizational setting changes often, adaptability is
commitments through which an organization’s mission and a key requirement for proactive planning. This also occurs in
purpose will be achieved and should focus on production of health anticipation of changing needs to promote growth within an
services to the patients. Philosophy states beliefs and values organization and is required of all leader-managers so that
while objectives state specific and measurable goals to be personal as well as organizational needs and objectives are met.
accomplished.
Example of Objective: TYPES OF PLANNING
● To strengthen and integrate the role of the hospital in the
promotion of health and prevention of illness through primary ● Planning also has many dimensions. Two of these are time span
health care services, linkages and referrals with community and complexity or comprehensiveness, but basically there are two
leaders, civic and government organizations and agencies. types of organizational planning:
Example of Goal: 1. Strategic Planning
● The nursing staff will provide effective patient care relative to ● Is a broad continuous systematic process that emphasizes
patient needs insofar as the hospital and community facilities assessment of the organizational environment both internally
permit through the use of care plans, individual patient care, and and externally such as economic, political, social, and
discharge planning, including follow-up contact. technological factors. It is a management tool that helps
organizations set long-term goals, a risk-taking decision with
C) DEVELOPING AND SCHEDULING PROGRAMS knowledge of their effects in the future, and evaluating the
outcomes through reliable feedback mechanism. It focuses
● Programs are determined, developed and targeted within a time on performance improvement and utilizes strategies to
frame to reach the set goals and objectives. Kron has developed accomplish the organization’s desired outcomes. This maybe
a planning formula which may be used for daily duties, or for done once or twice a year in an organization that changes
short-and long-range projects, (Venson, 2016) rapidly. At the unit level, any planning that is at least 6
months in the future maybe considered long-range planning,
THE PLANNING FORMULA (Marquis and Houston,2017).
● Strategic planning forecasts the future success of an
1) WHAT
organization by matching and aligning an organization’s
● What has been done? What should be done?
capabilities with its external opportunities. An organization
● What equipment and supplies have been used or are
could develop a strategic plan for dealing with the nursing
needed?
shortage, preparing succession managers in the
● What steps necessary in the procedure?
organization, developing a marketing plan, redesigning
● What sequence of activities was previously used?
workload, developing partnership, or simply planning for
● What other efficient methods may be used?
organizational success
2) WHEN
2. SWOT Analysis
● When should the job be done? When was it formerly done?
● One effective tool that can assist in strategic planning is
● When could it be done?
SWOT analysis (identification of strengths, weakness,
3) WHERE
opportunities, and threats) is one of the most commonly
● Where is the job to be done?
used in health care organizations. SWOT analysis is also
● Where does an activity occur in relation to those activities
known as TOWS analysis was developed by Albert
immediately? preceding and following it?
Humphrey at Stanford University in the 1960s and 1970s.
● Where could supplies be stored, cleaned, and so forth?
● The first step in SWOT analysis is to define the desired end
4) HOW
state or objective. After the desired objective defined, the
● How will the job be done?
SWOT are discovered and listed. Decision makers must then
● What are the steps to be followed in doing the procedure?
decide if the objective can be achieved in view of the
How will the time and energy of personnel be used?
SWOTs. If the decision is no, a different objective is selected
● How much will it cost?
and the process repeats. With the results of your analysis
● How much time will it require?
the following should be included: 1) working out what you
5) WHO
hope to achieve, 2) being objective, 3) incorporating the
● Who has been doing the job? Who else could do it?
findings into the action plan, and 40 revisiting your findings
● Is more than one person involved?
on a regular basis.
6) WHY
● Perform correctly, SWOT allows strategic planners to identify
● To each of the questions, ask why.
those issues most likely to impact a particular organization or
● Why is this job, this procedure, this step necessary?
situation in the future and then to develop an appropriate
● Why is this done in this way, in this place, at this time, by
plan of action
this person? One more question can be added to make the
3. Strategic planning as management process
formula more helpful.
● Clearly define the purpose of the organization.
7) CAN
● Establish realistic goals and objectives consistent with
● Can some steps or equipment be eliminated?
the mission of the organization.
● Can this activity be efficiently combined with other
● Identify the organization’s external constituencies or
operations?
stakeholders and then determine their assessment of the
● Can somebody else do it?
organization’s purposes and operations.
● Can we get a machine to help?

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● Clearly communicate the goals and objectives to the
● Can we get enough money?
organization’s constituents.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 9

 ● Develop a sense of ownership of the plan. situations while leaving some discretion and initiative to those
● Develop strategies to achieve the goals. who must carry out that policy. Though, some policies required by
● Ensure that the most effective use is made of the accrediting agencies, many policies are specific to the individual
organization’s resources. institution, thus providing management with a means to internal
● Provide a mechanism for informed change as needed. control.
● Provide a mechanism for informed change as needed. ● Policies may also be implied or expressed. Implied policies
● Build a consensus about where the organization is going. neither written nor expressed verbally, have usually developed
overtime and follow a precedent.
It should be noted, though, that some critics argue that strategic ● For example: a hospital may have an implied policy that
planning is rarely this linear. Nor is it static. Strategic planning employees should be encouraged and supported in their activity
instead involves various actions and reactions that are partially in community, regional, and national health organizations. Another
planned and partially unplanned. example might be that nurses who limit their maternity leave to 3
months can return to their former jobs and shifts with no statue
Sample of 5-year Development Plan change.
● While expressed policies are delineated verbally or inwriting. Most
organizations have many written policies that are readily available
to all people and promote consistency of action. Expressed
policies may include a formal dress code, policy for sick leave or
vacation time, and disciplinary procedures.
● Procedures are plans that establish customary or acceptable
ways of accomplishing a specific task, and delineate a sequence
of steps that required action. Established procedure save staff
time, facilitate delegation, reduce cost, increase productivity, and
provide a means control. Procedures identify the process or
steps needed to implement a policy and are generally found in
manuals at the unit level of the organizations, (Marquis and
Huston, 2017).
● Guidelines outlining the scope and standards of practice for
specialty practice areas. Nurses must be careful to assure that
the procedures they perform and the process used in performing
them consistent within the limits of state and national regulatory
bodies.
4. Operational Planning ● Manager also has a responsibility to review and revise policies
● Is a detailed work plan or written blueprint in which the and procedures statements to ensure currency and applicability.
objectives of a nursing unit/department are put into The current explosion of evidence-based research as well as new
measurable actions? It provides a clear picture of how a regulations, technology, and drugs, keeping policies and
team; nursing unit or department will contribute to the procedures current and relevant is tremendous management
achievement of the organization’s strategic goals. It is known challenge. Because most units are inconstant flux, the needs of
as a management plan. Some categorical areas for the unit and the most appropriate means of meeting those needs
objectives are: patient satisfaction, patient safety, internal constantly change. For example, the unit manager is responsible
process, staffing, training and education, research, and for seeing that a clearly written policy holiday and vacation time
financial. exists and that it is communicated to all those it affects. The unit
● It is also a specific plan that supports the strategic plan by manager must also provide a clearly written procedural statement
implementing Its strategies, projects and programs. It how to request vacation or holiday time on that specific unit.
provides detailed information to direct its people to perform Nurse manager would assess any long-term change in patient
the day to day tasks and activities in running the nursing census or availability of human resources and revise the policy
unit/organization. The operational plan objectives are and procedural statements, (Marquis and Houston, 2017).
specific. These are concrete statements that nurse
managers seek to accomplish in terms of results. It includes CHANGE THEORY
the what (task to be undertaken), who (person responsible), ● In the mid-20th century Kurt Lewin (1951) developed change
when (timeline for task completion), and how much (amount theory, he identified 3 phases in which the change agent must
of financial resource to carry out the task). The formulation proceed before a planned change becomes part of the system:
and implementation of operational plan is the responsibility unfreezing, movement, and refreezing.
of middle and front -line managers and its done yearly. 1. Unfreezing
Operational planning is an upward approach because team ● Unfreezing is the first phase; this occurs when the change- agent
members actively involved in the planning process. They are convinces members of the group. To change or when guilt,
encouraged to develop personal to-do list necessary to anxiety, or concern can be elicited. This is where employee
reach the targets or milestones of their nursing units, (DOH, become discontented and aware of a need to change. Change
2016) agent needs to have made a thorough and accurate assessment
The table below summarizes the difference between the of the extent of and interest in change, for them to become
strategic planning and operational planning. effective as change agent. The nature and depth of motivation
and environment where change will occur must also be
D) ESTABLISHING NURSING STANDARDS, POLICIES, considered by the change agent, (Marquis and Houston, 2017).
AND PROCEDURES 2. Movement
● Nursing Standards Institutions develop their own standards of ● Movement this is the 2nd phase of planned changed change
nursing practice, the standard of Nursing Practice and Nursing agent must identifies, plans, and implements appropriate
Service Administration formulated by the Association of the strategies, ensuring driving forces exceed restraining forces.
Nursing Service Administrators of the Philippines and revised Because changes are not that easy it’s a complex process and it
2008. requires a great deal of planning and intricate timing. Human
● The established standards in an evaluation provides provide behavior changes. Or attitudes and values underlie that behavior,
professional desirable norms against which department’s takes some time.
performance can be measured. Areas of improvement are 3. Refreezing
identified and a plan of action to correct this is made and ● Refreezing is the last phase, during this phase the change agent
implemented. assists in stabilizing the system change so that it becomes
● Nursing Standards, the philosophy shall be based on the belief integrated into the status quo. If refreezing is incomplete, the
that the client is integral whole and that he is a unique individual change surely ineffective and pre change behaviors will be
with needs that can be met through nursing interventions. resumed. For this to occur, the change agent must be supportive
● Nursing Service Policies are plans reduced to statements or and reinforce the individual adaptive behavior efforts of those
instructions that direct organizations in their decision making. It affected by the change, (Marquis and Houston, 2017).
direct individual behavior toward the organization’s mission and

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define broad limits and desired outcomes of commonly recurring

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 10

 ● Formulate a budget guideline to synchronize with financial
BUDGETING & FORECASTING linkages
● Budgeting, it is the financial guideline where the allocation of ● Settle an Operating and Capital Budget
each resource such as money, time and people will be acquired ● Manage a budget hearing
and used. It is the financial “road map” which projects the future ● Prioritize your budget based on necessity
costing and a plan for manpower utilization, and other resources ● Conclude your proposed budget plan
in line with the operating programs. Phase 3 Approval and Execution
● A nurse manager uses his/her expertise to utilize the efficient and ● Summarized the proposed nursing service budget plan and let the
effective budgetary planning and processes. In budget authorize finance budget committee to review and approve the
preparation, the nursing services purposely control and establish budget.
the monthly as well as the annual financial budget plan report. ● Make a budget plan ready for improvement in order to calibrate
any errands to the General Appropriations Act (GGA).
PURPOSE OF BUDGETING ● Cascade the proposed budget plan accordingly to all nursing unit
staff and department
● A forecast of income and expenditure Phase 4 Monitoring and Reporting
● A tool for decision making, to provide financial framework ● Observe the proper delivery or implementation of the budget plan.
● Measured the financial report and its statistical data ● Make an analysis between the proposed budget and the
IMPORTANCE OF BUDGET actual performance.
● Clarify and justify the results to determine the significant trends
● To control the over spending of the nursing services. Budgeting ● Ready to make an adjustment based on the required needs.
helps you control the spending beyond the means in related to ● Present the financial report according to hospital policy.
nursing activities.
● To monitor income and expenses of the Nursing services. FACTORS IN BUDGET PLANNING
Budgeting helps you keep on track of the income and 1) Type of patient and the length of stay in the hospital. Assess
expenditures of the Nursing services. whether the patient is under medical, surgical, maternity, surgical,
● Rationalization of the financial transparency and accountability of communicable disease or chronically ill and the severity of its
the Nursing services. Budgeting gives you a precise report illness
summary of the financial responsibilities. 2) Bed capacity and hospital size
TYPES OF BUDGET 3) Physical plant of the hospital, design and the size of the
wards/unit and other treatment rooms.
1. Personnel Budget 4) Personnel policies. Includes the salaries of the personnel,
● it is a type of budget affected by personnel policies such as salary overtime pays or shift differential; extended leave of absence and
related to posiiton and number of days allowed for educational holidays.
and personal leave. 5) Grouping of patients
● the workforce budget because it is forecasting the volume of 6) Standard of Nursing Care
operational staff. 7) Method of performing nursing care
● It monitors the personnel budget to determine the needs of 8) Method of documentation
nursing staff either in short for long term basis. The manager 9) Proportion of nursing care providers (professional /
should aware of the increasing or decreasing of patient’s volume non-professional)
per day/per hour or per minute so as they would know the number 10) Amount and quality of supervision available and provided
of staff nurses to be assigned., (Marquis and Huston, 2017 11) Competencies of job description and qualification
2. Operating Budget 12) Method of patient assignment
● which the accounts for revenues and expenses were the 13) Amount and kind of labor-saving devices and equipment
concerned needs, it is also reflects the costing of the services on 14) Amount of centralized service provided
the supplies, utilities, repairs and maintenance while 15) Nursing service requirement ancillary departments
● It is an annual budget that includes the revenues and expenses 16) Reports required by administration
associated with the daily activities of the Nursing department. 17) Affiliation of nursing students or medical students
Provides an over view of an agency’s functions by projecting the
planned operations, usually for the upcoming year. BUDGETING METHODS
3. Capital Budget ● INCREMENTAL BUDGETING – simplest method for budgeting.
● related to a long term range planning of the institution’s physical Since the budget for the next coming year may be projected, the
acquisitions, disposal and improvement. programs and services were not prioritized.
● Considers the purchased related to the acquisitions of the major ● ZERO-BASED BUDGETING – the method does not automatically
equipment and necessities involving the physical facilities of the claim to be funded. A set funding priority is the main purpose of
Nursing services. this method.
4. Cash Budget ● FLEXIBLE BUDGETING – this method calculates what the
● appears to make adequate funds available as needed and to use expenses should be specified in the program
an extra fund profitably. ● PERFORMANCE BUDGETING – emphasizes the outcomes and
● Plan to make adequate funds available as needed and to use an results instead of activities and outputs.
extra fund profitably.
5. Flexible Budget FACTORS IN DETERMINING BUDGETARY
● budgets that flex up and down over the course of the year REQUIREMENT
depending on volume., (Marquis and Huston, 2017).
● Budgets that flex up and down over the course of the year ● Asses the appropriate provision in the current General
depending on volume Appropriation Act.
6. Budgeting Budget ● Associate the sources of funds (General, national, city,
● has Determining Factors for Budgetary Requirements. This municipal…)
pertains with the awareness of the nursing staff about the budget ● Evaluate the current appropriations and actual expenditures for
planning and proceeds of the department., (DOH Guidelines the current year.
2016). ● Analyze the projected changes in other department that will affect
the nursing service budget.
BUDGETING PROCESS ● Consider the required expenditures, supplies, equipment and
material, repair and replacement for the next coming year.
Phase 1 Gathering Data ● Projects the estimated personnel salaries and benefits including
● Study the overall past performance based on proposed goal. their unusual leaves.
Gather environmental information ● Assess the cost of Human Resource Development and Research
● Regulates the overall expenses and revenues from the past Programs.
reports to present based on proposed budget. ● Render this information into peso and submit the official forms to
Phase 2 Planning the Medical Center Chief for approval and inclusion in the general
● Create a Budget Committee budget.
● Set Objectives based on strategic goals The efficiency of the budget management resources determines

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● Establish a program or project for future goals the productivity goal of the nursing service management. It

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 11

reflects the consistency of the budget costing ability of the nurse ○ There must be impersonal rules and impersonality of
manager interpersonal relationships.
○ A system of procedures for dealings with work situations
TIME MANAGEMENT must exist.
○ A system of rules covering the rights and duties of each
● It is a technique for allocating one’s time through the setting of position must be in place.
goals, assigning priorities, and identifying and eliminating wasted ○ Selection for employment and promotion is based on
time, and using managerial techniques to reach goals efficiently. technical competence
● Time management defined as making optimal use of available ● Organizing is the process of establishing formal authority and
time. Oftentimes manager’s complaint or keep telling they don’t involves setting up the organizational structure through
have enough or lack of time in accomplishing such goals. They identification of groupings, roles and relationships, determining
always argue that there is not enough time in the day to do the staff needed by developing and maintaining staffing
everything that must be done. The problem that this individual is patterns and distributing them in the various areas as needed. It
time poor., rather that problem is poorly using of time. One of the includes developing job descriptions by defining the qualifications
strategies in managing the time is learn to prioritize duties, and functions of personnel.
managing and controlling crisis, reducing stress and balancing ● An organizational chart is a line drawing that shows how the
work and personal time, (Marquis and Houston,2017). parts of an organization are linked. It depicts the formal
FACTORS IN DETERMINING BUDGETARY REQUIREMENT organizational relationships, areas of responsibility, persons to
whom one is accountable and channels or organization
There are several time management principles that can be
used to plan effectively ELEMENTS OF ORGANIZING
● Planning anticipates the problem that arise from actions without ● The elements of organizing include setting up the organizational
thought.. structure, staffing, scheduling, and developing job descriptions. In
● Tasks to be accomplished should be done in sequence and this module, the setting up of an organizational structure will be
should be prioritized according to importance. discussed. The other elements will be discussed in the
● Setting deadlines in one’s work and adhering to them is an succeeding modules.
excellent exercise in self-discipline.
● Deferring, postponing, or putting off decisions, actions, or SETTING UP THE ORGANIZATIONAL STRUCTURE
activities can become a habit which oftentimes causes lost
opportunities and productivity, generating personal or ● The creation of an organizational system compatible with the
interpersonal crises. philosophy, conceptual framework, and goals of the organization
● Delegation permits a manager to take priority for decision making provides the means for the accomplishment of an organization’s
and to assign tasks to the lowest possible consistent with his/her purpose.
judgment, facts, and experience, (Venson, 2016). ● Understanding the organizational structure as a whole facilitates
the development of roles and relationships to enable the
TIME-SAVING TECHNIQUES, DEVICES, AND achievement by goals. The organizational structure refers to the
METHODS TO BETTER USE OF TIME process by which a group is formed, its channels of authority,
span of control and lines of communication. Departmentalization
1) Conduct an inventory of your activities Logging your activities for and division of work provide orderliness in administration.
one day would show how much time is usually spent on each Through a breakdown of activities, each individual becomes
activity. responsible for a specified set of activities and performs such.
2) Set goals and objectives and write them down. Set priorities. Plan ● The successful setting up of the organizational structure enables
on making things happen rather than reacting to crises. an organization to achieve its purposes.
3) With the use of calendars, executive planners, logs or journals, 1) It informs the members of their responsibilities so that they
write what you expect to accomplish yearly, monthly, weekly or may carry them out.
daily. 2) It allows the manager and the individual workers to
4) Breakdown large projects into smaller parts. concentrate on his/her specific role and responsibilities.
5) Devote a few minutes at the beginning of each day. 3) It coordinates all organizational activities so there is
6) Organize your work space so its functional. Sort paper work on minimal duplication of effort or conflict.
your table according to priority 4) It reduces the chances of doubt and confusion concerning
7) Close your door when you need to concentrate. Agree on a period assignments.
of quiet office time. 5) It avoids overlapping of functions because it pinpoints
8) Learn to delegate. responsibilities.
9) In a meeting, define the purpose clearly before starting. Distribute 6) It shows to whom and for whom they are responsible.
the agenda in advance and control interruptions during the ● Other individuals that the nurse may need to be accountable to
meeting. include the immediate supervisor, the patient and family, central
10) Take or return phone calls during specified time. Maintain a administration, and the physician because all of them participate
telephone log so you can return calls at a time. in the nurse’s work. The organizational structure of the Nursing
11) Develop effective decision-making skills. Do no afraid to say “no”. service should be updated, reviewed, approved, and documented
12) Take a rest breaks and make good use of your spare time. by the proper authority. Date of last review should be
Reward yourself periodically, (Venson, 2016) documented.
Three Steps to Time Management Types of Organization Classified by Nature of Authority
1) Allow time to planning and establish priorities. 1) Lines organization is the simplest and the most direct type of
2) Complete the highest task whenever possible and finish one task organization in which each position has general authority over
before beginning another. the lower positions in the hierarchy. Example: Clinical and
3) Reprioritize based on the remaining tasks and on new information Administration
that may have been received 2) Informal organizations refer to horizontal relationships rather
than vertical. This is composed of small groups of workers with
ORGANIZING
similar interests.
3) Staff organization is purely advisory to the line structure with no
ORGANIZATIONAL THEORY AND BUREAUCRACY authority to put recommendations into action. Example: Training
● Max Weber is known as the father of organizational theory. and Research
According to him, bureaucracy is an institutional method for 4) Functional organization is one where each unit is responsible
applying general rules to specific cases, making the actions of for a given part of the organization’s workload. There is clear
management fair and predictable. Other characteristics of delineation of roles and responsibilities which are actually
bureaucracy are the following: interrelated. Example: All standing and ad hoc committees
○ There must be a clear division of labor. Organizational Chart and Its Implication
○ A well-defined hierarchy of authority must exist which
separates the superiors from subordinates. There must be ● An organizational chart is a line drawing composed of boxes that
shows the parts of an organization are linked. It depicts the formal

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remuneration for work, recognition of authority, allotment
of privileges and conferring of promotion.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 12

 organizational relationships, areas of responsibility, persons to ● This principle supports a centralized authority that aligns
whom one is accountable and channels of communication. authority and responsibility. Communication flows through the
chain of command that tends downward. In modern nursing
LINES IN THE ORGANIZATIONAL CHART organization, the chain of command is flat. Communication flows
● Unbroken Solid lines are classified into two. The solid horizontal freely in all directions with responsibility and authority delegated
lines represent communication between people with similar to the lowest operational level
sphere of responsibility and power but different functions. The 3) Homogeneous Assignment or Departmentation. Workers
solid vertical lines between positions denote the official chain of performing similar assignments are grouped together for a
command and formal path of communication and authority. Those common purpose. This promotes the specialization of activities,
having the greater decision-making authority are at the top; those simplifies the administrator’s work, and helps maintain effective
with the least are at the bottom. control.
● Dotted or broken lines it represents staff position. Staff member 4) Span of Control. The number of workers that a supervisor can
provides information and assistance to the manager but has effectively manage should be limited, depending upon the pace
limited organizational authority. It also provides for specialization and pattern of the working area. It also refers to span of
but does not have legitimate authority as it acts in an advisory managerial responsibility and the number which one superior
capacity. can assist, teach and help to reach the objectives of their own
jobs
FIVE MAJOR CHARACTERISTICS OF AN 5) Exception Principle. Recurring decisions should be handled in
ORGANIZATIONAL CHART a routine manner by lower-level managers whereas problems
involving unusual matters should be referred to the higher-level
An organizational chart should show the following components Subordinates should report only unusual from normal
1) Division of work – each box represents the individual or functioning, so that managers can limit their attention to
sub-unit responsible for a given task the organization’s work significant events.
load. Ex: Medical Services, Hospital Operations and Patient 6) Decentralization or Proper Delegation of Authority.
Support Services, Nursing Services, and Finance Services. Decentralization is the process of conferring specified decision
2) Chain of Command – lines indicate who reports to whom and making to the lower levels of the organization. Basic top-level
by what authority Ex: Flat (decentralized) or tall (centralized) decisions and policies must receive attention at the top levels.
organizations. Executives should be developed to handle situations delegated
3) Type of work to be performed – indicated by labels or to the, this delegation of authority is still subject to the
descriptions for the boxes. Ex: Ancillary Services, Training and supervision and control of the delegating superior. Distribution of
education Department, and Patient Care Services. necessary information about critical issues is vital to any
4) Grouping of work Segments – shown by the clusters of work delegation process. An executive should have sufficient
groups (departments or single units). Ex: Operating Room and information to make a good decision.
Post Anesthesia Care Unit, Labor Room and Delivery Room 7) The Principle of Requisite Authority. When a particular task is
Unit, Intensive Care and Coronary Care Unit delegated to a subordinate, the latter must also be given
5) Levels of Management – indicate individual and entire authority over resources needed for task accomplishment. He
management hierarchy. Hierarchy refers to a body of persons or She is accountable for the quality of his work.
things organized or classified in pyramidal fashion according to 8) The Principle of Organizational Centrality. Nursing personnel
rank, capacity or authority assigned to vertical levels with the interact with the greatest number of other healthcare workers,
offices ranked in grades, orders, or classes, one above the receive the greatest amount of work- related information and
other. Ex: Top management, middle management, and front-line become most powerful in organizational structure.
management 9) The Principle of Esprit d’ Corps. This means teamwork and
KINDS OF ORGANIZATIONAL CHART implies that in unity, there is strength.

An organizational chart should show the following components Figure 1. ORGANIZATIONAL STRUCTURE OF A MEDICAL
1) Structural chart shows the various components of the CENTER
organization and outlines the basic interrelationships. Figure 1 is an example of a hospital organizational chart. All units that
2) Functional chart reflects the functions and duties of the pertain to diagnosis and cure belong to the Medical Division and is
components of the organization and indicates the headed by the Chief of Professional Services or Chief of Clinics. The
interrelationships of these function. Within the boxes is the caring aspect fall under the Nursing Division and I headed by the Chief
function statement, which should be clear, inclusive and written Nurse or Director of nursing Services. The operations of the hospital
in the present tense. and patient support area is handled by the Hospital Operations and
3) Position chart specifies the names, positions, and titles or Patient Support Division. The Finance Division handles the financial
ranks of the personnel matters of the hospital.
PRINCIPLES OF ORGANIZATION
In designing the organizational structure of the nursing
department, certain organizational principles must be observed.
1) Unity of Command. Although employees may interact with
many different employees in the performance of their duties,
they should be responsible to only one superior. This is to avoid
confusion, overlapping of duties and misunderstanding This
method is modified by emerging organizational theory where
nurses and others are frequently engaged in matrix
organizations in which they answer for more than one supervisor
2) Scalar Principle or Hierarchy. The authority and responsibility
should flow in clear unbroken lines from the highest executive to
the lowest. The other form for this is “chain of command,” usually
a military term. Proper definition and delegation of authority and
responsibility facilitate the accomplishment of work. In this
connection, the following must be observed:
a) When responsibility for a particular job is delegated to a
subordinate, the latter should have authority over resources
needed to accomplish the task
b) When a particular function is delegated to a subordinate,
the superior own’s
c) responsibility is in no way diminished, and
d) When a person is bestowed the authority of action, he is
accountable for his actions to the person that bestowed him
such. The conscientious nurse exhibits accountability
toward her employing hospital, the patient, the government,

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her profession, and to God.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 13

 Figure 3 shows the organizational structure of a training hospital
ORGANIZATION OF THE NURSING SERVICE/DIVISION with an affiliated college of nursing or school of midwifery. Solid lines
● The Nursing Service/Division/Department is the largest group of depict direct relationships while broken lines show
hospital employees tasked with the responsibility of setting coordinated relationships.
standards for safe nursing practice, providing quality care to the
patients, and coordinating its services with the various Figure 4. ORGANIZATIONAL CHART OF A NURSING DIVISION
divisions/departments/services in the hospital and community. WITH ASSISTANT CHIEF NURSES FOR NURSE TRAINING AND
● The Nursing Service is headed by the Chief Nurse and may be RESEARCH AND FOR CLINICAL AREAS
called by other titles such as Director of Nursing Services. As the
administrator of nursing services the position may also be called
Assistant Director for Nursing as in the Philippine General
Hospital. She has several Chief Nurses under her who head their
respective departments. In specialty hospitals such as the Lung
Center of the Philippines, the National Kidney Institute, and the
Philippine Children’s Medical Center, the heads of the Nursing
Department are called Department Managers.
● The Chief Nurse (Nurse VII in DOH Hospitals) is directly
responsible to the Chief of Hospital or Medical Center Chief. She
is assisted by an Assistant Chief Nurse. In some bigger hospitals,
there may be two Assistant Chief Nurses; one for training and
research and the other for patient care services. Supervising
Nurses are in charge of two or more nursing units. The Head
Nurse or Senior Nurse is responsible for the management of a
nursing unit. The Staff Nurses provide direct patient care and are
assisted by nursing attendants who perform simple, routine tasks
for which they have been trained.

Figure 2. ORGANIZATIONAL STRUCTURE OF A HOSPITAL’S

NURSING SERVICE/DIVISION

Figure 4 is a typical nursing organizational chart of a training hospital.

The Chief Nurse is directly responsible to the Chief of Hospital. She is
assisted by an Assistant Chief Nurse. Under them are Supervising
Nurses for the clinical areas, for the special areas, and for training and
research. The Supervising Nurses are in charge of two or more nursing
units while the Senior Head Nurse is in charge of one nursing unit.
Under her are the staff nurses and nursing attendants.
FORMS OF ORGANIZATIONAL STRUCTURE
1) Traditional Hierarchical Structure (tall, centralized,
bureaucratic) This is commonly called line structure. Authority
and responsibility are clearly defined leading to simplicity of
relationships. This is associated with the principles of command,
vertical control and coordination levels, and downward
communications.

Figure 5. ORGANIZATIONAL CHART OF A NURSING SERVICE

Figure 2 shows an organizational structure of a nursing division SHOWING SEVERAL LAYERS OF POSITIONS BETWEEN CHIEF
delineating the hierarchy of positions from the Chief Nurse down to the NURSE AND NURSING STAFF.
Nursing attendant. The staff nurses, midwives, nursing attendants and
institutional workers are under the supervision of the Senior or head
Nurse

Figure 3. AN ORGANIZATIONAL STRUCTURE SHOWING THE

RELATIONSHIP OF THE NURSING SERVICE/DIVISION WITH THE
COLLEGE OF NURSING

Figure 5 shows a traditional hierarchical structure. The Chief Nurse is

directly responsible to the Chief of Hospital. Under her are Supervising
Nurses who are responsible for the Supervision of two or more nursing
units. The Senior or Head Nurse is in charge of a nursing unit. The
Staff nurses and the Nursing Attendants report directly to the Senior or
Head Nurse.

Figure 6. ORGANIZATIONAL CHART USING THE TITLES OF

PATIENT CARE ADMINISTRATOR AND COORDINATOR

🍎🍓🍑🍒🌶️ (Shane, Mae, Rocette, Mary, Khlaryzel) pg. 14

 TERMINOLOGIES
● Accountability means taking full responsibility for the quality of
work and behavior while engaged in the presence of the
profession.
● Authority is the right to act or make decisions without approval of
higher administrators. It includes the right to extract obedience
from subordinates. In government hospitals, flow of authority is
from the Chief of Hospital down to the Heads of the various
Divisions such as the Administrative Officer, the Chief of the
Nursing Division, and the Chief of Clinics.
● Change agent is a person skilled in the theory and
implementation of planned changes to deal appropriately with
these real human emotions and to connect and balance all
aspects of the organization that will be affected by that change.
The organizational chart in Figure 6 shows a different title for the Chief ● Communication is the transmission of information between
of Nursing Services. Likewise, Nursing Supervisors are given the title persons.
Patient Care Coordinators. ● Power is the ability to influence another to behave in accordance
with one’s wishes.
2) Decentralized (flat, horizontal, participatory) - The authority is ● Relationships within Nursing Services can be depicted through
shifted downwards to its divisions, services, and units. The the organizational chart.
decision making can occur where the work is being carried out, ○ Line relationship those that exists between the superior
thereby professionals who do the job can participate in and subordinated immediately and directly responsible to
managing the organization. him/her. Ex: Chief Nurse to Supervising Nurse, Head Nurse
3) Matrix - This is designed to focus on both the product and to all nursing staff.
function. The manager of the unit responsible for a service ○ Lateral relationship those that exists between position in
reports both to a functional and product manager. various divisions and sections of an undertaking where no
4) Hybrid A term applied to organizational structure that operate direct authority is involve. Ex: Senior Nurse and Physician,
with characteristics of different types of structures. Staff Nurse and Clinical Pharmacist.
ORGANIZATIONAL STRUCTURE FOR DEVOLVED HOSPITAL ○ Functional relationship those that arise when duties are
divided on a functional basis like when an individual
Figure 7. ORGANIZATIONAL STRUCTURE IN PRIMARY NURSING exercises authority on a particular subject by special skill or
knowledge. Ex: Chief Nurse with Administrative Officer,
Staff Nurse with Clinical Nurse Instructor.
○ Staff personnel provides advice, counsel, or technical
support that may be accepted, altered, or rejected by the
line officer.
● Responsibility is the obligation to perform the assigned tasks.
● Status is the rank a group bestows on a person in accord with the
group’s estimation of the person’s value and significance to group
goals. The status of the Nursing Director or Chief Nurse is equal
to that of the Administrative Officer and Chief of Clinics.
SWOT
● Strength are those internal attributes that help and organization
to achieve its objectives.
Figure 7 shows a decentralized clinical structure. Authority, ● Weakness are those internal attributes that challenge an
responsibility, and accountability are vested on primary care nurses organization in achieving its objectives.
who report directly to the nursing administrator. ● Opportunities are external conditions that promote achievement
of organizational objectives.
● The legal basis to consider in operating devolved hospitals is the ● Threat are external conditions that challenge or threaten the
Local Government Code (LGC) of 1991. Local government units achievement of organizational objectives
are given full autonomy in the exercise of their proprietary ● Organization is a group of people working together in achieving
functions and in their economic enterprises subject to limitations the organizational goal
provided in the code and other applicable laws.
● Section 18 of the Department of Health Rules and Regulations
Implementing the Local Government Code of 1991 (the “DOH
Rules”) gives authority to Local Government Units regarding the WEEK 10: STAFFING
management and operation, among others, of provincial, district,
It is the responsibility of the manager for the adequate and well
municipal, and city hospitals. Funding shall come from the share
communicate staffing and scheduling policies stressed. The manager
of the province or city in the national taxes and other national
must focus on her leadership responsibility for developing trust through
funds and funding support from the national government, its
fair staffing and scheduling procedures. Managers should do what they
instrumentalities and government-owned or controlled
can to see that employees feel they have some control over
corporations which are tasked by law to establish and maintain
scheduling, shift options, and staffing policies. Creating safe staffing
health services and facilities.
practices for equitable nurse-patient assignments on a regular basis
continues to a challenging role for nurse leaders. Because staffing
Figure 8. ORGANIZATIONAL STRUCTURE FOR DEVOLVED
patterns and scheduling policies directly affect the daily lives of all
HOSPITALS AND RURAL HEALTH UNITS
personnel, they must be administered fairly as well as economical,
Marquis and Huston, (2017).

STAFFING
● the process of hiring eligible candidates in the organization or
company for specific positions. In management, the meaning of
staffing is an operation of recruiting the employees by evaluating
their skills, knowledge and then offering them specific job roles
accordingly. Let us find out more about what is Staffing and what
it entails along with its functions and characteristics.
● https://www.toppr.com/guides/business-studies/staffing/introductio
n-to-staffing-and-itsmeaning/
● Staffing is the traditional management function of attraction and

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selection of the best people and putting them on job where their
talents and skills can be best utilized, and retention of these

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 15

 people through incentives, job training and job enrichment ● do not exhibit unusual symptoms and requires little
programs, in order to achieve both individual and organizational treatment/observation and/or instruction.
objectives. ● Average 1.5 NCH? day
● https://www.businessmanagementideas.com/staffing/staffing-mea ● 55:45 professional to non-professional nursing personnel
ning-features-andimportance/3508 Level II- Moderate care or Intermediate Care
NURSE STAFFING ● need some assistance in bathing, feeding or ambulating for short
● is the process of determining and providing the acceptable periods of time.
number and mix of the personnel to produce a desired level ● Extreme symptoms of their illness must have subsided or have
of care to meet the patient’s demand. not yet appeared.
● It purpose is to provide each unit with an appropriate and ● have slight emotional needs,
acceptable number of workers in each category to perform the ● with vital signs ordered up to three times per shift,
nursing task required (Professional Nursing in The Philippines ● intravenous fluids of blood transfusion,
11th edition by Lydia M. Venzon & Ronald M. Venzon). ● semi- conscious and exhibiting some psychosocial on social
problems: periodic treatments,
FACTORS AFFECTING STAFFING ● and/or observation and/or instructions.
1. Patient Factors ● Average nursing care hours per patient per day is 3 and the
● Census fluctuations ● 60:40. professional to non-professional
● Patient acuity Level III- Total Complete or Intensive Care
● Level of care/degree of dependence ● completely dependent upon the nursing personnel
● Patient age group ● provided complete bath, are fed,
● Special treatment and procedure ● may or may not be unconscious, with marked emotional needs,
● Communicability ● with vital signs more than three times per shift,
● Rehabilitation ● may be on continuous oxygen therapy,
● Patient and family care demands/expectations ● with chest or abdominal tubes
2. Staff Factors ● require close observation at least every 30 minutes for impending
● Number of nursing staff available hemorrhage,
● Ratio of professional to non-professional ● with hypo or hypertension and/or cardiac arrhythmia
● Number of leaves ● average NCH is 6
● Turn-over rate ● 65:35 professional to non-professional
● Span of supervision Level IV- Highly Specialized Critical Care
3. Nursing service factors ● need maximum nursing care with a ratio of 80 professionals to 20
● Nursing care modality in use nonprofessionals
● Type of services/patient classification system ● need continuous treatment and observation:
● Patterns of work schedule ● with many medications, IV piggy backs: vital signs every 15-30
● Training and staff development programs minutes: hourly output
● Research activities ● significant changes in doctor’s orders and
4. Health care organization factors ● average NCH 6-9 or more
● Type of hospital ● 70:30 to 80:20 professionals to non-professionals
● Services offered/population served
● Work time policy
● Administrative policy on weekend and holiday duty
● Presence of support services
● Nursing unit architectural design
● Availability of resources like equipment, materials and
supplies
● Technology anticipated
● Projected units of services
● Budget limitations

PATIENT CARE CLASSIFICATION SYSTEM

● Is primary developed to determine workloads requirements and
staffing needs. It is categorizing patients on the basis of certain
needs that can be clinically observe by the nurse. It is a method of
grouping patients according to the amount and complexity of their PERCENTAGE OF NURSING CARE HOURS
nursing care requirements and nursing time and skill they require.
● The assessment can serve in determining the amount of nursing ● Percentage of nursing care hours to be given by professional
care required within 24hours also the category of nursing nurses and by nonprofessional nursing personnel may defend on
personnel who should provide that care the patient’s condition in hospital
● Setting in which the care is being given.
● Table 2 shows the Classification of Patients by Levels of Care
according to Type of Hospital with Percentage of Patients at
Various Levels of Care

● Various nursing units may develop their own ways of classifying

care according to the acuity of their patient illness
CLASSIFICATION CATEGORIES
Level 1-Self-care or Minimal Care
● take a bath on his own,
● feed himself,
● feed and perform his activities of daily living.
● patients about to be discharged,
● non-emergency,
● newly admitted,

🍎🍓🍑🍒🌶️ (Shane, Mae, Rocette, Mary, Khlaryzel) pg. 16

 RELIEVERS NEEDED

● Personnel entitles for an average of 33 days leave per year.

● To determine the relievers needed, divide 33 (the average number
of days an employee is absent per year) by the number of
working days per year that each employee serves (whether 213
or 265).
● This will be 0.15 per person who works 40 hours per week and
0.12 per person for those working 48 hours per week.
● Multiply the computed reliever per person by the computed
number of nursing personnel. This will give the total number of
relievers needed
DISTRIBUTION BY SHIFTS
● morning shift needs 45 to 51 percent:
● afternoon shift 34 to 37 percent: and
● night shift 15 to 18 percent.

In the Philippines the distribution usually followed is 45 percent for the

morning shift, 37 percent for the afternoon shift, and 18 percent for the
night shifts.
Staffing Computation 3. Find the actual number of nursing care hours needed by the given
● the hospital should ensure that there is sufficient staff to cover all number of patients. Multiply the total nursing care hours needed
shift, off-duties, holidays, leaves, absences, and time for staff per day by the total number of days in a year.
development programs.
● The Forty-Hour week Law (Republic Act 5901), provides that
employees working in hospitals with 100 bed capacity and up will
work only 40 hours a week.
Staffing Formula
To compute for the staff needed in the In-Patient unit of the hospital the 4. Find the actual number of working hours rendered by each
following steps are considered: nursing personnel per year. Multiply the number of hours on duty
per day by the actual working days per year.
1. Categorize the number of the patients according to the levels of
care needed. Multiply the total number of patients according to
the level of percentage of patients at each level of care. (whether
minimal, intermediate, intensive or highly specialized)

5. Find the total number of nursing personnel needed.

a. Divide the total number of nursing care needed per year by
the actual number of working hours rendered by an
employee per year.
b. Find the number of relievers. Multiply the number of nursing
personnel needed by 0.15 (for those working 48hours per
week)
c. Add the number of relievers to the number of nursing
personnel needed.

6. Categorize the nursing personnel into professionals and

non-professionals. Multiply the number of nursing personnel
according to the ratio of professionals to non-professionals.

2. Find the total number of Nursing care hours needed by the

patients at each category level.
a. Find the number of patients at each level by the average
number of nursing care hours needed per day
b. Get the sum of the nursing care hours needed at the various
levels.

🍎🍓🍑🍒🌶️ (Shane, Mae, Rocette, Mary, Khlaryzel) pg. 17

7. Distribute by shift. the unit’s patient care requirements, the staff’s preference, their
education, training and experience.
SCHEDULING VARIABLES SHOULD BE CONSIDERED
a. length of scheduling period whether 2 or 4 weeks;
b. shift rotation;
c. week-ends off;
d. holidays offs;
e. vacation leave;
f. special days (birthdays, wedding anniversary, etc);
g. scheduled events in the hospital, training programs, or meetings;
h. job categories;
i. tardiness and;
j. continuing professional education (CPE) programs.
SCHEDULING
ADVANTAGES OF CYCLICAL SCHEDULE
● A schedule is a timetable showing planned work days and shifts
for nursing personnel. ● It is fair to all. Favoritism is minimized as all nursing personnel get
● The objective in scheduling is to assign working days and days-off their fair share of rotation to the various shifts.
to the nursing personnel so that adequate patient care is assured. ● It saves time as the schedule does not have to be redone every
● A desirable distribution of off-duty days can be achieved and the week or two.
individual members of the nursing team will feel that they are ● It enables the employees to plan ahead for their personal needs
treated fairly. They will also know their schedule in advance, preventing frequent changes in schedule.
Venzon, (2016). ● Scheduled leave coverage such as vacation, holidays and sick
leaves are more stable.
FACTORS CONSIDERED IN MAKING SCHEDULES ● Productivity is improved.
● different levels of the nursing staff: adequate coverage for 24
hours, seven days a week:
● staggered vacations and holidays: weekends:
● long stretches of consecutive working days: evening and night
shifts: and floating.
● An adequate mix of nurses and nursing attendants
● education, training and experiences.
● Afternoon and night shift requirements for the staff are usually
lower than in the morning shift.
● lower staff requirements on Saturdays and Sundays since there
are lesser medical rounds, fewer medical orders and lower patient
census.
● schedules for holidays are staggered at least once a month.
Vacations, whether forced or requested,
● Long stretched of consecutive working days
● Busy units may require additional help.
● Unscheduled absences may require a staff to be pulled out from
DIRECTING
her regular area
● Job dissatisfaction and high turnovers rates. ● the issuance of orders, assignments, and instructions that enable
the nursing personnel to understand what are expected of them. It
ASSESSING A SCHEDULING SYSTEM
includes supervision and guidance so that in doing their jobs well,
Scheduling may vary from agency to agency, but the scheduling nurses can maximally contribute to the organization’s goals in
system must function smoothly in terms of: general and to the objectives of nursing service in particular,
Venzon, (2016).
1. Ability to cover the needs of the unit a minimum required number
IMPORTANCE OF DIRECTING
of staff must meet the nursing needs of the patients in the units at
all shifts: ● Establish direction in carrying out desired action
2. Quality to enhance the nursing personnel’s knowledge, training ● Influence nursing personnel to follow the direction
and experience While permanent assignment to one unit ● Initiate actions
enhances skills in caring for a particular kind of patient (whether ● Integrate efforts
obstetrical, medical, surgical or pediatrics), many nurses who ● Become a means of motivation
have future plans of going into teaching, or specialization or even ● Provide stability
working abroad, would prefer to experience being assigned to ● Enable employee to cope with the changes
various units before settling down to a particular unit of their ● Help in efficient utilization of resources
choice:
3. Fairness to the staff All nursing personnel should get a fair share PURPOSE OF DIRECTING
of weekends, holidays offs, rotation patterns for the whole year
● Obtain the optimum return from all staff in the interest of the
including assignment to “difficult” or “light” or “undesirable” units or
institution
shifts:
● Bring personal and professional growth of employees
4. Stability The nursing personnel would like to know in advance
● Bridge the gap of directing
their schedule of assignment so that their personal schedules
● Create a direct link between the nurse managers and the nursing
(whether at home, social and civic responsibilities are in harmony
personnel through effective communication
with each other: and
● Maintain standards of services cooperatively to develop
5. Flexibility the ability to handle changes brought about by
coordination to avoid overlapping
emergency leaves, scheduled or unscheduled leaves of
● Assist in the problem solving of the matters concerning personnel
absences.
● Assess continuously the services given personnel performance
TYPES OF SCHEDULING
PRINCIPLES OF DIRECTING
1. Centralized Schedule One person, usually the Chief Nurse or
● Harmony of objectives
her designate, assigned the nursing personnel to the various nits
○ Employees work well when they feel that their physiological
of the hospital. This includes the shifts on duty and off-duty.
and psychological needs are met.
2. Decentralized Schedule shift and off-duties are arranged by the
● Unity of command
Supervising Nurse or Head or Senior Nurse of the particular unit.
○ Dual subordination brings disorder and chaos, undermines
3. Cyclical Schedule covers a designated number of weeks called
authority and leads to instability.

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the cycle length and is repeated thereon. It assigns the required
● Appropriate direction techniques
number of nursing personnel to each nursing unit consistent with

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 18

 ○ Motivation techniques such as pay, incentives, awards, 5 Rights of Delegation
status, promotion, etc., can increase job satisfaction, ● Right task
productivity and quality/excellence of work. ● Right circumstances
● Use of informal organization ● Right person
○ Special attention should be given to the informal organization ● Right direction and communication
to strengthen the formal organization. ● Right supervision and evaluation
● Managerial communication Steps in Delegation
○ Direct and personal contact or feedback makes supervision ● Prepare
effective and motivating. ● Assign
● Appropriate leadership style ● Confirm understanding and commitment
○ Nurse managers to influence their subordinates must provide ● Monitor accomplishment against the assigned tasks
good leadership. ● Ensure accountability
● Follow through follow up Pointers to Proper delegation of work
○ Nurse managers must monitor as to what extent the policies ● Provide clear and specific instructions
framed and issued directions have been enforced. ● Give authority commensurate to responsibility
● Keep subordinates informed
CHARACTERISTICS OF DIRECTING ● Show you have confidence in your subordinates
● Initiates action ● Be loyal
○ Giving directions and instructions the nurse managers get Ways for nurse Mangers to Delegate Successfully
the work started in the organization ● Train and develop subordinates
● Continuous process ● Plan ahead, it prevents problems
○ Nurse managers continuously takes steps to ensure that ● Control and coordinate the work of subordinate
orders and instructions are carried out properly. ● Visit subordinates periodically
● Takes place at every level ● Coordinate to prevent duplication of effort
○ Directing is a pervasive function of all manager at all levels in ● Specify goals and objectives
all units perform it. ● Solves problems
● Flows from top to bottom ● Know subordinates’ capabilities and match the task or duty to the
○ Nurse managers direct their immediate subordinates and employees.
take directions from their immediate superiors. ● Agree on performance standards
● Performance-oriented ● Take an interest
○ Directing function helps converting plans to performance. ● Do not take back delegated task
● Human level What Cannot Be Delegated
○ Human behavior is complex and unpredictable direction There are matters that cannot be delegated. Among these are:
function involves studying workers behavior and motivating ● Overall responsibility, authority, and accountability for satisfactory
them to work their best ability. completion of all activities in the unit.
● Authority to assign one’s name is never delegated.
ELEMENTS OF DIRECTING ● Evaluating the staff and/ or taking necessary corrective or
disciplinary action.
● Delegation ● Responsibility for maintaining morale of the opportunity to say a
● Supervision few words of encouragement to the staff especially the new ones.
● Communication ● Jobs that are too technical and those that involve trust and
● Problem solving and Decision making confidence.
● Motivation Why Nurse Managers Do Not Delegate
● There are some reasons why nurse managers fail to delegate.
1. DELEGATION ● Lack of confidence in their staff, feeling that only they could do the
● Delegating is the process by which a manager assigns specific task better and faster, or fear of loss of control if some of their
tasks/duties to workers with commensurate authority to perform duties are delegated. Subordinates may be apprehensive in
the job. The worker in return assumes responsibility for its accepting delegated task for fear of criticism, ineptitude, or
satisfactory performance and is held accountable form its results. incompetence.
● Paramount importance in delegation are the worker’s job ● Insecurities may be avoided if there is open communication
description, his/her knowledge base, his/her ability to carry put the among the staff.
task, and fairness not only to the employee but to the team as a ● Warm and cordial relationships where everyone is free to ask
whole. questions or seek clarifications regarding of delegated task which
Importance of Delegation to them may be too difficult to understand.
● Give subordinates a feeling of importance and motivate them for
appropriate results 2. SUPERVISION
● Develop the talents and skills of the subordinates, which can be ● The word “supervision” comes from the word “supervide” which
used for succession planning. means “to oversee or view directly.”
Purposes of Delegation ● Supervision is providing guidelines for the accomplishment of a
● Provide appropriate distribution of tasks for safe and quality task or activity with initial direction and periodic inspection of the
nursing care actual accomplishment of the task or activity.
● Promote individual responsibility and accountability ● It appraises not only the quantity and quality of work performed,
● Allow the nurse to perform more complex patient care and other but also the time within which the work is accomplished, the
related services proper and economic utilization of resources, the amount of
● Reduce workload to prevent burn out assistance needed by the worker, and the need for staff
● Enhance the knowledge and skills of nursing personnel and other development or continuing education programs.
health care workers ● The nurse who delegates is responsible for the acts of the
● Promote cost containment and effectiveness for the health care subordinate and may incur liability if found negligent in the
facility. process of delegating and supervising. This is under the doctrine
Principles of Delegation of I respondeat superior which mean “let the superior answer for
● Select the right person to whom the job is to be delegated. the acts of the subordinate.”
● Delegate both interesting and uninteresting tasks.
● Provide subordinate with enough time to learn. Qualities of Good Supervision
● Delegate gradually.
● Delegate in advance. Good supervision requires
● Consult before delegating. ● Good technical, managerial and human relation skills;
● Avoid gaps and overlaps. ● Ability to communicate well in both spoken and written language
Elements of Delegation and ability tom listen;
● Responsibility ● Firmness with flexibility to adjust to the needs of the situation;
● Authority ● Fairness in dealing with employees;
● Accountability ● Familiarity with hospital and nursing policies that affect patient

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care;

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 19

● Good decision-making skills; Types of Coordination
● Willingness to grow and develop; ● External
● Ability to accept changes and consider them as challenges; ○ Coordination with the outside parties with whom the
● Dignified and pleasing personality; organization has the business connections like government
● Ability to motivate employees and provide opportunities for supplies, customers, etc.
continuing professional growth and development; and ● Internal
● Advocacy for nurses and nursing. ○ Coordination among the employees of the same department
Principles of Good Supervision or section.
● Good supervision requires adequate planning and organization ● Horizontal
which facilitate cooperation, coordination, and synchronization of ○ Coordination that takes place between different departments.
services. ● Vertical
● Good supervision gives autonomy to workers depending on their ○ Coordination that exists between departments where the
competency, personality, and commitment. department heads are asked to coordinate the work of the
● Good supervision stimulates the worker’s ambition to grow into employees.
effectiveness. Coordination with Hospital Services
● Good supervision creates an atmosphere of cordiality and trust. ● Coordination with Medical Professional Services
● Good supervision considers the strengths and weaknesses of ○ Nurses should know the Medical Staff in their respective
employees. units, and their services and scheduled time of medical
● Good supervision strives to make the unit an effective learning rounds.
situation. ● Coordination with Administrative Service
● Good supervision considers equal distribution of work considering ○ Coordination with the Administrative services pertains to
age, physical condition, and competence both human and material resources.
Techniques in Supervision ● Coordination with Laboratory Service
● observation of the worker while making the rounds; ○ Request for laboratory examinations are forwarded to the
● spot checking of chats through nursing audits; laboratory unit.
● asking the patients about the care they receive; ● Coordination with the Radiology Service
● looking into the general condition of the units; ○ Request for x-ray examination are also forwarded to the
● getting feedback from co-workers or other supervisors or relatives x-ray service for proper scheduling and specific instructions.
● asking question discretely to find out the problems they encounter ● Coordination with the Pharmacy Service
in the wards; or ○ Policies regarding the procurement of drugs must be
● drawing out suggestions from the workers for improvement of observed.
their work or work situation. ● Coordination with the Dietary Service
○ Head is responsible for forwarding the diet list of the patients
Given in a soft, courteous manner, these will be taken willingly in the units.
and accepted as a challenge to improve performance. Give ● Coordination with the Medical social Service
harshly, especially in public, it builds up resentment, ill-will, and ○ Nurses coordinate with the Medical Social Service by
poor quality of work. referring patients with psycho-social problems.
Participatory Management ● Coordination with Medical Records Service
● Decentralization and participatory management have changed to ○ Nurses are responsible for the accurate documentation and
role of Supervision Nurses. completeness of the patient’s charts, including their safety
● They learn to delegate authority to Head Nurses, their and confidentiality.
responsibility for unit management decreases. ● Coordination with Community Agencies, other Institutions,
● The climate of supervision changes. and Civic Organization
● The nurses are given increasing. ○ Networking or linkages with community agencies, civic
● The nurses are given increasing authority to manage themselves. organizations, or other institutions are often necessary for
Rather than direct the work force, the Supervising Nurse assumes continuity of patient care.
the role of mentor, role model and facilitator.
● Some hospitals have changed the position of Supervising Nurse 4. MOTIVATION
into Clinical Coordinator or Clinical Managers.
● In participatory management there are mutual trust and support ● Motivation is influenced by complex set of social, professional and
There is increased accountability of the Head Nurse and of economic factor. Human beings are motivated by different goals,
employees through self-supervision. High morale and team work ambitions, and aspirations. Health worker will be motivated and
result in increased effectiveness and productivity and increased express job satisfaction if they feel that they are effective at their
commitment and recognized of contribution. Participation jobs and performing well.
increases individual and organizational capacities to learn, adapt, ● The amount and quality of work accomplished by the manager
and develop toward higher levels of excellence, Venson, (2016). directly reflect their motivation and that of their subordinates. They
● There are some disadvantages of participatory management. teach and empower their workers and apply knowledge, skills and
Among these are difficulty in changing the perception of techniques of motivational theories to achieve individual goals.
employees about the previous authoritarian management, IMPORTANCE OF MOTIVATION
occasional failure, and difficulty in fixing responsibilities. Nurses
can be more actively involved in participatory management Put human resources into action
through job enrichment, involvement in critical decisions that ● It is through motivation that the human resources can be utilized
affect them, and by providing liberal training and opening of by making full use of it.
career opportunities, Venzon, (2016). Improves level of efficiency of employees
● For getting best of his work performance, the gap between ability
3. COORDINATION and willingness has to be filled which helps in improving the level
of performance of subordinates.
● Coordination unites personnel and services toward a common ○ This result into:
objective. Synchronization of activities among the various ■ Increase productivity
services and departments enhances collaborative efforts resulting ■ Reducing cost of operations and
inefficient, smooth and harmonious flow of work. ■ Improving overall efficiency
● Supervising Nurses and Head/ Senior services coordinate their Leads to achievement of organizational goals
work with other departments services or units by conveying ● The goals of an organization can be achieved only when the
clearly define policies, standards operating procedures, policies, following factors take place:
and guidelines using the proper channels of communication. ○ There is best possible utilization of resources
Importance of Coordination ○ There is a co-operative work environment
● Ensure unity of direction ○ The employees are goal directed and they act in a purpose
● Create stronger workforce manner
● Enhance employee morale and provides satisfaction ○ Goals can be achieved if coordination and co-operation
● Facilitates diverse and specialized activities takes place simultaneously which can be effectively done
● Promote effective patient care management for general interest through motivation.

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● Establish positive work environment

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 20

Builds friendly relationship
● Motivation is an important factor which brings employees CONFLICT MANAGEMENT
satisfaction ● In the 20th century, conflict was considered to be an indication of
○ This could initiate the following things: poor organizational management. And can be destructive and can
○ Monetary and non-monetary incentives be avoided at all cost. If conflict occurs it can be ignored, denied
○ Promotion opportunities for employees or dealt with immediately and harshly. During this era people
○ Disincentives for inefficient employees. believed that conflict could be avoided if only employees were
Leads to stability of work force taught the one right way to do things and dissatisfaction were
● This is very important from the point of view of reputation and expressed and met with disapproval, Marquis & Huston, (2017).
goodwill of a concern, DOH Manual, (2016) ● Conflict generally defined as the internal or external discord that
results from differences in ideas, values, or feelings between two
PROBLEM SOLVING, DECISION MAKING or more people. Because managers have the interpersonal
● Decision making is one of the critical roles of a manager. Manager relationships with subordinates having a variety of different
must be decisive; they make decisions and are not afraid to take values, beliefs, backgrounds, and goals, conflict is an expected
risks. Know when it is time to make something, they do it, while outcome, Marquis & Huston, (2017
others procrastinate and wait for someone else to make a ● Conflict is neither good or bad, and it can produce growth or
decision. destruction, defending on how it is managed, Marquis &
● Decision is a course of action that is consciously chosen from Huston, (2017).
available alternatives for the purpose of achieving a desired SOURCES OF CONFLICT
result. It involves a choice utilizing mental processes at the
conscious level and is aimed at facilitating a defined objective. ● Human interaction
● And it is made at executive level and are more complex and affect ● It arises from the following:
a greater number of people. ○ Differences in knowledge,
○ Skills, values, interest:
5 STEPS IN DECISION MAKING ○ Scarcity of resources
1. Definition of the problem ○ Intergroup rivalry for rewards
● Situation through time and space may show a deviation from a ○ Role ambiguity
standard of performance. What should be done or avoided is not ○ Unworkable organization structure
what is being done or prevented. ○ Shift in organizational power base and organizational climate
● How to correct this deviation is the problem. and
● Relevant data should be collected as to recognize the real ○ Unacceptable leadership styles
problem. FACTORS THAT PROVOKE CONFLICT
2. Analysis of the Problem
● Once problem has been identified, the Supervisor/Head Nurse ● Failure to provide assistance or complete information on patient
proceeds to investigate, gather data, and analyze the cause and care
consequences of the problem. ● Varying perceptions of work situations can be caused different
● Prejudices and biases should not affect the decision. work responsibilities
● The manager should be open minded and flexible. ● Unstable staffing and work schedules
● Entire decision-making process should be objective to arrive at ● Highly differentiated work positions or role change
the best solution. ● Disagreement over policies and procedures
● Problem analysis means getting to the cause of the problem. ● Competition for scarce resources
3. Developing Alternatives Solutions/ Evaluation of Alternatives.
● It focuses on the search for analysis of alternatives and their CONFLICT PROCESS
possible consequences. LATENT CONFLICT
● Factors to considered in evaluating alternative solutions are time, ● First stage latent conflict, implies the existence of antecedent
available resources, labor, cost of tools and equipment to be conditions such as short staffing and rapid change
used, and the moral and legal implications. ● Could be prevented or reduced if managers examined the
4. Selection of a Solution organization more closely for antecedent conditions.
● After facts have been weighed and alternative solutions have ○ Example: change and budget cuts almost create conflict.
been explored, ranking of preferences is important. PERCEIVED CONFLICT OR SUBSTANTIVE CONFLICT
● The Supervising Nurse/Head Nurse chooses the best course to ● Second stage perceived conflict or substantive conflict is
follow considering advice from others, experience, and most intellectualized and often involves issues and roles.
importantly, logical reasoning. ● The person recognizes it logically and impersonally as occurring.
● The best solution that offers a better chance for success is then CONFLICT OR AFFECTIVE CONFLICT
chosen. ● Third stage felt conflict or affective conflict occurs when the
● Decisions may mean a compromise or a combination of two conflict is emotionalized.
possible solutions ● Felt emotion includes hostility, fear, mistrust, and anger. Possible
to perceive conflict and not feel it.
IMPLEMENTATION AND EVALUATION OF RESULTS
CONFLICT OR OVERT CONFLICT
● Fourth stage manifest conflict or overt conflict, action is taken.
INCLUDE THE FF ● Action maybe withdraw, compete, debate, or seek conflict
solution.
○ These include
1. Planning which entails consideration and selection of realistic ■ fear of retaliation,
objectives, policies, and procedures. ■ fear of ridicule,
2. Organizing which means helping personnel understand the ■ fear of alienating others,
decision and the procedures necessary for implementing the ■ a sense that they do not have the right to speak up and
decision; ■ pat negative experiences with conflict situations.
3. Staffing or the selection of the right person/s to carry out the AFTERMATH
decision; ● Final stage is aftermath there is always conflict aftermath positive
4. Controlling the environment and the group to prevent adverse or negative.
effects ● If conflict is managed poorly, the conflict issues frequently remain
THE ART OF DECISION MAKING INCLUDES and may return later to cause more conflict, Marquis and Huston,
(2017).
● Not making decision that others should make, to preserve morale ● The aftermath of conflict may be more significant than the
and authority; original conflict if the conflict has not been handled
● Not deciding on problems that are pertinent to matters at hand to constructively.
prevent waste of time and energy;
● Not deciding prematurely to prevent prejudice; and

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● Not making ineffective decisions to avoid losing the respectability
of the decision maker

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 21

 ● A manger recognizes which conflict management/resolution
TYPES OF CONFLICT strategy is appropriate for each situation.
1. Intergroup conflict ● In choosing the most appropriate strategy defends on many
● Occurs between two or more groups of people, departments, and variables such as:Marquis & Huston, (2017)
organization. ○ the situation itself,
● May caused by differences in opinion of the nursing staff of the ○ the urgency of the decision,
unit and that of the clinical Instructors in preparing for the RLE of ○ the power and status of the players,
nursing students ○ the importance of the issue, and
● Example: ○ the maturity of the people involved in the conflict
○ Staff nurses may claim that the nursing students do not meet 1. Avoidance
their role Expectations while the CI claim that the staff ● The parties involved are aware of a conflict but choose not to
nurses are not good role models themselves. acknowledge it or attempt to resolve it.
○ Two political affiliations with widely differing or contradictory ● Commonly used by groups who do not want to do something that
beliefs of nurses experiencing intergroup conflict with family may interfere with their relationships. Withdrawal behind walls of
and work issues, Marquis & Huston, (2017) insulation relieves the necessity of dealing with situations that
would arouse conflict.
2. Compromising
● Each party gives up something it wants. Both parties seek
expedient, acceptable answers for short periods when the goals
are only moderately important and the parties have equivalent
power.
● Not to result in a “lose-lose” situation, both parties must be willing
to give up something of equal value.
● Becomes “win-win” situation when both parties perceive they
have won more than other person.
2. Intrapersonal conflict 3. Competing
● Occurs within the person, it involves an internal struggle to clarify ● Is used when one party pursues what it wants at the expense of
contradictory values or wants. the others.Only one party typically wins, the competing party
● For managers, intrapersonal conflict may result from the multiple seeks to win regardless of the cost to others.
areas of responsibility associated with the management role. ● The supervisor or nurse manager exerts power at the
● When head Nurse is told not to schedule overtime for nurses but subordinate’s expense. Expressed through suppression of conflict
feels that shortage of nursing personnel greatly affects the quality through authority-obedience approach.
of nursing care resulting to job dissatisfaction of the clients. ● “Win-lose” conflict resolution strategies then typically leave the
● Example: loser angry, frustrated, and wanting to get even in the future.
○ Between the Nursing Director and the Finance Director who 4. Cooperating/Accommodating
do not agree on the resources (both human and material) ● Self-sacrifice
needed by the Nursing Service due to cost cutting measures. ○ Cooperating is the opposite of competing. One party
3. Intragroup conflict sacrifices his or her beliefs and allows the other party to win.
● Is manifested in feelings of unfairness over distribution of The actual problem usually not solved in this win-lose
assignments, off duties and holidays among the staff. situation.
● Example: ● Accommodating is another term used for this strategy.
● If individuals and/or groups cannot meet the expectations exacted ○ The person neglects his/her own needs to meet the goals of
on them, they become disenchanted. the other party. It is more powerful, or when the issue is ore
4. Interpersonal conflict important to someone else.
● Happens between two or more people with differing values, goals, ● Employees who use accommodation as a primary conflict
and beliefs. management strategy often develop resentment.
● Example: 5. Smoothing
○ Informational differences ● Is used to manage a conflict situation. It occurs when one party in
○ Role incompatibility because of differences between goals a conflict attempts to pacify the other party or those focus on
and responsibilities assigned to an individual and what the agreements rather differences.
individual be doing. ● Managers often use smoothing to get someone to accommodate
or cooperate with another party.
● Smoothing rarely results in resolution of the actual conflict.
○ This accomplished by complimenting one’s opponent,
downplaying differences, and focusing on minor areas of
agreement.
6. Collaboration
● Inspire mutual attention to the problem and utilizes the talents of
5. Covert conflict all parties. It focuses on problem solving to find mutually satisfying
● Is more dangerous because it is not what it appears on the solution.
surface. ● All parties set aside original goals and work together “win-win”
● It results in harbored feelings that drain both physical and solution, establish a subordinate or priority common goal. This is
psychological energy. the most effective method in conflict management.
ACCORDING TO RELATIONSHIP ● Collaboration enhances a person’s participation indecision making
to accomplish mutual goals.
6. Vertical conflict 7. Forcing
● Differences in opinions between superiors and subordinates are ● Is a method that yields an immediate end to the conflict but leaves
caused most often by inadequacy in communication, opposing the cause of the conflict unresolved.
interests, and lack of shared perceptions and attitudes
BASIC RULE ON MEDIATING A CONFLICT BETWEEN 2 OR
7. Horizontal or line and staff conflict
MORE PARTIES
● It happens as a common struggle or strife between departments or
services wherein the degree of interdependence and collaboration ● Establish clear guidelines and make them know to all.
determines the success in achieving shared goals and objectives. ● Do not postpone indefinitely. Select a time that is best for all
● Example: parties.
○ Lack of consensus between these departments and the clash ● Create an environment that makes people comfortable to make
of personalities also affect teamwork, Venzon, (2016). suggestions.
● Keep a two-way communication. Encourage full expression of
CONFLICT MANAGEMENT
positive and negative feelings with an accepting atmosphere.
● Management of conflict is one of the important roles of a nurse’s ● Stress a peaceful resolution rather than confrontation.
manager’s job. There are some common conflict management ● Build a bridge of understanding.
● Emphasize shared interests.

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strategies/ approaches to management conflict.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 22

 ○ Examine solutions and select the most acceptable to both ● The controlling process opens opportunities for improvement and
parties. compares performance against set standards. It provides
● Follow up on the progress of the plan. information about how well processes and people function so they
○ Give feedback to participants regarding their cooperation in can be motivated to perform better in the future.
resolving the conflict. ● The means of good performance and management includes
● In conflict management keeps conflict from escalating, makes leadership and commitment, full employee involvement, good
work productive, and helps translate conflict into a positive or planning, sound strategy implementation, measurement and
constructive force. evaluation, control and improvement, and achievement and
sustenance of standards of excellence, Venzon, (2016).
TIME MANAGEMENT
REASONS FOR CONDUCTING EVALUATION
● …nothing is particularly hard if you divide it into small jobs.
-Henry Ford- ● Evaluation plays an important role in quality and productivity
● …things which matter most must never be at the mercy of things improvement for several reasons.
that matter least. -Johann Wolfgang von Goethe ● It ensures that quality nursing care is provided.
● Time management defined as making optimal use of available ○ It allows for the setting of sensible objectives and ensures
time. Oftentimes managers complaint or keep telling they don’t compliance with them.
have enough or lack of time in accomplishing such goals. They ○ It provides standards for establishing comparisons.
always argue that there is not enough time in the day to do ○ It promotes visibility and means for employees to monitor
everything that must be done. The problem that this individual is their own performance.
time poor., rather that problem is poorly using of time. One of the ○ It highlights problems related to quality care and determines
strategies in managing the time is learn to prioritize duties, the areas that require priority attention.
managing and controlling crisis, reducing stress and balancing ○ It provides an indication of the costs of poor quality
work and personal time, (Marquis and Houston,2017). ○ It justifies the use of resources.
○ It provides feedback for improvement.
TIME MANAGEMENT PRINCIPLES
EVALUATION PRINCIPLES
● There are several time management principles that can be used
to plan effectively. ● In order that employees may be evaluated accurately and fairly,
a. Planning anticipates the problem that arise from actions without certain principle must be observed.
thought. ○ Evaluation must be based on the behavioral standards of
b. Tasks to be accomplished should be done in sequence and performance which the position requires.
should be prioritized according to importance. ○ Evaluating performance, there should be enough time to
c. Setting deadlines in one’s work and adhering to them is an observe employee’s behavior.
excellent exercise in self-discipline. ○ Employees should be given a copy of the job description,
d. Deferring, postponing, or putting off decisions, actions, or performance standards, and evaluation form before the
activities can become a habit which oftentimes causes lost scheduled evaluation conference. Areas needing
opportunities and productivity, generating personal or improvement must be prioritized to help the worker upgrade
interpersonal crises. his/her performance.
e. Delegation permits a manager to take priority for decision making ○ Evaluating conference should be scheduled and conducted
and to assign tasks to the lowest possible consistent with his/her at a convenient time for rater and the employee under
judgment, facts, and experience, (Venson, 2016). convenient time for rater and the employee under evaluation,
in pleasant surroundings, and with ample time for discussion.
TIME SAVING TECHNIQUES, DEVICES, AND METHODS TO ○ Evaluation report and conference should be perceived and
BETTER USE OF TIME accepted as a means of improving job performance.
1. Conduct an inventory of your activities. Logging your activities for CHARACTERISTICS OF AN EVALUATION TOOL
one day would show how much time is usually spent on each Evaluation tool should be:
activity.
2. Set goals and objectives and write them down. Set priorities. Plan Objective
on making things happen rather than reacting to crises. ● Objectivity means that the evaluation tool is free form bias
3. With the use of calendars, executive planners, logs or journals, Reliable,
write what you expect to accomplish yearly, monthly, weekly or ● Reliability refers to the accuracy or precision of the toll such that it
daily. will produce the same results if administered twice.
4. Breakdown large projects into smaller parts. Valid
5. Devote a few minutes at the beginning of each day. ● Validity refers to the relevance of the measurement to the
6. Organize your work space so its functional. Sort paper work on performance of the employee.
your table according to priority. Sensitivity
7. Close your door when you need to concentrate. Agree on a period ● That the instrument can measure fine lines of differences among
of quiet office time. the criteria being measured.
8. Learn to delegate. 5 BASIC COMPONENTS OF THE CONTROL PROCESS
9. In a meeting, define the purpose clearly before starting. Distribute
the agenda in advance and control interruptions during the ● Established of standards, objectives, and methods for measuring
meeting. performance;
10. Take or return phone calls during specified time. Maintain a ● Measurement of actual performance;
telephone log so you can return calls at a time. ● Comparison of results performance using standards and
11. Develop effective decision-making skills. Do no afraid to say “no”. objectives and identifying strengths and areas for correction
12. Take a rest breaks and make good use of your spare time. and/or improvement;
Reward yourself periodically, (Venson, 2016) ● Action to reinforce strengths or successes; and
● Implementation of corrective action as necessary.
3 STEPS TO TIME MANAGEMENT
ESTABLISHED OF STANDARDS FOR MEASURING
a. Allow time to planning and establish priorities. PERFORMANCE
b. Complete the highest task whenever possible and finish one task
before beginning another. Standards are desirable sets conditions and performance necessary to
c. Reprioritize based on the remaining tasks and on new information ensure the quality of nursing care services which are acceptable to
that may have been received. those instrumental to or responsible for setting and maintaining them
There are three types of performance standards: structure,
CONTROLLING process and outcomes.
1. Standards on structure are those that focus on the structure or
● Controlling or evaluating is an ongoing function of management
management system used by the agency to deliver care.
which occurs during planning, organizing, and directing activities.
2. Process standards refer to decision and actions of the nurse
It includes assessing and regulating performance in accordance
relative to the nursing process which are necessary to provide
with the plans adopted, the instructions issued, and the principles

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good nursing care.
established.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 23

3. Outcome standards are designated to measure the results of personnel at all aspects of the evaluation process increases
care provided in terms of changes in the health status of clients belief in its fairness and accuracy, establishes a commitment
served; changes in the level of their knowledge, skills, and to the evaluation, and increase motivation to utilize the results
attitudes; and satisfaction of those served including the members for improvement.
of the nursing and health team, Venzon, (2016). 2. Direct application of the rated performance to performance
standards and objectives expected of the worker.
MEASURING ACTUAL PERFORMANCE ● Predetermined toles for each member of the health team and
● Measurement of performance is an on-going, repetitive process the set goals in terms of behavioral objectives and success
with the actual frequency on the type of activity being measured. criteria (e.g. job description and procedure manual) should be
● For example, nursing care to patients is continuously monitored, established.
whereas, a formal performance appraisal may be done only twice 3. Development of behavioral expectations which have been
a year. mutually agreed upon by both the rater and the worker.
● Measurements may be scheduled in advance, may be done ● Participation in the formulation of goals motivates workers to
periodically but unannounced intervals, or may occur at random. work towards their accomplishment.
The purpose of measurement should be clarified about the task 4. Understanding the process and effective utilization of
and levels of are that need attention. procedures by the rater.
● Training in the appraisal process should be provided by the
COMPARING RESULTS OF PERFORMANCE WITH employer through inservice education.
STANDARDS AND OBJECTIVES 5. Rating of each individual by the immediate supervisor.
● Appraisal is more accurate when data are familiar with the
● Comparing the results of performance with standards and actual performance of the worker.
objectives is one of the easiest steps in the control process. 6. Concentration of the strength and weaknesses to improve
● Its performance matched standards and objectives, managers are individual performance.
assured that the needs of patients are met. However, if ● Reinforcement of strengths in performance encourages the
performance is contrary to standards and objectives set, then worker to further improve.
necessary action should be taken. 7. Encouragement feedback from the rated employees about their
performance needs and interests.
Reinforcing Strengths or Successes and Taking Corrective ● The immediate supervisor if better equipped to understand
Action as Necessary each worker. He / She does this by observation, questioning,
and listening
● Positive feedback stimulates motivation consistent high 8. Provision for initiating preventive and corrective action and
performance, and growth of the employee. Corrective actions are making adjustments to improve performance.
applied to improve performance ● The primary goal in the performance of all workers should be
to provide quality service to all clients.
Responsibility of the Head / Senior Nurses
Methods of Measuring Performance
● Being at the first level of supervision, the Head or Senior Nurses
know best whether their staff nurses perform satisfactorily at work. ● Methods of performance may be done both formally or informally.
Their influence has an impact on promoting quality care to Informal appraisal may consist of incidental observation of
patients. performance while the worker is engaged in performing nursing
● They have the responsibility to instruct subordinates regarding the care of responses made by the worker during conferences.
appropriate methods and procedures in providing nursing care. ● Interaction of worker with client, their families, visitors, and
● The feeling of responsibility to render quality performance must co-workers should also be noted. Formal appraisal is
be instilled in all employees for them to follow agreed upon written accomplished regularly and methodically by collecting objective
procedures and use materials and equipment correctly as fact that can demonstrate the difference between what is
instructed. expected and what was done.
● These methods include:
PERFORMANCE APPRAISAL ○ essay,
○ checklist,
● A control process by which employee’s performance is evaluated ○ ranking,
against standards. It is the most valuable tool in controlling human ○ rating scales,
resources, Venson, (2016). ○ forced-choice comparison, and
IMPORTANCE OF PERFORMANCE APPRAISAL ○ anecdotal records.

1. Determine salary standards and merit increases; ESSAY

2. Select qualified individuals for promotion or transfer; ● The appraiser writers a paragraph or more about the worker’s
3. Identify unsatisfactory employees for demotion or determination; strengths, weakness, and potentials. It is also difficult to make
4. Make inventories of talents within the institution; comparisons because the essays touch on different aspect of a
5. Determine training and developmental needs of employees; worker’s performance. It may also concentrate on those areas of
6. Improve the performance of work groups by examining improving, performance for which the supervisor has strong feelings.
and correcting interrelationship between members;
7. Improve communication between supervisors and employees and CHECKLIST
reach an understanding on the employees and reach am
understanding on the objectives of the job; ● A checklist is a compilation of all nursing performances expected
8. Establish standards or supervisory performance; of a worker. The appraiser’s task is to mark the appropriate
9. Discover the aspirations of employees and reconcile these with column whether the worker does or does not show the desired
the goals of the institutions; behavior. A quick glance at the completed form would reveal the
10. Provide “employee recognition “for accomplishments; and overall quality of the nurse’s performance.
11. Inform employees “where they stand.” RANKING
Factors Contributing to an Effective Performance Appraisal ● Is simple ranking, the evaluator ranks the employees according to
System how he/she fared with co-workers with respect to certain aspects
The controlling process is used to promote positive and favorable of performance or qualification. For example, Nurse A may rank
activity. Recognizing the common purposes for which the performance lowest in educational requirements for the next higher position
evaluation system has been created, nurse managers have the among five candidates for promotion but may rank first in clinical
responsibility to maintain a favorable climate that will lead to job proficiency. Nurse B may rank first in educational qualification but
satisfaction. may rank third in clinical proficiency.
Some factors contributing to a successful performance appraisal RATING SCALE
system are the following:
1. Compatibility between criteria for individual evaluation and ● A rating scale includes a series of items representing the different
organization goals. tasks or activities in the nurse’s job description or the absence or

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● The elements of the performance evaluation system should presence of desired behaviors and the extent to which these are
be agreed upon at each level of management, involvement of possessed.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 24

● Example:
a. On a scale of 1 to 5, indicate the degree of the nurse’s skill in PRINCIPLES OF QUALITY INSURANCE
assessing the patient’s condition where each of the a. All health professionals should collaborate in the effort to measure
corresponding possessed. an improve care.
5 - Excellent b. Coordination is essential in planning a comprehensive quality
4 - Very Satisfactory assurance program.
3 - Moderately Satisfactory or Average c. Resource expenditure for quality assurance activities is
2 - Minimally Satisfactory appropriate.
1 - Unsatisfactory d. There should be focus on critical factors such as functions and
b. A descriptive graphic rating scale may be used to describe activities that promise to yield the greatest health and financial
punctuality in reporting for duty such as: benefit to reveal significant findings.
1 - Oftentimes late e. Quality patient care is accurately evaluated through adequate
2 - Sometimes late documentation.
3 - Always report on time f. The ability to achieve nursing objectives defends upon the optimal
FORCED-CHOICE COMPARISON functioning of the entire nursing process and its effective
monitoring.
● In this method, the evaluator is asked to choose the statement g. Feedback to practitioners is essential to improve practice.
that best describes the nurse being evaluated. The items are so h. Peer pressure provides the impetus to effect prescribed changes
grouped that the evaluator is forced to choose from favorable as based on the results of assessment and needed improvements on
well as unfavorable statements and to counter the tendency the quality of care.
towards leniency by some evaluators i. Reorganization in the formal organizational structure may be
● Example: required if assessment reveals the need for a different pattern of
○ Select the statement that best describes the nurse being health care.
evaluated and the statement that least described him/her: j. Collection and analysis of data should be utilized to motivate
1 - Respect the ideas of orders remedial action.
2 - Limited communication ability
3 - Even-tempered QUALITY ASSURANCE AND PERFORMANCE EVALUATION
4 - Capable of enduring long hours of hard work ● Performance evaluation focuses on the worker.
5 - Tends to be loner ● It asks questions about how well the worker satisfies the
ANECDOTAL RECORDING requirements of his/her job within the organization.

● The anecdotal record describes the nurse’s experience with a QUALITY ASSURANCE METHODS
group or a person, or in validating technical skills and ● The primary purpose of QA programs in nursing is to measure
interpersonal relationship. and improve the quality of nursing delivered in the agency.
● Example: Methods used are concurrent and retrospective patient care
○ Miss A was on her way to take her lunch. She passed by a audits, patient care profile analysis, peer review, and quality
patient who was reaching for her food tray but was having a circles. Patient is the best, sometimes the only judge of the
hard time as this was placed on her left side. Her right hand interpersonal aspects of care, example, empathy and
had an intravenous line. Miss A stopped, positioned the food communication including the surroundings of patients care such
tray comfortably and assisted the patient to eat although she as rooms and foods oftentimes called the “hotel” services.
herself was late for lunch. Miss A acted in a commendable ● Patients satisfaction is an essential goal of health care and it’s the
manner. important part of quality care.
The anecdotal records should include
(1) a description of the particular occasion, DEVELOPING QUALITY ASSURANCE CRITERIA
(2) a delineation of the behavior noted including answer to the
questions who, what, why, when, where, and how, and ● Structure, process and outcome, or any combination of these are
(3) the evaluators’ opinion or assessment of the incident or behavior. common approaches to evaluation.
Structure approach
● The descriptive notes are organized to get impressions of the ● includes physical setting,
overall behavior in a given period. Caution should therefore be ● instrumentalities, and
taken against the tendency to note negative more often than ● conditions through which nursing care is given such as
positive behavior. ○ the philosophy and
○ objectives,
QUALITY ASSURANCE ○ the building,
○ organizational structure,
● According to Venzon assurance is achieving a sense of ○ financial resources and
accomplishment and implies a guarantee of excellence. While ○ equipment.
quality is the degree of excellence. In order for the organization to Process Approach
be truly effective, each must work together. To provide quality of ● includes the steps in the nursing process incompliance with
service, workers must accept the responsibility that they have to established standards of nursing practice.
do the right thing/job the first time and every time. Each have to Outcome Approach
accept the quality is everyone’s responsibility, Venzon, (2016). ● identifies desirable changes in the patient’s health status such as
● Quality of care is the degree to which health services for ○ modification of symptoms,
individuals and population increases the likelihood of desired ○ signs,
health outcomes and consistent with the current professional ○ knowledge,
knowledge. It is balance of benefits and harms to a client. ○ attitudes,
● Quality assurance is a process of evaluation that is applied to ○ satisfaction,
the health care system and the provision of health care services ○ skill level and
by health workers. It promotes collegial and sharing relationships ○ compliance with the treatment regimen
among workers instead of a feeling of threat when observed and
evaluated, Venzon, (2016). NURSING ADULT COMMITTEE
● Quality improvement program in an organization is the umbrella
program that extents the many areas for the purpose of ● A nursing audit committee is composed of representative from all
accountability to the consumer and the payor. The program levels of the nursing staff: a member of the training staff,
continuous, ongoing measurement and evaluation process that supervising nurse, head nurse/senior nurse, and a staff nurse.
includes structure, process, and outcome. ● In smaller hospitals, the chief nurse or his assistant may be a
● Indicators are valid and reliable quantitative measures of member of this committee
structure, process, and outcome that are related to one or more
dimensions of performance. It refers to measure of performance. PATIENT CARE ADULT
Clinical Indicators relate to clients. Indicators may be focused on ● Patient care audits may be concurrent or retrospective.
service, practice, or governance.

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● A concurrent audit is one which patient care is observed and
evaluated.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 25

Given through: Mutual Beneficial Supplier Relationships
● a review of patient’s charts during confinement ● An organization and its suppliers are interdependent and a
● observation of the staff as patient care is given mutually beneficial relationship enhance the ability of both to
● inspection of patients and/or observation of the effects of patient create value.
care where the focus is on the patient, (done during the rounds or
patient interview. STRATEGIES IN TQM
Retrospective audit is one which patient care is evaluated Internal Processes
through: ● A comprehensive quality management program is based on real
● review of discharged patient’s charts and evidence from within your organization.
● questionnaires sent to or interviews conducted on discharged Cost Reduction
patients. ● Cost reduction, particularly in large-scale organizations, is often
one of the most effective fixes for organizational performance
PEER REVIEW improvement.
● The newest addition to performance appraisal tools, the Environmental effects
360-degree evaluation, includes an assessment by all individual ● QM strategies can help you to analyze your organization’s effect
within the spere of influence of the individual being appraised. on the environment, whilst focusing on processes that can
● For example: minimize your environmental impact.
○ The 360-degree evaluation of a ward clerk or unit secretary Regulatory compliance
might include feedback from the nursing staff, from patients, ● Regulatory compliance can be built your quality management
and from staff from other departments who interact with that strategy to ensure requirements are dealt with proactively.
individual on a regular basis. Most 360-degree feedback
tools include self-assessment. CONTINUOUS QUALITY IMPROVEMENT (CQI)
● It is a process through which the level of quality I defined,
QUALITY CIRCLES pursued, achieved and continuously improved through the
● Quality circles are one of the most publicized approaches to establishment of formal mechanism/systems and structures within
quality control. It is defined as: the organization.
○ a group of workers doing similar work who meet regularly ● Continuous quality improvement (CQI) is a process of
and voluntarily on normal working time, under the leadership continuously improving a system by gathering data or
of their supervisor, to identify, analyze, and solve work performance and using multi-disciplinary team to analyze the
-related problems and to recommend solutions to system, collect measurements, and propose changes.
management. QUALITY IMPROVEMENT PLANS (QIP)
Utilization of Results
● The results may be given orally or written and is directed to the ● It is an organization’s framework for developing and improving
nursing staff in the unit who administers the care or their processes. It includes the direction, timeline, activities, and
immediate supervisors. assessment measures of quality and quality improvement within
● Consistent positive findings deserve a commendation from the the organization.
nursing service. Negative feedback should tactfully be conveyed ● Every hospital is expected to set targets aimed at making
in a face to face situation so that assessment results may easily improvements in the areas of Safety, Effectiveness, Access and
be clarified. Patient-Centeredness.
● The aim of QIP is to help providers self-assess their performance
QUALITY MANAGEMENT (QM) in delivering quality education and care, and to plan future
improvements
● It is defined as a formalized system that the documents the
● QIP also helps help regulatory authorities with assessing the
structure, responsibilities and procedures required to achieve and
quality of the service.
deliver a quality product.
● Things to include in QIP
● It describes the standards, quality practices, resources and
○ Plan improvement initiative
processes pertinent to an organization.
○ Methods
TOTAL QUALITY MANAGEMENT (TQM) ○ Process measures
○ Target for process methods
● It is a way to ensure customer satisfaction by involving all ○ Comments
employees in the improvement of the quality of every product or
service. SAMPLE OF QIP
● It aims to reduce waste and cost or poor quality. It is a structured The goal is to deliver safe, high-quality care to patients in all
system for involving an entire organization in continuous quality critical settings.
improvement process targeted to meet and expected outcomes
● Patient Centered Care
PRINCIPLES OF QUALITY IMPROVEMENT ○ Falls and injuries
○ Pressures Ulcers
Leadership ○ Ventilators Associated Pneumonia (VAP)
● Leaders establish unity of purpose and direction of the ○ Intravascular Catheter-Related Infections
organization. ○ Preventing Other health care Associated Infections
Customer Focus ● Opportunities for Patient Safety and Quality Improvement
● Organizations defend on their customers and there should ○ Reducing Medication Errors
understand current and future customer need. ○ Dandoffs
Process Approach ● Working Conditions and Work Environment for Nurses
● A desired result is achieved more efficiently when related ○ Nurse fatigue and stress
resources and activities are managed as a process. ○ Nursing Turnover
Involvement of People ○ Teamwork
● People at all levels are the essence of an organization and their ○ Nursing Workload and Patient Safety
full involvement enables their abilities to be used for the ● General Resources on Nursing and Quality of Care
organization benefit.
System Approach PRINCIPLES OF QUALITY IMPROVEMENT
● Identifying; understanding, and managing a system of interrelated To achieve different level of performance and improve quality,
processes for a given objective improves the organizations an organization’s current system needs to change.
effectiveness and efficiency.
1. Work as systems and processes
Continuous Improvement
● To make improvements, an organization needs to
● Continual improvement should be a permanent objective of the
understand its own delivery system and key processes.
organizations.
2. Focus on Patients
Factual approach to decision making
● An important measure of quality is the extent to which
● Effective decisions are based on the analysis of data and
patients’ needs and expectations are met.

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information.
3. Focus on Being Part of the Team.

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 26

 ● QI is a team process, a team harnesses the knowledge, cause for dismissal conforms with the criteria of a major discipline
skills, experience, and perspective of different individuals violation as contained in the policy manual, and for government
within the team to make lasting improvements. employees, those contained in the Civil Service Rules and
4. Focus on use of the data Regulations and the codes of conduct.
● Data is the cornerstone of QI. ● A review is usually done by higher management. In the case of
● It is used to describe how well current systems are working; government employees, this is further reviewed by their
what happens when changes are applied, and to document respective departments and final affirmation is done by the Civil
successful performance. Service Commission.

DISCIPLINARY TERMINOLOGIES
● Part of the controlling process in management is discipline. ● Benchmarking is a tool to assist quality of care decision making.
Discipline meant rigid obedience to rules and regulations, the It is a continuous process of measuring what exists against the
violation of which resulted in punitive actions. best in search for industry best practices.
● Today, discipline is regarded as a constructive and effective ● Best practice is a service, function, or process that has been
means by which employees take personal responsibility for their fine-tuned, improved, and implemented to produce superior
own performance and behavior. This is termed as self-discipline outcome. It is an activity that lead to establishing benchmarks.
Some factors that influence self-discipline are: ● Sentinel event indicators measure low-volume but serious
● A strong commitment to the vision, philosophy, goals, and undesirable, and often avoidable process or outcome such as
objectives of the institution. Strong commitment result in falls and medication errors.
cohesion and teamwork which in turn encourage within the
organization.
● Laws that govern the practice of all professionals and their
respective Codes of Conduct. Week 11: APPLICATION OF RESEARCH IN
○ For all government employees, in Civil Service Rules and NURSING LEADERSHIP AND MANAGEMENT
Regulations as provided for in P.D. 807 and the Code of
Conduct for Public Officials, R.A. 6713, are also to be
complied with. STUDY GUIDE
● Understanding the rules and regulations of the agency. All ● The Integration of research evidence into our clinical nursing
employees are oriented on the rules, regulations, and policies of practice is important for the delivery of high-quality and safe
the agency. An atmosphere of mutual trust and confidence. nursing care. The behaviours of nurse managers, nurse leaders
● Pressure from peers and organization. Social pressures from and administrators have been identified as vital to support
co-workers and the organization demand that workers perform research use and evidence-based practice. However minimal
their jobs to the beat of their abilities evidence exists indicating what constitutes effective nursing
DISCIPLINARY APPROACHES leadership for this purpose, or what kinds of interventions.
● The purpose of application of researches in nursing leadership is
● A sound disciplinary program must be tailored to the objectives of to describe leadership activities of nurse managers that influence
the institution. This should include a set of disciplinary policies nurses' use of research evidence. And to identify interventions
and procedures, a uniform application of disciplinary rules, a aimed at supporting nurse managers to influence research use in
disciplinary committee, and an orientation program for all new clinical nursing practice and what decision made help leaders to
employees where expectations of appropriate performance and successfully influence research-based care.
behavior are emphasized. Research
● Successful implementation of disciplinary action is characterized ● Helps nurses determine effective best practices and improve
by promptness, fairness, impartiality, no punitiveness, advance patient care.
warning, and follow – through. ● Research also helps nursing respond to changes and challenges
● Effective supervision aids supervisors in analyzing the work in the healthcare environment, individual, family, patient and
problems of their subordinates. Counseling becomes part of an group populations and government regulations. Researchers
oral warning session before resorting to a disciplinary action. make discoveries, the practice of nursing continues to change
and nurses is innovative.
DISCIPLINARY ACTION ● In this complex world of 1st century, the role of nurse
● Any employee charged for breach of the rules and regulations, continuously evolved significantly. Nurses work in a variety of
policies, and norms of conduct shall be given due process. settings, the hospital, the classroom, the community health, the
● There must be existing rules of conduct governing his/her business sector, home health care, and the laboratory among the
behavior and a documentation of actual violation of such rule many.
must support charges. ● Though each role carries different responsibilities, the primary
● The employee charge must be notified in writing about the goal of a professional nurse remains the same: to be the client's
violation and given the right to counsel. advocate and provide optimal care on the basis of evidence
● Disciplinary action should be progressive in nature such as obtained through research.
counseling and oral warning, written warning, suspension, and ● Research is typically not among the traditional responsibilities of
dismissal an entry-level nurse. Many nurses are involved in either direct
patient care or administrative aspects of health care.
COUNSELING AND ORAL WARNING ● Nursing research is a growing field in which individuals within the
profession can contribute a variety of skills and experiences to the
Counseling and oral warning are best given in private and in an science of nursing care.
informal atmosphere. The employee is given a fair chance to air his/her ● There are frequent misconceptions as to what nursing research
side. is. Some individuals do not even know how to begin to define
WRITTEN WARNING nursing research.
● According to Polit and Beck (2006), nursing research is:
A written warning is the second step in disciplinary action. It is - systematic inquiry designed to develop knowledge about
preceded by an interview similar to the oral warning. issues of importance to nurses, including nursing practice,
nursing education, and nursing administration.
SUSPENSION
PATIENT SATISFACTION
● Suspension over minor violation is given after an evidence of oral
and written warnings. Although a violation is a major infraction, ● Patient satisfaction is an important and commonly used
suspension, rather than dismissal is applied when management indicator for measuring the quality in health care.
feels that the employee can still be rehabilitated. - affects clinical outcomes, patient retention, and medical
● Accurate documentation of oral and written warnings including malpractice claims.
suspension, if done, are necessary evidence of due process. - affects the timely, efficient, and patient-centered delivery of
quality health care.
DISMISSAL
● A study extends previous research in client satisfaction by

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● Dismissal is invoked only when all other disciplinary efforts have showing how a patient satisfaction study can help answer
failed. The Disciplinary Committee should be very sure that the questions, such as why client is satisfied or dissatisfied, whether

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 27

 the health care complaint handling is effective and how to improve 4. Refine the general question, formulating a specific research
clients' satisfaction. question(s).
● Researchers helps improve client satisfaction. 5. Consider your reasons for conducting preliminary research and
- Researchers demonstrated that there are differences in determine the form it should take.
satisfaction levels among different genders. To explore a. If you want to evaluate the feasibility of carrying out the
further the reasons for these differences, a research made it planned protocols and interventions of an anticipated larger
separated to compare the specific causal links between the study with randomization of participants, conduct a
two gender samples and to draw broader inference from the randomized pilot study.
results. Some findings provide support for the application of b. If you want to evaluate the feasibility of using all or part of an
CS study to derive customer knowledge, which also reveals intervention—and, possibly, other processes—in a proposed
some interesting suggestions for future research. larger study, but without randomizing participants, conduct a
nonrandomized pilot study.
ACTION RESEARCH c. If you want to evaluate aspects of data collection, data
management, the adequacy of resources to carry out a
● In the health Care settings, the leadership, interpersonal, and study, or other processes to be undertaken in an anticipated
management skills needed to manage such change effectively future trial (excluding the specific intervention and exact
within multi-professional in a variety of health care settings. It protocol) with a small sample, conduct a feasibility study that
provides unique use of action research as a model for planning is not a pilot study.
and implementing change at the patient-service interface. It also 6. Design the study.
makes use of evidence and case studies to demonstrate the a. Choose a research design (cross-sectional, cohort, or
stages of the change process Includes tips and useful strategies correlation, for example).
for achieving change. b. Determine setting, sample size, recruitment strategy,
● A dynamic change can be achieved at the individual, team, randomization (if appropriate), instruments, data analysis,
departmental and organizational level it covers a range of topics and procedures.
including: organizational culture; leadership; conflict resolution; c. Ensure protection of human subjects (submit plan for
managerial roles; and organizational analysis institutional review board approval).
7. Collaborate with stakeholders at the setting to minimize disruptions
MANAGING CHANGE IN HEALTHCARE
and obtain support.
● Managing Change in Healthcare is ideal for all nursing and allied 8. Carry out the study.
health care trainees taking courses in management and 9. Analyze the results.
leadership. It will also be invaluable for qualified professionals and 10. Relate the findings to plans for a future study.
managers who need a clear and engaging guide To the key a. Do results suggest it is worthwhile to pursue the study as
issues and skills underpinning effective healthcare management. planned?
Below is an example of Action Research that can be applied with b. Do results provide data suggesting it would be important to
Nursing leadership and Management. modify aspects of this study to improve the anticipated larger
study?
c. Do results provide the data needed to propose a larger study
as planned?
11. Disseminate your findings.

JOURNAL SHARING AND REACTION ON SHARED

GOVERNANCE
● Reflective journaling is a term that refers to documenting your
ideas, personal thoughts and experience through writing.
● Reflective writing is a valued tool for teaching nursing students
and for documentation, support, and generation of nursing
knowledge among experienced nurses.
● Expressive or reflective writing is becoming widely accepted in
both professional and lay publications as a mechanism for coping
with critical incidents. Reflective journaling is a comfortable
medium for nurses to be more open about their journey and
experience.
● Nurses can choose to write a scientific type of reflection, or
introspective – that which relates to their thoughts, feelings and
beliefs about their experience.
● Introspection can help increase self-confidence, creativity and the
joy of learning in an environment that is open, honest and
nonjudgmental.
● Reflective journaling can also be a great way to map a nurse’s
progress and achievements in his or her nursing/clinical education
as well as in their career. It lets them look back and analyze
thought patterns, which in turn would help them to value their own
FEASIBILITY STUDIES
learning and growth progress.
● Feasibility studies can provide such data and this can validate SHARED RESPONSIBILITY FOR IMPLEMENTING
study procedures or identify procedures in need of revision. All of EVIDENCE-BASED PRACTICE
this information is helpful in convincing a funding agency that a
study is worthy of support. ● Evidence-based practice (EBP) is the process of collecting,
● It will encourage you to consider research value and discuss how processing, and implementing research findings to improve
you might conduct such work yourself or support this type of clinical practice, the work environment, or patient outcomes.
inquiry. Example of a feasibility study conducted in preparation for ● According to the American Nurses Association (ANA)
an anticipated future study exploring the relationship between - nursing interventions should be practical, methodical
RNs and family caregivers of hospitalized older adults decisions based on EBP research studies. Utilizing the EBP
Step-by-Step Guide to Feasibility Research approach to nursing practice helps us provide the highest
1. Identify a problem and/or a question. quality and most cost-efficient patient care possible.

🍎🍓🍑🍒🌶️
2. Review the literature. ● When evaluating EBP nursing research studies, focus on these
3. Identify gaps in our knowledge. four criteria:

(Shane, Mae, Rocette, Mary, Khlaryzel) pg. 28

 a. validity - the legitimacy, accuracy, and soundness of all
aspects of the study
b. reliability - the extent to which a measurement's result is
consistent
c. relevance - the logical connection between two ideas, tasks,
or events
d. outcome - the conclusions reached through the process of
research.
● Facilitating EBP is a shared responsibility of the professional
nurse, the organization, leader-managers and the education or
staff development department.
● The management team should set the example by supporting and
acknowledging nurses who participate in, publish, or otherwise
share new EBP research data that may benefit nurses and
patients in their facilities and the community. As the field of
nursing continues to evolve, nurses must become proficient in
evaluating, participating in, and sharing EBP research with our
healthcare team to improve clinical practice and patients'
outcomes.
TRAINING NEEDS ANALYSIS
● Training Need Analysis is a process in which the company
identifies training and development needs of its employees so that
they can do their job effectively. It involves a complete analysis of
training needs required of various levels of t organization.
● It is a process which helps the organization review the state of
their training. Its importance is to helps them to determine all the
training needs to be completed in a certain period to allow their
team to complete their job as effectively as possible.
● The purpose of training needs analysis is to identify performance
requirements and the knowledge, skills, and abilities needed by
an agency’s workforce to achieve the requirements. An effective
training needs assessment will help direct resources to areas of
greatest demand.
Three Levels of Training Needs Analysis
1. Organizational Analysis
- TNA at the organizational level
- Ex: SWOT analysis
2. Task Analysis
- tasks to be performed on the job are analyzed
- knowledge, skills, and abilities needed to do those are also
analyzed
3. Individual Analysis
- who needs to be trained and what training is needed

There are 3 key steps involved in training needs analysis to ensure

your business is making the most of the process:
1. Decide On Skill Sets
- To decide on the skill sets that you require all your team
members to have in order to do their jobs properly.
2. Evaluate The Skills Of Staff
- To look at all your team members and evaluate their current
skill levels in relation to the skills you have laid out in the first
stage of this process.
3. Highlight The Skills Gap
- Know what the gap is, you need to use training to help close
that gap and ensure your team is at the level you expect
them to b

🍎🍓🍑🍒🌶️ (Shane, Mae, Rocette, Mary, Khlaryzel) pg. 29