N107A - NURSING LEADERSHIP and MANAGEMENT Directing

It is the issuing of assignments, orders, instructions that permit the worker to know what is expected of him, and the guidance and overseeing of the worker so that he can contribute effectively to the attainment of organizational objectives. It actuates efforts to accomplish goals.

1. Delegation 2. Supervision 3. Coordination 4. Communication 1. DELEGATION is the process by which a manager assigns specific tasks/duties to workers with commensurate authority to perform the job - is a means of allocating and decentralizing authority, imposing responsibility and accountability and assigning tasks down to the lowest possible level at which there is sufficient competence and information for effective decision making on task performance. Basic Concept of Delegation 1. Authority the right to decide and command 2. Responsibility obligation to do what is asked 3. Accountability responsible / answerable for ones actions Matters that should not be delagated a. Overall authority, responsibility, and accountability(ARA) for satisfactory completion of all activities in the unit. b. Authority to sign ones name c. Evaluating the staff & giving corrective or disciplinary actions. d. Maintaining morale or words of encouragement. e. Too technical jobs 2. SUPERVISION Is a process of getting the work done through others which is done properly , on time and within the budget. Importance of Supervision (Concern-Purposed ) 1.It is concerned with people as well as the work area, working condition and work itself. 2.It is also concerned with the planning execution, and evaluation of work. 3.Orientation, training and guidance of individual according to their needs and is directed toward utilization of their capabilities and the development of new skill. 3. COORDINATION Coordination unites personnel and service to a common objective. Synchronization of activities with the various services and departments enhances collaborative efforts resulting in efficient, smooth, and harmonious work flow. Types of Coordination 1.Intradepartmental -coordination is usually within the department. 2.Interdepartmental -coordination between one department to another department. 3. Extra-installation -coordination is from hospital to another agency. Patients are often referred to the health center nearest their resident upon discharge from the hospital for follow up. 4. COMMUNICATION Is the process whereby a message is passed from sender to receiver with the hope that the information exchange will be understood as the sender intended. Elements of Communication 1. sender 2. message 3. receiver Lines of Communication 1. Downward higher to lower level - Traditional type, from superior to subordinate 2. Upward lower level mgt. to higher - in form of feedback, from subordinate that goes upward 3. Horizontal between hierarchal levels - Lateral communication that flows between peers, personnel or departments 4. Outward deals with info that flows from caregivers to the patients, their families & relatives, visitors

Elements of Directing

 1. 2. 3.

Types of Communication Verbal Communication Written Communication Non-verbal Communication

Grapevine communication an informal communication network It flows haphazardly between people at all hierarchal levels. It involves 3-4 people at a time. Subject to error and distortion. The sender has little accountability for the message. Types of Non-verbal Communication 1. Personal appearance the appearance of a person gives the general impression of his personality and self concept. Nurses should always appear neat and clean. (proper decorum)They must carry their uniforms with pride and dignity. 2. Intonation of the voice the intonation of the nurses voice should be soft and gentle. It should not be irritating to the ear. 3. Facial expression a friendly smile establishes immediate rapport with the client and invites trust and confidence in the nurse. 4. Posture and gait the nurses posture and gait indicate his physical wellness, his emotions, and attitude towards his clients. 5. Touch touch is a way of caring. A gentle touch conveys a caring person. A rough person indicates insensitivity to the patients and unresponsiveness to their needs. 1. 2. 3. 4. Modes of Communication used by Managers Written communication- electronic mail, memo Face to face communication- oral, direct Non- verbal- includes facial expression, body language Telephone- rapid & allows the receiver to clarify messages at the time it is given.

Assertive Behavior Conflict - A natural inevitable conditions and often a pre-requisite to change. - A consequence of real or perceived differences in goals, values, ideas, attitudes, beliefs, feelings and actions. LEVELS/Sources of CONFLICT 1. Intrapersonal 2. Interpersonal 3. Intragroup/Intergroup Types of conflict 1. Competitive Conflict occurs when two or more groups attempt the same goals and only one group can attain them. * Conflict is resolve by determining the set of rules. 2. Disruptive Conflict takes place in an environment filled with fear, anger and stress. * No mutually acceptable set of rules and the goal of each party is to eliminate the opponent. Conflict Management / Conflict Resolution 1. Win-win resolution- focus on goals and attempts to meet the needs of both parties. 2. Lose-lose resolution- one which neither side wins, the settlement reached is unsatisfactory to both sides. 3. Win-lose resolution/Dominance or Suppression this strategy represses rather than settles conflict, creates situation that the loser left angry and antagonistic. 4. Negotiation conflicting parties give and take on various issues. IV. CONTROLLING - Is an on going function of management occurring during planning, organizing & directing activities. - It is assessing/regulating performance in accordance w/ the plans that have been adopted, the instructions issued & the principles established. - Is the process by which managers assures that the actual expenditures & activities conform to plan. Importance of Controlling The controlling process plays an important role in: 1. identifying opportunities for improvement, 2. comparing performance against set standard, 3. providing information about how well processes and people are doing 4. so that they can be motivated to perform better in the future.

Controlling cont. Characteristics of an Evaluation Tool 1. It should be objective - objectivity means that the evaluation tool is free from bias. 2. It should be reliable - reliability refers to the accuracy or precision of the tool that if administered twice, it will produce the same results. 3. It should be valid - validity refers to the relevancy of the measurement to the performance of the employee. 4. It should be sensitive - sensitivity means the ability of the measured fine line differences among the criteria being measured. Control Process - It is a continuous flow between measuring, comparing and action. 4 STEPS in Control Process 1. Establishing Performance objectives and standard. 2. Measuring actual performance. 3. Comparing measured performances against established objectives and standards. 4. Taking necessary corrective actions. Standards the basic component of control process. - These are desirable sets of conditions & performance essential in ensuring the quality of nursing care services which are acceptable to those instrumental responsibilities in setting/maintaining them 3 Types of Standards 1. Structure are those that focus on the structure or mgt. system used by the agency to deliver care w/c includes the number & categories of nursing personnel, functions & physical facilities & equipment. 2. Process Standards refers to decisions & actions of the nurse relative to the nursing process w/c are necessary to provide good nursing care. These include assessment, plan of care, & nursing intervention. 3. Outcome Standards are designed to measure the results of care provided in terms of changes in the health status of clients served, changes in the level of their knowledge, skills & attitudes, & satisfaction of those served including the members of the nursing/health team. 1. 2. 3. Techniques for Monitoring and Measuring Service Nursing Rounds Quality Assurance Nursing Audit

Quality Control - is essentially the activities & techniques employed to achieve and maintain the quality of a product service or processes - conceived & assessment of the level of nursing care provided & its effects on the pt. through process & outcome - it includes monitoring activity but it is also concerned w/ finding & eliminating causes of quality problems so that the requirements of the costumer are continuously met. - level of nursing care provided is assessed in quality control. Focus of Quality Control: 1. pt./client/family satisfaction of nursing care 2. facilities & climate 3. methods used to deliver nursing care 4. outcome of nursing care Measuring Actual Performance - Measurement of Performance is an on-going repetitive process w/ the actual frequency dependent on the type of activity being measured. Ex:- Nursing care of pt. is monitored continuously - Formal performance appraisal done only twice a yr. Measurements may be scheduled in advance or may be done periodic but unannounced intervals or may occur at random The purpose of measurement should be clarified & the staff should be informed so the tasks & levels of that need attention.

Performance Appraisal It is a control process in which employees performance are evaluated against standards. It is the most valuable tool in controlling human resources & productivity. It evaluates how well the nursing personnel have performed during a specific period of time.

Purposes of Performance Appraisal 1. Determine salary standards & to merit increases 2. Select qualified individuals for promotion or transfer. 3. Identify unsatisfactory employees for demotion or termination. 4. Make inventories of talents within the institution. 5. Determine training & developmental needs of the employees. 6. Improve the performance of work groups by examining, improving, and correcting interrelationship between members. 7. Improve communication between supervisor & employee 8. Establish standards of supervisory performance. 9. Discover the aspirations of employees & to reconcile this with the goals of the institution. 10.Provide employee recognition for accomplishment. 11.Inform employees where they stand. Methods of Measuring Performance 1. Informal appraisal w/c consist of: a. Incidental observation of work performance while engaged in performing nursing care b. Responses made workers during conferences c. Noting the interaction of workers with the clients, their families, visitors & co-workers 2. Formal Appraisal is accomplished regularly & methodically by collecting objective facts that can demonstrate the difference between what was expected & what was done. 1. Essay - the Appraiser writes a paragraph or more covering the workers strengths, weaknesses & potentials Essay Appraisals carry significant weight on the presumption that an honest statement from someone who knows the person well is fully valid. 2. Checklists - contains compilation of all nursing performance expected of a worker. The appraisers task is to place a checkmark in the appropriate column whether the worker does or does not show the desired behavior. A quick glance at the completed forms would reveal the over-all quality of the nurses performance. 3. Ranking - In simple ranking, the evaluator ranks the employees according to how he or she talked w/ respect to certain aspects of performance or qualifications. Example: Nurse A may rank lowest in educational requirements for the next higher position among the five candidates for promotion but may rank first in clinical proficiency while nurse B may rank first in educational qualification but rank third in clinical proficiency. 4. Rating Scales - it includes a series of items representing the different tasks or activities in the nurses job description or the absence or presence of desired behavior & the extent to w/c these are possessed. Example: 1. On a scale of 0-5 indicate the degree of the nurses skill in assessing the pt. condition where each of the corresponding number means: 5 Excellent 2 Minimally satisfactory 4 Very satisfactory 1 - Unsatisfactory 3 Moderately satisfactory or average Example of Rating Scale 2. A descriptive graphic rating scale may be to describe punctuality in reporting for duty such as: 1 Often times late 2 Sometimes late 3 Always reports on time 5. Forced Choice Comparison The Evaluator is asked to choose from the statements that best describe the nurse being evaluated. The items are so grouped that the evaluator is forced to choose from favorable as well as unfavorable statements & to counterpart the tendency towards leniency of some evaluators. Example of Forced Choice Comparison:

Select from the following statements w/c will best describe the nurse being evaluated & the least describes him/her; 1. respects the ideas of other 2. communication ability 3. even-tempered 4. capable of enduring long hours of hard work 5. tends to be a loner 6. Anecdotal Recording - describes the nurses experience w/ a group or a person or in validating technical skills & interpersonal relationship. It should include: 1. description of the particular occasion 2. delineation of the behavior noted including who, what, why, when, where, & how. 3. evaluators opinion or estimate of the incident or behavior. The descriptive notes are organized to get impressions of the over-all behavior in a given period of time. Caution should therefore be taken against tendency not to give the negative behavior more often than the positive behavior. Example: Miss A was on her way to her lunch. She passed by a client who was reaching for his food tray but was in a hard time as this was placed on her left side. Her right hand had an IV line. Ms. A stopped positioned the food tray comfortably & assisted the patient to eat although she herself was late for lunch. Miss a acted in a commendable manner. Quality Assurance -assures patient of an acceptable standard of care provided for them. -A problem solving process that systematically assesses the quality of care & corrects any defect that is observed. -It is the estimation of the degree of excellence patient health outcomes & in activity & other resource outcomes. -is the measurement of the actual level of service provided plus the efforts to modify when necessary. (by William Some) Methods of Quality Assurance 1. Patient care audits a. Concurrent, open chart or Benedicter - is one in w/c patient care is observed & evaluated - a review of the patient charts while the patients are still confined in the hospital - observation of the staff as patient care is given - inspection of patient and/or observation of the effects of pt. care where the focus is on the patient (done during rounds or patient interview) b. Retrospective audits, Phaneuf or closed chart -is one in w/c patient care is evaluated through: 1. A review of discharged patients charts 2. Questionnaire last or interviews conducted on discharged patient 2. Peer review Peers (employees of the same profession, ranks & setting) may do patient care audits evaluating anothers job performance against accepted standard. 3. Quality Circles - is one of the most publicized approaches to quality introduced by Japanese - A group of workers doing similar work meets regularly, voluntarily, in normal working time, under the leadership of their supervisor, to identify, analyze and solve work-related problems & so recommended should implement the solution themselves. Nursing Audit Committee - is created & composed of a representative form all levels of the nursing staff 1. member of the training staff 3. Head/senior nurse 2. supervising nurse 4. Staff nurse Control of Resources Part of the control process is the periodic review of the utilization of materials & supplies in the various nursing units. Consumption of supplies & materials should be proportionate to the number of patient to be served be these in the form of dressing, treatment done, injection given, etc. Requisition of/or stocking a large number of supplies & materials should be avoided to prevent pilferage (steal), misuse or spoilage. A large order is merited (deserve) when in a large demand.

Know the average daily usage supplies. Order the correct materials. Checking inventory levels- to prevent stocking of items. All equipments utilization report is made including frequency of breakdown. This will help evaluate the quality of equipment purchased, the way it is handled, used & operated. Regular inspection of equipment to prevent breakdown and/or to detect needed repair. Monthly linen inventory is done to determine the adequacy of linen issued & utilized in the various units measures should be instituted to prevent losses. Absences due to leaves whether scheduled or not, should be analyzed as these may have implications for staffing. Provisions for relievers should be included in the staffing pattern to maintain quality service ___________ Discipline Part of the controlling process in management is discipline. In the past, discipline connotes rigid obedience to rules & regulations, the violation result to positive actions. Today, discipline is regarded as a constructive & effective means be w/c employees take personal responsibility for their own performance & behavior. This termed as self-discipline. Factors That Influence Self-discipline are: 1. A strong commitment to the vision, philosophy, goals, & objective - a strong commitment results in obsession & teamwork w/c in turn encourages greater conformity to expected norms of conduct within the organization. 2. Laws that governs the practice of all professionals & their respective Codes of Conduct - Among government employees, the CS Rules & Regulations as per P.D. 807 And the Code Of Conduct for Public Officials R.A. 6713 are also to be complied with. Factors That Influence Self-discipline are: 3. Understanding the rules & regulations of the agency - All employees are oriented to the rules, regulations & policies of the agency. Some organizations give their employees a handbook containing these & the possible sanctions for their infractions. 4. An atmosphere of mutual trust & confidence - self-discipline thrives best in an atmosphere of trust & confidence between superiors & subordinates. Subordinates will consult their superiors w/ their problems without fear. - the superiors trust their subordinates will do their best performing their job w/o being snoopervised - Any employee charged for break of the rules & regulations, policies, norms of conduct shall be given the corresponding due process. - There must be existing rules of conduct governing his behavior & an actual violation of such rule the employee charged must be notified in writing about the violation. He is given the right to be counseled. Disciplinary action should be progressive in nature such as: 1. Counseling & Oral warning - counseling & oral warning is best given in private & in an informal atmosphere - Employee is given a fair chance to air his side. The relevant facts are analyzed & evaluated against his past performance. He is then counseled regarding expectation of improved behavior/performance, ways of correcting the problem & a warning that a repetition of the same offense may warrant further disciplinary action. The employee commits to correct the behavior. - He is informed of any follow-up action that may be taken. 2. Written warning - is the second step in disciplinary action - it is preceded by an interview similar to oral warning. - he is told after the interview that he will be given a written warning, this includes: One. Statement of the problem Two. Identification of the rule w/c was violated 3. Suspension 4. Dismissal Nothing follows. NOTE: PLEASE STUDY HARDER. Your quizzes in directing and controlling will be included or given on the day of your unit and midterm examination as you have requested. But the coverage of the exam both unit and midterm long exam will be from planning to controlling. Goodluck! THANK YOU VERY MUCH!