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Nursing leadership and management



The Planning Process
Planning, a basic function of management, it is a principal
duty of all managers within the division of nursing It is a systematic
process and re!uires "nowledgeable activity based on sound
managerial theory The first element of management defined by #ayol
was planning $e defined it as ma"ing a plan of action to provide for
foreseeable future This plan of action must have unity, continuity,
fle%ibility and precision #ayol outlined the contents of a plan of action
for his business, a large mining and metallurgical firm This plan
included annual and &' year forecasts #orecasting ta"es advantage of
input from others It improves with yearly e%perience, gives se!uence
in activity and protects a business against undesirable changes #ayol(s
concept was that planning facilitates wise use of resources and
selection of the best approaches to achieving ob)ectives *lanning
facilitates the art of handling people+ it re!uires moral courage,
because it can fail ,ffective planning re!uires continuity of tenure
-ood planning is a sign of competence
.ccording to Urwic", investigations should be carried out
and their results e%pressed in concrete terms *lanning should be based
on ob)ectives, which should be framed in terms of ma"ing a product or
providing service that the community needs /implification and
standardi0ation are basic to sound planning procedures *lanning
provides information to coordinate wor" effectively and accurately .
good plan should be based on an ob)ective, be simple, have standards,
be fle%ible, be balanced and use available resources first
Douglass stated that 1planning is having a specific aim or
purpose and mapping out a program or method beforehand for
accomplishment of the goal2 /he further defined planning as being 1a
continuous process assessing, establishing goals and ob)ectives, and
implementing and evaluating or controlling them, which is sub)ect to
change as new facts are "nown2
.le%ander stated that planning 1is deciding in advance what
to do, how to do it, when to do it, and who to do it2 /he dealt with
long and short term planning, decision ma"ing, strategies, policies,
programs, rules and procedures as elements of planning2
*lanning is an administrative function that ta"es some of the
ris" out of decision ma"ing and problem solving It ensures that the
probable outcome will be desirable and effective in terms of use of
human and material resources and production of the product or
service In nursing, planning helps to ensure that the clients or patients
will receive the nursing services they want and need and that these
services are delivered by satisfied nursing wor"ers
Purposes of Planning
Douglass listed the following as reasons for planning3
& It leads to success in achieving goals and ob)ectives
4 It gives meaning to wor"
5 It provides for effective use of available personnel and facilities
6 It helps in coping with crisis situations
7 It is cost8effective
9 It is based on past and future, thus helping reduce the element of
: It can be used to discover the need for change
; It is needed for effective control
.mong the activities of planning that Douglass addresses are
assessment by collection, classification, analysis, interpretation and
translation of data+ strategic planning+ development of standards+
identification of needs and priority setting+ management by ob)ectives+
and formulation of policies, rules, regulations, methods and
Donovan wrote planning has several benefits, among which
satisfactory outcomes of decisions are+ improved functions in
emergencies+ assurance of economy of time, space and materials+ and
the highest use of personnel /he included decision ma"ing,
philosophies and ob)ectives as "ey elements in planning
/everal factors relative to successful planning should be
"nown and put into action by successful managers These are3
& . "nowledge of characteristics of planning
4 . "nowledge of elements of the planning process
5 . "nowledge of the strategic or long range planning process
6 . "nowledge of tactical or short range planning process <functional
versus operational=
7 . "nowledge of planning standards
9 . "nowledge of s"ill in applying the planning processes, including
standards, to the wor" situation
: /"ill in bringing the planning process up to the standard set, when
there are deficiencies
Characteristics of Planning
>evey and >oomba in &?;6 identified the following
characteristics or re!uirements of planning3
& Planning is purposeful This means that planning is a deliberate,
rational and ob)ective process .nalyses of both the internal and
e%ternal factors to determine the organi0ation(s environment re!uire
tools and models to be used Identification of goals and ob)ectives are
done only after the environment has been assessed and the
organi0ation has clearly perceived its role and purpose
4 Planning is process oriented *lanning is not an isolated act, it is a
continuous and iterative process The organi0ation accelerates to a
desired state due to repetitions and modifications of the planning
cycle The planning process needs recognition of the interdependency
of the organi0ation(s varied components, since an organi0ation is
prompted to do large, comple% and interrelated decisions *lanning
becomes an integral component of managing It aims toward an
understanding, not only of the problems associated with goals and
ob)ectives, but also of the re!uired standards and control to achieve the
5 Planning is hierarchical in nature -enerally, a system of plans is
developed by an organi0ation Different plans are generated by and for
certain components of the organi0ation It is the integrative nature of
the planning process that calls for all members to contribute to the
process in their own ways This move shows the organi0ation(s true
commitment to the planning process as evidenced by both descending
and ascending flows of ideas to help the organi0ation reach its
planning goals
6. Planning is future oriented The future is dealt with through
planning and therefore re!uires forecasts of economic variable, the
needs and demands of patients, health services utili0ation, social
environment and direction of political forces Interactive planning
could be observed by organi0ations in this regard *lanners may be
categori0ed as pre8active and interactive planners *re8active planners
assume that the future evolves logically and that !uantitative models
aid planners 1see2 and cope with the future while interactive planners
are less prone to predestined thin"ing and are more concerned with
1ma"ing2 a future than 1seeing2 one
7 Planning is multi-dimensional *lanning can have as many
dimensions as the system for which the plans are being made The "ey
dimensions may be identified as follows3
a Time8 short range or less than one year, medium range or
less than five years and long range or over five years
b Organi0ational level8 regional, hospital8wide,
c #unctional area8 identified by departmental organi0ation,
li"e patient services, finance and maintenance
d Orientation8 internal or e%ternal, such as involving
hospital resource development or hospital mar"et development
e /cope8 comprehensive plan, strategic plan, tactical plan
and implementation plan
*lanning involves the collection, analysis and organi0ation
of many "inds of data that will be used to determine both the nursing
care needs of patients and the management plans that will provide the
resources and processes to meet those needs .ccepting the fact that
nursing is clinical practice discipline providing a human service, nurse
managers plan in order to nurture the practitioners who provide the
/ome of the "inds of data that must be collected and
analy0ed for planning purposes include3
& Daily average patient census
4 @ed capacity and percent of occupancy
5 .verage length of stay
6 Number of births
7 Number of operations
9 Trends in patient populations
a Diagnoses
b .ge groups
c .cuity of illness
d *hysical dependency
: Trends in technology
a Diagnostic procedures
b Therapeutic procedures
; ,nvironmental analysis
a #orces impacting on nursing form within3 availability of
nurses, turnover other departments
b #orces impacting on nursing form outside3 government,
education, accreditation bodies and others
c Trends in health care in nursing including changes in
d Threats to the nursing profession
e Opportunities for the nursing profession
Elements of Planning
,lements of planning have been e%plicitly described by
/wansburg in &??5 Characteri0ed as being a conceptual or thin"ing
process, planning produced specific elements or constituent parts that
were readily identifiable, namely3
a Aritten statement of mission and purpose
b *hilosophy
c Ob)ectives and
d Detailed management or operation plans
Overcoming Barriers to Planning
@enefits of effective planning include timely accomplishment of
higher !uality wor" and best possible use of capital and human
resources @ecause in planning is essential, managers must be able to
overcome barriers that impede planning #or successful organi0ational
planning, the manager must remember several points3
• The organi0ation can be more effective if movement within
it is directed at specified goals and ob)ectives Unfortunately,
the novice manager fre!uently omits establishing a goal or
ob)ective /etting a goal for a plan "eeps managers focused
on the bigger picture and saves them from getting lost in the
minute details of planning
• @ecause a plan is a guide to reach a goal, it must be fle%ible
and allow for read)ustment as une%pected events occur This
fle%ibility is a necessary attribute for the manager in all
planning phases and the management process
• The manager should include in the planning process people
and units that could be affected by the course of action
.lthough time consuming, employee involvement in how
things are done and by whom increases commitment to goal
Nursing Division Planning
8These are road maps that describe the business by name and
location Nurse Banagers are tas"ed to ma"e them more
informative by adding a description that provides a summary of
the wor" of the division The summary contains sufficient
information regarding the nature of wor" in the nursing division
Caried information relate to the nursing products and services
provided by !uantity such as3
a admissions
b discharges
c patient days
d number of patients by acuity categories
e research pro)ects
f education programs
g students
h outpatient visits
i mar"eting activities of the nursing division with its total
revenues and e%penses
) managerial style of the division and its impact on
The Planning Formula
& W!T8 Ahat has been doneD Ahat should be doneD Ahat
e!uipment and supplies have been used or neededD Ahat steps
are necessary in the procedureD Ahat se!uence of activities was
previously usedD Ahat other efficient methods may be usedD
4 WEN8 Ahen should the )ob be doneD Ahen was it formerly
doneD Ahen could it be doneD
5 WE"E8 Ahere is the )ob to be doneD Ahere does an activity
occur in relation to those activities immediately preceding and
following itD Ahere could supplies be stored, cleaned and so
6 OW8 $ow will the )ob be doneD Ahat are the steps to be
followed in doing the procedureD $ow will the time and energy
of personnel be usedD $ow much will it costD $ow much time
will it re!uireD
7 WO8 Aho has been doing the )obD Aho else could do itD Is
more than one person involvedD
9 W#8 To each of the !uestions .s" why Ahy is this )ob, this
procedure, this step necessaryD Ahy is this done in this way, in
this place, at this time, by this personD
: C!N8 Can some steps or e!uipment be eliminatedD Can this
activity be efficiently combined with other operationsD Can
somebody else do it betterD Can we get machine to helpD Can we
get enough moneyD
Time $anagement
8 Is a techni!ue for allocating one(s time through the setting
of goals, assigning priorities, identifying and eliminating wasted
time and using managerial techni!ues to reach goals efficiently
One(s personality, education and culture influence how he or she
manages time The way one views time influences the degree of
stress he or she will feel when time is mismanaged
Three Basic %teps in Time $anagement

Time %aving Techni&ues
& Conduct an inventory of your activities
4 /et goals and ob)ectives and write them down
5 Aith the use of calendars, e%ecutive planners, logs or )ournals write
what you e%pect to accomplish yearly, monthly, wee"ly or daily
6 @rea" down large pro)ects into smaller parts
7 Devote a few minutes at the beginning of each day for planning
9 Organi0e your wor" space so its functional
: Close your door when you need to concentrate
; >earn to delegate
? In a meeting, define the purpose clearly before starting
&' Ta"e or return phone calls during specified time
&& Develop effective decision8ma"ing s"ills
&4 Ta"e rest brea"s and ma"e good use of your spare time
O"(!N')!T'ON!* %ETT'N( O%P'T!*
Organi+ational setting hospital is an e%plicit and implicit
institutional rules and policies designed to provide a structure where
various wor" roles and responsibilities are delegated, controlled and
coordinated It determines how information flows from level to level
within the company It is a multifaceted organi0ation comprising many
& .llow time for planning and establishing priorities
4 Complete the highest priority tas" whenever possible,
and finish one tas" before beginning another
5 Reprioriti0e based on the remaining tas"s and on new
information that may have been received
committees, departments, types of personnel and services .nd it
re!uires highly trained employees, efficient systems and control
"EP,B*'C !CT NO. -../
.N .CT R,EUIRIN- T$, >IC,N/UR, O# .>> $O/*IT.>/ IN
T$, *$I>I**IN,/ .ND .UT$ORIFIN- T$, @UR,.U
O# B,DIC.> /,RCIC,/ TO /,RC, ./ T$, >IC,N/IN-
Section 1. This .ct shall also be "nown as the Hospital Licensure
Section 2. Definitions H .s used in this .ct H
<a= 'Hospital' means a place devoted primarily to the maintenance
and operation of facilities for the diagnosis, treatment and care of
individuals suffering from illness, disease, in)ury or deformity, or in
need of obstetrical or other medical and nursing care The term
Ihospital shall also be construed as any institution, building or place
where there are installed beds, or cribs, or bassinets for twenty8four8
hour use or longer by patients in the treatment of diseases, diseased8
conditions, in)uries, deformities, or abnormal physical and mental
states, maternity cases, and all institutions such as those for
convalescence, sanitarial or sanitarial care, infirmities, nurseries,
dispensaries and such other names by which they may designated
<b= 'Government hospital' means a hospital operated and maintained
either partially or wholly by the national, provincial, municipal or city
government or other political subdivision, or by any department,
division, board or other agency thereof
<c= 'Private hospital' means one which is privately owned,
established and operated with funds raised or contributed through
donations, or by private capital or other means, by private individuals,
association, corporation, religious organi0ation, firm, company or )oint
stoc" association
<d= 'Clinic' means a place in which patients avail of medical
consultations or treatments on an out8patient basis $owever, any
clinic or dispensary where there is at least si% beds or cribs or bassinets
installed for twenty8four8hour use by patients shall be construed to fall
within the definition of a hospital as described in this .ct
<e= 'Licensee' is the person or persons granted a license to operate
and maintain a hospital according to an approved minimum standard
Section 3. Construction *ermit H No hospital, government or
private, shall be constructed unless plans have been approved and
construction permit issued by the licensing agency as defined in this
Section 4. Registration and license H No hospital shall operate or
be opened to the public unless it shall have been registered and a
license for its operation obtained from the licensing agency provided
in this .ct
Section 5. >icensing .gency H #or purposes of setting standards in
hospital construction and operation, the @ureau of Bedical /ervices in
addition to its present duties shall act as the licensing agency The
/ecretary of $ealth shall reorgani0e this @ureau to include a staff of
hospital architects, hospital administrators, sanitary engineers and such
personnel as may be necessary to carry out the purposes of this .ct
without necessarily increasing the present personnel strength of this
Section 6. *owers and duties of the licensing agency H The @ureau
of Bedical /ervices, or the licensing agency shall have the following
powers and duties3
a To conduct an ocular survey of all e%isting hospitals in the
*hilippines, government or private, with a view to determine their
fitness to operate considering their facilities and physical plant
b To prescribe standard plans for government hospital plants in
consultation with the Division of .rchitecture, @ureau of *ublic
c To approve plans for hospital plants, government or private, and to
issue permits or authority to construct hospitals in accordance with the
provisions of this .ct
d To "eep a permanent register of approved hospitals or those issued
licenses to operate indicating the name of the hospital, address or
location, type of hospital, name of the director or administrator,
ownership, number of authori0ed beds and bassinets and such other
pertinent data as may be necessary
e To grant licenses for the operation and maintenance of hospitals or
revo"e the same in accordance with the provisions of this .ct
f To ma"e periodic inspection of all hospitals so as to chec"
compliance with rules and regulations legally promulgated or with the
provisions of this .ct and to ma"e recommendations to directors or
administrators of hospitals for the correction of defects found during
such inspections
g To publish yearly a list of all approved hospit ma"e periodic
inspection of all hospitals so as to chec" compliance with rules and
regulations legally promulgated als indicating the name, location, type,
authori0ed beds, and name of the director or administrator
h To submit yearly reports to the /ecretary of $ealth, the /pea"er of
the $ouse of Representatives, the *resident of the /enate and the
chairmen and members of the Committees on $ealth of both $ouses
of Congress, such reports to include a list of approved hospitals
indicating the name of the hospital, location, bed capacity and name of
the director or administrator and ma"e recommendations on hospital
needs or re!uirements for hospital service in certain communities that
do not en)oy such hospital services
Section 7. #iling of .pplication for Construction *ermit H
.pplication for a permit to construct a hospital shall be submitted to
the Office of the Director, @ureau of Bedical /ervices in a form
prescribed by the latter and accompanied by a plan of the hospital
plant proposed to be constructed The application shall state the name
of the hospital, ownership, number of beds proposed to be operated,
location and type of hospital to be constructed
Section 8. Binimum /tandards of Construction H In order that a
permit to construct a hospital can be issued the hospital plan shall
provide sufficient bed space for the hospital bed capacity proposed, a
laboratory room, an operating room, including wor" rooms for
sterili0ation, anesthesia preparation, etc, an J8ray or radiology room,
pharmacy, dispensary or out8patient department, delivery room,
isolation rooms, autopsy room or morgue, sufficient !uarters for
residents, nurses, attendants and helpers and sufficient number of toilet
Aards shall be constructed such that segregation of the se%es is
observed and as far as practicable classified as to the type of cases to
be confined
Secction 9. .pplication for Registration and Issuance of >icense H
.pplication for registration of a hospital and for the issuance of a
license for its operation and maintenance shall be filed with the @ureau
of Bedical /ervices on a form prescribed by it Registration may be
made and license issued upon compliance with the provisions of
/ection eight hereof and the rules and regulations prescribed by the
licensing agency pursuant to the provisions of this .ct
Section 10. Inspection H *ermit to construct a hospital or a ma)or
portion thereof and license to operate and maintain the same shall be
issued by the licensing agency only after a representative of the
licensing agency has conducted an ocular inspection and certified that
the applicant has satisfactorily complied with re!uisites prescribed in
this .ct The license to operate and maintain a hospital shall be
renewed every year upon payment of the prescribed fees
Section 11. Revocation of >icense H The licensing agency may
suspend or revo"e a license already issued for any of the following
grounds3 <a= repeated violation by the licensee of any provision of this
.ct or of any other e%isting law+ <b= repeated violation of rules and
regulations prescribed in the implementation of this .ct+ or <c=
repeated failure to ma"e necessary corrections or ad)ustments re!uired
by the licensing agency in the improvement of facilities and services
Section 12. $earing H .ny person, association, corporation, or any
other private entity who has been refused a license to operate and
maintain a hospital or whose license for such hospital has been
suspended or revo"ed shall be entitled to an administrative hearing to
be conducted by the /ecretary of $ealth and his two undersecretaries
to determine the )ustifiability of such denial, suspension or revocation
of the license3 provided, that the licensee may resort to the courts, as in
other cases provided by law
Section 13. /eparate >icenses Re!uired H /eparate licenses shall
be re!uired for hospitals or branches thereof maintained in separate
premises, even though they are operated under the same management3
provided, however, that separate licenses shall not be re!uired for
separate buildings in the same compound3 provided, further, that
permits for construction or alteration of buildings within the same
compound shall also be secured from the licensing agency to
determine compliance with standards and re!uirements herein
Section 14. >icense not transferable H >icense for the operation of
hospitals shall not be transferable The licensing agency shall be
notified of any change in ownership, change of name of the hospital,
and transfer of location and in the latter case, an application for a new
license should be submitted
Section 15. Rules and Regulations H The @ureau of Bedical
/ervices acting as a licensing agency and sub)ect to the approval of the
/ecretary of $ealth, shall promulgate rules and regulations to
implement the provisions of this .ct
Section 16. Classification of $ospitals H The licensing agency
shall study and adopt a system of classifying hospitals in the
*hilippines as to3 <&= general or special+ <4= hospital services
capabilities+ <5= si0e or bed capacity and <6= class of hospital whether
training or not
Section 17. #ees H ,ach applicant for a permit to construct a
hospital shall pay the amount of five pesos as permit fee . registration
fee of five pesos and an annual license fee of ten pesos shall li"ewise
be collected for each hospital and for each approved license3 provided,
that a government hospital shall be e%empt from the payment of such
fees The amount herein collected shall be officially receipted by the
licensing agency and shall constitute as a revolving fund for the use of
the licensing agency
Section 18. *enalties H .ny person, partnership, association, or
corporation who establishes, operates, conducts, manages or maintains
a hospital or hospital clinic within the meaning of this .ct without first
obtaining a license as provided for in this .ct or violates any provision
hereof shall be guilty of a misdemeanor, and upon conviction thereof
shall be liable to a fine of not more than five hundred pesos for the
first offense and not more than one thousand pesos for each
subse!uent offense, and each day that the hospital shall operate after
the first conviction shall be considered a subse!uent offense
Section 19. Repeal H .ny law or laws or parts thereof inconsistent
with the provisions of this .ct are hereby repealed
Section. 20. ,ffectivity H This .ct shall ta"e effect upon its
C*!%%'F'C!T'ON OF O%P'T!*
Clinics have the medical facility smaller than a hospital It is
a health care facility that is primarily devoted to the care of
outpatients Clinics can be privately operated or publicly managed and
funded, and typically cover the primary health care needs of
populations in local communities
$ospitals are also classified according to ownership It can
be a public or a private hospital Pu0lic ospital 1government
hospital2 is a hospital owned, established by the government The
facility may be under the national government li"e the, the Department
of $ealth <DO$=, -overnment Owned or Controlled Corporations
<-OCC= or >ocal -overnment Units <>-Us= Private ospital is a
hospital owned, established and operated with funds through donation,
principal investment or other means by any individual, non8
government corporation, association or organi0ation
Training hospital is also "nown as teaching hospital It is a
hospital that provides clinical education and training to future and
current doctors, nurses, and other health professionals, in delivering
medical care to patients Non-training or non8teaching hospital don(t
have facilities for the teaching K training of medical K paramedical
students K trainers
*evel 3 It is a hospital which offers primary care services to patients
. variety of services are offered at a primary care hospital, including
referrals to specialty hospitals and providers who can provide
advanced care to patients who cannot be treated in a primary care
facility alone It is e!uipped with the service capabilities needed to
support licensed physicians rendering services in Bedicine, *ediatrics,
Obstetrics and Binor /urgery The nursing care for patients is minimal
supervised care
*evel .. It is a don8departmentali0ed hospital e!uipped with the
service capabilities needed to support licensed physicians in providing
inpatient and outpatient services < general medicine, pediatrics,
surgery, anesthesia, obstetrics and gynecology, first level radiology,
secondary clinical laboratory, pharmacy= The nursing care for patients
is intermediate supervised care
*evel* 4. It is a fully departmentali0ed and e!uipped with all clinical
services provided by >evel 4 hospitals It has a specialty clinical care,
tertiary clinical laboratory, pharmacy, and second level radiology The
nursing care for patients is total and intensive care
*evel -. It is the teaching and training hospital It has all clinical
services provided by >evel 5 hospitals and has speciali0ed forms of
treatments, intensive care and surgical procedures It has tertiary
clinical laboratory, third level radiology, pharmacy and the nursing
care for patients is continuous and speciali0ed critical care
uman "elations
The human relations movement began in the &?6's with
attention focused on the effect individuals have on the success or
failure of an organi0ation Classic organi0ation and management
theory concentrates on the physical environment and fails to analy0e
the human element+ human relations theory stresses the social
environment The chief concerns of the human relations movement are
individuals, group process, interpersonal relations, leadership, and
communication Instead of concentrating on the organi0ationIs
structure, managers encourage wor"ers to develop their potential and
help them meet their needs for recognition, accomplishment, and sense
of belonging
Theor5 of Douglas $c(regor 1Theor5 6 and Theor5 #2
Bcgregor developed Theory J and Theory G to emphasi0e
on the factors that stimulate )ob satisfaction and what motivates people
to be involved and contribute productively at wor" Theory J and
Theory G are about two different ways to motivate or influence others
by underlying attitudes about human nature ,ach view reflects
different attitudes about nature of humans The Theory J view is that,
in bureaucratic organi0ations, employees prefer security, direction, and
minimal responsibility Coercion, threats, or punishments are
necessary because people do not li"e the wor" to be done These
employees are not able to offer creative solutions to help the
organi0ations advance Bc-regor beliefs about Theory J were related
to the classical perspective of organi0ations that included scientific
management, bureaucracy theory, and administrative principles
The assumptions of Theory G are that, in the conte%t of the
right conditions, people en)oy their wor"+ can show self8control and
discipline+ are able to contribute creatively+ and are motivated by ties
to the group, the organi0ation, and the wor" itself In essence, this
view espouses the belief that people are intrinsically motivated by their
wor" Theory G was a guide for managers to ta"e advantage of the
potential of each person, which Bc-regor thought was only partially
being utili0ed and to provide support and encouragement to employees
to do good wor"
Theor5 ) 1William Ouchi2
Ouchi identified that Lapanese organi0ations had better
productivity than organi0ations in the United /tates and that they were
managed differently with their use of !uality circles to pursue better
productivity and !uality Theory F focuses on a better way of
motivating people through their involvement The organi0ation invests
in its employees and addresses both home and wor" issues creating a
path for career development Democratic leaders, who are s"illed in
interpersonal relations, foster employee involvement
Behavioral Theor5 05 "ensis *i7ert
>i"ert and his associates in the University of Bichigan
conducted an e%tensive leadership research They identified 6 basic
styles or systems of leadership which are the following3
%5stem ' 8 E9ploitative !uthoritative
It is where decisions are imposed on
subordinates Botivation in this "ind of system is usually characteri0ed
by threats $igh levels of management have great responsibilities but
lower levels have virtually none There is very little communication
and no )oint teamwor" in this system
%5stem '' 8 Benevolent !uthoritative
It is where leadership is by a condescending
form of master8servant trust Ahere motivations are mainly by
rewards Banagerial personnel feel more responsibility while the
lower levels feel little responsibility There is little communication and
relatively little teamwor" in this system
%5stem ''' 8 Consultative
It is where leadership is by superiors who have
substantial but not complete trust in their subordinates Botivations are
rewards and some involvement It is where a high proportion of
personnel, especially those at higher levels feel responsibility for
achieving organi0ation goals There is some communication and a
moderate amount of teamwor" in this system
%5stem ': 8 Participative (roup
It is where leadership is by superiors who have
complete confidence in their subordinates Botivation is by economic
rewards based on goals which have been set in participation *ersonnel
at all levels feel real responsibility for the organi0ational goals There
is much communication and substantial amount of cooperative
teamwor" in this system
It is generally considered that leadership behavior improves
in effectiveness as it approaches /ystem IC This system is the one
which is ideal for the profit8oriented and human8concerned
organi0ations >i"ert says that this system should be adopted by all
To convert an organi0ation, 6 main Features of Effective
$anagement must be put into practice3
• The motivation to wor" must be fostered by modern
principles and techni!ues
• ,mployees must be seen as people who have their own
needs, desires, and values and their self8 worth must be
maintained or enhanced
• .n organi0ation of tightly "nit and highly effective wor"
groups must be built up which are committed to achieving
the ob)ectives of the organi0ation
• /upportive relationships must e%ist within each wor" group
Conflict is defined as a disagreement in values or beliefs
within oneself or between people that causes harm or has the potential
to cause harm Conflict is a catalyst for change and has the ability to
stimulate either detrimental or beneficial effects If properly
understood and managed, conflict can lead to positive outcomes and
practice environment, but if it is left unattended, it can have a negative
impact on both the individual and the organi0ation <Lohansen, 4'&4+
Molb, 4'&5+ Borisson, 4'';=
.ccording to Deutsch <&?:5= defined conflict as a clash or a
struggle that occurs when one(s balance among feeling, thoughts,
desires, and behaviors is threatened This disturbance results in
incompatible behavior that interferes with goals Conflict is a struggle
between or among interdependent, independent, or dependent forces
*eople may disagree on the four aspects of a conflict
<@rin"ert, 4'&'= These aspects include facts, goals, methods of goal
achievement, and the value or standards used to select the goals or
methods This means that the actual facts of the dispute may be in
!uestion, the goals each side wishes to achieve may not be the same,
how to achieve the agreed upon goal is not acceptable to one side or
the other, or values are in dispute
Causes ; %ources
Newstrom <4'&&= stated that conflict occurs when people <a=
have different set of values, <b= have threats to status, <c= have
contrasting perceptions, <d= lac" trust, and <e= have personality clashes
& Specialization N . group that assumes responsibility for a
particular set of tas"s or area of service sets itself apart from
the other groups
4 Multitask Roles N The nursing role re!uires that one be a
manager, a s"illed caregiver, a human relations e%pert, a
negotiator, an advocate, and so forth ,ach role with its
different tas"s re!uires different orientations that may cause
5 Role Interdependence N . role of nurse practitioner in
private practice would not be as complicated as one being a
part of a multidisciplinary health care team
6 Task lurrin! N This results from role ambiguity and failure
to designate responsibility and accountability for a tas" to
one individual or one group
7 "i##erentiation N . group of people may occupy the same
role, but the attitude, emotion, and cognitive behaviors of
these people toward their role differ
9 Scarcit$ o# Resources N Competition for money, patients, and
positions is an absolute source of interperson and intergroup
: Chan!e % Ahenever change occurs, conflict is not far
behind .s change becomes more apparent or threatening
; &ne'ual Re(ards % Ahen people are rewarded differently,
conflict is often a result unless they were involved in
developing the reward system
? Communication Pro)lems % .mbiguities, perceptual
distortion, language failures, cultural misunderstands, and
incorrectly used communication channels all may cause
In conclusion, it is assumed that conflict e%ists within people
and within groups+ the causes of conflict, although stated generally, are
uni!ue to a situation
T5pes of Conflict
Recogni0ing conflict is part of our daily ta"e in life, it
suggests that mastering conflict8management strategies is essential for
overall well8being and personal and professional growth . need e%ist
to determine the type of conflict present in a specific situation, because
the more accurately conflict is defines the more li"ely it will be
a= Intrapersonal conflict N It occurs within a person when
confronted with the need to thin" or act in a way that seems
at odds with one(s sense of self Euestions often arise that
create conflict over priorities, ethical standards, and values
b= Interpersonal conflict N It transpires between and among
patients, family members, nurses, physicians, and members
of other departments Conflicts occur that focus on a
difference of opinion *riority, or approach with others
c= Organi0ation conflict N It arises when discord e%ists about
policies and procedures, personnel codes of conduct, or
accepted norms of behavior and patterns of communication
In managing a conflict, there are about seven methods used
in conflict management These methods often dictate the outcome of
the conflict+ depending on the nature of conflict and the desired
%trategies ; Techni&ues
& Avoidin! % This techni!ue is usually common and is used
among interpersonal conflict The parties involved in the
conflict ignore it, either consciously or unconsciously There
may be circumstances where avoidance is appropriate, such
as <&= when one of the parties is leaving so the conflict will
resolve itself+ <4= the conflict is not solvable and not all that
important+ <5= there are other, more important issues at sta"e
 .dvantages3 It does not ma"e a big deal out of
nothing+ conflict may be minor in comparison to
other priorities
 Disadvantages3 Conflict can become bigger than
anticipated+ source of conflict might be important
to one person or group than to others
4 Accommodatin! % This techni!ue is often called smoothing
or cooperating In this techni!ue, one side of the
disagreement decides or is encouraged to accommodate the
other side by ignoring or sidestepping their own feeling
about the issue This is clearly a techni!ue where one party
gains, or wins, and the other loses
 .dvantages3 One side is more concerned with an
issue than the other side+ sta"es not high enough
for one group and that side is willing to give in
 Disadvantages3 One side holds more power and
can force the other side to give in+ the importances
of the sta"es are not as apparent to one side as to
the other
5 Competin! % . techni!ue that produces a winner and a loser
The concept is that there is an all8out effort to win at all
costs This techni!ue may be used when time is too short to
allow other techni!ues to wor" or when decision has been
made !uic"ly
 .dvantages3 *roduces a winner+ good when time
is short and sta"es are high
 Disadvantages3 *roduces a loser+ leaves anger and
resentment on losing side
6 Compromisin! % It is a method used where both sides can
win and neither side should lose It useful for goal
achievement and is often seen as appeasement+ each side
gives up something and each side gains something
 .dvantages3 No one should win or lose, but both
should gain something+ good for disagreements
between individuals
 Disadvantages3 Bay cause a return to the conflict
if what is given up becomes more important than
the original goal
7 *e!otiatin! % It is a techni!ue used in collective bargaining
and is very useful for conflict management at all levels It is
used when the sta"es are high+ the idea of it is that each
party will gain something, so general agreement is reached,
but consensus is not necessarily the goal
 .dvantages3 /ta"es are very high, and solutions
are rather permanent+ often involves powerful
 Disadvantages3 .greements are permanent, even
though even though each side has gains and losses
9 Colla)oratin! % It is when both sides wor" together to
develop the optimal outcome+ it is designed to find the best
solution so that all of the perceived important goals are
achieved This re!uires maturity and a spirit of cooperation
to reach each other(s goals
 .dvantages3 @est solution for the conflict and
encompasses all important goals of each side
 Disadvantages3 Ta"es a lot of time+ re!uires
commitment to success
: Con#rontin! % This techni!ue heads off conflict as soon as
the first symptoms appear @oth parties are brought together,
the issues are clarified, and some outcome is achieved
 .dvantages3 Does not allow conflict to ta"e root+
very powerful
 Disadvantages3 Bay leave impression that conflict
is not tolerated+ may ma"e something big out of
The "ey to a successful conflict management is an open,
honest, and clear communication .lso, courtesy in communicating is
encouraged+ it includes listening attentively in each side Bost
importantly, the use of foul languages and gestures are not acceptable
in the situation There should be a normal tone of voice and both
parties must be calm when tal"ing
The setting for such discussions should be private, rela%ed,
and comfortable -round rules such as not interrupting, which party
should go first, time limits, must be agreed before the beginning of the
discussion .lso adherence to ground rules is a must
%taffing is the process of determining and providing the
acceptable number and mi% of nursing personnel to produce a desired
level of care to meet the patient(s demand
It is also the process of assigning competent people to fill the
roles designated for the organi0ational structure through recruitment,
selection and development, apart from recruitment, selection, and
hiring, this process also includes induction and orientation of the new
staff on the goals, mission, vision, ob)ectives, and philosophy of the
The purpose of all staffing activities is to provide each
nursing unit with an appropriate and acceptable number of wor"ers in
each category to perform the nursing tas"s re!uired Too few or an
improper mi%ture of nursing personnel will adversely affect the !uality
and !uantity performed /uch situation can lead to high rates of
absenteeism and staffs turn8over resulting in low morale and
Other definitions include<
• %taffing is defined as a human resources plan to fill
positions in an organi0ation with !ualified personnel
• Accordin! to A*A +,-./0, staffing is essential in order to
provide optimal patient care Innovative and collaborative
strategies that focus on developing long8term solutions will
improve the !uality of patient care outcomes
• .ccording to M$rtle 1liza)eth 2itchell A$delotte+.34/05
nurse staffing methodology should be an orderly, systematic
process, based upon sound rationale, applied to determine
the number and "ind of nursing personnel re!uired to
provide a nursing care of a predetermined standard to a
group of patients in a particular setting The end result is
prediction of the "ind and number of staff re!uired to give
care to patients2
• #or Smith +.33/0 and 6arner +,--705 staffing management
has the ma)or goal to provide the right number of nursing
staff with the right !ualifications to deliver high8!uality,
safe, and cost8effective nursing care to a group of patients
and their families
• In one o# the #ore(ord to the American 8r!anization o#
*urse 19ecutives +A8*105 mono!raph5 Sta##in! and
Mana!ement and Methods: Tools and Techni'ues #or
*ursin! Leaders5 e$ers +,---05 staffing is one of the
outcomes and indicators of the effectiveness of nursing
management practices2
/taff retention is vital to solving the nursing shortage . host of
factors8including )ob satisfaction, supervision, the wor" environment,
and personal factors that affect whether staff remain in their )obs or
resign so here are the following factors that affect staffing3
#actors that affect staffing include3
& The type, philosophy and ob)ectives of the hospital and the
nursing service+
4 The population served or the "ind of patients served whether
pay or charity+
5 The number of patients and severity of their illness8
"nowledge and ability of nursing personnel are matched with
the actual care needs of patients+
6 .vailability and characteristics of the nursing staff, including
education, level of preparation, mi% of personnel, number
and position+
7 .dministrative policies such as rotation, wee"ends, and
holiday off8duties+
9 /tandards of care desired which should be available and
clearly spelled out Institutions may be utili0e the .N/.*(s
/tandard of Nursing practice+ *RC8.N/.*(s /tandards of
/afe Nursing *ractice andO or the hospitals themselves may
formulateO develop their own standards+
: >ayout of the various nursing units and resources available
within the department such as ade!uate e!uipment, supplies
and materials+
; @udget including the amount allotted to salaries, fringe
benefits, supplies, materials and e!uipment+
? *rofessional activities and priorities in non patient activities
li"e involvement in professional organi0ations, formal
education development, participation in research and staff
&' Teaching program of the e%tent of staff involvement in
teaching activities+
&& ,%pected hours of wor" perannum of each employee This is
influenced by the 6'8hour wee" law+ and
&4 *atterns of wor" schedule8traditional 7 days per wee", ;
hour per day+ 6 days a wee", ten hours per day and three
days off+ or 5 P days of &4 hours per day and 5 P days off
The $ospital Nursing /ervice .dministration Banual of the
Department of $ealth has recommended the following
nursing care hours for patients in various nursing units of the
CasesO *atients NC$O*tOday *rof To
Non *rof
& -eneral Bedicine 57 9'36'
4 Bedical 56 9'36'
5 /urgical 56 9'36'
6 Obstetrics 5' 9'36'
7 *ediatrics 69 :'35'
9 *athologic
4; 77367
: ,ROICUORR 9' :'35'
; CCU 9' ;'34'
To formulate a staffing schedule, identify your client needs, determine
the ideal staffing level and strive toward that goal /chedule the right
combination of nurses and assistants for each shift and deply staff so
that you neither overe%tend nor waste resources
/ome steps to follow when !uantifying staffing re!uirements were
discussed by Aever"a <4'':=3
& Use census estimates3 it focus on the number of clients on the unit
and how much care each one re!uires To compute the estimate,
multiply the number of clients <C>= by the average amount of time <T=
that each re!uires to estimate the hours of care <$OC=
4 Client acuity3 the level of care clients need and can be used to
determine staffing schedules
5 Bi% of s"ills3 to meet the needs of a unit, each shift re!uires staff
with the correct mi% of !ualifications . nurse manager must assemble
a team that(s capable of meeting the client(s needs on a particular unit
and maintain a profile of all staff members that includes their
!ualifications, certifications, general s"ills, language s"ills and
6 /tandard scheduling processes3 formulating policies for choosing
vacation times, selecting shifts and e%changing shifts
7 /chedule in advance3 nurses have a chance to loo" ahead and sign
up for unassigned shifts
9 Meep the budget in mind3 it is important to "eep an eye on overtime,
ma"ing sure costs do not e%ceed the budget
;*ursin! is not <ust an ART5 it has a heART= *ursin! is not <ust a
SCI1*C15 )ut it has a conSCI1*C1=>
? Anon$mous
$OD!*'T'E% OF N,"%'N( C!"E
This refers to the manner in which nursing care is organi0ed and
provided The decision of which care delivery model is used is based
on the needs of the patients, comple%ity of the tas"s to be completed,
economic resources of the organi0ation and availability of competent
staff in the different s"ill levels ,ach model has strengths and
wea"nesses that should be considered when deciding which to
Case $ethod= Total Patient Care
In case method, the nurse for one patient whom the nurse cares for
e%clusively It evolved into what we now call private duty nursing It
was the first type of nursing care delivery system It is the oldest
patient care delivery method In this method one professional nurse
assumes total responsibility of providing complete care for one or
more patients <&89= while she is on duty This method is used
fre!uently in intensive care units and in teaching nursing students
8Consistency in carrying out the nursing care plan
8*atient needs are !uic"ly met as high number of RN hours are spent
on the patient
8Relationship based on trust is developed between the RN and the
patient(s family
8The line of responsibility and accountability are clear
8It can be costly
8RNs doesn(t have same patients from day to day, therefore may loo"
at the patient on a shift8by8shift basis rather than on a continuum of
Functional Nursing
It began during the Aorld Aar II when the demand for client care
outstripped the supply of nurses and the rapid construction of hospitals
as a result of the [email protected] .ct
It is a tas"8oriented method wherein a particular nursing function is
assigned to each staff member The medication nurse, treatment nurse
and bedside nurse are all products of this system #or efficiency,
nursing was essentially divided into tas"s, a model that proved very
beneficial when staffing was poor The "ey idea was for nurses to be
assigned to tas"s, not to patients *ersonnel with less training are
assigned to provide more basic care such as bed bath and bed ma"ing
8a very efficient way to delivery care
8could accomplish a lot of tas"s in a small amount of time
8staff members do only what they are capable of doing
8least costly as fewer RNs are re!uired
8 Care of patients become fragmented and depersonali0ed
8patients do not have one identifiable nurse
8very narrow scope of practice for RNs
8leads to patient and nurse dissatisfaction
Team Nursing
This is the most commonly used model and is still in use today It is
also called as 1partners in care2 or 1patient service partners2 It was
developed in the &?7'(s in order for somewhat improve the
disintegration that was inherent in the functional model The goal of
team nursing is for the team to wor" democratically In the ideal team,
an RN is assigned as a team leader for a group of patients The team
leader has a core of staff reporting to her, and together they wor" to
disseminate the care activities The team member possessing the s"ill
needed by the individual patient is assigned to that patient, but the
team leader still has accountability for all of the care Team
conferences occur in which the e%pertise of every staff member is used
to plan the care The team is most commonly made up of
>*Ns<licensed practical nurse= and U.*<unlicensed assistive
personnel=, but occasionally there is another RN
8,ach member(s capabilities are ma%imi0ed so )ob satisfaction should
be high
8patients have one nurse <Team leader= with immediate access to other
health providers
8re!uires a team spirit and commitment to succeed
8RN may be the team leader one day and a team member the ne%t, thus
continuity of patient care may suffer
8Care is still fragmented with only ; or &4 hours accountability
8communication is comple%
Primar5 Nursing
It is now referred now as a professional practice model The hallmar"
of this modality is that one nurse cares for one group of patients with a
468hour accountability for planning their care In other words, a
*rimary Nurse <*N= cares for her primary patients every time she
wor"s and for as long as the patient remains on her unit .n .ssociate
Nurse cares for the patient in the *N(s absence and follows the *N(s
individuali0ed plan of care This is a decentrali0ed delivery model3
more responsibility and authority is placed with each staff nurse The
nurse is accountable for each patientIs total care continuously until
discharge even when technically off duty
Today this model is still used in hospitals, but may use practical nurses
as associate nurses
It is a model of care delivery that emerged during the &?;'(s to meet
the increasing comple% needs of clients The goal is for each client(s
care to be comprehensive and coordinated, from the admission to
discharge ,ach client is assigned to a primary nurse, who is a RN, and
that the nurse provides care for that client when he or she is wor"ing
8increased satisfaction for patients and nurses
8more professional system3 RN plans and communicates with all
healthcare members RN(s are seen as more "nowledgeable and
8RNs more satisfied because they continue to learn as a part of the in8
depth care they re!uired to deliver to their patients
8team leader can provide guidance to new or ine%perienced nurses and
other staff
8only confines a nurse talents to a limited number of patients, so other
patients cannot benefit if the RN is competitive
8can be intimidating for RNs who are less s"illed and "nowledgeable
8high cost because there is a higher RN s"ill mi%
Q Delegate3 1to entrust to another+ to appoint as one(s
representative+ to assign responsibility or authority2 <Berriam
Aebster(s Dictionary 4'&6=
QDelegation3 1the act of empowering to act for another2
<Berriam Aebster(s Dictionary 4'&6=
Delegation can be understood as finishing a wor" or tas"
through others or as a direct performance of one or group of people
towards a success of a goal The .merican Nurses .ssociation <.N.=
defined delegation as a transfer of a responsibility from one person
specifically a competent individual to another in doing or performing a
tas" <Bar!uis, @>, 4''9= .nother definition would be from the
National Council of /tate @oards of Nursing <NC/@N= which entails
that it is transferring of a selected nursing tas" to an individual that is
!ualified to perform one in a selected situation This suggests that
delegation is comple%, re!uires insight, and )udgment regarding the
environment in which it ta"es place as well as individuals that are
involved in it
Delegation is a ma)or element of the direct functioning of
nursing management It is one of the effective management of a nurse
manager that gets wor" done through her members according to
/wansburg, RC &??? The importance of this is to accomplish wor"
by managers not only through their effort but as well as to those of
their subordinates which eventually ma"es it easier
Reasons for Delegating3
Nursing management is an art that seldom wor"s alone It
needs an interdisciplinary and interactive nature of nursing calls for
)uggling creative applications regarding its( being an art of nursing
/"ills for health8care delivery often start with direct patient care and
can affect in directing bigger groups and organi0ation <*atronis Lones,
R. 4'':= #inancial pressures inside as well as outside the health
agency, managed care, and professional salaries create a greater need
for increased delegation
The ideal nursing practice incorporates many s"ill levels of
health8care personnel with goals for patient care, yet it involves legal
definitions and fiscal awareness To achieve both patient care goals
together with the employee(s goal, the nurses( should plan to e%tend
his or her scope of practice through delegation It is not only as a s"ill
for management but it also involves ethical issues for nurses The code
of ethics for nurses in relation to delegation <.merican Nurses
.ssociation 4''&= endorses delegation, where 1RtShe nurse is
responsible and accountable for individual nursing practice and
determines the appropriate delegation of tas"s consistent with the
nurse(s obligation to provide optimum patient care2
@uild professional nurses( self esteem by delegating as much
of the authority for nursing practice as possible *rofessional nurses
want authority over their practice and can be educated to perform
management tas"s related to it Nurse Banagers will determine what
authority to delegate through communication with clinical nurses
.uthority should be commensurate with assigned responsibility
>astly, this delegation will help the nurses and the health team to
deliver a !uality care for the patients in an organi0ed manner, and each
employee will be able to give a respond in decision ma"ing and gain
satisfaction with their )obs
*rinciples of Delegation3
There are a few guidelines in form of principles which can be a help to
the manager to process of delegation The principles of delegation are
as follows3
& Principle of result e9cepted8 suggests that every
manager before delegating the powers to the
subordinate should be able to clearly define the goals as
well as results e%pected from them The goals and
targets should be completely and clearly defined and
the standards of performance should also be notified
#or e%ample, a mar"eting manager e%plains the
salesmen regarding the units of sale to ta"e place in a
particular day, say ten units a day have to be the target
sales Ahile a mar"eting manager provides these
guidelines of sales, mentioning the target sales is very
important so that the salesman can perform his duty
efficiently with a clear set of mind
4 Principle of Parit5 of !uthorit5 and "esponsi0ilit58
.ccording to this principle, the manager should "eep a
balance between authority and responsibility @oth of
them should go hand in hand
.ccording to this principle, if a subordinate is given a
responsibility to perform a tas", then at the same time
he should be given enough independence and power to
carry out that tas" effectively This principle also does
not provide e%cessive authority to the subordinate
which at times can be misused by him The authority
should be given in such a way which matches the tas"
given to him Therefore, there should be no degree of
disparity between the two
5 Principle of a0solute responsi0ilit58 This says that the
authority can be delegated but responsibility cannot be
delegated by managers to his subordinates which means
responsibility is fi%ed The manager at every level, no
matter what is his authority, is always responsible to his
superior for carrying out his tas" by delegating the
powers It does not means that he can escape from his
responsibility $e will always remain responsible till
the completion of tas" ,very superior is responsible for
the acts of their subordinates and are accountable to
their superior therefore the superiors cannot pass the
blame to the subordinates even if he has delegated
certain powers to subordinates e%ample if the
production manager has been given a wor" and the
machine brea"s down If a repairman is not able to get
repair wor" done, production manager will be
responsible to C,O if their production is not completed
6 Principle of !uthorit5 level8 This principle suggests
that a manager should e%ercise his authority within the
)urisdiction O framewor" given The manager should be
forced to consult their superiors with those matters of
which the authority is not given that means before a
manager ta"es any important decision, he should ma"e
sure that he has the authority to do that on the other
hand, subordinate should also not fre!uently go with
regards to their complaints as well as suggestions to
their superior if they are not as"ed to do This principle
emphasi0es on the degree of authority and the level up
to which it has to be maintained
Importance of Delegation <Borrison, B, 4''&=3
& Through delegation, a manager is a0le to divide the
>or7 and allocate it to the su0ordinates. This helps
in reducing his wor" load so that he can wor" on
important areas such as N planning and business
4 With the reduction of load on superior? he can
concentrate his energ5 on important and critical
issues of concern. This way he is able to bring
effectiveness in his wor" as well in the wor" unit This
effectively helps a manager to prove his ability and
s"ills in the best manner
5 Delegation of authorit5 is the ground on >hich the
superior-su0ordinate relationship stands. .n
organi0ation functions as the authority flows from top
level to bottom This in fact shows that through
delegation, the superior8subordinate relationship
become meaningful The flow of authority is from top
to bottom which is a way of achieving results
6 Delegation of authority in a way gives enough room
and space to the su0ordinates to flourish their
a0ilities and s7ill. Through delegating powers, the
subordinates get a feeling of importance They get
motivated to wor" and this motivation provides
appropriate results to a concern Lob satisfaction is an
important criterion to bring stability and soundness in
the relationship between superior and subordinates
Delegation also helps in brea"ing the monotony of the
subordinates so that they can be more creative and
efficient Delegation of authority is not only helpful to
the subordinates but it also helps the managers to
develop their talents and s"ills /ince the manager gets
enough time through delegation to concentrate on
important issues, their decision8ma"ing gets strong and
in a way they can flourish the talents which are re!uired
in a manager Through granting powers and getting the
wor" done, it helps the manager to attain
communication s"ills, supervision and guidance,
effective motivation and the leadership traits are
flourished Therefore it is only through delegation, a
manager can be tested on his traits
7 Delegation of authorit5 is help to 0oth superior and
su0ordinates. This, in a way, gives stability to a
concern(s wor"ing Aith effective results, a concern can
thin" of creating more departments and divisions flow
wor"ing This will re!uire creation of more managers
which can be fulfilled by shifting the e%perienced,
s"illed managers to these positions This helps in both
virtual as well as hori0ontal growth which is very
important for a concern(s stability
QQTherefore, from the above points, we can )ustify that delegation
is not )ust a process but it is a way by which manager multiples
himself and is able to bring stability, ability and soundness to a
Rights of Delegation3
7 Rights to delegation according to NC/@N <<Bar!uis, @>, 4''9=
8NC/@N in U/ presents 7 rights to delegation from the perspectives of
both nursing service administrator and staff nurse
& "ight Tas73 The nurse ma"es an assessment of the patient or
a group of patients and determines that an activity can be
delegated to a specific member of the health care team
Mnowledge of state practice acts and agency directives are
essential when ma"ing decisions about what patient care
tas"s can be delegated In the case e%ample the registered
nurses decision to have the >icensed *ractical Nurse <>*N=
respond to the medical emergency was problematic because
the >*N was re!uired to assess and ma"e a comple% clinical
decision about the inmate(s need for medical care
4 "ight Circumstances3 The nurse(s assessment of the patient
or group of patients also identifies the health care need<s= to
be addressed by the delegated tas"<s= and the goal or
outcome to be achieved The nurse(s decision about which
tas"<s= to delegate matches the staff(s competency and level
of supervision available The registered nurse in the case
e%ample did not assess the patient(s needs or identify the
outcome to be achieved by the tas" that was delegated to the
>*N The nurse also made no )udgment about what level of
supervision or monitoring would be appropriate in the
5 "ight Person3 The registered nurse considers the s"ills and
abilities of individual personnel in ma"ing decisions about
delegation of tas"s The registered nurse wor"s with each
member of the team to improve performance and
implements remedies when performance is below standard
In the case e%ample the >*N had considerable e%perience
responding to medical emergencies at the correctional
facility and had wor"ed in the emergency department at the
local hospital The registered nurse did not understand that
monitoring or supervision of the >*N(s performance was
re!uired as part of the state practice act and e%pected by the
6 "ight Communication3 The registered nurse communicates
specifically what, how and by when delegated tas"s are to be
accomplished Communication includes the purpose and
goal of the tas", limitations and e%pectations for reporting
In the case e%ample there was no meaningful communication
that too" place between the RN and >*N The >*N was not
e%pected to communicate assessment data to the nurse and
no limitations on the >*N(s actions were stipulated The
>*N reported the conclusion that both inmates were 1o"ay2
but was as"ed no follow up !uestions by the RN to amplify
the basis for the decision The >*N did not communicate
with the registered nurse when the inmate was later found
unresponsive even after the 1on call2 physician was called
7 "ight %upervision3 The registered nurse monitors and
evaluates both the patient and the staff(s performance of
delegated tas"s The registered nurse is prepared to
intervene on behalf of the patient as necessary and provides
staff feedbac" to increase competency in tas" performance
In the case e%ample the RN had several opportunities to
monitor the patient(s care and to intervene but failed to do
so The nurse was unaware of the responsibility to monitor
and supervise the >*N in the performance of the delegated
tas" The nurse said that the >*N always provided the
response to medical emergencies and did not thin" the RN
could alter this 1assignment2
Ahat can(t be delegatedD
.lthough delegation is the s"ill most used to e%tend and
e%pand the nurse(s sphere of influence, certain aspects of the nursing
process cannot be delegated <@asvanthappa, @T, 4'''=
- .n e%ample of which is the practice8defining functions of
assessment and evaluation, in which it re!uires nursing
)udgment, can never be delegated
- Implementation of nursing care, even delegated care, still
remains the responsibility of the nurse
- Never delegate the power to discipline, responsibility for
maintaining morale, overall control, )obs that are technical,
or duties involving trust or confidence These are
complicated areas in which re!uires speciali0ed "nowledge
and s"ills of a nurse manager
Common Delegation ,rrors3
& ,nder delegating8 often comes from a manager(s false
assumption that delegation may be interpreted as a lac" of
ability on his or her part to do the )ob or a certain tas"
correctly or even completely Delegation need not limit the
manager(s control, prestige, and power+ rather it can e%tend
the manager(s influence and capacity by increasing what he
or she can accomplish together with his or her subordinates
4 Over delegating8 some managers over delegate, because
they are poor in terms of handling time, sometimes they
spend most of it trying to organi0e things /ome managers
who tends to be li"e this, most li"ely to feel being insecure
in their ability to successfully finish a certain tas" or )ob
This error will overwor" and ma"e his or her subordinates
get tired which eventually leads to decrease as well in their
productivity in a certain time
5 'mproperl5 delegating8 this type of error include situations
that managers delegate a certain matter in a wrong timing,
wrong person, or even for a wrong reason to be particular
,%ample would be delegating a tas" that is beyond the
subordinate(s capacity in achieving the tas" or doing it
,ffective Delegation </wansburg, RC &???=3
& Train and develop subordinates It is an investment -ive
them reasons for the tas", authority, details, opportunity for
growth, and written instructions, if needed
4 *lan ahead It prevents problems
5 Control and coordinate the wor" of subordinates Do not
peer over their shoulders To prevent errors, develop ways of
measuring the accomplishment of ob)ectives with
communication, standards, measurements, and feedbac"
Nursing employees want to "now the e%pectations of their
leader towards them
6 Cisit subordinates fre!uently /pot the potential problem in
their tas"s especially in issues of morale, disagreement, and
7 Coordinate to prevent duplication of effort
9 /olve problems and thin" about new ideas ,mphasi0e to
them on solving their own problems
: .ccept delegation as desirable
; /pecify goals and ob)ectives
? Mnow your member(s capacity and match the tas" or duty to
them Ba"e sure your subordinate "nows the importance of
his or her tas"
&' .gree on performance standards Relate managerial
references to employee performance
&& Ta"e an interest
&4 .ssess the result .ccept the fact that the employees will
perform tas"s in their own way
&5 -ive appropriate rewards
&6 Do not ta"e bac" delegated tas"s
/uccessful Delegation Results in3
T Ba"es wor" easier
T Improves efficiency
T Increases employee effectiveness
T Develops employees
T ,nsures that the right people do the right )obs
@arriers to Delegation3
a Delegator8 possesses authority to delegate by virtue of both
position in the agency and state government license to do
certain tas"s
- *reference for operating by oneself
- Demand that everyone 1"now all the details2
- 1I can do it better myself2 fallacy
- >ac" of e%perience in the )ob or delegating
- Insecurity
- #ear of being disli"ed
- Refusal to allow mista"es
- >ac" of confidence in subordinates
- *erfectionism, leading to e%cessive control
- >ac" of organi0ational s"ill in balancing wor"loads
- #ailure to delegate authority to commensurate with
- Uncertainty over tas"s and inability to e%plain
- Disinclination to develop subordinates
- #ailure to establish effective controls and to follow up
b Delegatee8 receives direction for what to do from the
delegator The relationship between the two individuals
e%ists within the wor"place environment or through agency
- >ac" of e%perience
- >ac" of competence
- .voidance of responsibility
- Overdependence on the boss
- Disorgani0ation
- Overload of wor"
- Immersion in trivia
c %ituation8 necessary to ensure that goals for patient care can
be met by the delegatee #amiliar situations and
environments enhance clients( safety and competent
performance of any tas"
- One8person8show policy
- No toleration of mista"es
- Criticality of decisions
- Urgency, leaving no time to e%plain <crisis management=
- Confusion in responsibilities and authority
- Understaffing
Frederic7 Winslo> Ta5lor
• $e postulated 1 The /cientific Banagement
Theory2 in the year &?&&
• Is "nown as the father of scientific management
• $e detailed his principles on increasing the
productivity of wor"ers in Bidvale /teel Aor"s
*lant in *ennsylvania
Principles of Ta5lor
• 1Rule of the thumb2 Using time and motion studies and the
e%pertise of e%perienced wor"ers, wor" could be
scientifically designed to promote greatest efficiency of time
and energy
• 1/cientific personnel must be established2 so that wor"ers
can be hired, trained and promoted based on their
capabilities and competence ,ach employee(s limitations
and abilities should be identified so that the person will be
matched to the most appropriate )ob
• Aor"ers should be able to view how they 1fit2 into the
organi0ation and how they contribute to overall
organi0ational productivity Taylor thought this could be
accomplished by the use of financial incentives as a reward
for wor" accomplished Taylor viewed humans as 1economic
animals2 motivated solely by money
• Relationships between managers and wor"ers should be
interdependent, and wor" should be shared e!ually @ut their
roles are not the same Banagers was to plan, prepare and
supervise Ahile wor"ers do the wor"
"esult of %cientific $anagement
• *roductivity and profits rose dramatically
• Organi0ations were provided with a rational means of
harnessing the energy of industrial revolution
enr5 (antt
• Developed the -antt Chart in &?&'(s
• . disciple of Taylor, and was also concerned with problems
of efficiency
• Contributed to scientific management by refining previous
wor" rather than introducing new concepts
• $is -antt Chart depicts the relationship of the wor" planned
or completed on one a%is to the amount of time needed or
used on the other This allows one to visuali0e multiple tas"s
that have to be done
• $e recommended that wor"ers be selected scientifically and
provided with detailed instructions for their tas"s
(antt Chart
enri Fa5ol
• Mnown for his 1-eneral .dministrative Theory2 in &?6?
• $e developed his management strategies in the mining
3- Principles of $anagement
• Division of >or7 or separation of >or7 Aor" should be
divided among individuals and groups to ensure that effort
and attention are focused on special portions of the tas"
• !uthorit5 Banagers must be able to give orders Note that
responsibility arises wherever authority is e%ercised
• Discipline ,mployees must obey and respect the rules that
govern the organi0ation
• ,nit5 of command ,very employee should receive orders
from only one superior
• ,nit5 of direction ,ach group of organi0ational activities
that have the same ob)ective should be directed by one
manager using one plan
• %u0ordination of individual interests to the general
interest The interests of any one employee or group of
employees should not ta"e precedence over the interests of
the organi0ation as a whole
• "emuneration Aor"ers must be paid a fair wage for their
• Centrali+ation Refers to the degree to which subordinates
are involved in decision ma"ing
• %calar chain The line of authority from top management to
the lowest ran"s represents the scalar chain
• Order this principle is concerned with systematic
arrangement of men, machine, material etc there should be
specific place for every employee in organi0ation
• E&uit5 Banagers should be "ind and fair to their
• %ta0ilit5 of tenure of personnel. Banagement should
provide orderly personnel planning and ensure that
replacements are available to fill vacancies
• 'nitiative ,mployees who are allowed to originate and
carry out plans will e%ert high levels of effort
• Esprit de corps *romoting team spirit will build harmony
and unity within the organi0ation
Nursing Banagement is performing leadership
functions of governance and decision8ma"ing within organi0ations
employing nurses It includes processes common to all management
li"e planning, organi0ing, staffing, directing and controlling
Nurse Banager is the environmentalist of the unit
$eOshe is always assessing the conte%t in which a practice and wor"
environment that is positive and healthy can affect people(s
 *urposes of Banagement3
 accomplishing the goals of the organi0ation
 maintaining the !uality of service or care within the financial
limitations of the organi0ation
 encouraging the motivation of the employees and the clients
in the area
 increasing the ability of the subordinates and peers to accept
 developing a team spirit and increased morale
 furthering the professional development of the personnel
 Characteristics of Banagement
 providing a clear direction
 encouraging open communication
 coaching and supporting people
 providing ob)ective recognition
 establishing ongoing controls
 choosing the right people for the right )ob
 impact of decision8ma"ing
 encouraging innovation and ideas
 integrity
 Characteristics of a Banager
 selecting the right people to staff the organi0ation
 the financial implications of decisions
 encouraging innovation and new ideas
 giving subordinates clear8cut decisions when they(re needed
 consistently demonstrating a high level of integrity
 ? principles of a nurse manager
& a culture that promotes collaboration through trust, diversity,
and team orientation
4 a culture with clear, respectful, open and trusting
5 a culture in which everyone is accountable and "nows what
is e%pected
6 ade!uate numbers of !ualified staff to meet patient e%pectations and
provide balance to the wor" and home life of staff
7 presence of leadership who serves as an advocate for nursing,
supports empowerment of nurses, and ensures availability of resources
9 a structure for participation in shared decision ma"ing
: ongoing education and professional development
; recognition of contributions of nursing staff
? recognition by nurses of the contributions they provide to practice
 Types of Banagement
& /cientific Banagement
4 #unctional approach
› *lanning
› Organi0ing
› /taffing K motivation
› Coordinating
› Delegating K directing
› @udgeting
› Controlling
Nurse administrator is a person who is charged
with the financial decision8ma"ing, staff administration and policy
ma"ing as concerns nurses in an establishment
*rimary responsibility3 *.TI,NT
/econdary responsibility3 IN/TITUTION
 Ba)or competencies
 Communication
 Relationships building
 $ealth care environment
 @usiness s"ills
 >eadership
 Characteristics for moral devp3
 Cheerfulness
 Citi0enship
 Cleanliness
 Courage
 Courtesy
 $elpfulness
 $onesty
 Mindness
 >oyalty
 *atience
 *unctuality
 Respect
 Responsibility
 /elf8control
 /elf8reliance
 /portsmanship
 Thrift
 Tolerance
 6 categories for education3
. Unlicensed care providers
@ *ost8licensure with an internship
C Residency
D -raduate education
 Responsibilities of a nurse administrator
& Overall responsibility for nursing patient care
4 ,stablishing and documenting administrative procedure for
the nursing team
5 *romoting the development of nursing staff
6 @udgeting and maintaining practice and standard guidelines
7 *roviding communication between practice and nursing staff
9 /cheduling and supervising of nursing staff
: .naly0ing nursing treatment and diagnosis decisions
; Troubleshooting and patient consultation
? Team building e%ercises and employee counseling
 >,C,>/ O# B.N.-,B,NT
& Top8level managers
4 Biddle8level managers
5 #irst8level managers
 Top8level managers
8 generally ma"e decisions with the help of few guidelines or
structures, coordinate internal K e%ternal influences, K view
the org as a whole
 Biddle8level managers
8 conduct day to day operations with some involvement in
long8term planning K policy ma"ing
8 responsible for the people K activities within the
departments they supervise, K they too have a 468hour
responsibility for their defined area
 #irst8level managers
8 responsible for clinical nursing practice, patient care delivery, K use
of human, fiscal, K other resources, personal development, compliance
with regulatory K professional standards, fostering interdisciplinary,
collaborative relationships K strategic planning

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