NCM119: NURSING LEADERSHIP AND MANAGEMENT

PLANNING
Instructor: Gloria P. De Leon, RN, MAN, EdD
September 2023

PLANNING ͕ Increase of charges

͕ Legal threats
͕ Opportunities would include:
INTRODUCTION ͕ Improved or new facilities
͕ Recruitment of medical and nursing personnel
͕ Planning is the most basic and fundamental activity of the ͕ Referrals
management process. ͕ New health care programs
͕ All other management functions are dependent on planning.
͕ Planning is forecasting of events, making decisions, setting Operational Planning
goals, setting of priorities, developing policies and setting ͕ Deals with day–to-day maintenance activities.
standards. ͕ It is done in conjunction with the preparation of the budget.
͕ Rowland (1992) describes planning as always future-oriented. It ͕ Planning may also relate to the improvement and maintenance
is the process whereby management bridges the time span of facilities.
between where it is at present and where it wants to be at some ͕ Nurse managers are most likely to be involved in this type of
point in the future. planning.
͕ Planning involves the choice of objectives along with the
policies, strategies, programs, procedures and rules that are Unit Planning
necessary for the accomplishment of these objectives. ͕ In nursing, planning or a department or unit should be done on a
daily, weekly or long-range basis.
Planning directs our thinking toward: ͕ Daily planning is related to the care done on the client or
͕ What activity we expect to do ͕ When we expect to do it patient.
͕ Why it will be done ͕ How it will be done ͕ It may include among other things:
͕ Where it will be done ͕ Who is going to do it ͕ The taking of the health history of the client
͕ Assessing his or her health status
Planning involves: ͕ Formulating the nursing diagnosis
͕ Managerial function ͕ Intellectual process ͕ Implementing the care plan
͕ Goal-oriented ͕ Futuristic
͕ Pervasive ͕ Decision-making Planning of the Nursing Unit
͕ Continuous activity ͕ There are three other groups in the line of responsibility all of
which are directly responsible to the head nurse.
Advantages of Planning ͕ General staff nurses and student nurses who give bedside
͕ Planning facilitates management by objectives care to the patients.
͕ Planning minimizes uncertainties ͕ Non-professional workers (nurses aids, orderlies, clerks)
͕ Planning facilitates coordination ͕ Housekeeping personnel
͕ Planning improves employee’s morale
͕ Planning helps in achieving economies The following are practical day-to-day planning actions suggested
͕ Planning facilitates controlling for the nurse manager:
͕ At the beginning of each day, make a list of actions to be
TYPES OF PLANNING accomplished for the day. Cross off the actions as they are
accomplished or at the end of the day. At the beginning of the
There are two major types of organizational planning: next work day, carry over actions not accomplished; either do the
͕ Strategic or long-range planning first or decide whether they really need to be done. Do not hold
͕ Operational or short-range planning tasks over from one day to the next indefinitely.
͕ Plan meetings ahead, if the meeting is a nursing responsibility,
Strategic Planning prepare and distribute a copy of the agenda in advance.
͕ It refers to determining the long term objectives of the ͕ Identify developing problems and place them in the appropriate
institutions and the policies that will be used to achieve these portion of the division's operational or management plan.
objectives. ͕ Review the operational or management plan on a scheduled
͕ It is usually done at the executive level of management. basis. Review it with key managers so that each knows his/her
͕ It is future-oriented. personal responsibilities for accomplishment of activities.
͕ Review the appropriate portions of the department operational or
Some of the purposes of strategic planning are to: management plan also with subordinate nurse managers when
͕ Help clarify the beliefs and values of the organization they are being counseled. Review department, unit or clinic plans
͕ Give direction to the organization at the same time.
͕ Improve communication and coordination of activities NATURE OF PLANNING
͕ Improve efficiency
͕ Eliminate duplication of efforts Planning includes the following concepts:
͕ Allow adaptation to the changing environment 1. Both strategic and tactical planning are incorporated.
͕ Set realistic and attainable goals Strategic planning involves determining the direction in which an
organization should be headed. Tactical planning involves
͕ The main output of strategic planning is to set the goals for the allocating resources that enable an organization to realize stated
organization. objectives.
͕ It is suggested that a situational analysis be done before 2. Plans are primary mechanisms for guiding organizational efforts.
making strategic plans. The real test of planning is the ability to direct efforts on a daily
͕ A tool that can be used is the WOTS analysis. basis, that is, to move from the abstract to the implemented
͕ What are the strengths and weaknesses and potential ͕ It is nor enough just to create plans.
opportunities of the organization and the threats to it? ͕ They must be articulated and then put into action.
͕ The internal weaknesses or strengths of a healthcare ͕ Planning should not occur just at the top echelons; it should
organization may include the following: be implemented throughout the organization.
͕ Expertise of nursing and medical personnel staff 3. Planning is a continual process that moves from setting the
͕ Qualifications mission to setting operational objectives.
͕ Over or under staffed 4. Values and expectations often determine what mission and
͕ Financial status strategies to adopt.
͕ Quality of patient care 5. Reviewing and evaluating plans support control. Planning does
͕ Abundance or scarcity of medical equipment and supplies not occur in a vacuum.
͕ Threats maybe: ͕ Accomplishments or failures are ultimately analyzed and
͕ Competition information gained for use to revise plans where necessary.
͕ Decrease in patient load 6. In nursing, goal planning ensures that clients will receive quality
͕ Shortage of nurses and other personnel nursing care.
͕ Low patient satisfaction

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PURPOSES OF PLANNING ͕ Observations are used for studies in which evaluation is the
primary objective or where the data required are complex, difficult
͕ To ensure success in planning the activities of the nursing to obtain and need considerable interpretation.
department or unit, the nurse manager should recognize the ͕ Such studies would include for example: Evaluating the activities
purposes of planning. of personnel or the quality of their performance.
͕ According to Swansburg, Planning: ͕ Data is recorded in the form of an evaluative rating of what is
͕ Leads to success in achieving goals and objectives being observed, a narrative description of what was seen, or
͕ Gives meaning to work entries on a checklist.
͕ Provides for effective use of available personnel and ͕ The use of these methods requires considerable control over the
facilities observation to ensure reliability.
͕ Helps in coping with crisis situations
͕ Is cost effective Developing the Plan of Action
͕ Is based on past and future, thus helping reduce the ͕ After recommendations have been formulated and priorities have
element of change been determined, they are incorporated into a definitive plan for
͕ Can be used to discover the need for change meeting nursing needs.
͕ Is needed for effective control ͕ In developing the plan, attention is given to the following:
͕ Specifying goals, objectives, and policies for carrying out
The Planning Phase recommendations and suggested programs.
͕ The planning process consists of different phases that are ͕ Phasing activities so that resolution of problems requiring
interdependent and continuous. immediate action leads to actions and measures for
͕ Each phase is important and significant and determines the attaining long-range goals.
actions needed to solve nursing problems related to nursing ͕ Specifying a time span for achieving specific objectives or
management. steps in the plan. Providing methods for evaluating progress
͕ Viewed in phases, the planning process includes the following in meeting objectives.
steps: ͕ In developing the plan, problems to be encountered in its
͕ Determining objectives phasing must be considered.
͕ Collecting data ͕ Example: Resistance to the introduction of new concepts
͕ Developing the plan of action ͕ Measures to surmount potential obstacles must be worked out in
͕ Evaluating the plan advance and integrated into the plan.

Determining Objectives Evaluating the Plan

͕ Nursing concerns requiring assessment by planning groups A plan is good or generally acceptable if it:
should first be identified. ͕ Is in line with a clearly stated objective.
͕ Then a study outline should be completed for each concern. ͕ Indicate the procedural method for putting the plan into action.
͕ The outline should list influential factors, information needed for ͕ Can be communicated effectively.
assessment, sources of data and any required special studies. ͕ Is operation, professionally sound and economically feasible.
͕ The completed study outline provides a basis for determining ͕ Represents an integrated whole and not an isolated entity.
planning procedures and the course to be followed. ͕ Allows for alternate courses of action as changes occur and
͕ The planning techniques, data requirements, and need for special opportunities for new approaches arise.
surveys and studies will, in turn, influence staff and budgetary ͕ Wisely utilizes human talents, abilities, and skills to their
requirements. maximum potential.
͕ Makes judicious use of material resources in order to improve
Collecting Data patient care and educate the nursing staff.
͕ Using existing data.
͕ The use of data from existing sources presents few problems and DECISION–MAKING
precludes elaborate, time-consuming data collection.
OVERVIEW

Use of these data involves: ͕ It is choosing options that are directed toward the resolution of
͕ Identifying their sources organizational problems and the achievement of organizational
͕ Assessing their relevance, timeliness and accuracy goals.
͕ Abstracting the data from the original sources ͕ The nurse manager is a decision maker and therefore plays a
͕ Analyzing the meaning and implication of the data's vital role in achieving the goals and objectives of the organization.

Methods of Collecting Original Data Attributes of a Decision–Maker

͕ Questionnaires As a decision maker, you must have the following attributes that are
͕ Interviews essential in making good and wise decisions:
͕ Observations ͕ The freedom to make the decision in question.
͕ The capacity and ability to make a wise decision (doing so
͕ Any one or all of these methods may be employed to gather data requires sound judgment, deliberation, objectivity and
on the same subject. experience).
͕ The will, motivation and commitment to choose. (this attribute
Questionnaire requires volition (free will), a conscious activity of the will to make
͕ Administering a questionnaire is the simplest type of data- a decision).
collecting method.
͕ It is time-consuming but less expensive compared to other TYPES OF DECISION
method
͕ Questionnaires are used to elicit data on the following:
Considered Decisions
͕ Objective facts – such as the number of facilities and
͕ Are usually those of great magnitude- that is, they tend to be
services available and number of personnel employed.
complicated and call for considerable reflection.
͕ Behavioral variables – such as kinds of nursing activities
͕ In addition to a lot of personal thought, they require interaction
performed.
with others, because the perceptions and ideas of other people
͕ Evaluation – such as feelings about the quality of patient
often provide multiple alternatives that help in approaching the
care.
problem situation.
͕ Specified events – such as the time spent by nurses on
͕ A considered decision requires time to find alternatives to seek
clerical activities.
other opinions, to get dissent, to determine implementation
problems.
Interviews
͕ Incorporating these elements in a decision-making situation leads
͕ Interviews are used when questionnaires cannot provide the
to appropriate decisions that can be implemented with minimum
depth of response required.
probability of success.
͕ The unstructured interview permits probing into the responses
solicited to verify meaning and to obtain in-depth data.
Operational Decisions
͕ The highly structured interviews allow for the collection of
͕ Operational decisions are those we make practically every day.
standardized data and information and for probing to clarify
Some of these decisions, in fact, may be made at approximately
and broaden responses.
the same time each day, and they may prevent problems as well
as solve them.
Observation

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 Swallowed-Hard Decisions ͕ In some cases you may find that while no single alternative
͕ Are those that are often personally uncomfortable to make provides the averages you want, combining elements of two or
because they may result in discomfort or uneasiness for more provides you with the most likely plan.
subordinates or others. ͕ The “resources factor” may swing your decision.
͕ These can be generally classified as decisions impacting ͕ Alternative A may have more advantage than Alternative B.
interpersonal relationships —that is, decisions about relationships
among people in an organization. Get into gear:
͕ Although this kind of decision makes us feel uncomfortable, it is ͕ After you have made a decision, make it operative.
the kind of decision that is necessary —the kind that managers
are paid to make.
BUDGET
Ten Second Decisions
͕ Ten seconds decisions are those we make during daily operation. OVERVIEW
They are the decisions that bring operations together, keep it
ready, alive, and running well.
͕ The overriding factor in a ten-second decision is the pressure to ͕ Although not totally responsible for the formation or planning of
make it quickly. the institutional budget, the nurse manager should be aware of
͕ Before making a ten-second decision: the financial concerns that affect the health organization and the
͕ Determine first whether the situation really requires it. nursing department.
͕ Determine the major objective of that decision. ͕ Since the nursing department accounts for as much as half of the
͕ Before leaping in and “solving the problem,” determine first total expenditure of the hospital, the nurse manager should
what you are trying to accomplish. actively participate in the preparation of the budget.
͕ Once you have identified objectives, determine what
alternatives are available. PURPOSES OF BUDGETING
͕ Once you have considered alternatives, the last question
concerns implications. That is, what could go wrong in the ͕ Budgeting is defined as allocation of scarce resources on the
future if you pursue a given course of action? basis of forecasted needs for proposed activities over a specified
͕ Consider these four areas when responding to problem situations period of time.
that require quick decisions. ͕ Budgeting is a function of management.
͕ If we do this automatically, we can shift from making snap ͕ Employees need to have resources to be able to perform their
decisions to making sound ten second decisions. tasks.

DECISION–MAKING PROCESS Purposes of Budgeting are to:

͕ Ensure the most effective use of scarce financial and non
The basic method for making a decision involves a sequence of six financial resources.
steps: ͕ Coordinate efforts among organizational departments.
1. Analyze and Identify the Situation ͕ Establish a frame for reference for managerial decisions.
͕ Clarify first the situation you are trying to resolve. ͕ Provide a criterion for evaluating managerial performances.
͕ Before making a decision, take into consideration the
circumstances. TYPES OF BUDGETING
͕ Find out what’s wrong and why it is wrong before you
proceed. Institutional budgets are usually divided into manpower budget, capital
2. Develop Alternatives expenditure budget, and operating budget.
͕ In every decision-requiring circumstance, there are at least 1. Manpower Budget – this budget includes wages, salaries, and
two possible actions, for example: compensations paid to permanent employees. It may also include
￫ Either taking action or not. fees paid to temporary or casual workers.
￫ In most cases, there are more. 2. Capital Expenditure Budget – this budget requires long-range
3. Compare Alternatives planning. It includes purchases of land, equipment, buildings or
͕ There are few cases where you are lucky enough to have expansion or existing buildings or plants.
one alternative that represents the likelihood of 100% 3. Operating Budget – this budget includes purchase of minor
satisfaction. Usually each alternative had advantages and equipment, repairs, supplies or overhead expenses.
disadvantages.
͕ An alternative that you might prefer may be too costly, or THE BUDGETING PROCESS
you may lack the manpower to carry it out. Where the
decision is crucial, take the time to actually write out the ͕ Budgeting is a complex process and an important aspect in
advantages and disadvantages of each alternative. organizational planning and control.
4. Rate the Risk ͕ In preparing the budget the nurse manager is expected to:
͕ One of the differences between decision making and ͕ Review the financial performance during the prior budgeting
problem solving is that a proper solution to a problem is time frame, month, quarter, or year end.
sure-fire. ͕ Formulate a new budget or financial plan for the coming
͕ If it is indeed the right solution, you are practically sure of period in relation to the goals and financial projections of the
getting the results desired. organization.
͕ But in decision making, the usual situation is one in which
every alternative you are considering includes an Phase 1: Planning
uncertainty factor. ͕ Set short and long-term goals
͕ Since you seldom have total information about the situation ͕ Form a budget committee
you are dealing with, you can never be sure that the ͕ Prioritize objectives
decision you make will be completely satisfactory. ͕ Analyze past performance
͕ Accordingly, in considering alternatives, it is important to ͕ Predict future costs and revenues
rate the degree of risk each one involves. Obviously, this ͕ Develop budget guidelines
must be an estimate.
͕ Yet this approximation should be a part of the Phase 2: Preparation
considerations that lead you to select the most desirable ͕ Translate objectives into projected costs and revenues
alternative. ͕ Write justifications for all requested expenses
͕ Eliminate lowest priority objectives as necessary
Select the most alternative: ͕ Present proposed budget
͕ If the previous steps have been done carefully, it is possible that
the most likely alternative becomes self-evident. Phase 3: Modification and Approval
͕ Prepare preliminary master budget from all department requests
But there are other possibilities: ͕ Compare projected costs with estimated revenues
͕ No alternative is desirable. ͕ Eliminate lowest priority items until the budget is balanced
͕ The risk involved in all alternatives, for example, may properly ͕ Approve final master budget
persuade you not to take any action, because no move you can ͕ Communicate the final budget to all departments
think of at the time promises to be successful.

Merge two or more alternatives: Phase 4: Monitoring

͕ Prepare monthly summaries of departmental expenses and
revenues
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͕ Compare actual expenses with budgeted expenses
͕ Investigate any variance above 5%
͕ Readjust budget and/or improve performance as necessary
͕ Continue to monitor on monthly basis