Definition and components

• Nursing service administration is a coordinated

activity,
• which provides all of the facilities necessary for
the rendering of nursing service to clients.
• Nursing service administration is the system of
activities
• directed toward the nursing care of clients, and
includes
• Nursing Leadership and Management
• It is both an art and a science.
• It is a science in the sense that one may
systematically study and analyze the behavior
of people to draw generalizations from them.
• It is an art because it requires qualities of
dynamic character to make them effective in
application.
• Nursing service administration is the process
of planning, organizing, leading and
controlling that encompasses human,
material, financial and informational resources
in an organizational environment
• to achieve the predetermined objectives.
• A leader is a person who influences a group of
people towards a specific result.
• It is not dependent on title or formal
authority.
• The leader has to be responsible for the
overall performance of the team and
recognize their strengths and weaknesses.
• Vision: outlines what the organization wants
to be.
• It is a long-term view and concentrates on the
future.
• Mission: Defines the fundamental purpose of
an organization
• Describing why the organization exists and
what it does to achieve its vision.
• Values: Beliefs that are shared among the
stakeholders of an organization.
• Values drive an organization's culture and
priorities and provide a framework in which
decisions are made.
• Strategy: means a combination of the ends
(goals) for which the firm is striving.
• A strategy is sometimes called a roadmap which
is the path chosen to plow towards the end vision.
 Management and leader ship
• Leadership is a process of directing and
influencing task-related activities of group
members.
• Main aspects of leadership
• Although leadership is defined differently the
main aspects of
• leadership include:
• Involvement of other people in the leadership
process.
• It is very difficult to think of leadership with out
people.
• Where leaders have very high power in the
relationship.
• There is influence of behavior of other people
working with the leader and employees.
• The influence is accepted by the subordinates.
• The acceptance is most often voluntarily.
• What is the Difference between Management and
Leadership?
• Managers
• Mangers appointed for both technical and
leadership competencies.
• Managers are delegated authority, including the
power to reward or punish.
• A manager is expected to perform functions such as
planning, organizing, directing (leading) and
controlling (evaluating).
• Managers always exist in the organization
• Leaders
• Leaders can be Formal or Informal
• Informal leaders are not managers.
• Leaders often are not even part of the
organization.
• Informal leaders get authority from followers
• Florence Nightingale, was not connected with
an organization but was still a leader.
• Effective managers also need to be good
leaders.
• Manager-leaders ask for information, provide
positive feedback, and understand the power
of groups.
• Management may be defined as the process of
planning, organizing, directing and controlling
to accomplish organizational objectives/goal
through the coordinated use of human and
material resources.
• Management is getting things done through
people
• Occurs in formal organization setting
• Involves achieving goals through people and utilization
of other resources.
 Process of planning, organizing, staffing, directing, and
controlling the use of f Orgn’s resources to effectively
and efficiently attain its goals.”
 ‘’Mgt. is the process of attaining Orgnal goals/objectives
through effective and efficient utilization of resources.’’
 Definition of Management
What is Management ?

The term ‘management’ has several meanings.

Depending on context and purpose
 There is no definition of Mgt. on w/c every one
agrees.
 There is no universally accepted standard definition
of Mgt.
 Types of Managers
• 1. First-line (or first/ low level), Supervisory
mangers:
• Responsible for the work of operating and do not
supervise other managers
• Direct non management employees and have
authority and responsibility for overseeing a
specific type of work and a particular group of
workers.
• First or lowest level of managers in the
organizational hierarchy.
• 2. Middle managers
• Managers in the midrange of the
organizational hierarchy
• They are responsible for other managers and
sometimes for some operating employees
• They report to more senior managers
• 3. Top managers / senior
• Mangers responsible for the overall
management of the organization
• They establish operating policies and guide
the organization’s interaction with its
environment.
• Small in number
• Eg
• 1. First-line mangers: Supervisors, Technical
supervisor
• 2. Middle director: Department heads,
Heads of services
• 3. Top managers: Executive officer, president
vice president
 The roles of health manager
• Three managerial role ,according to Mintzberg,
are interpersonal, informational, and decisional.
• 1) Interpersonal Roles-
• The three interpersonal roles managers play are
as:-
• Figurehead - they engage in activities that are
ceremonial and symbolic in nature; as a symbol
of legal authority, attending ceremonies, signing
documents, etc.
• Liaison - role involves formal and informal contacts
both inside and with external stakeholders, to
establish relationships that will help them achieve
organizational objectives.
• Horizontal as well as vertical chain of
communications
• Influencer - role includes motivating & leadership
when they seek to inspire, and set examples
through their own behavior. I.e. managers are
accountable, responsible, & motivator.
• 2) Informational Roles –
• The three informational roles are:
• a) Monitor - filter, evaluate and choose to act
or react to that information.
• B) Disseminator - role involves choosing to
disseminate the information.
• Communicating selected information to
subordinates.
• c) Spokesperson - represents and speaks on behalf
of the organization. Communicating selected
information to outsiders.
• 3. Decision-Maker Roles-
• There are four decision maker roles:
• Entrepreneur /Change agent: designing and
initiating changes within the organization.
• Organizations are internally dynamic and
continuously affected by the environment, unless
managers act
• Disturbance Handler-They handle both internal and
external disturbances and take corrective action.
• They anticipate disturbances and resolve conflicts.
• Resource allocator - managers decide who gets
what based on priority setting.
• Negotiator - managers choose how to interact with
their superiors, peers, and subordinates. i.e.
Negotiating with other parties representing
organizational interests.
• Being a good negotiator makes a manager a
better disturbance handler.
• Playing the information roles effectively
improves performance in the decisional roles
because managers have information with
which to make decisions.
• Different levels of these roles are used at
different levels of managers & by different
individuals.
• Senior managers engage in figure head, entrepreneur,
and spokesperson roles more frequently than do other
managers.
• Middle level managers often are heavily involved in
disturbance handler and resource allocation roles, and
many of them rely on their abilities to successfully play
their informational roles as a key ingredient in their
work.
• First level managers may play leader, disturbance
handler, and negotiator roles extensively in their daily
work.
 Principles of nursing leadership

1. Division of Labor = The more people specialize, the more

efficiently they can perform their work

2. Authority = Managers must give orders so that they can get

things done

Authority & responsibility should be closely

related
3. Discipline = Members in an organization need to respect the
rules and agreements that govern the organization.
4.Unity of Command. Each employee must receive instructions

from only one person.

5. Unity of Direction. The entire organization should be moving

toward a common objective, in a common
direction.

6. Remuneration = Consideration of variables such as cost of

living, success of the organization etc. to
determine rate of payment to both employees
and employers.
7. Subordination of Individual Interest to the Common
Gool.
In any undertaking, the interests of employees should not
take
precedence over the interests of the organization as a
whole.
8.Substitution of Resources
• Often when the resources that are normally used to
provide service became scarce or too expensive, different
resources may be used to provide the intended results.
Centralization Decreasing the role of subordinates in decision
making is centralization; increasing their role is
decentralization.
Fayol believed that managers should retain final
responsibility, But should at the same time give
their subordinates enough authority to do
their jobs properly.

9. Hierarchy(scalar chain) = Lower line managers should always

inform upper level managers. But, if this makes delay , cross
communication should be undertaken and superiors should
be informed
10. Order. To increase efficiency and coordination,
materials & people should be in the right place at the
right time.
11. Equity. All employees should be treated equally.

12.Stability of Staff. Retaining productive employees

should always be a high priority of management.
A high employee turnover rate undermines the
efficient functioning of an organization.
• 13.Management By Exception.
• management by exception means- selectivity
in information
• - priority in decision.
• Don't be overloaded with the routine,
unnecessary information, be selective.
• Decision must be made as closely as possible
in time and place.
 Skills of nursing leadership

• Three basic types of skills are needed for

successful management
• 1. Technical skill:
• the ability to use procedures, techniques and
knowledge of a specialized field
• Using specialized knowledge and expertise in
executing work related techniques and
procedures.
• Related to things :process or physical objects
• 2.Human (interpersonal) skill :
• The ability to work /get along with,
understand, motivate, and lead other people
as individuals.
• Builds cooperation among the team.
• Working with people: Attitude,
communication.
• 3. Conceptual skill:
• Ability to see the organization as a whole
(the mental abilities of managers to visualize
the complex relationships in a workplace-
among people, among departments, among
various organizations…).
• A manager with this skill has the ability or
better understand how various functions of
the organization complement one another
• The relationship of the organization to its
environment
• How changes in one part of the organization
affect the rest of the organization
• All managers use all these three types of skills
in performing management work.
 Nurses Role- as- a Leader

• As a leader, your first priority is to get the Job

done.
• In order to do this, you must:
• 1. Know your objectives and have a plan for
reaching them
• If you are unclear about your goals, clarify
them with your manager.
• On planning, list everything you have to do
both short & long-term goals.
• Set priorities.
• Decide which tasks are the most important in
achieving your objectives.
• Decide how much time you will need to
complete each task.
• Check to see that resources needed to
complete the task are available.
• 2. Build a team committed to achieving those
objectives
• 3. Help each team member to give his or her
best effort.
• Achieving goals depends on teamwork
• You simply cannot do everything on your own.
• As a leader, it is your Job to build a team that
values what it does and knows that it is
valued.
• Set clear standards
• Let your team know exactly what you expect
in terms of quality
• Strive to maintain high but realistic standards.
• Explain the "Why" as well as the "What"
• It is important for team members to understand why a
task is necessary and why it must be done in a certain
way and how it will be achieved.
• Encourage Involvement
• Team members who are involved in the decision
making process are more likely to feel they have a
stake in achieving goals.
• However, be sure your team understands that you are
responsible for making the final decision.
 Build positive working relationships

• 4. Strive to be fair with all employees at all times.

• 5. Be understanding. Keep in mind that everyone
makes mistakes occasionally.
• When you must criticize, be constructive and tactful.
• 6. Build an atmosphere of respect among team
members.
• 7. Put the team first. Make it clear that you are more
interested in the group's achievements than in the
personal gain.
 Until II.
Nursing personnel management

• Human resource management is the process of

acquiring and retaining the organization's human
resource.
• Acquisition of human resource includes: human
resource planning, recruitment, selection and
orientation
• Retention activities include: performance appraisal,
training and development, discipline and corrective
counseling, compensation and benefit
administration, safety, and health.
• A. Acquiring Human Resource
• 1. Human resources planning
• Health service organizations determine staffing
needs through human resources planning.
• Because organizations are dynamic, these
needs change.
• Present staff must be retained and new
employees recruited to meet changing needs.
• Staff needs in Health Service organizations are
driven by:
1.Organizational growth: occurs through
increased demand for services, higher
occupancy, facility expansion and the addition
of new services or intensifying services.
• 2. Employee turnover: through resignation,
discharge and retirement
• 1. Internal Sources-filling vacancies by transferring
or promoting from within.
Advantage
• It is cost effective, reduces recruiting and
relocation costs
• Usually quicker, and enhances employee morale
Disadvantage
• Seniority rules policy rather than best qualification
• 2. External sources -new employees may be
recruited from outside through advertising
vacancies.
• Recruitment
• Recruitment is the process of attracting
qualified people to apply for a job.
• It involves searching for and attracting
prospective employees either from within the
organization or outside the organization.
• It is the process of making applicants available
for selection.
• You can select only from those people who
apply for a job.
• Selection
• Selection is the process of choosing for
employment.
• It is to choose among the applicants using job
qualification as a guide.
• The essence of selection is to determine
whether an applicant is suited for the job in
terms of training, experience and abilities
• Sources of information for selection
• 1. Application forms and
• 2. pre employment interviews
• 3. Testing
• Orientation
• After selection, orientation occur. Orientation
programmes include information about the
organization, organizational structure, philosophy and
objectives of the organization, rules and regulations.
• Advantage
• Builds employees sense of identification with
the health service organization
• Helps the gain acceptance by fellow workers
• Give them a clear understanding of many
• things they need to know
• Enables the new employee to become familiar
with the entire organization as well as their own
work area and department
• Personnel Training
• Training is a management tool designed to enhance
organization's efficiency.
• Methods and Techniques of Training
• After determining an organization's training needs and
translating them into objectives.
• The next step is to design a training program to meet
these objectives.
• This is not an easy task, because each training
method has its strengths, weaknesses, and costs.
 Motivation
• Motivating Staff
• Why do you motivate people?
• Motivation is unquestionable important in
health care institutions because, like in any
other organization,
• people are required to function effectively if
they are to provide adequate patient care.
• Institution must motivate qualified personal
to seek employment in the institution and
then motivate them to remain on the job.
• Continual turnover means continual recruiting
and training costs, inconvenience, and
disruption of staff functions.
• Motivation Theories
• Need hierarchy Theory (Maslow)
• Maslow stated that a lower level need is
prerequisite, or controls behavior until it is
satisfied,
• and then the next higher need energizes and
directs behavior.
• The hierarchy, from the lowest to the highest
level, is as follows:
• A. physiological needs (e.g. hunger, thirst)
• B. safety needs (i.e., bodily safety),
• C. need for love and sense of belongings (e.g.
friendship) affection, (love)
• D. need for self-esteem (e.g. recognition,
appreciation, self respect)
• E. self actualization (e.g. developing one's
whole potential enjoy life).
• Maslow's need theory is frequently used in
nursing to
• provide an explanation of human behavior.
• A patient's needs are viewed in this
hierarchical order, with nursing
• care directed toward meeting the lower level
needs before addressing higher needs.
• Two Factor theories- Hertzberg (Theory of
Job satisfaction)
• The first set, called hygiene factors are those
factors that meet a person's need to avoid
pain, insecurity, and discomfort.
• The second set, called motivation factors are
those that meet needs to grow
psychologically, when met, the employeefeels
satisfied.
• Appropriate supervision
• Good interpersonal relationships
• Safe and tolerable working conditions (i
• ncluding reasonable policies and procedures)
• The hygiene factors include:
• Adequate salary
• The motivation factors include:
• Satisfying, meaningful work
• Opportunities for advancement and
achievement
• Appropriate responsibility
• Adequate recognition
• The leader manager's function is to ensure
that both sets of needs are met,
• some directly and others by providing
opportunities to meet them in a conducive
work environment.
• Satisfied need is no more motivator
 Unit III
Function of Nursing managment
• In every organization managers perform certain
basic functions in order to achieve the results.
• These functions are:
 Planning,
 Organizing,
 Staffing
 Leading/directing
 Controlling
I) Planning
• It is the process of establishing goals and a
suitable course of action to achieve the goals.
• Basically concerned with determining the
objective of an organization and the means for
achieving them.
• Planning enhances efficiency and effectiveness.
• Helps to deal with the present and anticipate the
future. Planning:-managers think through their
goals and actions in advance.
• It involves what to do, how to do and when to do
• Planning is a primary management function.
Why?
• Through planning managers clearly put and
outline exactly what organizations must do to be
successful.
 Ii, Organizing
• After objectives and plans have been established
management must organize human and physical
resources of the organization
• Organizing includes the provision of physical facilities
capital and personnel
• It is also concerned with the determination of relation
ships among functions, job and personnel
• It is the process of arranging and allocating
work, authority and resources among
organization members to achieve goals.
• It involves establishing authority &
responsibility relationships; division of work,
job design, coordination, information and
feedback systems in the organization.
 iii) Leading (directing, motivating, and
communicating)

• Is to lead, motivate, communicate and supervise

the employees toward organizational goal.
• It focuses on initiating action in the organization
or system.
• It is the process of directing and influencing the
task-related activities of group members or an
entire organization.
• The process of guiding the activities of
organization members in appropriate
direction.
• Influencing, directing, (activate ,motivate)
• Time and relationships.
• iv) Controlling
• The process of ensuring/ conforming the
actual activities in relation to planned
activities.
• A function for which managers:
• Establish standards of performance
• Gather information and Measure current
performance
• Compare performance with standard
• Taking corrective action
• Rewarding
• v) Decision Making
• Choosing between or among alternatives.
• A function made at all levels from planning up
to controlling.
• Senior managers make policy decisions and
resource allocation decisions that affect the
entire and various parts of the organizations.
• Middle- and first-level managers make
decisions about allocating and utilizing
resources provided by senior management
within their areas of authority and
responsibility.
• Management Functions of a Nurse Manager
• Success of management depends on learning
and using the management functions.
• These functions include planning, organizing,
staffing, directing, coordinating and
controlling.
• These functions represent these activities
expected of managers in all fields.
 Planning

• Planning is a technical managerial function that

enables organizations to deal with the present and
anticipate the future.
• It is the first and fundamental function of
management because all other management
functions are dependent on it.
• Planning is deciding what is to be done, when it is to
be done, how it is to be done and who is to do it.
• It is an orderly process that gives organizational
direction.
• Planning is the process of determining how the
organization can get where it wants to go.
• Planning is the process of determining exactly what
the organization will do to accomplish its objectives.
• In more formal terms, planning has been defined as
‘the systematic development of action programmes
aimed at reaching agreed objectives by the process
of analyzing, evaluating and selecting among
• the opportunities which are foreseen.
• Purpose of planning
• It gives direction to the organization.
• It improves efficiency.
• It eliminates duplication of efforts.
• It concentrates resources on important services.
• It reduces guess work.
• It improves communication and coordination of
activities
 The planning hierarchy

• Planning responsibilities are different for

managers at each organizational level.
• 1.Strategic planning
• Top-level managers, formulate long-term
strategic planning to reinforce the firm’s
mission (the mission clarifies organizational
purpose)
• Strategic plans are specified for five years
period or more.
 2.Tactical planning

• Middle management is responsible for

translating strategies into shorter-term tactics.
• Tactical plans are often specified in one-year
increments. Eg. annual budget.
• Translating strategic plans into measurable
tactical objectives is important because most
strategic objective is rather vague.
• Tactical plans are the courses of action
associated with reaching short-term goals.
• 3.Operational plans are:
• The day-to-day actions that support tactical
goals.
• Policies and procedures are
• The ongoing or standing plans that are used to
address recurring activities.
• Strategic, and operational plans will be
needed to achieve the associated objectives.
• A rule is a very specific guide to behavior.
• Goals: Are broad statements. There is one goal
for a service.
• Aims:
• Number of aims related to the goal. Specific to
a particular problem.
• Operational plans: two types
• Single-use plan
• Standing plan
• Single-use plan: is a detailed courses of action that
will not be repeated.
• Example:-
• Program: A single use plan
• Projects: Smaller, separate portions of programs
• Budgets: Financial resources allocated for certain
• Standing plan:
• An established set of decisions used to deal with
recurring organizational activities
• Policy:
• A standing plan that establish general guideline for
decision-making
• Facilitates channeling of management thinking toward
taking action
• Tells managers which decisions can be made and
which can not.
• Rules:
• Standing plans that detail specific actions to
be taken in a given situation
• Procedures:
• a standing plan that contains detailed
guidelines for handling organizational actions
that occur regularly.
• Management by objectives (MBO)
• An approach to planning and controlling based
on measurable and jointly set objectives.
• Consists of four steps:
• (1) Setting objectives jointly.
• All individuals in an organization are assigned a
specialized set of objectives that they try to
reach in during specified operation period
• Objectives are set mutually and agreed upon by
both
• (2) Developing action plans,
• (3) Periodically re-evaluating objectives and
plans and monitoring performance,
• Performance review how close are workers in
attaining goals
• (4) Conducting annual performance appraisals.
 Steps in planning
• There are six steps in planning
• Situation analysis
• Analyzing and selecting critical (priority)
problems
• Setting objectives and targets
• Identifying potential obstacles
• Designing the strategies
• Writing up the plan
• 1: Situational Analysis
• Review and describe organizational
characteristics, Consider,
• National health polices & programmes;
• Analyze the organizational structure and
functions of the health services;
• Identify limitations/ bottlenecks in the
organizational structure;
• Review past implementation experience;
• Analyze the health condition (magnitude);
• Study the size, composition and distribution of
the population;
• Collect information about resources;
• Selecting Critical Problem (Priority)
• Analyzing problems and constraints
• Define a problem: a problem is a difficulty or
obstacle seen to exist between a present
situation and desired future objective.
• Criteria - In identifying priority problem
• Does the Problem:-
• 1. affect large number of people
• 2. cause high infant mortality
• 3. affect maternal health
• 4. affect children and young persons
• 5. cause chronic conditions & handicap
• 6. affect socio-economic development
• 7. cause worry to the community
• If the answer to any one of the above question
is yes, the problem is
• a priority one.
• To be based on the above question, the
criteria can be:
• 1.The magnitude of problem
• 2.Degree of Severity
• 3.Feasibility
• . effectiveness
• . cost and
• . social acceptability of intervention
• 4.Community concern
• 5.Government concern and social acceptability
• Step 3: Setting Objective/ Target
• Objectives are desired end states (outcomes) of a
programme
• If the programme is made to have an objective
and target then:-
• It must be relevant - fits with health policy
• It must be feasible - achievable
• It must be observable
• It must be measurable
• In other words: Objective must be SMART:
• S = specific
• M = measurable
• A = Achievable
• R = Realistic
• T = Time bound
• Example: By the end of 2005 90% of eligible
children will be vaccinated against Eight target
disease in Harari region.
Step 4: Identifying Potential Obstacles
• Why objectives could not be attained?
• Which are the limitations & obstacles?
• Resources:
• People - lack of interest
• - no skilled people etc
• Equipment - not available
• - expensive
• Money - No budget
• Time - People may not have time
• Environmental Obstacles:
• Geographical problems
• Climate - type of diseases
• Technical - electricity
• Social factors – traditions may operate against
your plan
• After identification – Analyze the obstacle
• - obstacles might be modified, or
• - obstacles might be removed
 Example:- Analysis of Obstacles
Objective Obstacles Removed Modified

To provide trained -Shortage of Train & utulize

personnel for all Midwives TBA
women in child
Birth by 2015
• Step 5: Designing the Strategies
• Outline potential strategies this include
• The technology to be applied
• Procedure to be used
• Defining the role of the communities and
other relevant sectors
• Design the details of selected strategy
• Determine resources required in terms of
proposed strategy
• - time
• - staff
• - facilities/materials
• - money
• Estimate strategy costs & assess adequacy
 prepare action plan
• The purpose of writing the plan
• To request funds or resources
• For monitoring and evaluating the
implementation process by all concerned.
Steps
• What is to be done?
• The objectives and Targets are clearly stated
• Chose strategy
• Schedule of activities
• Allocate responsibilities for activities
• Resources
• Equipment - required
• When will the work be done (Gannt chart )
 Gannet chart for establishing an EPI out
reach site
September October
Discussion with staff 07 14 21 04 11 18
Training of staff on cold
chain mgt.
Ordering equipment

Discussion with staff

Training of staff on cold
chain mgt.
Ordering equipment

Discussion with staff

Training of staff on cold
chain mgt.
Ordering equipment
 Implementation
• Definition
• It is putting a program into action or doing the
work.
• What is to be implemented depends on the
plan.
• Once a program has been planned and
marketed, it must be implemented.
 Factors that facilitate Implementation

• 1. The implementer need to

• Know and review the plans drafted,
• Understand the goals/objectives,
• Write detail activities based on the
goals/objectives,
• Arrange time-table,
• Assign responsible bodies
• 2. Allocating the necessary Resources/Inputs
• Manpower
• Secure and deploy on time the necessary
manpower in kind and number.
• Money
• - Clear budget have to be available and utilized
effectively and efficiently.
• - Know the amount of budget allocated for
implementing the project/program/activity.
• - Close control of the utilization is very
essential.
• Information
• - Document all the necessary information
about the progress of the implementation.
• Time
• - Use time effectively.
• - Develop time-table to follow the
implementation.
 Coordination of the work

• Coordination of the work will facilitate

implementation and will help to complete the
program on time.
• Some of the areas to be considered in
coordination are:
• Give defined responsibilities to the staff.
• Give authority that can balance the authority
offered.
• Person in charge have to be assigned and be
known by all.
• Develop check lists that will guide coordination
such as:
• What is to be done?
• Where does the action will take place?
• When will be the action will take place?
• Which materials and equipment are needed?
• Who will be responsible at each level?
• Monitoring and control
• Monitoring is a continuous, systematic and
critical review of a project/program/activity
with the aim of checking progress.
• Corrective action has to be taken if any gap is
detected during monitoring.
• During monitoring check:
• If activities are implemented as planned or
not,
• If the time is properly utilized,
• If the necessary manpower is deployed,
• If the necessary resources utilized properly,
• If there is a need of modifying/changing, etc.
 Supervision
• Health service supervision is defined as "A
process of guiding, helping, training and
encouraging staff to improve their
performance
• in order to provide high quality health
services. "It is not fault finding.
• It is concerned with operational running of the
unit and should deal with the following key
questions:
• Do staff understand the responsibilities and
objectives that come with their job?
• How do staff organize their works and what
tasks have to be assigned to them?
• How do staff deal with the problems and
difficulties in their job?
• Do staff achieve high technical, ethical and
legal standards in their job?
• What personal and technical supports are
required for the employee to work effectively?
• What measure can be taken to improve the
performance of the staffs?
 Kinds of Supervision

• 1. Task-Oriented
• In this case, both quantity and quality of the
task are taken into consideration.
• 2. Person-Oriented
• Person-oriented supervision is the control of
the workers based on the understanding of
their needs, past training and styles of
working.
 Responsibilities of Supervisors

• Identify standards of good performance and

communicate to staff members.
• Work with staff to periodically assess their
performance compared to these standards.
• Provide feedback to staff about their
performance.
• Work with the staff and the community to
identify appropriate interventions that will
lead to improve worker performance and
delivery of high quality service.
• Mobilize resources from many different
sources to implement interventions.
• Needs of a Supervisor
• Knowledge of the work
• Skill in instructing
• Skill in improving methods
• Skill in leadership.
 Appropriate style of supervision
• Should the style of supervision be autocratic,
democratic, and Lessessfair?
• 1. Autocratic (directive)
• - "Do as I say" is the main say
• - One way communication only
• 2. Anarchic (lesessfair)
• - "Do what you like",
• 3. Democratic (supportive, participatory)
• - "Let us discuss and agree on what we are to
do"
• - two ways communication
• - Helps people to grow, to become responsible
• - involve he subordinates in decision-making,
 The experience of supervision in the
health sector
• Studies show a number of key problems in many
system of supervision.
• Lack of skilled/experienced staff
• lack of motivated staff
• Lack of resources to carry out supervision sustainable
• High turn of skilled manpower
• It is sometimes carried out without planning and
scheduling
• Feedback is not given on time
• Most of the time those areas which are far
away are not covered by supervision.
• Lack of transportation to reach inaccessible
areas
• Supervisors and Supervisees have in sufficient
time for supervision
• Supervision visits and sessions suffer from
poor scheduling
• Supervisors do not have the necessary
seniority and respect among the employees
• Feedback does not occur in the supervisory
process
• Supervisors fail to adopt the right supervisory
style
 Evaluation
• It is the process of determining the worth of a
system, project, course of action, etc.
• It involves the comparison of the actual
performance of the system, in order to find
out to what extent organizion purposes have
been achieved.
• Efficiency: the ability to minimize the use of
resources in achieving organizational
objectives. “Doing things right.”
• Effectiveness: the ability to determine
appropriate objective. “Doing the right thing.”
• How to evaluate work progress monitoring
• Monitoring is the day-to-day watch on, or
continuous follow-up of, the on going
activities.
• It is carried out through observation of men,
materials, and discussion with workers.
• Monitoring is one of the tools for evaluation.
• It is regularly checking to see that program activities
are being done as planned.
• It means collecting information and keeping records
about activities to check whether the work is being
carried out as planned
• The goals of monitoring are:
• To identify any problem early,
• To solve without delaying the progress of the
program.
• Effectiveness: the ability to determine
appropriate objective. “Doing the right thing.”
• How to evaluate work progress monitoring
• Monitoring is the day-to-day watch on, or
continuous follow-up of, the on going
activities.
• It is carried out through observation of men,
materials, and discussion with workers.
• Monitoring is one of the tools for evaluation.
• It is regularly checking to see that program activities
are being done as planned.
• It means collecting information and keeping records
about activities to check whether the work is being
carried out as planned
• The goals of monitoring are:
• To identify any problem early,
• To solve without delaying the progress of the
program.
• Key areas of monitoring
• 1. Adequacy of supply, materials and budget.
• 2. Training, type, relevance and quality.
• 3. Quantity and quality of work done.
• Formative/ Diagnostic Evaluation
• Any combination of measurements obtained
and judgment made before or during the
implementation of materials, methods activities
or programs to control or assure or
• improve the quality of performance or delivery.
• Is providing information on progress.
• It must therefore be continuously possible.
• Measures the progress or gains made from the
beginning
• until completed.
• Enables activities to be adjusted in accordance
with progress made . Therefore, it is a teaching
method.
• Is very useful in guidance and prompt to ask for
help.
•
• Is carried out frequently.
• 4. Summative/ Certifying Evaluation
• Any combination of measurements and
judgments that permit
• conclusions to be dawned about impact
outcome or benefits of the program or
method.
 Monitoring performance against
behavioral objectives
• Monitoring: Is the process of finding out the
value of something
• Determining the value or worth of objects of
interest against standard of acceptability
• Levels of monitoring performance
• Effectiveness-the amount of the intended
objectives that have been attained
• Efficiency-the degree to which the program
achieved its result at the lowest possible cost
• Steps of controlling performance
• 1. Decide what is to be controlled?
• 2. Collect the information needed to provide the
evidence
• 3. Compare the results with the targets or objectives
• 4. Judge to what extent the targets and objectives
have been meet
• 5. Decide whether to continue the programme
unchanged, to change it or to stop it
• How to monitor work progress?
• Work progress is monitored in order to
measure the efficiency of the team,
• I.e. to find out whether the team completed
the work which was assigned to it in order to
reach its targets.
• Was carried out in time and its budget was
not overspent?
• Here are three ways to monitor behaviors
• 1. Observation
• Observation is taking a planned approach to
watching your employee ‘in action’.
• The idea is that you plan to observe the
specific behaviors that you have described in
your performance objectives.
 Feedback
• Feedback is about getting feedback from people on
the employee’s performance. This could be from:
• team members
• other departments
• Regular feedback keeps communication open
between management and employees.
• A positive working environment provides employees
with constructive feedback so they know how well
they are performing work responsibilities.
• Feedback also enables employees to improve
work performance, when necessary.
• As a supervisor or manager, knowing how to
properly give feedback to employees can help
create a more effective work environment.
• Frequent communication helps employees
know where they stand, which benefits both
the company and the employees.
• Positive feedback is something every employee
wants to receive on his job performance.
• Positive feedback is an important aspect in an
organization's
• How to Give Feedback to Receptive Employees
• 1 Provide employees with positive feedback as
soon as possible.
• For example, if an employee presents an effective
presentation , praise the performance immediately.
• 2 Speak with an employee privately within 24
hours of a situation
• when you must give negative feedback.
Communicate negative feedback
constructively and specifically to enable an
employee to improve.
• 3 Explain the behavior or conduct you desire
or expect.
• 4 Schedule regular meetings with employees
(monthly or bi-monthly) to give overall
performance feedback.
• Before extending the feedback, compile specific
examples of either negative or positive situations
that you wish to cover with the feedback.
• When the feedback is negative, give employees a
clear idea of what you expect to enable them to
improve performance.
• 5.Give employees an opportunity to share
their ideas and concerns after you extend the
feedback.
• Listen attentively to employees' ideas and
consider implementing ideas that might help
improve the organization.
 Unit IV.
Organizing Care

Delivery system
• Organizing
• Organizing may be defined as the arranging of
component parts into functioning wholes.
• The purpose of organizing is to coordinate
activities so that a goal can be achieved.
• For example, organizing is considered step in
the nursing process
• In the nursing process, planning includes
writing objectives, setting priorities, and
determining activities to meet the objectives.
• Thus, organizing may be considered part of
the planning, even though it is not specifically
identified.
• Planning, and thus organizing, may be viewed
as being part of all processes, including the
leadership process.
• Thus, planning and organizing may be said to
answer the what, why, how, when, and where
questions about specific activities.
• There are six steps in the organizing process:
• 1. Establish overall objectives
• 2. Formulate supporting objectives, policies
and plans
• 3. Identify and classify activities necessary to
accomplish the objectives
• 4. Group the activities in light of the human and
material resources available and the best way of
using them under the circumstances
• 5. Delegate to the head of each group and the
authorities necessary to perform the activities
• 6. Tie the groups together horizontally and
vertically, through authority relationships, and
information systems.
• Establishing Objectives
• The first step in the process of organizing is to
establish overall objectives.
• Objectives are explicit, concise statements of
what is to be accomplished.
• They provide directions for selecting materials
and methods to achieve the desired goal.
• Behavioral objectives can be measured through
observable performance.
• Overall objectives are usually broad and give a
general idea of what is to be accomplished.
• Five criteria for sound objectives in a
management area have been established.
• First, the objective must be acceptable to both
the leader and the group who will be involved
in achieving it.
• Second, the objective must be attainable
within a reasonable period of time, that is, it
must be realistic.
• Third, the objective must be motivational
• When the nurse leader collaborates with
group members in establishing objectives,
members’ ideas should be included, so that
• they will feel a part of the objective.
• When members have input into the objective, it
becomes their own, and they are motivated to achieve
it.
• Fourth, the objective must be simple.
• It should be clearly describe only one behavior.
• A good objective is as brief as possible, yet it’s meaning
is clear.
• Finally, the objective must be communicated to all
• The leader, the group, and their superiors should all
know
 Formulate Supporting Objectives
• Another part of the second step in the
organizing process is the recognition of
existing policies, procedures, and rules that
affect the task and objectives.
• A policy is a guide to action that provides a
standard decision for recurring problems and
is made by top-level administrators.
• Policies aid in keeping activities in line with
the overall objectives of the organization.
• For example, all critical patients on being
discharge must go to the door in a
wheelchair” is a policy to aid in meeting the
overall goal, “patients will not fall in the
hospital.”
 Identify and Classify Activities

• If the written objectives are very specific, the

required activities will be obvious.
• The activities that a nurse will have to perform
to provide care include giving medications,
bathing patients, making beds
• The nurse leader must know when, what, how
and why activities are done.
• Then prioritize activities based on biological
and behavioral sciences.
 Group Activities

• The fourth step in the process of organizing is

group activities according to the human and
material resources available.
• Once all the activities have been identified and
given a priority, the nurse leader must analyze
• resources, so that they can be used to best
advantage in terms of time, talents, and economy.
• The nurse leader must assess both group members
and the material resources that she/he has at hand.
• Delegation
• Delegation is the process of assigning part or all of one
person’s responsibility to another person or persons.
• Delegating is an effective management competency by
• which nurse managers get the work done through the
employees.
• The ultimate responsibility for that activity still belongs
to the nurse leader(i.e. the person who delegated the
activity).
• The following list suggests ways for nurse
managers to successfully delegate.
• Train and develop subordinates.
• Give them reasons for the task, authority,
details, opportunity for growth, and written
instructions if needed.
• Control and coordinate the work of
subordinates,
• Follow up by visiting subordinates frequently.
• Expect employees to make suggestions to
improve work and use the feasible ones.
• Encourage employees to solve their own
problems, and then give them the autonomy
and freedom to do.
• Give appropriate rewards
• Do not take back delegated tasks.
 Staffing

• Staffing is the management activity that

provides for appropriate and adequate
personnel to fulfill the organization’s objectives.
• The nurse manager decides how many and
what type of personnel are required to provide
care for patients.
• Nurse manager is in a position to monitor how
successful the staffing pattern is as to provide
input into needed change.
• Staffing is a complex activity that involves
ensuring that the ratio of nurse to patient
provides quality care.
• The situation of a nursing shortage and the
high activity levels of admitted patients to
acute care areas complicate this process.
• Staffing depends directly on the workload or
patient care needs.
• Directing
• Directing is a function of the manager that gets
work done through others.
• Directing includes five specific concepts:
• Giving directions, supervising, leading, motivating,
and communicating, as described below:
• Giving directions is the first activity and suggests
that directions should be clear, concise and
consistent
• Supervising is concerned with the training and
discipline of the work force.
• Leading is the ability to inspire and to influence
others to the attainment of objectives
• Motivating is the set of skills the manager uses to
help the employee to identify his/her needs and finds
ways within the organization to help satisfy them.
• Communicating: involves the what, how, by whom,
and why of directives or effectively using the
communication process.
• Coordinating
• Coordinating is by definition the act of
assembling and synchronizing people and
activities
• so that they function harmoniously in the
attainment of organizational objectives.
• Controlling
• Is the regulation of activities in accordance with the
plan.
• Controlling is a function of all managers at all levels.
• Control involves establishing standards of
performance.
• Determining the means to be used in measuring
performance, evaluating performance, and providing
feedback of performance.
• Controlling is not manipulation, rigid, and
autocratic.
• Management by objectives (MBO) can be
considered as a control mechanism.
• Based on MBO principle determining
objectives (standards) against which
performance can be measured can be stated.
• Second, specific measures have to be
established to determine whether these
objectives are met.
• Third, the actual accomplishment of the
objectives would be measured in relation to the
standard
• and this information would be fed back to the
individual.
• Then corrective action could be taken.
 Unit V

• Communication
• Communication is a complex process of sending
and receiving verbal and nonverbal messages.
• Allows for exchange of information, feelings,
needs, and preferences
• The process of creating common understanding
• The process of sharing information
• The process of generating and transmitting
meanings
Purposes of communication
• Information
• Education
• Persuasion
Goals of communication: Shared Meaning
• 1. Mutual understanding of the meaning of the
message.
• 2. Feedback/response indicates if the meaning of
the message was communicated as intended.
 Types of Communication
• People Communicate in a variety of ways.
• 1. Verbal Communication-is an exchange of
information using words and includes both the
spoken and the written word.
• Verbal communication depends on language.
Language is a prescribed way of using words so
that people can share information effectively.
• The verbal form of communication is used
extensively by nurses when speaking with
clients, giving oral reports to other nurses,
writing care plans and recording in nursing
progress reports.
• Characteristics: simple, brief, clear, well timed,
relevant, adaptable,
• 2. Non verbal communication-is the exchange of
information without the use of words. It is communication
through gestures, facial expressions, posture, body
movement, voice tone, rate of speech, eye contact.
• It is generally accepted that non-verbal communication
expresses more of true meaning of a message than those
verbal communication.
• Therefore, nurses must be aware of both the non verbal
messages they send and receive from clients.
• Non verbal is less conscious than verbal, requires
systematic observation and valid interpretation
• Levels of Communication
• Intrapersonal-is the messages one sends to oneself,
including self-talk, or communication with oneself.
• A person receiving internal or external messages
organizes, interprets, and assigns meaning to the
messages.
• Interpersonal-Two way communication.
• is the process that occurs between two people
either in face-to-face or over the telephone
• An important outcome of interpersonal
communication is the development of an
interpersonal relationship.
• There is a feedback
• Public(Mass) –sending a message for a large
population. No feed back.
 Communication Model

• The communication model comprises seven

elements:
• 1. The source
• 2. Encoder
• 3. The message
• 4. The channel
• 5. Decoder
• 6. The receiver
• 7. Feedback
• The communication process begins when a
person, known as the sender, generates a
message.
• Message, to create meanings, and to
understand various situations.
• Messages are generated by external factors,
such as what the sender sees, hears, touches,
tastes, or smells.
• Encoding-Producing message
• Encoding involves the use of language and
other specific signs and symbols for sending
messages.
• The language peculiar to a specific culture are
encoding skills.
• The use of gestures and other nonverbal
behaviors is an encoding ability
• The message:
• The message is a stimulus produced by a sender
and responded to by a receiver.
• Messages may be verbal, or nonverbal.
• Is a series of words in connected speech or
writing form the grammatically complete
expression of a single thought.
• The order established through sentences.
• Clear, short and to the point.
• The channel: it is a route through which a message is
transmitted.
• Is the medium through which a message is
transmitted.
• Communication channels include: visual and auditory.
• The visual channel is sight, observation, and
perception.
• The auditory channel consists of spoken words.
• Eg.The sensory channel involves: seeing written
words,or listening spoken words.
• Decoding: Interpreting and understands what
we mean by conveyed message.
• The receiver is the person who intercepts the
sender’s message. Receiving is influenced by
complex physiological, psychological, and
cognitive processes.
• Is some one for whom message is being
transmitted. The receiver is the target of
communication.
• The physiological component involves the
process of hearing. Intact, healthy ears, as well
as those areas of the brain involved in the
hearing process, enable the receiver to hear
messages.
• Good eyesight allows for the reception of
messages via the visual channel.
• The psychological process refers to mental
mechanisms that affect human behavior. This
component may enhance or impede the
receiving process.
• For example, anxiety may restrict the
perceptual field, causing the person to hear,
see, or feel less accurately.
Feedback is the information the sender receives
about the receiver’s reaction to the message.
• Is the response of the receiver which allows
us to determine the success or failure of our
communication.
• The function of feedback is to provide the
sender with information about the receiver’s
perception of a situation. Having this
information.
• The sender can then adjust the delivery of the
message to communicate more effectively.
• Communication is reciprocal in that both the
sender and receiver must be involved; the
sender must transmit the message, and the
receiver must provide feedback for a
communication to be complete.
Communication Techniques in Nursing
• Conversation skills
• Be knowledgeable about the topic of
conversation and have accurate information
• Be clear and concise
• Avoid words that may be interpreted
differently
• Be truthful
• Take advantage of available opportunities
• Listening Skills- is a skill that involves both
• hearing and interpreting what is said.
• Techniques to improve listening skills
• When ever possible sit when communicating
with a client
• Be alert but relaxed and take sufficient time so
that the client feels at ease during the
conversation
• Maintain eye contact with the client
• Indicate that you are paying attention to what
the client is saying by nodding head.
• Think before responding to the client
 Information system

• Definition.
• Information system is a set of components &
procedures organized with the objective of
generating information for the health care
management decisions at all levels of the
health system.
• Purpose.
• To monitor the health status and health
services of a nation
• To improve management decisions at all
levels
• By making available timely and relevant
information required for rational and effective
decision
• Information system enhances appropriate
decision making for client care
• Information is usually presented as Indicators
• Indicator is warning light that comes on when
something is wrong and Prompts you to take
action.
• Indicators show us the speeds and the final
status we have achieved.
• Use of Indicators
• In planning as baseline
• To assess our activities while we are
undertaking them.
• When the situation changes, the indicator
changes
• Indicators are instruments of evaluation.
• Indicators compare between an actual
situation (numerator) and a standard
(denominator).
• Types of indicators:
• Input indictors (the inputs into the process)
• Process indicators (Are we doing a good job?”. They
cover the area of efficiency and quality of work done).
• Output indicators (Are we achieving the production
we wanted to achieve?” They cover the area of
productivity)
•
•
•
• Guiding principles for strengthening
Information system:
• Accuracy: Data should be accurate and
standardized for comparative purpose
• Timeliness: Health data should be produced,
submitted, processed and used within a
reasonable time.
• 3. Comprehensiveness: Essential health
indicators should include key aspects of the
health system.
• 4.Representativeness: Statistics reported
should be representative of the situation in
individual countries and should be as
complete as possible
• 5. Relevance: Information collected should
reflect the needs of the client
• The implementation of Information system
involves;
• Data collection
• Transmission,
• Processing
• Analysis and
• Reporting as well as
• Decision-making
 Unit VI
• Managing Time
• Time is a non-renewable resource.
• Maximize Managerial Time
• 1. Set goals- determines the short, medium and long-
range goals.
• Which goals must be completed before others? Which
will take the longest to achieve? Setting priorities
helps resolve goal conflict.
• 2. Once you have determined and ranked your goals
plan schedule
• Planning time arrangements
• Events are arranged in daily, weekly, monthly
or yearly time periods.
• The periodicity depends on the frequency or
regularity of particular events.
• Time plans are written in various common
forms known as :
• Timetable: daily or weekly regularly recurring
events.
• Schedule: intermittent or irregular or variable
events, and where they take place.
• Roster: duties planned for different staff
members, for different times in turn.
• Preparing a health unit time table
• List all activities that happen regularly each
week.
• Then arrange them in an appropriate time table
grid.
 Managing stress
• Stress is the body’s physiological reaction to any
stimulus.
• Any situation, event, or agent that threatens a
person’s security is a stressor.
• Anxiety, frustration, anger, and feelings of inadequacy,
helplessness, or powerlessness are emotions often
associated with stress.
• For example, a sleep disturbance may be present,
eating and activity patterns may be altered, and family
processes or role performance may be disrupted.
• Stress management is directed toward
reducing and controlling stress and improving
coping.
• The need to prevent illness, improve the
quality of life, and decrease the cost of health
care
• Stress control is a significant health-
promotion goal.
• Adaptation is an ongoing process by which
individuals adjust to stressors in order to achieve
homeostasis (equilibrium) between physiological,
psychological, and sociocultural needs.
• The well person is one who is coping effectively
with stressors to maintain a high level of well-
being.
• The nurse’s goal is to identify and support the
client’s positive adaptive responses.
 Unit VII
• Problem solving
• Problem: is the difference between actual and
desired states of affairs
• Gap where one is and wants to be
• The definition put managers in a better position
to create more effective and efficient solutions.
i.e. problem solving
• Depending on the situation, problems can be
resolved , solved, or dissolved
• Problem-solving is not usually an easy task for a
manager
• It takes much time of the senior and mid-level
managers
• The outcome of problem-solving affects allocation and
utilization of resources
• The creative problem-solving process consists of four
steps:
• (1) identifying the problem,
• (2) generating alternative solutions,
• (3) selecting a solution, and
• (4) Implementing and evaluating the solution.
• (1) Identifying the problem
• Problem analysis: problem recognition and
definition includes data collection and
evaluation
• Decision Making
• Decision making-is a choice made between
two or more alternatives.
• It is choosing the best alternative to reach the
predetermined objective.
• Thus decision making is a process of
identifying and selecting a course of action to
solve specific problem.
• Decision making is a major part of
management,
• because When planning, organizing, staffing,
leading, and controlling, managers make
decisions on a daily basis.
• Many decisions are made in order to solve
problems
• Techniques for Decision Making in Small
Groups
• There are three useful procedures for a small
group of people that helps them to arrive at a
decision for a problem. These include:
• 1.Brainstorming
• 2. The nominal group technique
• 3.The Delphi method.
• 1. Brainstorming
• Brainstorm is a discussion technique developed by
Osborn (1957) to stimulate the production and
generation of creative ideas in groups.
• Brainstorming enhances by allowing them to express
their ideas freely without being inhibited by the fear of
criticism.
• The assumption that underlies brainstorming is that if
group members feel uninhibited about expressing their
ideas, more ideas and better ideas will emerge from the
group.
• The brainstorming technique is relatively easy
to use in small group discussions. The rules for
brainstorming technique include:
• 1. Generate numerous ideas about an issue
• 2. Welcome free thinking and facilitate open
expression of ideas
• 3. Withhold any evaluation or criticism of the
ideas that are expressed
• Nominal Group Technique
• This technique is designed to promote the
expression of many high quality ideas from
members who initially work independently
and then share their ideas with the group.
• The overall goal of the nominal group
technique is to arrive at a group decision that
represents a pooled judgment that is based on
the independent ideas of all group members.
• The steps for nominal group technique include:
• 1. Group members, without any discussion,
independently write down their ideas about a
problem or task
• 2. Each group member presents an idea to the group
without discussion.
• This process continues around the table until all
ideas have been expressed.
• The ideas are summarized and listed on either a
chart or a chalkboard
• Delphi Method
• The Delphi method of decision-making was
initially developed by Dalkey and his
associates (1963, 1969)
• who used this method to gather data from
groups of experts for the purpose of making
forecasts about future events.
• More recently, in health care, the Delphi
method has been employed to determine
priorities
• In this method, participants are usually in
different geographical locations and they do
not meet for face-to-face interaction as they
typically do in the brainstorming and nominal
group technique procedures.
• Steps in the Delphi Method of Group Decision
Making include:
• 1. Group members are sent a questionnaire which
asks them to identify important questions or issues
on a specific topic
• 2. Members responses are compiled and a second
questionnaire is administered which asks members
to assess and prioritize the list of responses derived
from the first round
• 3. Step 2 is repeated in subsequent rounds.
• Each time the priorities of members are
summarized and narrowed down to those,
which are the most important.
• The results are returned to each group
member for further ranking and evaluation.
• 4. In the last phase, a final summary and
ranking is provided to each member of the
group.
• The major disadvantage of the Delphi method
are that it does not allow for the development
of emotions and
• feelings in the group, and it does not allow for
face to face feedback and clarification. Overall,
however, the
• Delphi method is a very useful, though time
consuming, decision-making technique.
 Steps of Decision making
• The formal decision making process may be
described in 7 steps:
• Defining the problem or opportunity
• Identifying limiting factors
• Developing potential alternatives
• Analyzing the alternatives
• Selecting the best alternative
• Limiting factors help rule out many possible
choices. Time and resources are usually major
limiting factors to possible decisions.
• Alternatives are the potential solutions that
can be identified after considering the limiting
factors.
• Analysing the alternatives identifies the
consequences, the advantages and
disadvantages for each possible choice.
• Selecting the best alternative is making the choice
that offers the most advantages and the fewest
disadvantages.
• Implementing the decision requires taking action to
get results.
• This includes communicating the decision to
appropriate personnel & putting plans, programs,
and procedures into effect.
• Establishing a control and evaluation system
provides a feedback mechanism.
 Types of decisions

• Ends-means
• Ends: Objectives/outputs
• Means: Strategies/operational
Programs/activities
• 1. Administrative decisions made by senior
managers eg.“Policy decisions”
• Resource allocation and utilization
• 2. Operational decisions made by mid-level and first-
line managers
• Day-to-day activities E.g. personnel eployment,
purchases, specific work assignments
• 3. Programmed decisions.
• Elements of some decisions which are similar and
made so often.Repetitive and routine
• Eg. procedures rules and manuals. E.g. patient
admission, scheduling, inventory and supply
ordering
 Unit VIII.
Managing Groups

• A health team include the study of how people

form and function within a group structure.
• The group becomes a unit when it shares a
common goal and acts in union to achieve the
goal.
• A group may be defined as a collection of
individuals who interact with each other on a
regular basis, who are psychologically aware of
each other, and who see themselves as a group.
• Groups are categorized as primary or
secondary.
• Primary groups are composed of individuals
who interact on a "face to face" basis, and the
relationships are personal. In addition, there
are no written, formal rules or regulations
because they are unnecessary.
• Examples of primary groups are families or
groups of friends.
• Secondary groups are larger and more impersonal.
• These groups are organized around formal rules,
procedures, policies and other regulations.
• The work place is composed of secondary groups that
are found in departments or at levels and that form
the work group.
• The leader deals with the secondary group in the work
place.
• Secondary groups may also be categorized as formal
or informal groups.
• Formal groups are the official or legitimate work
group,
• while informal groups form for different reasons.
• The leader must be able to influence both groups
and thus move the work group toward meeting its
objectives.
• An effective work group is characterized by the
ability to meet its goals through a high degree of
appropriate communication and understanding
among its members.
• This type of group makes good decisions
based on respect for all members.
• Another characteristic is the ability to arrive
at a balance between group productivity and
satisfying individual needs.
• The leader does not dominate a group l;
instead there is flexibility between the leader
and members to use individual talents
appropriately.
• This group is cohesive and can objectively
review its own work and face its problems.
• The leader who enhances cohesion and
cooperation will be moving the group toward
completion of its goals.
• Phases of Small Groups
• Orientation Phase (forming phase) : The
beginning period in the small group process is
called the orientation phase.
• During this phase, individuals spend time
assessing their purpose for joining the group
and figuring out where they fit in the group.
• Members engage in testing the other
members and the leader to determine what is
appropriate and acceptable behavior within
the group.
• Members spend time at this point trying to
identify the
• nature of the task and the ground rules.
• Conflict Phase: During this phase, members
become less interested in orientation issue,
such as how they are fitting into the group.
• Each member wants to be perceived by others
as a competent group member with
something to others.
• In addition, frequent discussions typically
occur about what task needs to be completed,
which rules of procedure will be followed, and
how decisions will be made in the group.
• Here leaders can assist group members to
satisfy their needs for control or influence
within the group during the conflict phase.
• Cohesion Phase (Norming Phase): This phase is
the developmental phase and members of a task
group may become aware of time pressures and
realize that they need to start moving toward
consensus in order to meet their objectives.
• Members of a therapy group may become more
understanding of one another differences and
more able to accept these differences in the
group.
• Still others may observe the splits and factions of the
previous stages and feel the need to move closer
rather than farther away from others.
• Essentially, members want to develop more unity
during this phase.
• During this phase, there is greater expression of the
ideas, opinions, and observations on task issues.
• The leader provides guidance and direction only as
needed during this phase and essentially assumes a
non-dominant role.
• Working Phase (Performing phase): This phase
involves more time, and a greater depth.
• At this point members feel secure to express both
positive and negative emotions in task groups
• Yet communication usually remains positive.
• The group spirit and the feeling of unity among
members are often high during the working
phase.
• Termination Phase: This phase usually occurs
when the goals of a group have been fulfilled
• Or when the allotted time has run out.
• During the termination phase, leaders need to
summarize the work of the group
• Emphasize goal achievement.
 Team Work
• A team is defined as two or more people who
interact and influence each other toward a common
purpose
• Types of teams
• 1. Formal Team: is a team deliberately created by
managers to carry out specific activities, which help
the organization to achieve its objectives.
• Formal team can be classified as
• a. Command team: is a team composed of a
manager and employees that report to the manager.
• b. Committee: a formal organizational team
usually relatively long lived, created to carry
out specific organizational tasks.
• c. Task force or project team: A temporary
team to address a specific problem.
• 2. Informal team: emerge whenever people
come together and interact regularly.
• This group has a function :
• a. to hold in common the norms and values of
their members
• b. give to their members status, security and
social, satisfaction
• c. help their members communicate
• d. help solve problems
• e. act as a reference groups
 Characteristics of a team
• Awareness of the characteristics of a team
helps to
• manage effectively the group.
• Effective teams are built on:
• Communication
• Trust
• Shared decision-making
• Positive reinforcement
• Cooperation
• Flexibility
• Focus on common goals
• Teams that are effective can achieve more
together than they would as individuals all
working alone
• Stages of team development
• Teams move through five stages to develop
• a. Forming: during the initial stage the team
forms and
• learns the behaviour acceptable by the group
• b. Storming: as the group becomes more
comfortable
• with one another they begin to assert their
individual personalities
• c. Norming: the conflicts that arose in the
previous
• stages are addressed and hopefully resolved.
• Group unity emerges as members establish
common goals, norms and ground rules.
• d. Performing: it is a stage by which a group
begins to operate as a unit
• Team cohesiveness
• Team cohesiveness is the degree of solidarity
and positive feelings held by individuals towards
their group.
• The more cohesive the group the more strongly
• members feel about belonging to it.
• Teams have less tension and hostility and fewer
misunderstandings than less cohesive groups
do.
• Studies have found that cohesive teams tend
to produce more uniform output than less
cohesive groups.
• Ways to improve team cohesiveness
• 1. Introduce competition
• 2. Increase interpersonal attraction
• 3. Increase interaction
• 4. Create common goals
 Unit IX.
Performance Appraisal

• Performance appraisal is a systemic review of

an individual employee's performance on the
job, which is used to evaluate the
effectiveness of his/her work
• Purpose:
• Provide information as a base management
decisions regarding such matters as salary
raises promotions, transfers, or discharges
• Helps to assist employees in their personal
development
• Performance appraisal information will help
to assess the effectiveness of hiring and
recruiting practices
• Supply information to the organization that
will help to identify training and development
needs of the employees
• Helps in the establishment of standards of job
performance often used as a criterion to
assess the validity of personnel selection and
training procedures
• A formal appraisal is more accurate, fair and
useful to all concerned
 Appraisal
• Relate performance appraisal to the job
description
• Tools of performance appraisal
• Rating scales-the tool consists of a behavior
which the person being evaluated demonstrates.
• The checklist- it describes the standard of
performance and the rater indicates by placing a
checkmark in a column if the employee
demonstrates the behavior
• Management by objective- it focuses on the
evaluator's observations of the employee's
performance
• as measured against very specific
predetermined goals that have been jointly
agreed by the employee and the evaluator.
 Unit XI
Budgeting
• Budgeting: Is a plan for the allocation of
resources.
• 1. Prerequisite for budgeting
• Organizational structure
• Job descriptions
• Goals and objectives
• Formal budgeting policies and procedures
• 2. Major types of budgets
• 1. Operating/recurrent- estimates of operating
expenses,
• Example: personnel salaries, supplies, light
water, drugs, repairs and maintenance
• 2. Plant/Capital-estimates of expenditure for
adding, replacing or improving buildings or
equipment for the budget period
• Example: buildings, major equipment
• Personnel Budgets
• Personnel budgets estimate the cost of direct
labor necessary to meet the organization’s
objectives.
• It includes recruitment, hiring, and assignment,
of personnel.
• The current staffing patterns, number of
unfilled positions and last year’s reports can
provide a base for proposals.
• Flexible Budgets
• Some costs are fixed and do not change with
the volume of business.
• Some variable expenses are unpredictable and
can be determined only after change has begun
• Thus the need for flexible budgets, to show the
effects of changes in volume of business on
expense items.
• 4. The budget period
• Most health care agencies budget on a
monthly basis for a 1-year period. The budget
year often begins July 1 and ends June 30.
• 5. Advantages of Budgeting
• Budgets plan for detailed program activities.
• They help fix accountability assignment of
responsibility and authority.
• They state goals for all units, offer standard of
performance.
• Staffing, equipment, and supply needs can be
projected and waste minimized.
 Unit XII.
Managing and initiating change

• Management of Change
• Change is defined as "the process of alteration or
transformation of individuals, groups, and
organization."
• Purpose of change
• To meet changing clients needs
• To meet changing market conditions
• To respond to internal pressures
• To take advantage of new opportunities
• To respond to competitive pressure
• Factors that cause change
• A number of internal and external forces,
often interacting to reinforce one another,
stimulate changes in organization.
• Pressure for change may arise from a number
of sources within the organization, particularly
from new strategies, technologies, and
employee attitudes and behavior.
• Unexpected opportunities may arise that
permit the innovators inside the organization
to develop new ways of doing things. This can
stimulate organizational change.
• External forces, from technological advances
to competitive actions can pressure
organizations to modify their structure, goals,
and methods of operation.
• Managing Change in an Organization
• Planned change, is the result of consciously
designed preparation to reach a desired goal
or organizational state.
• An effective management of change involves
change agents, performances gaps, levels and
targets of change.
• a. Change Agent
• In every situation in which a change is desired,
some person or group must be designated as
the catalyst for change.
• That person or group is called the change
agent.
• The change agent is the individual who is
responsible for taking a leadership role in
managing the process of change.
• The individual, group, or organization that is
the target of the change attempt is called the
client systems.
• Managers or staff at various levels in
organizations can serve as change agents.
• Consultants brought in from outside can also
be change agents.
• b. Performance Gaps
• It is the difference between the status and the
desired new standard of performance or desired
organizational state.
• The change agents think in terms of performance
gaps.
• c. Levels and Targets of change
• Change agents must identify the level at which their
efforts will be directed. Effects can be made to
change individuals, groups, and entire organizations.
 Programming Change

• The realization of organizational change

requires effective planning or programming.
• A change program should incorporate the
following processes.
• 1. Recognizing the need for change .
• The need for change is, when results are not
inline with expectations, things clearly are not
working well, or dissatisfaction is apparent.
• 2. Setting Goals – Defining the future state or
organizational conditions desired after change.
• 3. Diagnosing the present conditions in
relation to the stated goals.
• 5. Developing strategies and action plans.
• 1. Unfreezing
• It involves making the need for change.
• It is the process of creating a climate ready for
change.
• In this stage, the management convinces
individuals and groups that present conditions
or behavior are inappropriate.
• 2. Changing
• Once the members have been prepared to
accept change, their behavioral patterns have
to be redefined.
• There are three methods of reassigning
individuals' new patterns of behavior.
• These are:
• a. Compliance – It is achieved by strictly
enforcing the reward and punishment
• strategy for good or bad behavior. The fear of
punishment or actual reward seems to change
the behavior for the better.
• . Internalization – Internalization involves
some internal changing of the individual’s
thought processes in order to adjust to a new
environment.
• 3. Refreezing – It means locking the new
behavior pattern into place by means of
supporting or reinforcing mechanisms, so that
it becomes the new norm.
• It is the process of institutionalizing the new
state of behavior or work by rewards (praise,
etc).
• Resistance to change and gaining support
• 1. Reasons for resistance
• Change is neither always accepted nor always
rejected.
• Some people desire change and welcome new
experiences as a break from monotony.
• on the other hand, there are a good number of
people who resist change for various reasons than
one. Management may recognize the need for
change, but most employees may resist the process.
• The reasons for resistance to change .
• 1. Parochial self interest
• Threat to status
• Threat to power base
• 2. Misunderstanding and lack of trust
• Lack of information
• Misinformation
 Managing resistances to change

• 1. Education and communication

• Management should educate employees
about changes before they occur.
• It should communicate not only the nature of
the change but its logic.
• The process include one-on-one discussions,
presentations to groups.
• 2. Participation and Involvement .
• If management involves those who might resist
change with the design and implementation of
the change, resistance may be prevented.
• In general, when employees participate in the
decision to change, they are committed to
implementing it. Therefore, employees should
also be involved in the change's design and
implementation.
• 3. Negotiation and Agreement
• When necessary, management can offer
concrete incentives for cooperation with the
change.
• Rewards such as bonuses, wages and salaries,
and recognition, to reinforce the direction of
change.
 Dealing with conflicts

• Conflict is an expressed struggle between at

least two interdependent parties, who
perceive incompatible goals.
 characteristics of a conflict
(1) At least two parties are involved in some
form of interaction
(2) difference in goals and/or values
 Types of Conflict

• Interpersonal Conflicts
• Interpersonal conflicts are those that arise
between two Individuals
• because people are constantly interacting and
therefore differing.
• Inter-group conflicts
• Inter-group conflicts can occur between two
small groups
• A small group may be a family or a group
 Personal Group Conflicts

• Conflicts between an individual and a small

group or between an individual and a large
group are called personal –group conflicts.
• The nurse who does not finish giving her
patient’s bath before she goes to lunch will be
in conflict with the rest of the staff if they
 Intrapersonal Conflicts

• Conflict may also be intrapersonal (i.e., within

a person).
• The individual feels tension because of a
disagreementwithin him-or herself.
• Intrapersonal conflict may result from having
to make a choice between two things of
generally equal value (positive or negative),
from ambivalence about doing or not doing
something
• Eg. a nurse leader may experience intrapersonal
role conflict when she must choose between
going to a parent teacher conference about her
child or going to a professional nursing meeting.
• Several options are available, but the individual
must first decide what is most important, and
then work to change his or her attitudes, or else
use a systematic decision making process to
identify a solution.
 Conflict Resolution or Suppression

• In conflict situations, individuals can either

suppress conflict or engage in activity, which
will lead to its resolution.
• Behavior directed toward the resolution of
conflict can be characterized by three different
communication strategies:
• (1) Win- Lose, (2) Lose-Lose, or (3) Win -Win.
• Lose – Lose Strategies
• In lose-lose conflicts both parties try to win over
the other but both end up losing to each other.
• Neither person’s goals are achieved and the
relationship is weakened.
• Attempts by individuals to dominate over each
other result in mutually destructive
communication between the participants and
negative outcomes.
• Win- Win Strategies
• The win-win strategy is an approach that allows
both individuals to feel they
• have accomplished all or part of their goals.
• This strategy tries to satisfy mutual needs, to
solve problems creatively, and to develop
relationships.
• There is no attempt by one party to win over or
control another party in this approach.
• Win-win strategies mean both parties
communicate in ways that allow each of them
to satisfy at least some of their needs.
• Win-Win solutions strengthen relationships.
• Avoidance
• Avoidance is a style characteristic of individuals
who are passive and who do not want to
recognize conflict.
• These persons generally prefer to ignore conflict
situations rather than confront them directly.
• Health care practitioners are frequently dealing
with life and death decisions for patients
• They often need to suppress their own
concerns or conflicts with other staff
members’ in order to perform the necessary
services.
• In these critical situations, avoidance of
conflict may facilitate the health care delivery
process.
• In general, avoidance is not a constructive
style of confronting conflict.
• They bottle up their feelings of irritation,
frustration, or anger, inside themselves,
creating more anxiety, instead of expressing
them or resolving the situation.
• Furthermore, avoidance is essentially a static
approach to conflict:
• It does nothing to solve problems or to make
changes that could prevent conflicts.
 Competition
• Individuals attempt to resolve a struggle by
controlling or persuading others in order to
achieve their own ends.
• A competitive style is based on a win-lose
conflict strategy.
• Competition produce solutions to conflicts
that are more effective and more creative
than if competition were not present.
• For example, in a community in which school
of nursing are competing to provide specific
training, the quality of trainings will be higher,
• and the costs to the public will eventually be
lower than if there were no competition.
• on the interpersonal level, when two
professionals compete to provide quality care,
• The outcomes can be very positive for clients.
• In effect, competitive approaches to conflict
can challenge participants to make their best
efforts, and this can have positive results.
 Unit XIII.

• Quality assurance and risk management

• Definitions
• In order to understand the quality assurance,
the nurse manager should be familiar with the
following definitions.
• A standard is the desired quantity, quality, or
level of performance that is established as a
criterion against which worker performance
will be measured.
• A norm is current level of performance of a selected
work group with reference to a given criterion.
• Example, a norm for writing nursing diagnosis in the
ward for each patient within 12 hours of admission
is 50 percent.
• An Objective is a goal toward which effort is
directed.
• To be effective, an objective should be expressed in
observable, measurable terms and should include
target date for fulfillment.
• For example, “By January, 1995, all head
nurses will be certified trainers of
cardiopulmonary resuscitation.”
• Quality Assurance describes all activities
related to establishing; maintaining and
assuring high quality care for patients.
• Quality Assurance Process
• Quality assurance process is the systematic
process of evaluating the quality of care given in
a particular unit or institution.
• It involves setting standards, determining criteria
to meet those standards, data collection,
evaluating how well the criteria have been met,
• making plans for change based on the evaluation,
and following up on implementation for change.
• Setting Standards- The nursing profession
should have to design standards of nursing
practice that are specific to the patient
population served
• These standards could serve as the foundation
upon which all other measures of quality
assurance are based.
• An example of a standard is: Every patient will
have a written care plan.
• Determining Criteria-
• After standards of performance are
established, criteria must be determined that
will indicate if the standards are being met
and to what degree they are met.
• One criterion to demonstrate that the
standards regarding care plans for every
patient are being met would be:
• A nursing care plan is developed and written by
a nurse within 12 hours of admission.
• This criterion, then, provides a measurable
indicator to evaluate performance.
• Data Collection- The actual collection of data is
the third step in quality assurance.
• Sufficient observations and random samples
are necessary for producing reliable and valid
information.
• Data collection methods include patient
observations and interviews, nurse observations
and interviews, and review of charts. Flow sheets
and Kardexes are also resources from which to
assemble information about past and present
conditions.
• A policy should outline guidelines of the reporting
of quality assurance data so it is clear who in the
organization needs to receive quality assurance
information.
• The policy should also state at what level in the
organization the analysis of the different criteria is
to take place
• to whom these analyses and recommendations are
to be reported
• who is responsible for implementing the
recommendations,
• and who is responsible for follow up. Unless definite
policies are established, the system may fail and
changes in nursing practice are not likely to occur .
 Evaluating Performance

• Several methods can be used to evaluate

performance.
• These include reviewing documented records,
observing activities as they take place, examining
patients, and interviewing patients, families, and
staff.
• Records are the most commonly used source for
evaluation because of the relative ease of their
use, but they are not as reliable as direct
observations.
• Care plan could be checked nursing diagnosis
interventions planned, and discharge planning.
• Monitoring Nursing Care
• In addition to the individual patient care activities
described, another component of quality assurance
is the ongoing monitoring of nursing care.
• Several methods are used to monitor nursing care.
These include the nursing audit, peer review,
utilization review, and patient satisfaction.
• Nursing Audit can be retrospective or concurrent.
• A retrospective audit is conducted after a patient’s
discharge and involves examining records of a large
number of cases.
• The patients’ entire course of care is evaluated and
comparisons made across cases.
• Recommendations for change can be made from
the perspective of many patients with similar care
problems and with the spectrum of care
considered.
• A concurrent audit is conducted during the
patient’s course of care; it examines the care
being given to achieve a desirable outcome in
the patient’s health and evaluates the nursing
care activities bearing provided.
• Changes can be made if they are indicated by
patient outcomes.
• Peer Review- occurs when practicing nurses
determine the standards and criteria that
indicate quality care and then assess
performance against these.
• In this case, nurses are the “experts” at
knowing what the indicators of quality care
and when such care has been provided.
• Patient Satisfaction.
• It is using a questionnaire and asking the
patient to fill out before leaving the
institution.
• Such questionnaire includes care given in a
timely fashion and other variables in the
environment that contribute to recovery
rather than standards of professional care.