NCMB 419: LEADERSHIP AND MANAGEMENT

MIDTERM REVIEWER | K. AGLOCO

RECORDS MANAGEMENT BENEFITS OF RECORD MANAGEMENT

• Records management (RM) is the supervision and • Saves time by ensuring that records can be found
administration of digital or paper records, regardless of easily and quickly
format. • Save space by preventing records from being kept
• It is a systematic and effective control of records (both longer than
paper and electronic). • Necessary
• It aims to ensure that records are accurate and reliable, • Saves money by reducing storage costs and
can be retrieved speedily and efficiently, and efficiently, maintenance costs
and are kept for no longer than necessary. • Improves efficiently by ensuring records are readily
• It is crucial to all organizations. Unless records are accessible legally
managed efficiently it is possible to conduct business, • Improves compliance by keeping records in line with
to account for what happened in the past, or to make legal and regularly requirements
decisions are kept for no longer than necessary. • Keeps records under control by preserving data and
• Records management activities include the creation, preventing accumulation control of epheral material
receipt, maintenance, use and disposal of records. • Improves the quality of information, providing staff with
• Documentation may exist in contracts, memos, paper access to accurate and reliable quality records security
files, electronic files, reports, emails, videos, instant • Increases the security of confidential records continuity
message logs or database records. • Support business continuity and risk management
• Paper records may be stored in physical boxes on- • Records are managed efficiently and can be easily
premises or at a storage facility. Digital records may be assessed and used
stored on storage media in-house or in the cloud. The • Records are stored as cost effectively as possible and
goal of records management is to help an organization when no longer required they are disposed of in a
keep the necessary documentation accessible for both timely and efficient manner.
business operations and compliance audits. • Complies with requirements concerning records and
CONCEPT records management practices to ensure compliance
with institution
• Information is “data, ideas, thoughts, or memories • Records of longer term value are identified and
irrespective of medium.” protected for historical and other research
• Documents are any “recorded information or objects
that can be treated as individual units RECORD
• Records are “information created, received, and • It is a permanent written communication that
maintained as evidence and information by an documents information relevant to a client’s health care
organization or person, in pursuance of legal management. E.g. chart is a continuing account of
obligations or in the transaction of business.” client health care status and need.
• Archives are those records that have been selected • A record is a clinical, scientific, administrative and legal
for permanent preservation because of their document relating to the nursing care given to the
administrative, informational, legal and historical value individual family and community.
as evidence of official business
CLASSIFICATION OF RECORDS
IMPORTANCE OF RECORD MANAGEMENT
• Active Record – a record that is regularly referenced
• To provide evidence of actions and decisions or required for current use
• To support accountability and transparency • Inactive Record – a record that is still needed by an
• To comply with legal and regulatory obligations, organization but not for current operations
including employment, contract and financial law as • Electronic Record – a record recorded or formatted
well as the data protection act and freedom of only a computer can process
information act
• To protect the interests of staff, students and other SAMPLE OF RECORDS
stakeholders
• Administrative records of Grants/Contracts
• Help to address complaints or legal processes.
• Bid documents
• To support patient choice and control over treatment
• Blueprint of facilities
and services
• Consent forms-adult-minor
• To support day to day business of the health care
• Endowment Fund Records
delivery
• Equipment inventory reports
• To support evidenced based practice
• General ledgers
• To assist clinical and other types of audits
• Meeting minutes
• To support sound administrative and managerial
• Payroll folders
decision making.
• Contracts-purchase lease rental, and etc.
• To support improvement in clinical effectiveness
through research RECORDS IN THE NURSING OFFICE AND UNIT
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MIDTERM REVIEWER | K. AGLOCO
• Administrative records: organogram, job description,
procedure manual
• Personnel records: personal files, records
• Patient records send to medical center chief/medical
director
• Leave record, duty roster, minutes of the meeting,
budget etc.
• Miscellaneous: circular log book, formats, etc.
WARD RECORDS
PRINCIPLES OF RECORD WRITING
• Reducting or increase in beds
• Nurses should develop their own method of expression
• Change in medical staff and non-nursing personnel for
and form in record writing
the ward
• Records should be written with clearly and
• The introduction and patient of support
appropriately
• Records should contain facts based on observation CHARACTERISTIC OF A GOOD RECORD AND
conversation and action REPORTING
• Select relevant facts and the recording should be neat,
• Accuracy
complete and uniform
• Consciousness
• Records should be written immediately after an
interview • Thoroughness
• Records are confidential documents. • Up to date
• Organization
SAFEKEEPING AND RELEASE OF RECORDS • Confidentiality
1. Sentinel events • Objectivity
2. Anecdotal PURPOSES OF RECORD
3. Incident report
4. Kardex • Supply data that are essential for programme planning
5. Patients chart/records and evaluation
6. 201 file • Provide the practitioner with data required for the
application of professional services for the
NURSES RESPONSIBILITY FOR RECORD KEEPING AND improvement of family health
RECORDING • Used as tools of communication between health
• Keep under safe custody of nurse workers the family and other development personnel
• No individual sheet should be separated • Shows the health problem in the family and other
• Not accessible to patient and visitors factors that affect health
• Strangers is not permitted to read records • Indicates plan for future
• Records are not handed over to the legal advisors • Provides baseline data to estimate the long term
without written permission of the administration changes related to services
• Handed carefully, not destroyed ADMINISTRATIVE PURPOSE OF CLINICAL RECORDS
• Identified with bio-data of the patients such as name,
age, admission number, diagnosis, etc. • Legal documents: poisoning, assault, rape, leaving
• Never sent outside the hospital without the written against medical advice (LAMA/HAMA/DAMA)
administrative permission • Research or statistics rates
• Audit and nursing audit
NURSING ADMINISTRATOR’S RESPONSIBILITY • Quality of care
• Protection from loss • Continuity of care
• Safeguarding its concerns • Informative purposes: MEN census
• Completeness • Teaching purposes of students
• Responsibility for nurse notes • Diagnostic purposes: test reports
• Admission record IMPORTANCE OF RECORDS IN HOSPITAL (FOR
• Scientific value of the nurse notes INDIVIDUAL AND FAMILY)
• Record of order carried out
• Serve the history of the client
• Assist in the continuity of cares
INDIVIDUAL STAFF RECORD • Evidence to support if legal issues arise
• Assess health needs: research and teaching
• A separate set of record is needed for staff, giving
details of their sickness and absences. FOR THE DOCTOR

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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
• Serve the guide for diagnosis, treatment, follow up and ACTIVE PHASE
evaluation
It means that they are often used, shared between colleagues,
• Indicate progress and continuity of care
retrieved to support day-to-day business and referred to.
• Self-evaluation of medical practice
• Protect doctor in legal issues • Identify and apply an appropriate security classification
• Used for teaching and research • Distinguish between records and non-record copies or
working documents, to be able to appropriately
FOR THE NURSES
segregate them in the filing system
• Document nursing service rendered • Place the record in an organizational classification
• Planning and evaluation of service for future scheme (or file plan) either in paper (e.g. in a filing
improvement cabinet or in a binder) orinelectronic version (e.g. on a
• Guide for professional growth shared drive or in a system) to ensure that it's
• Communication tool between nurse and other staff preserved within its context
involved in the care • Preserve the integrity of the record, which means
• Indicate plan for future ensuring that it has not been altered after completion
• Maintain its usability which means making it available
FOR AUTHORITIES for all colleagues who need an access to the record to
do their job
• Statistical Information
• Facilitate identification and preservation of records with
• Administrative control
permanent retention
• Future reference
• Evaluation of care in terms of quality, quantity and INACTIVE PHASE
adequacy
During this stage, we should free up space in our offices to new
• Help supervisor to evaluate service
records, but we need to ensure keeping inactive records handy.
• Guide staff and students
• Legal evidence of service rendered by each employee The objectives of this stage are:
• Provide justification of expenditure of funds
• Identify the records that are not required to be stored
in the primary office space (paper) or systems/shared
drives (electronic)
• Organize and list them
• Transfer them to the local Records Center (for field
missions the local Records Center within mission area;
for HQ offices the ARMS Records Center)
• Retrieve only those records that are needed from time
to time
DISPOSITION PHASE
The objectives of this stage are:

• Identify records with archival value (permanent

retention), list them, organize them
• Identify records due fordisposal/destruction, list them,
WHAT IS THE RECORDS LIFECYCLE?
gather necessary approvals for the destruction and
Create/receive-starts when records are either received from an proceed with an environmentally friendly destruction
external source or created internally. The objectives of this initial process
stage are:
INTRA-DISCIPLINARY, INTERDISCIPLINARY AND
• Create complete and accurate records that provide MULTIDISCIPLINARY AND WORK COLLABORATION
evidence of the organization’s functions, activities, COLLABORATION
decisions, transactions, procedures, etc.
• Identify and apply an appropriate security classification • Current educational and clinical environments can be
• Distinguish between records and non-record copies or less than supportive of interpersonal learning
working documents, to be able to appropriately interaction. Urges the nurse educator community to
segregate them in the filing system work with peers in other profession to provide students
• Place the record in an organizational classification with learning opportunities that acknowledge a
scheme (or file plan) either in paper (e.g. in a filing profoundly changed health care environment.
cabinet or a binder) orinelectronic version (e.g. on a Providing educational experiences that prepare
shared drive or in a system) to ensure that it’s graduates for todays’ practice is no loner an option; it
preserved within its context is imperative to align health professional education with
the societal needs, Marquis & Huston, (2012).
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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
• The nursing profession is faced with increasingly • Improved teamwork
complex health care issues driven by technological and
TYPE OF COLLABORATION
medical advancements, an ageing population,
increased numbers of people living with chronic Interdisciplinary
disease, and increased costs of health care services
• Collaborative partnerships between educational • Is the term used to indicate the combining of two or
institutions and service agencies have been viewed as more disciplined, professions, department, integrated
one way to provide research which ensures an for one plan formulation usually in regard to practice,
evolving health-care system with comprehensive and research education, and/or theory?
coordinated services that are evidence-based, cost Multidisciplinary
effective and improve health-care outcomes.
• Considerable progress has been made in nursing over • Refers to independent work and decision making, such
the past several decades, especially in the area of as when disciplines work side-by-side on a problem.
education.
Tran disciplinary
• Countries have either developed new, strengthened
and re-oriented the existing nursing educational • Efforts involve multiple disciplines sharing together
programs in order to ensure that the graduates have their knowledge and skills across traditional
the essential competence to make effective disciplinary boundaries in accomplishing tasks or
contributions in improving people’s health and quality goals.
of life
Inter professional collaboration
MEANING
• Interactions of two or more disciplines involving
• The roots of the word collaboration, namely co-, and professionals who work together, with intention, mutual
elaborate, combine in Latin to mean “work to together.” respect, and commitments for the sake of a more
That means the interaction among two or more adequate response to a human problem.
individuals, which can encompass a variety of actions
such as communication. Information sharing, NEED FOR COLLABORATION
coordination, cooperation, problem solving, and • Increasing gap between nursing education and nursing
negotiation. service.
• Teamwork and collaboration are often used • Graduate nurses often lack practical skills despite their
synonymously. significant knowledge of nursing process and theory.
• The collaborative process involves a synthesis of • Clearly, a partnership between nursing educators and
different perspective to better understand complex hospital nursing personnel is essential to meet the
problems. challenge
• An effective collaboration is characterized by building
and sustaining “win-win- win” relationship. MODELS OF COLLABORATION
• Is a process by which members of various disciplines PRECEPTORSHIP MODEL
(or agencies) share their expertise to accomplishing a
common goal? • A preceptor is teacher or instructor with special training
• Accomplishing this goal requires these individuals to and he care provide practical training to an intern or
understand and appreciate what they are contribute to staff.
the whole” • The best preceptor like to teach and they will volunteer
• “Collaboration is the most formal inter organizational for the role rather than wait to be assign
relationship involving shared authority and
Responsibilities of the Preceptee’s
responsibility for planning, implementation, and
evaluation of a joint effort, Marquis and Huston, (2017). • Provide an orientation for the students and
• Collaboration defined as a joint communication and • Review agency guideline with students, especially
decision-making process with the goal of satisfying the those that will impact the student experience directly.
health care needs of a target population. NNCCS, • Help students feel a sense of belonging in the agency
(2012). • Provide opportunities for the student to participate in
• Mattessich, Murray and Monsey (2001), define important agency functions such as meetings,
collaboration as’… a mutually beneficial and well- outreach events, etc. as appropriate.
defined relationship entered into by two or more • Be aware of the student’s learning goals so that can be
organizations to achieve common goal. help structure experiences that will help the student
EFFECTS OF COLLABORATION meet goals.
• Give honest, constructive feedback to the student and
• Improved patient outcomes faculty supervisor as needed.
• Reduced length of stay • Meet with student at frequent, regular intervals to
• Cost savings provide feedback, evaluate progress and resolve
• Increased nursing job satisfaction and retention problems
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MIDTERM REVIEWER | K. AGLOCO
• Remember what may see basic or easy for the
preceptor may not be basic or simply to the student
MENTORSHIP MODEL

• Mentoring is A developmental relationship in which a

more experienced person helps a less experience
person
The Value of Mentoring: Mentoring provides

• Retention by means of personal relationship

• Staff development and career guidance
• Job satisfaction, and a healthy workplace environment
Roles of Mentors

• Teacher (educational expertise)

• Guider MENTOR VS PRECEPTOR LEARNER OUTCOMES
• Counselor (practical expertise)
• Advisor Mentors

MENTORS VS PRECEPTORS • Self-actualization

• Guide to established own place in the profession
Mentors • Enhanced problem-solving
• Older than Learner • Personal satisfaction in sharing knowledge
• Possesses wisdom and experience Preceptors
• Career networking
• Facilitator • Bridge theory to practice gap.
• Guide • Achievement of planned learning outcomes
• Advisor • Skills and knowledge
• Role model • Anxiety reduction
• Chosen LECTURER PRACTITIONER MODEL
• May have no formal preparation
• Share Life, education, work experience • Each clinical placement gave to have named lecturer /
• Type of relationship” close, personal friendship practitioner or clinical educator who will assist in the
• Not an evaluator organization, facilitation and supervision of the clinical
learning experience throughout the entire programs.
Preceptors
Role of Lecturer Practitioner
• Willing to teach and learn skills
• Expertise • Promote active discussion within the clinical setting to
• Competent practitioner encourage understanding
• Teaching and support • Work with clinical staff to identify alternative means to
• Orientation and Socialization gain relevant experience
• Role Model • Play an active role in overall assessment to help
student achieves the required learning outcome
• Selected
• Assigned to learner Research Joint Appointments
• Prepared for role
• Competent practitioner • Is a formalized agreement between two institutions
where an individual holds a position in each institution
• Support needed from peers, educators, manager
and carries out specific and defined responsibilities”?
• Functional not intimate relationship
• The goal of this approach is to use the implementation
• May evaluate
of research findings as a basis for improving critical
thinking and clinical decision-making of nurses
• In this arrangement the researcher is a faculty member
at the educational institution with credibility in
conducting research and with an interest in developing
a research programs in the clinical setting
• The Director of Nursing Research, provides education
regarding research and assists with the conduct odd
Research in the practice setting.

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• She/He also lecturer or supervisor in the educational supported by Hospital - University to Students Coached
institution. by Clinicians
• A formal agreement exists within the two organizations
regarding specific responsibilities and the percentage
of time allocated between each salary and Benefits are
shared between the two organizations
CLINICAL SCHOOL OF NURSING MODEL

• The concept of a Clinical School of Nursing is one that

Encompasses the highest level of academic and
clinical nursing research and education.
• The development of the Clinical School offers benefits
to both hospital and university.
• It brings academic staff to the hospital, with
opportunities for exchange of ideas with clinical nurses
with increased opportunities for clinical nursing
research. NNCCS, 2014
• It has a fundamental importance and close link
between the theory and practice of nursing at all levels
COLLABORATIVE CLINICAL EDUCATION MODEL

• In an effort to improve the quality of new graduate

transition, Epworth Hospital and Deakin University ran
a collaborative project (2003) founded by the National
Safety and Quality Council to improve the support base
for new graduates while managing the quality of patient
are delivery.
The collaborative clinical Education Epworth Deakin (CCED)
model developed to facilitate

• Clinical learning
• Promote clinical scholarship and In a hospital setting, multidisciplinary teams, involves or
• Build nurse workforce capability combines several academic or professional disciplines, either
formal or informal groups meet to accomplish goals and
Example objectives, members practice independently of one another,
• Undergraduate nursing students attending lectures at each of the member is being guided by their own professional
Deakin University in the traditional manner but standards however leadership always determined by
completing all tutorials, clinical learning, laboratories professional hierarchy.
and clinical placements at Epworth Hospital throughput As illustrated above the interdisciplinary and multidisciplinary
their three year course. team collaboration involves the contribution from different
• Tutorials, laboratories and clinical placements are departments of their services and shared their own professional
conducted by Epworth clinicians who are prepared and expertise to achieve optimum health of the patient. The vital role
supported by Deakin School of Nursing Faculty. of the nurse it to coordinate, communicate and documents
• These clinicians also support the student-preceptor services provided by the team as shown in the illustration.
relationship in the clinical learning component of the
curriculum. In a community setting, the Intra-agency, Inter-agency,
• All the models pursue collaboration as a means of multidisciplinary and sectoral collaboration are important in the
developing trust, recognizing the equal value of effective and efficient delivery of health services to the
stakeholders and bringing mutual benefit to both individuals, families, population groups and the community. The
partners on order to promote high quality research, nurse is responsible in maintaining harmonious relationship
continued professional education and quality health within the health unit (intra-agency) and coordinating activities
care. of the members of the health team to ensure achievement of
group goals.
• Application of these models can reduce the perceived
gap between education and service in nursing, also DEVELOPMENT OF TEAM WORK AND COLLABORATION
can help in the development of competent and efficient
nurses for the betterment of nursing profession. STAGES OF TEAM DEVELOPMENT

Students Coached by Clinicians - Nursing Education

Supported by Clinical Facilitator - Clinical Facilitators are

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• Encouraging
• Following
• Climatizing
3. Individual roles in which a team member attempts to
satisfy individual rather than team goals. A team is
most productive when all three (3) sets are managed
simultaneous. Individual roles are:
• Blocking/Aggressing
• Out of field
• Digressing
• Recognition seeking (Sullivan and Decker, 2009
According to Tuckman there 4 stages of Team Development.
These stages are important and inevitable for a team to grow, NURSE’S ROLE IN ESTABLISHING COLLABORATIVE
face challenges and difficulties effectively and deliver positive RELATIONSHIP IN THE DELIVERY OF HEALTH CARE
results. PROGRAMS AND SERVICES

• Stage 1 Forming, the leader may seek control over the A. Maintains good interpersonal relationships intra-
team and exemplify styles such as “tyrant”, agency and inter-agency.
“superwoman”, “party host”, or “reluctant candidate”, B. Respects the role of other team members.
Members are also characterized by dependency- C. Acts as a liaison/advocate of the client during decision
seeking behaviors and will most likely rely on the group making by the inter-professional team.
leader. They may also take on the roles of “scapegoat” Interpersonal Relationship Defined:
and “helper’.
• Stage 2 Storming, Leader tries to persuade the team • The term Interpersonal Relationships refers to
and may use “salesman” ad “nice guy” styles often reciprocal social and emotional interactions between
struggling to be a socio—emotional leader. Team two or more persons in an environment and who share
members may demonstrate resistance. Despite common interests and goals.
persistence of scapegoating among team members,
IMPORTANCE OF INTERPERSONAL RELATIONSHIP FOR
new roles that help reduce tension may emerge.
NURSES:
• Stage 3 Norming, coalitions of member’s exercise
leadership based on previously demonstrated 1. Helps build positive functional multidisciplinary team.
competence. Members have evolved into colleagues 2. Improves intra and/or inter-team communication,
who were able to defer to each other’s relevant coordination, and cooperation
experience. 3. Builds mutual understanding and cooperation
• Stage 4 Performing, Authority is exercise by coalition 4. Facilitates better understanding of oneself
of colleagues. Team members exemplify 5. Improves decision making and problem-solving
interdependence.
To maintain good interpersonal relationship in working with a
TOOLS FOR FACILITATING HEALTH CARE TEAM WORK team to achieve its goal of providing safe and quality patient/
client care, it is also important for the nurse to appropriately
• Working together does not necessarily produce respond to conflict situations.
effective teamwork.
• Here is a simple outline that will guide in the • In the process, conflict may occur within the individual
understanding of the process of developing health care (intrapersonal), between two or more individuals
teamwork. Analysis of informal roles provides another (interpersonal), and between one or more groups
useful tool for understanding the team process. (intragroup).
• Categories of Conflict
There are three (3) broad sets of informal roles:
o Conflict is a disagreement among people
1. Task roles that are necessary for accomplishing the involved that results from differences in ideas,
team’s task. These roles are as follows: values, or feelings, differences in economic
• Initiating/energizing and professional values, poorly defined role
• Information/opinion giving expectations and there is competition among
• Information/opinion seeking the professional themselves, Filley (1975).
• Reality testing/clarifying NURSE INTERPERSONAL RELATIONSHIP
• Coordinating
• Orienting • Doctor - Nurse relationship
• Procedural Technician • Nurse – Patient relationship
2. Maintenance roles which help the team function as a • Nurse – Nurse relationship
team. Maintenance roles are: • One of the most distinctive aspects of human being is
• Harmonizing that we are social beings
• Gatekeeping
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• Interpersonal relationships are and have been the core • Building mutual understanding and cooperation
of our social system since the dawn of civilization • Improved decision making and problem
• Nursing is a therapeutic process and demands an
III. Interpersonal relationship for patients
association between the nurse and the patient
• Is a strong, deep or close association or acquaintance • Developing a sense of security and comfort
between two or more people that may range in duration • Fostering trust and cooperation
from brief to enduring • Facilitating communication
• Are social associations, connections, or affiliation • Improving socialization
between two or more people • Developing and maintaining positive feelings
• They vary in differing levels of intimacy and sharing,
implying the discovery or establishment of common TYPES OF INTERPERSONAL RELATIONSHIP
ground, and may be centered around something(s)
I. FRIENDSHIP
shared in common
• In nursing care can be defined, based on a theory 1, • Theories of friendship emphasize the concept as a
as the interaction between two or more people who freely chosen association where individuals develop a
communicate, transfer values and energy from their common ground of thinking and behaving when they
roles in society enter into the relationship by including mutual love,
• Such interaction is continuous trust respect and unconditional acceptance for each
other.
DYNAMICS OF INTERPERSONAL RELATIONSHIP
• Friendship is a relationship with no formalities and the
I. DYAD individuals enjoy each other’s presence

• A Dyad consists of two interacting people II. LOVE

• It is the simplest of the three interpersonal dynamics • A in formalized intimate relationship characterized by
• One Person relays a message and the other listen passion, intimacy, trust and respect is called love.
• It is none of the most unstable interpersonal dynamic. • Individuals in a romantic relationship are deeply
The interaction ends when one constituent of the dyad attached to each other and share a special bond
refuses to listen or share his or her message
• It is also one of the most intimate interpersonal III. PLATONIC
dynamic as the focus of listening and communication
• A relationship between two individuals without feelings
is centered on only one person
of sexual desire for each other is called a platonic
II. TRIAD relationship.
• In such a relationship, a man and a woman are just
• A triad consists or three interaction people. friends and do not mix love with friendship.
• The members engage in the relay and reception of • Platonic relationship might end in a romantic
thoughts and ideas. relationship with partners developing feelings of love
• It is more stable than the dyad as the third members for each other
may act as a mediator when there is conflict between
the other two. IV. FAMILY

III. GROUP • Family communication patterns established roles and

identify and enable personal and social growth of
• A group consist of more than three members and is a individuals.
collection of triads and dyads. • Family relationships can get distorted if there is an
• It is the most stable from of interpersonal relationship unresolved conflict between member sense other
PURPOSES OF INTERPERSONAL RELATIONSHIP family members have significant emotional difficulties
but fails to bring them out unless the physician or nurse
I. Interpersonal relationship for an individual enquires
• Personal growth and development V. PROFESSIONAL
• Source of enjoyment
• Sense of security • Individual working for the same organization are said
to share a professional relationship and are called
• Context of understanding
colleagues.
• Interpersonal needs
• Colleagues may or may not like each other
• Establishing personal identity
TYPES OF RELATIONSHIP AMONG HEALTH
II. Interpersonal relationship for nurses
PROFESSIONALS
• Building a positive functional multidisciplinary team
COMPLEMENTARY RELATIONSHIP
• Improving intra-and/or inter-team communication,
coordination and cooperation • One person is dominant and the other is submission

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• Control is not divided equally between the two - Client’s medical history, age, name, address
participants
ORIENTATION PHASE
• Relationship are stable and predictable also inhibit
creativity and independent thinking - Start with an initial encounter with nurse and patient
o Physician - The fact formulation begins between the nurse and the
o Nurse patient.
- The nurse clarifies his or her roles and responsibilities
SYMMETRICAL RELATIONSHIP
within the therapeutic boundary to the patient.
• Control is more evenly distributed between the two - The Nurse identifies the patient’s problems and
participants - After developing a trustworthy relationship, the patients
• Free to express their opinions start clarifying doubts, share perceptions and convey
• Power struggles occurs when participants complete to their needs and expectation to the nurse.
acquire or give up control - There are several factors that may affect this phase in
o Both Dominant a nurse-patient relationship
o Both Submissive WORKING PHASE
PARALLEL RELATIONSHIP A. IDENTIFICATION
• Control moves back and forth between the two - The nurse must approach the patient with empathic
participants understanding to perceive the patient’s current feeling.
• Participant take turns holding and giving control, - The nurse must avoid vagueness and ambiguity by
depending on the circumstances, rather than using specific terminology rather than abstractions in
competing for control communication process
• Effective and flexible communication - The nurse helps the patients identify their problems in
o Nurse / Physician their own context and use the available resources to
solve the problem.
5 TYPES OF NURSE-PHYSICIAN RELATIONSHIP
- The patient’s self-esteem will be boosted by having
1. Collegial relationships feeling of
- Characterized by equal trust, power, and respect are B. EXPLOITATION
illustrated by the following excerpt
- In this phase, the patient is made to understand the
- Nurses and physicians frequently used the words
problems by exploring all available avenues to solve
peers or equals in describing these relationships.
the problem.
2. Collaborative relationship - The nurse can help the patient by extending minimal
professional
- Marked by mutual trust, power, respect, and - The patient start exploitation all the available resources
3. Student – teacher relationship in spite of making requests to others to extend help
- Finally, the patient with his or her problems
- Either the physician or the nurse can be the teacher.
- With residents and at times with attending physicians TERMINATION PHASE
who are dealing with comorbid disease outside of their - This is the termination of the professional relationship
specialty, nurses may take a teaching / guiding role that begins with convalesce and rehabilitation stage of
- Physicians who teach are identified as having a lot of hospitalization
knowledge and “always willing to explain or teach - The patient’s needs have already been met by the
4. Friendly stranger relationship collaborative efforts of the
- It psychological dependence persists between both of
- Is characterized by a formal exchange of information them, it become difficult to resolve the transferences or
and a somewhat neutral feeling tone. counter transferees. A nurse must aware of the
5. Hostile / Adversarial relationship techniques to resolve it.
- The relationship must be terminated by maintain a
- Are marked by anger, verbal abuse, real or implied healthier emotional balance by both the parties
threats, or resignation
THE MANAGEMENT PROCESS
PHASES OF INTERPERSONAL RELATIONSHIP
A. PLANNING
- Hildegard Peplau (1952) gave the interpersonal relationship
model • Planning, a basic function of management, is a
principal duty of all managers, is a critically important
PRE- ORIENTATION PHASE to and precedes all other management functions.
• Defined as pre determining course of action in order to
- Self-awareness of the nurse. Planning the progress of
arrive at a desired result
the interaction

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• The most basic and essential activity of management 4. Planning utilizes all available resources
functions that decide what needs to be done for the 5. Must be precise in its scope & nature
day, month, or years ahead 6. Should be time bound
• It is a systematic process and requires knowledgeable 7. Projected plan must be documented
activity based on sound managerial theory. It entails
IMPORTANCE OF PLANNING
forecasting or setting the broad outline of the work to
be done. Nurse Manager must know how to plan for the following
• Planning is defined as deciding in advance, it directs reasons:
our thinking on what we expect to do, why it will be
done, who is going to do it, and how when and where 1. Planning leads to the achievement of goals and
objectives.
to be done.
• Without adequate planning, the management process • Workers relate what they do to meaningful results. It
fails and organizational needs and objectives cannot ensures alignment of nursing unit/department and
be met. financial plans with the strategic plan.
• The first element of management defined by Henry • Thus, increase the probability of achieving
Fayol is planning in which he defines as making a plan organizational goals, vision, and mission. Also, it
of action to provide foreseeable future. establishes a framework for decision making
• According to him that plan must have unity, continuity, consistent with top management objectives.
flexibility, and precision. The plan should be included
annual and 1o year forecasts, taking advantage of 2. Planning is gives meaning to work.
input of others. • Employees or workers experience greater satisfaction
• Planning improves experience, gives sequence in if what they do becomes meaningful to them. Ensures
activity, and protects business against undesirable safe and quality care through awareness of individual
changes. His concepts are that planning facilitates responsibility and accountability.
wise use of resources and selection of best
approaches to achieving objectives. 3. Planning provides for effective use of available resources
• Planning facilitates the art of handling people. Because and facilities.
planning fail, it requires moral courage. Effective
• The best use of personnel and material resources
planning requires continuity of tenure. Good planning
prevents wastage.
is a sign of competence, (Marquis and Huston 2017).
• Planning is designed for the nurse administrators who 4. Planning helps in coping with crises. Hospitals must
are seeking more effective means of improving current provide for disaster plans.
and future performance.
• It offers principles of planning and decision-making • It allows the workers to function more clearly and
guides in nursing practice. It deals with those aspects efficiently when actual emergencies occur such as fire,
of planning that directly affects the nurse typhoons, earthquakes, or during New Year
administrators on a personal as well as organizational celebrations and or other occasions when more people
level. are likely to get hurt. Manages risk and copes with
crisis situations.
PURPOSE OF PLANNING
5. Planning is cost effective.
1. Planning increases the chances of success.
2. It forces analytic thinking and evaluation of alternatives • Cost can be controlled through planning for efficient
3. It establishes a framework for decision making that is operation. Projecting the number of operations in a
consistent with top Management objectives. given day, including daily dressings, helps in
4. It orients people to action instead or reaction. determining accurately the needed weekly supplies in
5. It includes day-to-day and future-focus managing. the surgical units so as to prevent undersupply,
6. It helps to crisis management and provides decision- oversupply or pilferages.
making flexibility. 6. Planning is based on past and future activities.
7. It provides a basis of for managing organizational and
individual and individual Performance. • Evaluation of programs. Schedules, and activities
8. It increases employee involvement and improves whether successful or not, prevents and/or reduces the
communication. recurrence of problems and provides better ideas in
9. It is cost effective. modifying or avoiding them.

PRINCIPLES OF PLANNING 7. Planning leads to the realization of the need for change.

1. Planning is always based & focused on the vision • Discovers the need for change that leads to create new
mission, philosophy, and clearly defined objectives of services and productivity.
organization. • Many of the hospitals have found out that in-patient
2. Planning is a continuous process hospital days can greatly reduce by having the
3. Planning should be pervasive. laboratory and diagnostic work up in the Out-patient
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Department. Minor surgeries are also done at the OPD • It encompasses both higher and lower echelons and
so that more hospital beds can be allotted to critically- vice versa and spreads horizontally through peer levels
ill patients or for those needing specialized services. and/or across services and members of the health
team.
8. Planning improves communication and team
collaboration through people involvement in planning 4. Planning should be efficient.
activities.
• It should contribute to the attainment of objectives not
9. Planning provides the basis for control. only in terms of peso value, man –hours, units of
production but should also include individual values
• It becomes the basis for evaluating the
and group satisfaction.
accomplishment of the set programs/activities.
CHARACTERISTICS OF A GOOD PLAN
10. Planning is necessary for effective control,
1. Be precise with clearly-worded objectives, including
• Nurse- managers evaluate the environment or setting
desired results and methods of evaluation.
in which they work or where the patients are confined
2. Be guided by policies and/or procedures affecting the
and make necessary recommendations to make
planned actions.
hospital conditions more therapeutic not only for the
3. Indicate priorities.
patients but for the workers as well. Performance of
4. Develop actions that are flexible and realistic in terms
workers and evaluation of services to patients’ base on
of available personnel, equipment, facilities, and time.
criteria set during the planning stage will indicate
5. Develop a logical sequence of activities.
whether standards of care are met and whether
6. Include the most practical methods for achieving each
changes are indicated.
objective.
SCOPE OF PLANNING 7. Pervade the whole organization.

• The Top Management or the Nursing Directors, The effectiveness of a plan is enhanced by the environment in
Chief Nurses or Directors of Nursing and their which the nursing personnel work. A positive climate promotes
assistants are the one who set the overall goals and good working relationships and leads toward achievement of
policies of an organization. It’s their responsibility to identified goals.
covers the over-all management of the organization’s BASIS IN PLANNING THE NURSING SERVICE
Nursing Service.
• The Middle management or Nursing Supervisors A. FORECASTING
direct the activities to actually implement the broad • Forecasting helps managers look into the future and
operating policies of the organization such as staffing decide in advance where the agency would like to be
and delivery of services to the units. The formulation of and what is to be done in order to get there. Forecasts
policies, rules and regulations, methods and and estimates provide the bases for planning. Forecast
procedures for intermediate level planning for ongoing describe the ultimate conditions or projections that
activities and projects is done in coordination with top provide the general incentive and direction to planning.
management and those in the lower level. It anticipates the environment or setting where the plan
• At the lower or first –level management, the Head will be operationalized such as:
Nurses or Senior Nurses (including Charge Nurses • The hospital, this includes the type of hospital served
or team Leaders) do the daily and weekly plans for the (level 1, level 2, level 3, or level 4); the kind of service
administration of direct patient care in their respective it offers (general or special) its philosophy mission and
units. goals and categories of their budget 9 national or
local).
MAJOR ASPECT OF PLANNING
• The community it serves, this includes the kind of
1. Planning should contribute to objectives. people served their needs, expectations, literacy rate,
economic levels, employment rates, demographic
• It should seek to achieve a consistent, coordinated statistics, cultural values, values and services available
structure of operation focused on desired ends. Actions in the community.
without plans often result to chaos and failure. • The goals of care, vary according to the needs of the
2. Planning precedes all levels other processes of community, agency, trends in technology and in
management. changing needs of the community, agency, trends in
technology and in changing concepts of the nurses’
• Without a plan there would be nothing to organize, roles and functions.
direct, and control. Planning leads to easy • A mistake common to novice managers is a failure to
accomplishment of the organizational objectives which complete adequate proactive planning. Instead, many
is necessary for group effort. Planning and control are managers operate in a crisis mode and fail to use
inseparable. available historical patterns to assist them in planning.
Nor do they examine present clues and projected
3. Planning pervades all levels.
statistics to determine future needs. Forecasting

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involves trying to estimate how a condition will be in the • The philosophy of nursing service dovetails with the
future. Forecasting takes advantage of input from philosophy of the agency. It is an intentionally chosen
others, gives sequence in activity and protects an set of values or purposes that serve as the bases for
organization against undesirable changes. determining the means to accomplish nursing
• Changes in technology, payment structures, and objectives.
resource availability, the manager who is unwilling or • Nursing philosophy may be broad and general, yet is
unable to forecast accurately impedes the directs nursing behavior, giving it a sense of purpose.
organization’s efficiency and the unit’s effectiveness. Generally emphasized in the statement of the
• Forecast must be supported by facts, reasonable philosophy are the quality, quantity and scope of
estimates and accurate reflection of policies and plans. service; decision making based on factual information;
appropriate delegation of function; achievement of
B. SETTING THE VISION, MISSION, PHILOSOPHY, GOALS organizational goals; vertical and horizontal
AND OBJECTIVES.
communication; and the flexibility to meet the changing
• Every organization has a guiding vision and mission. needs of the organization, individuals, the community,
Most often, the purpose and philosophy are explicitly and society in general.
stated and detailed in a formal mission statement. This Example of Philosophy:
mission statement reflects the organization’s values
and provides the reader with and indication of the • The Hospital is committed to assume a vital role in
behavior and strategic actions that can be expected health promotion, disease prevention, curative,
from that organization. rehabilitative, and primary health care in partnership
• Mission statement outlines the agency’s reason for with public health counterparts, the clients, families,
existing (whether hospital or health care), who the and communities.
target clients are (poor, the needy, the middle or upper
Organization and people who set Goals and objectives do better
class), and what services will be provided (in-patient,
than those who do not. This management truism has been
out-patient, emergency).
proven overtime. When a manager forms a goal, puts them in
• A vision statement outlines the organization’s future
paper, and reviews them periodically, it forces him/her into
role and function. It gives the agency something to
action to try and accomplish them. This is true for everyone. The
strive for.
more person sets goals and specifies objectives for each of the
• Most health care organizations have mission
result areas he/she likes to achieve, the more likely he/she
statements that speak to providing high quality or
reach these.
excellence in patient care. Some mission statements
focus exclusively on providing care. • Goals and objectives differ in that goals are more
• The mission of other organizations may be community general and they cover a broad area.
based, and these organizations consequently will • Objectives, on the other hand, tend to be more
focus on providing community outreach and specific. Objectives are concrete. They are action
population-based services to a specific community or commitments through which an organization’s mission
population within a community. and purpose will be achieved and should focus on
production of health services to the patients.
Example of Mission:
• Philosophy states beliefs and values while objectives
• The Medical Center, as a public, tertiary hospital is so state specific and measurable goals to be
maintained as the people’s partner and improved to accomplished.
improve to provide accessible, quality, cost effective,
Example of Objective:
preventive, promote, curative, rehabilitative health care
services to the general public, especially the destitute. • To strengthen and integrate the role of the hospital in
The institution is also committed to medical, nursing, the promotion of health and prevention of illness
and allied health education, training and research. through primary health care services, linkages and
referrals with community leaders, civic and
Example of Vision:
government organizations and agencies.
• The Medical Center envisions itself to become a
Example of Goal:
Center Excellence providing holistic approach to health
services. As a Center of Wellness, the services • The nursing staff will provide effective patient care
provided shall enable the people to improve their relative to patient needs insofar as the hospital and
health and increase control over it. community facilities permit through the use of care
plans, individual patient care, and discharge planning,
• A philosophy describes the vision. It is a statement of including follow-up contact.
beliefs and values that direct one’s life or one’s
practice. In an organization, the philosophy is the C. DEVELOPING AND SCHEDULING PROGRAMS
sense of purpose of the organization and the reason • Programs are determined, developed and targeted
behind its structure and goals. within a time frame to reach the set goals and
objectives. Kron has developed a planning formula
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which may be used for daily duties, or for short-and situation, planning efforts are directed at returning the
long-range projects, (Venson, 2016) organization to a previous, more comfortable state.
Often times, in reactive planning, problems are dealt
THE PLANNING FORMULA
with separately without integration with the whole
1. WHAT organization. Because it is done in response to a crisis,
this type of planning can lead to hasty decision and
• What has been done? mistakes.
• What should be done? • Inactivism is another type of conventional planning.
• What equipment and supplies have been used or are Inactivists seek the status quo, and they spent their
needed? energy preventing change and maintaining conformity.
• What steps necessary in the procedure? When changes do occur, they occur slowly and
• What sequence of activities was previously used? incrementally.
• What other efficient methods may be used? • Preactivism, preactive planners utilize technology to
accelerate change and are future oriented. Unsatisfied
2. WHEN
with the past or present, preactivists do not value
• When should the job be done? experience and believe that the future is always
• When was it formerly done? preferable to the present.
• When could it be done? • Interactive or proactive planning. Planners who fall
into this category consider the past, present, and future
3. WHERE and attempt to plan the future of the organization rather
than react to it. Because the organizational setting
• Where is the job to be done?
changes often, adaptability is a key requirement for
• Where does an activity occur in relation to those
proactive planning. This also occurs in anticipation of
activities immediately?
changing needs to promote growth within an
• preceding and following it? organization and is required of all leader-managers so
• Where could supplies be stored, cleaned, and so forth? that personal as well as organizational needs and
4. HOW objectives are met.

• How will the job be done? TYPES OF PLANNING

• What are the steps to be followed in doing the Planning also has many dimensions. Two of these are time span
procedure? and complexity or comprehensiveness, but basically there are
• How will the time and energy of personnel be used? two types of organizational planning:
• How much will it cost?
• How much time will it require? STRATEGIC PLANNING

5. WHO • Is a broad continuous systematic process that

emphasizes assessment of the organizational
• Who has been doing the job? environment both internally and externally such as
• Who else could do it? economic, political, social, and technological factors.
• Is more than one person is involved? • It is a management tool that helps organizations set
long-term goals, a risk-taking decision with knowledge
6. WHY
of their effects in the future, and evaluating the
• To each of the questions, ask why. outcomes through reliable feedback mechanism.
• Why is this job, this procedure, this step necessary? • It focuses on performance improvement and utilizes
• Why is this done in this way, in this place, at this time, strategies to accomplish the organization’s desired
by this person? outcomes. This maybe done once or twice a year in an
• One more question can be added to make the formula organization that changes rapidly. At the unit level, any
more helpful. planning that is at least 6 months in the future maybe
considered long-range planning, (Marquis and
7. CAN Houston,2017).
• Strategic planning forecasts the future success of an
• Can some steps or equipment be eliminated?
organization by matching and aligning an
• Can this activity be efficiently combined with other
organization’s capabilities with its external
operations?
opportunities.
• Can somebody else do it?
• An organization could develop a strategic plan for
• Can we get a machine to help? dealing with the nursing shortage, preparing
• Can we get enough money? succession managers in the organization, developing
FOUR PLANNING MODES: a marketing plan, redesigning workload, developing
partnership, or simply planning for organizational
• Reactive planning occurs after a problem exists. success.
Because there is a dissatisfaction with the current
SWOT ANALYSIS
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• One effective tool that can assist in strategic planning instead involves various actions and reactions that are partially
is SWOT analysis (identification of strengths, planned and partially unplanned.
weakness, opportunities, and threats) is one of the
Sample of 5-year Development Plan
most commonly used in health care organizations.
SWOT analysis is also known as TOWS analysis was
developed by Albert Humphrey at Stanford University
in the 1960s and 1970s.
• The first step in SWOT analysis is to define the desired
end state or objective. After the desired objective
defined, the SWOT are discovered and listed. Decision
makers must then decide if the objective can be
achieved in view of the SWOTs. If the decision is no, a
different objective is selected and the process repeats.
With the results of your analysis the following should
be included: 1) working out what you hope to achieve,
2) being objective, 3) incorporating the findings into the
action plan, and 40 revisiting your findings on a regular OPERATIONAL PLANNING
basis.
• Perform correctly, SWOT allows strategic planners to • Is a detailed work plan or written blueprint in which the
identify those issues most likely to impact a particular objectives of a nursing unit/department are put into
organization or situation in the future and then to measurable actions?
develop an appropriate plan of action • It provides a clear picture of how a team; nursing unit
or department will contribute to the achievement of the
organization’s strategic goals.
• It is known a management plan.
• Some categorical areas for objectives are: patient
satisfaction, patient safety, internal process, staffing,
training and education, research, and financial.
• It is also a specific plan that supports the strategic plan
by implementing Its strategies, projects and programs.
It provides detailed information to direct its people to
perform the day to day tasks and activities in running
the nursing unit/organization.
• The operational plan objectives are specific. These are
concrete statements that nurse managers seek to
accomplish in terms of results. It includes the what
(task to be undertaken), who (person responsible),
when (timeline for task completion), and how much
STRATEGIC PLANNING AS MANAGEMENT PROCESS (amount of financial resource to carry out the task).
• The formulation and implementation of operational
Includes the following step: plan is the responsibility of middle and front -line
1. Clearly define the purpose of the organization. managers and its done yearly.
2. Establish realistic goals and objectives consistent with • Operational planning is an upward approach because
the mission of the organization. team members actively involved in the planning
3. Identify the organization’s external constituencies or process.
stakeholders and then determine their assessment of • They are encouraged to develop personal to-do list
the organization’s purposes and operations. necessary to reach the targets or milestones of their
4. Clearly communicate the goals and objectives to the nursing units, (DOH, 2016).
organization’s constituents.
Sample of Operational Plan
5. Develop a sense of ownership of the plan.
6. Develop strategies to achieve the goals.
7. Ensure that the most effective use is made of the
organization’s resources.
8. Provide a mechanism for informed change as needed.
9. Provide a mechanism for informed change as needed.
10. Build a consensus about where the organization is
going.
It should be noted, though, that some critics argue that strategic
planning is rarely this linear. Nor is it static. Strategic planning

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providing management with a means to internal
control.
• Policies may also be implied or expressed. Implied
policies neither written nor expressed verbally, have
usually developed overtime and follow a precedent.
o For example: a hospital may have an implied
policy that employees should be encouraged
and supported in their activity in community,
regional, and national health organizations.
Another example might be that nurses who
limit their maternity leave to 3 months can
return to their former jobs and shifts with no
statue change.
• While expressed policies are delineated verbally or
inwriting. Most organizations have many written
policies that are readily available to all people and
promote consistency of action. Expressed policies may
include a formal dress code, policy for sick leave or
vacation time, and disciplinary procedures.
• Procedures are plans that establish customary or
acceptable ways of accomplishing a specific task, and
delineate a sequence of steps that required action.
The table below summarizes the difference between the Established procedure save staff time, facilitate
strategic planning and operational planning. delegation, reduce cost, increase productivity, and
provide a means control. Procedures identify the
process or steps needed to implement a policy and are
generally found in manuals at the unit level of the
organizations, (Marquis and Huston, 2017).
• Guidelines outlining the scope and standards of
practice for specialty practice areas. Nurses must be
careful to assure that the procedures they perform and
the process used in performing them consistent within
the limits of state and national regulatory bodies.

D. ESTABLISHING NURSING STANDARDS, POLICIES, AND Manager also has a responsibility to review and revise policies
PROCEDURES and procedures statements to ensure currency and applicability.

• Nursing Standards Institutions develop their own • The current explosion of evidence-based research as
standards of nursing practice, the standard of Nursing well as new regulations, technology, and drugs,
Practice and Nursing Service Administration keeping policies and procedures current and relevant
formulated by the Association of the Nursing Service is tremendous management challenge.
Administrators of the Philippines and revised 2008. • Because most units are inconstant flux, the needs of
• The established standards in an evaluation provides the unit and the most appropriate means of meeting
provide professional desirable norms against which those needs constantly change.
department’s performance can be measured. Areas of • For example, the unit manager is responsible for
improvement are identified and a plan of action to seeing that a clearly written policy holiday and vacation
correct this is made and implemented. time exists and that it is communicated to all those it
• Nursing Standards, the philosophy shall be based on affects.
the belief that the client is integral whole and that he is • The unit manager must also provide a clearly written
a unique individual with needs that can be met through procedural statement how to request vacation or
nursing interventions. holiday time on that specific unit. Nurse manager would
• Nursing Service Policies are plans reduced to assess any long-term change in patient census or
statements or instructions that direct organizations in availability of human resources and revise the policy
their decision making. It direct individual behavior and procedural statements, (Marquis and Houston,
toward the organization’s mission and define broad 2017).
limits and desired outcomes of commonly recurring In the mid-20th century Kurt Lewin (1951) developed change
situations while leaving some discretion and initiative theory, he identified 3 phases in which the change agent must
to those who must carry out that policy. Though, some proceed before a planned change becomes part of the system:
policies required by accrediting agencies, many unfreezing, movement, and refreezing.
policies are specific to the individual institution, thus

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• Unfreezing is the first phase; this occurs when the Budgeting is also has Determining Factors for Budgetary
change- agent convinces members of the group. To Requirements. This pertains with the awareness of the nursing
change or when guilt, anxiety, or concern can be staff about the budget planning and proceeds of the
elicited. This is where employee become discontented department., (DOH Guidelines 2016).
and aware of a need to change. Change agent needs
NURSING BUDGET is a plan for allocation of resources based
to have made a thorough and accurate assessment of
on preconceived needs for a proposed series of programs to
the extent of and interest in change, for them to
deliver patient care during one fiscal year.
become effective as change agent. The nature and
depth of motivation and environment where change will A HOSPITAL BUDGET is a financial plan to meet future service
occur must also be considered by the change agent, expectations. Budgeting translate these needs to manpower,
(Marquis and Houston, 2017). equipment and supplies so that both services are provided at
• Movement this is the 2nd phase of planned changed the highest level of quality at a minimum cost.
change agent must identifies, plans, and implements
appropriate strategies, ensuring driving forces exceed PURPOSE OF BUDGETING
restraining forces. Because changes are not that easy 1. A forecast of income and expenditure
it’s a complex process and it requires a great deal of 2. A tool for decision making, to provide financial
planning and intricate timing. Human behavior framework
changes Or attitudes and values underlie that 3. Measured the financial report and its statistical data.
behavior, takes some time.
• Refreezing is the last phase, during this phase the IMPORTANCE OF BUDGET
change agent assists in stabilizing the system change Nurse Manager must know how to budget for the following
so that it becomes integrated into the status quo. If reasons:
refreezing is incomplete, the change surely ineffective
and pre change behaviors will be resumed. For this to • To control the over spending of the Nursing services.
occur, the change agent must be supportive and • Budgeting helps you control the spending beyond the
reinforce the individual adaptive behavior efforts of means in related to nursing activities.
those affected by the change, (Marquis and Houston, • To monitor income and expenses of the Nursing
2017). services.
• Budgeting helps you keep on track of the income and
BUDGET
expenditures of the Nursing services.
• Budgeting, it is the financial guideline where is the • Rationalization of the financial transparency and
allocation of each resources such as money, time and accountability of the Nursing services. Budgeting gives
people will be acquired and used. It is the financial you a precise report summary of the financial
“road map” which projects the future costing and a plan responsibilities.
for manpower utilization, and other resources in line
TYPES OF BUDGET
with the operating programs.
• Annual operating plan Personnel Budget.
• Estimate of future costs
• A financial plan that includes estimated expenses as • It monitors the personnel budget to determine the
well as income for a period of time needs of nursing staff either in short for long term
• A nurse manager uses his/her expertise to utilize the basis.
efficient and effective budgetary planning and • It is the type of budget affected by personnel policies
processes. In budget preparation, the nursing services such as salary related to position and number of days
purposely control and establish the monthly as well as allowed for educational and personal leave.
the annual financial budget plan report. • The manager should aware of the increasing or
• Normally, there are five types of Budget; (1) Personnel decreasing of patient’s volume per day/per hour or per
Budget said to be the workforce budget because it is minute so as they would know the number of staff
forecasting the volume of operational staff. (2) nurses to be assigned., (Marquis and Huston, 2017)
Operating Budget which the accounts for revenues Operating or Revenue and Expense Budget.
and expenses were the concerned needs, it is also
reflects the costing of the services on the supplies, • It is an annual budget that includes the revenues and
utilities, repairs and maintenance while the (3) Capital expenses associated with the daily activities of the
Budget related to a long term range planning of the Nursing department.
institution’s physical acquisitions, disposal and • Deals primarily with salaries, supplies, and contractual
improvement. (4) Cash Budget appears to make an services
adequate funds available as needed and to use an • Provides an over view of an agency’s functions by
extra fund profitably. (5) Flexible Budget, budgets that projecting the planned operations, usually for the
flex up and down over the course of the year upcoming year.
depending on volume., (Marquis and Huston, 2017).
Capital Budget.

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• Considers the purchased related to the acquisitions of PRE-REQUISITES FOR BUDGETING
the major equipment and necessities involving the
1. Sound organizational structure with clear lines of
physical facilities of the Nursing services.
authority and responsibility is needed.
• Related to long range planning
2. Non-monetary statistical data –such as number of
• Include physical changes such as replacement, or
admission, average length of stay, percentage of
expansion of the plant, major equipment and
occupancy and number of patient days –are used for
inventories
planning and control of the budgetary process.
Cash Budget. 3. Chart of accounts are designed to be consistent with
the organizational plan.
• Plan to make adequate funds available as needed and 4. Managerial support is essential for a budgetary
to use an extra fund profitably. program.
Flexible Budget. 5. Formal budgeting policies and procedures should be
available in the budget manual.
• Budgets that flex up and down over the course of the
FACTORS IN BUDGET PLANNING
year depending on volume of labor costs and capital
expenditures Nursing service are determined to consider the budget planning
proceeds are;
BUDGETING PROCESS
1. Type of patient and the length of stay in the hospital.
The budgeting process involves four (4) distinct phases:
Assess whether the patient is under medical, surgical,
PHASE 1 GATHERING DATA maternity, surgical, communicable disease or
chronically ill and the severity of its illness
• Study the overall past performance based on proposed 2. Bed capacity and hospital size
goal. 3. Physical plant of the hospital, design and the size of
• Gather environmental information the wards/unit and other treatment rooms.
• Regulates the overall expenses and revenues from the 4. Personnel policies. Includes the salaries of the
past reports to present based on proposed budget. personnel, overtime pays or shift differential; extended
PHASE 2 PLANNING leave of absence and holidays.
5. Grouping of patients
1. Create a Budget Committee 6. Standard of Nursing Care
2. Set Objectives based on strategic goals 7. Method of performing nursing care
3. Establish a program or project for future goals 8. Method of documentation
4. Formulate a budget guideline to synchronize with 9. Proportion of nursing care providers (professional /
financial linkages non-professional)
5. Settle an Operating and Capital Budget 10. Amount and quality of supervision available and
6. Manage a budget hearing provided
7. Prioritize your budget based on necessity 11. Competencies of job description and qualification
8. Conclude your proposed budget plan 12. Method of patient assignment
13. Amount and kind of labor-saving devices and
PHASE 3 APPROVAL AND EXECUTION
equipment
1. Summarized the proposed nursing service budget plan 14. Amount of centralized service provided
and let the authorize finance budget committee to 15. Nursing service requirement ancillary departments
review and approve the budget. 16. Reports required by administration
2. Make a budget plan ready for improvement in order to 17. Affiliation of nursing students or medical students
calibrate any errands to the General Appropriations Act
BUDGETING METHODS
(GGA).
3. Cascade the proposed budget plan accordingly to all • INCREMENTAL BUDGETING – simplest method for
nursing unit staff and department. budgeting. Since the budget for the next coming year
may be projected, the programs and services were not
PHASE 4 MONITORING AND REPORTING
prioritized.
1. Observe the proper delivery or implementation of the • ZERO-BASED BUDGETING – the method does not
budget plan. automatically claim to be funded. A set funding priority
2. Make an analysis between the proposed budget and is the main purpose of this method.
the actual performance. • FLEXIBLE BUDGETING – this method calculates
3. Clarify and justify the results to determine the what the expenses should be specified in the program
significant trends • PERFORMANCE BUDGETING – emphasizes the
4. Ready to make an adjustment based on the required outcomes and results instead of activities and outputs.
needs.
5. Present the financial report according to hospital FACTORS IN DETERMINING BUDGETARY REQUIREMENT
policy.

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• Asses the appropriate provision in the current General d. Deferring, postponing, or putting off decisions, actions,
Appropriation Act. or activities can become a habit which oftentimes
• Associate the sources of funds (General, national, city, causes lost opportunities and productivity, generating
municipal…) personal or interpersonal crises.
• Evaluate the current appropriations and actual e. Delegation permits a manager to take priority for
expenditures for the current year. decision making and to assign tasks to the lowest
• Analyze the projected changes in other department possible consistent with his/her judgement, facts, and
that will affect the nursing service budget. experience, (Venson, 2016).
• Consider the required expenditures, supplies, TIME-SAVING TECHNIQUES, DEVICES, AND METHODS
equipment and material, repair and replacement for the TO BETTER USE OF TIME.
next coming year.
• Projects the estimated personnel salaries and benefits 1. Conduct an inventory of your activities.
including their unusual leaves.
Logging your activities for one day would show how much time
• Assess the cost of Human Resource Development and is usually spent on each activity.
Research Programs.
• Render this information into peso and submit the 2. Set goals and objectives and write them down. Set
official forms to the Medical Center Chief for approval priorities. Plan on making things happen rather than
and inclusion in the general budget. reacting to crises.
3. With the use of calendars, executive planners, logs or
The efficiency of the budget management resources determines journals, write what you expect to accomplish yearly,
the productivity goal of the of the nursing service management. monthly, weekly or daily.
It reflects the consistency of the budget costing ability of the 4. Breakdown large projects into smaller parts.
nurse manager. 5. Devote a few minutes at the beginning of each day.
TIME MANAGEMENT 6. Organize your work space so its functional. Sort paper
work on your table according to priority.
…nothing is particularly hard if you divide it into small jobs. 7. Close your door when you need to concentrate. Agree
on a period of quiet office time.
-Henry Ford-
8. Learn to delegate.
…things which matter most must never be at the mercy of things 9. In a meeting, define the purpose clearly before starting.
that matter least. Distribute the agenda in advance and control
interruptions during the meeting.
-Johann Wolfgang von Goethe- 10. Take or return phone calls during specified time.
• Time management defined as making optimal use of Maintain a telephone log so you can return calls at a
available time. time.
• It is a technique for allocating one’s time through the 11. Develop effective decision-making skills. Do no afraid
setting of goals, assigning priorities, and identifying to say “no”.
and eliminating wasted time, and using managerial 12. Take a rest breaks and make good use of your spare
techniques to reach goals efficiently. time. Reward yourself periodically, (Venson, 2016)
• Oftentimes manager’s complaint or keep telling they THREE STEPS TO TIME MANAGEMENT
don’t have enough or lack of time in accomplishing
such goals. They always argue that there is not enough a. Allow time to planning and establish priorities.
time in the day to do everything that must be done. The b. Complete the highest task whenever possible
problem that this individual is time poor., rather that and finish one task before beginning another.
problem is poorly using of time. c. Reprioritize based on the remaining tasks and
• One of the strategies in managing the time is learn to on new information that may have been
prioritize duties, managing and controlling crisis, received.
reducing stress and balancing work and personal time, ORGANZING
(Marquis and Houston,2017).
ORGANIZATIONAL THEORY AND BUREAUCRACY
TIME MANAGEMENT PRINCIPLES
Max Weber is known as the father of organizational theory.
There are several time management principles that can be used According to him, bureaucracy is an institutional method for
to plan effectively. applying general rules to specific cases, making the actions of
a. Planning anticipates the problem that arise from management fair and predictable. Other characteristics of
actions without thought. bureaucracy are the following:
b. Tasks to be accomplished should be done in sequence • There must be a clear division of labor.
and should be prioritized according to importance.
• A well-defined hierarchy of authority must exist which
c. Setting deadlines in one’s work and adhering to them
separates the superiors from subordinates. There must
is an excellent exercise in self-discipline.
be remuneration for work, recognition of authority,
allotment of privileges and conferring of promotion.
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• There must be impersonal rules and impersonality of service should be updated, reviewed, approved, and
interpersonal relationships. documented by the proper authority. Date of last review should
• A system of procedures for dealings with work be documented.
situations must exist.
TYPES OF ORGANIZATION CLASSIFIED BY NATURE OF
• A system of rules covering the rights and duties of each
AUTHORITY
position must be in place.
• Selection for employment and promotion is based on 1. Lines organization is the simplest and the most direct type
technical competence. of organization in which each position has general authority over
the lower positions in the hierarchy. Line of authority flows from
Organizing is the process of establishing formal authority and top to bottom
involves setting up the organizational structure through
identification of groupings, roles and relationships, determining Example: Clinical and Administration
the staff needed by developing and maintaining staffing patterns
2. Informal organizations (flat/horizontal) refer to horizontal
and distributing them in the various areas as needed. It includes
relationships rather than vertical. This is composed of small
developing job descriptions by defining the qualifications and
groups of workers with similar interests.
functions of personnel.
3. Staff organization is purely advisory to the line structure with
An organizational chart is a line drawing that shows how the
no authority to put recommendations into action.
parts of an organization are linked. It depicts the formal
organizational relationships, areas of responsibility, persons to Example: Training and Research
whom one is accountable and channels or organization.
4. Functional organization is one where each unit is
ELEMENTS OF ORGANIZING responsible for a given part of the organization’s workload.
There is clear delineation of roles and responsibilities which are
The elements of organizing include setting up the organizational
actually interrelated.
structure, staffing, scheduling, and developing job descriptions.
Example: All standing and ad hoc committees
A. SETTING UP THE ORGANIZATIONAL STRUCTURE
ORGANIZATION
• The creation of an organizational system compatible
with the philosophy, conceptual framework, and goals • Consists of the structure and process which allow the
of the organization provides the means for the agency to enact its philosophy and utilize its
accomplishment of an organization’s purpose. conceptual framework to achieve its goals. It refers to
• Understanding the organizational structure as a whole a body or persons, methods, policies and procedures
facilitates the development of roles and relationships to arranged in a systematic process through the
enable the achievement by goals. delegation of function and responsibilities
• The organizational structure refers to the process by
which a group is formed, its channels of authority, span ORGANIZATIONAL CHART AND ITS IMPLICATION
of control and lines of communication. • An organizational chart is a line drawing composed of
• Departmentalization and division of work provide boxes that shows the parts of an organization are
orderliness in administration. Through a breakdown of linked.
activities, each individual becomes responsible for a • It depicts the formal organizational relationships, areas
specified set of activities and performs such. of responsibility, persons to whom one is accountable
The successful setting up of the organizational structure enables and channels of communication.
an organization to achieve its purposes: There are two lines in the organizational chart
1. It informs the members of their responsibilities so that • Unbroken Solid lines are classified into two.
they may carry them out. o The solid horizontal lines represent
2. It allows the manager and the individual workers to communication between people with similar
concentrate on his/her specific role and sphere of responsibility and power but
responsibilities. different functions.
3. It coordinates all organizational activities so there is o The solid vertical lines between positions
minimal duplication of effort or conflict. denote the official chain of command and
4. It reduces the chances of doubt and confusion formal path of communication and authority.
concerning assignments. Those having the greater decision-making
5. It avoids overlapping of functions because it pinpoints authority are at the top; those with the least
responsibilities. are at the bottom.
6. It shows to whom and for whom they are responsible. • Dotted or broken lines it represents staff position.
Other individuals that the nurse may need to be accountable to Staff member provides information and assistance to
include the immediate supervisor, the patient and family, central the manager but has limited organizational authority. It
administration, and the physician because all of them participate also provides for specialization but does not have
in the nurse’s work. The organizational structure of the Nursing legitimate authority as it acts in an advisory capacity.

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FIVE MAJOR CHARACTERISTICS OF AN
ORGANIZATIONAL CHART
An organizational chart should show the following components:
1. Division of work – each box represents the individual
or sub-unit responsible for a given task the
organization’s work load.
3. Position chart specifies the names, positions, and titles or
a. Ex: Medical Services, Hospital Operations and
ranks of the personnel.
Patient Support Services, Nursing Services, and
Finance Services.
2. Chain of Command – lines indicate who reports to
whom and by what authority
b. Ex: Flat (decentralized) or tall (centralized)
organizations.
3. Type of work to be performed – indicated by labels
or descriptions for the boxes. Ex: Ancillary Services,
Training and education Department, and Patient Care
Services.
4. Grouping of work Segments – shown by the clusters PRINCIPLES OF ORGANIZATION
of work groups (departments or single units). Ex: In designing the organizational structure of the nursing
Operating Room and Post Anesthesia Care Unit, Labor department, certain organizational principles must be observed.
Room and Delivery Room Unit, Intensive Care and
Coronary Care Unit. 1. Unity of Command. Although employees may interact
5. Levels of Management – indicate individual and entire with many different employees in the performance of
management hierarchy. Hierarchy refers to a body of their duties, they should be responsible to only one
persons or things organized or classified in pyramidal superior. This is to avoid confusion, overlapping of
fashion according to rank, capacity or authority duties and misunderstanding This method is modified
assigned to vertical levels with the offices ranked in by emerging organizational theory where nurses and
grades, orders, or classes, one above the other. Ex: others are frequently engaged in matrix organizations
Top management, middle management, and front-line in which they answer for more than one supervisor
management. 2. Scalar Principle or Hierarchy. The authority and
responsibility should flow in clear unbroken lines from
KINDS OF ORGANIZATIONAL CHART the highest executive to the lowest. The other form for
1. Structural chart shows the various components of the this is “chain of command,” usually a military term.
organization and outlines the basic interrelationships. Proper definition and delegation of authority and
responsibility facilitate the accomplishment of work. In
this connection, the following must be observed:
a. When responsibility for a particular job is
delegated to a subordinate, the latter should have
authority over resources needed to accomplish
the task
b. When a particular function is delegated to a
subordinate, the superior own’s responsibility is in
no way diminished, and
c. When a person is bestowed the authority of action,
he is accountable for his actions to the person that
bestowed him such. The conscientious nurse
exhibits accountability toward her employing
hospital, the patient, the government, her
profession, and to God.
i. This principle supports a centralized authority
2. Functional chart reflects the functions and duties of the that aligns authority and responsibility.
components of the organization and indicates the Communication flows through the chain of
interrelationships of these function. Within the boxes is the command that tends downward. In modern
function statement, which should be clear, inclusive and written nursing organization, the chain of command
in the present tense. is flat. Communication flows freely in all
directions with responsibility and authority
delegated to the lowest operational level
3. Homogenous Assignment or Departmentation.
Workers performing similar assignments are grouped
together for a common purpose. This promotes the
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specialization of activities, simplifies the
administrator’s work, and helps maintain effective
control.
4. Span of Control. The number of workers that a
supervisor can effectively manage should be limited,
depending upon the pace and pattern of the working
area. It also refers to span of managerial responsibility
and the number which one superior can assist, teach
and help to reach the objectives of their own jobs
5. Exception Principle. Recurring decisions should be
handled in a routine manner by lower-level managers
whereas problems involving unusual matters should be
referred to the higher-level Subordinates should report
only unusual from normal functioning, so that
managers can limit their attention to significant events.
6. Decentralization or Proper Delegation of Authority.
Decentralization is the process of conferring specified
decision making to the lower levels of the organization.
Basic top-level decisions and policies must receive Figure 1. ORGANIZATIONAL STRUCTURE OF A MEDICAL
attention at the top levels. Executives should be CENTER
developed to handle situations delegated to the, this
delegation of authority is still subject to the supervision ORGANIZATION OF THE NURSING SERVICE/DIVISION
and control of the delegating superior. Distribution of • The Nursing Service/Division/Department is the largest
necessary information about critical issues is vital to group of hospital employees tasked with the
any delegation process. An executive should have responsibility of setting standards for safe nursing
sufficient information to make a good decision. practice, providing quality care to the patients, and
7. The Principle of Requisite Authority. When a coordinating its services with the various
particular task is delegated to a subordinate, the latter divisions/departments/services in the hospital and
must also be given authority over resources needed for community.
task accomplishment. He She is accountable for the • The Nursing Service is headed by the Chief Nurse and
quality of his work. may be called by other titles such as Director of
8. The Principle of Organizational Centrality. Nursing Nursing Services. As the administrator of nursing
personnel interact with the greatest number of other services the position may also be called Assistant
healthcare workers, receive the greatest amount of Director for Nursing as in the Philippine General
work-related information and become most powerful in Hospital. She has several Chief Nurses under her who
organizational structure. head their respective departments.
9. The Principle of Esprit d’ Corps. This means • In specialty hospitals such as the Lung Center of the
teamwork and implies that in unity, there is strength.
Philippines, the National Kidney Institute, and the
Figure 1 is an example of a hospital organizational chart. All Philippine Children’s Medical Center, the heads of the
units that pertain to diagnosis and cure belong to the Medical Nursing Department are called Department Managers.
Division and is headed by the Chief of Professional Services or • The Chief Nurse (Nurse VII in DOH Hospitals) is
Chief of Clinics. The caring aspect fall under the Nursing directly responsible to the Chief of Hospital or Medical
Division and I headed by the Chief Nurse or Director of nursing Center Chief. She is assisted by an Assistant Chief
Services. The operations of the hospital and patient support Nurse. In some bigger hospitals, there may be two
area is handled by the Hospital Operations and Patient Support Assistant Chief Nurses; one for training and research
Division. The Finance Division handles the financial matters of and the other for patient care services.
the hospital. • Supervising Nurses are in charge of two or more
nursing units.
• The Head Nurse or Senior Nurse is responsible for
the management of a nursing unit.
• The Staff Nurses provide direct patient care and are
assisted by nursing attendants who perform simple,
routine tasks for which they have been trained.
Figure 2 shows an organizational structure of a nursing division
delineating the hierarchy of positions from the Chief Nurse down
to the Nursing attendant. The staff nurses, midwives, nursing
attendants and institutional workers are under the supervision of
the Senior or head Nurse.

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Figure 4. ORGANIZATIONAL CHART OF A NURSING

DIVISION WITH ASSISTANT CHIEF NURSES FOR NURSE
TRAINING AND RESEARCH AND FOR CLINICAL AREAS
Figure 2. ORGANIZATIONAL STRUCTURE OF A HOSPITAL’S
NURSING SERVICE/DIVISION FORMS OF ORGANIZATIONAL STRUCTURE

Figure 3 shows the organizational structure of a training hospital 1. TRADITIONAL HIERARCHICAL STRUCTURE (TALL,
with an affiliated college of nursing or school of midwifery. Solid CENTRALIZED, BUREAUCRATIC)
lines depict direct relationships while broken lines show • This is commonly called line structure. Authority and
coordinated relationships. responsibility are clearly defined leading to simplicity of
relationships. This is associated with the principles of
command, vertical control and coordination levels, and
downward communications.
MERITS OF LINE ORGANIZATION
1. Simplest
2. Unity of Command
3. Better discipline
4. Fixed responsibility
5. Flexibility
6. Prompt decision
Figure 5 shows a traditional hierarchical structure. The Chief
Nurse is directly responsible to the Chief of Hospital. Under her
are Supervising Nurses who are responsible for the Supervision
of two or more nursing units. The Senior or Head Nurse is in
Figure 3. AN ORGANIZATIONAL STRUCTURE SHOWING charge of a nursing unit. The Staff nurses and the Nursing
THE RELATIONSHIP OF THE NURSING SERVICE/DIVISION Attendants report directly to the Senior or Head Nurse.
WITH THE COLLEGE OF NURSING
Figure 4 is a typical nursing organizational chart of a training
hospital. The Chief Nurse is directly responsible to the Chief of
Hospital. She is assisted by an Assistant Chief Nurse. Under
them are Supervising Nurses for the clinical areas, for the
special areas, and for training and research. The Supervising
Nurses are in charge of two or more nursing units while the
Senior Head Nurse is in charge of one nursing unit. Under her
are the staff nurses and nursing attendants.

Figure 5. ORGANIZATIONAL CHART OF A NURSING

SERVICE SHOWING SEVERAL LAYERS OF POSITIONS
BETWEEN CHIEF NURSE AND NURSING STAFF.
The organizational chart in Figure 6 shows a different title for the
Chief of Nursing Services. Likewise, Nursing Supervisors are
given the title Patient Care Coordinators.

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Figure 7. ORGANIZATIONAL STRUCTURE IN PRIMARY

Figure 6. ORGANIZATIONAL CHART USING THE TITLES OF NURSING
PATIENT CARE ADMINISTRATOR AND COORDINATOR
The legal basis to consider in operating devolved hospitals is
2. DECENTRALIZED (FLAT, HORIZONTAL, the Local Government Code (LGC) of 1991. Local government
PARTICIPATORY) units are given full autonomy in the exercise of their proprietary
functions and in their economic enterprises subject to limitations
• The authority is shifted downwards to its divisions, provided in the code and other applicable laws.
services, and units. The decision making can occur
where the work is being carried out, thereby Section 18 of the Department of Health Rules and Regulations
professionals who do the job can participate in Implementing the Local Government Code of 1991 (the “DOH
managing the organization. Rules”) gives authority to Local Government Units regarding the
management and operation, among others, of provincial,
3. MATRIX district, municipal, and city hospitals. Funding shall come from
• This is designed to focus on both the product and the share of the province or city in the national taxes and other
function. The manager of the unit responsible for a national funds and funding support from the national
service reports both to a functional and product government, its instrumentalities and government-owned or
manager. controlled corporations which are tasked by law to establish and
maintain health services and facilities.

4. HYBRID Figure 8. ORGANIZATIONAL STRUCTURE FOR DEVOLVED

• A term applied to organizational structure that operate HOSPITALS AND RURAL HEALTH UNITS
with characteristics of different types of structures. TERMINOLOGIES

• Accountability means taking full responsibility for the

quality of work and behavior while engaged in the
presence of the profession.
• Authority is the right to act or make decisions without
approval of higher administrators. It includes the right
to extract obedience from subordinates. In government
hospitals, flow of authority is from the Chief of Hospital
down to the Heads of the various Divisions such as the
Administrative Officer, the Chief of the Nursing
ORGANIZATIONAL STRUCTURE FOR DEVOLVED
Division, and the Chief of Clinics.
HOSPITAL
• Change agent a person skilled in in the theory and
Figure 7 shows a decentralized clinical structure. Authority, implementation of planned chnaged to deal
responsibility, and accountability are vested on primary care appropriately with these real human emotions and to
nurses who report directly to the nursing administrator. connect and balance all aspects of the organization
that will be affected by that change.
• Communication is the transmission of information
between persons.

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• Power is the ability to influence another to behave in • Creating safe staffing practices for equitable nurse-
accordance with one’s wishes. patient assignments on a regular basis continues to a
• Relationships within Nursing Services can be challenging role for nurse leaders.
depicted through the organizational chart. • Because staffing patterns and scheduling policies
o Line relationship those that exists between directly affect the daily lives of all personnel, they must
the superior and subordinated immediately be administered fairly as well as economical, Marquis
and directly responsible to him/her. Ex: Chief and Huston, (2017).
Nurse to Supervising Nurse, Head Nurse to • Staffing is the process of hiring eligible candidates in
all nursing staff. the organization or company for specific positions. In
o Lateral relationship those that exists management, the meaning of staffing is an operation
between position in various divisions and of recruiting the employees by evaluating their skills,
sections of an undertaking where no direct knowledge and then offering them specific job roles
authority is involve. Ex: Senior Nurse and accordingly.
Physician, Staff Nurse and Clinical • Staffing is the traditional management function of
Pharmacist. attraction and selection of the best people and putting
o Functional relationship those that arise them on job where their talents and skills can be best
when duties are divided on a functional basis utilized, and retention of these people through
like when an individual exercises authority on incentives, job training and job enrichment programs,
a particular subject by special skill or in order to achieve both individual and organizational
knowledge. Ex: Chief Nurse with objectives.
Administrative Officer, Staff Nurse with • Nurse Staffing is the process of determining and
Clinical Nurse Instructor. providing the acceptable number and mix of the
o Staff personnel provides advice, counsel, or personnel to produce a desired level of care to meet
technical support that may be accepted, the patient’s demand. It purpose is to provide each unit
altered, or rejected by the line officer. with an appropriate and acceptable number of workers
• Responsibility is the obligation to perform the in each category to perform the nursing task required
assigned tasks. (Professional Nursing in The Philippines 11th edition
• Status is the rank a group bestows on a person in by Lydia M. Venzon & Ronald M. Venzon).
accord with the group’s estimation of the person’s
value and significance to group goals. The status of the FACTORS AFFECTING STAFFING
Nursing Director or Chief Nurse is equal to that of the 1. Patient Factors
Administrative Officer and Chief of Clinics.
• SWOT • Census fluctuations
o Strength are those internal attributes that • Patient acuity
help and organization to achieve its • Level of care/degree of dependence
objectives. • Patient age group
o Weakness are those internal attributes that • Special treatment and procedure
challenge an organization in achieving its • Communicability
objectives. • Rehabilitation
o Opportunities are external conditions that • Patient and family care demands/expectations
promote achievement of organizational
objectives. 2. Staff Factors
o Threat are external conditions that challenge
• Number of nursing staff available
or threaten the achievement of organizational
• Ratio of professional to non-professional
objectives
• Number of leaves
• Organization is a group of people working together in
• Turn-over rate
achieving the organizational goal
• Span of supervision
STAFFING
3. Nursing service factors
• It is the responsibility of the manager for the adequate
and well communicate staffing and scheduling policies • Nursing care modality in use
stressed. • Type of services/patient classification system
• The manager must focus on her leadership • Patterns of work schedule
responsibility for developing trust through fair staffing • Training and staff development programs
and scheduling procedures. • Research activities
• Managers should do what they can to see that 4. Health care organization factors
employees feel they have some control over
scheduling, shift options, and staffing policies. • Type of hospital
• Services offered/population served
• Work time policy

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• Administrative policy on weekend and holiday duty • Semi- conscious and exhibiting some psychosocial on
• Presence of support services social problems: periodic treatments
• Nursing unit architectural design • And/or observation and/or instructions
• Availability of resources like equipment, materials and • Average nursing care hours per patient per day is 3
supplies and the 60:40. Professional to non-professional
• Technology anticipated
LEVEL III- TOTAL COMPLETE OR INTENSIVE CARE
• Projected units of services
• Budget limitations • Completely dependent upon the nursing personnel
• Provided complete bath, are fed
PATIENT CARE CLASSIFICATION SYSTEM
• May or may not be unconscious, with marked
• Is primary developed to determine workloads emotional needs
requirements and staffing needs. • With vital signs more than three times per shift
• It is categorizing patients on the basis of certain needs • May be on continuous oxygen therapy
that can be clinically observe by the nurse. • With chest or abdominal tubes
• It is a method of grouping patients according to the • Require close observation at least every 30 minutes for
amount and complexity of their nursing care impending hemorrhage
requirements and nursing time and skill they require. • With hypo or hypertension and/or cardiac arrhythmia
• The assessment can serve in determining the amount • Average NCH is 6/day
of nursing care required within 24hours also the • 65:35 professional to non-professional
category of nursing personnel who should provide that
care. LEVEL IV- HIGHLY SPECIALIZED CRITICAL CARE

TABLE 1: Nursing care hours per patient per day according to • Highly specialized critical cre
classification of patients by units • Need maximum nursing care with a ratio of 80
professionals to 20 non-professionals
• Need continuous treatment and observation:
o With many medications, iv piggy backs: vital
signs every 15-30 minutes: hourly output
• Significant changes in doctor’s orders and
• Average NCH 6-9 or more
• 70:30 to 80:20 professionals to non-professionals
Various nursing units may develop their own ways of classifying
care according to the acuity of their patient illness TABLE 1 Categories or levels of care of patients, nursing care
hours needed for patient per day and ratio of professionals to
CLASSIFICATION CATEGORIES non-professionals
LEVEL 1-SELF-CARE OR MINIMAL CARE

• Patients that can do self-care or minimal care

• Take a bath on his own
• Feed himself
• Feed and perform his activities of daily living
• Patients about to be discharged
• Non-emergency
• Newly admitted
• Requires little treatment
• Do not exhibit unusual symptoms and requires little
treatment/observation and/or instruction. PERCENTAGE OF NURSING CARE HOURS
• Average 1.5 NCH/ Day
• Percentage of nursing care hours to be given by
• 55:45 professional to non-professional nursing
professional nurses and by non-professional nursing
personnel
personnel may defend on the patient’s condition in
LEVEL II- MODERATE CARE OR INTERMEDIATE CARE hospital
• Setting in which the care is being given. Table 2 shows
• Need some assistance in bathing, feeding or the Classification of Patients by Levels of Care
ambulating for short periods of time. according to Type of Hospital with Percentage of
• Extreme symptoms of their illness must have subsided Patients at Various Levels of Care
or have not yet appeared.
• Requires periodic assessment and treatment Total 2. Number of working and non-working days and hours of
• Have slight emotional needs nursing personnel per year
• With vital signs ordered up to three times per shift
• Intravenous fluids of blood transfusion
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1. Categorize the number of the patients according to the
levels of care needed. Multiply the total number of
patients according to the level of percentage of patients
at each level of care. (whether minimal, intermediate,
intensive or highly specialized)
Table 3. Classification of Patients by Levels of Care according
to Type of Hospital with Percentage of Patients at Various
Levels of Care

RELIEVERS NEEDED
Compute for relievers needed, the following should be
considered:
1. Average number of leaves taken each year ------------------- 15
2. Find the total number of Nursing care hours needed by
a. Vacation leave-------------------------------------------------------- 10
the patients at each category level.
b. Sick leave ---------------------------------------------------------------- 5 a. Find the number of patients at each level by
the average number of nursing care hours
2. Holidays ---------------------------------------------------------------- 12 needed per day
3. Special Privileges as per CSC MC#6 s. 1996 ------------------ 3 b. Get the sum of the nursing care hours needed
at the various levels.
4. Continuing Education Program for Professionals -------------- 3
Table 4. Categories or levels of care of patients, nursing care
Personnel entitles for an average of 33 days leave per year. hours needed per patients per day and ratio of professionals to
non-professionals.
• To determine the relievers needed, divide 33 (the
average number of days an employee is absent per
year) by the number of working days per year that each
employee serves (whether 213 or 265).
• This will be 0.15 per person who works 40 hours per
week and 0.12 per person for those working 48 hours
per week.
• Multiply the computed reliever per person by the
computed number of nursing personnel. This will give
the total number of relievers needed.
4. Find the actual number of nursing care hours needed
DISTRIBUTION BY SHIFTS by the given number of patients. Multiply the total
nursing care hours needed per day by the total number
• Morning shift (6-2) needs 45 to 51 percent: of days in a year.
• Afternoon shift (2-10) 34 to 37 percent: and 5. Find the actual number of working hours rendered by
• Night shift (10-6) 15 to 18 percent. each nursing personnel per year. Multiply the number
• In the Philippines the distribution usually followed is 45 of hours on duty per day by the actual working days per
percent for the morning shift, 37 percent for the year.
afternoon shift, and 18 percent for the night shifts. 6. Find the total number of nursing personnel needed.
• Staffing Computation, the hospital should ensure that a. Divide the total number of nursing care
there is sufficient staff to cover all shift, off-duties, needed per year by the actual number of
holidays, leaves, absences, and time for staff working hours rendered by an employee per
development programs. year.
• The Forty-Hour week Law (Republic Act 5901), b. Find the number of relievers. Multiply the
provides that employees working in hospitals with 100 number of nursing personnel needed by 0.15
bed capacity and up will work only 40 hours a week. (for those working 48hours per week)
o Hospital employees working in = or > 100 bed c. Add the number of relievers to the number of
capacity will work 40 hrs/week nursing personnel needed.
o If it is < 100 bed capacity 48hrs/week 7. Categorize the nursing personnel into professionals
and non-professionals. Multiply the number of nursing
STAFFING FORMULA personnel according to the ratio of professionals to
To compute for the staff needed in the In-Patient unit of the non-professionals.
hospital the following steps are considered: 8. Distribute by shift.

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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
Example: SCHEDULING
Find the number of nursing personnel needed for 250 patients • A schedule is a timetable showing planned work days
in a tertiary hospital. and shifts for nursing personnel.
• The objective in scheduling is to assign working days
1. Categorize the patients according to level of care needed.
and days-off to the nursing personnel so that adequate
250patients x .30 = 75 patients needing minimal care patient care is assured.
• A desirable distribution of off-duty days can be
250 patients x .45 = 112.5 patients needing moderate care
achieved and the individual members of the nursing
250 patients x .15 = 37.5 patients needing intensive care team will feel that they are treated fairly. They will also
know their schedule in advance, Venzon, (2016).
250 patients x .01 = 25 patients needing highly specialized care
FACTORS CONSIDERED IN MAKING SCHEDULES
TOTAL: 250
Different levels of the nursing staff: adequate coverage for 24
2. Find the number of nursing care hours (NCH) needed by hours, seven days a week:
patients at each level of care per day.
• Staggered vacations and holidays: weekends:
75 patients x 1.5 (NCH needed at level I) = 112.5 NCH/day • Long stretches of consecutive working days: evening
112.5 patients x 3 (NCH needed at level II) = 337.5 NCH/day and night shifts: and floating.
• An adequate mix of nurses and nursing attendants
37.5 patients x 4.5 (NCH needed at level III) = 168.75 NCH/day • Education, training and experiences.
25 patients x 6 (NCH needed at level IV) = 150 NCH/day • Afternoon and night shift requirements for the staff are
_______________ usually lower than in the morning shift.
Total 768.75 NCH/day. • Lower staff requirements on saturdays and sundays
3. Find the total NCH needed by 250 patients per year. since there are lesser medical rounds, fewer medical
orders and lower patient census.
768.5 x 365 (days/year) = 280,593.75 NCH/day • Schedules for holidays are staggered at least once a
4. Find the actual working hours rendered by each nursing month. Vacations, whether forced or requested
personnel per year. • Long stretched of consecutive working days
• Busy units may require additional help.
8 (hrs/day) x 213 (working days/year) = 1,704 (working • Unscheduled absences may require a staff to be pulled
hours/year) out from her regular area
5. Find the total number of nursing personnel needed. • Job dissatisfaction and high turnovers rates.

a. Total NCH/year = 280,593.75 ASSESSING A SCHEDULING SYSTEM

________________ _________ = 165 Scheduling may vary from agency to agency, but the scheduling
Working hrs/year 1,704 system must function smoothly in terms of:
b. Relief x Total Nsg Personnel = 165 x 0.15 = 25 1. Ability to cover the needs of the unit a minimum
c. Total Nursing Personnel needed 165 + 25 = 190 required number of staff must meet the nursing needs
of the patients in the units at all shifts:
6. Categorize to professionals and non-professional 2. Quality to enhance the nursing personnel’s
personnel Ratio of professionals to non-professionals in a knowledge, training and experience While
tertiary hospital is 65:35 permanent assignment to one unit enhances skills in
caring for a particular kind of patient (whether
190 x .65 = 124 professional nurses
obstetrical, medical, surgical or pediatrics), many
190 x .35 = 66 nursing attendants nurses who have future plans of going into teaching, or
specialization or even working abroad, would prefer to
7. Distribute by shifts. experience being assigned to various units before
124 nurses x .45 = 56 nurses on AM shift settling down to a particular unit of their choice:
3. Fairness to the staff All nursing personnel should get
124 nurses x .37 = 46 nurses on PM shift a fair share of weekends, holidays offs, rotation
124 nurses x .18 = 22 nurses on night shift patterns for the whole year including assignment to
“difficult” or “light” or “undesirable” units or shifts:
Total 124 nurses 4. Stability The nursing personnel would like to know in
advance their schedule of assignment so that their
66 Nsg attendants x .45 = 30 Nursing attendants on AM Shift
personal schedules (whether at home, social and civic
66 Nsg attendants x .37 = 24 Nursing attendants on PM Shift responsibilities are in harmony with each other: and
5. Flexibility the ability to handle changes brought about
66 Nsg attendants x .18 = 12 Nursing attendants on night shift by emergency leaves, scheduled or unscheduled
Total 66 Nursing attendants leaves of absences.
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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
TYPES OF SCHEDULING DIRECTING
1. Centralized Schedule One person, usually the Chief • Directing is the issuance of orders, assignments, and
Nurse or her designate, assigned the nursing instructions that enable the nursing personnel to
personnel to the various nits of the hospital. This understand what are expected of them.
includes the shifts on duty and off-duty. • It includes supervision and guidance so that in doing
2. Decentralized Schedule shift and off-duties are their jobs well, nurses can maximally contribute to the
arranged by the Supervising Nurse or Head or Senior organization’s goals in general and to the objectives of
Nurse of the particular unit. nursing service in particular, Venzon, (2016).
3. Cyclical Schedule covers a designated number of
weeks called the cycle length and is repeated thereon. IMPORTANCE OF DIRECTING
It assigns the required number of nursing personnel to • Establish direction in carrying out desired action
each nursing unit consistent with the unit’s patient care • Influence nursing personnel to follow the direction
requirements, the staff’s preference, their education,
• Initiate actions
training and experience.
• Integrate efforts
The following scheduling variables should be
• Become a means of motivation
considered:
a. Length of scheduling period whether 2 or 4 • Provide stability
weeks • Enable employee to cope with the changes
b. Shift rotation • Help in efficient utilization of resources
c. Week-ends off PURPOSE OF DIRECTING
d. Holidays offs
e. Vacation leave • Obtain the optimum return from all staff in the interest
f. Special days (birthdays, wedding of the institution
anniversary, etc) • Bring personal and professional growth of employees
g. Scheduled events in the hospital, training • Bridge the gap of directing
programs, or meetings • Create a direct link between the nurse managers and
h. Job categories the nursing personnel through effective communication
i. Tardiness • Maintain standards of services cooperatively to
j. Continuing professional education (cpe) develop coordination to avoid overlapping
programs • Assist in the problem solving of the matters concerning
ADVANTAGES OF CYCLICAL SCHEDULE personnel
• Assess continuously the services given personnel
• It is fair to all. Favoritism is minimized as all nursing performance
personnel get their fair share of rotation to the various
shifts. PRINCIPLES OF DIRECTING
• It saves time as the schedule does not have to be Harmony of objectives
redone every week or two.
• It enables the employees to plan ahead for their • Employees work well when they feel that their
personal needs preventing frequent changes in physiological and psychological needs are met.
schedule. Unity of command
• Scheduled leave coverage such as vacation, holidays
and sick leaves are more stable. • Dual subordination brings disorder and chaos,
• Productivity is improved. undermines authority and leads to instability.

Example of Schedule Appropriate direction techniques

• Motivation techniques such as pay, incentives, awards,

status, promotion, etc., can increase job satisfaction,
productivity and quality/excellence of work.
Use of informal organization

• Special attention should be given to the informal

organization to strengthen the formal organization.
Managerial communication

• Direct and personal contact or feedback makes

supervision effective and motivating.
Appropriate leadership style

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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
• Nurse managers to influence their subordinates must PURPOSES OF DELEGATION
provide good leadership.
• Provide appropriate distribution of tasks for safe and
Follow through follow up quality nursing care
• Promote individual responsibility and accountability
• Nurse managers must monitor as to what extent the
• Allow the nurse to perform more complex patient care
policies framed and issued directions have been
and other related services
enforced.
• Reduce workload to prevent burn out
CHARACTERISTICS OF DIRECTING • Enhance the knowledge and skills of nursing personnel
and other health care workers
• Initiates action • Promote cost containment and effectiveness for the
o Giving directions and instructions the nurse health care facility.
managers get the work started in the
organization PRINCIPLES OF DELEGATION
• Continuous process
• Select the right person to whom the job is to be
o Nurse managers continuously takes steps to
delegated.
ensure that orders and instructions are
carried out properly. • Delegate both interesting and uninteresting tasks.
• Takes place at every level • Provide subordinate with enough time to learn.
o Directing is a pervasive function of all • Delegate gradually.
manager at all levels in all units perform it. • Delegate in advance.
• Flows from top to bottom • Consult before delegating.
o Nurse managers direct their immediate • Avoid gaps and overlaps.
subordinates and take directions from their ELEMENTS OF DELEGATION
immediate superiors.
• Performance-oriented • Responsibility
o Directing function helps converting plans to • Authority
performance. • Accountability
• Human level
o Human behavior is complex and 5 RIGHTS OF DELEGATION
unpredictable direction function involves • Right task
studying workers behavior and motivating • Right circumstances
them to work their best ability. • Right person
ELEMENTS OF DIRECTING • Right direction and communication
• Right supervision and evaluation
• Delegation
• Supervision STEPS IN DELEGATION
• Communication • Prepare
• Problem solving and Decision making • Assign
• Motivation • Confirm understanding and commitment
DELEGATION • Monitor accomplishment against the assigned tasks
• Ensure accountability
• Delegating is the process by which a manager assigns
specific tasks/duties to workers with commensurate POINTERS TO PROPER DELEGATION OF WORK
authority to perform the job. The worker in return
• Provide clear and specific instructions
assumes responsibility for its satisfactory performance
• Give authority commensurate to responsibility
and is held accountable form its results.
• Keep subordinates informed
• Paramount importance in delegation are the worker’s
• Show you have confidence in your subordinates
job description, his/her knowledge base, his/her ability
to carry put the task, and fairness not only to the • Be loyal
employee but to the team as a whole. WAYS FOR NURSE MANGERS TO DELEGATE
IMPORTANCE OF DELEGATION SUCCESSFULLY:

• Give subordinates a feeling of importance and motivate • Train and develop subordinates
them for appropriate results • Plan ahead, it prevents problems
• Develop the talents and skills of the subordinates, • Control and coordinate the work of subordinate
which can be used for succession planning. • Visit subordinates periodically
• Coordinate to prevent duplication of effort
• Specify goals and objectives
• Solves problems

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 NCMB 419: LEADERSHIP AND MANAGEMENT
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• Know subordinates’ capabilities and match the task or • Ability to communicate well in both spoken and written
duty to the employees. language and ability tom listen
• Agree on performance standards • Firmness with flexibility to adjust to the needs of the
• Take an interest situation
• Do not take back delegated task • Fairness in dealing with employees
• Familiarity with hospital and nursing policies that affect
WHAT CANNOT BE DELEGATED
patient care
There are matters that cannot be delegated. Among these are: • Good decision-making skills
• Willingness to grow and develop
• Overall responsibility, authority, and accountability for • Ability to accept changes and consider them as
satisfactory completion of all activities in the unit. challenges
• Authority to assign one’s name is never delegated. • Dignified and pleasing personality
• Evaluating the staff and/ or taking necessary corrective • Ability to motivate employees and provide
or disciplinary action. opportunities for continuing professional growth and
• Responsibility for maintaining morale of the opportunity development
to say a few words of encouragement to the staff • Advocacy for nurses and nursing.
especially the new ones.
• Jobs that are too technical and those that involve trust PRINCIPLES OF GOOD SUPERVISION
and confidence.
• Good supervision requires adequate planning and
WHY NURSE MANAGERS DO NOT DELEGATE organization which facilitate cooperation, coordination,
and synchronization of services.
There are some reasons why nurse managers fail to delegate.
• Good supervision gives autonomy to workers
• Lack of confidence in their staff, feeling that only they depending on their competency, personality, and
could do the task better and faster, or fear of loss of commitment.
control if some of their duties are delegated. • Good supervision stimulates the worker’s ambition to
Subordinates may be apprehensive in accepting grow into effectiveness. Good supervision creates an
delegated task for fear of criticism, ineptitude, or atmosphere of cordiality and trust.
incompetence. • Good supervision considers the strengths and
• Insecurities may be avoided if there is open weaknesses of employees.
communication among the staff. • Good supervision strives to make the unit an effective
• Warm and cordial relationships where everyone is free learning situation.
to ask questions or seek clarifications regarding of • Good supervision considers equal distribution of work
delegated task which to them may be too difficult to considering age, physical condition, and competence
understand.
TECHNIQUES IN SUPERVISION
SUPERVISION
• Observation of the worker while making the rounds
• The word “supervision” comes from the word • Spot checking of chats through nursing audits
“supervide” which means “to oversee or view directly.” • Asking the patients about the care they receive
• Supervision is providing guidelines for the • Looking into the general condition of the units
accomplishment of a task or activity with initial direction • Getting feedback from co-workers or other supervisors
and periodic inspection of the actual accomplishment or relatives
of the task or activity. • Asking question discretely to find out the problems they
• It appraises not only the quantity and quality of work encounter in the wards
performed, but also the time within which the work is • Drawing out suggestions from the workers for
accomplished, the proper and economic utilization of improvement of their work or work situation.
resources, the amount of assistance needed by the
worker, and the need for staff development or Given in a soft, courteous manner, these will be taken willingly
continuing education programs. and accepted as a challenge to improve performance. Give
• The nurse who delegates is responsible for the acts of harshly, especially in public, it builds up resentment, ill-will, and
the subordinate and may incur liability if found poor quality of work.
negligent in the process of delegating and supervising. PARTICIPATORY MANAGEMENT
This is under the doctrine of I respondeat superior
which mean “let the superior answer for the acts of the • Decentralization and participatory management have
subordinate.” changed to role of Supervision Nurses.
• They learn to delegate authority to Head Nurses, their
QUALITIES OF GOOD SUPERVISION responsibility for unit management decreases.
Good supervision requires • The climate of supervision changes.
• The nurses are given increasing.
• Good technical, managerial and human relation skills

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 NCMB 419: LEADERSHIP AND MANAGEMENT
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• The nurses are given increasing authority to manage • Vertical
themselves. Rather than direct the work force, the o Coordination that exists between
Supervising Nurse assumes the role of mentor, role departments where the department heads are
model and facilitator. asked to coordinate the work of the
• Some hospitals have changed the position of employees.
Supervising Nurse into Clinical Coordinator or Clinical
COORDINATION WITH HOSPITAL SERVICES
Managers.
• In participatory management there are mutual trust and • Coordination with Medical Professional Services
support There is increased accountability of the Head o Nurses should know the Medical Staff in their
Nurse and of employees through self-supervision. High respective units, and their services and
morale and team work result in increased effectiveness scheduled time of medical rounds.
and productivity and increased commitment and • Coordination with Administrative Service
recognized of contribution. Participation increases o Coordination with the Administrative services
individual and organizational capacities to learn, adapt, pertains to both human and material
and develop toward higher levels of excellence, resources.
Venson, (2016). • Coordination with Laboratory Service
• There are some disadvantages of participatory o Request for laboratory examinations are
management. Among these are difficulty in changing forwarded to the laboratory unit.
the perception of employees about the previous • Coordination with the Radiology Service
authoritarian management, occasional failure, and o Request for x-ray examination are also
difficulty in fixing responsibilities. Nurses can be more forwarded to the x-ray service for proper
actively involved in participatory management through scheduling and specific instructions.
job enrichment, involvement in critical decisions that • Coordination with the Pharmacy Service
affect them, and by providing liberal training and o Policies regarding the procurement of drugs
opening of career opportunities, Venzon, (2016). must be observed.
COORDINATION • Coordination with the Dietary Service
o Head is responsible for forwarding the diet list
• Coordination unites personnel and services toward a of the patients in the units.
common objective. Synchronization of activities among • Coordination with the Medical social Service
the various services and departments enhances o Nurses coordinate with the Medical Social
collaborative efforts resulting inefficient, smooth and Service by referring patients with psycho-
harmonious flow of work. social problems.
• Supervising Nurses and Head/ Senior services • Coordination with Medical Records Service
coordinate their work with other departments services o Nurses are responsible for the accurate
or units by conveying clearly define policies, standards documentation and completeness of the
operating procedures, policies, and guidelines using patient’s charts, including their safety and
the proper channels of communication. confidentiality.
IMPORTANCE OF COORDINATION • Coordination with Community Agencies, other
Institutions, and Civic Organization
• Ensure unity of direction o Networking or linkages with community
• Create stronger workforce agencies, civic organizations, or other
• Enhance employee morale and provides satisfaction institutions are often necessary for continuity
• Facilitates diverse and specialized activities of patient care.
• Promote effective patient care management for MOTIVATION
general interest
• Establish positive work environment • Motivation is influenced by complex set of social,
professional and economic factor. Human beings are
TYPES OF COORDINATION motivated by different goals, ambitions, and
• External aspirations. Health worker will be motivated and
• Coordination with the outside parties with express job satisfaction if they feel that they are
whom the organization has the business effective at their jobs and performing well.
connections like government supplies, • The amount and quality of work accomplished by the
customers, etc. manager directly reflect their motivation and that of
• Internal their subordinates. They teach and empower their
o Coordination among the employees of the workers and apply knowledge, skills and techniques of
same department or section. motivational theories to achieve individual goals.
• Horizontal IMPORTANCE OF MOTIVATION
o Coordination that takes place between
different departments. • Put human resources into action

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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
o It is through motivation that the human • Situation through time and space may show a deviation
resources can be utilized by making full use from a standard of performance. What should be done
of it. or avoided is not what is being done or prevented.
• Improves level of efficiency of employees • How to correct this deviation is the problem.
o For getting best of his work performance, the • Relevant data should be collected as to recognize the
gap between ability and willingness has to be real problem.
filled which helps in improving the level of
performance of subordinates. 2. Analysis of the Problem
▪ This result into: • Once problem has been identified, the
▪ Increase productivity Supervisor/Head Nurse proceeds to investigate,
▪ Reducing cost of operations and gather data, and analyze the cause and consequences
▪ Improving overall efficiency of the problem.
• Leads to achievement of organizational goals • Prejudices and biases should not affect the decision.
o The goals of an organization can be achieved • The manager should be open minded and flexible.
only when the following factors take place:
• Entire decision-making process should be objective to
▪ There is best possible utilization of
arrive at the best solution.
resources
• Problem analysis means getting to the cause of the
▪ There is a co-operative work
problem.
environment
▪ The employees are goal directed 3. Developing of Alternatives Solutions/ Evaluation of
and they act in a purpose manner Alternatives.
▪ Goals can be achieved if co-
ordination and co-operation takes • It focuses on the search for analysis of alternatives and
place simultaneously which can be their possible consequences.
effectively done through motivation. • Factors to considered in evaluating alternative
• Builds friendly relationship solutions are time, available resources, labor, cost of
o Motivation is an important factor which brings tools and equipment to be used, and the moral and
employees satisfaction legal implications.
▪ This could initiate the following 4. Selection of a Solution
things:
▪ Monetary and non-monetary • After facts have been weighed and alternative
incentives solutions have been explored, ranking of preferences
▪ Promotion opportunities for is important.
employees • The Supervising Nurse/Head Nurse chooses the best
▪ Disincentives for inefficient course to follow considering advice from others,
employees. experience, and most importantly, logical reasoning.
• Leads to stability of work force • The best solution that offers a better chance for
o This is very important from the point of view success is then chosen.
of reputation and goodwill of a concern, DOH • Decisions may mean a compromise or a combination
Manual, (2016). of two possible solutions.
PROBLEM SOLVING, DECISION MAKING IMPLEMENTATION AND EVALUATION OF RESULTS
• Decision making is one of the critical roles of a Include the following;
manager. Manager must be decisive; they make
decisions and are not afraid to take risks. Know when 1. Planning which entails consideration and selection of
it is time to make something, they do it, while others realistic objectives, policies, and procedures.
procrastinate and wait for someone else to make a 2. Organizing which means helping personnel
decision. understand the decision and the procedures necessary
for implementing the decision;
• Decision is a course of action that is consciously
3. Staffing or the selection of the right person/s to carry
chosen from available alternatives for the purpose of
out the decision;
achieving a desired result. It involves a choice utilizing
4. Controlling the environment and the group to prevent
mental processes at the conscious level and is aimed
adverse effects.
at facilitating a defined objective.
• And it is made at executive level and are more complex The art of decision making includes:
and affect a greater number of people.
• Not making decision that others should make, to
FIVE STEPS IN DECISION MAKING preserve morale and authority;
1. Definition of the problem • Not deciding on problems that are pertinent to matters
at hand to prevent waste of time and energy;
• Not deciding prematurely to prevent prejudice; and

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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
• Not making ineffective decisions to avoid losing the • Second stage perceived conflict or substantive
respectability of the decision maker. conflict is intellectualized and often involves issues
and roles.
CONFLICT MANAGEMENT
o The person recognizes it logically and
• In the 20th century, conflict was considered to be an impersonally as occurring.
indication of poor organizational management. And • Third stage felt conflict or affective conflict occurs
can be destructive and can be avoided at all cost. If when the conflict is emotionalized.
conflict occurs it can be ignored, denied or dealt with o Felt emotion includes hostility, fear, mistrust,
immediately and harshly. During this era people and anger. Possible to perceive conflict and
believed that conflict could be avoided if only not feel it.
employees were taught the one right way to do things • Fourth stage manifest conflict or overt conflict,
and dissatisfaction were expressed and met with action is taken.
disapproval, Marquis & Huston, (2017). o Action maybe withdraw, compete, debate, or
• Conflict generally defined as the internal or external seek conflict solution.
discord that results from differences in ideas, values, o Fear of retaliation
or feelings between two or more people. Because o Fear of ridicule
managers have the interpersonal relationships with o Fear of alienating others
subordinates having a variety of different values, o A sense that they do not have the right to
beliefs, backgrounds, and goals, conflict is an expected speak up
outcome, Marquis & Huston, (2017 o Pat negative experiences with conflict
• Conflict is neither good or bad, and it can produce situations.
growth or destruction, defending on how it is managed, • Final stage is aftermath there is always conflict
Marquis & Huston, (2017). aftermath positive or negative.
o If conflict is managed poorly, the conflict
SOURCES OF CONFLICT issues frequently remain and may return later
Human interaction to cause more conflict, Marquis and Huston,
(2017).
It arises from the following: o The aftermath of conflict may be more
significant than the original conflict if the
• Differences in knowledge
conflict has not been handled constructively.
• Skills, values, interest
• Scarcity of resources TYPES OF CONFLICT:
• Intergroup rivalry for rewards
1. INTERGROUP CONFLICT
• Role ambiguity
• Unworkable organization structure • Occurs between two or more groups of people,
• Shift in organizational power base and organizational departments, and organization.
climate and • May caused by differences in opinion of the nursing
• Unacceptable leadership styles staff of the unit and that of the clinical Instructors in
preparing for the RLE of nursing students
FACTORS THAT PROVOKE CONFLICT
Example:
• Failure to provide assistance or complete information
on patient care • Staff nurses may claim that the nursing students do not
• Varying perceptions of work situations can be caused meet their role
different work responsibilities • Expectations while the CI claim that the staff nurses
• Unstable staffing and work schedules are not good role models themselves.
• Highly differentiated work positions or role change • Two political affiliations with widely differing or
• Disagreement over policies and procedures contradictory beliefs of nurses experiencing intergroup
• Competition for scarce resources conflict with family and work issues, Marquis & Huston,
(2017)
CONFLICT PROCESS
2. INTRAPERSONAL CONFLICT
• First stage latent conflict, implies the existence of
antecedent conditions such as short staffing and rapid • Occurs within the person, it involves an internal
change struggle to clarify contradictory values or wants.
o Could be prevented or reduced if managers • For managers, intrapersonal conflict may result from
examined the organization more closely for the multiple areas of responsibility associated with the
antecedent conditions. management role.
o Example: change and budget cuts almost • When head Nurse is told not to schedule overtime for
create conflict. nurses but feels that shortage of nursing personnel
greatly affects the quality of nursing care resulting to
job dissatisfaction of the clients.
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 NCMB 419: LEADERSHIP AND MANAGEMENT
MIDTERM REVIEWER | K. AGLOCO
Example: • A manger recognizes which conflict
management/resolution strategy is appropriate for
• Between the Nursing Director and the Finance Director
each situation.
who do not agree on the resources (both human and
material) needed by the Nursing Service due to cost In choosing the most appropriate strategy defends on many
cutting measures. variables such as: Marquis & Huston, (2017)
3. INTRAGROUP CONFLICT • The situation itself
• The urgency of the decision
• Is manifested in feelings of unfairness over distribution
• The power and status of the players
of assignments, off duties and holidays among the
• The importance of the issue
staff.
• The maturity of the people involved in the conflict
Example:
1. AVOIDANCE
• If individuals and/or groups cannot meet the
expectations exacted on them, they become • The parties involved are aware of a conflict but choose
disenchanted. not to acknowledge it or attempt to resolve it.
• Commonly used by groups who do not want to do
4. INTERPERSONAL CONFLICT something that may interfere with their relationships.
Withdrawal behind walls of insulation relieves the
• Happens between two or more people with differing
necessity of dealing with situations that would arouse
values, goals, and beliefs.
conflict.
Example:
2. COMPROMISING
• Informational differences
• Each party gives up something it wants. Both parties
• Role incompatibility because of differences between
seek expedient, acceptable answers for short periods
goals and responsibilities assigned to an individual and when the goals are only moderately important and the
what the individual be doing.
parties have equivalent power.
5. COVERT CONFLICT • Not to result in a “lose-lose” situation, both parties must
be willing to give up something of equal value.
• Is more dangerous because it is not what it appears on • Becomes “win-win” situation when both parties
the surface. perceive they have won more than other person.
• It results in harbored feelings that drain both physical
and psychological energy. 3. COMPETING

ACCORDING TO RELATIONSHIP: • Is used when one party pursues what it wants at the
expense of the others.
6. VERTICAL CONFLICT • Only one party typically wins, the competing party
• Differences in opinions between superiors and seeks to win regardless of the cost to others.
subordinates are caused most often by inadequacy in • The supervisor or nurse manager exerts power at the
communication, opposing interests, and lack of shared subordinate’s expense.
perceptions and attitudes. • Expressed through suppression of conflict through
authority-obedience approach.
7. HORIZONTAL OR LINE AND STAFF CONFLICT • “Win-lose” conflict resolution strategies then typically
• It happens as a common struggle or strife between leave the loser angry, frustrated, and wanting to get
departments or services wherein the degree of even in the future.
interdependence and collaboration determines the 4. COOPERATING/ACCOMMODATING
success in achieving shared goals and objectives.
• Self-sacrifice
Example: • Cooperating is the opposite of competing. One party
• Lack of consensus between these departments and sacrifices his or her beliefs and allows the other party
the clash of personalities also affect teamwork, to win. The actual problem usually not solved in this
Venzon, (2016). win-lose situation.
• Accommodating is another term used for this strategy.
CONFLICT MANAGEMENT • The person neglects his/her own needs to meet the
goals of the other party.
• Management of conflict is one of the important roles of
a nurse’s manager’s job. There are some common • It is more powerful, or when the issue is ore important
conflict management strategies/ approaches to to someone else.
management conflict. • Employees who use accommodation as a primary
conflict management strategy often develop
resentment.

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5. SMOOTHING -Johann Wolfgang von Goethe-

• Is used to manage a conflict situation. It occurs when • Time management defined as making optimal use of
one party in a conflict attempts to pacify the other party available time.
or those focus on agreements rather differences. • Oftentimes managers complaint or keep telling they
• Managers often use smoothing to get someone to don’t have enough or lack of time in accomplishing
accommodate or cooperate with another party. such goals.
• Smoothing rarely results in resolution of the actual • They always argue that there is not enough time in the
conflict. day to do everything that must be done.
• This accomplished by complimenting one’s opponent, • The problem that this individual is time poor., rather
downplaying differences, and focusing on minor areas that problem is poorly using of time.
of agreement. • One of the strategies in managing the time is learn to
prioritize duties, managing and controlling crisis,
6. COLLABORATION
reducing stress and balancing work and personal time,
• Inspire mutual attention to the problem and utilizes the (Marquis and Houston,2017).
talents of all parties.
TIME MANAGEMENT PRINCIPLES
• It focuses on problem solving to find mutually satisfying
solution. There are several time management principles that can be used
• All parties set aside original goals and work together to plan effectively.
“win-win” solution, establish a subordinate or priority
a. Planning anticipates the problem that arise from
common goal.
actions without thought.
• This is the most effective method in conflict
b. Tasks to be accomplished should be done in sequence
management.
and should be prioritized according to importance.
• Collaboration enhances a person’s participation c. Setting deadlines in one’s work and adhering to them
indecision making to accomplish mutual goals. is an excellent exercise in self-discipline.
7. FORCING d. Deferring, postponing, or putting off decisions, actions,
or activities can become a habit which oftentimes
• Is a method that yields an immediate end to the conflict causes lost opportunities and productivity, generating
but leaves the cause of the conflict unresolved. personal or interpersonal crises.
e. Delegation permits a manager to take priority for
BASIC RULES ON MEDIATING A CONFLICT BETWEEN
decision making and to assign tasks to the lowest
TWO OR MORE OR PARTIES
possible consistent with his/her judgement, facts, and
• Establish clear guidelines and make them know to all. experience, (Venson, 2016).
• Do not postpone indefinitely. Select a time that is best
TIME-SAVING TECHNIQUES, DEVICES, AND METHODS
for all parties.
TO BETTER USE OF TIME.
• Create an environment that makes people comfortable
to make suggestions. 1. Conduct an inventory of your activities.
• Keep a two-way communication. Encourage full
Logging your activities for one day would show how
expression of positive and negative feelings with an
much time is usually spent on each activity.
accepting atmosphere.
• Stress a peaceful resolution rather than confrontation. 1. Set goals and objectives and write them down. Set
• Build a bridge of understanding. priorities. Plan on making things happen rather than
• Emphasize shared interests. reacting to crises.
• Examine solutions and select the most acceptable to 2. With the use of calendars, executive planners, logs or
both parties. journals, write what you expect to accomplish yearly,
• Follow up on the progress of the plan. monthly, weekly or daily.
3. Breakdown large projects into smaller parts.
Give feedback to participants regarding their cooperation in 4. Devote a few minutes at the beginning of each day.
resolving the conflict. 5. Organize your work space so its functional. Sort paper
In conflict management keeps conflict from escalating, makes work on your table according to priority.
work productive, and helps translate conflict into a positive or 6. Close your door when you need to concentrate. Agree
constructive force. on a period of quiet office time.
7. Learn to delegate.
TIME MANAGEMENT 8. In a meeting, define the purpose clearly before starting.
Distribute the agenda in advance and control
…nothing is particularly hard if you divide it into small jobs.
interruptions during the meeting.
-Henry Ford- 9. Take or return phone calls during specified time.
Maintain a telephone log so you can return calls at a
…things which matter most must never be at the mercy of things time.
that matter least.

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10. Develop effective decision-making skills. Do no afraid • Evaluating conference should be scheduled and
to say “no”. conducted at a convenient time for rater and the
11. Take a rest breaks and make good use of your spare employee under convenient time for rater and the
time. Reward yourself periodically, (Venson, 2016) employee under evaluation, in pleasant surroundings,
and with ample time for discussion.
THREE STEPS TO TIME MANAGEMENT
• Evaluation report and conference should be perceived
a. Allow time to planning and establish priorities. and accepted as a means of improving job
b. Complete the highest task whenever possible and performance.
finish one task before beginning another.
CHARACTERISTICS OF AN EVALUATION TOOL
c. Reprioritize based on the remaining tasks and on new
information that may have been received. Evaluation tool should be:
CONTROLLING • Objective
o Objectivity means that the evaluation tool is
• Controlling or evaluating is an ongoing function of
free form bias
management which occurs during planning,
• Reliable
organizing, and directing activities. It includes
o Reliability refers to the accuracy or precision
assessing and regulating performance in accordance
of the toll such that it will produce the same
with the plans adopted, the instructions issued, and the
results if administered twice.
principles established.
• Valid
• The controlling process opens opportunities for
o Validity refers to the relevance of the
improvement and compares performance against set
measurement to the performance of the
standards. It provides information about how well
employee.
processes and people function so they can be
motivated to perform better in the future. • Sensitivity
o That the instrument can measure fine lines of
• The means of good performance and management
differences among the criteria being
includes leadership and commitment, full employee
measured.
involvement, good planning, sound strategy
implementation, measurement and evaluation, control BASIC COMPONENTS OF THE CONTROL PROCESS
and improvement, and achievement and sustenance of
standards of excellence, Venzon, (2016). The control process may be divided into five basic components;

REASONS FOR CONDUCTING EVALUATION • Established of standards, objectives, and methods for
measuring performance;
Evaluation plays an important role in quality and productivity • Measurement of actual performance;
improvement for several reasons. • Comparison of results performance using standards
• It ensures that quality nursing care is provided. and objectives and identifying strengths and areas for
• It allows for the setting of sensible objectives and correction and/or improvement;
ensures compliance with them. • Action to reinforce strengths or successes; and
• It provides standards for establishing comparisons. o Implementation of corrective action as
necessary.
• It promotes visibility and means for employees to
monitor their own performance. ESTABLISHED OF STANDARDS FOR MEASURING
• If highlights problems related to quality care and PERFORMANCE
determines the areas that require priority attention.
• It provides an indication of the costs of poor quality Standards are desirable sets conditions and performance
necessary to ensure the quality of nursing care services which
• It justifies the use of resources.
are acceptable to those instrumental to or responsible for setting
• It provides feedback for improvement.
and maintaining them.
EVALUATION PRINCIPLES
There are three types of performance standards: structure,
In order that employees may be evaluated accurately and fairly, process and outcomes.
certain principle must be observed.
1. Standards on structure are those that focus on the
• Evaluation must be based on the behavioral standards structure or management system used by the agency
of performance which the position requires. to deliver care.
• Evaluating performance, there should be enough time 2. Process standards refer to decision and actions of the
to observe employee’s behavior. nurse relative to the nursing process which are
• Employees should be given a copy of the job necessary to provide good nursing care.
description, performance standards, and evaluation 3. Outcome standards are designated to measure the
form before the scheduled evaluation conference. results of care provided in terms of changes in the
Areas needing improvement must be prioritized to help health status of clients served; changes in the level of
the worker upgrade his/her performance. their knowledge, skills, and attitudes; and satisfaction

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of those served including the members of the nursing 5. Determine training and developmental needs of
and health team, Venzon, (2016). employees
6. Improve the performance of work groups by examining
MEASURING ACTUAL PERFORMANCE
improving, and correcting interrelationship between
• Measurement of performance is an on-going, repetitive members
process with the actual frequency on the type of activity 7. Improve communication between supervisors and
being measured. employees and reach an understanding on the
• For example, nursing care to patients is continuously employees and reach am understanding on the
monitored, whereas, a formal performance appraisal objectives of the job
may be done only twice a year. 8. Establish standards or supervisory performance
• Measurements may be scheduled in advance, may be 9. Discover the aspirations of employees and reconcile
done periodically but unannounced intervals, or may these with the goals of the institutions
occur at random. The purpose of measurement should 10. Provide “employee recognition “for accomplishments
be clarified about the task and levels of are that need 11. Inform employees “where they stand.”
attention. FACTORS CONTRIBUTING TO AN EFFECTIVE
COMPARING RESULTS OF PERFORMANCE WITH PERFORMANCE APPRAISAL SYSTEM
STANDARDS AND OBJECTIVES The controlling process is used to promote positive and
• Comparing the results of performance with standards favorable activity. Recognizing the common purposes for which
and objectives is one of the easiest steps in the control the performance evaluation system has been created, nurse
process. managers have the responsibility to maintain a favorable climate
that will lead to job satisfaction.
• Its performance matched standards and objectives,
managers are assured that the needs of patients are Some factors contributing to a successful performance
met. However, if performance is contrary to standards appraisal system are the following:
and objectives set, then necessary action should be
taken. 1. Compatibility between criteria for individual
evaluation and organization goals.
REINFORCING STRENGTHS OR SUCCESSES AND a. The elements of the performance evaluation
TAKING CORRECTIVE ACTION AS NECESSARY system should be agreed upon at each level
of management, involvement of personnel at
• Positive feedback stimulates motivation consistent
all aspects of the evaluation process
high performance, and growth of the employee.
increases belief in its fairness and accuracy,
Corrective actions are applied to improve performance.
establishes a commitment to the evaluation,
RESPONSIBILITY OF THE HEAD / SENIOR NURSES and increase motivation to utilize the results
for improvement.
• Being at the first level of supervision, the Head or 2. Direct application of the rated performance to
Senior Nurses know best whether their staff nurses performance standards and objectives expected of
perform satisfactorily at work. Their influence has an the worker.
impact on promoting quality care to patients. a. Predetermined toles for each member of the
• They have the responsibility to instruct subordinates health team and the set goals in terms of
regarding the appropriate methods and procedures in behavioral objectives and success criteria
providing nursing care. (e.g. job description and procedure manual)
• The feeling of responsibility to render quality should be established.
performance must be instilled in all employees for them 3. Development of behavioral expectations which
to follow agreed upon written procedures and use have been mutually agreed upon by both the rater and
materials and equipment correctly as instructed. the worker.
a. Participation in the formulation of goals
PERFORMANCE APPRAISAL
motivates workers to work towards their
• Performance appraisal is a control process by which accomplishment.
employee’s performance is evaluated against 4. Understanding the process and effective utilization
standards. It is the most valuable tool in controlling of procedures by the rater. Training in the appraisal
human resources, Venson, (2016). process should be provided by the employer through
in-service education.
IMPORTANCE OF PERFORMANCE APPRAISAL 5. Rating of each individual by the immediate
1. Determine salary standards and merit increases supervisor.
2. Select qualified individuals for promotion or transfer a. Appraisal is more accurate when data are
3. Identify unsatisfactory employees for demotion or familiar with the actual performance of the
determination worker.
4. Make inventories of talents within the institution 6. Concentration of the strength and weaknesses to
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strengths in performance encourages the worker to respect to certain aspects of performance or
further improve. qualification.
7. Encouragement feedback from the rated • For example, Nurse A may rank lowest in educational
employees about their performance needs and requirements for the next higher position among five
interests. candidates for promotion but may rank first in clinical
a. The immediate supervisor if better equipped proficiency. Nurse B may rank first in educational
to understand each worker. qualification but may rank third in clinical proficiency.
b. He / She does this by observation,
questioning, and listening RATING SCALE
9. Provision for initiating preventive and corrective • A rating scale includes a series of items representing
action and making adjustments to improve the different tasks or activities in the nurse’s job
performance. description or the absence or presence of desired
a. The primary goal in the performance of all behaviors and the extent to which these are
workers should be to provide quality service possessed.
to all clients.
Example:
METHODS OF MEASURING PERFORMANCE
a. On a scale of 1 to 5, indicate the degree of the nurse’s skill in
• Methods of performance may be done both formally or assessing the patient’s condition where each of the
informally. Informal appraisal may consist of incidental corresponding possessed.
observation of performance while the worker is
engaged in performing nursing care of responses 5 - Excellent
made by the worker during conferences. 4 - Very Satisfactory
• Interaction of worker with client, their families, visitors,
and co-workers should also be noted. Formal appraisal 3 - Moderately Satisfactory or Average
is accomplished regularly and methodically by
2 - Minimally Satisfactory
collecting objective fact that can demonstrate the
difference between what is expected and what was 1 - Unsatisfactory
done.
b. A descriptive graphic rating scale may be used to describe
These methods include: punctuality in reporting for duty such as:
• Essay 1 - Oftentimes late
• Checklist
2 - Sometimes late
• Ranking
• Rating scales 3 - Always report on time
• Forced-choice comparison
FORCED-CHOICE COMPARISON
• Anecdotal records
ESSAY • In this method, the evaluator is asked to choose the
statement that best describes the nurse being
• The appraiser writers a paragraph or more about the evaluated.
worker’s strengths, weakness, and potentials. • The items are so grouped that the evaluator is forced
• It is also difficult to make comparisons because the to choose from favorable as well as unfavorable
essays touch on different aspect of a worker’s statements and to counter the tendency towards
performance. leniency by some evaluators.
• It may also concentrate on those areas of performance
Example:
for which the supervisor has strong feelings.
Select the statement that best describes the nurse being
CHECKLISTS
evaluated and the statement that least described him/her:
• A checklist is a compilation of all nursing performances
1 - Respect the ideas of orders
expected of a worker.
• The appraiser’s task is to mark the appropriate column 2 - Limited communication ability
whether the worker does or does not show the desired
3 - Even-tempered
behavior.
• A quick glance at the completed form would reveal the 4 - Capable of enduring long hours of hard work
over-all quality of the nurse’s performance.
5 - Tends to be loner
RANKING
ANECDOTAL RECORDING
• Is simple ranking, the evaluator ranks the employees
according to how he/she fared with co-workers with • The anecdotal record describes the nurse’s experience
with a group or a person, or in validating technical skills
and interpersonal relationship.
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Example: c. Resource expenditure for quality assurance activities
is appropriate.
Miss A was on her way to take her lunch. She passed by a
d. There should be focus on critical factors such as
patient who was reaching for her food tray but was having a hard
functions and activities that promise to yield the
time as this was placed on her left side. Her right hand had an
greatest health and financial benefit to reveal
intravenous line. Miss A stopped, positioned the food tray
significant findings.
comfortably and assisted the patient to eat although she herself
e. Quality patient care is accurately evaluated through
was late for lunch. Miss A acted in a commendable manner.
adequate documentation.
The anecdotal records should include f. The ability to achieve nursing objectives defends upon
the optimal functioning of the entire nursing process
(1) A description of the particular occasion, and its effective monitoring.
(2) A delineation of the behavior noted including answer to g. Feedback to practitioners is essential to improve
the questions who, what, why, when, where, and how, practice.
and h. Peer pressure provides the impetus to effect
(3) The evaluators’ opinion or assessment of the incident prescribed changes based on the results of
or behavior. assessment and needed improvements on the quality
The descriptive notes are organized to get impressions of the of care.
over-all behavior in a given period. Caution should therefore be i. Reorganization in the formal organizational structure
taken against the tendency to note negative more often than may be required if assessment reveals the need for a
positive behavior. different pattern of health care.
j. Collection and analysis of data should be utilized to
QUALITY ASSURANCE motivate remedial action.
• According to Venzon assurance is achieving a sense QUALITY ASSURANCE AND PERFORMANCE
of accomplishment and implies a guarantee of EVALUATION
excellence. While quality is the degree of excellence.
In order for the organization to be truly effective, each • Performance evaluation focuses on the worker.
must work together. To provide quality of service, • It asks questions about how well the worker satisfies
workers must accept the responsibility that they have the requirements of his/her job within the organization.
to do the right thing/job the first time and every time. QUALITY ASSURANCE METHODS
Each have to accept the quality is everyone’s
responsibility, Venzon, (2016). • The primary purpose of QA programs in nursing is to
• Quality of care is the degree to which health services measure and improve the quality of nursing delivered
for individuals and population increases the likelihood in the agency.
of desired health outcomes and consistent with the • Methods used are concurrent and retrospective patient
current professional knowledge. It is balance of care audits, patient care profile analysis, peer review,
benefits and harms to a client. and quality circles.
• Quality assurance is a process of evaluation that is • Patient is the best, sometimes the only judge of the
applied to the health care system and the provision of interpersonal aspects of care, example, empathy and
health care services by health workers. It promotes communication including the surroundings of patients
collegial and sharing relationships among workers care such as rooms and foods oftentimes called the
instead of a feeling of threat when observed and “hotel” services.
evaluated, Venzon, (2016). • Patients satisfaction is an essential goal of health care
• Quality improvement program in an organization is and it’s the important part of quality care.
the umbrella program that extents the many areas for
DEVELOPING QUALITY ASSURANCE CRITERIA
the purpose of accountability to the consumer and the
payor. The program continuous, ongoing Structure, process and outcome, or any combination of these
measurement and evaluation process that includes are common approaches to evaluation.
structure, process, and outcome.
• Indicators are valid and reliable quantitative measures Structure approach includes physical setting,
of structure, process, and outcome that are related to instrumentalities, and conditions through which nursing care is
one or more dimensions of performance. It refers to given such as:
measure of performance. Clinical Indicators relate to • Philosophy
clients. Indicators may be focused on service, practice, • Objectives
or governance.
• The building
PRINCIPLES OF QUALITY ASSURANCE • Organizational structure
• Financial resources
a. All health professionals should collaborate in the effort • Equipment.
to measure an improve care.
b. Coordination is essential in planning a comprehensive Process Approach includes the steps in the nursing process
quality assurance program. incompliance with established standards of nursing practice.
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Outcome Approach identifies desirable changes in the • Quality circles are one of the most publicized
patient’s health status such as modification of symptoms, signs, approaches to quality control.
knowledge, attitudes, satisfaction, skill level and compliance • It is defined as a group of workers doing similar work
with the treatment regimen. who meet regularly and voluntarily on normal working
time, under the leadership of their supervisor, to
NURSING AUDIT COMMITTEE
identify, analyze, and solve work -related problems and
• A nursing audit committee is composed of to recommend solutions to management.
representative from all levels of the nursing staff: a
Utilization of Results
member of the training staff, supervising nurse, head
nurse/senior nurse, and a staff nurse. • The results may be given orally or written and is
• In smaller hospitals, the chief nurse or his assistant directed to the nursing staff in the unit who administers
may be a member of this committee. the care or their immediate supervisors.
• Consistent positive findings deserve a commendation
PATIENT CARE AUDIT
from the nursing service.
• Patient care audits may be concurrent or retrospective. • Negative feedback should tactfully be conveyed in a
A concurrent audit is one which patient care is face to face situation so that assessment results may
observed and evaluated. easily be clarified.

Given through: QUALITY MANAGEMENT (QM)

• A review of patient’s charts during confinement • It is defined as a formalized system that the documents
• Observation of the staff as patient care is given the structure, responsibilities and procedures required
• Inspection of patients and/or observation of the effects to achieve and deliver a quality product.
of patient care where the focus is on the patient, (done • It describes the standards, quality practices, resources
during the rounds or patient interview. and processes pertinent to an organization.

Retrospective audit is one which patient care is evaluated TOTAL QUALITY MANAGEMENT (TQM)
through:
• It a way to ensure customer satisfaction by involving all
• Review of discharged patient’s charts employees in the improvement of the quality of every
• Questionnaires sent to or interviews conducted on product or service.
discharged patients. • It aims to reduce waste and cost or poor quality.
• It is a structured system for involving an entire
PEER REVIEW organization in continuous quality improvement
• Patient care audits may be done by peers, (employees process targeted to meet and expected outcomes.
of same profession, rank, and setting) evaluating PRINCIPLES OF QUALITY IMPROVEMENT
another’s job performance against accepted
standards. • Leadership
• Peer review has the potential to increase the accuracy o Leaders establish unity of purpose and
of performance appraisal. direction of the organization.
• It can also provide opportunities for increased • Customer Focus
professionalism and learning. o Organizations defend on their customers and
• The use of peer review in nursing should continue to there should understand current and future
expand as nursing increases its autonomy and customer need.
professional status. • Process Approach
o A desired result is achieved more efficiently
THE 360-DEGREE EVALUATION when related resources and activities are
• The newest addition to performance appraisal tools, managed as a process.
the 360-degree evaluation, includes an assessment by • Involvement of People
all individual within the spere of influence of the o People at all levels are the essence of an
individual being appraised. organization and their full involvement
• For example: The 360-degree evaluation of a ward enables their abilities to be used for the
clerk or unit secretary might include feedback from the organization benefit.
nursing staff, from patients, and from staff from other • System Approach
departments who interact with that individual on a o Identifying; understanding, and managing a
regular basis. system of interrelated processes for a given
• Most 360-degree feedback tools include self- objective improves the organizations
assessment. effectiveness and efficiency.
• Continuous Improvement
QUALITY CIRCLES o Continual improvement should be a
permanent objective of the organizations.

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• Factual approach to decision making The goal is to deliver safe, high-quality care to patients in all
o Effective decisions are based on the analysis critical settings.
of data and information.
Patient Centered Care
• Mutual Beneficial Supplier Relationships
o An organization and its suppliers are • Falls and injuries
interdependent and a mutually beneficial • Pressures Ulcers
relationship enhance the ability of both to • Ventilators Associated Pneumonia (VAP)
create value. • Intravascular Catheter-Related Infections
STRATEGIES IN TOTAL QUALITY MANAGEMENT • Preventing Other health care Associated Infections

• Internal Processes Opportunities for Patient Safety and Quality Improvement

o A comprehensive quality management • Reducing Medication Errors
program is based on real evidence from within • Dandoffs
your organization.
• Cost Reduction Working Conditions and Work Environment for Nurses
o Cost reductio, particularly in large-scale
• Nurse fatigue and stress
organizations, is often one of the most
effective fixes for organizational performance • Nursing Turnover
improvement. • Teamwork
• Environmental effects • Nursing Workload and Patient Safety
• QM strategies can help you to analyze your General Resources on Nursing and Quality of Care
organization’s effect on the environment, whilst
focusing on processes that can minimize your PRINCIPLES OF QUALITY IMPROVEMENT
environmental impact. To achieve different level of performance and improve quality,
• Regulatory compliance an organization’s current system needs to change.
o Regulatory compliance can be built your
quality management strategy to ensure 1. Work as systems and processes
requirements are dealt with proactively. i. To make improvements, an organization
needs to understand its own delivery system
CONTINUOUS QUALITY IMPROVEMENT (CQI) and key processes.
• It is a process through which the level of quality I 2. Focus on Patients
defined, pursued, achieved and continuously improved i. An important measure of quality is the extent
through the establishment of formal to which patients’ needs and expectations are
mechanism/systems and structures within the met.
organization. 3. Focus on Being Part of the Team
i. QI is a team process, a team harnesses the
QUALITY IMPROVEMENT PLANS (QIP) knowledge, skills, experience, and
perspective of different individuals within the
• It is an organization’s framework for developing and
team to make lasting improvements.
improving processes.
4. Focus on use of the data
• It includes the direction, timeline, activities, and i. Data is the cornerstone of QI.
assessment measures of quality and quality ii. It is used to describe how well current
improvement within the organization.
systems are working; what happens when
• Every hospital is expected to set targets aimed at changes are applied, and to document
making improvements in the areas of Safety, successful performance.
Effectiveness, Access and Patient-Centeredness.
• The aim of QIP is to help providers self-assess their DISCIPLINARY
performance in delivering quality education and care,
• Part of the controlling process in management is
and to plan future improvements.
discipline. Discipline meant rigid obedience to rules
• QIP also helps help regulatory authorities with
and regulations, the violation of which resulted in
assessing the quality of the service.
punitive actions.
Things to include in QIP • Today, discipline is regarded as a constructive and
effective means by which employees take personal
• Plan improvement initiative responsibility for their own performance and behavior.
• Methods This is termed as self-discipline
• Process measures
• Target for process methods Some factors that influence self-discipline are:
• Comments • A strong commitment to the vision, philosophy,
Sample of QIP goals, and objectives of the institution. Strong

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commitment result in cohesion and teamwork which in • Suspension over minor violation is given after an
turn encourage within the organization. evidence of oral and written warnings. Although a
• Laws that govern the practice of all professionals violation is a major infraction, suspension, rather than
and their respective Codes of Conduct. dismissal is applied when management feels that the
o For all government employees, in Civil employee can still be rehabilitated.
Service Rules and Regulations as provided • Accurate documentation of oral and written warnings
for in P.D. 807 and the Code of Conduct for including suspension, if done, are necessary evidence
Public Officials, R.A. 6713, are also to be of due process.
complied with.
DISMISSAL
• Understanding the rules and regulations of the
agency. All employees are oriented on the rules, • Dismissal is invoked only when all other disciplinary
regulations, and policies of the agency. An atmosphere efforts have failed. The Disciplinary Committee should
of mutual trust and confidence. be very sure that the cause for dismissal conforms with
• Pressure from peers and organization. Social the criteria of a major discipline violation as contained
pressures from co-workers and the organization in the policy manual, and for government employees,
demand that workers perform their jobs to the beat of those contained in the Civil Service Rules and
their abilities Regulations and the codes of conduct.
DISCIPLINARY APPROACHES • A review is usually done by higher management. In the
case of government employees, this is further reviewed
• A sound disciplinary program must be tailored to the by their respective departments and final affirmation is
objectives of the institution. This should include a set done by the Civil Service Commission.
of disciplinary policies and procedures, a uniform
TERMINOLOGIES
application of disciplinary rules, a disciplinary
committee, and an orientation program for all new • Benchmarking is a tool to assist quality of care
employees where expectations of appropriate decision making. It is a continuous process of
performance and behavior are emphasized. measuring what exists against the best in search for
• Successful implementation of disciplinary action is industry best practices.
characterized by promptness, fairness, impartiality, no • Best practice is a service, function, or process that
punitiveness, advance warning, and follow – through. has been fine-tuned, improved, and implemented to
• Effective supervision aids supervisors in analyzing the produce superior outcome. It is an activity that lead to
work problems of their subordinates. Counseling establishing benchmarks.
becomes part of an oral warning session before • Continuous quality improvement (CQI) is a process
resorting to a disciplinary action. of continuously improving a system by gathering data
DISCIPLINARY ACTION or performance and using multi-disciplinary team to
analyze the system, collect measurements, and
• Any employee charged for breach of the rules and propose changes.
regulations, policies, and norms of conduct shall be • Sentinel event indicators measure low-volume but
given due process. serious undesirable, and often avoidable process or
• There must be existing rules of conduct governing outcome such as falls and medication errors.
his/her behavior and a documentation of actual • Total quality management (TQM) is a way to ensure
violation of such rule must support charges. customer satisfaction by involving all employees in the
• The employee charge must be notified in writing about improvement of the quality of every product of service.
the violation and given the right to counsel.
APPLICATION OF RESEARCH IN NURSING LEADERSHIP
• Disciplinary action should be progressive in nature
AND MANAGEMENT
such as counseling and oral warning, written warning,
suspension, and dismissal. • The Integration of research evidence into our clinical
COUNSELING AND ORAL WARNING nursing practice is important for the delivery of high-
quality and safe nursing care.
• Counseling and oral warning are best given in private • The behaviours of nurse managers, nurse leaders and
and in an informal atmosphere. The employee is given administrators have been identified as vital to support
a fair chance to air his/her side. research use and evidence-based practice. However
minimal evidence exists indicating what constitutes
WRITTEN WARNING
effective nursing leadership for this purpose, or what
• A written warning is the second step in disciplinary kinds of interventions.
action. It is preceded by an interview similar to the oral PURPOSE
warning.
• The purpose of application of researches in nursing
SUSPENSION
leadership is to describe leadership activities of nurse
managers that influence nurses' use of research
evidence.
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• And to identify interventions aimed at supporting nurse ACTION RESEARCH
managers to influence research use in clinical nursing
• In the health Care settings, the leadership,
practice and what decision made help leaders to
interpersonal, and management skills needed to
successfully influence research-based care.
manage such change effectively within multi-
• Research helps nurses determine effective best
professional in a variety of health care settings.
practices and improve patient care. research also
• It provides unique use of action research as a model
helps nursing respond to changes and challenges in
the healthcare environment, individual, family, patient for planning and implementing change at the patient-
service interface.
and group populations and government regulations.
• Researchers make discoveries, the practice of nursing • It also makes use of evidence and case studies to
demonstrate the stages of the change process
continues to change and nurses is innovative.
Includes tips and useful strategies for achieving
• In this complex world of 21st century, the role of nurse
change.
continuously evolved significantly.
• A dynamic change can be achieved at the individual,
• Nurses work in a variety of settings, the hospital, the
team, departmental and organizational level it covers a
classroom, the community health, the business sector,
range of topics including: organizational culture;
home health care, and the laboratory among the many.
leadership; conflict resolution; managerial roles; and
• Though each role carries different responsibilities, the
organizational analysis
primary goal of a professional nurse remains the same:
• Managing Change in Healthcare is ideal for all
to be the client's advocate and provide optimal care on
nursing and allied health care trainees taking courses
the basis of evidence obtained through research.
in management and leadership. It will also be
• Research is typically not among the traditional
invaluable for qualified professionals and managers
responsibilities of an entry-level nurse. Many nurses
who need a clear and engaging guide to the key issues
are involved in either direct patient care or
and skills underpinning effective healthcare
administrative aspects of health care.
management.
• Nursing research is a growing field in which individuals
within the profession can contribute a variety of skills Below is an example of Action Research that can be applied with
and experiences to the science of nursing care. There Nursing leadership and Management.
are frequent misconceptions as to what nursing
research is. Some individuals do not even know how to Work-based learning: a leadership development example from
begin to define nursing research. an action research study of shared governance implementation
Tracey Williamson
• According to Polit and Beck (2006), nursing research
is: systematic inquiry designed to develop knowledge Abstract
about issues of importance to nurses, including nursing
practice, nursing education, and nursing Aim: An empowering action research study was undertaken to
administration. evaluate and strengthen the implementation of shared
governance. One aim was to identify factors that acted as aids
PATIENT SATISFACTION or barriers to effective decision-making by clinical leaders. As a
work-based learning approach, action research was expected to
• Patient satisfaction is an important and commonly
lead to integration of learning into practice by researcher and
used indicator for measuring the quality in health care.
participants alike.
Patient satisfaction affects clinical outcomes, patient
retention, and medical malpractice claims. It affects the Background: Shared governance replaces traditional
timely, efficient, and patient-centered delivery of quality hierarchies and requires and develops clinical leaders.
health care. Strategies are needed to maximize learning from introduction of
• A study extends previous research in client satisfaction such initiatives at the individual, group and organizational level.
by showing how a patient satisfaction study can help
answer questions, such as why client is satisfied or Methods: Participant-observations and interviews were
dissatisfied, whether the health care complaint undertaken with shared governance council members from one
model in north-west England.
handling is effective and how to improve clients'
satisfaction. Results: Leadership skills and knowledge and shared
• Researches helps improve client satisfaction. governance practices were significantly enhanced. Preparation
Researchers demonstrated that there are differences for council roles was considered inadequate. Increased
in satisfaction levels among different genders. To structured time for reflection and action planning was indicated.
explore further the reasons for these differences, a
research made it separated to compare the specific Conclusions: Implementation of shared governance has
causal links between the two gender samples and to succeeded in developing leadership capacity. Evaluation
draw broader inference from the results. findings have led to improvements in the overall shared
o Some findings provide support for the governance model. Action research has been found to have
application of CS study to derive customer great utility at optimizing work-based learning. Nurse Managers
knowledge, which also reveals some need to develop their coaching and facilitating skills and
interesting suggestions for future research. recognize there is no "quick fix" for developing clinical leaders.

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Implications include the need to support learners in identifying a. Do results suggest it is worthwhile to pursue
and implementing changes arising from work-based learning the study as planned?
activities, the significant resource implications and the need to b. Do results provide data suggesting it would be
optimize the organizational climate if work-based learning important to modify aspects of this study to
approaches to leadership and management development are to improve the anticipated larger study?
succeed. c. Do results provide the data needed to
propose a larger study as planned?
FEASILIBILITY
11. Disseminate your findings.
• Feasibility studies can provide such data and this can JOURNAL SHARING
validate study procedures or identify procedures in
need of revision. • Reflective journaling is a term that refers to
• All of this information is helpful in convincing a funding documenting your ideas, personal thoughts and
agency that a study is worthy of support. experience through writing.
• It will encourage you to consider research value and • Reflective writing is a valued tool for teaching nursing
discuss how you might conduct such work yourself or students and for documentation, support, and
support this type of inquiry. generation of nursing knowledge among experienced
• Example of a feasibility study conducted in preparation nurses.
for an anticipated future study exploring the • Expressive or reflective writing is becoming widely
relationship between RNs and family caregivers of accepted in both professional and lay publications as a
hospitalized older adults. mechanism for coping with critical incidents.
• Reflective journaling is a comfortable medium for
STEP-BY-STEP GUIDE TO FEASIBILITY RESEARCH
nurses to be more open about their journey and
1. Identify a problem and/or a question. experience.
2. Review the literature. • Nurses can choose to write a scientific type of
3. Identify gaps in our knowledge. reflection, or introspective – that which relates to their
4. Refine the general question, formulating a specific thoughts, feelings and beliefs about their experience.
research question(s). Introspection can help increase self-confidence,
5. Consider your reasons for conducting preliminary creativity and the joy of learning in an environment that
research and determine the form it should take. is open, honest and nonjudgmental.
a. If you want to evaluate the feasibility of • Reflective journaling can also be a great way to map a
carrying out the planned protocols and nurse’s progress and achievements in his or her
interventions of an anticipated larger study nursing/clinical education as well as in their career. It
with randomization of participants, conduct a lets them look back and analyze thought patterns,
randomized pilot study. which in turn would help them to value their own
b. If you want to evaluate the feasibility of using learning and growth progress.
all or part of an intervention—and, possibly,
SHARED RESPONSIBILITY FOR IMPLEMENTING
other processes—in a proposed larger study,
EVIDENCE-BASED PRACTICE
but without randomizing participants, conduct
a nonrandomized pilot study. • Evidence-based practice (EBP) is the process of
c. If you want to evaluate aspects of data collecting, processing, and implementing research
collection, data management, the adequacy findings to improve clinical practice, the work
of resources to carry out a study, or other environment, or patient outcomes.
processes to be undertaken in an anticipated • According to the American Nurses Association (ANA),
future trial (excluding the specific intervention nursing interventions should be practical, methodical
and exact protocol) with a small sample, decisions based on EBP research studies. Utilizing the
conduct a feasibility study that is not a pilot EBP approach to nursing practice helps us provide the
study. highest quality and most cost-efficient patient care
6. Design the study. possible.
a. Choose a research design (cross-sectional,
cohort, or correlation, for example). When evaluating EBP nursing research studies, focus on these
b. Determine setting, sample size, recruitment four criteria:
strategy, randomization (if appropriate),
• Validity—the legitimacy, accuracy, and soundness of
instruments, data analysis, and procedures.
all aspects of the study
c. Ensure protection of human subjects (submit
• Reliability—the extent to which a measurement's result
plan for institutional review board approval).
is consistent
7. Collaborate with stakeholders at the setting to minimize
• Relevance—the logical connection between two ideas,
disruptions and obtain support.
tasks, or events
8. Carry out the study.
9. Analyze the results. • Outcome—the conclusions reached through the
10. Relate the findings to plans for a future study. process of research.

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• Facilitating EBP is a shared responsibility of the 1. Decide On Skill Sets
professional nurse, the organization, leader-managers a. To decide on the skill sets that you require all
and the education or staff development department. your team members to have in order to do
• The management team should set the example by their jobs properly.
supporting and acknowledging nurses who participate 2. Evaluate The Skills Of Staff
in, publish, or otherwise share new EBP research data a. To look at all your team members and
that may benefit nurses and patients in their facilities evaluate their current skill levels in relation to
and the community. the skills you have laid out in the first stage of
• As the field of nursing continues to evolve, nurses must this process.
become proficient in evaluating, participating in, and 3. Highlight The Skills Gap
sharing EBP research with our healthcare team to a. Know what the gap is, you need to use
improve clinical practice and patients' outcomes. training to help close that gap and ensure
your team is at the level you expect them to
TRAINING NEEDS ANALYSIS be
• Training Need Analysis is a process in which the
company identifies training and development needs of
its employees so that they can do their job effectively.
It involves a complete analysis of training needs
required of various levels of the organization.
• It is a process which helps the organization review the
state of their training. Its importance is to helps them to
determine all the training needs to be completed in a
certain period to allow their team to complete their job
as effectively as possible.
• The purpose of training needs analysis is to identify
performance requirements and the knowledge, skills,
and abilities needed by an agency’s workforce to
achieve the requirements. An effective training needs
assessment will help direct resources to areas of
greatest demand.
THREE LEVELS OF TRAINING NEEDS ANALYSIS

There are 3 key steps involved in training needs analysis to

ensure your business is making the most of the process:

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