NgCM 119: Nursing Leadership and Management

Activity for Midterm Period

CRITICAL ANALYSIS
October 16, 2023

Marie Ashley E. Casia

BSN 4

Instructions: Read and analyze each given situation below. Satisfy the questions in each item.

Part I: PLANNING

1. As The Head Nurse Of The Medical-surgical unit,

a) What type of planning should you consider for yourself and staff
Members?

As the Head nurse of the medical-surgical unit, the type of planning I would consider for
myself and staff will be strategic planning. Strategic planning because it focuses an
organization's efforts, resources, and actions on achieving a single objective meeting the need
for a future workforce that satisfies organizational and patient care requirements while fostering
nurses' success. In strategic planning, I can see a long-term outlook. For example, in 3 to 5
years, I can change the mission and vision of the unit if they have already been met. This type
of Planning will help provide my team with knowledge and the tools necessary to provide a high
quality type of care.

b) How will you ascertain that your plan is good or poor?

First, I have to determine what is good planning and what is poor planning. I need to know
its definition first, then know the indicators of good and bad planning. Good planning involves a
continuous process of assessment, establishment of goals and objectives, implementation, and
evaluation of change as new facts become unknown, while poor planning is the failure to set
goals,make assessments, provide for implementation, or anticipate any possible change in
circumstances. I will also use the steps of strategic planning by assessing the environment and
using SWOT analysis.

c) How Will you apply the elements of planning in the unit?

For instance, I will offer an educated guess regarding the future. For example,If there is a
code blue, I will prepare the necessary resources. I need to be specific with my goals and
objectives while setting them. As a measure of the objectives, I will use the SMART method. I
should consider my schedules as well as my strategies and programs while designing
strategies, programs, projects, and activities and determining a time frame. I should also
practice time management and budgeting. For example, I will assign someone to Manila to
attend the seminar. In this instance, I should budget for this situation carefully in order to
improve the performance of my unit.

d) What Are The Possible Reasons Why The Staff Resist Planning?
There might be a variety of reasons why the staff is resistant to planning. For instance,
many assume that adjusting to the way they are used to doing things would take too much time.
The staff believes they are unprepared to adapt to the procedure. It can also be expensive, and
this could be due to a lack of resources.

e) Which Of The Models Of Planning do you Find Effective?Why?

In the models of Planning, I found the most effective is the Alignment Model because it is
a tool that assists in determining the degree to which an organization's longer-term objectives
are aligned with its resources and skills, as well as opportunities, vulnerabilities, and risks that
must be controlled. If the organizations have internal issues, this is the most effective model to
detect it.

2. Jose was promoted recently as manager of a cancer care clinic which had just expanded its
hours from 6 AM to 11 PM. Jose has realized that staff nurses are reluctant to sign up and do
quality chart audits. He gathers information about quality improvement, reviews the literature on
motivation and incentives, and discusses the issue with other nurse managers. He continues to
manage the clinic, thinking about the information he has gathered but does not consciously
make a decision or reject new ideas. When working on a new problem, self- scheduling for the
change in hours, he realizes a connection between the two problems.
Many nurses complain that by the time they receive the schedule, the day shifts are filled. Jose
tells them that he will review the chart audits and that those nurses who regularly participate in
quality improvement projects will receive a perk. They will be allowed to have a first choice at
selecting the schedule they want to work on a rotating basis. He discusses the plan with the
staff and proposes a 2 month trial period to determine whether the solution is effective.

a) Identify the steps in critical thinking that Jose used to arrive at the solution.

The steps in critical thinking that Jose used to arrive at the solution are: first, Planning; next,
Critical thinking; followed by Decision-making; Problem-solving; and lastly, Setting objectives.

b) What management style does Jose is showing based on the situation

above? Explain.

The management style that Jose is showing based on the situation above is Transactional
Leadership style . Transactional leadership is a type of leadership style in nursing that is built
upon a structure of reward and punishment based on performance.The staff nurses know what
is expected of them to do.
c) If you are Jose,create or develop a sample plan applicable for the
situation.

I will create a Plan called Scheduling Tool, and its content will be the allocated staff for the
allotted day and time.
3. You are the unit manager of St. Peter Medical Center,
a) Create a goal and objectives of your unit.

Goal:
“ Providing the Best Patient Experience Possible”
Objectives:
- Continuing on the path to becoming a High-Reliability Organization.
- Working collaboratively with our foundation and partners to advance our Master Program
and Plan.
- Continually developing and taking delight in our hospital's overall experience.
- Using existing and new technologies to provide more efficient and effective treatment to
patients and families.

b) Develop a strategic plan of your goal and objectives, follow the steps. Plan
should have all the elements of planning. Create a SWOT.
c) What Are Your Measures To Avoid Resistance?
To avoid resistance, I will initially pay attention to my staff's concerns in order to discover
the sources of resistance and resolve the root cause of the issues. Next, I will interact with them
as frequently as possible to minimize a lack of communication and to reduce the chance of
filling the gap with supposition. This will be less probable if you are more open in your
communication with the staff members.

d) What are your strategies, programs and activities that will be implemented to realize your
plan?

I will apply multitasking to be able to save time and effort. I will also use tools in project
management, such as a Gant chart, to be able to show the task and schedule. Communicating
openly with the staff members as well in order to know their opinions about the plan.

e) Create a Gantt chart of your plan.

f) Develop a sample budget plan and budget proposal of your activity or
Program.

The Operational budget clearly indicates the organization's total income, total costs, and
net profit for the previous years (George, 2021). This budget is considered a revenue and
spending prediction for one or more years. This is regulated by the management team at the
start of the year, and it may represent projected activity levels.

g) What model of planning are you adapting in your plan?

The Model of Planning I will be adapting in my plan would be the Alignment Model. An
alignment model is a tool which helps in assessing how well an organization's longer-term
objectives are aligned to its strengths, resources, and prospects as well as with risks,
vulnerabilities, and management-related opportunities.
Part II: ORGANIZING
1. Recently,you have discovered throughy our access on data of your unit's pressure ulcer rates
that it is significantly higher than those of other units. Your staffing has been stable and in
accordance with your staffing plan. Your staffs are experienced, and in fact, you have the
longest tenured staff in the hospital.Why is your unit’s pressure ulcer rate is higher compared to
other units? What are the possible causes? What are your next steps/ actions after finding out
the pressure ulcer rate? What are your measures to resolve the problem?

In my opinion, inadequate care may be the reason why ulcer rates are higher in some
units than others. Although I have a staffing strategy and my staff has experience managing
pressure ulcer rates, that does not imply I can't improve them. A potential reason is that they
must have been overly aware that their patients might develop pressure ulcers and they didn't
make enough of an effort to prevent it, such as turning the patients every two hours. In this
case, I would have a meeting with the staff, bring up the problem, and remind them that it is still
crucial to pay attention, even to minor details like the occurrence of pressure ulcers in patients.
To improve and reduce the pressure ulcer rate, we must always assess in order to know the
direct measure and to provide an update on whether the pressure ulcer rate is decreasing or
improving by progressing in pressure ulcer prevention. When it comes to staffing strategies, I
advise not just improving that staffing strategy, but also improving the results of care plans for
dealing with situations like these. The next stage is to enable conversation among the members
of your team in order for them to comprehend your approach that you have created and to have
instructed and recommended follow your plan throughout each step.

2. You are the nurse manager of the psychiatric unit of your facility.What Would You consider in
planning for staffing of your unit?

As the nurse manager of a mental patient's unit, it is my duty to establish secure, healthy
surroundings that facilitate the work of my healthcare team and promote participation from
patients. The position is crucial in developing a professional atmosphere and a way of life where
members of multidisciplinary teams may improve patient outcomes and advance their careers.
Strong interpersonal and leadership skills are required for the position of nurse manager. They
should be effective in organizing employees and resources to achieve goals and objectives. We
must be capable leaders who can balance working with the nursing staff and the management
of healthcare facilities.
3. You are a new nurse and you have increasing concerns regarding staff levels in your unit.
You are becoming anxious each time you go to work. What would you do?

As a nurse, I have the right to discuss this matter with the nurse manager in order to
resolve my problem as soon as possible. I have the right to work in a safe workplace, especially
when my job involves maintaining and caring for people's lives. Addressing this worry can also
assist to reduce tension.

4. What Are The Different Organizational Structures? Draw These Structures. Make Sample
organizational chart of a small hospital.

The different organizational Structures are: Line Organization/ Bureaucratic/ Pyramidal,

Flat/Horizontal Organizational, Staff Organization, Functional, Ad Hoc , Matrix, Shared
Governance Organizational Structure, and Lateral Organization.
Part III: DIRECTING
Recall during your Related Learning Experience in the hospital with the nursing leaders or
managers or interview a nursing leader or manager.
1. What Are The Characteristics Of Good Directions?
– Describe how a nurse manager carried out her task in directing.

The nurse manager must have all the characteristics of Good directing which is, It must be
clear, concise, consistent and complete. Apart from being understandable, the person giving
directions must explain the rationale well and make certain that it is understood. The words
used in giving directions indicate their importance such as “must”, “shall” and “will” should
indicate that the directions are mandatory, “may” which denotes that the action is
recommended, “should” ,places a directive between mandatory and recommended action. The
person giving directions must speak distinctly and slowly. Directions must come across as
requests not commands using a specific tone and set of words. Manager should give directions
in a logical manner and prioritize the tasks directed to be done by importance and time. It is
important also to avoid giving too many directions at one time, Personalize directions, Always
check to make sure directions have been followed and Provide feedback for actions done.

– Record all activities of nurse manager dealing with all the elements of
directing.

A nurse manager is delegating a task to her staff member, Supervising the staff, Staff
Development, Coordination, Collaboration,Communication and Evaluation.

2. What Are The Different Levels Of Communication?

– Present the flow of communication in the nursing service.
Top Level – director and administrator of nursing services
Middle Level –nurse supervisors and area managers
First Line Managers – head nurses, unit managers, senior staff nurses
Operating Level – staff nurses, nursing aides/ attendants

– Trace the area of authority, responsibility and accountability.

Authority or The right to do something, or to tell someone else to do it, and to

enforce it, in order to reach organizational objectives o The right to make decisions o Authority
rights exist because power is vested in hierarchical positions of Power has been legitimized by
the organization o Is a tool, a resource or Without the system of authority, an organization could
not function o If no one in an organization had authority, employees could come to work and
leave when they wanted to and could carry out their assignments any way they wanted to rather
than the way prescribed by higher authority o Examples: A police officer gives a motorist a
ticket for driving 45 mph in a 30 mph zone. The officer's authority services form the city council
The department manager at Wal-Mart assigned work shifts for her personnel during the
Christmas holidays. Her authority was delegated to her by the store manager o Delegated
downward in organizations form higher level of management to lower levels Accountability o Is
the fact that employees will be judged by the extent to which they fulfill their responsibilities of
"being accountable" infers that one's supervisor can confer either punishment or reward,
depending upon how well one has exercised the responsibility to use the delegated authority o
Example: The CEO of an organization delegates authority to the CFO, CIO, and other
vice-president level executives to carry out their specific tasks.

3. Name some forms of communication employed by management.Which is most

effective? Do a research on non-verbal communication, discuss your findings.

-Formal Communication
-Informal Communication
-Downward Communication
-Upward Communication
- Horizontal Communication
- Oral or Verbal Communication:

Written Communication Oral or Verbal Communication: In my opinion, this is the most

effective form of communication in this way because the staff and managers can exchange
ideas and ask if they understand. It is also a big help for the superior because he/she can easily
minimize and avoid conflicts. Nonverbal communication is a type of communication in which
actions and indications play a larger role in establishing or creating a discussion. When a
person employs nonverbal communication, it involves hand gestures, body language, look, and
facial expressions. It also includes a technique to display your sentiments and emotions to
someone so that they may know and express that you are pleased, grateful, and confident.

4. What Should a manager do to ensure that his message is understood and reach his
subordinates? Explain.

The manager should use a common vocabulary, use symbols or language the receiver
understands, and have a question and answer portion. She may ask her subordinate to repeat
or explain on their own the message she gave them.
5. The grape vine is the mode of communication in the informal organization. How useful is it to
managers?

Information spreads quickly through the grapevine. Employees frequently learn about
organizational changes or events through the grapevine before formal channels. When official
communication is weak or insufficient, the grapevine fills the hole, ensuring that workers receive
the information they require. Management can utilize the grapevine as a feedback mechanism
to measure employee opinion, issues, or responses to decisions. It can serve as a warning
mechanism for possible problems. It improves cohesiveness. Informal information sharing may
improve staff ties and promote a sense of community and belonging. Employees may see
information that flows through both formal channels and the grapevine as more genuine or
trustworthy. The grapevine is adaptive because of its flexibility, and it may reach people at
different levels and departments without the limits of hierarchy.

Part IV: CONTROLLING

1. In your Related Learning Experience in various affiliated hospitals,recall the managers,
supervisors and head nurses that you have worked with. How is controlling implemented in the
unit? What are the areas that need controlling? Why?
In the Hospital at Maayo, Ms. Baring is one of the head in the Cardiovascular Unit. I have
observed how she delegates tasks to her subordinates. She applied the performance to ensure
accomplishment of organizational goals. She also reminds her subordinates about possible
scenarios like if the machine of echocardiogram is not working in the first room, they can use it
in the other room. Through this situation, It shows the feedforward control. The areas that need
controlling is that the head is too hands off with the staff. I believe that she should monitor them
more to see their errors even if it's minimal.

2. Enumerate And briefly explain the steps in controlling. Are they applicable to health care
settings and every situation? Discuss.

● Establishing or setting goals and standards -plays a big role in controlling the process
because if the organization knows their goals, they can focus on achieving them.
● Measuring actual performance - this is the second step in the controlling process where
they can compare and measure the actual performance to know if the plans are working.
● Taking corrective action - this third step is doing if there are some discrepancies between
actual performance and goal where the managers should take an action. Setting
corrective actions can reduce the losses.
● Following up on corrective action - In this step where managers must also take their
logical thinking or conclusions and it requires evaluations and comparisons.
 Yes, they have significance in the healthcare environment and in any circumstance since
the controlling process is a procedure in which the performances in accomplishing the goals that
are established may be measured.

3. How does a good control system affect employees as individuals and the hospital as a
whole?

Techniques for control can provide details about the consistency, fairness, and reliability
of an organization. In other words, controls may increase employee perceptions of corporate
goodwill and increase their level of trust in their company. Control management is essential to
your company since it helps with problem identification, corrective action implementation,
reducing deviation from standards, and project management timeliness. Your company is far
more likely to succeed if such a framework is in place.

4. What are the criteria for effective control? Is it needed or applied by nurse managers in their
unit? Why?

The criteria for effective control is composed of Characteristics of Effective Control

where Control systems must be designed appropriately to be designed appropriately to be
effective When control standards are not flexible or unrealistic, employees cannot focus on the
organization’s goals.Control systems must prevent, not cause, the problems they were designed
to detect. It is needed and applied by nurse managers in their unit because it provides high
quality of care. Controls assist in better defining an organization's objectives so that people and
resources may be directed toward them. They protect against resource mismanagement and
promote remedial action. Having strong records implies that management will have a better
understanding of what happened in the past and where change can be implemented effectively.

5. What makes planning and controlling inseparable?Give examples.

Planning and controlling are regarded as inseparable in management since, without

planning and control, we have no idea where we are headed or where you are leading them.
Although planning and controlling are two distinct managerial tasks, they are interconnected. In
the majority of organizations, planning and controlling are done at the same time. These two
functions' boundaries cross across with one another. As a result, controlling cannot be done
efficiently without good planning, and planning becomes ineffective in the absence of any
control. Any organization's plans will be useless if there isn't enough preparation. As a result,
both the planning and the regulating processes are strengthened by one another. Prior to the
process of controlling, the planning phase should begin. It indicates that managing corporate
operations is carried out in accordance with the standards and guidelines outlined by
management in the strategic plans. Example is in applying Operational Management, This
includes controlling the costs and improving the quality of services provided to the patients.

6. In what way is a performance appraisal a component of management control system?

Explain briefly.

Performance appraisal may be a component of a management control system since it

involves evaluation, yearly review, and accomplishments that the management control system
also has, and it can be used to provide feedback to workers or staff on their performance and
advancement in their job sector. Management Control System has an excellent method of
arranging objectives and establishing a condition in which internal and external events arise in a
task and can be managed appropriately.

7. What are the kinds of formal control? In what area of the nursing service is it used?
Why?
The two kinds of formal control are pre-action control and post-action control. Pre-action
control involves controlling by means of personal supervision and utilizing control checks
consisting of policies and procedures for any given task or function. For example, in the ward,
the supervisor checks the FDAR of the staff to see if it is correct, while post-action control is
controlling whether the task or function is being performed or may have been performed and
correcting deviations from standards or plans. For example, in the ward, the performance data
of nurses has decreased, the issue of medication has arisen, and the actions were corrected by
providing light near the preparation of medications. These kinds of controls are used to improve
the performance of the staff and provide a better quality of care.