DIRECTING Ability to accept changes and consider them as

Directing is known as the act of issuing of orders, challenges

assignments, and instructions to accomplish the Dignified and pleasing personality
organization’s goals and objectives. Ability to motivate employees and provide opportunity
It involves the process of getting the organization’s work for continuing education program
done. Advocacy for nurses and nursing
It entails explaining what it is to be done, to and by
whom, at what time, how and why the task should be Principles of good Supervision
done. Good supervision requires adequate planning and
organization which facilitate cooperation, coordination
Directing Includes: and synchronization of services
 Delegation of work to be performed Gives autonomy to workers depending on their
 Utilization of policies and procedures, competencies, personality and commitment
 supervision of personnel, Stimulates the worker’s ambition to grow into
 coordination of services, effectiveness
 communicating,
 staff development, Techniques in Supervision
 making decisions Observation of the workers while making the rounds
Spot checking of charts through nursing audits
Activities Related to the Directing Functions Asking the patients about the care they receive
 telling people what is to be done and explaining Looking into the general condition of the units
how to do it Getting feedback from co-workers or other supervisors
 issuing instructions and orders to subordinates or relatives
 inspiring them to contribute towards the Asking questions discretely
achievement of objectives
 supervising their activities Types of Communication
 providing leadership and motivation  Spoken Words
 Written Words
Elements of Directing  Physical Expression or Significant Gestures
SUPERVISION:
Comes from the word ‘supervide” meaning “to oversee Verbal Communication
or view directly” Involves spoken words.
It’s an active process of directing, guiding and speak slowly, pronouncing the words clearly.
influencing the outcome of a person’s performance of Clearly understood words.
an activity. relevant information should be conveyed.
Praises the quantity & quality of work performed Immediate response is determined.
Proper and economic utilization of resources
The amount of assistance needed by the worker Non-verbal Communication
The need for staff development and continuing Transmission of message without the use of words.
education program Such as:
 Facial expressions
Legal Implications that pertain to delegation and  Gestures
supervision:  Touch
The nurse whom delegates is responsible for the acts of  body language or vocal tones
the subordinates “ Respondeat superior”
Supervision legally means “personally observing a Written Communication
function or activity Must be clear, correct, complete and concise.
Delegating functions or activities while retaining the Written communication comes in a form of
accountability memoranda, hospital orders, documentation, records
Evaluating and ensuring that the nursing care provided and reports, policies, procedures and the like.
is adequate and delivered appropriately Ambiguous terms should be avoided.

Qualities of Good Supervision Four – dimensional Flow of Communication in Nursing

Good technical, managerial and human relation skills Care
Ability to communicate well in both spoken &written
language; ability to listen Principles of Effective Communication:
Firmness and flexibility to adjust to the needs of the Feedback is essential to effective communication
situation Communication thrives best in a supportive
Fairness in dealing with employees environment
Familiarity with hospital and nursing policies that affect
patient’s care A manager’s communication skill is vital to the
Good decision making skills attainment of the goals of organization.
Willingness to grow and develop
Adequate and timely communication of work-related Increase workers satisfaction
issues or changes that may affect jobs enhances Facilitates coordination
compliance. Helps promote trust between the patient and
personnel
Flow/ Lines of Communication
Downward Communication- traditional line of Principles of Effective Communication:
communication is from superior to subordinates which Clear lines of communication serves as the linking
may pass through various levels of management. process by which parts of the organization are unified
(includes policies, rules and regulations, memoranda, towards goal achievement
interviews, handbooks, job description) Simple, concise and exact messages ensure
Upward Communication – emanates from subordinates understanding of the messages to be conveyed
and goes upward. Usually in the form of a feedback to
show the extent to which downward communication Downward Communication- traditional line of
has received, accepted and implemented communication is from superior to subordinates which
Horizontal Communication- or lateral flows from peers, may pass through various levels of management.
personnel or departments on the same level. Used (includes policies, rules and regulations, memoranda,
frequently in the form of , relatives and the community. interviews, handbooks, job description)
Outward communication – deals with information that
flows from Upward Communication – emanates from subordinates
Coordination – unites personnel and services towards a and goes upward. Usually in the form of a feedback to
common objective. show the extent to which downward communication
Synchronization of activities among various services and has received, accepted and implemented
departments enhances collaborative efforts Horizontal Communication- or lateral flows from peers,
personnel or departments on the same level. Used
Barriers to Effective Communication frequently in the form of , relatives and the community.
Too much information – people suffer from what we call
sensory overload Outward communication – deals with information that
The message is poorly organized – communicating also flows from
involves planning Coordination – unites personnel and services towards a
Inaudible voice – when talking in front of a crowd be common objective.
sure that you have loud and clear voice so that Synchronization of activities among various services
everybody will be able to hear what you are saying and departments enhances collaborative efforts
Mannerisms – distract attention
Lack of understanding CONTROLLING
Reasons for conducting Evaluation
Inconsistent verbal and non-verbal communication
Noise – any factors that disturbs, confuses or interferes Evaluation ensures that quality nursing care is provided
with communication It allows for the setting of sensible objectives and
Differing perceptions – people who have different ensures compliance with them
backgrounds of knowledge and experience often It provides standards for establishing comparisons
perceive the same phenomenon from different It promotes stability and a means for employees to
perspective monitor their own performance
Language differences – the words used must mean the
same thing to sender and receiver Reasons for conducting Evaluation
Too many links in the communication process It highlights problems related to quality care and
determines the areas that require priority attention
Overcoming Barriers to Communication It provides an indication of the costs of poor quality
 Use feedback to facilitate understanding and increase It justifies the use of resources
the potential for appropriate action It provides feedback for improvement
 Repeat message in order to provide assurance that
they are properly received Evaluation Principles:
 Use multiple channels so that the accuracy of the The evaluation must be based on the behavioral
information may be enhanced standards of performance (goals and objectives were
 Use simplified language that are easily clearly defined and presented to the employee)
understandable and which eliminates the possibility of There should be enough time to observe the
people getting mixed- up with meanings employee’s behavior.

COMMUNICATION: The employee should be given a copy of the job

Transmission of information, opinions and intentions description, performance standards and evaluation
between and among individuals. form before the scheduled evaluation conference.
It facilitates work The employee’s performance appraisal should include
Increases motivation both satisfactory and unsatisfactory results with specific
Effect change behavioral instances to exemplify these evaluative
Optimizes patient care comments.
Evaluation Principles: Purposes of Performance Appraisal:
Areas needing improvement must be prioritized to help Discover the aspirations of employees and reconcile
worker upgrade his/her performance these with goals of the institution
The evaluation conference should be scheduled and Provide employees recognition for accomplishment
conducted at a convenient time for the rater and the Inform employees “where they stand”
employee under evaluation
The evaluation report and conference should be Factors Contributing to an Effective Performance
structured in such a way that it is perceived and Appraisal System
accepted positively as a means of improving job
performance Compatibility between the criteria for individual
evaluation and organization goals
Characteristics of an Evaluation tool: Direct application of the rated performance to
Objective – performance standards and objectives expected of the
Reliability – workers
Validity – Development of behavioural expectation which have
Sensitivity – been mutually agreed upon by the rater and the worker

Basic Components of the Control Process Factors Contributing to an Effective Performance

Establishment of standards, objectives and methods for Appraisal system
measuring performance Understanding the process and effective utilization of
Measurement of actual performance procedures by the rater
Comparison of results of performance with standards Rating of each individual by the immediate supervisor
and objectives and identifying strengths and areas for Concentration on the strengths and weaknesses to
correction and or improvement improve individual performance]
Action to reinforce strengths or successes
Implementation of corrective action as necessary Methods of Measuring Performance:
 Essay
Three Types of Performance Standards:  Checklist
Standards or Structure – those that focus on the  Ranking
structure or management system used by the agency to  Rating Scales
deliver care.  Forced Choice Comparison
Process standards – refers to decisions and actions of  Anecdotal Recording
the nurse relative to the nursing process which are
necessary to provide good nursing care. QUALITY ASSURANCE
Outcome standard - designed to measure the results of Assurance means – achieving a sense of
care, provided in terms of changes in the health status accomplishment and implies a guarantee of excellence
of client. Quality – the degree of excellence
Assurance – formal guarantee of a degree of excellence
Performance Appraisal
A control process in which employees performance is QUALITY ASSURANCE
evaluated against standards. became the organizational mechanism for measuring
most valuable tool in controlling human resources and performance against standards and reporting incidents
productivity. and errors, such as mortality and morbidity rates
It reflects how well the nursing personnel have consisted primarily of retrospective chart audits of
performed during a specific period of time. various patient diagnoses and procedures.
The method was thought to be punitive, with its
Purposes of Performance Appraisal: emphasis on “doing it right,”
Determine salary and merit increase
Select qualified individuals for promotion or transfer TOTAL QUALITY MANAGEMENT
Identify unsatisfactory employees for demotion or also referred to as quality improvement (QI) and
termination performance improvement (PI)
Make inventories of talents within the institution
Determine training and developmental needs of Quality Improvement (QI) – will be referred to as a
employees systematic process of organization-wide participation
and partnership in planning and implementing
Purposes of Performance Appraisal: continuous improvement methods to understand,
Improve the performance of work groups by examining, meet, or exceed customer needs and expectations and
improving correcting interrelationships between improve patient outcomes
members This proactive approach emphases “doing the right
Improve communication between supervisors and thing” for customers.
employees and reach an understanding on the
objectives of the job PRINCIPLES OF QUALITY IMPROVEMENT
Establish standards of supervisory performance
The priority is to benefit patients and all other internal Patient Satisfaction Data- health care facilities get
and external customers. feedback from patients by having them fill out a
Quality is achieved through the participation of questionnaire that asks how they felt about their health
everyone in the organization. care encounter.
Improvement opportunities are developed by focusing
on the work process. CONTROLLING
Decisions to change or improve a system or process are 1. Delegation
made based on data. – the process by which manager assigns specific
Improvement of the quality of service is continuous tasks/duties to workers with commensurate authority
process. to perform the job.

DIFFERENCE BETWEEN IN FOCUS Q.A AND Q.I. (ANA &) defined delegation as the transfer of
responsibility for the performance of a task from one
person to another.

(NCBSN) defines delegation as transferring to a

competent individual the authority to perform a
selected nursing task in a selected situation.

Five Rights of Delegation

1. Right Task.
One that is delegable for a specific patient.
2. Right Circumstances.
Appropriate patient setting, available resources, and
other relevant factors considered.
3. Right Person.
Right person is delegating the right task to the right
Methodologies for Quality Improvement person to be performed on the right person.
The plan do? study act Cycle (PDSA) 4. Right Direction/Communication.
What are we trying to accomplish? Clear, concise description of the task, including its
How will we know that a change in an improvement? objective, limits and expectations.
What changes can we make that will result in 5. Right Supervision.
improvement? Appropriate monitoring, evaluation, intervention, as
needed, and feedback.
The FOCUS Methodology
Focus on an Opportunity for Improvement Two Criteria are of paramount:
Organize a Team The ability of the worker to carry out its tasks
Clarify the current Process Fairness not only to the employee but to the team as a
Understand the Degree of change Needed whole
Select a Solution for improvement
Other Improvement Strategies Reasons for Delegation
Benchmarking – is the continual and collaborative For the nurse manager
discipline of measuring and comparing the results of key 1. To free up time for planning and organizing.
work processes with those of the best performers. 2. To help the nurse manager learn how to properly and
Regulatory requirements – the Joint commission (JC) effectively manage and develop employees.
has developed standards to guide critical activities 3. To keep the nurse manager from ‘spreading
performed by the health care organizations him/herself too thin’.
Preparation for an accreditation survey and the survey 4. Delegation encourages open communication and
results will provide a wealth of information and data, trust.
which can be utilized as ideas for improvement 5. It can show the nurse manager a better way of
strategies. handling people and resources.

Other Improvement Strategies Principles of Delegation:

Sentinel Event Review – is an unexpected occurrence Select the right person to whom the job is to be
involving death or serious physical or psychological delegated
injury to a patient. Events are called sentinel because
they require immediate investigation. Delegate both interesting and uninteresting tasks
Measurements - to assess and monitor outcomes, Uninteresting job can be used to challenged, motivate,
health care organizations collect and report measures at and increase a person’s performance and commitment
various levels in the organizations. Interesting jobs- draw out the best among employees
and inspire them to high achievement.
Other Improvement Strategies Provide subordinates with enough time to learn
Storyboard: How to share Your Story – QI teams share Expertise can be achieved through training and
their work with others using a storyboard. experience.
 - Delegate gradually both of them should go hand in hand
New employee may not be able to assume full if a subordinate is given a responsibility to perform a
responsibility as employees who have stayed longer on task, at the same time he should be given enough
the job. independence and power to carry out that task
- Delegate in advance effectively
Specify goals and objectives to be met within a set time
frame. Principles of Delegation
- Consult before delegating Principle of Authority level
Clarifications minimize problems and promote -suggests that a nurse manager should
teamwork. exercise his authority within the
- Avoid gaps and overlaps jurisdiction / framework given
A gap occurs when a job is left out with no one taking
responsibility. -before a nurse manager takes any important decision,
he should make sure that he has the authority to do so
STRATEGIES TO ENSURE EFFECTIVE DELEGATION: -emphasizes the degree of authority and the level up to
Plan ahead which it has to be maintained
Identify Necessary skills and levels Delegation of Authority:
Select Most Capable Personnel is an organizational process wherein, the manager
Communicate Goal Clearly divides his work among the subordinates and give them
the responsibility to accomplish the respective tasks.
STRATEGIES TO ENSURE EFFECTIVE DELEGATION: Along with the responsibility, he also shares the
Empower the delegate authority, i.e. the power to take decisions with the
Set Deadlines and Monitor Progress subordinates, such that responsibilities can be
Model the Role: Provide Guidance completed efficiently.
Evaluate Performance
Reward Accomplishment Elements of Delegation of Authority
There are three major elements of delegation of
Delegated tasks must be based on authority:
• Policies Elements of Delegation
• Job Description 1. Authority
• Capabilities of Workers - the right to delegate duties and give direction, to take
decisions and to give orders so as to achieve the
Policies/Procedures/Rules and Regulations - these are organizational objectives
the standing Plans of an organization. Authority should be accompanied with an equal amount
of responsibility.
Nursing service exists for the standardization & as a 2. Responsibility
source of guidance for the nursing staff - is the duty of the person to complete the task assigned
Policies promote consistency of action and stability. to him.
They speed up decision making A person who is given the responsibility should ensure
Policies conserve time by setting standards that he accomplishes the tasks assigned to him.
involves reliability. dependability, and the obligation to
- Uniformity of standards promotes fairness and accomplish work when assignment is accepted.
prevents conflicts The person held responsible for a job is answerable for
- Policies are usually written and made available it.
as manuals
- Procedure manual outlines a standard Differences between Authority and Responsibility
technique or method in performing duties being responsible and answerable for actions or
- Serves as a guide for action inactions of self or others in then context of delegation.
- Manuals are used by employees to orient them Accountability can not be delegated.
to procedures For example, if ’A’ is given a task with sufficient
- Principles of Delegation authority, and ’A’ delegates this task to B and asks him
- Principle of Result Expected to ensure that task is done well, responsibility rest with
’B’, but accountability still rest with ’A’. The top level
Suggests that: management is most accountable.
-every nurse manager before delegating the powers to
the subordinate should be able to clearly define the What are the Common Delegation Errosr?
goals as well as results expected from them - Underdelegating
-goals and targets should be completely and clearly - Overdelagating
defined and the standards of performance should also - Improperly Delegating
be notified clearly
Common Delegation Errors:
Principle of Parity of Authority and Responsibility Underdelegating – manager’s false assumption:
the nurse manager should keep a balance between delegation may be interpreted as the lack of ability on
authority and responsibility his or her part to do the job correctly or completely
Manger’s desire to complete the whole job personally
due to lack of trust in the subordinates

Over delegating – Careful not to over delegate to

exceptionally competent employees, because they may
become overworked and tired, which can decrease their
productivity.

Improperly Delegating – delegation of tasks and

responsibilities beyond which the person cannot
perform properly. delegating at the wrong time, to the
wrong person, or for the wrong reason

What Cannot be Delegated?

Responsible for maintaining morale or the opportunity

to say a few words of encouragement to the staff
especially the new ones.
Jobs that are too technical and those that involve trust
and confidence.

Why Nurse Managers do not delegate?

Lack of confidence in their staff

Feels that they are the only one who can do the tasks
and much faster
Mistakes in delegation can be costly.
Failure to delegate wisely increases management costs
and contributes to personnel dissatisfaction.
Fear of losing control of the staff.
Fear of failing to get others do the work.
Fear of criticism.

Effective Delegation
Effective ways of delegation for nurse managers
• Train and develop subordinates.
• Plan ahead.
• Control and coordinate the work of subordinates but
do not peer over their shoulders.
• Follow-up by visiting subordinates frequently.
• Coordinate to prevent duplication of effort.
• Solve problems and think about new ideas.
• Accept delegation as desirable.

Effective ways of delegation for nurse managers

• Accept delegation as desirable.
• Specify goals and objectives.
• Know subordinates capabilities and match the task or
duty to the employee.
• Agree on performance standards.
• Take an interest in employees.
• Assess results.
• Give appropriate rewards.
• Do not take back delegated tasks.