Management Process

Directing
 Directing/Leading
The issuance of orders, assignments, and
instructions that enable the nursing personnel
to understand what are expected of them.
This includes supervision and guidance so
that in doing their jobs well and maximally
contribute to the organization’s goal and to the
objectives of the nursing service.
This actuates efforts to accomplish goals and
it is a connecting link between organizing for
work and getting the job done.
 It must be complete, understandable and
given in a logical order.
Too many directions given at one time often
result in confusion and poor performance.
Written directions prevent
misunderstanding. Clear directions, follow-up
and supervision help maintain quality of work.
Giving directions in a courteous manner
encourages cooperation, interest, and better
performance in the jobs.
This includes:
delegation of work to be performed,
utilization of policies and procedures,
supervision of personnel,
coordination of services,
communication,
staff development, and
making decisions.
Five Rights of Delegation
1. Right tasks
2. Right circumstances
3. Right persons
4. Right direction/communication
5. Right supervision
Outcomes of Effective Delegation
1. Protect patient safety
2. Achieve desirable patient outcomes
3. Provide accountability for nursing care
4. Decrease nurse liability
“Never tell people how to do
things. Tell them what you want
to achieve, and they will
surprise you with their
ingenuity. George Patton, 1944
 Elements of Directing
Delegation
Supervision
Power
Time Management
Motivation
Communication
Coordination
Delegation
The process by which a manager assigns
specific tasks/ duties to workers with
commensurate authority to perform the job.
The ultimate responsibility and
accountability rest with the Manager who
delegates the task.
It also trains and develops staff members
who desire greater opportunities and challenges
in their work making them more committed
and satisfied in their jobs.
Criteria of paramount
importance in delegation
Worker’s job description
His/her knowledge base
Ability to carry out the task
Fairness to the employee and the team as
a whole
Principles of Delegation
1. Select the right person to whom the job is to be
delegated.
2. Delegate both interesting and uninteresting task.
3. Provide subordinates with enough time to learn.
4. Delegate gradually.
5. Delegate in advance.
6. Consult before delegating.
7. Avoid gaps and overlaps.
Benefits of Delegation
Frees manager to handle complex problems
when others may be better prepared
Provides learning or “stretching”
opportunities
Increases power
Rules of Delegation
The manager cannot delegate total
responsibility.
Do not delegate responsibility without
authority.
Delegate to the right person, at the right time,
and for the right reason.
Say no when you must.
Reward.
Don’t delegate only the “boring” jobs
What Cannot Be Delegated
There are matters that cannot be delegated,
these are
1. Overall responsibility, authority, and
accountability for satisfactory completion of
all activities in the unit.
2. Authority to sign one’s name is never
delegated.
3. Evaluating the staff and/ or taking necessary
corrective or disciplinary action.
4. Responsibility for maintaining morale or
the opportunity to say a few words of
encouragement to the staff especially to
new ones.
5. Job that are too technical and those that
involve trust and confidence.
Why Nurse Managers Do Not Delegate
Lack of confidence in their staff
Feeling that they can do the task better and
faster
Fear of loss of control if some of their duties
are delegated
Subordinates may be apprehensive in
accepting delegated tasks for fear of criticism,
ineptitude, or incompetence
Nursing Care Assignment
Four Basic Methods
1. Functional Nursing
This kind of nursing modality is task-oriented in which
a particular nursing function is assigned to each other.
Advantages:
It allows most work to be accomplished in the
shortest time possible
Worker learn to work fast
They gain skill faster in a repetitive tasks
Disadvantages:
Fragmentation of nursing care; holistic care is
not achieve
Diminished nurse’s accountability and
responsibility
Patient cannot identify who is their “real nurse”
Nurse-patient relationship is not fully developed
Evaluation of nursing care is poor and outcomes
are rarely documented
Difficult to find a specific person who can
answer the patient’s or relatives’ questions
2. Total Care or Case Nursing
One nurse is assigned to one patient for the
delivery of total care.
The nurse plans, coordinates, implements,
evaluates, and documents the nursing care given
within a shift.
This is a common assignment for private duty
nurses, in special care units such as ICU and in
isolation, and nursing students.
In this modality, the nurse is accountable for
his/her actions.
Advantages
Consistency of one individual caring for patients
for an entire shift
It enables the patient, nurse, and family to develop
a relationship based on trust
Nurse has more opportunity to observe and
monitor progress of the model
Disadvantage
It utilize a high level of RN hours to deliver care
and are more costly than other models of delivery
3. Team Nursing
A decentralized system of care in which a
qualified professional nurse leads a group of nursing
personnel in providing for the nursing needs of a
group of patients through participative effort.
The team leader assigns patients and tasks to
team members according to job descriptions and
responsible for coordinating the total care of a group
of patients.
The heart of team nursing is the team conference
and the intent is to provide patient-centered care.
Advantages
The RN is able to get work done through others
Require the RN to have very good delegation and
supervision skills
Communication is complex
Disadvantages
Patients often receive fragmented, depersonalized
care
Shared responsibility and accountability can cause
confusion and lack of accountability
4. Primary Nursing
A form of assigning responsibilities for patient
care, is an extension of the principle of
decentralization of authority.
The RN is responsible for the total care of a small
group of patients from admission to discharge.
The primary nurse assesses the patient’s needs for
care, sets care goals, writes nursing care plan,
implement plan, evaluate the outcomes of care, and
make necessary changes when necessary.
It assumes a 24-hour responsibility for nursing
care.
Advantages
Provision of increased autonomy;
Increasing motivation, responsibility, and
accountability;
 It ensure continuity of care;
Makes available the increased knowledge of the
patient’s psychosocial and physical needs;
Increased rapport and trust between the nurse
and the patient; therapeutic relationship;
Improves communication with the members of
the health team;
Eliminates the use of nursing aid in the provision
of nursing care.

Disadvantages
High cost because of higher RN skill mix
With no geographical boundaries within the unit
Nurse-patient ratios must be realistic to ensure
that enough nursing time is available to meet the
patient care needs
Other Nursing Assignments
Modular Method
A modification of team and primary nursing. The
RN provides direct nursing care with the assistance
of aides.
The professional nurse provides leadership,
support, and instruction to the non-professional
nursing personnel.
The greatest responsibility falls on the RN who
assesses the patient’s needs, plans and implements
care, and evaluate outcomes including guiding and
instructing his/her partners.
Case Management
A system of patient care delivery that focuses on
the achievement of outcomes within effective and
appropriate time frames and resources.
care is directed by a case manager who ideally is
involved in a group practice.
Case manager is responsible for the assessment of
patient and family, formulating nursing diagnosis,
develop nursing care plan, delegates nursing care to
associates, actuates interventions, coordinate and
collaborates with interdisciplinary team, and
evaluates outcomes of care.
Supervision
“Supervise” comes from the word “supervide”,
means to oversee or view directly. The result is the
attainment of the a service that is both efficient and
effective.
It provides guidelines for the accomplishment of
a task with initial direction and periodic inspection
of the actual accomplishment of the tasks or activity.
Supervisors should bring to management’s
attention concerns that affect quality nursing care
such as inadequate staffing and resources.
Qualities of Good Supervision
1. Good technical, managerial and human relation
skills;
2. Ability to communicate well in both written and
spoken language and ability to listen;
3. Flexibility in every situation;
4. Fairness in dealing with employees;
5. Familiarity with hospital and nursing policies
6. Good decision-making skills;
7. Willingness to grow and develop;
8. Ability to accept changes and consider them
as challenges;
9. Dignified and pleasing personality;
10. Ability to motivate employees and provide
opportunities for continuing professional
growth and development; and
11. Advocacy for nurses and nursing.
Principles of Good Supervision
1. Requires adequate planning and organization
which facilitate cooperation, coordination, and
synchronization of services.
2. Gives autonomy to workers depending on their
competency, personality and commitment.
3. Stimulates the worker’s ambition to grow into
effectiveness.
4. Create an atmosphere of cordiality and trust.
5. Considers the strengths and weaknesses of
employees.
6. Strives to make the unit an effective learning
situation. It promotes a teaching-learning
environment where learners are stimulated
to exercise critical thinking and creativity in
patient care.
7. Considers equal distribution of work
considering age, physical condition, and
competence.
Techniques in Supervision
Observation of the worker while making the rounds;
Spot checking of charts through nursing audits;
Asking the patients about the care they receive;
Looking into the general condition of the units;
Getting feedback from co-workers or supervisor or
relatives;
Asking question discretely to find out the problem
encounter;
Drawing out suggestions from the workers for
improvement of their work.
Participatory Management
There is mutual trust and support and
increased accountability of the Head Nurse and
of employee through self supervision.
High morale and team work result in
increased effectiveness and productivity and
increased commitment and recognition of
contribution.
Leading
Means “to guide, to go before and show the way”.
It includes:
The leadership roles
Leadership qualities

Leadership styles

Leadership skills

Essential qualities of Nurse leaders

Power
Means being to make change and to prevent
change from happening.
Power has the energy to initiate and sustain
action.
The ability to act and influence others.
The ability to impose the will of one
person/group to bring about certain behaviors in
other person or group.
Forms of Power
1. Legitimate Power – given to a manager by nature
of his position in the organization. E.g. Head Nurse
2. Reward Power – base on the ability of the
manager to administer reward to others.
3. Coercive Power – founded on the managers to use
punishment on others for non-compliance with
order.
4. Expert Power – derived from some special ability/
skills/knowledge demonstrated by individual.
5. Referent Power/Charismatic Power –
high level of trust and respect, leader with this is
extremely influential
6. Information Power – has significant
knowledge or understanding that is useful,
accurate and timely.
7. Connection Power – complex web of
relationship and connectedness.
Guidelines for Using Power Positively
1. Preserve credibility
2. Stay up-to-date with technology
3. Act with confidence
4. Show respect and avoid arrogance
5. Ask, don’t demand
6. Give clear directions
7. Follow-up to ensure compliance
8. Be considerate
9. Avoid expressing hostility
Make request that are reasonable
Be a positive role model
Use relationship correctly
Avoid name dropping
Be ready to reciprocate; do favors for others
Accountability – means being responsible and
liable for one’s decisions and actions.
Responsibility – being reliable and dependable.
Obliged to accomplish work and to perform at
an acceptable level based on education and
training.
Time Management
The actions that help nurses use their time most
effectively and productively and achieving more with
the time that is available.
The key is to focus effort on the activities that will
get the maximum results.

Time management actions

Prioritizing tasks
Analyzing how time is being used
Assessing distractions that detract
Motivation
All human beings are motivated by different
goals, ambitions, and aspirations.
Motive is a need or desire that incites and
directs a person’s action.
Motivation is a force within the individual
that influences strength or direction of
behavior (Mills).
The amount and quality of work
accomplished by the manager directly reflect
their motivation and that of their subordinates.
Intrinsic versus Extrinsic Motivation
Motivational Theories
Need Theory
Abraham Maslow’s Hierarchy of
Needs
The two-factor theory
McClelland’s Three basic needs Theory
Expectancy Theory
Operant Theory
Equity Theory
Communication
Communication is the transmission of
information, opinions, and intentions between
and among individuals.
It includes:
Principles of effective communication
Types of communication
Lines of communication

(* Refer to previous topics on communication)

Coordination
Coordination unites personnel and services
toward a common objective.
Synchronization of activities among the various
services and departments enhances collaborative
efforts resulting in efficient, smooth and
harmonious flow of work.
It prevents overlapping of functions, promotes
good working relationships, and ensures work
schedule are accomplish as targeted.
 Supervising Nurses, Head/Senior Nurses
coordinate their work with the other
departments, services or units by conveying
clearly defined policies, standard operating
procedures, policies and guidelines using the
proper channel of communication.
Coordination with
The Medical Service
Administrative Service
The Laboratory Service
Radiology Service
The pharmacy Service
Dietary Service
Medical Social Service
Medical Records Service
Community Agencies, Other Institutions,
and Civic Organizations
Staff Development
This is one aspect of human resource
management in nursing.
It provide structure and assistance for
employees to learn in greater depth and to
translate the knowledge, skills, abilities, and
principles learned in nursing practice within
their institution of employment.
It includes Orientation, In-service education,
Specialty courses, Formal education.
Ethical Decision Making
A decision is a course of action that is
consciously chosen from available alternatives
for the purpose of achieving a desired result.
It involves a choice utilizing the mental
processes at the conscious level and is aimed at
facilitating a defined objective.
Five Steps on the decision Making
Definition of the problem
Analysis of the problem
Development of alternative
solutions/Evaluation of alternatives
Selection of a solution
Implementation and evaluation of results
Conflict Management
Conflict is an inevitable as change in any
organization because of the complexity of
relationships within the organization, the
interaction among its members or their
dependence on one another.
Conflict means a clash between two opposing
and oftentimes hostile parties
It includes:
The recognition of sources of conflicts
Identifying the type of conflict
How to manage to minimize conflict
Use the common approaches to the
management of conflict
The common approaches to the management
of conflict are avoidance, accommodation,
compromise, collaboration, and competition.
Also include smoothing, withdrawing, and
forcing.
Basic Rules in mediating a Conflict
1. Establish clear guidelines and make them known
to all.
2. Do not postpone indefinitely. Select time for all
parties.
3. Create an environment that makes people
comfortable to make suggestions.
4. Keep a two-way communication. Encourage full
expression of positive and negative feelings with
an accepting atmosphere.
5. Stress a peaceful resolution rather than
confrontation. Build a bridge of
understanding.
6. Emphasize shared interests. Examine all
solutions and select the most acceptable to
both parties.
7. Follow up on the progress of the plan. Give
feedback to participants regarding their
cooperation in resolving the conflict.
 Thank You!
Management Process
Directing