nursing management process
TRANSCRIPT
NURSING NURSING MANAGEMENT MANAGEMENT
PROCESSPROCESS
NURSING MANAGEMENTNURSING MANAGEMENT Is the process of working through staff Is the process of working through staff
members to be able to provide members to be able to provide comprehensive care to the patientcomprehensive care to the patient
This includes planning, organizing, directing This includes planning, organizing, directing and controllingand controlling
The task of the nurse manager is to plan, The task of the nurse manager is to plan, organize, direct and control available organize, direct and control available financial, material, and human resources in financial, material, and human resources in order to provide effective, economic care to order to provide effective, economic care to groups of patientsgroups of patients
ORGANIZING
CONTROLLING
PLANNING
DIRECTING/ LEADING
STAFFING
Purpose of the Nursing Management Process
To achieve scientifically – based, holistic, To achieve scientifically – based, holistic, individualized care for the patientindividualized care for the patient
To achieve the opportunity to work To achieve the opportunity to work collaboratively with patients and otherscollaboratively with patients and others
To achieve continuity of careTo achieve continuity of care
Characteristic of Nursing Management Process
SystematicSystematicDynamicDynamic InterpersonalInterpersonalGoal DirectedGoal DirectedUniversally ApplicableUniversally Applicable
PRINCIPLES OF NURSING PRINCIPLES OF NURSING MANAGEMENTMANAGEMENT
1. Nursing Management is planning1. Nursing Management is planning
2. Nursing Management is effective use of 2. Nursing Management is effective use of timetime
3. Nursing Management is decision making3. Nursing Management is decision making
4. Meeting patient’s nursing care needs is 4. Meeting patient’s nursing care needs is the business of the nurse managerthe business of the nurse manager
5. Nursing Management is the formulation 5. Nursing Management is the formulation and achievement of social goaland achievement of social goal
6. 6. Nursing Management is organizingNursing Management is organizing
FOUR BUILDING BLOCKS OF FOUR BUILDING BLOCKS OF NURSING MANAGEMENTNURSING MANAGEMENT
1. Unit1. Unit
2. Department2. Department
3. Executive officer leader3. Executive officer leader
4. Operational Level – 4. Operational Level – organizational structureorganizational structure
7. Nursing Management denotes a 7. Nursing Management denotes a function, social position or rank, a function, social position or rank, a discipline and a field of studydiscipline and a field of study
8. Nursing Management is the active 8. Nursing Management is the active organ of the division of nursing of organ of the division of nursing of the organization and of the society in the organization and of the society in which it functionswhich it functions
9. Organizational culture reflects 9. Organizational culture reflects values and beliefsvalues and beliefs
10. Nursing Management is directing 10. Nursing Management is directing and leadingand leading
11. A well manage division of nursing 11. A well manage division of nursing motivates employee to perform motivates employee to perform satisfactorysatisfactory
12. Nursing Management is effective 12. Nursing Management is effective communicationcommunication
13. Nursing Management is 13. Nursing Management is controlling or evaluatingcontrolling or evaluating
3 LEVELS OF SKILLS MANAGEMENT IN NURSING:
1. Conceptual skills refers to an individual’s mental ability to
coordinate a variety of interests and activities.
2. Interpersonal skills refer to interpersonal styles which mean the
ways in which individuals interact and communicate with others
3. Technical skills are the tools, procedures, and
techniques that are unique to the nurse manager’s specialized situation
NURSING MANAGEMENT PROCESS: focuses on:
PlanningOrganizingStaffingDirecting or leadingControlling
PLANNINGPLANNING Is deciding in advance what to do, how to
do a particular task, when to do it, and who is to do it.
Is predetermining a course of action in order to arrive at a desired results.
Components of PlanningComponents of Planning
PLANNING:PREDETERMINED
ACTION
WHAT TO DO:-nursing activities
HOW TO DO IT:-technique,principles
WHO IS TO DO IT:-professional,
nonprofessional
Is predetermining a course of action in order to arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them , which is subject to change as new facts are known.
PRINCIPLES OF PLANNING
1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization.
2. Planning is a continuous process.3. Planning should be pervasive within
the entire organization covering the various departments, services and the various levels of management to provide maximal cooperation and harmony.
4. Planning utilizes all available resources.
5. Planning must be precise in its scope and nature.
6. Planning should be time bounded.7. Projected plans must be
documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement
Reasons for PlanningReasons for Planning It leads to success in the achievements of goals
and objectives It provides meaning to work It provides for the effective use of available
personnel and facilities It helps nurses cope with crises and problems
calmly and efficiently It is cost effective It is based on past and future activities It reduces the element of change It is necessary for effective control
Characteristics of a GOOD PLANIt should have a clearly worded
objectives, including results and methods for evaluation
Be guided by policies and/or procedures affecting the planned action
Indicate priorities
Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities and time
Develop a logical sequence of activities
Select the most practical methods for achieving each objective
TYPES OF PLANNING1. STRATEGIC OR LONG-RANGE PLANNING
“what are the right things to do”
- usually extending 3 to 5 years into the future.
2. OPERATIONAL OR SHORT-RANGE PLANNING
“how does one do things right”
- deals with day to day maintenance activities.
3. CONTINUOUS OR ROLLING PLANS - similar to operating plans, involves mapping
out the day-to-day activities.
Approaches in Planning:Approaches in Planning:Reactive PlanningReactive Planning – is done in response to – is done in response to
an existing problem.an existing problem. Increase incidence of post op infectionIncrease incidence of post op infection Increase staff turn overIncrease staff turn overStaff absenteeismStaff absenteeism
Proactive PlanningProactive Planning – done before a – done before a problem occurs. It may done in problem occurs. It may done in anticipation of changing needs or to anticipation of changing needs or to promote growth & excellence.promote growth & excellence.
ELEMENTS OF PLANNINGForecasting or Estimate the futureSet Objectives/Goals and Determine Results
DesiredDevelop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame
Prepare the Budget and Allocation of Resources
Establish Policies Procedures and Standards
Elements of PlanningElements of Planning--Forecast or Estimate the Future-Forecast or Estimate the Future- Forecasting is looking into the future Refers to estimation of time series, cross
sectional or longitudinal data In making forecast, the planner should consider
3 things: Agency Community affected Goals of care
Forecast must be supported by facts, reasonable estimates and accurate reflection of policies and plans
Elements of PlanningElements of PlanningSet Objectives/Goals and Determine Results Set Objectives/Goals and Determine Results
DesiredDesired GOALS are broad statements of intent derived
from the purposes of the organization. Is a desired aim or condition toward which one is
willing to work Individual goals- are personal goals; based on one’s
desired in life Group goals- may refer also to organizational goals
although on a smaller scale Organizational goals- management goals of an
organization that are established to justify its existence
They are the potential result that will move the org. closer to its vision & mission
Objectives –Objectives –- specific aimsspecific aims, purposes or targets set for , purposes or targets set for
accomplishment.accomplishment.- Should include plan of action to facilitate the Should include plan of action to facilitate the
accomplishment of needs or desired goals.accomplishment of needs or desired goals.- Should answer the questions of:Should answer the questions of:
whowho WhatWhat Where, andWhere, and WhyWhy And be flexible enough to allow for changes or And be flexible enough to allow for changes or
elimination when they are no longer useful.elimination when they are no longer useful.
The objectives of the Nursing Department is congruent to its vision as well as to the 11 key areas of responsibilities to nursing practice:
To observe ethical principles and standards that govern nursing practice. (ethico-moral-legal responsibilities)
To establish well coordinated referral system for the continuity of patient’s/ client’s care. (communication)
To assure the application of acceptable performance of functions, duties, and responsibilities of every position in the nursing department. (safe & quality nursing care, management of resources)
To encourage its nursing personnel to participate in nursing research for improving nursing care. ( research)
To utilize media for information campaign to intensify health education program. (health education)
- - ELEMENTS OF PLANNING-ELEMENTS OF PLANNING-
MISSION OR PURPOSE- The mission statement outlines the agency’s reason for existing ( whether hospital or health care), who the target clients are ( the poor, the needy, the middle or upper class), and what services will be provided ( in-patient, out-patient, emergency).
- reason for the existence of the organization (Nursing service exist to promote and maintain health)
-What is the reason for existence?- What do you have to offer to our clients?- What makes us unique and distinct from
competitors?- What we are doing and what we are going
to do in pursuit of the vision?- Mission is broadly stated definition of:
- Who are our primary clients/ customers?- What are the major products & services?- What are the organization’s basic technologies?
MissionMission The BON shall unwaveringly pursue the
advancement of nursing development in the country by:
1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders
2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws
3. unifying the nursing sector through good governance
4. fostering linkages with the domestic and international stakeholders
Vision:Vision: A thought, concept or objective formed by A thought, concept or objective formed by
the imagination.the imagination.What do you want to create within a What do you want to create within a
certain period of time?certain period of time?What do you want to be?What do you want to be?Where do you want to be?Where do you want to be?
Vision
The Board of Nursing under the guidance of the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.
PHILOSOPHY- Philosophy is the sense of purpose of the
organization and the reason behind its structure and goals.
- Philosophy states the beliefs that influence nursing practice and beliefs about health care.
- What kind of nursing service would you believe on that will provide efficiently and effectively nursing care according to the clients need for care?
- What staffing status should you set up towards adequate staffing patterns base on the level of acuity of the clients?
POLICIESPolicies in general, they are guidelines to
help in the safe and efficient achievement of organizational objectives.Policy Manual must contain all the guides
necessary to operate Nursing Service.
PROCEDURESProcedures are specific directions form
implementing written policies.Procedure Manual must contain all necessary
nursing procedure that are being performed relative to patient care.
Elements of PlanningElements of Planning Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame
Strategy is the techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives.
Programs are activities put together to facilitate attainment of some desired goals.
Time Management is a technique for allocation of one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goals efficiently
Principles of Time Management
1) Planning for contingencies-planning anticipates the problem that will arise from actions without thought
2) Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance
3) Inventory4) Sequencing5) Setting and keeping deadlines- and adhering to
deadline is an excellent exercise in self discipline
6) Deciding on how time will be spent
Time Saving Techniques, Devices and Time Saving Techniques, Devices and Methods to Better Use of TimeMethods to Better Use of Time
1. Conduct an inventory of your activities.1. Conduct an inventory of your activities.2.2. Set goals and objectives and write them down.Set goals and objectives and write them down.3.3. With the use of calendars, executive planners, logs or With the use of calendars, executive planners, logs or
journals, write what you expect to accomplish yearly, journals, write what you expect to accomplish yearly, monthly, weekly or daily.monthly, weekly or daily.
3.3. Break down large projects into smaller parts.Break down large projects into smaller parts.4.4. Devote a few minutes at the beginning of each day for Devote a few minutes at the beginning of each day for
planning.planning.5.5. Organize your work space so it is functional.Organize your work space so it is functional.6.6. Close your door when you need to concentrate.Close your door when you need to concentrate.7.7. Learn to delegate.Learn to delegate.8.8. In a meeting, define the purpose clearly before starting.In a meeting, define the purpose clearly before starting.9.9. Take or return phone calls during specified time.Take or return phone calls during specified time.10.10. Develop effective decision-making skills.Develop effective decision-making skills.11.11. Take rest breaks and make good use of your spare time.Take rest breaks and make good use of your spare time.
Multitasking
Part of daily life & becomes a way of life.Trying to get more things done in less time
which does not really make a person more efficient.
Ex. Nurse is asked to do a lot of things, any one of
which may demand her full attention.The net effect of multi tasking, when several
task are done at once, some of them end up being performed in a haphazard manner which can have disastrous consequences.
DEVELOPING AND SCHEDULING PROGRAMS Programs are predetermined, developed and
targeted within a time frame to reach the set goals and objectives.
The Planning Formula WHAT WHEN WHERE HOW WHO WHY CAN
Elements of PlanningElements of PlanningPrepare the Budget and Allocation of Prepare the Budget and Allocation of
ResourcesResourcesPREPARING THE BUDGET
A budget is the annual operating plan, a financial “road map” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs.
A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year.
A hospital budget is a financial plan to meet future service expectations.
Factors in BUDGET planning Type of patient, length of stay in the hospital and
acuteness of illness Size of hospital and bed occupancy Physical lay out of the hospital, size and plan of
the wards, units, nurse’s station, treatment rooms, etc
Personnel policies Salaries paid to various type of nursing personnel
including OT pay or shift differential Extent of VL, SL, holidays Provision for staff development programs
Grouping of patients such as those in specialized areas
Standards of nursing care: kind and amount of care to be given as it affects the number of hours of bedside care
The method of performing nursing care whether simple or complex; the method of documentation
Proportion of nursing care provided by the professional nurses and those given by nonprofessionals
Amount and quality of supervision available and provided; the efficiency of job description and job classification
Method of patient assignment whether functional, case, team or primary
Amount and kind of labor-saving devices and equipments
Amount of centralized service provided: sterile supply , central o2 supply, linen supply
Nursing service requirements of the ancillary departments: clinics, admitting office, ER
Reports required by administration whether simple or complex
Affiliation of nursing students or medical students
Elements of PlanningElements of PlanningEstablishing Nursing Standards, Policies & Establishing Nursing Standards, Policies &
ProceduresProceduresNursing Standards
Standard- a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which quality of practice or education can be judged
Nursing Care Standard – a descriptive statement desired quality against which to evaluate nursing care
Purpose of nursing standards Improved quality of care Decrease the cost of nursing care Determine nursing negligence
Sources of nursing standardsDOH, BON, Professional Organization, Nursing Programs
Nursing Service Policies
Policies in general are guidelines to help in safe and efficient achievement of organizational objectives.
Standing plans of the nursing organization. They are the conceptual plans that are translated
into physical entities usually called manuals. Usually develop by a policy committee. At nursing division level, committee is made of
representatives from nursing specialist and top nursing management.
There are 3 general areas in nursing which requires policy formulation. These are:
Areas in which confusion about the locus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfare
Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property
Areas involving matters of personnel management and welfare
Nursing proceduresProcedures are specific directions for
implementing written policiesManual contains detailed plans for
nursing skills ( procedures) that include steps is proper sequence.
Procedures outline a standard technique or method for performing duties and serve as a guide for action.
Phases of PlanningPhases of PlanningPhase I: Developing the PlanPhase I: Developing the Plan
Developing a plan is to establish its purpose.Developing a plan is to establish its purpose.Must be clear about the purpose of planning Must be clear about the purpose of planning
to avoid confusion.to avoid confusion.However, purpose may be stated in broad However, purpose may be stated in broad
terms until through assessment of the terms until through assessment of the situation is done or problem is donesituation is done or problem is done
Example: Reduce children & adult morbidity Example: Reduce children & adult morbidity rates in Brgy. Dosrates in Brgy. Dos
When assessing the situation/ problem:When assessing the situation/ problem: Information to confirm or revise the identified Information to confirm or revise the identified
problem is needed.problem is needed.When problems & environmental situations When problems & environmental situations
are already assessed – objectives are are already assessed – objectives are formulated.formulated.
Objectives should be written as measurable Objectives should be written as measurable so that they can serve a guidelines for so that they can serve a guidelines for evaluation.evaluation.
Example: The occurrence of communicable Example: The occurrence of communicable diseases among children in brgy. Dos will be diseases among children in brgy. Dos will be reduced by 50% in 2008, 80% in 2009 and reduced by 50% in 2008, 80% in 2009 and 100% by 2012.100% by 2012.
Phase II. Presenting the Plan:Phase II. Presenting the Plan:Plans for projects are presented to Plans for projects are presented to
admin/management for approval.admin/management for approval.Planner needs to be persuasive in Planner needs to be persuasive in
convincing othersconvincing others to accept the plan.to accept the plan.Must be presented in organized manner Must be presented in organized manner
& clearly, concise and direct in & clearly, concise and direct in professional manner.professional manner.
Phase III: Implementation & monitoring:Phase III: Implementation & monitoring:Identifying & arranging activities Identifying & arranging activities
according to sequence.according to sequence.Setting target dates for completing each Setting target dates for completing each
activityactivityAssignment of responsibilities to Assignment of responsibilities to
particular individualsparticular individualsAllocation of resourcesAllocation of resources
ORGANIZING:ORGANIZING:
ORGANIZINGis the process of establishing formal authority.Involves setting up the organizational
structure through identification of groupings, roles and relationships.
Determines staff needed through developing and maintaining staffing patterns and distributes them in the various areas as needed.
Develops job descriptions by defining thequalifications and functions of personnel
Organizing is one way which nursing management coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion.
Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies.
6 Steps in organizing:6 Steps in organizing:1.1. Establishing Establishing enterprise objectivesenterprise objectives2.2. FormulatingFormulating supporting objectives, policies and supporting objectives, policies and
plansplans3.3. Identifying Identifying and and classifyingclassifying activities necessary activities necessary
to accomplish the objectives to accomplish the objectives 4.4. GroupingGrouping these activities in the light of human these activities in the light of human
and material resources availableand material resources available5.5. DelegatingDelegating the head of each group to perform the head of each group to perform
the activitiesthe activities6.6. Trying together the Trying together the group horizontally and group horizontally and
verticallyvertically, through authority relationships and , through authority relationships and information flows.information flows.
1.1. Development of mission, philosophy, and Development of mission, philosophy, and objectivesobjectives
2.2. Development of organizational charts. Development of organizational charts. - indicates who has the legitimate power - indicates who has the legitimate power to make decisions and who should give to make decisions and who should give and receive directionsand receive directions
3.3. Development of job descriptionsDevelopment of job descriptions- a written account of the organizational - a written account of the organizational relationships, responsibilities, and skills relationships, responsibilities, and skills required for appointment and a resume required for appointment and a resume of duties delegated to the position by top of duties delegated to the position by top managementmanagement
Organizational StructureOrganizational Structure- A framework in which the management A framework in which the management
process is carried out in an organizationprocess is carried out in an organization
Designed to:Designed to:1.1. show clear show clear lines of authoritylines of authority, , 2.2. flow of communicationflow of communication and and 3.3. relationships relationships among departments, and among departments, and 4.4. to to pinpoint pinpoint person/s responsible and person/s responsible and
accountableaccountable
Upper levels
Middle Levels
LowerLevel
Patterns of Organizational Structure
Tall or Centralized StructureFlat or Decentralized Structure
TALL OR CENTRALIZED STRUCTURE
Responsible for only a few
subordinates, so there
is a narrow span of control
Because of the vertical
nature of the structure,
there are many levels
of communication
TALL OR CENTRALIZED STRUCTURE
Flat or Decentralized Structures Refers to an
organizational structure with few or no levels of intervention between management and staff, where decision making is spread among people. Communication from lower to higher levels is easy and direct.
Flat or Decentralized Structure
Types of Organization Classified by Nature of Authority
Line Organization- Informal Organization- Staff Organization- Functional Organization Ad Hoc OrganizationAd Hoc Organization Matrix OrganizationMatrix Organization
TYPES OF ORGANIZATIONAL STRUCTURE
Line Organization-
each position has
general authority
over the lower positions
in the hierarchy.
(also known as Bureaucratic/Pyramidal)
Informal Organization- (Flat or horizontal organization)refers to horizontal relationship rather than vertical.
Staff Organization – Staff Organization –
Is purely advisory to Is purely advisory to
the line structure w/ the line structure w/
no authority to putno authority to put
recommendationsrecommendations
into action.into action.
DIRECTOR
TRAINING OFFICERCHIEF NURSE
DIRECTOR
SN SN SN
Training OfficerChief Nurse
Functional Organization-
purely advisory to the line
structure with no authority
to put recommendations
into action
CEO
Nursing Pharmacy StoreroomDietary
Ad Hoc OrganizationAd Hoc Organization – – modification of the modification of the bureaucratic structure bureaucratic structure and used as temporary and used as temporary basis to facilitate basis to facilitate completion of a completion of a project within a project within a formal line formal line organizationorganization
Matrix OrganizationMatrix Organization – – designed to focus on designed to focus on both products and both products and function. It has both function. It has both vertical and vertical and horizontal chain of horizontal chain of command. Most command. Most complex organization complex organization structure.structure.
SN SN
SN
CN
Concentric or CircularConcentric or Circular - - shows outward flows of communication from center
PRINCIPLES OF ORGANIZATION
Communication: effective and open communication in all
forms; thread that binds the organization together.Directions of communication:Downward UpwardLateral/HorizontalOutward
UPWARDUPWARD
(to superior)(to superior)
HORIZONTALHORIZONTAL NURSES NURSES OUTWARDOUTWARD
(peer)(peer) (IFC) (IFC)
DOWNWARDDOWNWARD
( subordinates)( subordinates)
Downward- ex: policies,rules, Downward- ex: policies,rules, regulations, performance appraisalregulations, performance appraisal
Upward – ex: grievance procedure, Upward – ex: grievance procedure, incident reports, written reportsincident reports, written reports
Horizontal/ lateral - endorsementsHorizontal/ lateral - endorsements Outward - image to the publicOutward - image to the public
Unity of Command – employee has one supervisor and one plan for a group activity with same objective.
Span of Control - the number of employees that the number of employees that one supervisor manages in an organization. one supervisor manages in an organization. To determine the span of control:To determine the span of control:
• Limit the number of subordinates that you can Limit the number of subordinates that you can effectively inspire, animate, direct, and effectively inspire, animate, direct, and coordinatecoordinate
• Note that too few immediate subordinates Note that too few immediate subordinates result in oversupervision; too many in result in oversupervision; too many in undersupervisionundersupervision
• Be responsible for the actions of subordinatesBe responsible for the actions of subordinates
Delegation of authority – determine the line and staff of authority which delineates the distribution of power.
Similar Assignments - responsibilities assigned responsibilities assigned to a particular unit of an organization should be to a particular unit of an organization should be clear-cut and well understood. clear-cut and well understood.
Guidelines to follow:Guidelines to follow:• Do not assign a function to more than one independent unit of Do not assign a function to more than one independent unit of
the organization. Overlapping responsibilities causes confusion the organization. Overlapping responsibilities causes confusion and delayand delay
• Assign definite and clear cut responsibilities to each member of Assign definite and clear cut responsibilities to each member of the organizationthe organization
• Never permit an organization to grow so elaborately as to Never permit an organization to grow so elaborately as to hinder work assignmenthinder work assignment
• Assign specific, clear-cut, and similar functions to subordinates.Assign specific, clear-cut, and similar functions to subordinates.• Assign every necessary function to a specific individual.Assign every necessary function to a specific individual.
Unity of Purpose - definite plans must be definite plans must be formulated based upon the objectives, formulated based upon the objectives, policies, standards and work procedures policies, standards and work procedures previously accepted by the organization.previously accepted by the organization.
Every component in an organization Every component in an organization should work toward unity of effort and should work toward unity of effort and authority and that responsibility for each authority and that responsibility for each action should be decentralized to the units action should be decentralized to the units and individuals responsible for the actual and individuals responsible for the actual performance of operations.performance of operations.