NCM 119 LEC other’s needs).

MIDTERM
2. TECHNICAL SKILLS
NURSING MANAGEMENT PROCESS - The proficiency in performing an activity in the
correct manner with the right technique.
OVERVIEW OF THE NURSING MANAGEMENT - (ability to use the tools, equipment, procedures,
PROCESS and techniques of a specialized field)
Changes in the Health Care Delivery System
** The Philippine Nursing Law of 2002, R.A. 9173 focuses 3. CONCEPTUAL SKILLS
on 3 changes in the effort to improve people’s health: - ability to see individual matters as they relate to
1. HOSPITAL or INSTITUTIONAL CARE the total picture and to develop creative ways of
- emphasis shifted to community health delivery identifying pertinent factors, responding to the
big problems, and discarding irrelevant facts
2. PHYSICAL CARE
- efforts are now directed toward a holistic 4. POLITICAL SKILLS
approach to care of individuals, families, and - One’s ability to enhance one’s power, build a
communities power base, and establish the “right”
connections.
3. RECIPIENTS OF CARE
- patients, individuals, families, and 5. DIAGNOSTIC and ANALYTICAL SKILLS
communities are now active participants in - Ability to identify and evaluate problems and
healthcare efforts. analyze decisions made.
∞ The management process is universal. Knowledge of this
process assures nurses of the smooth functioning of their ** ALL managers must have these types of skills, but the
units in attaining their goal of quality care through the mix of skills a manager requires varies with his / her rank
judicious use of available human and materials resources in the hierarchy
within a specified time∞

THREE MAJOR AREAS OF RESPONSIBILITY BY ¤ KNOWLEDGE, ATTITUDE AND ABILITY

THE NURSE MANAGER: FACTORS:
1. KNOWLEDGE FACTOR
- refers to ideas, concepts, or principles that can be
expressed and are accepted because they have
logical proofs.

2. ATTITUDE FACTORS
- relate to those beliefs, feelings, and values that
may be based on emotions and may not be
subjected to conscious verbalization.
Include:
⬧ Interest in one’s work
⬧ confidence in one’s mental competence
⬧ desire to accept responsibility
⬧ respect for the dignity of one’s associates
⬧ desire for creative contribution

3. ABILITY FACTORS
- are abstract factors but they direct one’s thinking
DEVELOPING FUTURE MANAGERS: to factors that can be developed by an individual
¤ MANAGEMENT SKILLS ¤ manager who takes time to consider them.
1. HUMAN RELATIONSHIP SKILLS Include:
- Pertains to dealing with people and how to ⬧ skill
“get along” with them. ⬧ art
- (ability to work with and for people, to ⬧ judgment
communicate with others, and to understand
⬧ wisdom.
= Provides services for all kinds of illnesses,
diseases, injuries, and deformities.
ACADEMIC REQUIREMENTS FOR NURSING  Example: Philippine General Hospital
SERVICE ADMINISTRATORS IN THE PHIL. (Taft Avenue, Metro Manila)
1. Chief Nurses or Nursing Service Directors of Hospitals
with 100-bed capacity are required to have a Master of Arts 2. SPECIAL HOSPITALS
in Nursing (MAN) with a major in Nursing Administration. = Provide services for one particular kind of illness
2. Supervising Nurses or disease or health and medical care
- at least 9 units in graduate studies in nursing.  Example: National Kidney and Transplant Institute
(East Avenue, Diliman, Quezon City)

CONCEPTUAL FRAMEWORK OF THE NURSING

MANAGEMENT PROCESS: B. OWNERSHIP AND CONTROL:
1. GOVERNMENT HOSPITAL– operated and
controlled either partially or wholly by the
national, provincial, municipal, or city government
or other political subdivision, board, or other
agency.
2. PRIVATE OR NON- GOVERNMENTAL
HOSPITALS – are privately owned, established
and operated with funds, raised capital or other
means by private individuals, associates,
corporations, religious organizations, firms,
companies, or joint stocks corporations.

C. TRAINING AND NON-TRAINING

1. TRAINING – a departmentalized hospital with an
accredited residency training program in one or
more specified specialties or discipline
THE SETTING 2. NON-TRAINING – a hospital that may be
HOSPITAL departmentalized but without an accredited
- An integral part of a social and medical residency training program in one or more
organization, the function of which is to provide specialty disciplines
for the population it serves, complete health care,
both curative and preventive, and whose out-
patient services reach out to the family in its HOSPITAL CATEGORIES
home environment: it is also a center for the According to the Service capabilities they offer:
training of health workers and bio-social LEVEL I
research. (Expert Committee on Organization of - Municipal and medicare hospitals have facilities
Medical Care of the WHO) and capabilities for first-contact emergency or
- It is a place devoted primarily to the maintenance initial care and management of patient requiring
and operation facilities for the diagnosis, immediate treatment as well as primary care on
treatment and care of individuals suffering from prevalent diseases in the locality.
illness, disease or deformity, or in need of Clinical Services:
obstetrical or other medical and nursing care. 1. General Medicine
(Hospital Licensure Law, R.A. 4226) 2. Pediatrics
- Any institution, building or place where there are 3. Obstetrics
beds, cribs, or bassinets for 24 hour use or longer 4. Non – Surgical Gynecology
by patients in the treatment of diseases, diseased 5. Minor Surgery
condition, injuries, deformities, and all - May provide anciliary services (primary clinical
institutions such as those for convalescence, laboratory, 1st level radiology and pharmacy)
sanitorial care, infirmaries, nurseries, - Provide nursing care for patients who require minimal
dispensaries and such other names by which they category of supervised care for 24 hours or longer.
may be designated.
LEVEL 2
CLASSIFICATION OF HOSPITALS: - Non- departmentalized hospital that provide
A. CLINICAL clinical care and management on the prevalent
1. GENERAL HOSPITALS diseases in the locality requiring hospitalization.
- It has expertise of trained specialists. (hospitals • Why it will be done
with 50 beds up to 100 beds capacity) • Where it will be done
Clinical Services: • When we expect to do it
1. General medicine • How it will be done
2. Pediatrics • Who is going to do it
3. Obstetrics and gynecology
4. Surgery and anesthesia

- Administrative and Ancillary Services IMPORTANCE OF PLANNING:

(secondary clinical laboratory, first level 1. It leads to the Achievement of goals and objectives
radiology, and pharmacy) - workers relate what they do to meaningful results
- Nursing care provided in Level 1 Hospital, since plans are focus on objectives
intermediate, moderate and partial category of
supervised care for 24 hours or longer. 2. It gives meaning to work
- employees or workers experience greater
satisfaction if what they do become meaningful
3. LEVEL 3 to them
- Specialized centers, regional hospitals, medical
centers, provincial or general hospitals. They
3. It provides for effective use of available resources
have capabilities for providing medical care to
and facilities
cases requiring sophisticated diagnostic and
- the best use of personnel and material resources
therapeutic equipment and expertise of trained
prevent wastage
specialists and the sub-specialists.
Clinical Services:
1. Services provided by level 2 hospital 4. It helps in coping with crisis
2. Specialty clinical care - Hospital should provide for disaster plans. This
- Nursing Care provided in level 3 hospital as well as allow workers to function more clearly and
continuous and highly specialized critical care effectively when actual emergencies occur such
as typhoons, earthquakes, or during New years
celebration or other occasions where more
4. SPECIAL TERTIARY LEVEL people are likely to get hurt
- Composed of special tertiary centers in particular
which are fully equipped with sophisticated 5. It is cost effective
diagnostic and therapeutic facilities for specific - cost effective measures are identified
medical problem area. - cost can be controlled through planning for
efficient operation.
Ex: Projecting the number of operations in a given day,
including daily dressings helps in determining accurately
PLANNING the needed supplies in the surgical units so as to prevent
- Planning is pre-determining a course of action in undersupply or over supply.
order to arrive at a desired result. It is a
continuous process of assessing, establishing
goals and objectives, implementing and 6. It is based on the past and future activities
evaluating which is subject to change as new - evaluation of programs, schedules and
facts are known. activities whether successful or not, prevent
- It is forecasting of events, making decisions, and or reduces the recurrence of problems and
setting goals, priorities, developing policies and provides better ideas in modifying or avoiding
setting standards. them.
- (Rowland and Rowland 1992) Described it as
future-oriented. It is the process whereby 7. It discovers the need for change
management bridges the time span between - Many hospitals have found out that in-patient
where it is at present and where it wants to hospital days can greatly be reduced by having
become at some point in the future the lab and diagnostic work up in the OPD.
- Planning is the most fundamental activity of the - Minor surgeries are also done at the OPD so
management process. All other management more hospital bed can be allotted to critically
functions are dependent on planning. ill patients and those needing services.

It directs our attention towards: 8. It is necessary for effective control

• What activity we expect to do
- Nurse managers evaluate the environment or preparation of the budget. It would also relate
setting in which they work where patients are to the improvement and maintenance of
confined and make necessary recommendation facilities. Nurse managers are involved in this
to make hospital condition more therapeutic type of planning.
not only for the patients but for the workers as
well.
- Performance of workers and patient care 3. UNIT PLANNING
services are also evaluated based on the - Planning for a department or unit done on a
criteria set during the planning stage to daily, weekly or long-range basis
indicate whether standards have been followed  A daily planning related to the care done on patient
and whether charges are indicated. a. Taking health history
b. Assessing his health status
c. Formulating the nursing diagnosis
TYPES OF PLANNING: d. Implementing the care plan
1. STRATEGIC OR LONG-RANGE PLANNING
- Refers to determining the long-term objective
of the institution and the policies that will be SCOPE OF PLANNING
used to achieve these objectives A. TOP MANAGEMENT (Nursing Director)
- It is usually done in the executive level of - Set overall goals and policies of the
management. organization
- It is future-oriented. Extended 3-5 years in the - Scope of responsibility is the overall
future management of the organization
- The main output of strategic planning is to set
the goals for the organization B. MIDDLE MANAGEMENT (Nursing
- A SITUATIONAL ANALYSIS be done first supervisors)
before making the strategic plan: SWOT • Directs the activities to actually implement the
analysis is the tool to be used. broad operating policies of the organization –
- Before making a plan, identify the Strengths, staffing, and delivery of services to the units.
Weaknesses, Opportunities, and Threats of the
organization.
C. LOW or FIRST-LEVEL MANAGEMENT (head
STRENGTHS AND WEAKNESSES INCLUDE: nurses, senior nurses, charge nurse, or team leader)
a. Expertise in nursing and medical personnel • Daily schedule or weekly plans for the
staff administration of direct patient care in their
b. Qualifications respective units.
c. Over and under-staff
d. Financial status
e. Quality of patient care WHY MANAGERS FAIL TO PLAN EFFECTIVELY?
f. Abundance or scarcity of medical equipment 1. Lack of knowledge of philosophy, goals and
or supplies. objectives of the agency
2. Lack understanding of the significance of the
THREATS planning process
• Competition 3. Doesn’t know how to manage their time to devote
• Decrease in patient load for planning
• Shortage of nurses and other personnel 4. Lack confidence in formulating plans or fear the
• Low patient’s satisfaction planning may bring about unwanted changes that
• Increase of charges they are unwilling to do or are unable to cope with.
• Legal threats

OPPORTUNITIES MAJOR ASPECTS OF PLANNING

• Improve or new facilities *Plans can be understood through the four major aspects.
• Recruitment of medical and nursing personnel 1. PLANS SHOULD CONTRIBUTE TO
• Referrals OBJECTIVES
• New health care programs • It should seek to achieve a consistent,
coordinated structure of operations focused on
desired ends. Actions without plans often
2. OPERATIONAL or SHORT-RANGE PLANNING result to chaos.
- Deals with the day-to-day maintenance
activities. It is done in conjunction with the
2. PLANNING PRECEEDS ALL OTHER • describes and reflects an organization’s core
PROCESSES OF MANAGEMENT (Organizing, value
Directing, Controlling) MISSION STATEMENT
• It supports easy accomplishment of the • outlines the purpose the agency is in
agency’s objectives that are necessary for • Whether a hospital or health care facility
group effort. • Who the target client’s are (the poor, the
needy, the middle or upper-class)
• What services are provided (in-patient, out-
3. IT PERVADES ALL LEVELS patient, emergency)
• It encompasses both higher to lower echelon Example:
and vice versa and spread horizontally through “The medical center, as a public, tertiary hospital is
peer levels and/or across services and maintained as the people’s partner and improved to provide
members of the health team accessible, quality, cost-effective, preventive, promotive,
curative, rehabilitative health care services to the general
4. IT SHOULD BE EFFICIENT public, especially the destitute. The institution is also
• It should contribute to the attainment of committed to medical, nursing and allied health education,
objectives not only in terms of peso value, training and research”
man-hours, units of products but also include
individual values and group satisfaction. Fear,
resentment and low morale results in low PHILOSOPHY
production. - describes the vision. It is a statement of beliefs
and values that direct one’s life or one’s
practice.
ELEMENTS OF PLANNING: - it is the sense of purpose of the organization
 FORECASTING and the reason behind it’s structure and goals.
• It estimates the future, including the - It explains the beliefs that determine how the
environment in which the plan will operate mission or purpose is achieved; it gives
IT INCLUDES: direction toward the attainment of the set of
• Who the patients will be goals and objectives.
• Their customs and belief
• Language and dialect barriers
• Severity of their condition or illness GOALS AND OBJECTIVES
• Kind of care they will receive • Goals are more general and cover a broad area
• The number and kind of personnel required while objective tend to be more specific and are
(professional and non-professional) concrete
• The resource-equipment, facilities, supplies needed - Goals are broad statements of overall intent of an
organization or individual
- Objectives are concrete specific statements of the
goals that the nurse manager seek to accomplish
B. SETTING THE VISION, MISSION, - They are actions commitments through which its
PHILISOPHY, GOALS AND OBJECTIVES mission or purpose is achieved and the philosophy
• Results to be achieved can be determined or belief sustained. They are stated in terms of
results to be achieved and should focus on the
VISION production of health care services to the patients.
• provides an image of the desired future Objectives state specific and measurable goals to
VISION STATEMENT be accomplish.
• outlines the organization’s future role and
function. C. DEVELOPING AND SCHEDULING
• It gives the agency something to strive for. PROGRAMS
• It outlines the agency’s reason for existing. - By developing and scheduling programs, the
Example: activities needed within a set time can be defined.
“The medical center envisions itself to become a Center of = Programs are determined, developed and targeted within
excellence providing holistic approach to health care a time frame to reach the goals and objectives set.
services. As a center of wellness, the services provided
shall enable the people to improve their health and increase
control over it” PLANNING FORMULA (by KRON)
1. WHAT
– What should be done? What has been done?
MISSION What equipment and supplies have been used or
are needed? What steps are necessary in the 1. Procrastination and indecision (Postponing and
procedures? What sequence of activities was deferring)
previously used? What more efficient methods 2. Lack of self-discipline
may be used. 3. Inability to say “NO”
2. WHEN 4. Inability to delegate
– When should the job be done? When was it 5. To act without thinking
formerly done? When could it be done? 6. To jump from task to task without finishing any of
3. WHERE them
– Where is the job to be done? Where does an PRINCIPLES OF TIME MANAGEMENT
activity occur in relation to those activities 1. Planning anticipates the problems that will arise
immediately preceding and following it? Where from action without thought
could supplies be stored and cleaned and so forth? ∞ It anticipates the crises that may occur or the
4. HOW resources needed to solve the problems
– How will the job be done? What are the steps to
be followed in doing the procedure? How will the 2. Prioritize tasks to be accomplished
time and energy of personnel be used? How much ∞ Tasks to be accomplished should be done in sequence
it will cost? How much time will it require? or in order and should be prioritized according to
5. WHO importance. Failure to prioritize oftentimes result in
– Who has been doing the job? Who else could do spending more time on unimportant tasks.
it? Is more than one person involved?
6. WHY 3. Set deadlines to one’s work and adhere to them
– To each of the question, ask why? Why are this ∞ This is an excellent exercise in self – discipline. It
job, this procedure, and this step necessary? Why enables one to have time for himself/herself because of
is this done in this way, in this place, at this time, effective use of time.
by this person?
7. CAN 4. Procrastination
– Can some steps or equipments be eliminated? ∞ Deferring, postponing, or putting off decisions,
Can this activity be efficiently combined with actions or activities can become a habit which oftentimes
other operations? Can somebody else do it better? cause lost opportunities and productivity, generating
Can we get a machine to help? Can we get enough personal or interpersonal crisis.
money?
5. Delegation permits a manager to take authority for
decision making and judgment, facts and experience
∞ delegation frees manager of some time that can be
TIME MANAGEMENT devoted to other tasks
- It is a technique for allocation of one’s time
through setting of goals, assigning priorities,
identifying and eliminating time wastes and use of TIME SAVING TECHNIQUES, DEVICES AND
managerial techniques to reach goals efficiently. METHODS TO BETTER USE OF TIME:
- “Work smarter, not harder” to get more work 1. Conduct and inventory of your activities
done in less time - Log in activities for one day to determine how
much time is spent on each activity.
FACTORS THAT INFLUENCE TIME MANAGEMENT: - Identify time problems, examine your old habits
1. One’s personality that get in the way of using your time well
2. Education 2. Set goals and objectives and write them down
3. Culture 3. With the use of calendars, executive planners, logs
= these factors influence how one manage time or journals, write what you expect to accomplish
yearly, monthly, weekly, or daily.
SYMPTOMS OF TIME MANAGEMENT 4. Breakdown large projects into smaller parts.
1. Rushing Do first thing first and concentrate on one thing at
2. Fatigue and listlessness with hours of non- a time. Get all the data you need to avoid breaks in
productive activity your work.
3. Constant missed deadlines 5. Devote a few minutes at the beginning of each day
4. Insufficient time for rest and personal relationship for planning.
5. Feeling overwhelmed by details and demands At the end of each day, account for the task that
among others you have accomplished. Prepare a list of what is to
be done the following day.
INTERNALLY GENERATED TIME WASTER 6. Organize your work space so it is functional.
Sort paperwork on your table according to priority.
7. Close your door when you need to concentrate.
Agree on a period of quiet office time. Avoid COMPONENTS OF BUDGET:
having an “open-door” policy during the entire 1. CASH BUDGET
workday. - Forecast an estimate of the amount of money being
8. Learn to delegate. received. It consists of the beginning cash balance,
9. In a meeting, define the purpose clearly before estimates of the receipts and disbursement, and the
starting. estimated balance for a given period corresponding
Distribute the agenda in advance and control to that of the operating and capital budget.
interruptions during the meeting. Conduct the 2. OPERATING BUDGET
meeting according to time schedule. - Deals primarily with salaries, supplies, contractual
10. Take or return phone calls during specified time. services, employee benefits, laundry services,
Maintain a telephone log so you can return calls at drugs and pharmaceuticals in-service education,
one time in possible. Outline your basic points and travel to professional meetings, books, periodicals,
move immediately into the business of the call. professional magazines, repairs and maintenance
11. Develop effective decision-making skills. among others. (revenue and expense budget)
Don’t be afraid to say “NO”. 3. CAPITAL EXPENDITURE BUDGET
12. Take a rest-breaks and make good use of your - Consists of accumulated data for fix assets that are
spare time. Reward yourself periodically. expected to be acquired during the budgeted
period: of estimated cost and sources of funds for
expected replacement, improvement and additions
PREPARING A BUDGET to fixed assets.
Budget - Requires long range planning. Includes purchases
- is an annual operating plan, a financial “road map” of equipments and buildings.
and a financial plan which serves as an estimate of
the future cost and a plan for utilization of
manpower, material and other resources to cover FACTORS IN BUDGET PLANNING
capital projects in the operating programs. 1. Type of patient, length of stay in the hospital and
the acuteness of the illness.
NURSING BUDGET 2. Size of the hospital and its bed occupancy.
- Is a plan for allocation of resources based on 3. Physical layout of the hospital, the size and plan of
preconceived needs, for a proposed series of the wards and units, the Nurse’s station, treatment
programs to deliver patient care during one fiscal rooms, etc.
year 4. Personal policies
a. Salaries paid to various types of nursing
HOSPITAL BUDGET personnel, including pay for overtime or
- Is a financial plan to meet future service shift differential.
expectations. These expectations are derived from b. Extent of vacation, sick leaves and
the best judgment needs of the community. holidays.
c. Provision of staff development programs
BUDGETING including instructional staff
- is allocating of scarce resources on the forecasted 5. Grouping of patients such as those in specialized
needs for the proposed activities over a specified areas as intensive care units
period of term. 6. Standards of nursing care: The kind and amount of
care to be given as it affect the number of hours of
bedside care.
7. Method of performing nursing care whether simple
BUDGETING INVOLVES: or complex; method of documentation.
• Examining resources 8. Proportion of nursing care provided by
• Anticipating cost professional nurses and those given by non-
• Predicting gains and shortfalls professional.
9. Amount and quality of supervision available and
2 COMMON APPROACHES TO BUDGETING: provided; the efficiency of job classification.
1. Incremental budgeting 10. Method of patient assignment whether functional,
- Develop annually based on the previous year’s case, team, or primary.
expenses 11. Amount and kind of labor-saving devices and
equipment, intercommunication systems.
12. The amount of centralized service provided: sterile
2. Zero base budgeting
supply, central oxygen service, linen supply.
- Each year, the budget begins at zero
13. The nursing service requirements of the ancillary - Effective tool for orienting new employees, a
departments: clinics, admitting office, emergency reference when unexpected problems arise, a basis
rooms. for developing administrative procedures and a
14. Reports required by administration whether simple firm basis for discussion when differences occur.
or complex - Periodic review of policies are needed to evaluate
15. Affiliation of nursing students or medical students: their effectively and workability. If there’s a
inexperienced students need more equipment and problem in their implementation, it should be
supplies. discussed and verified as to whether these are
ESTABLISHING NURSING STANDARDS, POLICIES being followed and should changes be necessary,
AND PROCEDURES: all personnel should be informed.
» Will define the course of action
» A good reference of Nursing standard was developed EXAMPLES OF NURSING SERVICES POLICIES:
by the joint nursing committee of the ANSAP – was 1. Accidents – Care, reporting, precaution to prevent
first printed in 1981 2. Admission – receiving, consent, notifying doctor,
» The function of these established standards in an care of patient
evaluation process is to: 3. Autopsies – Obtaining informed consent
a. Supply professionally desirable norms against 4. Breakages – Classification, responsibility,
which the department’s performance can be measured. reporting
b. Areas of improvement are identified 5. Bulletin board – Location, posting of information
c. A plan of action to correct is to be made and 6. Complaints – How handled, action taken
implemented.

NURSING SERVICE POLICIES

☻Policies are broad guidelines for the managerial
decisions that are necessary in organizational and INTERDEPARTMENTAL POLICIES
departmental planning. They govern the action of - Developed in keeping with overall hospital
workers and supervisors at all levels and are intended policies, thus ensuring unity and harmonious
to achieve pre-determined goals. relationship among departments.

EXAMPLES:
1. Admission – Type of patients, time, reservation,
3 GENERAL AREAS IN NURSING THAT identification of patient, signing consent
REQUIRES POLICY FORMULATION: 2. Transfer – request, departments to be notified
a. Areas in which confusion about the locus of 3. Discharges – Notifications, against medical
responsibility might result in neglect advise, conduction, clearances.
malperformance of an act necessary to a patient’s
welfare. - Procedures are specific directions for
b. Areas pertaining to the protection of patient’s and implementing written policies. Areas where
families’ rights (e.g. right to privacy, property procedures are needed – related to job situation
rights) and those involve patient care.
c. Areas involving personnel management and - Nursing procedure manual should be available in
welfare each unit to familiarize nurses of the common
nursing procedures utilized in the nursing unit.

CHARACTERISTICS OF A GOOD POLICY

*A good policy should be*
1. Written and understandable and known by those
who will be affected by them.
2. Comprehensive in scope, stable, flexible, so they
can be applied to different conditions that are not
so diverse that they require different set of policies.
3. Consistent to prevent uncertainty, feelings of bias,
preferential treatment and unfairness.
4. Realistic and prescribe limits
5. Allow for discretion and interpretation by those
responsible for it.

NURSING SERVICE POLICY MANUAL

NURSING PROCESS IN THE DELIVERY OF 3. To achieve continuity of care
NURSING CARE SERVICES

NURSING MANAGEMENT PROCESS CHARACTERISTICS OF THE NURSING

- The nursing process is based on a nursing theory MANAGEMENT PROCESS:
developed by Ida Jean Orlando. She developed this 1. SYSTEMATIC – It has an ordered sequence of
theory in the late 1950’s as she observed nurse in activities and each activity depends on the
action. She saw ‘’good” nursing and ‘’bad’’ accuracy of the activity that precedes it and
nursing. influences the activity following it.
- Nursing process is a systematic, rational method, 2. DYNAMIC- It has great interaction and
planning and providing individualized nursing overlapping among the activities and each activity
care. is fluid and flows into the next activity.
- The general principles of management as applied 3. INTERPERSONAL – It ensures that nurses are
in the nursing process use the same objectives. patient-centered rather than task-centered and
- The nursing management process supports the encourages them to work with other members of
nursing process. the health team to help patients use their strengths
- Nursing management process of data gathering, to meet their own personal needs.
planning, organizing, staffing, directing, and 4. GOAL-DIRECTED – It is a means for nurses and
controlling, support the nursing process of patients to work together to identify specific goals
assessment, diagnosis, planning, implementation, related to wellness promotion, disease and illness
and evaluation. prevention, health restoration, coping and altered
functioning, which are most important to the
patient, and to match them with appropriate
The Nursing Management Processes Support the Nursing nursing actions.
Process: 5. UNIVERSALLY APPLICABLE – It allows nurses
to practice nursing with well or ill people, young
or old, and in any type of practice setting

FIVE MAJOR TYPES OF NURSING CARE

DELIVERY SYSTEM (Marquis and Huston, 2012)
1. Total Patient Care
- Registered Nurse assumes responsibility for a
group of patients for a shift- and provides all care
to the patient.
- typically performed by nursing students.
- Common use areas: ICU and PACU
- ADVANTAGES – continuity for the shift,
responsibility is clear, generally satisfying for
nurses.
- DISADVANTAGES – can be very expensive, may
FIVE STEPS OF NURSING PROCESS: not utilize RN time wisely, and may not be
1. ASSESSMENT – collecting, validating, and possible with staffing shortages
communicating patient data
2. DIAGNOSIS – analyzing patient data to identify
patient strengths and problems
3. PLANNING – specifying patient outcomes and
related nursing interventions
4. IMPLEMENTING – carrying out the plan of care
5. EVALUATING – measuring the extent to which
the patient achieved the outcome
Total Patient Care (Case Method) Delivery

PURPOSE OF THE NURSING MANAGEMENT 2. Functional Nursing

PROCESS: - Staff Members are assigned to a specific task or
1. To achieve scientifically- based, holistic, group of tasks for patients- example Medication
individualized care for the patient. Nurse, IV nurse, Vital sign Nurse—RN assumes
2. To achieve the opportunity to work collaboratively overall direction of care.
with patients and others. - Common Use areas: Operating room
- ADVANTAGES - incorporates the use of LPNs
and UAPs and maximizes their skills, can be cost
effective.
- DISADVANTAGES - can lead to fragmentation
and gaps in patient care- not holistic

5. Case Management
- RN Case Manager supervises the care of the
patient and the use of resources across the
continuum to focus on the individual patients.
- ADVANTAGES – can be very cost-effective and
3. Team or Modular Nursing
satisfying for patients who are high-risk/ problem-
- RN Team Leader coordinates a group of patients
prone.
working with other team members (RNs, LPNs,
- DISADVANTAGES – Case Management is not a
and UAPs) utilizing their skills.
true inpatient delivery system but rather the
- Common Use Areas: Inpatient and Outpatient
management of patient care
Areas
- ADVANTAGES - If done well can be very
satisfying to staff and patients as well as cost-
effective.
- DISADVANTAGES – requires high-level
leadership skills from RN – harder to do with
higher patient acuity and inconsistent team
members

LEADERSHIP RESPONSIBILITIES IN SELECTING

A MODEL
- Determine whether the patient acuity and patient
need in the setting fit the model being
recommended.
4. Primary Nursing - Assess whether your staff is ready and trained to
- Registered Nurses assume 24/7 accountability for utilize a new model.
their primary patients to establish a plan of care - Ensure that your staff understands scope of
and coordinate cxare even in their absence. practice issues
- Common Use areas: Hospice, Home Health, long- - Ensures that the model will allow your nursing
term care settings staff to do their best work.
- ADVANTAGES - can result in high job - Determine the economic feasibility.
satisfaction and excellent holistic care for patients. - Assess the adequacy of your nursing resources to
- DISADVANTAGES – requires high RN mix, support the model
difficult to do with today’s flexible scheduling,
some staff don’t want the accountability and HOT ISSUES WITH NURSING CARE DELIVERY
responsibility SYSTEMS:
- Movement of nursing back to Team or Modular
Approach.
- Increasing numbers of Associate Degree Nurses
with no Leadership Training who are assigned as
Team Leaders.
- Confusion about the scope of practice particularly REGISTERED NURSE CAN DELEGATE THE
with LPNs in Acute care has led to a reduction of FOLLOWING:
LPN use and an increase in PCA or PCT use - The task involving activities of daily living
- Data Collection such as Intake/ output, weight,
vital signs, glucose finger sticks
- Administration of medications or performance of
WHAT EVERY NURSING LEADER NEEDS TO treatments
KNOW ABOUT THE FLORIDA NURSE PRACTICE
ACT BEFORE INTRODUCING A NEW NURSING
CARE DELIVERY SYSTEM SUPERVISION OF CARE
1. SUPERVISION - Supervision of care in an Acute Care Setting is
– the provision of guidance by a qualified ALWAYS the responsibility of a RN.
nurse and periodic inspection by the nurse - Licensed Practice Nurses in Nursing Home setting
for the accomplishment of a nursing task can supervise care given by other LPNs or UAPs
or activity. providing that they have 6 months experience and
2. DELEGATION a 30hour supervisory course.
– transferring to a competent individual the
authority performs a selected nursing task
in a selected situation

PRACTICE OF PROFESSIONAL NURSING

- Observation, Assessment, Nursing Diagnosis,
Planning, Intervention, Evaluation of Care and
Health Teaching.
- Administration of Medications and treatments as
prescribed by a duly authorized licensed
practitioner in the state.
- Supervision and Teaching of other personnel
- Performance of selected acts including
administration of treatments and medications in the
care of the ill, injured, or infirm and the promotion
of wellness, maintenance of health, and prevention
of illness of others.
- Works under the direction of a Registered Nurse, a
Licensed Physician, a Licensed Osteopath, a
Licensed Podiatric Physician, or a Dentist

UNLICENSED ASSISTIVE PERSONNEL – UAPs

• Certified Nursing Assistants
• Personnel Care Assistance
• Student Nurses
• Patient Care Technicians
• LPNs
• Nursing Attendants

REGISTERED NURSES CAN NOT DELEGATE THE

FOLLOWING:
- Assessment or Reassessment of patients
- Planning of Care
- Evaluation of Care
- Decisions about whether to contact a Physician
about changes in a Patient’s condition
ORGANIZING
SOLID CONNECTING LINES
◊ Organization - Represent direct communication relationship
- comprises structure and process, which allow the between individuals or departments.
agency to enact its philosophy and utilize its
conceptual framework to achieve its goals
◊ Organization VERTICAL LINES
- refers to the body of persons, methods, policies, - Are referred to as line of authority and
and procedures arranged in a systemic process accountability
through delegation of functions and responsibilities • Lines of authority
for the accomplishment of purpose. - represent the responsibility of individuals to
◊ Organizing supervise other officials
- is the process of establishing formal authority. It
involves setting up the organizational structure • Lines of accountability
through identification of groupings, roles and - also known as reporting relationship
relationships, determining the staff needed through - represents a responsibility to report to another
developing and maintaining staff patterns and person
distributing them in the various areas as needed - the same lines that represent authority when
and developing the job descriptions by defining the moving down the chart, represent accountability
qualifications and functions of personnel. when moving up the chart.
◊ An organizational chart - Taking together the vertical lines demonstrate the
- is a line drawing that shows how the parts of an chain of command.
organization is linked. It depicts the formal
organizational relationships, areas of responsibility, ACCOUNTABILITY/ LIABILITY = is being responsible
persons to whom one is accountable and channels to another person for your action and use of resources.
of communication

• CHAIN OF COMMAND
ELEMENTS OF ORGANIZING - is the path of authority and accountability from one
1. SETTING UP THE ORGANIZATIONAL individual at the bottom of the organization to the
STRUCTURE very top administrative authority.
- The creation of an organizational system - also referred to as the hierarchy of the organization
compatible with the philosophy, conceptual
framework, and goals of the organization provides • HORIZONTAL SOLID LINES
the means for the accomplishment of an - connect individuals who are at the same level in
organization’s purpose. the organization and have official relationship.
- Refers to the process by which a group is formed, - these individuals are required to work together for
its channels of authority, span of control, and lines certain objectives in the organization but none has
of communication. the authority over the others. They are placed in
the same level in the organizational chart and they
PURPOSES: have to report to the same superior.
• It informs members of their responsibilities so that ¤Example¤
they may carry them out. All unit managers are connected by solid horizontal lines to
• It allows the manager and the individual workers indicate that they have official working relationships but
to concentrate on his/her specific roles and none has the authority over the other
responsibilities.
• It coordinates all organizational activities so there
is minimal duplication of effort or conflict. • DOTTED LINES
• It reduces the chances of doubt and confusion - represent communication relationship in which
concerning assignments neither individual has direct authority or
• It avoids overlapping of functions because it accountability to the others and they do not have
pinpoints responsibilities. the same superior.
• It shows to whom or for whom they are
responsible.
• SPAN OF CONTROL
- refers to the number of subordinates and different
BOXES (in the organizational chart) tasks for which a person in authority is responsible
- may represent individuals in the organization or and these people are also responsible for reporting
may indicate the entire department. to person in authority.
TYPES OF ORGANIZATIONAL STRUCTURE: hospital or hospital administrator and the chief
A. Informal Structure - Consists of personal and nurse. Those in the middle and lower levels of
social relationships among the members of the management are in concentric circles. This shows
organization, not reflected in the organizational the outward flow of formal authority, which is
chart. from the center moving outward.

B. Formal structure - Describes the position and

related responsibilities, working relationships 5 MAJOR CHARACTERISTICS OF AN
among various departments. ORGANIZATIONAL CHART
a. Division of Work
 It has 2 forms. - Each box represents the individual or sub-unit
a. Hierarchic or Bureaucratic Model responsible for a given task in the organization’s
- It is straight forward, and has a direct chain of command workload.
pattern that emphasizes superior-subordinate relationships.
b. Chain of Command
b. Adaptive / Adhocracy or Organic Model - Oath of authority and accountability
- More free-form, open and flexible. Motivation is not - Lines indicate who reports to whom and by what
derived from supervision but rather from the needs of the authority
system, peer pressure, and task-related, rewards and
recognition are based on results of individual or group c. Type of work to be performed
work, and management in participative. - Indicated by labels or descriptions for the boxes

TYPES: d. Grouping of Work Segments

1. Free form - Shown by clusters of work groups (departments
2. Collegial management or single units)
3. Project management
4. Task forces
5. Matrix organization e. Levels of Management
- Indicates individual and entire management
hierarchy

ORGANIZATIONAL CHART HIERARCHY

- it depicts chain of command, division of work, - Refers to a body of persons or things organized or
levels of management, and functional classified in pyramidal fashion according to rank,
communication pattern. capacity or classes, one above the other.
USES:
• Outlines administrative control
• Used for policy making and planning
• Used to evaluate strengths and weaknesses of the TYPES OF ORGANIZATION CLASSIFIED BY
present structure NATURE OF AUTHORITY
• Shows the relationships with other department and A. LINE ORGANIZATION
the agencies - Simplest and most direct type of organization in
• Used to orient new personnel to the organization. which each position has general authority over
lower positions in the hierarchy.
TYPES: Ex. Clinical and Administration
a. VERTICAL / TALL CHART
- It depicts the chief executive at the top with lines B. INFORMAL ORGANIZATION
of authority flowing down the hierarchy. It clearly - Refers to horizontal relationships rather than
defines the relationships between and among the vertical. This is composed of small groups of
different levels in the organization. workers with similar interests.

b. HORIZONTAL/ FLAT CHART C. FUNCTIONAL ORGANIZATION

- It depicts the manager at the top with a wide span - Is one where each unit is responsible for a given
of control. Levels of management are not shown, part of the organization’s workload. There is clear
employees report to one manager. delineation of roles and responsibilities which are
actually interrelated.
c. CONCENTRIC / CIRCULAR ORGANIZATION Ex. All Standing and Ad Hoc Communities
- Depicts top management in the center represented
by the board of trustees of directors, Chief of
D. STAFF ORGANIZATION
- Is pure advisory to the line structure with no
authority to put recommendations into action.
Ex. Training and research

PRINCIPLES OF ORGANIZING
A. UNITY OF COMMAND
- Employees are responsible to only one superior to
avoid confusion, overlapping of duties and
misunderstanding.

B. SCALAR PRINCIPLE or HIERARCHY (Chain of

Command) Fig. 5: Organizational chart of Nursing division with
- Authority and responsibility should flow in clear assistant chief nurses for Training and research and for
unbroken lines from the highest executive to the clinical areas.
lowest. Proper definition and delegation of
authority and responsibility facilitate FLAT ORGANIZATION STRUCTURE
accomplishment of work.

C. HOMOGENOUS ASSIGNMENT or
DEPARTMENTATION
- Workers performing similar assignments are
grouped together for a common purpose:
• Specialization of activities
• Simplifies the administrator’s work
• Helps maintain administrative work

D. SPAN OF CONTROL
- It refers to the span of managerial responsibility
and the number which one superior can assist,
teach and help to reach the objectives of their own
jobs.
Fig. 4: An organizational Structure showing the relationship
E. EXCEPTION PRINCIPLE of the nursing service / division with the College of
- Recurring decisions should be handles in a Nursing
routine manner by lower-level managers whereas
problems involving unusual matters should be
referred to the higher level. This will enhance
decision making of subordinates.

F. DECENTRALIZATION or PROPER
DELEGATION of AUTHORITY
- It is the process of pushing decision making to the
lowest levels of organization.
STAFFING 3 PHILOSOPHIES DURING SCREENING
PROCESS:
STAFFING - Screen out applicants who do not fit the image of
- The process of determining and providing the the agency
acceptable number and mix of nursing personnel to - Try to fit the job to a promising applicant
produce a desired level of care to meet the patient’s - Try to fit the applicant to the job
demand. It should be orderly, systematic and based
upon sound rationale. It is complex. c. Interview – to obtain further information about the
applicant, to give information and to determine if the
GOAL/PURPOSE applicant qualifies for the position.
- To provide each unit with an appropriate and
acceptable number of each category of workers to During the Interview, observe the applicant:
perform the nursing tasks required. - If he/she show genuine interest in the job
- Has willingness to work and assume
OBJECTIVES: responsibilities
• To provide continuous quality nursing care - If he/she well mannered
• Evaluate staffing practice periodically
• Utilize talents and skills d. Orientation – introducing the applicant to her new job. It
is the process of becoming familiar with a new environment
FACTORS AFFECTING STAFFING: and adapting well to it.
a. Type, philosophy and objectives of the hospital and This would include:
the nursing service. > Tour of the Physical facilities
b. Population served of the kind of patient‘s served > Introduction to co-workers
whether pay or charity. >Description of the organizational structure of the
c. Number of patients and severity of their illness. institution
d. Availability and characteristics of the nursing staff > Information on the Philosophy, goals, policies
including education, level of preparation, mix of and the standards of the institution
personnel, number and position. > Functions of the members of the health team
e. Administrative policies such as rotation weekends > In-service education training program
and holiday off duties.
f. Standard of care desired.
g. Layout of various nursing units and resources 2. Systems of Assignment
available within the department. 5 Methods of assigning personnel:
h. Budget including the amount allotted for salaries, a. CASE METHOD
fringe benefits, supplies, materials and equipment. - Each patient is assigned to a nurse for total
i. Professional activities and priorities in non-patient patient care
activities.
j. Teaching program or the extent of staff b. FUNCTIONAL METHOD
involvement in teaching activities. - based on the concept of division of labor where nurses
k. Expected hours of work per annum of each and other caregivers are assigned to do specific tasks on
employee. several patients.
l. Patterns of work schedule.
c. TEAM METHOD
- based on group approach where staff members work as a
STAFFING PROCESS team to give total care to a selected group of patients.
1. Selection of Personnel
a. Recruitment – method of enlisting personnel for d. PRIMARY METHOD
employment - Is based on the philosophy that patient’s instead of tasks
Methods of Recruitment include: should be the focus of professional nurse. The primary
* Advertising nurse who is the registered nurse is given the full
*Word of mouth responsibility to give total patient care to 4-6 patients. He is
* Employee recommendation responsible for the care of this patient 24 hours a day
throughout the hospitalization. An associate nurse also an
b. Screening – applicants submit resume. This helps RN, cares for the patient using the care plan designed by
in determining whether the applicant is qualified the primary nurse while the latter goes off duty.
and meets the minimum requirement.
e. MODULAR METHOD
- It is the combination of the primary and team nursing.
The nurse is assisted by non-nursing members of the health
team such as nurse attendants and assistants to give nursing
care to 8-12 patients.

PATIENT CARE CLASSIFICATION SYSTEM

- It is the method of grouping patients according to
the amount and
- complexity of their nursing care requirement, of
nursing time and skill they
- require.

TO develop a workable patient classification system, the

nurse manager must determine the following:
- The number of categories into which the patients
should be divided
- Characteristics of patients in each category
- Type and number of case procedures that will be COMPUTING FOR THE NUMBER OF NURSING
needed by a typical patient in each category PERSONNEL NEEDED
- Time needed to perform these procedures that will ♦ Total Number of working and non-working days and
be required by typical patient in each category hours of nursing personnel per year:

CLASSIFICATION CATEGORIES:
a. LEVEL I – Minimal care of self care
b. LEVEL II – Moderate or intermediate care or
partial care
c. LEVEL III – Total, complete or intensive care
d. LEVEL IV - Highly specialized care

♦ Categories of Levels of care of patients, Nursing care

hour (NCH) needed per patient per day and ratio of
professionals to non-professionals.

♦ Percentage of patients at various levels of care per type of

hospital
♦ DISTRIBUTION BY SHIFTS c. Self scheduling
- Staff nurse in a unit collectively decide and
implement the monthly work schedule.

d. Cyclical schedule
- An approach which covers a designated number
of weeks called cycle length and is repeated
thereon.
♦ STAFFING FORMULA
ADVANTAGES OF CYCLICAL SCHEDULE
• It is fair to all
• It saves time
• It enables the employee to plan ahead for personal
needs preventing frequent changes in schedule
3. SCHEDULING
* A time table showing planning work days and • Schedule leave coverage are more stable
shifts for nursing personnel • Productivity is improved.

OBJECTIVES: ROTATING WORK SHIFTS

To assign working days and day offs to the nursing - 3 shifts a day (AM, PM, NOC)
personnel so that:
a. Adequate patient care is assured while avoiding
overstaffing C. Developing Job Descriptions
b. A desirable distribution of off duty days can be JOB DESCRIPTIONS
achieved - A statement that sets duties and responsibilities of
c. Individual members of the nursing team will feel a specific job. It is an important management tool
that they are treated fairly. to make certain that responsibilities are wisely
d. They will know their schedule in advance. delegated, that work is efficiently distributed, that
talents are fully used, and morale is maintained.
FACTORS CONSIDERED in MAKING SCHEDULES:
a. Different levels of the nursing staff CONTENTS OF A JOB DESCRIPTION
b. Adequate coverage for 24 hours, 7 days a week a. Identifying data
c. Staggered vacation and holidays • Position title: Staff Nurse
d. Weekends • Department: Nursing
e. Long stretches of consecutive working days • Supervisor’s title: Head / Senior Nurse
f. Evening and night shifts
g. Floating b. Job Summary
⮚ Essential features of the job that distinguishes it
from others
SCHEDULING AND CONTINUING PROFESSIONAL
EDUCATION PROGRAMS c. Qualification requirements - Education, preparation,
Assessing a scheduling system training, and experience necessary to fill the position
a. Ability to cover the needs of the unit d. Job relationships – source of workers
b. Quality to enhance the nursing personnel’s e. Specific and actual functions and activities.
knowledge, training and experience
c. Fairness to the staff USES OF JOB DESCRIPTION
d. Stability • For recruitment and selection of qualified
e. Flexibility personnel
• To orient new employee of their new job
TYPES OF SCHEDULING • For job placement, transfer or dismissal
a. Centralized Schedule • As an aid in evaluating the performance of an
- One person usually the chief nurse or her employee
designate prepare the schedule, assigns the nursing • For budgetary purposes
personnel to the various units of the hospital, this • For determining departmental functions and
includes the shifts on duty and off-duty. relationships to help define the organizational
structure
b. Decentralized Schedule • For classifying levels of nursing functions
- Shift and off-duties are arranged by the according to skill levels required
supervising Nurse, Head or senior nurse of the • To identify training needs
particular unit.
• As basis for staffing serves as a channel of 9. Conduct discharge planning with patient, family
communication and the health team.
Refers to community health agencies as needed.
Job Description: STAFF NURSE 10. Document accurately observations and services
Position Title: STAFF NURSE / NURSE 1 rendered to the
patients.
STAFF NURSE
• Is a professional nurse responsible for rendering B. Hospital Nursing service policies and regulations
holistic nursing to patients in assigned areas, the 1. Observes hospital and nursing service rules,
specific function and responsibilities of which regulations and policies.
depend upon the organizational structure of the 2. Interprets to patients and family and visitors rules
Nursing service department / division. and regulations and policies that affect them.

QUALIFICATION REQUIREMENTS: C. Learning experiences of Nursing and Midwifery

Education: Bachelor of Science in Nursing Students
License: Registered Nurse 1. Coordinate with clinical instructors the activities of
Job Summary: the affiliating students such as helping select
• Provides direct nursing care to patients towards the patient assignment to enhance learning experience
promotion of health, prevention of diseases, particularly on patient care
restoration of health, alleviation of suffering and 2. Demonstrate what good nursing is in the way she
assisting the dying to face death with dignity and cares for patients. Act as a role model to the
peace. students.

Job Relationships: D. Orientation of Non-professional workers in the unit

• Source of workers: Registered Nurse - Participate in the orientation of new, non-
• Promoted to: Senior nurse / Nurse II professional nursing personnel
• Responsible to: Senior Nurse / Nurse II
E. Research and studies
FUNCTIONS: - Participates in / initiates nursing research and
A. PATIENT CARE MANAGEMENT studies. Utilizes results for improvement of nursing
♥ The staff nurse shall initiate and perform nursing care practice.
services to meet the needs of the patient in assigned areas /
unit utilizing the nursing process. F. Professional Responsibilities
1. Assess the individual’s needs for nursing care 1. Takes initiative and responsibility for professional
based on the patient’s history, result of physical, organizations and participates actively in their
diagnostic and laboratory examinations. programs and activities.
2. Infers correct nursing diagnosis 2. Keeps self professionally updated through
3. Plans/prioritizes nursing care activities considering continuing education programs
overall health needs of the patient the extent of his 3. Update professional license.
coping abilities including that of his family and
significant others and his readiness, acceptance and
abilities of self care. JOB DESCRIPTIONS OF THE HEAD NURSE /SENIOR
4. Institute nursing interventions consistent with NURSE / NURSE II
overall plans of care with special considerations Position Title: Head Nurse / Senior Nurse / Nurse II
for his safety and comfort. Definition
5. Executes written, legal preparations for treatment, - A head nurse /senior nurse / Nurse II is a
therapies and medications. professional nurse who assumes responsibility for
6. Provide health teaching to patient, his family and managing the human and material resources of a
significant others so that they may understand this nursing unit to provide quality patient care and an
illness and participate actively in his care. environment conducive of staff growth and
7. Coordinate patient’s care services with members of satisfaction.
the health team
8. Evaluates/modifies nursing care provided in terms Qualification requirements
of: - Bachelor of science in Nursing; registered Nurse;
☻ Effectiveness and efficiency of nursing at least 1 year of clinical Nursing experience; with
measures rendered supervisory development training or training in the
☻ feedback from patients / family / significant nursing especially of the clinical nursing unit to
others which he/she is prepared for promotion; or 9 units
to Nursing management and supervision in the activities and problems
Graduate school as required by RA 7164 6. Presents changes or innovations to staff in a positive
manner
Employment variable 7. Provides a conducive climate in which the staff will
- Membership to the agency’s nursing association feel free to consult her/him for problems or assistance.
and other professional associations such as the
Integrated Nurses of the Philippines and Philippine
Nurses Association. C. MANAGEMENT OF PATIENT CARE UNITS
- Maintains an environment that encourages
quality patient care and staff satisfaction
Job Relationships 1. Provides safe, clean, secure environment for
• Source of workers: Nurse I / Staff Nurse patients, visitors and personnel
• Promotion to: Nurse III / Supervising 2. Requisitions adequate supplies, and equipment
Nurse needed for patient care
• Responsible to: Nurse III / Supervising 3. Monitors utilization of supplies and equipment
Nurse through monthly audits and inventories
• Responsible for: Nurse I / Staff Nurse / 4. Cooperates/coordinates with other hospital
Nursing attendant services/departments for appropriate support
service.
FUNCTIONS: 5. Prepares monthly, semi-annual, annual reports of
A. Management of Care – Assumes responsibility for achievements / problems.
quality patient care delivery for the nursing unit. 6. Maintains effective communication within the
1. Participates in the development of nursing unit / departments and other services through
standards, policies, procedures regarding patient conferences/meetings.
care and updates these as necessary
2. Promotes / Utilizes Quality Assurance Standards D. EDUCATIONAL RESPONSIBILITIES
and Programs in the unit 1. Assists in staff development activities
3. Supervises and evaluates the quality of patient care • Coordinates with training staff in planning,
through frequent rounds. implementing, and evaluating orientation of new
4. Acts as liason with the Medical staff to coordinate nursing personnel.
medical and nursing management of patient care. • Informs training staff of the training needs of
5. Serves as resource person to nursing personnel nursing personnel under her
under him/her in assessing, planning, 2. Assists clinical instructors of affiliating colleges of
implementing, and evaluating nursing care Nursing or school of midwifery in planning,
provided implementing and evaluating the learning experience
6. Assumes the role of patient advocate of the students.
7. Coordinated patient care with other members of 3. Assumes responsibility for own learning and
the health team, other hospital units, services and development needs.
divisions
8. Serves as committee member within the E. Acts as supervising nurse in the absence of one and
department, hospital of professional organization when so delegated.
9. Keep superiors informed regarding problems /
issues in patient carewithin the nursing unit.

B. Management of Nursing Personnel

- Provides leadership and direction to nursing
personnel in accordance with organization and
departmental goals.

1. Participates in the selection of nursing staff to the

unit.
2. Schedules staff assignments considering experience,
interest and training
3. Adjusting staff levels / ratio according to the acuity
of the patient’s illness, the number of patients and
number of nurses.
4. Advises and/or informs staff regarding new or
revised policies and procedures.
5. Keeps supervising Nurses informed of personnel
DIRECTING WHY NURSE MANAGERS DO NOT DELEGATE?
- Lack of confidence to their staffs
DIRECTING - Subordinate are apprehensive for fear of criticism,
- Is the issuance of orders, assignments, and ineptitude or incompetence
instructions that enable the nursing personnel to
understand what is expected from them NURSING CARE ASSIGNMENTS
- It is the connecting link between organizing for Otherwise called modalities of Nursing Care, systems of
work and getting the job done care patterns, or Nursing care
*Directions must be complete, understandable, and given in
a logical order*

Directing Includes:
a. Delegation of work
b. Utilization of policies and procedures
c. Supervision of personnel
d. Coordination of services
e. Communication
f. Staff development
g. Making decisions

ELEMENTS OF DIRECTING
A. Delegation
- It is the process by which a manager assigns
specific tasks/duties to workers with
commensurate authority to perform the job.
- Managers assign responsibility, give authority, and
create accountability within the subordinate --- it
relies on TRUST.

PRINCIPLES OF DELEGATION:
1. Select the right person to whom the job is to be
delegated
2. Delegate both interesting and uninteresting tasks
3. Provide subordinate with enough time to learn
4. Delegate gradually
5. Delegate in advance
6. Consult before delegating
7. Avoid gaps and overlaps

PURPOSE OF DELEGATION
1. Saves time and can help develop others
2. Maximizes the use of the talents of staffs
3. Uses latent abilities in personnel that contribute to
their growth and development

WHAT CANNOT BE DELEGATED:

1. Overall responsibility, authority and accountability
for satisfactory completion of all activities of 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 of the
opportunity to say a few words of encouragement
to the staff especially the new ones
5. Jobs that are too technical and those that involves
trust and confidence
E. MODULAR METHOD Participatory Management
F. CASE MANAGEMENT - Role of Supervising Nurses have changes through
decentralization to participator management.
- From unit management, she assumes the role of a
B. Utilizing/Revising/Updating Nursing Service mentor, role model, and facilitator.
Policies & Procedures - In participatory management, there’s mutual
- Both policies and procedures should be trust and support. There’s increased accountability
periodically reviewed and revised. It is essential of the Head nurse and employees through self-
for the standardization of the Nursing Service and supervision, which results in high morale and
serves as guidance for the nursing staff. teamwork. Thus increasing effectiveness,
- Policies = promote consistency of action a productivity and commitment.
stability, speed up decision-making, and conserve
time.
- Procedure manuals = serve as guides for action. LEADING
Helps inform, and teach personnel with regard to - “to guide”, to go before and show the way
patient care thus reduces chances of errors. - Its activities include directing which is actuating
efforts to accomplish goals; supervising or
C. Supervision overseeing the work of employees and
- To supervise means to inspect, guide, evaluate, and coordinating or unifying personnel and services
improve the work performance of employees among others.
through criteria against which the quality and
quantity of work production and utilization of time
and resources are made.
- It involves overseeing the activities of others.

PURPOSE OF SUPERVISION:
- It is concerned with people, the work area,
working conditions, and the work itself.
It is carried out to:
1. Inspect, evaluate, and improve worker performance
2. Provide suitable working conditions of the staff
3. Orient, train, and guide individual members

PRINCIPLES OF SUPERVISION: - Managers at each level of the hierarchy direct,

1. Is focused on improvement of the work rather than supervise, and coordinate the efforts of their
on upgrading the worker. subordinates.
2. It is based on the needs of individuals that have - It is the manager’s duty to ensure that all activities
been cooperatively determined. in her nursing unit are going on smoothly, that the
3. Is cooperatively planned. patient’s welfare is promoted and protected, that
4. Employs democratic methods employees adhere to established standards and
5. Stimulates the staff to improve continuously procedures, and that proper workflow is facilitated.
6. Helps create a social, psychological and physical
atmosphere in which the individuals is free to Leadership Qualities
function on his or her own top level. 2 types of a leader:
1. Formal or appointed leader
- a leader chosen by the administration and given official
SUPERVISORY TECHNIQUES or legitimate authority or power to act.
1. Observation of the worker while making her 2. Informal leader
rounds. - does not have official sanction to direct the activities
2. Spot checking of charts through nursing audits. - does not have the authority but have the ability to lead
3. Asking the patient about the care they receive. others.
4. Looking into the general condition of the units.
5. Getting feedbacks from co-workers or other
supervisors or relatives.
6. Asking questions discretely to find out problems of
drawing out suggestions from workers for
improvement of their work or work situation.
LEADERSHIP STYLES THE FOLLOWING ARE FOUNDATIONS OF GOOD
1. Autocratic, directive or Bureaucratic Leadership INTERPERSONAL RELATION:
• High concern for production, low concern for a. Self-awareness
people b. Self-acceptance
• Most effective in crises; it brings order out of c. Acceptance of others and sensitivity to other’s
chaos needs
• Sometimes called “centric”, the leader makes d. Respect for the job
decisions for the group, he/she is center of
attention MOTIVATION
• Also called Theory X by McGregor - A leadership function aimed to arouse, excite, or
influence another person to behave in some role or
2. Democratic, Participative, or Consultative perform some action the person would not
Leadership ordinarily do.
• High concern for both production and people - It refers to some inner desire, impulse, or intention
• Collaborative spirit and joint efforts exist that causes no one to act or believe in certain way,
• Also called Theory Y by McGregor or seek a particular goal.
• The leader is also called a “radic” leader because
he radiates out to encompass the needs of others THEORIES OF MOTIVATION:
1. Maslow’s Theory of Human Motivation
3. Permissive, Ultraliberal or Laissez-faire Style of - Human beings is motivated by a number of basic
Leadership needs. It is the unsatisfied needs that have the
• “let-alone” style of leadership greatest influence on behavior.
• Less concern for both production and people
• This style is effective in highly motivated
professionals like those engaging in research; but
not useful in highly structured organizations like
the health care delivery system.

4. Situational Leadership
• “contingency” style of leadership
• The work situation, the manager’s leadership style
and expectations, and the follower’s characteristics
and expectations blend together and form a
productive combination.
• The leader must know himself, and must be
flexible to make adaptations and changes

5. Theory Z
• Introduced by William Ouchi, enlarges from
Theory Y
• Democratic approach of leadership 2. HERZBERG’S THEORY OF JOB SATISFACTION
• It refers to Japanese management practices of - Introduced by Frederick Herzberg – propose a two-
consensus decision-making, quality circles, and factor motivational need theory
employee participation to enhance productivity - Claimed that workers are motivated by two steps of
• It has a humanistic viewpoint and focuses on needs
developing ways of motivating people through: a. Hygiene factors or needs
a) Collective decision-making - associated with working conditions (Pay, quality
b) Slower promotion of supervision, job security, and agency policy)
c) Holistic concern
d) Long term employment b. Motivation factor or needs
e) Indirect supervision - associated with work itself (challenges, added
responsibility, opportunities for personal growth and
INTERPERSONAL RELATIONS advancement)
- It refers to the manner in which people respond to
and identify with each other in situations of ♣Lack of Hygiene factors causes job satisfaction and
everyday living. Absence Of Motivation Factors causes lack of job
- It is the dynamics of how people interact, and why satisfaction.
they react to each other as they do.
⮚ Refer to lab results promptly and file them
MOTIVATING STAFF
• Manage change properly properly in the chart for easy reference.
• Assign undesirable jobs on rotation basis
• Job redesign > Job rotation, job enlargement, job Coordination with Radiology Services
enrichment - Nurses observe the following:
• Provide productive climate and high morale ⮚ Requests should be properly filled in and
forwarded to the x-ray department for proper
scheduling and specific instructions
D. COORDINATION OF SERVICES ⮚ If you’re not familiar of the procedure always refer
♥ It unites personnel and services toward a common to your procedure manual
objective
♥It enhances collaborative efforts resulting in an efficient, ⮚ Prepare the patient properly – patient’s history and
smooth, and harmonious flow of work observe for allergies, give specific instructions, and
♥ Prevents overlapping of functions, promotes good provide assistance in bringing the patient to the X-
working relationships, and work schedules are ray unit.
accomplished as targeted.
⮚ Observe proper endorsement especially with the
Coordination with medical services: preparations.
- As Nurses, we should know the following: ⮚ Follow up results if necessary and refer promptly
⮚ Medical staffs and file results properly in the chart for easy
reference.
⮚ Details about their patients (diagnosis, actual
condition, medical plan & treatment, Coordination with Pharmacy Services
etc.) - Regarding procurement of drugs:
- Nurses are not only implementers of care
⮚ Policies should be jointly formulated by the
Coordination with Administrative services: administrative, medical, and Nursing Services, and
- Pertains to both human and material resources the pharmacy must be circulated to all units
- As nurses, we participate in the following:
⮚ Units must be provided with an established
⮚ Budget planning for staffing, adequate facilities, Hospital drugs formulary through the Unit Drug
and material resources Dose System (UDSS). It would depend upon the
services of the pharmacy department
⮚ Report promptly repairs and maintenance of
equipments, request supplies needed in the ⮚ As use of Narcotic drugs:
unit/department • Must have yellow prescription
• Must be stock properly
⮚ Observe preventive maintenance as well as
• Should be properly recorded
undergo training in handling highly sophisticated = Clinical Pharmacist in the Unit – prepare medicines
equipments prescribed by the physicians and are administered by the
nurse in the units.
Coordination with Laboratory services
- Responsibility of nurses are the following: Coordination with the Dietary Department
⮚ Request should be properly filled in and forwarded - Responsibility of the nurse:
to the laboratory department ⮚ Prepare the diet list
⮚ Direct the medical technologist where the patients ⮚ Must be aware of the prescribed diet of their
are located and provide assistance when necessary. patients, their preferences for food, allergies as
⮚ Specimens (sputum, urine, feces, and those well and restrictions
collected after procedures like CSF and for ⮚ See to it that the right diet goes to the right patient,
biopsies) should be properly labeled. assist them when necessary, observe their appetite
⮚ Give proper instructions to patients if they need Inform dietary service if patient need dietary instructions or
if there are changes in their diet
special preparations relevant to the exams, endorse
properly, provide tags, or label the chart to be
Coordination with the Medical Social Services
reminded of such.
⮚ Nurses refer patients with psycho-socio-economic
3. TRANSMISSION
problems to the Medical Social Services
⮚ Is the actual expression of the message
⮚ Volunteer civic groups also coordinate with the
Medical social services 4. RECEIVING

Coordination with the Medical Record Services ⮚ The receiver’s senses of seeing and hearing are
- Responsibility of the nurse: activated as the transmitted message is received
⮚ Accurate documentation and completeness of the
5. DECODING
patient’s chart, including its safety and
confidentiality ⮚ Receiver defines words and interprets gestures
during transmission of speech
⮚ Discharged patient’s chart should be forwarded to
the Medical record section. 6. RESPONSE OR FEEDBACK

Coordination with Community agencies, other ⮚ It is important for the manager or the sender to
institutions and Civic Organizations know that the message has been received and
accurately interpreted.
⮚ Necessary for the continuity of patient care

⮚ Proper referral should be observed

E. COMMUNICATION
- It is the transmission of information, opinions, and
intentions between and among individuals
Nurse managers communicate in order to:
a. Facilitate work
b. Increase motivation In an organization, there are 4 lines of communication
c. Effect change
d. Optimize care
e. Increase work satisfaction
f. Facilitate coordination

STEPS IN COMMUNICATION PROCESS

1. IDEATION
⮚ Begins when the sender decides to share the 1. UPWARD COMMUNICATION
= emanates from subordinates and goes upward
content of a message with someone, sense a need = usually in the form of feedback to show the
to communicate, develops an idea or selects extent to which communication has been received, accepted
information to share and implemented
= Does not floe easily as downward
Purpose of communication is to: communication because subordinates may not have the
• Inform ability to express their thoughts or may be too shy to
• Persuade express them
• Command = It includes discussion between subordinates and
• Inquire superiors, grievances, procedures, written reports, incident
• Entertain reports and statistical reports.
2. ENCODING 2. DOWNWARD COMMUNICATION
⮚ Involves putting meaning into symbolic forms: = the traditional line of communication is from
Speaking, writing or non-verbal behavior superior to subordinate which may pass through various
levels of management
= the communication is primarily directives and
⮚ Words are symbolic and their meaning is subjected
activities coordinated at various levels of the organization
= It includes: to various interpretations
a. Policies ⮚ The leader should try to be aware of the choice of
b. Rules and regulations
words or phrases used in conveying a message to
c. memoranda
avoid misinterpretation or sending a wrong
d. Employees handbook
message to a group.
e. Interviews
f. Job description
g. Performance appraisal
PRINCIPLES OF COMMUNICATION
1. Clear lines of communication serve as a linking
3. HORIZONTAL or LATERAL
process by which parts of the organization are
COMMUNICATION
unified towards goal achievement
= flows between peers, personnel or department on the
2. Simple exact and concise messages ensure
same level
understanding of the message to be conveyed
= used frequently in the form of:
3. Feedback is essential to effective communication
a. Endorsement between shifts
4. Communication thrives best in a supportive
b. Nursing rounds
environment, which encourages positive values
c. Journal meetings and conferences
among its personnel.
d. Referrals between departments or services
5. A manager’s communication skill is vital to the
= there will be coordination and cooperation among various
attainment of the goals of the organization.
departments, thus ensuring smooth workflow
6. Adequate and timely communication of work-
related issues of changes that may affect jobs
4. OUTWARD COMMUNICATION
enhances compliance.
= deals with information that flows from caregivers to the
patients, their families, relatives, visitors and the
F. STAFF DEVELOPMENT
community
= this facilitates participation of patients in their plan of ⮚ As supervisors and head nurses, they should
care participate in determining the training needs of
= Communication of the philosophy, vision and mission of their staff.
the employees, value their work, which could enhance
support from their families. ⮚ New employees are given the opportunities to
observe a more experienced staff by “shadowing”
or by being a big sister or a buddy.

BLOCKS TO COMMUNICATION: ⮚ Nurses are given opportunities to attend seminars

1. Poor Listening Habits or conferences or go back to formal schooling.
Things to be observed to improve listening skills:
• Give full attention to the person speaking
• Listen carefully with your mind
• Maintain eye contact to convey undivided attention G. DECISION MAKING PROCESS
Decision – Is a course of action that is consciously chosen
2. PSYCHOLOGICAL BLOCKS from available alternatives
for the purpose of achieving a desired result.
⮚ An individual hears something that produces a
profound emotional reaction. An intense response 5 STEPS in DECISION MAKING PROCESS
to a communicated message very likely will 1. DEFINITION OF THE PROBLEM
produce a temporary block to the rest of the
message and constructive communication will not ⮚ Events through time and space may show deviation
continue until feeling have not defuse. from a standard of performance. This deviation to
be corrected is the problem.
3. ENVIRONMENTAL DISTRACTIONS ⮚ In order to recognize the real problem, the decision
⮚ Refers to sudden, distracting noises that occur maker should gather all relevant data.
when communication is taking place like engaging ⮚ After the real cause has been identified, the
in a serious discussion. Attention is diverted to the
environmental stimuli. question of “why the problem occurs” be
answered.
4. SEMANTIC BARRIERS
2. ANALYSIS OF THE PROBLEM
⮚ Means getting to the cause of the problem through
investigating, gathering of data and evaluating
results.

3. DEVELOPING ALTERNATIVE SOLUTIONS

⮚ This step focuses on the search for and the analysis
of alternatives and their possible consequences.
⮚ Use of logic is the key to this step

⮚ It involves the premises “if we do this, the result

will be ---”

Factors to be considered in evaluating alternative

solution:
a. Time
b. Available resources
c. Labor
d. Cost of tools and equipments to be used
e. Moral and legal implication
⮚ Sufficient information enables the decision maker
to arrive at a rational decision.

4. SELECTION OF A SOLUTION
⮚ Ranking preferences, weighing its advantages and
disadvantages.
⮚ Choosing the best course or best solution that offer
a better chance for success.
⮚ It may be a compromise or a combination of two
possible solutions.

5. IMPLEMENTATION AND FOLLOW UP

⮚ The major management function in implementing
a decision include:
a. Planning – which entails consideration and
selection of realistic objectives, policies
and procedures.
b. Organizing – help personnel understand the decision
and the procedures necessary for implementing the
decision.
c. Staffing – Or selection of the right person to carry
out the decision

d. Controlling – Manipulate the environment and the

group to prevent adverse effect. A
follow-up appraisal through observation, feedback and
making of reports to see if problems have been
resolved
CONTROLLING/ EVALUATION ⮚ These would include objects, machines, and
∞ It is the management function in which performance is materials
measured and corrective action is taken to ensure the
accomplishment of organizational goal
∞ It is assessing/regulating performance in accordance with Reasons for conducting Evaluation:
the plans that have been adopted, the instruction issued and 1. Ensures quality nursing care is provided
the principles established. 2. Sets sensible objectives and comply with them
∞ (Peter Drucker) – The management function that aims 3. Provides standards for establishing comparisons
to keep activities directed in such a way that desired results 4. Provides visibility and a means for employees to
are achieved. monitor their own performance
∞ It aims to verify whether activities and performances of 5. Highlights quality problems related to quality care
employees are in conformity with the adopted plans, and determined the areas that require priority
principles, and practices. attention
- IT is also known as EVALUATING and it is an 6. Gives an indication of the costs of poor quality
ongoing function of the management which occurs 7. Justify the use of resources
during planning, organizing and directing 8. Provides feedback for improvement
activities.
- IT plays an important role in identifying
opportunities for improvement, comparing Characteristics of an Evaluation tool
performances against set standards, and providing 1. Objective – free from bias
information about how well people are doing, so 2. Reliable – refers to the accuracy or precision of the
that they can be motivated to perform better in the tool that if administered twice, will produce the
future. same results
3. Validity – relevancy of the measurement to the
performance of the
The control process can be expressed in a formula: employee
Ss + Sa + F + C = I 4. Sensitive – ability to measure the fine lines of
differences among the criteria being measured
Standard set + Standard applied + Feedback +
Correction will yield Improvement
BASIC COMPONENTS OF THE CONTROL PROCESS
1. Establishing standards for measuring performance
OBJECTS OF CONTROL **STANDARDS – are desirable sets of conditions and
• Control is always performed in relation to performance essential in ensuring quality of nursing care
something like the following: services
1. FUNCTIONS
There are 3 types of Standard structure:
⮚ Specific or assigned duties in the performance of a a. Structure Standards
given task
⮚ Focus on the structure or management system used
2. PROCEDURES by the agency to deliver care which includes the
number and categories of nursing personnel, their
⮚ These are established as the prescribed way of education, personal and professional qualities and
doing something is a business proficiencies, their function and physical facilities
and equipment.
3. STRUCTURES
⮚ These are the activities in various units or b. Process Standards

departments of business organizations are ⮚ Refers to decisions and actions of the nurse
observed, supervised and made subject to control relative to the nursing process, which are necessary
in the light of company objectives to provide good nursing care.

4. PERSONNEL c. Outcome standards

⮚ It includes the performance of the work force as ⮚ Are designed to measure the results of care
well as their behavior provided in terms of change in health status of
clients served, change in the level of their
5. RESOURCES knowledge, skills and attitudes and satisfaction of
those served including the members of nursing /
⮚ It is the control process in which employees
health team.
performance is evaluated against standards.
2. Establishing Objectives and methods for ⮚ It is the most valuable tool in controlling human
measuring performance
resources and productivity
⮚ The establishment of the objectives provides clear
⮚ Reflect how will the person have performed during
direction and communication of expected levels of
or at a specific period of time.
achievement.
The most common used method for measuring nursing care
METHODS OF MEASURING PERFORMANCE
are:
a. INFORMAL APPRAISAL
a. TASK ANALYSIS
⮚ Incidental observation of performance while
⮚ Actions and procedures such as written guides,
worker engaged in performing nursing care or by
schedules, rules, records and budgets are inspected.
responses made by the worker during conferences,
as well as, interacting with clients, their families,
b. QUALITY CONTROL
visitors, and co-workers.
⮚ Activities and techniques are employed to achieve
and maintain the quality of a product, service or b. FORMAL APPRAISAL
process. ⮚ Accomplished regularly and methodically by
collecting objective facts that can demonstrate the
difference between what is expected and what was
3. Measuring actual performance
done.
⮚ It is ongoing, repetitive process with the actual These methods would include:
frequency dependent on the type of activity being 1. ESSAY
measured. ⮚ Appraiser writes a paragraph or more about the
worker’s strengths, weaknesses and potentials
4. Comparing results of performance with standards and 2. CHECKLISTS
objectives
⮚ A compilation of all nursing performances
⮚ If performance matches standards and objectives,
expected of a worker
managers are assured that the needs of patients are 3. RANKING
being met, otherwise, necessary actions is needed.
⮚ Evaluator ranks the employees according to how
5. Reinforcing strengths or successes and taking corrective she/he fared with co-workers with respect to
action as necessary certain aspects of performances or qualifications.
4. RATING SCALES
⮚ Positive feedback stimulates motivation,
consistently high performance and growth of ⮚ It includes series of items representing the different
employee. Corrective actions are applied to tasks or activities in the nurse’s job description or
improve performance. the absence or presence of desired behaviors and
the extent to which these are possessed.
5. FORCED-CHOICE COMPARISON
RESPONSIBILITY OF HEAD / SENIOR NURSE ⮚ Evaluator is asked to choose the statement that best
1. Instruct subordinates in the appropriate methods
describes the nurse being evaluated.
and procedures in providing nursing care
6. ANECDOTAL RECORDING
2. Inform likely causes of errors or defects and the
preventive measures necessary ⮚ It describes the nurse’s experience with a group or
3. Initiate and / or facilitate any steps necessary to person, or in validating technical skills and
improve methods, equipments, materials and interpersonal relationship.
conditions in the work area for which they are
responsible.

B. QUALITY ASSURANCE
CONTROL PROCESS “Quality” – degree of excellence
A. PERFORMANCE APPRAISAL “Assurance” – formal guarantee of a degree of excellence
• It is the estimation of the degree of excellence in • Review of patient’s chart while still admitted
patient health outcomes and in activity and other • Observation of staff as patient care is given
resource outcomes. • Inspection of patient and / or observation of the
• (Williamson) It is the measurement of the actual effects of patient care where the focus is on the
level of service provided plus the efforts to modify patient. This is done during rounds or patient
when necessary the provisions of these services in interview.
light of the results of such measurement
• It assures patients that an acceptable standards or b. Retrospective audit
care will be provided to them.
⮚ Patient care is evaluated through:
• Review of discharged patient’s chart
QUALITY ASSURANCE vs PERFORMANCE • Questionnaire sent to or interviews conducted on
EVALUATION discharged patients
Performance Evaluation
⮚ Focuses on the worker, it shows how well the 2. PEER REVIEW
worker satisfies the requirement of his / her job
⮚ Patient care audit maybe done by peers, evaluating
within the organization
Quality assurance another’s job performance against accepted
standards.
⮚ Focuses on the care and service the patient receives
than on how well the professional performs the 3. QUALITY CIRCLES
duties that the position requires
⮚ Introduced by the Japanese

⮚ It is a group of workers doing similar work who

meet regularly, voluntarily, on normal working
DEVEOPING QUALITY ASSURANCE CRITERIA time, under the leadership of their supervisor, to
Common approaches to evaluation identify, analyze, and solve work-related problems
a. Structure approach and to recommend solutions to management

⮚ This include physical setting, instrumentalities and

conditions through which nursing care is given C. CONTROL OF RESOURCES
b. Process approach ⮚ Periodic review of the utilization of materials and
⮚ This includes steps in the nursing process in supplies in various nursing units
compliance with established standards of nursing • Consumptions of supplies and materials should be
practice. proportionate to the number of patients served
c. Outcome approach (dressings, treatments done, injections, etc.)
• Requisition of stocks, HN must know the average
⮚ It identifies desirable changes in the patient’s daily usage and time required to receive the
health status. supplies.
• Inventory of supplies, ordering correct materials to
QUALITY ASSURANCE METHODS prevent overstocking items not frequently
• Equipment utilization report including frequency
⮚ Purpose of QA programs in nursing is to measure
of breakdown, to evaluate the quality of equipment
and improve the quality of nursing delivered in the purchased, what it is handled, used or operated.
agency. • Preventive maintenance, regular inspection of
equipments
NURSING AUDIT COMMITTEE • Absence of staffs
⮚ It is composed of all levels of nursing staff –
D. DISCIPLINE
Training staff, Supervising nurse, Head-senior
> It is an employer’s action against and employee for
nurse, and a staff nurse.
violation of company policies or rules. It connotes rigid
obedience to rules and regulation, the violation of which
results to punitive actions.
1. PATIENT CARE AUDITS
a. Concurrent audit
⮚ Patient care is observed and evaluated. It is given General guidelines:
through: 1. Be sure of the facts
2. Listen
3. Control your feelings
4. Avoid entrapment
5. Keep records
6. Know your authority
7. Keep others advised

DISCIPLINARY APPROACHES
⮚ Develop a sound disciplinary program tailored to
the objectives of the institution / organization.
These should include:
1. A set of disciplinary policies and procedures
2. Uniform application of disciplinary rules
3. A disciplinary committee
4. An orientation program for all new employees
where expectations of appropriate performance and
behavior emphasized

DISCIPLINARY ACTIONS
⮚ Discipline is something to use to help correct
behavior that interferes with the work group
achieving its purpose in an orderly manner. It is a
rational action taken by you – not an emotional
reaction.

• When working with a discipline problem, use the

idea of progressive discipline. It is based on the
principle that a person is entitled to an opportunity
to improve. These steps are as follows:
1. Counseling and oral warning
2. Written warning
3. Suspension
4. Dismissal
• Today, discipline is regarded as a constructive and
effective means by which employees take personal
responsibility for their own performance and
behavior. This is termed as self-discipline.

FACTORS INFLUENCING SELF DISCIPLINE:

1. Strong commitment to the vision, philosophy,
goals and objectives of the institution.
2. Laws that govern the practice of all professionals
and their respective Codes of conduct.